Physical therapy for acute and sub-acute low back pain: A systematic review and expert consensus

OBJECTIVE

To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions.

DATA SOURCES

A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years.

REVIEW METHODS

Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts.

RESULTS

Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain.

CONCLUSIONS

The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years.

The effects of biofeedback training for efficient activation of infraspinatus on proprioception and EMG activity during shoulder external rotation

The purpose of this study investigated which biofeedback (BF) training enables efficient activation of the infraspinatus muscle that affect joint position sense (JPS) and force sense (FS) of the shoulder joint. Twenty healthy males participated and performed three external rotation (ER) exercises under three randomly assigned training conditions: 1) non-biofeedback (NBF), 2) BF and 3) force biofeedback (FBF). Each exercise was performed at intervals of one week between training conditions. After performed the ER exercise under each training condition, the relative error (RE) was calculated at shoulder ER 45° and 80°, and then shoulder ER force were measured to determine the JPS error and FS error, respectively. Muscle activity of infraspinatus and posterior deltoid were measured and compared between training conditions. The RE of shoulder ER 45° and 80° were significantly lower under the FBF conditions than other training conditions (P < 0.05). The RE of shoulder ER force were also significantly lower under the FBF conditions compared to those under the other training conditions (P < 0.05). The activity of the infraspinatus muscle was significantly higher under the FBF conditions during all three ER exercises than other training conditions (p < 0.05). We suggest that BF trainings can be useful to improve the proprioception of shoulder joint as well as activation of infraspinatus muscle while performing the ER exercises.

Effects of the abdominal drawing-in maneuver on hamstring rotational activity and pelvic stability in females

BACKGROUND

The medial hamstring (MH) and lateral hamstring (LH) can be selectively trained through tibial internal and external rotation during prone knee flexion. However, no study has identified how a combined tibial rotation and lumbo-pelvic stability strategy influences MH and LH muscle activities.

OBJECTIVE

To investigate the combined effects of tibial rotation and the abdominal drawing-in maneuver (ADIM) on MH and LH muscle activities as well as pelvic rotation during prone knee flexion.

METHODS

Fifteen female volunteers performed prone knee flexion with tibial internal and external rotation, with and without the ADIM. Under each condition, MH and LH muscle activities were measured by surface electromyography (EMG), and the pelvic rotation angle by a smartphone inclinometer application.

RESULTS

The results showed increased MH (without the ADIM: p< 0.001, effect size (d) = 2.05; with the ADIM: p< 0.001, d= 1.71) and LH (without the ADIM: p< 0.001, d= 1.64; with the ADIM: p= 0.001, d= 1.58) muscle activities under internal and external tibial rotation, respectively. However, addition of the ADIM led to increased MH (internal tibial rotation: p= 0.001, d= 0.67; external tibial rotation: p= 0.019, d= 0.45) and LH (internal tibial rotation: p= 0.003, d= 0.79; external tibial rotation: p< 0.001, d= 1.05) muscle activities combined with reduced pelvic rotation (internal tibial rotation: p< 0.001, d= 3.45; external tibial rotation: p< 0.001, d= 3.01) during prone knee flexion.

CONCLUSIONS

These findings suggest that the ADIM could be useful for reducing compensatory pelvic rotation and enhancing selective muscle activation in the MH and LH, according to the direction of tibial rotation, during prone knee flexion.

Effect of Pelvic Floor Muscle Training Using Pressure Biofeedback on Pelvic Floor Muscle Contraction and Trunk Muscle Activity in Sitting in Healthy Women

Pelvic floor muscle training (PFMT) has been recommended as the first choice as one of the effective methods for preventing and improving urinary incontinence (UI). We aimed to determine whether pressure biofeedback unit training (PBUT) improves short term and retention performance of pelvic floor muscle contraction. The muscle activities of the external oblique (EO), transversus/internal oblique (TrA/IO), multifidus (MF) and the bladder base displacement were measured in the verbal feedback group (n = 10) and PBU group (n = 10) three times (baseline, post-training, and at the 1-week follow-up). Surface electromyographic activity was recorded from the EO, TrA/IO, and MF muscles. The bladder base displacement was measured using ultrasound. The results were analyzed using two way mixed ANOVA. The bladder base displacement may have elevated more in the PBU group than in the verbal feedback group due to decreased TrA/IO activity. These findings indicate that PBUT is a better method than verbal feedback training.

The application of the Neurac technique vs. manual therapy in patients during the acute phase of subacromial impingement syndrome: A randomized single-blinded controlled trial

BACKGROUD

Although the effect of exercise in patients during the subacute and/or chronic subacromial impingement syndrome has been reported, only a few studies have examined the effect of pain free exercise in the acute phase of this disorder.

OBJECTIVE

To compare the effect of training using the Neurac technique which combines body segments suspension and vibration vs. manual therapy, on various relevant outcome parameters in patients with acute subacromial impingement syndrome (PASIS).

METHOD

Twenty-six patients underwent a 4 week intervention program. Using random assignment, half of the patients were treated using the Neurac device while the other half was treated using manual therapy. The outcome parameters consisted of shoulder pain, shoulder function, range of motion (ROM) and the isokinetic strength of the external and internal rotators at 60 and 180∘/s.

RESULTS

Following either modes of interventions, the pain, function, and ROM improved significantly compared to pre-intervention levels in both groups. Time-by-group interaction was observed for the rotational strength which increased significantly and exclusively in the Neurac group.

CONCLUSIONS

Given its positive effect on shoulder pain, function, ROM and the isokinetic strength of the external and internal rotators, we recommend the application of the Neurac technique in PASIS.

The effect of toe-tap exercise on abductor hallucis activity and medial longitudinal arch angle in individuals with pes planus

BACKGROUND: Active interventions for pes planus, including short-foot exercises (SF) and toe-spread-out exercises (TSO), aim to continuously support the medial longitudinal arch (MLA) by activating the abductor hallucis (AbdH) muscle. However, compensatory movements, such as ankle supination and/or plantar flexion, often occur during these exercises. OBJECTIVE: To examine the effects of a novel exercise, i.e., the toe-tap (TT) exercise on AbdH activity and MLA angle. METHODS: A total of 16 participants with pes planus participated in this study. Participants performed SF, TSO, and TT exercises. Electromyographic activity of the AbdH and MLA angle during three AbdH contraction exercises were recorded using surface EMG system and digital image analysis program, respectively. The differences in outcome measures among the three exercises were analyzed using one-way repeated-measures analysis of variance. RESULTS: The EMG activity of the AbdH was significantly greater during the TT exercise compared to the SF and TSO exercises. The MLA angle was significantly smaller during the TT exercise compared with the SF and TSO exercises. CONCLUSIONS: These findings suggest that the TT exercise could be effective in activating the AbdH and increasing height of the MLA, as part of a sports rehabilitation program for individuals with pes planus.

Recovery of renal function in patients with lupus nephritis and reduced renal function: the beneficial effect of hydroxychloroquine

Background

Reduced renal function is associated with worse renal outcome in patients with lupus nephritis (LN). However, there is insufficient knowledge regarding renal function recovery in patients with LN with reduced baseline renal function. Therefore, the present study aimed to investigate renal function recovery and related factors in patients with reduced baseline renal function.

Methods

The present retrospective longitudinal cohort study included patients with LN and reduced renal function. Reduced renal function was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2. Recovery of renal function was determined by an eGFR of >60 mL/min/1.73 m2 at six months after baseline, and factors associated with it were evaluated using logistic regression analysis.

Results

We included 90 patients with LN, with a mean eGFR value of 37.2 ± 13.9 mL/min/1.73 m2. Forty-six (51.1%) patients recovered their renal function after six months. On multivariate analysis, hydroxychloroquine use (odds ratio (OR) = 3.891, 95% confidence interval (CI) 1.196–12.653, p = 0.024), prolonged LN (OR = 0.926, 95% CI 0.874–0.981, p = 0.009) and high-grade tubular atrophy (OR = 0.451, 95% CI 0.208–0.829, p = 0.013) were associated with renal function recovery. During follow up, 25 patients were on end-stage renal disease (ESRD). Kaplan–Meier analysis revealed that renal function recovery after six months and lower probability of ESRD are associated.

Conclusions

In patients with LN and reduced renal function, renal function recovery at six months was associated with use of hydroxychloroquine and inversely related to longer duration of LN and higher grade of tubular atrophy.

Impact of stringent response in proteinuria on long-term renal outcomes in proliferative lupus nephritis

Objectives

Favourable long-term prognosis in proliferative lupus nephritis (LN) is associated with the achievement of complete renal response (CR), which is defined as a urine protein/creatinine ratio (UPCR) of < 0.5. However, it is unclear whether a more stringent cut-off for proteinuria (normal value of proteinuria; UPCR < 0.15) is better than CR. We aimed to evaluate the effect of stringent CR, defined as a UPCR of <0.15, on long-term renal outcomes in proliferative LN.

Methods

We included 87 patients with class III or IV LN who achieved CR at one year after induction therapy. Clinical and laboratory data were compared between the stringent and non-stringent CR groups. Logistic regression analysis was performed to identify factors associated with achievement of stringent CR. Cox analysis was performed to analyse the risk factors for renal flare and development of chronic kidney disease (CKD).

Results

The stringent and non-stringent CR groups included 58 and 29 patients, respectively. The two groups showed no significant baseline differences in terms of the clinical, laboratory and pathological classification. The sustained CR rates during five years were 91.3% and 50.0% ( p = 0.014) in the stringent and non-stringent CR groups, respectively. In Cox analyses, the achievement of stringent CR was associated with a lower risk of five-year renal flare rate (hazard ratio (HR) = 0.161, 95% confidence interval (CI) 0.063–0.411, p < 0.01) and development of CKD (HR = 0.189, 95% CI 0.047–0.752, p = 0.018). Mycophenolate mofetil induction therapy was associated with achievement of stringent CR at a borderline level of significance (HR = 7.268, 95% CI 0.894–59.089, p = 0.064).

Conclusion

Achievement of stringent CR predicted lower risk of renal flare and development of CKD in proliferative LN. These findings suggest that stringent CR is a valuable treatment target in proliferative LN.

Effects of non-paretic arm movements during bridge exercises on trunk muscle activity in stroke patients

[Purpose] The purpose of this study was to determine the effects of non-paretic arm movement during the bridge exercise on trunk muscle activity in stroke patients. [Participants and Methods] In total, 18 stroke patients were recruited. Surface EMG electrodes were attached over the trunk muscles (rectus abdominis, RA; internal oblique, IO; erector spinae, ES), and three kinds of bridge exercises were performed: 1) ‘standard’ bridge, 2) bridge with unilateral isometric arm flexion, and 3) bridge with unilateral isometric arm horizontal abduction. [Results] According to the activity of the trunk muscles measured during bridge exercises, only the IO and ES showed significantly greater muscle activity during bridges with isometric arm horizontal abduction and flexion than during the standard bridge. Additionally, comparison of the paretic and non-paretic sides showed that muscle activity was higher on the paretic side. [Conclusion] This study showed that, as an exercise to heighten the activity of the trunk muscles in stroke patients, bridge exercises with accompanying non-paretic arm flexion and horizontal abduction were more effective clinically than a standard bridge.

Scapula muscle exercises using the Neurac technique for a patient after radical dissection surgery: a case report

Background: After radical neck dissection, spinal accessory nerve damage can result in scapular muscle weakness, which causes shoulder pain, dysfunction, and a limited range of motion (ROM); scapular muscle strengthening exercises are used to reduce these symptoms. This report focuses on the importance of trapezius and serratus anterior strength exercises to reduce symptoms after radical neck dissection. Case Description: The patient was a 30-year-old female who had received radical neck dissection 3 years previously. She complained of shoulder pain, dysfunction, and limited ROM during shoulder elevation. Outcome: She was successfully treated by increasing trapezius and serratus anterior strength and improving pain, function, and range of motion by applying the Neurac technique for 12 weeks. Further controlled studies are required to identify the generalizability of these findings.

Effects of deep breathing on internal oblique and multifidus muscle activity in three sitting postures

[Purpose] This study was to investigate differences in the level of activity of the external oblique (EO), internal oblique (IO), and multifidus (MF) muscles with deep breathing in three sitting postures. [Subjects and Methods] Sixteen healthy women were recruited. The muscle activity (EO, IO, MF) of all subjects was measured in three sitting postures (slumped, thoracic upright, and lumbo-pelvic upright sitting postures) using surface electromyography. The activity of the same muscles was then remeasured in the three sitting postures during deep breathing. [Results] Deep breathing significantly increased activity in the EO, IO, and MF compared with normal breathing. Comparing postures, the activity of the MF and IO muscles was highest in the lumbo-pelvic upright sitting posture. [Conclusion] An lumbo-pelvic upright sitting posture with deep breathing could increase IO and MF muscle activity, thus improving lumbo-pelvic region stability.

Evaluation of abundance of artificial radionuclides in food products in South Korea and sources

Food samples are collected nationwide from January 2016 to February 2017 and their contents of artificial radionuclides are measured to address the growing concerns regarding the radioactive contamination of food products in Korea. Specifically, 900 food samples are collected for this study and their contents of representative artificial radionuclides ¹³⁴Cs, ¹³⁷Cs, ^239,240Pu, and ⁹⁰Sr are analyzed. The analysis shows that the activity concentrations of ¹³⁷Cs in fish range from minimum detectable activity (MDA) to 340 mBq/kg of fresh weight. The concentration factor (CF) determined for ¹³⁷Cs as a measure of its bioavailability is calculated to be ca. 74 and found to be very similar to that (100) recommended by the International Atomic Energy Agency. With an MDA of <0.221 mBq/kg, the results reveal that ^239,240Pu values in fish are below the MDA. The activity concentrations of ¹³⁷Cs and ⁹⁰Sr are lower than the MDA in both shellfish and seaweed, while the activity concentrations of ^239,240Pu in shellfish range from 0.26 to 2.18 mBq/kg, and for seaweed samples range from 2.07 to 3.38 mBq/kg. The atom ratios of ²⁴⁰Pu/²³⁹Pu in shellfish caught at the Korean coast vary from 0.209 to 0.237, with a mean of 0.227. The higher ²⁴⁰Pu/²³⁹Pu atom ratio determined in shellfish is thought to be caused by the plutonium transported from the Pacific Proving Grounds rather than other sources such as the Fukushima nuclear power plant accident. The activity concentrations of ¹³⁷Cs in mushrooms are found to vary from 1.0 to 21.4 Bq/kg, with the highest concentrations observed in the Oak (shiitake) and Sarcodon asparatus. ¹³⁴Cs is detected in three mushroom specimens collected from Jeju Island and about 3-3.6% of ¹³⁷Cs present in the wild mushrooms native to the Jeju Island are introduced as a result of the Fukushima nuclear plant accident. The annual effective doses of ¹³⁷Cs received through consumption of mushrooms and fish are 2.0 × 10^-4 mSv yr^-1 and 3.9 × 10^-5 mSv yr^-1, and those values are negligible compared to the annual effective doses limit of 1 mSv yr^-1.

Relationship between hamstring length and gluteus maximus strength with and without normalization

[Purpose] This study assessed the relationship between hamstring length and gluteus maximus (GM) strength with and without normalization by body weight and height. [Subjects and Methods] In total, 34 healthy male subjects volunteered for this study. To measure GM strength, subjects performed maximal hip joint extension with the knee joints flexed to 90° in the prone position. GM strength was normalized for body weight and height. [Results] GM strength with normalization was positively correlated with hamstring length, whereas GM strength without normalization was negatively correlated with hamstring length. [Conclusion] The normalization of GM strength by body weight and height has the potential to lead to more appropriate conclusions and interpretations about its correlation with hamstring length. Hamstring length may be related to GM strength.

Difference in trunk stability during semicircular turns with and without a bag in elderly women

BACKGROUND

Direction changes while walking are more likely to cause a hip fracture than is falling while walking in a straight line. Trunk stability is an important contributor to safe and effective walking, and arm movements influence trunk movement while walking. However, the difference in the trunk stability during semicircular turns performed by elderly women with a light bag has not been examined.

OBJECTIVE

To investigate the effects of carrying a bag on trunk stability during semicircular turns in elderly women.

METHODS

We enrolled 15 community-dwelling elderly women capable of independent walking. Participants walked with and without a bag at a self-selected speed along a marked path, which included semicircular turns, while fitted with an accelerometer attached over the L3 spinous process.

RESULTS

Gait velocity was faster during semicircular turning with a bag versus without a bag. The normalized medial-lateral center of mass acceleration was lower during semicircular turning with a bag versus without a bag.

CONCLUSIONS

We suggest that a light additional arm load and increased arm swing contributes to trunk stability and efficient walking during semicircular turning by elderly women.

Effect of modified bridge exercise on trunk muscle activity in healthy adults: a cross sectional study

•

Bridge exercise with unstable surface increases trunk muscle activities.

•

Bridge exercise with hip abduction increases trunk muscles activities.

•

Modified bridge exercises are useful for co-activation of trunk muscles.

Design

This is a cross-sectional study.

Setting

University research laboratory.

Participants

Fifteen healthy adults (mean age: 27.47 years) volunteered for this study.

Intervention

The individuals performed standard bridge exercise and modified bridge exercises with right leg-lift (single-leg-lift bridge exercise, single-leg-lift bridge exercise on an unstable surface, and single-leg-lift hip abduction bridge exercise).

Main outcome measures

During the bridge exercises, electromyography of the rectus abdominis, internal oblique, erector spinae, and multifidus muscles was recorded using a wireless surface electromyography system. Two-way repeated-measures analysis of variance (exercise by side) with post hoc pairwise comparisons using Bonferroni correction was used to compare the electromyography data collected from each muscle.

Results

Bilateral internal oblique muscle activities showed significantly greater during single-leg-lift bridge exercise (95% confidence interval: right internal oblique = −8.99 to −1.08, left internal oblique = −6.84 to −0.10), single-leg-lift bridge exercise on an unstable surface (95% confidence interval: right internal oblique = −7.32 to −1.78, left internal oblique = −5.34 to −0.99), and single-leg-lift hip abduction bridge exercise (95% confidence interval: right internal oblique = −17.13 to −0.89, left internal oblique = −8.56 to −0.60) compared with standard bridge exercise. Bilateral rectus abdominis showed greater electromyography activity during single-leg-lift bridge exercise on an unstable surface (95% confidence interval: right rectus abdominis = −9.33 to −1.13, left rectus abdominis = −4.80 to −0.64) and single-leg-lift hip abduction bridge exercise (95% confidence interval: right rectus abdominis = −14.12 to −1.84, left rectus abdominis = −6.68 to −0.16) compared with standard bridge exercise. In addition, the right rectus abdominis muscle activity was greater during single-leg-lift hip abduction bridge exercise compared with single-leg-lift bridge exercise on an unstable surface (95% confidence interval = −7.51 to −0.89). For erector spinae, muscle activity was greater in right side compared with left side during all exercises (95% confidence interval: standard bridge exercise = 0.19–4.53, single-leg-lift bridge exercise = 0.24–10.49, single-leg-lift bridge exercise on an unstable surface = 0.74–8.55, single-leg-lift hip abduction bridge exercise = 0.47–11.43). There was no significant interaction and main effect for multifidus.

Conclusions

Adding hip abduction and unstable conditions to bridge exercises may be useful strategy to facilitate the co-activation of trunk muscles.

Greater trochanter location measurement using a three-dimensional motion capture system during prone hip extension

[Purpose] The greater trochanter (GT) is an important structure in biomedical research, but the measurement methods require development. This study presents data from a new measurement method that does not use GT-marker-based measurement (No GT-m) in comparison with GT-marker based measurement (GT-m). [Subjects and Methods] We recruited 20 healthy subjects, who were asked to perform and maintain a prone position and then move to the prone hip extension. A motion capture system collected the kinematic data and the location of the GT was calculated by two measurements. [Results] GT migration distance differed significantly between the two measurements and the coefficient of the variation value was lower for the No GT-m method. Thigh lengths of the No GT-m method were comparable to the original lengths. There were significant differences between the GT-m and the other methods. [Conclusions] These data suggest that the GT-m method yielded a lower precision with a smaller GT migration distance. In the comparison of thigh length, the No GT-m method was in close agreement with the original length. We suggest that determining the location of the GT using the No GT-m has greater accuracy than the GT-m method.

Effects of observation of hand movements reflected in a mirror on cortical activation in patients with stroke

[Purpose] The purpose of this study was to examine what changes occur in brain waves when patients with stroke receive mirror therapy intervention. [Subjects and Methods] The subjects of this study were 14 patients with stroke (6 females and 8 males). The subjects were assessed by measuring the alpha and beta waves of the EEG (QEEG-32 system CANS 3000). The mirror therapy intervention was delivered over the course of four weeks (a total of 20 sessions). [Results] Relative alpha power showed statistically significant differences in the F3, F4, O1, and O2 channels in the situation comparison and higher for hand observation than for mirror observation. Relative beta power showed statistically significant differences in the F3, F4, C3, and C4 channels. [Conclusion] This study analyzed activity of the brain in each area when patients with stroke observed movements reflected in a mirror, and future research on diverse tasks and stimuli to heighten activity of the brain should be carried out.

Relationship Between Weightbearing Ankle Dorsiflexion Passive Range of Motion and Ankle Kinematics During Gait

BACKGROUND

Measurement of weightbearing ankle dorsiflexion (DF) passive range of motion (PROM) has been suggested as a way to estimate ankle kinematics during gait; however, no previous study has demonstrated the relationship between ankle DF during gait and ankle DF PROM with knee extension. We examine the relationship between maximum ankle DF during gait and nonweightbearing and weightbearing ankle DF PROM with knee extension.

METHODS

Forty physically active individuals (mean ± SD age, 21.63 ± 1.73 years) participated in this study. Ankle DF PROM with knee extension was measured in the nonweightbearing and weightbearing conditions; maximum ankle DF during gait was assessed using a three-dimensional motion analysis system. The relationship between each variable was calculated using the Pearson product moment correlation coefficient, and the difference in ankle DF PROM between the nonweightbearing and weightbearing conditions was analyzed using a paired t test.

RESULTS

The weightbearing measurement (r = 0.521; P < .001) for ankle DF PROM showed a greater correlation with maximum ankle DF during gait than did the nonweightbearing measurement (r = 0.245; P = .029). Ankle DF PROM was significantly greater in the weightbearing than in the nonweightbearing condition (P < .001) despite a significant correlation between the two measurements (r = 0.402; P < .001).

CONCLUSIONS

These findings indicate that nonweightbearing and weightbearing measurements of ankle DF PROM with knee extension should not be used interchangeably and that weightbearing ankle DF PROM with the knee extended is more appropriate for estimating ankle DF during gait.

The effect of isolating the paretic limb on weight-bearing distribution and EMG activity during squats in hemiplegic and healthy individuals

BACKGROUND

Neural reorganization for movement therapy after a stroke is thought to be an important mechanism that facilitates motor recovery. However, there is a lack of evidence for the effectiveness of exercise programs in improving the lower limbs.

OBJECTIVE

We investigated the immediate effect of isolating the paretic limb using different foot positions ((i) foot parallel; both feet parallel, (ii) foot asymmetry; paretic foot backward by 10 cm, and (iii) foot lifting; nonparetic foot lifting by normalization to 25% of knee height) on weight-bearing distribution and electromyography (EMG) of the thigh muscle during squats.

METHODS

In total, 20 patients with hemiplegia and 16 healthy subjects randomly performed three squat conditions in which the knee joint was flexed to 30°. Weight distribution was measured using the BioRescue system. Muscle activity was measured using a surface EMG system.

RESULTS

Patients with hemiplegia exhibited significantly decreased weight bearing on the paretic foot at 0° and 30° knee flexion compared with the nondominant foot of a healthy subject. The muscle activity of the quadriceps was significantly lower in patients with hemiplegia compared to healthy subjects. Weight bearing and EMG activity of the quadriceps femoris on the paretic or nondominant side significantly increased during a knee flexion of 30° with under the foot asymmetry and foot lifting positions compared with the parallel foot position.

CONCLUSION

Isolating the paretic limb using the asymmetric foot positions and lifting of the foot during squats might help patients with hemiplegia to improve weight-bearing and achieve greater activation of the quadriceps muscle in the paretic limb.

Reproducibility of isometric shoulder protraction and retraction strength measurements in normal subjects and individuals with winged scapula

BACKGROUND

The strength of the shoulder protractors and retractors may be compromised in individuals with winged scapula (IwWS). However, no standard approach to measuring the strength of these muscles has been described. The aim of this study was to study the intra-rater and inter-rater reproducibility of a fixed-base isometric dynamometer and to describe cutoff scores for clinically meaningful change for protraction and retraction isometric strength.

METHOD

Twice during a week, 20 normal subjects and 20 IwWS were tested by 2 independent raters.

RESULTS

IwWS were significantly weaker (P < .001) than control subjects in their protraction and retraction isometric strength. Excellent intra-rater and inter-rater correlations were obtained in most combinations, leading to low cutoff scores for meaningful change expressed in terms of the smallest real difference.

CONCLUSION

When it is properly used, the technique described in this paper is recommended as an effective clinical tool for the quantitative assessment of protraction and retraction isometric strength, both for status determination and for monitoring of change in IwWS during and after rehabilitation.

Effects of spring-loaded crutches on gastrocnemius activity and upward displacement of the body during gait

[Purpose] This study investigated the effects of spring-loaded crutches on gastrocnemius muscle activity and upper body displacement in the sagittal plane during gait. [Subjects and Methods] The study involved 12 healthy males. All subjects performed crutch gait by using spring-loaded crutches and axillary crutches. During this gait, the gastrocnemius muscle activity was measured using a wireless electromyography system, and upward displacement of the body was measured using a three-dimensional motion analysis system. [Results] The gastrocnemius activity was significantly lower but upward displacement of the body was significantly greater with the spring-loaded crutches than with axillary crutches. [Conclusion] Spring-loaded crutches allow efficient crutch gait and involve less effort from the gastrocnemius muscle.

Effects of isometric hip movements on electromyographic activities of the trunk muscles during plank exercises

[Purpose] The purpose of this study was to investigate the effect of isometric hip adduction and abduction on trunk muscle activity during plank exercises. [Subjects and Methods] Nineteen healthy male subjects were recruited for this study. All subjects performed the traditional plank exercise (TP), plank exercise with isometric hip adduction (PHAD), and plank exercise with isometric hip abduction (PHAB) by using an elastic band. Electromyographic (EMG) activities of the internal oblique (IO) and external oblique (EO) were measured during the 3 plank exercises by using an Electromyography system. [Results] Internal oblique and external oblique muscle activities were significantly greater during plank exercise with isometric hip adduction and plank exercise with isometric hip abduction than during traditional plank exercise. Internal oblique and external oblique muscle activities did not differ between the plank exercise with isometric hip adduction and plank exercise with isometric hip abduction conditions. [Conclusion] These findings demonstrate that loaded isometric hip movements may be a useful strategy to increase trunk muscle activity during plank exercises.

Differences in performance on the functional movement screen between chronic low back pain patients and healthy control subjects

[Purpose] Differences in scores on the Functional Movement Screen between patients with chronic lower back pain and healthy control subjects were investigated. [Subjects and Methods] In all, 20 chronic lower back pain patients and 20 healthy control subjects were recruited. Chronic lower back pain patients and healthy controls performed the Functional Movement Screen (deep squat, hurdle step, inline lunge, shoulder mobility, active straight leg raise, trunk stability pushup, and rotary stability). The Mann-Whitney test was used to analyze differences in Functional Movement Screen scores between the two groups. [Results] Chronic lower back pain patients scored lower on the Functional Movement Screen total composite compared with healthy control subjects. Chronic lower back pain patients scored lower on Functional Movement Screen subtests including the deep squat, hurdle step, active straight leg raise, and rotary stability tests. [Conclusion] The deep squat, hurdle step, active straight leg raise, and rotary stability tasks of the Functional Movement Screen can be recommended as a functional assessment tools to identify functional deficits in chronic lower back pain patients.

Selective recruitment of the thoracic erector spinae during prone trunk-extension exercise

OBJECTIVE

This study examined the effect of modified prone trunk-extension (PTE) exercises on selective activity of the thoracic erector spinae.

METHODS

Thirty-nine healthy subjects performed four modified PTE exercises, involving location of the edge of the table (iliac crests [IC] vs. xiphoid process [XP]) and the degree of trunk extension (horizontal vs. hyperextension). Electromyography signals were collected bilaterally from the longissimus thoracis (LT), iliocostalis thoracis (ICT), and iliocostalis lumborum (ICL). Normalized LT:ICL and ICT:ICL ratios were calculated. The data were analyzed using a repeated measures two-way analysis of variance.

RESULTS

The LT:ICL and ICT:ICL ratios were significantly higher under the XP than the IC condition (p < 0.05); however, the degree of trunk extension did not affect the ratio (p > 0.05). Activity in the lumbar erector spinae and left ICT muscles was greater when subjects were in the hyperextended position than in the horizontal position. Moreover, activity in the thoracic erector spinae was greater when the table edge was aligned with the IC compared with the XP (p < 0.05).

CONCLUSIONS

Our findings suggest that PTE exercise with the XP aligned with the table edge increased the selective activation of the thoracic erector spinae muscles.

The effect of Graston technique on the pain and range of motion in patients with chronic low back pain

[Purpose] Clinicians have reported the effects of various instrument assisted soft tissue mobilization (IASTM) in patients. The purpose of this study was to investigated the effects of the Graston technique and general exercise on pain and range of motion (ROM) in patients with CLBP. [Subjects and Methods] 30 patients with CLBP participated in the study (Graston technique: 15; Control: 15). Before and after the 4-week intervention program, pain was assessed using a visual analog scale (VAS). Lumbar ROM was measured using a smartphone. The main effects and interaction were analyzed by two-way repeated ANOVA. [Results] A significant time-by-group interaction was observed for the VAS and ROM. A post hoc paired t-test showed that pain decreased significantly post-intervention within the Graston group. The lumbar ROM significantly increased post-intervention in both groups. [Conclusion] The Graston technique and general exercise resulted in pain relief and increased ROM. However, the Graston group showed significantly increased VAS and ROM more than control group. These findings suggest that the Graston technique can be useful as a pain decrease and ROM increase for patients with CLBP.

Is there an agreement among the items of the Korean physical therapist licensing examination, learning objectives of class subjects, and physical therapists' job descriptions?

PURPOSE

To determine the agreement among the items of the Korean physical therapist licensing examination, learning objectives of class subjects, and physical therapists' job descriptions.

METHODS

The main tasks of physical therapists were classified, and university courses related to the main tasks were also classified. Frequency analysis was used to determine the proportions of credits for the classified courses out of the total credits of major subjects, exam items related to the classified courses out of the total number of exam items, and universities that offer courses related to the Korean physical therapist licensing examination among the surveyed universities.

RESULTS

The proportions of credits for clinical decision making and physical therapy diagnosis-related courses out of the total number credits for major subjects at universities were relatively low (2.06% and 2.58%, respectively). Although the main tasks of physical therapists are related to diagnosis and evaluation, the proportion of physiotherapy intervention-related items (35%) was higher than that of examination and evaluation-related items (25%) on the Korean physical therapist licensing examination. The percentages of universities that offer physical therapy diagnosis and clinical decision making-related courses were 58.62% and 68.97%, respectively.

CONCLUSION

Both the proportion of physiotherapy diagnosis and evaluation-related items on the Korean physical therapist licensing examination, and the number of subjects related to clinical decision making and physical therapy diagnosis in the physical therapy curriculum, should be increased to ensure that the examination items and physical therapy curriculum reflect the practical tasks of physical therapists.

New method to incorporate Type B uncertainty into least-squares procedures in radionuclide metrology

We discuss a new method to incorporate Type B uncertainty into least-squares procedures. The new method is based on an extension of the likelihood function from which a conventional least-squares function is derived. The extended likelihood function is the product of the original likelihood function with additional PDFs (Probability Density Functions) that characterize the Type B uncertainties. The PDFs are considered to describe one's incomplete knowledge on correction factors being called nuisance parameters. We use the extended likelihood function to make point and interval estimations of parameters in the basically same way as the least-squares function used in the conventional least-squares method is derived. Since the nuisance parameters are not of interest and should be prevented from appearing in the final result, we eliminate such nuisance parameters by using the profile likelihood. As an example, we present a case study for a linear regression analysis with a common component of Type B uncertainty. In this example we compare the analysis results obtained from using our procedure with those from conventional methods.

The effects of gait with use of smartphone on repositioning error and curvature of the lumbar spine

[Purpose] This study evaluated the effect of smartphone use on lumbar spine repositioning error and lumbar curvature while walking on a treadmill. [Subjects] A total of 20 healthy individuals (18 males and 2 females) volunteered for this study. [Methods] The subjects walked for 20 min on a treadmill while using a smartphone. To determine the effect of smartphone use, lumbar repositioning error was measured using an electronic goniometer while lumbar curvature was assessed using a Spinal Mouse before and immediately after treadmill use. Differences in the lumbar repositioning error and lumbar curvature data between the pre- and post-walking were compared using the paired t-test. [Results] The lumbar spine repositioning error was significantly greater post-walking compared with pre-walking (6.70±2.91° vs. 3.02±1.79°). There was no significant difference in lumbar curvature between pre- and post-walking (14.24±3.18° vs. 13.94±3.12°). [Conclusion] These findings indicate that the lumbar repositioning error increased immediately after walking while using a smartphone, but that the lumbar curvature was unchanged.

Taping of the elbow extensor muscle in chronic stroke patients: comparison between before and after three-dimensional motion analysis

[Purpose] This study aimed to observe the effect of kinesio taping on the quality of movement of each arm during a reaching task in patients with right-sided hemiparetic stroke. [Subjects and Methods] Sixteen right-handed participants who had had a right-sided hemiparetic stroke were requested to perform a reaching task with each arm, with and without kinesio taping. A three-dimensional motion analysis system was used to measure peak angular velocity, time to reach peak angular velocity, and movement units during elbow motion. [Results] In the right arm, movements during the reaching task with kinesio taping were faster, smoother, and more efficient than those without kinesio taping. The peak angular velocity increased, and the time to reach peak angular velocity decreased. Movement units decreased significantly. However, in the untaped arm, the movement was slower, rougher, and less efficient. [Conclusion] Kinesio taping provided a positive effect on the reaching movement of the taped arm of right-handed persons who had had a right-sided hemiparetic stroke.

Effects of the Neurac(®) technique in patients with acute-phase subacromial impingement syndrome

[Purpose] This study investigated the effects of the Neurac technique on shoulder pain, function, and range of motion in patients with acute-phase subacromial impingement syndrome. [Subjects] Thirteen patients (seven females and six males) with acute-phase subacromial impingement syndrome participated in this study. [Methods] Shoulder pain, function, and range of motion were assessed before and after the application of the Neurac technique. [Results] Pain and function scores were significantly lower after than before the Neurac intervention. Shoulder range of motion was significantly greater after Neurac intervention than before it. [Conclusion] The Neurac technique is a useful intervention for patients with acute-phase subacromial impingement syndrome.

Effects of controlled condylar rotation exercise on symmetrical mouth opening in patients with temporomandibular disorder

[Purpose] The purpose of this study was to determine the effects of a 4-week program of active condylar rotation exercise on the extent of the lateral mandibular shift during mouth opening in patients with temporomandibular disorder. [Subjects and Methods] Patients with temporomandibular disorder (n = 12; 7 men and 5 women) were recruited. The active range of temporomandibular motion was recorded using 3-dimensional ultrasound-based motion analysis. The paired t-test was used to assess changes in lateral mandibular shift before and after active condylar rotation exercise. [Results] The degree of the lateral mandibular shift during mouth opening and the mouth opening-lateral mandibular shift ratio were significantly lower after active condylar rotation exercise than before the exercise. [Conclusion] Active condylar rotation exercise may effectively reduce the degree of the lateral mandibular shift during mouth opening to produce symmetrical mouth opening in patients with mild temporomandibular disorder.

Immediate effects of an end-range mobilization technique on shoulder range of motion and skin temperature in individuals with posterior shoulder tightness

[Purpose] This study investigated the effects of an end-range mobilization technique on the range of motion of the glenohumeral internal rotation and the skin temperature of the shoulder in individuals with posterior shoulder tightness. [Subjects] Thirteen subjects with posterior shoulder tightness who had glenohumeral internal rotation deficit ≥ 15° participated. [Methods] All subjects underwent glenohumeral joint end-range mobilization intervention. The internal rotation range of motion of the glenohumeral joint was measured by a goniometer and the shoulder skin temperature was measured by a digital infrared thermographic imaging device before and immediately after the intervention. Paired t-tests were used to analyze the differences in these parameter pre and post-intervention. [Results] The glenohumeral internal rotation range of motion and skin temperature of the posterolateral shoulder in increased significantly post-intervention. [Conclusion] The end-range mobilization technique is effective for increasing the glenohumeral internal rotation range of motion and skin temperature of the shoulder in individuals with posterior shoulder tightness.

Reliability of ankle dorsiflexion passive range of motion measurements obtained using a hand-held goniometer and Biodex dynamometer in stroke patients

[Purpose] This study investigated the reliability of ankle dorsiflexion passive range of motion (DF-PROM) measurements obtained using a goniometer and Biodex dynamometer in stroke patients. [Subjects] Fifteen stroke patients participated in this study. [Methods] Ankle DF-PROM was assessed using a goniometer and Biodex dynamometer. Ankle DF-PROM was measured during two sessions with 7 days between tests. Intraclass correlation coefficient, standard error of measurement, and minimal detectable change values were used to assess the reliability of measurements obtained using both instruments. [Results] The intra-rater reliability for ankle DF-PROM using the goniometer was moderate and good for the two raters, while using the Biodex dynamometer, it was good for both raters. Inter-rater reliability using the goniometer was moderate; using the Biodex, it was good. [Conclusion] Both intra- and inter-reliability measurements of ankle DF-PROM were higher using a Biodex dynamometer than with a goniometer.

Effects of Crossed Brassiere Straps on Pain, Range of Motion, and Electromyographic Activity of Scapular Upward Rotators in Women With Scapular Downward Rotation Syndrome

BACKGROUND

Scapular downward rotation syndrome manifests as an abnormally downward-rotated scapula at rest or with arm motion and typically results in neck and shoulder pain. The brassiere strap has been suggested as a possible contributing factor to scapula downward rotation and pain in the upper trapezius because of increased downward rotational force on the lateral aspect of the scapula. No study, however, has examined the influences of a modified brassiere strap on pain in and the function of the scapular muscles.

OBJECTIVE

To examine the effects of crossed brassiere straps on the pressure pain threshold (PPT) of the upper trapezius, neck rotation range of motion (ROM), and electromyographic activity of the scapular upward rotators in females with scapular downward rotation syndrome.

DESIGN

Cross-over design.

SETTING

Laboratory.

PARTICIPANTS

In total, 15 female subjects with scapular downward rotation syndrome were recruited at hospitals and a local university.

METHODS

All participants performed neck rotation and humeral elevation under 2 different conditions: parallel and crossed brassiere straps.

MAIN OUTCOME MEASUREMENTS

The PPT of the upper trapezius was measured using an analog algometer, whereas neck rotation ROM was quantified with a 3-dimensional ultrasonic motion analysis system. The electromyographic activities of the upper trapezius, serratus anterior, and lower trapezius during humeral elevation were assessed with a surface electromyography system. Outcome measures were assessed under parallel and crossed brassiere strap conditions, and differences in outcomes between the conditions were analyzed using a paired t-test.

RESULTS

The PPT and neck rotation ROM were increased when the subject was wearing the brassiere with crossed versus parallel straps (P < .001). Greater electromyographic activities of the serratus anterior, lower trapezius, and lesser upper trapezius muscles during humeral elevation were found under the crossed strap condition than the parallel strap condition (P < .05).

CONCLUSIONS

These findings provide useful information for clinicians when designing management programs to decrease pain and improve biomechanical function for females with scapular downward rotation syndrome.

Relationships among the Y balance test, Berg Balance Scale, and lower limb strength in middle-aged and older females

Background:

Older females have less dynamic postural control and muscle strength than do middle-aged females. Aging-related strength losses may limit balancing performance.

Objective:

The purpose of this study was to investigate the ability of the Y Balance Test (YBT) and lower limb strength to discriminate between females in 2 age groups, the relationship between YBT distance and the Berg Balance Scale (BBS), and the degree to which performance on YBT distance is related to lower limb strength in middle-aged and older females.

Method:

The 40 healthy, independently active females were divided into 2 groups: older and middle-aged. The participants underwent measurements of YBT distance using the YBT, maximal muscular strength of the lower limbs using a handheld dynamometer, and the BBS.

Results:

The YBT distance in 3 directions and lower limb muscle strength for both lower limbs were significantly lower in the older adults than in the middle-aged group. A moderate correlation but insignificant correlation was found between the YBT composite distance and the BBS score. In the older females, YBT distance was significantly positively correlated with strength of the knee flexor and hip abductor. In the middle-aged group, YBT distance was significantly positively correlated with strength of the knee flexor and hip extensor.

Conclusions:

Performance on the YBT was influenced by the strength of lower limb. We suggested that YBT can be used to alternative as a measurement of dynamic balance. Proper training programs for older people could include not only strengthening exercises but also YBT performance to improve balance.

The influence of gastrocnemius stretching combined with joint mobilization on weight-bearing ankle dorsiflexion passive range of motion

[Purpose] The purpose of this study was to investigate the effect of gastrocnemius stretching combined with talocrural joint mobilization on weight-bearing ankle dorsiflexion passive range of motion. [Subjects] Eleven male subjects with bilateral limited ankle dorsiflexion passive range of motion with knee extended participated in this study. [Methods] All subjects received talocrural joint mobilization while performing gastrocnemius stretching. Ankle dorsiflexion passive range of motion was measured using an inclinometer under weight-bearing conditions before and immediately after intervention. A paired t-test was used to analyze the difference between weight-bearing ankle dorsiflexion passive range of motion pre- and post-intervention. [Results] A significant increase in weight-bearing ankle dorsiflexion passive range of motion was found post-intervention compared with pre-intervention. [Conclusion] These findings demonstrate that gastrocnemius stretching combined with joint mobilization is effective for increasing weight-bearing ankle dorsiflexion passive range of motion.

Comparison of selective electromyographic activity of the superficial lumbar multifidus between prone trunk extension and four-point kneeling arm and leg lift exercises

[Purpose] This study examined the selective electromyographic activity of the lumbar paraspinal muscles in healthy male and female subjects in the prone trunk extension (PTE) and four-point kneeling arm and leg lift (FPKAL) exercises to determine the most beneficial exercise for selective activation of the lumbar multifidus (LM). [Subjects and Methods] Twenty healthy male and female subjects participated in this study. Surface electromyographic data were collected from the left-side lumbar erector spinae (LES) and LM muscles during PTE and FPKAL exercises. [Results] The LM/LES ratio related to selective activation of the lumbar paraspinal muscles during the FPKAL exercise was higher than that during PTE. [Conclusion] FPKAL exercise is safe and effective for the selective activation of the LM muscle.

Immediate combined effect of gastrocnemius stretching and sustained talocrural joint mobilization in individuals with limited ankle dorsiflexion: A randomized controlled trial

BACKGROUND

Although gastrocnemius stretching and talocrural joint mobilization have been suggested as effective interventions to address limited ankle dorsiflexion passive range of motion (DF PROM), the effects of a combination of the two interventions have not been identified.

OBJECTIVE

The aim of the present study was to compare the effects of gastrocnemius stretching combined with joint mobilization and gastrocnemius stretching alone.

DESIGN

A randomized controlled trial.

METHODS

In total, 24 individuals with limited ankle DF PROM were randomized to undergo gastrocnemius stretching combined with joint mobilization (12 feet in 12 individuals) or gastrocnemius stretching alone (12 feet in 12 individuals) for 5 min. Ankle kinematics during gait (time to heel-off and ankle DF before heel-off), ankle DF PROM, posterior talar glide, and displacement of the myotendinous junction (MTJ) of the gastrocnemius were assessed before and after the interventions. The groups were compared using two-way repeated measures analysis of variance.

RESULTS/FINDINGS

Greater increases in the time to heel-off and ankle DF before heel-off during gait and posterior talar glide were observed in the stretching combined with joint mobilization group versus the stretching alone group. Ankle DF PROM and displacement of the MTJ of the gastrocnemius were increased significantly after the interventions in both groups, with no significant difference between them.

CONCLUSIONS

These findings suggest that gastrocnemius stretching with joint mobilization needs to be considered to improve ankle kinematics during gait.

Effects of kinesio taping on lumbopelvic-hip complex kinematics during forward bending

[Purpose] The aim of this study was to investigate the effect of kinesio taping (KT) on the kinematics of the lumbo-pelvic-hip complex during forward bending by individuals with reduced hamstring extensibility. [Subjects] Eighteen males with reduced hamstring extensibility were randomly assigned to one of two groups:, the hamstring KT group (n=9), or the sham KT group (n=9). [Methods] The kinematics of the lumbopelvic-hip complex during lumbar forward bending was measured using a motion capture system before and after applying KT. [Results] The angle of lumbar flexion during late lumbar forward bending increased significantly post-KT compared to pre-KT measurements in the hamstring KT group. [Conclusion] These findings suggest that KT does not directly affect an individual’s movement during lumbar forward bending.

Effects of performing an abdominal hollowing exercise on trunk muscle activity during curl-up exercise on an unstable surface

[Purpose] The purpose of this study was to investigate the effects of the abdominal hollowing exercise on trunk muscle activity during the curl-up exercise on an unstable surface by measuring electromyography (EMG) activity. [Subjects] Fourteen young healthy adults (nine male, five female) voluntarily participated in this study. [Methods] Each subject was asked to perform a curl-up exercise on two supporting surfaces (stable and unstable surfaces) combined with the abdominal hollowing exercise on an unstable surface. The muscle activities of the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transverse abdominis (TrA) were measured using surface EMG during performance of the curl-up exercise. [Results] The EMG activity of the RA and EO was significantly higher on an unstable surface than on a stable surface during the curl-up exercise. The EMG activities of the TrA and IO were greater in combination with the abdominal hollowing exercise on an unstable surface than during the curl-up exercise on both a stable and unstable surface. [Conclusion] These findings suggest that the local trunk muscle activity during the curl-up exercise is more strongly affected by combination with the abdominal hollowing exercise than by performance on an unstable supporting surface.

Effects of humeral head compression taping on the isokinetic strength of the shoulder external rotator muscle in patients with rotator cuff tendinitis

[Purpose] The purpose of this study was to examine the effects of humeral head compression taping (HHCT) on the strength of the shoulder external rotator muscle in patients with rotator cuff tendinitis. [Subjects and Methods] Twenty patients with rotator cuff tendinitis were recruited. The shoulder external rotator strength was measured using a Biodex isokinetic dynamometer system. A paired t-test was performed to evaluate within-group differences in the strength of the shoulder external rotator muscle. [Results] Significantly higher shoulder external rotator peak torque and peak torque per body weight were found in the HHCT condition than in the no-taping condition. [Conclusion] HHCT may effectively increase the shoulder external rotator muscle strength in patients with rotator cuff tendinitis.

Comparison of lumbar repositioning error according to different lumbar angles in a flexion pattern (FP) subgroup of patients with non-specific chronic low back pain

[Purpose] This study determined the change in lumbar position sense according to lumbar angles in a flexion pattern (FP) subgroup of patients with non-specific chronic low back pain (NCSLBP). [Subjects] Thirteen subjects with FP low back pain participated. [Methods] The lumbar repositioning error (RE) of subjects was measured between a neutral starting position and re-position phases at three angles, in sitting and standing upright positions. [Results] Lumbar RE was significantly greater during lumbar flexion at a 30° angle in the sitting position than in the other tasks. [Conclusion] In the flexion-related subgroup, the lumbar RE measurement may be a more sensitive evaluation method using a lumbar flexion angle of 30° while in the sitting position, compared with other angles in sitting or standing positions.