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Effects of the Russian current in the treatment of low back pain in women: blinded, randomized clinical trial
Abstract
Background
Low back pain (LBP) is a high impact condition that affects the working population, generating social and economic repercussions, the most relevant symptoms being pain and functional disability. Conservative treatment is often based on stabilizing spinal muscles with exercises: the Russian current (RC) is reported as an alternative, because it promotes muscle contraction, providing muscle strengthening and hypertrophy.
Objective
To assess the effectiveness of the RC in aiding the treatment of low back pain.
Methods
This randomized study included 23 women aged 18–30 years, divided into two groups: the control group (CG) and the Russian current group (RCG), for four weeks. Pain (visual analogue scale, VAS; pressure algometer, PA), function (Oswestry Low Back Disability Index), resistance (trunk resistance [TR] test) and thickness changes in the muscle (ultrasound image) were evaluated before and after the RC protocol and at one-month follow-up.
Results
There were significant VAS reductions in both groups, but at follow-up these had only been maintained in the RCG, which presented lower values than the CG in the second evaluation. For PA, Oswestry and TR, there were differences only in the RCG. In a comparison of LBP between the groups, the initial difference disappeared in subsequent evaluations; TR presented higher values in evaluation 2 and 3 in the RCG group. In terms of thickness changes, differences between the groups were reduced after treatment.
Conclusion
The proposed treatment was effective in the reduction of LBP, with short-term improvement in resistance and thickness changes of the multifidus.
... While NMES is traditionally delivered under static conditions (10,11) or superimposed with voluntary isometric contractions (11), whole-body electromyostimulation (WB-EMS) is a recent iteration of NMES which delivers current through a form-fitted suit and allows for whole-body resistance training in conjunction with muscle stimulation (13) Handheld TENS and NMES units deliver current at frequencies that typically range from 2 to 300 Hz (10). In contrast, larger, medium-frequency, stand-alone units (14)(15)(16) can produce carrier frequencies ranging from 1 to 4 kHz, allowing for a variety of clinical applications (10,14,15,17). For example, interferential current (IFC) is a medium-frequency treatment typically used for pain relief (10,17,18), while Russian (10,12) and Aussie (14) current are medium-frequency iterations of EMS. ...
... While NMES is traditionally delivered under static conditions (10,11) or superimposed with voluntary isometric contractions (11), whole-body electromyostimulation (WB-EMS) is a recent iteration of NMES which delivers current through a form-fitted suit and allows for whole-body resistance training in conjunction with muscle stimulation (13) Handheld TENS and NMES units deliver current at frequencies that typically range from 2 to 300 Hz (10). In contrast, larger, medium-frequency, stand-alone units (14)(15)(16) can produce carrier frequencies ranging from 1 to 4 kHz, allowing for a variety of clinical applications (10,14,15,17). For example, interferential current (IFC) is a medium-frequency treatment typically used for pain relief (10,17,18), while Russian (10,12) and Aussie (14) current are medium-frequency iterations of EMS. ...
... Of the fourteen included studies, twelve were stand-alone, and two formed a pair with a shared recruitment process and inclusion/ exclusion criteria, but different interventions. Eight studies evaluated sensory electrotherapy: six used TENS (39, 40, [42][43][44]46), and two used IFC (16,37) The remaining six studies evaluated EMS: one used NMES (38), one used Russian current (15), one used Aussie current (14), one used mid-frequency (2,500 Hz) current with progressive low-frequency (LF) modulation (41), and two used WB-EMS (13,45) Furthermore, eight studies were comprised of stand-alone transcutaneous electrotherapy interventions (13-16, 37, 44-46), three studies included only mixed interventions (38,40,42) (electrotherapy plus an additional intervention), and three studies evaluated both stand-alone and mixed interventions (39, 41, 43) Study characteristics are provided in Table 2 (44) compared 20 min of conventional TENS and 20 min of low-frequency TENS with 20 min of percutaneous neuromodulation therapy (PNT). There were no significant between-group differences in current pain, but PNT was significantly more effective than both TENS interventions at improving activity pain (p < 0.05). ...
Introduction
Chronic low back pain (CLBP) is the leading cause of years lived with disability worldwide. Transcutaneous electrotherapies have been widely used to treat CLBP but, with the partial exception of transcutaneous electrical nerve stimulation (TENS), their effect on pain, disability, quality-of-life, and psychosocial outcomes have not been systematically reviewed. The purpose of this systematic review and meta-analysis was to clarify the overall effect of transcutaneous electrotherapies on patient-reported outcome measures (PROMs) in CLBP patients.
Methods
Four databases and two study registries were searched for studies that utilized transcutaneous electrotherapies as a primary intervention for CLBP, compared against active or passive controls. Two reviewers independently extracted study data and assessed risk of bias. Studies were grouped by intervention vs. comparison, and by time of follow-up. Meta-analyses were conducted where appropriate.
Results
A total of 89 full-text were assessed for eligibility; 14 studies were included, with 6 in the meta-analyses (all TENS or mixed TENS). Pain: meta-analyses revealed no significant difference for TENS vs. active control, TENS vs. passive control, or mixed TENS vs. active control at post-intervention, nor for mixed TENS vs. active control at 1-month post-intervention. Interferential current (IFC) was more effective than active control (2 studies), while electromyostimulation (EMS) was generally superior to passive, but not active, controls (6 studies).
Disability
Meta-analyses revealed no significant difference for TENS vs. active control at post-intervention, mixed TENS vs. active control at post-intervention, or mixed TENS vs. active control at 1-month post-intervention. IFC was more effective than active control (2 studies), while the EMS results were mixed (6 studies). We were unable to perform meta-analyses for quality-of-life or psychosocial outcomes.
Conclusion
There is moderate evidence that TENS is similar to all controls for improving pain and disability. There is limited evidence that IFC is superior to active controls for improving pain and disability. There is limited evidence that EMS is superior to passive but not active controls for improving pain, and similar to all controls for improving disability.
Systematic Review Registration
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=452851, Identifier (CRD42023452851).
... Specifically, bias in selected of the reported results was judged to be of at least 'some concerns' for all outcomes because no protocols for statistical analysis could be found for any of the included studies; therefore, a comparison between the published report and the protocol could not be performed, which automatically elevates the risk of bias for this domain. In total, there were 'some concerns' of bias for 16 comparisons [17,[26][27][28][29][30][31] and a high risk of bias for 4 comparisons [32][33][34]. The risk-of-bias assessment is presented in Supplementary Table S1. ...
... Of the ten included studies, eight were stand-alone [26][27][28][29][30][32][33][34] and two formed a pair with a shared recruitment process and inclusion/exclusion criteria but different interventions [17,31]. Four studies used sensory electrotherapy: three used TENS [28,33,34] and one used IFC [29]. ...
... Four studies used sensory electrotherapy: three used TENS [28,33,34] and one used IFC [29]. The remaining six studies evaluated EMS: one used NMES [26], one used Russian current [32], one used Aussie current [30], one used mid-frequency (2500 Hz) current with progressive low-frequency (LF) modulation [27], and two used WB-EMS [17,31]. Furthermore, five studies comprised stand-alone transcutaneous electrotherapy interventions [27][28][29][30]32], four studies included only mixed interventions [17,26,31,33] (electrotherapy plus an additional intervention), and two studies evaluated both stand-alone and mixed interventions [27,28]. ...
Chronic low back pain (CLBP) affects paraspinal muscle size, quality (e.g., fatty infiltration), range of motion (ROM), and strength. Although transcutaneous electrotherapies are used to treat CLBP, their effects on paraspinal-related outcomes are not fully known. The aim of this systematic review and meta-analysis was to assess the overall effect of transcutaneous electrotherapies on trunk/lumbar ROM, paraspinal muscle morphology, and trunk muscle function (including strength and endurance) in CLBP patients. A systematic search of four databases and two study registers was conducted between 1 February 2022 and 15 September 2022. Two reviewers were responsible for screening and data extraction. Of the 3939 independent records screened, 10 were included in the systematic review and 2 in the meta-analysis. The results suggest there is limited evidence that both EMS and EMS plus exercise are superior to passive and active controls, respectively, for improving trunk muscle endurance. There is limited evidence that neither TENS nor mixed TENS are superior to controls for improving trunk muscle endurance. There is limited evidence that NMES is superior to passive controls for improving trunk muscle strength. The effect of transcutaneous electrotherapy on the other investigated outcomes was inconclusive. Future transcutaneous electrotherapy studies should focus on paraspinal-based outcomes that are under-studied.
... Chronic low back pain (CLBP) is a persistent condition characterized by functional impairment and discomfort lasting more than three months, typically localized between the last rib and the iliac crest (1,2). CLBP often leads to work-related limitations and absences, incurring substantial social and healthcare costs, rendering it of significant clinical and economic importance (3). ...
... Corroborating this, a very large effect size was observed, which indicates that, in addition to the statistical difference, the difference between the means also had clinical relevance. The time effect can be explained by the fact that both interventions were able to increase muscle recruitment, as observed in previous studies related to endurance, power, and muscle volume (1,14,22,23). Regarding the intervention, there was no statistical difference in RMS when comparing the different volumes (E15 and E30) of NMES. The interaction between time and intervention was also not significant. ...
Introduction: Neuromuscular electrostimulation (NMES) represents a therapeutic approach for addressing chronic low back pain (CLBP); however, the influence of NMES dose on muscle activity remains subject to debate.
Objective: To compare the impact of two distinct NMES protocols employing Aussie current, characterized by varying dosages emphasizing time cycle alterations, on electromyographic activity within the multifidus muscles in individuals afflicted with CLBP.
Methods: A randomized clinical trial encompassed 18 volunteers diagnosed with mechanical CLBP. These volunteers were randomly assigned to two NMES intervention groups with dissimilar dosages: 15 repetitions ([Formula: see text][Formula: see text]) and 30 repetitions ([Formula: see text][Formula: see text] ). In both interventions, the current amplitude was tailored to individual perception and documented at the culmination of each session. Over the course of four weeks, two sessions took place per week. Electromyographic activity of the multifidus muscles was evaluated using surface electromyography before and after the intervention. The assessment focuses on both time-domain analysis using Root Mean Square (RMS) and frequency-domain analysis involving mean activation frequency (FREQ).
Results: There are no interactions between the time and intervention, but there is the time effect on RMS, indicating that post-intervention muscle activity exceeded pre-intervention values in both groups. FREQ values did not exhibit statistically significant discrepancies.
Conclusions: This study showed that NMES using the Aussie current is effective in increasing muscle activity in individuals with CLBP, and the results were not influenced by the different cycle times with equal volumes.
... To our knowledge, this is the first report on the acute effect of a single electromyostimulation (EMS) session on low back pain. Although previous research found EMS to be effective at reducing pain intensity in CLBP patients [44][45][46], those studies involved multiple treatment sessions over the course of several weeks. Our results are even more notable given that pain reduction is not a primary aim of NMEStype treatments [13]. ...
Background/Objectives: Individuals with chronic low back pain (CLBP) have altered lumbar multifidus stiffness properties compared to healthy controls. Although neuromuscular electrical stimulation (NMES) application to the multifidus might affect stiffness, this has never been investigated. The aims of this study were to examine the effect of a single NMES treatment on multifidus stiffness and pain intensity in CLBP patients. Methods: 30 participants (13 male, 17 female) were randomized to one of two intervention (‘phasic’ and ‘combined’) protocols with the StimaWELL 120MTRS system. Multifidus stiffness at L4 and L5 was measured via shear-wave elastography (SWE) at rest and in standing prior to, and 15 min after, a 20 min NMES treatment. Pain intensity was measured pre- and post-treatment with the numerical pain rating scale (NPRS). Results: There were significant increases in resting shear modulus at right L4 (p = 0.001) and bilaterally at L5 (p = 0.017; p = 0.020) in the ‘combined’ intervention group, and a significant between-group difference at right L4 (p < 0.001). There were significant decreases in standing shear modulus at right L4 (p = 0.015) and left L5 (p = 0.036) in the ‘combined’ intervention group, and a significant between-group difference at left L5 (p = 0.016). Both groups experienced significant decreases in pain intensity (MD combined group = 1.12, 95% CI [0.34, 1.90], p = 0.011) (MD phasic group = 1.42, 95% CI [0.68, 2.16], p = 0.001). Conclusions: There were multiple significant changes in multifidus stiffness in the combined group, but not in the phasic group. Both groups experienced significant decreases in low back pain intensity.
... Although values per assessed area were similar, comparison was challenging due to the limited number of included studies. The lack of protocol descriptions in half of the studies [18][19][20]31,32,35,38,40,42,47,48,52,56 makes it difficult to reproduce and comprehend the best evaluation methods. ...
Objective
The pressure pain threshold is commonly employed to assess pain in various conditions. Despite its widespread use, the measurement of pressure pain thresholds is not consistently described across studies. Therefore, this review aimed to systematically examine the evidence regarding the assessment of pressure pain thresholds in patients with low back pain, including the protocols and body sites employed.
Methods
Six databases were systematically screened from their earliest records to May 2023 to identify studies utilizing pressure pain thresholds. Eligibility screening was conducted for the identified studies, and the included studies underwent appraisal using the appropriate tool corresponding to their study design.
Results
Upon categorizing based on the type of pain, we included 5 studies involving acute low back pain and 43 studies with chronic pain. The meta-analysis was conducted to compare subjects with and without pain, revealing no significant difference for the paraspinal region (SMD = −4.19, 95%CI = −11.7 to 3.32, z = −1.09, p = .27), piriformis (SMD = −1.24, 95%CI = −4.25 to 1.76, z = −0.81, p = .42) and quadratus lumborum musculature (SMD = −0.37, 95%CI = −1.35 to 0.60, z = −0.75, p = .45).
Conclusion
The paraspinal and gluteal musculature are the most frequently evaluated. Concerning the protocols for assessment, no consensus was identified. However, studies that assessed chronic low back pain typically adhered to a similar approach regarding the number of measures and a constant increase in pressure.
Key Indexing Terms
Low back painPain thresholdSystematic reviewMeta-analysis
... The use of Russian current in conjunction with abdominal exercises is hardly discussed in the literature. 2,8 ...
Background: Diastasis recti abdominis (DRA) is the most common complication occurring post-delivery that limits the functional well-being of the affected individuals. Management of diastasis recti can include an abdominal binder, core strengthening, taping, and various surgical procedures. There is limited evidence to support the Russian current and structured exercise intervention in managing patients with DRA. Methodology: Three patients identified with DRA underwent a multi-modal treatment regimen including a hot moist pack, Russian current, abdominal binder, transverse abdominus activation exercises, treadmill training, and stationary cycling training. Outcomes were assessed using the visual analogue scale, abdominal girth, Ranney DRA scale, Oswestry low back disability questionnaire, and McGill’s torso battery test. These measures were administered at baseline and discharge. Results: Each patient demonstrated improvements in all outcome measures. The visual analogue scale improved by a mean of 7.3 on a 0–10 point scale, DRA reduced to 1 finger and the Oswestry disability questionnaire showed no disability. Conclusion: Structured exercises and Russian current were effective in managing three patients with DRA. The inclusion of Russian current and structured exercise within this multi-modal approach may enhance the conservative management of patients with DRA.
... [19] A recent study investigating the effect of a 4-week Russian current intervention in young women with CLBP found a nonstatistically significant increase in lumbar multifidus thickness, with medium effect sizes. [20] The results from NMES interventions on CLBP patient outcomes more broadly are also mixed. Hicks et al. (2016) trial found that combined trunk muscle training with NMES was more effective than a passive control intervention (heat + ultrasound + massage) at improving performance-based and self-rated function in older adults with CLBP. ...
Background
Neuromuscular electrical stimulation (NMES) is used to improve muscle strength clinically when rehabilitating various musculoskeletal disorders. However, the effects of NMES on muscle morphology and function in individuals with non-specific chronic low back pain (CLBP) have scarcely been investigated. Although research links deficits in the paraspinal musculature with subjective reports of pain and disability, it is unknown if treatment with NMES can help reverse these deficits. Therefore, the primary aim of this study is to compare the effects of two muscle therapy protocols with a medium-frequency electrotherapy device (the StimaWELL 120MTRS system) on multifidus muscle morphology and function in CLBP patients. The secondary aims are to determine the effects of these protocols subjective reports of pain intensity, pain interference, disability, and catastrophizing.
Methods
A total of 30 participants with non-specific CLBP, aged 18–60, will be recruited from local orthopedic clinics and databases. Participants will be randomized (1:1) to either the phasic or combined (phasic + tonic) muscle therapy protocols on the StimaWELL 120MTRS system. Participants will undergo 20 supervised electrotherapy treatments over a 10-week period. The primary outcomes will be multifidus morphology (e.g. cross-sectional area (CSA), fat infiltration) and function (e.g., contraction measured via %thickness change from a rested to contracted state, and stiffness at rest and during contraction). Secondary outcomes will include pain intensity, interference, disability, and catastrophizing. Both primary and secondary outcomes will be obtained at baseline and at 11-weeks; secondary outcomes measured via questionnaires will also be obtained at 6-weeks, while LBP intensity will be measured before and after each treatment. Paired t-tests will be used to assess within-group changes for all primary outcome measures. A two-way repeated-measures analysis of variance will be used to assess changes in secondary outcomes over time.
Discussion
The results of this trial will help clarify the role of medium-frequency NMES on lumbar multifidus morphology and function.
Trial Registration
NCT04891692, registered retrospectively on May 18, 2021.
... Chronic low back pain (CLBP) is characterized by functional loss, pain or discomfort located in the area below the last rib and above the iliac crest in the lumbosacral region lasting for three months or longer 1,2 . In the urban area of São Paulo, a prevalence of individuals with low back pain (LBP) of 48.1% 3 was observed and the prevalence of chronic pain in Brazil was indicated at 45.59%, ranging from 23.02 to 76.17% 4 . ...
BACKGROUND AND OBJECTIVES
Neuromuscular electrical stimulation (NMES) is one of the resources that can be used in the treatment of patients with chronic low back pain. It is possible that issues related to the stimulation parameters may affect the results obtained with the use of these currents. Therefore, the aim of this review was to investigate the effects of NMES on aspects of lumbopelvic muscle function in individuals with chronic low back pain.
CONTENTS
The study is a systematic review that used 10 databases for the search through a comprehensive combination of descriptors that met the research question. The selection criteria based on the PICOT strategy were population - individuals with chronic low back pain (specific and/or non-specific); intervention - NMES; outcomes - paravertebral and/or abdominal muscle changes (muscle power and endurance). The articles were selected by two independent reviewers, who developed the tools for data extraction. Four articles were included in this review. In three of them, there was a significant increase in muscle strength and endurance, as well as muscle cross-sectional area in the group that received NMES compared to the control group.
CONCLUSION
NMES showed positive effects in optimizing aspects of muscle function in individuals with chronic low back pain. However, the methods employed are very heterogeneous, which made it impossible to perform a quantitative analysis.
Keywords:
Electric stimulation therapy; Low back pain; Skeletal muscle
Introduction
One of the parameters observed in functional capacity over the years is the decrease in neuromuscular responses, a fact that is attributed to the contemporary lifestyle. Thus, there is a need to carry out interventions that induce the improvement of functional capacity. Some studies have associated electrostimulation (NMES) with Strength Training (ST) to enhance the results in improving neuromuscular function. However, little is known about the effects of this association due to the numerous protocols to be manipulated. Furthermore, adaptive responses to strength training are dependent on volume and intensity manipulation.
Objective
To investigate the influence of ST, concomitant with NMES (NMES+) on functional capacity.
Methods
This is a systematic review with meta-analysis. For the search of the articles, descriptors associated with functional capacity and NMES+ were selected in the Cochrane, PubMed, Embase and VHL meta-searcher databases. Inclusion criteria were articles that presented neuromuscular electrostimulation superimposed on voluntary contraction and ST intensity control; and that did not have a therapeutic purpose. The analysis of titles, abstracts and data extraction were performed by trios of reviewers. To assess the qualities of scientific evidence, the risk of bias was analyzed through the ROB2 tool, meta- analysis and evaluation of the quality of evidence (GRADE).
Results
This meta-analysis selected 3 studies. The main outcomes observed in the studies were agility, balance, cardiorespiratory capacity and strength and power. A significant improvement in effect estimates for cardiorespiratory capacity alone was observed between the two studies.
Conclusion
Despite the significant effect of the use of NMES+, in relation to ST in isolation, the quality of the evidence was considered low, probably due to the limited number of scientific evidence found, requiring further studies to identify the real effect of this association.
Objective
Chronic low-back pain (CLBP) is the leading cause of disability globally. CLBP is associated with a decrease in cross-sectional area (CSA) and an increase in fat infiltration (FI) of the lumbar paraspinal muscles, such as erector spinae (ES). Neuromuscular electrical stimulation (NMES) therapy showed promising outcomes in the treatment of CLBP, but its impact on ES morphology is unknown. Therefore, this study aimed to compare the effect of two NMES protocols on ES CSA and FI in a cohort of patients with CLBP.
Methods
Twenty participants with CLBP (aged 18–60 years old) were randomized into the phasic ( n = 11) or the combined ( n = 9) protocol groups. They completed a 10-week (20 sessions) NMES therapy using the StimaWELL 120MTRS device. Magnetic resonance imaging (MRI) examinations were acquired at baseline and post-intervention to assess ES CSA and FI at all spinal levels (e.g., L1–L2 to L5–S1). Statistical analyses were conducted to assess the effect of the intervention on ES morphology irrespective of groups, and between groups.
Results
Irrespective of groups, participants showed a decrease in left ES CSA ( p = 0.005) at L2–L3 and left ES FI at L5–S1 ( p = 0.040). We also observed a greater decrease in ES FI in the combined protocol compared to the phasic protocol on the right side at L3–L4 ( p = 0.029) and L4–L5 ( p = 0.015). No other changes in ES CSA or FI were observed ( p > 0.05).
Conclusion
NMES therapy demonstrated minimal effect on ES morphology in patients with CLBP. Further research is needed to extend and confirm our findings.
Background
Neuromuscular electrical stimulation (NMES) is used to improve muscle strength clinically when rehabilitating various musculoskeletal disorders. However, the effects of NMES on muscle morphology and function in individuals with non-specific chronic low back pain (CLBP) have scarcely been investigated. Although research links deficits in the paraspinal musculature with subjective reports of pain and disability, it is unknown if treatment with NMES can help reverse these deficits. Therefore, the primary aim of this study is to compare the effects of two muscle therapy protocols with a medium-frequency electrotherapy device (the StimaWELL 120MTRS system) on multifidus muscle morphology in CLBP patients. The secondary aims are to determine the effects of these protocols on multifidus muscle function, as well as subjective reports of pain intensity, pain interference, disability, and catastrophizing.
Methods
A total of 30 participants with non-specific CLBP, aged 18-60, will be recruited from local orthopedic clinics and databases. Participants will be randomized (1:1) to either the phasic or combined (phasic + tonic) muscle therapy protocols on the StimaWELL 120MTRS system. Participants will undergo 20 supervised electrotherapy treatments over a 10-week period. The primary outcomes will be multifidus cross-sectional area (CSA) and fat infiltration. Secondary outcomes will include multifidus contraction (measured via %thickness change from a rested to contracted state), multifidus stiffness (at rest, and during contraction), as well as pain intensity, interference, disability, and catastrophizing. Both primary and secondary outcomes will be obtained at baseline and at 11-weeks; secondary outcomes measured via questionnaires will also be obtained at 6-weeks, while low back pain intensity will be measured before and after each treatment. Paired t-tests will be used to assess within-group changes for all primary outcome measures. A two-way repeated-measures analysis of variance will be use to assess changes in secondary outcomes over time.
Discussion
The results of this trial will help clarify the role of medium-frequency NMES on lumbar multifidus morphology and function.
Trial Registration
NCT04891692
Trial Sponsor
Concordia University, Montreal, Quebec, Canada
Background
Ultrasound imaging has been suggested for studying the structure and function of nerves and muscles; however, reliability studies are limited to support the usage. The main aim of this study was to explore the intrarater within-session reliability of evaluating the sciatic nerve and some related muscles morphology by ultrasound imaging.
Methods
Three B-mode images from two scans (transverse and longitudinal) were acquired from the multifidus, biceps femoris, soleus and medial gastrocnemius muscles bilaterally from 15 participants with sciatica and 15 controls in one session, 1-h apart. The data were collected from March to July 2017. Contraction ratio was measured only by longitudinal scan, while the echo intensity was measured using maximum rectangular region of interest in two scans (transverse and longitudinal) for all muscles. Cross-sectional area, direct (tracing) and indirect (ellipsoid formula) methods were used to measure the sciatic nerve. Intraclass correlation coefficient (ICC 3,1), standard error of measurement and minimal detectable change were calculated.
Results
Good to high ICCs (0.80–0.96) were found for muscle contraction ratio in the longitudinal scans in all the muscles in both sciatica and control groups. For echo intensity measurements ICCs ranged from moderate to high, with higher ICCs seen with the maximum region of interest in the transverse scans. The minimal detectable change values ranged between 0.11 and 0.53 cm for contraction ratio.
Conclusions
Ultrasound imaging has high intrarater within-session reliability for assessing the sciatic nerve Cross-sectional area and muscle contraction ratios. Transverse scans with the maximum region of interest result in higher reliability. The sciatic Cross-sectional area is most accurately measured utilizing the direct tracing method rather than the indirect ellipsoid method.
Objective
This study aimed to establish sex- and age-dependent distributions of the cross sectional area and fatty infiltration ratio of paraspinal muscles, and to examine the correlation between paraspinal muscle degeneration and low back pain in the Japanese population.
Methods
In this cross-sectional study, data from 796 participants (241 men, 555 women; mean age, 63.5 years) were analyzed. The measurement of the cross sectional area and fatty infiltration ratio of the erector spinae and multifidus from the level of T12/L1 to L4/5 and psoas major at the level of T12/L1 was performed using axial T2-weighted magnetic resonance imaging. Multivariate logistic regression analysis was used to estimate the association between fatty infiltration of the paraspinal muscles and the prevalence of low back pain.
Results
The cross sectional area was larger in men than women, and tended to decrease with age, with the exception of the erector spinae at T12/L1 and L1/2 in women. The fatty infiltration ratio was lower in men than women, except for multifidus at T12/L1 in 70–79 year-olds and psoas major in those less than 50 years-old, and tended to increase with age. Logistic regression analysis adjusted for age, sex, and body mass index showed that the fatty infiltration ratio of the erector spinae at L1/2 and L2/3 was significantly associated with low back pain (L1/2 level: odds ratio, 1.05; 95% confidence interval, 1.005–1.104; L2/3 level: odds ratio, 1.05; 95% confidence interval, 1.001–1.113).
Conclusion
This study measured the cross sectional area and fatty infiltration ratio of paraspinal muscles in the Japanese population using magnetic resonance imaging, and demonstrated that the fatty infiltration ratio of the erector spinae in the upper lumbar spine was significantly associated with the presence of low back pain. The measurements could be used as reference values, which are important for future comparative studies.
Objective
To investigate if electrical stimulation through Russian current is able to maintain morphology of the cranial tibial muscle of experimentally denervated rats.
Methods
Thirty-six Wistar rats were divided into four groups: the Initial Control Group, Final Control Group, Experimental Denervated and Treated Group, Experimental Denervated Group. The electrostimulation was performed with a protocol of Russian current applied three times per week, for 45 days. At the end, the animals were euthanized and histological and morphometric analyses were performed. Data were submitted to statistical analysis with a significance level of p<0.05.
Results
The Experimental Denervated Group and the Experimental Denervated and Treated Group had cross-sectional area of smaller fiber compared to the Final Control Group. However, there was significant difference between the Experimental Denervated Group and Experimental Denervated and Treated Group, showing that electrical stimulation minimized muscle atrophy. The Experimental Denervated and Treated Group and Initial Control Group showed similar results.
Conclusion
Electrical stimulation through Russian current acted favorably in maintaining morphology of the cranial tibial muscle that was experimentally denervated, minimizing muscle atrophy.
Background
Evidence is lacking on whether fat infiltration in the multifidus muscles affects outcomes after total disc replacement (TDR) surgery and if it develops after surgery. The aims of this study were 1) to investigate whether pre-treatment multifidus muscle fat infiltration predicts outcome 2 years after treatment with TDR surgery or multidisciplinary rehabilitation, and 2) to compare changes in multifidus muscle fat infiltration from pre-treatment to 2-year follow-up between the two treatment groups. Methods
The study is secondary analysis of data from a trial with 2-year follow-up of patients with chronic low back pain (LBP) and degenerative disc randomized to TDR surgery or multidisciplinary rehabilitation. We analyzed (aim 1) patients with both magnetic resonance imaging (MRI) at pre-treatment and valid data on outcome measures at 2-year follow-up (predictor analysis), and (aim 2) patients with MRI at both pre-treatment and 2-year follow-up. Outcome measures were visual analogue scale (VAS) for LBP, Oswestry Disability Index (ODI), work status and muscle fat infiltration on MRI. Patients with pre-treatment MRI and 2-year outcome data on VAS for LBP (n = 144), ODI (n = 147), and work status (n = 137) were analyzed for prediction purposes. At 2-year follow-up, 126 patients had another MRI scan, and change in muscle fat infiltration was compared between the two treatment groups. Three radiologists visually quantified multifidus muscle fat in the three lower lumbar levels on MRI as <20% (grade 0), 20–50% (grade 1), or >50% (grade 2) of the muscle cross-section containing fat. Regression analysis and a mid-P exact test were carried out. ResultsGrade 0 pre-treatment multifidus muscle fat predicted better clinical results at 2-year follow-up after TDR surgery (all outcomes) but not after rehabilitation. At 2-year follow-up, increased fat infiltration was more common in the surgery group (intention-to-treat p = 0.03, per protocol p = 0.08) where it was related to worse pain and ODI. Conclusions
Patients with less fat infiltration of multifidus muscles before TDR surgery had better outcomes at 2-year follow-up, but findings also indicated a negative influence of TDR surgery on back muscle morphology in some patients. The rehabilitation group maintained their muscular morphology and were unaffected by pre-treatment multifidus muscle fat. Trial registrationNCT 00394732 (retrospectively registered October 31, 2006).
This narrative review investigated imaging parameters of the paraspinal muscles and their association with spinal degenerative features and low back pain (LBP) found in the literature. Three principal signs of muscle degeneration were detected on imaging: decreased muscle size, decreased radiographic density, and increased fat deposits. Men have a higher density of paraspinal muscles than women, younger individuals have a higher density than older ones, and lean individuals have a higher density than those with an increased body mass index. Fatty infiltration appears to be a late stage of muscular degeneration and can be measured noninvasively by an MRI scan. Fatty infiltration in the lumbar multifidus is common in adults and is strongly associated with LBP, especially in women, independent of body composition. Fatty infiltration develops in areas where most degenerative changes are found. MR spectroscopy studies have corroborated that the lumbar multifidus in LBP subjects has a significantly higher fat content than asymptomatic controls. There is a strong need for establishing uniform methods of evaluating normal parameters and degenerative changes of the paraspinal muscles. Additional imaging studies are needed to improve the understanding of the association and causal relationships between LBP, spinal degeneration, and changes in the paraspinal muscles.
Background: Lumbar muscle dysfunction due to pain might be related to altered lumbar muscle structure. Macroscopically, muscle degeneration in low back pain (LBP) is characterized by a decrease in cross-sectional area and an increase in fat infiltration in the lumbar paraspinal muscles. In addition microscopic changes, such as changes in fiber distribution, might occur. Inconsistencies in results from different studies make it difficult to draw firm conclusions on which structural changes are present in the different types of non-specific LBP. Insights regarding structural muscle alterations in LBP are, however, important for prevention and treatment of non-specific LBP. Objective: The goal of this article is to review which macro- and/or microscopic structural alterations of the lumbar muscles occur in case of non-specific chronic low back pain (CLBP), recurrent low back pain (RLBP), and acute low back pain (ALBP). Study Design: Systematic review. Setting: All selected studies were case-control studies. Methods: A systematic literature search was conducted in the databases PubMed and Web of Science. Only full texts of original studies regarding structural alterations (atrophy, fat infiltration, and fiber type distribution) in lumbar muscles of patients with non-specific LBP compared to healthy controls were included. All included articles were scored on methodological quality. Results: Fifteen studies were found eligible after screening title, abstract, and full text for inclusion and exclusion criteria. In CLBP, moderate evidence of atrophy was found in the multifidus; whereas, results in the paraspinal and the erector spinae muscle remain inconclusive. Also moderate evidence occurred in RLBP and ALBP, where no atrophy was shown in any lumbar muscle. Conflicting results were seen in undefined LBP groups. Results concerning fat infiltration were inconsistent in CLBP. On the other hand, there is moderate evidence in RLBP that fat infiltration does not occur, although a larger muscle fat index was found in the erector spinae, multifidus, and paraspinal muscles, reflecting an increased relative amount of intramuscular lipids in RLBP. However, no studies were found investigating fat infiltration in ALBP. Restricted evidence indicates no abnormalities in fiber type in the paraspinal muscles in CLBP. No studies have examined fiber type in ALBP and RLBP. Limitations: Lack of clarity concerning patient definitions, exact LBP symptoms, and applied methods. Conclusions: The results indicate atrophy in CLBP in the multifidus and paraspinal muscles but not in the erector spinae. No atrophy was shown in RLBP and ALBP. Fat infiltration did not occur in RLBP, but results in CLBP were inconsistent. No abnormalities in fiber type in the paraspinal muscles were found in CLBP. © 2016, American Society of Interventional Pain Physicians. All rights reserved.
Background:
The aim of this systematic review was to update scientific knowledge concerning the safety of neuromuscular electrical stimulation (NMES) to increase exercise capacity and prevent cardiac cachexia in patients with implantable cardioverter defibrillators (ICDs).
Methods:
A systematic review including the electronic databases PubMed, MEDLINE, and SCOPUS was conducted for the time period from 1966 to March 31, 2016.
Results:
Only four articles fulfilled the inclusion criteria (three original articles/safety studies and one case report). The three (safety) studies used NMES to increase muscle strength and/or endurance capacity of the thighs. NMES did not show electromagnetic interference (EMI) with ICD function. EMI was described in a case report of 2 patients with subpectoral ICDs and application of NMES on abdominal muscles.
Conclusion:
This review indicates that NMES may be applied in cardiac ICD patients if 1) individual risks (e. g., pacing dependency, acute heart failure, unstable angina, ventricular arrhythmic episode in the last 3 months) are excluded by performing a safety check before starting NMES treatment and 2) "passive" exercise using NMES is performed only for thighs and gluteal muscles in 3) compliant ICD patients (especially for home-based NMES) and 4) the treatment is regularly supervised by a physician and the device is examined after the first use of NMES to exclude EMI. Nevertheless, further studies including larger sample sizes are necessary to exclude any risk when NMES is used in this patient group.
Purpose:
We aimed to investigate the prevalence of lumbar multifidus muscle (LMM) atrophy in patients having mechanical low back pain with and without disc hernia.
Methods:
In total, 2028 lumbar magnetic resonance imaging (MRI) scans of low back pain patients (age range, 18-88 years) were re-evaluated retrospectively. LMM atrophy was visually assessed in axial sections of L4-L5 and L5-S1 levels.
Results:
LMM atrophy prevalence at both levels was significantly higher in subjects ≥40 years compared with younger adults (P < 0.001). LMM atrophy was significantly more frequent in women than in men (P < 0.001). Among patients with low back pain without hernia, LMM atrophy was significantly more frequent than normal muscle (n=559 vs. n=392; P < 0.001). Frequency of LMM atrophy in low back pain patients without disc hernia was 13%. Hernia was more frequent in patients with LMM atrophy compared with patients without atrophy (P < 0.001).
Conclusion:
LMM atrophy is more common in women; its prevalence and severity are observed to increase with advancing age, and disc hernia is found more frequently in individuals with LMM atrophy.
BACKGROUND AND OBJECTIVES:
Chronic low back pain has an incidence of 70% in general population and induces significant limitations. As treatment, physiotherapy stands out with a wide variety of techniques among them, for pain relief, electrotherapy is a useful tool. This study aimed at comparing the analgesic effects of transcutaneous electrical nerve stimulation and interferential current in patients with chronic low back pain.
METHODS:
Randomized clinical trial carried out between August 2013 and May 2014 in the clinic school of physiotherapy, Ulbra-Torres, with chronic low back pain patients. Patients were divided in two groups: intervention group (IG) treated with interferential current and control group (CG) treated with transcutaneous electrical nerve stimulation. Visual analog scale, Oswestry Questionnaire and Roland Morris Disability Questionnaire were used for baseline evaluation. Patients were treated for five weeks, twice a week, in a total of 10 interventions. At the end, they were re-evaluated and one month after they were submitted to follow-up with the visual analog scale.
RESULTS:
Participated in the study 28 patients, being 14 in IG and 14 in CG. Sample was homogeneous intragroups for gender, age, color and mean pain duration. There has been significant pain improvement in both groups by the visual analog scale and functionality improvement by Oswestry and Roland Morris Disability Questionnaires when comparing baseline and final evaluations (p<0.05).
CONCLUSION:
There were positive results in chronic low back pain improvement both with transcutaneous electrical nerve stimulation and interferential current, without significant difference between transcutaneous currents.
[Purpose] The aim of this study was to investigate the effects of combined application of progressive resistance training and Russian electrical stimulation on quadriceps femoris muscle strength in elderly women with osteoarthritis of the knee. [Subjects] Thirty women over 65 years of age diagnosed with knee osteoarthritis participated in the present study. The subjects were randomly assigned to a control group (n=10), a progressive resistance training group (n=10), or a Russian electrical stimulation group (n=10). [Methods] Each group was treated 3 times weekly for 8 weeks, and each session lasted 45 minutes. Muscle strength was assessed by measuring the peak torque of the quadriceps femoris muscle. Outcome measurements were performed at baseline and at the fourth and eighth weeks of the treatment period. [Results] All groups showed significant intragroup differences in the quadriceps femoris muscle peak torque after the treatment intervention. There were significant intergroup differences between the Russian electrical stimulation group and the other groups. [Conclusion] The results of this study suggest that combined application of progressive resistance training and Russian electrical stimulation can be effective in strengthening the quadriceps femoris muscle in elderly women with knee osteoarthritis.
Ultrasound is frequently used to measure activity in the lumbar multifidus muscle (LMM). However previous reliability studies on diagnostic ultrasound and LMM have included a limited number of subjects and few have used Bland-Altman's Limits of Agreement (LOA). Further one does not know if activity affects the subjects' ability to contract the LMM.
From January 2012 to December 2012 an inter- and intra-examiner reliability study was carried out in a clinical setting. It consisted of a total of four experiments with 30 subjects in each study. Two experienced examiners performed all measurements. Ultrasound measurements were made of: 1. the LMM in the resting state, 2. during a contracted state, 3. on subsequent days, and, before and after walking. Reliability and agreement was tested for 1. resting LMM, 2. contracted LMM, and 3. thickness change in the LMM. Mean values of three measurements were used for statistical analysis for each spinal level. The intra-class correlation coefficient (ICC) 3.1 and 3.2 was used to test for reliability, and Bland-Altman's LOA method to test for agreement.
All of the studies indicate high levels of reliability, but as the LMM thickness increased (increasing contraction) the agreement between examiners was poorer than for low levels of contraction.
The use of diagnostic ultrasound to measure the LMM seems to be reliable in subjects who have little or no change in thickness of the LMM with contraction.
Study design:
Randomized clinical trial.
Objectives:
To compare the effects of functional stabilization training (FST) versus standard training on knee pain and function, lower-limb and trunk kinematics, trunk muscle endurance, and eccentric hip and knee muscle strength in women with patellofemoral pain.
Background:
A combination of hip- and knee-strengthening exercise may be more beneficial than quadriceps strengthening alone to improve pain and function in individuals with patellofemoral pain. However, there is limited evidence of the effectiveness of these exercise programs on the biomechanics of the lower extremity.
Methods:
Thirty-one women were randomized to either the FST group or standard-training group. Patients attended a baseline assessment session, followed by an 8-week intervention, and were reassessed at the end of the intervention and at 3 months after the intervention. Assessment measures were a 10-cm visual analog scale for pain, the Lower Extremity Functional Scale, and the single-leg triple-hop test. A global rating of change scale was used to measure perceived improvement. Kinematics were assessed during the single-leg squat. Outcome measures also included trunk endurance and eccentric hip and knee muscle strength assessment.
Results:
The patients in the FST group had less pain at the 3-month follow-up and greater global improvement and physical function at the end of the intervention compared to those in the standard-training group. Lesser ipsilateral trunk inclination, pelvis contralateral depression, hip adduction, and knee abduction, along with greater pelvis anteversion and hip flexion movement excursions during the single-leg squat, were only observed in the FST group after the intervention. Only those in the FST group had greater eccentric hip abductor and knee flexor strength, as well as greater endurance of the anterior, posterior, and lateral trunk muscles, after training.
Conclusion:
An intervention program consisting of hip muscle strengthening and lower-limb and trunk movement control exercises was more beneficial in improving pain, physical function, kinematics, and muscle strength compared to a program of quadriceps-strengthening exercises alone.
Neuromuscular electrical stimulation (NMES) is a common clinical modality that is widely used to restore1, maintain2 or enhance3-5 muscle functional capacity. Transcutaneous surface stimulation of skeletal muscle involves a current flow between a cathode and an anode, thereby inducing excitement of the motor unit and the surrounding muscle fibers.
NMES is an attractive modality to evaluate skeletal muscle adaptive responses for several reasons. First, it provides a reproducible experimental model in which physiological adaptations, such as myofiber hypertophy and muscle strengthening6, angiogenesis7-9, growth factor secretion9-11, and muscle precursor cell activation12 are well documented. Such physiological responses may be carefully titrated using different parameters of stimulation (for Cochrane review, see 13). In addition, NMES recruits motor units non-selectively, and in a spatially fixed and temporally synchronous manner14, offering the advantage of exerting a treatment effect on all fibers, regardless of fiber type. Although there are specified contraindications to NMES in clinical populations, including peripheral venous disorders or malignancy, for example, NMES is safe and feasible, even for those who are ill and/or bedridden and for populations in which rigorous exercise may be challenging.
Here, we demonstrate the protocol for adapting commercially available electrodes and performing a NMES protocol using a murine model. This animal model has the advantage of utilizing a clinically available device and providing instant feedback regarding positioning of the electrode to elicit the desired muscle contractile effect. For the purpose of this manuscript, we will describe the protocol for muscle stimulation of the anterior compartment muscles of a mouse hindlimb.
Background:
Low-frequency pulsed current (LFPC) and Russian current (RC), a type of kilohertz-frequency alternating current, have been frequently used for muscle strengthening in rehabilitation programs. Despite the popularity of these current types, it is unclear which is most effectively able to generate a similar submaximal torque with minimal discomfort and current amplitude.
Objective:
To compare discomfort and current amplitude between LFPC and RC to achieve a knee extensor torque of 10% of the maximal isometric voluntary contraction (MIVC).
Methods:
Twenty-two healthy subjects were subjected to three electrically elicited knee extensor submaximal contractions (10% MIVC) that were sustained for 10 seconds. The current amplitude required to achieve 10% MIVC and subjective discomfort were assessed directly by the electrical stimulator and with the Visual Analogue Pain Scale, respectively. A paired t-test was used to determine differences between the electrical currents (α = 0.05).
Results:
LFPC required significantly lower current amplitude (15%) and a lower discomfort level (50%) to achieve 10% of MIVC compared to RC.
Conclusion:
LFPC current seems to be more effective than RC with respect to discomfort level and current amplitude to produce 10% of MIVC.
Low back pain (LBP) is the most common disorder seen in physical therapy practice. There are several hundred clinical trials on the management of LBP. To summarize these trials, researchers wrote Evidence Based Practice (EBP) guidelines. This article reviewed the implications of EBP guidelines recommendations for physical therapy practice.
To review the recommendations for conservative management of LBP published in EBP guidelines since 2002.
Searches were performed on the following databases: Google web searching engine, Medline, Cochrane Library, and the Guideline Clearing House. Guidelines published in English and addressing conservative management of LBP were included.
Thirteen multidisciplinary and three mono-disciplinary guidelines met the inclusion criteria. LBP was triaged into three groups: with red flags, with radiculopathy, or non-specific. Patients without red flags could be safely managed without specialist referral. Patient education was recommended for all patients with LBP. There was an agreement to advise spine manipulation for patients with acute and sub-acute non-specific LBP. There was a consensus to recommend exercises for acute, sub-acute, and chronic LBP. Few guidelines addressed conservative management of LBP with radiculopathy. Overall, the guidelines did not offer specific advice for manipulation (hypomobility or instability) and exercise (stabilization or directional preference).
Multidisciplinary guidelines focused on primary care and lacked details significant for physical therapy practice. There is a need for mono-disciplinary physical therapy guidelines to improve the balance between evidence and professional relevance.
Impaired motor and sensory functions have been associated with low back pain (LBP). This includes disturbances in a wide range of sensorimotor control e.g. sensory dysfunctions, impaired postural responses and psychomotor control. However, the physiological mechanisms, clinical relevance and characteristics of these findings in different spinal pathologies require further clarification.The purposes of this study were to investigate postural control, lumbar muscle function, movement perception and associations between these findings in healthy volunteers (n=35), patients with lumbar disc herniation (n=20) and lumbar spinal stenosis (LSS, n=26).Paraspinal muscle responses for sudden upper limb loading and muscle activation during flexion-extension movement and the lumbar endurance test were measured by surface electromyography (EMG). Postural stability was measured on a force platform during two- and one-footed standing. Lumbar movement perception was assessed in a motorised trunk rotation unit in the seated position. In addition, measurements of motor-(MEP) and somatosensory evoked potentials (SEP) and needle EMG examination of lumbar multifidus muscles were performed in the LSS patients. Clinical and questionnaire data were also recorded. A short latency paraspinal muscle response (~50 ms) for sudden upper limb loading was observed. The latency of the response was shortened by expectation (p=0.017). The response latency for unexpected loading was similar in healthy persons and disc herniation patients but the latency was not shortened by expectation in the patients (p = 0.014). Also impaired postural control (p < 0.05) and lumbar movement perception (p = 0.012) were observed in disc herniation patients. The impaired lumbar movement perception (p=0.054) and anticipatory muscle activation (p = 0.043) tended to be restored after successful surgery but postural control had still not recovered after 3 months of follow-up. The majority of LSS patients were unable to sense a rotational movement in the lumbar area and thus had clearly impaired lumbar movement perception (p = 0.006). Abnormal MEPs had only inconsistent and SEPs showed no associations with impaired movement perception and postural stability in LSS. Abnormal needle EMG findings and flexion-extension activation of paraspinal muscles were frequently observed in LSS patients. Lumbar paraspinal muscle endurance was better than in previously evaluated healthy subjects and chronic LBP patients (p < 0.001).The results demonstrated clearly impaired lumbar sensory and motor function in sciatica and LSS patients. The pure reflex activation of paraspinal muscles was not affected in sciatica but a difference was found in the premotoneuronal response control. The impaired proprioceptive functions and premotoneuronal response control seem to recover at least partially but the maintenance of postural stability is a complex activity which does not seem to recover automatically in operated sciatica patients at least in three months follow-up. Paraspinal muscle denervation and dysfunction were clearly detectable in LSS but lumbar paraspinal muscle endurance was unexpectedly good
Cross-sectional study design.
To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age.
Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited.
Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed.
For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (P<.001) was found. The horizontal side-support (mean +/- SD contracted-rest thickness ratio: TrA, 1.95 +/- 0.69; IO, 1.88 +/- 0.52) and the abdominal crunch (mean +/- SD contracted-rest thickness ratio: TrA, 1.74 +/- 0.48; IO, 1.63 +/- 0.41) exercises resulted in the greatest change in muscle thickness for both muscles. The abdominal drawing-in maneuver (mean +/- SD contracted-rest thickness ratio: TrA, 1.73 +/- 0.36; IO, 1.14 +/- 0.33) and quadruped opposite upper and lower extremity lift (mean +/- SD contracted-rest thickness ratio: TrA, 1.59 +/- 0.49; IO, 1.25 +/- 0.36) exercises resulted in changes in TrA muscle thickness with minimal changes in IO muscle thickness.
Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription.
Prospective, cross-sectional observational study.
The aim of this study was to determine if there was an association between wasting of psoas and multifidus as observed on MRI scans and the presenting symptoms, reported pathology, pain, or disability of a cohort of patients presenting with unilateral low back pain.
Current physiotherapy practice is often based on localized spine stabilizing muscle exercises; most attention has been focused on transversus abdominus and multifidus with relatively little on psoas.
Fifty consecutive patients presenting to a back pain triage clinic with unilateral low back pain lasting more than 12 weeks were recruited. The cross-sectional surface area (CSA) of the muscles was measured. Duration of symptoms, rating of pain, self-reported function, and the presence of neural compression were recorded.
Data analysis compared the CSA between the symptomatic and asymptomatic sides. There was a statistically significant difference in CSA between the sides (P < 0.001). There was a positive correlation between the percentage decrease in CSA of psoas on the affected side and with the rating of pain (rho = 0.608, P < 0.01), reported nerve root compression (rho = 0.812, P < 0.01), and the duration of symptoms (rho = 0.886, P < 0.01). There was an association between decrease in the CSA of multifidus and duration of symptoms.
Atrophy of multifidus has been used as one of the rationales for spine stabilization exercises. The evidence of coexisting atrophy of psoas and multifidus suggests that a future area for study should be selective exercise training of psoas, which is less commonly used in clinical practice.
People with epilepsy (PWE) are less physically active compared with the general population. Explanations include prejudice, overprotection, unawareness, stigma, fear of seizure induction and lack of knowledge of health professionals. At present, there is no consensus on the role of exercise in epilepsy. This paper reviews the current evidence surrounding the risks and benefits associated with physical activity (PA) in this group of patients. In the last decade, several publications indicate significant benefits in physiological and psychological health parameters, including mood and cognition, physical conditioning, social interaction, quality of life, as well as potential prevention of seizure presentation. Moreover, experimental studies suggest that PA provides mechanisms of neuronal protection, related to biochemical and structural changes including release of β-endorphins and steroids, which may exert an inhibitory effect on the occurrence of abnormal electrical activity. Epileptic discharges can decrease or disappear during exercise, which may translate into reduced seizure recurrence. In some patients, exercise may precipitate seizures. Available evidence suggests that PA should be encouraged in PWE in order to promote wellbeing and quality of life. There is a need for prospective randomized controlled studies that provide stronger clinical evidence before definitive recommendations can be made.
Mice selected for high (HA) and low (LA) swim stress-induced analgesia (SSIA) are a unique model for studying the genetic background of this phenomenon. HA and LA mice show substantial differences in the magnitude of the antinociceptive response to stress and when treated with exogenous opioids. However, the direct cause underplaying this distinctive feature has not yet been identified. The current study was designed to investigate the possibility that disturbances in G-protein signaling could explain the divergent response to opioid agonists. Supraspinal and spinal opioid sensitivity was assessed in vivo with intraperitoneal morphine and subsequent thermal stimulus exposure. The level of opioid receptor-mediated G-protein activation was investigated by means of DAMGO and morphine-stimulated [35S]GTPγS assay in the brain and spinal cord homogenates from HA and LA mice. Morphine (3 - 249 μmol/kg, i.p) was over 6 - and 3 - times more potent in HA than LA mice in the hot plate and tail-flick assays, respectively. Additionally, HA mice showed elevated β - endorphin levels in the brain. Enhanced efficacy of agonist-stimulated [35S]GTPγS binding was detected in opioid receptor-rich limbic regions of HA mice like the hypothalamus and hippocampus. Increased G-protein activity also emerged in the thalamus, periaqueductal gray matter and prefrontal cortex. In conclusion, the magnitude of the antinociceptive response to opioids in HA and LA mice is correlated with alterations in G-protein activation in brain regions responsible for integration and descending modulation of nociceptive information as well as at sites governing the emotional response to stressful stimuli.
Background and Purpose
Spasticity is a major disabling symptom in patients post stroke. Though studies have demonstrated that electrical stimulation (ES) can reduce spasticity and improve passive ankle range of motion (ROM), not many studies have evaluated the effectiveness of ES on active ankle ROM. The purpose of this study was to determine the effectiveness of Faradic and Russian currents in the reduction of ankle plantar-flexor spasticity and improving motor recovery in patients post stroke.
Methods
Eighty-three patients (29 females and 54 males; mean age of 57.12 years) were randomly assigned to Group 1 (task-oriented exercises), Group 2 (Faradic current for 10 min and task-oriented exercises), and Group 3 (Russian current for 10 min and task-oriented exercises) for a period of 5 sessions per week for 6 weeks. All patients were assessed for soleus and gastrocnemius muscles spasticity measured by modified modified Ashworth scale; active and passive range ROM measured by goniometer; and functional ambulation measured by modified Emory Functional Ambulation Profile at the time of recruitment to study and after 6 weeks.
Results
Both the types of stimulation and exercises were not associated with improvements in modified Emory Functional Ambulation Profile (p > 0.05). The results showed that all the groups are effective in improving passive ankle ROM (p < 0.05) and reducing soleus and gastrocnemius muscles spasticity (p < 0.05). Though all the groups were effective in improving active ankle ROM, no group was found to be superior to another after treatment
Conclusion
Adding ES to exercises are associated with low to medium effect sizes (<0.5) in reducing spasticity and improving ankle ROM.
We investigated the effects of cyclic muscle twitch contraction caused by neuromuscular electrical stimulation on immobilization-induced muscle contracture and fibrosis in rats. Twenty-nine rats were divided into control, immobilization (IM), and immobilization with muscle contraction (MC) groups. The ankle joints of the IM and MC rats were fixed in full plantar flexion with a plaster cast for 4 weeks. In the MC group, cyclic muscle twitch contraction of the soleus muscle was induced using a commercial device (1 Hz, 4±2 mA, 60 min/day, 5 times/week) with the ankle joint immobilized. The dorsiflexion range of ankle joint motion in the MC group was significantly greater than that in the IM group. The expressions of fibrosis-related genes (i.e., hypoxia inducible factor-1α, transforming growth factor-β1, α-smooth muscle actin, and types I and III collagen) were significantly decreased in the MC group compared to the IM group. The fluorescence intensities of type I and type III collagen in the perimysium and endomysium in the MC group were significantly decreased compared to the IM group. These results suggest that cyclic muscle twitch contraction induced by neuromuscular electrical stimulation might alleviate skeletal muscle fibrosis, reducing immobilization-induced muscle contracture.
Objectives:
To determine measurement reliability of abdominal and lumbar MF muscles from a single ultrasound (US) image in older adults.
Methods:
Resting thickness of rectus abdominis and obliquus externus, resting and contracted thickness of obliquus internus, transversus abdominis and lumbar MF, and resting cross-sectional area (CSA) of MF levels (L2-5) were obtained from US images of 92 community-dwelling older adults (aged 65-89 years). Measurements of images were undertaken by an experienced rater and repeated 7-10 days later for intra-rater, and by a second expert rater for inter-rater calculations. Intra-rater reliability was estimated for all muscles. Inter-rater reliability was estimated for all abdominal muscles and for L5 multifidus. Reliability was estimated by intraclass correlation coefficients (ICC).
Results:
Intra-rater ICC(3,1) and inter-rater ICC(2,1) of resting thickness measures of all muscles and CSA of MF were ≥0.86. The ICCs for percentage thickness change were ≥0.76 for the abdominal muscles, and ≥0.42 for MF.
Conclusions:
Measurement reliability of US imaging for abdominal and MF muscle thickness and MF CSA was high, and consistent with previous findings for younger adults. Reliability of percentage thickness change was lower suggesting caution is needed when using this as an outcome measure or study factor among older adults.
OBJECTIVE
The objective of this study was to assess the cross-sectional areas (CSAs) of lumbar paraspinal muscles in adults with isthmic spondylolisthesis (IS), to compare them with those in the normative population, and to evaluate their correlations with demographic factors and MRI changes in various spinal elements.
METHODS
The authors conducted a retrospective study of patients who had undergone posterior lumbar interbody fusion for IS, and 2 of the authors acting as independent observers calculated the CSAs of various lumbar paraspinal muscles (psoas, erector spinae [ES], multifidus [MF]) on preoperative axial T2-weighted MR images from the L-3 to L-5 vertebral levels and computed the CSAs as ratios with respect to the corresponding vertebral body areas. These values were then compared with those in an age- and sex-matched normative population and were analyzed with respect to age, sex, duration of symptoms, grade of listhesis, and various MRI changes at the level of the listhesis (pedicle signal change, disc degeneration, and facetal arthropathy).
RESULTS
Compared with values in normative controls, the mean CSA value for the ES muscle was significantly higher in the study cohort of 120 patients (p = 0.002), whereas that for the MF muscle was significantly lower (p = 0.009), and more so in the patients with PSC (p = 0.002). Magnetic resonance imaging signal change in the pedicle was seen in half of the patients, all of whom demonstrated a Type 2 change. Of the variables tested in a multivariate analysis, age independently predicted lower area values for all 3 muscles (p ≤ 0.001), whereas female sex predicted a lower mean psoas area value (p < 0.001). None of the other variables significantly predicted any of the muscle area values. A decrease in the mean MF muscle area value alone was associated with a significantly increased likelihood of a PSC (p = 0.039).
CONCLUSIONS
Compared with normative controls, patients with IS suffer selective atrophy of their MF muscle, whereas their ES muscle undergoes a compensatory hypertrophy. Advancing age has a detrimental effect on the areas of the lumbar PSMs, whereas female sex predisposes to a decreased psoas muscle area. Multifidus muscle atrophy correlates with PSC, indicating the role of this deep stabilizer in the biomechanical stability of spondylolisthetic spines. This may be of clinical significance in targeted physiotherapy programs during the conservative management of IS.
Objective . To evaluate intra- and inter-examiner reliability for the assessment of relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area, i.e., total cross-sectional area minus intramuscular fat, from T1-weighted magnetic resonance images obtained in older adults with chronic low back pain.
Design . Reliability study.
Subjects . n = 13 (69.3 ± 8.2 years old)
Methods . After lumbar magnetic resonance imaging, two examiners produced relative cross-sectional area measurements of multifidi, erector spinae, psoas, and quadratus lumborum by tracing regions of interest just inside fascial borders. Pixel-intensity summaries were used to determine muscle-to-fat infiltration indices; relative muscle cross-sectional area was calculated. Intraclass correlation coefficients were used to estimate intra- and inter-examiner reliability; standard error of measurement was calculated.
Results . Intra-examiner intraclass correlation coefficient point estimates for relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area were excellent for multifidi and erector spinae across levels L2-L5 (ICC = 0.77–0.99). At L3, intra-examiner reliability was excellent for relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area for both psoas and quadratus lumborum (ICC = 0.81–0.99). Inter-examiner intraclass correlation coefficients ranged from poor to excellent for relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area.
Conclusions . Assessment of relative cross-sectional area, muscle-to-fat infiltration indices, and relative muscle cross-sectional area in older adults with chronic low back pain can be reliably determined by one examiner from T1-weighted images. Such assessments provide valuable information, as muscle-to-fat infiltration indices and relative muscle cross-sectional area indicate that a substantial amount of relative cross-sectional area may be magnetic resonance-visible intramuscular fat in older adults with chronic low back pain.
Context:
Neuromuscular electrical stimulation (NMES) is a common modality used to retrain muscles and improve muscular strength after injury or surgery, particularly for the quadriceps muscle. There are parameter adjustments that can be made to maximize the effectiveness of NMES. While NMES is often used in clinical practice, there are some limitations that clinicians should be aware of, including patient discomfort, muscle fatigue, and muscle damage.
Evidence acquisition:
PubMed was searched through August 2014 and all articles cross-referenced.
Study design:
Clinical review.
Level of evidence:
Level 3.
Results:
Clinicians can optimize torque production and decrease discomfort by altering parameter selection (pulse duration, pulse frequency, duty cycle, and amplitude). Pulse duration of 400 to 600 µs and a pulse frequency of 30 to 50 Hz appear to be the most effective parameters to optimize torque output while minimizing discomfort, muscle fatigue, or muscle damage. Optimal electrode placement, conditioning programs, and stimulus pattern modulation during long-term NMES use may improve results.
Conclusion:
Torque production can be enhanced while decreasing patient discomfort and minimizing fatigue.
Study Design
Single-blind, block-randomization crossover design.
Objective
To compare the knee extensor muscle torque production elicited with 2500-Hz burst-modulated alternating current (BMAC) and with a monophasic pulsed current (MPC) at the maximum tolerated stimulation intensity.
Background
Neuromuscular electrical stimulation (NMES) is often used for strengthening the quadriceps following knee surgery. Strength gains are dependent on muscle torque production, which is primarily limited by discomfort. Burst-modulated alternating current stimulation is a clinically popular waveform for NMES. Prior research has established that MPC with a relatively long pulse duration is effective for high muscle torque production.
Methods
Participants in this study were 20 adults with no history of knee injury. A crossover design was used to randomize the order in which each participant's dominant or nondominant lower extremity received NMES and the waveform (MPC or BMAC) this limb received. Stimulation intensity was incrementally increased until participants reached their maximum tolerance. The torque produced was converted to a percentage of each participant's maximum volitional isometric contraction of the respective limb.
Results
A general linear model for a 2-treatment, 2-period crossover design was utilized to analyze the results. The mean ± SD electrically induced percent maximum volitional isometric contraction at maximal participant tolerance was 49.5% ± 19.6% for MPC and 29.8% ± 12.4% for BMAC. This difference was statistically significant (P = .002) after ccounting for treatment order and limb, which had no effect on torque production.
Conclusion
Neuromuscular stimulation using MPC may be more efficacious than using BMAC to achieve a high torque output in patients with quadriceps weakness. J Orthop Sports Phys Ther 2015;45(12):1035–1041. Epub 10 Nov 2015. doi:10.2519/jospt.2015.5861
Background:
Chronic low back pain is considered as a high-impact condition that affects the working population of Latin America, with long reaching social and economic repercussions. Its true frequency is unknown due to the absence of well-designed clinical trials that use standardized definitions and criteria.
Objectives:
To evaluate the prevalence of chronic non-specific low back pain among the Latin American population.
Study design:
A systematic review of chronic non-specific low back pain in Latin America.
Setting:
Meeting of Change Pain Latin America, Mexico.
Methods:
Data sources included relevant literature identified through searches of published studies between August 30, 2002, and August 30, 2012, in 7 electronic databases: Cochrane BVS, Pubmed, Medline, Lilacs, Scielo, Hinari, and MedCarib. Publications dealing with low back pain of a post-traumatic, infectious, or malignant origin were excluded. Two reviewers selected in an independent manner all eligible studies using the MOOSE checklist and extracted data on both prevalence and risk factors associated with low back pain. A narrative synthesis of the results was drafted, which was later validated by a panel of clinical experts on pain.
Results:
Twenty-eight studies were included in the review, comprising a total of 20,559 subjects from 7 countries in the region. Four of these studies, with significant methodological differences between them, measured the frequency of chronic low back pain with results that varied from 4.2% to 10.1%. Four studies are part of the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) program reports, and were pooled and analyzed separately because of their particular design. Their prevalence estimations varied between 1.8% and 11.3%. The remaining 20 studies evaluated a total population of 6,992 subjects, and found a prevalence of low back pain of 31.3%. Based on an epidemiological model constructed on both times to resolution and low back pain recurrence rates, the prevalence of chronic low back pain in Latin America was estimated to be around 10.5%. Some risk factors reported by the authors are long working hours with the worker in the sitting position, obesity and overweight, pregnancy, smoking, advanced age, lifting and carrying heavy loads, domestic work, sedentary lifestyles, and duration of current employment. A subgroup analysis of the population under study yielded an estimated prevalence of low back pain of 16.7% for the population exposed to a lower number of risk factors and 65% for the higher risk subgroup. In this review, we made an exhaustive search of studies evaluating the epidemiology of chronic low back pain in the Latin America region.
Limitations:
The large topographic and chronologic variability in definitions of low back pain, interviewer bias, and subject selection bias.
Conclusions:
Despite the sparse information and the methodological heterogeneity of the studies, pooled results allowed for an indirect estimation of the prevalence of low back pain in the region that was pretty consistent with the published results obtained from other settings. New studies need to be carried out to supplement and overcome the methodological weaknesses of those previously conducted.
It is well-known that placebo is a substance without medical effects, which benefits the health status because of the patient's belief that the substance is effective and that the nocebo is defined as a substance without medical effects but which worsenes the health status of the person taking it by the negative beliefs and expectations of the patient. Starting with the history of the placebo effect and giving a review of the most significant studies reporting about the placebo effect from 1939-2013 it was our intention to give the all-around look on this phenomena discussing the neurobiological and other theories of its origin and concentrating especially on the field of psychiatry and finally coming to conclusions regarding the conductance of clinical trials and ethics. Regarding psychiatry, the placebo effect has a substantial role in most of psychiatric conditions including depression, anxiety, addictions, and contrary to what may have been expected, schizophrenia. Likewise, the nocebo effect is not to be neglected as the studies are being conducted to identify the factors causing it so it could be prevented.
Introduction:
We studied the effects of different neuromuscular electrical stimulation (NMES) currents, 2 kHz-frequency alternating currents (KACs, Russian and Aussie) and 2 pulsed currents (PCs), on isometric knee extension torque and discomfort level, both in isolation and combined, with maximum voluntary contraction (MVC).
Methods:
Twenty-one women (age 21.6 ± 2.5 years) were studied. We evaluated torque evoked by NMES or NMES combined with maximum voluntary contraction of the quadriceps muscle of healthy women. Discomfort level was measured using a visual analog pain scale.
Results:
Despite comparable levels of discomfort, evoked torque was lower for Russian current compared with the other modalities (Russian 50.8%, Aussie 71.7%, PC500 76.9%, and PC200 70.1%; P < 0.001). There was no advantage in combining NMES with MVC compared with isolated NMES.
Conclusions:
The Aussie and PC approaches proved superior to Russian current for inducing isometric knee extension torque. This information is important in guiding decision making with regard to NMES protocols for muscle strengthening.
Ultrasound imaging (USI) has been shown to be a reliable measure for direct assessment of the lumbar multifidi among younger adults. However, given age- and chronic low back pain (CLBP)-related spinal changes, similar studies are needed before clinical use of USI among older adults with CLBP. The goals of this study were to evaluate intra- and interexaminer reliability for USI assessment of multifidi thickness at rest and during a contraction and to determine standard error of measurement values (SEMs) and minimal detectable change values (MDCs) among older adults with CLBP.
Thirty-one adults, aged 60 to 85 years, with CLBP were recruited. Two examiners performed USI assessments of multifidus thickness at rest and during a contralateral lower extremity lift. Intraclass correlation coefficients (ICCs) were used to estimate inter- and intraexaminer reliability. Additionally, SEMs and MDCs were calculated.
All USI measurement techniques demonstrated excellent within-day, interexaminer procedural reliability (ICCs: 0.82-0.85) and good-to-excellent between-day, interexaminer procedural reliability (ICCs: 0.72-0.79). The SEMs ranged from 0.36 to 0.46 cm; MDCs ranged from 1.01 to 1.26 cm. Regardless of the measurement technique, examiner 1, the more experienced examiner, demonstrated lower SEMs and MDCs than examiner 2.
Lower ICCs, greater SEMs, and greater MDCs for USI multifidus thickness assessment in older adults with CLBP, when compared with previously published, procedural reliability results for younger adults with and without low back pain, may indicate that imaging is more challenging in this patient population. Factors, such as examiner training and participant anthropometrics, may impact reliability.
Good-to-excellent intra- and interexaminer USI procedural reliability may provide clinicians a direct assessment technique for clinical evaluation of the lumbar multifidi in older adults with CLBP. SEMs and MDCs may allow for accurate interpretation of USI assessments in this population.
Short periods of muscle disuse, due to illness or injury, result in substantial skeletal muscle atrophy. Recently we have shown that a single session of neuromuscular electrical stimulation (NMES) increases muscle protein synthesis rates To investigate the capacity for daily NMES to attenuate muscle atrophy during short-term muscle disuse.
Twenty-four healthy, young (23±1 y) males participated in the present study. Volunteers were subjected to 5 days of one-legged knee immobilisation with (NMES; n=12) or without (CON; n=12) supervised NMES sessions (40 min sessions, twice daily). Two days prior to and immediately after the immobilisation period, CT-scans and single leg one-Repetition Maximum (1RM) strength tests were performed to assess quadriceps muscle cross-sectional area (CSA) and leg muscle strength, respectively. Furthermore, muscle biopsies were taken to assess muscle fibre CSA, satellite cell content and mRNA and protein expression of selected genes.
In CON, immobilisation reduced quadriceps CSA by 3.5±0.5% (P<0.0001) and muscle strength by 9±2% (P<0.05). In contrast, no significant muscle loss was detected following immobilisation in NMES although strength declined by 7±3% (P<0.05). Muscle MAFbx and MuRF1 mRNA expression increased following immobilisation in CON (P<0.001 and P=0.07, respectively) whereas levels either declined (P<0.01) or did not change in NMES, respectively. Immobilisation led to an increase in muscle myostatin mRNA expression in CON (P<0.05) but remained unchanged in NMES.
During short-term disuse, NMES represents an effective interventional strategy to prevent the loss of muscle mass, but it does not allow preservation of muscle strength. NMES during disuse may be of important clinical relevance in both health and disease. This article is protected by copyright. All rights reserved.
To evaluate the efficacy of transcutaneous electrical neurostimulation (TENS) in patients with chronic low back pain (LBP).
Design: Prospective, randomized, multicentre, single-blind study. Setting: Twenty-one French pain centres. Participants: Two hundred thirty-six consecutive adult patients consulting for chronic LBP, with or without radicular pain (mean age ± standard deviation: 53 ± 13 years; range: 28-86 years). Intervention: Patients were randomly assigned to receive either active (n = 117) or sham (n = 119) TENS in four 1-h daily treatment sessions for 3 months. Main outcome measures: The primary outcome measured was improvement of functional status at 6 weeks (Roland-Morris Disability Questionnaire). Secondary outcome measures were improvement of functional status at 3 months, pain relief (weekly visual analogue scale assessments), positive functional repercussions of pain levels on quality of life, a diminution of the use of analgesic and anti-inflammatory medication, satisfaction with the overall treatment strategy and compliance.
Functional status did not differ between the groups, whether at 6 weeks or 3 months (p = 0.351 at 6 weeks). A significant improvement between the first and last visual analogue scale assessments was observed in patients with either lumbar pain alone or lumbar and radicular pain treated with active TENS. Other outcome measures did not differ significantly between the two groups.
There was no functional benefit of TENS in the treatment of patients with chronic LBP.
To perform a systematic review of the global prevalence of low back pain, and to examine the influence that case definition, prevalence period, and other variables have on prevalence.
We conducted a new systematic review of the global prevalence of low back pain that included general population studies published between 1980 and 2009. A total of 165 studies from 54 countries were identified. Of these, 64% had been published since the last comparable review.
Low back pain was shown to be a major problem throughout the world, with the highest prevalence among female individuals and those aged 40-80 years. After adjusting for methodologic variation, the mean ± SEM point prevalence was estimated to be 11.9 ± 2.0%, and the 1-month prevalence was estimated to be 23.2 ± 2.9%.
As the population ages, the global number of individuals with low back pain is likely to increase substantially over the coming decades. Investigators are encouraged to adopt recent recommendations for a standard definition of low back pain and to consult a recently developed tool for assessing the risk of bias of prevalence studies.
Previous data regarding neuromuscular electrical stimulation (NMES) have suggested that muscle torque production with interferential current (IFC) is inferior to Russian current; however, waveform parameters specific and critical to NMES were inconsistent, making interpretation of previous findings precarious. The purpose of this investigation was to compare muscle force production of three electrical stimulating waveforms when using equivalent stimulus parameters.
The percent of maximal voluntary isometric knee extensor force (%MVIF) elicited using interferential, Russian, and burst-modulated biphasic pulsed currents were compared in 23 healthy college-aged subjects. A repeated measures single factor design in a university laboratory setting was used.
A significant effect for waveform used was noted. Data showed significantly greater %MVIF of the knee extensors were obtained using IFC or burst-modulated BP current versus conventional Russian current.
The results of this investigation suggest that IFC and burst-modulated BP current are viable waveform options for purposes of eliciting muscle force. These findings offer significant new evidence with strong clinical implications when selecting waveform parameters for elicitation of muscle force for NMES.
A cross-sectional imaging study of young adults.
To evaluate whether severity of low back symptoms predicts atrophy in the paraspinal muscles of young adults.
Although an increased fat content of the lumbar muscles has been observed among adults with chronic LBP, there is limited knowledge of this association in younger populations.
The population-based study sample consisted of 554 subjects (321 females and 233 males) from the 1986 Northern Finland Birth Cohort. Latent Class Analysis (LCA) was used to cluster the subjects according to the low back symptoms and functional limitations at 18, 19, and 21 years. The mean age of the subjects at the time of the MRI (magnetic resonance imaging) was 21 years (range, 20-23). Muscle atrophy was evaluated by assessing the fat content of the paraspinal muscles using Opposed-Phase MRI. The cross-sectional areas (CSAs) of the erector spinae and multifidus muscles were also measured.
LCA analysis produced five clusters differing in symptoms, ranging from a cluster (n = 65) in which subjects had high likelihood of symptoms and functional limitations at all time points, to a cluster (n = 165) with no pain ever. The fat content of the multifidus muscles was significantly higher among women than men (14.0% vs. 5.3%, P < 0.001), but it was not significantly associated with symptom severity. The CSA of both erector spinae and multifidus muscles were significantly larger among men than women (P < 0.001 in all of the muscles), but were not associated with pain severity.
Low back symptoms and functional limitations over a 3-year period were not associated with increased fat content or a reduction in the cross-sectional area of lumbar paraspinal muscles among young adults.
To determine the effectiveness of progressive quadriceps strengthening with or without neuromuscular electrical stimulation (NMES) on quadriceps strength, activation, and functional recovery after total knee arthroplasty (TKA), and to compare progressive strengthening with conventional rehabilitation.
A randomized controlled trial was conducted between July 2000 and November 2005 in an academic outpatient physical therapy clinic. Two hundred patients who had undergone primary, unilateral TKA for knee osteoarthritis were randomized to 1 of 2 interventions 4 weeks after surgery, and 41 patients eligible for enrollment who did not participate in the intervention were tested 12 months after surgery (standard of care group). All randomized patients received 6 weeks of outpatient physical therapy 2 or 3 times per week through 1 of 2 intervention protocols: an exercise group (volitional strength training) or an exercise-NMES group (volitional strength training and NMES). Treatment effects were evaluated by a burst superimposition test to assess quadriceps strength and volitional activation 3 and 12 months postoperatively. The Medical Outcomes Study Short Form 36 and Knee Outcome Survey were completed. Knee range of motion, Timed Up and Go, Stair-Climbing Test, and 6-Minute Walk were also measured.
Strength, activation, and function were similar between the exercise and exercise-NMES groups at 3 and 12 months. The standard of care group was weaker and exhibited worse function at 12 months compared with both treatment groups.
Progressive quadriceps strengthening with or without NMES enhances clinical improvement after TKA, achieving similar short- and long-term functional recovery and approaching the functional level of healthy older adults. Conventional rehabilitation does not yield similar outcomes.
Transcutaneous electrical stimulation using kilohertz-frequency alternating current (AC) became popular in the 1950s with the introduction of "interferential currents," promoted as a means of producing depth-efficient stimulation of nerve and muscle. Later, "Russian current" was adopted as a means of muscle strengthening. This article reviews some clinically relevant, laboratory-based studies that offer an insight into the mechanism of action of kilohertz-frequency AC. It provides some answers to the question: "What are the optimal stimulus parameters for eliciting forceful, yet comfortable, electrically induced muscle contractions?" It is concluded that the stimulation parameters commonly used clinically (Russian and interferential currents) are suboptimal for achieving their stated goals and that greater benefit would be obtained using short-duration (2-4 millisecond), rectangular bursts of kilohertz-frequency AC with a frequency chosen to maximize the desired outcome.
In order to evaluate the role of endogenous opioids in sustaining analgesia induced by transcutaneous nerve stimulation (TNS), we measured plasma beta-lipotropin (BLPH), beta-endorphin (BEP), ACTH and cortisol changes concomitantly with nociceptive flexion reflex (RIII) threshold after TNS (80 microseconds rectangular waves at 85 Hz) in a group of healthy volunteers (A). The same protocol was carried out in another group of volunteers using placebo stimulation (0.5 Hz) (B). RIII threshold significantly increased 0.5 h after TNS in group A and no changes were recorded in group B. Similarly, both BLPH and BEP plasma levels increased at the end of TNS only in group A. ACTH and cortisol concentrations show only random variations after both high and low frequency TNS. A positive linear correlation was found between the maximum percentage increase of RIII threshold after high frequency TNS and the maximum percentage increase of BLPH plasma levels occurring 20 min beforehand (r = 0.856, P less than 0.001). A less positive correlation was found between RIII and BEP levels (r = 0.574, P less than 0.05). These data indicate that the so-called post-stimulation analgesia could be supported by the enhancement of the endogenous opioid system.
The Oswestry Disability Index (ODI) has become one of the principal condition-specific outcome measures used in the management of spinal disorders. This review is based on publications using the ODI identified from the authors' personal databases, the Science Citation Index, and hand searches of Spine and current textbooks of spinal disorders.
To review the versions of this instrument, document methods by which it has been validated, collate data from scores found in normal and back pain populations, provide curves for power calculations in studies using the ODI, and maintain the ODI as a gold standard outcome measure.
It has now been 20 years since its original publication. More than 200 citations exist in the Science Citation Index. The authors have a large correspondence file relating to the ODI, that is cited in most of the large textbooks related to spinal disorders.
All the published versions of the questionnaire were identified. A systematic review of this literature was made. The various reports of validation were collated and related to a version.
Four versions of the ODI are available in English and nine in other languages. Some published versions contain misprints, and many omit the scoring system. At least 114 studies contain usable data. These data provide both validation and standards for other users and indicate the power of the instrument for detecting change in sample populations.
The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure. The process of using the ODI is reviewed and should be the subject of further research. The receiver operating characteristics should be explored in a population with higher self-report disabilities. The behavior of the instrument is incompletely understood, particularly in sensitivity to real change.
To assess the activities of paraspinal and abdominal muscles during therapeutic exercises for the treatment of patients with nonspecific chronic low back pain (CLBP), and to study the effects of active physical rehabilitation on these activities.
A cross-sectional study comparing muscle activities during 18 stabilization exercises, and a prospective follow-up of patients with CLBP during rehabilitation.
Rehabilitation clinic in university hospital in Finland.
Nine volunteers (5 men, 4 women) aged 27 to 58 years.
Three months of active outpatient rehabilitation (4 to 6 times in a rehabilitation clinic, supplemented with self-motivated exercise at home) supervised by a physiotherapist.
Surface electromyography was recorded bilaterally from L5 level paraspinal, rectus abdominis, and obliquus externus abdominis muscles. The recorded signal was averaged and normalized to the maximal electromyographic amplitude obtained during the maximal voluntary contraction. The measurements were taken before and after the exercise treatment period.
CLBP patients showed variable trunk muscle activity patterns during the different therapeutic exercises, similar to those that we reported earlier in healthy subjects. The maximal trunk isometric extension (pre, 147.3+/-75.9Nm; post, 170.1+/-72.3Nm) and flexion (pre, 72.0+/-37.9Nm; post, 93.5+/-42.5Nm) torques did not show a significant changes during the exercise period. However, trunk rotation-flexion torque (pre, 52.9+/-26.5Nm; post, 82.4+/-65.8Nm) increased significantly (35.8%) after the exercise period (P<.05). The corresponding maximal electromyographic amplitudes of back and abdominal muscles remained unchanged. Disability, as assessed by visual analog scale and Oswestry Disability Index, did not change.
The CLBP patients performed therapeutic exercises with similar abdominal and back extensor muscle activities in the same way as the healthy subjects in our earlier studies. In this study, active physical rehabilitation had no effect on the abdominal and back muscle activities or on pain and functional disability indices.
On the language of pain. By Ronald Melzack, Warren S. Torgerson. Anesthesiology 1971; 34:50-9. Reprinted with permission. The purpose of this study was to develop new approaches to the problem of describing and measuring pain in human subjects. Words used to describe pain were brought together and categorized, and an attempt was made to scale them on a common intensity dimension. The data show that: 1) there are many words in the English language to describe the varieties of pain experience; 2) there is a high level of agreement that the words fall into classes and subclasses that represent particular dimensions or properties of pain experience; 3) substantial portions of the words have approximately the same relative positions on a common intensity scale for people who have widely divergent backgrounds. The word lists provide a basis for a questionnaire to study the effects of anesthetic and analgesic agents on the experience of pain.
The management of chronic low back pain (CLBP) has proven to be very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.
Eletroestimulação e core training sobre dor e arco de movimento na lombalgia
- Bordiak
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A estimulação russa no fortalecimento da musculatura abdominal/Russian stimulation in strengthening abdominal muscle
- Lima
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Eletroestimulação neuromuscular, exercícios contrarresistência, força muscular, dor e função motora em pacientes com osteoartrite primária de joelho
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Lombalgia ocupacional
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