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Assessing the efficacy of a specific physiotherapy intervention for the prevention of low back pain in female adolescent rowers: a field study

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Abstract

Objectives: To determine the efficacy of a specific physiotherapy intervention administered to adolescent female rowers with the aim to decrease the prevalence of low back pain (LBP) and associated levels of pain and disability. A secondary aim of the study was to determine whether changes in lower limb endurance and flexibility were evident in an experimental group. Design: A non randomized controlled trial in adolescent female rowers with and without LBP. Setting: Curtin University of Technology, Western Australia and the participating private school boatshed, Perth, Western Australia. Participants: Participants were 82 adolescent female rowers, with and without LBP. These participants attended the same school and were aged between 13-17 years [experimental group 13.9(0.9) years, control group 13.8(1.0) years] Main Outcome Measures: Primary outcome measures in this study included; LBP point prevalence, pain intensity (utilizing a visual analogue scale) and disability level (utilizing a modified Oswestry questionnaire). These measures were taken at four time points over the rowing season. Secondary outcome measures of lower limb flexibility (sit and reach test) and lower limb endurance (timed squat test) were taken in the experimental group only. Results: The experimental group demonstrated a significant reduction in the prevalence of LBP across the rowing season 48% to 19% pre-season to midseason and from 48% to 24% pre-season to end-season. The prevalence of LBP in the control group slightly increased from 22% to 25% pre-season to mid-IV season and was unchanged at 22% pre-season to end-season. A significant increase in the proportion of subjects pain-free was shown in the experimental group at mid-season compared with pre-season (p=0.007), but no change thereafter (p>0.05). In the control group the proportion pain-free remained relatively stable across the four time points (p>O.2 for changes between consecutive times). The experimental group rowers demonstrated reduced pain intensity over the course of the rowing season compared with the control group [mean pre-end season exp 6.4(21.0), control -2.7(17.6) Z= -2.283, P = 0.022]. Levels of disability did not differ between the groups across the rowing season. Significant improvements in lower limb endurance and flexibility were observed in the experimental group (p=<0.05). Conclusions: A specific physiotherapy exercise intervention was effective in reducing the prevalence of LBP in a population of adolescent female rowers and reducing pain intensity levels in subjects who complained of LBP at the commencement of the rowing season. A randomized trial to test the intervention under more rigorous scientific conditions is recommended.

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... Eight articles met the selection criteria2930314748495051, which made a total of 16 independent analysis units, or groups, of which 11 were treatment groups and 5 control groups. (Additional file 2).Table 1 shows the individual characteristics of each of the integrated studies. ...
... In two articles (three treatment groups) subjects were randomly assigned to groups [30,31] and in one article the groups were randomly assigned but the subjects were not [29]. Only one study [48] used an active control group, in comparison with an inactive control group. The sample size in the treatment group at the posttest was more than fifteen subjects in seven articles [ ...
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Article
The purpose of this study was to investigate changes in lumbar flexion together with the pattern and level of muscle activity of selected erector spinae during a rowing trial.Design. Cross-sectional repeated measures design. Low back pain is a common problem in rowers. The amount of lumbar flexion occurring during rowing might influence the possibility of injury. Sixteen young adult school rowers participated in the study. Changes in lumbar flexion and muscle activity were recorded across the drive phase, at three stages of an ergometer based rowing trial. Lumbar flexion was calculated by computerised motion analysis of surface markers attached to the spinous processes of L1 and S1. Surface electromyography techniques were used to examine the magnitude of activity from three erector spinae muscles. The median frequency of the electromyographic signal was examined to quantify fatigue in the erector spinae muscles during isometric maximal effort muscle activation prior to and after the rowing trial. Lumbar flexion increased significantly (P<0.05) during the rowing trial, as did the magnitude of electromyographic activity from sites over the lumbar multifidus, iliocostalis lumborum and longissimus thoracis muscles. The median frequency decreased significantly (P<0.05) in each muscle examined. The findings showed that rowers attain relatively high levels of lumbar flexion during the rowing stroke, and these levels are increased during the course of the rowing trial. Indirect evidence of muscle fatigue in erector spinae muscles was also apparent, and this observation may in part be responsible for the increased levels of lumbar flexion observed. Excessive lumbar flexion may influence the potential for injury to spinal structures. An awareness of increased lumbar flexion and muscle fatigue in the erector spinae muscles may be important for injury prevention programs for rowers.
Article
Relationships between adolescent physical fitness and adult health-related fitness were investigated. Forty-five subjects (20 males, 25 females) participated in physical fitness tests in 1976 and again in 2001. The adolescent physical fitness tests were distance running (2,000 m for boys or 1,500 m for girls), 50 m run, pull-ups (boys) or flexed arm hangs (girls), shuttle run, a 30-sec sit-up test, standing broad jump, hand grip-test, and sit-and-reach test. The adult health-related physical fitness index (APFI), stratified by sex, was formed by summing the z-scores of a bicycle ergometer test, sit-up test, hand-grip test, and sit-and-reach test. Height- and weight-adjusted correlations between adolescence and adulthood for exactly similar tests for men and women were, respectively, 0.74 (95% CI, 0.44-0.89) and 0.53 (95% CI, 0.17-0.76) in sit-and-reach tests, 0.41 (95% CI, -0.04 to 0.72) and 0.55 (95% CI, 0.20-0.78) in sit-up tests, and 0.53 (95% CI, 0.11-0.44) and 0.44 (95% CI, 0.05-0.71) in hand-grip tests. When all adolescent tests were put in regression analysis together with BMI in 2001, the significant explanatory factors for APFI were distance running ability and the sit-and-reach test for men and sit-up test, flexed arm hang, and BMI in 2001 for women.
Article
A normative within-subjects single-group study. To compare spinal-pelvic curvature and trunk muscle activation in 2 upright sitting postures ("thoracic" and "lumbo-pelvic") and slump sitting in a pain-free population. Clinical observations suggest that both upright and slump sitting postures can exacerbate low back pain. Little research has investigated the effects of different upright sitting postures on trunk muscle activation. Spinal-pelvic curvature and surface electromyography of 6 trunk muscles were measured bilaterally in 2 upright (thoracic and lumbo-pelvic) sitting postures and slump sitting in 22 subjects. Thoracic, compared to lumbo-pelvic, upright sitting showed significantly greater thoracic extension (P < 0.001), with significantly less lumbar extension (P < 0.001) and anterior pelvic tilt (P = 0.03). Furthermore, there was significantly less superficial lumbar multifidus (P < 0.001) and internal oblique (P = 0.03) activity, with significantly higher thoracic erector spinae (P < 0.001) and external oblique (P = 0.04) activity in thoracic upright sitting. There was no significant difference in superficial lumbar multifidus activity between thoracic upright and slump sitting. Different upright sitting postures resulted in altered trunk muscle activation. Thoracic when compared to lumbo-pelvic upright sitting involved less coactivation of the local spinal muscles, with greater coactivation of the global muscles. These results highlight the importance of postural training specificity when the aim is to activate the lumbo-pelvic stabilizing muscles in subjects with back pain.
Article
Prospective controlled intervention study. To evaluate a specific segmental muscle training program of the lumbar spine in order to prevent and reduce low back pain in young female teamgym gymnasts. Teamgym is a team sport comprising three events: trampette, tumbling and floor programme. In a recent study, it was found that teamgym gymnasts practice and compete despite suffering from back pain. Specific muscle control exercises of the lumbar spine have shown good results in reducing pain intensity and functional disability levels in patients with low back pain. To our knowledge, this type of training has not been studied in an adolescent athletic population before. Fifty-one gymnasts, with and without LBP, 11-16 years old, from three top-level gymnastics team participated in the study comprising 12 weeks. Every day the gymnasts answered a questionnaire regarding low back pain. After baseline (4 weeks) the intervention group performed a specific segmental muscle training program. Twenty-four gymnasts (47%) reported low back pain during baseline. Nine gymnasts failed to answer the questionnaire every day and the following results are based on 42 gymnasts (intervention group, n = 30, and control group, n=12). Gymnasts in the intervention group reported significantly less number of days with low back pain at completion compared to baseline (P=0.02). Gymnasts in the control group showed no difference in terms of days with low back pain or intensity of low back pain between baseline and completion. Eight gymnasts (out of 15) with LBP in the intervention group became pain free. Specific segmental muscle control exercises of the lumbar spine may be of value in preventing and reducing low back pain in young teamgym gymnasts.
Sullivan PB Gender differences in motor control of the trunk during prolonged ergometer rowing
  • L Ng
  • A Burnett
  • O 'kwon
  • J-K Shim
  • I Shim
  • Shin
20 Ng L, Burnett A, O'Sullivan PB Gender differences in motor control of the trunk during prolonged ergometer rowing. Edited by Y Kwon, J Shim, J-K Shim, I Shin.). XXVIth International Society of Biomechanics Conference; Seoul National University; 2008a; 270-273.
Development and validation of a core endurance intervention program
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  • Am Mcmanus
  • Rsw Masters
Tse SE, McManus AM, Masters RSW. Development and validation of a core endurance intervention program. J Strength and Cond Res 2005;19 (3):547552.
Fitness, health and work capacity. International Standards for Assessment
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Larson LA. Fitness, health and work capacity. International Standards for Assessment. New York: MacMillan, 1974; 525-532.
Evaluation of specific stabilizing exercises in the treatment of chronic LBP with the radiological diagnosis of spondylosis and spondylolisthesis
  • Pb Sullivan
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  • L Twomey
'Sullivan PB, Allison G, Twomey L. Evaluation of specific stabilizing exercises in the treatment of chronic LBP with the radiological diagnosis of spondylosis and spondylolisthesis. Spine 1997;22:2259-65.