Intra-examiner and inter-examiner reliability of rehabilitative ultrasound imaging for lumbar multifidus and anterolateral abdominal muscles in females with recurrent low back pain: an observational, cross-sectional study

Aim: To examine the reliability of rehabilitative ultrasound imaging performed to measure the thickness of the transverse abdominis, internal oblique, external oblique, and lumbar multifidus muscles in females with recurrent low back pain. Material and methods: A sample of 15 women was recruited. Two independent examiners recorded the thickness of their deep abdominal and spinal muscles by rehabilitative ultrasound imaging. Imaging scans of the transverse abdominis, internal oblique, and external oblique muscles were performed in the supine position and in the midaxillary line, between the lower edge of the ribcage and the iliac crest. Imaging of the lumbar multifidus was done in the prone position and at the level of the L5/S1 zygapophyseal joints. Imaging scans were performed bilaterally in rest and contraction, three times by the first examiner (at baseline, after two hours, and one week later) and once by the second examiner. Results: Good to excellent within-session intra-rater (ICC = 0.76, 0.97), good to excellent between-session intra-rater reliability (ICC = 0.73, 0.93), and good to excellent inter-rater reliability (ICC = 0.73, 0.98) were obtained. Conclusions: The results showed that rehabilitative ultrasound imaging can be used as an excellent reliable instrument by one or two examiners to measure the thickness of the transverse abdominis, internal oblique, external oblique and lumbar multifidus muscles in females with recurrent low back pain.

Trunk muscle activation patterns during active hip abduction test during remission from recurrent low back pain: an observational study

Background The active hip abduction test (AHAbd) is widely used to evaluate lumbopelvic stability, but the onset of trunk muscle activation during the test in individuals with recurrent low back pain (rLBP) has not been investigated so far. It is important to investigate the pattern of trunk muscle activation during the AHAbd test to provide insight into the interpretation of observation-based assessment results; this may help to create exercise therapy interventions, from a movement control perspective, for people seeking treatment for rLBP. The purpose of this study was to compare the timing of trunk muscle activation between individuals with and without rLBP and to assess potential differences. Methods Seventeen subjects in remission from rLBP and 17 subjects without rLBP were recruited. We performed surface electromyography of the transversus abdominis/internal abdominal oblique, external oblique, erector spinae, and gluteus medius muscles during the AHAbd test on both sides. The onset of trunk muscle activation was calculated relative to the prime mover gluteus medius. The independent-samples t- and Mann-Whitney U tests were used to compare the onset of trunk muscle activation between the two groups. Results The onset of transversus abdominis/internal abdominal oblique activation on the ipsilateral (right AHAbd: −3.0 ± 16.2 vs. 36.3 ± 20.0 msec, left AHAbd: −7.2 ± 18.6 vs. 29.6 ± 44.3 ms) and contralateral sides (right AHAbd: −11.5 ± 13.9 vs. 24.4 ± 32.3 ms, left AHAbd: −10.1 ± 12.5 vs. 23.3 ± 17.2 ms) and erector spinae on the contralateral side (right AHAbd: 76.1 ± 84.9 vs. 183.9 ± 114.6 ms, left AHAbd: 60.7 ± 70.5 vs. 133.9 ± 98.6 ms) occurred significantly later in individuals with rLBP than in individuals without rLBP (p < 0.01). During the left AHAbd test, the ipsilateral erector spinae was also activated significantly later in individuals with rLBP than in individuals without rLBP (71.1 ± 80.1 vs. 163.8 ± 120.1 ms, p < 0.05). No significant difference was observed in the onset of the external oblique activation on the right and left AHAbd tests (p > 0.05). Conclusions Our results suggest that individuals with rLBP possess a trunk muscle activation pattern that is different from that of individuals without rLBP. These findings provide an insight into the underlying muscle activation patterns during the AHAbd test for people with rLBP and may support aggressive early intervention for neuromuscular control.

Sagittal Integral Morphotype of Competitive Amateur Athletes and Its Potential Relation with Recurrent Low Back Pain

Athletes have higher thoracic and lumbar curvature in standing than the reference values of the non-athletic population. The sagittal integral morphotype method (SIM) assessment has not previously been applied to competitive amateur athletes (CAA). The propose of the present study was to determine the SIM of CAA treated at a sports-medicine center and to identify spinal misalignments associated with recurrent low back pain (LBP). An observational analysis was developed to describe the SIM in 94 CAA. The thoracic and lumbar curvatures of the CAA were measured in standing, sitting, and trunk forward flexion. Association analysis (Pearson’s chi-square and Cramér’s V tests) was then performed to identify the SIM misalignments associated with LBP. Effect size was analyzed based on Hedges’ g. The most common thoracic SIMs in CAA were total hyperkyphosis (male = 59.02%; female = 42.42%) and static hyperkyphosis (male = 11.48%; female = 6.06%). Hyperlordotic attitude (female = 30.30%; male = 4.92%), static-functional hyperkyphosis (male = 16.39%; female = 3.03%), and structured hyperlordosis (female = 21.21%; male = 1.64%) were the most common lumbar SIMs. Hyperlordotic attitude, static functional lumbar hyperkyphosis, and structured hyperlordosis were associated with LBP in male and female athletes.

Are neuromuscular adaptations present in people with recurrent spinal pain during a period of remission? a systematic review

A plethora of evidence supports the existence of neuromuscular changes in people with chronic spinal pain (neck and low back pain), yet it is unclear whether neuromuscular adaptations persist for people with recurrent spinal pain when in a period of remission. This systematic review aimed to synthesise the evidence on neuromuscular adaptations in people with recurrent spinal pain during a period of remission. Electronic databases, grey literature, and key journals were searched from inception up to the 4th of September 2020. Eligibility criteria included observational studies investigating muscle activity, spine kinematics, muscle properties, sensorimotor control, and neuromuscular performance in adults (≥ 18 years) with recurrent spinal pain during a period of remission. Screening, data extraction, and quality assessment (Newcastle-Ottawa Scale) were conducted independently by two reviewers. Data synthesis was conducted per outcome domain. A meta-analysis with a random-effects model was performed where possible. The overall strength of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines (GRADE). From 8292 records, 27 and five studies were included in a qualitative and quantitative synthesis, respectively. Very low level of evidence supports muscle activity changes in people with recurrent low back pain, especially greater co-contraction, redistribution of muscle activity, and delayed postural control of deeper trunk muscles. Reduced range of motion of the lumbar spine was also found. Meaningful conclusions regarding other outcome domains or people with recurrent neck pain could not be drawn. In conclusion, people with recurrent low back pain during a period of remission show muscle activity and spine kinematics adaptations. Future research should investigate the long-term impact of these changes, as well as adaptations in people with recurrent neck pain.

Therapeutic guidelines in chronic low back pain

Chronic low back pain is a heterogeneous group of disorders with recurrent low back pain over 3 months. The high incidence of lumbago is an important phenomenon in our industrial society. Patients with chronic low back pain often receive multidisciplinary treatment. The bio approach, the psycho-approach, and the social approach optimally reduce the risk of chronicity by providing rehabilitation for patients with persistent pain after the initial acute phase. Damage to the structures of the spinal cord and the occurrence of low back pain as a result of evolutionary, social and medical causes disrupt the rhythm of life and cause less or greater disability. Recovery of patients with low back pain is not limited only to influencing the pain syndrome but requires the implementation of programs to eliminate the complaints that this pathology generates in personal, family and socio-professional terms. This paper aims to familiarize the audience with the medication used, and the programs for active recovery in patients suffering from chronic low back pain.