Effect of progressive postural control exercise and yoga on pain, disability and core muscle endurance in patients with chronic low back pain

BackgroundThe functional limitations associated with chronic low back pain (CLBP) are substantial and are highly correlated with core muscle endurance and psychosocial factors. Core muscle endurance is known to affect physical performance, whereas pain catastrophizing and fear avoidance beliefs can contribute to disability. A comprehensive understanding of the interrelated impact of these factors is critical for developing effective rehabilitative strategies. The study aimed to (1) examine the correlation between core muscle endurance and functional mobility in CLBP subjects and (2) explore the influence of psychosocial factors, pain catastrophizing, and fear-avoidance beliefs on that correlation.MethodsA cross-sectional study was conducted on 136 adults; core muscle endurance was measured by plank, side-bridge, and back extensor tests. The timed up and go (TUG) and five times sit-to-stand test (5TSTS) were utilized to evaluate functional mobility. Pain intensity was assessed using the visual analog scale (VAS), and disability using the Oswestry disability index (ODI). Psychosocial factors were measured using the pain catastrophizing scale (PCS) and the fear-avoidance beliefs questionnaire (FABQ).ResultsCore muscle endurance measures were moderately correlated with functional mobility outcomes (TUG: r = −0.42 to −0.50, p < 0.05; 5TSTS: r = − 0.35 to −0.43, p < 0.05). Hierarchical regression showed muscle endurance accounted for 32% of the variance in mobility, while adding psychosocial factors increased the adjusted R2 to 0.52 (p < 0.05). High-psychosocial-risk subgroups analyzed within the study had poorer mobility (TUG: 9.45 ± 1.32 vs. 7.89 ± 1.21 s; p = 0.001).ConclusionPsychosocial factors and endurance of the core muscles in CLBP can significantly predict functional mobility. Integrating physical and psychological rehabilitation strategies might improve mobility outcomes, bolster human dignity, and enhance quality of life.

Background: Postural and respiratory control cooperation is crucial in handball, which requires high levels of postural control, strength, aerobic and respiratory endurance. In the literature, no study has been found that examines the relationship between respiratory and core endurance in handball players. This study aims to investigate the correlation between core muscle endurance and respira-tory muscle function in elite handball players. Materials and Methods: Twenty-four female handball players were (22.17±3.42 years) included in the study. Core endurance, pulmonary functions including Forced Vital Capacity (FVC), Forced Expiratory Volume in First Second (FEV1), FEV1/FVC, Peak Expiratory Flow (PEF), respiratory muscle endurance and strength (Maximal Inspiratory Pressure; MIP, Maximal Expiratory Pressure; MEP) were evaluated in players. Results: There were positive significant correlations between dominant wall sit hold test duration (s) and respiratory muscle performance, including respiratory muscle endurance (cmH2Oxs) (r=0.536) and duration (Tmax) (r=0.441), MIP (r=0.446; r=0.439), MEP (r=0.482;r=0.546) (cmH2O/%). The positive significant correlations were observed between non-dominant wall sit hold duration and MIP (r=0.534; r=0.548) (cmH2O/%), MEP (r=0.442) (%) (p≤0.05). The respiratory muscle endurance and expiratory muscle strength values (53.4%, p=0.001; r=0.764) have a significant influence on core muscle endurance. Conclusions: Trainings that include core-respiratory muscle cooperation should be developed for better postural control, strength and endurance in handball players. The contribution of a compre-hensive training program to improve postural stability and respiratory function on athletic perfor-mance should be investigated.

Purpose: Non-specific chronic low back pain (LBP) is the most common type of chronic LBP and a common debilitating condition, especially in athletes, that can also affect performance. The core muscles are necessary to create a stable level of support for sports performance and appropriate movements of all organs, and its deficiency is related to complications, such as LBP. This research aims to investigate the effect of a fatigue protocol on core muscle endurance in athletes with and without non-specific chronic LBP. Methods: A controlled laboratory study was conducted; 42 female athletes with and without non-specific chronic LBP were selected through convenience sampling method and divided into two groups with non-specific chronic LBP and without non-specific chronic LBP. McGill’s core endurance test was used to measure core muscle endurance. The measurements were done before and after the implementation of the functional core fatigue protocol (FCFP). SPSS software, version 22 and dependent t-tests and analysis of covariance (ANCOVA) were used to evaluate mean differences obtained in the two groups. The significance level was considered 95%, and the α level was ≤0.05. Results: The analysis of covariance (ANCOVA) showed a significant difference between the two groups with and without non-specific chronic LBP after performing the functional core fatigue protocol (FCFP) in McGill’s test scores in isometric flexion exercise (P=0.001), isometric extensor exercise (P=0.001), right side bridge (P=0.001) and left side bridge (P=0.001). In the post-test measurement, the endurance of the core muscles decreased in the LBP group. Conclusion: The findings revealed that fatigue can affect the core stability and reduce the core muscles endurance of female athletes with non-specific chronic LBP. Therefore, core muscle weakness can be recognized as a risk factor for chronic LBP, and in order to prevent this damage, it is recommended to strengthen this area in rehabilitation programs.

Pilates is a popular type of exercise, aimed at improving core muscle strength and endurance, core stability, and joint flexibility through a variety of whole-body exercises. Research has shown that Pilates improves body composition, muscle endurance, and joint flexibility. Adequate protein intake is a key factor in supporting the adaptive response of skeletal muscle to exercise training. However, whether protein supplementation augments the adaptations to Pilates training remains unknown. Thus, the aim of the present study was to investigate the effects of protein supplementation during Pilates training on body composition, core muscle endurance, and joint flexibility in trained women. Nineteen Pilates-trained women (31 ± 9 y) performed 10 weeks of Pilates training using the Reformer and Cadillac apparatuses, at least 2 times per week. Participants were randomly allocated to either a placebo (n = 10) or protein supplementation group (n = 9) in a quadruple-blind (participants, intervention providers, investigators, and outcome assessors) design. Participants received 0.6 g of maltodextrin or whey protein per kg body weight daily, respectively. Habitual dietary intake was monitored throughout the study. Before and after the intervention, anthropometric measures (body weight, body mass index, waist and hip circumferences), body composition [through full-scan dual-energy X-ray absorptiometry (DXA) and multifrequency bioelectrical impedance analysis (BIA)], core muscle endurance (through the McGill's torso muscular endurance test battery), and joint flexibility (through the sit-and-reach test) were assessed. Data were analyzed by 2-way ANOVA (supplement × time) with repeated measures on time. Common DXA and BIA variables (whole-body fat and lean mass) were compared through paired Student's t tests and subjected to Pearson's correlation analysis. The level of statistical significance was set at α = 0.05. Participants received, on average, 1.3 g protein/kg body weight/day from their habitual diet. After 10 weeks of Pilates training and regardless of supplementation, body fat (assessed by BIA) and hip circumference decreased; lean mass, total water, and extracellular water (by BIA) increased; and arm lean mass, trunk bone mineral content, and trunk bone area (by DXA) increased (all p < 0.05). The common BIA and DXA variables were highly correlated (r > 0.78, p < 0.001) and did not differ pre-intervention (p > 0.1), although they differed post-intervention (p < 0.001), with BIA overestimating lean mass compared with DXA. Core muscle endurance and joint flexibility increased with training (p < 0.05), with no effect of supplementation. Ten weeks of Pilates training improved core muscle endurance, joint flexibility, and aspects of body composition in healthy trained women, but these adaptations were not enhanced by daily supplementation with 0.6 g of protein per kilogram body weight.

To assess the maintenance of the effect of duloxetine in the treatment of chronic low back pain. Patients (N = 181) with chronic low back pain entered a 41-week extension phase after completing a 13-week placebo-controlled treatment phase. The maintenance of the effect was assessed in patients taking duloxetine 60/120 mg/day who met the response criteria (> or = 30% reduction in Brief Pain Inventory average pain) at the end of the placebo-controlled phase. In addition, physical function was evaluated using the Roland-Morris Disability Questionnaire, the Clinical Global Impressions-Severity of Illness, and the Brief Pain Inventory Pain Severity and Interference ratings. Quality of life, safety, and tolerability outcomes were also assessed. Finally, placebo-treated patients were switched to duloxetine 60 mg/day at the beginning of the extension phase and their response to treatment is also reported. Initial responders to duloxetine treatment demonstrated further significant improvement (within-group) in pain, physical function, and quality of life. Significant within-group improvements were also observed in the extension phase for placebo-treated patients who were switched to duloxetine. Duloxetine was well tolerated with no new safety findings reported. In this study, the analgesic effect of duloxetine in patients with chronic low back pain was not only maintained for 41 weeks, but additional statistically significant improvement in pain and function was observed.

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Background: Sprint acceleration is a critical component of success in both individual and team sports, particularly those requiring rapid, explosive movements over short distances. Acceleration refers to the ability to increase velocity in the shortest possible time, a performance attribute heavily influenced by neuromuscular coordination, muscle power, and biomechanical efficiency. Core endurance is the capacity of the trunk muscles to maintain postural control and stability which plays a pivotal role in optimizing sprint mechanics and enhancing athletic output.Aim: To investigate the correlation between core muscle endurance and sprint acceleration performance among recreational college athletesMethodology: A cross-sectional correlational study was conducted involving 60 recreational college athletes (20males, 40 females), aged between 18–25 years, all within a normal body mass index (BMI) range. Participantswere screened based on predefined inclusion and exclusion criteria. Core muscle endurance was assessed using theprone plank test, while sprint acceleration was measured using a 35-meter sprint test. Data were statistically analyzed using Spearman’s correlation coefficient due to non-normal distributionResults: Analysis revealed a weak negative correlation between core endurance and sprint acceleration time (r = -0.339, p = 0.01). This indicates that athletes with higher core endurance tended to perform better in the 35-meter sprint test, albeit modestly.Conclusion: The findings suggest that core endurance, as evaluated by the prone plank test, is modestly associated with sprint acceleration in recreational athletes. Incorporating core endurance training into conditioning programs may contribute to improved sprint performance and overall athletic efficiency.

This study aimed to investigate the added effect of jaw clenching on the efficacy of lumbar stabilization exercises to manage chronic non-specific low back pain. This randomized controlled trial was conducted at the Sindh Institute of Physical Medicine and Rehabilitation (SIPM&R) Karachi from April 2021 to April 2023. Eighty patients with chronic non-specific low back pain participated in this study. Forty patients each were randomly allocated to the lumbar stability exercise (LSE) group' and the lumbar stability exercise with teeth clenching (LSETC) group. Patients in both groups performed respective exercises twice weekly for 12 weeks. The Numeric Pain Rating Scale (NPRS), Roland Morris Disability Questionnaire (RMDQ), and Pressure Biofeedback Unit (PBU) were used to assess pain, disability, and muscle endurance respectively. Data were collected at the baseline, after six weeks and 12 weeks of intervention. A p-value of <0.05 was considered statistically significant. Both groups showed statistically significant improvements in pain, disability, and muscle endurance. Upon further stratification, participants aged 20-30 years in the LSETC group showed significantly higher scores than the LSE group for NPRS, RMDQ, and PBU after 12 weeks. Overall, the LSETC group showed relatively higher improvement in mean scores for NPRS, RMDQ, and PBU than the LSE group. Lumbar stabilization exercises with and without jaw movement are effective for the treatment of chronic non-specific low back pain. The addition of teeth clenching enhanced the effectiveness of lumbar stability exercises, especially in young adults. Trial Registration: Clinicaltrials.gov (NCT04801212), Prospectively registered on March 16, 2021.

COVID-19 might have a negative impact on sports performance. There are few studies in the literature that assess how the sports performance of adolescent athletes is affected by COVID-19. This study aimed to compare the sports performance of adolescent overhead athletes who had COVID-19 infection with those who had not. The study involved adolescent elite overhead athletes from basketball, volleyball, handball, and tennis. Athletes' performance were assessed using core muscle endurance, hand grip strength, upper extremity functional performance, reaction time and agility performance, and the 3-min step test. Study included 47 adolescent overhead athletes (mean age 15.15 ± 1.51 years). The COVID-19 group showed significantly higher Borg Scale scores and decrease in oxygen saturation levels only after the step test (p = 0.02, p = 0.02, respectively). Additionally, COVID-19 group had lower grip strength in both right and left hands compared to the non-COVID group (p = 0.01, p = 0.05, respectively). No significant association was found between core muscle power and endurance, upper extremity functional performance, reaction time and agility performance (p > 0.05). Our results showed reduced hand grip strength and increased fatigue following COVID-19 infection in adolescent overhead athletes. Time period after COVID-19 infection had a negative correlation with sports performance and core endurance.

P128. Spinal cord stimulation decreases pain and disability in patients with non-radicular, nonoperative chronic axial low back pain

A cohort study with 1-year follow-up. To identify prognostic factors in patients with chronic nonspecific low back pain (LBP). The factors (e.g., sociodemographical, low back-related, radiological, and biological) associated with persistent pain and disability for patients with chronic nonspecific LBP are uncertain. Furthermore, sparse information exists about the relationship between biological factors like impaired fasting glucose tolerance and chronic nonspecific LBP. The participants consisted of 250 patients with nonspecific LBP of more than 6 months duration and degenerative lumbar osteoarthritis. The patients were originally recruited for a randomized controlled trial from the clinics of general practitioners, physiotherapists, and chiropractors. Potential predictors were evaluated at baseline. The outcome was absolute level of pain-related disability (Roland-Morris Disability Questionnaire [RMDQ]) at 1 year. The association between potential prognostic factors and the outcome was analyzed with multivariate linear backward regression. At baseline and 1 year, the RMDQ scores were 9.5 and 5.1 points, respectively. Mean (SD) baseline values for body mass index (BMI), EuroQol (EQ)-index, EQ-visual analogue scale were 25.4 (4.3), 0.60 (0.3), and 61.2 (20.8), respectively. Higher pain-related disability levels (1-year RMDQ score) were associated with 6.1 mmol/L or more fasting glucose level at baseline (β, 3.7; 95% confidence interval [CI], 1.2-6.1; P = 0.00), baseline pain-related disability (β 0.2; 95% CI, 0.1-0.4; P = 0.00), BMI (β, 0.2; 95% CI, 0.1-0.3; P < 0.03), EQ-index (β, -4.5; 95% CI, 6.9 to 2.1; P = 0.00), and EQ-visual analogue scale (β, 0.3; 95% CI, -0.6 to -0.0; P = 0.03). However, a limited number of patients had 6.1 mmol/L or more of fasting glucose level at baseline (13/250 patients). The imaging findings, modic changes, and high intensity zones had no predictive ability. Increased pain-related disability at 1 year was seen in patients with impaired fasting glucose tolerance, greater pain-related disability, higher BMI, and lower quality of life at baseline.

This prospective longitudinal study with a minimum 2‐year follow‐up assessed the long‐term outcome of a group of patients with chronic discogenic low back pain who had failed to improve with comprehensive nonoperative care and who were subsequently treated with intradiscal electrothermal therapy (IDET). Previous reports of patient outcomes at 1 year after IDET have demonstrated statistically significant improvement. The study group was comprised of 58 patients with chronic symptoms of more than 6 months who failed to improve with nonoperative care and subsequently underwent IDET. Visual analogue scale (VAS) pain scores, SF‐36 scores, and sitting tolerance times were collected pretreatment and at 6, 12, and 24 months. The entire study group demonstrated a significant improvement in pain as demonstrated by statistically significant improvement in VAS scores and bodily pain SF‐36 scores. The IDET‐treated group demonstrated a significant improvement in physical function as noted by statistically significant improvement in sitting tolerance times and physical function SF‐36 scores. Bodily pain and physical function scores demonstrated significant improvement between the 1‐year and 2‐year observation points. Additionally, quality of life improvement was demonstrated by a statistically significant improvement in all the SF‐36 subscales. The authors concluded that a cohort of patients with chronic discogenic low back pain who had failed to improve with comprehensive nonoperative care demonstrated a statistically significant improvement in pain, physical function, and quality of life at 2 years after IDET.

BackgroundQigong includes training for body and mind, one method is Zhineng Qigong. Scientific literature on qigong for chronic low back pain (LBP) is sparse. This study aimed to investigate feasibility including evaluation of a Zhineng Qigong intervention for pain and other lumbar spine-related symptoms, disability, and health-related quality of life in patients with chronic LBP and/or leg pain.MethodsProspective interventional feasibility study without control group. Fifty-two chronic pain patients (18–75 years) with LBP and/or leg pain (Visual Analogue Scale ≥ 30) were recruited from orthopaedic clinics (spinal stenosis, spondylolisthesis, or segmental pain) and primary healthcare (chronic LBP). Patients from orthopaedic clinics were 1–6 years postoperative after lumbar spine surgery or on lumbar surgery waiting list. Patients received a 12-week training intervention with European Zhineng Qigong. The intervention consisted of face-to-face group activities in non-healthcare setting (4 weekends and 2 evenings per week), and individual Zhineng Qigong training. Main health outcomes were self-reported in a 14-day pain diary, Oswestry Disability Index (ODI), Short Form 36 version 2 (SF-36v2), and EuroQol 5 Dimensions 5 Levels (EQ-5D-5L), once directly before and once directly after the intervention.ResultsRecruitment rate was 11% and retention rate was 58%. Dropouts did not report higher pain (baseline), only 3 dropped out because of lumbar spine-related pain. Adherence was median 78 h group attendance (maximum 94 h) and 14 min daily individual training. Ability to collect outcomes was 100%. Thirty patients completed (mean 15 years symptom duration). Twenty-five had degenerative lumbar disorder, and 17 history of lumbar surgery. Results showed statistically significant (within-group) improvements in pain, ODI, all SF-36v2 scales, and EQ-5D-5L.ConclusionsDespite low recruitment rate, recruitment was sufficient. A multicentre randomized controlled trial is proposed, with efforts to increase recruitment and retention rate. After this Zhineng Qigong intervention patients with chronic LBP and/or leg pain, also patients with considerable remaining LBP/sciatica after lumbar surgery, had significantly improved in pain and function. Results support involvement of postoperative patients in a future study. The results are promising, and this intervention needs to be further evaluated to provide the most reliable evidence.Trial registrationNCT04520334. Retrospectively registered 20/08/2020.

BACKGROUND: Proprioceptive neuromuscular facilitation (PNF) is one of the neurophysiological techniques aimed at reducing pain and disability. This systematic review objective addresses the current evidence on PNF techniques’ effectiveness in chronic low back and neck pain. METHODS: Literature search in PubMed, Scopus, Cochrane, Wiley and Ovid databases were searched until 2021. The content of the titles and the abstracts were analysed to gather information about the effects of PNF in chronic back and neck pain with outcomes of pain and disability. The quality of the studies was analysed by the Joanna Briggs Institute (JBI) critical appraisal score. Meta-analysis was performed on Visual Analogue Scale (VAS), Numerical Rating Scale (NRS) for chronic low back pain and Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ) for disability. RESULTS: Nine studies addressed the different PNF based interventions on chronic low back pain, with a total of 416 participants. The intervention period ranged 3–6 weeks, and two studies conducted 12-weeks follow-up. Many studies measured pain using a VAS and NRS, whereas the disability through ODI and RMDQ. The JBI score ranged from 6/13 to 11/13. None of the PNF studies treated chronic neck pain. CONCLUSION: PNF might be beneficial for reducing low back pain and related disability. The long term effects of PNF on chronic low back pain, and also to determine its benefits on chronic neck pain are warranted in future studies.

A Prospective Outcome Study on the Effects of Facet Joint Radiofrequency Denervation on Pain, Analgesic Intake, Disability, Satisfaction, Cost, and Employment