Back Pain Rehabilitation Research Articles

Intra-day, short- and long-term reliability of surface electromyographic measurements during a standardized measurement protocol for lower back pain patients

Background The identification of back muscle dysfunction is a prerequisite for successful rehabilitation. Therefore, surface electromyography can be used for diagnostic and evaluative purposes. However, data quality highly depends on a) variance and inaccuracies in methodological procedures and b) on time-dependent changes, particularly in complex conditions such as chronic low back pain. Objective To assess intra-day, short-term and long-term reliability of a protocol designed for electromyographic measurements of the paraspinal muscles. Methods Three everyday tasks were selected for measurement in two healthy populations (mean age (years): 26.25/30.49 (SD: 7.05/11.03), sex-balanced). The procedure follows a detailed protocol (e.g., including ultrasound, electrode placement, movement commands). Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) were calculated. Results Prone extension task demonstrated excellent test-retest agreement in all timespans (ICC = 0.92–0.96, SEM = 6.08–8.11, MDC = 16.85–22.49). Forward bending reliability ranged from moderate in long-term (ICC = 0.68–0.71, SEM = 1.98–2.52, MDC = 5.48–6.99) to good in intra-day (ICC = 0.76–0.89, SEM = 1.73–2.15, MDC = 4.79–5.95) to excellent in short-term assessment (ICC = 0.97, SEM = 1.07–1.21, MDC = 2.96–3.34). Sitting task showed the lowest test-retest agreement ranging between good to moderate in intra-day (ICC = 0.60–0.77, SEM = 1.22–1.26, MDC = 1.61–3.48)) and short-term reliability (ICC = 0.50–0.75, SEM = 1.24–2.06, MDC = 0.62–4.04) and moderate in long-term reliability (ICC = 0.65–0.71, SEM = 1.43–1.85, MDC = 3.95–5.12). Conclusion Using standardized procedures, surface electromyography can provide reliable data for practitioners in low back pain rehabilitation. Timespan had a limited influence on reliability compared to the type of task performed.

Rehabilitation of back pain with laser associated with negative or positive pressure massage in workers: A randomized controlled trial

Background and purposeWork-related musculoskeletal disorders (WMSDs) are an array of conditions affecting the human locomotor system, such as muscles, tendons, nerves, bones, and joints. It is related to physiological, kinesiological and biomechanical changes which result in pain, paresthesia, inflammation, weakness, tiredness, heaviness in limbs, fatigue, reduced range of motion and/or compression of peripheral nerves. The aim of this study was to investigate the therapeutic effects of positive (massage gum) or negative pressure (vacuum therapy) combined with laser on the health of workers with back pain, investigating pain intensity, shoulder mobility, spinal flexibility, life quality, and well-being. MethodsTwenty-one workers (female and male) aged between 20 and 60 years and who had medical referral for pain complaint in low back, neck and shoulders due to WMSDs participated in this study and were randomized into 3 groups: (1) Positive Pressure plus Laser Group (PPL): positive pressure using a massage gun was applied after the laser; (2) Negative Pressure plus Laser Group (NPL): negative pressure by vacuum was applied together with the laser and; (3) Control group (CG): without positive and negative pressure treatments or laser therapy. All workers received an educational booklet with postural orientation and suggestions focused on stretching exercises. Anamnesis, visual analogue scale (VAS) to assess pain intensity, and functional tests to assess spine flexibility and shoulders mobility were performed. Quality of life and well-being also were evaluated. The regions of lumbar, thoracic and cervical spine were treated once a week, totaling seven sessions. ResultsThe main result was a reduced pain and an increased spinal flexibility, shoulders mobility, and quality of life in the PPL and NPL groups compared to the CG (p < 0.05). Furthermore, NPL showed better results compared to PPL (p < 0.05) for lumbar and cervical pain, as well as for right shoulder mobility. ConclusionTherefore, laser combined with negative pressure massage was more effective in reducing lumbar and cervical pain and increasing shoulder mobility compared to positive pressure massage in workers.

The superiority trial of Baduanjin training on patients chronic low back pain: a study protocol for a randomized controlled trial

BackgroundCNSLBP accounts for 85% of all LBP cases and impairs physical health, quality of life, and work productivity, posing a significant health and economic burden. Baduanjin (BDJ) exercises are traditional Chinese Qi Gong mind-body exercises that have been practiced for over 1,000 years. However, the standard BDJ protocol established by the State Sports General Administration does not stimulate core muscles, limiting the effectiveness of low back pain rehabilitation. Therefore, it is necessary to improve the original BDJ protocol.MethodsThis 24-week single-center, single-blind, parallel-group randomized control superiority trial will allocate 100 patients into two groups (control and intervention) at a 1:1 ratio. The patients in the control group will perform the standard BDJ protocol established by the State Sports General Administration. The patients in the patients in the control group will perform the standard BDJ protocol established by the State Sports General Administration. The intervention group will perform intervention. The primary outcomes will be Quebec back pain disability scale. Secondary outcomes will include visual analog scale pain scores, Surface electromyography. The assessments of the tests will be performed at four time points. Adverse events will be recorded faithfully during the study.DiscussionThis randomized control trial is the first to compare a standard BDJ protocol and an optimized protocol in patients with CNSLBP. This study can help guide rehabilitation programs.Trial registrationChinese Clinical Trial Registry, ChiCTR2200065618, Registered on 10 Nov. 2022. This protocol is the first version 1, which was approved on 26 Aug 2022.

Combined exercise Intervention protocol validation in sedentary workers health risk with Nonspecific Chronic low back pain People

Background: Most chronic low back pain is nonspecific as the cause of the pain is unknown. Hence exercise protocol focussing on one area of fitness is not appropriate. A general exercise programme that combines muscular strength, flexibility and aerobic fitness would benefit the rehabilitation of Nonspecific Chronic Low Back Pain and its health risk. The present study aimed to validate the content of the combined exercise intervention protocol. Methods: The development and expert judgement stages are part of the content validation process. The development of the exercise protocol was based on a comprehensive literature review. The protocol was created in a step-by-step progressive manner. Exercises for flexibility (20 minutes), stabilisation and strengthening (20 minutes), and aerobic (20 minutes) make up the three main parts of the exercise protocol. 12 independent professionals with a minimum of 10 years of experience were invited. Ten of the twelve specialists consented to take part in the study. In India, all of the professionals were engaged in orthopaedic and musculoskeletal physical therapy. There are two professors, three associate professors, and five senior physiotherapists among the experts. Responses were gathered by mail. During the validation phase, The Exercise protocol was graded by the experts on relevance and ease of performance using a 5-point scale. After collecting the responses content validity index and kappa values were calculated. Results: 37 out of 39 items in the combined exercise intervention protocol showed good agreement. Treadmill walking with 60-75% and 80% and above target heart rate showed a kappa value of 0.66 for relevance and 0.50 for ease of performance. Conclusions: The designed exercise protocol exhibited good content validity.

Abdominal Drawing-In Maneuver is Less Effective for Core Stability During High Load Tasks: A Systematic Review

Context: The abdominal drawing-in maneuver (ADIM) is a technique commonly used to activate deep core muscles for the prevention and rehabilitation of low back pain. However, its benefits during high-load tasks (HLT) are unclear. Objectives: The primary objective of this article is to review the literature to determine whether the use of ADIM enhances core stabilization during HLT. Additionally, we will examine if other factors, beyond load, could influence the effectiveness of this activation maneuver. Methods: A search was conducted using PubMed databases for studies that compared interventions using ADIM to those without ADIM. The literature search spanned from January 1981 to March 2024. Only studies that included kinematic assessments were selected. Results: The search yielded 359 studies, of which 24 were included in the final analysis. Task load was analyzed based on Mottram and Comerford's criteria, alongside other approaches such as the source of the perturbation applied to the subject and body position. In conditions using ADIM, better performance was observed in only 16.66% of interventions with HLT, whereas other conditions (OC) without ADIM performed better in 83.33% of interventions using HLT. When core stability was tested against external perturbations, ADIM was less effective in all scenarios. In lying positions, ADIM performed better in 4 tasks, while OC performed better in 2. In upright positions, ADIM was more effective in 7 tasks, while OC performed better in 6. Conclusions: The findings suggest that ADIM should not be used if the goal is to train core stability and strength during HLT. Abdominal drawing-in maneuver was less effective for stabilizing the core during tasks involving external perturbations, and its use was also less decisive in upright positions.

Adherence and Compliance of Different Delivery Methods of Home Exercise in Individuals With Nonspecific Low Back Pain

Autonomous exercise within nonspecific low back pain rehabilitation is a necessary tool to treat low back pain. The purpose of this study was to quantify adherence and compliance during two different 6-week home-exercise programs. Forty adults were randomly allocated to a gamified and packet group. Adherence, compliance, and system usability assessments occurred after 3 and 6 weeks. Packet group adherence was similar at 3 weeks and at 6 weeks. System usability was significantly greater at 6 weeks than at 3 weeks in the packet group. Adherence or compliance was not influenced. The usability of the intervention methodology was considered great by both groups.

Perturbation-based Balance Training in Adults Aged Above 55 Years with Chronic Low Back Pain: A Comparison of Effects of Water versus Land Medium - A Preliminary Randomized Trial.

'Rapid balance reaction' or 'perturbation' training is an emerging paradigm in elderly back pain rehabilitation due to its connection to postural stability. This study aimed to inform the feasibility and practicality of perturbation-based balance training (PBT) using a stratification approach and to determine the effectiveness of land versus water-based PBT in elderly individuals with chronic low back pain (CLBP). Elderly CLBP participants (n=24) received exercise interventions as per treatmentbased classification (TBC) and were randomly allotted into water-based perturbation exercises (WBPE, Mean age=63.0±2.6years, n=12) and land-based perturbation exercise group (LBPE, 62.3±2.6 years, n=12). Pain intensity, disability, scores of fear-avoidance beliefs, fall efficacy, and rate of perceived exertion (RPE) were assessed before and at the end of 6 weeks. WBPE group reported a significant reduction in pain score (median difference(MD)):2, p<0.03), fear avoidance behaviour for work (MD:9, p<0.01) and fear avoidance behaviour for physical activity (MD:10, p< 0.05), improved straight leg raise right (SLR) (MD:37.5°, p<0.05), and improved modified fall efficacy scores (MFES, MD:25, p<0.05) compared to the LBPE group at post-intervention. Within-group analysis in both groups revealed significant improvement in clinical outcomes except for fear-avoidance beliefs related to physical activity in the LBPE group. Subgroup analysis revealed that the high BMI elderly CLBP group of LBPE had significant improvements similar to the WBPE group except for scores of FABQ physical activity scores and SLR. Possible key factors for future research are discussed in the realms of perturbation exercise in the elderly with CLBP.

Exercise-induced neuroplasticity: a new perspective on rehabilitation for chronic low back pain.

Chronic low back pain patients often experience recurrent episodes due to various peripheral and central factors, leading to physical and mental impairments, affecting their daily life and work, and increasing the healthcare burden. With the continuous advancement of neuropathological research, changes in brain structure and function in chronic low back pain patients have been revealed. Neuroplasticity is an important mechanism of self-regulation in the brain and plays a key role in neural injury repair. Targeting neuroplasticity and regulating the central nervous system to improve functional impairments has become a research focus in rehabilitation medicine. Recent studies have shown that exercise can have beneficial effects on the body, such as improving cognition, combating depression, and enhancing athletic performance. Exercise-induced neuroplasticity may be a potential mechanism through which exercise affects the brain. This article systematically introduces the theory of exercise-induced neuroplasticity, explores the central effects mechanism of exercise on patients with chronic low back pain, and further looks forward to new directions in targeted neuroplasticity-based rehabilitation treatment for chronic low back pain.

Comparison of trunk muscle activity during lumbar stabilization exercises on stable and unstable surfaces.

Lumbar stabilization exercises (LSE) provide dynamic trunk stability, promote muscle strength and endurance, and improve low back pain rehabilitation and performance. To clarify the differences in trunk muscle activity during LSEs on stable and different unstable surfaces. Fifteen healthy males performed three exercises (elbow-toe, hand-knee, and side bridge) on stable (floor) and unstable surfaces. Muscle activity of the bilateral rectus abdominis, internal oblique, external oblique, and erector spinae were recorded. Data were compared using the Friedman test. Pairwise comparisons were performed using Wilcoxon's signed rank test if significant differences were observed. In the elbow-toe exercise, muscle activity of the rectus abdominis and right internal oblique increased in the following order: floor, low-difficulty, and high-difficulty unstable surface. In the hand-knee exercise, muscle activity of the internal oblique on the lower-extremity elevated side, external oblique, and erector spinae on the upper-extremity elevated side were greater on unstable surface exercise performance. In the side bridge exercise, rectus abdominis muscle activity was highest on a high-difficulty unstable surface. Trunk muscle activity increased during exercise on unstable surfaces. Since the effects of unstable surfaces vary depending on muscle and exercise types, exercise difficulty and surface stability must be considered accordingly.

Specialized Physiotherapy and Pharmacological Management Strategies in Optimizing Chronic Lower Back Pain Rehabilitation

Specialized Physiotherapy and Pharmacological Management Strategies in Optimizing Chronic Lower Back Pain Rehabilitation

Trial of Remote Rehabilitation for Low Back Pain Using the Health Care App

Trial of Remote Rehabilitation for Low Back Pain Using the Health Care App

Trunk Muscle Activity and Ratio of Local Muscle to Global Muscle Activity during Supine Bridge Exercises under Unstable Conditions in Young Participants with and without Chronic Low Back Pain.

Core exercises on an unstable surface increase trunk muscle activity, especially for local muscle groups. Therefore, there is a possibility that exercises on an unstable surface would be effective in the rehabilitation of non-specific chronic low back pain (NSCLBP). The present study assessed trunk muscle activities during bridge exercise on the floor and two kinds of unstable surfaces, i.e., a balance ball and the BOSU, for individuals with and without NSCLBP. This study enrolled 17 and 18 young participants with and without NSCLBP, respectively. In the balance ball condition, both groups showed a significant increase in erector spinae activity compared to the floor condition, and the increase in activity was significantly greater in the NSCLBP group than in the control group (p = 0.038). On the other hand, neither group showed significant changes in trunk muscle activities in the BOSU condition compared to those in the floor condition. The control group showed a significant increase in internal oblique/transversus abdominis activity under the balance ball condition (p = 0.020), whereas there were no significant changes in these muscle activities between the balance ball and floor conditions in the NSCLBP group. The present study showed that participants with NSCLBP significantly increased muscle activity of the erector spinae, one of the global back muscles, on the balance ball in spite of small effects on muscle activity of the internal oblique/transversus abdominis, which is one of the local abdominal muscles. Therefore, attention should be paid to the application of bridge exercises on the balance ball for individuals with NSCLBP.

Changes in spinal motor behaviour are associated with reduction in disability in chronic low back pain: A longitudinal cohort study with 1-year follow-up.

The need to improve spinal motor behaviour in chronic low back pain (CLBP) rehabilitation remains unclear. The objective of this study was to test if changes in spinal motor behaviour were associated with changes in disability after an interdisciplinary rehabilitation program (IRP) in patients with CLBP. Seventy-one patients with CLBP participating in an IRP were included. Spinal motor behaviour was assessed with biomechanical (lumbar angular amplitude and velocity, erector spinae muscle activity and duration of the task), cognitive-emotional (task-specific fear [PRF]) and pain-related (movement-evoked pain [MEP]) measures during a lifting task before and after the IRP. Disability was measured before and after the IRP, and at 3-month and 1-year follow-ups. After adjusting for confounders, changes in disability were significantly associated with MEP changes (β adj. = 0.49, p < 0.001) and PRF changes (β adj. = 0.36, p = 0.008), but not with changes in any of the biomechanical measures. MEP at the end of IRP was also associated with disability at 3 months (β adj. = 0.37, p = 0.001) and 1 year (β adj. = 0.42, p = 0.01). Biomechanical measures at the end of the IRP were not associated with disability, except for the duration of the task that was significantly associated with reduction of disability at 3 months (β non-adj = 0.5, p < 0.001). Pain-related and cognitive-emotional measures of spinal motor behaviour were associated with reduction in disability following an IRP. Future research is needed to further investigate causal relationships between spinal motor behaviour and disability. This study supports a multidimensional understanding and analysis of spinal motor behaviour, integrating the cognitive-emotional, pain-related and biomechanical domains. It also supports the consideration of spinal motor behaviour as a potentially important treatment target in chronic low back pain management. Moreover, it suggests that reducing movement-evoked pain and task-specific fear may have more influence on disability than changing lumbar amplitude, lumbar angular velocity or erector muscle activity, which may have important implications for rehabilitation.

Thomas Wilson Meade. 21 January 1936—24 October 2022

Tom Meade made outstanding contributions to our understanding of the role of the haemostatic (clotting) system in the causation of cardiovascular disease by combining epidemiological approaches with rigorous standardization of laboratory methods. As director of the MRC Epidemiology and Medical Care Unit (EMCU) at Northwick Park Hospital he led major prospective studies to investigate the relationship between a range of haemostatic factors and cardiovascular disease outcomes. He also led several major randomized trials of interventions to reduce cardiovascular risk, notably the Thrombosis Prevention Trial. The EMCU also undertook several landmark studies on common and often neglected conditions to improve knowledge of the burden of ill health (for example from incontinence) and effective interventions, including for low back pain and stroke rehabilitation. In his later career he also set up and led a series of large case–control studies among myocardial infarction, stroke, deep vein thrombosis and pulmonary embolism cases, together with their matched controls using a primary care database, showing elevated risks of both arterial and venous thrombosis following respiratory infections. He had many major scientific leadership roles, including playing a significant role in guiding the UK Biobank at its inception and chairing the steering committee of the Heart Protection Study Collaborative Group.

Biopsychosocial rehabilitation in the working population with chronic low back pain: a concept analysis.

To identify the essential attributes of biopsychosocial rehabilitation for chronic low back pain in the working population. A concept analysis was conducted according to the 8-step method of Walker and Avant. This framework provides a clear concept and theoretical and operational definitions. Five databases were searched, followed by a systematic screening. Subsequently, attributes, illustrative cases, antecedents, consequences and empirical referents were formulated. Of the 3793 studies identified, 42 unique references were included. Eleven attributes were identified: therapeutic exercise, psychological support, education, personalization, self-management, participation, follow-up, practice standard, goal-setting, social support, and dietary advice. Subsequently, illustrative cases were described. Antecedents, such as motivation, preparedness and a multidisciplinary team, were found, together with consequences such as decreased pain, less sick-leave and increased function and work status. Finally, examples of empirical referents were given. This study identified the attributes that are necessary to develop biopsychosocial rehabilitation intervention programmes for chronic low back pain. The defined concept of biopsychosocial rehabilitation for chronic low back pain may serve as a solid base to further develop and apply interventions. Future research should focus on the objectification of biopsychosocial rehabilitation and conceptualization regarding how personalization is done.

Outcome measures and their importance for effective equine back pain rehabilitation

Effective rehabilitation and strategies to prevent equine back pain are required due to the frequency of dysfunction impacting performance and welfare. Reliable and valid measures should be used establish a baseline in pain and dysfunction levels, and used to monitor change during rehabilitation, as well as support future research assessing the efficacy of treatment interventions. Such measures are collectively known as outcome measures and can include specific objective markers of impairments such as reduced range of motion, or pain on palpation. The aim of this narrative review is to discuss the options and tools available to use as outcome measures in relation to the treatment and rehabilitation of back pain in the horse. In this paper, the outcome measures critically discussed relate to conformation and standing posture, muscle dimensions, palpation, range of motion, objective gait analysis, functional analysis, owner reported outcome measures and pain scales. Recommendations are made to assist with selection of a suitable outcome measure. In conclusion, complex laboratory-based analysis systems are available as gold-standard objective systems, although realism for clinical practitioners working in the field limits their use. There is a requirement for new outcome measures that are not subject to observer bias nor time or financially consuming, however it is possible to use those available currently to assist in clinical decision making for the benefit of the horse.

The Efficiency of Respiratory Exercises in Rehabilitation of Low Back Pain: A Systematic Review and Meta-Analysis.

Low back pain (LBP) is a common musculoskeletal disorder, and respiratory exercise is considered a nonsurgical management method. Therefore, this systematic review and meta-analysis aims to estimate the results of randomized controlled trials on the effect of respiratory training in reducing LBP and its dose relationship. The present study was conducted from January 2020 to January 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (2020). Relevant studies were searched in multiple databases including PubMed, Web of Science, the Cochrane Library, EBSCO, Scopus, ScienceDirect, Wan Fang and China Knowledge Network, ClinicalTrials.gov, and Google Scholar, using a combination of MeSH/Emtree terms and free-text words. The heterogeneity of the studies was assessed using the I2 statistic. A total of 14 publications were included in the meta-analysis, with a total sample size of 698 individuals, aged 60-80years. Respiratory exercise was effective in relieving LBP (standardized mean difference = -0.87, P < .00001) and improving physical disability (standardized mean difference = -0.79, P < .00001). The type of breathing and the total duration of breathing exercises were found to be the source of heterogeneity in this study by subgroup analysis. Subgroup analysis revealed that the most significant effect sizes of breathing resistance exercise to reduce LBP and the most significant effect sizes of breathing relaxation techniques to alleviate physical disability were performed 3 to 5 times per week and period >4weeks. Respiratory exercise reducing LBP and improving functional disability was most effective when the total duration of the intervention was >500minutes. Funnel plots showed that the results of the 2 overall studies were reliable without publication bias. Respiratory exercise can effectively reduce LBP and improve physical disability. Therefore, these exercises can be regarded as a part of a LBP management plan. We recommend an exercise program with 30 to 50 minutes, 3 to 5 times per week, and >4weeks of breathing resistance exercise program as the most effective for treating LBP.

Failed Back Pain Rehabilitation Syndrome and A Necessary Paradigm Shift in Back Pain Rehabilitation Guidelines and Industry wide Accountability for Outcomes

Failed Back Pain Rehabilitation Syndrome and A Necessary Paradigm Shift in Back Pain Rehabilitation Guidelines and Industry wide Accountability for Outcomes

Application Progress of Transcranial Direct Current Stimulation in Rehabilitation of Chronic Low Back Pain

Application Progress of Transcranial Direct Current Stimulation in Rehabilitation of Chronic Low Back Pain

Comparing the effectiveness of flexi-bar and stability exercises on postural control in chronic nonspecific low back pain: A randomized controlled study.

This study aimed to compare the effect of flexi-bar and stabilization exercises on static and dynamic postural control in patients with chronic nonspecific low back pain. In this randomized controlled study conducted between November 2019 and March 2020, 38 patients (19 males, 19 females; mean age: 33.8±6.2 years; range, 20 to 45 years) were randomly assigned into flexi-bar (n=19) and stabilization (n=19) groups. Both groups received general physiotherapy for three sessions per week, a total of 10 sessions. Besides, the flexi-bar group received flexi-bar exercises, and the stabilization group received stabilization exercises. Postural sway was assessed with a force platform in three difficult conditions, including open eye, close eye, and one-leg standing and dynamic posture with the modified Star Excursion Balance Test. After the intervention, both groups showed a significant improvement in static and dynamic postural control (p<0.05). However, no significant differences were found between groups after treatment, while only the phase-plane portrait of opened eyes condition was significantly improved (p=0.03), in the flexi-bar group compared to the stabilization group. Both flexi-bar and stabilization exercises effectively improved static and dynamic postural control, but none of the exercises was superior to the other. Flexi-bar is recommended as an effective tool in low back pain rehabilitation.