Immediate effects of a lumbar spine manipulation on pain sensitivity and postural control in individuals with nonspecific low back pain: a randomized controlled trial.

BACKGROUND: According to the American Physical Therapy Association, there is strong evidence to show that vertebral mobilization and manipulation procedures can be used to improve spinal and hip mobility and reduce pain and incapacity in low back pain patients that fit the clinical prediction rule. OBJECTIVES: To evaluate the immediate effects of high-velocity low-amplitude (HVLA) manipulation on pain and postural control parameters in individuals with nonspecific low back pain. METHODS: This study used a participant-blinded and assessor-blinded randomized controlled clinical trial involving a single session, in which 24 participants were randomly distributed into control (simulated manipulation) and intervention (HVLA lumbar manipulation) groups. The primary (pain: subjective pain intensity and pressure pain threshold) and secondary outcomes (postural control: ellipse area, center of pressure [COP] excursion, COP RMS velocity, and differences between the COP and center of projected gravity) were evaluated before and after the session using a numerical pain scale, algometer, and a force platform. For all outcomes, multiple mixed 2 (group) × 2 (time) ANOVAs were performed. RESULTS: For the subjective pain intensity, only time was significant as a main effect, where pre-intervention presented a greater value then post-intervention (F [1.44] = 4.377; p = 0.042; r = 0.30). For the pressure pain threshold no significant effect was found. For the postural control parameters, as a main effect, only the ellipse area was significantly greater in the control group (F [1.44] = 6.760; p = 0.013; effect size = 0.36). CONCLUSIONS: There was a reduction in subjective pain intensity, evaluated using a numerical scale, in both the intervention and control groups immediately after the intervention, suggesting that the spinal manipulation had a similar effect to the placebo procedure. No effect of HVLA lumbar manipulation was identified for postural control variables in either the intervention or control groups. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov under the number NCT02312778, registered at 14 September 2014.

Electrical Activity of Powerhouse Muscles During the Teaser Exercise of Pilates Using Different Types of Apparatus.

We compared the electrical activity of certain powerhouse muscles-External Oblique, Multifidus, Adductor Longus, and Gluteus Medius-during the teaser exercise of the Pilates Method, performed on various types of apparatus-the Mat, Reformer, and Wall Unit. Fifteen female practitioners of the Classic Pilates Method (32.6 ± 7.7 years old; 21.9 ± 1.9 body mass index) performed the teaser in each situation while electromyographic (EMG) and kinematic data were collected. Root mean square values of the flexion phase were compared. All muscles showed higher EMG activity in Reformer compared with Wall Unit, and Multifidus, Adductor Longus, and Gluteus Medius showed higher EMG activity in Mat compared with Wall Unit. No difference was found between Reformer and Mat.

Back pain and body posture evaluation instrument (BackPEI): development, content validation and reproducibility.

OBJECTIVES: Following a search conducted in several databases, no instrument was found that jointly evaluates the prevalence of back pain and its associated demographic, social-economic, hereditary, behavioral and postural risk factors. Thus, the present study aims to develop the Back Pain and Body Posture Evaluation Instrument (BackPEI) for school-age children and verify its validity and reproducibility. METHODS: Twenty-one questions were elaborated to compose the BackPEI instrument, eight experts checked the content validity, and its reproducibility was tested by applying the questionnaire to 260 primary schoolchildren, at two different times with a 7-day interval. RESULTS: The reproducibility data for the first 20 questions, analyzed using the kappa (k) coefficient, were classified as "very good" (k > 0.8) or "good" (0.6 < k ≤ 0.8). The reproducibility data for the pain intensity question, analyzed using the Wilcoxon test and the intraclass correlation coefficients (ICC), demonstrated that there was no difference between the averages (p = 0.251) and the responses were highly correlated (ICC = 0.937) for these two tests. CONCLUSIONS: The BackPEI constitutes a valid and reproducible instrument which is relevant for the evaluation of back pain and its associated risk factors.

Estimated force and moment of shoulder external rotation muscles: differences between transverse and sagittal planes.

The aim of this study was to compare shoulder muscle force and moment production during external rotation performed in the transverse and sagittal planes. An optimization model was used for estimating shoulder muscle force production of infraspinatus, teres minor, supraspinatus, anterior deltoid, middle deltoid and posterior deltoid muscles. The model uses as input data the external rotation moment, muscle moment arm magnitude, muscle physiologic cross-sectional area and muscle specific tension. The external rotation moment data were gathered from eight subjects in transverse and six subjects in sagittal plane using an isokinetic dynamometer. In the sagittal plane, all studied muscles presented larger estimated force in comparison with the transverse plane. The infraspinatus, teres minor, supraspinatus and posterior deltoid muscles presented larger moment in sagittal when compared with transverse plane. When prescribing shoulder rehabilitation exercises, therapists should bear in mind the described changes in muscle force production.