Can a Single Trial of a Thoracolumbar Myofascial Release Technique Reduce Pain and Disability in Chronic Low Back Pain? A Randomized Balanced Crossover Study.

Although manual therapy for pain relief has been used as an adjunct in treatments for chronic low back pain (CLBP), there is still the belief that a single session of myofascial release would be effective. This study was a crossover clinical trial aimed to investigate whether a single session of a specific myofascial release technique reduces pain and disability in subjects with CLBP. 41 participants over 18 years old were randomly enrolled into 3 situations in a balanced and crossover manner: experimental, placebo, and control. The subjects underwent a single session of myofascial release on thoracolumbar fascia and the results were compared with the control and placebo groups. The outcomes, pain and functionality, were evaluated using the numerical pain rating scale (NPRS), pressure pain threshold (PPT), and Oswestry Disability Index (ODI). There were no effects between-tests, within-tests, nor for interaction of all the outcomes, i.e., NPRS (η 2 = 0.32, F = 0.48, p = 0.61), PPT (η2 = 0.73, F = 2.80, p = 0.06), ODI (η2 = 0.02, F = 0.02, p = 0.97). A single trial of a thoracolumbar myofascial release technique was not enough to reduce pain intensity and disability in subjects with CLBP.

Increased Activation Amplitude Levels of Gluteus Medius in Women During Isometric and Dynamic Conditions Following a 4-week Protocol of Low-load Eccentric Exercises.

BACKGROUND: The dysfunction of gluteus medius (GMed) has been implicated in other musculoskeletal disorders including low back pain and lower limb injuries. The purpose of this study was to use a protocol involving low-load eccentric exercises to observe the effects on the three subdivisions of GMed activation through surface electromyography (sEMG) and digital dynamometry. METHODS: Eleven female subjects having femoral instability participated in a 4-week protocol (three sessions per week/non-consecutive days). At each session, two low-load eccentric exercises (12% of maximal isometric voluntary contraction [MVIC]) in abduction, extension and external rotation were applied to the hip joint. The sEMG of the GMed subdivisions (anterior, mid and posterior) during a squat and MVIC were assessed. The digital dynamometry was also assessed during MVIC. Parametric paired t-test was used to compare the results before and after treatment with α = 0.05. RESULTS: The results showed an increased sEMG activity of GMed (middle and posterior portions) during isometric voluntary contraction and squat after the protocol. No difference was noted to the anterior subdivision of GMed. Another finding was the significant difference to the dynamometry results, showing improvements to generate strength to the GMed as a whole muscle in abduction. CONCLUSION: The 4-week exercise protocol was effective to increase the activation of the GMed middle and posterior subdivisions, improving also the capacity to generate strength as a whole muscle during the proposed tasks. Copyright © 2015 John Wiley & Sons, Ltd.

Immediate electromyographic changes of the upper limb muscles following cervical manipulation in a patient with essential tremor: a case report / Alterações eletromiográficas imediatas dos músculos dos membros superiores após manipulação cervical em uma paciente com tremor essencial: estudo de caso

Introduction and Objective: The purpose of this case report is to evaluate upper limb muscle electric behavior by surface electromyography before and after cervical manipulation in a patient with essential tremor. Methods: In 2009, essential tremor was diagnosed by a neurologist in a 25-year-old woman. Previous treatment included Paroxetine for a number of months, without alteration of her symptoms. The patient was assessed by surface electromyography of the upper limb muscles (flexor and extensor of the wrist, long heads of biceps and triceps) before and after being subjected to high-velocity, low-amplitude spinal manipulation to her mid cervical spine (C3-C4 level, 1 manipulation/side). Results: There was an increase of the median frequency rate and a decrease of the electrical activity of these muscles. Conclusion: This case study showed the cervical manipulation technique acutely modifying the electromyographic activity, increasing the median frequency, and decreasing the muscle recruitment of the upper limb. It suggests improved motor control during the tasks.

Introdução e Objetivo: O objetivo neste estudo de caso foi avaliar o comportamento elétrico dos músculos do membro superior, por eletromiografia, antes e após manipulação cervical em paciente com tremor essencial. Métodos: Uma mulher (25 anos) apresentou-se com tremor essencial, diagnosticado em 2009 por neurologista. Foi empregado tratamento prévio com Paroxetina por meses, sem diminuição dos sintomas. A paciente foi avaliada por eletromiografia dos músculos dos membros superiores (flexores e extensores do punho, cabeça longa do bíceps e do tríceps) antes e após manipulação de alta velocidade e baixa amplitude na cervical média (nível C3-C4, 1 manipulação para cada lado). Resultados: Observou-se aumento na frequência mediana e diminuição na atividade elétrica dos músculos avaliados. Conclusão: A técnica de manipulação cervical modificou de forma imediata a atividade eletromiográfica, aumentando a frequência mediana e diminuindo o recrutamento dos músculos do membro superior para a paciente estudada, sugerindo melhor controle motor durante a atividade proposta.

The Pilates breathing technique increases the electromyographic amplitude level of the deep abdominal muscles in untrained people.

OBJECTIVE: To evaluate the behaviour of the upper rectus abdominis, lower rectus abdominis and transverse abdominis/internal oblique (TrA/IO) by using surface electromyography during trunk flexion with and without the Pilates breathing technique. METHODS: Nineteen female subjects (without experience of the Pilates method) were recruited. The muscles were evaluated while trunk flexion was performed by using the Pilates breathing technique (POW) and Step Barrel device, followed by another contraction without the technique (NORM). Normality was accepted, and the paired t-test was used to determine data differences (p < 0.05). RESULTS: Significant differences were noted in the amplitude level of activation between TrA/IO-POW and TrA/IO-NORM. The activation amplitude level of TrA/IO-POW significantly increased compared with all the other muscles under the NORM condition. CONCLUSION: The breathing technique of the Pilates method associated with trunk flexion increases TrA/IO electrical activity.

Immediate improvements in activation amplitude levels of the deep abdominal muscle following a sacroiliac joint manipulation during rapid upper limb movement.

OBJECTIVE: To assess the immediate effects on the electrical activity of the transversus abdominis/internal oblique (TrA/IO) muscle during rapid voluntary upper limb movements before and after a sacroiliac joint (SIJ) manipulation. METHODS: Twenty healthy subjects who had innominate fixation, assessed by standing flexion test, were recruited. All subjects were submitted to SIJ manipulation and the TrA/IO muscles were evaluated bilaterally, before and after the procedure, through surface electromyography while ten random rapid upper limb flexions or abductions were performed. Normality was accepted, and the paired t-test was used to determine data differences (p < 0.05). The correlations were calculated using Pearson correlation coefficient. RESULTS: All subjects presented an increase of SIJ mobility after manipulation (negative standing flexion test). Significant differences in muscle activation were noted to ipsi- and contralateral TrA/IO recruitment, prior to (A1) and after (A2) the manipulation. The A2 data were statistically greater than those in the A1. The Pearson coefficient revealed a strong correlation between the TrA/IO side and the increase in muscle activation amplitude level. Also, the data showed a moderate to strong correlation between this last variable and the moments of evaluation. CONCLUSION: The SIJ manipulation immediately improved the electrical activity of the TrA/IO muscle during rapid voluntary upper limb movements, suggesting improved segment stability and an increment to the afferent stimuli in order to affect the motor response.

Immediate electromyographic changes of the biceps brachii and upper rectus abdominis muscles due to the Pilates centring technique.

OBJECTIVE: To evaluate the electrical behaviour of the biceps brachii (BB) and upper rectus abdominis (URA) by surface electromyography (sEMG) during a forearm flexion with and without the Pilates centring technique. METHODS: Ten female subjects (with a minimum of one week of experience with the Pilates method) were recruited. The long head of the BB and URA were evaluated while an isotonic contraction of the BB was performed using the Pilates breathing technique and powerhouse contraction, followed by another contraction without these techniques. The data were normalised by a maximal voluntary isometric contraction. Normality was accepted, and the paired t-test was used to determine data differences (p < 0.05). RESULTS: The recruitment increased with the centring technique for both muscles, with greater activity during the concentric compared to the eccentric phase. In addition, this last phase, the centring activation was greater than without the Pilates technique. CONCLUSION: The Pilates method seems to influence the increase in BB activity during dynamic contraction, especially during the eccentric phase.

Manipulation and selective exercises decrease pelvic anteversion and low-back pain: a pilot study.

OBJECTIVES: To study the effect of a protocol involving joint manipulation and specific exercises for pelvic stability to influence proprioceptive input to the spinal tissues and to observe the effects on sensorimotor function. METHODS: Seven patients with pelvic anteversion and low back pain participated in an eight-week protocol (three sessions per week/nonconsecutive days). At each session, a high-velocity, low-amplitude manipulative thrust was applied to the sacroiliac joint, followed by quadriceps eccentric and hamstring concentric contractions. The perceived pain symptoms, pelvic anteversion as determined by photogrammetry analysis, and the electromyographic activity of the rectus femoris and lateral and medial hamstrings during flexion and extension exercises were assessed before and after treatment. Non-parametric tests were used to compare the groups before and after treatment with α=0.05. RESULTS: Perceived pain symptoms decreased after treatment (p=0.0007). The differences in the pelvis angles (p=0.0130) suggested significant differences between the assessments, and the electromyographic activities of all the muscles during isometric voluntary contraction increased. CONCLUSION: The eight-week manipulation/exercise protocol was effective for these subjects' needs. Further research should include a greater sample size to confirm the results and to determine the lead factors of pelvic stability.