On-Site Physiotherapy in Emergency Department Patients Presenting with Nonspecific Low Back Pain: A Randomized Controlled Trial.

Background: There is a high incidence of nonspecific Low Back Pain (LBP) in patients visiting Emergency Departments (EDs), but there is a lack of knowledge regarding emergency physiotherapy for LBP. The effect of on-site physiotherapy in these patients was therefore never demonstrated. We assessed short-term outcomes, feasibility and patient satisfaction with physiotherapy in ED patients presenting with nonspecific LBP. Methods: A block-randomized, controlled, open-label trial with a follow-up of 42 days. Patients aged 18 years or older presenting to an ED with nonspecific LBP were prospectively enrolled. Both groups received the same booklet with written information on LBP management and exercises. Patients in the intervention group were given additional instructions by a certified physiotherapist. Results: We included 86 patients in the primary analysis. The median age was 40, and 40.7% were female. At day 7, the median Oswestry Disability Index (ODI) was 2 points lower in the intervention group compared to the control group, which was not statistically significant. There was no between-group difference in pain at day 7. Patients who received physiotherapy felt significantly more confident with the exercises they were taught (p = 0.004, effect size = 0.3 [95% CI 0.1 to 0.5]). Conclusions: On-site physiotherapy in ED patients presenting with nonspecific low back pain is associated with higher patient satisfaction, compared to standard of care. The effect of physiotherapy was small, with only minimal improvement in disability, but without a reduction in pain. Despite the very small effect size, physiotherapeutic interventions should be investigated in larger cohorts with an extended intervention including patient education, exercises, and other physiotherapeutic modalities.

Hamstring muscle architecture and myotonometer measurements in elite professional football players with a prior strained hamstring.

The purpose of this study was to compare the fascicle length, angle pennation and mechanical properties of the biceps femoris long head (BFlh) in dominant and non-dominant limbs in previously injured and uninjured professional football players. Fifteen professional football players were recruited to participate in this study. Seven players had suffered a BFlh injury during the previous season. Myotonometry mechanical properties were measured in the proximal, common tendon and distal BFlh using MyotonPRO, and angle pennation and fascicle length were also measured. We observed significantly higher distal BFlh frequency, stiffness, decrement, relaxation and creep than in the common tendon and proximal BFlh. The previously injured players showed significantly higher frequency and stiffness, and lower relaxation and creep in the dominant BFlh than did uninjured players. There were no significant differences between the fascicle length and angle pennation in previously injured and uninjured BFlh. Myotonometric measurement provides a quick and inexpensive way to check the properties of the BFlh in professional football players. Professional football players with previous BFlh injury showed higher intrinsic tension and a poorer capacity to deform than did players with no injury to the BFlh.

Repeatability of spatiotemporal, plantar pressure and force parameters during treadmill walking and running.

BACKGROUND: Instrumented treadmills with integrated pressure mats measure spatiotemporal, pressure and force parameters and are often used to investigate changes in gait patterns due to injury or rehabilitation. RESEARCH QUESTION: What is the within- and between-day repeatability of such an instrumented treadmill for spatiotemporal parameters, peak pressures and forces during walking and running? METHODS: Treadmill gait and running analysis were performed at 5.0, 6.5, and 9.0 km/h in 33 healthy adults (age: 31.6 ±â€¯7.4 years; body mass index: 23.8 ±â€¯3.2 kg/m2) once on day 1 and twice on day 7. For all three speeds, intraclass correlation coefficents (ICC) and smallest detectable differences (SDC) corresponding to 95% limits of agreement were calculated for spatiotemporal parameters and peak pressures and forces in the heel, midfoot, and forefoot regions. RESULTS: All spatiotemporal parameters and peak forces in the heel, midfoot, and forefoot regions showed a good within- and between-day repeatability (ICCs > 0.878) for all gait speeds with within-day repeatability being generally higher. For peak pressures, only the heel and forefoot regions but not the midfoot region, showed good repeatability (ICC > 0.9) at all gait speeds. SDCs ranged from 1.5 to 2.5° for foot rotation, 4.4 to 6.6 cm for stride length, 0.7 to 2.5% for length of stance phases, and 2.8 to 9.2 N/cm2 for peak pressures in all foot regions. For walking, SDCs of peak forces in the heel, midfoot and forefoot regions were below 60 N, and for running below 135 N. SIGNIFICANCE: Except for peak pressures in the midfoot, spatiotemporal and kinetic gait parameters during walking and running showed a good within- and between-day repeatability. Hence, the investigated treadmill is suitable to analyze gait patterns and changes in gait patterns due to interventions.