Validity and reliability of dry needle placement in the deep lumbar multifidus muscle using ultrasound imaging: an in-vivo study.

OBJECTIVES: To use ultrasound (US) imaging to determine the validity and reliability of needle placement of two dry needling (DN) protocols for the lumbar multifidus (LM) in individuals with a high body mass index (BMI). METHODS: Twenty-one participants with a BMI higher than 25 kg/m2 completed the study. A US scanner was used to determine the location of needle placement after a 100 mm long needle was inserted in the LM at L4 and L5 following two DN protocols for the deep LM muscle. US images were saved and viewed 6 months later to determine the intra-tester reliability. RESULTS: The probability of reaching the deep LM muscle was high (85-95%) at L4 and L5. Although the needle reached a bony landmark 85-100% of the time, it only reached the vertebra lamina as intended 70-75% of the time. The intra-tester reliability of needle placements based on analysis of real-time and recorded US images was poor-to-moderate. CONCLUSIONS: Although the bony drop may not indicate that the needle has reached the vertebra lamina as the protocol intended, reaching a bony drop is still meaningful as it coincided with reaching the LM in the majority of participants.

Factors influencing adherence to an app-based exercise program in adolescents with painful hyperkyphosis.

BACKGROUND: Software applications (apps) could potentially promote exercise adherence. However, it is unclear whether adolescents with painful hyperkyphosis will use an app designed for a home exercise program. The purpose of this study is to assess factors regarding adherence to an app-based home exercise program in adolescents with hyperkyphosis and back pain who were provided a one-time exercise treatment. METHODS: Twenty-one participants were instructed in a one-time exercise treatment and asked to complete a home exercise program 3 times a week for 6 months using an app called PT PAL. At a 6-month follow-up, 14 participants completed a survey assessing factors related to their experiences using the app and their treatment engagement. RESULTS: Although most participants did not use the app, they reported performing their exercises a few times per week. The adolescent participants considered the app to be more of a barrier than a supportive measure for promoting exercise adherence. Most participants still reported bothersome back pain. CONCLUSIONS: Although adherence to the 6-month app-based home exercise program was not successful, adolescents still viewed technology support such as text reminders as a potential solution. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03212664. Registered 11 July 2017. Retrospectively registered.

Six-Month Follow-up of Supervised Spinal Stabilization Exercises for Low Back Pain in Adolescent Idiopathic Scoliosis.

PURPOSE: To evaluate the effectiveness of 8 weeks of weekly spinal stabilization exercises compared with 1-time treatment in participants with adolescent idiopathic scoliosis and low back pain at a 6-month follow-up. METHODS: Thirty-two participants were evaluated at a 6-month follow-up. The supervised group received weekly spinal stabilization exercises. The unsupervised group received a 1-time treatment and home exercise program. RESULTS: Both groups improved in all outcome measures. The supervised group had significantly reduced Numeric Pain Rating Scale and Improved Global Rating of Change scores, but had no differences in the revised Oswestry Back Pain Disability Questionnaire, or Patient-Specific Functional Scale scores in comparison with the unsupervised group.

Spinal Stabilization Exercise Effectiveness for Low Back Pain in Adolescent Idiopathic Scoliosis: A Randomized Trial.

PURPOSE: To compare 8 weeks of weekly supervised spinal stabilization exercises with 1-time treatment in participants with low back pain and adolescent idiopathic scoliosis. METHODS: Participants were randomly assigned to the supervised or unsupervised group. Seventeen participants in the supervised group received weekly physical therapy, and 17 participants in the unsupervised group received a 1-time treatment followed by home exercises. RESULTS: Significant between-group differences were found in the Numeric Pain Rating Scale and the Patient-Specific Functional Scale scores after 8 weeks (P < .01), indicating the supervised group had significantly more pain reduction and functional improvements than the unsupervised group. However, no between-group differences were found in back muscle endurance, the revised Oswestry Back Pain Disability Questionnaire scores, or the Global Rating of Change scores. CONCLUSIONS: Supervised physical therapy may be more effective than 1-time treatment in reducing pain and improving function in patients with adolescent idiopathic scoliosis and low back pain. VIDEO ABSTRACT: For more insights from the authors, access Supplemental Digital Content 1, at http://links.lww.com/PPT/A85.

Ultrasonographic measurements of paraspinal muscle thickness in adolescent idiopathic scoliosis: a comparison and reliability study.

PURPOSE: To examine paraspinal muscle asymmetries in patients with mild adolescent idiopathic scoliosis (AIS) compared with controls using ultrasound (US) imaging and to determine reliability of the US imaging. METHODS: Twenty adolescents (10 with and 10 without AIS) whose muscle thickness of the deep paraspinals at T8 and the multifidus at L1 and L4 vertebral levels was determined using US imaging. RESULTS: Ultrasound imaging had good intrarater reliability (ICC3,3 = 0.83-0.99) and interrater reliability (ICC2,3 = 0.93-0.99). Significantly greater muscle thicknesses were found on the concave side at T8 and L1 compared with the corresponding convex side. Significantly greater normalized muscle thickness values were found on the concave side at T8, L1, and L4 in patients with mild AIS compared with controls. CONCLUSIONS: Ultrasound imaging is reliable for measuring the deep thoracic paraspinals and lumbar multifidus in adolescents with and without idiopathic scoliosis. Significant paraspinal muscle asymmetries were found in mild AIS. VIDEO ABSTRACT: For more insights from the authors, access Supplemental Digital Content 1, at http://links.lww.com/PPT/A76.