Effect of motor control training on hip muscles in elite football players with and without low back pain

Objectives: Previous research has shown that motor control training improved size and function of trunk muscles in elite football players with and without low back pain (LBP). Imbalances in hip muscles have been found in athletes with LBP and it is not known if motor control training can change these muscles. This study investigated if a motor control intervention program affected hip muscle size in elite football players with and without LBP. Design: Panel-randomised intervention design. Methods: Forty-six players from one club in the Australian Football League (AFL) participated in a motor control training program delivered across the season as a stepped-wedge intervention design with 3 treatment arms: 15 weeks intervention, 8 weeks intervention and a wait-list control who received 7 weeks intervention toward the end of the playing season. Presence of LBP was assessed by interview and physical examination. Cross-sectional areas of iliacus, psoas, iliopsoas, sartorius, gluteus minimus, and gluteus medius muscles were measured from magnetic resonance images taken at 3 time points during the season. Results: Iliopsoas, sartorius and gluteus medius muscle size increased for players who received intervention (p < 0.05). For players with current LBP, sartorius and gluteus medius muscle size increased for those who received motor control training (p < 0.05). Conclusions: Motor control training programs aimed at the lumbo-pelvic region also benefit the hip muscles. For players with current LBP, the intervention mitigated sartorius muscle atrophy and increased gluteus medius muscle size. These findings may help guide the management of LBP in elite football players

Terrestrial neuro-musculoskeletal rehabilitation and astronaut reconditioning : Reciprocal knowledge transfer [Editorial]

[Extract] Research on astronauts can benefit patients with conditions affecting the neuro-musculoskeletal systems and vice versa, as both face the challenge of managing the effects of disuse. Deconditioning in astronauts after spaceflight is a useful model for studying interventions for optimal recovery, as changes occur relatively rapidly and without the complication of underlying pathology seen in musculoskeletal and neurological disorders, where the effects of disuse are difficult to study in isolation. Physical inactivity is a major problem in the general population, despite well-known benefits, causing public health and economic concerns worldwide (Kohl et al., 2012, Lee et al., 2012), so translating motivation strategies from astronauts would be very beneficial. Clinical conditions associated with disuse can also provide lessons for optimising exercise programmes to minimise deconditioning during spaceflight and reconditioning the astronaut on their return to Earth. The purpose of this Supplement is to highlight areas where space and terrestrial research and clinical management may have lessons for one another

The relationship between the piriformis muscle, low back pain, lower limb injuries and motor control training among elite football players

Objectives: Australian Football League (AFL) players have a high incidence of back injuries. Motor control training to increase lumbopelvic neuromuscular control has been effective in reducing low back pain (LBP) and lower limb injuries in elite athletes. Control of pelvic and femoral alignment during functional activity involves the piriformis muscle. This study investigated (a) the effect of motor control training on piriformis muscle size in AFL players, with and without LBP, during the playing season, and (b) whether there is a relationship between lower limb injury and piriformis muscle size. Design: Stepped-wedge intervention. Methods: 46 AFL players participated in a motor control training programme consisting of two 30. min sessions per week over 7-8 weeks, delivered across the season as a randomised 3 group single-blinded stepped-wedge design. Assessment of piriformis muscle cross-sectional area (CSA) involved magnetic resonance imaging (MRI) at 3 time points during the season. Assessment of LBP consisted of player interview and physical examination. Injury data were obtained from club records. Results: An interaction effect for Time, Intervention Group and LBP group (F=3.7, p=0.03) was found. Piriformis muscle CSA showed significant increases between Times 1 and 2 (F=4.24, p=0.046), and Times 2 and 3 (F=8.59, p=0.006). Players with a smaller increase in piriformis muscle CSA across the season had higher odds of sustaining an injury (OR. =1.08). Conclusions: Piriformis muscle size increases across the season in elite AFL players and is affected by the presence of LBP and lower limb injury. Motor control training positively affects piriformis muscle size in players with LBP

Lower limb MSK injuries among school-aged rugby and football players: a systematic review

Objective The objective of this systematic review was to explore the incidence of lower limb musculoskeletal (MSK) injuries sustained by rugby union, rugby league, soccer, Australian Rules and Gaelic football players under 18 years. The review sought to identify the mechanisms and types of injury sustained and to compare between sports.Design This systematic review focused on the incidence of lower limb injury in adolescent team sports that involved running and kicking a ball. A literature search of studies published prior to January 2020 was conducted using SportDiscus, Medline and PubMed databases. The Standard Quality Assessment Criteria appraisal tool was used to assess the quality of each article included in the review. Two or more authors independently reviewed all papers.Results Sixteen papers met the inclusion criteria; prospective cohort (N=14), retrospective (n=1) and longitudinal (n=1). These studies investigated injuries in rugby union and rugby league (n=10), football (soccer) (n=3), Australian Rules (n=2) and Gaelic football (n=1). There were a total of 55 882 participants, aged 7–19 years old, who reported 6525 injuries. The type, site and mechanisms of injury differed across sports.Summary Lower limb injuries were common in adolescent rugby, soccer, Gaelic football and Australian Rules football players, however these studies may not fully reflect the true injury burden where recurrent and overuse injuries have not been considered. There were differences between sports in the mechanisms, types and severity of injury

Hypogravity reduces trunk admittance and lumbar muscle activation in response to external perturbations

Reduced paraspinal muscle size and flattening of spinal curvatures have been documented after spaceflight. Assessment of trunk adaptations to hypogravity can contribute to develop specific countermeasures. In this study, parabolic flights were used to investigate spinal curvature and muscle responses to hypogravity. Data from five trials at 0.25g, 0.50g and 0.75g were recorded from six participants, positioned in a kneeling-seated position. During the first two trials, participants maintained a normal, upright posture. In the last three trials, small-amplitude perturbations were delivered in the anterior direction at the T10 level. Spinal curvature was estimated using motion capture cameras. Trunk displacement and contact force between the actuator and participant were recorded. Muscle activity responses were collected using intramuscular electromyography (iEMG) of the deep and superficial lumbar multifidus, iliocostalis lumborum, longissimus thoracis, quadratus lumborum, transversus abdominis, obliquus internus and obliquus externus muscles. The root mean square iEMG and the average spinal angles were calculated. Trunk admittance and muscle responses to perturbations were calculated as closed-loop frequency response functions. Compared with 0.75g, 0.25g resulted in: lower activation of the longissimus thoracis (P=0.002); lower responses of the superficial multifidus at low frequencies (P=0.043); lower responses of the superficial multifidus (P=0.029) and iliocostalis lumborum (P=0.043); lower trunk admittance (P=0.037) at intermediate frequencies; and stronger responses of the transversus abdominis at higher frequencies (p=0.032). These findings indicate that exposure to hypogravity reduces trunk admittance, partially compensated by weaker stabilizing contributions of the paraspinal muscles and coinciding with an apparent increase of the deep abdominal muscle activity

From Basile to Barbie. Doll fantasies, toy princesses, and clockwork females

Few studies quantify spinal posture behaviour at both the thoracolumbar and lumbar spinal regions. This study compared spontaneous spinal posture in 50 asymptomatic participants ( 21 males ) during three conditions: 10-min computer task in sitting ( participants naïve to the measure ), during their perceived ‘correct’ sitting posture, and standing. Three-dimensional optical tracking quantified surface spinal angles at the thoracolumbar and lumbar regions, and spinal orientation with respect to the vertical. Despite popular belief that lordotic lumbar angles are ‘correct’ for sitting, this was rarely adopted for 10-min sitting. In 10-min sitting, spinal angles flexed 24( 7–9 )deg at lumbar and 12( 6–8 )deg at thoracolumbar regions relative to standing ( P < 0.001 ). When participants ‘corrected’ their sitting posture, their thoracolumbar angle −2( 7 )deg was similar to the angle in standing −1( 6 )deg ( P = 1.00 ). Males were flexed at the lumbar angle relative to females for 10-min sitting, ‘correct’ sitting and standing, but showed no difference at the thoracolumbar region

Different ways to balance the spine in sitting: Muscle activity in specific postures differs between individuals with and without a history of back pain in sitting

Previous research explored muscle activity in four distinct sitting postures with fine-wire electromyography, and found that lumbar multifidus muscle activity increased incrementally between sitting with flat thoracolumbar and lumbar regions, long thoracolumbar lordosis, or short lordosis confined to the lumbar region. This study used similar methods to explore whether people with a history of low back pain provoked by prolonged sitting used different patterns of trunk muscle activity in specific postures.Fine-wire electromyography electrodes were inserted into the right lumbar multifidus (deep and superficial), iliocostalis (lateral and medial), longissimus thoracis and transversus abdominis muscles. Superficial abdominal muscle activity was recorded with surface or fine-wire electrodes. Electromyography amplitude was compared between postures for the back pain group and observations were contrasted with the changes previously reported for pain-free controls. For comparison between groups normalised and non-normalised electromyography amplitudes were compared.Individuals with a history of back pain demonstrated greater activity of the longissimus thoracis muscle in the long lordosis compared with the flat posture [mean difference (95% CI): 46.6 (17.5-75.7)%, normalised to sitting posture peak activity], but pain-free participants did not [mean difference: 7.7 (minus 12-27.6)%]. Pain-free participants modulated lumbar multifidus activity with changes in lumbar curve, but people with a history of pain in prolonged sitting did not change multifidus activity between the long and short lordotic postures.In clinical ergonomic interventions that modify spinal curves and sagittal balance in sitting, the muscle activity used in those postures may differ between people with and without a history of back pain

Imaging with ultrasound in physical therapy: What is the PT’s scope of practice? A competency-based educational model and training recommendations.

Physical therapists employ ultrasound (US) imaging technology for a broad range of clinical and research purposes. Despite this, few physical therapy regulatory bodies guide the use of US imaging, and there are limited continuing education opportunities for physical therapists to become proficient in using US within their professional scope of practice. Here, we (i) outline the current status of US use by physical therapists; (ii) define and describe four broad categories of physical therapy US applications (ie, rehabilitation, diagnostic, intervention and research US); (iii) discuss how US use relates to the scope of high value physical therapy practice and (iv) propose a broad framework for a competency-based education model for training physical therapists in US. This paper only discusses US imaging— not ’therapeutic’ US. Thus, ’imaging’ is implicit anywhere the term ’ultrasound’ is used.pre-print847 K

Exploring the use of ultrasound imaging by physiotherapists: An international survey

Background: National surveys in New Zealand, Australia and the United Kingdom suggest ultrasound imaging (USI) use by physiotherapists is increasing. However, concerns exist regarding clarity for scopes of practice, and availability and standardisation of training. Objectives: To investigate physiotherapists' understanding of scopes of practice for the use of USI; clarify the professional contexts, clinical uses and levels of training; and identify barriers preventing physiotherapists' USI use. Design: A cross-sectional, observational survey. Methods: An Internet-based survey, offered in 20 different languages, was used including items covering five domains: (1) demographic and professional characteristics; (2) knowledge of scope of practice; (3) USI use; (4) USI training content and duration; and (5) perceived barriers to physiotherapists' use of USI. Results: 1307 registered physiotherapists from 49 countries responded; 30% were unsure of the scope of practice for physiotherapists' USI use. 38% of participants were users of USI, reporting varied contexts and clinical uses, reflected in the broader categories of: (i) biofeedback; (ii) diagnosis; (iii) assessment; (iv) injection guidance; (v) research; (vi) and teaching. The training users received varied, with formal training more comprehensive. 62% were non-users, the most common barrier was lack of training (76%). Conclusion: These findings suggest physiotherapists' USI use is increasing in various contexts; however, there is uncertainty regarding scopes of practice. There are discrepancies in training offered, with a lack of training the most common barrier to physiotherapists' use of USI. International guidelines, including a USI training framework, are needed to support the consistent and sustainable use of USI in physiotherapy