Diaphragmatic activation correlated with lumbar multifidus muscles and thoracolumbar fascia by B-mode and M-mode ultrasonography in subjects with and without non-specific low back pain: a pilot study.

Background and Objectives: The diaphragm, the lumbar multifidus muscles, and the thoracolumbar fascia (TLF) execute an important role in the stability of the lumbar spine and their morphology has been modified in subjects with non-specific low back pain (NS-LBP). While it is true that three structures correlate anatomically, the possible functional correlation between them has not been investigated previously in healthy subjects nor in subjects with NS-LBP. The aim of the present study was to examine this functional nexus by means of a comparison based on ultrasonographic parameters of the diaphragm, the lumbar multifidus muscles, and the TLF in subjects with and without NS-LBP. Materials and Methods: A sample of 54 (23 NS-LBP and 31 healthy) subjects were included in the study. The thickness and diaphragmatic excursion at tidal volume (TV) and force volume (FV), the lumbar multifidus muscles thickness at contraction and at rest, and the TLF thickness were evaluated using rehabilitative ultrasound imaging (RUSI) by B-mode and M-mode ultrasonography. The diaphragm thickening capacity was also calculated by thickening fraction (TF) at tidal volume and force volume. Results: There were no significant differences recorded between the activation of the diaphragm and the activation of the lumbar multifidus muscles and TLF for each variable, within both groups. However, there were significant differences recorded between both groups in diaphragm thickness and diaphragm thickening capacity at tidal volume and force volume. Conclusions: Diaphragmatic activation had no functional correlation with the activation of lumbar multifidus muscles and TLF for both groups. Nevertheless, subjects with NS-LBP showed a reduced diaphragm thickness and a lower diaphragm thickening capacity at tidal volume and force volume, compared to healthy subjects

Median Nerve Neural Mobilization Adds No Additional Benefit When Combined with Cervical Lateral Glide in the Treatment of Neck Pain: A Randomized Clinical Trial

Background: This study aimed to compare the effectiveness of cervical lateral glide (CLG) added to median nerve neural mobilization (MNNM) in patients with neck pain (NP). Methods: A single-blinded randomized controlled clinical trial was carried out in a Pain Management Unit from a Hospital. A total sample of 72 patients with NP was recruited from a hospital. Patients were randomized to receive isolated CLG (n = 36) or CLG + MNNM (n = 36). Bilateral elbow extension range of motion (ROM) on upper limb neurodynamic test 1 (ULNT1), bilateral pressure pain thresholds (PPT) on the median nerve at elbow joint, C6 zygapophyseal joint and tibialis anterior, Visual analogue scale (VAS), body chart distribution of pain, active cervical ROM (CROM), Neck Disability Index (NDI), and Tampa Scale of Kinesiophobia (TSK-11) were measured at baseline as well as immediately, 15 days, and 1 month after treatment. Results: There were no statistically significant interactions (p > 0.05) between treatment and time for median nerve mechanosensitivity outcomes, pain intensity, symptom distribution, and PPT of the widespread pain assessment, as well as cervical function, and kinesiophobia. Conclusions: MNNM gave no additional benefit to CLG in patients with NP regarding pain intensity, symptom distribution, mechanosensitivity, functionality, and kinesiophobia. Only two treatment sessions and the short follow-up are important issues, therefore, justifying further studies to answer the research question with better methodology

Comparison of cranio-cervical flexion training versus cervical proprioception training in patients with chronic neck pain:A randomized controlled clinical trial

Objective: To compare the effects of cranio-cervical flexion vs cervical proprioception training on neuromuscular control, pressure pain sensitivity and perceived pain and disability in patients with chronic neck pain. Methods: Twenty-eight volunteers with chronic non-specific neck pain were randomly assigned to 1 of 2 interventions and undertook 6 physiotherapist-supervised sessions over a period of 2 months. Both groups performed daily home exercise. Performance on the cranio-cervical flexion test, pressure pain thresholds and reported levels of pain and disability were measured before and immediately after the first treatment session, 1 month after starting treatment and 2 months after starting treatment (at completion of the intervention). Results: At 2 months, both groups improved their performance on the cranio-cervical flexion test (p 0.05). Both groups showed a reduction in their pain at rest and disability at 2 months, but this was also not different between groups (p>0.05). Pressure pain sensitivity did not change for either group. Conclusion: Both specific cranio-cervical flexion training and proprioception training had a comparable effect on performance on the cranio-cervical flexion test, a test of the neuromuscular control of the deep cervical flexors. These results indicate that proprioception training may have positive effects on the function of the deep cervical flexors

Psychometric Proprieties of a Mobile Application to Measure the Craniovertebral Angle a Validation and Reliability Study

The aim of this study was to assess the psychometric properties of the mobile application forward head posture in terms of validity, inter- and intra-rater reliability, minimum detectable change, sensitivity, and specificity to measure craniovertebral angle. In total, 44 subjects (mean age 23.30 ± 4.44 years) were evaluated in the standing position with markers on the tragus and cutaneous prominence of seventh cervical vertebra (C7). We had two experienced and trained physiotherapists assess cervical posture using the mobile application forward head posture and photogrammetry. Intraclass correlation coefficients were used to determine validity and reliability. A contingency table was made to determine sensitivity and specificity. Intra-rater reliability of the mobile application forward head posture had an intraclass correlation coefficient of 0.88. The inter-rater reliability generated an intraclass correlation coefficient of 0.83 to 0.89. Criterion validity data were above 0.82. The minimum detectable change was 4.96° for intra-rater and 5.52° for inter-rater reliability. The smartphone application exhibited 94.4% sensitivity and 84.6% specificity. The smartphone application forward head posture is a valid and reliable tool to measure craniovertebral angle in a standing position and, therefore, could be a useful assessment tool in clinical practice

Effectiveness of Transcutaneous Neuromodulation on Abductor Muscles Electrical Activity in Subjects with Chronic Low Back Pain: A Randomized, Controlled, Crossover Clinical Trial

Introduction: Non-specific chronic low back pain (NSCLBP) is a major cause of functional impairment, resulting in consequences like job absenteeism and reduced quality of life. Risk factors such as muscle weakness and tightness have been implicated. Electromagnetic fields have therapeutic effects on human tissue, including pain relief and muscle relaxation. This study aimed to examine the impact of a tape with magnetic particles (MPT) applied to the lumbar area on abductor muscle strength and surface electromyography (sEMG) of the Gluteus Medius and Tensor of the Fascia Lata muscles in individuals with NSCLBP. Methods: It was carried out a double-blind, randomized, controlled, crossover trial and with test retest, with 41 consecutive patients younger than 65 years who previously diagnosed with NSCLBP to assess the effect of a MPT over hip abductor muscle strength and activity. sEMG and force data were obtained during the Hip Stability Isometric Test (HipSIT). The HipSIT was used to assess the abduction strength using a hand-held dynamometer and sEMG. The HipSIT uses the maximum voluntary isometric contraction (MVIC). Four trials were recorded and the mean extracted for analysis. The tape was applied with either a MPT or a sham magnetic particle tape (SMPT) bilaterally without tension on from L1 to L5 paravertebral muscles. Results: The significant increase in the recruitment of fibers and the significant increase in the maximum voluntary contraction by applying MPT with respect to the SMPT, correspond to the increases in the Peak Force and the decrease in the time to reach the maximum force (peak time) of both muscles. Conclusion: Application of a MPT in patients with NSCLBP suggests an increase in muscle strength of the Gluteus Medius and Tensor Fascia Lata bilaterally during the HipSIT test. Lumbar metameric neuromodulation with MPT improves muscle activation of the hip musculature

Validity and reliability of methods for sonography education in physiotherapy: onsite vs. online

[eng] Background: in physiotherapy, the interest in sonography education has been increasing in recent decades, giving rise to opportunities in education in an attempt to meet the elevated demand. In other health professions, online education has demonstrated to be of interest, and another possibility by which to obtain knowledge. Methods: this exploratory observational prospective study compared the outcomes between onsite versus online education, and was approved by the ethics committee of the Francisco de Vitoria University. Two groups (onsite and online) with 136 attendants and two levels for each (basic and advanced) received the same content but through different presentations. Theoretical exams were conducted via 'Kahoot' and practical exams using phantoms, and the results were subject to statistical analyses. Results: the average age of onsite participants was 29.5 (25-35.25) years and 34 (28.5-40.5) for the online participants, with a higher percentage of women. The average score ranks in the Kahoot_basic test were higher for both online groups corresponding to basic (group 1) and advanced (group 2) levels: 7 (6.5, 7.5) for group 1 and 7 (6.5, 8.5) for group 2 vs. the onsite groups: 6 (5.5, 7) for group 1 and 6 (5, 6.5) for group 2. In the practical exam, the model detected that a small negative difference between the Onsite 2 group and the total effect (−1.23148, SE = 0.43687) was significant (t = −2.819, p = 0.00558) with a low effect size (R2adjusted = 0.025) for the measurements of the hollow structure; the difference between the Online 2 and Onsite 1 group was positive (1.5026, SE = 0.5822) and significant (t = 2.5809, p = 0.0113), with a low effect size (R2adjusted = 0.016) for the solid structure depth measurement. Conclusions: the results showed that there could be an opportunity to access sonography knowledge through online education in physical therapy compared to the traditional onsite model. These conclusions support the use of a low-cost and accessible method for ultrasound education

Abdominal and Pelvic Floor Activity Related to Respiratory Diaphragmatic Activity in Subjects with and without Non-Specific Low Back Pain

One of the advances in physiotherapy in recent years is the exploration and treatment by ultrasound imaging. This technique makes it possible to study the relationship between the musculature of the anterolateral wall of the abdomino-pelvic cavity, the pelvic floor muscles and the diaphragm muscle, among others, and thus understand their implication in non-specific low back pain (LBP) in pathological subjects regarding healthy subjects. Objective: To evaluate by RUSI (rehabilitative ultrasound imaging) the muscular thickness at rest of the abdominal wall, the excursion of the pelvic floor and the respiratory diaphragm, as well as to study their activity. Methodology: Two groups of 46 subjects each were established. The variables studied were: non-specific low back pain, thickness and excursion after tidal and forced breathing, pelvic floor (PF) excursion in a contraction and thickness of the external oblique (EO), internal oblique (IO) and transverse (TA) at rest. Design: Cross-sectional observational study. Results: Good-to-excellent reliability for measurements of diaphragm thickness at both tidal volume (TV) (inspiration: 0.763, expiration: 0.788) and expiration at forced volume (FV) (0.763), and good reliability for inspiration at FV (0.631). A correlation was found between the EO muscle and PF musculature with respect to diaphragmatic thickness at TV, inspiration and expiration, and inspiration at FV, in addition to finding significant differences in all these variables in subjects with LBP. Conclusion: Subjects with LBP have less thickness at rest in the OE muscle, less excursion of the pelvic diaphragm, less diaphragmatic thickness at TV, in inspiration and expiration, and in inspiration to FV

Test-Retest Reliability of Ultrasonographic Measurements from the Rectus Femoris Muscle 1–5 Years after Anterior Cruciate Ligament Reconstruction in the Ipsilateral and Contralateral Legs: An Observational, Case-Control Study

About 40% of traumatic injuries in sports are related to the knee. Of these, 33% require arthroscopic surgery. The rehabilitative ultrasound imaging technique is a simple method to obtain objective real-time results on the state and measurement of the musculoskeletal tissue and its use can represent an important change in the process of functional diagnosis and recovery of these injuries. The aim was to quantify the differences in the thickness, muscle contraction time, and muscle relaxation time of the rectus femoris muscle between individuals with knee arthroscopy and healthy individuals and to verify the reliability of the inter-examiner measurements in these ultrasound variables. An observational case-control study with individuals (18–60 years aged) who underwent surgery for anterior cruciate ligament through knee arthroscopy a year or more before. A total of 38 subjects were divided into 2 groups, case and control. Ultrasound measurements were taken of the following outcomes: thickness at rest and contraction, muscle contraction time, and muscle relaxation time of the rectus femoris muscle. Excellent inter-examiner reliability was obtained for all ultrasound measurements (ICC3.3 > 0.90). No significant changes were found in the rate of contraction or rest of the rectus femoris muscle. On the other hand, if significant changes in the thickness of the rectus femoris muscle were found between control and case group. Arthroscopic surgery for anterior cruciate ligament reconstruction does not appear to modify function but does modify the thickness of the rectus femoris muscle on ultrasound examination. Ultrasound appears to be a reliable tool for the study of these measurements in the rectus femoris muscle