Inspiratory muscle training affects proprioceptive use and low back pain.

We have shown that individuals with recurrent nonspecific low back pain (LBP) and healthy individuals breathing against an inspiratory load decrease their reliance on back proprioceptive signals in upright standing. Because individuals with LBP show greater susceptibility to diaphragm fatigue, it is reasonable to hypothesize that LBP, diaphragm dysfunction, and proprioceptive use may be interrelated. The purpose of this study was to investigate whether inspiratory muscle training (IMT) affects proprioceptive use during postural control in individuals with LBP

'Piriformissyndroom: een overzicht van de recente literatuur'

The piriformis syndrome (PS) is in certain cases quite a controversial diagnosis in sciatica. It is considered to be a form of sciatica as a result of compression of the sciatic nerve in its course at the height of the piriformis muscle. In the literature, the debate on the clinical relevance of PS is active, as only limited opportunities exist to confirm its diagnosis by means of technical studies. Still, the percentage of patients in whom the piriformis muscle is a source of pain, is estimated at only 6% of the total amount of patients with sciatica. Both anamnestic (gluteal pain and an increase of sciatica when sitting) and clinical (local pain at palpation of the sciatic notch and pain provocation with manoeuvres increasing the tension of the piriformis muscle) findings may suggest the diagnosis. Although PS used to be considered as an exclusively clinical diagnosis, several authors describe the usefulness of an electromyography with an electrophysiological reflex examination (Hoffmann reflexes S1) of the sciatic nerve and an MRI of the pelvis (with an MR neurography of the sciatic nerve) as a possible way to support the clinical examination. There is evidence for a conservative treatment of PS based on analgesics, physiotherapy, injections of local anesthetics and/or corticosteroids, or the more recently studied botulinum neurotoxin injections. Surgery may be considered when the symptoms persist despite conservative therapy. © 2013 Tijdschrift voor Geneeskunde.status: publishe

The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain

STUDY DESIGN: A two-group experimental design with repeated measures on one factor was used. OBJECTIVES: To investigate the role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain. SUMMARY OF BACKGROUND DATA: Proprioceptive deficits have been identified in patients with low back pain. The underlying mechanisms, however, are not well documented. METHODS: Lumbosacral position sense was determined before, during, and after lumbar paraspinal muscle vibration in 23 young patients with low back pain and in 21 control subjects. Position sense was estimated by calculating the mean absolute error, constant error, and variable error between six criterion and reproduction sacral tilt angles. RESULTS: Repositioning accuracy was significantly lower in the patient group than in healthy individuals (absolute error difference between groups = 2.7 degrees, P /= 0.05) and in the patient group (P > 0.05). CONCLUSIONS: Patients with low back pain have a less refined position sense than healthy individuals, possibly because of an altered paraspinal muscle spindle afference and central processing of this sensory input. Furthermore, muscle vibration can be an interesting expedient for improving proprioception and enhancing local muscle control.status: publishe

Open versus closed kinetic chain exercises for patellofemoral pain : a prospective, randomized study

The goal of this prospective study was to evaluate the efficacy of open versus closed kinetic chain exercises in the nonoperative management of patellofemoral pain. Sixty patients were randomized into a 5-week program that consisted of only closed kinetic chain exercises or only open kinetic chain exercises. Muscle characteristics, subjective symptoms, and functional performance were evaluated in this study at the time of the initial physical examination, at the end of the treatment period, and 3 months later. Both groups experienced a statistically significant decrease in pain and an increase in functional performance. This study shows that both open and closed kinetic chain exercise programs lead to an improved subjective and clinical outcome in patients with anterior knee pain. The few significantly better functional results for some of the tested parameters in the closed kinetic chain group suggest that this type of treatment is a little more effective than the open kinetic chain program in the treatment of these patients

Reflex response times of vastus medialis oblique and vastus lateralis in normal subjects and in subjects with patellofemoral pain syndrome

Various authors have indicated that imbalance of the vastus medialis/vastus lateralis muscles might lead to patellofemoral pain syndrome. However, few reports have been published to substantiate such a hypothesis. The purpose of this study was to attempt to set a scale for the normal reflex response times or the vastus medialis oblique and vastus lateralis muscles after a patellar tendon tap and to determine if patellofemoral pain syndrome patients have an alteration in this firing sequence. A control group of 80 healthy adults was compared with a group of 19 patellofemoral pain syndrome patients. Results indicated that the reflex response time of the vastus medialis oblique was significantly shorter than the reflex response time of the vastus lateralis in the normal subjects (p less than or equal to .01). When comparing these data in the patellofemoral pain syndrome group, a significant earlier Firing was obtained from the vastus lateralis in comparison with the vastus medialis oblique (p less than or equal to .01). These findings suggest that a reversal has occurred in the firing pattern of the vastus medialis oblique and vastus lateralis muscles in patellofemoral pain syndrome patients. The results indicate an alteration in the neuromuscular answer of the vastus medialis oblique and vastus lateralis muscles during a patellar tendon tap

Study of differences in peripheral muscle strength of lean versus obese women: an allometric approach

OBJECTIVE: To investigate whether peripheral muscle strength is significantly different between lean and obese women controlled for age and physical activity, using an allometric approach. DESIGN: Cross-sectional study of isometric handgrip and isokinetic leg and trunk muscle strength. SUBJECTS: 173 obese (age 39.9+/-11.4 y, body mass index (BMI) 37.8+/-5.3 kg/m(2)) and 80 lean (age 39.7+/-12.2 y, BMI 22.0+/-2.2 kg/m(2)) women. MEASUREMENTS: Anthropometric measures (weight, height) and body composition (bioelectrical impedance method), isometric handgrip (maximal voluntary contraction on the Jamar dynamometer), isokinetic trunk flexion-extension, trunk rotation, and knee flexion-extension (Cybex dynamometers). RESULTS: Absolute isokinetic strength output (that is, strength uncorrected for fat-free mass) was larger in obese compared to lean women, except for knee flexion and isometric handgrip, which were not significantly different (P>0.05). Pearson correlation coefficients between strength measures and fat-free mass (kg) were low to moderate both in lean (r=0.28-0.53, P<0.05) and in obese (r=0.29-0.49, P<0.001) women. There was no correlation with fat mass (kg) in the lean, whereas in the obese women a weak positive relation could be observed for most isokinetic data (r=0.21-0.39, P<0.01). When correcting for fat-free mass (raised to the optimal exponent determined by allometric scaling), all strength measurements were at least 6% lower in obese when compared to the lean women, except for trunk flexion, which was at least 8% stronger in obese women. DISCUSSION: The higher absolute knee extension strength measures of leg and the similar extension strength of the trunk in the obese sample compared to the lean might be explained by the training effect of weight bearing and support of a larger body mass. However when the independent effect of fat-free mass is removed, these strength measures, as well as oblique abdominal muscle and handgrip strength, turned out to be lower in obese women. These observations could be the reflection of the overall impairment of physical fitness as a consequence of obesity and its metabolic complications.status: publishe

Preliminaire studie over het belang van de opsporing van ademhalingsproblemen bij patiënten met lage rugpijn

The objective of this article was to investigate whether respiratory problems and signs correlate with the intensity of or disability due to low back pain (LBP). Patients with LBP, aged 20-80 years, were asked to take part in a cross-sectional observational study. The following variables were recorded in 104 patients: age, sex, weight, height, daily medication use that can affect the respiratory system, respiratory problems, smoking history and pack years, allergy that affects the airways, breathing pattern, maximal inspiratory pressure (MIP), isometric handgrip force, Nijmegen Hyperventilation Questionnaire (NHQ) score, numeric rating scale (NRS) of LBP, Oswestry Low Back Pain Disability questionnaire. The total cohort disclosed a low-normal inspiratory muscle strength (79.9%). In 31.8%, a presence of a respiratory problem, mainly hyperventilation, was noted. There was a significant correlation between smoking and NHQ score with the degree of disability due to LBP. By each additional point on the NHQ, the probability of a higher disability due to LBP increased 1.1 times. There was a significant correlation between the intensity of or disability due to LBP and the intake of medication affecting the respiratory system. If an allergy was present, it was six times more likely to have a significant disability because of LBP. Patients with LBP need to be screened and treated for underlying breathing problems. Prevention of LBP in a population with comorbidities might be needed and smoking cessation is recommended in the rehabilitation of LBP. Further studies concerning the link between the respiratory system and LBP have to demonstrate if additional training of inspiratory muscles in a LBP population with low MIP (%) could be beneficial.status: publishe