Search

Low back pain (LBP) is a major cause of physical disability in the world. The origin of this condition can be due to differents causes, with a specific cause or of unknown mechanical origin,being characterized as unspecific. In this case a physical therapy treatment approach with manual therapy is relevant, which includes the Muscle Energy Technique (MET) classified as a common conservative treatment for pathologies of the spine, mainly in LBP and disability. This study assessed the effectiveness of the muscle energy technique on nonspecific low back pain.Patients with acute, subacute or chronic non-specific low back pain. The primary outcomes were pain and disability. This study was designed by a systematic review and meta-analysis, registered in PROSPERO (CRD42020219295). For the report and methodological definitions of this study, the recommendations of the PRISMA protocol and the Cochrane collaboration, were followed, respectively.The search yielded 164 citations, which 19 were eligible randomised trials were included in the review (n = 609 patients with low back pain). The methodological quality of the studies averaged 4.2 points, with an interval of 2 to 7 points. Three RCTs showed satisfactory methodological quality (PEDro score ≥6). For patients with chronic LBP, a significant result on pain (but with a small and clinically unimportant effect) in favor of MET versus other (MD =-0.51 [95% CI,-0.93 to -0.09] p=0.02, n=376, studies=11, I2=80%). In patients with subacute LBP, MET enabled a significant and moderate effect to reduce pain intensity when compared to the control group (MD =-1.32 [95% CI,-2.57 to -0.06] p = 0,04, n= 120, studies=3, I2=88%). No significant effects were observed for the disability.MET is not considered an efficient treatment to improve the incapacity of the lumbar spine, but it may be beneficial in reducing the intensity of LBP, although showing a small clinical effect in chronic LBP and a moderate effect in subacute LBP.

Introduction: Low back pain (LBP) is the most common musculoskeletal complaint in pregnancy, being responsible for many negative impacts. Objective: To evaluate the effect of LBP on static and dynamic balance in pregnant women and whether pregnancy mediates the results compared to non-pregnant women. Methods: 44 women (mean age 30 yrs) participated voluntarily in this study: 16 pregnant women with LBP starting in pregnancy, 14 pregnant women without LBP and 14 non-pregnant women as a group control. Participants were assessed for static postural balance using a force platform and dynamic mobility balance using the Timed Up and Go (TUG) test. Results: The pregnant women with LBP showed significant (P < 0.04, for mean, d= 1,2) poor postural balance in static tests (force platform), in the area of COP eyes open. In dynamic balance (TUG test), statistical difference was found between the groups (P 0.038) and the effect size were moderate to strong in the comparison between the three groups. The most sensitive differences were reported mainly between pregnant women with LBP versus non-pregnant control group in balance measures from force platform. Conclusion: The findings indicate that LBP associated to pregnant clinical status can decrease the balance capacity in women. These results have implication for balance evaluation and retraining in pregnant women with and without LBP from rehabilitation or prevention programs.

Introduction: Parkinson’s disease is most prevalent among elderly people, 65 years and over, and leads to an alteration in motor control associated with postural instability. Current evidence shows that postural control decreases with the aging process. In addition, postural control is more altered in healthy aged men than in women. Until today, few studies have evaluated the combined impact of Parkinson’s disease and sex on postural control. This review has allowed to evaluate the impact of Parkinson’s disease and sex on postural control measurements in elderly people. Methodology: Studies have been selected from two main databases: PubMed and EBSCO using the keywords “Parkinson”, “postural control OR balance” and “sex”. Articles related to the evaluation of postural control, including men and women with Parkinson’s aged over 65 years old, regardless of stage, were included (n = 179). Articles were excluded if not written in French or English or not presenting original content. Results: Ten (10) studies out of 179 that fulfilled inclusion and exclusion criteria were reported in the final analysis, which cumulates a total of 944 individuals with Parkinson’s (410 women). In general, results show greater postural instability among people with Parkinson’s compared to healthy subjects, and this according to different objective measurements using stabilographic parameters from force platforms. Only two studies out of ten evaluated postural control while briefly considering distinctions between sex, but without showing a significant difference between men and women with Parkinson’s. Parkinson’s severity, length of time of Parkinson’s disease and cognitive state of the person are the three variables with a negative impact on postural control. Conclusion: Older people with Parkinson’s disease have greater postural instability. Sex does not seem to influence the postural control of elderly people with Parkinson’s, although more studies are necessary.

Background Low back pain is common during pregnancy. Lumbar stabilization and stretching exercises are recommended to treat low back pain in the general population. However, few studies have applied the effects of these two interventions in pregnant women with low back pain. Aim To compare the effects of lumbar stabilization and stretching exercises for the treatment of gestational low back pain. Design A pilot randomized clinical trial. Setting Laboratory of Functional Evaluation and Human Motor Performance and physical therapy clinics. Population Initially, 30 pregnant women with low back pain were recruited, of which 24 met the following inclusion criteria: being between 19-29 weeks of gestation; being in prenatal clinical follow-up; having nonspecific mechanical low back pain started in pregnancy; not participating in specific low back pain treatment in the last 3 months. A total of 20 women completed the study (10 each group). Methods The main outcome measures were clinical (pain by Visual Analogue Scale (VAS) and McGill Pain Questionnaire and disability by Roland Morris Questionnaire), and secondary outcome measures were: postural balance (force platform); muscle activation level of multifidus, iliocostalis lumborum, rectus abdominis and external abdominal oblique (electromyography). The women were randomized into two groups for 6 weeks of intervention twice a week for a 50-minute treatment: 1) lumbar stabilization exercise protocol and 2) stretching exercise protocol. Results There was a significant reduction (P=0.03) in pain (1.68 in VAS and 4.81 for McGill questionnaire) for both interventions, but no change in disability score. In addition, both interventions were comparable for a significant improvement in postural stability (in mean d=0.77) for the velocity sway parameter, and significantly increased activation (P>0.05) of the external abdominal oblique muscle after intervention. Conclusions Both modalities (lumbar stabilization and stretching) were efficient for pain reduction, improving balance and increasing one trunk activity muscle after 6 weeks of intervention in pregnant women with low back pain. Clinical rehabilitation impact The present study has implications, especially for clinical decision-making with regard to therapy choice in pregnant women with LBP to reduce pain and improve trunk function as measured through balance performance.

Postural control declines with age and can be affected by low back pain. Poor balance has been reported in people with chronic low back pain (CLBP), which in turn could be explained by the changes in trunk muscle activation.Are there differences between younger and older adults with and without chronic low back pain (CLBP) on trunk muscle activity during one-legged stance task?Twenty (20) with, and 20 subjects without nonspecific CLBP participated in the study. Each group was comprised of 10 younger (50% males; mean age: 31 years) and 10 older adults (50% males; mean age: 71 years). Subjects performed 3 × 30-second trials of one-legged stance, with eyes open, on a force platform, while surface electromyography (EMG) measurements were obtained bilaterally on the multifidus at L5, iliocostalis lumborum at L3, rectus abdominis and biceps femoris muscles.EMG amplitude analysis was processed by the Root Mean Square (250 ms window epochs) and normalized by the peak of activation during the balance tasks, to determine the muscular activity of each muscle.Participants with CLBP presented 15% lower lumbar muscle activation (p 0.05), and 23% higher co-activation (ratio between rectus adominis by multifidus) than participants without CLBP, regardless of age. Significant differences (p 0.05) between older and young groups were observed only for lower lumbar muscles (mean 24% lower in older than younger adults) and rectus adominis muscles (mean 17% lower in older than younger adults).CLBP individuals have different trunk muscle activity than those without CLBP, and older adults exhibit lower trunk activation during one-legged stance balance task. The use of the EMG in evaluation of trunk neuromuscular function during one-legged stance may thus be a valuable tool when assessing balance in CLBP and older people.

The application of the margin of manoeuvre (MM) concept in work rehabilitation is new. It allows for variations in both health status and work demands, and the interaction between the two, to be taken into account. The objective of this exploratory study was to document the relationship between the presence of an MM in the workplace and the return to work (RTW), after a long-term absence.This study used the data collected during an earlier study that sought to identify the dimensions and indicators of the MM. The data were analysed on three levels, and the convergences and divergences in the MM indicators and dimensions in relation to the RTW were grouped accordingly.Eleven workers and five clinicians participated in this study. The results support the proposition that the presence of a sufficient MM in the workplace is associated with RTW of individuals at the end of a rehabilitation programme despite a long-term absence (n = 6), and conversely, that its absence would appear to be associated with a non-return to work (n = 4).A better understanding of this concept will help further the development of a tool to assist clinicians in their task of assessing a worker's capacity to return to a given job.

Introduction The task of evaluating workers’ capacity to return to their pre-injury employment or other jobs continues to pose a daily challenge for clinicians. In this study, a concept frequently used in the field of ergonomics, the margin of manoeuvre (MM), was applied during the rehabilitation process. The study identified the indicators of the MM taken into account during the return to work of workers with musculoskeletal disorders. Methods This study used a multiple-case design. A case was defined as a dyad comprising a worker admitted to a work rehabilitation program and the clinician who was managing the return-to-work process. The results were then validated with investigators and expert ergonomists, through group interviews. Content analyses were performed using the conceptual framework for the work activity model adapted from Vezina and the procedures recommended by Miles and Huberman. Results A total of 11 workers, five clinicians, two experts and two investigators participated in this study. The interview analysis process resulted in a more detailed definition of the MM and the identification of 50 indicators. The indicators were classified according to six dimensions: (1) work context; (2) employer’s requirements and expectations; (3) means and tools; (4) worker’s personal parameters; (5) work activity; and (6) impacts of the work situation. Conclusions The more specific indicators identified in this study will allow for more systematic observation of the MM. Subsequent studies will seek to link each indicator described in the model with a specific method of observation.

Introduction: Musculoskeletal disorders are among the main causes of short- and long-term disability. Aim: Identify the methods for assessing multidimensional components of illness representations. Methods: An electronic literature search (French, English) from 1980 to the present was conducted in medical, paramedical and social science databases using predetermined key words. After screening titles and abstracts based on a specific set of criteria, sixty-four articles were reviewed. Results: Qualitative approaches for assessing illness representation were found mainly in the fields of anthropology and sociology and were based on the explanatory models of illness. The interviews reviewed were: the Short Explanatory Model Interview, the Explanatory Model of Illness Catalogue and the McGill Illness Narrative Interview. Quantitative approaches were found in the health psychology field and used the following self-administered questionnaires: the Survey of Pain Attitudes, the Pain Beliefs and Perceptions Inventory, the Pain Beliefs Questionnaire, the Fear-Avoidance Beliefs Questionnaire, the Implicit Model of Illness Questionnaire, the Illness Perception Questionnaire, including its derivatives, and the Illness Cognition Questionnaire. Conclusion: This review shows the actual use and existence of multiple interviews and questionnaires in assessing multidimensional illness representations. All have been used and/or tested in a medical context but none have been tested in a work disability context. Further research will be needed to determine their suitability for use in a work disability context.