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Background: Scientific research has demonstrated impaired central pain modulation, cognitive and psychosocial deficits in patients with chronic whiplash associated disorders (CWAD). However, the underlying mechanisms remain unclear. To date, research regarding central pain modulation, cognitive performance and psychosocial characteristics in patients with chronic non-traumatic neck pain is lacking. Purpose: To examine central pain modulation (i.e. central sensitization), cognitive and psychosocial functioning in patients with CWAD and chronic idiopathic neck pain (CINP) compared to healthy individuals. Methods: Ninety-five women, 28 healthy pain-free controls, 35 CINP and 32 CWAD patients were enrolled. First, all participants filled out psychosocial questionnaires, namely the Short Form Health Survey (SF-36), the Neck Disability Index (NDI) and the Central Sensitization Inventory (CSI). Next, they were subjected to cognitive performance assessments and experimental pain measurements. Participants completedthe modified Perceived Deficits Questionnaire (mPDQ) in order to evaluate self-perceived cognitive deficits. Subsequently, they performed the Trail Making Test (TMT), an objective cognitive test. Afterwards, pressure pain thresholds (PPTs), and conditioned pain modulation (CPM) were examined. The Kruskal-Wallis test was applied to explore differences between all study groups. Post-hoc comparisons with a significance threshold of p

Background: Structural brain plasticity is observed as a consequence of alterations in input/behavior or of disease. For instance aging is associated with structural decline of the brain, and structural brain alterations have been identified in certain medical pathologies. While physical exercise has a positive impact on function, health status and quality of life in those affected by disease or neurodegenerative related deteriorations, the question remains if structural plasticity of the brain underlies these beneficial effects. Aims: To summarize the current evidence concerning the effect of physical therapy/training on the structure of the brain in elderly and adults affected by disease related impairments, and whether exercise training induced changes in brain structure are associated with improvements in functional outcome. Methods: A systematic literature review following the PRISMA-guidelines was performed. Results: Sixteen articles we included, from which 5 examined the effect of physical training in healthy elderly adults and 11 in patients suffering from medical conditions. Failing to blind participants and therapist(s), not accounting for confounders, and incomplete data reporting were the most frequent causes for high risk of bias. Conclusions: There is strong evidence for increased gray matter (GM) volume in prefrontal cortex, temporal lobe (hippocampus) and supplementary motor area after aerobic training, and moderate evidence for increased GM volume in sensory & motor cortices and temporal lobe (hippocampus) after pathology-specific training. General exercise programs and resistance training do not increase GM volume. There is weak evidence supporting cortical thickness increases after pathology specific training, but not following aerobic and general exercise programs. In healthy elderly, aerobic exercise is neuroprotective and increases both GM and white mater (WM) volume. Regarding WM microstructural reorganization no clear conclusions can be drawn. The observed volumetric brain changes are related to post-training improvements in physical or cognitive performance, indicating improvements in functionality due to training are subserved by structural brain plasticity.

BACKGROUND AND AIMS: There is a growing need to identify patient pre-treatment characteristics that could predict the responsiveness to specific interventions. Therefore this study aimed to identify predictors of response to outpatient multimodal rehabilitation (favourable versus non-favourable outcome) and predictors of therapeutic adherence (drop-out versus adherence to therapy) in patients with chronic low back pain. METHODS: A total of 273 chronic low back patients participated in an exercise-based rehabilitation program of an outpatient rehabilitation centre in Belgium between September 2013 and February 2015. A univariate and a multivariate logistic regression analysis were performed to analyse predictors. A linear mixed model was used for analysis of repeated measures. RESULTS: A higher age (OR=0.962) and a higher Tampa Scale of Kinesiophobia score (OR=0.870) increased the odds to complete the treatment program, whereas higher levels of back pain intensity (OR=1.247) increased the odds for non-adherence. A higher Oswestry Disability Index score (OR=0.963) decreased the odds for a favorable outcome. The treatment program had significant group, time, and time-by-group interaction effects on back pain intensity, catastrophizing, kinesiophobia and depressive symptoms, with the favorable outcome group showing a significant improvement after treatment. CONCLUSIONS: Assessment of chronic low back pain patient pre-treatment characteristics such as age, degree of kinesiophobia, back pain intensity and disability levels is of great importance as they may allow therapists to identify patients with a good prognosis or patients at risk for non-responding to multimodal treatment program. Directing the treatment according to those characteristics could function as a tool to optimize treatment benefits. At the same time, patients at risk for non-responding could be identified and referred to a different treatment approach.

Context: Overhead activities such as throwing, tennis, or volleyball place athletes at considerable risk for overuse injuries. A relationship between scapulothoracic muscle imbalance and shoulder pain has been suggested.Objective: To compare the isokinetic muscle performance of the scapular muscles between overhead athletes with impingement symptoms and uninjured overhead athletes and to identify strength deficits in the patient population.Design: A repeated-measures analysis of variance with 1 within-subjects factor (side) and 1 between-subjects factor (group) was used to compare strength values and agonist:antagonist ratios across sides and across groups.Setting: University laboratory.Patients or Other Participants: Thirty overhead athletes with chronic shoulder impingement symptoms and 30 overhead athletes without a history of shoulder pain.Intervention(s): A linear protraction-retraction movement in the scapular plane at 2 velocities (12.2 cm/s and 36.6 cm/s).Main Outcome Measure(s): Isokinetic strength values and protraction:retraction ratios for both velocities.Results: Overhead athletes with impingement symptoms showed decreased force output:body weight at both velocities in the protractor muscles on the injured side compared with the uninjured side (-13.7% at slow velocity, -15.5% at high velocity) and compared with the control group at high velocity (-20.7%). On both sides, the patient group had significantly lower protraction:retraction ratios than the control group, measured at slow velocity (nondominant = -11%, dominant = -13.7%).Conclusions: Overhead athletes with impingement symptoms demonstrated strength deficits and muscular imbalance in the scapular muscles compared with uninjured athletes.