The aim of this study was to investigate the effect of continuous ultrasound (US) plus exercise on the endurance of paravertebral muscles of patients with chronic non specific low back pain (CNSLBP).In this pilot, pretest-posttest study, 22 patients with CNSLBP participated. Patients received 10 sessions of treatment, including continuous US plus exercise therapy, over a period of four consecutive weeks. Median frequency slopes of Iliocostalis and Multifidus muscles as well as holding time during Biering-Sorensen test were measured using surface electromyography. In addition, function and pain were measured using Functional Rating Index (FRI) questionnaire and VAS.Five females and 15 males with a mean age of 31.7 years completed the treatment. Descriptive data showed a decrease of 0.01 and 0.02 mean in median frequency slope of right and left Iliocostalis respectively and a mean of 0.08 decrease for both right and left Multifidus muscles. Endurance time increased 1.8 seconds mean. Both function (17%) and pain (24%) improved post treatment.Larger population studies in the context of high quality, randomized clinical trial are needed to validate the results.

There is growing interest in the role of abnormal asymmetrical posture, which is considered one of the most important etiological factors reported to be associated with mechanical low back pain.This study was conducted to investigate the effect of lumbar extension traction on the pain, function and whole spine sagittal balance as represented in lumbar curvature, thoracic curvature, C7 plumb line, and sacral slope.Eighty patients with chronic mechanical low back pain (CMLBP) and definite hypolordosis were randomly assigned to traction or a control group. The control group (n=40) received stretching exercises and infrared radiation, whereas the traction group (n=40) received lumbar extension traction in addition to stretching exercises and infrared radiation three times a week for 10 weeks. Back pain rating scale, Oswestry Disability Index, and radiological spine sagittal balance parameters in terms of lumbar lordosis, thoracic kyphosis, sacral slope, and positioning of C7 plumb line were measured for all patients at three intervals (before treatment, after 10 weeks of treatment, and at six months follow-up).There was a significant difference between the traction and control groups adjusted to baseline value of outcome at 10 weeks post treatment with respect to lumbar lordotic curve (P=0.000), thoracic kyphosis (P=0.013), sacral slope (P=0.001), C7 plump line distance (p=0.001), while there was no significant difference with respect to pain (p=0.29) and Oswestry Disability Index (ODI) (p=0.1). At 6-months follow-up, there were significant differences between both groups for all the previous variables (p< 0.05).Lumbar extension traction in addition to stretching exercises and infrared radiation improved the spine sagittal balance parameters and decreased the pain and disability in CMLBP.

To investigate the effects of knee osteoarthritis (OA) on activities of daily living and motor and functional improvement in stroke patients with hemiparesis.This prospective case-controlled study included 60 inpatients (44 women, 16 men; mean age 66.1 ± 7.6 years, range 51-79 years) with hemiparesis after stroke. Main outcome measures included the Brunnstrom motor recovery stages of the lower extremity, Functional Ambulation Category (FAC), Barthel index, knee pain as assessed by a VAS, and radiographic severity of knee OA based on the Kellgren-Lawrence (K/L) criteria.Between improvements in FAC score and time since stroke , Barthel score, knee pain at rest, K/L radiological grade revealed weak but significant correlations (r: 0.254-0.393) (p< 0.05). Regression analysis revealed that time since stroke, knee pain at rest and radiologically knee ostearthritis had a significant effect on the improvement in ambulation level (r=0.134, p=0.001; r=0.137, p<0.05; r=-0.007, p< 0.05; respectively).The present study shows that knee OA had a negative effect on ambulation levels in hemiplegic patients after stroke. Thus, knee pain at rest and knee ostearthritis could be evaluated as a functional outcome factor for the improvement of the ambulation levels within stroke patients.

Patients with osteoporotic vertebral compression fracture (OVCF) have postural changes and increased risk of falling. The aim of this study is to compare balance characteristics between patients with OVCF and healthy control subjects.Patients with severe OVCF and control subjects underwent computerised dynamic posturography (CDP) in this case-control study.Forty-seven OVCF patients and 45 controls were recruited. Compared with the control group, the OVCF group had significantly decreased average stability; maximal stability under the `eye open with swayed support surface' (CDP subtest 4) and 'eye closed with swayed support surface' conditions (subtest 5); and decreased ankle strategy during subtests 4 and 5 and under the `swayed vision with swayed support surface' condition (subtest 6). The OVCF group fell more frequently during subtests 5 and 6 and had longer overall reaction time and longer reaction time when moving backward during the directional control test.OVCF patients had poorer static and dynamic balance performance compared with normal control. They had decreased postural stability and ankle strategy with increased fall frequency on a swayed surface; they also had longer reaction times overall and in the backward direction. Therefore, we suggest balance rehabilitation for patients with OVCF to prevent fall.

To investigate training effects of two different resistance and proprioceptive exercising concepts of neck muscles.Twenty-six healthy women participated in a randomized pilot trial. The test persons were randomized to two different neck-training programs (resistance training (RT) and proprioceptive resistance training (PRT)). They performed a standardized training program for the duration of ten weeks two times weekly. The neck strength, the cross-sectional area of three neck muscle groups (1. sternocleidomastoid muscles; 2. multifidus and semispinalis cervicis muscles; 3. semispinalis capitis and splenius muscles) and the proprioceptive capability evaluated by the dynamic joint repositioning error (DJRE) of the head were assessed pre- and post-intervention.Strength gain did not differ significantly between the two resistance training groups (PRT group: 8.2% to 29.3%; RT group: 1.4% to 19.8%). Change of hypertrophy of all neck muscle groups was significantly (p< 0.001 to p=0.013) greater in the PRT group (18.9% to 32.3%) than in the RT group (1.5% to 12.9%). The DJRE deteriorated with 35% in the RT group and did not change in PRT group (-2.0%).In combination with resistance training, proprioceptive training led to a significantly higher muscle hypertrophy and didn't effect a significant deterioration of the proprioceptive capability compared to isolated resistance training.

Current evidence suggests that lumbosacral transforaminal epidural steroid injection (TFESI) is an effective treatment for lumbosacral radicular pain. However, practitioners may be reluctant to attempt this intervention in obese patients because of a perceived reduction in the chance of providing pain relief due to the increased technical difficulty of TFESI in individuals with a larger body habitus. No study to date has compared the effectiveness of TFESI in groups stratified by BMI. We report pilot data addressing whether lumbosacral transforaminal epidural steroid injection is as effective in treating lumbosacral radicular pain in the obese and overweight population as it is in the non-overweight population.This study consisted of 9 normal weight (18.5 < BMI < 25), 9 overweight (25 < BMI < 30), and 6 obese (BMI > 30) patients who presented with lumbosacral radicular pain and received a TFESI. For each group, percent reduction in pain and the proportion of individuals with a 50% or greater reduction in pain 2-4 weeks after TFESI was determined.Comparing the overweight and obese groups to the normal weight group, no significant differences were found in the percent improvement in pain after TFESI (p=0.7154, p=0.4566) or in the proportion of each group with a 50% or greater reduction in lower back pain after TFESI (p=0.2968).Our pilot data indicates that lumbosacral TFESI is as effective in providing short-term relief of lumbosacral radicular pain in obese and overweight patients as it is in non-overweight patients. However, our sample size was not large enough to find a significant difference at a power of 80%. We plan to perform a larger prospective study to confirm the findings of this study.Case-control study, Level II-2.

Many studies have evaluated factors related to lumbar multifidus (MF) muscle atrophy. However, few studies have investigated radiculopathy and the MF muscle. In this study, the association between radiculopathy and lumbar MF muscle atrophy in magnetic resonance imaging (MRI) was evaluated.In total, 100 patients with low back pain or radiating leg pain were examined. Their lumbar MRIs were visually analyzed semi-quantitatively for signs of lumbar MF muscle atrophy. The severity and extent of MF atrophy were compared between non-radiculopathy (Non-rad) and radiculopathy (Rad) groups. Asymmetry of MF atrophy was also compared between unilateral radiculopathy (UniR) and bilateral radiculopathy (BiR) groups.Significantly more severe and extensive MF atrophy was observed in the Rad group than in the Non-rad group (p< 0.01). However, no difference in the asymmetry of MF atrophy was found between the UniR and BiR groups (p> 0.05).More severe and extensive atrophy in the lumbar MF muscle was associated with radiculopathy. Thus, we might consider the presence of radiculopathy when severe and extensive multi-level involvement of MF atrophy is seen in MRI.

Cervical and lumbar roots may be irritated or compressed due to the pathological conditions such as disc herniations, degenerative foraminal stenosis, trauma and tumors. Electrophysiologic tests are frequently used in conjunction with imaging modalities for evaluation of low back and neck pain radiating to extremities, primarily for the purpose of establishing the presence or absence of a radiculopathy. In this study, we aimed to evalulate the relationship between clinic and electroneuromyographic (ENMG) findings in patients with suspected radiculopathies. Forty one patients with radicular complaints in the upper extremities and 51 patients with radicular complaints in the lower extremities were included in this study. McNemar test and Kappa coefficients between the two methods were applied to each group of patients, in order to test the significance of the difference between the two diagnostic procedures' ability on finding out the pathology. The McNemar test identified a significant difference between the two diagnostic approaches both for cervical and lumbar radiculopathies (p<0.001). The Kappa coefficients between the two methods were determined as 0.08 and 0.07, respectively. This means, efficacy of anamnesis and neurological examination for the prediction of electrodiagnostic tests was found to be limited. Normal neurological examination results in a patient with suspected radiculopathy can not eliminate abnormal electrodiagnostic test results; likewise, abnormal findings in the neurological examination would not mean finding pathologies in the electrodiagnostic tests. For more accurate approach to a patient, neurological examination and electrodiagnostic tests must be used and interpreted together.

Muscle imbalance between the abductor hallucis (AbdH) and adductor hallucis (AddH) has been demonstrated in hallux valgus (HV). Clinically, the short-foot (SF) is performed for strengthening foot intrinsic muscle. The toes-spread-out (TSO), the newly introduced, was devised to correct HV deformity. However, there was no study to determine which exercise is effective in balancing the ratio of activation between AbdH and AddH muscles. The purpose of this study was to compare the muscle activities of the AbdH and AddH between SF and TSO exercises in subjects with mild HV.Eighteen subjects with mild HV participated. The muscle activity of AbdH and AddH and the angle of first metatarsophalangeal (MTP) joint in the horizontal plane were measured during the SF and TSO exercises. Values of dependent variables were compared using a paired t-test between the SF and TSO exercises.The TSO exercise showed significantly greater activation of the AbdH than did the SF exercise (mean difference=44.96% of maximum voluntary isometric contraction; p< 0.001). There was no significant difference between the SF and TSO exercises in activating the AddH (mean difference=8.28% of maximum voluntary isometric contraction; p=0.271). The ratio of AbdH to AddH muscle activity was significantly higher in the TSO exercise than in the SF exercise (mean difference=0.54; p=0.001). The angle of the first MTP joint in the horizontal plane during the TSO was significantly greater than that in the SF exercise (mean difference=9.60°; p<0.001).These results suggest that the TSO exercise can be recommended for preventing or correcting HV deformity at an early stage.

This study aims to analyze muscle activity of the lower limbs during stance phase of gait in accordance with the application of various vertical loadings.Participants who met the criterion for this study (n=11). During their gait, various vertical loadings (0 kg, 0.5 kg, 1 kg) were provided and their muscle activities in the lower limbs during stance phase were measured. In order to accurately measure their gait, they were instructed to walk 5 gait cycles, and 3 gait cycles excluding the front and back 1 cycle were used for analysis. For the objectivity of data, measurements were made three times under each condition and average values were employed for statistic analysis.The intervention of applying various vertical loadings of 0 kg, 0.5 kg, 1 kg to the lower limbs during swing phase in order to compare muscle activities of the lower limbs during stance phase of gait resulted in the following outcomes. Tibialis anterior and peroneus longus muscle activities did not significantly differ with the application of various vertical loadings to the lower limbs during swing phase, while gluteus medius muscle activities significantly differed according to the levels of loadings applied. There were significant differences in muscle activities between the loading of 0 kg and the loading of 0.5 kg.Clinicians may use these results to effectively progress strengthening for gluteus medius in the rehabilitation of lower extremity injuries.