Amir Hossein Kahlaee

The relationship between flexibility and EMG activity pattern of the erector spinae muscles during trunk flexion–extension

BACKGROUND Movements in the lumbar spine, including flexion and extension are governed by a complex neuromuscular system involving both active and passive units. Several biomechanical and clinical studies have shown the myoelectric activity reduction of the lumbar extensor muscles (flexion-relaxation phenomenon) during lumbar flexion from the upright standing posture. The relationship between flexibility and EMG activity pattern of the erector spinae during dynamic trunk flexion-extension task has not yet been completely discovered. OBJECTIVE The purpose of this study was to investigate the relationship between general and lumbar spine flexibility and EMG activity pattern of the erector spinae during the trunk flexion-extension task. METHODS Thirty healthy female college students were recruited in this study. General and lumbar spine flexibilities were measured by toe-touch and modified schober tests, respectively. During trunk flexion-extension, the surface electromyography (EMG) from the lumbar erector spinae muscles as well as flexion angles of the trunk, hip, lumbar spine and lumbar curvature were simultaneously recorded using a digital camera. The angle at which muscle activity diminished during flexion and initiated during extension was determined and subjected to linear regression analysis to detect the relationship between flexibility and EMG activity pattern of the erector spinae during trunk flexion-extension. RESULTS During flexion, the erector spinae muscles in individuals with higher toe-touch scores were relaxed in larger trunk and hip angles and reactivated earlier during extension according to these angles (P<0.001) while in individuals with higher modified schober scores this muscle group was relaxed later and reactivated sooner in accordance with lumbar angle and curvature (P<0.05). Toe-touch test were significantly correlated with trunk and hip angles while modified schober test showed a significant correlation with lumbar angle and curvature variables. CONCLUSION The findings of this study indicate that flexibility plays an important role in trunk muscular recruitment pattern and the strategy of the CNS to provide stability. The results reinforce the possible role of flexibility alterations as a contributing factor to the motor control impairments. This study also shows that flexibility changes behavior is not unique among different regions of the body.

Trunk Muscles Activation Pattern During Walking in Subjects With and Without Chronic Low Back Pain: A Systematic Review

The purpose of this study was to identify how activity patterns of trunk muscles change in chronic LBP during walking.

The Association Between Neck Pain and Pulmonary Function: A Systematic Review.

Abstract The aim of this study was to systematically review the evidence on respiratory function changes in patients with chronic neck pain. MEDLINE, Elsevier, ProQuest, PubMed, Scopus, Springer, and Google scholar electronic databases were explored thorough December 2015. English-language studies investigating cervical musculoskeletal and respiratory parameters in patients with chronic neck pain were included. Characteristics of the patients, sampling method and size, musculoskeletal and respiratory parameters studied, and appropriateness of the statistical tests were considered. Studies were rated based on study design and performance. Of the 68 studies reviewed, 9 observational studies met our inclusion criteria. Significant difference in maximum inspiratory and expiratory pressures were reported in patients with chronic neck pain compared to asymptomatic subjects. Some of the respiratory volumes were found to be lower in patients with chronic neck pain. Muscle strength and endurance, cervical range of motion, and psychological states were found to be significantly correlated with respiratory parameters. Lower Pco2 in patients and significant relationship between chest expansion and neck pain were also shown. Respiratory retraining was found to be effective in improving some cervical musculoskeletal and respiratory impairment. Functional pulmonary impairments accompany chronic neck pain. Based on the observed association, investigation of the effectiveness of management of CNP on respiratory function is strongly suggested.

Effect of spinal stabilization exercise on dynamic postural control and visual dependency in subjects with chronic non-specific low back pain

BACKGROUND Motor control approach towards chronic non-specific low back pain (CNLBP) has gained increasing attention. CNLBP patients have shown to be more visually dependent for the postural control process than control subjects but no study has yet investigated the treatment programs effect on this disorder. METHODS Forty CNLBP patients volunteered to participate in this experimental study. The subjects were randomly assigned into either stabilization exercise (SE) or control group both receiving 12 sessions of routine physiotherapy for four weeks. The SE group also received intensive stabilization exercise. Balance (in terms of overall (OSI), anteroposterior (APSI) and mediolateral stability indices (MLSI)) and functional disability were assessed by Biodex Balance System(®) (BBS) and Oswestry Low Back Disability Questionnaire, respectively prior and after the interventions. The balance tests were performed with open and closed eyes. RESULTS Both interventions significantly decreased all stability indices but the SE group showed a more pronounced improvement in OSI and APSI. In the SE group, vision deprivation had smaller destabilizing effects on OSI and APSI as compared with the control group. The groups were not statistically different prior and after the interventions on all dependent variables. Oswestry index reduction in the SE group was more pronounced but the interaction of time and group variables were not significant on pain intensity. CONCLUSION Both interventions effectively enhanced stability indices and functional capabilities and reduced pain intensity in CNLBP patients. The SE protocol made the patients less visual dependent perhaps via better stability. Since pain reduction was not different between the groups, more functional improvement in SE group cannot simply be interpreted via the pain interference and might be related to postural control capabilities of the patients.

Congenital bony fusion (absence) of the knee: A case report

Congenital knee ankylosis is a rare condition which might be accompanied with other abnormalities or not. To our knowledge, there is no report on true bony ankylosis of the knee. The only ones in the literature include fibrous knee ankylosis. Thus this seems to be the first presentation of true congenital bony fusion of the knee joint.

The Relevance of Proprioception to Chronic Neck Pain: A Correlational Analysis of Flexor Muscle Size and Endurance, Clinical Neck Pain Characteristics, and Proprioception

Background Impairment in the cervical proprioception and deep flexor muscle function and morphology have been regarded to be associated with chronic neck pain (CNP). Objective The aim of the study is to assess the relationship between proprioception and flexor endurance capacity and size and clinical CNP characteristics. Design This was an observational, cross-sectional study. Setting Rehabilitation hospital laboratory. Subjects Sixty subjects with or without CNP participated in the study. Methods Joint position error, clinical deep flexor endurance test score, longus colli/capitis and sternocleidomastoid muscle size, pain intensity, neck pain-related disability, and fear of movement were assessed. Multivariate analysis of variance and Pearson correlation tests were used to compare the groups and quantify the strength of the associations among variables, respectively. Logistic regression analysis was performed to test the predictive value of the dependent variables for the development of neck pain. Results CNP patients showed lower flexor endurance (P = 0.01) and smaller longus colli size (P < 0.01). The joint position error was not statistically different between the groups. Longus colli size was correlated with local flexor endurance in both CNP (P = 0.01) and control (P = 0.04) groups. Among clinical CNP characteristics, kinesiophobia showed fair correlation with joint position error (r = 0.39, P = 0.03). Left rotation error and local flexor endurance were significant predictors of CNP development (β = 1.22, P = 0.02, and β = 0.97, P = 0.02, respectively). Conclusions The results indicated that cervical proprioception was associated neither with deep flexor muscle structure/function nor with clinical CNP characteristics. Left rotation error and local flexor endurance were found relevant to neck pain development.

Relationship Between Proprioception and Endurance Functionality of the Cervical Flexor Muscles in Chronic Neck Pain and Asymptomatic Participants

Objective: The purpose of this study was to compare the relationship between flexion endurance capacity and joint position error in participants with or without chronic neck pain (CNP). Methods: Sixty‐one CNP and 60 asymptomatic volunteers participated in this cross‐sectional, case‐control, and correlational analysis study. The measured variables included absolute and constant joint repositioning errors in the sagittal and horizontal directions, clinical flexor endurance test score, pain intensity, and neck disability index. Results: The groups did not statistically differ in flexion endurance (P > .05). The CNP group had a smaller absolute error on the right (P < .01) and left (P = .01) rotation and an overshooting error pattern in the flexion direction (P < .05). But the asymptomatic group did not exhibit any over‐/undershooting pattern tendency (P > .05). Although flexion endurance was not correlated with any of the joint repositioning error components in either group, pain and disability scores were significantly correlated with left rotation absolute error (r = –0.34 and &rgr; = –0.37, respectively). Conclusion: The clinical cervical flexor endurance test, ignoring the relative contribution of the deep and superficial groups of muscles, may not efficiently characterize CNP patients.

The Effectiveness of Occupational Therapy Supervised Usage of Adaptive Devices on Functional Outcomes and Independence after Total Hip Replacement in Iranian Elderly: A Randomized Controlled Trial.

The aim of this randomized controlled trial was to assess the effect of an occupational therapy protocol of teaching the usage of adaptive devices to older individuals in Iran who have had a total hip replacement as compared with conventional occupational therapy on functional outcomes and independence. Forty individuals diagnosed with osteoarthritis and a total hip replacement aged >60 years were randomly allocated to either control group (n = 20) or experimental (n = 20) group. Pain, disability, independence and hip muscle strength were assessed with visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis and Barthel Index and dynamometer, 2 days before and 6 weeks after the hip operation. Both groups received conventional occupational therapy, but the experimental group was additionally supervised on the use of adaptive devices. Correct use of the devices was instructed during the training session. Both groups significantly improved on all variables post-operatively. However, the experimental group showed significantly more improvement in all dependent variables post-operatively. No data were available on the use of the devices by the control group patients. Supervision of the utilization of the adaptive devices during regular home visits by the occupational therapist is recommended. Further research is needed to clarify which aspects of this supervision were most beneficial for the patients. Copyright

The Influence of Cognitive Behavioral Therapy on Pain, Quality of Life, and Depression in Patients Receiving Physical Therapy for Chronic Low Back Pain: A Systematic Review

The purpose of this systematic review was to investigate the effect of adding the cognitive behavioral treatment (CBT) component to routine physical therapy (PT) on pain and depression reduction, improvement in quality of life, and enhanced function in patients with chronic low back pain (CLBP).

The Effect of Early Progressive Resistive Exercise Therapy on Balance Control of Patients With Total Knee Arthroplasty: A Randomized Controlled Trial

Background and Purpose: Although total knee arthroplasty (TKA) is a common treatment for severe osteoarthritis, high risks of fall and balance loss are the main complications of this procedure. While multiple rehabilitation protocols have been suggested for TKA, efficacy of early resistive exercise therapy aimed at improving balance has not yet been thoroughly investigated. Methods: In this double-blind randomized controlled trial study, 40 patients with severe osteoarthritis, sampled by a simple convenient method, were randomly assigned into either “control” group or “early resistive exercise” group. After TKA surgery, both groups attended a routine rehabilitation program while the experimental group received extra early resistive exercises. Static, semidynamic, and dynamic balance were assessed by the Sharpened Romberg (SRBT), Star Excursion (SEBT), and Berg (BBT) balance tests prior to surgery, after the rehabilitation process (seventh week), and at a 2-week later follow-up time (ninth week). Results: At the end of the seventh and ninth weeks, in both groups all 3 balance scores were significantly enhanced comparing the baseline scores (P < .001). The experimental group had significantly higher scores than the control group in SRBT, SEBT, and BBT after the intervention and at the follow-up time (P < .001). Discussion and Conclusions: The findings of this study showed that rehabilitation following TKA is accompanied by balance (static, semidynamic, and dynamic) improvement, and this improvement is greater among patients participating in an early resistive exercise regimen. Early progressive resistive exercise in addition to routine physical therapy may lead to better balance performance than routine physical therapy and might be incorporated into the postoperative physical therapy of these patients. Further studies with longer follow-up periods are needed to confirm these results.