Daniel Pecos Martín

Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study.

OBJECTIVE The purpose of this study was to determine immediate effects of ischemic compression (IC) and ultrasound (US) for the treatment of myofascial trigger points (MTrPs) in the trapezius muscle. METHODS Sixty-six volunteers, all CEU-Cardenal Herrera University, Valencia, Spain, personnel, participated in this study. Subjects were healthy individuals, diagnosed with latent MTrPs in the trapezius muscle. Subjects were randomly placed into 3 groups: G1, which received IC treatment for MTrPs; G2, which received US; and G3 (control), which received sham US. The following data were recorded before and after each treatment: active range of motion (AROM) of cervical rachis measured with a cervical range of motion instrument, basal electrical activity (BEA) of muscle trapezius measured with surface electromyography, and pressure tolerance of MTrP measured with visual analogue scale assessing local pain evoked by the application of 2.5 kg/cm(2) of pressure using a pressure analog algometer. RESULTS The results showed an immediate decrease in BEA of the trapezius muscle and a reduction of MTrP sensitivity after treatment with both therapeutic modalities. In the case of IC, an improvement of AROM of cervical rachis was also been obtained. CONCLUSION In this group of participants, both treatments were shown to have an immediate effect on latent MTrPs. The results show a relation among AROM of cervical rachis, BEA of the trapezius muscle, and MTrP sensitivity of the trapezius muscle gaining short-term positive effects with use of IC.

Pain Neurophysiology Education and Therapeutic Exercise for Patients With Chronic Low Back Pain: A Single-Blind Randomized Controlled Trial.

OBJECTIVE To assess the effect of a pain neurophysiology education (PNE) program plus therapeutic exercise (TE) for patients with chronic low back pain (CLBP). DESIGN Single-blind randomized controlled trial. SETTING Private clinic and university. PARTICIPANTS Patients with CLBP for ≥6 months (N=56). INTERVENTIONS Participants were randomized to receive either a TE program consisting of motor control, stretching, and aerobic exercises (n=28) or the same TE program in addition to a PNE program (n=28), conducted in two 30- to 50-minute sessions in groups of 4 to 6 participants. MAIN OUTCOMES MEASURES The primary outcome was pain intensity rated on the numerical pain rating scale which was completed immediately after treatment and at 1- and 3-month follow-up. Secondary outcome measures were pressure pain threshold, finger-to-floor distance, Roland-Morris Disability Questionnaire, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and Patient Global Impression of Change. RESULTS At 3-month follow-up, a large change in pain intensity (numerical pain rating scale: -2.2; -2.93 to -1.28; P<.001; d=1.37) was observed for the PNE plus TE group, and a moderate effect size was observed for the secondary outcome measures. CONCLUSIONS Combining PNE with TE resulted in significantly better results for participants with CLBP, with a large effect size, compared with TE alone.

C0065 Different feedback methods to improve lumbar multifidus contraction

Background The high prevalence of non-specific low back pain and its correlation with the findings in the lumbar multifidus muscles (electromyography activity, morphology and thickness) and good results in motor control exercises programs to reduce pain and disability justifies the use of tools to facilitate the integration of the muscle contraction. Methods Experimental study, randomised controlled trial single-blinded formed by 3 parallel groups: verbal order (n=5), visual feedback (n=6) and visual feedback with transcutaneous electrical stimulation (n=6). Descriptive data (age, gender, height and weight) and thickness of multifidus by ultrasound imaging data (2 pre-intervention and 2 post-intervention) were collected. Results Statistically significant differences were found in lumbar multifidus thickness after interventions between groups (p<0.001). Thickness differences were greater in visual feedback group (0.64 cm) and visual feedback with transcutaneous electrical stimulation (0.56 cm) than verbal order group (0.29 cm). Pre-intervention measurements error were less than 0.05 cm. Conclusions The results of this study suggest that the use of visual feedback by ultrasound imaging with or without transcutaneous electrical stimulation improve the lumbar multifidus contraction capacity in asymptomatic subjects.

C0096 Ultrasound images changes of the lumbar multifidus muscle during the straight leg raise test in patients with low back pain

Background Changes in function of lumbar multifidus (LM) muscle have been observed in patients with low back pain (LBP). These changes seem to contribute to the development of pain and dysfunction in the lumbopelvic region.The aim of this study was to determine changes in thickness of LM measured by ultrasound imaging during straight leg raise test (SLR) in chronic LBP patients and asymptomatic subjects. Methods The percentage of change in thickness of LM muscle during SLR and after maintaining a 5 s SLR using ultrasound imaging was compared. Observed changes were analysed as contraction percentage (contraction thickness-resting thickness/contraction thickness x 100). Results Thirty-nine patients, 18 with chronic LBP (mean age: 43±9 years) and 21 asymptomatic subjects (mean age: 42±1 years) were recruited. The analysis of variance showed significant differences between both groups for ultrasound imaging measures. We observed statistically significant differences in contraction percentage during SLR comparing LBP patients with asymptomatic subjects in right LM (t=3.353; p=0.002) and in left LM muscle (t=3.889; p<0,001), with a percentage difference between groups of 8.00063% y 6.653%, respectively. The analysis of changes in contraction percentages after maintaining a SLR during 5 s revealed significant differences in both right and left LM (6.37029% y 8.51805% respectively). Conclusions There are changes in thickness of LM muscle in LBP patients during SLR, which suggests that patients with chronic LBP exhibit lower activation of this muscle during the SLR test. Ultrasound imaging measures during SLR seems to represent a non-invasive and clinically useful method to register changes in LM function.