Gisela Sole

The effectiveness of manual therapy in the management of musculoskeletal disorders of the shoulder: A systematic review

A systematic review of randomised controlled trials (RCTs) was conducted to determine the effectiveness of manual therapy (MT) techniques for the management of musculoskeletal disorders of the shoulder. Seven electronic databases were searched up to January 2007, and reference lists of retrieved articles and relevant MT journals were screened. Fourteen RCTs met the inclusion criteria and their methodological qualities were assessed using the PEDro scale. Results were analyzed within diagnostic subgroups (adhesive capsulitis (AC), shoulder impingement syndrome [SIS], non-specific shoulder pain/dysfunction) and a qualitative analysis using levels of evidence to define treatment effectiveness was applied. For SIS, there was no clear evidence to suggest additional benefits of MT to other interventions. MT was not shown to be more effective than other conservative interventions for AC, however, massage and Mobilizations-with-Movement may be useful in comparison to no treatment for short-term outcomes for shoulder dysfunction.

Selective strength loss and decreased muscle activity in hamstring injury.

STUDY DESIGN Cross-sectional, controlled laboratory study. OBJECTIVES To determine whether thigh muscle isokinetic torque patterns and activity, measured by electromyography (EMG), of individuals with hamstring injury differ from control individuals. BACKGROUND Neuromuscular control during thigh muscle strength assessment following hamstring injuries has not been reported. METHODS Fifteen athletes with prior hamstring injury (hamstring-injured group [HG]) were compared to 15 uninjured athletes (control group [CG]). The injuries were incurred 6 weeks to 12 months prior to participation, and all injured athletes had returned to at least partial training. Participants performed 5 isokinetic concentric extensor, concentric flexor, and eccentric flexor torque tests at 60°/s in the seated position. Peak torque was determined for each contraction type, as well as average torque for each of 4 time-based movement quartiles. EMG root-mean-squares were calculated in these movement quartiles for the biceps femoris and medial hamstrings. RESULTS No significant differences were found for peak torque for all contractions, when comparing HG injured and uninjured sides to CG bilateral averages. The HG injured limb eccentric flexor torque was significantly lower in the fourth quartile (approximately 25° to 5° knee flexion, hamstring lengthened range) compared to the CG bilateral average (P = .025). Eccentric flexor biceps femoris and hamstrings EMG root-mean-squares of the HG injured and the uninjured sides were significantly lower in the second to fourth quartiles (towards the lengthened range), compared to the CG bilateral averages (P<.05). CONCLUSION Decreased strength and EMG activation in a lengthened hamstrings range for the athletes with prior hamstring injury suggested a change in neuromuscular control. Lengthened range assessment of isokinetic eccentric flexor torque may be useful for the assessment of athletes with a prior injury; however, results should be confirmed with prospective studies.

Effects of external pelvic compression on form closure, force closure, and neuromotor control of the lumbopelvic spine – A systematic review

Optimal lumbopelvic stability is a function of form closure (joint anatomy), force closure (additional compressive forces acting across the joints) and neuromotor control. Impairment of any of these mechanisms can result in pain, instability, altered lumbopelvic kinematics, and changes in muscle strength and motor control. External pelvic compression (EPC) has been hypothesised to have an effect on force closure and neuromotor control. However, the specific application parameters (type, location and force) and hypothesized effects of EPC are unclear. Thus, a systematic review was conducted to summarize the in vivo and in vitro effects of EPC. Eighteen articles met the eligibility criteria, with quality ranging from 33% to 72% based on a modified Downs and Black index. A modified van Tulders rating system was used to ascertain the level of evidence synthesised from this review. There is moderate evidence to support the role of EPC in decreasing laxity of the sacroiliac joint, changing lumbopelvic kinematics, altering selective recruitment of stabilizing musculature, and reducing pain. There is limited evidence for effects of EPC on decreasing sacral mobility, and affecting strength of muscles surrounding the SIJ, factors which require further investigation.

Altered muscle activation following hamstring injuries

Objective The purpose of this study was to compare the electromyographic (EMG) activity of gluteal and thigh muscles of sportspeople with a recent hamstring injury with uninjured controls during a weight-bearing task. Study design Cross-sectional. Setting University laboratory. Participants 16 participants with a hamstring injury (hamstring-injured group, HG) and 18 control participants (control group (CG)) participated in the study. Main outcome measure The EMG activity of gluteal, quadriceps and hamstring muscles was recorded during a movement from double- to single-leg movement using surface electrodes. Results The EMG onsets of biceps femoris and medial hamstrings were significantly earlier for the HG injured and the uninjured sides in preparation for single-leg standing when compared with the CG average. There were no differences in onsets for the gluteal and quadriceps muscles when comparing the injured or uninjured legs of the HG to the bilateral average of the CG. Conclusion The earlier onset of the injured and the uninjured hamstrings in preparation for single leg stance of the HG in comparison with the CG suggests an alteration in the motor control of these muscles. Altered neuromuscular control following a hamstring injury may be a factor to be considered in the rehabilitation of hamstring injuries.

Extrinsic feedback and management of low back pain: A critical review of the literature

Effective intervention for low back pain (LBP) can include feedback in one form or other. Although extrinsic feedback (EF) can be provided in a number of ways, most research has not considered how different EF characteristics (e.g. timing and content) influence treatment outcomes. A systematic search related to feedback and LBP was performed on relevant electronic databases. This narrative review aims to describe the forms of feedback provision in the literature regarding management of LBP, and to discuss these in light of previously recommended principles for the use of extrinsic feedback. The present review found support for the provision of EF that focuses on content characteristics including program feedback, summary results feedback, and external focus of attention. Temporal characteristics should enhance the use of intermittent or self-selected feedback. The literature does not support the provision of concurrent or constant EF. As much of the literature related to EF in the management of LBP has not considered content and timing characteristics we have identified future research directions that will clarify the use of content and timing characteristics of EF relative to the management of LBP.

The effects of shoulder injury on kinaesthesia : A systematic review and meta-analysis

The aim of this systematic review was to synthesize the evidence for changes for proprioceptive variables consisting of movement and position sense in participants with glenohumeral musculoskeletal disorders. Five databases were searched until 13th August 2013. Methodological quality was assessed and meta-analyses were performed for active and passive joint reposition sense (AJPS and PJPS) and movement sense, determined with threshold to detection of passive motion (TTDPM). The search yielded 17 studies, four of which were classified as having high methodological quality, seven as moderate and six as low quality. For participants with post-traumatic glenohumeral instability, pooled findings indicate moderate evidence for higher TTDPM for involved shoulders compared to control groups and the contralateral uninvolved side, indicating decreased movement sense. For AJPS and PJPS there was moderate to limited evidence for significant increased errors for involved compared to uninvovled shoulders, but not when compared to the control groups. Limited evidence was found for decreased AJPS acuity for patients with chronic rotator cuff pain and for patients with unspecified shoulder pain compared to healthy controls. Movement sense is most likely to be impaired after shoulder injury involving post-traumatic instability when compared to the contralateral shoulder and to controls, while deficits for AJPS and PJPS are more likely to be evident compared to the contralateral shoulder in participants with glenohumeral musculoskeletal disorders.

Dose–response relationship between work-related cumulative postural exposure and low back pain: A systematic review

OBJECTIVES To assess the evidence for a dose-response relationship between ROM, duration, and frequency of trunk flexion, and risk of occupational LBP. METHODS An electronic systematic search was conducted using Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Scopus databases focusing on cohort and case-control studies. Studies were included if they focused on non-specific LBP and postural exposure, considering ROM, duration, or frequency of trunk flexion as independent variables. No language restriction was imposed. Included studies were assessed for risk of bias using the Newcastle-Ottawa Scale for observational studies and a summary of evidence is presented. RESULTS Eight studies were included and all were methodologically rated as high quality. The included studies yielded a total of 7023 subjects who were considered for risk analysis. Different outcome measures for postural exposure were adopted making meta-analysis difficult to perform. CONCLUSIONS We could not find a clear dose-response relationship for work posture exposures and LBP. Limited evidence was found for ROM and duration of sustained flexed posture as risk factor for LBP. We found no evidence for frequency of trunk flexion as a risk factor for LBP.

Clinical Measurement of Scapular Upward Rotation in Response to Acute Subacromial Pain

STUDY DESIGN Block-counterbalanced, repeated-measures crossover study. OBJECTIVES To assess scapular upward rotation positional adaptations to experimentally induced subacromial pain. BACKGROUND Existing subacromial pathology is often related to altered scapular kinematics during humeral elevation, such as decreased upward rotation and posterior tilting. These changes have the potential to limit subacromial space and mechanically impinge subacromial structures. Yet, it is unknown whether these changes are the cause or result of injury and what the acute effects of subacromial pain on scapular upward rotation may be. METHODS Subacromial pain was induced via hypertonic saline injection in 20 participants, aged 18 to 31 years. Scapular upward rotation was measured with a digital inclinometer at rest and at 30°, 60°, 90°, and 120° of humeral elevation during a painful condition and a pain-free condition. Repeated-measures analyses of variance were conducted for scapular upward rotation position, based on condition (pain or control) and humeral position. Post hoc testing was conducted with paired t tests as appropriate. RESULTS Scapular upward rotation during the pain condition was significantly increased (range of average increase, 3.5°-7.7°) compared to the control condition at all angles of humeral elevation tested. CONCLUSION Acute subacromial pain elicited an increase in scapular upward rotation at all angles of humeral elevation tested. This adaptation to acute experimental pain may provide protective compensation to subacromial structures during humeral elevation.

The effectiveness of a lumbopelvic monitor and feedback device to change postural behavior: a feasibility randomized controlled trial.

STUDY DESIGN Feasibility randomized controlled trial. OBJECTIVES To assess the feasibility of a trial to investigate the effectiveness of a lumbopelvic monitor as a feedback device for modifying postural behavior during daily work-related activities. BACKGROUND Frequent or sustained flexed postures play a role in the development or maintenance of nonspecific low back pain. The provision of postural feedback could help individuals with or at risk of nonspecific low back pain improve their postural awareness and avoid hazardous or pain-provoking postures. METHODS Sixty-two participants employed in a health care organization were randomly allocated into 1 of 3 groups: a control group, an intermittent feedback group, and a constant feedback group. Adherence and follow-up rates were assessed. Differences in postural pattern between baseline and follow-up measurements were used to assess the effectiveness of the lumbopelvic monitor as a postural feedback device. RESULTS Adherence was approximately 75%. With the exception of 1 center, the follow-up overall rates exceeded the a priori desired threshold of 80%. Within-group comparisons revealed no significant differences in postural pattern for the control group and intermittent feedback group. The constant feedback group showed a significant reduction in flexed posture at the follow-up period compared with the baseline period. Differences between groups did not reach statistical significance; however, the constant feedback group, compared with the control group, demonstrated an effect size (d) of 0.60. CONCLUSION The provision of constant postural feedback seems promising for promoting changes in postural behavior. This feasibility trial identified adherence and follow-up rates and sample-size estimates important to the conduct of a fully powered efficacy trial. Level of Evidence Therapy, level 2b-.

Exploring a model of asymmetric shoe wear on lower limb performance

OBJECTIVES Asymmetric medial or lateral outer sole heel wear is often seen in worn footwear. We assessed the effect of 1 mm thick medial and lateral hindfoot wedges on the heel raise performance task. DESIGN Crossover trial with repeated measures. SETTING University laboratory. PARTICIPANTS Thirty-eight physically active and injury free participants. METHODS A 1 mm thick tapered wedge was affixed to the medial or lateral aspect of the bare hindfoot. The main outcome measurements were maximum number of single leg heel raises (MHR) and the rate at which these were performed (RHR). RESULTS The geometric mean MHR for the medial wedge condition decreased by 23.4% relative to the baseline control (P < .001), however, the difference between the lateral wedge and the baseline control conditions was not statistically significant. The RHR decreased by 10.7% (P = .004) with the medial wedge compared to the baseline control condition, and 22.4% relative to the lateral wedge (P < .001). The RHR increased by 8.5% (P = .022) for the lateral wedge compared to the baseline control condition. CONCLUSIONS Performance of the single leg heel raise task decreased when using a medial hindfoot wedge in the barefoot condition. These findings may have implications for assessment of footwear.