Mohammad Reza Nourbakhsh

The relationship between hip abductor muscle strength and iliotibial band tightness in individuals with low back pain

BackgroundShortening of the iliotibial band (ITB) has been considered to be associated with low back pain (LBP). It is theorized that ITB tightness in individuals with LBP is a compensatory mechanism following hip abductor muscle weakness. However, no study has clinically examined this theory. The purpose of this study was to investigate the muscle imbalance of hip abductor muscle weakness and ITB tightness in subjects with LBP.MethodsA total of 300 subjects with and without LBP between the ages of 20 and 60 participated in this cross-sectional study. Subjects were categorized in three groups: LBP with ITB tightness (n = 100), LBP without ITB tightness (n = 100) and no LBP (n = 100). Hip abductor muscle strength was measured in all subjects.ResultsAnalysis of Covariance (ANCOVA) with the body mass index (BMI) as the covariate revealed significant difference in hip abductor strength between three groups (P < 0.001). Post hoc analysis showed no significant difference in hip abductor muscle strength between the LBP subjects with and without ITB tightness (P = 0.59). However, subjects with no LBP had significantly stronger hip abductor muscle strength compared to subjects with LBP with ITB tightness (P < 0.001) and those with LBP without ITB tightness (P < 0.001).ConclusionThe relationship between ITB tightness and hip abductor weakness in patients with LBP is not supported as assumed in theory. More clinical studies are needed to assess the theory of muscle imbalance of hip abductor weakness and ITB tightness in LBP.

Altered muscular activation during prone hip extension in women with and without low back pain

BackgroundAltered movement pattern has been associated with the development of low back pain (LBP). The purpose of this study was to investigate the activity pattern of the ipsilateral erector spinae (IES) and contralateral erectorspinae (CES), gluteus maximus (GM) and hamstring (HAM) muscles during prone hip extension (PHE) test in women with and without LBP. A cross-sectional non-experimental design was used.MethodsConvenience sample of 20 female participated in the study. Subjects were categorized into two groups: with LBP (n = 10) and without LBP (n = 10). The electromyography (EMG) signal amplitude of the tested muscles during PHE (normalized to maximum voluntary electrical activity (MVE)) was measured in the dominant lower extremity in all subjects.ResultsStatistical analysis revealed greater normalized EMG signal amplitude in women with LBP compared to non-LBP women. There was significant difference in EMG activity of the IES (P = 0.03) and CES (P = 0.03) between two groups. However, no significant difference was found in EMG signals of the GM (P = 0.11) and HAM (P = 0.14) among two groups.ConclusionThe findings of this study demonstrated altered activation pattern of the lumbo-pelvic muscles during PHE in the women with chronic LBP. This information is important for investigators using PHE as either an evaluation tool or a rehabilitation exercise.

The relationship between hamstring length and gluteal muscle strength in individuals with sacroiliac joint dysfunction

Abstract It has been suggested that tight hamstring muscle, due to its anatomical connections, could be a compensatory mechanism for providing sacroiliac (SI) joint stability in patients with gluteal muscle weakness and SIJ dysfunction. The purpose of this study was to determine the relationship between hamstring muscle length and gluteal muscle strength in subjects with sacroiliac joint dysfunction. A total of 159 subjects with and without low back pain (LBP) between the ages of 20 and 65 years participate in the study. Subjects were categorized into three groups: LBP without SIJ involvement (n = 53); back pain with SIJ dysfunction (n = 53); and no low back pain (n = 53). Hamstring muscle length and gluteal muscle strength were measured in all subjects. The number of individuals with gluteal weakness was significantly (P = 0·02) higher in subjects with SI joint dysfunction (66%) compared to those with LBP without SI joint dysfunctions (34%). In pooled data, there was no significant difference (P = 0·31) in hamstring muscle length between subjects with SI joint dysfunction and those with back pain without SI involvement. In subjects with SI joint dysfunction, however, those with gluteal muscle weakness had significantly (P = 0·02) shorter hamstring muscle length (mean = 158±11°) compared to individuals without gluteal weakness (mean = 165±10°). There was no statistically significant difference (P>0·05) in hamstring muscle length between individuals with and without gluteal muscle weakness in other groups. In conclusion, hamstring tightness in subjects with SI joint dysfunction could be related to gluteal muscle weakness. The slight difference in hamstring muscle length found in this study, although statistically significant, was not sufficient for making any definite conclusions. Further studies are needed to establish the role of hamstring muscle in SI joint stability.

Relationship between muscle length and moment arm on EMG activity of human triceps surae muscle.

PURPOSE The purpose of this experiment was to evaluate the effects of both muscle length and moment arm (MA) on the electromyographic (EMG) and force output of the triceps surae (TS) muscle. RELEVANCE It is well recognized that changes in muscle length affect both the muscles force generating capacity as well as its twitch speed. This relationship is well established in animal preparations. Contrary to animal experiments where length can be directly manipulated in isolated muscles, human experiments require that all muscle length changes be secondary to changes in a joint angle. Such experimental manipulations therefore produce changes in not only muscle length, but also in the muscles MA. The relative effect of muscle length and MA changes on muscle EMG has not been determined in previous experiments. METHODS This study was executed in two phases. First, using fresh human cadaver lower limbs, data were gathered describing the relationship between knee and ankle angle changes for maintenance of a constant TS muscle length, while its MA at the ankle joint has been changed. In the second phase of the study, results obtained from phase one were applied to 10 healthy adult human subjects to measure the EMG (surface and fine wire) activity of TS at three different conditions: when both length and MA were shortened, when muscle length was decreased given a constant MA and when MA was shortened given a constant muscle length. RESULTS A significant increase in muscle activity was found as both the length and MA of TS muscle were shortened. A similar pattern of increased muscle activity was observed when the MA was shortened given a constant muscle length. No significant change in TS activity was found when muscle length was shortened, given a constant MA at the ankle joint. CONCLUSIONS The findings of this study indicate that changes in the Achilles tendon MA predominate over the muscle length variations in determining the level of TS activity when generating plantar flexion torque.

An alternative approach to treating lateral epicondylitis. A randomized, placebo-controlled, double-blinded study

Objective: To investigate the effect of noxious level electrical stimulation on pain, grip strength and functional abilities in subjects with chronic lateral epicondylitis. Design: Randomized, placebo-control, double-blinded study. Setting: Physical Therapy Department, North Georgia College and State University. Subjects: Eighteen subjects with chronic lateral epicondylitis between the ages of 24 and 72 years participated in this study. Subjects were randomly assigned into treatment or placebo groups. Interventions: Subjects received six sessions of low-frequency electrical stimulation over the palpated tender points. The intensity of electrical stimulation was set at 0 in the placebo group. Main measurements: Grip strength, functional status, pain intensity and limited activity due to pain were assessed before and after treatment. Six-month follow-up data were collected in treatment group only. Results: Both clinically and statistically significant improvements in average grip strength were found (treatment group: 28% increase; placebo group: 2.5% decrease; P=0.04), functional activity (treatment group: 110% increase; placebo group: 22% increase; P= 0.003), pain intensity (treatment group: 3.1 point decrease; placebo group: 0.2 point increase; P=0.01) and activity limitation due to pain (treatment group: 4.1 points increase; placebo group: 1.9 point decrease; P= 0.003) between the treatment and placebo groups. Follow-up data showed that 100% of subjects maintained the improved function, and 83% remained pain-free for at least six months post treatment. Conclusion: The results of this study indicated that symptoms of chronic lateral epicondylitis could be effectively treated by noxious level low-frequency electrical stimulation.

The neurophysiological effects of dry needling in patients with upper trapezius myofascial trigger points: study protocol of a controlled clinical trial

Introduction Dry needling (DN) is an effective method for the treatment of myofascial trigger points (MTrPs). There is no report on the neurophysiological effects of DN in patients with MTrPs. The aim of the present study will be to assess the immediate neurophysiological efficacy of deep DN in patients with upper trapezius MTrPs. Methods and analysis A prospective, controlled clinical trial was designed to include patients with upper trapezius MTrPs and volunteered healthy participants to receive one session of DN. The primary outcome measures are neuromuscular junction response and sympathetic skin response. The secondary outcomes are pain intensity and pressure pain threshold. Data will be collected at baseline and immediately after intervention. Ethics and dissemination This study protocol has been approved by the Research Council, School of Rehabilitation and the Ethics Committee of Tehran University of Medical Sciences. The results of the study will be disseminated in a peer-reviewed journal and presented at international congresses.

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.

Therapeutic effects of dry needling in patients with upper trapezius myofascial trigger points

Background Active myofascial trigger points (MTrPs) are major pain generators in myofascial pain syndrome. Dry needling (DN) is an effective method for the treatment of MTrPs. Objective To assess the immediate neurophysiological and clinical effects of DN in patients with upper trapezius MTrPs. Methods This was a prospective, clinical trial study of 20 patients with upper trapezius MTrPs and 20 healthy volunteers (matched for height, weight, body mass index and age), all of whom received one session of DN. Primary outcome measures were neuromuscular junction response (NMJR) and sympathetic skin response (SSR). Secondary outcomes were pain intensity (PI) and pressure pain threshold (PPT). Data were collected at baseline and immediately post-intervention. Results At baseline, SSR amplitude was higher in patients versus healthy volunteers (p<0.003). With respect to NMJR, a clinically abnormal increment and normal reduction was observed in patients and healthy volunteers, respectively. Moreover, PPT of patients was less than healthy volunteers (p<0.0001). After DN, SSR amplitude decreased significantly in patients (p<0.01), but did not change in healthy volunteers. A clinically important reduction in the NMJR of patients and increment in healthy volunteers was demonstrated after DN. PPT increased after DN in patients, but decreased in healthy volunteers (p<0.0001). PI improved after DN in patients (p<0.001). Conclusions The results of this study showed that one session of DN targeting active MTrPs appears to reduce hyperactivity of the sympathetic nervous system and irritability of the motor endplate. DN seems effective at improving symptoms and deactivating active MTrPs, although further research is needed. Trial registration number IRCT20130316128.

Dry needling versus trigger point compression of the upper trapezius: a randomized clinical trial with two-week and three-month follow-up

ABSTRACT Objectives: The purpose of this randomized controlled trial was to investigate the long-term clinical effect of dry needling with two-week and three-month follow up, on individuals with myofascial trigger points in the upper trapezius muscle. Methods: A sample of convenience (33 individuals) with a trigger point in the upper trapezius muscle, participated in this study. The individuals were randomly assigned to two groups: trigger point compression (N = 17) or dry needling (N = 16). Pain intensity, neck disability, and disability of the arm, hand, and shoulder (DASH) were assessed before treatment, after treatment sessions, and at two-week and three-month follow ups. Results: The result of repeated measures ANOVA showed significant group-measurement interaction effect for VAS (p = .02). No significant interaction was found for NPQ and DASH (p > .05). The main effect of measurements for VAS, NPQ, and DASH were statistically significant (p < .0001). The results showed a significant change in pain intensity, neck disability, and DASH after treatment sessions, after two weeks and three months when compared with before treatment scores in both groups. There was no significant difference in the tested variables after two-week or three-month as compared to after treatment sessions between the two groups. However, pain intensity after treatment sessions was significantly different between the two groups (p = .02). Discussion: Dry needling and trigger point compression in individuals with myofascial trigger point in the upper trapezius muscle can lead to three-month improvement in pain intensity and disability.

Physiotherapy with and without Superficial Dry Needling Affects Pain and Muscle Strength in Patients with Patellofemoral Pain Syndrome

Objectives: To investigate the clinical efficacy of physiotherapy with and without superficial dry needling on patients with knee pain; patellofemoral pain syndrome. Methods: A randomized clinical trial conducted in 2015, Tehran, Iran. Of patients with patellofemoral pain syndrome, thirty-four subjects were randomly divided into two groups (17 in each group). Group A was subjected to physiotherapy and group B to physiotherapy with superficial dry needling. Only for group B, superficial dry needling was applied during the ten-day sessions of physiotherapy, every other day. The needle remained for 6 minutes at threepoints of the quadriceps muscle, accompanied with needle rotation. Both groups received 10 therapy sessions. For both groups, in the first and tenth sessions, knee pain and quadriceps muscle strength was evaluated. Results: Statistical analysis showed the two variables in each group had significant improvements after the 10 sessions (P<0.05). Comparing the two groups, group B showed more pain reduction based on the visual analog scale (P<0.05). However, according to manual muscle testing method, the muscle strength between both the groups showed no significant difference (P<0.156). Discussion: Physiotherapy with and without superficial dry needling were seen to reduce pain and increase muscle strength of patients with patellofemoral pain syndrome. However, performing physiotherapy with superficial dry needling had a more significant effect on reducing knee pain. Superficial needling can cause many physiological and neurophysiological effects. Through stimulation of pain control mechanisms, it can help in further reduction of pain. A B S T R A C T