Pavel Kolar

Postural Function of the Diaphragm in Persons With and Without Chronic Low Back Pain

STUDY DESIGN A case-control study. OBJECTIVES To examine the function of the diaphragm during postural limb activities in patients with chronic low back pain and healthy controls. BACKGROUND Abnormal stabilizing function of the diaphragm may be an etiological factor in spinal disorders. However, a study designed specifically to test the dynamics of the diaphragm in chronic spinal disorders is lacking. METHODS Eighteen patients with chronic low back pain due to chronic overloading, as ascertained via clinical assessment and magnetic resonance imaging, and 29 healthy subjects were examined. Both groups presented with normal pulmonary function test results. A dynamic magnetic resonance imaging system and specialized spirometric readings were used with subjects in the supine position. Measurements during tidal breathing (TB) and isometric flexion of the upper and lower extremities against external resistance with TB were performed. Standard pulmonary function tests, including respiratory muscle drive (PI(max) and PE(max)), were also assessed. RESULTS Using multivariate analysis of covariance, smaller diaphragm excursions and higher diaphragm position were found in the patient group (P<.05) during the upper extremity TB and lower extremity TB conditions. Maximum changes were found in costal and middle points of the diaphragm. A 1-way analysis of covariance showed a steeper slope in the middle-posterior diaphragm in the patient group both in the upper extremity TB and lower extremity TB conditions (P<.05). CONCLUSION Patients with chronic low back pain appear to have both abnormal position and a steeper slope of the diaphragm, which may contribute to the etiology of the disorder.

Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment

The aim was to describe diaphragmatic behavior during postural limb activities and examine the ventilatory and stabilizing functions of the diaphragm. Thirty healthy subjects were examined in the supine position using a dynamic MRI system assessed simultaneously with specialized spirometric readings. The diaphragmatic excursions (DEs) were measured at three diaphragmatic points in the sagittal plane; the diaphragm positions (DPs) as related to a reference horizontal baseline were determined. Measurements were taken during tidal breathing (TB) and isometric flexion of upper or lower extremities against external resistance together with TB. Mean DE in both upper and lower postural limb activities was greater compared with the TB condition (P < 0.05), with the effect greater for lower limb activities. Inspiratory DPs in the upper and lower extremity activities were lower compared with TB alone (P < 0.01). Expiratory DP was lower only for lower extremity activities (P < 0.01). DP was most affected at the apex of the crescent and crural (posterior) portion of the diaphragm. DEs correlated strongly with tidal volume (Vt) in all conditions. Changes in DEs relative to the initial value were minimal for upper and lower extremities but were related to lower values of Vt (P < 0.03). Significant involvement of the diaphragm in the limb postural activities was found. Resulting DEs and DPs differed from the TB conditions, especially in lower extremity activities. The differences between the percent changes of DEs vs. Vt found for lower extremity activities were confirmed by both ventilatory and postural diaphragm recruitment in response to postural demands.

Developmental kinesiology: three levels of motor control in the assessment and treatment of the motor system.

Three levels of sensorimotor control within the central nervous system (CNS) can be distinguished. During the neonatal stage, general movements and primitive reflexes are controlled at the spinal and brain stem levels. Analysis of the newborns spontaneous general movements and the assessment of primitive reflexes is crucial in the screening and early recognition of a risk for abnormal development. Following the newborn period, the subcortical level of the CNS motor control emerges and matures mainly during the first year of life. This allows for basic trunk stabilization, a prerequisite for any phasic movement and for the locomotor function of the extremities. At the subcortical level, orofacial muscles and afferent information are automatically integrated within postural-locomotor patterns. Finally, the cortical (the highest) level of motor control increasingly becomes activated. Cortical control is important for the individual qualities and characteristics of movement. It also allows for isolated segmental movement and relaxation. A child with impaired cortical motor control may be diagnosed with developmental dyspraxia or developmental coordination disorder. Human ontogenetic models, i.e., developmental motor patterns, can be used in both the diagnosis and treatment of locomotor system dysfunction.

Arnica/Hydroxyethyl Salicylate Combination Spray for Ankle Distortion: A Four-Arm Randomised Double-Blind Study

570 patients with acute ankle joint distortion were randomized to four treatment groups: a combination spray of arnica tincture and hydroxyethyl salicylate (HES; group A, n = 228), arnica (B, n = 57), HES (C, n = 228), and placebo (D, n = 57). The medication was applied 4-5 times daily for 10 days. Efficacy was assessed on day 3-4 by evaluating pain on motion on a visual analogue scale (VAS). Pain improvement in group A was significantly superior over groups B–D (t-test with unadjusted baseline values, P < 4 × 10−7 and ANCOVA after adjustment, P < 5 × 10−11) and approximately corresponded to the cumulative effect of the single constituents (12.1, 7.5, and 18.7 mm VAS for A versus B, A versus C, and A versus D; 95% CI 8.0–16.2, 4.7–10.4, and 14.8–22.5 mm). The combination is justified by the additive effects of the single active constituents.

Effects of shoulder girdle dynamic stabilization exercise on hand muscle strength

BACKGROUND: Shoulder girdle stabilization influences hand strength but the effects of functional training remain unknown. OBJECTIVE: To determine the influence of shoulder girdle stabilization on hand muscle strength. METHODS: Handgrip strength (with hand in neutral position, supination, pronation) and tripod pinch strength were measured in 20 healthy volunteers (10 in training/control groups) weekly over six weeks. The training consisted of six specific Dynamic Neuromuscular Stabilization (DNS) exercises performed five times per week. The exercises were designed to obtain maximum joint stability within the shoulder. RESULTS: Using mixed effects models, the training group showed significant improvement relative to the control group on all measures of hand muscle strength ( p< 0.05). The gains were particularly pronounced in handgrip strength in the neutral position (dominant hand: Estimate = 0.26, standard error [SE] = 0.04, p< 0.001; non-dominant hand: Estimate = 0.23, SE = 0.03, p< 0.001). That is, the training group gained about 0.25 standard deviations over the control group per session for a total of 1.5 standard deviations (about 27 Newtons) across all sessions. CONCLUSIONS: Shoulder girdle exercises based on DNS may generate clinically significant gains in hand muscle strength.

Evaluation of muscle strength and manual dexterity in patients with Charcot-Marie-Tooth disease

STUDY DESIGN Matched pair study. INTRODUCTION Differences in hand-muscle strength/dexterity between dominant (DH) and non-dominant (NDH) hand in Charcot-Marie-Tooth disease (CMT) are not well understood. PURPOSE OF THE STUDY To compare muscle strength/dexterity between DH and NDH and to correlate manual dexterity, strength and sensory function. PATIENTS AND METHODS Thirty CMT patients were studied using functional muscle testing (FMT) and strength (dynamometry), dexterity (the Nine Hole Peg Test [NHPT]), and Jebsen-Taylor Hand Function [JTT]), and sensory function (the Nottingham Sensory Assessment [NSA]). RESULTS Scores were worse for DH than NDH on FMT (p = 0.043) and NHPT (p = 0.014) but not on JTT (p = 0.098), handgrip strength (p = 0.710) or tripod pinch (p = 0.645). NSA did not correlate significantly with any tests (ps0.05). CONCLUSIONS In CMT disease, DH appears more impaired than NDH in terms of function and dexterity. Greater muscle weakness in DH may also emerge as CMT progresses. LEVEL OF EVIDENCE 3b.

Pulmonary function in patients with hereditary motor and sensory neuropathy: A comparison of patients with and without spinal deformity

We assessed pulmonary function in hereditary motor and sensory neuropathy. Fourteen neuropathy patients without spinal deformity (group 1), 14 with spinal deformity (group 2), and 16 individuals with idiopathic spinal deformity (group 3) matched to group 2 for age, height and Cobb angle, were included. Hereditary motor and sensory neuropathy severity was measured with Charcot-Marie-Tooth Neuropathy Score. All participants exhibited mild decrease in maximal inspiratory pressure at the mouth. One-way analysis of variance yielded significant main effects for lung volumes - slow vital capacity, forced expiratory volume in 1s, and total lung capacity (ps<.01), attributable to greater volumes in group 1 compared to groups with spinal deformity - and transfer factor for carbon monoxide (p=.013), reflecting differences between groups 1 vs. 2. Slow vital capacity and total lung capacity correlated with maximal inspiratory pressure at the mouth in group 2, whereas slow vital capacity correlated with muscle work in group 3 (ps<.05). Decreased lung volume may be due to impaired respiratory muscle strength in hereditary motor and sensory neuropathy with spinal deformity and due to spinal deformity in idiopathic patients.

Diastasis of rectus abdominis muscles in low back pain patients

BACKGROUND Abdominal muscles are important spinal stabilizers and its poor coordination, as seen in diastasis of rectus abdominis (DRA), may contribute to chronic low back pain (LBP). However, this has not yet been studied directly. OBJECTIVES To conduct a pilot study to examine the association between DRA and LBP. METHODS Using a digital caliper, standard clinical DRA measurement was performed in 55 participants with and 54 without chronic LBP. RESULTS Participants were on average 55 years old, 69 (63%) were women. Among the 16 participants with DRA, 11 (69%) had chronic LBP; among the 93 participants without DRA, 44 (47%) had LBP. Among men, 7 of 9 (77%) with DRA had LBP and 14 of 31 (45%) without DRA had LBP. Among women, 4 of 7 (57%) with DRA had LBP and 30 of 62 (48%) without DRA had LBP. BMI was the strongest correlate of DRA and may explain the relation between DRA and chronic LBP. CONCLUSIONS DRA and LBP may be interrelated, especially among men. This may be a function of greater BMI in individuals with chronic LBP. Understanding the association between DRA, LBP, and BMI may have important implications for treatment of LBP and for intervention.

Cerebellar function and hypermobility in patients with idiopathic scoliosis

Abstract Objectives To determine if individuals with adolescent idiopathic scoliosis (AIS) present with significant cerebellar dysfunction and hypermobility when compared with healthy controls. Methods International Cooperative Ataxia Rating Scale (ICARS), pendulum reflexes, and 10 hypermobility tests according to Janda were assessed in 11 subjects with radiologically confirmed structural idiopathic scoliosis and in 11 individuals without scoliosis. Results Idiopathic scoliosis group scored significantly worse in gait and posture ICARS subscale (P = 0.014) and in total ICARS (P = 0.021). There was no significant difference in pendulum reflexes between the groups. Comparing with the healthy controls, the AIS group presented with significant hypermobility in head rotation (P = 0.038) and forward bend tests (P = 0.041). Total evaluation of all 10 hypermobility tests approached statistical significance (P = 0.051) with the AIS group, demonstrating greater hypermobility. Conclusions Signs of cerebellar dysfunction and hypermobility were identified in subjects with idiopathic scoliosis, which may be an important aspect in rehabilitation.