Stéphanie Grosdent

Effectiveness of a semi-intensive multidisciplinary outpatient rehabilitation program in chronic low back pain

OBJECTIVES To evaluate the efficacy of a semi-intensive multidisciplinary outpatient program complying with the requirements of the Belgian National Institute for Health and Disability Insurance and intended for patients with chronic low back pain. METHODS We included 262 patients with nonspecific chronic low back pain, among whom 136 (73 women and 63 men) with a mean pain duration of 11.3 years completed the outpatient program (36 sessions each lasting 2h). The program consisted of education about back-sparing techniques, interventions by an occupational therapist and psychologist, and physical reconditioning. Three sessions (sessions 1, 18, and 36) were used to evaluate pain intensity, functional impairment, kinesiophobia, cognitive knowledge, knowledge of appropriate spinal movement technique, and physical performance (trunk muscle strength and endurance, mobility of the pelvis and lumbar spine, and aerobic capacity). RESULTS All study variables were significantly improved at study completion compared to baseline: pain intensity was decreased by 44%, functional impairment by 40%, and kinesiophobia by 11% whereas knowledge was improved by 59%, back-sparing technique by 95%, trunk muscle strength by 40% on average, trunk extensor muscle endurance by 90%, mobility by 8%, and aerobic capacity by 18%. CONCLUSIONS A semi-intensive multidisciplinary outpatient program was beneficial in patients with chronic low back pain. Careful patient selection and increased patient involvement in the program may help to improve adherence.

Relationship between different measures of pain-related fear and physical capacity of the spine in patients with chronic low back pain

BACKGROUND CONTEXT It has been controversially stated that pain-related fear is a more important determining factor for disability in chronic low back pain (CLBP) than pain or physical impairment in itself. So far, the relationship between psychological and physiological determinants of chronic pain, that is, pain-related fear and physiological abilities, remains unclear. PURPOSE To evaluate whether pain-related fear assessed by different tools (both task specific and non task specific) is related to physical capacity measured by specific spine tests and, secondarily, to explore the relationship between different pain-related fear assessment tools. STUDY DESIGN/SETTING Cross-sectional study. PATIENT SAMPLE Fifty patients with CLBP (50% women; meanage [standard deviationage]: 44.2 [9.5 years]). OUTCOME MEASURES Physical capacity by means of three specific spine tests, that is, the finger-floor distance test (flexibility), a maximal isometric strength test of trunk extensor muscles (strength), and the Sorensen test (endurance). Pain-related fear by means of self-report measures, that is, the Tampa Scale for Kinesiophobia (TSK), the Photograph Series of Daily Activities (PHODA), and a fear visual analog scale (FVAS) tailored to the spine tests. METHODS Participants were asked to complete the TSK and PHODA and to perform the three spine tests. Right before performing each of the spine tests, an FVAS was filled out. Linear regression analyses controlling for gender and age were performed to study the association between the pain-related fear measurements and the results of the spine tests. To investigate the relationship between the pain-related fear measurements, correlation tests were performed. RESULTS The linear regression analyses revealed that neither the TSK and PHODA scores nor the FVAS scores were significantly related to the physical capacity measurements. The correlational tests showed no significant correlation between the PHODA, TSK, and FVAS scores. CONCLUSIONS The present study shows that neither the task-specific tool (FVAS) nor the non task-specific questionnaires (TSK and PHODA) were significantly correlated to the spine tests in patients with CLBP. This is contrary to earlier evidence according to which physical capacity is inversely related to the level of pain-related fear, and it suggests that one should not draw conclusions about physical capacity based on pain-related fear scores. Furthermore, the different assessment tools for pain-related fear were surprisingly not correlated with each other.

Cardiovascular Responses to Static Assessments of Trunk Muscles

ABSTRACT. Objectives: To investigate the cardiovascular responses to standard static assessments of strength and endurance of trunk extensor muscles. Methods: Trunk extensor performances of 10 healthy men, age 48.2 ± 5.6 years, and 10 healthy women, age 49 ± 5.7 years, were assessed by means of a maximum static strength test [consisting in maximal voluntary contractions [MVC] performed with a specific dynamometer], and two static endurance tests [the Sorensen test, and a 50 percent MVC test]. Heart rate [HR], auscultatory systolic blood pressure [SBP], and diastolic blood pressure [DBP] were recorded throughout the tests. Results: The MVCs induced significant increases of HR and SBP [mean peak values averaging 90 [female] to 95 [male] beats per minute [bpm] and 133 [female] to 141 [male] mmHg]. The HR, SBP, and DBP values increased significantly across time throughout both endurance static tests. At the end of these tests, mean HR, SBP, and DBP reached 114 to 122 bpm, 172 to 185 mmHg, and 112 to 120 mmHg, respectively. Genders differed significantly with regard to holding times [longer in females], but a gender effect was only found on SBP [higher in males]. HR and SBP increases were significantly higher in males than in female subjects. Conclusions: The strength test seems less demanding than expected, though our results need to be confirmed. Standard static endurance tests yield sizeable functional stress on the cardiovascular system. Our study emphasizes the need to exclude subjects with cardiac trouble from such efforts and suggests the relevance of monitoring cardiovascular parameters if tests are performed until exhaustion.

Is the Sørensen test valid to assess muscle fatigue of the trunk extensor muscles

BACKGROUND Very few studies have quantified the degree of fatigue characterized by the decline in the maximal voluntary contraction (MVC) force of the trunk extensors induced by the widely used Sørensen test. OBJECTIVE Measure the degree of fatigue of the trunk extensor muscles induced by the Sørensen test. METHODS Eighty young healthy subjects were randomly divided into a control group (CG) and an experimental group (EG), each including 50% of the two genders. The EG performed an isometric MVC of the trunk extensors (pre-fatigue test) followed by the Sørensen test, the latter being immediately followed by another MVC (post-fatigue test). The CG performed only the pre- and post-fatigue tests without any exertion in between. RESULTS The comparison of the pre- and post-fatigue tests revealed a significant (P< 0.05) decrease in MVC force normalized by body mass (-13%) in the EG, whereas a small increase occurred in the CG (+2.7%, P= 0.001). CONCLUSIONS This study shows that the Sørensen test performed until failure in a young healthy population results in a reduced ability of the trunk extensor muscles to generate maximal force, and indicates that this test is valid for the assessment of fatigue in trunk extensor muscles.

Efficacy and cost-effectiveness: A study of different treatment approaches in a tertiary pain centre

Chronic pain is considered to be a complex phenomenon, involving an interrelation of biological, psychosocial and sociocultural factors. Currently, no single treatment or therapy can address all aspects of this pathology. In our expert tertiary pain centre, we decide to assess the effectiveness of four treatments for chronic pain classically proposed in our daily clinical work: physiotherapy; psycho‐education; physiotherapy combined with psycho‐education; and self‐hypnosis/self‐care learning.

Dental occlusion influences knee muscular performances in asymptomatic females.

Abstract Grosdent, S, O’Thanh, R, Domken, O, Lamy, M, and Croisier, J-L. Dental occlusion influences knee muscular performances in asymptomatic females. J Strength Cond Res 28(2): 492–498, 2014—Some authors claim that occlusal appliances can enhance athletic performance. Therefore, this study investigated the influence of dental occlusion on knee muscle strength performance. Twelve healthy female subjects (mean age, 24.1 ± 3.1 years) without temporomandibular joint dysfunction participated in this study. Isokinetic quadriceps and hamstring strength were assessed in relation to 3 randomized jaw conditions: mouth closed in maximum intercuspidation without splint, mouth closed on a balanced splint which optimized contact over the dental arch, mouth closed on a piece of resin of 1 mm which created an imbalanced occlusion. Tests were performed at 60 and 240°·s−1 in concentric and 30°·s−1 in eccentric exertions. Concentric performances did not show any significant difference between the 3 jaw conditions (p > 0.05). In contrast, in the eccentric trials related to quadriceps performance, significant differences (p ⩽ 0.05) were observed between the resin condition and the 2 other modalities (without splint or with a balanced splint). The imbalanced occlusion created by the resin component corresponded to an average decrease of 9% in eccentric peak torque. The eccentric hamstring peak torques also showed a significant difference (p ⩽ 0.05) between measurements with splint and with resin (7% decrease when occlusion was imbalanced). In conclusion, among asymptomatic females, artificial imbalanced occlusion induces immediate and significant alteration of knee eccentric muscle performances. Therefore, occlusion examination should be undertaken on a regular and frequent basis for high-level athletes. Moreover, for athletes using mouthguards, muscular performance assessments should be planned with and without the dental protection.

Muscular Performance Assessment of Trunk Extensors: A Critical Appraisal of the Literature

Despite growing research efforts, non-specific low back pain (LBP) remains a major public health burden throughout the industrialized world. Epidemiological data indicate a point prevalence ranging from 19% (Hillman et al., 1996) to 27% (Picavet & Schouten, 2003) and a lifetime prevalence of about 60% (Hillman et al., 1996). Costs to society stem mainly from chronic forms, which account for only 5–10% of cases (Nachemson et al., 2000).

A comparison of two stretching programs for hamstring muscles: A randomized controlled assessor-blinded study

ABSTRACT Most parameters regarding hamstring flexibility training programs have been investigated; however, the joint (i.e. hip or knee) on which the stretching should preferentially be focused needs to be further explored. This randomized controlled assessor-blinded study aimed to investigate the influence of this parameter. We randomly assigned 111 asymptomatic participants with tight hamstring muscles in three groups: a control group and two groups following a different home-based 8-week (five 10-minute sessions per week) hamstring stretching program (i.e. stretching performed by flexing the hip while keeping the knee extended [SH] or by first flexing the hip with a flexed knee and then extending the knee [SK]). Range of motion (ROM) of hip flexion and knee extension were measured before and after the stretching program by means of the straight leg raising test and the passive knee extension angle test, respectively. Eighty-nine participants completed the study. A significant increase in ROM was observed at post-test. Analyses showed significant group-by-time interactions for changes regarding all outcomes. Whereas the increase in hip flexion and knee extension ROM was higher in the stretching groups than in the CG (especially for the SH group p < 0.05), no differences between the two stretching groups were observed (p > 0.05). In conclusion, the fact that both stretching programs resulted in similar results suggests no influence of the joint at which the stretching is focused upon, as assessed by the straight leg raising and knee extension angle tests.

Lumbopelvic motor control and low back pain in elite soccer players: a cross-sectional study

ABSTRACT This study aimed to investigate the relationship between the history of low back pain and quality of lumbopelvic motor control in soccer players. Forty-three male elite soccer players (mean age, 18.2 ± 1.4 years) filled in questionnaires related to low back pain and attended a session to assess lumbopelvic motor control by means of five tests (the bent knee fall out test, the knee lift abdominal test, the sitting knee extension test, the waiter’s bow and the transversus abdominis test). A physiotherapist, blinded to the medical history of the participants, scored (0 = failed, 1 = correct) the performance of the players for each of the tests resulting in a lumbopelvic motor control score ranging from 0 to 5. Forty-seven per cent of the soccer players reported a disabling low back pain episode lasting at least two consecutive days in the previous year. These players scored worse lumbopelvic motor control than players without a history of low back pain (lumbopelvic motor control score of 1.8 vs. 3.3, P < 0.01). The between-groups difference was particularly marked for the bent knee fall out test, the knee lift abdominal test and the transversus abdominis test (P < 0.01). In conclusion, most soccer players with a history of low back pain had an altered lumbopelvic motor control. Further research should examine whether lumbopelvic motor control is etiologically involved in low back pain episodes in soccer players.

Técnicas de rehabilitación abdominal y vertebral para el paciente con lumbalgia

Con frecuencia se recomiendan ejercicios de rehabilitacion abdominal y vertebral en el tratamiento clinico de los pacientes con lumbalgia cronica. Este tratamiento, sin embargo, no puede limitarse solo a estos ejercicios, teniendo en cuenta los numerosos factores favorecedores del paso a la cronicidad y a su persistencia. Estos ejercicios deben ser individualizados. El objetivo de este articulo consiste en establecer una clasificacion y una descripcion de estos ejercicios basadas en la evidencia cientifica. La eficacia de los ejercicios de control sensitivomotor, que pueden asociarse a un trabajo de resistencia o de fuerza muscular en estos pacientes, ha sido demostrada en numerosos estudios, pero su superioridad en relacion con otros ejercicios debe todavia confirmarse. Algunos ejercicios pueden realizarse con aparatos medicos sofisticados que permitirian trabajar mas especificamente a los musculos vertebrales, un incremento de eficacia clinica en relacion con otros tratamientos activos que, sin embargo, no puede ser demostrado. Se aplican con frecuencia los estiramientos de los musculos del tronco, sobre todo vertebrales, en el tratamiento de los pacientes con lumbalgia, a pesar de que no existan en la literatura demasiados estudios. Los ejercicios terapeuticos tipo Pilates, que incluyen varios componentes como ejercicios de control motor y estiramientos, parecen ser tan eficaces como otros tipos de tratamientos activos. La electroestimulacion neuromuscular, cuya eficacia queda por demostrar, ha sido tambien descrita en algunos estudios muy heterogeneos.