The Measurement of Lumbar Proprioception in Individuals With and Without Low Back Pain Effects of two 4-week proprioceptive neuromuscular facilitation programs on muscle endurance, flexibility, and functional performance in women with chronic low back pain. Effects of spinal manipulation on trunk proprioception in subjects with chronic low back pain during symptom remission. Evidence-based medicine and the challenge of low back pain: where are we now? Inclusion and exclusion criteria used in non-specific low back pain trials: a review of randomised controlled trials published between 2006 and 2012 [Increase in strength after active therapy in chronic low back pain (CLBP) patients: muscular adaptations and clinical relevance]. The Effects of Combination Patterns of Proprioceptive Neuromuscular Facilitation and Ball Exercise on Pain and Muscle Activity of Chronic Low Back Pain Patients Chen-Style Tai Chi for Individuals (Aged 50 Years Old or Above) with Chronic Non-Specific Low Back Pain: A Randomized Controlled Trial [Use of isokinetic techniques vs standard physiotherapy in patients with chronic low back pain. Preliminary results]. Repositioning accuracy and movement parameters in low back pain subjects and healthy control subjects
Study Design . A clinical trial comparing a  back pain group with a pain‐free group .  Objectives . To investigate whether proprioceptive deficits existed in a group of individuals reporting low back pain . Summary of Background Data . Little work has so far been conducted on the measurement of proprioception in the spine . Those studies that have been carried out , however , have failed to identify proprioceptive deficits in individuals with back pain . Previous work on peripheral joints has revealed that proprioception is affected with muscular or joint injury or degeneration . Methods . Forty individuals took part in the study , 20 with back pain and 20 with no pain . Participants were required to reproduce a predetermined target position , in st and ing and four‐point kneeling , 10 times in 30 seconds . A computer screen was used to provide visual feedback on position . A mean deviation from the target position was obtained for each individual . A measurement of left elbow position sense was conducted in five individuals from each group to establish differences in short‐term motor memory between the groups . Results . There were no differences between the subject groups in terms of short‐term motor memory ( P > 0.05 ) . A two‐way analysis of variance between subject groups and position to identify differences in accuracy ( deviation from the target ) found that there were differences between subject groups in either position ( P < 0.05 ) . There was no significant difference in accuracy between the positions used ( P > 0.05 ) . Conclusions . Differences in proprioception do exist between individuals with back pain and those free from back pain . Further research needs to be undertaken on proprioceptive exercise programs and their effect on back pain BACKGROUND AND PURPOSE Improving functional performance in patients with chronic low back pain is of primary importance . The purpose of this study was to examine the effects of 2 proprioceptive neuromuscular facilitation ( PNF ) programs on trunk muscle endurance , flexibility , and functional performance in subjects with chronic low back pain ( CLBP ) . SUBJECTS Eighty-six women ( 40.2+/-11.9 [ mean+/-SD ] years of age ) who had complaints of CLBP were r and omly assigned to 3 groups : rhythmic stabilization training , combination of isotonic exercises , and control . METHODS Subjects trained with each program for 4 weeks with the aim of improving trunk stability and strength . Static and dynamic trunk muscle endurance and lumbar mobility were measured before , at the end of , and 4 and 8 weeks after training . Disability and back pain intensity also were measured with the Oswestry Index . RESULTS Multivariate analysis of variance indicated that both training groups demonstrated significant improvements in lumbar mobility ( 8.6%-24.1 % ) , static and dynamic muscle endurance ( 23.6%-81 % ) , and Oswestry Index ( 29.3%-31.8 % ) measurements . DISCUSSION AND CONCLUSION Static and dynamic PNF programs may be appropriate for improving short-term trunk muscle endurance and trunk mobility in people with CLBP OBJECTIVE The purpose of this study was to examine the immediate effects of spinal manipulative therapy ( SMT ) on trunk proprioception in subjects with asymptomatic chronic low back pain ( CLBP ) and determine if those effects lasted 1 week . METHODS This unbalanced r and omized controlled crossover design examined 33 subjects with CLBP .  Proprioception was tested via joint position sense , threshold to detect passive motion ( TTDPM ) , direction of motion ( DM ) , and force reproduction . Each subject received lumbar manipulation or a sham procedure followed by proprioception retest . This procedure was repeated 1 week later using the opposing treatment . Subjects receiving SMT in the second session returned a third time receiving the sham procedure again . RESULTS Spinal manipulative therapy produced an effect for TTDPM in the manipulation first group ( P = .008 ) , the sham procedure produced an effect for joint position sense in the sham first group ( P = .005 ) . Spinal manipulative therapy had a 1-week effect for the manipulation first group ( P = .006 ) . No effect was noted for either DM or force reproduction . CONCLUSIONS Results suggest SMT had minimal immediate effect on trunk proprioception . The effects noted occurred in session 1 , implicating learning as a potential source . Learning , from repetitive proprioception training , may enhance neuromuscular control in subjects with CLBP before the use of therapeutic exercise . Subjects showed smaller deficits than previously reported for TTDPM or DM , suggesting proprioception deficits may correlate with pain level Low  back pain  has long been described as a challenge for both primary care physicians and specialists . Management of  low back pain  has also been criticized as frequently arbitrary , inappropriate , or ineffective . Contributing factors have been an inadequate evidence base and a need for more rigorous appraisal s of the available literature . Evidence -based medicine , an approach to clinical problem solving , is predicated on the premise that high- quality health care will result from practice s consistent with the best evidence . In contrast to the traditional medical paradigm that placed a heavy reliance on expert opinion , authority , and un systematic clinical observations , evidence -based medicine emphasizes the need for rigorous critical appraisal s of the scientific literature to inform medical decision making . Evidence -based medicine places strong weight on the requirement for valid studies , particularly r and omized controlled trials , to appropriately evaluate the effectiveness of health care interventions . Because of the rapidly increasing volume of medical literature , however , most clinicians are unable to keep up-to- date with all the new data . Two types of preprocessed evidence that can aid busy clinicians in medical decision making are systematic review s and evidence -based clinical practice guidelines . Like primary studies , systematic review s and clinical practice guidelines must adhere to high method ologic st and ards to reduce error and bias . As in other areas of medicine , the approach to the management of low back pain has been positively affected by the availability of more clinical trials and better use of critical appraisal techniques to evaluate and apply research findings . In addition to more rigorous primary studies , an increasing number of high- quality systematic review s and evidence -based clinical practice guidelines for low back pain are also available . Although some research gaps and method ologic shortcomings persist , the richer evidence base has greatly improved our underst and ing of what does and does not work for low back pain . Despite these advances , the best available evidence often does not inform everyday clinical decisions for low back pain . Nonetheless , there is widespread agreement that adherence to evidence -based practice will help improve low back pain patient outcomes and reduce arbitrary variations in care . This article review s basic principles of evidence -based medicine , discusses evidence -based medicine in the context of low back pain management , and summarizes some useful evidence -based medicine re sources Background Low back pain is a common health complaint result ing in substantial economic burden . Each year , upwards of 20 r and omised controlled trials ( RCTs ) evaluating interventions for non-specific low back pain are published . Use of the term non-specific low back pain has been criticised on the grounds of encouraging heterogeneity and hampering interpretation of findings due to possible heterogeneous causes , challenging meta-analyses . We explored selection criteria used in trials of treatments for nsLBP . Methods A systematic review of English- language reports of RCTs in nsLBP population sample s , published between 2006 and 2012 , identified from MEDLINE , EMBASE , and the Cochrane Library data bases , using a mixed- methods approach to analysis . Study inclusion and exclusion criteria were extracted , thematically categorised , and then descriptive statistics were used to summarise the prevalence by emerging category . Results We included 168 studies . Two inclusion themes ( anatomical area , and symptoms and signs ) were identified . Anatomical area was most reported as between costal margins and gluteal folds ( n = 8 , 5 % ) , while low back pain ( n = 150 , 89 % ) with or without referred leg pain ( n = 27 , 16 % ) was the most reported symptom . Exclusion criteria comprised 21 themes . Previous or scheduled surgery ( n = 84 , 50 % ) , pregnancy ( n = 81 , 48 % ) , malignancy ( n = 78 , 46 % ) , trauma ( n = 63 , 37 % ) and psychological conditions ( n = 58 , 34 % ) were the most common . Sub-themes of exclusion criteria mostly related to neurological signs and symptoms : nerve root compromise ( n = 44 , 26 % ) , neurological signs ( n = 34 , 20 % ) or disc herniation ( n = 30 , 18 % ) . Specific conditions that were most often exclusion criteria were spondylolisthesis ( n = 35 , 21 % ) , spinal stenosis ( n = 31 , 18 % ) or osteoporosis ( n = 27 , 16 % ) . Conclusion RCTs of interventions for non-specific low back pain have incorporated diverse inclusion and exclusion criteria . Guidance on st and ardisation of inclusion and exclusion criteria for nsLBP trials will increase clinical homogeneity , facilitating greater interpretation of between-trial comparisons and meta-analyses . We propose a template for reporting inclusion and exclusion criteria INTRODUCTION Active treatments are advocated for the management of  non-specific chronic low back pain ( CLBP ) , although few studies have documented the relative efficacy of differing types of programme . A number of the available treatments comprise exercise routines on specially design ed training machines , which are ostensibly better disposed to reverse the compromised trunk muscle function displayed by these patients than are ' free exercise ' programmes . However , in using these muscle-training programmes , the physiological or anatomical adaptations that might account for the improved performance are rarely investigated , let alone identified . This is an important issue , because if the ' newly-acquired strength ' is mostly specific to performance on the devices on which the patient has trained and been tested , and reflects the skill in executing these particular tasks , this will not necessarily assist the patient during performance of his/her everyday activities . The aims of the present study were ( 1 ) to quantify the changes in back muscle performance in chronic LBP patients following 3 months active therapy , and ( 2 ) to analyse the corresponding changes in activation and cross-sectional area of the paraspinal muscles . METHODS 148 individuals ( 57 % women ) with CLBP ( age 45.0+/-10.0 years ; duration of LBP 10.9+/-9.5 years ) were r and omised to a treatment which they attended 2/week for 3 months : active physiotherapy , muscle reconditioning on training devices , or low-impact aerobics . Pre- and post-therapy , assessment s were made of isometric trunk muscle strength in each plane of movement and of erector spinae activation ( using surface electromyography ) during back extension . In a sub-group of 56 patients , the cross-sectional area of the paravertebral muscles was determined using magnetic resonance imaging ( MRI ) . In all patients , self-rated pain intensity , pain frequency and disability were assessed before and after therapy . RESULTS 132/148 patients completed the therapy .  Isometric strength in each movement plane increased significantly in all groups post-therapy . Apart from trunk extension , the changes were significantly greater in the devices group than in the other two groups ( Fig 1 ) . Activation of the paraspinal muscles during back extension also increased significantly in all groups ( Fig 2 ) and was weakly , but significantly ( r = 0.37 ; p = 0.0001 ) correlated with increased strength in back extension . Although , at baseline , highly significant correlations were observed between the size of the paraspinal muscles ( at L3/4 and at L4/5 ) and isometric back extension strength ( r=0.75 ; p < 0.0001 ) , post-training increases in strength were not accompanied by corresponding changes in muscle size . None of the improvements in strength showed any relationship with the clinical changes in pain and disability , regardless of whether the latter were examined on an individual basis or in relation to ' outcome groups ' . CONCLUSION The superior trunk strength shown by the devices group post-therapy was considered to be attributable , in part , to a ' learning effect ' , of the type often seen when training and testing are carried out on the same machines . These gains are considered to be mostly ' task-specific ' . However , part of the improvement in strength after active therapy ( in all groups ) also appeared to be due to an increased neural activation of the trunk muscles . These positive effects should be transferable to the performance of everyday activities for which the same muscles are employed , although the percentage improvement is probably not as high as the measured increase in strength might suggest . Possible roles for improved co-ordination and changes in motivation and /or pain tolerance after therapy can not be excluded . No differences in the clinical outcome were observed between the three therapy groups , and the changes in physical performance after therapy did not correlate with the clinical outcome . It is therefore question able whether strength measurements have any clinical significance in documenting the success of rehabilitation programmes , other than on a motivational basis . The results of the present study suggest that the value of supervised active therapy programmes does not reside in the reversal of specific muscular deficiencies , but rather in the provision of a source of confirmation/encouragement for the patient , that movement is not harmful , and a foundation upon which to further build . Whether the utilisation of specific training devices , or individual instruction , is necessary to elicit these particular effects is question able [ Purpose ] The purpose of this study was to compare two methods for the muscle stabilization of the trunk of patients with chronic low back pain . The methods comprised combination patterns of proprioceptive neuromuscular facilitation ( PNF ) and ball exercise . [ Subjects and Methods ] The subjects were 40 volunteers who had low back pain . All subjects were r and omly assigned to either a group which received proprioceptive neuromuscular facilitation or a group which performed ball exercise . Measurements were taken four times in total , at pre-intervention , two weeks later , four weeks later , and six weeks later . The main measurement methods used were the visual analogue scale ( VAS ) for pain and electromyography ( EMG ) for muscle activity . [ Results ] VAS and EMG activity were significantly reduced in the PNF combination pattern group and the ball exercise group . A comparison of the groups showed significant differences . In VAS and EMG activity ; in particular , the combination pattern group using PNF increased EMG activity more than the ball exercise group did after six weeks of intervention . [ Conclusion ] This study showed that PNF combination pattern training for six weeks was more effective for patients with low back pain than performing ball exercise Tai Chi ( TC ) can be considered safe and effective intervention to improve pain and pain-related functional disability . However , it is unclear that whether aging individuals with Chronic Non-Specific Low Back Pain ( CNS-LBP ) can achieve positive results . This study , therefore , attempted to explore the effects of TC on pain and functional disability in CNS-LBP patients aged 50 years old or above . Forty-three individuals ( aged 50 years old or above ) with CNS-LBP were r and omly assigned into three groups : Chen-Style TC group ( n = 15 ) , Core Stabilization training ( CST ) group ( n = 15 ) , and control group ( n = 13 ) . Participants in the TC group participated in Chen-style TC training program ( three 60-min sessions per week for 12 weeks ) , individuals in CST group received 12-week Core Stabilization exercise on the Swiss ball , whereas individuals in the control group maintained their unaltered lifestyle . Pain intensity as primary outcome was measured using the Visual Analogue Scale ( VAS ) , A BiodexSystem 3 isokinetic dynamometer was used to measure knee and ankle joint position sense ( JPS ) as secondary outcomes at baseline and after the 12-week intervention . TC and CST have significant effects in VAS for CNS-LBP patients ( p < 0.01 , TC group OR CST group versus control group in mean of the post-minus-pre assessment ) . However , the feature of joint position sense ( JPS ) of ankle inversion , ankle eversion and knee flexion did not occur , it showed no significant effects with TC and CST . TC was found to reduce pain , but not improve lower limb proprioception in patients with CNS-LBP . Future research with larger sample sizes will be needed to achieve more definitive findings on the effects of TC on both pain and lower limb proprioception in this population OBJECTIVE To determine if the use of an isokinetic device for trunk exercise is more effective than st and ard physiotherapy in promoting motor disinhibition for patients with chronic low back pain . POPULATION chronic low back pain out patients who are treated in a Rheumatology or PM & R unit within an academic hospital . METHODOLOGY This is a prospect i ve , controlled , r and omized study , with two groups of treatment : one treated with isokinetic techniques and the other with st and ard physiotherapy , six sessions for each treatment during 2 weeks . Outcome measures include pain ( VSA ) , trunk mobility ( Schöber index , distance from fingers to floor ) , muscle extensibility and muscle strength ( Biering-Sorensen and Shirado-Ito test ) , and functional capacity ( Quebec scale ) . RESULTS Seventeen subjects were enrolled . The results suggest that both isokinetic exercise and physiotherapy result in improved range of motion , extensibility , muscle strength , and pain , without any significant superiority of one technique over the other . However , each technique has specific advantage . DISCUSSION Despite method ologic limitations , this study shows that isokinetic exercise is not better than physiotherapy in reversing motor inhibition in chronic low back pain . Our results are consistent with those of other studies in the literature , with regard to the absence of established overall superiority of one exercise technique or program over the other in this population , and with regard to partial benefits of specific exercise techniques . CONCLUSION The non-specific benefit of one technique indicates that further studies are needed to evaluate the benefit of combining exercise techniques in chronic low back pain , in order to address the multiple factors involved in this pathology Study Design : A control group study with repeated measures . Objective : To compare  trunk repositioning parameters  in chronic low back pain ( LBP ) and healthy subjects . Summary and background data : Recent evidence suggests that chronic LBP patients exhibit deficits in trunk proprioception and motor control . Trunk repositioning and the various spatio-temporal parameters related to it can be used to evaluate sensori-motor control and movement strategies . Methods : Fifteen control subjects and 16 chronic LBP subjects participated in this study . Subjects were required to reproduce different trunk position in flexion ( 15 ° , 30 ° and 60 ° ) and extension ( 15 ° ) . In the learning phase preceding each condition , visual feedback was provided . Following these learning trials , subjects were asked to perform ten consecutive trials without any feedback . Movement time , movement time variability and peak velocity were obtained and a temporal symmetry ratio was calculated . Peak angular position variability and absolute error in peak angular position were also calculated to evaluate spatial accuracy . Results : Two subgroups of LBP patients were identified . One subgroup of LBP subjects demonstrated longer movement time and smaller peak velocities and symmetry ratios than normal subjects . No group difference was observed for peak angular position variability and absolute error in peak angular position . Conclusion : Chronic LBP patients , when given a sufficient learning period , were able to reproduce trunk position with a spatial accuracy similar to control subjects . Some LBP subjects , however , showed modifications of movement time , peak velocity and acceleration parameters . We propose that the presence of persistent chronic pain could induce an alteration or an adaptation in the motor responses of chronic LBP subjects
This systematic review covered all the relevant literature , but none of the included studies offered a valid , reliable and feasible method to assess neuromotor capacity in everyday physiotherapy clinical practice
BACKGROUND Physiotherapists and clinicians require methods that can be used in everyday practice for measuring proprioception of the trunk in individuals with non-specific low back pain ( NSLBP ) .
OBJECTIVE Our objective was to conduct a systematic literature review of methods used for assessment of proprioception of the trunk in individuals with non-specific low back pain .