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Akram Muharram, Wenge Liu, Zhenyu Wang, Lei Sun and Weifen Wu

Edited by Lindsey E. Eberman

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Kari Brody, Russell T. Baker, Alan Nasypany and Jim May

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Haley Dvorak, Christina Kujat and Jason Brumitt

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Leila Ahmadnezhad, Ali Yalfani and Behnam Gholami Borujeni

Chronic low back pain (CLBP) is generally accepted as one of the most common musculoskeletal disorders, affecting, on average, 4% to 33% of people. CLBP can also affect the quality of life and lead to disability and absenteeism. Approximately 85% of the cases of low back pain (LBP) are described as

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Marcin Grzes´kowiak, Zbigniew Krawiecki, Wojciech Łabe˛dz´, Jacek Kaczmarczyk, Jacek Lewandowski and Dawid Łochyn´ski

Flexion-relaxation phenomenon (FRP) is a physiological condition described as a silence in paraspinal muscle bioelectrical activity during full trunk flexion; that is, in normal subjects without chronic low back pain (CLBP), back muscles cease their electrical activity at a certain position during

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Yaser Alikhajeh, Elyas Barabadi and Gholam Rasul Mohammad Rahimi

.1016/j.spinee.2014.01.026 24462537 4. Maher C . Effective physical treatment for chronic low back pain . Orthop Clin North Am . 2004 ; 35 : 57 – 64 . PubMed ID: 15062718 doi: 10.1016/S0030-5898(03)00088-9 15062718 5. Mannion A , Balagué F , Pellisé F , Cedraschi C . Pain measurement in

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Kaitlyn C. Jones, Evelyn C. Tocco, Ashley N. Marshall, Tamara C. Valovich McLeod and Cailee E. Welch Bacon

Impression of Change; RMDQ, Roland–Morris Disability Questionnaire; SF-36, Short Form-36; TE, therapeutic exercise; TSK-11, Tampa Scale for Kinesiophobia; VAS, visual analog scale; CLBP, chronic low back pain. Implications for Practice, Education, and Future Research Two of the 3 studies 2 – 4 appraised for

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Valerie Gladwell, Samantha Head, Martin Haggar and Ralph Beneke

Objective:

To evaluate the effect of a program of modified Pilates for active individuals with chronic non-specific low back pain.

Design:

A single blind randomized controlled trial.

Participants:

49 individuals with chronic low back pain were randomly allocated to control (n = 24) or Pilates group (n = 25). Thirty-four individuals completed the study (14 and 20 individuals for control and Pilates group, respectively).

Intervention:

The Pilates group undertook a six week program of Pilates. Both groups continued with normal activity.

Main Outcome Measures:

An assessor blinded to group allocation conducted functional and questionnaire-based assessments pre- and post- intervention.

Results:

Improvements were seen in the Pilates group post- intervention period with increases (P < 0.05) in general health, sports functioning, flexibility, proprioception, and a decrease in pain. The control group showed no significant differences in the same measures post- intervention.

Conclusions:

These data suggest that Pilates used as a specific core stability exercise incorporating functional movements can improve non-specific chronic low back pain in an active population compared to no intervention. Additionally, Pilates can improve general health, pain level, sports functioning, flexibility, and proprioception in individuals with chronic low back pain.

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Christoph Dehner, Andreas Schmelz, Hans-Ullrich Völker, Jochen Pressmar, Martin Elbel and Michael Kramer

Context:

Chronic low back pain (LBP) has been reported with a high incidence in elite rowers. It results in less effective training, long interruptions in training, and a drop in performance.

Objective:

The authors hypothesized that exercise-induced LBP in rowers is caused by a chronic functional compartment syndrome (CFCS) of the multifidus muscle.

Design:

Controlled clinical trial.

Setting:

The rowers were tested in their training camp. The control group was tested at a university hospital.

Participants:

14 volunteer elite rowers complaining of LBP and 16 healthy volunteer amateur athletes.

Main Outcome Measurements:

Intramuscular pressure (IMP), tissue oxygenation pressure (pO2), and median frequency (MF) shift in the electromyographic power density spectrum during isometric fatiguing extension at 60% of maximum voluntary contraction.

Results:

At the beginning (controls 186.6 mm Hg vs rowers 60.2 mm Hg, P = .002) and the end (controls 224.1 mm HG vs rowers 77.1 mm Hg, P < .001) of the endurance exercise the median IMP was significantly higher in the healthy controls. Nearly identical resting pO2 was measured in both groups (controls 37.6 mm Hg vs rowers 37.3 mm Hg, P = .740). Rowers showed higher median MF shift (rowers −11.5 Hz vs controls −8.5 Hz, P = .079) during contraction.

Conclusions:

These observations cannot sufficiently be explained by the CFCS model and suggest that factors other than IMP have an additional effect on pain generation during exercise in elite rowers.

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Athanasios Trampas, Anastasia Mpeneka, Vivian Malliou, George Godolias and Periklis Vlachakis

Context:

Previous studies showed improved dynamic-balance (DB) performance after core-stability (CS) exercises in populations with chronic low back pain. Although clinical massage plus exercise is likely to better enhance analgesia than exercise alone, its efficacy on balance remains unclear.

Objective:

To evaluate the immediate effects of CS exercises plus myofascial trigger-point (MTrP) therapy in comparison with CS exercises alone on DB performance, pressure-pain threshold (PPT), and cross-sectional area of active MTrPs in patients with clinical instability of the lumbar spine and chronic myofascial pain syndrome.

Design:

Randomized, assessor-blind, test–retest.

Setting:

University research laboratory.

Patients:

10 physically active adults (5 men, 5 women).

Main Outcome Measures:

Single-leg DB performance and side-to-side ratios in 2 planes of motion (frontal, sagittal), as well as PPT and cross-sectional area of active MTrPs, were measured using stabilometry, pressure algometry, and real-time ultrasound scanning, respectively.

Interventions:

The 1st group performed CS exercises alone, whereas the same exercise program was applied in the 2nd group plus cross-fiber friction on active MTrPs (3.5 min/MTrP).

Results:

Within-group statistically and clinically significant differences were observed only for group II in PPT. However, group I also exhibited a large effect size with clinically significant changes from baseline on this outcome. Furthermore, patients in group II clinically improved their balance ratios and differed from group I at posttest in sagittal-plane DB performance of the painful side.

Conclusion:

CS exercises immediately increase the PPT of active MTrPs in physically active adults with clinical instability of the lumbar spine and chronic myofascial pain syndrome. When MTrP therapy is added, side-to-side asymmetries in DB are minimized.