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

intensity and disability in long-term effects and outcomes past a time frame of 3 mo. Abbreviations: LBP, low back pain; N/A, not applicable; NPRS, numerical pain rating scale; NS-LBP, nonspecific low back pain; PCS, pain catastrophizing scale; PE, pain neurophysiology education; PGIC, Patient Global

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Barton E. Anderson and Kellie C. Huxel Bliven

Clinical Scenario:

Research has shown a link between poor core stability and chronic, nonspecific low back pain, with data to suggest that alterations in core muscle activation patterns, breathing patterns, lung function, and diaphragm mechanics may occur. Traditional treatment approaches for chronic, nonspecific low back pain focus on exercise and manual therapy interventions, however it is not clear whether breathing exercises are effective in treating back pain.

Focused Clinical Question:

In adults with chronic, nonspecific low back pain, are breathing exercises effective in reducing pain, improving respiratory function, and/or health related quality of life?

Summary of Key Findings:

Following a literature search, 3 studies were identified for inclusion in the review. All reviewed studies were critically appraised at level 2 evidence and reported improvements in either low back pain or quality of life following breathing program intervention.

Clinical Bottom Line:

Exercise programs were shown to be effective in improving lung function, reducing back pain, and improving quality of life. Breathing program frequencies ranged from daily to 2–3 times per week, with durations ranging from 4 to 8 weeks. Based on these results, athletic trainers and physical therapists caring for patients with chronic, nonspecific low back pain should consider the inclusion of breathing exercises for the treatment of back pain when such treatments align with the clinician’s own judgment and clinical expertise and the patient’s preferences and values.

Strength of Recommendation:

Grade B evidence exists to support the use of breathing exercises in the treatment of chronic, nonspecific low back pain.

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Michelle Jones, Gareth Stratton, Tom Reilly and Vishwanath Unnithan

The purpose of this study was to evaluate the efficacy of a specific 8-week exercise rehabilitation program as an intervention to treat recurrent nonspecific low back pain in adolescents. A randomized controlled trial involving 54 adolescents (14.6 ± 0.6 years) who suffered from recurrent nonspecific low back pain participated in either the exercise rehabilitation program or a control condition. Pre- and postintervention measures of low back pain status and biological risk indicators were taken. Two-way mixed ANOVA was conducted and significance was set at p < .01. Significant improvement was noted in the exercise rehabilitation group for perceived severity of pain (effect size 1.47) and number of occasions missing physical activity (effect size 0.99). Significant improvement in the exercise rehabilitation group for sit-and-reach performance, hip range of motion, lumbar sagittal mobility (modified Schöber), and number of sit-ups in 60 s were also identified. In conclusion, the specific exercise program appeared to provide positive benefits for adolescents suffering from recurrent nonspecific low back pain. Further evaluation is required to evaluate the effectiveness of the exercise rehabilitation program in relation to other interventions and to assess the long-term effectiveness.

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Yaser Alikhajeh, Elyas Barabadi and Gholam Rasul Mohammad Rahimi

pain . Pain Clinic . 2004 ; 16 ( 1 ): 35 – 42 . doi: 10.1163/156856904322858684 26. Al-Shareef AT , Omar MT , Ibrahim AH . Effect of kinesio taping on pain and functional disability in chronic nonspecific low back pain . Spine . 2016 ; 41 ( 14 ): E821 – E828 . PubMed ID: 27392262 doi: 10

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Sara J. Golec and Alison R. Valier

identify the impact of adherence to clinical practice guidelines on the outcomes of patients with low back pain and subsequent synthesis of findings is warranted. Focused Clinical Question Does adherence to clinical practice guidelines for patients with nonspecific low back pain reduce pain and disability

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Michelle A. Sandrey

not for use in isolation. ▸ The strength of recommendation is grade B, due to inconsistent evidence. ▸ Evidence is lacking as to which instability tests should be included for athletes. Clinical Scenario Nonspecific low back pain can be caused by several variables including spinal instability, muscle

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Rupal Mehta, Marco Cannella, Sharon M. Henry, Susan Smith, Simon Giszter and Sheri P. Silfies

Trunk muscle timing impairment has been associated with nonspecific low back pain (NSLBP), but this finding has not been consistent. This study investigated trunk muscle timing in a subgroup of patients with NSLBP attributed to movement coordination impairment (MCI) and matched asymptomatic controls in response to a rapid arm-raising task. Twenty-one NSLBP subjects and 21 matched controls had arm motion and surface EMG data collected from seven bilateral trunk muscles. Muscle onset and offset relative to deltoid muscle activation and arm motion, duration of muscle burst and abdominal–extensor co-contraction time were derived. Trunk muscle onset and offset latencies, and burst and co-contraction durations were not different (p > .05) between groups. Patterns of trunk muscle activation and deactivation relative to arm motion were not different. Task performance was similar between groups. Trunk muscle timing does not appear to be an underlying impairment in the subgroup of NSLBP with MCI.

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Karen D. Kendall, Christie Schmidt and Reed Ferber


It has been theorized that a positive Trendelenburg test (TT) indicates weakness of the stance hip-abductor (HABD) musculature, results in contralateral pelvic drop, and represents impaired load transfer, which may contribute to low back pain. Few studies have tested whether weakness of the HABDs is directly related to the magnitude of pelvic drop (MPD).


To examine the relationship between HABD strength and MPD during the static TT and during walking for patients with nonspecific low back pain (NSLBP) and healthy controls (CON). A secondary purpose was to examine this relationship in NSLBP after a 3-wk HABD-strengthening program.




Clinical research laboratory.


20 (10 NSLBP and 10 CON).


HABD strengthening.

Main Outcome Measures:

Normalized HABD strength, MPD during TT, and maximal pelvic frontal-plane excursion during walking.


At baseline, the NSLBP subjects were significantly weaker (31%; P = .03) than CON. No differences in maximal pelvic frontal-plane excursion (P = .72), right MPD (P = 1.00), or left MPD (P = .40) were measured between groups. During the static TT, nonsignificant correlations were found between left HABD strength and right MPD for NSLBP (r = −.32, P = .36) and CON (r = −.24, P = .48) and between right HABD strength and left MPD for NSLBP (r = −.24, P = .50) and CON (r = −.41, P = .22). Nonsignificant correlations were found between HABD strength and maximal pelvic frontal-plane excursion for NSLBP (r = −.04, P = .90) and CON (r = −.14, P = .68). After strengthening, NSLBP demonstrated significant increases in HABD strength (12%; P = .02), 48% reduction in pain, and no differences in MPD during static TT and maximal pelvic frontal-plane excursion compared with baseline.


HABD strength was poorly correlated to MPD during the static TT and during walking in CON and NSLBP. The results suggest that HABD strength may not be the only contributing factor in controlling pelvic stability, and the static TT has limited use as a measure of HABD function.

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TaeYeong Kim, JaeHyuk Lee, SeJun Oh, Seungmin Kim and BumChul Yoon

The prevalence of nonspecific low back pain (LBP) is 80%. 1 Over half of individuals with nonspecific LBP will experience chronic symptoms lasting longer than 1 year, and these symptoms result in high health care costs. 2 Effective management to reduce pain intensity and to prevent a chronic pain

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Emma Hoffman, Abrianna D’Onofrio, Shelby Baez and Julie Cavallario

differences in flexion peak torque, extension peak torque, agonist/antagonist ratio, flexion ratio, or extension ratio between the experimental or placebo group after taping. Level of evidence 1B 2B PEDro score 9 6 Support for the answer The use of Kinesio Tape in patients with nonspecific low back pain was