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Background: Understanding postural control in low back pain (LBP) subgroups can help develop targeted interventions to improve postural control. The studies on this topic are limited. Therefore, the primary purpose of this study was to compare the postural control of LBP subgroups with healthy individuals during overhead load lifting and lowering. Methods: In this cross-sectional study, the participants were 52 with LBP and 20 healthy. The LBP patients were classified based on the O'Sullivan classification system into 21 flexion patterns and 31 active extension patterns. The participants lifted the box from their waists to their overheads and lowered it to their waists. Changes in postural control parameters were measured with a force plate system. Results: The results of the analysis of variance showed that during load lifting, the mediolateral phase plane (p =.044) and the mean total velocity (p =.029) had significant differences between flexion patterns and healthy. Also, the load-lowering results showed that active extension patterns, compared with healthy, had significant differences in the anteroposterior–mediolateral phase plane (p =.042). The patients showed less postural sway than the healthy. Conclusions: The results in this work highlight the importance of identifying the homogenous subgroups in LBP and support the classification of heterogeneous LBP. Different subgroups exhibit different postural control behaviors. These behaviors can be due to the loading of various tissues during different tasks. [ABSTRACT FROM AUTHOR]

Introduction: Groin pain is a common issue among athletes. Adductor-related pain is known as the most common cause of groin pain. Although, non-operative treatments have limited efficacy, Capacitive and Resistive Energy Transfer (TECAR), can be used in the treatment of musculoskeletal conditions. The objective of the present study is to explore the effect of TECAR therapy on pain, range of motion (ROM), strength, and subscales of the "Copenhagen Thigh and Groin Assessment Scale"(HAGOS) questionnaire in athletes suffering from adductor-related groin pain (ARGP). Methods: This study was a two arm parallel groups randomized sham-controlled superiority trial. A total of 22 male professional athletes (mean age 21.36 years) were randomly assigned to either the real TECAR therapy (n = 11) or sham TECAR therapy (n = 11) group, using block-balanced randomization. Both groups received stretching exercises. Intervention group received 10 sessions of TECAR therapy while, the control group received sham TECAR therapy. Primary outcome was pain that was measured by Visual Analogue Scale (VAS). Secondary outcomes included ROM, strength, and HAGOS questionnaire subscales. All outcomes were assessed at baseline, after 5 sessions, after 10 sessions, and one month after treatment. Analysis of Variance (ANOVA) and Analysis of Covariance were used to compare between-group mean differences. P-value was set at 0.05. Effect size Cohen's d was also reported. This study took place from September 2022 to August 2023 at the Rehabilitation Clinic at Iran University of Medical Sciences. Results: A total of 22 male athletes were included (11 in each group), with a mean age of 21.09 years in the TECAR group and 21.63 years in the sham group. TECAR therapy was associated with significant reductions in pain intensity across all evaluation sessions. Specifically, after 5 sessions, there was a large effect size for pain reduction (p = 0.01, Cohen's d = -1.09 [95% CI: -0.195 to -1.987]); after 10 sessions, the effect was even larger (p = 0.001, Cohen's d = -2.153 [95% CI: -1.103 to -3.203]); and at the 1-month follow-up, the pain reduction persisted (p = 0.001, Cohen's d = -1.96 [95% CI: -0.944 to -2.978]). In terms of secondary outcomes, there was a significant improvement in hip adduction ROM at the 1-month follow-up (p = 0.03, Cohen's d = 0.908 [95% CI: 0.03 to 1.78]). However, no statistically significant differences were found for other secondary outcomes, with effect sizes ranging from no effect to intermediate. Conclusion: The results of this study suggest that TECAR therapy may reduce pain and improve hip adduction range of motion in athletes with adductor-related groin pain. Trial registration: This trial was registered at the (https://www.irct.ir), (IRCT20220622055250N1) on 18/09/2022. [ABSTRACT FROM AUTHOR]

Background: In hallux valgus, morphological changes and functional weakness of intrinsic foot muscles occur, especially in the abductor hallucis muscle. Objectives: This study aimed to investigate how a conservative treatment with the addition of neuromuscular electrical stimulation affects the volume and strength of the muscle, the correction of deformity, passive range of motion, pain, and disability. Methods: Twenty-eight female participants (48 feet) were randomly assigned to two groups. The interventions included orthoses and exercise (Ortho) in both groups. One group received additional neuromuscular electrical stimulation of abductor hallucis muscle to activate it. Each group received the treatments for one month and was assessed two times, at baseline before starting and after one month of treatment. Mixed within-between ANOVA, analysis of covariance, and nonparametric tests were used for data analysis. Results: The muscle volume, abduction strength, goniometric angle, and passive hallux dorsi/plantar flexion showed significant changes in both groups (p <.001). Subscales of the foot and ankle ability questionnaire, significantly changed (p ≤.05). Pain decreased significantly in the two groups (p <.001 and p =.02). Intermetatarsal angle did not significantly differ between the two groups (p =.86, partial eta effect size = 0.001). But, the hallux valgus angle mean (on MRI) in the Ortho group was less than that of the orthoNMES group (p =.007, partial eta effect size = 0.15). Conclusion: Both groups showed nearly identical treatment effects in the primary volume and hallux valgus correction outcome measures. In this study, adding neuromuscular electrical stimulation did not have an additional effect compared to conservative in the treatment of hallux valgus. Trial registration number: The RCT Code is IRCT20200915048725N1. [ABSTRACT FROM AUTHOR]

Introduction: Upper limb motor disability, with a prevalence of approximately 77%, is the most common complication after stroke. Despite advancements in rehabilitation, many patients face persistent upper limb discrepancies. Adopting top-down and bottom-up interventions may enhance neuroplasticity and improve upper limb function. This study aims to determine the effect of motor cortical transcranial direct-current stimulation (tDCS) as a top-down approach combined with task-oriented training (TOT) as a bottom-up intervention on changes in electroencephalography (EEG) spectral power in chronic stroke patients. Materials and Methods: Thirty chronic hemiparetic stroke survivors were randomly assigned to receive real or sham stimulation targeting the primary motor cortex (C3/C4) at 2 mA for 20 minutes and TOT daily over 15 sessions. EEG was conducted before and after the intervention, with a 3-month follow-up and the relative powers of delta to gamma frequency bands were recorded during the movement task with each hand (healthy and involved). Results: Significant differences in the theta (P=0.000), alpha (P=0.004), beta (P=0.000) and gamma (P=0.003) relative powers were observed between groups at follow-up. Additionally, the Friedman test revealed a significant decrease in alpha and beta bands' relative powers in the healthy hand of the control group at follow-up (P=0.001). The experimental group displayed increased alpha and beta powers and decreased theta without statistical significance. Conclusion: The increase in the relative power of low frequencies and the decrease in high frequencies in the sham group, which were more prominent than the increases in alpha and beta bands' relative power and the decrease in theta in the experimental group, can indicate that the real-tDCS can prevent the recovery drop of relative powers. Due to the inconsistent effects of tDCS on the EEG power spectrum in stroke patients, conventional tDCS administration may require adjustments for optimal application to brain target points. [ABSTRACT FROM AUTHOR]

Aim: To examine the reliability of rehabilitative ultrasound imaging performed to measure the thickness of the transverse abdominis, internal oblique, external oblique, and lumbar multifidus muscles in females with recurrent low back pain. Material and methods: A sample of 15 women was recruited. Two independent examiners recorded the thickness of their deep abdominal and spinal muscles by rehabilitative ultrasound imaging. Imaging scans of the transverse abdominis, internal oblique, and external oblique muscles were performed in the supine position and in the midaxillary line, between the lower edge of the ribcage and the iliac crest. Imaging of the lumbar multifidus was done in the prone position and at the level of the L5/S1 zygapophyseal joints. Imaging scans were performed bilaterally in rest and contraction, three times by the first examiner (at baseline, after two hours, and one week later) and once by the second examiner. Results: Good to excellent within-session intra-rater (ICC = 0.76, 0.97), good to excellent between-session intra-rater reliability (ICC = 0.73, 0.93), and good to excellent inter-rater reliability (ICC = 0.73, 0.98) were obtained. Conclusions: The results showed that rehabilitative ultrasound imaging can be used as an excellent reliable instrument by one or two examiners to measure the thickness of the transverse abdominis, internal oblique, external oblique and lumbar multifidus muscles in females with recurrent low back pain.

Objectives: The study investigated the influence of starting load position during lifting on postural control in nonspecific chronic low back pain (LBP) and healthy volunteers. Patients and methods: The cross-sectional study included 20 healthy males (mean age: 31.8±7.4 years; range, 18 to 55 years) and 52 male patients (mean age: 33.4±9.2 years; range, 18 to 55 years) with chronic LBP between February 2016 and April 2018. Postural control characteristics were assessed by a force plate system. Center of pressure signals were obtained at a frequency of 100 Hz, and the mean of three trials was calculated. The participants were told to place their feet hip-width apart on the force plate while standing barefoot. They were then asked to lift a box weighing 10% of their body weight from the ground to waist height and then from waist height to overhead with straight elbows. They moved the box at their selected speed. The examinations began upon the examiner's command. Results: Results indicated a significant difference (p<0.001) in all postural control variables in chronic LBP patients who lifted a load at different heights. In addition, there was a significant difference between all of the postural control measures of this study in healthy participants during load lifting at different heights (p<0.05), with the exception of the mediolateral standard deviation of velocity (p=0.067). Conclusion: Different lifting heights impact LBP patients' and healthy people's postural control differently. Postural control was more challenging during waist-to-overhead lifting in the patient group. This may be due to a stiffening strategy. The central nervous system reduces postural sway at higher centers of mass. [ABSTRACT FROM AUTHOR]

Context: Clinical evaluation of the spine is commonplace in musculoskeletal therapies, such as physiotherapy, physical medicine/rehabilitation, osteopathic, and chiropractic clinics. Sit-to-stand (STS) is one of the most mechanically demanding daily activities and crucial to independence. Difficulty or inability to perform STS is common in individuals with a variety of motor disabilities, such as low back pain (LBP). Objective: The purpose of this systematic review was to evaluate available evidence in literature to determine 2-dimensional and 3-dimensional kinematics of the spine during STS in patients with LBP and healthy young adult participants using motion analysis systems (electromagnetic and marker based). Methods: Electronic databases (PubMed/MEDLINE [National Library of Medicine], Scopus, ScienceDirect, and Google Scholar) were searched between January 2002 and February 2017. Additionally, the reference lists of the articles that met the inclusion criteria were also searched. Prospective studies published in peer-reviewed journals, with full text available in English, investigating the kinematics of the spine during STS in healthy subjects (mean age between 18 and 50 y) or in patients with LBP using motion analysis systems, were included. Sixteen studies fulfilled the eligibility criteria. All information relating to methodology and kinematic modeling of the spine segments along with the outcome measures was extracted from the studies identified for synthesis. Results: The results indicated that the kinematics of the spine are greatly changed in patients with LBP. In order to develop a better understanding of spine kinematics, studies recommended that the trunk should be analyzed as a multisegment. It has been shown that there is no difference between the kinematics of patients with LBP and healthy population when the spine is analyzed as a single segment. Furthermore, between-gender differences are present during STS movement. Conclusion: This review provided a valuable summary of the research to date examining the kinematics of the spine during STS. [ABSTRACT FROM AUTHOR]

Previous studies have demonstrated that respiratory dysfunction has a potential association with low back pain (LBP). Despite the role of the diaphragm for respiration and spinal stability, knowledge of the function of both sides of the diaphragm in subjects with LBP is still limited. This study aimed to compare the structural integrity and function of the right and left hemidiaphragm by ultrasonography (USG) in subjects with and without nonspecific chronic low back pain (NS-CLBP). A total of 37 subjects with NS-CLBP and 34 healthy subjects participated in this case-control study. The thickness, thickness change, and excursion of the right and left hemidiaphragm were compared within and between the groups during quiet breathing (QB) and deep breathing (DB) through B-mode and M-mode ultrasound imaging. The LBP group had a significantly smaller degree of right hemidiaphragm thickness change (P =.001) compared with the healthy control group, with a strong effect size. Nevertheless, there was no significant change for diaphragm thickness and excursion between the two groups. The result showed that, in the healthy group, the right hemidiaphragm had a significantly smaller thickness at expiration and larger thickness change compared with the left hemidiaphragm, with a moderate effect size. Based on the multivariate prediction analysis, the right hemidiaphragm thickness change might significantly predict LBP. We found that participants with LBP had a smaller degree of right hemidiaphragm thickness change. Also, the right hemidiaphragm thickness change might significantly predict LBP. [ABSTRACT FROM AUTHOR]