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 Neuromuscular strategies for lumbopelvic control during frontal and sagittal plane movement challenges differ between people with and without low back pain. Comparison between Kinesio Taping and a Traditional Physical Therapy Program in Treatment of Nonspecific Low Back Pain Short-term effects of interferential current electro-massage in adults with chronic non-specific low back pain: a randomized controlled trial Specific Trunk and General Exercise Elicit Similar Changes in Anticipatory Postural Adjustments in Patients With Chronic Low Back Pain: A Randomized Controlled Trial Evaluation of a specific home exercise program for low back pain. How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists Recurrent non-specific low-back pain in adolescents: the role of exercise Physical Therapy Treatment of Back Complaints on Children and Adolescents Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. Kinesio Taping reduces disability and pain slightly in chronic non-specific low back pain: a randomised trial. Deficits in Neuromuscular Control of the Trunk Predict Knee Injury Risk The natural history of trunk list, its associated disability and the influence of McKenzie management Movement control exercise versus general exercise to reduce disability in patients with low back pain and movement control impairment. A randomised controlled trial
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 Observation-based assessment s of movement are a st and ard component in clinical assessment of patients with non-specific low back pain . While aberrant motion patterns can be detected visually , clinicians are unable to assess underlying neuromuscular strategies during these tests . The purpose of this study was to compare coordination of the trunk and hip muscles during 2 commonly used assessment s for lumbopelvic control in people with low back pain ( LBP ) and matched control subjects .  Electromyography was recorded from hip and trunk muscles of 34 participants ( 17 with LBP ) during performance of the Active Hip Abduction ( AHAbd ) and Active Straight Leg Raise ( ASLR ) tests .  Relative muscle timing was calculated using cross-correlation . Participants with LBP demonstrated a variable strategy , while control subjects used a consistent proximal to distal activation strategy during both frontal and sagittal plane movements . Findings from this study provide insight into underlying neuromuscular control during commonly used assessment tests for patients with LBP that may help to guide targeted intervention approaches [ Purpose ] Nonspecific low back pain ( NSLBP ) is a very common but largely self-limiting condition . Several types of tape and their associated application methods are available for different conditions . The aim of the present study was to observe the effect of Kinesio taping ( KT ) compared with traditional management of NSLBP . [ Subjects and Methods ] Forty male and female patients with a mean age of 34.8±7.54 years were r and omly divided into two groups ; group 1 ( n=20 ) which underwent conventional physical therapy with KT , and group 2 ( n=20 ) , which underwent only conventional physical therapy . The intervention sessions for both groups were three times per week for four weeks . Outcomes were assessed for activities of daily living ( ADL ) using the Rol and -Morris Disability Question naire , pain severity using a visual analogue scale , and ranges of motion ( ROMs ) of trunk flexion and extension using the modified Schober ’s test . [ Results ] Significant differences in measures of pain , ADL , and trunk flexion and extension ROMs were observed post intervention within each group . In comparison , there were no significant differences in measures of pain , ADL , and trunk flexion and extension ROMs post intervention between groups . [ Conclusion ] A physical therapy program involving strengthening exercises for abdominal muscles and stretching exercises for back , hamstring , and iliopsoas muscles with or without Kinesio taping was beneficial in the treatment of chronic low back pain Objectives : To analyse the effectiveness of a combined procedure of massage and electrotherapy with interferential current in individuals with chronic non-specific low back pain of mechanical aetiology . Design : A single blinded r and omized controlled trial . Setting : Clinical setting . Participants : Sixty-two individuals with chronic non-specific low back pain were r and omly assigned to an experimental or control group . For 10 weeks the experimental group underwent treatment comprising 20 sessions ( twice a week ) of massage with interferential current in the lumbar and dorsal – lumbar area , and the control group received superficial lower back massage ( effleurage , superficial pressure and skin rolling ) . Main outcome variables : Oswestry Disability Index , pain visual analogue scale , Tampa Scale for Kinesiophobia , Rol and Morris Disability Question naire , McQuade Test , Side Bridge Test , quality of life scores and the range of trunk anteflexion motion , which were all assessed before the treatment and immediately after the last treatment session . Results : The 2 × 2 mixed model ANOVA with repeated measurements showed statistically significant group * time interactions for the visual analogue scale ( F = 12.839 ; P = 0.001 ) , Oswestry Disability Index ( F = 5.850 ; P = 0.019 ) , Rol and Morris Disability Question naire ( F = 8.237 ; P = 0.006 ) and quality of life ( physical function ( F = 16.792 ; P = 0.001 ) , physical role ( F = 14.839 ; P = 0.001 ) and body pain ( F = 11.247 ; P = 0.001 ) ) . Conclusions : In individuals with chronic non-specific low back pain  , interferential current electro-massage achieved a significantly greater improvement in disability , pain and quality of life in comparison to superficial massage after 20 treatment sessions Study Design . A r and omized controlled trial . Objective . To compare changes in self-rated disability , pain , and anticipatory postural adjustments between specific trunk exercise and general exercise in patients with chronic low back pain . Summary of Background Data . Chronic low back pain is associated with altered motor control of the trunk muscles . The best exercise to address altered motor control is unclear . Methods . Sixty-four patients with chronic low back pain were r and omly assigned to a specific trunk exercise group ( SEG ) that included skilled cognitive activation of the trunk muscles in addition to a number of other best practice exercises , whereas the general exercise group performed only seated cycling exercise . The training program lasted for 8 weeks . Self-rated disability and pain scores were collected before and after the training period . Electromyographic activity of various trunk muscles was recorded during performance of a rapid shoulder flexion task before and after training . Muscle onsets were calculated , and the latency time ( in ms ) between the onset of each trunk muscle and the anterior deltoid formed the basis of the motor control analysis . Results . After training , disability was significantly lower in the SEG ( d = 0.62 , P = 0.018 ) . Pain was reduced in both groups after training ( P < 0.05 ) , but was lower for the SEG ( P < 0.05 ) . Despite the general exercise group performing no specific trunk exercise , similar changes in trunk muscle onsets were observed in both groups after training . Conclusion . SEG elicited significant reductions in self-rated disability and pain , whereas similar between-group changes in trunk muscle onsets were observed . The motor control adaptation seems to reflect a strategy of improved coordination between the trunk muscles with the unilateral shoulder movement . Trunk muscle onsets during rapid limb movement do not seem to be a valid mechanism of action for specific trunk exercise rehabilitation programs BACKGROUND The prescription of exercise as a conservative treatment for lumbar pain is frequent and seems effective for the chronic cases of nonspecific low back pain . However , there is no evidence favoring one type of exercise over another . Often , exercise programs are prescribed without adequate evaluation of the individual characteristics like posture , muscular force , and extensibility . Patients with totally different causes of low back pain will often be given the same type of exercises . OBJECTIVE Our objective was to compare the effectiveness of 2 home exercise programs in decreasing disability and pain related to subacute and chronic nonspecific low back pain . To do so we compared a specific ( individualized ) exercise program with a program of commonly prescribed exercises for low back pain . METHOD In a control group study , 20 patients with chronic or subacute nonspecific low back pain participated after giving their informed consent . All subjects were evaluated ( physical evaluation of lumbar and pelvic muscles [ 1 ] force and [ 2 ] extensibility , [ 3 ] trunk range of motion ) and then divided in 2 groups : 10 patients received specific exercises ( experimental group ) based on their evaluation , and 10 patients received a commonly prescribed exercise program for low back pain ( control group ) . Six weeks later a second physical evaluation was conducted . Pain ( visual analog pain scale ) and disability ( modified Oswestry ) question naires were also completed by each subject at both evaluations . DESIGN This was a r and omized experimental study . RESULTS Both groups had similar age , weight , and sex characteristics . The experimental group showed significant improvements for some components targeted by the program . The control group significantly had improvement of some physical characteristics not related to their initial deficits . Even if both groups showed some improvements in muscular force and extensibility , only the members of the group who received specific exercises significantly reduced their level of pain and disability . Both groups showed a similar rate of participation in the program . CONCLUSION The results of this study suggest that applying a specific physical evaluation and exercise prescription is an appropriate treatment for people having subacute or chronic nonspecific pain . Thus clinicians should prescribe exercise programs based on individual muscular deficits rather than most commonly prescribed exercise programs & NA ; Guidelines for the management of low back pain ( LBP ) have existed for many years , but adherence to these by health care practitioners ( HCPs ) remains suboptimal . The aim of this study was to measure the attitudes , beliefs and reported clinical behaviour of UK physiotherapists ( PTs ) and general practitioners ( GPs ) about LBP and to explore the associations between these . A cross‐sectional postal survey of GPs ( n = 2000 ) and PTs ( n = 2000 ) was conducted that included the  Pain Attitudes and Beliefs Scale ( PABT.PT )  , and a vignette of a  patient with non‐specific LBP ( NSLBP )  with questions asking about recommendations for work , activity and bedrest . Data from 1022 respondents ( 442 GPs and 580 PTs ) who had recently treated patients with LBP were analysed . Although the majority of HCPs reported providing advice for the vignette patient that was broadly in line with guideline recommendations , 28 % reported they would advise this patient to remain off work . Work advice was significantly related to the PABS.PT scores with higher biomedical ( F1,986 = 77.5 , p < 0.0001 ) and lower behavioural ( F1,981 = 31.9 , p < 0.001 ) scores associated with advice to remain off work . We have demonstrated that the attitudes and reported practice behaviour of UK GPs and PTs for patients with NSLBP are diverse . Many HCPs held the belief that LBP necessitates some avoidance of activities and work . The attitudes and beliefs of these HCPs were associated with their self‐reported clinical behaviour regarding advice about work . Future studies need to investigate whether approaches aim ed at modifying these HCP factors can lead to improved patient outcomes This study evaluated the efficacy of an exercise programme as an intervention for  recurrent non-specific low-back pain ( NLSBP ) in adolescents . A r and omized controlled trial was conducted with an experimental group ( n = 27 , age 14.6 years ) who participated in an 8-week exercise programme and a matched control group ( n = 27 , age 14.6 years ) who continued normal daily activities . All participants suffered from recurrent NSLBP . Pre and post intervention measures of NSLBP status ( pain severity and consequences ) and daily inactivity ( time spent sitting , PC time , TV time ) were reported in one week diaries . Two-way mixed ANOVA ( independent variables : pre/post and experimental/control ) was conducted for each dependent variable , significance was set at P < 0.05 . Significant interaction effects were identified for the severity of pain , number of occasions missing sport due to NSLBP and amount of sport participated in . In each case the experimental group benefited from the exercise programme . In contrast , no significant interaction effects were observed for physical inactivity , both groups spent a similar amount of time sitting , watching TV and using a PC pre- and post- intervention . It was concluded that an exercise programme acted as an effective short-term treatment strategy for NSLBP in adolescents . Further evaluation is required to assess the long-term effectiveness Study Design . A r and omized controlled trial was performed . Objectives . To evaluate how 2 different treatment options affect perception of health , pain , and physical functioning over time among children and adolescents with low back pain ( LBP ) . Summary of Background Data . LBP among children and adolescents has increased . The literature shows that children with LBP also suffer from this condition as adults . Thus , it is important to prevent and treat LBP in children and adolescents . Methods . Forty-five children and adolescents were consecutively r and omized into one of 2 treatment groups and were studied for 12 weeks . Group 1 was given individualized physical therapy and exercise and a st and ardized self-training program and back education . Group 2 was given self-training program and back education but no individualized therapy . The children and adolescents were tested before and after the treatment period .  Child Health Question naire Child Form 87 , Rol and & Morris Disability Question naire , Painometer , Back Saver Sit and Reach , and test of trunk muscle endurance  were used to evaluate the interventions . Results . Both groups improved statistically significant in most parameters over time . On comparison between the groups the physical function measured by Rol and & Morris Disability Question naire and the duration of pain measured by Painometer improved statistically significant in Group 1 . Conclusion . An individual assessment by a knowledgeable physiotherapist and an active treatment model improve how children and adolescents experience their back problems with respect to health and physical function , pain , strength , and mobility , regardless of whether treatment consists of a home exercise program with follow-up or home exercise combined with exercise and treatment supervised by a physiotherapist BACKGROUND CONTEXT Low back pain ( LBP ) is a prevalent disorder in society that has been associated with increased loss of work time and medical expenses . A common intervention for LBP is spinal manipulation , a technique that is not specific to one scope of practice or profession . PURPOSE The purpose of this systematic review was to examine the effectiveness of physical therapy spinal manipulations for the treatment of patients with low back pain . METHODS A search of the current literature was conducted using PubMed , CINAHL , SPORTD iscus , Pro Quest Nursing and Allied Health Source , Scopus , and Cochrane Controlled Trials Register . Studies were included if each involved : 1 ) individuals with LBP ; 2 ) spinal manipulations performed by physical therapists compared to any control group that did not receive manipulations ; 3 ) measurable clinical outcomes or efficiency of treatment measures , and 4 ) r and omized control trials . The quality of included articles was determined by two independent authors using the criteria developed and used by the Physiotherapy Evidence Data base ( PEDro ) . RESULTS Six r and omized control trials met the inclusion criteria of this systematic review . The most commonly used outcomes in these studies were some variation of pain rating scales and disability indexes . Notable results included varying degrees of effect sizes favoring physical therapy spinal manipulations and minimal adverse events result ing from this intervention . Additionally , the manipulation group in one study reported statistically significantly less medication use , health care utilization , and lost work time . CONCLUSION Based on the findings of this systematic review there is evidence to support the use of spinal manipulation by physical therapists in clinical practice . Physical therapy spinal manipulation appears to be a safe intervention that improves clinical outcomes for patients with low back pain QUESTION Does Kinesio Taping reduce disability , pain , and kinesiophobia in people with chronic non-specific low back pain ? DESIGN R and omised trial , with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS Sixty adults with chronic non-specific low back pain . INTERVENTION The experimental intervention was Kinesio Taping over the lumbar spine for one week ; the control intervention was sham taping . OUTCOME MEASURES The following outcomes were measured at baseline , immediately after the week with the tape in situ , and four weeks later : Oswestry Disability Index , Rol and - Morris Low Back Pain and Disability Question naire , pain on a 10-cm visual analogue scale , Tampa kinesiophobia scale , trunk flexion range of motion , and the McQuade test of trunk muscle endurance . RESULTS At one week , the experimental group had significantly greater improvement in disability , by 4 points ( 95 % CI 2 to 6 ) on the Oswestry score and by 1.2 points ( 95 % CI 0.4 to 2.0 ) on the Rol and -Morris score . However , these effects were not significant four weeks later . The experimental group also had a greater decrease in pain than the control group immediately after treatment ( mean between-group difference 1.1 cm , 95 % CI 0.3 to 1.9 ) , which was maintained four weeks later ( 1.0 cm , 95 % CI 0.2 to 1.7 ) . Similarly trunk muscle endurance was significantly better at one week ( by 23 sec , 95 % CI 14 to 32 ) and four weeks later ( by 18 sec , 95 % CI 9 to 26 ) . Other outcomes were not significantly affected . CONCLUSION Kinesio Taping reduced disability and pain in people with chronic non-specific low back pain , but these effects may be too small to be clinical ly worthwhile . TRIAL REGISTRATION ACTRN12612000402842 Background Female athletes are at significantly greater risk of anterior cruciate ligament ( ACL ) injury than male athletes in the same high-risk sports . Decreased trunk ( core ) neuromuscular control may compromise dynamic knee stability . Hypotheses ( 1 ) Increased trunk displacement after sudden force release would be associated with increased knee injury risk ; ( 2 ) coronal ( lateral ) , not sagittal , plane displacement would be the strongest predictor of knee ligament injury ; ( 3 ) logistic regression of factors related to core stability would accurately predict knee , ligament , and ACL injury risk ; and ( 4 ) the predictive value of these models would differ between genders . Study Design Cohort study ( prognosis ) ; Level of evidence , 2 . Methods In this study , 277 collegiate athletes ( 140 female and 137 male ) were prospect ively tested for trunk displacement after a sudden force release . Analysis of variance and multivariate logistic regression identified predictors of risk in athletes who sustained knee injury . Results Twenty-five athletes ( 11 female and 14 male ) sustained knee injuries over a 3-year period . Trunk displacement was greater in athletes with knee , ligament , and ACL injuries than in uninjured athletes ( P < .05 ) . Lateral displacement was the strongest predictor of ligament injury ( P = .009 ) . A logistic regression model , consisting of trunk displacements , proprioception , and history of low back pain , predicted knee ligament injury with 91 % sensitivity and 68 % specificity ( P = .001 ) . This model predicted knee , ligament , and ACL injury risk in female athletes with 84 % , 89 % , and 91 % accuracy , but only history of low back pain was a significant predictor of knee ligament injury risk in male athletes . Conclusions Factors related to core stability predicted risk of athletic knee , ligament , and ACL injuries with high sensitivity and moderate specificity in female , but not male , athletes Abstract Lumbosacral list is a clinical sign that is frequently associated with low back pain and intervertebral disc lesions . This study examines the influence of McKenzie management on the natural history of trunk list . Patients with trunk list and low back pain were r and omised into two groups : a control group receiving non-specific back massage and general back care advice , and a group treated according to the McKenzie protocol .  Trunk list was measured over a period of 90 days and patients completed Oswestry Disability Question naires . There was a significantly greater resolution of list after 90 days in the group receiving McKenzie treatment compared to the control group . There was poor correlation between list magnitude and Oswestry scores . These data support previous observations that trunk list is not necessarily related to the degree of physical disability . The McKenzie method of assessment and treatment may assist in the resolution of trunk list , but it was ineffective in improving clinical condition Background Non-specific low back pain ( NSLBP ) in subacute and chronic stages can be treated effectively with exercise therapy . Research guidelines recommend evaluating different treatments in defined subgroups of patients with NSLBP . A subgroup of patients with movement control impairment ( MCI ) improved significantly on patient specific function and disability in a previous case series after movement control exercises . Methods / Design In a r and omised controlled trial ( RCT ) we will compare the effectiveness of movement control and general exercise in patients with MCI . 106 participants aged 18 - 75 will be recruited in 5 outpatient hospital departments and 7 private practice s. Patients r and omly assigned to the movement control exercise group will be instructed to perform exercises according to their MCI . The general exercise group will follow an exercise protocol aim ed at improving endurance and flexibility . Patients in both groups will receive 9 - 18 treatments and will be instructed to do additional exercises at home . The primary outcome is the level of disability assessed using the patient specific functional scale ( PSFS ) which links the perceived pain to functional situations and is measured before treatment and at 6 and 12 months follow-up . Secondary outcomes concern low back pain related disability ( Rol and Morris question naire , RMQ ) , grade d chronic pain scale ( GCPS ) , range of motion and tactile acuity . Discussion To our knowledge this study will be the first to compare two exercise programs for a specific subgroup of patients with NSLBP and MCI . Results of this study will provide insight into the effectiveness of movement control exercise and contribute to our underst and ing of the mechanisms behind MCI and its relation to NSLBP.Trial registration Current Controlled Trials IS RCT
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 .