Journal of Back and Musculoskeletal Rehabilitation

Plantar fasciitis is considered the most common cause of foot pain. Numerous non-surgical treatments have been used to relieve symptoms. Taping is one of the most widespread treatments, with several techniques utilized in clinical practice.

To evaluate, based on existing literature, the efficacy of different taping techniques in relieving symptoms and dysfunction caused by plantar fasciitis.

PubMed, CINAHL, PEDro, ISI Web of Science, and Google Scholar databases were searched from inception until December 2012, using a predefined search strategy. Controlled trials of any methodological quality were included, without any language restrictions. The methodological quality of interventional studies was evaluated inter alia by the PEDro score.

Five randomized control trials, one cross-over study and two single group repeated measures studies met the inclusion criteria. Two studies were high quality; two were moderate quality and four were of poor methodological quality. All eight studies favored the use of different taping techniques. The most common technique was low dye taping.

We found that in the short-term, taping is beneficial in treating plantar fasciitis. The best evidence exists for low dye taping and calcaneal taping. More research is needed to investigate long-term effect and effectiveness of specific taping techniques.

Scapular winging and tipping are types of abnormal scapular kinematics, which is caused by not only the entrapment of peripheral nerve, but also imbalance of the scapulothoracic musculatures. The purpose of this study was to investigate the presence of muscular imbalance in the middle and lower parts of the serratus anterior and upper trapezius in people with scapular winging and tipping.

Twenty male participants (age, 23.0 ± 1.92 y) were placed into symptomatic group ( n = 10 ) and control group ( n = 10 ). Participants completed two individual trials of a push-up plus, and a diagonal shoulder elevation, while electromyography (EMG) recorded muscle activity of the low and middle serratus anterior and upper trapezius. The root mean squared EMG values for three muscles were normalized using maximum voluntary isometric contractions (%MVIC). The value was calculated using modified isolation equation for comparing activation of middle and lower serratus anterior (%isolation).

During a diagonal shoulder elevation, the % maximal voluntary isometric contraction (%MVIC) data showed that the symptomatic participants had significantly greater activation of the middle serratus anterior compared to the control group ( P = 0.01 ). During a diagonal shoulder elevation, the symptomatic participants had not only significantly increased %isolation of the middle serratus anterior, but also significantly decreased for the lower serratus anterior compare with the control group ( p = 0.00 ).

Present result indicated that different muscle activation between middle and lower serratus anterior could represent in group with scapular dyskinesis, and need for selective activation of the lower serratus anterior in patients with scapular winging and tipping.

Bone scintigraphy is a molecular imaging technique routinely used for the evaluation of benign and malignant bone abnormalities. This study aimed at evaluating spinal degenerative changes detected by bone scintigraphy and determining associations between image features and patients’ anthropometric and demographic variables.

In a cross-sectional study, 64 men and 52 women underwent bone scintigraphy. Experts identified all image regions suggesting degenerative joint disease (DJD) and classified region intensity on a 3-point scale. Image characteristics were correlated to the patients’ body mass index (BMI), age, weight, height, activity level, and sex. Data analysis included descriptive statistics and association coefficients.

DJD was found in 53 patients (46%). In men, there was weak but statistically significant correlation between DJD and activity level, and DJD and age, but not BMI or weight. In women, only a weak, not statistically significant, linear correlation was found between DJD and BMI, and DJD and weight.

Molecular imaging with bone scintigraphy showed that spinal degenerations are associated with different anthropometric and demographic features in men and women. Interestingly, no association was found between DJD and increased body weight in men while a weak association may exist in women. The results prompt for additional studies to better determine the risk factors for DJD and low back pain in male and female patients.

Diagnostic study, Level II (retrospective study).

Recent studies have shown that a transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) application reduces pain in subjects with musculoskeletal disorders. However there are no clinical trials evaluating or comparing the muscle relaxation generated for these devices.

To compare the muscle relaxation of the upper trapezius induced by the application of TENS and IFC in females with chronic nonspecific neck discomfort.

Sixty-four females between 18 and 40 years of age and a history of nonspecific neck discomfort were randomly assigned to a TENS or an IFC group. The women in the TENS (N=32; mean age 22 years) and IFC (N=32, mean age 23 years) group were submitted to current application during 3 consecutive days and were assessed by electromyography (EMG) in different times aiming to quantify the muscular tension of the upper trapezius. A visual analogue scale (VAS) was used as pain measure at baseline (before TENS or IFC application) and at the end of the study.

At baseline, demographic, pain, and EMG assessment data were similar between groups. Those in the IFC group had a significant trapezius relaxation after 3 IFC applications when compared to baseline and intermediate evaluations ( P < 0.05 ). In contrast, the same analysis showed no significant difference between all assessments in the TENS group ( P > 0.05 ). In relation to pain relief, both groups showed an improvement at the end of the study when compared to baseline (both, P < 0.05 ). The between-group analysis showed no difference for the subjects who received such IFC as TENS application ( P < 0.05 ).

IFC induced the upper trapezius relaxation after 3 sessions in females with neck discomfort, but the TENS application did not change the muscular tension. However, these results should be carefully interpreted due to the lack of differences between groups. A significant pain decrease was found in the subjects of both groups, however, only the IFC application presented a clinically important improvement.

Information concerning low back pain in adolescents with scoliosis is rather limited in literature. While the epidemiology of back pain at the age of adolescence has been described extensively, studies evaluating the effects of therapeutic interventions are still sparse.

The study was conducted in two groups with juvenile idiopathic scoliosis I ^o . The clinical group was 21 persons with low back pain and the control group was 11 persons without pain. In order to assess the quality of life and the level of pain We used the abridged version of WHOQOL (World Human Organizations Quality of Life questionnaire) and MPQ-SF (Short Form of McGill Pain questionnaire). The treatment consisted of a combination of manual therapy and rehabilitation exercises.

We obtained a significant improvement in the area of the physical health: 7.17 in the clinical group ( p = 0.000613 ); 6.12 for females ( p = 0.015400 ); 9.19 for males ( p = 0.022311 ). The assessment of the quality of life was different between the clinical and the control groups. The decrease in pain in the clinical group was 5.71 ( p = 0.000132 ), 5.93 for females ( p = 0.001474 ) and 5.29 for males ( p = 0.027709 ). Data represents more than a double decrease in strong and moderate pain.

A combination of rehabilitation exercises and soft manual therapy is effective in reducing the low back pain in adolescents and enhancing the somatic facet of the quality of life.

Breast cancer treatment may be a cause of postural disorders.

Assessment of the effects of various forms of physical activity on body posture in the sagittal plane in women post breast cancer treatment.

Sixty women who had received breast cancer treatment. The study group was intentionally divided into three groups of 20 women who followed different exercise regimens: Nordic Walking (NW), water resistance exercise (WE) or general fitness exercise (GE).

Photogrammetric examination of body posture using a Computer-Based Body Posture Diagnostics apparatus performed at baseline and after an 8-week regimen of appropriately selected physical exercise.

A favourable tendency for the shallowing of thoracic kyphosis and the reduction of lumbar curvature of the spine was noted in the NW group. Reduced kyphosis was also noted in the WE group, however it was accompanied by more pronounced lumbar lordosis and a tendency for excessive forward bending of the trunk. In the GE group, on the other hand, no significant differences were observed in terms of the shape of anteroposterior spinal curvatures.

The diversity observed in the shape of anteroposterior spinal curvatures following physical training regimens of different type and nature demonstrates the need of appropriate exercise selection to attain the desired therapeutic outcome. Balanced postural changes were only identified among the women in the NW group. In the GE group, however, training only sustained the status existing prior to the initiation of the exercise regimen.

Despite the recommendations of national and international societies for the treatment of patients with acute neck and back pain, still too many radiologic examinations were performed. The purpose of this study was to analyze and optimize diagnostics and treatment of patients with acute back pain.

The medical records of 484 patients presented to the emergency clinic with acute neck or back pain were analyzed for clinical history, physical examination, radiographic findings and therapy.

Radiographs of the lumbar, cervical, or thoracic spine were performed in 338 cases (70%). Radiographs were normal in 142 patients (42%) and degenerative changes were identified in 123 patients (36%). Only 2 patients (0.4%) had radiographic findings that had direct therapeutic relevance: 1 patient with metastatic disease and 1 patient with posttraumatic C1–C2 instability. For most patients without sensorimotor deficits and absent specific indications for radiography (“red flags”), therapy was not affected by the results of radiography.

Plain radiography of the spine was unnecessary in most patients initially evaluated with non-specific acute back pain and does not improve the clinical outcome. The implementation of national and international guidelines is a slow process, but helps to reduce costs and to protect patients from unnecessary ionizing radiation exposure.

Co-existing depressive symptoms aggravate the chronic course of pain and may interfere with successful rehabilitation.

To examine the psychosocial rehabilitation success of a standard rehabilitation program with a supplemental cognitive-behavioral management training of depressive symptoms compared to the standard rehabilitation alone among patients with chronic low back pain (CLBP) and depressive symptoms.

Effects on psychological measures (depressive symptoms, anxiety, and somatization) were evaluated prior to, 6, 12, and 24 months after rehabilitation among N = 84 consecutively admitted patients with CLBP and depressive symptoms, aged from 34–59 years. Furthermore, self-reported days of sick leave were determined.

Favorable effects on depressive symptoms and anxiety persisted up to the 24-month follow-up assessment and incremental effects of the new program on depressive symptoms and anxiety were found at the 6-month follow-up assessment. Days of sick leave were decreased 6 months after rehabilitation and frequencies of clinical levels of psychological symptoms at the 24-month follow-up assessment were attenuated in the intervention group.

The long-term psychological rehabilitation success among patients with CLBP and depressive symptoms was improved by the newly developed program, whose clinical significance was also supported. Thus, significant factors for the further development of CLBP were ameliorated.

To evaluate the extent of intra-subject difference in hamstring flexibility and its possible relationship to the severity of Low Back Pain (LBP). A secondary purpose was to evaluate the extent of intra-rater reliability using both electrogoniometer and conventional goniometer for measuring hamstring tightness.

Potential correlations between muscle impairments and LBP may lead to more effective treatments and prevention strategies.

Seventy two participants with mechanical LBP were recruited for this study. The sample included; 41 females, 31 males with a mean age of 33.69 ± (11.04) years, height of 170 ± (9) cm, and weight of 79.5 ± (1.6) kg. Hamstring length was detected indirectly using the Active Knee Extension method in the 90/90 position from supine. The amount of extension was measured using both electro-goniometer (EG)and a standard goniometer (SG).

Right lower extremities of these patients were significantly more flexible than left ones at α = 0.025 ( t 72 = 3.14 , p = 0.002 ). Similarly, dominant lower extremities of these patients were significantly more flexible than the non dominant ones at α = 0.025 ( t 72 = 2.56 , p = 0.013 ). Additionally, Oswestry scores of the patients were significantly and positively correlated with the amount of hamstring tightness of the right lower extremities ( r = 0.244 , p = 0.039 ), left lower extremities ( r = 0.225 , p = 0.048 ) and the average of both sides ( r = 0.24 , p = 0.039 ). However, the Oswestry scores were negatively, but insignificantly correlated to the absolute difference between right and left extremities at ( r = − 0.156 , p = 0.091 ). Finally, the extent of intrasubject reliability in measuring hamstring tightness using EG and SG was found to be high (ICC=0.93).

There is a possible relation between mild mechanical LBP and hamstrings tightness. It was found that the more the tightness, the higher the severity of LBP that patient experienced. Also, these patients had one of their lower extremities significantly tighter than the other. Such tightness was successfully detected utilizing both EG and SG. These findings and their possible pathomechanical consequences should be considered while constructing effective rehabilitation protocols for patients with mechanical LBP.

Low back pain (LBP) hampers performance and experiencing an episode of LBP is strongly associated with recurrent episodes.

The prevalence of LBP and associated risk factors among young elite athletes in popular sports in the Netherlands were studied.

A questionnaire-based cross-sectional study was performed among 236 young elite athletes aged between 14–25 years in field hockey, football and speed skating.

One hundred and eighty one ( n = 181 ) athletes responded (response rate 77%). The overall, 12-month prevalence of LBP for the three sports was 60%: field hockey 56%, football 64% and speed skating 60%. Satisfaction with their own performance (OR=0.5 95%CI:0.3–0.9) and with the coaching staff (OR=0.5, 95%CI:0.4–0.8) were associated with a lower occurrence of LBP in field hockey. No sport-related risk factors were found in football. In speed skating more training hours (OR=1.1, 95%CI:1.0–1.2), performance of Pilates (OR=4.1, 95%CI:1.1–15.7) and more time spent on warming up (OR=1.1, 95%CI:1.0–1.1) were associated with the occurrence of LBP.

Prevalence of LBP among young elite athletes compared to the general age-related population was 3–5 times higher. Sport-related risk factors of LBP were found in field hockey and in speed skating.

The available literature is lacking in reports on the quantitative analysis of posture in patients with lumbar stenosis.

The aim of this study was to analyze body posture in patients with lumbar spinal canal stenosis.

The study involved 100 people: 49 persons with severe lumbar spine stenosis and 51 control subjects without any history of back pain. All participatants were evaluated by a photogrammetric method.

Photogrammetric measurements showed statistically significant differences in the shape of the anterior-posterior curvatures of the spine. In the study group thoracic kyphosis was significantly greater ( p = 0.043 ), and the depth of lumbar lordosis was significantly smaller ( p = 0.038 ). The inclination of the thoracolumbar segment was also significantly lower ( p = 0.013 ).

1. Measurements of body posture indicate a deepening of thoracic kyphosis and flattening of lumbar lordosis in lumbar stenosis patients. 2. Flattening of physiological lordosis seems to be caused by enlargment of the space of the spinal canal and dural sac in this position.

Recent studies have indicated that maximum expiration could be a useful way of performing challenging exercises that include coactivation of the deep and superficial abdominal muscles. However, little is known about the effect of maximum expiration on the activity of the abdominal muscles during lumbar stabilizing exercise.

The purpose of our study was to quantify changes in the activities of the abdominal muscles during side bridge exercise in combination with maximum expiration.

Experimental laboratory study.

The activities of the rectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscles were measured using electromyography in 12 healthy men performing 3 tasks: holding the breath after maximum expiration in the supine position, holding the breath after resting expiration during side bridge exercise, and holding the breath after maximum expiration during side bridge exercise.

Significant increases in the activities of the abdominal muscles (RA, EO, and IO) occurred with maximum expiration when compared with resting expiration during side bridge exercise ( P < 0.05 ).

This is the first study to demonstrate the effect of maximum expiration on abdominal muscle activities during a stabilizing exercise, thus contributing to existing knowledge about therapeutic exercise for alternative core training.

There is a lack of studies on obesity measured by outer abdominal fat (OAF), which describes abdominal subcutaneous adipose tissue thickness with regard to spino-pelvic parameters. We investigated OAF and its physiologic values on computed tomography (CT) scans with regard to age, gender, facet joint (FJ) arthritis, FJ orientation, lumbar lordosis (LL) and pelvic incidence (PI).

OAF, lumbar FJs, LL and PI were evaluated on CT scans.

CT scans of 620 individuals with a mean age of 42.5 years were reviewed. OAF showed a mean value of 19.7 millimeters (mm). It significantly increased with age until 70 years and decreased thereafter ( p ≤ 0.0001 ). There was no significant gender difference. OAF was significantly increased with FJ arthritis ( p = 0.01 ), but not with FJ orientation, LL or PI.

OAF on CT scans seems to have a mean value of 19.7 mm. It is higher in the older age groups until 70 years. As a novelty finding, OAF significantly increases with higher degrees of FJ arthritis, but is notrelated to gender or other spino-pelvic parameters such as FJ orientation, LL or PI. Differences in fat distributionmay be found at other anatomic sites, such as visceral fat. Obese patientsmay benefit from weight loss by decreasing their FJ arthritis, which maypotentially decrease associated back pain, which may be worth further investigations.

To improve hamstring extensibility some methods have been analyzed and compared for determining their acute and chronic effectiveness.

To compare the immediate effect of electrical muscle elongation (EME) versus Kinesio tape (KT) in hamstring muscle extensibility.

One hundred and twenty adult amateur athletes with hamstring shortness (straight leg raise test angle < 80 °) were randomly assigned to a group: group 1 (EME session of 4 KHz interferential current, bipolar technique and AMF=100 Hz, n = 40 ), group 2 (KT, n = 40 ) or group 3 (control group, no intervention, n = 40 ). Hamstring extensibility was assessed before and after the intervention through the active knee extension test. Results: Significant improvements were found in both EME and KT groups whereas no changes were detected in the control group. However, no significant differences between both techniques were detected. The EME group showed large effect size ( d = 0.843 ) while the KT group reached medium effect size ( d = 0.431 ).

Both electrical muscle elongation and Kinesio tape are effective techniques in the short-term in amateur athletes with decreased hamstring extensibility. The higher increase of hamstring extensibility, with a better clinical effect was achieved with the application of electrical muscle elongation. However, no significant differences were found when comparing the effectiveness of both techniques.

Control of pain management is an important up-stream process in fibromyalgia (FM) mechanisms.

To investigate whether adapted physical activity (APA) could change the illness perception in relation to the FM personality profile.

Thirty-seven women with FM allocated randomly: 19 treatment group (TG) and 18 control group (CG). Interventions: exercises program included ten sessions, two times for week for one hour each and observation for CG. Scales: Illness Perception Questionnaire-revisited (IPQ-r) for the mental representation of the disease, Minnesota Multiphasic Personality Inventory profiles (MMPI-2) for personality tool and Fibromyalgia Impact Questionnaire (FIQ) for function, impact and symptoms. Outcome assessments were performed before rehabilitation treatment (T0) than at the end (T1), and a follow-up 12 weeks after treatment (T2).

APA was efficacy to improve FIQ values in TG at T1 and T2 test days ( P = 0.014 ). Changes in IPQ-R values in T2 were not significant. All patients presented a baseline T-score ≥ 65 in at least one of the basic and content MMPI-2 scales (Hy, D, Hs and Hea and Anx).

APA was efficacy in FM, but further research to differentiate between illness experience rather than focus on a strict personality profile are necessary.

Posture and physical function have been quantified in mature adults, but not in elderly females.

To quantify standing posture and measures of physical function in community-dwelling women over the age of 65 years, and to examine relationships between these variables.

Fifty-three women were recruited from day care service users (average age: 83.7 ± 6.3 years old). Standing postural alignments were assessed using 2-dimensional analyses with a digital video camera. The time up and go test (TUG) and other physical function tests were conducted.

Decreased lower cervical angle (increased forward head position) was significantly correlated with increased upper cervical angle (increased chin-up, r = − 0.45 ), increased thoracic spine angle (increased kyphosis, r = − 0.38 ), and decreased lumbar spine angle (thoracolumbar segments backward relative to the pelvis, r = 0.48 ). The decreased lumbar spine angle was significantly correlated with increased thoracic angle (increased kyphosis, r = − 0.37 ), increased pelvic plane angle (increased anterior pelvic tilt, r = − 0.49 ), and decreased knee flexion angle ( r = 0.46 ). Increased TUG time (slower walking speed) was correlated to increased forward head position ( r = 0.30 ) and thoracolumbar segments forward relative to the pelvis ( r = 0.34 ).

Posture and physical function measures were provided for community-dwelling females who were >65 years of age. They did not demonstrate any correlation between measured knee strength, back strength or single leg standing with measures of postural alignment, but TUG showed a moderate correlation with the lower cervical and lumbar spine posture measures.

Psychosocial factors are known to play a key role in determining the progress of back pain patients. However, it is not known whether these factors are applicable to military personnel, who tend to be fitter than the general population.

The aim was to identify physical and psychological predictors in a prospective study of the outcome of back pain rehabilitation over 6 months and a longer follow-up time of between 15 and 32 months.

Two hundred and fifty military personnel reporting for a residential rehabilitation programme completed a battery of physical and psychological tests. The physical tests included 800 m run time and the Biering-Sorensen test. The psychological/psychosocial measures included items on fear avoidance, self efficacy, anxiety and depression and occupational psychosocial factors such as job satisfaction.

Self efficacy and 800 m run time predicted self-reported functional ability at 6 months and medical discharge/return to full fitness at 15–32 months. Patients with 800 m run times of more than 3 minutes 31 seconds had a four times greater chance of medical discharge from the Armed forces.

Eight hundred metre run time and self-efficacy were independent predictors of both self-reported functional ability at 6 months and return to full fitness/medical discharge at 15–32 months. Self-efficacy also predicted 40% of the variance in the intensity of back pain and 10% of other non-back pain. Rehabilitation should include greater emphasis on physical fitness and on improving self-efficacy.

The number of studies and evidences is inadequate especially with regard to the efficacy of pulsed radiofrequency (PRF) application in non-spinal indications. The purpose of this study was to investigate the effect of PRF on pain, functioning and quality of life in patients with advanced knee OA.

The study included 21 patients with complaints of knee pain. Intra-articular PRF was applied for 10 minutes at 42°C. Pain severity was assessed using the 10 cm standard visual analogue scale (VAS). Outcome measures also included a 20-meter walk test, a 6-minute walk test, WOMAC, Lequesne index, and the Short Form-36 (SF-36). All measurements were assessed before treatment and 4 and 12 weeks after the treatment.

A statistically significant improvement was found in VAS scores at rest and after walking, subscores of SF36-pain and SF36-social functioning, and Lequesne score at week four ( p < 0.05 ). This improvement was maintained for the scores of VAS-walking at week 12 ( p < 0.05 ).

It is possible to state that intra-articular PRF application is effective and safe for the pain treatment of patients with advanced knee OA. Therefore, we think that PRF application will be included in chronic pain treatment guidelines in the future with the increase in the number of future studies.

Spinal posture and mobility are significant for protecting spine. The aim was to compare effects of different postural training interventions on spinal posture and mobility.

Ninety-six university students (ages: 18–25 years) were allocated into Electrical Stimulation (ES) ( n = 24 ), Exercise ( n = 24 ), Biofeedback Posture Trainer (Backtone) ( n = 24 ), and Postural Education ( n = 24 , Controls) groups. All the groups got postural education. The interventions were carried out 3 days a week for 8 weeks. Spinal Mouse® device (Idiag, Fehraltorf, Switzerland) was used to detect thoracic and lumbar curvatures and mobility (degrees) in standing and sitting positions. Paired Student’s t-test, one-way ANOVA, and pairwise post-hoc tests were used.

ES decreased thoracic curvature, the exercise decreased thoracic and lumbar curvature and increased thoracic mobility in standing position between pre-post training ( p < 0.05 ). Exercise and Backtone improved thoracic curvature in sitting ( p < 0.05 ). In Exercise Group, thoracic curvature decreased compared to Backtone and Education Groups, and thoracic mobility increased compared to all groups ( p < 0.05 ).

The exercise was effective and superior in improving thoracic and lumbar curves, and mobility among university students. ES decreased thoracic curve. Biofeedback posture trainer improved sitting posture.

A prospective randomized controlled trial, Level 1.

Relative precision is to denote the ratio of the error variance of two sample designs. The aim of the present study was to compare measurement precisions of the Oswestry Back Pain Disability Questionnaire and a computer adaptive testing (CAT) method for measuring disability resulting from back pain.

A cross-sectional study was carried out with two independent convenient samples from two out-patient rehabilitation clinics for back pain ( N = 42 ) and non-back pain groups ( N = 42 ). Participants were asked to fill out the ODQ and CAT of International Classification of Functioning, Disability and Health – Activity Measure (ICF-AM). A series of Rasch analyses were performed to calculate person ability measures.

The CAT measures had greater precision in discriminating the groups than did the ODQ measure in comparisons of the relative precision.

The CAT measure appears to be more effective than the ODQ measure in terms of measurement precision. By administering test items calibrated in a way, CAT measures using item response theory may promise a means with measurement precision as well as efficiency.

Myofascial pain syndrome (MPS) which is an important cause of musculoskeletal pain has shown a dramatic increase in recent years.

We aimed to evaluate the efficacy of intramuscular electrical stimulation therapy (IMS) and low-level-laser-therapy (LLLT) in patients with MPS.

Patients were randomly divided into three groups. First group were treated with LLLT and stretching exercise. Second group were treated with IMS and stretching exercise. Third group were treated with only streching exercise. The patients were evaluated through the pain intensity, pain threshold, cervical joint movement range and the neck disability index parameters.

An improvement was found in all parameters for all groups, except for the pain threshold within the control group at the end of the treatment and one month after the treatment. It was found that pain score was significantly lower in Group 1 and 2 at one month after the treatment compared to Group 3. Similarly, it was found that pain threshold score was significantly higher in Group 2 at one month after the treatment compared to Group 3.

In this study we observed that both LLLT and IMS treatments added on to stretching are effective in improving pain parameters in patients with MPS.

The physical injuries caused by +Gz include skeletal-muscle overloads. This study has aimed at demonstrating ergonomic conditions of the pilots from the Brazilian Air Force’s Aerial Demonstration Squadron (BAFADS) during flight.

All the 13 pilots from the BAFADS were evaluated through an interview. Surface electromyography (SEMG) was employed during the flight manoeuvre simulation (under normal and overload conditions).

The report analyses showed perception of discomfort in the right shoulder related to +Gz. The SEMG showed moderate levels of shoulder muscles activation for normal contractions (± 25%). During vigorous contraction, levels of recruitment were high: upper trapezius fibres (± 105%), middle trapezius fibres (± 90%) and posterior deltoid fibres (± 95%). The great demand from the deltoid muscles (posterior fibres) infers a very high level of recruitment from the rotator cuff muscle, which may explain the discomfort in the pilots’ shoulder during the flight manoeuvre.

The mutual analysis of both methods not only does it demonstrate a correlation between symptoms and muscle recruitment, but also provides data to implement intervention measures for pilots’ physical training in order to minimise the discomfort symptoms during flights.

Systematic repetition or prolonged posture in specific postures adopted during training could generate modifications on the sagittal spinal curvatures. Spinal alteration in its physiologic curvatures in the sagittal plane has been associated with predisposition to spinal disorders. The objective was to evaluate and compare the changes produced on the sagittal thoracic and lumbar spinal curvatures, and pelvic tilt from standing posture on the floor to upper, middle, lower and aerodynamic handlebars postures adopted on their own road bicycles.

A total of twenty-eight male professional cyclists (179.92 ± 5.78 cm; 67.18 ± 5.74 kg) participated in the study. Cyclists had an experience of 17.22 ± 6.16 years in cycling, and spent 6.52 ± 0.51 days per week and 3.78 ± 0.61 hours per day training on their bicycles. Sagittal spinal curvatures (thoracic and lumbar) and pelvic tilt were measured in the standing position on the floor and while sitting on a bicycle with different handlebar-hand positions (high, middle, low and aerodynamic) using a Spinal Mouse system.

The thoracic spine showed significantly greater angular values while in a standing posture than on the bicycle in all handlebar-hands postures evaluated. The lumbar curvature changed from lordosis (negative values – anterior convexity) in standing posture to kyphosis (positive values – posterior convexity) in all handlebar-hands positions on the bicycle. The aerodynamic handlebar positions showed the greatest lumbar flexion (lumbar kyphosis) and anterior pelvic tilt.

Professional cyclists passively maintain their thoracic spine straighter on the bicycle due to handlebar-hands support than in standing posture. However, the lumbar spine is flexed on the bicycle in all handlebar-hands evaluated. The pelvis is modified to greater anterior pelvic tilt when the handlebar-hands position is farther and lower regarding the saddle of the bicycle.

Inter-rater reliability of generalised lumbar extensor muscle CSA has been identified, however, more detailed reliability metrics of individual trunk muscles are lacking.

To report muscle volume and muscle fatty infiltrate (MFI) inter-rater reliability of individual trunk muscles between two novice assessors.

Lumbar axial MRI scans from 10 healthy male participants were analysed. The muscles erector spinae (ES), multifidus (M), rectus abdominis (RA), and psoas (PS) were manually traced, region of interest quantified and muscle volume and MFI determined by both assessors. Agreement between the assessors was determined using intraclass correlation coefficients (3,1), Bland-Altman plots and Lin’s concordance coefficient.

Good to excellent agreement was found for volume (ICC 0.77–0.96) and MFI (0.84–0.96) for all muscles on first evaluation, except for M volume, which required a second evaluation. Best agreement for muscle volume and MFI was found for ES (ICC 0.96).

First evaluation of muscle volume and MFI yields high to excellent inter-rater agreement, except for M, where further training and/or experience is required to achieve acceptable reliability outcomes. This may have clinical implications due to the relevance of M atrophy reported in patients with low back pain.

It is possible to increase multi-directional trunk stability using co-activation. However, it is unclear whether there is a preference for left or right trunk rotation after intensive unilateral stability training. The aim of this study was to examine the directional preference in trunk rotational stability after unilateral core training.

This study was conducted on 16 female basketball players. For eight weeks, eight participants performed unilateral core training that focused on one side of the trunk. The remaining eight participants were not provided any additional training. To determine rotational trunk stability, all participants were requested to maintain an upright sitting posture against sudden, external, left or right rotational perturbations of the trunk. Angular displacement of the trunk was measured using a motion analyzer.

At the end of the training period, the angular displacement in response to the perturbation was reduced for both rotational directions (left: − 26 % , right: − 24 % ) in the trained group ( p < 0.05 ).

This study showed that trunk stability improved without particular directional preference in response to unilateral core training. This result adds to our understanding of the nature of trunk stability and multi-directional improvement.

Intervention study, Level 1b.