Manual therapy
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In the last decade, concepts regarding spinal stability have been redefined. Whereas traditional stability models considered only the integrity of the intervertebral disc and spinal ligaments, mechanisms contributing to spinal stability are now thought to include neural and muscular elements. Lumbar muscles capable of generating intersegmental stiffness are considered necessary for the control of multi-planar segmental spinal motion. ⋯ The transversus abdominis, psoas, quadratus lumborum and multifidus were each noted to have segmental attachment patterns in the lumbar spine. As a group, they surround the lumbar motion segments from the anterolateral aspect of a vertebral body to the spinous process. A hypothetical role for this muscle group in maintaining lumbar spine stability is discussed as are suggestions for future research.
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The aim of this pilot study was to examine whether differences existed in spinal kinematics and trunk muscle activity in cyclists with and without non-specific chronic low back pain (NSCLBP). Cyclists are known to be vulnerable to low back pain (LBP) however, the aetiology of this problem has not been adequately researched. Causative factors are thought to be prolonged forward flexion, flexion-relaxation or overactivation of the erector spinae, mechanical creep and generation of high mechanical loads while being in a flexed and rotated position. ⋯ Cyclists in the pain group showed a trend towards increased lower lumbar flexion and rotation with an associated loss of co-contraction of the lower lumbar multifidus. This muscle is known to be a key stabiliser of the lumbar spine. The findings suggest altered motor control and kinematics of the lower lumbar spine are associated with the development of LBP in cyclists.
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Comparative Study Clinical Trial Controlled Clinical Trial
Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients.
There has been little investigation into whether or not differences exist in the nature of physical impairment associated with neck pain of whiplash and insidious origin. This study examined the neck flexor synergy during performance of the cranio-cervical flexion test, a test targeting the action of the deep neck flexors. Seventy-five volunteer subjects participated in this study and were equally divided between Group 1, asymptomatic control subjects, Group 2, subjects with insidious onset neck pain and Group 3, subjects with neck pain following a whiplash injury. ⋯ Myoelectric signals (EMG) were detected from the muscles during performance of the test. The results indicated that both the insidious onset neck pain and whiplash groups had higher measures of EMG signal amplitude (normalized root mean square) in the sternocleidomastoid during each stage of the test compared to the control subjects (all P<0.05) and had significantly greater shortfalls from the pressure targets in the test stages (P<0.05). No significant differences were evident between the neck pain groups in either parameter indicating that this physical impairment in the neck flexor synergy is common to neck pain of both whiplash and insidious origin.