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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The development of chronic symptoms following whiplash injury is common and contributes substantially to costs associated with this condition. The currently used Quebec Task Force classification system of whiplash associated disorders is primarily based on the severity of signs and symptoms following injury and its usefulness has been questioned. Recent evidence is emerging that demonstrates differences in physical and psychological impairments between individuals who recover from the injury and those who develop persistent pain and disability. ⋯ In contrast those individuals who develop persistent moderate/severe pain and disability show a more complex picture, characterized by additional impairments of widespread sensory hypersensitivity indicative of underlying disturbances in central pain processing as well as acute posttraumatic stress reaction, with these changes present from soon after injury. Based on this heterogeneity a new classification system is proposed that takes into account measurable disturbances in motor, sensory and psychological dysfunction. The implications for the management of this condition are discussed.