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Measuring abdominal muscle weakness in patients with low back pain and matched controls: a comparison of 3 devices.

OBJECTIVE: To compare 3 hand held devices used to measure isometric abdominal muscle strength: the adapted sphygmomanometer, the vigorometer and the Penny & Giles myometer. METHODS: Subjects were men, aged 22 to 43 years. Fifteen had a history of low back pain and 18 age matched controls had no low back pain. The test position was a half sit-up at 45 degrees, knees at 90 degrees, feet secured. The single observer applied pressure with one of the devices downwards, just below the sternal notch, while the patient maintained that position. Order of methods was random, controlled by a series of 3 x 3 Latin squares. The vigorometer and myometer were calibrated to mm Hg. Even numbered subjects were tested twice; odd numbered subjects had their measurements timed. RESULTS: One subject was unable to complete the study. Subjects with low back pain had abdominal muscle strength 38.8 mmHg lower than healthy controls [F(1,62) = 72.84, P2 < 0.01]. Order of measurements was similar [F(2,62) = 1.19, P2 = 0.31]; instruments differed [F(2,62) = 27.94, P2 < 0.01]. Duplicate readings were similar (minimum P2 > 0.10); all 3 devices detected significant differences between the 2 groups (P2 < 0.01); mean measurement time was 19 s and time to measure with each device was similar (P2 = 0.70). CONCLUSION: All 3 instruments performed equally well. Since the sphygomanometer is available at about 1/5 the cost of the vigorometer and 1/12 the cost of the myometer, it is the preferred instrument.

Abdominal Muscles↗

Effects of three different training modalities on the cross sectional area of the lumbar multifidus muscle in patients with chronic low back pain.

OBJECTIVES: To determine the effect of different training schedules on the cross sectional area (CSA) of the lumbar multifidus muscle in patients with chronic low back pain. METHODS: Each of 59 nine patients was randomly assigned to one of three programmes: 10 weeks of stabilisation training (group 1; n = 19); 10 weeks of stabilisation training combined with dynamic resistance training (group 2; n = 20); 10 weeks of stabilisation training combined with dynamic-static resistance training (group 3; n = 20). Before and after 10 weeks of training, multifidus CSAs were measured from standard computed tomography images at three different levels (upper end plate of L3 and L4, and lower end plate of L4). RESULTS: The CSA of the multifidus muscle was significantly increased at all levels after training in group 3. In contrast, no significant differences were found in groups 1 and 2. CONCLUSIONS: General stabilisation exercises and dynamic intensive lumbar resistance training have no significant effect on the CSA of the lumbar multifidus muscle in patients with chronic low back pain. The static holding component between the concentric and eccentric phase was found to be critical in inducing muscle hypertrophy during the first 10 weeks. Treatment consisting of stabilisation training combined with an intensive lumbar dynamic-static strengthening programme seems to be the most appropriate method of restoring the size of the multifidus muscle.

Adult↗

Psoas-bladder hitch procedure: our experience with repair of the injured ureter in men.

Nine patients with injury to the pelvic portion of the ureter successfully underwent the psoas-bladder hitch procedure and tunnelization as an antireflux measure. Of these 9 patients 1 had a Boari bladder wall flap next to the hitch procedure to further elongate the posterolateral corner of the bladder and to bridge a ureteral defect more than 5 cm. Postoperatively, 2 patients had ureteral reflux on the side of repair and 1 had reflux on the opposite side, which was caused by excision of the bladder tumor and damage of the muscle layers backing the undamaged ureter.

Aged↗

A quantitative study of trunk muscle strength and fatigability in the low-back-pain syndrome.

A quantitative study of the trunk muscle strength and fatigability was performed using an isokinetic dynamometer to determine the role of trunk muscles in the low-back-pain syndrome and in particular to investigate the correlation of trunk muscle strength and lumbar lordosis. Most patients demonstrated a generalized weakness of the trunk muscles. The trunk muscle strength of patients suffering from backache for less than one month was significantly lower than that of the controls. The strength of the trunk muscles was not influenced by the duration of symptoms. There was no imbalance between the trunk flexors and extensors. The patients with back pain had a greater fatigability of the trunk flexors than the controls. There was negative correlation between the trunk muscle strength or fatigue and lumbar lordosis.

Adult↗

[Change in the content and makeup of the phospholipids in the microsomal fraction of rat skeletal muscles under the influence of a flight on the Kosmos-690 biosatellite].

The content and composition of phospholipids in the microsomes isolated from the back femoral muscles of rats flown for 20.5 days aboard the biosatellite Cosmos-690 were studied. Gamma-irradiation applied in the ground-based control experiments did not change the amount of total phospholipids in microsomes of skeletal muscles and altered insignificantly the content of their individual fractions. On the 2nd postflight day a substantial increase in the content of total and fractional phospholipids in microsomes was found. The decrease seems to be induced by weightlessness. On the 26th postflight day the content of total phospholipids returned to the normal whereas their fractional composition still remained changed.

Animals↗

Muscle strength as a predictor of bone mineral density in young women.

It is widely accepted that physical activity is beneficial to bone. However, the specific relationships of muscle strength to bone mineral density (BMD) are poorly understood. We examined strength and BMD in 59 women aged 18-31 years who ranged in exercise patterns from sedentary to active. Mineral density of the right proximal femur (hip) and spine (L2-4) was evaluated by dual-energy x-ray absorptiometry. BMD at the midradius was measured by single-photon absorptiometry. Dynamic strength (one repetition maximum) was measured for the following muscle groups: back, elbow flexors (biceps), leg extensors (quadriceps), and the hip flexors, extensors, adductors, and abductors. Isometric grip strength was assessed by dynamometry. Mineral density at the hip correlated independently with muscle strength and body weight, but not with age. Specifically, femoral neck BMD was significantly correlated with back strength and weight, whereas trochanter and overall hip mineral density were significantly related to biceps, back, and hip adductor strength. Hip mineral density was not related to strength of the quadriceps groups or to that of the hip flexors, extensors, or abductors. In addition, muscle strength was an independent predictor of lumbar spine and midradius mineral density. In stepwise multiple regression analysis, biceps strength proved the most robust predictor of hip BMD and grip strength best predicted bone density at the lumbar spine and radius. We conclude that muscle strength is an independent predictor of bone mineral density, accounting for 15-20% of the total variance in bone density of young women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

The influence of specific training on trunk muscle recruitment patterns in healthy subjects during stabilization exercises.

Low back pain is a major problem involving high medical costs, therefore effective prevention strategies are essential. Stabilization exercises seem to facilitate the neuromuscular control of the lumbar spine and may be useful in prevention programs. To investigate whether specific lumbar stabilization training has an effect on muscle recruitment patterns in a healthy population, in the present study 30 subjects were recruited to perform two types of testing exercises, i.e. bridging exercises and exercises in four-point kneeling, both before and after training. Surface electromyographic data of different abdominal and back muscles were obtained. After training, analysis of the relative muscle activity levels (percentage of maximal voluntary isometric contraction) showed a higher activity of the local (segmental-stabilizing) abdominal muscles, but not of the local back muscles; minimal changes in global (torque-producing) muscle activity also occurred. Analysis of the local/global relative muscle activity ratios revealed higher ratios during all exercises after training, although not all differences were significant. These results indicate that muscle recruitment patterns can be changed in healthy subjects by means of a training program that focuses on neuromuscular control. Additional studies are needed to evaluate this type of training as a prevention strategy.

Abdominal Muscles↗

[Movements of the lumbar spine. A biomechanical study].

The lumbar spine presents movements of flexion-extension, lateral inflexions and rotations, which are, in fact, the result of movements within each mobile spinal segment. These mobile segments present six levels of freedom corresponding to translation and rotation movements in the three spacial planes. Lumbar mobility decreases markedly with age. Muscles not only participate in the movement itself, but also in its control and in maintaining spinal stability. Their action also depends on the effect of gravity. The authors report various studies concerning spinal stresses during varied movements and positions. Flexion of the trunk is the most stressing; walking, rotations and lateral inflexions increase only moderately the intradiscal pressure. All of the these results concur with the classic ergonomic notions.

Abdomen↗

['Stiff-person'-syndrome].

In two patients, a man aged 54 years and a woman aged 49 years, stiff-person syndrome was diagnosed. This is a rare disorder of the central nervous system, with signs of an autoimmune pathogenesis. Patients present with pain and stiffness of the lower back, a complaint that is regularly seen in general practice. Moreover, the disease causes hypertonia and very painful cramps of the lower back and legs. Electromyographic examination in the resting condition reveals continuous muscle activity in the long back muscles, which decreases following the administration of diazepam. In 60% of patients, antibodies to glutamic acid decarboxylase may be found in the serum or cerebrospinal fluid; this enzyme is involved in the production of the inhibiting neurotransmitter gamma-aminobutyric acid. Both patients were treated with diazepam, baclofen and corticosteroids. Stiff-person syndrome is a rare but treatable disorder that should be considered when patients present with stiffness and pain in the lower back and upper legs.

Adrenal Cortex Hormones↗

Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain.

BACKGROUND AND PURPOSE: The purpose of this randomized controlled trial was to examine the usefulness of the addition of specific stabilization exercises to a general back and abdominal muscle exercise approach for patients with subacute or chronic nonspecific back pain by comparing a specific muscle stabilization-enhanced general exercise approach with a general exercise-only approach. SUBJECTS: Fifty-five patients with recurrent, nonspecific back pain (stabilization-enhanced exercise group: n=29, general exercise-only group: n=26) and no clinical signs suggesting spinal instability were recruited. METHODS: Both groups received an 8-week exercise intervention and written advice (The Back Book). Outcome was based on self-reported pain (Short-Form McGill Pain Questionnaire), disability (Roland-Morris Disability Questionnaire), and cognitive status (Pain Self-Efficacy Questionnaire, Tampa Scale of Kinesiophobia, Pain Locus of Control Scale) measured immediately before and after intervention and 3 months after the end of the intervention period. RESULTS: Outcome measures for both groups improved. Furthermore, self-reported disability improved more in the general exercise-only group immediately after intervention but not at the 3-month follow-up. There were generally no differences between the 2 exercise approaches for any of the other outcomes. DISCUSSION AND CONCLUSION: A general exercise program reduced disability in the short term to a greater extent than a stabilization-enhanced exercise approach in patients with recurrent nonspecific low back pain. Stabilization exercises do not appear to provide additional benefit to patients with subacute or chronic low back pain who have no clinical signs suggesting the presence of spinal instability.

Abdominal Muscles↗

Altered patterns of abdominal muscle activation in patients with chronic low back pain.

This study investigated patterns of abdominal muscle recruitment during the abdominal drawing in manoeuvre in subjects with chronic low back pain (CLBP) and radiological diagnosis of spondylolysis or spondylolisthesis. Data were collected using surface electromyography from 12 physically active subjects with CLBP and 10 controls. The control subjects displayed an ability to preferentially activate internal oblique with minimal activation of upper rectus abdominis during the action of drawing in the abdominal wall. The group with CLBP were unable to achieve this. This finding may reflect the presence of neuromuscular dysfunction in this group. Further study is required to investigate if these findings are linked to the ability of patients with CLBP to provide dynamic stability of their lumbar spine.

Journal Article↗