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Objective. To investigate balance functions in older women and evaluate the association of the fear-avoidance beliefs model (FABM) factors with balance and mobility performance. Participants. Fifteen older women with CLBP was compared with age-matched pain-free controls (n=15). Main Outcome Measures. Pain intensity, falls-related self-efficacy and intrinsic constructs in the FABM were evaluated. Postural steadiness (centre of pressure (COP)) and mobility functions were assessed. Linear relationships of FABM variables with COP and mobility score were estimated. Results. CLBP showed lower mobility score compared to controls. CLBP presented lower falls-related self-efficacy and it was associated with reduced mobility scores. FABM variables and falls-related self-efficacy were correlated with postural steadiness. Physical activity was reduced in CLBP, but no between-group difference was evident for knee extensor strength. No systematic linkages were observed between FABM variables with mobility score or postural steadiness. Conclusions. Back pain status affects balance and mobility functions in older women. Falls-related self-efficacy is lower in CLBP and is associated with reduced mobility. Disuse syndrome in CLBP elderly is partly supported by the results of this preliminary study.

Background: The flexion relaxation phenomenon (FRP) represents a well-studied neuromuscular response that occurs in the lumbar and cervical spine. However, the cervical spine FRP has not been investigated extensively, and the speed of movement and loading effects remains to be characterized. The objectives of the present study were to evaluate the influence of load and speed on cervical FRP electromyographic (EMG) and kinematic parameters and to assess the measurement of cervical FRP kinematic and EMG parameter repeatability.Methods: Eighteen healthy adults (6 women and 12 men), aged 20 to 39 years, participated in this study. They undertook 2 sessions in which they had to perform a standardized cervical flexion/extension movement in 3 phases: complete cervical flexion; the static period in complete cervical flexion; and extension with return to the initial position. Two different rhythm conditions and 3 different loading conditions were applied to assess load and speed effects. Kinematic and EMG data were collected, and dependent variables included angles corresponding to the onset and cessation of myoelectric silence as well as the root mean square (RMS) values of EMG signals. Repeatability was examined in the first session and between the 2 sessions.Results: Statistical analyses revealed a significant load effect (P < 0.001). An augmented load led to increased FRP onset and cessation angles. No load x speed interaction effect was detected in the kinematics data. A significant load effect (P < 0.001) was observed on RMS values in all phases of movement, while a significant speed effect (P < 0.001) could be seen only during the extension phase. Load x speed interaction effect was noted in the extension phase, where higher loads and faster rhythm generated significantly greater muscle activation. Intrasession and inter-session repeatability was good for the EMG and kinematic parameters.Conclusions: The load increase evoked augmented FRP onset and cessation angles as well as heightened muscle activation. Such increments may reflect the need to enhance spinal stability under loading conditions. The kinematic and EMG parameters showed promising repeatability. Further studies are needed to assess kinematic and EMG differences between healthy subjects and patients with neck pain.

OBJECTIVE:Endurance of the back extensor muscles has become important for clinical decisions that guide interventions, particularly for chronic low back pain patients. Very little information is available regarding back muscle endurance in the elderly. The aim of this study was to investigate back extensor muscle endurance in healthy elderly subjects during a modified Sorensen test. METHODS:Sixteen elderly and 20 young male adults participated in our cross-sectional study. The subjects performed a modified Sorensen test (on a 45 degrees Roman chair) to quantify lumbopelvic extensor muscle endurance. Pre and postfatigue back extension maximal voluntary force was assessed according to an isometric lift test in a semicrouched position. Endurance time, perceived exertion (Borg CR10 scale), and postfatigue reduction of lifting force were recorded and compared among groups. RESULTS:Elderly subjects showed a trend toward decreased endurance time compared to young adults, but the difference was not significant. Similar perceived exertion and diminished maximal force after the fatiguing protocol were observed in both young and elderly subjects. Maximal isometric lift force was significantly associated with endurance time in young but not in elderly subjects. CONCLUSIONS:Lumbopelvic extensor muscle endurance and perceived exertion do not differ between young and healthy elderly individuals. However, back muscle endurance seems to be modulated by different neurophysiologic factors in the elderly. Normative data on young adults should be interpreted with caution in assessing back fitness in elderly subjects.

The aims of this study were to evaluate the influence of breathing when measuring lumbar postural control during a clinical progressive lumbar stabilization test (LST) and to estimate the intrasession reliability of the LST. The lumbar postural control index was calculated by using a biofeedback pressure unit. The LST was performed in two different positions (crook lying and upright) and two respiratory conditions (apnea and breathing) by 20 healthy individuals. The intrasession reliability of the lumbar postural control index of one trial was estimated with intraclass correlation coefficient (ICC) based on an Anova model. The results showed that the lumbar postural control index is similar between testing positions. There is an increase of the lumbar postural control index during breathing compared to the apnea. The reliability of the lumbar postural control index was fair to good (ICC 0.28–0.58). We also found that for the apnea, three trials had to be averaged to attain an ICC of 0.80 for both positions. The results of the present study indicate that the progressive LST can be similarly conducted in either supine or upright posture. Clinicians should be aware of the influence of breathing during LST. However, breathing could also serve as a clinical strategy to challenge lumbar spine postural control and stability during bracing therapeutic exercises.

Objective: This study evaluated the effects of spinal manipulation on spatiotemporal flexion-relaxation phenomenon parameters in individuals with chronic low back pain.Methods: Twenty-seven adults with chronic low back pain participated in this study and first performed a block of 5 complete trunk flexion-extensions. The experimental group (n = 13) was then submitted to lumbar spine manipulation, whereas the control group (n 14) was placed in a side-lying control position for 10 seconds. All study participants performed thereafter a second block of 5 trunk flexion-extensions. Trunk and pelvis angles and Surface EMG of erector spinae at L2 and L5 were recorded during the flex ion-extension tasks. Flexion angles corresponding to the onset and cessation of myoelectric silence, normalized EMG, and the extension-relaxation ratio were compared across experimental conditions.Results: A significant reduction of EMG activity at full trunk flexion at the L2 erector spinae level was observed in the experimental group compared to the control group. No significant effect was seen at L5 in both groups. The experimental group Presented a significantly increased postmanipulation FRR at L2, whereas the control group ratio did not vary after the "side-lying control position." No significant difference was seen at L5 in both groups. Flexion-relaxation phenomenon onset and cessation angle did not differ across groups or conditions.Conclusions: This study shows that lumbar spine manipulation can, at least for a brief period, modulate stabilizing neuromuscular responses of the lumbar spine in a group of patients with low back pain. (J Manipulative Physiol Ther 2009;3:2:203-209)

BACKGROUND:The cervical flexion-relaxation phenomenon (FRP) is a neck extensor myoelectric "silence" that occurs during complete cervical flexion. The aim of this study was to assess the presence of this phenomenon in the cervical region and to explore the kinematics and EMG parameters in two different experimental conditions.PATIENTS AND METHODS:Nineteen young healthy adults (22.2+/-2.4 years), without any cervical pain history, participated in this study and performed each of the experimental conditions. They had to accomplish a cervical flexion from a neutral seated position and from a 45 degrees forward leaning seated position. Neck kinematics was assessed using a kinematic capture device in order to assess onset and cessation angle of the PFR. Cervical paraspinal and trapezius muscles EMG activities were also recorded. All data were compared in order to assess the differences between the two experimental conditions.RESULTS:Eighteen of the nineteen subjects showed a FRP. The phenomenon appears between 72.6 and 76.3% of maximal cervical flexion and disappears during the return to neutral position between 91.9 and 93.1% of maximal cervical flexion. The FRP was observed, at least unilaterally, in 84.2% (67.4% bilaterally) of tasks without forward bending of trunk, and 90.5% (79.0% bilaterally) of tasks with 45 degrees forward bending of trunk. A significant increase in the flexion-relaxation ratio was observed in the 45 degrees forward leaning condition. No significant difference could be observed between the two experimental conditions for the kinematics parameters.CONCLUSION:The results of the present study indicate that cervical spine flexion in healthy subjects is characterized by a flexion-relaxation response. Moreover, the results indicate that trunk inclination might facilitate the evaluation of the cervical FRP.

Les auto questionnaires font partie integrante de l’evaluation des patients ayant des douleurs cervicales. Le Questionnaire de Bournemouth integre la realite biopsychosociale dans l’evaluation des douleurs cervicales et sa version anglais (QBc-a) est validee et presente des proprietes psychometriques de moderees a excellentes. L’objectif de cette etude est de traduire et valider une version francaise de ce questionnaire. La traduction et l’adaptation a ete completee en utilisant la methode de traduction contre-traduction qui a permis d’obtenir un consensus entre les deux versions. L’etude de validation impliquait 68 sujets (âge moyen 41 ans) qui participaient a un essai clinique randomise concernant l’efficacite des therapies manuelles pour les douleurs cervicales. Le protocole experimental permettait d’obtenir des donnees pour evaluer la validite conceptuelle, la validite conceptuelle longitudinale, la fidelite test-retest et la sensibilite au changement. Les donnees de validite conceptuelle (r = 0,67 et 0,61 et 0,42 respectivement pour la validite conceptuelle pre, post traitement et longitudinale), de fidelite test-retest (r =0,97) et de sensibilite au changement (taille de l’effet =0,56 et reponse moyenne normalisee = 0,61) sont adequates pour suggerer une utilisation de cet auto questionnaire pour la gestion des patients ayant des douleurs cervicales.

Self questionnaires are an important aspect of the management of neck pain patients. The Bournemouth Questionnaire (BQ), based on the biopsychosocial model, is designed to evaluate patients with neck pain. The validated English version of this questionnaire (BQc-English) has psychometric properties that range from moderate to excellent. The goal of this study is to translate and validate a French version of the Bournemouth Questionnaire for neck pain patients (BQc-f). Its translation and adaptation are performed using the translation back-translation method, generating a consensus among the translators. This validation study was performed on 68 subjects (mean age 41 years old) who participated in a randomized controlled trial regarding the efficiency of manual therapy for neck pain patients. This experimental protocol was designed to generate data in order to evaluate the construct validity, longitudinal validity, test-retest reliability and responsiveness. The BQc-f psychometric properties of construct validity (r = 0.67, 0.61, 0.42) for pre treatment, post treatment and longitudinal validity, respectively), test-retest reliability (r = 0.97) and responsiveness (effect size = 0.56 and mean standardized response = 0.61) are sufficient to suggest it could be used in the management of patients with neck pain.

Paraspinal muscle fatigability during various trunk extension tests has been widely investigated by electromyography (EMG), and its task-dependency is established recently. Hip extensor muscle fatigability during the Sorensen test has been reported. The aim of the present experiments was to evaluate the task-dependency of back and hip extensor muscle fatigue during two variants of the Sorensen test. We hypothesized that the rate of muscular fatigue of the hip and back extensor muscles varies according to the test position. Twenty healthy young males with no history of low back pain volunteered to participate in this cross-sectional study. They were asked to perform two body weight-dependent isometric back extension tests (S1 = Sorensen test; S2 = modified Sorensen on a 45° Roman chair). Surface EMG activity of the paraspinal muscles (T10 and L5 levels) and hip extensor muscles (gluteus maximus; biceps femoris) was recorded, and muscular fatigue was assessed through power spectral analysis of the EMG data by calculating the rate of median power frequency change. We observed hip extensor muscle fatigue simultaneously with paraspinal muscle fatigue during both Sorensen variants. However, only L5 level EMG fatigue indices showed a task-dependency effect between S1 and S2. Hip extensor muscles appear to contribute to load sharing of the upper body mass during both Sorensen variants, but to a different extent because L5 level fatigue differs between the Sorensen variants. Our findings suggest that task-dependency has to be considered when EMG variables are compared between two types of lumbar muscle-fatiguing tasks.

Prolonged standing has been associated with the onset of low back pain symptoms in working populations. So far, it is unknown how individuals with chronic low back pain (CLBP) behave during prolonged unconstrained standing (PS). The aim of the present study was to analyze the control of posture by subjects with CLBP during PS in comparison to matched healthy adults. The center of pressure (COP) position of 12 CLBP subjects and 12 matched healthy controls was recorded in prolonged standing (30min) and quiet stance tasks (60s) on a force plate. The number and amplitude of COP patterns, the root mean square (RMS), speed, and frequency of COP sway were analyzed. Statistical analyses showed that CLBP subjects produced less postural changes in the antero-posterior direction with decreased postural sway during the prolonged standing task in comparison to the healthy group. Only CLBP subjects were influenced by the prolonged standing task, as demonstrated by their increased COP RMS, COP speed and COP frequency in the quiet standing trial after the prolonged standing task in comparison to the pre-PS trial. The present study provides additional evidence that individuals with CLBP might have altered sensory-motor function. Their inability to generate responses similar to those of healthy subjects during prolonged standing may contribute to CLBP persistence or an increase risk of recurrent back pain episodes. Moreover, quantification of postural changes during prolonged standing could be useful to identify CLBP subjects prone to postural control deficits.

Background Neck problems are often recurring or chronic. After pain, unsteadiness and balance problems are among the most frequent symptoms reported by chronic neck pain (CNP) patients. Altered sensorimotor control of the cervical spine and sensorimotor integration problems affecting postural control have been observed in CNP patients. Very few data are available regarding the post-intervention effects of rehabilitation programs on postural control in CNP. Case presentation This is a case study of a traumatic CNP patient (a 45-year old female) with postural unsteadiness who participated in an 8-week rehabilitation program combining therapeutic exercises with spinal manipulative therapy. Pre-intervention data revealed that the postural control system was challenged when postural control sensory inputs were altered, particularly during the head-extended-backward condition. Post-intervention centre of pressure measurements indicated a drastic reduction in postural sway during trials with changes in neck orientation. Conclusion This case report indicates that an 8-week rehabilitation program combining therapeutic exercises with spinal manipulative therapy may have had an effect on improvement of postural control in a trauma CNP patient with unsteadiness. These results warrant further studies to investigate the relationships between pain amelioration, sensorimotor control of the cervical spine, muscle fitness and postural steadiness.

Background: The flexion relaxation phenomenon (FRP) is an interesting model to study the modulation of lumbar stability. Previous investigations have explored the effect of load, angular velocity and posture on this particular response. However, the influence of muscular fatigue on FRP parameters has not been thoroughly examined. The objective of the study is to identify the effect of erector spinae (ES) muscle fatigue and spine loading on myoelectric silence onset and cessation in healthy individuals during a flexion-extension task.Methods: Twenty healthy subjects participated in this study and performed blocks of 3 complete trunk flexions under 4 different experimental conditions: no fatigue/no load (1), no fatigue/load (2), fatigue/no load(3), and fatigue/load (4). Fatigue was induced according to the Sorenson protocol, and electromyographic (EMG) power spectral analysis confirmed that muscular fatigue was adequate in each subject. Trunk and pelvis angles and surface EMG of the ES L2 and L5 were recorded during a flexion-extension task. Trunk flexion angle corresponding to the onset and cessation of myoelectric silence was then compared across the different experimental conditions using 2 x 2 repeated-measures ANOVA.Results: Onset of myoelectric silence during the flexion motion appeared earlier after the fatigue task. Additionally, the cessation of myoelectric silence was observed later during the extension after the fatigue task. Statistical analysis also yielded a main effect of load, indicating a persistence of ES myoelectric activity in flexion during the load condition.Conclusion: The results of this study suggest that the presence of fatigue of the ES muscles modifies the FRP. Superficial back muscle fatigue seems to induce a shift in load-sharing towards passive stabilizing structures. The loss of muscle contribution together with or without laxity in the viscoelastic tissues may have a substantial impact on post fatigue stability.

Little information on quantitative sagittal plane postural alignment and evolution in children exists. The objectives of this study are to document the evolution of upright, static, sagittal posture in children and to identify possible critical phases of postural evolution (maturation).

OBJECTIVES:To estimate the immediate test-retest reliability of a single measure of several center of pressure (COP) variables, to report the number of trials to be averaged to obtain a reliable measurement of postural steadiness, and to determine the minimal metrically detectable change (MMDC).DESIGN:Cross-sectional study.SETTING:University biomechanics laboratory.PARTICIPANTS:Seven community-living, healthy elderly people over the age of 60 years (range, 62-73y).INTERVENTIONS:Not applicable.MAIN OUTCOME MEASURES:The COP was estimated from 2 force platforms and the following measures were calculated: (1) root mean square (RMS), (2) COP range, (3) COP mean velocity, (4) mean power frequency (MPF), (5) median power frequency (MedPF), and (6) sway area. Intraclass correlation coefficients (ICCs) were determined by using 9 successive quiet standing trials.RESULTS:The ICCs obtained for 1 measure of 120 seconds were.58 and.58 for the RMS,.83 and.94 for the COP mean velocity,.52 and.62 for the COP range,.44 and.30 for the MPF, and.34 and.47 for the MedPF in anteroposterior (AP) and mediolateral (ML) directions, respectively. The ICC of the COP sway area obtained for 1 measure was.41. Only 2 trials had to be averaged to obtain an ICC over.90 for the COP mean velocity associated with an MMDC of +/-1.2mm/s (AP) and +/-0.6mm/s (ML).CONCLUSIONS:Mean velocity was the most reliable COP measure and using 2 repetitions allowed for reliable measurement of postural steadiness. For the other COP variables, 3 trials of 120 seconds were needed to obtain an ICC over.80.

Evaluation of postural control is generally based on the interpretation of the center of pressure (COP) and the center of mass (COM) time series. The purpose of this study is to compare three methods to estimate the COM which are based on different biomechanical considerations. These methods are: (1) the kinematic method; (2) the zero-point-to-zero-point double integration technique (GLP) and (3) the COP low-pass filter method (LPF). The COP and COM time series have been determined using an experimental setup with a force plate and a 3D kinematic system on six healthy young adult subjects during four different 30s standing tasks: (a) quiet standing; (b) one leg standing; (c) voluntary oscillation about the ankles and (d) voluntary oscillation about the ankles and hips. To test the difference between the COM trajectories, the root mean square (RMS) differences between each method (three comparisons) were calculated. The RMS differences between kinematic–LPF and GLP–LPF are significantly larger than kinematic–GLP. Our results show that the GLP method is comparable to the kinematic method. Both agree with the unified theory of balance during upright stance. The GLP method is attractive in the clinical perspective because it requires only a force plate to determine the COP–COM variable, which has been demonstrated to have a high reliability.