Background & Objectives: Musculoskeletal disorders are the main cause of occupational or work–related diseases. Occupational illnesses and especially chronic non–specific low back pain account for the majority of musculoskeletal disorders and cause long–term physical conditions and related treatments for the affected person. These individuals may even leave their jobs due to pain and illness. So this condition is very important. These diseases, due to their physiology, cause numerous problems, like pain and imbalance in the affected patients, resulting in increased healthcare costs and declined quality of life. Therapeutic exercise interventions in people with chronic non–specific back pain can be effective to a great extent, and for this purpose, various exercise programs have been proposed. However, some contradictory results are also observed in previous research investigating the effect of core stability exercises on patients with chronic low back pain. Accordingly, the present study aimed to investigate the effect of a stable weekly exercise program on static and dynamic balance in patients with chronic non–specific low back pain.
Methods: The present quasi–experimental study was conducted on 40 medical staff with low back pain working at Shariati Hospital in Isfahan City, Iran. The study subjects were randomly divided into two groups of control and intervention (each group of 20 subjects). The control group performed the routine exercises and the intervention group performed the stability training for 8 weeks. Before and after the intervention, the static and dynamic balance of the patients was measured by the Balance Error Scoring System (BESS) and Star Balance Test. In the BESS, the static balance of each subject on two stable and unstable surfaces was assessed. Moreover, they were evaluated in three physical states, including a standing position on two legs, standing on one leg with 90–degree knee flexion, and the tandem stance with non–dominant foot behind dominant foot in heel–toe fashion, with closed eyes and hands on hips. Additionally, each situation was preserved for 20 seconds. The subject receive 1 negative score for each of these mistakes: opening the eyes, removing the hands from the hips, laying the foot at the time of standing on one leg on the ground, stepping leakage or any movement of the legs, lifting the toe or heel, a flexion or abduction of>30 degrees in the pelvis, and staying>5 seconds. Also, a standard RA was recorded in the off–state. The star test (dynamic balance) was performed 8 times for each subject in 8 directions, as follows: anterior, anterolateral, anteromedial, posterior, medial, posteromedial, posterolateral and lateral. In this test, 8 directions with a 45–degree angle were drawn as a star on the ground. Before initiating the test, the dominant leg of the study subject was determined; if the right leg were dominant, the test would have been performed in the clockwise direction, and if the left leg were dominant, the test would have been performed in a counterclockwise direction. The obtained data were analyzed by the t–test, Chi–squared test, Wilcoxon test, and Mann–Whitney U test at a significance level of 0.05 in SPSS version 23 software.
Results: The results showed that, in the examination of dynamic balance, in the core stability group, significant progress was made in the anterior (p=0.001), anteromedial (p=0.001), medial (p<0.001), posteromedial (p=0.001), posterior (p<0.001), posterolateral (p<0.001), lateral (p<0.001), anterolateral (p<0.001) and the combination of eight directions (p=0.011), after eight weeks of general exercises. However, in the control group, no significant improvement was observed in the anterior, anteromedial, medial, posteromedial, posterior, posterolateral, and lateral before and after eight weeks of general exercises (p>0.05). Nevertheless, there was a significant decrease in anterolateral direction (p=0.016). In the analysis of static balance, in the core stability group, a significant improvement was achieved in different situations of unstable level (p=0.001) and stable level (p=0.008). However, no significant progress was observed for the control group in different situations of unstable level and stable levels (p>0.05).
Conclusion: Based on the present study’s findings, the core stability training intervention affected the static and dynamic balance of medical personnel suffering from chronic non–specific back pain and improved the physical performance of these patients.
Background & Objectives: Being prone to Low Back Pain (LBP) development is a concept in the field of back pain prevention. Those prone to develop LBP show differences in motor control patterns compared to those who are not. Therefore, the present study aimed to compare postural sway and duration of the stance phase of gait between 18-30 years old men prone to LBP and non-prone to LBP.
Methods: The current study was observational and comparative. The statistical population comprised all the students living in the University of Tehran dormitory. Of whom, 33 individuals were selected purposefully based on inclusion and exclusion criteria. The inclusion criteria were as follows: being 18-30 years old men; having body mass index of 18-30 kg/m2; not working in a job in the last 12 months that required prolonged standing, lacking apparent musculoskeletal disorders in the trunk, upper and lower limbs; lacking any visual, vestibular, nervous, muscular, or pain problems affecting the balance; lacking LBP that causes any of the following outcomes: receiving medical interventions, absence of work for more than 3 days, and surgery in the waist, pelvis, and lower limbs. The exclusion criteria were as follows: report of low back pain at the beginning of long standing protocol, not able to complete the study questionnaire, score more than 13 in the Baecke physical activity questionnaire, score more than 13 in Borg scale (almost heavy work), and reluctant to finish the test. The study participants were divided into two groups: prone to develop low back pain (16 patients) and non-prone to develop LBP (17 patients) by performing active hip abduction test and reporting their pain based on the visual analog scale during the prolonged standing protocol. Postural sway and duration of the stance phase of gait were measured using the Biodex balance system and Foot Medisense device. Data analysis was done using the independent t test and Mann-Whitney U test in SPSS version 28 software, at a significance level of α=0.05.
Results: The results showed no significant difference between the prone to LBP group and the non-prone group regarding the anterior-posterior stability index, the medial-lateral stability index, and the overall stability index( in both static and dynamic positions for all indexes) and duration of the stance phase of gait between low back pain developers and non-pain developers.
Conclusion: It seems that people prone to develop LBP do not experience any changes in postural sway and duration of stance phase of gait before the onset of low back pain, and these variables may not be able to help identify those who are prone to develop low back pain.
Abstract
Background & Objectives: Ankle injury is one of the most common sports and daily life injuries. Usually, in 15%–60% of cases, Functional Ankle Instability (FAI) occurs after the initial sprain of the ankle. People with FAI have different muscle recruitment patterns and neuromuscular firing rates than healthy people. The human body relies on three sensory systems to maintain balance: vision, somatosensory, and vestibular. Information obtained from weight can be united by all three systems in the central nervous system, and balance can be established. Virtual reality technology is a new way to create more visual impairment and instability. By providing unreal visual cues, virtual reality makes the central nervous system rely on somatosensory and vestibular to maintain balance. This study aims to investigate the electromyographic activity of selected lower limb muscles in feedback and feedforward phases with and without using virtual reality in male badminton players with and without FAI.
Methods: The current research method was quasi–experimental. The statistical population of this research comprised Badminton athletes aged 15 to 18 who were playing at the professional level. Thirty Badminton players were divided into two groups with and without ankle instability, and each group included 15 subjects. The Cumberland Ankle Instability Tool (Hiller et al., 2006) was used to diagnose FAI. The group with FAI received a Cumberland questionnaire score of 0 to 27, and the control group received a score of 27 to 30. The Anterior Drawer of the Ankle Test was performed to ensure the absence of mechanical instability, and if the participants showed mechanical instability, they were excluded from the research. Motion Lab System MA400 (DTU) device was used to measure the electrical activity of muscles, and the F–RG model electrode was made by Skintact. The electromyographic activity of the tibialis anterior, peroneus longus, and lateral gastrocnemius muscles in the feedforward and feedback phases was studied using virtual reality. After checking the normality of the data, the independent t test and Man–Whitney U test were used to analyze the data at a significance level of 0.05 using SPSS 27.
Results: The independent t test and Man–Whitney U test results showed a significant difference in the feedforward and feedback phases between the groups with FAI and without FAI regarding the tibialis anterior, peroneus longus muscles activities (p<0.05). When using Virtual Reality in the feedforward phase, there is a significant difference between the tibialis anterior (p=0.003) and lateral gastrocnemius muscles (p<0.001) in the group with and without FAI when using virtual reality. It should be noted that the activity of the tibialis anterior and lateral gastrocnemius muscle in the group without functional instability of the ankle in the feedforward phase was higher than the group with FAI. Also, a significant difference was observed in the feedback phase in the tibialis anterior (p=0.006) and the lateral gastrocnemius muscle (p<0.001) between the group with and without ankle functional instability. It should be noted that the activity of the tibialis anterior and lateral gastrocnemius muscle in the group without ankle functional instability in the feedback phase was higher than in the group with ankle functional instability. Also, there is no significant difference between the FAI and non–FAI groups regarding peroneus longus.
Conclusion: According to the results, virtual reality can change the electromyography activity of the ankle muscles. There are changes in the electromyographic activity of the tibialis anterior and lateral gastrocnemius muscle when using virtual reality between athletes with and without FAI, indicating the effect of virtual reality on the electromyographic activity of ankle muscles in these people.
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