This study gave no evidence that 8 treatments with individually instructed motor control exercises or sling exercises were superior to general exercises for chronic low back pain.

BackgroundLow back pain (LBP) is a common cause of disability and is ranked as the most burdensome health condition globally. Self-management, including components on increased knowledge, monitoring of symptoms, and physical activity, are consistently recommended in clinical guidelines as cost-effective strategies for LBP management and there is increasing interest in the potential role of digital health.ObjectiveThe study aimed to synthesize and critically appraise published evidence concerning the use of interactive digital interventions to support self-management of LBP. The following specific questions were examined: (1) What are the key components of digital self-management interventions for LBP, including theoretical underpinnings? (2) What outcome measures have been used in randomized trials of digital self-management interventions in LBP and what effect, if any, did the intervention have on these? and (3) What specific characteristics or components, if any, of interventions appear to be associated with beneficial outcomes?MethodsBibliographic databases searched from 2000 to March 2016 included Medline, Embase, CINAHL, PsycINFO, Cochrane Library, DoPHER and TRoPHI, Social Science Citation Index, and Science Citation Index. Reference and citation searching was also undertaken. Search strategy combined the following concepts: (1) back pain, (2) digital intervention, and (3) self-management. Only randomized controlled trial (RCT) protocols or completed RCTs involving adults with LBP published in peer-reviewed journals were included. Two reviewers independently screened titles and abstracts, full-text articles, extracted data, and assessed risk of bias using Cochrane risk of bias tool. An independent third reviewer adjudicated on disagreements. Data were synthesized narratively.ResultsOf the total 7014 references identified, 11 were included, describing 9 studies: 6 completed RCTs and 3 protocols for future RCTs. The completed RCTs included a total of 2706 participants (range of 114-1343 participants per study) and varied considerably in the nature and delivery of the interventions, the duration/definition of LBP, the outcomes measured, and the effectiveness of the interventions. Participants were generally white, middle aged, and in 5 of 6 RCT reports, the majority were female and most reported educational level as time at college or higher. Only one study reported between-group differences in favor of the digital intervention. There was considerable variation in the extent of reporting the characteristics, components, and theories underpinning each intervention. None of the studies showed evidence of harm.ConclusionsThe literature is extremely heterogeneous, making it difficult to understand what might work best, for whom, and in what circumstances. Participants were predominantly female, white, well educated, and middle aged, and thus the wider applicability of digital self-management interventions remains uncertain. No information on cost-effectiveness was reported. The evidence base for interactive digita...

Background: Persistent whiplash associated disorders (WAD) have been associated with alterations in kinesthetic sense and motor control. The evidence is however inconclusive, particularly for differences between WAD patients and patients with chronic non-traumatic neck pain. The aim of this study was to investigate motor control deficits in WAD compared to chronic non-traumatic neck pain and healthy controls in relation to cervical range of motion (ROM), conjunct motion, joint position error and ROM-variability.

The effect of electrode position on the upper trapezius muscle on the myo-electric signal amplitude was investigated with special reference to arm position and estimate of force output. Previously, a depression of the electromyogram (EMG) signal has been reported midway between the seventh cervical vertebrae (C7) and acromion (Veiersted 1991, Eur J Appl Physiol 62:91-98) although this electrode position has been recommended (Zipp 1982, Eur J Appl Physiol 50: 41-54). Ten healthy subjects performed maximal shoulder elevations with the arm in vertical, abducted and flexed positions and they performed a dynamic movement test. The myo-electric signal was recorded along the length of the right upper trapezius muscle by a 16-channel bipolar array electrode and was integrated with a 0.2-s time resolution. A region just lateral to the midpoint between C7 and the lateral edge of acromion was found with high and stable amplitudes (% coefficient of variation equalled 5.6). At the midpoint a dip in the amplitude profile appeared which was slightly displaced by arm abduction or flexion probably due to sliding of the skin relative to the muscle. A linear EMG-force relationship was found in the region with high signal amplitudes, whereas the more lateral and the dip region showed highly variable EMG-force relationships. Thus, it was found that when using bipolar surface electrodes with an interelectrode distance of 2 cm a centre position 2 cm lateral to the midpoint between C7 and acromion provided good repeatability and high signal yield.

Objective. To examine the association between leisure time physical exercise, body mass index (BMI), and risk of fibromyalgia (FM). Methods. A longitudinal study with baseline assessment of physical exercise (frequency, duration, and intensity) and BMI was used to explore the risk of having FM at 11-year followup in a large, unselected female population (n ‫؍‬ 15,990) without FM or physical impairments at baseline. Results. At followup, 380 cases of incident FM were reported. A weak dose-response association was found between level of physical exercise and risk of FM (for trend, P ‫؍‬ 0.13) where women who reported the highest exercise level had a relative risk (RR) of 0.77 (95% confidence interval [95% CI] 0.55-1.07). BMI was an independent risk factor for FM (for trend, P < 0.001), and overweight or obese women (BMI >25.0 kg/m 2 ) had a 60 -70% higher risk compared with women with normal weight (BMI 18.5-24.9 kg/m 2 ). Overweight or obese women who exercised >1 hour per week had an RR of 1.72 (95% CI 1.07-2.76) compared with normal-weight women with a similar activity level, whereas the risk was >2-fold higher for overweight or obese women who were either inactive (RR 2.09, 95% CI 1.36 -3.21) or exercised <1 hour per week (RR 2.19, 95% CI 1.39 -3.46). Conclusion. Being overweight or obese was associated with an increased risk of FM, especially among women who also reported low levels of physical exercise. Community-based measures aimed at reducing the incidence of FM should emphasize the importance of regular exercise and the maintenance of normal body weight.