Journal of Back and Musculoskeletal Rehabilitation最新文献

BackgroundIntegrative neuromuscular training (INT) is increasingly incorporated into football conditioning programs to improve neuromuscular function and athletic performance. However, its overall effectiveness across various aspects of physical fitness and sport-specific skills remains unclear.ObjectiveTo systematically review and meta-analyze the effects of INT on physical fitness and football-specific performance outcomes in football players.MethodsFollowing PRISMA guidelines, this review was prospectively registered in PROSPERO (CRD420251052631). Comprehensive research was conducted in Web of Science, PubMed, SCOPUS, Embase, and CNKI up to May 2025. Methodological quality was evaluated using the TESTEX and ROB 2 tools, while the GRADE framework assessed evidence certainty. Where appropriate, random-effects model meta-analyses were applied.ResultsTwelve randomized controlled trials involving 276 football players of varying ages and competitive levels were included. INT produced significant improvements in lower-limb muscle strength (ES = 1.065; p < 0.001), power (ES = 0.453; p < 0.001), sprint speed (ES = -0.341; p = 0.001), agility (ES = -0.398; p < 0.001), balance (ES = -0.897; p < 0.001), and dribbling performance (ES = -1.028; p < 0.05). In contrast, shooting performance showed no significant improvement (ES = 0.324; p = 0.181). Notably, all effect estimates were supported by low-certainty evidence according to the GRADE assessment.ConclusionINT may be associated with small-to-moderate improvements in strength, sprint speed, power, agility, balance, and dribbling compared with regular training; however, these findings are supported by low-certainty evidence and should be interpreted with caution. Future high-quality studies with standardized protocols are warranted to clarify its impact on advanced technical skills and optimize its integration into football training programs.

BackgroundChronic nonspecific low back pain (CNLBP) is a leading cause of disability, with diaphragm dysfunction implicated in impaired spinal stability. However, systematic evidence on targeted interventions remains limited.ObjectiveTo quantify the efficacy of diaphragm-focused interventions on pain and function in CNLBP.MethodsThe systematic review/meta-analysis followed PRISMA-Cochrane guidelines. Analyzed randomized controlled trials (RCTs) assessing diaphragmatic interventions (manual therapy, respiratory training, neuromuscular re-education). Databases were searched until February 2025. Random-effects models and subgroup analyses were applied.ResultsMeta-analysis of 7 RCTs (n = 283) showed diaphragmatic interventions significantly reduced pain (overall SMD = -1.11, 95%CI: -1.52--0.71, p < 0.01). Diaphragmatic training (SMD = -1.37) and manual therapy (SMD = -1.25) were most effective, while neuromuscular re-education was not significant (SMD = -0.62). For disability, overall SMD was -0.83（95%CI: -1.14--0.52, p < 0.01, with manual therapy showing the largest effect size (SMD = -1.30), followed by diaphragmatic training (SMD = -0.69) and neuromuscular re-education (SMD = -0.47). Excluding one 4-week DNS study eliminated heterogeneity and increased pain effect to SMD = -1.24. Evidence certainty was low (GRADE).ConclusionDiaphragm-targeted interventions improve short-to-midterm pain and function. Future high-quality RCTs are needed to confirm long-term efficacy and standardize protocols.

BackgroundClassifying low back pain (LBP) based solely on symptom duration may be insufficient to explain underlying paraspinal muscle degeneration and dysfunction in recurrent and chronic LBP cases.MethodsFifty-nine females (45 with non-specific low back pain, 14 pain-free controls) were categorized into subgroups using cluster analysis based on personal, pain-related, psychological, and functional characteristics. Lumbar paraspinal muscle structure was assessed using T1-weighted Dixon MRI to measure muscle cross-sectional area (CSA), fat CSA, and muscle fat index (MFI). Muscle function was evaluated using T2-weighted MRI to determine resting T2 values (T2-rest) and T2 shift following muscle activation (T2-shift) at three specific lumbar levels: upper L3 (UL L3), upper L4 (UL L4), and lower L4 (LL L4).ResultsFour new LBP subgroups were identified and compared to HC (healthy control (n = 14), 23.6%): Neutral (NT; n = 5, 8.5%), Personal and Pain Affected (PA; n = 9, 15.3%), Maladaptive cognition affected (MCA; n = 25, 42.4%), and Personal, Pain, Psychological, and Functional Affected (PPFA; n = 6, 10.2%). NT resembled HC indicating healthy lumbar muscle, PA subgroup showed with a higher fat CSA and MFI in paraspinals muscle. PA and MCA exhibited localized muscle hyperactivity. PPFA subgroups remained metabolically inactive.ConclusionsThis novel LBP subgrouping framework revealed distinct patterns of paraspinal muscle fatty infiltration and dysfunction. Fatty infiltration and hyperactivity were linked to BMI, chronicity, and cognitive traits; hypoactivity was found in those with broad psychosocial and functional impairments.

BackgroundCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The effects of ultrasound-guided nerve hydrodissection in the treatment of CTS are controversial.ObjectiveTo evaluate the short-term effectiveness of 5% dextrose (D5 W) injection with ultrasound-guided nerve hydrodissection method together with wrist orthosis treatment in mild and moderate CTS patients and the contribution of this treatment to wrist orthosis treatment.MethodsIn this prospective randomized controlled trial, forty-four participants with mild to moderate CTS were randomly assigned the wrist orthosis treatment group (control) and wrist orthosis with D5 W injection treatment group (study) using stratified block randomization. All patients were evaluated via the Visual Analog Scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), grip strength (GST), and median nerve cross-sectional area (CSA).ResultsWithin-group analysis demonstrated statistically significant improvements in VAS, BCTQS, and BCTQF scores in the control group, and in all evaluated parameters in the study group (p < 0.05). Between-group comparisons of change scores revealed no statistically significant differences for VAS (MD -0.8, 95% CI -1.74 to 0.14), BCTQS (MD -2.95, 95% CI -6.38 to 0.48), CSA (MD -0.46, 95% CI -1.20 to 0.28), or GST (MD 1.33, 95% CI -0.43 to 3.09). However, a statistically significant between-group difference was observed for the BCTQF score, favoring the study group (MD -1.65, 95% CI -3.65 to -0.35; p < 0.05).ConclusionUSG-guided hydrodissection injection with D5 W in CTS improves wrist orthosis treatment. This injection helps patients perform functions that affect daily activities, such as grasping more effectively. For patients who use wrist orthoses but do not achieve sufficient improvement in their functions, hydrodissection injection with D5 W can be recommended.

Background and PurposeUpper limb motor impairment after stroke is a leading cause of long-term disability. This single-center pilot randomized controlled trial (RCT) evaluated the safety, feasibility, and preliminary efficacy of intermittent theta-burst stimulation (iTBS) combined with task-oriented training (TOT) for upper limb rehabilitation. iTBS, a non-invasive brain stimulation technique, may enhance recovery when paired with task-oriented training (TOT), particularly in the subacute phase of heightened neuroplasticity.MethodsTwenty-nine patients with subacute stroke were randomized into three groups: (1) iTBS + TOT (n = 10), (2) sham iTBS + TOT (n = 9), and (3) traditional physiotherapy (n = 10). All underwent a 4-week intervention. Primary outcomes were safety and feasibility. Secondary outcomes included motor impairment (Fugl-Meyer Assessment for Upper Extremity, FMA-UE), functional independence (Modified Barthel Index, MBI), and neurological deficit (National Institutes of Health Stroke Scale, NIHSS), assessed at baseline, week 2, and week 4.ResultsTwenty-nine participants completed the trial without any adverse events, and one participant from Group 2 discontinued early due to discharge. At week 4, the iTBS + TOT group showed greater improvements in FMA-UE (22.9 points vs. 3.6 and 10.2; p = 0.013; p = 0.013), NIHSS (3.0 vs 6.6; p = 0.009), and MBI (90.7 vs 51.4; p < 0.001) compared with controls, indicating potential functional benefits.ConclusionsThis exploratory pilot RCT suggests that combining iTBS with TOT is safe and feasible, with preliminary evidence supporting its potential to improve upper limb recovery in subacute stroke. However, these findings should be interpreted with caution and validated in larger, adequately powered trials.

BackgroundRepetitive transcranial magnetic stimulation (rTMS) is a noninvasive and painless technique used to modulate central nervous system activity. It has shown promise in improving motor, swallowing, speech, and cognitive functions in patients after stroke. However, limited research has focused on its effect on post-stroke balance, and stimulation parameters remain inconsistent.ObjectiveTo systematically evaluate the efficacy of rTMS on balance function in stroke patients by analyzing stimulation parameters, target sites, and clinical outcomes from recent RCTs, and to identify optimal evidence-based protocols for post-stroke balance rehabilitation.MethodsThe PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched for RCTs. Eighteen RCTs were included. All included studies demonstrated high methodological quality (PEDro scores ≥ 6).ResultsThe primary motor cortex (M1) and cerebellum were the most frequently targeted stimulation sites. Most studies employed low-frequency rTMS (LF-rTMS) or iTBS. Across the included studies, rTMS demonstrated improvements in balance(BBS), lower-limb motor function(FMA-LE) and gait parameters compared with control groups (P < 0.05). Effect sizes varied depending on stimulation site and parameters. Clinical improvements were sustained across multiple assessment domains. Some studies reported a greater reduction in pdBSI in the rTMS group (mean difference: -0.12, 95% CI:-0.22 to -0.02, P = 0.026) and a smaller increase in MEP amplitude (mean difference: 8.5 μV, 95% CI:0.9 to 16.1 μV, P = 0.028).ConclusionCurrent evidence suggests that rTMS targeting M1 or cerebellum may effectively improve balance in stroke patients. Preliminary evidence supports either (1) LF-rTMS to the unaffected M1 or (2) cerebellar iTBS as potentially effective protocols. However, further high-quality trials are needed to establish standardized treatment parameters.

BackgroundChronic nonspecific low back pain (CNLBP) is linked to changes in trunk motor control, often presenting as increased movement regularity. Entropy-based metrics quantify such alterations in motor variability, yet evidence remains fragmented.ObjectiveThe present study aims to systematically review studies employing entropy measures to assess trunk movement regularity in individuals with and without CNLBP.MethodsA comprehensive search was conducted across nine databases, including PubMed, Scopus, and Embase. Cross-sectional studies comparing CNLBP participants to healthy controls were included. Two independent reviewers handled study selection, data extraction, and risk of bias assessment.ResultsFive studies (n =222) met the inclusion criteria. Of the 222 participants in the pooled dataset, 42% were healthy controls and 58% had CNLBP, with an age range of 24.5 to 56.75 years. The weighted mean age across studies was approximately 43 years. Higher entropy (i.e., lower regularity) was observed in postural and gait tasks among CNLBP individuals. Conversely, reduced entropy (i.e., higher regularity) was noted in flexion-extension tasks, highlighting task-specific motor adaptations.ConclusionCNLBP is associated with task-dependent alterations in trunk movement regularity. Future research should standardize entropy computation and data collection protocols to enhance study comparability and clinical applicability.

BackgroundCore muscular endurance is believed to support both postural control and proprioceptive accuracy.ObjectivesThis study aimed to investigate the relationship between core endurance, dynamic balance, and proprioceptive function of the hip and shoulder joints in healthy young adults.MethodsSixty healthy young adults (mean age: 20.9 ± 2.4 years) participated. Core endurance was evaluated using McGill tests: Trunk Anterior Flexor Test (TAFT), Trunk Posterior Extensor Test (TPET), Right and Left Lateral Plank Tests (RLPT, LLPT). Dynamic balance was assessed with the Pedalo^® platform, while shoulder and hip proprioception (flexion and abduction) was measured using the Biodex System 3 Pro.ResultsSignificant positive correlations were observed among the McGill core endurance tests, with the strongest association between RLPT and LLPT. However, no significant bivariate correlations were found between the core endurance tests and dynamic balance or shoulder and hip proprioception (flexion and abduction). In the regression analysis, only the mean lateral plank time (LPTmean) emerged as a significant predictor of dynamic balance, whereas the Trunk Posterior Extensor Test (TPET) showed a small but significant association with shoulder flexion joint position sense error. No core endurance test significantly predicted shoulder abduction or hip proprioception.ConclusionsThese findings suggest that lateral core endurance may be particularly associated with dynamic balance under tasks that involve medio-lateral stability demands, and that posterior trunk endurance (TPET) may be related to shoulder flexion proprioception in healthy young adults. These associations are correlational and should be interpreted with caution.

BackgroundLumbar stabilization exercises (LSEs) are commonly used to improve spinal stability; however, few studies have evaluated LSEs performed in the sitting position.ObjectiveTo investigate the characteristics of newly developed chair-based LSEs based on muscle activity.MethodsThis prospective, single-group study included 23 healthy males. Trunk muscle activity during exercise was evaluated using surface electromyography and ultrasonography to compare two newly developed chair-based lumbar stabilization exercises with conventional LSEs. The Lateral Abdominal Expansion (LAE) and Hip Flexion with Arm Resistance (HFAR) exercises, both involving isometric contractions, were specifically developed for this purpose.ResultsThe two chair-based exercises showed a greater preferential activation ratio of the transversus abdominis than did the prone and side bridges. Furthermore, transversus abdominis/internal oblique activity was greater in LAE than in all conventional LSEs and in HFAR than in the prone and side bridges. Conversely, multifidus activation was lower during LAE and HFAR than during the bridge and bird-dog but remained greater than that observed in the draw-in and prone bridge.ConclusionThe LAE and HFAR may be promising for the preferential activation of the transversus abdominis and multifidus.

BackgroundTelerehabilitation refers to the provision of medical rehabilitation services to individuals in remote locations through the use of online communication technologies.ObjectiveThis study aims to investigate the impact of a telerehabilitation-based aerobic exercise program on physical fitness in patients with epilepsy.MethodsA total of 42 individuals, aged 18-50, diagnosed with epilepsy were randomly assigned to the study group (SG) (n = 21) and the control group (CG) (n = 21). The SG participated in a regimen consisting of 45 min of conventional physiotherapy combined with 30 min of telerehabilitation-based aerobic exercise, conducted 3 times per week for 8 weeks. The CG received only conventional physiotherapy with the same frequency and duration. Pre- and post-treatment measurements were taken, including body composition (muscle mass, body fat percentage, body weight) assessed through bioelectrical impedance analysis, physical performance evaluated via the Short Physical Performance Battery (SPPB), muscular endurance measured with the 30-s stand-and-sit test, and treatment satisfaction assessed using the visual analog scale.ResultsThe SG demonstrated significant improvements in physical performance (p = 0.01) and muscular endurance (p < 0.001) compared to the CG. However, there was no superority of SG compared to the CG for body composition parameters. (p > 0.05, for all) Within-group comparisons revealed that SG showed significant improvements in body composition measurements (p < 0.001), while no significant changes were observed in the CG for either all parameters. (p > 0.05, for all).ConclusionTelerehabilitation-based aerobic exercise proves to be an effective intervention for enhancing physical fitness in individuals with epilepsy.