Background: Different individualized interventions have been used to improve chronic low back pain (CLBP). However, their superiority over group-based interventions has yet to be elucidated. We compared an individualized treatment involving pain neuroscience education (PNE) plus motor control exercise (MCE) with group-based exercise (GE) in patients with CLBP. Methods: Seventy-three patients with CLBP were randomly assigned into the PNE plus MCE group (n = 37) and GE group (n = 36). Both PNE plus MCE and GE were administered twice weekly for 8 weeks. Pain intensity (as measured using the VAS), disability (as measured using the Roland-Morris Disability Questionnaire), fear-avoidance beliefs (as measured using the Fear-Avoidance Beliefs Questionnaire), and selfefficacy (as measured using the Pain Self-Efficacy Questionnaire) were assessed at baseline and 8 weeks post-intervention. A 2 9 2 variance analysis (treatment group 9 time) with a mixed-model design was applied to statistically analyze the data. Results: Both groups showed significant improvements in all the outcome measures, with a large effect size (P < 0.001, partial eta squared [gp 2 ] = 0.66 to 0.81) after the intervention. The PNE plus MCE group showed greater improvements, with a moderate effect size in pain intensity (P = 0.041, gp 2 = 0.06) and disability (P = 0.021, gp 2 = 0.07) compared to the GE group. No significant difference was found in fearavoidance beliefs during physical activity and work, and selfefficacy (P > 0.05) between the 2 groups. Conclusion: PNE and MCE seem to be better at reducing pain intensity and disability compared to GE, while no significant differences were observed for fear-avoidance beliefs and self-efficacy between the 2 groups in patients with CLBP. With regard to the superiority of individualized interventions over group-based ones, more studies are warranted. &

Background This study sought to determine the effects of a 6-week neuromuscular training (NMT) and NMT plus external focus (NMT plus EF) programs on trunk and lower extremity inter-segmental movement coordination in active individuals at risk of injury. Methods Forty-six active male athletes (controls = 15, NMT = 16, NMT plus EF = 15) participated (age = 23.26 ± 2.31 years) in this controlled, laboratory study. Three-dimensional kinematics were collected during a drop vertical jump (DVJ). A continuous relative phase (CRP) analysis quantified inter-segmental coordination of the: (1) thigh (flexion/extension)—shank (flexion/extension), (2) thigh (abduction/adduction)—shank (flexion/extension), (3) thigh (abduction/adduction)—trunk (flexion/extension), and (4) trunk (flexion/extension)—pelvis (posterior tilt/anterior tilt). Analysis of covariance compared biomechanical data between groups. Results After 6 weeks, inter-segmental coordination patterns were significantly different between the NMT and NMT plus EF groups (p < 0.05). No significant differences were observed in CRP for trunk-pelvis coupling comparing between NMT and NMT plus EF groups (p = 0.134), while significant differences were observed CRP angle of the thigh-shank, thigh-trunk couplings (p < 0.05). Conclusions Trunk and lower extremity movement coordination were more in-phase during DVJ in the NMT plus EF compared to NMT in active individuals at risk of anterior cruciate ligament injury. Trial registration: The protocol was prospectively registered at UMIN_RCT website with ID number: UMIN000035050, Date of provisional registration 2018/11/27.

Purpose The purpose of the study was to investigate the influence of a 72-h KT application on trunk and lower extremity kinematics during different landing tasks. Methods Twenty-nine competitive male athletes participated in this study. The sum of knee valgus and lateral trunk lean, symmetry index (SI), and peak angles of lateral trunk lean, hip flexion, knee abduction and flexion were assessed for all participants during single-leg drop landing (SLDL), single-leg vertical drop jump (SLVDJ), vertical drop jump (DLVDJ), and double leg forward jump (DLFJ), at baseline and seventy-two hours following KT application. Results The KT application resulted in more knee flexion and abduction, sum of knee valgus and lateral trunk lean as compared with the non-KT condition during SLDL (P < 0.05). Nonetheless, there were no differences in SI, maximum angle of the lateral trunk lean during SLDL, SLVDJ, nor hip flexion, knee abduction, and flexion during DLVDJ, and DLFJ tasks (P > 0.05). Conclusions The research findings suggest that KT after 72-h application may improve knee abduction and sum of knee valgus and lateral trunk lean during SLDL, knee flexion during SLDL and SLVDJ in individuals displaying risky single-leg kinematics. Therefore, KT application may marginally improve high-risk landing kinematics in competitive male athletes. Level of evidence Level III.

Introduction: Patients with non-specific low back pain (NSLBP) and movement control dysfunction demonstrate alternation in hip muscles flexibility and spinal movement patterns. Therapeutic modalities that augment hip muscles flexibility could help these patients. The aim of this study was to investigate the effect of global postural reeducation (GPR) on pain and hip muscle flexibility in patients with NSLBP and movement control dysfunction. Materials and Methods: A total of 27 men with a mean age of 31.21±2.5147 years, height of 166.44±6.11 cm, and weight of 64.21±5.25 kg participated in this study. The visual analogue scale (VAS) was used to evaluate pain. The flexibility of hip muscles (rectus femoris, tensor fasciae latae, external rotators and hamstring) was measured using universal goniometer. All data were assessed at baseline and after the intervention. The Shapiro-Wilk test and paired t test were used for statistical analysis at significance level of P=0.05. Results: Our results revealed a decline in pain (P<0.004) and an increase in the flexibility of the hamstring muscles in the right (P<0.003) and left (P<0.003) legs. There were no statistically significant differences in the flexibility of rectus femoris muscle, external rotators, and tensor fasciae latae. Conclusion: The results suggest that GPR had a significant effect on the level of pain. Further, it affected the flexibility of hamstring muscles in legs. Using GPR is recommended for pain relief and improving the flexibility of hamstring muscles in patients with NSLBP.

Background: There is some evidence that high-load lumbar stabilization exercises, such as back bridge, can recruit both local and global muscles. Hypothesis: Therapeutic exercises would optimize gluteus maximus (GMax), gluteus medius (GMed), multifidus (MF), and transversus abdominis (TrA) activation, while minimizing the activation of the tensor fascia latae (TFL) and erector spinae (ES) muscles in healthy individuals. Design: Cross-sectional study. Setting: Research laboratory. Level of Evidence: Level 4. Methods: In this cross-sectional study, surface electromyography (EMG) of GMax, GMed, TFL, TrA, MF, and ES was used to quantify the gluteal-to-TFL muscle activation (GTA) index and a ratio of local to global (L/G) lumbar muscles during (1) the elbow-toe exercise in the prone position, (2) the elbow-toe with right left lifted, (3) the hand-knee with left arm and right leg lifted, (4) the back bridge, (5) the back bridge with right leg lifted, (6) the back bridge with left leg lifted, (7) the side bridge with left leg lifted, (8) the side bridge with right leg lifted, and (9) the elbow-toe with right leg horizontally lifted exercises in healthy individuals (20 men, 20 women; age, 25 ± 4 years). Results: The back bridge exercise with left leg lift generated the highest L/G muscles activity ratio (L/G = 3.35) while the hand-knee exercise yielded the lowest L/G muscles activity ratio (L/G = 1.21). The side bridge exercise with left elbow and foot and lifting the right leg (GTA = 63.78), hand-knee exercise (GTA = 49.62), back bridge (GTA = 28.05), and elbow-toe exercise with left leg horizontally lifted (GTA = 23.02) generated the highest GTA indices, respectively. Meanwhile, the normalized EMG amplitude for GMax was significantly less than the TFL, for elbow-toe exercise ( P < 0.001), back bridge with left leg lift ( P = 0.001), side bridge exercise with the right elbow and foot and lifting the left leg ( P = 0.002), and elbow-toe exercise with right leg horizontally lifted ( P < 0.001). Conclusion: The highest GTA indexes were observed during (1) the side bridge lifting the dominant leg and (2) the hand-knee horizontally lifting dominant leg, respectively. The L/G ratio was highest during (1) the back bridge lifting nondominant leg, (2) back bridge, and (3) back bridge lifting dominant leg, respectively. This study supports the use of back bridge exercises to strengthen the MF and side bridges to improve gluteal muscle activation. Clinical Relevance: The highest GTA index was observed in the side bridge lifting the right leg. Highest L/G ratio was in the back bridge with nondominant leg lifted. This study supports the use of back bridge exercises to strengthen the MF. This study supports the use of side bridges to improve gluteal muscle activation.

Introduction Ankle dorsiflexion range of motion (DF-ROM) has been shown to be associated with poor landing posture. However, previously used tasks have been controlled, and it is unclear whether clinical measurements of the ankle DF-ROM, are associated with landing positions during sport-specific task. This study sought to determine the relationship between ankle DF-ROM and landing positions. Methods Thirty male soccer players participated in this study. The ankle DF-ROM was measured by the weight bearing lunge test in degrees using a cell phone app (TiltMeter). Landing patterns were assessed during a soccer-specific task using landing error scoring system items using Kinovea software. Simple correlations were used to evaluate the relationships between ankle DF-ROM and landing error scores. Results Significant correlations were found between ankle DF-ROM and landing errors (r = -0.450, P = 0.006). A decreased ankle DF-ROM was associated with greater landing errors in a soccer specific situation. Conclusion These results suggest that ankle DF-ROM may serve a useful clinical measure for identifying poor landing posture in the real-world environment. Therefore, assessment of ankle DF-ROM could be included in the screening process, which could help identify the cause of the faulty motion.

Background Knee osteoarthritis (OA) is a multifactorial form of rheumatic condition contributing to physical and psychological factors. Treatments have been provided solely and often compared with each other. An alternative view is that combined treatments addressing physical and psychological factors may result in more benefits. This study aimed to investigate the effect of pain neuroscience education (PNE) followed by Pilates exercises (PEs) in participants with knee OA, compared to PE alone. Methods In this two-arm assessor-blind pilot randomized controlled trial, fifty-four community-dwelling adults with knee OA were randomly assigned to the PNE followed by PEs and PEs groups (27 in each group). The study was conducted between early July 2021 and early March 2022 at the university’s health center. Primary outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales of pain and physical limitation and secondary outcomes were Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Pain Self-Efficacy Questionnaire, and Timed "Up & Go" test covering function. The primary and secondary outcomes were measured at baseline and eight weeks post-treatment. A general linear mixed model was used for between-group comparison with a statistical significance level of 0.05. Results Significant within-group differences were observed in all outcomes in both groups at post-treatment. There were no statistically between-group differences in pain (adjusted mean difference: -0.8; 95% CI -2.2 to 0.7; p = 0.288), physical limitation (adjusted mean difference: -0.4; 95% CI -4 to 3.1; p = 0.812) and function (adjusted mean difference: -0.8; 95% CI -1.8 to 0.1; p = 0.069) at eight weeks. For pain catastrophizing (adjusted mean difference: -3.9; 95% CI -7.2 to -0.6; p = 0.021), kinesiophobia (adjusted mean difference: -4.2; 95% CI -8.1 to -0.4; p = 0.032), and self-efficacy (adjusted mean difference: 6.1; 95% CI 0.7 to 11.5; p = 0.028) statistically between-group improvements were observed favoring PNE followed by PEs group after the treatment. Conclusions Combining PNE with PEs could have superior effects on psychological characteristics but not on pain, physical limitation, and function, compared to PEs alone. This pilot study emphasizes the need to investigate the combined effects of different interventions. Trial registration IRCT20210701051754N1.

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