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Although low back pain (LBP) is a widespread and disabling health problem, there is a lack of evidence based medicine with respect to its treatment and rehabilitation. A major reason for this is the poor understanding of the underlying mechanisms of the LBP syndromes. In an attempt to fill this gap, the present review article provides an overview of the sensory-motor control aspects of trunk stabilization and postural control of the trunk, and how they may relate to the evolution of LBP. In particular, the anatomy and physiology of the sensory-motor control mechanisms of the trunk muscles that contribute to general and segmental stability of the lumbar spine will be elucidated. Furthermore, a brief overview of current theories of postural control will be provided with respect to spinal stabilization. Finally, a concept of the pathophysiological changes within the sensory-motor control mechanisms of the lumbar spine in the presence of muscle injury and pain will be presented. The impact of pain and muscle injury on the muscular support for the lumbar motion segment will be discussed along with the deficits in neuromuscular control in LBP patients with decreased segmental lumbar stability.

Patients with severe chronic heart failure (CHF) suffer from marked weakness of skeletal muscles. Neuromuscular electrical stimulation (NMES) proved to be an alternative to active strength training. The objective of this study was to test the feasibility and effectiveness of NMES in patients with chronic heart failure. Seven patients (56.0 +/- 5.0 years, CHF for 20 +/- 4 months, left ventricular ejection fraction 20.1 +/- 10.0%) finished an 8 week course of NMES of the knee extensor muscles. The stimulator delivered biphasic, symmetric, constant voltage impulses of 0.7 ms pulse width with a frequency of 50 Hz, 2 s on and 6 s off. No adverse effects occurred. After the stimulation period, the isokinetic peak torque of the knee extensor muscles increased by 13% from 101.0 +/- 8.7 Nm to 113.5 +/- 7.2 Nm (p = 0.004). The maximal isometric strength increased by 20% from 294.3 +/- 19.6 N to 354.14 +/- 15.7 N (p = 0.04). This increased muscle strength could be maintained in a 20 min fatigue test indicating decreased muscle fatigue. These results demonstrate that NMES of skeletal muscles in patients with severe chronic heart failure is a promising method for strength training in this group of patients.

This study intended in evaluating the effectiveness of exercise therapy in patients with craniomandibular disorders (CMD). Twenty consecutive patients suffering from CMD with anterior disc displacement without reduction consulting a CMD service were included in the study if they met following criteria: (i) pain in the temporomandibular region, (ii) reduced incisal edge clearance (<35 mm), (iii) magnet resonance imaging confirmed anterior disc displacement without reduction and (iv) evidence of postural dysfunction. All patients were assigned to a waiting list, serving as a no-treatment control period, according to a before-after trial. The treatment consisted of active and passive jaw movement exercises, correction of body posture and relaxation techniques. A total of 18 patients completed the study, no adverse effects occurred. Following main outcome measures were evaluated: (1) pain at rest (2) pain at stress (3) impairment (4) mouth opening at base-line, before and after treatment and at 6 month follow-up. As a result of treatment pain, impairment and mouth opening improved significantly more than during control period (paired samples t-test P < 0.05). After treatment four patients had no pain at all (chi-square: P < 0.05) and only seven patients revealed an impaired incisal edge clearance after treatment. (chi-square Test, P < 0.001). At follow up, seven patients had no pain and experienced no impairment. Exercise therapy seems to be useful in the treatment of anterior disc displacement without reduction.

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Our results demonstrate correlation between localized muscle fatigue and biomechanical adaptations that occur during a cyclic lifting task. This new technique may provide researchers and clinicians with a means to investigate fatigue-related effects of repetitive work tasks or assessment procedures that might be useful in improving education, lifting ergonomy, and back school programs. Although both the dynamic and static tasks resulted in spectral shifts in the electromyographicic data, the fact that these methods led to different muscle-specific findings indicates that they should not be considered as equivalent assessment procedures.

To avoid reduction of postural stability in rehabilitation processes, we recommend to include antagonist muscles in a comprehensive strength training regime or balance skill training.