Ademhaling - TIGRA Fysiotherapie · Ademhaling Michelle D Smith, Anne Russell and Paul W Hodges...
Transcript of Ademhaling - TIGRA Fysiotherapie · Ademhaling Michelle D Smith, Anne Russell and Paul W Hodges...
www.stabiliteitstrainingscentrum.nl
Ademhaling
Michelle D Smith, Anne Russell and Paul W Hodges
Disorders of breathing and continence have a stronger
association with back pain than obesity and physical
activity Australian Journal of Physiotherapy 2006 Vol. 52 – © Australian Physiotherapy Association
2006
Key words: Back Pain, Urinary Incontinence, Respiration Disorders, Epidemiology
Although obesity and physical activity have been argued to predict back pain, these factors
are also related to incontinence and breathing difficulties. Breathing and continence
mechanisms may interfere with the physiology of spinal control, and may provide a link to
back pain. The aim of this study was to establish the association between back pain and
disorders of continence and respiration in women. We conducted a cross-sectional analysis of
self-report, postal survey data from the Australian Longitudinal Study on Women’s Health.
We used multinomial logistic regression to model four levels of back pain in relation to both
the traditional risk factors of body mass index and activity level, and the potential risk factors
of incontinence, breathing difficulties, and allergy. A total of 38 050 women were included
from three age-cohorts. When incontinence and breathing difficulties were considered,
obesity and physical activity were not consistently associated with back pain. In contrast, odds
ratios (OR) for often having back pain were higher for women often having incontinence
compared to women without incontinence (OR were 2.5, 2.3 and 2.3 for young, mid-age and
older women, respectively). Similarly, mid-aged and older women had higher odds of having
back pain often when they experienced breathing difficulties often compared to women with
no brerathing problems (OR of 2.0 and 1.9, respectively). Unlike obesity and physical
activity, disorders of continence and respiration were strongly related to frequent back pain.
This relationship may be explained by physiological limitations of co-ordination of postural,
respiratory and continence functions of trunk muscles.
Zit in map hoofdcursus
Marshall Hagins, PhD,* Markus Pietrek, MD,† Ali Sheikhzadeh, PhD,† Margareta Nordin,
Dr. Sci.,† and Kenneth Axen, PhD‡
The effects of breath control on intra-abdominal pressure
during lifting tasks SPINE Volume 29, Number 4, pp 464–469 ©2004, Lippincott Williams & Wilkins, Inc.
Key words: intra-abdominal pressure, breath control, low back pain, lifting
Study Design. This was a repeated measures study examining 11 asymptomatic subjects
while performing dynamic lifting using various postures, loads, and breath control methods.
Objectives. To examine the effects of breath control on magnitude and timing of intra-
abdominal pressure during dynamic lifting.
www.stabiliteitstrainingscentrum.nl
Summary of Background Data. Intra-abdominal pressure has been shown to increase
consistently during static and dynamic lifting tasks. The relationship between breath control
and intra-abdominal pressure during lifting is not clear.
Methods. Eleven healthy subjects were tested using lifting trials consisting of two levels of
posture and load and four levels of breath control (natural breathing, inhalation- hold,
exhalation-hold, inhalation-exhalation). Intraabdominal pressure was measured using a
microtip pressure transducer placed within the stomach through the nose. Timing of intra-
abdominal pressure was determined relative to lift-off of the weights. Repeated measures
analysis of variance was used to determine the effect of breath control, posture, and load on
intra-abdominal pressure magnitude and timing.
Results. There was a significant effect of breath control (P _ 0.018) and load (P _ 0.002), but
not of posture (P _ 0.434), on intra-abdominal pressure magnitude. The inhalation- hold form
of breath control produced significantly greater peak intra-abdominal pressure than all other
forms of breath control (P _ 0.000 for all comparisons). No other comparisons among levels
of breath were significantly different. No significant main effects of breath control were found
relative to intra-abdominal pressure timing.
Conclusions. Breath control is a significant factor in the generation of intra-abdominal
pressure magnitude during lifting tasks. The effects of respiration should be controlled in
studies analyzing intra-abdominal pressure during lifting.
Zit in map hoofdcursus
P.W. Hodges,* R. Sapsford, and L.H.M. Pengel
Division of Physiotherapy, the University of Queensland, Brisbane, Queensland, Australia
Postural and respiratory functions of the pelvic floor
muscles Neurourology and Urodynamics 26:362–371 (2007)
Key words: pelvic floor electromyography; postural control; respiration
Aims: Due to their contribution to modulation of intra-abdominal pressure (IAP) and stiffness
of the sacroiliac joints, the pelvic floor muscles (PFM) have been argued to provide a
contribution to control of the lumbar spine and pelvis. Furthermore, as IAP is modulated
during respiration this is likely to be accompanied by changes in PFM activity.
Methods: In order to evaluate the postural and respiratory function of the PFM, recordings of
anal and vaginal electromyographic activity (EMG) were made with surface electrodes during
single and repetitive arm movements that challenge the stability of the spine. EMG recordings
were also made during respiratory tasks: quiet breathing and breathing with increased dead-
space to induce hypercapnoea.
Results: EMG activity of the PFM was increased in advance of deltoid muscle activity as a
component of the pre-programmed anticipatory postural activity. This activity was
independent of the direction of arm movement. During repetitive movements, PFM EMG was
tonic with phasic bursts at the frequency of arm movement. This activity was related to the
peak acceleration of the arm, and therefore the amplitude of the reactive forces imposed on
the spine. Respiratory activity was observed for the anal and vaginal EMG and was primarily
expiratory. When subjects moved the arm repetitively while breathing, PFM EMG was
primarily modulated in association with arm movement with little respiratory modulation.
Conclusions: This study provides evidence that the PFM contribute to both postural and
respiratory functions.
Zit in map hoofdcursus
www.stabiliteitstrainingscentrum.nl
Lee DG, Lee LJ, McLaughlin L.
Diane Lee & Associates, BC, Canada. [email protected]
Stability, continence and breathing: the role of fascia
following pregnancy and delivery. J Bodyw Mov Ther. 2008 Oct;12(4):333-48. Epub 2008 Jul 1
Pregnancy-related pelvic girdle pain (PRPGP) has a prevalence of approximately 45% during
pregnancy and 20-25% in the early postpartum period. Most women become pain free in the
first 12 weeks after delivery, however, 5-7% do not. In a large postpartum study of prevalence
for urinary incontinence (UI) [Wilson, P.D., Herbison, P., Glazener, C., McGee, M.,
MacArthur, C., 2002. Obstetric practice and urinary incontinence 5-7 years after delivery. ICS
Proceedings of the Neurourology and Urodynamics, vol. 21(4), pp. 284-300] found that 45%
of women experienced UI at 7 years postpartum and that 27% who were initially incontinent
in the early postpartum period regained continence, while 31% who were continent became
incontinent. It is apparent that for some women, something happens during pregnancy and
delivery that impacts the function of the abdominal canister either immediately, or over time.
Current evidence suggests that the muscles and fascia of the lumbopelvic region play a
significant role in musculoskeletal function as well as continence and respiration. The
combined prevalence of lumbopelvic pain, incontinence and breathing disorders is slowly
being understood. It is also clear that synergistic function of all trunk muscles is required for
loads to be transferred effectively through the lumbopelvic region during multiple tasks of
varying load, predictability and perceived threat. Optimal strategies for transferring loads will
balance control of movement while maintaining optimal joint axes, maintain sufficient intra-
abdominal pressure without compromising the organs (preserve continence, prevent prolapse
or herniation) and support efficient respiration. Non-optimal strategies for posture, movement
and/or breathing create failed load transfer which can lead to pain, incontinence and/or
breathing disorders. Individual or combined impairments in multiple systems including the
articular, neural, myofascial and/or visceral can lead to non-optimal strategies during single or
multiple tasks. Biomechanical aspects of the myofascial piece of the clinical puzzle as it
pertains to the abdominal canister during pregnancy and delivery, in particular trauma to the
linea alba and endopelvic fascia and/or the consequence of postpartum non-optimal strategies
for load transfer, is the focus of the first two parts of this paper. A possible physiological
explanation for fascial changes secondary to altered breathing behaviour during pregnancy is
presented in the third part. A case study will be presented at the end of this paper to illustrate
the clinical reasoning necessary to discern whether conservative treatment or surgery is
necessary for restoration of function of the abdominal canister in a woman with postpartum
diastasis rectus abdominis (DRA).
McGill SM, Karpowicz A.
Department of Kinesiology, Spine Biomechanics Laboratory, University of Waterloo,
Waterloo, ON, Canada. [email protected]
Exercises for spine stabilization: motion/motor patterns,
stability progressions, and clinical technique. Arch Phys Med Rehabil. 2009 Jan;90(1):118-26
www.stabiliteitstrainingscentrum.nl
OBJECTIVE: To quantify several forms of the curl-up, side-bridge, and birddog exercises
(muscle activity and 3-dimensional [3D] spine position) including some corrective techniques
to assist clinical decision-making.
DESIGN: A basic science study of a convenience sample with a retest of expert intervention.
SETTING: Spine Biomechanics Laboratory/Research Clinic.
PARTICIPANTS: Healthy men (N=8) performed the exercises, and 5 subjects repeated the
exercises as an expert applied corrective techniques.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Surface electromyography of selected trunk and hip
muscles together with video analysis and 3D spine posture were collected.
RESULTS: Comparison of muscle activation levels showed there were justifiable
progressions in each exercise form. In general, bracing of the abdominal wall enhanced
activation of the obliques, but different techniques caused migration of muscle activity to
other muscles. Examples of specific findings include the following. Movement during these
traditionally isometric exercises such as drawing squares with the hand/foot while in the
birddog posture enhances activation of many muscle groups. Breathing while holding the
isometric exercises had differing effects on muscle activation which was exercise dependent.
Some corrective exercise techniques, such as fascial raking, substantially changed relative
activation between muscles in the abdominal wall.
CONCLUSIONS: The data presented in this study may be used to guide the clinical decision
process when choosing a specific exercise form together with selecting the correct starting
level, a logical progression, suitable dosage, and possible corrective technique to enhance
tolerance of a patient.
Balogh A.
Pilates and pregnancy RCM Midwives. 2005 May;8(5):220-2.
Swiss Cottage Pilates Studio, London. [email protected]
Pregnancy is associated with a number of musculoskeletal problems. It is important to educate
all mothers, as well as those involved in ante- and postnatal care with advice on bras and
exercises that are safe in pregnancy (in particular pelvic floor exercises). There is not much
that can be done to alter the inevitable physiological and hormonal changes of pregnancy.
However, by strengthening the core stabilising muscles around the pelvis and spine, and
improving the breathing pattern, it is hoped that one can optimise the body for the challenges
it may face. Pilates is based on the principle that a central core is developed and then
movements are introduced to challenge this core stability. This philosophy is clearly
applicable in pregnancy--a significant test both mentally and physically on the mother's body.
By maximising the mother's core stability before and during pregnancy, it should be possible
to limit any potential harm. Returning to exercise soon after the birth is important for the
mother's physical and mental wellbeing--she looks after her baby's body for nine months, who
cares for hers?
Hart N, Laffont I, de la Sota AP, Lejaille M, Macadou G, Polkey MI, Denys P, Lofaso F
Service de Physiologie-Explorations Fonctionnelles, Rééducation Fonctionnelle et Centre
d'Innovation technologique Hôpital Raymond Poincaré, Garches, France.
www.stabiliteitstrainingscentrum.nl
Respiratory effects of combined truncal and abdominal support in patients with spinal
cord injury.
Arch Phys Med Rehabil. 2005 Jul;86(7):1447-51.
OBJECTIVE: To determine whether a custom girdle, designed to provide truncal stability
and abdominal support, will improve pulmonary function, enhance inspiratory muscle
activity, and reduce the sensation of respiratory effort in patients with spinal cord injury
(SCI).
DESIGN: Pulmonary function, transdiaphragmatic pressure time product (PTP di ), twitch
(Tw Pdi) and maximal transdiaphragmatic pressures (Pdi), and perception of respiratory effort
(Borg Rating of Perceived Exertion score) were measured with and without an abdominal
girdle in a seated position.
SETTING: Rehabilitation hospital.
PARTICIPANTS: Ten patients with posttrauma SCI (injury level, C5-T6).
INTERVENTION: Application of the abdominal girdle.
MAIN OUTCOME MEASURES: Borg score and measures of lung volumes, dynamic
abdominal compliance, and Tw Pdi and maximal Pdi.
RESULTS: Wearing of the girdle was associated with a lower Borg score (P = .002) and
reduced functional residual capacity (P = .006) but increased inspiratory capacity (P = .02)
and forced vital capacity (P = .02). Although there was a decrease in dynamic abdominal
compliance (P < .001) and an increase in PTP di (P = .02), this was accompanied by an
increase in both Tw Pdi (P = .02) and maximal Pdi (P = .03).
CONCLUSIONS The custom girdle reduced the sensation of respiratory effort in patients
with SCI by optimizing the operating lung volumes and decreasing abdominal compliance,
which enhanced diaphragm performance.
O'Sullivan PB, Beales DJ, Beetham JA, Cripps J, Graf F, Lin IB, Tucker B, Avery A.
School of Physiotherapy, Curtin University of Technology, Shenton Park, Western Australia,
Australia. [email protected]
Altered motor control strategies in subjects with sacroiliac
joint pain during the active straight-leg-raise test. Spine. 2002 Jan 1;27(1):E1-8
STUDY DESIGN: An experimental study of respiratory function and kinematics of the
diaphragm and pelvic floor in subjects with a clinical diagnosis of sacroiliac joint pain and in
a comparable pain-free subject group was conducted.
OBJECTIVE: To gain insight into the motor control strategies of subjects with sacroiliac
joint pain and the resultant effect on breathing pattern.
SUMMARY OF BACKGROUND DATA: The active straight-leg-raise test has been
proposed as a clinical test for the assessment of load transfer through the pelvis. Clinical
observations show that patients with sacroiliac joint pain have suboptimal motor control
strategies and alterations in respiratory function when performing low-load tasks such as an
active straight leg raise.
METHODS: In this study, 13 participants with a clinical diagnosis of sacroiliac joint pain
and 13 matched control subjects in the supine resting position were tested with the active
straight leg raise and the active straight leg raise with manual compression through the ilia.
Respiratory patterns were recorded using spirometry, and minute ventilation was calculated.
Diaphragmatic excursion and pelvic floor descent were measured using ultrasonography.
www.stabiliteitstrainingscentrum.nl
RESULTS: The participants with sacroiliac joint pain exhibited increased minute ventilation,
decreased diaphragmatic excursion, and increased pelvic floor descent, as compared with
pain-free subjects. Considerable variation was observed in respiratory patterns. Enhancement
of pelvis stability via manual compression through the ilia reversed these differences.
CONCLUSIONS: The study findings formally identified altered motor control strategies and
alterations of respiratory function in subjects with sacroiliac joint pain. The changes observed
appear to represent a compensatory strategy of the neuromuscular system to enhance force
closure of the pelvis where stability has been compromised by injury.
Hodges PW, Heijnen I, Gandevia SC.
Department of Physiology, Prince of Wales Medical Research Institute and University of New
South Wales, Sydney, Australia. [email protected]
Postural activity of the diaphragm is reduced in humans
when respiratory demand increases. J Physiol. 2001 Dec 15;537(Pt 3):999-1008.
1. Respiratory activity of the diaphragm and other respiratory muscles is normally co-
ordinated with their other functions, such as for postural control of the trunk when the limbs
move. The integration may occur by summation of two inputs at the respiratory motoneurons.
The present study investigated whether postural activity of the diaphragm changed when
respiratory drive increased with hypercapnoea.
2. Electromyographic (EMG) recordings of the diaphragm and other trunk muscles were made
with intramuscular electrodes in 13 healthy volunteers. Under control conditions and while
breathing through increased dead-space, subjects made rapid repetitive arm movements to
disturb the stability of the spine for four periods each lasting 10 s, separated by 50 s.
3. End-tidal CO(2) and ventilation increased for the first 60-120 s of the trial then reached a
plateau. During rapid arm movement at the start of dead-space breathing, diaphragm EMG
became tonic with superimposed modulation at the frequencies of respiration and arm
movement. However, when the arm was moved after 60 s of hypercapnoea, the tonic
diaphragm EMG during expiration and the phasic activity with arm movement were reduced
or absent. Similar changes occurred for the expiratory muscle transversus abdominis, but not
for the erector spinae. The mean amplitude of intra-abdominal pressure and the phasic
changes with arm movement were reduced after 60 s of hypercapnoea.
4. The present data suggest that increased central respiratory drive may attenuate the postural
commands reaching motoneurons. This attenuation can affect the key inspiratory and
expiratory muscles and is likely to be co-ordinated at a pre-motoneuronal site.
Hodges PW, Gandevia SC.
Prince of Wales Medical Research Institute, University of New South Wales, Sydney, New
South Wales 2031, Australia. [email protected]
Changes in intra-abdominal pressure during postural and
respiratory activation of the human diaphragm J Appl Physiol. 2000 Sep;89(3):967-76.
www.stabiliteitstrainingscentrum.nl
In humans, when the stability of the trunk is challenged in a controlled manner by repetitive
movement of a limb, activity of the diaphragm becomes tonic but is also modulated at the
frequency of limb movement. In addition, the tonic activity is modulated by respiration. This
study investigated the mechanical output of these components of diaphragm activity.
Recordings were made of costal diaphragm, abdominal, and erector spinae muscle
electromyographic activity; intra-abdominal, intrathoracic, and transdiaphragmatic pressures;
and motion of the rib cage, abdomen, and arm. During limb movement the diaphragm and
transversus abdominis were tonically active with added phasic modulation at the frequencies
of both respiration and limb movement. Activity of the other trunk muscles was not
modulated by respiration. Intra-abdominal pressure was increased during the period of limb
movement in proportion to the reactive forces from the movement. These results show that
coactivation of the diaphragm and abdominal muscles causes a sustained increase in intra-
abdominal pressure, whereas inspiration and expiration are controlled by opposing activity of
the diaphragm and abdominal muscles to vary the shape of the pressurized abdominal cavity.
Hodges PW, Butler JE, McKenzie DK, Gandevia SC.
Prince of Wales Medical Research Institute, Sydney, Australia.
Contraction of the human diaphragm during rapid
postural adjustments. J Physiol. 1997 Dec 1;505 ( Pt 2):539-48.
1. The response of the diaphragm to the postural perturbation produced by rapid flexion of the
shoulder to a visual stimulus was evaluated in standing subjects. Gastric, oesophageal and
transdiaphragmatic pressures were measured together with intramuscular and oesophageal
recordings of electromyographic activity (EMG) in the diaphragm. To assess the mechanics of
contraction of the diaphragm, dynamic changes in the length of the diaphragm were measured
with ultrasonography.
2. With rapid flexion of the shoulder in response to a visual stimulus, EMG activity in the
costal and crural diaphragm occurred about 20 ms prior to the onset of deltoid EMG. This
anticipatory contraction occurred irrespective of the phase of respiration in which arm
movement began. The onset of diaphragm EMG coincided with that of transversus abdominis.
3. Gastric and transdiaphragmatic pressures increased in association with the rapid arm
flexion by 13.8 +/- 1.9 (mean +/- S.E.M.) and 13.5 +/- 1.8 cmH2O, respectively. The
increases occurred 49 +/- 4 ms after the onset of diaphragm EMG, but preceded the onset of
movement of the limb by 63 +/- 7 ms.
4. Ultrasonographic measurements revealed that the costal diaphragm shortened and then
lengthened progressively during the increase in transdiaphragmatic pressure.
5. This study provides definitive evidence that the human diaphragm is involved in the control
of postural stability during sudden voluntary movement of the limbs.
Shirley D, Hodges PW, Eriksson AE, Gandevia SC.
Spinal stiffness changes throughout the respiratory cycle. J Appl Physiol. 2003 Oct;95(4):1467-75.
Source
www.stabiliteitstrainingscentrum.nl
School of Physiotherapy, Faculty of Health Sciences, Univ. of Sydney, P.O. Box 170,
Lidcombe, Sydney NSW 1825, Australia. [email protected]
Abstract
Posteroanterior stiffness of the lumbar spine is influenced by factors, including trunk muscle
activity and intra-abdominal pressure (IAP). Because these factors vary with breathing, this
study investigated whether stiffness is modulated in a cyclical manner with respiration. A
further aim was to investigate the relationship between stiffness and IAP or abdominal and
paraspinal muscle activity. Stiffness was measured from force-displacement responses of a
posteroanterior force applied over the spinous process of L2 and L4. Recordings were made
of IAP and electromyographic activity from L4/L2 erector spinae, abdominal muscles, and
chest wall. Stiffness was measured with the lung volume held at the extremes of tidal volume
and at greater and lesser volumes. Stiffness at L4 and L2 increased above base-level values at
functional residual capacity (L2 14.9 N/mm and L4 15.3 N/mm) with both inspiratory and
expiratory efforts. The increase was related to the respiratory effort and was greatest during
maximum expiration (L2 24.9 N/mm and L4 23.9 N/mm). The results indicate that changes in
trunk muscle activity and IAP with respiratory efforts modulate spinal stiffness. In addition,
the diaphragm may augment spinal stiffness via attachment of its crural fibers to the lumbar
vertebrae.
www.stabiliteitstrainingscentrum.nl
Houding en emotie
Emoties binnen een fysiotherapeutische setting FysioPraxis, 3, 34-
37; Burken, P. van. (2002), dit artikel is voorzien van een bruikbare literatuurlijst die dieper
op deze stof ingaat.
Artikel in de map hoofdcursus
De deeelnemers vinden deze tekst op de site van Psychfysio.
http://www.psychfysio.nl/Publicaties/Burken2002a.asp
www.stabiliteitstrainingscentrum.nl
Claudine JC Lamoth*1, John F Stins1, Menno Pont2, Frederick Kerckhoff2 and Peter J Beek1
Address: 1Research Institute MOVE, Faculty of Human Movement Sciences, VU University
Amsterdam, van der Boechorststraat 9, 1081 BT, Amsterdam, the Netherlands and
2Rehabilitation Center Amsterdam, Department of Health and Behavior, Overtoom 283, 1054
HW, Amsterdam, the Netherlands
Email: Claudine JC Lamoth* - [email protected]; John F Stins - [email protected];
Menno Pont - [email protected];
Frederick Kerckhoff - [email protected]; Peter J Beek - [email protected]
* Corresponding author
Effects of attention on the control of locomotion in
individuals with chronic low back pain Journal of NeuroEngineering and Rehabilitation 2008, 5:13 doi:10.1186/1743-0003-5-13
Abstract
Background: People who suffer from low back pain (LBP) exhibit an abnormal gait pattern,
characterized by shorter stride length, greater step width, and an impaired thorax-pelvis
coordination which may undermine functional walking. As a result, gait in LBP may require
stronger cognitive regulation compared to pain free subjects thereby affecting the degree of
automaticity of gait control. Conversely, because chronic pain has a strong attentional
component, diverting attention away from the pain might facilitate a more efficient walking
pattern.
Methods: Twelve individuals with LBP and fourteen controls participated. Subjects walked
on a treadmill at comfortable speed, under varying conditions of attentional load: (a) no
secondary task, (b) naming the colors of squares on a screen, (c) naming the colors of color
words ("color Stroop task"), and (d) naming the colors of words depicting motor activities.
Markers were attached to the thorax, pelvis and feet. Motion was recorded using a three-
camera SIMI system with a sample frequency of 100 Hz. To examine the effects of health
status and attention on gait, mean and variability of stride parameters were calculated. The
coordination between thoracic and pelvic rotations was quantified through the mean and
variability of the relative phase between those oscillations.
Results: LBP sufferers had a lower walking speed, and consequently a smaller stride length
and lower mean thorax-pelvis relative phase. Stride length variability was significantly lower
in the LBP group but no significant effect of attention was observed. In both groups gait
adaptations were found under performance of an attention demanding task, but significantly
more so in individuals with LBP as indicated by an interaction effect on relative phase
variability.
Conclusion: Gait in LBP sufferers was characterized by less variable upper body movements.
The diminished flexibility in trunk coordination was aggravated under the influence of an
attention demanding task. This provides further evidence that individuals with LBP tighten
their gait control, and this suggests a stronger cognitive regulation of gait coordination in
LBP. These changes in gait coordination reduce the capability to deal with unexpected
perturbations, and are therefore maladaptive.
Artikel in map hoofdcursus
Exp Brain Res (2011) 212:603–611 DOI 10.1007/s00221-011-2767-z
www.stabiliteitstrainingscentrum.nl
Walk to me when I smile, step back when I’m angry:
emotional faces modulate whole-body approach–avoidance
behaviors John F. Stins • Karin Roelofs • Jody Villan • Karen Kooijman • Muriel A. Hagenaars •
Peter J. Beek
Keywords Emotional facial expression Postural control Emotion Reaction time Step initiation
Approach–avoidance
Abstract Facial expressions are potent social cues that can induce behavioral dispositions,
such as approach– avoidance tendencies. We studied these tendencies by asking participants
to make whole-body forward (approach) or backward (avoidance) steps on a force plate in
response to the valence of social cues (happy or angry faces) under affect-congruent and
incongruent mappings. Posturographic parameters of the steps related to automatic stimulus
evaluation, step initiation (reaction time), and step execution were determined and analyzed as
a function of stimulus valence and stimulus–response mapping. The main result was that
participants needed more time to initiate a forward step towards an angry face than towards a
smiling face (which is evidence of a congruency effect), but with backward steps, this
difference failed to reach significance. We also found a reduction in spontaneous body sway
prior to the step with the incongruent mapping. The results provide a crucial empirical link
between theories of socially induced action tendencies and theories of postural control and
suggest a motoric basis for socially guided motivated behavior.
Artikel in map hoofdcursus
John F Stins*, Annick Ledebt, Claudia Emck, Elisabeth H van Dokkum and
Peter J Beek
Address: Research Institute MOVE, Faculty of Human Movement Sciences, VU University
Amsterdam, van der Boechorststraat 9, 1081 BT,
Amsterdam, The Netherlands
Email: John F Stins* - [email protected]; Annick Ledebt - [email protected]; Claudia
Emck - [email protected]; Elisabeth H van
Dokkum - [email protected]; Peter J Beek - [email protected]
* Corresponding author
Patterns of postural sway in high anxious children Behavioral and Brain Functions 2009, 5:42 doi:10.1186/1744-9081-5-42
Abstract
Background: Current research suggests that elevated levels of anxiety have a negative impact
on the regulation of balance. However, most studies to date examined only global balance
performance, with little attention to the way body posture is organized in space and time. The
aim of this study is to examine whether posturographic measures can reveal (sub)clinical
balance deficits in children with high levels of anxiety.
Methods: We examined the spatio-temporal structure of the centre-of-pressure (COP)
fluctuations in children with elevated levels of anxiety and a group of typically developing
children while maintaining quiet stance on a force plate in various balance challenging
conditions. Balance was challenged by adopting sensory manipulations (standing with eyes
closed and/or standing on a foam surface) and using a cognitive manipulation (dual-tasking).
www.stabiliteitstrainingscentrum.nl
Results: Across groups, postural performance was strongly influenced by the sensory
manipulations, and hardly by the cognitive manipulation. We also found that children with
anxiety had overall more postural sway, and that their postural sway was overall less complex
than sway of typically developing children. The postural differences between groups were
present even in the simple baseline condition, and the group differences became larger with
increasing task difficulty.
Conclusion: The pattern of postural sway suggests that balance is overall less stable and more
attention demanding in children with anxiety than typically developing children. The findings
provide further evidence for a neuro-behavioral link between psychopathology and the
effectiveness of postural control.
Dit artikel is in map hoofdcursus
Stins JF, Roerdink M, Beek PJ.
To freeze or not to freeze? Affective and cognitive
perturbations have markedly different effects on postural
control. SourceResearch Institute MOVE, Faculty of Human Movement Sciences, VU University
Amsterdam, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands.
Abstract
Similar effects have been reported for diverting attention from postural control and increased
anxiety on the characteristics of center-of-pressure (COP) time series (decreased excursions
and elevated mean power frequency). These effects have also received similar interpretations
in terms of increased postural stiffness, suggesting that cognitive and affective manipulations
have similar influences on postural control. The present experiment tested this hypothesis by
comparing postural conditions involving manipulations of attention (diverting attention from
posture using cognitive and motor dual tasks) and anxiety (standing at a height), and by
complementing posturography with electromyographic analyses to directly examine
neuromuscular stiffness control. Affective and cognitive manipulations had markedly
different effects. Unlike the height condition, diverting attention from balance induced smaller
COP amplitudes and higher sway frequencies. In addition, more regular COP trajectories
(lower sample entropy) were found in the height condition than the dual-task conditions,
suggesting elevated attentional investment in posture under the affective manipulation.
Finally, based on an analysis of the cross-correlation function between anterior-posterior COP
time series and enveloped calf muscle activity, indications of tighter anticipatory
neuromuscular control of posture were found for the height condition only. Our data suggest
that affective and cognitive perturbations have qualitatively different effects on postural
control, and thus are likely to be associated with different control processes, as evidenced by
differences in neuromuscular regulation and attentional investment in posture.
Roelofs K, Hagenaars MA, Stins J.
www.stabiliteitstrainingscentrum.nl
Facing freeze: social threat induces bodily freeze in
humans. Source Department of Clinical, Health and Neuropsychology, Leiden University Institute for
Psychological Research, Leiden, The Netherlands. [email protected]
Abstract
Freezing is a common defensive response in animals threatened by predators. It is
characterized by reduced body motion and decreased heart rate (bradycardia). However,
despite the relevance of animal defense models in human stress research, studies have not
shown whether social threat cues elicit similar freeze-like responses in humans. We
investigated body sway and heart rate in 50 female participants while they were standing on a
stabilometric force platform and viewing cues that were socially threatening, socially neutral,
and socially affiliative (angry, neutral, and happy faces, respectively). Posturographic
analyses showed that angry faces (compared with neutral faces and happy faces) induced
significant reductions in body sway. In addition, the reduced body sway for angry faces was
accompanied by bradycardia and correlated significantly with subjective anxiety. Together,
these findings indicate that spontaneous body responses to social threat cues involve freeze-
like behavior in humans that mimics animal freeze responses. These findings open avenues
for studying human freeze responses in relation to various sociobiological markers and social-
affective disorders.
www.stabiliteitstrainingscentrum.nl
Motor control algemeen
Manohar M. Panjabi
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New
Haven, Connecticw U.S.A.
The Stabilizing System of the Spine. Part I. Function,
Dysfunction, Adaptation, and Enhancement JOURNAL OF SPINAL DISORDERS & TECHNIQUES Vol.5 No.4 August 1992
Summary: Presented here is the conceptual basis for the assertion that the spinal stabilizing
system consists ofthree subsystems. The vertebrae, discs, and ligaments constitute the passive
subsystem. All muscles and tendons surrounding the spinal column that can apply forces to
the spinal column constitute the active subsystem. The nerves and central nervous system
comprise the neural subsystem, which determines the requirements for spinal stability by
monitoring the various transducer signals, and directs the active subsystem to provide the
needed stability. A dysfunction of a component of any one of the subsystems may lead to one
or more of the following three possibilities: (a) an immediate response from other subsystems
to successfully compensate, (b) a long-term adaptation response of one or more subsystems,
and (c) an injury to one or more components of any subsystem. It is conceptualized that the
first response results in normal function, the second results in normal function but with an
altered spinal stabilizing system, and the third leads to overall system dysfunction, producing,
for example, low back pain. In situations where additional loads or complex postures are
anticipated, the neural control unit may alter the muscle recruitment strategy, with the
temporary goal of enhancing the spine stability beyond the normal requirements. Key Words:
Spine stabilizing system-Spinal instability-Lumbar spine-Muscle function-Low back pain.
In map hoofdcursus
Manohar M. Panjabi
Departmmt of Orthopaedics and Rehabilitation, Yale University School of Medicine, New
Haven, Connecticut, U.S.A
The Stabilizing System of the Spine. Part II. Neutral Zone
and Instability Hypothesis JOURNAL OF SPINAL DISORDERS & TECHNIQUES Vol.5 No.4 August 1992
Summary: The neutral zone is a region of intervertebral motion around the neutral posture
where little resistance is offered by the passive spinal column. Several studies-in vitro
cadaveric, in vivo animal, and mathematical simulations-have shown that the neutral zone is a
parameter that correlates well with other parameters indicative of instability ofthe spinal
system. It has been found to increase with injury, and possibly with degeneration, to decrease
with muscle force increase across the spanned level, and also to decrease with instrumented
spinal fixation. In most of these studies, the change in the neutral zone was found to be more
sensitive than the change in the corresponding range of motion. The neutral zone appears to
be a clinically important measure of spinal stability function. It may increase with injury to
the spinal column or with weakness of the muscles, which in turn may result in spinal
instability or a low-back problem. It may decrease, and may be brought within the
www.stabiliteitstrainingscentrum.nl
physiological limits, by osteophyte formation, surgical fixation/fusion, and muscle
strengthening. The spinal stabilizing system adjusts so that the neutral zone remains within
certain physiological thresholds to avoid clinical instability. Key Words: Spine stabilizing
system-Spinal instability- Neutral zone-Muscle function-Low-back pain.
In map hoofdcursus
J. Hoffman, P. Gabel
Expanding Panjabi’s stability model to express movement: A
theoretical model Abstract
Novel theoretical models of movement have historically inspired the creation of new methods
for the application of human movement. The landmark theoretical model of spinal stability by
Panjabi in 1992 led to the creation of an exercise approach to spinal stability. This approach
however was later challenged, most significantly due to a lack of favourable clinical effect.
The concepts explored in this paper address and consider the deficiencies of Panjabi’s model
then propose an evolution and expansion from a special model of stability to a general one of
movement. It is proposed that two body-wide symbiotic elements are present within all
movement systems, stability and mobility. The justification for this is derived from the
observable clinical environment. It is clinically recognised that these two elements are present
and identifiable throughout the body in different joints and muscles, and the neural
conduction system. In order to generalise the Panjabi model of stability to include and
illustrate movement, a matching parallel mobility system with the same subsystems was
conceptually created. In this expanded theoretical model, the new mobility system is placed
beside the existing stability system and subsystems.
The ability of both stability and mobility systems to work in harmony will subsequently
determine the quality of movement. Conversely, malfunction of either system, or their
subsystems, will deleteriously affect all other subsystems and consequently overall movement
quality. For this reason, in the rehabilitation exercise environment, focus should be placed on
the simultaneous involvement of both the stability and mobility systems. It is suggested that
the individual’s relevant functional harmonious movements should be challenged at the
highest possible level without pain or discomfort. It is anticipated that this conceptual
expansion of the theoretical model of stability to one with the symbiotic inclusion of mobility,
will provide new understandings on human movement. The use of this model may provide a
Universal system for body movement analysis and understanding musculoskeletal disorders.
In turn, this may lead to a simple categorisation system alluding to the functional face-value
of a wide range of commonly used passive, active or combined musculoskeletal interventions.
Further research is required to investigate the mechanisms that enable or interfere with
harmonious body movements. Such work may then potentially lead to new and evolved
evidence based interventions.
Zit in map Hoofdcursus
Tsao H, Danneels L, Hodges PW.
Source; Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of
Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
Individual fascicles of the paraspinal muscles are activated
by discrete cortical networks in humans.
www.stabiliteitstrainingscentrum.nl
Clin Neurophysiol. 2011 Aug;122(8):1580-7. doi: 10.1016/j.clinph.2011.01.048. Epub 2011
Mar 5.
Abstract
OBJECTIVE: To investigate whether functional specificity in different fascicles of the
paraspinal muscles is associated with discrete organisation within the motor cortex.
METHODS: In 11 healthy volunteers, electromyographic (EMG) activity was recorded
bilaterally using fine-wire intramuscular electrodes from the short and deep fibres of
multifidus (DM) at L4, and the longer and more superficial fibres of longissimus erector
spinae (LES) at L4 and L1. Surface electrodes were also placed over the right LES at L4 and
L1. Organisation at the motor cortex associated with motor excitation was investigated using
transcranial magnetic stimulation (TMS).
RESULTS: The results showed that motor cortical representation for DM was located
posteriorly to that for LES. TMS maps from surface recordings of LES showed two optimal
sites, which were located in proximity to the sites for DM and LES from intramuscular
recordings.
CONCLUSION: Different fascicles of the paraspinal muscles are organised and thus could
be controlled by discrete neuronal networks within the motor cortex. Further, TMS mapping
from surface recordings of paraspinal muscles may be confounded by cross-talk from multiple
underlying fascicles.
SIGNIFICANCE: Discrete organisation at the motor cortex appears consistent with
differential activation of different fascicles of the paraspinal muscles with function.
Benedict Martin Wand a, Luke Parkitny b, Neil Edward O’Connell c, Hannu Luomajoki d,
James Henry McAuley b, Michael Thacker e, G. Lorimer Moseley b,*
a School of Health Sciences, The University of Notre Dame Australia, Fremantle, WA,
Australia
b Neuroscience Research Australia & The University of New South Wales, Barker Street,
Randwick, Sydney, NSW 2031, Australia
c Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Brunel
University, Uxbridge, UK
d Zürich University of Applied Sciences, Institute of Physiotherapy, Department of Health,
Winterthur, Switzerland
e CHAPS & Centre for Neuroimaging Sciences, IoP King’s College London, London, UK
3rd International conference on movement dysfunction 2009
Cortical changes in chronic low back pain: Current state
of the art and implications for clinical practice Manual Therapy 16 (2011) 15e20
Keywords: Low back pain Cortical reorganisation Physical therapy
Abstract
There is increasing evidence that chronic pain problems are characterised by alterations in
brain structure and function. Chronic back pain is no exception. There is a growing sentiment,
with accompanying theory, that these brain changes contribute to chronic back pain, although
empirical support is lacking. This paper reviews the structural and functional changes of the
brain that have been observed in people with chronic back pain. We cast light on the clinical
implications of these changes and the possibilities for new treatments but we also advise
caution against concluding their efficacy in the absence of solid evidence to this effect.
Zit in map hoofdcursus
www.stabiliteitstrainingscentrum.nl
Paul W. Hodges ⇑
Pain and motor control: From the laboratory to
rehabilitation Journal of Electromyography and Kinesiology 21 (2011) 220–228
Review The University of Queensland, Centre for Clinical Research Excellence in Spinal
Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Qld 4072,
Australia
Keywords: Motor control Pain Musculoskeletal pain Rehabilitation
Abstract
Movement is changed in pain and is the target of clinical interventions. Yet the understanding
of thephysiological basis for movement adaptation in pain remains limited. Contemporary
theories are relatively simplistic and fall short of providing an explanation for the variety of
permutations of changes in movement control identified in clinical and experimental contexts.
The link between current theories and rehabilitation is weak at best. New theories are required
that both account for the breadth of changes in motor control in pain and provide direction for
development and refinement of clinical interventions. This paper describes an expanded
theory of the motor adaptation to pain to address these two issues. The new theory, based on
clinical and experimental data argues that: activity is redistributed within and between
muscles rather than stereotypical inhibition or excitation of muscles; modifies the mechanical
behaviour in a variable manner with the objective to ‘‘protect’’ the tissues from further pain
or injury, or threatened pain or injury; involves changes at multiple levels of the motor system
that may be complementary, additive or competitive; and has short-term benefit, but with
potential long-term consequences due to factors such as increased load, decreased movement,
and decreased variability. This expanded theory provides guidance for rehabilitation directed
at alleviating a mechanical contribution to the recurrence and persistence of pain that must be
balanced with other aspects of a multifaceted intervention that includes management of
psychosocial aspects of the pain experience.
Zit in map hoofdcursus
H. Tsao,1 M. P.Galea2 and P.W. Hodges1
Reorganization of the motor cortex is associated with
postural control deficits in recurrent low back pain Brain (2008), 131, 2161-2171
Keywords: motor cortex; postural control; transcranial magnetic stimulation; abdominal
muscles
ABSTRACT Many people with recurrent low back pain (LBP) have deficits in postural control of the trunk
muscles and this may contribute to the recurrence of pain episodes. However, the neural
changes that underlie these motor deficits remain unclear. As the motor cortex contributes to
control of postural adjustments, the current study investigated the excitability and
organization of the motor cortical inputs to the trunk muscles in 11 individuals with and
without recurrent LBP. EMG activity of the deep abdominal muscle, transversus abdominis
(TrA), was recorded bilaterally using intramuscular fine-wire electrodes. Postural control was
www.stabiliteitstrainingscentrum.nl
assessed as onset of TrA EMG during single rapid arm flexion and extension tasks. Motor
thresholds (MTs) for transcranial magnetic stimulation (TMS) were determined for responses
contralateral and ipsilateral to the stimulated cortex. In addition, responses of TrAtoTMS over
the contralateral cortex were mapped during voluntary contractions at 10% ofmaximum.MTs
andmap parameters [centre of gravity (CoG) and volume] were compared between healthy
and LBP groups.The CoG of themotor corticalmap of TrA in the healthy group was »2
cmanterior and lateral to the vertex, but wasmore posterior and lateral in the LBP group.The
location of the CoG and themap volume were correlated with onset of TrA EMG during rapid
armmovements. Furthermore, the MT needed to evoke ipsilateral responses was lower in the
LBP group, but only on the less excitable hemisphere.These findings provide preliminary
evidence of reorganization of trunk muscle representation at the motor cortex in individuals
with recurrent LBP, and suggest this reorganization is associated with deficits in postural
control.
Zit in map hoofdcursus
G.A. Jull a,*, D. Falla b, B. Vicenzino a, P.W. Hodges a
a Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, Division of
Physiotherapy, School of Health and Rehabilitation Sciences,
The University of Queensland, Brisbane, QLD 4072, Australia
b Centre for Sensory-Motor Interaction (SMI), Department of Health Science and
Technology, Aalborg University, Denmark
The effect of therapeutic exercise on activation of the deep
cervical flexor muscles in people with chronic neck pain Manual Therapy 14 (2009) 696–701
Keywords: Neck pain; Electromyography; Motor training; Feedforward control
ABSTRACT
Deep cervical flexor muscle (DCF) activation is impaired with neck pain. This study
investigated the effects of low load cranio-cervical flexion (C-CF) and neck flexor
strengthening exercises on spatial and temporal characteristics of DCF activation during a
neck movement task and a task challenging the neck’s postural stability. Forty-six chronic
neck pain subjects were randomly assigned to an exercise group and undertook a 6-week
training program. Electromyographic (EMG) activity was recorded from the DCF,
sternocleidomastoid (SCM) and anterior scalene (AS) muscles pre and post intervention
during the cranio-cervical flexion test (CCFT) and during perturbations induced by rapid,
unilateral shoulder flexion and extension. C-CF training increased DCF EMG amplitude and
decreased SCM and AS EMG amplitude across all stages of the CCFT (all P< 0.05). No
change occurred in DCF EMG amplitude following strength training. There was no
significant between group difference in pre-post intervention change in relative latency of
DCF but a greater proportion of the C-CF group shortened the relative latency between the
activation of the deltoid and the DCF during rapid arm movement compared to the strength
group (P< 0.05). Specific low load C-CF exercise changes spatial and temporal characteristics
of DCF activation which may partially explain its efficacy in rehabilitation.
Zit in map hoofdcursus
Britt Stugea,_, Inger Holma,b, Nina Vøllestada
www.stabiliteitstrainingscentrum.nl
aSection for Health Science, University of Oslo, P.O. Box 1153, Blindern, N-0316 Oslo,
Norway
bPhysical Department, Rikshospitalet University Hospital, Oslo, Norway
Professional Issue
To treat or not to treat postpartum pelvic girdle pain with
stabilizing exercises? Manual Therapy Received 3 June 2004; received in revised form 2 June 2005; accepted 26
July 2005
Keywords: Postpartum pelvic girdle pain; Stabilizing exercises; Evidence-based practice
Abstract
Women with pelvic girdle pain (PGP) often consult physical therapists for help and are
treated with different therapies without firm evidence for the effectiveness. Two randomized
controlled trials have investigated the effect of stabilizing exercises for PGP. The most recent
study demonstrated significant positive results in favour of exercises (Stuge et al. The efficacy
of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after
pregnancy.
A randomized controlled trial. Spine 2004a;29(10):351–9), the other did not (Mens et al.
Diagonal trunk muscle exercises in peripartum pelvic pain: a randomized clinical trial. Phys.
Ther. 2000;80(12):1164–73). Consequently, the two studies provide contradictory advice for
treatment of PGP.
The question is thus, whether stabilizing exercises should be recommended as treatment for
PGP. Both the studies are of high methodological quality and are comparable with regard to
subjects studied. However, there are several differences in the interventions and these are
explored and discussed for better understanding of the conflicting results. Exercises that
focused on only global muscles showed no effect. However, these exercises were not
individualized and they were instructed by videotape. In the more recent study, exercises that
initially focused on local muscles, and then gradually added global muscles showed a
significant, positive effect. Exercises in that study were supervised, corrected, individualized
concerning choice of exercises, order and dosage, and pain was avoided. This comparison
indicates that effective treatment of postpartum PGP may be achieved when exercises for the
entire spinal musculature are included, individually guided and adapted to each individual.
Zit in map hoofdcursus
Stuge B, Lærum E, Kirkesola G, Vøllestad N. The Efficacy of a Treatment Program Focusing
on Specific Stabilizing
Exercises for Pelvic Girdle Pain After Pregnancy. A
Randomized Controlled Trial. SPINE 2004;29(4);351-9
Stuge B, Veierød M B, Lærum E, Vøllestad N.
The Efficacy of a Treatment Program Focusing on Specific
Stabilizing Exercises for Pelvic Girdle Pain After
www.stabiliteitstrainingscentrum.nl
Pregnancy. A Two-Year Follow-up of a Randomized
Clinical Trial. SPINE 2004;29(10):E197-203
Eyal Lederman*
CPDO Ltd., 15 Harberton Road, London N19 3JS, UK
CRITICAL REVIEW The myth of core stability Received 26 October 2008; received in revised form 3 May 2009; accepted 4 August 2009
KEYWORDS Core stability; Spinal stabilisation; Transversus abdominis; Chronic lower back
and neuromuscular rehabilitation
Summary The principle of core stability has gained wide acceptance in training for the
prevention of injury and as a treatment modality for rehabilitation of various musculoskeletal
conditions in particular of the lower back. There has been surprisingly little criticism of this
approach up to date. This article re-examines the original findings and the principles of core
stability/spinal stabilisation approaches and how well they fare within the wider knowledge of
motor control, prevention of injury and rehabilitation of neuromuscular and musculoskeletal
systems following injury.
Zit in map hoofdcursus
Stuart M. McGill a, Sylvain Grenier a, Natasa Kavcic a, Jacek Cholewicki b
a Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1,
Canada
b Yale University School of Medicine, New Haven, CT, USA
Coordination of muscle activity to assure stability of the
lumbar spine Journal of Electromyography and Kinesiology 13 (2003) 353–359
Keywords: Stability; Lumbar; Muscle; Motor control
Abstract
The intention of this paper is to introduce some of the issues surrounding the role of muscles
to ensure spine stability for discussion—it is not intended to provide an exhaustive review and
integration of the relevant literature. The collection of works synthesized here point to the
notion that stability results from highly coordinated muscle activation patterns involving
many muscles, and that the recruitment patterns must continually change, depending on the
task. This has implications on both the prevention of instability and clinical interventions with
patients susceptible to sustaining unstable events.
Artikele in hoofdcursusmap
Barr KP, Griggs M, Cadby T:
Lumbar Stabilization Core Concepts and Current
Literature, Part 1 Am J Phys Med Rehabil 2005;84:473–480.
www.stabiliteitstrainingscentrum.nl
Key Words: Low Back Pain, Spine, Exercise, Rehabilitation
ABSTRACT
The factors that affect lumbar stability have been an area of extensive research. The clinical
application of this research in the form of lumbar stabilization exercise programs has become
a common treatment of low back pain and is also increasingly used by athletes to improve
performance and by the general public for health and the prevention of injury. This article
includes a review of the key concepts behind lumbar stabilization. The literature regarding
how those with low back pain differ in their ability to stabilize the spine from those without
low back pain is discussed, and an overview of current research that assesses the benefits of a
lumbar stabilization program to treat low back pain is provided.
Zit in map hoofdcursus
www.stabiliteitstrainingscentrum.nl
Peter B. O’Sullivan, PhD,* Wim Dankaerts, PhD,*† Angus F. Burnett, PhD,*
Garreth T. Farrell, M Manip Ther,* Evonne Jefford, M Manip Ther,*
Clare S. Naylor, M Manip Ther,* and Kieran J. O’Sullivan, M Manip Ther*
Effect of Different Upright Sitting Postures on Spinal-
Pelvic Curvature and Trunk Muscle Activation in a Pain-
Free Population SPINE Volume 31, Number 19, pp E707–E712
Conclusions. Different upright sitting postures resulted in altered trunk muscle activation.
Thoracic when compared to lumbo-pelvic upright sitting involved less coactivation of the
local spinal muscles, with greater coactivation of the global muscles. These results highlight
the importance of postural training specificity when the aim is to activate the lumbo-pelvic
stabilizing muscles in subjects with back pain.
Betekenis voor de cursus: houding in zit en het aansturen van de lage rugspiertraining. Ook is
deze studie van belang voor het duidelijk maken van de lagerugbeweging bij bepaalde
brugoefeningen met de Swissbal (psoaskiep).
Zit in map hoofdcursus
Michael P. Reiman, P. Cody Weisbach, and Paul E. Glynn
The Hip’s Influence on Low Back Pain: A Distal Link to a
Proximal Problem Journal of Sport Rehabilitation, 2009, 18, 24-32
Keywords: strength, rehabilitation
Abstract: Low back pain (LBP) is a multifactorial dysfunction, with one of the potential
contributing factors being the hip joint. Currently, research investigating the examination and
conservative treatment of LBP has focused primarily on the lumbar spine. The objective of
this clinical commentary is to discuss the potential link between hip impairments and LBP
using current best evidence and the concept of regional interdependence as tools to guide
decision making and offer ideas for future research.
Conclusion
Best current evidence supports the link between impairments at the hip and LBP. Research
suggests that decreased hip ROM, hip-extensor strength, and hip-adductor or -flexor
endurance might contribute to pain in the lumbar area. Because of this emerging relationship,
we suggest that hip-joint ROM, muscle performance, anatomical alignment, and mobility be
considered during examination of patients with LBP. Identifying hip impairments would lead
to an impairment-based approach to treatment because current evidence has not identified the
subgroup of LBP patients who would specifically benefit from treatment aimed at the hip.
Because of the lack of high-quality research to help guide decision making, clinicians are left
to intervene with impairment-level treatments. Interventions should focus on restoring hip
ROM through both thrust and nonthrust mobilizations aimed at the areas of restriction.
Treatments might also include both strength and endurance training of the identified impaired
www.stabiliteitstrainingscentrum.nl
hip musculature. Future research should further test the theoretical basis of treating the hip for
LBP. Case studies or case series investigating the effects of hip mobilization or specific hip
strengthening in LBP and HSS populations would be helpful in describing how clinicians use
these techniques to treat this population. CPRs to identify subgroups of LBP and HSS patients
who will benefit from specific interventions aimed at the hip could help clinicians decide
when it is most appropriate to use these techniques. Most important to substantiate this
relationship would be randomized controlled trials to determine whether treating the hip adds
benefit to treatment of lumbar-spine impairments, which would also be necessary to validate
the CPR. Until such research is has been done to better direct treatment, it is recommended
that clinicians consider taking a regional approach to the examination and treatment of LBP.
Attention should be paid to the hip joint and its surrounding soft tissue, and interventions
should be applied based on the impairments identified.
Zit in map hoofdcursus
Claudine JC Lamoth*1, John F Stins1, Menno Pont2, Frederick Kerckhoff2 and Peter J Beek1
Address: 1Research Institute MOVE, Faculty of Human Movement Sciences, VU University
Amsterdam, van der Boechorststraat 9, 1081 BT,
Amsterdam, the Netherlands and 2Rehabilitation Center Amsterdam, Department of Health
and Behavior, Overtoom 283, 1054 HW, Amsterdam, the Netherlands
Email: Claudine JC Lamoth* - [email protected]; John F Stins - [email protected];
Menno Pont - [email protected];
Frederick Kerckhoff - [email protected]; Peter J Beek - [email protected]
* Corresponding author
Research Effects of attention on the control of locomotion
in individuals with chronic low back pain Journal of NeuroEngineering and Rehabilitation
Abstract
Background: People who suffer from low back pain (LBP) exhibit an abnormal gait pattern,
characterized by shorter stride length, greater step width, and an impaired thorax-pelvis
coordination which may undermine functional walking. As a result, gait in LBP may require
stronger cognitive regulation compared to pain free subjects thereby affecting the degree of
automaticity of gait control. Conversely, because chronic pain has a strong attentional
component, diverting attention away from the pain might facilitate a more efficient walking
pattern.
Methods: Twelve individuals with LBP and fourteen controls participated. Subjects walked
on a treadmill at comfortable speed, under varying conditions of attentional load: (a) no
secondary task, (b) naming the colors of squares on a screen, (c) naming the colors of color
words ("color Stroop task"), and (d) naming the colors of words depicting motor activities.
Markers were attached to the thorax, pelvis and feet. Motion was recorded using a three-
camera SIMI system with a sample frequency of 100 Hz. To examine the effects of health
status and attention on gait, mean and variability of stride parameters were calculated. The
coordination between thoracic and pelvic rotations was quantified through the mean and
variability of the relative phase between those oscillations.
Results: LBP sufferers had a lower walking speed, and consequently a smaller stride length
and lower mean thorax-pelvis relative phase. Stride length variability was significantly lower
in the LBP group but no significant effect of attention was observed. In both groups gait
adaptations were found under performance of an attention demanding task, but significantly
www.stabiliteitstrainingscentrum.nl
more so in individuals with LBP as indicated by an interaction effect on relative phase
variability.
Conclusion: Gait in LBP sufferers was characterized by less variable upper body movements.
The diminished flexibility in trunk coordination was aggravated under the influence of an
attention demanding task. This provides further evidence that individuals with LBP tighten
their gait control, and this suggests a stronger cognitive regulation of gait coordination in
LBP. These changes in gait coordination reduce the capability to deal with unexpected
perturbations, and are therefore maladaptive.
www.stabiliteitstrainingscentrum.nl
Angus F. Burnetta,_, Mary W. Corneliusa, Wim Dankaertsb,c, Peter B. O’Sullivanb
aSchool of Biomedical and Sports Science, Edith Cowan University, 100 Joondalup Drive,
Joondalup, 6027 Western Australia, Australia
bSchool of Physiotherapy, Curtin University of Technology, Western Australia, Australia
cDepartment of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent,
Belgium
Spinal kinematics and trunk muscle activity in cyclists: a
comparison between healthy controls and non-specific
chronic low back pain subjects—a pilot investigation Manual Therapy 9 (2004) 211–219
Abstract
The aim of this pilot study was to examine whether differences existed in spinal kinematics
and trunk muscle activity in cyclists with and without non-specific chronic low back pain
(NSCLBP). Cyclists are known tobe vulnerable tolo w back pain (LBP) however, the
aetiology of this problem has not been adequately researched. Causative factors are thought to
be prolonged forward flexion, flexion–relaxation or overactivation of the erector spinae,
mechanical creep and generation of high mechanical loads while being in a flexed and rotated
position. Nine asymptomatic cyclists and nine cyclists with NSCLBP with a flexion pattern
disorder primarily related tocy cling were tested. Spinal kinematics were measured by an
electromagnetic tracking system and EMG was recorded bilaterally from selected trunk
muscles. Data were collected every five minutes until back pain occurred or general
discomfort prevented further cycling. Cyclists in the pain group showed a trend towards
increased lower lumbar flexion and rotation with an associated loss of co-contraction of the
lower lumbar multifidus. This muscle is known to be a key stabiliser of the lumbar spine. The
findings suggest altered motor control and kinematics of the lower lumbar spine are
associated with the development of LBP in cyclists.
Conclusions The findings of this pilot study lend further credibility to the idea that clinical
presentation of individuals suffering NSCLBP should be considered. During clinical
evaluation, all subjects in this study reported that their LBP was precipitated by flexion
related activities, in particular, during cycling. Cyclists in the pain group showed a trend
towards increased lower lumbar rotation and flexion with associated loss of cocontraction of
the muscles whose primary role is to control these movements (LM). Although these results
should be viewed with caution due to the small sample size in this study, they do lend support
to the presence of an underlying motor control disorder that predisposes the cyclists to
flexion/rotation strain of the low lumbar spine. Further research intothis group with a larger
sample size is required and rehabilitation strategies to manage LBP in cyclists needs tobe
formerly assessed.
Zit in map hoofdcursus
www.stabiliteitstrainingscentrum.nl
Buikdruk
Pijn en stijfheid in de bekkengordel hebben een relatie met buikdruk. Bij het uitvoeren van
oefenstof zal de therapeut rekening houden met het mogelijk bestaan of ontstaan van
inadequate buikdruk, alsmede de wijze van ademen.
Ian A.F. Stokes a,, Mack G. Gardner-Morse a, Sharon M. Henry b
a Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT
05405, USA
b Department of Rehabilitation and Movement Science, University of Vermont, Burlington,
VT 05405, USA
Abdominal muscle activation increases lumbar spinal
stability: Analysis of contributions of different muscle
groups Clinical Biomechanics xxx (2011) xxx–xxx
Keywords: Abdominal muscles; Biomechanics; Stability; Rehabilitation
Abstract
Background: Antagonistic activation of abdominal muscles and increased intra-abdominal
pressure are associated with both spinal unloading and spinal stabilization. Rehabilitation
regimens have been proposed to improve spinal stability via selective recruitment of certain
trunk muscle groups. This biomechanical analytical study addressed whether lumbar spinal
stability is increased by such selective activation.
Methods: The biomechanical model included anatomically realistic three-layers of curved
abdominal musculature, rectus abdominis and 77 symmetrical pairs of dorsal muscles. The
muscle activations were calculated with the model loaded with either flexion, extension,
lateral bending or axial rotation moments up to 60 Nm, along with intra-abdominal pressure
up to 5 or 10 kPa (37.5 or 75 mm Hg) and partial bodyweight. After solving for muscle
forces, a buckling analysis quantified spinal stability. Subsequently, different patterns of
muscle activation were studied by forcing activation of selected abdominal muscles to at least
10% or 20% of maximum.
Findings: Spinal stability increased by an average factor of 1.8 with doubling of intra-
abdominal pressure. Forcing at least 10% activation of obliques or transversus abdominis
muscles increased stability slightly for efforts other than flexion, but forcing at least 20%
activation generally did not produce further increase in stability. Forced activation of rectus
abdominis did not increase stability.
Interpretation: Based on analytical predictions, the degree of stability was not substantially
influenced by selective forcing of muscle activation. This casts doubt on the supposed
mechanism of action of specific abdominal muscle exercise regimens that have been proposed
for low back pain rehabilitation
Artikel in map hoofdcursus
Ian A.F. Stokes a,⁎, Mack G. Gardner-Morse a, Sharon M. Henry b
a Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT
05405, USA
www.stabiliteitstrainingscentrum.nl
b Department of Rehabilitation and Movement Science University of Vermont, Burlington,
VT 05405, USA
Intra-abdominal pressure and abdominal wall muscular
function: Spinal unloading mechanism Clinical Biomechanics 25 (2010) 859–866
Keywords: Abdominal muscles; Spinal loading; Biomechanics
Background: The roles of antagonistic activation of abdominal muscles and of intra-
abdominal pressurization remain enigmatic, but are thought to be associated with both spinal
unloading and spinal stabilization in activities such as lifting. Biomechanical analyses are
needed to understand the function of intra-abdominal pressurization because of the anatomical
and physiological complexity, but prior analyses have been oversimplified.
Methods: To test whether increased intra-abdominal pressure was associated with reduced
spinal compression forces for efforts that generated moments about each of the principal axis
directions, a previously published biomechanical model of the spine and its musculature was
modified by the addition of anatomically realistic three-layers of curved abdominal
musculature connected by fascia to the spine. Published values of muscle cross-sectional areas
and the active and passive stiffness properties were assigned. The muscle activations were
calculated assuming minimized muscle stress and stretch for the model loaded with flexion,
extension, lateral bending and axial rotation moments of up to 60 Nm, along with intra-
abdominal pressurization of 5 or 10 kPa (37.5 or 75 mm Hg) and partial bodyweight (340 N).
Findings: The analysis predicted a reduction in spinal compressive force with increase in
intra-abdominal pressurization from 5 to 10 kPa. This reduction at 60 Nm external effort was
21% for extension effort, 18% for flexion effort, 29% for lateral bending and 31% for axial
rotation.
Interpretation: This analysis predicts that intra-abdominal pressure produces spinal
unloading, and shows likely muscle activation patterns that achieve this.
Zit in map hoofdcursus
Jan Mens_, Gilbert Hoek van Dijke, Annelies Pool-Goudzwaard, Victor van der Hulst, Henk
Stam
Department of Rehabilitation Medicine, Erasmus Medical Centre, Dr. Molewaterplein 40,
3015 Rotterdam, GD, The Netherlands
Possible harmful effects of high intra-abdominal pressure
on the pelvic girdle Journal of Biomechanics 39 (2006) 627–635
Keywords: Low back pain; Intra-abdominal pressure; Biomechanics; Pelvic bones
Abstract
The present study explores the hypothesis that a high intra-abdominal pressure (IAP) loads the
ligaments of the pelvic girdle to such an extent that frequent periods of high IAP might cause
pain and/or interfere with recovery of patients with pelvic girdle pain (PGP). In a theoretical
model the size of the load of IAP on the pelvic girdle was computed. The diameters of
abdomen and pelvis needed for the calculations were measured on MRI scans; the IAP values
during activities were gained from literature. In slim, healthy subjects the calculated load on
the pelvic ring during activities of daily living was 26.0–52.0N with peaks to 135 N. During
www.stabiliteitstrainingscentrum.nl
straining, vigorous work or heavy exercises the load could increase to values ranging from
104 to 520 N. The load is higher in subjects with pain or fatigue, or in case of a distended
abdomen. When the load on the pelvic ring induced by IAP is larger than 100 N, the force
exceeds the force at which a pelvic belt relieves complaints in PGP; at 90 N, the force is
larger than the force at which isometric hip adduction provokes pain in PGP. We conclude
that the size of the load induced by IAP on the pelvic girdle seems to be sufficient to cause
pain in patients with PGP and might interfere with recovery. It seems worthwhile to give
patients with PGP instructions to reduce IAP as much as possible during activities.
Zit in map hoofdcursus
Paul W Hodges a,b,c,_, A.E. Martin Erikssond, Debra Shirleye, Simon C Gandeviab,c
aDepartment of Physiotherapy, The University of Queensland, Brisbane, Qld. 4072, Australia
bPrince of Wales Medical Research Institute, Sydney, Australia
cUniversity of New South Wales, Sydney, Australia
dDepartment of Community Medicine and Rehabilitation, Physiotherapy, University of
Umea°, Umea°, Sweden
eDepartment of Physiotherapy, University of Sydney, Sydney, Australia
Intra-abdominal pressure increases stiffness of the lumbar
spine Journal of Biomechanics 38 (2005) 1873–1880
Keywords: Intra-abdominal pressure; Spinal stiffness; Diaphragm; Trunk control
Abstract
Intra-abdominal pressure (IAP) increases during many tasks and has been argued to increase
stability and stiffness of the spine. Although several studies have shown a relationship
between the IAPincrease and spinal stability, it has been impossible to determine whether this
augmentation of mechanical support for the spine is due to the increase in IAPor the
abdominal muscle activity which contributes to it. The present study determined whether
spinal stiffness increased when IAPincreased without concurrent activity of the abdominal
and back extensor muscles. A sustained increase in IAPwas evoked by tetanic stimulation of
the phrenic nerves either unilaterally or bilaterally at 20 Hz (for 5 s) via percutaneous
electrodes in three subjects. Spinal stiffness was measured as the force required to displace an
indentor over the L4 or L2 spinous process with the subjects lying prone. Stiffness was
measured as the slope of the regression line fitted to the linear region of the force–
displacement curve. Tetanic stimulation of the diaphragm increased IAPby 27–61% of a
maximal voluntary pressure increase and increased the stiffness of the spine by 8–31% of
resting levels. The increase in spinal stiffness was positively correlated with the size of the
IAPincrease. IAPincreased stiffness at L2 and L4 level. The results of this study provide
evidence that the stiffness of the lumbar spine is increased when IAPis elevated.
Zit in map hoofdcursusus
www.stabiliteitstrainingscentrum.nl
Lichaamsbewust en aandacht
Aandacht en lichaamsbewustwording worden als belangrijke voorwaarde gezien voor het
optimaal uitvoeren van oefentherapie. Bij de aangeboden oefentherapeutische interventies ter
beïnvloeding van spanning en pijn in het bekkengebied zal de nadruk gelegd worden op het
aandachtig meemaken van die oefenstof en de reacties in het lichaam. Dit op basis van
onderstaande literatuur.
Robert Schütze a,*, Clare Rees a, Minette Preece b, Mark Schütze b
a School of Psychology, Curtin University of Technology, Perth, Australia
b Department of Pain Management, Sir Charles Gairdner Hospital, Perth, Australia
Low mindfulness predicts pain catastrophizing in a fear-
avoidance model of chronic Pain PAIN_ 148 (2010) 120–127
Abstract
The relationship between persistent pain and self-directed, non-reactive awareness of present-
moment experience (i.e., mindfulness) was explored in one of the dominant psychological
theories of chronic pain - the fear-avoidance model[53]. A heterogeneous sample of 104
chronic pain outpatients at a multidisciplinary pain clinic in Australia completed
psychometrically sound self-report measures of major variables in this model: Pain intensity,
negative affect, pain catastrophizing, pain-related fear, pain hypervigilance, and functional
disability. Two measures of mindfulness were also used, the Mindful Attention Awareness
Scale [4] and the Five-Factor Mindfulness Questionnaire [1]. Results showed that
mindfulness significantly negatively predicts each of these variables, accounting for 17-41%
of their variance. Hierarchical multiple regression analysis showed that mindfulness uniquely
predicts pain catastrophizing when other variables are controlled, and moderates the
relationship between pain intensity and pain catastrophizing. This is the first clear evidence
substantiating the strong link between mindfulness and pain catastrophizing, and suggests
mindfulness might be added to the fear-avoidance model. Implications for the clinical use of
mindfulness in screening and intervention are discussed.
Door P. van Burken: Hoe minder mindfull de patiënt is des te sterker spelen de factoren van
het fear-avoidance model.
Volgens de auteurs van dit artikel leidt catastroferen over pijn tot (bewegings)angst en
vermijding. Catastroferen over pijn bepaalt voor 7-31% de variatie in pijn intensiteit. Een
manier om catastroferen te beïnvloeden is via cognitief-gedragsmatige interventies. Een
recente ontwikkeling is de inzet van mindfulness. Het gaat er daarbij niet om de innerlijke
ervaring van pijn te veranderen maar om deze te accepteren.
Mindfulness is een aandachttoestand die min of meer tegengesteld is aan de aandacht die bij
catastroferen optreedt.
Catastroferen
Aandacht gericht op interpretaties en (abstracte) concepten.
Beoordelend
Automatisch (vaak)
www.stabiliteitstrainingscentrum.nl
Mindfulness
De aandacht gericht op de concrete actuele ervaring in het huidige moment
Niet-beoordelend (accepterend)
Intentioneel / opzettelijk
Er zijn onderzoeken die aannemelijk maken dat mindfulness gunstige effecten heeft op
stemming en pijn bij chronische pijnpatiënten. In de huidige studie willen de auteurs
onderzoeken of mindfulness negatief correleert met de herstelbelemmerende factoren uit het
bekende fear-avoidance model van chronische pijn, te weten: pijn intensiteit, catastroferen,
angst voor pijn, pijn hypervigilantie, en functionele beperkingen. Ze verwachten de sterkste
negatieve correlatie tussen mindfulness en catastroferen. Meer specifiek veronderstellen de
auteurs dat de mate van mindfulness de relatie die tussen catastroferen en pijn bestaat,
afzwakt.
Methode
De onderzoekspopulatie bestond uit een heterogene groep van 104 volwassen chronische
pijnpatiënten (outpatient) die op een afspraak wachten van hun pijnspecialist in het
ziekenhuis. De volgende variabelen werden via vragenlijsten gemeten:
•Duur en locatie van de pijn
•Mindfulness:
◦Five-Factor Mindfulness Questionnaire (FFMQ) Dit om een aantal factoren van mindfulness
te meten.
◦Mindful Attention Awareness Scale (MAAS) Dit om een totaal score te krijgen. (De FFMQ
geeft geen totaal score).
•Pijn intensiteit: subschaal uit de Brief Pain Inventory (BPI)
•Functionele beperkingen: subschaal uit de Brief Pain Inventory (BPI)
•Negatieve stemming: subschaal uit de I-PANAS-SF.
•Pijn catastroferen: Pain catastrophizing Scale (PCS).
•Pijn gerelateerde angst: Tampa Scale for Kinesiophobia (TSK).
•Pijn hypervigilantie: Pain Vigilance and Awareness Questionnaire (PVAQ).
Resultaten
De chronische pijnpatiënten bleken op de MAAS niet minder mindfull dan een steekproef uit
de algemene bevolking. Mindfulness gemeten via de MAAS correleerde negatief met elk van
de gemeten variabelen uit het fear-avoidance model. In een regressie analyse werd het aandeel
van mindfulness nader onderzocht. Dit maal met de vijf factoren van FFMQ. De vijf factoren
gezamenlijk verklaren 17%-41% van de factoren van het fear-avoidance model
(pijncatastroferen 41% verklaarde variantie). Na statistische controle op een aantal relevante
achtergrond variabelen, kwam de ‘uniek’ verklaarde variantie van mindfulness op 5% te
liggen. Mindfulness blijkt dus inderdaad onafhankelijk te modereren tussen pijnintensiteit en
catastroferen, maar zwak. Hoe lager de patiënt op mindfulness scoort des te sterker was de
relatie tussen pijn intensiteit en catastroferen. Deze uitkomst lijkt erop te wijzen dat de mate
waarop iemand mindfull in het huidige moment kan blijven het piekeren en catastroferen over
pijn vermindert.
Een suggestie van de auteurs is patiënten met pijn te screenen met de MAAS op de mate van
mindfulness en als die laag is daar een interventie voor aan te bieden. Mogelijk dat
www.stabiliteitstrainingscentrum.nl
chroniciteit daardoor beter voorkomen kan worden, en ook de ervaren pijn en disfunctioneren
wat vermindert. Hoewel diverse kleine trails hoopgevend zijn wat betreft de invloed van
mindfulness op chronische pijn, moet een grote trail nog uitgevoerd worden.
drs. P. van Burken
www.PsychFysio.nl
Jensen, M. P. (2010).
A Neuropsychological Model of Pain: Research and
Clinical Implications. The Journal of Pain, 11(1), 2-12.
De neuropsychologie van pijn en pijn-interventies
Jensen geeft een neuropsychologisch overzicht van hersenen en pijn. Vier regio’s blijken
daarbij erg belangrijk: prefrontale cortex, anterior cingulate cortex, sensorische cortex en de
insula.
Prefrontale cortex (PFC)
De prefrontaal cortex encodeert de cognitieve aspecten van acute en chronische pijn: de
betekenis van pijn en beslissingen rond coping met pijn. De PFC heeft in het algemeen een
inhiberende functie. Hoe sterker de activatie PFC des te minder pijn. Vanuit PFC kan top-
down pijndemping ontstaan door invloed op het periaqueductale grijs in de hersenstam.
Anterior Cingulate Cortex (ACC)
Activiteit van de ACC is betrokken bij zowel de affectie/emotionele dimensie van pijn
(=lijden) als de motivationeel/motorische dimensie (voorbereiden en initiëren van
gedragsmatige coping met pijn). Ze speelt een belangrijke rol bij het creëren van angstige
herinneringen in relatie tot pijn.
Primaire en secundaire sensorische cortex (S1 en S2)
Zowel de S1 als S2 is betrokken bij het spatieel encoderen van de nociceptie. S2 ontvangt als
eerste in de cortex de nociceptieve input. Waarschijnlijk encodeert S2 sterker de intensiteit en
kwaliteit van de pijn dan S1.
Insula
De insula is de sensorische component van het limbische systeem. Het encodeert hoe iemand
zich voelt op een groot aantal domeinen die gerelateerd zijn aan motivatie (de mate waarin
iemand dorst, honger, pijn, jeuk heeft versus verzadigd en fysiek tevreden zijn). Vooral bij
zuurstofgebrek, laag bloedsuiker niveau en pijn wordt ze actief.
Het pijn netwerk en plasticiteit
Er is geen pijncentrum in het brein. Pijn is het gevolg van het activeren van een netwerk van
verschillende regionen.
Langdurige perifere nociceptieve input sensitiseert bepaalde hersenregionen die de
verwerking van toekomstige nociceptieve input beïnvloeden. Patiënten met fibromyalgie en
chronische lage rugpijn hebben een verhoogde activatie in bepaalde regionen. Ook de
organisatie en structuur van de hersenen kan bij pijn veranderen. Regio S1 mond kan
bijvoorbeeld in de richting van S1 regio van het geamputeerde ledemaat verschuiven. Bij
www.stabiliteitstrainingscentrum.nl
fibromyalgie en chronische lage rugpijn is de grijze stof in PFC afgenomen, waardoor de
pijninhibitie ook afgenomen is. Per chronische pijn aandoening kan er een ander
activatiepatroon in de hersenen zijn.
Interventies gericht op cognities
Cognitieve herstructurering of cognitieve therapie
Het gaat hierbij om het achterhalen en corrigeren van disfunctionele automatische opvattingen
over pijn. Voorbeelden daarvan zijn catastroferen over pijn, vrees gerelateerde opvattingen
en/of een lage eigen effectiviteit verwachting. Cognitieve interventies zal primair effect
hebben op de PFC en via deze regio ook op de ACC. Immers cognitie (minder catastroferen:
PFC) geeft minder pijnlijden (ACC). Via deze emotionele pijnregio zal indirect ook minder
S1/S2 activatie optreden. Deze hypothesen moeten nog bevestigd worden, maar er zijn al
aanwijzingen.
Acceptatie gerichte therapie
Hierbij wordt de patiënt aangemoedigd/aangeleerd om het vechten tegen de pijn te stoppen en
de inspanningen te verleggen richting het behalen van andere gewaardeerde levensdoelen.
Cognitieve therapie zal de inhoud van de cognities willen veranderen, acceptatie gerichte
benaderingen willen daarentegen meer de focus verleggen. Beide benaderingen zullen een
primair effect hebben op de activiteit van de PFC. Omdat acceptatie gerichte benaderingen
ook aanmoedigen de aandacht te verleggen van pijn naar andere levensdoelen, zal deze
aandachtsverschuiving ook impact kunnen hebben op de sensorische component van de
pijnwaarneming (S1/S2). Er zijn aanwijzingen dat acceptatie gerichte therapie een sterker
effect heeft op de pijn intensiteit dan cognitieve therapie.
Interventies gericht op gedrag
Operante benadering
Deze benadering vertrekt vanuit de visie dat pijn gedrag/communicatie sterk beïnvloed wordt
door de omgeving (negeren, belonen, straffen). Het gaat daarbij niet alleen om de activiteiten
te verhogen, maar ook om duidelijk te maken dat pijn niet perse schade betekent, en dat
bewegen juist herstel veroorzaakt. Ook de operante benadering verschuift de aandacht weg
van de pijn in de richting van activiteiten. De betekenis van de pijn (PFC), het pijnlijden
(ACC) en de pijnsensatie (S1/S2) kan afnemen.
Motivational interviewing (MI)
Het centrale idee is dat de patiënt niet zozeer nieuwe vaardigheden moet aanleren, maar de
motivatie moet krijgen om de vaardigheden die hij al heeft te gaan inzetten. De patiënt wordt
aangemoedigd persoonlijke relevante redenen voor veranderingen te verzinnen en zichzelf te
overtuigen dat deze door hem haalbaar zijn. Dit vanuit intrinsieke motivatie. Waarschijnlijk
activeert MI sterker de anterior cortex (PFC) dan de posterior cortex (S1/S2 en insula).
Interventies gericht op vermogen relaxatie en comfort te ervaren
Relaxatie training
Relaxatie training kan de pijn verminderen maar dit correleert niet met een actuele spiertonus
vermindering perifeer, maar juist wel met de perceptie van afname van spierspanning en
www.stabiliteitstrainingscentrum.nl
toegenomen self efficacy. Dus het (centrale) corticale effect is belangrijker. Relaxatie training
richt zich op het ervaren van fysieke sensaties van ontspanning (S1/S2) maar dit ook in
combinatie met mentale rust (Insula/ACC). De verhoogde self efficacy zal waarschijnlijk met
verhoogde PFC activiteit correleren.
Hypnose
Hypnose bevat vaak een introductie die lijkt op relaxatie, gevolgd door suggesties gericht op
emoties of pijnsensaties/beleving. Hypnotische suggesties gericht op het reduceren van
pijnongemak in plaats van pijn intensiteit vermindert wel de activiteit in ACC, maar niet in de
sensorisch cortex. Andersom blijkt dat suggesties gericht op de pijn intensiteit maar niet op
pijnongemak de activiteit in S1 (en deels in S2) vermindert, maar niet in ACC. Men mag
verwachten dat suggesties gericht op self efficacy de PFC activeert, en dat suggesties gericht
op tevredenheid de insula zal activeren, maar dit moet nog worden onderzocht.
Placebo interventies
Placebo interventies hebben waarschijnlijk het sterkste effect via verwachtingen (PFC) en
motivatie (limbische systemen bijv ACC en Insula). Inderdaad blijkt bij een review dat PFC
activiteit toeneemt en ACC af.
Klinische implicatie
Kennis van deze relaties tussen de pijndimensies en neuropsychologie kan helpen bij de keuze
van interventies. Het leert de therapeut te luisteren naar welke elementen in de
pijnrapportage/beleving/gedrag het sterkst aanwezig zijn (sensorisch, cognitief affectief,
motivationeel) om vervolgens te speculeren dat een bepaald hersendeel daarbij betrokken is,
en men zich met interventies hier relatief specifiek op kan richten.
Bron: Jensen, M. P. (2010). A Neuropsychological Model of Pain: Research and Clinical
Implications. The Journal of Pain, 11(1), 2-12.
www.PsychFysio.nl
drs. P. van Burken
Jeanet J.A. Landsman-Dijkstra a,b,∗, Ruud van Wijck b,
Johan W. Groothoff c, Piet Rispens b
a Lifestyle Training Center, Dalfsen, The Netherlands
b Institute of Human Movement Sciences, University of Groningen, P.O. Box 196, 9700 AD
Groningen, The Netherlands
c Department of Social Medicine, University of Groningen, Groningen, The Netherlands
The short-term effects of a body awareness program:
better self-management of health problems for individuals
with chronic a-specific psychosomatic symptoms Patient Education and Counseling 55 (2004) 155–167
Keywords: Chronic A-specific Psychosomatic Symptoms; Stress; Self-management; Body
awareness
www.stabiliteitstrainingscentrum.nl
Abstract
A three-day residential Body Awareness Program (BAP) was developed to teach people with
Chronic A-specific Psychosomatic Symptoms (CAPS) to react adequately to disturbances of
the balance between a daily workload and the capacity to deal with it. The short-term effects
of the program for people withCAPSare presented in this study. The design is a non-control
group design with pre- and post-measures (2 months after the program). The sample for this
paper was formed by 187 participants. The mean age is 42.3 (S.D. = 8.9), and 57% is female.
The results showed decreased stress-related symptoms, increased quality of life, increased
self-efficacy, less depressive attribution style, more expression of emotions, and a positive
change of lifestyle. Most of these measured changes can be interpreted as clinically relevant
outcomes with medium-to-large effect sizes. Personal pre-training goals were attained by 85%
of the participants. Spouses also confirmed the found effects. Evaluation of the BAP gives
enough evidence to conclude that this program leads to positive effects in CAPS. Participants
react more adequately to disturbances between daily workload and the capacity to deal with
this load. They are more capable of self-management in coping with stress and psychosomatic
symptoms. Conclusions are drawn about the prevention by early interventions for patients
with a-specific physical symptoms.
Zit in map hoofdcursus
Naranjo, J. R., & Schmidt, S. (2012).
Is it me or not me? Modulation of perceptual-motor
awareness and visuomotor performance by mindfulness
meditation. BMC Neurosci, 13(1), 88. doi: 10.1186/1471-2202-13-88
Samenvatting door drs. P. van Burken (www.psychfysio.nl)
Mindfulness training helpt om tijdens bewegen minder fouten te maken
Het vermogen om jezelf als de oorzaak van je handelingen te ervaren is een essentieel element
in het ervaren van een zelf. Onder normale omstandigheden zijn we ons slechts beperkt
bewust van onze motorische handelingen. Vaak ontstaat motorisch bewustzijn pas als er een
conflict is tussen de voorspelde en de actuele sensorische consequenties.
Bij mindfulness training leert men om continu gewaar te zijn van de sensaties en ervaringen in
het huidige moment. Het bewustzijn van bewegen in het dagelijks leven valt hier ook onder.
Mindfulness training kan het motorisch bewustzijn versterken. Toch is hier nog maar weinig
onderzoek naar gedaan.
De auteurs onderzochten daarom of mindfulness meditatie een gunstig effect heeft op
motorisch bewustzijn, motorische nauwkeurigheid en bewegingsduur tijdens een
visuomotorische taak. Daarbij werd in verschillende mate verkeerde bewegingsfeedback
gegeven.
Methode
De onderzoekers bestudeerden twee groepen. Een groep betrof deelnemers aan een
mindfulness training van 8 sessies (MBSR) (N=11). De meting werd aan het begin van de
training en na acht weken gedaan. De controlegroep bestond uit mensen die geen mindfulness
training kregen (N=11). De tweede groep deelnemers bestond uit mensen die al lange tijd
ervaring hadden met mindfulness meditatie (N=9),. Deze proefpersonen werden vergeleken
met mensen zonder deze ervaring (N=11).
www.stabiliteitstrainingscentrum.nl
Taak
De proefpersonen moesten een digitale pen verplaatsen van punt A naar punt B. Ze konden
daarbij de verplaatsing van hun hand niet zien omdat er een solide projectieblad overheen
geplaatst was. Op dat projectieblad zag men een lichtpunt als zijnde het startpunt en een
lichtpunt als zijnde het eindpunt. Een zich daartussen verplaatsend lichtpunt gaf visuele
feedback over het afgelegde traject. De proefpersonen moesten een aantal rechtlijnige
trajecten afleggen. De feedback kon gemanipuleerd worden. Ze varieerde van gelijk zijnde
aan de actuele beweging van de arm onder het projectblad tot sterk afwijkend van de actuele
beweging. De valse feedback werd gemanipuleerd in een range van -27graden en + 27 graden.
De opdracht was om rustig en bewust een rechte lijn van het startpunt na het eindpunt te
trekken.
Bij foute feedback moesten de proefpersonen dus direct een bijstelling doen in hun
oorspronkelijke motorische preparatie. Na elke trail moesten de proefpersonen aangeven op
een schaal van 0-5 in welke mate zij de beweging volledig aan zichzelf toeschreven en geen
perceptueel motorconflict ervoeren. 0= geen conflict, 5 is sterk conflict.
Resultaten De resultaten laten zien dat mindfulness training geassocieerd is met het maken van minder
motorische fouten en trager bewegen. De drempel om een perceptueel-motorisch conflict op
te merken is in de mindfulness groep verlaagd. Dit gold voor de mindfulness trainingsgroep
maar niet voor de langdurig mediterenden. Het effect van minder fouten en trager bewegen
trad het sterkst op in trails waarbij perceptuele-motor incongruentie werd ervaren. Het lijkt
erop dat men zich dan meer motorisch bewust wordt van de afwijking in bewegingsfeedback
en overschakelt op meer mindful en trager bewegen. Daardoor kon beter correctie op het
bewegingstraject plaatsvinden.
Opmerking samenvatter
Zoals we al eerder schreven is bewustzijn van bewegen niet altijd gunstig. Toch zijn er
diverse methoden, zoals Feldenkrais, waarbij bewust bewegen centraal staat. Dit onderzoek
laat zien dat motorisch bewustzijn gunstig kan uitpakken in motorische situaties waar men
geconfronteerd wordt met onjuiste feedback. Bovendien bleek dit trainbaar via mindfulness
training.
Misschien mag men dit vertalen naar bewegingen die sterk intentioneel zijn. Misschien is het
ook zo dat mindfulness training het motorische bewustzijn versterkt en dat daardoor meer
informatie beschikbaar komt die aangewend kan worden voor correcte uitvoering van de
beweging. Bij mikken op een doel is primaire gerichtheid op het doel essentieel en
bijvoorbeeld niet een gerichtheid op de schouder. Overmatige gerichtheid op je eigen
lichaamsbeweging kan hier hinderen. Het huidige onderzoek laat echter zien dat mindful
bewegen weldegelijk ingezet kan worden om beter te ‘mikken’. Althans bij een rustige
bewegingstaak. Een correcte uitvoering van krachtraining kan hier ook onder vallen. Mogelijk
speelt voorgrond-achtergrond hier. Op de voorgrond houdt men de gerichtheid op het doel,
maar op de achtergrond is nu meer mindful informatie over het bewegingsverloop aanwezig
en kunnen correctieve strategieën ingezet worden terwijl men primair gericht blijft op het
doel. Kortom: mindful bewegen kan een vruchtbaar onderzoeksveld zijn binnen de
fysiotherapie. De vraag blijft dan bij welke typen van beweging een verhoogd motorisch
zelfbewustzijn gunstig is en bij welke vormen van bewegen juist niet.
Dit artikel in deze samenvatting laten lezen, samen met andere artikele op wwwpsychfysio.nl
Jeanet J.A. Landsman-Dijkstraa,*,1, Ruud van Wijckb,1,
Johan W. Groothoffc,1
www.stabiliteitstrainingscentrum.nl
aLifestyle Training Centre, Dalfsen, The Netherlands
bInstitute of Human Movement Sciences, University of Groningen, The Netherlands
cDepartment of Social Medicine, University of Groningen, The Netherlands
The long-term lasting effectiveness on self-efficacy,
attribution style, expression of emotions and quality of life
of a body awareness program for chronic a-specific
psychosomatic symptoms Patient Education and Counseling 60 (2006) 66–79
Keywords: Chronic a-specific psychosomatic symptoms; Stress; Self-management; Body
awareness
Abstract
Objective: A 3-day residential body awareness program (BAP) was developed to teach
people with chronic a-specific psychosomatic symptoms (CAPS) to react adequately to
disturbances of the balance between a daily workload and the capacity to deal with it. The
long-term effects of the program on body awareness, psychological factors, psychosomatic
symptoms and quality of life for people with CAPS are presented in this study.
Methods: A pre–post design is used with post-measures 2 and 12 months after the program,
without controls (n = 122). Mean age is 42.5 (S.D. = 9.0) and 60% is female.
Results: The results showed an increase of body awareness, self-efficacy, expression of
emotions and quality of life. Stress-related symptoms decreased and the attribution style was
found to be less depressive. Participants achieved significantly higher levels of functioning at
2 months which increased significantly more at 12 months. The majority of the measured
changes can be interpreted as clinically relevant outcomes with medium-to-large effect sizes.
Spouses of the participants also confirm the found effects.
Discussion and conclusion: Evaluation of the BAP gives evidence to conclude that this
program leads to the theoretically expected long-term effects in CAPS. Participants react
more adequately to disturbances between daily workload and the capacity to deal with this
load. Two and 12 months after the 3-day program, they are more capable of self-management
in coping with stress and psychosomatic symptoms.
Practice implications: This article sheds new light on the difficulties that individuals with
psychosomatic symptoms and their professional interventionists encounter when attempting to
manage the chronicity of the problems. By paying more attention to learning self-management
by increasing body awareness and self-efficacy, patient educators may be able to increase
their effectiveness.
Zit in map hoofdcursus
Jeanet J.A. Landsman-Dijkstraa,1,*, Ruud van Wijckb,1, Johan W. Groothoff c,1
aLifestyle Training Centre, Dalfsen, The Netherlands
bInstitute of Human Movement Sciences, University of Groningen, The Netherlands
cDepartment of Social Medicine, University of Groningen, The Netherlands
Improvement of balance between work stress and recovery
after a body awareness program for chronic aspecific
psychosomatic symptoms Patient Education and Counseling 60 (2006) 125–135
www.stabiliteitstrainingscentrum.nl
Keywords: Chronic aspecific psychosomatic symptoms; Stress; Self-management; Quality of
life
Abstract
Objective: A 3-day residential body awareness program (BAP) was developed to teach
people with chronic aspecific psychosomatic symptoms (CAPS) to react adequately to
disturbances of the balance between a daily workload and the capacity to deal with it. The
long-term effects of the program in improving the balance between work stress and recovery
are presented in this study. The intervening effect of ‘improved balance’ on quality of life is
also analysed.
Methods: A pre–post design is used with post-measures at 2 and 12 months after the
program, without controls (n = 122). Mean age is 42.5 years (S.D. = 9.0) and 60% of
participants are female.
Results: The results show participants become more active physically and socially, and at the
same time take the opportunity to recover. There was a difference measured in changing
balance for participants who are fully employed and participants who are not working or are
working part-time due to health problems: the second group reintegrated into work, the first
group spent more time socialising inside the family. Personal goals are realised by 85% of the
participants. Realising personal goals and becoming more active is a mediating factor for
increasing quality of life. The majority of the measured changes can be interpreted as
clinically relevant outcomes with medium-to-large effect sizes. Spouses of the participants
also confirm these effects.
Discussion and conclusion: Evaluation of the BAP gives evidence to conclude that this
program leads to long-term effects in CAPS. Participants react more adequately to
disturbances between daily workload and the capacity to deal with this load. Two and 12
months after the 3-day program, they changed their behaviour to a more active lifestyle and
increased self-management in coping with stress and psychosomatic symptoms.
Practice implications: By paying more attention to the balance between work stress and
recovery, patient educators may be able to increase their effectiveness. Personal goal
realization can be effective in guiding people by getting them out of the negative spiral.
Nederlands abstract van ditzelfde artikel door EVIDENCE BASED PRACTICE
ATTENDERING SPANNING, ONTSPANNING EN PSYCHOSOMATIEK
NEDERLANDS PARAMEDISCH INSTITUUT 1 NR. 4 - 14 SEPTEMBER 2006
Spanning, Ontspanning en Psychosomatiek
Lichaamsbewustwordingstraining geeft betere balans tussen werkstress en herstel :
persoonlijke trainingsdoelen realiseren helpt mensen uit een negatieve spiraal
Landsman JJA, van Wijck R, Groothoff JW. Improvement of balance between work
stress and recovery after a body awareness program for chronic aspecific
psychosomatic symptoms. Patient Education and Counseling 2006; 60(2): 125-135.
In Dalfsen is een driedaagse interne leefstijltraining ontwikkeld. Hierin wordt mensen met
chronische aspecifieke lichamelijke klachten (CALK) geleerd om adequaat te reageren op
verstoringen van de balans tussen lichamelijke en psychische belasting en belastbaarheid.
Technieken uit bio-energetica, ademtherapie en haptonomie worden toegepast om
lichaamsbewustwording te vergroten. In dit artikel zijn de lange termijn effecten beschreven
ten aanzien van de balans tussen werkstress en herstel. Er is een pre-post design gebruikt met
nametingen op twee en twaalf maanden na de driedaagse interventie, zonder controlegroep (n
=122). De gemiddelde leeftijd is 42,5 jaar (SD 9.0) en 60% is vrouw. De vier meest
genoemde symptomen zijn vermoeidheid, zich gespannen voelen, slaapproblemen en
hoofdpijn.
www.stabiliteitstrainingscentrum.nl
Meetinstrumenten/uitkomstmaten Evenwicht tussen werkstress en herstel: 1 week in
dagboek tijdregistratie voor activiteiten (werk, vrijetijdsbesteding, sport, sociale activiteiten,
etc.)
Realiseren van doelen: Goal Attainment Scale
Kwaliteit van Leven: World Health Quality of Life scale en de Nederlandse
versie van de Hopkins SCL-90
Resultaten
De deelnemers worden actiever op zowel fysiek als sociaal gebied en maken tegelijkertijd
meer en effectiever gebruik van hun mogelijkheden om te herstellen na inspanning. Er is meer
flexibiliteit, de deelnemers hebben meer gedragsalternatieven en passen deze toe bij het
hanteren van dagelijkse stress. Zowel het langdurig als kortdurend ziekteverzuim is gedaald.
Persoonlijke trainingsdoelen (zoals eigen grenzen leren kennen, leren ontspannen, omgaan
met stress op het werk, etc.) werden door 85% van de deelnemers gerealiseerd. De
meerderheid van de gemeten veranderingen zijn klinisch relevant met gemiddelde tot grote
effectmaten.
Conclusie
Twaalf maanden na de lichaamsbewustwordingstraining is er een gedragsverandering.
Deelnemers hebben een actievere levensstijl en kunnen beter omgaan met stress en
psychosomatische symptomen. [SH]
Zit in map hoofdcursus
Jeanet J.A. Landsman-Dijkstra a,b,∗, Ruud van Wijck b,
Johan W. Groothoff c, Piet Rispens b
a Lifestyle Training Center, Dalfsen, The Netherlands
b Institute of Human Movement Sciences, University of Groningen, P.O. Box 196, 9700 AD
Groningen, The Netherlands
c Department of Social Medicine, University of Groningen, Groningen, The Netherlands
Patient Education and Counseling 55 (2004) 155–167
The short-term effects of a body awareness program:
better self-management of health problems for individuals
with chronic a-specific psychosomatic symptoms_ Keywords: Chronic A-specific Psychosomatic Symptoms; Stress; Self-management; Body
awareness
Abstract
A three-day residential Body Awareness Program (BAP) was developed to teach people with
Chronic A-specific Psychosomatic Symptoms (CAPS) to react adequately to disturbances of
the balance between a daily workload and the capacity to deal with it. The short-term effects
of the program for people with CAPS are presented in this study. The design is a non-control
group design with pre- and post-measures (2 months after the program). The sample for this
paper was formed by 187 participants. The mean age is 42.3 (S.D. = 8.9), and 57% is female.
The results showed decreased stress-related symptoms, increased quality of life, increased
self-efficacy, less depressive attribution style, more expression of emotions, and a positive
change of lifestyle. Most of these measured changes can be interpreted as clinically relevant
outcomes with medium-to-large effect sizes. Personal pre-training goals were attained by 85%
of the participants. Spouses also confirmed the found effects. Evaluation of the BAP gives
www.stabiliteitstrainingscentrum.nl
enough evidence to conclude that this program leads to positive effects in CAPS. Participants
react more adequately to disturbances between daily workload and the capacity to deal with
this load. They are more capable of self-management in coping with stress and psychosomatic
symptoms. Conclusions are drawn about the prevention by early interventions for patients
with a-specific physical symptoms.
Zit in map hoofdcursus
Claudine JC Lamoth*1, John F Stins1, Menno Pont2, Frederick Kerckhoff2 and Peter J Beek1
Address: 1Research Institute MOVE, Faculty of Human Movement Sciences, VU University
Amsterdam, van der Boechorststraat 9, 1081 BT, Amsterdam, the Netherlands and
2Rehabilitation Center Amsterdam, Department of Health and Behavior, Overtoom 283, 1054
HW, Amsterdam, the Netherlands
Email: Claudine JC Lamoth* - [email protected]; John F Stins - [email protected];
Menno Pont - [email protected]; Frederick Kerckhoff - [email protected];
Peter J Beek - [email protected] * Corresponding author
Effects of attention on the control of locomotion in
individuals with chronic low back pain Journal of NeuroEngineering and Rehabilitation
Abstract
Background: People who suffer from low back pain (LBP) exhibit an abnormal gait pattern,
characterized by shorter stride length, greater step width, and an impaired thorax-pelvis
coordination which may undermine functional walking. As a result, gait in LBP may require
stronger cognitive regulation compared to pain free subjects thereby affecting the degree of
automaticity of gait control. Conversely, because chronic pain has a strong attentional
component, diverting attention away from the pain might facilitate a more efficient walking
pattern.
Methods: Twelve individuals with LBP and fourteen controls participated. Subjects walked
on a treadmill at comfortable speed, under varying conditions of attentional load: (a) no
secondary task, (b) naming the colors of squares on a screen, (c) naming the colors of color
words ("color Stroop task"), and (d) naming the colors of words depicting motor activities.
Markers were attached to the thorax, pelvis and feet. Motion was recorded using a three-
camera SIMI system with a sample frequency of 100 Hz. To examine the effects of health
status and attention on gait, mean and variability of stride parameters were calculated. The
coordination between thoracic and pelvic rotations was quantified through the mean and
variability of the relative phase between those oscillations.
Results: LBP sufferers had a lower walking speed, and consequently a smaller stride length
and lower mean thorax-pelvis relative phase. Stride length variability was significantly lower
in the LBP group but no significant effect of attention was observed. In both groups gait
adaptations were found under performance of an attention demanding task, but significantly
more so in individuals with LBP as indicated by an interaction effect on relative phase
variability.
Conclusion: Gait in LBP sufferers was characterized by less variable upper body movements.
The diminished flexibility in trunk coordination was aggravated under the influence of an
attention demanding task. This provides further evidence that individuals with LBP tighten
their gait control, and this suggests a stronger cognitive regulation of gait coordination in
LBP. These changes in gait coordination reduce the capability to deal with unexpected
perturbations, and are therefore maladaptive.
www.stabiliteitstrainingscentrum.nl
Fascia
R. Schleip *, W. Klingler, F. Lehmann-Horn
Department of Applied Physiology, Ulm University, Albert-Einstein-Allee 11, 89069 Ulm,
Germany
Active fascial contractility: Fascia may be able to contract
in a smooth muscle-like manner and thereby influence
musculoskeletal dynamics
Summary Dense connective tissue sheets, commonly known as fascia, play an important role
as force transmitters in human posture and movement regulation. Fascia is usually seen as
having a passive role, transmitting mechanical tension which is generated by muscle activity
or external forces. However, there is some evidence to suggest that fascia may be able to
actively contract in a smooth muscle-like manner and consequently influence musculoskeletal
dynamics. General support for this hypothesis came with the discovery of contractile cells in
fascia, from theoretical reflections on the biological advantages of such a capacity, and from
the existence of pathological fascial contractures. Further evidence to support this hypothesis
is offered by in vitro studies with fascia which have been reported in the literature: the
biomechanical demonstration of an autonomous contraction of the human lumbar fascia, and
the pharmacological induction of temporary contractions in normal fascia from rats. If
verified by future research, the existence of an active fascial contractility could have
interesting implications for the understanding of musculoskeletal pathologies with an
increased or decreased myofascial tonus. It may also offer new insights and a deeper
understanding of treatments directed at fascia, such as manual myofascial release therapies or
acupuncture. Further research to test this hypothesis is suggested.
Conclusions These results suggest, that fascia is a contractile organ, due to the presence of
myofibroblasts. This ability is expressed on the one hand in chronic tissue contractures which
include tissue remodeling; and on the other hand in smooth muscle-like cellular contractions
over a time frame of minutes to hours, which can be strong enough to influence low back
stability and other aspects of human biomechanics. This offers future implications for the
understanding and clinical management of pathologies which go along with increased or
decreased myofascial stiffness (such as low back pain, tension headache, spinal instability, or
fibromyalgia). It also offers new insights for treatments directed at fascia, such as osteopathy,
the Rolfing method of myofascial release, or acupuncture. Further research on fascial
contractility is indicated and promising.
Artikel in map hoofdcursus.
www.stabiliteitstrainingscentrum.nl
Extremiteiten
L Öhberg1, R Lorentzon2, H Alfredson2
1Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
2Department of Surgical and Perioperative Science, Sports Medicine and National Institute
for Working Life, University of Umeå
Correspondence to: Dr Öhberg Department of Radiology, University Hospital of Umeå,
901 85 Umeå, Sweden; [email protected]
Eccentric training in patients with chronic Achilles
tendinosis: normalised tendon structure and decreased
thickness at follow up Br J Sports Med2004;38:8-11 doi:10.1136/bjsm.2001.000284
Abstract
Objective: To prospectively investigate tendon thickness and tendon structure by
ultrasonography in patients treated with eccentric calf muscle training for painful chronic
Achilles tendinosis located at the 2–6 cm level in the tendon.
Methods: The patients were examined with grey scale ultrasonography before and 3.8 years
(mean) after the 12 week eccentric training regimen. At follow up, a questionnaire assessed
present activity level and satisfaction with treatment.
Results: Twenty six tendons in twenty five patients (19 men and six women) with a mean age
of 50 years were followed for a mean of 3.8 years (range 1.6–7.75). All patients had a long
duration of painful symptoms (mean 17.1 months) from chronic Achilles tendinosis before
treatment. At follow up, 22 of 25 patients were satisfied with treatment and active in Achilles
tendon loading activities at the desired level. Ultrasonography showed that tendon thickness
(at the widest part) had decreased significantly (p<0.005) after treatment (7.6 (2.3) v 8.8 (3)
mm; mean (SD)). In untreated normal tendons, there was no significant difference in
thickness after treatment (5.3 (1.3) mm before and 5.9 (0.8) mm after). All tendons with
tendinosis had structural abnormalities (hypoechoic areas and irregular structure) before the
start of treatment. After treatment, the structure was normal in 19 of the 26 tendons. Six of the
seven patients with remaining structural abnormalities experienced pain in the tendon during
loading.
Conclusions: Ultrasonographic follow up of patients with mid-portion painful chronic
Achilles tendinosis treated with eccentric calf muscle training showed a localised decrease in
tendon thickness and a normalised tendon structure in most patients. Remaining structural
tendon abnormalities seemed to be associated with residual pain in the tendon.
Bernhardsson S, Klintberg IH, Wendt GK.
Evaluation of an exercise concept focusing on eccentric
strength training of the rotator cuff for patients with
subacromial impingement syndrome. Clin Rehabil. 2011 Jan;25(1):69-78. doi: 10.1177/0269215510376005. Epub 2010 Aug 16.
www.stabiliteitstrainingscentrum.nl
Journal of Clinical Rehabilitation 25 (2011):69-78)
Abstract
OBJECTIVE: To evaluate the effect on pain intensity and function of an exercise concept
focusing on specific eccentric strength training of the rotator cuff in patients with subacromial
impingement syndrome.
DESIGN: Single-subject research design with baseline and treatment phases (AB design).
SETTING: Home-based training programme supervised and supported by visits to
physiotherapy clinic.
SUBJECTS: Ten patients, mean (SD) age 54 (8.6) years, symptom duration 12 (9.1) months.
INTERVENTION: Daily eccentric strengthening exercises of the rotator cuff during 12
weeks.
MAIN MEASURES: Primary outcome measures: Pain intensity, assessed with a visual
analogue scale, and function, using the Patient-Specific Functional Scale. Secondary outcome
measures: Shoulder function evaluated with the Constant score, and shoulder-related quality
of life evaluated with the Western Ontario Rotator Cuff Index.
RESULTS: Pain intensity decreased significantly in eight of the ten subjects. Function
improved significantly in all ten subjects. Constant score increased in nine subjects and
Western Ontario Rotator Cuff Index increased in seven subjects. Mean Constant score for the
whole group increased significantly from 44 to 69 points (P = 0.008). Mean Western Ontario
Rotator Cuff Index increased from 51 to 71% (P = 0.021).
CONCLUSION: A 12-week eccentric strengthening programme targeting the rotator cuff and
incorporating scapular control and correct movement pattern can be effective in decreasing
pain and increasing function in patients with subacromial impingement syndrome. A
randomized controlled trial is necessary to provide stronger evidence of the method.
Boling MC, Bolgla LA, Mattacola CG, Uhl TL, Hosey RG.
Outcomes of a weight-bearing rehabilitation program for
patients diagnosed with patellofemoral pain syndrome. Archives of Physical Medicine and Rehabilitation 2006; 87(11):
1428-1435.
Bespreking door NPI, S. van de Heuvel.
Het patellofemorale pijnsyndroom (PFP) is in de Verenigde Staten een veel voorkomende
oorzaak van kniepijn. Een van de meest algemeen geaccepteerde ontstaanswijze is het
abnormaal sporen van de patella, mogelijk door een vertraagde aanspanning van de vastus
medialis ten opzichte van de vastus lateralis. EMG onderzoek hiernaar is gaande, maar
er is (nog) geen consensus bereikt, omdat de resultaten elkaar tegenspreken. Ook is er sprake
van verzwakte heupmusculatuur, wat een rol zou kunnen spelen bij PFP. De auteurs van dit
artikel hebben in een laboratoriumsetting middels EMG registratie van de m quadriceps en de
m gluteus medius het effect van 6 weken revalidatie bij mensen met PFP onderzocht.
Onderzoek De onderzoeksgroep bestond uit 14 studenten (9 vrouwen en 5 mannen) van de
universiteitskliniek van Kentucky met het patellofemoraal pijnsyndroom. Zij kregen een
revalidatieprogramma. De controlegroep bestond uit 14 studenten (9 vrouwen en 5 mannen)
zonder knieklachten. Er is een voormeting en een nameting uitgevoerd. Tevens is de
intrawaarnemer betrouwbaarheid van EMG metingen onderzocht.
www.stabiliteitstrainingscentrum.nl
Interventie Revalidatie van 6 weken met het accent op belaste spierversterkende oefeningen
(uitstappen, traplopen, hurkzit, met en zonder gewichten) voor de m quadriceps femoris en de
heupabductoren, met vooraf rekken van de hamstrings, quadriceps en kuitspieren. Drie sessies
per week, een keer met supervisie en 2 keer thuis (bijgehouden met een trainingslogboek). De
oefeningen, met behulp van een Airax evenwichtskussen en Thera-band, moesten pijnvrij
worden uitgevoerd en werden indien mogelijk iedere week zwaarder (programma
uitvoerig beschreven in het artikel). De deelnemers aan het revalidatieprogramma kregen een
instructievideo mee en een voorlichtingsbrochure.
Meetinstrumenten
- EMG (begin van contractie (timing) en contractieduur) van vastus medialis, vastus lateralis
en gluteus medius bij traplopen (omhoog en omlaag);
- VAS: ergste pijn in de afgelopen week (10 cm);
- Functional Index Questionnaire (FIQ) 16 puntsvragenlijst.
Resultaten Het EMG van de vastus medialis en vastus lateralis, de VAS en de FIQ scores
verbeterden significant bij de studenten met PFP na de revalidatie. Bij de voormeting
verschilde de timing van de vastus medialis en vastus lateralis van de PFP groep significant
ten opzichte van de controlegroep, maar na de interventie niet meer. Er zijn geen verschillen
gevonden in de timing en contractieduur van de m. gluteus medius. De therapietrouw
gebaseerd op het trainingslogboek was hoog (98,3%).
Discussie Nadelen van het onderzoek zijn de kleine omvang van de studiepopulatie en het
ontbreken van een controlegroep met klachten, waardoor er niet gerandomiseerd kon worden.
Ook de matige intrawaarnemer betrouwbaarheid van de EMG metingen is een beperking.
Conclusie Dit onderzoek geeft bewijs dat een belast revalidatieprogramma voor patiënten met
het patellofemoraal pijnsyndroom een verandering geeft van de timing van contractie van de
vastus lateralis en medialis van de m quadriceps femoris. Ook is aangetoond dat een
gesuperviseerd thuisoefenprogramma voor studenten met patellofemoraal pijnsyndroom de
pijn vermindert en de functionele toestand verbetert. [S.P. van den Heuvel; NPi]
Zampagni ML, Corazza I, Molgora AP, Marcacci M.
Biomechanics Laboratory-Rizzoli Orthopaedics Institute, Bologna, Italy; Center of
Bioengineering and Motor Sciences, Trento University, Italy.
Can ankle imbalance be a risk factor for tensor fascia lata muscle weakness?
J Electromyogr Kinesiol. 2008 May 1
Risk factors that can determine knee and ankle injuries have been investigated and causes are
probably multifactorial. A possible explanation could be related by the temporary inhibition
of muscular control following an alteration of proprioceptive regulation due to the ankle
imbalance pathology. The purpose of our study was to validate a new experimental set up to
quantify two kinesiologic procedures (Shock Absorber Test (SAT) and Kendall and Kendall's
Procedure (KKP)) to verify if a subtalus stimulus in an ankle with imbalance can induce a
non-appropriate response of controlateral tensor fascia lata muscle (TFL). Fifteen male soccer
players with ankle imbalance (AIG) and 14 healthy (CG) were tested after (TEST) before
(NO-TEST) a manual percussion in subtalus joint (SAT). A new tailor-made device equipped
with a load cell was used to quantify TFL's strength activation in standardized positions. Two
trials for each subject were performed, separated by at least one 4-min resting interval. In NO-
TEST conditions both AIG and CG showed a progressive adaptation of the subject to the
force imposed by operator. No reduction in mean force, mean peak force, and muscle force
duration (p>0.5). AIG presented significant differences (mean difference 0.92+/-0.46s;
p=0.000) in muscle force duration in TEST conditions. Our results indicated that "wrong"
www.stabiliteitstrainingscentrum.nl
proprioceptive stimuli coming from the subtalus joint in AIG might induce inhibition in terms
of duration of TFL muscle altering the knee stability. This kinesiological evaluation might be
useful to prevent ankle and knee injuries.
Gregory R Waryasz*1,2 and Ann Y McDermott1,3
Address: 1Tufts University School of Medicine, Boston, MA, USA, 2Department of
Nutrition, Brigham and Women's Hospital, Boston, MA, USA and 3Kinesiology Department,
California Polytechnic State University, San Luis Obispo, CA, USA
Email: Gregory R Waryasz* [email protected]; Ann Y McDermott -
* Corresponding author
Patellofemoral pain syndrome (PFPS): a systematic review
of anatomy and potential risk factors Dynamic Medicine 2008, 7:9
Abstract
Background: Patellofemoral Pain Syndrome (PFPS), a common cause of anterior knee pain, is successfully
treated in over 2/3 of patients through rehabilitation protocols designed to reduce pain and
return function to the individual. Applying preventive medicine strategies, the majority of
cases of PFPS may be avoided if a pre-diagnosis can be made by clinician or certified athletic
trainer testing the current researched potential risk factors during a Preparticipation Screening
Evaluation (PPSE). We provide a detailed and comprehensive review of the soft tissue,
arterial system, and innervation to the patellofemoral joint in order to supply the clinician with
the knowledge required to assess the anatomy and make recommendations to patients
identified as potentially at risk. The purpose of this article is to review knee anatomy and the
literature regarding potential risk factors associated with patellofemoral pain syndrome and
prehabilitation strategies. A comprehensive review of knee anatomy will present the
relationships of arterial collateralization, innervations, and soft tissue alignment to the
possible multifactoral mechanism involved in PFPS, while attempting to advocate future use
of different treatments aimed at non-soft tissue causes of PFPS.
Methods: A systematic database search of English language PubMed, SportDiscus, Ovid
MEDLINE, Web of Science, LexisNexis, and EBM reviews, plus hand searching the
reference lists of these retrieved articles was performed to determine possible risk factors for
patellofemoral pain syndrome.
Results: Positive potential risk factors identified included: weakness in functional testing;
gastrocnemius, hamstring, quadriceps or iliotibial band tightness; generalized ligamentous
laxity; deficient hamstring or quadriceps strength; hip musculature weakness; an excessive
quadriceps (Q) angle; patellar compression or tilting; and an abnormal VMO/VL reflex
timing. An evidence-based medicine model was utilized to report evaluation criteria to
determine the at-risk individuals, then a defined prehabilitation program was proposed that
begins with a dynamic warm-up followed by stretches, power and multi-joint exercises, and
culminates with isolation exercises. The prehabilitation program is performed at lower
intensity level ranges and can be conducted 3 days per week in conjunction with general
strength training. Based on an objective one repetition maximum (1RM) test which
determines the amount an individual can lift in good form through a full range of motion,
prehabilitation exercises are performed at 50–60% intensity.
Conclusion: To reduce the likelihood of developing PFPS, any individual, especially those
with positive potential risk factors, can perform the proposed prehabilitation program.
www.stabiliteitstrainingscentrum.nl
Zit in map hoofdcursuss
MICHAEL M. REINOLD, Rafael Escamila, Kevin E. Wilk
Current Concepts in the Scientific and Clinical Rationale
Behind Exercises for Glenohumeral and Scapulothoracic
Musculature Level of evidence Level 5. J Orthop Sports Phys Ther 2009; 39(2):105-117. doi:10.2519/
jospt.2009.2835
Key words electromyography, infraspinatus, serratus anterior, supraspinatus, trapezius
Synopsis The biomechanical analysis of rehabilitation exercises has led to more scientifically
based rehabilitation programs. Several investigators have sought to quantify the biomechanics
and electromyographic data of common rehabilitation exercises in an attempt to fully
understand their clinical indications and usefulness. Furthermore, the effect of pathology on
normal shoulder biomechanics has been documented. It is important to consider the
anatomical, biomechanical, and clinical implications when designing exercise programs. The
purpose of this paper is to provide the clinician with a thorough overview of the available
literature relevant to develop safe, effective, and appropriate exercise programs for injury
rehabilitation and prevention of the glenohumeral and scapulothoracic joints.
www.stabiliteitstrainingscentrum.nl
Swissbal
Rafael F. Escamilla, PT, PhD, CSCS, FACSM1 • Clare Lewis, PT, PsyD, MPH, MTC,
FAAOMPT2 • Duncan Bell, MPT3Gwen Bramblet, MPT3 • Jason Daffron, MPT3 • Steve
Lambert, MPT3 • Amanda Pecson, MPT3Rodney Imamura, PhD4 • Lonnie Paulos, MD5 •
James R. Andrews, MD6
Core Muscle Activation During Swiss Ball and Traditional
Abdominal Exercises J Orthop Sports Phys Ther 2010;40(5):265-276. doi:10.2519/jospt.2010.3073
KEY WORDS: crunch, EMG, low back pain, lumbar spine, rectus abdominis, sit-up
STUDY DESIGN: Controlled laboratory study using a repeated-measures, counterbalanced
design.
OBJECTIVES: To test the ability of 8 Swiss ball exercises (roll-out, pike, knee-up, skier, hip
extension right, hip extension left, decline push-up, and sitting march right) and 2 traditional
abdominal exercises (crunch and bent-knee sit-up) on activating core (lumbopelvic hip
complex) musculature.
BACKGROUND: Numerous Swiss ball abdominal exercises are employed for core muscle
strengthening during training and rehabilitation, but there are minimal data to substantiate the
ability of these exercises to recruit core muscles. It is also unknown how core muscle
recruitment in many of these Swiss ball exercises compares to core muscle recruitment in
traditional abdominal exercises such as the crunch and bent-knee sit-up.
METHODS: A convenience sample of 18 subjects performed 5 repetitions for each exercise.
Electromyographic (EMG) data were recorded on the right side for upper and lower rectus
abdominis,
external and internal oblique, latissimus dorsi, lumbar paraspinals, and rectus femoris, and
then normalized using maximum voluntary isometric contractions (MVICs).
RESULTS: EMG signals during the roll-out and pike exercises for the upper rectus
abdominis (63% and 46% MVIC, respectively), lower rectus abdominis (53% and 55%
MVIC, respectively), external oblique (46% and 84% MVIC, respectively), and internal
oblique (46% and 56% MVIC, respectively) were significantly greater compared to most
other exercises, where EMG signals ranged between 7% to 53% MVIC for the upper rectus
abdominis, 7% to 44% MVIC for the lower rectus abdominis, 14% to 73% MVIC for the
external oblique, and 16% to 47% MVIC for the internal oblique. The lowest EMG signals
were consistently found in the sitting march right exercise. Latissimus dorsi EMG signals
were greatest in the pike, knee-up, skier, hip extension right and left, and decline push-up
(17%-25% MVIC), and least with the sitting march right, crunch, and bent-knee sit-up
exercises (7%-8% MVIC). Rectus femoris EMG signal was greatest with the hip extension
left exercise (35% MVIC), and least with the crunch, roll-out, hip extension right, and decline
push-up exercises (6%-10% MVIC). Lumbar paraspinal EMG signal was relative low (less
than 10% MVIC) for all exercises.
CONCLUSIONS: The roll-out and pike were the most effective exercises in activating upper
and lower rectus abdominis, external and internal obliques, and latissimus dorsi muscles,
while minimizing lumbar paraspinals and rectus femoris activity.
Zit in map hoofdcursus
www.stabiliteitstrainingscentrum.nl
Gregory J Lehman*1, Brandon MacMillan2, Ian MacIntyre1, Michael Chivers1
and Mark Fluter2
Address: 1Department of Graduate Studies, Canadian Memorial Chiropractic College,
Toronto, ON, Canada and 2Undergraduate Department,
Canadian Memorial Chiropractic College, Toronto, ON, Canada
Email: Gregory J Lehman* - [email protected]; Brandon MacMillan -
[email protected]; Ian MacIntyre - [email protected];
Michael Chivers - [email protected]; Mark Fluter - [email protected]
* Corresponding author
Shoulder muscle EMG activity during push up variations
on and off a Swiss ball Dynamic Medicine 2006, 5:7 doi:10.1186/1476-5918-5-7
Abstract
Background: Surface instability is a common addition to traditional rehabilitation and
strength exercises with the aim of increasing muscle activity, increasing exercise difficulty
and improving joint proprioception. The aim of the current study was to determine if
performing upper body closed kinetic chain exercises on a labile surface (Swiss ball)
influences myoelectric amplitude when compared with a stable surface. Methods: Thirteen
males were recruited from a convenience sample of college students. Surface
electromyograms were recorded from the triceps, pectoralis major, latissimus dorsi, rectus
abdominis and external oblique while performing push up exercises with the feet or hands
placed on a bench and separately on a Swiss ball. A push up plus exercise was also evaluated
with hands on the support surface.
Results and discussion: Not all muscles responded with an increase in muscle activity. The
pectoralis major muscle was not influenced by surface stability. The triceps and rectus
abdominis muscles showed increases in muscle activity only when the hands were on the
unstable surface. The external oblique muscle was only influenced by surface stability during
the performance of the push up plus exercise. No muscle showed a change in activation level
when the legs were supported by the Swiss ball instead of the bench.
Conclusion: Muscle activity can be influenced by the addition of surface instability however
an increase in muscle activity does not influence all muscles in all conditions. The
relationship between the participant's center of mass, the location of the unstable surface and
the body part contacting the Swiss ball may be important factors in determining the muscle
activation changes following changes in surface stability.
Zit in map hoofdcursus
Gregory J Lehman*1, Trish Gordon2, Jo Langley2, Patricia Pemrose2 and
Sara Tregaskis2
Address: 1Department of Graduate Studies, Canadian Memorial Chiropractic College,
Toronto, ON, Canada and 2Undergraduate Department,
Canadian Memorial Chiropractic College, Toronto, ON, Canada
Email: Gregory J Lehman* - [email protected]; Trish Gordon - [email protected]; Jo
Langley - [email protected];
Patricia Pemrose - [email protected]; Sara Tregaskis - [email protected]
* Corresponding author
www.stabiliteitstrainingscentrum.nl
Replacing a Swiss ball for an exercise bench causes
variable changes in trunk muscle activity during upper
limb strength exercises Keywords: EMG; exercise; spine; stability; swissballs; rehabilitation; low back pain
Abstract
Background: The addition of Swiss balls to conventional exercise programs has recently
been adopted. Swiss balls are an unstable surface which may result in an increased need for
force output from trunk muscles to provide adequate spinal stability or balance. The aim of
the study was to determine whether the addition of a Swiss ball to upper body strength
exercises results in consistent increases in trunk muscle activation levels.
Methods: The myoelectric activity of four trunk muscles was quantified during the
performance of upper body resistance exercises while seated on both a stable (exercise bench)
and labile (swiss ball) surface. Participants performed the supine chest press, shoulder press,
lateral raise, biceps curl and overhead triceps extension. A repeated measures ANOVA with
post-hoc Tukey test was used to determine the influence of seated surface type on muscle
activity for each muscle.
Results & Discussion: There was no statistically significant (p < .05) difference in muscle
activity between surface conditions. However, there was large degree of variability across
subjects suggesting that some individuals respond differently to surface stability. These
findings suggest that the incorporation of swiss balls instead of an exercise bench into upper
body strength training regimes may not be justified based only on the belief that an increase
spinal stabilizing musculature activity is inherent. Biomechanically justified ground based
exercises have been researched and should form the basis for spinal stability training as
preventative and therapeutic exercise training regimes.
Conclusion: Selected trunk muscle activity during certain upper limb strength training
exercises is not consistently influenced by the replacement of an exercise bench with a swiss
ball.
Zit in map hoofdcursus
Diane E. Gregory, Nadine M. Dunk, and Jack P. Callaghan, University of Waterloo,
Waterloo, Ontario, Canada
Stability Ball Versus Office Chair:m Comparison of Muscle
Activation and Lumbar Spine Posture During Prolonged
Sitting CONCLUSION
There does not appear to be any advantage to using a stability ball as an office chair. No
postural or muscular activation differences were observed between the ball and the chair, with
the exception of reduced pelvic tilt while sitting on the ball. However, the increased reported
discomfort and potential safety issues associated with sitting on an unstable surface question
the use of a stability ball as an office chair.
Zit in map hoofdcursus