Arch Phys Med Rehabil. 2018 Feb 21. pii: S0003-9993(18)30116-3. doi: 10.1016/j.apmr.2018.01.027. [Epub ahead of print]
Best Core Stabilization for Anticipatory Postural Adjustment and Falls in Hemiparetic Stroke
.Lee NG1, You JSH2, Yi CH3, Jeon HS3, Choi BS1, Lee DR4, Park JM5, Lee TH6, Ryu IT7, Yoon HS8.Author information
OBJECTIVES:To compare the effects of conventional core stabilization and dynamic neuromuscular stabilization (DNS) on anticipatory postural adjustment (APA) time, balance performance, and fear of falls in chronic hemiparetic stroke.
DESIGN:Two-group randomized controlled trial with pretest-posttest design.
SETTING:Hospital rehabilitation center.
PARTICIPANTS:Adults with chronic hemiparetic stroke (N=28).
INTERVENTIONS:Participants were randomly divided into either conventional core stabilization (n=14) or DNS (n=14) groups. Both groups received a total of 20 sessions of conventional core stabilization or DNS training for 30 minutes per session 5 times a week during the 4-week period.
MAIN OUTCOME MEASURES:Electromyography was used to measure the APA time for bilateral external oblique (EO), transverse abdominis (TrA)/internal oblique (IO), and erector spinae (ES) activation during rapid shoulder flexion. Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), and Falls Efficacy Scale (FES) were used to measure trunk movement control, balance performance, and fear of falling.
RESULTS:Baseline APA times were delayed and fear of falling was moderately high in both the conventional core stabilizationand DNS groups. After the interventions, the APA times for EO, TrA/IO, and ES were shorter in the DNS group than in the conventional core stabilization group (P<.008). The BBS and TIS scores (P<.008) and the FES score (P<.003) were improved compared with baseline in both groups, but FES remained stable through the 2-year follow-up period only in the DNS group (P<.003).
CONCLUSIONS:This is the first clinical evidence highlighting the importance of core stabilization exercises for improving APA control, balance, and fear of falls in individuals with hemiparetic stroke.
IMPORTANCE: Limited evidence is available regarding long-term outcomes of opioids compared with nonopioid medications for chronic pain.
OBJECTIVE: To compare opioid vs nonopioid medications over 12 months on pain-related function, pain intensity, and adverse effects.
DESIGN, SETTING, AND PARTICIPANTS: Pragmatic, 12-month, randomized trial with masked outcome assessment. Patients were recruited from Veterans Affairs primary care clinics from June 2013 through December 2015; follow-up was completed December 2016. Eligible patients had moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use. Of 265 patients enrolled, 25 withdrew prior to randomization and 240 were randomized.
INTERVENTIONS: Both interventions (opioid and nonopioid medication therapy) followed a treat-to-target strategy aiming for improved painand function. Each intervention had its own prescribing strategy that included multiple medication options in 3 steps. In the opioid group, the first step was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. For the nonopioid group, the first step was acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug. Medications were changed, added, or adjusted within the assigned treatment group according to individual patient response.
MAIN OUTCOMES AND MEASURES: The primary outcome was pain-related function (Brief Pain Inventory [BPI] interference scale) over 12 months and the main secondary outcome was pain intensity (BPI severity scale). For both BPI scales (range, 0-10; higher scores = worse function or pain intensity), a 1-point improvement was clinically important. The primary adverse outcome was medication-related symptoms (patient-reported checklist; range, 0-19).
RESULTS: Among 240 randomized patients (mean age, 58.3 years; women, 32 [13.0%]), 234 (97.5%) completed the trial. Groups did not significantly differ on pain-related function over 12 months (overall P = .58); mean 12-month BPI interference was 3.4 for the opioid group and 3.3 for the nonopioid group (difference, 0.1 [95% CI, -0.5 to 0.7]). Pain intensity was significantly better in the nonopioid group over 12 months (overall P = .03); mean 12-month BPI severity was 4.0 for the opioid group and 3.5 for the nonopioid group (difference, 0.5 [95% CI, 0.0 to 1.0]). Adverse medication-related symptoms were significantly more common in the opioid group over 12 months (overall P = .03); mean medication-related symptoms at 12 months were 1.8 in the opioid group and 0.9 in the nonopioid group (difference, 0.9 [95% CI, 0.3 to 1.5]).
CONCLUSIONS AND RELEVANCE: Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01583985.
DNS stands for Dynamic Neuromuscular Stabilization. DNS was developed by Professor Pavel Kolar of the Prague School of Rehabilitation at Charles University Motol Hospital in the Czech Republic. DNS is a system based on developmental kinesiology and human ontogenesis. Every human with a normally developing central nervous system activates the same sequence of movement, locomotor, patterns. These patterns are ideal with perfect joint centration (maximum bearing surface congruency) and co-activation of the agonist/antagonist musculature controlling the joint. These patterns are unlearned and are genetically programmed or pre-determined. DNS is concerned with activating these patterns to restore ideal biomechanics and human locomotion. A foundational concept in DNS is activation of the Intrinsic Spinal Stabilization System (ISSS) through the mechanism of Intra-Abdominal Pressure (IAP). When we have proper activation and descent of the diaphragm, concentric activity, we compress our viscera creating increased IAP pushing back against the trunk wall in all directions. Due to the increased IAP we have reactive eccentric activity of all of the components of the trunk and pelvic floor. This fixes/stabilizes the ISSS and makes the trunk an anchor for distal and proximal muscle pull from the extremities. This mechanism is pre-requisite for all other purposeful extremity movement to stabilize the trunk and prevent aberrant movement in the spine. This mechanism represents a global pattern of control that when working properly ensures the most efficient strategy for human locomotion
This hallmark study shows the stabilization function of the trunk that is required preceding any purposeful movement of the extremities. The trunk functions as an anchor for muscle pull towards and away from the spine. This is governed by a global motor control pattern or strategy. When there is dysfunction in the motor control pattern (CNS) there is instability and aberrant movement in the spine. Dynamic Neuromuscular Stabilization (DNS) accesses and restores the ideal movement strategy/global motor control pattern.
Where has the year gone? It is almost December and the holiday season is in full swing! This is a wonderful time of the year but it’s also a time when our exercise regimen takes a backseat to our indulgences. Did you vow to exercise more this year? Or maybe you are already thinking of your soon to be New Year’s Resolutions. The time is now. The best answer to staying healthy is staying active.
Exercise brings about the following myriad of benefits:
Decreased risk of cardiovascular disease
Decreased risk of Type 2 diabetes
Decreased risk of osteoporosis (weight bearing/strengthening exercise)
Decreased risk of certain types of cancer
Decreased risk of falls
Improved mood and outlook on life
How can I get started you might ask? Well it’s as simple as getting outside and going on a brisk walk. Research suggests that brisk walking at a moderate-intensity can provide benefits for you. So, if you think you are not in shape enough to begin. Think again.
DID YOU KNOW??? Most frail, older individuals gain benefit from exercise at least as much as younger people. !!
If you have a chronic health condition- it is always important to talk to your doctor about beginning a safe program for you-
But, the bottom line is: the health benefits far outweigh the risks of getting hurt.
If you have questions feel free to ask Dr. Brad Kulig or myself, Dr. Julie Kulig. We are happy to provide you with advice on beginning an exercise regimen.
With fall sports upon us, here is an interesting article on how to increase athletic performance:
A non-randomized experimental feasibility study into the immediate effect of three different spinal manipulative protocols on kicking speed performance in soccer players. -Chiropr Man Therap. 2015 Jan 13; 23 (1)
There were 4 groups of 10:
group 1: SI joint manipulation
group 2: lumbar spine manipulation
group 3: combination of lumbar spine and SI joint manipulation
group 4: laser
result: significant increase in kicking speed/ performance in the manipulation groups with the best being the combination group 3.
Moral of the story: to improve performance in your sport - come get adjusted.
Did you know 9/10 Americans suffer from headaches?(1) What do you do when you have a headache? Pop an Advil? Does it go away? Did you know there is a better alternative?
In 2014 the Journal of Manipulative and Physiological Therapeutics (JMPT) found that interventions commonly used in chiropractic care improved outcomes for the treatment of acute and chronic neck pain. In 2011 a study published in JMPT found that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches.(2)
Headaches have many triggers. The majority of headaches are caused by muscle tension in the neck. With hours spent texting on our cell phones, sitting at a desk or sitting in front of a computer screen, it’s no wonder we leave work with a pounding headache.
We’ve all heard of the recent term “text neck” and it’s no joke. When we spend hours at a time in a static position we are asking for joint irritation and muscle tension in the upper back, neck and head.
Chiropractic care can help reduce muscle tension and restore proper joint function, while alleviating pain. We use a combination of spinal manipulation, manual soft tissue manipulation, and corrective exercises to help reduce and control your pain.
If you’re suffering from chronic headaches- suffer no more- come see us today!
2. Bryans R, Descarreaux M, Duranleau M, et al. Evidence based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther 2011; 34: 274-89.
by: Julie E. Kulig, DC
Pregnancy is a beautiful time, a time of new beginnings, a time of joy and new life. It also can be a time of discomfort. Many pregnant ladies, especially those entering into the second and third trimesters complain of low back, mid back, and hip pain. Many pregnant ladies feel like they have no options because they don’t want to take any medications that may have an impact their unborn child.
Why so much pain with pregnancy you may wonder?
As your baby grows your center of mass shifts anteriorly, causing an increase in lumbar lordosis resulting in associated low back and pelvic discomfort. This increase in lordosis also places additional stressors on the thoracic spine resulting in pain. The muscles in our low back tighten and the muscles in the front of our thighs begin to shorten; further increasing the lumbar lordosis which again places stress on our low back, mid back, neck, and ribs. These biomechanical stresses can cause musculoskeletal pain throughout the entire body. (1)
Pregnancy should be a time of excitement, not pain. Pregnant women should know- Chiropractic care is a great option for those with any musculoskeletal pain! Chiropractic manipulation and myofascial (muscle) work are highly effective, evidence-based, safe options for those of you suffering from mechanical based back or neck pain. In a study found in the Journal of the American Osteopathic Association they found that patients who received regular obstetric care, along with osteopathic manual treatment were SIGNIFICANTLY less likely to experience progressive back-specific dysfunction associated with pregnancy. (2)
Chiropractic care also helps to create a healthy environment for the baby which encourages a healthy birthing experience. Research shows that chiropractic care during pregnancy may even help to shorten birthing times (3) Pregnancy is a time of great joy. Let us help you keep it that way and keep you feeling your best throughout your pregnancy and beyond.
2. Licciardone, JC, and S. Aryal. "Prevention of Progressive Back-specific Dysfunction during Pregnancy: An Assessment of Osteopathic Manual Treatment Based on Cochrane Back Review Group Criteria." The Journal of the American Osteopathic Association (n.d.): n. pag. Pubmed.gov. The Osteopathic Research Center. Web. 13 July 2016.
3. Borggren CL. Pregnancy and chiropractic: a narrative review of the literature. Journal of Chiropractic Medicine. 2007;6(2):70-74. doi:10.1016/j.jcme.2007.04.004.