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The importance of incorporating lumbo-pelvic stability core and controlling motor exercises in patients with chronic low back pain (CLBP) reinforces the use of strategies to improve biopsychosocial beliefs by reducing biomedical postulations. However, clinical practice guidelines recommend multimodal approaches incorporating exercise and manual therapy (MT), and instead reject the application of kinesiotape (KT) in isolation. Therefore, the objectives of this study were to analyze the effects of 12 weeks of exercises combined with MT or KT on perceived low back pain using the visual analog scale (VAS) and muscle electric activity measured with electromyography (EMG) of the rectus abdominis and multifidus in CLBP (mild disability) and to explore the relationship between the rectus abdominis and multifidus ratios and pain perception after intervention. A blinded, 12-week randomized controlled trial (RCT) was carried out, involving three parallel groups of patients with CLBP. The study was registered at Clinicaltrial.gov and assigned the identification number NCT05544890 (19/09/22). The trial underwent an intention-to-treat analysis. The primary outcome revealed a multimodal treatment program supplemented by additional therapies such as MT and KT, resulting in significant reductions in perceived low back pain. The subjective assessment of individuals with CLBP indicated no discernible distinction between exclusive core stability exercises and control-motor training when combined with MT or KT. Notably, our findings demonstrated positive alterations in both the mean and peak EMG values of the right rectus abdominis in the exercise group, suggesting a beneficial impact on muscle activation. This study focused on assessing the activation levels of the trunk musculature, specifically the rectus abdominis (RA) and multifidus (MF), in individuals with CLBP exhibiting mild disability according to the Oswestry Disability Index. Importantly, improvements in the VAS values were observed independently of changes in muscle electrical activity.

Chronic pelvic pain syndrome (CPPS) is frequently associated with psychological issues. Repetitive peripheral magnetic stimulation (rPMS) is potentially effective in treating CPPS, while repetitive transcranial magnetic stimulation (rTMS) has demonstrated therapeutic effects on anxiety and depression. Therefore, the study proposed herein aims to assess the efficacy and safety of dual-target magnetic stimulation in CPPS patients with psychological disorders. This prospective, double-blind, randomized controlled trial will recruit 75 CPPS participants. After stratification by sex, participants will be randomly assigned via block randomization (1:1:1), sequentially based on enrollment order, to one of three groups: dual-target magnetic stimulation (rPMS and rTMS), rPMS, and sham stimulation, all receiving standard treatment. The dual-site magnetic stimulation group will receive left dorsolateral prefrontal cortex (DLPFC) rTMS (120% resting motor threshold [RMT], 10 Hz, 4-s stimulation, 26-s interval, 3000 pulses in total [depression cases]) or right DLPFC rTMS (120% RMT, 1 Hz, 10-s stimulation, 2-s interval, 1000 pulses in total [anxiety cases]) combined with rPMS (50% of maximum stimulation intensity, 20 Hz, 2-s stimulation, 28-s interval, 1600 pulses in total). The rPMS group will receive only rPMS. The sham stimulation group will undergo sham transcranial and peripheral stimulation. All treatments will be administered five times a week, once daily, for 4 weeks. Primary outcomes will be the pelvic pain scale (females) or the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI, males). Secondary outcomes will include assessment of pelvic floor muscle surface electromyography, pudendal nerve motor evoked potentials, the Depression, Anxiety, and Stress Scale (DASS-21), and the Short Form 36 (SF-36) quality of life scale. We hypothesize that dual-target magnetic stimulation will show greater effectiveness than rPMS and sham stimulation in relieving pain symptoms and psychological distress in CPPS patients with comorbid mental disorders. The study was prospectively registered at the Chinese Clinical Trial Registry (ChiCTR; http://www.chictr.org.cn, ID: ChiCTR2300078761) on December 18, 2023; Protocol version 1.0-20220709.

Purpose Neck and shoulder complaints are common among employees in occupations characterized by intensive computer use. Treatment has varied from passive rest to active treatments and active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area. Our study investigates the effect of the latter approach. The purpose of this study was in a randomised controlled trial to investigate if intensive scapular function training (SFT)—in terms of training of the lower trapezius and the serratus anterior muscle while minimizing direct training of the upper trapezius—is effective in reducing pain in adults with chronic non-specific pain in the neck/shoulder region. Methods 47 office workers with chronic non-specific pain in the neck/shoulder region were randomized to 10 weeks 3 × 20 min SFT with training supervision or to a control group. At baseline and at follow-up the participants were tested for maximum isometric shoulder strength by a blinded tester. Further, once a week participants reported pain intensity of the neck/shoulder during the previous week. Results In intention-to-treat analysis neck- and shoulder pain decreased 2.0 (95 % CI 0.35; 3.64) in SFT compared with control group ( p  < 0.05). Pressure Pain Threshold (PPT) increased 129 kPa in the lower trapezius in SFT compared with the control group ( p  < 0.01). Shoulder elevation strength increased 7.7 kg in SFT compared with the control group ( p  < 0.01) with no change in shoulder protraction strength. Conclusions SFT reduces pain intensity and increases shoulder elevation strength in adults with chronic non-specific pain in the neck/shoulder region. The magnitude of improvement in pain intensity was clinically relevant.

Background This study was conducted to determine the effects of combined exercises applied with supervised and telerehabilitation methods on pain intensity, pain pressure threshold, muscular endurance, grip strength, neck and upper extremity disabilities in dentists with chronic neck pain (CNP). Methods Fifty-five dentists with CNP were included in the study and randomly divided into three groups as supervised group ( n  = 19), telerehabilitation group ( n  = 19) and control group ( n  = 17). The participants had a mean age of 35.20 ± 4.16 years, with ages ranging from 30 to 44 years and of the participants, 43 were female (78%) and 12 were male (22%). Combined exercises consisting of resistance, stretching and postural alignment exercises were applied with supervised and telerehabilitation methods three days a week for 12 weeks. The control group received a non-resistance exercise sheet matching the other protocols. Initially, all patients were assessed for pain intensity (VAS), pain pressure threshold, grip strength (hand, lateral and pinch grip), muscular endurance (deep neck flexors, scapular, static and dynamic core), neck and upper extremity disability. The assessments were repeated after 12 weeks of training. Results The telerehabilitation group demonstrated positive changes in pain intensity, pain pressure threshold, and neck disability that were statistically significant ( p  < 0.05). Supervised group has improved all assessments except dynamic core endurance and grip strength ( p  < 0.05). There was also a decrease in pain intensity and neck disability index in the control group ( p  < 0.05). When the changes resulting from exercise training were compared between the groups, it was seen that the changes in the supervised group were superior ( p  < 0.05). Conclusions The results showed that combined exercises applied under supervision were more effective than telerehabilitation or home exercises in dentists with CNP, and telerehabilitation was more effective than home program. Although the telerehabilitation method is not as effective as supervised exercise training, it can be an alternative method to reduce pain and disability for dentists who cannot participate in a regular exercise program due to their working conditions. Long-term follow-up studies are needed to determine how long the effect of exercise training applied with telerehabilitation continues in dentists with CNP.

Purpose To evaluate the effect of a multidisciplinary rehabilitation programme on disability, kinesiophobia, catastrophizing, pain, quality of life and gait disturbances in patients with chronic low back pain (CLBP). Methods This was a parallel-group, randomised, superiority-controlled pilot study in which 20 patients were randomly assigned to a programme consisting of motor training (spinal stabilising exercises plus usual-care) and cognitive–behavioural therapy (experimental group, 10 subjects) or usual-care alone (control group, 10 subjects). Before treatment, 8 weeks later (post-treatment), and 3 months after the end of treatment, the Oswestry Disability Index, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, a pain numerical rating scale, and the Short-Form Health Survey were assessed. Spatio-temporal gait parameters were also measured by means of an electronic walking mat. A linear mixed model for repeated measures was used for each outcome measure. Results The programme had significant group ( p  = 0.027), time ( p  < 0.001), and time-by-group interaction ( p  < 0.001) effects on disability, with the experimental group showing an improvement after training of about 61 % (25 % in the control group). The analyses of kinesiophobia, catastrophizing, and the quality of life also revealed significant time, group, and time-by-group interaction effects in favour of the experimental group, and there was a significant effect of time on pain. Both groups showed a general improvement in gait parameters, with the experimental group increasing cadence significantly more. Conclusion The multidisciplinary rehabilitation programme including cognitive–behavioural therapy was superior to the exercise programme in reducing disability, kinesiophobia, catastrophizing, and enhancing the quality of life and gait cadence of patients with CLBP.

Background As a leading cause of disability, chronic low back pain (CLBP) is a musculoskeletal condition often associated with impaired physical and cognitive functions. Due to its multi-factorial facets, the application of multimodal interventions is recommended. MultiMove is a multimodal intervention designed for CLBP patients, which combines motor-cognitive and dancing exercises. This study aimed to assess the effects of an additional MultiMove intervention to a standard inpatient rehabilitation on clinical and functional outcomes in CLBP patients. Methods For this prospective, two-arm, controlled pilot trial, 27 CLBP patients (17 females, 10 males) undergoing a 3-week inpatient rehabilitation, in a rehabilitation clinic in Germany, were recruited. The intervention group (IG, n  = 15, 61.6 ± 1.8 years) received a daily MultiMove session in addition to the standard rehabilitation, while the control group (CG, n  = 12, 63.8 ± 2.2 years) followed the standard rehabilitation. Physical (Timed Up and Go (TUG) [primary outcome], Five-Repetition Sit-to-Stand (FRSTS), and Six-Minute Walk Test (6MWT), trunk range of motion, single and dual task walking)), clinical (acute/chronic pain intensity, Oswestry Disability Index, EQ-5D-5 L), cognitive (Stroop Color Word Test, Trail Making Test), and psychosocial outcomes (Tampa Scale of Kinesiophobia, Beck Depression Inventory-II, Coping Strategies Questionnaire) were assessed during the first (pre-test) and last day (post-test) of the inpatient rehabilitation. Results The statistical analyses revealed improvements in trunk range of motion (sagittal plane: p  = 0.018, d  = 1.00; transversal plane: p  = 0.006, d  = 1.18) and 6MWT performance ( p  = 0.003, d  = 1.30) in the IG compared to the CG. Moreover, lower dual task costs for a gait variability measure ( p  = 0.034, d  = 0.97) as well as reduced chronic pain intensity ( p  = 0.004, d  = 1.33), kinesiophobia ( p  = 0.035, d  = 1.15), and depression ( p  = 0.034, d  = 1.08) were found in favour of the IG. Conclusion Data indicate that the multimodal intervention MultiMove improved clinical and functional outcomes in CLBP patients during inpatient rehabilitation. Therefore, conducting a randomized controlled trial with a large sample size is recommended to verify and extent these results. Trial registration MultiMove project (German Clinical Trial Register, ID: DRKS00021696 / 10.07.2020, https://drks.de/drks_web/navigate.do?navigationId=trial.HTML26TRIAL_ID=DRKS00021696 ) and was carried out in the rehabilitation clinic Bad Salzelmen (Schönebeck, Germany).

Purpose We systematically reviewed the evidence on factors that predict duration of sick leave in workers after 6 weeks low back pain (LBP) related sick leave. We hypothesized that different factors affect the duration of the leave depending on the time away from work. Methods The review occurred in seven phases: (1) developing the central question, (2) conducting the literature search, (3) identifying relevant publications, (4) quality appraisal, (5) data extraction, (6) evidence synthesis, and (7) knowledge translation. We searched for studies that reported episodes of LBP and sick leave that lasted more than 6 weeks. All included studies reported at least one prognostic factor where return to work was the outcome. Results We identified twenty-two relevant publications. The impact of pain, functional status and radiating pain seems to change with duration of work disability. Workers’ recovery expectations remain important after 6 weeks. Modified duties are rarely studied in later phases of work disability. Depression/mental health did not appear to be an important factor in later phases. Workplace physical factors remain important. There is insufficient evidence that pain catastrophising and fear avoidance are predictive factors in later phases. There was moderate evidence for age in the later phases. Functional capacity and claim related factors were supported by some evidence. Discusion Physical demands in the workplace are preventing workers from getting back to work in a timely fashion across phases. The psychosocial work environment is understudied in later phases. Overall, we cannot conclude that prognostic factors change over time.

Background: Non-specific chronic neck pain is a prevalent musculoskeletal disorder with a significant impact on individuals’ quality of life. The lack of consensus on effective therapeutic management complicates the establishment of standardized treatment protocols. Home exercise programs have yielded positive results. This study aimed to assess the effectiveness of a telerehabilitation program distributed through videoconferencing for patients with non-specific chronic neck pain compared to a home-based exercise program. Methods: A randomized controlled trial was conducted involving 36 participants who were divided into two groups: the experimental group (n = 18) received manual therapy combined with telerehabilitation, while the home-based group (n = 18) received the same manual therapy treatment along with recommendations for home exercises. Key outcome measures, including neck-related disability, kynesiophobia, anxiety and depression, pain intensity, pressure pain threshold, quality of life, and adherence to self-treatment, were evaluated at baseline and post-treatment. Results: No statistically significant differences were observed between groups. However, both groups demonstrated improvements in all study variables except for the mental component of quality of life immediately post-treatment. Conclusions: After eight weeks of manual therapy and exercise, both the telerehabilitation and home-based exercise programs resulted in significant improvements in disability, pain, and kynesiophobia, indicating that telerehabilitation is as effective as home-based exercise.

IntroductionPostpartum lumbopelvic pain (LPP) is a prevalent condition among women following childbirth. Due to the importance of respiratory muscles in lumbopelvic stability, and the changes they undergo during pregnancy, this study aims to assess the effects of motor control training and breathing exercises on pain, disability and core muscle activity in women suffering from LPP after childbirth.Methods and analysis52 women with postpartum LPP will participate in this two-parallel-armed, superiority randomised controlled trial, comprising 24 treatment sessions. The intervention group consists of motor control training and breathing exercises, and the control group includes motor control training. The diaphragm excursion, pelvic floor and abdominal muscle activity, pain and disability will be evaluated using ultrasound imaging, visual analogue scale and Oswestry Disability Index, before and after the intervention, respectively.Ethics and disseminationEthical approval was obtained from the human research ethics committee of the Iran University of Medical Sciences (IR.IUMS.REC.1403.017). The study results will be submitted to a relevant journal and conferences.Trial registration numberThis clinical trial has been registered in the Iranian Registry of Clinical Trials on 21 May 2024 (registration number: IRCT20180916041051N2).