Musculoskeletal Unit

Leuven, Belgium

Musculoskeletal Unit

Leuven, Belgium

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Astfalck R.G.,Curtin University Australia | O'Sullivan P.B.,Curtin University Australia | O'Sullivan P.B.,Telethon Institute of Child Health Research | Straker L.M.,Curtin University Australia | And 7 more authors.
Spine | Year: 2010

Study Design.: A preliminary cross-sectional comparative study of adolescents with nonspecific chronic low back pain (NSCLBP) and healthy controls. Objective.: To investigate whether differences in spinal kinematic and trunk muscle activity exist in both usual and slump sitting in adolescents with NSCLBP. Summary of Background.: Evidence suggests that low back pain commonly develops in adolescence and increases the risk for low back pain in adulthood. Sitting is an important consideration in adolescents with NSCLBP: currently there are no reports investigating their motor control strategies in sitting. Methods.: Twenty-eight adolescents (14 female) with NSCLBP and 28 matched pain-free controls were recruited from a large cohort study. Pain subjects were subclassified based on O'Sullivan's classification system. Three-dimensional lumbo-pelvic kinematic data and the activation of 3 back and 2 abdominal muscles were recorded during usual and slump sitting. The flexion-relaxation phenomenon in sitting was also investigated. Results.: Spinal posture in usual and slump sitting were similar for adolescents with and without NSCLBP. However, differences were identified in both sitting conditions when those with NSCLPB were subclassified and compared with controls. Muscle activation differences were not consistently identified, with only lower levels of internal oblique activation in usual sitting in NSCLBP compared with pain-free controls showing significance. Flexion relaxation was observed in both iliocostalis and thoracic erector spinae in the NSCLBP group but not controls. Conclusion.: This study provides preliminary results. Differences with sitting posture are only seen when adolescents with NSCLBP are classified. Trunk muscle activation is not a sensitive marker for discriminating subgroups of NSCLBP during adolescence. © 2010, Lippincott Williams & Wilkins.


Bunzli S.,University of Melbourne | McEvoy S.,University of Limerick | Dankaerts W.,Musculoskeletal Unit | O'Sullivan P.,Curtin University Australia | O'Sullivan K.,University of Limerick
Physical Therapy | Year: 2016

Background. Cognitive functional therapy (CFT) has been shown to reduce pain and disability in people with chronic low back pain. Objectives. The purpose of this study was to investigate participants’ experience of CFT by comparing participants who reported differing levels of improvement after participation in CFT, potentially yielding insight into the implementation of this approach. Design. This was a noninterventional, cross-sectional, qualitative study with an interpretive description framework. Methods. Individuals who had participated in CFT in 2 physical therapy settings (in Ireland and Australia) were recruited through purposive sampling based on disability outcomes postintervention (n=9), and theoretical sampling (n=5). This sampling strategy was used to capture a range of participant experiences but was not used to define the final qualitative groupings. Semistructured interviews were conducted 3 to 6 months postintervention. Results. Three groups emerged from the qualitative analysis: large improvers, small improvers, and unchanged. Two themes encapsulating the key requirements in achieving a successful outcome through CFT were identified: (1) changing pain beliefs and (2) achieving independence. Changing pain beliefs to a more biopsychosocial perspective required a strong therapeutic alliance, development of body awareness, and the experience of control over pain. Independence was achieved by large improvers through newly cultivated problem-solving skills, self-efficacy, decreased fear of pain, and improved stress coping. Residual fear and poor stress coping meant that small improvers were easily distressed and lacked independence. Those who were unchanged continued to feel defined by their pain and retained a biomedical perspective. Conclusions. A successful outcome after CFT is dependent on instilling biopsychosocial pain beliefs and developing independence among participants. Small improvers may require ongoing support to maintain results. Further study is needed to elucidate the optimal approach for those who were unchanged. © 2016 American Physical Therapy Association.

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