THE BACK PAGE RESEARCH REVIEW Mini reviews REVIEWED BY SHAWN THISTLE In this edition of Research review , we present two mini-reviews from Research Review Service’s publication: Top Papers Not Reviewed by Research Review Service in – the full document is available at www.researchreviewservice.com. Whereas our regular column goes into more depth, detail and analysis, as well as focusing our readers on the clinical applications of the studies, these mini-reviews provide a more general overview of the research papers in question. function. Overall, however, the evidence on the clinical e cacy of CSE compared with other exercises is sparse for pain and disability, showing confl icting, or at best, small e ects. The purpose of this randomized controlled trial was to in-vestigate the effect of three different exercise interventions on feed-forward activation or timing of deep abdominal muscles in chronic LBP patients. Results Overall, very minor or no e ects were found in onset after CSE treatment, meaning abdominal muscle onset was largely una ected by eight weeks of exercises in chronic LBP patients. Fur-ther, there was no association between change in onset and LBP itself. Comments This was one of the fi rst randomized trials investigating di erent loads and types of exercises, including CSEs, on abdominal muscle feed-forward activa-tion (timing) in patients with chronic LBP. Unfortunately, the results add further doubt to the clinical impor-tance of muscle activation “timing” in LBP. Clinicians should remember that prior research has demonstrated that deep abdominal muscles activate vari-ably in both healthy and LBP popula-tions. These large variations between individuals may justify exploration of differential effects in subgroups of LBP, but for now the exact manner in which we can utilize and interpret this information remains controversial. This does not mean that CSEs may not be e ective, and it is well established that exercise (any type, really) is a very e ective intervention for LBP! Get your patients moving! For current and previous research reviews by Shawn Thistle, please visit www.canadianchiropractor.ca. www.canadianchiropractor.ca Study #: Painful shoulder and side of sleeping STUDY TITLE: Association between the side of unilateral shoulder pain and preferred sleeping position: A cross sectional study of Danish patients AUTHORS: Kempf B and Kongsted A PUBLICATION INFORMATION: J Manipulative Physiol Ther ; : -. could recommend switching sides of the bed (even temporarily to relieve pain) in those who sleep with a spouse or partner. Study #: Core stability exercise and feed-forward activation of deep abdominal muscles in chronic LBP STUDY TITLE: Eff ect of core stability exercises on feed-forward activation of deep abdominal muscles in chronic low back pain: A randomized controlled trial AUTHORS: Vasseljen O et al. PUBLICATION INFORMATION: Spine ; (): -. Summary This cross-sectional study addressed a question that we encounter frequently in practice – can sleeping position a ect my shoulder pain? No evidence exists to support, nor refute, this theory. The authors evaluated adult patients seek-ing chiropractic care and with unilateral shoulder pain – the patients were asked about sleeping position and, if sleeping with a partner, which side of the bed they slept on. A total of participants were included from chiropractic clinics. Results This study shed some light on a rela-tionship that, until this point, has been described with pure speculation or an-ecdote. Even though the sample size wasn’t huge ( subjects), the results certainly reveal that clinicians should inquire about the preferred side for sleeping in patients with generalized shoulder pain. Although altering sleep-ing position may be di cult, clinicians Summary It is generally accepted that low back pain (LBP) may contribute to, or result from, motor control alterations in trunk/ abdominal musculature; however, the exact nature of this relationship remains unclear. Core stability exercises (CSEs) originally became popular in LBP treatment and rehabilitation based on observed changes in abdominal muscle activation patterns in LBP patients. Because deep trunk muscles contribute to stabilization of the spine, it is hypoth-esized that any defi cit in feed-forward activation may increase one’s suscepti-bility to spinal injury or dysfunction. CSEs typically consist of low-load ex-ercises emphasizing voluntary and isolated control of trunk muscles, which is assumed to help restore trunk motor SHAWN THISTLE, BKIN HONS, DC, CSCS, practises full time in Toronto. He is the founder and president of Research Review Service Inc., an online, subscription-based service designed to help busy practitioners integrate current, relevant, scientific evidence into their practice (www.researchreviewservice.com). 42 Canadian Chiropractor July/August 2013
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