CASE REPORT
Low back pain in the overhead athletes: Evaluation and treatment based on movement system
Jakub Ławnicki 1,   Michał Hadała 2,3  
,   Wojciech Zaręba 1,3
 
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1
Department of Physical Therapy, Medical University of Gdańsk, Poland
2
Universidad Catolica de Valencia, Spain
3
Fizjo-Sport, Poland
CORRESPONDING AUTHOR
Michał Hadała   

Stokrotek 10, 35-604 Rzeszów, Poland.
Submission date: 2017-01-05
Acceptance date: 2017-03-28
Online publication date: 2017-07-01
Publication date: 2019-12-20
 
Pol. Ann. Med. 2017;24(2):214–220
 
KEYWORDS
ABSTRACT
Introduction:
Low back pain (LBP) is a common problem in sports. There is high risk for back pain occurrence in athletes. The knowledge about LBP in overhead athletes is limited. The Movement System (MS) approach is based on association of symptoms and incorrect movements of the spine. The main goal is to identify the localization and direction of improper movements and to restore appropriate motor control of the movement pattern.

Aim:
To present functional evaluation and therapeutic approach based on the MS in the case of LBP in overhead athlete.

Case study:
The study presents a 26-year-old overhead athlete with chronic mechanical LBP, which is related to his sports activity. He reported exacerbation incidents, which had eliminated him from physical activity.

Results and discussion:
Physical examination of the patient had shown deficit of lumbar motor control in directions of extension and rotation of pelvis coupled with functional alterations in muscles. These movements were associated with pain symptoms. The patient had undergone a 4-month-lenght-therapy program, which was focused on spine motor control training and functional reeducation of muscles. A subsequent examination showed an improvement in motor control of the movement and considerable decrease of pain symptoms.

Conclusions:
(1) The MS approach allows to identify the incorrect movement and to relate it with pain symptoms. (2) Reeducation of motor control based on movement system evaluation allows decreasing pain symptoms.

 
REFERENCES (43)
1.
Deyo RA, Tsui-Wu YJ. Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine. 1987;12(3):264–268.
 
2.
Jette AM, Smith K, Haley SM, Davis KD. Physical therapy episodes of care for patients with low back pain. Phys Ther. 1994;74(2):101–110.
 
3.
Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41(5):778–799.
 
4.
Tymecka-Woszczerowicz, Wrona W, Kowalski PM, Hermanowski T. Indirect costs of back pain—review. Pol Ann Med. 2015;22(2):143–148.
 
5.
Hoogendoorn WE, van Poppel MN, Bongers PM, Koes BW, Bouter LM. Physical load during work and leisure time as risk factors for back pain. Scand J Work Environ Health. 1999;25(5):387–403.
 
6.
Picavet HSJ, Schuit AJ. Physical inactivity: a risk factor for low back pain in the general population. J Epidemiol Community Health. 2003;57(7):517–518.
 
7.
Arnau JM, Vallano A, Lopez A, Pellisé F, Delgado MJ, Prat N. A critical review of guidelines for low back pain treatment. Eur Spine J. 2006;15(5):543–553.
 
8.
Karmisholt K, Gotzsche PC. Physical activity for secondary prevention of diseases: systematic reviews of randomized clinical trials. Dan Med Bull. 2005;52(2):90–94.
 
9.
Hendrick P, Milosavljevic S, Hale L, et al. The relationship between physical activity and low back pain outcomes: a systematic review of observational studies. Eur Spine J. 2011;20(3):464–474.
 
10.
Harris-Hayes M, Sahrmann SA, van Dillen LR. Relationship between the hip and low back pain in athletes who participate in rotation-related sports. J Sport Rehabil. 2009;18(1):60–75.
 
11.
Sward L, Hellstrom M, Jacobsson B, Peterson L. Back pain and radiologic changes in the thoracolumbar spine of athletes. Spine. 1990;15(2):124–129.
 
12.
Triki M, Koubaa A, Masmoudi L, Fellmann N, Tabka Z. Prevalence and risk factors of low back pain among undergraduate students of a sports and physical education institute in Tunisia. Libyan J Med. 2015;9(10):26802.
 
13.
Lo YPC, Hsu YCS, Chan KM. Epidemiology of shoulder impingement in upper arm sports events. Br J Sports Med. 1990;24(3):173–177.
 
14.
Wang HK, Cochrane T. A descriptive epidemiological study of shoulder injury in top level English male volleyball players. Int J Sports Med. 2001;22(2):159–163.
 
15.
Seil R, Rupp S, Tempelhof S, Kohn D. Sports injuries in team handball. A oneyear prospective study of sixteen men’s senior teams of a superior nonprofessional level. Am J Sports Med. 1988;26(5):681–687.
 
16.
Ribeiro A, Pascoal AG. Resting scapular posture in healthy overhead throwing athletes. Man Ther. 2013;18(6):547–550.
 
17.
Bahr R, Bahr IA. Incidence of acute volleyball injuries: a prospective cohort study of injury mechanisms and risk factors. Scand J Med Sci Sports. 1997;7(3):166–171.
 
18.
Harris-Hayes M, van Dillen LR, Sahrmann SA. Classification, treatment and outcomes of a patient with lumbar extension syndrome. Physiother Theory Pract. 2005;21(3):181–196.
 
19.
Comerford MJ, Mottram SL. Movement and stability dysfunction— contemporary developments. Man Ther. 2001;6(1):15–26.
 
20.
Sahrmann SA. Diagnosis and treatment on movement impairment syndromes. St. Louis, USA: Mosby Inc.; 2002.
 
21.
van Dillen LR, Sahrmann SA, Norton BJ. Movement system impairment-based categories for low back pain: stage 1 validation. J Orthop Sports Phys Ther. 2003;33(3):126–142.
 
22.
van Dillen LR, Maluf KS, Sahrmann SA. Further examination of modifying patient-preferred movement and alignment strategies in patients with low back pain during symptomatic tests. Man Ther. 2009;14(1):52–60.
 
23.
Azevedo DC, van Dillen LR, Santos Hde O, Oliveira DR, Ferreira PH, Costa LO. Movement System Impairment-based classification versus general exercise for chronic low back pain: protocol of a randomized controlled trial. Phys Ther. 2015;95(9):1287–1294.
 
24.
Sahrmann SA. Does postural assessment contribute to patient care? J Orthop Sports Phys Ther. 2002;32(8):376–379.
 
25.
Walker ML, Rothstein JM, Finucane SD, Lamb RL. Relationship between lumbar lordosis, pelvic tilt, and abdominal muscle performance. Phys Ther. 1987;67(4):512–516.
 
26.
Williams PE, Goldspink G. Changes in sarcomer length and physiological properties in immobilized muscle. J Anat. 1978;127(3):459–468.
 
27.
Araujo F, Lucas R, Alegrete N, Azevedo A, Barros H. Individual and contextual characteristics as determinants of sagittal standing posture: a populationbased study of adults. Spine J. 2014;14(10):2373–2383.
 
28.
Newcomer KL, Jacobson TD, Gabriel DA, Larson DR, Brey RH, An KN. Muscle activation patterns in subjects with and without low back pain. Arch Phys Med Rehabil. 2002;83(6):816–821.
 
29.
Oddsson LI, De Luca CJ. Activation imbalances in lumbar spine muscles in the presence of chronic low back pain. J Appl Physiol. 2003;94(4):1410–1420.
 
30.
Lamoth CJ, Meijer OG, Daffertshofer A, Wuisman PI, Beek PJ. Effects of chronic low back pain on trunk coordination and back muscle activity during walking: changes in motor control. Eur Spine J. 2006;15(1):23–40.
 
31.
Saunders SW, Schache A, Rath D, Hodges PW. Changes in three dimensional lumbo-pelvic kinematics and trunk muscle activity with speed and mode of locomotion. Clin Biomech (Bristol, Avon). 2005;20(8):784–793.
 
32.
Hu H, Meijer OG, Hodges PW, et al. Control of the lateral abdominal muscles during walking. Hum Mov Sci. 2012;31(4):880–896.
 
33.
HodgesPW, Kaigle Holm A, Holm S, et al. Intervertebral stiffness of the spine is increased by evoked contraction of transversus abdominis and the diaphragm: in vivo porcine studies. Spine. 2003;28(23):2594–2601.
 
34.
Hase K, Stein RB. Turning strategies during human walking. J Neurophysiol. 1999;81(6):2914–2922.
 
35.
Marshall PW, Patel H, Callaghan JP. Gluteus medius strength, endurance, and co-activation in the development of low back pain during prolonged standing. Hum Mov Sci. 2011;30(1):63–73.
 
36.
Fredericson M, Cookingham CL, Chaudhari AM, Dowdell BC, Oestreicher N, Sahrmann SA. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med. 2000;10(3):169–175.
 
37.
Santos FG, Carmo CM, Fracini AC, Pereira RRP, Takara KS, Tanaka C. Chronic low back pain in woman: muscle activation during task performance. J Phys Ther Sci. 2013;25(12):1569–1573.
 
38.
Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine. 2004;29(19):108–114.
 
39.
Hodges PW, Moseley GL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol. 2003;13(4):361–370.
 
40.
Comerford MJ, Mottram SL. Functional stability re-training: principles and strategies for managing mechanical dysfunction. Man Ther. 2001;6(1):3–14.
 
41.
HadałaM, Gryckiewicz S. Movement pattern and muscle balance as a source of lumbar spine health according to the concept of Kinetic Control. Pol Ann Med. 2014;21(2):152–157.
 
42.
Maluf KS, Sahrmann SA, van Dillen LR. Use of a classification system to guide nonsurgical management of a patient with chronic low back pain. Phys Ther. 2000;80(11):1097–1111.
 
43.
DankaertsW, O’Sullivan P, Burnett A, Straker L. Differences in sitting postures are associated with nonspecific chronic low back pain disorders when patients are subclassified. Spine. 2006;31(6):698–704.