ECSS Paris 2023: OP-MH30
INTRODUCTION: Chronic non-specific low back pain (CNSLBP) is often linked to posterior-chain dysfunction, characterized by impaired trunk/hip extensor strength, reduced endurance, and altered motor control under load. While resistance training is commonly used, the specific impact of targeted posterior-chain protocols on functional load-regulation remains under-examined. This study evaluated the effects of an 8-week posterior-chain resistance training (PCRT) program on muscle strength, endurance, and load-regulation strategies during functional tasks in individuals with CNSLBP. METHODS: Eighteen participants with chronic non-specific low back pain (CNSLBP) (age: 26.1±4.7 yrs; pain duration: 3.5±5.0 yrs) were randomized into three groups: high-intensity posterior-chain resistance training (PCRT-HI, n=6), moderate-intensity (PCRT-MI, n=6), or control (Con, n=6). Training was conducted twice weekly for eight weeks, focusing on multi-joint posterior-chain movements. Primary outcomes included neuromuscular Endurance, such as Biering–Sorensen test (BST) duration and median frequency slope of electromyography (EMG), and Load Regulation, such as center of pressure (COP) path length and Symmetry Indices (SI) for force, mean pressure, and contact area during unloaded barbell squats and deadlifts. RESULTS: BST endurance significantly improved in both PCRT-HI (△= 27.1± 14.2 s) and PCRT-MI (△= 23.8±18.4 s) compared to Con (△=17.4±17.3 s; p=0.009), with no difference between intensities. However, PCRT-HI showed a significantly greater reduction in the medial frequency slope of the right gluteus maximus (reflecting improved fatigue resistance) compared to Con (PCRT-HI: 0.10 ± 0.10 Hz/s; PCRT-MI: 0.06 ±0.07 Hz/s; Con: -0.03 ± 0.06 Hz/s; p=0.034). Regarding load regulation, both training groups showed comparable improvements in COP path length and force symmetry (SI) during squats and deadlifts, suggesting enhanced postural control and bilateral loading strategies compared to the control group. CONCLUSION: An 8-week PCRT program effectively enhances trunk endurance and load-regulation strategies in individuals with CNSLBP. While both intensities improved functional endurance, high-intensity training may elicit superior neuromuscular adaptations in the gluteus maximus. These findings suggest that targeting the posterior chain improves objective biomechanical markers during fundamental lifting tasks, which is critical for long-term back health.
Read CV Jen-Chieh LiaoECSS Paris 2023: OP-MH30
INTRODUCTION: Patients possibly having chronic exertional syndrome of the anterior leg compartment (ant-CECS) require a confirmatory intra compartment pressure (ICP) measurement, but this invasive test is patient unfriendly and imprecise. Earlier ultrasound (US) studies suggested that morphology of the leg crural fascia covering the muscle may be different in CECS. Aim of this observational study was to analyse the curvature of the crural fascia in ant-CECS and healthy controls at rest and following a standard treadmill exercise. An US device, equipped with a pressure monitor that automatically acquires time-synchronized images at standardized lower leg landmarks with 10mmHg and 80mmHg externally applied probe pressure, was used (CPMX1, Compremium AG, Switzerland). METHODS: Between February 2023 and February 2024, patients with a history, physical examination and ICP above the Pedowitz criteria (ICP ≥15mmHg at rest, or ≥30mmHg or ≥20mmHg 1 and 5 minutes post-exercise, respectively) and healthy controls matched for sex, age and BMI underwent leg imaging with 10mmHg and 80mmHg external US probe pressure. The curvature of the fascia was measured before and after a standard treadmill test using novel mathematical modelling (extreme convex to extreme concave, +40 to -40). RESULTS: A total of 209 US images in 21 ant-CECS patients (13 males; age 31 ± 11; BMI 26 ± 5) who were 1:1 matched with 21 healthy controls (13 males; age 36 ± 14; BMI 24 ± 3) were analysed. With 10mmHg external pressure, fascia curvature at rest in ant-CECS and controls was not different (ant-CECS 18.6 ± 4.4 vs controls 17.5 ± 6.3, p=0.53). Thirty seconds and five minutes after exercise, the fascia was more convex in ant-CECS compared to controls (thirty seconds: ant-CECS 26.4 ± 5.8 versus controls 22.8 ± 5.4, p=0.05; five minutes: ant-CECS 24.3 ± 4.9 versus controls 20.1 ± 5.9, p=0.02). Curvature changes at 80mmHg external pressure were not different between groups. CONCLUSION: Following exercise, the crural fascia in patients with ant-CECS is more convex compared to healthy controls. References Pedowitz RA, Hargens AR, Mubarak SJ, et al. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. The American Journal of Sports Medicine 1990;18(1):35-40. Sellei RM, Wollnitz J, Reinhardt N, et al. Non-invasive measurement of muscle compartment elasticity in lower limbs to determine acute compartment syndrome: Clinical results with pressure related ultrasound. Injury 2020;51(2):301-06. van Heeswijk K, Spek D, Muijsenberg J, et al. Reliability of Ultrasound Based Compressibility of the Lower Leg Anterior Tibial Muscle Compartment in Healthy Volunteers. International Journal of Sports Physical Therapy 2025;20(2) doi: 10.26603/001c.128284
Read CV Kay van HeeswijkECSS Paris 2023: OP-MH30
INTRODUCTION: Carpal Tunnel Syndrome (CTS) represents the most prevalent entrapment neuropathy of the upper limb and presents a significant challenge in sport and exercise medicine due to persistent sensorimotor impairment and activity limitations. Conservative management—including gliding and resistance exercise protocols are recommended to attenuate symptoms and enhance hand function. However, the biomechanical mechanisms underpinning these clinical benefits remain unresolved. Elevated shear-wave velocity (SWV) in the median nerve and associated flexor tendons has been linked to reduced tissue elasticity and increased intracarpal pressure, yet no randomized trials have examined whether exercise interventions alter intrinsic tissue elasticity in CTS. METHODS: In a prospective, assessor-blinded, three-arm randomized controlled trial, 102 adults (age 20–80) with electrodiagnostically confirmed mild to moderate CTS were randomized (1:1:1) to gliding exercise, resistance exercise, or control groups. Standardized interventions were performed daily over three weeks. SWE measurements were obtained at the carpal tunnel inlet using a Canon Aplio i800 system. Median nerve and third FDS tendon SWV were recorded with rigorously controlled probe placement and motion stability indices. Median nerve cross-sectional area (CSA) was also assessed. The primary outcome was post-intervention change in median nerve SWV adjusted for baseline. Secondary outcome included changes in tendon SWV and nerve CSA, and subjective symptom change evaluated on a Likert scale. RESULTS: Intention-to-treat analyses revealed no statistically significant differences in median nerve and 3rd FDS SWV between either intervention and control groups at 3 weeks. Similarly, changes in median nerve CSA did not differ between groups. In contrast, analysis of self-reported symptom change indicated a significant overall group effect (H = 9.01, p = 0.011, ε² = 0.071), with the gliding exercise group demonstrating greater symptom improvement relative to controls. No significant symptom differences were observed between exercise modalities. CONCLUSION: Short-term exercise protocols do not produce measurable alterations in intrinsic tissue elasticity as quantified by SWE in mild to moderate CTS, despite yielding meaningful symptomatic relief. These findings challenge the assumption that improvements in CTS symptoms are mediated by biomechanical remodeling of nerve or tendon material properties and suggest alternative mechanisms, such as enhanced neural excursion, modified vascular dynamics, or central pain modulation, may be responsible for early clinical adaptation. Future research should explore neuromuscular, vascular, and central adaptations using multimodal assessment frameworks to elucidate the mechanisms through which exercise promotes recovery in CTS. Furthermore, the effect of longer intervention duration on elasticity of soft tissue should be investigated.
Read CV Jošt PetercaECSS Paris 2023: OP-MH30