Rehabilitation from lumbopelvic deconditioning on earth and in space

Winnard, Andrew (2016) Rehabilitation from lumbopelvic deconditioning on earth and in space. Doctoral thesis, Northumbria University.

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Abstract

Astronauts experience low back pain (LBP) and heightened spinal injury risk due to lumbopelvic deconditioning following spaceflight. Atrophy and reduced control of the lumbar multifidus (LM) and transversus abdominis (TrA) muscles have been linked with LBP, and are commonly found in astronauts, as well as individuals with LBP in the general population. Many people have difficulty voluntarily recruiting LM and TrA, presenting a rehabilitation challenge. Previously, it was found that LM and TrA are recruited automatically during Functional Readaptive Exercise Device (FRED) exercise, and that the recruitment is tonic, which is the most effective way to train these muscles, suggesting it could be suitable for use post spaceflight and in LBP populations. However, the mechanisms underpinning the effect that FRED exercise has on LM and TrA needed to be investigated before clinical trialling the device to determine:
1. What current interventions are used to prevent or rehabilitate lumbopelvic deconditioning and what are their effects?
2. Do the underlying mechanisms of FRED exercise indicate that it may be a useful intervention to trial in the rehabilitation of lumbopelvic deconditioning resulting from microgravity exposure in astronauts and a sedentary lifestyle in the general population?
3. What are the requirements for a standard and progressive training protocol using the FRED?
Interventions preventing lumbopelvic deconditioning in human spaceflight simulation studies were systematically reviewed regarding effectiveness and future needs. Countermeasures during microgravity exposure were found ineffective for maintaining lumbopelvic health, presenting an immediate rehabilitation need, and future countermeasure refinement within the human spaceflight community. Rehabilitation to recover lumbar lordosis and train LM and TrA was suggested as beneficial.
Recruitment of the LM and TrA muscles and movement variability was measured during FRED exercise using all available foot movement amplitudes on the device. Both muscles were recruited in all settings, and the challenge to the muscle and movement control was increased in larger amplitudes.
Four chapters measured lumbopelvic kinematics and movement variability. Assessment was made of kinematic effects, the usefulness of FRED generated visual exercise feedback, the exercise familiarisation time and the effect of using the device handle bars in people with and without LBP.
The FRED promotes increased lumbar extension and anterior pelvic tilt compared to over ground walking.
Increasing crank amplitude increased movement variability, ΔTrAmax, ΔLMmax and TrA muscle recruitment. There was more variation away from the target exercise frequency when visual feedback was not provided. It took 170 seconds for asymptomatic individuals to familiarise to FRED exercise and155 for those with LBP. Spinal positioning became more flexed with reduced movement variability when the handles were used during exercise.
There is now sufficient evidence that FRED exercise promotes beneficial lumbopelvic posture and deep muscle activity to justify a clinical trial of the device in astronaut and general deconditioned LBP populations. Following an eighty second familiarisation period, training should begin in the smallest exercise amplitude and increase in one amplitude setting intervals once FRED users can maintain a consistent movement speed, using visual feedback, but without using the handle bars.

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