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Stephane Bouilland
05-17-1994, 04:53 PM
Two weeks ago, I sent the following message :

Dear Suscribers,

Isokinetic Lifting and other isokinetic techniques are used in some
programs of intensive physical exercises for the rehabilitation of
persons who suffer from chronic low back pain. Isokinetic lifting
is known to be safe and to offer a lot of security because the patient
can adjust his own effort and because he can stop it when he wants.But the
isokinetic mouvement is not natural and we haven't learnt it when child.
I wonder if this doesn't make the isokinetic more dangerous that it seems to be.
I would be interrested in getting somes opinions about the use of isokinetic
lifting in chronic low back pain rehabilitation. I'm also looking for
references of articles for or against this technique.Are there any other
reasons who could make it dangerous?
Thanks in advance to peoples who will answer me, I will post the responses.

Stephane BOUILLAND
L.A.I.H.
Universite de Valenciennes
Le Mont Houy - BP 311
59304 Valenciennes Cedex
France.

E-mail:Bouilland@univ-valenciennes.fr



Here are the responses I received :


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Forwarded from the PHYSIO mailbase

Heather Upfield

================================================== ===============
| Heather Upfield, list-owner PHYSIO mailbase |
|(UK) phupfi@uk.ac.qmced.main (Internet) phupfi@main.qmced.ac.uk|
|Department of Physiotherapy, Queen Margaret College, Edinburgh,|
| EH12 8TS, Scotland, UK. Tel: 031-317 3642, Fax: 031-317 3256 |
================================================== ===============

----- Begin message from CBS%UK.AC.MAILBASE::NISP::MAILER-DAEMON 26-Apr-94

Date: Mon, 25 Apr 1994 16:09:05 -0400 (EDT)
From: "Gordon S. Cummings"
Subject: Re: Isokinetic Lifting and Low Back Pain
To: physio@mailbase.ac.uk

I have had very limited experience with isokinetic machines to
recondition or t o test those with back pain. Yet in this experience I
have seen some pretty serious set-backs in patients being tested opon
discharge. They were tested on Isostation B testing apparatus which
unnaturally blocks knee and hip motion. I did not do long term follow up
but cvan assure they were hurting pretty badly at the end of testing, and
had been pain free for a week or two prior to testing.
Until otherwise proven I will stick with the idea of specificity of
exercise. I believe that these machines in general, and most of the
testing positions in general, are inadequate as tests for weight bearing
function, inappropriate for weight bearing training, and can harm when
carelessly managed.

Data?? Nope! sorry.

Chiao

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Good morning Stephane

I have received your inquiry about low back pain, and I am
responding as the list-owner of a Physiotherapy mailbase
entitled PHYSIO. The list is fairly new, but already has 220
members from all over the world: mainly academic physiotherapists,
but also researchers and clinicians. Would you be interested
in joining?

I am taking the liberty of sending you a leaflet about it, but
in the meantime if you have any inquiries, then please contact
me at the address below.

Sincerely

Heather Upfield

================================================== ===============
| Heather Upfield, list-owner PHYSIO mailbase |
|(UK) phupfi@uk.ac.qmced.main (Internet) phupfi@main.qmced.ac.uk|
|Department of Physiotherapy, Queen Margaret College, Edinburgh,|
| EH12 8TS, Scotland, UK. Tel: 031-317 3642, Fax: 031-317 3256 |
================================================== ===============

In order to join the PHYSIO list, it is very simple. Send a
message as follows:

To: mailbase@mailbase.ac.uk
Subj: joining
Join PHYSIO Stephane Bouilland

You will automatically be added to the list, and thereafter, to
talk to other list members, send a message:

To: physio@mailbase.ac.uk

There are now well over 200 people on the list, from 15 different
countries on all 5 Continents. If you join the list, you will
be the first from France!


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Date: 2-MAY-1994 15:05:19.37
From: SMTP%"ROBIN@hms01.hms.uq.oz.au"
Subj: Re: Isokinetic Lifting and Low Back Pain
To: bouilland
CC:
70 records, external message id MAIL$DD5521E100050097.MAI
Attributes: None
Gidday,
I have some comments which may be of interest. The normal
pattern of coordination of lower limb joints during self-selected
lifting (i.e., the way people lift when not told what to do) involves
a deviation from synchronous coordination of the knee, hip and lumbar
vertebral joints which has the functional consequence of reducing
muscular effort. If fatigue may be presumed to be liked to injury,
then any manipulation (training or physical situation) which disrupts
this normal pattern of interjoint coordination may not be desireable,
either during rehabilitation or lifting performance.

To elaborate: Self-selected lifting from a normal standing position
to pick up a load at floor level and place on a shelf at shoulder
height involves first flexion of the ankle, knee, hip and lumbar
vertebral joints to lower the hands to grasp the load, and then
extension of the joints as the load is lifted. While flexion and
extension occur at the same time, they do not occur occur in
synchrony and the pattern of deviation from synchrony is consistent.
Rpaid knee extension occurs in the early part of the lifting
phase. Rapid hip extension is delayed slightly and rapid extension of
the lumbar vertebral joints is delayed substantially. This pattern of
interjoint coordination has a number of functional consequences.
During the early lifting phase (when load acceleration is greatest)
the lumbar vertebral complex is flexed by about 45 degrees, and
remains relatively static. The trunk extensor musculature is thus
lengthened and not shortening rapidly, and thus is relatively strong.
Similarly, estimation of the length changes of the biarticular
hamstrings (using equations based on cadaveric data) revealed that
the consequence of rapid knee extension during early lifting is that
the onset of rapid hamstring shortening is delayed, thus maintaining
the strength of the hamstrings early in the lifting phase.
In addition, the relatively isometric contraction of the biarticular
hamstrings (in concert with cocontraction of the monarticular knee
extensors) allows the hamstrings to act as a tendon and thus
(paradoxically) the monoarticular knee extensors conribute to hip
extension during early lifting.

The data supporting these statements is presented in a paper recently
accepted by _Human Factors_: Burgess-Limerick, R., Abernethy, B.,
Neal., R.J., & Kippers, V. (in press). Self-selected manual lifting
technique: Functional consequences of the interjoint coordination.

The expected date of pulication of this paper is June 1995, so if
you are interested in more details before then I'd be happy to
forward a copy.

Robin Burgess-Limerick robin@hms01.hms.uq.oz.au
Department of Human Movement Studies
The University of Queensland
AUSTRALIA

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Dear Stephane
I don't have personal experience of isokinetics as related to low back
pain rehabilitation, but know of the following references which may be of
use to you, if you haven't already seen them. Hope this is of some help.


Dvir, Z. Clinical applicability of isokinetics: a review. Clin Biomech 6
(1991): 133 144.
Mostardi, R. A., D. A. Noe, M. W. Kovacik, and J. A. Porterfield.
Isokinetic lifting strength and occupational injury. A prospective
study. Spine 17, no. 2 (1992): 189-193.
Newton, M., and G. Waddell. Trunk strength testing with iso-machines:
a review of scientific evidence. Spine 18, no. 7 (1993):
801-811.
Newton, M., M. Thow, D. Somerville, I. Henderson, and G. Waddell. Trunk
strength testing with iso-machines: Part 2: Experimental evaluation of the
Cybex II Back Testing System in normal subjects and
patients with chronic low back pain.S Spine 18, no. 7 (1993): 812-824.



Anne Mannion
University of Bristol
U.K.
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I have no data to support my opinion, however I do feel that the
constraints used to stabilize the patient can in some cases lead to
patients hurting themselves during testing, especially if they have not
been training on the same equipment. My prejudice is that the back
works in close harmony if not coupled motion with the peripheral limbs.
When integrated motion is blocked then the back is working is artificial
isolation which seems to be associated with injuries I have witnessed.

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Hello Stephane BOUILLAND,

I ran across an article which may be what you are looking for if you do not
already have a copy. Here is the reference:

Newton, M. and Waddell, G., 1994, "Trunk Strength Testing with Iso-Machines
-- Part 1: Review of a Decade of Scientific Evidence," _Spine_, 18(7):
801-811.

They seem to come to the conclusion that there was "inadequate scientific
evidence to support the use of iso-machines in preemployment screening,
routine clinical assessment or medico-legal evaluation."

I hope this helps,

Dan

Dan Baker, Ph.D.

drbaker+@pitt.edu

Spine Mechanics Laboratory
Musculoskeletal Research Center
Dept. of Orthopaedic Surgery
University of Pittsburgh

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We have several world class athletes who swear by isokenetic lifting. You
can put just as much effort in kenetic as iostonic lifting. Sometimes even
more if you work hard. The availability of kenetic machines is limited in
this country. They make too
much noise and dont kWORK YOOU hard enough. You can get a great workout
with them but YOU must work hard instead of just work agains the iron.
I feel you can get just as good and safe workiout with real iron, just go
light and work on form.

I am now 60 days from back surgery and doing wonderfully after removal of 2
discs. I am doing lite good mornings and squats. In all programs you need
to exercise your mind first.

--
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robert l lamons rlamons@tjhsst.vak12ed.edu
Thomas Jefferson High School for Science and Technology
A Fairfax County Public School in Northern Virginia
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