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Using stochastic resonance and strength training as part of a rehabilitation programme for recurrent low back pain treatment: a case study

Washif JA, Teichmann J, Kok LY, Schmidtbleicher D

J Exerc Rehabil, 2019 Feb;15(1):139-147.
PMID: 30899750 DOI: 10.12965/jer.1836532.266

Low back pain (LBP) is a common disabling health problem that can cause decreased spine proprioception. Stochastic resonance (SR) can influence detection performance, besides improving patients with significant sensory deficits, but have not been thoroughly tested for LBP. This study aimed to examine the application of SR therapy (SRT) and strength training for LBP treatment. The subject was a resistance-trained male in his early thirties. His back pain was unbearable after a strength training session. Standard pain relief alleviated the pain but the LBP developed at a similar intensity after 4 weeks. SRT (4-5 sets ×90 sec, 30-sec rest interval, supine position) was prescribed along with other exercises for 3 weeks (phase 1), and followed by tailor-made strength training for 16 weeks (phase 2). The Oswestry Disability Index was 66.7% (interpreted as "crippled") prior to first SRT, and reduced to minimal levels of 15.6% and 6.7% after four and seven SRT sessions, respectively. Similarly, pain intensity was ranging from 5 to 9 (distracting-severe) of the Numeric Rating Scale (NRS-11) prior to the first session but this was reduced considerably after four sessions (NRS-11: 0-1). During phase 2, the patient performed without complaining of LBP, two repetitions of bench press exercise at a load intensity of 1.2 his body weight and attained 4 min of plank stabilisation. This LBP management strategy has a clinically meaningful effect on pain intensity, disability, and functional mobility, by receding the recurrent distracting to severe LBP.
Unexpected-Disturbance Program for Rehabilitation of High Performance Athletes

Teichmann J, Suwarganda EK, Lendewig C, Wilson BD, Yeo WK, Aziz RA, et al.

J Sport Rehabil, 2016 May;25(2):126-32.
PMID: 27269799 DOI: 10.1123/jsr.2014-0280

The Unexpected-Disturbance Program (UDP) promotes exercises in response to so-called involuntary short- to midlatency disturbances.
Unexpected-Disturbance Program for Rehabilitation of High-Performance Athletes

Teichmann J, Suwarganda EK, Lendewig C, Wilson BD, Yeo WK, Aziz RA, et al.

J Sport Rehabil, 2016 May;25(2):126-32.
PMID: 25658597 DOI: 10-1123/jsr.2014-0280

CONTEXT: The Unexpected-Disturbance Program (UDP) promotes exercises in response to so-called involuntary short- to midlatency disturbances.
OBJECTIVE: This study investigated the effectiveness of the UDP in the last 6 wk of rehabilitation.
DESIGN: Pre-post study with 2-tailed paired t tests for limited a priori comparisons to examine differences.
SETTING: National Sports Institute of Malaysia.
PARTICIPANTS: 24 Malaysian national athletes.
INTERVENTIONS: 7 sessions/wk of 90 min with 3 sessions allocated for 5 or 6 UDP exercises.
MAIN OUTCOMES: Significant improvements for men and women were noted. Tests included 20-m sprint, 1-repetition-maximum single-leg press, standing long jump, single-leg sway, and a psychological questionnaire.
RESULTS: For men and women, respectively, average strength improvements of 22% (d = 0.96) and 29% (d = 1.05), sprint time of 3% (d = 1.06) and 4% (d = 0.58), and distance jumped of 4% (d = 0.59) and 6% (d = 0.47) were noted. In addition, athletes reported improved perceived confidence in their abilities. All athletes improved in each functional test except for long jump in 2 of the athletes. Mediolateral sway decreased in 18 of the 22 athletes for the injured limb.
CONCLUSION: The prevention training with UDP resulted in improved conditioning and seems to decrease mediolateral sway.
A Three Week Unexpected Disturbance Program Improves Physical Performance of Elite Female Athletes

Teichmann J, Suwarganda EK, Beaven CM, Hébert-Losier K, Lee JW, Tenllado Vallejo F, et al.

J Sport Rehabil, 2016 Dec 19.
PMID: 27992260 DOI: 10.1123/jsr.2016-0082

CONTEXT: Sensorimotor training is commonly used in a rehabilitative setting; however, the effectiveness of an unexpected disturbance program (UDP) to enhance performance measures in uninjured elite athletes is unknown.
OBJECTIVE: To assess the impact of a three-week UDP program onstrength, power, and proprioceptive measures.
DESIGN: Matched-group, pre- post design.
SETTING: National Sports Institute.
PARTICIPANTS: Twenty-one international-level female field hockey athletes.
INTERVENTIONS: Two 45 min UDP sessions were incorporated into each week of a three week training program (total 6 sessions).
MAIN OUTCOME MEASURES: One-repetition maximum strength, lower limb power, 20 m running speed, and proprioception tests were performed before and after the experimental period.
RESULTS: Substantial improvements in running sprint speed at 5- (4.4 ± 2.6%; Effect Size [ES]: 0.88), 10- (2.1 ± 1.9%; ES: 0.51), and 20-m (1.0 ± 1.6%; ES: 0.23) were observed in the UDP group. Squat jump performance was also clearly enhanced when compared to the control group (3.1 ± 6.1%; ES: 0.23). Small but clear improvements in maximal strength were observed in both groups.
CONCLUSION: A three week UDP can elicit clear enhancements in running sprint speed and concentric-only jump performance. These improvements are suggestive of enhanced explosive strength and are particularly notable given the elite training status of the cohort and relatively short duration of the intervention. Thus, we would reiterate the statement by Gruber and colleagues (2004) that sensorimotor training is a "highly efficient" modality for improving explosive strength.