Journal of Back and Musculoskeletal Rehabilitation - Volume Preprint, issue Preprint
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Journal of Back and Musculoskeletal Rehabilitation is a journal whose main focus is to present relevant information about the interdisciplinary approach to musculoskeletal rehabilitation for clinicians who treat patients with back and musculoskeletal pain complaints. It will provide readers with both 1) a general fund of knowledge on the assessment and management of specific problems and 2) new information considered to be state-of-the-art in the field. The intended audience is multidisciplinary as well as multi-specialty.
In each issue clinicians can find information which they can use in their patient setting the very next day. Manuscripts are provided from a range of health care providers including those in physical medicine, orthopedic surgery, rheumatology, neurosurgery, physical therapy, radiology, osteopathy, chiropractic and nursing on topics ranging from chronic pain to sports medicine. Diagnostic decision trees and treatment algorithms are encouraged in each manuscript. Controversial topics are discussed in commentaries and rebuttals. Associated areas such as medical-legal, worker's compensation and practice guidelines are included.
The journal publishes original research papers, review articles, programme descriptions and cast studies. Letters to the editors, commentaries, and editorials are also welcomed. Manuscripts are peer reviewed. Constructive critiques are given to each author. Suggestions for thematic issues and proposed manuscripts are welcomed.
Abstract: BACKGROUND: Lumbar lordosis is required for bipedalism. OBJECTIVES: To investigate age-related changes in lumbar lordosis and to clarify the relationships between lumbar lordosis and vertebral wedging and disc degeneration. METHODS: A total of 300 women were included in this retrospective study, 50 in each of six age groups (20-, 30-, 40-, 50-, 60- and 70-year-olds). Patients with vertebral collapse, instable fracture or disc sequestration were excluded. In each patient, lumbar lordosis angle, posterior vertebral wedging, L5-S1 intervertebral disc angle, L5/L1 vertebral height ratio and L5-S1 intervertebral disc/L1-L2 intervertebral disc height ratio were examined.…Significance level was set at p< 0.05 and two-sided tests were used. RESULTS: Significant differences were found in lumbar lordosis according to age group (p < 0.001). Lumbar lordosis correlated most strongly with L4 posterior vertebral wedging, L5 posterior vertebral wedging and L5-S1 intervertebral disc angle, in that order (r = 0.50, r = 0.40, r= 0.32, respectively; p < 0.001). CONCLUSION: In this cohort, strong spinal structure was maintained during physiological aging from 20 to 40 years of age; lumbar lordosis increased by 50 years of age. Increased lordosis correlated with increased posterior vertebral wedging and loss of posterior disc height.
Abstract: BACKGROUND : Studies have shown late post-operative physical disability and residual pain in patients following lumbar disc surgery despite growing evidence of its beneficial effects. Therefore, rehabilitation is required to minimise the late post-operative complications. OBJECTIVE: To assess the feasibility of manipulative rehabilitation to improve late post-operative outcomes. METHODS: Twenty-one patients aged 25-65 years undergoing lumbar microdiscectomy were randomly assigned to the rehabilitation group (n = 14) or active control group (n = 7) by simple randomisation. Eight rehabilitation sessions were initiated 2-3 weeks after surgery. Thirty-minute sessions were conducted twice weekly…for four weeks. Post-operative physical disability and pain were assessed at baseline and at the two-year follow-up. RESULTS: Post-operative physical disability improved more in patients who had undergone rehabilitation than in those who had received control care (63% vs. -23%, P< 0.05). Post-operative residual low back and leg pain were alleviated in the treatment group (26% and 57%, respectively), but intensified in the control group (-5% and -8%, respectively). CONCLUSIONS: This study demonstrated the potential of manipulative rehabilitation and importance of post-operative management after lumbar disc surgery. Definitive trials with larger sample sizes are required to confirm the feasibility and potential therapeutic effectiveness of this approach.
Abstract: BACKGROUND: Malignant peripheral nerve sheath tumor (MPNST) arising in benign schwannoma with multiple intraosseous spinal metastasis is extremely rare, having a highly aggressive progression and poor prognosis. In such cases, the malignant cells of MPNST usually have an epithelioid morphology. Here, the authors present a very rare case of spindle cell type MPNST arising in benign schwannoma. CASE: A 47-year-old woman had a history of wide marginal excision of right buttock spindle cell sarcoma previously. However, metastatic lesions to C7, L1 body, and the right lung were detected during follow-up. Total spondylectomy and stabilization of the…C7 and L1 tumors were performed within an interval of 5 months. However, the patient expired 6 months after the last surgery. From analysis and study of three tumor specimens (right buttock, cervical and lumbar spine), the pathological diagnosis based on histomorphologic and immunohistochemical studies was spindle cell sarcoma, high grade, most consistent with MPNST arising in schwannoma. RESULTS : It is important that pathologists and surgeons recognize that spindle cell type MPNST may arise in benign schwannoma, as this recognition aids in assessment of patients with schwannoma and contributes to the pathologist making a more precise diagnosis, and the surgeon better determining the appropriate therapeutic options and surgical methods.
Abstract: PURPOSE: To compare the short-term effect of prolotherapy and conservative terapy for the Tietze syndrome. PATIENTS AND METHODS: From 2013 to 2014, twenty-one patients underwent prolotherapy (group 1) and thirteen underwent conservative therapy with analgesics (group 2). A visual analogue score (VAS) was recorded for measurement of pain intensity in all patients before (Pre VAS) and after injection first day (VAS1), first week (VAS2) and fourth week (VAS3). Group 2 were received systemic nonsteroidal anti-inflammatory drug. VAS score was recorded similarly at the same times (Pre VAS, VAS1, VAS2, VAS3), and clinical affects were compared between…the two groups. RESULTS: The mean VAS score (mm) before prolotherapy was 7.10 in patients who received prolotherapy, and 7.14 mm in patients who treated nonsteroidal anti-inflammatory drug. The mean VAS after the fist injection was 2.19 mm and dropped to 1.52 mm after the third injection. The mean VAS after the nonsteroidal anti-inflammatory drug treatment dropped 2.62 mm and during the same scores to 3 weeks later. There was no significant difference between the group 1 and group 2 in the age, sex and comorbidity. Also there was no significant difference between the group 1 and group 2 in clinical and radiological evidence. The prolotherapy group showed a faster recovery, including significantly reduced clinic findings (p: 0.001). Third VAS is significant finding for the prolotherapy group. CONCLUSION: Prolotherapy could be performed safely and is a method with a favorable long term treatments for t he Tietze Syndrome. It may be the ideal procedure for patients with drugs side effects and advers events especially for those with limited liver and kidney reserve or significant comorbidities.
Abstract: BACKGROUND: Estimation of handgrip strength (HGS) is routinely used by clinicians and epidemiologists for objective assessment of functional status of hand and upper extremity. It is also used as an indirect indicator of overall physical strength and health status in variety of clinical situations and chronic general medical conditions. OBJECTIVE: The present study was conducted to examine the effects of upright and slouch sitting postures and voluntary teeth clenching on hand grip strength in healthy young male subjects. METHODS: One hundred healthy young males (aged 18-30 years) participated in this study. The HGS…was measured using a commercially available dynamometer for the dominant hand. The HGS was measured during four test conditions; (a) slouch sitting without teeth contact, (b) slouch sitting with teeth clenching, (c) upright sitting without teeth contact, and (d) upright sitting with teeth clenching. RESULTS: The HGS values were significantly higher during slouch than upright sitting posture, both during similar and opposite teeth related conditions (p< 0.001). Teeth clenching had no effect on the in HGS values during slouch or upright sitting posture (P> 0.05). CONCLUSIONS: As compared to upright sitting, higher HGS values can be obtained during slouch sitting in young healthy males. Teeth clenching does not affect the HGS values during slouch or upright sitting posture.
Keywords: Hand grip strength (HGS), sitting posture, teeth clenching
Abstract: BACKGROUND: Whiplash Associated Disorders (WAD) is a biopsychosocial problem, education may be an essential part in the treatment and the prevention of chronic WAD. However, it is still unclear which type of educative intervention has already been used in WAD patients and how effective such interventions are. OBJECTIVE: To examine the effectiveness of a cognitive behavioral exercises approach (CBEA) for self-training of the neck relative to usual care in individuals with WAD in acute phase. METHODS: Forty-one patients, 65.9% female (mean ± SD age: 41 ± 11 years), with WAD were recruited…immediately after the accident (within 48 hours) and assigned according to patient choice to receive a CBEA self-training of the neck or usual care for 15 days. The primary outcome measure was pain intensity and disability as measured with the Neck Disability Index (NDI). Secondary outcome measures included the presence of headaches, dizziness, nausea, and difficulties with concentration and memory. Measurements were taken at pre-treatment, 2 weeks post-treatment and 4- and 12- weeks after the injury. RESULTS: Patients receiving the CBEA intervention experienced a greater reduction in pain as compared to those receiving the usual care at the end as well as 4 and 12 weeks after the intervention (P< 0.001), for the Neck Disability Index (NDI) decreased more in the CBEA than controls over the 15 days and (F[3.0] = 552.383; P= 0.001), and in both groups at all follow-up periods (all, P= 0.001). CONCLUSIONS: This quasi-experimental clinical trial provides evidence that a CBEA for self-training of the neck may be more beneficial in treating pain than usual care in patients with WAD. However, the CBEA had limited value in improving NDI. Future studies should include several therapists, a measure of a long-term outcomes and randomize patients to groups.
Abstract: BACKGROUND AND OBJECTIVES: The aim of the study determining whether or not Non-invasive Spinal Decompression Therapy (NSDT) was effective in resorption of herniation, increasing disc height in patients with lumbar disc herniation (LHNP). METHODS: A total of twenty patients diagnosed as LHNP and suffering from pain at least 8 weeks were enrolled to the study. Patients were allocated in study (SG) and control groups (CG) randomly. Both groups received combination of electrotherapy, deep friction massage and stabilization exercise for fifteen session. SG received additionally NSDT different from CG. Numeric Anolog Scale, Straight leg raise test, Oswestry…Disability Index (ODI) were applied at baseline and after treatment. Disc height and herniation thickness were measured on Magnetic Resonance Imagination which performed at baseline and three months after therapy. RESULTS: Both treatments had positive effect for improving pain, functional restoration and reduction in thickness of herniation. Although reduction of herniation size was higher in SG than CG, no significant differences were found between groups and any superiority to each other (p > 0.05). CONCLUSIONS: This study showed that patients with LHNP received physiotherapy had improvement based on clinical and radiologic evidence. NSDT can be used as assistive agent for other physiotherapy methods in treatment of lumbar disc herniation.
Abstract: BACKGROUND: Inconsistencies in the literature concerning the effect of neck pain have led to a lack of understanding concerning the complete pathophysiology of neck pain. While the effect of neck pain on motor function as measured by active range of motion and isometric neck strength is well documented the effect of neck pain on sensory measures such as tactical acuity and neck reposition error (NRE) remain poorly understood. OBJECTIVE: The purpose of this study was to evaluate a combined sensorimotor evaluation to explore the potential benefits of incorporating both sensory and motor task into a physical…evaluation of neck pain suffers to gain an added knowledge of the complete pathophysiology of their health status. METHODS: A cross-sectional study that measured neck joint reposition error, tactical acuity, neck isometric strength and range of motion in 40 volunteer participants (22 pain, 18 control). RESULTS: A statistically significant increase in NRE in flexion (2.75 ∘ ± 1.52 ∘ vs. 4.53 ∘ ± 1.74 ∘ and in extension (3.78 ∘ ± 1.95 ∘ vs 5.77 ∘ ± 2.73 ∘ in participants suffering from neck pain was observed. Additionally, the dermatome C5 was found to be the most affected. No differences were found in neck strength or neck range of motion between healthy controls and patients with chronic moderate neck pain.
Keywords: Tactile acuity, neck reposition error, isometric neck strength, range of motion, two-point discrimination, proprioception training
Abstract: BACKGROUND: Playing violin may lead to overload of the locomotor system. OBJECTIVE: The aim of this study was to assess body parameters for trunk symmetry in child violinists and compare with the control group. METHODS: We analyzed body posture of 101 children aged 7–12 years, mean age 11.09 ± 9.46, 49 child violinists and control group of 52 children. RESULTS: We found statistically significant differences for the difference in depth of the lower corners of scapulae and upper posterior spina iliaca, though greater asymmetries were found in…the clinical control group. The remaining parameter values are close to significance, which may suggest that the process of postural change among the children had just started and that the existing asymmetries were easy to correct. We found positive correlation between body height and the difference in distance of the lower corners of scapulae from the spine: OL (p = 0.029, correlation coefficient value was 0.167) and the Thales triangle height: (p = 0.018, correlation coefficient was 0.214). CONCLUSIONS: Position maintained while playing the violin changed some parameters characterizing the curvature of the spine in frontal plane. We found the importance of detailed analysis of children body posture and its critical assessment.