Journal of Back and Musculoskeletal Rehabilitation - Volume 14, issue 3
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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: Disc excision for lumbar disc herniation has become the most common surgical procedure of the lumbar spine. The United States has the highest rate of back surgery than any developed country. In this review, various surgical approaches are discussed, including simple discectomy, discectomy and fusion, chemonucleolysis, percutaneous discectomy and microdiscectomy. According to the literature, fusion does not have any added benefit, nor does there appear to be any difference among the other surgical techniques, with the exception of percutaneous discectomy. A review of the non-surgical options is also presented. There is evidence to support the immediate relief of sciatic pain…with surgical intervention, although recent studies on the non-operative treatment have actually shown comparable short-term results. Regarding long term outcomes, the literature has not shown any statistical difference between surgical and non-surgical treatment options. Moreover, this review illustrates that aggressive rehabilitation with appropriate pain control may actually be the superior treatment option when one considers the cost, complications and morbidity associated with surgery. Thus, indications for surgery remain controversial, and will require further clarification. In the future, more long term, unbiased, randomized and controlled trials are needed to measure not only pain relief and reoperation rates, but also the patients' return to work and premorbid functional state.
Abstract: The purpose of this study was to determine the relationship between five common methods of measuring isometric trunk strength and endurance: Isometric flexion and extension tests, an upright lifting task, and timed isometric flexion and extension endurance tests. Fifty-six healthy individuals (aged 18–65 years) with no history of back problems or disease volunteered for this study. Data were analyzed using a Pearson Product Moment Correlation Coefficient and Student’s T-test. Significant relationships (p < 0.0001 ) were found between the B-200 isometric extension and upright pull (r = 0.75 ); B-200 isometric flexion and upright pull (r…= 0.78 ); and B-200 isometric flexion and B-200 isometric extension (r = 0.80 ). Men demonstrated greater strength than women in B-200 isometric flexion and extension, as well as in the upright pull measures (p < 0.05 ). A variety of measures are frequently used to evaluate trunk “strength” in force production and endurance. Although strong correlation was observed among measures of force, no significant relationships were demonstrated between endurance and force measures. This suggests that a subject who demonstrates a strong performance on strength test of force may not necessarily display an equally strong performance on a strength test of endurance. Hence, to obtain a full picture of a person’s performance capabilities, measures of both force and endurance should be incorporated into evaluation protocols.
Abstract: Measurements of trunk flexibility have frequently been used to aid in diagnostic, prognostic and therapeutic processes. However, the speed at which these tests should be performed has not been established. Some authors have performed range of motion studies with subjects moving at their maximum speed, whilst others have asked subjects to move at slow speeds. McIntyre et al. (1991) suggested that tests of human performance should be performed at the subject’s preferred speed, since this is a more reliable measure of function. However, the influence of speed on movement characteristics has received limited attention. In addition the impact of speed…on repeatability of measures of motion is unclear. The impact of test speed was investigated in a sample of normal control subjects and low back pain subjects with known spinal stenosis. Measurements of lumbar spine motion were obtained using a triaxial potentiometric analysis system (CA ∼ 6000 Spinal Motion Analyser, OSI, USA) during a simple antero-posterior flexion-extension test. Each subject was asked to perform a series of three flexion-extension tests at three different speeds; as fast as they could, slowly and at their preferred/ normal rate of movement. The results demonstrated that in both study populations the speed at which the test was performed had no significant effect on the resultant ROM of flexion. However, in the normal population it did have an influence on ROM extension, with the tests performed at a fast speed producing a significantly greater ROM extension (p < 0.05 ) than tests performed at the subject’s preferred speed or at a slow speed. Not surprisingly the mean velocity characteristics of each test speed showed significant differences in both populations. In terms of test repeatability however, the results indicated that testing at a subject’s preferred speed produced more consistent readings of motion characteristics (in terms of both ROM and velocity). In addition all parameters of motion were significantly impaired in the spinal stenosis group with p < 0.01 .
Keywords: motion analysis, lumbar spine, speed of movement, velocity, range of motion, repeatability
Abstract: The biological, physical and functional status change was measured in 104 patients with recent (< 1 year) onset synovitis. Measurements were taken initially and at 1 year. The purpose was to determine which biological and physical measures correlated with poor performance. Patients completed questionnaires quantifying activity, (the Human Activity Profile [HAP] and Sickness Impact Profile [SIP]), pain (Wisconsin Brief Pain Inventory), fatigue (Multidimensional Assessment of Fatigue), sleep, and mood (POMS and CES-D). They were evaluated for articular involvement (Ritchie Index) and biological markers of disease activity (platelets, sedimentation rate, C-reactive protein and rheumatoid factor) (RF). In all,…30 men and 74 women participated. A total of 45 patients met the American College of Rheumatology criteria for rheumatoid arthritis (RA); of these, 24 were rheumatoid factor (RF) positive, 18 had spondylitis, and 41 had unclassified arthritis. Low activity level at 1 year (HAP and SIP) correlated with high numbers of inflamed joints initially (p < 0.002 ); with more than 10 involved joints regardless of diagnostic groupp = 0.001 ); and joint symmetry (p < 0.009 ) A high platelet count was associated with low activity level at 1 year (p = 0.01 ); and high sedimentation rate was associated with more pain (p < 0.05 ). Low activity level (p < 0.04 ), fatigue (p = 0.03 ) and sleeplessness (p = 0.02 ) were correlated with RF+ RA.
Abstract: The purpose of this study was two-fold: (1) to investigate the relationship between time perception and pain intensity while controlling for the effects of anxiety, depression, and perceived control over pain; and (2) to investigate the differences in time perception among the sufferers of somatic, neuropathic, and combined pain. The study utilized the following measures of independent and dependent variables: a 3-minute retrospective time estimation task, a Numerically Anchored Pain Intensity Scale, the McGill Pain Questionnaire, the Beck Depression Inventory, the Hospital Anxiety Scale, and the Numerically Anchored Perceived Control Over Pain Scale. The results revealed two things: (1) greater…pain intensity is associated with overestimation of time and the majority of pain patients report a perceived slowing down of time while in pain; and (2) there were no differences in time perception as a function of pain type. The results of this study present several potential diagnostic and therapeutic uses for pain patients.
Keywords: time, perception, pain, intensity, measurement
Abstract: This study examined the feasibility of applying ankle taping in order to affect the capability of isometric contraction of the ankle evertor-peroneal muscle. Twenty six normal subjects (10 males and 16 females, 20–35 years of age) participated in this study. Normal subjects had incurred no ligamentous injuries to the lateral components of foot and were without an unstable condition. Subjects were randomly assigned to start the program with or without ankles taped. They performed three trials of isometric contraction of ankle evertors with and without ankles wrapped. Peak value of each isometric contraction was obtained from integrated EMG. Data analysis…was performed with ANOVA, indicating no interaction effect of taping sequence when applying ankle taping to the isometric contraction of the peroneus longus. Moreover, the isometric contractions of the peroneus longus with and without ankle taping did not significantly differ. Results in this study demonstrate that applying ankle taping does not significantly affect the isometric contraction of the peroneus longus.
Abstract: One of the mechanical factors associated with carpal tunnel syndrome is repeated movement of flexion and extension at the wrist. The objective of this study was to determine whether prolonged positioning of flexion at the wrist, in the absence of repetitive movement, could cause carpal tunnel syndrome. The study was performed in a group of stroke patients with prolonged flexion but poor volitional movement at the wrist. Forty-eight patients who suffered stroke at least 6 months before the study were included. Patients with severe spasticity (Ashworth scale > 3 ) and motor strength of> 2 / 5…were excluded. Tinels Phalen’s, Semmes-Weinstein monofilament tests, median and ulnar nerve conduction studies were performed on all patients. If both nerves showed abnormal latencies or conduction, contralateral median and ulnar nerves and peroneal nerve in one extremity were also studied, to rule out peripheral neuropathy. Patients with peripheral neuropathy were subsequently excluded from the study. Carpal tunnel syndrome was diagnosed if distal motor latency was > 4.2 m sec and/or if distal sensory latency was > 3.5 m sec. Twenty-one patients met the inclusion criteria. None of them were wearing resting hand splint. Mean age of the patients was 61.2 ± 9.9 yr. Resting position of the wrist was flexion in all patients. Seven of the 21 hands showed carpal tunnel syndrome (30%) no significant difference in the degree of wrist flexion between those who had and those who did not have carpal tunnel syndrome, demonstrating that carpal tunnel syndrome can occur in the presence of flexion of the wrist even in the absence of repetitive movements.
Abstract: The aim of this study was to assess and determine the factors that are related to patient compliance to physical exercise regimen in patients with knee osteoarthritis. A total of 120 patients with a mean age of 57.3 ± 8.4 years were enrolled in the exercise program. Demographics and clinical characteristics of the subjects were obtained. A 3-month home-based exercise program consisting of standard exercises was prescribed. The frequency and accuracy of the exercises were recorded at the end of the first week and each month after that and compliance to the exercise therapy was determined. The mean…compliance of the patients to exercises were 90 ± 2.3% and 85 ± 3.1%, study. A positive correlation was found between the duration of the disease, pain scores, difference of circumference of both knees, range of flexion degree, and compliance to the exercises. In conclusion, higher compliance was demonstrated after a 3-month home-based exercise program in patients. Further studies are needed to assess long term compliance to exercise regimen in patients suffering from knee osteoarthritis.