Journal of Back and Musculoskeletal Rehabilitation - Volume 15, issue 1
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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: Manipulation, or manual medicine, is a highly utilized form of treatment for many types of musculoskeletal disorders, but there are many questions about the efficacy and safety of this form of treatment. This review of published trials for treatment of the upper body (cervical, thoracic, and upper limb) describes the patient groups that have been studied and may benefit from manual treatment, their outcomes, and their limitations. Cervical manipulation in particular has historically received criticism regarding safety, and the incidence of side effects, severe complications, and contraindications are discussed. The number of studies published for the upper body is small…compared to the lumbar spine, and the lack of uniformity of the information still leaves the individual practitioner to decide if and when manipulation fits into his or her treatment algorithms for this region of the body.
Abstract: There is increasing interest in the application of magnetic/electromagnetic fields for therapeutic purposes. Magnetotherapy provides non-invasive, safe and easy to apply methods to directly treat the site of injury, the source of pain and inflammation as well as other types of dysfunction. This review summarizes several decades of experience worldwide in studying biological and clinical effects initiated by various magnetic and electromagnetic fields. The physiological basis for tissue repair as well as physical principles of dosimetry and application of magnetic fields are discussed. An analysis of magnetic/electromagnetic stimulation is followed by a discussion of the advantage of magnetic field stimulation…compared with electric current stimulation. Finally, the proposed mechanisms of action are discussed.
Keywords: magnetic field, electromagnetic field, electric current, therapy
Abstract: Recent studies have demonstrated that immune cell-derived β-endorphin inhibits peripheral nociception. Changes in the β-endorphin content of peripheral blood mononuclear cells (PBMC) were also reported in various human disorders. These findings suggest the modulation of pain by immuno-neural interaction through opioid-dependent mechanisms. The aim of this study, therefore, was to determine whether the levels of β-endorphin in PBMC of patients with complex regional pain syndrome (CRPS) differ from those of healthy subjects. Heparinized venous blood was collected from ten CRPS patients (7 women and 3 men; mean age 39.4 ± 13.0 years) and 13 age-matched healthy volunteers (6 women and…7 men; mean age 38.4 ± 10.8 years). PBMC were separated by density gradient centrifugation. β-endorphin was extracted from the cells in a commercial cell lysis buffer and its concentration was measured by enzyme immunoassay technique. Immunoreactive β-endorphin levels in PBMC from the CRPS patients were significantly lower than those from the healthy volunteers (101.5 ± 57.5 versus 222.1 ± 77.6, P < 0.001), and were not correlated to the present pain intensity or pain duration. The results indicate an altered condition of the immune-linked opioid system underlying CRPS. Further immunological approaches may provide new insight into the pathophysiology of CRPS.
Abstract: Two different methods for scoring the severity of radiological changes in 19 patients with ankylosing spondylitis, using plain X-rays of the lumbar spine and sacroiliac (SI) joints, were assessed in relation to clinical and laboratory measurements. Bath Ankylosing Spondylitis Radiology Index (BASRI) and Stoke Ankylosing Spondylitis Spine Score (SASSS) were used to evaluate radiologic changes. Disease activity was assessed using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). There was no correlation between duration of morning stiffness, night pain, laboratory variables (ESR, CRP, hemoglobin, platelets) and any of the radiological scores. No significant correlation was found between BASDAI and both of…the radiological scores. BASRI and SASSS correlated significantly with occiput-to-wall distance, Schober test, and finger-to-fibula distance. There was no significant correlation of radiologic scores with finger-to-floor distance and chest expansion. Right and left SI joint scores correlated significantly with BASRI and SASSS. The good correlation between spinal indexes and lack of correlation between clinical indicators of disease activity supports the notion that these two radiological scoring methods are measures of disease severity or deformity rather than disease activity. Radiological scoring methods are fundamental for the diagnosis and progression in AS and BASRI may be a more practical and appropriate method.
Abstract: Celebral palsy (CP), unlike many other neurodevelopmental disorders, is associated with abnormalities of pregnancy and birth, particularly “birth asphyxia” and low birthweight. The aim of this research was to define and evaluate the degree up to which the physiotherapeutic treatment after puberty, when the musculoskeletal system is almost developed, can have a positive influence on bone mineral density (BMD). In the research 26 individuals having different forms of CP, 13 males and 13 females, participated. The percentage according to the form of the disease gender was tetraplegic 50% women, average age 25.4 years, diplegic 26.9% and 6 women,…average age 27.2 years, hemiplegic 23.1% individuals), 3 men and 3 women, average age 27.2 years. Before the measurements there were clinical tests and EEG's. The program was conducted 3 times per week for twenty six (26) weeks and included energetic, energopathetic and energetic with resistance exercises. Each session consisted of a one-on-one program of exercise with the upper, lower extremities and lumbar region. Dual energy X-ray absorptiometry (DEXA) was used to assess bone mineral density (BMD) of the lumbar spine and femoral neck. To minimize operator-related variability, all scans were performed and analyzed by the same trained technologist. For the control of the statistical importance of the value changes the ANOVA test was used from the statistical package SPSS. After intervention, the physiotherapy group had a significantly greater increase in bone mineral density in femoral neck, compared with control subjects, but not in the lumbar region (L2–L4), where the physiotherapy program was not intense. The results of this investigation show that a 6-month physiotherapeutic program enhances bone mineral density in individuals with cerebral palsy. This supports the concept that a minimal period of exercise is successful in eliciting an osteogenic response in these groups. The therapeutic goal of physiotherapists and orthopaedics is to promote exercise, especially weight-bearing activity, to decrease fragility and susceptibility to fractures in patients with decreased activity.
Keywords: celebral palsy, tetraplegic, diplegic, hemiplegic, bone mineral density BMD, exercise