Journal of Back and Musculoskeletal Rehabilitation - Volume 16, 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: Neck pain is reported in 75% is strongly associated with greater disability and decreased quality of life. Botulinum toxin type B (BoNT-B; Myobloc™ ) is a new botulinum toxin that has been proven safe and effective in reducing the pain, severity, and disability of patients with cervical dystonia. We analyzed a subset of efficacy data from two randomized, double blind, placebo-controlled clinical trials. The first study consisted of three treatment groups in patients who were responders to the type A toxin, including placebo (n = 38 ), 5000 units (U) (n = 36 ), 10,000 U…(n = 37 ). The second study consisted of placebo (n=38) and 10,000-U treatment groups (n = 39 ) in patients not responding to the type A toxin. For this analysis, the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS)-subscale scores for pain and three visual analog scales (Patient Analog Pain, Patient Global, and Principal Investigator Global Assessments) were evaluated. A dose-response effect was observed in the reduction of pain based on the TWSTRS-subscale scores. In both studies, mean improvements from baseline to week 4 for all patients were significant compared with placebo (P < 0.005 ). BoNT-B also significantly improved mean values for all VAS assessments. Our analysis confirms that BoNT-B significantly reduces the pain associated with cervical dystonia and improves patients’ overall condition. This clinical benefit suggests that BoNT-B may be useful in other pain syndromes involving involuntary muscle spasms or contractions.
Abstract: This study was designed to compare the effects of Transcutaneus Electrical Nerve Stimulation (TENS) and Electrical Muscle Stimulation (EMS) on myofascial trigger point (MTrP) of the upper trapezius muscle. A total of 40 patients were randomly divided into three groups. All patients had active MTrP in one side of the upper trapezius muscles. Group I was treated with TENS and trapezius-stretching exercises; Group II was treated with EMS and trapezius-stretching exercises and Group III, the control group, had only trapezius-stretching exercises. Subjective pain intensity with VAS, range of motion (ROM), and pain threshold (PT) were assessed before, immediately after…two week treatment and 3 months after treatment. Group I had a statistically significant reduction in VAS (P < 0.01 ), increase in PT and ROM (p < 0.05 ) at end of the treatment when compared with the control group. Only VAS was significantly improved (p < 0.05 ) in the Group II patients. At the end of the third month, both groups showed highly significant improvement (p < 0.01 ) in VAS and PT (but not ROM). There was no statistical difference in none of parameters between EMS and TENS groups in any time (p > 0.05 ). In conclusion, TENS seem to be more effective immediately after treatment but in long term evaluation there is no significant superiority of two electrotherapy techniques on each other.
Abstract: Back extensor muscle fatigability and its relationship to body mass index (BMI) was measured in 12 chronic nonspecific low back pain (CNLBP) patients (7 women and 5 men) and 12 healthy age-and gender-matched controls. Subjects performed SÃÿrensen back isometric endurance test until exhaustion while EMG spectral mean power frequency (MPF) over the lumbar erector spinae muscle and endurance time were recorded. The CNLBP patients had significantly shorter endurance time than healthy controls. Spectral MPF significantly declined as time of isometric contraction progressed. Relative decrease of the MPF per minute (MPF slope) for left and right side, and pooled MPF slope…was significantly higher in CNLBP patients compared with controls. In CNLBP patients the isometric endurance time correlated significantly negatively with BMI (r = − 0.71 ). In controls BMI correlated significantly positively with MPF slopes of left (r = 0.68 ) and right (r = 0.57 ) side, and pooled MPF slope (r = 0.62 ).
Keywords: low back pain, back extensor muscle fatigability, body mass index
Abstract: The purpose of this study was to determine the effect of pelvic stabilization during resistance training on the development of isometric lumbar extension strength (torque output) when testing and training are conducted on a lumbar dynamometer. Eighteen healthy volunteers were randomly assigned to one of two groups that trained on a lumbar extension dynamometer: One trained with pelvic stabilization (n = 9 ) and the other trained without pelvic stabilization (n = 9 ). Peak isometric lumbar extension torque was measured on the dynamometer at seven angles over the full range of lumbar flexion, before and…after a twelve-week, one time per week dynamic progressive resistance exercise program. Following training, peak isometric torque increased for the stabilization and without stabilization groups (average increase of 15.8 ± 11.8 % and 20.6 ± 17.2 % , respectively; p ≤ 0.05 ), while there was no difference in torque production between the groups (p > 0.05 ). This study demonstrates that pelvic stabilization is not required during training to develop lumbar extension strength when testing and training are conducted on the same machine.
Abstract: Objective: Nicotine and caffeine are vasoconstrictors. Complex regional pain syndrome (CRPS) is defined to involve disproportionate pain and autonomic dysfunction . The objectives of this study were to identify the prevalence of smoking and caffeine intake in CRPS, to explore the relationship of pain intensity with smoking and caffeine consumption, and to explore the relationship of pain intensity, anxiety and disability among CRPS patients who smoke, use caffeine, or both. Design: One hundred eleven patients, with CRPS type I or II, from two academic rehabilitation pain clinics were reviewed. Data were collected retrospectively by reviewing CRPS patients’ self-reported…pain level using visual analogue scales (VAS), Beck Depression Inventory (BDI), Pain Disability Index (PDI), and Pain Anxiety Symptoms Scale (PASS). Status of daily smoking and caffeine consumption were also recorded. Results: Smoking prevalence among CRPS was significant higher than the national average (p < 0.001 ). There were no significant relationships between the perceived pain level and either daily smoking, daily caffeine intake, or both (p > 0.430 ). In patients with CRPS I higher PASS scores were positively associated with dichotomous use of smoking and caffeine (p < 0.05 ). The PASS scores among patients with CRPS II were not available for analysis. Conclusions: The smoking prevalence was higher than the national average among patients with CRPS I and II. Among patients with CRPS I smoking and caffeine consumption were greater in those who reported more pain-related anxiety, but did not influence pain intensity. The clinical implications of these findings will be discussed.
Abstract: The subjective complaints of 866 WAD (whiplash associated disorders) patients were recorded at a follow-up examination some 32 months after the accident. The complaints were compared to a number of relatively objective examinations – X-ray, CT, MRI, EMG, Bone scan, and clinical assessment. Neck pain and radiating pain to the limbs were the major complaints. The big majority of the X-rays findings, both primary and late (98%), were found either non-pathological or indicating degenerative changes and old fractures. All positive CT and MRI findings not related to known degenerative changes and old fractures were considered relevant. Bone-scan and clinical…findings not related to old injuries were considered to be relevant to the WAD. Positive EMG findings were considered relevant except for those related with incidental CTS. Comparing the various testing modalities, CT and EMG were found positive in 25% and 33% of the tested sample (11% and 12% of the whole WAD patients), accordingly. Bone-scan and MRI were conducted in a much smaller sample of the patients, and only 33% and 25% (3% and 2% of the whole population) were found pathologic, accordingly. Clinically, C-C (chin-chest touch) and RoM tests identified 75 (9%) and 58 (7%) of the pathologic population, accordingly. Excluding degenerative changes and incidental CTS, only 25% of the patients had any objective supporting findings.
Abstract: Anterior shoulder dislocation can secondarily cause nerve injury and/or rotator cuff tear. An elderly male with a recent shoulder dislocation and multiple medical comorbidities was transferred to a rehabilitation inpatient service in order to maximize his functional status. Physical exam suggested a brachial plexus injury. Electrodiagnostic testing confirmed a complete musculocutaneous and a partial axillary nerve lesion. This specific combination of nerve lesions is a previously unreported complication of anterior shoulder dislocation. Prognosis and treatment are discussed, particularly the use of electrodiagnostic findings to tailor rehabilitation program design.