Journal of Back and Musculoskeletal Rehabilitation - Volume 18, issue 1-2
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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: Relentlessly progressive sympathetically maintained pain (SMP) with dystonia in a patient with CRPS1 was consistently responsive to systemic phentolamine, but not responsive at all to regional intravenous phentolamine. Sympatholysis was only transiently effective. Our observations suggest that neural activity that caused the pain and drove the dystonia probably originated in sympathetic-sensory coupling within dorsal root ganglia (DRGs) rather than in abnormally adrenosensitive afferent endings in the extremity.
Abstract: The purpose of this study was to document age-related alterations in trunk extensor strength and to compare these to changes in knee extensor strength over varying angles of muscle contraction. A secondary purpose was to compare age-related changes in trunk extensor endurance while statistically correcting for torso mass differences. Eighteen older (70 ± 7.3 years) and fifteen younger (22.1 ± 4.6 years) women volunteered for the study. Torso mass and trunk extension endurance (Modified-Sørenson test) were also evaluated. The results suggested that age-related torque production was both angle and muscle group dependent. Younger adults were 29% stronger in the knee…and 23% stronger in the trunk extensors. Furthermore, the difference between age groups in knee extensor strength was 2.30 Nm/kg at 78°, but only 0.47 Nm/kg at 6° of knee flexion. This angle discrepancy was not evident in the trunk extensors. Following torso mass correction, trunk extension endurance time did not differ between ages (Young: 160.4 ± 65.8 vs. Old: 159.5 ± 71.9 sec, $p =$ 0.99). Our study suggests that the elderly should focus on improving trunk extension strength rather than endurance. Also, knee extensor strength exercises should be emphasized between 60° and 108° of knee flexion in the elderly to combat the age-related loss of lower extremity strength.
Abstract: Flexion and extension of the spine induce loads to the anterior or posterior spinal column and therefore may affect disc hydration. Information related to the effect of activity on hydration of intervertebral discs could lead to a better understanding of the pathophysiology and rehabilitation of low back injury. A pilot study evaluating the effect of spine position and loading on the changes of disc hydration in vivo was conducted with three volunteers without low back pain history. Spines were scanned in neutral, flexion and extension positions. MRI was repeated after 6 hours of normal activity and 4 hours…of heavy activity with a weighted vest. Signal intensities of the intervertebral discs were measured at the L4-5 and L5-S1 levels. The signal intensities decreased by 9.3% at L4-5 and 8.3% at L5-S1 intervertebral discs compared to baseline after 6 hours of daily activity. The intensities decreased more (14.5% and 12.4%) with additional four hours of heavy activity. There was no change in disc signal intensity between neutral, flexion and extension of the spine. This study showed that: 1) rapid fluctuation of load such as between flexion and extension does not change disc hydration 2) prolonged loading of the spine decreases disc hydration.
Keywords: flexion-extension, vertically open MRI, disc hydration
Abstract: Manual therapists frequently use posteroanterior mobilisation as both an examination tool and a form of conservative treatment. At present our knowledge of the principles underlying this technique are scant. This study aimed to investigate changes in vertebral kinematics and soft tissue displacement as a result of a sustained posteroanterior (PA) mobilisation applied to the cervical spine of a subject with a history of chronic neck pain. Five subjects were recruited and written informed consent obtained. Subjects were scanned using a General Electric Signa SPI0 Open Interventional MRI scanner. Subjects were scanned in the prone position with their necks in…both neutral and flexed positions. In each position a PA mobilisation to the 2nd and 6th cervical vertebrae was performed. Sagittal images of the spine were obtained prior to, during and following the mobilisation, from which measures of vertebral angulation and translation were recorded. Measurements of intervertebral angulation and translation demonstrated little if any motion during the application of a PA mobilisation. Marked and significant changes were seen in terms of soft tissue compression and in some instances overall angulation of the cervical spine. These initial studies suggest that the application of a PA mobilisation to the cervical spine produces minimal if any intervertebral motion. This is in agreement with earlier studies investigating motion in healthy normal spines.
Abstract: Objective: To develop and appraise a non-invasive method of determining disruptions to cervical segment mechanics. Design: A modified open magnetic resonance imaging system and post-process analysis tool were used to determine relative cervical vertebrae rotations and translations in a cohort of symptomatic patients, the results of which were compared to validated precision measures obtained from lateral radiographs. Methods: The cervical motion of 14 subjects with chronic neck symptoms were investigated in neutral, full flexion and full extension positions under voluntary neuromuscular control using open magnetic resonance imaging and lateral röntgenograms. Planar rotations and translations were calculated from the…MRI images using the method of Dupuis et al. , and compared for agreement with the precision sagittal plane measurement technique of Frobin and colleagues [12, taken from the subjects lateral röntgenograms. Results: The interventional Magnetic Resonance method produced rotational results of up to 10° above and 9°c (SE 1.22) below the method of Frobin et al. , and translational results of 18 mm above or below (SE 2.12). The error of repeatability in the interventional Magnetic Resonance method was not significant (rotation P = 0.68, Translation P = 0.96). Conclusions: The disparity between methods limits the potential of Magnetic Resonance Imaging in clinical trials particularly those investigations into pseudarthrosis and instability.
Keywords: cervical instability, interventional magnetic resonance imaging, kinematics
Abstract: Objectives: The objective of this study was to test the reliability and validity of the Turkish version of the Quebec Back Pain Disability Scale (QBPDS) and Pain Disability Index (PDI) as well as the retainment of the psychometric properties of the original versions. The importance of the region-specific functional measures on patients with chronic low back pain was also assessed. Methods: Eighty-three patients with chronic low back pain were enrolled in the study. The QBPDS, the PDI and The Hospital Anxiety and Depression Scale (HADS) were filled by all subjects. Reliability was determined by internal consistency. Internal consistency…was measured by calculating Cronbach’s alpha and item-total correlation. Validity was examined by correlating the QBPDS and PDI scores to external criteria scores at a single point in time, defined as cross-sectional construct validity. Results: Cronbach’s alpha value for QBPDS and PDI was found 0.93 and 0.84 respectively, which were both statistically significant (p < 0.0001). The item-total correlations of QBPDS varied between 0.28 and 0.76, and that of PDI varied between 0.30 and 0.73. The cross-sectional construct validity coefficients of QBPDS were 0.63 for PDI, 0.46 for Visual Analogue Scale (VAS), 0.28 and 0.16 for HADS. Correlation coefficients of PDI were 0.49, and those of VAS and HADS were 0.36 and 0.24 respectively. Conclusion: Our results are in accordance with the previous findings of the English and French versions of the QBPDS and English version of the PDI, indicating that these functional scales are valid and reliable. However, due to the considerable overlap between generic and region-specific functional instruments, the use of both scales is not necessary. We conclude that the QBPDS and PDI both measure predominantly functional status in patients with chronic low back pain.
Keywords: functional status, low back pain, lumbar spine, reliability, validity
Abstract: Joint function is described by biomechanical parameters like range of motion (ROM), stiffness, laxity and stability. However, these terms are frequently used ambiguously. Due to the lack in standardisation, it is difficult to compare results of examinations. A literature survey is performed and an inventory is made about the definitions used for the terms. The final definition for ROM is the range of translation and rotation through which a joint may be actively or passively moved in a certain direction. Joint stiffness describes the resistance of the joint to imposed relative movement between two joint surfaces. Laxity is the normal…amount of motion that results from passive forces or moments and stability is the ability to control positions or movements of joints.
Keywords: stiffness, laxity, range of motion, stability
Abstract: Heterotopic ossification is the deposition of new bone around a joint. Its greatest clinical importance is the potential loss of joint range. Usually, it occurs in patients with head injury, spinal cord injury, burns, or direct trauma to muscle tissue. This is a case report of a 38-year-old patient with myasthenia gravis who developed limited range of motion of hips and the presence of new bone around bilateral hips confirmed with radiography and computerized tomography. This is the first report of myasthenia gravis with heterotopic ossification. This clinic presentation may be due to prolonged complete immobilization and/or mechanic ventilation as…a result of muscle paralysis.