Journal of Back and Musculoskeletal Rehabilitation - Volume 19, 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: In a prospective study conducted between the years 1999 and 2002 we harvested 26 valuable muscle samples from patients with an unstable lumbar spine from the multifidus muscle and erector spinae muscle at the level of the L4/L5/S1 segments and evaluated them using histochemical methods. Control samples were taken from six patients with a acute fracture of the low lumbar spine. A statistical difference was evident between the experimental and control group in type I fibres from the erector muscle. There was a percentage increase in type I fibres and a decrease in type IIA fibres from the erector muscle…compared to the control group. The percentage of IIX and IIC fibres in the musculus erector spinae was the same in both groups. The investigated multifidus muscle underwent significant changes in type IIA fibres, where the percentage decreased and the percentage of type IIX fibres was almost double in comparison to the control group. Fibres of types I and IIC were not statistically changed. Type IIX fibres react to the exceeding of normal ranges of movement in the functional spinal unit to prevent an abnormal shift and thus stabilize the segment. These changes in the multifidus muscle are the premise of its mostly local stabilizing function, whereas the erector muscle has predominantly postural, long-term stabilisation features because of the increase of type I fibres.
Keywords: Chronic low back pain, erector spinae muscle, multifidus muscle, muscle biopsy, fibre type distribution
Abstract: Anterior chest wall pain resulting from an athletic injury has a broad differential diagnosis including muscular strain, partial or complete pectoralis tear, avulsion of the pectoralis tendon, rotator cuff injury and referred pain. Rupture of the pectoralis major muscle is rare, except among bodybuilders, in whom this lesion has been well described. As a result of injury to the pectoralis muscles, the medial and lateral pectoral nerves may be injured as well, causing atrophy, asymmetry and weakness. We present a case of chronic pectoral pain in a twenty-five year-old male four years following his initial injury secondary to…a 370 pound bench-press. Both MRI and electrodiagnostic testing were used in order to diagnose medial pectoral nerve injury. The patient was conservatively managed, with a favorable outcome.
Abstract: Objectives: The purpose of the study was to examine the effects of a workplace physical exercise intervention on the intensity of low back symptoms. Methods: The study was a cluster randomized controlled trial with department (n=4) as the unit of randomization. The subjects were office workers [(n=36), mean age 47.1 (SD 8.4) years] who self-reported low back symptoms, which restricted their daily activities during the last 12 months. Low back symptoms were measured using the Borg CR10 scale. The cross-over design consisted of one intervention period of light resistance training and guidance and no training and no guidance…of 15 weeks duration. Statistical analyses were based on linear mixed models. Results: The active component of the intervention, light resistance training, resulted in a slight, but statistically significant, decrease in the intensity of low back symptoms (p=0.020). At the average training time of 5 minutes per working day (25 min/week) the average decrease during the 15-week period was 0.42 CR10 (95% CI 0.07–0.77) and 19% (95% CI 3–35). Conclusion: A physical exercise intervention, which included daily light resistance training, conducted during the working day affected low back symptoms in a positive direction among symptomatic office workers.
Keywords: CR10, low back pain, prevalence of low back symptoms, occupational health, physical activity, secondary prevention, exercise
Abstract: Objective: The weight of a child’s backpack is widely thought to contribute to back pain. No studies directly support numerous general guidelines on backpack use. This study is designed to investigate the relationship between back pain and backpack weight in an American school population. Study Design: Blinded, cross-sectional, observational study. One hundred and eighty four schoolchildren in the third grade and middle school levels filled out a questionnaire on individual habits and back pain. Height, weight, and backpack weight were measured by blinded observers. Results: While there was a relationship between age and back pain (45.6%…of middle schoolers, vs. 15.3% of 3rd graders, p < 0.01), the relationship between back pack weight and back pain was not significant. Those who carried other objects (musical instruments, sports bags, etc.) had have increased back pain (p= 0.019), but this relationship disappeared with age adjustment. Conclusion: Contrary to media hype, laws, and position statements, this first study of the relationship between back pack weight and pain suggests that there is no independent relationship between back pack use and back pain in American school children.
Keywords: Back pain, children, back packs, epidemiology
Abstract: The objective of this study was to determine whether there are changes in peak expiratory flow rate (PEFR) and chest expansion after a standardized physical therapy program in patients with chronic neck and back pain. In a university-based, out-patient physiotherapy department, thirty-three patients were assigned into the study (9 cervical disc herniation and 24 lumbar disc herniation, mean age respectively 45.0 ± 12.85 (30–72 years), 41.33 ± 11.69 (22–63 years). Data on pain intensity, PEFR and chest expansion were collected before and after physiotherapy programme. A combination of hot-pack, massage, interferential current and exercise were applied for two weeks. None…of the patients were given any breathing exercises. In both groups, a significant reduction in pain intensity and increase in PEFR occurred (p<0.05) after therapy. Although considerable increases were obtained in chest expansion, only CDH group showed significant improvement at axillary level (p<0.05). No significant relation was found between changes in pain intensity and PEFR in both of the groups (CDH group r=0.045, p=0.908, LDH group r=0.014, p=0.947). This study suggests that physiotherapy programmes aimed to reduce pain and improve postural alignment of the patients have shown positive effects on respiratory functions too.
Keywords: Neck pain, low back pain, PEFR, chest expansion, physiotherapy