Journal of Back and Musculoskeletal Rehabilitation - Volume 19, issue 2-3
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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: Study design: A prospective study made into cervical disc hernias. Objectives: To assess the changes in the early postoperative period of the patients with cervical disc hernia in terms of the pain and disability we measured according to ‘The Neck Pain and Disability Scale’, physical performance, fatigue, fear of activity (kinesiophobia), physical activity levels. Setting: Neurosurgical department. Summary of background data: Kinesiophobia and its associated avoidance behavior in the development of chronic musculoskeletal pain has been of great concern over the past decade, thus rendering appropriate and detailed assessments in the postoperative period very…important. Methods: Sixteen patients operated on because of cervical disc hernia were included in our study. The pain and disability, physical performance, fatigue, kinesiophobia, and physical levels of the patients were evaluated pre-postoperatively, during discharge and at the end of the second month. Results: While pain, disability measured according to ‘The Neck Pain and Disability Scale’ fatigue were decreasing, all performance measurements except the sit/stand, lying/sit and loaded reach were getting highest scores on the 2nd postoperative month. Although kinesiophobia, peaked at the 2nd postoperative month, physical activity level had also arrived the preoperative level at this time. Conclusion: Increased kinesiophobia, affected the physical performances and physical activity levels of the patients in daily lives in spite of decreased pain, disability and fatigue. Kinesiophobia had effects on postoperative recovery duration, daily life, and return to work. A detailed evaluation should be performed particularly for kinesiophobia in early postoperative period.
Keywords: Cervical fusion, neck pain, performance, physical activity, performance early period
Abstract: The purpose for this study was to examine efficacy of two spinal ortheses, a lumbar orthosis (LO) and a lumbosacral orthoses (LSO), in limiting spinal range of motion (ROM). Seventeen healthy male participants were instructed to perform three trials for trunk flexion, extension, and lateral bending in two orthoses, ProLign LO and UltraLign LSO (DeRoyal Industries, Inc.), and in an un-braced condition. A digital video camera was used to obtain kinematic data from the right sagittal and posterior views. Retroreflective markers and/or wands were used to monitor the motions of the hip, 1st thoracic vertebra (C7-T1), and 1st (T12-L1) and…5th (L5-S1) lumbar vertebrae during trunk flexion and extension as well as the motions of the C7-T1, T12-L1 and L5-S1 during lateral flexion. Selected variables were evaluated using a one-way analysis of variance with post hoc comparisons (P<0.05). Both orthoses were effective in restricting intervertebral movements in the three trunk movements. UltraLign LSO provided greater spinal restriction on ROM in all three trunk movements. ProLign LO offered less restriction on the lumbar movements compared to UltraLign LSO, but was still effective in the reduction of lumbar intervertebral segmental mobility compared to the no-brace trials.
Keywords: Orthoses, lumbar orthoses, lumbosacral orthoses, range of motion, spine
Abstract: Objective: Epidural steroid injections (ESIs) are widely used in clinical practice for the treatment of low back radicular pain. Anecdotally it has been conveyed that the reproduction of a patient’s usual pain during ESI was of prognostic value as to which patients would show favorable results from the procedure, however, there is no data available to support this supposition. Design: Retrospective. Setting: Outpatient Spine and Sports Medicine Clinic. Patients: Patients with lumbosacral radicular pain treated with fluoroscopically guided contrast enhanced lumbosacral transforaminal ESI. Outcome Measures: 11-point pain intensity numeric rating scale (PI-NRS).…Results: Overall the procedure provided statistically significant pain relief in both groups A (typical radicular pain reproduced) and B (typical radicular pain not reproduced) immediately and significant pain reduction was maintained until the time of the follow-up No reduction in pain was seen in group A vs. B, although in group B there was a strong trend toward having higher pain scores at all times. Conclusion: The reproduction of a patient’s typical radicular pain during a fluoroscopically guided contrast enhanced lumbosacral transforaminal ESI does not predict a significant decrease in pain scores immediately after the procedure or at follow up.
Abstract: Objectives: To compare back muscle endurance during the trunk holding test with and without remote muscle contraction using electromyographic (EMG) power spectral analyses. Methods: Eleven healthy male subjects were studied during the unsupported trunk holding test without grip power and with 20% and 50% grip power. Surface electrodes were placed over each erector spinae muscle at L1 level. Median frequency (MF) and mean power frequency (MPF) were evaluated by the ME3000P Fast Fourier Transform spectral analysis program. The rate of change was determined for each parameter during the test, and significance was examined by the Wilcoxon matched-pair signed-rank…test. Results: Both MF and MPF decreases with 20% grip power were significantly faster than without grip power (p=0.003 and 0.012). Both indices decreases with 50% grip power were significantly slower than with 20% grip power (MF: p=0.004, MPF: p=0.041). Conclusion: Changes in back muscle endurance by remote muscle contraction were confirmed using EMG power spectral analysis. We found that back muscle endurance with 20% grip power was lower than without remote muscle contraction, and the endurance with 50% grip power increased than with 20% grip power.
Abstract: Asymptomatic subjects greater than 55 years old received lumbar spine magnetic resonance imaging studies. Two radiologists, blinded to the subjects' history, independently read the scans for the presence of abnormalities. One radiologist also measured spinal canal dimensions. In 33 subjects, at least one disc bulge was present in 28 (84.8%) subjects, at least one disc herniation in 6 (18.2%), at least one degenerated facet joint in 25 (75.7%), ligamentous thickening in 22 (66.7%), and anterolisthesis in 6 (18.2%). Twenty-four (68.5%) had at least mild, 10 (28.6%) had at least moderate, and 2 (5.6%) had severe central canal stenosis. Mean osseous…spinal canal diameter gradually decreased from 20.4 mm at the L1-2 level to 16.0 mm at L5-S1. Midline thecal sac diameter and lateral recess anterior-posterior diameter were relatively unchanged. Interfacet distances both slowly increased from L1-2 to L5-S1. To achieve 95% and 90% specificities, the lower-limit cutoff should be 10.7 mm and 11.9 mm for the osseous spinal canal diameter, 6.5 mm and 7.6 mm for the thecal sac, and 3.7 mm and 4.3 mm for the lateral recess. Understanding the range of findings in asymptomatic older subjects will help clinicians better treat older patients with spinal disorders.
Abstract: A prospective randomized study was conducted comparing vertical ambulatory traction in 41 patients (group 1) to 35 patients treated by the same traction device combined with daily walking for 12 days and than 8 more sessions on alternating days (group 2). The pain score, lumbar spine range of motion and satisfaction with treatment were examined 1,6 and 12 months following completion of treatment. The results demonstrated improvement in pain score and range of motion at each follow up examination. The pain improvement in group 2 was significantly better than in group 1. One year after completion of treatment, 63%…of the patients from group 1 and 78% of the patients from group 2 were satisfied with the results.
Keywords: Low back pain, lumbar traction, treadmill
Abstract: A new treatment system using nuclear resonance as its active principle was applied, as an adjunct to a normal standardized physiotherapy programme. This novel NuclearResonanceTherapy (MBST® or MBS-Therapy) was applied for one hour on five successive days. The study was performed double blind, placebo-controlled and randomised on 62 rehabilitation patients suffering from chronic Low Back Pain at baseline, after one week and after 3 months. The pain measurements using the Visual Analogue Scale (VAS) showed a distinct reduction of pain after active MBST® and placebo. The Roland & Morris Disability Index (RM) total score also improved significantly in both groups,…but the improvement was more distinct in MBST® patients compared to placebo. After three months, the positive effect of MBST® on the RM total score was still significant (p<0.00001) whereas this was not the case for the placebo-treatment. The significant improvement in the MBST®-group was primarily evident in the RM-questions regarding incapacities caused by Low Back Pain, particularly sleeping problems, fatigue, bending ability, and the time required to get dressed. NuclearResonanceTherapy as a complementary treatment can improve the outcome obtained by inpatient rehabilitation programmes after 3 months.
Keywords: NuclearResonanceTherapy, MBST®, chronic low back pain, rehabilitation, Roland & Morris disability index
Abstract: Objectives: This study was conducted to determine the prevalence and risk factors of low back pain in pregnancy period. Methods: The study group was a cross sectional pregnant population admitted to health centers and hospitals for routine pregnancy controls. A structured questionnaire, disability indexes and Zung depression scale were administered to pregnant women. Nonparametric tests were used to determine pain sensation before and during the pregnancy. Logistic regression analysis was performed to determine the probable factors which may lead to pain sensation and to specify its severity. Results: This study was completed with 1357 pregnant women…with a mean age of 27.1 ± 9.9 years. The frequency of LBP in our study group was 734 (54.1%). Pain related restriction in daily activities were evaluated by Quebec and Oswestry indexes (respectively Kruskal Wallis; 74.561, p<0.001, Kruskal Wallis; 70.981, p<0.001) and a significant difference was found between those who suffered from pain and who did not. Logistic regression analysis revealed that in subjects who had pain before pregnancy had increased weight, smoking, increased maternal age, the highest Qswestry score and no assistance in their daily activities had both pain and more severe pain. A predominant decrease in disability was observed between fourth and fifth months of pregnancy. Conclusions: Low back pain prevalence in Turkish pregnant women is similar to the prevalence of pain in other countries. Oswestry disability index can be used to detect low back pain related to pregnancy and early physiotherapeutic treatment may be initiated.
Keywords: Low back pain, pregnancy, disability indexes, prevalance
Abstract: Nontraumatic acute myelopathy caused by cervical disc herniation is rare, and no case has been reported which the disease progresses during active labor. A 32-year-old primiparous woman encountered left cervical myelopathy during the second stage of labor. Cesarean section was performed two hours later because of the arrest of descent. Magnetic resonance imaging revealed C3–C6 disc herniation with a focal hyperintense signal in the cervical cord at C3–C4 level. She underwent anterior multilevel diskectomy with fusion and rehabilitation. She walked independently 1 month after surgery and reported only minimal paraesthesia in hands by 18 months. Our case suggested that accurate…diagnosis, early surgical intervention, and pertinent rehabilitation would be the keys to successful management.