Journal of Back and Musculoskeletal Rehabilitation - Volume 20, 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: Objective: The objective of this randomized controlled trial was to assess the efficacy of correcting pelvic obliquity by heel lifts to reduce pain and improve physical and emotional functioning in patients with chronic low back pain. Methods: Subjects were ≥ 20 years old with low back pain for at least one year. They were randomly assigned to experimental (n=9) or control (n=6) groups. Degree of pelvic obliquity was determined by postural radiographs. Main outcome measures were level of pain (McGill Pain Questionnaire – Short Form), and physical and emotional functioning (Medical Outcomes Study 36-Item Short Form Health Survey)…which were administered at baseline, end of treatment and 3- and 6-month follow-ups. Experimental subjects received heel lifts and custom-molded insoles to correct pelvic obliquity; controls received off-the-shelf insoles. A physical therapist taught exercises to both groups. Results: Baseline outcomes measures were similar in both groups. With treatment, experimental subjects had significant improvement in general health, physical and social functioning, and vitality, and significantly less pain than controls. Conclusion: Correction of pelvic obliquity appears to improve pain and functioning in patients with chronic low back pain.
Keywords: Chronic low back pain, pelvic obliquity, leg length discrepancy, pain, function
Abstract: The article describes the case of a 70-year-old woman who developed a spontaneous spinal epidural hematoma while on warfarin therapy. She presented more than 24 hours after the onset of back pain and paraplegia. The lesion was diagnosed by magnetic resonance imaging and urgent decompression surgery was performed. Despite appropriate rehabilitation, there was no neurological improvement in the first 14 months after the operation. The article discusses clinical presentation, diagnosis, treatment and factors that affect outcome in cases of spontaneous spinal epidural hematoma.
Abstract: The principle of tensegrity in massage. The study introduces a theoretical justification for the use of the tensegrity principle in massage. Balanced pulling forces occurring in the organism are a guarantee that optimal spatial arrangement of cells, tissues and organs is sustained. Stabilization of the skeleton of human body changes depending on the functional and resting muscular tonus. The phenomena is based on the principle of biokinematic chains, according to which any changes in the tonus of one of the elements of the chain cause changes in the tonus of other of its elements. It is called tensegrity or integration…of tensions. It describes a mechanical stabilization of a structure by balancing pulling forces (muscles, fascia, ligaments) and compression forces (bones and cartilage). Proper distribution of resting tonus of the muscles is a prerequisite to optimal spatial arrangement in the organism, known as structural homeostasis. One of the most fundamental tasks of massage is normalization of resting tonus of skeletal muscles. If it is to be effective in the long run, it has to take into consideration structural dependences in accordance with the principle of tensegrity. Therefore, massage should be performed not only in the painful area but also within those tissues (muscles, fascia, ligaments) which are in structural dependence with it and take part in balancing the tonus of painful tissues.
Abstract: Objectives: Many studies have been performed about work-related musculoskeletal pain (WRMSP) in various groups of professions. However pharmaceutical sales representatives (PSRs) have not been investigated with regard to their musculoskeletal problems related to their works. This study was aimed to investigate the prevalence of work-related musculoskeletal pain (WRMSP) and depression among PSRs; the quality of life in these subjects and to investigate which socio-demographic variables are associated with the presence of complaints, in Turkey. Methods: Among 170 participants, 73.5% completed the survey. A face-to-face questionnaire was given and SF-36 (Short Form-36) and Beck Depression Inventory (BDI) were applied.…Results: The highest frequencies of WRMSP were in low back (55.4%) and shoulder (41.1%). The most frequently self-reported complaints of the PSRs were long time standing at work (68.8%) and driving long distances (61.6%). There was significant difference between the groups with and without WRMSP all subgroups of SF-36 test (p< 0.05). Fourteen of the participants had depression according to BDI. There was a negative correlation between SF-36 and BDI scores (p< 0.05). Conclusions: WRMSP is common among PSRs in Turkey. Besides; depression, reduced QOL and low back pain are frequently seen. Modifications in ergonomics at work and work conditions may solve these problems.
Abstract: Objectives: The purpose of this study was to investigate the incidence of injuries in dance aerobic instructors in relation to the duration of warm up and cool down before, during and after a class and the types of stretching exercises. Methods: The sample of the study was constituted of 404 (120 male and 284 female) aerobic instructors who were educated in public and state colleges of physical education and sports in Greece. For the statistical treatment of the data, the method used was the analysis of frequencies and the non-parametric test X 2…. Results: According to the results, 58.7% of the instructors were injured: Most of the injured instructors were absent from class up to a month, 21.8% over a month and 12.9% up to a week. Out of all injuries, 159.5 (29.5%) were acute injuries and 384.5 (70.5%) overuse syndromes. The injury rate was 0.23 injuries per aerobic instructor per year. It was also recorded that there is a statistically important relation between the rate of injuries and the duration of the warm up and cool down. When the warm up and cool down during the program is about 15 minutes, the number of injured instructors appears significantly smaller. As for stretching exercises included in the warm up and cool down, the results showed that there is not a statistically significant relation between the rate of injuries and the type of stretching exercises. When instructors performed a private warm up and cool down before and after the program, the rate of injury decreased even further. Conclusions: Injuries may occur because of many factors, but in aerobic dance the duration of warm up and cool down must be taken into serious consideration, as much as specialized knowledge and constant update.
Abstract: We analyzed retrospectively electromyographic evaluations of 76 patients with stable post-traumatic lumbar radiculopathies who underwent repeated electrodiagnostic examinations. Their median time from injury was 4.5 years. Median time between examinations was 21 months. In 36 (46%) there was no significant change. 18 patients (24%) showed mild improvement, 8 (11%) marked improvement, 12 (16%) mild deterioration and 2 (3%) had severe deterioration. Patients who improved were examined usually shorter time after injury. None improved more than eight years after the injury. Marked worsening between examinations was seen only in older patients. A significant difference between examinations could be observed until up…to 44 months after the first. In conclusion, significant late changes of the EMG are rare in patients with stable traumatic radiculopathies, but can occur also after years.
Abstract: Background: The mainstream of treatment in myofascial pain is to breakdown the vicious cycle of pain through the elimination of trigger points (Trp). Several methods have been recommended in order to achieve this goal. Objectives: It is a prospective, randomised active controlled study of the effect of a variety of technical interventions in chronic myofascial pain syndrome compared with the effect of stretching exercise. Methods: Ninety patients with trigger points on one side of the trapezius muscle for more than 6 months duration were randomly assigned to one of the 5 groups. Group I. Botox-A Trp…injection (TPI) 10 U (n=18), Group II. Lidocaine 0.5% 1 ml (n=18), Group III: US (conventional) (n=18), Group IV. US (high-power pain threshold) (n=18); Group V. Stretching exercise (n=18). Stretching exercises were also combined with the therapies in groups I–IV. Visual analog scale (VAS) for pain intensity was used as the parameter for comparative evaluations before treatment and at one week and one month after treatment. Results: At 1 week post-treatment evaluations, all groups showed statistically significant improvements (p< 0.05), however, none of the treatment methods proved to be superior to the others when intergroup comparisons were made. At 1 month post-treatment evaluations, statistically significant improvements were detected both in Lidocaine Trp and Botox A Trp injection groups (p< 0.05), when compared to the other groups. There was no statistically significant difference between lidocaine and Botox A injection groups (p> 0.05). Conclusions: Lidocaine and Botox A Trp injections were more effective in treating patients with chronic MPS in one month controls. Both techniques in US treatment were equally effective.