Journal of Back and Musculoskeletal Rehabilitation - Volume 20, 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: Objective: The aim of our study was to detect the factors which might affect the recovery of the patients with Acute Non-Specific Low Back Pain [ANSLBP] according to their Body Mass Index [BMI], and to determine the effects of these factors on disability and the perceived functional level with quality of life. Design: A retrospective study. Patients: Ninety-three patients were included in the study, and separated as three groups according to BMI [normal weight group, Grade1 obesity group, Grade 2 obesity group]. Methods: Acute Low Back Pain Screening Questionnaire [ALBPSQ] and SF-36 Physical Functioning…Scale [PFS] were used in the evaluation of the patients. Results: The ALBPSQ and SF-36 PFS results of our patients in all three groups before and after the treatment were found to be significant in the direction of positive scores [p < 0.05]. When the SF-36 PFS scores and the total scores of ALBPSQ were compared among the groups according to the increase of the obesity, there existed a significant difference [p < 0.05]. Between the ALBPSQ and SF-36 PFS scores, in the three groups correlation was determined in the negative direction. Conclusion: With the treatment applied to our patients, pain and disability with the quality of life showed positive differences, but the results were observed to be affected unfavorably through the increase of obesity based on the functional status and decrease in the quality of life.
Keywords: Acute low back pain, function, quality of life
Abstract: Aim: The radiological lesions and neuropathic complications are common in Diabetes Mellitus (DM). Foot deformities may lead to abnormal pressure distribution and foot ulcers. The aims of this study are to examine neurological disorders of the lower extremity and the radiological deformities of the foot and to search if any correlation between neurologic disorders and radiological deformities exist in DM. Methods: 46 subjects (mean age 56.30 ± 13.45 years, 35 women, 11 men) with type-II DM and 30 non-diabetic subjects (mean age 55.20 ± 12.20 years, 22 women, 8 men) were included. Neurological examination for polyneuropathy and radiological…evaluation for foot deformities was performed by the same physiatrist. For polyneuropathy, superficial and deep sensation, pain, thermal, touch, proprioception and vibration senses were examined at right (RE) and left (LE) lower extremities. Foot deformities were evaluated by X-rays. Results: Peripheral sensorial neuropathy was present in 80.4% of the diabetic patients. In order of frequency from the highest to lowest; hallux valgus, epin calcanei, pes planus, fracture, lisfranc dislocation (LD), osteoporosis (OP), pes cavus and arterial and tendon calcification were detected in radiological examination. All the subjects with lisfranc dislocation, fracture, pes cavus and arterial calcification had neuropathy as well. Conclusion: Lisfranc dislocation, pes cavus and fractures were lesser in frequency but they were bilateral and their relation with sensorial neuropathy was about 100%, so they seemed to be more important in DM foot deformities. We think further studies with large number of subjects are necessary to show the existence of sensorial neuropathy and lisfranc dislocation, pes cavus and fracture association.
Abstract: Objectives: The purpose of the study was to describe a classification process of patients with low back pain for physical treatment, present a treatment flow and report on short-term outcome. Methods: A multiple subject case study, using a pretest-posttest design was conducted. As short-term outcome measurements, Borg CR 10 pain intensity scale, Oswestry Low Back Pain Disability Questionnaire and the Physical Health Scale from SF36 were used. The subjects were a consecutive sample of 16 adult patients with low back pain, at a physiotherapy clinic in primary care. Inclusion criteria were low back pain, with or without radiating…pain and regardless of duration. Exclusion criteria were pregnancy, previous back surgery, and known rheumatic or neurological disease. Patient interview, physical evaluation and two self-reported measurements were decisive for classification to one of four different treatments; pain modulation, stabilization exercise, mobilization, and training. Patients were treated and followed for up to twelve weeks after classification, and compared to baseline measurements at discharge. No comparisons between patients were made. Results: A clinical decision-making algorithm was constructed according to the differences in clinical presentations. A treatment flowchart describes how improved clinical status results in treatment adaptation. Improvements on all short-term outcome measurements were noted in the majority of patients. Conclusion: This pilot study describes an individualized clinical-decision algorithm for sub-grouping patients with low back pain into one of four treatment-based classifications: pain modulation, stabilization exercise, mobilization, and training. The follow up on classification, showing improvements in pain and disability scores at the individual level, suggests that the presented model may be used when clinical decisions on interventions for patients with chronic low back pain are made.
Keywords: Clinical decision-making, physiotherapy, categorization, treatment flow, low back pain
Abstract: Objective: In medicine, traction is used for act of pulling force for producing distraction or separation between two or more parts of body. However, it is limited to the cervical or lumbar spine in physiotherapic application. We aimed to investigate effect of new traction technique on anatomic structures of lumbar vertebrae, and its’ relation to different application of heating therapy. Method: Ninety five consecutive patients with persistent low back pain participated in this study. Traction applied on new table in prone position. Heating therapy applied concomitantly with traction (group I, n: 32) and sham traction (group III, n:…31), and before traction (group II, n:32). Lateral lumbosacral radiographs were obtained before and during traction. Results: Significant distraction in each disc space; decreasing in both lumbosacral angles and increasing in L1–S1 total distance were found with lying on new table without traction in three groups. Significant widening of all disc spaces and L1–S1 total distances were also obtained during traction in group I, while there were significant widening in L1–L2 anterior, L3–L4 anterior and posterior, L5–S1 posterior disc spaces, and L1–S1 anterior and posterior total distances during traction in group II and in posterior disc space of L5–S1 during sham traction in group III as compared to lying on table without traction. Conclusion: This is a preliminary study to investigate efficacy of new traction technique in prone position. Significant increasing in lumbar intervertebral disc spaces and changes in other anatomic structures were obtained on new table. Efficacy of traction application seemed to be increased by synchronized heating therapy. Creation of negative intradiscal pressure is important to suck back herniated disc material with distraction of lumbar vertebrae in prone position. Future clinical studies should be carried out to investigate efficacy of this traction technique in treatment of low back pain.
Keywords: Traction, prone position, low back pain, distraction, heating
Abstract: Objective: To compare group exercise program performed at hospital with home exercise pogram in patients with ankylosing spondylitis and to observe the efficacy of type of exercises. Patients and method: Forty-six patients with ankylosing spondylitis were enrolled into this prospective, randomized, comparative, open clinical trial. The first group performed instructed exercises at home for 6 months whereas the second group did the same exercises at the hospital for 2 hours weekly under the observation of a physiotherapist for 3 months. Three and 6 months after; pain at rest (VAS) and during activity, spinal mobility, functional capacity were evaluated.…Results: In group 1 significant improvement was observed at rest and during activity pain (p<0.005). Functinal improvement was better in the second group within 3 months. Since group 1 had a good range of cervical rotation, group 2 improved better (p<0.01). Conclusion: Spinal ranges of motion, functional status, depression and quality of life improved in group 2 patients remarkably. Group exercise had a decreasing effect on pain, activity of disease and fatigue. While home exercises improved spinal activity, it had no effect on functional status, disease activity, depression and fatigue.
Keywords: Ankylosing spondylitis, exercise, quality of life, functional capacity
Abstract: The aim of this study was to compare spinal curvature and muscle tone characteristics in elite female rhythmic gymnasts (n=32) and untrained controls (n=48). Results showed that the angles of lumbar lordosis (LL) and thoracic kyphosis (TK) were lower (p<0.001) in gymnasts in comparison with the control group. It was evident that the vertebral column of gymnasts had straightened in thoracic as well as in lumbar part of the spine. The trunk flexors in gymnasts were undertoned, the tone of rectus abdominis muscle was lower (p<0.001) in gymnasts compared to that of the control group, while tone of erector spinae…muscle (trunk extensor) was not differed from the control group. The tone of spinal muscles was higher (p<0.001) than that of abdominal muscles in gymnasts, whereas the tone of these muscles did not differ significantly in controls. In the control group, the tone of trunk flexor and extensor muscles were in balance, whereas in gymnasts it was imbalanced. The indicator of tone imbalance of the trunk flexor and extensor muscles correlated negatively with the difference in body height in supine and standing positions (L) (r = − 0.66, p<0.001) for the group of gymnasts. In gymnast, TK and LL correlated negatively with Oswestry score (r= − 0.68, p < 0.05 and r= − 0.66, p<0.05, respectively) and positively with L (r=0.63, p < 0.05 and r=0.60, p < 0.05 respectively). This indicates that the more rigid vertebral column, flattened in thoracal and lumbar part that appeared in gymnasts, associated with imbalance in muscle tone and low back pain (LBP). In 50% of measured gymnasts, LBP incidence was observed.
Keywords: Spine, muscle tone, skeletal physiology, children
Abstract: Lumbosacral radiculopathy is a relatively common condition, affecting approximately 1–10% of the population. Herniation of nucleus pulposus from the intervertebral disc initiates a strong inflammatory response that can result in pain with or without spinal nerve injury. Both inflammatory and mechanical factors are involved in the pathophysiology of radiculopathy. Each has a role in nerve injury while inflammation is thought to be the key mediator of radicular pain. The natural history of radiculopathy is generally favorable, with approximately 40% of patients experiencing significant improvement in symptoms within 6 weeks, and 90% demonstrating significant relief in long-term follow-up.
Abstract: The role of corticosteroids in the treatment of radiculopathy from a disc herniation is to provide temporary improvement of the disabling symptoms while the condition resolves. In addition, corticosteroids provide neuroprotective effects on the involved nerve roots. Early studies of corticosteroids for radiculopathy contained multiple methodological flaws and failed to demonstrate consistent results. Since each of these studies used inaccurate and less effective injection techniques, their results do not apply to current practice. More recent studies with better designs and more precise injection techniques have shown epidural corticosteroid injections to be an effective treatment for radiculopathy from herniated nucleus pulposus.…The literature on systemic corticosteroids remains limited.
Abstract: The aim of the present study was to record prospectively the injury incidence rate among elite and local division players in Greece and compare them in terms of their injury profile. A total of 649 Greek male and female volleyball players participating in the Greek Volleyball championships involving first division and local division, were observed on monthly basis for the 2005-06 period. The injury incidence rate, severity, diagnosis and the anatomical location of the injuries, which occurred during practice and competition in all the championship period, were recorded prospectively. Data were statistically analysed using X2 analysis of SPSS statistical…package. In terms of professional volleyball exposure time, elite athletes reported fewer injuries than the local division players. Although, ankle sprain was the most frequent injury for both groups, nevertheless chronic injuries were less for elite compared to local division players. Moreover, the most important injury factors aside from ‘step on others foot’ were for elite players ‘fatigue’ while for the local division players were ‘incorrect sprawls’ and ‘wrong technique’. Most injuries occurred during training and competitive season in middle heaters and universals. In conclusion, elite players reported fewer injuries compared to local division players and their injury profile was different.
Abstract: Ankylosing spondylitis (AS) is a systemic, chronic and inflammatory disease of uncertain etiology particularly affecting the spine and sacroiliac joints. At present, biological agents are used in cases resistant to treatment. However, there are safety problems regarding the use of these agents in patients with chronic viral hepatitis. We report a case monitored with a diagnosis of AS whose inactive HBV (hepatitis B virus) carrier state improved with antitumor necrosis factor-α (anti-TNF) treatment (infliximab).
Keywords: Ankylosing spondylitis, hepatitis B virus, anti-TNF-α
Abstract: Congenital or developmental osseous bridging between lumbar transverse processes is a very rare condition which may cause low back pain. Etiology of most of the cases is alleged to be post traumatic in origin whereas congenital nature is much less. The nature of bridging can not be determined just depending on patient's medical history. Radiological findings such as shape and outlines of bridging help in differentiation of congenital and traumatic etiology. We present x-ray and multidedector CT (MDCT) findings of a girl as the youngest to be reported with congenital transverse process bridging in the literature.
Keywords: Anomaly, CT, low back pain, lumbar vertebrae, osseous bridging
Abstract: A traumatic pedicle fracture in association with pre-existing bilateral spondylolysis and anterolisthesis has never been described. A 27-year-old male professional football player presented with acute gluteal pain caused by a traumatic fracture of the left pedicle L5 missed on plain radiographs, but seen on CT-scan and confirmed on bone scintigraphy. Instability caused by this fracture in association with pre-existing bilateral spondylolysis and grade I-anterolisthesis required immobilization of the lumbar spine. Since no neurological deficit was observed, it was decided not to operate but to treat the patient with analgesics and with a lumbar orthosis which would provide unilateral hip…fixation in extension during walking. We report here on the difficulties of diagnosis and on the successful treatment by means of immobilization in a lumbar orthosis. A rehabilitation program with specific sports-related exercises was devised.