Journal of Back and Musculoskeletal Rehabilitation - Volume 21, issue 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: Objective: The aim of the present study was to evaluate and compare the role of dual energy X-ray absorptiometry and three-phase bone scintigraphy in the diagnosis of complex regional pain syndrome type I of upper extremity. Methods: Five male and nineteen female patients diagnosed with complex regional pain syndrome type I (CRPSI) were included in this study. Three-phase bone scintigraphy (TPBS), bone mineral density (BMD) and bone mineral content (BMC) of wrist, metacarpophalangeal joint (MCP) and proximal interphalangeal (PIP) area in the affected and unaffected hands of patients were measured simultaneously using dual energy X-ray absorptiometry (DEXA). The…time passed between the precipitating event and clinical onset of CRPSI was also recorded. Results: TPBS findings were in agreement with CRPSI diagnosis in 96% of the patients (23 of 24 patients). Periarticular BMD and BMC values in wrist, MCP, and PIP joints were statistically lower in affected hands than in unaffected hands for all three regions. Moreover, we found no correlation between BMD or BMC values with the sex, age, dominant hand, and the duration between the clinical onset of CRPSI and its precipitating event. Conclusion: The present study suggests that beside TPBS, a valuable tool in the early diagnosis of CRPSI, DEXA can also be used in the determination of early demineralization of bones in CRPSI patients. DEXA is an accurate, noninvasive, rapid, and safe device for quantitative assessment of unilateral bone loss caused by upper limb CRPSI.
Keywords: Complex regional pain syndrome, densitometry, three-phase bone scintigraphy
Abstract: Study design: Cross-sectional pilot study on 24 healthy volunteers. Objectives: Investigate the value of stabilization exercises using a gym ball in paraspinal muscle activation by measuring changes in muscle signal intensity on MRI before and after exercise. Background: The gym ball is commonly used for rehabilitating spinal dysfunction. It is thought to rehabilitate some key muscle groups in the trunk. Methods: Twenty-four healthy volunteers (aged 21–50, 13 female and 11 male) had special sequence MR images of the lumbar spine showing an axial section of the paraspinal muscles at L4/5 level. Afterwards all were…subjected to 10 minutes of exercise on the gym ball followed by repeat MRI scans immediately, 5 and 10 minutes post exercise. Changes in the mean signal intensity at the same region of interest in multifidus, erector spinae and psoas muscles were evaluated using MRI software. Results: The mean signal intensity in the MR images of the same region in the multifidus (P < 0.03) and erector spinae (P < 0.005) muscles significantly increased after gym ball exercise. There was no statistically significant change in the signal intensity of the psoas muscle (P < 0.086). Conclusions: The multifidus and erector spinae muscles of a healthy individual can be activated by performing certain exercises on the gym ball.
Abstract: It is unclear whether fatigue induced by a tennis training session influences the effectiveness of balance exercise training program. Thus, the purpose of the present study was to investigate whether a balance program is more effective when performed before or after the regular tennis training session. The study was conducted on 36 young tennis players participating in the national young tennis championship. The participants were randomly divided into three subject groups, one control group (C group), and two intervention groups that performed a specific balance program for 12 weeks, three times per week, 16 min per session. One intervention group…performed the balance program immediately before the regular tennis training session (Pre training group) and the other group performed the same balance program immediately after tennis training (Post training group). Balance performance was assessed in all subjects at baseline (T0 ) and after the completion of the 12-week balance program (T12 ). The balance performance assessment was performed with two different balance boards and the Biodex Stability System. Two-way repeated measures ANOVA revealed that there was no difference (p > 0.05) in balance performance in the C group between T0 and T12 . In contrast, there was significant improvement between T0 and T12 for Pre and Post training groups. Furthermore, there were significant differences between group C and the two intervention groups after the 12-week balance training program, while there was no significant difference between the Pre and Post training groups. In conclusion, there was significant improvement in balance performance with the balance training program and there was no effect of the time the tennis training sessions were performed.
Abstract: The purpose of the present study was to: 1) determine whether mouthguard use effect Periotest values and the levels of pain in teeth of patients after initial and last visits of cervical traction treatment, 2) evaluate factors associated with the pain and periotest value. Forty patients with cervical disc herniation (CDH) diagnosed clinically and by computerized tomography were included in this study. Patients were assigned into two main groups as mouthguard (MG) and non-MG groups. Two main groups were individually matched for age, gender and periodontal disease. Then, both groups were assigned into four subgroups as MG and non-MG groups…with periodontal disease and periodontally healthy. The number of teeth, decay on all tooth surfaces, and clinical periodontal parameters were determined by two experienced periodontist. The levels of pain of tooth during cervical traction treatment in visits were measured by using a Visual Analog Scale (VAS). Tooth mobility was evaluated by Periotest (PTV). Level of VAS values or the degree of experiencing pain were associated significant with age, mouthguard use, probing clinical attachment level (CAL) ≥ 3 mm and periodontal disease. The degree of PTV values were associated significant with age, gender, mouthguard use, CAL ≥ 3 mm, Periodontal disease and Probing pocket depth (PPD) ≥ 4 mm. Patients aged 18–34 years were 2.48 times more likely to present higher pain than patients aged 45–60 years. Non-MG users were 2.65 times more likely to present higher VAS values than MG users. From the present study, we can conclude that both MG use and periodontal healthy reduces both pain and tooth mobility when compared to non-MG use and periodontal disease in cervical traction treatment.
Keywords: Cervical traction treatment, cervical disc herniation, mouthguard, tooth mobility, VAS, periodontal status
Abstract: Low back pain (LBP) is one of the most prevalent musculoskeletal disorders. Studies have shown certain relations between physical fitness and LBP by examining some measures of physical fitness. The aim of this study was to measure maximal anaerobic power and anaerobic capacity using Wingate anaerobic test in patients with chronic LBP versus healthy controls. Fifty four patients with chronic LBP (32 women, 22 men) and sixty healthy controls (30 women, 30 men) were enrolled in the study. The Wingate test was performed on a Monark 839E cycle ergometer. The peak power, the mean power and the fatigue index were…calculated. The values of peak power (305.7 ± 100.4 and 519.9 ± 102.5 watt) and mean power (226.7 ± 50.7 and 408.9 ± 76.5 watt) in patients with chronic LBP were significantly lower than the values of peak power (367.1 ± 103.7 and 634.7 ± 109.7 watt) and mean power (273.6 ± 56.2 and 462.4 ± 49.5 watt) in healthy controls in women and men respectively. In males, the values of fatigue index in patients (38.6 ± 15.2%) were lower significantly than the fatigue index values in controls (49.5 ± 9.3%). In females, the values of fatigue index were not different significantly between patients and controls (37.7 ± 15.3% and 42.6 ± 16.0% respectively). Maximal anaerobic power and anaerobic capacity in patients with chronic LBP were lower than healthy controls. These findings contribute to clarify different aspects of physical fitness of patients with chronic LBP.
Abstract: Background: The specific training of lumbar local stabilizing muscles is one of the recent focuses in management of patients with chronic LBP. Enhanced stability of the lumbar spine segments is the mechanism for pain relief with this specific exercise. Objective: The aim of this study was to compare the effect of motor control exercises with general exercises on the lumbar local stabilizing muscles thickness, activity limitation and pain in patients with chronic low back pain (LBP). Design: A double-blind, randomized controlled trial. Methods: Forty-nine patients with chronic LBP were randomly assigned to either a…motor control (n = 25) or a general exercises group (n = 24). Before and after intervention, we assessed the lumbar multifidus (LM) and Transversus abdominis (TA) muscles thickness (mm) using a 7.5 MHz B-mode transducer ultrasound, pain through visual analog scale and activity limitation through Back Performance Scale (Ordinal). A 16 session’s exercise program which lasted 8 weeks, twice per week, and 30 minutes per session was performed for both groups. Results: The mean TA thickness increased from 1.87 ± 0.63 mm to 2.39 ± 0.63 mm in the motor control group and from 1.93 ± 0.49 mm to 2.22 ± 0.47 mm in the general exercise group (P < 0.0001). The mean LM thickness increased from 8.63 ± 2.37 mm to 9.69 ± 2.49 mm in the motor control group and from 8.83 ± 1.53 mm to 9.26 ± 1.56 mm in the general exercise group (P < 0.0001). The mean activity limitation decreased from 8.83 ± 3.38 to 5.42 ± 2.43 in the motor control group and from 10.67 ± 2.81 to 7.25 ± 2.73 in the general exercise group (P < 0.0001). After treatment, there was no significant difference between two groups, with the exception of pain (P > 0.05). Conclusion: The motor control and general exercises decreased pain and increased TA and LM muscles thickness and lumbar mobility in patients with chronic LBP without any signs of spinal instability. Although, the motor control exercises were more effective than general exercises in pain decreasing.
Keywords: Low back pain, motor control exercise, general exercise, ultrasonography, lumbar multifidus, transversus abdominis, activity limitations, randomized controlled trial
Abstract: Objective: The prevalence of neck and shoulder pain in visual display terminal operators is estimated between 40% and 69%. One theory proposed for this is inadequate low load functioning of the postural muscles of the neck and shoulder girdle leading to microtrauma of cervical spine structures. A temporal sequence linking muscle performance to the subsequent development of neck pain has never been established. This pilot study sought to determine whether postural muscle performance factors are associated with neck pain in a population of visual display terminal users. Methods: Twenty-eight subjects underwent a baseline physical examination. Clinical measurements of…low-load deep cervical flexor muscle performance, shoulder girdle muscle endurance, neck column length, head and neck posture and body mass index were made and demographic factors collected. Following the examination, a Neck Pain and Disability Scale questionnaire was administered. Variables were analysed in a regression analysis with the questionnaire scores. Questionnaires were readministered at six months follow up. Results: Descriptive variables “years of occupational screen based keyboard use” (p = 0.021) and “use of reading glasses” (p = 0.027) were statistically significantly correlated with Neck Pain and Disability Scale score at baseline, while “hours of home computer use” (p < 0.001) was associated with the change in questionnaire score at 6 months follow up. Muscle performance factors did not contribute to either model. Conclusions: Given the sample size in this pilot study, we cannot rule out an association between muscle parameters and the onset of neck pain and disability. However, the influence of any such association would be weaker than other identified associated variables.
Abstract: The aim of this study is to determine the effect of a 12-week supervised multicomponent exercise program in women with knee OA. This prospective randomised controlled trial was performed in Antalya, Turkey. Thirty four of 136 patients diagnosed for knee OA were included and divided into exercise group (EG) and control group (CG). Outcome measures were collected before exercise (baseline) by five blinded trained assistants before randomisation, and at six week (mid-training) and also at 12th week (posttraining). A 12-week exercise program was supervised three times per week. Primary outcome measure was perceived quality of life as measured by the…Medical Outcomes Survey Short Form (SF-36) and secondary outcome measures were Body Mass Index (BMI), walking Visual Analog Scale (VAS) and physical performance such as chair-stand, chair sit-and-reach, and 6-minute walk distance. Results revealed an improvement in chair stand, walking VAS and in all the domains of SF-36 in EG (p < 0.004). In conclusions, a 12 week multicomponent exercise program, could improve physical performance, primarily lower extremity strength and all dimensions of health related quality of life might improve and walking pain decrease.
Abstract: The purpose of this observational study was to compare anthropometric and functional characteristics of office worker women who were healthy or suffered from chronic low back pain (CLBP). A group of 30 healthy and 30 women with CLBP were randomly selected from a sample of 648 office workers who participated in a previous epidemiological study. All subjects were matched for age, height and body weight. Their anthropometric and functional characteristics were measured using standardized procedures with established reliability and compared with the Student's t-test for independent samples. In their anthropometric characteristics, women with CLBP had significantly higher body mass index…and percent body fat (p = 0.035) whereas their leg length difference (p = 0.012) was almost double compared to same characteristics of healthy women. Regarding their functional characteristics, women with CLBP displayed significantly restricted mobility (p < 0.05) in all directions and decreased endurance (p < 0.05) in muscle function of their lower extremity, abdominals and trunk extensors as compared to healthy women. These results might suggest that anthropometric and functional characteristics need to be improved in Greek office workers as they may relate to the incidence of their low back pain.
Keywords: Low back pain, office workers, spinal mobility, physical fitness
Abstract: The objective measurement of free-living physical activity may be a useful method of assessing functional ability in different patient groups. The aim of this study was to investigate the convergent validity of free-living physical activity, as an outcome measure of functional ability in people with chronic low back pain (CLBP). Thirty-eight participants with CLBP were recruited from five physiotherapy out-patient departments. All participants completed the Roland Morris Disability Questionnaire (RMDQ), a measure of self-reported functional ability, and performed three physical performance tests; repeated sit-to-stand test, 50-foot walk test and 5-minute walk test. Each participant then wore a physical activity monitor,…continuously, over a one week period to measure free-living physical activity. A relatively weak but statistically significant relationship was found between all three measurement methods (r = 0.32 to 0.44, p < 0.05). The strength of the correlations suggests that each method measures a related but unique aspect of functional ability for this patient group. These results show that free-living physical activity monitoring possesses a level of convergent validity as an outcome measure of functional ability and may be a useful adjunct to current functional ability assessment techniques in individuals with CLBP.