Journal of Back and Musculoskeletal Rehabilitation - Volume 21, issue 4
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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: Purpose: To determine factors that affect low back pain in mothers with disabled children. Method: Thirty-one children with cerebral palsy (CP) and 27 children with muscular dystrophy (MD) and 30 healthy children and their mothers were included in study. The functional independence measure for children (Wee FIM) evaluated levels of independence of disabled children in ADL. A visual analog scale was used to assess back pain degree of mothers. An Oswestry low back pain questionnaire scale (OBPDQ) was used for determining physical disability. Environmental and architectural barriers were assessed according to international standards. The Ovako Working Postures Analysing…System (OWAS) evaluated disabled children’s mothers’ postures while transferring and lifting children. Results: There were differences between three groups. Pain intensity, duration and OBPDQ scores were higher in disabled children’s mothers than healthy children’s mothers. A negative correlation was found between Wee FIM locomotion, mobility, and OBPDQ scores. Pain intensity, duration, and OBPDQ scores were significantly higher in mothers of nonambulatory disabled children (p < 0.05). Home evaluation showed that barriers to stairs or lack of an elevator were the most significant home barriers. OWAS demonstrated that 94% of disabled children’s mothers back postures were 20 degrees overflexed and rotated, the lower extremities were generally right position (53%) or flexed knee (46%). Conclusions: Protective back health programs must be developed for disabled children’s mothers to teach correct transfer and lifting techniques. Suitable architecture and assistive devices should be implemented.
Abstract: Background: A repeated back extension exercises (RBEE) from prone position have been widely prescribed for patients with lumbosacral radiculopathy (LSR) and are reported to alter the intensity and distribution of radicular symptoms. This change in symptoms could indicate decompression/compression effect of RBEE on the compromised nerve root. Purpose: to evaluate the effect of RBEE from prone position on soleus H-reflex of patients with LSR. Patients and method: nineteen male and 11 female patients (38 ± 8.4 years) with confirmed chronic unilateral LSR participated in the study. All patients performed 30 repetitions of RBEE from prone position.…The soleus H-reflex was measured before and after the RBEE. The H-reflex was elicited by electrical stimulation of the tibial nerve on the poplitial fossa of both legs. The non-involved leg of the patient was used as a control. Subjective pain intensity and sit-to-stand performance were also measured before and after RBEE using numerical pain rating scale and a stopwatch respectively. Results: The H-reflex in the involved leg, pain intensity and the sit-to-stand test did not significantly improve after the RBEE (p < 0.43 – < 0.82). Conclusion: Single session of 30 repetitions of RBEE is not enough to improve the neurophysiology of the compromised nerve root, pain intensity and sit-to-stand performance of patients with chronic LSR.
Keywords: H-reflex, back extension, lumbosacral radiculopathy
Abstract: Anterior cruciate ligament rupture is one of the most common knee injuries in sport. A variety of surgical techniques and rehabilitation protocols are used to treat ACL injuries. Those injuries, lead to impair function and loss of proprioception. New research demonstrates that rehabilitation should be based on proprioception. The ACL not only serves a mechanical role by limiting passive knee mobility but also serves sensory role through the mechanoreceptors deep in its tissue, which communicate with the neuromuscular system to provide proprioceptive feedback. The main purpose of the study was to assess the influence of a balance-training program on knee…joint proprioception, between acl reconstructed patients who had a lack of proprioceptive ability. They had undergone acl reconstruction at a mean of 22 months (range 8–30) before the initiation of the study. They were randomly assigned into two groups, one experimental (group A) and one control (group B). We assessed proprioception using Biodex stability system and two different kinds of balance boards, in 24 patients with mean age 29,1 yr. The results shown that stability indices of balance appeared improved for the reconstructed leg and there were significant differences between the experimental group and the control group (p < 0.05).
Abstract: Background and objective: Sternotomy is a major type of surgery, and incidence, characteristics and clinical course of post-sternotomy pain are not well known. Myofascial pain also can occur according to sternotomy. So, the aim of this study was to investigate the incidence of myofascial pain and causative factors at post-sternotomy patients in different kind of cardiac surgeries. Methods: This study was performed between the years 2006–2007 at the Department of Cardiothoracic Surgery in Istanbul Kartal Kosuyolu Yuksek Ihtisas Hospital. 1226 patients over 18 years old were evaluated for myofascial pain. Trigger points in both upper trapezius, and both…pectoralis major were identified according to Simons and Gerwin diagnostic criteria (tenderness in a hyper sensible spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation). Myofascial pain evaluation again was performed with the same pain physician at all examination periods. Results: When results were evaluated statistically, of the 1226 total patients, only in 194 (15.8%) patients trigger points were determined. When patients who were determined to have trigger points, it was observed that 135 had undergone CABG. These 135 patients were evaluated in 2 groups; those LIMA used and those where LIMA not used. In 102 patients who underwent CABG where LIMA were used (n = 102, 75.5%). Especially of those 194 patients majority suffered from the muscle groups in the left side more than in right side in terms of trigger point formation. Besides that we have determined a parallel relation between the operation duration and trigger point formation that was statistically significant. Conclusion: As a conclusion, the formation of trigger point in upper trapezius and pectoralis major muscles in patients going under CABG with LIMA is 31.9% in patients postoperatively. We believe the reason for this incident is the graft harvesting of the internal mammary artery. Besides we believe that there is a parallel relation between the operation duration and trigger point formation, and more prospective studies are needed to state the relation between the formation of trigger points and the duration of the CABG.
Abstract: The failure of some cases of low back and pelvic girdle pain to progress following a motor vehicle collision (MVC) prompted the search for other sources of pain. The literature reports acetabular labral (AL) tears from all causes are under diagnosed. Our search found mention of 2 cases of posterior labral tears caused by the knee impacting the dash board in MVCs but we found no other articles that associated AL tears (particularly anterior tears) to MVCs. Failure to recognize and address the pathology may predispose the hip to degenerative changes over time. This report documents 16 cases…with a total of 21 hips with AL tears or labral pathology coupled with chronic low back and pelvic girdle pain following MVCs. Diagnosis was made with a combination of hip blocks and MRI/arthrogram (MRA). The most common clinical features are deep buttock and anterior groin pain, clicking, locking and a positive impingement test. Clinicians need to have a high index of suspicion of labral pathology in MVC cases with low back, buttock, groin and posterior pelvic girdle pain that fail to resolve with time and conservative treatment directed at the low back and pelvic girdle.
Keywords: Hip, labral tears, back pain, pelvic girdle pain, motor vehicle collision
Abstract: Objective: Strengthening exercises are given frequently to the patients with knee osteoarthritis. It is known that these patients have proprioceptive deficits. The effect of the kinesthesia exercises which aim to improve proprioception is not known in the knee osteoarthritis. The aim was to compare kinesthetic plus strengthening exercises vs. strengthening exercise alone, and to determine the effects of these exercises on the pain and functional status of women with mild to moderate knee osteoarthritis (OA) in the long term. Methods: Sixty women with knee OA were included in the study. “Kinesthesia-strengthening group” performed kinesthesia/balance exercises as well as…strengthening exercises, while the “strengthening group” performed only strengthening exercises. Patients were evaluated by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Medical Outcomes Study Short Form Health Survey (SF-36), Lequesne algofunctional index, and Beck depression inventory. Results: After the completion of the exercises, significant improvements occurred in both the groups in all the study parameters (p < 0.05). The comparison of the groups at week 8 showed that the results in SF-36 vitality, WOMAC-total score, Lequesne index and Beck depression inventory parameters in the kinesthesia-strengthening group were significantly better than those in the strengthening group (p < 0.05). Similarly, the comparison of the groups at the end of year 1 demonstrated that the results in WOMAC-pain, WOMAC-stiffness, WOMAC-physical function and WOMAC-total score in the kinesthesia-strengthening group were significantly beter than those in the strengthening group (p < 0.05). Conclusion: Carried out for one year, kinesthesia and balance exercises seem to be superior to strengthening exercises only on WOMAC parameters in women with mild to moderate knee OA.
Abstract: Low back pain (LBP) is an important clinical, social, and public health problem. Balneotherapy is a type of therapy by hot or warm waters containing minerals. The aim of this study was to investigate the effects of balneotherapy with exercise on pulmonary functions, aerobic exercise capacity, resting metabolic rate, body fat %, psychosocial condition and its efficiency on therapy in patients with LBP. Balneotherapy and exercise program were applied to group 1 (14 female, 9 male). Only an exercise program was applied to group 2 (13 female, 8 male). The measurements of maximal oxygen consumption, resting metabolic rate, pulmonary function…tests, body fat %, Oswestry disability index, visual analog scale, quality of life measure, symptom checklist-90-revised, the hospital anxiety and depression scale, spine joint mobility tests from all participants were performed before and after the treatment. An improvement was found in pulmonary function test (maximal volunteer ventilation), aerobic exercise capacity, pain and disability scores, spine mobility (extension distance), quality of life, and all psychiatric symptoms (except anxiety) in group 1 following therapy period. Also some improvements were observed in body fat percentage, pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory flow at 25% to 75% vital capacity and peak expiratory flow), and other spine joint mobility tests before and after therapy in group 1, though they were not statistically significant. Balneotherapy with exercise could be alternative therapy methods in patients with LBP.
Keywords: Low back pain, balneotherapy, exercise, aerobic capacity, pulmonary function
Abstract: Brucellosis is a systemic infectious disease presenting with possible osteoarticular involvement like sacroiliitis, peripheral arthritis, osteomyelitis, bursitis and spondylitis. Here we report a case of brucellar spondylitis involving cervical vertebrae complicated by epidural abscess without neurologic impairment. A 64 year-old woman with neck pain radiating to the left arm presented with coexisting low-grade fever, night sweats, chills, dorsal pain, arthralgia and fatigue. Musculoskeletal examination revealed tenderness over the cervical spinal processes and bilateral paraspinal muscles. Brucellosis was suspected due to unpasteurised fresh cheese consumption and was confirmed with agglutination tests. X-rays showed increased anterior…soft tissue thickness at the C4-7 level and a loss of height of the C6-C7 disc. MRI with gadolinium showed an epidural abscess lesion and diffuse hypointense signal intensity at C6-C7 vertebral end plates without any bony destruction. After 3 months with a combination of streptomycin, rifampicin and doxycycline treatment, all symptoms and signs disappeared, and MR imaging revealed evident narrowing of C6-C7 intervertebral disc space as a sequalae of spondylitis. During the follow up of 2 years, no relapse occurred. Since there is no specific symptom or sign of brucellosis, it should be suspected during the course of diagnosis, based on a patient's history, symptoms, radiological findings in regions where brucellosis is endemic.