Journal of Back and Musculoskeletal Rehabilitation - Volume 22, 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: Objective: The aim of our study was to evaluate the association between age, sex and body mass index (BMI) and lumbar spine degeneration features evaluated on computed tomography (CT) in a community-based sample. Methods: This cross-sectional study was an ancillary project to the Framingham Study. A sample of 3529 participants of the Framingham study aged 40–80 had a CT scan performed to assess aortic calcification. 187 individuals were randomly enrolled in this ancillary study. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (OA), spondylolysis, spondylolisthesis and spinal stenosis were evaluated. To evaluate the association between spinal degeneration…features and age, sex and BMI we used χ 2 test and logistic regression analyses. Results: 104 men and 83 women, mean age 52.6 ± 10.8 participated in the study. Statistically significant sexual dimorphism was found in prevalence of spondylolysis (p = 0.015) the male-to-female ratio was 3.3:1; and degenerative spondylolisthesis (p=0.008), the male-to-female ratio was 1:2.8. Prevalence of disc narrowing, facet joint OA, and degenerative spondylolisthesis showed a significant linear trend (p < 0.0001) of association with increasing age. Significantly higher prevalence of facet joint OA was found in the obese group OR (95%CI): 2.8 (1.1–7.2). Conclusions: Marked differences in the prevalence of spinal degeneration features occur in association with age, sex and obesity. Given the high prevalence of many of these degeneration features these simple demographic factors should be considered when interpreting imaging results reporting these features.
Abstract: Purposes: To investigate the responses of the craniovertebral (CV) angle to backpack loadings in adolescents with and without neck pain and to explore the relationships between CV angle, relative backpack weight, neck pain and disability. Methods: A cross-sectional single-blinded study was conducted on 60 adolescents (30 neck pain and 30 non-neck pain) aged from 13 to 18 years old. The verbal analog scale (VAS) and Chinese version of Northwick Park Neck Pain Questionnaire (NPQ) were used to assess neck pain severity and disability respectively. CV angle was measured in neutral and with backpack loadings of 5% to 30%…of subject’s body weight by using the Head Posture Spinal Curvature Instrument (HPSCI). Results: In both groups, CV angles gradually decreased with increment of backpack loadings and the amount of decreases became significant from 10% body weight onwards (P < 0.05). Although the changes of CV angles did not show any significant differences at any point of comparison between the groups, the neck pain group showed a clinically significant decrease of CV angle (~ 5°) at 10% relative loading whereas non-neck pain group did it at 15% relative loading. Change of CV angles did not show significant correlations with relative backpack weight, cervical pain and disability (P > 0.05). Conclusions: Our findings suggested a safety limit of 10% relative backpack load for adolescents. The results showed the tendency that the ability of maintaining good head posture in response to backpack loadings by non-neck pain subjects might be better than those with neck pain.
Abstract: Background and objective: Studies on back extensor endurance in adolescents are scarce. This study sought to establish reference data and pattern of back extensor endurance in school-aged adolescents with and without low-back pain (LBP) from Nigeria. Subjects and methods: This study recruited 625 adolescents aged 11 to 19 years from eight randomly selected secondary schools. The modified Biering-Sørensen test of Static Muscular Endurance (BSME) was used to assess isometric endurance of the back extensors. Demographic and anthropometric data were collected. A modified LBP questionnaire was used to assess the presence of LBP. Descriptive and inferential analyses were used…to analyze data. Significance was set at 0.05 α -level. Results: The mean isometric holding time (IHT) of all the participants was 132.9 ± 65.6. Males had significantly higher significant (p=0.026) IHT than females. Adolescents without LBP had a higher significant IHT (p=0.042) than those with reported history of previous LBP and those with present LBP (p=0.000) respectively. Using percentile values, poor endurance was defined as IHT that is < 90.0 s and < 67 s for males and females respectively; medium endurance was defined as IHT that ranged between 90 and 193 s and 67 and 170 s for males and females respectively while good endurance was defined as IHT that is > 193 s and > 170 s for males and females respectively. IHT was significantly related to each of body mass index, hip circumference and waist-to-hip ratio (p < 0.05). Conclusion: Isometric back extensors endurance in Nigerian adolescents was comparable to the original Biering-Sørensen mean value. Majority of the participants had medium endurance performance with the back endurance pattern in the ratio 1:2:1. Male had higher isometric back extensors endurance than females. Decreased isometric back extensors endurance was associated with the presence of LBP in adolescents.
Keywords: Back muscles' endurance, Sørensen test, back extensor muscles, isometric-holding time, adolescents, Nigerians
Abstract: We aimed to investigate the effects of body weight supported treadmill training (BWSTT) on cardio-pulmonary functions and on depression in subjects with incomplete spinal cord injury (SCI). Eight subjects (2 female, 6 male) with incomplete SCI participated in this study. Heart rate (HR), blood pressure (BP) and resting pulmonary function parameters were obtained from each subject at baseline and after BWSTT. The training programme was scheduled five times per week for six weeks. The psychological status was evaluated by Beck Depression Inventory (BDI). The post-BWSTT HR value was lower than the pre-training HR value (p< 0.05).…In comparison of pre- and post-BWSTT pulmonary parameters, there were only significant improvement in FVC and IC (p< 0.05). The mean BDI score was lower after BWSTT compared to before BWSTT value. As a conclusion, 6 weeks BWSTT had positive effect on heart rate and limited effect on pulmonary functions. There was an improvement in depression level of the SCI subjects.
Keywords: Spinal cord injury, body weight supported, cardio-pulmonary
Abstract: Aim: To evaluate evidence for involvement of the lower limb in spinal function and low back pain (LBP). Design: A hypothesis based on a critical review of the relevant biomechanical and clinical literature. Results: The spine resembles an inverted pendulum that supports the weight of the upper body; its stability requires a moving base that is provided by the joints of the lower limb, especially the hip. However, the sacroiliac joints are unlikely to be important for spinal function. The changing pattern of gait and development of lumbar lordosis, in early childhood, provide evidence for the…inter-dependence of spinal curvature and lower limb action. Clinical signs associated with LBP may be associated with an inability to rotate the trunk about the hips. These include disorientation of the pelvis and weakness or tightness of muscles around the hip. The “sway back” posture seen in LBP involves flexion of the hip, knee and ankle to compensate for abdominal and back muscle weakness. Conclusions: In order to understand the varied clinical presentation of LBP patients, the function of the spine should be considered in the context of the whole body, especially the lower limb.
Abstract: Purpose: The shoulder complex plays an integral role in the activities of daily living and the limitation of its function can greatly affect the patient. The aim of this study was to research the functional consequences of painful conditions in the shoulder region. Methods: Sixty five adult patients with shoulder pain for longer than one month in duration were included to the study. Dominant hands of the patients were determined. The subjects were divided into two groups: shoulder pain at the dominant upper extremity (Group I) or the nondominant one (Group II). The subjects were evaluated for shoulder…pain with visual analog scale (VAS), range of motion and functional status with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Results: In Group I, DASH score was significantly correlated with the VAS score measuring the pain during activity (p< 0.0001, r=0,625). In Group II, no relationship between DASH score, VAS scores and any other parameters was detected. Conclusion: The most important parameter disturbing the daily living of a patient with shoulder disease is the pain at the shoulder of dominant extremity occurring in active movement.
Keywords: Shoulder pain, function, DASH, dominant side, daily living activity, range of motion
Abstract: Background and objective: Epidural injections in the lumbar spine are provided by caudal, lumbar interlaminar or transforaminal routes. Caudal epidural steroid injections are often used for low back pain. Fluoroscopic guidance has been frequently cited as a requirement for this procedure. In this case report, we demonstrate the importance of fluoroscopic guidance during caudal epidural injection. Case report: A 60 years old male patient was admitted to our Algology Department for low back pain. After physical examination caudal epidural steroid injection was planned. The caudal space was identified under fluoroscopic control initially using an anteroposterior projection. After the…resultant epidurogram demonstrated vascular spread along the caudal epidural space the needle was withdrawn and the procedure was completed after reinserting the needle. Conclusion: A careful real time fluoroscopic monitoring should be applied with the injection of opaque material to minimize the risk of vascular injection.
Abstract: Osteopoikilosis is a benign osteosclerotic dysplasia of unknown origin, which is an inherited autosomal disorder. It is usually asymptomatic and may only be recognized on radiological examination. We report a 20-year-old man who suffers from back and shoulder pain during the routine physical examinations performed prior to the military recruitment. Numerous symmetric, small, ovoid and circular sclerotic bone lesions were found on the X-rays of the spine and shoulder. Dual energy X-ray absorptiometry (DXA) examination revealed osteopenia. In conclusion, typical radiographic examination of osteopoikilosis is usually diagnostic. However, it may sometimes be difficult to rule out the other diseases like…osteoblastic metastatic lesions as it is an uncommon disease. Physicians should be aware of possible coexisiting osteopenia or osteoporosis as reported in our case.