Journal of Back and Musculoskeletal Rehabilitation - Volume 23, 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: Purpose: L5 radiculopathy leads to weakness in ankle dorsiflexor, which can further affect ambulation status. The purpose of this study was to investigate the characteristics of gait patterns associated with L5 radiculopathy. Method: Nineteen patients with ankle dorsiflexor weakness due to L5 radiculopathy and 16 people with normal control underwent three-dimensional gait analysis. The comparison was made with three categories such as involved side, intact side of patients and normal control. The gait cycle was divided into 0% (initial contact), 0–20%, 20–60%, and 60–100% in order to identify the characteristics of involved side in comparison with intact side…and normal control. Results: Velocity, stride length, and cadence were reduced and double support time was increased in involved as well as intact sides of patients as compared to normal control. Maximal hip adduction of involved side was larger than intact side during the entire gait cycle. Maximal ankle dorsiflexion of involved side was smaller than intact side at 0–20% and 60–100%. Ankle power generation was decreased in involved side as compared to intact side and normal control. Conclusion: The pelvis of intact side was tilted downward due to hip abductor weakness of involved side in the stance phase whereas the pelvis of involved side was tilted upward for foot clearance in the swing phase. This contributed to increase in hip adduction of the involved side through the gait cycle. Eccentric contraction of ankle dorsiflexion that normally occurred in the loading response and the early swing phase was not sufficient and, therefore, ankle dorsiflexion was decreased in these gait cycles.
Abstract: The purpose of this study was to compare shoulder pain between wheelchair basketball players with trunk control and wheelchair basketball players without trunk control. Players were evaluated according the International Wheelchair Basketball Federation (IWBF) classification system. The study group comprised 60 wheelchair basketball players, who were rated according to the International Wheelchair Basketball Federation classification system. Players were divided into two groups according to their trunk control. Study participants completed an anonymous survey that included demographic data, medical history data, and the Wheelchair User's Shoulder Pain Index (WUSPI). There was no statistically significant difference between the two groups based on…the number of years of wheelchair use, active sport years, weekly working hours, and weekly training hours (p> 0.05). Statistically significant differences were found between wheelchair basketball players with trunk control and wheelchair basketball players with trunk control with respect to the duration of their disability, the daily number of transfers made to wheelchair, and Performance Corrected Wheelchair User's Shoulder Pain Index (PC-WUSPI) score (p< 0.05). The total PC-WUSPI score was higher among players without trunk control (p< 0.05). Study findings suggest that the shoulder pain of wheelchair basketball players must be analyzed. Trunk stabilization is the key factor affecting the function of the shoulder and is of primary importance for appropriate loading of the shoulder joint's many forms of articulation.
Keywords: Wheelchair basketball sports, WUSPI, shoulder, pain, trunk control
Abstract: Objective: To investigate the effect of the myokinetic stretching technique (MST) on morphological changes and associated clinical outcomes. Method: Infantile torticollis (N=32, 17 males) between 1 and 5 months of age (50.56 ± 20.74 days) were treated with the MST for approximately 30 minutes per session, 5 times a week at university hospital. Diagnostic real-time ultrasound imaging was used on both unaffected and affected sides before and after the treatment to measure the sternocleidomastoid (SCM) muscle thickness of the involved area. Range of motion, head symmetry, and plagiocephaly with radiographs were determined. Data were analyzed using unpaired and…paired t-test at p< 0.05. Results: A significant reduction in SCM muscle thickness was observed after the intervention (p< 0.05). This morphological change was associated with significant improvements in passive cervical range of motion and head symmetry (p< 0.05). The mean intervention duration was 53.59 ± 25.12 days to completely resolve the mass. These effects continued to exist one year post-intervention. Conclusions: This was the first clinical evidence that demonstrated the efficacy of MST for improving cervical motion and muscle thickness in infants with congenital muscular torticollis as well as shortening the treatment duration.
Abstract: Objectives: The purpose of this study was to longitudinally evaluate relationships between the incidence of stiff shoulder and sagittal alignments of the cervical spine, age-related changes on magnetic resonance imaging (MRI) and life styles of the subjects. Methods: The subjects were 69 men and 93 women. The mean follow-up period was 11.3 ± 0.7 years. Sagittal alignments of the cervical spine were classified into the following 4 types: lordosis, straight, kyphosis and sigmoid. MRI findings were evaluated for the progression of 1) decrease in signal intensity of disc, 2) posterior disc protrusion, and 3) disc space narrowing.…Results: Stiff shoulder was found in 29.6% of the subjects over the 10 years. In the group of subjects 30–49 years old, the incidence of stiff shoulder was 40.4%, and it was higher than those in other age groups. Stiff shoulder was significantly more frequent in women (45.2%) than in men. Its incidence was significantly lower in those who regularly participated in sports or exercise. There were no significant relationship between the incidence of stiff shoulder and the progressions in any of MRI findings during the follow-up period. Conclusions: Stiff shoulder was more frequent in middle-aged, female and non-exercising subjects. There was no correlation between the incidence of stiff shoulder and sagittal alignments of the cervical spine, or progression of age-related changes of the cervical disc on MRI.
Abstract: Background: Preprogrammed reactions (PPR) appear at a latency of higher than 40 ms, but before the voluntary muscle responds (~ 120 ms) to postural perturbations. Objective: To examine the difference in magnitude of preprogrammed reactions in patients with chronic low back pain (CLBP) and without low back pain. Methods: we analyzed electromyographic Root Mean Square (RMS) amplitudes of asymptomatic (n=25) and CLBP patients (n=25) on stable and unstable surfaces during expected and unexpected perturbations for rectus abdominus and erector spinae muscles. The mean PPR and PPR-combined voluntary response RMS amplitudes (VRPPR) were compared between the two…groups. To find the presence of PPR in LBP patients, a criteria was set that the obtained PPR RMS amplitude value should exceed 60% mean reflex RMS amplitude that occur within 50 ms after perturbation. Results: Fleiss’ kappa revealed a good agreement (κ = 0.7 to 0.9) among raters for absence of PPR in patients with CLBP and presence of PPR in asymptomatic population. The two way ANOVA revealed significantly different mean PPR and VRPPR RMS amplitudes between asymptomatic and LBP population for rectus abdominus and erector spinae muscles (p< 0.05). Conclusion: PPR responses were found absent (< 60% of Mean Reflex RMS) in patients with CLBP. Further, patients with CLBP demonstrated lower PPR amplitudes with higher peak voluntary responses compared to asymptomatic population, indicating difficulties in presetting of voluntary responses for regaining postural stability after perturbation.
Keywords: Back pain, electromyography, spine, muscle, reflex
Abstract: International classification of Functioning, Disability and Health has adapted a biopsychosocial model for management of chronic low back pain patient (CLBP). The influence of psychological factors seems to be important in the transition from acute to chronic low back pain (> 3 months). In particular, pain-related fear and pain catastrophizing are believed to be important factors for disability. A number of studies have shown that pain-related fear is a strong predictor of self-reported disability in both acute and chronic low back pain. This situation has led to the dependency of clinicians on radio-diagnostic procedures for decision making, which often increases…the financial burden. Research has evidenced that physicians and physical therapists, often fail to recognize psychological illnesses. The aim of this article is to describe the importance of fear avoidance behavior and to evaluate the immediate effect of cognitive behavioral therapy (CBT) during evaluation of patients with CLBP. An initial physical examination of a 24-year old female patient with CLBP, showed painful guarded movements over the lumbo-pelvic region, but the outcomes of her Fear-Avoidance Belief Questionnaire (FABQ) showed strong cues for psychological illness. Based on clinical reasoning, the patient was educated in terms of cognitive reconstruction. Interestingly after some CBT sessions, her spine guarding pattern was disappeared and that helped us to carry a more specific physical examination. After a few weekly therapeutic sessions of CBT, significant changes were seen in all outcome measures. It has been concluded that probably, by using specific biopsychosocial training, positive results in fear avoidance behavior can be achieved. Hence the psychotherapeutic management approach is considered as a useful economical tool in low back pain.
Keywords: Low back pain, fear avoidance behavior, FABQ, cognitive behavioral therapy (CBT), clinical reasoning
Abstract: Background and objective: Modic changes (MC) on magnetic resonance imaging (MRI) were described in 1988 by Modic et al. in a study among patients with chronic low back pain. Type 1 changes were shown to represent an acute inflammatory process while type 2 changes were found in chronic lesions. Since mechanical back pain is very common, it is often difficult to differentiate precisely the origin of the back pain in patients with ankylosing spondylitis (AS) based only on clinical assessment, laboratory findings and/or plain imaging. Case report: We report a male patient with AS who presented with low…back pain. MRI revealed MCs and spondylodiscitis, an uncommon manifestation of AS, at multiple levels of the thoracolumbar spine. Conclusion: We believe that MRI may provide key information in addition to the clinical, laboratory and plain radiological assessments and can help to guide physicians in decision-making when treating patients with AS.
Keywords: Modic changes, ankylosing spondylitis, magnetic resonance imaging, inflammation
Abstract: Objective: To describe the immediate effects of ischemic compression (IC) as a trigger point therapy in a case of a patient with neck pain. The application of IC is a safe and effective method to successfully treat elicited myofascial trigger points. The purpose of this method is to deliberate the blockage of blood in a trigger point area in order to increase local blood flow. This washes away waste products, supplies necessary oxygen and helps the affected tissue to heal. In this case study, we treated a 27-year-old female patient with a medical report of neck pain for at least…four months. The physical examination revealed a neck pain and stiffness at the left side and pain increases when moving the neck. An active myofascial trigger point was found in the left trapezius muscle. The following data were recorded: active range of motion of cervical rachis measured with a cervical range of motion instrument, basal electrical activity of the left trapezius measured with electromyography, and pressure tolerance of the myofascial trigger point measured with visual analogue scale, assessing local pain evoked by the application of 2.5 kg/cm2 pressure with an analogue algometer. Results: Immediately after application of the IC, all measured parameters improved compared to base line. The application of IC has been shown effective in the treatment of myofascial trigger points in a patient with neck pain. The results show a relation between active range of motion of cervical rachis, basal electrical activity of the trapezius muscle and myofascial trigger point sensitivity. Conclusions: In this case of a patient with neck pain, active range of motion of cervical rachis, basal electrical activity of the trapezius muscle and myofascial trigger point sensitivity gaining short-term positive effects with the application of one single ischemic compression session. Nevertheless, randomized controlled double-blinded studies should be conducted in future to examine the effectiveness of this ischemic compression technique in case of the presence of myofascial trigger points in the neck.