Journal of Back and Musculoskeletal Rehabilitation - Volume 23, issue 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: Introduction: In routine clinical practice a physical examination should include an assessment of ability/function. The use of a scale or index in low back pain (LBP) is mainly used to categorize patients and to measure syndrome severity. For this reason we developed an easy and quick to perform standardised measuring procedure of impairment in patients with LBP without using inclinometers. The new “Backache Index” (BAI) is applied in order to help therapists, doctors, and surgeons perform physical examinations easily. The factor of presence or absence of pain with respect to different lumbar movements is elaborated for the patient with LBP,…standing in an erect position. This resulted in outcome scores (0–3) for five impairment examinations of the trunk from which the sum of the scores gives the BAI (max. 15 points). Objectives: The purpose of this study was to develop the linguistic adaptation and to explore the reliability of this new Backache Index translated in a Spanish version called “indice de Dolor de Espalda” or IDE, which can fulfil the existing need for a reliable routine examination in the clinical environment for Spanish speaking clinicians and patients. Methods: Two independent translations were made by two separate professional translators to Spanish. Both versions were compared and consensus resulted in a single translation. In a pain center patients were asked to participate in this project as volunteers. The exclusion criteria have been used in patients with LBP suffering of severe spinal pathology or having deseases. In total 46 patients (67% females, age = 52 ± 13 years) underwent the physical examination at the first session (IDE-1) and were retested without any treatment after 3 days (IDE-2). Results: The two translations submitted by respective experts were identical and the final IDE was used in futher clinical examinations. The test-retest after 3 days of the same group revailed that the reliability for the 5 outcome scores was good (ICC ≥ 0.73). No significant difference was found between IDE-1 (4.65 ± 4.15 ) and IDE-2 (4.72 ± 4.20) and the absolute reliability was perfect with an ICC=0.97. Conclusions: The IDE form facilitates a better diffusion under the Spanish speaking population, allowing it to maintain the degree of homogenenity and acceptance that the “Indice de Dolor de Espalda” or IDE has in clinical practice, helping to spread among the Hispanic world one of the objectives that the creator of this index raised when it was developed.
Keywords: Low back pain, Dolor de Espalda, physical examination, Backache Index, scales, Spanish version
Abstract: Background and purpose: Patellar tendinopathy is a common overuse injury for which no evidence-based treatment guidelines exist. Extracorporeal Shock Wave Therapy (ESWT) seems to be an effective treatment for patellar tendinopathy but the most beneficial treatment strategies still need to be ascertained. Aim of this pilot study was to investigate if patient guided Piezo-electric, focused ESWT, without local anesthesia is a safe and well tolerated treatment which improves pain and function in patients with patellar tendinopathy. Methods: Nineteen male athletes with severe chronic patellar tendinopathy received 3 patient guided focused medium to high energy ESWT treatments at a…weekly interval. Before and after 3 months VISA-P and VAS (pain) scores were recorded. Data on side effects and complications of treatment were also collected. Results: No serious complications were reported and patients tolerated the treatment well. Mean VISA-P score improved from 36.1 to 50.1 (p < 0.05), VAS decreased from to 7.2 to 3.7 (p < 0.05). Conclusion: Patient guided Piezo-electric ESWT without local anesthesia is a safe and well tolerated treatment which should be considered as a treatment for patients with patellar tendinopathy.
Abstract: We sought to determine if simulated malingering trials of isometric cervical muscular strength in flexion, extension and right/left bending are substantially different from maximum effort trials in young, healthy subjects. A convenience sample of healthy, young adult subjects was used (M=9, F=9) who were free of neck pain. A uniaxial load cell was used to measure forces (N) produced by three trials of isometric flexion, extension and bilateral bending contractions of the head/neck muscles in two modes: comfortable maximum (MAX) and simulated (insincere) malingering (INSIN). An ANOVA model was created and tested post-hoc for paired differences within and between modes…and genders. A separate ANOVA was conducted to test for differences in the ratio between flexion and extension (F/E ratio). In MAX mode, males were stronger in all ranges vs females; the expected F/E and bilateral ratios were demonstrated and good consistency of effort within and between trials was demonstrated by low CV's and high ICC's, respectively. In INSIN mode, all mean peak values were significantly lower in both genders; however, the difference between genders disappeared. Within-trial consistency was much poorer with significantly higher CV's while between-trial variability was good as demonstrated by high ICC's. The flexion/extension ratio was increased in INSIN vs MAX, with no difference between genders. It appears that simulated malingering trials produced consistent patterns of deviation from maximal effort trials: reduced peak values, increased flexion/extension ratio and increased variability of within-trial effort. These findings may provide a basis for valid indicators of insincere effort in neck pain patients.
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: Objectives: This study explored how the effectiveness of prescription exercises for a home program for patients with non-specific low back pain by using the method with specified describing style in accordance with ATLAS (The Assessing the Learning Strategies of Adults) and traditional method that we often use in clinic. Patients and methods: Twenty-six patients with non-specific low-back pain were referred to the physical therapy department for exercise therapy. Subjects were randomly assigned to control group, and experimental group. The stability exercise procedures were considered for each group. For patients in control group, exercises procedures were demonstrated with wording…that we often use in clinic. For patients in experimental group, it was done by using the method with specified describing style in accordance with ATLAS (The Assessing the Learning Strategies of Adults). An Exercise Assessment Scale was also developed to measure exercise performance for this study. Results: All demographic parameters, functionality scores, and distribution of learning strategies were homogeneous in two groups. The correlation tests showed no significant relationship between personal factors and properly perception of the home exercise program in control and experimental group. Exercise Assessment Scale scores were compared in both groups which showed a significantly superiority in experimental group compared to the control group. Conclusions: The wording that we often use in clinic to describe home exercise program in patients with non-specific low back pain is not sufficient. While the method of specified describing style in accordance with ATLAS is more effective in understanding of exercises.
Keywords: Low back pain, home exercises, perception, training
Abstract: Aims: The aims of this study: 1) to determine postural changes according to wearing glasses and relationship between these changes and deep cervical flexor muscle group, 2) to investigate effectiveness of endurance training on postural changes and deep cervical flexor muscles. Methods: Seventy-three patients who had neck pain participated in this study and divided into two groups according to wearing glasses or not. Before and after endurance training for 6 weeks, postural angles of cervical region were counted, deep cervical flexor endurance test was performed and score of pain and disability index were noted of all subjects.…Results: Before treatment endurance levels were lower and scores of disability index were higher in experimental group (p< 0.05). After treatment endurance levels were improved, and scores of disability index were decreased more significantly in control group (p< 0.05). There were no significant differences between gaze, head and neck angles in both groups after treatment (p> 0.05). Conclusion: As a result it was seen that wearing glasses affected endurance of deep neck flexor muscles negatively, and it was not found relationship between postural angles and endurance of deep cervical flexor muscles. Also it was observed that endurance training for 6 weeks hadn’t affected postural angles but enhanced performance of deep cervical flexor muscles significantly.
Abstract: Background and objectives: The engagement of the first sacral nerve root is one of the most common etiologies in Sciatic Pain Syndrome (SPS). Different interfering methods are used in the physical therapy of people with SPS including physical modalities, exercise therapy, traction, and joint and neuromobilization, depending on the symptoms and radiculopathy phase. The present case study attempts to describe neuromobilization methods in treating chronic radiculopathy of the first sacral nerve root, as well as its abnormal neurodynamic responses. The case: The patient was a 36-year-old man with lower back pain during construction work 9 months before, and…presenting with complaint of burning pain and tingling in his left Posterior part of the thigh and leg. Active extension, rotation, and lateral flexion of the trunk in standing position had a complete range with no pain. SLR and Slump neurodynamic tests revealed that with increasing sensitive elements, there appeared to be abnormal sciatic nerve tension, and complaint due to returning burn and tingling in the posterior part of the thigh and leg. MRI findings revealed intervertebral disc dehydrations at L3-4, L4-5, and L5-S1 levels, as well as postero-lateral protrusion in L5-S1 intervertebral disc. Following three routine physical therapy sessions, with no improvement, neuromobilization technique was used for 6 sessions. Results: The usual routine physical therapy methods did have any visible impact in solving the patient’s problems during daily-life activities and physical diagnosis findings, yet, following neuromobilization technique, the assessment at the beginning of the eleventh session and the patient’s follow-ups two months later showed that his problems during daily-life activities and in neurodynamic tests were totally solved. Discussion and conclusion: Abnormal neurodynamic responses and consequently symptoms in patients with chronic radiculopathy may be due to a pathomechanic problem and deficiency in neural adjustment for movement and tension transfer. Neuromobilization techniques can increasingly useful in treatment of abnormal neural tensions and removing chronic radiculopathy symptoms.
Keywords: Chronic radiculopathy of the first sacral nerve root, posterior thigh pain, posterior leg pain, physical therapy, neuromobilization
Abstract: Butterfly vertebra is an uncommon congenital spinal anomaly. Only a small number of cases with butterfly vertebra have thus far been reported in the literature. We herewith describe a 32-year-old male admitted to our clinic with low back pain. He has been suffering from low back pain since early adolescence. Radiologic investigations confirmed presence of butterfly vertebra at Lumbar(L)2 level and L3-4, L4-5 posterior disc protrusion and slight osteoarthritic changes in lumbar spine which proved to be a coincidental finding along with nonspecific low back pain. Routine examination of the motor and sensory system was found to be normal.…Hematologic evaluation was made to rule out pathologic causes of anterior wedging of the vertebra like infections and metastases in the spine. Butterfly vertebra anomaly is considered to be incidental and usually asymptomatic. Awareness of this anomaly is important for correct diagnosis, while its imaging features may be confused with traumatic compression fracture, or with a pathologic fracture. Also, this spinal anomaly may be associated with many syndromes. This taken into account, all the necessary investigations should be carried out for purposes of achieving a correct diagnosis.