Journal of Back and Musculoskeletal Rehabilitation - Volume 24, 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: Background: Cervical epidural steroid injections (ESIs) are often used to treat patients with neck and upper extremity pain associated with a cervical radiculopathy. The effect of chronic opioid use in cervical radiculopathy patients managed with ESIs is unknown; past studies suggest that these patients may behave differently than opioid naïve patients. The purpose of this study is to determine the effect of chronic (greater than 6 months) opioid use on the immediate outcome of cervical ESIs. Methods: A two year retrospective chart review identified 22 consecutive patients with cervical radiculopathy who underwent a single level interlaminar cervical ESI,…main outcome variable was > 50% pain relief on VAS at follow up. Inclusion factors were unilateral disc protrusion, exclusion factors were severe central canal or foraminal stenosis, spondylolithesis, spinal instability, cord edema, or with multi-level disc protrusions. Results: Using a linear logistic regression analysis on both patient demographics and physical exam measures, the most significant explanatory model was the use of opiates at the time of injection; 70% of opioid naïve patients had a favorable outcome while only 20% of patients managed with chronic opioids had relief (p= 0.06). Conclusions: Patients managed with opioids chronically may respond in a different manner to ESIs when compared to opioid naïve patients.
Abstract: Aim: to evaluate and compare the angular disposition of the thoracic spine (at different postures) in elite cyclists and a group of individuals who do not exercise in a systematic manner. Methods: Sixty elite cyclists and sixty-eight sedentary individuals (control group), mean age: 21.91 (2.86) years participated in this study. Thoracic spine was measure with a Spinal Mouse® while relaxed standing, lying prone and sitting on the bicycle in three handlebar positions (upper, middle and lower handlebar). Results: The mean (SEM) thoracic kyphosis while standing was 48.17 (8.05°) and 42.68 (8.02°) in cyclists and control group,…respectively (p< 0.001). The thoracic curve adopted in lying prone was 34.69 (8.28°) in cyclists and 30.96 (7.24°) in control group (p< 0.05). On the bicycle, cyclists showed lower thoracic kyphosis with respect to control group (p> 0.05). The thoracic spine was adopted more neutral in the posture sitting on bicycle than in relaxed standing, in both groups analyzed. Conclusion: The posture adopted in cycling is not the only result of the higher thoracic curvature in cyclists when standing. It is necessary to include spinal postural awareness in the training plan and thoracic muscle resistance exercises that favour more aligned postures while standing.
Abstract: Background and objectives: Pain caused by medial superior cluneal nerve entrapment (MSCNE) is an infrequent cause of unilateral low back pain. There is limited information about this neuropathy in the literature. In this study, the etiologic factors leading to this clinical entity were evaluated and also the clinical and imaging findings were examined. Material and method: The study was conducted in 3 groups. The study group included 25 patients with MSCNE, the hernia group included 25 patients with herniated nucleosus pulposus and the control group included 25 healthy subjects. The initial evaluation included lumbar computerized tomography (CT) and…magnetic resonance imaging (MRI) in the study and the hernia groups. The comparisons between these two groups were made by using clinical assessment questionnaires (SF-36 mental and physical health scores and Oswestry scale). Additionally, all three groups were compared by lumbosacral radiographies and low back superficial ultrasonographies. As treatment, 1 ml of prilocaine combined with 1 ml of steroid injection was used in the study group. Results: In the study group, there was no disc herniation, facet joint problems, spinal stenosis or spondylolisthesis detected by CT or MRI. The SF-36 mental health score before treatment was lower in the study group than in the hernia group. The ultrasonographic examination detected a paravertebral hypoechogenic globular-shaped muscle disorganization associated with lipomatous degeneration exclusively localized to the trigger point in the study group. Both the mean soft tissue and the periiliac band thickness were significantly higher in the study group than in the other two groups. The lumbosacral radiographies did not show any significant difference in either the degree of lumbar spinal lordosis or the intercristal line levels among the three groups. Conclusion: This prospective study depicts the etiologic factors, ultrasonographic features and treatment protocol of MSCNE which is usually an underestimated cause of the low-back pain. Level of evidence: Diagnostic study, Level I-1 (prospective study).
Keywords: Cluneal nerve, nerve entrapment, back pain, ultrasound, trigger point
Abstract: Objectives: Low back pain is related to functional status and possible resulting disability. The Quebec Back Pain Disability Scale (QBPDS) has been used widely to evaluate functional disability in patients with low back pain. The purpose of this study was to assess: (a) the face and content validity, (b) the factor structure, (c) the concurrent validity, (d) the discriminant validity, (e) the internal consistency and the test-retest reliability (ICC) of the Greek version of the QBPDS. Methods: One hundred and sixty patients with low back pain participated in the study. Face and content validity of the translated QBPDS…were first investigated and afterwards exploratory factor analysis (EFA) was chosen to examine the factor structure of it. The concurrent and discriminant validity of the QBPDS was also assessed by a number of valid constructs. Finally, Cronbach α and Pearson r (ICC) were used to investigate the reliability of the instrument. Results: The face and content validity of the QBPDS were supported and the EFA confirmed the sixth initial factor structure of the instrument. The concurrent and discriminant validity of it was confirmed by examining correlations between the QBPDS with other constructs. The Cronbach a and the ICCs indices of the instrument were acceptable. Conclusion: The Greek translation of the QBPDS provided reliable and valid instrument for the evaluation of Greek patients with low back pain.
Keywords: Disability, low back pain, scale, validity, reliability
Abstract: Background: Back pain has multi-factorial etiology and is modified by environmental influences, character of work, and individual predispositions. Objective: The aim of this study was to compare the efficiency of analgesic DD current therapy and TENS in low back discopathy. Material and methods: Eighty patients (age, 45–60 years) with diagnosed low back pain syndrome due to discopathy were subjected to therapy. In the first group (DD) of 40 people, DD current therapy was applied. In the second group (TENS) of 40 people, TENS was applied. The third group of 40 people was a control group in…which a functional fitness test was performed for comparison purposes. The control group was in this case an equivalent to a norm. Before the beginning and on the completion of therapy in all patients, a pain level measurement and functional fitness test were performed. Results: On the basis of research conducted it was stated that both therapies reduce pain level effectively. Obtained analyzed results conclude that both therapies applied have an analgesic effect. Conclusions: DD current and TENS therapies in low back discopathy have an analgesic impact and improve functional fitness. The applied therapies have a comparable impact on researched parameters.
Abstract: Background: Systematic reviews have confirmed the effectiveness of work-related rehabilitation with significant cognitive-behavioural components for patients with musculoskeletal disorders (MSDs). In Germany, however, work-related rehabilitation focuses mainly on functional capacity training and less on psychosocial work demands. Objective: To evaluate the efficacy of multimodal work hardening (MWH) with a cognitive-behavioural approach. Methods: Patients with MSDs resulting in severe restriction of work ability were randomly assigned to treatment by either MWH or conventional musculoskeletal rehabilitation (controls). The primary outcome was work status. The work status at 6 months of follow-up was defined as positive if the patient…was working and had ≤ 6 weeks of sick leave, and that at 12 months was defined as positive if the patient was working and had ≤12 weeks of sick leave. Follow-up data were collected by postal questionnaires. Results: 236 patients consented to participate. Follow-up data were obtained from 169 (71.6%) participants at 6 months and 146 (61.9%) participants at 12 months. At 6 months, participants in the MWH group had a 2.4 times higher chance of a positive work status than the controls (OR=2.363; 95% CI: 1.266 to 4.410; p=0.007). At 12 months, the chances of a positive work status were still higher, but this difference was not statistically significant (OR=1.914; 95% CI: 0.849 to 4.317; p=0.118). Significance of the interaction term of treatment and time indicated more favourable outcomes for depression and anxiety, mental and physical health-related quality of life, and pain management in the MWH group. Conclusions: MWH improves health-related quality of life and is able to enhance the mid-term chances of work-life participation.
Keywords: Rehabilitation, musculoskeletal disorders, cognitive-behavioural approach, work hardening
Abstract: Objective: The study investigated the effectiveness of stretching, strengthening exercises, and the scapular stabilization exercises on the pain, shoulder range of motion (ROM), muscle strength, joint position sense (JPS), scapular dyskinesis and quality of life (OL) in the patients with subacromial impingement syndrome (SIS). Methods: 27 women and 13 men, mean age 51 (24–71) years old, were included in this study. All the patients were separated into 2 groups according to simple random table. Stretching and strengthening exercises were given to the group I (n=20) and scapular stabilization exercises were added to the group II (n=20). The pain…severity, shoulder ROM, muscle strength, JPS, lateral scapular slide test (LSST), Western Ontario Rotator Cuff (WORC) Index were evaluated before and after treatment. Patients completed a 6-week rehabilitation program, three times a week. Results: The results showed that all measurements improved statistically in both groups after treatment (p < 0.05). And the improvements in the muscle strength, JPS and scapular dyskinesia were significantly different in group II (p < 0.05). Conclusion: It is suggested that in the treatment of SIS; scapular stabilization exercises, given with stretching and strengthening exercises, can be more effective in increasing the muscle strength, developing the JPS and decreasing the scapular dyskinesis.
Abstract: Objective: The aim of this study was to investigate the effect of active group-exercising on women with non specific chronic low back pain (NSCLBP) in a sitting position. Methods: 25 females with NSCLBP underwent 8 group sitting-exercise sessions of a 45 minute duration, over an 8 week period. Pain intensity (VAS), back specific disability (Rolland Morris questionnaire-RMQ), and lumbar flexion and extension ranges of motion were measured twice, for reliability tests and cut-off score values, with a 1 week interval between measurements, prior to intervention and subsequently, six weeks following intervention. Results: Several significant changes in…outcome measures were indicated following intervention compared with baseline (p < 0.001): an increase in lumbar flexion and extension (mean differences of 6° for flexion and 4° for extension, cutoff score = 5.91°); reduction in VAS score (mean difference=4.21, cutoff score =4.48); an increase in RMQ total score (mean difference=10.76, cutoff score=8.15). Changes in the VAS score was highly correlated with changes in the RMQ score (r= –6.35). Conclusions: A functional program of group-exercising conducted in a sitting position, improved the functional, painful status and lumbar ranges of motion in the sagittal plane of women suffering from non specific chronic low back pain. As sitting is considered the most common posture in today’s workplace, applying this protocol during working hours would be very effective.
Keywords: LBP, sitting group exercise, Rolland Morris, VAS, Lumbar range of motion
Abstract: Background and objective: The aim of this study was to evaluate patient satisfaction, efficacy and safety of the pulsed radiofrequency (PRF) technique applied to the suprascapular nerve for the treatment of refractory shoulder pain. Methods: After obtaining Institutional Research Board approval and patients’ written informed consent, patients with chronic shoulder pain resistant to medical treatment were included in prospective study and PRF technique was applied to the suprascapular nerve for 480 seconds. Verbal Numerical Rating Scale (VNRS) at 0, 3, and 6 months post procedure and Modified MacNab score before and 6 months after procedure are performed. Fifty…percent or more decrease in VNRS and Modified MacNab score as Excellent and Good are accepted as a significant pain relief, 20 to 49% decrease is accepted as partial. Any complication related to procedure was also recorded. Results: Fifty-seven patients were included in the study. PRF treatment significantly relieved at the pain in 73.7% patients [42 patients out of 57]. Ten patients [17.5%] showed partial improvement and there were no changes at the pain scores in 5 patients [8.7%]. Forty-five patients [78.9%] showed improvement in VNRS scores as well as in Modified MacNab scores at 6 months after treatment. No side effects were reported. Pain scores were given as mean ± SD. Also, The Kaplan-Meier analysis was done for patients’ shoulder pain after treatment with pulsed radiofrequency. Conclusion: Pulsed radiofrequency technique application to the suprascapular nerve for 480 seconds shows remarkable improvement at patients’ chronic shoulder pain.