Journal of Back and Musculoskeletal Rehabilitation - Volume 24, 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: To investigate intra- and inter-observer reliability among physical medicine and rehabilitation specialists and a radiologist in interpretation of plain lumbar spine X-ray films in patients with low back pain. Methods: Three assessors (A: a resident of PM&R, B: an experienced PM&R specialist, C: an experienced radiologist) read the standard lumbosacral plain radiographs of 79 patients with 2–3 month time interval. Each assessor recorded the presence or absence of abnormalities on the radiograph according to a standardized assessment form. Results: For assessors B and C, all kappa values were > 0.40. Transitional vertebrae abnormalities reached to…the highest agreement ratio. The intrarater agreement showed higher kappas than the interrater agreement. The radiologists had the highest intrarater agreement, closely followed by the experienced PM&R specialist. Agreement among three assessors was substantial in sacralisation, lumbarisation and facet joint pathologies. Conclusion: We usually obtained a good intrarater agreement, especially for the experienced PM&R specialist and the radiologist indicating that experience increases diagnostic consistency. Besides the systematic differences in radiographic interpretation between the assessors, institutional specific conditions (esp. patient profile and regularities) may cause the phycians to pay more attention to a specific group of pathologies.
Keywords: Low back pain, Lumbar spine, plain radiograph, reliability
Abstract: Objective: To describe the kinematic adaptations of all lower limb joints in hip osteoarthritis patients during walking. Methods: Patients with unilateral primary hip OA, without associated joint disorders were included. Normal subjects were included as controls. Gait analysis, using a 3-dimensional computerised gait analysis system was used to evaluate the usual spatiotemporal parameters, the peak motion of the hips, knees, and ankles during walking, and the intersegmental coordination of the lower limbs. Results: Eleven patients, mean age =60.5 ± 7 years and nine controls, mean age=60.3 ± 7 years, were included. The gait of hip OA…patients was characterised as follows: a reduced stride length, a reduced maximal flexion and extension in the OA hip, a reduced maximal contralateral hip range of motion, an increased ipsi- and contralateral ankle dorsal flexion, a decreased ipsilateral relative temporal phase between the thighs and shanks segments and an increased ipsilateral relative phase between the shanks and foot segments. Conclusion: The present results suggest that hip OA patients use shorter stride length, less contra lateral and especially ipsilateral hip motion, modify ankles motion, and have a different intra-limb coordination pattern compared to control subjects.
Keywords: Hip osteoarthritis, gait analysis, kinematic, walking
Abstract: Objective: Hand-held flexible poles which are brought into oscillation to cause alternating forces on trunk, are advocated as training devices that are supposed to solicit increased levels of stabilizing trunk muscle activity. The aim of this study was to verify this claim by comparing electromyographic (EMG) activity of trunk muscles during exercises performed with a flexible pole and a rigid pole. Methods: Twelve healthy females performed three different exercises with flexible and rigid poles. EMG activity of iliocostalis lumborum (IL), multifidus (MU), rectus abdominis (RA), external oblique (EO) and internal oblique (IO), and was continuously measured. The EMG…signals were analyzed in time domain by calculation of the Root Mean Square (RMS) amplitudes over 250 ms windows. The mean RMS-values over time were normalized by the maximum RMS obtained for each muscle. Results: The IO showed a 72% greater EMG activity during the exercises performed with the flexible pole than with the rigid pole (p=0.035). In exercises performed in standing, the IO was significantly more active than when sitting (p=0.006). Conclusion: As intended, the cyclic forces induced by the oscillating pole did increase trunk muscle activation. However, the effect was limited and significant for the IO muscle only.
Abstract: An imbalance in the recruitment patterns of the quadriceps muscle has been implicated in patellofemoral knee pain; however ambiguity remains in the normal recruitment patterns of this muscle. We investigated the activity of the quadriceps muscle during the final degrees of knee extension, specifically in the medial and lateral components. Sixteen healthy subjects (age; 22.5 (± 3.4) years, body mass; 67.5 (± 12.1) kg and height; 173.9 (± 10.4) cm) participated. Torque and electromyographic (EMG) activity of the quadriceps muscle were measured during isokinetic and isometric knee extensions. Torque and EMG activity reduced in all component muscles during the…final degrees of isokinetic extension, but this did not occur during isometric contractions at similar angles. Normalised activity of rectus femoris (RF) was greater than that of vastus lateralis (VL) and vastus medialis obliquus (VMO) during the final degrees of isokinetic knee extension at 30°/sec; there were no differences between any component muscles at the higher velocities. VMO:VL and vastus medialis longus (VML):VL ratios were unchanged during knee extensions, except that VML:VL ratio increased significantly during the final degrees of extension at 30°/sec. Future work should compare these results with people with anterior knee pain, and explore this further during activities of daily living.
Abstract: Objective: To prevent overuse injuries related to excessively pronated feet, the strengthening of the foot intrinsic muscles has been recommended. The purpose of this study was to examine the effects of foot orthoses and a short-foot exercise intervention on the cross-sectional area (CSA) of the abductor hallucis (AbdH) muscle and strength of the flexor hallucis (FH) in subjects with pes planus. Methods: Twenty-eight subjects with pes planus were randomly assigned to the foot orthosis (FO) group or the combined foot orthosis and short-foot exercise (FOSF) group for an 8-week intervention. The CSA of the AbdH muscle and the…strength of FH were assessed before and after intervention. Data were analyzed using a mixed-model ANOVA. Results: Significant group by intervention interaction effects were observed in CSA of the AbdH (p=0.009) and strength of the FH (p=0.015). The results of the post hoc paired t-test showed that that the CSA of the AbdH muscle and the strength of the FH significantly increased after the intervention in both groups (p=0.000). The mean CSA of the AbdH muscle and the strength of FH were significantly greater in subjects in the FOSF group compared with subjects in the FO group (mean difference of FO vs. FOSF=13.61 mm2 in CSA of AbdH muscle; 0.90 kgf in strength of FH; p=0.008). Conclusions: Results from this study demonstrate that foot orthoses combined with short-foot exercise is more effective in increasing the CSA of the AbdH muscle and the strength of FH compared with foot orthoses alone. Therefore, foot orthoses combined with short-foot exercise are recommended for improving strength of AbdH muscle in subjects with pes planus.
Keywords: Abductor hallucis, medial longitudinal arch, pes planus, short-foot exercise
Abstract: Objective: To determine the effect of novel augmented abdominal drawing-in maneuver (ADIM) training using rehabilitative ultrasound imaging (RUSI) and electromyography (EMG) in adults with core instability. Methods: A convenience sample of 20 young adults with core instability (female =4; mean age ± standard deviation=24.4 ± 2.9 years) was recruited. Core instability was determined by the formal test. All subjects underwent an intensive ADIM that was augmented by comprehensive visual feedback via a pressure biofeedback unit, RUSI, and EMG. The intervention was provided for 20 minutes a day, 7 days a week, over a two-week period. Results:…The paired t-test showed that both transverse abdominal (TrA) and internal oblique (IO) muscle thickness during ADIM were significantly greater than at rest (p= 0.000). However, external oblique (EO) muscle thickness remained relatively unchanged. The mean EMG amplitudes of the EO and erector spinae (ES) muscles were significantly decreased after the intervention (p=0.001, p=0.008). The intra-class correlation coefficient (ICC1,2 ) showed the excellent test-retest reliability for muscle thickness (ranging from 0.90 to 0.98 in the prone position). Conclusion: This is the first evidence to demonstrate that the novel augmented ADIM training can effectively improve the lumbo-pelvic stabilization in adults with core instability.
Abstract: Introduction: A dynamometer employing a stabilization procedure (lumbar extension machine, MedX, Ocala, FL) is effective in improving strength and reducing symptoms of low back pain (LBP), and researchers have hypothesized that this effectiveness is due to the pelvic stabilization. However, effects of the dynamometer with and without pelvic stabilization on LBP have not been compared: This was the aim of the present study. Methods: Forty-two chronic LBP patients were randomly assigned to a lumbar extension training with pelvic stabilization group (STAB; n=15), a lumbar extension without pelvic stabilization group (NO-STAB; n=15) and a control group (n=12). STAB and…NO-STAB participants completed one weekly session of dynamic variable resistance exercise (one set of 8–12 repetitions to fatigue) on the lumbar extension machine (with or without pelvic stabilization) for 12 weeks. Pre- and post-test measures of self-reported LBP (101-point visual analog scale; pre-test mean of 25), related disability (Oswestry disability index; pre-test mean of 34) and lumbar strength were taken. Results: After the exercise program, the STAB group increased significantly in lumbar strength at all joint angles, and decreased significantly in visual analogue and Oswestry scores. However, there were no significant changes in these variables in the NO-STAB and control groups. Discussion: Isolated lumbar extension exercise is very effective in reducing LBP in chronic patients. However, when the pelvis is not stabilized, otherwise identical exercises appear ineffective in reducing LBP.
Abstract: Background: Trigger points on the palpable taut bands of the muscles are promoted as an important cause of musculoskeletal pain. Our hypothesis was latent trigger points (LTrPs) could decrease muscle strength also in healthy people. Objectives: The aim of our study was to investigate the relationship between LTrPs and muscle strength in a group of healthy adults. Methods: In total fifty healthy adults (20 women and 30 men) were included in the study. Trigger point examination for upper and middle trapezius, supraspinatus, serratus anterior and rhomboid major and minor were done bilaterally according to four criteria.…Subjects who have at least two trigger points in dominant side were assigned to Group 1 (28 subjects), subjects who don’t have any trigger points were assigned to Group 2 (23 subjects). Muscle strength for flexion and scaption was assessed with a Hand-Held Dynamometer (HHD) as break test on both sides. Both the subjects and the examiners were blind. For statistical analysis, independent sample t test was used to compare the differences between two groups. Results: No significant differences were found in muscle strength between dominant and non-dominant sides in both groups (p >0.05). Significant difference was observed in both sides when comparison of muscle strength between Group 1 and 2, muscle strength was lower in subjects who had trigger points (p < 0.05). Conclusions: This study indicated that although there is not significant difference between dominant and non-dominant side, muscle strength is lower significantly in both sides in subjects who have trigger points in comparison with healthy subjects. Our results underline the importance of palpation of LTrPs in scapular and shoulder muscles in healthy subjects as they may contribute to the muscle strength. Further research is neded to facilitate a better understanding of the mechanism of LTrPs and to test the relationship with muscle strength.
Keywords: Latent trigger point, muscle strength, healthy subjects, double-blind study
Abstract: Osteopoikilosis is a sclerosing bone dysplasia, characterized by multiple oval spots of radiodensities within the trabecular bone. It occurs equally common among men and women. Prevalence is estimated to be as high as 1:50,000. Most reported cases have been found incidentally on roentgenograms taken for other purposes. We present a 58-year-old woman with OPK associated with fibromyalgia and active myofascial trigger point in upper trapezius muscles.