Journal of Back and Musculoskeletal Rehabilitation - Volume 25, issue 1
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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: The article describes the case of 35 year old female who was admitted to the department with saddle type hypoesthesia, anal incontinence without muscle weakness of lower extremities and sciatica. Central lumbar disc herniation (LDH) was determined on level L5-S1 level and the patient was operated thereafter. In the postoperative period, the patient did not have any muscle weakness of leg but had residual saddle type sensory loss and sphincter dysfunction. This article discusses atypical presentation of cauda equina syndrome (CES) secondary to LDH. Early diagnosis and surgery are important factors for a better prognosis in CES.
Abstract: Introduction: The aim of this study was to evaluate the prevalence of work-related musculoskeletal pain (WRMSP) and depression and the quality of life (QOL) among teachers in Samsun, Turkey. Materials and Methods: Among 605 participants 99.30% (n=602) completed the survey. A face-to-face questionnaire was given to the participiants in order to evaluate the QOL (Short Form 36, SF-36), the presence of depression (Beck Depression Inventory, BDI) and the presence of pain (Visual Analogue Scale). Results: Among the participants (n=602), 290 were women (48%) and 312 were men (52%). Three hundred sixty three (60.3%) of the participants…reported that they had work-related pain. Most of the participants had WRMSP in low back (74.9%), shoulder (55.9%), neck (47.9%), back (42.7%), knee (30.9%) regions. There was a significant difference for BDI and the subscales of SF-36 test, except the emotional role limitation, mental health and energy between the participiants with WRMSP (Group 1) and the participiants without WRMSP (Group 2). BDI scores were significantly higher in the Group 1. The subscale scores of SF-36 were significantly lower in the Group 1. There was a negative correlation between SF-36 and BDI scores; indicating that teachers who have more depressive symptoms have also a lower QOL. Conclusions: Pain in neck, shoulder, back and low back regions are frequently seen in teachers. Depression is common and its presence reduces the QOL of teachers. Modifications of ergonomics in working conditions may reduce the frequency of these complications. The habit of carrying heavy loads, awkward back postures, longterm repetitive physical activities, psychosocial stressors and longterm standing must be reduced.
Keywords: Work-related pain, teachers, quality of life, depression, risk factors
Abstract: Objectives: A randomized, double-blind, clinical trial study was conducted with the aim of determining the efficacy of adding laser (830 nm) to ultrasound (US) and exercise for the management of shoulder tendonitis. Methods: 42 subjects (n = 21 , in adding laser group and n = 21 , in US and exercise group) received a course of 10 sessions treatment over one month in the shoulder region. Outcome measures such as Visual Analogue Scale (VAS), Tenderness Severity Scale (TSS), Constant Murley Score (CMS) and Manual Muscle Testing (MMT) were performed before treatment and at…the end of 4 weeks treatment. In addition, follow up were performed 2 months after the end of treatment based on the degree of pain improvement. Results: VAS, TSS and CMS improved significantly (P = 0.001 ) in both groups, however the muscle strengths only improved significantly in adding laser group (P < 0.01 ). Conclusion: It seems that both protocols of physical therapy interventions were effective in relieving the signs and symptoms of shoulder tendonitis. Furthermore, adding low level laser therapy (LLLT) to the US and exercise was more efficient in improving the muscle strength in patients with shoulder tendonitis over a period of three months. However, it should be emphasized that, the current results might be due to the effects of laser and exercise instead of laser, us and exercise (as we had no independent group for US).
Abstract: The study compared lower extremity kinematics and kinetics between male subjects with flat and normal feet when landing on both feet from platforms at different heights. Ten subjects with a flat feet arch and 10 subjects with a normal foot arch were recruited. They performed a double limb drop landing from 20, 40, and 60 cm onto a force-plate. A three-dimensional motion analysis system, force plates, and electromyography were used to analyze lower extremity kinetic and kinematic data. The GRF and angle of sagittal plane significantly increased with landing height in the flat foot group. In particular, hip joint angles…at a height of 60 cm were significantly greater. The electromyography values were significantly higher for the tibialis anterior and vastus lateralis muscles, but were significantly lower in the abductor hallucis, gastrocnemius, and biceps femoris muscles in the flat foot group. GRF, joint angles, and muscle activity patterns in the lower extremities increases more with height in flat footed individuals than in people with a normal foot arch. Flat feet may aggravate the risk of shock on landing from a height; this might be ameliorated by a compensatory strategy at the hip joints to facilitate load distribution.
Abstract: Background: Though the active straight leg raise (ASLR) test has been proposed as a reliable methodology for assessment of load transfer through the pelvis in patients with sacroiliac joint pain (SIJP), the tonicity and timing of muscle activation during the ASLR test have not been investigated. In clinical experiments, besides the ASLR test score, an increased duration of the test is also used for diagnosis of SIJP. Objective: This study was a cross-sectional design of electro-myographic pattern of sacroiliac stabilizer muscles to establish a platform for comparison of patients with SIJP and healthy controls. To identify if the…subjects with SIJP show changes in electromyographic pattern of sacroiliac stabilizer muscles as well as any duration difference in such tests for both groups. Methods: Fifteen female patients with sacroiliac pain and the same number of healthy females at the same age were participated in this study. All the patients were diagnosed as positive ASLR as well as self reported maximum pain over the sacroiliac joint. Surface electromyographic activity was recorded from rectus abdominus, external oblique, internal oblique, adductor longus, biceps femoris, gluteus maximus and erector spinea during ASLR. Tonicity and onset of muscle activity in relation to the initiation of the ASLR and their duration were also compared. Results: The participants with SIJP exhibited a significantly increased latency at the onset of adductor longus following the initiation of the ASLR test (P = 0.002 ) as compared to the healthy controls. A significant difference was also observed in tonicities of external oblique, biceps femoris, gluteus maximus and erector spinea as well as the duration of leg rising (P < 0.05 ) between the two groups. Conclusion: These findings suggest that an alteration in the motor control strategy for lumbopelvic stabilization in patients with SIJP may influence load transfer through the pelvic.
Keywords: Electromyography, active SLR, muscle timing, sacroiliac pain
Abstract: Background: Sit-to-stand (STS) movement is an important part of the overall pattern of walking and affects social independence. Objective: We examined the kinematics of STS movement using two adjustable handrails. Methods: Seventy-five subjects (25 college students, 25 independent elderly people, and 25 physically challenged elderly people) participated in the study. Five types of handrail positions (‘no handrails’, ‘both high’, ‘both low’, ‘high and low’ and ‘reverse high and low’) were evaluated. Kinematic data were collected using a VICON analyzer and a Myosystem was used to collect the electromyographic data. Results: STS movements with high…and low handrails in the elderly subjects took the shortest time and showed the largest decrease in torque (15%) compared to no handrails. The ‘high and low’ position also reduced the loads to the greatest extent. The average time period for STS was reduced by 15 to 30% using the high and low handrails compared to no handrail for all three groups. Conclusion: The ‘high and low’ handrail position best facilitates STS movement in the elderly by reducing the time needed to perform STS movements and by reducing the torque and subsequent wear on the joints and muscles.
Abstract: Study design: Controlled laboratory study. Objectives: To examine characteristics of neck movement at three-dimensional planes for subjects with mechanical neck disorder (MND) and measure cervical range of motion, coupling motion, and calculation of the upper cervical rotation ratio. Background: MND is characterized by symptoms of neck pain, headache, dizziness and limited range of motion (ROM). However, the characteristics of neck movements across the three-dimensional planes in MND patients remain unknown. Methods: Forty participants were recruited, which consisted of twenty-seven subjects with MND and 13 healthy subjects. A three-dimensional electromagnetic motion capture device with custom…data analysis software was used to measure the neutral position of the neck and the range of motion of upper and lower cervical spine. Results: The results indicate that subjects with MND had significantly decreased ROM in right rotation (p < 0.05 ) and extension (p < 0.05 ) movements compared to the healthy group. Increased coupling motion (p < 0.05 ) in the rotation plane during cervical flexion was also found in the MND group compared to control group. For rotations in neutral or in flexion positions, rotation to the right showed smaller range of motion compared to rotation to the left. Conclusion: In this study, MND was associated with altered cervical movement patterns with increases in coupling motion. The findings may help to differentiate MND from whiplash-associated disorder. Increasing upper cervical spine rotation mobility may be crucial for treating deficiencies in neck rotation in patients with MND.
Abstract: Objectives: 1. To compare postural alignment in erect standing between osteoporotic fallers, osteoporotic non-fallers and healthy women. 2. To compare BMI, number of fractures and intensity of pain between osteoporotic fallers and non-fallers. Methods: Thirty-six osteoporotic women with vertebral fractures and 40 healthy women participated in the study. Spinal curvatures were assessed with a digital inclinometer. Photographic measurements of knee, hip, shoulder and head were carried out in sagittal plane. Results: Significant differences were found between osteoporotic fallers and healthy women in the head (p = 0.040 ), and thoracic angles (p = 0.001…). Significant differences were found between fallers and non-fallers in BMI (p = 0.000 ), number of fractures (p = 0.033 ) and pain (p = 0.005 ), with fallers being heavier, with less fractures and pain than non-fallers. Conclusions: Osteoporotic fallers probably differ from osteoporotic non-fallers and healthy women. Researchers and clinicians may consider, in the future, the above differences when planning research and clinical intervention in this field. Replication studies are necessary to confirm the present findings.
Keywords: Postmenopausal osteoporosis, vertebral fracture, posture, falls, pain
Abstract: Background and objectives: Neck muscles have a major role in normal stability and mobility of cervical spine in healthy subjects. Weakness and related atrophy of these muscles may be a causative factor in cervical pain among office workers. The aim of this study was to compare the size and asymmetry of the neck semispinalis capitis muscle (SECM) between a group of female office workers with unilateral chronic non-specific neck pain (CNNP) and a group of healthy control subjects. Material and method: Twenty female office workers (10 patients with unilateral CNNP and 10 healthy subjects) participated in this study.…The right and left SECM sizes, anterior posterior dimension (APD) and lateral dimension (LD) were measured by an ultrasonography apparatus. The size of SECM was calculated as APD × LD. Results: The SECM size and the ratio of the size to body weight in patients were less than that of controls (P < 0.05 , P < 0.001 ). The size of SECM was also smaller in affected side than unaffected side in patients group (P < 0.05 ). Between sides asymmetry of SECM size was higher in patients than that of controls (P < 0.001 ). The mean APD of SECM of patients was less than that of controls (P < 0.01 ). There was not significant difference in LD between two groups. Conclusions: Neck SECM size and asymmetry measurements and the ratio of SECM size to body weight as well as APD appeared to be useful parameters to detect neck muscle atrophy in patients with CNNP.