Journal of Back and Musculoskeletal Rehabilitation - Volume 25, 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: Purpose: The purpose of this study was to investigate the diagnostic accuracy of a finding of pain during the straight leg raise test for lumbar disc herniation, lumbar radiculopathy, and/or sciatica. Patients and methods: The systematic review followed the PRISMA guidelines and captured articles that had variable designs, standardized reference standards, described an index test of a pain response, and that reported both sensitivity and specificity for the straight leg raise test. Each article specified that a positive straight leg raise test was one in which the subject felt pain during the administration of the test, and was…assessed for quality using the QUADAS tool. Sensitivities and specificities were evaluated along with positive and negative likelihood ratios. Results: The systematic review and hand search identified 7 articles for inclusion; three of these articles were rated as high quality using QUADAS scores. Sensitivity and specificity varied among the 7 studies with 4 suggesting that a pain response SLR is sensitive whereas 3 suggested it is a specific measure. Conclusions: Variability in reference standard may partly explain the inconsistencies in the diagnostic accuracy findings. Further, pain that is not specific to lumbar radiculopathy, such as that associated with hamstring tightness, may also lead to false positives for the SLR; and may inflate the sensitivity of the test.
Keywords: Straight leg raise test, straight leg raising test, systematic review, sensitivity, specificity, likelihood ratios
Abstract: Osteitis pubis among soccer athletes is a disabling painful condition and it is difficult to manage without integrating a multimodal treatment approach. There is limited scientific evidence on the effectiveness of exercise in treating Osteitis pubis especially when it progress to a chronic painful condition. The purpose of this case report is to discuss the successful multimodal physiotherapeutic management for a 15-year old soccer athlete diagnosed with stage-IV Osteitis pubis. Land and water based active core muscle strengthening exercises, Proprioceptive neuromuscular facilitation techniques (PNF) and Manual Therapy are some of the essential components incorporated in multimodal intervention approach with emphasis…to water based strength and endurance training exercises. The athlete was able to make progress to a successful recovery from his chronic painful condition and accomplished the clearly established clinical outcomes during each phase of rehabilitation.
Abstract: Background and objective: Polymyositis (PM) is an idiopathic inflammatory myopathy manifested by proximal limb muscles weakness, elevated creatinin kinase, electromyography changes, and muscle inflammation in biopsy. We report an instance of intensive rehabilitation therapy in a patient with clinically active polymyositis. Case report: A 19-year-old female patient, diagnosed with ‘electromyography and biopsy proven’ polymyositis for 5 years, suffered from worsening limbs weakness and dysphagia. In her history, she had upper and lower limbs weakness accompanied by dysphagia which was further complicated by right bronchial aspiration 9 months ago. A four-week trial of intensive training and exercise rehabilitation, concurrently…accompanied by medications was prescribed for this patient. At the end of therapy she achieved significant improvement in muscle strength, activities of daily living, and ambulation without any disease exacerbation. Conclusion: We concluded that short-term intensive training and exercise may lead to improvements in patients with PM, without causing a progress in the disease. Due to the rarity of PM and difficulty of conducting well-controlled studies to examine the risks and benefits of exercise in these patients, further research is necessary to investigate benefits of exercise training in active phase of disease.
Abstract: Background and objectives: Symptomatic ASD after lumbar spinal fusion surgery occurs most commonly in the cranial segment. The surgery for ASD contains anterior lumbar interbody fusion, posterior lumbar interbody fusion, decompression alone (laminotomy) and so on. But coblation nucleoplasty for ASD has not been reported previously. In this study, a case of coblation nucleoplasty after posterolateral fusion surgery at L4-L5 for adjacent segment degeneration (ASD) was reported and the clinical results were examined. Material and method: A 32-year-old male patient who had discectomy and fusion on the L4-L5 level seven years ago complained of chronic back pain for…four months with numbness on his right leg for a month. X-ray revealed mild lumbar instability on L3-L4 segment. Magnetic resonance imaging confirmed a right-sided L3-L4 herniated disc compressing the L4 nerve root. He underwent L3-L4 coblation nucleoplasty. The visual analog scale (VAS) was adopted to assess the relief of back pain, leg pain and numbness. Results: The operation was performed successfully and the symptoms were relieved significantly at the follow-up of more than twenty-four months. Conclusion: Although coblation nucleoplasty is not a regular therapy for ASD, the excellent outcome of this case suggests that this technique might be an option before a complicated revision surgery.
Keywords: Coblation nucleoplasty, adjacent segment degeneration, case report
Abstract: Background and objectives: The present study aims to determine whether the internal oblique (IO) and transversus abdominis (TrA) muscles, which are major lumbar stabilisers and also expiratory muscles, are affected by smoking. Methods: A total of 31 healthy individuals in their 20s (smokers: 15; non-smokers: 16) voluntarily participated in the study. They were made to maintain an upright standing posture with their scapulars on the wall. Then measurement was taken on the thickness of their right IO and TrA while they were at rest and in a state of forced expiration using a 7.5 MHz linear probe, an…ultrasonic imaging system. The thickness of the muscles was converted into the percentage of change in muscle thickness (PCMT) and relative contribution ratio (RCR) using a calculation formula, and then the data were analysed. Results: Significant differences were found between the two groups in the PCMT of the TrA and in the RCR of both TrA and IO. Conclusion: Smokers have a relatively higher degree of dependence on IO than TrA during forceful expiratory conditions compared with non-smokers. This relative overreaction of the IO is considered to likely cause problems in efficiently diffusing loads of the spine.
Keywords: Internal oblique, transversus abdominis, percentage of change in muscle thickness, relative contribution ratio
Abstract: Objective: This study aims to assess cortisol and dehydroepiandrosterone sulfate (DHEA-S) levels in post-menopausal women with FMS and correlate it with pain threshold and tolerance, depression and quality of life. Methods: We conducted a cross sectional observational study of 17 women with FMS (FMS group), and 19 healthy volunteers (CT group). Algometry, the Beck Depression Index (BDI) and Fibromyalgia Impact Questionnaire (FIQ) were used. Blood samples were collected in the morning (8:00–9:30 am) to determine cortisol and DHEA-S plasmatic levels by chemiluminescence. Results: Significant differences between groups were recorded for pain threshold and tolerance (p< 0.0001),…BDI (p< 0.0001) and all FIQ parameters (p< 0.0001). No significant differences in cortisol levels were found between the two groups (p=0.325). In the FMS group, a tangential effect was observed for DHEA-S (p=0.094) and positive correlations were found between DHEA-S, pain threshold (p=0.017) and pain tolerance (p=0.044). No correlation was observed between cortisol and DHEA-S levels and the variables of depression and quality of life for either group. Conclusions: There seems to be an influence of the decreased levels of DHEA-S and increased pain sensitivity in post-menopausal women with FMS.
Abstract: Objective: This study aims to investigate the associations among depression, anxiety, aerobic exercise capacity, body fat percentage, sum of skinfolds, abdomen circumference, and waist to hip ratio on the basis of body mass index (BMI) in adults. Methods: The subjects of the study were 60 obese participants (30 women, 30 men) with BMIs over 30 kg/m2 and 60 healthy controls (30 women, 30 men) with BMIs of 18–25 kg/m2 . Body fat percentage was calculated from the skinfold thicknesses using the formula. Body circumference measurements were performed using a tape measure. Maximal aerobic capacity (VO2 max) was…determined by Astrand submaximal exercise protocol. Two self-reported questionnaires, Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), were administered to all participants. Results: BMI, body fat percentage, sum of skinfolds, abdomen circumference, and waist to hip ratio were found to be higher in obese groups as compared to the controls, while VO2 max (ml/kg/min) values were lower in both genders. In males, BAI scores and mild-level anxiety percentage values were higher in the obese group than in the control group. There was no significant difference for BDI scores and levels between the obese and control groups in both genders. There was also no significant difference in BAI scores and levels between the obese and control groups in women. Conclusion: The fact that physical fitness being found poor in obese shows the existence of a condition that might constitute an increased tendency for obesity-related disorders. In addition, it was suggested that, in Turkey, attitudes toward obesity change depending on gender.
Keywords: Obesity, physical fitness, anxiety, depression, anthropometry, body fat
Abstract: Objectives: The purpose of this study was to investigate the effects of electrotherapy and exercise on pain intensity and mobility of connective tissue in patients with myofascial pain syndrome (MPS) in their cervical region. Methods: 60 patients were divided into 3 groups using a random allocation programme method. A hotpack was applied, and ultrasound was carried out on the patients in the treatment group who were also given exercise training. Exercise training was only given to the exercise group while the control group was given two weeks rest. The demographic characteristics, autonomic symptoms, and other MPS-associated symptoms of…patients were recorded. The Short-Form McGill Pain Questionnaire was used to evaluate the intensity and quality of pain, and a skin-roll test was used to evaluate connective tissue mobility. Results: There was a statistically significant difference between treatment and control group on the sensory pain, total pain, and Visuel Analog Scale measurements (p< 0.05). There was a decrease in connective tissue sensitivity measurements in the treatment and control groups. The connective tissue tension measurements were also decreased after treatment in the treatment and exercise groups. Conclusion: We concluded that combined treatment was more effective to decrease pain intensity, and increase connective tissue mobility.
Abstract: Objective: The purpose of this study was to examine whether strap length influences the trunk motion and gait symmetry of the ground reaction forces while walking with a single-strap bag. Methods: Seventeen Korean women participated in this study. The kinematics of trunk motion and ground-reaction forces was recorded while the participants walked at a self-paced speed under three conditions: no bag, a short-strap bag and a long-strap bag. Results: The amplitude of trunk rotation on the ipsilateral side (the bag side) decreased while walking with a short-strap bag compared to walking with a long-strap bag or…no bag (p< 0.05). The amplitude of trunk lateral bending toward the contralateral side and asymmetry in the mediolateral ground-reaction force significantly increased while walking with a long-strap bag compared to walking with a short-strap bag or no bag (p< 0.05). Conclusions: These results demonstrate that carrying a long-strap bag during walking resulted in increased trunk lateral bending and asymmetry in the mediolateral ground-reaction forces. It is therefore important to select the correct strap length when carrying a single-strap bag to prevent musculoskeletal disorders.
Abstract: Introduction: Osteoarthritis (OA) is a chronic disease characterized by the focal deterioration and abrasion of articular cartilage. The goals of therapy are preserving normal joint function, relieving pain and improving quality of life (QOL). This study is performed to investigate whether glocosamine sulfate and exercise could both delay joint structure degradation evaluated with magnetic resonance imaging (MRI) and improve symptoms in a short time period. Materials and methods: Thirty-nine women with the diagnosis of knee OA were enrolled in the study. Patients were randomized into two groups. Group I (n=20) received an exercise program, while group II (n=19)…received glucosamin sulphate (1500 mg/day) in addition to the exercise therapy. Both groups were treated for 12 weeks. The patients were evaluated before and after the treatment regarding pain, disability, functional performance, muscle strength, QOL, depression and MRI findings (cartilage volume, medial and lateral cartilage thickness). Results: Both groups showed significant improvements in pain, disability, functional performance, QOL and depression with no statistically significant difference between the groups after the therapy. While there were significant improvements for all MRI parameters expect right knee cartilage volume and lateral cartilage thickness in two groups, statistically significant differences could not be demonstrated between the groups after the therapy. Conclusion: We found no additional effect of glucosamine in delaying the radiological progression and relieving the symptoms of OA. We also demonstrated that exercise alone was adequate to prevent structural changes and cartilage loss of the knee joint as assessed by MRI. Level of evidence: Diagnostic study (prospective study).
Keywords: Exercise, glucosamine sulfate, osteoarthritis, knee cartilage, magnetic resonance imaging
Abstract: Background and objectives: To test the hypothesis that dry needling is more effective than sham dry needling in relieving myofascial pain of the temporomandibular muscles. Material and method: Fifty-two subjects with established myofascial trigger points were randomized into two groups; study group (N: 26) and placebo group (N: 26). Dry needling was applied using acupuncture needles. Sham dry needling was applied to the placebo group. Pain pressure threshold was measured with pressure algometry, pain intensity was rated using a 10-cm visual analog scale (VAS) and the unassisted jaw opening without pain measurement was performed. Evaluations were done by…a physician blinded to the data. Results: Of 52 patients assigned, 50 completed the study. Mean algometric values were significantly higher in the study group when compared to the placebo group (p values being less than 0.05). There were no differences between the two groups in terms of VAS and unassisted jaw-opening without pain values. Conclusion: Dry needling appears to be an effective treatment method in relieving the pain and tenderness of myofascial trigger points.
Abstract: The incidence of anterior cruciate ligament injury has continued to increase over the last two decades. This injury is associated with abnormal gait patterns and osteoarthritis of the knee. In order to accelerate recovery, the introduction of core stability exercises into the rehabilitation program is proposed. The theory underlying the use of core stability exercise relates to the neuroplasticity that follows anterior cruciate ligament injury. Neuroplasticity in lumbar, thoracic, cervical and brain regions diminish activation in the contralateral thalamus, postparietal cortex, SM1, basal ganglia–external globus pallidus, SII, cingulated motor area, premotor cortex, and in the ipsilateral cerebellum and SM1 and…increase activation in pre-SMA, SIIp, and pITG, indicating modifications of the CNS. In addition, the neuroplasticity can regulate the movement of trunk muscles, for example, sternocleidomastoid and lower trapezius muscles. Core stability also demonstrates a negative correlation with the incidence of anterior cruciate ligament injury. Therefore, we propose that core stability exercises may improve the rehabilitation of anterior cruciate ligament injuries by increasing core motor control. Specialized core stability exercises aimed at rectifying biomechanical problems associated with gait and core stability may play a key role in the management of anterior cruciate ligament injury.