Journal of Back and Musculoskeletal Rehabilitation - Volume 26, 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: Background: Identifying factors associated with walking capacity in people with lumbar spinal stenosis (LSS) may provide a better understanding of neurogenic claudication and inform future rehabilitation research. Objective: To examine factors associated with objectively measured walking capacity in a sample of people with LSS and self-reported walking limitations. Methods: Participants included 49 individuals (65.8 years ± 10) who were at least 45 years of age with clinically diagnosed lumbar spinal stenosis (LSS) confirmed on MRI or CT imaging. All participants completed a Self-Paced Walking Test with visual analog pain scales and body diagrams before and immediately…after walking. Questionnaires included the Physical Function and Symptom Severity Scales of the Swiss Spinal Stenosis Questionnaire, the Oswestry Disability Index (ODI) and the Health Utilities Index. Univariate linear relationships were examined, followed by development of a multivariate linear regression model with walking distance (m) as the dependent variable. A post-hoc analysis was also conducted including post-test symptom variables. Results: Variables retained from univariate analyses included years of leg pain, pre-test leg pain severity, the ODI, balance problems, and quality of life. When these variables were considered for a final model, only the ODI and balance problems were retained (R 2 = 0.33 ). Other than balance, none of the pre-test symptom variables entered into the final model. Post-hoc analysis including post-test symptom variables found the presence and severity of post-test leg pain to be most highly associated with walking distance. In an explanatory model considering the ODI, balance and these two post-walking factors, only presence of post-test leg pain added to the model (R 2 = 0.42 ). Conclusions: Factors found to be most highly associated with walking capacity in LSS were self-reported, pain-related function (ODI), balance problems, and presence of leg pain immediately following walking.
Abstract: Objective: The aim of this study was to investigate the effect of active non-weight-bearing (NWB) group exercising on women with non specific chronic low back pain (NSCLBP). Methods: Forty females with NSCLBP were assigned in a randomized control longitudinal single blinded pilot study. 20 of them were assigned to a NWB bi-weekly group exercise class and 20 females were included in the control group. The exercises involved the entire lumbo-pelvic spine aimed at improving lumbar mobility/flexibility and stability. Pain intensity (VAS), back specific disability (Rolland Morris questionnaire-RMQ), and lumbar flexion and extension ranges of motion measurements were taken…prior to intervention (t 0 ), immediately following 4 weeks of intervention (t 1 ) and 8 weeks later (t f u ). Reliability trials were conducted on 10 females. Non-parametric tests were used for statistical significance (p < 0.05 ). Results: The following significant changes in outcome measures were indicated at t 1 compared with t 0 and control group (p < 0.001 ): an increase in lumbar flexion and extension (mean difference=9.26° (+54%) for flexion and 5.95° for extension (+98%)); reduction in VAS score (mean difference=2.32 (+58%)) and RMQ score (mean difference=4.9 (−34%)). All changes remained significant at t f u . At t 0 , lumbar flexion was correlated with extension (r = 0.547 ) and VAS (r = − 0.581 ), whereas the RMQ score correlated with VAS score (r = 0.599 ) and negatively with lumbar extension (r = − 0.665 ). At t 1 , lumbar flexion correlated with extension (r = 0.664 ) and negatively with RMQ score (r = − 0.54 ). At t f u , changes in VAS score were negatively correlated with changes in lumbar flexion (r = − 0.522 ), while changes in lumbar flexion correlated with extension (r = 0.58 ). Conclusions: A functional program of NWB group exercising improves functional, painful status, lumbar flexion and extension ranges of motion in women suffering from NSCLBP.
Keywords: Low back pain, NWB group exercising, Rolland Morris, VAS, lumbar flexion and extension
Abstract: Background: Sensitive muscle strength tests are needed to measure muscle strength in the diagnosis and management of sciatica patients. Objective: The aim of this study was to assess the isokinetic muscle strength in sciatica patients’ and control subjects’ ankles that exhibited normal ankle muscle strength when measured clinically. Methods: Forty-six patients with L5 and/or S1 nerve compression, and whose age, sex, weight, and height matched 36 healthy volunteers, were recruited to the study. Heel-walking, toe-walking, and manual muscle testing were used to perform ankle dorsiflexion and plantar flexion strengths in clinical examination. Patients with normal ankle…dorsiflexion and plantar flexion strengths assessed by manual muscle testing and heel-and toe-walking tests were included in the study. Bilateral isokinetic (concentric/concentric) ankle plantar-flexion-dorsiflexion measurements of the patients and controls were performed within the protocol of 30°/sec (5 repetitions). Peak torque and peak torque/body weight were obtained for each ankle motion of the involved limb at 30°/s speed. Results: L5 and/or S1 nerve compression was evident in 46 patients (76 injured limbs). Mean disease duration was two years. The plantar flexion muscle strength of the patients was found to be lower than that of the controls (p = 0.036 ). The dorsiflexion muscle strength of the patients was found to be the same as that of the controls (p = 0.211 ). Conclusions: Isokinetic testing is superior to clinical muscle testing when evaluating ankle plantar flexion torque in sciatica patients. Therefore, isokinetic muscle testing may be helpful when deciding whether to place a patient into a focused rehabilitation program.
Abstract: Objectives: The aim of this study was to assess the point prevalence of low back pain (LBP) in patients with rheumatoid arthritis (RA); and to compare radiological and clinical aspects, as well as impact of LBP on health related quality of life (QoL), depression and disability in control patients with mechanical LBP (mLBP). Methods: Patients with RA and patients with mLBP of at least 3 months duration were consecutively recruited. All patients were examined and underwent lumbar X-ray and magnetic resonance (MR) imaging. Disc intensity, annulus fibrosis rupture, herniated nucleus pulposus (bulging, protrusion, extrusion or sequestration), stenosis, Schmorl…nodes, hemangiomas, Tarlov cysts, Type I or II degeneration, ligamentum flavum hypertrophy and loss of lordosis were assessed on MR. Assessments included QoL and disability scales like RAQoL, Short Form-36, Health Assessment Questionnaire (HAQ) and Oswestry Disability Index (ODI) and depression and anxiety scales as well. Results: Chronic LBP coexisted in 64.5% of patients with RA. Patients with LBP had higher scores on VAS-LBP compared to patients with RA+LBP. Additionally, patients with RA+LBP had the poorest scores on quality of life, functional disability and depression. Patients with mLBP had more frequent clinical manifestations and neurologic deficits. Patients with RA+LBP had more frequent Schmorl nodes compared to patients with mLBP. Conclusion: The association of RA with LBP leads to a significant decrease in the functional capacity and QoL as well as increase in depression risk. Appropriate diagnostic procedures and treatments should be administered to avoid further deterioration in functional disability and QoL.
Keywords: Rheumatoid arthritis, low back pain, quality of life, magnetic resonance, disability
Abstract: Background and Objectives: The aim of this study was to investigate the standing balance (with open and closed eyes) on rigid surface in women with myofascial neck pain syndromes. Material and Method: This study was carried out in single and double limbs stances, open versus closed eyes, and the results were compared with control group. Forty subjects (20 in each group) were tested on a force-platform, during 30 seconds. The mean velocity (cm/s), surface area (cm2), antero-posterior and medio-lateral displacements (cm) of center of foot pressure (COP) were determined. Results: There were significant differences between two…groups regarding the mean velocity and area of COP displacements. In addition, significant differences were observed in respect to eye and limb conditions (open versus closed; single versus double limbs stances; respectively) on mean velocity, area, antero-posterior (AP) and medio-lateral (ML) displacements of COP. Conclusion: Our results showed that myofascial neck pain syndrome might be one of the disturbing factors on standing balance.
Abstract: Background: Various inputs of proprioception have been identified and shown to influence low back proprioception sense. Objective: To investigate the effect of disrupting proprioception on lumbar spine repositioning error during forward bending. Method: Healthy-subjects (n = 28 ) and patients with non-specific chronic low-back pain (n = 10 ) aged between 20–50 years. Subjects performed 5 repetitions of a lumbar repositioning task targeting 30° of trunk-forward-bending from a seated-position with different proprioceptive disturbances administered to the low back. Video analysis of skin reflective markers measured lumbar spine range-of-motion. A control-task was performed without…any proprioceptive disturbance, while the remaining 4 tasks were electro-stimulation, vibration, taping and sitting on an unstable surface. Results: The healthy group showed significantly altered repositioning error when compared with the control task (p = 0.004 ): control-task vs. taping-task, vibration-task and unstable-sitting. In the NS-CLBP group, one motor-task showed significant difference in control-task vs. taping-task (p = 0.004 ). Comparison between the NS-CLBP and matched-healthy groups revealed that the NS-CLBP subjects had larger repositioning-error (p = 0.009 ) for control, taping and vibration tasks. Conclusions: Proprioceptive disturbances had the most significant effect in increasing repositioning-error among healthy subjects. The between-groups analysis confirmed evidence consistent with the literature of greater repositioning-error in people with NS-CLBP than healthy subjects.
Keywords: Kinematics, low back pain, proprioception, repositioning error, spine
Abstract: Background and Objective: Musculoskeletal disorder is a significant health problem affecting adults and young people alike. The prevalence of musculoskeletal pain resulting from musculoskeletal disorders is on the increase especially with increased use of laptops. This study determined the prevalence of musculoskeletal pain among undergraduate students of Obafemi Awolowo University (OAU), Ile-Ife who use laptops. Material and Method: This was a cross-sectional study and participants were selected using the non-probability sampling technique. The Boston University Computer and Health Survey questionnaire was self-administered to 400 undergraduate laptop users. Data were analyzed using descriptive statistics of frequency and percentage.…Results: Three hundred and seventy six out of 400 copies of administered questionnaires were amenable to data analysis representing a response rate of 94%. Pain in the shoulder was the most reported musculoskeletal complaint from 268 (75.7%) participants. Elbow pain was the least common complaint from 132 (37.3%) participants. The prevalence of musculoskeletal pain was slightly higher among female students 93 (50.3%) of 185 and highest among students aged between 24 and 26 years: 60 (37.5%). In addition, the prevalence of musculoskeletal complaints was highest among those who used single-strap laptop bags 176 (94.1%). Conclusion: There is a high prevalence of musculoskeletal pain among undergraduate laptop users in OAU and shoulder pain was the most commonly reported.
Abstract: Objective: To compare the sensitivity of physical examination (internal rotation of the hip) with radiographs (using the Kellgren-Lawrence grading scale) in the diagnosis of clinically significant hip osteoarthritis. Design: Case Series, Retrospective chart review of hip pain patients that underwent fluoroscopically guided hip steroid and anesthetic injections. Participants: 10 patients with hip pain patients seen at an academic outpatient center over a 2 year period were analyzed. Interventions: Fluoroscopically guided hip steroid and anesthetic injection. Main Outcome Measure: Pain relief and change in VAS pain score after intra-articular hip steroid and lidocaine…injection was the main outcome measure. Results: Based on Fisher’s exact test, there was no association between severity of radiographic hip arthritis and pain relief with intra-articular anesthetic/steroid injection (p = 0.45 ). Physical examination (provocative hip internal rotation) however was associated with a significant decrease in VAS pain score after intra-articular lidocaine and corticosteroid hip injection (p = 0.022 ). Conclusion: Simple hip radiographs alone are not sufficient to diagnose clinically significant hip osteoarthritis. Physical examination (hip internal rotation) was found to be more accurate than simple radiographs in the diagnosis of clinically significant hip osteoarthritis. Radiographs seem to best utilized when they are an extension of the physical examination and patient history.
Keywords: Hip osteoarthritis, Kellgren-Lawrence, pain, radiographs
Abstract: Introduction: Increased center of pressure excursions are well documented in patients with non-specific neck pain. While a linear relationship between pain intensity and postural sway has been described in low back pain patients, no such investigation has been conducted in adults with non-specific neck pain. Methods: Seventy patients with non-specific neck pain and a matching number of healthy controls were enrolled. Center of pressure parameters were measured by three static bipedal standing tasks of 90 sec duration each with eyes closed on a force platform. The pain intensity was assessed by a numeric rating scale (NRS), an equal…number of patients (n = 10 ) was enrolled per pain score. Results: The results confirmed an increased postural sway in pain sufferers compared to healthy controls. In addition, a significant and linear increase in postural sway was observed with higher pain ratings. Statistically significant changes in sway were reached with an incremental change in NRS scores of two to three points. Discussion and Conclusions: Mean velocity and sway area are closely related to self-reported pain scores in neck pain patients. This relationship has implications for clinical applications such as an objective monitoring tool for patients under treatment or rehabilitation.
Keywords: Postural sway, center of pressure, force-plate, neck pain, pain intensity
Abstract: Objectives: To investigate the prospective value of the transitional and dynamic patterns of pain disability over time on sick leave in chronic recurrent back/neck pain cases. Methods: The material used was based on a longitudinal study with three repeated measurements. The graded Chronic Pain Scale was used to assess levels of pain disability. The relationship between the transitional patterns of the pain disability score (ten defined states of decrease, increase or no change, between two time points) and sick leave was analyzed for 909 chronic/recurrent cases in three different models using logistic regression. Results: Those with…high level of pain disability have a more transitional pattern and their pain level changed during the time period studied. When adjusting for age, gender, education and previous sick leave, the final model indicated that the current level of pain disability was a risk factor in taking sick leave. The likelihood of sick leave was highest in the transition of pain into the highest levels of disability, independent of past disability level of pain. Earlier sick leave remained as an important predictor of sick leave. Conclusions: From a clinical and prognostic perspective the probability of sick leave will be different and can be predicted based on previous sick leave but not from former history of pain disability level or its transitional pattern.
Keywords: Back and neck pain, disability transition, sick leave