Journal of Back and Musculoskeletal Rehabilitation - Volume 27, 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: Purpose: F-wave analysis may help affirm or disprove a compression neuropathy. In this study we have analysed the effects of focal median nerve injury on F wave in Carpal Tunnel Syndrome (CTS). Method: We studied 57 patients (100 hands) with clinical and electrophysiological CTS and 31 (62 hands) healthy subjects. Median nerve F-waves were evaluated following 10 supramaximal stimuli and recording from abductor pollicis brevis muscles. Minimum, maximum, and mean F-wave latencies, frequency of the F wave (Fp), chronodispersion (F CD ), mean F/M amplitude ratios (mF/M-amp) and F-wave conduction velocity (FwCV) were…evaluated. Results: The CTS patients showed prolonged F-wave latencies, decreased Fp, and an increase of the F CD as compared with normative values. Absent F wave was presented in 8 of 34 hands (23.5%) with severe CTS patients. In the severe group, the FwCV was significantly slower (p < 0.001 ) and the mF/M-amp was significantly higher (p < 0.001 ) than that of mild and moderate groups, respectively. Also, the mF/M-amp was significantly greater and Fp was lower in the axonal type than in the demyelinating type. The F CD was not different among groups. A strong positive correlations between mMDL with Fmin (r = 0.81 , p < 0.000 ), Fmean (r = 0.80 , p < 0.000 ) and Fmax (r = 0.71 , p < 0.000 ) were revealed. Conclusion: Results support the differing effects of demyelinating and axonal injury on F-waves and suggest that the mF/M-amp ratio and FwCV, which is influenced by neuronal damages in the distal segment of the median nerve, is useful in the discrimination of CTS severity.
Keywords: Carpal Tunnel Syndrome, median nerve F waves, nerve conduction studies, subtypes
Abstract: Background and Objective: Corrective exercise interventions are often utilized to manage subjects with thoracic hyper-kyphosis, yet the quality of evidence that supports their efficiency is lacking. In this study, the efficacy of local and comprehensive corrective exercise programs (LCEP and CCEP) on kyphosis angle was evaluated. Material and Method: A prospective, randomised controlled design was used in the present study. Sixty patients with postural hyper-kyphosis deformity (⩾42°) entered the study for 12 weeks. Subjects were randomly assigned to a LCEP (n = 20 ), CCEP (n = 20 ), or Control groups (n =…20 ). Pre- and post-participation levels of kyphosis angle were measured by flexicurve ruler. Results: Both the LCEP and CCEP groups demonstrated statistically significant reductions in thoracic kyphosis angle compared to the control group (p = 0.001 ). Furthermore, based on Cohen’s d-value, the efficiency of CCEP was larger than LCEP. Conclusions: Considering the extremely large effect size of the CCEP, we recommend that this program be used in the correction of postural hyper-kyphosis deformity in future.
Abstract: Background and Objective: The high-power pain threshold ultrasound (HPPTUS) technique has been introduced as a novel treatment method in patients with myofascial trigger points (MTrPs). The aim of the current study was to compare the therapeutic effects of HPPTUS with those of the conventional ultrasound technique in elderly patients with latent MTrPs on the upper trapezius muscles of at least 1 side. Material and Methods: Forty-one participants received 8 treatment sessions with conventional ultrasound (n = 19 ) or with the HPPTUS technique (n = 22 ) for 4 consecutive weeks. Outcome variables included…visual analog scale (VAS) scores, pressure pain threshold (PPT), and range of motion (ROM). The data were analyzed using repeated analysis of variance (ANOVA) measurements. Results: The VAS scores recorded 1, 2, 3, and 4 weeks after HPPTUS were significantly lower than the baseline scores in both groups. The ROM (after 3 and 4 weeks) and PPT (after 4 weeks) values also significantly increased from their baseline values in both groups. On comparing the techniques, there were no significant differences in the VAS (p = 0.296 ), PPT (p = 0.768 ), and ROM (p = 0.822 ) values, although both techniques showed therapeutic effects for 4 weeks (p < 0.001 ). Conclusion: The results indicate that the HPPTUS technique in same manner as treatment of active MTrPs is not superior to the conventional ultrasound technique in the treatment of the elderly patients with the latent MTrPs.
Abstract: Background: The purpose of this study was to identify factors associated with Low Back Pain (LBP) among employee working at a package producing industry. Methods: A sample of 111 male blue-collar workers, between the ages of 18 to 50 years old and 31 white-collar workers between the ages of 17 to 50 years old completed a questionnaire which included demographic data, educational level, participation in sports activities, activity, postural habits, smoking, work conditions lifting and bending activities during the workday strenuous arm position and questions related with low back pain (LBP). The isometric strength of back muscles were…measured using a dynamometer. Result: The prevalence of LBP during the past 12 months was 55.9% for blue-collar workers and 51.6% for white-collar workers. The chi-square and t-test analysis showed statistically significant relations between LBP and smoking, number of years spent working in the last job, lifting activities between the ages of 30–34 years old. The incorrect standing and sitting posture of the blue-collar workers and the sitting posture with bending forward on the table of the white-collar workers were significantly related with LBP (p < 0.05 ). Conclusions: Our results identified the risk factors of LBP in a package producing company. The protective approaches aiming to avoid the risk factors could decrease the low back pain prevalence that increases each year passed worked at the company.
Abstract: Background and Objectives: Intrinsic variability is present in all actions, including repetitive tasks. The aim of this study was to evaluate the variability of anticipatory postural adjustments (APAs) of trunk muscles in participants with low back pain (LBP). Material and Method: The study included 21 participants with recurrent non-specific LBP (15 men, 6 women) and 21 healthy volunteers. Standard deviation of electromyographic activity of the external oblique (EO), transverse abdominis/internal oblique (TrA/IO), and erector spinae (ES) muscles onset relative to deltoid muscle onset was recorded in 75 rapid arm flexions, and the correlation with the participants’ avoidance belief…(the FABQ score) and disability (the Roland-Morris Questionnaire score) was statistically analyzed. Results: participants with LBP exhibited less variability in timing of APAs of the TrA/IO muscle compared with the control group (P = 0.047 ). The timing of APAs of the TrA/IO muscle was significantly correlated with the FABQ score (P = 0.006 ). There was no significant correlation between this variable and disability (P = 0.09 ). Decrease in variability of the timing of APA of the EO (P = 0.45 ) and ES (P = 0.6 ) muscles was not significant. Conclusion: The variability of the postural responses of participants with LBP decreased. Restoring variability in postural control responses might be a goal in rehabilitating these patients.
Keywords: Variability, posture, fear-avoidance belief, disability, low back pain
Abstract: Objective: To determine the effects of stabilization exercises on pain and function in patients with degenerative spondylolisthesis. Study Design: Nonrandomized clinical trial, with 6 months of follow up. Methods: Twenty patients over 50 years of age with degenerative spondylolisthesis underwent a 6-month, home-based training program of stabilization exercises. We applied functional and pain scales (Visual Analogue Scale [VAS] and Oswestry Disability Index [ODI]), and conducted an isokinetic trunk test. Statistical analysis included a T test for quantitative variables, a chi-squared test for qualitative data, and Pearson correlations. The significance alfa level was 0.05. Results:…Both pain and Oswestry Index scores were significantly decreased. Initial and final VAS “back pain” results were 63.50 ± 18.05 mm and 43.4 ± 22.09 (p = 0.007 ) respectively. Initial and final VAS “sciatic pain” results were 53.65 ± 29.03 mm and 36.65 ± 27.21 (p = 0.035 ) respectively. Oswestry Index at the beginning of the study was 30.35 ± 15.6%, decreasing to a final 20.15 ± 13.6% (p = 0.007 ). The results of VAS and ODI scores correlated significantly with improvement in the isokinetic test. Conclusion: Lumbar stabilization exercises could be an effective treatment option in controlling pain and improving function in patients with degenerative spondylolisthesis. Further investigation with randomized controlled trials is necessary to obtain confirmation of these results.
Abstract: Objective: To determine if the eccentric evertor/invertor and dorsiflexor/plantar-flexor ratio are altered in subjects with chronic ankle instability. Methods: Twenty chronic ankle instability (CAI) subjects as an experimental group, and twenty healthy subjects as a control group, were matched in age, gender, and activity level. CAI subjects have a history of at least one ankle sprain and repeated episodes of giving way were included in CAI group. Subjects with no prior history of ankle injury were included in the control group. Ankle evertor/invertor and dorsiflexor/plantar-flexor muscles eccentric torque ratios were measured using the eccentric muscle contraction at angular…velocities 60 and 120°/s. Results: Analysis of variance revealed that the eccentric contraction eversion/inversion ratio of CAI group was significantly lower than normal group ratio at angular velocities 60 and 120°/s (p = 0.041 and 0.012) respectively. The eccentric contraction dorsiflexion/plantarflexion ratio of CAI group was significantly higher than normal group ratio at both angular velocities (p = 0.036 and 0.013) respectively. Moreover, at angular velocities of 60°/s and 120°/s a deficit in inversion and eversion eccentric torques were identified in CAI group (p = 0.000 ), plantarflexion torque deficit of CAI group (p = 0.034 and 0.028), respectively, and no deficit was identified for dorsiflexion torque of CAI group (p = 0.595 and 0.696) respectively. Conclusion: Chronic ankle instability increases the dorsiflexion/plantarflexion muscles torque ratio and decreases the eversion/inversion ratio at angular velocities 60 and 120°/s. Therefore, the restoration of a normal eccentric inversion, eversion, and plantarflexion strength may prevent recurrent lateral ankle ligament sprain.
Abstract: Background and Purpose: Slumped sitting is known to increase disc pressure and aggravate chronic low back pain. In addition, it has been recognized that co-contraction of the deep spine-stabilizing muscles enhances lumbar segmental stability and the sacro-iliac joint. The purpose of this study was to compare the electromyographic (EMG) activity of the trunk muscles and the muscle thickness of the transverse abdominis (TrA) during slumped sitting with the same parameters during co-contraction and investigate how co-contraction influences spinal curvature. Subjects and Methods: Nine healthy male volunteers participated in the study. EMG signals were recorded during both sitting postures.…In order to measure the muscle thickness of the TrA, ultrasound images were captured. While the subjects performed both sitting postures, spinal curvature was measured using a hand-held device. Results: Significantly more activity of the trunk muscles, with the exception of the rectus abdominis muscle, and significantly greater muscle thickness of the TrA were observed during co-contraction of the trunk muscles than during slumped sitting. Co-contraction also resulted in significantly increased lumbar lordosis and a greater sacral angle when compared to slumped sitting. Conclusion: In this study, it was demonstrated that the instructions given to the subjects on co-contraction of the trunk muscles during sitting increased muscle activity with the exception of the rectus abdominis muscle, muscle thickness of the TrA, and lumbar lordosis.
Abstract: Background and Objectives: Shortened hamstring muscle length has been noted in persons with low back pain (LBP). Prolonged sitting postures, such as those adopted during different work settings and sedentary lifestyle has been associated with hamstring shortness and LBP. The purpose of this study was to investigate the effect of lifestyle and work setting on hamstring length and lumbar lordosis in subjects with and without LBP and to identify the relationship between hamstring muscles length and lumbar lordosis in individuals with different lifestyle and work setting. Material and Method: A total of 508 subjects between the ages of…20 and 65 were selected. Subjects were categorized into two groups of individuals with and without LBP. A questionnaire was used to obtain information about the subjects’ lifestyle and work setting. Hamstring muscle length and lumbar lordosis were measured in all subjects. Results: The results showed no significant difference in the number of subjects with different work setting or lifestyle in individuals with and without LBP. Hamstring muscle length or lumbar lordosis was not affected by type of work setting and lifestyle. Our data showed significant difference in hamstring length and no significant difference in lumbar lordosis between subjects with and without LBP in all categories. Lumbar lordosis was not different between individuals with and without hamstring tightness in normal and LBP subjects with different work setting and lifestyle. Conclusion: The findings of this study did not support the assumption that work setting and sedentary lifestyle would lead to hamstring tightness in subjects with LBP. It seems that work setting and lifestyle was not a contributing factor for hamstring tightness in subjects with LBP.
Keywords: Low back pain, hamstring, lumbar lordosis, work setting, lifestyle
Abstract: Background and Objectives: Lifting presents a significant risk for the development of low back pain. It is not known what effect lifting from a supermarket shopping trolley has on sagittal spinal curvature. The aim of this study is to determine the effect of lifting from a shopping trolley on sagittal spinal curvature. Methods: Fifteen female subjects (height 1.67 ± 0.04 m, weight 64.3 ± 5.0 kg) completed lifts of 9 kg from a shopping trolley and a surface matched for height whilst sagittal spinal curvature was measured using Qualysis motion analysis system. Seven retro-reflective markers were placed along…spine with angle between three markers representing regional curvature. No constraints on lifting technique were instigated. Results: Results demonstrate no difference in sagittal range of motion or spinal curvature across the two lifts. A small but significant difference in knee flexion angle was observed. These results demonstrate that the chosen lifting strategy was not influenced by the constraint imposed by the shopping trolley. Furthermore the function of knee flexion did not result in change in sagittal curvature during the lifts. Conclusion: Lifting from a shopping trolley has no effect of sagittal spinal curvature.
Keywords: Lifting, shopping trolley, curvature, range of motion, spine