Journal of Back and Musculoskeletal Rehabilitation - Volume 27, issue 2
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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: Scoliosis is the deviation in the normal vertical spine. Although there are numerous studies available about treatment approaches for scoliosis, the numbers of studies that talk about its etiology and pathology are limited. Objective: Aim of this study was to discuss the different types of scoliosis; its curves and etiological theories; and to note their implication on its treatment. Methods: We examined various electronic databases including Pub MED, Medline, Cinhal, Cochrane library and Google scholar using key words “scoliosis”, “etiology”, “pathology” and “conservative treatment”. References of obtained articles were also examined for cross references. The…search was limited to articles in English language. Results: A total of 145 papers, about Prevalence, History, Symptoms, classification, Biomechanics, Pathogenesis, Kinematics and Treatment of scoliosis were identified to be relevant. Conclusion: To choose the appropriate treatment approach for scoliosis we need to understand its etiology and pathogenesis first. Early intervention with conservative treatment like physiotherapy and bracing can prevent surgery.
Abstract: Background and Objectives: Measurement of the femoral cartilage thickness by using in-vivo musculoskeletal ultrasonography (MSUS) has been previously shown to be a valid and reliable method in previous studies; however, to our best notice, normative data has not been provided before in the healthy population.The aim of our study was to provide normative data regarding femoral cartilage thicknesses of healthy individuals with collaborative use of MSUS. Methods: This is across-sectional study run at Physical and Rehabilitation Medicine Departments of 18 Secondary and Tertiary Centers in Turkey. 1544 healthy volunteers (aged between 25–40 years) were recruited within the collaboration…of TURK-MUSCULUS (Turkish Musculoskeletal Ultrasonography Study Group). Subjects who had a body mass index value of less than 30 and who did not have signs and symptoms of any degenerative/inflammatory arthritis or other rheumatic diseases, history of knee trauma and previous knee surgery were enrolled. Ultrasonographic measurements were performed axially from the suprapatellar window by using linear probes while subjects’ knees were in maximum flexion. Three (mid-point) measurements were taken from both knees (lateral condyle, intercondylar area, medial condyle). Results: A total of 2876 knees (of 817 M, 621 F subjects) were taken into analysis after exclusion of inappropriate images. Mean cartilage thicknesses were significantly lower in females than males (all p< 0.001). Thickness values negatively correlated with age; negatively (females) and positively (males) correlated with smoking. Men who regularly exercised had thicker cartilage than who did not exercise (all p < 0.05). Increased age (in both sexes) and absence of exercise (males) were found to be risk factors for decreased cartilage thicknesses. Conclusion: Further data pertaining to other countries would be interesting to uncover whether ethnic differences also affect cartilage thickness. Collaborative use of MSUS seems to be promising in this regard.
Abstract: Vertebral hemangiomas (VHs) are common lesions in the adult population. They are usually asymptomatic and found incidentally on radiological imaging. New-onset back pain followed by subacute progression of thoracal myelopathy is the most common presentation in patients with neurological deficit. Differential diagnoses would include metastasis, multiple myeloma, lymphoma, Paget disease, osseous tumors such as Ewing sarcoma or hemangioblastoma and blood dyscrasia. We present a 41 year-old-male patient with thoracal VH causing myelopathy that completely improved after rehabilitation program with embolization and vertebroplasty procedures.
Abstract: Background: There are different methods to assess forward head posture (FHP) but the accuracy and discrimination ability of these methods are not clear. Objectives: Here, we want to compare three postural angles for FHP assessment and also study the discrimination accuracy of three photogrammetric methods to differentiate groups categorized based on observational method. Method: All Seventy-eight healthy female participants (23 ± 2.63 years), were classified into three groups: moderate-severe FHP, slight FHP and non FHP based on observational postural assessment rules. Applying three photogrammetric methods – craniovertebral angle, head title angle and head position…angle – to measure FHP objectively. Results: One – way ANOVA test showed a significant difference in three categorized group's craniovertebral angle (P< 0.05, F=83.07). There was no dramatic difference in head tilt angle and head position angle methods in three groups. According to Linear Discriminate Analysis (LDA) results, the canonical discriminant function (Wilks'Lambda) was 0.311 for craniovertebral angle with 79.5% of cross-validated grouped cases correctly classified. Conclusion: Our results showed that, craniovertebral angle method may discriminate the females with moderate-severe and non FHP more accurate than head position angle and head tilt angle. The photogrammetric method had excellent inter and intra rater reliability to assess the head and cervical posture.
Keywords: Observational assessment, photogrammetry, forward head posture
Abstract: Although current research findings suggest that postural control or static balance is impaired in subjects with low back pain, few studies have specifically addressed the effect of low back pain on static balance in elite athletes. Forty-four athletes belonging to Chilean national teams took part in this study; 20 had low back pain and the remaining 24 were healthy controls. Displacement of the centre of pressure was analyzed by computerized platform posturography, using a standardized protocol; subjects were required to stand upright on both feet, with eyes first open then closed. The results showed that, athletes with low back pain…used significantly more energy (p< 0.0182) and had a greater displacement of the centre of pressure (p< 0.005) with open eyes to control posture than healthy athletes. It may be concluded that static balance is impaired in elite athletes with low back pain and that analysis of two-footed stance provides a sensitive assessment of static balance in athletes.
Keywords: postural control, balance, posturography, stabilometry, low back pain
Abstract: Background and Objectives: Osteitis pubis refers to a painful, inflammatory condition involving the pubic bones, pubic symphysis, and adjacent structures. So, the aims of the study were to evaluate the strength of trunk muscles of soccer players suffering from osteitis pubis, and to compare the agonist/antagonist ratio of trunk muscles in osteitis pubis athletes with that of healthy athletes. Materials and Methods: Twenty-five soccer male athletes with osteitis pubis, and 25 healthy soccer athletes. Peak torque/body weight (PT/BW) was recorded from trunk muscles during isokinetic concentric and eccentric contraction modes at a speed of 120°/s for healthy and…osteitis pubis soccer players. Results: There was a significant decrease in concentric contraction of back muscles in osteitis pubis group (p=0.01). A significant decrease in eccentric contraction of abdominal muscles was also recorded in osteitis pubis group (p=0.008). Concentric abdominal/back muscles ratio was significantly higher in osteitis pubis group (p=0.016), with no significant difference in eccentric abdominal/back muscles ratio between both groups (p>0.05). Conclusion: Osteitis pubis group displayed concentric weakness of back muscle and eccentric weakness of abdominal muscles that lead to disturbance of the normal concentric abdominal/back ratio.
Keywords: Osteitis pubis, isokinetic, trunk muscles, ratio
Abstract: Background and Objective: Poor back endurance is a predictor of low back pain. Few studies have investigated back muscle fatigue in older people. The purpose of this study was to compare the back muscle fatigue by endurance time and perceived effort between young and older adults during dynamic exercise. Method: Sixteen older and 16 young adults, all healthy, participated in this study. The subjects performed a fatiguing trunk extension-flexion exercise on a Roman chair until exhaustion. Endurance time and perceived muscle fatigue (Borg CR-10 scale) were used as fatigue criteria. Results: The older adults were significantly…(T ( 30 ) = − 2 , 073 ; p = 0.039 ) more resistant to back muscle fatigue (time in mean 133 ± 52 s) than the young adults (mean 97 ± 27 s). In general, both groups had the same perception of high-level fatigue during the exercise bout (T ( 29 ) = 1.73 ; p = 0.092 ). Conclusion: The older adults presented better back endurance than young adults during a dynamic trunk extension exercise. These results have implications for back endurance in the primary prevention of low back pain in both young and older adults.
Keywords: Exercise, endurance, low back pain, aging, back muscles, rehabilitation
Abstract: Background: Evaluation of range of motion (ROM) is integral part of assessment of musculoskeletal system. This is required in health fitness and pathological conditions; also it is used as an objective outcome measure. Several methods are described to check spinal flexion range of motion. Different methods for measuring spine ranges have their advantages and disadvantages. Hence, a new device was introduced in this study using the method of dual inclinometer to measure lumbar spine flexion range of motion (ROM). Objectives: To determine Intra and Inter-rater reliability of mobile device goniometer in measuring lumbar flexion range of motion.…Method: iPod mobile device with goniometer software was used. The part being measure i.e the back of the subject was suitably exposed. Subject was standing with feet shoulder width apart. Spinous process of second sacral vertebra S2 and T12 were located, these were used as the reference points and readings were taken. Three readings were taken for each: inter-rater reliability as well as the intra-rater reliability. Sufficient rest was given between each flexion movement. Results: Intra-rater reliability using ICC was r=0.920 and inter-rater r=0.812 at CI 95%. Validity r=0.95. Conclusion: Mobile device goniometer has high intra-rater reliability. The inter-rater reliability was moderate. This device can be used to assess range of motion of spine flexion, representing uni-planar movement.
Keywords: Reliability, mobile device, iTune goniometer, range of motion
Abstract: Background: Cervical disc herniation (CDH) is the most common cause of cervical radiculopathy and could overlap with fibromyalgia (FM). Objective: The primary aim of the present study was to investigate the prevalences of FM and widespread pain in patients with cervical radiculopathy diagnosed as CDH in a cross-sectional study. The secondary aim was to analyze the localization of tender points (TPs) and associated symptoms in these patients comparing patients with FM. Methods: Fifty-two patients with cervical radiculopathy who carried the diagnosis of CDH and 51 patients with FM included to the study. The patients were questioned…for the distribution and the duration of pain and for a group of symptoms related to FM such as headache, fatigue with a two-point scale (0 “no”, 1 “yes”). The diagnosis of CDH was made with patients’ clinical evaluation and radiological findings with Magnetic Resonans Imaging Study. FM was diagnosed using the American College of Rheumatology criteria. Widespread pain was defined as all of the following parameters were present: pain in the left side of the body; pain in the right side of the body; pain above the waist; pain below the waist; axial skeletal pain; and duration of pain for more than 3 months. The number of TPs were counted by digital palpation. Results: Six female patients (11.5%) with CDH fulfilled the ACR 1990 criteria for FM. Of the patients with CDH 71.8% of TPs were located around the neck and shoulder regions, while 58.7% of TPs of the patients with FM were located around these regions. There were statistically significant differences between the patients with CDH and the patients with FM in terms of the duration of widespread pain, the number of TPs and the localization of TPs (p< 0.05). Conclusions: The prevalences of FM and widespread pain in patients with CDH were found as 11.5% and 78.8% respectively.
Abstract: Background and Objective: The Biering-Sorensen Test (BST) is a useful and well validated assessment tool in patients with chronic lumbar pain. However there is sometimes concern that it may lead to an unwarranted increase in pain. This study compared pain levels before and after the BST against a currently accepted functional assessment tool – the modified 20-metre shuttle test (MST) – in military patients with chronic low back pain. Methods: 56 patients with non-specific lumbar pain of more than three months duration were tested on admission and discharge from a three week in-patient rehabilitation programme using the BST…and the MST. A questionnaire was used to assess pain levels before and after both tests on admission and discharge from the group. The BST was carried out before the MST, with a time delay of 30–60 minutes. Results: There were significant increases in pain immediately after both the MST and the BST (range of mean increase: 2.2 to 3.2 points, p< 0.001). The mean absolute levels of pain after the BST on admission and discharge were 0.26 and 0.80 more than the levels after the MST. The mean increases were 0.36 and 1.16 more after the BST compared to that after the MST. Pain levels returned to normal within 60 minutes of the BST being completed. Conclusion: Using either comparison method, although the initial increases after the BST were slightly more, the amounts were comparable and much less that the minimal clinically important difference in pain which is 1.5.
Keywords: Biering-Sorensen, low back pain, validity, multi-stage test