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: Spinal epidural lipomatosis (SEL) can cause radicular pain due to spinal nerve root impingement. While SEL decompression surgery can provide symptom relief, these patients are often poor surgical candidates due to elevated BMI or immunosuppression. Transforaminal epidural steroid injection (TFESI) has been attempted as an alternative treatment for patients with SEL who are unable to tolerate conservative medical treatment. To date, only two such cases have been reported in the literature. Objectives: We report three additional cases of radicular pain associated with SEL, review the current literature on this condition, and describe the risks and benefits of…using TFESI to treat radicular pain due to SEL. Methods: We measured changes on the pain visual analogue scale (VAS) and pain disability index (PDI) from presentation to 1–5 weeks after treatment with sequential TFESIs. Results: Pain VAS scores improved by 50–75% and PDI scores improved 13–44 points. Conclusions: This case series suggests that TFESI can provide modest short-term symptom relief of lumbosacral radicular pain and improvement in disability caused by SEL. Further study of non-operative management of SEL is warranted, given the high risk associated with surgery in this population.
Abstract: Background and Objective: This study aimed to investigate the effects of thermal agents on electrical sensory threshold and current tolerance when applied prior to neuromuscular electrical stimulation. Methods: In this single-blind and cross-over trial, electrical sensory threshold and current tolerance of 24 healthy volunteers were evaluated by using biphasic symmetrical pulses (240 μsec, 50 pps), before and after thermal agent (cold pack, hot pack and ultrasound) applications. Results: Electrical sensory threshold increased after cold-pack, and current tolerance reduced after hot-pack applications (p< 0.05). Inter-agent comparisons of pre and post-application differences of the investigated parameters revealed that…the most obvious effects were caused by application of hot pack. Conclusions: Hot pack application prior to neuromuscular electrical stimulation (NMES) may reduce current tolerance and limit to reach the desired current intensity for strengthening the electrically induced contractions. Results are considered to be valuable for physiotherapists, who apply thermal agents and NMES consecutively, in their treatment programs.
Abstract: Background: Pulse frequency is one of the key determinants of analgesic outcomes by transcutaneous electrical nerve stimulation (TENS). However, optimal settings remain unclear. Objective: To compare the effects of different frequencies of TENS, on pressure pain threshold and tolerance. Methods: Currents with pulse duration of 110 μs, and pulse frequencies of 60 pps or 150 pps were applied on the volar aspects of the dominant forearms of 20 healthy volunteers, on two consecutive days, in a randomized order. Threshold and tolerance were measured at the beginning, after the 15th and 30th minutes of the applications, and…30 minutes after the applications. Results: Pressure pain threshold and tolerance values were higher at the 150 pps frequency, at all measurement times (p< 0.05). However, no frequencyXtime interaction and time-dependent changes were found for the outcome measures (p> 0.05). Conclusions: These findings established that, at 150 pps conventional TENS, threshold and tolerance values were consistently higher. These results are presented to inform future research regarding optimal conventional TENS parameters and to provide support for clinical applications.
Abstract: Background: Muscle fatigue of the trunk extensor musculature plays a considerable role in chronic low back pain (LBP). The underlying physiology of fatigue is complex and not fully understood. The Kinesio® Taping (KT) supports damaged structures while allowing mobility and at the same time may influence some of the mechanisms associated with muscle fatigue such as blood flow and proprioception. Objective: The aim of this study is to determine the influence of KT on the resistance to fatigue of the lumbar extensor musculature in a sample of young healthy subjects. Methods: A randomized, controlled, doubled-blinded clinical…trial was conducted. Ninety nine healthy subjects were randomized in to the three arms of the study Kinesio® Tape (KT), placebo (P) and control (C). Directly after application of KT we measured lumbar extensor musculature endurance with the Biering-Sorensen test. Subjects and researchers were blinded to the intervention. Time achieved (seconds) was compared between groups with one-way ANOVA with confidence intervals of 95%. Results: There were significant differences between the time achieved in the KT group versus the control group (p < 0.05). The placebo group performed better than the control group but worse than the KT group, these were not significant in either case. Conclusions: KT appears to improve the time to failure of the extensor muscle of the trunk obtained using the Biering-Sorensen test. These findings suggest that KT influences processes that lead to muscle fatigue and that KT could be effective in the management of LBP.
Abstract: Objectives: Fear of pain or re-injury and avoidance attitudes have a great impact on maintenance of chronic low back pain (CLBP) and disability. Fear-Avoidance Beliefs Questionnaire (FABQ) is developed to assess these psychosocial factors. The aim of this study was to provide a translated and validated version of the FABQ for Persian speaking population. Methods: Forward and backward translation techniques were carried out for translation and cultural adaptation of the questionnaire into Persian. Internal consistency and test-retest reliability were used to assess the reliability of the Persian questionnaire. Construct validity of the scale was assessed by divergent validity…(using Spearman correlation coefficient) and exploratory factor analysis. Principle component analysis with varimax rotation method was applied for assessment of factor analysis. Results: The test-retest reliability was excellent with the Intra-class Correlation (ICC) value of 0.802 and 0.808 for the physical activity and work subscales of the questionnaire, respectively. The Chronbach’s alpha coefficient value of 0.89, demonstrated adequate internal consistency of the questionnaire. Factor analysis revealed two factors which could explain 57.9% of the total variance. Items 7, 10 and 11 of the questionnaire were used in both major factors of the final Persian version. Regarding the divergent validity of the questionnaire, data demonstrated no correlation (r< 0.3) between factor 2 (which is about physical activity) and measured clinical variables (pain intensity and level of dysfunction), while factor 1 (which is about work) was fairly correlated with both pain intensity and disability level of the subjects. Conclusion: The provided Persian version of FABQ is a reliable and valid measurement and further research into its use as a diagnostic and prognostic tool is warranted. Development of this questionnaire will be useful for comparability between Persian and English language studies and facilitates an international collaboration in this field.
Keywords: Low back pain, questionnaire, validation, fear avoidance belief
Abstract: Background: There is no clear picture of pathoanatomy in clinically diagnosed LSS. Findings in the literature regarding imaging in LSS are heterogeneous. Objective: Characterize the pathoanatomy of LSS, as reported in the radiology reports, for a large community-based sample of patients with the clinical diagnosis of LSS. Methods: Retrospective review of clinical radiology reports. The sample comprised patients 40 years of age or older, with clinically diagnosed LSS. Radiology reports for lumbar MRI were obtained and data were extracted pertaining to the type and location of LSS. Results: 173 subjects with a mean age…of 66.2 ± 11.7 years were included (61% women). 68.2% had mixed stenosis, 19.1% had central stenosis only, and 12.7% had lateral stenosis only. By level, the most prevalent findings were at L4/5 (93%), L3/4 (66%) and L5/S1 (49%). This pattern was different in those with lateral stenosis only, where the proportion of findings at L5/S1 was higher than at L3/4. 156 subjects (90.2%) had findings of at least moderate severity. Considering moderate-severe findings only, 31% had mixed stenosis and 40.0% had multi-level findings (90.5% at adjacent segments). When mild findings were included for subjects with at least one moderate-severe finding the rate of mixed stenosis increased to 59%, and multi-level stenosis to 68.6%. The most common multi-level combinations were L3/4 and L4/5 for two-level stenosis and L2/3 through L4/5 for three-level. Conclusion: Results of this study confirm a number of pathoanatomical patterns in people diagnosed with LSS, including a high proportion of stenosis at L4/5, followed by L3/4 and L5/S1. Results also suggest a high prevalence of multi-level stenosis at adjacent segments. The prevalence of mixed stenosis varied from 31% to 68.2%; inclusion of mild findings resulted in a higher rate of both mixed and multi-level stenosis, compared to analysis of moderate-severe findings only. These results may guide future studies on LSS pathophysiology, by focusing attention toward the most prevalent radiological findings.
Keywords: Spinal stenosis, anatomy, magnetic resonance imaging
Abstract: Background Data: In patients with chronic low back pain, the center of gravity (COG) is abnormally located posterior to the center in most cases. Objective: The purpose of this study was to examine the effects of posterior-located COG on the functions (lumbar extension strength, and static and dynamic balance) and structure (lumbar lordosis angle and lumbosacral angle) of the lumbar spine. Material and Methods: In this study, the COG of chronic low back pain patients who complained of only low back pain were examined using dynamic body balance equipment. A total of 164 subjects participated in…the study (74 males and 90 females), and they were divided into two groups of 82 patients each. One group (n=82) consisted of patients whose COG was located at the center (C-COG); the other group (n=82) consisted of patients whose COG was located posterior to the center (P-COG). The following measures assessed the lumber functions and structures of the two groups: lumbar extension strength, moving speed of static and dynamic COGs, movement distance of the static and dynamic COGs, lumbar lordosis angle, and lumbosacral angle. The measured values were analyzed using independent t-tests. Results: The group of patients with P-COG showed more decreases in lumbar extension strength, lumbar lordosis angle, and lumbosacral angle compared to the group of patients with C-COG. Also this group showed increases in moving speed and movement distance of the static COG. However, there were no differences in moving speed and movement distance of the dynamic COG between the two groups. Conclusions: These findings suggest that chronic LBP patients with P-COG have some disadvantages to establish lumbar extension strength and static and dynamic balance, which require specific efforts to maintain a neutral position and to control posture.
Keywords: Balance, low back pain, lumbopelvic neutralization
Abstract: Background: Tuberculosis of the musculoskeletal system is not a common clinical condition; however, multifocal bone involvement is even rarer and difficult to recognize. Case: In this paper, we presented a patient who developed paraplegia 15 days before his hospital admission. He was operated by neurosurgeons due to spinal mass, but postoperative examination revealed vertebral and multifocal skeletal tuberculosis. It is difficult to diagnose this condition by conventional imaging methods. The importance of positron emission tomography (PET) in the diagnosis of skeletal tuberculosis was emphasized. Result: The importance of rehabilitation program in restoring functionality was overviewed in…the light of current literature. Vertebral and osteoarticular tuberculosis should be considered in patients with vertebral and thoracic mass presenting with neurological deficits.