Journal of Back and Musculoskeletal Rehabilitation - Volume 27, issue 3
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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 and Objective: Frozen shoulder is a common condition, yet its treatment remains challenging. In this review, the current best evidence for the use of physical therapy interventions (PTI) is evaluated. Method: MEDLINE, CINAHL, Cochrane, PEDro, ProQuest, Science Direct, and Sport Discus were searched for studies published in English since 2000. Results: 39 articles describing the PTI were analyzed using Sackett’s levels of evidence and were examined for scientific rigor. The PTI were given grades of recommendation that ranged from A to C. Conclusions: Therapeutic exercises and mobilization are strongly recommended for reducing pain,…improving range of motion (ROM) and function in patients with stages 2 and 3 of frozen shoulder. Low-level laser therapy is strongly suggested for pain relief and moderately suggested for improving function but not recommended for improving ROM. Corticosteroid injections can be used for stage 1 frozen shoulder. Acupuncture with therapeutic exercises is moderately recommended for pain relief, improving ROM and function. Electro- therapy can help in providing short-term pain relief. Continuous passive motion is recommended for short-term pain relief but not for improving ROM or function. Deep heat can be used for pain relief and improving ROM. Ultrasound for pain relief, improving ROM or function is not recommended.
Keywords: Mobilization, therapeutic exercises, pain, range of motion, function
Abstract: Background: Stump neuroma is a major cause of postamputation pain. Ultrasound is a practical way of imaging stump neuromas and can be employed for guiding therapeutic injections. Objective: The aim of this pilot study was to investigate the effectiveness of ultrasound-guided steroid injection in the treatment of stump neuroma. Methods: The amputee patients with stump neuroma who underwent a single ultrasound guided steroid injection in amputee rehabilitation unit of our hospital were reviewed. The pain logs employing a 11-point pain scale for each evaluation time (before the procedure, one day, one week, 2 weeks,…4 weeks, 6 weeks after procedure) and a subsequent phone call approximately six months after procedure were used as the source of information in the study. Mean changes in pain levels (pain in rest and pain with prosthesis) over time were evaluated. The patients that had 50% decrease in pain scores were regarded as having treated successfully. Time after amputation and duration of pain symptom were compared between successfully (Group A) and unsuccessfully (Group B) treated patients. Results: All patients (mean age, 29.7 ± 5.5 year) in the study were male (n=14). 12 patients were transtibial amputee (85.7%) and 2 patients were transfemoral amputee (14.3%). Both mean pain scores improved significantly in repeated measures (pain in rest F=25.35, p< 0.01; pain with prosthesis F=81,45, p <0,01). A total of 7 patients (50%) were regarded as having treated successfully. Time after amputation and duration of pain symptom were significantly longer in Group B. (p< 0.05, Group A: 16.8 ± 14.3 months after amputation, 3.5 ± 4.1 months pain duration; Group B: 80.2 ± 74.2 months after amputation, 52.8 ± 57.6 months pain duration). Conclusions: Steroid injection may have positive effect in the treatment of postamputation neuroma. The patients with shorter pain and amputation duration may respond well to the injection.
Abstract: Background: There is little knowledge in the literature on the role of time-related variables for the prognosis of acute and subacute low back pain (LBP). Objective: The aim of this study was to estimate the relationship between time-related LBP characteristics and prognostic factors for acute/subacute LBP. Methods: We performed a prospective inception cohort study of 315 patients attending a health practitioner for acute/subacute LBP or recurrent LBP. One-tailed correlations were conducted between patient characteristics and time-related variables. Results: The pattern of correlation between risk factors for and resources against persistent LBP differed between three…time-related variables. ‘Subacute LBP’ and ‘delayed presentation’ were positively associated with psychological factors. Both indicators were negatively correlated with resources against development of persistent LBP. Moreover, ‘delayed presentation’ was related positively with occupational stressors. In contrast, ‘recurrent LBP’ was only related to more impaired health-related factors. Conclusions: Patients with current LBP waiting longer until seeking help in primary care have a more disadvantageous profile of occupational and psychological risk factors and lower resource levels. A similar but less pronounced pattern occurred in those with subacute LBP compared to those with acute LBP. Consideration of time characteristics of LBP may help to better understand LBP.
Keywords: Back pain, prognosis, risk factors, resources, occupational, inception cohort
Abstract: Background: Muscular endurance of the back extensors is less frequently assessed than muscular strength, although the endurance capabilities of these muscles may be as important as the strength in the prevention and treatment of low-back pain. Objectives: The study aimed to establish reference values, pattern of back extensor endurance and the relationship between isometric endurance of back extensor muscles and selected anthropometric indices, in apparently healthy young Nigerian adults. Method: A total of 300 young adults (150 males and 150 females) aged 17–30 years, participated in this Cross sectional study. The modified Biering-Sorensen test…of Static Muscular Endurance (BSME) was used to assess isometric endurance of back extensor muscles. A height meter, bathroom weighing scale and flexible tape were used to collect data for the anthropometric indices-Body Mass Index (BMI), Height (H), Weight (W), Waist Circumference (WC), Hip Circumference (HC), Waist-to-Hip Ratio (WHR), Waist-to-Height Ratio (WHtR). Data obtained was Summarised using descriptive statistics of frequency, percentages, percentile, range, mean and standard deviation, and while the Pearson Product Moment Correlation was used to ascertain relationship. Alpha level was set at 0.05. Results: Mean Endurance Time (ET) for all the participants was 97.56 ± 43.96 secs. ET was inversely related to anthropometric indices- BMI, Height, Weight, WC,HC, WHR, WHtR. Males had higher maximum ET than females (288 secs and 254 secs). Gender differences was found in the anthropometric indices- BMI, WHR, WC, Weight and Height. Majority of the participants had medium endurance performance with the back endurance pattern in the ratio 1:2:1. Conclusion: The mean isometric back extensor endurance of apparently healthy young Nigerian adults was found to be lower than normal Biering-Sorensen holding times.
Keywords: Biering-Sorensen holding time, back extensor muscles', endurance, mean endurance time, anthropometric indices
Abstract: Objective: To compare the strength of hip muscle groups in sedentary women with bilateral patellofemoral pain syndrome (PFPS) with a matched control group of sedentary women without PFPS. Methods: Twenty four women between 19 and 23 years of age (PFPS group, n=12; control group, n=12) participated in this study. Strength for all 6 hip muscle groups was measured bilaterally in all subjects using a stabilized Hand-held dynamometer. Results: The hip musculature of sedentary women with bilateral PFPS was statistically weaker (range 31%–52%; p< 0.001) than that of the control group for all muscle groups.…Conclusion: This study demonstrated a statistically significant weakness of hip muscle groups in sedentary women with PFPS.
Abstract: Backgrounds and Objectives: Hemophilic arthropathy due to recurrent joint bleeding leads to physical, psychological and socioeconomic problems in children with hemophilia and reduces their quality of life. The purpose of this study was to evaluate joint damage through various parameters and to determine functional deterioration in the musculoskeletal system during walking using kinetic and kinematic gait analysis. Material and Method: Physical examination and kinetic and kinematic gait analysis findings of 19 hemophilic patients aged 7–20 years were compared with those of age, sex and leg length matched controls. Results: Stride time was longer in the hemophilia…group (p=0.001) compared to the age matched healthy control group, while hip, knee and ankle joint rotation angles were more limited (p=0.001, p=0.035 and p=0.001, respectively). In the hemophilia group, the extensor moment of the knee joint in the stance phase was less than that in the control group (p=0.001). Stride time was longer in the severe hemophilia group compared to the mild-moderate hemophilia and control groups (p=0.011 and p=0.001, respectively). Rotation angle of the ankle was wider in the control group compared to the other two groups (p=0.001 for both). Rotation angle of the ankle joint was narrower in the severe hemophilia group compared to the others (p=0.001 for each). Extensor moment of the knee joint was greater in the control group compared to the other two groups (p=0.003 and p=0.001, respectively). Walking velocity was higher in the control group compared to the severe hemophilia group. Conclusion: Kinetic and kinematic gait analysis has the sensitivity to detect minimal changes in biomechanical parameters. Gait analysis can be used as a reliable method to detect early joint damage.
Abstract: Objective: The aim of this study was to compare the effectiveness of low-level laser therapy and ultrasound therapy in the treatment of subacromial impingement syndrome. Materials and Methods: Thirty one patients with subacromial impingement syndrome were randomly assigned to low-level laser therapy group (n=16) and ultrasound therapy group (n=15). Study participants received 10 treatment sessions of low-level laser therapy or ultrasound therapy over a period of two-consecutive weeks (five days per week). Outcome measures (visual analogue pain scale, Shoulder Pain and Disability Index -SPADI-, patient's satisfactory level and sleep interference score) were assessed before treatment and at…the 1st and 3rd months after treatment. All patients were analyzed by the intent-to-treat principle. Results: Mean reduction in VAS pain, SPADI disability and sleep interference scores from baseline to after 1 month, and 3 months of treatment was statistically significant in both groups (P< 0.05). However, there was no significant difference in the mean change in VAS pain, SPADI disability and sleep interference scores between the two groups (P > 0.05). The mean level of patient satisfaction in group 1 at the first and third months after treatment was 72.45 ± 23.45 mm and 71.50 ± 16.54 mm, respectively. The mean level of patient satisfaction in group 2 at the first and third months after treatment was 70.38 ± 21.52 mm and 72.09 ± 13.42 mm, respectively. There was no significant difference in the mean level of patient satisfaction between the two groups (p > 0.05). Conclusions: The results suggest that efficacy of both treatments were comparable to each other in regarding reducing pain severity and functional disability in patients with subacromial impingement syndrome. Based on our findings, we conclude that low-level laser therapy may be considered as an effective alternative to ultrasound based therapy in patients with subacromial impingement syndrome especially ultrasound based therapy is contraindicated.
Keywords: Low energy laser, subacromial impingement syndrome, ultrasound treatment, disability
Abstract: Background and Objectives: Wrestling includes a variety of functional properties: muscular strength, flexibility, neuromuscular coordination, and static and dynamic balance. The aim of the study was to identify differences in the strength, flexibility, postural stability and core stabilization of young national and international wrestlers in different weight groups. Material and Method: Eighty-one male wrestlers (17–21 years old) were divided into 6 groups according to their body mass (light, middle and heavy) and wrestling style. The lumbosacral flexion, extension and lateral flexion range of motion, hamstring extensibility, back and leg muscle strength, postural stability, and core stabilization were assessed.…Results: Greco-Roman wrestlers had a higher lean body mass (6–12%) compared with freestyle wrestlers. However, the trunk lateral flexion flexibility was better in the Greco-Roman wrestlers (6–7%) than in the freestyle wrestlers, and the absolute back strength (BS) and leg strength (LS) were similar for both styles of wrestling. The BS/LBM and LS/LBM in the freestyle wrestlers were greater than in the Greco-Roman wrestlers, and the Light weight Greco-Roman wrestlers had the highest BS/LBM. The heavy weight Greco-Roman wrestlers and the light weight freestyle wrestlers had the greatest LS/LBM values. The postural control was similar for the two styles of wrestlers; however, the heavy weight Greco-Roman wrestlers had greater postural control in all directions compared with the light and middle weight Greco-Roman wrestlers. The core stabilization did not differ for the Greco-Roman and freestyle wrestlers except in the lateral bridge. Conclusion: The style of wrestling demonstrates different strength, flexibility and stability demands on the body. The differences between Greco-Roman and freestyle wrestlers may be due to the wrestling style differences in training and to competition-related demands. Level of Evidence: Comparative study, level lV (case series).
Abstract: Objective: To compare the therapeutic effects of a 3-dimensional corrective spinal technique (CST) and a conventional exercise program (CE) on altered spinal curvature and health related quality-of-life in patients with adolescent idiopathic scoliosis (AIS). Methods: Adolescents with idiopathic scoliosis (N=32, 6 males and 26 females) between 10 and 19 years of age (14.34 ± 2.60 years) were recruited and underwent the CST or CE for 60 minutes/day, 2–3 times a week, and an average of total 30 sessions. Diagnostic X-ray imaging technique was used to determine intervention-related changes in the Cobb angle, thoracic kyphosis angle, lumbar lordosis…angle, sacral slope, pelvic tilt, pelvic incidence, and vertebral rotation (Nash-Moe method). The Scoliosis Research Society-22 (SRS-22) health related quality-of-life questionnaire was used. Data were analysed using independent t-test, paired t-test, and non-parametric Mann-Whitney U-test at p < 0.05. Results: CST showed greater improvements in Cobb angle (p=0.003), vertebral rotation (p=0.000), and SRS-22 scores (self-image and treatment satisfaction subscale scores and total score, p=0.026, p=0.039, and p=0.041, respectively) as compared to the controls. There were no significant changes in the other measures between the two groups. Conclusions: This is the first clinical trial to investigate the effects of the 3-dimensional CST on spinal curvatures and health related quality-of-life in AIS, providing the important clinical rationale and compelling evidence for the effective management of AIS.
Abstract: Background: Synergistic co-activation of the abdominal and pelvic floor muscles (PFM) has been shown in literature. Some studies have assessed the reliability of ultrasound measures of the abdominal muscles. Objective: The aim of this study was to determine the reliability of ultrasound measurements of transverses abdominis (TrA) and obliquus internus (OI) muscles during different conditions (PFM contraction, abdominal hollowing manoeuvre (AHM) with and without PFM contraction) in participants with and without chronic low back pain (LBP). Methods: 21 participants (9 with LBP, 12 healthy) participated in the study. The reliability of thickness measurements at rest and…during each condition and thickness changes and percentage of this changes at different conditions were assessed. Results: The results showed high reliability of the thickness measurement at rest and during each condition of TrA and OI muscles, moderate to substantial reliability for the thickness change and percentage of thickness change of TrA, and fair to moderate reliability of the thickness change and percentage of thickness change of OI in both groups. Conclusions: Ultrasound imaging can be used as a reliable method for assessment of abdominal muscle activity with and without PFM contraction.
Keywords: Low back pain, pelvic floor muscles, abdominal muscles, reliability