Journal of Back and Musculoskeletal Rehabilitation - Volume 27, 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: Although the antinociceptive effect of high-velocity, low amplitude thrust manipulation (HVLAM) has been recognized by numerous systematic reviews, the underlying mechanism for manipulation-related pain relief remains poorly understood. An increasing number of studies have explored its analgesic mechanism suggesting that the excitation of the descending inhibitory pain mechanism (DIPM) might play the most important role for musculoskeletal pain relief. Objective: The objective of this review is to investigate the role of the DIPM in musculoskeletal pain following HVLAM as well as to identify the pain-relieving importance of this technique within clinical practice. Methodology: English literature…databases were searched to find studies related to the objective of the present review. Results and Conclusions: Findings from current literature support that HVLAM has a profound influence on nociceptive stimulus via the possible activation of the DIPM. It seems that the application of this technique activates the periaqueductal gray region area of the midbrain, stimulates the noradrenergic descending system and at the level of the spinal cord, the nociceptive afferent barrage is reduced and mechanical hypoalgesia is induced. However, the literature on HVLAM induced-analgesia is still problematic regarding the methodological design of the existing research. Despite these limitations, the clinical importance of the activation of the DIPM should not be ignored since the resulted analgesic effect of this technique can provide a window of opportunity to restore impaired physical performance and disability.
Abstract: Objectives: To summarize the current knowledge relating to diagnosing and treating Scheuermann’s disease. Scheuermann’s disease is the most common cause of structural kyphosis in adolescence. Methods: A literature-based narrative review of English language medical literature. Results and Conclusions: Recent studies have revealed a major genetic contribution (a dominant autosomal inheritance pattern with high penetrance and variable expressivity) to the etiology of Scheuermann kyphosis with a smaller environmental component (most probably mechanical factors). The natural history of Scheuermann kyphosis remains controversial, with conflicting reports as to the severity of pain and physical disability. Since we cannot predict…which kyphotic curves will progress, we are unable to determine effectiveness of brace treatment. Physical therapy is scarcely mentioned in the literature as an effective treatment for Scheuermann kyphosis. Although there is little evidence that physical therapy alone can alter the natural history of Scheuermann’s disease, it is often used as the first choice of treatment. Brace treatment appears to be more effective if an early diagnosis is made, prior to the curvature angle exceeding 50° in patients continuing to grow. Surgical treatment is rarely indicated for severe kyphosis (>75°) with curve progression, refractory pain, or a neurologic deficit. Rigorous methodology clinical trials are essential to evaluate the efficacy of conservative interventions, especially different exercises and manual therapies and their combinations with braces.
Abstract: Purpose: To compare responsiveness Short Form-36 (SF-36), Nottingham Health Profile (NHP), and QUALEFFO-41 scales in patients diagnosed with osteoporosis. Methods: A number of 70 osteoporosis patients who were in their menopause period at least for three years were enrolled in our study. The patients completed Short Form-36 (SF-36), Nottingham Health Profile (NHP), and QUALEFFO-41 scales during pretreatment period and one year after the termination of the treatment. Reponsiveness was compared between questionnaires using standardized responsiveness mean (SRM), the effect size (ES), and Guyatt’s method. Results: All scales revealed statistically significant improvement after the treatment. Upon this…finding, calculations related with responsiveness indices for SF-36 (Physical Health and Mental Health), NHP (Total point), and QUALEFFO-41 (Total point) demonstrated highly responsive. ES=1.67 and 1.55, SRM=1.55 and 1.85, Guyatt value=2.20 and 1.91 for SF-36 Physical Health and Mental Health. ES=1.35, SRM=1.35, Guyatt value=1.72 for NHP. QUALEFFO-41’s ES=2.56, SRM=4.32 and Guyatt value=2.31. Conclusion: Osteoporosis specific scale as QUALEFFO-41, gives more specific information about the quality of life of osteoporotic patients. If patients with osteoporosis will be compared with other diseases regarding quality of life, then SF-36, one scale was used to evaluate general quality life of such patients, should be preferred against NHP.
Keywords: Osteoporosis, Short Form-36, Nottingham Health Profile, QUALEFFO-41, quality of life scales
Abstract: Background and Objective: Despite the widespread use of trunk endurance tests, the reliability and validity of these tests in office workers with subacute nonspecific low back pain are unknown. Materials and Methods: This cross-sectional study involved 190 subjects: 30 men and 42 women without low back pain and 47 men and 71 women with low back pain. All subjects underwent timed prone and supine isometric lumbar and abdominal trunk endurance tests that were performed until subjective fatigue occurred. All subjects also completed the Roland Morris and Oswestry self-reported disability questionnaires. A test-retest study (7 days) was conducted with…31 participants with low back pain from the study. Results: For the abdominal trunk endurance test, males and females with low back pain had mean (SD) values of 62.06 (36.87) and 46.06 (29.28) seconds, respectively, both significantly lower than the asymptomatic workers. For the lumbar test, males and females with low back pain had mean (SD) values of 79.57 (30.66) and 75.49 (28.97) seconds, respectively, again, both significantly lower than the asymptomatic workers. The intraclass correlation coefficients of both tests exceeded 0.90 and the Kappa indices were excellent for both men and women. Receiver-operating curve analyses revealed areas under the curve very close to or exceeding 0.70 for both men and women for both tests. Conclusions: The lumbar and abdominal trunk muscle endurance tests appeared to be reliable and valid measures in office workers with subacute low back pain.
Keywords: Backache, lower back pain, occupational assessment, monitoring
Abstract: Background: Leg pain is associated with back pain in 25–65% of all cases and classified as somatic referred pain or radicular pain. However, distinction between the two may be difficult as different pathomechanisms may cause similar patterns of pain. Therefore a pathomechanism based classification system was proposed, with four distinct hierarchical and mutually exclusive categories: Neuropathic Sensitization (NS) comprising major features of neuropathic pain with sensory sensitization; Denervation (D) arising from significant axonal compromise; Peripheral Nerve Sensitization (PNS) with marked nerve trunk mechanosensitivity; and Musculoskeletal (M) with pain referred from musculoskeletal structures. Objective: To investigate construct validity of…the classification system. Methods: Construct validity was investigated by determining the relationship of nerve functioning with subgroups of patients and asymptomatic controls. Thus somatosensory profiles of subgroups of patients with low back related leg pain (LBRLP) and healthy controls were determined by a comprehensive quantitative sensory test (QST) protocol. It was hypothesized that subgroups of patients and healthy controls would show differences in QST profiles relating to underlying pathomechanisms. Results: 77 subjects with LBRLP were recruited and classified in one of the four groups. Additionally, 18 age and gender matched asymptomatic controls were measured. QST revealed signs of pain hypersensitivity in group NS and sensory deficits in group D whereas Groups PNS and M showed no significant differences when compared to the asymptomatic group. Conclusions: These findings support construct validity for two of the categories of the new classification system, however further research is warranted to achieve construct validation of the classification system as a whole.
Keywords: Low back pain, leg pain, classification system, validity, quantitative sensory testing, QST
Abstract: Background and Objectives: Exercises aiming to strengthen the upper extremities are recommended to increase activities of daily living (ADLs) in patients with spinal cord injury (SCI). The aim of this study was to compare the effects of upper extremity progressive resistance exercises (PRE) and endurance exercises (EE) performed with an arm ergometer in patients with paraplegia due to SCI. Materials and Methods: A total of 19 SCI patients were included in the study, and randomly divided into two groups. The first group performed PRE while the second group performed arm EE. The functional independence measurement (FIM) was used…on each patient at the beginning and at the end of the study. The elbow flexion and extension muscle strengths of each patient were determined with the computerized isokinetic dynamometer at the beginning and end of the study. Results: Post-training increased the FIM scores in both PRE (p=0.005) and EE groups (p=0.008). There were increases in the extension peak torque (PT) and total work (TW) at 180°/sec and 60°/sec angular velocity in the PRE group compared to the EE group (all p< 0.05). Conclusion: There were improvement in post-training muscle strength values in both the PRE (found to be more effective) and EE groups. Level of Evidence: Randomized trial (Level I).
Abstract: Background: Firefighters have a high incidence of low back pain and injury. Objective: To describe lumbar multifidus and abdominal muscle size characteristics in firefighters and to compare these characteristics to normative reference ranges. Methods: In career firefighters without current low back pain (62 males, 7 females), ultrasonography was used to assess: L4 and L5 lumbar multifidus cross-sectional area (CSA), asymmetry, and thicknesses; and external oblique, internal oblique, and transverse abdominal thicknesses. Comparisons of mean values in firefighters were made to the normative 95% reference ranges for the general population and soldiers. Results: Mean values…for lumbar multifidus and abdominal muscle size in firefighters fell within the 95% reference ranges for the general population and soldiers for all measurements, except L4 multifidus CSA in males and L5 multifidus CSA in females, which were larger in firefighters than the general population. Conclusions: The majority of lumbar multifidus and abdominal muscle size measurements in firefighters are similar to the general population and soldiers. The larger lumbar multifidus CSA in firefighters compared with the general population warrants further study. These data provide a basis for future research using ultrasonography to assess muscle size in firefighters and other workers in physically-demanding occupations.
Abstract: Objective: The aim of this trial was to investigate the effect of therapeutic microwave diathermy (MD) on pain, disability, trunk muscle strength, walking performance, mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). Methods: A total of 39 patients were included in this study. The patients were randomized into two groups. Group 1 (n=19) received MD treatment and exercises. Group 2 (n=20) was given only exercises. The pain (visual analog scale), disability (Oswestry Disability Questionnaire and pain disability index), walking performance (6 minute walking test, 6MWT), depression and QOL (Short Form…36) of all participants were evaluated. Patients were assessed before treatment (BT), after treatment (AT), and at a 1-month follow-up (F). Results: The patients with CLBP in each group had significant improvements in pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression AT and F when compared with their initial status. There was no statistically significant difference between the groups regarding the change scores between AT–BT test and F–BT test. Conclusion: Since a 2,450-MHz MD showed no beneficial effects on clinical parameters, exercise program could be preferable for the treatment of patients with CLBP alone.
Keywords: Chronic low back pain, microwave diathermy, trunk muscle strength, pain, disability, endurance, quality of life, depression
Abstract: Background: Current research has shown that exercise induces an increase in spinal range of motion (ROM) which is primarily due to spinal creep. However, there is a lack of consensus regarding the cause of spinal creep; some believe it is due to the warm up effect of exercise while others believe it is the result of the position of the lumbar spine during the exercise. Aim: The aim of this prospective study is to investigate first whether a change in lumbar spine ROM is seen following exercise and second whether a greater change in ROM is seen following…a fatiguing protocol in a seated position or in an upright position. Methods: Fifteen healthy individuals aged between 18 and 35 years volunteered to participate in the study. Range of motion was assessed with an electro-goniometer prior to and following two exercise tests which lasted for a period of nine minutes each. Submaximal protocols for the treadmill and bicycle were used. Results: No significant change in lumbar spine ROM was detected following the bicycle test (p=0.301) or the treadmill test (p=0.132) implying that the warm up effect of exercise has little impact on lumbar spine ROM. Likewise, no significant difference was seen in the changes following exercise on the bicycle and the treadmill, implying that position also has little effect on ROM. Conclusion: The findings of this study contradict those of previous research where an increase in lumbar spine ROM was seen following exercise. Further research using a large scale, heterogeneous cohort is needed to further determine the effects of exercise on lumbar spine ROM.
Keywords: Lumbar spine, range of motion, creep, position, exercise
Abstract: Background: Technological advancement in the medical laboratories has exposed the laboratory technicians to various ergonomic hazards due to nature of their work. Objective: The study aimed to analyze the working postures, to find out the prevalence of work related musculoskeletal disorders and to investigate the relationship between musculoskeletal disorders with individual factors, work characteristics and the working postures. Methods: The study was conducted among 60 medical laboratory technicians. Nordic Musculoskeletal Questionnaire (NMQ), Visual Analogue Scale (VAS) and RULA were used for this study. Results: Mean and SD of age, BMI and work experience of…the technicians were 28.6 ± 9.04 years, 22.07 ± 4.5 and 7.1 ± 8.2 years respectively. The overall prevalence of musculoskeletal problems experienced by the technicians was 73.3% and the major affected areas were trunk, knees, neck and ankles/feet. Statistical analysis shows significant associationsbetween musculoskeletal symptoms and VAS scores. Also a significant difference was found between the means of pre and post work shift scores of neck, low back and knee pain. Postural analysis showed that the subject’s mean Score A, B and Grand Score were found to be 3.98 ± 0.8, 4.95 ± 1.6 and 6 ± 1.02 respectively. The final RULA score 6 ± 1.02 emphasizes on poor workstation design which resulted in unnatural posture. Conclusions: The study highlighted the prevalence of postural and musculoskeletal problems among medical laboratory technicians. Intervention of administrative and engineering controls can significantly reduce ergonomic hazards.
Keywords: Posture, musculoskeletal disorders, medical laboratory technicians and occupational problems