Journal of Back and Musculoskeletal Rehabilitation - Volume 27, issue 4

Authors: Savva, Christos | Giakas, Giannis | Efstathiou, Michalis

Article Type: Review Article

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. Show more

Keywords: Joint manipulation, descending inhibitory pain mechanism, hypoalgesic, pain relieving, pressure pain thresholds

DOI: 10.3233/BMR-140472

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 377-382, 2014

Authors: Bezalel, Tomer | Carmeli, Eli | Been, Ella | Kalichman, Leonid

Article Type: Review Article

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. Show more

Keywords: Scheuermann's disease, etiology, review, spine, treatment

DOI: 10.3233/BMR-140483

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 383-390, 2014

Authors: Yilmaz, Figen | Doğu, Beril | Sahin, Fusun | Sirzai, Hulya | Kuran, Banu

Article Type: Research Article

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. Show more

Keywords: Osteoporosis, Short Form-36, Nottingham Health Profile, QUALEFFO-41, quality of life scales

DOI: 10.3233/BMR-140459

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 391-397, 2014

Authors: del Pozo-Cruz, Borja | Mocholi, Miguel H. | del Pozo-Cruz, Jesus | Parraca, Jose A. | Adsuar, Jose C. | Gusi, Narcis

Article Type: Research Article

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. Show more

Keywords: Backache, lower back pain, occupational assessment, monitoring

DOI: 10.3233/BMR-140460

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 399-408, 2014

Authors: Schäfer, Axel G.M. | Hall, Toby M. | Rolke, Roman | Treede, Rolf-Detlef | Lüdtke, Kerstin | Mallwitz, Joachim | Briffa, Kathryn N.

Article Type: Research Article

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. Show more

Keywords: Low back pain, leg pain, classification system, validity, quantitative sensory testing, QST

DOI: 10.3233/BMR-140461

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 409-418, 2014

Authors: Dost, Gulseren | Dulgeroglu, Deniz | Yildirim, Adem | Ozgirgin, Nese

Article Type: Research Article

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). Show more

Keywords: Spinal cord injury, progressive resistance exercise, endurance exercise, isokinetic dynamometer

DOI: 10.3233/BMR-140462

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 419-426, 2014

Authors: Nuzzo, James L. | Haun, Daniel W. | Mayer, John M.

Article Type: Research Article

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. Show more

Keywords: Firefighters, muscles, spine, ultrasonography

DOI: 10.3233/BMR-140463

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 427-433, 2014

Authors: Durmus, Dilek | Ulus, Yasemin | Alayli, Gamze | Akyol, Ye\c{s}im | Bilgici, Ayhan | Yazicioglu, Kamil | Kuru, Omer

Article Type: Research Article

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. Show more

Keywords: Chronic low back pain, microwave diathermy, trunk muscle strength, pain, disability, endurance, quality of life, depression

DOI: 10.3233/BMR-140464

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 435-443, 2014

Authors: Sly, Emma | Coleman, Cliona | Quinn, Daniel | Armstrong, Stephen Mark | Garvey, Chris | O'Donoghue, Ciara | Wilson, Fiona

Article Type: Research Article

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. Show more

Keywords: Lumbar spine, range of motion, creep, position, exercise

DOI: 10.3233/BMR-140465

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 445-452, 2014

Authors: Maulik, Shreya | Iqbal, Rauf | De, Amitabha | Chandra, Ananga Mohan

Article Type: Research Article

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. Show more

Keywords: Posture, musculoskeletal disorders, medical laboratory technicians and occupational problems

DOI: 10.3233/BMR-140466

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 453-461, 2014

Authors: Wand, Benedict Martin | James, Monique | Abbaszadeh, Sam | George, Pamela Jane | Formby, Pamela Margaret | Smith, Anne Julia | O'Connell, Neil Edward

Article Type: Research Article

Abstract: Background: There is considerable interest in the role that disturbance of body-perception may play in long standing pain problems such as chronic low back pain (CLBP), both as a contributor to the clinical condition and as a potential target for treatment. In some chronic pain conditions body-perception has been investigated using self-report questionnaires. There is currently no questionnaire for assessing body-perception in people with CLBP. Objective: To describe the development of a back-specific body-perception questionnaire and examine the psychometrics of this new scale. Methods: Based on available evidence a back-specific body-perception questionnaire was developed. Fifty-one people …with CLBP and an equal number of healthy controls completed the questionnaire; a subset of the patient population completed the questionnaire again one-week later. Scale-consistency and test-retest reliability were investigated on the patient sample. Validity was investigated by comparing responses between patients and controls as well as exploring the relationship between the questionnaire and important clinical characteristics. Results: All but one of the patients endorsed items on the questionnaire, which suggests that distorted body-perception may exist in this population. The internal-consistency and test-retest reliability of the scale appear acceptable. The discriminative validity of the questionnaire is supported by the marked differences in the questionnaire responses between patients and healthy controls and the construct validity by the significant association between the questionnaire score and important clinical variables. Conclusion: Symptoms of body-perception distortion were endorsed by most CLBP patients, while these symptoms are very infrequent amongst healthy controls. Our results suggest the questionnaire has reasonable psychometric properties. Show more

Keywords: Body image, low back pain, neuronal plasticity, reliability, validity

DOI: 10.3233/BMR-140467

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 463-473, 2014

Authors: Kamali, Fahimeh | Panahi, Fatemeh | Ebrahimi, Samaneh | Abbasi, Leila

Article Type: Research Article

Abstract: Objective: The aim of this study was to investigate the comparison of massage therapy and routine physical therapy on patients with sub acute and chronic nonspecific low back pain. Methods and Materials: Thirty volunteer female subjects with a sub acute or chronic nonspecific low back pain were randomly enrolled in two groups, massage therapy and routine physical therapy. After massage application, the hamstring and paravertebral muscles stretching and also stabilizing exercises were prescribed. In the routine physical therapy group, TENS, US and vibrator were used besides exercises. Pain intensity according to Numerical Rating Scale, functional disability level in …accordance to Oswestry Disability Index, and modified Schober test, for measurement of flexion range of motion, before and after ten sessions of treatment were used to evaluate the effectiveness of the treatment. Results: Pain intensity, Oswestry Disability Index and flexion range of motion had shown significant differences before and after intervention in both groups (p< 0.001). The statisticl analysis revealed that the massage therapy had significantly improved the pain intensity and Oswestry Disability Index compared to routine physical therapy (p=0.015, p=0.013 respectively), but the range of motion changes were not significant between two groups (p=1.00). Conclusion: It can be concluded that both massage therapy and routine physical therapy are useful for sub acute and chronic nonspecific low back pain treatment especially if accompanied with exercise. However, massage is more effective than other electrotherapy modalities, and it can be used alon e or with electrotherapy for the treatment of patients with low back pain. Show more

Keywords: Massage therapy, electrotherapy, nonspecific low back pain

DOI: 10.3233/BMR-140468

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 475-480, 2014

Authors: Ishida, Hiroshi | Watanabe, Susumu

Article Type: Research Article

Abstract: Background: Recent studies have indicated that maximum expiration could be a useful way of performing challenging exercises that include coactivation of the deep and superficial abdominal muscles. However, little is known about the effect of maximum expiration on the activity of the abdominal muscles during lumbar stabilizing exercise. Objectives: The purpose of our study was to quantify changes in the activities of the abdominal muscles during side bridge exercise in combination with maximum expiration. Design: Experimental laboratory study. Methods: The activities of the rectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscles …were measured using electromyography in 12 healthy men performing 3 tasks: holding the breath after maximum expiration in the prone position, holding the breath after resting expiration during side bridge exercise, and holding the breath after maximum expiration during side bridge exercise. Results: Significant increases in the activities of the abdominal muscles (RA, EO, and IO) occurred with maximum expiration when compared with resting expiration during side bridge exercise (P < 0.05). Conclusion: This is the first study to demonstrate the effect of maximum expiration on abdominal muscle activities during a stabilizing exercise, thus contributing to existing knowledge about therapeutic exercise for alternative core training. Show more

Keywords: Electromyography, abdominal muscles, stabilizing exercise

DOI: 10.3233/BMR-140469

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 481-484, 2014

Authors: Avendaño-Coy, Juan | Gómez-Soriano, Julio | Valencia, Marta | Estrada, Jesús | Leal, Francisco | Ruiz-Campa, Rafael

Article Type: Research Article

Abstract: Background: Botulinum toxin type A (BTX-A) intramuscular injections have been used for the treatment of myofascial pain syndrome (MPS), although its efficacy remains still unknown and its safety is controversial. Objective: To analyze the effectiveness and safety of the injection protocol for BTX-A in the shoulder-scapular and lumbar-pelvic girdles combined with physiotherapy in patients with primary and secondary MPS. Methods: Retrospective descriptive study including 301 medical files of patients with persistent MPS. Positive responses to treatment were considered to be a satisfactory level of effectiveness with 50% pain relief or a fully satisfactory level of effectiveness …at 80%. Results: Overall, 58.1% of patients obtained a positive result at 6 months. Differences in effectiveness were found between primary MPS (82.9% of patients) and secondary MPS (54.9%; p=0.002). In patients with secondary MPS, differences in effectiveness arose based on pathologies associated with MPS (p=0.03). In 23.9% of cases, mild and temporary adverse effects were observed post-infiltration. Conclusions: BTX-A injections and physiotherapy is an alternative to conventional treatment which should be considered when treating refractory MPS. Nonetheless, the differences in effectiveness based on diagnosis suggest the need to clarify the criteria used to select patients with MPS in future clinical trials and applications. Show more

Keywords: Botulinum toxin type A, myofascial pain syndromes, adverse effects

DOI: 10.3233/BMR-140470

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 485-492, 2014

Authors: Packer, Amanda Carine | Dibai-Filho, Almir Vieira | de Souza Costa, Ana Cláudia | dos Santos Berni, Kelly Cristina | Rodrigues-Bigaton, Delaine

Article Type: Research Article

Abstract: Background and Objective: There is a close interaction between the mandibular and cervical systems due to the existing neurological and biomechanical communications. This study aimed to evaluate the relationship between neck disability and mandibular range of motion (ROM). Materials and Methods: Fifty-two women aged between 18 and 40 years were recruited and allocated to four groups using two outcome measures: the Neck Disability Index (NDI) and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD): Group I (n=13), healthy volunteers; Group II (n=13), volunteers with TMD and neck disability; Group III (n=13), volunteers with TMD and without neck disability; …and Group IV (n=13), volunteers with neck disability and without TMD. Mandibular ROM was evaluated as part of the RDC/TMD clinical examination. Statistical analysis involved one-way ANOVA followed by Tukey’s test for comparisons between groups. Spearman’s correlation coefficients were calculated to determined correlations among the variables. Results: Significant differences were found in the mandibular ROM of functional opening in the comparisons between Groups I and III (p=0.009) and between Groups III and IV (p=0.024). No significant association was found between mandibular ROM and the NDI score (p > 0.05). Conclusion: Based on the methodology employed, there is no association between mandibular ROM and neck disability in university women. In this sense, clinical interventions focusing on the flexibility of the temporomandibular joint does not have repercussions on the neck disability and vice versa. Show more

Keywords: Neck pain, temporomandibular disorders, range of motion, articular

DOI: 10.3233/BMR-140471

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 493-498, 2014

Authors: Pan, Xian-Ming | Li, Wei | Huang, Xin | Deng, Shao-lin | Qu, Bo | Fan, Ling | Ma, Zehui | Jiang, Kai

Article Type: Research Article

Abstract: Background: Many surgical methods are available for repairing thoracolumbar fractures including short-segment internal fixation with posterior pedicle screws and anterior decompression and reduction. However, most methods are associated with significant surgical trauma and long postoperative recovery. The purpose of this study was to describe anterior single level interbody fusion and fixation for the repair of thoracolumbar fractures which may reduce surgical trauma and help speed recovery. Methods: A group of 21 patients who underwent single level anterior interbody fusion and fixation from June 2006 to June 2011 were compared with a group of 21 patients who underwent double …level anterior interbody fusion and fixation during the same period. The groups were compared with regard to operation time, intraoperative blood loss, fracture healing time, ratio of pre- to postoperative endplate height between adjacent vertebrae, Cobb angle in the sagittal plane, recovery of neural function, and internal fusion failure. Results: The 2 groups were similar with the exception of fracture location (P=0.017). The patients who underwent the single level procedure had a shorter operation time (P < 0.001), less blood loss (P < 0.001), and shorter follow-up (P < 0.001). Both groups had significant improvement in Cobb angle at 1 week and 1 year after surgery, but there was no significant difference between the groups. Both groups also exhibited improvement in neurological function, and the difference in improvement between the groups was not significant. Conclusions: Single level intervertebral fusion and internal fixation for thoracolumbar fractures provides as satisfactory an outcome as the traditional approach, double level anterior interbody fusion and fixation, and reduces the degree of surgical trauma. Show more

Keywords: Interbody fusion, anterior, single level, double level, thoracolumbar fracture

DOI: 10.3233/BMR-140473

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 499-505, 2014

Authors: Darzi, Mohammad Taghipour | Pourhadi, Samaneh | Hosseinzadeh, Somayeh | Ahmadi, Mahmood Haji | Dadian, Mohammad

Article Type: Research Article

Abstract: Background and Objectives: Low back pain and consequence disability is one of the most prevalence musculoskeletal disorders that human being ever had involved. Quality of life is a multidimensional concept and is beyond absolute physical health. In this study, we compared QOL between low back pain patients and healthy people using WHOQOL-BREF which is a generic and overall instrument. Methods: This descriptive-analytic study was carried out on 256 low back pain patients and healthy people in Shahid Beheshti Hospital, Babol. They filled out the questionnaires personally and the scores of different domains in two groups were compared. WHOQOL-BREF …has four domains of physical health, psychological health, social relations and environment health. The range of scores in each of these domains is from 4–20. The two questions are about the general quality of life and general health. Overall, a higher score indicates better quality of life. Results: The participants’ age range was from 18 to 63 with the mean ± SD of 36.63 ± 10.99. The scores of these four domains and general quality of life and general health of WHOQOL-BREF were lower in low back pain patients. These differences were statistically significant in physical health and environmental health. Conclusions: Lower QOL in low back pain patients necessitate doing some interventions such as education and rehabilitation in this group. This indicates the importance of more attention to these patients to plan future treatments in order to reinforce these domains. Show more

Keywords: Low back pain, quality of life, World Health Organization questionnaire

DOI: 10.3233/BMR-140474

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 507-512, 2014

Authors: Grabara, Małgorzata

Article Type: Research Article

Abstract: Objective: To assess the shape of anteroposterior vertebral curvatures in adolescents who practice team sports. Material and Methods: 57 females and 104 males aged 14–17 years, playing volleyball, basketball or handball, and 63 females and 99 males as a control group. A Rippstein plurimeter was used to measure the angles of thoracic kyphosis and lumbar lordosis. Results: The study has revealed significant differences in lumbar lordosis in male athletes compared to the control (p=0.01). Male volleyball players had greater thoracic kyphosis (p=0.002) than basketball players. Female athletes had lower thoracic kyphosis than the control group (p< …0.01). Normal values of thoracic kyphosis were more frequent in female athletes and male handball players whereas normal lumbar lordosis was more frequently seen in female volleyball players and male control group. Our investigations revealed significant (p< 0.05) correlations between the anteroposterior curvature of the spine and somatic parameters. Conclusion: Differences in thoracic kyphosis or lumbar lordosis among the athletes and the control group might be due to postural muscles strengthening as a result of regular engagement in intensive exercise. The variability of anteroposterior spine curvatures may not only be associated with directional physical activity; some contribution of the somatic structure is also possible. Show more

Keywords: Anteroposterior vertebral curvatures, athletes, Rippstein plurimeter, posture

DOI: 10.3233/BMR-140475

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 513-519, 2014

Authors: Cortés Godoy, Virginia | Gallego Izquierdo, Tomás | Lázaro Navas, Irene | Pecos Mart´n, Daniel

Article Type: Research Article

Abstract: Background: The effectiveness of exercise therapy in the treatment of osteoarthritis of the knee (KOA) is widely evidenced. The current study aims to compare the effectiveness of massage therapy as a co-adjuvant treatment for KOA. Methods: A blind, randomized controlled trial design was used. Eighteen women were randomly allocated to two different groups. Group A was treated with massage therapy and an exercise program, and Group B was treated with the exercise program alone. The intervention lasted for 6 weeks. Outcomes were assessed using a verbal analogue scale (VAS), the WOMAC index, and the Get-Up and Go test. …Baseline, post-treatment, and 1- and 3- month follow-up data were collected. Values were considered statistically significant at a p< 0.05. The Mann-Whitney U test was applied in order to find out the differences between groups, and to verify the existence of such differences, the Friedman Test for repeated measures complemented with multiple comparisons tests was carried out. Results: In both groups, significant differences were found in the three variables between the baseline measurement and three months after treatment, with the exception of the WOMAC variable in group B (p=0.064) No significant differences were found between both groups in the WOMAC index (p=0.508) and VAS (p=0.964) variables and the Get-Up and Go test (p=0.691). Conclusion: Combining exercise-based therapy with massage therapy may lead to clinical improvement in patients with KOA. The use of massage therapy combined with exercise as a treatment for gonarthrosis does not seem to have any beneficial effects. Show more

Keywords: Knee osteoarthritis, exercise therapy, massage therapy, adults

DOI: 10.3233/BMR-140476

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 521-529, 2014

Authors: Watanabe, Masahiro | Kaneoka, Koji | Wada, Yusuke | Matsui, Yasushi | Miyakawa, Shumpei

Article Type: Research Article

Abstract: Background and Objective: Sitting posture may often place large burden on trunk muscles, while trunk muscle activities in the sitting posture have not been well clarified. In this study, a difference in trunk muscle activity between two kinds of sitting postures was evaluated, focusing on low back pain induced by posture holding. Material and Methods: An experiment was conducted on the subjects sitting on a stable-seat and on an unstable-seat, with the pelvis inclined forward, backward, rightward, and leftward. Results: With the pelvis inclined forward, rightward and leftward, muscle activities were significantly increased in a stable-seat …sitting posture. In contrast, no significant increase in muscle activity was observed with the pelvis inclined in every direction in an unstable-seat sitting posture. Conclusions: With the pelvis inclined in the stable-seat sitting posture, muscle activities were imbalanced, while with the pelvis inclined in the unstable-seat sitting posture, muscle activities were not imbalanced. Thus, it is suggested that with the pelvis inclined to the maximum extent in the stable-seat sitting posture, low back pain may be induced by imbalanced muscle activities. Show more

Keywords: Low back pain, trunk muscle, electromyography, posture, pelvis incline, stable seat, unstable seat

DOI: 10.3233/BMR-140477

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 531-536, 2014

Authors: Civelek, Gul Mete | Ciftkaya, Pinar Oztop | Karatas, Metin

Article Type: Research Article

Abstract: Background and Objective: The aim of this study is to find prevalence and severity of restless legs syndrome (RLS) in patients with fibromyalgia syndrome (FMS) and detect effect of FMS and RLS coexistance on quality of sleep and life. Methods: In this study, presence and severity of RLS were detected in patients with FMS and Pitsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Fibromyalgia Impact Questionnaire (FIQ) scores of all patients were measured. Results: One hundred and fifteenfemale patients with median age 49 (39.0–57.0)[median (25–75% interquartile range)] were included in the study. In 42.6% …of patients RLS coexisting with FMS was found. RLS was classified as moderate in 42.9% of patients and as severe in 49.0% of patients. In patients with FMS ans RLS sleep quality, daytime sleepiness and quality of life were more severely impaired (PSQI scores were 9.0 ± 4.4 vs 7.8 ± 4.3, p=0.003; ESS scores were 5.0(3.0–7.5) vs 3.0(1.0–4.3), p=0.036 and FIQ scores were 68.1 ± 9.8 vs 59.4 ± 16.9, p=0.027) compared to patients with only FMS. Prevalence of RLS was found higher in FMS than normal population and quality of sleep and quality of life were worse in patients with RLS. Conclusions: Presence of RLS should be investigated in every patient with FMS and treatment plans should also cover RLS in case of coexistance with FMS. Prospective cohort studies are needed for better explanation of FMS and RLS coexistance. Show more

Keywords: Fibromyalgia syndrome, restless legs syndrome, quality of sleep, quality of life

DOI: 10.3233/BMR-140478

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 537-544, 2014

Authors: Davarian, Sanaz | Maroufi, Nader | Ebrahimi, Esmaeil | Parnianpour, Mohammad | Farahmand, Farzam

Article Type: Research Article

Abstract: Background and Objectives: It is suggested that activation of the transverse abdominis muscle has a stabilizing effect on the lumbar spine by raising intra-abdominal pressure without added disc compression. However, its feedforward activity has remained a controversial issue. In addition, research regarding bilateral activation of trunk muscles during a unilateral arm movement is limited. The aim of this study was to evaluate bilateral anticipatory activity of trunk muscles during unilateral arm flexion. Materials and Methods: Eighteen healthy subjects (aged 25 ± 3.96 years) participated in this study and performed 10 trials of rapid arm flexion in response to …a visual stimulus. The electromyographic activity of the right anterior deltoid (AD) and bilateral trunk muscles including the transverse abdominis/internal oblique (TA/IO), superficial lumbar multifidus (SLM) and lumbar erector spine (LES) was recorded. The onset latency and anticipatory activity of the recorded trunk muscles were calculated. Results: The first muscle activated in anticipation of the right arm flexion was the left TA/IO. The right TA/IO activated significantly later than all other trunk muscles (P< 0.0005). In addition, anticipatory activity of the right TA/IO was significantly lower than all other trunk muscles (P< 0.0005). There was no significant difference in either onset latency or anticipatory activity among other trunk muscles (P> 0.05). Conclusion: Healthy subjects showed no bilateral anticipatory co-activation of TA/IO in unilateral arm elevation. Further investigations are required to delineate normal muscle activation pattern in healthy subjects prior to prescribing bilateral activation training of transverse abdominis for subjects with chronic low back pain. Show more

Keywords: Anticipatory postural adjustments, motor control, low back, stability, self-induced perturbation

DOI: 10.3233/BMR-140480

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 545-551, 2014

Authors: Durmus, Dilek | Unal, Mustafa | Kuru, Omer

Article Type: Research Article

Abstract: Background and Objectives: The aim of this trial is to search effectiveness of specifically adapted exercise programs on its own and with low back school on pain, disability, trunk and quadriceps muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). Material and Method: A total of 121 patients with definite CLBP were included in this study. The patients were randomized into two groups. Group 1 (n=60) was given exercises only and accepted as the control group. Group 2 (n=61) received back school program and exercises. The …exercise treatment was performed 3 days a week, for 3 months. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ), walking performance (6 minute walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk and knee muscle strength were measured with a handheld dynamometer. Patients were assessed at baseline (BT), at the end of treatment (AT), and at the six month follow-up (F). Results: Statistically significant improvements were found between groups regarding all of the clinical parameters over time. Pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression of both groups also showed improvements AT. These improvements persisted at 6-months follow-ups (P < 0.05). There were statistically significant differences between the groups for pain, disability, muscle strength, endurance, 6MWT, QOL, and depression regarding the change scores between AT–BT test and F–BT test (P < 0.05). Group 2 improved more than group 1 except for mobility. Conclusion: Exercise programs can be modified and used successfully in CLBP and this effect can be increased with addition of back school further. Level of Evidence: Diagnostic study Level-I-I (prospective study). Show more

Keywords: Chronic low back pain, exercise, back school, muscle strength, pain, disability, endurance, quality of life, depression

DOI: 10.3233/BMR-140481

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 553-561, 2014

Authors: Linden, Michael | Scherbe, Sieghard | Cicholas, Burkhard

Article Type: Research Article

Abstract: Background: It is empirically well documented that psychotherapy is vital in the treatment of chronic back pain. Objective: To test in this randomized controlled clinical trial whether cognitive behavior group therapy is effective in respect to pain tolerance and disability apart from the effects on somatization in general and additional to the effects of a multimodal inpatient orthopedic rehabilitation programme. Methods: Fifty-three patients were randomly assigned to an intervention group, receiving six sessions of “cognitive behavior group therapy for back pain” (CBT-BP), and 50 to a control group who got unspecific occupational therapy sessions instead. Patients …were suffering from chronic back pain for at least six months. All patients were treated for 21 days in an orthopedic inpatient rehabilitation unit with a multimodal orthopedic treatment, including active physical therapy, patient education or motivation to exercise. Results: In both groups there is a significant improvement over time in the Symptom Checklist (SCL-90), the Rating of Health Locus of Control Attributions, the Fear Avoidance Beliefs Questionnaire (FABQS) and a Visual Analogue Pain Scale (VAS-pain). There are significant interactions between treatment group and VAS-pain and the FABQS, showing a superior improvement in the intervention group, while no significant superiority is found for the SCL. Conclusions: The experience of pain can be altered directly and not only through improvement of depression or general somatoform complaints. The study replicates other research and increases the evidence base for this mode of treatment. The treatment effect can be called specific as it is found additional to a multimodal inpatient care programme. Show more

Keywords: Cognitive behavior therapy, low back pain, rehabilitation, fear avoidance beliefs, pain, locus of control

DOI: 10.3233/BMR-140518

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 563-568, 2014

Article Type: Other

DOI: 10.3233/BMR-2014-27425

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 569-575, 2014

Article Type: Other

DOI: 10.3233/BMR-2014-27426

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 4, pp. 577-579, 2014