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: 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.
Keywords: Body image, low back pain, neuronal plasticity, reliability, validity
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.
Keywords: Massage therapy, electrotherapy, nonspecific low back pain
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.
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.
Keywords: Botulinum toxin type A, myofascial pain syndromes, adverse effects
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.
Keywords: Neck pain, temporomandibular disorders, range of motion, articular
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.
Keywords: Interbody fusion, anterior, single level, double level, thoracolumbar fracture
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.
Keywords: Low back pain, quality of life, World Health Organization questionnaire
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.
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.
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.