Journal of Back and Musculoskeletal Rehabilitation - Volume 28, issue 1
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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: Plantar fasciitis is considered the most common cause of foot pain. Numerous non-surgical treatments have been used to relieve symptoms. Taping is one of the most widespread treatments, with several techniques utilized in clinical practice. OBJECTIVE: To evaluate, based on existing literature, the efficacy of different taping techniques in relieving symptoms and dysfunction caused by plantar fasciitis. METHODS: PubMed, CINAHL, PEDro, ISI Web of Science, and Google Scholar databases were searched from inception until December 2012, using a predefined search strategy. Controlled trials of any methodological quality were included, without any language restrictions. The methodological…quality of interventional studies was evaluated inter alia by the PEDro score. RESULTS: Five randomized control trials, one cross-over study and two single group repeated measures studies met the inclusion criteria. Two studies were high quality; two were moderate quality and four were of poor methodological quality. All eight studies favored the use of different taping techniques. The most common technique was low dye taping. CONCLUSION: We found that in the short-term, taping is beneficial in treating plantar fasciitis. The best evidence exists for low dye taping and calcaneal taping. More research is needed to investigate long-term effect and effectiveness of specific taping techniques.
Abstract: OBJECTIVES: Scapular winging and tipping are types of abnormal scapular kinematics, which is caused by not only the entrapment of peripheral nerve, but also imbalance of the scapulothoracic musculatures. The purpose of this study was to investigate the presence of muscular imbalance in the middle and lower parts of the serratus anterior and upper trapezius in people with scapular winging and tipping. METHODS: Twenty male participants (age, 23.0 ± 1.92 y) were placed into symptomatic group (n = 10 ) and control group (n = 10 ). Participants completed two individual trials of a…push-up plus, and a diagonal shoulder elevation, while electromyography (EMG) recorded muscle activity of the low and middle serratus anterior and upper trapezius. The root mean squared EMG values for three muscles were normalized using maximum voluntary isometric contractions (%MVIC). The value was calculated using modified isolation equation for comparing activation of middle and lower serratus anterior (%isolation). RESULTS: During a diagonal shoulder elevation, the % maximal voluntary isometric contraction (%MVIC) data showed that the symptomatic participants had significantly greater activation of the middle serratus anterior compared to the control group (P = 0.01 ). During a diagonal shoulder elevation, the symptomatic participants had not only significantly increased %isolation of the middle serratus anterior, but also significantly decreased for the lower serratus anterior compare with the control group (p = 0.00 ). CONCLUSION: Present result indicated that different muscle activation between middle and lower serratus anterior could represent in group with scapular dyskinesis, and need for selective activation of the lower serratus anterior in patients with scapular winging and tipping.
Abstract: Background and Objectives: Bone scintigraphy is a molecular imaging technique routinely used for the evaluation of benign and malignant bone abnormalities. This study aimed at evaluating spinal degenerative changes detected by bone scintigraphy and determining associations between image features and patients’ anthropometric and demographic variables. Material and Method: In a cross-sectional study, 64 men and 52 women underwent bone scintigraphy. Experts identified all image regions suggesting degenerative joint disease (DJD) and classified region intensity on a 3-point scale. Image characteristics were correlated to the patients’ body mass index (BMI), age, weight, height, activity level, and sex. Data analysis…included descriptive statistics and association coefficients. Results: DJD was found in 53 patients (46%). In men, there was weak but statistically significant correlation between DJD and activity level, and DJD and age, but not BMI or weight. In women, only a weak, not statistically significant, linear correlation was found between DJD and BMI, and DJD and weight. Conclusion: Molecular imaging with bone scintigraphy showed that spinal degenerations are associated with different anthropometric and demographic features in men and women. Interestingly, no association was found between DJD and increased body weight in men while a weak association may exist in women. The results prompt for additional studies to better determine the risk factors for DJD and low back pain in male and female patients. Level of Evidence: Diagnostic study, Level II (retrospective study).
Keywords: Bone scintigraphy, molecular imaging, spinal degeneration, weight, low back pain, body mass index, musculoskeletal disorder
Abstract: BACKGROUND: Recent studies have shown that a transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) application reduces pain in subjects with musculoskeletal disorders. However there are no clinical trials evaluating or comparing the muscle relaxation generated for these devices. PURPOSE: To compare the muscle relaxation of the upper trapezius induced by the application of TENS and IFC in females with chronic nonspecific neck discomfort. METHODS: Sixty-four females between 18 and 40 years of age and a history of nonspecific neck discomfort were randomly assigned to a TENS or an IFC group. The women in the…TENS (N=32; mean age 22 years) and IFC (N=32, mean age 23 years) group were submitted to current application during 3 consecutive days and were assessed by electromyography (EMG) in different times aiming to quantify the muscular tension of the upper trapezius. A visual analogue scale (VAS) was used as pain measure at baseline (before TENS or IFC application) and at the end of the study. RESULTS: At baseline, demographic, pain, and EMG assessment data were similar between groups. Those in the IFC group had a significant trapezius relaxation after 3 IFC applications when compared to baseline and intermediate evaluations (P < 0.05 ). In contrast, the same analysis showed no significant difference between all assessments in the TENS group (P > 0.05 ). In relation to pain relief, both groups showed an improvement at the end of the study when compared to baseline (both, P < 0.05 ). The between-group analysis showed no difference for the subjects who received such IFC as TENS application (P < 0.05 ). CONCLUSION: IFC induced the upper trapezius relaxation after 3 sessions in females with neck discomfort, but the TENS application did not change the muscular tension. However, these results should be carefully interpreted due to the lack of differences between groups. A significant pain decrease was found in the subjects of both groups, however, only the IFC application presented a clinically important improvement.
Abstract: BACKGROUND: Information concerning low back pain in adolescents with scoliosis is rather limited in literature. While the epidemiology of back pain at the age of adolescence has been described extensively, studies evaluating the effects of therapeutic interventions are still sparse. MATERIAL AND METHOD: The study was conducted in two groups with juvenile idiopathic scoliosis Io . The clinical group was 21 persons with low back pain and the control group was 11 persons without pain. In order to assess the quality of life and the level of pain We used the abridged version of WHOQOL (World Human…Organizations Quality of Life questionnaire) and MPQ-SF (Short Form of McGill Pain questionnaire). The treatment consisted of a combination of manual therapy and rehabilitation exercises. RESULTS: We obtained a significant improvement in the area of the physical health: 7.17 in the clinical group (p = 0.000613 ); 6.12 for females (p = 0.015400 ); 9.19 for males (p = 0.022311 ). The assessment of the quality of life was different between the clinical and the control groups. The decrease in pain in the clinical group was 5.71 (p = 0.000132 ), 5.93 for females (p = 0.001474 ) and 5.29 for males (p = 0.027709 ). Data represents more than a double decrease in strong and moderate pain. CONCLUSION: A combination of rehabilitation exercises and soft manual therapy is effective in reducing the low back pain in adolescents and enhancing the somatic facet of the quality of life.
Keywords: Low back pain in adolescents, quality of life
Abstract: BACKGROUND: Breast cancer treatment may be a cause of postural disorders. OBJECTIVE: Assessment of the effects of various forms of physical activity on body posture in the sagittal plane in women post breast cancer treatment. STUDY GROUP: Sixty women who had received breast cancer treatment. The study group was intentionally divided into three groups of 20 women who followed different exercise regimens: Nordic Walking (NW), water resistance exercise (WE) or general fitness exercise (GE). METHODS: Photogrammetric examination of body posture using a Computer-Based Body Posture Diagnostics apparatus performed at baseline and after an 8-week…regimen of appropriately selected physical exercise. RESULTS: A favourable tendency for the shallowing of thoracic kyphosis and the reduction of lumbar curvature of the spine was noted in the NW group. Reduced kyphosis was also noted in the WE group, however it was accompanied by more pronounced lumbar lordosis and a tendency for excessive forward bending of the trunk. In the GE group, on the other hand, no significant differences were observed in terms of the shape of anteroposterior spinal curvatures. CONCLUSIONS: The diversity observed in the shape of anteroposterior spinal curvatures following physical training regimens of different type and nature demonstrates the need of appropriate exercise selection to attain the desired therapeutic outcome. Balanced postural changes were only identified among the women in the NW group. In the GE group, however, training only sustained the status existing prior to the initiation of the exercise regimen.
Keywords: Breast cancer, body posture, photogrammetry, physical activity
Abstract: BACKGROUND AND OBJECTIVES: Despite the recommendations of national and international societies for the treatment of patients with acute neck and back pain, still too many radiologic examinations were performed. The purpose of this study was to analyze and optimize diagnostics and treatment of patients with acute back pain. METHODS: The medical records of 484 patients presented to the emergency clinic with acute neck or back pain were analyzed for clinical history, physical examination, radiographic findings and therapy. RESULTS: Radiographs of the lumbar, cervical, or thoracic spine were performed in 338 cases (70%). Radiographs were normal in…142 patients (42%) and degenerative changes were identified in 123 patients (36%). Only 2 patients (0.4%) had radiographic findings that had direct therapeutic relevance: 1 patient with metastatic disease and 1 patient with posttraumatic C1–C2 instability. For most patients without sensorimotor deficits and absent specific indications for radiography (“red flags”), therapy was not affected by the results of radiography. CONCLUSIONS: Plain radiography of the spine was unnecessary in most patients initially evaluated with non-specific acute back pain and does not improve the clinical outcome. The implementation of national and international guidelines is a slow process, but helps to reduce costs and to protect patients from unnecessary ionizing radiation exposure.
Keywords: Low back pain, x-ray, red flags, spine radiographs
Abstract: BACKGROUND AND OBJECTIVES: Co-existing depressive symptoms aggravate the chronic course of pain and may interfere with successful rehabilitation. OBJECTIVE: To examine the psychosocial rehabilitation success of a standard rehabilitation program with a supplemental cognitive-behavioral management training of depressive symptoms compared to the standard rehabilitation alone among patients with chronic low back pain (CLBP) and depressive symptoms. METHODS: Effects on psychological measures (depressive symptoms, anxiety, and somatization) were evaluated prior to, 6, 12, and 24 months after rehabilitation among N = 84 consecutively admitted patients with CLBP and depressive symptoms, aged from 34–59 years.…Furthermore, self-reported days of sick leave were determined. RESULTS: Favorable effects on depressive symptoms and anxiety persisted up to the 24-month follow-up assessment and incremental effects of the new program on depressive symptoms and anxiety were found at the 6-month follow-up assessment. Days of sick leave were decreased 6 months after rehabilitation and frequencies of clinical levels of psychological symptoms at the 24-month follow-up assessment were attenuated in the intervention group. CONCLUSIONS: The long-term psychological rehabilitation success among patients with CLBP and depressive symptoms was improved by the newly developed program, whose clinical significance was also supported. Thus, significant factors for the further development of CLBP were ameliorated.
Keywords: Chronic low back pain, depressive symptoms, multidisciplinary inpatient orthopedic rehabilitation, cognitive-behavioral management of depressive symptoms, psychosocial outcomes
Abstract: PURPOSE: To evaluate the extent of intra-subject difference in hamstring flexibility and its possible relationship to the severity of Low Back Pain (LBP). A secondary purpose was to evaluate the extent of intra-rater reliability using both electrogoniometer and conventional goniometer for measuring hamstring tightness. IMPORTANCE: Potential correlations between muscle impairments and LBP may lead to more effective treatments and prevention strategies. METHODS: Seventy two participants with mechanical LBP were recruited for this study. The sample included; 41 females, 31 males with a mean age of 33.69 ± (11.04) years, height of 170 ± (9) cm, and…weight of 79.5 ± (1.6) kg. Hamstring length was detected indirectly using the Active Knee Extension method in the 90/90 position from supine. The amount of extension was measured using both electro-goniometer (EG)and a standard goniometer (SG). RESULTS: Right lower extremities of these patients were significantly more flexible than left ones at α = 0.025 (t 72 = 3.14 , p = 0.002 ). Similarly, dominant lower extremities of these patients were significantly more flexible than the non dominant ones at α = 0.025 (t 72 = 2.56 , p = 0.013 ). Additionally, Oswestry scores of the patients were significantly and positively correlated with the amount of hamstring tightness of the right lower extremities (r = 0.244 , p = 0.039 ), left lower extremities (r = 0.225 , p = 0.048 ) and the average of both sides (r = 0.24 , p = 0.039 ). However, the Oswestry scores were negatively, but insignificantly correlated to the absolute difference between right and left extremities at (r = − 0.156 , p = 0.091 ). Finally, the extent of intrasubject reliability in measuring hamstring tightness using EG and SG was found to be high (ICC=0.93). CONCLUSION: There is a possible relation between mild mechanical LBP and hamstrings tightness. It was found that the more the tightness, the higher the severity of LBP that patient experienced. Also, these patients had one of their lower extremities significantly tighter than the other. Such tightness was successfully detected utilizing both EG and SG. These findings and their possible pathomechanical consequences should be considered while constructing effective rehabilitation protocols for patients with mechanical LBP.
Abstract: BACKGROUND: Low back pain (LBP) hampers performance and experiencing an episode of LBP is strongly associated with recurrent episodes. OBJECTIVE: The prevalence of LBP and associated risk factors among young elite athletes in popular sports in the Netherlands were studied. METHODS: A questionnaire-based cross-sectional study was performed among 236 young elite athletes aged between 14–25 years in field hockey, football and speed skating. RESULTS: One hundred and eighty one (n = 181 ) athletes responded (response rate 77%). The overall, 12-month prevalence of LBP for the three sports was 60%: field hockey…56%, football 64% and speed skating 60%. Satisfaction with their own performance (OR=0.5 95%CI:0.3–0.9) and with the coaching staff (OR=0.5, 95%CI:0.4–0.8) were associated with a lower occurrence of LBP in field hockey. No sport-related risk factors were found in football. In speed skating more training hours (OR=1.1, 95%CI:1.0–1.2), performance of Pilates (OR=4.1, 95%CI:1.1–15.7) and more time spent on warming up (OR=1.1, 95%CI:1.0–1.1) were associated with the occurrence of LBP. CONCLUSIONS: Prevalence of LBP among young elite athletes compared to the general age-related population was 3–5 times higher. Sport-related risk factors of LBP were found in field hockey and in speed skating.
Keywords: Low back pain, prevention, risk factor, sports, youth