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: The available literature is lacking in reports on the quantitative analysis of posture in patients with lumbar stenosis. OBJECTIVE: The aim of this study was to analyze body posture in patients with lumbar spinal canal stenosis. METHODS: The study involved 100 people: 49 persons with severe lumbar spine stenosis and 51 control subjects without any history of back pain. All participatants were evaluated by a photogrammetric method. RESULTS: Photogrammetric measurements showed statistically significant differences in the shape of the anterior-posterior curvatures of the spine. In the study group thoracic kyphosis was significantly greater…(p = 0.043 ), and the depth of lumbar lordosis was significantly smaller (p = 0.038 ). The inclination of the thoracolumbar segment was also significantly lower (p = 0.013 ). CONCLUSIONS: 1. Measurements of body posture indicate a deepening of thoracic kyphosis and flattening of lumbar lordosis in lumbar stenosis patients. 2. Flattening of physiological lordosis seems to be caused by enlargment of the space of the spinal canal and dural sac in this position.
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 supine 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 AND OBJECTIVES: There is a lack of studies on obesity measured by outer abdominal fat (OAF), which describes abdominal subcutaneous adipose tissue thickness with regard to spino-pelvic parameters. We investigated OAF and its physiologic values on computed tomography (CT) scans with regard to age, gender, facet joint (FJ) arthritis, FJ orientation, lumbar lordosis (LL) and pelvic incidence (PI). MATERIAL AND METHOD: OAF, lumbar FJs, LL and PI were evaluated on CT scans. RESULTS: CT scans of 620 individuals with a mean age of 42.5 years were reviewed. OAF showed a mean value of 19.7 millimeters…(mm). It significantly increased with age until 70 years and decreased thereafter (p ≤ 0.0001 ). There was no significant gender difference. OAF was significantly increased with FJ arthritis (p = 0.01 ), but not with FJ orientation, LL or PI. CONCLUSION: OAF on CT scans seems to have a mean value of 19.7 mm. It is higher in the older age groups until 70 years. As a novelty finding, OAF significantly increases with higher degrees of FJ arthritis, but is notrelated to gender or other spino-pelvic parameters such as FJ orientation, LL or PI. Differences in fat distributionmay be found at other anatomic sites, such as visceral fat. Obese patientsmay benefit from weight loss by decreasing their FJ arthritis, which maypotentially decrease associated back pain, which may be worth further investigations.
Abstract: BACKGROUND: To improve hamstring extensibility some methods have been analyzed and compared for determining their acute and chronic effectiveness. OBJECTIVE: To compare the immediate effect of electrical muscle elongation (EME) versus Kinesio tape (KT) in hamstring muscle extensibility. METHODS: One hundred and twenty adult amateur athletes with hamstring shortness (straight leg raise test angle < 80 °) were randomly assigned to a group: group 1 (EME session of 4 KHz interferential current, bipolar technique and AMF=100 Hz, n = 40 ), group 2 (KT, n = 40 ) or group…3 (control group, no intervention, n = 40 ). Hamstring extensibility was assessed before and after the intervention through the active knee extension test. Results: Significant improvements were found in both EME and KT groups whereas no changes were detected in the control group. However, no significant differences between both techniques were detected. The EME group showed large effect size (d = 0.843 ) while the KT group reached medium effect size (d = 0.431 ). CONCLUSIONS: Both electrical muscle elongation and Kinesio tape are effective techniques in the short-term in amateur athletes with decreased hamstring extensibility. The higher increase of hamstring extensibility, with a better clinical effect was achieved with the application of electrical muscle elongation. However, no significant differences were found when comparing the effectiveness of both techniques.
Keywords: Muscle stretching, electric current, technique, range of movement, sport
Abstract: BACKGROUND: Control of pain management is an important up-stream process in fibromyalgia (FM) mechanisms. OBJECTIVE: To investigate whether adapted physical activity (APA) could change the illness perception in relation to the FM personality profile. METHODS: Thirty-seven women with FM allocated randomly: 19 treatment group (TG) and 18 control group (CG). Interventions: exercises program included ten sessions, two times for week for one hour each and observation for CG. Scales: Illness Perception Questionnaire-revisited (IPQ-r) for the mental representation of the disease, Minnesota Multiphasic Personality Inventory profiles (MMPI-2) for personality tool and Fibromyalgia Impact Questionnaire (FIQ) for function,…impact and symptoms. Outcome assessments were performed before rehabilitation treatment (T0) than at the end (T1), and a follow-up 12 weeks after treatment (T2). RESULTS: APA was efficacy to improve FIQ values in TG at T1 and T2 test days (P = 0.014 ). Changes in IPQ-R values in T2 were not significant. All patients presented a baseline T-score ≥ 65 in at least one of the basic and content MMPI-2 scales (Hy, D, Hs and Hea and Anx). CONCLUSION: APA was efficacy in FM, but further research to differentiate between illness experience rather than focus on a strict personality profile are necessary.
Abstract: BACKGROUND: Posture and physical function have been quantified in mature adults, but not in elderly females. OBJECTIVE: To quantify standing posture and measures of physical function in community-dwelling women over the age of 65 years, and to examine relationships between these variables. METHODS: Fifty-three women were recruited from day care service users (average age: 83.7 ± 6.3 years old). Standing postural alignments were assessed using 2-dimensional analyses with a digital video camera. The time up and go test (TUG) and other physical function tests were conducted. RESULTS: Decreased lower cervical angle (increased forward head…position) was significantly correlated with increased upper cervical angle (increased chin-up, r = − 0.45 ), increased thoracic spine angle (increased kyphosis, r = − 0.38 ), and decreased lumbar spine angle (thoracolumbar segments backward relative to the pelvis, r = 0.48 ). The decreased lumbar spine angle was significantly correlated with increased thoracic angle (increased kyphosis, r = − 0.37 ), increased pelvic plane angle (increased anterior pelvic tilt, r = − 0.49 ), and decreased knee flexion angle (r = 0.46 ). Increased TUG time (slower walking speed) was correlated to increased forward head position (r = 0.30 ) and thoracolumbar segments forward relative to the pelvis (r = 0.34 ). CONCLUSIONS: Posture and physical function measures were provided for community-dwelling females who were >65 years of age. They did not demonstrate any correlation between measured knee strength, back strength or single leg standing with measures of postural alignment, but TUG showed a moderate correlation with the lower cervical and lumbar spine posture measures.
Keywords: Posture, frail elderly women, physical function
Abstract: BACKGROUND: Psychosocial factors are known to play a key role in determining the progress of back pain patients. However, it is not known whether these factors are applicable to military personnel, who tend to be fitter than the general population. OBJECTIVE: The aim was to identify physical and psychological predictors in a prospective study of the outcome of back pain rehabilitation over 6 months and a longer follow-up time of between 15 and 32 months. METHODS: Two hundred and fifty military personnel reporting for a residential rehabilitation programme completed a battery of physical and psychological tests.…The physical tests included 800 m run time and the Biering-Sorensen test. The psychological/psychosocial measures included items on fear avoidance, self efficacy, anxiety and depression and occupational psychosocial factors such as job satisfaction. RESULTS: Self efficacy and 800 m run time predicted self-reported functional ability at 6 months and medical discharge/return to full fitness at 15–32 months. Patients with 800 m run times of more than 3 minutes 31 seconds had a four times greater chance of medical discharge from the Armed forces. CONCLUSIONS: Eight hundred metre run time and self-efficacy were independent predictors of both self-reported functional ability at 6 months and return to full fitness/medical discharge at 15–32 months. Self-efficacy also predicted 40% of the variance in the intensity of back pain and 10% of other non-back pain. Rehabilitation should include greater emphasis on physical fitness and on improving self-efficacy.
Keywords: Low back pain, self-efficacy, 800 m run time, military, rehabilitation
Abstract: BACKGROUND AND OBJECTIVE: The number of studies and evidences is inadequate especially with regard to the efficacy of pulsed radiofrequency (PRF) application in non-spinal indications. The purpose of this study was to investigate the effect of PRF on pain, functioning and quality of life in patients with advanced knee OA. METHODS: The study included 21 patients with complaints of knee pain. Intra-articular PRF was applied for 10 minutes at 42°C. Pain severity was assessed using the 10 cm standard visual analogue scale (VAS). Outcome measures also included a 20-meter walk test, a 6-minute walk test, WOMAC, Lequesne index,…and the Short Form-36 (SF-36). All measurements were assessed before treatment and 4 and 12 weeks after the treatment. RESULTS: A statistically significant improvement was found in VAS scores at rest and after walking, subscores of SF36-pain and SF36-social functioning, and Lequesne score at week four (p < 0.05 ). This improvement was maintained for the scores of VAS-walking at week 12 (p < 0.05 ). CONCLUSION: It is possible to state that intra-articular PRF application is effective and safe for the pain treatment of patients with advanced knee OA. Therefore, we think that PRF application will be included in chronic pain treatment guidelines in the future with the increase in the number of future studies.
Keywords: Knee, osteoarthritis, pain, quality of life, radiofrequency
Abstract: BACKGROUND AND OBJECTIVE: Spinal posture and mobility are significant for protecting spine. The aim was to compare effects of different postural training interventions on spinal posture and mobility. MATERIAL AND METHOD: Ninety-six university students (ages: 18–25 years) were allocated into Electrical Stimulation (ES) (n = 24 ), Exercise (n = 24 ), Biofeedback Posture Trainer (Backtone) (n = 24 ), and Postural Education (n = 24 , Controls) groups. All the groups got postural education. The interventions were carried out 3 days a week for 8 weeks. Spinal Mouse® device…(Idiag, Fehraltorf, Switzerland) was used to detect thoracic and lumbar curvatures and mobility (degrees) in standing and sitting positions. Paired Student’s t-test, one-way ANOVA, and pairwise post-hoc tests were used. RESULTS: ES decreased thoracic curvature, the exercise decreased thoracic and lumbar curvature and increased thoracic mobility in standing position between pre-post training (p < 0.05 ). Exercise and Backtone improved thoracic curvature in sitting (p < 0.05 ). In Exercise Group, thoracic curvature decreased compared to Backtone and Education Groups, and thoracic mobility increased compared to all groups (p < 0.05 ). CONCLUSIONS: The exercise was effective and superior in improving thoracic and lumbar curves, and mobility among university students. ES decreased thoracic curve. Biofeedback posture trainer improved sitting posture. LEVEL OF EVIDENCE: A prospective randomized controlled trial, Level 1.
Keywords: Back posture, posture education, electrical stimulation, exercise, orthotic device
Abstract: BACKGROUND AND OBJECTIVES: Relative precision is to denote the ratio of the error variance of two sample designs. The aim of the present study was to compare measurement precisions of the Oswestry Back Pain Disability Questionnaire and a computer adaptive testing (CAT) method for measuring disability resulting from back pain. MATERIAL AND METHOD: A cross-sectional study was carried out with two independent convenient samples from two out-patient rehabilitation clinics for back pain (N = 42 ) and non-back pain groups (N = 42 ). Participants were asked to fill out the ODQ and CAT…of International Classification of Functioning, Disability and Health – Activity Measure (ICF-AM). A series of Rasch analyses were performed to calculate person ability measures. RESULTS: The CAT measures had greater precision in discriminating the groups than did the ODQ measure in comparisons of the relative precision. CONCLUSIONS: The CAT measure appears to be more effective than the ODQ measure in terms of measurement precision. By administering test items calibrated in a way, CAT measures using item response theory may promise a means with measurement precision as well as efficiency.