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: Myofascial pain syndrome (MPS) which is an important cause of musculoskeletal pain has shown a dramatic increase in recent years. OBJECTIVES: We aimed to evaluate the efficacy of intramuscular electrical stimulation therapy (IMS) and low-level-laser-therapy (LLLT) in patients with MPS. METHODS: Patients were randomly divided into three groups. First group were treated with LLLT and stretching exercise. Second group were treated with IMS and stretching exercise. Third group were treated with only streching exercise. The patients were evaluated through the pain intensity, pain threshold, cervical joint movement range and the neck disability index parameters.…RESULTS: An improvement was found in all parameters for all groups, except for the pain threshold within the control group at the end of the treatment and one month after the treatment. It was found that pain score was significantly lower in Group 1 and 2 at one month after the treatment compared to Group 3. Similarly, it was found that pain threshold score was significantly higher in Group 2 at one month after the treatment compared to Group 3. CONCLUSIONS: In this study we observed that both LLLT and IMS treatments added on to stretching are effective in improving pain parameters in patients with MPS.
Abstract: BACKGROUND AND OBJECTIVES: The physical injuries caused by +Gz include skeletal-muscle overloads. This study has aimed at demonstrating ergonomic conditions of the pilots from the Brazilian Air Force’s Aerial Demonstration Squadron (BAFADS) during flight. METHODS: All the 13 pilots from the BAFADS were evaluated through an interview. Surface electromyography (SEMG) was employed during the flight manoeuvre simulation (under normal and overload conditions). RESULTS: The report analyses showed perception of discomfort in the right shoulder related to +Gz. The SEMG showed moderate levels of shoulder muscles activation for normal contractions (± 25%). During vigorous contraction, levels of…recruitment were high: upper trapezius fibres (± 105%), middle trapezius fibres (± 90%) and posterior deltoid fibres (± 95%). The great demand from the deltoid muscles (posterior fibres) infers a very high level of recruitment from the rotator cuff muscle, which may explain the discomfort in the pilots’ shoulder during the flight manoeuvre. CONCLUSION: The mutual analysis of both methods not only does it demonstrate a correlation between symptoms and muscle recruitment, but also provides data to implement intervention measures for pilots’ physical training in order to minimise the discomfort symptoms during flights.
Abstract: BACKGROUND AND OBJECTIVE: Systematic repetition or prolonged posture in specific postures adopted during training could generate modifications on the sagittal spinal curvatures. Spinal alteration in its physiologic curvatures in the sagittal plane has been associated with predisposition to spinal disorders. The objective was to evaluate and compare the changes produced on the sagittal thoracic and lumbar spinal curvatures, and pelvic tilt from standing posture on the floor to upper, middle, lower and aerodynamic handlebars postures adopted on their own road bicycles. MATERIAL AND METHOD: A total of twenty-eight male professional cyclists (179.92 ± 5.78 cm; 67.18 ± 5.74…kg) participated in the study. Cyclists had an experience of 17.22 ± 6.16 years in cycling, and spent 6.52 ± 0.51 days per week and 3.78 ± 0.61 hours per day training on their bicycles. Sagittal spinal curvatures (thoracic and lumbar) and pelvic tilt were measured in the standing position on the floor and while sitting on a bicycle with different handlebar-hand positions (high, middle, low and aerodynamic) using a Spinal Mouse system. RESULTS: The thoracic spine showed significantly greater angular values while in a standing posture than on the bicycle in all handlebar-hands postures evaluated. The lumbar curvature changed from lordosis (negative values – anterior convexity) in standing posture to kyphosis (positive values – posterior convexity) in all handlebar-hands positions on the bicycle. The aerodynamic handlebar positions showed the greatest lumbar flexion (lumbar kyphosis) and anterior pelvic tilt. CONCLUSIONS: Professional cyclists passively maintain their thoracic spine straighter on the bicycle due to handlebar-hands support than in standing posture. However, the lumbar spine is flexed on the bicycle in all handlebar-hands evaluated. The pelvis is modified to greater anterior pelvic tilt when the handlebar-hands position is farther and lower regarding the saddle of the bicycle.
Abstract: Myofascial pain is a major cause of musculoskeletal regional pain. Myofascial pain, which is a high-prevalence but eminently treatable condition, is almost universally underdiagnosed by physicians and undertreated by physical therapy modalities. Large numbers of patients can be left suffering in chronic pain for years. Dry needling, also referred to as Intramuscular Stimulation, is a method in the arsenal of pain management which has been known for almost 200 years in Western medicine, yet has been almost completely ignored. With the increase in research in this field over the past two decades, there are many high-quality studies that demonstrate dry…needling to be an effective and safe method for the treatment of myofascial pain when diagnosed and treated by adequately-trained physicians or physical therapists. This article provides an overview of recent literature regarding the treatment of myofascial pain syndrome, evidence for the efficacy of dry needling as a central component of its management, and a glimpse at developments in recent imaging methods to aid in the treatment of these problems.
Keywords: Myofascial pain syndrome, dry needling, intramuscular stimulation, trigger point
Abstract: BACKGROUND: Inter-rater reliability of generalised lumbar extensor muscle CSA has been identified, however, more detailed reliability metrics of individual trunk muscles are lacking. OBJECTIVE: To report muscle volume and muscle fatty infiltrate (MFI) inter-rater reliability of individual trunk muscles between two novice assessors. METHODS: Lumbar axial MRI scans from 10 healthy male participants were analysed. The muscles erector spinae (ES), multifidus (M), rectus abdominis (RA), and psoas (PS) were manually traced, region of interest quantified and muscle volume and MFI determined by both assessors. Agreement between the assessors was determined using intraclass correlation coefficients (3,1), Bland-Altman…plots and Lin’s concordance coefficient. RESULTS: Good to excellent agreement was found for volume (ICC 0.77–0.96) and MFI (0.84–0.96) for all muscles on first evaluation, except for M volume, which required a second evaluation. Best agreement for muscle volume and MFI was found for ES (ICC 0.96). CONCLUSIONS: First evaluation of muscle volume and MFI yields high to excellent inter-rater agreement, except for M, where further training and/or experience is required to achieve acceptable reliability outcomes. This may have clinical implications due to the relevance of M atrophy reported in patients with low back pain.
Abstract: BACKGROUND AND OBJECTIVES: It is possible to increase multi-directional trunk stability using co-activation. However, it is unclear whether there is a preference for left or right trunk rotation after intensive unilateral stability training. The aim of this study was to examine the directional preference in trunk rotational stability after unilateral core training. MATERIAL AND METHOD: This study was conducted on 16 female basketball players. For eight weeks, eight participants performed unilateral core training that focused on one side of the trunk. The remaining eight participants were not provided any additional training. To determine rotational trunk stability, all participants…were requested to maintain an upright sitting posture against sudden, external, left or right rotational perturbations of the trunk. Angular displacement of the trunk was measured using a motion analyzer. RESULTS: At the end of the training period, the angular displacement in response to the perturbation was reduced for both rotational directions (left: − 26 % , right: − 24 % ) in the trained group (p < 0.05 ). CONCLUSION: This study showed that trunk stability improved without particular directional preference in response to unilateral core training. This result adds to our understanding of the nature of trunk stability and multi-directional improvement. LEVEL OF EVIDENCE: Intervention study, Level 1b.
Abstract: Osteopetrosis is a rare genetic disorder caused by osteoclast failure. Dominant negative mutations of the ClCN7 gene cause the so-called, autosomal dominant osteopetrosis type II, which represents the most frequent and heterogeneous form of osteopetrosis, ranging from asymptomatic to intermediate-severe, thus suggesting additional genetic and environmental determinants affecting penetrance. Here, we present a case a 46 year-old woman complained low back pain for 15 years. The patient lacked any history of direct trauma and her pain was radiating to her left leg, increasing with physical activity, she had no pain at nights. The patient was diagnosed with autosomal dominant osteopetrosis…on the basis of the presence of typical radiological appearance. Were present a case report of osteopetrosis type II (an autosomal dominantly inherited disease) as a cause for low back pain without any familial penetrance of the disease.
Keywords: Autosomal dominant osteopetrosis, low back pain