Journal of Back and Musculoskeletal Rehabilitation - Volume 28, issue 2
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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: Objectives: The aim of the present study was to evaluate the symptomatic effects of glucosamine sulphate (GS) in comparison to the exercise therapy, as well effects on Magnetic Resonance Imaging (MRI) findings of cartilage loss in patients with knee osteoarthritis (OA). Materials and Methods: Seventy patients with a diagnosis of knee OA were randomly divided into two groups. First group of patients (n = 40 ) were treated with 1500 mg/day oral glucosamine sulphate and the second group (n = 30 ) performed a home exercise program for a period of 6 months.…Results: Compared with baseline, significant improvements were observed in the visual analogue scale pain scores and the Western Ontario and McMaster Universities osteoarthritis index and 20-min walking time in both groups (p < 0.001 ); there were no significant differences between the two treatment groups. Upon the evaluation of joint cartilage thickness by MRI, an improvement was evident in only in the area of medial femoral condyle of patients who had performed a home exercise program (p < 0.05 ). Conclusion: The results of the present study suggest that both oral GS treatment and exercise therapy are efficient in the symptomatic treatment of patients with knee OA. However, exercise therapy found to have a better chondroprotective effect than oral GS treatment in this patient population.
Abstract: Objective: The purposes of this study were to determine the reliability and validity of two clinical measurements of cervical lordosis and to compare these measurements of individuals with cervical spine symptoms to those of asymptomatic individuals. Methods: Fifty-seven participants were recruited for the study: 18 following cervical fusion, 20 with neck pain and no surgery, and 19 with no neck pain. Cervical lordosis was measured using a flexible ruler (flexirule) and a modified bubble inclinometer. Intertester and intratester reliability were calculated for both methods. Validity was assessed by correlating measurements taken using both methods to Cobb angles between…C2 and C7 on lateral view radiography of the participants in the cervical fusion and the neck pain groups. Results: Intraclass correlation coefficients (ICCs) revealed good intratester reliability for both methods. Intertester reliability was fair for the flexirule method but good for the inclinometer method. Pearson correlations with radiographic angles were poor for both methods. ANOVAs showed no significant difference in cervical lordosis measurements between asymptomatic and symptomatic groups. Conclusion: Although both the flexirule and inclinometer methods are reliable, neither method correlated with the Cobb angle on the radiography, suggesting these methods may measure different aspects of cervical spine alignment.
Abstract: Background: We previously demonstrated short length of rest with a cervical orthosis obtained a decreased tendency for neck or shoulder pain, neck stiffness, and impairment of cervical alignment after cervical laminoplasty. Postoperative maintenance of cervical motion may result in intervertebral instability and poor surgical outcomes. Objective: The purpose of this study was to compare the postoperative fusion rate, range of motion (ROM), vertebral listhesis, and surgical outcomes with the duration of rest with a cervical orthosis. Methods: We conducted cervical laminoplasty on 66 patients with spondylotic myelopathy. All patients were followed for at least two years.…Patients remained in bed for two weeks and wore a cervical orthosis for eight weeks postoperatively, postoperative bed rest for seven days and use of an orthosis for four weeks, or postoperative bed rest for five days followed by use of an orthosis for two weeks were assigned. Results: Long rest with a cervical orthosis produced multiple unions and limitation of cervical ROM, resulting in postoperative neck pain. Short rest maintained motion at multiple disc levels. There was no marked difference in neurogenic outcomes between short and long rest. Conclusions: A short rest period with a cervical orthosis is recommended to maintain cervical motion free from neck pain.
Abstract: Background and Objective: The amount of postural sway and sagittal deviation of lumbar lordosis angle in measurements of standing lumbar curvature obtained by flexible curve can be decreased when using a spine stabilizer instrument. However, this assumption has not been investigated so far. This study aims to determine the effect of using a spine stabilizer instrument on the validity, reliability, and standard errors of measurement of flexible curve in the standing lumbar curvature measurements. Material and Method: Thirty-four volunteer men aged between 19 and 30 years participated in the study By using a 50-cm flexible curve, with and…without spine stabilizer instrument, and a lumbar simple lateral radiograph (LSLR), the standing lumbar curvature was measured by three methods for each subject. These methods were called A, B and C, respectively. Results: By using the Pearson’s correlation analysis at significance level of 0.05, the coefficient of correlation between standing lumbar curvature measurements in methods A and B with C were 0.95 and 0.84, respectively. In addition, the intraclass correlation coefficient for methods A and B were 0.94 and 0.79, respectively. Also, results of the one-way analysis of variance for comparison of pairs indicated a significant difference in the mean values of standing lumbar curvature angles between methods B and C. Conclusions: Results indicated the flexible curve was an appropriate instrument for standing lumbar curvature measurements. Using spine stabilizer instrument to control postural sway increases the validity and reliability of flexible curve method and decreases its standard errors of measurement.
Abstract: Background: Measuring isometric strength is necessary in many areas of health and sport. However, trunk muscles have some particular characteristics that make them difficult to evaluate with simple, inexpensive instruments. Objective: To evaluate the reliability and validity of an instrument constructed with a hand-held dynamometer and a metallic structure (HHD+S) for measuring maximum isometric voluntary trunk muscle strength. Methods: Maximum isometric voluntary trunk muscle strength (extension, flexion and lateral flexion) was measured in 20 healthy individuals using the custom-made instrument (HHD+S) and the gold standard Back-Check (BC). Results: The results showed that the two…instruments had high and similar intra-subject reliability. The validity of the HHD+S was demonstrated by the high Pearson coefficient correlation between the two instruments (r ⩾ 0.78 ). Conclusions: Given the good trial reliability and the close correlation between the two instruments, we believe that the use of a hand-held dynamometer together with the custom-made metallic structure (HHD+S) allows an evaluation of the maximum isometric voluntary trunk muscle strength to be made, that is very similar in quality, accuracy and reliability to the BC.
Keywords: Maximum voluntary contraction, back strength, dynamometer, custom-made instrument
Abstract: Objective: There were gender differences regarding lower extremity kinematics. The purpose of this study was to investigate three-dimensional kinematics of lower extremity for young Chinese during daily activities and to identify gender differences in lower extremity kinematics. Methods: Lower extremity motions of 40 healthy volunteers (20 males and 20 females) were recorded while each subject performing each of three daily activities (walking, jogging, and deep squatting). The spatiotemporal parameters (speed, cadence and step length) and 3D joint kinematics (peak angles and mean range of motions) were compared with previous results and within gender group. Independents t-tests were used…to test statistical significance (p < 0.05 ). Results: Statistical analysis suggested that there was no gender difference in sagittal plane motions at the hip, knee and ankle joints, while females displayed greater non-sagittal plane joint motions compared to their male counterparts. Conclusions: The outcomes of this study added basic understanding of joint biomechanics during daily activities of Chinese and provided a basis for comparison to patients with various joint diseases.
Keywords: Daily activities, kinematics, gender difference, deep squatting
Abstract: Background: Patellofemoral osteoarthritis (PFOA) is associated with pain and decreased self-reported function. The impact of PFOA on actual physical performance is currently unknown. Objective: To investigate the impact of PFOA on physical performance and pain. Methods: Eight participants aged 40–65 years with bilateral, symptomatic, radiographic PFOA and 7 age- and gender-matched pain-free control participants without radiographic PFOA were studied. Physical performance was measured with the Timed-Up-and-Go (TUG) and 50-foot Fast-Paced-Walk (FPW) tests. Dependent variables included time to complete the TUG and FPW; pretest-posttest change in pain intensity (TUG and FPW); and self-reports of perceived knee pain,…stiffness, and physical function. Data were analyzed with nonparametric statistics. Results: The PFOA group TUG time was longer than the control group (p = 0.01 ). No difference between groups was found for FPW time. Pretest-posttest pain increased for the TUG and FPW in PFOA participants (p < 0.05 ). The PFOA group reported greater knee pain, stiffness, and less physical function than controls (previous 48 hours) (p < 0.01 ). Conclusions: Symptomatic, radiographic PFOA is associated with increased pain during the TUG and FPW tests and longer time required to complete the TUG. The TUG may be a more sensitive test of physical performance in PFOA.
Abstract: Background and Objectives: Low back pain (LBP) is a complaint of great importance among the elderly due to its significant impact on function. LBP could contribute to changes in the regulatory process of inflammatory mediators observed in elders. The aim of this study was to compare plasma levels of interleukin(IL)-6, soluble tumor necrosis factor receptor 1(sTNF-R1), and functionality among 3 groups of elderly women: GI, with LBP; GII, without LBP but reports of other pain; and GIII, without any reported pain. Material and Method: This was an observational study of a subsample of the international Back Complaints in…the Elders cohort study. IL-6 and sTNF-R1 were measured using the enzyme-linked immunosorbent assay. Functionality was assessed using the Timed Up and Go, gait speed and Roland Morris Disability Questionnaire; and pain, using the numerical pain scale. Results: Two hundred and thirteen women aged 71.35 ± 4.76 years were included. GI presented the highest sTNF-R1 levels (p = 0.016 ), worst TUG performance (p < 0.001 ) and slowest gait speed (p < 0.01 ) compared to GII and GIII, which were similar (p > 0.05 ). No difference was found between the IL-6 plasma levels in any of the groups. Conclusion: Elderly women with LBP had the highest sTNF-R1 plasma levels and the worst functional performance compared to elderly women with reports of other pain (not LBP) or no pain.
Keywords: Aged, BACE, cytokines, functional performance, low back pain
Abstract: Objectives: This study investigated the self-reported prevalence and impact of low back pain (LBP) during pregnancy in primiparous and multiparous women, and their treatment-seeking rationales and experiences, including their use of physiotherapy. Methods: A sample of 105 post-partum women was recruited. All participants answered a questionnaire; women who experienced LBP during pregnancy (n = 71 ) continue in the study and later they were also interviewed. Content analysis, descriptive and inferential statistics were used to analyse the data. Results: Reports of LBP were common (n = 71 ; 67.6%) and slightly more…frequent in primiparous (n = 40 ; 56.3%) than multiparous (n = 31 ; 43.7%) women. Multiparous women with LBP were significantly older (p < 0.001 ) and reported more sleep disturbances (p = 0.026 ) than primiparous women with LBP. LBP prevented women performing their daily activities (n = 41 ; 57.7%) and worsened with the advance of pregnancy (n = 55 ; 77.5%), yet 93.0% (n = 66 ) of these women received no treatment. Conclusion: LBP is a prevalent and important clinical condition affecting the daily life of many pregnant women. Nevertheless, few women seek any treatment and physiotherapy is rarely considered. Given the significant impact on quality of life, health professionals need to be proactive in asking women about LBP.
Keywords: Low back pain, pregnancy, multiparous, primiparous, physiotherapy
Abstract: Background and Objective: Forward bending is frequently performed in daily activities. However, excessive lumbar flexion during forward bending has been reported as a risk factor for low back pain. Therefore, we examined the effects of an exercise strategy using a stick on the angular displacement and movement onset of lumbar and hip flexion during forward-bending exercises in patients with lumbar flexion syndrome. Methods: Eighteen volunteers with lumbar flexion syndrome were recruited in this study. Subjects performed forward-bending exercises with and without a straight stick in standing. The angular displacement and movement onset of lumbar and hip flexion during…forward-bending exercises were measured by using a three dimensional motion analysis system. The significances of differences between the two conditions (with stick vs. without stick) was assessed using a one-way repeated analysis of variance. Results: When using a stick during a forward-bending exercise, the peak angular displacement of lumbar flexion decreased significantly, and those of right and left-hip flexion increased significantly compared with those without a stick. The movement onset of lumbar flexion occurred significantly later, and the onset of right-hip flexion occurred significantly earlier with than without a stick. Conclusions: Based on these findings, a stick exercise was an effective method to prevent excessive lumbar flexion and more helpful in developing hip flexion during a forward-bending exercise. These findings will be useful for clinicians to teach self-exercise during forward bending in patients with lumbar flexion syndrome.