Journal of Back and Musculoskeletal Rehabilitation - Volume 29, 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: Percutaneous radiofrequency (RF) rhizotomy of the medial branches of the dorsal rami from the spinal nerves is the standard treatment for cervical zygapophyseal joint mediated pain. There is a paucity of data regarding the longevity of analgesia following this procedure. OBJECTIVE: To determine the duration of complete pain relief, analgesic consumption and any adverse events following percutaneous cervical RF rhizotomy. METHODS: Retrospective chart review of patients who had undergone percutaneous cervical RF rhizotomy for zygapophyseal joint mediated neck pain. Patient reviews were undertaken by the pain consultant at 6 weeks, 6 months…and 1 year following the procedure. Where follow-up was incomplete, the patient was assumed only to have had pain relief until their last review where complete pain relief had been documented. Analgesic consumption and any adverse events were recorded. The data was analysed using Microsoft Excel® . RESULTS: At 12 months 63.64% of patients were pain free. Median duration of complete pain relief was 52 weeks. Patients who experienced pain relief had ceased using prescription analgesia by their 6 week review. There were no repeat cervical RF rhizotomies, procedure related infections or unplanned hospital admissions. CONCLUSION: Percutaneous cervical RF rhizotomy is an effective treatment for cervical zygapophyseal joint mediated neck pain.
Abstract: BACKGROUND: Spinal cord stimulation (SCS) is used for the treatment of chronic neuropathic pain, a notoriously difficult condition to treat. Failed Back Surgery Syndrome (FBSS) and Complex Regional Pain syndrome (CRPS) remain the strongest indications. Funding remains a difficult issue and the use of trial of stimulation is the traditional method of ensuring best outcomes from implantation. METHODS: A retrospective and consecutive review of 80 cases of spinal cord stimulation for patients with a diagnosis of FBSS and CRPS having undergone prior comprehensive medical management and interventional treatment with no sustained benefit. Trial of stimulation was…performed on-table and if acceptable coverage was achieved, the case proceeded to full implantation. RESULTS: The mean patient age was 50.08 years (range 28-80 years). At 12 months follow-up, thirty two patients (40%) no longer required analgesic medication. Thirty patients (37.5%) reported their pain was manageable with first line analgesics. Fourteen (17.5%) reported their pain was manageable first line analgesic and occasional tramadol or codeine. Four (5%) reported that their pain was manageable with NSAID's, paracetamol, amitriptyline, and regular codeine or tramadol. Seventeen out of eighty patients (21.25%) were unemployed before SCS implant, and at 12 months follow up eight of these patients (47.05%) had returned to work. There was no infective complications or explants. Two patients (2.53%) required one lead revision, which was successful. CONCLUSION: SCS is the most effective treatment for FBSS and CRPS, which is proven resistant to medical management. On-table trial and implantation is easy to perform with good success rate and low morbidity and if successful will reduce complication rates, especially infection.
Abstract: BACKGROUND AND OBJECTIVE: Actual studies show increasing poor posture especially in the cervical-thoracic spine. The aim of this study was to develop a model-based evaluation of posture and the amount of segmental spinal movement using a simple movement test. METHODS: Twenty-five subjects with forward head posture were recruited. We were interested in the external humeral rotation with the adduction of the shoulder, its influence on posture of the cervical thoracic spine and the evaluation of upright posture. Upright posture was determined as the change in the gradient of the trunk from forward posture to erect posture.…The kinematics of the cervical-thoracic spine and the inclination of the pelvis and thorax were measured in the sagittal plane with a motion analysis system. RESULTS: The kinematic model for the evaluation of upright posture and as a control the electromyography was presented. Correlation (Pearson r = 0.89; p < 0.01) was achieved between the gradients of the trunk in the initial and final position. CONCLUSION: The postural quality was more important than the quantity of spinal movement. Upright posture of the cervical-thoracic spine was provoked only if there was horizontal position of the pelvis and thorax. This should be considered in clinical practice.
Abstract: BACKGROUND: Lumbar open laser microdiscectomy has been shown to be an effective intervention and safe approach for lumbar disc prolapse. However early post-operative physical disability affecting daily activities have been sporadically reported. OBJECTIVE: To evaluate the feasibility of using early individualised manipulative rehabilitation to improve early post-operative functional disability following lumbar discectomy. METHODS: Randomised controlled pilot trial. Setting at a major metropolitan spine surgery hospital. Twenty-one patients aged 25-69 years who underwent lumbar microdiscectomy were randomised to either the manipulative rehabilitation treatment group or the active control group. Rehabilitation was initiated 2-3 weeks…after surgery, twice a week for 4 weeks. Each session was for 30 minutes. Primary outcomes were the Roland-Morris disability questionnaire and the visual analogue pain scale. Outcome measures were assessed at baseline and post-intervention. RESULTS: Early post-operative physical disability was improved with a 55% reduction by early individualised manipulative rehabilitation, compared to that of control care with a 5% increase. Early post-operative residual leg pain decreased with rehabilitation (55%) and control care (9%). CONCLUSION: This pilot study supports the feasibility of a future definitive randomised control trial and indicates this type of rehabilitation may be an important option for post-operative management after spinal surgery.
Keywords: Lumbar disc surgery, micro-discectomy, early post-operative disability, early post-operative residual pain, manipulative treatment, rehabilitation
Abstract: BACKGROUND: Very few studies have quantified the degree of fatigue characterized by the decline in the maximal voluntary contraction (MVC) force of the trunk extensors induced by the widely used Sørensen test. OBJECTIVE: Measure the degree of fatigue of the trunk extensor muscles induced by the Sørensen test. METHODS: Eighty young healthy subjects were randomly divided into a control group (CG) and an experimental group (EG), each including 50% of the two genders. The EG performed an isometric MVC of the trunk extensors (pre-fatigue test) followed by the Sørensen test, the latter being…immediately followed by another MVC (post-fatigue test). The CG performed only the pre- and post-fatigue tests without any exertion in between. RESULTS: The comparison of the pre- and post-fatigue tests revealed a significant (P< 0.05) decrease in MVC force normalized by body mass (-13%) in the EG, whereas a small increase occurred in the CG (+2.7%, P= 0.001). CONCLUSIONS: This study shows that the Sørensen test performed until failure in a young healthy population results in a reduced ability of the trunk extensor muscles to generate maximal force, and indicates that this test is valid for the assessment of fatigue in trunk extensor muscles.
Abstract: BACKGROUND: Little research is available concerning physical activity and its determinants in people with chronic neck pain. OBJECTIVE: To explore the relation between kinesiophobia and physical activity and gender effect on these relations in people with chronic neck pain. METHODS: Ninety-nine subjects (34 men and 65 women) with chronic neck pain were participated in the study. Pain intensity was assessed with Visual Analog Scale and kinesiophobia degree was determined by using Tampa Scale of Kinesiophobia. Level of physical activity was assessed with short form of the International Physical Activity Questionnaire. RESULTS:…There was no statistically correlation between neck pain intensity and kinesiophobia degree (p= 0.246, r= 0.123) and physical activity level (p= 0.432, r= -0.083). It was also found that kinesiophobia degree was not correlated to physical activity level (p= 0.148, r= -0.153). There was a negative correlation between kinesiophobia degree and physical activity level only for women, not for men (p= 0.011, r= -0.318). CONCLUSIONS: Our results showed that although people with chronic neck pain reported higher pain intensity and fear of movement, pain intensity and kinesiophobia degree did not associate to their physical activity levels. It can be speculated that high kinesiophobia degrees cause low physical activity levels for women, but not for men.
Abstract: OBJECTIVE: To investigate the effects of preoperative cardiac tests on the surgical treatment plan and subsequent effects on mortality in elderly patients with hip fracture. METHODS: In this retrospective study, 116 patients aged 60 years or above who underwent hip fracture surgery between 2010-2013 were evaluated. Of the patients with similar preoperative clinical risk factors, 20 patients with additional preoperative cardiac tests such as echocardiography or thalium scintigraphy constituted Group 1, whereas 28 patients without additional cardiac tests constituted Group 2. Statistical analyses were performed using the SPSS 21 statistical package software. Normal distribution of the…data was determined by the Shapiro-Wilk test and histography. Intergroup and mortality comparisons were performed by Mann-Whitney U, Yates-corrected chi-square and Fisher's exact tests. RESULTS: The mean time between fracture and operation was 6 days (range, 4-14) in Group 1, and 2 days (range, 0-3) in Group 2. There was a significant difference in time-to-operation between the groups (p< 0.001). The age and gender distribution of both groups were homomgenous (p= 0.64, p= 1.0). Both groups were comparable in terms of fracture type, treatment, and anesthesia (p= 0.36, p= 0.42, p= 1.0). At the end of 1 year, six (30%) patients in Group 1 and three (10.7%) patients in Group 2 were deceased. Both groups were comparable in terms of mortality (p= 0.137). There was a significant difference between the two groups in terms of complications (p< 0.05). CONCLUSIONS: Unnecessary cardiac tests in elderly patients with hip fracture led to a delay in their surgery, yet did not change their cardiac treatment plan. This delay in obtaining hip fracture surgery increases complication rates, hospitalization duration, and costs.
Abstract: BACKGROUND: Low back pain (LBP) is a common complaint in the postnatal period. Physiotherapy has many techniques to apply for such cases. OBJECTIVE: To investigate the effect of central postero-anterior (PA) lumbar mobilization on muscle activity in postpartum LBP. METHODS: Forty-five females with chronic LBP at least three months postnatal. Participants divided randomly and equally into three groups. Group A (Study group) received PA lumbar mobilization plus traditional treatment which consisted of Ultrasonic and Infra-red. Group B (Placebo group) received placebo mobilization plus traditional treatment. Group C (Control group) received traditional treatment only.…All patients received 3 sessions/week for 4 weeks. Pain intensity, functional disabilities and Surface EMG for recording para spinal muscle activity were measured before and after intervention. Statistical analysis was done by ANOVA and paired t-test. RESULTS: Central PA mobilization showed a significant reduction (P< 0.05) in the average surface EMG activity of the erector spinae musculature compared with the other groups as well as improvement in functional ability and reduction in pain intensity. CONCLUSION: A central PA mobilization significantly reduced pain intensity and surface EMG activity of erector spinae musculature as well as improvement in functional ability in mechanical low back pain in postnatal females.
Keywords: Mechanical low back pain, mobilization, postpartum, electromyography
Abstract: BACKGROUND AND OBJECTIVES: Decreased activity of hip abductor musculature has been suggested as a contributing factor for the disease progression in participants with symptomatic knee osteoarthritis (OA). In this study, the effectiveness of 6 weeks isolated hip abductor strengthening on WOMAC, 6 minute walk test and hip strength and endurance in participants with symptomatic medial compartment knee OA were studied. MATERIAL AND METHOD: Thirty persons with medial compartment knee OA were randomized to hip abductor strengthening group (n = 15) and conventional group (n = 15). Both the groups received intervention for 5…times per week for 6 weeks. 6 minute walk test, health status (WOMAC), hip strength (by modified syphgmomanometer) and hip endurance (number of repetitions) were assessed at baseline and post intervention. The dependent variables were analyzed using 2 × 2 ANOVA, with repeated measurement as second factor to determine the effects of the intervention on each outcome variable. RESULTS: Significant group-by-time interactions were observed for each variable of interest. Post hoc testing revealed that all the outcome measures improved significantly in the hip abductor strengthening group following the 6-week intervention than the control group. CONCLUSION: The incorporation of hip-strengthening exercises may be considered along with conventional exercises when designing a rehabilitation program for persons with knee OA.
Keywords: Knee, osteoarthritis, muscle strength, health status
Abstract: BACKGROUND: Conservative treatments have been proved to be effective to control pain and optimize function in fibromyalgia, however there is need for scientific evidence to make better clinical application across various physiotherapy applications. OBJECTIVE: The aim of this study was to investigate the effects of Laser and taping applications on pain, flexibility, anxiety, depression, functional status and quality of life in patients with fibromyalgia syndrome. METHODS: Forty-five female patients with fibromyalgia syndrome were included to the study and randomly allocated into three treatment groups; Laser (n= 15), placebo Laser (n= 15), and taping…applications (n= 15). Visual analogue scale for pain intensity, trunk flexibility, Fibromyalgia Impact Questionnaire for functional status, Short Form 36 Questionnaire for quality of life and health status, and Beck Depression Inventory for anxiety level were evaluated before and after three weeks interventions. RESULTS: There were decreased pain severity in activity (p= 0.028), anxiety level (p= 0.01) and improved general health status, quality of life (p= 0.01) found at Laser group, whereas there were increased trunk flexibility, flexion (p= 0.03), extension (p= 0.02) found at taping group. After interventions, there were decreased pain severity for whole groups at night for Laser group (p= 0.04), placebo Laser group (p= 0.001), taping group (p= 0.01) and improved functional status found for Laser group (p= 0.001), placebo Laser group (p= 0.001), taping group (p= 0.01). CONCLUSIONS: Kinesiotape application had a similar effect on parameters in FMS patient, so this method could be preferred instead of Laser application for rehabilitation program.
Keywords: Fibromyalgia, Laser therapy, quality of life