Journal of Back and Musculoskeletal Rehabilitation - Volume 29, issue 1

Authors: Duff, Patricia | Das, Basabjit | McCrory, Connail

Article Type: Review Article

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. Show more

Keywords: Zygapophyseal joint mediated neck pain, cervical rhizotomy

DOI: 10.3233/BMR-150597

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 1-5, 2016

Authors: Gopal, Hari | Fitzgerald, Joseph | McCrory, Connail

Article Type: Review Article

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. Show more

Keywords: CRPS, FBSS, spinal cord stimulation

DOI: 10.3233/BMR-150608

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 7-13, 2016

Authors: Jelínková, Ivana | Řorfová, Monika | Wagner, Heiko | Puta, Christian

Article Type: Research Article

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. Show more

Keywords: Postural examination, upright posture, measurement, kinematic analysis, electromyography

DOI: 10.3233/BMR-140568

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 15-21, 2016

Authors: Kim, Byungho J. | Ahn, Junghoon | Cho, Heecheol | Kim, Dongyun | Kim, Taeyeong | Yoon, Bumchul

Article Type: Research Article

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. Show more

Keywords: Lumbar disc surgery, micro-discectomy, early post-operative disability, early post-operative residual pain, manipulative treatment, rehabilitation

DOI: 10.3233/BMR-150591

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 23-29, 2016

Authors: Demoulin, Christophe | Boyer, Mathieu | Duchateau, Jacques | Grosdent, Stéphanie | Jidovtseff, Boris | Crielaard, Jean-Michel | Vanderthommen, Marc

Article Type: Research Article

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. Show more

Keywords: Isometric exercise, spinal muscles, fatigability, muscle endurance, low back pain

DOI: 10.3233/BMR-150592

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 31-40, 2016

Authors: Demirbüken, İlkşan | Özgül, Bahar | Kuru Çolak, Tuğba | Aydoğdu, Onur | Sarı, Zübeyir | Yurdalan, Saadet Ufuk

Article Type: Research Article

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. Show more

Keywords: Kinesiophobia, physical activity, chronic neck pain, gender

DOI: 10.3233/BMR-150594

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 41-47, 2016

Authors: Mutlu, Harun | Bilgili, Fuat | Mutlu, Serhat | Karaman, Ozgur | Cakal, Beytullah | Ozkaya, Ufuk

Article Type: Research Article

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. Show more

Keywords: Cardiac tests, hip fracture, mortality

DOI: 10.3233/BMR-150595

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 49-54, 2016

Authors: Kamel, Dalia M. | Raoof, Neveen A. Abdel | Tantawy, Sayed A.

Article Type: Research Article

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. Show more

Keywords: Mechanical low back pain, mobilization, postpartum, electromyography

DOI: 10.3233/BMR-150598

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 55-63, 2016

Authors: Singh, Shreya | Pattnaik, Monalisa | Mohanty, Patitapaban | Ganesh, G. Shankar

Article Type: Research Article

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. Show more

Keywords: Knee, osteoarthritis, muscle strength, health status

DOI: 10.3233/BMR-150599

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 65-75, 2016

Authors: Vayvay, Emre Serdar | Tok, Damla | Turgut, Elif | Tunay, Volga Bayrakci

Article Type: Research Article

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. Show more

Keywords: Fibromyalgia, Laser therapy, quality of life

DOI: 10.3233/BMR-150600

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 77-83, 2016

Authors: Lee, Mi-Young | Kim, Seong-Gil | Lee, Hae-Yong

Article Type: Research Article

Abstract: We attempted to investigate the effect of cervical stabilization exercise for a period of 5 weeks on active joint position sense in healthy young adults. Twenty-four subjects were randomly assigned to either the exercise group or the control group. The exercise group performed cervical stabilization exercise during the 5-week period. Cervical active joint position sense was measured using the head repositioning accuracy test. The result showed a positive interaction between time and group in the left and right rotation, flexion, and extension. Cervical stabilization exercise significantly improved the sense for four position senses in the exercise group (p< 0.05). However, …there was no difference in the four position senses in the control group (p> 0.05). In conclusion, we suggested that cervical stabilization exercise leads to improvement in accuracy of the joint position sense. Show more

Keywords: Cervical stabilization exercise, joint position sense, proprioception

DOI: 10.3233/BMR-150601

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 85-88, 2016

Authors: Picelli, Alessandro | Negrini, Stefano | Zenorini, Andrea | Iosa, Marco | Paolucci, Stefano | Smania, Nicola

Article Type: Research Article

Abstract: BACKGROUND: To date etiology of adolescent idiopathic scoliosis appears complex and still remains unclear. A distorted body schema has been proposed to be a part of a sequence of pathological events in the development of adolescent idiopathic scoliosis. OBJECTIVE: To investigate the awareness of trunk misalignment in adolescents with idiopathic scoliosis. METHODS: Information about 44 adolescents with idiopathic scoliosis was collected as follows: age; sex; handedness; family history of scoliosis; back pain; sport practice; shoulder and waist line symmetry; leg length; dorsal kyphosis; back hump; rehabilitation; scoliotic curve; Risser sign. We evaluated awareness …of trunk misalignment with a graphic table displaying pictures of progressively increasing scoliotic curves. Patients were asked to indicate which picture corresponded to their perceived own spinal alignment. RESULTS: Patients with thoracolumbar scoliosis overestimated their actual thoracic spine curve. Patients with thoracic-thoracolumbar scoliosis underestimated their actual thoracolumbar spine curve and overestimated their actual lumbar spine curve. Scoliotic curve > 15°, double curve, younger age, back pain, family history of scoliosis and lower Risser score related with a misperception of trunk alignment. CONCLUSIONS: Our results support the hypothesis that adolescents with idiopathic scoliosis have an altered corporeal awareness of their trunk alignment. Show more

Keywords: Body schema, body image, corporeal awareness, consciousness, rehabilitation

DOI: 10.3233/BMR-150602

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 89-96, 2016

Authors: Kim, Chang-Yong | Choi, Jong-Duk

Article Type: Research Article

Abstract: BACKGROUND: It is important to establish the effective evaluation approaches that are appropriate for measuring ankle proprioception. But, only a few studies used more than one test procedure simultaneously to identify proprioceptive deficits. Further, no data are available on the correlations between the measures of ankle proprioception and postural sway (PS) test in subjects with functional ankle instability (FAI). OBJECTIVE: The aim of this study was to identify the relationship between ankle proprioception measurements and PS test in subjects with FAI. METHODS: Of the 79 subjects enrolled in the case-control study, 40 had …FAI and 39 were control subjects. Ankle proprioception was evaluated by the angle reproduction (AR), force matching (FM), and the muscle reaction (MR) to sudden ankle inversion tests. For the AR and FM tests, absolute errors (AE) of ankle plantarflexion, dorsiflexion, inversion, and eversion directions were calculated. For the MR test, reaction times and activation of tibialis anterior (TA), peroneus longus (PL), and peroneus brevis (PB) muscles were measured during sudden ankle inversion with a 30° tilting angle. The PS test was investigated by using a force platform during single-limb standing test. Three trials were performed and averaged in each test. RESULTS: Reaction time of the PL (p = 0.006), a variable of MR test, and plantarflexion (p = 0.001, p = 0.009) and eversion (p = 0.016, p = 0.039) error variables of the AR and FM tests differed significantly between the control and FAI groups. Moreover, these variables (r = -0.381 ∼ 0.788, p < 0.05) showed strong significant correlations with the PS test-related variables, among others. CONCLUSIONS: The findings suggest that these variables of ankle proprioception measurements were more sensitive and discriminative than others, and could be useful to assess ankle instability, particularly if the method is to be applied in clinical studies and laboratory settings. Show more

Keywords: Ankle proprioception, correlation, functional ankle instability, postural sway

DOI: 10.3233/BMR-150603

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 97-107, 2016

Authors: Abaraogu, Ukachukwu Okoroafor | Ugwa, Wisdom Onyedikachi | Onwuka, Ezinne | Orji, Ebubechukwu

Article Type: Research Article

Abstract: BACKGROUND/AIM: Backpack effect posture, walking and physiological costs but there is dearth of literature on effects of backpack strap (1 versus 2 straps) on gait and perceived exertion among young adults. We determined the influence of type of backpack shoulder strap on gait parameters and perceived exertion of young adults in a free-living normal walking speed. METHODS: Twenty-five young adults with a mean age of 22 years underwent a self-selected normal speed walking for six minutes each under 3 testing conditions: without a backpack; with 1 strap; and with 2 straps. Selected gait parameters and perceived …exertion were assessed. RESULTS: There were no significant difference in stride length, stride time, step length, step time, gait speed, and cadence among the three walking conditions. However, perceived exertions were significantly higher when the backpack was carried with 15% irrespective of 1 strap or 2 straps. CONCLUSION: Momentary carriage of a backpack either on 1 strap or 2 straps does not appear to influence gait phases. However, this short bout of normal walking appear to increase perceived exertion in young adults irrespective of whether the backpack is wore on single or double shoulder strap. Show more

Keywords: Backpack load, backpack strap, young adults, perceived exertion, human gait

DOI: 10.3233/BMR-150605

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 109-115, 2016

Authors: Çınar-Medeni, Özge | Atalay Guzel, Nevin | Basar, Selda

Article Type: Research Article

Abstract: BACKGROUND: Single-limb postural stability is a key component of lower extremity functional status. Factors affecting postural stability should be well defined to prevent injuries. OBJECTIVE: The aim of this study was to investigate the effect of the hallux valgus angle on postural stability in asymptomatic subjects. METHODS: A total of 19 subjects were included in the study. The hallux valgus angle and postural stability were assessed. Participants were assigned to two groups according to whether the hallux valgus angle was pathological or not. A hallux valgus angle greater than 15 degrees was accepted …as pathological. The relationship between the hallux valgus angle and postural stability, and the differences in postural stability scores between the two groups were analyzed. Postural stability was assessed with a stabilometer. The test was performed with the eyes open. RESULTS: We found a significant correlation between the hallux valgus angle and mediolateral and overall stability index (r= 0.484, p= 0.036; r = 0.463, p= 0.046 respectively). Subjects with a pathological mild hallux valgus angle had greater stability index scores than normal subjects (p< 0.05). CONCLUSIONS: A mild hallux valgus angle has negative effects on postural stability as a forefoot deformity. This deformity should be taken into account for injury prevention strategies in pain-free younger adults. Show more

Keywords: Hallux valgus, postural balance, younger adults

DOI: 10.3233/BMR-150606

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 117-121, 2016

Authors: Mello, Roger Gomes Tavares | Carri, Igor Rodrigues | da Matta, Thiago Torres | Nadal, Jurandir | Oliveira, Liliam Fernandes

Article Type: Research Article

Abstract: BACKGROUND: Muscle activity is studied during trunk stabilization exercises using electromyograms (EMG) in time domain. However, the frequency domain analysis provides information that would be important to understand fatigue process. OBJECTIVE: To assess EMG of lumbar multifidus (LM) and erector spinae (ES) muscles, in time and frequency domains, during back bridge exercise. METHODS: Nineteen healthy young men performed the exercise for one minute and EMG was monitored by surface electromyography. Normalized root mean square (RMS) value and spectral median frequency (MF) were compared between beginning and final epochs of test. The dynamics of …the MF during whole test was also obtained by short-time Fourier transform. RESULTS: RMS values were about 30% of maximum voluntary contraction, and LM muscle showed greater MF than ES, which did not decrease at the final of exercise. However, the slope of MF was significant mainly for LM. CONCLUSIONS: Muscle activation of 30% is sufficient to keep lumbar stability and is suitable to improve muscular endurance. The significance of MF slope without decreasing at the final of exercise indicates challenging muscular endurance without imply on high fatigability. Due to lower muscular demand, this exercise might be recommended for trunk stabilizing for low back pain patients. Show more

Keywords: Back muscles, electromyography, exercise therapy, rehabilitation

DOI: 10.3233/BMR-150607

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 123-133, 2016

Authors: Öncü, Jülide | Ilişer, Reşat | Kuran, Banu

Article Type: Research Article

Abstract: BACKGROUND: Psychosocial risk factors are very important in the development of chronicity in low back pain. And Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) is the screening instrument concerning these psychosocial and work-related risk factors in patients with low back pain. OBJECTIVE: The purpose of the study was to evaluate the reliability and construct validity of Turkish version of the ÖMPQ in patients with low back pain. METHODS: Turkish ÖMPQ was developed using the ``forward-backward translation'' method. It was administered to 120 working Turkish patients with acute-subacute low back pain. Test-retest reliability was assessed by …intraclass correlation coefficients and internal consistency was assessed by Cronbach's alpha. Concurrent construct validity was evaluated by correlating the ÖMPQ with Oswestry Disability Index (ODI), fear avoidance beliefs questionnaire (FABQ), clinical and demographical variables and assessed with principal component analysis. RESULTS: The Turkish versions was re-tested for 110 patients with acute-subacute low back pain. Test-retest reliability was high with intraclass correlation coefficients of 0.93. Internal consistency was 0.96. The ÖMPQ score correlated highly (r> or = 0.60) with VAS-pain, ODI and sick-leave days; moderately (0.30 < r < 0.60) with FABQ and weakly (r< 0.30) with duration of pain and Schober test. Principal-components analysis revealed 3 factors explaining 43% of the variance. ÖMPQ had moderate predictive validity (AUC: 0.66; 95% CI 0.54; 0.81) in identifying patients with spinal pain that were under risk of long-term sick leave (> 15 days). The sensitivity was 0,54 and the specificity was 0.97. CONCLUSION: Turkish version of ÖMPQ is a valid, reliable, and acceptible instrument among Turkish working population with low back pain. Show more

Keywords: Low back pain, validation studies, sick-leave

DOI: 10.3233/BMR-150609

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 135-143, 2016

Authors: Ghizal, Fatima | Das, Siddharth Kumar | Verma, Narsingh | Mahdi, Abbas Ali

Article Type: Research Article

Abstract: Cytokines (TNF-α and IL-6) levels are reported to be perturbed in Fibromyalgia syndrome (FMS) patients. Moreover, Body Mass Index (BMI) may also be related to disturbed cytokines level. Therefore, the present study was planned to evaluate the levels of cytokines and to correlate them with BMI and Fibromyalgia Impact Questionnaire Revised (FIQR) in female FMS patients (n= 60) and control group (n= 60). 4 ml of blood samples were taken from both the group of patients and controls to measure the levels of IL-6 and TNF-α . Symptoms of FMS were assessed by FIQR. BMI was calculated by a …standard formula of weight in kilograms divided by height in meter square. There were significant differences in BMI levels in FMS patients than in control group. However, no significant association was found between BMI and TNF-α levels, and BMI and IL-6 levels in patient and control groups. However, a significant association was found between FIQR and BMI in patients group. On the basis of the results we conclude that the levels of IL-6 and TNF-alpha are not associated with BMI in FMS patients. Furthermore, patients with higher BMI may fall at the risk of FMS. Therefore, weight management may be an important aspect for treatment of FMS patients. Show more

Keywords: Fibromyalgia syndrome, body mass index, interleukin-6, tumor necrosis factor-alpha

DOI: 10.3233/BMR-150610

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 145-149, 2016

Authors: Alptekin, Kerem | Karan, Ayse | Dıracoglu, Demirhan | Yildiz, Aysel | Baskent, Akin | Eskiyurt, Nurten

Article Type: Research Article

Abstract: BACKGROUND: Deterioration associated with aging in the erect posture and balance to change the location of the center increased the rate of fall in older age is one of the reasons. Loss of muscle strength is one of the major factors affecting the posture. In this prospective, randomized and controlled study, it was aimed to investigate the effectiveness of strengthening postural muscles through electrostimulation or by applying biofeedback exercises with static posturography in patients aged 60 years and over with balance disorder. METHODS: Patients aged between 60-80 years, who applied to Istanbul Faculty of Medicine Physical Medicine …and Rehabilitation Department outpatient clinic and had been diagnosed with balance disorder using the Timed Up and Go (TUG) test, were included. 250 patients were screened, from them 67 patients were enrolled and 57 of them completed the study. Patients were randomized to three groups. The patients in Tetrax® group (TG) group (n:18) participated in a 15-minute exercise with Tetrax® which consisted of 15 minutes exercise session 3 times weekly for 4 weeks. The patients in EG group (n:19) received an electrostimulation program of postural muscles of 40 minutes per session 3 times weekly for 4 weeks. Patients in the control group (n:20) did 6-week balance exercises which were performed by other groups as well. 48 out of 57 patients attended the 6th-month control. As determinants of balance status Timed Up and Go Test (TUG), Berg Balance Scale (BBS) and Fall Index measured by Tetrax® were calculated at baseline, 1-month and 6-month follw up assesments. The patient's quality of life was assesed by Turkish version of World Health Organisation Quality of Life Questionnaire in Older Adults (WHOQOL-OLD.TR) at baseline and 6-month follow up assesments. RESULTS: TUG values in both EG and TG decreased significantly between baseline assesment and 1-month (mean differences for TG: -4,00 ± 1,309 and EG -2,588 ± 1,839 p= 0,002 for the each of groups) and baseline assesment and 6-month (mean differences for TG: -2,933± 1,223 and EG -2,058 ± 1,477 p= 0,003 for the each of groups). A significant increase was determined in BBS values between baseline and 1-month (mean differences for TG: 4.000 ± 2,360 and EG: 3,529 ± 2,672 p= 0,031 for the each of groups). Fall Index (FI) measured by Tetrax® decreased between baseline assesment and 1-month (p= 0,185), and 6-month (p= 0,086) respectively, also between 1-month and 6-month follow up assesments (p= 0,627), but all of them were not significant changes. In all three groups the quality of life (p= 0,951) improved. Exercises conducted with Tetrax® were more effective than electrostimulation of postural muscles in increasing TUG values and decreasing BBS values. CONCLUSIONS: Even though applying electrostimulation to postural muscles affected patients positively compared to pre-treatment, exercises performed with Tetrax® were more effective than the electrostimulation protocol to postural muscles in reducing balance disorder and this well-being continued even in the 6th month. Show more

Keywords: Balance disturbance, electrostimulation of postural muscles, static posturography, balance exercises, quality of life

DOI: 10.3233/BMR-150611

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 151-159, 2016

Authors: Weckström, Kristoffer | Söderström, Johan

Article Type: Research Article

Abstract: BACKGROUND: Although different conservative treatment options have been proposed, there is a paucity of research on the management of iliotibial band syndrome (ITBS) in runners. OBJECTIVE: To compare two treatment protocols for ITBS; radial shockwave therapy (RSWT) and manual therapy (ManT). Both therapies were administered concurrently with an exercise rehabilitation programme. METHODS: The study was designed as a randomised controlled clinical trial. Twenty-four runners with ITBS received 3 treatments at weekly intervals of either RSWT (n= 11) or ManT (n= 13). In addition, all subjects followed an exercise programme for at least 4 …weeks. Main outcome measures were established as mean differences (MD) in pain during treadmill running. RESULTS: There was no significant difference in pain reduction between the two interventions at 4 weeks (p= 0.796), and 8 weeks (p= 0.155) follow-up. Thus, both groups reported similar magnitude of reduced pain during the intervention (p= 0.864). The shockwave therapy (SWT) group reported a 51% decrease in pain at week 4 (p= 0.022), and a 75% decrease at week 8 (p= 0.004). The ManT group showed a 61% reduction in pain at week 4 (p= 0.059), and a 56% reduction at week 8 (p= 0.067). CONCLUSIONS: RSWT and ManT were equally effective in reducing pain in subjects with ITBS. Show more

Keywords: Iliotibial band syndrome, running, shockwaves, manual therapies, exercise therapy

DOI: 10.3233/BMR-150612

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 161-170, 2016

Authors: Sobczak, Stéphane | Dugailly, Pierre-Michel | Gilbert, Kerry K. | Hooper, Troy L. | Sizer, Jr., Phillip S. | James, C. Roger | Poortmans, Bernard | Matthijs, Omer C. | Brismée, Jean-Michel

Article Type: Research Article

Abstract: BACKGROUND: Stadiometry measures total trunk height variations but cannot quantify individual spinal segment height changes. Different methods exist to measure both intervertebral disc and lumbar spine height (LSH) variations but they are either limited by radiation exposure or cost. Musculoskeletal ultrasound could be a valuable alternative to measure spinal segmental height changes as a result of intervention. OBJECTIVE: To validate the use of musculoskeletal ultrasound (MSU) and new anatomical landmark references used in assessing inter-mammillary distances (IMD) and LSH changes resulting from lumbar spine traction. METHODS: Two unembalmed cadaveric lumbar spines were extracted …to assess (1) the reliability and validity of MSU, as compared to caliper, for measuring in vitro IMD and LSH using alternative anatomical landmarks than previously reported, and (2) the reliability of MSU for measuring in vitro IMD and lumbar spine height changes recorded during standardized mechanical traction up to 1.20 cm. RESULTS: Intra- and inter-rater reliability of musculoskeletal ultrasound for within and between sessions and for all experimental design, Standard Error ranged from 0.01 to 0.02 and from 0.03 to 0.04 cm for IMDs and LSHs, respectively. Root Mean Square Errors ranged from 1.6 to 6.8% and from 1 to 1.1% for IMDs and LSHs, respectively and mean ICC ranged from 0.98 to 1 for LSH. During traction, mean lumbar spine height measurement change using MSU was 1.15 ± 0.03 cm. Bland and Altman plots demonstrated confidence intervals included in the limits of agreement. Nevertheless, there were significant differences (p< 0.001) for both IMD measurements and lumbar spine height between caliper and ultrasound measurements. Musculoskeletal ultrasound overestimated distances of about 5.5 ± 1.5%. CONCLUSIONS: Musculoskeletal ultrasound is reliable and accurate for measuring intersegmental spinal distances and lumbar spine height with an apparent slight overestimation of distances. Based on mean differences, ultrasound technology seems to be valid for measuring lumbar spine height changes and could be suitable for in vivo research. Show more

Keywords: Lumbar spine, lumbar spine height, imaging, musculoskeletal ultrasound, spine, reliability, intervertebral disc

DOI: 10.3233/BMR-150613

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 171-182, 2016

Authors: Cho, Hee Kyung | Jung, Gil Su | Kim, Eun Hyuk | Cho, Yun Woo | Kim, Sang Woo | Ahn, Sang Ho

Article Type: Research Article

Abstract: BACKGROUD: Low back pain is associated with transversus abdominis (TrA) dysfunction. Recently, it was proposed that Neuromuscular Electrical Stimulation (NMES) could be used to stimulate deep abdominal muscle contractions and improve lumbopelvic stability. OBJECTIVE: The purpose of this study was to determine the optimal stimulation frequency required during NMES for the activation of deep abdominal muscles. METHODS: Twenty healthy volunteers between the ages of 24 and 32 were included. The portable research-stimulator was applied using a 10 second contraction time, and a 10 second resting time at 20 Hz, 50 Hz, and 80 …Hz. Changes in muscle thicknesses were determined for the TrA, obliquus internus (OI), and obliquus externus (OE) by real time ultrasound imaging. RESULTS: Significant thickness increases in the TrA, OI, and OE were observed during NMES versus the resting state (p < 0.05). Of the frequencies examined, 50 Hz NMES produced the greatest increase in TrA thickness (1.33 fold as compared with 1.22 fold at 20 Hz and 1.21 fold at 80 Hz) (p < 0.05). CONCLUSIONS: Our results indicate that NMES can preferentially stimulate contractions in deep abdominal stabilizing muscles. Most importantly, 50 Hz NMES produced greater muscle thickness increases than 20 or 80 Hz. Show more

Keywords: Neuromuscular electrical stimulation, frequency, abdominal muscle thickness, transversus abdominis, low back pain, real time ultrasound imaging

DOI: 10.3233/BMR-150638

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 1, pp. 183-189, 2016