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: 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.
Keywords: Cervical stabilization exercise, joint position sense, proprioception
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.
Keywords: Body schema, body image, corporeal awareness, consciousness, rehabilitation
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.
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.
Keywords: Backpack load, backpack strap, young adults, perceived exertion, human gait
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.
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.
Keywords: Back muscles, electromyography, exercise therapy, rehabilitation
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.
Keywords: Low back pain, validation studies, sick-leave
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.
Keywords: Fibromyalgia syndrome, body mass index, interleukin-6, tumor necrosis factor-alpha
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.
Keywords: Balance disturbance, electrostimulation of postural muscles, static posturography, balance exercises, quality of life
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.
Keywords: Iliotibial band syndrome, running, shockwaves, manual therapies, exercise therapy