Journal of Back and Musculoskeletal Rehabilitation - Volume 29, issue 2

Authors: Swaminathan, Ramesh | Williams, Jonathan M. | Jones, Michael D. | Theobald, Peter S.

Article Type: Research Article

Abstract: BACKGROUND: The relationship between muscular force and electromyography (EMG) has been investigated by numerous researchers. EMG has not previously been used as a means of estimating force in the cervical erector spinae (CES). OBJECTIVE: Use EMG of the CES musculature to indirectly predict neck extension force. METHODS: Isometric contractions of the CES muscles were studied at increasing levels of contractile force across all participants (n= 12) to produce an individualised force-EMG relationship. The method of least squares was used to determine the linear regression trend line for the force-EMG relationship. The validity …of these individual `correlation curves' was demonstrated through further, blinded, investigation. RESULTS: A linear relationship was identified for the individualised correlation curves that gained in strength for < 50% maximum voluntary contraction (MVC; R2 > 0.8 for 80% of trials). The prediction of muscle force from the correlation curves was found to be statistically similar to the equivalent experimental data (p> 0.05). Given the tendency of EMG to slightly overestimate force in most cases, an adjustment coefficient was calculated to reduce the error in the predicted force data. CONCLUSIONS: This study reports a validated method using EMG to indirectly acquire CES muscular force, which has application for clinicians and research scientists working in fields including sport and rehabilitation. Show more

Keywords: EMG, force, muscle, cervical spine

DOI: 10.3233/BMR-150626

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 279-285, 2016

Authors: Yanmaz, Muyesser Nergiz | Atar, Sevgi | Biçer, Mualla

Article Type: Research Article

Abstract: BACKGROUND: The fibromyalgia survey diagnostic criteria and severity scale (FSDC) is a self-reported version of 2010 preliminary diagnostic criteria for fibromyalgia syndrome (FMS). FSDC not only facilitates to diagnose FMS, it measures pain (the Widespread Pain Index (WPI)/FSDC Section 3), the Symptom Severity (SS)/FSDC Sections 1 and 2, and provides a score, polysymptomatic distress (PSD)/FSDC Total score in patients with FMS. The purpose of our study is to evaluate the reliability and validity of Turkish version of FSDC in Turkish patients with FMS. METHODS: The Turkish version FSDC was obtained by two forward translations of the …instrument into Turkish by two bilingual Turkish individuals, one of them was a physician. They were then back translated into English by two different bilingual individuals; another Turkish physician and a backtranslator whose mother tongue was English. The original version of FSDC, the two Turkish forward translations, and English back translations were then reviewed by the individuals involved in translations, and the last experimental Turkish version was created. This last version of Turkish FSDC studied on patients with newly diagnosed FMS by using American College of Rheumatology (ACR) 1990 classification criteria. Patients filled validated Turkish revised fibromyalgia impact questionnaire (rFIQ), our nonvalidated experimental Turkish FSDC; marked Visual Analog Scale (VAS) for pain and the disease severity. In 7 to 15 days, they have filled the nonvalidated Turkish FSDC for the second time. RESULTS: In 132 patients, by the test to retest reliability analysis of nonvalidated Turkish FSDC, for the 25 single items, correlation coefficients ranged 0.383 to 0.818 (all p< 0.01). There were significant correlations between nonvalidated Turkish FSDC assessment 1 and assessment 2 for Section 1+2 (SS) (r = 0.748), Section 3 (WPI) (r = 0.775), and the total scores (PSD) (r = 0.821) (all p< 0.01). Cronbach alpha was 0.766 for the nonvalidated Turkish FSDC assessment 1 total score, and 0.77 for the Turkish FSDC assessment 2 total score. There were significant correlations between nonvalidated Turkish FSDC assessment 1 total score and total rFIQ (r= 0.576), VAS pain (r= 0.443), VAS disease severity (r= 0.342) (all p< 0.01). Our results indicated that 94.7 % to 96 % of our patients satisfying 1990 FMS criteria also satisfied 2010 modified diagnostic criteria. CONCLUSIONS: The Turkish experimental version of FSDC is a reliable and valid instrument in Turkish FMS patients. It is easily completed, simple to score providing valuable instrument to diagnose and follow FMS. Show more

Keywords: Fibromyalgia, validation of measures, Turkish, validity, reliability

DOI: 10.3233/BMR-150627

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 287-293, 2016

Authors: Marques, Nise Ribeiro | Hallal, Camilla Zamfolini | Spinoso, Deborah Hebling | Crozara, Luciano Fernandez | Morcelli, Mary Hellen | Karuka, Aline Harumi | Navega, Marcelo Tavella | Gonçalves, Mauro

Article Type: Research Article

Abstract: BACKGROUND: Walking is a complex motor task that requires an integrated coordination of the trunk, lower limb, and upper limb movements. Previously, few studies have investigated the activation pattern of trunk muscles during walking. However, the mechanisms by how aging affects the recruitment of trunk muscles during walking remain unclear. OBJECTIVE: The present study aimed to compare the activation of trunk and lower limb muscles during walking in younger and older women. METHODS: Fifteen younger women between 18 and 30 yr and 19 older women between 60-82 yr walked on the treadmill at …a self-selected speed, while 1-min surface electromyography (EMG) signals were recorded from the multifidus, internal oblique, gluteus maximus, rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius lateralis. EMG signals were processed and a linear envelope was calculated at an initial stance (50 ms after heel contact) and final stance (50 ms before toe-off). RESULTS: Compared with younger women, older women had 52.32% lower activation of the internal oblique (p = 0.027) and 39.95% lower activation of the rectus femoris (p = 0.003) at initial stance. CONCLUSION: Results of this study demonstrated that older women had lower activation of trunk and knee muscles during the initial stance, which may have resulted from weakness and balance impairments caused by aging. Show more

Keywords: Aging, gait, electromyography, trunk stability

DOI: 10.3233/BMR-150628

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 295-300, 2016

Authors: Martín-Pintado-Zugasti, Aitor | Rodríguez-Fernández, Ángel Luis | Fernandez-Carnero, Josue

Article Type: Research Article

Abstract: BACKGROUND: Postneedling soreness is considered the most frequent secondary effect associated to dry needling. A detailed description of postneedling soreness characteristics has not been previously reported. OBJECTIVE: (1) to assess the intensity and duration of postneedling soreness and tenderness after deep dry needling of a trapezius latent myofascial trigger point (MTrP), (2) to evaluate the possible differences in postneedling soreness between sexes and (3) to analyze the influence on postneedling soreness of factors involved in the dry needling process. METHODS: Sixty healthy subjects (30 men, 30 women) with latent MTrPs in the upper …trapezius muscle received a dry needling intervention in the MTrP. Pain and pressure pain threshold (PPT) were assessed during a 72 hours follow-up period. RESULTS: Repeated measures analysis of covariance showed a significant effect for time in pain and in PPT. An interaction between sex and time in pain was obtained: women exhibited higher intensity in postneedling pain than men. The pain during needling and the number of needle insertions significantly correlated with postneedling soreness. CONCLUSIONS: Soreness and hyperalgesia are present in all subjects after dry needling of a latent MTrP in the upper trapezius muscle. Women exhibited higher intensity of postneedling soreness than men. Show more

Keywords: Needles, pain, trigger points, sex, gender

DOI: 10.3233/BMR-150630

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 301-308, 2016

Authors: Alemdar, Murat

Article Type: Research Article

Abstract: BACKGROUND: Comparing the distal sensory latencies of median and ulnar nerve over wrist-to-ring finger (RF) segment is a sensitive conduction parameter in the diagnosis of carpal tunnel syndrome (CTS). However to the best of our knowledge, there is not any research questioning whether the RF studies are useful in grading the CTS or not. OBJECTIVES: To determine whether the hands with moderate degree CTS and elicitable median nerve sensory responses over second finger and unelicitable responses over RF represent a more severe electrophysiological grade than the hands with elicitable responses over both fingers. MATERIAL …AND METHODS: In patients with clinical diagnosis with CTS, obtained values on sensory and motor nerve conduction studies of median and ulnar nerves were compared between median nerve-to-RF sensorial responders (group 1) and nonresponders (group 2). RESULTS: Seventy-four recordings belong to 59 patients with moderate degree CTS were included. There were 55 hands in group 1, and 19 in group 2. Mean sensory onset latency of median nerve over second finger was longer (4.17 ± 0.53 msec versus 3.47 ± 0.46 msec; p< 0.001), sensory conduction velocity was slower (34.1 ± 5.5 m/sec versus 40.1 ± 5.3 m/sec; p< 0.001), SNAP amplitude was smaller (7.0 ± 3.3 μ V versus 13.7 ± 6.7 μ V; p< 0.001), and distal motor latency was longer (5.75 ± 0.96 msec versus 4.76 ± 0.42 msec; p< 0.001) in group 2 than in group 1. CONCLUSION: Median nerve-to-RF sensorial nonresponders have a more progressed compressive neuropathy, and represent a more severe electrophysiological grade than the responders. Show more

Keywords: Carpal tunnel syndrome, median, ulnar, sensorial response, ring finger, electrophysiological grade

DOI: 10.3233/BMR-150631

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 309-315, 2016

Authors: Kim, Minhee | Kim, Yushin | Oh, Sejun | Suh, Dongwon | Eun, Seon-Deck | Yoon, BumChul

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: Application of hollowing and bracing, abdominal activation strategies (AAS), has focused on improving trunk stability. This study aimed to clarify the AAS effect on body sway during support surface translation while standing. MATERIALS AND METHODS: Twenty healthy subjects (10 male, 10 female; aged 25.45 ± 3.22 years) performed hollowing, bracing, and natural strategies while standing, and exerted to maintain their balance during forward and backward translation. Ultrasonography evaluations confirmed the appropriate application of the 3 strategies by measuring abdominal muscle thickness. Additionally, a motion analysis system was used to capture the whole body …sway along the sagittal plane. RESULTS: During backward translation, angular displacements of the trunk were significantly different among the 3 strategies (upper thoracic: F = 13.758, p < 0.001; lower thoracic: F = 8.477, p = 0.001; and lumbopelvis: F = 8.651, p = 0.001). AAS significantly decreased the sway by 25-36% in all inter-spinal segments compared with the natural strategy (p < 0.05). During forward translation, only angular displacement of the lower thoracic was significantly different among the 3 strategies (F = 7.640, p = 0.002), and bracing decreased the sway by 33.48% compared with the natural strategy (p = 0.003). No significant differences were seen between hollowing and bracing during forward and backward translation. CONCLUSIONS: AAS increased joint stability only in the trunk where joints are adjacent to abdominal muscles, but not in the lower extremities. The low impact of AAS on the lower extremities might have important implications on the paradigm of standing balance. Show more

Keywords: Abdominal activation strategies, body sway, abdominal muscles, perturbation

DOI: 10.3233/BMR-150633

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 317-325, 2016

Authors: Imamura, Marta | Alfieri, Fábio Marcon | Filippo, Thais Raquel Martins | Battistella, Linamara Rizzo

Article Type: Research Article

Abstract: BACKGROUND: The lumbar back and hip muscles are important for a normal functioning of the human spine and they are considered to be of etiological significance in chronic nonspecific low back pain (nCLBP). Inactivity and a lower level of physical activity in patients with nCLBP may change muscle characteristics and may be associated with pain and disability. Pressure algometry has been found to be non-invasive, efficient and reliable in the exploration of physio-pathological mechanisms involved in muscle pain syndromes. The subjective characteristic of the pressure pain thresholds (PPTs) cannot be avoided once it is the very objective of the …measurement, i.e. the minimum pain perceptible by the person, is a subjective factor. Most studies have revealed gender differences between PPTs, with females showing lower thresholds. OBJECTIVE: to determine whether demographic variables and PPTs, are related pain intensity and a disability in patients with nCLBP. METHODS: One hundred and twenty-four patients with nCLBP were included in the study. The Visual Analogue Scale (VAS) and the Roland-Morris Questionnaire for Low Back Pain (RM) were used to evaluate the intensity of pain and degree of disability. The PPT was performed from L1 up to S2 dermatomes, at the muscles over the Gluteus medius, minimus and maximus, including a point located at the level of the piriformis, at the Quadratus lumborum, at the Iliopsoas and points of reference located at the level of the L1 up to L5 ligaments. The pain intensity was assessed by visual analogue scale (VAS) and the lumbar function by Roland Morris questionnaire (RM). Multiple linear regression models were used for both the VAS and the RM. RESULTS: No significant differences were found between the PPTs measured at either left or right limb. The mean VAS value was 7.3 (± 1.5) and the RM score was 14.2 (± 5.3). The PPT-values showed significant negative correlations to the VAS and the RM. The highest correlation between the mean VAS and PPT-values were found at the level of the Gluteus medius (r= -0.34, p< 0.001), which was the only measurement correlated to the intensity of pain (r2 = 0.11, p< 0.001). The RM was correlated to the BMI, the level of education and the PPT values at the level of the Iliopsoas muscle and the L4-L5 supraspinous ligament. CONCLUSIONS: This study showed that most PPT values are correlated to the VAS and the RM. Nevertheless, the variability explained by PPT values and demographic characteristics was low for pain intensity and function. Show more

Keywords: Chronic nonspecific low back pain, hyperalgesia, pain pressure threshold, algometry

DOI: 10.3233/BMR-150636

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 327-336, 2016

Authors: Hojan, Katarzyna | Manikowska, Faustyna | Chen, Brian Po-Jung | Lin, Ching-Ching

Article Type: Research Article

Abstract: BACKGROUND: Previous literatures showed no evidence that wearing an external breast prosthesis may prevent changes in body posture in women who underwent mastectomy. OBJECTIVE: To determine whether the weight of an external breast prosthesis can contribute to posture changes in women post mastectomy. METHODS: Fifty-one women with unilateral mastectomy (age 58 ± 11.39 years) were divided into 2 subgroups by their operation side. Asymmetry of body posture was evaluated by using the electromyography activity of erector spinae muscles with four different weights of breast prosthesis. RESULTS: Despite the operation side, the erector spinae …muscle activities on the operation side and non-operation side were significantly different. Overall, for patients who had operation on the left side, their erector spinae muscle activity imbalance will be smaller, compared to the imbalance among patients with right operation side. The weight of the external breast prosthesis did not influence the differences of erector spinae muscle activities on the operation side and non-operation side. CONCLUSIONS: The weight of an external breast prosthesis for women after mastectomy may not be crucial when choosing a proper prosthesis. Show more

Keywords: Breast cancer, electromyography, erector spinae muscle, postural asymmetry

DOI: 10.3233/BMR-150648

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 337-342, 2016

Authors: Gokalp, Oguzhan | Akkaya, Semih | Akkaya, Nuray | Buker, Nihal | Gungor, Harun R. | Ok, Nusret | Yorukoglu, Cagdas

Article Type: Research Article

Abstract: BACKGROUND: Impaired postural balance due to somatosensory data loss with mechanical instability has been shown in patients with ACL deficiency. OBJECTIVE: To assess postural balance in patients with ACL insufficiency prior to surgery and following reconstruction with serial evaluations. METHODS: Thirty patients (mean age of 27.7 ± 6.7 years) who underwent arthroscopic reconstruction of ACL with bone-patellar tendon-bone autograft were examined for clinical and functional variables at preoperative day and postoperative 12th week. Posturographic analysis were performed by using Tetrax Interactive Balance System (Sunlight Medical Ltd, Israel) at preoperative day, at 4th, …8th, and 12th weeks following reconstruction. Data computed by posturographic software by the considerations of the oscillation velocities of body sways is fall risk as a numeric value (0-100, lower values indicate better condition). RESULTS: All of the patients (mean age of 27.7 ± 6.7 years) had significant improvements for clinical, functional evaluations and fall risk (p< 0.05). Mean fall risk was within high-risk category (59.9 ± 22.8) preoperatively. The highest fall risk was detected at postoperative 4th week. Patients had high fall risk at 8th week similar to preoperative value. Mean fall risk decreased to low level risk at 12th week. Preoperative symptom duration had relationships with preoperative fall risk and postoperative improvement of fall risk (p= 0.001, r= -0.632, p= 0.001, r= -0.870, respectively). The improvement of fall risk was higher in patients with symptoms shorter than 6 months (p= 0.001). CONCLUSIONS: According to these results, mean fall risk of patients with ACL insufficiency was within high risk category preoperatively, and fall risk improves after surgical reconstruction, but as the duration of complaints lengthens especially longer than 6 months, the improvement of fall risk decreases following reconstruction. Show more

Keywords: Postural balance, fall risk, anterior cruciate ligament, reconstruction

DOI: 10.3233/BMR-160659

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 343-350, 2016

Authors: van Helvoirt, Hans | Apeldoorn, Adri T. | Knol, Dirk L. | Arts, Mark P. | Kamper, Steven J. | van Tulder, Maurits W. | Ostelo, Raymond W.

Article Type: Research Article

Abstract: STUDY DESIGN: Prospective cohort study. BACKGROUND: Although lumbar radiculopathy is regarded as a specific diagnosis, the most effective treatment strategy is unclear. Commonly used treatments include transforaminal epidural steroid injections (TESIs) and Mechanical Diagnosis & Therapy (MDT), but no studies have investigated the effectiveness of this combination. MDT differentiates pain centralization (C) from non-centralization (NC), which indicates good vs. poor prognostic validity respectively. OBJECTIVE: The main aims were 1) to determine changes in Mechanical Diagnosis and Therapy (MDT) pain response classifications after transforaminal epidural steroid injections (TESIs) in candidates for lumbar herniated disc …surgery and 2) to evaluate differences in short and long term outcomes for patients with different pain response classifications. METHODS: Candidates for lumbar herniated disc surgery were assessed with a MDT protocol and their pain response classified as centralizing or peripheralizing. For this study,only patients were eligible who showed a peripheralizing pain response at intake. All patients then received TESIs and were reassessed and classified using the MDT protocol, into groups according to pain response (resolved, centralizing, peripheralizing with less pain and peripheralising with severe pain). After receiving targeted treatment based on pain response after TESIs, ranging from advice, MDT or surgery, follow-up assessments were completed at discharge and at 12 months. The primary outcomes were disability (Roland-Morris Disability Questionnaire [RMDQ] for Sciatica), pain severity in leg (visual analogue scale [VAS], 0-100) and global perceived effect (GPE). Linear mixed-models were used to determine between-groups differences in outcome. RESULTS: A total of 77 patients with lumbar disc herniation and peripheralizing symptoms were included. Patients received an average of 2 (SD 0.7) TESIs. After TESIs, 17 patients (22%) were classified as peripheralizing with continuing severe pain. These patients underwent surgery and were not further evaluated. Eleven (14%) patients were classified as resolved, 37 (48%) as centralizing with significant less pain, and 12 (16%) as peripheralizing with significant less pain. None of these patients underwent surgery. Resolved and centralizer subgroups had better outcomes in terms of VAS and RMDQ than the non-operated peripheralizers at discharge and at 12 months. The succes rates (GPE) for the resolved, centralizing, and peripheralizing with less pain patients were 100%, 100% and 33% respectively at short term, and 100%, 92% and 50% respectively at long term. CONCLUSION: After TESIs, a peripheralizing pain pattern changed to resolved or centralizing in 62% of the patients. For the non-operated patients, those with a centralising pattern after TESIs reported better pain and disability outcomes than those with peripheralizing pattern at short and long term. Show more

Keywords: Herniated disc, , transforaminal epidural injection, , MDT, , McKenzie

DOI: 10.3233/BMR-160662

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 351-359, 2016