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

Authors: Marshall, Amelia Rose | Noronha, Marcos de | Zacharias, Anita | Kapakoulakis, Theo | Green, Rodney

Article Type: Review Article

Abstract: BACKGROUND: Hip osteoarthritis (OA) is a major cause of morbidity. Rehabilitation for this population focuses on strengthening the hip muscles, particularly the abductors, however the deficit in function of these muscles is unclear. OBJECTIVES: To review the evidence for the differences in structure and function of hip abductors (gluteus medius and minimus and tensor fascia lata) in hip OA. METHODS: A systematic review was conducted using MEDLINE, AMED, CINAHL and SportDISCUS, from the earliest date to September 2013. Studies that compared hip OA patients with controls, or the unaffected contralateral hip were included. …Studies needed to report data on an outcome related to gross gluteal muscle function. RESULTS: An initial yield of 141 studies was reduced to 22 after application of inclusion/exclusion criteria. Meta-analysis confirmed greater hip abductor strength in the control group (standardized mean difference = SMD -0.93, 95%CI -1.70 to -0.16) and the unaffected limb (SMD -0.26, 95%CI -0.48 to -0.04). Meta-analyses showed no differences in muscle size either between groups or limbs. Few electromyography studies have been reported and meta-analysis was not possible. CONCLUSION: Hip abductor strength is reduced in OA patients when compared to healthy controls and to the unaffected limb. Data on muscle size and activity is limited. Show more

Keywords: Electromyography, osteoarthritis, lower extremity, muscle strength

DOI: 10.3233/BMR-150614

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 191-204, 2016

Authors: Coskun Benlidayi, Ilke | Basaran, Sibel | Seydaoglu, Gulsah | Guzel, Rengin

Article Type: Research Article

Abstract: BACKGROUND: Patients with spinal cord injury (SCI) and hemiplegia are at risk of fractures partly due to decreased bone mineral density with relation to the low levels of vitamin D. OBJECTIVE: The objective of this study is to evaluate the vitamin D profile of patients with SCI and post-stroke hemiplegia. METHODS: 25(OH)D levels of patients with SCI and hemiplegia were obtained from the electronic medical record database and compared with age- and sex-matched non-disabled controls. Furthermore, the effect of Functional Ambulation Category (FAC), American Spinal Injury Association (ASIA) level and Brunnstrom's recovery stage, …on vitamin D insufficiency, was studied. RESULTS: The study sample consisted of 173 individuals (118 patients and 55 controls). Vitamin D levels and sufficiency rates of the neurologically disabled patients was significantly lower than that of controls (p= 0.000 and p= 0.000, respectively). However, there was no difference between patients with SCI and hemiplegia regarding the 25(OH)D levels and vitamin D insufficiency (p= 0.303 and p= 0.952, respectively). There were no statistically significant differences in vitamin D status by American Spinal Injury Association (ASIA) level and Brunnstrom's score. However, regression analysis revealed that vitamin D insufficiency rate of non-functionally ambulatory (FAC = 0-2) patients was higher than that of functionally ambulatory (FAC = 3-5) ones (p= 0.044). CONCLUSIONS: Vitamin D status of patients with neurological disabilities was lower than that of controls. Non-functionally ambulatory patients had higher vitamin D insufficiency rate than functionally ambulatory patients. Preventative measures including adequate supplementation of vitamin D should be directed to neurologically disabled subjects, particularly those with non-functional ambulation. Show more

Keywords: Hemiplegia, neurological disorders, spinal cord injury, vitamin D, vitamin D insufficiency

DOI: 10.3233/BMR-150615

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 205-210, 2016

Authors: Drzaƚ-Grabiec, Justyna | Truszczyńska, Aleksandra | Fabjańska, Maƚgorzata | Trzaskoma, Zbigniew

Article Type: Research Article

Abstract: BACKGROUND: Decrease of physiological curvatures of the spine can lead to back pain. OBJECTIVE: The aim of this study was to compare the curvatures of the spine and body posture parameters in three positions: relaxed standing, relaxed sitting, corrected sitting. METHODS: The study included 40 healthy persons aged 18-32 years (mean 24.7 ± 2.3), with body height 152-195 cm (mean 171.8 ± 9.3), weight 47-115 kg (mean 66.4 ± 13.7), BMI 17.9-32.5 kg/m2 (mean 22.3 ± 3.0). The study was performed using the photogrammetric method. RESULTS: …After changing the position from relaxed standing to relaxed sitting, significant decrease of the inclination of the thoracolumbar region, the thoracic kyphosis depth and the lumbar lordosis depth were observed. Lumbar lordosis angle increased significantly. After the sitting position correction, the inclination of the upper thoracic and thoracolumbar region decreased, and the depth of thoracic kyphosis and lumbar lordosis increased. CONCLUSIONS: - In the relaxed sitting position, the lumbar lordosis was significantly smaller than in the standing position. - A change from the standing to the sitting position results in flattening of thoracic kyphosis. - The corrected sitting position does not adequately correct the spinal curvatures. Show more

Keywords: Body posture, standing position, sitting position, corrected sitting, position, moiré method

DOI: 10.3233/BMR-150616

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 211-217, 2016

Authors: Jubany, Júlia | Angulo-Barroso, Rosa

Article Type: Research Article

Abstract: BACKGROUND: Most of the EMG analysis algorithms developed to date don't detect the whole sequence of rhythmic and subtle changes that take place during the process of trunk stabilization. Indeed, the few recent methods that are capable of assessing these important EMG characteristics are highly complex and not accessible in most applied clinic contexts. OBJECTIVE: To validate and disseminate a software program suitable for detecting multiple and relatively small EMG bursts during a trunk stabilization response. METHODS: Ninety EMG recordings randomly selected from 50 individuals (24 with chronic low back pain) were …analysed by our algorithm based on means and standard deviations and an experienced examiner (as a gold standard). Concordance, sensitivity, specificity, positive predictive value and negative predictive value were considered to analyse reliability. RESULTS: Results showed a high degree of concordance between the two methods (87.2%), high sensitivity and specificity rates (79.5 and 89.2%), a moderate-low positive predicted value (66.9%) and a high negative predicted value (94.4%). CONCLUSION: The program provided is flexible and useful to detect EMG activity. The selected parameters of the program were able to detect onset/offset EMG bursts and were valid for the purpose of this study with a small tendency to over-detect bursts. Show more

Keywords: Electromyography, muscle onset and offset detection, low back, sudden load

DOI: 10.3233/BMR-150617

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 219-230, 2016

Authors: Hidalgo, Benjamin

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVES: Orthopaedic manual therapy (OMT) should be based not only on the best available evidence but also on patient values and clinician expertise. Low back pain (LBP) is a complex issue as the majority of people who suffer from LBP cannot be given a specific diagnosis based on imaging studies but kinematic analyses appear to be useful to determine dysfunctional patterns. In physical therapy, various forms of OMT are currently used to manage LBP and there is growing evidence for its use. The underlying principles of OMT are to treat neuro-musculo-skeletal disorders, the aim of which is …to reduce pain, as well as improve movement and function. Manual physical therapists use a range of treatment approaches including passive techniques (``hands on'') as well as different active techniques (``hands off'') and communication skills. Systems of stratification are available for classification of people with LBP into specific sub-groups (with sub-group specific OMT intervention). This approach has been shown to be more efficient than generic treatment, although subgroups are not mutually exclusive. Various mechanisms of action are reported in the literature concerning OMT effects. These effects may be biomechanical, neurophysiological and psychological. Moreover, it is essential that the treatment, regardless of the concept of OMT, is carried out on the basis of a systematic and valid clinical examination protocol aimed to correctly classify LBP. The use of pain provocative tests during combined movement examination provides confidence that examination findings are valid and can therefore be confidently used in clinical practice to manage patient. The integrative approach presented in this article is a mix of previously developed classification systems (i.e. based on pain mechanisms, prognosis, treatment responsiveness) and new tools, as kinematic analyses for LBP, and a novel validated combined movements examination CONCLUSION: As LBP is a complex and multidimensional problem, the integrative approach may help clinicians and researchers to better understand and then to treat patients with non-specific LBP. The efficacy of OMT treatments using an integrative approach in specific patients subgroups should be objectively analyzed according to validated kinematic analyses in future studies. Show more

Keywords: Orthopedic manual therapy, low back pain, evidence based, classification systems, stratification care, kinematic analysis, integrative approach

DOI: 10.3233/BMR-150619

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 231-239, 2016

Authors: Ehsani, Fatemeh | Arab, Amir Massoud | Assadi, Hamed | Karimi, Noureddin | Shanbehzadeh, Sanaz

Article Type: Research Article

Abstract: BACKGROUND: There was controversy in finding of studies related pelvic floor muscle (PFM) rehabilitation of subjects with low back pain (LBP), while this issue is very important for treatment of subjects with LBP. OBJECTIVE: The purpose of this study was to evaluate PFM contraction in three conditions of alone and with abdominal hollowing (AH) or abdominal bracing (AB) maneuvers in subjects with and without chronic LBP. METHODS: Subjects were divided into two groups: subjects with LBP (N = 25) and without LBP (N = 27). PFM contraction alone and during contraction with AH …or AB maneuvers was measured. The amount of bladder base movement was measured as an indicator of PFM activity. RESULTS: There were no differences in PFM activity between subjects with and without chronic LBP, when PFM contracted alone (P = 0.60), contracted with AH (P= 0.12) and AB maneuver (P = 0.54). Our data revealed that contraction of the PFM alone produce greater displacement of the bladder base than contraction of the PFM with AH (P = 0.005) or AB maneuver (P = 0.001) in both groups. However, no significant difference was found between contraction of the PFM with AH and AB maneuver in individuals with LBP (P = 0.31). CONCLUSION: It seems that PFM contraction alone is more effective than PFM contraction with AH or AB maneuvers in lifting the pelvic floor in subjects with and without LBP. Show more

Keywords: Abdominal muscles contraction, low back pain, pelvic floor muscles, ultrasound

DOI: 10.3233/BMR-150620

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 241-247, 2016

Authors: Ang, Coco | Nairn, Brian C. | Schinkel-Ivy, Alison | Drake, Janessa D.M.

Article Type: Research Article

Abstract: BACKGROUND: The flexion-relaxation phenomenon (FRP) in standing is a specific and sensitive diagnostic tool for low back pain. Seated flexion as an alternative could be beneficial for certain populations, yet the behavior of the trunk extensors during seated maximum flexion compared to standing flexion remains unclear. OBJECTIVE: Compare FRP occurrences and spine angles between seated and standing flexion postures in three levels of the erector spinae muscles. METHODS: Thirty-one participants free of back pain performed seated and standing maximum trunk flexion. Electromyographical signals were recorded from the bilateral lumbar (L3 ), lower-thoracic (T9 …), and upper-thoracic (T4 ) erector spinae and assessed for the occurrence of FRP. Spine angles corresponding to FRP onset and cessation were determined, and FRP occurrences and angles were compared between posture and muscle. RESULTS: FRP occurrence was similar in standing and seated maximum flexion across all muscles, with the lumbar muscles showing the greatest consistency. Standing FRP onset and cessation angles were consistently greater than the corresponding seated FRP angles. CONCLUSION: Considering the similar number of FRP occurrences, seated maximum flexion may constitute an objective criterion for low back pain diagnosis. Future work should seek to confirm the utility of this test in individuals with low back pain. Show more

Keywords: Flexion-relaxation, erector spinae, seated flexion, standing flexion, trunk angle

DOI: 10.3233/BMR-150621

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 249-258, 2016

Authors: Almeida, Gabriel Peixoto Leão | Silva, Ana Paula de Moura Campos Carvalho e | França, Fábio Jorge Renovato | Magalhães, Maurício Oliveira | Burke, Thomaz Nogueira | Marques, Amélia Pasqual

Article Type: Research Article

Abstract: BACKGROUND: It is theorized that increased dynamic knee valgus relates to decreased hip posterolateral muscle strength. OBJECTIVE: The aim here was to assess the relationship between the frontal plane projection angle (FPPA) of the knee and hip and trunk muscle strength in women with and without patellofemoral pain (PFP). METHODS: The sample comprised 43 women: Patellofemoral Pain Group (PPG, n = 22) and Control Group (CG, n = 21). Muscle strength for hip abduction, extension, external rotation and lateral core were measured using a handheld dynamometer. The FPPA was recorded during step-down. …RESULTS: The PPG showed a deficit for hip muscles torque and increased FPPA (P < 0.05). Negative correlation of the FPPA-Peak was found in the CG for the hip abductor (r = -0.31) and posterolateral complex (r = -0.32) (P < 0.05). In the PPG, the FPPA-Peak showed a moderate negative correlation to the torque of external rotators and posterolateral hip muscles, although this correlation did not reach statistical significance. CONCLUSIONS: These findings suggest that women with patellofemoral pain present greater dynamic knee valgus and hip muscle weakness. Abductor and posterolateral hip muscles strength are associated with increased FPPA only in the pain-free population. Show more

Keywords: Patellofemoral joint, kinematic, biomechanics, knee injuries, muscle strength dynamometer

DOI: 10.3233/BMR-150622

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 259-266, 2016

Authors: Kurz, Eduard | Scholle, Hans-Christoph | Schenk, Philipp | Anders, Christoph

Article Type: Research Article

Abstract: BACKGROUND: The Sorensen test is commonly used to assess back muscle endurance capacity. However, the clinical value of this test, requiring compensation of the entire upper body mass, is limited if pain occurs. Therefore, a test variant using only portions of upper body mass could be an alternative. OBJECTIVE: This study aimed to determine fatigue characteristics in lumbar muscles during a modified Sorensen test utilizing only 50% of the upper body mass and asked if localization-related effects of surface electrodes in the assessment of lumbar muscle fatigue should be considered. METHODS: Thirty-two young …(20-29 years) symptom-free men were enrolled and asked to maintain only 50% upper body mass for 10 minutes. Fatigue characteristics were bilaterally derived from four different lumbar levels using Surface EMG. Side-specific and SEMG parameter-independent repeated measures (four lumbar levels, nine time points) analyses of variance were conducted. RESULTS: All participants were able to complete the test. Over time, a spatial effect of fatigue-related amplitude alterations at the respective segments could be observed. CONCLUSIONS: By using this modified Sorensen test, muscular fatigue can be evoked. Electrophysiological assessment of lumbar fatigue should consider spatial differences. Show more

Keywords: SEMG, lumbar fatigue, spatial, back muscles

DOI: 10.3233/BMR-150623

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 267-271, 2016

Authors: Dar, G. | Hicks, G.E.

Article Type: Research Article

Abstract: BACKGROUND: Dry needling of muscles is mainly used for the management of pain in musculoskeletal disorders. Yet, the association between dry needling and motor performance of muscles is still unclear. OBJECTIVE: To investigate the immediate effect of dry needling on lumbar multifidus muscles' function in healthy subjects. METHODS: Twenty-eight volunteers were divided randomly into: study group (13 subjects) and control group (15 subjects) who underwent no intervention. Study group received dry needling to the lumbar multifidus muscles using a deep insertion technique with 4 needles (2 on each side of the spine). The …needles were left in situ for 10 minutes. Ultrasound imaging was used to measure multifidus muscles' thickness, pre and post-procedure during rest in a prone position and during contralateral active straight leg extension. RESULTS: Significant difference was found in the percentage of change of muscle activation post needling between groups on the right side at level L4-5. A slight increase in the percentage of muscle activity, post procedure was observed in the dry needling group compared with the control group, although not significant in other segments examined. CONCLUSION: An improvement of back muscle function following dry needling procedure in healthy individuals was found. This implies that dry needling might stimulate motor nerve fibers and as such increase muscle activity. Show more

Keywords: Ultrasound imaging, acupuncture, back muscles, spine, muscle strength

DOI: 10.3233/BMR-150624

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 273-278, 2016

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

Authors: Kim, Do Hyoung | Han, Seong Rok | Choi, Chan Young | Sohn, Moon Jun | Lee, Chae Heuck

Article Type: Research Article

Abstract: BACKGROUND: It was thought that the efficacy of pulsed radiofrequency (PRF) treatment of the medial branch in patients with lower back pain was not as long lasting as that of continuous radiofrequency (CRF) thermo-coagulation techniques. OBJECTIVE: The goal of this study was to determine the efficacy and the long-term effects of PRF treatment of the medial branch in selected low back pain patients. METHODS: We retrospectively reviewed and analyzed patients with lower back pain who underwent PRF treatment on the medial branch at our institute. Pain relief was evaluated by visual analog scale …(VAS) score at pretreatment, 2 weeks, 6 months, 1 year and 2 years post-treatment. Oswestry disability index (ODI) score was evaluated pretreatment and at 2 years post-treatment. We also recorded the satisfaction period after PRF treatment. RESULTS: Twenty-three patients were available for the 2-year follow-up analysis. None of the patients had any side effects or procedure-related complications during the follow up period. The average VAS score declined from 7.1 ± 2.4 pre-treatment to 2.9 ± 2.1 2 weeks post-treatment, 2.6 ± 1.8 at 6 months, 2.8 ± 2.1 at 1 year and 3.0 ± 2.5 at 2 years. The average ODI score decreased from 33.6 ± 13.6 pre-treatment to 15.3 ± 5.7 at 2 years post-treatment. Mean satisfaction period after PRF treatment was 16.6 ± 9.43 months. CONCLUSION: PRF treatment on the medial branch is an effective and safe treatment option for patients with lower back pain. Show more

Keywords: Pulsed radiofrequency, continuous radiofrequency, medial branch, low back pain

DOI: 10.3233/BMR-160668

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 361-366, 2016

Authors: Adiguzel, Emre | Yaşar, Evren | Tecer, Duygu | Güzelküçük, Ümüt | Taşkaynatan, Mehmet Ali | Kesikburun, Serdar | Özgül, Ahmet

Article Type: Research Article

Abstract: BACKGROUND: Peripheral nerve injury (PNI) is a common problem in the world resulting with severe disability. Etiological data is different in studies because of the study period, patient population, economic status, and workplace safety policies of the different countries. OBJECTIVE: To define epidemiological and etiological data of our patients with peripheral nerve injury and to identify factors influencing efficacy of rehabilitation methods and recovery. METHODS: Patients were compared by means of electromyography and muscle strength changes. Influence of orthotics use, disease interval and type of physical therapy (electrical stimulation or EMG biofeedback) was …assessed. RESULTS: There was no significant difference between groups. But we found weak correlation between EMG and motor changes. There was no difference in EMG and motor score changes in terms of orthotics use and type of physical therapy. When the patients were grouped according to EMG changes, we found significant difference by disease interval. Disease interval was longest in patients with no change in EMG. When the patients were grouped according to motor score changes, there was no significant difference by disease interval. CONCLUSION: Etiology of the patients didn't affect long term results in peripheral nerve injury. The results of this study might help rehabilitation teams to guide their follow-up. Show more

Keywords: Peripheral nerve injuries, rehabilitation, treatment outcome

DOI: 10.3233/BMR-160681

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 367-371, 2016

Authors: Coskun Benlidayi, Ilke | Salimov, Fariz | Kurkcu, Mehmet | Guzel, Rengin

Article Type: Research Article

Abstract: BACKGROUND: Data regarding the effectiveness of Kinesio Taping in temporomandibular disorders (TMD) is scarce. OBJECTIVE: To determine the efficacy of Kinesio Taping (KT) in patients with TMD. METHODS: Patients with TMDs were randomized into experimental and control groups. The experimental group (n= 14) received KT in combination with counseling and jaw exercise, whilst controls (n= 14) were given the regimen of counseling and exercise alone. Jaw movements, Visual analogue scale (VAS) scores and self-reported measures (functional limitation and masticatory efficiency) were evaluated at baseline, first and sixth weeks of the treatment. Biobehavioral questionnaire …was filled out at baseline and at sixth week. RESULTS: Active mouth opening improved more in the experimental group than controls (p= 0.003). In the experimental group, VAS for temporomandibular joint, masticatory efficiency and functional limitation improved significantly at the sixth week when compared to baseline (p= 0.011, p= 0.001 and p= 0.001, respectively), but not in controls. Subjective treatment efficacy was higher in the experimental group than that of controls (p= 0.000). Pain, depression and disability scores reduced significantly in the experimental group (p= 0.001, p= 0.006 and p= 0.01, respectively), but not in controls. CONCLUSION: In conclusion, KT in combination with counseling and exercise is more effective than counseling and exercise alone in TMDs. Show more

Keywords: Kinesio taping, temporomandibular disorder, temporomandibular joint, temporomandibular pain

DOI: 10.3233/BMR-160683

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 373-380, 2016

Authors: Babaei-Ghazani, Arash | Eftekharsadat, Bina

Article Type: Case Report

Abstract: A 26-year-old female who had been diagnosed with rheumatoid arthritis (RA) 5 years previously, developed multiple extra-articular cysts on shoulder and elbow. She referred to Physical Medicine and Rehabilitation department for musculoskeletal ultrasound guided intervention. RA cysts were resistance to previous blind injections and surgical resection. She had anterior shoulder and elbow pain and hand paresthesia. The average diameters of the cysts in sonography were 3 cm. The patient was keen to treat the cysts on her right shoulder and elbow as it hampered her activity of daily livings. However, it resisted previous interventions, when symptoms grew further we performed …ultrasound guided injection of cysts with Triamcinolone. The symptoms were relieved, and the cysts were resolved completely in 12 month follow up sonographic investigations. Show more

Keywords: Rheumatoid arthritis, multiple extra-articular synovial cysts, musculoskeletal sonography, ultrasound guided injection

DOI: 10.3233/BMR-150625

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 381-385, 2016

Authors: Ren, Kai | Lan, Tao | Yu, Zheng | Chen, Yang | Tian, Chang-Qing | Gu, Hu-Sheng | Yang, Xin-Jian

Article Type: Case Report

Abstract: BACKGROUND AND OBJECTIVE: Fibrous dysplasia (FD) is a benign bone lesion manifested by local pain, swelling and deformity change. We report a case of monostotic fibrous dysplasia of the first thoracic vertebrae that treated by radical removal and reconstruction. CASE REPORT: A 29-year-old man with monostotic fibrous dysplasia of the first thoracic vertebrae was admitted to our department because of persistent, dull back pain for 3 months. Radical removal of the first thoracic vertebrae and reconstruction were performed in a combined posterior-anterior approach. This patient experienced complete pain relief without any complication. CONCLUSION: …This report presents a rare case of monostotic fibrous dysplasia of the first thoracic vertebrae, with symptoms of chronic back pain that was successfully treated with radical excision and reconstruction, providing a good option to the patient. Show more

Keywords: Monostotic, fibrous dysplasia, spine, surgical treatment

DOI: 10.3233/BMR-150647

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 2, pp. 387-391, 2016