Journal of Back and Musculoskeletal Rehabilitation - Volume 29, issue 3

Authors: Wang, Liang | Guo, Qunfeng | Lu, Xuhua | Ni, Bin

Article Type: Review Article

Abstract: BACKGROUND: There are still no clearly defined clinical-practice guidelines related to surgical intervention for chronic low back pain (CLBP) in the absence of serious structural problems such as instability, spinal stenosis, spondylolysis, infection, or neoplasm. There is also a lack of high-quality evidence regarding CLBP treatment. OBJECTIVE: To compare the clinical effectiveness of lumbar surgery vs. nonsurgical treatment for chronic low back pain. METHODS: A search was conducted using MEDLINE® , Embase, and reference lists of articles and personal files. After a systematic search, studies were selected on the basis of inclusion criteria. …Six articles (904 patients) met the inclusion criteria for the study. Pooled estimates of clinical results were calculated with 95% confidence intervals. RESULTS: All six eligible studies were independent randomized clinical trials. Pooled data revealed that, compared with surgical treatment, nonsurgical treatment was associated with better Oswestry Disability Index scores. Both groups had similar Visual Analogue Scale and Emotional Distress Scale scores as well as General Function Scores. CONCLUSIONS: For chronic low back pain, nonsurgical treatment was shown to be effective, feasible, and safe during the follow-up period. More randomized controlled trials are needed to compare surgical and nonsurgical treatment of chronic low back pain. Show more

Keywords: Chronic low back pain, meta-analysis, surgical treatment, nonsurgical treatment, Lumbar, Oswestry Disability Index

DOI: 10.3233/BMR-150632

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 393-401, 2016

Authors: Karimi, Mohammad Taghi | Kavyani, Mahsa | Kamali, Mostafa

Article Type: Review Article

Abstract: INTRODUCTION: Scoliosis is one of the common spinal deformities and considered as lateral curvature of the spine. Scoliosis lead to changes in the synergy between body segments, spinal anatomy, left-right trunk symmetry and cause pathological gait pattern [1,4,5-7]. Scoliosis is a structural deformity, so it can alter center of mass (COM) position and weight distribution on lower limbs. This suggests that scoliotic patients show the poorer stability rather aged match normal group. It was controversial that scoliosis influences the balance and gait performances, and also the effects of brace on these parameters. Therefore, it was aimed to evaluate the …available literatures on balance and gait of scoliotic subjects. MATERIALS AND METHODS: We conducted a search via PubMed, Google scholar and ISI web of knowledge to identify studies on scoliosis field and the effect of this deformity on kinetic and kinematic parameters as well as the influence of bracing on mentioned parameters. Some key words such as kinetic, kinematic, gait, stability, and walking were used in combination with scoliosis. The publication dates of the full-length articles were between 1998 and 2014. Down and Black tool was used to evaluate the quality of the articles. RESULTS: Our multiple Medline searches led to the find out 54 papers that 26 of which were relevant based on title and abstract. Based on their references, we retrieved 6 more articles. We ultimately included 31 articles in this literature review. The number of studies regarding the influence of brace on kinetic and kinematic parameters in scoliotic subject was small. Based on the results of various studies, there is no correlation between gait pathology and scoliotic curve direction, no difference between stability of scoliotic and normal subjects and no difference between range of motions of lower limb joints in scoliotic subjects while walking with and without orthosis. CONCLUSION: There was a not sufficient robust evidence to judge about the influence of scoliosis deformity on kinetic and kinematic parameters. However, it should be emphasized that use of orthosis may influence the symmetry of gait and improve standing stability in adult with idiopathic scoliosis. Show more

Keywords: Idiopathic scoliosis, gait, balance, scoliosis brace

DOI: 10.3233/BMR-150641

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 403-415, 2016

Authors: Vieira, Edgar R. | Schneider, Paul | Guidera, Casey | Gadotti, Inae C. | Brunt, Denis

Article Type: Review Article

Abstract: Physical therapists (PTs) perform demanding tasks that can lead to work-related musculoskeletal disorders (WMSD), but the rates and characteristics of WMSD among PTs are not well known. The objective of this systematic review of the literature was to integrate the information published on the prevalence, types, and risks for WMSD among PTs. Four databases were searched using combinations and synonyms for WMSD, discomfort, symptoms, and PTs. Two reviewers independently searched and screened peer-reviewed articles published in English evaluating WMSD in PTs; agreement between reviewers was evaluated. From 867 unduplicated articles, 32 were eligible and included. Up to 90% of PTs …have WMSD during their careers; 50% experience WMSD within 5 years of practice. Low back was the body part most commonly affected. Female PTs and PTs working in hospitals have higher prevalence of WMSD. WMSD are associated with PTs' age, gender, specialty and job tasks. Performing manual therapy, lifting and transferring patients are tasks commonly associated with PTs' developing WMSD. The body parts affected differed by specialty and tasks. The findings presented in this review are useful to inform future research, quality improvement, and educational programs to reduce the rates of WMSD among PTs. Show more

Keywords: Musculoskeletal disorders, physical therapists, occupational injuries

DOI: 10.3233/BMR-150649

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 417-428, 2016

Authors: Gungen, Gonca Odemis | Ardic, Fusun | Findikoglu, Gulin | Rota, Simin

Article Type: Research Article

Abstract: BACKGROUND/OBJECTIVE: The aim of this study is to investigate the effect of mud compress (MC) therapy compared to hot pack (HP) therapy on cartilage destruction and subchondral bone alterations detected by urine levels of C telopeptide fragment of collagen type-II (uCTX-II) in patients with knee osteoarthritis (OA). METHODS: Fifty-nine patients between 49-74 years of age with bilateral knee OA divided into 2 groups. Twenty-five patients (16 females, 9 males) and 34 patients (22 females, 13 males) were given HP versus local natural organic and mineral-rich MC therapy respectively for 2 weeks as a total of 12 …sessions. uCTX-II, Visual Analog Scale (VAS), 15 m walking time, Western Ontario and McMaster Universities multifunctional (WOMAC) index were measured at baseline, after-treatment and 3 months after treatment. RESULTS: uCTX-II level did not show any difference between the two groups, however it decreased significantly in MC and HP groups 3 months after treatment (p< 0.017). WOMAC stiffness sore was significantly lower in MC group 3 months after treatment (p< 0.05). Both MC and HP therapies lowered VAS, WOMAC total and subscores significantly up to 3 months (p< 0.017). CONCLUSIONS: HP and MC therapies for OA of knee are not superior to one another with respect to the level of uCTX-II. MC may probably decrease the ongoing cartilage destruction and related subchonral bone interactions earlier compared to HP treatment in patients with knee OA as evidenced by decreased uCTX-II levels after-treatment. Show more

Keywords: Biomarker, balneotherapy, spa, bone, subchondral, CTX-II

DOI: 10.3233/BMR-150629

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 429-438, 2016

Authors: Lee, In-Hee

Article Type: Research Article

Abstract: OBJECTIVES: This study aimed to evaluate functional biomechanics in patients who undergo total knee arthroplasty (TKA). METHODS: Lower limb joint kinematics and kinetics were evaluated in 25 TKA patients at 3 months following TKA and 25 age-matched controls after 12 months following TKA. Participants were evaluated in a gait laboratory, with self-selected gait speed. RESULTS: Experimental group walked significantly slower (p < 0.01), using a shorter stride length (p < 0.01), compared to those for the controls. The experimental group exhibited significantly greater knee motion, lower knee extension moment (p < 0.01), and …lower peak power generation (p < 0.01) compared to those for the control group. Additionally, the TKA group showed significantly smaller peak ankle motion (p < 0.01), lower ankle dorsiflexion moments (p < 0.05), and ankle power generation (p < 0.01) compared to those for the control group. DISCUSSION: These biomechanical properties of gait in the experimental group may be a compensatory response to lesser recovered knee function to allow sufficient power generation for propulsion. Therefore, rehabilitative strategies at 3 months following TKA are needed to improve not only knee function but also hip and ankle function after TKA. Show more

Keywords: Total knee arthroplasty, biomechanics, gait

DOI: 10.3233/BMR-150635

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 439-444, 2016

Authors: Harvey, Steven | Hukins, David | Smith, Francis | Wardlaw, Douglas | Kader, Deiary

Article Type: Research Article

Abstract: BACKGROUND: Static radiographic techniques are unable to capture the wealth of kinematic information available from lumbar spine sagittal plane motion. OBJECTIVE: Demonstration of a viable non-invasive technique for acquiring and quantifying intervertebral motion of the lumbar spine in the sagittal plane. METHODS: Videofluoroscopic footage of sagittal plane lumbar spine flexion-extension in seven symptomatic volunteers (mean age = 48 yrs) and one asymptomatic volunteer (age = 54 yrs) was recorded. Vertebral bodies were digitised using customised software employing a novel vertebral digitisation scheme that was minimally affected by out-of-plane motion. RESULTS: …Measurement errors in intervertebral rotation (± 1°) and intervertebral displacement (± 0.5 mm) compare favourably with the work of others. Some subjects presenting with an identical condition (disc prolapse) exhibited a similar column vertebral flexion-extension relative to S1 (L3: max. 5.9°, min. 5.6°), while in others (degenerative disc disease) there was paradoxically a significant variation in this measurement (L3: max. 28.1°, min. 0.7°). CONCLUSIONS: By means of a novel vertebral digitisation scheme and customised digitisation/analysis software, sagittal plane intervertebral motion data of the lumbar spine data has been successfully extracted from videofluoroscopic image sequences. Whilst the intervertebral motion signatures of subjects in this study differed significantly, the available sample size precluded the inference of any clinical trends. Show more

Keywords: Videofluoroscopy, lumbar spine, intervertebral motion, spine kinematics, spinal instability

DOI: 10.3233/BMR-150639

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 445-457, 2016

Authors: Barbosa, Rafael Inácio | Fonseca, Marisa de Cássia Registro | Rodrigues, Eula Katucha da Silva | Tamanini, Guilherme | Marcolino, Alexandre Marcio | Mazzer, Nilton | Guirro, Rinaldo Roberto de Jesus | MacDermid, Joy

Article Type: Research Article

Abstract: OBJECTIVE: Compare the efficacy of orthoses and patient education with and without the addition to Low-Level Laser Therapy (LLLT - 660 nm, 30 mW, a continuous regime and bean area of 0.06 cm2 ). The laser irradiation was delivered with the fluency of 10J/cm2 in patients with mild and moderate Carpal Tunnel Syndrome (CTS). METHODS: 48 patients were randomized and 30 finished the protocol (a sample loss of 37.5%), 90% female and 10% males. Randomization was applied to allocate the patients in each one of the groups, with association or not to LLLT (group orthoses …or LLLT and orthoses). All of them were submitted to ergonomic home orientations. The short-term symptoms and function outcome were assessed through: Boston Carpal Tunnel Questionnaire (BCTQ) - Severity of Symptoms (SS) Functional Score (FS). Pain (VAS), Semmes-Weinstein monofilaments, 2PD and pinch strength was used for characterization of the sample. Most of the participants were women, over 4th decade enrolled on heavy hand duties occupations, right-handed, 66.7% affected on dominant hand, without alterations in sensory median nerve thresholds or pinch strength. RESULTS: Both groups showed a reduction of total BCTQ score and its subdomains after six weeks, with significant difference (p< 0.05), comparing to baseline. No significant difference was found between groups. A Minimal clinical change was observed after the intervention in 92.3% of participants for BCTQ subdomain severity of symptoms at individual comparison for LLLT and orthoses group and 76.5% for the orthoses group, demonstrating clinical relevance. Effect size Cohen's index was moderate for the severity of symptoms. CONCLUSION: LLLT in association to orthoses and ergonomic orientation seems to be effective in short-term symptoms relieve for patients with mild and moderate CTS. Show more

Keywords: Carpal tunnel syndrome, rehabilitation, conservative treatment, low-level laser therapy, orthoses, ergonomics

DOI: 10.3233/BMR-150640

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 459-466, 2016

Authors: Segal-Snir, Yael | Lubetzky, V. Anat | Masharawi, Youssef

Article Type: Research Article

Abstract: BACKGROUND: Exercise is considered the first line of treatment for people with non-specific chronic low back pain (NSCLBP) but the ideal exercise type is currently unclear. Given the unique anatomical structure of the lower lumbar spine and the lumbosacral junction transverse-plane rotation exercises may be helpful for people suffering from pain in this region. OBJECTIVE: We aimed to examine the effect of spinal rotation exercises delivered in a group format on range of motion, pain level and function parameters in women with NSCLBP. METHODS: This was a randomized controlled single-blinded study. Thirty-five women …with NSCLBP, participated in either a bi-weekly rotation exercise classes (n= 20) or a `wait-list' control group (n = 15). The exercises aimed at improving lumbar mobility in the transverse plane. Pain rated on a Visual Analog Scale, back specific disability (Rolland Morris questionnaire), and lumbar range of motion (flexion, extension and left and right rotation) were taken prior to intervention, immediately following 4 weeks of intervention and 8 weeks later. RESULTS: There were no significant differences for either group (p> 0.05) on all dependent variables at all times of measurements. CONCLUSIONS: A specific group program of rotation exercises had no effect on the functional status, pain level and lumbar range of motion in women with NSCLBP. Show more

Keywords: Low back pain, rotation exercises, group exercise, Rolland Morris, visual analog scale, lumbar rotation

DOI: 10.3233/BMR-150642

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 467-475, 2016

Authors: Ayhan, Cigdem | Bilgin, Sevil | Aksoy, Songul | Yakut, Yavuz

Article Type: Research Article

Abstract: BACKGROUND: Automatic and voluntary body position control is essential for postural stability; however, little is known about individual factors that impair the sensorimotor system associated with low back pain (LBP). OBJECTIVE: To evaluate automatic and voluntary motor control impairments causing postural instability in patients with LBP. METHODS: Motor control impairments associated with poor movement and balance control were analyzed prospectively in 32 patients with LBP. Numeric Rating Scale (NRS) for pain assessment, Oswestry Disability Index (ODI) for disability measurement, and computerized dynamic posturography (CDP) for analysis of postural responses were used to measure …outcomes of all patients. Computerized dynamic posturography tests including Sensory organization test (SOT), limits of stability test (movement velocity, directional control, endpoint, and maximum excursion), rhythmic weight shift (rhythmic movement speed and directional control), and adaptation test (toes-up and toes-down tests) were performed and the results compared with NeuroCom normative data. RESULTS: The mean age of the patients was 40.50 ± 12.28 years. Lower equilibrium scores were observed in SOT (p < 0.05). There was a significant increase in reaction time and decrease in movement velocity, directional control, and endpoint excursion (p < 0.05). Speed of rhythmic movement along the anteroposterior direction decreased, while speed increased along the lateral direction (p < 0.05). Poor directional control was recorded in the anteroposterior direction (p < 0.05). Toes-down test showed an increased COG sway in patients compared with that in the controls (p < 0.05). CONCLUSIONS: LBP causes poor voluntary control of body positioning, a reduction in movement control, delays in movement initiation, and a difficulty to adapt to sudden surface changes. Show more

Keywords: Low back pain, postural stability, balance control, posturography

DOI: 10.3233/BMR-150643

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 477-486, 2016

Authors: Dıraçoǧlu, Demirhan | Yıldırım, Nazmiye Kocaman | Saral, İlknur | Özkan, Mine | Karan, Ayşe | Özkan, Sedat | Aksoy, Cihan

Article Type: Research Article

Abstract: BACKGROUND: Anxiety and depression may cause temporomandibular joint (TMJ) complaints or TMJ disorders may trigger some of psychiatric problems. OBJECTIVE: The aim of this study was to determine the risk factors and the interactive role of anxiety and depression in patients with TMJ dysfunction. METHOD: A total of 273 patients who presented to the multidisciplinary outpatient clinic of TMJ diseases that were followed up for temporomandibular dysfunction (TMD), were included in this trial. Patients were classified in three sub-groups: patients with myofacial pain alone (group-1), patients with TMJ disorder alone (group-2), and patients …with TMJ disorder and also myofacial pain (group-3). All patients were examined using the standard TMJ examination and were evaluated with the Hospital Anxiety Depression (HAD) scale in order to determine anxiety and depression. RESULTS: According to the univariate analysis, risk factors for patients with confirmed anxiety and/or depression were being female (p= 0.005), existence of myofacial pain (p= 0.01), effects of stress on complaints (p= 0.005) and insufficient social support (p< 0.001). According to regression analysis, presence of psychopathology was increased 3.7 times in those being female, 3.5 times with insufficient social support, and 1.2 times with myofacial pain. CONCLUSIONS: Among the patients with TMD, the groups who were considered to have anxiety and depression were female patients, patients with deficient social support system, and patients with myofacial pain alone or patients with myofacial pain accompanying an existing TMJ disorder. The existence of anxiety and depression should be considered in addition to musculoskeletal pathologies during the treatment plan of patients with TMJ who have these risk factors. Show more

Keywords: Temporomandibular dysfunction, anxiety, depression, risk factors

DOI: 10.3233/BMR-150644

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 487-491, 2016

Authors: Yıldırım, Pelin | Ofluoglu, Demet | Aydogan, Seda | Akyuz, Gulseren

Article Type: Research Article

Abstract: BACKGROUND: Regular exercise training is one of the core components of multifactorial fall-prevention programs. OBJECTIVE: To compare the effect of Tai Chi and combined exercise prescription that consists of three main components of an exercise prescription on static balance, dynamic balance, fear of falling and mood. METHODS: Sixty older adults aged 55-76 were randomly assigned to Group 1 (Tai Chi exercise) or Group 2 (combined exercise prescription). Exercise was performed three times a week over a period of 12 weeks. Single Leg-Stance-Eyes Open (SLS-EO), Single Leg-Stance Eyes Closed (SLS-EC), computerized balance measurements, the …Timed Up and Go (TUG) test, Berg Balance Scale (BBS), the Survey of Activities and Fear of Falling in the elderly (SAFFE), the Geriatric Depression Scale (GDS), and the Beck Depression Scale (BDS) were assessed before and after the final training session. RESULTS: Both exercise groups yielded better results in dynamic balance assessments (TUG and BBS) at the 12th week (p< 0.05). Group 1 also showed significant improvements in the measurements of SLS-EO, SLS-EC, SAFFE, GDS, and BDS during the post-intervention period (all p< 0.05). When the groups were compared, a significant difference was found between groups in favor of Group 1 in terms of the SLS-EO and SAFFE (p< 0.05). CONCLUSIONS: It can be concluded that Tai Chi may be a more successful exercise intervention for factors-related to falls in older people. Show more

Keywords: Tai Ji, Tai Chi, balance, frail elderly, falls

DOI: 10.3233/BMR-150645

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 493-501, 2016

Authors: Law, S.W. | Szeto, G.P.Y. | Chau, W.W. | Chan, Carol | Kwok, Anthony W.L. | Lai, H.S. | Lee, Ryan K.L. | Griffith, James F. | Hung, L.K. | Cheng, J.C.Y.

Article Type: Research Article

Abstract: BACKGROUND: The objective of this study is to evaluate the effects of the Multi-disciplinary Orthopaedics Rehabilitation Empowerment (MORE) Program on reducing chronic disability among injured workers and improving efficiency of work rehabilitation process. METHODS: A cohort of patients with workplace injuries in the lower back were recruited from orthopaedics clinics and assigned to either MORE group (n= 139) or control group (n= 106). Patients in MORE group received an early MRI screening and a coordinated multi-disciplinary management, while patients in the control group received conventional care. Outcome variables are time to return-to-work (RTW) from date of …injury, waiting time for MRI screening and time to medical assessment board (MAB). RESULTS: Patients in the MORE Program had significantly shorter duration for RTW (MORE: 6.1 months, Control: 12.8 months, p< 0.01), and more RTW cases (n= 64, 46.0%) compared to Control group (n= 29, 27.4%). The MORE group also had much shorter waiting time for MRI scans (91.85 vs. 309.2 days, p< 0.001) and MAB referral after MRI scans (97.2 vs. 178.9 days, p= 0.001) compared to Control group. CONCLUSIONS: The MORE Program which emphasizes early intervention and early MRI screening, is shown to be effective in shortening sick leave and improving RTW outcomes of injured workers. Show more

Keywords: Low back pain, return-to-work, case management, worker's compensation

DOI: 10.3233/BMR-150650

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 503-513, 2016

Authors: Mehdikhani, Mahboobeh | Behtash, Hamid | Ganjavian, Mohammad S. | Khalaj, Nafiseh

Article Type: Research Article

Abstract: BACKGROUND: Hyperkyphosis with unknown reason is common in teenagers and can be corrected by orthotic management. OBJECTIVES: Investigation of orthotic outcomes by Milwaukee brace. METHODS: Sixty-one patients with idiopathic hyperkyphosis (> 45 degrees) were given Milwaukee brace before skeletal maturity. Hyperkyphosis was measured during the first visit without brace, in-brace, at the end of full-time and part time duration of treatment. After treatment completion, participants were categorized in two groups: with hyperkyphosis of 45 degrees and less (Group I) and more than 45 degrees (Group II). These groups were compared to interpret the …treatment outcomes. RESULTS: The mean kyphotic curve was 60.1 (SD ± 7.7) and 71 (SD = 10.1) degrees in Group I and II, respectively. The mean kyphotic curve at the time of full time and part time duration of treatment showed no significant difference in patients successfully completed the treatment (P = 0.10) while there was a significant difference between mean kyphotic curve in full time and part time treatment duration for patients with hyperkyphosis of more than 45 degrees (P < 0.05). CONCLUSIONS: Hyperkyphosis of less than 70 degrees can be treated if the in-brace correction is saved in part-time duration. Show more

Keywords: Hyperkyphosis, idiopathic hyperkyphosis, Milwaukee brace

DOI: 10.3233/BMR-150651

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 515-519, 2016

Authors: Lee, Dong-Rour | Jong-Soon Kim, Laurentius

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVES: The goal of this study is to analyze the effects of hand grip training on shoulder joint internal rotation (IR)/external rotation (ER) peak torque for healthy people. METHODS: The research was conducted on 23 healthy adults in their 20 s-30 s who volunteered to participate in the experiment. Hand grip power test was performed on both hands of the research subjects before/after the test to study changes in hand grip power. Isokinetic machine was used to measure the concentric IRPT (internal rotation peak torque) and concentric ERPT (external rotation peak torque) at the …velocity of 60°/sec, 90°/sec, and 180°/sec before/after the test. Hand grip training was performed daily on the subject's right hand only for four weeks according to exercise program. Finally, hand grip power of both hands and the maximum torque values of shoulder joint IR/ER were measured before/after the test and analyzed. RESULTS: There was a statistically significant difference in the hand grip power of the right hand, which was subject to hand grip training, after the experiment. Also, statistically significant difference for shoulder ERPT was found at 60°/sec. CONCLUSION: Hand grip training has a positive effect on shoulder joint IRPT/ERPT and therefore can help strengthen muscles around the shoulder without using weight on the shoulder. Consequently, hand grip training would help maintain strengthen the muscles around the shoulder in the early phase of rehabilitation process after shoulder surgery. Show more

Keywords: Hand grip training, grip power, shoulder joint internal rotation peak torque, shoulder joint external rotation peak torque

DOI: 10.3233/BMR-150652

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 521-525, 2016

Authors: Altuğ, Filiz | Ünal, Ayşe | Kilavuz, Gönül | Kavlak, Erdoğan | Çitişli, Veli | Cavlak, Uğur

Article Type: Research Article

Abstract: OBJECTIVE: The aim of our study is to examine the relationship between kinesiophobia (fear of movement), physical activity level and quality of life. METHODS: In this study, we assessed 112 patients consulting for low back pain (LBP) of ≥ 3 month's duration. We used Visual Analog Scale (VAS) for pain intensity, the International Physical Activity Questionnaire (IPAQ) for physical activity level, Tampa Kinesiophobia Scale for perception of kinesiophobia, Oswestry Disability Index for disability status of low back. RESULTS: The results of this study, there was no statistically significant correlation between International Physical …Activity Questionnaire, duration of pain, intensity of pain at rest and Tampa Kinesiophobia Scale (p> 0.05). It was found a statistically significant correlation between pain intensity at activity (p= 0.009), disability level (p= 0.000) and Tampa Kinesiophobia Scale. Tampa Kinesiophobia Scale were highly negative correlated with sub-scale of SF-36 Quality of Life Index (general health, physical function, social status, bodily pain, role limitations due to physical health) (p= 0.000). CONCLUSION: The kinesiophobia adversely affect the quality of life limiting the physical activity status of patients with chronic low back pain. Show more

Keywords: Chronic low back pain, Tampa Kinesiophobia Scale, physical activity level, quality of life

DOI: 10.3233/BMR-150653

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 527-531, 2016

Authors: Murao, Masanobu | Tsuboi, Miki | Nakajima, Masaaki

Article Type: Research Article

Abstract: BACKGROUND: Lumbar Multifidus (LM) exercise is a treatment in patients with low back pain. We designed a new exercise using device ``Core-Noodle'' (Copyright has been observed in Japan). OBJECTIVE: The purpose of this study was to record the electromyographic (EMG) activity of the lumbar multifidus during a novel exercise. METHODS: Twenty-one healthy young volunteers performed the LM exercise using Core-Noodle in three conditions: no-weight (NW), 1 kg weight (1W), 2 kg-weight (2W). This exercise was performed in supine with left shoulder abduct 90 degrees and right shoulder flexed 90 degrees. EMG activity was …recorded from surface electrodes on the LM and the thoracic part of the iliocostalis lumborum (ICLT), and normalized to values derived from maximal isometric trials (%MVIC). In addition, the ratio of the LM to ICLT (L/G ratio) was calculated to compare selectivity of LM activity. One-way ANOVA and Bonferroni method were used to draw comparisons among the three conditions. RESULTS: Muscle activation of LM was gradually increased in proportion to the loading dose. L/G ratio increased by weight loading significantly, but slightly decreased at 2W. CONCLUSIONS: The results suggest that characteristic EMG patterns of LM ``selective contraction'' and ``adjustment of load'' are obtained concurrently. Show more

Keywords: Lumbar multifidus (LM), low back pain (LBP), electromyography (EMG)

DOI: 10.3233/BMR-150654

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 533-539, 2016

Authors: Genç, Arzu | Kahraman, Turhan | Göz, Evrim

Article Type: Research Article

Abstract: BACKGROUND: The musculoskeletal problems (MSP) vary among different occupations since they had different characteristics and physical workloads. Therefore, it is important to know the difference between the occupational groups to design preventing physiotherapy interventions. OBJECTIVE: To investigate the prevalence differences of MSPs and related physical workload among hospital staff. METHODS: In this cross-sectional study, 416 hospital staff completed the Nordic Musculoskeletal Questionnaire for MSP and Physical Workload Questionnaire for assessing the physical workload. RESULTS: One-year prevalence of low back, neck, upper back, and shoulders were 73.8%, 59.9%, 59.4%, and 52.2%, …respectively. The most preventing MSPs from work found in the low back (39.2%), upper back (26.7%), and the neck (24.5%). MSP of low back impacted nurses the most with a 1-year prevalence of 81.3% and 57.1% of nurses were prevented from working. Nurses, service and cleaning staff had significantly more physical workload than secretaries and physicians. CONCLUSIONS: MSP of low back had the highest prevalence among hospital staff and it was the leading cause which prevented from working. Nurses were the most in danger in terms of MSPs among hospital staff. Physical workload was significantly higher in nurses, service and cleaning staff than secretaries and physicians. Show more

Keywords: Musculoskeletal pain, healthcare providers, occupational health, workload, nurses, physicians, low back pain

DOI: 10.3233/BMR-160655

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 541-547, 2016

Authors: Petersen, Shannon M. | Domino, Nathan A. | Cook, Chad E.

Article Type: Research Article

Abstract: BACKGROUND: People with neck pain often present with weakness in the scapulothoracic muscles. Few studies have examined lower trapezius (LT), middle trapezius (MT) and serratus anterior (SA) muscle strength in individuals with neck pain, nor compared strength to asymptomatic individuals. OBJECTIVES: The aim of this study was to examine LT, MT and SA muscle strength in individuals with chronic neck pain. METHODS: Descriptive cross sectional design. Twenty two individuals with chronic neck pain and 17 asymptomatic individuals were included. Participants were asked to complete a screening questionnaire, Neck Disability Index, and underwent manual …muscle testing for the LT, MT, and SA muscles bilaterally. Data analyses included paired and comparative independent t-tests. RESULTS: For individuals with neck pain, significant within subject differences in strength between sides for the LT (P< 0.01) and MT (P< 0.01) were present. In contrast, no within subject difference between sides for the asymptomatic group was found for any muscle. Individuals with neck pain were significantly weaker than asymptomatic individuals for the LT (p= 0.02), MT (p= 0.03), and SA (p= 0.01) on their side of neck pain, but not on their non-painful side. CONCLUSIONS: Significant within subject differences were found between sides for the LT and MT while significant between group differences were identified for all three muscles tested. Show more

Keywords: Axioscapular, dyskinesis, serratus anterior, scapula, trapezius

DOI: 10.3233/BMR-160656

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 549-555, 2016

Authors: Ashnagar, Zinat | Shadmehr, Azadeh | Hadian, Mohammadreza | Talebian, Saeed | Jalaei, Shohreh

Article Type: Research Article

Abstract: BACKGROUND: Whole Body Vibration (WBV) has been reported to change neuromuscular activity which indirectly assessed by electromyography (EMG). Although researches regarding the influence of WBV on EMG activity of the upper extremity muscles are in their infancy, contradictory findings have been reported as a result of dissimilar protocols. OBJECTIVE: The purpose of this study was to investigate the effects of WBV on electromyography (EMG) activity of upper extremity muscles in static modified push up position. METHODS: Forty recreationally active females were randomly assigned in WBV and control groups. Participants in WBV group received …5 sets of 30 seconds vibration at 5 mm (peak to peak) and 30 Hz by using vibratory platform. No vibration stimulus was used in the control group. Surface EMG was recorded from Upper Trapezius (UT), Serratus Anterior (SA), Biceps Brachii (BB) and Triceps Brachii (TB) muscles before, during and after the vibration protocol while the subjects maintained the static modified push up position. EMG signals were expressed as root mean square (EMGrms) and normalized by maximum voluntary exertion (MVE). RESULTS: EMGrms activity of the studied muscles increased significantly during the vibration protocol in the WBV group comparing to the control group (P ≤ 0.05). The results indicated that vibration stimulus transmitting via hands increased muscle activity of UT, SA, BB and TB muscles by an average of 206%, 60%, 106% and 120%, respectively, comparing to pre vibration values. CONCLUSIONS: These findings suggest that short exposure to the WBV could increase the EMGrms activity of the upper extremity muscles in the static modified push-up position. However, more sessions of WBV application require for a proper judgment. Show more

Keywords: Electromyography, whole body vibration, upper limb muscles, modified push up

DOI: 10.3233/BMR-160657

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 557-563, 2016

Authors: Tan, Boon-Kiang | Burnett, Angus | Hallett, Jonathan | Ha, Amy | Briggs, Andrew M.

Article Type: Research Article

Abstract: BACKGROUND: It is unknown whether questionnaires measuring psychosocial constructs related to low back pain (LBP) that were originally designed for adults are suitable for adolescents, and if paper and web-versions have similar measurement properties. OBJECTIVES: To examine selected psychometric properties for the paper- and web-based Back-Beliefs Questionnaire (BBQ) and the Fear Avoidance Beliefs Questionnaire (FABQ-phys) among adults and adolescents in two diverse countries and to determine whether differences existed between countries and pain groups. METHODS: A sample of 156 adults (Hong Kong, n= 75; Australia, n= 81) and 96 adolescents (Hong Kong, …n= 61; Australia, n= 35) participated in this cross-sectional study. RESULTS: Main effects for country and administration mode were observed in adult BBQ scores, where Australian adults reported significantly higher BBQ scores than Hong Kong adults (mean difference (MD); 95% CI: 2.85; 0.96-4.74) and significantly higher scores were recorded on the web mode compared to the paper mode (MD 0.74; 0.10-1.38). Similarly, Hong Kong adults and adolescents reported higher FABQ-phys scores than Australian adults and adolescents (MD; 95% CI: 3.40; 1.37-5.43 and 4.88; 0.53-9.23, respectively). Internal consistency values were mostly acceptable (α ≥ 0.7). CONCLUSION: Differences exist between cultures for LBP-related beliefs. The BBQ and FABQ-phys have acceptable measurement properties in both administration modes. Show more

Keywords: Psychometrics, adult, adolescent, beliefs, low back pain

DOI: 10.3233/BMR-160658

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 565-574, 2016

Authors: Dandinoğlu, Taner | Karadeniz, Murat | Yılmaz, Volkan | Tekin, Levent | Dinçer, Ümit

Article Type: Research Article

Abstract: BACKGROUND/PURPOSE: The purpose of this study was to evaluate the neuropathic symptoms after local steroid injection in CTS. Since 2001, neuropathic pain scales have been used in the assessment and follow-up of neuropathic pain. DN4 and LANSS pain questionnaires have been applied to groups, mostly consisted of radiculopathy and polyneuropathy cases, before and after various treatments and the results have been compared with the electrophysiologic findings. However to our knowledge there is yet no such study focusing on neuropathic complaints and the relationship between neuropathic pain and electrophysiological findings before and after local corticosteroid injection. METHODS: …Forty-one patients aged 22-65 years and diagnosed with carpal tunnel syndrome by nerve conduction studies who were also found to have neuropathic symptoms were included in the study. All patients received local steroid injection into the carpal tunnel while the questionnaires and nerve conduction studies were performed before and 2 months after the injection. RESULTS: Local steroid injection was found effective on clinical and electrophysiologic parameters as well as on DN4 and LANSS scores in CTS patients (p< 0.05). Electrophysiologic severity exhibited no statistically significant relationship with DN4 and LANSS scores, before and after treatment (p> 0.05). CONCLUSION: These findings suggests that the treatment of neuropathic complaints should be planned independently from the electrophysiologic findings and minimally invasive local steroid injection appears to be effective with regard to clinical and electrophysiologic aspects in CTS patients with neuropathic complaints. Show more

Keywords: Carpal tunnel syndrome, neuropathic pain, DN4, LANSS

DOI: 10.3233/BMR-160660

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 575-580, 2016

Authors: Xu, W.B. | Chen, S. | Fan, S.W. | Zhao, F.D. | Yu, X.J. | Hu, Z.J.

Article Type: Research Article

Abstract: BACKGROUND: Many studies have explored the relationship between facet tropism and facet joint osteoarthritis, disc degeneration and degenerative spondylolisthesis. However, the associations between facet orientation and tropism, and paraspinal muscles have not been studied. OBJECTIVE: To analyze the associations between facet orientation and tropism, and parameters of paraspinal muscles in patients with chronic low back pain. METHODS: Ninety-five patients with chronic low back pain were consecutively enrolled. Their facet joint angles were measured on computed tomography (CT) while gross cross-sectional area (GCSA), functional cross-sectional area (FCSA) and T2 signal intensity of lumbar …paraspinal and psoas muscle were evaluated on magnetic resonance imaging (MRI). RESULTS: The GCSA and FCSA were significantly smaller for multifidus muscle (P< 0.001), but significantly larger for erector spinae and psoas muscles (P< 0.001), in coronally-orientated group than those in sagittally-orientated group. The differences of bilateral GCSA and FCSA of multifidus muscle were significantly larger in facet tropism group than those in no facet tropism group (P= 0.009 and P= 0.019). CONCLUSIONS: Muscular asymmetries may develop in the lumbar region of the spine, which are associated with facet asymmetry in patients with chronic low back pain. Longitudinal studies are needed to understand the causal relationship between facet orientation and tropism and muscular asymmetry in future. Show more

Keywords: Facet orientation, facet tropism, paraspinal muscle, multifidus, erector spinae, psoas major, cross-sectional area, T2 signal intensity, computed tomography, magnetic resonance imaging

DOI: 10.3233/BMR-160661

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 581-586, 2016

Authors: Babina, R. | Mohanty, P.P. | Pattnaik, M.

Article Type: Research Article

Abstract: BACKGROUND: Altered respiratory function has been found to be associated with back pain. Limited chest excursion in subjects with chronic low back pain (CLBP) may be due to co-contraction or bracing of erector spinae and abdominal muscles; their flexed spinal posture; and/or their compromised spinal stability resulting from dysfunctional transversus abdominis. OBJECTIVE: To check for the effects of thoracic mobilization on respiratory parameters in subjects with chronic non-specific low back pain. METHODS: Sixty-two subjects (excluding 11 dropouts) with CLBP of age group 30-60 were randomly allocated to two groups. Both groups received individualized …treatment for low back pain (LBP) and HEP (home exercise program) regime of breathing exercises. In addition, group 1 received Maitland's Central postero-anterior vertebral pressure for thoracic spine (T1 -T8 ). Total treatment duration was 10 sessions in 2 weeks (5 sessions/week). RESULTS: Results showed significant improvement in respiratory parameters viz. Forced Vital Capacity (FVC), Sustained Maximal Inspiratory Pressure (SMIP) and Chest Wall Expansion (CWE) and Oswestry Disability Index (ODI) in both groups (p< 0.05) at end of 2 weeks of intervention. However, improvement was significantly more in group 1 (p < 0.05) receiving additional thoracic mobilization. CONCLUSION: Subjects with non-specific chronic low back pain with or without radiation to lower limbs when treated with thoracic central PA mobilization, in addition to LBP specific treatment and breathing exercises, show an improvement in respiratory parameters and reduction in disability. Show more

Keywords: Chronic low back pain, thoracic mobilization, respiration

DOI: 10.3233/BMR-160679

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 587-595, 2016

Authors: Baskan, Emre | Yağci, Nesrin | Telli Atalay, Orçin | Aslan Telci, Emine

Article Type: Research Article

Abstract: OBJECTIVE: The musculoskeletal pain is one of the leading health problems among employed women. The aim of our study was to examine musculoskeletal pain, depression and quality of life (QOL) among employed women and find out the differences with unemployed women. METHODS: A hundred and fifty employed women and 151 housewives were included in our study. We used visual analog scale (VAS) for the assessment of pain, Beck Depression Inventory (BDI) for the depressive symptoms and Nottingham Health Profile (NHP) for the assessment of QOL. RESULTS: The …ratio of musculoskeletal pain among employed women and unemployed women were found as 42.5% and 57.5% respectively. A mild level of depression was found among employed women whereas moderate and vigorous level of depression were found among unemployed women. There were significant differences in terms of depression and QOL parameters. When the correlations of pain, depression and QOL were analyzed, significant high positive relationships between spinal, lower extremity, upper extremity pain levels and BDI and NHP were found only in housewives. CONCLUSIONS: Lower levels of depression among employed women can give the idea that social ambience at work place, focusing at work and economic independence play a role in decreasing depression. Show more

Keywords: Employed women, musculoskeletal pain, depression

DOI: 10.3233/BMR-160682

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 597-601, 2016

Authors: Lee, Hee Song | Kim, Dae Jin | Oh, Yoongul | Min, Kyunghoon | Ryu, Ju Seok

Article Type: Research Article

Abstract: BACKGROUND: There is no evidence that one exercise program is better than another for rehabilitation of patients with chronic low back pain (CLBP). OBJECTIVE: To identify the safety and efficacy of a gradable stabilization exercise protocol in patients with CLBP. METHODS: This study is a retrospective cohort study with 65 patients. The exercise group received the gradable stabilization exercise protocol for 3 weeks over 6-8 visits, while the control group did not receive any exercise protocol. All subjects were evaluated with the visual analog scale (VAS), Oswestry Disability Index (ODI), Fear-Avoidance Belief Questionnaire …(FABQ), the active sit-up test (AST), side support test (SST), and extensor endurance test (EET). RESULTS: After gradable stabilization exercise, the exercise group showed significant improvement in VAS, FABQ-W, ODI, AST, SST and EET (p< 0.05). And the exercise group showed better improvement than the control group in VAS, FABQ-W, ODI, AST, SST and EET (p< 0.05). The rate of treatment success was 77.1% among patients assigned to the exercise group, as compared with 12.0% among those assigned to the control group. CONCLUSIONS: This study showed that the gradable stabilization exercise protocol has the possibility to improve clinical and physical findings. Show more

Keywords: Low back pain, exercise therapy, questionnaires, physical examination

DOI: 10.3233/BMR-160724

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 603-610, 2016

Authors: Kotan, Dilcan | Kaymak, Kamil | Gündogdu, Aslı Aksoy

Article Type: Brief Report

Abstract: The diaphragm pacing system (DPS) is a life quality improving operation in amyotrophic lateral sclerosis (ALS) patients who need mechanical ventilation or have chronic respiratory insufficiency. This procedure is gaining in popularity, and the number of centers implanting diaphragm pacing systems (DPS) is increasing. DPS delays the need for a ventilation machine in the early stages of Amyotrophic lateral sclerosis (ALS) disease. In this case study, we present a young female ALS patient. A DPS was implanted after respiratory insufficiency began. In the one-year follow-up period following her operation, her need for ventilatory support disappeared.

Keywords: ALS, diaphragm pacing system, respiratory insufficiency

DOI: 10.3233/BMR-150637

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 3, pp. 611-612, 2016