Journal of Back and Musculoskeletal Rehabilitation - Volume 29, issue 4
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Journal of Back and Musculoskeletal Rehabilitation is a journal whose main focus is to present relevant information about the interdisciplinary approach to musculoskeletal rehabilitation for clinicians who treat patients with back and musculoskeletal pain complaints. It will provide readers with both 1) a general fund of knowledge on the assessment and management of specific problems and 2) new information considered to be state-of-the-art in the field. The intended audience is multidisciplinary as well as multi-specialty.
In each issue clinicians can find information which they can use in their patient setting the very next day. Manuscripts are provided from a range of health care providers including those in physical medicine, orthopedic surgery, rheumatology, neurosurgery, physical therapy, radiology, osteopathy, chiropractic and nursing on topics ranging from chronic pain to sports medicine. Diagnostic decision trees and treatment algorithms are encouraged in each manuscript. Controversial topics are discussed in commentaries and rebuttals. Associated areas such as medical-legal, worker's compensation and practice guidelines are included.
The journal publishes original research papers, review articles, programme descriptions and cast studies. Letters to the editors, commentaries, and editorials are also welcomed. Manuscripts are peer reviewed. Constructive critiques are given to each author. Suggestions for thematic issues and proposed manuscripts are welcomed.
Abstract: BACKGROUND: Menstrual low back pain (LBP) in young females can reduce daily activity and cause functional disability, while the progressive application of kinesio-taping (KT) on pain reduction and functional correction has been stated. OBJECTIVE: This study has been designed to investigate the efficacy of the lumbar vertebral column KT in young female with menstrual LBP. METHODS: Thirty-two young females with menstrual LBP participated in this crossover study and were assigned randomly in two separate groups. The first group received KT during their first menstrual cycle and No-KT in their next menstrual, while the…other group had no KT during the first mentrual cycle and received KT during the next menstrual cycle. The primary outcome measurements included the visual analogue scale (VAS) of pain, Oswestry disability index and McGill pain questionnaire score which were planned to collect at the end of the third day of the menstrual cycle. RESULTS: Comparing pain and disability between two conditions, of menstrual cycle with KT and menstrual cycle without KT, revealed significant reduction in VAS (mean change = 1.7; 95%CI = 0.6 to 2.8; P= 0.005), McGill pain score (mean change = 20.1; 95%CI = 8.7 to 31.3; P= 0.001) and functional disability (mean change = 12.3; 95%CI = 7.2 to 17.5; P< 0.0001) by using KT during menstrual cycle. CONCLUSIONS: Results showed that KT may effectively reduce pain and disability. The findings may support the clinical application of kinesiotaping in young females with menstrual LBP.
Keywords: Kinesiotaping, low back pain, functional disability, menstrual cycle
Abstract: BACKGROUND AND OBJECTIVE: To evaluate the correlations of the cross-sectional area (CSA) of peripheral nerves in diabetic peripheral neuropathy (DPN) patients based on ultrasound (US) with clinical and demographic characteristics. METHODS: A DPN patient group (n= 53) and a matched healthy control group (n= 53) underwent US imaging of the sciatic, tibial and median nerves. The CSAs of these nerves were recorded, and their associations with pain intensity according to the visual analog scale (VAS) score and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale score, diabetes mellitus (DM) duration, body mass index…(BMI), HbA1c level and blood glucose levels were evaluated. RESULTS: The CSAs of the examined nerves in diabetic patients were larger than those in healthy individuals (p< 0.05). No correlations were detected between the CSAs of the examined nerves and the parameters of interest (p> 0.05), including the VAS and LANSS pain scale scores (p= 0.32 and p= 0.31, respectively). CONCLUSIONS: US is a sensitive diagnostic technique for detecting DPN; however, it does not indicate disease severity.
Keywords: Ultrasonography, diabetic peripheral neuropathy, cross-sectional area, body mass index, Leeds Assessment of Neuropathic Symptoms and Signs
Abstract: OBJECTIVE: The aim of this study is to evaluate the effects of calisthenic exercises on functionality, mobility, disaese activity, quality of life, and psychological status in patients with Ankylosing spondylitis (AS). METHODS: Prospective analysis of forty patients diagnosed with AS were randomized into two exercise groups. AS patients having diagnosis based on 1984-modified New York criteria were involved. Patients were given 8 weeks calisthenic exercise program. Outcome measures including the Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI), AS Quality of Life Questionnaire (ASQoL), Bath AS Patient Global…Score (BAS-G) Hospital Anxiety Depression Score (HADS), erythrocyte sedimentation rate (ESR) and the serum C-reactive protein (CRP) levels were assessed at the baseline and at 8 weeks. RESULTS: Thirty-seven participants completed the exercise programme. After the 8-week exercise programme, the home-based exercise group showed significant improvement in ESR levels and hospital-based exercise group showed significant improvements in terms of the BASMI and HADS-A scores. CONCLUSION: Calisthenic exercises can be easily performed both at home and in hospital setting. In patients with AS, calisthenic exercises performed at the hospital may improve the mobility, and psychological status (anxiety).
Abstract: BACKGROUND: Trunk muscle exercises are widely performed, and many studies have been performed to examine their effects on low back pains. However, the effect of trunk muscles activations during walking with pelvic floor muscle contraction (PFMC) and abdominal hollowing (AH) has not been clarified. OBJECT: To investigate whether walking with PFMC and AH is more effective for promoting local trunk muscle activation than walking without PFMC and AH. METHODS: Twenty healthy men (28.9 ± 3.14 years, 177.2 ± 4.25 cm, 72.1 ± 6.39 kg, body mass index 22.78 ± 2.38 kg/m2 )…were participated in this study. Surface electrodes were attached over the multifidus (MF), lumbar erector spinae (LES), thoracic erector spinae (TES), transverse abdominus-internal oblique abdominals (TrA-IO), external oblique abdominals (EO), and rectus abdominus (RA). The amplitudes of electromyographic signals were measured during a normal walking with and without PFMC and AH. RESULT: PFMC and AH while walking was found to result in significant bilateral increases in the normalized maximum voluntary contraction (MVC) of MFs and TrA-IOs (p< 0.05). Ratios of local muscle activity to global muscle activities were increased while performing PFMC and AH during normal walking. Bilateral TrA-IO/EO activity ratios were significantly increased by PFMC and AH (p< 0.05). CONCLUSION: Performance of the PFMC and AH during walking resulted in significantly more recruitment of local trunk muscles. This study suggests that PFMC and AH during normal daily walking improves activation of muscles responsible for spinal dynamic stabilization and might be useful if integrated into low back disability and pain physical rehabilitation efforts.
Abstract: BACKGROUND: While it is generally accepted that large breast sizes in females contribute to back pain and poor posture, the effects of breast size on spinal motion and muscle activation characteristics are poorly understood. OBJECTIVE: This study examined the relationship between breast size, spine motion, and trunk muscle activation. METHODS: Fifteen university-aged females, free of back pain symptoms, were tested. Breast sizes were calculated, and three-dimensional spine motion and activation from five trunk muscles bilaterally were measured during standing and trunk flexion movements. Correlations between breast size and motion and muscle activation measures…were assessed. RESULTS: Head and trunk angles were strongly, negatively correlated to breast size during upright standing; thoracic angles were moderately, positively correlated to breast size during thoracic flexion movements. Trunk muscles showed positive, moderate-strength relationships with breast size during upright standing and some trunk movements. CONCLUSIONS: These findings provide a preliminary indication that increasing breast sizes are associated with altered postures and increased muscle activation in a non-clinical population, and constitute a baseline for the study of females with a full range of breast sizes. Further research is required to confirm the generalizability of these findings to other sizes, in order to inform strategies for the prevention or reduction of back pain, as well as diagnosis, treatment, and rehabilitation techniques associated with breast size and back pain.
Keywords: Breast size, spine motion, spine posture, trunk muscle activation
Abstract: BACKGROUND: Nerve cuff electrodes provide a safe technique for recording nerve signals. Defining a more realized modeling to investigate the selectivity of a cuff electrode in recording from peripheral nervous system is an interesting field of research. METHODS: A four-contact cuff electrode was modeled to evaluate selective recording from a peripheral nerve. Fitzhugh-Nagumo equations were used to model the electromagnetic fields generated by active nerves and electrodes and the ``selectivity index'' used to quantify the selective property of the cuff electrode. RESULTS: The action potentials amplitude and impulse velocity generated by Fitzhugh-Nagumo model…are similar to real-life nerve measurements according to the literature. The electrical field distribution caused by the impulse propagation along a specific nerve was the maximum near the corresponding contact. Also, the selectivity was increased with increasing the distance between the active sources and the number of contacts. CONCLUSION: The results of this research showed that Fitzhugh-Nagumo equations could model the nerve excitation accurately and could be used in computer simulation for studying nervous systems. Also, using these equations indicated that multi-contact cuff electrodes could be used in recording peripheral nerve signals in order to discriminate active fascicles in a nerve bundle.
Abstract: BACKGROUND: Based on previous studies indicating that core stabilization exercises accompanied by abdominal drawing-in maneuvers increase the thickness of the transversus abdominis muscle. OBJECTIVE: The purpose of this study was to compare the measurements of abdominal muscle thicknesses during running in place in a limited area with the abdominal drawing-in maneuver. METHODS: The study classified the subjects into two experimental groups: the training group (M = 2, F = 13), and the control group (M = 2, F = 13). The training group performed three sets of running in place in a limited…area with abdominal drawing-in maneuvers each time, three times a week for six weeks. The abdominal muscle thicknesses of the subjects were measured using ultrasonography. RESULTS: Comparing the training group's abdominal muscle thickness before and after this study, there was a statistical significance in all of the external obliquus abdominis, the internal obliquus abdominis, and the transversus abdominis. In particular, thicknesses of external obliquus abdominis and internal obliquus increased remarkably. CONCLUSIONS: Running in place in a limited area accompanied by abdominal drawing-in maneuvers increased the thickness of the deep abdominal muscles that are the basis of trunk stabilization.
Keywords: Running in place in a limited area, abdominal drawing-in maneuver, abdominal muscle thickness
Abstract: BACKGROUND: Physical therapists are particularly vulnerable to work-related musculoskeletal disorders (WRMDs). OBJECTIVE: To evaluate the prevalence, causes and impact of WRMDs among physical therapists in the Kingdom of Saudi Arabia (KSA). METHODS: A cross-sectional study of physical therapists using a valid and reliable questionnaire. A total of 690 completed surveys were returned (response rate = 69%). The T-test and Pearson's correlation were used to identify correlations between variables and the incidence of WRMDs. RESULTS: Working hours/week and WRMDs were significantly correlated (p = 0.005). Lower back (46.5%) and…neck (26.6%) pain were most commonly encountered. WRMDs were significantly correlated with altered work habits (p = 0.036) but not with body mass index (p = 0.297). The prevalence of WRMDs among physical therapists was 47.7% with a significant difference between full- and part-time practice (p = 0.023). Adjustable beds/plinths (20%) and splints (18%) were the most commonly used assistive devices. CONCLUSIONS: Physical therapists are especially vulnerable to WRMDs with a prevalence of 47.7%. WRMDs are impacted by both work status and setting. Low back pain is the most common form of WRMDs (46.5%). Avoidance of poor work habits, increased ergonomic awareness and application of safety measures are essential to prevent WRMDs.
Keywords: Prevalence work related disorders, physical therapy, safety strategies
Abstract: OBJECTIVE: Degenerative changes in posterior elements of the spine such as thickening or hypertrophy of the ligamentum flavum (LF) may result in spinal stenosis. In the present study, we aimed to investigate the potential factors including age, intervertebral disc degeneration (IDD), facet joint degeneration (FJD), end plate degeneration (EPD), which may affect LF thickening and to reveal the relationship among those factors at each level of lumbar spine by evaluating the magnetic resonance images (MRI). METHODS: A total of 200 individuals with low back and/or leg pain complaints who had undergone lumbar MRI were included…in this study. The thickness of LF, FJD, IDD and EPD were assessed at all lumbar levels. RESULTS: Totally 1000 end plates, 1000 intervertebral discs and 2000 facet joints were evaluated and the thicknesses of 2000 LFs were measured from MRI images of 200 patients (100 males and 100 females). The mean age was 46.87 ± 12.47 years. LF thickness was strongly associated with FJD especially on the ipsilateral side. Age and IDD were correlated at whole vertebral levels. The age related changes (LF thickness, FJD, IDD and EPD) were more prominent at L4-L5 vertebral level. However, gender had no effect on LF thickness. CONCLUSION: The results of this study suggest that LF thickening may occur independently or could be associated with FJD especially on the ipsilateral side and this relationship is due to the vertebral level. The degree of disc degeneration increases with age and age related changes may be predominantly observed at L4-L5 vertebral level.
Abstract: BACKGROUND : The aim of this study was to clarify the effects of continuous passive motion (CPM) treatment on adhesive capsulitis (AC) in diabetes mellitus (DM) patients. METHODS: Forty-one DM patients with AC were randomized to two treatment groups. The first group (n= 20) (CPM group) received CPM treatments; the second group (n= 21) had conventional physical therapy (CPT group), including active stretching, range of motion (ROM) and pendulum exercises. All patients received electrotherapy. After a four-week-long physical therapy program, the patients were instructed to continue with an eight-week home exercise program. The patients rated the pain…they felt at night, both while at rest and in motion, in the past week using the visual analogue scale (VAS). Functional outcome evaluations were performed using the Constant Shoulder Score (CSS) and Shoulder Pain and Disability Index (SPADI). All patients were evaluated at baseline, and during the fourth and twelfth weeks of the study. RESULTS: There were significant improvements in both groups' active and passive ROM for the shoulder, VAS measures, SPADI pain and disability scores and CSS, and excluding the active and passive internal and external rotation of shoulder increased with both treatment methods (CPM or CPT) over time (p< 0.001), however these differences were found to be prominent in patients receiving CPM therapy. CONCLUSIONS: Both the CPM and CPT therapies seemed to be beneficial for the treatment of AC in DM patients, however CPM revealed more distinctive improvements in the function and pain levels of the AC patients.