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: Dentists are susceptible to Musculoskeletal Disorders (MSDs) due to prolonged static postures. To prevent MSDs, working postures of dental students should be assessed and corrected in early career life. OBJECTIVE: This study estimated the risk of developing musculoskeletal disorders in dental students using Rapid Upper Limb Assessment (RULA) tool. METHODS: A number of 103 undergraduate dental students from fourth and fifth academic years participated. Postures of these students were assessed using RULA tool while working in the dental clinic. They also answered a questionnaire regarding their knowledge about postural dental ergonomic principles.…RESULTS: The majority of the students (66%) were at intermediate and high risk levels to develop MSDs and their postures needed to be corrected. There was no significant correlation between RULA score and gender, academic year and different wards of dental clinics. There was no significant correlation between knowledge and RULA scores. CONCLUSIONS: Dental students did not have favorable working postures. They were at an intermediate to high risk for developing MSDs which calls for a change in their working postures. Therefore students should be trained with ergonomic principles and to achieve the best results, ergonomic lessons should be accompanied by practice and periodical evaluations.
Abstract: BACKGROUND: Hamstring tightness induces posterior pelvic tilt and decreased lumbar lordosis, which can result in low back pain OBJECTIVE: We investigated effects of hamstring stretch with pelvic control on pain and work ability in standing workers. METHODS: One hundred adult volunteers from a standing workers were randomly assigned to pelvic control hamstring stretching (PCHS) (n = 34), general hamstring stretching (GHS) (n = 34), control (n = 32) groups. The control group was performed self-home exercise. All interventions were conducted 3 days per week for 6 weeks, and included in the hamstring stretching…and lumbopelvic muscle strengthening. Outcomes were evaluated through the visual analog scale (VAS), straight leg raise test (SLR), sit and reach test (SRT), Oswestry disability index (ODI), and work ability index (WAI). RESULTS: Significant difference in VAS, SLR, SRT, ODI, and WAI were found in the PCHS and GHS groups. The control group was a significant difference only in ODI. The PCHS group showed a greater difference than the GHS group and control group in VAS, SLR, SRT, and ODI. CONCLUSIONS: The pelvic control hamstring stretch exercise would be more helpful in back pain reduction and improvement of work ability in an industrial setting.
Keywords: Hamstring stretch, pelvic control, low back pain, work ability, standing worker, industrial worker
Abstract: BACKGROUND: Radiographic examination is the gold standard to evaluate spine curves, but ionising radiations limit routine use. Non-invasive methods, such as skin-surface goniometer (IncliMed® ) should be used instead. OBJECTIVE: To evaluate intra- and interrater reliability to assess sagittal curves and mobility of the spine with IncliMed® . METHODS: a reliability study on agonistic football players. Thoracic kyphosis, lumbar lordosis and mobility of the spine were assessed by IncliMed® . Measurements were repeated twice by each examiner during the same session with between-rater blinding. Intrarater and interrater reliability were measured by Intraclass Correlation…Coefficient (ICC), 95% Confidence Interval (CI 95%) and Standard Error of Measurement (SEM). RESULTS: Thirty-four healthy female football players (19.17 ± 4.52 years) were enrolled. Statistical results showed high intrarater (0.805-0.923) and interrater (0.701-0.886) reliability (ICC > 0.8). The obtained intra- and interrater SEM were low, with overall absolute intrarater values between 1.39° and 2.76° and overall interrater values between 1.71° and 4.25°. CONCLUSIONS: IncliMed® provides high intra- and interrater reliability in healthy subjects, with limited Standard Error of Measurement. These results encourage its use in clinical practice and scientific research.
Keywords: Spine mobility, non-invasive spinal sagittal curves measure, reliability, Intraclass Correlation Coefficient, Standard Error of Measurement
Abstract: OBJECTIVE: The purpose of this study was to compare the effectiveness of three injections of standard linear HA versus single injection of lightly cross-linking HA in patients with knee OA. METHODS: Forty subjects were randomized into two groups. The first group received single dose intraarticular injection of 4 ml lightly cross-linking sodium hyaluronate (Monovisc), and the second group received three consecutive intraarticular injections of 2.5 ml standard linear sodium hyaluronate (Adant) with one week intervals. Visual analog scale (VAS)-pain and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores were measured. RESULTS: In…both groups, VAS-pain and WOMAC scores (except WOMAC-stiffness) were improved statistically lasting up to the 6th month with respect to before injection values (p< 0.001). There were no statistical differences in VAS-pain and WOMAC scores after injections (p> 0.05) in both groups. But in the 6th month visit, VAS-resting values were found to be statistically improved in standard linear HA group compared to lightly cross-linking HA group (p< 0.05). CONCLUSION: Although three-dose administration was significantly superior to single-dose at the sixth month, current knowledge is not sufficient to decide whether single-dose or multiple-dose HA injection should be chosen. There is a clear need for verification of our results with long-term studies on larger patient groups.
Abstract: BACKGROUND: According to previously conducted studies, people with Low Back Pain (LBP) present with static balance deficiencies. OBJECTIVE: The aim of the present study was to compare static, as well as dynamic balance ability between Chronic Low Back Pain (CLBP) and healthy subjects. METHODS: The CLBP group comprised 17 subjects and the control group of 16 subjects, matched for age, BMI and gender. The protocol applied compared the balance ability when performing the Star Excursion Balance Test (SEBT) and the static 1-leg stance position. The innovation introduced in the protocol was that the…participants performed not only the static 1-leg stance, but also the dynamic SEBT on a force plate which recorded the target sway (TS), i.e. the Center of Pressure (CoP) excursion. RESULTS: The CLBP group had significantly reduced performance in SEBT, coupled with greater static and dynamic TS values. Age and especially BMI also bear a significant effect on SEBT execution. The inclusion of SEBT and TS derived scores in a stepwise logistic regression equation lead to the correct classification of 85% of the subjects. CONCLUSIONS: Dynamic and static balance ability provide supplementary information for the identification of the presence of CLBP, with dynamic balance being more instrumental.
Keywords: Proprioception, Star Excursion Balance Test, body sway
Abstract: BACKGROUND : Myofascial pain syndrome is defined as ``pain and/or autonomic phenomena referred from active myofascial trigger points''. Trigger point injection is an effective treatment option, which is widely used to treat myofascial pain. Trigger point injection in the cervicothoracic regions can be associated with pneumothorax. CASE: In this paper, we presented a patient who developed pneumothorax after trigger point injection. RESULT: This case report indicates there is a risk of pneumothorax during trigger point injection in the cervicothoracic regions.
Keywords: Myofascial pain syndrome, pneumothorax, trigger point injection, complication
Abstract: BACKGROUND: Spinal accessory nerve (SAN) injury can be an overlooked cause of scapular winging and shoulder dysfunction. The most common etiology is iatrogenic injury following surgical procedures at the posterior triangle of the neck. We present three cases of isolated injury to the SAN following trauma. OBJECTIVE: To improve detection of SAN injuries through highlighting the clinical presentation, diagnosis and treatment via three cases in which the injuries were initially missed. METHODS: Clinical case series and narrative review. RESULTS: Three (3) patients were evaluated by history, physical exam and electrodiagnostic…study (EMG). Clinical symptoms included, a painful, droopy shoulder and difficulties with overhead activities. Clinical signs included the observation of scapular winging, and focal atrophy of the trapezius and in some cases the sternocleidomastoid (SCM). Novel clinical signs such as the active elevation lag sign and triangle sign were also helpful clinically to highlight the SAN as the site of pathology. EMG revealed denervation and reduced motor unit recruitment in the trapezius and SCM. CONCLUSIONS: Early detection of SAN injuries can be improved through appropriate clinical suspicion, a detailed history and careful physical exam. EMG testing can help guide prognosis, direct conservative and surgical treatment, and reduce patient morbidity.
Abstract: BACKGROUND: Latissimus dorsi, grade III tendon tears are an uncommon injury. There are very few cases reported in the literature, but most importantly, no cases could be found that relate to soccer. OBJECTIVE: To present a successful, non-operative rehabilitation program for a professional athlete, after a grade III latissimus dorsi tear. CASE DESCRIPTION: A 37 year old healthy, elite professional soccer goalkeeper was injured during a championship game. The athlete fell on his left side with an outstretched and externally rotated upper extremity in order to catch a ball that was going very…close to the left pole of his goal-post. After on-field and off-field clinical examinations, the diagnosis was a left latissimus dorsi tendon tear which was later confirmed by MRI as a grade III tear. INTERVENTION: During the first two weeks, intervention consisted of anti-inflammatory treatment and light therapeutic exercises. As the pain was subsiding and the strength was returning, the treatment shifted to purely strengthening and functional training. RESULTS: Four weeks after the injury, the athlete presented with pain 0/10 in all functional activities and full ROM in both active and passive movements. Before discharge, the athlete underwent a sport specific training program, without any complains, that cleared him to participate in normal training with the rest of the team. Three months after the injury the strength of the player's left shoulder was 5/5 in all movements. CONCLUSION: The protocol used yielded an accelerated return to sport (soccer) and function compared with other published research after a grade III latissimus dorsi tendon tear. One year later, the goalkeeper was still playing in the same competitive level without any re-injuries or complains, which means that this treatment protocol withstood the test of time.
Keywords: Grade III latissimus dorsi tear, latissimus dorsi tear in soccer, physical therapy after latissimus dorsi tear, latissimus dorsi tear rehabilitation, latissimus dorsi tear in football