Journal of Back and Musculoskeletal Rehabilitation - Volume 3, issue 3
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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: Considerable medical literature has been devoted to the use of spinal orthotics in the treatment of conditions effecting the lumbar spine. Nonetheless, when it comes to clinical application, controversy and misunderstanding continue to exist. This issue of The journal of Back and Musculoskeletal Rehabilitation attempts to reexplore this knowledge base and reexamine the clinical utility of lumbar spinal orthotics. This introductory article briefly covers the history and nomenclature of spinal orthotics with a more in-depth look at the mechanical principles of spinal orthotics. Finally, the more commonly perscribed orthotic designs are presented pictorially.
Keywords: Bracing, orthoses, orthotics, spinal orthotics, low back pain
Abstract: The principles behind the use of lumbar supports have changed drastically in recent years. Once used for immobilization, lumbar supports and body suits are now being used to encourage mobility and return to function in low back pain patients. Modern concepts regarding the stored/strain energy of elastic garments are introduced, followed by a discussion of how body suits and elastic supports utilize these properties to assist the low back pain patient. A number of different types of elastic garments are illustrated. The use of rigid corsets for low back pain began around the turn of the century with the…use of plaster jackets. More recently, heavy nylon, steel stays, and complex plastics have been used for the same purpose. The rationale for this type of immobilization includes assistance for weakened muscles, protection from injury, correction of deformity, control of pain, restriction of spinal movements, and increased temperature.1–4 Some of these proposed physiologic mechanisms have been investigated, including intraabdominal and intradiscal pressure changes, paraspinal electro myographic (EMG) activity, and intersegmental as well as gross spinal motions.4–9 The results ofthese studies have been equivocal, as have the findings of clinical trials investigating the efficacy of rigid orthoses.10–15 Further, certain disadvantages to the use of rigid orthoses have been described, including possible muscle atrophy and dependency. Also, because of the discomfort of the devices and the resultant interference with activities of daily living, patient compliance can be poor.16 Corsets and other similar rigid supports are not commonly used now, except for a few special cases. Elastic body suits or supports are replacing the rigid-backed brace, and the emphasis is shifting from immobilization to assisted mobility and increased function. These new garments are comfortable, and the patient is almost unaware of their presence. In this article the principles of stored or strain (elastic) energy will be reviewed, followed by a discussion of the merits of its use in the back pain patient. We will also illustrate some types of elastic garments available today.
Keywords: Lumbar supports, braces, elastic, strain energy, low back pain
Abstract: Many health care practitioners believe lumbosacral supports and braces can be used effectively in treatment and prevention of musculoskeletal disorders of the lumbar spine. Ninety-nine percent of 3,410 orthopedic surgeons surveyed in the United States reported prescribing spinal orthoses.1 While there is no hard scientific evidence of the clinical effectiveness of lumbosacral supports and braces as a group, there are retrospective studies that have documented acceptance by patients and improvement of symptoms in from 30% to 80% of the cases.2–4 The lower lumbar region is of particular interest because most disorders occur in one or both…of the lower two segments. The use of supports and braces in the management of many common disorders will be discussed. Disorders of the sacroiliac joints, spinal fractures, postsurgical management, and corrective braces used in the treatment of disorders such as scoliosis and kyphosis are not within the scope of this article. Medical as well as industrial health and safety literature is filled with the pros and cons of using lumbar supports and braces. Certain factual information concerning the effects of back supports and braces has been known fix many years, while certain other effects remain unclear. While it is true that we have not made many recent discoveries concerning the effects of back supports, we have seen a renewed interest in their use. This renewed interest seems to focus on prevention as well as treatment, as is especially evident in business and industry. There also seems to be increased awareness and evidence of back injuries in sports. This has created interest in and use of back supports, and has led to development of new concepts and designs of back supports. Perhaps another reason for the renewed interest in back supports and braces has to do with the recent changes in attitudes toward the treatment of back disorders in general. Most experts now agree that almost all back disorders can be treated most effectively with early intervention of exercise and patient education. We no longer tell the patient to rest, take it easy, and wait until he or she is completely free of pain before starting exercises and activities. Many practitioners are recognizing that placing a back support on a patient often assists him or her in returning to full function sooner, avoiding the well-documented harmfi.il effects of prolonged immobilization and inactivity.
Keywords: Spinal supports, low back pain, bracing, orthoses, supports
Abstract: The sacroiliac (SI) joint as a primary source of low back pain is a resurgent, yet controversial subject. In 1905, Goldthwaite proposed that the sacroiliac joint could be a physiologic pain generator independent of pregnancy.1 The role of the sacroiliac joint fell into obscurity over the ensuing decades, with the discovery of such tangible entities (with accepted pathophysiology) as the herniated nucleus pulposus,2 and spinal stenosis.3 Accordingly, there is a paucity of basic and clinical science information available to aid physicians in understanding the biomechanics, diagnosis, and rehabilitation of sacroiliac joint dysfunction.
Abstract: Symptomatic involutional osteoporosis is a significant clinical problem. The prevalence of radiographic vertebral compression fractures (VCF) reached 26% in a rigorous population study of men and women more than 50 years old.1 However, only an estimated 8% of the total affected population actually seek medical attention.2–4 Investigations of effective medical therapy have been extensive, while sound studies of the physical therapeutic measures have been relatively few.5–10 Pain and loss of functional mobility result from this disorder. Kyphosis, with or without vertebral compression fracture, is the major structural culprit that produces these disabling clinical problems. Spinal orthoses…are used clinically for mechanical support and pain relief of osteoporosis.5,11–13 However, little research exists on the efficacy of orthotics in osteoporosis. This article provides a practical approach to guide the practitioner in orthotic selection for selected patients. New concepts presented may stimulate further research interest and more appropriate orthosis prescription. By focusing on level of fracture, biomechanical deficits, and physiatric team mangement, the end product can better satisfy the patient.
Abstract: The use of ankle bracing, taping, and wrapping for athletic injuries is both overused and underused. The overuse occurs in patients who don't need ankle support at all, or who don't need it anymore. Underuse occurs in patients who could potentially return to activity sooner with the extra support. It is now well established and accepted that prolonged immobilization of a body part brings with it a number of deleterious effects. Immobilized animals have been shown to have decreased strength of muscles, bones, tendons, and ligaments.1–3 Immobility adversely affects the healing process and has been shown to decrease…ligamentous tissue, DNA, and collagen synthesis, and to decrease tensile strength compared to ligaments in mobilized rats.4 Similar effects are seen in humans. Proprioception is felt to be impaired after immobilization of the ankle,5–8 and persistent atrophy of the muscles may ensue.9 Weak muscles and poor proprioception predispose the athlete to further injury. Thus, it is clear that immobilizing joints as a part of treatment brings with it morbidity of its own. That is not to say that it is never necessary and useful. Certainly an unstable joint needs to be stabilized, but in recent years the emphasis has shifted from complete immobilization to providing support in only the unstable planes, allowing functional activity to occur in the stable planes. Bracing, taping, and wrapping are increasingly used to provide such support.
Abstract: A case of persistent low back pain occurring in association with facet joint synovial cysts is presented. A history of low back pain and negative plain radiographs illustrate the nonspecific nature of the problem these cysts cause. Magnetic resonance imaging (MRI) clearly demonstrates the presence of lumbar facet joint cysts. Our patient underwent a L5-S1 laminectomy prior to presenting with a new episode of low back pain. Workup, including computed tomography (CT) scan and MRI, confirmed the presence of bilateral synovial cysts at the L4-5 level. Our patient exhibited a partial clinical improvement after surgical excision of bilateral facet joint…cysts. Intraspinal synovial or ganglion cysts of the facet joints are rarely diagnosed. They originate from the synovium of the facet articulation. They can be a source of low back pain1 and present an important diagnostic and therapeutic challenge. Their presence can be easily overlooked using standard radiological techniques2 which may only demonstrate nonspecific degenerative changes such as disc space narrowing and osteophytes. If the patient undergoes surgery and the cyst is not identified preoperatively, the patient may be left with persistent back pain. Computed tomography scan and myelogram have been shown to demonstrate cystic lesions with calcified walls typical of facet joint cysts.3,4 In our case MRI definitively identified what was suspected on the CT scan. It is proposed that MRI is also a valuable, if not better imaging technique of the identification of these cysts.
Keywords: Low back pain, facet cysts, magnetic resonance imaging (MRI)