Journal of Back and Musculoskeletal Rehabilitation - Volume 30, issue 2
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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: In the literature it has been shown that posterior capsule flexibility is a precursor to shoulder problems. However, no study thus far has shown the influence of the flexibility of posterior capsule in different shoulder pathologies. OBJECTIVE: This study set about to compare the role of posterior capsule tightness in different shoulder problems. METHODS: One-hundred-twenty-five patients diagnosed with shoulder subacromial impingement syndrome (n= 52), partial rotator cuff tear (n= 31) or frozen shoulder (n= 42) and 30 asymptomatic peers participated in the study. Horizontal adduction was assessed in side-lying position for posterior…capsule tightness. Pain was measured via the visual analogue scale and shoulder range of motion and active total elevation was assessed with goniometer. Hand behind the back (HBB) test was assessed the active internal rotation by measuring the distance between T5 and the thumb. RESULTS: It was found that the affected side of the posterior capsules of the patients with subacromial impingement syndrome (p< 0.001), partial rotator cuff tear (p< 0.001) and frozen shoulder (p< 0.001) was stiffer than their healthy side. There were significant differences among groups in the level of tightness in the posterior capsule between the affected and the healthy sides (p< 0.001). All range of motion of the shoulder including HBB test and the posterior capsule tightness of the affected side are found to be correlated (p< 0.05). CONCLUSIONS: This study emphasized that the posterior capsule's susceptibility to tightness is most evident in frozen shoulder among different shoulder problems.
Abstract: BACKGROUND: The aim of the surgical treatment in proximal humeral fractures is to maintain bone alignment facilitating an early shoulder mobilization. This can be obtained with the use of an endomedullary nail with specific characteristics: a proximal angular multiplanar stability and the possibility to place proximal screws in the calcar region. The objective of this randomized controlled trial is to investigate the effects of an early rehabilitation program in 3-part proximal humeral fractures treated with endomedullary nailing. MATERIALS AND METHODS: 126 patients treated with the Diphos Proximal Humeral Nail (PHN), followed with an Intensive Rehabilitation Program…(IRP) started in the second postoperative day, were compared to 62 patients with a Standard Rehabilitation Program (SRP) where shoulder mobilization started after 3 weeks. The age of patients was under 65 years. Main Outcome measures were improvement of shoulder function based on Constant Score and quality of life on DASH questionnaire at 1, 3, 6 and 12 months after surgery. Safety outcome was no loss of radiological reduction at any follow-up control. RESULTS: A difference considered statistically significant (95% confidence interval) was demonstrated by Constant scores at 3 and 6 months and by DASH questionnaire scores at 1 month after surgery between IRP and SRP groups, however without loss of radiological reduction and maintaining the full fracture healing at the same mean period of 1,8 ± 0,7 months. DISCUSSION: This experience allows to highlight essential features of this new kind of endomedullary humeral nail, by its mechanical properties, in proximal humeral fractures in order to permit an early rehabilitation without creating displaced or consolidation delay. LEVEL OF EVIDENCE: III, randomized clinical-case-control study.
Abstract: BACKGROUND: The perception of body image and the deformity of the trunk in patients with adolescent idiopathic scoliosis (AIS) are a silver lining that has yet to be discussed in the relevant literature during brace rehabilitation treatment. OBJECTIVE: To determine whether and how the use of the brace changes perception of the trunk in patients with AIS by the drawing test. METHODS: We observed 32 subjects with AIS from our Rehabilitation outpatient clinic and divided them into the brace treatment (BG-16 subjects) and the non-brace treatment (CG-16 subjects). Trunk perception and quality of…life were evaluated using the Trunk Appearance Perception Scale and Scoliosis Research Society-22 questionnaire, and the perception of one's back was measured by the drawing test. RESULTS: Pain was lower in BG versus CG (p= 0.095). Satisfaction with the treatment was higher in BG than in CG (p= 0.002). Self-image did not differ significantly between the groups in terms of TAPS. Drawings of the most severe cases of scoliosis were made by the group without the brace. CONCLUSIONS: The use of the brace corrects the function of the trunk and has a positive influence on its perception.
Keywords: Body image, Chêneau brace, drawing, TAPS, quality of life
Abstract: BACKGROUND: Neck pain is an important cause of disability. In spite of its high prevalence rate, treatment of the disorder is a challenging topic. Stabilization exercise has been the topic of many studies. OBJECTIVE: To compare the effects of stabilization and routine exercises on chronic neck pain. METHODS: Forty patients were randomly assigned into either stabilization or routine exercise groups and undertook a 10-week training program. Electromyographic (EMG) activity was recorded from Sternocleidomastoid (SCM), Anterior Scalene (AS) and Splenius Capitis (SC) muscles bilaterally. Endurance time of deep flexor muscles was measured by chronometer.…Pain and disability were measured using Visual Analogue Scale (VAS) and neck disability index (NDI) questionnaire, respectively before and after training period. RESULTS: Findings revealed significant decreased pain and disability in both groups after intervention (P< 0/001). Flexor muscles endurance of stabilization group was significantly increased compared with that of routine (P< 0/001). Also EMG activity of SCM, AS and SC muscles were significantly decreased in stabilization group compared with routine (P< 0/001). CONCLUSION: Increased deep flexor endurance and decreased EMG activity of SCM, AS and SC muscles suggest an important role for stabilizing exercises on reducing the activity of superficial muscles in chronic neck pain.
Abstract: BACKGROUND: Although functional results of combined rehabilitation programs are reported, there have been no reports studying the effects of solo pendulum exercises on ultrasonographic measurements of acromiohumeral distance (AHD). OBJECTIVE: To investigate the effects of weighted and un-weighted pendulum exercises on ultrasonographic AHD and clinical symptoms in patients with subacromial impingement syndrome. METHODS: Patients with subacromial impingement syndrome were randomized to performing weighted (1.5 kilograms hand held dumbbell, N= 18) or un-weighted (free of weight, N= 16) pendulum exercises for 4 weeks, 3 sessions/day. Exercises were repeated for each direction of…shoulder motion in each session (ten minutes). Clinical situation was evaluated by Constant score and Shoulder Pain Disability Index (SPADI). Ultrasonographic measurements of AHD at 0°, 30° and 60° shoulder abduction were performed. All clinical and ultrasonographic evaluations were performed at the beginning of the exercise program and at end of 4 weeks of exercise program. RESULTS: Thirty-four patients (23 females, 11 males; mean age 41.7 ± 8.9 years) were evaluated. Significant clinical improvements were detected in both exercise groups between pre and post-treatment evaluations (p < 0.05). There was no significant difference for pre and post-treatment AHD measurements at 0°, 30°, and 60° shoulder abduction between groups (p > 0.05). There was no significant difference for pre and post-treatment narrowing of AHD (narrowing of 0°-30°, and 0°-60°) between groups (p > 0.05). CONCLUSION: While significant clinical improvements were achieved with both weighted and un-weighted solo pendulum exercises, no significant difference was detected for ultrasonographic AHD measurements between exercise groups.
Abstract: BACKGROUND: The Brief Pain Inventory (BPI) is both a questionnaire and an outcome measure that is used widely in clinical trials to assess pain associated with many conditions. The BPI Short Form has been extensively translated into foreign languages. The aim of this study was to assess the validity and reliability of a Turkish Brief Pain Inventory Short Form (BPI-TR) to evaluate musculoskeletal pain. METHODS: In total, 297 patients with musculoskeletal pain participated in the study. Demographic characteristics and brief medical histories were recorded. Pain intensity was assessed using a visual analogue scale (VAS) and quality-of-life…was assessed using the Short Form 36 (SF-36). Pain was evaluated using the BPI-TR in all patients. Internal consistency and test-retest analysis were used to assess reliability. The internal consistency of the scale items was assessed by calculating Cronbach's α value, which was expected to be > 0.7. The criterion validity of the BPI-TR was assessed by correlation with VAS scores. RESULTS: Pain intensity, pain interference, and other components of the Turkish version were consistent with validity thereof. Cronbach's α was 0.84 for pain intensity and 0.89 for pain interference. The extent of BPI-TR and VAS correlation was statistically significant. CONCLUSIONS: The BPI-TR may be used for assessment of musculoskeletal pain.
Abstract: OBJECTIVE: The purpose of this study was to compare the effectiveness of two different laser therapy regimens on pain, lumbar range of motions (ROM) and functional capacity in patients with chronic low back pain (CLBP). METHODS: Forty nine patients with CLBP were randomly assigned into two groups. Group 1 (n= 20) received hot-pack + laser therapy 1 (wavelength of 850 nm Gallium-Aluminum-Arsenide (Ga-Al-As) laser); group 2 (n= 29) received hot-pack + laser therapy 2 (wavelength of 650 nm Helyum-Neon (He-Ne), 785 ve 980 nm Gal-Al-As combined plaque laser) for 15 sessions. Pain severity, patient's and physician's…global assessments were evaluated with visual analogue scale (VAS). Modified Schober test, right and left lateral flexion measurements were done. Modified Oswestry Disability Questionnaire (MODQ) was used for evaluation of functional disability. Measurements were done before and after the treatment. RESULTS: After treatment there were statistically significant improvements in pain severity, patient's and physician's global assessment, ROM and MODQ scores in both groups (P< 0.05). After the treatment there were statistically significant differences between the groups in lateral flexion measurements and MODQ scores (P< 0.05) except in pain severity, Modified Schober test, patient's and physician's global assessments (P> 0.05) in favor of those patients who received combined plaque laser therapy (group 2). CONCLUSION: Laser therapy applied with combined He-Ne and Ga-Al-As provides more improvements in lateral flexion measurements and disability of the patients, however no superiority of the two different laser devices to one another were detected on pain severity.
Abstract: BACKGROUND: Several factors are associated with the presence of chronic low back pain; one of them is the flexibility of the hamstring muscles that influences the posture of the pelvic spine. OBJECTIVE: Investigate the influence of two different time periods of passive static stretching on the flexibility of the hamstring. METHODS: Forty-six physiotherapy students were divided into two groups performing stretching exercises: 30 s and 60 s duration. The collections consisted of: (1) pre-test: evaluation of the flexibility of the hip and knee, using a manual goniometer by means of the following tests:…Straight Leg Raise Test (SLR), Passive Hip Flexion Test (PHFT) and Modified Knee Extension Test (MKET), (2) intervention: stretching with different runtimes, (3) post-test: reappraisal of flexibility, conducted immediately after the intervention. RESULTS: Significant difference was observed intra groups, group that did stretching exercises lasting 30 seconds (G30) (SLR p = 0.000. PHFT p = 0.003 and MKET p = 0.000) and group that did stretching exercises lasting 60 seconds (G60) (SLR p = 0.000. PHFT p = 0.001 and MKET p = 0.002). Comparing the groups, no significant difference was found (SLR p = 0.307; PHFT p = 0.904; MKET p = 0.132). CONCLUSION: Thus it can be inferred that 30 seconds are sufficient for increased flexibility of young women. Therefore the time-treatment sessions can be optimized. Only the acute effect of stretching was observed; further investigation of the long-term effect is required.
Keywords: Lower extremity, muscle stretching exercises, range of motion, rehabilitation
Abstract: BACKGROUND: Low Back Pain (LBP) is considered as one of the most frequent disorders, which about 80% of adults experience in their lives. Lumbar disc herniation (LDH) is a cause for acute LBP. Among conservative treatments, traction is frequently used by clinicians to manage LBP resulting from LDH. However, there is still a lack of consensus about its efficacy. OBJECTIVE: The purpose of this study was to evaluate the effects of segmental traction therapy on lumbar discs herniation, pain, lumbar range of motion (ROM), and back extensor muscles endurance in patients with acute LBP induced by…LDH. METHODS: Fifteen patients with acute LBP diagnosed by LDH participated in the present study. Participants undertook 15 sessions of segmental traction therapy along with conventional physiotherapy, 5 times a week for 3 weeks. Lumbar herniated mass size was measured before and after the treatment protocol using magnetic resonance imaging. Furthermore, pain, lumbar ROM and back muscle endurance were evaluated before and after the procedure using clinical outcome measures. RESULTS: Following the treatment protocol, herniated mass size and patients' pain were reduced significantly. In addition, lumbar flexion ROM showed a significant improvement. However, no significant change was observed for back extensor muscle endurance after the treatment procedure. CONCLUSION: The result of the present study showed segmental traction therapy might play an important role in the treatment of acute LBP stimulated by LDH.
Keywords: Low back pain, physical therapy modalities, traction, inter-vertebral disc herniation, magnetic resonance imaging
Abstract: Pes planus is a condition that can cause pain along the innerfoot due to the absence or abnormal depression of the longitudinal arch. There are few studies available that compare therapy modalities used in these patients. In our study, those treated with conservative therapies - internal and external shoe modifications and pes planus exercises - were compared clinically and pedobarographyically. 60 pes planus patients were included in the study. In the first group; internal modification was performed by placing a medial longitudinal arch support inside the shoe. In the second group, external shoe modification was performed using the Thomas heel.…In the third group of patients however, only an exercise program was executed. The patients' foot pain levels, functional asssessment, satisfaction and quality of life were recorded. Pedobarography was used in measuring both static and dynamic plantar pressure. Assessments were carried out at baseline and at the end of the first and third months respectively where intra- and inter- group comparisons were performed. Each group was composed of 20 subjects. While improvement in terms of foot pain, foot function index and quality of life was observed in all the study groups (p< 0.05), the most improvement was observed in the group of patients treated with internal modification (p< 0.016). This was followed by the external modification and the exercise groups respectively. No difference was observed between the internal and external modification groups in terms of patient satisfaction. Cross-sectionally; clinical assessments, pedobarographic analysis were correlated. The changes observed after static and dynamic pedobarographic studies were not significantly different between the study groups. At the end of the study it was observed that internal modification yielded the most significant clinical improvement. In the literature, there are limited publications comparing the conservative treatments with each other. In this study we aimed to compare the conservative treatments for flatfoot.