Journal of Back and Musculoskeletal Rehabilitation - Volume 30, issue 2

Authors: Duzgun, Irem | Turgut, Elif | Çinar-Medeni, Özge | Kafa, Nihan | Tuna, Zeynep | Elbasan, Bulent | Oskay, Deran

Article Type: Research Article

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. Show more

Keywords: Posterior capsule, frozen shoulder, shoulder impingement syndrome, partial rotator cuff tear

DOI: 10.3233/BMR-160731

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 187-193, 2017

Authors: Caforio, Marco | Maniscalco, Pietro

Article Type: Research Article

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. Show more

Keywords: Proximal humeral fracture, physiotherapy, post-operative shoulder rehabilitation, diphos nail, humeral endomedullary nail

DOI: 10.3233/BMR-160732

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 195-202, 2017

Authors: Paolucci, Teresa | Piccinini, Giulia | Iosa, Marco | Piermattei, Cristina | De Angelis, Simona | Zangrando, Federico | Saraceni, Vincenzo Maria

Article Type: Research Article

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. Show more

Keywords: Body image, Chêneau brace, drawing, TAPS, quality of life

DOI: 10.3233/BMR-160733

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 203-210, 2017

Authors: Ghaderi, Fariba | Jafarabadi, Mohammad Asghari | Javanshir, Khodabakhsh

Article Type: Research Article

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. Show more

Keywords: Neck pain, electromyography, stabilization exercise

DOI: 10.3233/BMR-160735

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 211-219, 2017

Authors: Akkaya, Nuray | Akkaya, Semih | Gungor, Harun R. | Yaşar, Gokce | Atalay, Nilgun Simsir | Sahin, Fusun

Article Type: Research Article

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. Show more

Keywords: Acromiohumeral distance, ultrasonography, subacromial impingement syndrome, pendulum exercises, codman exercises

DOI: 10.3233/BMR-160737

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 221-228, 2017

Authors: Celik, Evrim Coskun | Yalcinkaya, Ebru Yilmaz | Atamaz, Funda | Karatas, Metin | Ones, Kadriye | Sezer, Tezgul | Eren, Imran | Paker, Nurdan | Gning, Ibrahima | Mendoza, Tito | Cleeland, Charles S.

Article Type: Research Article

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. Show more

Keywords: Pain assessment instrument, Brief Pain Inventory, musculoskeletal pain

DOI: 10.3233/BMR-160738

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 229-233, 2017

Authors: Koldaş Doğan, Şebnem | Ay, Saime | Evcik, Deniz

Article Type: Research Article

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. Show more

Keywords: Low level laser therapy, chronic low back pain, pain severity, functional capacity

DOI: 10.3233/BMR-160739

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 235-240, 2017

Authors: Cini, Anelize | de Vasconcelos, Gabriela Souza | Lima, Claudia Silveira

Article Type: Research Article

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. Show more

Keywords: Lower extremity, muscle stretching exercises, range of motion, rehabilitation

DOI: 10.3233/BMR-160740

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 241-246, 2017

Authors: Karimi, Noureddin | Akbarov, Parvin | Rahnama, Leila

Article Type: Research Article

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. Show more

Keywords: Low back pain, physical therapy modalities, traction, inter-vertebral disc herniation, magnetic resonance imaging

DOI: 10.3233/BMR-160741

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 247-253, 2017

Authors: Taspinar, Ozgur | Kabayel, Derya Demirbag | Ozdemir, Ferda | Tuna, Hakan | Keskin, Yasar | Mercimek, Oznur Berke | Süt, Necdet | Yavuz, Selcuk | Tuna, Filiz

Article Type: Research Article

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. Show more

Keywords: Pes planus, shoe modification, exercise

DOI: 10.3233/BMR-150399

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 255-263, 2017

Authors: Sariyildiz, Mustafa Akif | Batmaz, İbrahim | Yazmalar, Levent | Güneş, Mehmet | Turan, Yahya

Article Type: Research Article

Abstract: BACKGROUND: The significance of fluoroscopy-guided transforaminal epidural steroid injections (TFESI) in the treatment of lumbar disc herniation (LDH) is well known. The aim of our study is to investigate the effectiveness of TFESI on radicular pain, functionality, psychological status, and sleep quality in patients with LDH. METHODS: Seventy-five LDH patients (36 males, 39 females) were enrolled in the study. All patients received a fluoroscopically guided TFESI (betamethasone 40 mg, lidocaine 2%). Also all patients were evaluated according to (with the visual analogue scale) radicular pain, Oswestry disability index (ODI), hospital axiety and depression scale, and Pittsburgh …sleep quality index (PSQI) at baseline, at two weeks, and 12 months post injections. RESULTS: Mean age was 46.4 ± 12.5. When compared to baseline measurements there were significant improvements in radicular pain, ODI, modified schober, Laseque angle, finger to floor distance, depressive symptoms and PSQI scores at two weeks and 12 months after injection. Improvement of at least 50% in radicular pain relief, ODI score and sleep quality index was detected at two weeks 83%, 71%, 69% respectively. This rate showed regression at 12 months of 73%, 65% and 62% respectively. Duration of symptoms was significantly negatively correlated with changes in scores of radicular pain, ODI, depressive symptoms, and PSQI. There were no significant correlations with symptom duration and anxious symptoms. CONCLUSION: Fluoroscopy guided TFESI had positive effects on radicular pain, functionality, depressive symptoms and sleep quality in management of LDH. Show more

Keywords: TFESI, lumbar disc herniation, radicular pain, functionality, sleep quality, depressive symptoms

DOI: 10.3233/BMR-150438

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 265-270, 2017

Authors: Kavadar, Gulis | Demircioğlu, Demet Tekdos | Can, Halil | Emre, Tuluhan Yunus | Civelek, Erdinç | Senyigit, Abdulhalim

Article Type: Research Article

Abstract: BACKGROUND: Complementary and alternative medicine (CAM) use has been increasing. OBJECTIVE: To identify the factors associated with perceived benefit from CAM methods in back problems. METHODS: The study was conducted on patients who practiced any CAM methods due to complaints of back pain. Social-demographic properties, details of CAM methods employed were questioned. Severity of pain was measured by visual analog scale (VAS); benefits were evaluated by the Likert scale. Hierarchical cluster analysis was used to discover relationships among variables. RESULTS: In total, 500 patients (265 female, 235 male) …were included in the study. Mostly used methods were herbal therapy (32%), balneotherapy (31%), cupping (19.4%) and massage-manipulation (19.2%). Of patients, 355 (71%) were satisfied. The variables associated with benefit finding were female gender, age, chronicity and severity of pain, high educational level, upper middle income status, use as a result of recommendation, dissatisfaction with conventional methods, residence in an urban area, non-herbal method use, being married, and social insurance (p < 0.005). CONCLUSION: The majority of patients using CAM perceived benefits; in particular, women living in urban areas, highly educated, aged more than 40, who suffer from severe chronic back pain, may be more inclined to go to CAM therapists. Show more

Keywords: Complementary medicine, alternative medicine, back pain, benefit, cluster analysis

DOI: 10.3233/BMR-150470

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 271-277, 2017

Authors: Billis, E. | Koutsojannis, C. | Matzaroglou, C. | Gliatis, J. | Fousekis, K. | Gioftsos, G. | Papandreou, M. | McCarthy, C. | Oldham, J.A. | Tsepis, E.

Article Type: Research Article

Abstract: BACKGROUND: Although low back pain (LBP) is a debilitating problem internationally, there is not a lot of research on its impact on physical, psychosocial and lifestyle factors. Especially in mediterranean countries, such as Greece, it is not sufficiently explored whether physical (pain location, activity limitation etc.), sociodemographic (education, smoking etc.) or lifestyle factors (i.e. quality of life or anxiety) are influenced by LBP. OBJECTIVE: To estimate LBP prevalence in the Greek general population and explore its association with particular sociodemographic, physical and lifestyle factors. METHOD: A sample of 3125 people of the Greek …adult population was randomly selected by stratified sampling encompassing rural and urban representation within the Greek mainland. An extended survey form was developed entailing three sections; personal (sociodemographic) information, questions on symptomatology and physical factors (i.e. pain characteristics, recurrence, physical disability etc.) and 3 self-administered questionnaires (including mostly lifestyle factors); Hospital Anxiety and Depression (HAD) scale for anxiety and depression, SF-12 for quality of life (QoL) and Roland-Morris for disability. RESULTS: A total of 471 (15%) people reported LBP (210 males, mean age: 47.04 ± 15.03). Amongst them 60% reported sciatica, 76% suffered recurrent LBP and 70% received specialist care. Low disability levels, moderate to high pain intensity, gender differences and good self-reported QoL and psychosocial status were reported. Sociodemographic characteristics (income, smoking, marital status etc.) were not associated with LBP physical factors, apart from age which correlated with physical disability and wellness (r being 0.446 and 0.405, respectively, p< 0.001). Physical factors (particularly pain intensity and location) correlated with lifestyle factors (QoL) and disability (r ranging between 0.396 and 0.543, p< 0.001). Mental wellness, anxiety and depression (as lifestyle factors) were not associated with sociodemographic or physical factors. CONCLUSIONS: Physical parameters were amongst the most prevalent characteristics of the Greek sample, thus offering a direction towards a more targeted treatment and rehabilitation planning. Unlike previous literature, most sociodemographic characteristics were not correlated with any LBP physical or lifestyle factors, thus possibly indicating a different socioeconomic background and aetiology domain to that of the usual non-specific LBP spectrum. Show more

Keywords: Low back pain, prevalence, physical, sociodemographic, lifestyle, Greece

DOI: 10.3233/BMR-150484

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 279-290, 2017

Authors: Azatcam, Gokmen | Atalay, Nilgun Simsir | Akkaya, Nuray | Sahin, Fusun | Aksoy, Sibel | Zincir, Ozge | Topuz, Oya

Article Type: Research Article

Abstract: BACKGROUND: Although there are several studies of Transcutaneous Electrical Nerve Stimulation (TENS) and exercise in myofascial pain syndrome, there are no studies comparing the effectiveness of Kinesio Taping (KT) and TENS in myofascial pain syndrome patients. OBJECTIVE: To compare the early and late effects of TENS and KT on pain, disability and range of motion in myofascial pain syndrome patients. METHODS: Sixty-nine patients were divided into three groups randomly as TENS+Exercise, KT+Exercise and exercise groups. Visual Analogue Scale (VAS), pain threshold, Neck Disability Index and cervical contralateral lateral flexion were employed in the …evaluation of the patients performed before treatment, after treatment and 3rd month after treatment. RESULTS: The VAS, pain threshold, Neck Disability Index and contralateral lateral flexion values were improved in all groups both in after treatment and 3rd month after treatment (p< 0.01). In the comparison of after treatment vs. before treatment evaluations, VAS score was decreased in KT group compared to the TENS and control group (p= 0.001), in the TENS group compared to control group (p= 0.011). In the comparison of 3rd month and before treatment evaluations, VAS score was decreased in the TENS group compared to control group (p= 0.001) and in the KT group compared to the control group (p= 0.001). There was no significant difference between TENS and KT groups. All other parameters did not differ between the groups. CONCLUSIONS: TENS and KT added exercises can decrease pain severity and increase pain threshold, function and cervical range of motion in myofascial pain syndrome patients. Addition of TENS or KT to the exercise therapy resulted in more significant improvement compared to exercise therapy alone with a more pronounced improvement in KT group compared to the TENS group in the early period. Because KT was found to be more effective in decreasing the pain and had the advantage of being used in every 3 days, it seems to be beneficial in acute painful periods in myofascial pain syndrome patients. Show more

Keywords: Myofascial pain syndrome, TENS, Kinesio Taping, exercise

DOI: 10.3233/BMR-150503

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 291-298, 2017

Authors: Van Cant, Joachim | Pitance, Laurent | Feipel, Véronique

Article Type: Research Article

Abstract: BACKGROUND: Previous studies have reported strength deficit in hip abduction, extension and external rotation in females with patellofemoral pain (PFP) when compared with healthy control; however, there is conflicting evidence for a decrease in hip muscle endurance. Therefore, it seems important to evaluate hip muscle endurance in females with PFP. Moreover, trunk extensor and ankle plantar flexor endurance have not yet been evaluate in females with PFP. OBJECTIVE: To compare hip abductor, trunk extensor and ankle plantar flexor endurance between females with and without PFP. METHODS: Twenty females with PFP (mean age, 21.1 …years) and 76 healthy females (mean age, 20.5 years) were recruited. Subject performed three endurance clinical tests: (1) The hip abductor isometric endurance test, (2) The Sorensen test and (3) The heel rise test. Group differences were assessed using an independent t tests, or Mann-Whitney U tests for non-normally distributed data. RESULTS: Subjects with PFP exhibited significantly lower hip abductor, trunk extensor and ankle plantar flexor endurance than healthy controls. On average, subjects with PFP had deficits of 16% in hip abduction, 14% in trunk extension and 26% in ankle plantar flexion. CONCLUSION: Females with PFP exhibited diminished hip abductor, trunk extensor and ankle plantar flexor endurance compared to healthy controls. Show more

Keywords: Anterior knee pain, clinical tests, muscles performance, patellofemoral joint

DOI: 10.3233/BMR-150505

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 299-307, 2017

Authors: Tanaka, Shigeharu | Matsumoto, Shinsuke | Kawashima, Takaki | Mitani, Shigeru | Miura, Yasushi

Article Type: Research Article

Abstract: BACKGROUND: The symptoms of hip osteoarthritis (OA) influence instrumental activities of daily living (IADL). Evidence form previous studies suggest that body functions and walking speed are important etiological factors for IADL. However, no studies have investigated which factors that have the greatest influence on IADL. OBJECTIVE: The aims of this study were (1) to analyze factors related to IADL in patients with hip OA, including 10 m walking speed (10 mWS), and (2) to establish cut-off values for factors that predict maintenance of IADL. METHODS: Forty-eight patients participated in this study. IADL was …treated as dependent variable. Range of motion (ROM), muscle strength of the hips and knees, and 10 mWS were measured as independent variables. Other potential confounding factors were also measured. Data were analyzed using hierarchical multiple regression and Receiver Operating Characteristic curve analysis. RESULTS: The hip flexion ROM on the affected side and 10 mWS were selected as significant variables in this study. The cut-off values obtained were 92.5 degrees for the hip flexion ROM on the affected side and 42.3 m/min for 10 mWS. CONCLUSIONS: The suggested target associated with maintaining IADL in patients with hip OA is the cut-off value of 42.3 m/min for 10 mWS found in this study. Show more

Keywords: Instrumental activities of daily living, osteoarthritis of the hip, walking speed

DOI: 10.3233/BMR-160524

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 309-316, 2017

Authors: Karahan, Ali Y. | Yildirim, Pelin | Kucuksarac, Seher | Ordahan, Banu | Turkoglu, Gözde | Soran, Neslihan | Ozen, Kemal E. | Zinnuroglu, Murat

Article Type: Research Article

Abstract: INTRODUCTION: The effect of the application of kinesiotape on muscle strength is still uncertain. This trial represents the first randomized-controlled trial to investigate the immediate and delayed effects of kinesiotape application on triceps muscle strength in healthy subjects. METHOD: The trial was randomized and placebo-controlled. Young adult (18-35 years of age), healthy men were randomly assigned in a 1:1 ratio to either a kinesiotape group or a sham tape for the control group. ``Y''-shaped kinesiotape was applied to the triceps muscle in the sitting position. ``I''-shaped tape was used for the control group, and the sham …tape was placed horizontally on the triceps muscle. A hand-held digital dynamometer was used to evaluate the peak force of elbow extension and flexion. Assessments were carried out before taping, an hour after taping, and after the first week. RESULTS: The mean ages of the participants in the kinesiotape and control groups were 26.2 ± 4.8 and 26.7 ± 4.8, respectively. The mean values of the peak force before taping, after the first hour, and after first week were statistically analyzed using one-way repeated measures. No statistical significance was found for in-group analysis of either the kinesiotape group or the control group (p> 0.05). In addition, there was no statistical significance in the between-group assessments (p> 0.05). CONCLUSION: The triceps muscle is appropriate for studying the effects of kinesiotape on muscle strength because elbow extension is provided by only one fusiform-shaped muscle. The results of this study did not show any significant changes in immediate or delayed muscle strength according to the initial measurements and between-group assessments. Show more

Keywords: Athletic tape, muscle strength, elbow, muscle strength dynamometer

DOI: 10.3233/BMR-160529

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 317-323, 2017

Authors: Gravina, Aristide | Ferraro, Claudio | Poli, Patrizia | Barazzuol, Michele | Del Felice, Alessandra | Masiero, Stefano

Article Type: Research Article

Abstract: BACKGROUND: Gold standard for spine deformities assessment is X rays, but the procedure bears a risk of exposure. OBJECTIVE: To investigate intra-rater and inter-rater reliability of a pocket compass needle goniometer (IncliMed® , University of Padua) to non-invasively evaluate spine curves in children and adolescents. METHODS: Prospective reliability study in a paediatric population (mean age 12.5 years ± 2.5). Children with spine deformities (Scheuermann's or postural kyphosis, idiopathic scoliosis) and healthy controls were included. Two physician measured spinal curves with the surface goniometer IncliMed® within a temporal range of 10 minutes. …Participants were re-tested after a mean of 28 days for the intra-rater study. Agreement limit and coefficient of repeatability were calculated according to the linear regression analysis; the Bland and Altman method was applied to obtain average of differences and standard error of the mean of the differences. RESULTS: One hundred and thirty-nine subjects participated to the inter-rater reliability assessment; 30 to the intra-rater reliability assessment. Inter-observer variability for IncliMed® measurements was ± 11° both for kyphosis and for lordosis. The intra-observer variability for kyphosis and lordosis measurements was ± 11° and ± 12°. CONCLUSIONS: IncliMed® is a reliable, non-invasive tool to screen and monitor spinal curves in paediatric populations. Show more

Keywords: Compass goniometer, spine deformities, scoliosis, growth, inter-rater reliability, intra-rater reliability

DOI: 10.3233/BMR-160541

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 325-331, 2017

Authors: Tunç, Abdulkadir | Güngen, Belma Doğan

Article Type: Research Article

Abstract: BACKGROUND: Electro-diagnostic studies are the most reliable methods in diagnosis of carpal tunnel syndrome (CTS). Although there are many risk factors associated with CTS, there are a limited number of studies in the literature indicating that manual milking, which is frequently seen in Turkey, is a risk factor for CTS. OBJECTIVE: The purpose of this study was to evaluate demographic findings of cases referred due to initial diagnosis of CTS as well as aetiological data especially manual milking and to investigate the sensitivity of initial diagnosis of CTS. METHODS: Six hundred patients, who …were referred to our electromyography laboratory due to initial diagnosis of CTS, were included. Demographic findings, duration of complaints, existence of diabetes mellitus, and manual milking histories of all patients were recorded. Sensitivity of initial diagnosis was investigated based on electro-diagnostic test results. RESULTS: According to electro-diagnostic test results, 289 of the patients were diagnosed with CTS (48.17%). 110 (18.3%) of 600 patients had a history of manual milking. In 94 of this group (85.4%), CTS was detected. Statistically significant correlation was found between CTS and age, female gender, duration of complaints, obesity and manual milking. CONCLUSIONS: This study confirms that manual milking is an important risk factor for CTS in addition to female gender, age, symptom duration and obesity. The fact that sensitivity of initial diagnosis of CTS was found to be low according to electro-diagnostic test results indicates importance of detailed clinical evaluation. Show more

Keywords: Carpal tunnel syndrome, diagnosis, electromyography, manual milking

DOI: 10.3233/BMR-160547

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 333-338, 2017

Authors: McKean, Greg M. | Tsirikos, Athanasios I.

Article Type: Research Article

Abstract: BACKGROUND: Quality of life measurements evaluate surgical results from patients' reported outcomes. OBJECTIVE: To assess the impact of spinal deformity treatment using the Scoliosis Research Society-22 questionnaire. METHODS: SRS-22 data was collected in 545 consecutive patients (425 females-120 males) pre-operatively, 6-, 12- and 24-months post-operatively. Variables included type and age of surgery (mean: 15.14 ± 2.07 years), gender, diagnosis and year of surgery. Age at surgery was divided in: 10-12, 13-15, and 15-19 years. RESULTS: Mean pre-operative SRS-22 scores for the whole group were: function 3.77 ± 0.75; …pain 3.7 ± 0.97; self-image 3.14 ± 0.66; mental health 3.86 ± 0.77; total 3.62 ± 0.66. Mean 2-year post-operative scores were: function 4.39 ± 0.42; pain 4.59 ± 0.56; self-image 4.39 ± 0.51; mental health 4.43 ± 0.56; satisfaction 4.81 ± 0.40; total 4.52 ± 0.37 (p< 0.0001). Males performed better at 2-years post-surgery (4.62 ± 0.25) compared to females (4.49 ± 0.39), (p= 0.004). Patients with spondylolisthesis performed worse pre-operatively (2.93 ± 0.26) compared to other diagnoses (p< 0.0001). This did not impact 2-year post-operative outcomes. There were no significant changes regarding age or year of surgery, type of operation or between the 3 age groups. CONCLUSIONS: All individual domains and total SRS-22 scores improved significantly with incremental change during post-operative follow-up. Patient satisfaction was very high for all individual diagnosis. 2-year post-operative outcomes compared favorably to reported SRS-22 scores in healthy adolescents. Show more

Keywords: Spinal deformity, scoliosis, spinal fusion, quality of life assessment, patient satisfaction, Scoliosis Research Society-22 questionnaire

DOI: 10.3233/BMR-160558

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 339-346, 2017

Authors: Karademir, Mustafa | Eser, Olcay | Karavelioglu, Ergün

Article Type: Research Article

Abstract: BACKGROUND: Symptomatic lumbar intervertebral disc herniation (LDH) is rare in children and adolescents. To date, the treatments available for child and adolescent LDH, and the effect of each treatment, have not been fully reviewed. OBJECTIVE: The purpose of this retrospective study is to report the etiology, familial history, presenting symptoms, level of herniation, duration of symptoms, radiological findings, as well as treatment methods and outcome. METHODS: We retrospectively reviewed medical records of all patients with inclusion criteria of being younger than 20 years. (10-19 years); we used magnetic resonance imaging (MRI) to confirm …lumbar disc herniations between 2013 and 2016. All patients were followed up for a minimum of 12 months and discharged if they remained almost asymptomatic for 6 months. All patients were treated conservatively and 6 patients they have progressive neurological deficit and persistent back pain, were treated with surgical procedures. The Visual Analogue Scale (VAS), as well as the Oswestry Disability Scale (ODS) and the modified Ashworth Scale (AS) were used to analyze physical examination findings both before and after treatment. To detect lumbar disc degeneration, we used the modified Pfirrmann grading system with MRI. All statistical analyses were performed with commercially available SPSS 15.0 software, while p ≤ 0.05 was considered statistically significant. RESULTS: A total of 70 cases with lumbar disc herniation have been treated. The mean age was 17.14 ± 2.15 years (range 9-19 years). The male to female ratio was 35:35. The mean duration of symptoms was 7.21 ± 1.69 months. The follow-up duration was 17.31 ± 4.17 months. The most common level was L4-5 in 38 (54%) patients and the second was L5-S1 in 24 (34%) patients. Subligamentous protruded discs were found in 42 (60%), extruded in 6 (9%), and disc bulge with intact annulus in 22 (31%) cases. VAS before treatment was 6.05 ± 0.83, while at 6 months after treatment it was 3.1 ± 0.6. However, at the first-year examination, VAS was 2.17 ± 0.76. The ODS was indexed before treatment 42.03 ± 3.75, at 6 months being 25.01 ± 2.75 and at the first year 9.92 ± 2.67. VAS and the OSD were both significantly decreased after treatment (p < 0.05). CONCLUSIONS: Either conservative or surgical methods can be performed comfortably for adolescent lumbar disc herniations. We proposed surgical treatment for patients with incapacitating persistent low back pain or radicular pain that lasted more than 6 weeks, despite rest and medication. We also pursued the development of neurological deficits, including recurrent pain that disturbed routine life activities. Show more

Keywords: Adolescent, lumbar vertebra, disc herniation

DOI: 10.3233/BMR-160572

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 347-352, 2017

Authors: Zemková, Erika | Kyselovičová, Ol'ga | Jeleň, Michal | Kováčiková, Zuzana | Ollé, Gábor | Řtefániková, Gabriela | Vilman, Tomáš | Baláž, Miroslav | Kurdiová, Timea | Ukropec, Jozef | Ukropcová, Barbara

Article Type: Research Article

Abstract: BACKGROUND: Contrary to static and dynamic balance, there is a lack of scientific evidence on the training induced changes in reactive balance control in response to unexpected perturbations in overweight and obese individuals. OBJECTIVE: This study evaluates the effect of 3 months of resistance and aerobic training programs on postural responses to unexpected perturbations under stable and unstable conditions in the overweight and obese. METHODS: A group of 17 overweight and obese subjects, divided into two groups, underwent either resistance or aerobic training for a period of 3 months (3 sessions per week). …Prior to and after completing the training, they performed the load release balance test while standing on either a stable or unstable surface, with eyes open and closed. RESULTS: Peak posterior center of pressure (CoP) displacement, and the time to peak posterior CoP displacement during a bipedal stance on a foam surface with eyes open (17.3%, p = 0.019 and 15.4%, p = 0.029) and eyes closed (15.0%, p = 0.027 and 13.2%, p = 0.034), decreased significantly. In addition, the total anterior to posterior CoP displacement, and the time from peak anterior to peak posterior CoP displacement, both with eyes open (18.1%, p = 0.017 and 12.2%, p = 0.040) and eyes closed (16.3%, p = 0.023 and 11.7%, p = 0.044), also significantly decreased. However, after completing the resistance training, the parameters registered while standing on a stable platform, both with eyes open and closed, did not change significantly. The group that underwent an aerobic training also failed to show any significant changes in parameters of the load release balance test. CONCLUSION: Three months of resistance training in overweight and obese subjects improves reactive balance control in response to unexpected perturbations under unstable conditions, both with and without visual cues. Due to the fact that this unstable load release balance test was found to be sensitive in revealing post-training changes, it would be suitable for implementing in the functional diagnostic for this group, in addition to complementing existing testing methods. Show more

Keywords: Center of pressure, obesity, perturbation, postural responses, resistance exercises

DOI: 10.3233/BMR-160585

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 353-362, 2017

Authors: Ko, Gordon D. | Mindra, Sean | Lawson, Gordon E. | Whitmore, Scott | Arseneau, Leigh

Article Type: Case Report

Abstract: BACKGROUND: Two-thirds of adults worldwide will experience low back pain at some point in their life. In the following case series, we present four patients with sacroiliac (SI) joint instability and severe chronic low back pain, which was refractory to other treatment modalities. OBJECTIVE: We investigated the efficacy of platelet-rich plasma (PRP) injections, a novel orthobiologic therapy, for reducing SI joint pain, improving quality of life, and maintaining a clinical effect. METHODS: Short-form McGill Pain Questionnaire (SFM), Numeric Rating Scale (NRS), and Oswestry Low Back Pain and Disability Index were used for evaluation …of treatment at pretreatment, 12-months and 48-months after treatment. RESULTS: At follow-up 12-months post-treatment, pooled data from all patients reported a marked improvement in joint stability, a statistically significant reduction in pain, and improvement in quality of life. The clinical benefits of PRP were still significant at 4-years post-treatment. CONCLUSIONS: Platelet-rich plasma therapy exhibits clinical usefulness in both pain reduction and for functional improvement in patients with chronic SI joint pain. The improvement in joint stability and low back pain was maintained at 1- and 4-years post-treatment. Show more

Keywords: Musculoskeletal and joint disorders, drugs and medicines, orthopaedics, back pain, occupational and environmental medicine, Ehlers-Danlos syndrome, ligament laxity, sports and exercise medicine, fibromyalgia, neuropathic pain, motor vehicle accident

DOI: 10.3233/BMR-160734

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 363-370, 2017

Authors: Kim, Sol-Bi | Ko, Chang-Yong | Son, Jinho | Kang, Sungjae | Ryu, Jeicheong | Mun, Museong

Article Type: Case Report

Abstract: BACKGROUND: Management of a knee contracture is important for regaining gait ability in transtibial amputees. However, there has been little study of prosthesis training for enhancing mobility and improving range of motion in cases of restricted knee extension. OBJECTIVE: This study aimed to evaluate the effects of adaptive training for an assist device (ATAD) for a transtibial amputee with a knee flexion contracture (KFC). A male transtibial amputee with KFC performed 4 months of ATAD with a multidisciplinary team. During the ATAD, the passive range of motion (PROM) in the knee, amputee mobility predictor (AMP) assessment, …center of pressure (COP) on a force plate-equipped treadmill, gait features determined by three-dimensional motion analysis, and Short-Form 36 Item Health Survey (SF-36) scores were evaluated. RESULTS: Following ATAD, PROM showed immediate improvement (135.6 ± 2.4° at baseline, 142.5 ± 1.7° at Step 1, 152.1 ± 1.8° at Step 2, 165.8 ± 1.9° at Step 3, and 166.0 ± 1.4° at Step 4); this was followed by an enhanced COP. Gradually, gait features also improved. Additionally, the AMP score (5 at baseline to 29 at Step 4) and K-level (K0 at baseline to K3 at Step 4) increased after ATAD. Along with these improvements, the SF-36 score also improved. CONCLUSIONS: ATAD could be beneficial for transtibial amputees by relieving knee contractures and improving gait. Show more

Keywords: Adaptive training for assist device, transtibial amputee, knee flexion contracture, gait ability, quality of life

DOI: 10.3233/BMR-160736

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 371-381, 2017

Authors: Guan, Xiaofei | Zhao, Shan | Gu, Xin | Zhang, Hailong | He, Shisheng

Article Type: Case Report

Abstract: OBJECTIVE: To present a unique case of guide wire breakage as a rare complication during posterolateral endoscopic lumbar discectomy. BACKGROUND: Posterolateral endoscopic lumbar discectomy (PELD) has become a routinely performed minimally invasive spinal procedure. However, several complications of PELD have attracted our concerns, including the intraoperative injury to neural and vascular structures and failure of the surgery. We have countered a rare intraoperative complication of guidewire breakage during a PELD procedure, as far as we know, this has not been reported previously, and we wish to draw attention to this hazard. METHODS: The …medical records, operative reports, and radiographical imaging studies of a single patient were retrospectively reviewed. RESULTS: A 28-year-old man presented with right posterior sciatica for 3 months was admitted to the hospital. Unsatisfactory improvement was observed under supervised conservative treatment. Preoperative magnetic resonance imaging (MRI) showed a disc herniation at the L4-L5 level. After preoperative evaluation, a PELD procedure was performed with local anesthesia. After advancement of guide wire and discography, the guiding rod was found not in the vicinity of the extruding disc fragment. Therefore, the operator tried to redirect the guiding rod. However, after several attempts, the guide wire was broken in the disc fragment under imaging. With the patient's permit, the operator inserted the working cannula to the broken end of guide wire and retrieved it using straightened grasping forceps. Then foraminotomy and fragmentectomy were accomplished under endoscope. The patient made uneventful recovery and was free of symptoms for the following 6 months. CONCLUSIONS: In conclusion, the guide wire breakage during PELD procedures is a rare but a serious complication. An appropriate manner and operation is very important to prevent this complication. Once it does occur, the remnant of the guide wire can possibly be retrieved under endoscope with great experience. However, as for the beginners, a transfer to open operation is suggested to prevent new complications. Show more

Keywords: Endoscopic discectomy, case report, intraoperative complication, instrument breakage, working zone, minimally invasive surgery

DOI: 10.3233/BMR-150295

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 383-386, 2017

Authors: Liang, Jie | Wu, Weifei | Ru, Neng | Chen, Jianfeng

Article Type: Case Report

Abstract: BACKGROUND: The syrinx can occur in any region of the spinal cord and is common in cervical and/or thoracic region, and distributing along spinal cord is unusual, especially association with Chiari II malformation and scoliosis. OBJECTIVE: To report a first case of entire syringomyelia associated with Chiari II malformation and severe scoliosis and hydrocephalus. CASE PRESENTATION: The patient began to experience symptoms of bilateral hand weakness in adulthood. In this patient, MR imaging of the brain and spine showed syrinx along entire spine and hydrocephalus, cerebellar tonsillar herniation, and expansion of the fourth …ventricle and posterior cranial fossa. The patient underwent operative treatment to prevent the progression of her neurological deficit. At 12 months' follow-up, the patient's neurological deficit remains stable with the scoliosis left untreated. CONCLUSIONS: Foramen magnum decompression, duraplasty and syrinx-shunting are effective methods even to CM II and entire syrinx. Show more

Keywords: Entire syringomyelia, Chiari II malformation, severe scoliosis, hydrocephalus

DOI: 10.3233/BMR-150389

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 387-391, 2017

Authors: Zarghami, Amin | Nazari, Pouya

Article Type: Letter

DOI: 10.3233/BMR-160523

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 393-394, 2017