Journal of Back and Musculoskeletal Rehabilitation - Volume 30, 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: Dynamic tasks over unstable surfaces are commonly done in daily activities. OBJECTIVE: A number of studies indicated positive effect of doing postural tasks over unstable surface on trunk muscle activities in patients with low back pain (LBP), while the others reported opposite effects. Due to lack of consensus in the findings in this area of research, we aimed to systematically review studies, which investigated the effect of surface instability on trunk muscle activity in patients with LBP as compared to healthy individuals. METHIDS: A literature search was performed using the PubMed, Science…Direct, OVID, CINAHL, PEDro, Cochrane, Scopus and MEDLINE databases. Low back pain, unstable surface, posture or stability and trunk muscle activity were applied as keywords. The methodological quality was examined using valid assessment tools. RESULTS: The activity of superficial trunk muscles is impaired in patients with LBP during dynamic tasks over unstable surfaces. Differences in the methodology of included studies could be considered as reasons behind the inconsistencies in the findings in included studies. These studies included investigation of superficial or deep muscles, the timing of recorded muscle activity, the level of surface instability and the length of time over unstable surfaces. CONCLUSION: Dynamic tasks over unstable surfaces could decrease pre-program reaction (PPR) and increase voluntary reaction (VR) of superficial trunk muscles in patients with LBP, which may reduce the ratio of deep versus superficial muscles, compared to healthy individuals.
Abstract: BACKGROUND: Cumulative trauma disorder (CTD) is a term for various injuries of the musculoskeletal and nervous systems that are caused by repetitive tasks, forceful exertions, vibrations, mechanical compression or sustained postures. Although there are many studies citing incidence of CTDs, there are fewer articles about its etiology, pathology and management. OBJECTIVE: The aim of our study was to discuss the etiology, pathogenesis, prevention and management of CTDs. METHODS: A literature search was performed using various electronic databases. The search was limited to articles in English language pertaining to randomized clinical trials, cohort studies…and systematic reviews of CTDs. RESULTS: A total of 180 papers were identified to be relevant published since 1959. Out of these, 125 papers reported about its incidence and 50 about its conservative treatment. CONCLUSIONS: Workplace environment, same task repeatability and little variability, decreased time for rest, increase in expectations are major factors for developing CTDs. Prevention of its etiology and early diagnosis can be the best to decrease its incidence and severity. For effective management of CTDs, its treatment should be divided into Primordial, Primary, Secondary and Tertiary prevention.
Keywords: Cumulative trauma disorder, work related musculoskeletal disorders
Abstract: BACKGROUND: Electronic rulers on computer screen are used to measure the Cobb angle (CA) instead of traditional methods with rulers, protractors and pens. The variety of software used to assess radiographs might make the CA measurements cumbersome in everyday clinical practice. OBJECTIVE: The aim of the study was to verify the method of CA measurements on digital radiographs using Bunnell scoliometer (BS). METHODS: Eighty patients with idiopathic scoliosis were enrolled into the study. CA of each curve was measured by use of Centricity software and BS. CA on 30 randomly chosen patients were…measured 3 times by one researcher using only scoliometer. Three researchers measured CA on the same 30 radiographs using BS. RESULTS: The mean CA of 224 curves measured by Centricity and BS were 29° ± 12.2° and 28° ± 11.7°, respectively. The ICC for agreement for 2 methods was 0.96 with SEM of 1.7°. Excellent intra- and interobserver reliability of CA measurements with scoliometer was noted: ICC of 0.96 with SEM of 1.4° and ICC of 0.93 with SEM of 1.9°, respectively. CONCLUSIONS: The study revealed excellent reliability of CA measurements on digital radiographs using the BS. The proposed method of using the Bunnell scoliometer for CA measurements may be clinically useful.
Abstract: OBJECTIVES: Musculoskeletal symptoms of the neck and shoulder represent a condition whose basic characteristic is pain. These conditions are very often present in dental health professionals. The aim of the paper was to determine presence of discomforts in areas of head, neck, shoulders, upper back and upper limbs at health professionals in area of dentistry, as well as discomfort localisation and methods of treatment. METHODS: The research included 45 health professionals (dentists, dental assistants and dental technicians) employed at Dental Clinic of Vojvodina. The information was collected via questionnaire for analysis musculoskeletal disorders.…RESULTS: Most of the dentists (75.9%) and the dental assistants (90.9%) as well as nearly half of the dental technicians (40%) experience discomforts in area of the neck, which are occasional, present in all three working positions and this discomforts are a little more frequent at women. The present musculoskeletal disorders are followed by headache, whose presence is statistically more significant compared to the other symptoms. The headache is usually located in the occipital part, it occurs individually or joined with other symptoms. Due to said discomforts the examinees in 59.4% of the cases don't contact the doctor. Medical therapy prevails in opposition to physical therapy. CONCLUSION: The discomforts deriving from the cervical part of the spine are present at great percentage of our examinees. Considering the fact that the said discomforts affect performing both professional and everyday activities, its prevention is necessary in order to avoid the consequences they carry.
Abstract: OBJECTIVE: The aim of the study was to gain information about the incidence of mechanical Low Back Pain (MLBP) injuries etiology in elite track and field athletes and to assess the recurrence rate. BACKGROUND: The prevalence and the etiology of Low Back Pain (LBP) in athletic populations at the elite level of competition lack of longitudinal studies focused on certain sport fields. The present study evaluates MLBP incidents in elite track and field athletes visiting National Track and Field Centre in Thessaloniki, Greece and classifies MLBP according to etiology. METHODS: One hundred and…thirty Elite Track and Field Athletes with MLBP injuries were included in a 20-year observational cohort study recording the initial MLBP etiology according to a classification system based on mechanical diagnosis. It was examined if age, gender and sport category predispose the incidence of the initial MLBP etiology and if they consist risk factors for MLBP recurrence. RESULTS: Discogenic MLBP in elite track and field athletes was significantly higher at 46.9% (α = 0.05) compared with the other MLBP etiologies under consideration. Secondary findings of the present study regarding the incidence of MLBP etiology categories did not reveal significant associations with gender, age and contest categories (α = 0.05). Additionally, recurrence pathophysiology showed that discogenic MLBP obtained high recurrence rates at 0.48 (14 athletes from 29 athletes recurred) compared with other etiologies, followed by back elements injury recurrence rate at 0.24 (7 athletes out of 29). CONCLUSIONS: The study provided us with evidence of higher incidence of discogenic etiology of MLBP in elite track and field athletes. Further research is suggested in the use of etiology related LBP classification system in order to evaluate causes, prevalence and epidemiology of MLBP in athletic populations of specific sport categories.
Keywords: Incidence, mechanical low back pain, lumbar, sports injuries, track and field athletes
Abstract: BACKGROUND: The management of De Quervain's disease is determined more by Intuition than scientific data. The choice of first line conservative option for the management of De Quervain's disease is still a topic of debate. AIM: To evaluate the effectiveness of therapeutic ultrasound with or without spica splint in the management of De Quervain's disease (DQD). DESIGN: Randomized controlled trial (RCT). SETTING: Outpatient department of Al-Nafees Medical College Hospital, Islamabad, Pakistan. POPULATION: Thirty patients who had the history of the De Quervain's disease for at least 6…months were enrolled in the study. The ages of the patient were 30-50 year. The population included housewives, maids, painters, and teachers. METHODS: Thirty patients were divided into two groups. The control group was treated with therapeutic ultrasound while in the experimental group thumb spica splitting was also added. The data was collected from the subjects through Quick Disabilities of the Arm, Shoulder and Hand questionnaire. The demographic data was presented in the form of tables. Intervention-induced changes within the groups were investigated using paired sample t-test while independent sample t-test was used to compare the two groups. RESULTS: Significant changes within both groups (p ≤ 0.05) were observed as a result of intervention. Additionally, significant differences in some instrument items were found between experimental and control group (p ≤ 0.05) after intervention. However, some items did not demonstrate significant changes in both groups likely because there was no effect of De Quervain's disease on those items before the intervention. CONCLUSION: The results showed that the use of therapeutic ultrasound and spica splint together is more effective than using therapeutic ultrasound alone in the conservative management of De Quervain's disease. CLINICAL REHABILITATION IMPACT: This study provides evidence to the relevant clinicians and professionals on the utility of therapeutic ultrasound combined with thumb spica splint in the conservative management of DQD.
Abstract: BACKGROUND: The assessment of the lumbo-pelvic complex parameters is the basic procedure during the examination of the patients with low back pain syndrome (LBP). OBJECTIVE: The aim of the study was to define the relationship between pelvic tilt and following factors: age, BMI, ability to activate deep abdominal muscles, iliopsoas and hamstrings muscles length, lumbar lordosis and thoracic kyphosis angle value, in adults with and without low back pain. METHODS: The study covered a group of 60 female students aged 20-26. Average age was 22 years ± 1.83 (median = 22.5…years). In order to investigate the relationship between the anterior pelvic tilt and the analysed variables, simple linear regression and multiple linear regression were carried out. RESULTS: Individuals with and without pain differed significantly in terms of age, p < 0.001. There was a statistically significant relationship between the anterior pelvic tilt and the LBP (R2 = 0.07, p = 0.049) and the lumbar lordosis (R2 = 0.13, p = 0.02). CONCLUSIONS: The position of the pelvis depends on age, angle value of lumbar lordosis and BMI. Individuals with and without pain differed significantly in terms of the anterior pelvic tilt. The risk of LBP incidence increased with age in the study group.
Keywords: Pelvic tilt, lumbar lordosis, muscle length, low back pain
Abstract: Subacromial lipoma represents a rare cause of subacromial impingement syndrome (SIS). A 49-year-old male patient presented to clinic with progressive right shoulder pain and limited movement, ongoing for approximately 1 month. Magnetic resonance imaging (MRI) revealed a lesion, compatible with lipoma, extending through subacromial space and pressing on supraspinatus muscle. After histopathological verification of lipoma, mass was excised. Postoperatively, patient completed 1 month physical therapy and rehabilitation program. Patient was free of pain at 4-month follow-up. Subacromial lipoma should be included in differential diagnosis of SIS for patients unresponsive to conservative treatment; MRI is very useful to determine precise etiology…and inform surgical treatment.
Abstract: BACKGROUND: Forward head posture (FHP) causes changes in the strengths and rigidities of cervical muscles. OBJECTIVE: The aim of this study was to investigate correlations between FHP and respiratory functions and the muscle activities of respiratory accessory muscles in young adults in their 20s. METHODS: A volunteer sample of 33 healthy young adults participated in this study. Craniovertebral angle (CVA), cranial rotational angle (CRA), vital capacity (VC), forced vital capacity (FVC), forced expiratory volume at 1 second (FEV1), peak expiratory flow (PEF), maximal voluntary ventilation (MVV), and sternocleidomastoid (SCM) and upper trapezius activity…ratios were measured. RESULTS: Significant positive correlations were found between CVA and VC, FVC, FEV1, PEF, and MVV, and a significant negative correlation was found between CVA and SCM activity ratio. Significant negative correlations existed between CRA and VC and FVC, and significant positive correlations between CRA and SCM and upper trapezius activity ratios. CONCLUSION: FHP may act to lower respiratory functions, and thus, the maintenance of correct head posture is required to prevent such functional reductions.
Keywords: Forward head posture, respiratory function, respiratory accessory muscle activity
Abstract: BACKGROUND: Exercise of the spinal muscles is recommended for a variety of rehabilitative reasons but it is not always clear whether interventions are effective in improving the performance of the muscles or whether their benefit is elicited via other mechanisms. OBJECTIVE: To explore the effects of an exercise intervention on the size and exercise performance of the lumbar spine extensor muscles. METHODS: Eleven healthy participants undertook a four week programme of exercise. Magnetic resonance imaging and phosphorus spectroscopy were performed before and after the intervention to determine the time to fatigue and phosphocreatine…(PCr) depletion during a muscle endurance test (modified Biering-Sørensen) together with muscle cross-sectional area (CSA). RESULTS: The post intervention measures were significantly different to the pre-intervention results for the time to fatigue (post-pre: 20.5 ± 22.7 s (P = 0.014)) and PCr depletion both at the point of fatigue (post-pre: 9.5 ± 11.9% (P = 0.024)) and at a matched time-point (post-pre: 12.2 ± 11.9% (P = 0.007)). CSA was not significantly different in any muscle. CONCLUSIONS: Exercise improved the performance of the trunk muscles despite no impact on CSA. This demonstrated the importance of obtaining a wide range of measures when assessing the effectiveness of exercise intervention programmes.
Keywords: Spine muscles, exercise intervention, cross sectional area, magnetic resonance spectroscopy, magnetic resonance imaging