Journal of Back and Musculoskeletal Rehabilitation - Volume 30, issue 4

Authors: Ehsani, Fatemeh | Arab, Amir Massoud | Jaberzadeh, Shapour

Article Type: Research Article

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. Show more

Keywords: Low back pain, unstable surface, posture, stability, trunk muscle activity

DOI: 10.3233/BMR-150361

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 649-662, 2017

Authors: Iqbal, Zaheen A. | Alghadir, Ahmad H.

Article Type: Research Article

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. Show more

Keywords: Cumulative trauma disorder, work related musculoskeletal disorders

DOI: 10.3233/BMR-150266

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 663-666, 2017

Authors: Tyrakowski, Marcin | Czaprowski, Dariusz | Szczodry, Michal | Siemionow, Kris

Article Type: Research Article

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. Show more

Keywords: Cobb angle, scoliometer, idiopathic scoliosis, radiograph

DOI: 10.3233/BMR-150338

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 667-673, 2017

Authors: Radanović, B. | Vučinić, P. | Janković, T. | Mahmutović, E. | Penjašković, D.

Article Type: Research Article

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. Show more

Keywords: Musculoskeletal disorders, occupational exposure, neck pain, risk factors

DOI: 10.3233/BMR-150508

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 675-679, 2017

Authors: Malliaropoulos, Nikolaos | Bikos, Georgios | Meke, Maria | Tsifountoudis, Ioannis | Pyne, Dev | Korakakis, Vasileios

Article Type: Research Article

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. Show more

Keywords: Incidence, mechanical low back pain, lumbar, sports injuries, track and field athletes

DOI: 10.3233/BMR-150390

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 681-689, 2017

Authors: Awan, Waqar Ahmed | Babur, Muhammad Naveed | Masood, Tahir

Article Type: Research Article

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. Show more

Keywords: De Quervain's disease, tenosynovitis, therapeutic ultrasound, Quick DASH, spica splint

DOI: 10.3233/BMR-160591

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 691-697, 2017

Authors: Król, Anita | Polak, Maciej | Szczygieł, Elżbieta | Wójcik, Paweł | Gleb, Klaudia

Article Type: Research Article

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. Show more

Keywords: Pelvic tilt, lumbar lordosis, muscle length, low back pain

DOI: 10.3233/BMR-140177

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 699-705, 2017

Authors: Sucuoglu, Hamza | Akgun, Kenan

Article Type: Research Article

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. Show more

Keywords: Impingement syndrome, rehabilitation, shoulder, subacromial lipoma

DOI: 10.3233/BMR-140222

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 707-710, 2017

Authors: Kim, Mi-Sun | Cha, Yong-Jun | Choi, Jong-Duk

Article Type: Research Article

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. Show more

Keywords: Forward head posture, respiratory function, respiratory accessory muscle activity

DOI: 10.3233/BMR-140253

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 711-715, 2017

Authors: Fulford, Jonathan | Juroskova, Vladimira | Meakin, Judith R. | Barker, Alan R.

Article Type: Research Article

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. Show more

Keywords: Spine muscles, exercise intervention, cross sectional area, magnetic resonance spectroscopy, magnetic resonance imaging

DOI: 10.3233/BMR-150337

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 717-724, 2017

Authors: Shih, Hsu-Sheng | Chen, Shu-Shi | Cheng, Su-Chun | Chang, Hsun-Wen | Wu, Pei-Rong | Yang, Jin-Shiou | Lee, Yi-Shuang | Tsou, Jui-Yi

Article Type: Research Article

Abstract: BACKGROUND: Little is known about the effects of Kinesio taping and therapeutic exercise on correcting forward head posture. OBJECTIVE: To compare Kinesio taping versus therapeutic exercise for forward head posture on static posture, dynamic mobility and functional outcomes. METHODS: Sixty subjects (31 women, 29 men) with forward head postures participated in this study. They were randomly assigned to either one of the three groups: (1) exercise group (n = 20), (2) taping group (n = 20), and (3) control groups (n = 20). The horizontal forward displacement (HFD) between ear lobe and …acromion process, upper cervical and lower cervical angle (UCA, LCA), active range of motion (AROM) of cervical spine, and neck disability index (NDI) were measured before and after a 5-week intervention, and a 2-week follow-up. Data were analyzed by means of a mixed design repeated-measures ANOVA. RESULTS: Both taping and exercise groups showed significant improvements in HFD compared with the control group at post-treatment and follow-up. Compared with the control group, the exercise group exhibited significant improvements in the LCA and the side bending AROM at post-treatment. CONCLUSIONS: Both Kinesio taping and therapeutic exercise improve forward head posture after intervention and a 2-week follow-up. The effectiveness of therapeutic exercise is better than taping. Show more

Keywords: Forward head posture, Kinesio taping, therapeutic exercise

DOI: 10.3233/BMR-150346

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 725-733, 2017

Authors: Ferreira, A.P.A. | Póvoa, L.C. | Zanier, J.F.C. | Machado, D.C. | Ferreira, A.S.

Article Type: Research Article

Abstract: BACKGROUND: Evidence on the diagnostic performance of palpatory methods and possible confounding factors is scarce. OBJECTIVES: To examine the sensitivity of palpatory methods for location of lumbopelvic landmarks and to assess its association with personal characteristics. METHODS: Eighty-three participants (41 men, 55.6 (16.5) years, 25.9 (4.8) kg/m 2 [mean (SD)]) were enrolled in this single-blinded study. Fourteen body and softy-tissue landmarks were sequentially palpated from the spinous process of L4 to the ischial tuberosity. CT-scan images were used to assess what landmark was located. RESULTS: Sensitivity …for location was in range 22–86% for soft-tissues and 26–69% for bony landmarks. Reduction in sensitivity was observed from the quadratus lumborum to the inferior and lateral angle of the sacrum (86–26% and 75–33%, left and right sides, respectively). Palpations of L4 and L5 spinous processes were systematically more cephalic than other landmarks. Gender was weakly correlated to almost all landmarks (r p ⁢ b = 0.333 or weaker). Body mass index was weakly correlated to the accurate location of ILAS and quadratus lumborum, great trochanter, PSIS, and piriformis (r p ⁢ b = - 0.307 or weaker). CONCLUSIONS: Systematic and propagation errors were present using sequential palpatory methods. Palpation in men was more sensitive and higher BMI was associated with lower sensitivity for lumbopelvic landmarks. Show more

Keywords: Palpation, validity, anatomic landmarks, rehabilitation

DOI: 10.3233/BMR-150356

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 735-744, 2017

Authors: Ilhanli, Ilker | Guder, Necip | Gul, Murat | Celik, Canan

Article Type: Research Article

Abstract: BACKGROUND: Unvalidated Turkish adaptations of existing low back pain disability scales are often used. OBJECTIVE: To evaluate the validity and the reliability of the Turkish version of Aberdeen Low Back Pain Scale (ALBP). METHODS: The cross-cultural adaptation was performed in accordance with recently published guidelines. The Turkish version was administered to 120 patients. Test-retest and internal consistency were evaluated for reliability. Construct validity and criterion validity were measured. Responsiveness of the questionnaire towards changes by the treatment were assessed. All questionnaires were administered at admission, 1 day later, at the end of treatment, …and a month after the end of treatment. Patients were assessed with Ostwestry (OLBP), physical and mental component of SF-36 (PCSSF-36, MCSSF-36), Beck Depression Inventory (BDI), Schober test and visual analog scale for pain (VAS). RESULTS: Retest scores were significant and high (Internal Correlation Coefficent: 0.963). For internal consistency, Cronbach's alpha was 0.889. For construct validity, Spearman's Correlation Coefficent was 0.882. For criterion validity of ALBP, correlations were found significant and acceptable for OLBP, PCSSF-36, MCSSF-36, BDI, and VASactivity (p < 0.05). According to responsiveness; ALBP, OLBP, PCSSF-36, VAS and Schober test showed significant improvement after the treatment (p < 0.05). CONCLUSIONS: The Turkish version of the ALBP is reliable, valid and responsive. Show more

Keywords: Aberdeen Low Back Pain Scale, reliability, validity, low back pain

DOI: 10.3233/BMR-150362

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 745-750, 2017

Authors: Park, Kyue-Nam | Kwon, Oh-Yun | Kim, Su-Jung | Kim, Si-Hyun

Article Type: Research Article

Abstract: BACKGROUND: Although unilateral posterior neck pain (UPNP) is more prevalent than central neck pain, little is known about how UPNP affects neck motion and the muscle activation pattern during prone neck extension. OBJECTIVE: To investigate whether deviation in neck motion and asymmetry of activation of the bilateral cervical paraspinal muscles occur during prone neck extension in subjects with UPNP compared to subjects without UPNP. METHODS: This study recruited 20 subjects with UPNP and 20 age- and sex-matched control subjects without such pain. Neck motion and muscle onset time during prone neck extension were …measured using a three-dimensional motion-analysis system and surface electromyography. RESULTS: The deviation during prone neck extension was greater in the UPNP group than in the controls (p < 0.05). Compared with the controls, cervical extensor muscle activation in the UPNP group was significantly delayed on the painful side during prone neck extension (p < 0.05). CONCLUSIONS: Subjects with UPNP showed greater asymmetry of neck motion and muscle activation during prone neck extension compared with the controls. This suggests that UPNP has specific effects on neck motion asymmetry and the functions of the cervical extensors, triggering a need for specific evaluation and exercises in the management of patients with UPNP. Show more

Keywords: Asymmetry, neck motion, prone neck extension, surface EMG, unilateral posterior neck pain

DOI: 10.3233/BMR-150378

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 751-758, 2017

Authors: Khallaf, Mohamed Elsayed

Article Type: Research Article

Abstract: BACKGROUND: Lumbar intervertebral disc herniation affects a large number of patients annually and are the most common cause of sciatica. OBJECTIVES: This study was aimed at measuring the spino-pelvic alignment and its relation to the functional limitations in subjects with acutely herniated lumbar disc. METHODS: Sixteen patients with acute Lumbar Disc Herniation (LDH group) and 16 healthy matched volunteers (healthy group) represented the sample of the study. The patients were recently diagnosed as lumbar disc herniation (L4-5 or L5 -S1 ) with acute sciatica and antalgic posture using magnetic resonance imaging. Spino-pelvic …alignment was measured via Rasterstereography. Functional disability among patients was assessed using Oswestry Disability Index Arabic version. RESULTS: Trunk inclination, trunk imbalance, pelvic obliquity, pelvic torsion, lordotic and scoliotic angles were significantly different between groups (P ≤ 0.05). A non-significant difference in kyphotic angle was found between the patients and healthy controls. There was no association between the measured postural changes and functional disabilities in patients with lumbar disc herniation (P ≤ 0.05). CONCLUSION: There are significant postural changes in patients with acutely herniated lumbar disc which has no relation to functional disability. These results support the concept of staying active during acute stage. Show more

Keywords: Lumbar disc herniation, posture, functional disability

DOI: 10.3233/BMR-150393

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 759-765, 2017

Authors: Letafatkar, Amir | Nazarzadeh, Maryam | Hadadnezhad, Malihe | Farivar, Niloufar

Article Type: Research Article

Abstract: BACKGROUND: There is a relation between deficits of the proprioceptive system and movement control dysfunction in patients with chronic low back pain (LBP) but, the exact mechanism of this relation is unknown. Exercise therapy has been recognized as an effective method for low back pain treatment. In spite of this, it is not clear which of the various exercise therapy programs lead to better results. OBJECTIVE: Therefore, the present analyze the efficacy of a HUBER study aims to exercise system mediated sensorimotor training protocol on proprioceptive system, lumbar movement control (LMC) and quality of life (QOL) …in patients with chronic non-specific LBP. DESIGN: Quasi-experimental study. METHODS: 53 patients with chronic non-specific LBP (mean age 37.55 ± 6.67 years,and Body Mass Index (BMI) 22.4 ± 3.33) were selected by using Roland-Morris Disability Questionnaire (RMQ) and were assigned into two experimental (N = 27) and control groups (N = 26) The experimental group underwent a five-week (10 sessions) Sensorimotor training by using the Human Body Equalizer (HUBER) spine force under the supervision of an investigator. The movement control battery tests, the HUBER machine testing option, goniometer and visual analogue scale used for movement control, neuromuscular coordination, proprioception and LBP assessment respectively. The assessments were completed in pre-test and after five weeks. The paired and sample T tests were used for data analysis in SPSS program version 18 (Significance level were set at a P value < 0.05). RESULTS: The HUBER system mediated sensorimotor training demonstrated significant improvement in the proprioceptive system, LMC and QOL (P = 0.001). Also There was a significant reduction in the pain scores of subjects with chronic non-specific LBP in the sensorimotor group (P = 0.001). LIMITATIONS: In this study, only the short term effects of the sensorimotor training were examined. CONCLUSIONS: The results suggest that a sensorimotor training program causes significant improvement in patients with chronic non-specific LBP. Future research should be carried out with a larger sample size to examine the long term effects of the sensorimotor training program on treatment of patients with chronic non-specific LBP. Considering the efficacy of the sensorimotor training, it is recommended that this intervention should be applied to treatment of patients with chronic non-specific LBP in the future. Show more

Keywords: Chronic non-specific low back pain, movement control, proprioceptive system, sensorimotor training

DOI: 10.3233/BMR-150404

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 767-778, 2017

Authors: Moon, Young Eun | Seok, Hyun | Kim, Sang-Hyun | Lee, Seung Yeol | Yeo, Jung Ho

Article Type: Research Article

Abstract: BACKGROUND: Sacroiliac joint (SIJ) pain can cause lower back pain and pelvic discomfort. However, there is no established standard treatment for SIJ pain. Extracorporeal shock wave therapy (ESWT) is a novel, non-invasive therapeutic modality for musculoskeletal disorders. The mechanism underlying shockwave therapy is not fully understood, but the frequency with which ESWT is applied clinically has increased over the years. OBJECTIVE: We evaluated the efficacy of using ESWT to treating SIJ pain. METHODS: Thirty patients with SIJ pain were assigned randomly to ESWT (n = 15) and sham control (n = 15) groups. …The ESWT group received 2,000 shockwaves with energy set to the maximum level tolerable by the patient (energy density = 0.09-0.25 mJ/mm2 ). The probe was oriented perpendicular to the posterior SIJ line, and moved up and down along the joint line. The sham control group received 2,000 shockwaves with the probe oriented parallel to the posterior SIJ line. A 10-cm numeric rating scale (NRS) and the Oswestry Disability Index (ODI) scores were assessed before the intervention, and 1 and 4 weeks post-intervention. Participants were instructed to refrain from using any other conservative treatment, including anti-inflammatory medication and other physical modalities during the study. RESULTS: In the ESWT group, NRS decreased significantly at post-treatment week 4 (3.64 (95% confidence interval, 2.29-4.99)) compared to baseline (6.42 (5.19-7.66); P < 0.05). ODI improved at 1 and 4 weeks compared to baseline, but not significantly. In the sham group, NRS and ODI did not differ at any post-treatment time point. There was a significant group difference in NRS at week 4 post-treatment (3.64 (2.29-4.99) in the ESWT group vs. 6.18 (5.34-7.02) in the sham control group; P < 0.05), but this was not the case for ODI. CONCLUSIONS: ESWT represents a potential therapeutic option for decreasing SIJ pain. Show more

Keywords: Sacroiliac joint pain, extracorporeal shock wave, numeric rating scale

DOI: 10.3233/BMR-150405

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 779-784, 2017

Authors: Tasci Bozbas, Gulnur | Sendur, Omer Faruk | Aydemir, Ali Hakan

Article Type: Research Article

Abstract: OBJECTIVES: The aim of this study was to investigate the effect of primary knee osteoarthritis on the risk of falling. MATERIALS AND METHODS : One hundred participants (50 with knee osteoarthritis and 50 healthy controls) were included in this study. Primary knee osteoarthritis was diagnosed according to the American College of Rheumatology (ACR) criteria. Patients who were grade 2 or 3 by Kellgren-Lawrence criteria according to weight-bearing knee radiographs were included in this study. The risk of falling was evaluated by the interactive balance and coordination device both in the osteoarthritis and control groups. The functional status …and pain were evaluated with respectively Lequesne Index and Visual Analogue Scale. RESULTS: No statistically significant differences were found between the group of primary knee osteoarthritis and control in terms of age, BMI, and gender. The median falling index was 52 in the group with knee OA, whereas it was 31 in the control group. It was determined that primary knee osteoarthritis increased the risk of falling significantly and grade 3 primary knee osteoarthritis was statistically significantly higher than grade 2 (p < 0.001). The pain and functional status did not appear to be effective on the risk of falling in those patients (p > 0.05). DISCUSSION: Falling is among the important causes of mortality and morbidity in advanced age. Therefore, assessment of risk factors for falling and the strategies to prevent it are important. Primary knee osteoarthritis is one of the risk factors associated with falling. Therefore, medical approaches, proprioception training, balance-gait training, muscle strengthening exercises, and arrangements to prevent domestic injurious falling should be planned to reduce the risk of falling in the presence of primary knee osteoarthritis. Show more

Keywords: Knee osteoarthritis, proprioception, risk of falling, gonarthrosis

DOI: 10.3233/BMR-150413

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 785-789, 2017

Authors: Muyor, José M. | Zemková, Erika | Chren, Matej

Article Type: Research Article

Abstract: BACKGROUND: Systematic repetition postures adopted during trainings could generate alterations in the sagittal spinal curvatures. OBJECTIVE: The purposes were: 1) to analyse the sagittal spinal curvatures and pelvic tilt in Latin American style dancers; 2) to compare the spinal sagittal mobility and hamstring muscle extensibility between Latin American style dancers and non-dancers; and 3) to evaluate the influence of wearing dance shoes upon the sagittal spine posture in standing. METHODS: A total of 20 Latin American style professional dancers and 20 non-dancers (control group) were evaluated during standing, relaxed sitting, maximal trunk flexion …with knees flexed and extended, lying prone, and maximal trunk extension. Additionally, dancers were analysed while standing barefoot, and wearing heeled-shoes, during forward walking and the paso-doble posture. The hamstring muscle extensibility was evaluated by the active knee extension test. RESULTS: The spinal morphology in Latin American style professional dancers is characterised by lower thoracic kyphosis, lumbar lordosis and anterior pelvic tilt in the standing posture as well as a flexible spine, especially in flexion postures, in addition to suitable hamstring muscle extensibility. CONCLUSIONS: The spinal morphology of Latin American style professional dancers is characterised by lower thoracic kyphosis and lumbar lordosis and anterior pelvic tilt in the standing posture as well as a flexible spine, especially in flexion postures, and suitable hamstring muscle extensibility. Show more

Keywords: Injury prevention, flexibility, sport techniques, spinal mouse system

DOI: 10.3233/BMR-150448

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 791-800, 2017

Authors: Cha, Jae-Ryong | Kim, Yong-Chan | Yoon, Wan-Keun | Lee, Won-Gyu | Kim, Tae-Hwan | Oh, Jae-Keun | Kim, Seok-Woo | Ohn, Suk Hoon | Cui, Ji Hao

Article Type: Research Article

Abstract: BACKGROUND: Posterior lumbar surgery can lead to damage on paraspinal muscles. OBJECTIVE: Our study aimed to examine the recovery in the denervated paraspinal muscles by posterior lumbar surgery and to determine that of improvement in the lower back pain (LBP). METHODS: Depending on surgical treatments, the patients were divided into two groups: The group I (interspinous implantation with decompression) and II (posterior lumbar interbody fusion with decompression). The paraspinal mapping score was recorded for individual muscle. RESULTS: In the group I, there was reinnervation in the denervated multifidus and erector …spinae at the upper, surgical and lower levels at 12 months. In the group II, there was reinnervation in the denervated erector spinae at the upper, surgical and lower levels at 12 months. There was significant aggravation in the LBP in both groups at immediate postoperative. But there was significant improvement in it at 6 months in the group I and at 12 months in the group II. CONCLUSION: There was reinnervation in not only denervated multifidus and erector spinae at 12 months following interspinous ligament stabilization but also in denervated erector spinae at 12 months following pedicle screw fixation with fusion. Show more

Keywords: Degenerative lumbar disease, paraspinal muscle, denervation, recovery

DOI: 10.3233/BMR-150455

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 801-809, 2017

Authors: Hazar Kanik, Zeynep | Pala, Omer Osman | Gunaydin, Gurkan | Sozlu, Ugur | Alkan, Zeynep Beyza | Basar, Selda | Citaker, Seyit

Article Type: Research Article

Abstract: BACKGROUND: Scapular muscle endurance and core endurance reportedly influence shoulder injury risk. The exact relationship between scapular muscle endurance and core endurance, and how they impact one another in the healthy subjects remain unclear. OBJECTIVE: To investigate the relationship between scapular muscle endurance and core endurance in healthy subjects. METHODS: Fifty healthy volunteers (23 males, 27 females; mean age 20.42 ± 1.04 years) were participated in this study. Endurance of the serratus anterior and trapezius muscles was assessed using the scapular muscle endurance test. Sorensen test (endurance of trunk extensor muscles), …trunk flexor endurance test, and side bridge test (endurance of lateral core muscles) were conducted to assess the core endurance. Pearson's product moment correlations examined relationships between scapular muscle endurance and each of the core endurance tests scores. RESULTS: Scapular muscle endurance test scores showed a positive correlation with the side bridge test scores (r = 0.414; p = 0.003). No significant correlation was found between scapular muscle endurance test scores and the other core endurance tests scores (p > 0.05). CONCLUSIONS: There appears to be a link between the scapular muscle endurance and lateral core muscles in healthy subjects; however, more research is needed to provide a definitive answer on the nature of this relationship. Further studies involving patients with shoulder pathology are warranted. Show more

Keywords: Trapezius, serratus anterior, sorensen test, side bridge test

DOI: 10.3233/BMR-150497

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 811-817, 2017

Authors: Middendorp, Marcus | Vogl, Thomas J. | Kollias, Konstantinos | Kafchitsas, Konstantinos | Khan, M. Fawad | Maataoui, Adel

Article Type: Research Article

Abstract: BACKGROUND: Low back pain and lumbar intervertebral disc degeneration (IDD) are common findings. Valid data on correlation between clinical pain scores and grades of IDD are not available. OBJECTIVE: To investigate the correlation of intervertebral disc degeneration (IDD) at lumbar levels L4/5 and L5/S1 and the Oswestry Disability Index (ODI). METHODS: The lumbar discs L4/5 and L5/S1 of 591 patients were evaluated according to the 5-point (Grade I to Grade V) grading system as published by Pfirrmann et al. Functional status was assessed using the Oswestry Disability Index. Spearman's coefficient of rank correlation …was used for statistical analysis (p < 0.05). RESULTS: The majority of patients revealed lumbar discs with Pfirrmann grade II to grade IV changes (93.3% at level L4/5; 89.8% at level L5/S1), while a relatively low percentage of lumbar discs presented with grade I (level L4/5: 1.5%; level L5/S1: 2.0%) or grade V (level L4/5: 5.1%; level L5/S1: 8.1%) changes, respectively. Patients' ODI scores ranged between 0 and 91.11% (arithmetic mean of 32.77% ± 17.02%). The largest group of patients (48.39%) had moderate functional disability (ODI score between 21 and 40%). There was a weak, but statistically significant positive correlation between IDD and ODI for both evaluated lumbar levels. CONCLUSIONS: Increased lumbar IDD in MRI goes along with an increased ODI. Thus, MRI is a strong indicator of a patient's clinical appearance. However, low back pain cannot be explained by imaging alone. Clinical correlation is imperative for an adequate diagnostic advance in patients with low back pain. Show more

Keywords: Lumbar spine, low back pain, intervertebral disc degeneration, magnetic resonance imaging, Oswestry Disability Index

DOI: 10.3233/BMR-150516

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 819-823, 2017

Authors: Ekiz, Timur | Özbudak Demir, Sibel | Sümer, Hatice Gözde | Özgirgin, Neşe

Article Type: Research Article

Abstract: BACKGROUND: Although wheelchair appropriateness has been studied in general wheelchair users and spinal cord injury patients, it has not been studied in children with cerebral palsy yet. OBJECTIVE: To describe the wheelchair appropriateness in children with cerebral palsy. MATERIALS AND METHODS: Thirty children with cerebral palsy were included. Demographical and clinical features of the children were noted. All wheelchair parts were evaluated by the same rehabilitation physician who has attended a wheelchair-training course. Overall, the wheelchair was accepted as inappropriate if at least three parts were inappropriate. RESULTS: There were …30 children (15 M, 15 F) with a mean age of 10.8 ± 3.5 years. Seat depth (n= 21, 70%), cushion (n= 17, 56.7%), seat height (n= 16, 53.3%), and footrest (n= 16, 53.3%) were the most common inappropriate parts. Overall, 24 (80%) of the children use inappropriate wheelchair. Two (6.7%) children obtained wheelchairs by prescription, 28 (93.3%) obtained without prescription. Twenty-nine wheelchairs were manual and one wheelchair was motorized. Among 30 children, five (16.7%) experienced at least one wheelchair-related fall. CONCLUSION: In the light of our results, 80% of the children with cerebral palsy seem to use inappropriate wheelchair. Individually designed wheelchairs should be maintained for these children. Show more

Keywords: Wheelchair ergonomics, cerebral palsy, wheelchair-related fall, wheelchair appropriateness

DOI: 10.3233/BMR-150522

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 825-828, 2017

Authors: Onat, Sule Sahin | Ünsal-Delialioğlu, Sibel | Özel, Sumru

Article Type: Research Article

Abstract: BACKGROUND: The role of the selected prothesis on activities of daily living (ADL). OBJECTIVE: To evaluate the impact of prothesis on ADL in patients with lower-limb amputations. METHODS: The data of 500 patients with unilateral lower limb amputation were recorded. The activity level was defined based on the Medicare Functional Classification Level. Old and new prescribed prosthesis were recorded. Nottingham Extended Activities of daily living activities Daily Living Scale was used to evaluate ADL. RESULTS: Amputation levels were transfemoral (TF) in 268 (53.6%), transtibial (TT) in 178 (35.6%), knee disarticulation …(KD) in 54 (10.8%). In patients with TF and KD amputation active vacuum system, pin modular system, hydraulic system and mechanical modular prosthesis were replaced with the swing stance phase microprocessor-controlled prostheses. In patients with TT amputation pin modular system, hydraulic system and mechanical modular prosthesis were converted to active vacuum system prostheses. Prescribed new prosthesis has caused a statistically significant increase in all amputation levels in ADL of patients (p≤ 0.05). CONCLUSIONS: We observed that there was significant improvement in ADL when conventional prostheses replaced with advanced technology prostheses in unilateral lower extremity amputation patients. Show more

Keywords: Amputation, lower limb, daily living activities, protheses

DOI: 10.3233/BMR-160532

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 829-833, 2017

Authors: Topcu, Sacide Yildizeli

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: Most common and important cause of the low back pain is lumbar disc herniation. Patients with lumbar disc herniation face with difficulties during daily activities due to the reduction of physical functions. In order to maintain daily activities without pain and discomfort, the patients should be informed about proper positions and body mechanics. The aim of the study was to determine the knowledge and the applications of the patients with lumbar disc herniation about body mechanics. METHODS: This descriptive study was conducted with 75 patients with lumbar disc herniation in Edirne, Turkey. The …population consisted of 75 patients who accepted to participate in the study. In the collection of data the questionnaire, which was developed according to literature by the researcher, was used. Descriptive statistics, student t-test, variance and correlation analysis were used for assessment of the data. The significance level was accepted at 0.05. RESULTS: It was found that 53.3% of the patients experienced awful/very severe pain. and there were some points that the patients have enough information about; mobilisation, standing, carrying the goods, leaning back while sitting, leaning somewhere while standing, getting support from the chair when standing up, avoiding sudden position changes, changing feet frequently while standing. It was detected that a statistical relation between educational level and knowledge about body mechanics exists. CONCLUSION: This study shows that individuals with lumbar disc herniation have not enough information about body mechanics and they experienced long-term severe pain. Nurses and other health care workers have important role in explaining the importance of body mechanics to the patients and should encourage them to use that in daily life. Show more

Keywords: Body mechanics, low back pain, lumbar disc herniation, patients care

DOI: 10.3233/BMR-160542

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 835-840, 2017

Authors: Sencan, Savas | Ozcan-Eksi, Emel E. | Cil, Hemra | Tay, Bobby | Berven, Sigurd | Burch, Shane | Deviren, Vedat | Demir-Deviren, Sibel

Article Type: Research Article

Abstract: BACKGROUND: Transforaminal epidural steroid injection (TFE) is a widely accepted non-surgical treatment for pain in patients with spondylolisthesis. However, the effectiveness of TFE has not been compared in patients with degenerative (DS) and isthmic spondylolisthesis (IS). OBJECTIVE: To compare the effectiveness of bilateral TFEs in DS and IS. METHODS: Patients who underwent bilateral TFEs for spondylolisthesis at University of California San Francisco Orthopaedic Institute from 2009 to 2014 were evaluated retrospectively. RESULTS: DS patients (120 female, 51 male) were significantly older and had higher comorbidity than those with IS (18 …female, 14 male). They had better pain relief after TFE than patients with IS (72.11 ± 27.46% vs 54.39 ± 34.31%; p = 0.009). The number of TFEs, the mean duration of pain relief after TFE, follow-up periods, translation and facet joint widening were similar in DS and IS groups (p > 0.05). DS group had higher successful treatment rate (66.1% vs 46.9%, p = 0.009) and longer duration of pain relief (181.29 ± 241.37 vs 140.07 ± 183.62 days, p = 0.065) compared to IS group. CONCLUSIONS: Bilateral TFEs at the level of spondylolisthesis effectively decreased pain in patients. TFEs provided better pain relief for longer duration in patients with DS than for those with IS. Show more

Keywords: Degenerative spondylolisthesis, isthmic spondylolisthesis, transforaminal epidural steroid injection, pain relief, comorbidity scores

DOI: 10.3233/BMR-160543

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 841-846, 2017

Authors: Thanawat, Thanakorn | Nualnetr, Nomjit

Article Type: Research Article

Abstract: BACKGROUND: Chronic low back pain (LBP) can be managed by exercises which should be tailored to an individual's readiness to behavioral change. OBJECTIVE: To evaluate the effects of an intervention program based on the Transtheoretical Model of behavioral change (TTM) on back muscle endurance, physical function and pain in rice farmers with chronic LBP. METHODS: In a 32-week study, 126 rice farmers were allocated to the TTM (n= 62) and non-TTM (n= 64) groups. Modified Biering-Sorensen test, Oswestry Disability Questionnaire and visual analogue scale were used for evaluating back muscle endurance, physical function …and severity of pain, respectively. The evaluations were performed at baseline and at weeks 8, 20 and 32 of the study. Data were analyzed using repeated measure ANOVA. RESULTS: The back muscle endurance was significantly greater in the TTM group than in the non-TTM group at week 32 (p= 0.025). Physical function and severity of pain were significantly improved in the TTM group when compared with the non-TTM group at weeks 20 and 32 (p< 0.01). CONCLUSIONS: A TTM-based intervention could improve back muscle endurance and physical function, and reduce the pain in rice farmers with LBP. Further studies should be considered to explore the long-term effects of this intervention. Show more

Keywords: Low back pain, farmers, Transtheoretical Model, exercise, health promotion

DOI: 10.3233/BMR-160548

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 847-856, 2017

Authors: Sahin, Ebru | Dilek, Banu | Baydar, Meltem | Gundogdu, Mehtap | Ergin, Burcu | Manisali, Metin | Akalin, Elif | Gulbahar, Selmin

Article Type: Research Article

Abstract: BACKGROUND: Recently, proprioception deficits of the rotator cuff and the deltoid muscles have been suggested to play a pivotal role in the subacromial impingement syndrome (SIS). To date, there are no study has been found where the kinesthesia and joint position senses have been evaluated together in SIS. OBJECTIVE: To investigate the shoulder proprioception in patients with SIS. METHODS: Sixty-one patients with SIS and 30 healthy controls, aging between 25 and 65 years, were included in the study. Main outcome measure was proprioception, assessed with an isokinetic dynamometer. Kinesthesia, active and passive joint …repositioning senses were tested at 0° and 10° external rotation. All tests were repeated 4 times and the mean of angular errors were obtained. RESULTS: The mean age was 49.14 ± 10.27 and 48.80 ± 11.09 years in patient group and in control group respectively. No significant difference was found between two groups in terms of age, gender and dominance. When involved and uninvolved shoulders of the patient group were compared, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders at all angles (P < 0.05). When involved shoulders of the patient group were compared to the control group, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders in patient group at all angles (P < 0.05) except active position sense at 0°. When uninvolved shoulders of the patient group were compared to the control group, kinesthesia at 10° was significantly impaired (P < 0.05). CONCLUSION: This study showed that shoulder proprioception was impaired in patients with SIS. This proprioceptive impairment was found not only in involved shoulders but also in uninvolved shoulders in patients with SIS. Show more

Keywords: Shoulder, proprioception, kinesthesia, position sense, subacromial impingement syndrome

DOI: 10.3233/BMR-160550

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 857-862, 2017

Authors: Elsayed, Enas | Devreux, Isabelle | Embaby, Heba | Alsayed, Amani | Alshehri, Maram

Article Type: Research Article

Abstract: BACKGROUND: During pregnancy, the body undergoes many hormonal and anatomical changes causing several medical problems as the musculoskeletal system problems. OBJECTIVE: To investigate the plantar pressure distribution during pregnancy. SUBJECTS: Twenty two pregnant and non-pregnant females were selected from the King Abdulaziz University in Jeddah. METHODS: All females were evaluated by inspection regarding their deformities of the spine, pelvis, lower extremities and feet. Pain was assessed by the Visual Analog Scale (VAS), and the weight and height were recorded using a calibrated weighing scale. Finally, the plantar pressure distribution was …examined by a Global Postural Analysis device (GPA). RESULTS: The results revealed significant asymmetry of weight bearing in the study group (pregnant) compared to the control group (non-pregnant) (p< 0.05). In addition, there was a significant increase in pain intensity in the study group (p= 0.02). On the other hand, the results showed a non-significant difference between study and control groups regarding the three points of pressure (calcaneus, 1st metatarasal and 5th metatarsal) (p> 0.05). Moreover, there was a significant direct relationship between the month of pregnancy and increased weight bearing on the 5th metatarsal in the study group (p= 0.04). CONCLUSION: There is an effect of pregnancy on plantar pressure distribution as well as weight symmetry which should be considered when designing an antenatal program. Show more

Keywords: Pregnancy, global postural analysis, plantar pressure distribution, pain, musculoskeletal disorders

DOI: 10.3233/BMR-160555

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 863-867, 2017

Authors: dos Santos Glória, Igor Phillip | Politti, Fabiano | Leal Junior, Ernesto Cesar Pinto | Lucareli, Paulo Roberto Garcia | Herpich, Carolina Marciela | Antonialli, Fernanda Colella | de Paula Gomes, Cid André Fidelis | de Oliveira Gonzalez, Tabajara | Biasotto-Gonzalez, Daniela Aparecida

Article Type: Research Article

Abstract: INTRODUCTION: Kinesio taping consists of the attachment of a thin elastic tape over specific muscles, the thickness of which is similar to that of the epidermis. OBJECTIVE: The aim of the present study was to compare the effect of Kinesio taping and placebo taping on muscle torque, muscle activity and jumping performance soccer players. METHODS: Thirty athletes were randomly allocated to two groups (Group A: Kinesio taping and Group B: placebo taping). The participants were instructed to perform the Hop test's and were submitted to an isokinetic evaluation of the knee extensors as …well as an electromyographic evaluation of the retus femoris muscle of the dominant lower limb. Next, Kinesio taping was performed for the activation of the rectus femoris muscle in Group A and placebo taping was performed in Group B. The participants were reevaluated 30 minutes after taping and 24 hours after the first evaluation using the same tests. Intra-group and inter-group comparisons were made considering the three evaluation times. RESULTS: No statistically significant differences were found between groups at any evaluation time regarding the Hop test's, root mean square of the electromyographic signal or peak torque of the knee extensors of the dominant lower limb (p>0.05). CONCLUSION: Kinesio taping for the activation of the rectus femoris muscle has no effect on peak muscle torque, muscle activity or jumping performance among soccer players. Show more

Keywords: Kinesio taping, soccer, hop test, electromyography, sport performance, muscle strength

DOI: 10.3233/BMR-160556

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 869-877, 2017

Authors: Araujo, Amanda Costa | Filho, Rúben Negrão | Oliveira, Crystian B. | Ferreira, Paulo H. | Pinto, Rafael Z.

Article Type: Research Article

Abstract: BACKGROUND: In the low back pain (LBP) field, therapeutic alliance is considered a non-specific factor of interventions associated with improvements in clinical outcomes. However, there is a paucity of studies aimed to evaluate measurement properties of tools used to objectively quantify the alliance between therapist and patients, such as the Working Alliance Inventory (WAI) and Session Rating Scale (SRS). OBJECTIVE: To translate and cross-culturally adapt the short-form version of WAI - therapist and SRS into Brazilian Portuguese; to investigate the measurement properties, of the WAI-Patient, WAI-Therapist and SRS in patients with LBP and their physical therapists, …respectively. METHODS: One hundred patients with LBP and 18 physical therapists were recruited from physical therapy clinics in Brazil. Therapeutic alliance measures were collected at the initial assessment, prior to the second session, and at 2-month follow-up. The measurement properties investigated were reproducibility, internal consistency, ceiling/floor effects and responsiveness. RESULTS: Although WAI-Patient, WAI-Therapist and SRS were considered to have acceptable test-retest reliability (ICC2,1 > 0.70), these questionnaires showed problems with other measurement properties. WAI-Patient showed problems with internal consistency (i.e. Cronbach's alpha < 0.70 for all subscales). Presence of ceiling effect (i.e. > 15% of participants with the maximum score) and poor internal responsiveness were found for the WAI-Patient (Effect size = 0.15; 84% CI: 0.04 to 0.29) and for the SRS (Effect size = 0.05; 84% CI: -0.22 to 0.11). The WAI-Therapist revealed slightly better measurement properties. CONCLUSION: We identified psychometric limitations with most measurement properties of the WAI questionnaires and SRS. Future studies are needed to refine these tools. Show more

Keywords: Professional-patient relations, low back pain, physical therapy

DOI: 10.3233/BMR-160563

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 879-887, 2017

Authors: Petrofsky, Jerrold S. | Laymon, Michael | Alshammari, Faris | Khowailed, Iman Akef | Lee, Haneul

Article Type: Research Article

Abstract: BACKGROUND: It has been well documented at heat reduces pain and increases healing by increasing blood flow in tissue. OBJECTIVE: The purpose of this study was to see if the use of low level continuous heat (LLCH) and Ibuprofen used as a home therapy between physical therapy sessions at a clinic resulted in better therapy outcomes in people with chronic neck pain. METHODS: Ninety-two patients with chronic nonspecific neck pain were randomly divided into 4 groups; LLCH group, LLCH with Ibuprofen (IP) group, sham LLCH with sham IP group, and controls. All subjects …underwent 45 minutes of conventional physical therapy twice a week for 2 weeks. the neck disability index (NDI), subjective pain, range of motion (ROM), strength of the neck, and home exercise compliance were measured. RESULTS: Both LLCH and IP significantly reduced pain and NDI score, and increased ROM (p< 0.01). Home exercise compliance in LLCH and LLCH with IP group was significantly higher than the placebo and control groups (p < 0.05). CONCUSION: The use of LLCH alone and LLCH with IP as an adjunct to conventional physical therapy for chronic neck pain significantly improved pain attenuation and it causes greater compliance for home. Show more

Keywords: Low level continues heat, pain, Ibuprofen, compliance, exercise

DOI: 10.3233/BMR-160577

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 889-896, 2017

Authors: Alkan, Gokhan | Akgol, Gurkan

Article Type: Research Article

Abstract: OBJECTIVE: Although vitamin D deficiency has been associated with osteoporosis, as well as fractures, in elderly men and women, the role of vitamin D deficiency in the pathogenesis of osteoarthritis (OA) remains controversial. In this study, we aimed to investigate the effects of vitamin D deficiency on the functional status and disease prognosis of patients with knee osteoarthritis. PATIENTS AND METHODS: Our study comprised 100 patients that met the American College of Rheumatology criteria for a diagnosis of knee osteoarthritis. Each patient underwent knee radiography, the results of which were graded according to Kellgren and Lawrence …radiographic grading scale; those that met the diagnostic criteria were included in the study. The visual analog scale (VAS), Nottingham Health Profile (NHP), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne Knee Osteoarthritis Index were used to assess patients' pain, function and quality of life. Complete blood counts, sedimentation rates and serum C-reactive protein, rheumatoid factor, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, sodium, potassium, calcium, phosphorus, parathyroid and thyroid hormone levels were routinely recorded for each patient. Vitamin D levels were analyzed in winter (between November and February) using high performance liquid chromatography. RESULTS: Patients were divided into two groups, Group 1 and Group 2, according to the presence or absence of vitamin D deficiency. The groups did not differ significantly in terms of age, disease duration, sex distribution, presence of osteoporosis or radiographic stage of knee osteoarthritis (p = 0.793, 0.092, 0.250, 0.835 and 0.257, respectively). However, the NHP pain, physical activity, fatigue, social isolation, and emotional reactions subsets, WOMAC pain and physical function subsets and total score, Lequesne knee osteoarthritis index, and patient/physician VAS scores were significantly higher in Group 1 than in Group 2 (p < 0.05). CONCLUSIONS: Our study therefore suggests that vitamin D deficiency exacerbates pain, dysfunction and a poorer quality of life in patients with knee osteoarthritis. Further longer-term studies are needed to investigate the effects of vitamin D deficiency on OA-related symptoms. Show more

Keywords: Knee osteoarthritis, vitamin D deficiency, quality of life

DOI: 10.3233/BMR-160589

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 897-901, 2017

Authors: Shanb, Alsayed Abdelhameed | Youssef, Enas Fawzy | Muaidi, Qassim Ibrahim | Alothman, Abdullah Ahmed

Article Type: Research Article

Abstract: BACKGROUND: Osteoporosis usually develops gradually and progresses without significant signs and symptoms. It is one of the most common musculoskeletal conditions associated with aging. OBJECTIVES: To evaluate the effects of whole body vibration (WBV) or magnetic therapy in addition to standard pharmacological treatment on bone mineral density (BMD) in elderly individuals being treated for osteoporosis. METHODS: Eighty-five participants, 60–75 years of age, were randomly divided into three groups. All three groups received the same standard pharmacological treatment comprised of vitamin D, calcium, and alendronate sodium. In Group I, thirty participants were also exposed to …WBV for 25 minutes in each session with two sessions per week for 4 months. In Group II, thirty participants were exposed to magnetic therapy for 50 minutes in each session with two sessions per week for 4 months. In Group III, twenty-five participants received only pharmacological treatment. Dual-energy X-ray absorptiometry was used to measure BMD of the lumbar spine and femoral heads before and after interventions. Venus blood sample was drawn for analysis of calcium and vitamin D. RESULTS: An ANOVA test detected significant (p < 0.05) differences in BMD after treatment among the three groups with no significant difference was detected between patients receiving WBV and magnetic therapy. Statistical t-tests detected significant (p < 0.05) increases in BMD after application of WBV or magnetic therapy in combination with pharmacological treatment, but no significant increase after pharmacological treatment alone. CONCLUSIONS: Addition of either WBV or magnetic therapy to standard pharmacological treatment for osteoporosis significantly increased BMD in elderly subjects. No significant difference in effectiveness was detected between these two alternative therapy modalities. Consequently, either WBV or magnetic therapy could be effectively applied in conjunction with pharmacological treatment to increase BMD in elderly osteoporotic patients. Show more

Keywords: Vibration, magnetic therapy, osteoporosis, elderly individuals

DOI: 10.3233/BMR-160607

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 903-912, 2017

Authors: Kim, Kyung-Hee | Suh, Jung-Woo | Oh, Ki Young

Article Type: Research Article

Abstract: BACKGROUND: Local administration of opioids causes effective analgesia without adverse effects related to the central nervous system. After the beneficial demonstration of peripheral opioid receptors in joint synovia, intra-articular opioid injections were used for pain treatment. Clinical studies have reported the safety and efficacy of hyaluronate injection in the shoulder joint of patients with osteoarthritis, periarthritis, rotator cuff tears, and adhesive capsulitis. OBJECTIVES: To estimate the efficacy of intra-articular hyaluronate and tramadol injection for adhesive capsulitis of the shoulder compared with that of intra-articular hyaluronate injection alone. METHODS: Thirty patients with adhesive capsulitis …of the shoulder were randomized to the hyaluronate group (n = 16) or the tramadol group (n = 14). Hyaluronate group members were administered five weekly intra-articular hyaluronate injections; tramadol group members were administered three weekly intra-articular hyaluronate and tramadol injections and then two weekly intra-articular injections of hyaluronate. Visual Analog Scale (VAS), passive range of motion (PROM) of the shoulder joint, and Shoulder Pain and Disability Index (SPADI) scores were assessed at baseline and weeks 1, 2, 3, 4, and 6 after the initial injection. RESULTS: A significant improvement was observed in VAS, PROM, and SPADI scores between time points in both groups. In comparison in both groups at weeks 1 and 2 after the initial injection the VAS scores of the tramadol group were significantly lower than those of the hyaluronate group. CONCLUSIONS: Intra-articular hyaluronate with tramadol showed more rapid and strong analgesic effects than intra-articular hyaluronate alone and did not induce any adverse effects. Show more

Keywords: Adhesive capsulitis, analgesia, intraarticular injection, opioids

DOI: 10.3233/BMR-160641

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 913-920, 2017

Authors: Peña-Salinas, Marta | Oliva-Pascual-Vaca, Jesús | Heredia-Rizo, Alberto Marcos | Rodriguez-Blanco, Cleofás | Ricard, François | Oliva-Pascual-Vaca, Ángel

Article Type: Research Article

Abstract: BACKGROUND: Upper rib manipulative therapy appears to be effective on primary complaint of shoulder pain, but its efficacy has not been evaluated in subjects with whiplash-associated disorders. OBJECTIVE: To assess the immediate changes on neural and muscular mechanosensitivity after first-rib manipulation in patients with neck or cervicobrachial pain secondary to cervical whiplash (CW). METHODS: A single-blind (evaluators were blinded to subject allocation) randomized trial was conducted. Fifty-three (N = 53) subjects, 34.7 (SD 10.8 years; 56.6% females), with cervical or cervicobrachial pain following CW, were distributed into two groups. The experimental group (n …= 27) underwent a single first-rib high-velocity low-amplitude manipulation technique, while the control group (n = 26) received a sham placebo intervention. Outcome measures were taken at baseline and immediately after intervention, of the pressure pain threshold over the trigeminal, median and ulnar nerves, and over the area described for the location of tense bands in the upper trapezius, masseter, biceps brachii and triceps brachii muscles. RESULTS: No significant differences in mechanosensitivity values were observed after intervention in the between-groups comparison (p > 0.05). CONCLUSION: The use of a sole first-rib thrust technique has no immediate effect on neural or muscular mechanosensitivity, when compared to placebo, in subjects with cervical or cervicobrachial pain after CW. Show more

Keywords: Brachial plexus, manual therapy, pain threshold, ribs, whiplash injuries

DOI: 10.3233/BMR-160645

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 921-928, 2017

Authors: de Melo-Neto, João Simão | de Campos Gomes, Fabiana | de Morais, Dionei Freitas | Tognola, Waldir Antonio

Article Type: Research Article

Abstract: BACKGROUND: Spinal cord injury (SCI) has a negative impact on quality of life and healthcare costs. In recent years with the age pyramid inversion, there has been a high prevalence of SCI in the elderly. These patients must be studied in order to invest in the prevention and treatment of SCI in these patients. OBJECTIVE: To identify the characteristics and clinical aspects of spinal cord injury (SCI) in the elderly. METHODS: Retrospective study of elderly patients (≥ 60 years of age) with a clinical diagnosis of SCI. Clinical and socio-demographic variables were …collected from medical records. RESULTS: Sixty-two elderly patients were studied (56% men). The patients were analyzed according to gender. Women presented compression fractures associated with thoracolumbar transition, while men presented with listhesis associated with cervical lesions and increased complications. It was found that the need for surgical intervention was higher in men. Among many characteristics that differed between the elderly and younger people (< 60 years; n = 259), in the morphological diagnosis, we observed that compression fractures and dislocation fractures were more highly associated with ages ≥ 60 and < 60, respectively. After SCI, the elderly have a higher risk for late hemodynamic instability. CONCLUSION: Elderly individuals with SCI have distinct characteristics and clinical factors related to gender and age. Show more

Keywords: Aging, spinal injuries, spinal fractures, epidemiology

DOI: 10.3233/BMR-169686

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 929-936, 2017

Authors: Moustafa, Ibrahim Moustafa | Diab, Aliaa Attiah Mohamed | Hegazy, Fatma A. | Harrison, Deed E.

Article Type: Brief Report

Abstract: OBJECTIVE: To test the hypothesis that improvement of cervical lordosis in cervical spondylotic radiculopathy (CSR) will improve cervical spine flexion and extension end range of motion kinematics in a population suffering from CSR. METHODS: Thirty chronic lower CSR patients with cervical lordosis < 25° were included. IRB approval and informed consent were obtained. Patients were assigned randomly into two equal groups, study (SG) and control (CG). Both groups received stretching exercises and infrared; the SG received 3-point bending cervical extension traction. Treatments were applied 3 × per week for 10 weeks, care was terminated and …subjects were evaluated at 3 intervals: baseline, 30 visits, and 3-month follow-up. Radiographic neutral lateral cervical absolute rotation angle (ARA C2-C7) and cervical segmental (C2-C7 segments) rotational and translational flexion-extension kinematics analysis were measured for all patients at the three intervals. The outcome were analyzed using repeated measures one-way ANOVA. Tukey's post-hoc multiple comparisons was implemented when necessary. Pearson correlation between ARA and segmental translational and rotational displacements was determined. RESULTS: Both groups demonstrated statistically significant increases in segmental motion at the 10-week follow up; but only the SG group showed a statistically significant increase in cervical lordosis (p < 0.0001). At 3-month follow up, only the SG improvements in segmental rotation and translation were maintained. CONCLUSION: Improved lordosis in the study group was associated with significant improvement in the translational and rotational motions of the lower cervical spine. This finding provides objective evidence that cervical flexion/extension is partially dependent on the posture and sagittal curve orientation. These findings are in agreement with several other reports in the literature; whereas ours is the first post treatment analysis identifying this relationship. Show more

Keywords: Cervical spine, lordosis, flexion and extension, traction, spondylotic radiculopathy

DOI: 10.3233/BMR-150464

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 4, pp. 937-941, 2017