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

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