Journal of Back and Musculoskeletal Rehabilitation - Volume 30, issue 4
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Journal of Back and Musculoskeletal Rehabilitation is a journal whose main focus is to present relevant information about the interdisciplinary approach to musculoskeletal rehabilitation for clinicians who treat patients with back and musculoskeletal pain complaints. It will provide readers with both 1) a general fund of knowledge on the assessment and management of specific problems and 2) new information considered to be state-of-the-art in the field. The intended audience is multidisciplinary as well as multi-specialty.
In each issue clinicians can find information which they can use in their patient setting the very next day. Manuscripts are provided from a range of health care providers including those in physical medicine, orthopedic surgery, rheumatology, neurosurgery, physical therapy, radiology, osteopathy, chiropractic and nursing on topics ranging from chronic pain to sports medicine. Diagnostic decision trees and treatment algorithms are encouraged in each manuscript. Controversial topics are discussed in commentaries and rebuttals. Associated areas such as medical-legal, worker's compensation and practice guidelines are included.
The journal publishes original research papers, review articles, programme descriptions and cast studies. Letters to the editors, commentaries, and editorials are also welcomed. Manuscripts are peer reviewed. Constructive critiques are given to each author. Suggestions for thematic issues and proposed manuscripts are welcomed.
Abstract: BACKGROUND: 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.
Keywords: Forward head posture, Kinesio taping, therapeutic exercise
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.
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.
Keywords: Aberdeen Low Back Pain Scale, reliability, validity, low back pain
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.
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.
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.
Keywords: Chronic non-specific low back pain, movement control, proprioceptive system, sensorimotor training
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.
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.
Keywords: Knee osteoarthritis, proprioception, risk of falling, gonarthrosis
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.
Keywords: Injury prevention, flexibility, sport techniques, spinal mouse system
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.