Journal of Back and Musculoskeletal Rehabilitation - Volume 30, issue 5
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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: Whiplash Associated Disorders (WAD) is a biopsychosocial problem, education may be an essential part in the treatment and the prevention of chronic WAD. However, it is still unclear which type of educative intervention has already been used in WAD patients and how effective such interventions are. OBJECTIVE: To examine the effectiveness of a cognitive behavioral exercises approach (CBEA) for self-training of the neck relative to usual care in individuals with WAD in acute phase. METHODS: Forty-one patients, 65.9% female (mean ± SD age: 41 ± 11 years),…with WAD were recruited immediately after the accident (within 48 hours) and assigned according to patient choice to receive a CBEA self-training of the neck or usual care for 15 days. The primary outcome measure was pain intensity and disability as measured with the Neck Disability Index (NDI). Secondary outcome measures included the presence of headaches, dizziness, nausea, and difficulties with concentration and memory. Measurements were taken at pre-treatment, 2 weeks post-treatment and 4- and 12- weeks after the injury. RESULTS: Patients receiving the CBEA intervention experienced a greater reduction in pain as compared to those receiving the usual care at the end as well as 4 and 12 weeks after the intervention (P < 0.001), for the Neck Disability Index (NDI) decreased more in the CBEA than controls over the 15 days and (F= [ 3.0 ] 552.383; P = 0.001), and in both groups at all follow-up periods (all, P = 0.001). CONCLUSIONS: This quasi-experimental clinical trial provides evidence that a CBEA for self-training of the neck may be more beneficial in treating pain than usual care in patients with WAD. However, the CBEA had limited value in improving NDI. Future studies should include several therapists, a measure of a long-term outcomes and randomize patients to groups.
Abstract: BACKGROUND: Cervical radiculopathy (CR) is a disease of the cervical spine and a space-occupying lesion that occurs because of pathological problems with cervical nerve roots. Nerve root injury to produce functional disability. OBJECTIVE: The purpose of this study was to examine the effects of neural mobilization with manual cervical traction (NMCT) compared with manual cervical traction (MCT) on pain, functional disability, muscle endurance, and range of motion (ROM) in individuals with CR patients. METHODS: A blinded randomized clinical trial was conducted. Thirty CR patients were divided into two groups – those who received NMCT…and those who received MCT. The intervention was applied three times per week for eight weeks. It was measured in order to determine the pain and functional disability in patients with CR. The numeric pain rating scale (NPRS), neck disability index (NDI), ROM, and deep flexor endurance of patients were measured prior to the experiment, four weeks, and eight weeks after the experiment to compare the time points. A repeated-measures analysis of variance was used to compare differences within each group prior to the experiment. And Bonferroni test was performed to examine the significance of each time point. RESULTS: There were significant differences within each group prior to the intervention, four weeks after the intervention, and eight weeks after the intervention in NPRS, NDI, ROM, and deep flexor endurance (P < 0.05). NPRS and NDI more decreased, and, ROM and deep flexor endurance increased in the NMCT group than the MCT group (P < 0.05). CONCLUSIONS: These results suggest that the NMCT can pain relief, recovery from neck disability, ROM, and deep flexor endurance for patients with CR.
Abstract: BACKGROUND: Estimation of handgrip strength (HGS) is routinely used by clinicians and epidemiologists for objective assessment of functional status of hand and upper extremity. It is also used as an indirect indicator of overall physical strength and health status in variety of clinical situations and chronic general medical conditions. OBJECTIVE: The present study was conducted to examine the effects of upright and slouch sitting postures and voluntary teeth clenching on hand grip strength in healthy young male subjects. METHODS: One hundred healthy young males (aged 18–30 years) participated in this study. The HGS…was measured using a commercially available dynamometer for the dominant hand. The HGS was measured during four test conditions; (a) slouch sitting without teeth contact, (b) slouch sitting with teeth clenching, (c) upright sitting without teeth contact, and (d) upright sitting with teeth clenching. RESULTS: The HGS values were significantly higher during slouch than upright sitting posture, both during similar and opposite teeth related conditions (p < 0.001). Teeth clenching had no effect on the in HGS values during slouch or upright sitting posture (P > 0.05). CONCLUSIONS: As compared to upright sitting, higher HGS values can be obtained during slouch sitting in young healthy males. Teeth clenching does not affect the HGS values during slouch or upright sitting posture.
Keywords: Hand grip strength (HGS), sitting posture, teeth clenching
Abstract: BACKGROUND: Vitamin B12 and alpha lipoic acid (ALA) are known to promote functional and morphological recovery after peripheral nerve injury. OBJECTIVE: To compare the regenerative and neuroprotective effects of vitamin B12 and ALA treatment after sciatic nerve injury. METHODS: A total of 40 rats were randomly assigned to control (sciatic nerve exposure without injury or anastomosis), sham (sciatic nerve injury and epineural anastomosis were performed but no treatment was administered), PS (isotonic saline was administered for 12 weeks after surgery), ALA (2 mg/kg ALA was administered for 12 weeks after surgery), and vitamin B12 groups…(2 mg/kg cyanocobalamin was administered for 12 weeks after surgery). Functional recovery was determined by footprint analysis, in vivo neurophysiology, and ex vivo histopathological examination. RESULTS: ALA treatment produced significant improvements in sciatic functional index values and non-significant improvements on electroneuromyography compared to vitamin B12 treatment. Upon histopathological examination, the regenerative effects of ALA were relevant to axonal structural recovery whereas vitamin B12 produced greater improvements in edema and myelination. CONCLUSIONS: While both vitamin B12 and ALA produced improvements after sciatic nerve injury, ALA was more functionally effective. The unique ultrastructural effects of vitamin B12 and ALA treatment should be considered in future studies.
Abstract: PURPOSE: To compare the short-term effect of prolotherapy and conservative terapy for the Tietze syndrome. PATIENTS AND METHODS: From 2013 to 2014, twenty-one patients underwent prolotherapy (group 1) and thirteen underwent conservative therapy with analgesics (group 2). A visual analogue score (VAS) was recorded for measurement of pain intensity in all patients before (Pre VAS) and after injection first day (VAS1), first week (VAS2) and fourth week (VAS3). Group 2 were received systemic nonsteroidal anti-inflammatory drug. VAS score was recorded similarly at the same times (Pre VAS, VAS1, VAS2, VAS3), and clinical affects were compared between…the two groups. RESULTS: The mean VAS score (mm) before prolotherapy was 7.10 in patients who received prolotherapy, and 7.14 mm in patients who treated nonsteroidal anti-inflammatory drug. The mean VAS after the fist injection was 2.19 mm and dropped to 1.52 mm after the third injection. The mean VAS after the nonsteroidal anti-inflammatory drug treatment dropped 2.62 mm and during the same scores to 3 weeks later. There was no significant difference between the group 1 and group 2 in the age, sex and comorbidity. Also there was no significant difference between the group 1 and group 2 in clinical and radiological evidence. The prolotherapy group showed a faster recovery, including significantly reduced clinic findings (p: 0.001). Third VAS is significant finding for the prolotherapy group. CONCLUSION: Prolotherapy could be performed safely and is a method with a favorable long term treatments for Tietze Syndrome. It may be the ideal procedure for patients with drugs side effects and advers events especially for those with limited liver and kidney reserve or significant comorbidities.
Abstract: BACKGROUND: Mechanomyography (MMG) has been used to investigate mechanical characteristics of muscle contraction in clinical and experimental settings. OBJECTIVE: The aim of this study was to determine the test-retest reliability of mechanomyographic amplitude (MMG RMS ) measurements as a tool for measuring the maximal voluntary isometric contractions (MVICs) of trunk muscles in healthy participants. METHODS: There were ten young adults participating in this study. Accelerometers were used to detect surface MMG signals from three trials of 5-s MVICs of the rectus abdominis, external obliques, erector spinae, and multifidus in the…vertical, transverse, and longitudinal directions. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change were calculated. RESULTS: Good to excellent test-retest reliability of mechanomyographic amplitude (MMG RMS ) measurements was achieved for all MVICs of trunk muscles in healthy participants, as indicated by ICCs ranging from 0.99 to 0.64 for MMG RMS of the trunk muscles during MVIC. CONCLUSIONS: This study demonstrates that MMG is a reliable measurement to detect the activation amplitudes of trunk muscles during MVIC.
Abstract: BACKGROUND: Although the long-term survival and related predictors have been identified in stroke patients, there is little evidence about the mortality rates and its associated factors in stroke patients treated in rehabilitation units. OBJECTIVE: To evaluate 5-year mortality rates of patients with stroke and its relationship with the clinical characteristics after inpatient subacute-chronic rehabilitation. METHODS: The files of 1016 stroke patients (482 male, 534 female) who received inpatient rehabilitation program were examined retrospectively. Patients’ characteristics and functional ambulation category were recorded at the end of the rehabilitation program. The survival probability was estimated…using the Kaplan-Meier method and the univariate effects of predictors were determined using the log-rank test. The possible factors determined with univariate analyses were checked in the Cox regression analysis. RESULTS: A total of 273 patients (32%) died within 5 years after stroke. Age (p < 0.001, RR: 1.06, 95% CI: 1.05–1.08), presence of coronary artery disease (p = 0.003, RR: 1.53, 95% CI: 1.16–2.03) and poor walking ability (p < 0.001, RR: 2.06, 95% CI: 1.49–2.86) were independent prognostic factors for increased mortality. CONCLUSIONS: About one-third of the rehabilitation patients died within 5 years after stroke. As independent ambulation was a strong predictor for long-term survival, it should be provided via rehabilitation techniques. Future studies are proposed to determine the effects of rehabilitation methods on mortality rates.
Abstract: BACKGROUND: Inconsistencies in the literature concerning the effect of neck pain have led to a lack of understanding concerning the complete pathophysiology of neck pain. While the effect of neck pain on motor function as measured by active range of motion and isometric neck strength is well documented the effect of neck pain on sensory measures such as tactical acuity and neck reposition error (NRE) remain poorly understood. OBJECTIVE: The purpose of this study was to evaluate a combined sensorimotor evaluation to explore the potential benefits of incorporating both sensory and motor task into a physical…evaluation of neck pain suffers to gain an added knowledge of the complete pathophysiology of their health status. METHODS: A cross-sectional study that measured neck joint reposition error, tactical acuity, neck isometric strength and range of motion in 40 volunteer participants (22 pain, 18 control). RESULTS: A statistically significant increase in NRE in flexion (2.75 ∘ ± 1.52 ∘ vs. 4.53 ∘ ± 1.74 ∘ and in extension (3.78 ∘ ± 1.95 ∘ vs 5.77 ∘ ± 2.73 ∘ in participants suffering from neck pain was observed. Additionally, the dermatome C5 was found to be the most affected. No differences were found in neck strength or neck range of motion between healthy controls and patients with chronic moderate neck pain.
Keywords: Tactile acuity, neck reposition error, isometric neck strength, range of motion, two-point discrimination, proprioception training
Abstract: BACKGROUND : Studies have shown late post-operative physical disability and residual pain in patients following lumbar disc surgery despite growing evidence of its beneficial effects. Therefore, rehabilitation is required to minimise the late post-operative complications. OBJECTIVE: To assess the feasibility of manipulative rehabilitation to improve late post-operative outcomes. METHODS: Twenty-one patients aged 25–65 years undergoing lumbar microdiscectomy were randomly assigned to the rehabilitation group (n = 14) or active control group (n = 7) by simple randomisation. Eight rehabilitation sessions were initiated 2–3 weeks after…surgery. Thirty-minute sessions were conducted twice weekly for four weeks. Post-operative physical disability and pain were assessed at baseline and at the two-year follow-up. RESULTS: Post-operative physical disability improved more in patients who had undergone rehabilitation than in those who had received control care (63% vs. - 23%, P < 0.05). Post-operative residual low back and leg pain were alleviated in the treatment group (26% and 57%, respectively), but intensified in the control group (- 5% and - 8%, respectively). CONCLUSIONS: This study demonstrated the potential of manipulative rehabilitation and importance of post-operative management after lumbar disc surgery. Definitive trials with larger sample sizes are required to confirm the feasibility and potential therapeutic effectiveness of this approach.
Abstract: INTRODUCTION: Myofascial pain is a common impairment treated with various manual interventions including spinal thrust manipulation and stretching; however, the comparative efficacy of each intervention is uncertain. Therefore, the purpose of this investigation was to evaluate thrust manipulation targeting the cervicothoracic junction compared to a manual stretch of the upper trapezius muscle on cervical range of motion and upper trapezius pressure pain thresholds (PPTs). METHODS: Healthy participants with no significant history of neck pain were randomized into a thrust manipulation group, a stretching group, or a control group. Within group differences were evaluated via a dependent…t -test, and group by time interactions were evaluated by a two-way repeated measures ANOVA. RESULTS: One hundred and two participants were recruited to participate. Baseline demographics revealed no significant differences between groups. Significant group by time interactions were found for changes in PPTs for both the right and left upper trapezius. Also, significant differences were found for changes in cervical extension, as well as right and left cervical side bending favoring the treatment groups. DISCUSSION: This study demonstrates the potential independent effectiveness of spinal thrust manipulation or stretching for reducing PPTs at the upper trapezius. Future research should further evaluate the limitation of PPTs as a measure of muscle sensitivity as well as factors that may contribute to variability in the measurements among individuals seeking care.