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 AND OBJECTIVES: The aim of the study determining whether or not Non-invasive Spinal Decompression Therapy (NSDT) was effective in resorption of herniation, increasing disc height in patients with lumbar disc herniation (LHNP). METHODS: A total of twenty patients diagnosed as LHNP and suffering from pain at least 8 weeks were enrolled to the study. Patients were allocated in study (SG) and control groups (CG) randomly. Both groups received combination of electrotherapy, deep friction massage and stabilization exercise for fifteen session. SG received additionally NSDT different from CG. Numeric Anolog Scale, Straight leg raise test, Oswestry…Disability Index (ODI) were applied at baseline and after treatment. Disc height and herniation thickness were measured on Magnetic Resonance Imagination which performed at baseline and three months after therapy. RESULTS: Both treatments had positive effect for improving pain, functional restoration and reduction in thickness of herniation. Although reduction of herniation size was higher in SG than CG, no significant differences were found between groups and any superiority to each other (p > 0.05). CONCLUSIONS: This study showed that patients with LHNP received physiotherapy had improvement based on clinical and radiologic evidence. NSDT can be used as assistive agent for other physiotherapy methods in treatment of lumbar disc herniation.
Abstract: BACKGROUND: Deficits of dynamic balance in chronic low back pain patients have been reported by different studies in terms of impaired postural control. However, they excluded the degree of pain as a determinant affecting dynamic balance. OBJECTIVE: To evaluate the effect of pain intensity on dynamic balance control in terms of postural stability indices (PSIs) and limits of stability (LOS) in chronic LBP patients. METHODS: Sixty subjects (38 men, 22 women) participated in the current study, 45 patients with chronic LBP were selected randomly and served as the chronic LBP group while 15…healthy subjects served as the asymptomatic group (AS). The chronic LBP group was further classified in terms of pain intensity into 3 subgroups; low pain (LP), moderate pain (MP) and severe pain (SP) subgroups. The Biodex Balance System was used to measure the dynamic balance control (PSIs and LOS). RESULTS: Statistical significant differences were found among AS group and chronic LBP subgroups in PSIs and LOS. CONCLUSIONS: The intensity of pain has shown to be one of the determinants affecting dynamic balance in chronic LBP patients who showed differences in the impairment of PSIs and LOS with different degrees of pain.
Keywords: Dynamic balance, chronic low back pain, pain
Abstract: The main reason for waist and back pain in patients with gigantomasty is increased thoracic kyphosis and lumber lordosis. These symptoms and abnormal spinal angulations regress after reduction mammoplasty operations. However, the effect of chronic mechanical stress caused by gigantomasty on the spinal degenerative process is not clear yet. In this study with computed tomography it is shown that degenerative spondylosis is more widespread and severe in patients with large breasts.
Abstract: BACKGROUND: Although a leg length inequality (LLI) has the effect on the performed movement, more complex indices for the evaluation of kinematic variables of postural stability and a symmetry of a muscle activity during standing in subjects with the LLI were never used before. OBJECTIVE: The objective is to present appropriate parameters for an evaluation of kinematic variables of postural stability and muscle activity during standing, i.e. to consider EMG signals, in patients with LLI. METHODS: New indices are offered, such as a sway velocity (i.e. the mCTSIB method) and a modified…symmetry index (SI), for a quantitative evaluation of EMG signals. The set of data for evaluating the effect of a heel lift was measured on patients with the LLI and healthy volunteers. RESULTS: Prior to the heel lift application, significant statistic differences were found between the mCTSIB of patients and the CG. These differences were no longer statistically significant after the heel lift was applied. As for the SI, the lowest values were found in the CG, while the greatest values were collected among patients before applying the heel lift. CONCLUSIONS: The results point out the benefits of using the newly applied indices in patients with the LLI. Both methods may become useful tools for the evaluation of the physical state of patients with the LLI in a medical practice.
Keywords: Leg length inequality, heel lift, postural stability during standing, symmetry of muscle activity
Abstract: INTRODUCTION: The aim of this study was to compare kinesio taping along with conventional treatment to conventional treatment alone and to report the results of both a single and repetitive kinesio taping application applied on quadriceps femoris and hamstring muscles on pain, range of motion, muscle strength, and functional status in patients with knee osteoarthritis. METHODS: Fifty-four patients with knee osteoarthritis were randomly allocated to two groups. A total of 28 patients were included in kinesio taping group, others were included in the control group. Before and after intervention, pain was measured with visual analog scale,…range of motion was measured with universal goniometer, muscle strength was measured with dynamometer, and functional status was measured with Knee Injury Osteoarthritis Outcome Score. RESULTS: There were statistically significant improvements in measures of pain, range of motion, quadriceps muscle strength and functional status between pre- and post-treatment in both groups (p < 0.05). In comparison, there were no significant differences with these parameters between groups (p > 0.05). It was also found that significant difference was observed in terms of range of motion, pain, functional status between pre-treatment and post-taping in intervention group (p < 0.017). CONCLUSION: In conclusion, we could report that kinesio taping has significant immediate effects after a single kinesio taping application on range of motion, pain and functional status in patients with knee osteoarthritis. We could also report that KT in addition to conventional treatment is not superior to conventional treatment alone in terms of clinical outcomes over 3 weeks later.
Abstract: BACKGROUND: Cervical mobilization and manipulation have been shown to improve cervical range of motion and pain. Cervical rotatory thrust manipulation has been associated with adverse patient reaction and damage to the V3 segment of the vertebral artery (VA). OBJECTIVE: To document and describe the effects of an upper cervical (UC) traction based mobilization on participants with restricted and painful cervical rotation and to document if the mobilization changed blood flow velocity through the vertebral artery. METHODS: This case series examined the effects of a traction based spinal mobilization on two different groups of…participants. Group I included 93 participants with restricted bilateral cervical rotation that was also painful at end range. Group II included 30 different participants whose VA blood flow velocity was examined during the same mobilization. Pre- and post-mobilization active cervical rotation, pain intensity levels, and VA blood flow velocity during mobilization was documented. RESULTS: Paired T-tests were used to determine statistical significance for changes in cervical rotation, and VA blood flow velocity during mobilization. Ninety-three participants in group I demonstrated an average increase of 16 degrees of cervical rotation. No participant demonstrated an increase in pain, and no participant in group II (N = 30) demonstrated a change in VA blood flow velocity. CONCLUSIONS: The application this UC traction based mobilization improved active cervical rotation, end range rotation pain response, did not cause pain during its application and did not alter blood flow through the VA during application.
Abstract: BACKGROUND: Lumbar lordosis is required for bipedalism. OBJECTIVES: To investigate age-related changes in lumbar lordosis and to clarify the relationships between lumbar lordosis and vertebral wedging and disc degeneration. METHODS: A total of 300 women were included in this retrospective study, 50 in each of six age groups (20-, 30-, 40-, 50-, 60- and 70-year-olds). Patients with vertebral collapse, instable fracture or disc sequestration were excluded. In each patient, lumbar lordosis angle, posterior vertebral wedging, L5-S1 intervertebral disc angle, L5/L1 vertebral height ratio and L5-S1 intervertebral disc/L1-L2 intervertebral disc height ratio were examined. Significance…level was set at p < 0.05 and two-sided tests were used. RESULTS: Significant differences were found in lumbar lordosis according to age group (p < 0.001). Lumbar lordosis correlated most strongly with L4 posterior vertebral wedging, L5 posterior vertebral wedging and L5-S1 intervertebral disc angle, in that order (r = 0.50, r = 0.40, r = 0.32, respectively; p < 0.001). CONCLUSION: In this cohort, strong spinal structure was maintained during physiological aging from 20 to 40 years of age; lumbar lordosis increased by 50 years of age. Increased lordosis correlated with increased posterior vertebral wedging and loss of posterior disc height.
Abstract: BACKGROUND: Direction changes while walking are more likely to cause a hip fracture than is falling while walking in a straight line. Trunk stability is an important contributor to safe and effective walking, and arm movements influence trunk movement while walking. However, the difference in the trunk stability during semicircular turns performed by elderly women with a light bag has not been examined. OBJECTIVE: To investigate the effects of carrying a bag on trunk stability during semicircular turns in elderly women. METHODS: We enrolled 15 community-dwelling elderly women capable of independent walking. Participants…walked with and without a bag at a self-selected speed along a marked path, which included semicircular turns, while fitted with an accelerometer attached over the L3 spinous process. RESULTS: Gait velocity was faster during semicircular turning with a bag versus without a bag. The normalized medial-lateral center of mass acceleration was lower during semicircular turning with a bag versus without a bag. CONCLUSIONS: We suggest that a light additional arm load and increased arm swing contributes to trunk stability and efficient walking during semicircular turning by elderly women.
Keywords: Center of mass acceleration, gait velocity, older adults, semicircular turning, trunk stability
Abstract: BACKGROUND: The potential to accurately perform cervical movements during more challenging tasks might be of importance to prevent dysfunctional motion characteristics. Although sensorimotor function during dual-task conditions are of increasing interest in biomedical and rehabilitation research, effects of such conditions on movement consistency of the neck have not yet been investigated. OBJECTIVE: In this crossover MiSpEx(Medicine in Spine Exercise)-diagnostic study, we aimed to explore differences between single and dual-task conditions on cervical movement variability. METHODS: Nineteen healthy participants (9 male; 24.5 ± 3.3 y) performed 10 repetitive maximal cervical movements…in (1) flexion/extension and (2) lateral flexion, during one single- and during two dual-task test conditions (cognitive, motor) in a randomised and cross-over sequence. Latter consisted of a working memory n-back task (n = 2) and a repetitive ankle movement task. Range of motion (RoM) was assessed using an external three-dimensional ultrasonic movement analysis system. Coefficient of variation (CV) for repetitive RoM was analysed for differences between conditions and controlled for variances in intra-individual movement characteristics. RESULTS: Friedman and post-hoc Bonferroni-adjusted confidence intervals for differences from single- to dual-task values revealed changes in CV in flexion/extension from single-task to motor dual-task (+ 0.02 ± 0.02 (97.5%CI: 0.01; 0.03); p < 0.05) but not to cognitive dual-task condition (+ 0.01 ± 0.02 (97.5%CI: 0.003; 0.02)) nor for lateral flexion (p > 0.05). Pearson regression analyses revealed a linear negative (p < 0.01) influence of CV in flexion/extension on differences from single to both cognitive (R= 2 0.47) and motor dual-task (R= 2 0.55). Results for lateral flexion are comparable, baseline CV negatively impacts differences to cognitive (R= 2 0.2) and motor dual-task performance (R= 2 0.76; p < 0.01). CONCLUSIONS: Participants with comparable low cervical CV at single-task display a profound increase during dual-task conditions while participants with a higher variability remained almost stable or showed a decrease. The results point toward a complex interrelationship of motion patterns and adaptation processes during challenging tasks in respect of cervical CV.
Keywords: Kinematics, MiSpEx, motion analysis, coefficient of variation, dual-task
Abstract: BACKGROUND: Playing violin may lead to overload of the locomotor system. OBJECTIVE: The aim of this study was to assess body parameters for trunk symmetry in child violinists and compare with the control group. METHODS: We analyzed body posture of 101 children aged 7–12 years, mean age 11.09 ± 9.46, 49 child violinists and control group of 52 children. RESULTS: We found statistically significant differences for the difference in depth of the lower corners of scapulae and upper posterior spina iliaca, though greater asymmetries were found in the…clinical control group. The remaining parameter values are close to significance, which may suggest that the process of postural change among the children had just started and that the existing asymmetries were easy to correct. We found positive correlation between body height and the difference in distance of the lower corners of scapulae from the spine: OL (p = 0.029, correlation coefficient value was 0.167) and the Thales triangle height: (p = 0.018, correlation coefficient was 0.214). CONCLUSIONS: Position maintained while playing the violin changed some parameters characterizing the curvature of the spine in frontal plane. We found the importance of detailed analysis of children body posture and its critical assessment.