Journal of Back and Musculoskeletal Rehabilitation - Volume 31, issue 1

Authors: Andersen, Knut | Baardsen, Roald | Dalen, Ingvild | Larsen, Jan Petter

Article Type: Research Article

Abstract: BACKGROUND: Flying related transient Low Back Pain (LBP) among helicopter pilots is considered an occupational distress. OBJECTIVE: To examine if exercise programs can alleviate transient LBP. METHODS: Sixty-five helicopter pilots (92% males), all reporting flying related LBP, responded to an epidemiological survey and a long-term follow-up, 44.8 months later, comprising questions regarding transient LBP and number of sick leaves. Data from 37 pilots participating in two exercise programs, A; general for LBP, B; focused for lumbar trunk (LT), included information from clinical examinations and muscular endurance tests of the LT before and after …intervention. Twenty-eight pilots did not participate in any intervention. RESULTS: At long-term follow-up 42% of the pilots still reported flying related transient LBP. Among participants in program B 26% had persistent pain, 70% in program A and 46% among pilots without intervention. Sick-leave reduction was only observed among participants in program B (30% to 4%). Upon re-occurrence of LBP symptoms, half of the pilots in program B again performed exercises to improve their pain. CONCLUSION: This study indicates that exercise programs focused towards lumbar trunk muscular endurance reduces flying related transient LBP and sick-leave among helicopter pilots. These findings may have implications for the pilots’ working conditions. Show more

Keywords: Muscular endurance, lumbar trunk, sick leave, transient low back pin

DOI: 10.3233/BMR-170897

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 1-13, 2018

Authors: Gouttebarge, Vincent | Veenstra, Ersot | Goedegebuure, Simon | Frings-Dresen, Monique | Kuijer, Peter Paul

Article Type: Research Article

Abstract: OBJECTIVES: To study the incidence, diagnostics, treatment, anatomical region and return to play of non-acute groin injuries among professional footballers in the Netherlands. DESIGN: Prospective cohort study. METHODS: Medical staff members of all Dutch professional football clubs, recording prospectively injury occurrence of all professional footballers in their clubs, were asked to fill in an injury form about time-loss (⩾ 8 days) non-acute groin injury over the 2012–2013 season. RESULTS: A cohort of 410 players from 12 professional football clubs were included (response rate = 44%). The season incidence …of non-acute groin injuries was nearly 7% (29 non-acute groin injuries). In 82% of all cases, the player suffered from non-acute groin injury in the first half of the season. The average time to return to play was 35 days, ranging from 8 to 84 days. The adductors were the most affected anatomical regions (82%), with the most frequent diagnosis being overuse of the adductors (36%), followed by adductor tendinopathy (18%). In addition to medical history and physical examination, ultrasound (50%) and MRI (32%) were the diagnostic methods most frequently mentioned. As well as physical therapy, treatment consisted mostly of manual therapy (96%) and dry needling (61%). CONCLUSIONS: A professional club with a squad of 25 players can expect on average two non-acute groin injuries per season with an average time-loss of 35 days. Players are more at risk in the first half of the season. In Dutch professional football, ultrasound is commonly used to diagnose non-acute groin injury, while manual therapy is the most commonly applied treatment. Show more

Keywords: Professional athletes, injury, adductor, groin, soccer, return to play

DOI: 10.3233/BMR-150427

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 15-21, 2018

Authors: Taşpınar, Özgür | Gültepe, İlhami | Keskin, Yaşar | Aydın, Teoman | Kepekçi, Müge | Mutluer, Ahmet Serdar | Hocaoglu, İlknur Türk

Article Type: Research Article

Abstract: OBJECTIVE: This study compared the dietary habits of patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). METHODS: The nutritional status of 56 patients, seen at the Rheumatology Outpatient Clinic and diagnosed with RA based on the ACR-2010 criteria, was compared with that of 28 patients diagnosed with AS using the modified New York criteria. Nutritional status was determined using a form that was filled out during face-to-face interviews with all patients. Patient demographics, disease activity, smoking and alcohol use, concomitant diseases, disease duration and nutritional status were determined using a questionnaire. RESULTS: …RA patients consumed butter on 2 days a week, and AS patients on 1 day per month. Yoghurt was consumed by RA patients daily and by AS patients 3 days a week. CONCLUSIONS: Compared to the diet of AS patients, the diet of RA patients was richer in protein and lipids. The impact of diet on these two diseases remains to be determined in large-scale studies. Show more

Keywords: Ankylosing spondylitis, rheumatoid arthritis, diet

DOI: 10.3233/BMR-150476

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 23-27, 2018

Authors: Hofmann, Ulf K. | Wittmann, Sina | Fischer, Alena N. | Jordan, Maurice | Feierabend, Martina M. | Rondak, Ina-Christine | Ipach, Ingmar | Mittag, Falk

Article Type: Research Article

Abstract: BACKGROUND: Spinal surgeries have strongly increased in number over the past decade. The question of when it is safe to resume driving is thereby one the most frequently asked questions that patients ask of their treating physician. OBJECTIVE: The aim of this study was to assess braking performance before and after spine surgery. METHODS: Reaction time, foot transfer time (together brake response time [BRT]), and brake force (BF) were evaluated in a drive simulator. A longitudinal patient cohort (n = 27) was tested preoperatively and at the first …follow-up. A cross-sectional cohort (n = 27) was tested at > 1 year postoperatively. The values from these groups were compared with a healthy age-matched control group of 24 volunteers. RESULTS: No significant improvement in BRT was seen in lumbar fusion three months postoperatively (p = 0.597); BF was even weaker than it was preoperatively (p = 0.044). In comparison to the control group (median BRT 479 ms), preoperative BRT was already impaired in lumbar fusion patients (median 560 ms), representing an increased braking distance of 2.25 m at 100 km/h. CONCLUSION: Although most patients performed adequately, about one third presented critical braking performance. Risk factors for impaired braking may include scheduled multisegmental fusion surgery, female sex, and pain. Show more

Keywords: Total brake response time, driver reaction time, driving reaction time, lumbar fusion, nucleotomy, lumbar decompression

DOI: 10.3233/BMR-169570

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 29-36, 2018

Authors: Sağ, Mustafa Serdar | Sağ, Sinem | Tekeoğlu, İbrahim | Solak, Berna | Kamanlı, Ayhan | Nas, Kemal | Harman, Halil | Kantar, Mine

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: Rheumatoid arthritis (RA), insulin-dependent diabetes mellitus (IDDM), inflammatory bowel disease, systemic lupus erythematosus (SLE) and multiple sclerosis (MS) are some of the autoimmune diseases related to the decreases in Vitamin D levels. The same immunological properties as psoriasis, such as Th1/Th2 dysregulation, are seen in all of them. This study aims to compare 25-hidroksi Vitamin D (25-OHD) serum concentrations in patients with psoriasis and psoriatic arthritis. METHODS: This study includes 91 outpatients; 48 of these patients were chosen randomly among the psoriasis (PS) patients from the dermatology department of the researchers’ hospital. Forty-three of …them were chosen among the psoriatic arthritis (PsA) patients matching the age and gender criteria from the rheumatology department of the researchers’ hospital. In this study, 25-OHD serum concentrations among the psoriasis and psoriatic arthritis patients were compared. RESULT: There are more patients in the PsA group with 25-OHD levels lower than 20 ng/ml; however, this finding is insufficient to obtain statistical significance (p = 0.09). PsA and psoriasis groups had similar numbers of patients with 25-OHD levels ranging from 20 to 30 mg/mL and those higher than 30 mg/mL (p > 0.05). CONCLUSION: The literature does not show significant differences between the PS and PsA groups in terms of serum 25-OHD levels and a prevalence of Vitamin D deficiency. Besides, PASI scores were higher in the PS group. CRP values in the PsA group were higher than in the PS group. There was a poor negative correlation between CRP and serum 25-OHD levels in the PsA group. This correlation was not found in the PS group. Show more

Keywords: Psoriasis, psoriatic arthritis, Vitamin D

DOI: 10.3233/BMR-169617

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 37-43, 2018

Authors: DePasse, J. Mason | Park, Sara | Eltorai, Adam E.M. | Daniels, Alan H.

Article Type: Research Article

Abstract: OBJECTIVE/BACKGROUND: Treatment options for spinal cord injuries are currently limited, but multiple clinical trials are underway for a variety of interventions, drugs, and devices. The Food and Drug Administration website www.ClinicalTrials.gov catalogues these trials and includes information on the status of the trial, date of initiation and completion, source of funding, and region. This investigation assesses the factors associated with publication and the publication rate of spinal cord injury trials. DESIGN: Retrospective analysis of publically available data on www.ClinicalTrials.gov. METHODS: The www.ClinicalTrials.gov was queried for all trials on patients with spinal …cord injury, and these trials were assessed for status, type of intervention, source of funding, and region. Multiple literature searches were performed on all completed trials to determine publication status. RESULTS: There were 626 studies identified concerning the treatment of patients with spinal cord injury, of which 250 (39.9%) were completed. Of these, only 119 (47.6%) were published. There was no significant difference in the rate of publication between regions (p > 0.16) or by study type (p > 0.29). However, trials that were funded by the NIH were more likely to be published than trials funded by industry (p = 0.01). CONCLUSION: The current publication rate of spinal cord injury trials is only 47.6%, though this rate is similar to the publication rate for trials in other fields. NIH-funded trials are significantly more likely to become published than industry-funded trials, which could indicate that some trials remain unpublished due to undesirable results. However, it is also likely that many trials on spinal cord injury yield negative results, as treatments are often ineffective. Show more

Keywords: Clinical trials, publication bias, research funding, spinal cord injury

DOI: 10.3233/BMR-169628

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 45-48, 2018

Authors: Elbasan, Bulent | Akaya, Kamile Uzun | Akyuz, Mufit | Oskay, Deran

Article Type: Research Article

Abstract: BACKGROUND: Neurodevelopmental treatment (NDT), neuromuscular electrical stimulation (NMES), and Kinesio Taping (KT) applications are separately used to improve postural control and sitting balance in children with cerebral palsy (CP). OBJECTIVE: The aim of this study is to examine the combined effect of NDT, NMES and KT applications on postural control and sitting balance in children with CP. METHODS: Forty five children, in 3 groups, between the ages 5–12 years were included in the study. Group 1 received NDT; group 2 received NDT + NMES; and the group 3 received NDT + …NMES + KT for 6 weeks. Sitting function evaluated by the sitting section of the gross motor function measure (GMFM), and postural control assessed with the seated postural control measurement (SPCM). RESULTS: Seating section of GMFM was improved significantly in all the groups; however, increases in the group 3 were higher than groups 1 and 2 (p = 0.001). While significant differences were observed in all groups in the SPCM posture (p < 0.001), function (p < 0.001), and the total scores (p < 0.001); the change in the third group was higher according to the comparison of the three groups within each other. CONCLUSIONS: Implementation of the NMES, and KT additionally to NDT improve the sitting posture, postural control, seating function, and gross motor function in children with CP. Show more

Keywords: Motor control, physiotherapy, kinesio taping, electrical stimulation, cerebral palsy

DOI: 10.3233/BMR-169656

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 49-55, 2018

Authors: Schneider, Rainer

Article Type: Research Article

Abstract: BACKGROUND: The prevalence of chronic back pain poses major challenges for all health care systems and patients worldwide. Myofascial trigger therapy (MT), although a very popular standard non-pharmaceutical form of treatment, only shows small to medium effectiveness. OBJECTIVE: To test a new vibrotreatment (Cellconnect Impulse) transmitting low-frequency, vertical shock waves in a routine clinical practice. METHODS: Eligible patients were adults seeking physiotherapeutic treatment. They were randomly allocated to either six treatments of MT or to six treatments of combined MT and vibrotreatment. Outcome parameters were pain intensity, pain days, pain duration, and quality …of life. RESULTS: The pain relieving effects of the combined treatment were very large (d = 1.6). It clearly outperformed MT and considerably improved patients’ health related quality of life. CONCLUSIONS: Combining MT with Cellconnect Impulse enhances the physiotherapeutic effectiveness of treating chronic back pain. Show more

Keywords: Cellconnect Impulse, chronic back pain, myofascial trigger point therapy, quality of life, vibrotherapy

DOI: 10.3233/BMR-169662

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 57-64, 2018

Authors: Kim, Dong-Ki | Kim, Chang-Yong | Lee, Byoung-Kwon | Seo, Dongkwon

Article Type: Research Article

Abstract: BACKGROUND: Many studies have shown asymmetric behavior of the surface and deep layers of spine muscles in scoliosis patients, compared to normal individuals. However, there is a lack of research on the transversus abdominal (TA) muscle, which plays an important role in trunk stabilization. OBJECTIVE: To assess symmetry in subjects with adolescent idiopathic scoliosis (AIS) by measuring the thickness of abdominal muscles, and to investigate characteristic features through a comparative analysis of the data with healthy aged-matched group. METHODS: Subjects consisted of 33 AIS and 32 healthy subjects of similar ages between 11–28 years …old. We measured TA, internal abdominal oblique (IO), and external abdominal oblique (EO) muscles were measured using ultrasonography imaging. Three repeat measurements of the thickness of each muscle were performed during rest and contraction. RESULTS: For the healthy subjects, the intra-class correlation coefficients (ICCs) for the muscle thickness measures ranged from 0.70 to 0.99, standard error of measurement (SEM) was 0.38 cm, and minimal detectable change (MDC) was 1.07 cm. The ICCs for the muscle thickness measures in the AIS group ranged from 0.90 to 0.98, SEM was 0.45 cm, and MDC was 1.24 cm. The symmetry of the two groups was compared, and showed significant difference only in TA in AIS patient group (P < 0.01). CONCLUSIONS: In conclusion, treatment should be focused on exercises that emphasize symmetry, to induce normal action of the TA and structural changes in the spine because AIS induces asymmetry in TA, which plays an important role in trunk stability. Show more

Keywords: Abdominal muscles, adolescent idiopathic scoliosis, symmetry, transversus abdominis, ultrasonography

DOI: 10.3233/BMR-169667

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 65-74, 2018

Authors: Kwon, Jong Won | Kim, Sang Jun

Article Type: Research Article

Abstract: STUDY DESIGN: A prospective observational comparative study. BACKGROUND: Because epidural corticosteroids are more effective for pain relief when delivered close to the site of pathology, lumbar spinal stenosis with multilevel stenotic areas can be treated more effectively when medications cover all of the stenotic areas. Distribution of medications to the pathologic sites is considered an important factor in the effectiveness of inter-laminar epidural injection. OBJECTIVE: To determine whether spread of a lidocaine and triamcinolone mixture over the stenotic areas improves clinical symptom of spinal stenosis more effectively. METHODS: Twenty-four patients …with lumbar spinal stenosis were enrolled in this study. A lumbar inter-laminar epidural injection under fluoroscopic guidance was administered to each patient. A numeric rating scale (NRS), claudication distance, the Romberg test, and the Oswestry Disability Index (ODI) were checked pre-injection and at 2, 6, and 12 weeks after the epidural injection. Vertebrae that showed more than moderate stenosis were considered stenosis levels. Inter-laminar epidural injection was performed with radiopaque contrast and lidocaine mixed with triamcinolone acetate. When the contrast covered all of the stenosis levels, this was considered a sufficient distribution (SD) and when the contrast did not cover all stenosis levels, this was considered an insufficient distribution (ID). RESULTS: At 2 weeks, percentages of NRS improvement were 71.4 (IQR, 20.2) in SD group and 50.0 (IQR, 31.4) in ID group (P = 0.02), changes in Romberg test time were 0.0 (IQR, 35.0) in SD group and - 3.0 (IQR, 12.0) in ID group (P = 0.02), decreases in ODI were 9.6 (IQR, 11.2) in SD group and 0.0 (IQR, 7.8) in ID group (P = 0.02). However, these parameters were not significantly different at 6 weeks and 12 weeks. Claudication distance showed no significant group difference. CONCLUSION: Coverage of the stenotic area by the lidocaine, triamcinolone, and contrast dye mixture during inter-laminar epidural injection was an important predictor of acute pain reduction. Show more

Keywords: Spinal stenosis, epidural injection, contrast distribution, inter-laminar

DOI: 10.3233/BMR-169674

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 75-83, 2018

Authors: Chang, Nai-Jen | Chou, Willy | Hsiao, Pei-Chi | Chang, Wen-Dien | Lo, Yi-Ming

Article Type: Research Article

Abstract: BACKGROUND: Individuals with disc degeneration experience associated pain and disability. Considering its safety and affordability, Kinesio tape (KT) may be a viable treatment. However, most KT studies have demonstrated its effects in healthy adults and patients with nonspecific low back pain. The efficacy of KT in patients with disc degeneration is yet to be investigated. OBJECTIVES: To examine the acute effects of KT on patients with lumbar disc degeneration confirmed through magnetic resonance imaging. METHODS: A total of 31 eligible patients (aged 25–64 years) with low back pain caused by lumbar disc degeneration …were divided into mild and moderate-to-severe pain groups. KT was applied to the painful lumbar region in a lumbar brace-like pattern for 1 day. A visual analogue scale for pain and the Oswestry disability index were analysed before and after 1 day of taping. The Biering-Sorensen test for trunk muscle endurance was performed before, immediately after, and 1 day after taping as well as immediately after tape removal. RESULTS: After taping, both groups showed significant pain reduction (p < 0.001), but the reduction was of minimal clinical importance in the moderate-to-severe pain group. The magnitude of treatment (i.e. effect size) was higher in the moderate-to-severe pain group. Disability significantly decreased in both groups, particularly in the moderate-to-severe pain group, but the improvement was not clinically worthwhile. Trunk muscle endurance significantly improved in both groups with in situ taping, but it decreased after tape removal. CONCLUSIONS: KT may be adopted as an assistive aid for immediate pain reduction, particularly in lumbar disc degeneration patients with moderate-to-severe pain; however, its effects on disability and trunk muscle endurance are not clinically worthwhile. The long-term effects of KT, with or without active exercise, warrant further assessment. Show more

Keywords: Kinesio taping, low back pain, disc degeneration, Oswestry disability index, Biering-Sorensen test

DOI: 10.3233/BMR-169681

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 85-93, 2018

Authors: Cortell-Tormo, Juan M. | Sánchez, Pablo Tercedor | Chulvi-Medrano, Ivan | Tortosa-Martínez, Juan | Manchado-López, Carmen | Llana-Belloch, Salvador | Pérez-Soriano, Pedro

Article Type: Research Article

Abstract: BACKGROUND : Exercise is important as adjuvant in the chronic low back pain (CLBP) treatment. Functional training could involve benefits for low back pain (LBP) patients. OBJECTIVE: To evaluate the effects of a 12-week period of functional resistance training on health-related quality of life (HRQOL), disability, body pain, and physical fitness in CLBP females. METHODS: Nineteen females CLBP were recruited according to Paris Task Force on Back Pain criteria. Participants were randomly assigned to an exercise group (EG); and a control group (CG). Subjects were tested at baseline and at week 12 after 24 …sessions, 2 days per week. Body pain was assessed using visual analog scale (VAS), disability with Oswestry Disability Index (ODI) and HRQOL with Short Form 36 questionnaire. Physical fitness was measured using: flamingo test, back endurance test, side bridge test, abdominal curl-up tests, and 60-s squat test. RESULTS: EG showed significant improvements in physical function (10%; p < 0.05), body pain (42%; p < 0.05), vitality (31%; p < 0.05), physical component scale (15%; p < 0.05), VAS (62.5%; p < 0.01), ODI (61.3%; p < 0.05), balance (58%; p < 0.05), curl-up (83%; p < 0.01), squat (22%; p < 0.01), static back (67%; p < 0.01), and side bridge (56%; p < 0.01). CONCLUSION: Periodized functional resistance training decreased pain and disability and improved HRQOL, balance and physical fitness in females with CLBP, and can thus be used safely in this population. Show more

Keywords: Resistance training, disability, therapy, pain, exercise, women

DOI: 10.3233/BMR-169684

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 95-105, 2018

Authors: Doubkova, Lucie | Andel, Ross | Palascakova-Springrova, Ingrid | Kolar, Pavel | Kriz, Jiri | Kobesova, Alena

Article Type: Research Article

Abstract: BACKGROUND: Abdominal muscles are important spinal stabilizers and its poor coordination, as seen in diastasis of rectus abdominis (DRA), may contribute to chronic low back pain (LBP). However, this has not yet been studied directly. OBJECTIVES: To conduct a pilot study to examine the association between DRA and LBP. METHODS: Using a digital caliper, standard clinical DRA measurement was performed in 55 participants with and 54 without chronic LBP. RESULTS: Participants were on average 55 years old, 69 (63%) were women. Among the 16 participants with DRA, 11 (69%) had …chronic LBP; among the 93 participants without DRA, 44 (47%) had LBP. Among men, 7 of 9 (77%) with DRA had LBP and 14 of 31 (45%) without DRA had LBP. Among women, 4 of 7 (57%) with DRA had LBP and 30 of 62 (48%) without DRA had LBP. BMI was the strongest correlate of DRA and may explain the relation between DRA and chronic LBP. CONCLUSIONS: DRA and LBP may be interrelated, especially among men. This may be a function of greater BMI in individuals with chronic LBP. Understanding the association between DRA, LBP, and BMI may have important implications for treatment of LBP and for intervention. Show more

Keywords: Rectus abdominis diastasis, body mass index (BMI), intra-abdominal pressure, spinal stabilization, low back pain

DOI: 10.3233/BMR-169687

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 107-112, 2018

Authors: Baysal, Pınar Karaca | Baysal, Özgür | Erkılınç, Atakan | Gürcü, Mustafa Emre | Yeksan, Ayşe Nur | Gölboyu, Birzat Emre | Ekinci, Mürsel

Article Type: Research Article

Abstract: BACKGROUND: Pulsed radiofrequency (PRF) used for knee pain originating from osteoarthritis is one of these methods. OBJECTIVES: The aim of the study was to evaluate the knee functional status and pain palliation following the application of pulse radiofrequency in patients with cardiac comorbid disease who were diagnosed with advanced stage osteoarthritis. METHODS: Thirty-eight patients with high surgical risk having cardiac comorbidities with grade 3–4 gonarthrosis according to the Kellgren-Lawrence classification were retrospectively analyzed. PRF was applied to the saphenous nerve of each patient. Visual Analog Scale for knee pain evaluation both at rest …and on movement and the Lysholm Knee Scoring Scale for function evaluation were used. The patient status was evaluated before the procedure and at the first and sixth months after the procedure. RESULTS: The mean age was 68.8 years (range, 53–82 years). Both the rest and movement post-procedural Visual Analog Scale scores at first and sixth months were significantly lower than pre-procedural values (p < 0.001). A statistically significant improvement was also determined when pre- and one and six months post-procedural Lysholm scores were compared (p < 0.001). CONCLUSIONS: PRF is a safe and function sparing minimally invasive pain palliation method for knee osteoarthritis in elders with cardiac comorbidity. Show more

Keywords: Cardiovascular diseases, chronic pain, osteoarthritis, knee, pulsed radiofrequency, saphenous nerve

DOI: 10.3233/BMR-169690

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 113-118, 2018

Authors: Oh, Sejun | Kim, Minhee | Lee, Minyoung | Kim, Taeyeong | Lee, Dongshin | Yoon, Bumchul

Article Type: Research Article

Abstract: BACKGROUND: Myofascial trigger points (MTrPs) are related to low back pain and back muscle stiffening, and secondarily to movement impairment. MTrP therapy with an inflatable ball would improve clinical outcomes for chronic non-specific low back pain (CNSLBP) after 6 weeks. OBJECTIVE: The aim of this study was to investigate the effects of MTrPs with an inflatable ball for the elderly with CNSLBP. METHODS: Fifteen elderly patients with chronic non-specific low back pain were evaluated for pain, pressure sensitivity, and physical function at baseline and 1, 3, and 6 weeks of therapy. The visual analog scale …(VAS) and pressure pain threshold (PPT) were used to measure pain intensity and sensitivity, respectively. Straight-leg-raise (SLR) test, back range of motion (BROM), and Oswestry disability index were used to assess physical function. RESULTS: Significant differences were observed between the 3- and 6-week VAS scores (- 34.6%; p = 0.03); baseline and 1-week (7%; p = 0.02), 1- and 3-week (- 14%; p = 0.01), and 3- and 6-week PPTs (18%; p = 0.01); 3- and 6-week BROMs (Flexion, 7.1%; Extension, 41%; p = 0.048); baseline and 1-week (- 6.9%; p = 0.02), 1- and 3-week (3%; p = 0.01), and 3- and 6-week active SLR test scores (7%; p = 0.011); and baseline and 1-week (- 2.6%; p = 0.03), 1- and 3-week (8.34%; p = 0.01), and 3- and 6-week passive SLR test scores (5.3%; p = 0.025). CONCLUSION: Myofascial trigger point therapy with an inflatable ball relieved pain and improved physical function in the elderly with CNSLBP. Show more

Keywords: Chronic non-specific low back pain, elderly, inflatable ball, myofascial trigger point, myofascial trigger point therapy

DOI: 10.3233/BMR-169696

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 119-126, 2018

Authors: Ota, Susumu | Ohko, Hiroshi

Article Type: Research Article

Abstract: BACKGROUND: Sex differences in passive patellar mobility have not been quantitatively evaluated. OBJECTIVE: The present study aimed to: 1) investigate sex differences in absolute and normalized patellar mobility, and 2) verify the relationship between patellar mobility and knee joint laxity. METHODS: Two hundred and five pain-free individuals (205 knees, 103 men, 102 women) participated. Passive lateral and medial patellar displacement was measured using a modified patellofemoral arthrometer and manual pushing method at 0 ∘ and 30 ∘ knee flexion angles. The absolute values of lateral …and medial patellar displacement (LPD and MPD, respectively), and values normalized to patellar width (PW) and body height (HT) were used in the final analysis. RESULTS: At a 30 ∘ knee flexion angle, LPD/PW and LPD/HT were greater in women than in men (LPD/PW: 27.0 ± 6.7% vs. 22.6 ± 6.7%, LPD/HT: 0.81 ± 0.19% vs. 0.70 ± 0.15%, respectively, P < 0.001, effect size > 0.50). Absolute and normalized lateral and medial patellar mobility correlated positively with the range of the knee extension angle. CONCLUSIONS: Sex differences in LPD/PW and LPD/HT at a 30 ∘ knee flexion were detected in healthy subjects. Although the knee extension angle related to both the lateral and medial direction of the patellar mobility, the relations were only fairly correlated in asymptomatic young subjects. Show more

Keywords: Patellar mobility, sex difference, displacement, knee extension angle

DOI: 10.3233/BMR-169704

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 127-132, 2018

Authors: Galindez-Ibarbengoetxea, Xabier | Setuain, Igor | Ramírez-Velez, Robinson | Andersen, Lars L. | González-Izal, Miriam | Jauregi, Andoni | Izquierdo, Mikel

Article Type: Research Article

Abstract: BACKGROUND: While both manipulative treatment and physical exercises are used to treat cervical pain, it remains unclear which is most effective. OBJECTIVE: To compare the short-term effects of high-velocity, low-amplitude manipulation techniques (MT) with those of home-exercise (HE) with stretching and low-intensity (10% of max) isometric contractions on pain and function. METHODS: Single-blind randomized clinical trial was performed. A total of 27 asymptomatic subjects were randomly assigned to 2 groups: manipulation techniques (MT, n = 13) and home exercise (HE, n = 14). …The visual analogue scale (VAS); neck disability index (NDI); pressure pain thresholds; cervical spine range of motion and electromyography during the cranio-cervical flexion test was measured before and one week after the intervention. RESULTS: After the intervention, both groups showed improved (P < 0.05) NDI and VAS scores and flexion in both rotation ranges compared with the pre-intervention values. For the NDI, pain intensity, and neck flexion, the effects sizes were large; for the majority of the other measurements, the effect sizes were small to moderate. The MT group showed significantly better results than the HE group for 2 out of 17 tests. CONCLUSIONS: Both interventions improved function and pain after one week, with only marginal between-group differences in favor of MT. Show more

Keywords: Spinal manipulation, neck pain, cervical vertebrae, thoracic vertebrae, electromyography

DOI: 10.3233/BMR-169723

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 133-145, 2018

Authors: Mendes, André Augusto M.T. | de Freitas, Sandra Maria Sbeghen Ferreira | Amorin, César Ferreira | Cabral, Cristina Maria Nunes | Padula, Rosimeire Simprini

Article Type: Research Article

Abstract: OBJECTIVE: This study aimed to evaluate the effect of one workday on pain and perceived exertion, muscular strength, and electromyographic activity of the erector spinae muscles in welders with and without low back pain. This is an observational cohort study. PARTICIPANTS: Twenty-two welders, metallurgical shipbuilding, were equally divided into 2 groups: low back pain and no low back pain. Pain and perceived exertion. Muscular strength by maximal voluntary contractions and electromyographic activity of right and left erector spinae muscles during maximal voluntary contractions and in the 3 welding positions for 2 periods of the workday (in …the morning and at the end of the workday). RESULTS: At the end of workday, the pain increased significantly for the low back pain group (t(22) = 2.448; P = 0.023). The perceived exertion also increased significantly for both groups at the end of workday groups (F(1,22) = 8.570, P = 0.000) and periods (F(1,22) = 8.142, P = 0.000). There were no significant differences between groups and workday periods for muscular strength and electromyographic activity during maximal voluntary contractions of the erector spinae. There was no significance difference for electromyographic activity between groups and workday period and in the 3 welding positions. CONCLUSION: Although the pain and perceived exertion increased at the end of the workday, these results did not interfere in muscular strength and electromyographic activity of right and left erector spinae muscles. Thus, we can conclude that welders with chronic low back pain had a good physical capacity (muscular strength) and that muscle performance was maintained. Show more

Keywords: Occupational biomechanics, electromyographic, workplace, low back pain, ergonomics

DOI: 10.3233/BMR-169733

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 147-154, 2018

Authors: Moya-Ramón, Manuel | Juan-Recio, Casto | Lopez-Plaza, Diego | Vera-Garcia, Francisco Jose

Article Type: Research Article

Abstract: BACKGROUND: The selection and validation of age- and gender-specific criterion-referenced cut-points for abdominal endurance are still unclear. OBJECTIVE: To stablish normative values for abdominal endurance in adolescents by age and gender using the Bench Trunk Curl-up Test (BTC ). Additionally, the reliability of the BTC was analyzed. METHODS: Two hundred and sixteen untrained high school students (104 males - 112 females) were grouped into five age strata. Participants performed the BTC twice with a rest period of 72 h. Descriptive statistics and percentile scores were determined for each gender/age strata. …RESULTS: Males showed higher BTC scores than females (males: 90.07 ± 32.65 repetitions; females: 73.43 ± 27.74 repetitions), but no significant differences between age strata nor age * gender interaction were found. Significant differences for the BTC scores between sessions were found (T1 = 72.06 ± 26.28 repetitions; T2 = 81.44 ± 31.27 repetitions). The ICC was 0.82, whereas the typical error was 17.2%. CONCLUSIONS: Gender, but not age, is an important factor when abdominal endurance is compared between adolescents. Finally, the BTC is a reliable test, supporting the findings of this study. However, an extensive familiarization period to reduce the learning effect is necessary. Show more

Keywords: Abdominal muscles, endurance, teenagers, field test

DOI: 10.3233/BMR-169760

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 155-162, 2018

Authors: Anwer, Shahnawaz | Alghadir, Ahmad H. | Al-Eisa, Einas S. | Iqbal, Zaheen Ahmad

Article Type: Research Article

Abstract: BACKGROUND: Shoulder dysfunction is a major cause of musculoskeletal pain in general population. A variety of shoulder disorders can cause a reduction in shoulder range of motion and subsequent disability. OBJECTIVE: To investigate the relationship between the shoulder pain, range of motion, and disability in patients with shoulder dysfunction. METHODS: Sixty-four patients (49 men and 15 women) with shoulder disorders with a varying diagnosis including, adhesive capsulitis, rotator cuff injury, impingement syndrome, acromio-clavicular pain, and instability, participated in this cross-sectional study. Participants were asked to report the shoulder pain intensity and level of …disability on a numerical rating scale (NRS) and the shoulder pain and disability index (SPADI), respectively. In addition, the active shoulder range of motion was evaluated. RESULTS: The Spearman rank correlation coefficient was used to investigate the association between the shoulder pain, range of motion, and disability. A good negative correlation found between the shoulder abduction, flexion, and rotation range of motion with the NRS score (rho = - 0.710 to - 0.747). A moderate negative correlation found between the extension and the NRS score (rho = - 0.643). A good negative correlation found between abduction and the SPADI total score (rho = - 0.714). A moderate negative correlation found between the shoulder flexion and rotation range of motion with the SPADI total score (rho = - 0.547 to - 0.694). A fair negative correlation found between the extension and the SPADI total score (rho = - 0.495). A moderated positive correlation found between the NRS and the SPADI total score (rho = 0.667). CONCLUSIONS: The flexion, abduction, and rotation ROMs were most significantly associated with severity of pain and the physical disability in patients with shoulder dysfunction. Further, longitudinal studies are required to confirm these results. Show more

Keywords: Pain, range of motion, shoulder, disability

DOI: 10.3233/BMR-169762

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 163-167, 2018

Authors: Ji, Jiancheng | Guo, Shuai | Song, Tao | Xi, Fengfeng (Jeff)

Article Type: Research Article

Abstract: BACKGROUND: Most stroke survivors are suffering from physical motor impairments and confronting with the risk of falls, and well trunk stability is essential for balance during daily functional activities. OBJECTIVES: Current fall prevention devices have various limits to the efficient recovery of balance function of the trunk. To provide hemiplegic patients after stroke with the retraining of trunk position sense and a safety environment, a novel fall prevention device is proposed. METHODS: Firstly, the structure of the device is introduced and this work is a first effort towards restoring trunk balance function through …retraining of trunk position sense. Secondly, the kinematic and static model of the device are developed. Lastly, kinematic and static analysis are carried out to study the motion characteristics, and a contrast experiment was derived to show the effectiveness of robot. RESULTS: No obvious difference in balance ability between two groups prior treatment (P > 0.05). Fugl-Meyer assessment in all the cases were improved in different extent (P < 0.05). The robot group had significantly higher Fugl-Meyer scores after treatment than the control group (P < 0.05). CONCLUSIONS: The results show that the fall prevention device has good kinematic dexterity within the prescribed workspace and markedly improves balance function. Show more

Keywords: Trunk position sense, kinematics, fall prevention device, statics, force field

DOI: 10.3233/BMR-169765

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 169-176, 2018

Authors: Rezaei Motlagh, Fazel | Kamali, Mohammad | Babaee, Taher

Article Type: Research Article

Abstract: BACKGROUND: The Quality of Life Profile for Spinal Deformities (QLPSD) is the first specific questionnaire to evaluate health-related quality-of-life (HRQoL) in adolescents with spinal deformities. Measuring HRQoL is important because spinal deformities and their management may negatively affect quality of life (QoL), thereby importantly affecting treatment effectiveness. OBJECTIVE: This study aimed to examine the validity and reliability of a Persian version of the QLPSD through patients with adolescent idiopathic scoliosis and Scheuermann’s kyphosis. METHODS: A cross-sectional design was used to determine the validity and reliability of the Persian version of the QLPSD based …on the IQOLA protocols. RESULTS: The QLPSD was successfully culturally adapted, showing acceptable internal consistency (cronbach’s α = 0.88) and intraclass correlation coefficients (ICC = 0.91). Concurrent validity was supported by comparing scores on corresponding dimensions of the Persian versions of QLPSD and the Scoliosis Research Society-22r (SRS-22r) questionnaires (function, pain, and body-image). Discriminant validity was supported though observation of significant differences between participants who had different clinical characteristics (p < 0.05). CONCLUSIONS: The Persian QLPSD is valid and reliably measures QoL among adolescents with spinal deformities; it may be used in clinical evaluations and future research. Show more

Keywords: QLPSD, quality of life, spinal deformities, adaptation, validity, reliability

DOI: 10.3233/BMR-169775

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 177-182, 2018

Authors: Grabara, Małgorzata

Article Type: Research Article

Abstract: BACKGROUND: Young athletes at the stage of growth acceleration tend to exhibit increased susceptibility to postural abnormalities, especially in the trunk region. The aim of this study was to assess and compare the posture in male adolescent handball players over two years of regular training sessions. METHODS: The study group comprised 21 handball players. At the start of the study 15 participants were aged 14 and 6 participants were aged 15 (mean 14.25 ± 0.58). The measurements were repeated three times. Posture was assessed with a photogrammetric method based on the moiré phenomenon. …RESULTS: The analysis of posture relative to symmetry in the frontal and transverse planes did not reveal any significant differences between posture indicators obtained during the successive measurements. Sagittal plane posture indicators revealed significant changes in torso forward inclination angle and the shape of anteroposterior spinal curvatures. The latter consisted of significant deepening of the upper thoracic curve (angle α ) and flattening of the lumbosacral curve (angle γ ). CONCLUSIONS: A two-year period of handball training did not result in posture asymmetries in young male handball players. The observed changes in the shape of anteroposterior spinal curvatures might be related both to sports training and somatic parameters. Show more

Keywords: Asymmetries, spine, sagittal spinal curvatures, moiré technique, athletes

DOI: 10.3233/BMR-170792

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 183-189, 2018

Authors: Chen, Lianghua | Liu, Dandan | Zou, Liping | Huang, Ju | Chen, Junqi | Zou, Yucong | Lai, Jienuan | Chen, Jingjie | Li, Haihong | Liu, Gang

Article Type: Research Article

Abstract: OBJECTIVE: This study aims to evaluate the effect of high intensity laser therapy (HILT) in patients with lumbar disc protrusion (LDP). METHODS: This study included 63 patients suffering from protrusion of lumbar intervertebral disc; they were divided into Groups 1 (n = 32) and 2 (n = 31). Group 1 was treated with HILT and spinal decompression system (SDS). Patients in Group 2 received SDS alone. Evaluations were conducted on oswestry disability index (ODI), lumbosacral portion pain, and lower limb radiation pain with visual analogue scale (VAS) …of two patient groups before treatment, two weeks after treatment, and 1 month after follow-up visit. Lumbar flexion range and angle of straight leg raising before treatment and 2 weeks after treatment. RESULTS: After two weeks of treatment of two patient groups, ODI, VAS, lumbar flexion range and angle of straight leg raising significantly improved compared with their conditions before treatment (P < 0.01). A significant difference was noted in ODI, lumbar flexion range, and angle of straight leg raising between groups after two weeks of treatment (P < 0.05). Non-statistical significant difference was observed in lumbosacral portion pain and lower limb radiation pain with VAS (P > 0.05). However, difference in was VAS smaller in Group 1. All groups showed significantly different results in terms of ODI, lumbosacral portion pain, and lower limb radiation pain with VAS. CONCLUSION: As one of available treatments for LDP, HILT can speed up improvement in lumbar segment motion, angle of straight leg raising, and overall function and allow early return of patients to their family and society. Treatment effect is long-lasting and can be widely promoted and applied clinically. Show more

Keywords: High intensity laser, lumbar disc protrusion, spinal decompression system

DOI: 10.3233/BMR-170793

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 191-196, 2018

Authors: Kohns, David J. | Haig, Andrew J. | Uren, Brad | Thompson, Jeffery | Muraglia, Katrina A. | Loar, Sierra | Share, David | Shedden, Kerby | Spires, Mary Catherine

Article Type: Research Article

Abstract: BACKGROUND: Low back pain is a common complaint in emergency departments (ED), where deviations from standard of care have been noted. OBJECTIVE: To relate the ordering of advanced imaging and opioid prescriptions with the presentation of low back pain in ED. METHODS: Six hundred adults with low back pain from three centers were prospectively analyzed for history, examination, diagnosis, and the ordering of tests and treatments. RESULTS: Of 559 cases the onset of pain was less than one week in 79.2%; however, most had prior low back pain, 63.5% having …warning signs of a potential serious condition, and 83.9% had psychosocial risk factors. Computer tomography (CT) or magnetic resonance imaging (MRI) were ordered in 16.6%, opioids were prescribed in 52.6%, and hospital admission in 4.5%. A one-year follow-up of 158 patients found 40.8% received subsequent spine care and 5.1% had a medically serious condition. Caucasian race, age 50 years or older, warning signs, and radicular findings were associated with advanced imaging. Severe pain and psychosocial factors were associated with opioid prescribing. CONCLUSIONS: Most patients present to the ED with acute exacerbations of chronic low back pain. Risk factors for a serious condition are common, but rarely do they develop. Racial disparities and psychosocial factors had concerning relationships with clinical decision-making. Show more

Keywords: Low back pain, emergency medicine, radiology, opioids, evidence based medicine, racial disparity, magnetic resonance imaging, computer tomography, work disability

DOI: 10.3233/BMR-170806

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 197-204, 2018

Authors: Mohamed, Eman A. | El-Shamy, Fayiz F. | Hamed, Hany

Article Type: Research Article

Abstract: BACKGROUND: Postpartum low back pain harmfully affects all parts of women’s life. OBJECTIVE: To investigate the effect of kinesiotape on women with postnatal backache. METHODS: Thirty participants were randomly allocated to either group (A; n = 15), treated by kinesiotape with exercise program, or the group (B; n = 15), treated by exercise program. Visual analogue scale (VAS) and Back Pain Function Scale (BPFS) were evaluated.at baseline and after 2 weeks of intervention. RESULTS: There were no statistically significant changes …between group A and group B for baseline characteristics (p > 0.05). After two-week intervention, within group analyses revealed that VAS decreased (p < 0.05), with significant increase in BPFS (p > 0.05) in the two groups. Between group analyses showed that there was significant reduction of VAS (p < 0.05) and significant increase of BPFS (p < 0.05) in favor to group A than group B. CONCLUSIONS: Kinesiotape and postural correction exercises can be recommended as effective treatment methods for women’s postnatal back pain with better effect of kinesiotape and postural correction exercises than exercise alone. Show more

Keywords: Postpartum, low backache, Kinesiotape

DOI: 10.3233/BMR-170827

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 205-210, 2018

Authors: Lee, Dong Gyu | Chang, Min Cheol

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: We report the case of a patient who presented with right dorsal scapular neuropathy after a trigger point injection into the right rhomboid major muscle. Through a nerve conduction study and electromyography, we demonstrated dorsal scapular nerve injury in this patient. CASE REPORT: A 38-year-old man complained that his right shoulder functioned less optimally during push-up exercises after a trigger point injection 4 weeks prior. Physical examination revealed mildly reduced right shoulder retractor muscle strength compared with the left side. We performed a nerve conduction velocity test and electromyography 5 weeks after the injection. The …compound muscle action potential of the right dorsal scapular nerve showed low amplitude (left vs. right side: 5.2 vs. 1.6 mV) and delayed latency (left vs. right side: 4.9 vs. 6.8 ms). Positive sharp wave (1+ ) and mildly reduced recruitment were seen on electromyography of the rhomboid major muscle. The findings of the nerve conduction velocity test and electromyography indicated partial right dorsal scapular neuropathy. The nerve injury seemed to have been caused by the needle inserted during trigger point injection. CONCLUSION: Clinicians should pay attention to the occurrence of dorsal scapular nerve injury when performing trigger point injection into the rhomboid muscle. Show more

Keywords: Peripheral nerve injuries, myofascial pain syndromes, intramuscular injections, lidocaine, nerve conduction, electromyography

DOI: 10.3233/BMR-169740

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 211-214, 2018

Authors: Sheng, Xiaoyong | Cai, Guangyong | Gong, Xingjun | Yao, Zouying | Zhu, Ye | Wu, Lijun | Chu, Xufeng

Article Type: Research Article

Abstract: Clinically, it is difficult to differentiate osteoid osteoma, more than 50% of which occur in the fibia or tibia, from other diseases, i.e. spinal degenerative diseases, inflammatory and noninflammatory arthritis. In this case report, we presented an unusual case of lumbar osteoid osteoma in a 38-year-old male, who experienced low back pain and sciatica as initial symptoms. The patient was initially misdiagnosed as lumbar disc herniation for more than 10 years. With the usage of computed tomography (CT) and magnetic resonance imaging (MRI), the patient was finally diagnosed as osteoid osteoma in L5. To our knowledge, spinal osteoid osteoma with …sciatica as initial symptoms has never been reported. Although lumbar vertebra osteoid osteoma is clinically uncommon, it should be taken into consideration especially when patients experience long duration of pain in lumbar. Show more

Keywords: Osteoid osteoma, L5, lumbar disc herniation, misdiagnosis, case report

DOI: 10.3233/BMR-170850

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 1, pp. 215-219, 2018