Journal of Back and Musculoskeletal Rehabilitation - Volume 31, issue 1
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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: 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.
Keywords: Kinesio taping, low back pain, disc degeneration, Oswestry disability index, Biering-Sorensen test
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.
Keywords: Resistance training, disability, therapy, pain, exercise, women
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.
Keywords: Rectus abdominis diastasis, body mass index (BMI), intra-abdominal pressure, spinal stabilization, low back pain
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.
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.
Keywords: Chronic non-specific low back pain, elderly, inflatable ball, myofascial trigger point, myofascial trigger point therapy
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.
Keywords: Patellar mobility, sex difference, displacement, knee extension angle
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.
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.
Keywords: Occupational biomechanics, electromyographic, workplace, low back pain, ergonomics
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.
Keywords: Abdominal muscles, endurance, teenagers, field test
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.
Keywords: Pain, range of motion, shoulder, disability