Journal of Back and Musculoskeletal Rehabilitation - Volume 31, issue 2
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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: Spinal muscles endurance is fundamental for providing adequate trunk stability. OBJECTIVE: The purpose of this study was to compare the side bridge static endurance ability of the right versus left side. METHODS: Forty right hand dominant students, aged between 18 and 25 years, were recruited from Taibah University. Every participant had to lie down on his side and bear trunk weight on the arm with shoulder abducted to 90 ∘ and elbow flexed to 90 ∘ . Every participant had to lift off his trunk…of the supporting surface, keeping the trunk straight in neutral position, breathing normally and holding on that position as long as tolerated. RESULTS: A paired sample t test was calculated. The mean score, in seconds, for right side bridge was 41.6 (SD = 30.08), and for left side bridge was 38.00 (SD = 26.93). No significant difference was found between right and left side bridge endurance ability [t (39) = 1.67, p > 0.05]. Pearson correlation showed high positive correlation [r (38) = 0.89, p < 0.001]. CONCLUSIONS: Among healthy participants, clinicians should expect very close endurance profile for the musculature of the two sides of trunk. Clinicians should equally train both sides of trunk muscles stabilizers in order to enhance tolerance.
Abstract: BACKGROUND: Sciatica-related Foot Drop is a peripheral nervous condition that produces a loss of power in the ankle dorsiflexion muscles. Functional electrical stimulation is a modality of electrical stimulation that produces muscle contraction in a functional movement of the limb. This technique was utilized with positive effects in central nervous afflictions but it is not known whether or not it has any influence in motor recovery following peripheral nervous system problems. This study aims to clarify the effects of functional electrical stimulation on foot drop caused by peripheral nerve compression resulting from lumbar disc herniation. METHODS:…Fifty patients were enrolled in our study; of whom 25 were treated with EMG triggered electrical stimulation (EMG-FES) and 25 with heel-floor sensor triggered electrical stimulation (SWITCH-FES) during normal gait cycle. Patients received functional electrical stimulation (with a pulse of 60 Hz and phase duration of 200 ms) once a day, for 30 minutes during 5 consecutive days, over a period of 4 weeks. Electrical diagnostic tests (nerve conduction velocity/NCV and the amplitude of compound muscle action potential/CMAP), dynamometry and Osvestry Disability Index scores were measured at baseline and after treatment. RESULTS: We found that axonal loss was lower in the EMG-FES group than in the SWITCH-FES group (p < 0.004). The motor functional recovery was higher in terms of muscle force and overall functional status for the EMG-FES group compared to the SWITCH-FES group. This was underlined by Dynamometry test with a p value of < 0.0001 and ODI score with a statistical significant p value of < 0.0001. CONCLUSIONS: The overall results showed that there was a significant increase in all the parameters studied for both types of FES applications. However we found that the EMG triggered electrical stimulation technique had a higher influence on the quality of the muscle action control. For patients who cannot yet produce minimal muscle active contraction we recommend switch triggered stimulation first and then, immediately after the recovery of the motor control, to change to EMG triggered functional electrical stimulation.
Abstract: BACKGROUND: There is no consensus about treatment of neck patients who have radicular symptoms. OBJECTIVE: The purpose of the study was to investigate the effect of stabilization exercise training on pain and functional status in patients with cervical radiculopathy. METHODS: The patients (n = 32) with cervical radiculopathy were randomized to two groups as follows: Stabilization exercise group (Group 1; n = 18); Home-exercise group (Group 2; n = 16). The patients were evaluated with visual analog scale,…Neck Disability Index, SF-36 (Short-Form), Corbin postural assessment scale and hand grip at baseline, after treatment at 4th week and 3 rd month. RESULTS: At baseline, there were no statistically differences between groups in terms of evaluated parameters (p > 0.05). After treatment and three months later, pain and Neck Disability Index decreased; Corbin postural scores, hand grip and SF-36 scores improved statistically in both groups (p < 0.05). Changes of the measurements in both groups were similar and there were no significant differences between group 1 and group 2 at 4th week and 3rd month (p > 0.05) except postural scores. CONCLUSIONS: This study demonstrates that stabilization exercise training could be an effective intervention for decreasing pain and improving quality of life and posture in patients with cervical radiculopathy.
Abstract: BACKGROUND: Assessment of the joint cartilage using ultrasound imaging is important. OBJECTIVE: Our aim was to investigate the reliabilities of ultrasonographic measurements for talus dome (TCT) and metacarpal cartilage thicknesses (MCT). METHODS: Twenty healthy volunteers were recruited in the study. Every day, five physiatrists measured eight joint cartilage thicknesses. They repeated all the measurements in five consecutive days. RESULTS: Intra-observer intraclass correlation coefficient (ICC) values were “excellent” for all MCTs, except for the 3 rd left MCT on the 1 st day,…4 th left MCT on the 1 st day and 4 th right MCT on the 3 rd day which were “good”. They were “excellent” for the TCT measurements, except for the left side on the 3 rd day and the right side on the 4 th day which were “good”. Inter-observer ICC values pertaining to the 2 nd MCT measurements were “excellent” for all sonographers. Third and 4 th MCT measurements (at least one side) were “excellent” for four and three sonographers, respectively. On the other hand, while TCT measurements were “excellent” for 4 sonographers. CONCLUSIONS: Our results have shown that sonographic measurements of MCT and TCT have good to excellent reliabilities in healthy adults. These findings support the use of ultrasound for cartilage assessment in various diseases.
Abstract: BACKGROUND: Shoulder stabilization exercises consisted of a glenohumeral stabilization and scapular stabilization. No studies have been assessed the superiority of shoulder stabilization until now. OBJECTIVE: To compare the effect of a glenohumeral stabilization exercise (GSE) combined with a scapular stabilization exercise (SSE) on changes in shoulder function in patients with shoulder pain METHODS: Shoulder stability, scapular alignment, pain, muscle power, and range of motion (ROM) were measured before and after the intervention in both groups. RESULTS: Forty subjects with shoulder pain were randomly assigned to an experimental or control group.…GSE in the experimental group (n = 20) resulted in significantly better shoulder stability (P = 0.020, from 9.00 ± 6.90 score to 14.25 ± 8.58) and pain intensity (P = 0.042, 7.40 ± 2.44 score to 4.60 ± 2.06) compared to SSE in the controls (n = 20). However, no significant effects were observed for scapular symmetric alignment including the angles of inferior scapular distance (P = 0.555) and inferior scapular height difference (P = 0.770), muscle power including shoulder flexion (P = 0.942) and shoulder abduction (P = 0.551), or ROM including shoulder flexion (P = 0.852) and shoulder abduction (P = 0.622). CONCLUSION: This study suggests that GSE positively affects shoulder stability and pain control in patients with shoulder pain, probably through a centralization effect on the shoulder mechanism.
Abstract: BACKGROUND: Lumbar degenerative kyphosis (LDK) is characterized by sagittal imbalance resulting from degenerative loss of lumbar lordosis. The ability of transcutaneous neuromuscular electrical stimulation (NMES) to activate deep lumbar stabilizing muscles has been demonstrated. OBJECTIVE: The aim of this study was to evaluate the effects of transcutaneous NMES applied to optimal points on the lower abdomen and lumbar paraspinal region on gait problems in patients with lumbar degenerative kyphosis (LDK). METHODS: Twenty-one patients with lumbar degenerative kyphosis underwent three walking sessions in the following order; walking for 5 minutes without NMES, walking with NMES on the…lumbar multifidus (LM) only, and walking with NMES on both LM and transverse abdominis (TrA)/obliquus internus (OI). Differences in gait parameters at the commencement and completion of each of the three sessions were evaluated by gait analysis. RESULTS: During the 5-minute walk with NMES applied to the LM or to the LM and TrA/OI, participants showed lesser increases in spine forward tilt, pelvic anterior tilt, and external foot progression angle, and a lesser decrease in hip internal rotation than when walking without NMES (P < 0.05). In addition, with NMES, patients showed less decrement in gait velocity and stride length at walk completion than patients walking without NMES (P < 0.05). However, in the comparison between walks with NMES applied to the LM and walks with NMES applied to the LM and TrA/OI, we could not find any significant difference in changes of gait parameters (p > 0.05). CONCLUSIONS: Transcutaneous NMES applied at optimal points on the lower abdomen and back could provide a means of treating gait problems caused by a stooped trunk in LDK patients.
Abstract: BACKGROUND: Myofascial trigger points are dysfunctional structures present in skeletal muscles and are related to sensory, motor, and autonomic changes. Despite scientific advances in recent decades in the measurement of musculoskeletal pain, evaluation of this clinical phenomenon is supported with instruments that, although valid and reliable, have a considerable degree of subjectivity. OBJECTIVE: To correlate electrical impedance of the upper limbs and torso with pain intensity, functional capacity, catastrophizing, pressure pain threshold, and skin temperature on myofascial trigger points in the upper trapezius muscle of patients with neck pain. METHODS: A single-blind cross-sectional…study. Twenty-eight volunteers of both genders were included in the study, were aged 18–45 years, and had chronic neck pain and myofascial trigger points in the upper trapezius. The volunteers were assessed using the Numeric Rating Scale, the Neck Disability Index, the Pain-Related Self-Statement Scale, algometry, infrared thermography, and electrical bioimpedance. RESULTS: The following significant results were observed: a negative association between the pressure pain threshold on myofascial trigger point in the right upper trapezius and electrical impedance of the torso at 5 kHz (r s = - 0.392, p = 0.032), 50 kHz (r s = - 0.406, p = 0.026), 250 kHz (r s = - 0.388, p = 0.034), and to the frequency 500 kHz (r s = - 0.444, p = 0.014). CONCLUSION: Electrical impedance of the torso is associated with the pressure pain threshold of myofascial trigger points on the upper trapezius of individuals with neck pain. Thus, individuals with a lower pressure pain threshold have higher electrical impedance values of the torso and vice versa.
Abstract: OBJECTIVE: To evaluate the biomechanical effects of internal fixation with different screw insertion depths on vertebrae stiffness and screw stress for L1 fracture. METHODS: The established L1 fracture was fixed with 10 different depths of screw insertion: 10–100% screw-path length (SPL). Loading on the T12 endplate was simulated. RESULTS: Screws inserted to 60–100% depths has a higher axial displacement of screw against injured vertebrae and maximum stress of screws compared to those of screws inserted to 30–50% depths and 10–20% (P < 0.05). No significant difference was noted among 60–100% SPL…groups. Under single loading condition, the incidence rate of maximum stress of each screw ranged from 16.7–50.0%. Chi-square test showed superior screw has a higher incidence rate of maximum stress than inferior screw (P < 0.05). CONCLUSIONS: Screws inserted to 60% depth or more can achieve effective strength to withstand the postoperative height correction loss of the L1 vertebrae fracture. However, continuous prolonged depth of screw insertion did not significantly increase the effective strength of the screw against injured vertebrae and maximum equivalent stress of screws. The incidence rate of the maximum stress of each screw in correlated with position of screw insertion but not associated with the screw insertion depth.
Abstract: BACKGROUND: Retrospective study of 68 patients of symptomatic cervical spondylosis who were treated by anterior cervical discectomy and fusion (ACDF). OBJECTIVE: The purpose of this study was to compare the clinical and radiological outcomes of patients with single level cervical spondylosis using either zero-profile spacer (group A) or anterior cervical plate and cage (group B). METHODS: Clinical and radiological data of 68 patients undergoing ACDF from C3-C7 were collected retrospectively. There were 35 patients with a mean age of 54.05 years who received treatment by zero-profile implant. A total of 33 patients with…a mean age of 52.09 years underwent fusion by traditional plate with cage. Group A and group B were followed up for an average of 23.68 months and 24.39 months, respectively. Age, blood loss, and operation time were assessed. The clinical outcomes were evaluated by JOA and VAS score before and after surgery. In addition, incidence of dysphagia was recorded. The Cobb angle (from C2 to C7) change was measured on the lateral cervical spine radiographs. RESULTS: There was no significant difference in terms of operation time and blood loss between two groups. The postoperative JOA significantly increased and the VAS decreased correspondently in both groups. The postoperative Cobb angle increased and showed statistical difference compared with preoperative Cobb angle in both groups. There was no significant difference between group A and group B in achieving clinical symptoms and radiograph improvement according to postoperative JOA, VAS and Cobb angle comparison. The incidence of postoperative dysphagia was lower in the group A than group B. CONCLUSIONS: Our study suggests that the application of zero-p spacer can achieve similar clinical and radiological improvement compared with traditional plate and cage. Meanwhile, zero-p is superior to plate and cage with a lower incidence of postoperative dysphagia.
Keywords: Cervical spine, ACDF, zero-p spacer, plate and cage