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: OBJECTIVE: The aim of this study was to compare the musculoskeletal pain distribution, quality of life, and the hopelessness level in mothers with disabled children in different ambulation levels. METHODS: This study included a total of 177 mothers (mean age: 36.1 ± 6.5 years) of children with disabilities. The mothers were divided into 3 different groups according to the ambulation level of their disabled children: Ambulatory children (Group 1), partially ambulatory children (Group 2) and non-ambulatory children (Group 3). Musculoskeletal pain distribution (body diagram) and pain intensity (The Visual Analogue Scale), four quality…of life parameters (The Centers for Disease Control and Prevention Health-Related Quality of Life - 4 Questionnaire) and hopelessness level (Beck Hopelessness Scale) were evaluated in all mothers. RESULTS: The results of our study showed that musculoskeletal pain was most common (79.1%) in the mothers of disabled children. The frequency and severity of back, shoulder and elbow pain in the mothers, number of activity limitation days and hopelessness level were found to increase significantly as the ambulation level in the child decreased (p < 0.05). CONCLUSIONS: The risk of musculoskeletal pain, participation in daily life and hopelessness level in the mothers increased as the ambulation level of the disabled children decreased.
Keywords: Mothers, musculoskeletal pain, disabled children
Abstract: BACKROUND: Soft tissue mobilization techniques (STM) are used in clinical practice in treatment of congenital muscular torticollis(CMT).However, little is known about its effectiveness. OBJECTIVES: To investigate whether using STM to manage CMT in babies with mild to moderate head tilt was effective or not. METHODS: Twenty-nine babies with CMT aged between 0-6 months, who had a head tilt from 5 to 20 degrees were allocated to two groups. Both groups received a baseline home program (positioning, handling strategies, stretching and strengthening exercises, environmental adaptations). The study group (SG) also received STM three times a week.…Babies were evaluated initially, at six weeks, at 12 weeks and for follow-up at 18 weeks with muscle function scale, head tilt and range of motion for neck lateral flexion and rotation. RESULTS: Both groups showed significant improvements in all measured parameters (p < 0.05). In comparison of groups, there were differences at six weeks in favor of the SG for neck rotation (0.001) and head tilt (= 0.006); but at 12 weeks and follow up, there were no longer any differences between the groups in any of the measured parameters. CONCLUSIONS: STM techniques are effective in getting faster positive results in the treatment of CMT.
Abstract: BACKGROUND: Diaphragm is an important component of spinal stability. In presence of low back pain, there may be some alterations in this muscle like other muscles that are responsible for lumbal stabilization. OBJECTIVE: This study aims to assess the effects of stabilization exercises on diaphragm muscle thickness and motion along with lumbopelvic stability. METHODS: Twenty-one women with low back pain participated in the study. Stabilization exercises including motor control training were performed on treatment group (n = 11). In control group (n = 10),…strentghening exercises were peformed for back muscles, abdominal muscles and hip muscles. The patients underwent a total of 30 sessions of treatment, 3 days in a week for 10 weeks. The diaphragm muscle thickness and motion was evaluated using ultrasound (US), and lumbopelvic stability was evaluated using lumbopelvic stability tests. RESULTS: After the treatment, in the treatment group, increase in diaphragm thickness and improvement in lumbopelvic stability were statically significant (p < 0.05). However, there were no significant changes in diaphragm motion in both groups (p > 0.05). CONCLUSIONS: As a result, stabilization exercises increase diaphragm muscle thickness and improve lumbopelvic stability in women with low back pain. Therefore, stabilization exercises should be considered as a part of the treatment program in low back pain.
Keywords: Low back pain, diaphragm, ultrasound, stabilization exercises, general exercises, lumbopelvic stability
Abstract: BACKGROUND: Skin impedance is a biological signal that has been employed in the measurement of pain. However, there are few scientific data on skin impedance, with a great variety of assessment methods and controversial results. OBJECTIVE: To examine the intra- and inter-rater reliability of skin impedance measurement in individuals with chronic neck pain. METHODS: This is a blind cross-sectional study. Thirty individuals of both genders, aged between 18 and 45 years and with chronic neck pain were included in the study. Two examiners assessed skin impedance of the upper and lower limbs and…torso at two intervals separated by one week. For statistical analysis, we used the intraclass correlation coefficient (ICC 2 , 3 ) to determine the intra- and inter-rater reliability of skin impedance, with its respective confidence interval of 95%, standard error of measurement (SEM) and minimum detectable change (MDC). RESULTS: The intra-rater reliability was considered substantial to excellent, with ICC values ranging between 0.843 and 0.978, SEM between 0.58 and 15.26 Ω , and MDC between 1.61 and 42.31 Ω . The inter-rater reliability was moderate to excellent, with ICC values ranging between 0.761 and 0.997, SEM ranging between 0.22 and 16.72 Ω , and MDC ranging between 0.63 and 46.35 Ω . CONCLUSION: The measurement of skin impedance of the upper and lower limbs and torso in individuals with chronic neck pain has acceptable reliability values when considered at different times and by different examiners.
Keywords: Electric impedance, reproducibility of results, neck pain
Abstract: BACKGROUND: Ankylosing spondylitis (AS) can cause severe functional disorders that lead to loss of balance. OBJECTIVE: The aim of this study was to investigate the effects of balance and postural stability exercises on spa based rehabilitation programme in AS subjects. METHODS: Twenty-one participants were randomized to the study (n = 11) and control groups (n = 10). Patients balance and stability were assessed with the Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, Single Leg Stance Test (SLST) and Functional Reach Test (FRT).…AS spesicied measures were used for assessing to other parameters. The treatment plan for both groups consisted of conventional transcutaneous electrical nerve stimulation (TENS), spa and land-based exercises 5 days per week for 3 weeks. The study group performed exercises based on postural stability and balance with routine physiotherapy practice in thermal water and in exercise room. RESULTS: The TUG, SLST and FUT scores were significantly increased in the study group. In both groups, the BASMI, BASFI, BASDAI and ASQoL scores decreased significantly by the end of the treatment period (p < 0.05). CONCLUSIONS: In AS rehabilitation, performing balance and stability exercises in addition to spa based routine approaches can increase the duration of maintaining balance and can improve the benefits of physiotherapy.
Abstract: BACKGROUND: Adequate motor control is considered important for spinal stability and the prevention of low back pain in adulthood and in childhood. OBJECTIVE: Given that the sitting position can affect proprioception, this study aimed to evaluate the influence of using at school a triangular and dynamic cushion on schoolchildren’s trunk motor control. METHODS: Thirty 8-year-old schoolchildren were randomized into a control group (n = 15) and a “cushion group” (n = 15), in which the children used the cushion for one year…and a half. At the end of this period, a 3D-analysis was used to assess lumbar spine proprioception by means of a trunk repositioning task performed blindfolded in a seated position in two conditions (on a stable and on an unstable surface). RESULTS: The schoolchildren in the cushion group performed better at the trunk repositioning task (p = 0.02) and hold their lumbar lordosis (p = 0.03) better than the control children, in both conditions (stable and unstable). CONCLUSIONS: This preliminary study suggests that daily use of a triangular dynamic cushion has a beneficial impact on children’s lumbar proprioception. Further studies are needed to confirm these results and investigate the effectiveness of its use to prevent low back pain in adulthood.
Abstract: BACKGROUND: The question that was asked in the study was whether a training routine based on curl-up exercises with a load provided by body mass of the person increases local muscle strength or local muscle endurance. OBJECTIVE: The aim of this study was to evaluate the effect of 4 weeks training based on a small load and low movement velocity on electrical activity (EMG), cross-sectional area (CSA) of core stabilisers. METHODS: The EMG activity was measured in the rectus abdominis (RA), obliquus abdominis externus and erector spinae (ES) muscles. CSA of the muscles:…RA, anterolateral abdominal, psoas major, quadratus lumborum, ES, and multifidus at the level of L3-L4 were measured too. RESULTS: The training increased the CSA and thickness in most of the muscles studied. Statistically significant correlation was found only for the ES circumference (left side) and EMG activity for the right side (r = 0.627, p = 0.022) and left side (r = 0.624, p = 0.023). CONCLUSIONS: The training programme resulted in a increase in the number of curl-up repetitions revealing an endurance increase in abdominal muscles. Furthermore, there was a increase in the EMG activity of the RA. An increase of the CSA of all tested muscles showed an increase of muscle active force.
Keywords: Low back pain, curl-up exercise, muscle hypertrophy
Abstract: OBJECTIVE: To assess whether the clinical efficacy of a therapeutic protocol using surface neuromuscular electrical stimulation (sNMES) on patients with post-stroke dysphagia (PSD) is superior to that without sNMES, and whether swallowing functional outcome is different with regards to different electrode placement on patients’ skin of neck. METHODS: Thirty patients with PSD were randomly allocated into treatment group A (TGA), treatment group B (TGB) and control group according to a random number table. The three groups of patients all received traditional dysphagia therapy (TDT) and other general rehabilitation therapy such as physical therapy and occupational therapy…as a basic treatment project. Besides this, sNMES treatment was applied on different sites of patients’ neck skin in group A and B separately. All the patients received video-fluoroscopic swallowing study (VFSS) pre-treatment and 2 weeks post-treatment, during which the displacement of the hyolaryngeal complex towards the superior and anterior sides while swallowing semi-liquid diet were measured. Outcome of the VFSS was measured using dysphagia outcome and severity scale (DOSS). RESULTS: Post-treatment evaluation was carried out using water swallow test (WST), repetitive saliva swallowing test (RSST) and dysphagia outcome and severity scale (DOSS) from the three study groups were all improved (P < 0.05). The results of post-treatment evaluation using WST from TGA and TGB were 2.40 ± 1.26 and 2.10 ± 0.99 respectively, using RSST from TGA and TGB were 5.30 ± 1.89 and 5.20 ± 1.69 respectively, using DOSS from TGA and TGB were 5.20 ± 1.40 and 5.10 ± 1.45 respectively. Compared to control group, the results of post-treatment evaluation using the three scales, there were significant improvement between TGA and TGB (P < 0.05), however, the inter-group differences of TGA and TGB indicated no statistically significant difference (P > 0.05). The post-treatment evaluation of the moving distance of hyoid bone towards anterior side in swallowing was significantly improved as compared to TGB (- 8.40 ± 7.48, t = - 3.552, P = 0.006), and was statistically significant as compared to the control group (P > 0.05). CONCLUSIONS: Swallowing function in the patients with PSD was significantly improved using TDT combined with NMES. Stimulating electrodes placed at the suprahyoid region or on both suprahyoid and infrahyoid regions resulted in no difference of effect. However, NMES on suprahyoid region could further improve the moving distance of hyoid bone anteriorly.
Abstract: BACKGROUND: Work-related musculoskeletal disorders are the most common health problems which affect millions of office workers. OBJECTIVE: The objective of this study is to determine scapular positioning at rest and different anatomical planes, the assessment of pain, postural changes and the functionality of upper extremity that is caused by the lack of ergonomic principles among office workers of civil servants in TRNC (Turkish Republic of Northern Cyprus). METHODS: 183 individuals participated in the study and 2 groups were created by grand scores of Rapid Upper Limb Assessment (RULA) tool. Scapular dyskinesis, pain of…upper extremity and back, physical functions and symptoms of upper extremity, the self-rated neck disability, cervical and upper thoracic posture of workers were assessed. RESULTS: The difference between pain situation and the results of upper extremity and neck disability scores of the participants among the groups was significant (p < 0.05). No significant difference has been found statistically among the postural angle values of individuals (p > 0.05). A significant statistical difference has been found among the groups when the results of Lateral Scapular Slide Test (LSST) is examined (p < 0.05). CONCLUSIONS: Working environment and conditions cause the wrong of working posture and thus, lead individuals to spend more energy together with physical difficulty, and consequently affect general health.
Abstract: BACKGROUND: Prospective study. OBJECTIVE: To determine the change in spinal sagittal parameters which may occur throughout the day in healthy population. METHODS: Thirty-five healthy hospital employees were enrolled in the study. Two standing left lateral orthoroentgenograms were obtained at 8.00 a.m and at 6.00 p.m. Six spinopelvic parameters were measured on the X-rays. Thereafter, the subjects were divided into two cohorts according to their BMI as low BMI and high BMI. RESULTS: Thirty-five subjects with a mean age of 25.97 ± 8.21 were evaluated. No significant change…was found between morning and evening measurements for any of the parameters. Direct relationship was shown between thoracic kyphosis (TK) and lumbar lordosis (LL), lumbar lordosis and sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI) minus lumbar lordosis, sagittal vertebral axis (SVA) and pelvic incidence minus lumbar lordosis. In addition an inverse relationship was found between sacral slope and pelvic tilt, sacral slope and pelvic incidence minus lumbar lordosis, thoracic kyphosis and pelvic incidence minus lumbar lordosis, sacral slope and pelvic tilt, sagittal vertebral axis and lumbar lordosis (p < 0.05). Sagittal vertebral axis were found to be higher in the high BMI group, and daily change was lower but the differences were not statistically significant. Only the change in pelvic tilt value was found to be statistically significant in low BMI group. CONCLUSION: Routine workload in a hospital environment does not cause significant change in the spinopelvic parameters throughout the day.