Journal of Back and Musculoskeletal Rehabilitation - Volume 31, issue 4
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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: Medial collateral ligament (MCL) bursitis has been described as a distended and inflamed bursa between the superficial and deep portions of the MCL. It is a rare but important cause of medial knee pain. CASE DESCRIPTION: A 65-year-old woman with knee osteoarthritis (OA) presented with severe pain and swelling in her left knee. She did not have a traumatic injury. After a clinical examination, a slight decrease in the range of motion of the left knee, and a painful swelling and tenderness over the medial side of the knee and proximal tibia were detected. The…pain was exacerbated by valgus stress test. The magnetic resonance (MR) imaging showed a distended bursa with internal septations beneath the superficial portion of the MCL. MCL bursitis was considered as diagnosis and an ultrasound-guided corticosteroid injection into the bursa was performed. RESULTS: There was a significant improvement in pain intensity in the follow-up examination. A repeated MR imaging 2 months later showed a marked improvement, and approximation of the deep and superficial portions of the MCL. CONCLUSIONS: MCL bursitis, which is a rare condition, must be considered for the differential diagnosis of increased medial knee pain in patients with knee OA. Corticosteroid injection is an effective and safe treatment modality for the management.
Abstract: BACKGROUND: Previous studies in non-Chinese populations have found a relationship between performance on isometric trunk muscle endurance tests and low back pain (LBP). However, the relationship between trunk muscle endurance and LBP in Chinese populations has received little attention and age-referenced data have not been reported. OBJECTIVE: Evaluate the relationship between age-referenced isometric trunk muscle endurance values and LBP in a Chinese cohort. METHODS : One hundred and eighty-eight participants (20–59-years) performed four timed-endurance tests (Biering-Sørensen, plank, left/right side bridge) in random order. Participants with a history of LBP completed an Oswestry Disability Index…(ODI) and pain scale. Holding-times for the four tests were summed and receiver operating characteristic (ROC) curve analysis was performed to differentiate participants with and without LBP. RESULTS: Data were grouped by age. Analysis revealed similar endurance values to those reported in non-Chinese populations, except longer holding times were recorded in the 50–59 yr Chinese cohort. Pain scores were positively correlated with ODI scores. ROC curve analysis showed that the area under the curve was 0.723 and optimal cut-off was 288 sec (sensitivity and specificity both 0.75). CONCLUSIONS: This study is the first to describe trunk muscle endurance reference data in Chinese people. Individuals with a summed endurance time of < 288 seconds appear more likely to suffer LBP.
Keywords: Chinese, endurance, isometric, Biering-Sørensen, plank test, side bridge test
Abstract: BACKGROUND: The synergistic and protective effect of platelet-rich plasma (PRP) added to methlyprednisolone (MP) has been demonstrated via in-vitro studies. However, there is no report in the literature about this issue. OBJECTIVE: The aim of this study was to evaluate clinical outcomes of intra-articular (IA) MP injection prior to PRP injection in comparison with single-dose MP and PRP injections alone in patients with knee osteoarthritis (OA). METHODS: The treatment groups were “PRP group” (n = 37) who underwent single-dose IA PRP injection, “PRP +…MP group” (n = 40) who underwent MP injection one week prior to single-dose PRP injection, and “MP group” (n = 38) who underwent single-dose MP injection. Visual Analog Scale (VAS) and The Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were applied at first admission and at 1 st , 3 rd , 6 th , and 12 th month follow-ups. RESULTS: At the end of the 1st month, WOMAC score in PRP + MP group was significantly lower than PRP group. At the 3 rd month, WOMAC score in PRP + MP group was significantly lower than PRP and MP groups. At the 6 th month, VAS and WOMAC score in PRP + MP group was significantly lower than MP group. At the end of the 12 th month, no significant difference was observed among three groups in VAS and WOMAC scores. CONCLUSION: According to our results, IA MP injection prior to PRP injection resulted in significantly better clinical outcomes compared to PRP and MP injections alone in patients who had mild to moderate knee OA.
Abstract: OBJECTIVE: To help patients with disabilities of the arm and shoulder recover the accuracy and stability of movements, a novel and simple virtual rehabilitation and evaluation system called the Kine-VRES system was developed using Microsoft Kinect. METHODS: First, several movements and virtual tasks were designed to increase the coordination, control and speed of the arm movements. The movements of the patients were then captured using the Kinect sensor, and kinematics-based interaction and real-time feedback were integrated into the system to enhance the motivation and self-confidence of the patient. Finally, a quantitative evaluation method of upper limb…movements was provided using the recorded kinematics during hand-to-hand movement. RESULTS: A preliminary study of this rehabilitation system indicates that the shoulder movements of two participants with ataxia became smoother after three weeks of training (one hour per day). CONCLUSION: This case study demonstrated the effectiveness of the designed system, which could be promising for the rehabilitation of patients with upper limb disorders.
Abstract: OBJECTIVE: This study aimed to further clarify the underlying pathomechanism of non-union skeletal fractures. METHODS: Gene expression profile dataset GSE494 obtained from six non-union skeletal fracture and six normal samples was downloaded from the Gene Expression Omnibus database. Overlapping genes in at least two platforms were analyzed, and differentially expressed genes (DEGs) between normal and disease groups were screened. Transcriptional regulatory relationships and differentially regulated modules of various transcription factors (TFs) were determined. Differentially regulated modules with unknown functions were subjected to functional enrichment analysis. RESULTS: Overall, 4,252 overlapping genes in at…least two platforms and 77 DEGs, including 31 up and 46 downregulated genes, were obtained. Overall, 64,623 transcriptional regulatory relationships, including 49 TFs and 3,900 target genes, and 9 significant modules for differential regulation were identified. Three modules with unknown functions regulated by TFs, including zinc finger, ZZ-type containing 3 (ZZZ3), nuclear TF Y, alpha (NFYA), and POU class 2 homeobox 2 (POU2F2), were identified. Enriched GO-BP terms of NFYA and POU2F2 modules included cell adhesion and related terms and those of ZZ3 included cell cycle, cell proliferation, and associated terms. CONCLUSION: Three TFs, including ZZZ3, POU2F2, and NFYA, and their regulated modules may have important effects on non-union skeletal fractures. Cell proliferation may be related with ZZZ3; cell adhesion and its similar process may be related with POU2F2 and NFYA.
Abstract: OBJECTIVE: To explore the biomechanical influence of posterior tibial angle on the anterior cruciate ligament and knee joint forward stability. METHODS: The left knee joint of a healthy volunteer was scanned by CT and MRI. The data were imported into Mimics software to obtain 3D models of bone, cartilage, meniscus and ligament structures, and then Geomagic software was used to modify of the image. The relative displacement between tibia and femur and the stress of ACL were recorded. RESULTS: ACL tension was 12.195 N in model with 2 ∘…PTS, 12.639 N in model with 7 ∘ PTS, 18.658 N in model with 12 ∘ PTS. the relative displacement of the tibia and femur was 2.735 mm in model with 2 ∘ PTS, 3.086 mm in model with 7 ∘ PTS, 3.881 mm in model with 12 ∘ PTS. In the model with 30 ∘ flexion, the maximum tension of ACL was 24.585 N in model with 2 ∘ PTS, 25.612 N in model with 7 ∘ PTS, 31.481 N in model with 12 ∘ PTS. The relative displacement of the tibia and femur was 5.590 mm in model with 2 ∘ PTS, 6.721 mm in model with 7 ∘ PTS, 6.952 mm in model with 12 ∘ PTS. In the 90 ∘ flexion models, ACL tension was 5.119 N in model with 2 ∘ PTS, 8.674 N in model with 7 ∘ PTS, 9.314 N in model with 12 ∘ PTS. The relative displacement of the tibia and femur was 0.276 mm in model with 2 ∘ PTS, 0.577 mm in model with 7 ∘ PTS, 0.602 mm in model with 12 ∘ PTS. CONCLUSION: The steeper PTS may be a risk factor in ACL injury.
Abstract: BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the effects of a 10-week core and mobility training program on pain perception and low back disability score in professors, students and employees of a university. METHODS: Twenty-four individuals of a university who previously reported pain and low back disability were randomly assigned to an experimental group (EG; n = 8) that received 2 weekly sessions of 50 minutes of core and mobility training for 10 weeks; or to a control group (CG; n =…16). Both groups received a guideline to adopt ergonomic postures during work and activities of daily living. The visual analog pain scale (VAS) and the Roland-Morris questionnaire (RMQ) were applied pre- and post intervention. RESULTS: Significant reductions in the pain intensity perception (p = 0.014) and low back functional disability (p = 0.011) were noted in the EG pre- and post measures. However, no significant difference was observed in the CG. Thus, there was a significant difference between the EG and the CG in the post-intervention measures (p = 0.001). CONCLUSION: Core and mobility training and home-ergonomic instructions were effective to reduce the pain intensity perception and low back functional disability in the EG.
Keywords: Low back pain, spine, mobility limitation, core training
Abstract: BACKGROUND: The therapeutic effects of visible light and infrared is especially often used in physiotherapy. OBJECTIVE: The purpose of this study was to determine the effect of exposure to radiation on the motor units activity. METHODS: The study included 29 volunteers of whom the spontaneous and voluntary bioelectric activity of the trapezius muscle was evaluated using surface electromyography (value of average amplitude and frequency), before and immediately after a 15-minute irradiation. Additionally, the range of motion of the cervical spine and trigger points pain sensitivity to the pressure were assessed. RESULTS:…No statistically significant changes in the pain sensitivity threshold and the range of motion after the irradiation was applied. On the other hand, a 15-minute exposure to radiation induced an increase in the value of average amplitude of rest-related as well as exercise-related potentials and an increase in the average value of frequency of the right side biopotentials at rest and of both sides for active elevation. CONCLUSIONS: Infrared radiation and visible red light have a stimulating effect on the muscle ability to develop active contraction. It is proposed that the observed changes are associated with the thermal effect of radiation as well as with the so-called extra-visual effects.
Keywords: Infrared radiation, visible red light, surface electromyography
Abstract: BACKGROUND: Although low to moderate intensity exercise therapy is a predominant part of rehabilitation in nonspecific chronic low back pain (NSCLBP), effect sizes are small and optimal exercise modalities/intensities are unclear. Conversely, effects of high intensity training have not yet been investigated in this population. OBJECTIVE: The aim of this study is to investigate the feasibility of high intensity training (HIT) and to explore the magnitude of the effects of a HIT program on exercise capacity and disease related outcome measures compared to conventional therapy for persons with NSCLBP. METHODS: In this non-randomized…controlled feasibility study, treatment satisfaction, adherence, disability, pain, physical activity, body composition, exercise capacity and self-reported motivation, were assessed in persons with NSCLBP, before (PRE) and after (POST) 6 weeks (12 sessions, 1.5 hours/session, 2 x/week) of high intensity cardiovascular (100% VO 2Max ) and high load resistance (80% 1RM) training (HIT, n = 10) and compared to average intensity/load (60% VO 2max ) conventional physical therapy (CON, n = 10). RESULTS: At PRE, CON and HIT did not differ, except for gender ratio and lean mass. Compared to CON, HIT retained motivation to rehabilitate better (HIT: + 3%; CON: - 25%) and had higher therapy adherence (+ 16%) during the study course. No adverse events were noted in both groups. Whereas disability reduced in both groups (HIT: - 10.4%; CON: - 8.3%), peak workload (+ 7.0%), time to exhaustion (+ 9.5%), and activity level (+ 5.6%) only improved in HIT. CONCLUSIONS: High intensity exercise therapy appears to be a feasible rehabilitation approach in NSCLBP. Outcomes improved following the HIT protocol, warranting the investigation of its effectiveness in future large scale RCT studies.
Keywords: Low back pain, rehabilitation, high intensity, exercise therapy
Abstract: BACKGROUND: Nerve injury due to a movable cystic mass during knee motion is a rare neuropathy, which can be diagnosed precisely using a dynamic ultrasonogram. OBJECTIVE: To present a case with foot drop and common peroneal neuropathy that involved a movable cystic mass during knee flexion adjacent to the proximal tibiofibular joint. METHODS: Case report. RESULTS: A 47-year-old female was referred to our institute for a right foot drop. Common peroneal nerve (CPN) injury was confirmed by an electrophysiologic study. Upon a dynamic ultrasonographic study during knee flexion, a cystic…mass was found that was not scanned on the static images. The mass displaced the lateral head of the gastrocnemius muscle and CPN. A cystic mass that was adjacent to the proximal tibiofibular joint was confirmed by magnetic resonance imaging. CONCLUSION: Ultrasonography is a convenient first-line diagnostic method of peripheral nerve disorder by virtue of its higher spatial resolution, cost-effectiveness, and prompt diagnosis. The real-time and dynamic scanning attributes are the discriminative merits of this imaging tool. This case report suggests that CPN compression occurred due to a movable cystic mass during knee flexion. Dynamic ultrasonographic evaluations could be helpful to diagnose pathologic musculoskeletal conditions.