Journal of Back and Musculoskeletal Rehabilitation - Volume 31, issue 4

Authors: Nur, Hakan | Aytekin, Ayca | Gilgil, Erdal

Article Type: Case Report

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. Show more

Keywords: Medial collateral ligament (MCL), bursitis, knee osteoarthritis, knee pain

DOI: 10.3233/BMR-169741

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 589-591, 2018

Authors: Liu, Fang | Jones, Alice Y.M. | Evans, Kerrie | Tsang, Raymond C.C. | Ao, Lijuan

Article Type: Research Article

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. Show more

Keywords: Chinese, endurance, isometric, Biering-Sørensen, plank test, side bridge test

DOI: 10.3233/BMR-170872

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 593-602, 2018

Authors: Camurcu, Yalkin | Sofu, Hakan | Ucpunar, Hanifi | Kockara, Nizamettin | Cobden, Adem | Duman, Serda

Article Type: Research Article

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. Show more

Keywords: Platelet-rich plasma, intra-articular injection, knee osteoarthritis, corticosteroid

DOI: 10.3233/BMR-171066

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 603-610, 2018

Authors: Ding, W.L. | Zheng, Y.Z. | Su, Y.P. | Li, X.L.

Article Type: Other

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. Show more

Keywords: Virtual reality, patient rehabilitation, human-computer interaction, kinematics

DOI: 10.3233/BMR-140203

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 611-621, 2018

Authors: Zhang, Jun

Article Type: Research Article

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. Show more

Keywords: Non-union skeletal fractures, differentially expressed genes, transcription factors

DOI: 10.3233/BMR-169596

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 623-628, 2018

Authors: Qi, Yong | Sun, Hongtao | Fan, Yueguang | Li, Feimeng | Wang, Yunting | Ge, Chana

Article Type: Research Article

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. Show more

Keywords: Posterior tibial slope, anterior cruciate ligament, knee joint, finite element analysis

DOI: 10.3233/BMR-169703

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 629-636, 2018

Authors: Lima, Vicente Pinheiro | de Alkmim Moreira Nunes, Rodolfo | da Silva, Jurandir Baptista | Paz, Gabriel Andrade | Jesus, Marco | de Castro, Juliana Brandão Pinto | Dantas, Estélio Henrique Martin | de Souza Vale, Rodrigo Gomes

Article Type: Research Article

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. Show more

Keywords: Low back pain, spine, mobility limitation, core training

DOI: 10.3233/BMR-169739

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 637-643, 2018

Authors: Lubkowska, Anna | Radecka, Aleksandra | Bryczkowska, Iwona | Rotter, Iwona | Laszczyńska, Maria | Karakiewicz, Beata

Article Type: Research Article

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. Show more

Keywords: Infrared radiation, visible red light, surface electromyography

DOI: 10.3233/BMR-169745

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 645-656, 2018

Authors: Verbrugghe, Jonas | Agten, Anouk | O. Eijnde, Bert | Olivieri, Enzo | Huybrechts, Xavier | Seelen, Henk | Vandenabeele, Frank | Timmermans, Annick

Article Type: Research Article

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. Show more

Keywords: Low back pain, rehabilitation, high intensity, exercise therapy

DOI: 10.3233/BMR-170810

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 657-666, 2018

Authors: Kim, Nack Hwan | Lee, Sang-Heon

Article Type: Case Report

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. Show more

Keywords: Foot drop, peroneal neuropathy, ultrasonogram

DOI: 10.3233/BMR-170849

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 667-670, 2018

Authors: Senington, Billy | Lee, Raymond Y. | Williams, Jonathan Mark

Article Type: Review Article

Abstract: BACKGROUND: Fast bowlers display a high risk of lower back injury and pain. Studies report factors that may increase this risk, however exact mechanisms remain unclear. OBJECTIVE : To provide a contemporary analysis of literature, up to April 2016, regarding fast bowling, spinal kinematics, ground reaction force (GRF), lower back pain (LBP) and pathology. METHOD: Key terms including biomechanics, bowling, spine and injury were searched within MEDLINE, Google Scholar, SPORTDiscuss, Science Citation Index, OAIster, CINAHL, Academic Search Complete, Science Direct and Scopus. Following application of inclusion criteria, 56 studies (reduced from 140) were appraised …for quality and pooled for further analysis. RESULTS: Twelve times greater risk of lumbar injury was reported in bowlers displaying excessive shoulder counter-rotation (SCR), however SCR is a surrogate measure which may not describe actual spinal movement. Little is known about LBP specifically. Weighted averages of 5.8 ± 1.3 times body weight (BW) vertically and 3.2 ± 1.1 BW horizontally were calculated for peak GRF during fast bowling. No quantitative synthesis of kinematic data was possible due to heterogeneity of reported results. CONCLUSIONS: Fast bowling is highly injurious especially with excessive SCR. Studies adopted similar methodologies, constrained to laboratory settings. Future studies should focus on methods to determine biomechanics during live play. Show more

Keywords: Biomechanics, cricket fast bowling, injury, lower back pain

DOI: 10.3233/BMR-170851

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 671-683, 2018

Authors: Park, Taejune | Lee, Ho Jun | Kim, Jae Seong | Nam, Kiyeun

Article Type: Review Article

Abstract: BACKGROUND: Posterior epidural lumbar disc fragment is infrequent because of anatomical barriers, and it is difficult to diagnose posterior epidural lumbar disc fragment because of its rare incidence and the ambiguity of radiologic evaluations. And it is difficult to differentiate it from other diseases such as spinal tumors. OBJECTIVE: Differential diagnosis of posterior epidural lumbar disc fragment is clinically important because its diagnosis can affect treatment and prognosis. To investigate the incidence, anatomical concern, etiology, symptom, diagnostic tool, management and prognosis of posterior epidural lumbar disc fragment, we reviewed articles including case report. METHODS: …We performed a search of all clinical studies of posterior epidural lumbar disc fragment published to date. The following keywords were searched: Posterior epidural lumbar disc fragment, disc migration, posterior epidural disc, extradural migration, dorsal epidural migration, sequestrated disc, and disc fragment. RESULTS: We identified 40 patients of posterior epidural lumbar disc fragment from 28 studies. The most common presentation of posterior epidural lumbar disc fragment was sudden onset radiculopathy (70.0%), followed by cauda equina syndrome (27.5%). The most frequently used diagnostic modality was magnetic resonance imaging (MRI), conducted in 36 cases (90.0%), and followed by computed tomography in 14 cases (35.0%). After the imaging studies, the preoperative diagnoses were 45.0% masses, 20.0% lesions, and 12.5% tumors. Characteristic MRI findings in posterior epidural lumbar disc fragment are helpful for diagnosis; it typically displays low signals on T1-weighted images and high signals on T2-weighted images with respect to the parent disc. In addition, most of the disc fragments show peripheral rim enhancement on MRI with gadolinium administration. Electrodiagnostic testing is useful for verifying nerve damage. Surgical treatment was performed in all cases, and neurologic complications were observed in 12.5%. CONCLUSIONS: As posterior epidural lumbar disc fragment could be masqueraded as spinal tumor, if rim enhancement is observed in MRI scans with sudden symptoms of radiculopathy or cauda equina syndrome, it should be taken into consideration. Early diagnosis can lead to early surgery, which can reduce complications. Show more

Keywords: Posterior epidural migration of lumbar disc fragment, cauda equina syndrome, electromyography, magnetic resonance imaging

DOI: 10.3233/BMR-170866

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 685-691, 2018

Authors: Yagci, Gozde | Ayhan, Cigdem | Yakut, Yavuz

Article Type: Research Article

Abstract: BACKGROUND: In scoliosis, curve progresses due to muscle imbalance and poor posture. Basic body awareness therapy (BBAT) aims to improve posture, coordination, and balance by increasing body awareness, which may help decrease deformities. OBJECTIVE: This study aimed to investigate effects of Basic body awareness therapy (BBAT) on curve magnitude, trunk asymmetry, cosmetic deformity, and quality of life in adolescent idiopathic scoliosis (AIS) patients. METHODS: Twenty female AIS patients were randomly assigned to BBAT and traditional exercises (TEs) groups. The BBAT group received BBAT and traditional exercises (TEs), while the TEs group received …only TEs. The following assessments were included: Cobb angles using X-ray, angle of trunk rotation (ATR) using scoliometer, trunk asymmetry using the Posterior Trunk Symmetry Index (POTSI), cosmetic deformity using the Walter Reed Visual Assessment Scale (WRVAS), and quality of life using the SRS-22 test. Measurements were conducted at baseline examination and ten weeks later. Patients were instructed to wear their brace 23 h daily. Results were analyzed using the Wilcoxon rank-sum test to compare repeated measurements and Mann-Whitney U test to compare the groups. RESULTS: The BBAT group had greater improvement in the thoracic Cobb angle than the TEs group. Cosmetic deformity improved in both groups, whereas body asymmetry improved in only the BBAT group. SRS-22 scores were unchanged in both groups. CONCLUSIONS: BBAT as an additive to bracing and TEs improve curve magnitude, body symmetry and trunk deformity. Show more

Keywords: Idiopathic scoliosis, basic body awareness therapy, curve progression, body symmetry

DOI: 10.3233/BMR-170868

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 693-701, 2018

Authors: Sağ, S. | Sağ, M.S. | Tekeoğlu, I. | Kamanlı, A. | Nas, K. | Acar, B.A.

Article Type: Research Article

Abstract: OBJECTIVES: In this study, we aimed to investigate the relationship of NLR (Neutrophil lymphocyte ratio), MPV (mean platelet volume), PDW (distribution width) rates in rheumatoid arthritis (RA) patients with IL-17 and IL-1 beta which are within the cytokines playing an important role in etiopathogenesis and activity of the disease. PATIENTS AND METHODS: Fifty-seven RA patients diagnosed according to RA classification criteria of ACR/EULAR 2010 and 37 controls were included into the study. WBC (white blood cell), NEU (neutrophil), PLT (platelet), LYM (lymphocyte) values in complete blood count received from routine blood examination of patients were recorded, …and NLR, PLR (platelet lymphocyte ratio) rates were recorded. IL-17 and IL-1 beta were studies in serum samples. Disease activity of RA patients was evaluated with Disease Activity Score (DAS28). Age, gender, disease age, BMI (body mass index), medications used, co-morbid diseases, smoking of the patients were recorded. RESULTS: Fifty-seven RA patients (46 (80.7%) females, 11 (19.3%) males), and 34 patients (24 (70.6% females and 10 (29.4) males) as a control group were involved. Demographic characteristics were similar between two groups, and statistically significant difference was not detected between patient and control groups in terms of gender, age, and BMI (p > 0.05). We found higher NLR, MPV, PDW, IL-17 values in RA patients compared to control group (p < 0.05). There was a positive correlation of NLR with DAS28, CRP. While erythrocyte sedimentation rate (ESR) had negative correlation with MPV and PDW, it had positive correlation with PLT. We found positive correlation of C-reactive protein (CRP) with NLR and PLT. We could not find correlation of IL-1 beta and IL-17 with hematologic markers. CONCLUSION: In this study, we investigated the relationship of IL-17 and IL-1 beta which play an important role in pathogenesis of RA patients with the parameters analyzed in routine complete blood count, providing information about disease activity such as DAS 28, CRP, and ESR. We illuminated on an issue which has not discussed before by looking from a different angle. More extensive, follow-up studies are needed to emphasize the importance of these parameters and to reveal the relationship between cytokines during the follow-up of the disease activity. Show more

Keywords: Rheumatoid arthritis, IL-17, neutrophil lymphocyte ratio

DOI: 10.3233/BMR-170903

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 703-707, 2018

Authors: Tuan, Shenghui | Liou, Ihsiu | Su, Hungtzu | Tsai, Yunjeng | Chen, Guanbo | Sun, Shufen

Article Type: Research Article

Abstract: BACKGROUND: Most studies used hyaluronic acid (HA) requiring 3–5 intra-articular injections (IAJ) for knee osteoarthritis (KOA). OBJECTIVE: We evaluated the efficacy of a single IAJ of a novel HA by measuring the thickness of quadriceps and femoral intercondylar cartilage (FIC) under ultrasonography (US) in addition to subjective self-reported measures. METHODS: Forty-nine patients with KOA (Kellgren-Lawrence grades 2–3) received unilateral IAJ of HYAJOINT Plus to the worse knee and were assessed at baseline and 1, 3 and 6-months after IAJ. Outcome measures were the (1) Visual Analog Scale for pain (VAS), (2) Western Ontario …and McMaster Universities Osteoarthritis Index (WOMAC), (3) Lequesne’s Index, (4) single-leg-stance duration (5) thigh circumference, and (6) thickness of quadriceps and FIC under US. RESULTS: Forty-six patients completed the 6-month-follow-up study. All outcome measures improved significantly after HA injection (p < 0.001). Both VAS and WOMAC-pain subscale scores improved significantly at 1, 3, and 6 months (p < 0.01). The US thickness of the quadriceps and FIC improved significantly at both 3 and 6 months (p < 0.05). The Lequesne’s index, single-leg-stance and thigh circumference improved significantly at 6 months (p < 0.01). CONCLUSIONS : HYAJOINT Plus is effective both subjectively and objectively for 6 months and is safe as a treatment for KOA. Show more

Keywords: Knee pain, osteoarthritis, hyaluronic acid, ultrasonography

DOI: 10.3233/BMR-170950

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 709-718, 2018

Authors: Cokorilo, Nebojsa | Mikalacki, Milena | Satara, Goran | Cvetkovic, Milan | Marinkovic, Dragan | Zvekic-Svorcan, Jelena | Obradovic, Borislav

Article Type: Research Article

Abstract: BACKGROUND: Aerobic exercises to music can have a positive effect on functional and motor skills of an exerciser, their health, as well as an aesthetic and socio-psychological component. OBJECTIVE: The objective of this study was to determine the effects of reactive exercising in a group on functional capabilities in physically active and physically inactive women. METHODS: A prospective study included 64 healthy women aged 40–60 years. The sample was divided into the experimental group (N = 36), i.e. physically active women who have been engaged in recreational group …exercises at the Faculty of Sport and Physical Education, University of Novi Sad, Serbia, and the control group (N = 28), which consisted of physically inactive women. All the participants were monitored using the same protocol before and after the implementation of the research. All women had their height, weight and body mass index measured as well as their spiroergometric parameters determined according to the Bruce protocol. RESULTS: A univariate analysis of variance has shown that there is a statistically significant difference between the experimental group and the control group in maximum speed, the total duration of the test, relative oxygen consumption, absolute oxygen consumption and ventilation during the final measurement. After the training intervention, the experimental group showed improvements in all the parameters analyzed compared with pretest values. CONCLUSION: The recreational group exercise model significantly improves aerobic capacity and functioning of the cardiovascular system. Therefore, it is essential for women to be involved more in any form of recreational group exercising in order to improve functional capacity and health. Show more

Keywords: Spirometry, ergometry, exercise, cardiorespiratory fitness

DOI: 10.3233/BMR-170952

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 719-725, 2018

Authors: Areerak, Kantheera | van der Beek, Allard J. | Janwantanakul, Prawit

Article Type: Research Article

Abstract: BACKGROUND: Neck pain has an episodic course with varying time for recovery and identification of individuals likely to recover is important. OBJECTIVE: The aim of this study was twofold: 1a) to explore the duration of recovery from nonspecific neck pain, and 1b) to investigate the relation between recovery duration and age, and 2) to evaluate whether the NHBOW can predict duration of recovery from non-specific neck pain. METHODS: One hundred and three from 342 office workers reported non-specific neck pain, with information collected on pain intensity and disability every month for 12 months. The …time to recovery was measured from the onset of neck pain to full recovery. The 103 office workers were divided into two groups using the NHBOW score. Kaplan-Meier survival curves were used to describe the median time to recovery. The survival curves of the two NHBOW groups were compared using Cox regression analysis. RESULTS: The median time to recovery from neck pain was 2 months. The duration of recovery was not significantly related with age of participants. There was no significant difference in time to recovery from neck pain between the NHBOW low-score group and the high-score group. CONCLUSION: This study showed that the NHBOW was unable to predict duration of recovery from nonspecific neck pain in office workers. Show more

Keywords: Health literacy, office worker, recovery, prognosis

DOI: 10.3233/BMR-170958

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 727-734, 2018

Authors: Truszczyńska-Baszak, Aleksandra | Wysocka, Edyta | Starzec, Małgorzata | Drzał-Grabiec, Justyna | Tarnowski, Adam

Article Type: Research Article

Abstract: OBJECTIVES: Lumbar spinal stenosis may lead to urinary inconsistence and can have a negative impact on the quality of life. The aim of the study was to assess the incidence of urinary incontinence and quality of life in female patients with spinal canal stenosis comparing to control group. METHODS: The study population consisted of 50 women diagnosed with severe lumbar spinal canal stenosis. Their mean age was 55.32 ± 12.97 years. The clinical control group consisted of 30 women who did not suffer from any spine disorders. Their mean age was 54.87 ± …12.01 years. There was no difference between both groups regarding age, weight, BMI and number of parity. The women diagnosed with clinical and radiographic symptoms of spinal canal stenosis filled out an anonymous questionnaire, ODI, ICIQ-UI-SF, and ICIQ-LUTSqol questionnaires. RESULTS: We found urinary incontinence in 56% of women with lumbar spinal canal stenosis and in 43% of clinical control group. We also found a statistically significant correlation between duration of lumbar stenotic symptoms, the SLR sign, number of deliveries and the intensity of urinary incontinence. CONCLUSIONS: Urinary incontinence in women with lumbar spinal canal stenosis is significantly different from the control group. Leakage of urine happened more frequently, the amount of urine leaked was greater, and the general impact on everyday life is harsher, as compared to the clinical control group. Show more

Keywords: Spinal canal stenosis, urinary incontinence, quality of life

DOI: 10.3233/BMR-170976

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 735-741, 2018

Authors: Duray, M. | Yagci, N. | Ok, N.

Article Type: Research Article

Abstract: BACKGROUND: Self-efficacy that is associated with various pain-related disabilities such as chronic low back pain (LBP), should be questioned besides physical assessments. OBJECTIVES: To investigate the physical factors associated with self-efficacy in patients with chronic mechanic LBP. METHODS: One hundred nine patients diagnosed as chronic mechanic LBP (65 females, 44 males) between 20–50 years old were included to this study. The intensity of LBP was assessed by using a 10-cm Visual Analogue Scale. For musculoskeletal fitness measurement; muscle strength, muscle endurance, and flexibility tests were applied. Functional Reach Test for balance evaluation, Self-Efficacy …Scale for self-efficacy measurement, Roland-Morris Disability Questionnaire for disability level evaluation were used. RESULTS: We found a moderate negative correlation between self-efficacy and pain intensity (r = - 0.506); a negative and strong correlation between self-efficacy and disability level (r = - 0.654) (p < 0.05). Self efficacy had a significant association with right (r = 0.265) and left (r = 0.290) lateral side bending flexibility (p < 0.05). According to multiple regression analysis results, it was found that disability level had a significant effect on self-efficacy (β = - 2.014; p < 0.01). CONCLUSIONS: Poor musculoskeletal fitness and pain intensity may cause decreasing self-efficacy but the major determinant of decreased self-efficacy was low-back related disability scores. Show more

Keywords: Low back pain, self-efficacy, physical fitness

DOI: 10.3233/BMR-170993

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 743-748, 2018

Authors: Raţă, Bogdan Constantin | Raţă, Marinela | Antohe, Bogdan

Article Type: Case Report

Abstract: BACKGROUND: Most lesions of the soft tissues, especially those at the muscle level, are due to the lack of elasticity of the connective tissue and fascia. Stretching is one of the most commonly used methods of treatment for such musculoskeletal issues. OBJECTIVE: This study tracks the effects of stretching on the electromyographic activity of muscle chains, applied to a 24-year-old athlete diagnosed with the Haglund’s disease. METHOD: For the evaluation, we used visual examination and surface electromyography (maximum volumetric isometric contraction). The therapeutic intervention consisted in the application of the static stretching positions, …which intended the elongation of the shortened muscle chains. The treatment program had a duration of 2 months, with a frequency of 2 sessions per week and an average duration of 60 minutes. RESULTS: The posterior muscle chains recorded an increase in the EMG activity, while the anterior muscle chains tended to diminish their EMG activity. As a result of the applied treatment, all the evaluated muscle chains recorded a rebalancing of the electromyographic activity, demonstrating the efficiency of stretching as a method of global treatment of muscle chains. CONCLUSIONS: By analysing all the data, we have come to the conclusion that static stretching is an effective treatment method for shortened muscle chains. Show more

Keywords: Stretching, muscle chains, athletics

DOI: 10.3233/BMR-170998

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 749-758, 2018

Authors: Alemdar, Murat

Article Type: Research Article

Abstract: BACKGROUND: Comparison of sensory conduction of median nerve (MN) with the one of ulnar nerve (UN) over writs-to-ring finger (RF) segment is useful in electrodiagnosis of carpal tunnel syndrome (CTS). However, there is not any consensus regarding the usage of this technique in grading of CTS. OBJECTIVES: To determine whether the hands of CTS with elicitable MN sensory responses on index finger, but not on RF (non-respondings) compose a more severe electrophysiologic grade than the hands with elicitable responses on both fingers (respondings). MATERIAL AND METHODS: The patients with bilateral moderate grade of CTS in whom …one hand was responding and the contralateral hand was non-responding were included. Conduction study results of MN and UN were compared between respondings and non-respondings. RESULTS: A total of 19 patients were included. Mean distal sensory onset latency (DSOL) of MN over index finger was longer (4.26 ± 0.49 msec versus 3.44 ± 0.39 msec; p < 0.001), sensory conduction velocity (SCV) was slower (33.7 ± 4.3 m/sec versus 40.2 ± 3.0 m/sec; p < 0.001), SNAP amplitude was smaller (10.3 ± 3.3 μ V versus 19.1 ± 7.7 μ V; p < 0.001), distal motor latency was longer (5.69 ± 0.60 msec versus 4.63 ± 0.32 msec; p < 0.001), and minimum F wave latency was longer (29.3 ± 1.7 msec versus 26.8 ± 1.4 msec; p < 0.001) in non-respondings than respondings. The nonresponding hand had a longer MN DSOL and slower SCV on index finger compared with contralateral responding hand in all of 19 patients. CONCLUSION: Non-responding hands have more progressed median neuropathies, and represent a more severe electrophysiologic grade than responding hands. Further studies are warranted to determine whether the absence of MN sensory responses on ring finger is related with forthcoming NCS worsening and a preferable hallmark for deciding surgical intervention or not. Show more

Keywords: Carpal tunnel syndrome, median nerve, ulnar nerve, sensory response, ring finger, electrophysiologic grade

DOI: 10.3233/BMR-171068

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 759-766, 2018

Authors: Moalej, Sepehr | Asadabadi, Mahsa | Hashemi, Rezvan | Khedmat, Leila | Tavacolizadeh, Reza | Vahabi, Zahra | Shariatpanahi, Ghazal

Article Type: Research Article

Abstract: BACKGROUND: Scoliosis is the abnormal sideways curve of the spine. Screening for scoliosis is controversial, and there has been significant heterogeneity between studies. In Iran, there is still no suitable device to screen sideways curves in spine. OBJECTIVE: To investigate the simple scolioscreen software for screening the students of elementary schools for detecting schoolchildren scoliosis. This students has been examined by trained medical student and data entered in scolioscreen application of an iPhone. METHODS: One hundred forty-four 7–12 years old students from primary schools in the 17th district of Tehran were randomly invited …to participate. Initial screening of the students was done in schools by health care provider or medical student who has been trained by a pediatrician to undergo a vertebral examination. Scoliometer for iPhone’s smartphone has been used for measuring the angle of deviation. RESULTS: 1.4% of students had overt scoliosis and 10.4% were suspected to have a kind of mild abnormality in spine curve. These individuals were referred to clinic for radiologic evaluation and it was confirmed that relative frequency of this abnormality was defined as 4.86% in our population study. There was no significant correlation between sex and degree of spinal curve. CONCLUSIONS: Regarding the high rate of scoliosis in our population and approval of this screening test in different studies, routine use of this screening method is highly recommended in schoolchildren. It is cost beneficial and can be effective in prevention and early treatment of scoliosis. Show more

Keywords: Scoliosis, iPhone, scolioscreen, children, school

DOI: 10.3233/BMR-171078

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 767-774, 2018

Authors: Chatterjee, Arijit | Sahu, Subhashis

Article Type: Research Article

Abstract: BACKGROUND: A huge number of labourers work in the construction industry in India both in organized and unorganized sectors. The construction labourers most often work for an extended period of time and they are compelled to uphold altered static and dynamic operational stance in awkward positions during the complete period of work which raises the demand on the musculoskeletal system and may lead to work related musculoskeletal disorders (WRMSDs). OBJECTIVE: This study is intended to explore the operational stance and occupation related musculoskeletal manifestations amongst the construction labourers. One hundred sixty four male labourers from …different construction sites in West Bengal were randomly taken for this study. METHODS: A modified Nordic questionnaire on MSD and the 12 item General Health Questionnaire (GHQ12) were administered on the construction labourers. Rapid Entire Body Assessment (REBA) and Ovako Work Analysis System (OWAS) methods were applied to analyze the operational stance. Finally, discomfort levels of the specific operational stance were calculated by the use of risk level and BPD scale. RESULTS: The study revealed that most of the construction labourers habitually worked in awkward operational stance and were affected by altering musculoskeletal manifestations like pain in low back, neck, and wrist. We also found that there is a significant (p < 0.05) association between the intensity of pain feeling, age, year of working experience and risk level of the individual working postures of the labourers. CONCLUSION: Appropriate work-rest schedule, amendments of some working techniques and use of some ergonomically designed equipment may lessen the WRMSDs and improve the health eminence of construction labourers in unorganized sectors. Show more

Keywords: Construction labourers, operational stance, risk level, WRMSDs

DOI: 10.3233/BMR-170935

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 775-783, 2018

Authors: Vulfsons, S. | Chervonenko, S. | Haddad, M. | Weisman, M.H. | Lavi, N. | Dar, G.

Article Type: Research Article

Abstract: BACKGROUND: The concept of myofascial continuity suggests that muscles activate along kinematic chains with common fascial coverings. Yet, the literature lacks evidence in regards to the function of anatomical chains in populations suffering from low back pain (LBP). OBJECTIVE: To examine muscle activations along the superficial back line in LBP patients compared to healthy controls. METHODS: The sample study included 20 males with chronic LBP (mean age 28.7 (± 3.05) years, mean BMI 24.91 (± 2.76)) and 17 healthy controls (mean age 31.06 (± 7.76) years, …mean BMI 23.46 (± 3.43)). Muscle activation (gastrocnemius, hamstrings, erector spine, and upper trapezius) along the superficial back line was measured using surface EMG. All subjects underwent five test conditions: Conditions 1–3 involved passive movement, active movement and active movement against maximum isometric resistance of the right gastrocnemius muscle. Conditions 4 and 5 involved neck extension without and with isometric resistance from the prone position. The main outcome was relative muscle activation amplitude between research and control subjects. RESULTS: Muscle activation along the posterior anatomical chain was observed during distal movement (plantar flexion or neck extension). LBP patients showed significant lower muscle activation in the erector spine of lower back region compared with the control group during active plantar flexion and active neck extension (p < 0.05). Lower muscle activation in other regions (gastrocnemius, hamstrings, erector spine level T6) was observed in the research group (although not significant). CONCLUSION: LBP may cause or result in a lower muscle activation of the posterior kinematic myofascial chain muscles. Show more

Keywords: Myofascial continuity, anatomical chain, muscle activation

DOI: 10.3233/BMR-160627

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 4, pp. 785-793, 2018