Journal of Back and Musculoskeletal Rehabilitation - Volume 31, issue 5

Authors: Wewege, Michael A. | Booth, John | Parmenter, Belinda J.

Article Type: Research Article

Abstract: BACKGROUND/OBJECTIVE: This meta-analysis compared progressive aerobic training (PAT) to progressive resistance training (PRT) for pain, disability and quality of life (QoL) in people with chronic non-specific low back pain (CNSLBP). METHODS: Five electronic databases were systematically searched up to 1 March 2016. Randomised controlled trials included land-based PAT, PRT or combined PRT and PAT, versus usual care for CNSLBP. Exercise interventions were supervised a minimum of once per week and performed ⩾ 2 days/week for ⩾ 6 weeks. Outcome measurements were pain intensity, disability, and QoL. Standardised mean difference (SMD) and mean …difference (MD) were calculated using Review Manager 5.3. RESULTS: Six studies were included, comprising 333 participants (94 PRT, 93 PAT, 146 usual care; 66% female; age = 44 ± 6 years; duration of pain = 7 ± 6 years). Exercise significantly reduced pain intensity (SMD = - 0.42 [- 0.80, - 0.03]; p < 0.03) although neither mode proved superior. PRT significantly improved the Short Form Health Survey-Mental Component Score (SF-MCS) (MD = 5.74 [2.02, 9.47]; p = 0.002). CONCLUSIONS: PAT and PRT decreased pain intensity in individuals with CNSLBP although neither mode was superior. Resistance exercise improved psychological wellbeing. High-quality RCTs comparing PAT, PRT, and PAT + PRT, are required. Show more

Keywords: Aerobic exercise, resistance exercise, chronic low back pain, disability, quality of life

DOI: 10.3233/BMR-170920

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 5, pp. 889-899, 2018

Authors: Farahbakhsh, Farzin | Rostami, Mohsen | Noormohammadpour, Pardis | Mehraki Zade, Ali | Hassanmirazaei, Bahar | Faghih Jouibari, Morteza | Kordi, Ramin | Kennedy, David J.

Article Type: Research Article

Abstract: BACKGROUND: The prevalence of low back pain (LBP) in athletes across a variety of time frames and sports is not known. OBJECTIVES: To systematically collate and appraise studies on the prevalence of LBP in athletes and stratify by point, one year and life-time prevalence. METHODS: A comprehensive search was conducted in February 2016. The following sources were individually searched: PubMed (1950 to present), Ovid SP Medline (1950 to present), ISI (1982 to present) and Google Scholar; Surveys were included if they aimed to report the prevalence of LBP amongst the athletes. Two reviewers …independently evaluated the methodological quality of the studies. RESULTS: The literature search generated 4379 records. Title and/or abstracts were reviewed by two investigators and full-texts of 201 relevant articles were selected for further evaluation. Studies were included if they reported the prevalence of LBP in an athletic population (any level of participation in sports and any age range) and were written in English. Furthermore, to adequately assess the prevalence rate, studies had to report the number of athletes with LBP as a percentage of the total number of athletes. Studies that did not contain necessary data to calculate prevalence rate including case reports and non-original studies were excluded and 41 studies entered the bias assessment step. A bias assessment was applied to the methodology of 41 studies, and 36 with low to moderate risk for bias were included in this review. LBP in athletes was shown to have a point prevalence ranging from 10% to 67%, a one-year prevalence ranging from 17% to 94%, and a life-time prevalence ranging from 33% to 84%. The highest prevalence of LBP was found among skiers, floorball players and rowers and the lowest were found in shooters, golfers and triathletes. CONCLUSION: Like general population, LBP is quite prevalent among athletes. There is a lack of sound data on the prevalence and mechanism of LBP in some popular sports such as volleyball, swimming and track and field. The lack of standardization of research methods and outcome measurement tools are significant problems in literature. Researchers need to use standard and internationally acceptable definitions for LBP and related functional disability. Investigators are encouraged to conduct epidemiologic studies, along with search for possible mechanism of LBP, by recruitment of large sample population of the athletes who are selected through randomization of the national population and adopt recent recommendations for a standard definition of LBP. Show more

Keywords: Low back pain, athletes, systematic review

DOI: 10.3233/BMR-170941

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 5, pp. 901-916, 2018

Authors: Doğan, Sevil Ceyhan | Karadağ, Ahmet | Durmuş, Kasım | Şahin, Özlem | Altuntaş, Emine Elif

Article Type: Research Article

Abstract: BACKROUND: The exact etiopathogenesis of fibromyalgia syndrome (FM) is still unclear but the pathogenesis of FM is associated with neurogenic inflammation. Allergic rhinitis (AR) is a common inflammatory and immunological disease of the nasal mucosa. As a result, it is known that neurogenic inflammation has a role in the pathophysiology of both FM and AR. OBJECTIVE: The aim of this study was to evaluate AR and nasal allergic inflammation using nasal mucociliary clearance time (NMC) in FM patients. METHODS: Forty-five FM patients and fifty healthy controls were included in the study. In both …groups, AR was evaluated by total nasal symptom scoring (TNSS) and NMC was measured using saccharine transit time test (STT). RESULTS: TNSS was positive in 9 patients (20%) in the FM group and no positivity in the control group. In FM group, the mean value of TNSS was higher than that of the control group (p = 0.0001). The average value of STT of FM patients was statistically significantly longer when compared to the control group (p = 0.0001). CONCLUSION: The results we obtained suggest that there is a high possibility of coexistence of FM and AR. As a result, the coexistence of AR and FM cannot be denied but we believe that comprehensive clinical studies should be conducted on this subject. Show more

Keywords: Fibromyalgia syndrome, allergic rhinitis, nasal mucociliary clearance time, saccharine, nasal symptom scoring

DOI: 10.3233/BMR-170837

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 5, pp. 917-922, 2018

Authors: Nam, Hyung Seok | Han, Manyong | Choi, Hyung Yun | Song, Kyuman | Kang, Seonggyu | Ahn, Sung Min | Lee, Shi-Uk

Article Type: Research Article

Abstract: BACKGROUND: Optimal seatback angles for automobile drivers’ seats have been investigated based on comfort and back muscle activities; however, radiology supported evidences are scarce. OBJECTIVE: The aim of this study was to evaluate optimal range of the seatback reclining regarding torso angles for an automobile driver’s seat to preserve lumbar lordosis. METHODS: Thirty-one healthy volunteers were recruited among five body type categories. Lateral lumbar spine X-rays were obtained for the neutral sitting posture without seatback (reference), and with reclining angles of 23 ∘ to 33 ∘ …by 2 ∘ intervals. The Cobb angles for the L1-L4, L4-S1, and L1-S1 segments were measured. RESULTS: The Cobb angle for L4-S1 was nearest to the reference (18.74 ± 1.57 ∘ , mean ± standard error mean) at reclining angles of 29 ∘ and 31 ∘ (14.51 ± 1.41 ∘ and 14.47 ± 1.43 ∘ , respectively). The Cobb angle at L4-S1 between reclining angles of 27 ∘ (12.02 ± 1.31 ∘ ) and 29 ∘ (14.51 ± 1.41 ∘ ) were significantly different (p < 0.001). Tall men showed relatively preserved lordosis angles at all reclining angles. Fat men and short women demonstrated prominent loss of lordosis with excessively kyphotic L1-L4 segment. CONCLUSIONS: Reclining angles of 29 ∘ to 31 ∘ revealed to be optimal for preserving lordosis at the L4-S1 segment. Individualized healthcare-related guideline for driver’s seat adjustment setting is necessary. Show more

Keywords: Lumbar lordosis, reclining angle, driver’s seat

DOI: 10.3233/BMR-170875

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 5, pp. 923-930, 2018

Authors: Wanke, Eileen M. | Gabrys, Lars | Leslie-Spinks, Jeremy | Ohlendorf, Daniela | Groneberg, David A.

Article Type: Research Article

Abstract: BACKGROUND: Despite the high popularity of Latin American dance and the specific movement patterns characteristic of this dance discipline, studies on the physical effects of these dance style specific movement patterns are still lacking. OBJECTIVE: The purpose of the present study is to analyze strength level differences and shortening of relevant muscle groups resulting from formation dance, taking performance standard and gender into consideration. Furthermore, the correlation between the findings of muscle function tests (MFT) and the occurrence of lumbar spine complaints is evaluated. METHODS: A total of 66 participants (m: n = …31, f: n = 35) volunteered for this cross-sectional study (examination group, n = 39, m: n = 19, f: n = 20). The control group consisted of n = 27 participants (m: n = 12, f: n = 15). Besides isometric maximal strength tests (Digi Max system , mechaTronic ), relevant muscle groups were examined for shortenings (hip flexors, hamstrings). RESULTS: The male participants in dance sport reached a significantly higher strength level in the muscles of the spine region (p = 0.011) than the participants of the control group. The female elite dance athletes developed a significantly higher strength level in the knee flexors on the right side than the dancers of the advanced group (NL) (p = 0.021). At that, muscle shortening were observed that seem to be specific to dance sport. In addition, gender specific differences were observed both in strength levels and in tendency to shortenings. CONCLUSION: The specific requirements profile of Latin American formation dance seems to produce affects in the form of muscular imbalance on both sides of the body. These differences of muscular status were mainly observed between dance sport competitors and non-dancers rather than between performance levels. Future investigations with higher numbers of participants would be necessary here. Show more

Keywords: Dance sport, isometric maximal strength, lateralization, muscle imbalance

DOI: 10.3233/BMR-160633

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 5, pp. 931-938, 2018

Authors: Sivas, Filiz | Uzun, Özlem | Başkan, Bedriye | Bodur, Hatice

Article Type: Research Article

Abstract: OBJECTIVES: Determining neuropathic pain component (NPC) among patients with chronic low back pain-radicular pain (CLBP-RP) and the adjustment between scales of neuropathic pain. MATERIAL-METHODS: One hundred and one patients with CLBP-RP were included in the study. The severity of CLBP-RP was evaluated by visual analogue scale (VAS). The Douleur Neuropathique 4 Questions (DN4) and Leeds Assessment of Neuropathic Symptoms and Signs Scales (LANSS) were used to evaluate the NPC. RESULTS: The mean score of CLBP-RP assessed by VAS was 80 mm. NPC was detected a rate of 65.3% by DN4 and 40.6% by LANSS. …NPC was 75.4% in females and 47.2% in males according to DN4, and 52.3% in females and 19.4% in males according to LANSS. The female gender, occupation, and VAS scores were determined to be significant factors contributing to presence of NPC according to logistic regression analyses (p < 0.01, p < 0.05, p < 0.05). A medium degree accordance was established between DN4 and LANSS scales according to kappa coefficient (Kappa = 0.532, p < 0.05). CONCLUSION: CLBP is among the diseases causing mixed type pain accompanied by nociceptive and neuropathic pain. NPC was detected in a considerable part of patients with radicular pain. Identifying the character of radicular pain is significant to develop proper management strategies. Show more

Keywords: Low back-radicular pain, neuropathic pain, LANSS, DN4

DOI: 10.3233/BMR-160786

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 5, pp. 939-946, 2018

Authors: Kumar, Mukesh | Srivastava, Sanjay | Das, V. Soami

Article Type: Research Article

Abstract: BACKGROUND: Overhead work-activities and repetitive use of arm in occupational tasks are known risk factors to cause shoulder injury that often develops to functional disability. Rehabilitation exercises (REs) are capable of slowing this development. OBJECTIVE: The main objective of the present work is to experiment with common REs and to identify those which produce significant integrated electromyography (iEMG) activation of selected shoulder muscles namely, posterior deltoid, infraspinatus, teres minor, upper trapezius, middle trapezius and lower trapezius. METHODS:   Ten healthy male occupational workers, exposed to the risk of shoulder injury, performed six REs while …iEMG activities of concerning muscles are recorded using Biopac MP 150 system. REs are cross-examined statistically to select those which yield higher iEMG activations. RESULTS: Results indicate that upper trapezius presents the highest iEMG activity in exercise 6 (standing ER at 90 ∘ abduction and 90 ∘ elbow flexion). Middle trapezius and lower trapezius show highest activation in exercise 1 (prone horizontal abduction at 90 ∘ with full external rotation with thumb right up). Also, posterior deltoid, infraspinatus, and teres minor have the highest iEMG activity in this exercise. CONCLUSIONS: Results provide basic information to select appropriate rehabilitation programs for occupational workers exposed to the risk of shoulder injury. Show more

Keywords: Trapezius, posterior deltoid, teres minor, infraspinatus, electromyography

DOI: 10.3233/BMR-171020

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 5, pp. 947-954, 2018

Authors: Balci, Tugce Onal | Turk, Ayla Cagliyan | Sahin, Fusun | Kotevoglu, Nurdan | Kuran, Banu

Article Type: Research Article

Abstract: BACKGROUND: In treatment of adhesive capsulitis, deep heating agents have been shown to have positive effects on pain and function. OBJECTIVE: To evaluate if addition of ultrasound used in treatment of adhesive capsulitis will provide additional benefits. METHODS: Thirty patients with adhesive capsulitis were included in a prospective, double-blind, randomized controlled trial. Hotpack, TENS (Transcutaneus Electrical Nerve Stimulation), exercise and active ultrasound therapies were applied to the first group (n = 15), whereas sham ultrasound was applied to the second group (n = …15) in addition to hotpack, TENS and exercise. The patients were evaluated using joint range of motion, UCLA shoulder scale and Shoulder Disability Questionnaire scales at baseline and at 6th and 24th weeks post-treatment. RESULTS: When pain and the clinical and functional parameters were compared in both groups, significant improvement was found compared to baseline (p < 0.001). At week 24, no difference was found in terms of pain at rest, but all other parameters were improved compared to week 6. When the groups were compared, no difference was found in any comparison between 6th and 24th week (p > 0.05). CONCLUSION: Adding ultrasound treatment to a combination of physical therapy modalities did not provide any additional benefits for the treatment of adhesive capsulitis. Show more

Keywords: Capsulitis, exercise, therapeutics, shoulder, ultrasonic therapy

DOI: 10.3233/BMR-150482

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 5, pp. 955-961, 2018

Authors: Zati, Alessandro | Cavazzuti, Lorenzo | Colori, Biagio Carmine Maria | Benedetti, Maria Grazia

Article Type: Research Article

Abstract: BACKGROUND: Nonspecific Chronic Low Back Pain (CLBP) is a condition difficult to treat due to multiple etiopathogenesis and there is wide consensus on the multidisciplinary approach. In physiotherapy, the Medium Frequencies (MF) diathermy has recently been introduced but without enough evidence of effectiveness. OBJECTIVE: To explore the effects of a deep heating therapy (DHT) produced by a MF diathermy for the treatment of CLBP compared with a superficial heating therapy (SHT). The study was a double blind randomized trial. METHODS: Forty-nine patients affected by CLBP were randomly subdivided in 2 groups and treated …with either DHT (450 KHz) or SHT via electric resistance applying the same instrument on the lumbar spine. NRS (Numerical Rating Scale) for pain and ODI (Oswestry Disability Index) for disability were used as outcome measures. The follow up was: T1, 15 days (end of the therapy); T2, 30 days; T3, 45 days after T0. RESULTS: Both therapies were effective in reducing pain throughout the follow up with greater improvement in DHT group at T1. DHT resulted to have a higher efficacy with respect to SHT in reducing disability (ODI) throughout all follow ups. CONCLUSION: This study provides evidence of the positive effects of MF radio waves diathermy in the treatment of CLBP. Show more

Keywords: Diathermy, radio waves, chronic low back pain

DOI: 10.3233/BMR-170944

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 5, pp. 963-971, 2018

Authors: Atiç, Ramazan | Aydın, Abdulkadir

Article Type: Research Article

Abstract: OBJECTIVE: The aim of the study was to evaluate and compare clinical and demographic characteristics, functional status and quality of life among patients who underwent amputation for the most common reason in our region. METHODS: Demographic data, level of and reasons for undergoing amputation and clinical data on the use of prostheses in 126 patients were recorded. The amputees were divided into three groups: vascular, trauma and landmine. Variables related to clinical and demographic characteristics, daily life activities and quality of life were investigated. Duration of prosthesis use, daily walking distance with prosthesis, 10-m walking speed …with the prosthesis and 6-min walking distance of the amputees were recorded. The Short Form-36, Turkish version of the Trinity Amputation and Prosthesis Experience Scales and Beck Depression Inventory were used to evaluate the patients’ quality of life. The residual limb pain scale was used to evaluate the severity of pain. RESULTS: Comparison between the amputees in the trauma and vascular groups showed highly significant results (P < 0.001) in amputees in the trauma group with respect to all parameters of daily life activities, functional status and quality of life. Comparison between the vascular and landmine amputees showed significant results (P < 0.001) in the landmine amputees with respect to all parameters except emotional role functioning, social functioning and mental health. Comparison between the amputees in the trauma and landmine groups showed no significant results (P > 0.05) with respect to all parameters expect emotional role functioning and mental health. CONCLUSIONS: While the clinical and demographic characteristics, functional status and quality of life parameters were similar in the amputees in the trauma and landmine groups, they showed statistically significant differences in almost all parameters compared with those in vascular amputees. Show more

Keywords: Vascular amputation, trauma amputation, landmine amputation, quality of life, SF-36, Beck Depression Inventory

DOI: 10.3233/BMR-181148

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 5, pp. 973-979, 2018

Authors: Çatalbaş, Necdet | Akkaya, Nuray | Atalay, Nilgun Simsir | Sahin, Fusun

Article Type: Research Article

Abstract: BACKGROUND: Clinical and electrophysiological effects of therapeutic ultrasound (US) were researched in many studies on patients with CTS with conflicting results. OBJECTIVE: To assess the effects of continuous and pulsed US treatments by ultrasonographic imaging in addition to clinical and electrophysilogical parameters in patients with carpal tunnel syndrome (CTS). METHOD: Fifty-four patients with idiopathic CTS were randomly divided into three groups. All patients used night splints for two weeks. In addition to splint therapy, continuous, pulsed or sham US treatments were applied to patients 10 min/session, 5 sessions/week for two weeks. Clinical situation (pain, hand function, …strength), electrophysiological studies (motor distal latency, MDL, sensorial distal latency, SDL), and ultrasonographic area measurements of median nerve were evaluated. All evaluations were applied at pretreatment (baseline), posttreatment (2 nd week) and in the 6 th week. RESULTS: Whereas significant differences were detected for clinical, functional and ultrasonographic imaging findings in each group in the 2 nd week and 6 th week compared to baseline (p < 0.0167 for both), no electrophysiological improvements were detected in pulsed-US (p > 0.0167) and only improvement for SDL in sham US group in the 2 nd week evaluation (p < 0.0167). CONCLUSION: According to the results of this study, continuous, pulsed or sham US treatments combined with splinting had similar effects on clinical, electrophysiological and ultrasonographic imaging improvements. Additionally, ultrasonographic imaging may be a preferable objective evaluation tool to prove the early posttreatment clinical improvements when electrophysiological changes could not be detected. Show more

Keywords: Carpal tunnel syndrome, continuous ultrasound, pulsed ultrasound, ultrasonography, imaging

DOI: 10.3233/BMR-160652

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 5, pp. 981-989, 2018

Authors: Wilke, Jan | Vogt, Lutz | Pfarr, Tatjana | Banzer, Winfried

Article Type: Research Article

Abstract: BACKGROUND: Most methods assessing soft tissue stiffness are associated with high costs and considerable technical effort. A previous study demonstrated that the tissue compliance meter represents an affordable alternative with straightforward handling. However, little data exists describing its measurement properties. OBJECTIVE: The study aimed to elucidate the reliability and validity of a semi-electronic tissue compliance meter (STCM). METHODS: Tissue stiffness at the lateral calf was examined in 34 healthy participants (24 ± 5 yrs, 21 men). Measurements on two consecutive days were used to estimate test-retest reliability, day-to-day reliability and inter-rater reliability. Validity was …examined twofold. Firstly, STCM data were correlated with those of another method, the myotonometry. Secondly, STCM measurements at different levels of isometric contraction (M.gastrocnemius) were examined for systematic differences. RESULTS: Intraclass correlations (ICC) revealed high test-retest reliability (ICC 0.84, 95% CI: 0.70 to 0.92; p < 0.05) and day-to-day reliability (0.84, 0.71 to 0.92; p < 0.05). Inter-rater reliability was sufficient to good (0.75, 0.56 to 0.87; p < 0.05). Cross-validation with myotonometry revealed a strong correlation of both methods (r = 0.86; p < 0.05). Stiffness assessments during isometric contraction demonstrated that the STCM can discriminate different force levels (χ 2 = 57.1, p < 0.05). CONCLUSIONS: The STCM provides valid and reliable measurements of tissue stiffness. Further study is needed to provide norm values for different body regions and to reveal alterations in patients with musculoskeletal disorders. Show more

Keywords: Soft tissue, tissue hardness, elasticity, muscle tone

DOI: 10.3233/BMR-170871

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 5, pp. 991-997, 2018

Authors: Algahtani, Hussein | Shirah, Bader | Alassiri, Ali H. | Habib, Ben Attia | Almuhanna, Rakan | Ahamed, Mohamed Firoze

Article Type: Research Article

Abstract: Dysferlinopathies encompass a group of neuromuscular diseases characterized by the absence of dysferlin in skeletal muscle. It is a genetic disorder caused by a mutation in the dysferlin gene (DYSF) with an autosomal recessive mode of inheritance. In this article, we report a case of Limb-girdle muscular dystrophy type 2B with a rare homozygous duplication c.164dupA, p.(Ile57Hisfs*8) (rs863225020) in DYSF in a Saudi patient. To the best of our knowledge, this is the first case from Saudi Arabia with complete clinical data, pathology findings, radiology findings, and genetic analysis. Although there is no curative treatment for this disease, an accurate …diagnosis is important to avoid using steroids and immunosuppressive medications, which are not effective and may have several side effects. Further studies are needed to explore potential therapies for this rare condition. Show more

Keywords: Dysferlinopathy, limb-girdle muscular dystrophy type 2B, muscular dystrophy, Saudi Arabia

DOI: 10.3233/BMR-181129

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 5, pp. 999-1004, 2018