Journal of Back and Musculoskeletal Rehabilitation - Volume 32, 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: The asymmetric loading of trunk muscles in sports like golf or tennis may cause side-to-side imbalances in rotational muscle strength and endurance. Such imbalances may be compounded by the presence of low back pain (LBP) and related injuries. However, trunk rotational power is a better predictor of athlete performance, and therefore its ability to reveal these asymmetries/dysbalances should be investigated. OBJECTIVE: This study compares peak and mean values of power during trunk rotations on the dominant and non-dominant side in golfers, ice-hockey players, tennis players, and an age-matched control group of fit individuals.…METHODS: Groups of 17 golfers, 17 ice-hockey players, 21 tennis players, and 39 fit individuals performed standing trunk rotations to each side with a bar weight of 5.5, 10.5, 15.5, and 20 kg placed on the shoulders. Peak power and mean power in the acceleration phase of trunk rotations were measured using the FiTRO Torso Premium system. RESULTS: Peak power and mean power in the acceleration phase of trunk rotations were significantly higher on the dominant (D) than non-dominant (ND) side at weights of 5.5 kg (14 and 14%), 10.5 kg (17 and 14%), 15.5 kg (16 and 15%), and 20 kg (16 and 16%) in ice-hockey players, at 5.5 kg (14 and 13%), 10.5 kg (17 and 14%), and 15.5 kg (15% – only peak power) in tennis players, and at 5.5 kg (17 and 18%) and 10.5 kg (19 and 17%) in golfers. However, their values did not differ significantly at these weights (< 10%) in the age-matched control group. The D/ND ratio was the highest in ice-hockey players (1.18, 1.19), followed by golfers (1.16, 1.17) and finally tennis players (1.12, 1.16). CONCLUSION: Taking into account significantly higher trunk rotational power on the dominant than the non-dominant side in golfers, tennis players and ice-hockey players at lower and/or higher weights and no significant side-to-side differences in a control group of fit individuals, this parameter may be considered specific to their asymmetric loading during trunk rotations. However, whether these asymmetries/dysbalances expressed by the D/ND ratio could also identify the likelihood of LBP, needs to be proven.
Abstract: BACKGROUND: Aquatic exercises are often recommended for people with osteoarthritis (OA), however, there is a lack of evidence about the effects of these exercises. OBJECTIVES: The purpose of this study was to investigate the effects of two different aquatic exercise trainings on cardiopulmonary endurance and emotional status in patients with knee osteoarthritis. METHODS: Eighty-nine patients who had been diagnosed with knee osteoarthritis were divided into three groups as two different aquatic exercise training groups (only lower extremity training vs. lower extremity + upper extremity and trunk exercises) or the control…group. All groups have received the conventional therapy which consisted of hotpack, ultrasound, transcutaneous electrical nerve stimulation (TENS), and home exercises. Six-minute walk test (6MWT) and the Hospital Anxiety and Depression Scale (HAD) were used for assessing cardiopulmonary endurance and emotional status, respectively. RESULTS: Following the treatment, all groups improved in terms of systolic blood pressure, walking distance and total HAD scores. Group 1 showed additional improvements in diastolic blood pressure, heart rate and perceived exertion, while Group 2 showed additional improvements only in perceived exertion. Greater changes before and after the treatment in diastolic blood pressure at rest and following 6MWT, perceived exertion following 6MWT, walking distance, HAD depression scores and HAD anxiety scores were observed in Group 1. CONCLUSIONS: Exercise therapy consisting of only lower extremity exercises in water might be more effective in improving exercise capacity and depression levels in comparison to upper extremity and trunk added exercises or conventional physical therapy.
Keywords: Osteoarthritis, exercise, exercise capacity, emotional status
Abstract: BACKGROUND: Endothelin-1 (ET-1) is one of the probable inflammatory factors stimulating cartilage degradation in osteoarthritis (OA) pathogenesis. OBJECTIVE: To assess ET-1 level in OA and its correlation with radiographic findings, cartilage morphology and clinical parameters. METHODS: One hundred and thirty-nine subjects (89 OA, 50 controls) were included in this cross-sectional study. Both knee and hand joints of the participants were examined using plain radiography and ultrasound imaging by which distal femoral cartilage thickness/grading and second metacarpophalangeal cartilage thickness were assessed. Subjects were evaluated for pain and functional status using visual analogue scale, Western…Ontario and McMaster Universities Arthritis Index and Duruöz Hand Index. RESULTS: Serum ET-1 levels were higher in the OA group than the control group. Serum ET-1 levels were not correlated with cartilage thickness in patients with OA. Serum ET-1 levels were not correlated with either pain or other clinical parameters in the knee OA group and in the hand OA group. CONCLUSION: This is the first study evaluating the relationship between serum ET-1 levels and cartilage morphology and clinical parameters, which did not show any conclusive result. Future studies, overcoming the limitations of this study, might provide a better understanding of the role of ET-1 in the pathogenesis of OA.
Abstract: BACKGROUND: Lower back pain (LBP) is often work-related and is commonly observed among nurses. LBP occurs below the 12th rib and above the gluteal fold. In nurses, back disorders are mainly associated with heavy physical activity, such as lifting and moving patients. OBJECTIVE: The aim of the presented work is to evaluate the prevalence, risk factors, and associations of personal characteristics, general health status, and physical load with complaints of LBP. METHODS: In this study, sixty nurses were randomly chosen to answer self-administered questionnaires. The results were analyzed using the SPSS system.…RESULTS: An incidence rate of 61.7% for LBP among nurses was noticed. Among the sites of injury, LBP predominated with a rate of 51.2%. Severity of injury mostly ranged between mild to moderate levels of severity, and 20% of the nurses with LBP were working in obstetrics and gynecology units. Our study also showed that 66.7% of the participating nurses had experienced LBP only after taking on nursing jobs. CONCLUSIONS : The present study demonstrated that nurses working in Jeddah exhibit a high prevalence of lower back pain. In order to reduce the risk of work-related musculoskeletal disorders among nurses, the physical therapist’s role is vital and nurses’ practice of relaxation and stretching exercises in between work schedules is mandatory.
Keywords: Lower back pain, risk factors, nurses, physical work load
Abstract: BACKGROUND: Fibromyalgia syndrome (FMS) is a disorder characterized by chronic widespread pain and muscle soreness. Because of its high prevalence, many therapeutic approaches have been proposed with the aim of improving overall physical function and reducing pain. Since low adherence is one of the major limitations among these patients, treatments that do not interfere with their daily routines, such as KT, would be a feasible option. OBJECTIVE: The main goal of this study was to analyze the effect of Kinesio Tape (KT) on pain, posture, body comfort and quality of life (QoL) in people with FMS.…METHODS: Thirty-five women (between 17 and 70 years of age) with FMS were randomly allocated to two treatment groups, depending on the location of the KT: “Upper trunk group” (UTG) (n = 18) and “Global trunk group” (GTG) (n = 17). The intervention period lasted 3 weeks. Pain, comfort, trunk posture and QoL were assessed before and after the intervention. RESULTS: Both KT treatments were effective in reducing pain and improving neck and shoulder comfort (p < 0.05). The GTG achieved a significant improvement in thoracic comfort (p < 0.05), whereas the UTG experienced a significant improvement in non-dominant side trunk posture and showed a significant improvement in the QoL score (p < 0.05). CONCLUSION: GT and UT KT applications have positive effects on patients with FMS and may be considered as a suitable treatment option among this population.
Keywords: Body comfort, fibromyalgia, Kinesio Tape, pain, quality of life
Abstract: OBJECTIVE: The aim of this study was to determine the prerequisite physical features of classical ballet education. METHODS: Students who enrolled and were rejected for the applications of State Conservatory Ballet Main Art Branch in the academic year 2013–2014 and 2014–2015 were compared with their exam results. This study involves defining the physical ability and determining physical fitness by using Eurofit tests including the Flamingo Balance test (FB), Plate Tapping (PT), Sit and Reach (SITR), Standing Broad Jump (SBJ), Handgrip test (HG), Sit Up in 30 Seconds (SU) and Shuttle Run 10 ×…5 meter (SR), Heath-Carter somatotyping method and anthropometric measurements which determine ballet students’ body type and physical abilities. Sixty-nine girls between 8–11 years old who applied for ballet education at the State Conservatory Ballet Main Art Branch were included in the study. While the average of age, height and weight measurements of enrolled students were 9.40 ± 0.74 year, 1.38 ± 0.08 m and 30.03 ± 4.73 kg respectively, the same dimensions were found in rejected students, i.e. 9.79 ± 0.94 year, 1.40 ± 0.10 m and 35.59 ± 7.31 kg respectively. RESULTS: Measurements of diameter, circumference and subcutaneous fat were lower (p < 0.05) for enrolled students. The major body type of enrolled students was identified as mesomorphy, whereas the major body type of rejected students was identified as endomorphy. All dimensions of the Eurofit tests, except the strength test, were significantly different in enrolled students (p < 0.05). CONCLUSIONS: The parameters used in this study can be convenient in objectively evaluating classical ballet education.
Abstract: BACKGROUND: Flexibility changes according to stretching intensity have been rarely investigated. I aimed to assess the effect of different stretching intensities on hamstring flexibility by measuring them in a setting similar to real clinical settings. METHODS : Stretching intensities were quantified using an easy method, and participants were grouped according to intensity: 100% (P100), 70% (P70), 40% (P40), and 10% (P10) of maximum voluntary isometric contraction. Proprioceptive neuromuscular facilitation stretching intensities were measured using a sling system and tension dynamometer. Hamstring flexibility was measured (before; immediately after; and 3, 6, 9, 12, and 15 min after stretching)…using the active knee extension test. Flexibility was compared between subgroups, and longitudinal changes in flexibility were additionally observed in each group. RESULTS: At identical time points, no significant difference in hamstring flexibility was found between the high-intensity (P100) and moderate-intensity (P70, P40) groups. A significant difference was found between P100 and P10 immediately after and 12 and 15 min after stretching. Increased flexibility was maintained until the end in P100 and P70 but not P40 and P10. CONCLUSIONS: High-intensity and moderate-intensity stretching increases flexibility compared with low-intensity stretching. Furthermore, high-intensity stretching was superior to moderate-intensity stretching in terms of maintaining flexibility over time.
Abstract: BACKGROUND: Latent myofascial trigger point (LMTP) is a small hypersensitive area in skeletal muscles that becomes painful under compression or stimulation. LMTPs are relevant for various musculoskeletal disorders. Although several treatments have been introduced to treat LMTP, the most efficient one is yet to be found. OBJECTIVE: The main purpose of the present study was to compare pressure release, phonophoresis of betamethasone and dry needling on the upper trapezius latent myofascial trigger point. METHODS: Sixty participants (mean ± SD age, 23.6 ± 2.1 y), with at least…one latent myofascial trigger point in the upper trapezius muscle, participated in this study. Subjects were randomly divided into three groups (pressure release, phonophoresis with betamethasone and dry needling groups) for two weeks. Pain intensity, pain pressure threshold and active cervical range of motion were assessed. RESULTS: Significant pain decrease, active cervical range of motion and pain pressure threshold increase were observed in the three groups (p < 0.001). The dry needling and phonophoresis groups reported more significant improvement compared to the pressure release group (p < 0.001). There was no difference between the dry needling and phonophoresis groups. CONCLUSIONS: Considering the significant, positive effects of all three methods, dry needling and phonophoresis seem to be more effective than pressure release.
Keywords: Trigger point, trapezius muscle, phonophoresis, betamethasone, needles
Abstract: BACKGROUND: Although commonly utilized treatments, no study has directly compared the effectiveness of joint mobilization and stabilization exercise in individuals with forward head posture (FHP). OBJECTIVE: This study aimed to investigate the effects of upper cervical and upper thoracic spine mobilization versus deep cervical flexors exercise (DCFE) in individuals with FHP. METHODS: Thirty-one participants with FHP were randomized into the mobilization (n = 15) or exercise (n = 16) group. The treatment period was 4 weeks with follow-up assessment at 4 weeks and 6…weeks after the initial examination. Outcomes assessed included the craniovertebral angle (CVA), numeric pain rating scale (NPRS), respiratory function, and the global rating of change (GRC). RESULTS: Participants in the mobilization group demonstrated significant improvements (p < 0.05) in CVA, NPRS, and respiratory function, as compared to those in the exercise group. In addition, 9 of 15 (60%) participants in the mobilization group, as compared to 4 of 16 participants (25%) in the exercise group, had a GRC score of + 4 or higher. CONCLUSIONS: The combination of upper cervical and upper thoracic spine mobilization indicated better overall short-term outcomes in CVA, NPRS, respiratory function, and GRC compared with DCFE in individuals with FHP.
Keywords: Forward head posture, mobilization, exercise, neck pain, respiration
Abstract: BACKGROUND: Chronic low back pain (CLBP) is a public health problem that causes high levels of disability. Psychological and physical factors could play a critical role in the disability perception of patients. OBJECTIVE: The objective was to identify the psychological and physical factors associated with CLBP disability in patients and assess differences between asymptomatic subjects and CLBP patients through physical tests and psychological self-reports. METHODS: A cross-sectional study was performed. Total sample of 80 participants were classified into two groups: patients with CLBP (n = 49) and asymptomatic…subjects (i.e. the control group) (n = 31). The physical tests included lower back range of motion (LBROM), postural stability, lower back strength (LBS), and lumbopelvic motor control tests. The psychological self-reports included low back disability (Roland Morris Disability Questionnaire), self-efficacy, pain catastrophizing, and pain-related fear. RESULTS: Self-efficacy and LBS displayed moderate negative correlations with disability in patients with CLBP (R = - 0.47 and - 0.40, respectively). Disability was predicted by self-efficacy and LBROM (β = - 0.45 and - 033 respectively, p < 0.01), explaining 30% of the variance in these patients. The comparative analysis showed statistically significant differences between groups in the physical/psychological variables (p < 0.01); however, the effect-sizes were small for all these variables. CONCLUSIONS: The results of this study highlight the relevance of psychological and physical factors in CLBP patient disability. Evaluation and treatment in CLBP patients should take these factors into account.
Keywords: Low back pain, chronic pain, disability, range of motion, self-efficacy
Abstract: BACKGROUND: The aim of this study was to determine the relationship between bone mineral density (BMD), gluteus maximus muscle volume, and hip fracture type in patients with hip trauma. METHODS: A total of 134 patients were included in the study; 76 were in the study group [mean age 71.89 (65–80)] (hip fracture group), and 58 were in the control group [mean age 71.27 (65–80)] (hip trauma without fracture). The fracture type, femoral head diameter (FHD), and body mass index (BMI) were assessed. Fracture type was evaluated according to AO/OTA classification. The total gluteus maximus volume t…(GMV) was evaluated via computed tomography (CT). RESULTS: In both groups, there were significant positive correlations between BMD and tGMV/FHD, tGMV/BMI, and tGMV. When comparing the groups regarding total muscle volume, the muscle volume in the control group was significantly higher. CONCLUSION: According to this study, GMV have an impact on bone mineral density. The risk of hip fracture should not be assessed by only examining bone density in patients over 65 years of age. The clinical relevance is that increasing the gluteal muscle volume above cut-off value in elderly individuals may help to reduce hip fracture risk.
Keywords: Muscle volume, osteosarcopenia, osteoporosis, hip fracture
Abstract: BACKGROUND: Cervical pain is the biggest musculoskeletal health problem in industrialised countries. There is an important association between this and decrease in range of motion. OBJECTIVE: Estimate the validity and reliability intra and inter examiner of two Smartphone apps regarding the measurement of lower and upper cervical spine range of motion in subjects with chronic cervical pain. METHODS: A cross-sectional study was conducted. The sample consisted of 25 subjects with chronic cervical pain. An examiner made a measurement of the range of motion using the CROM device as a gold standard, afterwards, another…examiner did the same using a Smartphone, in order to establish validity. After this, the Smartphone examiner and a new examiner simultaneously conducted the intra and inter examiner reliability. RESULTS: Measurement of the lower and upper cervical spine range show an excellent validity (> 0.75), with an excellent intra and inter reliability (> 0.75) in all movements except flexion of upper cervical spine (0.75–0.65). CONCLUSION: The two Smartphone applications used in this study showed an excellent validity compared to the CROM. The intra and inter reliability is excellent for all movements, except for the upper cervical spine flexion.
Keywords: Range of motion, cervical spine, validity, reliability, CROM, inclinometer
Abstract: BACKGROUND: Although low back pain (LBP) is known to be multi-factorial, certain studies have suggested that a deficit in hip extension and rotation range of motion (ROM) may be associated with LBP in athletes. OBJETIVE: The purpose of this study was to compare hip extension and rotation ROMs in elite tennis players with and without a history of LBP. METHODS: Forty-two male and 22 female young elite tennis players completed this study. Participants were divided into two groups: (1) 32 with history of LBP and (2) 32 without history of LBP. Descriptive measures of…passive hip extension and rotation ROMs of the dominant and non-dominant limbs were taken. Active hip rotation ROMs were also assessed. Magnitude-based inferences on differences between groups and legs were made by standardizing differences. RESULTS: The inter-group statistical analysis reported no significant differences (p > 0.05; trivial effect with a probability higher than 95%; d ⩽ 0.4) in any ROM measure analyzed. Further, neither LBP group nor control group reported significant bilateral or side-to-side differences (p > 0.05; trivial effect with a probability higher than 99%; d < 0.3) between legs regarding hip extension and rotation ROM measures. CONCLUSION: No relationship between hip extension and rotation ROM and history of LBP was found.
Keywords: Injury prevention, tennis, rotation-related sports, muscle flexibility, flexibility training
Abstract: BACKGROUND: Exercises are usually prescribed in association with orthotic intervention for management of idiopathic scoliosis, however the role of these exercises on the efficacy of brace and/or balance is not clear yet. OBJECTIVES: To investigate the role of exercise (the Blount and Moe protocol) on static balance and Cobb angle changes in adolescents with spinal deformities during weaning from brace. METHODS: Seventeen brace users were allocated into 3 groups (good, moderate, and weak), according to their exercise quality and quantity static balance was evaluated on 4 conditions (standing on a platform/foam; with/without brace)…using a force platform. Center of pressure displacement parameters were compared among the 3 groups. The mean Cobb angles of scoliosis and kyphosis at the beginning of brace use and at the start of the weaning phase were compared in general and among the 3 analogous groups. RESULTS: No significant difference was found in the static balance parameters and also in Cobb angles among the 3 groups. However, scoliosis and kyphosis Cobb angles were improved significantly as a result of using the brace (p < 0.01). CONCLUSIONS: The exercise quantity and quality in association with bracing, up to the weaning phase, has no effect on static balance and changes in scoliosis and kyphosis, but the curvature of scoliosis and kyphosis is reduced after wearing a brace.
Keywords: Spinal deformity, Blount and Moe exercise, static balance, brace
Abstract: BACKGROUND: There is a lack of evidence in reliability of the modified sphygmomanometer to measure the brace-interface pad pressure in adolescents with Scheuermann’s kyphosis (SK). OBJECTIVES: To evaluate the intra- and inter-observer reliability of modified sphygmomanometer for measuring interface pad pressure in the Milwaukee brace. METHODS: Two observers measured the pressure of the shoulder and kyphosis pads in Milwaukee brace on 33 adolescents with SK with an average age of 14.67 ± 1.72 years and Cobb angle 64.48 ∘ ± 7.53 ∘…. All measurements were obtained in one day. The measurements were done in the inhalation and exhalation of tidal breathing during standing and sitting positions. The intraclass correlation coefficient (ICC), 95% confidence interval (CI), and linear mixed model ANOVA effects were calculated. RESULTS: The intra-observer reliability varied from a good ICC of 0.81 (0.66–0.90) to an excellent of 0.97 (0.95–0.98). The inter-observer reliability also varied from a good ICC of 0.82 (0.67–0.91) to an excellent of 0.96 (0.93–0.98). The linear mixed model ANOVA analysis showed that the rater, position, and breathing had a significant effect on the pad pressure measurements. CONCLUSIONS: The modified sphygmomanometer is a reliable tool to measure the pad pressure of the Milwaukee brace for adolescents with SK.
Abstract: BACKGROUND: Physiotherapy scoliosis specific exercises include exercises to attain and maintain proper posture, as well as flexibility movements such as stretching. OBJECTIVE: To examine the effect of prior muscle stretching on the performance of posture exercise in females with adolescent idiopathic scoliosis (AIS). METHODS: Eighteen females with AIS were randomly assigned to perform a posture maintenance task for three minutes preceded by either stretching protocol (group A) or no-stretching (group B). A second session was carried out after three days, where the same procedure was repeated in a reverse order between groups. During…each session, three outcomes were tested: the ability to complete the task, the ability to maintain postural body alignment, and the perceived effort. RESULTS: All participants completed the task in both sessions. Subjects’ ability to preserve the required lower trunk alignment decreased following stretching compared to no-stretching. Lower-trunk angle changed toward flexion by 10 ∘ and 4.3 ∘ respectively, p = 0.032. There was no difference in perceived effort. CONCLUSIONS: Prior muscle stretching has a negative effect on the ability to preserve body positional alignment during posture exercise. The present findings should be considered by practitioners when designing protocols for scoliosis-specific exercises. Stretching immediately prior to posture maintenance exercises should be avoided.
Abstract: Frozen shoulder is a common disorder characterized by pain and limitation of the glenohumeral joint motions. While it is usually clinically diagnosed, as it can also mimic several other painful shoulder pathologies, imaging techniques can contribute to the differential diagnosis. In the literature, static and dynamic ultrasonographic findings have been reported to better characterize this condition and plan for treatment. We studied a 50-year-old male patient with capsular stiffness of the shoulder on whom Ultrasound (US) examination was performed. Our study exemplifies another interesting ultrasonographic finding: during dynamic evaluation the “frozen” movements of the glenohumeral joint can simply be visualized.
Abstract: BACKGROUND: Sciatica of extraspinal origin represents both a diagnostic and a therapeutic challenge for spine specialists. Among these, quadratus femoris muscle (QF) is often overlooked as a pain-generator. REPORTED CASE: A 62-year old man was referred from general practitioner for isolated sciatica in the left leg, refractory to conservative treatments. Plain x-rays of the spine did not show any pathological finding nor did magnetic resonance imaging (MRI). MRI and CT showed QF with unusual morphologic features and agenesis of the contralateral QF. Ultrasonography-guided injection in the muscle was performed with mepivacaine and methylprednisolone obtaining relief of…the symptoms. DISCUSSION: Leg pain can be very disabling and, when combined with a normal MRI of the spine, diagnosis can be tricky. Several causes of sciatica of extraspinal origin have been described, some of them originating from the so-called “deep gluteal space”. Anecdotal communications on anatomical variations of the quadratus femoris muscle are reported in literature. CONCLUSIONS: Differential diagnosis of sciatica of extraspinal origin must rule out sacroiliac and hip joint so as deep gluteal space structures. Among these, quadratus femoris muscle is often overlooked as a pain-generator. Ultrasonography-guided intramuscular injections and a program of stretching and strengthening exercises can achieve durable control on the symptoms.
Keywords: Low back pain, extraspinal sciatica, quadratus femoris, deep gluteal space, ultrasonography-guided injections