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 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