Journal of Back and Musculoskeletal Rehabilitation - Volume 32, issue 5
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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: Low back and pelvic pain in pregnant women is a clinical condition of which the etiology is multifactorial. Thus, various variables can influence the low back and pelvic pain’s intensity. OBJECTIVE: The purpose of this study was to analyze the influence of the gestational trimester, practice of physical activity and weight gain on the intensity of low back and pelvic pain in low risk pregnant women. METHODS: Two hundred and sixty-seven pregnant women participated in this study. The gestational age, body mass index, weight gain, physical activity practice and the low back…and pelvic pain were evaluated. RESULTS: We found a significant difference (P = 0.02) in pain intensity, when comparing active and sedentary pregnant women. No significant differences were found when comparing pain intensity between the gestational trimesters (2 nd versus 3 rd ; P = 0.60). There was no significant relation between the weight gain and pain intensity (r = 0.03 | P = 0.28). The multivariate analysis indicated that sedentary pregnant women have a higher risk (P = 0.001) of intense pain and the pain is not influenced by the weight gain (P = 0.08) and the gestational trimester (P = 0.98). CONCLUSIONS: Sedentary pregnant women have 30% more chances to have higher pain intensities when compared to the active women, regardless of the gestational trimester and weight gain.
Keywords: Pregnancy, low back pain, gestational age, exercises, body weight
Abstract: BACKGROUND: Kinesiophobia is an important problem that increases neck pain and causes it to become chronic. OBJECTIVE: This study aims to compare the relationship between pain, quality of life, and kinesophobia in non-specific chronic neck pain. METHODS: In total 87 patients were included in the study. Pain was assessed with Visual Analog Scale (VAS), kinesiophobia with Tampa Kinesiophobia Scale (TKS), and quality of life with Health Status Questionnaire Short Form-36 (SF-36). RESULTS: The median age was 50 (40–59) years and the median complaint duration was 12 (8–48) months. The median…value of VAS at rest was 4 (2–6) and the median value of VAS during the activity was 7 (5–8). The median TKS scores were 41 (39–45), the median SF-36 general health scores were 61 (45–75), and the median SF-36 mental health scores were 72 (52–80). There was a weak correlation between the TSK scores and gender, education level, and SF-36 general health scores (r = 0.206, p = 0.023; r = - 0.235, p = 0.004; r = 0.236/p = 0.027 respectively). There was no relationship between kinesiophobia and the other variables. CONCLUSION: TSK scores showed a correlation with gender, education level, and SF-36 general health scores. We conclude that as the education level decreases, kinesophobia scores increase, and as kinesophobia scores increase, the quality of life decreases.
Keywords: Neck pain, kinesiophobia, quality of life
Abstract: BACKGROUND: The short foot (SF) exercise is a strengthening exercise for the intrinsic foot muscles that is difficult to master. OBJECTIVE: To examine the effect of three different electromyographic (EMG) biofeedback methods on learning the SF exercise. METHODS: Thirty-six healthy subjects were randomly allocated to the control group (CTG), EMG-controlled electrical stimulation group (ESG), visual EMG biofeedback group (VSG), and combination EMG-controlled electrical stimulation with visual EMG biofeedback group (CBG). The CTG practiced the SF exercise for 5 minutes using the conventional method. The other groups each used the EMG biofeedback method and…the conventional method. The EMG activity of the abductor hallucis (ABH), the medial longitudinal arch (MLA) angle, and the foot length during the SF exercise were measured before and after 5 minutes of practice. RESULTS: The EMG activity of the ABH in the VSG and CBG was significantly higher than that before practice. There were no intergroup differences in MLA morphology. CONCLUSIONS: These results suggest that visual EMG biofeedback is an effective method of increasing the EMG activity of the ABH during the SF exercise in a short practice time.
Abstract: BACKGROUND: Pelvic girdle pain (PGP) is a significant problem that affects daily living activities in postpartum women. OBJECTIVE: This study aimed to investigate the effect of stabilizing exercises with or without pelvic floor muscles (PFM) training on pain, functional disability, trunk range of motion (ROM) and PFM strength in women with PGP. METHODS: Forty postpartum women participated in the study. Their age ranged from 25–35 years and their body mass index (BMI) was 25–29.9 kg/m 2 . They were randomly assigned into two groups equal in number. Group (A) received…local stabilizing exercises, while group (B) received stabilizing exercises and PFM training. Pain, functional disability, trunk ROM and PFM strength have been evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI), Schober test and Kegel periniometer respectively. RESULTS: Both groups (A and B) revealed a significant decrease (p = 0.001) in pain and functional disability and a significant increase (p = 0.001) in trunk ROM and PFM strength. However, group (B) showed a significant decrease (p = 0.001) in pain, and functional disability and a significant increase in PFM strength when compared with group (A). CONCLUSIONS: PFM training should be an essential part in rehabilitation programs of PGP postpartum.
Abstract: BACKGROUND: Non-surgical treatment is the primary approach to degenerative conditions of the lumbar spine and may involve multiple modalities. There is little literature to guide an evidence-based approach to care. OBJECTIVE: To determine the effectiveness of CNT (comprehensive non-surgical treatment) in patients with degenerative spondylolisthesis (DS) and spondylolytic spondylolisthesis (SS), and to identify predictor variables for success of CNT in avoiding surgery. METHODS: All patients who underwent CNT for spondylolisthesis (n : 203) were included. CNT consisted of patient education, pain control with transforaminal epidural steroid injections (TFEs) and/or medications, and…exercise programs. RESULTS: Surgical and non-surgical patients were similar in age, smoking status, comorbidity scores, facet joint widening, and translation of spondylolisthesis. After CNT, only 21.6% of patients with DS and 31.3% of patients with SS chose to have surgery in 3-years follow-up. The non-surgical group reported significantly better pain relief (73.6% vs 55%) after TFEs for a longer period (152.8 vs 45.6 days) and lower opioid use than the surgical group (28.2% vs 55.3%). CONCLUSIONS: CNT is effective in spondylolisthesis and more successful in DS than SS. CNT may decrease the need for surgery, particularly in patients who report pain relief greater than 70% for average five months after TFEs.
Keywords: Spondylolisthesis, back pain, epidural, steroids, non-surgical treatment
Abstract: OBJECTIVE: The purpose of this study was to apply the Brief International Classification of Functioning (ICF) Core Set for Hand Conditions to the physical therapy outcome measures, and to evaluate the contribution of these measures to overall health in subjects with ulnar wrist pain. METHODS: Thirty-five subjects with ulnar wrist pain received a 4-week home-based treatment program including orthotics and strengthening exercises. Investigators measured pain, function, grip strength, and overall health four weeks post-intervention. Regression analysis was used to investigate the effect of these variables on overall health represented by the Short Form (SF-36) questionnaire.…RESULTS: Fifty-three percent of the variability in SF-36 physical health summary scores was explained by the studied variables with grip strength predicting 31% of the variability. CONCLUSIONS: The Brief ICF Core Set for Hand Conditions can be a useful abridged list of categories relevant to functioning and health in subjects with ulnar wrist pain.
Keywords: Ulnar wrist pain, Brief International Classification of Functioning Core Set, hand conditions, physical therapy
Abstract: BACKGROUND: Pain from myofascial trigger points is often treated by dry needling (DN). Empirical evidence suggests eliciting a local twitch response (LTR) during needling is essential. Muscle damage after eliciting LTR can increase the risk of tissue fibrosis in some cases. OBJECTIVE: This study aimed to compare two methods of DN including with and without LTR on clinical parameters. METHODS: Twenty-six participants suffering from chronic non-specific neck pain with an active trigger point (TrP) in their upper trapezius muscles were recruited via the convenience sampling method. Participants were randomly assigned in DN with…LTR (control group) and without eliciting LTR or “de qi” (experimental group). Then, they received 3 sessions of dry needling, 3 days apart. We evaluated pain, pain pressure threshold, active cervical lateral flexion range of motion, and Neck Disability Index before the intervention and 4 weeks after the treatment. RESULTS: After the treatment, significant higher changes were seen in the experimental group compared to the control group (p < 0.05) regarding pain, pain pressure threshold, and active cervical lateral flexion. However, there was no significant difference between groups according to the disability (p > 0.05). CONCLUSION: DN without eliciting LTR has superiority over the DN along with eliciting LTR while the treatment aimed to receive long-term effects.
Keywords: Trigger point, upper trapezius, dry needling, local twitch response, “de qi”
Abstract: BACKGROUND: Neural mobilization is an effective technique in the management of cervical radiculopathy (CR). However, the difference between active versus passive upper extremity (UE) neural mobilization techniques in the management of cervical radiculopathy is not well established. OBJECTIVE: To determine the role of active versus passive UE neural mobilization in females with cervical radiculopathy. METHODS: A double blind randomized controlled trial was conducted at Shifa International Hospital from Sep 2016 to Feb 2017, and 44 females were included and randomized into 2 groups, receiving 12 treatment sessions in total. Group A received active…whereas Group B received passive UE neural mobilization, along with cervical traction and Unilateral Posterior Anterior (UPA) glide regardless of the group. Numeric pain rating scale (NPRS), Neck Disability Index (NDI) and cervical range of motion (ROM) were used as outcome measurement tools. Non-parametric tests of significance were used for inter group and intra group comparison (Mann-Whitney U test and Wilcoxon test). RESULTS: A statistically significant difference was observed between pre and post NPRS, NDI and ROM scores after 4 weeks of treatment for both groups (p < 0.05). However, no significant differences were observed in post treatment scores of active and passive neural mobilization groups (p > 0.05). CONCLUSION: Both active and passive neural mobilization is effective in the management of cervical radiculopathy. One of the interventions is not superior to the other.
Abstract: BACKGROUND: Body height (BH) measurement is an important part of the clinical evaluation of children with idiopathic scoliosis (IS) as its progression is defined based on the observation of a growth spurt. OBJECTIVE: The aim of the study is to assess diurnal variation of BH in children with IS. METHODS: BH was measured in 98 children with IS (Cobb angle: 10 ∘ –52 ∘ , mean 21.2 ∘ ± 9.9 ∘ ) both in standing and sitting position. The…measurements were performed 4 times a day – between: (1) 7:00 and 8:00; (2) 11:00 and 12:00; (3) 15:00 and 16:00 and (4) 19:00 and 20:00. RESULTS: A significant decrease in BH during the day was observed in both standing and sitting positions (p < 0.001). The highest decrease in height was observed between the measurements performed between 7:00 and 8:00 and measurements carried out in the evening (19:00–20:00). For standing, the mean loss of height was 0.7 cm (± 0.7), i.e. 0.43% of initial standing height, for sitting the mean decrease in height was 0.7 cm (± 0.7), i.e. 0.79% of initial sitting height. CONCLUSIONS: BH decreases in children with IS during daytime. Due to diurnal BH variation, the time of the day should be recorded when measuring patients with IS.
Keywords: Idiopathic scoliosis, body height, diurnal variation, treatment, evaluation, progression
Abstract: BACKGROUND: There are no Colombian studies published that assess non-specific low back pain (NSLBP) risk factors in children. OBJECTIVE: To determine the factors associated with NSLBP in 73 children (19.2% girls) aged 10–12 years in one military school in Bucaramanga, Colombia. METHODS: A questionnaire was used to obtain information of risk factors. Subsequently, children’s weight and height were measured. The backpack was weighed at the beginning of each day from Monday to Friday. Crude and adjusted prevalence ratios were calculated, with their respective 95% confidence interval (CI). RESULTS: The one-month…prevalence of NSLBP was 39.7% (95% CI 28.4–51.9). In the multivariate analysis, carrying backpacks wearing between 12% and 20% of body weight, having a perception that the backpack is very heavy, and being a passive smoker increase the likelihood of NSLBP, while being 11-year-old compared to 10-year-old decreases the likelihood of having NSLBP, adjusted for gender, body mass index, and history of LBP in parents. CONCLUSIONS: High prevalence of low back pain was found in children between 10 and 12 years old. The study of the decisive factors of low back pain is important to identify children at risk, as well as to develop efficient primary prevention programs.
Keywords: Backpack, children, low back pain, risk factors