Journal of Back and Musculoskeletal Rehabilitation - Volume 32, issue 6
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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: Patellofemoral pain syndrome (PFPS) is one of the most common knee disorders affecting women. OBJECTIVE: The purpose of this study was to investigate the effects of balance taping on PFPS. METHODS: Balance taping using kinesiology tape was applied for 2.5 months (average of 16 h/day) to both knees in a 26-year-old female nurse with bilateral PFPS. RESULTS: The congruence angle decreased in the right and left knees from 30 ∘ to 5 ∘ and from 20 ∘ to 5 ∘…, respectively. The Patient Specific Functional Scale score increased from 17/50 to 50/50, indicating improved functional state of the knees, while the Numeric Pain Rating Scale scores for from sitting to standing, from standing to sitting, and kneeling improved from 6/10 and 0/10, indicating no pain in the knee joints. Application of repeated balance taping for 2.5 months reduced PFPS. CONCLUSION: Considering the outcome of the study, we recommend balance taping as a complementary treatment method for PFPS.
Abstract: BACKGROUND AND OBJECTIVE: Musculoskeletal problems are a common health problem with professional and ergonomic features. This study’s purpose was to investigate the musculoskeletal problems distribution and related factors among academicians. METHODS: This study was performed by using a personal and professional information questionnaire, the Extended Nordic Musculoskeletal Questionnaire and International Physical Activity Questionnaire Short Form. RESULTS: The study was completed with 142 academicians (89 female, 53 male). Mean age was 39.91 ± 8.90 years, physical activity level was 1067.31 ± 1866.95 MET-minute/week, and work time was 13.73…± 9.15 years. Neck and lower back pain were mostly seen in academicians and their incidence was equal (63.4%). The most experienced pain the previous year was neck pain (39.4%), and upper back pain is the most experienced pain today (19%). The body part that mostly caused the use of medication is neck pain (23%), and mostly caused limitation and sick-leave was low back in the past 12 months (respectively 19.7% and 9.2%). Gender, body mass index, weekly workload, physical activity level, and marital status have been determined to have an effect on musculoskeletal problems in academicians (p < 0.05). CONCLUSION: The most common musculoskeletal problems reported by academicians were in the upper back and neck regions, which have low level physical activity.
Abstract: BACKGROUND: Within the thenar eminence, the median nerve innervates three muscles: abductor pollicis brevis (APB), flexor pollicis brevis (FPB), and opponens pollicis (OP). Of these muscles, APB was often considered as the sole contributor to the thenar compound muscle action potential (CMAP). OBJECTIVE: To evaluate subcomponents of the thenar CMAP from the median nerve innervated muscles. METHODS: Surface and needle CMAPs were recorded in normal human subjects from three recording sites: proximal (site-I), middle (site-II), and distal (site-III) aspects of the thenar eminence when the median nerve was activated at the wrist.…RESULTS: In the site-I and -II, both the surface and needle CMAPs shared many similar characteristics although the needle CMAPs were larger (∼ 5 folds) and briefer (∼ 60%, needle/surface duration). In addition, on the surface recording, the CMAP was larger (by ∼ 1.9 mV) when recorded from the site-I comparing to that of the site-II. In the site-III, the surface recordings registered a delayed (by ∼ 3.8 ms) CMAP. The muscle fiber action potential (MFAP) study suggested a predominant FPB contribution in the site-III. CONCLUSION: The optimal recording site for APB derived thenar CMAP is the site-I and for FPB is the site-III. The CMAPs registered by the needle recordings are more robust than the surface ones.
Abstract: BACKGROUND: Changes in the motor control of the spine were found in patients with chronic low back pain (CLBP). Sudden loading of the spine is supposed to be the cause of about 12% of lower back injuries. However, some aspects of this problem, such as alterations in the sensory-motor control of the spine, remain questionable. OBJECTIVE: To investigate the effects of familiarization with loading, weight and size of loading on neuromuscular responses during sudden upper limb loading in CLBP patients. METHODS: In this quasi-experimental study surface electromyography of the erector spinae (ES) and…transverses abdominis/internal oblique (TrA/IO) and external oblique (EOA) muscles were recorded in 7 men and 13 women with CLBP and 20 asymptomatic subjects (10 men and 10 women) aged 18–45 years from the general community familiarization. Moreover, investigating control of the posture measurements of the center of pressure (COP) and vertical ground reaction force (GRF) or Fz were recorded using a force plate. Data were analyzed using paired t -test and independent t -test with the significance level of 0.05. RESULTS: Data analyses were performed using SPSS version 18. Some electromyography and force plate variables were significantly different for different conditions in each group and between the asymptomatic and low back pain groups (p ⩽ 0.05). CONCLUSION: Several motor control changes were observed in the CLBP patients. These patients showed decreased trunk muscle activity as well as too early and too delayed responses compared to asymptomatic subjects.
Keywords: Chronic low back pain, surface electromyography, posture
Abstract: BACKGROUND: Changes in postural stability may be a reason for injuries in individuals who have altered musculoskeletal alignment. Q angle (QA) has shown to be a predictor for lower extremity injuries. However, the relationship between balance and QA has not been investigated in young adults. OBJECTIVE: The aim of the study was to investigate the relationship between QA and balance in young adults. METHODS: Ninety participants performed the single leg stance test (SLST) and Star Excursion Balance Test (SEBT) to assess static and dynamic balance, respectively. QA was measured using a manual goniometer.…Participants were divided into low, normal and high QA groups. RESULTS: The relationship between SLST and QA was not statistically significant in both eyes opened and closed condition (r = - 0.030, p = 0.782; r = 0.031, p = 0.774; respectively). SLST scores did not differ among the three groups in both eyes opened and closed condition (p = 0.781, p = 0.790; respectively). QA significantly correlated with lateral, posterolateral directions and sum score of SEBT (r = 0.240, p = 0.023; r = 0.269, p = 0.010; r = 0.210, p = 0.047). The comparisons among the low, normal and high Q angle groups’ SEBT scores showed that balance performance in lateral direction was poorer in low QA group (p = 0.027). CONCLUSIONS: The results of the study showed that QA and dynamic balance have a significant relationship. To reduce musculoskeletal injury risk, the dynamic balance should be assessed in young adults who have lower QA.
Keywords: Q angle, lower extremity, star excursion balance test, single leg stance test
Abstract: BACKGROUND: Unstable neck posture, muscle imbalance, and segmental instability can cause neck pain and decrease the respiratory function. OBJECTIVE: To examine effects of a neck stabilization exercise on respiratory muscle activity and maximal voluntary ventilation (MVV) in patients with a chronic stroke. METHODS: A total of 40 patients with a chronic stroke participated in this study. They were randomly divided into two groups (20 in each group). However, ten patients dropped out of the experiment (5 in each group). The experimental group (n = 15) performed a 15-minute…neck stabilization exercise and a 15-minute breathing retraining exercise in addition to a rehabilitation exercise treatment. The control group (n = 15) completed a 30-minute breathing retraining exercise in addition to a rehabilitation exercise treatment. Exercises were conducted for 30 minutes a day, five times a week, for a total of six weeks. Activities of major respiratory muscles and MVV were measured before and after the experiment. RESULTS: Both the experimental group and the control group showed significant difference in activities of major respiratory muscles and MVV before and after the experiment (p < 0.05). The experimental group showed a significantly higher increase compared to the control group (p < 0.05). CONCLUSIONS: The application of a combination of a neck stabilization exercise and a breathing retraining exercise to patients with a chronic stroke can increase activity of respiratory muscles and MVV.
Abstract: BACKGROUND: Spinal disorders are common health problems which include wide categories of diseases that affect the spinal soft tissues, joints and bone. OBJECTIVE: The aim of this systematic review was to evaluate the effectiveness of high intensity laser therapy (HILT) on pain and function in patients with spinal disorders. METHODS: Six databases were searched up to the end of February 2018 including PubMed, MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), Open Grey and Grey Literature Report. In addition, the reference lists of all included studies were searched…for any relevant studies. PEDro scale and GRADE system were performed to assess the quality of the studies. A meta-analysis was conducted to calculate the overall effect size. RESULTS: A total of ten randomised controlled trials (RCTs) met the inclusion criteria, with four studies of the efficacy of HILT on neck pain (NP) and six on low back pain (LBP). According to the PEDro scale assessment, only two studies were rated as high quality, while the remainder were rated as fair or low quality. Forest plots showed that HILT with exercise was significantly more effective than placebo HILT with exercise in terms of pain reduction (SMD - 1.11; 95% CI - 1.42 to - 0.80; P < 0.00001; I 2 0%) and functional improvement (SMD - 1.03; 95% CI - 1.33 to - 0.72; P < 0.00001; I 2 0%). Meta-analyses also showed that HILT alone or HILT with conventional physiotherapy (CPT) significantly provided better outcomes than CPT alone. CONCLUSIONS: HILT is considered as a complementary modality for pain reduction and function improvement in patients with spinal disorders. However, the quality of the body of evidence was rated from ‘very low’ to ‘low’ quality. Further high quality trials are required for standardisation of irradiation parameters and the treatment protocol to establish the efficacy of HILT for spinal disorders.
Keywords: High intensity laser therapy, rehabilitation, spinal disorders, neck pain, low back pain
Abstract: BACKGROUND: Healthy individuals who develop low back pain (LBP) during standing (standing intolerant) respond favorably to stabilization-based exercise interventions. People with clinical LBP meeting clinical prediction rules for stabilization-based exercise share characteristics with standing intolerant individuals. OBJECTIVE: To investigate the impact of stabilization-based exercise on standing tolerance, muscle activation and clinical measures in individuals with LBP meeting clinical prediction rules for stabilization-based exercise. METHODS: Participants with and without LBP completed testing pre- and post-6 weeks of progressive home exercise intervention. Testing included clinical examination and electromyography during sagittal and frontal plane movements. LBP…was also assessed by visual analogue scale (VAS) during standing. Outcomes included clinical findings, muscle sequencing, and VAS in standing. RESULTS: The LBP group had non-significant decreases in Oswestry Disability Index (- 2.1%, p = 0.22), baseline VAS (- 7.1 mm, p = 0.11), lumbopelvic reversal (p = 0.06) and positive active hip abduction test (p = 0.06). Significant improvements were seen in standing VAS (- 5.6 mm, p < 0.001). The LBP group had beneficial changes in activation strategies in standing flexion (p < 0.05) following intervention, with no changes during frontal plane movement strategies. CONCLUSIONS: Individuals with LBP meeting clinical prediction rules for stabilization-based exercise demonstrated increased standing tolerance and sagittal plane muscle sequencing following a 6-week intervention.
Keywords: Low back pain, prolonged standing, stabilization exercise, muscle activation
Abstract: BACKGROUND AND OBJECTIVES: Bone marrow oedema is a multifactorial conditioned illness. Alongside any strain relief of an affected joint, treatment with Iloprost also belongs to the choice of cures. In past studies, a modulatory effect on bone could be shown. The hypothesis of the present work is that Iloprost has a growth-stimulating effect on osteoblasts in vitro . METHODS: Human osteoblasts were isolated and cultivated. Subsequently, the cells were treated with Iloprost in bioavailable concentrations. Alterations of the cell structure were examined by means of light microscopy. A regulation of the number of vital cells was…carried out by using a CASY cell counter. Possible cell impairment after Iloprost treatment was analysed by means of XTT Elisa as well as FDA and PI staining via fluorescence microscopy. RESULTS: Using light microscopy, no changes in cell structure could be observed. With the CASY cell counter, no increase in the numbers of osteoblasts appeared after Iloprost treatment. Also, XTT Elisas and fluorescence microscopy did not reveal any cell impairment due to Iloprost. CONCLUSION: Our results could not confirm a modulatory effect in mature osteoblasts. On the basis of the present work we could not verify any growth-stimulating effect by Iloprost in mature osteoblasts in vitro . Admittedly, effects had been shown previously during osteogenesis, but we do exclude an effect on mature osteoblasts which have already differentiated.
Keywords: Iloprost, bone marrow edema, osteoblasts, in vitro
Abstract: BACKGROUND: Recently, a variety of virtual reality (VR)-based interventions have been studied. However, they were only partially applied to physical therapy. OBJECTIVE: The present study investigated the effects of a VR exercise program by comparing the results of VR and conventional exercise on balance in patients with functional ankle instability (FAI). METHODS: Twenty-one participants with symptoms of FAI participated in this study. In the VR training program, the strength and balance exercises were done for 10 minutes each using a program included in the Nintendo Wii Fit Plus for VR intervention. In the…conventional program, four ankle strength exercises using the TheraBand and the balance exercises were performed for 10 minutes each. Static and dynamic balance were measured in the overall, anterior-posterior, and medial-lateral directions. RESULTS: Static balance in the VR exercise was significantly lower in the overall direction than in the conventional exercise. Dynamic balance in the virtual reality exercise was significantly lower than in the conventional exercise at level 2, level 4, and level 8 balance in the medial-lateral direction. CONCLUSIONS: This study has shown that VR exercise is more effective in the overall direction (static) and medial-lateral direction (dynamic) of balance than conventional method in patients with FAI.
Abstract: BACKGROUND: The optimal rehabilitation program for patients with post-total hip arthroplasty (THA) after developmental dysplasia of the hip (DDH) remains unclear. OBJECTIVE: The aim of the present study was to evaluate the clinical outcomes, to define a postoperative rehabilitation program, and to report the complication rate of THA in patients with DDH. METHODS: DDH hips (n = 89) were recruited. The transverse proximal femoral shortening osteotomy was applied to all patients. The rehabilitation program was performed on the first day immediately after operation to the 6 th…week. Pain was assessed via Visual Analogue Scale, and the function was evaluated by the Harris Hip Score at the end of the 3 rd month and the first year. The weakness of hip abduction was assessed via the Trendelenburg test before the operation and at one year. RESULTS: Statistically significant improvements were seen for pain (p < 0.001) and function (p < 0.001) in the third month. This improvement continued for pain from three months to one year (p < 0.001). However, the function did not increase from month three to one year (p = 0.47). The Trendelenburg test was positive in all cases in the first assessment; it decreased to 24.7% at one year. The complication rate was 11.23%. CONCLUSIONS: The pain and function of patients who performed exercise following THA due to DDH might improve, especially in the first three months.
Keywords: Pain, function, arthroplasty, exercises, rehabilitation, hip, developmental dysplasia of the hip
Abstract: BACKGROUND AND OBJECTIVE: This study determined the hand muscle strength parameters and reference values in healthy subjects using the Nicholas Manual Muscle Tester (NMMT) and Manual Muscle Test (MMT) and compared these methods. METHODS: The study was carried out with 200 (102 males, 98 females) healthy adults aged between 18–25 years. Muscle strength evaluations of the hand were performed to determine hand motor ability using both NMMT and MMT. RESULTS: The mean values of age, weight, height and body mass index (BMI) were 19.48 ± 0.95 years, 60.66 ±…8.82 kg, 165.30 ± 7.95 cm and 22.14 ± 2.25 kg/m 2 , respectively, in females, whereas the same values were found as 20.40 ± 1.34 years, 72.53 ± 9.45 kg, 176.20 ± 6.29 cm and 23.25 ± 2.90 kg/m 2 , respectively, in males. There was a statistically significant difference in all demographic data between genders (p < 0.05). Furthermore, correlation coefficient in NMMT was found to be between 0.503 and 0.954. However, there was no correlation between the MMT and NMMT results. CONCLUSION: The observations presented need to be taken into consideration for evaluate musculoskeletal problems and also can be used as reference values for evaluating treatment outcomes.
Keywords: Nicholas Manual Muscle Tester, hand muscles, muscle strength, Manual Muscle Test
Abstract: BACKGROUND: The optimum repetition number of standing back-extension exercise (SBEE) effective for the prevention and improvement of low back pain (LBP) is unknown. OBJECTIVE: To determine the effect of physiotherapy on LBP by investigating the optimum repetition number of SBEE via optical analysis and electromyographic (EMG) examination of the multifidus muscles. METHODS: Hemodynamics and multifidus muscle activity were examined in 16 healthy adult men using near-infrared spectroscopy and surface EMG after performing repetitive SBEE. RESULTS: Oxidized hemoglobin (Oxy-Hb) levels significantly increased in the second extension phase but decreased in the…third and subsequent extension phases; deoxidized hemoglobin (deOxy-Hb) levels increased in the third and subsequent extension phases. In the standing phase, no significant difference was observed; in the third and subsequent phases, Oxy-Hb levels decreased and deOxy-Hb levels increased. Muscular activity significantly decreased in the second standing phase but increased in the third and subsequent phases. No significant difference was observed in the extension phase with respect to the number of SBEE repetitions performed. In healthy individuals, hemodynamics improved up to second repetition of SBEE; subsequent repetitions may decrease hemodynamics because of increased activity of the multifidus muscles. CONCLUSIONS: In healthy individuals, hemodynamics improved up to second repetition of SBEE.
Keywords: Near-infrared spectroscopy, low back pain, standing back-extension exercise
Abstract: BACKGROUND: The quality of life of breast cancer survivors who had a mastectomy may decrease due to potential physical problems and reduced upper extremity functions. OBJECTIVE: This study aimed to compare the physical characteristics, upper extremity functions and quality of life of breast cancer survivors and healthy women. METHODS: A total of 66 women participated in this study: breast cancer survivors (n = 33) and healthy counterparts (n = 33) participated in this study. The Lateral Scapular Dyskinesia Slide Test was used to…evaluate scapular dyskinesia, the hand-held dynamometer was used to measure upper extremity muscular strength, the Angle Reproduction Test was used to measure upper extremity position sense, the Disabilities of the Arm, Shoulder and Hand questionnaire was used to assess upper extremity functions, and the Short Form-36 was used to assess the quality of life. RESULTS: The findings showed that the prevalence of scapular dyskinesia was higher, whereas upper extremity muscle strength, shoulder joint position sense, upper extremity functions and many sub-dimensions of quality of life were reduced in breast cancer survivor women compared to the healthy women (p < 0.05). CONCLUSIONS: Several physical characteristics, upper extremity functions and quality of life of breast cancer survivor women who had a mastectomy were affected more in comparison to healthy women. Thus, these parameters should be included in physiotherapy assessment and treatment programs.
Keywords: Breast cancer survivor, scapular dyskinesia, muscle strength, position sense, functions, quality of life
Abstract: Arthrofibrosis is a common complication for patients with bone fracture following external and internal fixation. In this review, we summarize the related factors and significant pathways for joint adhesion following fracture surgery. Moreover, the different types of treatments and related preventive measures are also discussed. Many factors related to the development and treatment of arthrofibrosis are discussed in this review in order to provide possible clues for the prospective targets to develop new medication or treatments for preventing or reducing the joint adhesion following orthopedic surgery.
Abstract: This narrative review will summarise a clinical approach to the investigation of back pain in children and adolescent patients, including a discussion of the epidemiology, presentation, investigation and clinical management of back pain in children and adolescents. This will assist the prompt and accurate diagnosis of spinal disorders that require significant medical intervention. Existing evidence suggests a relatively high incidence of non-specific back pain among young people; 27–48% of presentations of back pain in children and adolescents are attributed to non-specific back pain. Low back pain among schoolchildren is often linked to psychosocial factors and only occasionally requires medical attention,…as pain is benign and self-limiting. Nonetheless, those young patients who seek medical assistance exhibit a higher incidence of organic conditions underlying the major symptom of spinal pain. A cautious and comprehensive strategy – including a detailed history, examination, radiographic imaging and diagnostic laboratory studies – should be employed, which must be accurate, reliable, consistent and reproducible in identifying spinal pathologies. A specific diagnosis can be reached in 52–73% of the cases. For cases in which a specific diagnosis cannot be made, re-evaluation after a period of observation is recommended. At this later stage, minor symptoms unrelated to underlying pathology will resolve spontaneously, whereas serious pathologies will advance and become easily identified.
Keywords: Back pain, clinical assessment, management, children, adolescents