Journal of Back and Musculoskeletal Rehabilitation - Volume 33, issue 1
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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: Auditory feedback enables an individual to identify and modify the differences between actual and intended movement during the motor learning process. OBJECTIVE: We investigated the effects of gait training with auditory feedback on trunk control, muscle activation, and dynamic balance in patients with hemiparetic stroke. METHODS: Twenty participants with hemiparetic stroke were recruited in this study and randomly assigned to the experimental (n = 10) or control (n = 10) group. The subjects in the experimental group participated in gait training with…auditory feedback for 30 minutes, 5 times a week, for 4 weeks, whereas those in the control group received conventional gait training for 30 minutes, 5 times a week, for 4 weeks. During auditory feedback training, a beeping sound is produced every time a patient loaded weight that was higher than the preset threshold on the cane. Activation of the erector spinae muscle was measured using surface electromyography, and trunk control was evaluated using the Trunk Impairment Scale (TIS). Dynamic balance was measured using the Timed Up and Go (TUG) test. RESULTS: Muscle activation was significantly higher in the experimental group than in the control group (6.6 ± 9.2% vs 1.4 ± 5.4% nonparetic peak activity). No significant difference was found in the TIS score between the experimental and control groups. Based on the TUG test, a significant improvement was observed in the experimental group compared to the control group (12.1 ± 11.4 vs 3.8 ± 4.7 s). CONCLUSION: Our findings indicate that gait training with auditory feedback was beneficial for improving trunk control and muscle activation in patients with hemiparetic stroke.
Keywords: Biofeedback, cane, stroke, trunk control
Abstract: OBJECTIVE: To evaluate the longitudinal effect of a group physical activity service to help patients self-manage un-resolving back pain. BACKGROUND: Back pain is one of the most common and costly conditions. Large scale trials have demonstrated a role for less traditional treatment including exercise, yet the long term effects of patient centred, group physical activity programmes remains unclear. METHODS: One hundred and eighty-one un-resolving back pain patients (aged 53 ± 17 years) completed a 6 × 2 h physical activity programme. All activities were relevant to activities of…daily living and incorporated activities to develop aerobic fitness, flexibility, core activation, and muscular strength and endurance. Dietary advice, home diaries and pedometers were provided. RESULTS: Measures of back pain, aerobic fitness, muscular endurance and body composition showed significant (p < 0.05) pre-post intervention improvements. Disability rating decreased by 19% alongside improvements in aerobic fitness (15%), back extension (36%) back flexion (16%) and grip strength (5%). Six month follow up identified (p < 0.05) reductions in body fat (6.5%) whilst aerobic fitness, disability rating and muscular strength and endurance remained stable. CONCLUSION: Group physical activity programmes could contribute to the self-management of back pain, enabling sustained improvements in fitness, physical activity and body fatness.
Keywords: Physical activity, back pain, disability, self-management, group exercise, fitness
Abstract: BACKGROUND AND OBJECTIVES: Neurodynamic techniques are used to restore neural functions. However, there are few studies about the effects on performance. The aim of this study was to investigate the immediate effects on vertical jumping (VJ) and horizontal jumping (HJ) of 2 different tension loading techniques applied to young adults. MATERIAL AND METHOD: In this randomised double-blind study, a total of 68 participants with a mean age of 21.31 ± 1.21 years were separated into 2 groups using the closed envelope system: the femoral nerve mobilization (FNM) group and the sciatic nerve mobilization…(SNM) group. The FNM and SNM techniques were applied as 2 seconds stretching with 2 seconds resting for 10 repetitions. The VJ and HJ performance of the participants was evaluated before and after the interventions by a researcher blinded to the groups. RESULTS: The mean VJ performance before and after interventions was measured as 34.56 ± 7.80 cm and 35.89 ± 8.15 cm in the FNM group (p < 0.05) and 31.74 ± 8.31 cm and 32.76 ± 8.45 cm in the SNM group (p < 0.05). The effects of the techniques on HJ performance were not statistically significant (p > 0.05). There was no superiority between the techniques (p > 0.05). CONCLUSION: The neurodynamic techniques were found to provide an immediate increase in VJ performance. Neurodynamic techniques are generally used in patient populations to improve treatment outcomes. According to these study results, neurodynamic techniques can be safely used to provide an immediate increase in performances of individuals with no lower extremity problems.
Abstract: BACKGROUND: Heating the skin and muscles is a commonly accepted method of pain relief and a modality to increase relaxation in muscles and increase tissue blood flow. OBJECTIVE: The purpose of the present study was to examine the effect of local heat applied to trigger points and to determine if there was pain relief in the neck and plantar fascia. METHODS: Forty adults were divided into 2 different groups according to their pain; twenty subjects had plantar foot pain and the other 20 had nonspecific neck pain. The 20 subjects in each group…were randomly subdivided into a heat and a sham group. Sensitivity to pressure was measured with an algometer. A stopwatch was given to the subject and started when either the heat patch or placebo was applied. Heat cells were applied at trigger points on the pain area. RESULTS: Subjective pain significantly decreased in both sham and heat group patients with neck pain (p < 0.05), however, the change was greater in the heat group and there was a significant difference between the heat and sham groups (p = 0.002, d = 0.81). For the plantar pain group, a significant decrease in subjective pain was found in the heat group but not in the sham group. Pressure pain threshold significantly decreased in the heat group patients both with neck and plantar pain but for the sham group there was an increase in the pressure after sham treatment. Pain relief during the intervention was also significantly different between the heat and sham group in both patients with neck and plantar pain. CONCLUSION: The effect of local heat on trigger points of the body on pain relief was significantly better in the heat groups than in the sham groups. This finding is significant because using heat on trigger points could be an alternative to dry needling performed by healthcare professionals. This modality can be alternative for home use and avoids opioids.
Keywords: Heat, neck, pain, plantar fascia, trigger point
Abstract: BACKGROUND: Spinal sagittal imbalance caused by degenerative changes or iatrogenic factors in the elderly can cause symptoms such as anteversion and low back pain (LBP). There are different and conflicting opinions about the relationship between the degree of lumbar lordosis and functional status of patients with chronic low back pain (CLBP). OBJECTIVE: This study aimed to determine the relationships among the lumbar lordosis index, sacral horizontal angle, and CLBP in the elderly. METHODS: Subject data were collected from Lishui City, Zhejiang Province, China, using cluster sampling according to the background information provided by…national physical fitness monitoring. The 207 subjects were urban and rural individuals, 60–69 years old. Radiographs were evaluated according to a standardized protocol. The lumbar lordosis index and sacral horizontal angle were recorded. Data on the prevalence and functional status of CLBP were collected through field investigations. Statistical correlations between the radiographic parameters and the prevalence and functional status of CLBP measurements were evaluated. RESULTS: No significant difference was observed in the sacral horizontal angles among the subjects with and without CLBP; however, the lumbar lordosis index of CLBP subjects was significantly higher than that of those without CLBP (P = 0.028) and showed a significant association with CLBP (P = 0.013). Neither the sacral horizontal angle nor the lumbar lordosis index showed significant correlations with the Oswestry Disability Index in CLBP subjects. CONCLUSIONS: The lumbar lordosis index, but not the sacral horizontal angle, was significantly associated with CLBP in the subjects.
Keywords: Chronic low back pain, elderly, sacral horizontal angle, lumbar lordotic index
Abstract: PURPOSE: To analyze the relevance between serum IL-6 with the early postoperative (post-op) knee joint range of motion (ROM) in the elderly undergoing total knee arthroplasty (TKA). To evaluate the factors affecting early post-op knee joint ROM in the elderly after TKA. METHODS: One hundred and forty-three patients undergoing TKA were included. The patients’ general data, perioperative knee joint ROM and serum IL-6, pre-op HSS, WOMAC, SF-36 scores and Wells scores were collected. Repeated data variance analyses were performed to analyze the relevance between serum IL-6 with post-op knee joint ROM. Correlative regression and regression analysis…were performed to evaluate the multiple factors affecting knee joint ROM in the elderly undergoing TKA. RESULTS: The 2-week-post-op (2w-post-op) knee joint ROM was significantly higher in the low IL-6 serum concentration group (< 46.45 ng/L) than in the high group (⩾ 46.45 ng/L) (97.78 ± 7.44 ∘ VS 91.85 ± 7.42 ∘ , F = 16.860, P = 0.000). A significant negative correlation was found between 1d-post-op serum IL-6 concentration with 2w-post-op knee joint ROM (R = - 0.513, P = 0.000). The factors influencing the 2w-post-op knee joint ROM included pre-op HSS scores, pre-op WOMAC scores and whether to retain PCL (posterior cruciate ligament) (R 2 = 0.451, P = 0.009). CONCLUSION: A higher 1d-post-op IL-6 serum concentration indicated a lower knee joint ROM in the elderly two weeks after TKA.
Keywords: Total knee arthroplasty, Interleukin-6, IL-6, inflammatory factors, range of motion, ROM
Abstract: BACKGROUND: Taekkyon, a Korean form of martial arts, has been trained for a long period. However, it is not yet known whether the Taekkyon exercise has better effects on functional mobility or balance in older adults than other types of well-investigated exercise programs such as Tai Chi (TC). OBJECTIVE: This study aimed to compare the effects of TC and Taekkyon exercise programs on the lower-extremity strength, balance, and gait ability of community-dwelling older women as a fall prevention method. METHODS: Community-dwelling older women were randomly allocated into the TC group (n 1…= 23) and the Taekkyon group (n 2 = 23). Both groups completed 1 h of either TC or Taekkyon exercises twice weekly for 12 consecutive weeks (24 sessions in total). We measured the Timed Up and Go test (TUG), Functional Reach test (FR), one-leg standing test (OLS), Five Times Sit-to-Stand test (5 × STS), 30 Second Sit-to-Stand test (30 s STS), and spatiotemporal gait parameters (gait velocity, step length, step width, stride time, and cadence) before and after the intervention. RESULTS: Both groups similarly showed statistically significant improvements in balance (TUG, FR, and OLS), lower-extremity strength (5 × STS and 30 s STS), and spatiotemporal gait parameters except for step width (P < 0.05). Moreover, the TC group showed greater improvement in the OLS test than the Taekkyon group (P < 0.05). CONCLUSIONS: The results from this study support the efficacy of the TC and Taekkyon exercise programs at improving mobility in this population of older women. However, this study did not clarify which exercise program is more effective as general balance and mobility training program for older women.
Keywords: Aging, balance, falling, Taekkyon, Tai Chi
Abstract: OBJECTIVES: To compare pelvis, hip and knee kinematics during gait and extensibility of hip muscles between low back pain (LBP) and asymptomatic subjects. METHODS: Forty adult volunteers (11 men and 29 women) between 18 to 30 years from university population were included in this study. Twenty patients with LBP formed the LBP group, and 20 asymptomatic subjects formed the control group. Pelvic tilt and knee valgus, peak hip and knee joint excursion, and temporo-spatial variables were assessed during gait with Kinovea software. Extensibility of hip muscles was measured by Active Knee Extension test (AKE), modified Ober…test, and Thomas test. RESULTS: There was a significant increase in pelvic tilt (p < 0.01), valgus angle (p < 0.01), and a significant decrease in hip extension (p < 0.01) in the LBP group compared to the control group. There was a significant decrease in extensibility of the hip flexors (p < 0.05) of the dominant leg and in the hip abductors (p < 0.01) in the LBP group compared to the control group. CONCLUSIONS: The findings of this study suggest that non-specific mechanic LBP patients present differences in the pelvis, hip and knee kinematics in sagittal and frontal plane during gait and less hip flexors and abductors muscles extensibility compared to asymptomatic subjects.
Keywords: Low back pain, lower limb, biomechanics, gait
Abstract: BACKGROUND: A few studies have noted that paraspinal muscle training is important to reduce pain for patients with lumbar disc herniation (LDH). However, little is known about the exact signs for necessary training of lumbar multifidus muscles (LMM). OBJECTIVE: The study aimed to analyze the relationship between the straight leg-raising test (SLR) and the area of fat infiltration in LMM for patients with LDH. METHOD: One hundred and fourteen LDH patients were involved in this study. Clinical data were collected from a medical record system. On the MRI images, the cross-sectional areas (CSA) of bilateral…fat infiltration in LMM were measured by picture archiving and communication system (PACS). RESULT: For 61 patients with inclusive LDH, the positive side of SLR was positively correlated with the side of the larger total CSA of fat infiltration in LMM of L2-S1 (r = 0.75, p ï ¼ 0.01), and the CSA of fat infiltration on the side of SLR with a positive result was significantly larger than that on the side of SLR with a negative result only at L3-4 and L4-5 levels (p ï ¼ 0.01). CONCLUSION: SLR may be used as an important sign for dysfunction of LMM and can identify the more severe side.
Keywords: Multifidus muscle, disc herniation, fat infiltration, straight leg-raising test
Abstract: BACKGROUND: In the current literature, exercises performed using fitness equipment and body weight have been used in order to decrease the bilateral deficit (BLD) and increase the hamstring-quadriceps (H/Q) ratio. No studies have previously investigated the effect of therabands, which are both portable and practical to be used anywhere, in regard to the BLD and H/Q ratio. OBJECTIVES: The purpose of this study was to investigate the effect of several 10-week lower extremity exercises performed through therabands on the BLD and H/Q ratio. METHODS: Twenty-seven voluntary male soccer players participated in the study.…The players were categorized into the control group (CG) (n = 14) and the theraband exercise group (TBG) (n = 13). Theraband exercises for the lower extremity were performed by the soccer players in the TBG for four days every week over a 10-week period. The dominant (D) and non-dominant (ND) leg concentric extension and flexion of the soccer players were determined through an isokinetic dynamometer at 30 ∘ s - 1 and 240 ∘ s - 1 angular velocities. The data were analyzed through SPSS 24. To determine the difference between the BLD, H/Q ratios, and pre- and post-test of peak torque (PT), the Wilcoxon test was employed. RESULTS: As a result of the analysis, it was found that the BLD for the TBG decreased, which was statistically significant (p < 0.05), whereas there were no statistically significant differences for the H/Q ratio for both the CG and TBG; the D and ND leg H/Q rate of the TBG at 240 ∘ s - 1 angular velocity increased in the post-test. CONCLUSIONS: It was found that the exercises performed with the theraband were extremely efficient at increasing the PT and decreasing the BLD.