Journal of Back and Musculoskeletal Rehabilitation - Volume 34, issue 3
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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: Adolescent idiopathic scoliosis (AIS) is a common structural spine deformity affecting 2%–4% of adolescents. Due to the unknown cause of idiopathic scoliosis, its therapy is a long-term and often unsatisfactory process. In the literature, it is often suggested that problems related to the feeling of one’s own body are caused by AIS. OBJECTIVE: The aim of this study was to assess the feeling of one’s own body among children with and without scoliosis on the example of feeling the head position, pelvis shape and balance. METHOD: The research included 62 children: 30…with scoliosis and 25 without diagnosed scoliosis with an age range between 11 to 19 years. The minimum scoliosis value was 7 ∘ and the maximum was 53 ∘ . The average value was 25 ∘ . During the study, three functional tests were used: Cervical Joint Position Error Test (CJPET), Clinical Test of Sensory Integration on Balance (CTSIB) and Body proportion demonstration test (BPDT). RESULTS: The results of the tests showed statistically significant differences (CJPET p = 3.54 * 10 - 14 , CTSIB p = 0.0376, BPDT p = 0.0127). However, none of the studies showed a correlation between the results of people with scoliosis and the value of their Cobb angles.
Abstract: BACKGROUND: There are currently no reports of biomechanical changes in patients with forward head posture (FHP) that result in altered muscle activation throughout various functions with muscle activation response during diverse sleep postures. OBJECTIVE: This study investigated neck and back muscle activity in individuals with and without FHP during a maintained side-sleeping position by incorporating various pillow designs. METHODS: Thirty-four participants (i.e., 17 in each group) were enrolled. The muscle activity was investigated via surface electromyography during the use of three trial pillows: orthopedic pillow, hollow pillow, and Thai neck support pillow.…RESULTS: With the application of all three trial pillow, the FHP group demonstrated significantly greater middle-lower trapezius muscle activity than the normal head posture group (p < 0.05). Sternocleidomastoid and upper trapezius (UT) muscle activity were similar between the two groups (p > 0.05). Only UT muscle activity was affected by variations in pillow design. In the normal group, no difference was observed in the muscle activity between all three pillows (p > 0.05). CONCLUSIONS: Feasibly, the ability to appropriately modify a pillow configuration without creating undesired muscle activation was limited to those exhibiting FHP. Therefore, specially designed pillows or mattresses should be investigated in terms of their relevance to muscle fatigue and potential musculoskeletal pain in FHP patients.
Keywords: Pillow, sleep, electromyography, forward head posture, muscle activity
Abstract: BACKGROUND: Musculoskeletal disorders in acromegaly compromise upper and lower limb activity. Corresponding changes can be better assessed by a functional capacity test incorporating multitasking, such as the Glittre Activities of Daily Living Test (GA-T). OBJECTIVES: To evaluate functional capacity in adults with acromegaly using the GA-T and to correlate functional capacity with hand function and health-related quality of life. METHODS: The GA-T was applied to 36 patients with acromegaly and an equal number of healthy individuals. Additionally, participants completed the Acromegaly Quality of Life (AcroQoL) questionnaire and underwent a chronic pain assessment using…a map of the human body, a hand function evaluation using the Cochin Hand Functional Scale (CHFS), and a handgrip strength test. RESULTS: Relative to the comparison group, patients with acromegaly required more time to perform the GA-T, showed worse hand function, and reported that squatting to accomplish shelving tasks was the major difficulty. GA-T time was correlated with the AcroQoL global score, handgrip strength, and the CHFS (r s = - 0.487, p = 0.002; r s = - 0.369, p = 0.026; r s = 0.538, p = 0.0007, respectively). CONCLUSIONS: Patients with acromegaly exhibited a reduced functional capacity as assessed by the GA-T. Additionally, an association was identified between the total GA-T time and both hand function and quality of life.
Keywords: Acromegaly, exercise, functional capacity, activity of daily living, quality of life
Abstract: BACKGROUND AND OBJECTIVE: Lumbar spinal stenosis (LSS) is a common spinal disorder that causes patients to assume a forward-trunk posture. Spinal alignment affects swing limb angles and stance limb muscle activities. Therefore, we investigated the effects of differences in step up (SU) and step down (SD) tasks on the kinematics of the trunk and swing limb as well as stance limb muscle coordination in patients with LSS. METHODS: Nine elderly female patients diagnosed with LSS were recruited for this study. The sagittal kinematics of the trunk and swing limb and isolated contraction ratio of the gluteus…medius (GMed) and vastus lateralis (VL) during SU and SD tasks were measured using a motion analysis system and surface electromyography system. RESULTS: Thoracic (17.71 ∘ ± 7.77 ∘ ) and spine angles (13.64 ∘ ± 11.34 ∘ ) as well as swing hip (48.48 ∘ ± 12.76 ∘ ) and pelvic angles (7.52 ∘ ± 10.33 ∘ ) were significantly greater during SU than SD (10.14 ∘ ± 8.41 ∘ , 10.03 ∘ ± 11.03 ∘ , 29.42 ∘ ± 10.57 ∘ , 3.21 ∘ ± 10.11 ∘ , all P < 0.05, respectively). The isolated contraction ratio of the GMed of the stance limb (34.12% ± 13.28%) was significantly higher during SU than during SD (26.65% ± 10.02%), whereas that of the VL of the stance limb (65.88% ± 13.28%) was significantly lower during SU than during SD (73.35% ± 10.02%, P = 0.011 for both comparisons). CONCLUSIONS: Patients with LSS demonstrated trunk compensatory mechanisms to address swing hip and knee angles. Trunk position affected pelvic limb muscle coordination in the standing support limb. These findings demonstrate that SD are more challenging than SU for patients with LSS, possibly due to reduced ability to generate adequate leg extensor muscular output to safely control the motion of the body’s center of mass. Therefore, trunk positions must be considered when patients with LSS undergo rehabilitation programs, particularly those involving SD or descending stairs, so that healthcare professionals can better assist patients with LSS. In addition, this study provides a background for further studies.
Abstract: BACKGROUND: The cervical flexion relaxation phenomenon (FRP) is a myoelectric silence of neck extensor muscles which occurs after a certain degree of flexion. Impaired flexion relaxation can impose the vertebral structures to excessive loading resulting from the persistence of muscular contraction. OBJECTIVE: This study aimed to investigate the incidence or absence of FRP in cervical erector spinae (CES) and upper trapezius muscles in patients with chronic neck pain (CNP). METHODS: Twenty-five patients with CNP and 25 healthy volunteers were recruited. They accomplished cervical flexion and extension from a neutral position in four phases…in the sitting position. The surface electromyography activity of both CES and upper trapezius muscles was recorded in each phase. Cervical flexion and extension movements were simultaneously measured using an electrogoniometer. RESULTS: FRP in CES was observed in 84% and 36% of healthy subjects and CNP patients, respectively. Flexion relaxation ratio (FRR) in CES was lower in CNP patients than in healthy subjects (mean diff = 1.33; 95% CI: 0.75–1.91) (P < 0.001). Only in CNP patients, FRR in right erector spinea was significantly higher than that in the left erector spinea (P = 0.04). CONCLUSIONS: FRP incidence in CNP patients was less than in healthy subjects. Moreover, this phenomenon begins later in CNP patients than in healthy subjects indicating prolonged activity of CES muscles during flexion in the CNP group. The difference between FRR in the right and left sides of erector spinea muscles can result in CNP.
Abstract: BACKGROUND: Sarcopenia has been found to affect the postoperative outcomes of lumbar surgery. The effect of sarcopenia on the clinical outcomes in patients who underwent stand-alone lateral lumbar interbody fusion (LLIF) has not yet been examined. OBJECTIVE: To investigate whether sarcopenia affects the Oswestry Disability Index (ODI) and visual analog scale (VAS) score for back pain following single-level stand-alone LLIF. METHODS: Patients who underwent a single level stand-alone LLIF for lumbar diseases were retrospectively investigated. Sarcopenia was defined according to the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia. Patients were…divided into the sarcopenia (SP) and non-sarcopenia (NSP) group. Univariate analysis was used to compare with regards to demographics and clinical outcomes. Multivariate logistic regression was performed to elucidate factors predicting poor clinically improvement. RESULTS: Sixty-nine patients were enrolled, with 16 and 53 patients in the SP and NSP group respectively. In the SP group, patients were much older (P = 0.002), their body mass index was significantly lower (P < 0.001), the percent of women was higher (P = 0.042), and the skeletal muscle mass index (SMI) (P < 0.001) and gait speed were much lower (P = 0.005). The postoperative ODI scores were much higher and the improvement rate was much lower (both P < 0.001) in the SP group, whereas VAS scores for back pain showed no difference between the two groups. SMI and gait speed had a moderate and weak correlation with the final ODI score, respectively. Low SMI and low gait speed were independently associated with poor clinical outcomes at the final follow-up. CONCLUSIONS: Sarcopenia impacts the final clinical outcomes of stand-alone LLIF for lumbar diseases. Low SMI and low gait speed were negative impact factors for the clinical improvement after stand-alone LLIF.
Abstract: BACKROUND: New training methods are constantly used to improve the ability of skeletal muscles to develop strength. OBJECTIVE: The aim of the present study was to investigate the effect of half-squat training with free weights and flywheel device on isokinetic knee muscle strength for well-trained amateur soccer players. METHODS: Forty eight players were randomly divided into three groups (n = 16 each): Desmotech Training group (DT), Free Weight Training group (WT) and one Control Group (CON). DT and WT performed an eight-week half-squat training program, with two sessions…per week. The DT group performed training with a flywheel device. Isokinetic concentric-eccentric strength assessments of the knee extensors-flexors muscle groups were performed at different angular velocities (60, 180 and 240 ∘ /s). RESULTS: The eight-week training program improved all the isokinetic joint moment indicators examined in the DT and WT groups (p < 0.01). The DT group achieved higher performances at all the isokinetic parameters examined, however, without statistically significant differences to the WT group. CONCLUSIONS: Flywheel-based exercise is an effective training method and is suggested to be used to strengthen the lower limbs of soccer players.
Abstract: BACKGROUND: Myofascial Pain Syndrome causes disability in daily life activities and despite all efforts, it continues to be a challenge, perpetuating suffering, overloading services and costs. New treatment options need to be tested. OBJECTIVE: We aimed to quantify the rESWT short-term analgesic effect and identify the predictors of success through comparing results achieved in MPS and Articular Pain (AP). METHOD: Retrospective cohort study of 1,580 patients with Myofascial Pain Syndrome or Articular Pain underwent two weekly radial Extracorporeal Shock-wave Therapy sessions. The pain intensity was measured by Visual Analog Scale before and one…week after the end of the treatment (3 weeks). RESULTS: The therapy decreases pain by 62.50% (p < 0.0001), with a high success rate (91.59%) and a low worsening of baseline conditions rate (2.1%). The best recommendation is for patients with intense myofascial pain (Visual Analog Scale ⩾ 70 mm), using high shock-wave frequency (⩾ 15 Hz). CONCLUSIONS: Two rESWT sessions promote pain relief, with a high success rate and low rates of treatment abandonment and worsening. The best results are obtained in myofascial pain patients with high pain intensity, treated with high-frequency dosage.
Abstract: BACKGROUND: One of the most difficult complications of total hip arthroplasty is an infection in the area of the implant with an incidence of 0.5% to 2.5% resulting in the most severe situation in prosthesis removal. OBJECTIVE: The aim of the study was to assess postural stability and functional disorders in patients after hip prosthesis removal. METHODS: A group of 15 patients after hip prosthesis removal was compared to a control group of 15 healthy persons who were age-matched without any symptoms of degenerative disorders in the lower spine and lower extremities. The…static balance test was conducted on a bi-modular stabilometric platform, registering the movement of the centre of foot pressure. The functional state of the patients was assessed on the basis of the Harris Hip Score (HHS). RESULTS: Patients had poor functional result (HSS mean 62.29 ± 12.92 points). Obtained results of postural stability of patients showed huge difficulties maintaining stability and showed statistically significant differences in a majority of the analysed parameters. CONCLUSIONS: Several stability parameters showed significantly worse results in patients after hip prosthesis removal. Special attention should be paid and focused physiotherapy should be undertaken for patients with a stability disorder and functional status to prevent falls and improve functioning.
Keywords: Postural stability, hip, Girdlestone procedure, hanging hip