Journal of Back and Musculoskeletal Rehabilitation - Volume 35, 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: Patients with temporomandibular disorders (TMD) mostly suffer from muscle-related pain. Several conservative interventions have been suggested as treatments for TMD in the last years. OBJECTIVE: The aim of this systematic review with meta-analysis was to assess the efficacy of rehabilitative approaches in reducing pain in patients with muscle-related TMD. METHODS: PubMed, Scopus, and Web of Science were systematically searched from inception until April 28 th , 2021 to identify randomized controlled trials (RCTs) presenting: patients with painful muscle-related TMD; rehabilitative approaches as interventions; placebo or sham treatment as…comparisons; pain intensity, using visual analogue scale as outcome. A meta-analysis was performed to evaluate the overall effect on painful muscle-related TMD patients. PROSPERO registration number of this systematic review is CRD42021251904. RESULTS: Out of 1997 papers suitable for title/abstract screening, 189 articles were assessed for eligibility. Sixteen RCTs were included and most of them (n = 6, 37.5%) investigated the effects of the laser therapy. The meta-analysis revealed that rehabilitative interventions had a significant overall effect size (ES) of 1.44 (p < 0.0001) in decreasing pain in patients with muscle-related disorders. CONCLUSION: Findings of this systematic review with meta-analysis suggested that rehabilitative approaches might be effective in reducing pain in muscle-related TMD patients. However, the low number of RCTs evaluating conservative approaches might impair the synthesis of evidence regarding the different techniques, calling for caution in the interpretation of these results.
Abstract: BACKGROUND: Imbalance or decreased trunk strength has been associated with non-specific low back pain (NSLBP). OBJECTIVE: This systematic review aimed (I) to evaluate the quality of evidence of studies evaluating the reliability of trunk strength assessment with an isokinetic dynamometer in NSLBP patients, (II) to examine the reliability of trunk strength assessment using an isokinetic dynamometer in NSLBP patients and (III) to determine the most reliable protocol for trunk strength assessment in NSLBP patients. METHOD: PRISMA guidelines were followed. Three databases were used: PubMed, Scopus, and Web of Science with the following keywords:…Isokinetic, Dynamometer, Trunk strength testing, Muscle testing, Isokinetic measurement, CORE, Abdominal muscles, Abdominal wall, Torso, Trunk, Spine, Reliability and, Reproducibility. We included only test-retest studies, focused on the reliability of isometric and isokinetic strength assessed with an isokinetic dynamometer in NSLBP adults’ patients, published in English and from inception to March 30, 2021. The methodological quality was evaluated with the CAT scale and QAREL checklist. RESULTS: Five hundred and seventy-seven articles were retrieved, of which five are included in this review. Three articles provide good quality of evidence, the reliability of trunk strength assessment in NSLBP patients is excellent, and the most reliable protocol for isometric assessment is in a seated position (ICC = 0.94–0.98) and for isokinetic strength in standing position, at 60 ∘ /s and 120 ∘ /s (ICC = 0.98). CONCLUSION: There is good quality evidence regarding the trunk strength assessment’s reliability. Reliability is excellent in NSLBP patients; however, a familiarization process should be considered to obtain clinically reliable data. The most reliable protocol is in a seated position for isometric strength and a standing position for isokinetic strength.
Keywords: Reproducibility, test re-test, torso, core muscles, trunk strength testing, back pain
Abstract: BACKGROUND: Tendinopathies are overuse tendon injuries showing load-dependant pain, stiffness, weakness of movement in the affected area, and impairment in the movements. The scientific interest on the role of Hyaluronic Acid (HA) for the management of tendinopathies has been increased due to its anti-inflammatory and lubricative properties. OBJECTIVE: To collect evidence regarding the effectiveness and safety of HA injections in reducing pain in patients affected by tendinopathies. METHODS: A scientific literature search was conducted using the PubMed, Medline and PEDro electronic databases. The databases were searched since their inception until July 2021. The…search was limited to English language articles. Different combinations of the terms and MeSH terms “tendinopathy”, “tendinosis”, “tendinitis”, “hyaluronic acid”, “hyaluronate”, “infiltration”, “hyaluronic injections”, “viscosupplementation” connected with various boolean operators were used for other electronic databases. RESULTS: One hundred and one records were identified from the selected databases plus three additional papers identified by the authors through other sources. After removing duplicated papers and title/abstract screening, 19 studies were included in our review (eight papers on shoulder, three on elbow, four on hand, one on knee, and three on ankle). CONCLUSION: The results showed that none of the studies report severe adverse effects and most of them support the use of HA injections in tendinopathies, with a special attention to pain reduction and functional assessment. Further studies are warranted to better investigate effects and methods of administration of HA in tendinopathies.
Abstract: BACKGROUND: Sudden onset of acute torticollis in children is rare and is usually diagnosed as atlantoaxial rotatory subluxation (AARS). The common treatment for acute AARS without neurological symptoms is halter traction in conjunction with muscle relaxant and sedative agents, followed by cervicothoracic orthotic immobilization. To the best of our knowledge, a case of acute AARS treatment with high-intensity laser therapy (HILT) has not yet been reported so far. OBJECTIVE: We aimed to report a case of acute AARS treatment with HILT successfully and to discuss about the clinical effect of HILT in AARS. METHODS:…We reported a 9-year-old girl with acute onset of torticollis visiting the rehabilitation outpatient department. RESULS: The physical examination revealed a typical cock robin position without neurological symptoms. A series of evaluations, including open-mouth odontoid radiograph and soft tissue sonography, confirmed the diagnosis of acute AARS. The patient received HILT over the left suboccipital and upper back muscle groups, which started on the day of the first rehabilitation clinic visit, once a week, for four weeks. Torticollis and neck pain improved gradually with each session of HILT, and the symptoms resolved completely after the fourth session. Dynamic computed tomography (CT) of the cervical spine showed no evidence of obvious AARS after the treatment. CONCLUSIONS: The patient had no complaints after HILT in a case of acute AARS resulting from a mechanical factor. Due to its pain-relief and muscle-release characteristics, HILT indicates the probable benefit of relaxation of spastic muscles for patients with AARS.
Keywords: Torticollis, atlantoaxial rotatory subluxation, high intensity laser, cock robin position, posture, children
Abstract: BACKGROUND: Spinal nerve root anomaly is a rare feature that can result in unexpected outcomes in epidural steroid injections or surgical procedures. Preoperative diagnostic tools for root anomalies are limited, as they are usually found intraoperatively. OBJECTIVE: This case report aims to propose an effective diagnostic process for nerve root anomalies by introducing clinical manifestations, electrodiagnostic findings, and sophisticated imaging techniques such as coronal view magnetic resonance imaging (MRI) of the lumbosacral spine. CASE DESCRIPTION: A 43-year-old female complained of low back pain with radicular pain to the lower extremities. Based on physical…examination, electrodiagnosis, and imaging studies, right L5 radiculopathy was diagnosed. Repetitive image-guided epidural steroid injections presented unsuccessful outcomes. She was then referred to a neurosurgeon for surgical decompression, which resulted in significant improvement in her radicular pain. A nerve root anomaly was found intraoperatively, and the coronal images of postoperative MRI depicted the conjoined nerve root of the lumbar spine. CONCLUSION: When proper image-guided spinal interventions for discogenic radicular pain are not effective, a clinician should be advised to consider the possibility of anatomical variation, including nerve root anomalies. Early diagnosis of nerve root anomalies by utilizing multiple diagnostic tools, especially coronal MRI, can aid in preoperative diagnosis and proper clinical decisions for symptom management.
Abstract: BACKGROUND: Sacro-iliac joint (SIJ) pain is an often-misdiagnosed cause (up to 30% cases) of atypical low back pain (LBP) that might be treated with a wide range of conservative interventions. However, Platelet-Rich-Plasma (PRP) ultrasound-guided injections at SIJ level in subjects with mitochondrial disorders have not yet been investigated. CASE PRESENTATION: A 52-year-old Caucasian male with fluoroquinolone-related mitochondrial dysfunction referred to a Physical Medicine and Rehabilitation Outpatient, complaining of severe SIJ pain (Numeric Pain Related Scale, NPRS= 8). We performed two bilateral PRP ultrasound-guided injections at the sacro-iliac level. PRP is a simple, efficient, and…minimally invasive approach. After the first PRP injection, there was a considerable reduction of pain (NPRS= 8 vs 5). The second PRP infiltration was performed after 2 weeks and in both cases no adverse events. At the 6-month follow-up evaluation, the patient showed good physical recovery, with the absence of pain (NPRS= 0). CONCLUSION: To the best of our knowledge, this is the first report in the literature assessing the safety and effectiveness of PRP ultrasound-guided injections for SIJ pain in a patient affected by mitochondrial disorders. Thus, this case report might have relevant clinical implications in the treatment of SIJ pain in patients affected by this rare pathological condition, albeit further observational studies are warranted to confirm these findings.
Abstract: BACKGROUND: Young people tend to spend most of their time in activities involving inappropriate positions, which can promote musculoskeletal alterations and disorders. OBJECTIVE: To investigate the prevalence of low back pain (LBP) in young people and analyse its associations with daily postural habits. METHODS: Cross-sectional and retrospective study evaluating 679 Brazilian young people (15 to 18 years old), using questionnaires about LBP and awareness of postural habits. The prevalence values were calculated for the present moment, the last three months and throughout life. The Mann-Whitney U test and the Chi-square test were applied.…RESULTS: The prevalence of LBP at the present moment was 27.2%, 57.7% over the last three months and 73.9% throughout life. Boys and girls presented significantly different values, a larger number of girls manifesting pain for the three moments. The associated postural habits were: turning the body, reduction of lumbar lordosis when seated, not placing the feet on the floor, crossing the legs when sitting in the classroom and at home, sitting or lying in an inappropriate position, and distributing the body asymmetrically on the legs when standing. CONCLUSIONS: Young people from 15 to 18 years of age show a high prevalence of low back pain. Inadequate postural habits adopted during everyday activities are associated with this complaint. These findings could contribute to the implementation of prevention and rehabilitation strategies.
Keywords: Adolescent, risk factors, low back pain, habits, prevalence
Abstract: BACKGROUND: Core strength is an important aspect of physical fitness. A dynamometer was developed to measure isokinetic core muscle strength in multiple planes of motion. Establishing the reliability is needed before it can be used in practice. OBJECTIVE: Examine the intra-observer reliability of a trunk isokinetic dynamometer. METHODS: 31 participants were recruited. Tests were performed twice with an interval of 5–9 days by the same observer. Testing included rotation, flexion/extension and lateral flexion at speeds of 90 ∘ /s and 60 ∘ /s. The main outcome measure…was peak torque (PT). The secondary outcomes included peak torque angle (PTA), time to peak torque (TTPT) and compensatory torques (CompTQ). The intra-observer reliability was investigated using intraclass correlation coefficients (ICC). RESULTS: Peak torque reliability was good to excellent (ICC = 0.70–0.91), whereas the reliability of the PTA (ICC = - 0.04–0.56) and TTPT (ICC = 0.01–0.68) were poor to moderate. CompTQ reliability was moderate to good (ICC = 0.20–0.88). CONCLUSIONS: The intra-observer reliability of the isokinetic measurement of core strength peak torque was good. The secondary outcomes peak torque angle and time to peak torque were less reliable and the compensatory torques showed moderate to good reliability. This isokinetic dynamometer could have useful applications in the field of sports medicine and rehabilitation.
Keywords: Core strength, dynamometer, isokinetic, peak torque, sports medicine
Abstract: BACKGROUND: Not much is known about developmental motor disorders in the first year of life of children diagnosed with idiopathic scoliosis (IS). OBJECTIVE: This study aimed to compare the occurrence of asymmetry or muscle tone disorders in the first year of life in adolescents with IS and their healthy counterparts. METHODS: The parents of adolescents with IS and without scoliosis completed a survey on the occurrence of asymmetry, abnormal muscle tone, and physiotherapy in their children in the first year of life. Pearson’s chi square test and Cramer’s coefficient were used.…RESULTS: The final analysis included 527 surveys completed by parents of adolescents with idiopathic scoliosis (150) and without scoliosis (377). A significantly higher frequency of asymmetry (p = 0.001) and muscle tone disorders (p = 0.001) was noted in adolescents with idiopathic scoliosis. The results also revealed a significant association between scoliosis and asymmetry (p = 0.001), as well as muscle tone (p = 0.001). CONCLUSIONS: Developmental asymmetry or improper muscle tone in the first year of life could be considered a potential factor in the development of scoliosis; however, this hypothesis should be confirmed in future studies. Infants diagnosed with developmental disorders require systematic observation.
Keywords: Idiopathic scoliosis, motor disorders, infant, asymmetry, muscle tone, physiotherapy