Journal of Back and Musculoskeletal Rehabilitation - Volume 37, issue 3

Authors: Kudo, Shintarou | Hatanaka, Mizuki | Kanazawa, Seiya | Hirakawa, Keisuke | Hara, Shigeyuki | Tsutsumi, Masahiro

Article Type: Research Article

Abstract: BACKGROUND: Short foot exercises (SFE) take a long time to master and require a feedback tool to improve motor learning. OBJECTIVE: This study aimed to investigate the effect of bio-feedback of talonavicular joint movements in learning SFE with ultrasound (US) imaging. METHODS: This study included thirty-one healthy volunteers and was designed as a double-blind randomized control trial. Subjects were randomly assigned to one of two groups: the control group, which performed SFE under verbal instruction, and the US bio-feedback (USBF) group, which performed SFE with real-time bio-feedback of the talonavicular joint alignment. All subjects …underwent two sessions of 5 minutes each, and SFE was performed as a self-exercise, between sessions, for one week. The difference in foot length and navicular height were assessed at baseline, after Session 1, before Session 2, and one week after Session 2. These differences were compared between the two groups using the Mann-Whitney U test. RESULTS: In terms of navicular height change, the USBF group (7.5 ± 4.3 mm) was significantly higher than the control group (4.2 ± 3.3 mm) one week after session 2 (p = 0.04, effect size = 0.86). CONCLUSION: SFE with USBF is an effective intervention for performing SFE. Show more

Keywords: Foot exercise, ultrasonography, motor learning, bio-feedback

DOI: 10.3233/BMR-230163

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 671-678, 2024

Authors: Özbudak, Pınar | Karataş, Özlem | Kaçar, Cahit

Article Type: Research Article

Abstract: BACKGROUND: Vitamin D deficiency is common in postmenopausal women and is associated with low vitamin D intake, increased age, decreased absorption. Especially at advanced age, vitamin D deficiency may increase muscle weakness and disbalance resulting in increased risk of fracture. OBJECTIVES: This study aims to explore the correlation between 25(OH) vitamin D3 levels and quadriceps muscle strength in postmenopausal women. METHODS: We evaluated bilateral qadriceps muscle strength in postmenopausal women with isokinetic test. We evaluated the correlation of muscle power with measurements of parathormone, vitamin D, Calcium, creatinine, alanine transaminase, alkaline phosphatase, total …creatine kinase. RESULTS: The mean vitamin D level of 95 participants included in the study was 18.24 ± 8.94 ng/ml. Vitamin D levels were found to be deficient (< 10 ng/ml) in 23 (24.1%), insufficient in 62 (65.26%) and normal in 10 (10.53%) of the 95 participants. A weak negative correlation was observed between participants’ vitamin D levels and PT values (r = - 0.271, p = 0.012). A moderate negative correlation was found between ALP and vitamin D levels (r = - 0.317, p = 0.002). However, there was no significant correlation between vitamin D levels and the 60∘ and 90∘ flexion and extension peak torque values (All p values > 0.05). CONCLUSIONS: Vitamin D levels and muscle strength weren’t statistically significant. Few studies are available in the related literature, highlighting the need for further research to achieve a clearer consensus. Show more

Keywords: Cholecalciferol, muscle strength correlation, postmenopause, vitamin D3

DOI: 10.3233/BMR-230172

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 679-686, 2024

Authors: Park, Donghwi | Choi, Jin-Woo | Chang, Min Cheol

Article Type: Research Article

Abstract: BACKGROUND: Despite the application of various therapeutic methods, pain caused by complex regional pain syndrome (CRPS) is not sufficiently managed and often progresses to a chronic stage. For the systematic and effective treatment of CRPS, we developed an algorithm for multimodal medication therapy based on the established pathophysiology of CRPS to control CRPS-related pain. OBJECTIVE: In this study, we present the outcomes of our novel algorithm for multimodal medication therapy for patients with CRPS, consisting of three major components: multimodal oral medication, intravenous ketamine, and intravenous lidocaine therapy. METHODS: We retrospectively investigated patients …with CRPS who received multimodal therapy. Pain severity scores were evaluated using a numerical rating scale at four time points (P1, pain at initial consultation; P2, pain after oral medication; P3, pain after ketamine treatment; and P4, pain after lidocaine treatment). The effect of the multimodal medication therapy algorithm on pain management was evaluated at each time point. RESULTS: In patients with CRPS, multimodal oral medication, intravenous ketamine, and intravenous lidocaine therapies led to significantly improved pain control (p < 0.05). Additionally, the combination of these three therapies (through the multimodal medication therapy algorithm) resulted in significant pain relief in patients with CRPS (p < 0.05). CONCLUSIONS: Our multimodal medication therapy algorithm effectively controlled pain in patients with CRPS. However, further prospective studies with large sample sizes and randomized controlled trials are needed for more accurate generalization. Show more

Keywords: Complex regional pain syndromes, drug therapy, neuralgia, ketamine, lidocaine

DOI: 10.3233/BMR-230179

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 687-696, 2024

Authors: Soares, Denise | Abbady, Karim | Kasap, Suat | Shabanliyski, Dimitar

Article Type: Research Article

Abstract: BACKGROUND: Weightlifting is an Olympic sport for dynamic strength and power, and requires the execution of different lifting techniques It is important to analyze the forces subjected to the lower back during weightlifting movements to prevent injuries. Digital Human Modeling (DHM) is a powerful tool that can be used to analyze and optimize the performance of humans while doing their work or activities. OBJECTIVE: The purpose of this study is to present a simulation analysis of the lower back forces during the execution of two weightlifting techniques: Snatch (SN) and Clean & Jerk (CJ), with different …loads and for both genders. METHODS: Digital Human modelling through JACK simulation package was used analyze the forces exerted on the lumbosacral area (L5-S1) of the lower back in order to determine the risk for low back injuries. The level of compression and shear forces recommended by the literature have been set as thresholds. The simulaitons were performed in male and female models, with loads from 20–100 kg. RESULTS: The results show that any weight higher than 60 kg in both movements poses risk for the weightlifters in terms of compression and shear forces. It has been observed that weightlifters can lift greater loads in the CJ technique compared to the SN technique. Furthermore, females are able to lift higher loads with lower risk of injuries. CONCLUSION: Weightlifting is a high-risk activity due to the high levels of shear and compression forces that the body is exposed to during the lifting techniques. Digital Human Modeling holds significant value due to their ability to facilitate the exploration of diverse conditions within a safe environment, devoid of any potential harm to human subjects. Show more

Keywords: Health, injury prevention, spine, female, male

DOI: 10.3233/BMR-230181

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 697-706, 2024

Authors: Lee, Jun-Hyeok | Jeon, Hye-Seon | Park, Joo-Hee | Kim, Ji-Hyun | Kwon, Oh-Yun | Choi, Woochol Joseph | Kim, Young-Ho | Kim, Jong-Man

Article Type: Research Article

Abstract: BACKGROUND: Maintaining correct posture and optimal spine function has become an important issue due to the increased use of computers and smartphones. OBJECTIVE: To investigate the effect of a 4-week downhill treadmill exercise (DTWE) program on participants with thoracic kyphosis and forward head posture (FHP). METHODS: Twenty-eight male participants were randomly assigned to the DTWE (n = 14) or standard treadmill walking exercise (STWE) (n = 14) group. They performed 30-minute exercise three times a week for 4 weeks. The vertebral angle was measured …using a three-dimensional (3D) motion analysis system. Surface electromyography (EMG) was performed to record muscle activity in the thoracic erector spinae (TES), sternocleidomastoid muscle (SCM), and cervical erector spinae (CES). RESULTS: The DTWE group showed significant increases in the craniovertebral angle (CVA) and TES EMG activity and significant decreases in the thoracic kyphosis angle and SCM and CES EMG activity compared with those shown by the STWE group following the intervention (p < 0.05). However, lumbar lordosis or pelvic tilt angles did not differ significantly between the groups after the intervention (p > 0.05). CONCLUSIONS: DTWE can be effective in reducing thoracic kyphosis and FHP without causing compensatory movements of the lumbar spine and pelvis. Show more

Keywords: Electromyography, kinematics, rehabilitation

DOI: 10.3233/BMR-230187

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 707-713, 2024

Authors: Zhong, Xiqiang | Shen, Guangjie | Qian, Yunfan | Li, Yimin | Tang, Chengxuan | Tang, Xiaojun | He, Shaoqi

Article Type: Research Article

Abstract: BACKGROUND: Percutaneous kyphoplasty (PKP) is the preferred treatment for osteoporotic vertebral compression fractures (OVCF) Currently, the preoperative anesthesia methods for PKP are mainly local anesthesia and tracheal intubation general anesthesia. OBJECTIVE: To assess whether patient sensitivity to pain measured preoperatively could predict the patients’ pain response during PKP treatment under local anesthesia, to facilitate the development of an optimal preoperative anesthesia plan for patients. METHODS: Fifty-five female patients diagnosed with osteoporotic single vertebral fracture who were treated with PKP under local anesthesia were selected. The patients’ pain sensitivities, including pain threshold and pain …tolerance threshold, were evaluated with a pain test device on the day before the operation in the ward. Heart rate (HR), mean arterial pressure (MAP), and blood oxygen saturation (SpO2 ) were recorded before anesthesia, post-anesthesia, after needle puncture, and after balloon dilatation. At the same time, blood was drawn at the above time points to determine the level of norepinephrine (NA) as an indicator of intraoperative pain stress response. The numerical rating scale (NRS) during surgery was recorded at the end of the surgery. RESULTS: The preoperative pain tolerance threshold of 55 surgical patients was correlated with the intraoperative NRS score (r = - 0.768, P < 0.001), as well as with the preoperative and intraoperative changes in HR (r = - 0.791, P < 0.001), MAP (r = - 0.819, P < 0.001), and NA (r = - 0.553, P < 0.001). Thus, the lower the preoperative pain tolerance threshold, the more severe the patient’s response to pain during PKP treatment under local anesthesia, and the greater the hemodynamic changes. Consequently, the intraoperative experience becomes worse. However, there was no correlation between preoperative pain threshold and NRS scores (r = - 0.069, P = 0.616) nor between the preoperative and intraoperative changes in HR (r = 0.103, P = 0.453), MAP (r = 0.086, P = 0.535), and NA (r = - 0.058, P = 0.674). CONCLUSION: The results indicated that preoperative pain assessment could predict the level of pain response in OVCF patients during PKP surgery under local anesthesia. Show more

Keywords: PKP, OVCF, Pain threshold, Pain tolerance

DOI: 10.3233/BMR-230194

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 715-721, 2024

Authors: Pawłowska, Katarzyna Maria | Pawłowski, Jakub | Grochulska, Agnieszka

Article Type: Research Article

Abstract: BACKGROUND: Hip osteoarthritis is a major civilizational challenge of the ageing population, usually due to the reduced function of gait. In the light of this fact, gait analysis has become an important issue for the doctor, the physiotherapist and the patient, as it serves as a useful tool in diagnosis, recovery, and rehabilitation. Pedobarography is one of the most modern gait analysis methods. OBJECTIVE: The aim of this study is to assess the distribution of pressure forces of the foot on the ground during gait in patients with hip osteoarthritis. METHODS: Dynamic foot …tests were performed by means of a two-meter RSscan® International platform, equipped with 16.384 sensors with the scanning frequency level exceeding 500 Hz. Patients were divided into two groups: the research group of N = 60 individuals with hip osteoarthritis, aged 52–84; and the control group of N = 32 individuals without hip osteoarthritis, aged 50–74. Data distribution analysis was performed with the Shapiro-Wilk test, followed by a non-parametric Mann-Whitney U  test. RESULTS: The differences between the mean results of maximal peak values of pressure and force in such areas as the big toe, metatarsal I, III, IV, V, lateral and medial heel are significantly lower in the research group than in the control group. Only in the area of metatarsal II, the mean value of pressure is higher in the research group than in the control group. For all metatarsals, the midfoot and medial heel mean results of the contact area are significantly higher in the research group than in the control group. The differences between mean load rate were also tested. The test revealed statistical significance of metatarsal II and III, and the medial heel while metatarsal II displayed a higher mean value in the research group than in the control group. CONCLUSION: The distribution of the pressure forces of the foot can indicate imbalances which cause degenerative changes. Therefore, early detection of changes can help in prevention or delay of hip osteoarthritis in conjunction with proper therapy. Show more

Keywords: Hip osteoarthritis, gait, pedobarography

DOI: 10.3233/BMR-230195

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 723-731, 2024

Authors: Passos, Muana Hiandra Pereira dos | Pícon, Sol Patrícia Beltrán | Batista, Gabriel de Amorim | Nascimento, Vinícius Yan Santos | Oliveira, Felipe Augusto da Silva | Locks, Francisco | Pitangui, Ana Carolina Rodarti | de Araújo, Rodrigo Cappato

Article Type: Research Article

Abstract: BACKGROUND: Low back pain is prevalent in workers’ health and functional performance. OBJECTIVE: To evaluate the effects of a physical exercise program on low back pain and disability in fruit workers. METHODS: This randomized controlled trial assigned 44 workers (37 ± 9 years) to two groups. The experimental group consisted of 10 men and 12 women with an average age of 38 (± 9) years, and the control group consisted of 8 men and 14 women with an average age of 36 (± 10) years. The experimental group (EG) performed …a program of strength and flexibility exercises for eight weeks, twice a week. The control group (CG) received minimal care, with a booklet with guidelines for performing exercises. The primary outcomes included changes in perceived disability and the intensity of pain evaluated by the Rolland-Morris questionnaire and the Numerical Pain Scale, respectively. All outcomes were measured at baseline and after eight weeks of intervention. RESULTS: A significant difference was observed in the within-group analysis, with a mean reduction in pain intensity in the EG and CG of - 4.55 (95%CI - 7.01 to - 2.09) and - 3.81 (95%CI 1.72–5.90), respectively. For disability, a reduction of - 4.45 (95% CI - 8.89 to - 0.02) was observed in the EG and of - 4.43 (- 7.38 to - 1.48) in the CG. There were no significant differences in the between-groups analysis. CONCLUSIONS: The exercise program was not superior to using the educational booklet. However, both interventions showed substantial decreases in pain and disability levels. Show more

Keywords: Low back pain, occupational health, farmer, exercise

DOI: 10.3233/BMR-230201

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 733-742, 2024

Authors: Moreno-Navarro, Pedro | Sabido, Rafael | Barbado, David | Prat-Luri, Amaya | Vera-Garcia, Francisco J.

Article Type: Research Article

Abstract: BACKGROUND: Body tilt changes could affect the intensity/difficulty of core stability exercises, but there is still a lack of knowledge about its impact. OBJECTIVE: To analyse the trunk muscles activation during prone plank exercises at different body tilts. METHODS: Twenty-four young adults who performed recreational gymnastic activities participated in this study. Electromyography activity of the rectus abdominis (RA), external oblique (EO), internal oblique (IO) and erector spinae (ES) was recorded during the performance of six variations of the prone plank exercise (planking with feet supported on the ground [conventional horizontal position] and planking …with feet supported on wall bars at five different heights increasing the angle tilt) and an inverted position exercise. RESULTS: The RA, EO and IO activation in all prone plank variations were higher than those observed in the conventional prone plank. In addition, the coefficient of variation of the muscle activation increased with the declination angle, reaching the highest values in the inverted position for the RA and ES muscles. CONCLUSION: The results seem to indicate that the body tilt variation could be used as an easy and inexpensive strategy for modulating the neuromuscular demands and the motor control challenge during planking exercises. Show more

Keywords: Core stability, electromyography, load progression, training program

DOI: 10.3233/BMR-230209

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 743-750, 2024

Authors: Wator, Jennifer | Battis, Aurora | Vellucci, Chris | Beaudette, Shawn M.

Article Type: Research Article

Abstract: BACKGROUND: Rowing-related low back disorders may occur from inconsistent technique, high trunk flexion and training volumes, overactivation of paraspinal muscles, and fatigue. OBJECTIVE: To examine if kinesiology tape (KT) affixed to the trunk dorsum affects muscular co-activation and neuromuscular control to limit dangerous rowing movements and associated injuries. METHODS: Participants (n = 18) completed two 2000 m rowing trials under BASELINE and KT conditions. KT was applied to the skin superficial to the paraspinals bilaterally with 60% pre-strain. Participants were instructed to minimize any sensation of tension. Whole body …kinematics were obtained using inertial measurement units (IMUs), and surface electromyograms (EMGs) were recorded from trunk and lower extremity. Changes in joint range-of-motion (ROM) and co-activation indices (CAIs) were analyzed for shoulder, lumbar, hip, and knee. RESULTS: Responding participants (n = 5) were identified by reduced maximum lumbar flexion during the KT condition. As expected, significant differences occurred in maximum and minimum lumbar flexion/extension between responders and non-responders to KT. Additionally, there was significant reduction in mean trunk muscle co-activation in both those who did and did not respond to KT through reductions in maximum lumbar flexion. CONCLUSION: KT can be an effective at reducing mean trunk co-activation during a rowing trial in the flexed catch position. Variable responses suggest that further work is necessary to optimize the efficacy of sensory cues derived from KT during rowing movements. Show more

Keywords: Electromyography, lower back pain, lumbar, sensory feedback

DOI: 10.3233/BMR-230216

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 751-760, 2024