Journal of Back and Musculoskeletal Rehabilitation - Volume 8, 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: Purpose of the study: To determine possible malfunction of the upper thoracic aperture (an upward displacement of the first rib at the costotransverse joint) as the cause of thoracic outlet syndrome (TOS) symptoms among consecutive TOS patients admitted for conservative treatment. Basic procedures: Fifteen consecutive TOS patients, with a positive TOS index, admitted for conservative treatment were investigated with a three-dimensional CT scan of the upper thoracic aperture. A rehabilitation program was administered at a rehabilitation ward. The CT scans were evaluated for a possible upward displacement of the first rib at the costotransverse joint. The outcome of conservative therapy…was classified as good if the patient was symptom free and poor if loading of the upper limbs still produced symptoms. Outcome follow-up time was 1 year. Main findings: An asymmetry of the first rib was shown on the symptomatic side, indicating an upward displacement of the first rib at the costotransverse joint, in 12 of the patients. Only three patients did not respond to therapy. Eleven patients were engaged in sedentary work. Conclusion: Malfunction of the upper thoracic aperture, especially among patients doing sedentary work, seems to cause TOS symptoms. A carefully planned conservative therapy program based on the functional findings of the individual patient is recommended.
Keywords: Thoracic outlet syndrome, Computerized tomography, First rib
Abstract: The purpose of this study was to investigate the effect of back injury and load on the ability to replicate a target standing posture. Subjects included 16 back-injured males and 16 age-matched controls. Subjects were asked to reproduce a target standing posture and to repeat this task while holding a weight. Trunk inclination was measured using an electrogoniometer. Analysis of variance indicated that back-injured subjects were less accurate in reproducing the target posture than were control subjects. Back-injured subjects typically overestimated how much they had moved and therefore underestimated the target position. Both groups demonstrated a small but statistically significant…difference between the load and no-load condition, with greater degrees of trunk inclination under the load condition. Analysis of covariance indicated that neither self-reported pain level nor maximum voluntary range of motion contributed to significant differences between the two groups. These data indicate that, following injury to the back, individuals may develop an inaccurate perception of body position. This study has implications for training the injured worker.
Keywords: Back injury, Posture, Biomechanics, Proprioception
Abstract: The magnetic resonance imaging (MRI) reports and pain questionnaires of 100 patients with complaints of lower back or neck pain were reviewed. Prior to physician examination, each patient had completed a questionnaire which included pain drawings and a rating on a pain scale. The information given on the drawings and questionnaires was compared to the MRI reports. The levels of agreement between them were analyzed. The results show that the pain questionnaire with drawing is a useful tool in the evaluation of patients when the diagnoses of herniated nucleus pulposis (HNP) or spinal stenosis are in question. The levels of…agreement between the pain drawings and the MRI findings were stronger for the cervical spine than for the lumbar spine and also stronger for the presence of HNP than for central canal spinal stenosis. Particularly useful was the negative predictive power for ruling out cervical and lumbar pathology.
Abstract: The purpose of this investigation was to determine how the position of tibial rotation effects the EMG activity of the medial and lateral hamstrings during low-force isometric knee flexion contractions. Forty-five subjects (ages 18–35) with no history of lower extremity injury or disease volunteered for this study. While lying prone, and with surface EMG electrodes secured to the bellies of their right medial (semitendinous and semimembranosus) and lateral (long head of the biceps femoris) hamstring muscles, each subject held the knee in 45° of flexion for 8 s against 5% of their body weight. This was performed three times in…each of the positions of neutral tibial rotation, external tibial rotation, and internal tibial rotation. The root-mean-square (RMS) of the EMG activity from these muscles was determined for each of the contractions. A repeated measures ANOVA was used to compare the RMS values of the two muscle groups in the three positions. The average RMS values (in microvolts [mV]) obtained were (means and standard deviation): medial hamstrings in external rotation: 50.74 ± 23.11; in neutral: 65.57 ± 25.35; in internal rotation: 70.73 ± 31.86; lateral hamstrings in external rotation: 66.08 ± 46.99; in neutral: 46.18 ± 39.34; in internal rotation: 27.68 ± 17.86. A statistically significant interaction was found between tibial rotation and hamstring muscle (p < 0.0001). These results are consistent with the presumed function of these muscles in that EMG activity in the medial hamstrings increased when the tibia was rotated internally, whereas the lateral hamstring EMG activity increased when the tibia was rotated externally.
Keywords: Isometric, Hamstrings, Electromyography, Manual muscle test
Abstract: This article will describe how to approach the prescription of physical therapy for ‘chronic pain syndrome’. Initial sections will describe script writing for physical and occupational therapies, and review types of exercise and physical therapeutics. Exercise regimens that the literature supports for patients with chronically painful syndromes will also be discussed. The author emphasizes that the practitioner cannot write a therapy script for ‘chronic pain syndrome.’ Instead, the practitioner should understand that physical and occupational therapy can remedy impairments of flexibility, strength and endurance and the patient should be examined to identify these impairments. When the practitioner has identified poor…flexibility or contracture, weakness or loss of strength, or poor endurance in the patient with chronic pain, the practitioner can then write a physical therapy or occupational therapy script with goals to improve these impairments. It is not necessary for the practitioner to be familiar with the nuances of exercise application; it is only necessary for the practitioner to identify contracture, weakness and poor endurance, and to direct the therapist's attention to these deficits via a therapy script. The practitioner should include precautions on a script to a therapist. These precautions are based on the patient's concurrent medical and surgical diagnoses. Lastly, the literature describing therapeutic interventions in patients with chronic pain syndromes is poor because the painful conditions are poorly characterized and the therapeutic interventions are poorly described; however, where specific exercise programs for specific diagnoses were identified, the exercise regimens are discussed.
Keywords: Chronic pain syndrome, Script writing, Physical and occupational therapies
Abstract: According to a recent Time magazine article, a 1995 study at Dartmouth-Hitchcock Medical Center found that one of the best predictors of survival among 232 heart-surgery patients was the degree to which the patients said they drew comfort and strength from religious faith. Those who did not had more than three times the death rate of those who did (June 24, 1996, pp. 59–68) Likewise, according to the article, numerous studies have found lower rates of depression among the religiously committed. The article goes on to state that patients with chronic health problems are failing to find relief in…a doctor's office, and the increasing use of high-tech scans and tests of modern medicine leave patients feeling uncared for and alienated. Dr. Herbert Benson, President of the Mind/Body Medical Institute at Boston's Deaconess Hospital and Harvard Medical School, in his book, Timeless Healing, demonstrated the role of meditation and spirituality in patients battling chronic illnesses. A 5-year study found that those who claimed to feel the intimate presence of a higher power had better health and more rapid recoveries. As clinicians, we were not trained to recognize or teach our patients how to act on the role of faith and hope in healing. However, as researchers, we cannot dismiss the possibility that there is a definite relationship. The following commentary is offered to you as food for thought. Today, as we continue to seek ways to reduce health care costs while still providing effective methods of treating illness, we must not rule out factors such as faith and hope in meeting our ultimate goal of healing the sick.