Journal of Back and Musculoskeletal Rehabilitation - Volume Pre-press, issue Pre-press
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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: Low back pain is a very common musculoskeletal complaint that impacts patients’ quality of life in numerous ways. Facet joint injection is a widely used spinal intervention to relieve back pain. Effects of facet joint injection on spinopelvic parameters and the relationship between injection levels and spinopelvic parameter changes have not been evaluated before. OBJECTIVE: To compare spinopelvic parameters before and after injections at different levels, and to evaluate the correlation between these changes and functional outcome. METHODS: 144 patients were included in the study and retrospectively grouped by injection level: Group 1 (n =…72), L4-L5 and L5-S1, and group 2 (n = 72), L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1. Pre- and post-injection Oswestry Disability Index (ODI), sacral slope, pelvic tilt, pelvic incidence, and intervertebral angles between T12 and S1 were compared. The correlation between ODI and radiographic parameter changes was evaluated. RESULTS: The pre- to post-injection ODI change was significantly lower in group 2 (p = 0.010). There was no significant difference between the groups in terms of pre- and post-injection spinopelvic parameters before and after injection (p > 0.05) except pelvic tilt (p = 0.001 and p = 0.007, respectively). There was a significant moderate positive correlation between the change in the ODI value and the change in pelvic tilt (P = 0.012, r = 0.581). CONCLUSIONS: Multilevel lumbar facet injections are clinically more effective than only two-level lower level lumbar injections. Pelvic tilt changes positively correlate with the ODI score changes.
Abstract: BACKGROUND: Problems related to ankle instability, decreased proprioceptive sensation, altered static and dynamic balance abilities are suggested as major representative factors that contribute to the recurrence of ankle sprains. OBJECTIVE: To assess the effect of a three-week intervention (intervention emphasizing diagonal eccentric contraction (IEDEC) and intervention of general exercise (IGE)) on static and dynamic balance abilities, ankle strength and joint position sense at pre- and post-intervention, and at two- and three-week post-intervention. METHODS: Twenty-five participants with ankle instability, including a history of ankle sprain and recurrent episodes of giving way, were enrolled in…the study. They were randomly classified into the IEDEC group (n = 12) and the IGE group (n = 13). Dynamic balance was examined using the Y Balance Test, four-way ankle strength was measured, and the static balance was evaluated using the total displacement of the center of pressure (COP). To identify the joint position error, eversion and inversion of the ankle angle were measured. RESULTS: The results revealed significant increases in ankle dynamic stability and strength at two and three weeks post-intervention (p < 0.05). Similarly, the total displacement of the COP differed significantly over time, with a higher COP during the initial measurement than at two and three weeks intervention (p < 0.05) General balance training with IEDEC can improve position sense during ankle inversion (p < 0.05). CONCLUSION: General balance training with IEDEC improved the position sense of the inversion. Combined therapeutic intervention, such as with the manual technique, could be a beneficial approach to maximize the treatment effects.
Abstract: BACKGROUND AND OBJECTIVE: Jumping stump is an uncommon movement disorder characterized by involuntary movements and severe neuropathic pain in the stump. The pathophysiology and etiology of this phenomenon have not yet been clearly elucidated, and unfortunately, no proven treatment with successful recovery exists. This report aims to describe a severe painful jumping stump, possibly due to neuromas, in a traumatic transradial amputee. MATERIALS AND METHOD: We performed ultrasound examination of the painful stump depicted neuroma. Electromyographic evaluation of the stump revealed arrhythmic motor unit action potentials (MUAPs) with normal duration and amplitude; other movement disorders, such…as myokymia and fasciculations, were excluded. Ultrasound should be preferred to magnetic resonance imaging (MRI) for evaluation of stumps in patients with painful stump because MRI may not be helpful due to motion artefacts. The involuntary movements ceased after surgical excision of the neuroma following failure of conservative treatments. CONCLUSION: This report confirms that neuromas are clearly associated with jumping stump. Ultrasonographic and electromyographic assessments are necessary to reveal the features of this pathology for treatment planning.
Keywords: Amputee, electromyography, jumping stump, movement disorder, pain, peripherally-induced movement disorder, stump, neuroma
Abstract: BACKGROUND: The Back Pain Attitudes Questionnaire (Back-PAQ) is a tool developed for the assessment of attitudes about back pain. However, this tool is not available in the Arabic language. The availability of the Arabic version of the questionnaire will enable clinicians and researchers in Arabic-speaking countries to assess patients’ attitudes towards back pain. OBJECTIVE: We aimed to translate and cross-culturally adapt the English version of the Back-PAQ into Arabic and study its psychometric properties. METHODS: The translation and cross-cultural adaptation processes were performed according to published guidelines. The translated Arabic version was tested…for face and content validity on 40 participants. The psychometric properties of the final Arabic version were tested on 110 participants. Participants completed the Arabic version of the Back-PAQ and Fear-Avoidance Beliefs Questionnaire (FABQ). A subgroup of 50 participants completed the questionnaire twice in a week interval to determine the Back-PAQ test-retest reliability. RESULTS: The majority of participants found the questionnaire understandable and the questions relevant and appropriate for their back problem. There was a fair correlation between the Back-PAQ-Arabic and the FABQ physical activity scale (rho = 0.283, p = 0.001), and little to no correlation with total FABQ (rho = 0.186, p = 0.026) and education level (rho = - 0.162, p = 0.045). The Arabic Back-PAQ-Arabic showed moderate internal consistency with Cronbach’s α of 0.601, and excellent test-retest reliability (ICC 2 , 1 = 0.963). The Back-PAQ standard error of measurement was 3.57 and minimum detectable changes was 9.90. CONCLUSION: The Arabic version of the Back-PAQ has adequate validity and reliability properties.
Keywords: Low back pain, Back Pain Attitudes Questionnaire, attitude, Arabic, translation, cross-cultural adaptation
Abstract: BACKGROUND: Although the Pilates method has been reported to be effective in women with low back pain (LBP), the efficacy of Pilates exercises in pregnant women with LBP has not been evaluated widely. OBJECTIVE: The purpose of this study was to determine the effects of clinical Pilates exercises on lumbopelvic stabilization, pain, disability and quality of life in pregnant women with LBP. METHODS: Fourty pregnant women were randomized into either a Pilates exercise group (n = 20) or control group (n = 20).…Subjects in the Pilates exercise group performed the exercises two times a week for eight weeks. Subjects in the control group followed regular prenatal care. Lumbopelvic stabilization was assessed with a pressure biofeedback unit, pain with the Visual Analog Scale, disability with the Oswestry Low Back Pain Questionnaire and quality of life with the Nottingham Health Profile (NHP). RESULTS: Pain and disability were significantly improved in the Pilates exercise group after intervention (p = 0.03, p < 0.001, respectively). There were also significant improvements in sleep, physical mobility sub-parameters of NHP and lumbopelvic stabilization after Pilates exercises (p = 0.048, p = 0.007, respectively). However, there were no statistically significant changes in all outcome measures in the control group (p > 0.05). CONCLUSIONS: Pilates exercises can be recommended as an effective and safe method for increasing lumbopelvic stabilization, reducing pain and disability, improving physical mobility and sleep problems in pregnant women with LBP.
Keywords: Pilates exercises, disability, pain, quality of life, lumbopelvic stabilization, pregnancy, low back pain
Abstract: BACKGROUND: The benefits of spinal realignment and stabilization in scoliosis need to be examined. OBJECTIVE: We aimed to investigate the long-term effect of a neuromuscular stabilization technique (NST) on Cobb’s angle in patients with adolescent idiopathic scoliosis. METHODS: Twenty females recruited from two hospitals participated in this study. On the basis of convenience of location, participants were allocated to either the experimental group (EG) that underwent the NST, or the control group (CG) that received education for a home exercise program. The NST for the EG was performed for an average of…30 min per session, three times a week for six months, and consisted of spinal realignment and stabilization. Then, 12- and 18-month measurements for long-term follow-ups were conducted for the EG. The outcome measure was Cobb’s angle. RESULTS: Between-group comparison revealed a statistically significant difference at post-test (t = - 3.26, p < 0.01) but not pre-test (t = - 1.36, p = 0.19). Participants of the EG (- 6.20 ± 2.49 ∘ ) showed greater differences between pre- and post-test scores compared to participants of the CG (- 1.40 ± 0.52 ∘ ) (p < 0.05). Within-group comparisons showed a significant difference in both groups (p < 0.05). In the EG, Cobb’s angle significantly changed across the follow-up sessions (p < 0.05), indicating more improvements by the 12-month (8.50 ± 4.03 ∘ ) and 18-month (6.60 ± 3.89 ∘ ) follow-ups. CONCLUSION: This study shows that the NST may be a beneficial option to correct spinal alignments in patients with adolescent idiopathic scoliosis.
Abstract: BACKGROUND: The abdominal drawing-in exercise could help improve delayed transversus abdominis (TrA) activation during limb movement in subjects with recurrent low back pain (rLBP). However, little is known about whether the same effect is observed during lifting tasks in subjects with rLBP. OBJECTIVE: This study aimed to clarify whether a single session of abdominal drawing-in exercise could correct the altered trunk muscle activation patterns during a lifting task in subjects with rLBP. METHODS: Fifteen subjects with rLBP performed lifting tasks before and immediately after three sets of 10 repetitions of isolated TrA voluntary…contractions. The time of onset and activation amplitude during the lifting tasks were measured by surface electromyography (EMG) and compared between the trials before and immediately after exercise. RESULTS: During lifting, the onset of internal abdominal oblique/TrA (IO/TrA) and multifidus activation occurred earlier, the EMG amplitude of IO/TrA increased, and the EMG amplitude of erector spinae and multifidus decreased, compared with the pre-exercise data. CONCLUSIONS: These results suggest a possibility that the abdominal drawing-in exercise might be effective in improving the muscle recruitment pattern in people with rLBP.
Abstract: BACKGROUND AND OBJECTIVE: Morel-Lavallée Lesion (MLL) of the knee is an uncommon cause of knee swelling usually due to high-energy impact or in patients on anticoagulation. MLL of the knee due to low-energy non-athletic associated trauma in patients without antithrombotic therapy is rare. Early diagnosis can be achieved using point-of-care ultrasound. CASE REPORT: A 60-year-old female who was previously well was referred to our center for a persistently swollen left knee 2 months after a fall while on a flight of stairs. A point-of-care ultrasound identified a possible MLL of the knee. This was subsequently confirmed on magnetic…resonance imaging (MRI). The lesion resolved with ultrasound-guided therapeutic aspiration. CONCLUSION: MLL of the knee should be a differential diagnosis of traumatic knee swelling, even in low-energy trauma and in patients without bleeding diatheses. Ultrasound is a readily available and rapid modality that can aid both in the diagnosis and management of such lesions.
Abstract: BACKGROUND: Teachers present with shoulder musculoskeletal disorders, which result in pain and poor shoulder function. OBJECTIVE: To determine the effect of an eight-week shoulder rehabilitation intervention on pain and function, range of motion and muscle strength among teachers. METHODS: Thirty teachers presenting with shoulder pain were recruited and divided into equal control and experimental groups. The intervention group participated in an eight-week rehabilitation programme. Pre- and post-intervention measurements included the scapular position test, range of motion, muscle strength measurements as well as a shoulder rating questionnaire. RESULTS: There was a significant improvement…in the experimental group’s internal range of motion for the dominant (p = 0.006) and non-dominant arms (p = 0.003) post-intervention. Additionally, significant improvements were found in muscle strength in the experimental group in dominant and non-dominant flexion; abduction; external rotation (p < 0.001); dominant internal rotation (p < 0.001) and non-dominant internal rotation strength (p = 0.007). Post-intervention questionnaire data found a decrease in pain (p = 0.003); improved ability to perform daily activities (p = 0.006); improved overall score (p < 0.001) and satisfaction (p = 0.023) in the intervention group compared to the control group. CONCLUSION: The implementation of a rehabilitation programme in schools should be considered to manage the prevalence of shoulder musculoskeletal disorders among teachers.
Keywords: Intervention, musculoskeletal disorders, prevalence, range of motion, muscle strength, teachers
Abstract: BACKGROUND: The child’s spine shows changes in posture and balance of its curvatures during growth and musculoskeletal spinal conditions are likely to develop, such as back pain (BP). OBJECTIVE: The purposes of this study were (a) to describe the sagittal spinal alignment in a relaxed standing position and (b) to analyze its association with BP among 8 to 12-year-old children. METHODS: This was a cross-sectional study. A total of 731 elementary schoolchildren (379 girls and 352 boys), from 16 Spanish schools, participated. An unilevel inclinometer was used to quantify the sagittal spinal curvatures (thoracic and lumbar)…in a relaxed standing position. Sagittal spinal morphotype was analyzed by sex, age, weight, height, and BMI. Children’s parents or legal guardians filled in a questionnaire according to the children’s responses about the BP suffered in the previous week and the preceding year. RESULTS: The mean angular value of thoracic kyphosis was 36.08 ± 8.99 ∘ and significantly higher in males than in females (p = 0.036). In contrast, the mean value of lumbar lordosis was 32.11 ± 7.46 ∘ , being higher in females than in men (p < 0.01). The thoracic curve tends to increase by age (p = 0.003). Children who had low back pain (LBP) in the previous week had a significantly greater lumbar curve (35.88 ± 8.20 ∘ ) than those who did not have LBP in the preceding week (32.24 ± 7.30 ∘ ). The angle for lumbar curvature was a small predictor of LBP occurrence in the assessed children (OR = 1.082 [small]; 95% CI = 1.009–1.160, p = 0.028). CONCLUSIONS: To conclude, almost 3/4 of the students were classified with normal thoracic kyphosis; however, 27.36% of the students had thoracic hyperkyphosis. Lumbar hyperlordosis was identified in 9.05% of the students, and was 2.5 times more frequent in girls. The lumbar curvature was a small predictor of LBP occurrence in the assessed children and the angle of lumbar curvature that most accurately identified individuals at risk of developing LBP was determined to be 33 ∘ . The results of this study indicate the need to assess sagittal spinal curvatures at school during development ages.
Keywords: Kyphosis, lordosis, inclinometer, spine, spinal imbalance, children