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: Lumbar vertebrae carry the greatest load from the spinal column, often leading to several pathologies, including degenerative disc disease (DDD), potentially, disturbing spinal movement patterns. Mobilisation increases hypomobile segment mobility, however there is little evidence on mobilisation in patients suffering with different types of DDD. OBJECTIVE: To assess the efficacy of mobilisation in young patients with DDD, as diagnosed by MRI. METHODS: Thirty patients (24–35 years) participated in this study, and were divided into two groups, based on progression levels of DDD diagnosed by MRI (protrusion-PRO/extrusion-EXT). Twenty sessions of sustained stretch mobilisation…(grade III) were applied to both groups over four weeks. Numeric rating scale (NRS), Oswestry disability index (ODI), straight leg raise (SLR), passive lumbar extension (PLE) and lumbar range of motion (ROM) assessed outcome variables. Three trial stages were investigated: pre-therapy(1), post-therapy(2) and follow-up(3). RESULTS: Age (p = 0.007) and NRS (p = 0.002) were significantly different before therapy. Patient outcomes were significantly improved for all parameters in both groups, except SLR which improved in the EXT group only (p = 0.043). CONCLUSIONS: Applied treatments improved patient outcomes and were statistically significant in both groups, however, better outcomes were observed in the EXT group during follow-up. Mobilisation was a safe and effective procedure for the treatment of DDD.
Keywords: Mobilisation, herniated disc, low back pain, spine, lumbosacral region
Abstract: BACKGROUND: Differences in pain processing, muscle structure and function have been reported in patients with low back pain (LBP) with different grades of pain chronicity. OBJECTIVE: The present study aims to examine differences in psychological factors, disability and subjective fatigue between subgroups of LBP based on their chronification grade. METHODS: Twenty-one healthy controls (HC) and 54 LBP patients (categorized based on the grades of chronicity into recurrent LBP (RLBP), non-continuous chronic LBP (CLBP), or continuous (CLBP)) filled out a set of self-reporting questionnaires. RESULTS: The Hospital Anxiety and Depression Scale…(HADS) and Multidimensional Pain Inventory (MPI) scores indicated that anxiety, pain severity, pain interference and affective distress were lower in HC and RLBP compared to non-continuous CLBP. Anxiety scores were higher in non-continuous CLBP compared to RLBP, continuous CLBP and HC. The Pain Catastrophizing Scale for Helplessness (PSCH) was higher in non-continuous CLBP compared to HC. The Survey of Pain Attitudes (SOPA) showed no differences in adaptive and maladaptive behaviors across the groups. The Pain Disability Index (PDI) measured a higher disability in both CLBP groups compared to HC. Moreover, the Rolland Morris Disability Questionnaire (RMDQ) showed higher levels of disability in continuous CLBP compared to non-continuous CLBP, RLBP and HC. The Checklist Individual Strength (CIS) revealed that patients with non-continuous CLBP were affected to a higher extent by severe fatigue compared to continuous CLBP, RLBP and HC (subjective fatigue, concentration and physical activity). For all tests, a significance level of 0.05 was used. CONCLUSIONS: RLBP patients are more disabled than HC, but have a tendency towards a general positive psychological state of mind. Non-continuous CLBP patients would most likely present a negative psychological mindset, become more disabled and have prolonged fatigue complaints. Finally, the continuous CLBP patients are characterized by more negative attitudes and believes on pain, enhanced disability and interference of pain in their daily lives.
Abstract: BACKGROUND: Previous studies have examined when activities of daily living (ADL) recovery more than six months after surgery can be predicted, and how much accuracy the predictors have. OBJECTIVE: The purpose of this study was to determine the predictors of ADL decline and evaluate their accuracies one year post-operation for hip-fracture patients. METHODS: We studied patients who underwent hip fracture surgery and were able to walk independently pre-operatively. The predictors of ADL declined one year post-operation, as analyzed using data of the basic medical attributes of the patients, including pain, 30-s chair-stand test,…dementia [using the Revised Hasegawa Dementia Scale (HDS-R)], and walking/mobility style [using Barthel Index (BI)]. Using a receiver operating curve (ROC) curve, the cut-off value for each significant predictor was determined in the logistic regression analysis. To calculate the cut-off values and diagnostic performances of each of the extraction factors. RESULTS: The data of 36 patients were collected over a period of one year. The prior probability of ADL decline at one year post-operation was 44.4%. The results of logistic regression analyses showed that the score of HDS-R at admission and the walking/mobility BI score at three weeks post-operation were significant predictors of the one year post-operative decline in ADL. The results of the ROC analyses showed that the cut-off value of the HDS-R score at admission was < 23 points. The posterior probability increased to 62.0%. In contrast, the cut-off value of the walking/mobility BI score was 0 points. The posterior probability increased to 91.0%. CONCLUSION: The ADL decline of the patients who underwent hip fracture surgery at one year after surgery can be predicted at three weeks post-operation.
Abstract: BACKGROUND: Rehabilitation is currently the preferred first-line treatment for thoracic outlet syndrome (TOS). When physiotherapy fails, the next treatment option is usually surgery – a complex procedure with potential complications. OBJECTIVE: We sought to establish whether an intensive, multidisciplinary, day-hospital-based rehabilitation programme could reduce the symptoms of TOS after the failure of private-practice physiotherapy and before surgery was considered. METHODS: We performed a retrospective, single-centre study of 63 TOS patients admitted to our day hospital for 3 weeks (15 therapy sessions) between 2003 and 2014. The data were extracted from hospital records or…gathered in a phone interview. RESULTS: Immediately after discharge, the observed improvements in hand function were related to lifting a load, reaching a high shelf, sweeping the floor, cleaning windows, and combing hair. Three months after the end of the intensive rehabilitation program, 80% of the patients reported a reduction in their symptoms. Forty-one of the 63 patients were subsequently contacted by phone. The mean time interval between the end of the rehabilitation programme and the phone interview was 4.5 years (median: 3.5 years; range: 1–12 years). Twenty-seven patients (66%) reported a worsening in hand function, and 25% had undergone surgery. Twenty-three patients had kept the same job, 7 had changed jobs after retraining, 4 had stopped working before the programme but were able to return to work afterwards (including one patient in a part-time job), 4 had not returned to work, and 3 received disability benefits. CONCLUSION: An intensive, multidisciplinary, hospital-based rehabilitation programme was associated with improvements in the great majority of patients with TOS – even after private-practice physiotherapy had failed.
Keywords: Thoracic outlet syndrome, rehabilitation, physical and rehabilitation medici
Abstract: BACKGROUND: Pain relief is important both for the movement of patients suffering from low back pain and the quality of life. Dry needling is effective on myofascial trigger points but its effect on the area of pain and the functional balance is not fully known. OBJECTIVE: To examine the immediate effect of dry needling on pain and functional balance of patients suffering from low back pain. METHODS: Twenty five patients with sub-chronic low back pain were randomly divided into two groups: the intervention or control group. Needles were used for the participants of the…intervention group, bilaterally at the spinus level, one and a half finger breath from the midline in levels L2–L5 of the lumbar spine. A third line of needles was inserted in the interspinosus spaces, except L5-S1 level. Bipedal stance, lateral loading and mediolateral body sway were assessed using a pair of force plates. Pain tolerance was assessed using an algometer. RESULTS: The pain tolerance significantly increased in the intervention group from (M = 4.87, SE 0.663) to (M = 6.52, SE 0.547) (F( 1 , 23 ) = 7.8, p < 0.05) after intervention. During mediolateral body sway the force signal in the dominant frequency significantly increased in the intervention group from (M = 43.2, SE 4.6) to (M = 54,9, SE 3.6) (F( 1 , 23 ) = 4.63, p < 0.05) after intervention, exhibiting more controlled rhythmic behavior. CONCLUSIONS: Dry needling in painful areas and penetrating all the muscle groups seems to improve pain and functional balance, yet its effect on specific muscles needs to be studied further.
Keywords: Low back pain, dry needling, force platforms, body sway
Abstract: OBJECTIVE: The purpose of this systematic review with meta-analysis was to compare the effects of low load resistance combined with blood flow restriction (BFR) versus conventional quadriceps strengthening on knee symptoms and function as well as knee extensor strength and muscle thickness in adults with knee conditions. LITERATURE SURVEY: Guidelines based on the latest evidence highlight the importance of quadriceps strengthening to reduce pain and improve function in patients with knee conditions. Blood flow restriction is based on brief periods of vascular occlusion which cause muscle hypertrophy and increased strength. Before it can be recommended for individuals…with knee conditions, quadriceps strengthening with low load resistance combined with BFR (LL-BFR) must show beneficial effects on clinical outcomes in addition to quadriceps strength and mass. METHODS: A systematic review with meta-analysis was conducted to identify relevant studies through PubMed, PEDro, and ScienceDirect up to January 2019. The protocol was registered on PROSPERO (CRD42019121306). Differences in pre- and post-intervention means and standard deviations were extracted to calculate the standardized mean difference for each intervention in each included study. SYNTHESIS: Eight studies were included. Limited evidence suggests that LL-BFR is more beneficial on quadriceps strength and thickness in patients with knee conditions than LL training alone or in addition to a rehabilitation program. Limited evidence indicates that LL-BFR training is equally effective in improving function and muscle thickness compared with a HL quadriceps strengthening program but elicits less knee pain, corresponding to additional benefits of 22 (95% confidence interval 1 to 43) mm on a 0–100 mm visual analogue scale. CONCLUSIONS: BFR could be a useful option for patients with knee conditions where conventional quadriceps strengthening program exacerbate knee symptoms. Future investigations should compare different BFR protocols to help establish better guidelines for clinicians.
Abstract: BACKGROUND: Alterations in plantar loading patterns are risk factors for stress injuries of the lower limb, particularly of the foot and ankle. Epidemiological studies have revealed a higher incidence of soccer-related stress fractures of the fifth metatarsal (MT V) in younger athletes than in their adult counterparts. OBJECTIVE: The aim of the present study was to assess the plantar pressure distributions of members of four high-level soccer teams of different age groups to identify age-related differences in loading patterns. METHODS: A total of 65 elite soccer players were included in the study. Data…were computed with sensor-loaded insoles (pedar ® X system, novel Inc., Munich, Germany) while the players ran in soccer shoes. Plantar pressures for nine defined regions on the preferred and nonpreferred foot were analyzed. RESULTS: The participants consisted of 17 elite male soccer professionals from the first national league (mean 23 years, height 184 cm, weight 81 kg), 14 players from the under-21 squad (U21, 20 years, 180 cm, 75 kg), 15 players from the U17 squad (16 years, 176 cm, 69 kg) and 19 players from the U16 squad (15 years, 179 cm, 70 kg). We detected statistically significantly elevated peak pressures on the lateral aspects of the nonpreferred foot compared with the preferred foot in the U16 and U17 players, corresponding to a relative increase by 29% (p = 0.044) in the lateral midfoot, a relative increase by 24% (p = 0.031) in MT heads 4–5 in the U16 players and a difference of 18% (p = 0.049) in the lateral midfoot in the U17 players. In contrast, the U21 and adult professional players displayed symmetric plantar pressure distributions in all foot regions. CONCLUSIONS: In contrast to adult elite soccer players, adolescents demonstrate asymmetric foot loading patterns with increased peak loads in the lateral aspects of the nonpreferred foot. Our results may provide some explanation for MT V stress fractures that occur in elite adolescents.
Abstract: BACKGROUND: In people with chronic low back pain (cLBP) and active discopathy, glucocorticoid intradiscal injection (GC IDI) reduces LBP in the short-term. Lumbosacral immobilization may be useful to obtain long-term results. OBJECTIVE: To assess the feasibility of a lumbosacral immobilization using a pantaloon cast following GC IDI in people with cLBP sand active discopathy. METHODS: We conducted a retrospective feasibility study. Participants were allocated to experimental or control groups by preferences. The experimental group received lumbosacral immobilization using a custom-made pantaloon cast worn continuously for one week following a GC IDI of 25 mg…of prednisolone acetate. The control group received GC IDI alone. The primary endpoint was the feasibility of lumbosacral immobilization assessed by the rate of refusal and early withdrawal of the cast. RESULTS: Twelve patients were offered lumbosacral immobilization following GC IDI: the rate of refusal was 3/12 (25.0%) and was 3/9 (33.3%) of early withdrawal. Mean (95% CI) acceptability of the procedure was 55.0 (26.9–83.1)/100 in the experimental group (N = 6) and 61.6 (25.1–98.2)/100 in the control group (N = 6). CONCLUSIONS: We found high rates of refusal and early withdrawal of the lumbosacral immobilization using a pantaloon cast following GC IDI in people with nonspecific cLBP and active discopathy.
Keywords: Chronic low back pain, Modic 1, active discopathy, intradiscal therapy, glucocorticoid, lumbar brace
Abstract: BACKGROUND: Low back pain (LBP) is a common problem that causes pain, disability, and gait and balance problems. Neurodynamic techniques are used in the treatment of LBP. OBJECTIVE: The aim of this study was to compare the effects of electrotherapy and neural mobilization on pain, functionality, gait, and balance in patients with LBP. MATERIALS AND METHODS: A total of 41 patients were randomly assigned to either the neural mobilization group (NMG, n = 20) or electrotherapy group (ETG, n = 21). Assessment tools…used were Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI) for functionality, straight leg raise test (SLRT) for neural involvement, and baropedographic platform (Zebris FDM-2 TM ) for gait and static balance measurements. RESULTS: Both groups showed a significant decrease in pain and functional disability, while only the NMG group showed a significant increase in SLRT scores (p < 0.05). However, there were no statistically significant pre- to post-treatment changes in gait or static balance parameters in either group (p < 0.05). CONCLUSION: Neural mobilization was effective in reducing pain and improving functionality and SLRT performance in patients with LBP, but induced no change in gait and static balance parameters. Neural mobilization may be used as self-practice to supplement standard treatment programs.
Keywords: Balance, disability, gait, low back pain, neurodynamics
Abstract: BACKGROUND: Damage on the somatosensory system could cause sensation of dizziness, a condition known as cervicogenic dizziness (CD). Manual physical therapy has shown beneficial effects, relieving the symptoms of cervicogenic dizziness. However, the effect of upper cervical spine manipulation is unknown, as this is a technique that respects the International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) safety criteria. OBJETIVE: To assess the effects of upper cervical spine traction-manipulation in subjects with cervicogenic dizziness. METHODS: This was a descriptive case series study. Treatment focused on the upper cervical spine manipulation procedure. Evaluation was…performed before and after the treatment. Variables recorded include upper and lower cervical range of motion, Cervical Flexion-Rotation Test (CFRT), dizziness intensity and cervical pain (VAS), self-perceived dizziness measured with Dizziness Handicap Inventory (DHI) and subjective perception of outcome (GROC-scale). RESULTS: Ten subjects were recruited. After the treatment protocol, there was an increased range of movement towards the most restricted side, as measured by the CFRT (p < 0.001), decreased intensity of dizziness (p < 0.001) and intensity of pain (p < 0.001). Functional capacity also improved after the intervention (p < 0.011). CONCLUSION: Upper cervical spine manipulation may decrease dizziness intensity and cervical pain and improve functional ability and upper cervical spine mobility in patients with cervicogenic dizziness.
Keywords: Cervical spine, dizziness, manual therapy, range of movement and functional capacity