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: BACKGROUD: Although the effect of exercise in patients during the subacute and/or chronic subacromial impingement syndrome has been reported, only a few studies have examined the effect of pain free exercise in the acute phase of this disorder. OBJECTIVE: To compare the effect of training using the Neurac technique which combines body segments suspension and vibration vs. manual therapy, on various relevant outcome parameters in patients with acute subacromial impingement syndrome (PASIS). METHOD: Twenty-six patients underwent a 4 week intervention program. Using random assignment, half of the patients were treated using the Neurac…device group while the other half was treated using manual therapy. The outcome parameters consisted of shoulder pain, shoulder function, range of motion (ROM) and the isokinetic strength of the external and internal rotators at 60 and 180 ∘ /s. RESULTS: Following either modes of interventions, the pain, function, and ROM improved significantly compared to pre-intervention levels in both groups. Time-by-group interaction was observed for the rotational strength which increased significantly and exclusively in the Neurac group. CONCLUSIONS: Given its positive effect on shoulder pain, function, ROM and the isokinetic strength of the external and internal rotators, we recommend the application of the Neurac technique in PASIS.
Abstract: BACKGROUND: Respiratory muscle training (RMT) has been recommended to mitigate impacts of spinal cord injuries (SCI), but the optimal dosage in terms of the frequency, intensity, time, and type (FITT principle) to promote health in SCI individuals remains unclear. OBJECTIVE: To discuss research related to the effects of RMT on pulmonary function, respiratory muscle strength and cardiorespiratory fitness in athletes and non-athletes with SCI, presenting the FITT principle. METHODS: We performed a systematic review. PubMed, Lilacs, Scopus, Web of Science, PEDro, SciELO and Cochrane databases were searched between 1989 and August 2018. Participants…were athletes and non-athletes with SCI. RESULTS: 4,354 studies were found, of which only 17 met the eligibility criteria. Results indicated that RMT is associated with beneficial changes in pulmonary function and respiratory muscle strength and endurance among athletes and non-athletes, whereas no effect was reported for maximal oxygen uptake. It was not possible to establish an optimal RMT dose from the FITT principle, but combined inspiratory/expiratory muscle training seems to promote greater respiratory changes than isolated IMT or EMT. CONCLUSION: The use of RMT elicits benefits in ventilatory variables of athletes and non-athletes with SCI. However, it remains unclear which RMT type and protocol should be used to maximize benefits.
Abstract: BACKGROUND: Intra-articular distension is a validated treatment in adhesive capsulitis of the shoulder and is commonly followed by intensive in-patient physical therapy. A recent meta-analysis found that physical therapy is as effective as intra-articular distension (IAD) and that an early distension could be the primary choice for treating frozen shoulder. The question of the additional contribution of physical therapy prior to IAD compared with IAD followed by physical therapy has not been raised. OBJECTIVES: We compared IAD preceded by physical therapy to that followed by physical therapy in terms of pain relief and functional outcome.…METHODS: We enrolled patients with primitive adhesive capsulitis of the shoulder. The eligible patients were randomized into three groups: A, B and C. Group A received intra-articular distension followed by physical therapy, group B received intra-articular distension in the middle of physical therapy and group C received physical therapy alone. Patients were assessed at the beginning of the protocol (T0), after 6 weeks (T1) and after 12 weeks (T2). The main outcome measures were pain using a Visual Analog Scale and the Disabilities of Arm, Shoulder and Hand Questionnaire. RESULTS: Out of the 179 enrolled patients, only 122 completed the follow up: group A (n = 34), group B (n = 46) and group C (n = 42). Compared to intra-articular distension preceded by physical therapy, IAD followed by physical therapy did not improve significantly the outcome in terms of pain relief (p = 0.123) but it enhanced the upper extremity function (p = 0.002). Upper extremity pain and function were found to improve with time regardless of the protocol (p < 0.001). CONCLUSIONS: IAD followed by physical therapy is more beneficial than IAD preceded by physical therapy in terms of upper extremity function. IAD, whether or not preceded by physical therapy, does not significantly improve pain compared to physical therapy alone. Time is a crucial factor to take into consideration while treating adhesive capsulitis of the shoulder.
Abstract: BACKGROUND: Auditory feedback enables an individual to identify and modify the differences between actual and intended movement during the motor learning process. OBJECTIVE: We investigated the effects of gait training with auditory feedback on trunk control, muscle activation, and dynamic balance in patients with hemiparetic stroke. METHODS: Twenty participants with hemiparetic stroke were recruited in this study and randomly assigned to the experimental (n = 10) or control (n = 10) group. The subjects in the experimental group participated in gait training with…auditory feedback for 30 minutes, 5 times a week, for 4 weeks, whereas those in the control group received conventional gait training for 30 minutes, 5 times a week, for 4 weeks. During auditory feedback training, a beeping sound is produced every time a patient loaded weight that was higher than the preset threshold on the cane. Activation of the erector spinae muscle was measured using surface electromyography, and trunk control was evaluated using the Trunk Impairment Scale (TIS). Dynamic balance was measured using the Timed Up and Go (TUG) test. RESULTS: Muscle activation was significantly higher in the experimental group than in the control group (6.6 ± 9.2% vs 1.4 ± 5.4% nonparetic peak activity). No significant difference was found in the TIS score between the experimental and control groups. Based on the TUG test, a significant improvement was observed in the experimental group compared to the control group (12.1 ± 11.4 vs 3.8 ± 4.7 s). CONCLUSION: Our findings indicate that gait training with auditory feedback was beneficial for improving trunk control and muscle activation in patients with hemiparetic stroke.
Keywords: Biofeedback, cane, stroke, trunk control
Abstract: BACKGROUND: It is important to evaluate clinical efficacy and safety of posterior internal fixation using pedicle screw system. OBJECTIVES: To investigate clinical characteristics of patients diagnosed with fracture-dislocation of the thoracic spine with or without minimal spinal cord. METHODS: Twenty-eight patients with fracture-dislocation of thoracic spine with or without minimal spinal cord injury were retrospectively analyzed. All patients received posterior reduction and internal fixation using pedicle screw system. RESULTS: The mean follow-up duration was 11.4 months. Among 28 patients, 24 cases were complicated with bilateral pedicle or laminal fracture. Preoperatively, the…percentage of vertebral displacement was (32.1 ± 20.6)%, significantly declined to (7.5 ± 6.0)% (t = 4.575, P = 0.001) and maintained at (7.9 ± 6.3)% at the final follow-up. Preoperative local kyphosis angle was measured as (16.2 ± 11.3) ∘ , restored to (15.4 ± 5.9) ∘ postoperatively and (15.8 ± 5.4) ∘ during the final follow-up. No statistical significance was observed at three time points (all P > 0.05). The remaining 25 patients were evaluated with normal and complete neurological function. No severe complications were observed intra- and postoperatively. CONCLUSIONS: Posterior internal fixation using pedicle screw is an efficacious and safe therapy which achieves proper reduction and preserves spinal cord function.
Abstract: OBJECTIVE: To investigate the efficacy of High Intensity Laser Therapy (HILT) and Transcutaneous Electrical Nerve Stimulation (TENS) in low back pain (LBP). METHODS: Forty patients aged between 18 to 60 were included in this study. The patients were randomized into two groups as TENS (Group I) and HILT (Group II). The severity of pain was measured by Visual Analog Scale (VAS), and the range of motion (ROM) of the joint was measured by goniometer. The Oswestry Disability Questionnaire (ODQ) was used to assess the effect of LBP on daily living activities, and the Beck Depression Inventory…(BDI) was used to assess depression. All patients were taken into physical therapy program for 5 days a week for a total of 20 sessions. Patients in Group I received ultrasound, hot pack and HILT, while the patients in Group II received ultrasound, hot pack and TENS. RESULTS: In the comparison of post-treatment improvements, among all parameters only VAS score had a significant difference in favor of Group I. CONCLUSIONS: The study demonstrated that HILT is more effective than TENS in terms of pain reduction and that HILT can be used as an alternative to TENS.
Keywords: Low back pain, electrotherapy, HILT, TENS
Abstract: BACKGROUND: Leaning forward has been accepted as a foundational approach to facilitate trunk-stabilizing muscles in the abdominal and lumbopelvic regions for patients with back pain during rehabilitation. However, how trunk muscles are activated and recruited during leaning forward performed under dynamic upper-extremity motion conditions is not completely understood. OBJECTIVE: To determine whether activation of selected trunk muscles changes depending on shoulder movements during leaning forward exercise in healthy young adults. METHODS: Twenty-four healthy adults (6 men and 18 women) participated in this study. The participants performed 3 types of leaning forward exercises: leaning forward…alone (leaning forward 1), leaning forward with horizontal shoulder abduction (leaning forward 2), and leaning forward with shoulder flexion (leaning forward 3). Surface electromyography (EMG) was used to record activation of the erector spinae (ES), multifidus (MF), rectus abdominis (RA), and internal oblique (IO) on the dominant side. RESULTS: There was a significant main effect of exercise type on the activation of the IO, RA, and MF muscles. Activation of the IO and MF during leaning forward 1 was significantly decreased compared to activation in leaning forward 2 and 3; the activation of IO and RA showed the greatest increase during leaning forward 3. Furthermore, the IO/RA ratio was significantly increased during leaning forward 2 and 3 in comparison to leaning forward 1; the MF/ES ratio was also significantly increased during leaning forward 3, compared with leaning forward 1. CONCLUSION: The integration of shoulder movements during leaning forward exercises could be effective in the facilitation of EMG activity of IO and MF muscles, especially with shoulder flexion.
Keywords: Leaning exercise, trunk stability, upper-extremity movement
Abstract: BACKGROUND: The interest in biological treatments that have the potential to modify cartilage biology has gradually increased in recent years. OBJECTIVE: The aim of our study was to investigate the effects of intra-articular platelet-rich plasma (IA-PRP) injections on the femoral cartilage thickness, pain, functional status, and quality of life of patients with knee osteoarthritis. METHODS : A total of 71 patients (109 knees) with knee osteoarthritis who were administered IA-PRP injections twice with two-week intervals were included in this study. The resting and activity pain values measured using a Visual Analogue Scale (VAS), the Western Ontario…and McMaster Universities Osteoarthritis Index (WOMAC), and the Lequesne index and the quality of life scores measured using Short Form-36 (SF-36) were recorded at the baseline and 1-month, 3-month, and 6-month follow ups. The femoral cartilage thickness was measured via ultrasonography before treatment, and at 3-month and 6-month follow ups. Obtained results were analyzed by the Wilcoxon signed rank test. RESULTS: The mean age of the patients was 47.4 ± 10.4 years old. The resting and activity pain scores were significantly decreased at 1-month, 3-month and 6-month follow ups when compared to the pre-injection values (p < 0.05). Significant reductions were found in the Lequesne index and WOMAC pain, stiffness, and function scores at 1, 3, and 6 months (p < 0.05), while a significant increase was detected in the third month scores when compared to the first month. Significant improvements were determined in the physical functioning, physical role, pain, general health, and emotional role sub-scores during the 6-month period (p < 0.05). However, there was no significant difference with regard to the cartilage thickness at the follow ups (p > 0.05). CONCLUSIONS: The results of our study indicated that the IA-PRP injections improved the pain, stiffness, physical functioning, and quality of life of knee osteoarthritis patients; however, they did not seem to affect the cartilage thickness during the 6-month follow up period.
Abstract: BACKGROUND: Weakness of the trapezius and serratus anterior (SA) muscle may be a risk factor for unilateral neck pain. OBJECTIVE: This study examined the trapezius (upper, middle, and lower) and SA muscle strength ipsilateral and contralateral to the painful side in violinists with unilateral neck pain. METHOD: Twenty-six female violinists with unilateral neck pain participated in this study. Participants reported the pain intensity and duration and completed the Neck Disability Index (NDI). The strengths of the upper (UT), middle (MT), and lower (LT) trapezius and SA muscles were measured using a handheld…dynamometer. Paired t-test was used to compare the strength of the muscles between ipsilateral and contralateral to the painful side within subjects. The relationship between pain intensity, pain duration, and neck disability and strength deficit of the muscle was demonstrated by Pearson’s correlation and Spearman’s rank correlation. RESULTS: The strengths of the UT, MT, LT, and SA muscles were significantly decreased on the painful side compared with the contralateral side (P < 0.05). Except for an association between pain intensity and the percent strength deficit of the UT (r = 0.41; P < 0.05), there were no significant associations between pain intensity, pain duration, or NDI and the percent strength deficit of the UT, MT, LT and SA muscles (P > 0.05). CONCLUSIONS: These results suggest that decreased UT, MT, LT, and SA muscle strength on the side of the pain should be considered in the rehabilitation of violinists with unilateral neck pain.
Abstract: BACKGROUND AND OBJECTIVE: We evaluated the effect of caudal epidural pulsed radiofrequency stimulation in patients with chronic lumbosacral radicular pain due to postlumbar surgery syndrome who were unresponsive to at least two epidural steroid injections through the interlaminar, transforaminal, or caudal route. METHODS: We recruited 25 patients with chronic persistent radicular pain in one or both legs (⩾ 4 on the Numeric Rating Scale [NRS]) despite spinal surgery. They were unresponsive to at least two epidural steroid injections. We retrospectively conducted this study. Electrode needles were placed into the epidural space (S2-3…intervertebral level) through the sacral hiatus, and pulsed radiofrequency stimulation was administered. The outcomes were evaluated using the NRS scores for radicular pain before treatment and 1–3 months after treatment. Successful pain relief was defined as a ⩾ 50% reduction in the scores at 3 months after treatment. RESULTS: The pain scores changed significantly over time (p < 0.001): pretreatment, 4.9 ± 0.9; 1 month, 3.6 ± 1.4; 2 months, 3.8 ± 1.4; and 3 months, 3.9 ± 1.4. At 1, 2, and 3 months after pulsed radiofrequency (PRF) procedure, the NRS scores were significantly reduced compared with the scores before the treatment. Eight patients (32%) reported successful pain relief at 3 months after treatment. CONCLUSIONS: Although only 32% of the patients with postlumbar surgery syndrome showed successful pain relief after treatment, the result is encouraging because we recruited only patients unresponsive to repeated epidural steroid injections.