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: Recent initiatives, such as earlier diagnosis and treatment, have enhanced the survival of patients with systemic sclerosis (SSc). Despite these initiatives, there is extreme variability in rehabilitation strategies for these patients. In 2006, the Glittre-ADL test (TGlittre) was developed to evaluate functional capacity using multiple tasks similar to the activities of daily living (ADLs). OBJECTIVES: To evaluate the impact of therapist-oriented home rehabilitation (TOHR) on functional capacity using TGlittre and to examine the effects of TOHR on physical function, hand function, and quality of life (QoL) among women with SSc. METHODS: This…quasi-experimental and longitudinal study included 12 women with SSc who underwent TOHR 3 times per week for 12 weeks. Before and after TOHR, functional capacity was assessed using TGlittre, physical function was examined by the Health Assessment Questionnaire Disability Index (HAQ-DI), hand function was evaluated using the Cochin Hand Functional Scale (CHFS) and handgrip strength (HGS), and QoL was evaluated using the Short Form-36 Health Survey Questionnaire (SF-36). RESULTS: When comparing the pre- and post-TOHR values of TGlittre, a significant reduction was found in total time (p = 0.002) and manual time (p = 0.010). There was a nonsignificant decrease in HAQ-DI scores between pre- and post-TOHR (p = 0.07). Regarding hand function, there was a significant reduction in the CHFS between pre- and post-TOHR (p = 0.036), although no significant difference was observed in HGS between pre- and post-TOHR (p = 0.08). Regarding QoL, there was an increase in all SF-36 categories, although physical function was the only category that was significantly increased (p = 0.008). CONCLUSION: After TOHR, patients with SSc are able to more quickly perform TGlittre tasks when considering both total and manual times. TOHR also positively affects manual skills and QoL.
Abstract: BACKGROUND: According to reports in the literature, osteoporotic vertebral compression fracture (OVCF) is associated with paraspinal muscle degeneration; however, the association between the severity of OVCF and paraspinal muscle degeneration is not clear. OBJECTIVE: The purpose of this study was to investigate the association between paraspinal muscle degeneration and OVCF severity in postmenopausal women. METHODS: Three hundred and seventy-six MRI images from 47 patients were collected and analyzed. Sagittal and axial coronal T2-weighted images were used to measure the fractured vertebra sagittal cross-sectional area (FSCSA), the adjacent normal vertebral body sagittal cross-sectional area…(NSCSA), paraspinal muscle cross-sectional area (CSA), and the fat cross-sectional area (FCSA). The ratio of fractured vertebra compressed sagittal cross-sectional area (RCSA) and fatty infiltration ratio (FIR) was subsequently calculated. The formulas for RCSA and FIR calculations are as follows: RCSA = (NSCSA-FSCSA)/NSCSA; FIR = FCSA/CSA. RCSA and FIR represent the severity of OVCF and paraspinal muscle degeneration, respectively. RESULTS: The correlation between paraspinal muscle degeneration and OVCF severity was analyzed using the Pearson correlation, and multiple regression analysis was performed to explore related risk factors. OVCF severity was closely associated with paraspinal muscle degeneration (L3/4 FIR r = 0.704, P < 0.05; L4/5 FIR r = 0.578, P < 0.05; L5/S1 FIR r = 0.581, P < 0.05). Multiple regression analysis demonstrated that the risk factor for OVCF severity was L3/4 FIR (β = 0.421, P = 0.033). CONCLUSION: OVCF severity was associated with the FIR of paraspinal muscles, and L3/4 FIR was a predictive factor for OVCF severity in postmenopausal women.
Keywords: Osteoporosis, vertebral fracture, paraspinal muscle, fatty infiltration, postmenopausal women
Abstract: BACKGROUND: Determining the association between radiographic spinal instability assessment and lower back lumbar diseases with lower limb symptoms can contribute to evidence-based assessment and treatment in clinical practice and rehabilitation. Therefore, radiological evidence of lumbar spine instability assessment, such as sagittal translation (ST) and segmental angulation (SA), is clinically important. OBJECTIVE: To identify factors associated with the assessment of spinal instability in lumbar disc herniation with leg pain and discogenic low back pain using ST and SA. METHODS: We examined 112 patients with lumbar disc herniation with leg pain and 116 with discogenic…low back pain at our clinic from 2016 to 2021. Data on age, gender, sports activities, and occupation were collected from medical records. Additionally, ST and SA of L4 and L5 during maximum trunk flexion and extension were measured using radiography. Simple and multiple logistic regression analyses were used for statistical analysis. RESULTS: Simple logistic regression analysis showed that ST and SA (odds ratio [OR]: 1.11; 95% confidence interval [CI]: 1.03–1.19) were associated with lumbar disc herniation. Multiple logistic regression analysis showed that only ST was associated with lumbar disc herniation (OR: 2.29; 95% CI: 1.78–3.00). CONCLUSION: Multiple logistic regression analysis showed that ST was associated with lumbar disc herniation with leg pain and had a stronger association than SA.
Keywords: Sagittal translation, segmental angulation, lumbar disc herniation, discogenic low back pain leg pain, spinal instability
Abstract: BACKGROUND: Lateral elbow tendinopathy (LET) is one of the most common lesions of the upper extremity. The level of evidence from studies on LET treatment protocols is insufficient. OBJECTIVE: The aim of this study was to compare the acute effects of mobilization with movement (MWM) and muscle energy technique (MET) on pain, grip strength, and functionality in patients diagnosed with LET. METHODS: Forty-five patients with LET aged 30–55 years were enrolled in this study. Patients were divided into three groups: MWM, MET, and control group. The control group received a 4-week home exercise…program. In addition to the home exercise program in the MWM group, 12 sessions of MWM and 12 sessions of MET were performed in the MET group. Participants’ pain, grip strength, and functionality were assessed before and after the study. RESULTS: After the treatment period, greater improvement in pain, grip strength, finger strength, and functionality were observed in the MWM and MET groups than in the control group (p < 0.05), but no statistically significant difference was found between the MWM and MET groups (p > 0.05). CONCLUSIONS: This study shows that MWM and MET, used in addition to home exercises, can be used to relieve pain and increase grip strength, finger strength, and functionality.
Abstract: BACKGROUND: Musculoskeletal (MSK) pain is a debilitating multi-perceptual condition afflicting many individuals, especially individuals in the medical profession. OBJECTIVE: To analyze and evaluate the prevalence of musculoskeletal pain among medical students at Jordanian universities during the complete virtual learning process. METHODS: A cross-sectional study of 593 medical students at two Jordanian universities was conducted. A modified Nordic questionnaire was used to assess musculoskeletal pain in three body regions. RESULTS: Five hundred ninety-three students at the two Jordanian universities participated in this study. The prevalence of having MSK pain during the…past week in the neck, shoulder, and lower back was 34.6%, 27%, and 41%, respectively; during the past 12 months, it was 61.2%, 45.5%, and 63.1%, respectively. Overall prevalence of having MSK pain was 58.9% in the last week and 78.1% in the past 12 months. 66.8% of students who had psychosomatic symptoms and 62.3% of those with depressive symptoms in the past week had MSK pain. Students who studied 8 hours per day had higher percentages of MSK pain (68.4%) (OR 1.12, 95% CI 0.965–1.312). The average number of hours using a computer per day was significantly associated with MSK pain (p = 0.032). MSK pain during the last week was significantly associated with psychosomatic symptoms (OR 1.842, 95% CI 1.272–2.668, p = 0.001). Family history of MSK pain was significantly related to the presence of the problem in participants (OR 1.732, 95% CI 1.182–2.538, p = 0.005). Gender, depressive symptoms, average hours of computer use per day, and average hours of study at home per day did not show significant relationships with MSK pain over the year. CONCLUSIONS: High prevalence of MSK pain was observed among medical students. Measures to balance in-person and virtual learning should be considered in medical schools to minimize the risk of MSK pain.
Keywords: Musculoskeletal pain, neck, shoulder, low back pain, Jordan
Abstract: BACKGROUND: Despite being used as a manipulation technique, no studies have examined the effectiveness of physiotherapy instrument mobilization (PIM) as a mobilization technique on pain and functional status in patients with low back pain (LBP). OBJECTIVE: To investigate the effectiveness of PIM in patients with LBP and to compare it with the effectiveness of manual mobilization. METHODS: This is a double blind, randomized clinical trial. Thirty-two participants with LBP were randomly assigned to one of two groups. The PIM group received lumbar mobilization using an activator instrument, stabilization exercises, and education; and the…manual group received lumbar mobilization using a pisiform grip, stabilization exercises, and education. Both groups had a total of 4 treatment sessions over 2–3 weeks. The following outcomes were measured before the intervention, and after the first and fourth sessions: Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI) scale, Pressure pain threshold (PPT), lumbar spine range of motion (ROM), and lumbar multifidus muscle activation. RESULTS: There were no differences between the PIM group and the manual group in any outcome measures. However, over the period of study, there were improvements in both groups in NPRS (PIM: 3.23, Manual: 3.64 points), ODI (PIM: 17.34%, Manual: 14.23%), PPT (PIM: ⩽ 1.25, Manual: ⩽ 0.85 kg.cm 2 ), lumbar spine ROM (PIM: ⩽ 9.49 ∘ , Manual: ⩽ 0.88 ∘ ), and/or lumbar multifidus muscle activation (percentage thickness change: PIM: ⩽ 4.71, Manual: ⩽ 4.74 cm; activation ratio: PIM: ⩽ 1.17, Manual: ⩽ 1.15 cm). CONCLUSIONS: Both methods of lumbar spine mobilization demonstrated comparable improvements in pain and disability in patients with LBP, with neither method exhibiting superiority over the other.
Abstract: BACKGROUND: To maximize the ball velocity in the tennis sever, the shoulder plays a key role in the kinetic chain. But shoulder inefficiency leads to shoulder injuries such as shoulder impingement syndrome (SIS). Thus, to verify the scapular movements during the tennis serve could help prevent shoulder injury in tennis players. OBJECTIVE: This case-control study aimed to verify the scapular movements during flat first serve for elite tennis players with shoulder impingement syndrome compared to those without it. METHODS: Eight elite tennis players (4 males and 4 females) with SIS and 8 elite healthy…players (4 males and 4 females) performed flat first serves, and the three-dimensional scapular kinematic data was recorded using the Qualisys motion capture system through spherical reflective markers including the acromion marker cluster. RESULTS: The scapula was more internally rotated (median difference: 10.40 ∘ ) in the male players with SIS than in those without it at the maximally externally rotated humerothoracic joint during flat first serve, and female players with SIS (median difference: 7.16 ∘ and 11.28 ∘ , respectively) had more internally rotated scapula at the maximally externally rotated humerothoracic joint and ball impact. CONCLUSION: Increased scapular internal rotation may be something that affects shoulder injuries in the overhead sports, and it may help to prevent and rehabilitate overhead injuries including SIS.
Abstract: BACKGROUND: There is a sex-related difference in strength and endurance in trunk muscles: males have more strength while females have more endurance. OBJECTIVE: Investigate sex-related differences in motor control strategies in back muscles during isometric contractions (IC) in the Sorensen test posture. METHODS: Thirty-six healthy and young volunteers performed different tasks: three maximal voluntary contraction (MVC) tests recorded with a bio-feedback force sensor, and followed by five loaded IC (LIC) tests using bodyweight and loads of 0 to 8 kg with a 2-kg step. Surface electromyography was used to measure the activity of…bilateral lumbar paravertebral (LP) and quadratus lumborum (QL) muscles. RESULTS: Sex-related and load-related differences in EMG amplitudes were highlighted during LIC tests. Females showed significantly (p -value = 0.02) greater EMG amplitude for the highest load (8 kg) than males. Besides, significant differences between low (2 and 4 kg) and high (6 and 8 kg) loads for both LP and QL muscles and for both sexes were observed. Finally, for MVC tests, males produced significantly (p -value = 1.02e-4) greater strength during MVC tests (4.25 ± 1.37 N/kg vs 2.60 ± 0.78 N/kg). CONCLUSION: The results were clinically relevant to bring attention to load strategy during rehabilitation, particularly in females who seemed to recruit the QL muscle more.
Keywords: Electromyography, motor control, back muscles, sexual dimorphism, sorensen test
Abstract: BACKGROUND: Pelvic floor muscles (PFM) are important for lumbar stability. However, the relationship between lumbar and hip motion angle changes (MAC) caused by PFM contraction and each PFM’s function remains unclear. OBJECTIVE: To clarify the lumbar spine and hip motion changes produced by PFM contraction and the relationship between MAC and PFM function. METHODS: In 21 healthy females, motion angle was measured for prone hip extension movement using natural movement (NM), PFM contracting movement (PM), and reducing lumbar movement (RM) methods. The PFM functional indices were bladder base elevation distance, continuous bladder base…elevation time, and pelvic floor location. RESULTS: The PM showed no significant difference in lumbar motion angle but had significantly smaller hip motion than the NM (NM; 26.1 ± 8.3, PM; 29.2 ± 11.0). MAC was significantly greater in RM (lumbar spine; 4.4 ± 3.2, hip; 5.9 ± 8.7) than in PM (lumbar spine; 0.4 ± 4.4, hip; 3.1 ± 5.1) for both the lumbar spine and hip. Lumbar spine and hip MAC of PM was significantly correlated with pelvic floor location (lumbar spine; r = - 0.44, hip; r = 0.54). CONCLUSION: PFM contraction does not attenuate lumbar spine motion but reduces hip motion. MAC due to PFM contraction during lumbar movement tasks is related to the PFM functional index.
Keywords: Lumbar spine, pelvic floor muscle, motion angle, hip joint
Abstract: BACKGROUND: Complex regional pain syndrome (CRPS) is a clinical diagnosis and an umbrella term for a heterogeneous group of states associated with pain disproportionate to any inciting event, together with a number of signs and symptoms that are manifested mainly in the limbs. There are often concerns among clinicians and patients about the potential harms caused by pain provocation during physiotherapy of CRPS, even though clinical guidelines de-emphasize pain-contingency. OBJECTIVE: The objective of this narrative review is to summarize current evidence regarding potential harms due to pain provocation during so-called exposure-based therapies in individuals with CRPS.…METHODS: Six studies evaluating exposure-based approach were included (n = 6). RESULTS: Although only one included study focused primarily on safety and in the rest of the included studies the reporting of harms was insufficient and therefore our certainty in evidence is very low, taken together with outcome measures, available data does not point to any long-term deterioration in symptoms or function, or any major harms associated with pain provocation during physiotherapy of CRPS. CONCLUSION: There is a great need for higher-quality studies to determine which therapeutic approach is the most appropriate for whom and to evaluate the risks and benefits of different approaches in more detail.