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: Treatment of total ruptures of adductor longus is challenging in professional sports. Time for return to pre-injury level as well as re-injury rates are of concern and surgical and conservative treatment approaches are debated; yet no consensus approach described for professional athletes. We present a case of a professional soccer player who experienced a rupture in his left adductor longus proximal tendon during a game and was treated conservatively. This case was followed-up during clinical assessment, imaging and strength testing until and after return to play. Primary outcome measure was the return to standard play condition at his pre-injury level…without any functional deficits, measured by isokinetic testing. Second outcome measure was the recurrence. No recurrence was observed during the first year of follow-up. Total ruptures are very challenging for both the physician and the player to make a quick decision due to minimal or lack of pain. Functional outcomes are almost identical although operative treatments need longer time to return to play. This case report adds another example to the literature of a successful return to play after non-operative treatment of adductor longus rupture at elite level soccer.
Keywords: Total rupture, soccer, return to play, groin pain, platelet rich plasma
Abstract: BACKGROUND: Breast cancer survivors have side effects from surgical treatment and adjuvant that may acutely or chronically compromise the musculoskeletal system, resulting in loss of muscle strength OBJECTIVE: Handgrip strength and electromyography of the upper limbs and its relationship with dominance in women submitted to surgery for breast cancer. METHODS: Were evaluated 28 women. The handgrip strength was measured through dynamometer associated with electromyographic, in the muscles: descending trapezius, biceps brachial, triceps brachial, extensor carpi ulnaris, radial extensor carpi and superficial flexor of wrist and fingers. RESULTS: Reduction in grip strength…on the side affected by the surgery, that occurred when the surgery was performed on the non-dominant side. The electromyographic showed significant differences in affected side. This shows the need to consider the affected side by surgery and dominance. CONCLUSIONS: Decreased grip strength and lower electromyographic activity of upper limb affected by surgery for breast cancer, when the side affected was not the dominant this loss was greater.
Keywords: Hand therapy, rehabilitation, breast cancer, EMG, handgrip strength
Abstract: BACKGROUND: The synergistic and protective effect of platelet-rich plasma (PRP) added to methlyprednisolone (MP) has been demonstrated via in-vitro studies. However, there is no report in the literature about this issue. OBJECTIVE: The aim of this study was to evaluate clinical outcomes of intra-articular (IA) MP injection prior to PRP injection in comparison with single-dose MP and PRP injections alone in patients with knee osteoarthritis (OA). METHODS: The treatment groups were “PRP group” (n = 37) who underwent single-dose IA PRP injection, “PRP +…MP group” (n = 40) who underwent MP injection one week prior to single-dose PRP injection, and “MP group” (n = 38) who underwent single-dose MP injection. Visual Analog Scale (VAS) and The Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were applied at first admission and at 1 st , 3 rd , 6 th , and 12 th month follow-ups. RESULTS: At the end of the 1st month, WOMAC score in PRP + MP group was significantly lower than PRP group. At the 3 rd month, WOMAC score in PRP + MP group was significantly lower than PRP and MP groups. At the 6 th month, VAS and WOMAC score in PRP + MP group was significantly lower than MP group. At the end of the 12 th month, no significant difference was observed among three groups in VAS and WOMAC scores. CONCLUSION: According to our results, IA MP injection prior to PRP injection resulted in significantly better clinical outcomes compared to PRP and MP injections alone in patients who had mild to moderate knee OA.
Abstract: OBJECTIVE: To help patients with disabilities of the arm and shoulder recover the accuracy and stability of movements, a novel and simple virtual rehabilitation and evaluation system called the Kine-VRES system was developed using Microsoft Kinect. METHODS: First, several movements and virtual tasks were designed to increase the coordination, control and speed of the arm movements. The movements of the patients were then captured using the Kinect sensor, and kinematics-based interaction and real-time feedback were integrated into the system to enhance the motivation and self-confidence of the patient. Finally, a quantitative evaluation method of upper limb…movements was provided using the recorded kinematics during hand-to-hand movement. RESULTS: A preliminary study of this rehabilitation system indicates that the shoulder movements of two participants with ataxia became smoother after three weeks of training (one hour per day). CONCLUSION: This case study demonstrated the effectiveness of the designed system, which could be promising for the rehabilitation of patients with upper limb disorders.
Abstract: BACKGROUND: Aerobic exercises to music can have a positive effect on functional and motor skills of an exerciser, their health, as well as an aesthetic and socio-psychological component. OBJECTIVE: The objective of this study was to determine the effects of reactive exercising in a group on functional capabilities in physically active and physically inactive women. METHODS: A prospective study included 64 healthy women aged 40–60 years. The sample was divided into the experimental group (n = 36), i.e. physically active women who have been engaged in recreational group…exercises at the Faculty of Sport and Physical Education, University of Novi Sad, Serbia, and the control group (n = 28), which consisted of physically inactive women. All the participants were monitored using the same protocol before and after the implementation of the research. All women had their height, weight, body mass index measured as well as spiroergometric parameters determined according to the Bruce protocol. RESULTS: A univariate analysis of variance has shown that there is a statistically significant difference between the experimental group and the control group in maximum speed, the total duration of the test, relative oxygen consumption, absolute oxygen consumption and ventilation during the final measurement. After the training intervention, the experimental group showed improvements in all the parameters analyzed compared with pretest values. CONCLUSION: The recreational group exercise model significantly improves aerobic capacity and functioning of the cardiovascular system. Therefore, it is essential for women to be involved more in any form of recreational group exercising in order to improve functional capacity and health.
Abstract: BACKGROUND: A huge number of labourers engaged in construction industry in India both in organized and unorganized sectors. The construction labourers most often work for an extended period of time and they are compelled to uphold altered static and dynamic operational stance in awkward positions during the complete period of work which raises the demand on the musculoskeletal system and may lead to work related musculoskeletal disorders (WRMSDs). OBJECTIVE: This study is intended to explore the operational stance and occupation related musculoskeletal manifestations amongst the construction labourers. One sixty four male labourers from different construction…sites of West Bengal was randomly taken for this study. METHODS: A modified Nordic questionnaire on MSD and the 12 item General Health Questionnaire (GHQ12) were administered on the construction labourers. Rapid Entire Body Assessment [REBA] and Ovako Work Analysis System [OWAS] methods were applied to analyze the operational stance. Finally, discomfort levels of the specific operational stance were calculated by the use of risk level and BPD scale. RESULTS: From the study it was revealed that most of the construction labourers habitually in awkward operational stance and were affected by altering musculoskeletal manifestations like pain in low back, neck, and wrist. It has been also found that there is a significant (p < 0.05) association between the intensity of pain feeling, age, year of working experience and risk level of the individual working postures of the labourers. CONCLUSION: Appropriate work-rest schedule, amendments of some working techniques and use of some ergonomically designed equipment may lessen the WRMSDs and improve the health eminence of construction labourers in unorganized sectors.
Keywords: Construction labourers, operational stance, risk level, WRMSDs
Abstract: BACKGROUND: Comparison of sensory conduction of median nerve (MN) with the one of ulnar nerve (UN) over writs-to-ring finger (RF) segment is useful in electrodiagnosis of carpal tunnel syndrome (CTS). However, there is not any consensus regarding the usage of this technique in grading of CTS. OBJECTIVES: To determine whether the hands of CTS with elicitable MN sensory responses on index finger, but not on RF (non-respondings) compose a more severe electrophysiologic grade than the hands with elicitable responses on both fingers (respondings). MATERIAL AND METHODS: The patients with bilateral moderate grade of CTS in whom…one hand was responding and the contralateral hand was non-responding were included. Conduction study results of MN and UN were compared between respondings and non-respondings. RESULTS: A total of 19 patients were included. Mean distal sensory onset latency (DSOL) of MN over index finger was longer (4.26 ± 0.49 msec versus 3.44 ± 0.39 msec; p < 0.001), sensory conduction velocity (SCV) was slower (33.7 ± 4.3 m/sec versus 40.2 ± 3.0 m/sec; p < 0.001), SNAP amplitude was smaller (10.3 ± 3.3 μ V versus 19.1 ± 7.7 μ V; p < 0.001), distal motor latency was longer (5.69 ± 0.60 msec versus 4.63 ± 0.32 msec; p < 0.001), and minimum F wave latency was longer (29.3 ± 1.7 msec versus 26.8 ± 1.4 msec; p < 0.001) in non-respondings than respondings. The nonresponding hand had a longer MN DSOL and slower SCV on index finger compared with contralateral responding hand in all of 19 patients. CONCLUSION: Non-responding hands have more progressed median neuropathies, and represent a more severe electrophysiologic grade than responding hands. Further studies are warranted to determine whether the absence of MN sensory responses on ring finger is related with forthcoming NCS worsening and a preferable hallmark for deciding surgical intervention or not.
Keywords: Carpal tunnel syndrome, median nerve, ulnar nerve, sensory response, ring finger, electrophysiologic grade
Abstract: BACKGROUND: Self-efficacy that is associated with various pain-related disabilities such as chronic low back pain (LBP), should be questioned besides physical assessments. OBJECTIVES: To investigate the physical factors associated with self-efficacy in patients with chronic mechanic LBP. METHODS: One hundred nine patients diagnosed as chronic mechanic LBP (65 females, 44 males) between 20–50 years old were included to this study. The intensity of LBP was assessed by using a 10-cm Visual Analogue Scale. For musculoskeletal fitness measurement; muscle strength, muscle endurance, and flexibility tests were applied. Functional Reach Test for balance evaluation, Self-Efficacy…Scale for self-efficacy measurement, Roland-Morris Disability Questionnaire for disability level evaluation were used. RESULTS: We found a moderate negative correlation between self-efficacy and pain intensity (r = - 0.506); a negative and strong correlation between self-efficacy and disability level (r = - 0.654) (p < 0.05). Self efficacy had a significant association with right (r = 0.265) and left (r = 0.290) lateral side bending flexibility (p < 0.05). According to multiple regression analysis results, it was found that disability level had a significant effect on self-efficacy (β = - 2.014; p < 0.01). CONCLUSIONS: Poor musculoskeletal fitness and pain intensity may cause decreasing self-efficacy but the major determinant of decreased self-efficacy was low-back related disability scores.
Keywords: Low back pain, self-efficacy, physical fitness
Abstract: OBJECTIVE: To explore the biomechanical influence of posterior tibial angle on the anterior cruciate ligament and knee joint forward stability. METHODS: The left knee joint of a healthy volunteer was scanned by CT and MRI. The data were imported into Mimics software to obtain 3D models of bone, cartilage, meniscus and ligament structures, and then Geomagic software was used to modify of the image. The relative displacement between tibia and femur and the stress of ACL were recorded. RESULTS: ACL tension was 12.195 N in model with 2 ∘…PTS, 12.639 N in model with 7 ∘ PTS, 18.658 N in model with 12 ∘ PTS. the relative displacement of the tibia and femur was 2.735 mm in model with 2 ∘ PTS, 3.086 mm in model with 7 ∘ PTS, 3.881 mm in model with 12 ∘ PTS. In the model with 30 ∘ flexion, the maximum tension of ACL was 24.585 N in model with 2 ∘ PTS, 25.612 N in model with 7 ∘ PTS, 31.481 N in model with 12 ∘ PTS. The relative displacement of the tibia and femur was 5.590 mm in model with 2 ∘ PTS, 6.721 mm in model with 7 ∘ PTS, 6.952 mm in model with 12 ∘ PTS. In the 90 ∘ flexion models, ACL tension was 5.119 N in model with 2 ∘ PTS, 8.674 N in model with 7 ∘ PTS, 9.314 N in model with 12 ∘ PTS. The relative displacement of the tibia and femur was 0.276 mm in model with 2 ∘ PTS, 0.577 mm in model with 7 ∘ PTS, 0.602 mm in model with 12 ∘ PTS. CONCLUSION: The steeper PTS may be a risk factor in ACL injury.
Abstract: BACKGROUND: Most lesions of the soft tissues, especially those at the muscle level, are due to the lack of elasticity of the connective tissue and fascia. Stretching is one of the most commonly used methods of treatment for such musculoskeletal issues. OBJECTIVE: This study tracks the effects of stretching on the electromyographic activity of muscle chains, applied to a 24-year-old athlete diagnosed with the Haglund’s disease. METHOD: For the evaluation, we used visual examination and surface electromyography (maximum volumetric isometric contraction). The therapeutic intervention consisted in the application of the static stretching positions,…which intended the elongation of the shortened muscle chains. The treatment program had a duration of 2 months, with a frequency of 2 sessions per week and an average duration of 60 minutes. RESULTS: The posterior muscle chains recorded an increase in the EMG activity, while the anterior muscle chains tended to diminish their EMG activity. As a result of the applied treatment, all the evaluated muscle chains recorded a rebalancing of the electromyographic activity, demonstrating the efficiency of stretching as a method of global treatment of muscle chains. CONCLUSIONS: By analysing all the data, we have come to the conclusion that static stretching is an effective treatment method for shortened muscle chains.