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: Previous studies in non-Chinese populations have found a relationship between performance on isometric trunk muscle endurance tests and low back pain (LBP). However, the relationship between trunk muscle endurance and LBP in Chinese populations has received little attention and age-referenced data have not been reported. OBJECTIVE: Evaluate the relationship between age-referenced isometric trunk muscle endurance values and LBP in a Chinese cohort. METHODS : One hundred and eighty-eight participants (20–59-years) performed four timed-endurance tests (Biering-Sorensen, plank, left/right side bridge) in random order. Participants with a history of LBP completed an Oswestry Disability…Index (ODI) and pain scale. Holding-times for the four tests were summed and receiver operating characteristic (ROC) curve analysis was performed to differentiate participants with and without LBP. RESULTS: Data were grouped by age. Analysis revealed similar endurance values to those reported in non-Chinese populations, except longer holding times were recorded in the 50–59 yr Chinese cohort. Pain scores were positively correlated with ODI scores. ROC curve analysis showed that the area under the curve was 0.723 and optimal cut-off was 288 sec (sensitivity and specificity both 0.75). CONCLUSIONS: This study is the first to describe trunk muscle endurance reference data in Chinese people. Individuals with a summed endurance time of < 288 seconds appear more likely to suffer LBP.
Keywords: Chinese, endurance, isometric, Biering-Sorensen, plank test, side bridge test
Abstract: Muscle strength is usually measured using isometric hand-held dynamometers (HHDs) in the clinic. However, during functional activities, the muscle acts more dynamically. The aim of this study was to investigate the relation between clinically measured plantar flexor (PF) muscle strength (PFMS) and laboratory measurements of peak ankle plantar flexion power generation (APFPG), peak ankle moment (PAM), peak plantar flexion velocity (PFV) and mean gait velocity in healthy participants. METHODS: The maximum PFMS on non-dominant sides in 18 able-bodied persons 23.88 (SD 3.55 years) was measured before (Pre-S) and after a stretching (Post-S) procedure (135 sec. ×…13 rep. with 5 sec. rest) using a HHD. The stretching procedure was used to generate temporary PF muscle weakness. Gait analysis was carried out for Pre-S and Post-S conditions. Normalized (by weight and height) and non-normalized HHD scores and differences for both conditions were correlated by Pearson correlation coefficient calculations (p < 0.05). RESULTS: Reduced PFMS (%23, p < 0.001) in Post-S, according to the HHD scores, has only a weak correlation with APFPG (r > 0.3, p < 0.5). Gait velocity was found to be strongly correlated with APFPG only in the Post-S condition (r = 0.68, p < 0.002). HHD scores and PAM were moderately correlated with the non-normalized Post-S condition (r = 0.44, p = 0.70) and strongly correlated with the non-normalized Pre-S condition (r = 0.62, p < 0.01). DISCUSSION: HHD scores of plantar flexor muscles give very limited information about the PF performance during walking in healthy individuals. Simple normalization did not improve the relations. Clinically measured isometric muscle strength and muscle weakness have only moderate strengths for establishing a treatment protocol and for predicting performance during walking in neurologically intact individuals.
Abstract: BACKGROUND: Nonspecific Chronic Low Back Pain (CLBP) is a condition difficult to treat due to multiple etiopathogenesis and there is wide consensus on the multidisciplinary approach. Among physiotherapy the Medium Frequencies (MF) diathermy has recently been introduced but without enough evidence of effectiveness. OBJECTIVE: To explore the effects of a deep heating therapy (DHT) produced by a MF diathermy for the treatment of CLBP compared with a superficial heating therapy (SHT). The study was a double blind randomized trial. METHODS: Forty-nine patients affected by CLBP were randomly subdivided in 2 groups and treated…with either DHT (450 KHz) or SHT via electric resistance applying the same instrument on the lumbar spine. NRS (Numerical Rating Scale) for pain and ODI (Oswestry Disability Index) for disability were used as outcome measures. The follow up was: T1, 15 days (end of the therapy); T2, 30 days; T3, 45 days after T0. RESULTS: Both therapies were effective in reducing pain throughout the follow up with greater improvement in DHT group at T1. DHT resulted to have a higher efficacy with respect to SHT in reducing disability (ODI) throughout all follow ups. CONCLUSION: This study provides evidence of the positive effects of MF radio waves diathermy in the treatment of CLBP.
Keywords: Diathermy, radio waves, chronic low back pain
Abstract: BACKGROUND: Hamstring shortness is the most common musculoskeletal condition in sports athletes, which often contributes to hamstring strain injury. To effectively mitigate the hamstring shortness, contemporary HR, SCS, and IASTM soft tissue techniques have been used. The best practical evidence about the therapeutic effects and the biomechanical mechanisms underpinning these manual techniques remain unknown. OBJECTIVE: The purpose of this study was to compare the effects of HR, SCS, and IASTM techniques on improving hamstring and quadriceps muscle strength, related ratio, knee joint passive stiffness, and pain threshold. METHODS: Forty-five participants (21 males and…24 females) with hamstring shortness participated in this study. The participants were randomly assigned to each of the three soft tissue mobilization technique groups. A Biodex System Isokinetic Dynamometer was used to measure muscle strength and knee joint passive stiffness during knee extension and flexion. Pressure algometry was used to measure hamstring pain threshold. One-way ANOVA were used to determine the statistical significance of the hamstring and quadriceps strength, related ratios, knee joint passive stiffness, and pain threshold in each technique. The significance level was set at α = 0.05. RESULTS: The IASTM group showed greater improvement in the peak quadriceps strength (p = 0.000), the peak quadriceps and hamstring (Q:H) strength ratio (p = 0.004), passive knee stiffness (p = 0.000), and pain threshold (p = 0.017) than the HR or SCS groups. CONCLUSION: The present comparative study provided first clinical evidence that IASTM technique is a best soft tissue mobilization technique to improve the strength, associated strength ratio, knee joint passive stiffness, and pain threshold among individuals with hamstring shortness.
Abstract: BACKGROUND: In treatment of adhesive capsulitis, deep heating agents have been shown to have positive effects on pain and function. OBJECTIVE: To evaluate if addition of ultrasound used in treatment of adhesive capsulitis will provide additional benefits. METHODS: Thirty patients with adhesive capsulitis were included in a prospective, double-blind, randomized controlled trial. Hotpack, TENS (Transcutaneus Electrical Nerve Stimulation), exercise and active ultrasound therapies were applied to the first group (n = 15), whereas sham ultrasound was applied to the second group (n =…15) in addition to hotpack, TENS and exercise. The patients were evaluated using joint range of motion, UCLA shoulder scale and Shoulder Disability Questionnaire scales at baseline and at 6th and 24th weeks post-treatment. RESULTS: When pain and the clinical and functional parameters were compared in both groups, significant improvement was found compared to baseline (p < 0.001). At week 24, no difference was found in terms of pain at rest, but all other parameters were improved compared to week 6. When the groups were compared, no difference was found in any comparison between 6th and 24th week (p > 0.05). CONCLUSION: Adding ultrasound treatment to a combination of physical therapy modalities did not provide any additional benefits for the treatment of adhesive capsulitis.
Abstract: BACKGROUND: Weakness of trunk muscles is a common disorder in children with cerebral palsy (CP). They encounter decreased levels of endurance that can lead to diminished capacity of movement. OBJECTIVE: To evaluate the effect of core stability training on the endurance of trunk muscles and gait parameters in children with hemiplegic CP. METHODS: Thirty children with hemiplegic CP aged 10 to 12 years were randomly assigned to two groups of equal number; control group (A) and study group (B). Both groups underwent the same designed physical therapy program. Moreover, group B underwent core…stability training 3 times/week for 8 weeks. Endurance time of trunk muscles and gait parameters were measured before and after the intervention using the trunk endurance tests and the Biodex gait trainer respectively. RESULTS: Both groups showed pre- and post-test statistically significant improvements in the endurance time of trunk flexors and extensors and gait parameters but only group B showed significant improvement in the endurance time of lateral trunk muscles. There were post-treatment statistically significant differences between both groups in favor of group B regarding all measured variables. CONCLUSION: Addition of core stability exercises to the treatment program can effectively improve the endurance time of trunk muscles and gait in children with hemiplegic CP.
Abstract: BACKGROUND: It is hypothesized that inherent differences in movement strategies exist between control subjects and those with a history of lower back pain (LBP). Previous motion analysis studies focus primarily on tracking spinal movements, neglecting the connection between the lower limbs and spinal function. Lack of knowledge surrounding the functional implications of LBP may explain the diversity in success from general treatments currently offered to LBP patients. OBJECTIVE: This pilot study evaluated the response of healthy controls and individuals with a history of LBP (hLBP) to a postural disturbance. METHODS: Volunteers (n =…26) were asked to maintain standing balance in response to repeated balance disturbances delivered via a perturbation platform while both kinematic and electromyographic data were recorded from the trunk, pelvis, and lower limb. RESULTS: The healthy cohort utilized an upper body-focused strategy for balance control, with substantial activation of the external oblique muscles. The hLBP cohort implemented a lower limb-focused strategy, relying on activation of the semitendinosus and soleus muscles. No significant differences in joint range of motion were identified. CONCLUSIONS: These findings suggest that particular reactive movement patterns may indicate muscular deficits in subjects with hLBP. Identification of these deficits may aid in developing specific rehabilitation programs to prevent future LBP recurrence.
Keywords: Lower back pain, balance, electromyography, posture, kinematics
Abstract: BACKGROUND: Hippotherapy is a form of therapeutic exercise for conservative treatment of lumbar spine segmental instability and/or hypomobility in subjects with low back pain (LBP). OBJECTIVE: The current study evaluates the effects of a hippotherapy simulator on pain, disability, and range of motion (ROM) of the spinal column in subjects with mechanical LBP. METHODS: In a randomized clinical trial, 80 subjects were randomly assigned to either the control or intervention groups. All subjects underwent routine physiotherapy. In addition, the intervention group underwent hippotherapy with a hippotherapy simulator for 15 sessions, each lasting 15…minutes. Pain, disability, and ROM of the lumbar spinal column of the subjects were measured in the first and last physiotherapy sessions respectively. RESULTS: Improvement in pain intensity was higher in the hippotherapy simulator group over the first eight days of treatment (Hippotherapy vs. Control Point changes: Day 12: p = 0.010; after treatment: p = 0.005). The hippotherapy simulator group had significantly higher improvement in disability score in comparison to the control group (p < 0.001); mean changes in the modified Schober test were not significant (p = 0.423). CONCLUSION: The hippotherapy simulator decreased pain and disability in subjects with LBP; however, no additional improvement in lumbar spine ROM was observed.
Keywords: Hippotherapy, low back pain, physiotherapy, Schober test
Abstract: BACKGROUND: Hypomobility on a cervical segment is a frequent finding which is sometimes asymptomatic. The effects of inhibitory suboccipital techniques on cervical mobility have not been evaluated. OBJECTIVE: To compare the effect on cervical mobility, of pressure maintained suboccipital inhibition manual technique versus a self-treatment using an Occipivot cushion, in asymptomatic subjects with limited mobility assessed by the flexion-rotation test. METHODS: Before-after randomized uncontrolled trial. Thirty-two subjects were recruited and randomized into two groups: Manual Group and Instrumental Group, receiving a single session of the assigned technique. Upper and overall cervical spine mobility…was measured. Subjective sensation during technique application and post-treatment, and number and intensity of headache episodes during the following 15 days after treatment were also registered. RESULTS: Comparing with the Instrumental Group, the Manual Group showed statistically significant improvements on flexion-rotation test (p < 0.01 to p < 0.03), upper cervical extension (p < 0.01), overall right rotation (p < 0.05) and overall right (p < 0.01) and left (p < 0.01) side-bending. CONCLUSION: In asymptomatic subjects with limited cervical mobility, pressure maintained suboccipital inhibition manual technique achieves further improvement on cervical range of motion than the technique using the Occipivot cushion.
Keywords: Range of motion, cervical vertebrae, atlantoaxial joint, suboccipital muscle inhibition
Abstract: OBJECTIVE: To investigate the effect of mirror therapy (MT) in conjunction with a standard physical therapy program on shoulder range of motion (ROM), pain and quality of life in patients with adhesive capsulitis (AC). METHOD: This prospective, randomized, controlled, single blind study included 30 patients with AC who were scheduled to undergo 10 sessions of standard physical therapy. The participants were divided into two identical groups, namely, The MT group and the control group. After each session, the MT group underwent active ROM exercises with the reflective side of the mirror while the control group underwent…active ROM exercises with the non-reflective side of the mirror. Pre-treatment and post-treatment shoulder pain (VAS), shoulder function (UCLA shoulder scale) and quality of life (SF-36) were assessed, and active and passive ROM were quantified with a goniometer. RESULTS: Both groups revealed a significant reduction of shoulder pain and significant improvement of shoulder function, active and passive ROM, and quality of life after the treatment. Post-treatment measurements showed that the MT group had a significantly lower amount of pain compared to the control group (p = 0.007). The UCLA scores were significantly higher in the MT group (p = 0.003). The MT group had significantly better post-treatment active flexion, active abduction, passive flexion, and passive abduction values (p = 0.001, p = 0.02, p = 0.002, and p = 0.02, respectively). The MT group had significant post-treatment improvement in physical function, physical role limitation and emotional role limitation, and pain parameters including SF-36 (p = 0.003, p = 0.01, p = 0.015, and p = 0.002, respectively). CONCLUSION: MT in conjunction with physical therapy appears to be an effective treatment modality that reduces shoulder pain and improves shoulder ROM, shoulder function, and quality of life among patients with AC.