Journal of Back and Musculoskeletal Rehabilitation - Volume 27, issue 1

Authors: Aygül, Recep | Kotan, Dilcan | Ulvi, Hızır | Kuyucu, Mutlu | Özdemir, Gökhan | Ertekin, Ayfer | Odabaş, Faruk Ömer

Article Type: Research Article

Abstract: Purpose: F-wave analysis may help affirm or disprove a compression neuropathy. In this study we have analysed the effects of focal median nerve injury on F wave in Carpal Tunnel Syndrome (CTS). Method: We studied 57 patients (100 hands) with clinical and electrophysiological CTS and 31 (62 hands) healthy subjects. Median nerve F-waves were evaluated following 10 supramaximal stimuli and recording from abductor pollicis brevis muscles. Minimum, maximum, and mean F-wave latencies, frequency of the F wave (Fp), chronodispersion (F CD ), mean F/M amplitude ratios (mF/M-amp) and F-wave conduction velocity (FwCV) were …evaluated. Results: The CTS patients showed prolonged F-wave latencies, decreased Fp, and an increase of the F CD as compared with normative values. Absent F wave was presented in 8 of 34 hands (23.5%) with severe CTS patients. In the severe group, the FwCV was significantly slower (p < 0.001 ) and the mF/M-amp was significantly higher (p < 0.001 ) than that of mild and moderate groups, respectively. Also, the mF/M-amp was significantly greater and Fp was lower in the axonal type than in the demyelinating type. The F CD was not different among groups. A strong positive correlations between mMDL with Fmin (r = 0.81 , p < 0.000 ), Fmean (r = 0.80 , p < 0.000 ) and Fmax (r = 0.71 , p < 0.000 ) were revealed. Conclusion: Results support the differing effects of demyelinating and axonal injury on F-waves and suggest that the mF/M-amp ratio and FwCV, which is influenced by neuronal damages in the distal segment of the median nerve, is useful in the discrimination of CTS severity. Show more

Keywords: Carpal Tunnel Syndrome, median nerve F waves, nerve conduction studies, subtypes

DOI: 10.3233/BMR-130409

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 1-6, 2014

Authors: Seidi, Foad | Rajabi, Reza | Ebrahimi, Ismail | Alizadeh, Mohamad Hossein | Minoonejad, Hooman

Article Type: Research Article

Abstract: Background and Objective: Corrective exercise interventions are often utilized to manage subjects with thoracic hyper-kyphosis, yet the quality of evidence that supports their efficiency is lacking. In this study, the efficacy of local and comprehensive corrective exercise programs (LCEP and CCEP) on kyphosis angle was evaluated. Material and Method: A prospective, randomised controlled design was used in the present study. Sixty patients with postural hyper-kyphosis deformity (⩾42°) entered the study for 12 weeks. Subjects were randomly assigned to a LCEP (n = 20 ), CCEP (n = 20 ), or Control groups (n = …20 ). Pre- and post-participation levels of kyphosis angle were measured by flexicurve ruler. Results: Both the LCEP and CCEP groups demonstrated statistically significant reductions in thoracic kyphosis angle compared to the control group (p = 0.001 ). Furthermore, based on Cohen’s d-value, the efficiency of CCEP was larger than LCEP. Conclusions: Considering the extremely large effect size of the CCEP, we recommend that this program be used in the correction of postural hyper-kyphosis deformity in future. Show more

Keywords: Thoracic hyper-kyphosis, exercise interventions, postural correction

DOI: 10.3233/BMR-130411

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 7-16, 2014

Authors: Kim, Yushin | Yang, Hong-Ryeol | Lee, Jae-Woo | Yoon, Bum-Chul

Article Type: Research Article

Abstract: Background and Objective: The high-power pain threshold ultrasound (HPPTUS) technique has been introduced as a novel treatment method in patients with myofascial trigger points (MTrPs). The aim of the current study was to compare the therapeutic effects of HPPTUS with those of the conventional ultrasound technique in elderly patients with latent MTrPs on the upper trapezius muscles of at least 1 side. Material and Methods: Forty-one participants received 8 treatment sessions with conventional ultrasound (n = 19 ) or with the HPPTUS technique (n = 22 ) for 4 consecutive weeks. Outcome variables included …visual analog scale (VAS) scores, pressure pain threshold (PPT), and range of motion (ROM). The data were analyzed using repeated analysis of variance (ANOVA) measurements. Results: The VAS scores recorded 1, 2, 3, and 4 weeks after HPPTUS were significantly lower than the baseline scores in both groups. The ROM (after 3 and 4 weeks) and PPT (after 4 weeks) values also significantly increased from their baseline values in both groups. On comparing the techniques, there were no significant differences in the VAS (p = 0.296 ), PPT (p = 0.768 ), and ROM (p = 0.822 ) values, although both techniques showed therapeutic effects for 4 weeks (p < 0.001 ). Conclusion: The results indicate that the HPPTUS technique in same manner as treatment of active MTrPs is not superior to the conventional ultrasound technique in the treatment of the elderly patients with the latent MTrPs. Show more

Keywords: Aged, high-power pain threshold, interventional ultrasound, myofascial pain syndromes, trigger points

DOI: 10.3233/BMR-130414

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 17-23, 2014

Authors: Yildirim, Yucel | Gunay, Sevtap | Karadibak, Didem

Article Type: Research Article

Abstract: Background: The purpose of this study was to identify factors associated with Low Back Pain (LBP) among employee working at a package producing industry. Methods: A sample of 111 male blue-collar workers, between the ages of 18 to 50 years old and 31 white-collar workers between the ages of 17 to 50 years old completed a questionnaire which included demographic data, educational level, participation in sports activities, activity, postural habits, smoking, work conditions lifting and bending activities during the workday strenuous arm position and questions related with low back pain (LBP). The isometric strength of back muscles were …measured using a dynamometer. Result: The prevalence of LBP during the past 12 months was 55.9% for blue-collar workers and 51.6% for white-collar workers. The chi-square and t-test analysis showed statistically significant relations between LBP and smoking, number of years spent working in the last job, lifting activities between the ages of 30–34 years old. The incorrect standing and sitting posture of the blue-collar workers and the sitting posture with bending forward on the table of the white-collar workers were significantly related with LBP (p < 0.05 ). Conclusions: Our results identified the risk factors of LBP in a package producing company. The protective approaches aiming to avoid the risk factors could decrease the low back pain prevalence that increases each year passed worked at the company. Show more

Keywords: Low back pain, risk factors, ergonomics

DOI: 10.3233/BMR-130415

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 25-32, 2014

Authors: Hedayati, Rozita | Kahrizi, Sedighe | Parnianpour, Mohammad | Bahrami, Fariba | Kazemnejad, Anushiravan | Mobini, Bahram

Article Type: Research Article

Abstract: Background and Objectives: Intrinsic variability is present in all actions, including repetitive tasks. The aim of this study was to evaluate the variability of anticipatory postural adjustments (APAs) of trunk muscles in participants with low back pain (LBP). Material and Method: The study included 21 participants with recurrent non-specific LBP (15 men, 6 women) and 21 healthy volunteers. Standard deviation of electromyographic activity of the external oblique (EO), transverse abdominis/internal oblique (TrA/IO), and erector spinae (ES) muscles onset relative to deltoid muscle onset was recorded in 75 rapid arm flexions, and the correlation with the participants’ avoidance belief …(the FABQ score) and disability (the Roland-Morris Questionnaire score) was statistically analyzed. Results: participants with LBP exhibited less variability in timing of APAs of the TrA/IO muscle compared with the control group (P = 0.047 ). The timing of APAs of the TrA/IO muscle was significantly correlated with the FABQ score (P = 0.006 ). There was no significant correlation between this variable and disability (P = 0.09 ). Decrease in variability of the timing of APA of the EO (P = 0.45 ) and ES (P = 0.6 ) muscles was not significant. Conclusion: The variability of the postural responses of participants with LBP decreased. Restoring variability in postural control responses might be a goal in rehabilitating these patients. Show more

Keywords: Variability, posture, fear-avoidance belief, disability, low back pain

DOI: 10.3233/BMR-130416

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 33-40, 2014

Authors: Nava-Bringas, Tania Inés | Hernández-López, Mario | Ramírez-Mora, Isabel | Coronado-Zarco, Roberto | Israel Macías-Hernández, Salvador | Cruz-Medina, Eva | Arellano-Hernández, Aurelia | León-Hernández, Saúl Renán

Article Type: Research Article

Abstract: Objective: To determine the effects of stabilization exercises on pain and function in patients with degenerative spondylolisthesis. Study Design: Nonrandomized clinical trial, with 6 months of follow up. Methods: Twenty patients over 50 years of age with degenerative spondylolisthesis underwent a 6-month, home-based training program of stabilization exercises. We applied functional and pain scales (Visual Analogue Scale [VAS] and Oswestry Disability Index [ODI]), and conducted an isokinetic trunk test. Statistical analysis included a T test for quantitative variables, a chi-squared test for qualitative data, and Pearson correlations. The significance alfa level was 0.05. Results: …Both pain and Oswestry Index scores were significantly decreased. Initial and final VAS “back pain” results were 63.50 ± 18.05 mm and 43.4 ± 22.09 (p = 0.007 ) respectively. Initial and final VAS “sciatic pain” results were 53.65 ± 29.03 mm and 36.65 ± 27.21 (p = 0.035 ) respectively. Oswestry Index at the beginning of the study was 30.35 ± 15.6%, decreasing to a final 20.15 ± 13.6% (p = 0.007 ). The results of VAS and ODI scores correlated significantly with improvement in the isokinetic test. Conclusion: Lumbar stabilization exercises could be an effective treatment option in controlling pain and improving function in patients with degenerative spondylolisthesis. Further investigation with randomized controlled trials is necessary to obtain confirmation of these results. Show more

Keywords: Degenerative spondylolisthesis, pain, functionality, stabilization exercise, strength

DOI: 10.3233/BMR-130417

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 41-46, 2014

Authors: Abdel-aziem, Amr Almaz | Draz, Amira Hussin

Article Type: Research Article

Abstract: Objective: To determine if the eccentric evertor/invertor and dorsiflexor/plantar-flexor ratio are altered in subjects with chronic ankle instability. Methods: Twenty chronic ankle instability (CAI) subjects as an experimental group, and twenty healthy subjects as a control group, were matched in age, gender, and activity level. CAI subjects have a history of at least one ankle sprain and repeated episodes of giving way were included in CAI group. Subjects with no prior history of ankle injury were included in the control group. Ankle evertor/invertor and dorsiflexor/plantar-flexor muscles eccentric torque ratios were measured using the eccentric muscle contraction at angular …velocities 60 and 120°/s. Results: Analysis of variance revealed that the eccentric contraction eversion/inversion ratio of CAI group was significantly lower than normal group ratio at angular velocities 60 and 120°/s (p = 0.041 and 0.012) respectively. The eccentric contraction dorsiflexion/plantarflexion ratio of CAI group was significantly higher than normal group ratio at both angular velocities (p = 0.036 and 0.013) respectively. Moreover, at angular velocities of 60°/s and 120°/s a deficit in inversion and eversion eccentric torques were identified in CAI group (p = 0.000 ), plantarflexion torque deficit of CAI group (p = 0.034 and 0.028), respectively, and no deficit was identified for dorsiflexion torque of CAI group (p = 0.595 and 0.696) respectively. Conclusion: Chronic ankle instability increases the dorsiflexion/plantarflexion muscles torque ratio and decreases the eversion/inversion ratio at angular velocities 60 and 120°/s. Therefore, the restoration of a normal eccentric inversion, eversion, and plantarflexion strength may prevent recurrent lateral ankle ligament sprain. Show more

Keywords: Eccentric contraction, chronic ankle instability, ankle muscles

DOI: 10.3233/BMR-130418

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 47-53, 2014

Authors: Watanabe, Susumu | Kobara, Kenichi | Yoshimura, Yosuke | Osaka, Hiroshi | Ishida, Hiroshi

Article Type: Research Article

Abstract: Background and Purpose: Slumped sitting is known to increase disc pressure and aggravate chronic low back pain. In addition, it has been recognized that co-contraction of the deep spine-stabilizing muscles enhances lumbar segmental stability and the sacro-iliac joint. The purpose of this study was to compare the electromyographic (EMG) activity of the trunk muscles and the muscle thickness of the transverse abdominis (TrA) during slumped sitting with the same parameters during co-contraction and investigate how co-contraction influences spinal curvature. Subjects and Methods: Nine healthy male volunteers participated in the study. EMG signals were recorded during both sitting postures. …In order to measure the muscle thickness of the TrA, ultrasound images were captured. While the subjects performed both sitting postures, spinal curvature was measured using a hand-held device. Results: Significantly more activity of the trunk muscles, with the exception of the rectus abdominis muscle, and significantly greater muscle thickness of the TrA were observed during co-contraction of the trunk muscles than during slumped sitting. Co-contraction also resulted in significantly increased lumbar lordosis and a greater sacral angle when compared to slumped sitting. Conclusion: In this study, it was demonstrated that the instructions given to the subjects on co-contraction of the trunk muscles during sitting increased muscle activity with the exception of the rectus abdominis muscle, muscle thickness of the TrA, and lumbar lordosis. Show more

Keywords: Trunk muscle, co-contraction, sitting posture, electromyography, ultrasound images, spinal curvature

DOI: 10.3233/BMR-130419

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 55-61, 2014

Authors: Arab, Amir Massoud | Nourbakhsh, Mohammad Reza

Article Type: Research Article

Abstract: Background and Objectives: Shortened hamstring muscle length has been noted in persons with low back pain (LBP). Prolonged sitting postures, such as those adopted during different work settings and sedentary lifestyle has been associated with hamstring shortness and LBP. The purpose of this study was to investigate the effect of lifestyle and work setting on hamstring length and lumbar lordosis in subjects with and without LBP and to identify the relationship between hamstring muscles length and lumbar lordosis in individuals with different lifestyle and work setting. Material and Method: A total of 508 subjects between the ages of …20 and 65 were selected. Subjects were categorized into two groups of individuals with and without LBP. A questionnaire was used to obtain information about the subjects’ lifestyle and work setting. Hamstring muscle length and lumbar lordosis were measured in all subjects. Results: The results showed no significant difference in the number of subjects with different work setting or lifestyle in individuals with and without LBP. Hamstring muscle length or lumbar lordosis was not affected by type of work setting and lifestyle. Our data showed significant difference in hamstring length and no significant difference in lumbar lordosis between subjects with and without LBP in all categories. Lumbar lordosis was not different between individuals with and without hamstring tightness in normal and LBP subjects with different work setting and lifestyle. Conclusion: The findings of this study did not support the assumption that work setting and sedentary lifestyle would lead to hamstring tightness in subjects with LBP. It seems that work setting and lifestyle was not a contributing factor for hamstring tightness in subjects with LBP. Show more

Keywords: Low back pain, hamstring, lumbar lordosis, work setting, lifestyle

DOI: 10.3233/BMR-130420

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 63-70, 2014

Authors: Williams, Jonathan M. | Theobald, Peter S. | Jones, Michael D.

Article Type: Research Article

Abstract: Background and Objectives: Lifting presents a significant risk for the development of low back pain. It is not known what effect lifting from a supermarket shopping trolley has on sagittal spinal curvature. The aim of this study is to determine the effect of lifting from a shopping trolley on sagittal spinal curvature. Methods: Fifteen female subjects (height 1.67 ± 0.04 m, weight 64.3 ± 5.0 kg) completed lifts of 9 kg from a shopping trolley and a surface matched for height whilst sagittal spinal curvature was measured using Qualysis motion analysis system. Seven retro-reflective markers were placed along …spine with angle between three markers representing regional curvature. No constraints on lifting technique were instigated. Results: Results demonstrate no difference in sagittal range of motion or spinal curvature across the two lifts. A small but significant difference in knee flexion angle was observed. These results demonstrate that the chosen lifting strategy was not influenced by the constraint imposed by the shopping trolley. Furthermore the function of knee flexion did not result in change in sagittal curvature during the lifts. Conclusion: Lifting from a shopping trolley has no effect of sagittal spinal curvature. Show more

Keywords: Lifting, shopping trolley, curvature, range of motion, spine

DOI: 10.3233/BMR-130421

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 71-75, 2014

Authors: Unver, Bayram | Ertekin, Özge | Karatosun, Vasfi

Article Type: Research Article

Abstract: Objectives: (1) to evaluate the change in time of pain, stair climbing ability and fear of falling (FOF), (2) to determine the association between pain, stair climbing ability and FOF for patients with knee osteoarthritis (OA) following the knee replacement over the course of six months, (3) and to compare the results with healthy controls in terms of stair climbing ability and FOF. Methods: Fifteen female healthy controls and 21 female consecutive subjects who were scheduled to undergo primary bilateral knee replacement for the treatment of knee OA were involved. Pain, stair climbing ability and FOF were assessed …with a numerical pain rating scale, Going up and Down Scale (GUDS) and Tampa Scale for Kinesiophobia (TSK) at pre-surgery and discharge. After discharge, patients were asked to answer the outcome measures at 2, 4, 8, 12 and 26 week by phone. Results: Patients had significantly improvement in the postoperative 26-week scores of pain (p < 0.001 ), stair ability (p < 0.001 ), and FOF (p = 0.006 ) compared with the preoperative scores. There was also decreased pain at 4.week, improved stair ability at 8.week, and delayed improvement at FOF in patients. While patients had significantly worse stair ability than controls preoperatively (p < 0.001 ), the difference was not significant at postoperative 26-week (p = 0.561 ). A positive significant correlation was found between the stair ability, FOF and pain scores (p < 0.001 ). Conclusion: It would be reasonable to consider that FOF control is potentially useful for preventing severe functional limitation in stair climbing for subsequent knee OA before and early after the surgery. Show more

Keywords: Total knee replacement, knee osteoarthritis, stair ability, fear of falling, pain

DOI: 10.3233/BMR-130422

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 77-84, 2014

Authors: Grabara, Małgorzata

Article Type: Research Article

Abstract: Objectives: To evaluate and compare the posture in young female handball players and a group of non-training peers. Material and Methods: 125 handball players and 135 non-training individuals as a control group. All the subjects were aged 12–15. Measurements of basic somatic parameters (body height and mass, BMI, fat mass and total body water) were taken with an electronic balance ‘Tanita’. The posture was evaluated using the moiré method. We analysed the shape of the spine in the sagittal plane and the position of the spine, pelvis and shoulder girdle in terms of symmetry. Results: In …13-year-old handball players there was a smaller inclination of the thoracolumbar segment and a greater forward tilt of the torso. Among the training 15-year-olds, the inclination of the lower back, the sum of angles of anteroposterior curvatures and the angle of lumbar lordosis were smaller than in their non-training peers. Moreover, a correct pelvic alignment in the frontal plane, and pelvis and scapulas asymmetries in the transverse plane were more common in handball players. Conclusion: The formation of anteroposterior curvatures of the spine diversified some of the age groups of training and non-training young females. Handball training can affect the quality of posture. Show more

Keywords: Posture, female athletes, asymmetries, anteroposterior curvatures, handball training

DOI: 10.3233/BMR-130423

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 85-92, 2014

Authors: Iles, Ross A. | Taylor, Nicholas F. | Davidson, Megan | O'Halloran, Paul

Article Type: Research Article

Abstract: Background: A health coaching intervention in addition to usual physiotherapy care increased recovery expectation and activity in people with non-chronic NSLBP and low recovery expectation. Objective: We aimed to fully describe the coaching intervention to allow replication and enable a deeper understanding of the mechanisms behind health coaching in this setting. Methods: A qualitative analysis was conducted using notes taken by the coach during the health coaching intervention. Two researchers independently applied open coding and content analysis, using the factors of low recovery expectation identified in a previous qualitative investigation as a framework. Results: …For the majority of participants coaching rapidly progressed to goal setting and action planning, with less time spent on increasing the importance and confidence to return to activity. The factors of the person, progression, pain, performance and treatment were addressed across all phases of the coaching intervention. Conclusion: This effective health coaching intervention for people with non-chronic NSLBP and low recovery expectation concentrated on goal setting and action planning and addressed the essential factors of recovery expectations. This study suggests that coaching interventions are likely to be different in this population compared to similar interventions in chronic conditions due to pre-existing levels of readiness to change. Show more

Keywords: Low back pain, coaching, motivational interviewing, recovery expectation, qualitative, content analysis

DOI: 10.3233/BMR-130424

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 93-101, 2014

Authors: Di Sante, Luca | Paoloni, Marco | De Benedittis, Stefano | Tognolo, Lucrezia | Santilli, Valter

Article Type: Case Report

Abstract: Background and Objective: Iliopsoas bursitis (IB) is characterized by inflammation and enlargement of the iliopsoas bursa. Although this condition is often associated with degenerative or inflammatory arthritis, infections, trauma, overuse and impingement syndromes, osteonecrosis and hip replacement, the pathogenesis of IB remains uncertain. We present a case report of IB associated with moderate hip osteoarthritis (HOA). Methods: We present a case report of a 73-year-old man with chronic left hip pain that did not respond to conservative treatments. An ultrasonography examination of the left hip revealed fluid-induced distension of the iliopsoas bursa, which was treated with aspiration followed …by a corticosteroid-anesthetic injection. Results: At the 30-day follow-up, despite an initial improvement in the patient’s symptoms, both the pain and functional limitation returned, though not in association with bursa distension. The patient therefore underwent a total hip arthroplasty, which fully relieved the symptoms. Conclusion: We hypothesize that iliopsoas bursitis may, when associated with other pathological conditions, not be the only source of pain. It should, nevertheless, be considered for differential diagnosis purposes. Show more

Keywords: Iliopsoas bursitis, groin pain, hip osteoarthritis, ultrasonography

DOI: 10.3233/BMR-130412

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 103-106, 2014

Authors: Sonagere, Matthew B. | Haig, Andrew J. | Patel, Rakish | Lucas, David R. | Gomez-Hassan, Diana

Article Type: Case Report

Abstract: Background: The differential diagnosis of benign-appearing posterior element lesions is complex. Objective: To explore the etiology of an unusual benign lesion found on the lamina of L5 described in a case report. Methods: Case report. The patient’s medical, surgical and imaging histories as well as medical literature were reviewed. Results: A 35-year old male complained of low back pain radiating to both legs for 5 months. Abdominal CT scan 1 year prior as well as post symptom-onset CT and MRI showed a well-corticated lesion lateral to the spinous process of L5. After failed rehabilitation …and injection, operation revealed normal cortical bone. Pain was not markedly relieved post-operatively. Conclusion: The pre-surgical differential diagnosis of this lesion included osteosarcoma and osteoid osteoma, however benign pathological results suggest the possibility of atypical spina bifida occulta, Baastrup changes, atypical sacralization of L5, or a resolved fracture with heterotopic ossification. Show more

Keywords: Lumbar spine, back pain, congenital anomaly, sacralization of L5, spinous process, facet joint

DOI: 10.3233/BMR-130413

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 27, no. 1, pp. 107-110, 2014