Journal of Back and Musculoskeletal Rehabilitation - Volume 28, issue 4

Authors: Kumar, Tarun | Kumar, Suraj | Nezamuddin, Md. | Sharma, V.P.

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVES: Low back pain is a common health problem in human being and about 5 to 15% will develop chronic low back pain (CLBP). The clinical findings of CLBP suggest that lumbar mobility is decreased and recruitment order of core muscles is altered. In literature, there is no data about the effect of core muscles strengthening in the chronicity (short duration, long duration) of CLBP. This study evaluated the effect of core muscle strengthening intervention on chronicity of chronic low back pain. METHOD: Thirty patients were recruited from the outpatient department of the National …Institute for the Orthopaedically Handicapped. These 30 patients divided into two groups: A and B on the basis of duration of low back pain. Group-A patients complain about pain duration for more than twelve months and Group B complains about pain duration from three to twelve months. Both the groups were received same intervention for six weeks. Assessment was done pre intervention and post intervention after six weeks for both the groups. %For both the groups the assessment was done after six weeks for pre and post intervention. RESULTS: The result described both the groups showed improvement in all the outcome measures including pain as well as in function using Numerical pain rating scale, Oswestry Disability Index, Sorensen test, Gluteus Maximus Strength, Activation of transversus abdominis and Modified-Modified Schober's Test. The improvement was statistically non-significant with inter groups and significant within group. CONCLUSION: This study concludes that core muscle strengthening exercise along with lumbar flexibility and gluteus maximus strengthening is an effective rehabilitation technique for all chronic low back pain patients irrespective of duration (less than one year and more than one year) of their pain. Show more

Keywords: Chronic low back pain, pressure biofeedback unit, core muscle strengthening, lumbar flexibility, Gluteus maximus strengthening

DOI: 10.3233/BMR-140572

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 28, no. 4, pp. 699-707, 2015

Authors: Özkul, Çağla | Kılınç, Muhammed | Yıldırım, Sibel Aksu | Topçuoğlu, Elif Yalçın | Akyüz, Müfit

Article Type: Research Article

Abstract: BACKGROUND: Chronic pain is a common consequence of spinal cord injury (SCI). No therapeutic drugs or drug groups are proven to be superior for neuropathic pain and treatments only aim to convert pain from dull to tolerable levels and not to remove it. OBJECTIVE: This study was planned to compare the effect of visual illusion (VI) and transcutaneous electrical nerve stimulation (TENS) on pain intensity, pain quality and functional capacity in SCI patients with neuropathic pain. METHODS: Twenty-four patients were included and randomly categorized into two groups. In the first group (n= 12), visual …illusion was applied for first two weeks, 1 week wash out period and then TENS was applied for 2 weeks. In second group (n= 12), TENS was applied firstly, 1 week wash out and then %visual illusion VI were applied. Pain severity, pain quality, and functional capacity were assessed with the visual analog scale (VAS), the neuropathic pain scale (NPS), and the brief pain inventory (BPI), respectively. A pre-post-treatment and cross over design was used. RESULTS: Wilcoxon signed-rank tests were used for within group analyses. Mann-Whitney U tests were used for analyses that compared different groups. It was observed that pain intensity decrease immediately after both applications (VI: p= 0.07, TENS: p= 0.08). After TENS application for 2 weeks, it was observed that significant decrease in most (p= 0.04) and less (p= 0.02) pain intensity; while there was no significant decrease in pain intensity after 2 weeks for VI (p> 0.05). When findings of NPS were analyzed, hot (p= 0.047), sharp (p= 0.02), unpleasant (p= 0.03) and deep items (p= 0.047) decreased after VI application. When the results of BPI were detected, they were observed that the negative effect of pain on moving ability (p= 0.04) after visual illusion application and the negative effect of pain on mood (p= 0.03), relationships with others (p= 0.04) and sleep (p= 0.04) after TENS application decreased significantly. CONCLUSION: TENS and VI therapies can be successfully used in clinical practice as an alternative treatment or as a supportive method separetely or together. Show more

Keywords: Neuropathic pain, transcutaneous electrical nerve stimulation, visual illusion, physical therapy

DOI: 10.3233/BMR-140573

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 28, no. 4, pp. 709-719, 2015

Authors: Lukovic, Tanja | Cukovic, Sasa | Lukovic, Vanja | Devedzic, Goran | Djordjevic, Dusica

Article Type: Research Article

Abstract: BACKGROUND: Although intensively investigated, the procedures for assessment and monitoring of scoliosis are still a subject of controversies. OBJECTIVE: The aim of this study was to assess validity and reliability of a number of physiotherapeutic measurements that could be used for clinical monitoring of scoliosis. METHODS: Fifteen healthy (symmetric) subjects were subjected to a set of measurements two times, by two experienced and two inexperienced physiotherapists. Intra-observer and inter-observer reliability of measurements were determined. Following measurements were performed: body height and weight, chest girth in inspirium and expirium, the length of legs, the spine …translation, the lateral pelvic tilt, the equality of the shoulders, position of scapulas, the equality of stature triangles, the rib hump, the existence of m. iliopsoas contracture, Fröhner index, the size of lumbar lordosis and the angle of trunk rotation. RESULTS: Intraclass correlation coefficient was high (> 0.8) for majority of measurements when experienced physiotherapists performed them, while inexperienced physiotherapists performed precisely only basic, easy measurements. CONCLUSIONS: We showed in this pilot study on healthy subjects, that majority of basic physiotherapeutic measurements are valid and reliable when performed by specialized physiotherapist, and it can be expected that this protocol will gain high value when measurements on subjects with scoliosis are performed. Show more

Keywords: Scoliosis, assessment, monitoring, diagnosis

DOI: 10.3233/BMR-140574

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 28, no. 4, pp. 721-730, 2015

Authors: Pagare, Venus K. | Dhanraj, Teena | Thakkar, Dhaval | Sareen, Aarti | Palekar, Tushar J.

Article Type: Research Article

Abstract: BACKGROUND: Low back pain (LBP) is a major public health problem and is the leading musculoskeletal cause of disability. Various bio-behavioral factors which can be associated with disability due to LBP have been identified. When considering these factors associated with LBP, beliefs that people hold are among the most important factors to consider. OBJECTIVE: To find out the prevalence of LBP among the general population and to investigate their beliefs towards LBP. METHODS: A cross-sectional survey of the general population was conducted. Demographic information and information on beliefs regarding low back pain …was gathered from 921 individuals. The respondents were asked to rate their agreement with 7 statements, corresponding to Deyo's 7 myths. RESULTS: 75% of the population reported lifetime prevalence of LBP. Regarding the beliefs about LBP, general population exhibited diverse attitudes. Out of 7 myths explored, 3 myths were found to be dead and buried in more than 50% of the sampled population. However, 4 out of 7 myths still exist among the population. CONCLUSIONS: Prevalence of Low Back Pain was found to be high among the general population sampled and also myths regarding LBP still exist among them. Show more

Keywords: Bio-behavioral factors, bio-psychosocial model, disability, kinesiophobia, myths, low back pain

DOI: 10.3233/BMR-140575

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 28, no. 4, pp. 731-737, 2015

Authors: Bhide, Rohit Prakash | Solomons, Cassandra | Devsahayam, Suresh | Tharion, George

Article Type: Research Article

Abstract: BACKGROUND: Upper extremity strengthening and gait training with orthoses form a major part of inpatient rehabilitation of paraplegic patients in developing countries. This helps to overcome architectural barriers and limited wheelchair accessible environment in the community. OBJECTIVES: To evaluate the changes in physiological properties of the Triceps Brachii muscle following exercise training in individuals with paraplegia. The authors also explored the correlation between muscle property changes and gait parameters using orthoses in paraplegic persons. METHODS: Twelve subjects with complete paraplegia and neurological level of injury (NLI) from T9 to L1, underwent exercise training for a …mean 64.1 ± 4.1 days. Triceps brachii was chosen as the sample muscle. Variables like arm circumference, time to fatigue and mean power frequency (MF) (surface EMG parameter), were recorded at the beginning and the end of training, during a sub-maximal isometric elbow extension. Non-parametric tests were used to assess statistical significance between the two recordings. Additionally, gait parameters like walking speed and distance (with the help of orthoses) were obtained and compared with the above variables, to determine impact of upper extremity strengthening on gait improvements in such patients. RESULTS: Statistically significant changes were noted in bilateral arm circumferences (p= 0.003 bilaterally) and MF drop, expressed as percentage (right p= 0.04, left p= 0.01), indicative of better muscle resilience and adaptation. Significant positive correlation was observed between `time to fatigue' and the orthoses-aided total walking distance (right ρ = 0.65, left ρ = 0.69). CONCLUSIONS: Exercise training induces noticeable changes in the muscles of upper extremities favoring better muscle adaptation. Furthermore, positive correlation between `time to fatigue' and (orthotic) aided walking distance highlights the positive impact of strengthening program on gait parameters in paraplegic patients. These findings are important and relevant in developing countries with environmental barriers. Upper extremity strengthening should be included in the rehabilitation of paraplegic patients who are being trained for ambulation with orthoses. Show more

Keywords: Exercise, paraplegia, muscle fatigue, surface electromyography, triceps

DOI: 10.3233/BMR-140577

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 28, no. 4, pp. 739-747, 2015

Authors: Özdemir, E. | Paker, N. | Bugdayci, D. | Tekdos, Demircioglu D.

Article Type: Research Article

Abstract: OBJECTIVE: The purpose of this study was to compare the quality of life of patients with lumbar spinal stenosis (LSS) with that of the controls' and to investigate the factors related with the quality of life in LSS. METHODS: Fifty-four patients with LSS were included in the study whose diagnosis were made by clinically and magnetic resonance imaging (MRI). Control group consisted of age and sex matched 54 individuals. Both of the patient and control groups were evaluated with the Short Form-36 (SF-36) health survey and Hospital Anxiety Depression Scale (HADS). The Oswestry Pain and Disability …Index (ODI) was used for the assessment of the disability. RESULTS: SF-36 scores in the LSS group was lower than that of the controls'. There was a significantly positive correlation between the SF-36 scores and walking distance in LSS group. A moderately negative correlation was found between the SF-36 and the ODI, HADS anxiety and depression scores. There was a significantly positive correlation between the ODI and the HADS anxiety and depression scores. HADS anxiety and depression scores in the patient group were significantly higher than that of the controls'. CONCLUSIONS: As a result, quality of life was decreased in subjects with LSS. The factors related with the quality of life were the walking distance, severity of the disability and emotional status in LSS. Show more

Keywords: Lumbar spinal stenosis, quality of life, SF-36, disability, anxiety, depression

DOI: 10.3233/BMR-140578

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 28, no. 4, pp. 749-753, 2015

Authors: Tirgar, Aram | Javanshir, Khodabakhsh | Talebian, Arash | Amini, Fatemeh | Parhiz, Alireza

Article Type: Research Article

Abstract: BACKGROUND: Dentists have to remain in a fixed position during dental practices for the accuracy required, therefore they are susceptible to musculoskeletal disorders (MSDs). OBJECTIVES: Considering the infrequency of ergonomics studies in general dental practitioners (GDPs), especially in cervical region, this study aimed to reviews MSDs in the neck region among GDPs. METHODS: An analytic cross-sectional study was carried out among the GDPs in 2011. A total of 60 dentists (40 males and 20 females) were examined through a combination of questionnaires (concerning their demographic …information) such as the Nordic standardized musculoskeletal disorder questionnaire (NMQ) and Body Discomfort Assessment questionnaire (BDA). Each dentist's working posture was assessed using Rapid Upper Limb Assessment (RULA) and deep cervical flexor muscle endurance through a Craniocervical Flexion test (CCFT). Descriptive statistical indexes and Chi-square test were used for statistical analysis, while considering p< 0.05. RESULTS: The mean dental practice experience was 16.9 ± 5.6 years with average 41.2 ± 13.4 working hours per week. About 45% of dentists took regular exercises weekly. Some 83.3% of these dentists expressed to be suffering from the cervical pain, whereas, 56.7% complained about back pains and 41% shoulder problems. Female dentists were found more at risk of neckache, discomfort and pain in shoulder and hand than males. Greater pain frequency in knee was found in more experienced and older age dentists (P= 0.07). Results from the CCF test showed that the deep cervical flexor muscles endurance increased with regular exercise and decreased with aging. CONCLUSION: Many dentists experience the MSDs, especially in cervical region, as a consequence of occupational stresses. Therefore, detecting occupational risk factors, standards of work position, regular exercise and following ergonomic policy are intensely recommended. Show more

Keywords: Musculoskeletal disorders (MSDs), Rapid Upper Limb Assessment (RULA), ergonomics, Craniocervical Flexion Test (CCFT), dentistry, general dental practitioners (GDPs)

DOI: 10.3233/BMR-140579

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 28, no. 4, pp. 755-759, 2015

Authors: Bulut, Gul Tugba | Caglar, Nil Sayiner | Aytekin, Ebru | Ozgonenel, Levent | Tutun, Sule | Demir, Saliha Eroglu

Article Type: Research Article

Abstract: BACKGROUND: The position of metacarpophalangeal (MCP) joints may be an important factor affecting the efficacy of splinting in patients with carpal tunnel syndrome (CTS). OBJECTIVE: The aim of the present study was to compare the efficacy of a neutral volar static wrist splint with a neutral volar static wrist and MCP splint in patients with CTS. METHODS: Fifty-four hands were included into the study. A neutral volar static wrist splint was given to the symptomatic hands of the patients in group 1 while a neutral volar static wrist and MCP splint was given to …the symptomatic hands of the patients in group 2. Evaluation parameters were Visual Analog Scale for pain severity (VASp), grip strength, pinch strength, electrophysiologic tests and CTS Questionnaire (CTSQ) at baseline and four weeks later. RESULTS: At baseline there was no difference between groups. The intergroup comparison of the improvement showed significant differences in VASp at rest, grip strength, pinch strength and CTSQ functional capacity scores between groups in favor of wrist MCP splint. Although there were significant improvements with regard to sensory amplitude and motor latency in both groups after therapy, the differences between groups were not at the level of significance. CONCLUSIONS: The position of MCP joints seems to be an important factor for the treatment of CTS and should be considered while prescribing a splint to the patients with CTS. Show more

Keywords: Carpal tunnel syndrome, splint, electrophysiological tests, wrist joint, metacarpophalangeal joint

DOI: 10.3233/BMR-140580

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 28, no. 4, pp. 761-767, 2015

Authors: Silva, Luís | Castro, Maria António | Marta, Sérgio | Almeida, José | Vaz, João R. | Pezarat-Correia, Pedro | Cabri, Jan

Article Type: Research Article

Abstract: BACKGROUND: The University of Western Ontario Questionnaire for Musculoskeletal Conditions in Senior Golfers (MSK Golfers) was developed in Canada because of a lack of knowledge concerning musculoskeletal conditions directly related to golf play and warm-up, although the high injury incidence in golf practice. This lack of epidemiological measures also exists for the Portuguese golf population. OBJECTIVE: The purpose of this study was to translate and cross-culturally adapt the MSK Golfers questionnaire into Portuguese and to test its construct validity and reproducibility. METHODS: The MSK Golfers was translated from English to Portuguese and tested for …psychometric properties. Sixty-one golfers, aged between 14 and 70 years and with at least 1 year of practice in golf, were recruited. The validity of the MSK Golfers was assessed by evaluating data quality (missing, floor and ceiling effects). Reproducibility analysis included intra-class correlation coefficients (ICC) (2,1) and Cohen's Kappa coefficient. RESULTS: The ICC values for continuous items ranged from 0.634 to 0.998 with the exception of one item on golf activity. Kappa statistics for the categorical items ranged between 0.714 and 1.00. CONCLUSIONS: The Portuguese version of the MSK Golfers, including playing characteristics and warm-up patterns of golfers, showed a high reliability for a golfing population with an age range of 14 to 70 years. Show more

Keywords: Questionnaire, sport medicine, musculoskeletal injuries, golf

DOI: 10.3233/BMR-140582

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 28, no. 4, pp. 769-782, 2015

Authors: Capkin, E. | Karkucak, M. | Cakırbay, H. | Topbas, M. | Karaca, A. | Köse, M.M. | Gökmen, F.

Article Type: Research Article

Abstract: BACKGROUND: Low back pain (LBP) is a public health problem commonly seen in all societies. OBJECTIVE: The aim of this study was to determine the prevalence and specific risk factors of low back pain (LBP) in the central and outlying districts of the province of Trabzon, a Black Sea region of Turkey. METHOD: A random sample of 7897 (4006 men and 3789 women) adults was collected by using sampling techniques of stratification. In this study questionnaires were completed at face-to-face interviews with participants selected on the basis of place of residence, gender and age …group. The used variables in this study were: use of cigarettes, status of marriage, level of education, and presence of chronic disease, the prevalence of lifetime LBP and of LBP in the preceding year. Chronic LBP was determined as being present for more than 6 weeks. RESULTS: The lifetime prevalence of LBP in the general population was determined at 62.1%. Prevalence in the preceding year was 46.1%, and that of LBP lasting more than six week was 18.1%. Lifetime prevalence of LBP, prevalence of LBP in the preceding year and prevalence of pain lasting more than six week were all statistically significantly higher in women (p< 0.001). Use of cigarettes, female gender, marriage, a low level of education and presence of chronic disease were identified as independent risk factors for LBP (p< 0.001). CONCLUSION: Lower back pain is a common public health problem. Recommendations were made for local health services to prevent LBP, including health education through combating chronic diseases, reducing cigarette consumption, improvement of working environments and life styles. Show more

Keywords: Low back pain, prevalence, Turkey, smoking, life style

DOI: 10.3233/BMR-150584

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 28, no. 4, pp. 783-787, 2015