Journal of Back and Musculoskeletal Rehabilitation - Volume 28, issue 4
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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: OBJECTIVE: This study examined the effect of modified prone trunk-extension (PTE) exercises on selective activity of the thoracic erector spinae. METHODS: Thirty-nine healthy subjects performed four modified PTE exercises, involving location of the edge of the table (iliac crests [IC] vs. xiphoid process [XP]) and the degree of trunk extension (horizontal vs. hyperextension). Electromyography signals were collected bilaterally from the longissimus thoracis (LT), iliocostalis thoracis (ICT), and iliocostalis lumborum (ICL). Normalized LT:ICL and ICT:ICL ratios were calculated. The data were analyzed using a repeated measures two-way analysis of variance. RESULTS: The LT:ICL and ICT:ICL…ratios were significantly higher under the XP than the IC condition (p < 0.05); however, the degree of trunk extension did not affect the ratio (p > 0.05). Activity in the lumbar erector spinae and left ICT muscles was greater when subjects were in the hyperextended position than in the horizontal position. Moreover, activity in the thoracic erector spinae was greater when the table edge was aligned with the IC compared with the XP (p < 0.05). CONCLUSIONS: Our findings suggest that PTE exercise with the XP aligned with the table edge increased the selective activation of the thoracic erector spinae muscles.
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Abstract: BACKGROUND: Chronic neck pain is one of the most usual neuromusculoskeletal pain conditions which can lead patients to chronic disability. Similarly to other pain conditions, the changed psychological status of these patients is believed to be associated with their pain condition and disability. However, the association between the psychological status of patients with idiopathic neck pain and their pain intensity and disability is minimally explored. OBJECTIVE: This study was aimed at investigating the association between psychological states (anxiety, depression, kinesiophobia, catastrophizing) of patients with chronic idiopathic neck pain and self-reported pain and disability. METHODS:…Forty five patients with idiopathic chronic neck pain (more than 6 months, at least once a week) participated. Their psychological states were assessed by using the Hospital Anxiety and Depression scale, Pain Catastrophizing scale and Tampa Scale for Kinesiophobia. Self-reported disability was recorded with the Neck Disability Index. Pain intensity was recorded by using a visual analog scale. RESULTS: Neck pain intensity was significantly correlated with anxiety (p< 0.05). Disability was significantly correlated with anxiety, depression and catastrophizing (p< 0.05). Multiple regression analysis showed that pain-induced disability can be significantly predicted by anxiety and catastrophizing (p< 0.05). CONCLUSIONS: It can be concluded that anxiety, depression and catastrophizing of patients with chronic neck pain is associated with their self-reported disability, whereas anxiety is also associated with their pain intensity. Anxiety and catastrophizing may be important predicting markers of patients' self-reported disability.
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Abstract: OBJECTIVE: The objective of this study is to investigate musculoskeletal system problems and quality of life of mothers of children with cerebral palsy with different levels of disability. METHODS: 100 children (37 girls and 63 boys) with cerebral palsy (CP) and their mothers were included in this study. Functional levels of children with CP were assessed by using the Gross Motor Function Classification System (GMFCS) and the Pediatric Functional Independence Measure (WeeFIM). Quality of life of mothers regarding health was assessed by using the Nottingham Health Profile (NHP). Musculoskeletal system problems of mothers were assessed by…using the Neck Disability Index (NDI) and the Roland-Morris Disability Questionnaire (RMDQ). RESULTS: No statistical significance was found when GMFCS levels of children with CP and the NHP, DASH-T, RMDQ, NDI and the BAE values of mothers were compared in an inter-group way (p> 0.05). When the NHP parameters and the existence of lower and arm pains of mothers were compared with their BAI, NDI, RMDQ and DASH-T scores, a statistically significant relationship was found among them (p< 0.05). CONCLUSION: As functional levels of children with CP get worse, upper extremity, lower back and neck problems and anxiety levels of mothers increase and this situation negatively affects mothers' quality of life.
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Keywords: Cerebral palsy, musculoskeletal, mother, quality of life
Abstract: BACKGROUND: The relationship between low back pain (LBP) and reduced hip rotation has been well established. However, there is a lack of studies investigating the effect of treatment targeted at the hip in people with LBP. OBJECTIVE: The aim of this study was to assess the level of effectiveness that different types of exercises targeted at the hip had on pain and function in individuals with non-specific chronic or recurrent LBP with concurrent reduced hip rotation. METHOD: Thirty participants were assigned to one of three exercise groups: hip rotation stretching, multi-directional hip stretching and…hip strengthening. All groups participated in a six week home exercise program. Pain (numerical rating scale), functional disability (Modified Oswestry Disability Questionnaire; MOD), and hip rotation measurements were assessed at baseline and post intervention. RESULTS: Results revealed that all exercise groups were effective in improving pain and function (MOD) (P< 0.05). Between group comparisons revealed that hip strengthening was more effective than hip rotation exercises in improving functional disability (P= 0.03). The majority of participants in all groups (60-70%) demonstrated clinical improvements in pain, but only the hip strengthening group had the majority of participants (80%) exhibit clinical improvements in function. CONCLUSION: In individuals with non-specific LBP and reduced hip rotation, clinical intervention of providing exercises targeted at the hip can be beneficial in improving pain and function, with strengthening exercises most beneficial for improving function.
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Keywords: Low back pain, hip range of motion, hip rotation
Abstract: BACKGROUND: The surface electromyography (sEMG), by evaluating the paraspinal muscle activity, may be used for diagnosis and evaluation of rehabilitation effectiveness patients with low back pain. OBJECTIVE: The purpose of the study was to determine the intra- and inter-session reliability of the measurement of the activity of the lumbar erector spinae (LES) activity (extension-flexion ratio). METHODS: The study included 21 asymptomatic subjects, aged 14 to 27 years, mean 23.7 ± 2.9. The LES muscle activity was assessed with using of the sEMG during forward trunk flexion and extension by two examiners. Based…on the quotient of the LES muscle activity obtained during four concentric and eccentric tasks the extension-flexion ratio was calculated. RESULTS: The measurements displayed excellent or fair-to-good reliability (intraclass correlation coefficient ranged from 0.90 to 0.68). The typical error and coefficient of variations, ranged from 0.34 to 0.58, and from 13.7 to 21.9, respectively. CONCLUSIONS: The measurement of the extension-flexion ratio performed with the use of sEMG shows high level of intra- and inter-session reliability, suggesting that this parameter is a reliable tool in evaluation of the lumbar paraspinal muscles activity. However, the level of typical error should be taken into account.
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Keywords: Reliability, typical error, surface electromyography, extension-flexion ratio
Abstract: OBJECTIVE: The effect of different exercise programs on cervical flexor muscles dimensions in patients with chronic neck pain is yet to be demonstrated. The purpose of this study was to assess the effect of two exercise programs; craniocervical flexion (CCF) and cervical flexion (CF), on flexor muscles dimensions in patients with chronic neck pain. METHODS: Following ethical approval, 60 patients were randomly assigned into either a CCF group or a CF group. Patients in the CCF group were given CCF exercises and those in the CF group received CF exercises. All patients received interventions for a…period of ten weeks. Pain intensity and functional disability were assessed using numerical pain rate scale and neck disability index, respectively. Dimensions of longus colli (LC) and sternoclidomastoid (SCM) muscles were measured using ultrasonography (US). All measurements were taken before and after interventions. RESULTS: Following intervention, the CCF group demonstrated a significant increase in LC muscle dimensions including cross sectional area, width and thickness compared with the CF group. A statistically significant increase was found on SCM thickness in the CF group. Following intervention, SCM thickness measurement in the CCF group showed no significant changes. Statistically significant decrease on pain intensity and disability were also found in both groups. CONCLUSION: Present findings demonstrated that craniocervical flexion program which specifically recruiting deep cervical flexor muscles increased LC muscle dimension significantly and CF program as an endurance training program increased SCM thickness.
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Abstract: BACKGROUND: Chronic low-back pain (LBP) may be related to decreased lumbar multifidus muscle cross-sectional area (CSA). OBJECTIVE: In this study, core stabilization exercises were designed to enhance neuromuscular control and correct multifidus dysfunction. METHODS: The subjects were healthy women (n = 11) and women with chronic LBP (n = 17). Lumbar multifidus muscle CSAs were measured by ultrasonography. Tests were carried out before training exercises for lumbar stability, and again 4 months and 8 months after training. RESULTS: In women with LBP, the mean multifidus muscle CSA increased by 22% on the…right side and 23% on the left side after 8 months of lumbar stabilization training, compared with baseline measurements. In healthy women, mean multifidus muscle CSA increased by 24% on the right side and 23% on the left side, compared with baseline values. CONCLUSIONS: A core stabilization exercise program significantly increased multifidus muscle CSAs in both healthy women and women with chronic LBP.
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Abstract: OBJECTIVE: The aim of this study was to investigate effects of Clinical Pilates Exercises on bone mineral density (BMD), physical performance and quality of life (QOL) in postmenopausal osteoporosis. METHODS: Forty-one women were recruited to the study. The subjects were divided into two groups, as the Pilates group and the control group. Subjects were evaluated for BMD at the lumbar region. Physical performance level was measured. Pain intensity level was scored with Visual Analogue Scale. QUALEFFO-41 was used for assessing QOL. RESULTS: BMD values increased in the Pilates group (p < 0.05), while BMD…decreased in the control group (p< 0.05). Physical performance test results showed significant increases in the Pilates group (p< 0.05) whereas there was no changes in the control group (p> 0.05). Pain intensity level in the Pilates group was significantly decreased after the exercise (p< 0.05), while it was unchanged in the control group. There were significant increases in all parameters of QOL in the Pilates group. Conversely, some parameters of QOL showed decreases in the control group (p< 0.05). CONCLUSIONS: Pilates Exercises is effective to increase BMD; QOL and walking distance and also beneficial to relieve pain. Physiotherapist can use Pilates Exercises for the subjects with osteoporosis in the clinics.
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Abstract: BACKGROUND: Despite the popularity of core stabilization, there is limited evidence as to the relationship between performance on tests of isometric trunk muscle endurance and physical activity levels in adults. OBJECTIVE: To investigate the relationship between isometric trunk muscle endurance and physical activity related energy expenditure in healthy young adults. METHODS: A total of 51 participants (24 female) participated in the study. Median age and body mass index were; 22 years (Min-max: 18-26 years) and 21.8 kg/m2 (Min-Max: 18.59-28.98 kg/m2 ), respectively. Participants completed the International Physical Activity Questionnaire. Isometric trunk muscle endurance…was assessed with holding times of isometric trunk flexor, extensor, and lateral side bridge tests. Collected data were summarized based on median and interquartile ranges. The Spearman's correlation test was used to ascertain the relationship between isometric trunk muscle endurance and physical activity related energy expenditure. RESULTS: There were no gender differences in holding times of the trunk flexor and trunk extensor endurance tests (p> 0.05). Males showed higher endurance scores for side bridge test than females (p< 0.001). No difference was found in physical activity related energy expenditure between males and females. No correlation was observed between isometric trunk muscle endurance and physical activity related energy expenditure for either females or males (p> 0.05). CONCLUSIONS: According to our findings, trunk muscle endurance is not related to physical activity related energy expenditure in healthy young adults.
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Keywords: Trunk muscles, endurance, energy expenditure, young adults, physical activity
Abstract: BACKGROUND AND OBJECTIVES: Spinal canal stenosis is the most common reason for spinal surgeries in patients over 65 years of age. The aim of the study was to assess static balance in patients prior to and after surgical decompression of lumbar spinal canal stenosis. MATERIAL AND METHODS: The study population consisted of 30 patients suffering from spinal canal stenosis. Their static balance was measured, i.e. quantitative analysis of balance reaction parameters in quiet standing was performed. RESULTS: The analysis of the collected data did not reveal any statistically significant differences between parameters measured prior…to and after the surgery (for p< 0.05). A tendency for a decrease of measured parameters was observed. The regularity of changes was determined; in addition, for this analysis, the Spearman's rank correlation coefficient was used. CONCLUSIONS: The analysis of the collected data did not reveal any statistically significant improvement of balance reactions after spinal canal stenosis surgery. In spite of pain reduction, there was no improvement in balance reactions, as behavioural patterns for balance reactions had been fossilised before surgery.
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