Journal of Back and Musculoskeletal Rehabilitation - Volume 29, issue 4

Authors: Roberts, Simon B. | Tsirikos, Athanasios I.

Article Type: Review Article

Abstract: Neuromuscular scoliosis (NMS) is the second most prevalent spinal deformity (after idiopathic scoliosis) and is usually first identified during early childhood. Cerebral palsy (CP) is the most common cause of NMS, followed by Duchenne muscular dystrophy (DMD). Progressive spinal deformity causes difficulty with daily care, walking and sitting, and can lead to back and rib pain, cardiac and pulmonary complications, altered seizure thresholds, and skin compromise. Early referral to specialist spinal services and early diagnosis of NMS is essential to ensure appropriate multidisciplinary patient management. The most important goals for patients are preservation of function, facilitation of daily care, and …alleviation of pain. Non-operative management includes observation or bracing for less severe and flexible deformity in young patients as a temporising measure to provide postural support. Surgical correction and stabilisation of NMS is considered for patients with a deformity >40-50°, but may be performed for less severe deformity in patients with DMD. Post-operative intensive care, early mobilisation and nutritional supplementation aim to minimise the rate of post-surgical complications, which are relatively common in this patient group. However, surgical management of NMS is associated with good long-term outcomes and high satisfaction rates for patients, their relatives and carers. Show more

Keywords: Neuromuscular diseases, cerebral palsy, Duchenne muscular dystrophy, scoliosis, surgery, bracing, orthoses

DOI: 10.3233/BMR-160675

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 613-623, 2016

Authors: Sanzarello, Ilaria | Merlini, Luciano | Rosa, Michele Attilio | Perrone, Mariada | Frugiuele, Jacopo | Borghi, Raffaele | Faldini, Cesare

Article Type: Review Article

Abstract: Low back pain is one of the four most common disorders in all regions, and the greatest contributor to disability worldwide, adding 10.7% of total years lost due to this health state. The etiology of chronic low back pain is, in most of the cases (up to 85%), unknown or nonspecific, while the specific causes (specific spinal pathology and neuropathic/radicular disorders) are uncommon. Central sensitization has been recently recognized as a potential pathophysiological mechanism underlying a group of chronic pain conditions, and may be a contributory factor for a sub-group of patients with chronic low back pain. The purposes of …this narrative review are twofold. First, to describe central sensitization and its symptoms and signs in patients with chronic pain disorders in order to allow its recognition in patients with nonspecific low back pain. Second, to provide general treatment principles of chronic low back pain with particular emphasis on pharmacotherapy targeting central sensitization. Show more

Keywords: Chronic low back pain, chronic disorders, central sensitization

DOI: 10.3233/BMR-160685

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 625-633, 2016

Authors: Chen, Zexin | Yu, Yunxian

Article Type: Review Article

Abstract: OBJECTIVE: The objective of this meta-analysis was to systematically assess the association between aortic calcification (AC) and fractures. METHOD: Relevant studies were identified through searching PubMed, EMBASE and Cochrane databases before August 2014. Two investigators extracted data independently from the included studies. A random-effects model was derived to composite the pooled HRs or ORs for association of aortic calcification with fractures. RESULTS: A total of 15 articles (21927 subjects) were included in the final meta-analyses. Comparing with non-calcification subjects, patients with aortic calcification were associated with increased risk of fractures (OR = 2.97, …95% CI: 1.98-4.42). Stratified analysis indicated that patients with aortic calcification showed a higher risk of fractures in hemodialysis patients (OR = 1.89, 95% CI: 1.33-2.67; I2 = 0.0%, p= 0.781) and general population (OR = 2.90, 95% CI: 1.80-4.80; I2 = 33.0%, p= 0.225), respectively. Similar significant association between severe aortic calcification and fractures were also observed. CONCLUSIONS: Patients with aortic calcification or severe aortic calcification were associated with higher risk of fractures. Show more

Keywords: Aortic calcification, fractures, meta-analysis

DOI: 10.3233/BMR-160700

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 635-642, 2016

Authors: Rajabzadeh, Fatemeh | Taghipour, Morteza | Pourahmadi, Mohammad Reza | Arab, Amir Massoud

Article Type: Research Article

Abstract: OBJECTIVE: The purpose of this study was to investigate the relationship between flexion-rotation test and ultrasound (US) thickness measurement of the antero-lateral abdominal muscles. DESIGN: Following ethical approval, a convenience sample of 55 subjects between the ages of 20 and 30 years participated in this study. Endurance of the abdominal muscles was measured using the flexion-rotation test in all subjects. US thickness measurement for the transversus abdominis (TrA), internal oblique (IO) and external oblique (EO) muscles was performed on the right side at rest in a supine position. RESULTS: Pearson correlation coefficient between …the variables of the study showed no significant relationship between the flexion-rotation test and US thickness measurements of the TrA (r = -0.03, P = 0.80), IO (r = -0.13, P = 0.32), and EO (r = -0.14, P = 0.31) muscles. The significance level of 0.05 was chosen. CONCLUSION: It seems that there is no significant relationship between the flexion-rotation test and US measurement of abdominal muscles thickness. Show more

Keywords: Ultrasound, thickness, endurance, abdominal muscles, clinical test

DOI: 10.3233/BMR-160663

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 643-648, 2016

Authors: Kofotolis, Nikolaos | Kellis, Eleftherios | Vlachopoulos, Symeon P. | Gouitas, Iraklis | Theodorakis, Yannis

Article Type: Research Article

Abstract: BACKGROUND: Pilates programs are widely used as a form of regular exercise in a broad range of populations investigating their effectiveness for chronic low back pain (CLBP) treatment. OBJECTIVE: The aim of this study was to compare the effects of a Pilates program and a trunk strengthening exercise program on functional disability and health-related quality of life (HRQOL) in women with nonspecific CLBP. METHODS: A total of 101 volunteer women with CLBP provided data with a 3-month follow-up. They were randomized to either a Pilates (n= 37), trunk strengthening exercise (n= 36) or …a control group (n= 28), exercising for a period of 8 weeks, three times a week. Data were collected on HRQOL using the Short-Form 36 Health Survey (SF-36v2), and functional disability using the Roland Morris Disability Questionnaire prior to program initiation, mid-intervention, immediately after program termination, and three months post-intervention. RESULTS: The Pilates participants reported greater improvements on self-reported functional disability and HRQOL compared with participants in the trunk strengthening exercise and control groups (p < 0.05). The effects were retained for a period of three months after program termination for the Pilates group and to a lesser extent for the trunk strengthening exercise group. CONCLUSIONS: An 8-week Pilates program improved HRQOL and reduced functional disability more than either a trunk strengthening exercise program or controls among women with CLBP. Show more

Keywords: Exercise rehabilitation, lumbar spine muscle recruitment, stabilization exercises, back pain

DOI: 10.3233/BMR-160665

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 649-659, 2016

Authors: Bilgili, Adem | Çakır, Tuncay | Doğan, Şebnem Koldaş | Erçalık, Tülay | Filiz, Meral Bilgilisoy | Toraman, Füsun

Article Type: Research Article

Abstract: OBJECTIVE: To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on clinical recovery in the management of patients with complex regional pain syndrome Type I (CRPS Type I). MATERIAL AND METHOD: The study included 30 patients with stage 1 and 2 CRPS Type I in the upper extremities. The patients were randomly assigned into 2 groups, group 1 (n= 15) received conventional TENS therapy for 20 minutes, and group 2 (n= 15) received sham TENS therapy. The standard physical therapy program, which included contrast bath for 20 minutes; whirlpool bath for 15 minutes; assisted active …and passive range of motion, and static stretching exercises up to the pain threshold, was also conducted in both groups. Therapy was scheduled for 15 sessions. A visual analogue scale (VAS) was used to assess spontaneous pain. The Leeds Assessment of Neuropathic Signs and Symptoms (LANSS) scale and the Douleur Neuropathique en 4 Questions (DN-4) were used to assess neuropathic pain. In addition, range of motion (ROM) was measured using a goniometer and volumetric measurements were taken to assess edema. Functional capacity was assessed using a hand dynamometer and the Duruöz Hand Index (DHI). All measurements were performed at baseline and after therapy. RESULTS: Significant improvements were achieved in spontaneous and neuropathic pain scores, edema, ROM, and functional capacity in both groups (p< 0.05). However, improvement was found to be significantly greater in group 1 regarding pain intensity, neuropathic pain assessed using LANNS, edema, and in the 2nd -3rd finger ROM measurements (p< 0.05). No significant difference was detected between groups regarding improvements in 4th -5th finger and wrist ROM measurements, grip strength, and DN4 and DHI scores (p> 0.05). CONCLUSION: The addition of TENS to the physical therapy program was seen to make a significant contribution to clinical recovery in CRPS Type 1. Show more

Keywords: Complex regional pain syndrome, transcutaneous electrical nerve stimulation, pain, functional capacity

DOI: 10.3233/BMR-160667

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 661-671, 2016

Authors: Ogston, Jena B. | Crowell, Richard D. | Konowalchuk, Brian K.

Article Type: Research Article

Abstract: BACKGROUND: Approaches in the treatment of general chronic low back pain (CLBP) are multifaceted relative to specific interventions. In the past, passive interventions have commonly been employed with little evidence to support their effectiveness. Recent reviews suggest a focus on active exercises programs that includes pain education and cognitive behavioral therapy. OBJECTIVE: To investigate the outcomes of CLBP patients and describe the approach in persons undergoing a group spinal rehabilitation program using graded exercise, and operant conditioning. METHODS: Adult patients with CLBP participated in a twice weekly 90 minute exercise sessions for 8-weeks …(n= 201). The program consisted of behavioral education, stretching, aerobic exercises, graded progressive resistance exercise, MedX isotonic strengthening, and functional bending lifting task exercises. RESULTS: A total of 201 patient records were evaluated where the overall ODI improvement was 13.2% (± 14.0) (p< 0.001). There were significant and clinically meaningful improvements in flexibility, VAS, functional lifting tasks (p< 0.001), and lumbar extension strength (p= 0.01) at 8-week follow-up. Questionnaires were delivered via mail with a 21% return rate revealed sustained improvements. CONCLUSION: CLBP patients undergoing an 8-week intensive exercise approach incorporating both behavioral and physical conditioning principles showed both significant and clinically significant improvements in this observational case series. Long-term benefits were also seen in both the 6 and 12 month follow-up questionnaires although further investigation is warranted due to limited survey return rate and study design. Show more

Keywords: Kinesiophobia, graded exercise, group therapy, Oswestry, operant conditioning, rehabilitation, chronic low back pain

DOI: 10.3233/BMR-160669

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 673-684, 2016

Authors: Babu, Ashwin N. | McCormick, Zachary | Kennedy, David J. | Press, Joel

Article Type: Research Article

Abstract: In the past two decades, the cost associated with managing low back pain has increased significantly. Improved consciousness of how clinicians utilize resources when managing low back pain is necessary in the current economic climate. The goal of this review is to examine the component costs associated with managing low back pain and provide practical solutions for reducing healthcare costs. This is accomplished by utilizing examples from a major metropolitan area with several major academic institutions and private health care centers. It is clear that there is considerable local and national variation in the component costs of managing low back …pain, including physician visits, imaging studies, medications, and therapy services. By being well informed about these variations in one's environment, clinicians and patients alike can make strides towards reducing the financial impact of low back pain. Investigation of the cost discrepancies for services within one's community of practice is important. Improved public access to both cost and outcomes data is needed. Show more

Keywords: Health expenditure, low back pain, delivery of health care

DOI: 10.3233/BMR-160670

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 685-692, 2016

Authors: Ekedahl, Harald | Jönsson, Bo | Annertz, Mårten | Frobell, Richard B.

Article Type: Research Article

Abstract: BACKGROUND: Transforaminal epidural steroid injection (TESI) is a frequently used intervention for lumbar radicular pain. OBJECTIVE: To evaluate the value of MRI findings, neurologic assessment and the Slump test (neurodynamic test) as predictors of treatment response to TESI. METHOD: One hundred subjects (mean age 58 [SD13], 54% females) were included in this trial. The sample was stratified by location of disc herniaton, grade of nerve root compression, clinically assessed neurologic deficit and positive Slump test. Treatment response was primarily evaluated by Visual Analogue Scale for leg pain after three weeks. Predictive value for …each stratum was analyzed using logistic regression after the sample was dichotomized into definite treatment response (≥ 50% reduction of pain) and negative response (≤ 0% reduction) to TESI (the 1-49% reduction group was excluded). RESULTS: The overall definite treatment response rate was 27%. The Slump test was the only predictor of the response to TESI (p= 0.031). The definite treatment response rates for subjects with positive and negative Slump test were 33% and 15%, respectively. CONCLUSION: In patients with chronic low back related leg pain, MRI findings and neurologic assessment results failed to predict treatment response, whereas a positive Slump test predicted the best 3-week response to TESI. Show more

Keywords: Lumbar radicular pain, transforaminal epidural steroid injection, predictive value of tests

DOI: 10.3233/BMR-160671

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 693-702, 2016

Authors: Batmaz, İbrahim | Sarıyıldız, Mustafa Akif | Çilesizoğlu, Nurçe | Karkucak, Murat | Yazmalar, Levent | Serdar, Ömer Faruk | Çapkın, Erhan | Nas, Kemal

Article Type: Research Article

Abstract: BACKGROUND: Psoriatic arthritis (PsA) is a common form of arthritis that may vary from asymmetric oligoarthritis to symmetric polyarthritis and spondyloarthritis. OBJECTIVES: To evaluate femoral cartilage thickness using ultrasonography in patients with PsA. METHODS: Thirty-three patients (24 female, 9 male) with a diagnosis of PsA and 31 age-, sex- and body mass index-similar healthy subjects were enrolled in this study. Demographic and clinical characteristics of the patients were recorded, including disease duration, morning stiffness and medications. The femoral cartilage thicknesses of both knees (while held in maximum flexion) were measured with a 7-12 …MHz linear probe. Three mid-point measurements were taken from both knees (at the lateral condyle, intercondylar area and medial condyle). RESULTS: Cartilage thicknesses were similar between PsA patients and healthy control subjects. However, there were significant correlations between cartilage thickness and the Maastricht Ankylosing Spondylitis Enthesitis Score, Bath AS functional index and Bath AS disease activity index scores. CONCLUSION: Femoral cartilage thickness is similar between PsA patients and healthy controls. The femoral cartilage thickness in PsA patients is associated with disease activity, functional inadequacy, and enthesopathy scores. Show more

Keywords: Psoriatic arthritis, femoral cartilage, thickness, ultrasound

DOI: 10.3233/BMR-160672

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 703-708, 2016

Authors: Forozeshfard, Mohammad | Bakhtiary, Amir Hoshang | Aminianfar, Atefeh | Sheikhian, Sajedeh | Akbarzadeh, Zeinab

Article Type: Research Article

Abstract: BACKGROUND: Menstrual low back pain (LBP) in young females can reduce daily activity and cause functional disability, while the progressive application of kinesio-taping (KT) on pain reduction and functional correction has been stated. OBJECTIVE: This study has been designed to investigate the efficacy of the lumbar vertebral column KT in young female with menstrual LBP. METHODS: Thirty-two young females with menstrual LBP participated in this crossover study and were assigned randomly in two separate groups. The first group received KT during their first menstrual cycle and No-KT in their next menstrual, while the …other group had no KT during the first mentrual cycle and received KT during the next menstrual cycle. The primary outcome measurements included the visual analogue scale (VAS) of pain, Oswestry disability index and McGill pain questionnaire score which were planned to collect at the end of the third day of the menstrual cycle. RESULTS: Comparing pain and disability between two conditions, of menstrual cycle with KT and menstrual cycle without KT, revealed significant reduction in VAS (mean change = 1.7; 95%CI = 0.6 to 2.8; P= 0.005), McGill pain score (mean change = 20.1; 95%CI = 8.7 to 31.3; P= 0.001) and functional disability (mean change = 12.3; 95%CI = 7.2 to 17.5; P< 0.0001) by using KT during menstrual cycle. CONCLUSIONS: Results showed that KT may effectively reduce pain and disability. The findings may support the clinical application of kinesiotaping in young females with menstrual LBP. Show more

Keywords: Kinesiotaping, low back pain, functional disability, menstrual cycle

DOI: 10.3233/BMR-160673

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 709-715, 2016

Authors: Kelle, Bayram | Evran, Mehtap | Ballı, Tugsan | Yavuz, Ferdi

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: To evaluate the correlations of the cross-sectional area (CSA) of peripheral nerves in diabetic peripheral neuropathy (DPN) patients based on ultrasound (US) with clinical and demographic characteristics. METHODS: A DPN patient group (n= 53) and a matched healthy control group (n= 53) underwent US imaging of the sciatic, tibial and median nerves. The CSAs of these nerves were recorded, and their associations with pain intensity according to the visual analog scale (VAS) score and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale score, diabetes mellitus (DM) duration, body mass index …(BMI), HbA1c level and blood glucose levels were evaluated. RESULTS: The CSAs of the examined nerves in diabetic patients were larger than those in healthy individuals (p< 0.05). No correlations were detected between the CSAs of the examined nerves and the parameters of interest (p> 0.05), including the VAS and LANSS pain scale scores (p= 0.32 and p= 0.31, respectively). CONCLUSIONS: US is a sensitive diagnostic technique for detecting DPN; however, it does not indicate disease severity. Show more

Keywords: Ultrasonography, diabetic peripheral neuropathy, cross-sectional area, body mass index, Leeds Assessment of Neuropathic Symptoms and Signs

DOI: 10.3233/BMR-160676

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 717-722, 2016

Authors: Aydın, Teoman | Taşpınar, Özgür | Sarıyıldız, M. Akif | Güneşer, Meryem | Keskin, Yasar | Canbaz, Nurayet | Gök, Murat | Camli, Adil | Kiziltan, Huriye | Eris, Ali H.

Article Type: Research Article

Abstract: OBJECTIVE: The aim of this study is to evaluate the effects of calisthenic exercises on functionality, mobility, disaese activity, quality of life, and psychological status in patients with Ankylosing spondylitis (AS). METHODS: Prospective analysis of forty patients diagnosed with AS were randomized into two exercise groups. AS patients having diagnosis based on 1984-modified New York criteria were involved. Patients were given 8 weeks calisthenic exercise program. Outcome measures including the Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI), AS Quality of Life Questionnaire (ASQoL), Bath AS Patient Global …Score (BAS-G) Hospital Anxiety Depression Score (HADS), erythrocyte sedimentation rate (ESR) and the serum C-reactive protein (CRP) levels were assessed at the baseline and at 8 weeks. RESULTS: Thirty-seven participants completed the exercise programme. After the 8-week exercise programme, the home-based exercise group showed significant improvement in ESR levels and hospital-based exercise group showed significant improvements in terms of the BASMI and HADS-A scores. CONCLUSION: Calisthenic exercises can be easily performed both at home and in hospital setting. In patients with AS, calisthenic exercises performed at the hospital may improve the mobility, and psychological status (anxiety). Show more

Keywords: Ankylosing spondylitis, calisthenic exercise, mobility, anxiety

DOI: 10.3233/BMR-160677

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 723-730, 2016

Authors: Lee, Ah Young | Baek, Seung Ok | Cho, Yun Woo | Lim, Tae Hong | Jones, Rodney | Ahn, Sang Ho

Article Type: Research Article

Abstract: BACKGROUND: Trunk muscle exercises are widely performed, and many studies have been performed to examine their effects on low back pains. However, the effect of trunk muscles activations during walking with pelvic floor muscle contraction (PFMC) and abdominal hollowing (AH) has not been clarified. OBJECT: To investigate whether walking with PFMC and AH is more effective for promoting local trunk muscle activation than walking without PFMC and AH. METHODS: Twenty healthy men (28.9 ± 3.14 years, 177.2 ± 4.25 cm, 72.1 ± 6.39 kg, body mass index 22.78 ± 2.38 kg/m2 ) …were participated in this study. Surface electrodes were attached over the multifidus (MF), lumbar erector spinae (LES), thoracic erector spinae (TES), transverse abdominus-internal oblique abdominals (TrA-IO), external oblique abdominals (EO), and rectus abdominus (RA). The amplitudes of electromyographic signals were measured during a normal walking with and without PFMC and AH. RESULT: PFMC and AH while walking was found to result in significant bilateral increases in the normalized maximum voluntary contraction (MVC) of MFs and TrA-IOs (p< 0.05). Ratios of local muscle activity to global muscle activities were increased while performing PFMC and AH during normal walking. Bilateral TrA-IO/EO activity ratios were significantly increased by PFMC and AH (p< 0.05). CONCLUSION: Performance of the PFMC and AH during walking resulted in significantly more recruitment of local trunk muscles. This study suggests that PFMC and AH during normal daily walking improves activation of muscles responsible for spinal dynamic stabilization and might be useful if integrated into low back disability and pain physical rehabilitation efforts. Show more

Keywords: Pelvic floor muscle contraction, abdominal hollowing, walking, local trunk muscle activation, surface electromyography, multifidus, transverse abdominus, internal oblique abdominals

DOI: 10.3233/BMR-160678

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 731-739, 2016

Authors: Schinkel-Ivy, Alison | Drake, Janessa D.M.

Article Type: Research Article

Abstract: BACKGROUND: While it is generally accepted that large breast sizes in females contribute to back pain and poor posture, the effects of breast size on spinal motion and muscle activation characteristics are poorly understood. OBJECTIVE: This study examined the relationship between breast size, spine motion, and trunk muscle activation. METHODS: Fifteen university-aged females, free of back pain symptoms, were tested. Breast sizes were calculated, and three-dimensional spine motion and activation from five trunk muscles bilaterally were measured during standing and trunk flexion movements. Correlations between breast size and motion and muscle activation measures …were assessed. RESULTS: Head and trunk angles were strongly, negatively correlated to breast size during upright standing; thoracic angles were moderately, positively correlated to breast size during thoracic flexion movements. Trunk muscles showed positive, moderate-strength relationships with breast size during upright standing and some trunk movements. CONCLUSIONS: These findings provide a preliminary indication that increasing breast sizes are associated with altered postures and increased muscle activation in a non-clinical population, and constitute a baseline for the study of females with a full range of breast sizes. Further research is required to confirm the generalizability of these findings to other sizes, in order to inform strategies for the prevention or reduction of back pain, as well as diagnosis, treatment, and rehabilitation techniques associated with breast size and back pain. Show more

Keywords: Breast size, spine motion, spine posture, trunk muscle activation

DOI: 10.3233/BMR-160680

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 741-748, 2016

Authors: Taghipour-Farshi, Hamed | Frounchi, Javad | Ahmadiasl, Nasser | Shahabi, Parviz | Salekzamani, Yaghoub

Article Type: Research Article

Abstract: BACKGROUND: Nerve cuff electrodes provide a safe technique for recording nerve signals. Defining a more realized modeling to investigate the selectivity of a cuff electrode in recording from peripheral nervous system is an interesting field of research. METHODS: A four-contact cuff electrode was modeled to evaluate selective recording from a peripheral nerve. Fitzhugh-Nagumo equations were used to model the electromagnetic fields generated by active nerves and electrodes and the ``selectivity index'' used to quantify the selective property of the cuff electrode. RESULTS: The action potentials amplitude and impulse velocity generated by Fitzhugh-Nagumo model …are similar to real-life nerve measurements according to the literature. The electrical field distribution caused by the impulse propagation along a specific nerve was the maximum near the corresponding contact. Also, the selectivity was increased with increasing the distance between the active sources and the number of contacts. CONCLUSION: The results of this research showed that Fitzhugh-Nagumo equations could model the nerve excitation accurately and could be used in computer simulation for studying nervous systems. Also, using these equations indicated that multi-contact cuff electrodes could be used in recording peripheral nerve signals in order to discriminate active fascicles in a nerve bundle. Show more

Keywords: Cuff electrode, selective electrical stimulation, tripolar configuration, Fitzhugh-Nagumo

DOI: 10.3233/BMR-160684

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 749-756, 2016

Authors: Gong, Wontae

Article Type: Research Article

Abstract: BACKGROUND: Based on previous studies indicating that core stabilization exercises accompanied by abdominal drawing-in maneuvers increase the thickness of the transversus abdominis muscle. OBJECTIVE: The purpose of this study was to compare the measurements of abdominal muscle thicknesses during running in place in a limited area with the abdominal drawing-in maneuver. METHODS: The study classified the subjects into two experimental groups: the training group (M = 2, F = 13), and the control group (M = 2, F = 13). The training group performed three sets of running in place in a limited …area with abdominal drawing-in maneuvers each time, three times a week for six weeks. The abdominal muscle thicknesses of the subjects were measured using ultrasonography. RESULTS: Comparing the training group's abdominal muscle thickness before and after this study, there was a statistical significance in all of the external obliquus abdominis, the internal obliquus abdominis, and the transversus abdominis. In particular, thicknesses of external obliquus abdominis and internal obliquus increased remarkably. CONCLUSIONS: Running in place in a limited area accompanied by abdominal drawing-in maneuvers increased the thickness of the deep abdominal muscles that are the basis of trunk stabilization. Show more

Keywords: Running in place in a limited area, abdominal drawing-in maneuver, abdominal muscle thickness

DOI: 10.3233/BMR-160686

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 757-762, 2016

Authors: Muaidi, Qassim I. | Shanb, Alsayed Abdelhameed

Article Type: Research Article

Abstract: BACKGROUND: Physical therapists are particularly vulnerable to work-related musculoskeletal disorders (WRMDs). OBJECTIVE: To evaluate the prevalence, causes and impact of WRMDs among physical therapists in the Kingdom of Saudi Arabia (KSA). METHODS: A cross-sectional study of physical therapists using a valid and reliable questionnaire. A total of 690 completed surveys were returned (response rate = 69%). The T-test and Pearson's correlation were used to identify correlations between variables and the incidence of WRMDs. RESULTS: Working hours/week and WRMDs were significantly correlated (p = 0.005). Lower back (46.5%) and …neck (26.6%) pain were most commonly encountered. WRMDs were significantly correlated with altered work habits (p = 0.036) but not with body mass index (p = 0.297). The prevalence of WRMDs among physical therapists was 47.7% with a significant difference between full- and part-time practice (p = 0.023). Adjustable beds/plinths (20%) and splints (18%) were the most commonly used assistive devices. CONCLUSIONS: Physical therapists are especially vulnerable to WRMDs with a prevalence of 47.7%. WRMDs are impacted by both work status and setting. Low back pain is the most common form of WRMDs (46.5%). Avoidance of poor work habits, increased ergonomic awareness and application of safety measures are essential to prevent WRMDs. Show more

Keywords: Prevalence work related disorders, physical therapy, safety strategies

DOI: 10.3233/BMR-160687

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 763-769, 2016

Authors: Karavelioglu, Ergun | Kacar, Emre | Gonul, Yucel | Eroglu, Mehmet | Boyaci, Mehmet Gazi | Eroglu, Selma | Unlu, Ebru | Ulasli, Alper Murat

Article Type: Research Article

Abstract: OBJECTIVE: Degenerative changes in posterior elements of the spine such as thickening or hypertrophy of the ligamentum flavum (LF) may result in spinal stenosis. In the present study, we aimed to investigate the potential factors including age, intervertebral disc degeneration (IDD), facet joint degeneration (FJD), end plate degeneration (EPD), which may affect LF thickening and to reveal the relationship among those factors at each level of lumbar spine by evaluating the magnetic resonance images (MRI). METHODS: A total of 200 individuals with low back and/or leg pain complaints who had undergone lumbar MRI were included …in this study. The thickness of LF, FJD, IDD and EPD were assessed at all lumbar levels. RESULTS: Totally 1000 end plates, 1000 intervertebral discs and 2000 facet joints were evaluated and the thicknesses of 2000 LFs were measured from MRI images of 200 patients (100 males and 100 females). The mean age was 46.87 ± 12.47 years. LF thickness was strongly associated with FJD especially on the ipsilateral side. Age and IDD were correlated at whole vertebral levels. The age related changes (LF thickness, FJD, IDD and EPD) were more prominent at L4-L5 vertebral level. However, gender had no effect on LF thickness. CONCLUSION: The results of this study suggest that LF thickening may occur independently or could be associated with FJD especially on the ipsilateral side and this relationship is due to the vertebral level. The degree of disc degeneration increases with age and age related changes may be predominantly observed at L4-L5 vertebral level. Show more

Keywords: Ligamentum flavum, facet joint, intervertebral disc, end plate degeneration, MRI

DOI: 10.3233/BMR-160688

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 771-777, 2016

Authors: Ekim, Ayşe Aydemir | İnal, Esra Erkol | Gönüllü, Emel | Hamarat, Hatice | Yorulmaz, Göknur | Mumcu, Gamze | Yılmazer, Şebnem | Kaya, Dilek Serin | Kuzgun, Selen | Çolak, Ertuǧrul | Orhan, Hikmet

Article Type: Research Article

Abstract: BACKGROUND : The aim of this study was to clarify the effects of continuous passive motion (CPM) treatment on adhesive capsulitis (AC) in diabetes mellitus (DM) patients. METHODS: Forty-one DM patients with AC were randomized to two treatment groups. The first group (n= 20) (CPM group) received CPM treatments; the second group (n= 21) had conventional physical therapy (CPT group), including active stretching, range of motion (ROM) and pendulum exercises. All patients received electrotherapy. After a four-week-long physical therapy program, the patients were instructed to continue with an eight-week home exercise program. The patients rated the pain …they felt at night, both while at rest and in motion, in the past week using the visual analogue scale (VAS). Functional outcome evaluations were performed using the Constant Shoulder Score (CSS) and Shoulder Pain and Disability Index (SPADI). All patients were evaluated at baseline, and during the fourth and twelfth weeks of the study. RESULTS: There were significant improvements in both groups' active and passive ROM for the shoulder, VAS measures, SPADI pain and disability scores and CSS, and excluding the active and passive internal and external rotation of shoulder increased with both treatment methods (CPM or CPT) over time (p< 0.001), however these differences were found to be prominent in patients receiving CPM therapy. CONCLUSIONS: Both the CPM and CPT therapies seemed to be beneficial for the treatment of AC in DM patients, however CPM revealed more distinctive improvements in the function and pain levels of the AC patients. Show more

Keywords: Shoulder pain, frozen shoulder, continuous passive motion, physical therapy

DOI: 10.3233/BMR-160689

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 779-786, 2016

Authors: Muaidi, Qassim I.

Article Type: Research Article

Abstract: BACKGROUND: Knee proprioception in the sagittal plane has been widely investigated in prospective studies, however limited information is known about proprioceptive acuity during active knee rotation and the way most commonly injured. OBJECTIVE: To investigate whether proprioceptive acuity during active internal and external knee rotation varies at different ranges in the transverse plane. METHODS: Healthy volunteers (N: 26) without previous injury or surgery of the knee joint participated in the study.Knee rotation proprioceptive acuity was measured using a custom-designed device. The measure of proprioceptive acuity used in this study was the just-noticeable-difference (JND). …Participants actively rotated the knee at different intervals(initial, mid, and terminal internal or external rotation range) to one of four movement blocks and the magnitude of the permitted motion was judged. RESULTS: The means of the JND for proprioceptive acuity at initial internal rotation (0.80° ± 0.06) were significantly (p< 0.002) lower than for mid (1.62° ± 0.18), and terminal (2.08° ± 0.35) internal rotation. The means of the JND for proprioceptive acuity at initial external rotation (1.16° ± 0.10) were significantly (p< 0.04) lower than for mid (1.95° ± 0.30), and terminal (1.97° ± 0.24) internal rotation. CONCLUSIONS: Participants perceived smaller differences between active internal and external rotation movements at initial rotation range than at the mid and terminal rotation range of movement. This suggests better proprioceptive acuity at the initial rotation range of movement in the transverse plane. Show more

Keywords: Proprioception, knee, JND, range intervals

DOI: 10.3233/BMR-160690

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 787-794, 2016

Authors: Tsunoda, Kenji | Mutsuzaki, Hirotaka | Hotta, Kazushi | Tachibana, Kaori | Shimizu, Yukiyo | Fukaya, Takashi | Ikeda, Eiji | Wadano, Yasuyoshi

Article Type: Research Article

Abstract: OBJECTIVE: To reveal correlates of shoulder pain in wheelchair basketball players from the Japanese national team. METHODS: Study participants were 19 males (29.7 ± 5.2 years) and 21 females (29.0 ± 8.2 years) players. We assessed shoulder pain using the wheelchair user's shoulder pain index (WUSPI). As potential correlates of shoulder pain, age, ability class, practice time and years of experience in wheelchair basketball were collected. RESULTS: The total WUSPI score for men (16.18 ± 17.39 points) was significantly higher than that for women (8.62 ± 15.70 points). In …men, higher age was significantly correlated with greater shoulder pain for total WUSPI score and on two WUSPI items. Lower ability in wheelchair basketball was correlated with men's greater shoulder pain on three WUSPI items. In men, there were also significant correlations between longer years of experience and greater shoulder pain for total WUSPI score and on three WUSPI items. For women, there were significant correlations between longer practice time and less pain for total WUSPI score and on four WUSPI items. CONCLUSIONS: Because top male wheelchair basketball players have a higher risk of shoulder pain than female players, daily care of shoulder and periodic medical checkups are needed, especially for older male players with lower ability and more experience. Show more

Keywords: Shoulder pain, wheelchair user's shoulder pain index, disability, athlete, wheelchair sports

DOI: 10.3233/BMR-160691

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 795-800, 2016

Authors: Yazmalar, Levent | Sarıyıldız, Mustafa Akif | Batmaz, İbrahim | Alpaycı, Mahmut | Burkan, Yahya Kemal | Özkan, Yasemin | Okçu, Mehmet | Çevik, Remzi

Article Type: Research Article

Abstract: BACKGROUND: Subacromial impingement syndrome (SIS) is characterized by pain and disability of shoulder. Various treatment methods have been used for SIS. OBJECTIVES: The aim of our study was to evaluate efficacy of therapeutic ultrasound (US) on pain, disability, anxiety, depression, sleep quality and quality of life in patients with SIS. METHODS: Patients with SIS were randomly divided into two groups, including the group 1 (continuous US group; 3 MHz, 1.5 W/cm2 , n = 26) and group 2 (sham US group, n = 24). Additionally, transcutaneous electrical nerve stimulation (TENS) + exercise program …were added in both groups. Pain and disability of the shoulder were assessed by the Shoulder Pain and Disability Index (SPADI), while anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Quality of life was evalutaed by the Nottingham Health Profile (NHP). Patients were evaluated at baseline and after end of three weeks. RESULTS: Both groups had significantly improvements in terms of SPADI-pain, SPADI-disability, SPADI-total, NHP-pain and NHP-sleep scores after the three weeks interventions. There were significantly improvements in the Group 1 in terms of PSQI-total, and NHP-physical activity. Group 2 had significantly improvements in terms of anxiety-HADS, depression-HADS and NHP-emotional reaction scores. In the inter-group comparison, there were no significantly differences in the change scores were observed in any domains of SPADI scores, anxiety, depression and sleep scores, or any NHP scores. CONCLUSIONS: Our study showed that US does not have any benefits on SIS. TENS + exercise program are not effective on anxiety, depression and fatigue, however TENS +$ exercise program are effective on pain, disability and sleep disturbance in patients with SIS. Show more

Keywords: Ultrasound, subacromial impingement, anxiety, depression, sleep

DOI: 10.3233/BMR-160692

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 801-807, 2016

Authors: Lee, Ji-Hyun | Cynn, Heon-Seock | Yoon, Tae-Lim | Choi, Sil-Ah | Kang, Tae-Woo

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVES: Excessive activity of the tibialis anterior muscle may be a causal mechanism in overuse injuries such as stress fracture in pes planus patients. However, information about this relationship is limited. In this study, we compared the angle of the medial longitudinal arch, the activities of the abductor hallucis and tibialis anterior muscles, and the activity ratio of tibialis anterior/abductor hallucis in individuals with pes planus and those with a neutral foot position during short-foot exercises conducted while sitting. METHODS: Differences between the groups were analyzed using an independent t-test. In all, 28 university …students participated in this study (14 subjects in each group). RESULTS: The activity of the abductor hallucis muscle was significantly lower (p < 0.001), and the activity ratio of tibialis anterior/abductor hallucis was significantly greater (p = 0.012) in the pes planus group than in the neutral foot group during the exercise. CONCLUSIONS: Clinicians should recognize that pes planus patients may compensate for reduced activation of the abductor hallucis to maintain the angle of the medial longitudinal arch during the sitting short-foot exercise. Show more

Keywords: Abductor hallucis, pes planus, short-foot exercise, tibialis anterior

DOI: 10.3233/BMR-160693

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 809-815, 2016

Authors: Yildirim, Adem | Sürücü, Gülseren Dost | Karamercan, Ayşe | Gedik, Dilay Eken | Atci, Nermin | Dülgeroǧlu, Deniz | Özgirgin, Neşe

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVES: A number of exercises to strengthen the upper extremities are recommended to increase functional independence and quality of life (QoL) in patients with paraplegia. Circuit resistance training (CRT) is a type of progressive resistive exercise performed repeatedly at fixed mechanical exercise stations. The aim of this study was to investigate the potential benefits of CRT for upper extremity muscle strength, functional independence, and QoL in patients with paraplegia. MATERIALS AND METHODS: Twenty-six patients with paraplegia who were participating in a conventional rehabilitation program at a tertiary education and research hospital were enrolled in …this study. The participants were randomly assigned to two groups. The exercise group participated in the CRT program, which consisted of repetitive exercises for the upper extremities performed at fixed mechanical stations 5 sessions per week for 6 weeks, in addition to conventional rehabilitation. Participants in the control group received only conventional rehabilitation over the same period. We compared the groups with respect to QoL, as well as isokinetic muscle test outcomes in the upper extremities, using the Functional Independence Measure (FIM) and Borg's scale. RESULTS: We observed significant increases in scores on the physical component of the FIM, Borg's scale, and QoL in both the exercise and control groups. Furthermore, the large majority of isokinetic values were significantly more improved in the exercise group compared to the control group. When post-treatment outcomes were compared between the groups, improvements in scores on the physical component of the FIM and in most isokinetic values were significantly greater in the exercise group. CONCLUSIONS: This study showed that CRT has positive effects on muscle strength in the upper extremities and the physical disability components of the FIM when added to conventional rehabilitation programs for paraplegic patients. However, we observed no significant improvement in QoL scores after adding CRT to a conventional treatment regime. LEVEL OF EVIDENCE: Randomized trial (Level II) Show more

Keywords: Circuit resistance training, upper extremities, paraplegia, isokinetic tests

DOI: 10.3233/BMR-160694

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 817-823, 2016

Authors: Wirth, B. | Ferreira, T. Duarte | Mittelholzer, M. | Humphreys, B.K. | Boutellier, U.

Article Type: Research Article

Abstract: BACKGROUND: Patients with chronic neck pain show also respiratory dysfunctions. OBJECTIVE: To investigate the effects of respiratory muscle endurance training (RMET) on chronic neck pain. METHODS: In this pilot study (single-subject design: 3 baseline measurements, 4 measurements during RMET), 15 neck patients (49.3 ± 13.7 years; 13 females) conducted 20 sessions of home-based RMET using a SpiroTiger® (normocapnic hyperpnoea). Maximal voluntary ventilation (MVV), maximal inspiratory (Pimax ) and expiratory (Pemax ) pressure were measured before and after RMET. Neck flexor endurance, cervical and thoracic mobility, forward head posture, chest wall expansion …and self-assessed neck disability [Neck Disability Index (NDI), Bournemouth questionnaire] were weekly assessed. Repeated measure ANOVA (Bonferroni correction) compared the first and last baseline and the last measurement after RMET. RESULTS: RMET significantly increased MVV (p= 0.025), Pimax (p= 0.001) and Pemax (p< 0.001). During RMET, neck disability significantly decreased (NDI: p= 0.001; Bournemouth questionnaire: p= 0.002), while neck flexor endurance (p< 0.001) and chest wall expansion (p< 0.001) increased. The changes in respiratory and musculoskeletal parameters did not correlate. CONCLUSIONS: RMET emerged from this pilot study as a feasible and effective therapy for reducing disability in patients with chronic neck pain. The underlying mechanisms, including blood gas analyses, need further investigation in a randomized controlled study. Show more

Keywords: Neck pain, respiratory dysfunction, respiratory muscle endurance training

DOI: 10.3233/BMR-160695

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 825-834, 2016

Authors: Tanik, Nermin | Balbaloğlu, Özlem | Ucar, Mehmet | Sarp, Umıt | Atalay, Tugay | Çelikbilek, Asuman | Göçmen, Ayşe Yeşim | Inan, Levent Ertugrul

Article Type: Research Article

Abstract: OBJECTIVE: Vitamin D deficiencies are associated with a variety of chronic diseases. The goal of the present study was to investigate the relationship between vitamin D levels and carpal tunnel syndrome (CTS). METHODS: This study included 90 patients with mild to moderate CTS and assessed their routine serum 25-hydroxyvitamin D levels. Additionally, the pain level of each subject was evaluated using the Visual Analogue Scale and the Douleur Neuropathique 4 Questionnaire (DN4). RESULTS: The severity levels of CTS were at a 75% mild level in the vitamin D deficiency group and a 47.1% …mild level in the vitamin D normal group, with a significant difference between groups (p = 0.008). Correlation analyses revealed positive correlations between body mass index and DN4 scores (r = 0.499, p = 0.025) and between vitamin D levels and CTS severity (r = 0.364, p = 0.004) in the vitamin D deficiency group. CONCLUSIONS: The present findings demonstrated that CTS may be triggered by vitamin D deficiency, and that the severity of CTS was correlated with vitamin D levels in the deficiency group. Additionally, there was a correlation between weight gain and neuropathic pain intensity in CTS patients with vitamin D deficiency. The present findings indicate that vitamin D levels should be assessed in CTS patients. Show more

Keywords: 25-Dihydroxyvitamin, carpal tunnel syndrome, neuropathic pain

DOI: 10.3233/BMR-160696

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 835-839, 2016

Authors: Onat, Şule Şahin | Malas, Fevziye Ünsal | Öztürk, Gökhan Tuna | Ekiz, Timur | Akkaya, Nuray | Özbudak Demir, Sibel | Kara, Murat

Article Type: Research Article

Abstract: OBJECTIVE: To compare the distal femoral cartilage thickness of the non-amputee sides in patients who had unilateral transfemoral amputation with those of healthy subjects by using ultrasound. METHODS: Thirty transfemoral amputees (27 male, 3 female) and 30 age-, sex-, and body mass index-matched healthy controls were included. Functional usage of the prosthesis was evaluated by using Houghton score. The cartilage thickness was measured from the following midpoints; medial femoral condyle (MFC), intercondylar area, and lateral femoral condyle. RESULTS: Thirty patients with unilateral transfemoral amputation (mean age; 38.6 ± 9.5 years) and 30 healthy …controls (mean age; 38.4 ± 9.4 years) were included. Although femoral cartilage thicknesses were found to be lower for all measurements in the amputees, the difference reached significance only in the MFC (p= 0.031). In the patient group, cartilage thickness values did not correlate with age, duration of amputation, daily walking time, stump length or Houghton score. CONCLUSION: The distal femoral cartilage thickness seems to be decreased medially on the non-amputee sides of the transfemoral amputees when compared with the healthy subjects. Further studies concerning the follow-up designs, functional parameters and osteoarthritis scales are awaited. Show more

Keywords: Femoral cartilage, ultrasound, transfemoral amputation, medial femoral condyle

DOI: 10.3233/BMR-160697

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 841-844, 2016

Authors: Tekin, Ali Çağrı | Çakar, Murat | Esenyel, Cem Zeki | Adaş, Müjdat | Bayraktar, Mehmet Kürşad | Özcan, Yusuf | Saygılı, Mehmet Selçuk | Tekin, Zeynep Nilüfer

Article Type: Research Article

Abstract: BACKGROUND: Soft tissue injuries may co-occur with tibial plateau fractures. These injuries may include medial or lateral ligament ruptures, peroneal nerve lesions, anterior cruciate ligament ruptures, and meniscus tears. OBJECTIVE: The aim of this study was to investigate the frequency of meniscus tears in lateral tibial plateau fractures and to evaluate the clinical and radiological results of meniscus repairs. MATERIALS AND METHOD: The study included 19 patients who underwent surgery for a closed lateral tibial plateau fracture. Anteroposterior and lateral radiographs of the knee, followed by magnetic resonance imaging (MRI) examinations, were undertaken …for all cases. The clinical and radiological evaluation of the surgical treatment results was performed according to the Rasmussen criteria. RESULTS: Meniscus lesions were found in 10 (52.6%) patients. Nine meniscus tears were found in patients with type 2 fractures, and one meniscus tear was found in a patient with a type 3 fracture. All of the menisci were separated from the peripheral capsule adhesion point. On the MRI examination during follow-up, all of the repaired lateral menisci were determined to be in their original anatomic location. CONCLUSION: For successful outcomes in lateral plateau fractures, it is essential to determine whether there is a meniscus tear. In cases with meniscus tears, meniscus repair can be easily performed and should be considered because it has a positive impact on the treatment outcome. Show more

Keywords: Knee joint, intra-articular fractures, menisci, tibial

DOI: 10.3233/BMR-160698

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 845-851, 2016

Authors: Dilek, Banu | Batmaz, Ibrahim | Sarıyıldız, Mustafa Akif | Sahin, Ebru | Ilter, Leman | Gulbahar, Selmin | Cevik, Remzi | Nas, Kemal

Article Type: Research Article

Abstract: BACKGROUND: Lateral epicondylitis (LE) is a painful condition that affects the tendinous tissue of the lateral epicondyle of the humerus and leads to loss of function of the affected limb. Therefore it can have a major impact on the patient's social and personal life. Many treatments are recommended for lateral epicondylitis; unfortunately the evidence is limited. OBJECTIVES: The aim of study was to investigate the effect of kinesio taping (KT) on pain, grip strength and function in patients LE. METHODS: Thirty-one (23 females, 8 males) patients with LE were included. KT was applied …twice a week for 2 weeks. Pain at rest, activity of daily living (ADL), night and palpation on lateral epicondyle was evaluated with the visual analog scale (VAS 0-10 cm), and the grip strength was measured with a hand held dynamometer. The stage of the disease was evaluated by the Nirschl score and the functional status was assessed with Patient-Rated Forearm Evaluation Questionnaire (PRTEQ) score. These parameters were evaluated before, at 2 weeks and 6 weeks after treatment. Patients' satisfaction was also recorded on a Likert scale after treatment at 2 weeks and 6 weeks. RESULTS: The average age of the patients was 43.58 ± 9.02. The dominant limb was affected in 64.5% (20) of the patients. After the application of KT on lateral epicondyle, there was a significant improvement in all parameters in terms of pain, Nirschl score, hand grip strength, patient satisfaction, and PRTEQ scores at 2 and 6 weeks. CONCLUSIONS: Kinesio taping can be an effective treatment method in LE. This application improves pain, grip strength and functional status of the patients with LE. Show more

Keywords: Lateral epicondylitis, Kinesio taping, functional status, treatment

DOI: 10.3233/BMR-160701

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 853-858, 2016

Authors: Movahhed, Taraneh | Dehghani, Mahboobe | Arghami, Shirazeh | Arghami, Afarin

Article Type: Research Article

Abstract: BACKGROUND: Dentists are susceptible to Musculoskeletal Disorders (MSDs) due to prolonged static postures. To prevent MSDs, working postures of dental students should be assessed and corrected in early career life. OBJECTIVE: This study estimated the risk of developing musculoskeletal disorders in dental students using Rapid Upper Limb Assessment (RULA) tool. METHODS: A number of 103 undergraduate dental students from fourth and fifth academic years participated. Postures of these students were assessed using RULA tool while working in the dental clinic. They also answered a questionnaire regarding their knowledge about postural dental ergonomic principles. …RESULTS: The majority of the students (66%) were at intermediate and high risk levels to develop MSDs and their postures needed to be corrected. There was no significant correlation between RULA score and gender, academic year and different wards of dental clinics. There was no significant correlation between knowledge and RULA scores. CONCLUSIONS: Dental students did not have favorable working postures. They were at an intermediate to high risk for developing MSDs which calls for a change in their working postures. Therefore students should be trained with ergonomic principles and to achieve the best results, ergonomic lessons should be accompanied by practice and periodical evaluations. Show more

Keywords: Dentistry, RULA, posture, ergonomics, musculoskeletal disorders

DOI: 10.3233/BMR-160702

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 859-864, 2016

Authors: Han, Hyun-Il | Choi, Ho-Suk | Shin, Won-Seob

Article Type: Research Article

Abstract: BACKGROUND: Hamstring tightness induces posterior pelvic tilt and decreased lumbar lordosis, which can result in low back pain OBJECTIVE: We investigated effects of hamstring stretch with pelvic control on pain and work ability in standing workers. METHODS: One hundred adult volunteers from a standing workers were randomly assigned to pelvic control hamstring stretching (PCHS) (n = 34), general hamstring stretching (GHS) (n = 34), control (n = 32) groups. The control group was performed self-home exercise. All interventions were conducted 3 days per week for 6 weeks, and included in the hamstring stretching …and lumbopelvic muscle strengthening. Outcomes were evaluated through the visual analog scale (VAS), straight leg raise test (SLR), sit and reach test (SRT), Oswestry disability index (ODI), and work ability index (WAI). RESULTS: Significant difference in VAS, SLR, SRT, ODI, and WAI were found in the PCHS and GHS groups. The control group was a significant difference only in ODI. The PCHS group showed a greater difference than the GHS group and control group in VAS, SLR, SRT, and ODI. CONCLUSIONS: The pelvic control hamstring stretch exercise would be more helpful in back pain reduction and improvement of work ability in an industrial setting. Show more

Keywords: Hamstring stretch, pelvic control, low back pain, work ability, standing worker, industrial worker

DOI: 10.3233/BMR-160703

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 865-871, 2016

Authors: Alderighi, Marzia | Ferrari, Raffaello | Maghini, Irene | Del Felice, Alessandra | Masiero, Stefano

Article Type: Research Article

Abstract: BACKGROUND: Radiographic examination is the gold standard to evaluate spine curves, but ionising radiations limit routine use. Non-invasive methods, such as skin-surface goniometer (IncliMed® ) should be used instead. OBJECTIVE: To evaluate intra- and interrater reliability to assess sagittal curves and mobility of the spine with IncliMed® . METHODS: a reliability study on agonistic football players. Thoracic kyphosis, lumbar lordosis and mobility of the spine were assessed by IncliMed® . Measurements were repeated twice by each examiner during the same session with between-rater blinding. Intrarater and interrater reliability were measured by Intraclass Correlation …Coefficient (ICC), 95% Confidence Interval (CI 95%) and Standard Error of Measurement (SEM). RESULTS: Thirty-four healthy female football players (19.17 ± 4.52 years) were enrolled. Statistical results showed high intrarater (0.805-0.923) and interrater (0.701-0.886) reliability (ICC > 0.8). The obtained intra- and interrater SEM were low, with overall absolute intrarater values between 1.39° and 2.76° and overall interrater values between 1.71° and 4.25°. CONCLUSIONS: IncliMed® provides high intra- and interrater reliability in healthy subjects, with limited Standard Error of Measurement. These results encourage its use in clinical practice and scientific research. Show more

Keywords: Spine mobility, non-invasive spinal sagittal curves measure, reliability, Intraclass Correlation Coefficient, Standard Error of Measurement

DOI: 10.3233/BMR-160704

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 873-880, 2016

Authors: Dıraçoğlu, Demirhan | Tunçay, Tuğba Baysak | Şahbaz, Tuğba | Aksoy, Cihan

Article Type: Research Article

Abstract: OBJECTIVE: The purpose of this study was to compare the effectiveness of three injections of standard linear HA versus single injection of lightly cross-linking HA in patients with knee OA. METHODS: Forty subjects were randomized into two groups. The first group received single dose intraarticular injection of 4 ml lightly cross-linking sodium hyaluronate (Monovisc), and the second group received three consecutive intraarticular injections of 2.5 ml standard linear sodium hyaluronate (Adant) with one week intervals. Visual analog scale (VAS)-pain and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores were measured. RESULTS: In …both groups, VAS-pain and WOMAC scores (except WOMAC-stiffness) were improved statistically lasting up to the 6th month with respect to before injection values (p< 0.001). There were no statistical differences in VAS-pain and WOMAC scores after injections (p> 0.05) in both groups. But in the 6th month visit, VAS-resting values were found to be statistically improved in standard linear HA group compared to lightly cross-linking HA group (p< 0.05). CONCLUSION: Although three-dose administration was significantly superior to single-dose at the sixth month, current knowledge is not sufficient to decide whether single-dose or multiple-dose HA injection should be chosen. There is a clear need for verification of our results with long-term studies on larger patient groups. Show more

Keywords: Hyaluronan, intraarticular injection, knee osteoarthritis

DOI: 10.3233/BMR-160714

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 881-886, 2016

Authors: Tsigkanos, Christos | Gaskell, Lynne | Smirniotou, Athanasia | Tsigkanos, Georgios

Article Type: Research Article

Abstract: BACKGROUND: According to previously conducted studies, people with Low Back Pain (LBP) present with static balance deficiencies. OBJECTIVE: The aim of the present study was to compare static, as well as dynamic balance ability between Chronic Low Back Pain (CLBP) and healthy subjects. METHODS: The CLBP group comprised 17 subjects and the control group of 16 subjects, matched for age, BMI and gender. The protocol applied compared the balance ability when performing the Star Excursion Balance Test (SEBT) and the static 1-leg stance position. The innovation introduced in the protocol was that the …participants performed not only the static 1-leg stance, but also the dynamic SEBT on a force plate which recorded the target sway (TS), i.e. the Center of Pressure (CoP) excursion. RESULTS: The CLBP group had significantly reduced performance in SEBT, coupled with greater static and dynamic TS values. Age and especially BMI also bear a significant effect on SEBT execution. The inclusion of SEBT and TS derived scores in a stepwise logistic regression equation lead to the correct classification of 85% of the subjects. CONCLUSIONS: Dynamic and static balance ability provide supplementary information for the identification of the presence of CLBP, with dynamic balance being more instrumental. Show more

Keywords: Proprioception, Star Excursion Balance Test, body sway

DOI: 10.3233/BMR-160721

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 887-893, 2016

Authors: Ahiskalioglu, Elif Oral | Alici, Haci Ahmet | Dostbil, Aysenur | Celik, Mine | Ahiskalioglu, Ali | Aksoy, Mehmet

Article Type: Case Report

Abstract: BACKGROUND : Myofascial pain syndrome is defined as ``pain and/or autonomic phenomena referred from active myofascial trigger points''. Trigger point injection is an effective treatment option, which is widely used to treat myofascial pain. Trigger point injection in the cervicothoracic regions can be associated with pneumothorax. CASE: In this paper, we presented a patient who developed pneumothorax after trigger point injection. RESULT: This case report indicates there is a risk of pneumothorax during trigger point injection in the cervicothoracic regions.

Keywords: Myofascial pain syndrome, pneumothorax, trigger point injection, complication

DOI: 10.3233/BMR-160666

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 895-897, 2016

Authors: Macaluso, Steven | Ross, Douglas C. | Doherty, Timothy J. | Doherty, Christopher D. | Miller, Thomas A.

Article Type: Case Report

Abstract: BACKGROUND: Spinal accessory nerve (SAN) injury can be an overlooked cause of scapular winging and shoulder dysfunction. The most common etiology is iatrogenic injury following surgical procedures at the posterior triangle of the neck. We present three cases of isolated injury to the SAN following trauma. OBJECTIVE: To improve detection of SAN injuries through highlighting the clinical presentation, diagnosis and treatment via three cases in which the injuries were initially missed. METHODS: Clinical case series and narrative review. RESULTS: Three (3) patients were evaluated by history, physical exam and electrodiagnostic …study (EMG). Clinical symptoms included, a painful, droopy shoulder and difficulties with overhead activities. Clinical signs included the observation of scapular winging, and focal atrophy of the trapezius and in some cases the sternocleidomastoid (SCM). Novel clinical signs such as the active elevation lag sign and triangle sign were also helpful clinically to highlight the SAN as the site of pathology. EMG revealed denervation and reduced motor unit recruitment in the trapezius and SCM. CONCLUSIONS: Early detection of SAN injuries can be improved through appropriate clinical suspicion, a detailed history and careful physical exam. EMG testing can help guide prognosis, direct conservative and surgical treatment, and reduce patient morbidity. Show more

Keywords: Nerve, trauma, injury, shoulder

DOI: 10.3233/BMR-160674

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 899-904, 2016

Authors: Fysentzou, Christodoulos

Article Type: Case Report

Abstract: BACKGROUND: Latissimus dorsi, grade III tendon tears are an uncommon injury. There are very few cases reported in the literature, but most importantly, no cases could be found that relate to soccer. OBJECTIVE: To present a successful, non-operative rehabilitation program for a professional athlete, after a grade III latissimus dorsi tear. CASE DESCRIPTION: A 37 year old healthy, elite professional soccer goalkeeper was injured during a championship game. The athlete fell on his left side with an outstretched and externally rotated upper extremity in order to catch a ball that was going very …close to the left pole of his goal-post. After on-field and off-field clinical examinations, the diagnosis was a left latissimus dorsi tendon tear which was later confirmed by MRI as a grade III tear. INTERVENTION: During the first two weeks, intervention consisted of anti-inflammatory treatment and light therapeutic exercises. As the pain was subsiding and the strength was returning, the treatment shifted to purely strengthening and functional training. RESULTS: Four weeks after the injury, the athlete presented with pain 0/10 in all functional activities and full ROM in both active and passive movements. Before discharge, the athlete underwent a sport specific training program, without any complains, that cleared him to participate in normal training with the rest of the team. Three months after the injury the strength of the player's left shoulder was 5/5 in all movements. CONCLUSION: The protocol used yielded an accelerated return to sport (soccer) and function compared with other published research after a grade III latissimus dorsi tendon tear. One year later, the goalkeeper was still playing in the same competitive level without any re-injuries or complains, which means that this treatment protocol withstood the test of time. Show more

Keywords: Grade III latissimus dorsi tear, latissimus dorsi tear in soccer, physical therapy after latissimus dorsi tear, latissimus dorsi tear rehabilitation, latissimus dorsi tear in football

DOI: 10.3233/BMR-160699

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 905-916, 2016

Authors: Khatibi, Ali

Article Type: Article Commentary

DOI: 10.3233/BMR-160664

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 917-918, 2016

Article Type: Other

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 919-928, 2016

Article Type: Other

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 29, no. 4, pp. 929-933, 2016