Journal of Back and Musculoskeletal Rehabilitation - Volume 30, issue 1

Authors: Tanina, Hideaki | Nishimura, Yukihide | Tsuboi, Hiroyuki | Sakata, Takeshi | Nakamura, Takeshi | Murata, Ken-ya | Arakawa, Hideki | Umezu, Yuichi | Tajima, Fumihiro

Article Type: Research Article

Abstract: BACKGROUND: The erector spinae is more resistant to fatigue in adult women than men. However, no study has reported the sex differences in back muscle fatigue in children. OBJECTIVE: The aim of this study was to evaluate the fatigability of erector spinae in prepubertal children and adults, in both males and females. METHODS: Fourteen prepubertal boys, 13 prepubertal girls, 14 adult men, and 13 adult women performed the Sørensen back isometric endurance test until exhaustion. The results of electromyographic (EMG) power spectral analysis of erector spinae were compared between both age groups and …sexes. RESULTS: The slopes of EMG power spectral median and mean power frequency were significantly higher in males than in females, in both age groups. Furthermore, the slopes were significantly lower in prepubertal children than in adults, in both males and females. CONCLUSIONS: Our results showed major differences in the fatigue threshold of the erector spinae between boys and girls and children and adults. The muscle fatigued faster in prepubertal boys and adult men than in prepubertal girls and adult women. In both sexes, a lower slope of EMG power spectrum parameters of the erector spinae was noted during endurance test in prepubertal children compared to adults. Show more

Keywords: Electromyography, erector spinae muscle, muscle fatigue, prepubertal, children, sex difference

DOI: 10.3233/BMR-160705

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 1-9, 2017

Authors: Komur, Baran Heval | Durmus, Tahir Mutlu | Mutlu, Serhat | Guler, Olcay | Mutlu, Harun | Yucel, Bulent

Article Type: Research Article

Abstract: BACKGROUND: The aim of this study was to measure the rotational angle defect between fracture ends in paediatric forearm diaphyseal fractures on radiographs. METHODS: Evaluations were performed on 78 paediatric patients who presented at the emergency department with a diaphyseal forearm fracture during 2013-2014. Thirty-two patients who underwent conservative treatment and had < 10° of angulation and translation of not more than half the bone diameter after application of a plaster cast were included in the study. A rotational formula was used with diameter values to determine changes. The degree of rotation of both ends of …the fracture line and the forearm rotational defect of the fracture line were calculated. FINDINGS: Fractures included an isolated radius in 16 cases, an isolated ulna in four cases, and both bones in 12 cases. The mean lateral angular (LAT-θ) value was 26.13 ± 5.93° on the proximal fracture end, and the distal mean LAT-θ was 30.29 ± 6.24° (p = 0.037). The mean proximal anteroposterior angular (AP-θ) value was 26.83 ± 5.75°, and the distal mean AP-θ was 30.58 ± 7.27° (p = 0.008). A significant correlation was detected between the AP-Δ and LAT-Δ measurements (p = 0.883). INTERPRETATION: The rotational defect was mathematically calculated directly from radiographs using a rotational measurement formula. Show more

Keywords: Direct radiograph, forearm diaphyseal fracture, rotation measurement

DOI: 10.3233/BMR-160707

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 11-16, 2017

Authors: Hayta, Emrullah | Salk, Ismail | Gumus, Cesur | Tuncay, Mehmet Siddik | Cetin, Ali

Article Type: Research Article

Abstract: OBJECTIVE: We aimed to evaluate the effects of extra corporeal shock-wave therapy (ESWT) on the calcaneal spur length and pain severity in overweight and obese patients with symptomatic calcaneal spur. METHODS: In eighty patients with symptomatic calcaneal spur, ESWT was administered on days 0 and 7, and visual analog scale (VAS) scores and calcaneal spur lengths (CSLs) before and 3 months later after treatment were recorded. A lateral heel radiograph was used for computer-aided linear measurements of CSL. RESULTS: Of 80 patients, 59 (73.7%) were female and 21 were male (26.3%); age was …45.9 ± 8.3 years; BMI was 31.6 ± 4.4 kg/m2 ; and symptom duration was 2.3 ± 2.4 years. The CSL and VAS score after treatment were significantly lower than those before treatment (CSL before vs. after: 5.7 ± 1.0 vs. 4.4 ± 0.9, p = 0.001; VAS score before vs. after: 8.3 ± 1.4 vs. 4.6 ± 2.2; p = 0.03). The CSLs before and after treatment had a significant strong correlation (r = 0.832, p = 0.001). The VAS scores before and after treatment presented a significant mild correlation (r = 0.242, p = 0.03). CONCLUSIONS: In overweight and obese patients with symptomatic calcaneal spur, ESWT reduces the CSL and pain severity during a follow-up of three-month duration. Show more

Keywords: Calcaneal spur, extracorporeal shock wave therapy, pain X-ray imaging

DOI: 10.3233/BMR-160708

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 17-22, 2017

Authors: Metikaridis, Damianos T. | Hadjipavlou, Alexander | Artemiadis, Artemios | Chrousos, George P. | Darviri, Christina

Article Type: Research Article

Abstract: BACKGROUND: Studies have shown that stress is implicated in the cause of neck pain (NP). OBJECTIVES: The purpose of this study is to examine the effect of a simple, zero cost stress management program on patients suffering from NP. METHODS: This study is a parallel-type randomized clinical study. People suffering from chronic non-specific NP were chosen randomly to participate in an eight week duration program of stress management (N= 28) (including diaphragmatic breathing, progressive muscle relaxation) or in a no intervention control condition (N= 25). Self-report measures were used for the evaluation of …various variables at the beginning and at the end of the eight-week monitoring period. Descriptive and inferential statistic methods were used for the statistical analysis. RESULTS: At the end of the monitoring period, the intervention group showed a statistically significant reduction of stress and anxiety (p= 0.03, p= 0.01), report of stress related symptoms (p= 0.003), percentage of disability due to NP (p= 0.000) and NP intensity (p= 0.002). At the same time, daily routine satisfaction levels were elevated (p= 0.019). No statistically significant difference was observed in cortisol measurements. CONCLUSIONS: Stress management has positive effects on NP patients. Show more

Keywords: Neck pain, stress, relaxation techniques, muscle relaxation, guided imagery, autogenic training

DOI: 10.3233/BMR-160709

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 23-33, 2017

Authors: Rhee, Min-Hyung | Kim, Laurentius Jongsoon

Article Type: Research Article

Abstract: BACKGROUND: Many studies reported that the morbidity of the respiratory and circulatory diseases is higher among smokers than non-smokers. Some recent studies reported the effects of smoking on the musculoskeletal system. However, it is difficult to generalize the experimental environment because it is different from activities of daily living environment. OBJECTIVE: The purpose of this study was to compare the differences in the activation of abdominal muscles during trunk extension between smokers and non-smokers. METHODS: The subjects were 30 healthy adults (15 smokers and 15 non-smokers). The percentage of maximal voluntary isometric contraction …(%MVIC) values of rectus abdominis (RA), external oblique (EO), internal oblique and transversus abdominis(IO&TrA) were measured using the surface electromyography System. RESULTS: The results showed no significant differences in the %MVIC of RA and EO between smokers and non-smokers. However, the %MVIC of IO&TrA showed a significant difference between smokers and non-smokers. The %MVIC of IO&TrA of non-smokers was higher. CONCLUSIONS: The non-smokers showed greater activation of deep abdominal muscles than smokers did. Show more

Keywords: Activation of abdominal muscles, smokers, non-smokers, trunk extension

DOI: 10.3233/BMR-160710

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 35-38, 2017

Authors: Yao, Kaihan | Yew, Wei Ping

Article Type: Research Article

Abstract: Suprascapular nerve injury is increasingly being recognized as an important cause of shoulder dysfunction. The non-specific clinical features of suprascapular nerve injury can make diagnosis difficult. However, it is essential for clinicians to consider it as part of the differential diagnoses in patients with vague pain or sensory disturbances over the posterosuperior part of their shoulder or have unexplained atrophy and weakness of their supraspinatus or infraspinatus muscle. Electrodiagnostic studies are useful in confirming and localising the nerve injury, while MRIs can be employed to determine the cause of nerve injury and assess the integrity of the rotator cuff muscles. …Isolated suprascapular nerve injury can be managed with a trial of conservative management for at least 6 months. Subsequently, decompression of the nerve through open or arthroscopic techniques can be considered - both are associated with high rates of pain relief and functional improvement. Show more

Keywords: Suprascapular nerve injury, neuropathy, shoulder dysfunction, nerve decompression

DOI: 10.3233/BMR-160711

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 39-44, 2017

Authors: Karabag, Hamza | Yetisgin, Alparslan | Savik, Emin | Kilic, Mustafa | Aridici, Rifat | Taskin, Abdullah | Ulas, Turgay

Article Type: Research Article

Abstract: BACKGROUND: Chronic inflammation is believed to have a role in the development of lumbar disc herniation (LDH). Ceruloplasmin (CP), an acute phase protein, is known to limit inflammation. OBJECTIVE: To evaluate CP levels in patients with LDH. METHODS: Thirty-five patients with LDH and 35 healthy individuals were enrolled in the study. Participants were divided into two groups; group 1 (n = 35) consisted of patients with LDH, and group 2 (n = 35) consisted of healthy subjects. Surgery specimens were taken from all patients who underwent LDH-related surgery. CP levels were measured in …both blood and tissue samples. Pain intensity was evaluated using a visual analog scale (VAS). RESULTS: There were no significant differences in gender, age, or body mass index between the control and LDH patients (p > 0.05 for all). Compared with the control patients, LDH patients had significantly higher serum CP levels (p < 0.001). In LDH patients, tissue CP levels were significantly higher than serum levels (p < 0.001). According to bivariate analysis, the serum CP levels were significantly correlated with the VAS score in group 1 (r = 0.491, p = 0.003). CONCLUSIONS: The present study showed that CP levels increased in both the serum and the tissues of patients with LDH compared to patients without LDH, possibly as a consequence of LDH-associated inflammation. Show more

Keywords: Ceruloplasmin, inflammation, lumbar disc herniation

DOI: 10.3233/BMR-160712

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 45-49, 2017

Authors: Copurgensli, Canan | Gur, Gozde | Tunay, Volga Bayrakcı

Article Type: Research Article

Abstract: BACKGROUND: Cervical Spondylosis (CS) is a degenerative and painful pathology, which needs conservative treatment to relieve symptoms. OBJECTIVE: The aim was to investigate the effects of Mulligan's mobilization (MM) and Kinesio taping (KT) on pain, range of motion (ROM), muscle strength, and function in CS. METHODS: Forty-five subjects were randomly placed into three groups: Group 1: control group (conventional rehabilitation-CR); Group 2: MM and CR; Group 3: KT and CR. Assessments including neck pain, cervical ROM, muscle strength and Neck Disability index (NDI) were conducted at baseline, after three-week treatment, and at one-month …follow up. Results were analyzed using ANCOVA. RESULTS: In all groups, pain and NDI scores reduced, cervical ROM and muscle strength increased with time (p< 0.001). Greater improvements in neck extension, left and right rotation were obtained in the KT and MM groups when compared to the control group (p< 0.05). In the KT group, improvement in right lateral flexion ROM was greater than the control and deep cervical flexor muscle strength was greater than the MM and the control groups (p< 0.05). CONCLUSION: KT and MM contributed to CR for increasing cervical ROM and deep cervical flexor muscle strength in patients with CS. Show more

Keywords: Spondylosis, rehabilitation, neck pain

DOI: 10.3233/BMR-160713

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 51-62, 2017

Authors: Turk, Ayla Cagliyan | Fidan, Nurdan | Ozcan, Oguzhan | Ozdemir, Ferda | Tomak, Leman | Ozkurt, Sultan | Sahin, Fusun

Article Type: Research Article

Abstract: BACKGROUND: Shoulder pain is frequently observed in haemodialysis patients. OBJECTIVE: To compare haemodialysis patients with or without shoulder pain in terms of shoulder motion ranges, β2 microglobulin levels and magnetic resonance imaging findings. METHODS: Forty-three patients undergoing dialysis were enrolled, of which 23 patients had explicit shoulder pain at night, which appeared during dialysis. Range of joint motion was evaluated. β 2 microglobulin value was recorded. MRI was used to evaluate rotator cuff tendons for thickness, homogeneity, integrity and presence of effusion. RESULTS: Ranges of motion were significantly lower …in the painful shoulder group. Supraspinatus tendon thickness and the number of areas with effusion were higher in the painful group. There was a positive correlation between the β 2 microglobulin level and supraspinatus (r:0.352 p< 0.05) and subscapular (r:0.454 p< 0.05) tendon thicknesses. While effusion areas and pain (r:0.351 p< 0.05) showed positive correlation, there was a negative correlation between pain and shoulder motion ranges. CONCLUSIONS: Shoulder pain in dialysis patients can be related with tendon thickness and effusion. While the β 2 microglobulin level affects tendon thickness, it has no relation to pain and movement constraint. Show more

Keywords: Amyloidosis, β 2 microglobulin, haemodialysis, Magnetic Resonance Imaging, shoulder pain

DOI: 10.3233/BMR-160715

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 63-69, 2017

Authors: Wenzel, H.H.B. | in 't Veld, R. Huis | Melman, W.P.R. | Havinga, M.E. | Pakvis, D.

Article Type: Research Article

Abstract: BACKGROUND: Psychological risk factors have shown to be important prognostic indicators of back surgery outcome. Prevalence of these risk factors has rarely been examined in an outpatient clinic population. Furthermore, it is unclear to which extent they play a role, in absence of routinely used psychological screening tools, in treatment assignment. OBJECTIVE: First aim of this study was to examine the prevalence of psychological risk factors in back pain patients at an orthopaedic outpatient clinic. Second aim was to investigate the prognostic value of these identified risk factors in treatment assignment by the orthopaedic surgeons (conservative …vs. surgery). METHODS: Sixty-six adult back pain patients were included. Psychological risk factor prevalence was determined with the Hospital Anxiety and Depression Scale, Tampa Scale of Kinesiophobia and Pain Catastrophizing Scale. Prognostic value of these risk factors in treatment assignment was examined using statistics. RESULTS: Respectively, 30 (45% HADS Anxiety), 27 (41%, HADS Depression), 19 (29%, PCS) and 37 (56%, TSK) patients scored above cut-off. No prognostic value of risk factors in treatment assignment, was found. CONCLUSIONS: The majority of patients in our study is at risk of poor surgical outcome due to presence of psychological risk factors. Future studies should target the development of screening tools for an early identification of those at risk. Show more

Keywords: Back pain, surgery, psychological, risk factors, screening

DOI: 10.3233/BMR-160716

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 71-78, 2017

Authors: Flavell, Carol Ann | Gordon, Susan | Watt, Kerrianne

Article Type: Research Article

Abstract: BACKGROUND: Measurement of lumbar spine movement and neuro-dynamic flexibility is fundamental to clinical examination and forms part of most systems or protocols used to classify patients with low back pain. However, the increased age and body mass index reported in the chronic low back pain subgroup, may compromise the reliability of these measurements. Specifically, this relates to greater soft tissue excursion relative to the underlying bony landmarks used for these clinical tests. OBJECTIVE: The objective of this research was to determine the intra-examiner reliability for six lumbar spine and two neuro-dynamic examination tests in older and …overweight individuals selected to represent a similar age and body mass index of a chronic low back pain population. METHODS: Nineteen volunteers (56.00 ± 7.62 years) performed sets of eight lumbar spine examination tests. Five repetitions of each set of tests were conducted with rest periods between sets. One examiner measured lumbar flexion, extension, right and left lateral flexion and rotation using a tape measure. A goniometer was used to measure Slump and Passive Straight Leg Raise (PSLR) test. RESULTS: Intra-class correlation coefficients (ICC intra ) were calculated to evaluate the reliability of measurement for each test. The eight tests showed ICC ranges between `Large' and `Nearly Perfect' (0.68-0.99). Measurement of lateral flexion and rotation had the highest reliability and extension the lowest. CONCLUSIONS: This study was conducted on an asymptomatic older, overweight population and the ICC results support the suitability of these methods and tools for measurement in a clinical setting for this population demographic. Measurement reliability in the study population was comparable with previous research in populations of contrasting demographics. Accordingly, further investigation specifically in a chronic low back pain population is indicated as the paucity of previous literature for some of the movement tests disallowed comparisons, and the reliability reported in this study may not be directly transferable to a chronic low back pain population. Show more

Keywords: Adult, spine, movement, measurement, intra-examiner, reliability

DOI: 10.3233/BMR-160717

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 79-84, 2017

Authors: Rossettini, Giacomo | Rondoni, Angie | Lovato, Tommaso | Strobe, Marco | Verzè, Elisa | Vicentini, Marco | Testa, Marco

Article Type: Research Article

Abstract: BACKGROUND: Passive Intervertebral Movements (PIVMs) are commonly used to assess and treat patients with non-specific neck pain. Only very few studies have investigated 3D movements until now. OBJECTIVE: This study assessed intra- and inter-rater reliability of three-dimensional (3D) cervical PIVMs performed by physical therapy students in patients with non-specific neck pain. METHODS: Thirty-one patients, mean age 47.2 ± 7.2 years, were independently evaluated by 2 physical therapy students. The raters (A and B) assessed mobility, end-feel and pain provocation performing bilaterally the 3D cervical segmental side-bending test (3D CSSB) from levels C2-C3 …to C6-C7. Percentage agreement (raw, positive and negative), Cohen's kappa (95% CI), prevalence index and bias index were calculated to estimate intra- and inter-reliability. RESULTS: Intra-rater reliability showed kappa values ranging between fair and substantial (k 0.29-0.80) for pain provocation, mobility and end-feel, with percentage agreements between 61%-90%. Inter-rater reliability presented kappa values ranging between fair and substantial (k 0.22-0.62) for pain provocation, mobility and end-feel, with percentage agreements between 61% and 80%. CONCLUSIONS: Intra-rater reliability of 3D PIVMs was superior to inter-rater reliability in patients with non-specific neck pain. The most repeatable evaluation parameter was pain. However overall poor reliability suggests avoiding the use of these techniques alone to examine patients and measure their outcome. Further studies are needed to investigate PIVMs reliability in combination with other assessment procedure in symptomatic patients. Show more

Keywords: Neck pain, physical therapy modalities, symptom assessment, reproducibility of results, physical examination

DOI: 10.3233/BMR-160718

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 85-99, 2017

Authors: Ozturk, Erhan Arif | Gundogdu, Ibrahim | Kocer, Bilge | Comoglu, Selcuk | Cakci, Aytul

Article Type: Research Article

Abstract: BACKGROUND: Although there are studies evaluating pain in Parkinson's disease (PD), to our knowledge, there is no study evaluating the following topics in a cohort of PD patients; (1) frequency of chronic pain, (2) characteristics of chronic pain, (3) severity of chronic pain, (4) types of chronic pain, (5) independent predictors of chronic pain, (6) impact of chronic pain on health-related quality of life (HRQoL), and (7) the role of chronic pain among the independent predictors of HRQoL. OBJECTIVE: The purpose of this study was to evaluate the frequency, characteristics, severity, types, and independent factors of …chronic pain, as well as the relationship of chronic pain with HRQoL in a cohort of PD patients. METHODS: One-hundred and thirteen individuals with a confirmed diagnosis of PD who were consecutively referred to the Ministry of Health Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Movement Disorders Outpatient Clinic were included in the study. Demographic variables, disease characteristics, disease-related motor symptoms and motor complications, comorbid conditions, and health-related quality of life were evaluated and recorded. Pain lasting longer than three months was defined as `chronic pain' and participants were questioned relating to the characteristics of the chronic pain. The Visual Analogue Scale was used for assessment of pain. RESULTS: Seventy-three patients (64.6%) suffered from chronic pain. Of these, 12 (16.4%) had previous pain at the time of diagnosis of PD. The sources of pain experienced by patients were 89.0% musculoskeletal, 31.5% radicular/peripheral neuropathic, 15.1% dystonic, and 4.1% central parkinsonian, respectively. Twenty-six patients (35.6%) had different types of pain simultaneously. The pain type with the highest severity was a central parkinsonian pain. The independent predictors of chronic pain included gender (female), Unified Parkinson's Disease Rating Scale (UPDRS) part II (activities of daily living), UPDRS part III (motor symptoms) rigidity subscore, and depression. When compared with individuals not having chronic pain, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) Physical Component Summary and Mental Component Summary scores were lower in patients with chronic pain. Also, it was shown that the most significant factor on SF-36 was chronic pain. CONCLUSIONS: This study demonstrated that chronic pain is a common problem in patients with PD, that different pain types may co-exist, and that they may negatively affect the HRQoL of patients. Chronic pain was correlated with both disease-related factors such as rigidity and daily living activities and also general factors such as gender and depression. We found that chronic pain is the most significant predictor of quality of life in PD patients. We believe, that in addition to treating motor symptoms and complications associated with them, treatment of comorbid conditions such as pain and depression bear significance for improving the quality of life in PD patients. The study indicates that PD patients who are optimally treated, may require additional rehabilitation treatment for non-motor associated pain and thus improve their HRQoL. Show more

Keywords: Parkinson's disease, chronic pain, pain characteristics, health-related quality of life

DOI: 10.3233/BMR-160720

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 101-108, 2017

Authors: Karahan, Ali Yavuz | Sahin, Nilay | Baskent, Akın

Article Type: Research Article

Abstract: BACKGROUND: Failed back surgery syndrome (FBSS) is a condition characterized by persistent pain following back surgeries. OBJECTIVE: To determine the effects of different exercises programs in FBSS. METHODS: A single-blind, randomized, controlled trial designed. One hundred participants with failed back surgery syndrome were randomly assigned to three different exercises groups (Isokinetic, Dynamic lumbar stabilization (DLS), and home exercises (HE) groups) and a control group. Patients were evaluated before and after 8-week exercise program and follow-ups at the 3rd and 6th months after the exercise program. Finger-floor distance and lumbar Schober for …lumbar mobility, visual analog scale (VAS) for pain, Modified Oswestry Disability Index, Beck Depression Inventory, fear-avoidance attitudes survey, and progressive-isoinertial weight lifting test were used as follow-up parameters. Lumbar muscle strength was assessed with the isokinetic dynamometer. RESULTS: VAS levels were decreased from 67.7 to 22.8 in isokinetic and from 68.7 to 25.0 in DLS and from 64.6 to 47.1 in HE groups at the end of the program (p< 0.05). Also, all of other follow-up parameters of the isokinetic and DLS exercise groups viewed significant improvements compared to the control group. CONCLUSIONS: According to our results either isokinetic or DLS exercises are more effective in FBSS patients. Show more

Keywords: Dynamic lumbar stabilization, exercise, failed back surgery syndrome, treatment, isokinetic

DOI: 10.3233/BMR-160722

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 109-120, 2017

Authors: Baek, Seung Ok | Cho, Hee Kyung | Kim, So Yeon | Jones, Rodney | Cho, Yun Woo | Ahn, Sang Ho

Article Type: Research Article

Abstract: BACKGROUND: Transcutaneous neuromuscular electrical stimulation (NMES) is known to stimulate contraction of deep lumbar stabilizing muscles. OBJECTIVE: The purpose of this study was to investigate changes in deep lumbar stabilizing muscle thickness during transcutaneous NMES on specific abdominal wall and paraspinal regions. METHODS: Thirty patients with low back pain (LBP) were recruited. Three sessions were preformed: Session 1: NMES on abdominal wall, Session 2: NMES on lumbar paraspinal area, and Session 3: concurrent NMES on abdominal wall and lumbar paraspinal area. Real time ultrasound imaging (RUSI) of three abdominal stabilizing muscles; transverse abdominis …(TrA), obliquus internus (OI), obliquus externus (OE) muscles and one posterior stabilizer, the lumbar multifidus muscles (LM) was captured. RESULTS: All studied muscles of TrA, OI, OE, and LM were found to have significant thickness increases during all three sessions compared to resting state (p < 0.05). Thicknesses changes of TrA, OI, and LM were significant during simultaneous NMES of both abdominal wall and lumbar paraspinal regions (Session 3) (p < 0.05). CONCLUSIONS: Our results indicate that concurrent NMES on abdominal wall and lumbar paraspinal area is most effective to maximally activate deep lumbar stabilizers. Rehabilitative efforts for patients with LBP may benefit from simultaneous transcutaneous NMES of abdominal and lumbar regions. Show more

Keywords: Neuromuscular electrical stimulation, lumbar stabilizing muscle, real time ultrasound imaging, low back pain

DOI: 10.3233/BMR-160723

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 121-127, 2017

Authors: Taspinar, Ferruh | Taspinar, Betul | Ozkan, Yasemin | Afsar, Emrah | Gul, Canan | Durmaz, Elif Dilara

Article Type: Research Article

Abstract: OBJECTIVES: Lumbar disc herniation leads to disability by restricting of patients' lives and reducing their quality of life. This situation causes a decrease in motivation of patients by triggering depressive mood. Therefore, the aim of the study was investigation of correlation between fear avoidance beliefs and burnout syndrome in patients with lumbar disc herniation. METHODS: Totally forty-seven patients (24 male and 23 female patients) diagnosed lumbar disc herniation was included in this study. Maslach II Burnout Inventory (MBI) and Fear Avoidance Beliefs Questionnaire (FABQ) for determining of levels of burnout and fear avoidance level were used, …respectively. RESULTS: It was observed that MBI and FABQ scores of the patients were 50.78 ± 10.07 and 36.61 ± 13.91, respectively. Moderate level correlation was found between FABQ and MBI total scores (r= 0.49, p= 0.00). CONCLUSIONS: Fear avoidance beliefs of patients with chronic back pain can affect level of burnout syndrome. Therefore, symptoms of burnout syndrome and fear avoidance beliefs of patients should be considered in evaluation and treatment process. Show more

Keywords: Pain, burnout, avoidance, low back pain

DOI: 10.3233/BMR-160725

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 129-134, 2017

Authors: Gamus, Dorit | Glasser, Saralee | Langner, Elisheva | Beth-Hakimian, Aliza | Caspi, Israel | Carmel, Narin | Siev-Ner, Itzhak | Amir, Hagai | Papa, Moshe | Ziv, Amitai | Lerner-Geva, Liat

Article Type: Research Article

Abstract: BACKGROUND: Low back pain (LBP) is one of the most common health complaints, with lifetime prevalence rates as high as 84%. The Oswestry Disability Index (ODI) is often the measure of choice for LBP in both research and clinical settings and, as such, has been translated into 29 languages and dialects. Currently, however, there is no validated version of Hebrew-translated ODI (ODI-H). OBJECTIVE: To examine the psychometric properties of the ODI-H. METHODS: Cross-culturally appropriate translation into Hebrew was conducted. A convenience sample of 115 participants (Case Group) with LBP and 68 without LBP …(Control Group) completed the ODI-H, SF-36 Health Survey, and two Visual Analog Scales (VAS). RESULTS: Internal consistency was α = 0.94 and test-retest reliability for 18 participants repeating the ODI-H was 0.97. No floor or ceiling effects were noted for Cases, although there was a floor effect for the Control Group. Scores were significantly different for the two groups, indicating discriminant validity. Concurrent validity was reflected by significant correlations with SF-36 scores, particularly the Physical Functioning and Bodily Pain subscales (-0.83 and -0.79, respectively) and with the VAS (0.84 and 0.79). CONCLUSIONS: The ODI-H is a valid and reliable measure of low back pain-related disability for the Hebrew-speaking public. Show more

Keywords: Oswestry Disability Index, ODI, Hebrew, low back pain, validation, SF-36 Health Survey, Visual Analog Scale, translation, reliability, psychometric, assessment

DOI: 10.3233/BMR-160726

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 135-143, 2017

Authors: Marcolino, Alexandre Márcio | Fonseca, Marisa de Cássia Registro | Leonardi, Naiara Tais | Barbosa, Rafael Inácio | Neves, Lais Mara Siqueira das | de Jesus Guirro, Rinaldo Roberto

Article Type: Research Article

Abstract: PURPOSE: The purpose this study was perform a biomechanical evaluation to compare the influence of commercial models of different non-articular proximal forearm orthoses widths (2.5 cm, 5.5 cm, 7.5 cm and 12.0 cm) in the extensor muscle activation, range of motion and grip strength in healthy subjects. METHODS: Was analyzed data from extensor carpi radialis, extensor carpi ulnares and extensor digitorum comunis using surface electromyography, simultaneous with a wrist electrogoniometer MiotecTM and a hydraulic dynamometer JamarTM . The sequence of tests with all the commercial orthoses models was randomized. Statistics analyses were performed by linear …model with mixed effects. RESULTS: According to our findings the non-articular proximal forearm orthoses (2.5 cm - narrowest) positioned close to lateral epicondyle provided lesser muscle activation on extensor carpi radialis brevis/longus and extensor digitorum comunis, decreased wrist extension and grip strength during submaximal grip task (p< 0.01). CONCLUSIONS: A narrow non-articular proximal forearm orthosis positioned close to the lateral epicondyle might decrease the extensor muscle activation and therefore could reduce mechanical stress on its insertion, based on this sample. Clinical studies must be conducted to confirm these findings. Show more

Keywords: Orthoses, brace, lateral epicondylitis, electromyography, wrist biomechanics

DOI: 10.3233/BMR-160727

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 145-151, 2017

Authors: Jentzsch, Thorsten | Geiger, James | Werner, Clément M.L.

Article Type: Research Article

Abstract: BACKGROUND: Fascial dehiscence after spinal instrumentation is usually located at the mechanically stressed interscapular thoracic spine and often causes cosmetic impairment and pain. However, therapy options remain barely discussed. Synthetic meshes have been successfully used in the treatment of abdominal hernias. OBJECTIVE: It was hypothesized that synthetic meshes are a successful treatment option for spinal fascial dehiscence. METHODS: This retrospective study of a prospective database investigated all consecutive patients who received a synthetic mesh for a fascial dehiscence of the spine between 2010 and 2014 after prior spinal instrumentation. Primary outcomes were healing …of the fascial dehiscence, recurrence, infection, revision, subjective satisfaction on a visual analog scale (VAS), and the Oswestry Disability Index (ODI). Among others, secondary outcomes consisted of seroma formation and return to work. The evaluated risk factors consisted of the body mass index (BMI), outer abdominal fat (OAF), back tissue, smoking, immunomodulatory therapy, preoperative radiation dose, and instrumented levels. RESULTS: Sixteen patients with a mean follow up of 24 (SD 15) months were included. Every fascial dehiscence successfully healed with the synthetic mesh and there were no recurrences, infections or revisions. The mean subjective satisfaction level was VAS 7.3 and the mean ODI was 26%. Five (31%) patients had a seroma postoperatively, but did not show any differences in the outcome (e.g. ODI of 28%). In the patient group < 65 years (n = 12), all but two patients, who had work restrictions due to other diseases, regained at least some capacity to work. Worse ODI scores were found for patients with increased BMI, OAF, back tissue, cortisone therapy, instrumented levels, preoperative radiation dose, and smokers. CONCLUSION: Synthetic meshes are a successful treatment option for spinal fascial dehiscence, even seemingly in patients with a higher risk profile such as obese and immunocompromised patients as well as in revision procedures. They are associated with respectable cosmetic results, pain relief and clinical outcome. Postoperatively, it is recommended to leave drains for more than five to seven days in order to avoid seroma formation and to avoid weight training for six weeks. Further prospective, comparative studies are recommended. Show more

Keywords: Synthetic mesh, spinal fascial dehiscence, instrumentation of the spine, Oswestry Disability Index (ODI), patient satisfaction

DOI: 10.3233/BMR-160728

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 153-162, 2017

Authors: Yilmaz Yelvar, Gul Deniz | Çirak, Yasemin | Dalkilinç, Murat | Demir, Yasemin Parlak | Baltaci, Gul | Kömürcü, Mahmut

Article Type: Research Article

Abstract: BACKGROUND: Postural control allows performance of daily and sports activities. The previous studies show that postural sway inceases in orthopaedic injuries such as osteoarthritis and total knee arthroplasty. OBJECTIVE: To compare postural sway, risk of falling and function between individuals with and without patellofemoral pain syndrome (PFS). METHODS: This study included 22 subjects with patellofemoral pain syndrome, age-matched pain-free 22 females serving as a control group. Visual anolog scale and Kujala were used to evaluate the pain. Posturographic assesment was performed by Tetrax posturographic device. Biering Modified Sorenson test for extensor endurance and …sit-up test for flexor endurance were used for the evaluation of trunk endurance. Timed get-up and go test was used for lower extremity function. The Student's t Test was used to compare variables between the groups. The Pearson correlation coefficients were calculated to examine correlation between the quantitative variables. RESULTS: Postural sway included eyes open without pillow, eyes open on pillow, eyes closed on pillow, risk of falling, function and postural stabilization included flexor endurance, extansor endurance are impared in patient with patellofemoral pain syndrome when compare to controls. In subjects with PFPS increased postural sway significantly associated with body mass index (r= 0.52), pain duration (r= 0.43), postural control (extansor endurance) (r= -0.50) and risk of falling (r= 0.62) on pillow with open eyes. In addition we found function significantly related with postural control (extansor endurance and flexor endurance) (r= -0.59 and r= -0.59) and risk of falling (r= 0.77) CONCLUSIONS: Decreased neuromuscular control of the trunk core and increased postural sway and falling risk were found in patients with PFPS. Patients may be evaluated for deficits in postural control and falling risk before treatment. Show more

Keywords: Patellofemoral pain syndrome, postural sway, postural control, falling, function

DOI: 10.3233/BMR-160729

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 163-170, 2017

Authors: Verim, Sabahattin | Batmaz, İbrahim | Yazmalar, Levent | Nas, Hüsamettin Çavaş Kemal | Çevik, Remzi

Article Type: Research Article

Abstract: BACKGROUND: Fibromyalgia syndrome (FMS) is a non-articular rheumatic disorder of unclear etiology, characterized by widespread body pain, fatigue and, psychological complaints OBJECTIVES: To investigate the serum levels of neuron-specific enolase (NSE) in patients with FMS and to evaluate the relationship between cognitive function, quality of life and psychological state. MATERIALS AND METHODS: Fifty-five female patients diagnosed with fibromyalgia according to the American College of Rheumatology (ACR) classification criteria, and 40 healthy female subjects were enrolled in the study. Life quality scale [(Fibromyalgia Impact Questionnaire (FIQ)], psychological state (Beck Depression Scale), and cognitive dysfunction …(mini mental test, clock drawing test) scales were used for patients and control subjects. Serum NSE levels were studied using the ECLIA method. RESULTS: No significant differences were found in the serum NSE levels between the FMS patients and the control subjects (p> 0.05). Life quality and psychological state scores were found to be higher in FMS patients relative to the control group (p< 0.001). However, no significant differences were detected in cognitive function (p> 0.05). Significant correlations were not found between the serum NSE levels and quality of life, psychological state and cognitive functions (p> 0.05). CONCLUSION: No significant difference was determined between the groups in terms of NSE levels. Further studies, including larger series, should be carried out to clarify this relationship. Show more

Keywords: Fibromyalgia syndrome, neuron-specific enolase, cognitive dysfunction, quality of life, psychological state

DOI: 10.3233/BMR-160730

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 171-174, 2017

Authors: Abdel Raoof, Neveen A. | Battecha, Kadrya H. | Elsayed, Salah Eldin B. | Soliman, Elsadat Saad

Article Type: Research Article

Abstract: BACKGROUND: Noninvasive rasterstereography has been reported as a helpful tool for assessing pelvic parameters. However, the validation and reproducibility of this tool are still questionable. OBJECTIVE: To investigate the correlation between video rasterstereography device (VRD) and X-ray photography in terms of validity and reproducibility (inter- and intra-examiner reliability) in pelvic parameters. METHODS: Thirty male and female healthy subjects with a mean age (26.9 ± 4.9 years) participated in this study. Subjects were examined by VRD for three pelvic parameters (pelvic torsion, pelvic tilt, and pelvic inclination). Measurements were conducted by three different examiners. …Subjects were examined by X-ray radiography for the same pelvic parameters as well. Pearson correlation coefficient (r) was used to examine the validity and Intra-class correlation coefficient (ICC) was used to check intra- and inter-examiner reliability. RESULTS: For pelvic torsion, tilt, and inclination the validity levels of VRD were 0.867, 0.996, and 0.930 (P < 0.05), respectively; while the intra- and inter-examiner reliability coefficients were 0.999, 0.999, and 0.998 and 0.990, 0.997, and 0.989, respectively. CONCLUSION: The results of this study revealed that the VRD has both high validity and reliability in assessing the selected three pelvic parameters that reflect the three fundamental planes of movement in healthy subjects. Further studies using VRD are recommended to assess low back pain-associated pelvic parameters. Show more

Keywords: Surface topography, validity, reproducibility, pelvic parameters

DOI: 10.3233/BMR-150444

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 175-181, 2017

Authors: Ekşioğlu, Emel | Kesikburun, Bilge | Çakçı, Aytül

Article Type: Case Report

Abstract: BACKGROUND: Protracted Febrile Myalgia is a rare form of vasculitis that is diagnosed in patients with Familial Mediterranean Fever. OBJECTIVE: To present a case with Familial Mediterranean and Anklosing Spondylitis on anti-TNF therapy for three years, who developed protracted febrile myalgia syndrome. METHODS: Case report. RESULTS: A 35-year-old woman with known Familial Mediterranean Fever and Anklosing Spondylitis for 3 years presented with fever, diarrhea, intermittent abdominal pain and severe diffuse muscular pain lasting for two weeks. The patient was investigated for any infection focus. The patient was diagnosed as having …Protracted Febrile Myalgia four weeks after the onset of the symptoms. Prednisolone 1 mg/kg per day was applied. Her fever and muscle pain resolved within 48 hours. CONCLUSION: The coexisting Ankylosing Spondylitis disease and the use of anti-TNF treatment in patients with Familial Mediterranean Fever could be a confounding factor for the investigation of fever. Steroid therapy has a dramatic response. Show more

Keywords: Protracted Febrile Myalgia, anti-TNF therapy, steroid, Familial Mediterranean Fever

DOI: 10.3233/BMR-160719

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 1, pp. 183-185, 2017