Journal of Back and Musculoskeletal Rehabilitation - Volume 30, issue 3

Authors: Orr, Lindsay C. | George, Steven Z. | Simon, Corey B.

Article Type: Research Article

Abstract: BACKGROUND: Pain sensitivity has been negatively associated with physical activity levels. Few studies have examined associations between experimentally induced pain sensitivity and physical activity in adults with chronic low back pain and pain-free controls. OBJECTIVE: The objective of this study was to examine associations between physical activity levels and how an individual processes pain using experimentally induced pain stimuli. METHODS: Seventy subjects (CLBP = 49; mean age = 46.8 ± 14.9; Pain-free = 21; mean age = 45.3 ± 18.2, n of females = 46) participated. A self-report questionnaire derived from …the International Physical Activity Questionnaire (IPAQ) was used to calculate an activity level index. Pain sensitivity was assessed via quantitative sensory testing (QST) at the right lower extremity. RESULTS: Moderate (U = 688, p< 0.05) and vigorous (U = 649, p< 0.05) physical activity levels were higher in pain-free vs. individuals with CLBP. Activity level was not associated with pain sensitivity (Pain-free: R2 = 0.02, p> 0.05; CLBP: R2 = 0.01, p> 0.05). Both moderate (R2 = 0.49, p< 0.05) and vigorous (R2 = 0.68, p< 0.01) physical activity were associated with pain modulation amongst pain-free individuals. CONCLUSIONS: Findings suggest that physical activity influences pain modulation amongst pain-free individuals, however no relationship exists once CLBP is present. However, future investigation will elucidate the extent to which physical activity level either prevents CLBP or is effective in alleviating CLBP. Show more

Keywords: Physical activity, pain modulation, chronic low back pain

DOI: 10.3233/BMR-150429

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 3, pp. 575-581, 2017

Authors: Hotfiel, T. | Carl, H.D. | Wendler, F. | Jendrissek, A. | Heiß, R. | Swoboda, B.

Article Type: Research Article

Abstract: BACKGROUND: Plantar pressure leads to stress on plantar tissue and can be seen as risk factor for metatarsal stress fractures or plantar ulcers and is associated with prolonged and complicated recurrence of existing tissue damages. A clear demarcation of a systematic raise of body load regarding its effect on plantar pressure has not been described. OBJECTIVE: Assessing plantar pressure patterns in different conditions of body weight, comparing data to initial body weight. METHODS: Seventeen healthy volunteers were asked to participate. Peak pressure values were assessed during walking with dynamic pedobarography and analysed from …three foot sections. Body weight was loaded up gradually with 10%, 20% and 30% of the individual initial weight by using a weighted vest. RESULTS: We were able to detect a statistically significant increase of plantar pressure for all foot regions in case of loaded body weight of 20% and 30% comparing to initial weight (p< 0.05). The midfoot area displays a significant increase for peak pressure for the preferred foot even for 10% body load. CONCLUSIONS: Peak plantar pressure increases with loaded body weight. The midfoot area seems to be a sensitive area in case of adapting increasing foot load. Considering the clinical relevance, loaded body weight has to be seen as risk factor for increasing plantar pressure patterns and should be considered in recurrence of plantar ulcers or stress fractures. Show more

Keywords: Plantar pressure, body weight, stress fractures, plantar ulcers

DOI: 10.3233/BMR-150442

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 3, pp. 583-589, 2017

Authors: Bornemann, R. | Jansen, T.R. | Otten, L.A. | Sander, K. | Wirtz, D.C. | Pflugmacher, R.

Article Type: Research Article

Abstract: BACKGROUND: In case of complex vertebral fractures, posterior fixation is often required for correction of deformity and instability. Fixation is commonly supported by balloon kyphoplasty (BKP) anterior. A development of BKP is radiofrequency-targeted vertebral augmentation (RF-TVA), which leads to comparable results for augmentation and pain relief. OBJECTIVE: This prospective study evaluates the outcome of posterior fixation combined with RF-TVA or BKP, respectively. METHODS: VAS, ODI, kyphosis angle and vertebral height of 44 patients were evaluated preoperatively, 3 and 12 months postoperatively. RESULTS: Both treatments improved vertebral height and kyphosis angle. …At 12 months, vertebral height restoration was still significantly better in the BKP group (p < 0.001) and the improvement of kyphosis angle was comparable between both groups (p = 0.71). VAS and ODI improvements were significantly better in the RF-TVA group (p < 0.001). 8% of BKP patients had cement extravasations, compared to 10.5% in the RF-TVA group (p = 1.0). CONCLUSIONS: Combining posterior fixation with RF-TVA leads to better results of VAS and ODI, whereas the vertebral height restoration was favorable for patients treated with BKP. Cement leakage was comparable between both groups. It was asymptomatic and within reported ranges. Limitations of this study are the patient number and different stabilization instrumentation. Show more

Keywords: Radiofrequency kyphoplasty, balloon kyphoplasty, vertebral fractures, posterior fixation, RFK, RF-TVA, BKP

DOI: 10.3233/BMR-140224

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 3, pp. 591-596, 2017

Authors: Çolak, Tuğba Kuru | Akgül, Turgut | Çolak, ılker | Dereli, Elif Elçin | Chodza, Mehmet | Dikici, Fatih

Article Type: Research Article

Abstract: BACKGROUND: Quality of life and cosmethic appearance have gained importance as outcomes in AIS treatment. Improving aesthetic appearance and quality of life are defined as the primary aims of scoliosis treatment by health professionals. Studies that assess and compare the different treatment results in the field of quality of life and cosmethics are some what limited. OBJECTIVE: A cross-sectional study was designed to compare quality of life and deformity perception in patients with adolescent idiopathic scoliosis (AIS) received conservative (exercise or exercise + brace) or surgical treatment. METHODS: A total of 68 (58 …females) patients aged 10-18 years with AIS received conservative (exercise or exercise+brace) or surgical treatment were invited to participate in the study. Quality of life (Scoliosis Research Society-23 (SRS-23)) and perception of deformity (Walter Reed Visual Assessment (WRVAS)) were assessed. RESULTS: Conservatively treated patients had significantly superior scores in function domain of SRS-23 than surgically treated patients (exercise/surgery, exercise+brace/surgery; p= 0.009, 0.004). Otherwise, surgically treated patients had significantly superior scores in self-image (p= 0.000, 0.000), and satisfaction with management (p= 0.001, 0.006) domains of SRS-23, and WRVAS (p= 0.000, 0.000) than conservative groups. CONCLUSION: In addition to radiographic assessments, quality of life, aesthetic perception, functionality, satisfaction with management, psycho-social status should carefully be taken into consideration by health professionals in the teratment of AIS. Show more

Keywords: Adolescent idiopathic scoliosis, quality of life, perception, exercise, brace, surgery

DOI: 10.3233/BMR-160564

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 3, pp. 597-602, 2017

Authors: Resorlu, Hatice | Zateri, Coskun | Nusran, Gurdal | Goksel, Ferdi | Aylanc, Nilufer

Article Type: Research Article

Abstract: PURPOSE: To investigate the relation between chondromalacia patella and the sulcus angle/trochlear depth ratio as a marker of trochlear morphology. In addition, we also planned to show the relationship between meniscus damage, subcutaneous adipose tissue thickness as a marker of obesity, patellar tilt angle and chondromalacia patella. METHODS: Patients with trauma, rheumatologic disease, a history of knee surgery and patellar variations such as patella alba and patella baja were excluded. Magnetic resonance images of the knees of 200 patients were evaluated. Trochlear morphology from standardized levels, patellar tilt angle, lateral/medial facet ratio, subcutaneous adipose tissue thickness …from 3 locations and meniscus injury were assessed by two specialist radiologists. RESULTS: Retropatellar cartilage was normal in 108 patients (54%) at radiological evaluation, while chondromalacia patella was determined in 92 (46%) cases. Trochlear sulcus angle and prepatellar subcutaneous adipose tissue thickness were significantly high in patients with chondromalacia patella, while trochlear depth and lateral patellar tilt angle were low. The trochlear sulcus angle/trochlear depth ratio was also high in chondromalacia patella and was identified as an independent risk factor at regression analysis. Additionally, medial meniscal tear was observed in 35 patients (38%) in the chondromalacia patella group and in 27 patients (25%) in the normal group, the difference being statistically significant (P = 0.033). CONCLUSIONS: An increased trochlear sulcus angle/trochlear depth ratio is a significant predictor of chondromalacia patella. Medial meniscus injury is more prevalent in patients with chondromalacia patella in association with impairment in knee biomechanics and the degenerative process. Show more

Keywords: Chondromalacia patella, meniscal tear, trochlear morphology

DOI: 10.3233/BMR-160536

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 3, pp. 603-608, 2017

Authors: Reyhan, Aycan Çakmak | Dereli, Elif Elçin | Çolak, Tuğba Kuru

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: Low back pain is a common problem during pregnancy. Although the pain usually occurs in the third trimester, it might be seen in the first trimester, too. There are various types of applications for the treatment of low back pain during pregnancy. However, there is a lack of evidence for the effectiveness of each method. If there is not an obvious deficit, bed rest, exercise, conventional physiotherapy, using protective principles for the lumbar area are recommended, since the main and the only complaint is low back pain. It is aimed in the current review to investigate …the use of Kinesio tape in the low back pain seen during pregnancy and to review the literature related to this subject. CONCLUSION: There are only a few studies investigating the effect of Kinesio tape during pregnancy in the literature and they mostly did not aim to study the low back pain, further evidence and studies are needed to investigate the use of Kinesio tape for the low back pain seen during pregnancy as there is not evidence strong enough. Kinesiotape application aims to increase circulation and mobility, and regarding these gains decreased pain and increased performance are expected. Show more

Keywords: Kinesiotape, low back pain, physiotherapy, pregnancy

DOI: 10.3233/BMR-160584

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 3, pp. 609-613, 2017

Authors: Hauswirth, Jürg | Ernst, Markus J. | Preusser, Marianne Lanz | Meichtry, André | Kool, Jan | Crawford, Rebecca J.

Article Type: Research Article

Abstract: BACKGROUND: Lateral gliding cervical spine mobilisation is shown to improve shoulder pain, disability and function. However, despite common clinical-use, no study reports the effect of unilateral anterior-posterior (A-P) cervical mobilisation on shoulder pain and function, and particularly in patients after arthroscopic shoulder surgery. OBJECTIVE: Examine the immediate effect of single-level Grade III cervical unilateral A-P mobilisation on shoulder pain, flexion and abduction range of motion (ROM) and external rotator strength compared to placebo cervical unilateral A-P light touch pressure. METHODS: Single session intervention with a crossover design in 32 (15 women) postoperative arthroscopic …shoulder patients. RESULTS: Immediate and superior treatment effects were shown for A-P cervical mobilisation in improving flexion ROM, isometric strength of external rotation, and pain intensity during flexion (all p< 0.05) when compared to the placebo. However, effects may not be considered clinically meaningful. CONCLUSION: Unilateral A-P mobilisation applied to the cervical spine shows a tendency toward positively influencing post-arthroscopy shoulder pain and function. Further study examining cervical mobilisations directed in different planes to influence shoulder motion appear warranted. Show more

Keywords: Shoulder arthroscopy, cervical spine mobilisation, pain, range of motion, isometric strength

DOI: 10.3233/BMR-160566

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 3, pp. 615-623, 2017

Authors: Feng, Qiang | Jiang, Chongmin | Zhou, Yu | Huang, Yun | Zhang, Ming

Article Type: Research Article

Abstract: CONTEXT: Non-specific back pain has become a public health problem affecting adolescent health. OBJECTIVE: To examine the relationships between abnormalities in spinal morphology and non-specific back pain among adolescents. DESIGN: Cross-sectional study. SETTING: Junior and senior high schools. PATIENTS: Participants were screened using a questionnaire regarding back pain. Students in the pain group (n= 273, 121 boys and 152 girls) reported experiencing upper and/or lower back pain within the previous month, and those who did not report pain were assigned to the group without pain (n= 127, …63 boys and 64 girls). Participants who had experienced acute upper and/or lower back injuries within the previous month or received a definitive diagnose of disease were excluded. METHODS: The SpinalMouse® was used to measure the thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), sacrum/hip angle (SA), and incline angle (INA) in both the standing position and sitting position. The SpinalMouse® also was used to measure the sacral, thoracic, and lumbar range of motion (ROM) in the fully flexed position and fully extended position in the sagittal plane. The thoracic and lumbar ROM in left/right lateral flexion was recorded. The Matthiass test was used to assess changes in the measured angles upon loading. RESULTS: Among junior high school students, 47.0% of boys and 53% of girls had an abnormal TKA. Among senior high school students, 52.6% of boys and 46.99% of girls had an abnormal TKA. The incidence of LLA abnormality was significantly higher among junior high boys than girls (p< 0.05), as was the incidence of hypolordosis (p< 0.05). Significantly fewer senior high boys than girls had a normal LLA value (p< 0.05). An excessive TKA (p< 0.05, odds ratio = 1.236) and limited lumbar ROM (p< 0.01, odds ratio = 0.975) were correlated with back pain in adolescents. CONCLUSIONS: The incidences of TKA and LLA abnormality are high among Chinese adolescents, and an excessive TKA and insufficient total lumbar ROM may be risk factors for non-specific back pain in adolescents. Show more

Keywords: Adolescence, lumbar lordosis angle, non-specific back pain, spinal morphology, spinal function, SpinalMouse, thoracic kyphosis angle

DOI: 10.3233/BMR-160544

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 3, pp. 625-633, 2017

Authors: Mishra, Sudhir Ramkishore | Shastri, Mona | Ramesh, Jaishree

Article Type: Case Report

Abstract: Hurler syndrome is an inherited autosomal recessive disorder of lysosomal accumulation of un-degraded glucosaminoglycan secondary to deficiency of a-L-Iduronidase enzyme. It is most severe form of Mucopolysaccharidosis with incidence of 1:100 000. It has multisystemic involvement leading to multiple deformity, disability and death within 10th years of life. A 2 year old boy presented with umbilical hernia, gross developmental delay and a progressive spinal deformity. On detailed clinical, radiological and laboratory investigation he was diagnosed as Hurler's syndrome. Till date only treatment available is enzyme replacement therapy which is neither cost effective nor easily available. Thus a multidisciplinary rehabilitation …team set a goal oriented and well-coordinated approach and successfully rehabilitated the patient. To conclude early diagnosis, multidisciplinary, goal oriented and well-coordinated, rehabilitation team can be key in management of hurler syndrome. Show more

Keywords: Hurler syndrome, mucopolysaccharidosis, a-L-Iduronidase

DOI: 10.3233/BMR-150317

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 3, pp. 635-639, 2017

Authors: Shariat, Ardalan | Lam, Eddie T.C. | Shaw, Brandon S. | Shaw, Ina | Kargarfard, Mehdi | Sangelaji, Bahram

Article Type: Research Article

Abstract: STUDY DESIGN: True experimental design. BACKGROUND: The back squat is an integral aspect of any resistance training program to improve athletic performance. It is also used for injury prevention of the lower limbs. OBJECTIVE: The purpose of this study was to examine the effect of back squat training at different intensities on strength and flexibility of the hamstring muscle group (HMG). METHODS: Twenty-two male recreational bodybuilders with at least two years of experience in resistance training were recruited to participate in a nine-week training program. They were randomly …assigned to a heavy back squat group (90-95% of one repetition maximum) or a moderate-intensity back squat group (60-65% of one repetition maximum). RESULTS: The heavy back squat group resulted in a significantly (p < 0.001) increased in one repetition maximum strength but a significant (p < 0.001) reduction in HMG flexibility when compared to their counterparts. The results of the study indicate that while a heavy back squat training program is effective in improving strength, it has an adverse effect on the flexibility of the HMG. CONCLUSION: The implication of this study is that there is a tradeoff between strength and flexibility and trainers should select the appropriate training protocols for their athletes to maximize athletic performance. Show more

Keywords: High-intensity, injury, resistance training, maximum strength, multi-joint

DOI: 10.3233/BMR-160526

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 3, pp. 641-647, 2017