Journal of Back and Musculoskeletal Rehabilitation - Volume 30, issue 5

Authors: Villafañe, Jorge Hugo | Perucchini, Davide | Cleland, Joshua A. | Barbieri, Cristina | de Lima e Sá Resende, Fernanda | Negrini, Stefano

Article Type: Research Article

Abstract: BACKGROUND: Whiplash Associated Disorders (WAD) is a biopsychosocial problem, education may be an essential part in the treatment and the prevention of chronic WAD. However, it is still unclear which type of educative intervention has already been used in WAD patients and how effective such interventions are. OBJECTIVE: To examine the effectiveness of a cognitive behavioral exercises approach (CBEA) for self-training of the neck relative to usual care in individuals with WAD in acute phase. METHODS: Forty-one patients, 65.9% female (mean ± SD age: 41 ± 11 years), …with WAD were recruited immediately after the accident (within 48 hours) and assigned according to patient choice to receive a CBEA self-training of the neck or usual care for 15 days. The primary outcome measure was pain intensity and disability as measured with the Neck Disability Index (NDI). Secondary outcome measures included the presence of headaches, dizziness, nausea, and difficulties with concentration and memory. Measurements were taken at pre-treatment, 2 weeks post-treatment and 4- and 12- weeks after the injury. RESULTS: Patients receiving the CBEA intervention experienced a greater reduction in pain as compared to those receiving the usual care at the end as well as 4 and 12 weeks after the intervention (P < 0.001), for the Neck Disability Index (NDI) decreased more in the CBEA than controls over the 15 days and (F= [ 3.0 ] 552.383; P = 0.001), and in both groups at all follow-up periods (all, P = 0.001). CONCLUSIONS: This quasi-experimental clinical trial provides evidence that a CBEA for self-training of the neck may be more beneficial in treating pain than usual care in patients with WAD. However, the CBEA had limited value in improving NDI. Future studies should include several therapists, a measure of a long-term outcomes and randomize patients to groups. Show more

Keywords: Whiplash, cognitive-behavioural exercises, neck

DOI: 10.3233/BMR-140162

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 943-950, 2017

Authors: Kim, Dong-Gyu | Chung, Sin Ho | Jung, Ho Bal

Article Type: Research Article

Abstract: BACKGROUND: Cervical radiculopathy (CR) is a disease of the cervical spine and a space-occupying lesion that occurs because of pathological problems with cervical nerve roots. Nerve root injury to produce functional disability. OBJECTIVE: The purpose of this study was to examine the effects of neural mobilization with manual cervical traction (NMCT) compared with manual cervical traction (MCT) on pain, functional disability, muscle endurance, and range of motion (ROM) in individuals with CR patients. METHODS: A blinded randomized clinical trial was conducted. Thirty CR patients were divided into two groups – those who received NMCT …and those who received MCT. The intervention was applied three times per week for eight weeks. It was measured in order to determine the pain and functional disability in patients with CR. The numeric pain rating scale (NPRS), neck disability index (NDI), ROM, and deep flexor endurance of patients were measured prior to the experiment, four weeks, and eight weeks after the experiment to compare the time points. A repeated-measures analysis of variance was used to compare differences within each group prior to the experiment. And Bonferroni test was performed to examine the significance of each time point. RESULTS: There were significant differences within each group prior to the intervention, four weeks after the intervention, and eight weeks after the intervention in NPRS, NDI, ROM, and deep flexor endurance (P < 0.05). NPRS and NDI more decreased, and, ROM and deep flexor endurance increased in the NMCT group than the MCT group (P < 0.05). CONCLUSIONS: These results suggest that the NMCT can pain relief, recovery from neck disability, ROM, and deep flexor endurance for patients with CR. Show more

Keywords: Radiculopathy, mobilization, traction

DOI: 10.3233/BMR-140191

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 951-959, 2017

Authors: Alghadir, Ahmad | Zafar, Hamayun | Iqbal, Zaheen A.

Article Type: Research Article

Abstract: BACKGROUND: Estimation of handgrip strength (HGS) is routinely used by clinicians and epidemiologists for objective assessment of functional status of hand and upper extremity. It is also used as an indirect indicator of overall physical strength and health status in variety of clinical situations and chronic general medical conditions. OBJECTIVE: The present study was conducted to examine the effects of upright and slouch sitting postures and voluntary teeth clenching on hand grip strength in healthy young male subjects. METHODS: One hundred healthy young males (aged 18–30 years) participated in this study. The HGS …was measured using a commercially available dynamometer for the dominant hand. The HGS was measured during four test conditions; (a) slouch sitting without teeth contact, (b) slouch sitting with teeth clenching, (c) upright sitting without teeth contact, and (d) upright sitting with teeth clenching. RESULTS: The HGS values were significantly higher during slouch than upright sitting posture, both during similar and opposite teeth related conditions (p < 0.001). Teeth clenching had no effect on the in HGS values during slouch or upright sitting posture (P > 0.05). CONCLUSIONS: As compared to upright sitting, higher HGS values can be obtained during slouch sitting in young healthy males. Teeth clenching does not affect the HGS values during slouch or upright sitting posture. Show more

Keywords: Hand grip strength (HGS), sitting posture, teeth clenching

DOI: 10.3233/BMR-150278

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 961-965, 2017

Authors: Horasanli, Bahriye | Hasturk, Askin Esen | Arikan, Murat | Togral, Guray | Helvacioglu, Fatma | Dagdeviren, Atilla | Mut, Senem | Harman, Ferhat | Argun, Guldeniz

Article Type: Research Article

Abstract: BACKGROUND: Vitamin B12 and alpha lipoic acid (ALA) are known to promote functional and morphological recovery after peripheral nerve injury. OBJECTIVE: To compare the regenerative and neuroprotective effects of vitamin B12 and ALA treatment after sciatic nerve injury. METHODS: A total of 40 rats were randomly assigned to control (sciatic nerve exposure without injury or anastomosis), sham (sciatic nerve injury and epineural anastomosis were performed but no treatment was administered), PS (isotonic saline was administered for 12 weeks after surgery), ALA (2 mg/kg ALA was administered for 12 weeks after surgery), and vitamin B12 groups …(2 mg/kg cyanocobalamin was administered for 12 weeks after surgery). Functional recovery was determined by footprint analysis, in vivo neurophysiology, and ex vivo histopathological examination. RESULTS: ALA treatment produced significant improvements in sciatic functional index values and non-significant improvements on electroneuromyography compared to vitamin B12 treatment. Upon histopathological examination, the regenerative effects of ALA were relevant to axonal structural recovery whereas vitamin B12 produced greater improvements in edema and myelination. CONCLUSIONS: While both vitamin B12 and ALA produced improvements after sciatic nerve injury, ALA was more functionally effective. The unique ultrastructural effects of vitamin B12 and ALA treatment should be considered in future studies. Show more

Keywords: Alpha lipoic acid, cyanocobalamin, sciatic nerve injury, neuroprotection, nerve regeneration, electroneuromyography

DOI: 10.3233/BMR-150386

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 967-974, 2017

Authors: Senturk, Ekrem | Sahin, Erkan | Serter, Selim

Article Type: Research Article

Abstract: PURPOSE: To compare the short-term effect of prolotherapy and conservative terapy for the Tietze syndrome. PATIENTS AND METHODS: From 2013 to 2014, twenty-one patients underwent prolotherapy (group 1) and thirteen underwent conservative therapy with analgesics (group 2). A visual analogue score (VAS) was recorded for measurement of pain intensity in all patients before (Pre VAS) and after injection first day (VAS1), first week (VAS2) and fourth week (VAS3). Group 2 were received systemic nonsteroidal anti-inflammatory drug. VAS score was recorded similarly at the same times (Pre VAS, VAS1, VAS2, VAS3), and clinical affects were compared between …the two groups. RESULTS: The mean VAS score (mm) before prolotherapy was 7.10 in patients who received prolotherapy, and 7.14 mm in patients who treated nonsteroidal anti-inflammatory drug. The mean VAS after the fist injection was 2.19 mm and dropped to 1.52 mm after the third injection. The mean VAS after the nonsteroidal anti-inflammatory drug treatment dropped 2.62 mm and during the same scores to 3 weeks later. There was no significant difference between the group 1 and group 2 in the age, sex and comorbidity. Also there was no significant difference between the group 1 and group 2 in clinical and radiological evidence. The prolotherapy group showed a faster recovery, including significantly reduced clinic findings (p: 0.001). Third VAS is significant finding for the prolotherapy group. CONCLUSION: Prolotherapy could be performed safely and is a method with a favorable long term treatments for Tietze Syndrome. It may be the ideal procedure for patients with drugs side effects and advers events especially for those with limited liver and kidney reserve or significant comorbidities. Show more

Keywords: Pain, Tietze syndrome, prolotherapy

DOI: 10.3233/BMR-159269

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 975-978, 2017

Authors: Ng, How Hing | Lin, Wen-Yen | Lei, Kin Fong | Cheng, Chih-Hsiu | Jeng, Shiau-Chian | Lin, Yang-Hua

Article Type: Research Article

Abstract: BACKGROUND: Mechanomyography (MMG) has been used to investigate mechanical characteristics of muscle contraction in clinical and experimental settings. OBJECTIVE: The aim of this study was to determine the test-retest reliability of mechanomyographic amplitude (MMG RMS ) measurements as a tool for measuring the maximal voluntary isometric contractions (MVICs) of trunk muscles in healthy participants. METHODS: There were ten young adults participating in this study. Accelerometers were used to detect surface MMG signals from three trials of 5-s MVICs of the rectus abdominis, external obliques, erector spinae, and multifidus in the …vertical, transverse, and longitudinal directions. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change were calculated. RESULTS: Good to excellent test-retest reliability of mechanomyographic amplitude (MMG RMS ) measurements was achieved for all MVICs of trunk muscles in healthy participants, as indicated by ICCs ranging from 0.99 to 0.64 for MMG RMS of the trunk muscles during MVIC. CONCLUSIONS: This study demonstrates that MMG is a reliable measurement to detect the activation amplitudes of trunk muscles during MVIC. Show more

Keywords: Test-retest reliability, mechanomyography, trunk muscle, maximal voluntary isometric contraction

DOI: 10.3233/BMR-159364

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 979-985, 2017

Authors: Öztürk, Gökhan Tuna | Erden, Ender | Yalçın, Süha | Bölük, Hüma | Karabay, İlkay | Sümer, Gözde | Durmuş, Ebru | Ersöz, Murat | Kara, Murat

Article Type: Research Article

Abstract: BACKGROUND: Although the long-term survival and related predictors have been identified in stroke patients, there is little evidence about the mortality rates and its associated factors in stroke patients treated in rehabilitation units. OBJECTIVE: To evaluate 5-year mortality rates of patients with stroke and its relationship with the clinical characteristics after inpatient subacute-chronic rehabilitation. METHODS: The files of 1016 stroke patients (482 male, 534 female) who received inpatient rehabilitation program were examined retrospectively. Patients’ characteristics and functional ambulation category were recorded at the end of the rehabilitation program. The survival probability was estimated …using the Kaplan-Meier method and the univariate effects of predictors were determined using the log-rank test. The possible factors determined with univariate analyses were checked in the Cox regression analysis. RESULTS: A total of 273 patients (32%) died within 5 years after stroke. Age (p < 0.001, RR: 1.06, 95% CI: 1.05–1.08), presence of coronary artery disease (p = 0.003, RR: 1.53, 95% CI: 1.16–2.03) and poor walking ability (p < 0.001, RR: 2.06, 95% CI: 1.49–2.86) were independent prognostic factors for increased mortality. CONCLUSIONS: About one-third of the rehabilitation patients died within 5 years after stroke. As independent ambulation was a strong predictor for long-term survival, it should be provided via rehabilitation techniques. Future studies are proposed to determine the effects of rehabilitation methods on mortality rates. Show more

Keywords: Stroke, rehabilitation, survival analysis

DOI: 10.3233/BMR-160534

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 987-990, 2017

Authors: Cheever, Kelly M. | Myrer, J. William | Johnson, A. Wayne | Fellingham, Gilbert W.

Article Type: Research Article

Abstract: BACKGROUND: Inconsistencies in the literature concerning the effect of neck pain have led to a lack of understanding concerning the complete pathophysiology of neck pain. While the effect of neck pain on motor function as measured by active range of motion and isometric neck strength is well documented the effect of neck pain on sensory measures such as tactical acuity and neck reposition error (NRE) remain poorly understood. OBJECTIVE: The purpose of this study was to evaluate a combined sensorimotor evaluation to explore the potential benefits of incorporating both sensory and motor task into a physical …evaluation of neck pain suffers to gain an added knowledge of the complete pathophysiology of their health status. METHODS: A cross-sectional study that measured neck joint reposition error, tactical acuity, neck isometric strength and range of motion in 40 volunteer participants (22 pain, 18 control). RESULTS: A statistically significant increase in NRE in flexion (2.75 ∘ ± 1.52 ∘ vs. 4.53 ∘ ± 1.74 ∘ and in extension (3.78 ∘ ± 1.95 ∘ vs 5.77 ∘ ± 2.73 ∘ in participants suffering from neck pain was observed. Additionally, the dermatome C5 was found to be the most affected. No differences were found in neck strength or neck range of motion between healthy controls and patients with chronic moderate neck pain. Show more

Keywords: Tactile acuity, neck reposition error, isometric neck strength, range of motion, two-point discrimination, proprioception training

DOI: 10.3233/BMR-169535

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 991-997, 2017

Authors: Kim, Byungho J. | Kim, Taeyeong | Ahn, Junghoon | Cho, Heecheol | Kim, Dongyun | Yoon, Bumchul

Article Type: Research Article

Abstract: BACKGROUND : Studies have shown late post-operative physical disability and residual pain in patients following lumbar disc surgery despite growing evidence of its beneficial effects. Therefore, rehabilitation is required to minimise the late post-operative complications. OBJECTIVE: To assess the feasibility of manipulative rehabilitation to improve late post-operative outcomes. METHODS: Twenty-one patients aged 25–65 years undergoing lumbar microdiscectomy were randomly assigned to the rehabilitation group (n = 14) or active control group (n = 7) by simple randomisation. Eight rehabilitation sessions were initiated 2–3 weeks after …surgery. Thirty-minute sessions were conducted twice weekly for four weeks. Post-operative physical disability and pain were assessed at baseline and at the two-year follow-up. RESULTS: Post-operative physical disability improved more in patients who had undergone rehabilitation than in those who had received control care (63% vs. - 23%, P < 0.05). Post-operative residual low back and leg pain were alleviated in the treatment group (26% and 57%, respectively), but intensified in the control group (- 5% and - 8%, respectively). CONCLUSIONS: This study demonstrated the potential of manipulative rehabilitation and importance of post-operative management after lumbar disc surgery. Definitive trials with larger sample sizes are required to confirm the feasibility and potential therapeutic effectiveness of this approach. Show more

Keywords: Lumbar microdiscectomy, post-operative disability, post-operative residual pain, manipulative rehabilitation

DOI: 10.3233/BMR-169546

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 999-1004, 2017

Authors: Hanney, William J. | Puentedura, Emilio J. | Kolber, Morey J. | Liu, Xinliang | Pabian, Patrick S. | Cheatham, Scott W.

Article Type: Research Article

Abstract: INTRODUCTION: Myofascial pain is a common impairment treated with various manual interventions including spinal thrust manipulation and stretching; however, the comparative efficacy of each intervention is uncertain. Therefore, the purpose of this investigation was to evaluate thrust manipulation targeting the cervicothoracic junction compared to a manual stretch of the upper trapezius muscle on cervical range of motion and upper trapezius pressure pain thresholds (PPTs). METHODS: Healthy participants with no significant history of neck pain were randomized into a thrust manipulation group, a stretching group, or a control group. Within group differences were evaluated via a dependent …t -test, and group by time interactions were evaluated by a two-way repeated measures ANOVA. RESULTS: One hundred and two participants were recruited to participate. Baseline demographics revealed no significant differences between groups. Significant group by time interactions were found for changes in PPTs for both the right and left upper trapezius. Also, significant differences were found for changes in cervical extension, as well as right and left cervical side bending favoring the treatment groups. DISCUSSION: This study demonstrates the potential independent effectiveness of spinal thrust manipulation or stretching for reducing PPTs at the upper trapezius. Future research should further evaluate the limitation of PPTs as a measure of muscle sensitivity as well as factors that may contribute to variability in the measurements among individuals seeking care. Show more

Keywords: Algometry, pressure pain threshold, spinal manipulation, stretching

DOI: 10.3233/BMR-169573

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1005-1013, 2017

Authors: Demirel, Aynur | Yorubulut, Mehmet | Ergun, Nevin

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVES: The aim of the study determining whether or not Non-invasive Spinal Decompression Therapy (NSDT) was effective in resorption of herniation, increasing disc height in patients with lumbar disc herniation (LHNP). METHODS: A total of twenty patients diagnosed as LHNP and suffering from pain at least 8 weeks were enrolled to the study. Patients were allocated in study (SG) and control groups (CG) randomly. Both groups received combination of electrotherapy, deep friction massage and stabilization exercise for fifteen session. SG received additionally NSDT different from CG. Numeric Anolog Scale, Straight leg raise test, Oswestry …Disability Index (ODI) were applied at baseline and after treatment. Disc height and herniation thickness were measured on Magnetic Resonance Imagination which performed at baseline and three months after therapy. RESULTS: Both treatments had positive effect for improving pain, functional restoration and reduction in thickness of herniation. Although reduction of herniation size was higher in SG than CG, no significant differences were found between groups and any superiority to each other (p > 0.05). CONCLUSIONS: This study showed that patients with LHNP received physiotherapy had improvement based on clinical and radiologic evidence. NSDT can be used as assistive agent for other physiotherapy methods in treatment of lumbar disc herniation. Show more

Keywords: Intervertebral disc displacement, pain, rehabilitation, exercise, traction

DOI: 10.3233/BMR-169581

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1015-1022, 2017

Authors: Soliman, Elsadat Saad | Shousha, Tamer Mohamed | Alayat, Mohamed Salaheldien

Article Type: Research Article

Abstract: BACKGROUND: Deficits of dynamic balance in chronic low back pain patients have been reported by different studies in terms of impaired postural control. However, they excluded the degree of pain as a determinant affecting dynamic balance. OBJECTIVE: To evaluate the effect of pain intensity on dynamic balance control in terms of postural stability indices (PSIs) and limits of stability (LOS) in chronic LBP patients. METHODS: Sixty subjects (38 men, 22 women) participated in the current study, 45 patients with chronic LBP were selected randomly and served as the chronic LBP group while 15 …healthy subjects served as the asymptomatic group (AS). The chronic LBP group was further classified in terms of pain intensity into 3 subgroups; low pain (LP), moderate pain (MP) and severe pain (SP) subgroups. The Biodex Balance System was used to measure the dynamic balance control (PSIs and LOS). RESULTS: Statistical significant differences were found among AS group and chronic LBP subgroups in PSIs and LOS. CONCLUSIONS: The intensity of pain has shown to be one of the determinants affecting dynamic balance in chronic LBP patients who showed differences in the impairment of PSIs and LOS with different degrees of pain. Show more

Keywords: Dynamic balance, chronic low back pain, pain

DOI: 10.3233/BMR-169588

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1023-1029, 2017

Authors: Sanal, Bekir | Korkmaz, Mehmet | Nas, Omer Fatih | Can, Fatma | Hacikurt, Kadir

Article Type: Research Article

Abstract: The main reason for waist and back pain in patients with gigantomasty is increased thoracic kyphosis and lumber lordosis. These symptoms and abnormal spinal angulations regress after reduction mammoplasty operations. However, the effect of chronic mechanical stress caused by gigantomasty on the spinal degenerative process is not clear yet. In this study with computed tomography it is shown that degenerative spondylosis is more widespread and severe in patients with large breasts.

Keywords: Gigantomasty, computed tomography, degenerative spondylosis

DOI: 10.3233/BMR-169600

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1031-1035, 2017

Authors: Kutilek, Patrik | Svoboda, Zdenek | Viteckova, Slavka | Hana, Karel | Vana, Zdenek

Article Type: Research Article

Abstract: BACKGROUND: Although a leg length inequality (LLI) has the effect on the performed movement, more complex indices for the evaluation of kinematic variables of postural stability and a symmetry of a muscle activity during standing in subjects with the LLI were never used before. OBJECTIVE: The objective is to present appropriate parameters for an evaluation of kinematic variables of postural stability and muscle activity during standing, i.e. to consider EMG signals, in patients with LLI. METHODS: New indices are offered, such as a sway velocity (i.e. the mCTSIB method) and a modified …symmetry index (SI), for a quantitative evaluation of EMG signals. The set of data for evaluating the effect of a heel lift was measured on patients with the LLI and healthy volunteers. RESULTS: Prior to the heel lift application, significant statistic differences were found between the mCTSIB of patients and the CG. These differences were no longer statistically significant after the heel lift was applied. As for the SI, the lowest values were found in the CG, while the greatest values were collected among patients before applying the heel lift. CONCLUSIONS: The results point out the benefits of using the newly applied indices in patients with the LLI. Both methods may become useful tools for the evaluation of the physical state of patients with the LLI in a medical practice. Show more

Keywords: Leg length inequality, heel lift, postural stability during standing, symmetry of muscle activity

DOI: 10.3233/BMR-169616

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1037-1044, 2017

Authors: Aydoğdu, Onur | Sari, Zübeyir | Yurdalan, S. Ufuk | Polat, M. Gülden

Article Type: Research Article

Abstract: INTRODUCTION: The aim of this study was to compare kinesio taping along with conventional treatment to conventional treatment alone and to report the results of both a single and repetitive kinesio taping application applied on quadriceps femoris and hamstring muscles on pain, range of motion, muscle strength, and functional status in patients with knee osteoarthritis. METHODS: Fifty-four patients with knee osteoarthritis were randomly allocated to two groups. A total of 28 patients were included in kinesio taping group, others were included in the control group. Before and after intervention, pain was measured with visual analog scale, …range of motion was measured with universal goniometer, muscle strength was measured with dynamometer, and functional status was measured with Knee Injury Osteoarthritis Outcome Score. RESULTS: There were statistically significant improvements in measures of pain, range of motion, quadriceps muscle strength and functional status between pre- and post-treatment in both groups (p < 0.05). In comparison, there were no significant differences with these parameters between groups (p > 0.05). It was also found that significant difference was observed in terms of range of motion, pain, functional status between pre-treatment and post-taping in intervention group (p < 0.017). CONCLUSION: In conclusion, we could report that kinesio taping has significant immediate effects after a single kinesio taping application on range of motion, pain and functional status in patients with knee osteoarthritis. We could also report that KT in addition to conventional treatment is not superior to conventional treatment alone in terms of clinical outcomes over 3 weeks later. Show more

Keywords: Kinesio taping, osteoarthritis, physiotherapy

DOI: 10.3233/BMR-169622

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1045-1051, 2017

Authors: Creighton, Douglas S. | Marsh, Doug | Gruca, Mark | Walter, Melissa

Article Type: Research Article

Abstract: BACKGROUND: Cervical mobilization and manipulation have been shown to improve cervical range of motion and pain. Cervical rotatory thrust manipulation has been associated with adverse patient reaction and damage to the V3 segment of the vertebral artery (VA). OBJECTIVE: To document and describe the effects of an upper cervical (UC) traction based mobilization on participants with restricted and painful cervical rotation and to document if the mobilization changed blood flow velocity through the vertebral artery. METHODS: This case series examined the effects of a traction based spinal mobilization on two different groups of …participants. Group I included 93 participants with restricted bilateral cervical rotation that was also painful at end range. Group II included 30 different participants whose VA blood flow velocity was examined during the same mobilization. Pre- and post-mobilization active cervical rotation, pain intensity levels, and VA blood flow velocity during mobilization was documented. RESULTS: Paired T-tests were used to determine statistical significance for changes in cervical rotation, and VA blood flow velocity during mobilization. Ninety-three participants in group I demonstrated an average increase of 16 degrees of cervical rotation. No participant demonstrated an increase in pain, and no participant in group II (N = 30) demonstrated a change in VA blood flow velocity. CONCLUSIONS: The application this UC traction based mobilization improved active cervical rotation, end range rotation pain response, did not cause pain during its application and did not alter blood flow through the VA during application. Show more

Keywords: Cervical mobilization, cervical manipulation, vertebral artery

DOI: 10.3233/BMR-169644

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1053-1059, 2017

Authors: Yildiz, Hulya Kurtul | Ekin, Elif Evrim

Article Type: Research Article

Abstract: BACKGROUND: Lumbar lordosis is required for bipedalism. OBJECTIVES: To investigate age-related changes in lumbar lordosis and to clarify the relationships between lumbar lordosis and vertebral wedging and disc degeneration. METHODS: A total of 300 women were included in this retrospective study, 50 in each of six age groups (20-, 30-, 40-, 50-, 60- and 70-year-olds). Patients with vertebral collapse, instable fracture or disc sequestration were excluded. In each patient, lumbar lordosis angle, posterior vertebral wedging, L5-S1 intervertebral disc angle, L5/L1 vertebral height ratio and L5-S1 intervertebral disc/L1-L2 intervertebral disc height ratio were examined. Significance …level was set at p < 0.05 and two-sided tests were used. RESULTS: Significant differences were found in lumbar lordosis according to age group (p < 0.001). Lumbar lordosis correlated most strongly with L4 posterior vertebral wedging, L5 posterior vertebral wedging and L5-S1 intervertebral disc angle, in that order (r = 0.50, r = 0.40, r = 0.32, respectively; p < 0.001). CONCLUSION: In this cohort, strong spinal structure was maintained during physiological aging from 20 to 40 years of age; lumbar lordosis increased by 50 years of age. Increased lordosis correlated with increased posterior vertebral wedging and loss of posterior disc height. Show more

Keywords: Lumbar lordosis, aging, vertebral wedge, bipedalism

DOI: 10.3233/BMR-169666

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1061-1067, 2017

Authors: Shin, Sun-Shil | Yoo, Won-Gyu | An, Duk-Hyun | Oh, Jae-Seop | Kim, Ki-Song | Kim, Tae-Ho | Choi, Jong-Sang

Article Type: Research Article

Abstract: BACKGROUND: Direction changes while walking are more likely to cause a hip fracture than is falling while walking in a straight line. Trunk stability is an important contributor to safe and effective walking, and arm movements influence trunk movement while walking. However, the difference in the trunk stability during semicircular turns performed by elderly women with a light bag has not been examined. OBJECTIVE: To investigate the effects of carrying a bag on trunk stability during semicircular turns in elderly women. METHODS: We enrolled 15 community-dwelling elderly women capable of independent walking. Participants …walked with and without a bag at a self-selected speed along a marked path, which included semicircular turns, while fitted with an accelerometer attached over the L3 spinous process. RESULTS: Gait velocity was faster during semicircular turning with a bag versus without a bag. The normalized medial-lateral center of mass acceleration was lower during semicircular turning with a bag versus without a bag. CONCLUSIONS: We suggest that a light additional arm load and increased arm swing contributes to trunk stability and efficient walking during semicircular turning by elderly women. Show more

Keywords: Center of mass acceleration, gait velocity, older adults, semicircular turning, trunk stability

DOI: 10.3233/BMR-169680

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1069-1074, 2017

Authors: Niederer, Daniel | Vogt, Lutz | Vogel, Johanna | Banzer, Winfried

Article Type: Research Article

Abstract: BACKGROUND: The potential to accurately perform cervical movements during more challenging tasks might be of importance to prevent dysfunctional motion characteristics. Although sensorimotor function during dual-task conditions are of increasing interest in biomedical and rehabilitation research, effects of such conditions on movement consistency of the neck have not yet been investigated. OBJECTIVE: In this crossover MiSpEx(Medicine in Spine Exercise)-diagnostic study, we aimed to explore differences between single and dual-task conditions on cervical movement variability. METHODS: Nineteen healthy participants (9 male; 24.5 ± 3.3 y) performed 10 repetitive maximal cervical movements …in (1) flexion/extension and (2) lateral flexion, during one single- and during two dual-task test conditions (cognitive, motor) in a randomised and cross-over sequence. Latter consisted of a working memory n-back task (n = 2) and a repetitive ankle movement task. Range of motion (RoM) was assessed using an external three-dimensional ultrasonic movement analysis system. Coefficient of variation (CV) for repetitive RoM was analysed for differences between conditions and controlled for variances in intra-individual movement characteristics. RESULTS: Friedman and post-hoc Bonferroni-adjusted confidence intervals for differences from single- to dual-task values revealed changes in CV in flexion/extension from single-task to motor dual-task (+ 0.02 ± 0.02 (97.5%CI: 0.01; 0.03); p < 0.05) but not to cognitive dual-task condition (+ 0.01 ± 0.02 (97.5%CI: 0.003; 0.02)) nor for lateral flexion (p > 0.05). Pearson regression analyses revealed a linear negative (p < 0.01) influence of CV in flexion/extension on differences from single to both cognitive (R= 2 0.47) and motor dual-task (R= 2 0.55). Results for lateral flexion are comparable, baseline CV negatively impacts differences to cognitive (R= 2 0.2) and motor dual-task performance (R= 2 0.76; p < 0.01). CONCLUSIONS: Participants with comparable low cervical CV at single-task display a profound increase during dual-task conditions while participants with a higher variability remained almost stable or showed a decrease. The results point toward a complex interrelationship of motion patterns and adaptation processes during challenging tasks in respect of cervical CV. Show more

Keywords: Kinematics, MiSpEx, motion analysis, coefficient of variation, dual-task

DOI: 10.3233/BMR-169699

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1075-1080, 2017

Authors: Cygańska, Anna | Truszczyńska-Baszak, Aleksandra | Drzał-Grabiec, Justyna | Tarnowski, Adam

Article Type: Research Article

Abstract: BACKGROUND: Playing violin may lead to overload of the locomotor system. OBJECTIVE: The aim of this study was to assess body parameters for trunk symmetry in child violinists and compare with the control group. METHODS: We analyzed body posture of 101 children aged 7–12 years, mean age 11.09 ± 9.46, 49 child violinists and control group of 52 children. RESULTS: We found statistically significant differences for the difference in depth of the lower corners of scapulae and upper posterior spina iliaca, though greater asymmetries were found in the …clinical control group. The remaining parameter values are close to significance, which may suggest that the process of postural change among the children had just started and that the existing asymmetries were easy to correct. We found positive correlation between body height and the difference in distance of the lower corners of scapulae from the spine: OL (p = 0.029, correlation coefficient value was 0.167) and the Thales triangle height: (p = 0.018, correlation coefficient was 0.214). CONCLUSIONS: Position maintained while playing the violin changed some parameters characterizing the curvature of the spine in frontal plane. We found the importance of detailed analysis of children body posture and its critical assessment. Show more

Keywords: Child, posture, musicians, spinal column

DOI: 10.3233/BMR-169700

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1081-1086, 2017

Authors: Köroğlu, Fahri | Çolak, Tuğba Kuru | Polat, M. Gülden

Article Type: Research Article

Abstract: BACKGROUND: Low back pain is one of the most important causes of morbidity. OBJECTIVE: This study was designed to evaluate the effect of Kinesio ® taping on pain, functionality, mobility and endurance in chronic low back pain treatment. METHODS: Patients with chronic low back pain were randomly divided into three groups. Therapeutic ultrasound, hot packs, and transcutaneous electrical nerve stimulation were applied to each group for ten sessions during two weeks, and therapeutic exercises were applied in the clinic under physiotherapist supervision starting from the sixth session. Kinesio ® …tape was applied to the patients in the first group after each treatment session, and placebo tape was applied to the patients in the second group. No taping was applied to the third group, which constituted the control group. All the patients were evaluated pre and post-treatment in respect of pain, functional status (Oswestry scale), flexibility and endurance. RESULTS: The study included 60 patients (32 females). When the initial demographic and clinical characteristics of the groups were evaluated, all assessment results, except the Oswestry scores, were similar (p = 0.000). When the average changes in the clinical evaluations were evaluated after the treatment, a statistically significant improvement demonstrating the superiority of the taping group was observed in pain, functionality, flexibility and endurance values (p = 0.000, 0.000, 0.000, 0.000). CONCLUSIONS: Kinesio ® taping in chronic low back pain is an easy and effective method which increases the effectiveness of the treatment significantly in a short period when applied in addition to exercise and electrotherapy methods. Show more

Keywords: Back pain, Kinesio® taping, physiotherapy

DOI: 10.3233/BMR-169705

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1087-1093, 2017

Authors: Maicki, Tomasz | Bilski, Jan | Szczygieł, Elżbieta | Trąbka, Rafał

Article Type: Research Article

Abstract: PURPOSE: The aim of this study was to evaluate the effectiveness of PNF and manual therapy methods in the treatment of patients with cervical spine osteoarthritis, especially their efficacy in reducing pain and improving functionality in everyday life. Long-term results were also compared in order to determine which method of treatment is more effective. SUBJECTS AND METHODS: Eighty randomly selected females aged 45–65 were included in the study. They were randomly divided into two groups of 40 persons. One group received PNF treatment and the other received manual therapy (MAN.T). To evaluate functional capabilities, the Functional …Rating Index was used. To evaluate changes in pain, a shortened version of the McGill Questionnaire was used. RESULT: The PNF group achieved a greater reduction in pain than the MAN.T group. The PNF group showed a greater improvement in performing daily activities such as sleeping, personal care, travelling, work, recreation, lifting, walking and standing as well as decreased intensity and frequency of pain compared to the MAN.T group. CONCLUSION: The PNF method proved to be more effective in both short (after two weeks) and long (after three months) term. Show more

Keywords: Chronic pain, neck pain, rehabilitation

DOI: 10.3233/BMR-169718

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1095-1101, 2017

Authors: Shah, Sweni | Balaganapathy, M.

Article Type: Research Article

Abstract: BACKGROUND: Among all musculoskeletal disorders back pain is the most common reason for functional limitation in working age. It is due to low back pain (LBP) that the ODI has become one of the principal outcome measures for evaluation of disability and has been widely used in research as well as in clinical practice. So far, validated Gujarati version of the ODI 2.1a has not been reported. OBJECTIVE: To accomplish the translation and validation of the Oswestry Disability Index (ODI) version 2.1a into the Gujarati language. STUDY DESIGN: Cross-sectional study. METHODS: …The validation of the ODI-Gujarati was tested in 120 patients diagnosed with non-specific LBP, who were receiving physiotherapy at a clinic in Gujarat, India. Data was collected at on initial visit and after 48 hours. During both visits, patients completed the Oswestry Disability Index-Gujarati (ODI-G), Roland-Morris Disability Questionnaire-Gujarati (RMDQ-G), and Visual Analogue Scale-Pain (VAS-P). RESULTS: Internal consistency was measured by Cronbach’s alpha. The Gujarati version indicated high internal consistency (α = 0.96). Test-retest reliability was measured by intra-class correlation coefficient and it revealed very high correlation (ICC = 0.92). Construct validity was confirmed by strong correlation with RMDQ-G (r = 0.76), and concurrent validity indicated moderate correlation with VAS-P (r = 0.50). Factor analysis explained that the ODI was loaded on 1 factor. CONCLUSION: The Oswestry disability index version 2.1a was successfully translated into Gujarati language, showing excellent psychometric properties. Therefore, it can be used in evaluating the disability amongst Gujarati population with LBP for both clinical and research purposes. Show more

Keywords: ODI-Gujarati version 2.1a, low back pain, reliability, validity

DOI: 10.3233/BMR-169728

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1103-1109, 2017

Authors: Aydin, Gülümser | Demir, S. Özbudak | Ekiz, Timur | İnanir, Murat | Tosun, Aliye

Article Type: Research Article

Abstract: OBJECTIVE: The aim of this study was to compare the biochemical parameters of the urine and blood in spinal cord injury (SCI) patients and healthy subjects. METHODS: Thirty male patients with SCI were enrolled. Biochemical features of the urine and blood of the SCI patients were compared to healthy subjects. Extracted stones were analyzed by X-ray diffraction. RESULTS: A total of 30 patients with SCI (mean age of 28.77 ± 7.3 years) and 10 healthy subjects (mean age of 27.6 + 6.2 years) were included. Among the patients …with SCI; 12 of them (40%) had urinary stones and 18 of them (60%) did not. Urinary stone was localized in the kidneys and bladder in 25% and 75% of the subjects, respectively. The mean duration of cord injury at diagnosis of urinary stone was 9.2 ± 6 months. Urine cultures obtained on admission were negative for the control group, while the microorganism isolation rate was 73.3% in the SCI group. The urinary excretion of citrate and Mg were lower in the patient group compared with control group (p = 0.008, p = 0.001, respectively). As for the diffraction analysis of eight stones; five (62.5%) of the stones were calcium oxalate, two (25%) of them were calcium phosphate, and one (12.5%) was magnesium ammonium phosphate. CONCLUSION: Both infection and metabolic changes play an important role in stones formation in SCI patients. The urinary excretion of citrate and Mg was decreased and urinary PH was increased in SCI patients. Show more

Keywords: Spinal cord injury, urolithiasis, bladder stone, crystallization inhibitor, magnesium, urinary tract infection, citrate

DOI: 10.3233/BMR-169747

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1111-1115, 2017

Authors: Karaahmet, Ozgur Zeliha | Gurcay, Eda | Sancioglu, Hande | Unlu, Ece | Cakci, Aytul

Article Type: Research Article

Abstract: Hysterical paralysis, a type of conversion disorder, presents with the loss of motor or sensory function. Although this disorder is nonorganic, it resembles the symptoms of a structural disease of the nervous system. It is generally associated with a traumatic or social event. The patients often require excessive testing and comprehensive assessment in exposing this psychogenic ailment. We reported the most dramatic type of conversion disorder, hysterical paralysis, in which full recovery was obtained with early recognition and rehabilitation approach including faradic stimulation.

Keywords: Hysterical paralysis, conversion motor disorder, rehabilitation, faradic stimulation

DOI: 10.3233/BMR-169764

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1117-1119, 2017

Authors: Lizis, Paweł | Kobza, Wojciech | Manko, Grzegorz

Article Type: Research Article

Abstract: BACKGROUND: Osteoarthritis (OA) of the knee is a degenerative, painful pathology, needing conservative treatment for symptoms’ relief. OBJECTIVE: Comparing the effects of Extracorporeal shockwave therapy (ESWT) and Kinesiotherapy (KIN) on perceived health and range of motion (ROM) of the affected knee. METHOD: A pilot randomized controlled trial with concealed allocation, assessor blinding, intention-to-treat analysis. Forty participants, aged 40–75 with OA of the knee were randomized to an ESWT and a KIN groups. The ESWT group completed 5 interventions for 5 weeks, the KIN group completed the same number of interventions. All evaluations were …performed at baseline and after the treatment for: perceived health (Western Ontario and McMaster Universities questionnaire – WOMAC), range of motion (ROM). RESULTS: After the intervention the statistical significant between groups differences favoring the ESWT were found in the WOMAC with regard to pain (p < 0.000), stiffness (p = 0.018), physical function (p < 0.000), total score (p < 0.000), extension and flexion of the affected knee (p = 0.015, p < 0.000) respectively. CONCLUSIONS: ESWT improves WOMAC and ROM better then KIN on the affected knee in patients with OA of the knee. Show more

Keywords: Extracorporeal shockwave therapy, kinesiotherapy, osteoarthritis of the knee

DOI: 10.3233/BMR-169781

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1121-1128, 2017

Authors: Chung, Jae Yoon | Kim, Sung Sun | Kim, Sung Kyu

Article Type: Research Article

Abstract: BACKGROUND: Malignant peripheral nerve sheath tumor (MPNST) arising in benign schwannoma with multiple intraosseous spinal metastasis is extremely rare, having a highly aggressive progression and poor prognosis. In such cases, the malignant cells of MPNST usually have an epithelioid morphology. Here, the authors present a very rare case of spindle cell type MPNST arising in benign schwannoma. CASE: A 47-year-old woman had a history of wide marginal excision of right buttock spindle cell sarcoma previously. However, metastatic lesions to C7, L1 body, and the right lung were detected during follow-up. Total spondylectomy and stabilization of …the C7 and L1 tumors were performed within an interval of 5 months. However, the patient expired 6 months after the last surgery. From analysis and study of three tumor specimens (right buttock, cervical and lumbar spine), the pathological diagnosis based on histomorphologic and immunohistochemical studies was spindle cell sarcoma, high grade, most consistent with MPNST arising in schwannoma. RESULTS : It is important that pathologists and surgeons recognize that spindle cell type MPNST may arise in benign schwannoma, as this recognition aids in assessment of patients with schwannoma and contributes to the pathologist making a more precise diagnosis, and the surgeon better determining the appropriate therapeutic options and surgical methods. Show more

Keywords: Malignant peripheral nerve sheath tumor, schwannoma, spindle cell, intraosseous metastasis, spine

DOI: 10.3233/BMR-169590

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1129-1135, 2017

Authors: Resorlu, Hatice | Inceer, Besir Sahin | Kılıc, Sevilay | Isık, Selda

Article Type: Research Article

Abstract: Pustulotic arthro-osteitis is a rare disease involving the skin and musculoskeletal system that was first described by Sonozaki. Onset is frequently seen at age 30–40. The prevalences between the sexes are similar. Palmoplantar pustulosis and sternoclavicular joint involvement are the most typical findings. It may be difficult to distinguish seronegative spondyloarthropathies and SAPHO syndrome due to sacroiliac joint, vertebral column and peripheral joint involvement. Arthritis being non-erosive and short-lived in character and the absence of deformity or contracture in the joints are significant clinical characteristics. Anti-inflammatory and immunesuppressive drugs are used in the treatment of the disease, the course of …which involves remission and flare-ups. We describe the case of a 43-year-old male patient diagnosed with pustulotic arthro-osteitis. Show more

Keywords: Pustulotic arthro-osteitis, sonozaki syndrome, colchicine

DOI: 10.3233/BMR-169646

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1137-1139, 2017

Authors: Lee, Dong Gyu | Cho, Yun Woo | Cho, Kil-Ho | Chang, Min Cheol

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: Nowadays, pulsed radiofrequency (PRF) is being used to control several types of musculoskeletal pain. Herein, we report a successful application of ultrasound (US)-guided PRF for a patient with refractory sciatic neuropathic pain. CASE REPORT: We applied US-guided PRF to a 50-year-old man, suffering from refractory neuropathic pain on the left foot following sciatic neuropathy for a period of approximately 6 months. We performed PRF on the level of piriformis muscle because the lesion of the sciatic nerve was presented digitally from the level of piriformis muscle on the magnetic resonance images. Under US …guidance, the catheter needle was placed close to the left sciatic nerve, and dysesthesia and tingling sensation were reported to be less than 0.2 V. The PRF treatment was administered at 5 Hz and 5 ms pulsed width for 360 seconds at 45 V. After PRF on the left sciatic nerve, pain intensity – based on a numeric rating scale – decreased from 8 to 2. The reduction of pain was sustained for at least 6 months after the PRF procedure. CONCLUSION: We concluded that the PRF treatment is a very useful treatment technique for patients with refractory sciatic neuropathy. Show more

Keywords: Sciatic neuropathy, neuropathic pain, pulsed radiofrequency, ultrasound

DOI: 10.3233/BMR-169724

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1141-1145, 2017

Authors: Yıldız, Davut | Ekiz, Timur | Doğan, Adil

Article Type: Research Article

DOI: 10.3233/BMR-169608

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 5, pp. 1147-1148, 2017