Journal of Back and Musculoskeletal Rehabilitation - Volume 31, issue 2

Authors: Burger, M. | Dreyer, D. | Fisher, R.L. | Foot, D. | O’Connor, D.H. | Galante, M. | Zalgaonkir, S.

Article Type: Research Article

Abstract: BACKGROUND: Ankle sprains are common musculoskeletal injuries in which the ligaments of the ankle partially or completely tear due to sudden stretching. OBJECTIVES: To critically appraise, evaluate and establish the best available evidence to determine the effectiveness of proprioceptive and neuromuscular training (PNT) compared to bracing in reducing the recurrence rate of ankle sprains in athletes. METHODOLOGY: The following seven databases were searched in June 2017: PubMed, Cochrane Library, PEDro, ScienceDirect, Scopus, SPORTDiscus, EBSCO Host: CINAHL. The main search terms used were “ankle sprains”, “proprioceptive training”, “neuromuscular training” and “bracing”. The quality of …the trials were critically appraised according to the PEDro scale. The RevMan 5 © software was used to pool results. RESULTS: Three studies met the inclusion criteria and the quality according to the PEDro scale ranged from 4/10–7/10. The pooled data showed no difference between PNT and bracing in reducing the recurrence rate of ankle sprains in athletes at 12 months after initiation of the study. CONCLUSION: This systematic review of the overall effect suggested that current evidence (Level II) does not favour the use of PNT over bracing in reducing the recurrence rate of ankle sprains. Physiotherapists are advised to use either PNT or bracing according to the patients preference and their own expertise. Show more

Keywords: Ankle sprains, proprioceptive training, neuromuscular training, bracing

DOI: 10.3233/BMR-170804

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 221-229, 2018

Authors: El-gohary, Tarek M. | Abd Elkader, Samiha M. | Emara, Hatem A. | Ibrahim, Mahmoud I. | Khaled, Osama A. | Ahmed, Mostafa S.

Article Type: Research Article

Abstract: BACKGROUND: Spinal muscles endurance is fundamental for providing adequate trunk stability. OBJECTIVE: The purpose of this study was to compare the side bridge static endurance ability of the right versus left side. METHODS: Forty right hand dominant students, aged between 18 and 25 years, were recruited from Taibah University. Every participant had to lie down on his side and bear trunk weight on the arm with shoulder abducted to 90 ∘ and elbow flexed to 90 ∘ . Every participant had to lift off his trunk …of the supporting surface, keeping the trunk straight in neutral position, breathing normally and holding on that position as long as tolerated. RESULTS: A paired sample t test was calculated. The mean score, in seconds, for right side bridge was 41.6 (SD = 30.08), and for left side bridge was 38.00 (SD = 26.93). No significant difference was found between right and left side bridge endurance ability [t (39) = 1.67, p > 0.05]. Pearson correlation showed high positive correlation [r (38) = 0.89, p < 0.001]. CONCLUSIONS: Among healthy participants, clinicians should expect very close endurance profile for the musculature of the two sides of trunk. Clinicians should equally train both sides of trunk muscles stabilizers in order to enhance tolerance. Show more

Keywords: Trunk endurance, static stability, stabilization exercises, healthy subjects

DOI: 10.3233/BMR-169538

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 231-237, 2018

Authors: Sardaru, Dragos Petrica | Matei, Daniela | Zaharia-Kezdi, Dan | Pendefunda, Liviu

Article Type: Research Article

Abstract: BACKGROUND: Sciatica-related Foot Drop is a peripheral nervous condition that produces a loss of power in the ankle dorsiflexion muscles. Functional electrical stimulation is a modality of electrical stimulation that produces muscle contraction in a functional movement of the limb. This technique was utilized with positive effects in central nervous afflictions but it is not known whether or not it has any influence in motor recovery following peripheral nervous system problems. This study aims to clarify the effects of functional electrical stimulation on foot drop caused by peripheral nerve compression resulting from lumbar disc herniation. METHODS: …Fifty patients were enrolled in our study; of whom 25 were treated with EMG triggered electrical stimulation (EMG-FES) and 25 with heel-floor sensor triggered electrical stimulation (SWITCH-FES) during normal gait cycle. Patients received functional electrical stimulation (with a pulse of 60 Hz and phase duration of 200 ms) once a day, for 30 minutes during 5 consecutive days, over a period of 4 weeks. Electrical diagnostic tests (nerve conduction velocity/NCV and the amplitude of compound muscle action potential/CMAP), dynamometry and Osvestry Disability Index scores were measured at baseline and after treatment. RESULTS: We found that axonal loss was lower in the EMG-FES group than in the SWITCH-FES group (p < 0.004). The motor functional recovery was higher in terms of muscle force and overall functional status for the EMG-FES group compared to the SWITCH-FES group. This was underlined by Dynamometry test with a p value of < 0.0001 and ODI score with a statistical significant p value of < 0.0001. CONCLUSIONS: The overall results showed that there was a significant increase in all the parameters studied for both types of FES applications. However we found that the EMG triggered electrical stimulation technique had a higher influence on the quality of the muscle action control. For patients who cannot yet produce minimal muscle active contraction we recommend switch triggered stimulation first and then, immediately after the recovery of the motor control, to change to EMG triggered functional electrical stimulation. Show more

Keywords: Functional electrical stimulation, foot drop, sciatica, lumbar disc herniation

DOI: 10.3233/BMR-169578

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 239-245, 2018

Authors: Akkan, Hakan | Gelecek, Nihal

Article Type: Research Article

Abstract: BACKGROUND: There is no consensus about treatment of neck patients who have radicular symptoms. OBJECTIVE: The purpose of the study was to investigate the effect of stabilization exercise training on pain and functional status in patients with cervical radiculopathy. METHODS: The patients (n = 32) with cervical radiculopathy were randomized to two groups as follows: Stabilization exercise group (Group 1; n = 18); Home-exercise group (Group 2; n = 16). The patients were evaluated with visual analog scale, …Neck Disability Index, SF-36 (Short-Form), Corbin postural assessment scale and hand grip at baseline, after treatment at 4th week and 3 rd month. RESULTS: At baseline, there were no statistically differences between groups in terms of evaluated parameters (p > 0.05). After treatment and three months later, pain and Neck Disability Index decreased; Corbin postural scores, hand grip and SF-36 scores improved statistically in both groups (p < 0.05). Changes of the measurements in both groups were similar and there were no significant differences between group 1 and group 2 at 4th week and 3rd month (p > 0.05) except postural scores. CONCLUSIONS: This study demonstrates that stabilization exercise training could be an effective intervention for decreasing pain and improving quality of life and posture in patients with cervical radiculopathy. Show more

Keywords: Cervical radiculopathy, neck pain, stabilization exercise, disability

DOI: 10.3233/BMR-169583

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 247-252, 2018

Authors: Onat, Şule Şahin | Ata, Ayşe Merve | Serrano, Simão | Shyu, Shaw-Gang | Constantino, João | Yalçın, Süha | Açıkel, Cengiz | Kara, Murat | Özçakar, Levent

Article Type: Research Article

Abstract: BACKGROUND: Assessment of the joint cartilage using ultrasound imaging is important. OBJECTIVE: Our aim was to investigate the reliabilities of ultrasonographic measurements for talus dome (TCT) and metacarpal cartilage thicknesses (MCT). METHODS: Twenty healthy volunteers were recruited in the study. Every day, five physiatrists measured eight joint cartilage thicknesses. They repeated all the measurements in five consecutive days. RESULTS: Intra-observer intraclass correlation coefficient (ICC) values were “excellent” for all MCTs, except for the 3 rd left MCT on the 1 st day, …4 th left MCT on the 1 st day and 4 th right MCT on the 3 rd day which were “good”. They were “excellent” for the TCT measurements, except for the left side on the 3 rd day and the right side on the 4 th day which were “good”. Inter-observer ICC values pertaining to the 2 nd MCT measurements were “excellent” for all sonographers. Third and 4 th MCT measurements (at least one side) were “excellent” for four and three sonographers, respectively. On the other hand, while TCT measurements were “excellent” for 4 sonographers. CONCLUSIONS: Our results have shown that sonographic measurements of MCT and TCT have good to excellent reliabilities in healthy adults. These findings support the use of ultrasound for cartilage assessment in various diseases. Show more

Keywords: Cartilage thickness, metacarpal, reliability, talus, ultrasound

DOI: 10.3233/BMR-169606

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 253-257, 2018

Authors: Jeon, Na-Young | Chon, Seung-Chul

Article Type: Research Article

Abstract: BACKGROUND: Shoulder stabilization exercises consisted of a glenohumeral stabilization and scapular stabilization. No studies have been assessed the superiority of shoulder stabilization until now. OBJECTIVE: To compare the effect of a glenohumeral stabilization exercise (GSE) combined with a scapular stabilization exercise (SSE) on changes in shoulder function in patients with shoulder pain METHODS: Shoulder stability, scapular alignment, pain, muscle power, and range of motion (ROM) were measured before and after the intervention in both groups. RESULTS: Forty subjects with shoulder pain were randomly assigned to an experimental or control group. …GSE in the experimental group (n = 20) resulted in significantly better shoulder stability (P = 0.020, from 9.00 ± 6.90 score to 14.25 ± 8.58) and pain intensity (P = 0.042, 7.40 ± 2.44 score to 4.60 ± 2.06) compared to SSE in the controls (n = 20). However, no significant effects were observed for scapular symmetric alignment including the angles of inferior scapular distance (P = 0.555) and inferior scapular height difference (P = 0.770), muscle power including shoulder flexion (P = 0.942) and shoulder abduction (P = 0.551), or ROM including shoulder flexion (P = 0.852) and shoulder abduction (P = 0.622). CONCLUSION: This study suggests that GSE positively affects shoulder stability and pain control in patients with shoulder pain, probably through a centralization effect on the shoulder mechanism. Show more

Keywords: Glenohumeral stabilization exercise, scapular stabilization exercise, shoulder pain, shoulder stabilization

DOI: 10.3233/BMR-169612

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 259-265, 2018

Authors: Jung, Gil Su | Chang, Min Cheol | Seo, Sang Wan | Lee, Dong Gyu | Kwak, Sang Gyu | Cho, Hee Kyung | Ahn, Sang Ho

Article Type: Research Article

Abstract: BACKGROUND: Lumbar degenerative kyphosis (LDK) is characterized by sagittal imbalance resulting from degenerative loss of lumbar lordosis. The ability of transcutaneous neuromuscular electrical stimulation (NMES) to activate deep lumbar stabilizing muscles has been demonstrated. OBJECTIVE: The aim of this study was to evaluate the effects of transcutaneous NMES applied to optimal points on the lower abdomen and lumbar paraspinal region on gait problems in patients with lumbar degenerative kyphosis (LDK). METHODS: Twenty-one patients with lumbar degenerative kyphosis underwent three walking sessions in the following order; walking for 5 minutes without NMES, walking with NMES on the …lumbar multifidus (LM) only, and walking with NMES on both LM and transverse abdominis (TrA)/obliquus internus (OI). Differences in gait parameters at the commencement and completion of each of the three sessions were evaluated by gait analysis. RESULTS: During the 5-minute walk with NMES applied to the LM or to the LM and TrA/OI, participants showed lesser increases in spine forward tilt, pelvic anterior tilt, and external foot progression angle, and a lesser decrease in hip internal rotation than when walking without NMES (P < 0.05). In addition, with NMES, patients showed less decrement in gait velocity and stride length at walk completion than patients walking without NMES (P < 0.05). However, in the comparison between walks with NMES applied to the LM and walks with NMES applied to the LM and TrA/OI, we could not find any significant difference in changes of gait parameters (p > 0.05). CONCLUSIONS: Transcutaneous NMES applied at optimal points on the lower abdomen and back could provide a means of treating gait problems caused by a stooped trunk in LDK patients. Show more

Keywords: Neuromuscular electrical stimulation, gait, degenerative kyphosis, dynamic sagittal imbalance

DOI: 10.3233/BMR-169638

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 267-274, 2018

Authors: Dibai-Filho, Almir Vieira | Barros, Marília Artese | de Oliveira, Alessandra Kelly | de Jesus Guirro, Rinaldo Roberto

Article Type: Research Article

Abstract: BACKGROUND: Myofascial trigger points are dysfunctional structures present in skeletal muscles and are related to sensory, motor, and autonomic changes. Despite scientific advances in recent decades in the measurement of musculoskeletal pain, evaluation of this clinical phenomenon is supported with instruments that, although valid and reliable, have a considerable degree of subjectivity. OBJECTIVE: To correlate electrical impedance of the upper limbs and torso with pain intensity, functional capacity, catastrophizing, pressure pain threshold, and skin temperature on myofascial trigger points in the upper trapezius muscle of patients with neck pain. METHODS: A single-blind cross-sectional …study. Twenty-eight volunteers of both genders were included in the study, were aged 18–45 years, and had chronic neck pain and myofascial trigger points in the upper trapezius. The volunteers were assessed using the Numeric Rating Scale, the Neck Disability Index, the Pain-Related Self-Statement Scale, algometry, infrared thermography, and electrical bioimpedance. RESULTS: The following significant results were observed: a negative association between the pressure pain threshold on myofascial trigger point in the right upper trapezius and electrical impedance of the torso at 5 kHz (r s = - 0.392, p = 0.032), 50 kHz (r s = - 0.406, p = 0.026), 250 kHz (r s = - 0.388, p = 0.034), and to the frequency 500 kHz (r s = - 0.444, p = 0.014). CONCLUSION: Electrical impedance of the torso is associated with the pressure pain threshold of myofascial trigger points on the upper trapezius of individuals with neck pain. Thus, individuals with a lower pressure pain threshold have higher electrical impedance values of the torso and vice versa. Show more

Keywords: Physical therapy, myofascial pain syndromes, muscle, skeletal, electrical impedance

DOI: 10.3233/BMR-169671

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 275-284, 2018

Authors: Liu, Jifeng | Yang, Sheng | Lu, Jianmin | Fu, Dapeng | Liu, Xipeng | Shang, Depeng

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the biomechanical effects of internal fixation with different screw insertion depths on vertebrae stiffness and screw stress for L1 fracture. METHODS: The established L1 fracture was fixed with 10 different depths of screw insertion: 10–100% screw-path length (SPL). Loading on the T12 endplate was simulated. RESULTS: Screws inserted to 60–100% depths has a higher axial displacement of screw against injured vertebrae and maximum stress of screws compared to those of screws inserted to 30–50% depths and 10–20% (P < 0.05). No significant difference was noted among 60–100% SPL …groups. Under single loading condition, the incidence rate of maximum stress of each screw ranged from 16.7–50.0%. Chi-square test showed superior screw has a higher incidence rate of maximum stress than inferior screw (P < 0.05). CONCLUSIONS: Screws inserted to 60% depth or more can achieve effective strength to withstand the postoperative height correction loss of the L1 vertebrae fracture. However, continuous prolonged depth of screw insertion did not significantly increase the effective strength of the screw against injured vertebrae and maximum equivalent stress of screws. The incidence rate of the maximum stress of each screw in correlated with position of screw insertion but not associated with the screw insertion depth. Show more

Keywords: Thoracolumbar burst fracture, pedicle screw, insertion depth, biomechanical analysis, finite element analysis

DOI: 10.3233/BMR-169692

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 285-297, 2018

Authors: Lan, Tao | Lin, Jian-Ze | Hu, Shi-Yu | Yang, Xin-Jian | Chen, Yang

Article Type: Research Article

Abstract: BACKGROUND: Retrospective study of 68 patients of symptomatic cervical spondylosis who were treated by anterior cervical discectomy and fusion (ACDF). OBJECTIVE: The purpose of this study was to compare the clinical and radiological outcomes of patients with single level cervical spondylosis using either zero-profile spacer (group A) or anterior cervical plate and cage (group B). METHODS: Clinical and radiological data of 68 patients undergoing ACDF from C3-C7 were collected retrospectively. There were 35 patients with a mean age of 54.05 years who received treatment by zero-profile implant. A total of 33 patients with …a mean age of 52.09 years underwent fusion by traditional plate with cage. Group A and group B were followed up for an average of 23.68 months and 24.39 months, respectively. Age, blood loss, and operation time were assessed. The clinical outcomes were evaluated by JOA and VAS score before and after surgery. In addition, incidence of dysphagia was recorded. The Cobb angle (from C2 to C7) change was measured on the lateral cervical spine radiographs. RESULTS: There was no significant difference in terms of operation time and blood loss between two groups. The postoperative JOA significantly increased and the VAS decreased correspondently in both groups. The postoperative Cobb angle increased and showed statistical difference compared with preoperative Cobb angle in both groups. There was no significant difference between group A and group B in achieving clinical symptoms and radiograph improvement according to postoperative JOA, VAS and Cobb angle comparison. The incidence of postoperative dysphagia was lower in the group A than group B. CONCLUSIONS: Our study suggests that the application of zero-p spacer can achieve similar clinical and radiological improvement compared with traditional plate and cage. Meanwhile, zero-p is superior to plate and cage with a lower incidence of postoperative dysphagia. Show more

Keywords: Cervical spine, ACDF, zero-p spacer, plate and cage

DOI: 10.3233/BMR-169708

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 299-304, 2018

Authors: Telci, Emine Aslan | Yarar, Feride | Cavlak, Uğur | Atalay, Orcin Telli

Article Type: Research Article

Abstract: OBJECTIVE: The aim of this study was to compare the musculoskeletal pain distribution, quality of life, and the hopelessness level in mothers with disabled children in different ambulation levels. METHODS: This study included a total of 177 mothers (mean age: 36.1 ± 6.5 years) of children with disabilities. The mothers were divided into 3 different groups according to the ambulation level of their disabled children: Ambulatory children (Group 1), partially ambulatory children (Group 2) and non-ambulatory children (Group 3). Musculoskeletal pain distribution (body diagram) and pain intensity (The Visual Analogue Scale), four quality …of life parameters (The Centers for Disease Control and Prevention Health-Related Quality of Life - 4 Questionnaire) and hopelessness level (Beck Hopelessness Scale) were evaluated in all mothers. RESULTS: The results of our study showed that musculoskeletal pain was most common (79.1%) in the mothers of disabled children. The frequency and severity of back, shoulder and elbow pain in the mothers, number of activity limitation days and hopelessness level were found to increase significantly as the ambulation level in the child decreased (p < 0.05). CONCLUSIONS: The risk of musculoskeletal pain, participation in daily life and hopelessness level in the mothers increased as the ambulation level of the disabled children decreased. Show more

Keywords: Mothers, musculoskeletal pain, disabled children

DOI: 10.3233/BMR-169709

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 305-313, 2018

Authors: Keklicek, Hilal | Uygur, Fatma

Article Type: Research Article

Abstract: BACKROUND: Soft tissue mobilization techniques (STM) are used in clinical practice in treatment of congenital muscular torticollis(CMT).However, little is known about its effectiveness. OBJECTIVES: To investigate whether using STM to manage CMT in babies with mild to moderate head tilt was effective or not. METHODS: Twenty-nine babies with CMT aged between 0-6 months, who had a head tilt from 5 to 20 degrees were allocated to two groups. Both groups received a baseline home program (positioning, handling strategies, stretching and strengthening exercises, environmental adaptations). The study group (SG) also received STM three times a week. …Babies were evaluated initially, at six weeks, at 12 weeks and for follow-up at 18 weeks with muscle function scale, head tilt and range of motion for neck lateral flexion and rotation. RESULTS: Both groups showed significant improvements in all measured parameters (p < 0.05). In comparison of groups, there were differences at six weeks in favor of the SG for neck rotation (0.001) and head tilt (= 0.006); but at 12 weeks and follow up, there were no longer any differences between the groups in any of the measured parameters. CONCLUSIONS: STM techniques are effective in getting faster positive results in the treatment of CMT. Show more

Keywords: Congenital muscular torticollis, pediatric physiotherapy, musculoskeleteal manipulations

DOI: 10.3233/BMR-169746

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 315-321, 2018

Authors: Dülger, Esra | Bilgin, Sevil | Bulut, Elif | İnal İnce, Deniz | Köse, Nezire | Türkmen, Ceyhun | Çetin, Hatice | Karakaya, Jale

Article Type: Research Article

Abstract: BACKGROUND: Diaphragm is an important component of spinal stability. In presence of low back pain, there may be some alterations in this muscle like other muscles that are responsible for lumbal stabilization. OBJECTIVE: This study aims to assess the effects of stabilization exercises on diaphragm muscle thickness and motion along with lumbopelvic stability. METHODS: Twenty-one women with low back pain participated in the study. Stabilization exercises including motor control training were performed on treatment group (n = 11). In control group (n = 10), …strentghening exercises were peformed for back muscles, abdominal muscles and hip muscles. The patients underwent a total of 30 sessions of treatment, 3 days in a week for 10 weeks. The diaphragm muscle thickness and motion was evaluated using ultrasound (US), and lumbopelvic stability was evaluated using lumbopelvic stability tests. RESULTS: After the treatment, in the treatment group, increase in diaphragm thickness and improvement in lumbopelvic stability were statically significant (p < 0.05). However, there were no significant changes in diaphragm motion in both groups (p > 0.05). CONCLUSIONS: As a result, stabilization exercises increase diaphragm muscle thickness and improve lumbopelvic stability in women with low back pain. Therefore, stabilization exercises should be considered as a part of the treatment program in low back pain. Show more

Keywords: Low back pain, diaphragm, ultrasound, stabilization exercises, general exercises, lumbopelvic stability

DOI: 10.3233/BMR-169749

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 323-329, 2018

Authors: Barros, Marília Artese | Dibai-Filho, Almir Vieira | de Oliveira, Alessandra Kelly | de Jesus Guirro, Rinaldo Roberto

Article Type: Research Article

Abstract: BACKGROUND: Skin impedance is a biological signal that has been employed in the measurement of pain. However, there are few scientific data on skin impedance, with a great variety of assessment methods and controversial results. OBJECTIVE: To examine the intra- and inter-rater reliability of skin impedance measurement in individuals with chronic neck pain. METHODS: This is a blind cross-sectional study. Thirty individuals of both genders, aged between 18 and 45 years and with chronic neck pain were included in the study. Two examiners assessed skin impedance of the upper and lower limbs and …torso at two intervals separated by one week. For statistical analysis, we used the intraclass correlation coefficient (ICC 2 , 3 ) to determine the intra- and inter-rater reliability of skin impedance, with its respective confidence interval of 95%, standard error of measurement (SEM) and minimum detectable change (MDC). RESULTS: The intra-rater reliability was considered substantial to excellent, with ICC values ranging between 0.843 and 0.978, SEM between 0.58 and 15.26 Ω , and MDC between 1.61 and 42.31 Ω . The inter-rater reliability was moderate to excellent, with ICC values ranging between 0.761 and 0.997, SEM ranging between 0.22 and 16.72 Ω , and MDC ranging between 0.63 and 46.35 Ω . CONCLUSION: The measurement of skin impedance of the upper and lower limbs and torso in individuals with chronic neck pain has acceptable reliability values when considered at different times and by different examiners. Show more

Keywords: Electric impedance, reproducibility of results, neck pain

DOI: 10.3233/BMR-169753

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 331-336, 2018

Authors: Gunay, Selim M. | Keser, Ilke | Bicer, Zemzem T.

Article Type: Research Article

Abstract: BACKGROUND: Ankylosing spondylitis (AS) can cause severe functional disorders that lead to loss of balance. OBJECTIVE: The aim of this study was to investigate the effects of balance and postural stability exercises on spa based rehabilitation programme in AS subjects. METHODS: Twenty-one participants were randomized to the study (n = 11) and control groups (n = 10). Patients balance and stability were assessed with the Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, Single Leg Stance Test (SLST) and Functional Reach Test (FRT). …AS spesicied measures were used for assessing to other parameters. The treatment plan for both groups consisted of conventional transcutaneous electrical nerve stimulation (TENS), spa and land-based exercises 5 days per week for 3 weeks. The study group performed exercises based on postural stability and balance with routine physiotherapy practice in thermal water and in exercise room. RESULTS: The TUG, SLST and FUT scores were significantly increased in the study group. In both groups, the BASMI, BASFI, BASDAI and ASQoL scores decreased significantly by the end of the treatment period (p < 0.05). CONCLUSIONS: In AS rehabilitation, performing balance and stability exercises in addition to spa based routine approaches can increase the duration of maintaining balance and can improve the benefits of physiotherapy. Show more

Keywords: Spa-exercise therapy, spondyloarthropathy, aquatic exercise, balance training, berg balance scale

DOI: 10.3233/BMR-169755

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 337-346, 2018

Authors: Fettweis, T. | Onkelinx, M.N. | Schwartz, C. | Demoulin, C. | Croisier, J.L. | Vanderthommen, M.

Article Type: Research Article

Abstract: BACKGROUND: Adequate motor control is considered important for spinal stability and the prevention of low back pain in adulthood and in childhood. OBJECTIVE: Given that the sitting position can affect proprioception, this study aimed to evaluate the influence of using at school a triangular and dynamic cushion on schoolchildren’s trunk motor control. METHODS: Thirty 8-year-old schoolchildren were randomized into a control group (n = 15) and a “cushion group” (n = 15), in which the children used the cushion for one year …and a half. At the end of this period, a 3D-analysis was used to assess lumbar spine proprioception by means of a trunk repositioning task performed blindfolded in a seated position in two conditions (on a stable and on an unstable surface). RESULTS: The schoolchildren in the cushion group performed better at the trunk repositioning task (p = 0.02) and hold their lumbar lordosis (p = 0.03) better than the control children, in both conditions (stable and unstable). CONCLUSIONS: This preliminary study suggests that daily use of a triangular dynamic cushion has a beneficial impact on children’s lumbar proprioception. Further studies are needed to confirm these results and investigate the effectiveness of its use to prevent low back pain in adulthood. Show more

Keywords: Ergonomics, schoolchildren, sitting position, lumbar spine, reposition sense, proprioception

DOI: 10.3233/BMR-169763

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 347-353, 2018

Authors: Rutkowska-Kucharska, Alicja | Szpala, Agnieszka

Article Type: Research Article

Abstract: BACKGROUND: The question that was asked in the study was whether a training routine based on curl-up exercises with a load provided by body mass of the person increases local muscle strength or local muscle endurance. OBJECTIVE: The aim of this study was to evaluate the effect of 4 weeks training based on a small load and low movement velocity on electrical activity (EMG), cross-sectional area (CSA) of core stabilisers. METHODS: The EMG activity was measured in the rectus abdominis (RA), obliquus abdominis externus and erector spinae (ES) muscles. CSA of the muscles: …RA, anterolateral abdominal, psoas major, quadratus lumborum, ES, and multifidus at the level of L3-L4 were measured too. RESULTS: The training increased the CSA and thickness in most of the muscles studied. Statistically significant correlation was found only for the ES circumference (left side) and EMG activity for the right side (r = 0.627, p = 0.022) and left side (r = 0.624, p = 0.023). CONCLUSIONS: The training programme resulted in a increase in the number of curl-up repetitions revealing an endurance increase in abdominal muscles. Furthermore, there was a increase in the EMG activity of the RA. An increase of the CSA of all tested muscles showed an increase of muscle active force. Show more

Keywords: Low back pain, curl-up exercise, muscle hypertrophy

DOI: 10.3233/BMR-169780

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 355-362, 2018

Authors: Meng, Pingping | Zhang, Shuchao | Wang, Qiang | Wang, Peipei | Han, Chao | Gao, Jinghui | Yue, Shouwei

Article Type: Research Article

Abstract: OBJECTIVE: To assess whether the clinical efficacy of a therapeutic protocol using surface neuromuscular electrical stimulation (sNMES) on patients with post-stroke dysphagia (PSD) is superior to that without sNMES, and whether swallowing functional outcome is different with regards to different electrode placement on patients’ skin of neck. METHODS: Thirty patients with PSD were randomly allocated into treatment group A (TGA), treatment group B (TGB) and control group according to a random number table. The three groups of patients all received traditional dysphagia therapy (TDT) and other general rehabilitation therapy such as physical therapy and occupational therapy …as a basic treatment project. Besides this, sNMES treatment was applied on different sites of patients’ neck skin in group A and B separately. All the patients received video-fluoroscopic swallowing study (VFSS) pre-treatment and 2 weeks post-treatment, during which the displacement of the hyolaryngeal complex towards the superior and anterior sides while swallowing semi-liquid diet were measured. Outcome of the VFSS was measured using dysphagia outcome and severity scale (DOSS). RESULTS: Post-treatment evaluation was carried out using water swallow test (WST), repetitive saliva swallowing test (RSST) and dysphagia outcome and severity scale (DOSS) from the three study groups were all improved (P < 0.05). The results of post-treatment evaluation using WST from TGA and TGB were 2.40 ± 1.26 and 2.10 ± 0.99 respectively, using RSST from TGA and TGB were 5.30 ± 1.89 and 5.20 ± 1.69 respectively, using DOSS from TGA and TGB were 5.20 ± 1.40 and 5.10 ± 1.45 respectively. Compared to control group, the results of post-treatment evaluation using the three scales, there were significant improvement between TGA and TGB (P < 0.05), however, the inter-group differences of TGA and TGB indicated no statistically significant difference (P > 0.05). The post-treatment evaluation of the moving distance of hyoid bone towards anterior side in swallowing was significantly improved as compared to TGB (- 8.40 ± 7.48, t = - 3.552, P = 0.006), and was statistically significant as compared to the control group (P > 0.05). CONCLUSIONS: Swallowing function in the patients with PSD was significantly improved using TDT combined with NMES. Stimulating electrodes placed at the suprahyoid region or on both suprahyoid and infrahyoid regions resulted in no difference of effect. However, NMES on suprahyoid region could further improve the moving distance of hyoid bone anteriorly. Show more

Keywords: Stroke, neuromuscular electrical stimulation, dysphagia, video-fluoroscopic swallowing study, hyolaryngeal complex

DOI: 10.3233/BMR-170788

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 363-370, 2018

Authors: Depreli, Ö. | Angın, E.

Article Type: Research Article

Abstract: BACKGROUND: Work-related musculoskeletal disorders are the most common health problems which affect millions of office workers. OBJECTIVE: The objective of this study is to determine scapular positioning at rest and different anatomical planes, the assessment of pain, postural changes and the functionality of upper extremity that is caused by the lack of ergonomic principles among office workers of civil servants in TRNC (Turkish Republic of Northern Cyprus). METHODS: 183 individuals participated in the study and 2 groups were created by grand scores of Rapid Upper Limb Assessment (RULA) tool. Scapular dyskinesis, pain of …upper extremity and back, physical functions and symptoms of upper extremity, the self-rated neck disability, cervical and upper thoracic posture of workers were assessed. RESULTS: The difference between pain situation and the results of upper extremity and neck disability scores of the participants among the groups was significant (p < 0.05). No significant difference has been found statistically among the postural angle values of individuals (p > 0.05). A significant statistical difference has been found among the groups when the results of Lateral Scapular Slide Test (LSST) is examined (p < 0.05). CONCLUSIONS: Working environment and conditions cause the wrong of working posture and thus, lead individuals to spend more energy together with physical difficulty, and consequently affect general health. Show more

Keywords: Scapular dyskinesis, ergonomics, pain, disability, posture

DOI: 10.3233/BMR-170790

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 371-380, 2018

Authors: Ozkunt, Okan | Sariyilmaz, Kerim | Gemalmaz, Halil Can | Kaya, Ozcan | Dikici, Fatih

Article Type: Research Article

Abstract: BACKGROUND: Prospective study. OBJECTIVE: To determine the change in spinal sagittal parameters which may occur throughout the day in healthy population. METHODS: Thirty-five healthy hospital employees were enrolled in the study. Two standing left lateral orthoroentgenograms were obtained at 8.00 a.m and at 6.00 p.m. Six spinopelvic parameters were measured on the X-rays. Thereafter, the subjects were divided into two cohorts according to their BMI as low BMI and high BMI. RESULTS: Thirty-five subjects with a mean age of 25.97 ± 8.21 were evaluated. No significant change …was found between morning and evening measurements for any of the parameters. Direct relationship was shown between thoracic kyphosis (TK) and lumbar lordosis (LL), lumbar lordosis and sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI) minus lumbar lordosis, sagittal vertebral axis (SVA) and pelvic incidence minus lumbar lordosis. In addition an inverse relationship was found between sacral slope and pelvic tilt, sacral slope and pelvic incidence minus lumbar lordosis, thoracic kyphosis and pelvic incidence minus lumbar lordosis, sacral slope and pelvic tilt, sagittal vertebral axis and lumbar lordosis (p < 0.05). Sagittal vertebral axis were found to be higher in the high BMI group, and daily change was lower but the differences were not statistically significant. Only the change in pelvic tilt value was found to be statistically significant in low BMI group. CONCLUSION: Routine workload in a hospital environment does not cause significant change in the spinopelvic parameters throughout the day. Show more

Keywords: Sagittal balance, change, healthy, collapse, spinopelvic, parameters

DOI: 10.3233/BMR-170796

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 381-388, 2018

Authors: Son, Jae-Ik | Yi, Chung-Hwi | Kwon, Oh-Yun | Cynn, Heon-Seock | Lim, One-Bin | Baek, Yun-Jeong | Jung, Ye-Ji

Article Type: Research Article

Abstract: BACKGROUND : Among the tools for relieving lower back pain, footrests are commonly recommended. Few studies have investigated the effects of footrest and the proper application of footrest height. OBJECTIVE : The purpose of this study was to compare the effects of the normalized footrest height on muscle fatigue, kinematics, kinetics, and pain intensity. METHODS : In total, 13 males who had a history of non-specific lower back pain during prolonged standing were recruited. The experimental conditions were 2-hour prolonged standing with no footrest and with footrests of 5%, 10%, and 15% of body height. Muscle …fatigue was investigated through measurements of the median frequency ratio and the muscle activity ratio (post/pre) in lumbar erector spinae. The lumbo-pelvic angles, and the external moment in the lumbar region were investigated. A visual analog scale was used to investigate the intensity of the pain. RESULTS : The footrests at 10% and 15% of the body height caused a lower change in the median frequency ratio and the muscle activity ratio than the other conditions. The footrest at 10% of the body height placed the lowest external moment on the lumbar region among all the conditions. The pain intensity was significantly lower in with footrest conditions than with no footrest condition. CONCLUSIONS : The results suggests that a footrest height of 10% of the body height can be recommended as a normalized height for prolonged standing work in subjects with a history of non-specific lower back pain during prolonged standing. Show more

Keywords: Footrest, lower back pain, normalization, prolonged standing

DOI: 10.3233/BMR-170798

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 389-396, 2018

Authors: Tekin, Fatih | Kavlak, Erdogan | Cavlak, Ugur | Altug, Filiz

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: The aim of this study was to show the effects of an 8-week Neurodevelopmental Treatment based posture and balance training on postural control and balance in diparetic and hemiparetic Cerebral Palsied children (CPC). METHODS: Fifteen CPC (aged 5–15 yrs) were recruited from Denizli Yağmur Çocukları Rehabilitation Centre. Gross Motor Function Classification System, Gross Motor Function Measure, 1-Min Walking Test, Modified Timed Up and Go Test, Paediatric Balance Scale, Functional Independence Measure for Children and Seated Postural Control Measure were used for assessment before and after treatment. An 8-week NDT based posture and balance …training was applied to the CPC in one session (60-min) 2 days in a week. RESULTS: After the treatment program, all participants showed statistically significant improvements in terms of gross motor function (p < 0.05). They also showed statistically significant improvements about balance abilities and independence in terms of daily living activities (p < 0.05). Seated Postural Control Measure scores increased after the treatment program (p < 0.05). CONCLUSIONS: The results of this study indicate that an 8-week Neurodevelopmental Treatment based posture and balance training is an effective approach in order to improve functional motor level and functional independency by improving postural control and balance in diparetic and hemiparetic CPC. Show more

Keywords: Cerebral palsy, postural control, balance, Bobath Concept

DOI: 10.3233/BMR-170813

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 397-403, 2018

Authors: Han, Ji Won | Kim, Young Mi

Article Type: Research Article

Abstract: BACKGROUND: The abdominal muscles, upper extremities, and diaphragm work in synergy to maintain trunk stability during breathing. OBJECTIVE: This study aimed to investigate the effects of a breathing technique combined with dynamic upper extremity exercise on the pulmonary function of healthy adults. METHOD: Forty male participants in their 20s were recruited and randomly divided into two groups of 20 participants each: the experimental group performed a dynamic upper extremity exercise with breathing, and the control group only performed the breathing exercise. The experimental duration was 4 weeks, and both groups performed each training …three times per a week. We performed pulmonary function test. RESULTS: Forced vital capacity increased significantly in both groups after the training period, but it was not significantly different between the two groups. Similarly, the forced expiratory volume at one second was not significantly different after training, but was significantly different between the two groups. In contrast, the peak expiratory flow did not show any significant within-group or between-group difference. CONCLUSION: Consequently, we came up with result that breathing exercise with dynamic upper extremity exercise improves pulmonary function. Our findings indicate that the breathing and dynamic upper extremity exercise described here should be considered in patients who require breathing therapy, since it seems to have beneficial effects on pulmonary function. Show more

Keywords: Dynamic upper extremity exercise, breathing exercise, pulmonary function

DOI: 10.3233/BMR-170823

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 405-409, 2018

Authors: Borman, Pinar | Yaman, Ayşegül | Calp, Emel

Article Type: Research Article

DOI: 10.3233/BMR-150512

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 31, no. 2, pp. 411-413, 2018