Journal of Back and Musculoskeletal Rehabilitation - Volume 33, issue 3

Authors: Karkucak, Murat | Batmaz, İbrahim | Kerimoglu, Servet | Ayar, Ahmet

Article Type: Research Article

Abstract: BACKGROUND: Facet syndrome is defined as pain that arises from any structure of the facet joints, including the fibrous capsule, synovial membrane, hyaline cartilage, and bone. OBJECTIVES: To compare the effectiveness of US-guided and blind injections on clinical outcome in facet syndrome. MATERIALS AND METHODS: Forty-seven patients with the diagnosis of facet syndrome were included. Patients were consecutively randomized into one of the two groups. The patient’s history, physical examination and routine laboratory parameters were obtained and diagnose was established based on physical findings. Two injections (mixture of 2 ml of 1% lidocaine hydrochloride and …20 mg of triamcinolone, to a single or maximum two sites depending on the clinical characteristics of the facet joint) were performed with 15 days apart, as blinded or US-guided manner. Clinical outcome assessments were carried out at 0, 2nd and 6th weeks, using Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and State-Trait Anxiety Inventory (STAI). RESULTS: The patients’ initial VAS and ODI were not significantly different. When the two groups were compared in the 6th week in terms of VAS scores, improvement was more pronounced in the US-guided injection group (US-guided group (n = 23) before 7.6 (2.2) cm, after 3.0 (1.7) cm, P = 0.0001 vs blind group (n = 24) before 7.2 (1.3) cm, after 5.2 (2.0) cm, P = 0.0001). The improvement in initial and 6th week ODI was statistically significant in the US-guided injection group (P = 0.006). Except STAI I for US-group, trait anxiety scale scores were significant in both groups. CONCLUSION: The US-guided local injections offer better clinical outcome in the treatment of facet syndrome. Show more

Keywords: Facet joint, injection, ultrasound, low back pain

DOI: 10.3233/BMR-181447

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 431-436, 2020

Authors: Tang, Xiaojun | Huang, Yijiang | He, Shaoqi | Tang, Chengxuan | Peng, Maoxiu | Dai, Minghai | Chen, Wenliang

Article Type: Research Article

Abstract: BACKGROUND: It is important to evaluate clinical efficacy and safety of posterior internal fixation using pedicle screw system. OBJECTIVES: To investigate clinical characteristics of patients diagnosed with fracture-dislocation of the thoracic spine with or without minimal spinal cord. METHODS: Twenty-eight patients with fracture-dislocation of thoracic spine with or without minimal spinal cord injury were retrospectively analyzed. All patients received posterior reduction and internal fixation using pedicle screw system. RESULTS: The mean follow-up duration was 11.4 months. Among 28 patients, 24 cases were complicated with bilateral pedicle or laminal fracture. Preoperatively, the …percentage of vertebral displacement was (32.1 ± 20.6)%, significantly declined to (7.5 ± 6.0)% (t = 4.575, P = 0.001) and maintained at (7.9 ± 6.3)% at the final follow-up. Preoperative local kyphosis angle was measured as (16.2 ± 11.3) ∘ , restored to (15.4 ± 5.9) ∘ postoperatively and (15.8 ± 5.4) ∘ during the final follow-up. No statistical significance was observed at three time points (all P > 0.05). The remaining 25 patients were evaluated with normal and complete neurological function. No severe complications were observed intra- and postoperatively. CONCLUSIONS: Posterior internal fixation using pedicle screw is an efficacious and safe therapy which achieves proper reduction and preserves spinal cord function. Show more

Keywords: Clinical characteristics, fracture dislocation, pedicle screw, spinal cord injury, thoracic spine

DOI: 10.3233/BMR-181410

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 437-442, 2020

Authors: Jellad, Anis | May, Wafa | Zrig, Ahmed | Kalai, Amine | Jguirim, Mahbouba | Frih, Zohra Ben Salah | Golli, Mondher

Article Type: Research Article

Abstract: BACKGROUND: Intra-articular distension is a validated treatment in adhesive capsulitis of the shoulder and is commonly followed by intensive in-patient physical therapy. A recent meta-analysis found that physical therapy is as effective as intra-articular distension (IAD) and that an early distension could be the primary choice for treating frozen shoulder. The question of the additional contribution of physical therapy prior to IAD compared with IAD followed by physical therapy has not been raised. OBJECTIVES: We compared IAD preceded by physical therapy to that followed by physical therapy in terms of pain relief and functional outcome. …METHODS: We enrolled patients with primitive adhesive capsulitis of the shoulder. The eligible patients were randomized into three groups: A, B and C. Group A received intra-articular distension followed by physical therapy, group B received intra-articular distension in the middle of physical therapy and group C received physical therapy alone. Patients were assessed at the beginning of the protocol (T0), after 6 weeks (T1) and after 12 weeks (T2). The main outcome measures were pain using a Visual Analog Scale and the Disabilities of Arm, Shoulder and Hand Questionnaire. RESULTS: Out of the 179 enrolled patients, only 122 completed the follow up: group A (n = 34), group B (n = 46) and group C (n = 42). Compared to intra-articular distension preceded by physical therapy, IAD followed by physical therapy did not improve significantly the outcome in terms of pain relief (p = 0.123) but it enhanced the upper extremity function (p = 0.002). Upper extremity pain and function were found to improve with time regardless of the protocol (p < 0.001). CONCLUSIONS: IAD followed by physical therapy is more beneficial than IAD preceded by physical therapy in terms of upper extremity function. IAD, whether or not preceded by physical therapy, does not significantly improve pain compared to physical therapy alone. Time is a crucial factor to take into consideration while treating adhesive capsulitis of the shoulder. Show more

Keywords: Bursitis, frozen shoulder, intra-articular distension, physical therapy

DOI: 10.3233/BMR-181426

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 443-450, 2020

Authors: Utku, Uygar | Cetin, Gözde | Atilla, Nurhan | Gisi, Kadir | Gökce, Mustafa

Article Type: Research Article

Abstract: OBJECTIVE: The aim of this study was to assess the cerebral blood flow velocity as a marker by using transcranial Doppler (TCD) ultrasonography in patients with ankylosing spondylitis (AS). METHODS: A total of 30 AS patients aged 20 to 50 were enrolled in the AS group (male/female: 4/26, mean age: 34.7 ± 5.9) consecutively. The control group (non-AS group; male/female: 4/26, mean age: 32.3 ± 4.7) consisted of 30 age- and sex-matched, randomly selected patients without AS who had other diagnoses such as fibromyalgia and did not have risk factors …for atherosclerosis. Bilateral middle cerebral artery (MCA) peak-systolic, end-diastolic, and mean blood flow velocities, Gosling’s pulsatility index values, and Pourcelot’s resistance index values were recorded with TCD by a neurosonologist blinded to the AS and control groups. RESULTS: The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels and cerebral blood flow velocities of bilateral MCA were significantly higher in the AS group than in the control group. CONCLUSIONS: This study highlights that the increased cerebral blood flow is indirectly associated with atherosclerosis regarding persistent inflammation in patients with AS. Show more

Keywords: Ankylosing spondylitis, inflammation, atherosclerosis, stroke

DOI: 10.3233/BMR-170947

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 451-454, 2020

Authors: Drzał-Grabiec, J. | Walicka-Cupryś, K. | Zajkiewicz, K. | Rachwał, M. | Piwoński, P. | Perenc, L.

Article Type: Research Article

Abstract: BACKGROUND: Systematic observations of fetal posture show that, although for most of the time the fetus does not have a preferred posture, it has a certain repertoire of repeated active postures. The observed postures cannot be considered random configurations of head and limb position: the fetus and the young infant have an active, but variable posture that is relatively unrelated to the orientation of the force of gravity. MATERIALS AND METHOD: The study included 101 children, aged 6–7, including 50 preterm children, 48 boys and 53 girls (research group) and 51 full-term children; 22 boys and …53 girls (control group). The photogrammetric method with moire effect on Mora 4G CQ Elektronik was used to examine the body posture. RESULTS: Significant statistical differences in GAMMA (p < 0.001) and KLL (p = 0.020) parameters in preterm children and in control group were noted. Both parameters presented higher value in the control group. CONCLUSIONS: The posture of preterm children is characterized by a smaller angle of upper thoracic curvature and smaller angle of lumbar lordosis. The posture of preterm children in sitting position is characterized by a smaller angle of thoracic kyphosis. Preterm birth disturbs the development of proper antigravitational mechanism and causes possible posture dysfunctions at the age of 6. Show more

Keywords: Body posture, spine, photogrammetric method, preterm infant

DOI: 10.3233/BMR-170882

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 455-462, 2020

Authors: Ojukwu, Chidiebele Petronilla | Ikele, Chioma Nneka | Nwobodo, Onyekachi Darlington | Okemuo, Adaora Justina | Ikele, Ikenna Theophilus | Uchenwoke, Chigozie Ikenna | Ezeugwu, Uchechukwu Anthonia

Article Type: Research Article

Abstract: BACKGROUND: Despite the increasing emergence of modern facilities, the ancient practice of writing on a teaching board is still common in the teaching profession. Ergonomic guidelines of this practice are required for the prevention of work-related neck musculoskeletal disorders inherent of teachers. OBJECTIVE: This study investigated the effects of varying teaching board heights on the activities of the neck muscles. METHODS: Thirty participants (15 males and 15 females) participated in this experimental study. Each performed writing tasks on a teaching board set at five different heights derived from their standing height (SH) [(D …10 = SH minus 10% of SH; Norm H = SH; Sum 10 = SH plus 10% of SH; Sum 20 = SH plus 20% of SH; Sum 25 = SH plus 25% of SH)]. Electromyographic (EMG) activities of both components of the sternocleidomastoid and upper trapezius muscles were measured during each task. Asymmetry ratio of right and left muscle components were determined. Data were analyzed with one-way ANOVA. RESULTS: EMG activities of the four muscles as well as their asymmetry ratios significantly (p < 0.01) increased with increasing board heights. CONCLUSION: Teaching board-related tasks have increased possibilities of inducing neck disorders when performed beyond Norm H vertical heights. Show more

Keywords: Teaching board height, neck muscles, electromyography

DOI: 10.3233/BMR-191500

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 463-468, 2020

Authors: Yildirim, I. | Aydin Altinbas, M. | Demirezen, N.B. | Dener, S. | Sezgin, V.

Article Type: Research Article

Abstract: BACKGROUND: Individualized exercise programs should be prepared according to duration and intensity. OBJECTIVE: The current study focused on the effect of different types of exercises regularly done for eight weeks on sedentary young women’s body components and lipid profile. METHODS: The sample of the study was composed of 30 sedentary women recruited from Afyon Kocatepe University. The participants were randomly sorted into three groups and received combined exercises (aerobic + resistance exercises), aerobic exercises and cardio tennis exercises three days a week for eight weeks but no dietary program …was given. Before and after the exercise programs, participants’ body weights, heights, waist and hip circumferences were measured and their body components were analyzed through the bioelectrical impedance method. For the lipid profile analyses, 5 cc. of blood samples were drawn from forearm veins of the participants with the help of health specialists, and a biochemical doctor analyzed lipid profile markers such as total cholesterol, triglyceride, HDL, LDL, and VLDL. RESULTS: It was found that exercises regularly done for eight weeks affected young women’s body components considerably while it did not influence their lipid profile. CONCLUSIONS: The effect on body components depended on time. No difference was found in terms of exercise type. Show more

Keywords: Exercise, body composition, lipid profile

DOI: 10.3233/BMR-181323

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 469-475, 2020

Authors: Cui, Xilong | Yu, Haiyang | Jiang, Jishi | Yin, Wen | Liang, Chengmin | Fu, Qingsong | Zhai, Yunlei

Article Type: Research Article

Abstract: OBJECTIVES: We aimed to evaluate the efficacy and safety of anterior column opening structural bone grafting with posterior column compression technique for the treatment of obsolete vertebral compression fractures with severe spinal kyphosis. METHODS: Fourteen patients with senile obsolete vertebral compression fractures and severe spinal kyphosis were admitted to our hospital. During the treatment processing, an “eggshell” osteotomy, anterior column opening structural bone grafting with posterior column compression, and pedicle screw internal fixation were performed in all patients. The Cobb angle, Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) pre-operatively, post-operatively, and at the last …follow-up were analyzed. Furthermore, the intra-operative blood loss and the operative time were also analyzed. RESULTS: The average osseous fusion time was 3.6 months (range from 3 to 5 months). The average operative time was 236 ± 20.1 min (range from 198 to 261 min). The average intra-operative blood loss was 1350.5 ± 70.2 ml (range from 809 to 2216 ml). The Cobb angle of localized kyphosis was 63.4 ± 12.4 ∘ pre-operatively, while 10.0 ± 2.1 ∘ post-operatively, and 12 ± 3.4 ∘ at the last follow-up evaluation, respectively. The average VAS score was decreased significantly from 8.7 ± 3.2 pre-operatively to 1.9 ± 0.4 post-operatively. The average ODI score was decreased from 78.3 ± 2.4% pre-operatively to 19.3 ± 5.3% post-operatively. CONCLUSIONS: Anterior column opening structural bone grafting with posterior column compression technique is effective, can effectively restore the sagittal balance of the spine, ease pain, and improve the quality of life of the patients with obsolete vertebral compression fractures and spinal kyphosis. Show more

Keywords: Anterior column opening, structural bone grafting, posterior column compression technique, internal fixation, obsolete spinal fracture, kyphosis

DOI: 10.3233/BMR-181242

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 477-483, 2020

Authors: Trampe, Delphine | Gouteron, Anaïs | Naaim, Alexandre | Laroche, Davy | Grelat, Mickael | Casillas, Jean-Marie

Article Type: Research Article

Abstract: BACKGROUND: Tools for functional assessment of chronic low back pain (LBP) are lacking. OBJECTIVE: To determine the correlations and the responsiveness of the 400 m comfortable walk test (400 mCWT) and the 200 m fast-walk test (200 mFWT) in the functional assessment of a multimodal program. METHODS: One hundred and twenty-seven participants (68 females) with LBP and with or without radicular pain completed a Quebec Back Pain Disability Scale, a Sorensen test, a Shirado test, a 400 mCWT and a 200 mFWT, at baseline and at the end of the program. …RESULTS: No significant side effect was reported during walk tests. Walking speed was significantly increased after the program (0.18 ± 0.15 m.s - 1 for the 400 mCWT and 0.17 ± 0.17 m.s - 1 for the 200 mFWT). Clinical parameters were also significantly improved (82.02 ± 83.1 seconds for the Shirado, 92.1 ± 100.1 seconds for the Sorensen, - 14.0 ± 12.9 for the Quebec scale). A significant relationship was found between the increase in walking speed for the two walk tests and the improvement of the Quebec scale. The gait speed improvement was close to the minimal clinically important change (95% confidence interval: 0.14–0.22) determined from the Quebec scale threshold (minimum detectable change). CONCLUSIONS: Both 400 mCWT and 200 mFWT are correlated with functional parameters and are responsive for the functional assessment of LBP. Show more

Keywords: Chronic low back pain, multimodal pain management, rehabilitation, walk speed, walk test

DOI: 10.3233/BMR-171019

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 485-494, 2020

Authors: Akiyama, Kei

Article Type: Research Article

Abstract: BACKGROUND: Evaluation of the effect of a pad on foot morphologies in patients with medial tibial stress syndrome (MTSS) requires more reliable and objective methods, rather than conventional subjective observations. OBJECTIVE: The objective of this study was to investigate the effect of pads on foot morphologies during quiet standing in athletes with MTSS. METHODS: We measured three-dimensional foot morphologies in 30 feet with MTSS and 40 healthy feet. RESULTS: The analysis showed that Hallux valgus degree, calcaneal angle, arch height, and arch height ratio differed significantly as a result of …the pad support, compared to no pad support in the MTSS group. The pad support only resulted in significant differences in arch height, compared to no support in the control group. Furthermore, thumb side angle, calcaneal angle, and arch height ratio were significantly different between the MTSS and control groups. CONCLUSIONS: Our study results suggest that changes in foot morphologies because of the use of a pad can be measured objectively in patients with MTSS. Show more

Keywords: Pad, arch height, calcaneal angle, foot length, foot width, medial tibial stress syndrome

DOI: 10.3233/BMR-181295

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 495-499, 2020

Authors: Madić, Dejan | Obradović, Borislav | Golik-Perić, Dragana | Marinković, Dragan | Trajković, Nebojša | Gojković, Zoran

Article Type: Research Article

Abstract: BACKGROUND: Soccer as a sport has a very high injury rate and low back pain (LBP) is considered to be the most common overuse injury typically occurring in the back and spine in elite soccer players. OBJECTIVE: This study aimed to investigate differences in knee muscle strength and muscle imbalances in soccer players according to lower back pain. METHODS: One hundred and thirty-six male professional soccer players (20.49 ± 3.73 years, 76.57 ± 8.24 kg, 182.63 ± 6.73 cm) volunteered for the study. The isokinetic dynamometer PrimaDOC (EASYTECH, …Italy) was used to assess the hamstring and quadriceps strength at the selected speeds of 60 ∘ /s, whereas the Roland-Morris Disability Questionnaire (RDQ) was used as a health status measure to assess physical disability caused by low back pain. RESULTS: A univariate analysis of variance has shown that there is a statistically significant difference among the groups divided into Absolute peak torque right knee flexors, Absolute peak torque left knee flexors, Ratio between hamstrings and quadriceps strength right leg, and Ratio between hamstrings and quadriceps strength left leg based on the RDQ scores. On the other hand, no other significant differences among the groups were found in other parameters CONCLUSION: The current study indicates that knee muscle strength variables, resulting from an isokinetic testing, have the potential to discriminate between soccer players with and without a history of low back pain. However, low back pain is a multidimensional phenomenon and knee muscle strength or imbalance alone cannot be expected to explain low back pain. Show more

Keywords: Soccer, assessment, differences, muscle imbalances, low back pain

DOI: 10.3233/BMR-171109

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 501-506, 2020

Authors: Park, Ji-Su | An, Duk-Hyun | Kam, Kyung-Yoon | Yoon, Taehyung | Kim, Taehoon | Chang, Moon-Young

Article Type: Research Article

Abstract: BACKGROUND: The resistive jaw opening exercise (RJOE) was suggested as a potential remedial treatment for patients with dysphagia. However, clinical evidence is insufficient. OBJECTIVE: To investigate the effect of RJOE on hyoid bone movement, aspiration, and oral intake level in stroke patients with dysphagia. METHODS: Forty stroke patients with dysphagia were randomly allocated into either the experimental group (n = 20) or placebo group (n = 20). The experimental group performed RJOE using a portable device, while the placebo group performed RJOE using …a sham device with fewer loads. Intervention was conducted 5 times a week for 4 weeks. Hyoid bone movement was analyzed by two-dimensional analysis of anterior and superior motion based on a videofluoroscopic swallowing study. Aspiration was assessed using a penetration-aspiration scale (PAS), and oral intake level was assessed using the functional oral intake scale (FOIS). RESULTS: Both groups showed statistically significant differences in hyoid movement, PAS, and FOIS scale (p < 0.05). However, after the intervention, there was no significant difference between the two groups except for the liquid type of PAS. Effect sizes (Cohen’s d) were 0.9 and 0.7, 0.6 and 0.6, and 1.1 for the anterior and superior movement of the hyoid bone, semisolid and liquid type of PAS, and FOIS scale respectively. CONCLUSIONS: This study suggests that RJOE helps in hyoid movement, aspiration reduction, and oral intake in patients with dysphagia after stroke. Show more

Keywords: Aspiration, dysphagia, hyoid bone, jaw, stroke

DOI: 10.3233/BMR-181477

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 507-513, 2020

Authors: Matsumura, Masashi | Usa, Hideyuki | Ogawa, Daisuke | Ichikawa, Kazuna | Hata, Masafumi | Takei, Hitoshi

Article Type: Research Article

Abstract: BACKGROUND: The prevalence of radiographic knee osteoarthritis (OA) in Japan is high, with an estimated 25,300,000 affected individuals. OBJECTIVE: The purpose of this study was to clarify the characteristics of knee osteoarthritis by comparing differences between patients with knee osteoarthritis and healthy elderly individuals with respect to alignment of the pelvis and lower extremities and range of motion. METHODS: Twenty-six women (13 with medial knee osteoarthritis and 13 healthy elderly) participated in this study. Pelvic tilt, knee extension angle, femoro-tibial angle, quadriceps angle, navicular drop, and leg-heel alignment were measured. In addition, the …range of motion was measured at the hip, knee, and ankle joints. RESULTS: Patients with knee osteoarthritis showed a posterior pelvic tilt, knee flexion, varus, and foot pronation alignment compared to healthy subjects. The range of motion for hip extension, adduction, knee flexion, extension, and ankle dorsiflexion was significantly smaller while the range of motion for eversion was significantly larger in the knee osteoarthritis group. CONCLUSION: People with medial knee OA have different static alignment and ROM compared to those without knee OA. The results clarify the comprehensive characteristics of the pelvis and lower extremities in knee osteoarthritis. Show more

Keywords: Knee osteoarthritis, range of motion, lower extremity, Japanese

DOI: 10.3233/BMR-171038

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 515-521, 2020

Authors: Chang, Min Cheol | Lee, Dong Gyu

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: We evaluated the effect of caudal epidural pulsed radiofrequency stimulation in patients with chronic lumbosacral radicular pain due to postlumbar surgery syndrome who were unresponsive to at least two epidural steroid injections through the interlaminar, transforaminal, or caudal route. METHODS: We recruited 25 patients with chronic persistent radicular pain in one or both legs (⩾ 4 on the Numeric Rating Scale [NRS]) despite spinal surgery. They were unresponsive to at least two epidural steroid injections. We retrospectively conducted this study. Electrode needles were placed into the epidural space (S2-3 …intervertebral level) through the sacral hiatus, and pulsed radiofrequency stimulation was administered. The outcomes were evaluated using the NRS scores for radicular pain before treatment and 1–3 months after treatment. Successful pain relief was defined as a ⩾ 50% reduction in the scores at 3 months after treatment. RESULTS: The pain scores changed significantly over time (p < 0.001): pretreatment, 4.9 ± 0.9; 1 month, 3.6 ± 1.4; 2 months, 3.8 ± 1.4; and 3 months, 3.9 ± 1.4. At 1, 2, and 3 months after pulsed radiofrequency (PRF) procedure, the NRS scores were significantly reduced compared with the scores before the treatment. Eight patients (32%) reported successful pain relief at 3 months after treatment. CONCLUSIONS: Although only 32% of the patients with postlumbar surgery syndrome showed successful pain relief after treatment, the result is encouraging because we recruited only patients unresponsive to repeated epidural steroid injections. Show more

Keywords: Postlumbar surgery syndrome, lumbosacral radiculopathy, caudal epidural space, pulsed radiofrequency, chronic pain, refractory pain

DOI: 10.3233/BMR-170981

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 3, pp. 523-528, 2020