Journal of Back and Musculoskeletal Rehabilitation - Volume 34, issue 4

Authors: Beckers, Laura

Article Type: Editorial

DOI: 10.3233/BMR-215003

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 497-498, 2021

Authors: Sun, Weige | Zhang, Haijiao | Lv, Chenxu | Tang, Limei | Tian, Suzhai

Article Type: Review Article

Abstract: BACKGROUND: Many non-drug interventions for decreasing non-specific chronic low back pain (NSCLBP) in nurses have been extensively studied, but the most effective approach is still unclear. OBJECTIVE: This systematic review and network meta-analysis evaluated the efficacies of 12 non-drug interventions in reducing NSCLBP in nurses. METHODS: PubMed, ScienceDirect, Web of Science, Cochrane, EMBASE, CINAHL, Medline, WANFANG, VIP, China Knowledge Integrated, and SinoMed were searched from their establishment to July 2019. Randomized controlled trials (RCTs) comparing non-drug interventions for NSCLBP in nurses were included and analyzed using Stata v15 statistical software. RESULTS: …A total of 31 RCTs (n = 7116) and 12 non-drug interventions were included. The first three results with the highest surface areas under the curve ranking area (SUCRAs) were low back exercise plus healthy education, single low back exercise, and yoga (SUCRAs: 79.4%, 76.2%, and 75.1%, respectively). In addition, single yoga was inferior to protective equipment (standardized mean difference [SMD] = 3.88, 95% confidence interval [CI]: 0.92 to 6.84) and multidisciplinary intervention (SMD = - 4.06, 95% CI: - 7.33 to - 0.78). CONCLUSIONS: Low back exercise plus health education may be the best approach to reduce NSCLBP in nurses. Considering the heterogeneity, our findings need to be confirmed in future multicenter large sample RCTs in different countries. Show more

Keywords: Non-drug intervention, non-specific chronic low back pain, nurses, systematic review, network meta-analysis

DOI: 10.3233/BMR-200147

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 499-510, 2021

Authors: Barbari, Valerio | Storari, Lorenzo | Maselli, Filippo | Testa, Marco

Article Type: Article Commentary

Abstract: BACKGROUND: Explaining pain to patients through pain neuroscience education (PNE) is currently a widespread treatment studied in the musculoskeletal context. Presently, there is sufficient evidence supporting the effectiveness of PNE in patients with chronic musculoskeletal disorders. However, clinicians must pay attention to the actual possibility to transfer research findings in their specific clinical context. OBJECTIVE: We analysed the applicability of results of studies focused on PNE, which has not been done previously. METHODS: A detailed discussion on PNE applicability is provided, starting from published randomized controlled trials that investigated the effectiveness of PNE. …RESULTS: This paper markedly points out the awareness of clinicians on the need for an accurate contextualization when choosing PNE as an intervention in clinical practice. Show more

Keywords: Pain neuroscience education, musculoskeletal disorders, applicability, clinical trials

DOI: 10.3233/BMR-200091

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 511-520, 2021

Authors: Park, Sihwa | Park, Sunhee | Yoo, Jaehyun | Jee, Yong-Seok

Article Type: Research Article

Abstract: BACKGROUND AND OBJECTIVE: This study investigated whether equine riding affects static or dynamic mechanical contractions on the thighs and trunk muscles in inactive women. METHODS: Participants consisted of 30 women with a mean (SD) age of 21.06 (0.44) years. They were randomly allotted as follows: equine group (EQG, n = 15) and control group (CON, n = 15). Two types of muscle contraction properties in their thighs and trunk were measured through a tensiomyography (static muscle tester) and an isokinetic device (dynamic muscle tester), respectively. Using …the body weights of EQG and CON as covariates, a 2-way between-groups multivariate analysis of covariance was used to investigate group differences in the mechanical quantification of the thighs and trunk. RESULTS: The effectiveness of 8 weeks of equine riding was hardly observed in a static muscle test, whereas in the dynamic muscle test, the dominant and non-dominant hip extensor/flexor, the dominant hip abductor/adductor, and trunk extensor in the EQG showed a significant increase, compared to no changes in the CON. CONCLUSIONS: This study did not find any particular differences in a static muscle test in inactive women, but showed improvements in the dynamic mechanical properties of the thighs and trunk, which are major muscle groups related to spinal alignment. Show more

Keywords: Equine exercise, tensiomyography, static muscle contraction, dynamic muscle contraction

DOI: 10.3233/BMR-200008

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 521-535, 2021

Authors: Cabrita, Bruno | Dias, Sara | Fernandes, Ana Luísa | Correia, Sílvia | Ferreira, Jorge | Simão, Paula

Article Type: Research Article

Abstract: BACKGROUND: Neuromuscular diseases are characterized by the compromise of respiratory muscles, thoracic ventilation, muscle strength and coughing capacity. Patients have low quality of life and increased morbidity and mortality mostly due to respiratory impairment. OBJECTIVE: To assess the benefits of adding inspiratory muscle training to neuromuscular patients’ treatment and their compliance to the approach. METHODS: We conducted a single-center prospective study with neuromuscular patients with decreased maximal inspiratory pressure. We developed an inspiratory muscle training protocol with three-month duration and once-daily training. The protocol had a progressive intensity that was individually tailored based …on patients’ baseline characteristics and tolerance. We used Powerbreathe Medic Classic devices to perform the training. RESULTS: There were 21 patients who met the inclusion criteria and were enrolled in the study. Muscular dystrophy (n = 12, 57.3%) and amyotrophic lateral sclerosis (n = 4, 19%) were the most common diseases. After three months of training, patients increased their maximal inspiratory muscle pressure (p = 0.002) and peak cough flow (p = 0.011). Compliance to the protocol was 99 ± 5.5%. CONCLUSIONS: This protocol showed significant improvements on pulmonary muscles function and might be considered as an adjunct treatment to neuromuscular treatment. However, these positive results require larger further studies to validate the clinical benefits long-term. Show more

Keywords: Inspiratory, training, neuromuscular, rehabilitation

DOI: 10.3233/BMR-200141

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 537-543, 2021

Authors: Akgol, Gurkan | Elbasti, Muhammet Sahin | Gulkesen, Arif | Alkan, Gokhan | Kaya, Arzu | Ulusoy, Hasan

Article Type: Research Article

Abstract: BACKGROUND: Although carpal tunnel syndrome (CTS) is a common neuromuscular disorder, studies on its conservative treatment are inadequate and contradictory. OBJECTIVES: This study aimed to investigate and compare the effectiveness of low power laser therapy (LPLT) and Kinesio taping (KT) for the treatment of CTS. METHODS: Sixty patients with CTS were included in this study. One group received 15 sessions of KT, and the second group underwent 15 sessions of LPLT within three weeks. All patients were assessed with hand grip strength (HGS), Visual Analogue Scale (VAS)-pain, Douleur Neuropathique-4 (DN4) score, Boston Questionnaire …(BQ), and electroneuromyography before and after treatment. RESULTS: Before treatment, all clinical and neurophysiological parameters were similar between the groups. After treatment, both groups significantly improved in terms of HGS, VAS-pain, DN4, and BQ. However, the LPLT group had significantly better HGS, VAS-pain, DN4, and BQ than the KT group. In addition, while median nerve motor distal latency and median nerve sensory conduction velocity improved significantly with treatment in both groups, the LPLT group’s improvement was significantly better than that of the KT group. CONCLUSIONS: In patients with CTS, both LPLT and KT were effective treatments. However, the LPLT group had significantly better improvements than the KT group. Show more

Keywords: Carpal tunnel syndrome, kinesio taping, laser therapy, low power laser

DOI: 10.3233/BMR-200179

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 545-553, 2021

Authors: Osama, Muhammad

Article Type: Research Article

Abstract: BACKGROUND: Neck is one of the most common sites of musculoskeletal symptoms, and muscle shortening and weakness is observed to be a common cause of neck pain and disability. OBJECTIVE: To compare the immediate and short term effects of static stretching (SS), autogenic inhibition (AI) and reciprocal inhibition (RI) muscle energy techniques (MET) on isometric muscle strength in the management of mechanical neck pain. METHODS: A randomized controlled trial was conducted on 78 participants with neck pain randomly allocated to SS, AI-MET and RI-MET groups. All the participants received Trans Cutaneous Electrical Nerve …Stimulation (TENS), hot pack and unilateral postero-anterior glide, followed by 3–5 repetitions of either SS, AI-MET or RI-MET for five consecutive sessions. Numeric pain rating scale (NPRS) and Modified Sphygmomanometer Dynamometry (MSD) were used as outcome measurement tools. One way ANOVA and repeated measures ANOVA were used for inter-group and intra-group comparison. RESULT: In terms of MSD scores, a significant difference (p < 0.05) was observed between the groups. Both AI-MET and RI-MET were found to be comparatively more effective than SS, however AI-MET was found to be the most effective. CONCLUSION: AI-MET is more effective than SS and RI-MET in terms of improving isometric muscle strength in patients with mechanical neck pain. Show more

Keywords: Dynamometer, muscle strength, muscle stretching, muscle tonus, neck pain, passive stretching, relaxed stretching, static stretching

DOI: 10.3233/BMR-200002

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 555-564, 2021

Authors: Wang, Ya-Dong | Ming, Yu-Xiang | Pang, Yong-Hua | Chen, Wei-Nan | Zong, Xu-Hua | Wu, Ji-Yun | Deng, Ya-Kai

Article Type: Research Article

Abstract: BACKGROUND: Persisting shoulder stiffness adversely affects quality of life by causing pain and motion restrictions especially in patients with diabetes. OBJECTIVE: The aim of this study was to evaluate the outcomes of arthroscopic capsular release in patients with idiopathic shoulder stiffness. METHOD: A literature search was conducted in electronic databases and studies were selected by following precise eligibility criteria. Random-effects meta-analyses were performed to estimate the changes at latest follow-up in scores of the Constant, American Shoulder and Elbow Surgeons (ASES), and University of California at Los Angelis (UCLA) scales, Visual Analogue Scale …(VAS), and shoulder range of motion. RESULTS: Nineteen studies were included. The follow-up duration was 42 months [95% confidence interval (CI): 32, 51]. Improvements in scores of the Constant, ASES, UCLA scales, and VAS were 48.3 [95% CI: 38.0, 58.6], 44.6 [95% CI: 24.6, 64.6], 19.3 [95% CI: 16.6, 22.0], and - 6.1 [95% CI: - 6.9, - 5.4] respectively (P < 0.05 all). Improvements in the shoulder range of motion were: abduction 82.0 [95% CI: 65.0, 98.9]; forward flexion 75.9 [95% CI: 59.7, 92.1]; external rotation 43.2 [95% CI: 37.5, 49.0]; and internal rotation 25.4 [95% CI: 15.2, 35.5] degrees; P < 0.05 all). CONCLUSION: Arthroscopic capsular release effectively improves shoulder function in patients with idiopathic shoulder stiffness. Show more

Keywords: Shoulder, stiffness, capsular release, arthroscopy, range of motion

DOI: 10.3233/BMR-200267

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 565-572, 2021

Authors: Ibrahim, Alaa | Mortada, Eman | Alqahtani, Saeed | Alkathri, Haya | Alsayyed, Rania | Abualait, Turki | Alwhaibi, Reem

Article Type: Research Article

Abstract: BACKGROUND: Studies investigating the association between developmental dysplasia of the hip (DDH) and risk factors in Saudi Arabia are rare. OBJECTIVE: Investigate the association between DDH and several risk factors among Saudi children. METHODS: The medical records of 82 children born in or admitted to King Abdul Aziz Medical City in Riyadh, Saudi Arabia with clinical suspicion of hip dislocation (HD) were included. The association between DDH and the following risk factors was investigated: age < 3 y, female-gender, twinning, first-born child, C-section, breech presentation, prematurity, positive family history and …presence of associated abnormalities. RESULTS: HD was confirmed in 73 (89%) children (Positive HD) and excluded in 9 (11%) children (Negative HD). Eleven (13.4%) children were excluded from the positive cases as it was confirmed that they have paralytic hip dislocation not DDH. DDH was confirmed in 62 children (75.6%). The Chi square test (χ 2 ) and odds ratios (OR) revealed that the positive family history, female-gender, age < 3 years, and presence of associated abnormalities had significant associations with the presence of DDH with P values and OR equal 0.00 (16.4), 0.002 (3.1), 0.005 (2.6), and 0.04 (1.9) respectively. Breech presentation, twinning, first-born children, prematurity, and C-section were not associated with DDH with P values and OR equal 0.93 (1.1), 0.46 (0.4), 0.11 (0.4), 0.08 (0.3), and 0.002 (0.3) respectively. CONCLUSIONS: Positive family history, female-gender, age < 3 years, and presence of associated abnormalities had approximately 16, 3, 2.5, and 2 times increased risk for DDH. Show more

Keywords: Developmental dysplasia of the hip, risk factors, twinning, first-born, C-section, breech, prematurity, positive family history

DOI: 10.3233/BMR-191819

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 573-580, 2021

Authors: Yang, Fengguang | Wang, Yonggang | Ma, Yingping | Hu, Xuchang | Li, Xiangli | Ma, Zhanjun | He, Xuegang | Gao, Yicheng | Yang, Yong | Kang, Xuewen

Article Type: Research Article

Abstract: BACKGROUND: Lumbar X-rays are usually preferred in patients with lower back pain, but lumbar spinal stenosis (LSS) cannot be directly observed on lumbar X-ray films. OBJECTIVE: The purpose of this study is to explore the correlation between the degree of single-segment central LSS and lumbar X-ray measurements. METHODS: The data of 60 male patients aged 39–78 years with single-segment central LSS were analyzed. Linear correlation analysis was used to determine the correlation between the single-segment central LSS and the various measurement parameters. Multiple linear regression analysis was used to analyze the factors affecting …single-segment central LSS. RESULTS: There were significant differences in S 1 /S 0 , E, B, L 1 - 5 Cobb, and M among the three groups (p < 0.05). S 1 /S 0 was positively correlated with E, B, L 1 - 5 Cobb, and M (p < 0.05), but was not correlated with D (p = 0.66). After multiple linear regression analysis, B, L 1 - 5 Cobb, and M were independently associated with S 1 /S 0 . CONCLUSIONS: The B, L 1 - 5 Cobb, and M parameters were independently associated with single-stage central LSS, and would likely be of particular value in evaluating the degree of single-segment central LSS; B, L 1 - 5 Cobb, and M served as independent predictors of the degree of LSS. These findings will guide clinicians’ decision-making in the future. Show more

Keywords: Lumbar spinal stenosis, lumbar degenerative disease, lumbar X-ray, dural sac compression

DOI: 10.3233/BMR-200051

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 581-587, 2021

Authors: Jeon, Jeong Woo | Hong, Jiheon

Article Type: Research Article

Abstract: BACKGROUND: The screw-home mechanism (SHM) plays an important role in the stability of the knee. Accordingly, the analysis of tibial rotation patterns can be used to elucidate the effect of SHM-related factors. OBJECTIVE: The purpose of this study was to compare the magnitude of the angle and the pattern of SHM between passive and active movements. METHODS: We studied twenty healthy males, of which the angle of knee flexion-extension and tibial longitudinal rotation (TLR) during active and passive movements were measured using the inertial measurement unit. Student’s t -tests were used …to compare the magnitude of TLR. The waveform similarity was quantified using a coefficient of multiple correlation (CMC). RESULTS: Significant differences were found in the TLR between the active and passive movements (p < 0.05). The knee flexion-extension waveform similarity was excellent (CMC = 0.956). However, the waveform similarity of TLR was weak (CMC = 0.629). CONCLUSION: The SHM increased abruptly during the last 20 ∘ of the active (extension) movement compared with passive extension. The SHM occurred mainly owing to the geometry and shape of the articular surfaces of the knee joint. In addition, muscle contraction was considered to be an important factor in the articulation movement. Show more

Keywords: Screw-home movement, inertial measurement unit, inertial sensor, knee stability, tibia longitudinal rotation

DOI: 10.3233/BMR-200110

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 589-595, 2021

Authors: Yalçın, Ümit

Article Type: Research Article

Abstract: BACKGROUND: Clinical studies assessing the impacts of ozone on the musculoskeletal framework are slowly expanding. OBJECTIVE: In this study, we analyzed the impact of paravertebral ozone treatment (OT) injection treatment on distress and disability in patients with lumbar disc hernia (LDH). METHODS: The records of 432 patients with L4-5 and L5-S1 LDH were examined retrospectively. 298 patients who met the inclusion criteria and who provided written informed consent were divided into two groups. Each group received 15 sets of physiotherapy at a rate of five sets every week (study group (n …= 139), control group (n = 159)). Six OT injections were applied solely to the study group, two days per week. A visual pain score (VAS) was set up for distress and the Oswestry Disability Questionnaire (ODI) for disablement was administered when the groups were called to control before treatment, towards the end of the treatment, and three months after the treatment ended. RESULTS: The groups had significantly reduced (p < 0.05) VAS and ODI scores following and three months after the treatment contrasted with their scores before the treatment. The Physiotherapy + OT group had significantly lower (p < 0.05) VAS and ODI scores than the physiotherapy group following and three months after the treatment. CONCLUSIONS: Paravertebral OT injection is quite a safe and helpful treatment technique in LDH patients. Further studies should be conducted to investigate the long-term outcomes of the paravertebral OT application. Show more

Keywords: Lumbar disc herniation, pain, ozone therapy, physiotherapy

DOI: 10.3233/BMR-200129

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 597-604, 2021

Authors: Kersten, R.F.M.R. | Fikkers, J. | Wolterbeek, N. | Öner, F.C. | van Gaalen, S.M.

Article Type: Research Article

Abstract: BACKGROUND: Low back pain is a common health problem for which there are several treatment options. For optimizing clinical decision making, evaluation of treatments and research purposes it is important that health care professionals are able to evaluate the functional status of patients. Patient reported outcome measures (PROMs) are widely accepted and recommended. The Roland Morris Disability Questionnaire (RMDQ) and the Oswestry Disability Index (ODI) are the two mainly used condition-specific patient reported outcomes. Concerns regarding the content and structural validity and also the different scoring systems of these outcome measures makes comparison of treatment results difficult. …OBJECTIVE: Aim of this study was to determine if the RMDQ and ODI could be used exchangeable by assessing the correlation and comparing different measurement properties between the questionnaires. METHODS: Clinical data from patients who participated in a multicenter RCT with 2 year follow-up after lumbar spinal fusion were used. Outcome measures were the RMDQ, ODI, Short Form 36 – Health Survey (SF-36), leg pain and back pain measured on a 0–100 mm visual analogue scale (VAS). Cronbach’s alpha coefficients, Spearman correlation coefficients, multiple regression analysis and Bland-Altman plots were calculated. RESULTS: three hundred and seventy-six completed questionnaires filled out by 87 patients were used. The ODI and RMDQ had both a good level of internal consistency. There was a very strong correlation between the RMDQ and the ODI (r = 0.87; p < 0.001), and between the VAS and both the ODI and RMDQ. However, the Bland-Altman plot indicated bad agreement between the ODI and RMDQ. CONCLUSIONS: The RMDQ and ODI cannot be used interchangeably, nor is there a possibility of converting the score from one questionnaire to the other. However, leg pain and back pain seemed to be predictors for both the ODI and the RMDQ. Show more

Keywords: Oswestry Disability Index, Roland Morris Disability Questionnaire, clinical outcome, patient reported outcome measures, correlations, low back pain

DOI: 10.3233/BMR-200206

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 605-611, 2021

Authors: Macedo, Liane Brito | Richards, Jim | Borges, Daniel Tezoni | Melo, Samara Alencar | Reis, Daniela Dantas | Brasileiro, Jamilson Simões

Article Type: Research Article

Abstract: OBJECTIVE: To evaluate the effect of different taping techniques on back muscle fatigue in people with low back pain. METHODS: Sixty women with chronic non-specific low back pain were randomly assigned to four groups of 15 participants each: control (CG), Kinesio Taping (KT) with tension (KTT), KT no tension (KTNT) and Micropore ® (MP), which were applied over the erector spinae muscles. The median frequency (MF) fatigue slopes of the longissimus muscle and sustained contraction time during a trunk fatigue test (Ito test), and pain using the numerical pain rating scale (NPRS) …were collected at three time points: pre-treatment, three and ten days after intervention at a university laboratory. RESULTS: Significant differences were seen in the MF slopes between groups (p = 0.01, η 2 = 0.20), with the KTT showing a mean difference (MD = 0.31, p = 0.04) and KTNT (MD = 0.28, p = 0.04) compared with CG. Significant reductions in NPRS were seen between time points (p < 0.001, η 2 = 0.28), with a reduction between pre and 3 days (MD = 1.87, p < 0.001), and pre and 10 days (MD = 1.38, p < 0.001), with KTT and KTNT both showing clinically important changes. CONCLUSION: KT, with or without tension, has a tendency to reduce back muscle fatigue and reduce pain in individuals with chronic non-specific low back pain. Show more

Keywords: Bandages, electromyography, lumbar spine, muscle fatigue

DOI: 10.3233/BMR-200207

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 613-621, 2021

Authors: Yalçın, Ümit

Article Type: Research Article

Abstract: BACKGROUND: Although studies examined kinesiological taping (KT) and extracorporeal shock wave therapy (ESWT) in myofascial pain syndrome (MPS), no study has yet compared these two treatments. OBJECTIVE: This study aimed to compare the efficacy of KT and ESWT on pain, pain threshold, functional level and neck movements in the treatment of MPS, which is an important cause of disability and constitutes 50–80% of chronic painful diseases. METHODS: Two hundred and sixty-two patients diagnosed with MPS in the upper part of the unilateral trapeze muscle were included in the study. The patients were divided …into three groups according to the treatment they received: Group 1 (n = 75): ESWT + exercise, Group 2 (n = 82): KT + exercise, Group 3 (n = 105) and the latter receiving only exercise therapy (control group). Visual analog scale (VAS), pain threshold with algometer, Neck Disability Index (NDI), and neck contralateral lateral flexion angle were assessed before and three months after treatment. RESULTS: VAS, pain threshold, NDI and contralateral flexion angle values after treatment improved significantly in the ESWT and KT groups (p < 0.05) compared to the control group. The level of improvement in the ESWT group was higher (p < 0.05) than in the KT group in terms of VAS, pain threshold and NDI scores. CONCLUSION: Exercise, KT and ESWT applications in MPS were effective in all of the parameters examined. However, the ESWT + exercise therapy was more effective in terms of pain, pain threshold and disability. Show more

Keywords: Myofascial pain syndrome, kinesiological taping, extracorporeal shock wave therapy

DOI: 10.3233/BMR-200234

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 623-630, 2021

Authors: Endo, Naoto | Ishii, Daisuke | Ishibashi, Kiyoshige | Yamamoto, Satoshi | Takeda, Kotaro | Kohno, Yutaka

Article Type: Research Article

Abstract: BACKGROUND: Rotator cuff muscles are structurally and functionally different from other upper-limb muscles because they are responsible for glenohumeral joint stability. Neuromuscular electrical stimulation (NMES) induces excitability changes (increase or decrease) of the corticospinal tract (CST) in the peripheral muscles, such as those of the finger. However, it remains unclear whether similar results are obtained when targeting the infraspinatus muscle, which has properties that differ from other muscles, in healthy subjects. OBJECTIVE: We investigated the immediate effects of NMES on the corticospinal excitability of the infraspinatus muscle, a rotator cuff muscle, in healthy subjects. …METHODS: Thirteen healthy right-handed men (mean age: 26.77 ± 2.08 years) participated in this study. The motor evoked potentials (MEPs) and the maximum compound muscle action potential (Mmax) were recorded before NMES to the right infraspinatus and within 15 minutes after the end of the NMES. RESULTS: NMES on the infraspinatus muscle significantly increased its MEP amplitude (Pre: 0.45 mV [0.33–0.48]; Post: 0.54 mV [0.46–0.60] (median [lower quartile to higher quartile]); p = 0.005) but had no effect on Mmax (Pre: 2.95 mV [2.59–4.71]; Post: 3.35 mV [2.76–4.72]; p = 0.753). CONCLUSIONS: NMES application to the infraspinatus muscle increases CST excitability without producing immediate changes in the neuromuscular junction or muscle hypertrophy. Show more

Keywords: Infraspinatus muscle, rotator cuff muscles, electrical stimulation, transcranial magnetic stimulation, motor evoked potential

DOI: 10.3233/BMR-200298

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 631-637, 2021

Authors: Develi, Elif | Subasi, Feryal | Aslan, Goksen K. | Bingol, Zuleyha

Article Type: Research Article

Abstract: BACKGROUND: In the literature, novel physiotherapy and rehabilitation approaches are getting significant attention as a way to cope with secondary complications in the management of asthma. OBJECTIVE: To investigate the effectiveness of core stabilization exercises combined with the Asthma Education Program (AEP) and breathing exercises in patients with asthma. METHODS: The study sample consists of 40 asthmatic patients (age 52.25 ± 11.51 years) who were randomly divided into a Training Group (TG) (n = 20) and a Control Group (CG) (n = …20). All subjects were included in the AEP, and both groups were trained in breathing retraining exercises (2 times/wk, 6-week duration in the clinic). The core stabilization exercise program was also applied in the TG. Respiratory muscle strength (maximum inspiratory and expiratory pressures), physical activity level (International Physical Activity Questionnaire Short Form (IPAQ)), health-related quality of life (Asthma Quality of Life Questionnaire (AQOL)), functional exercise capacity (six-minute walking test (6MWT)), and dynamic balance (Prokin PK200) were assessed before and after the interventions. RESULTS: The TG showed more significant improvements in MIP (Δ TG:4.55 cmH 2 O, Δ CG:0.95 cmH 2 O), IPAQ (Δ TG:334.15 MET-min/wk., Δ CG:99 MET-min/wk.), 6MWT (Δ TG:24.50 m, Δ CG:11.50 m), and dynamic balance sub-parameters compared to the mean difference between the initial assessment and after a 6-week intervention program, which included twelve exercise sessions (p < 0.01). CONCLUSIONS: The findings present greater improvements in inspiratory muscle strength, physical activity level, functional exercise capacity, and dynamic balance when core stabilization exercises are included in the pulmonary rehabilitation program for the management of asthma. Show more

Keywords: Asthma education, breathing exercises, core stabilization, dynamic balance, functional capacity, respiratory muscle strength

DOI: 10.3233/BMR-191803

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 639-648, 2021

Authors: Shin, Hun Kyu | Park, Jai Hyung | Lee, In Gyu | Park, Jin Hun | Park, Jun Hyoung | Cho, Yongun

Article Type: Research Article

Abstract: BACKGROUND: The number of patients with an osteoporotic vertebral compression fracture, which is often accompanied by lower back pain and restrained activities, is growing. Balloon kyphoplasty involves the inflation of a balloon to restore height and reduce kyphotic deformity before stabilization with polymethylmethacrylate. However, there is a great deal of debate about whether balloon kyphoplasty also increases fracture morbidity by either inducing or facilitating subsequent adjacent vertebral fractures. OBJECTIVE: To evaluate the relationship between the rate of vertebral body height loss before balloon kyphoplasty and the etiology of early adjacent vertebral fracture after augmentation. …METHODS: A total of 59 patients with osteoporotic vertebral compression fractures who underwent kyphoplasty were enrolled. This study defined early adjacent segmental fractures as new fractures occurring within three months after surgery. This study included the rate of vertebral body height loss. RESULTS: Early adjacent vertebral fractures were diagnosed in nine (15%) of the 59 patients. The patients were divided into two groups, with and without adjacent vertebral fractures. There was no significant difference in terms of age, body mass index, bone mineral density, local kyphotic angle, Cobb’s angle, cement volume, cement leakage, and percent height restored between the groups with fractures and without fractures. There was a statistically significant difference between the two groups in the rate of vertebral body height loss. The rate of vertebral body height loss was significantly higher in the fracture group than in the without fracture group. CONCLUSIONS: A high rate of vertebral body height loss increased the risk of early adjacent vertebral fractures after balloon kyphoplasty. Show more

Keywords: Osteoporotic vertebral compression fracture, adjacent vertebral fracture, balloon kyphoplasty, vertebral body height loss

DOI: 10.3233/BMR-200121

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 649-656, 2021

Authors: Schneider, Byron J. | Haring, R. Sterling | Song, Amos | Kim, Peter | Ayers, Gregory D. | Kennedy, David J. | Jain, Nitin B.

Article Type: Research Article

Abstract: BACKGROUND: Back pain is a leading reason for seeking care in the United States (US), and is a major cause of morbidity. OBJECTIVE: To analyze demographic, patient, and visit characteristics of adult ambulatory spine clinic visits in the United States from 2009–2016. METHODS: Data from the National Ambulatory Medical Care Survey from 2009–2016 were used and were sample weighted. RESULTS: Most patients presenting for ambulatory spine care were 45–64 years (45%), were most commonly female (56.8%), and private insurance (45%) and Medicare (26%) were most common payors. The percentage of …visits for spine care done at a primary care setting was 50.1% in 2009–2010 and 48.3% in 2014–2015. Approximately 15.5% were seen in orthopedic surgery clinics in 2009–2010 and 7.3% in 2015–2016. MRI was utilized in 11.7% in 2009–2010 and 11.0% in 2015–2016. Physical therapy was prescribed in 13.2% and narcotic analgesic medications were prescribed in 36.2% of patients in 2015–2016. CONCLUSIONS: MRI was used more frequently than guidelines recommended, and physical therapy was less frequently utilized despite evidence. A relatively high use of opiates in treatment of back pain was reported and is concerning. Although back pain represents a substantial public health burden in the United States, the delivery of care is not evidence-based. Show more

Keywords: Low back pain, epidemiology, primary care

DOI: 10.3233/BMR-200145

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 657-664, 2021

Authors: Krause, Frieder | Niederer, Daniel | Banzer, Winfried | Vogt, Lutz

Article Type: Research Article

Abstract: BACKGROUND: A considerable part of patients with non-specific low back pain (LBP) suffer from a recurrence of symptoms after therapy cessation. OBJECTIVE: The aim of this cohort study was to evaluate the predictive value of active and passive treatments and treatment modalities on a recurrence of low back pain after cessation of medically prescribed therapy. METHODS: Patients with non-specific LBP from a health- and therapy-center were included. Treatments were monitored and categorized as active or passive. During one year after therapy cessation, patients were monitored to retrieve information about recurrence of symptoms. Patients …were dichotomized (recurrence versus no recurrence). An ROC-Analysis was used to determine optimal cut-offs for relevant treatment characteristics’ (passive versus active; frequency) impact on recurrence risk. The relative risk for a recurrence was calculated based on Chi 2 -test. RESULTS: Data from 96 participants (56 females, 40 males, mean age 49 years, standard deviation 11 years) were analysed. A total of 34 participants had recurring LBP. The frequency of active treatment differed significantly between groups with or without recurrence (p < 0.05). A therapy frequency of 1.45 active treatments/week was a sensitive cut-off (sensitivity: 0.73) to discriminate the recurrence groups. Participants with an active therapy frequency of less than 1.45 treatments per week showed an 82% increased relative recurrence risk (RR: 1.824 (95%-CI: 1.077–3.087)). CONCLUSIONS: The results empathize the importance of active treatments (i.e. exercise) in the therapy and (secondary) prevention of non-specific LBP. Less than 1.45 active treatment sessions/week increases the 1-year-risk of a recurrence by 82%. Performing at least two treatments sessions per week is therefore recommended. Show more

Keywords: Unspecific low back pain, therapy frequency, recurrence-risk, compliance, MiSpEx, NCLBP

DOI: 10.3233/BMR-200149

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 665-670, 2021

Authors: Sung, Ha-Rim | Oh, Se-Jung | Ryu, Jun-Nam | Cha, Yong-Jun

Article Type: Research Article

Abstract: OBJECTIVE: The purpose of this study was to investigate the most effective ankle joint position for squat exercise by comparing muscle activities of lower extremity and erector spinae muscles in different ankle joint positions. METHODS: Thirty-seven normal healthy adults in their 20s participated in this study. Muscle activities of dominant vastus medialis oblique, vastus lateralis, biceps femoris, and erect spinae were measured in three ankle joint positions; dorsiflexion, neutral, and plantar flexion. RESULTS: Muscle activities of the vastus medialis oblique, vastus lateralis, and erector spinae muscles were statistically different in the three ankle …joint positions during squat exercise (p < 0.05). Vastus medialis oblique muscles showed higher muscle activity in ankle plantar flexion than in the dorsiflexion or neutral positions (plantar flexion > neutral position, + 3.3% of maximal voluntary isometric contraction (MVIC); plantar flexion > dorsiflexion, + 12.2% of MVIC, respectively). Vastus lateralis muscles showed 7.1% of MVIC greater muscle activity in the neutral position than in dorsiflexion, and erector spinae muscles showed higher muscle activity in dorsiflexion than in plantar flexion or in the neutral position (dorsiflexion > neutral position, + 4.3% of MVIC; dorsiflexion > plantar flexion, + 7.1% of MVIC, respectively). CONCLUSION: In squat exercises designed to strengthen the vastus medialis oblique, ankle joint plantar flexion is probably the most effective ankle training position, and the dorsiflexion position might be the most effective exercise for strengthening the erector spinae muscle. Show more

Keywords: Squat exercise, muscle activity, ankle joint position, multi-joint position

DOI: 10.3233/BMR-191807

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 671-676, 2021

Authors: Jabbar, Karim Mohammad | Gandomi, Farzaneh

Article Type: Research Article

Abstract: BACKGROUND: Hyperkyphosis (HKP) and forward head posture (FHP) occur due to prolonged poor postures and repetitive activities. OBJECTIVE: The present study aimed to compare the effects of the National Academy of Sports Medicine (NASM) and Sahrmann corrective exercises on HKP and FHP correction. METHODS: This quasi-experimental study was conducted on 30 subjects with HKP and FHP, who were randomly assigned to the NASM (n = 15) and Sahrmann groups (n = 15). The ImageJ software and a spinal mouse device were used to …measure FHP and HKP deformities, and neck and shoulder muscle strength, range of motion (ROM), and pulmonary function were assessed as the secondary outcomes before and after the eight-week intervention. RESULTS: FHP improved more significantly in the Sahrmann group compared to the NASM group (P < 0.05), while no significant difference was observed between the groups in HKP (P > 0.05). The improvement in the neck and shoulder muscle strength was more significant in the Sahrmann group compared to the NASM (P < 0.05), except for the neck flexors. In addition, the neck extension ROM enhanced more significantly in the Sahrmann group compared to the NASM group (P < 0.05). CONCLUSION: According to the results, the Sahrmann corrective exercises that focused on the correction of imbalanced muscle stiffness had more significant effects on the correction of FHP, neck and shoulder muscle strength and neck extension ROM. Show more

Keywords: Forward head posture, hyperkyphosis, corrective exercises, pulmonary function

DOI: 10.3233/BMR-200160

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 677-687, 2021

Authors: Erdağı, Kenan | Poyraz, Necdet

Article Type: Research Article

Abstract: BACKGROUND: The multifidus muscle is located near the spine and controls the erection of the spine and stabilization during movements of the spine and extremities, and assists in all other spinal movements. Differences in paraspinal muscles between sides and levels, particularly in he multifidus, have been proposed as possible indicators of low back pain or spinal pathology. OBJECTIVE: This study aims to examine the cross-sectional area of the lumbar multifidus muscle at L4-L5 vertebral levels on ultrasound images of athletes in Olympic-style weightlifting, judo athletes and sedentary individuals. METHODS: This study included asymptomatic …male athletes (athletes in Olympic-style weightlifting, n = 17, age: 19.24 ±  1.88, judo athletes, n = 17, age: 19.18 ± 1.23) and sedentary individuals (n = 17, age: 19.88 ± 1.31). The cross-sectional area of lumbar multifidus muscles was assessed bilaterally at the L4-L5 segments level in prone and using ultrasound imaging. RESULTS: Lumbar multifidus muscle cross-sectional areas of athletes in Olympic-style weightlifting and judo athletes were larger than those of sedentary individuals (p < 0.004). No asymmetric development was observed in cross-sectional areas of right-left lumbar multifidus muscle at L4-L5 levels of athletes in Olympic-style weightlifting and sedentary individuals (p >  0.008). The cross-sectional areas of the right and left lumbar multifidus muscle at L5 segment of individuals in judo athletes was found to be asymmetrical (p < 0.008). CONCLUSION: Our study shows that the cross-sectional areas of athletes in Olympic-style weightlifting and judo athletes are larger than that of sedentary individuals. The difference in the cross-sectional area of the lumbar multifidus muscle of athlete and sedentary groups might be said to result from hypertrophic effect of trainings of these athletes on the cross-sectional area of the lumbar multifidus muscle. Show more

Keywords: Multifidus muscle, ultrasound imaging, Olympic-style weightlifting, judo

DOI: 10.3233/BMR-200101

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 689-696, 2021

Authors: Mourits, B.M.P. | Meulekamp, M.Z. | van der Wurff, P. | Lucas, C.

Article Type: Research Article

Abstract: OBJECTIVE: The main objective of this study was to identify general and military-related factors that are associated with the level of recovery in Dutch service members with chronic low back pain (CLBP) who followed a rehabilitation program. MATERIAL AND METHOD: One hundred five consecutive service members with CLBP were included in this study. The level of disability, was used to distinguish a recovered and non-recovered group. Level of pain and self-perceived recovery were used as secondary outcome measurements. Differences were evaluated within and between the groups using the Student’s t -test Bivariate logistic regression …analyses were used for identifying the prognostic factors related to various outcomes of recovery RESULTS: After following the rehabilitation program, 64.8% of the service members recovered from CLBP. The recovered group, demonstrated significant effect sizes in disability and in pain The non-recovered group showed on disability a non-significant effect and in pain a significant effect. The self-perceived recovery in the recovered group was “much improved” and the non-recovered group “slightly improved”. The results of the bivariate regression analyses showed no significant independent prognostic factors related to recovery. CONCLUSIONS: In this study, no significant independent prognostic factors could be identified that were associated to the various outcomes of recovery in service members with CLBP who followed a rehabilitation program. Show more

Keywords: Prognostic, rehabilitation, service members

DOI: 10.3233/BMR-200123

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 697-705, 2021

Authors: Tsigkanos, Christos | Demestiha, Theano | Spiliopoulou, Chara | Tsigkanos, Georgios

Article Type: Research Article

Abstract: BACKGROUND: Kinematic analysis has been a dominant tool for addressing the neuromuscular and proprioceptive alterations that occur in Low Back Pain (LBP) patients. Movement variability is a crucial component of this analysis. In the recent years application of non-linear indices seems to be showing the way. OBJECTIVE: The aim of the study was to compare movement variability, as expressed mainly by non-linear indices, at the pelvis and lumbar spine between LBP patients and healthy participants during gait. METHODS: Sixteen (16) LBP patients and thirteen (13) healthy control subjects (non-athletes) participated in the study. …Participants walked on a treadmill at different walking conditions while recorded by a 6-infrared camera optoelectronic system. Kinematic variability of pelvic and lumbar movement was analyzed using linear (standard deviation – SD) and non-linear indices (Maximal Lyapunov Exponent – LyE and Approximate Entropy – ApEn). RESULTS: Healthy subjects were found to have significantly greater mean values than LBP patients at seven pelvic and lumbar components in LyE, ApEn and SD. Specifically, the calculated LyE at the pelvis during normal gait was proven to have a sensitivity of 92.3% and a specificity of 90% in the discrimination of healthy subjects from LBP patients. Female subjects presented with higher variability in gait measures than males. CONCLUSION: Healthy participants presented with higher movement variability in their kinematic behavior in comparison to LBP patients. Lower variability values may be partly explained by the attempt of LBP patients to avoid painful end of range of motion positions. In this perspective non-linear indices seem to relate to qualitive characteristics of movement that need to be taken into consideration during rehabilitation. Show more

Keywords: Low back pain, movement variability, gait kinematics, Maximal Lyapunov Exponent, Approximate entropy

DOI: 10.3233/BMR-200260

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 707-714, 2021

Authors: Żłobiński, Tobiasz | Stolecka-Warzecha, Anna | Hartman-Petrycka, Magdalena | Błońska-Fajfrowska, Barbara

Article Type: Research Article

Abstract: BACKGROUND: Hallux valgus, one of the most common foot disorders, contributes to the formation of pain and changes foot biomechanics. OBJECTIVE: To assess the impact of Kinesiology Taping (KT) on foot loading during gait in patients with hallux valgus. METHODS: Forty feet with hallux valgus were examined. Patients wore the KT for a month and the parameters of the foot during gait on a baropodometric platform were measured three times: before taping, immediately after application of taping and after one month’s use. RESULTS: The taping had a statistically significant effect …on dynamic foot measurements. The maximum and mean foot load (p < 0.001), foot surface (p < 0.001), ratio of forefoot to hindfoot load (p < 0.01) and the proportions of the lateral and medial foot loading (p < 0.05) all changed. During gait cycle, taping significantly increased the load and surface at the first metatarsal head (p < 0.001) while there was a decrease around the second to fifth (p < 0.001) metatarsal heads. CONCLUSIONS: Using KT to correct a hallux valgus is a procedure that has an impact on the dynamic parameters of the foot during gait. The use of this method could become an alternative to surgical treatment for those patients, who have any contraindication for surgery. Show more

Keywords: Hallux valgus, Kinesiology Taping, gait, biomechanics of foot

DOI: 10.3233/BMR-200231

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 4, pp. 715-721, 2021