Journal of Back and Musculoskeletal Rehabilitation - Volume 34, issue 6

Authors: Cho, Sung Hak

Article Type: Research Article

Abstract: BACKGROUND: Compared with healthy people, patients with chronic tension-type headache (CTTH) are likely to have forward head postures (FHP) and a higher number of active trigger points (aTrP) on the suboccipital muscle. OBJECTIVE: This study aims to verify how the suboccipital muscle inhibition (SMI) on aTrPs and the FHP correction exercise can effectively reduce symptoms of the CTTH patients. METHOD: The subjects of this study were 45 individuals with CTTH, divided into three groups of 15 patients each: a) the SMI group using the myofascial release technique; b) the SMIEx group subject to …both the SMI therapy and FHP correction exercises; and c) the control group. Group A and B were given the relevant interventions twice a week for four consecutive weeks, and went through the headache impact test (HIT-6) and examinations on the pressure pain threshold (PPT) of the headache areas, the type and number of myofascial trigger points (TrP), the soft tissue PPT, and the posture before and after the intervention. RESULTS: There was a significant improvement in the HIT-6, the headache PPT, the soft tissue PPT, the TrP, and the posture in Group A and B patients to whom the SMI technique and SMIEx interventions were applied. The biggest reduction and increase in the HIT-6 and the headache PPT respectively were seen in the SMIEx group. CONCLUSION: According to this study, the SMIEx can be an effective intervention for patients with CTTH. Show more

Keywords: Chronic tension-type headache (CTTH), suboccipital muscle inhibition(SMI) technique, FHP correction exercise

DOI: 10.3233/BMR-191667

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 989-996, 2021

Authors: Brück, Katrin | Jacobi, Kirsten | Schmidt, Tobias

Article Type: Research Article

Abstract: BACKGROUND: Chronic neck pain (CNP) is a common health problem in western industrialized nations. In recent years, the fascial tissue has attracted the attention of therapists, and a treatment of the fasciae promises to be a meaningful approach in the therapy of patients with CNP. OBJECTIVE: The aim of this study was to investigate the effectiveness of a fascial treatment (FT) compared to manual therapy (MT) and to no intervention (control group, CG) in patients with CNP. METHODS: Sixty participants with CNP were randomized into three groups. Primary outcome parameters were pain intensity …as measured by the visual analogue scale (VAS), and severity of illness as measured by the Neck Pain and Disability Scale (NPAD). Secondary outcome parameter was the range of motion (ROM) of the cervical spine. RESULTS: Repeated measures t -tests demonstrated significant decreases with medium to large effect sizes for the FT (VAS: d R ⁢ M = 1.14; NPAD: d R ⁢ M = 0.51) and for the MT (VAS: d R ⁢ M = 1.15; NPAD: d R ⁢ M = 0.72). CONCLUSION: Our results confirmed the effectiveness of MT on pain and severity of illness in the treatment of patients suffering from CNP. Furthermore, the results demonstrated the effectiveness and clinical relevance of FT for this population. Show more

Keywords: Chronic neck pain, fascial treatment, HVLA, manual therapy, myofascial tissue, osteopathy

DOI: 10.3233/BMR-191731

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 997-1006, 2021

Authors: Fung, Kerry W.Y. | Chow, Daniel H.K. | Shae, W.C.

Article Type: Research Article

Abstract: BACKGROUND: Active exercise is the only proven effective intervention for knee osteoarthritis (OA). The addition of manual therapy has shown to improve outcome of exercises. Passive mobilization with submaximal bilateral passive ankle dorsiflexion was examined in a double-blinded randomized controlled clinical trial. A passive ankle dorsiflexion apparatus was used to standardize the frequency, range of motion, and duration parameters. OBJECTIVES: The purpose of the study was to determine whether a simple standardised mobilization technique could be incorporated as a safe and unsupervised conservative treatment for knee OA. METHODS: In total, 73 participants were randomly …assigned to the experimental (n = 37) or control group (n = 36). All participants performed active exercises and received six sessions of 10-minute dorsiflexion intervention, either real or sham, for two weeks. Pre- and post-experimental assessments for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and range of motion of the knee were conducted. RESULTS: Results were analyzed using two-way repeated measures analysis of variance and Independent-Samples Mann-Whitney U Test. The mean score of WOMAC for the experimental and control groups changed from 31.84 to 18.19 and 34.74 to 21.06, respectively, after the intervention. The VAS also showed significant improvements. Significant improvements were observed in WOMAC in both groups after the intervention; however, differences between the groups were not statistically significant. CONCLUSIONS: Exercise with either 30 ∘ or 5 ∘ of passive dorsiflexion yielded favorable clinical effects. Although submaximal bilateral ankle dorsiflexion was proven to be safe for elderly participants with osteoarthritis of the knee, whether it provided extra benefits to exercises alone was unclear. Further research is required to determine the effectiveness of dorsiflexion and optimal range of mobilization. Show more

Keywords: Knee, osteoarthritis, mobilization, WOMAC

DOI: 10.3233/BMR-191799

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1007-1014, 2021

Authors: Ojukwu, Chidiebele Petronilla | Ezeukwu, Obinna Antoninius | Anih, Chinagozim Faith | Okemuo, Adaora Justina | Ezugwu, Uchechukwu Anthonia | Ikele, Chioma Nneka | Igweagu, Chukwuma Paulinus | Ezugwu, Lazarus Eneje

Article Type: Research Article

Abstract: BACKGROUND: High prevalence of breastfeeding (BF)-related musculoskeletal disorders (MSDs) in nursing mothers have been reported in previous studies. Studies are scarce on the biomechanical effects of the commonly utilized BF positions. OBJECTIVE: This study evaluated the electromyographic (EMG) activities of the trunk muscles in response to three BF positions commonly utilized by mothers globally. METHODS: 20 non-pregnant nulliparous females participated in this experimental study. EMG activities from erector spinae (ES) and external oblique (EO) muscles were recorded bilaterally in three BF conditions: cradle (C1); cross-cradle (C2); football (FB). Data were analyzed using descriptive …statistics and inferential statistics of one-way analysis of variance with alpha level set at 0.05. RESULTS: The activity levels of right EO and ES muscles significantly increased during the C2 hold, while the left EO and ES muscles revealed significantly higher EMG levels in the C1 trial. Asymmetrical activity between the right and the left parts of the EO muscle was significantly higher during the C2 hold. CONCLUSION: These findings suggest that compared to C2 and C1 holds, FB hold may be more biomechanically efficient relative to its decreased muscular demands. The physical stresses associated with BF may be higher with the adoption of C2 and C1 holds, especially for prolonged periods. Show more

Keywords: Breastfeeding positions, electromyography, trunk muscle activities

DOI: 10.3233/BMR-200018

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1015-1021, 2021

Authors: Lim, Wootaek

Article Type: Research Article

Abstract: BACKGROUND: In clinical practice, knee flexion at the prone position for manual muscle testing of hamstrings and hip extension at the supine position for stretching of hamstring muscles are typically proposed. OBJECTIVE: Although different positions have been proposed for different purposes in hamstrings, the understanding of the changing the functional role of hamstrings with position changes is poorly understood. METHODS: The electromyographic (EMG) activity and hip extension force were compared among different postures; hip neutral, internal, and external rotation. EMG and force were measured in prone position during knee flexion and those were …additionally measured in supine position during hip extension. In supine position, additional measurements were made in hip neutral, internal and external rotation. RESULTS: Hamstrings showed high EMG activity during knee flexion. Knee flexion force in prone position was significantly decreased at hip extension force in supine position. In supine position, EMG activity was significantly higher in semitendinosus (ST) than biceps femoris (BF) during internal rotation. CONCLUSIONS: It should be noted that bi-articular muscles may have different functional dependencies on the corresponding muscles for each joint. In addition, because the altered alignment of the hamstring muscles that was affected by hip rotation had a significant effect on muscle activity, and hip rotation may be helpful for selective training of medial or lateral hamstrings. Show more

Keywords: Electromyography, force, hamstrings, hip rotation

DOI: 10.3233/BMR-200064

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1023-1029, 2021

Authors: Nitayarak, Haifah | Charntaraviroj, Pornpimol

Article Type: Research Article

Abstract: BACKGROUND: Scapular stabilization exercises can improve forward shoulder posture in young women. However, the effects of optimal exercise protocols on neck and shoulder postures, scapular muscle imbalance and thoracic kyphosis are still unclear. OBJECTIVES: To investigate the effects of scapular stabilization exercises on neck and shoulder postures, scapular muscle imbalance and thoracic kyphosis in young women with upper crossed syndrome. METHODS: Thirty-nine women aged 18–25 years with upper crossed syndrome were recruited. Participants were randomly allocated intotwo groups. The exercise group performed scapular stabilization exercises using elastic bands at 10 repetitions/set, 3 sets/day, …and 3 days/week for 4 weeks. The control group did not perform any exercises during the experimental period. The cervical and shoulder angles were evaluated using the Kinovea program. A caliper, handheld dynamometer and flexi ruler were used to evaluate the length of the pectoralis minor, strength of the scapular stabilizer muscles and degree of the mid-thoracic curve, respectively. RESULTS: The exercise group showed significant differences (p < 0.05) in the increase in cervical and shoulder angle, length of the pectoralis minor, and strength of the scapular muscles, except in the degree of mid-thoracic curve compared to the control group. CONCLUSION: This study indicated that scapular stabilization exercises can improve forward head and shoulder posture, increase the flexibility of the pectoralis minor and strengthen the scapular muscles. Show more

Keywords: Upper crossed syndrome, posture, muscle imbalance, scapular stabilization exercise

DOI: 10.3233/BMR-200088

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1031-1040, 2021

Authors: Petit, Audrey | Le Borgne, Margaux | Albert, Valérie | Durand, Marie-José

Article Type: Research Article

Abstract: BACKGROUND: Addressing chronic low back pain (cLBP) from the point of view of representation allows better understanding the behaviors associated with it and thus improve its medical and socio-occupational management. The Quebec Questionnaire of Representations related to Work Disability (QRWoD) proposes an evaluation of 9 dimensions of the cLBP-related representation. OBJECTIVE: To translate and adapt the QRoWD to French language and assess its validity and reliability in French cLBP workers on prolonged sick leave. METHODS: A prospective study was conducted from March 2017 to April 2018 in the Department of occupational health of …the University Hospital of Angers, France. The QRWoD is a self-administered questionnaire (87 items) which assesses Identity, Acute/Chronic duration, Consequences, Personal Control, Treatment Control, Cyclical Timeline, Coherence, Emotional Representation and Causes dimensions. The Internal consistency (Cronbach’s α ) and the convergent validity (Pearson correlations) in comparison to validated instruments for each dimension were assed. RESULTS: Fifty French workers (29 men, 43 ± 9.1 years, 293.6 ± 173.0 days of work absence) were included. The internal consistency (all α > 0.7) and the convergent validity (all r 2 > 0.25, p < 0.01) of each dimension were very satisfactory except for the Cyclical Timeline dimension. CONCLUSIONS: The French version of the QRoWD seems to be valid and relevant among the target population. Show more

Keywords: Chronic low back pain, cross-cultural adaptation, dimensions, representation, validity, work disability

DOI: 10.3233/BMR-200093

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1041-1048, 2021

Authors: Arslan, Serdar | Dinç, Engin

Article Type: Research Article

Abstract: BACKGROUND: The Functional Movement Screen (FMS) is a clinical assessment tool used to determine musculoskeletal dysfunctions and asymmetries in athletes. OBJECTIVE: The aim of this study was to investigate whether FMS scores differed between elite youth male soccer players with low body fat percentage and those with normal body fat percentage and between those with and without a history of soccer injury. METHODS: Fifty-three elite youth male soccer players were included in the study. The participants’ injury histories were recorded, followed by body composition assessment and FMS tests. The participants were grouped according …to body fat percentage and injury history for data analysis. RESULTS: The mean age, weight and height of the participants were 17.11 ± 0.91 years, 68.78 ± 7.41 kg and 1.77 ± 0.57 meters, respectively. Comparisons of the groups according to body fat percentage and injury history revealed no differences in FMS scores (p > 0.05). CONCLUSION: Lower body fat percentage did not confer an advantage or disadvantage to elite youth male soccer players in terms of FMS scores FMS scores provide limited information to predict injuries in elite youth male players. Show more

Keywords: Football, body fat, injuries, sports, body composition, athletes

DOI: 10.3233/BMR-200100

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1049-1056, 2021

Authors: Nam, Soo-Jin | Oh, Duck-Won

Article Type: Research Article

Abstract: BACKGROUND: Side-lying hip abduction exercise could be beneficial to improve the neuromuscular control of the hip abductor; however, there has been limited information available to determine the exercise load during the exercise. OBJECTIVE: This study aimed to demonstrate the effects of using external loads on the hip abductor muscles during side-lying hip abduction exercises in females with gluteus medius (GM) weakness. METHODS: This study enrolled 24 females with weakness in the GM. Electromyographic (EMG) data of the quadratus lumborum (QL) and GM muscles were recorded during the exercise under three load conditions: no-load, …external load-1 (3% of body weight), and external load-2 (5% of body weight). RESULTS: During the exercise, the EMG activities of the QL were significantly different under all three conditions (p < 0.05), with greater activity observed in the external load-2 condition (92.05 ± 65.93% maximal voluntary isometric contraction [MVIC]) as compared to the others, and in the external load-1 condition (82.47 ± 57.36% MVIC) as compared to the no-load condition (48.94 ± 45.09% MVIC). Furthermore, the GM/QL ratios showed significant differences between no-load (1.78 ± 1.47) and external load-1 conditions (0.93 ± 0.60), and between no-load and external load-2 (0.85 ± 0.45) conditions (p < 0.05). CONCLUSION: These findings suggest that greater load could be a factor to increase the QL activity during the exercise in females with weakened GM. Show more

Keywords: Hip abduction, load, exercise

DOI: 10.3233/BMR-200108

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1057-1062, 2021

Authors: Soer, Remko | Six Dijkstra, Marianne W.M.C. | Bieleman, Hendrik J. | Oosterveld, Frits G.J. | Rijken, Noortje H.M.

Article Type: Research Article

Abstract: BACKGROUND: Many patients visiting physiotherapists for musculoskeletal disorders face psychosocial challenges which may form a large barrier to recover. There are only a limited number of evidence based psychosocial therapies, but they are mainly based on breathing exercises. OBJECTIVE: to study which respiration frequency would lead to the highest relaxation, reflected in vagal tone derived from the heart rate variability (HRV) in healthy subjects. METHODS: A randomized controlled cross sectional study was performed. Respiration cycles of four, five, six, seven and eight breaths per minute (BPM) were delivered in randomized order for two minutes …each. HRV metrics were measured during the sessions with electrocardiogram (ECG). Repeated Measures ANOVA’s were performed to analyze differences between breathing frequencies. RESULTS: 100 healthy volunteers were included (40 male). Standard Deviation of inter beat intervals (SDNN) values were significantly highest at 5 BPM, whereas the Root Mean Square of Successive Differences (RMSSD) values appeared highest at 7 breaths per minute (p < 0.01). High Frequency (HF) power was lowest at 4 BPM, whereas Low Frequency (LF) power was not significantly influenced by respiration frequency. CONCLUSIONS: Breathing at a frequency of 5 to 7 breaths per minute leads to highest HRV values, but there is no single respiration ratio that maximizes all metrics. Physiotherapists may use five to seven BPM as guidance to determine ideal breathing frequencies. Show more

Keywords: Heart rate variability, breathing frequencies, relaxation, stress, physiotherapy

DOI: 10.3233/BMR-200190

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1063-1068, 2021

Authors: Koltak, Cansu | Yurt, Yasin

Article Type: Research Article

Abstract: BACKGROUND: Low level laser therapy (LLLT) is known to be effective in tendinopathies. No study yet investigated the effect of LLLT on posterior tibial tendon dysfunction (PTTD) in comparison to orthotic treatment. OBJECTIVE: The aim was to compare the effects of LLLT and insole application on pain, function and muscle strength in subjects with stage 2 PTTD. METHODS: Fifty-two subjects with stage 2 PTTD were randomly assigned to the LLLT and insole groups. The foot pain, function and strength of invertor and evertor muscles of the subjects was evaluated before and after treatment, …and after 9 months. RESULTS: Significant improvement was observed in the foot function and pain (p < 0.05) in both groups after treatment, but in the 9-month follow-up, the insole group had better values. The increase in 180 ∘ .sec - 1 concentric invertor muscle strength was found significant after the treatment and in month-9 as compared to the initial values (p < 0.05). CONCLUSIONS: Both treatments are effective in reducing treating foot pain, as well as improving the function in subjects with stage 2 PTTD. However, at the end of the 9-month follow-up, it was seen that insoles were more effective. Neither method had a clinically important effect on muscle strength. Show more

Keywords: Low level laser therapy, foot orthoses, posterior tibial tendon dysfunction

DOI: 10.3233/BMR-200199

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1069-1078, 2021

Authors: Hussein, Hisham Mohamed | Morsi, Amal Ahmed | Abdelraoof, Neveen Abdellatif

Article Type: Research Article

Abstract: BACKGROUND: Low back pain (LBP) is a common musculoskeletal problem, which commonly affects balance. Sustained natural apophyseal glide (SNAG) is a successful treatment approach for LPB. However, its influence on balance problems has not been studied before. OBJECTIVE: To investigate the immediate effect of SNAG on postural stability and pain in individuals with flexion-dominant chronic low back pain (FCLBP). METHODS: Randomized placebo-controlled trial in which 64 participants with FCLBP were randomly allocated into two groups (SNAG and sham). SNAG group (n = 32) received central lumbar SNAG …on the symptomatic lumbar level(s). Sham group (n = 32) received sham SNAG. The outcome measures were postural stability indices; overall stability index (OSI), anteroposterior stability index (APSI), and mediolateral stability index (MLSI) in addition to pain intensity. Outcomes were assessed using the Biodex Balance System and visual analog scale respectively. Measures were taken before and immediately after interventions. RESULTS: There were statistical significance and high effect size (ES) in favor of the SNAG group regarding OSI, APSI, and pain (p < 0.01, cohen’s d ES = 1.3, 1.4, 1.1 respectively). MLSI showed moderate ES (cohen’s d = 0.7) but did not reach a statistically significant level (p = 0.05). CONCLUSION: Lumbar SNAG produces an immediate improvement in postural stability and pain in individuals with FCLBP. Show more

Keywords: Balance, immediate effect, low back pain, sustained natural apophyseal glide

DOI: 10.3233/BMR-200217

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1079-1086, 2021

Authors: Kim, Ji Young | Kim, Seong Yoel

Article Type: Research Article

Abstract: BACKGROUND: Hamstring flexibility plays a significant role in physiotherapy. Various stretching studies have been conducted to increase hamstring flexibility, but the effects of the Fascial Distortion Model (FDM) on hamstring flexibility have not yet been investigated. Moreover, no studies have compared the effects of FDM and static stretching. OBJECTIVES: To investigate the effects of the FDM on hamstring flexibility compared with static stretching. METHODS: Thirthy healthy adults were divided into two groups: static stretching and FDM groups. Static stretching was performed to hamstring in the supine position. The FDM was performed using trigger …band techniques that followed the hamstring in a longitudinal direction. Hamstring flexibility was measured using the active knee extension angle (KEA), passive straight leg raising (SLR), sit-and-reach (SR), and finger-floor distance (FFD) tests. A paired t -test and an independent t -test were performed to compare the hamstring flexibility measurements. RESULTS: Both groups showed significant differences (p < 0.05) in KEA, SLR, SR, and FFD before and after. However, no significant difference (p > 0.05) was found between the two groups. CONCLUSIONS: There was no difference in the effects of FDM and static stretching on hamstring flexibility. Show more

Keywords: Static stretching, fascial distortion model, FDM, hamstring, flexibility

DOI: 10.3233/BMR-200219

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1087-1092, 2021

Authors: Kısacık, Pınar | Tunay, Volga Bayrakcı | Bek, Nilgün | Atay, Özgür Ahmet | Selfe, James | Karaduman, Aynur Ayşe

Article Type: Research Article

Abstract: BACKGROUND: Patellofemoral pain (PFP) is a common knee problem. The foot posture in a relaxed stance is reported as a distal factor of PFP. However, the effects of short foot exercise (SFE) on the knee and functional factors have not yet been investigated in patients with PFP. OBJECTIVE: This study aimed to investigate the additional effects of SFE on knee pain, foot biomechanics, and lower extremity muscle strength in patients with PFP following a standard exercise program. METHODS: Thirty patients with a ‘weak and pronated’ foot subgroup of PFP were randomized into …a control group (ConG, n = 15) and a short foot exercise group (SFEG, n = 15) with concealed allocation and blinded to the group assignment. The program of ConG consisted of hip and knee strengthening and stretching exercises. SFEG program consisted of additional SFE. Both groups performed the supervised training protocol two times per week for 6 weeks. Assessment measures were pain visual analog scale (pVAS), Kujala Patellofemoral Score (KPS), navicular drop test (NDT), rearfoot angle (RA), foot posture index (FPI), and strength tests of the lower extremity muscles. RESULTS: Both groups displayed decreases in pVAS scores, but it was only significant in favor of SFEG. NDT, RA, and FPI scores decreased in SFEG whereas they increased in ConG. There was a significant group-by-time interaction effect in hip extensor strength and between-group difference was found to be significantly in favor of SFEG. CONCLUSIONS: An intervention program consisting of additional SFE had positive effects on knee pain, navicular position, and rearfoot posture. An increase in the strength of the hip extensors may also be associated with improved stabilization by SFE. Show more

Keywords: Patellofemoral pain, short foot exercises, foot core, foot posture

DOI: 10.3233/BMR-200255

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1093-1104, 2021

Authors: Lee, Jihoon | Park, Chanhee | Cha, Youngjoo | You, Joshua (Sung) H.

Article Type: Research Article

Abstract: BACKGROUND: Although the instrument-assisted manual (IM) technique has been widely utilised to improve soft tissue and joint mobility, its therapeutic benefits and underlying neuromechanical mechanisms remain unknown compared to those of conventional static stretching (SS) and hold-relax (HR) manual techniques. OBJECTIVE: This study aimed to compare the effects of the SS, HR, and IM techniques on muscle activity, kinematics, and strength during deep squatting in limited ankle dorsiflexion (DF) syndrome. METHODS: This was a cross-sectional randomised controlled study including 39 adults divided into three groups: SS group: 13, HR group: 13, IM group: …13. Outcome measures were the tibialis anterior (TA): gastrocnemius (GCM) balance ratio and ankle, knee, hip and thoracolumbar junction angles. TA muscle strength was analysed to evaluate the limited ankle DF. Analysis of variance was performed, with P < 0.05. RESULTS: The TA:GCM balance ratio, ranges of motion of ankle DF and knee flexion, and TA muscle strength in the IM group improved significantly compared to that in either the SS group or HR group (P < 0.05). CONCLUSIONS: Our novel results demonstrated that IM was most effective in normalising TA:GCM balance, ankle DF range of motion, and TA muscle strength during deep squatting in adults with limited ankle DF. Show more

Keywords: Ankle dorsiflexion, deep squatting, hold-relax, static stretching, manual technique

DOI: 10.3233/BMR-200257

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 34, no. 6, pp. 1105-1112, 2021