Journal of Back and Musculoskeletal Rehabilitation - Volume 35, issue 2

Authors: Klunklin, Kasisin | Sangsin, Apiruk | Leerapun, Taninnit

Article Type: Research Article

Abstract: BACKGROUND: Fluoroscopy-guided caudal epidural steroid injection (EDSI) is an option for conservative treatment of low back pain and sciatica; however, repeated exposure to radiation is a concern. With the blind technique, the needle misplacement rate is 30%; hence, ultrasound-guided caudal EDSI is a favored option. OBJECTIVE: To determine the efficacy of ultrasound-guided EDSI for low back pain and sciatica. METHODS: One hundred and ten patients with low back pain and sciatica who were unresponsive to conservative treatment, were prospectively recruited. Ultrasound-guided caudal EDSI was administered at 0, 3, and 6 weeks. Visual Analog …Scale (VAS) score was recorded at 0, 2, 4, 12, and 24 weeks. Patients completed the Roland-Morris Disability Questionnaire (RMDQ) at pre-injection and 24 weeks post-injection. RESULTS: VAS was significantly reduced at 2, 4, 12, and 24 weeks (p < 0.01). At 2, 4, 12, and 24 weeks after injection, 20%, 26%, 74%, and 83% of patients displayed > 50% VAS reduction, respectively. The mean pre-injection RMDQ score was 15 and that post-injection at 24 weeks was 7 (p < 0.01). The majority of patients had > 50% reduction in the RMDQ score. CONCLUSIONS: Ultrasound-guided EDSI was safe and efficacious for low back pain and sciatica treatment at the intermediate follow-up. Show more

Keywords: Low back pain, sciatica, epidural injection, ultrasound

DOI: 10.3233/BMR-200224

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 2, pp. 317-322, 2022

Authors: Jeon, Se Hwan | Yang, Young-Mo | Lee, Yoon Jae | Kim, Me-Riong | Kim, Eun-Jung | Ha, In-Hyuk

Article Type: Research Article

Abstract: BACKGROUND: Patients with lumbar disc herniation (LDH) may experience low back pain (LBP) and radiating pain (RP). Currently, there is no substantial clinical benefit (SCB) of assessing both LBP and RP due to LDH. OBJECTIVE: To determine enhanced SCB values by simultaneously assessing LBP and RP. METHODS: We retrospectively evaluated hospitalized LDH patients with concomitant LBP and RP between June 1, 2012, and May 31, 2013, and determined the numeric rating scale (NRS) and Oswestry Disability Index (ODI) scores at admission and discharge. Furthermore, the area under the receiver operating characteristic curve (AUC) …was computed to assess diagnostic accuracy. RESULTS: SCB as per NRS for both LBP and RP was - 2.50 in the 186 enrolled patients (AUC: 0.699 and 0.704, respectively). SCB as per ODI was - 18.78 (AUC: 0.771). SCB for the mean of the two NRS scores for LBP and RP was - 2.75 (AUC: 0.757). SCB for NRS score with a larger change in LBP and RP was - 3.50 (AUC: 0.767). CONCLUSIONS: SCB may be determined by comprehensively considering LBP and RP and choosing the mean NRS or NRS score with a large change. Show more

Keywords: Lumbar disc herniation, low back pain, radiating pain, substantial clinical benefit, numeric rating scale, Oswestry Disability Index

DOI: 10.3233/BMR-200244

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 2, pp. 323-329, 2022

Authors: Park, Kyu-Yong | Jeon, In-Cheol | Hwang, Ui-Jae | Jung, Sung-Hoon | Ha, Sung-Min | Yim, Shin-Young

Article Type: Research Article

Abstract: BACKGROUND: Prone hip extension (PHE) has been investigated to strengthen the hip joint and back extensor muscles. However, it has not been compared with various PHE exercises in individuals with iliopsoas shortness. OBJECTIVE: This study compared pelvic compensation and hip and back extensor muscle activities in individuals with iliopsoas shortness during prone hip extension (PHE) using the abdominal drawing-in maneuver alone (PHEA) and after iliopsoas stretching (PHEAS). METHODS: Twenty-five individuals with iliopsoas shortness were included in the study. Electromyography was used to investigate bilateral erector spinae (ES) and ipsilateral gluteus maximus (GM), biceps …femoris (BF), and semitendinosus (ST) muscles during PHE, PHEA, and PHEAS. Pelvic anterior tilting and rotation angles were measured during each PHE exercise via electromagnetic motion tracking. A modified Thomas test was used to examine the hip extension angle before and after iliopsoas stretching. One-way repeated-measures analysis of variance was used to investigate differences in pelvic anterior tilting and rotation angle and in hip and back extensor muscle activities among PHE, PHEA, and PHEAS. The level of statistical significance was set at α = 0.01. RESULTS: GM muscle activity was significantly greater with PHEAS, compared to PHE and PHEA (p < 0.01). Bilateral ES and ipsilateral BF and ST muscle activities were significantly reduced with PHEAS, compared to PHE and PHEA (p < 0.01). Anterior pelvic tilting and rotation angles were significantly reduced with PHEAS, compared to PHE and PHEA (p < 0.01). CONCLUSIONS: PHEAS is recommended to selectively strengthen GM muscles with minimal BF and ST muscle activities and pelvic compensation in individuals with iliopsoas shortness. The abdominal drawing-in maneuver (ADIM) after iliopsoas stretching is more efficient than ADIM alone during PHE, especially in individuals with iliopsoas shortness. Show more

Keywords: Gluteus maximus, iliopsoas stretching, prone hip extension

DOI: 10.3233/BMR-200251

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 2, pp. 331-339, 2022

Authors: Tuna, Serpil | Çelik, Berna | Balcı, Nilüfer

Article Type: Research Article

Abstract: BACKGROUND: Physical therapy and exercise programs are frequently used in the treatment of knee osteoarthritis (OA). However, it is not known at what stage of knee OA it is more effective. OBJECTIVE: The purpose of this work was to determine the relationship between the effectiveness of the physical therapy and exercise programs and the radiological findings presence/grade of knee OA. MATERIAL AND METHODS: Overall, 92 patients (65F, 27M) with knee OA were enrolled in the retrospective study. Standard knee radiographs were graded according to Kellgren-Lawrence. Pain and functional status were evaluated using a …visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, at the end of the physical therapy program (first month), and at third-month control visits. The demographic characteristics and VAS/WOMAC scores of the subjects were obtained from patient files. RESULTS: We analyzed 131 knees of 92 patients with knee OA (65F, 27M, mean age 53.02 ± 11.13 years). The mean total VAS and WOMAC scores on the first and third months were significantly lower than the initial values (all p < 0.001). The mean VAS scores on the first and third months were significantly lower than the initial values in the group without radiological damage, but WOMAC scores were similar between the evaluations (p = 0.009, p 50 = 0.003, respectively). The mean VAS and WOMAC scores on the first and third months were significantly lower than the initial values in the grade 1 according to the Kellgren-Lawrence radiological grades (all p < 0.001). CONCLUSIONS: According to the results of our study, physical therapy and exercise was effective on pain in all patients with knee OA, but only effective on knee functional capacity in the group with radiological findings, and especially more effective in patients with Kellgren-Lawrence grade 1. Show more

Keywords: Gonarthrosis, Kellgren-Lawrence, WOMAC, physical therapy

DOI: 10.3233/BMR-200287

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 2, pp. 341-346, 2022

Authors: Zafereo, Jason | Wang-Price, Sharon | Dickson, Tara

Article Type: Research Article

Abstract: BACKGROUND: The Movement System Impairment (MSI) model is useful for identifying spine-hip mobility and motor control deficits that may contribute to low back pain (LBP). While previous studies have found differences in global spine-hip movement impairments between lumbar MSI subgroups, no studies have compared segmental spine movement impairments between these subgroups. Therefore, the purpose of this study is to analyze segmental lumbar mobility in participants with LBP and a lumbar flexion- or extension-based MSI. METHODS: Forty participants with subacute-chronic LBP were placed into one of three age groups (< 35, 35–54, or > …54 years-old) and then classified into a flexion- or extension-based MSI sub-group. Segmental lumbar range of motion (ROM) was measured in degrees using a skin-surface device. Total lumbar and segmental flexion and extension ROM of L1-L2 to L5-S1 was compared between MSI sub-groups for each age group using separate two-way ANOVAs. RESULTS: Significant main effects were found for the independent variables of MSI subgroup and age. Participants in all three age groups with a flexion-based MSI displayed significantly less lumbar extension (- 0.6 ∘ ) at L4-5 as compared to participants with an extension-based MSI (- 2.1 ∘ ), p = 0.03. In addition, lumbar total and segmental ROM was significantly less for older individuals in both subgroups. CONCLUSIONS: Individuals with LBP may demonstrate a pattern of lumbar segmental hypomobility in the opposite direction of their MSI. Future studies may investigate the added value of direction-specific spinal mobilization to a program of MSI-based exercise. Show more

Keywords: Classification, low back pain, rehabilitation, range of motion

DOI: 10.3233/BMR-200288

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 2, pp. 347-355, 2022

Authors: Dülger, Esra | Bilgin, Sevil | Karakaya, Jale | Soylu, Abdullah Ruhi

Article Type: Research Article

Abstract: BACKGROUND: The transversus abdominis (TrA) is an important muscle for spinal stabilization. The abdominal draw-in maneuver (ADIM) is a method that selectively activates the TrA without overactivation of the external oblique (EO) and internal oblique (IO). Individuals with low back pain may have trouble in understanding proper contraction of the TrA. OBJECTIVE: The aim of this study was to investigate the differences between two feedback techniques to re-educate the TrA. METHODS: One hundred eighty healthy volunteers (123 female, 57 male) were randomized into two groups. The ADIM was performed with different feedback methods: …conventional (verbal and tactile) feedback and visual feedback from real-time ultrasound images. RESULTS: A within-group comparison revealed a significant increase in the thickness of the TrA, IO, and EO during the ADIM (p < 0.001) in both groups. The mean change (SD) in the thickness of the TrA and IO between rest and the ADIM was an increase of 2.541.25 and 1.882.14 in group 1 and 1.821.27 and 1.241.87 in group 2, respectively (p < 0.001). No significant differences were observed in EO thickness between the two groups. CONCLUSIONS: Although visual biofeedback shows a greater effect on ADIM training, both approaches are applicable, and clinicians may decide on which to use based on their clinical environment and experience. Show more

Keywords: Ultrasound imaging, transversus abdominis, visual feedback, low back pain

DOI: 10.3233/BMR-200299

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 2, pp. 357-361, 2022

Authors: Ariel, Efrat | Levkovitz, Yechiel | Goor-Aryeh, Itay | Motti, Ratmansky

Article Type: Research Article

Abstract: BACKGROUND: Electrotherapy is part of a physician’s toolbox for treating various musculoskeletal conditions, including radicular pain, but the preferred modality is yet unclear. OBJECTIVE: To compare the short-term efficacy of three electrotherapeutic modalities in relieving lumbar disc herniation (LDH)-induced radicular pain. METHODS: Fourteen patients with LDH-induced radicular pain attended a single session of electrotherapy, which included four 10-min consecutive treatments: transcutaneous electrical nerve stimulation (TENS), interferential (IF) stimulation, a combined treatment with pulsed ultrasound and IF current (CTPI), and a sham control. Treatments were randomized and the straight leg raise (SLR) degree was …measured immediately before and after each treatment. RESULTS: Each of the three active modalities significantly improved the SLR score. The most prominent improvement was observed in the CTPI condition, followed by IF and, finally, TENS. The sham stimulation did not affect the SLR scores. CONCLUSIONS: A single session with either TENS, IF current or CTPI is sufficient to improve the range of motion and degree of radicular pain associated with LDH. CTPI appears to be the most effective modality of the three, possibly due to greater penetration efficiency of the induced current. The effects of a long-term treatment schedule are yet to be identified. Show more

Keywords: Transcutaneous electric nerve stimulation, straight leg raise, interferential current, combined pulsed ultrasound and interferential current, disc herniation, nerve root irritation

DOI: 10.3233/BMR-200302

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 2, pp. 363-371, 2022

Authors: Wattananon, Peemongkon | Silfies, Sheri P. | Wang, Hsing-Kuo

Article Type: Research Article

Abstract: BACKGROUND: New motor adaptation to pain theory suggests that patients with low back pain (LBP) use the lumbopelvic stiffening strategy by redistribution of within and between muscle activities to protect painful structure. This could result in an altered postural control of the lumbopelvic region during active prone hip rotation (PHR). OBJECTIVE: To investigate coordination and timing of lumbopelvic and hip movements, and smoothness of the lumbopelvic control during PHR between participants with and without LBP. METHODS: Eight participants with LBP and eight participants without LBP were recruited. The electromagnetic tracking system was used …to record kinematic data during PHR. Cross-correlation between hip rotation and lumbopelvic movement in the transverse plane was calculated. Correlation at zero time-lag, time-lag, correlation at time-lag, and maximal lumbopelvic motion were derived. Frequency of movement disruption was identified. An independent t -test was used in conjunction with the effect size and 95% minimal detectable difference (MDD 95 ) to determine the difference in kinematic parameters. RESULTS: Participants with LBP demonstrated a significant delay (exceeding MDD 95 ) in lumbopelvic motion while nonsignificant frequency of disrupted motion on the painful side PHR demonstrated a trend with a large effect size that exceeded MDD 95 . There were trends with moderate to large effect sizes and differences exceeding MDD 95 in delay of lumbopelvic motion with greater movement disruption on the nonpainful side in participants with LBP. CONCLUSION: Participants with LBP used a lumbopelvic stiffening strategy for postural control to protect painful structures; however, the stiffening might complicate efforts to smoothly control lumbopelvic movement. Show more

Keywords: Prone hip rotation, low back pain, motion analysis, motor adaptation

DOI: 10.3233/BMR-200308

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 2, pp. 373-382, 2022

Authors: Ahn, Sun-hee | Jung, Sung-hoon | Kim, Hyun-a | Kim, Jun-hee | Weon, Young-soo | Kwon, Oh-yun

Article Type: Research Article

Abstract: BACKGROUND: Due to the extended use of smartphones, people spend a lot of time on these devices while lying down. OBJECTIVE: The purpose of the present study was to compare the differences in neck muscle activity of participants while they watched videos on a smartphone in four different lying positions (supine (SUP), prone on elbows (PE), side lying (SIDE), and 45 ∘ head turn while side lying (45-SIDE)). METHODS: Twenty-three healthy volunteers (22.4 ± 1.7 years) were enrolled in this study. We assessed the activities of …their right and left sternocleidomastoid (SCM), anterior scalene, cervical erector spinae (CES), and upper trapezius (UT) muscles while they watched videos on a smartphone in four different lying positions. RESULTS: The right and left SCM and CES had significantly different muscle activities depending on the lying positions. The SCM activity had a significantly greater asymmetry in the 45-SIDE position, while the CES activity had a significantly greater asymmetry in the SIDE and 45-SIDE positions. Moreover, the UT activity had a significantly greater asymmetry in the SUP, PE, and SIDE positions. CONCLUSIONS: Neck muscle activity and asymmetry were the lowest in the SUP position relative to the other positions. Therefore, lying down in the SUP position may minimize neck muscle activation while using a smartphone. Show more

Keywords: Electromyography, neck muscles, posture, smartphone

DOI: 10.3233/BMR-200315

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 2, pp. 383-391, 2022

Authors: Ceballos-Laita, Luis | Medrano-de-la-Fuente, Ricardo | Mingo-Gómez, María Teresa | Hernando-Garijo, Ignacio | Estébanez-de-Miguel, Elena | Jiménez-del-Barrio, Sandra

Article Type: Research Article

Abstract: BACKGROUND: Myofascial trigger points (MTrPs) in neck muscles seem to be related to the main symptoms of patients with chronic neck pain. OBJECTIVE: The objective was to investigate the effects of dry needling (DN) on pain, disability, kinesiophobia, pain catastrophizing and psychological distress in patients with chronic neck pain. METHODS: A double blind randomized controlled pilot trial was designed. Twenty-one patients with chronic neck pain were randomly allocated to the DN group (n = 7), Sham-DN group (n = 7) or Control group …(n = 7). All groups received a Transcutaneous Electrical Nerve Stimulation and Therapeutic Ultrasound (TENS/US) protocol with patient education. The DN and Sham-DN groups received two sessions of DN and sham DN, respectively. The primary outcome was pain intensity. Secondary outcomes were disability, kinesiophobia, pain catastrophizing, psychological distress, self-reported improvement and success of blinding. RESULTS: The DN group showed a greater decrease in pain intensity, disability and pain catastrophizing compared to the Sham-DN group (p < 0.05) and the Control group (p < 0.05). The DN group showed the highest self-reported improvement. CONCLUSION: Adding two sessions of DN in active MTrPs in upper trapezius, levator scapulae and sternocleidomastoid muscles to a TENS/US protocol with patient education decreased pain intensity, disability and pain catastrophizing in patients with chronic neck pain. Show more

Keywords: Neck pain, chronic pain, myofascial trigger points, dry needling, disability

DOI: 10.3233/BMR-200322

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 2, pp. 393-401, 2022