Journal of Back and Musculoskeletal Rehabilitation - Volume 35, issue 3

Authors: Timmerman, Hans

Article Type: Editorial

DOI: 10.3233/BMR-225001

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 461-462, 2022

Authors: Landesa-Piñeiro, Laura | Leirós-Rodríguez, Raquel

Article Type: Review Article

Abstract: BACKGROUND: Lateral epicondylitis is a tendinopathy with a prevalence of between 1–3% of the population aged 35–54 years. It is a pathology with a favorable evolution, but with frequent recurrences (which imply an economic extra cost). OBJECTIVE: The objective of this review was to determine the efficacy of physiotherapy treatment for the treatment of epicondylitis and, if any, to identify the most appropriate techniques. METHODS: A systematic search was carried out in October 2020 in the databases of PubMed, Cinahl, Scopus, Medline and Web of Science using the search terms: Physical therapy modalities, Physical …and rehabilitation medicine, Rehabilitation, Tennis elbow and Elbow tendinopathy. RESULTS: Nineteen articles were found, of which seven applied shock waves, three applied orthoses, three applied different manual therapy techniques, two applied some kind of bandage, one applied therapeutic exercise, one applied diacutaneous fibrolysis, one applied high intensity laser, and one applied vibration. CONCLUSIONS: Manual therapy and eccentric strength training are the two physiotherapeutic treatment methods that have the greatest beneficial effects, and, furthermore, their cost-benefit ratio is very favorable. Its complementation with other techniques, such as shock waves, bandages or Kinesio ® taping, among others, facilitates the achievement of therapeutic objectives, but entails an added cost. Show more

Keywords: Tennis elbow, physical therapy modalities, rehabilitation, tendinopathy, lateral epicondylitis

DOI: 10.3233/BMR-210053

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 463-477, 2022

Authors: Rao, Yi | Hou, Fangxing | Huang, Hongshi | Xiao, Xiangzuo

Article Type: Case Report

Abstract: BACKGROUND: The anterior cruciate ligament (ACL) reconstruction (ACLR) under the arthroscopy is a widespread procedure for ACL rupture, which could stabilize knee and promote recovery. However, one of its complications is the injury of infrapatellar branch of saphenous nerve (IBSN). In traditional Chinese medicine, acupotomy functions via releasing and stripping adhesion tissues. Accordingly, acupotomy is suitable for the treatment of entrapped nerve injury and tissues adhesion. CASE DESCRIPTION: A 14-year-old man, who had ACLR before and returned to normal activity, presented with severe pain after a mild strain two weeks ago. The physical and imaging examinations …revealed the compression injury of IBSN. METHODS: We provided the ultrasound-guided perineural injection of 0.4% lidocaine, while it only alleviates the symptoms temporally and partially. Acupotomy using a small needle knife (0.4*40 mm) was performed. RESULTS: The severe pain was immediately resolved. The visual analog pain scale (VAS) decreased from 10 to 1 and return to normal walking. The diameter of IBSN became smaller and the signal of peripheral soft tissue became hypoechoic in ultrasound. CONCLUSION : In this case, the combined treatments of ultrasound-guided perineural injection and acupotomy are thought to be innovative procedures for IBSN entrapment with relative long-lasting therapeutic effects. Show more

Keywords: Ultrasound, acupotomy, injection, ACL reconstruction

DOI: 10.3233/BMR-210110

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 479-483, 2022

Authors: Alfonso-Mora, Margareth Lorena | Ramírez-Moreno, Jose | Guerra-Balic, Miriam | Sánchez-Martín, Ricardo | Castellanos, Adriana Lucía | Rengifo, María Leonor

Article Type: Other

Abstract: BACKGROUND: Low back pain (LBP) is one of the most common reasons for visiting the doctor. The Mézières method (MM) emphasises body awareness and uses a global postural rehabilitation approach. It is used in the management of LBP, but its effectiveness has received limited formal evaluation. OBJECTIVE: To determine the effects of MM on quality of life, pain and functional disability in people with LBP and understand the patient’s bodily experience during the MM intervention. METHODS: This protocol study of single-blind randomised controlled trial with a mixed methods design will include 54 people …with LBP aged 18 to 65 years. Participants will be randomised into two groups, one will receive MM and the other will receive a control intervention, administered through 10 treatment sessions. Participants will also construct a narrative to provide an understanding of their bodily experience. RESULTS: The assessed outcomes will include pain, back pain-related disability assessed using the Roland Morris Questionnaire, and quality of life related to health assessed using the SF12. Outcomes will be assessed at baseline, after the intervention and at a 6 weeks follow-up. Show more

Keywords: Low back pain, Mézières method, exercise, physical therapy

DOI: 10.3233/BMR-200344

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 485-493, 2022

Authors: de Lorena, Suélem B. | Duarte, Angela L.B.P. | Bredemeier, Markus | Fernandes, Vanessa M. | Pimentel, Eduardo A.S. | Marques, Cláudia D.L. | Ranzolin, Aline

Article Type: Research Article

Abstract: BACKGROUND: The effects of stretching exercises in fibromyalgia (FM) deserves further study. OBJECTIVE: To evaluate the effectiveness of a Physical Self-Care Support Program (PSCSP), with emphasis on stretching exercises, in the treatment of FM. METHODS: Forty-five women with FM were randomized to the PSCSP (n = 23) or to a control group (n = 22). The PSCSP consisted of weekly 90-minute learning sessions over 10 weeks, providing instructions on wellness, postural techniques, and active stretching exercises to be done at home. The control group …was monitored through 3 medical appointments over 10 weeks and included in a waiting list. The primary outcomes were the Fibromyalgia Impact Questionnaire (FIQ), the Visual Analogue Scale (VAS) for pain, and the Sit and Reach Test (SRT) at the end of the study. RESULTS: Nineteen and 21 patients completed the trial in PSCSP and control groups, respectively. After 10 weeks, the PSCSP group showed significantly better FIQ (difference between adjusted means, - 13.64, 95% CI, - 21.78 to - 5.49, P = 0.002) and SRT scores (7.24 cm, 3.12 to 11.37, P = 0.001) than the control group, but no significant difference in pain VAS (- 1.41, - 3.04 to 0.22, P = 0.088). Analysis using multiple imputation (MI) and delta-adjusted MI for missing outcomes rendered similar results. CONCLUSIONS: A PSCSP emphasizing stretching exercises significantly improved FIQ and SRT scores, and may be a helpful therapy for FM. Show more

Keywords: Fibromyalgia, physiotherapy, stretching, self-management, randomized controlled trial

DOI: 10.3233/BMR-191820

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 495-504, 2022

Authors: Xue, Jing | Song, Yueming | Liu, Hao | Liu, Limin | Li, Tao | Gong, Quan

Article Type: Research Article

Abstract: BACKGROUND: Numerous studies on the comparison of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open-transforaminal lumbar interbody fusion (O-TLIF) for the treatment of lumbar disc herniation (LDH) have been published, but there is no clear conclusion. OBJECTIVE: The aim of this study was to evaluate the efficacy of MIS-TLIF compared with O-TLIF in the treatment of LDH in the Chinese population by meta-analysis. METHODS: Studies on the treatment of LDH by MIS-TLIF versus O-TLIF were searched in Pubmed, Web of Science, Medline, Embase, CNKI, VIP and China Wanfang databases from the establishment …of the databases to January 2020. The meta-analysis was used to analyze the pooled operation time, intraoperative blood loss, postoperative drainage, postoperative ground movement time, Waist and leg Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) score and Japanese orthopaedic association (JOA) score. Mean difference (MD) and standard mean difference (SMD) were used as the effect size. RESULTS: Eleven studies with 1132 patients were included. The results showed that MIS-TLIF compared with O-TLIF, MD = - 133.82 (95% CI: - 167.10 ∼ - 100.53, P < 0.05) in intraoperative blood loss, MD = - 114.43 (95% CI: - 141.12 ∼ - 87.84, P < 0.05) in postoperative drainage, MD = - 3.30 (95% CI: - 4.31 ∼ - 2.28, P < 0.05) in postoperative ground movement time, SMD = - 1.44 (95% CI: - 2.63 ∼ - 0.34, P < 0.05) in postoperative low back pain VAS score, SMD = 0.41 (95% CI: 0.15 ∼ 0.66, P < 0.05) in postoperative JOA score, MD = 4.12 (95% CI: - 11.64 ∼ 19.87, P > 0.05) in the average operation time, SMD = - 0.00 (95% CI: - 0.36 ∼ 0.36, P > 0.05) in leg pain VAS score, and SMD = - 0.59 (95% CI: - 1.22 ∼ 0.03, P > 0.05) in ODI score. CONCLUSION: MIS-TLIF was superior to O-TLIF in the treatment of LDH, especially in the intraoperative blood loss, postoperative drainage, postoperative ground movement time and low back pain in the Chinese population. Show more

Keywords: Lumbar disc herniation (LDH), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), open-transforaminal lumbar interbody fusion (O-TLIF), randomized controlled trials, meta-analysis

DOI: 10.3233/BMR-210004

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 505-516, 2022

Authors: Jung, Sung-Hoon | Hwang, Ui-Jae | Ahn, Sun-Hee | Kim, Jun-Hee | Kwon, Oh-Yun

Article Type: Research Article

Abstract: BACKGROUND: Thoracic mobilisation improves thoracic hyperkyphosis and respiratory function. Diaphragmatic excursion is associated with respiratory function; however, limited studies have assessed the effect of thoracic mobilisation on diaphragmatic excursion. OBJECTIVE: This study aimed to investigate the effects of thoracic mobilisation on diaphragmatic excursion and respiratory function in individuals with thoracic hyperkyphosis. METHODS: Participants were recruited through Internet advertising and participated voluntarily. Nineteen healthy participants (age: 33.37 ± 6.56 years; height: 170.32 ± 7.92 cm; weight: 69.77 ± 14.70 kg) with thoracic hyperkyphosis underwent thoracic mobilisation for 8 weeks. …Diaphragmatic excursion, thoracic kyphosis, and respiratory function were measured. Thoracic mobilisation was provided using a mechanical massage device. RESULTS: Thoracic mobilisation for 8 weeks significantly improved diaphragmatic excursion during deep breathing (p = 0.015), forced vital capacity (p < 0.01), and thoracic hyperkyphosis (p < 0.01). CONCLUSIONS: Thoracic mobilisation can be recommended in respiratory rehabilitation programs to increase diaphragmatic excursion and respiratory function for the management and prevention of respiratory dysfunction in individuals with thoracic hyperkyphosis. Show more

Keywords: Diaphragm, thoracic vertebra, massage, kyphosis, respiratory

DOI: 10.3233/BMR-210143

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 517-523, 2022

Authors: Eryiğit, Sevim | Al Kafee, Abdullah | Akan, Aydin

Article Type: Research Article

Abstract: BACKGROUND: Quadratus lumborum (QL) discrete region extensions might change depending on whether leg length discrepancy (LLD) individually has any extra erector spinae action in the lumbar spine, which can result in serious injury to the lower extremities and lumbar vertebrae. OBJECTIVE: This study aims to investigate the effect of QL muscle activity on LLD by using electromyography (EMG) signals. METHODS: The study employed a randomized controlled design. A total of 100 right-handed volunteers were included in this study. All participants were assessed manually by tape measurement for LLD. EMG signals were recorded during …the resting and maximal isometric contraction positions to determine QL muscle activity. The power spectral density (PSD) methods were applied to compute EMG signals. RESULTS: In maximal isometric contraction position, comparing the short right LLD (Right side = 0.00064 ± 0.00001, Left side = 0.00033 ± 0.0006) and short left LLD (Right side = 0.00001 ± 0.00008, Left side = 0.00017 ± 0.0001), it was found that the short right LLD group had significantly increased PSD of EMG values. In resting position, the short right LLD (Right side = 0.0002 ± 0.0073, Left side = 0.00016 ± 0.0065) had significantly increased PSD of EMG compared to the short left LLD (Right side = 0.00004 ± 0.0003, Left side = 0.0001 ± 0.0008) values of the QL muscle activity. The results of both groups were also statistically significant (p < 0.05). CONCLUSIONS: The present study showed that it is possible to determine effective experimental interventions for functional LLD using EMG signal analysis of QL muscle activity on an asymptomatic normal population. Show more

Keywords: Pelvic asymmetry, leg length discrepancy, discrete Fourier transform, quadratus lumborum, electromyography signal

DOI: 10.3233/BMR-181177

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 525-530, 2022

Authors: Nakanowatari, Tatsuya | Sasaki, Riho | Nakane, Yukino | Yamaguchi, Tomofumi | Nagase, Tokiko | Kanzaki, Hideto | Kiyoshige, Yoshiro

Article Type: Research Article

Abstract: BACKGROUND: Shortening of tensor fasciae latae is one factor that causes a functional leg length discrepancy. A shoe lift has been used to correct the compensatory posture resulting from the discrepancy. Despite the potential therapeutic benefit of a shoe lift, the mechanism by which it exerts its effect is unclear. OBJECTIVE: To investigate the effect of a shoe lift on tensor fasciae latae length during standing with an artificial functional leg length discrepancy using ultrasonic shear wave elastography. METHODS: Twenty-two healthy individuals performed static standing under three conditions: drop of the pelvis and …flexion of the leg resulting from fixing in the hip abduction position using a hip orthosis (functional leg length discrepancy condition); drop of the pelvis by the orthosis, but no flexion of the leg due to a shoe lift (shoe lift condition); and normal bilateral standing condition. The shear elastic modulus of tensor fasciae latae was calculated using ultrasonic shear wave elastography. RESULTS: The shear elastic modulus was significantly lower in the functional leg length discrepancy condition than in the shoe lift and normal conditions (p = 0.038). CONCLUSIONS: Using a shoe lift for the functional leg length discrepancy can result in a functional hip position that elongates tensor fasciae latae. Show more

Keywords: Functional leg length discrepancy, tensor fasciae latae, shoe lift, ultrasonic shear wave elastography

DOI: 10.3233/BMR-191755

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 531-537, 2022

Authors: Öncü, Mehmet | Genç, Erdinç

Article Type: Research Article

Abstract: BACKGROUND: Calcaneal spur and hallux valgus are common foot deformities and both conditions have been shown to disrupt foot biomechanics. OBJECTIVES: This study aimed to investigate the association between calcaneal spur and hallux valgus using radiographic and demographic data. METHODS: A total of 1375 patients (1083 women; mean age: 45.5 years) with standard ankle lateral and foot conventional anteroposterior radiographs were evaluated. The following data were obtained: age, gender, laterality, hallux valgus angle (HVA), intermetatarsal angle (IMA), and calcaneal spur. Patients with a HVA of 15 ∘ and above were …considered to have hallux valgus. Patients with hallux valgus were classified into three different groups according to the HVA. RESULTS: The prevalence of calcaneal spur was higher in older age and women (45.8%, 30.2%; p < 0.01, p < 0.01, respectively). Subjects with and without calcaneal spurs had similarities in terms of their laterality, having a HVA of ⩾ 15 ∘ and an IMA of ⩾ 11 ∘ (p > 0.05). Hallux valgus severity was not associated with calcaneal spur (p > 0.05). In addition, the hallux valgus prevalence was higher in patients who were over 50 years old (58.2%, p = 0.046). CONCLUSIONS: The presence of calcaneal spurs does not affect the prevalence of hallux valgus. The severity of hallux valgus determined according to the HVA was similar in patients with and without calcaneal spurs. In addition, female gender and older age were identified as risk factors for calcaneal spurs, while only older age was a risk factor for hallux valgus. Show more

Keywords: Hallux valgus, calcaneal spur, plantar fasciitis, heel pain

DOI: 10.3233/BMR-200140

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 539-544, 2022

Authors: Guo, Yu-Jie | Hu, Xiao-Yun | Li, Jia-Yu | Yang, Lei

Article Type: Research Article

Abstract: BACKGROUND: Exercise training after lumbar fusion surgery (LFS) is important for regaining the strength in the spinal muscles, pain management, and minimizing dysfunction. It may be prudent to evaluate technologies such as web-based chat and social media apps for increasing the efficacy of post-surgery interventions in LFS patients. OBJECTIVE: To explore the effectiveness of a WeChat-based individualized post-discharge rehabilitation program in patients with LFS. METHODS: Seventy-two eligible discharged LFS patients were enrolled from October 2018 to February 2019. The experimental group (36 cases) received a 10-week WeChat-based individualized rehabilitation program, while the control …group (36 cases) received routine follow-up guidance. The outcomes were measured using the Exercise Compliance Questionnaire, Numerical Rating Scale, Oswestry Disability Index and Chinese version of the self-efficacy for exercise scale. RESULTS: The analysis using generalized estimation equations method shows significant differences in the interaction effect of group*time in exercise compliance (Wald c 2 = 7.459, P < 0.05), group effect in pain (Wald c 2 = 5.811, P < 0.05) and self-efficacy (Wald c 2 = 16.383, P < 0.05). However, there was no significant difference between the experimental and control groups in the group effect in dysfunction improvement (Wald c 2 = 2.289, P > 0.05). CONCLUSIONS: The WeChat-based rehabilitation intervention can improve exercise compliance and self-efficacy, and help achieve greater pain relief compared to the routine intervention. However, the WeChat-based intervention did not offer better improvement in the self-dysfunction in the post-discharge LFS patients. Show more

Keywords: Lumbar fusion surgery, rehabilitation program, WeChat, post-discharge, nursing

DOI: 10.3233/BMR-200280

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 545-557, 2022

Authors: Castellanos, Ramon

Article Type: Research Article

Abstract: BACKGROUND: Facet joint syndrome (FJS) pain is a significant contributor to back pain and has a high rate of opioid prescription. Unfortunately, there are a limited number of therapeutic options for these patients. OBJECTIVE: To evaluate the safety and effectiveness of amniotic membrane/umbilical cord particulate (AM/UC) in managing FJS pain. METHODS: A single-center, investigator-initiated, retrospective study was performed on consecutive patients with FJS pain who received intra- or peri-articular injection of AM/UC between July 1, 2018 and July 26, 2019. Primary outcome was change in Patient Global Impression of Change (PGIC) at 6 …weeks, 3 months, 6 months, and 12 months to assess the self-reported percent improvement relative to baseline. Safety was assessed by AM/UC- and procedure-related complications. Paired t -tests were used to determine whether there is a statistically significant improvement of pain post-injection compared to baseline. RESULTS: There were a total of 54 patients (69.7 ± 13.4 years; 31 female) presenting baseline pain score of 9.2 ± 1.0 despite prior treatments of activity modification (66.7%), NSAIDs (61.1%), opioids (37.0%), and physical therapy (35.2%). Mean GPIC improvement was 65.3%, 67.5%, 56.9%, and 56.7% among responders 30 , respectively. There were no complications. CONCLUSION: This study supports the safety and effectiveness of AM/UC particulate injection in managing FJS pain. Show more

Keywords: Amniotic, chronic low back, facet, pain, umbilical cord

DOI: 10.3233/BMR-200330

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 559-564, 2022

Authors: Sabashi, Kento | Kasahara, Satoshi | Tohyama, Harukazu | Chiba, Takeshi | Koshino, Yuta | Ishida, Tomoya | Samukawa, Mina | Yamanaka, Masanori

Article Type: Research Article

Abstract: BACKGROUND: Knee osteoarthritis (OA) impairs postural control and may affect how the lower limb joints are used for postural control. OBJECTIVE: To investigate how individuals with knee OA use lower limb joints for static postural control. METHODS: Ten patients with knee OA and thirteen healthy controls performed quiet standing for 30 s. The standard deviation of the center of mass (COM) and lower limb joint motions in the anterior-posterior (AP) and medial-lateral (ML) planes were calculated from three-dimensional marker trajectories. Pearson’s correlation analysis and independent t -tests were conducted to investigate the relationship between …COM and lower limb joint motion and to compare group difference, respectively. RESULTS: The AP hip angular velocity alone in the knee OA group and the AP hip and knee angular velocity in the control group were significantly correlated with the AP COM velocity. The ML hip angular velocity was significantly correlated with the ML COM velocity in both groups. The knee OA group exhibited a significantly larger standard deviation of AP COM velocity than the control group. CONCLUSIONS: Individuals with knee OA depended solely on the contribution of the hip to the AP COM velocity, which could not be successfully controlled by the knee. Show more

Keywords: Knee osteoarthritis, quiet standing, postural control, center of mass, kinematics

DOI: 10.3233/BMR-200337

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 565-572, 2022

Authors: Radwan, Nadia L. | Ibrahim, Marwa M. | Mahmoud, Waleed S.

Article Type: Research Article

Abstract: BACKGROUND: Adolescents with idiopathic scoliosis present postural instability when compared with healthy subjects. Although Schroth exercises therapy (SET) is broadly utilized, its effect on postural stability is still not clear. OBJECTIVES: To compare the two treatment periods of the SET for improving the postural stability indices and Cobb angle, and to examine the correlation between the Cobb angle and stability indices in adolescent idiopathic scoliosis (AIS). METHODS: Twenty girls aged 10–16 years with AIS (study group) and 20 age-matched girls without AIS (control group) were examined. The Biodex Balance System was used to …evaluate the overall stability index (OSI), anteroposterior index (APSI), and mediolateral stability index (MLSI) in the study group before SET and one and three months after the therapy. A plain X-ray was used to measure the Cobb angle before and three months after SET. Stability indices and Cobb angle were measured only once for the control group. RESULTS: One-way repeated-measures ANOVA revealed that the three-month duration of SET was the most effective for improving OSI, APSI, and MLSI (p < 0.001). The significant proximities of OSI, APSI, and MLSI to the normal values post three months of SET were 29.65%, 24.07, and 20% respectively. The MLSI was robust and correlated with the Cobb angle (r = 0.85) three months post intervention. CONCLUSION: Stability indices and Cobb angles were highly improved after three months of SET compared to one month among AIS patients. The MLSI is the most substantial index correlated with the Cobb angle. Show more

Keywords: Adolescent idiopathic scoliosis, Biodex Balance System, postural balance, Schroth exercises

DOI: 10.3233/BMR-200342

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 573-582, 2022

Authors: Lee, Sang Hoon | Choi, Hyun Hee | Chang, Min Cheol

Article Type: Research Article

Abstract: BACKGROUND: Many patients complain of chronic cervical radicular pain, and pulsed radiofrequency (PRF) is known to have a positive effect for alleviating neuropathic pain. OBJECTIVES: In the present study, we used ultrasound (US) guidance and compared the effects of monopolar PRF with those of bipolar PRF in patients with chronic cervical radicular pain refractory to repeated transforaminal epidural steroid injections. METHODS: Sixty-six patients with chronic cervical radicular pain were included in this study. Patients were randomly assigned to one of the two groups: monopolar or bipolar PRF group (n = …33 per group). Pain intensity was evaluated using a numeric rating scale (NRS) at pretreatment, and at 1 and 3 months after the treatment. Target stimulation site was the extraforaminal nerve root. RESULTS: Compared to the pretreatment NRS scores, patients in both groups showed a significant decrease in NRS scores at 1 and 3 months after the treatment. Reductions in the NRS scores over time were significantly larger in the bipolar PRF group. Three months after the treatment, 18 patients (54.5%) in the monopolar PRF group and 27 (81.8%) in the bipolar PRF group reported successful pain relief (pain relief of ⩾ 50%). CONCLUSIONS: US-guided PRF can be an effective interventional technique for the management of chronic refractory cervical radiculopathy. Moreover, bipolar PRF has better treatment outcome than monopolar PRF. Show more

Keywords: Ultrasound, pulsed radiofrequency, monopolar, bipolar, cervical radicular pain, chronic pain

DOI: 10.3233/BMR-201842

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 583-588, 2022

Authors: Kurokawa, Yuki | Kato, Satoshi | Demura, Satoru | Shinmura, Kazuya | Yokogawa, Noriaki | Yonezawa, Noritaka | Shimizu, Takaki | Kitagawa, Ryo | Miaki, Hiroichi | Tsuchiya, Hiroyuki

Article Type: Research Article

Abstract: BACKGROUND: Abdominal bracing is effective in strengthening the trunk muscles; however, assessing performance can be challenging. We created a device for performing abdominal trunk muscle exercises. The effectiveness of this device has not yet been evaluated or compared OBJECTIVE: We aimed to quantify muscle activity levels during exercise using our innovative device and to compare them with muscle activation during abdominal bracing maneuvers. METHODS: This study included 10 men who performed abdominal bracing exercises and exercises using our device. We measured surface electromyogram (EMG) activities of the rectus abdominis (RA), external oblique, internal oblique …(IO), and erector spinae (ES) muscles in each of the exercises. The EMG data were normalized to those recorded during maximal voluntary contraction (%EMGmax). RESULTS: During the bracing exercise, the %EMGmax of IO was significantly higher than that of RA and ES (p < 0.05), whereas during the exercises using the device, the %EMGmax of IO was significantly higher than that of ES (p < 0.05). No significant difference was observed in the %EMGmax of any muscle between bracing exercises and the exercises using the device (p = 0.13–0.95). CONCLUSIONS: The use of our innovative device results in comparable activation to that observed during abdominal bracing. Show more

Keywords: Abdominal muscles, electromyography, exercise, stability

DOI: 10.3233/BMR-210001

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 589-596, 2022

Authors: Kashif, Muhammad | Manzoor, Nosheen | Safdar, Rimsha | Khan, Hafsa | Farooq, Maryam | Wassi, Ahmad

Article Type: Research Article

Abstract: BACKGROUND: Cervicogenic headache (CGH) is a common condition that results in significant disability. To treat this dysfunction, Mulligan described sustained natural apophyseal glides (SNAGs) as a manual therapy approach. However, only inconclusive short-term evidence exists for treating CGH with SNAGs. OBJECTIVE: The present study aims to investigate the effect of SNAGs in the treatment of CGH. METHODS: Fourty female patients ranging from 20 to 40 years with CGH were randomly assigned to two groups: 20 in a treatment group and 20 in a control group. SNAGs were applied to the treatment group while …the control group received placebo treatment. Both groups received their respective treatment for 20 minutes, alternately three times per week, for a total of 12 times in four weeks. The outcome measures were the Neck Disability Index (NDI) and the Visual Analogue Scale (VAS). Participants were assessed at baseline and at the end of each week. The data was analyzed using SPSS version 20. Independent t-testing was used to reveal changes between groups. One-way ANOVA was used to determine changes within groups. The level of significance was P < 0.05. RESULTS: Twenty participants (100%) in the treatment group and 17 (85%) in the control group had a history of headache aggravation with active movements or passive head positioning. There was no significant difference at baseline (p > 0.05), indicating that both groups were homogeneous at the time of recruitment. The p value (p < 0.05) showed a significant difference in pain and level of disability at three and four weeks (p < 0.05) in patients treated with SNAGs. However, the cervical range of motion (ROM) showed a statistically significant improvement in flexion and extension in the treatment group (p < 0.05) while there was no significant improvement in side flexion and rotation ROM in both groups (p > 0.05). CONCLUSION: This study found that SNAGs were effective in reducing pain and neck disability and improved ROM in females with CGH. Show more

Keywords: Cervicogenic headache, females, SNAGs

DOI: 10.3233/BMR-210018

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 597-603, 2022

Authors: Uebayashi, Kazuma | Okubo, Yu | Nishikawa, Takuya | Morikami, Taro | Hatanaka, Jindo

Article Type: Research Article

Abstract: BACKGROUND: Given the characteristics of the superficial trunk muscles that cross the chest and pelvis, their excessive contraction might limit chest mobility. OBJECTIVE: To examine the immediate effects of two types of trunk muscle exercises on chest mobility and trunk muscle activities. METHODS: Fourteen healthy men (age: 21.1 ± 1.0 years, height: 172.7 ± 5.6 cm, weight: 61.0 ± 7.1 kg, body mass index: 20.4 ± 1.7 kg/m 2 ; mean ± SD) randomly performed …trunk side flexion and draw-in exercises using a cross-over design. The chest kinematic data and trunk muscle activities were measured before and after each intervention during the following tasks: maximum inspiration/expiration and maximum pelvic anterior/posterior tilt while standing. Two-way repeated measures analysis of variance was used for statistical analysis (P < 0.05). RESULTS: After the side flexion, upper and lower chest mobility significantly decreased, and superficial trunk muscle activity significantly increased during the maximum pelvic anterior tilt (P < 0.05). Additionally, after the draw-in, upper chest mobility significantly increased during the maximum pelvic anterior tilt (P < 0.05). CONCLUSIONS: Increased activity of the superficial abdominal muscles might limit chest mobility during maximum pelvic anterior tilt. Conversely, the facilitation of deep trunk muscles might increase upper chest mobility during the maximum pelvic anterior tilt. Show more

Keywords: Electromyography, thorax, thoracic wall, rib cage, torso, kinematics

DOI: 10.3233/BMR-210019

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 605-614, 2022

Authors: Salbaş, Ender | Ketenci, Sertaç

Article Type: Research Article

Abstract: BACKGROUND: Although there are a few studies on the seasonality of facial paralysis, no studies have utilized internet data for this purpose. The use of internet data to investigate diseases and user-contributed health-related content is increasingly prevalent, and has earned the name “infodemiology”. OBJECTIVE: This study aims to use Google Trends data to investigate whether there is a seasonal variation in facial paralysis. METHODS: In this observational study, the search volume for the terms “facial paralysis” and “Bell’s palsy” for a total of 19 countries was queried from Google Trends, selecting the time …interval between January 2004 and October 2020. RESULTS: In the Cosinor analysis of data from a total of 19 countries, from both northern and southern hemisphere, a statistically significant seasonality was found in the search volume of facial paralysis. It was observed that facial paralysis searches peaked in spring in the northern hemisphere and in winter in the southern hemisphere. CONCLUSION: Internet search query data showed that facial paralysis has a seasonal variation, with peaks in spring for the northern hemisphere and winter for the southern hemisphere. Further studies are needed to understand the deviation between hemispheres and the cause of the peak in winter-spring season. Show more

Keywords: Facial paralysis, Bell’s palsy, infodemiology, internet search, seasonality

DOI: 10.3233/BMR-210021

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 615-623, 2022

Authors: Yotnuengnit, Pattarapol | Boonyapaisancharoen, Pongrin | Jamin, Nastasja | Schulte-Goecking, Heike | Azad, Shahnaz-Christina | Kraft, Eduard | Piravej, Krisna | Leukert, Johannes

Article Type: Research Article

Abstract: BACKGROUND: Worldwide, chronic low back pain (CLBP) is one of the most common causes of physical and psychological disabilities. The factors that affect low back pain (LBP) between Western and Eastern countries are different. OBJECTIVE: We assessed the factors associated with LBP and their impact in German and Thai CLBP participants. METHODS: This cross-sectional study was conducted in 100 Thai and 100 German CLBP participants. Data were collected before the participants received treatment in the outpatient rehabilitation clinic. We used standardized questionnaires to assess the demographic and socioeconomic data, clinical features of the …pain, the impact of pain during daily activities, and psychological consequences. RESULTS: We found a statistically significant difference between the two groups for minimal pain intensity (NRS German = 3.01, Thai = 1.83), and the participants’ acceptable pain intensity (NRS German = 1.97, Thai = 3.88). The German participants had a higher negative impact score in their daily living compared to the Thai participants (German = 23.5, Thai = 10). Also, the German participants suffered more often from depression (CES-D score; German = 17, Thai = 4). However, the average back pain intensity was the same for both groups. CONCLUSION: German CLBP participants had significantly more depressive symptoms and pain-related impairments compared to the Thai participants. On the other hand, there were no differences in maximum and average pain severities. Show more

Keywords: Chronic low back pain, socioeconomic status, psychological effect, Thailand, Germany

DOI: 10.3233/BMR-210029

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 625-632, 2022

Authors: Öztürk, Gökhan Tuna | Erden, Ender | Erden, Ebru | Ulašlı, Alper Murat

Article Type: Research Article

Abstract: BACKGROUND: Piriformis syndrome (PS) is the common entrapment neuropathy causing buttock pain. Patients are conventionally treated with lifestyle modification, exercise, non-steroidal anti-inflammatory drugs, corticosteroid or botulinum toxin injections. However, some patients may not respond to these conventional treatment methods. Platelet rich plasma (PRP) injection has been shown to be beneficial in various muscular injuries, but its effects have not yet been investigated in PS. OBJECTIVE: The aim of this study was to explore the effect of PRP on pain and functional status in patients with PS, and to identify any correlations between clinical changes and demographic …features. METHODS: A total of 60 patients with PS were randomly separated into two groups (PRP and control groups). All patients received one session of either PRP or saline injection performed under ultrasound guidance. The pain was measured with a visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were noted at three intervals in both groups: before treatment, 1 week after treatment and 1 month after treatment. RESULTS: The VAS and ODI scores were improved in both groups. The improvement was more obvious in the PRP group in the first week, and the results were similar for both groups when measured 1 month after the treatment. CONCLUSION: Ultrasound-guided PRP injection provided greater improvements in both pain and functional status in patients with PS, starting in the early period after treatment. A repeat injection might be needed for a long-term effect. Show more

Keywords: Platelet rich plasma, PS, ultrasound, injection

DOI: 10.3233/BMR-210032

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 633-639, 2022

Authors: Nechvátal, Pavol | Hitrík, Tomáš | Kendrová, Lucia Demjanovič | Macej, Michal

Article Type: Research Article

Abstract: BACKGROUND: Low back pain (LBP) causes disability in daily life, and presents not only a health but also a socio-economic problem. New treatment options need to be tested and confirmed. OBJECTIVE: Compare the effect of the McKenzie method and spiral stabilization in patients with LBP. METHODS: Sixty patients with an average age of 47 years, which were included in our prospective, comparative study were randomly divided into two 30-member groups. One group exercised according to the McKenzie method (MDT), the other one according to the Spiral Stabilization Method (SPS). During the initial examination the …Aberdeen Back Pain Scale was used to determine the degree of managing with daily activities and functionality, and the Roland-Morris Disability Questionnaire was used to determine the degree of disability. Check- up was performed after 2 and 6 weeks of treatment. RESULTS: In both groups, there was a significant improvement in results after 2 and 6 weeks of treatment (p < 0.05). When comparing the effect of 2 and 6 weeks of treatment of both therapeutic procedures (MDT and SPS), the difference was insignificant (p > 0.05). CONCLUSIONS: None of these two treatment methods achieved better results, as they both have a comparable effect on reducing disability and improving the management of daily activities and physical functions. Therefore, both are equally effective in patients with LBP. Show more

Keywords: Disability, low back pain, McKenzie method, spine

DOI: 10.3233/BMR-210055

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 641-647, 2022

Authors: Kirmizi, Muge | Sengul, Yesim Salik | Angin, Salih

Article Type: Research Article

Abstract: BACKGROUND: Flexible flatfoot is associated with altered plantar pressure distribution, but it is not clear how muscle fatigue affects plantar pressure characteristics in flexible flatfoot and normal foot. OBJECTIVE: To investigate the effects of calf muscles fatigue on plantar pressure variables in flexible flatfoot and normal foot. METHODS: Twenty-five people with flexible flatfoot and twenty-five people with normal foot were included. The unilateral heel-rise test was used to induce calf muscles fatigue. Plantar pressure variables were collected during preferred walking immediately before and after fatigue. The two-way mixed-design ANOVA was used to determine …the main effect of fatigue and the interaction between foot posture and fatigue. RESULTS: Fatigue caused medialization of the contact area under the forefoot and the maximum force under the heel and forefoot (p < 0.05). When examining the differences in the effects of fatigue between groups, the contact area under the medial heel increased with fatigue in flexible flatfoot but decreased in normal foot; moreover, the contact area and maximum force under the midfoot and the maximum force under the third metatarsal decreased with fatigue in flexible flatfoot but increased in normal foot (p < 0.05). CONCLUSIONS: Calf muscles fatigue caused medialization of the maximum force and contact area. Especially the midfoot was affected differently by fatigue in flexible flatfoot and normal foot. Show more

Keywords: Pes planus, plantar pressure analysis, heel rise, foot biomechanics, fatigue

DOI: 10.3233/BMR-210069

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 649-657, 2022

Authors: Almalki, Husam | Herrington, Lee | Jones, Richard

Article Type: Research Article

Abstract: BACKGROUND: In order to administer the International Knee Documentation Committee Subjective Knee Form (IKDC) questionnaire to Arabic speakers, a rigorous process of cross-cultural adaptation and validation is required in order to reach equivalence between the original publication and target version of the questionnaire. OBJECTIVES: The main aim of this study is to translate and culturally adapt the IKDC into Arabic to suit the Arabic population. The secondary aim is to assess the Arabic version of the IKDC in order to test the psychometric characteristics (reliability, validity and dimensionality). METHODS: The translation process has …been carried out according to cross-cultural adaptation guidelines in accordance with the American Orthopaedic Society for Sports Medicine guidelines with forward/backward translations and pre-testing. The Arabic IKDC, Knee injury and Osteoarthritis Outcome Score (KOOS), RAND-36-Item Health Survey (RAND-36) questionnaire, and visual analogue scales (VAS) of pain were tested in 105 ACLR patients. Test-retest reliability, internal consistency, construct validity and content validity were evaluated. RESULTS: The test-retest reliability proved excellent with a high value for the intraclass correlation coefficient (r = 0.95). The internal consistency was strong (Cronbach’s α = 0.91). Good construct validity by the strong correlations between similar component of the KOOS subscales, Rand-36 subscales and VAS, and good content validity with absence of floor and ceiling effects. CONCLUSIONS: The Arabic version of the IKDC is a valid and reliable instrument for Arabic patients with ACLR. However, further research is required with a more varied knee sample in order to enable generalisation to a wider population. Show more

Keywords: International Knee Documentation Committee (IKDC), cross-cultural adaptation, translation, knee outcome

DOI: 10.3233/BMR-210136

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 659-665, 2022

Authors: Kurzeja, Piotr | Ogrodzka-Ciechanowicz, Katarzyna | Prusak, Jarosław | Szurmik, Tomasz

Article Type: Research Article

Abstract: BACKGROUND: The gold standard in the clinical assessment of the extent of scoliosis is the Cobb method but the analysis also covers the changes that occur within the spine and trunk in relation to the transverse and sagittal planes. OBJECTIVE: The study aimed to estimate changes in the sagittal plane of the spine in girls with right-sided thoracic adolescent idiopathic scoliosis. METHODS: The study involved 29 girls with scoliosis (13.6 ± 0.6 years) and 36 healthy girls as the comparison group. The tests included an interview, clinical examination (with the …use of Adam’s test and the Cobb angle), and examination of shape of the spine surface with the use of the photogrammetric method and the projection moire effect. RESULTS: Lower values of the thoracic kyphosis parameters were found in the scoliosis group. Significant differences were noted for the parameters of the lumbosacral section α (p = 0.02), thoracolumbar section β (p < 0.001), the upper thoracic section γ (p < 0.001), thoracolumbar and upper thoracic section β + γ (p < 0.001) and the total size of α + β + γ (p < 0.001) curvatures. CONCLUSIONS: The study showed that with an increase in the angular value of the thoracic curvature, the thoracic kyphosis decreased. Show more

Keywords: Idiopathic scoliosis, moire topography, spine

DOI: 10.3233/BMR-210206

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 667-676, 2022

Authors: Wang, Yonggang | Wang, Dongmin | Kang, Xuewen | Ma, Zhanjun | Ma, Ying’ping | Hu, Xuchang | Ma, Bing | He, Xuegang | Wang, Shixiong | Gao, Bingren

Article Type: Research Article

Abstract: BACKGROUND: Scoliosis causes changes in the thorax, but it is unclear what type of changes occur in the thoracic profile after scoliosis surgery. OBJECTIVE: To investigate changes in rib cage deviation in the postoperative period after adolescent idiopathic scoliosis (AIS) surgery. METHODS: Forty-four patients with AIS with a main right thoracic curvature underwent posterior surgical fusion (PSF), and radiological parameters of the spine and thorax were evaluated. RESULTS: The correction rates of main thoracic curve (MT)-Cobb angle at immediate after surgery and postoperative follow-up (2 years) were 64% and 66%, …respectively. At these two postoperative time points, the correction rates of height of thoracic vertebrae 1 to 12 (T1T12) were 10% and 12%; the correction rates of Rib-vertebra angle difference (RVAD) were 59% and 52%; the correction rates of Apical rib hump prominence (RH) were 58% and 76%; while the correction rates of Apical vertebral body-rib ratio (AVB-R) were 23% and 25%, respectively. Statistical analysis showed that all these radiological parameters at the two postoperative time points were significantly different from the preoperative values (p < 0.001). There were significant correlations between MT-Cobb angle and T1-T12 height (p < 0.001), RVAD (p < 0.001), RH (p < 0.001), and AVB-R (p < 0.001). CONCLUSIONS: Posterior spinal fusion appears to be effective at correcting scoliosis, and the correction of rib cage deviation also plays an important role. Show more

Keywords: Adolescent idiopathic scoliosis, AIS, posterior surgical fusion, PSF, thoracic

DOI: 10.3233/BMR-210258

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 3, pp. 677-686, 2022