Journal of Back and Musculoskeletal Rehabilitation - Volume 36, issue 2

Authors: Dai, Jun | Liu, Xiao-Feng | Wang, Qian-Liang | Peng, Yu-Jian | Zhang, Qian-Zhong-Yi | Jiang, Feng-Xian | Yan, Jun

Article Type: Research Article

Abstract: BACKGROUND: The unilateral biportal endoscopic (UBE) technique has been widely used in spine surgery. At present, a traditional rigid working channel is available for the UBE system. A metal semicircular canal is located in the working channel. However, due to the metal material of the working channel, arthroscopy and instruments are constrained from moving in UBE surgery. Additionally, an assistant is needed during the procedure to hold the traditional working channel. OBJECTIVE: For simplicity of operation and convenient movement of the arthroscopy and instrument, we describe a new method for establishing operative channels in UBE surgery. …METHODS: We retrospectively reviewed 50 patients who underwent unilateral biportal endoscopic discectomy (UBED) from February 2020 to August 2020 via our new method. The Oswestry Disability Index (ODI) and visual analogue scale (VAS) score were measured preoperatively and 1 month, 3 months, 6 months and 12 months postoperatively. Statistical comparisons were made using analysis of covariance and paired t tests. RESULTS: The VAS scores for back pain at the five time points were 5.20 ± 2.57, 1.96 ± 0.95, 1.50 ± 0.84, 1.64 ± 1.08 and 1.18 ± 0.39. The leg pain VAS scores were 7.02 ± 2.25, 2.02 ± 1.27, 1.48 ± 0.89, 1.32 ± 0.79 and 0.88 ± 0.52. The ODI values were 51.08 ± 19.97, 19.62 ± 15.51, 8.26 ± 7.40, and 7.54 ± 6.42 to 3.24 ± 1.10. The postoperative ODIs and VAS scores of low back pain and leg pain were significantly lower than those before surgery, and differences were statistically significant (all p < 0.05). The pressure of the closed outflow was significantly higher than that of the open outflow (37.35 ± 13.11 mm Hg vs. 24.55 ± 12.64 mm Hg p = 0.003). After we tightened the infusion strap to open the outflow, the pressure decreased significantly (26.4 ± 14.08 mm Hg vs. 37.35 ± 13.11 mm Hg p = 0.015). There were 2 cases of complications, including 1 case of postoperative recurrence and 1 case of dural tears. CONCLUSION: This study demonstrates the technical feasibility, safety, and efficacy of modified channel establishment in UBE surgery. Show more

Keywords: Degenerative disc disease, minimally invasive surgery, operative channel establishment, unilateral biportal endoscopy

DOI: 10.3233/BMR-220005

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 367-375, 2023

Authors: Kaske, Sigune | Tjardes, Thorsten | Lefering, Rolf | Bouillon, Bertil | Maegele, Marc

Article Type: Research Article

Abstract: BACKGROUND: Persisting back pain is a frequent consequence after severe trauma including injury to the spine. Reports on the incidence and relevance of back pain in severely injured patients in the absence of direct injury to the spine are scarce. OBJECTIVE: To assess the frequency of relevant back pain and its effect on health-related quality of life (HRQoL) in trauma patients with spine injury compared to patients without direct impact to spine postdischarge and two years after trauma within an observational study. METHODS: A two-year follow-up survey by using the Polytrauma Outcome Chart …(PoloChart) and a set of specific questionnaires on socioeconomic and other HRQoL aspects was conducted among adult patients that had been treated for severe traumatic injuries (ISS ⩾ 9) at a German level 1 trauma center between 2008 and 2017. Patient subgroups included patients with relevant (VAS ⩾ 3) versus non-relevant back pain (VAS < 3) stratified by visual analogue scale (VAS 0–10). Patients with relevant back pain were separated into patients with (AIS spine ⩾ 1) and without spine injury (AIS spine = 0) according to the Abbreviated Injury Score (AIS). RESULTS: 543/1010 questionnaires were returned yielding a response rate of 54%. Patients were predominantly male (n = 383/543; 71%) with a mean age 45 ± 19 years, mostly blunt trauma (n = 524/543; 97%) and a mean ISS 18 ± 12 points. 32.4% of patients had sustained a spine injury defined by an AIS spine ⩾ 1 (n = 176/543). Half of these patients suffered from relevant back pain two years after trauma (n = 90/176; 51.1%); in contrast, in non-spine injured patients one in three patients reported relevant back pain (n = 127/367; 34.6%). Patients with relevant back pain reported significantly lower HRQoL as measured by the 36-Item Short Form Health Survey and the Trauma Outcome Profile. The use of pain medication after discharge and at two years after trauma was significantly higher in patients with relevant back pain (n = 183/211; 86.7% vs. n = 214/318; 75.8%; p < 0.001; pain medication 2 years after trauma: n = 113/210, 53.8% vs. 68/317, 21.5%, p < 0.001). CONCLUSION: Persisting back pain is frequent at two years after trauma independent of presence or absence of initial injury to the spine and associated with lower HRQoL in almost every dimension including physical, mental and social domains. Show more

Keywords: Spine injury, quality of life, severe injury, trauma, pain, outcome research

DOI: 10.3233/BMR-220011

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 377-385, 2023

Authors: Yan, Zhi-Wei | Yang, Zhen | Zhao, Feng-Long | Gao, Yan | Wu, Zhen-Kun | Wang, Jie-Long | Zhou, Mei

Article Type: Research Article

Abstract: BACKGROUND: The persistence of symptoms in patients with chronic neck pain is considered to be associated with variation in the neck muscle structure and associated neuromuscular control. Sling exercise therapy (SET) has been demonstrated to relieve the symptoms of chronic neck pain, whereas it is controversial whether this benefit is correlated to altered neck muscle structure and associated neuromuscular control in the patients. OBJECTIVE: To investigate the effect of SET on cervical muscle structure (thickness) and associated neuromuscular control in patients with chronic neck pain. METHODS: Twenty-five patients with chronic neck pain were …randomly assigned to the SET group (n = 12) or the control group (n = 13). The SET group received the SET intervention for 4 weeks, while the control group maintained normal activities of daily living. At baseline and after 4 weeks of intervention, Visual analogue scale and neck disability index were measured in both groups, and changes in the thickness of the superficial cervical muscles were assessed using musculoskeletal ultrasound. Surface electromyography (EMG) was adapted to assess the neuromuscular control of the neck while the participant was performing the cranio-cervical flexion test. RESULTS: At 4 weeks, the SET group had a significant reduction of RMS in both UT and SCM of EMG compared to the control group (p < 0.05). Regarding ultrasound, the SET group had significantly lower muscle thickness compared to the control group in both the rest position and the MVIC position (p < 0.05). There were no within-group differences in the control group (p > 0.05), while the SET group showed significant reductions in both RMS and muscle thickness (p < 0.05). CONCLUSION: 4-week SET was effective in reducing pain and dysfunction in patients with chronic neck pain, which may be related to improved neck muscle thickness and neuromuscular control of the neck. Show more

Keywords: Exercise prescription, musculoskeletal disorders, pain, ultrasonography

DOI: 10.3233/BMR-220030

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 387-397, 2023

Authors: Wada, Osamu | Yamada, Minoru | Kamitani, Tsukasa | Mizuno, Kiyonori | Tadokoro, Kou | Kurita, Noriaki

Article Type: Research Article

Abstract: BACKGROUND: Whether the lower phase angle associated with worse physical function is a result of pain and muscle weakness in patients with lumbar spinal stenosis (LSS) is unclear. OBJECTIVE: To evaluate the association between phase angle and back pain-specific disabilities in patients with LSS. METHODS: In this single-center, cross-sectional study, 491 participants with LSS were enrolled. The phase angle and back pain-specific disability were measured using bioelectrical impedance analysis and the Oswestry Disability Index, respectively. General linear models were used to examine associations between phase angle and the Oswestry Disability Index with or …without adjustment for age, sex, low back and lower limb pain, numbness in the lower extremities, total fat mass, and lower limb muscle mass. RESULTS: The mean (SD) phase angle was 4.4 ∘ (1.0 ∘ ), and the mean Oswestry Disability Index was 36.1 (14.1) points. Greater phase angles were associated with less Oswestry Disability Index points (p = 0.037) independent of fat mass, low back pain, and hip or lower limb pain. CONCLUSIONS: A lower phase angle was associated with worse functional disability. Low phase angle may be an indicator of functional impairment due to low back pain associated with LSS. Show more

Keywords: Phase angle, bioelectrical impedance analysis, functional disability, lumbar spinal stenosis, Oswestry Disability Index

DOI: 10.3233/BMR-220038

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 399-405, 2023

Authors: Alshami, Ali M. | Alqassab, Fadhila H.

Article Type: Research Article

Abstract: BACKGROUND: Despite being used as a manipulation technique, no studies have examined the effectiveness of physiotherapy instrument mobilization (PIM) as a mobilization technique on pain and functional status in patients with low back pain (LBP). OBJECTIVE: To investigate the effectiveness of PIM in patients with LBP and to compare it with the effectiveness of manual mobilization. METHODS: This is a double blind, randomized clinical trial. Thirty-two participants with LBP were randomly assigned to one of two groups. The PIM group received lumbar mobilization using an activator instrument, stabilization exercises, and education; and the …manual group received lumbar mobilization using a pisiform grip, stabilization exercises, and education. Both groups had a total of 4 treatment sessions over 2–3 weeks. The following outcomes were measured before the intervention, and after the first and fourth sessions: Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI) scale, Pressure pain threshold (PPT), lumbar spine range of motion (ROM), and lumbar multifidus muscle activation. RESULTS: There were no differences between the PIM group and the manual group in any outcome measures. However, over the period of study, there were improvements in both groups in NPRS (PIM: 3.23, Manual: 3.64 points), ODI (PIM: 17.34%, Manual: 14.23%), PPT (PIM: ⩽ 1.25, Manual: ⩽ 0.85 kg.cm 2 ), lumbar spine ROM (PIM: ⩽ 9.49 ∘ , Manual: ⩽ 0.88 ∘ ), and/or lumbar multifidus muscle activation (percentage thickness change: PIM: ⩽ 4.71, Manual: ⩽ 4.74 cm; activation ratio: PIM: ⩽ 1.17, Manual: ⩽ 1.15 cm). CONCLUSIONS: Both methods of lumbar spine mobilization demonstrated comparable improvements in pain and disability in patients with LBP, with neither method exhibiting superiority over the other. Show more

Keywords: Activator, manual therapy, physical therapy, lumbar spine

DOI: 10.3233/BMR-220042

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 407-418, 2023

Authors: Bagcaci, Sinan | Unuvar, Bayram Sonmez | Gercek, Hasan | Ugurlu, Ibrahim | Sert, Ozlem Akkoyun | Yilmaz, Kamil

Article Type: Research Article

Abstract: BACKGROUND: Lateral elbow tendinopathy (LET) is one of the most common lesions of the upper extremity. The level of evidence from studies on LET treatment protocols is insufficient. OBJECTIVE: The aim of this study was to compare the acute effects of mobilization with movement (MWM) and muscle energy technique (MET) on pain, grip strength, and functionality in patients diagnosed with LET. METHODS: Forty-five patients with LET aged 30–55 years were enrolled in this study. Patients were divided into three groups: MWM, MET, and control group. The control group received a 4-week home exercise …program. In addition to the home exercise program in the MWM group, 12 sessions of MWM and 12 sessions of MET were performed in the MET group. Participants’ pain, grip strength, and functionality were assessed before and after the study. RESULTS: After the treatment period, greater improvement in pain, grip strength, finger strength, and functionality were observed in the MWM and MET groups than in the control group (p < 0.05), but no statistically significant difference was found between the MWM and MET groups (p > 0.05). CONCLUSIONS: This study shows that MWM and MET, used in addition to home exercises, can be used to relieve pain and increase grip strength, finger strength, and functionality. Show more

Keywords: Tennis elbow, musculoskeletal manipulations, pain, muscle strength

DOI: 10.3233/BMR-220061

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 419-427, 2023

Authors: Samarah, Omar Q. | Maden, Hana A. | Sanwar, Basheer O. | Farhad, Abdallah P. | Alomoush, Forat | Alawneh, Anas | Hadidi, Fadi Al | Bashaireh, Khaldoon | Hammad, Yazan S.

Article Type: Research Article

Abstract: BACKGROUND: Musculoskeletal (MSK) pain is a debilitating multi-perceptual condition afflicting many individuals, especially individuals in the medical profession. OBJECTIVE: To analyze and evaluate the prevalence of musculoskeletal pain among medical students at Jordanian universities during the complete virtual learning process. METHODS: A cross-sectional study of 593 medical students at two Jordanian universities was conducted. A modified Nordic questionnaire was used to assess musculoskeletal pain in three body regions. RESULTS: Five hundred ninety-three students at the two Jordanian universities participated in this study. The prevalence of having MSK pain during the …past week in the neck, shoulder, and lower back was 34.6%, 27%, and 41%, respectively; during the past 12 months, it was 61.2%, 45.5%, and 63.1%, respectively. Overall prevalence of having MSK pain was 58.9% in the last week and 78.1% in the past 12 months. 66.8% of students who had psychosomatic symptoms and 62.3% of those with depressive symptoms in the past week had MSK pain. Students who studied 8 hours per day had higher percentages of MSK pain (68.4%) (OR 1.12, 95% CI 0.965–1.312). The average number of hours using a computer per day was significantly associated with MSK pain (p = 0.032). MSK pain during the last week was significantly associated with psychosomatic symptoms (OR 1.842, 95% CI 1.272–2.668, p = 0.001). Family history of MSK pain was significantly related to the presence of the problem in participants (OR 1.732, 95% CI 1.182–2.538, p = 0.005). Gender, depressive symptoms, average hours of computer use per day, and average hours of study at home per day did not show significant relationships with MSK pain over the year. CONCLUSIONS: High prevalence of MSK pain was observed among medical students. Measures to balance in-person and virtual learning should be considered in medical schools to minimize the risk of MSK pain. Show more

Keywords: Musculoskeletal pain, neck, shoulder, low back pain, Jordan

DOI: 10.3233/BMR-220065

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 429-436, 2023

Authors: Takahashi, Makoto | Iwamoto, Koji | Tomita, Kazuhide | Ueda, Shinji | Igawa, Takeshi | Miyauchi, Yukio

Article Type: Research Article

Abstract: BACKGROUND: Determining the association between radiographic spinal instability assessment and lower back lumbar diseases with lower limb symptoms can contribute to evidence-based assessment and treatment in clinical practice and rehabilitation. Therefore, radiological evidence of lumbar spine instability assessment, such as sagittal translation (ST) and segmental angulation (SA), is clinically important. OBJECTIVE: To identify factors associated with the assessment of spinal instability in lumbar disc herniation with leg pain and discogenic low back pain using ST and SA. METHODS: We examined 112 patients with lumbar disc herniation with leg pain and 116 with discogenic …low back pain at our clinic from 2016 to 2021. Data on age, gender, sports activities, and occupation were collected from medical records. Additionally, ST and SA of L4 and L5 during maximum trunk flexion and extension were measured using radiography. Simple and multiple logistic regression analyses were used for statistical analysis. RESULTS: Simple logistic regression analysis showed that ST and SA (odds ratio [OR]: 1.11; 95% confidence interval [CI]: 1.03–1.19) were associated with lumbar disc herniation. Multiple logistic regression analysis showed that only ST was associated with lumbar disc herniation (OR: 2.29; 95% CI: 1.78–3.00). CONCLUSION: Multiple logistic regression analysis showed that ST was associated with lumbar disc herniation with leg pain and had a stronger association than SA. Show more

Keywords: Sagittal translation, segmental angulation, lumbar disc herniation, discogenic low back pain, leg pain, spinal instability

DOI: 10.3233/BMR-220067

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 437-444, 2023

Authors: Chen, Zhibiao | Xian, Zuxin | Chen, Huanzhou | Zhong, Yuan | Wang, Feng

Article Type: Research Article

Abstract: BACKGROUND: Patients exhibit considerable variations in gait patterns especially in knee hyperextension in the stance phase after stroke. If knee hyperextension is untreated it may lead to pain, reduced independence in activities of daily living, deformities and instability. OBJECTIVE: The aim of this study was to investigate the immediate effects of a buffered knee orthosis on gait of stroke patients with knee hyperextension. METHODS: A total of nine patients with knee hyperextension after stroke were selected to wear buffered knee orthosis developed by Zhongshan Traditional Chinese Medicine Hospital and Ruike Medical Technology (Shanghai) …Co., Ltd during walking training and daily walking. Then the gait analysis system of Motionanalysis was used to analyze and evaluate kinematic and spatiotemporal parameters of the gait in patients with independent walking or walking with a buffered knee orthosis. RESULTS: After wearing the buffered knee brace, initial contact, maximum and minimum angles of support phase, the toe off the ground, maximum and minimum angles of swing phase on the injured side of knee and ankle increased. Minimum angle of support phase and maximum angle of swing phase on the uninjured side of ankle decreased, while the toe off the ground and minimum angles of swing phase increased significantly (all P < 0.05); There was no significant difference in other kinematics, in parameters between time and space, in walking speed among subjective gait parameters (P > 0.05). Walking distance, confidence, sense of security, and the feeling of walking hyperextension were all improved. In addition, the number of asymmetric kinematic parameters and spatiotemporal parameters decreased. CONCLUSION: The buffered knee orthosis can effectively prevent knee hyperextension after stroke, improve the knee and ankle sagittal motion, gait asymmetry, gait subjective feeling, and does not affect gait space-time parameters. Show more

Keywords: Stroke, knee hyperextension, buffered knee orthosis, gait

DOI: 10.3233/BMR-220069

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 445-454, 2023

Authors: de Alegria, Samantha Gomes | Azevedo, Beatriz Luiza Pinheiro Alves | Oliveira, Jéssica Gabriela Messias | da Silva, Matheus Mello | Gardel, Damara Guedes | Mafort, Thiago Thomaz | Lopes, Agnaldo José

Article Type: Research Article

Abstract: BACKGROUND: Recent initiatives, such as earlier diagnosis and treatment, have enhanced the survival of patients with systemic sclerosis (SSc). Despite these initiatives, there is extreme variability in rehabilitation strategies for these patients. In 2006, the Glittre-ADL test (TGlittre) was developed to evaluate functional capacity using multiple tasks similar to the activities of daily living (ADLs). OBJECTIVES: To evaluate the impact of therapist-oriented home rehabilitation (TOHR) on functional capacity using TGlittre and to examine the effects of TOHR on physical function, hand function, and quality of life (QoL) among women with SSc. METHODS: This …quasi-experimental and longitudinal study included 12 women with SSc who underwent TOHR 3 times per week for 12 weeks. Before and after TOHR, functional capacity was assessed using TGlittre, physical function was examined by the Health Assessment Questionnaire Disability Index (HAQ-DI), hand function was evaluated using the Cochin Hand Functional Scale (CHFS) and handgrip strength (HGS), and QoL was evaluated using the Short Form-36 Health Survey Questionnaire (SF-36). RESULTS: When comparing the pre- and post-TOHR values of TGlittre, a significant reduction was found in total time (p = 0.002) and manual time (p = 0.010). There was a nonsignificant decrease in HAQ-DI scores between pre- and post-TOHR (p = 0.07). Regarding hand function, there was a significant reduction in the CHFS between pre- and post-TOHR (p = 0.036), although no significant difference was observed in HGS between pre- and post-TOHR (p = 0.08). Regarding QoL, there was an increase in all SF-36 categories, although physical function was the only category that was significantly increased (p = 0.008). CONCLUSION: After TOHR, patients with SSc are able to more quickly perform TGlittre tasks when considering both total and manual times. TOHR also positively affects manual skills and QoL. Show more

Keywords: Systemic sclerosis, rehabilitation, exercise, functional capacity

DOI: 10.3233/BMR-220077

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 455-463, 2023