Journal of Back and Musculoskeletal Rehabilitation - Volume 36, issue 3

Authors: Yazici, Alikemal | Yerlikaya, Tuba | Oniz, Adile

Article Type: Research Article

Abstract: BACKGROUND: Although several studies have been conducted to determine the cause of low back pain (LBP), a sufficient correlation has not been found between research findings and symptoms. Therefore there seems to be a need for studies to explain the relationship between pain and morphological changes in the paraspinal muscles of patients with LBP through comparisons with healthy control subjects. OBJECTIVE: The aim of this study was to examine degeneration in the lumbar musculus multifidus (LMF) and lumbar musculus erector spinae (LES) muscles in patients with chronic LBP with non-radiculopathy lumbar disc herniation (LDH), patients with …mechanical LBP, and healthy individuals. METHODS: The study included 35 patients with mechanical LBP, 38 patients with non-radiculopathy LDH, and a control group of 36 healthy participants. In all patients and the control group, evaluations were made on axial magnetic resonance imaging slices at L3-S1 level of the LMF and LES cross-sectional areas (CSA), total CSA (TCSA = LMF+ LES), fat infiltrations and asymmetries. RESULTS: The mean CSA values of the right and left LMF and LES showed significant differences between the groups (p < 0.001, p = 0.002, p = 0.002, p = 0.010, respectively). Fat infiltrations showed a difference between the right-left LMF and left LES groups (p = 0.007, p < 0.001, p = 0.026, respectively). Asymmetry was not observed between the CSA and TCSA of the right and left sides. CONCLUSION: A correlation was found between fat infiltration in the LMF and mechanical LBP and LDH. However, no significant correlation was determined between LBP and the CSA and TCSA of the LMF and LES. This was thought to be due to an incorrect result of CSA and TCSA in the evaluation of muscle mass. Therefore, for a more accurate evaluation of muscle mass, it can be considered necessary to measure muscle atrophy associated with fat infiltration or functional CSA. Show more

Keywords: Low back pain, paraspinal muscles, intervertebral disc displacement, magnetic resonance imaging

DOI: 10.3233/BMR-220055

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 3, pp. 637-650, 2023

Authors: Hinnekens, Simon | Bara, Julie | Scheen, Pauline | Hidalgo, Benjamin

Article Type: Research Article

Abstract: BACKGROUND: There is a sex-related difference in strength and endurance in trunk muscles: males have more strength while females have more endurance. OBJECTIVE: Investigate sex-related differences in motor control strategies in back muscles during isometric contractions (IC) in the Sorensen test posture. METHODS: Thirty-six healthy and young volunteers performed different tasks: three maximal voluntary contraction (MVC) tests recorded with a bio-feedback force sensor, and followed by five loaded IC (LIC) tests using bodyweight and loads of 0 to 8 kg with a 2-kg step. Surface electromyography was used to measure the activity of …bilateral lumbar paravertebral (LP) and quadratus lumborum (QL) muscles. RESULTS: Sex-related and load-related differences in EMG amplitudes were highlighted during LIC tests. Females showed significantly (p -value = 0.02) greater EMG amplitude for the highest load (8 kg) than males. Besides, significant differences between low (2 and 4 kg) and high (6 and 8 kg) loads for both LP and QL muscles and for both sexes were observed. Finally, for MVC tests, males produced significantly (p -value = 1.02e-4) greater strength during MVC tests (4.25 ± 1.37 N/kg vs 2.60 ± 0.78 N/kg). CONCLUSION: The results were clinically relevant to bring attention to load strategy during rehabilitation, particularly in females who seemed to recruit the QL muscle more. Show more

Keywords: Electromyography, motor control, back muscles, sexual dimorphism, sorensen test

DOI: 10.3233/BMR-220058

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 3, pp. 651-660, 2023

Authors: Shin, Sun-Shil | An, Duk-Hyun | Yoo, Won-Gyu

Article Type: Research Article

Abstract: BACKGROUND: Sway-back posture in the sagittal profile is a commonly adopted poor standing posture. Although the terms, definitions, and adverse health problems of sway-back posture are widely used clinically, few studies have quantified sway-back posture. OBJECTIVE: To investigate spinal sagittal alignment in sway-back posture while standing based on global and regional angles using inertial measurement units (IMUs). METHODS: This cross-sectional study recruited 30 asymptomatic young adults. After measuring the sway angle while standing, the participants were divided into sway-back and non-sway-back groups (normal thoracic group). Each participant stood in a comfortable posture for …5 seconds with IMUs at the T1, T7, T12, L3, and S2 levels. Then, we measured the global and regional lumbar and thoracic angles and sacral inclination in the standing position. RESULTS: Although there was no difference in the global lumbar angle, there was a difference in regional lumbar angles between the two groups. The normal thoracic group had balanced lumbar lordosis between the upper and lower lordotic arcs, whereas the sway back group tended to have a flat upper lumbar angle and increased lower lumbar angle. CONCLUSION: It is useful to assess the global and regional angles in the spinal sagittal assessment of individuals with sway-back posture. Show more

Keywords: Assessment, lordosis, lumbar, posture, sway back

DOI: 10.3233/BMR-220072

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 3, pp. 661-667, 2023

Authors: Takahiro, Fujimoto | Shigeharu, Tanaka

Article Type: Research Article

Abstract: BACKGROUND: The extent of asymmetry in the muscle tissue composition ratios with hip fractures has not been clarified. OBJECTIVE: To determine whether there is a difference in the muscle tissue composition ratios between the fractured and non-fractured sides of the trunk and thighs immediate measurement. METHODS: Forty-four patients (84.6 ± 7.0 years) were included. Computed tomography images were used for measurements. The muscle tissue composition ratio was measured using muscle cross-sectional area (CSA) and attenuation coefficient (Hounsfield units; HU). Defined each HU attenuation range as follows: low-density muscle (LDM), low-quality …muscle tissue with fat infiltration, normal-density muscle (NDM), muscle contractor tissue, and intramuscular adipose tissue (IMAT), fat infiltration tissue. The CSA of each muscle tissue was expressed as a percentage: %LDM, %NDM, and %IMAT. A paired t -test was performed for comparison. RESULTS: The %LDM on the fractured side was higher in the thigh and erector spinae. The %NDM on the fractured side was lower in the thigh. There was no significant difference in the %IMAT for all muscles. CONCLUSION: The thigh on the fractured side showed asymmetry with low %NDM and high %LDM. This characteristic captures a characteristic of muscle tissue that may have importance in hip fracture etiology. Show more

Keywords: Hip fractures, muscle tissue, adipose tissue, aged, computed tomography

DOI: 10.3233/BMR-220083

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 3, pp. 669-676, 2023

Authors: El-Din Mahmoud, Lama Saad | El Meligie, Mohamed Magdy | Yehia, Radwa Mohammed

Article Type: Research Article

Abstract: BACKGROUND: The effectiveness of the muscle energy technique (MET) on postpartum meralgia paresthetica (MP) affecting the lateral femoral cutaneous nerve is unknown. OBJECTIVE: To investigate the effectiveness of the MET on postpartum MP affecting the lateral femoral cutaneous nerve. METHODS: In this randomized controlled trial, 30 patients with postpartum MP were randomly allocated to study and control groups. The study group received the MET with conventional therapeutic exercises and the control group received the conventional exercises alone for four weeks (thrice a week, for 30–40 minutes duration). Lateral femoral cutaneous nerve distal latency, …pain intensity, response to the prone knee bend (PKB) test and pelvic compression test were assessed. RESULTS: Patients allocated to the MET group had improvements compared to the controls in pain intensity (MD: - 1.66, 95%CI - 2.39 to - 0.94), distal latency (MD: - 0.66, 95%CI - 0.94 to - 0.36), and knee range of motion in the PKB test (MD: 19.5 ∘ , 95%CI 13 to 26.1) with high treatment effects, Cohen’s d –ES = 1.71 , 1.86 and 2.24 respectively. However, there was no between-group difference for the pelvic compression test (p = 0.41). CONCLUSION: The MET can reduce pain, distal latency, and increase the prone knee range of motion in women with MP affecting the lateral femoral cutaneous nerve. Show more

Keywords: Muscle energy technique, lateral femoral cutaneous nerve, distal latency, pain intensity, postpartum, pelvic compression test

DOI: 10.3233/BMR-220090

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 3, pp. 677-684, 2023

Authors: Kim, Taegyu | Kim, Young Hoon | Park, Jae Myoung | Choi, Hokyung

Article Type: Research Article

Abstract: BACKGROUND: To maximize the ball velocity in the tennis sever, the shoulder plays a key role in the kinetic chain. But shoulder inefficiency leads to shoulder injuries such as shoulder impingement syndrome (SIS). Thus, to verify the scapular movements during the tennis serve could help prevent shoulder injury in tennis players. OBJECTIVE: This case-control study aimed to verify the scapular movements during flat first serve for elite tennis players with shoulder impingement syndrome compared to those without it. METHODS: Eight elite tennis players (4 males and 4 females) with SIS and 8 elite healthy …players (4 males and 4 females) performed flat first serves, and the three-dimensional scapular kinematic data was recorded using the Qualisys motion capture system through spherical reflective markers including the acromion marker cluster. RESULTS: The scapula was more internally rotated (median difference: 10.40 ∘ ) in the male players with SIS than in those without it at the maximally externally rotated humerothoracic joint during flat first serve, and female players with SIS (median difference: 7.16 ∘ and 11.28 ∘ , respectively) had more internally rotated scapula at the maximally externally rotated humerothoracic joint and ball impact. CONCLUSION: Increased scapular internal rotation may be something that affects shoulder injuries in the overhead sports, and it may help to prevent and rehabilitate overhead injuries including SIS. Show more

Keywords: Tennis, overhead activity, scapular, kinematic, shoulder injury

DOI: 10.3233/BMR-220096

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 3, pp. 685-690, 2023

Authors: Paludo, Tatiane | Zardo, Franciele | de Mattos, Brenda Tubelo Pereira | Frata, Bruna | Ling, Chen Chai | de Castro Barroso, Gustavo | Cechetti, Fernanda

Article Type: Research Article

Abstract: BACKGROUND: In the motor rehabilitation of individuals with neurological disorders, including cerebral palsy (CP), Neurodevelopmental treatment (NDT) one of the most used approaches worldwide. OBJECTIVE: To verify muscle activation in NDT handling in individuals with severe CP using electromyography. METHODS: This was a controlled, cross-sectional, quantitative clinical trial. The individuals were evaluated using electromyography to analyze the muscular activation of the spinal erector, gluteus medius, rectus abdominis and multifidus during different NDT handling. We evaluated 59 individuals: 39 with spastic quadriparesis CP (Gross Motor Function Classification System, level IV–V) and 20 typically-developing individuals …(control group). These groups were homogeneous with respect to age and gender. RESULTS: There was a significant difference in muscle activation of the spinal erector, gluteus medius, rectus abdominis and multifidus in the six NDT handling used in this study: side-sitting for kneeling; supine for lateral decubitus, prone position for lateral decubitus, “sitting on horseback”, sitting on the roll, and proprioceptive stimulation sitting on the ball. CONCLUSION: The results show that all NDT handling analyzed in this study were effective for muscle activation of the spinal erector, gluteus medius, rectus abdominis and multifidus in individuals with severe spastic quadriparetic CP. Show more

Keywords: Cerebral palsy, electromyography, physical therapy, neurological rehabilitation, brain injury

DOI: 10.3233/BMR-220113

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 3, pp. 691-700, 2023

Authors: Aicha, Ben Tekaya | Ahmed, Fendri | Seif, Boukriba | Ines, Mahmoud | Leila, Rouached | Selma, Bouden | Rawdha, Tekaya | Olfa, Saidane | Habiba, Mizouni | Leila, Abdelmoula

Article Type: Research Article

Abstract: BACKGROUND: A higher prevalence of cardiovascular risk was observed in spondyloarthritis (SpA). The relationship between disease-related factors structural damage and subclinical atherosclerosis is still unknown. OBJECTIVE: The aim of our study was to evaluate the association of subclinical atherosclerosis with radiographic structural damage in patients with SpA. METHODS: Forty-seven SpA patients who fulfilled the ASAS criteria were enrolled in a case-control study conducted over 12 months and compared with 47 age and sex-matched healthy controls. None of the subjects had a previous history of cardiovascular diseases or cardiovascular risk factors. Demographic and disease characteristics …were recorded. Structural lesions were evaluated using plain radiography, and two scoring tools were used to spine (BASRI and mSASSS). Subclinical atherosclerosis was assessed using ultrasound measurements of flow-mediated dilation (FMD) and carotid intima-media thickness (cIMT). RESULTS: The median age of patients was 36 years. The sex ratio was 2.35. The median BASRI total score was 3 (IQR 2–4), median mSASSS score was 10 (IQR 415). cIMT was significantly increased in SpA patients compared to controls (p < 0.0001), and FMD was significantly lower in patients than in healthy subjects (p = 0.008). cIMT was significantly associated with ankylosis of the facet joints (p = 0.035) and Romanus spondylitis (p = 005). FMD was negatively associated with vertebral squaring (p = 0049), bridging syndesmophytes (p = 0031) and mSASSS score (p = 0.047). CONCLUSION: Our result supports the association of radiographic structural damage and subclinical atherosclerosis assessed using cIMT and FMD. This finding highlights the importance of earlier treatment in order to prevent radiographic damage progression and atherosclerotic events. Show more

Keywords: Spondyloarthritis, atherosclerosis, carotid intima-media thickness, radiography

DOI: 10.3233/BMR-220141

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 3, pp. 701-708, 2023

Authors: Qiu, Mei-Guang | Zhou, Shi-Guo | Lin, Shi-Shui | Hu, Xu | Lin, Cheng | Lin, Ke-Feng

Article Type: Research Article

Abstract: BACKGROUND: For the treatment of single-level lumbar degenerative disc disease (DDD), oblique lateral interbody fusion (OLIF) has clinical advantages. Whether internal fixation needs to be combined for treatment has been the subject of debate. OBJECTIVE: To compare the early clinical effects of standalone oblique lateral interbody fusion (S-OLIF) versus OLIF combined with lateral screw fixation of the vertebral body (F-OLIF) on single-level lumbar DDD. METHODS: A retrospective analysis was performed on the data of 34 patients for whom the OLIF technique was applied to treat single-level lumbar DDD from August 2018 to May …2021. Patients were divided into the S-OLIF (n = 18) and F-OLIF groups (n = 16). Intraoperative blood loss, operative time, and length of hospital stay were recorded. The pain visual analogue scale (VAS) and Oswestry disability index (ODI) before and after the operation were evaluated. The disc height (DH), foraminal height (FH), fused segment lordosis (FSL), lumbar lordosis (LL), cage subsidence, and fusion by CT examination were measured before and after the operation. RESULTS: The S-OLIF group experienced a shorter operative time and less intraoperative blood loss than the F-OLIF group, and the differences were statistically significant (p < 0.05), but the difference in the length of hospital stay was not statistically significant. The postoperative VAS score and ODI of the two groups were significantly lower than those before the operation, but the postoperative differences between the two groups were not statistically significant. Differences were not statistically significant in postoperative FH, DH, FSL and LL of the two groups. Both groups were followed up for no less than 12 months. In the two groups, fusion was achieved at the last follow-up visit. CONCLUSION: According to short-term follow-up results, both S-OLIF and F-OLIF can achieve reliable and stable fusion and good clinical effect in the treatment of single-level lumbar DDD. Show more

Keywords: Lumbar spine, lumbar degenerative disc, oblique lateral interbody fusion, minimally invasive, clinical effect

DOI: 10.3233/BMR-220156

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 3, pp. 709-719, 2023

Authors: Jardim, Marco | Santos, Inês | da Silva, Madalena Gomes

Article Type: Research Article

Abstract: BACKGROUND: Gluteus medius (GM) is a segmented muscle involving three muscular subdivisions. Rehabilitation exercises has been suggested to strengthen specific subdivisions. OBJECTIVE: This study aimed to evaluate muscular activation of the anterior, middle, and posterior subdivisions of the GM during two different exercises. METHODS: A total of 28 healthy active subjects participated in this study. Muscle activity using surface electromyography was recorded for the three GM subdivisions during figure-of-four position (FFP) and wall press (WP). Non-parametric Kruskal-Wallis test was used to detect differences between GM subdivisions on each exercise and the Mann-Whitney U …test was used to compare muscular activation across exercises. RESULTS: There were statistically significant differences (P < 0.001) in all GM subdivision during FFP and WP exercises. Both exercises showed greater activation of the posterior subdivision than the middle and anterior subdivisions, with the WP causing highest activation of the posterior subdivision. CONCLUSION: In line with the WP exercise, the FFP produces sufficient activity to provide potential strength gains on the posterior subdivision and could be a viable option to include in the early stages of the rehabilitation process. Clinicians may use this information to make more informed decisions about exercise selection for strengthening specific GM subdivision. Show more

Keywords: Hip joint, gluteus medius, exercise, surface electromyography, muscular activity

DOI: 10.3233/BMR-220188

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 3, pp. 721-729, 2023