Journal of Back and Musculoskeletal Rehabilitation - Volume 36, issue 5

Authors: Cha, Youngjoo | Yoon, Hyunsik | Park, Chanhee | You, Sung (Joshua) H.

Article Type: Research Article

Abstract: BACKGROUND: Although millions of people with osteoarthritis (OA) have altered biomechanical alignment, movement, and knee joint pain during gait, there are no effective and sustainable interventions. To mitigate such impairments, we developed an untacted self-automated robotic and electromyography (EMG)-augmented upper-trunk-lower reciprocal locomotor training (SRGT) intervention. OBJECTIVE: To compare the effects of SRGT and conventional treadmill gait training (CTGT) on the medial knee joint space width (JSW), hip adduction moment (HAM), knee varus deformity, pain, and physical function in community-dwelling older adults with OA. METHODS: Older adults diagnosed with medial compartment knee OA (5 …men, 35 women; mean age = 78.50 ± 9.10 years) were recruited and underwent either SRGT or CTGT, 30 min a day, 3 times a week, over a 4-week period. Outcome measurements included the JSW, HAM, knee varus angle (VA), and Western Ontario McMaster Universities osteoarthritis index (WOMAC). RESULTS: Analysis of covariance (ANCOVA) showed that SRGT ed to greater changes in medial knee JSW (p = 0.00001), HAM (p = 0.00001), VA (p = 0.00001), and WOMAC (p = 0.00001) scores. CONCLUSION: This study provides the first evidence for the long-term clinical and biomechanical effects of SRGT on JSW, knee joint kinematics, kinetics, and WOMAC scores in older adults with OA. Most importantly, self-automatic robotic gait training may be an alternative, effective, and sustainable treatment for the upper-trunk-lower reciprocal locomotor training in older adults with OA. Show more

Keywords: Osteoarthritis, robotic gait training, kinematics, kinetics

DOI: 10.3233/BMR-220182

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1101-1110, 2023

Authors: Oleiwi, Malik Abdulkadhim | Shah, Sayed Zulfiqar Ali | Bilal, Hazrat | Zeb, Alam | Ahmad, Ashfaq | Hegazye, Fatma A. | Chen, Hong

Article Type: Review Article

Abstract: BACKGROUND: Low back pain (LBP) is a prevalent disabling ailment that affects people all over the world. A wide variety of orthotic designs, ranging from lumbosacral corsets to rigid thermoplastic thoraco-lumbosacral orthosis are used for managing LBP. OBJECTIVE: Explore and summarize quality literature on the efficacy of orthotic devices in the management of LBP. METHODS: A systematic review and meta-analysis of the literature on the efficacy of orthosis in low back pain management conducted using electronic databases. Studies utilizing orthotic management alone or combined with other therapies for 2 weeks or above were …included. A meta-analysis was performed on primary and secondary variables using Mean difference (MD), Inverse variance (IV), and fixed effect model with 95% CI, Physiotherapy Evidence Database (PEDro) scale, Cochrane Risk of Bias 2 (RoB2) tool were used to assess the quality of evidence and the risk bias. RESULTS: Out of 14671 studies, only 13 Randomized Controlled Trials (RCT) were deemed eligible for inclusion in this study, all level 1 evidence. We found that orthotics could significantly mitigate LBP (P -value < 0.00001). Similarly, a significant reeducation in LBP-associated disability was observed after orthotic intervention (P -value 0.004). CONCLUSION: Lumber orthosis plays a significant role in LBP and associated disability mitigations in sufferers of LBP. Show more

Keywords: Low back pain, orthotic devices, assistive device, lumbosacral

DOI: 10.3233/BMR-220200

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1111-1125, 2023

Authors: Liu, Yang | Hao, Jingdong | Du, Mingkui | Hu, Sanbao

Article Type: Research Article

Abstract: BACKGROUND: The reason that participants develop pain episodes during the Sorensen test remains unclear. Lumbar lordosis and trunk muscle are important for dynamic stability of the spine; however, their role in pain episodes during the Sorensen test has not yet been discussed. OBJECTIVE: To investigate the effects of muscular morphology and lumbar curvature on pain development during the Sorensen test in patients with non-specific low back pain (LBP). METHODS: Ninety-one patients diagnosed with chronic non-specific LBP and underwent the Sorensen test were enrolled. Lumbar lordosis, cross-sectional area and fat infiltration rate of trunk …muscle and centroid line of psoas major (dividing into three types: anterior arc, linear and posterior arc) were measured using ImageJ software. All recruited patients were grouped into pain episode and exhaustion groups and were matched for the confounders based on propensity scores. The above parameters were compared between groups and further adjusted for confounding bias. RESULTS: After adjustment , the mean differences in lumbar lordosis of 12.1 ± 2.3 ∘ between the two groups in the complete cohort and of 13.9 ± 2.5 ∘ in the matching cohort remained significant, the exhaustion group had a 0.22-fold and 0.08-fold risk of presenting as linear and posterior arc types, respectively, compared with the pain episode group in the complete cohort (p = 0.008, p = 0.004), the corresponding values were 0.19-fold and 0.05-fold, respectively, in the matching cohort (p = 0.014, p = 0.010). Logistic regression demonstrated that lumbar lordosis, the linear and posterior arc types were significantly associated with pain episode during the test (OR = 0.78, p < 0.001; OR = 4.50, p = 0.038; OR = 9.93, p = 0.033). CONCLUSIONS: Lower lumbar lordosis and linear and posterior arc types of the psoas major centroid line were possibly relevant to the pain episode during Sorensen test in patients with chronic non-specific LBP. Show more

Keywords: Isometric contraction, low backache, spinal curvatures, psoas muscles

DOI: 10.3233/BMR-220298

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1127-1138, 2023

Authors: Shan, Hai-Hua | Chen, Hong-Fang | Lu, Xiang-Hong | Zhang, Xin-Mei | Liu, Si-Lan | Chang, Xiao-Lan | Ni, Hong-Yan | Gou, Xiao-Jun

Article Type: Research Article

Abstract: BACKGROUND: Myofascial pain syndrome (MPS) is a common disease with easy persistence and recurrence. In clinical practice, although many methods have been adopted to prevent and treat MPS, the control of MPS is still not satisfactory. OBJECTIVE: To compare the safety and effectiveness of buccal acupuncture, inactivation of trigger points (MTrPs), and their combination in the treatment of MPS. METHODS: Two hundred MPS patients in the pain clinic were randomly divided into four groups (n = 50) to receive oral drugs (Group A), oral drugs + …buccal needle (Group B), oral drugs + MTrP inactivation (Group C), or oral drugs + buccal needle + MTrP inactivation (Group D). RESULTS: The visual analogue scale (VAS) and cervical range of motion (ROM) of Group D were significantly lower than those of the other three groups, and the pressure pain threshold (PPT) value of labelled MTrPs was significantly higher than those of the other three groups (P < 0.05). The excellent rate and total effective rate of Group D were significantly higher than those of the other three groups. Group C had the highest pain score and the lowest acceptance score. The results showed that buccal acupuncture combined with ultrasound-guided dry needle-evoked inactivation of MTrPs can significantly reduce the VAS score of MPS patients, improve the range of motion of the cervical spine, and improve patient satisfaction. CONCLUSIONS: This study provides a highly accepted and satisfactory treatment for MPS, which is worthy of clinical promotion. Show more

Keywords: Acupuncture, myofascial pain syndrome, oral drugs, dry needle, pain

DOI: 10.3233/BMR-220321

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1139-1150, 2023

Authors: Chankavee, Nanniphada | Amatachaya, Sugalya | Hunsawong, Torkamol | Thaweewannakij, Thiwabhorn | Mato, Lugkana

Article Type: Research Article

Abstract: BACKGROUND: Hyperkyphosis is a condition often seen in older women. This condition causes muscle imbalance in the upper back of the body and impacts balance control. Long stick exercise (LSE) is an exercise programme for the elderly that improves muscle strength and balance control. OBJECTIVE: This research was designed to investigate the effects of a modified LSE on hyperkyphosis, muscle imbalance and balance control in elderly community-dwelling women with hyperkyphosis. METHODS: Twenty-eight elderly women with hyperkyphosis were divided into experimental and control groups. The experimental group was assigned to practice the modified LSE …programme 30–40 minutes/day, 3 days/week, for 12 weeks. Hyperkyphosis, pectoralis minor length, muscle strength, functional reach test (FRT) and timed up and go test (TUG) were obtained at baseline, after 6 weeks and after 12 weeks of exercise. RESULTS: The experimental group demonstrated improved hyperkyphosis, pectoralis minor length, muscle strength, FRT, and TUG after 12 weeks of training. Moreover, the experimental group exhibited significantly greater improvements in all outcomes than the control group (p < 0.05). CONCLUSION: The modified LSE programme is an alternative exercise that is easy and low-impact for improving hyperkyphosis, muscle imbalance, and balance control in elderly community-dwelling women with hyperkyphosis. Show more

Keywords: Kyphosis, exercise training, gerontology

DOI: 10.3233/BMR-220350

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1151-1162, 2023

Authors: Cantele, Francesca | Posanti, Elena | Pittarello, Chiara | Masiero, Stefano

Article Type: Research Article

Abstract: BACKGROUND: Brace treatment is the most effective tool for avoiding curve progression in moderate adolescent idiopathic scoliosis and high adherence is required to achieve therapeutic success. Despite this, the compliance often is impaired by the concern about the psychological well-being of adolescents. OBJECTIVE: This 36-month follow-up study investigated if the patients most adherent to brace treatment could report a stronger impairment in the quality of life and body image. METHODS: 64 adolescents with idiopathic scoliosis responded to the Scoliosis Research Society-22 revised Patient Questionnaire at 12, 24, and 36 months after prescription of …a TLSO rigid brace. Retrospectively, participants who wore a brace for more than 75% of the prescribed time were assigned to the good-compliance group (GC); the others formed the poor-compliance group (PC). RESULTS: At 12 months the GC group showed higher scores in treatment satisfaction and at 36 months they did not differ from the PC group in the overall SRS-22r score. Moreover, they achieved a statistically significant improvement in the scoliosis severity, although they showed lower scores in the self-image domain. CONCLUSION: In our patient’s cohort, increased brace adherence does not compromise QoL and provides better treatment outcomes. However, more attention is needed to maintain good self-perception. Show more

Keywords: Scoliosis, adolescence, brace, body image

DOI: 10.3233/BMR-220361

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1163-1169, 2023

Authors: Yu, Il-Young | Kang, Min-Hyeok

Article Type: Research Article

Abstract: BACKGROUND: The Y exercise is a therapeutic exercise facilitating lower trapezius muscle activity. OBJECTIVE: To identify the effects of scapular movement cues (posterior tilt vs. posterior tilt with adduction/depression) on trapezius muscle activity during Y exercise. METHODS: Fifteen healthy men without current shoulder pain performed general Y exercise; Y exercise with cues for scapular posterior tilt; and Y exercise with cues for scapular posterior tilt, adduction, and depression. Electromyography (EMG) data for the trapezius muscles were collected during Y exercise. The posterior tilt angle of the scapula was measured in the prone position …with and without cues for scapular posterior tilt using an inclinometer application. RESULTS: The greatest lower trapezius muscle activity was observed during Y exercise with cues for scapular posterior tilt, while the greatest EMG activity of the upper trapezius was observed during Y exercise with cues for scapular posterior tilt, adduction, and depression (p < 0.05). Middle trapezius muscle activity did not significantly differ among the three Y exercise conditions (p = 0.175). Cues for scapular posterior tilt significantly increased the scapular posterior tilt angle in the prone shoulder abduction position (p = 0.007). CONCLUSION: Cues for scapular posterior tilt were most effective in facilitating lower trapezius muscle activity during Y exercise. Show more

Keywords: Biofeedback, electromyography, exercise, scapula, superficial back muscles

DOI: 10.3233/BMR-220366

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1171-1178, 2023

Authors: Devorski, Luk | Skibski, Andrew | Fukuda, David H. | Stout, Jeffrey R. | Ingersoll, Christopher D. | Mangum, L. Colby

Article Type: Research Article

Abstract: BACKGROUND: Adequate normalization methodology to establish maximum voluntary isometric contraction (MVIC) is needed to compare %MVIC values for core exercise completed until discontinuation. Clinicians can use %MVIC classifications to guide their preventative and rehabilitative exercise interventions. OBJECTIVE: The aim of this study was to compare %MVIC of the external oblique (EO) between normalization techniques of side-lying lateral trunk flexion and Roman chair lateral trunk flexion. METHODS: Twenty-two participants completed two MVIC techniques followed by one repetition of the prone bridge plank (PBP), torso elevated side plank (TESP), foot elevated side plank (FESP), dead …bug and bird dog. The average %MVIC during the first 5-seconds, last 5-seconds and overall duration of exercise were included for analysis. ANOVA was used to compare normalized %MVIC from each of the 5 exercises between MVIC techniques. Alpha set a priori p = 0.05. RESULTS: The side-lying table technique yielded no %MVIC values above 100%, while the Roman chair technique produced 7 values above 100%. The largest mean difference between techniques was during the last 5-seconds of the torso elevated side plank (57.87 ± 38.51%MVIC, p < 0.001). CONCLUSION: The side-lying table technique likely provides the optimal methodology of %MVIC determination. Show more

Keywords: Core stability, isometric contraction, surface electromyography

DOI: 10.3233/BMR-220368

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1179-1184, 2023

Authors: Suo, Yan-Hui | Chen, Jun-Lin | Li, Qing-Shan | Chen, Xuan | Xie, Yan-Ping | Gu, Pei-Feng | Li, Xiao-Nan | Li, Yuan-Shen

Article Type: Research Article

Abstract: BACKGROUND: A Hoffa fracture is an unstable intra-articular break that is generally treated with surgery. OBJECTIVE: To evaluate the feasibility and clinical outcomes of using a suture anchor combined with auxiliary fixation for the treatment of a lateral femoral condyle Hoffa fracture. METHODS: The study retrospectively reviewed 8 patients (5 males and 3 females) with a lateral femoral condyle Hoffa fracture who had been treated by combining a suture anchor with auxiliary fixation between January 2016 and April 2020. The mean age of patients was 37.5 years (ranging from 23 to 45). According …to Letenneur’s classification, there were 4 cases of type I, 2 cases of type II, and 2 cases of type III fractures. The clinical outcomes were assessed using Letenneur’s functional assessment. RESULTS: The follow-up duration ranged between 14–24 months. All patients achieved primary healing of the incision and fracture union, as well as normal flexion and extension of the knee joint, with 7 cases showing excellent outcomes and 1 case showing a good outcome. No postoperative complications, such as fracture displacement, anchor loosening, or fracture malunion, occurred in this series. CONCLUSION: Our results indicated that a suture anchor, combined with external fixation, was an effective treatment for a lateral femoral condyle Hoffa fracture. Accordingly, this procedure is worthy of wider clinical application. Show more

Keywords: Suture anchor, external fixation, femoral condyle, Hoffa fracture

DOI: 10.3233/BMR-220378

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1185-1192, 2023

Authors: Murgia, Massimiliano | de Sire, Alessandro | Ruiu, Pierangela | Agostini, Francesco | Bai, Arianna Valeria | Pintabona, Giovanni | Paolucci, Teresa | Bemporad, Jonathan | Paoloni, Marco | Bernetti, Andrea

Article Type: Research Article

Abstract: BACKGROUND: Cerebral palsy (CP) is the most common physical disability in childhood. It is a heterogeneous condition in terms of etiology, motor type and severity of impairments. Clinical impairments, such as increased muscle tone (spasticity), muscle weakness and joint stiffness contribute to the abnormal development of functional activities, including gait. OBJECTIVE: The objective of this study was to investigate the popliteal angle to hamstring length after ultrasound guided Incobotulinum toxin A injections for spasticity in CP patients. METHODS: In this proof-of-concept study, we included outpatients with CP and crouch gait correlated to hamstrings …spasticity referred to the Pediatric Rehabilitation outpatient clinic of Umberto I University Hospital, Sapienza University of Rome, in the period between February and October 2018. METHODS: Modified Ashworth Scale (MAS) of hamstring muscles, Popliteal Angle and Modified Popliteal Angle, Passive Knee Extension and 10 Meter Walk Test (10MWT) were assessed at baseline (T0) and three weeks after ultrasound guided injection (T1) of Incobotulinum Toxin A (dose weight and site dependent). RESULTS: Thirteen patients (5 male and 8 female), mean aged 9.91 ± 3.59, were included. The clinical evaluation at T0 showed hamstring muscles spasticity, with MAS of 2.4 ± 0.6, popliteal angle - 51.7 ∘ ± 11.0 ∘ , modified popliteal angle of - 39.5 ∘ ± 11.0 ∘ , passive knee extension of - 14.0 ∘ ± 8.7 ∘ and 10MWT of 14.3 ± 4.6 seconds. At T1, hamstring muscles MAS mean value was 1.7 ± 0.6 (p < 0.01), popliteal angle 41.3 ∘ ± 7.0 ∘ (p < 0.001), modified popliteal angle - 32.9 ∘ ± 10.4 ∘ (p < 0.001), passive knee extension - 4.0 ∘ ± 4.2 ∘ (p < 0.05) and 10MWT 12.6 ± 4.8 seconds (p < 0.05). None of the treated patients reported any adverse event related to Incobotulinum Toxin A injection. CONCLUSION: Incobotulinum toxin A treatment has been proven to be safe and effective for hamstring muscles spasticity management in CP patients. Further studies with larger samples and longer follow-up are warranted to assess the efficacy of this treatment on the popliteal angle. Show more

Keywords: Cerebral palsy, popliteal angle, spasticity, rehabilitation, botulinum toxin

DOI: 10.3233/BMR-220381

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1193-1201, 2023