Journal of Back and Musculoskeletal Rehabilitation - Volume 36, issue 6

Authors: Farì, Giacomo

Article Type: Editorial

DOI: 10.3233/BMR-235004

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1217-1218, 2023

Authors: Lippi, Lorenzo | Folli, Arianna | Turco, Alessio | Moalli, Stefano | Curci, Claudio | Ammendolia, Antonio | de Sire, Alessandro | Invernizzi, Marco

Article Type: Review Article

Abstract: BACKGROUND: Spinal cord injury (SCI) is a disabling condition characterized by multilevel skeletal muscle impairment and rapid cortical and trabecular bone loss. Rehabilitation is a cornerstone of the long-term management of patients with SCI; however, the optimal rehabilitation strategy for improving bone health has not been fully characterized. OBJECTIVE: To characterize the current evidence supporting different rehabilitation interventions improving bone health in patients with SCI. METHODS: On November 17 th , 2022, five databases (PubMed, Scopus, Web of Science, Cochrane, and PEDro) were systematically searched for randomized controlled trials (RCTs) …assessing SCI patients undergoing rehabilitation interventions. The primary outcomes were bone macroscopical effects. Secondary outcomes were changes in bone metabolisms and functional outcomes. RESULTS: Out of 499 records, 11 RCTs met the eligibility criteria and were included. Electrical stimulation combined with physical exercise was assessed by 5 studies, standing intervention was assessed by 3 studies, vibration was assessed by 1 study, ultrasound therapy was assessed by 1 study, and electroacupuncture combined with a pulsed magnetic field was assessed by 1 study. The rehabilitation intervention was administered combined with pharmacological treatment (3 studies) or alone (8 studies). Positive effects in terms of BMD were reported by 3 studies. The quality assessment revealed some concerns in 9 out of 11 studies, in accordance with the Cochrane Risk of Bias assessment – version 2. CONCLUSION: Our data suggest that multicomponent interventions including rehabilitation might be considered a suitable option to improve bone health management in SCI patients. Further studies are mandatory to characterize the optimal combination of non-pharmacological interventions reducing bone loss and improving the risk of fractures in patients with SCI. Show more

Keywords: Osteoporosis, spinal cord injury, rehabilitation, bone health, physiotherapy

DOI: 10.3233/BMR-230006

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1219-1235, 2023

Authors: Reyes-Ferrada, W. | Chirosa-Rios, L. | Martinez-Garcia, D. | Rodríguez-Perea, A. | Jerez-Mayorga, D.

Article Type: Research Article

Abstract: BACKGROUND: Low back pain is one of the leading causes of disability globally, with a high economic and social burden. A decrease or imbalance in trunk strength has been associated with the occurrence of low back pain and its severity. Trunk strength training is helpful in the treatment of Non-specific low back pain (NSLBP) patients. However, we do not know the effects of trunk isokinetic training (IKT) on pain intensity, disability, and trunk strength. OBJECTIVE: This systematic review aimed to determine the effects of trunk IKT in NSLBP patients on pain intensity, disability, and trunk flexor …and extensor isokinetic strength. METHODS: We searched PubMed, Web of Science, Scopus, CENTRAL, and PEDro, from January 2001 until March 2021 and updated to November 2022. Randomized controlled trials (RCTs) that investigated the effect of IKT in adult participants with NSLBP on pain intensity, disability, or isokinetic trunk strength were included. Mean difference (MD) and 95% confidence intervals (95% CI) were calculated for pain. Bias was assessed using the Cochrane risk of bias (RoB) tool and evidence certainty via Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Among 1750 retrieved articles, eight were included in this review. Meta-analysis comparing IKT (trunk isokinetic training, n = 134) with control groups (conventional exercises, n = 133) revealed that IKT decreases pain intensity (MD - 1.50 (95% CI: - 2.60; - 0.39)) immediately post-intervention, and one month (MD - 1.97 (95% CI: - 2.92; - 1.03)) and at six months follow-up (MD - 2.48 (95% CI: - 2.77; - 2.19)), although with a very low to low quality according to the GRADE rating. Besides, IKT decreases disability and increases isokinetic trunk strength, but with scant evidence. CONCLUSIONS: Trunk IKT could be a novel clinical tool for pain management in patients with NSLBP, although evidence is scarce. In addition, few RCTs exist for IKT on disability or trunk isokinetic strength in patients with NSLBP. Therefore, further research on this topic is needed. Show more

Keywords: Rehabilitation, exercises, strengthening, dynamometer, core muscles, chronic pain

DOI: 10.3233/BMR-220301

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1237-1250, 2023

Authors: Kulshreshtha, Poorvi | Deepak, Kishore Kumar

Article Type: Review Article

Abstract: BACKGROUND: The heterogeneity of symptoms and ineffective treatment raise questions about the current diagnostic criteria of fibromyalgia (FM). Misdiagnosis of FM often leads to less than efficacious treatment and poor quality of life. OBJECTIVE: This article reviews relevant evidence-based literature on personality traits in FM patients with an autonomic dysfunction perspective based on a hierarchical model to explain the utility of considering the personality trait in FM diagnosis. METHODS: A narrative review of articles concerning chronic pain, FM, and personality traits with respect to autonomic dysfunction in FM was conducted after extensive relevant …literature searches. RESULTS: Reports discussing the predisposing factors, including coping styles, anger, suicide risk, a lack of physical activity and social support, in maintaining persistent pain in FM exist. Relationships between pain duration and severity and personality traits like neuroticism and extraversion have been reported. Coexisting clinical manifestations of FM like sleep disorders, anxiety, and intestinal irritability indicate autonomic dysfunction. CONCLUSIONS: This article lays out a constructive framework for individualized and personalized medicine for the effective rehabilitation of FM patients. The quest to find a definitive diagnosis of FM should include personality biomarkers that might translate into personalized medicine. An individualistic approach may bank upon artificial intelligence algorithms for both diagnostic as well as prognostic purposes in FM. Show more

Keywords: Artificial intelligence, autonomic nervous system, biomarkers, chronic pain, diagnosis, personality

DOI: 10.3233/BMR-220353

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1251-1260, 2023

Authors: Baik, Seung-Min | Kim, Seok-Hyun | Lee, Ji-Hyun

Article Type: Review Article

Abstract: BACKGROUND: Adolescent idiopathic scoliosis (AIS), which is the most common type of scoliosis, is a progressive disease that occurs in children aged 10–16 years. Abnormal curvature in AIS provokes spinal asymmetry of the upper body alignment and might deteriorate postural balancing and control ability. OBJECTIVE: To evaluate the effect of exercise interventions on balance and postural stability in patients with adolescent idiopathic scoliosis. METHODS: Embase, Scopus, Pubmed (Medline) and Web of Science databases were searched using the terms idiopathic scoliosis, physiotherapy, and balance. The articles selected were published in English in peer-reviewed journals …from 2012 to July 2022. RESULTS: Ten studies met the inclusion criteria. The PEDro scale values ranged from 2 to 6 (mean, 3.6), indicating a low level of scientific rigor. In the sample studies, spinal stabilization exercises were most often trialed (n = 3), followed by Schroth’s exercise (n = 2), stretching and self-elongation exercise (n = 2), the exercise protocol of Blount and Moe, physiotherapeutic scoliosis-specific exercise, and proprioceptive neuromuscular facilitation exercise (all n = 1). CONCLUSIONS: Physical therapists will be able to apply hippotherapy, Schroth exercise, physiotherapy scoliosis-specific exercise, trunk stabilization, proprioceptive neuromuscular facilitation exercise, spinal stabilization exercise, core stabilization exercise, and body awareness therapy to manage balance impairments in patients with adolescent idiopathic scoliosis, and further studies are needed to provide stronger evidence. Show more

Keywords: Equine-assisted therapy, proprioception, sensory processing

DOI: 10.3233/BMR-220391

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1261-1272, 2023

Authors: Aydin, Abdulkadir | Atiç, Ramazan

Article Type: Research Article

Abstract: BACKGROUND: During the COVID-19 pandemic, it is thought that healthcare workers are most exposed to musculoskeletal disorders. However, there are limited studies in the literature examining the musculoskeletal disorders among healthcare workers during the COVID-19 pandemic. OBJECTIVE: The aim of this study was to examine musculoskeletal problems and psychological disorders in healthcare personnel working at Dicle University Faculty of Medicine and Research Hospitals during the COVID-19 pandemic and to come up with solutions for rehabilitation. METHODS: The Cornell Musculoskeletal Disorder Questionnaire (CMDQ) was used to assess musculoskeletal problems in the past week. Additionally, …Beck depression inventory (BDI) was used to evaluate the psychological state of the participants. Questions on demographic characteristics, habits, the presence and localisation of musculoskeletal system (MSS) diseases, severity and duration of pain, chronic diseases, trauma history and working conditions were included in the questionnaire prepared by the researchers. RESULTS: The study included 74 nurses, 42 residents, 26 specialists, 24 technicians, 16 dentists, 12 physiotherapists, and 26 other allied health personnel. Dentists had the highest total CMDQ score (160.73) whereas resident doctors had the lowest total CMDQ score (98.33). Low back, neck and back pain were the most common MSS problems. BDI was highest in nurses and 70.27% of the nurses were women. The total workplace ergonomics score was found to be 25.91%, and the visual analogue scale (VAS) was highest in nurses (6.72). CONCLUSIONS: While MSS pain is concentrated on the waist, neck and back regions in all healthcare workers. We concluded that the uncertainty associated with the pandemic, delay in preventive measures such as vaccination and medication, rapid and strong transmission of the disease and increasing number of deaths have led to an increase in stress, depression and burnout among healthcare workers. Show more

Keywords: Health worker, ergonomics, burnout, anxiety, psychosocial impacts

DOI: 10.3233/BMR-220229

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1273-1283, 2023

Authors: Abass, Mohamed Yassen | Shendy, Wael | Samir, Hatem | Sweif, Radwa E. | Ahmed, Mai A. | Awad, Amina

Article Type: Research Article

Abstract: BACKGROUND: Chronic mechanical cervical pain (CMCP) is a common disabling problem worldwide, interfering with upper extremities function. However studying the impact of CMCP on shoulder proprioception is still lacking. OBJECTIVE: To investigate the impact of CMCP on shoulder proprioception in young adults compared with normal control (NC) individuals. METHODS: A comparative study was conducted between two groups; 40 patients with CMCP (mean age 32.28 ± 6.586) and 40 age and sex matched NC (mean age 33.43 ± 9.021). The Biodex isokinetic dynamometer was used to assess shoulder …active sense of position at 30 ∘ external and internal rotations. The absolute angular error was calculated for the dominant and non-dominant shoulders. RESULTS: The absolute angular error was significantly increased only in the CMCP at both rotation angles for both shoulders, showing a remarkable increase on the dominant shoulder and in the external rotation range compared with NC. CONCLUSIONS: CMCP can significantly impair shoulder proprioception, particularly on the dominant side and in external rotation range. This could emphasize the careful examination of shoulder proprioception for the early detection of shoulders at risk, to eliminate the possibility of shoulder instability and/or injury in young adults with CMCP. Show more

Keywords: Chronic mechanical cervical pain, shoulder proprioception, shoulder stability, isokinetic dynamometer

DOI: 10.3233/BMR-220173

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1285-1293, 2023

Authors: Lin, Wujian | Wang, Weiming | Sun, Yiping | You, Longfei | Li, Yilin | Wu, Shaoping | Liao, Lingxiao | Andersen, Lars Louis | Wang, Yuling

Article Type: Research Article

Abstract: BACKGROUND: Based on electromyography measurements, shoulder vibratory exercises efficiently stimulate shoulder muscles activity. Yet very few studies have supported that shoulder vibratory exercises increased shoulder muscles strength and function, and the noninferiority compared with conventional elastic resistance exercises remains unknown. OBJECTIVE: This study investigated the effect of vibratory exercises versus conventional elastic resistance exercises with elastic bands on shoulder external rotation muscles strength and functional performance in young adults. METHODS: 26 young adults (7 males and 19 females, with age 23.89 ± 3.02) were recruited and randomly allocated to shoulder …vibratory exercises with FLEXI-BAR (FLEXI-BAR group) or conventional resistance exercises with elastic band (TheraBand group) for 3 times/week, 4 weeks totally. Shoulder external rotator muscles strength test and Underkofler softball distance throw test (USDTT) were performed before and after the training period. RESULTS: After 4 weeks training, shoulder external rotator muscles strength increased 22.25 ± 15.06 N (P = 0.004, effect size = 1.48) within FLEXI-BAR group and 22.81 ± 14.94 N (P = 0.007, effect size = 1.53) within TheraBand group. There were no statistically significant differences between groups in the three muscle strength tests (P > 0.65). Regarding shoulder function, FLEXI-BAR exercises increased the throw distance 0.81 ± 0.92 meters in USDTT (P = 0.041, effect size = 0.88) while TheraBand exercise did not (P = 0.284), yet there was no statistically significant between group effects (P = 0.608). CONCLUSIONS: These findings suggest that shoulder vibratory exercises can improve shoulder muscles strength in young adults and can be a useful alternative to the conventional elastic resistance exercises to improve the shoulder muscles strength and function. This provides therapists with more options in terms of choosing training equipment for rehabilitation programs. Show more

Keywords: Vibration, FLEXI-BAR, TheraBand, resistance training, rehabilitation

DOI: 10.3233/BMR-220190

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1295-1305, 2023

Authors: Yoon, Sam-Won | Son, Ho-Hee

Article Type: Research Article

Abstract: BACKGROUND: Studies regarding effects of therapeutic tapings when patients with patellofemoral pain syndrome (PFPS) descend stairs are limited. OBJECTIVE: The purpose of this study was to investigate the effect of McConnell taping (MT) and Kinesio taping (KT) on kinematic variables when patients with PFPS descend stairs. METHODS: Fifty PFPS patients were randomly assigned to either the MT group or the KT group. Pain and lower extremities joint angles were measured while descending stairs before and after the intervention. All outcomes measured were analyzed using either paired t tests or independent t tests to …compare the difference within or between groups, respectively. RESULTS: There was a statistically significant difference in both groups in anterior knee pain scale score (p < 0.05). As a result of analysis of lower extremities joint angles at initial contact, loading response, and terminal stance, there were statistically significant within-group differences in hip, knee flexion, abduction and lateral rotation angles in both groups (p < 0.05). There were statistically significant within-group differences in hip flexion, knee flexion, and dorsiflexion angles in pre-swing (p < 0.05). There was a statistically significant difference between the groups in the following events: (1) knee lateral rotation angle at initial contact; (2) hip flexion angle at loading response; (3) and hip flexion at terminal stance angle (p < 0.05). CONCLUSION: MT and KT were effective in lowering knee pain and improving lower extremities joint angle when patients with PFPS descend stairs. In the comparison between the groups, the MT group showed significantly reduced anterior knee pain and increased range of motion of the lower extremities joint compared to the KT group. Show more

Keywords: Knee injury, alignment, lower extremity, gait analysis, initial contact

DOI: 10.3233/BMR-220244

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1307-1316, 2023

Authors: Liu, Yingmin | Feng, Chengbao | Li, Yuyuan | Qie, Dandan | Xu, Bin | Wen, Yafei | Ma, Su | Yu, Wanglin | Xie, Zhanqing

Article Type: Research Article

Abstract: BACKGROUND: Long-round needle usage can treat muscular pain, but there is little research on cervical spondylotic radiculopathy (CSR). OBJECTIVE: To explore the efficacy and safety of long-round needle usage in treating CSR. METHODS: Ninety-eight patients with CSR were randomly divided into control and observation groups. They were treated with filiform needles and long-round needles, respectively. The therapeutic effect, safety, inflammatory factors and neck dysfunction index (NDI), McGill pain questionnaire (MPQ) and Generic Quality of Life Inventory-74 (GQOL-74) scores were compared between the two groups. RESULTS: After treatment, the effective rate …and safety of the observation group were better than those of the control group. The NDI and MPQ scores in the observation group were significantly lower than those in the control group, and the GQOL-74 score was higher than that in the control group. The level of interleukin-8 in the observation group was significantly lower than that in the control group, and the level of interleukin-10 was significantly higher than that in the control group. CONCLUSIONS: Long-round needle therapy has a good effect on patients with CSR, which can safely improve the quality of life of patients with mild local inflammatory damage. Show more

Keywords: Treatment outcome, inflammation, quality of life

DOI: 10.3233/BMR-220295

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1317-1323, 2023

Authors: Hangai, Mika | Kaneoka, Koji | Dohi, Michiko | Niitsu, Mamoru | Onishi, Takahiro | Nakajima, Kohei | Okuwaki, Toru

Article Type: Research Article

Abstract: BACKGROUND: Sacroiliac joint (SIJ) dysfunction in athletes affects competitiveness. However, the pathology and imaging features have not been clarified. OBJECTIVE: To clarify the association between SIJ pain and MRI findings in high-performance athletes. METHODS: Fifty-two Japanese high-performance athletes with or without SIJ pain were recruited. MRI short tau inversion recovery (STIR) semi-coronal and semi-axial images of their SIJs were taken. The relationships between high-signal changes in MRI-STIR and SIJ pain and pain duration were investigated. Six athletes with continuous SIJ pain were prospectively followed. RESULTS: The proportion of athletes with …high-signal changes in the SIJ was significantly higher among athletes with SIJ pain for one month or more (76.9%, 10/13) than among athletes with SIJ pain for less than one month (18.2%, 2/11) and among athletes without SIJ pain (28.6%, 8/28). High-signal changes on painful SIJs were most often present in the sacrum. In three of the six athletes who were prospectively followed, the high-signal area and intensity on MRI both diminished as their symptoms improved. CONCLUSIONS: High-signal changes of the SIJ on MRI-STIR images in high-performance athletes may reflect their SIJ pain. Show more

Keywords: Sacroiliac joint, bone marrow edema, magnetic resonance imaging (MRI), high-performance athletes, mechanical stress, differential diagnosis

DOI: 10.3233/BMR-220323

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1325-1333, 2023

Authors: Wingood, Mariana | Bruch, Kathryn C. | Franssen, Nicholas | Mulpeter, Kaleigh | Scott, Leanne | Henry, Sharon | Gell, Nancy

Article Type: Research Article

Abstract: BACKGROUND: Despite the extensive evidence supporting physical activity (PA) for managing chronic low back pain (CLBP), little is known about PA prescription by physical therapists treating patients with CLBP. OBJECTIVE: 1) Explore how PA prescriptions provided by outpatient physical therapists treating patients with CLBP align with PA guidelines. 2) Examine the barriers and facilitators of PA prescription among physical therapists working with patients with CLBP. METHODS: We conducted a qualitative study with outpatient physical therapists who treat CLBP. Semi-structured interviews provided an understanding of physical therapist experience with PA prescription among patients with …CLBP. The interviews were transcribed, coded, and analyzed thematically. RESULTS: The 18 participants had an average of 13.4 (6.4) years of clinical experience in outpatient physical therapy. Thematic analysis revealed: 1) Physical therapists’ articulate knowledge of PA guidelines and importance of physical activity; 2) Patient factors take priority over the PA guidelines for people with CLBP; and 3) The importance of building and maintaining a strong patient-therapist relationship influences physical therapist prescription of PA for patients with CLBP. CONCLUSION: When providing PA recommendations for patients with CLBP, general movement recommendations are emphasized in place of explicit PA prescriptions. Our findings highlight factors for consideration when prescribing movement and PA for patients with CLBP. Show more

Keywords: Physical activity, chronic low back pain, physical therapy, decision making, pain management

DOI: 10.3233/BMR-220360

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1335-1343, 2023

Authors: Lin, Aixin | Guo, Xudong | Lai, Guilin | Kang, Jihe | Wang, Zhaoheng | Chen, Haiwei | Liu, Wenzhao | Kang, Xuewen

Article Type: Research Article

Abstract: BACKGROUND: Adolescent idiopathic scoliosis (AIS) is a common structural disorder of the spine in adolescents, often associated with structural deformities in both coronal and axial positions. Apical vertex rotation (AVR) is one of the main indicators of axial deformity in patients with scoliosis. Currently, there are few studies on the impact of AVR in the treatment of AIS. OBJECTIVE: This study examined the influence of different AVR on AIS after brace treatment. METHODS: Data were collected from 106 AIS participants aged 11–16 years from the orthopedic outpatient clinic of the Second Hospital of …Lanzhou University. Two orthopaedic professionals measured the Cobb angle, AVR and spinal mid-line offset before and after brace treatment, and descriptive and linear correlation analyses were used to determine the correlation between AVR and AIS measured parameters. RESULTS: (1) In AIS volunteers with the same AVR, the treatment effect of AIS with lumbar predominant curvature was higher than that of AIS with thoracic predominant curvature. The treatment effect tended to decrease with increasing AVR. (2) Spinal mid-line deviation was associated with AVR. For patients with AIS with I and II degrees of AVR, the treatment effect of spinal mid-line offset after bracing is better. For AIS patients with AVR III degrees and above, the degree of correction of spinal mid-line offset decreases with the continuous correction of Cobb angle. CONCLUSIONS: The efficacy of AIS was found to be related to the severity of AVR. The efficacy of AIS with predominantly lumbar curvature was significantly higher than that of AIS with predominantly thoracic curvature. The efficacy of treatment of mid-line spinal deviation also decreased with increasing AVR. Show more

Keywords: Adolescent idiopathic scoliosis, brace treatment, Cobb angle, apical vertebral rotation, spinal mid-line deviation

DOI: 10.3233/BMR-220363

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1345-1354, 2023

Authors: Choi, Chi-Whan | Koo, Jung-Wan | Jeong, Yeon-Gyu

Article Type: Research Article

Abstract: BACKGROUND: Individualized exercise programs based on personal impairment could lead to successful rehabilitation. An effective way to train spine stability is to find exercises that take advantage of the synergistic relation between local and global stabilization systems. OBJECTIVE: This study aimed to investigate synergistic relationship between the muscles of the local and global systems during three modified side bridge exercises compared with traditional side bridge (TSB). METHODS: Twenty healthy participants performed TSB, both leg lift while side-lying (BLLS), torso lift on a 45 ∘ bench while side-lying (TLBS), and …pelvic lift on side-lying (PLS) in random order. Surface electromyography data were analyzed. RESULTS: The results indicate that PLS was effective as TSB on trunk muscle activity. However, BLLS and TLBS demonstrated significantly less rectus abdominal (RA) muscle activity compared to TSB (p < .001). Additionally, BLLS and TLBS had a higher internal oblique (IO)/RA muscle activity ratio than TSB (p < .001). CONCLUSIONS: PLS could be a suitable alternative exercise for individuals who are unable to perform TSB, as it can effectively activate trunk muscles. BLLS and TLBS may be appropriate for training the local stability system, while limiting activation of the RA. Show more

Keywords: Modified side bridge exercise, surface electromyography, muscle activity and ratio

DOI: 10.3233/BMR-220380

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1355-1363, 2023

Authors: Shen, Xiangyu | Yang, Zhen | Zhang, Peng | Xu, Yingye | Wang, Jielong

Article Type: Research Article

Abstract: BACKGROUND: Adolescent idiopathic scoliosis (AIS) has a great negative impact on the physical and mental health of patients; thus, a range of effective, timely interventions are urgently needed. Currently, there is a lack of evidence to illustrate the effect of balance training in patients with AIS, and the traditional AIS therapy often ignores the recovery in balance function of patients with AIS. OBJECTIVE: To investigate the effect of balance training combined with Schroth therapy among adolescent with mild idiopathic scoliosis. METHODS: 59 adolescents (aged 10 to 18, 35.59% male) with idiopathic scoliosis were …selected and divided into an intervention group (n = 30) and a control group (n = 29). Participants in both groups received routine rehabilitation treatment based on Schroth therapy, and balance training was added in the intervention group. The duration of treatment for both groups was 6 weeks. The Trunk Rotation Angle (ATR), Cobb angle, Scoliosis Research Society 22 (SRS-22) scale and balance function of the two groups were evaluated at baseline and after the intervention. RESULTS: No significant difference of outcomes were observed between groups at baseline (P > 0.05). After 6 weeks of intervention, the ATR, Cobb angle, SRS-22 and balance function of the two groups improved significantly compared with those before treatment (P < 0.05), and the intervention group had a significant improvement than the control group (P < 0.05). CONCLUSION: Balance training combined with Schroth therapy for adolescents with mild idiopathic scoliosis can significantly improve ATR, Cobb angle and quality of life, as well as overall balance function. Show more

Keywords: Adolescent idiopathic scoliosis, cobb angle, balance training, stability limit

DOI: 10.3233/BMR-220383

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1365-1373, 2023

Authors: Yilmaz Gokmen, Gulhan | Akcay, Burcin | Kecelioglu, Sule | Ozen, Melike Sumeyye | Yuce, Hamiyet

Article Type: Research Article

Abstract: BACKGROUND: Kinesio taping (KT) is one of the treatment methods used on patients with shoulder impingement syndrome (SIS). There are different results regarding its effectiveness in the literature. OBJECTIVE: To investigate the effects of scapular KT combined with a conventional physiotherapy program on scapular dyskinesia, shoulder pain, upper extremity function, and well-being in patients with SIS. METHODS: The study was conducted with 60 outpatients diagnosed with SIS, aged 40–65 years. The patients were divided into two groups: KT [conventional physiotherapy program + scapular KT (targets scapular retraction and is applied …along the inferior-medial edge of the scapula, starting from the processus coracoids), n = 30] and control [conventional physiotherapy program, n = 30]. In before- and after-treatment evaluations, the Lateral Scapular Slide Test (LSST) for scapular dyskinesia, a Visual Analogue Scale (VAS) for shoulder pain, and the Disabilities of the Arm, Shoulder, and Hand (DASH) for upper extremity function were used. In addition, at the end of treatment, a Kinesio taping Satisfaction Survey, created by the researchers, was filled out by the KT group for the assessment of well-being. RESULTS: The interaction effect of Group*Time was not statistically significant in all outcome measures (p > 0.05). However, the main effect of both group and time was statistically significant in the DASH-Function/Symptom, VAS-Rest, VAS-Activity, and VAS-Night (p < 0.05). Moreover, only the main effect of time was statistically significant in LSST-1 and LSST-3 (p < 0.05). In the KT group, the satisfaction level was 8.50 ± 1.69 and the recommendation level was 8.72 ± 1.81. CONCLUSION: Both conventional physiotherapy programs and additional scapular KT improved scapular dyskinesia, reduced pain, and increased the upper extremity function. Adding scapular KT to treatment did not change the results, but it had positive psychological effects and yielded a high satisfaction rate. Show more

Keywords: Kinesio taping, pain, scapula, shoulder impingement syndrome, upper extremity

DOI: 10.3233/BMR-220396

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1375-1383, 2023

Authors: Arinli, Yağmur | Umutlu, Gökhan | Pehlevan, Zekai

Article Type: Research Article

Abstract: BACKGROUND: Hip, trunk, knee, and ankle/foot muscles may lead to increased variability in the components of balance and plantar pressure distribution (PPD) analysis. However, the role of these muscle groups in the PPD of different ballet techniques in novice ballet dancers has not previously been studied. OBJECTIVE: Our objective was to examine whether balance and PPD vary among five different ballet techniques and correlate with the agonist-to-antagonist strength performance of trunk, knee, hip, and ankle muscles in adolescent ballet dancers. METHODS: The anthropometric parameters, muscle strength performance, balance, and PPD of sixty healthy …female ballet dancers (age: 14.36 ± 2.18 y) were measured at 48-h intervals. RESULTS: The forefoot’s PPD was significantly greater than the midfoot and rearfoot for all techniques (p = 0.000). The percent plantar load of forefoot during développé à la seconde (side, front, back), passé, and penché was greater than midfoot (166.56%, 161.51%, 168.11%, 165.14%, 174.04%) and rearfoot (47.75%, 32.84%, 43.83%, 48.73%, 49.66) for all techniques, respectively. The forefoot’s PPD, impulse, and contact area during all techniques were significantly correlated with the trunk muscle strength ratio (p < 0.05). CONCLUSION: Ballet dancers with higher trunk muscle strength imbalance showed a greater percentage difference in pressure load between the left and right foot in the anterior and posterior directions, poor balance, aggravated trunk imbalance, increased PPD, contact area, and impulse in the forefoot during each technique. Show more

Keywords: Upper extremity, lower extremity, biomechanics, joint range of motion, kinematics

DOI: 10.3233/BMR-220406

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1385-1397, 2023

Authors: Zhong, Yuxian | Ding, Yu | Fu, Bensheng | Ma, Guanghao | Cui, Hongpeng | Li, Minyue | Yu, Yang | Guan, Ling

Article Type: Research Article

Abstract: BACKGROUND: Despite being used as a program of postoperative rehabilitation, few randomized controlled trials have compared the effectiveness of postoperative exercise based on gait analysis in patients with lumbar spinal stenosis (LSS). OBJECTIVE: To investigate the effectiveness of postoperative exercise based on gait analysis in patients with LSS and to compare it with the effectiveness of conventional exercise. METHODS: This was a double-blind, randomized clinical trial. Sixty-eight participants with LSS were randomly assigned to one of two groups. After receiving a standardized surgical procedure, the observation group received exercises based on 3-D gait …analysis, and the control group received empirical physiotherapy containing 4 basic interventions. Both groups took a one-hour session twice daily for 2 weeks. The Oswestry Disability Index (ODI) scale and the Visual Analog Scale (VAS) were measured before and 2 weeks and 6 months after intervention. The gait indicators were measured before and 6 months after intervention. RESULTS: At baseline, there were no significant differences in the ODI, VAS or absolute symmetry index (ASI) of the gait variables between the observation group and the control group. However, at 6 months, pain intensity, walking, standing, social life and summary scores of ODI and VAS of the leg demonstrated significant differences (p < 0.05, respectively) between groups, and the observation group had greater reductions in ASI of stride length, hip flexion, knee flexion and ankle dorsiflexion compared with the control group (p < 0.05, respectively). CONCLUSIONS: The postoperative rehabilitation scheme based on gait analysis resulted in significant short- to medium-term improvements in pain intensity, walking, standing, social life and the summary score of ODI, VAS of leg and symmetry of stride length, hip flexion, knee flexion and ankle dorsiflexion compared with empirical exercise in patients with LSS. Show more

Keywords: Spinal osteoarthritis, physical therapy modalities, low back pain, kinematics, perioperative period

DOI: 10.3233/BMR-220409

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1399-1409, 2023

Authors: Yamane, Masahiro | Aoki, Mitsuhiro | Sasaki, Yuji | Hayashi, Tomoya | Okino, Kumiko

Article Type: Research Article

Abstract: BACKGROUND: The activity of deep trunk muscles (psoas major; PM, quadratus lumborum; QL, transverse abdominis; TrA, and lumbar multifidus; MF) in response to external perturbation is not clearly known. OBJECTIVE: This study aimed to record the onset and amount of activity of the deep trunk muscles during sagittal plane perturbations. METHODS: Fourteen healthy males participated in this study. The activity of the right deep trunk muscles was recorded using wire electrodes. In standing, the participants performed three tasks: a pendulum impacted from anterior with predictable and unpredictable and posterior with unpredictable. …RESULTS: In predictable anterior perturbation, the TrA and PM demonstrated feedforward activation, while all deep trunk muscles demonstrated feedback activation in unpredictable anterior and posterior perturbations. In the anticipatory postural adjustment phase, the activity of the TrA was large in predictable anterior perturbation, while that of all deep trunk muscles was slight in other perturbations. In the compensatory postural adjustment phase, the activity of the PM, QL, and TrA in unpredictable anterior perturbation and those of the PM, QL, and MF in unpredictable posterior perturbation were large. CONCLUSIONS: These results showed that the onset and magnitude of deep trunk muscle activity changed depending on both predictable or unpredictable perturbation and the direction of perturbation. Show more

Keywords: Electromyography, core stability, healthy participants, muscles, postural control

DOI: 10.3233/BMR-220416

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1411-1420, 2023

Authors: Saleh, Nour El Hoda | Hamdan, Yara | Shabaanieh, Abdullah | Housseiny, Nourhan | Ramadan, Ahmad | Diab, Aly Haj | Sadek, Zahra

Article Type: Research Article

Abstract: BACKGROUND: The effectiveness of physical therapy (PT) in patients with chronic non-specific low back pain (CNSLBP) is mainly evaluated through pain, disability, and health-related quality of life (HRQOL). However, recent studies have recommended the consideration of improvement from patients’ perspectives. OBJECTIVE: This study aimed to investigate the relationship between the global perception of improvement in Lebanese patients with CNSLBP who have undergone PT, the HRQOL levels, as well as pain intensity. METHODS: 132 patients with CNSLBP who have undergone PT completed a questionnaire consisting of sociodemographic and CNSLBP characteristics questions, pain intensity numeric …scale (NRS), 12-Item Short-Form Health Survey (SF-12), and the Global Perceived Effect scale (GPE). Binary logistic regressions and Pearson correlation coefficient were used for analyses. RESULTS: Global perceived improvement of PT varies according to HRQOL levels. A significant correlation was found between pain intensity after PT, perceived improvement from PT, and HRQOL. Educational level and pain irradiation have been shown to be predictive factors of perceived improvement after PT. CONCLUSION: Pain and HRQOL are interrelated and contributed to elucidating the global perception of improvement after PT in patients with CNSLBP. The findings suggest that patients’ global perception of improvement should be considered in evaluating the benefits of physical therapy in addition to pain and HRQOL. Show more

Keywords: Low back pain, physical therapy specialty, quality of life

DOI: 10.3233/BMR-220423

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1421-1428, 2023

Authors: Delen, Veysel | İlter, Server

Article Type: Research Article

Abstract: BACKGROUND: Some interrelationships among fibromyalgia (FM), loss of cervical lordosis (LCL), and headache have been reported. Thus, it is sensible to examine LCL as a factor underlying FM and headache. OBJECTIVE: In this study we aimed to assess LCL in chronic neck pain patients (CNPP) with FM and its association with headache features and FM severity. METHODS: CNPP with (n = 55; mean age 40.0 ± 8.5; range 20 to 55 years) and without FM (n = 55; mean age …38.5 ± 8.9; range 20 to 55 years) were included in the study. Cervical lordosis was assessed by measuring the Cobb angle on the lateral cervical radiographs. The patients were asked about headache features within the last month. In addition, the CNPP with FM were evaluated by the Turkish version of the Revised Fibromyalgia Impact Questionnaire. RESULTS: There were no statistically significant differences between the groups in terms of age, weight, height, body mass index, working status, and neck pain duration (p > 0.05 for each). The CNPP with FM had significantly reduced cervical lordosis angle compared with those without. The CNPP with FM had significantly higher headache frequency than those without (p = 0.008). There was statistically significant negative correlation between cervical lordosis angle and headache frequency in the CNPP with FM (r: - 0.336; p = 0.012). CONCLUSION: According to the results of this study, LCL may be associated with FM and headache frequency in the CNPP with FM. Show more

Keywords: Fibromyalgia, neck pain, cervical lordosis

DOI: 10.3233/BMR-230019

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1429-1434, 2023

Authors: Mendez-Rebolledo, Guillermo | Guzman-Muñoz, Eduardo | Valdés-Badilla, Pablo | Ramirez-Campillo, Rodrigo | Cruz-Montecinos, Carlos | Núñez-Cortés, Rodrigo | Cabrera-Aguilera, Ignacio | Calatayud, Joaquín

Article Type: Research Article

Abstract: BACKGROUND: Although measures of exercise performance and physical activity are known to be related to 6-minute walk test (6mWT), the role of the strength of each muscle group of the lower limb in the locomotor capacity during the development period is unknown. OBJECTIVE: To identify the role of the isometric strength of lower limb muscles and cardiovascular parameters on the locomotor capacity in children and adolescents, controlling for participants sex, age, and height. METHODS: Participants (7 to 15 years old; female, n = 113; male, n = …128) were assessed for isometric strength (seven lower limb muscles), cardiovascular parameters (diastolic pressure, oxygen saturation, resting heart rate, respiratory rate), and 6mWT. Participants were split into nine age groups and separated by 1-year intervals. RESULTS: Hip flexors-controlled for sex, age, and height-explained a meaningful percentage of the variance (R= 2 0.45; p < 0.001) for 6mWT distance, and the resting heart rate explained a change in R 2 of only 2% (p = 0.008). CONCLUSIONS: Isometric strength of hip flexors explained ∼ 50% of the 6mWT distance, suggesting the importance of strength from an early age. Other factors, such as cardiovascular parameters, while relevant, may exert a secondary role on youth’s capacity. Show more

Keywords: Gait, lower extremity, walk test, muscle strength, musculoskeletal and neural physiological phenomena

DOI: 10.3233/BMR-230049

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1435-1446, 2023

Authors: Lippi, Lorenzo | Turco, Alessio | Folli, Arianna | Vicelli, Federico | Curci, Claudio | Ammendolia, Antonio | de Sire, Alessandro | Invernizzi, Marco

Article Type: Research Article

Abstract: BACKGROUND: Blood flow restriction (BFR) training improves muscle strength and functional outcomes, but the proprioceptive implications of this technique in the rehabilitation field are still unknown. OBJECTIVE: The present study aimed at assessing the effects of BFR in terms of stabilometric and balance performance. METHODS: In this pilot randomized cross-over study, healthy young adults were included and randomly assigned to Groups A and B. Both groups underwent a postural assessment with and without wearing a BFR device. Study participants of Group A underwent postural baseline assessment wearing BFR and then removed BFR …for further evaluations, whereas subjects in Group B performed the baseline assessment without BFR and then with BFR. Stabilometric and balance performance were assessed by the robotic platform Hunova, the Balance Error Scoring System (BESS), the self-reported perceived balance (7-point Likert scale), and discomfort self-rated assessment. Moreover, the safety profile was recorded. RESULTS: Fourteen subjects were included and randomly assigned to Group A (n: 7) and Group B (n: 7). Significant differences were shown in balance tests in static conditions performed on the Hunova robot platform in terms of average distance RMS (root-mean-square) with open eyes (OE), anteroposterior (AP) trunk oscillation range with OE, mediolateral (ML) average speed of oscillation with OE, and total excursion AP range with closed eyes (CE) (BFR: 3.44 ± 1.06; without BFR: 2.75 ± 0.72; p = 0.041). Moreover, elastic balance test showed differences in Romberg index (BFR: 0.16 ± 0.16; without BFR: 0.09 ± 0.07; p = 0.047). No adverse events were reported. CONCLUSION: Taken together, our data showed that BFR affects balance performance of healthy subjects. Further studies are needed to better characterize the possible role of BFR treatment in the context of a specific rehabilitation protocol. Show more

Keywords: Blood flow restrictions, physiotherapy, balance, postural assessment, rehabilitation

DOI: 10.3233/BMR-230063

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1447-1459, 2023

Authors: Çiftçi, Rukiye

Article Type: Research Article

Abstract: BACKGROUND: Somatotype causes differentiation of physical, physiological and biochemical metabolisms in the body. To what extent meniscopathy (M) is affected by somatotype profiles has been an issue of concern. OBJECTIVE: The aim of the study was to investigate whether somatotype profiles have an effect on kinesiophobia, pain, proprioception and isokinetic muscle strength in patients with an M diagnosis. METHODS: 172 (85 female, 87 male) M patients between the ages of 18 and 65 were included in the study. The Heath-Carter method was used to determine somatotype components. Biodex Isokinetic system at 120 ∘ …/sec angular speed was used for muscle strength measurements, a digital inclinometer with goniometer was used for proprioception measurement, the Tampa Kinesiophobia Scale (TKS) was used for the assessment of kinesiophobia, the Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scale was used for the assessment of fatigue and pain, and the visual analogue scale (VAS) was used for pain assessment. RESULTS: Five somatotype profiles were found. When the right-left knee proprioception values were compared according to the somatotype profiles of patients, a significant difference was found in favor of balanced ectomorph at 15 ∘ and 30 ∘ . No significant difference was found when TKS, FACIT, VAS values were compared in terms of somatotype profiles; while no significant difference was found in TKS, FACIT, VAS (REST-NIGHT) in terms of gender, a significant difference was found in VAS MOVE. Endomorph somatotype was dominant in the M patients. CONCLUSIONS: Individuals with M disease showed significant differences in terms of endomorph components. Obesity may also be one of the negative findings for M disease. Somatotype classification may represent a suitable tool for monitoring M. Show more

Keywords: Meniscopathy, somatotype, VAS, FACIT, kinesiophobia

DOI: 10.3233/BMR-230072

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1461-1468, 2023

Authors: Giray, Esra | Karayigit, Merve | Senocak, Kubra Cambekli | Illeez, Ozge Gulsum | Ozkan, Feyza Unlu | Aktas, Ilknur | Gozke, Eren

Article Type: Case Report

Abstract: BACKGROUND: Delayed radiation-induced motor neuron syndrome (DRIMNS) is an atypical motor neuron disorder that develops months or years after radiation therapy. In this study we present a case of DRIMNS that developed forty years after radiotherapy and to discuss differential diagnoses. CASE PRESENTATION: A 56-year-old male patient was admitted to our clinic with complaints of increasing difficulty in walking for the past year. He had a history of operation and radiotherapy due to testicular tumor. Electroneuromyography (ENMG) and thoracic, lumbosacral, plexus and pelvic magnetic resonance imaging (MRI) were performed considering radiculopathy, plexopathy and motor neuron disease …in the differential diagnosis. MRIs revealed no abnormality. Needle EMG of lower extremity and lumbar paraspinal muscles revealed fibrillation and positive sharp waves concomitant with fasciculations and reduced recruitment suggesting anterior horn cell/root involvement. DRIMNS was considered rather than motor neuron disease based on the long duration of symptoms with slow progressive course and history of radiotherapy to the pelvic region. CONCLUSION: DRIMNS is a rare entity that should be considered in the differential diagnosis of lower extremity muscle weakness in a patient with a history of malignancy and radiotherapy. EMG findings are very valuable in making the diagnosis together with the clinical picture. Show more

Keywords: Case report, electromyography, radiation, radiation-induced motor neuron syndrome, rehabilitation, testicular cancer

DOI: 10.3233/BMR-220410

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 6, pp. 1469-1475, 2023