Journal of Back and Musculoskeletal Rehabilitation - Volume 37, issue 1

Authors: Soer, Remko

Article Type: Editorial

DOI: 10.3233/BMR-245000

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 1-2, 2024

Authors: Tamura, Hiroyuki | Hirohama, Kenta | Hamada, Kazuaki | Imura, Takeshi | Mitsutake, Tsubasa | Tanaka, Ryo

Article Type: Review Article

Abstract: BACKGROUND: Knee pain is the main symptom of knee osteoarthritis. Walking is effective against knee pain, and some studies have shown that gait modification can also relieve this condition. However, the quality of evidence for the clinically significant effects of gait modification on knee pain has not been examined. OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the level of evidence for the clinically significant effects of gait modification on knee pain and determine if the effects are greater than the minimal clinically important difference (MCID). METHODS: We comprehensively searched electronic databases …such as MEDLINE, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature. Intervention studies with experimental groups who received gait modification and control groups who did not were evaluated. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the level of evidence. RESULTS: Nine studies met the inclusion criteria. All were included in the systematic review and two in the meta-analysis. Results showed that gait modification have significant effects (p = 0.02), and the quality of evidence was very low. However, several studies have revealed that the effects of gait modification, when used as a foot-focused intervention, were greater than the MCID. CONCLUSIONS: We concluded that there is a lack of high-quality evidence that supports the general efficacy of gait modification. Although based on low-quality evidence, when applied to the foot, it may have clinically significant effects. Show more

Keywords: Osteoarthritis, walking, minimal clinically important difference

DOI: 10.3233/BMR-220291

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 3-12, 2024

Authors: Jiang, Xiaoyu | Sun, Wenyu | Chen, Qiang | Xu, Qiling | Chen, Guoming | Bi, Hongyan

Article Type: Review Article

Abstract: BACKGROUND: A range of studies concerning the effects of breathing exercises on chronic low back pain (CLBP) have been proven inconclusive. OBJECTIVE: The study aimed to evaluate the effectiveness of breathing exercises for the treatment of CLBP. METHODS: We considered randomized controlled trials in English or Chinese that used breathing exercises for the treatment of CLBP. An electronic search was performed in the MEDLINE, EMBASE, Web of Science, Cochrane Library, CNKI, Wan Fang, and CBM databases for articles published up to November 2022. Two reviewers independently screened the articles, assessed the risk of …bias using the Cochrane risk of bias tool, and extracted the data. The outcomes included pain, lumbar function and pulmonary function post-intervention. RESULTS: A total of thirteen studies (n = 677) satisfied the inclusion criteria. The meta-analysis results demonstrated a significant effect of breathing exercises on the Visual Analog Scale (VAS) score (SMD = - 0.84, 95% CI: - 1.24 to - 0.45, P < 0.0001), the Oswestry Disability Index (ODI) score (SMD = - 0.74, 95% CI: - 0.95 to - 0.54, P < 0.00001), Forced Vital Capacity (FVC) score (MD = 0.24, 95% CI: 0.10 to 0.37, P = 0.0006), Forced Expiratory Volume in 1 second /Forced Vital Capacity (FEV1/FVC) (MD = 1.90, 95% CI: 0.73 to 3.07, P = 0.001), although there was no significant difference between the breathing exercises and control interventions for Forced Expiratory Volume in the first second (FEV1) score (MD = 0.22, 95% CI = [0.00, 0.43], P = 0.05), and Maximal Voluntary Ventilation (MVV) score (MD = 8.22, 95% CI = [- 4.02, 20.45], P = 0.19). CONCLUSION: Breathing exercises can reduce pain, assist people with lumbar disabilities, and improve pulmonary function, and could be considered as a potential alternative treatment for CLBP. Show more

Keywords: Low back pain, respiratory exercise, exercise therapy, pulmonary function, meta-analysis

DOI: 10.3233/BMR-230054

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 13-23, 2024

Authors: Zhang, Wang | Liu, Xiao | Liu, Haibin | Zhang, Xiaowei | Song, Tiangang | Gao, Bohua | Ding, Duoduo | Li, Hengyi | Yan, Zhiwei

Article Type: Research Article

Abstract: BACKGROUND: Sedentary behavior is widespread among older adults and accelerates the decline of motor function. Nevertheless, there is insufficient evidence concerning the effectiveness of regular exercise in enhancing the same in sedentary older adults. OBJECTIVE: To compare the effects of 24 weeks of aerobic and combined aerobic-resistance exercise on the motor function of sedentary older adults. METHODS: Sixty healthy sedentary older (65–80 years) were randomly enrolled. Participants were randomly divided into 3 groups (1:1:1): aerobic exercise group (AEG), combined aerobic-resistance exercise group (CEG), and health education group (HEG). The training group underwent …a five-day-a-week regimen, with each session lasting for 40 minutes (including 10 min warm-up and cool-down). HEG received only monthly health lectures. We assessed lower limb muscle strength (30-second sit-to-stand ability), single-dual task gait, static and dynamic balance functions at baseline and after 24 weeks of intervention using per-protocol analysis. RESULTS: Among 60 elderly healthy who were randomized (mean age 70.59 ± 3.31 years; 28 women (46%)), 42 (70%) completed the evaluation after 24 weeks. Both the aerobic exercise and combined aerobic-resistance exercise groups exhibited improved 30-second sit-to-stand ability, static balance in closed-eye standing mode, and dynamic balance (P < 0.05). However, there were no statistically significant changes in the single-task gait parameters of stride length, stride width, and stride speed (P > 0.05). Additionally, compared to the aerobic exercise group, the combined exercise group showed an increase in dual-task gait speed and medial and lateral dynamic stability indices (P < 0.05). CONCLUSION: Both the aerobic exercise and combined aerobic-resistance exercise programs are effective in enhancing lower limb muscle strength, dynamic balance, and static balance while standing with eyes closed in sedentary older adults. Furthermore, the combined aerobic-resistance exercise program is more effective in improving dual-task gait speed as well as medial and lateral dynamic balance. Show more

Keywords: Sedentary behavior, older, aerobic exercise, resistance training, muscle strength, gait

DOI: 10.3233/BMR-220414

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 25-36, 2024

Authors: Osama, Muhammad

Article Type: Research Article

Abstract: BACKGROUND: Muscle energy technique (MET) is found to be effective for the management of neck pain and in addition to the muscle specific approach, clinicians may also adopt movement specific approach for METs. However, the literature is deficient in terms of comparison of muscle specific and movement specific METs in the management of mechanical neck pain. OBJECTIVE: To compare the effects of muscle specific and movement specific METs in the management of mechanical neck pain. METHODS: A single blind parallel design randomized controlled trial was conducted on 66 participants with mechanical neck pain …ranging from 40–80 mm on visual analogue scale (VAS), aged between 19–44 years with pain and limitation on cervical motion. Once included, the participants were randomly allocated to two groups, namely the muscle specific MET group and the movement specific MET group. Outcome measures included VAS, Neck Disability Index (NDI) and cervical range of motion (ROM). RESULTS: No significant differences (p > 0.05) were observed, neither immediately nor after 5 days, between muscle specific and movement specific MET in terms of VAS, NDI and ROM. However, a significant difference (p < 0.05) was observed in both groups in terms of pre- and post-analysis for all outcome variables. CONCLUSIONS: Both muscle specific and movement specific METs are effective in the management of mechanical neck pain, with no significant differences between the two treatment techniques. Show more

Keywords: Cervical spine, muscle energy technique, neck pain, pain, physical therapy, range of motion

DOI: 10.3233/BMR-210293

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 37-46, 2024

Authors: Hwang, Byeong-Hun | Jeon, In-Cheol

Article Type: Research Article

Abstract: BACKGROUND: Normal alignment of the foot is important because the feet support the body’s weight. The intrinsic muscles of the foot mainly maintain the alignment and movement of the foot, whereas the abductor hallucis (AbdH) aligns the first metatarsophalangeal joint and maintains the medial longitudinal arch. OBJECTIVE: This study was conducted to investigate the muscle activity of the AbdH and hallux valgus (HV) angle during three different foot exercises. METHODS: Participants included 15 subjects aged 20–24 years with mild HV. All subjects performed three different foot exercises in random order: short foot exercise …(SF), toe spread out exercise (TSO), and TSO with a pressure bio-feedback unit (TSOP). The muscle activity of the AbdH and the HV angle were measured during each foot exercise using surface electromyography and X-ray and then compared using one-way repeated-measures analysis of variance, followed by Bonferroni adjustment. RESULTS: AbdH muscle activity differed significantly among SF, TSO, and TSOP. AbdH muscle activity was greater in TSOP (89.60%) than in SF (19.99%) and TSO (60.96%) (p = 0.006). The HV angle was significantly smaller in TSOP (15.72 ∘ ) than in SF (18.85 ∘ ) and TSO (16.81 ∘ ) (p = 0.001). CONCLUSIONS: TSOP can be recommended as an effective AbdH strengthening exercise in subjects with mild HV. Show more

Keywords: Abductor hallucis, hallux valgus, pressure biofeedback unit, toe spread out exercise

DOI: 10.3233/BMR-220252

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 47-54, 2024

Authors: Yabroudi, Mohammad A. | Aldardour, Ahmad | Nawasreh, Zakariya H. | Obaidat, Sakher M. | Altubasi, Ibrahim M. | Bashaireh, Khaldoon

Article Type: Research Article

Abstract: BACKGROUND: Knee osteoarthritis (OA) is a common and disabling disease among the elderly population. The optimal conservative treatment for knee OA is not well established. OBJECTIVE: This study aimed to assess the effectiveness of pulsed electromagnetic field (PEMF) combined with progressive resistance exercise (PRE) in improving physical function and pain in patients with knee OA. METHODS: Thirty-four patients with knee OA (17 in each group) participated in a single-blind randomized control study. Patients were randomly assigned to receive 24 sessions of either combined PEMF and PRE (treatment group) or PRE only (control group). …Patients were evaluated at pre-treatment, post-treatment (2 months), and at 3-month and 6-month follow-ups using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Numeric Pain Rating Scale (NPRS); walking speed and 5-times chair stand test. Mixed ANOVA was used for statistical analysis with Bonferroni adjustments. RESULTS: There was no significant group-by-time interaction for any outcome (P > 0.05). However, both groups scored significantly higher on the NPRS and KOOS at post-treatment, 3-, and 6-month follow-up compared to their baseline. Further, both groups completed the 5-times chair stand test and walking speed test with significantly less time at all post-treatment time points than the pre-treatment. None of the study outcomes (NPRS, KOOS, walking speed, and 5 times chair stand) were significantly different between groups at any of the time points. CONCLUSION: Both treatment options, PRE only versus PRE with PEMF, were equally effective in decreasing pain and improving physical function in patients with knee OA. This would suggest that the optimal parameters for PEMF that may show beneficial effects for knee OA when added to PRE training need to be determined. Show more

Keywords: Knee osteoarthritis, resistance training, electromagnetic field

DOI: 10.3233/BMR-220261

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 55-65, 2024

Authors: Jang, Tae-Jin | Jeon, In-Cheol

Article Type: Research Article

Abstract: BACKGROUND: Sedentary work may lead to low back pain. In particular, a slumped sitting position may exacerbate low back pain because of tissue damage caused by excessive lumbar flexion and posterior pelvic tilting. Subjects with low back pain may have excessive changes in the lumbopelvic posture and back muscle activity in the sitting position. OBJECTIVE: The purpose of this study was to compare the effects of vibration-based biofeedback using a motion sensor belt and no biofeedback on multifidus (MF) muscle activity and pelvic tilt angle during typing. METHODS: Thirty subjects with low back …pain accompanied by hip flexion limitation (15 each in the biofeedback and non-biofeedback groups) were enrolled. Electromyography was used to investigate MF muscle activity before and after typing for 30 min. Pelvic tilt was measured after typing in a sitting position for 30 min. Independent t-tests were used to compare MF muscle activity, and pelvic and second sacrum tilt angles, between the biofeedback and non-biofeedback groups. RESULTS: After typing for 30 min, changes in MF muscle activity (11.45% and - 7.19% for the biofeedback and nonbiofeedback groups, respectively) and pelvic and second sacrum tilt angles (3.15 ∘ and 4.12 ∘ for the biofeedback group and - 11.05 ∘ and - 18.16 ∘ for the non-biofeedback group, respectively) were significantly smaller in the biofeedback than non-biofeedback group (p < 0.05). CONCLUSION: Vibration-based biofeedback minimizes the reduction in MF muscle activity and changes in pelvic and second sacrum tilt angles during typing in individuals with low back pain accompanied by hip flexion limitation. Show more

Keywords: Biofeedback, multifidus, pelvis, sacrum, typing

DOI: 10.3233/BMR-220284

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 67-73, 2024

Authors: Şimşek, Abdullah Talha | Baysal, Begümhan | Adam, Baha Eldin | Çalış, Fatih | Topçam, Arda | Demirkol, Mahmut | Doğan, Mahmut Bilal | Binguler, Ayse Hande Erol | Karaarslan, Numan | Balak, Naci

Article Type: Research Article

Abstract: BACKGROUND: It is known that a possible decrease in disc height (DH) and foraminal size after open lumbar microdiscectomy (OLM) may cause pain in the long term. However, there is still insufficient information about the short- or long-term pathoanatomical and morphological effects of microdiscectomy. For example, the exact temporal course of the change in DH is not well known. OBJECTIVE: The purpose of this study was to examine morphological changes in DH and foramen dimensions after OLM. METHODS: In patients who underwent OLM for single-level lumbar disc herniation, MRI scans were obtained before …surgery, and at an average of two years after surgery. In addition to DH measurements, foraminal area (FA), foraminal height (FH), superior foraminal width (SFW), and inferior foraminal width (IFW), were measured bilaterally. RESULTS: A postoperative increase in DH was observed at all vertebral levels, with an average of 5.5%. The mean right FHs were 15.3 mm and 15.7 mm before and after surgery, respectively (p = 0.062), while the left FHs were 14.8 mm and 15.8 mm before and after surgery (p = 0.271). The mean right SFW was 5.4 mm before surgery and 5.7 mm after surgery, while the mean right IFW ranged from 3.6 mm to 3.9 mm. The mean left SFW was 4.8 mm before surgery and 5.2 mm after surgery, while the mean left IFW ranged from 3.5 mm to 3.9 mm. Before surgery, the FAs were, on average, 77.1 mm 2 and 75.6 mm 2 on the right and left sides, respectively. At the 2-year follow-up, the mean FAs were 84.0 mm 2 and 80.2 mm 2 on the right and left sides, respectively. CONCLUSIONS: Contrary to prevalent belief, in patients who underwent single-level unilateral OLM, we observed that there may be an increase rather than a decrease in DH or foramen size at the 2-year follow-up. Our findings need to be confirmed by studies with larger sample sizes and longer follow-ups. Show more

Keywords: Disc height, foraminal area, foraminal height, lumbar disc herniation, magnetic resonance imaging, open lumbar microdiscectomy

DOI: 10.3233/BMR-220371

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 75-87, 2024

Authors: Lim, Eun-Hee | Kim, Seong-Yeol | Kim, Da-Sol | Won, Yu Hui | Park, Sung-Hee | Ko, Myoung-Hwan | Seo, Jeong-Hwan | Kim, Gi-Wook

Article Type: Research Article

Abstract: BACKGROUND: Ischemia reperfusion (IR) injury may result in rhabdomyolysis and compartment syndrome when blood supply returns after thrombectomy for patients with acute limb ischemia. OBJECTIVE: We highlight the value of early diagnosis and treatment in post-thrombectomy patients with IR injuries in their lower legs. CASE DESCRIPTION: Two patients received thrombectomy due to left superficial femoral artery occlusion. Both patients complained of left calf pain during ambulation at the 1- and 3-day follow up post-thrombectomy, as well as a heating sensation, swelling, weakness, and sensory changes in the affected leg. For early diagnosis musculoskeletal …ultrasounds were performed and in both cases revealed swelling and change of echogenicity in the left calf. To further diagnosis, magnetic resonance imaging of the left leg revealed limb IR-induced muscular injury and rhabdomyolysis, respectively. In both cases, an electrodiagnostic study revealed peripheral nerve injury in the left leg. Medications were provided for neuropathic pain control and early rehabilitation was performed to improve function. In both cases, patients reported during their follow-up that their pain and muscle weakness had improved. CONCLUSION: When post-thrombectomy calf pain occurs early evaluation and treatment should be performed to identify any potential IR injury. Show more

Keywords: Ischemia, reperfusion injury, rehabilitation, ultrasonography, electromyography

DOI: 10.3233/BMR-220398

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 89-97, 2024

Authors: Skvortsov, Dmitry | Altukhova, Alyona | Kaurkin, Sergey | Akhpashev, Alexander

Article Type: Research Article

Abstract: BACKGROUND: This study on gait biomechanics is based on a functional test (FT) performed at free and fast walking speeds. OBJECTIVE: We investigated the pattern of changes in gait biomechanical parameters and the knee function in patients after anterior cruciate ligament (ACL) injury or its reconstruction. METHODS: The study included 51 patients (33 males, 18 females) with a confirmed recent or old history of ACL tear, before or after reconstruction (26 patients). Mocap data was obtained using an inertial system. All patients were divided into three groups: 41 patients with physiological response (compensation), …6 patients with signs of decompensation, and 4 non-assessable patients. RESULTS: Increase in gait speed was associated with decrease in the walking cycle duration, stance and double support phases. In the compensation group, the physiological response of the knee was manifested in increased amplitudes. In the decompensation group, the amplitudes remained unchanged or decreased. In the compensation group, there were increases in the symmetrical muscle activity. The decompensation group was characterized by electromyography asymmetry. CONCLUSION: The observed universal physiological mechanism limiting the load on the damaged joint can be used for accurate assessment of the knee functional state in various periods of rehabilitation. Show more

Keywords: Knee joint, anterior cruciate ligament injuries, gait analysis, rehabilitation

DOI: 10.3233/BMR-220415

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 99-109, 2024

Authors: Kang, Jung Hoon | Im, Soo Bin | Kim, Ju Hyung | Jeong, Je Hoon

Article Type: Research Article

Abstract: BACKGROUND: The Subaxial Cervical Spine Injury Classification System (SLICS) is a commonly used algorithm for diagnosing and managing subaxial cervical spine trauma. A SLIC score 4 suggests either surgery or non-surgically treatment depending on the surgeon’s experience and patient’s conditions. OBJECTIVE: Prognosis and treatment results were analyzed in patients with SLIC score 4. METHODS: The patients with SLIC score 4 were retrospectively reviewed from 2012 to 2019. Forty-one patients were included and divided into two groups: non-surgically treated and surgically treated. Demographic data and radiographs were analyzed. Statistical analysis was performed to determine …the difference between the two clinical groups. RESULTS: Twenty-two patients were non-surgically treated, and nineteen patients were surgically treated. There was no neurological deterioration in both groups. However, there was no statistically significant difference in the last follow-up AISA and Nurick grade (p > 0.05). There was no significant difference in the number of patients who showed improvement when comparing the initial and the last follow-up neurological status (p > 0.05). CONCLUSION: Regardless of the treatment method, the spinal cord injury patients with SLICS point 4 showed a relatively good prognosis. Patients with SLIC score 4 could be treated non-surgically or surgically based on the surgeon’s experience and factors associated with the patient’s acute health status and chronic comorbidities. Show more

Keywords: Cervical spine, subaxial injury classification, spinal cord injury, cervical spine trauma

DOI: 10.3233/BMR-220428

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 111-117, 2024

Authors: Moriki, Kento | Ogihara, Hirofumi | Yoshikawa, Koji | Kikuchi, Kenta | Endo, Ryunosuke | Sato, Takaaki

Article Type: Research Article

Abstract: BACKGROUND: Sleep quality in patients with chronic low back pain (CLBP) may affect quality of life (QoL), possibly due to worsening pain, central sensitization (CS), and cognitive factors. However, causal relationship among the factors has not been confirmed yet. OBJECTIVE: The purpose of this study was to test the hypothesis that sleep quality in patients with CLBP is attributable to pain, cognitive factors, and CS, and influences QoL, by structural covariance analysis. METHODS: This is a cross-sectional study. Participants were recruited from six health care facilities and 101 patients with CLBP were included. …Structural covariance analysis assessed the fit of data to the model using goodness of fit index (GFI), adjusted goodness of fit index (AGFI), comparative fit index (CFI), and mean squared approximation error (RMSEA). RESULTS: The structural covariance analysis showed that the goodness-of-fit indices were high (GFI = 0.993, AGFI = 0.964, CFI = 1.00, RMSEA < 0.01). Sleep quality was not directly influenced by QoL but rather by CS and cognitive factors. CONCLUSION: This study suggests that sleep quality in patients with CLBP is indirectly mediated through multiple pathways, including cognitive factors and CS, which may influence QoL. Show more

Keywords: Sleep quality, cognitive factors, central sensitization, quality of life, chronic low back pain

DOI: 10.3233/BMR-220429

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 119-125, 2024

Authors: Preiss, Sandra | Beinert, Konstantin | Taube, Wolfgang

Article Type: Research Article

Abstract: BACKGROUND: Working in awkward and sustained postures is, besides psychosocial risk factors, the most reported physical risk factor for neck pain. Accurate proprioception is fundamental to correcting awkward head-to-trunk positions, but impaired proprioceptive performance has been found in patients with chronic neck pain. OBJECTIVE: The aim was to compare the effectiveness of two different interventions in a workplace set-up on sensorimotor performance and pain sensitivity in people with chronic neck pain. METHODS: A total of 25 patients with chronic neck pain participated in this double-blind study. Patients were randomly allocated to the visuomotor …tracking task group or the video group (watching a massage video, imagining themselves being massaged). The primary outcomes were cervical joint position sense acuity and pressure pain threshold of the cervical spine, evaluated by a blinded assessor. RESULTS: There were significant time by group interactions for cervical joint position sense acuity (F 1 ; 23 : 4.38; p = 0.048) and pressure pain threshold (F 1 ; 23 : 5.78; p = 0.025), with the tracking task group being more accurate in cervical joint position sense testing and less pain sensitive for pressure pain threshold. CONCLUSIONS: The visuomotor tracking task improves cervical joint position sense acuity and reduces pressure pain threshold immediately after intervention in people with chronic neck pain. Show more

Keywords: Neck muscles, exercise therapy, proprioception, posture, pain perception

DOI: 10.3233/BMR-220431

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 127-136, 2024

Authors: You, Xuanhe | Wu, Diwei | Chen, Anjing | Zhou, Xinran | Fan, Haiquan | Jiang, Yang

Article Type: Research Article

Abstract: BACKGROUND: Muscle imbalance has long been recognized as one of the possible pathogeneses for adolescent idiopathic scoliosis (AIS). PIEZO2, the susceptibility gene of AIS, has been identified to play an important role in neuromuscular activities. OBJECTIVE: This study aims to compare the mRNA expression of PIEZO2 between concave and convex paraspinal muscles of AIS patients and to identify the relationship between the ratio of PIEZO2 expression and curve magnitude. METHODS: Twenty female AIS patients (right thoracic curve) who underwent spinal correction surgery were divided into moderate (n = …12) and severe (⩾ 70 degrees) curve groups (n = 8). The morphology of the paraspinal muscles was assessed with spinal MRI. Multifidus specimens were collected during surgical operations from the concave and convex sides of the apical region, and mRNA expression of the PIEZO2 gene was compared between sides. The localization of PIEZO2 protein expression was confirmed with the markers PAX7 and PAX3, and the percentage of PIEZO2 + cells was also investigated. RESULTS: In the moderate curve group, fatty infiltration in the deep paraspinal muscle was significantly higher on the concave side than on the convex side. There were no differences in deep muscle area, superficial muscle area, or fatty infiltration of superficial paraspinal muscle. The mRNA expression of PIEZO2 was significantly increased on the concave side, and the asymmetric expression predominantly occurred in moderate curves rather than severe ones. PIEZO2 was expressed on satellite cells instead of fibers of the muscle spindle. The percent of PIEZO2 + PAX7 + cells in myofibers was significantly higher on the concave side in the moderate curve group, but not in the severe curve group. CONCLUSIONS: Asymmetric morphological changes occur in the deep paraspinal muscles of AIS. The PIEZO2 is asymmetrically expressed in the multifidus muscle and is preferentially expressed in satellite cells. Show more

Keywords: PIEZO2, adolescent idiopathic scoliosis, paraspinal muscle, satellite cells

DOI: 10.3233/BMR-220440

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 137-146, 2024

Authors: Daly, Emily | Prodoehl, Janey

Article Type: Research Article

Abstract: BACKGROUND: Deep neck flexor muscle atrophy and increased superficial neck muscle activation are associated with disability and pain intensity in individuals with neck pain. There is a lack of evidence to support direct assessment of deep neck flexor muscles in a non-invasive way during exercise performance to help determine the effectiveness of different neck strengthening exercises. OBJECTIVE: Compare longus colli (LC) and sternocleidomastoid (SCM) activation between individuals with and without neck pain using real time ultrasound (RTUS) during a series of craniocervical exercises. METHODS: This cross-sectional cohort study recruited 10 control and 10 …neck pain participants to complete four deep neck flexor activation activities involving varying levels of craniocervical flexion. Dimensions of the LC and SCM were measured using RTUS at rest and during exercise. Independent t-tests assessed baseline differences and analysis of variance examined activation changes. RESULTS: At rest, the neck pain group had significantly smaller cross-sectional area and thickness of the LC compared to the control group (p < 0.05). During exercise, the neck pain group showed significantly larger increases in LC thickness and cross-sectional area across exercise compared to the control group, with no differences in SCM activation between groups. CONCLUSIONS: Despite atrophy, individuals with neck pain can activate their deep neck flexor muscles appropriately without activating their superficial neck flexor muscles in a supine series of craniocervical flexion exercise as measured by non-invasive ultrasound imaging. Show more

Keywords: Cervicalgia, ultrasonography, longus colli, rehabilitation, exercise therapy

DOI: 10.3233/BMR-230002

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 147-156, 2024

Authors: Hagovská, Magdaléna | Buková, Alena | Takáč, Peter

Article Type: Research Article

Abstract: BACKGROUND: Currently there are not enough studies that compared frequent types of collective sports with regard to the prevalence of pain and disability of the lower limb. OBJECTIVE: To determine the prevalence of lower limb pain and disability in team sports players. METHODS: 388 athletes with average age 27.26 ± 4.69, from sports clubs at the national level were included in the study. The Oxford Hip Score was used to determine the prevalence of hip pain. The International Knee Documentation Committee was used to determine the prevalence of knee pain. …The Foot and Ankle Disability Index was used to determine the prevalence of ankle pain. RESULTS: Hockey players had a prevalence of hip pain of 97.2% and a 14.3 times higher risk of developing hip pain compared with football and floorball players. Floorball players had a 81.9% prevalence of knee pain, with a 3.8 times higher the risk of knee pain compared with football and hockey. Floorball players had a 62.3% prevalence of ankle pain and a 1.8 times higher the risk of developing ankle pain compared with football and hockey players. CONCLUSIONS: The highest percentage of knee 81.9% and ankle 62.3% pain, as well as the greatest risk of pain, was found among floorball players. Hockey players had the highest prevalence (97.2%) and risk of developing hip pain. Show more

Keywords: Disability, pain, sport injuries

DOI: 10.3233/BMR-230048

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 157-163, 2024

Authors: Vongsirinavarat, Mantana | Kao-ngampanich, Pattipon | Sinsurin, Komsak

Article Type: Research Article

Abstract: BACKGROUND: Self-corrective exercise is commonly used in the training protocol of patients with adolescent idiopathic scoliosis (AIS). The muscle activation pattern during symmetrical and overcorrection exercises is then explored to guide the treatment. OBJECTIVE: To compare the paraspinal muscle activity during three self-corrective positions and the habitual standing in AIS. METHODS: Thirty-three adolescents with double curved scoliosis were examined. The curve type and Cobb’s angle were determined from their whole spine X-ray. They adopted habitual standing, symmetrical correction and two overcorrected positions (O1 and O2). The surface electromyography (EMG) was monitored on both …sides of paraspinal muscles at the apex areas of scoliotic curves. The EMG ratio between sides was inferred as the corrective effect. RESULTS: All three self-correction positions produced greater EMG ratios compared with the habitual standing. The greatest EMG ratios were observed during the O1 position at the thoracic curve and the habitual standing at the lumbar curve. Participants with different subtypes of curves exhibited similar patterns of EMG ratios. CONCLUSION: From the biomechanical viewpoint, all three self-corrective positions possibly provided therapeutic effects for the scoliotic body regardless of the subtype of scoliosis curves. The O1 position seemed to be most effective for the adjusting activation of thoracic paraspinal muscles. The symmetrical corrective position is otherwise recommended for adjusting the lumbar muscle activation. Show more

Keywords: Scoliosis, therapeutic exercise, EMG, postural training

DOI: 10.3233/BMR-230055

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 165-173, 2024

Authors: Bi, Li-Na | Zheng, Xin | Qi, Yan-Yan | Hu, Su | Li, Chang | Zhang, Yan

Article Type: Research Article

Abstract: BACKGROUND: In adults with type 2 diabetes (T2DM), sarcopenia and obesity are two common body composition issues. OBJECTIVE: We investigated the associated influencing factors of muscle mass loss in obese adults with T2DM, to provide a theoretical basis for the prevention of sarcopenic obesity in patients with T2DM. METHODS: We recruited 315 participants in this study. The participants underwent body composition assessment and clinical information was collected. Dual-energy X-ray absorptiometry was used to verify the accuracy of the body composition data. Based on their body fat percentage, 189 patients with T2DM were classified …as obese. Patients with T2DM and obesity were grouped into the muscle mass loss group and non-muscle mass loss group based on gender. We collected demographic and clinical information about patients with T2DM who were obese, including their age, gender, body mass index (BMI), appendicular skeletal muscle index (ASMI), and body fat percentage (PBF). RESULTS: Among the participants who were obese and had T2DM, 56.61% (107/189) experienced muscle mass loss, with a detection rate of 43.42% (33/76) among females and 65.49% (74/113) among males. Body mass index, fat index, Android fat, Gynoid fat, limb fat, trunk fat, and total body bone mineral content were all lower in the muscle mass loss group compared to the non-muscle mass loss group, regardless of gender (all P < 0.001). Muscle mass loss in obese adults with T2DM was affected by BMI, body fat index, and limb fat. CONCLUSION: Muscle mass loss is more prevalent in adults with T2DM and a high PBF. Body mass index, body fat index, and limb fat are the protective factors of muscle mass loss in adult patients with T2DM and obesity. Show more

Keywords: Appendicular skeletal muscle index (ASMI), influencing factors, muscle mass loss, obesity, Type 2 diabetes mellitus (T2DM)

DOI: 10.3233/BMR-230065

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 175-181, 2024

Authors: Menek, M. Yilmaz | Menek, B.

Article Type: Research Article

Abstract: BACKGROUND: Percussion massage therapy is a popular approach in sport medicine for physical therapists, but few researchers have investigated the comparison with other intervention methods. OBJECTIVE: This study aimed to examine the comparison of the effects of dynamic stretching, static stretching and percussive massage therapy on balance and physical performance in individuals. METHODS: The participants who were 18–25 years of age, able to perform performance tests, did not have any orthopedic surgery, did not have problems during running and sudden turning, and did not have a professional sports history were included in the …study. Participants were assigned randomly to three groups as dynamic stretching (DS) (n = 16), static stretching (SS) (n = 16) and percussive massage therapy (PMT) (n = 16) groups. Horizontal jumping test, T drill test and balance measurements on a single leg with open and closed eyes of all participants were recorded before and after applications. RESULTS: When the values of the pre and post-treatment of all groups in the study were compared, significant improvements were observed in the t-test, horizontal jumping test and right/left foot balance with eyes open in DS group (p < 0.05). Significant improvements were observed in all values in the PMT group (p < 0.05). In the comparison of the differences between the groups, PMT group values were more significant than the SS group in all parameters. CONCLUSION: Percussive massage therapy would be an alternative that can be used to increase the performance and balance of individuals before exercise. Show more

Keywords: Exercise, massage therapy, postural balance, vibration, warm-up exercise

DOI: 10.3233/BMR-230069

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 183-193, 2024

Authors: Shen, Hongtao | Tang, Weilong | Yin, Xiaoyu | Shao, Tuo | Liu, Xing | Gu, Jiaao | Hu, Yuhang | Yu, Lei | Yu, Zhange | Zhang, Zhenyu

Article Type: Research Article

Abstract: BACKGROUND: Percutaneous kyphoplasty (PKP) or percutaneous short-segment fixation (PSSF) is often used to treat Kummell’s disease. However, it is not clear which treatment is better for patients. OBJECTIVE: To retrospectively compare the clinical efficacy of PVP and PSSF for the treatment of Kummell’s disease. METHOD: 60 patients were involved in this research and the period of follow-up was at least 2 years. 27 of them were treated with PVP (Group I) and the rest who received PSSF (Group II). The visual analog scale (VAS) and radiographic indexes of each participant had been measured …preoperatively as well as 1 week, 3 months, and 2 years postoperatively. Additionally, the Oswestry Disability Index (ODI) scores were assessed at the last time point. RESULTS: Comparing the two groups, no statistical significance was found among all parameters preoperatively. The time of operations and blood loss is less in Group I. At each time point after operation, the imaging indices in Group II are lower (P < 0.05). One week after treatments, the VAS scores are lower in Group I, and similarly, 3 months are the same (P < 0.05), while VAS are similar at the last time point. In the aspect of ODI scores, they are lower in Group II during long-term follow-up. CONCLUSION: For the treatment of Kummell’s disease, both PVP and PSSF have been found to be effective. PVP can provide rapid pain relief with a shorter operation time. However, in cases with severe kyphosis deformity, PSSF should be given priority. Show more

Keywords: Kummell’s disease, percutaneous vertebroplasty, percutaneous short-segment fixation, clinical evaluation

DOI: 10.3233/BMR-230083

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 195-203, 2024

Authors: Takeuchi, Ryosuke | Iwamoto, Yoshitaka | Kawakami, Wataru | Takeuchi, Yasutaka | Miyoshi, Fumiya | Ishii, Yosuke | Takahashi, Makoto

Article Type: Research Article

Abstract: BACKGROUND: Dynamic knee valgus (DKV) during dynamic activity is associated with patellofemoral pain, one of the most common sports disorders, especially in females. No studies have examined the factors that can lead to DKV in females as compared to males while addressing the influence of factors on each other. OBJECTIVE: To identify factors of pelvis and lower joints kinematics affecting DKV during single-leg squat (SLS) in females compared to males with multiple regression analysis. METHODS: Forty-four healthy young people (24 females, 20 males) performed SLS, and pelvis, hip, knee, and ankle 3D kinematics …were recorded. The 2D knee frontal plane projection angle (FPPA) was adopted as the DKV measurement. Multiple regression analysis was performed to determine the relationship between FPPA and the kinematics of each joint and segment. RESULTS: Hip adduction and pelvic contralateral rotation were explanatory factors for FPPA in females. Hip adduction, hip internal rotation, and knee external rotation were explanatory factors in males. CONCLUSIONS: The lower limb or pelvic motion factors affecting DKV during SLS differ between the sexes, with pelvic contralateral rotation being extracted only in women, possibly due to differences in pelvic width. Show more

Keywords: Knee injury, pelvis, sex characteristic, regression analysis

DOI: 10.3233/BMR-230086

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 205-211, 2024

Authors: Josipović, Petra | Moharč, Metka | Sironić, Filip | Salamon, Dea | Vidmar, Gaj | Šarabon, Nejc

Article Type: Research Article

Abstract: BACKGROUND: Traction-and-vibration-therapy (TVT) relieves pain in participants with hip osteoarthritis. Hip TVT is usually performed manually by the physiotherapist. OBJECTIVE: A medical device was developed to perform hip-TVT in order to investigate effects on hip disability, pain intensity, recovery of balance and functional mobility in older adults with hip osteoarthritis and also to reduce physiotherapists’ workload and help standardize treatment of hip TVT. METHODS: In a block-randomized 3-month controlled trial involving 28 older adult participants with symptomatic primary hip osteoarthritis (SPHOA), one group (n = 10) received device-performed …TVT, one (n = 10) manual TVT, and one (n = 8) sham/placebo therapy. Hip disability (Harris Hip Score), pain intensity (visual-analog-scale), recovery of balance and gait (Functional Gait Assessment) and functional mobility (Timed-Up-and-Go-test) were assessed at baseline, after 3 weeks without intervention, and after 3-month intervention. RESULTS: The Device TVT and Manual TVT groups exhibited superior outcomes compared to the Placebo group in terms of hip disability (p = 0.005 and p < 0.001, respectively), pain intensity (p = 0.002 and p < 0.001, respectively), and functional mobility (TUG) (p = 0.012 and p = 0.011, respectively). Furthermore, the recovery of balance and gait (FGA) showed a significant improvement in the Device TVT group when compared to the Placebo group (p = 0.043). The effect sizes ranged from 0.17 to 0.51, indicating moderate to large effects. CONCLUSION: Device-performed-TVT is comparable to manual hip-TVT for reducing pain and improving mobility in older adults with SPHOA, and may be beneficial in terms of reducing physiotherapists’ workload and better therapy standardization. Show more

Keywords: Osteoarthritis, hip, traction, vibration, equipment and supplies, medical

DOI: 10.3233/BMR-230109

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 213-224, 2024

Authors: Inyoung, Kong

Article Type: Research Article

Abstract: BACKGROUND: The diaphragm plays an important role in trunk stability. Therefore, diaphragmatic dysfunction is associated with low back pain. OBSECTIVE: This study aimed to confirm the effectiveness of diaphragm stretching technique as a treatment method for low back pain by evaluating the diaphragm contraction rate, trunk muscle activity in patients with low back pain. METHODS: Thirty-four patients with low back pain were randomly divided into two group: an experimental group and a control group. The diaphragm stretching technique was conducted in the experimental group and the placebo intervention was conducted in the control …group. The diaphragm stretching technique was conducted once, maintaining the tension for 7 min. The placebo intervention was conducted in the same position as the diaphragm stretching technique but with only light contact maintained without pressure. The diaphragm contraction rate and trunk muscle activity were measured before and after the intervention, and the changes were compared and analyzed. A paired sample t -test was used to compare measurements before and after the intervention within the group. An independent t -test was used to compare the experimental and control group. Statistical significance (α ) was set at 0.05. RESULTS: In the experimental group, the diaphragm contraction rate increased significantly after the intervention. Trunk muscle activity decreased significantly (p < 0.05). However, all domains in the control group receiving the placebo intervention were not significantly different (p > 0.05). Comparative analysis of changes before and after the intervention between the groups showed significant differences in the diaphragm contraction rate and trunk muscle activity in the experimental group (p < 0.05). CONCLUSION: The diaphragm stretching technique improved the diaphragm contraction rate and trunk muscle activity was lower due to the improved trunk stabilization function of the diaphragm. Therefore, the diaphragm stretching technique can be recommended as a physical therapy intervention to improve pain in patients with low back pain. Show more

Keywords: Diaphragm contraction rate, diaphragm stretching technique, low back pain, trunk muscle activity, trunk stabilization

DOI: 10.3233/BMR-230141

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 225-231, 2024

Authors: Kim, Jinhong | Cho, Juchul

Article Type: Research Article

Abstract: BACKGROUND: Although mulligan sustained natural apophyseal glides (SNAG) and maitland mobilization (MM) are common interventions for musculoskeletal disease, no study has directly compared the effectiveness of mid-thoracic spine mobilization in subacute stroke patients. OBJECTIVE: To investigate the effects of mid-thoracic spine mobilization (SNAG vs. MM) on postural balance and gait ability in subacute stroke patients. METHODS: Fifty subacute stroke patients were randomly allocated to the SNAG (n = 17), MM (n = 16), and control (n = 17) …groups, each receiving a neuro-developmental therapy program for four successive weeks. The SNAG and MM groups additionally received mid-thoracic spine mobilization (T4∼ 8). The primary outcome measure was postural sway, and secondary outcome measures included the five times sit-to-stand test (FTSST), functional reach test (FRT), 10-m walk test (10MWT), 6-minute walk test (6MWT) and global rating of change (GRC). RESULTS: Participants reported no adverse events, and there was no loss to follow-up. The SNAG and MM group patients demonstrated significant improvements (p < 0.05) in postural sway, FTSST, FRT, 10MWT, and 6MWT compared with those in the control group, with no between-group differences. CONCLUSIONS: Mid-thoracic spine mobilization allows significant improvements in postural balance and gait ability in subacute stroke patients, with no differences between the SNAG and MM techniques. Show more

Keywords: Stroke, mobilization, postural balance, gait

DOI: 10.3233/BMR-230144

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 233-240, 2024

Authors: Huaranga, Marco Aurelio Ramírez | Villanueva Carpintero, María de Gracia | Plasencia Ezaine, Angel Estuardo | Calle Ochoa, Jorge | Vedia, Iris de la Rocha | Arenal Lopez, Rocío | Méndez Leo, María Luis | Fernández Ordoñez, Maruja | Zamora, María Dolores Ruiz de Castañeda

Article Type: Research Article

Abstract: BACKGROUND: Monopolar radiofrequency ablation (MRFA) of the genicular nerves has been considered the main interventional treatment for chronic knee pain. However, the variable locations of these nerves could suggest that traditional MRFA of genicular nerves may be insufficient to cover the area needed to provide complete sensory denervation. For these reasons, some alternatives have been proposed to achieve an increase in the lesion area that offers better outcomes such a bipolar radiofrequency ablation (BRFA). OBJECTIVE: To describe the efficacy and safety of the bipolar radiofrequency ablation (BRFA) of the genicular nerves in the patients with chronic …knee pain. METHODS: A retrospective study was conducted in the Pain Medicine Department. Institutional review board approval from the Hospital Ethical Committee and informed consent were obtained. We reviewed our database for BRFA of genicular nerves from January 2018 to December 2021 for patients with chronic knee pain. The cannulas were placed using ultrasound guidance (10 cm, 22-gauge and 10 mm active curved tip), and each pair of cannulas were subjected to BRFA for 90 seconds at 80 ∘ C. Data analysis was conducted using T-test for paired variables (Visual analogue scale and EuroQol, an instrument intended to complement other forms of quality-of-life measures). RESULTS: Twenty-five patients met inclusion criteria after excluding 7 based on the study design. The mean improvement of our patients according to the VAS was - 3.98 (95%CI: - 4.37 to - 3.59) p < 0.0001 and EuroQol + 0.416 (95%CI: 0.364 to 0.468) p < 0.0001. The mean duration of improvement was 8 (6–11) months after BRFA. There were no reported serious adverse events related to the procedure, only local pain for 24 to 48 hours in 3 patients. CONCLUSIONS: We can conclude that BRFA reduces procedural pain and increases the treatment area, providing more complete sensory denervation and improved clinical outcomes. Show more

Keywords: Chronic knee pain, bipolar radiofrequency, radiofrequency ablation, genicular nerves, ultrasound guidance procedure

DOI: 10.3233/BMR-220400

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 241-248, 2024