Journal of Back and Musculoskeletal Rehabilitation - Volume 37, issue 3

Authors: Giray, Esra

Article Type: Editorial

DOI: 10.3233/BMR-245002

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 521-524, 2024

Authors: Smeets, Yasemin | Soer, Remko | Chatziantoniou, Evangelia | Preuper, Rita H.R. Schiphorst | Reneman, Michiel F. | Wolff, André P. | Timmerman, Hans

Article Type: Review Article

Abstract: BACKGROUND: Central sensitization cannot be demonstrated directly in humans. Therefore, studies used different proxy markers (signs, symptoms and tools) to identify factors assumed to relate to central sensitization in humans, that is, Human Assumed Central Sensitization (HACS). The aims of this systematic review were to identify non-invasive objective markers of HACS and the instruments to assess these markers in patients with fibromyalgia (FM). METHODS: A systematic review was conducted with the following inclusion criteria: (1) adults, (2) diagnosed with FM, and (3) markers and instruments for HACS had to be non-invasive. Data were subsequently extracted, …and studies were assessed for risk of bias using the quality assessment tools developed by the National Institute of Health. RESULTS: 78 studies (n = 5234 participants) were included and the findings were categorized in markers identified to assess peripheral and central manifestations of HACS. The identified markers for peripheral manifestations of HACS, with at least moderate evidence, were pain after-sensation decline rates, mechanical pain thresholds, pressure pain threshold, sound ‘pressure’ pain threshold, cutaneous silent period, slowly repeated evoked pain sensitization and nociceptive flexion reflex threshold. The identified markers for central manifestations of HACS were efficacy of conditioned pain modulation with pressure pain conditioning and brain perfusion analysis. Instruments to assess these markers are: pin-prick stimulators, cuff-algometry, repetitive pressure stimulation using a pressure algometer, sound, electrodes and neuroimaging techniques. CONCLUSIONS: This review provides an overview of non-invasive markers and instruments for the assessment of HACS in patients with FM. Implementing these findings into clinical settings may help to identify HACS in patients with FM. Show more

Keywords: Fibromyalgia, central sensitization, nociplastic pain, non-invasive markers, pain threshold, electrophysiological techniques, human assumed central sensitization

DOI: 10.3233/BMR-220430

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 525-584, 2024

Authors: Hernandez-Lucas, Pablo | Leirós-Rodríguez, Raquel | Lopez-Barreiro, Juan | García-Soidán, José L.

Article Type: Review Article

Abstract: BACKGROUND: Clinical practice guidelines stress the importance of prevention and treatment of non-specific back pain through exercise therapy. However, it has not yet been confirmed whether the combination of exercise plus education is more effective than such interventions taken separately. OBJECTIVE: To determine if the combination of exercise plus education is more effective for the prevention of non-specific back pain than exercise or education alone. METHOD: A systematic search of studies whose sample consisted of participants without non-specific back pain (primary prevention) and participants with non-specific back pain (secondary and tertiary prevention) was …conducted in the following databases in March 2023: PubMed, Scopus, Web of Science and Medline. RESULTS: A total of 16 articles were selected. Statistically significant results were found in the pain variable with SMD = - 2.02 (95% CI = - 2.71 to - 1.33; p < 0.001), the disability variable with SMD = - 1.14 (95% CI = - 1.63 to - 0.65; p < 0.001), and the kinesiophobia variable with SMD = - 1.8 (95% CI = - 2.54 to - 1.05; p < 0.001). CONCLUSION: Interventions that combine exercise and education seem to have a greater preventive effect on non-specific back pain, disability and kinesiophobia than those that include exercise or education in an isolated manner. Show more

Keywords: Exercise therapy, health education, primary prevention, secondary prevention, tertiary prevention

DOI: 10.3233/BMR-230252

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 585-598, 2024

Authors: Deniz, Volkan | Güzel, Nevin Atalay | Kelle, Bayram | Antmen, Ali Bülent

Article Type: Research Article

Abstract: BACKGROUND: Haemophilic arthropathy is likely to influence posture and muscle stiffness in adolescent male haemophilia patients (HP). OBJECTIVE: This study aimed to investigate the possible change in upright standing posture and stiffness of the superficial postural muscles in HP. METHODS: Twenty-two HP aged between 12 and 19 years and twenty-two healthy peers were included in the study. The photogrammetry was used to assess the upright standing posture from sagittal and frontal planes. Also, stiffness of the superficial postural muscles was evaluated using the myotonometry. RESULTS: A significant difference was found in …the craniovertebral, lumbar lordosis, knee flexion-valgus, and ankle plantar flexion angles between the groups (p < 0.05). Craniovertebral, knee flexion, and knee valgus angles were lower; whereas lumbar lordosis and ankle plantar flexion angles were higher in HP compared to the healthy peers. Stiffness of the rectus femoris muscle was lower in HP (p < 0.001). CONCLUSION: This study revealed that the ankle, knee, lumbar, and craniovertebral segments’ posture angles were changed and the stiffness of the rectus femoris muscle decreased in HP. Postural alterations and reduced rectus femoris stiffness should be considered in management of the musculoskeletal complications of haemophilia. Show more

Keywords: Alignment, bleeding disorders, muscle viscoelasticity, photogrammetry

DOI: 10.3233/BMR-230185

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 599-609, 2024

Authors: Liu, Yayun | Tang, Xiaozheng | Ding, Yuanjun | Li, Jingtang

Article Type: Research Article

Abstract: BACKGROUND: The clavicle is recognized as the bone most vulnerable to fractures. Moreover, approximately 80% of fractures occur in the middle third of the clavicle. Conservative treatment is associated with a higher rate of nonunion, while surgical treatment of fracture via internal fixation may have a variety of postoperative complications. Therefore, to improve patient satisfaction and reduce the complications related to internal fixation techniques, we modified the surgical approach to external fixation. OBJECTIVE: The purpose of this study was to assess the modified intervention’s prospects for clinical application. METHODS: A total of 36 patients …with middle clavicle fractures were treated with screw–rod external fixation between April 2015 and October 2019. We observed the operative time, intraoperative blood loss, length of hospital stay, and fracture healing time. The patients were followed up regularly, and the clinical efficacy of the modified intervention was evaluated. Finally, the patients’ shoulder function was assessed based on the disabilities of the arm, shoulder, and hand (DASH) score. RESULTS: For the screw–rod external fixation, the mean operative time was found to be 48.6 ± 6.8 min, the intraoperative blood loss was 30.6 ± 17.2 mL, the length of hospital stay was 4.5 ± 1.5 days, and the fracture healing time was 2.8 ± 0.4 months. Eventually, all the patients healed well, with the combined “excellent” and “good” rate of shoulder function being assessed to be as high as 94.44%. Furthermore, the DASH scores were all less than 10, with the average score being 4.65 ± 3.34. CONCLUSIONS: The screw–rod external fixation technique offers the advantages of convenience, reliability, and good aesthetics, suggesting that it could be used as an alternative treatment method for fractures of the middle third of the clavicle. Show more

Keywords: Treating fractures, middle third of the clavicle, screw–rod external fixation

DOI: 10.3233/BMR-220424

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 611-616, 2024

Authors: Wang, Li | Huang, Bing-Yao | Xie, Xiao-Min | Sang, Di | Tan, Tian-Hui | Li, Guang-Lin | Cao, Xue-Mei | Jiang, Nai-Fu

Article Type: Research Article

Abstract: BACKGROUND: Chronic lower back pain (CLBP) is one of the most common disorders worldwide. Flash cupping has the ability to relieve CLBP; nevertheless, its impact on CLBP and the likely mechanism of action have not been studied. OBJECTIVE: The goal of this study was to assess the impact of a single, brief cupping session on CLBP and low back muscle activity using multichannel surface electromyography (sEMG). METHODS: In this randomized controlled trial, 24 patients with CLBP were enrolled and randomly assigned to the control group (treated by acupuncture) and cupping group (treated by acupuncture …and flash cupping). Acupuncture was applied on the shen shu (BL23), dachang shu (BL25), and wei zhong (BL40) acupoints in both the groups. A brief cupping treatment was applied to the shen shu (BL23), qihai shu (BL24), dachang shu (BL25), guanyuan shu (BL26), and xiaochang shu (BL27) acupoints on both sides of the lower back in the cupping group. The numeric rating scale (NRS) was used to assess therapy efficacy for lower back pain (LBP) before and after treatment. Surface EMG data collected during symmetrical trunk flexion-extension movements were utilized to measure lower back muscle activity and the effectiveness of LBP therapy. RESULTS: There was no statistically significant difference (P = 0.63) in pain intensity between the two groups before and after treatment. There was a statistically significant difference (P = 0.04) between the control group and the cupping group in the sEMG topographic map parameter CoGx-To-Midline. CONCLUSION: This study established a connection between the action mechanism of flash cupping and enhanced horizontal synchronization of lower back muscular activity. Show more

Keywords: Acupuncture, chronic lower back pain, electromyography, flash cupping, surface

DOI: 10.3233/BMR-230095

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 617-628, 2024

Authors: Dıracoglu, Demirhan | Sezikli, Selim | Dernek, Bahar | Yildirim, Mustafa Aziz | Sen, Ekin Ilke

Article Type: Research Article

Abstract: BACKGROUND: Many formulations and dosing regimens are available for hyaluronic acid (HA). OBJECTIVE: To compare different doses of linear, high-molecular weight (HMW) HA injections among patients with knee osteoarthritis (OA). METHODS: Hundred patients were included in this randomized, single-blinded trial and randomly divided into three HA injection groups. The first group received five weekly 20 mg HA injections, the second group received three weekly 32 mg HA injections, and the third group received a single 48 mg HA injection. Patients were evaluated at baseline, 1, 3, and 6 months after the last injection for pain, stiffness, and …function using the visual analog scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. Quality of life, patient’s global assessment, and Timed Up and Go (TUG) test scores were also evaluated. RESULTS: There was significant improvement in the WOMAC, VAS-pain, quality of life, patient’s global assessment, and TUG test mean scores at all follow-up time points (p < 0.001). However, the groups showed no significant differences in WOMAC, VAS-activity pain, and patient global scores at any follow-up point. CONCLUSION: Intra-articular injections of different doses of linear HMW HA can improve pain, stiffness, function, and quality of life in patients suffering from knee OA over a six-month period. Show more

Keywords: Hyaluronic acid, osteoarthritis, knee, intra-articular injection

DOI: 10.3233/BMR-230097

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 629-639, 2024

Authors: Chokphukiao, Pakwipa | Amatachaya, Sugalya | Poncumhak, Puttipong | Intaruk, Roongnapa | Thaweewannakij, Thiwabhorn | Somboonporn, Charoonsak | Peungsuwan, Punnee | Amatachaya, Pipatana | Sooknuan, Thanat

Article Type: Research Article

Abstract: BACKGROUND: Many older adults are at risk of sarcopenia, a gradual loss of muscle mass affecting muscle strength and physical function, which can lead to adverse health consequences deteriorating their independence. However, the detection could be delayed due to the requirement of many measures, including a complex imaging modality. Thus, an exploration for a practical community- or home-based measure would be helpful to identify at-risk older adults and begin the timely management. OBJECTIVE: To explore the ability of the upper limb loading during a seated push-up test (ULL-SPUT) to determine the presence of sarcopenia in community-dwelling …older adults. METHODS: Older adults (n = 110; 62 females, average age approximately 77 years) were cross-sectionally assessed for sarcopenia using standard measures (handgrip strength, appendicular skeletal muscle mass, and walking speed) and the ULL-SPUT. RESULTS: Data from standard measures indicated that 44 participants had sarcopenia. The ULL-SPUT index of < 16.9 kg/m2 for females (sensitivity = 86%, specificity = 78%, area under the receiver operating characteristic curve [AUC] = 0.85) and < 19.7 kg/m2 for males (sensitivity = 73%, specificity = 69%, AUC = 0.83) could optimally identify participants with sarcopenia. CONCLUSION: The ULL-SPUT index could be used to screen and monitor older adults with sarcopenia in various clinical, community, and home settings. This practical measure may be accomplished using a digital bathroom scale on a hard, even surface. Outcomes would identify an adult who should undergo further confirmation of sarcopenia through standard measures or the initiation of timely management to promote treatment effectiveness. Show more

Keywords: Body composition, community health services, frail elderly, muscle strength, health status

DOI: 10.3233/BMR-230143

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 641-649, 2024

Authors: Afzal*, Muhammad Waqar | Ahmad, Ashfaq | Gilani, Syed Amir | Zulfaqar, Nimra | Fatima, Sahar | Mahmmod, Tahir

Article Type: Research Article

Abstract: BACKGROUND: Translation and validation of important scales in other languages reduce bias in reporting the functional status of the patient. OBJECTIVE: To translate the Back Pain Functional Scale into Urdu (BPFSu), adapt it for use in other cultures, and evaluate its psychometric properties. METHOD: According to Beaton guidelines, translation and cultural adaption was carried out. On 100 Urdu-literate men and women aged 18–60 years with lower back pain, the final BPFSu was assessed for psychometric qualities. First at baseline and again after 7 days, participants completed the BPFSu, the Functional Rating Index (FRI), and the …Numeric Pain Rating Scale (NPRS). RESULTS: Internal consistency of the BPFSu was excellent (Cronbach’s alpha: 0.937). No floor and ceiling effects were found Excellent test-retest reliability (ICC = 0.882, CI 95%; 0.830–0.919) was achieved. Spearman correlation coefficient showed criterion validity with the NPRS (rho = â ⁢ ˆ ⁢ ’ 0.701, p ⩽ 0.001) and Pearson correlation coefficient showed construct validity with the FRI (r = â ⁢ ˆ ⁢ ’ 0.740, p ⩽ 0.001). The minimum detectable changes were 9.96, while the standard error of measurement was 3.6. CONCLUSION: The BPFSu is a valid and reliable instrument for assessing physical function in individuals experiencing low back discomfort. Show more

Keywords: Back pain, back pain functional scale, translation, cross-cultural adaptation

DOI: 10.3233/BMR-230153

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 651-658, 2024

Authors: Deen, Nazar | Akhtar, Saeed | Qazi, Fawad Hafeez | Uzair, Rahila | Khan, Mohammad | Tasneem, Sharjeel

Article Type: Research Article

Abstract: BACKGROUND: Cervical radiculopathy is a common condition encountered in clinical practice and is characterized by compression or irritation of the nerve roots in the cervical spine. OBJECTIVE: To compare the effectiveness of manual intermittent cervical longitudinal mobilization (mICLM) and therapeutic modalities in managing acute, sub-acute and chronic radiculopathy pain. METHODS: This was a multicenter, double-blinded, randomized controlled trial. Individuals with radiculopathies were randomized into interventional; (IG, n = 18) receiving mICLM and control group; (CG, n = 17), receiving Microwave Diathermy (MWD) and …transcutaneous electrical nerve stimulation (TENS) at the cervico-dorsal area daily for two weeks. The neck pain disability index (NPDI), numeric pain rating scale (NPRS), and global rating of change score (GRoC) were used as outcome measures. Statistical analysis was conducted using SPSS version 23.0. RESULTS: Both mICLM and MWD with TENS were equally effective in reducing the pain and disability in either group. However, it was noted that mICLM had a better impact on acute, sub-acute and chronic cases of radiculopathy pain comparatively. Mean age was 42.3 (SD = ± 10.9) years. 54.3% were between the age group of 40–60 years out of which 51.4% were male and 48.6% were female. 51.4% were in IG and 48.6% were in CG. The mean comparison of NPAD and NPRS within groups was significant with p < 0.01* . Post treatment mean comparison of NPAD outcomes in IG and CG remain significant with p = 0.004* and p < 0.01* respectively. The post NPAD and NPRS between IG and CG were found statistically insignificant with p = 0.75 and p = 0.57 respectively. CONCLUSION: mICLM and therapeutic modalities showed similar outcomes in managing radiculopathy pain. The study highlights the need for further research to understand the effectiveness of these interventions in larger patient populations. Show more

Keywords: Cervical pain, radiculopathy, pain stages, longitudinal mobilizations, therapeutic agents, exercises, and outcome measures

DOI: 10.3233/BMR-230154

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 3, pp. 659-670, 2024