Journal of Back and Musculoskeletal Rehabilitation - Volume 37, issue 5

Authors: Mengi, Alper | Bulut, Gül Tugba

Article Type: Research Article

Abstract: BACKGROUND: There are no data on the additional contribution of dry needling (DN) for trigger points (TPs) accompanying patients with cervical spondylosis (CS). OBJECTIVE: To analyse the contribution of DN applied to concomitant active TPs in the upper trapezius muscle on the treatment outcomes of physiotherapy in CS. METHODS: In this prospective randomized controlled study, 70 patients with CS and active TPs in the upper trapezius muscle were included. The first group received physiotherapy for 5 days per week for 3 weeks. The second group received DN with the same program. All participants …were evaluated before treatment (day 0) and at the end of treatment (day 21) in terms of pain, functional status, quality of life, anxiety/depression scores, and number of TPs. RESULTS: 33 patients in the first group and 32 patients in the second group completed the study. While the change over time was found significant in all variables, the change was not different between groups. The group-time interaction effect was not found to be statistically significant in any variable. Percentage changes of all variables were similar between the groups. CONCLUSION: DN treatment added to the physiotherapy did not contribute to recovery in patients with CS. Show more

Keywords: Cervical spondylosis, myofascial pain, neck pain, trigger point

DOI: 10.3233/BMR-230287

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1213-1221, 2024

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

Article Type: Research Article

Abstract: BACKGROUND: Sufficient shoulder flexor strength is necessary for accurate movement of the shoulder joint because several factors can cause compensatory movements of the scapula. OBJECTIVE: We investigated the influence of external fixation on the isometric shoulder flexors strength (ISFS) in individuals with and without scapular elevation (SE) during shoulder flexion. METHODS: The healthy and SE groups included 29 individuals. The ISFS was measured using a tensiometer (kg) under conditions of with and without external fixation, in a random order. The change in the ISFS (the strength difference with and without external fixation) was …compared between the healthy and SE groups using an independent t -test. RESULTS: The change in the ISFS differed significantly between the healthy and SE groups (3.5% and 32.3%, respectively; p = 0.001). CONCLUSION: These findings suggest that external fixation should be considered during shoulder flexion to determine the ISFS accurately in individuals with compensated SE. Show more

Keywords: Compensation, scapular elevation, shoulder flexor, strength

DOI: 10.3233/BMR-230288

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1223-1229, 2024

Authors: Xue, Youdi | Xia, Jihua | Ma, Chao | Dai, Weixiang | Zhang, Zhaochuan

Article Type: Research Article

Abstract: BACKGROUND: Osteoporosis is the most common disease in postmenopausal women and the elderly, which can lead to vertebral compression fracture. OBJECTIVE: To investigate the related factors of severe osteoporotic vertebral compression fracture (SOVCF) and evaluate the long-term outcomes of percutaneous kyphoplasty (PKP) for treating SOVCF through comparison with mild OVCF (MOVCF). METHODS: From September 2015 to March 2019, 294 osteoporotic vertebral compression fracture (OVCF) patients treated with PKP were analyzed. Compression of the anterior margin of the fractured vertebral body beyond 2/3 of the original height was defined as SOVCF. Baseline data, clinical …and imaging findings before and after surgery and at the last follow-up were recorded. Numerical Rating Scale (NRS) was used to evaluate low back pain, the Oswestry Disability Index (ODI) was used to evaluate activity of daily life. Anterior vertebral height (AVH) and local kyphosis angle (LKA) was used to evaluate radiographic outcomes. During the follow-up, patients with recurrent back pain were examined by MRI to identify new fractures and the incidence of adjacent vertebral fracture (AVF) was recorded. Age, sex, body mass index (BMI), dual energy X-ray absorptiometry based T value, duration of symptom, history of trauma, steroid use, and fracture site were collected for univariate logistic regression analysis Variables with a P -value of less than 0.05 were then included in multivariate analysis to determine the related factors for SOVCF. RESULTS: Logistic regression analysis indicated that longer duration of symptom (OR = 1.109, 95%CI: 1.038–1.185, P = 0.002), lower T value (OR = 0.332, 95%CI: 0.139–0.763, P = 0.001), and steroid use (OR = 31.294, 95%CI: 1.020–960.449, P = 0.049) were related factors of SOVCF. Compared with the MOVCF group, the SOVCF group had longer operation time (57.3 ± 13.51 minutes vs 44.9 ± 8.13 minutes, P < 0.001), more radiation exposure (39.9 ± 7.98 times vs 25.5 ± 4.01 times, P < 0.001), and higher cement leakage rate (55.81% vs 18.73%, P < 0.001). At the last follow-up, the SOVCF group had higher NRS (2.28 ± 0.85 vs 1.30 ± 0.71, P < 0.001), and ODI (16.23 ± 4.43 vs 12.88 ± 3.34, P < 0.001). After operation and at the last follow-up, the SOVCF group had higher LKA and lower AVH (all P < 0.05). The AVF rate at the last follow-up was higher in the SOVCF group at the last follow-up (4.78% vs 18.60%, P < 0.001). CONCLUSION: Lower T value, longer duration of disease, and steroid use were related factors of SOVCF. Compared with MOVCF, PKP for SOVCF had longer operation time, more radiation exposure, and higher cement leakage rate, and the long-term outcomes were worsen. Show more

Keywords: Kyphoplasty, bone mineral density, bone cement

DOI: 10.3233/BMR-230324

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1231-1240, 2024

Authors: Bastos de Oliveira, Viviane | Albuquerque Brandão, Maria Clara | Coelho de Albuquerque Pereira, Wagner | Fernandes de Oliveira, Liliam

Article Type: Research Article

Abstract: BACKGROUND: Multifidus is an important lumbar muscle with distinct superficial and deep fibers responsible for torque production and stabilization, respectively. Its mechanical properties change when transitioning from lying to sitting positions, necessitating enhanced stability. It holds crucial clinical relevance to assess these layers separately, especially in the sitting posture, which demands increased neuromuscular control compared to the prone position. OBJECTIVE: To compare lumbar multifidus stiffness in lying versus sitting postures, analyzing both superficial and deep layers. METHODS: Supersonic Shear Imaging captured elastographic images from 26 asymptomatic volunteers in prone and seated positions. …RESULTS: Left multifidus shear modulus in lying: 5.98 ± 1.80/7.96 ± 1.59 kPa (deep/superficial) and sitting: 12.58 ± 4.22/16.04 ± 6.65 kPa. Right side lying: 6.08 ± 1.97/7.80 ± 1.76 kPa and sitting: 13.25 ± 4.61/17.95 ± 7.12 kPa. No side differences (lying p = 0.99, sitting p = 0.43). However, significant inter-postural differences occurred. CONCLUSION: Lumbar multifidus exhibits increased stiffness in sitting, both layers affected, with superior stiffness in superficial versus deep fibers. Applying these findings could enhance assessing multifidus stiffness changes, for classifying tension-induced low back pain stages. Show more

Keywords: Shear modulus, mechanical properties, ergonomic, ultrasound, muscle

DOI: 10.3233/BMR-230333

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1241-1248, 2024

Authors: Riaz, Saima | Rehman, Syed Shakil Ur | Hassan, Danish | Hafeez, Sana

Article Type: Research Article

Abstract: BACKGROUND: Escala de Calidad de vida Osteoporosis (ECOS-16) was originally developed in Spanish to evaluate the quality of life (QoL) in post-menopausal women (PMW) with osteoporosis or osteopenia based on the osteoporosis-specific QoL instruments. ECOS-16 has been translated into several languages, but the Urdu version is not yet available. OBJECTIVE: To translate the ECOS-16 Questionnaire into Urdu and determine its validity and reliability in PMW with osteopenia. METHODS: This was a linguistic validity and reliability study. ECOS-16 was translated into Urdu using Beaton’s guidelines. Content validity was examined using Waltz’s four-point ordinal scale. …Twenty osteopenia-afflicted PMW aged 48–70 underwent pilot testing for face validity. Discriminant validity was determined by an independent T-test between PMW women with and without osteopenia. Convergent validity was assessed using Spearman’s correlation coefficient. Cronbach’s alpha and Intraclass correlation coefficient (ICC2,1 ) assessed internal consistency and test-retest reliability. The factor analysis was used to describe the factors. RESULTS: Each question’s content validity ratio (CVR) was 0.83–1.00, while the scale’s S-CVR was 0.96. Each question’s Likert scale content validity index (CVI) was 0.91–0.93, while the scale’s S-CVI was 0.91. Significant discriminant validity was found between groups in weeks I and II (p -value < 0.001). A correlation coefficient of 0.89 and 0.96 (p -value < 0.001) between Urdu ECOS-16 total score and SF-36 and EQ-5D scores suggests convergent validity. One component explained 83.86% of Urdu ECOS-16’s variance in factor analysis. Excellent test-retest reliability (ICC2,1 = 0.990, 95% CI, 0.985–0.994, p -value < 0.001). Cronbach’s alpha for standardized items was 0.995. CONCLUSION: ECOS-16 translated in Urdu is a valid and reliable questionnaire to assess QoL in PMW with osteopenia. It has a simple and easy language that can be understood easily by the Urdu-speaking population. Show more

Keywords: Bone diseases, post-menopausal period, osteoporosis, quality of life, spinal fracture

DOI: 10.3233/BMR-230342

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1249-1258, 2024

Authors: Saleh, Marwa Shafiek | Mohamed, Walaa Mohsen | Elsayed, Walaa Hamdy | Abdelatief, Emad Eldin Mohamed

Article Type: Research Article

Abstract: BACKGROUND: Proprioceptive neuromuscular facilitation (PNF) stretching exercises have been widely advocated for the management of patients with different musculoskeletal conditions. However, its effect on the treatment of temporomandibular dysfunction (TMD) in patients with forward head posture (FHP) has not been fully investigated. OBJECTIVE: To investigate the effect of PNF stretching exercises on the treatment of TMD in patients with FHP. METHODS: A prospective, randomized, double-blinded clinical trial. Twenty-four patients with TMD and FHP aged from 18–40 years were randomly assigned to PNF or control group. The PNF group composed of 12 patients received …PNF stretching exercises of masticatory muscles in addition to routine physical therapy treatment (FHP correction exercises and ultrasound for the temporomandibular joint); the control group composed of 12 patients received routine physical therapy treatment only. Interventions were conducted twice a week for six weeks. Craniovertebral angle, pain threshold, pain intensity, temporomandibular joint ROM, and temporomandibular joint function were assessed for all participants before and after the intervention. The outcomes were analyzed using Two-way mixed MANOVA. For further multiple comparisons, post-hoc tests with the Bonferroni correction were performed. RESULTS: There was no significant difference between both groups pre-treatment (p > 0.05). Comparison between groups post-treatment revealed statistically significant differences in all outcome measures (p < 0.05) in favor of the PNF group. CONCLUSION: Adding PNF stretching exercises of masticatory muscles to routine physical therapy programs is an effective method for management of TMD in patients with FHP more than routine physical therapy programs alone. Show more

Keywords: Neck posture, craniovertebral angle, neuromuscular facilitation, craniomandibular disorders

DOI: 10.3233/BMR-230358

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1259-1268, 2024

Authors: Unuvar, Bayram Sonmez | Tufekci, Osman | Gercek, Hasan | Torlak, Mustafa Savas | Erbas, Onur

Article Type: Research Article

Abstract: BACKGROUND: Unilateral osteoarthritis (OA) affects single knees and presents a unique scenario where individuals experience varying degrees of symptoms between their affected and unaffected knees. OBJECTIVE: This study aims to investigate differences in muscle tightness between symptomatic and asymptomatic knees in individuals with unilateral knee OA while exploring the interplay among pain, functionality, and muscle tightness. METHODS: In this cross-sectional study, thirty knee OA patients underwent assessments for hamstring (Active Knee Extension, Straight Leg Raise), iliotibial band (Ober Test), and quadriceps tightness (Modified Thomas Test). Pain intensity was measured using the Visual Analog …Scale (VAS), and functional limitations were evaluated via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: A negative correlation was observed between participants’ pain and AKE (p = 0.004, r = - 0.515), ASLR (p = 0.27, r = - 0.403), Ober (p = 0.010, r = - 0.461) values. However, no significant correlation was found with the Modified Thomas value (p = 0.204, r = - 0.239). There was also a negative correlation between participants’ WOMAC scores and AKE (p = 0.019, r = - 0.427), OBER (p = 0.004, r = - 0.510), and Modified Thomas (p = 0.022, r = - 0.416) values, while ASLR (p = 0.286, r = - 0.202) values showed no significant correlation. Comparisons between AKE, Ober, and Modified Thomas values showed higher values in asymptomatic extremities (AKE: p = 0.025, Ober: p = 0.021, Modified Thomas: p = 0.030). CONCLUSION: This study emphasizes the significance of muscle tightness in the symptomatic extremities of individuals with unilateral knee OA. The results indicate that increased muscle tightness makes pain worse and limits movement. It’s crucial for healthcare providers treating OA to focus on improving muscle flexibility, reducing pain, and enhancing overall function. Show more

Keywords: Hamstring muscles, knee, muscle tightness, osteoarthritis, quadriceps muscle

DOI: 10.3233/BMR-230373

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1269-1276, 2024

Authors: Shi, Tao | Shou, Fenyong | Xia, Qun | Zhang, Tao | Teng, Donghui | Jing, Wanli | Zhou, Qiang

Article Type: Research Article

Abstract: BACKGROUND: The effect of anti-osteoporosis treatment in elderly patients with osteoporosis and lumbar discectomy and fusion (LIF) for lumbar degenerative diseases is not well known. OBJECTIVE: This study aimed to evaluate the effect of perioperative anti-osteoporosis treatment in the patients with osteoporosis and LIF. METHODS: From January to December 2022, patients were divided into three groups according to the inclusive criteria: the normal group (Group A), the osteopenia group (Group B) and the osteoporosis group (Group C). Quantitative computed tomography (QCT), height of the intervertebral space (HIS), segmental sagittal angle (SSA), visual analogue …scale (VAS) score and Oswestry Disability Index (ODI) were compared between the groups at the follow-up time. The serum Ca2 + , osteocalcin (OC), propeptide of type I procollagen (PINP) C-terminal cross-linking telopeptide of type I collagen (β -CTX) and 25-OH vitamin D (25-OH VD ) levels were compared between the groups at the time of follow-up. Interbody fusion was graded on the X-ray and CT images at the follow-up time. RESULTS: There were 165 patients in this study. There were significant differences in the mean age, mean score, HIS and SSA between the groups at the different follow-up times. There were significant differences in the concentrations of serum Ca2 + , OC, β -CTX, 25-OH VD and PINP at the sixth month after surgery between the groups. There were significant differences in the concentrations of serum Ca2 + , β -CTX and 25-OH VD between the pre-surgery and at six months after surgery in Group B and β -CTX and 25-OH VD in Group C. There was a significant difference in the degree of fusion between Group B and C (χ 2 = 5.6243, P < 0.05). CONCLUSION: In elderly patients with LIF and osteoporosis, anti-osteoporosis therapy could reduce bone resorption and thus facilitate fusion. Anti-osteoporosis medication tends to enhance radiological, functional, and fusion short-term outcomes. Show more

Keywords: Elderly patients, degenerative lumbar disease, lumbar discectomy and fusion, osteoporosis, anti-osteoporosis

DOI: 10.3233/BMR-230381

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1277-1287, 2024

Authors: Labanca, Luciana | Berti, Lisa | Tedeschi, Roberto | D’Auria, Lucia | Platano, Daniela | Benedetti, Maria Grazia

Article Type: Research Article

Abstract: BACKGROUND: Among non-pharmacological interventions, Multiwave Locked System (MLS) Laser therapy has been used in patients with several musculoskeletal pathologies and in combination with other therapeutical interventions. The effects of sole MLS therapy on pain and function in patients with chronic non-specific low-back pain are unknown. OBJECTIVE: The objective of this study was to investigate the effects of MLS Laser therapy on pain, function, and disability in patients with chronic non-specific low back pain in comparison to a placebo treatment group. METHODS: Forty-five patients were randomized into two groups: the MLS Laser group and …the Sham Laser group, undergoing 8 sessions of either a MLS Laser therapy or a Sham Laser therapy, respectively. At the beginning of the therapy (T0), at the end of the therapy (T1), and 1 month after the end of therapy (T2) patients were assessed for low back pain (by means of a VAS scale), function (by means of kinematic and electromyographic assessment of a forward bending movement) and self-reported disability (by means of the Roland-Morris and Oswestry Disability questionnaires). RESULTS: There was a significant reduction of pain and disability in both groups at T1 and T2 in comparison with T0. At T2 patients in the MLS group showed a significantly lower pain in comparison with patients in the Sham group (VAS = 2.2 ± 2 vs. 3.6 ± 2.4; p < 0.05). No differences between the two groups were found for function and disability. CONCLUSION: Both MLS Laser and Sham Laser therapies lead to a significant and comparable reduction in pain and disability in patients with chronic non-specific low back pain. However, one month after treatment, MLS Laser therapy has been found to be significantly more effective in reducing pain as compared to sham treatment. Show more

Keywords: Flexion-relaxation phenomenon, multifidus, forward bending, electromyography, kinematics

DOI: 10.3233/BMR-230383

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1289-1298, 2024

Authors: Cai, Congcong | Gazali, Nurul Adliah | Tan, Xin Ning | Soon, Benjamin | Lee, Adrian Thian Huat | Aw, Qian Wen Simone | Dana, Dharini D/O | Kwok, Joanne Ching Tung | Kwa, Mei Jun

Article Type: Research Article

Abstract: BACKGROUND: The psoas major (PM) has been identified as a potential contributor to chronic low back pain (LBP). However, few studies have investigated the effects of upright functional movement on PM activation in cLBP individuals. OBJECTIVE: This cross-sectional study aims to compare PM muscle activation characteristics in chronic LBP (cLBP) and healthy subjects during the transition from quiet double-leg standing to standing hip flexion. METHODS: Ultrasound Imaging was used to assess PM thickness at the lumbar vertebral level of L4–5 in 12 healthy and 12 cLBP participants. The changes in thickness between the test positions …were utilized as a proxy for PM activation. RESULTS: The cLBP group exhibited greater thickness changes on the non-dominant side PM during contralateral hip flexion but not ipsilateral hip flexion (p = 0.369) compared to their healthy counterparts (p = 0.011; cLBP: resting 27.85 mm, activated 34.63 mm; healthy: resting 29.51 mm, activated 29.00 mm). There were no significant differences in dominant side PM thickness changes between the two groups during either contralateral or ipsilateral hip flexion (p = 0.306 and p = 0.077). CONCLUSION: Our findings suggest a potential overactivation of the PM in the cLBP population. This insight may aid in the development of tailored rehabilitation programs. Show more

Keywords: Low back pain, psoas muscles, muscle contraction, ultrasonography

DOI: 10.3233/BMR-230384

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1299-1308, 2024

Authors: Do, Junghwa | Lim, Woo-Taek | Kim, Dae Yul | Ko, Eun Jae | Ko, Myoung-Hwan | Kim, Geon Woo | Kim, Ji Hye | Kim, SooBin | Kim, Hwal

Article Type: Research Article

Abstract: BACKGROUND: Chronic stroke can impair cardiopulmonary function, mobility, and daily activities. This study assessed the impact of robot-assisted gait training (RAGT) on such impairments. OBJECTIVE: To investigate the effects of robot-assisted gait training on cardiopulmonary function, walking ability, lower extremity function and strength, activities of daily living (ADLs), and blood test results among individuals with chronic stroke. METHODS: A multicenter, prospective, single-blinded, randomized controlled trial with 22 chronic stroke participants compared RAGT against a control exercise regimen. RAGT involved three days weekly sessions of high-intensity interval training for 8 weeks (24 sessions) with …a Morning Walk® device. The control group also performed home exercises. (24 sessions) Measures included VO2 max, Functional Ambulatory Category, 2-minute walk test, 10-meter walk test, Motricity Index-Lower, Korean version of the Fugl-Meyer Assessment Scale, Modified Barthel Index, Berg Balance Scale, muscle strength, InBody body composition, and blood tests (cholesterol, lipid, glucose). RESULTS: RAGT significantly improved VO2 max, gait, balance, and lower limb strength compared with controls, with significant improvements in 2-minute walk test, 10-meter walk test, Motricity Index-Lower, and Fugl-Meyer Assessment outcomes. No changes were seen in muscle mass or blood markers. CONCLUSION: RAGT enhances cardiopulmonary function and ambulatory capacity in chronic stroke patients, underscoring its potential in stroke rehabilitation. Show more

Keywords: Cerebrovascular accident, robotics, high-intensity interval training, rehabilitation

DOI: 10.3233/BMR-230385

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1309-1319, 2024

Authors: Ortiz, Ralph | Motyka, Thomas | Petterson, Stephanie | Krystofiak, Jason

Article Type: Research Article

Abstract: BACKGROUND: Sustained acoustic medicine (SAM) is a noninvasive long-term treatment that provides essential mechanical and thermal stimulus to accelerate soft tissue healing, alleviate pain, and improve physical activity. SAM increases localized deep tissue temperature, blood flow, cellular proliferation, migration, and nutrition exchange, resulting in reduced inflammation and an increased rate of tissue regeneration. OBJECTIVE: To assess the efficacy of SAM treatment of discogenic back pain in the lower spinal column to reduce pain, improve quality of life, and lower pharmacotherapy use. METHODS: Sixty-five subjects with chronic low back pain were randomly assigned to …SAM (N = 33) or placebo (N = 32) groups. Subjects self-applied SAM device bilaterality on the lower lumbar region for 4 hours daily for 8 weeks and completed daily pain diaries before, during, and after treatment. Subjects recorded pain reduction using a numeric rating scale (NRS), medication use, and physical activity using the Global Rating of Change (GROC) and Oswestry Disability Index (ODI). RESULTS: SAM treatment significantly reduced chronic lower back pain from baseline relative to placebo treatment (p < 0.0001). SAM treated subjects reported significantly lower back pain at 4 weeks, with the highest pain reduction (- 2.58 points NRS, p < 0.0001) reported at 8 weeks. Similar trends were observed in improved physical activity (3.48 GROC, p < 0.0001, 69–88% ODI, p < 0.0001) and 22.5% (15.2 morphine milligram equivalent) reduction in the use of opioid medication from baseline to 8 weeks. CONCLUSION: Daily, home-use SAM treatment significantly improves the clinical symptoms of chronic lower back pain, improves physical mobility, and reduces daily medication use. SAM treatment is well-tolerated by patients and may be considered a safe, non-invasive treatment option for chronic discogenic, lower back pain. Show more

Keywords: Low back pain, low-intensity continuous ultrasound, ultrasound therapy, sustained acoustic medicine, mechanotransduction, herniated discs, chronic pain, durable medical equipment

DOI: 10.3233/BMR-230402

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1321-1332, 2024

Authors: Alzahrani, Abdullah | Alshehri, Mansour Abdullah | Alzahrani, Hosam

Article Type: Research Article

Abstract: BACKGROUND: Physiotherapists must identify potential red flags that may impede recovery and function in individuals with low back pain (LBP) or put them at risk. OBJECTIVES: This study aimed to (1) investigate physiotherapists’ awareness and use of red flags for individuals with LBP in Saudi Arabia and (2) identify factors associated with their awareness and use of LBP red flags. METHODS: This cross-sectional study collected data using an anonymous online questionnaire (February–July 2023). It included physiotherapists working in private/public hospitals in Saudi Arabia. The questionnaire asked about the participants’ characteristics, their awareness of …LBP red flags, and their use of red flags for LBP assessment. RESULTS: A total of 643 participating physiotherapists (26.2 ± 3.8 years), 63.8% of whom were females, completed the survey. Most participants (94.4%) had adequate awareness of LBP red flags, and more than half (61%) had good utilization of red flags when assessing individuals with LBP. There was a positive correlation between the physiotherapists’ awareness and use of LBP red flags. CONCLUSION: The majority of the participating physiotherapists in Saudi Arabia were aware of LBP red flags, and many reported to have good use of red flags in clinical practice when assessing and managing individuals with LBP. Show more

Keywords: Low back pain, red flags, physiotherapists, awareness, cross-sectional

DOI: 10.3233/BMR-230410

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1333-1343, 2024

Authors: Koca, Tuba Tülay | Berk, Ejder | Özel, Elif | Yılmaz, Ahmet Said | Ertürk, Zeynel

Article Type: Research Article

Abstract: BACKGROUND: Sarcopenia and frailty may develop at varying rates depending on the metabolic, structural, and functional changes in the muscle structure after stroke. OBJECTIVE: To evaluate the prevalence of sarcopenia and frailty in patients with stroke and affecting clinical parameters. METHODS: This was a cross-sectional and analytical study. Twenty-six (49.1%) women and 27 men (50.9%) with stroke with an average age of 60.2 ± 10.3 (median = 62) years were included in the study. To evaluate physical performance, balance, and mobility, we used the 4-meter walk test …(4-MWT), timed up and go test, chair sit and stand test, and the Berg Balance Scale (BBS). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. The SARC-F scale was used for sarcopenia. RESULTS: The average stroke duration was 21.6 ± 18.2 months. Prefrailty was present in 14 (26.4%) patients, frailty was present in 34 (64.2%) patients, and two (3.8%) patients were normal. Sarcopenia was detected in 28 (52.8%) patients. According to handgrip strength, the prevalence of low muscle strength was 17% (n = 9). In the sarcopenic group, female sex (p = 0.005) was more frequent, 4-MWT was longer (p = 0.003), chair stand test results were lower (p < 0.001), the clinical frailty scale (CFS) was higher (p < 0.001), fall risk was higher compared with the BBS (p < 0.001), there was lower HG strength (p = 0.009), lower malnutrition scores (PNI, prognostic nutritional index, p < 0.001), and lower lymphocyte counts (p = 0.037). EAT-10 scores and dysphagia presence (p = 0.026), the presence of malnutrition (p < 0.021) and Nottingham Health Profile score (p < 0.001) were higher in the sarcopenic group. CONCLUSION: Sarcopenia and frailty frequently develop in patients with chronic stroke, with low lymphocyte counts, physical performance, muscle strength, and mobility and balance scores, and it is associated with poor prognostic factors including high disease severity, dysphagia, malnutrition, risk of falling, and poor quality of life. Show more

Keywords: Stroke, sarcopenia, frailty

DOI: 10.3233/BMR-230423

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1345-1354, 2024

Authors: Zhang, Nannan | Chen, Jianmin | Wang, Zhiyong | Ni, Jun

Article Type: Research Article

Abstract: BACKGROUND: After undergoing fibula-free flap harvest, patients may experience complications such as ankle instability. It remains unclear whether these patients have deficits of proprioception, and the recovery process is also uncertain. OBJECTIVE: This study aimed to objectively evaluate proprioception on the donor and normal side of surgical patients during long-term follow-up using the Pro-kin system. METHODS: This study enrolled 36 patients who underwent reconstruction of the head and neck using osseous free flaps harvested from the fibula. Each patient underwent pre-operative evaluations and was subsequently evaluated at postoperative months 1, 3, 6, and …12. The study assessed the proprioceptive evaluation of the lower limbs, muscle function, range of motion of the ankle, and donor side complications. RESULTS: On the donor side, the average trace error (ATE) at postoperative month 1 was significantly higher than pre-operation, postoperative months 6 and 12 (P < 0.05). The test execution time (TTE) at postoperative month 1 was significantly increased by 9.875s compared to the pre-operative levels (P = 0.012, 95% confidence interval [CI] 4: 1.877–17.873) and by 11.583s compared to postoperative month 12 (P = 0.007, 95% CI: 2.858–20.309). The reduction in range of motion of ankle dorsiflexion was most pronounced at postoperative month 1, exhibiting an 11.25∘ decrease compared to pre-operative levels (P < 0.001, 95% CI: 6.304–16.16). Although the range of motion of ankle dorsiflexion gradually improved over time at postoperative months 3, 6, and 12, it remained lower than pre-operative levels (P < 0.05). CONCLUSION: The study revealed that the patients exhibited proprioceptive disturbances in both lower limbs at postoperative month 1. The proprioceptive function gradually improved over time, with a gradual decrease in donor site complications. Show more

Keywords: Fibula-free flap harvest, proprioception, pro-kin system, ankle instability, rehabilitation

DOI: 10.3233/BMR-230436

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1355-1362, 2024

Authors: Ewertowska, Paulina | Formella, Oskar | Poniatowski, Łukasz | Zielińska, Afrodyta | Krzysztofik, Michał | Czaprowski, Dariusz

Article Type: Research Article

Abstract: BACKGROUND: Whole-body vibration (WBV) is being used in rehabilitation and sport. Studies confirm its positive impact on muscle strength and power or regulating muscle hypertension. However, there are some uncertainties regarding its influence on postural stability. This issue seems particularly interesting in the case of individuals with generalized joint hypermobility (GJH), for whom proprioceptive training and muscle strengthening exercises are recommended while techniques that decrease muscle tension are not advised. OBJECTIVE: The aim of the study was to evaluate the acute effect of WBV on postural stability in adults with GJH. METHODS: 60 …participants were categorized into the groups: 1) hypermobility with vibration (GJH+ WBV), 2) hypermobility without vibration (GJH–WBV), 3) control group with vibration (CTRL+ WBV), 4) control group without vibration (CTRL–WBV). The first and the third group completed WBV (frequency: 15 Hz and 30 Hz, amplitude 3 mm, 3 × 3 min). The second and fourth groups participated only in measurement sessions. GJH was assessed using the Beighton test. Postural stability was measured as the overall stability index (OSI) on the Biodex Balance System on the stable and unstable platform with open and closed eyes. Measurements were taken before and after WBV for two weeks. RESULTS: At a frequency of 15 Hz, a significant time effect was observed for measurements Before and After in CTRL–WBV on the stable platform with open eyes (p = 0.012) and on the unstable platform with closed eyes (p = 0.000) for the GJH+ WBV and CTRL+ WBV groups. There were no significant interactions (p > 0.05) between factors. At a frequency of 30 Hz, there was a significant time effect Before and After (p = 0.047) on the stable platform with open eyes, but no interaction was found between factors (p = 0.835). CONCLUSION: There is no positive acute effect of WBV on postural stability in adults with and without GJH. Show more

Keywords: Joint instability, vibration, postural control, balance

DOI: 10.3233/BMR-240004

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1363-1371, 2024

Authors: Koca, Tuba Tülay | Özer, Alev

Article Type: Research Article

Abstract: BACKGROUND: During pregnancy, many pregnant women experience lumbopelvic pain due to mechanical, systemic, and hormonal reasons and this pain and fear of movement (kinesiophobia) causes daily life limitations. OBJECTIVE: To examine low back pain (LBP), kinesiophobia, disability, and related conditions that develop together during pregnancy. METHODS: The was a cross-sectional and analytical study. The presence, severity, and duration of pain in the lumbopelvic region were questioned. Postpartum LBP was evaluated using a self-administered questionnaire, disability using the Oswestry Disability Index (ODI), pain intensity using a visual analog scale (VAS), physical activity levels using …the physical activity level during pregnancy questionnaire and the international physical activity questionnaire short form, and kinesiophobia was evaluated using the Tampa Scale for Kinesiophobia. RESULTS: The study comprised 120 pregnant women with a mean age of 27.4 ± 6.1 years. It was observed that 42.3% of the pregnant had LBP (n = 69). The mean body mass index (BMI) was 73.6 ± 16.2 kg/m2 , and the mean VAS score was 5.5 ± 2 cm. When we divided the group according to the presence of LBP, age (p = 0.49), gestational week (p = 0.75), and gravida (p = 0.81) were similar. BMI (p = 0.038) and ODI scores (p < 0.001) were higher in the group with LBP. CONCLUSION: LBP in pregnant women has a higher frequency than in the normal population, regardless of age, gestational week, and gravida. Obesity appears to be a risk factor for LBP and increases disability. Kinesiophobia in pregnant women is significantly associated with obesity and disability. Unless there are contraindications, a physically active pregnancy process and regular exercise should be recommend. Show more

Keywords: Lumbopelvic pain, disability, exercise, pregnancy

DOI: 10.3233/BMR-240006

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1373-1380, 2024

Authors: Li, Mengshi | Shi, Qiongfang | Che, Xinle | Du, Xingyan | Wang, Dongming | Song, Yufeng

Article Type: Research Article

Abstract: BACKGROUND: Patients who underwent total knee arthroplasty (TKA) often experience muscle loss due to pain and limited mobility. Nutritional supplementation and rehabilitation may positively affect the decline in muscle function. OBJECTIVE: The purpose of this study is to evaluate whether whey protein intervention, in addition to conventional rehabilitation training, is beneficial in improving muscle function and quality of life in patients after TKA. METHODS: 72 patients who met the criteria were selected for this randomized controlled study. For the experimental group, whey protein was used as a daily supplement for 12 weeks, while …the control group was given a placebo, during which both groups received conventional rehabilitation training. Muscle strength and each of the secondary observables needed to be measured and statistically analyzed preoperatively and at 4, 8, and 12 weeks post-intervention. RESULTS: In total, 62 subjects completed the study: 32 in the experimental group and 30 in the control group. Both groups showed significant improvement in muscle strength, VAS, ROM, AKS and leg circumference after 12 weeks of treatment. Compared to the control group, patients in the experimental group showed significant improvement in muscle strength, VAS, ROM, AKS and leg circumference (p = 0.001, p = 0.002, p = 0.001, p = 0.001, p = 0.001, respectively) after 12 weeks of treatment. CONCLUSION: The 12-week intervention of whey protein nutritional supplement showed significant improvement in muscle mass and function among post-TKA patients besides aiding with conventional rehabilitation exercise. Show more

Keywords: Nutritional supplementation, isometric muscle strength, rehabilitation

DOI: 10.3233/BMR-240013

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1381-1390, 2024

Authors: Nakata, Akimi | Osuka, Satoshi | Ishida, Tomoya | Saito, Yuki | Koshino, Yuta | Samukawa, Mina | Kasahara, Satoshi | Tohyama, Harukazu

Article Type: Research Article

Abstract: BACKGROUND: Lumbopelvic movement patterns during prone hip extension has been proposed as a clinical screening method for trunk muscle dysfunction in patients with chronic low back pain (CLBP). However, correlations between trunk muscle onset and pelvic kinematics have not been investigated. OBJECTIVE: To examine the correlation between trunk muscle onset and pelvic kinematics during prone hip extension in participants with CLBP. METHODS: Fifteen patients with CLBP and 15 healthy individuals participated. We evaluated the muscle activities of the lumbar multifidus, the longissimus, and the semitendinosus via electromyogram and the displacement angles of the …pelvic tilt, oblique and rotation. RESULTS: The onset of the multifidus at the ipsilateral side of hip extension was significantly delayed in the patients with CLBP compared to the control group (P < 0.001). The onset of the ipsilateral multifidus in the control group was significantly correlated with increased anterior pelvic tilt angle (P = 0.019, r = 0.597), whereas no significant correlation was observed in the CLBP group (P = 0.810, r = - 0.068). CONCLUSION: The results suggest that pelvic kinematics during prone hip extension does not predict the delayed trunk muscle onset in patients with CLBP. Show more

Keywords: Biomechanics, electromyography, pelvis, paraspinal muscles, rehabilitation

DOI: 10.3233/BMR-240028

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1391-1400, 2024

Authors: Shahidzadeh, Azadeh | Toopchizadeh, Vahideh | Shahidzadeh, Arezoo | Farshbaf-Khalili, Azizeh | Salekzamani, Yaghoub

Article Type: Research Article

Abstract: BACKGROUND: Choosing appropriate complementary methods, such as exercise, along with taping methods may be effective in treating patients with kyphosis. OBJECTIVE: The present study aimed to examine the effect of different tape tensions/directions combined with corrective exercises on the degree of postural kyphosis in adolescents. METHODS: In this randomized controlled trial, 54 adolescents with postural kyphosis were assigned into three groups: No taping (control), I-shaped taping technique with 10% stretching force (Kinesiotape I), and I-shaped taping using facilitation technique with 40% stretching force (Kinesiotape II). Both groups in Kinesiotaping also received a V-shaped …tape (10% stretching force). All participants received a similar comprehensive corrective exercise. Patients received the allocated interventions for 6 weeks and visited every two weeks at the clinic. Measurements were done using a flexible ruler, kyphometer, and photogrammetry. RESULTS: Between-group analyses revealed no significant differences between the study groups following the interventions (p > 0.05). However, the within-group analyses according to flexible ruler, Kyphometer, and Photogrammetry measurements indicated that exercise alone (control) [p = 0.011, p = 0.056, and p = 0.005, respectively], Kinesiotape I – exercise [p = 0.001, p = 0.002, p = 0.013, and respectively], as well as Kinesiotape II – exercise [p < 0.001, p < 0.001, and p < 0.001, respectively] significantly decreased the postural kyphosis degree except exercise alone using Kyphometer measurement. No adverse events were observed during the study. CONCLUSION: The findings of photogrammetry, flexible rulers, and photogrammetry similarly indicated that the corrective exercises with or without tape tension/directions significantly decreased the postural kyphosis degree in adolescents. Show more

Keywords: Athletic tape, exercise therapy, kyphosis, adolescent, randomized controlled trials

DOI: 10.3233/BMR-240040

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1401-1415, 2024

Authors: Park, Eunjin | Lee, Yeon Soo | Yi, Jin-Seok | Choi, Eunseok

Article Type: Case Report

Abstract: BACKGROUND: Cervicogenic headache is characterized by chronic posterior neck pain radiating to one side of the head, resulting from cervical spine bone or soft tissue diseases. Cervical ganglioneuroma (GN), a rare benign neuroblastic tumor, especially in the cervical spine, may cause cervicogenic headache-like symptoms. OBJECTIVE: We report a case of GN which was surgically removed successfully to relieve the symptom. CASE REPORT: A 68-year-old male presented with right posterior neck pain with referred pain to the ipsilateral occipital area in May 2020. Despite administration of medications, physical therapy, and spine interventions, the symptoms …intermittently recurred over one year. In July 2021, the patient complained of painful limitation of neck motion, especially on right-sided bending; no motor or sensory deficits, except for subjective numbness of the finger tips, were detected. Plain radiography of the cervical spine showed moderate degenerative changes in the mid-cervical spine. Cervical MRI revealed a cystic mass (1.5 cm × 0.5 cm × 1 cm-in size) around the right C2 dorsal root ganglion adjacent to the C1–C2 facet joint. His symptoms significantly improved after complete tumor excision. CONCLUSION: GN of the upper cervical spine should be considered when persistent cervicogenic headache is refractory to conservative management. In such a case, advanced imaging studies such as MRI should be performed for early diagnosis and appropriate treatment. Show more

Keywords: Chronic neck pain, upper cervical spine pain, cervical dorsal root ganglia

DOI: 10.3233/BMR-230330

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1417-1422, 2024