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