Journal of Back and Musculoskeletal Rehabilitation - Volume 24, issue 1

Authors: Golriz, Samira | Walker, Bruce

Article Type: Review Article

Abstract: Purpose: A systematic review of the literature was conducted to answer the following questions: 1. Does usage or weight of load carriage system cause pain, perceived exertion or discomfort? 2. Can load carriage system placement on the spine influence pain, perceived exertion or discomfort? 3. Can load carriage system design influence the amount of pain, perceived exertion or discomfort caused by their use? Method: Eight databases were searched. Each included study was analysed and quality appraised by two independent reviewers. Results: Forty-seven articles that addressed the research questions were included in the study. Significant variability in …the study design and populations of the studies prevented data pooling and the evidence is conflicting. However, qualitative synthesis of the studies shows that carrying loads may provoke low back pain; and it may also trigger neck, thoracic and shoulder pain. Backpack weight can influence perceived pain, however other factors are involved. Discussion: There is conflicting but positive evidence on the correlation between backpack load carrying and experiencing pain during different stages of life. The research to date is lacking with the most commonly identified methodological deficiencies being poor overall design, the lack of justification of sample size, providing training sessions for examiners, and not utilising calibrated, valid and reliable instruments for measurement. Show more

Keywords: Backpack, pain, systematic review, front pack, double pack

DOI: 10.3233/BMR-2011-0275

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 24, no. 1, pp. 1-16, 2011

Authors: Talebian, Saeed | Hosseini, Majid | Bagheri, Hossein | Olyaei, Gholam Reza | Reazasoltani, Asghar

Article Type: Research Article

Abstract: Background: Trunk muscle fatigue has high relevance in human performance. Most authors agree that the use of the median frequency is preferred as a fatigue indicator. Most work has to date, been done on dynamic fatigue measurements, using the similarity index (SI). Objective: Repeated trunk flexion-extensions were measured using the B200 Isostation. Muscle activity was recorded by surface electromyography (EMG) in order to evaluate fatigue of trunk flexor and extensor muscles. Twenty male university students participated in this pilot study, including 6 apparently healthy subjects with a history of low back pain (LBP), and 14 healthy matched controls. …All participants were instructed to perform repeated trunk flexion-extension against 50% of their back extensors maximal volutary contractions (MVCs) resistance until they could no longer perform the task. The SI was calculated from quantitative analysis of EMG data recording during dynamic trunk flexion extension task. Median frequency was also measured before and after fatiguing contractions. Results: The results of this study revealed a significant decrease in the SI and median frequency measurements following fatigue in both groups (p< 0.05). Conclusion: The results of this study indicated that in both groups changes in SI measurements following fatigue are in agreement with the changes in median frequency measurements. Show more

Keywords: Similarity Index (SI), muscle fatigue, surface electromyography (EMG), {B200} isostation

DOI: 10.3233/BMR-2011-0270

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 24, no. 1, pp. 17-22, 2011

Authors: Ali, I. | Ulbricht, C. | McGregor, A.H.

Article Type: Research Article

Abstract: The spinal muscles have received great attention in low back pain (LBP) with suggestions of a de-conditioning syndrome. It is not known whether it is a long or short term consequence of LBP. This study explored the cross section area (CSA) and muscle quality of the spinal extensor group in LBP patients referred to a spinal clinic. MRI scans of 100 annoymised patients were retrospectively reviewed; sagittal and transverse (from levels L3-5) images were archived and analysed to determine CSA and levels of fat infiltration of the extensor muscle groups. Forty six patients had spinal stenosis (28 males, 18 females, …mean age 66 ± 14.2 years) and 54 had a disc prolapse (28 males, 26 females, mean age 50 ± 12.9 years). CSA was significantly smaller in the stenotics at both L3/4 and L4/5. Patients presenting with leg pain and a disc herniation had a significantly smaller CSA (p < 0.01) at L3/4 and L4/5 levels. Fat infiltration was present in both groups but was significantly greater in the stenotic group (p < 0.01) and was present at a similar degree at all spinal levels. Multiple regression analysis confirmed that reduced CSA was linked to leg pain (p < 0.01) and age was linked with fat infiltration (p < 0.01). Future work should explore the extent of such changes in an age and sex matched control population with no current back pain or sciatica. Show more

Keywords: Cross sectional area, muscle fat, sciatica, back extensors, MRI, degeneration

DOI: 10.3233/BMR-2011-0271

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 24, no. 1, pp. 23-30, 2011

Authors: Lee, Sang Chul | Rha, Dong-Wook | Chang, Won Hyuk

Article Type: Research Article

Abstract: Objective: The purpose of this study was to evaluate the efficacy of intra-articular ketorolac to improve intra-articular hyaluronic acid (HA) therapy in knee osteoarthritis with respect to the initiation of pain relief. Methods: This study was designed as a single-blind study with a blinded observer and a 3-month follow-up. Forty-three patients with knee osteoarthritis were randomized to the ketorolac group (n=21) or the HA group (n=22). Ketorolac group members were given three weekly intra-articular injections of HA with ketorolac and then two weekly intra-articular injections of HA; and HA group members were given five weekly intra-articular HA injections. …Visual analog scale (VAS), pain rating score (PRS) and adverse events were assessed at baseline and at 1st, 3rd, 5th, and 16th week after treatment commencement. Results: Significant improvement regarding pain assessment tools was observed in the ketorolac group by the addition of ketorolac to HA as compared with the HA group within 16 weeks of follow-up (p < 0.05). In the ketorolac group, 5 of the 21 subjects developed focal post-injection knee pain for about 8 hours after injection. Conclusion: Intra-articular HA with ketorolac showed more rapid analgesic onset than intra-articular HA alone and did not induce any serious complications. Show more

Keywords: Osteoarthritis, intra-articular injection, ketorolac, hyaluronic acid

DOI: 10.3233/BMR-2011-0272

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 24, no. 1, pp. 31-38, 2011

Authors: Yildiz, Necmettin | Atalay, Nilgun Simsir | Gungen, Gonca Odemis | Sanal, Engin | Akkaya, Nuray | Topuz, Oya

Article Type: Research Article

Abstract: Objective: The aim of this study was to compare the efficacy of ultrasound (US) and ketoprofen phonophoresis (PH) in the treatment of carpal tunnel syndrome (CTS). Design: This study was a prospective, randomised, controlled, double-blinded clinical trial with follow-up at 8 weeks. Fiftyone patients (76 median nerves) with clinical and electrophysiologic evidence of mild or moderate CTS were included in the study. They were randomly assigned to one of three groups; group 1 received sham US and splinting, group 2 received US and splinting, and group 3 received ketoprofen phonophoresis and splinting. Patients were evaluated by use of …electrophysiological variables such as median motor distal latency (mMDL), median sensory distal latency (mSDL), functional status scale (FSS), symptom severity scale (SSS) and visual analog scale (VAS). Electrophysiological variables and scales were evaluated at the beginning, end of therapy (2nd week) and 8th week. Results: All the randomised patients were included in the intention-to-treat (ITT) analysis. The per protocol (PP) analysis included only those patients who complied with the study protocol. After completing 2 weeks of treatment, seven out of 51 randomized patients did not finish the study protocol due to non-compliance to splinting, illness and lost to follow-up. Those patients were excluded from PP analysis. Participants were similar in all clinical, electrophysiological and demographic respects (p>0.05). An improvement was found in all parameters (VAS, FSS, SSS, mMDL and mSDL) for all groups at the end of the treatment and 8th week. It was found that pain score was significantly lower in group 3 compared to other treatment groups at 8th week according to ITT and PP analysis (p= 0.002, p=0.004 and p=0.001, p=0.001). Conclusion: Ketoprofen PH as adjuvant therapy on splinting is effective with respect to reduction of pain. Adding US therapy to the splinting is not superior to the splinting alone in patients with CTS. Show more

Keywords: Ultrasound, ketoprofen, phonophoresis, carpal tunnel syndrome

DOI: 10.3233/BMR-2011-0273

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 24, no. 1, pp. 39-47, 2011

Authors: van der Worp, H. | Zwerver, J. | Kuijer, P.P.F.M. | Frings-Dresen, M.H.W. | van den Akker-Scheek, I.

Article Type: Research Article

Abstract: Patellar tendinopathy is a common injury in jumping athletes. Little is known about work-related etiological factors for patellar tendinopathy and related work limitations. The aim of this study was to identify work-related etiological factors for patellar tendinopathy and to determine the relation between patellar tendinopathy and work limitations. Basketball and volleyball players between 18 and 35 years were invited to complete an online-questionnaire concerning knee complaints, etiological risk factors for patellar tendinopathy and related work limitations. A total of 1505 subjects were included in the analysis. Risk factors for patellar tendinopathy were gender and heavy physically demanding work. The odds …for having patellar tendinopathy were significantly higher for heavy physically demanding occupations compared to mentally demanding occupations. 30% of subjects with patellar tendinopathy with a physically demanding job reported to be impaired in their work and 17% reported to be less productive. Basketball and volleyball players with heavy physically demanding work seem to have an increased risk for developing patellar tendinopathy. This finding has important clinical relevance in the treatment of this injury. Working activities should be adjusted in order to reduce the total load on the patellar tendon and help prevention and recovery. Show more

Keywords: Patellar tendinopathy, occupation, etiology, work-related limitations, knee injury

DOI: 10.3233/BMR-2011-0274

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 24, no. 1, pp. 49-55, 2011

Authors: Kesiktas, Nur | Karagülle, Zeki | Erdogan, Nergis | Yazıcıoglu, Kamil | Yılmaz, Hurriyet | Paker, Nurdan

Article Type: Research Article

Abstract: Effects of balneotherapy on Primary Fibromyalgia Syndrome (FMS) have been studied well, except for its effect on the respiratory symptoms of FMS. In this study we allocated 56 patients with FMS into three groups who matched according to age, gender and duration of illness. All three groups received the same three physical therapy modalities (PTM): transcutaneous electrical nerve stimulation (TENS), ultrasound (US) and infrared (IR). The first group received PTM plus balneotherapy (PTM+BT), the second group received PTM alone (PTM), whilst the third group received PTM plus hydrotherapy (PTM+HT). All groups were treated for three weeks and in the same …season. All patients were assessed at four time points: (a) at baseline, (b) on the 7{th} day of therapy, (c) at the end of therapy (after 3 weeks) and (d) at 6 months after the end of therapy. The effectiveness of treatments in all groups were evaluated in three main categories (pain, depressive and respiratory symptoms). Tender point count, total algometric measurements and pain with visual analog scale for pain; Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) for depression; dyspnea scale, and spirometric measurements for respiratory symptoms; plus quality of life with visual analog scale as a general measurement of effectiveness were taken at all four assessment time points. Both at the end of therapy and at the 6 months follow up significant improvements in dyspnea scale, and spirometric measurements, as well as in other measured parameters were observed in group PTM+BT. All groups achieved significant improvements in BDI and HDRS but scores of PTM and PTM+HT groups had overturned at 6 months follow up. Except second group which receieved PTM alone, pain evaluation assessments were improved at 6 month follow up in PTM+HT and PTM+BT groups. But PTM+BT group had more significant improvements at the end of therapy. PTM group had no significant change for dyspnea scale and spirometric measurements. PTM combined BT and HT groups achieved significant improvements at the end of therapies for dyspnea scale and spirometric measurements, but only PTM +BT group had significant improvements for dyspnea scale and spirometric measurements at six month follow up. The group of PTM+BT was significantly better than other groups. Our results suggest that supplementation of PTM with balneotherapy is effective on the respiratory and other symptoms of FMS and these effects were better than other protocols at 6 month follow up. Show more

Keywords: Fibromyalgia, spirometry, balneotherapy, hydrotherapy, physical therapy modalities

DOI: 10.3233/BMR-2011-0276

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 24, no. 1, pp. 57-65, 2011