Journal of Back and Musculoskeletal Rehabilitation

BACKGROUND: Patients with fibromyalgia present a reduced capacity of upper and lower limb physical performance and affect their independence in performing everyday activities.

OBJECTIVE: The purpose of the present systematic review was to summarize evidence for the effectiveness and structure of exercise programs on functional aerobic capacity in patients with fibromyalgia syndrome.

METHODS: Keyword searches were made of seven databases. The systematic review was limited to English language studies of people with FM that evaluated the effects of exercise programs on functional aerobic capacity (6-minute walk test).

RESULTS: The criteria for inclusion were satisfied by 12 randomized controlled trial (RCT) studies. The main cumulative evidence indicates that the programs based on aerobic exercise alone and on aquatic exercises have large (effect size = 0.85) and moderate (effect size = 0.44) effects.

CONCLUSIONS: Aerobic and aquatic exercises at the proper intensity favour the increased functional aerobic capacity of fibromyalgia patients; however, most works do not adequately detail the intensity of the exercises. Moderate intensity exercise (aerobic and aquatic exercise) performed at least two times per week and 30-60 minutes a day is effective for increasing functional aerobic capacity, favouring the daily activities of daily living in this population.

BACKGROUND: Chronic low back pain causes socioeconomic burdens. Whether lumbar fusion is more effective than nonsurgical treatment of discogenic low back pain (DLBP) is controversial. Several randomized controlled trials that compared conservative treatment and fusion surgery had conflicting conclusions.

OBJECTIVE: To compare between the effectiveness of lumbar fusion and nonsurgical intervention in patients with chronic low back pain caused by disc degeneration.

METHODS: PubMed, the Cochrane Library, EMBASE, the Science Citation Index, Chinese Biomedical Literature Database, and references of relevant papers published from 1990 to 2013 were searched. Related data matching standards established for this research were extracted and statistically analyzed by using the RevMan (5.2) software.

RESULTS: Meta-analysis of 6 randomized controlled trials with a total of 889 patients revealed no difference in Oswestry Disability Index(ODI) score for DLBP between the fusion surgery and nonsurgical groups (mean difference, 1.94; 95% confidence interval [CI], -6.02 to 2.14). Postsurgical complication rate significantly differed between the 2 groups(risk ratio, 22.11; 95% CI, 55.99-81.60).

CONCLUSIONS: Fusion surgery was not superior to nonsurgical treatment in terms of changes in ODI scores for DLBP. Fusion surgery resulted in surgical complications. Longer follow-up observation is necessary regarding condition-specific disability, pain, and life satisfaction.

OBJECTIVE: The purpose of this study is to compare the plantar foot pressure and the center of pressure (COP) pathway of normal and flat feet while crossing an obstacle at different heights.

METHODS: Nineteen subjects (10 normal feet, 9 flat feet) participated in this study. The plantar foot surface was divided into the following seven regions for pressure measurement: two toe regions, three forefoot regions, one midfoot region, and one heel region. A one-way ANOVA with repeated measurements was used to compare the plantar foot pressure of normal and flat feet according to the obstacle height.

RESULTS: The trend analysis showed a quadratic trend during level walking for the normal foot group, but a linear trend appeared as the obstacle height increased. In the flat foot group, the trend analysis showed a linear trend regardless of the obstacle height. In the 2nd-3rd metatarsal head region, the plantar pressure of the flat foot group increased more than the normal foot group as the obstacle height increased; however, in the 4th-5th metatarsal head region, the plantar pressure in flat feet was lower than in normal feet. In the heel region, the plantar pressure in both groups generally increased as the obstacle height increased, but the plantar pressure in the flat foot group was lower than in the normal foot group.

CONCLUSION: We believe that, due to a loss of longitudinal arch, the COP path and plantar pressure of flat feet may be different from normal feet when crossing obstacles of different heights.

OBJECTIVES: To compare the thickness of lateral abdominal muscles and Cross Sectional Area (CSA) of lumbar Multifidus Spinae (LM) muscles of competitive off-road cyclists with and without Low Back Pain (LBP). We also aimed to compare the maximum isometric back strength and endurance, as well as flexibility of lower back in cyclists with LBP and in the controls.

METHODS: The thickness of Transversus Abdominis (TrA), Internal Oblique (IO) and External Oblique (EO) along with the CSA of LM muscles of 14 professional competitive off-road cyclists with LBP and 24 controls were measured by ultrasound (US) in hook-lying position on the examination table, and mounted on the bicycle. In addition, the back strength and endurance of the subjects and the flexibility of the participants were measured.

RESULTS: Data showed a significantly lower thickness of Transversus Abdominis (TrA) and CSA of LM muscles in cyclists with LBP comparing to controls in all positions. No significant result regarding the flexibility of the subjects in case group comparing with the controls was found (p= 0.674). In addition, it was found that there is no significant difference in isometric back strength of the subjects between the groups(p= 0.105). However, we found that subjects with LBP have a lower endurance in back dynamometry with 50% of their maximum isometric back strength(p= 0.016).

CONCLUSION: In this study, useful information regarding possible factors associated with low back pain in off- road cyclists was found (lower thickness of TrA and LM muscles and decreased back endurance).

In the present study, we aimed to examine the changes in the thickness of the transversus abdominis (TrA) and internal oblique (Io) muscles using ultrasonography in adults who performed bridge exercises with the abdominal drawing-in maneuver and a sling and received micro vibrations. In total, 32 subjects were divided into a therapy (n= 16) and control (n= 16) groups. The therapy group completed nine sets, with four repetitions, of bridge exercises with the sling and received vibrations. The control group completed nine sets, with four repetitions, of bridge exercises with the sling and did not receive vibrations. The thicknesses of the TrA and Io muscles were measured in both groups using ultrasonography before and after therapy. According to the pressure applied to the biofeedback unit, both groups showed significant changes in the thicknesses of the TrA and Io muscles after therapy (P< 0.05). The change in the thickness of the TrA muscle after therapy was significantly different between the 2 groups when the pressures applied at 38, 42, and 46 mmHg (P< 0.05). Moreover, the change in the thickness of the Io muscle did not significantly different between the 2 groups at any of the pressures applied (P> 0.05). These findings indicate that approximately 15 minutes of vibrations during bridge exercises on unstable surfaces with a sling facilitates the activation of the deep trunk muscles and further enhances the activation of the TrA.

BACKGROUND: Chronic low back pain (CLBP) is a serious health problem in industrialised countries and the efficacy of current treatment options is unsatisfying.

OBJECTIVE: The present study examines the effects of a combined intervention that utilizes visual feedback, motion and sensory discrimination training in CLBP patients.

METHODS: Thirty patients of an outpatient orthopaedic rehabilitation unit were randomly assigned to either feedback or control group. In addition to standard treatment, patients of the feedback group received 6 feedback sessions where they watched the image of their back during a brief 2-point discrimination training and, after that, while they were tilting their pelvis up and down on the left and right side using their lumbar musculus multifidus solely. The control group received 6 sessions consisting of 2 units of physiotherapy, relaxation training and movement training (walking) each.

RESULTS: A significant effect on self-reported pain and sensory discrimination threshold could be found for the feedback intervention, while, as expected, other pain related variables, like pain anxiety, pain vigilance, depression and cognitive appraisal of pain remained unchanged.

CONCLUSIONS: These findings imply that very simple feedback interventions without major technical requirements could be a valuable supplement to standard treatment in CLBP.

OBJECTIVE: The aim of this study was to investigate the psychometric properties of the Italian version of the Pain Catastrophizing Scale (PCS-I) in patients with chronic low back pain.

METHODS: In a cross sectional study a total of 150 subjects with chronic low back pain were included. The Italian translation of the PCS was administered to all subjects. The properties of the Italian version of the PCS were explored by a Rasch analysis.

RESULTS: The PCS-I, by means of few modifications, fitted the Rasch model and passed the independent t-test for a unidimensional scale. The response categories for item 2 ``I fell I can't go on'' needed to be collapsed from 4 to 3 levels. Only the item 7 ``I keep thinking to of other painful events'' showed fit residual that exceeded the chosen thresholds of± 2.5. No Differential functioning (DIF) was observed for age, sex, marital status, BMI and smoking.

CONCLUSION: The Italian version of PCS, with the purposed modifications, seems to reflect a unidimensional construct of Pain Catastrophizing. The scale seemed to be quite robust across age, sex, marital status, BMI and smoking. Targeting of the scale was moderate. A raw score to metric conversion was proposed.

PURPOSE: Lumbar Segmental Instability (LSI) is a subgroup of nonspecific Low Back Pain (NSLBP) without any accepted diagnostic tool as a gold standard. Some authors emphasize on quality measure such as centre of rotation (COR) but construct validity of this measure had not been approved. Therefore the purpose of the present study was to evaluate Concurrent and Convergent validity of COR in differentiating LSI.

METHODS: A total of 66 volunteered males participated in three groups named control, NSLBP and LSI groups based on clinical examination. Patients were diagnosed as LSI according to screening criteria adopted by Hicks et al. Study variables included CORs of lumbar segments in sagittal plane. Three x-rays were taken in neutral, flexion and extension positions. The variables were calculated using CARA software. The ANOVA and Tukey test were utilized in statistic analysis.

RESULTS: ANOVA results demonstrated mean differences between three groups for COR of L4 motion segment in y axis (p= 0/008) and L5 motion segment in y axis (p= 0/005) were significant. Tukey test showed significant difference for COR of L4 motion segment in y axis between LSI and healthy groups (p= 0/038) and between LSI and NSLBP groups (p= 0/009). For COR of L5 motion segment in y axis, tukey test demonstrated mean difference between LSI and healthy groups (p= 0/028) and between LSI and NSLBP groups (p= 0/007) were significant. Tukey test did't show any significant difference between NSLBP and healthy groups for COR of L4 (p= 0/852) and L5 (p= 0/871) motion segments in y-axis.

CONCLUSIONS: The COR has ability to differentiate patients with signs and symptoms of LSI from other NSLBP and healthy subjects based on the present study results. However, more researches are needed to develop and support results of this study.

BACKGROUND: In a recent genome wide association study, polymorphisms in the DSCAM and CNTNAP2 genes were reported to be related with susceptibility of AIS. Consequently, further replication studies are warranted in other populations due to ethnic difference in genetic background.

OBJECTIVE: To explore whether single nucleotide polymorphisms (SNPs) of DSCAM (rs2222973) and CNTNAP2 (rs11770843) genes are associated with the susceptibility and curve severity of AIS in a Chinese Han population.

METHODS: A total of 648 AIS patients and 573 age- and sex-matched healthy adolescents in rs2222973 were recruited, and in rs11770843 there were 100 AIS patients and 100 age- and sex-matched healthy adolescents included in present study. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was repeatedly carried out to verify the linkage of AIS with SNPs rs2222973 in the DSCAM gene and rs11770843 in the CNTNAP2 gene. Case-control and case-only studies were respectively performed to define the contribution of the DSCAM gene polymorphisms to predisposition and disease severity of AIS.

RESULTS: Association analysis of the DSCAM SNP rs2222973 with AIS revealed no significant differences both in genotype frequency (p= 0.280) and allelic frequency (p= 0.643). The CNTNAP2 SNP rs11770843 (C/T) was not found in either the AIS or control group; all 100 AIS patients and 100 normal controls had the T/T genotype. Among skeletally matured AIS patients, the average maximal Cobb angles were also comparable within different DSCAM genotypes.

CONCLUSION: Our study did not repeatedly confirm the association of the rs2222973 or the rs11770843 with AIS in a Chinese Han population. We concluded that the associations of rs2222973 with AIS predisposition and curve severity are negative in a Chinese Han population.

BACKGROUND: The use of bandages improves quasi-static posture control in individuals with knee osteoarthritis, but it is unknown whether this increased sensory input influences postural control in dynamic tasks.

OBJECTIVE: Assess the effect of bandage use on motor performance and reported pain in individuals with knee osteoarthritis during obstacle crossing.

METHODS: Twenty-four individuals with knee osteoarthritis were enrolled. A force plate was used to measure the vertical and anterior-posterior components of the ground reaction force during obstacle crossing, for the trailing and leading legs, under conditions with and without the use of a bandage. Pain was assessed using the visual analogue scale.

RESULTS: With use of a bandage, the propulsive time, time to active peak, propulsive peak, passive peak, and active impulse were significantly reduced in the trailing leg, and the braking peak was significantly increased in the leading leg. The pain parameters did not exhibit any variation.

CONCLUSIONS: These results suggest that the use of a bandage allowed for a more rapid movement, better estimates of the force applied against the ground in the propulsive stage, and a reduction in the overload on the locomotor system in the loading response stage.

BACKGROUND AND OBJECTIVES: Low back pain is a common health problem in human being and about 5 to 15% will develop chronic low back pain (CLBP). The clinical findings of CLBP suggest that lumbar mobility is decreased and recruitment order of core muscles is altered. In literature, there is no data about the effect of core muscles strengthening in the chronicity (short duration, long duration) of CLBP. This study evaluated the effect of core muscle strengthening intervention on chronicity of chronic low back pain.

METHOD: Thirty patients were recruited from the outpatient department of the National Institute for the Orthopaedically Handicapped. These 30 patients divided into two groups: A and B on the basis of duration of low back pain. Group-A patients complain about pain duration for more than twelve months and Group B complains about pain duration from three to twelve months. Both the groups were received same intervention for six weeks. Assessment was done pre intervention and post intervention after six weeks for both the groups. %For both the groups the assessment was done after six weeks for pre and post intervention.

RESULTS: The result described both the groups showed improvement in all the outcome measures including pain as well as in function using Numerical pain rating scale, Oswestry Disability Index, Sorensen test, Gluteus Maximus Strength, Activation of transversus abdominis and Modified-Modified Schober's Test. The improvement was statistically non-significant with inter groups and significant within group.

CONCLUSION: This study concludes that core muscle strengthening exercise along with lumbar flexibility and gluteus maximus strengthening is an effective rehabilitation technique for all chronic low back pain patients irrespective of duration (less than one year and more than one year) of their pain.

BACKGROUND: Chronic pain is a common consequence of spinal cord injury (SCI). No therapeutic drugs or drug groups are proven to be superior for neuropathic pain and treatments only aim to convert pain from dull to tolerable levels and not to remove it.

OBJECTIVE: This study was planned to compare the effect of visual illusion (VI) and transcutaneous electrical nerve stimulation (TENS) on pain intensity, pain quality and functional capacity in SCI patients with neuropathic pain.

METHODS: Twenty-four patients were included and randomly categorized into two groups. In the first group (n= 12), visual illusion was applied for first two weeks, 1 week wash out period and then TENS was applied for 2 weeks. In second group (n= 12), TENS was applied firstly, 1 week wash out and then %visual illusion VI were applied. Pain severity, pain quality, and functional capacity were assessed with the visual analog scale (VAS), the neuropathic pain scale (NPS), and the brief pain inventory (BPI), respectively. A pre-post-treatment and cross over design was used.

RESULTS: Wilcoxon signed-rank tests were used for within group analyses. Mann-Whitney U tests were used for analyses that compared different groups. It was observed that pain intensity decrease immediately after both applications (VI: p= 0.07, TENS: p= 0.08). After TENS application for 2 weeks, it was observed that significant decrease in most (p= 0.04) and less (p= 0.02) pain intensity; while there was no significant decrease in pain intensity after 2 weeks for VI (p> 0.05). When findings of NPS were analyzed, hot (p= 0.047), sharp (p= 0.02), unpleasant (p= 0.03) and deep items(p= 0.047) decreased after VI application. When the results of BPI were detected, they were observed that the negative effect of pain on moving ability (p= 0.04) after visual illusion application and the negative effect of pain on mood (p= 0.03), relationships with others (p= 0.04) and sleep(p= 0.04) after TENS application decreased significantly.

CONCLUSION: TENS and VI therapies can be successfully used in clinical practice as an alternative treatment or as a supportive method separetely or together.

BACKGROUND: Although intensively investigated, the procedures for assessment and monitoring of scoliosis are still a subject of controversies.

OBJECTIVE: The aim of this study was to assess validity and reliability of a number of physiotherapeutic measurements that could be used for clinical monitoring of scoliosis.

METHODS: Fifteen healthy (symmetric) subjects were subjected to a set of measurements two times, by two experienced and two inexperienced physiotherapists. Intra-observer and inter-observer reliability of measurements were determined. Following measurements were performed: body height and weight, chest girth in inspirium and expirium, the length of legs, the spine translation, the lateral pelvic tilt, the equality of the shoulders, position of scapulas, the equality of stature triangles, the rib hump, the existence of m. iliopsoas contracture, Fröhner index, the size of lumbar lordosis and the angle of trunk rotation.

RESULTS: Intraclass correlation coefficient was high (> 0.8) for majority of measurements when experienced physiotherapists performed them, while inexperienced physiotherapists performed precisely only basic, easy measurements.

CONCLUSIONS: We showed in this pilot study on healthy subjects, that majority of basic physiotherapeutic measurements are valid and reliable when performed by specialized physiotherapist, and it can be expected that this protocol will gain high value when measurements on subjects with scoliosis are performed.

BACKGROUND: Low back pain (LBP) is a major public health problem and is the leading musculoskeletal cause of disability. Various bio-behavioral factors which can be associated with disability due to LBP have been identified. When considering these factors associated with LBP, beliefs that people hold are among the most important factors to consider.

OBJECTIVE: To find out the prevalence of LBP among the general population and to investigate their beliefs towards LBP.

METHODS: A cross-sectional survey of the general population was conducted. Demographic information and information on beliefs regarding low back pain was gathered from 921 individuals. The respondents were asked to rate their agreement with 7 statements, corresponding to Deyo's 7 myths.

RESULTS: 75% of the population reported lifetime prevalence of LBP. Regarding the beliefs about LBP, general population exhibited diverse attitudes. Out of 7 myths explored, 3 myths were found to be dead and buried in more than 50% of the sampled population. However, 4 out of 7 myths still exist among the population.

CONCLUSIONS: Prevalence of Low Back Pain was found to be high among the general population sampled and also myths regarding LBP still exist among them.

BACKGROUND: Upper extremity strengthening and gait training with orthoses form a major part of inpatient rehabilitation of paraplegic patients in developing countries. This helps to overcome architectural barriers and limited wheelchair accessible environment in the community.

OBJECTIVES: To evaluate the changes in physiological properties of the Triceps Brachii muscle following exercise training in individuals with paraplegia. The authors also explored the correlation between muscle property changes and gait parameters using orthoses in paraplegic persons.

METHODS: Twelve subjects with complete paraplegia and neurological level of injury(NLI) from T9 to L1, underwent exercise training for a mean 64.1 ± 4.1 days. Triceps brachii was chosen as the sample muscle. Variables like arm circumference, time to fatigue and mean power frequency (MF) (surface EMG parameter), were recorded at the beginning and the end of training, during a sub-maximal isometric elbow extension. Non-parametric tests were used to assess statistical significance between the two recordings. Additionally, gait parameters like walking speed and distance (with the help of orthoses) were obtained and compared with the above variables, to determine impact of upper extremity strengthening on gait improvements in such patients.

RESULTS: Statistically significant changes were noted in bilateral arm circumferences(p= 0.003 bilaterally) and MF drop, expressed as percentage (right p= 0.04, left p= 0.01), indicative of better muscle resilience and adaptation. Significant positive correlation was observed between `time to fatigue' and the orthoses-aided total walking distance (right ρ = 0.65, left ρ = 0.69).

CONCLUSIONS: Exercise training induces noticeable changes in the muscles of upper extremities favoring better muscle adaptation. Furthermore, positive correlation between `time to fatigue' and (orthotic) aided walking distance highlights the positive impact of strengthening program on gait parameters in paraplegic patients. These findings are important and relevant in developing countries with environmental barriers. Upper extremity strengthening should be included in the rehabilitation of paraplegic patients who are being trained for ambulation with orthoses.

OBJECTIVE: The purpose of this study was to compare the quality of life of patients with lumbar spinal stenosis (LSS) with that of the controls' and to investigate the factors related with the quality of life in LSS.

METHODS: Fifty-four patients with LSS were included in the study whose diagnosis were made by clinically and magnetic resonance imaging(MRI). Control group consisted of age and sex matched 54 individuals. Both of the patient and control groups were evaluated with the Short Form-36(SF-36) health survey and Hospital Anxiety Depression Scale (HADS). The Oswestry Pain and Disability Index (ODI) was used for the assessment of the disability.

RESULTS: SF-36 scores in the LSS group was lower than that of the controls'. There was a significantly positive correlation between the SF-36 scores and walking distance in LSS group. A moderately negative correlation was found between the SF-36 and the ODI, HADS anxiety and depression scores. There was a significantly positive correlation between the ODI and the HADS anxiety and depression scores. HADS anxiety and depression scores in the patient group were significantly higher than that of the controls'.

CONCLUSIONS: As a result, quality of life was decreased in subjects with LSS. The factors related with the quality of life were the walking distance, severity of the disability and emotional status in LSS.

BACKGROUND: Dentists have to remain in a fixed position during dental practices for the accuracy required, therefore they are susceptible to musculoskeletal disorders (MSDs).

OBJECTIVES: Considering the infrequency of ergonomics studies in general dental practitioners (GDPs), especially in cervical region, this study aimed to reviews MSDs in the neck region among GDPs.

METHODS: An analytic cross-sectional study was carried out among the GDPs in 2011. A total of 60 dentists (40 males and 20 females) were examined through a combination of questionnaires (concerning their demographic information) such as the Nordic standardized musculoskeletal disorder questionnaire (NMQ) and Body Discomfort Assessment questionnaire (BDA). Each dentist's working posture was assessed using Rapid Upper Limb Assessment (RULA) and deep cervical flexor muscle endurance through a Craniocervical Flexion test (CCFT). Descriptive statistical indexes and Chi-square test were used for statistical analysis, while considering p< 0.05.

RESULTS: The mean dental practice experience was 16.9 ± 5.6 years with average 41.2 ± 13.4 working hours per week. About 45% of dentists took regular exercises weekly. Some 83.3% of these dentists expressed to be suffering from the cervical pain, whereas, 56.7% complained about back pains and 41% shoulder problems. Female dentists were found more at risk of neckache, discomfort and pain in shoulder and hand than males. Greater pain frequency in knee was found in more experienced and older age dentists (P= 0.07). Results from the CCF test showed that the deep cervical flexor muscles endurance increased with regular exercise and decreased with aging.

CONCLUSION: Many dentists experience the MSDs, especially in cervical region, as a consequence of occupational stresses. Therefore, detecting occupational risk factors, standards of work position, regular exercise and following ergonomic policy are intensely recommended.

BACKGROUND: The position of metacarpophalangeal (MCP) joints may be an important factor affecting the efficacy of splinting in patients with carpal tunnel syndrome (CTS).

OBJECTIVE: The aim of the present study was to compare the efficacy of a neutral volar static wrist splint with a neutral volar static wrist and MCP splint in patients with CTS.

METHODS: Fifty-four hands were included into the study. A neutral volar static wrist splint was given to the symptomatic hands of the patients in group 1 while a neutral volar static wrist and MCP splint was given to the symptomatic hands of the patients in group 2. Evaluation parameters were Visual Analog Scale for pain severity (VASp), grip strength, pinch strength, electrophysiologic tests and CTS Questionnaire (CTSQ) at baseline and four weeks later.

RESULTS: At baseline there was no difference between groups. The intergroup comparison of the improvement showed significant differences in VASp at rest, grip strength, pinch strength and CTSQ functional capacity scores between groups in favor of wrist MCP splint. Although there were significant improvements with regard to sensory amplitude and motor latency in both groups after therapy, the differences between groups were not at the level of significance.

CONCLUSIONS: The position of MCP joints seems to be an important factor for the treatment of CTS and should be considered while prescribing a splint to the patients with CTS.

BACKGROUND: The University of Western Ontario Questionnaire for Musculoskeletal Conditions in Senior Golfers (MSK Golfers) was developed in Canada because of a lack of knowledge concerning musculoskeletal conditions directly related to golf play and warm-up, although the high injury incidence in golf practice. This lack of epidemiological measures also exists for the Portuguese golf population.

OBJECTIVE: The purpose of this study was to translate and cross-culturally adapt the MSK Golfers questionnaire into Portuguese and to test its construct validity and reproducibility.

METHODS: The MSK Golfers was translated from English to Portuguese and tested for psychometric properties. Sixty-one golfers, aged between 14 and 70 years and with at least 1 year of practice in golf, were recruited. The validity of the MSK Golfers was assessed by evaluating data quality(missing, floor and ceiling effects). Reproducibility analysis included intra-class correlation coefficients (ICC) (2,1) and Cohen's Kappa coefficient.

RESULTS: The ICC values for continuous items ranged from 0.634 to 0.998 with the exception of one item on golf activity. Kappa statistics for the categorical items ranged between 0.714 and 1.00.

CONCLUSIONS: The Portuguese version of the MSK Golfers, including playing characteristics and warm-up patterns of golfers, showed a high reliability for a golfing population with an age range of 14 to 70 years.

BACKGROUND: Low back pain (LBP) is a public health problem commonly seen in all societies.

OBJECTIVE: The aim of this study was to determine the prevalence and specific risk factors of low back pain (LBP) in the central and outlying districts of the province of Trabzon, a Black Sea region of Turkey.

METHOD: A random sample of 7897 (4006 men and 3789 women) adults was collected by using sampling techniques of stratification. In this study questionnaires were completed at face-to-face interviews with participants selected on the basis of place of residence, gender and age group. The used variables in this study were: use of cigarettes, status of marriage, level of education, and presence of chronic disease, the prevalence of lifetime LBP and of LBP in the preceding year. Chronic LBP was determined as being present for more than 6 weeks.

RESULTS: The lifetime prevalence of LBP in the general population was determined at 62.1%. Prevalence in the preceding year was 46.1%, and that of LBP lasting more than six week was 18.1%. Lifetime prevalence of LBP, prevalence of LBP in the preceding year and prevalence of pain lasting more than six week were all statistically significantly higher in women (p< 0.001). Use of cigarettes, female gender, marriage, a low level of education and presence of chronic disease were identified as independent risk factors for LBP (p< 0.001).

CONCLUSION: Lower back pain is a common public health problem. Recommendations were made for local health services to prevent LBP, including health education through combating chronic diseases, reducing cigarette consumption, improvement of working environments and life styles.

OBJECTIVE: This study examined the effect of modified prone trunk-extension (PTE) exercises on selective activity of the thoracic erector spinae.

METHODS: Thirty-nine healthy subjects performed four modified PTE exercises, involving location of the edge of the table (iliac crests [IC] vs. xiphoid process [XP]) and the degree of trunk extension (horizontal vs. hyperextension). Electromyography signals were collected bilaterally from the longissimus thoracis (LT), iliocostalis thoracis (ICT), and iliocostalis lumborum (ICL). Normalized LT:ICL and ICT:ICL ratios were calculated. The data were analyzed using a repeated measures two-way analysis of variance.

RESULTS: The LT:ICL and ICT:ICL ratios were significantly higher under the XP than the IC condition (p < 0.05); however, the degree of trunk extension did not affect the ratio (p > 0.05). Activity in the lumbar erector spinae and left ICT muscles was greater when subjects were in the hyperextended position than in the horizontal position. Moreover, activity in the thoracic erector spinae was greater when the table edge was aligned with the IC compared with the XP (p < 0.05).

CONCLUSIONS: Our findings suggest that PTE exercise with the XP aligned with the table edge increased the selective activation of the thoracic erector spinae muscles.

BACKGROUND: Chronic neck pain is one of the most usual neuromusculoskeletal pain conditions which can lead patients to chronic disability. Similarly to other pain conditions, the changed psychological status of these patients is believed to be associated with their pain condition and disability. However, the association between the psychological status of patients with idiopathic neck pain and their pain intensity and disability is minimally explored.

OBJECTIVE: This study was aimed at investigating the association between psychological states (anxiety, depression, kinesiophobia, catastrophizing) of patients with chronic idiopathic neck pain and self-reported pain and disability.

METHODS: Forty five patients with idiopathic chronic neck pain (more than 6 months, at least once a week) participated. Their psychological states were assessed by using the Hospital Anxiety and Depression scale, Pain Catastrophizing scale and Tampa Scale for Kinesiophobia. Self-reported disability was recorded with the Neck Disability Index. Pain intensity was recorded by using a visual analog scale.

RESULTS: Neck pain intensity was significantly correlated with anxiety(p< 0.05). Disability was significantly correlated with anxiety, depression and catastrophizing (p< 0.05). Multiple regression analysis showed that pain-induced disability can be significantly predicted by anxiety and catastrophizing (p< 0.05).

CONCLUSIONS: It can be concluded that anxiety, depression and catastrophizing of patients with chronic neck pain is associated with their self-reported disability, whereas anxiety is also associated with their pain intensity. Anxiety and catastrophizing may be important predicting markers of patients' self-reported disability.

OBJECTIVE: The objective of this study is to investigate musculoskeletal system problems and quality of life of mothers of children with cerebral palsy with different levels of disability.

METHODS: 100 children (37 girls and 63 boys) with cerebral palsy (CP) and their mothers were included in this study. Functional levels of children with CP were assessed by using the Gross Motor Function Classification System(GMFCS) and the Pediatric Functional Independence Measure (WeeFIM). Quality of life of mothers regarding health was assessed by using the Nottingham Health Profile (NHP). Musculoskeletal system problems of mothers were assessed by using the Neck Disability Index (NDI) and the Roland-Morris Disability Questionnaire (RMDQ).

RESULTS: No statistical significance was found when GMFCS levels of children with CP and the NHP, DASH-T, RMDQ, NDI and the BAE values of mothers were compared in an inter-group way (p> 0.05). When the NHP parameters and the existence of lower and arm pains of mothers were compared with their BAI, NDI, RMDQ and DASH-T scores, a statistically significant relationship was found among them (p< 0.05).

CONCLUSION: As functional levels of children with CP get worse, upper extremity, lower back and neck problems and anxiety levels of mothers increase and this situation negatively affects mothers' quality of life.

BACKGROUND: The relationship between low back pain (LBP) and reduced hip rotation has been well established. However, there is a lack of studies investigating the effect of treatment targeted at the hip in people with LBP.

OBJECTIVE: The aim of this study was to assess the level of effectiveness that different types of exercises targeted at the hip had on pain and function in individuals with non-specific chronic or recurrent LBP with concurrent reduced hip rotation.

METHOD: Thirty participants were assigned to one of three exercise groups: hip rotation stretching, multi-directional hip stretching and hip strengthening. All groups participated in a six week home exercise program. Pain (numerical rating scale), functional disability (Modified Oswestry Disability Questionnaire; MOD), and hip rotation measurements were assessed at baseline and post intervention.

RESULTS: Results revealed that all exercise groups were effective in improving pain and function (MOD) (P< 0.05). Between group comparisons revealed that hip strengthening was more effective than hip rotation exercises in improving functional disability (P= 0.03). The majority of participants in all groups (60-70%) demonstrated clinical improvements in pain, but only the hip strengthening group had the majority of participants(80%) exhibit clinical improvements in function.

CONCLUSION: In individuals with non-specific LBP and reduced hip rotation, clinical intervention of providing exercises targeted at the hip can be beneficial in improving pain and function, with strengthening exercises most beneficial for improving function.

BACKGROUND: The surface electromyography (sEMG), by evaluating the paraspinal muscle activity, may be used for diagnosis and evaluation of rehabilitation effectiveness patients with low back pain.

OBJECTIVE: The purpose of the study was to determine the intra- and inter-session reliability of the measurement of the activity of the lumbar erector spinae (LES) activity (extension-flexion ratio).

METHODS: The study included 21 asymptomatic subjects, aged 14 to 27 years, mean 23.7 ± 2.9. The LES muscle activity was assessed with using of the sEMG during forward trunk flexion and extension by two examiners. Based on the quotient of the LES muscle activity obtained during four concentric and eccentric tasks the extension-flexion ratio was calculated.

RESULTS: The measurements displayed excellent or fair-to-good reliability (intraclass correlation coefficient ranged from 0.90 to 0.68). The typical error and coefficient of variations, ranged from 0.34 to 0.58, and from 13.7 to 21.9, respectively.

CONCLUSIONS: The measurement of the extension-flexion ratio performed with the use of sEMG shows high level of intra- and inter-session reliability, suggesting that this parameter is a reliable tool in evaluation of the lumbar paraspinal muscles activity. However, the level of typical error should be taken into account.

OBJECTIVE: The effect of different exercise programs on cervical flexor muscles dimensions in patients with chronic neck pain is yet to be demonstrated. The purpose of this study was to assess the effect of two exercise programs; craniocervical flexion (CCF) and cervical flexion (CF), on flexor muscles dimensions in patients with chronic neck pain.

METHODS: Following ethical approval, 60 patients were randomly assigned into either a CCF group or a CF group. Patients in the CCF group were given CCF exercises and those in the CF group received CF exercises. All patients received interventions for a period of ten weeks. Pain intensity and functional disability were assessed using numerical pain rate scale and neck disability index, respectively. Dimensions of longus colli (LC) and sternoclidomastoid (SCM) muscles were measured using ultrasonography (US). All measurements were taken before and after interventions.

RESULTS: Following intervention, the CCF group demonstrated a significant increase in LC muscle dimensions including cross sectional area, width and thickness compared with the CF group. A statistically significant increase was found on SCM thickness in the CF group. Following intervention, SCM thickness measurement in the CCF group showed no significant changes. Statistically significant decrease on pain intensity and disability were also found in both groups.

CONCLUSION: Present findings demonstrated that craniocervical flexion program which specifically recruiting deep cervical flexor muscles increased LC muscle dimension significantly and CF program as an endurance training program increased SCM thickness.

BACKGROUND: Chronic low-back pain (LBP) may be related to decreased lumbar multifidus muscle cross-sectional area (CSA).

OBJECTIVE: In this study, core stabilization exercises were designed to enhance neuromuscular control and correct multifidus dysfunction.

METHODS: The subjects were healthy women (n = 11) and women with chronic LBP (n = 17). Lumbar multifidus muscle CSAs were measured by ultrasonography. Tests were carried out before training exercises for lumbar stability, and again 4 months and 8 months after training.

RESULTS: In women with LBP, the mean multifidus muscle CSA increased by 22% on the right side and 23% on the left side after 8 months of lumbar stabilization training, compared with baseline measurements. In healthy women, mean multifidus muscle CSA increased by 24% on the right side and 23% on the left side, compared with baseline values.

CONCLUSIONS: A core stabilization exercise program significantly increased multifidus muscle CSAs in both healthy women and women with chronic LBP.

OBJECTIVE: The aim of this study was to investigate effects of Clinical Pilates Exercises on bone mineral density (BMD), physical performance and quality of life (QOL) in postmenopausal osteoporosis.

METHODS: Forty-one women were recruited to the study. The subjects were divided into two groups, as the Pilates group and the control group. Subjects were evaluated for BMD at the lumbar region. Physical performance level was measured. Pain intensity level was scored with Visual Analogue Scale. QUALEFFO-41 was used for assessing QOL.

RESULTS: BMD values increased in the Pilates group (p < 0.05), while BMD decreased in the control group (p< 0.05). Physical performance test results showed significant increases in the Pilates group (p< 0.05) whereas there was no changes in the control group (p> 0.05). Pain intensity level in the Pilates group was significantly decreased after the exercise (p< 0.05), while it was unchanged in the control group. There were significant increases in all parameters of QOL in the Pilates group. Conversely, some parameters of QOL showed decreases in the control group (p< 0.05).

CONCLUSIONS: Pilates Exercises is effective to increase BMD; QOL and walking distance and also beneficial to relieve pain. Physiotherapist can use Pilates Exercises for the subjects with osteoporosis in the clinics.

BACKGROUND: Despite the popularity of core stabilization, there is limited evidence as to the relationship between performance on tests of isometric trunk muscle endurance and physical activity levels in adults.

OBJECTIVE: To investigate the relationship between isometric trunk muscle endurance and physical activity related energy expenditure in healthy young adults.

METHODS: A total of 51 participants (24 female) participated in the study. Median age and body mass index were; 22 years (Min-max: 18-26 years) and 21.8 kg/m² (Min-Max: 18.59-28.98 kg/m²), respectively. Participants completed the International Physical Activity Questionnaire. Isometric trunk muscle endurance was assessed with holding times of isometric trunk flexor, extensor, and lateral side bridge tests. Collected data were summarized based on median and interquartile ranges. The Spearman's correlation test was used to ascertain the relationship between isometric trunk muscle endurance and physical activity related energy expenditure.

RESULTS: There were no gender differences in holding times of the trunk flexor and trunk extensor endurance tests (p> 0.05). Males showed higher endurance scores for side bridge test than females (p< 0.001). No difference was found in physical activity related energy expenditure between males and females. No correlation was observed between isometric trunk muscle endurance and physical activity related energy expenditure for either females or males (p> 0.05).

CONCLUSIONS: According to our findings, trunk muscle endurance is not related to physical activity related energy expenditure in healthy young adults.

BACKGROUND AND OBJECTIVES: Spinal canal stenosis is the most common reason for spinal surgeries in patients over 65 years of age. The aim of the study was to assess static balance in patients prior to and after surgical decompression of lumbar spinal canal stenosis.

MATERIAL AND METHODS: The study population consisted of 30 patients suffering from spinal canal stenosis. Their static balance was measured, i.e. quantitative analysis of balance reaction parameters in quiet standing was performed.

RESULTS: The analysis of the collected data did not reveal any statistically significant differences between parameters measured prior to and after the surgery (for p< 0.05). A tendency for a decrease of measured parameters was observed. The regularity of changes was determined; in addition, for this analysis, the Spearman's rank correlation coefficient was used.

CONCLUSIONS: The analysis of the collected data did not reveal any statistically significant improvement of balance reactions after spinal canal stenosis surgery. In spite of pain reduction, there was no improvement in balance reactions, as behavioural patterns for balance reactions had been fossilised before surgery.

BACKGROUND: Femoral nerve injury is not a common complication of the abdominopelvic surgical procedures.

OBJECTIVE: To present a case of femoral neuropathy after nephrectomy.

METHODS: Case report.

RESULTS: A 71-year-old female patient with a right-sided congenital hip dysplasia developed numbness, tingling and burning pain in the right thigh and muscle weakness in the right hip after the nephrectomy surgery. Neurological examination and electrodiagnostic test revealed a femoral nerve injury. Prognosis of the femoral neuropathy was good. The quadriceps muscle weakness improved within six months.

CONCLUSION: Postoperative femoral neuropathy is an unexpected complication after total nephrectomy surgery. The prognosis is relatively good and early physical therapy can produce rapid recovery.

A 22-year-old patient undergoing unilateral surgical reconstruction of the anterior cruciate ligament (ACL) of the right knee volunteered for the research project and followed an established contemporary hospital-based rehabilitation programme. The patient was supervised post-surgically by an experienced and clinically specialized physiotherapist. The clinical outcomes of rehabilitation were assessed by selected validated patient-reported and objectively-measured outcomes of functional performance capability on four different occasions (pre-surgery, 6^th, 12^th and 24^th week post-surgery). The patient scored 30, 56, 60 and 85 on IKDC(maximum score, 100); 46, 53, 90 and 91 on Lysholm (maximum score, 100); 141, 73, 128 and 175 on K-SES (maximum score, 220); 17, 12, 6 and 6 on the symptom subsection of KOOS (maximum score, 28); 7, 7, 5 and 5 on the pain subsection (maximum score, 36); 1, 0, 3 and 1 on the daily function subsection (maximum score, 68); 0, 0, 5 and 5 on the sport and recreation function subsection (maximum score, 20); 13, 11, 15 and 13 on the quality of life subsection (maximum score, 16) of KOOS at pre-surgery and at the 6^th, 12^th and 24^th week following ACL reconstruction, respectively. Moreover, the patient scored 1.96 m, 1.92 m and 1.99 m on single-leg hop (injured leg) when assessed at pre-surgery and at the 12^th and 24^th week post-surgery, respectively, following ACL reconstruction. The total time spent in supervised rehabilitation by the patient (675 minutes) was computed as the aggregate patient-reported time spent in exercise during each hospital-based rehabilitation session(verified by physiotherapist evaluation) across the total number of sessions. The patient managed to return to the sport in which he had participated prior to the injury, immediately after the completion of the contemporary rehabilitation programme, at 24 weeks post-surgery. A total of fifteen physiotherapy sessions supervised by the physiotherapist, were attended by the patient during the 24 week rehabilitation period. The latter number of physiotherapy sessions was substantially less than the average supervised physiotherapy sessions reported in the literature.

Most cases of scapular winging (SW) are attributed to either long thoracic or spinal accessory nerve lesions. Dorsal scapular nerve lesions are quite rare and the literature contains very few case reports of SW secondary to rhomboid paralysis. We are reporting the unusual case of a young patient who developed right-side scapular winging due to dorsal scapular neuropathy and rhomboids palsy, and we highlight the role of conservative treatment and rehabilitation for cases of mild/medium injury to the dorsal scapular nerve or to the rhomboid muscles. For those cases, physiotherapy is recommended, and this is mainly aimed at strengthening the trapezius in order to compensate for rhomboids weakness.