Journal of Back and Musculoskeletal Rehabilitation

Auditory feedback enables an individual to identify and modify the differences between actual and intended movement during the motor learning process.

We investigated the effects of gait training with auditory feedback on trunk control, muscle activation, and dynamic balance in patients with hemiparetic stroke.

Twenty participants with hemiparetic stroke were recruited in this study and randomly assigned to the experimental ( n = 10) or control ( n = 10) group. The subjects in the experimental group participated in gait training with auditory feedback for 30 minutes, 5 times a week, for 4 weeks, whereas those in the control group received conventional gait training for 30 minutes, 5 times a week, for 4 weeks. During auditory feedback training, a beeping sound is produced every time a patient loaded weight that was higher than the preset threshold on the cane. Activation of the erector spinae muscle was measured using surface electromyography, and trunk control was evaluated using the Trunk Impairment Scale (TIS). Dynamic balance was measured using the Timed Up and Go (TUG) test.

Muscle activation was significantly higher in the experimental group than in the control group (6.6 ± 9.2% vs 1.4 ± 5.4% nonparetic peak activity). No significant difference was found in the TIS score between the experimental and control groups. Based on the TUG test, a significant improvement was observed in the experimental group compared to the control group (12.1 ± 11.4 vs 3.8 ± 4.7 s).

Our findings indicate that gait training with auditory feedback was beneficial for improving trunk control and muscle activation in patients with hemiparetic stroke.

To evaluate the longitudinal effect of a group physical activity service to help patients self-manage un-resolving back pain.

Back pain is one of the most common and costly conditions. Large scale trials have demonstrated a role for less traditional treatment including exercise, yet the long term effects of patient centred, group physical activity programmes remains unclear.

One hundred and eighty-one un-resolving back pain patients (aged 53 ± 17 years) completed a 6 × 2 h physical activity programme. All activities were relevant to activities of daily living and incorporated activities to develop aerobic fitness, flexibility, core activation, and muscular strength and endurance. Dietary advice, home diaries and pedometers were provided.

Measures of back pain, aerobic fitness, muscular endurance and body composition showed significant ( p < 0.05) pre-post intervention improvements. Disability rating decreased by 19% alongside improvements in aerobic fitness (15%), back extension (36%) back flexion (16%) and grip strength (5%). Six month follow up identified ( p < 0.05) reductions in body fat (6.5%) whilst aerobic fitness, disability rating and muscular strength and endurance remained stable.

Group physical activity programmes could contribute to the self-management of back pain, enabling sustained improvements in fitness, physical activity and body fatness.

Neurodynamic techniques are used to restore neural functions. However, there are few studies about the effects on performance. The aim of this study was to investigate the immediate effects on vertical jumping (VJ) and horizontal jumping (HJ) of 2 different tension loading techniques applied to young adults.

In this randomised double-blind study, a total of 68 participants with a mean age of 21.31 ± 1.21 years were separated into 2 groups using the closed envelope system: the femoral nerve mobilization (FNM) group and the sciatic nerve mobilization (SNM) group. The FNM and SNM techniques were applied as 2 seconds stretching with 2 seconds resting for 10 repetitions. The VJ and HJ performance of the participants was evaluated before and after the interventions by a researcher blinded to the groups.

The mean VJ performance before and after interventions was measured as 34.56 ± 7.80 cm and 35.89 ± 8.15 cm in the FNM group ( p < 0.05) and 31.74 ± 8.31 cm and 32.76 ± 8.45 cm in the SNM group ( p < 0.05). The effects of the techniques on HJ performance were not statistically significant ( p > 0.05). There was no superiority between the techniques ( p > 0.05).

The neurodynamic techniques were found to provide an immediate increase in VJ performance. Neurodynamic techniques are generally used in patient populations to improve treatment outcomes. According to these study results, neurodynamic techniques can be safely used to provide an immediate increase in performances of individuals with no lower extremity problems.

Heating the skin and muscles is a commonly accepted method of pain relief and a modality to increase relaxation in muscles and increase tissue blood flow.

The purpose of the present study was to examine the effect of local heat applied to trigger points and to determine if there was pain relief in the neck and plantar fascia.

Forty adults were divided into 2 different groups according to their pain; twenty subjects had plantar foot pain and the other 20 had nonspecific neck pain. The 20 subjects in each group were randomly subdivided into a heat and a sham group. Sensitivity to pressure was measured with an algometer. A stopwatch was given to the subject and started when either the heat patch or placebo was applied. Heat cells were applied at trigger points on the pain area.

Subjective pain significantly decreased in both sham and heat group patients with neck pain ( p < 0.05), however, the change was greater in the heat group and there was a significant difference between the heat and sham groups ( p = 0.002, d = 0.81). For the plantar pain group, a significant decrease in subjective pain was found in the heat group but not in the sham group. Pressure pain threshold significantly decreased in the heat group patients both with neck and plantar pain but for the sham group there was an increase in the pressure after sham treatment. Pain relief during the intervention was also significantly different between the heat and sham group in both patients with neck and plantar pain.

The effect of local heat on trigger points of the body on pain relief was significantly better in the heat groups than in the sham groups. This finding is significant because using heat on trigger points could be an alternative to dry needling performed by healthcare professionals. This modality can be alternative for home use and avoids opioids.

Spinal sagittal imbalance caused by degenerative changes or iatrogenic factors in the elderly can cause symptoms such as anteversion and low back pain (LBP). There are different and conflicting opinions about the relationship between the degree of lumbar lordosis and functional status of patients with chronic low back pain (CLBP).

This study aimed to determine the relationships among the lumbar lordosis index, sacral horizontal angle, and CLBP in the elderly.

Subject data were collected from Lishui City, Zhejiang Province, China, using cluster sampling according to the background information provided by national physical fitness monitoring. The 207 subjects were urban and rural individuals, 60–69 years old. Radiographs were evaluated according to a standardized protocol. The lumbar lordosis index and sacral horizontal angle were recorded. Data on the prevalence and functional status of CLBP were collected through field investigations. Statistical correlations between the radiographic parameters and the prevalence and functional status of CLBP measurements were evaluated.

No significant difference was observed in the sacral horizontal angles among the subjects with and without CLBP; however, the lumbar lordosis index of CLBP subjects was significantly higher than that of those without CLBP ( P = 0.028) and showed a significant association with CLBP ( P = 0.013). Neither the sacral horizontal angle nor the lumbar lordosis index showed significant correlations with the Oswestry Disability Index in CLBP subjects.

The lumbar lordosis index, but not the sacral horizontal angle, was significantly associated with CLBP in the subjects.

To analyze the relevance between serum IL-6 with the early postoperative (post-op) knee joint range of motion (ROM) in the elderly undergoing total knee arthroplasty (TKA). To evaluate the factors affecting early post-op knee joint ROM in the elderly after TKA.

One hundred and forty-three patients undergoing TKA were included. The patients’ general data, perioperative knee joint ROM and serum IL-6, pre-op HSS, WOMAC, SF-36 scores and Wells scores were collected. Repeated data variance analyses were performed to analyze the relevance between serum IL-6 with post-op knee joint ROM. Correlative regression and regression analysis were performed to evaluate the multiple factors affecting knee joint ROM in the elderly undergoing TKA.

The 2-week-post-op (2w-post-op) knee joint ROM was significantly higher in the low IL-6 serum concentration group ( < 46.45 ng/L) than in the high group ( ⩾ 46.45 ng/L) (97.78 ± 7.44 ∘ VS 91.85 ± 7.42 ∘ , F = 16.860, P = 0.000). A significant negative correlation was found between 1d-post-op serum IL-6 concentration with 2w-post-op knee joint ROM ( R = - 0.513, P = 0.000). The factors influencing the 2w-post-op knee joint ROM included pre-op HSS scores, pre-op WOMAC scores and whether to retain PCL (posterior cruciate ligament) ( R 2 = 0.451, P = 0.009).

A higher 1d-post-op IL-6 serum concentration indicated a lower knee joint ROM in the elderly two weeks after TKA.

Taekkyon, a Korean form of martial arts, has been trained for a long period. However, it is not yet known whether the Taekkyon exercise has better effects on functional mobility or balance in older adults than other types of well-investigated exercise programs such as Tai Chi (TC).

This study aimed to compare the effects of TC and Taekkyon exercise programs on the lower-extremity strength, balance, and gait ability of community-dwelling older women as a fall prevention method.

Community-dwelling older women were randomly allocated into the TC group ( n 1 = 23) and the Taekkyon group ( n 2 = 23). Both groups completed 1 h of either TC or Taekkyon exercises twice weekly for 12 consecutive weeks (24 sessions in total). We measured the Timed Up and Go test (TUG), Functional Reach test (FR), one-leg standing test (OLS), Five Times Sit-to-Stand test (5 × STS), 30 Second Sit-to-Stand test (30 s STS), and spatiotemporal gait parameters (gait velocity, step length, step width, stride time, and cadence) before and after the intervention.

Both groups similarly showed statistically significant improvements in balance (TUG, FR, and OLS), lower-extremity strength (5 × STS and 30 s STS), and spatiotemporal gait parameters except for step width ( P < 0.05). Moreover, the TC group showed greater improvement in the OLS test than the Taekkyon group ( P < 0.05).

The results from this study support the efficacy of the TC and Taekkyon exercise programs at improving mobility in this population of older women. However, this study did not clarify which exercise program is more effective as general balance and mobility training program for older women.

To compare pelvis, hip and knee kinematics during gait and extensibility of hip muscles between low back pain (LBP) and asymptomatic subjects.

Forty adult volunteers (11 men and 29 women) between 18 to 30 years from university population were included in this study. Twenty patients with LBP formed the LBP group, and 20 asymptomatic subjects formed the control group. Pelvic tilt and knee valgus, peak hip and knee joint excursion, and temporo-spatial variables were assessed during gait with Kinovea software. Extensibility of hip muscles was measured by Active Knee Extension test (AKE), modified Ober test, and Thomas test.

There was a significant increase in pelvic tilt ( p < 0.01), valgus angle ( p < 0.01), and a significant decrease in hip extension ( p < 0.01) in the LBP group compared to the control group. There was a significant decrease in extensibility of the hip flexors ( p < 0.05) of the dominant leg and in the hip abductors ( p < 0.01) in the LBP group compared to the control group.

The findings of this study suggest that non-specific mechanic LBP patients present differences in the pelvis, hip and knee kinematics in sagittal and frontal plane during gait and less hip flexors and abductors muscles extensibility compared to asymptomatic subjects.

A few studies have noted that paraspinal muscle training is important to reduce pain for patients with lumbar disc herniation (LDH). However, little is known about the exact signs for necessary training of lumbar multifidus muscles (LMM).

The study aimed to analyze the relationship between the straight leg-raising test (SLR) and the area of fat infiltration in LMM for patients with LDH.

One hundred and fourteen LDH patients were involved in this study. Clinical data were collected from a medical record system. On the MRI images, the cross-sectional areas (CSA) of bilateral fat infiltration in LMM were measured by picture archiving and communication system (PACS).

For 61 patients with inclusive LDH, the positive side of SLR was positively correlated with the side of the larger total CSA of fat infiltration in LMM of L2-S1 ( r = 0.75, p ⁢ ï ⁢ ¼ ⁢ œ 0.01), and the CSA of fat infiltration on the side of SLR with a positive result was significantly larger than that on the side of SLR with a negative result only at L3-4 and L4-5 levels ( p ⁢ ï ⁢ ¼ ⁢ œ 0.01).

SLR may be used as an important sign for dysfunction of LMM and can identify the more severe side.

In the current literature, exercises performed using fitness equipment and body weight have been used in order to decrease the bilateral deficit (BLD) and increase the hamstring-quadriceps (H/Q) ratio. No studies have previously investigated the effect of therabands, which are both portable and practical to be used anywhere, in regard to the BLD and H/Q ratio.

The purpose of this study was to investigate the effect of several 10-week lower extremity exercises performed through therabands on the BLD and H/Q ratio.

Twenty-seven voluntary male soccer players participated in the study. The players were categorized into the control group (CG) ( n = 14) and the theraband exercise group (TBG) ( n = 13). Theraband exercises for the lower extremity were performed by the soccer players in the TBG for four days every week over a 10-week period. The dominant (D) and non-dominant (ND) leg concentric extension and flexion of the soccer players were determined through an isokinetic dynamometer at 30 ∘ s - 1 and 240 ∘ s - 1 angular velocities. The data were analyzed through SPSS 24. To determine the difference between the BLD, H/Q ratios, and pre- and post-test of peak torque (PT), the Wilcoxon test was employed.

As a result of the analysis, it was found that the BLD for the TBG decreased, which was statistically significant ( p < 0.05), whereas there were no statistically significant differences for the H/Q ratio for both the CG and TBG; the D and ND leg H/Q rate of the TBG at 240 ∘ s - 1 angular velocity increased in the post-test.

It was found that the exercises performed with the theraband were extremely efficient at increasing the PT and decreasing the BLD.

This study aimed to investigate the relationship between chronic shoulder pain and the increase in BMI.

A prospective, cross-sectional study design was adopted for the study. Two hundred and eighty-five patients with chronic shoulder pain were evaluated for eligibility. A total of 94 patients were excluded from the study. The 191 remaining volunteers filled out a questionnaire (Pain (VAS), Shoulder Pain and Disability Index (SPADI)) and weight, height, C-reactive protein (CRP) results and 1-hour-rate of erythrocyte sedimentation rate (ESR) were measured. The participants were dived into the normal weight, overweight or obese group, considering the obesity classification defined by the World Health Organization (WHO).

A statistically significant correlation was found between the increase in BMI and pain (VAS), SPADI (pain, activity and total) and ESR. Although there was no statistically significant difference between the normal weight and overweight groups in all parameters, there was a statistically significant difference between the obese group and other groups.

Shoulder pain may associated with obesity and we recommend the addition of weight control to the treatment of patients with shoulder pain.

This study aimed to investigate performance (touch-coordinate errors, inter-touch interval) of touch screen technology in adolescents with unilateral spastic cerebral palsy (USCP) and healthy peers.

This prospective case-control study included 31 adolescents. The participants consisted of 15 adolescents with CP in the USCP group and 16 age-matched healthy peers in the control group. All participants performed an aiming-tapping task with an Android tablet. Four sessions were randomly applied: visual feedback (VF) and no VF with the dominant hand’s index finger (DHF), and VF and no VF with the non-dominant hand’s index finger (NDHF). Inter-touch interval (ITI) and touch-coordinate errors (TCE) were calculated.

There were significant differences between the groups for VF and no VF-NDHF TCE and ITI (respectively p = 0.001, p = 0.01, p = 0.001, p = 0.004) and VF and no VF-DHF TCE values (respectively p = 0.01, p = 0.008). When comparing the dominant and non-dominant hand in the USCP group, there was a significant difference on TCE with no VF ( p = 0.01).

This study provided insight into the touch screen performance of adolescents with USCP, who performed an aiming-tapping task with a tablet. Results showed that both affected and unaffected hand performance of touch screen tasks was impaired in adolescents with USCP.

Hallux valgus (HV) is one of the most common deformities of the foot, and it causes great difficulties for the patients.

We aimed to investigate the effects of different rigid taping techniques on HV angle, foot motor performance, balance and walking parameters.

Twenty-two voluntary individuals (12 males, 10 females) with flexible HV deformities between 18 and 35 years of age were included in the study. All measurements were done before and after placebo, athletic and Mulligan tapings were applied. After a three-day interval, new taping was applied on the same subject. HV angle was measured by goniometer. Foot motor performance (single leg heel rise test), balance (unilateral stance, limits of stability, sensory integration of balance) and temporospatial parameters of gait (step length, stride length, step width, foot angle and cadence) were evaluated.

HV angles were reduced in all taping groups ( p < 0.05). The Mulligan taping method was the most effective method in reducing HV angle. Foot motor performance was not affected by any type of taping ( p > 0.05). Athletic taping increased step length and step width but reduced foot angle and cadence. The Mulligan taping increased cadence and reduced foot angle ( p < 0.01). Both taping methods did not affect the postural stability and fall risk ( p > 0.05). Stability limits were increased in Mulligan taping group ( p < 0.05).

It can be concluded that Mulligan taping method may be an alternative treatment method for HV rehabilitation especially as it increased the limits of stability and maintaining the balance. Mulligan method is more effective than athletic taping in terms of reducing instant HV angle.

Lateral epicondylitis (LE) is a common problem of the arm. Mulligan has proposed the use of mobilization with movement for LE.

To investigate the effects of Mulligan’s mobilization with movement (MWM) in LE.

Forty patients were included in the study and randomly assigned to group 1 ( n = 20), who received MWM, exercise and cold therapy, or group 2 ( n = 20), who received exercise and cold therapy. The sessions were conducted five times a week for two weeks. All measures were conducted at baseline, after treatment, at 1st and 3rd months follow-ups. Mann-Whitney U test, a visual analogue scale (VAS) for pain intensity, Patient-rated Tennis Elbow Evaluation (PRTEE) Questionnaire for pain intensity and functional disability and a dynamometer for hand grip strength were applied.

VAS activity pain significantly decreased in group 1 after treatment ( p = 0.001), at the 1 st ( p < 0.001) and 3 rd months ( p = 0.040). There was a significant decrease in VAS night pain in group 1 ( p = 0.024), and a significant increase in pain-free grip strength ( p = 0.002) after treatment. PRTEE-Pain scores decreased in group 1 after treatment ( p < 0.001), 1 st ( p < 0.001) and 3 rd months ( p = 0.001).

MWM plus exercise and cold therapy is a safe and effective alternative with positive effects on elbow pain, functional capacity, and pain-free, maximum grip strength.

This study aimed to assess the effects of early enteral nutrition (EN) in elderly patients with hip fracture.

The patients were classified into two groups (with and without EN). We compared the pre- and postoperative albumin (ALB) and inflammatory marker levels of each group and the time spent in bed and quality of life 3 months after surgery between the two groups.

The pre- and postoperative IL-6 levels of the experimental group (61.68 ± 51.80 pg/L) were lower than those of the control group (233.11 ± 206.31 pg/L) ( P < 0.001). The experimental group spent a shorter period of time in bed (38.75 ± 14.26 days) in comparison to the control group (99.71 ± 56.87 days) ( P < 0.001). Quality of life was better in the experimental group than in the control group ( P < 0.001).

Early EN reduced the increment of postoperative IL-6 levels and improved healing postoperatively.

Chronic obstructive pulmonary disease (COPD) may increase the risk of osteoporosis and resulting fractures can contribute to disability and mortality of patients. We intended to evaluate the frequency of osteoporosis in male smokers with and without COPD and study whether any correlation existed between osteoporosis and COPD.

This case-control study was carried out in the Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh between July 2013 and June 2015. Seventy four male smokers with COPD and 66 age-matched male smokers without COPD were enrolled. All individuals underwent Bone Mass Densitometry (BMD) by Dual-Energy X-Ray Absorptiometry (DEXA).

COPD and non-COPD groups did not differ regarding age and smoking pack-years. Osteoporosis at femoral neck (48.6% versus 16.7%; p < 0.001) and lumbar spine (68.9% versus 37.9%; p < 0.01) was significantly higher in COPD compared to controls. Osteopenia did not differ significantly. Patients with COPD were 4.5 times more likely to develop osteoporosis than controls after adjusting age, smoking-pack years and BMI (adjusted OR = 4.5; 95% CI = 1.8–11.5).

Osteoporosis is more frequent in male smokers with COPD compared to smokers without COPD. COPD is a risk factor of osteoporosis independent of age, smoking and BMI.

The aim of this study was to determine the effects of platelet-rich plasma (PRP) treatment on pain, functionality, quality of life, and cartilage thickness in patients with knee osteoarthritis (OA).

Sixty patients with chronic knee pain were randomly separated into two groups. The first group was administered 4-ml PRP intra-articularly (IA) in three doses at one-week intervals, and the second group had only one dose of a 4-ml saline solution IA. The patients’ pain was measured using the Visual Analogue Scale (VAS); functionality was measured using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). The distal femur cartilage thickness was assessed using ultrasonography (USG).

All baseline parameters were similar ( p > 0.05). In the first and sixth months after the treatment, the VAS scores of the PRP group were significantly low ( p < 0.001). In the same group, only the pain sub-score was low in the WOMAC assessment in the first month after treatment. However, in the sixth month, all parameters of the WOMAC score were lower than those of the placebo group ( p < 0.05). Cartilage thickness measurements were similar in the two groups ( p < 0.05).

PRP treatment had positive effects on the pain, physical function, and quality of life of patients with knee OA, but it did not increase cartilage thickness.

: Adolescent idiopathic scoliosis (AIS) may change the physical orientation of body segments and affect balance in individuals. Spinal/trunk brace is commonly used for the management of idiopathic scoliosis. The aim of this study was to compare the standing stability of AIS patients with and without a brace, and to compare them with healthy subjects.

: Twenty subjects (10 healthy subjects and 10 AIS with thoracolumbar/lumbar curve) were recruited for the study. Stability of the scoliotic subjects was evaluated while standing with and without orthosis. A Kistler force plate was employed to estimate the mediolateral and anteroposterior displacements of center of pressure.

: The results of this study indicated that there was no significant difference between center of pressure variables in healthy subjects and scoliotic patients. Moreover, trunk bracing only influenced the center of pressure (CoP) excursion in mediolateral direction ( p < 0.05).

: Although further research studies are needed, results showed that there was no difference between stability of scoliotic and normal subjects. Moreover, the use of orthosis did not improve their standing stability.

Smartphone devices have been used to measure range of motion (ROM) in different joints.

To verify the concurrent validity of thoracolumbar ROM using a mobile application and a digital inclinometer, as well as the intrarater reliability of individuals with and without back pain.

One investigator was responsible for measuring the ROM during the evaluations performed on 20 asymptomatic subjects and 20 symptomatic subjects in two consecutive days.

Regarding to the concurrent validity, the Intraclass Correlation Coefficients (ICC) were classified as very good for all analyzed movements. For intrarater reliability, the mobile application had ICC varying between good and very good for the symptomatic subjects and very good for asymptomatic subjects.

The mobile application may be considered a valid and reliable tool to assess thoracolumbar ROM for both asymptomatic and chronic low back pain subjects.

Cervical radiculopathy is a relatively common musculoskeletal disorder resulting in a significant social and occupational impact. Manual therapy is thought to provide relief in cervical radiculopathy; however, evidence is lacking regarding the comparison of different manual therapy concepts.

To determine the effects of Maitland’s oscillatory mobilization as compared to Kaltenborn’s sustained stretch mobilization in the management of cervical radiculopathy.

A randomized controlled trial was conducted at Fauji Foundation Hospital comprising of 46 patients randomized into oscillatory and sustained stretch mobilization groups. Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI) and cervical range of motion (ROM) were used as outcome variables.

No significant differences were observed at base line between the two groups ( P > 0.05) except for ROM in extension and left side bending ( P < 0.05). In terms of pre and post treatment comparison, P value of less than 0.05 was observed for both groups, indicating both treatments to be effective in isolation. However, post treatment comparison between both groups showed oscillatory mobilization to be superior to sustained stretch mobilization ( P < 0.05) in the management of cervical radiculopathy except for the outcomes of pain and side bending.

Both oscillatory and sustained stretch mobilization techniques are found to be effective in the management of cervical radiculopathy in terms of pain, range and disability. However, oscillatory mobilization is found to be superior in terms of functional ability and range of motion.

To examine the effects of age, time from stroke onset, gender and side of paresis in gait re-education with the use of treadmill with biofeedback, in patients with chronic stroke.

The study was performed with a group of 50 patients. 10-metre walk test, 2-minute walk test, “Up and Go” test, the number of steps performed with the paretic lower limb at a distance of 10 metres, Barthel index and FIM scale were used to assess the effects of rehabilitation.

The study shows that the subjects’ abilities and fitness prior to the rehabilitation were not related to age, sex or side of paresis. Analysis of the impact of age, time from stroke and sex on rehabilitation outcomes showed no statistically significant correlations. On the other hand, analysis of rehabilitation results relative to the side of paresis showed that the latter factor significantly differentiates rehabilitation outcomes measured with gait velocity test – p = 0.045.

Age, duration of time from stroke onset, and sex do not affect outcomes of gait re-education based on treadmill training in patients at a chronic stage post-stroke and Brunnstrom recovery stage 3–4. Side of paresis significantly differentiates rehabilitation outcomes measured with speed test. The best scores in all the performance measures before rehabilitation were identified in the group 3–6 years after stroke.