Journal of Back and Musculoskeletal Rehabilitation

There is little evidence on intra-articular (IA) treatment in knee osteoarthritis (KOA) and there is a lack of long-term follow-up studies.

To assess the long-term effectiveness and safety of IA oxygen-ozone (O 2 O 3 ) and hyaluronic acid (HA) in terms of functioning in KOA patients over a 31-week period.

Patients aged ⩾ 60 years with KOA were randomly allocated to receive 4 IA knee injections (1/week) of O 2 O 3 or HA (T0–T3) and a follow-up visit 4 weeks after the fourth injection (T4). In this extension study we assessed VAS and safety in patients with Visual Analogue Scale (VAS) ⩾ 4 at the at 6-month follow-up visit (T5), undergoing a second treatment cycle (T5–T8) and 1-month follow-up visit (T9).

Forty-two patients (aged 70.5 ± 5.8 years) were randomly allocated to O 2 O 3 ( n = 22) or HA group ( n = 20). Twenty-three underwent another IA cycle: 12 (54.6%) in the O 2 O 3 group and 11 (55.0%) in the HA group. Both groups showed significant reduction in VAS ( p < 0.013) compared to baseline during both cycles. At follow-up visits (T4 and T9), VAS was significantly lower in the HA group ( p < 0.013). There were no differences in adverse events occurrence between groups.

IA O 2 O 3 might be comparable to HA in terms of effectiveness and safety in reducing pain in KOA patients, although at both follow-up visits (T4 and T9) VAS was significantly lower in the HA group.

The prevalence of sexual problems is very high among women with fibromyalgia.

To evaluate the prevalence of sexual problems in women with FM and the potential association among physical activity, quality of life and sexual function. We aimed to contribute in the understanding of the relationships between sexual function and the symptoms of FM.

The sample of this cross-sectional study comprised 113 women with FM and 116 age-matched women without FM. Sexual function was assessed using the 15D questionnaire. Health-related quality of life (using EQ-5D-5L and 15D questionnaires), impact of fibromyalgia and physical activity were also assessed.

The prevalence of sexual problems among women with fibromyalgia was 76%, while it was 15% in healthy controls. This prevalence was even higher among those aged 50 or over. Sexual function was significantly associated with quality of life, distance walked, impact of fibromyalgia and four of the symptoms: depression, anxiety, tenderness and memory problems.

More than three out of four women with fibromyalgia have any kind of sexual problem. Depression, anxiety and tenderness seems to be the most relevant symptoms associated with sexual function. Physical activity may be protective and reduce the risk of having sexual problems.

We hypothesized that cervical radiculopathy (CR) has a role in subacromial impingement syndrome (SAIS) etiology, which cannot be directly connected to anatomical causes.

We aimed to investigate the presence of cervical radiculopathy in patients with SAIS diagnosed clinically and radiologically.

Patients who had a clinical and radiological SAIS diagnosis between 2014 and 2016 were included in the study. Patients with secondary causes that led to SAIS were excluded. Cervical MRI of all patients with SAIS was examined for cervical radiculopathy.

A significant ( p < 0.05) relationship was found between SIAS and the presence of root compression on the same side. 35% of the patients with SIAS had root compression on the same side.

Cervical radiculopathy and shoulder impingement syndrome can be easily confused due to the similarity of the symptoms and the anatomical proximity of the lesions. Although both diseases can occur with different mechanisms, we believe that there is a cause and effect relationship between them.

Osteopathic manipulation treatment is widely used in the clinical practice in the care of patients with chronic nonspecific low back pain, however, its benefits still seem uncertain.

This study aimed to verify the efficacy of osteopathic manipulation for chronic nonspecific low back pain.

Forty-two participants with chronic nonspecific low back pain were selected and randomized into two groups: active control group (ACG – n = 19) and osteopathic manipulation treatment group (OMTG – n = 23). Therapeutic exercises were performed with the ACG and osteopathic manipulation techniques with the OMTG. The interventions were carried out over 5 weeks of treatment, totaling 10 treatments for the ACG and 5 for the OMTG.

The visual analogue scale (VAS) was used to measure chronic nonspecific low back pain and the Oswestry Disability Index 2.0, Tampa Scale of Kinesiophobia and Beck Depression Inventory were used to measure disability, kinesiophobia and depression, respectively.

The final chronic nonspecific low back pain in both groups was significantly lower than the initial low back pain ( p ⩽ 0.01) and the final chronic nonspecific low back pain of the OMTG was significantly lower than that of the ACG ( p = 0.001).

This study demonstrated that the treatments were effective in both groups. However, the efficacy of the osteopathic manipulation treatment was greater than that of the therapeutic exercises.

Chronic obstructive pulmonary disease (COPD) is a progressive disease negatively affecting health-related quality of life. The related scales in Turkish are limited in number and generalizability.

To perform validity and reliability studies of the Turkish version of the Clinical Chronic Obstructive Pulmonary Disease Questionnaire (CCQ).

This study was conducted at the Department of Chest Diseases, with 100 volunteer COPD patients with a mean age of 67.72 ± 9.78 years. After obtaining the necessary permission, translation procedures were applied for Turkish cultural adaptation. Finally, a single Turkish translation was created, and this questionnaire was evaluated by linguists. Incomprehensible items were corrected in a pilot study. Baseline and test-retest measurements after two weeks were performed. Internal consistency analysis was made for validity, and correlations were calculated with the 36-Item Short Form Health Survey (SF-36), the modified Medical Research Council (mMRC) Dyspnea Scale and Respiratory Function Tests (RFTs).

Cronbach’s alpha value was found to be 0.90 for the first obtained data and 0.91 for the second obtained data. There was similarity at the rate of 0.97 between the first and second measurements in terms of total scores of the CCQ. The questionnaire significantly correlated with the SF-36, mMRC and RFTs ( - 0.85 ⩽ r ⩽ 0.69, p < 0.05).

As a result of this study, the Turkish version of CCQ was determined to be reliable and valid. The CCQ is an easy-to-use questionnaire in terms of application-calculation and can be safely used for the clinical assessment and monitoring of patients.

Injections are a good alternative to conventional treatment-resistant cases with rotator cuff (RC) lesions before operation. Currently, different injection methods are used in RC lesions.

To evaluate the efficacy of different injection methods (platelet-rich plasma [PRP], corticosteroid [COR] and prolotherapy [PRO]) in RC tendon lesions.

One hundred and twenty-nine patients were divided into 4 groups as PRP, COR, PRO and the lidocaine group. Subacromial injection was applied to all groups. They were evaluated using the Visual Analogue Scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Western Ontario Rotator Cuff Index (WORC) at 3, 12 and 24 weeks post-injection.

In the COR group in the 3rd week, VAS and WORC scores were significantly lower than the other groups ( p < 0.01 and p < 0.05 respectively). In the PRP group in the 24 th week, VAS and WORC scores were found to be significantly lower than the COR group ( p < 0.01 and p < 0.05 respectively). In the COR group in the 3rd week the ASES score was found to be significantly higher than the PRP and PRO group ( p < 0.01).

In patients with RC lesions, corticosteroid injection provides short-term relief for pain, function, and quality of life, while PRP injection works for long-term wellbeing. For all types of applied injections, improvement in pain, function and quality of life were observed.

We aimed to evaluate the efficacy of the treatment of knee osteoarthritis (OA) patients by using microfracture technique in combination with autologous bone marrow stem cell transplantation.

A clinical study was conducted between November 2011 and January 2015 and involved 46 patients (aged from 46 to 69) with primary knee OA grade II and III (according to Kellgren-Lawrence classification) at the Orthopedic Trauma Department, Vietnam-Germany Friendship Hospital. Patients were randomly assigned to receive knee arthroscopy and then bone-marrow stem cells from their pelvic bones via injection.

The mean Visual Analogue Scale (VAS) score of present pain decreased from 5.68 before surgery to 1.7 24 months after surgery. The mean preoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) was 36.34 ( ± 3.13), which increased to 74.62 ( ± 2.86) 24 months after surgery. On the MRI scans, the average Noyes score decreased from 12 ( ± 1.46) to 7 ( ± 1.50). Cartilage volume increased on average from 0.4512 ( ± 0.26) cm 3 to 0.5463 ( ± 0.29) cm 3 12–24 months after surgery.

Treatment of osteoarthritis by a combination of arthroscopic microfracture and transplantation of autologous bone-marrow stem cells was an invasive, safe and effective method which showed an improvement in the clinical symptoms (VAS score) and knee functions (KOOS points).

The study aims to measure the cross-sectional area of the lumbar erector spinae muscles from L3–L4 intervertebral disc levels by using magnetic resonance images of Olympic style weightlifting athletes (male n = 15, female n = 15) and sedentary individuals (male n = 15, female n = 15).

A 1.5 Tesla device was used for the magnetic resonance imaging process of all participants. The images were then executed in ImageJ software and the cross-sectional area was measured after the required synchronization steps were conducted.

On the images taken from L3–L4 intervertebral disc levels, we observed that right-left cross-sectional area measurements of erector spinae muscles of sedentary males and females in the control groups were smaller than those of male and female athletes in Olympic style weightlifting. We also found a symmetry between right-left cross-sectional area measurements of groups of athletes.

From the study findings, we might conclude that trainings of Olympic style weightlifting possess a hypertrophic effect on the cross-sectional area of erector spinae muscles of Olympic style weightlifting athletes.

The Hybrid Assistive Limb (HAL) is a robotic exoskeleton designed to support impaired limbs.

We aimed to evaluate whether active exercise using a single-joint HAL (HAL-SJ) following total knee arthroplasty can facilitate the recovery of knee flexion.

Twenty-two patients who underwent total knee arthroplasty were randomly allocated to the HAL-SJ group ( n = 12) or conventional physical therapy (CPT) group ( n = 10). On postoperative day 5, patients performed active knee flexion exercises either with or without HAL-SJ assistance every second day. Outcome measures included active and passive knee flexion range of motion (ROM), muscle strength, and pain intensity, as assessed by the visual analog scale, and were assessed on postoperative days 5 (pre-treatment) and 10 (post-treatment). Active ROM was measured at 6 months postoperatively; further long-term follow-up was performed by telephone interview.

Both groups showed significant improvement between postoperative days 5 and 10 in all outcome measures. Improvements in active ROM ( p < 0.01), passive ROM ( p < 0.01), muscle strength ( p < 0.01), and pain ( p < 0.01) were significantly greater in the HAL-SJ group than in the CPT group. Long-term outcomes were also significantly better in the HAL-SJ group.

HAL therapy enables patients to perform painless active movements and facilitates the recovery of knee function.

Core-strength is vital for Greco-Roman wrestling, although studies have yet to establish the effectives of core-specific training in this sport.

To examine the effect of core-specific strength training on determinants of Greco-Roman wrestling performance in elite junior athletes.

Twenty state-level, junior, Greco-Roman wrestlers were randomized into a core-specific training group (COR; n = 12) and a control group (CON; n = 8). The COR group undertook a 4-week, core-specific training program concurrently with their typical training program, whilst the CON group completed 4 weeks of typical training only. Both groups completed overhead medicine ball throw (OMBT), Suplexes, bridges and medicine ball chest throw (MBCT) prior to and following the intervention.

The COR group demonstrated significantly greater improvement in bridges ( p = 0.037; F = 5.046) and OMBT ( p < 0.001; F = 26.43) than the CON group, with moderate to large between-group effect sizes (ES = 0.79–2.35). In addition, the effect size calculations were moderate-to-large (0.79–0.87) for Suplex and MBCT, with measures for the COR group greater than the CON group.

Accordingly, core-specific training programs should be combined with wrestling-specific conditioning programs to improve back and hip extensor performance in junior Greco-Roman wrestlers.

Facet syndrome is defined as pain that arises from any structure of the facet joints, including the fibrous capsule, synovial membrane, hyaline cartilage, and bone.

To compare the effectiveness of US-guided and blind injections on clinical outcome in facet syndrome.

Forty-seven patients with the diagnosis of facet syndrome were included. Patients were consecutively randomized into one of the two groups. The patient’s history, physical examination and routine laboratory parameters were obtained and diagnose was established based on physical findings. Two injections (mixture of 2 ml of 1% lidocaine hydrochloride and 20 mg of triamcinolone, to a single or maximum two sites depending on the clinical characteristics of the facet joint) were performed with 15 days apart, as blinded or US-guided manner. Clinical outcome assessments were carried out at 0, 2nd and 6th weeks, using Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and State-Trait Anxiety Inventory (STAI).

The patients’ initial VAS and ODI were not significantly different. When the two groups were compared in the 6th week in terms of VAS scores, improvement was more pronounced in the US-guided injection group (US-guided group ( n = 23) before 7.6 (2.2) cm, after 3.0 (1.7) cm, P = 0.0001 vs blind group ( n = 24) before 7.2 (1.3) cm, after 5.2 (2.0) cm, P = 0.0001). The improvement in initial and 6th week ODI was statistically significant in the US-guided injection group ( P = 0.006). Except STAI I for US-group, trait anxiety scale scores were significant in both groups.

The US-guided local injections offer better clinical outcome in the treatment of facet syndrome.

It is important to evaluate clinical efficacy and safety of posterior internal fixation using pedicle screw system.

To investigate clinical characteristics of patients diagnosed with fracture-dislocation of the thoracic spine with or without minimal spinal cord.

Twenty-eight patients with fracture-dislocation of thoracic spine with or without minimal spinal cord injury were retrospectively analyzed. All patients received posterior reduction and internal fixation using pedicle screw system.

The mean follow-up duration was 11.4 months. Among 28 patients, 24 cases were complicated with bilateral pedicle or laminal fracture. Preoperatively, the percentage of vertebral displacement was (32.1 ± 20.6)%, significantly declined to (7.5 ± 6.0)% ( t = 4.575, P = 0.001) and maintained at (7.9 ± 6.3)% at the final follow-up. Preoperative local kyphosis angle was measured as (16.2 ± 11.3) ∘ , restored to (15.4 ± 5.9) ∘ postoperatively and (15.8 ± 5.4) ∘ during the final follow-up. No statistical significance was observed at three time points (all P > 0.05). The remaining 25 patients were evaluated with normal and complete neurological function. No severe complications were observed intra- and postoperatively.

Posterior internal fixation using pedicle screw is an efficacious and safe therapy which achieves proper reduction and preserves spinal cord function.

Intra-articular distension is a validated treatment in adhesive capsulitis of the shoulder and is commonly followed by intensive in-patient physical therapy. A recent meta-analysis found that physical therapy is as effective as intra-articular distension (IAD) and that an early distension could be the primary choice for treating frozen shoulder. The question of the additional contribution of physical therapy prior to IAD compared with IAD followed by physical therapy has not been raised.

We compared IAD preceded by physical therapy to that followed by physical therapy in terms of pain relief and functional outcome.

We enrolled patients with primitive adhesive capsulitis of the shoulder. The eligible patients were randomized into three groups: A, B and C. Group A received intra-articular distension followed by physical therapy, group B received intra-articular distension in the middle of physical therapy and group C received physical therapy alone. Patients were assessed at the beginning of the protocol (T0), after 6 weeks (T1) and after 12 weeks (T2). The main outcome measures were pain using a Visual Analog Scale and the Disabilities of Arm, Shoulder and Hand Questionnaire.

Out of the 179 enrolled patients, only 122 completed the follow up: group A ( n = 34), group B ( n = 46) and group C ( n = 42). Compared to intra-articular distension preceded by physical therapy, IAD followed by physical therapy did not improve significantly the outcome in terms of pain relief ( p = 0.123) but it enhanced the upper extremity function ( p = 0.002). Upper extremity pain and function were found to improve with time regardless of the protocol ( p < 0.001).

IAD followed by physical therapy is more beneficial than IAD preceded by physical therapy in terms of upper extremity function. IAD, whether or not preceded by physical therapy, does not significantly improve pain compared to physical therapy alone. Time is a crucial factor to take into consideration while treating adhesive capsulitis of the shoulder.

The aim of this study was to assess the cerebral blood flow velocity as a marker by using transcranial Doppler (TCD) ultrasonography in patients with ankylosing spondylitis (AS).

A total of 30 AS patients aged 20 to 50 were enrolled in the AS group (male/female: 4/26, mean age: 34.7 ± 5.9) consecutively. The control group (non-AS group; male/female: 4/26, mean age: 32.3 ± 4.7) consisted of 30 age- and sex-matched, randomly selected patients without AS who had other diagnoses such as fibromyalgia and did not have risk factors for atherosclerosis. Bilateral middle cerebral artery (MCA) peak-systolic, end-diastolic, and mean blood flow velocities, Gosling’s pulsatility index values, and Pourcelot’s resistance index values were recorded with TCD by a neurosonologist blinded to the AS and control groups.

The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels and cerebral blood flow velocities of bilateral MCA were significantly higher in the AS group than in the control group.

This study highlights that the increased cerebral blood flow is indirectly associated with atherosclerosis regarding persistent inflammation in patients with AS.

Systematic observations of fetal posture show that, although for most of the time the fetus does not have a preferred posture, it has a certain repertoire of repeated active postures. The observed postures cannot be considered random configurations of head and limb position: the fetus and the young infant have an active, but variable posture that is relatively unrelated to the orientation of the force of gravity.

The study included 101 children, aged 6–7, including 50 preterm children, 48 boys and 53 girls (research group) and 51 full-term children; 22 boys and 53 girls (control group). The photogrammetric method with moire effect on Mora 4G CQ Elektronik was used to examine the body posture.

Significant statistical differences in GAMMA ( p < 0.001) and KLL ( p = 0.020) parameters in preterm children and in control group were noted. Both parameters presented higher value in the control group.

The posture of preterm children is characterized by a smaller angle of upper thoracic curvature and smaller angle of lumbar lordosis. The posture of preterm children in sitting position is characterized by a smaller angle of thoracic kyphosis. Preterm birth disturbs the development of proper antigravitational mechanism and causes possible posture dysfunctions at the age of 6.

Despite the increasing emergence of modern facilities, the ancient practice of writing on a teaching board is still common in the teaching profession. Ergonomic guidelines of this practice are required for the prevention of work-related neck musculoskeletal disorders inherent of teachers.

This study investigated the effects of varying teaching board heights on the activities of the neck muscles.

Thirty participants (15 males and 15 females) participated in this experimental study. Each performed writing tasks on a teaching board set at five different heights derived from their standing height (SH) [(D 10 = SH minus 10% of SH; Norm H = SH; Sum 10 = SH plus 10% of SH; Sum 20 = SH plus 20% of SH; Sum 25 = SH plus 25% of SH)]. Electromyographic (EMG) activities of both components of the sternocleidomastoid and upper trapezius muscles were measured during each task. Asymmetry ratio of right and left muscle components were determined. Data were analyzed with one-way ANOVA.

EMG activities of the four muscles as well as their asymmetry ratios significantly ( p < 0.01) increased with increasing board heights.

Teaching board-related tasks have increased possibilities of inducing neck disorders when performed beyond Norm H vertical heights.

Individualized exercise programs should be prepared according to duration and intensity.

The current study focused on the effect of different types of exercises regularly done for eight weeks on sedentary young women’s body components and lipid profile.

The sample of the study was composed of 30 sedentary women recruited from Afyon Kocatepe University. The participants were randomly sorted into three groups and received combined exercises (aerobic + resistance exercises), aerobic exercises and cardio tennis exercises three days a week for eight weeks but no dietary program was given. Before and after the exercise programs, participants’ body weights, heights, waist and hip circumferences were measured and their body components were analyzed through the bioelectrical impedance method. For the lipid profile analyses, 5 cc. of blood samples were drawn from forearm veins of the participants with the help of health specialists, and a biochemical doctor analyzed lipid profile markers such as total cholesterol, triglyceride, HDL, LDL, and VLDL.

It was found that exercises regularly done for eight weeks affected young women’s body components considerably while it did not influence their lipid profile.

The effect on body components depended on time. No difference was found in terms of exercise type.

We aimed to evaluate the efficacy and safety of anterior column opening structural bone grafting with posterior column compression technique for the treatment of obsolete vertebral compression fractures with severe spinal kyphosis.

Fourteen patients with senile obsolete vertebral compression fractures and severe spinal kyphosis were admitted to our hospital. During the treatment processing, an “eggshell” osteotomy, anterior column opening structural bone grafting with posterior column compression, and pedicle screw internal fixation were performed in all patients. The Cobb angle, Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) pre-operatively, post-operatively, and at the last follow-up were analyzed. Furthermore, the intra-operative blood loss and the operative time were also analyzed.

The average osseous fusion time was 3.6 months (range from 3 to 5 months). The average operative time was 236 ± 20.1 min (range from 198 to 261 min). The average intra-operative blood loss was 1350.5 ± 70.2 ml (range from 809 to 2216 ml). The Cobb angle of localized kyphosis was 63.4 ± 12.4 ∘ pre-operatively, while 10.0 ± 2.1 ∘ post-operatively, and 12 ± 3.4 ∘ at the last follow-up evaluation, respectively. The average VAS score was decreased significantly from 8.7 ± 3.2 pre-operatively to 1.9 ± 0.4 post-operatively. The average ODI score was decreased from 78.3 ± 2.4% pre-operatively to 19.3 ± 5.3% post-operatively.

Anterior column opening structural bone grafting with posterior column compression technique is effective, can effectively restore the sagittal balance of the spine, ease pain, and improve the quality of life of the patients with obsolete vertebral compression fractures and spinal kyphosis.

Tools for functional assessment of chronic low back pain (LBP) are lacking.

To determine the correlations and the responsiveness of the 400 m comfortable walk test (400 mCWT) and the 200 m fast-walk test (200 mFWT) in the functional assessment of a multimodal program.

One hundred and twenty-seven participants (68 females) with LBP and with or without radicular pain completed a Quebec Back Pain Disability Scale, a Sorensen test, a Shirado test, a 400 mCWT and a 200 mFWT, at baseline and at the end of the program.

No significant side effect was reported during walk tests. Walking speed was significantly increased after the program (0.18 ± 0.15 m.s - 1 for the 400 mCWT and 0.17 ± 0.17 m.s - 1 for the 200 mFWT). Clinical parameters were also significantly improved (82.02 ± 83.1 seconds for the Shirado, 92.1 ± 100.1 seconds for the Sorensen, - 14.0 ± 12.9 for the Quebec scale). A significant relationship was found between the increase in walking speed for the two walk tests and the improvement of the Quebec scale. The gait speed improvement was close to the minimal clinically important change (95% confidence interval: 0.14–0.22) determined from the Quebec scale threshold (minimum detectable change).

Both 400 mCWT and 200 mFWT are correlated with functional parameters and are responsive for the functional assessment of LBP.

Evaluation of the effect of a pad on foot morphologies in patients with medial tibial stress syndrome (MTSS) requires more reliable and objective methods, rather than conventional subjective observations.

The objective of this study was to investigate the effect of pads on foot morphologies during quiet standing in athletes with MTSS.

We measured three-dimensional foot morphologies in 30 feet with MTSS and 40 healthy feet.

The analysis showed that Hallux valgus degree, calcaneal angle, arch height, and arch height ratio differed significantly as a result of the pad support, compared to no pad support in the MTSS group. The pad support only resulted in significant differences in arch height, compared to no support in the control group. Furthermore, thumb side angle, calcaneal angle, and arch height ratio were significantly different between the MTSS and control groups.

Our study results suggest that changes in foot morphologies because of the use of a pad can be measured objectively in patients with MTSS.

Soccer as a sport has a very high injury rate and low back pain (LBP) is considered to be the most common overuse injury typically occurring in the back and spine in elite soccer players.

This study aimed to investigate differences in knee muscle strength and muscle imbalances in soccer players according to lower back pain.

One hundred and thirty-six male professional soccer players (20.49 ± 3.73 years, 76.57 ± 8.24 kg, 182.63 ± 6.73 cm) volunteered for the study. The isokinetic dynamometer PrimaDOC (EASYTECH, Italy) was used to assess the hamstring and quadriceps strength at the selected speeds of 60 ∘ /s, whereas the Roland-Morris Disability Questionnaire (RDQ) was used as a health status measure to assess physical disability caused by low back pain.

A univariate analysis of variance has shown that there is a statistically significant difference among the groups divided into Absolute peak torque right knee flexors, Absolute peak torque left knee flexors, Ratio between hamstrings and quadriceps strength right leg, and Ratio between hamstrings and quadriceps strength left leg based on the RDQ scores. On the other hand, no other significant differences among the groups were found in other parameters

The current study indicates that knee muscle strength variables, resulting from an isokinetic testing, have the potential to discriminate between soccer players with and without a history of low back pain. However, low back pain is a multidimensional phenomenon and knee muscle strength or imbalance alone cannot be expected to explain low back pain.

The resistive jaw opening exercise (RJOE) was suggested as a potential remedial treatment for patients with dysphagia. However, clinical evidence is insufficient.

To investigate the effect of RJOE on hyoid bone movement, aspiration, and oral intake level in stroke patients with dysphagia.

Forty stroke patients with dysphagia were randomly allocated into either the experimental group ( n = 20) or placebo group ( n = 20). The experimental group performed RJOE using a portable device, while the placebo group performed RJOE using a sham device with fewer loads. Intervention was conducted 5 times a week for 4 weeks. Hyoid bone movement was analyzed by two-dimensional analysis of anterior and superior motion based on a videofluoroscopic swallowing study. Aspiration was assessed using a penetration-aspiration scale (PAS), and oral intake level was assessed using the functional oral intake scale (FOIS).

Both groups showed statistically significant differences in hyoid movement, PAS, and FOIS scale ( p < 0.05). However, after the intervention, there was no significant difference between the two groups except for the liquid type of PAS. Effect sizes (Cohen’s d) were 0.9 and 0.7, 0.6 and 0.6, and 1.1 for the anterior and superior movement of the hyoid bone, semisolid and liquid type of PAS, and FOIS scale respectively.

This study suggests that RJOE helps in hyoid movement, aspiration reduction, and oral intake in patients with dysphagia after stroke.

The prevalence of radiographic knee osteoarthritis (OA) in Japan is high, with an estimated 25,300,000 affected individuals.

The purpose of this study was to clarify the characteristics of knee osteoarthritis by comparing differences between patients with knee osteoarthritis and healthy elderly individuals with respect to alignment of the pelvis and lower extremities and range of motion.

Twenty-six women (13 with medial knee osteoarthritis and 13 healthy elderly) participated in this study. Pelvic tilt, knee extension angle, femoro-tibial angle, quadriceps angle, navicular drop, and leg-heel alignment were measured. In addition, the range of motion was measured at the hip, knee, and ankle joints.

Patients with knee osteoarthritis showed a posterior pelvic tilt, knee flexion, varus, and foot pronation alignment compared to healthy subjects. The range of motion for hip extension, adduction, knee flexion, extension, and ankle dorsiflexion was significantly smaller while the range of motion for eversion was significantly larger in the knee osteoarthritis group.

People with medial knee OA have different static alignment and ROM compared to those without knee OA. The results clarify the comprehensive characteristics of the pelvis and lower extremities in knee osteoarthritis.

We evaluated the effect of caudal epidural pulsed radiofrequency stimulation in patients with chronic lumbosacral radicular pain due to postlumbar surgery syndrome who were unresponsive to at least two epidural steroid injections through the interlaminar, transforaminal, or caudal route.

We recruited 25 patients with chronic persistent radicular pain in one or both legs ( ⩾ 4 on the Numeric Rating Scale [NRS]) despite spinal surgery. They were unresponsive to at least two epidural steroid injections. We retrospectively conducted this study. Electrode needles were placed into the epidural space (S2-3 intervertebral level) through the sacral hiatus, and pulsed radiofrequency stimulation was administered. The outcomes were evaluated using the NRS scores for radicular pain before treatment and 1–3 months after treatment. Successful pain relief was defined as a ⩾ 50% reduction in the scores at 3 months after treatment.

The pain scores changed significantly over time ( p < 0.001): pretreatment, 4.9 ± 0.9; 1 month, 3.6 ± 1.4; 2 months, 3.8 ± 1.4; and 3 months, 3.9 ± 1.4. At 1, 2, and 3 months after pulsed radiofrequency (PRF) procedure, the NRS scores were significantly reduced compared with the scores before the treatment. Eight patients (32%) reported successful pain relief at 3 months after treatment.

Although only 32% of the patients with postlumbar surgery syndrome showed successful pain relief after treatment, the result is encouraging because we recruited only patients unresponsive to repeated epidural steroid injections.