Journal of Back and Musculoskeletal Rehabilitation

Muscle synergies contribute to scapular position during arm movement. The trapezius and serratus anterior (SA) muscles are the main stabilizers and are therefore the main target muscles of therapeutic exercises.

To systematically review the current literature investigating the optimal activation ratio of the scapular muscles during a range of closed kinetic chain exercises.

A systematic review search was conducted to identify studies reporting shoulder electromyography (EMG) activity during rehabilitation exercises in healthy participants. The search was conducted in PubMed, Cochrane Library, MEDLINE, CINAHL, Scopus, SPORTDiscus, and ScienceDirect. The included studies reported closed kinetic chain exercises and the muscle activity as a percentage of maximum voluntary isometric contraction (%MVIC) or muscle ratios of the lower trapezius (LT), middle trapezius (MT), and SA with respect to the upper trapezius (UT). Muscle ratios were classified as optimal if they were equal to or lower than 0.6, and the adapted Newcastle-Ottawa Scale (NOS) was used to evaluate the methodological quality of the selected studies.

Twenty-nine studies were included in this review; 7 main exercises and 30 variations of these were reported. The average electromyographic activity of the concentric and eccentric phase was considered. Half Push Up, Push Up Plus, and Scap Protraction exercises showed optimal SA activity (UT/SA < 0.6), while Press Up, Half Push Up, and One Hand Plank exercises showed optimal LT activity (UT/LT < 0.6). According to the NOS, 15 studies were classified as moderate methodological quality.

The exercises in higher positions (e.g. exercises with the trunk closest to the vertical line) or unstable surfaces tend to favor UT activity over the MT, LT and SA. The exercises including scapular retraction showed optimal UT/MT and UT/LT ratios, while those including scapular protraction showed optimal UT/SA ratios. This will assist therapists in the correct selection of exercises for shoulder rehabilitation.

Shoulder pain from rotator cuff pathology and glenohumeral osteoarthritis is a common entity encountered in musculoskeletal practices. Orthobiologic agents are being increasingly used as a treatment option and understanding their safety and efficacy is necessary.

To systematically evaluate the available evidence for orthobiologic use in rotator cuff and glenohumeral pathology.

A systematic review was undertaken following PRISMA guidelines. Randomized clinical trials (RCTs) and prospective cohort studies evaluating non-operative treatment with prolotherapy, platelet-rich plasma (PRP), or medicinal signaling cells (MSCs) for rotator cuff pathology and glenohumeral osteoarthritis were included. Bias risk assessments used were the Cochrane tool and Newcastle-Ottawa score.

The search yielded 852 potential articles, of which 20 met the inclusion criteria with a breakdown of 5 prolotherapy, 13 PRP, and 2 MSC. Sixteen studies were RCTs and 4 were cohort studies. Six studies were deemed “low risk of bias or good quality”. Efficacy results were mixed, and no serious adverse events were reported from orthobiologic treatment.

Orthobiologics offer a relatively safe management option with inconclusive evidence for or against its use for rotator cuff pathology. No studies on glenohumeral osteoarthritis met the inclusion criteria. Adoption of standardized preparation reporting and consistent use of functional outcome measures is imperative for future studies to consider.

Jumping stump is an uncommon movement disorder characterized by involuntary movements and severe neuropathic pain in the stump. The pathophysiology and etiology of this phenomenon have not yet been clearly elucidated, and unfortunately, no proven treatment with successful recovery exists. This report aims to describe a severe painful jumping stump, possibly due to neuromas, in a traumatic transradial amputee.

We performed ultrasound examination of the painful stump depicted neuroma. Electromyographic evaluation of the stump revealed arrhythmic motor unit action potentials (MUAPs) with normal duration and amplitude; other movement disorders, such as myokymia and fasciculations, were excluded. Ultrasound should be preferred to magnetic resonance imaging (MRI) for evaluation of stumps in patients with painful stump because MRI may not be helpful due to motion artefacts. The involuntary movements ceased after surgical excision of the neuroma following failure of conservative treatments.

This report confirms that neuromas are clearly associated with jumping stump. Ultrasonographic and electromyographic assessments are necessary to reveal the features of this pathology for treatment planning.

Morel-Lavallée Lesion (MLL) of the knee is an uncommon cause of knee swelling usually due to high-energy impact or in patients on anticoagulation. MLL of the knee due to low-energy non-athletic associated trauma in patients without antithrombotic therapy is rare. Early diagnosis can be achieved using point-of-care ultrasound.

A 60-year-old female who was previously well was referred to our center for a persistently swollen left knee 2 months after a fall while on a flight of stairs. A point-of-care ultrasound identified a possible MLL of the knee. This was subsequently confirmed on magnetic resonance imaging (MRI). The lesion resolved with ultrasound-guided therapeutic aspiration.

MLL of the knee should be a differential diagnosis of traumatic knee swelling, even in low-energy trauma and in patients without bleeding diatheses. Ultrasound is a readily available and rapid modality that can aid both in the diagnosis and management of such lesions.

Scoliosis is frequently associated with pain and radiculopathy, but it is not considered a possible cause of acute spinal cord injury (SCI). Here we present a case report in which scoliosis was apparently linked to spinal cord ischaemia.

A 20-year-old woman with conservatively treated severe scoliosis presented with acute spinal cord infarction, which occurred during a spinal flexion while she was tidying up the bed. Other causes of SCI were excluded. Early rehabilitation was started and the patient progressively regained motor and sensory functions, with an AIS reduction from A to C. Bowel and bladder disorders persisted and were autonomously managed with a trans-anal irrigation device and intermittent catheterisation after voluntary micturition.

Early detection and management of spinal curvature disorders are essential in preventing long-term complications of scoliosis. Although the aetiology of spinal cord ischaemia in severe scoliosis should be better clarified, this rare case report suggests that scoliosis might be involved in its pathogenesis. Thus, we recommend early diagnosis of spinal curvature disorders and adequate rehabilitative treatment in order to prevent potential subsequent neurological complications.

Teachers present with shoulder musculoskeletal disorders, which result in pain and poor shoulder function.

To determine the effect of an eight-week shoulder rehabilitation intervention on pain and function, range of motion and muscle strength among teachers.

Thirty teachers presenting with shoulder pain were recruited and divided into equal control and experimental groups. The intervention group participated in an eight-week rehabilitation programme. Pre- and post-intervention measurements included the scapular position test, range of motion, muscle strength measurements as well as a shoulder rating questionnaire.

There was a significant improvement in the experimental group’s internal range of motion for the dominant ( p = 0.006) and non-dominant arms ( p = 0.003) post-intervention. Additionally, significant improvements were found in muscle strength in the experimental group in dominant and non-dominant flexion; abduction; external rotation ( p < 0.001); dominant internal rotation ( p < 0.001) and non-dominant internal rotation strength ( p = 0.007). Post-intervention questionnaire data found a decrease in pain ( p = 0.003); improved ability to perform daily activities ( p = 0.006); improved overall score ( p < 0.001) and satisfaction ( p = 0.023) in the intervention group compared to the control group.

The implementation of a rehabilitation programme in schools should be considered to manage the prevalence of shoulder musculoskeletal disorders among teachers.

The Back Pain Attitudes Questionnaire (Back-PAQ) is a tool developed for the assessment of attitudes about back pain. However, this tool is not available in the Arabic language. The availability of the Arabic version of the questionnaire will enable clinicians and researchers in Arabic-speaking countries to assess patients’ attitudes towards back pain.

We aimed to translate and cross-culturally adapt the English version of the Back-PAQ into Arabic and study its psychometric properties.

The translation and cross-cultural adaptation processes were performed according to published guidelines. The translated Arabic version was tested for face and content validity on 40 participants. The psychometric properties of the final Arabic version were tested on 110 participants. Participants completed the Arabic version of the Back-PAQ and Fear-Avoidance Beliefs Questionnaire (FABQ). A subgroup of 50 participants completed the questionnaire twice in a week interval to determine the Back-PAQ test-retest reliability.

The majority of participants found the questionnaire understandable and the questions relevant and appropriate for their back problem. There was a fair correlation between the Back-PAQ-Arabic and the FABQ physical activity scale (rho = 0.283, p = 0.001), and little to no correlation with total FABQ (rho = 0.186, p = 0.026) and education level (rho = - 0.162, p = 0.045). The Arabic Back-PAQ-Arabic showed moderate internal consistency with Cronbach’s α of 0.601, and excellent test-retest reliability (ICC 2 , 1 = 0.963). The Back-PAQ standard error of measurement was 3.57 and minimum detectable changes was 9.90.

The Arabic version of the Back-PAQ has adequate validity and reliability properties.

Although the Pilates method has been reported to be effective in women with low back pain (LBP), the efficacy of Pilates exercises in pregnant women with LBP has not been evaluated widely.

The purpose of this study was to determine the effects of clinical Pilates exercises on lumbopelvic stabilization, pain, disability and quality of life in pregnant women with LBP.

Fourty pregnant women were randomized into either a Pilates exercise group ( n = 20) or control group ( n = 20). Subjects in the Pilates exercise group performed the exercises two times a week for eight weeks. Subjects in the control group followed regular prenatal care. Lumbopelvic stabilization was assessed with a pressure biofeedback unit, pain with the Visual Analog Scale, disability with the Oswestry Low Back Pain Questionnaire and quality of life with the Nottingham Health Profile (NHP).

Pain and disability were significantly improved in the Pilates exercise group after intervention ( p = 0.03, p < 0.001, respectively). There were also significant improvements in sleep, physical mobility sub-parameters of NHP and lumbopelvic stabilization after Pilates exercises ( p = 0.048, p = 0.007, respectively). However, there were no statistically significant changes in all outcome measures in the control group ( p > 0.05).

Pilates exercises can be recommended as an effective and safe method for increasing lumbopelvic stabilization, reducing pain and disability, improving physical mobility and sleep problems in pregnant women with LBP.

The abdominal drawing-in exercise could help improve delayed transversus abdominis (TrA) activation during limb movement in subjects with recurrent low back pain (rLBP). However, little is known about whether the same effect is observed during lifting tasks in subjects with rLBP.

This study aimed to clarify whether a single session of abdominal drawing-in exercise could correct the altered trunk muscle activation patterns during a lifting task in subjects with rLBP.

Fifteen subjects with rLBP performed lifting tasks before and immediately after three sets of 10 repetitions of isolated TrA voluntary contractions. The time of onset and activation amplitude during the lifting tasks were measured by surface electromyography (EMG) and compared between the trials before and immediately after exercise.

During lifting, the onset of internal abdominal oblique/TrA (IO/TrA) and multifidus activation occurred earlier, the EMG amplitude of IO/TrA increased, and the EMG amplitude of erector spinae and multifidus decreased, compared with the pre-exercise data.

These results suggest a possibility that the abdominal drawing-in exercise might be effective in improving the muscle recruitment pattern in people with rLBP.

The benefits of spinal realignment and stabilization in scoliosis need to be examined.

We aimed to investigate the long-term effect of a neuromuscular stabilization technique (NST) on Cobb’s angle in patients with adolescent idiopathic scoliosis.

Twenty females recruited from two hospitals participated in this study. On the basis of convenience of location, participants were allocated to either the experimental group (EG) that underwent the NST, or the control group (CG) that received education for a home exercise program. The NST for the EG was performed for an average of 30 min per session, three times a week for six months, and consisted of spinal realignment and stabilization. Then, 12- and 18-month measurements for long-term follow-ups were conducted for the EG. The outcome measure was Cobb’s angle.

Between-group comparison revealed a statistically significant difference at post-test ( t = - 3.26, p < 0.01) but not pre-test ( t = - 1.36, p = 0.19). Participants of the EG ( - 6.20 ± 2.49 ∘ ) showed greater differences between pre- and post-test scores compared to participants of the CG ( - 1.40 ± 0.52 ∘ ) ( p < 0.05). Within-group comparisons showed a significant difference in both groups ( p < 0.05). In the EG, Cobb’s angle significantly changed across the follow-up sessions ( p < 0.05), indicating more improvements by the 12-month (8.50 ± 4.03 ∘ ) and 18-month (6.60 ± 3.89 ∘ ) follow-ups.

This study shows that the NST may be a beneficial option to correct spinal alignments in patients with adolescent idiopathic scoliosis.

Problems related to ankle instability, decreased proprioceptive sensation, altered static and dynamic balance abilities are suggested as major representative factors that contribute to the recurrence of ankle sprains.

To assess the effect of a three-week intervention (intervention emphasizing diagonal eccentric contraction (IEDEC) and intervention of general exercise (IGE)) on static and dynamic balance abilities, ankle strength and joint position sense at pre- and post-intervention, and at two- and three-week post-intervention.

Twenty-five participants with ankle instability, including a history of ankle sprain and recurrent episodes of giving way, were enrolled in the study. They were randomly classified into the IEDEC group ( n = 12) and the IGE group ( n = 13). Dynamic balance was examined using the Y Balance Test, four-way ankle strength was measured, and the static balance was evaluated using the total displacement of the center of pressure (COP). To identify the joint position error, eversion and inversion of the ankle angle were measured.

The results revealed significant increases in ankle dynamic stability and strength at two and three weeks post-intervention ( p < 0.05). Similarly, the total displacement of the COP differed significantly over time, with a higher COP during the initial measurement than at two and three weeks intervention ( p < 0.05) General balance training with IEDEC can improve position sense during ankle inversion ( p < 0.05).

General balance training with IEDEC improved the position sense of the inversion. Combined therapeutic intervention, such as with the manual technique, could be a beneficial approach to maximize the treatment effects.

Low back pain is a very common musculoskeletal complaint that impacts patients’ quality of life in numerous ways. Facet joint injection is a widely used spinal intervention to relieve back pain. Effects of facet joint injection on spinopelvic parameters and the relationship between injection levels and spinopelvic parameter changes have not been evaluated before.

To compare spinopelvic parameters before and after injections at different levels, and to evaluate the correlation between these changes and functional outcome.

144 patients were included in the study and retrospectively grouped by injection level: Group 1 ( n = 72), L4-L5 and L5-S1, and group 2 ( n = 72), L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1. Pre- and post-injection Oswestry Disability Index (ODI), sacral slope, pelvic tilt, pelvic incidence, and intervertebral angles between T12 and S1 were compared. The correlation between ODI and radiographic parameter changes was evaluated.

The pre- to post-injection ODI change was significantly lower in group 2 ( p = 0.010). There was no significant difference between the groups in terms of pre- and post-injection spinopelvic parameters before and after injection ( p > 0.05) except pelvic tilt ( p = 0.001 and p = 0.007, respectively). There was a significant moderate positive correlation between the change in the ODI value and the change in pelvic tilt ( P = 0.012, r = 0.581).

Multilevel lumbar facet injections are clinically more effective than only two-level lower level lumbar injections. Pelvic tilt changes positively correlate with the ODI score changes.

Low back pain is a common problem in pregnant woman. Elastic tape is an alternative method that may reduce low back pain.

To compare the effect of elastic tape to placebo tape in the treatment of low back pain in pregnant women.

Forty pregnant women were allocated into two groups: elastic group ( n = 20) and placebo group ( n = 20). All participants were taped by either stretched (elastic group) or non-stretched (placebo group) Kinesio tape at the lower back area for one week.

After the application of stretched elastic tape, lower back pain was significantly reduced by 29.4% ( p = 0.003) immediately post-taping and by a further 75.4% after wearing the tape for a week. Compared to the placebo group, lower back pain was significantly reduced in the elastic group after one week of wearing the tape ( p < 0.001). Compared to placebo, the application of elastic tape significantly reduced the disability score (Roland-Morris Disability Questionnaire) after one week of wearing the tape ( p = 0.018). Taping to the back improved walking speed (immediately and after one week) in both the elastic ( p < 0.001, p < 0.001) and placebo groups ( p < 0.001, p = 0.001); however, the application of either tape had little effect on posture change.

Elastic tape reduced back pain and improved physical function in pregnant women compared to the placebo tape.

To date the Neck OutcOme Score (NOOS) was not cross-culturally adapted, validated or available in the Arabic language, although it was available in other languages.

To translate and cross-culturally adapt the Arabic version of the Neck OutcOme Score (NOOS-Ar) and study its psychometric properties.

A sample of 146 subjects with chronic neck pain filled in the NOOS-Ar questionnaire to determine the Cronbach’s alpha ( α ) for internal consistency, test-retest reliability by intraclass correlation coefficients ( 2 , 1 ) [ICC ( 2 , 1 ) ], inter-item correlation, measurement error by coefficient of variance and minimal detectable change, ceiling and floor effects, convergent construct validity with visual analog scale (VAS) by Spearman’s rank correlation coefficient ( ρ ) and factor analysis to calculate and determine its psychometric properties.

Excellent internal consistency (Cronbach’s α > 0.9) and test-retest reliability [ICC ( 2 , 1 ) > 0.9] were observed in NOOS-Ar. None of the five subscales of the NOOS-Ar showed a floor or ceiling effect. The coefficient of variance was generally high, but the minimal detectable change was within the acceptable range ( < 30%). The ‘everyday activity and pain’ and ‘symptoms’ subscales of the NOOS-Ar, showed a moderate correlation with VAS.

The NOOS-Ar is highly reliable and has a moderate to good degree of convergent construct validity with VAS with no floor or ceiling effects.

Low back pain (LBP) is a common health condition and the leading cause of activity limitation and absenteeism in most parts of the world. One-fifth of patients with LBP develop chronic pain disability.

This study investigated the disability levels in patients with different types of lumbar spinal disorders.

A total of 528 patients visiting spine clinics between June 2017 and February 2018 were enrolled in this study. A demographic checklist, the patients’ medical records, the Oswestry Disability Questionnaire, and the Visual Analog Scale (VAS) were used to collect the data.

Non-specific LBP (29.5%) and discopathy (27%) were the most common final diagnoses. The obtained Oswestry Disability Index (ODI) was significantly higher in older patients, those with higher body mass index, more work experience, and smokers. Lower ODI was found in individuals with a history of regular exercise. Most individuals in all diagnostic groups were categorized into the high ODI group ( p ⩽ 0.001).

In patients with lumbar spine lesions, ODI is significantly correlated with age, BMI, work experience, smoking, and the type of disorder (discopathy, spondylolysis, and spondylolisthesis). Regular exercise is associated with lower levels of disability.

Sorensen Test time-to-task-failure (TTF) predicts several low back pain (LBP) clinical outcomes, including recurrence. Because the test is described as a measure of trunk extensor (TE) muscle endurance, LBP rehabilitation programs often emphasize endurance training, but the direct role of TE muscle function on Sorensen Test-TTF remains unclear.

To assess the discriminative and associative properties of multiple markers of isolated TE performance with regard to Sorensen Test-TTF in individuals with recurrent LBP.

Secondary analysis of baseline measures from participants in a registered (NCT02308189) trial (10 men; 20 women) was performed. Participants were classified by Sorensen Test-TTF as high, moderate or low risk for subsequent LBP episodes, and compared to determine if classification could discriminate differences in TE function. Correlations between Sorensen Test-TTF and isolated TE performance, anthropometrics and disability were investigated.

Individuals at risk of subsequent LBP episodes had greater perceived disability and fat mass/TE strength ratios ( P ⩽ 0.05) than those not at risk. Modest, significant ( r = 0.36–0.42, P ⩽ 0.05) associations were found between Sorensen Test-TTF, TE endurance and fat mass/TE strength. Exploratory analyses suggested possible sex-specific differences related to Sorensen Test-TTF.

Isolated TE muscle endurance is only one of several factors with similar influence on Sorensen Test-TFF, thus LBP rehabilitation strategies should consider other factors, including TE strength, anthropometrics and perceived disability.

Patients with chronic non-specific low back pain (CNSLBP) have pain, disability, and decreased functional capacity, however, the association is still unknown.

This study aimed to examine the association between pain, disability, and functional capacity in patients with CNSLBP.

Thirty participants with CNSLBP were interviewed for demographic data and assessed for pain intensity by visual analog scale (VAS), disability level by Oswestry Disability Index (ODI), and functional capacity comprising functional reach (FR), five times sit-to-stand (5STS), and two-minute step (2MS). The association and linear regression were analyzed using the Spearman correlation coefficient, point-biserial correlation, and multiple linear regression, respectively.

A significant association was found between VAS and ODI, VAS and 5STS, 5STS, and 2MS. For demographic data, some variables were significantly correlated to VAS and functional capacity. VAS was also correlated with sex and age, FR was correlated with height, 5STS was correlated with age, and 2MS was correlated with age, body mass index, and physical activity level.

The association among pain intensity, disability level, functional capacity, and demographic data suggests that apart from pain and disability level, functional capacity is associated with pain, which can be recommended for objective assessment regarding some demographic variables that can contribute to clinical outcome measures.