Journal of Back and Musculoskeletal Rehabilitation

Health anxiety is often associated with musculoskeletal symptoms and gender, but there are limited studies that investigate these relationships during the COVID-19 pandemic.

We aimed to compare the genders regarding health anxiety and musculoskeletal symptoms during the COVID-19 pandemic and to investigate the relationship of musculoskeletal symptoms with physical activity and health anxiety.

Assessments were performed through an online questionnaire. Eighty-five males and eighty-five females were included by matching genders in terms of age, body mass index, education level, number of days spent at home during the pandemic, and physical activity. The Short Health Anxiety Inventory, the International Physical Activity Questionnaire-Short Form, and the Nordic Musculoskeletal Questionnaire were used to assess health anxiety, physical activity, and musculoskeletal symptoms, respectively.

Females had a higher level of health anxiety and more musculoskeletal symptoms than males ( p < 0.05). There were weak to moderate correlations in females and weak correlations in males between musculoskeletal symptoms and health anxiety ( p < 0.05). Also, a weak negative correlation was found between physical activity and musculoskeletal symptoms in both genders ( p < 0.05).

Females are more anxious and have more musculoskeletal symptoms during the pandemic than males. Also, health anxiety is related to musculoskeletal symptoms in both genders.

Femoral neck fractures often occur in the elderly, which usually results in hip pain.

The purpose of this study was to evaluate the difference in the treatment of Pauwels type III femoral neck fractures with medial femoral support plate combined with cannulated screws and cannulated screws alone.

PubMed, ScienceDirect, China Academic Journals Full-text Database (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), Embase and Cochrane Library were used to collect clinical controlled trials of the medial femoral support plate combined with hollow screw internal fixation and simple hollow screw internal fixation for Pauwels type III femoral neck fracture.

Seven articles ( n = 409 cases) were evaluated for quality and included in this meta-analysis. Four hundred and nine patients with Pauwels type III femoral neck fractures were included: 202 in the experimental group and 207 in the control group. The results showed that, compared with simple hollow screw internal fixation, the medial femoral support plate combined with hollow screw internal fixation has a longer operation time (MD = 23.05, 95% CI = 13.86–32.24), and more intraoperative blood loss (MD = 91.55, 95% CI = 50.72–132.39), shorter healing time (MD = - 1.48, 95% CI ( - 1.71, - 1.26)), lower incidence of complications (RR = 0.34, 95% CI = 0.19–0.61), lower VAS score (MD = - 1.28, 95% CI ( - 1.83, - 0.72)), and higher Harris score (MD = 8.49, 95% CI (4.15, 12.83)).

Medial femoral plate combined with cannulated screw for Pauwels type III femoral neck fracture can shorten healing time, reduce postoperative complications, and improve the postoperative Harris score.

The Muscle Energy Technique (MET) is one of the treatments of choice for the management of chronic mechanical low back pain (MLBP); however, there is a paucity of evidence to justify its effectiveness.

The objectives of this review are to explore, analyze and summarize the available evidence related to the effectiveness of MET in the management of chronic MLBP.

The scoping review methodology was adopted based on a recommendation from the work of Arksey and O’Malley, to systematically appraise literature and map the existing evidence on the effectiveness of MET in the management of chronic MLBP. A systematic search was performed comprising of an electronic search of online databases using key search terms and subsided by a hand search to identify the existing literature on the topic which was summarized and discussed.

Initially 25,195 hits were identified which were screened to examine their eligibility based on predetermined inclusion criteria after removing duplicate articles. Eleven articles met the inclusion criteria and were discussed.

Generally there exists a scarcity of published articles on the effect of MET in chronic MLBP. However, the analysis of the retrieved articles showed that the MET procedure is a favourable intervention that is safe (i.e. no adverse effects) and can be effective as a standalone treatment or in combination with other treatment strategies for patients with chronic MLBP with the potential to provide numerous physical and psychosocial benefits.

Adhesive capsulitis is a debilitating condition which causes the capsule of the gleno-humeral joint to thicken and contract progressively. The effectiveness of various non-operative methods has been demonstrated to improve the pain, range of motion (ROM) and functional status of patients with adhesive capsulitis.

This study aims to review recent evidence on the efficacy of physiotherapy interventions in the treatment of adhesive capsulitis.

PubMed, Physiotherapy Evidence Database (PEDro), Science Direct and Cochrane databases were searched for studies published since 2013. The search terms included: Frozen shoulder, adhesive capsulitis, physical therapy, rehabilitation, manual therapy, mobilization, exercise, education, and electrotherapy. The search was limited to studies published in English and studies that used human subjects.

Quality scores of 33 articles were reviewed according to the Sackett’s critical appraisal criteria and the grades of recommendation were determined for physiotherapy interventions used in the studies.

The empirical evidence suggests that certain physical therapy techniques and modalities are strongly recommended for pain relief, improvement of ROM, and functional status in patients with adhesive capsulitis, while others are either moderately or mildly recommended. However, the efficacy of one treatment modality over another is uncertain. The poor methodological rigors demonstrated in most of the reviewed studies emphasize the urgent need of properly conducted, adequately sampled randomized controlled trials with adequate follow up to determine the superior combination of treatment.

The struggle with pain often interferes with the ability of chronic low back pain (CLBP) patients to pursue important life values due to psychological inflexibility.

This research examined life values, related inhibitors and facilitators relevant to personalized therapy planning.

Two hundred and forty-four CLBP patients completed the Chronic Pain Values Inventory (CPVI). Of these, 68 patients were interviewed to assess inhibitors and facilitators related to life values. Mixed-effects models quantitatively examined differences in the values, structuring content analysis served to qualitatively analyze the interviews.

Participants rated the value “family” as being of highest importance and success. The largest discrepancy between importance and success was found for “health”. Content analyses revealed a broad range of inhibitors and facilitators related to the examined life values with the highest number of inhibitors related to “work”. Facilitators were also found to be of relevance to all life values, but to a lower extent than inhibitors.

The perceived importance and success of life values and their related inhibitors and facilitators may differentially affect CLBP patients. Considering such individual aspects is therefore of utmost importance to improve patient care, as they enable treatment goals and the therapeutic strategies to be adapted accordingly.

Despite the fact that non-specific low back pain (LBP) is a frequent symptom, its management remains suboptimal in primary care. A plausible reason is the persistence of erroneous fears and beliefs among general practitioners (GPs).

We aimed to determine the core qualities an educational program should have to reduce erroneous fears and beliefs about LBP among GPs.

We used a two step-approach. In the first step, meaningful qualities were collected using comprehensive data source triangulation from GPs, experts and literature. In the second step, qualities were extracted by three independent investigators in a standardized manner using the Template for Intervention Description and Replication checklist.

Qualities were collected from 8 GPs, 24 experts and 15 articles. Extraction revealed a wide range of qualities depending on participants’ background and literature. After consensus between investigators, the most meaningful qualities included evidence-based messages and web-based interventions (videos and classes) delivered by a multidisciplinary panel of experts. We found no systematic trend for when and how much, and how to tailor the intervention.

Data source triangulation revealed that the core qualities of an educational program targeting fears and beliefs about LBP among GPs should include evidence-based information, web-based interventions and a multidisciplinary panel of experts. Our findings will help us to design a provisional targeted educational intervention. This will be further assessed in a mixed-method feasibility study and then in a randomized controlled trial.

Patients with fibromyalgia syndrome (FMS) often have sleep problems and balance disorders.

The aim of the study was to examine sleep quality and balance disorders and the relationship between sleep quality and balance, functional status and the frequency of falls in patients with FMS.

Fifty women with FMS and 50 healthy women were included in the study. Sleep quality was assessed with the numeric rating scale (NRS) and the Pittsburgh Sleep Quality Index (PSQI) and balance and balance self-confidence were assessed with the Berg Balance Scale (BBS) and Activities-Specific Balance Confidence (ABC) Scale, respectively. Functional status and symptom severity of patients were assessed with the Fibromyalgia Impact Questionnaire (FIQ) and the Symptom Impact Questionnaire (SIQR). The number of falls in the last six months were recorded.

In the patient group, sleep quality scores were significantly higher, and BBS and ABC scores were significantly lower than the control group. NRS scores were significantly correlated with the BBS, FIQ, and SIQR scores, and the PSQI scores were significantly correlated with the BBS and ABC scores and the number of falls in FMS.

This study showed that the prevalence of sleep and balance disorders is higher in FMS patients. A relationship was reported between the sleep quality and balance and functional status and frequency of falls.

The straight leg raise test (SLR) is one of the most performed physical tests for mechanosensitivity and impairment of the nervous system. According to the anatomy of the tibial nerve, ankle dorsiflexion and eversion movements could be used to perform the tibial neurodynamic test (TNT). To date, no study has documented the normal responses of the TNT.

To document normal responses of the TNT in asymptomatic individuals and to investigate influences from sex and leg dominance.

A cross-sectional study with 44 asymptomatic volunteer subjects, a total of 88 lower limbs, was carried out. The range of motion (ROM), quality, and distribution of sensory responses were recorded. The hip flexion ROM was measured when subjects reported an intensity of their symptoms of 2/10 (P1) and 8/10 (P2).

The mean ROM for hip flexion at P1 was 44.22 ± 13.13 ∘ and 66.73 ± 14.30 ∘ at P2. Hip flexion was significantly greater at P2 than P1 ( p < 0.001). However, it was not different between sex or limbs ( p > 0.05). The descriptor of the quality of sensory responses most often used by participants was stretching (88.6% and 87.5% for P1 and P2, respectively) in the popliteal fossa and posterior calf.

This study describes the sensory responses of asymptomatic subjects resulting from the TNT. Our findings indicate that TNT responses are independent of the influence of sex or leg dominance.

Musculoskeletal disorders are of multi-factorial origin, including individual, physical, and psychosocial factors. An effective education program for musculoskeletal disorders should include predisposing factors.

This study aimed to examine the effect of risk factor education on pain intensity and disability levels compared to a home-based exercise program in office workers with nonspecific neck or low back pain.

A pilot cluster randomized clinical trial was conducted in 46 workers with neck or low back pain. The education group received checklists of risk factors and handbooks providing information on how to manage them. The exercise group received a home-based exercise program to manage their neck or low back pain. The primary outcome measures were pain intensity and disability levels.

There was no significant difference in pain intensity or disability level between groups at baseline and follow-ups. However, neck and low back pain intensity, but not disability level, at the 3-month and 6-month follow-ups was significantly lower than those at baseline in both groups.

Risk factor education was not more effective than the home-based exercise program in terms of pain intensity or disability reduction in workers with nonspecific neck or low back pain.

The Depression Scale (DEPS) is a commonly used screening tool for major depression in studies investigating low back pain, yet it has not been validated for patients with back-specific problems.

To assess the psychometric properties of the DEPS in patients with degenerative spinal disease.

Six hundred and thirty-seven patients with a degenerative spinal disease completed the DEPS instrument. The Rasch Measurement Theory was applied to analyze the measurement properties of the DEPS. The main hypothesis-driven approach was whether the DEPS would meet relevant psychometric criteria for assessing depressive symptoms among patients with degenerative spinal disease.

The Mean (SD) DEPS score was 9.2 (6.6). Scale minimum or maximum points among participants were 2.4% and 0.8%, respectively. Cronbach’s alpha for internal consistency was 0.92. Person Separation Index for reliability was 0.88. All items had ordered thresholds and seven of the 10 items had good item fit. Unidimensionality of the DEPS was supported (proportion of significant t -tests, 4.5%).

This study supports the validity of the DEPS for screening depressive symptoms in patients with degenerative spinal disease.

Virtual reality training is commonly used for balance problems in neurological conditions with the use of visual and auditory biofeedback. The knowledge about the effective implementation of this training in chronic low back pain is lacking.

The objective of this study is to find the radiological and biochemical effects of virtual reality training in football players with chronic low back pain.

A randomized, single-blinded controlled study was conducted on 36 participants. The first group received virtual reality training (VRT; n = 12), the second group received combined physical rehabilitation (CPR; n = 12), and the third group (control group; n = 12) received conventional training exercises for four weeks. Radiological (muscle cross-sectional area and muscle thickness) and biochemical (CRP, TNF- α , IL-2, IL-4, IL-6) values were measured at baseline and after four weeks.

Four weeks following training, the VRT group showed more significant changes in the muscle cross-sectional area than the CPR and control groups ( p ⩽ 0.001). Biochemical measures such as CRP, TNF- α , IL-2, IL-4, and IL-6 also showed significant improvement in the VRT group compared to the other two groups ( p ⩽ 0.001).

The results show that virtual reality training has positive effects on the radiological and biochemical aspects in university football players with chronic low back pain.

Extracorporeal shock wave therapy is among the conservative treatments for symptomatic heel spur.

The purpose of this trial is to evaluate and compare the therapeutic effects of radial shock wave (RSWT) and focused shock wave (FSWT) applied in the treatment of symptomatic heel spur.

Fifty-five participants were randomly divided into two comparative groups that were administered FSWT and RSWT, respectively. The severity of dysfunction (Foot Function Index, FFI), ground reaction forces (GRF) and walking temporal parameters were measured in all patients at baseline and at weeks 1, 3, 6, 12 and 24 after treatment.

In both groups, a gradual decrease in the FFI values occurred after treatment. The percentage reduction in the FFI was comparable for both groups. Statistically significant changes were only noted between some measurements of GRF and walking temporal parameters. The percentage changes in the values of the force and temporal parameters were similar between the groups.

Both FSWT and RSWT are efficacious in the treatment of symptomatic heel spur and their therapeutic effects are comparable. Objective data registered by force platforms during walking are not useful for tracing the progress of treatment applied to patients with symptomatic heel spur between consecutive procedures.

Proprioception, one’s sense of movement and position, is a common term used in back rehabilitation. Kinesthetic rehabilitation may be useful in managing lower back pain; however, reliable measures are required to quantify lumbar proprioception sense.

To investigate intrarater and interrater reliability of neutral lumbar positioning (NLP) and target lumbar positioning (TLP) tests and compare the position sense errors in subjects with non-specific low back pain and healthy controls.

Intrarater (between-day) and interrater (within-day) reliability of NLP and TLP tests were assessed in 30 subjects with low back pain and 30 healthy subjects using a digital inclinometer. NLP is evaluated when the subject is repositioned to neutral from flexion, while TLP is evaluated in lumbar flexion, by bending laterally left and right.

Intrarater reliability for NLP tests had ICC values of 0.85 and 0.89 and TLP tests had 0.78 and 0.92. Likewise, interrater reliability for NLP had ICC values of 0.75 and 0.85, and for the TLP test, the interrater reliability had 0.78 and 0.93. Subjects with back pain had significantly larger neutral and target lumbar proprioceptive errors compared to healthy controls ( p < 0.001).

Intrarater and interrater reliability showed good agreement for both NLP and TLP tests of lumbar proprioception. Subjects with nonspecific low back pain have impaired lumbar proprioceptive sense.

Adolescent idiopathic scoliosis screening still needs a considerable implementation, particularly throughout a school-based assessment protocol.

This study aims to evaluate the effectiveness of clinical examinations currently in use for the diagnosis of adolescent idiopathic scoliosis, through a survey carried out in secondary schools to standardize a screening protocol that could be generalized.

In their classrooms, the adolescents underwent an idiopathic scoliosis screening through three examinations: Adam’s test, axial trunk rotation (ATR) and plumb line. In case of single positivity to one of the three examinations, a column X-ray examination was recommended.

The sensitivity and diagnostic specificity of Adam’s test or ATR were 56.3% and 92.7%, respectively. The positivity to at least one between ATR or plumb line showed that sensitivity was higher than specificity: 91.3% versus 80.8%; the positivity to at least one between Adams’s test or plumb line showed a sensitivity of 95.2% and a specificity of 81.5%. Finally, the positivity to all three examinations showed an increase in specificity (99.7%).

Taken together, our findings show that this school-based screening protocol had a very high specificity in early diagnosis of adolescent idiopathic scoliosis.

Respiratory-muscle weakness is an important clinical problem. The respiratory system’s health is a decisive factor in the physical and social life of the elderly. Changes in respiratory muscular strength and function activate the torso’s adjustment ability, which affects daily activities.

This study aimed to investigate the effects of resistance exercises combined with breathing exercises on the respiratory-muscle strength of elderly women.

This study included 26 elderly woman, who were randomly divided into two sub-groups of 13 participants each. The experimental group performed breathing exercises and dynamic upper- and lower-extremity exercises, and the control group practiced only dynamic upper- and lower-extremity exercises. The maximum expiratory pressure (MEP) and maximum inspiratory pressure (MIP) were measured both before and at the end of the six-week study.

In both groups, both the post-test MIPs and MEPs were significantly higher than the pre-intervention ones ( p < 0.05). For MIPs, the between-group difference was not statistically significant, either before the intervention or post-test ( p > 0.05). For MEPs, the between-group difference was statistically significant at post-intervention points ( p < 0.05).

The results showed that resistance exercises applying maximum expiration improved the respiratory-muscle strength of elderly women. These findings indicate that resistance exercises applying maximum expiration as described here in should be considered in patients who require breathing therapy, because the combination seems to significantly increase the strength of the respiratory muscles.

The aim was to analyze the effect of one session and three sessions of strength training (ST) on pain in women with fibromyalgia (FM).

Twenty-three women with FM performed three sessions of ST for a week. Each training session worked the main muscle groups and lasted 60 min. Three sets of 12 repetitions were performed with 1 min intervals in between. The load was increased based on the perception of subjective effort of each patient. Pain intensity was evaluated immediately after the first and third sessions using a Fischer digital algometer.

After the first ST session, pain reduction was observed. No significant differences were found in pain thresholds on the baseline versus the third session. The analysis of MBI demonstrated that the ST does not worsen patients’ pain, indicating a 52.2% trivial effect and a 39.1% beneficial effect.

Our results suggest that there is no harmful effect on the pain of women with FM after an acute session of ST. We emphasize that despite the promising results, more studies on the subject are needed to help understand pain in patients with FM.

Fibromyalgia syndrome (FMS) is an extra-articular rheumatological disease characterised by widespread chronic musculoskeletal pain. Metal-induced oxidative stress contributes to the severity of FMS.

First, this study evaluated the association between plasma levels of toxic heavy metals and essential metals with oxidative stress (OS) markers. Second, the OS markers and metal contents were correlated with the disease severity by assessing the Fibromyalgia Impact Questioner Revised (FIQR) and tender points (TP).

A total of 105 FMS patients and 105 healthy controls of similar age and sex were recruited. OS parameter such as lipid peroxidation (LPO), protein carbonyl group (PCG), nitric oxide (NO) and essential metals such as zinc (Zn), magnesium (Mg), manganese (Mn), copper (Cu) and toxic heavy metals such as aluminium (Al), arsenic (As), lead (Pb) were estimated.

Levels of LPO, PCG, NO ( p < 0.001) and Cu, Mn, and Al ( p < 0.001), were significantly higher, and Mg ( p < 0.001) and Zn ( p < 0.001) were significantly lower in patients compared to controls. A positive association was observed between OS parameters, FIQR and TP with Cu, Al and Mn. A significant negative association was observed between Zn and Mg with FIQR, TP and OS parameters.

Heavy metals such as Al induce OS parameters and decrease the levels of essential trace elements such as Mg and Zn, which may be responsible for the severity of FMS.

Various cupping sizes of cupping therapy have been used in managing musculoskeletal conditions; however, the effect of cupping sizes on skin blood flow (SBF) responses is largely unknown.

The objective of this study was to compare the effect of three cupping sizes of cupping therapy on SBF responses.

Laser Doppler flowmetry (LDF) was used to measure SBF on the triceps in 12 healthy participants in this repeated measures study. Three cup sizes (35, 40 and 45 mm in diameter) were blinded to the participants and were tested at - 300 mmHg for 5 minutes. Reactive hyperemic response to cupping therapy was expressed as a ratio of baseline SBF.

All three sizes of cupping cups resulted in a significant increase in peak SBF ( p < 0.001). Peak SBF of the 45 mm cup (9.41 ± 1.32 times) was significantly higher than the 35 mm cup (5.62 ± 1.42 times, p < 0.05). Total SBF of the 45 mm cup ((24.33 ± 8.72) × 10 3 times) was significantly higher than the 35 mm cup ((8.05 ± 1.63) × 10 3 times, p < 0.05). Recovery time of the 45 mm cup (287.46 ± 39.54 seconds) was significantly longer than the 35 mm cup (180.12 ± 1.42 seconds, p < 0.05).

Our results show that all three cup sizes can significantly increase SBF. The 45 mm cup is more effective in increasing SBF compared to the 35 mm cup.