Journal of Back and Musculoskeletal Rehabilitation

In this study we investigate the effects of paravertebral ozone injections (POI), which have been used as a new treatment approach for lower back pain in recent years, on pain and physical activity in patients with acute lumbar disc herniation (LDH) as an additional treatment.

Thirty-eight patients were assigned into the ozone therapy (OT) group ( n = 20) and placebo control (PC) group ( n = 18). Both groups received two sessions per week, a total of 8 sessions of lumbar POI. The ozone concentrations of 20–25 μ g/ml (30 ml) and 0.1 μ g/ml (30 ml) were administered to the OT and PC groups, respectively. The patients were assessed with the visual analog scale (VAS) and Oswestry Disability Index (ODI) before the treatment (V1), 15 (V2) and 30 (V3) days after the treatment started, and one month (V4) after the treatment ended.

A significant improvement was seen in the VAS and ODI scores in the final follow-up (V4) as compared with the baselines scores (V1) in both groups ( P < 0.05). The patients in the OT group had lower mean VAS and ODI scores in V2, V3, and V4 follow-ups compared with the patients in the PC group. This significant difference reached its peak in the final follow-up (V4) ( P < 0.05).

As an additional treatment combined with conservative treatment, lumbar POI can lessen pain and disability in patients with acute LDH.

Performing thoracic manipulations for neck pain can result in immediate improvements in neck function.

The aim of this study was to investigate the immediate effects of thoracic manipulation on cervical joint position sense and cervical range of motion in individuals with chronic mechanical neck pain.

Eighty male volunteers between 18–25 years and having chronic or recurrent neck or shoulder pain of at least 3 months duration with or without arm pain were randomized into two groups: Thoracic Manipulation Group (TMG:50) and Control Group (CG:30), with a pretest-posttest experimental design. The TMG was treated with thoracic extension manipulation while the CG received no intervention. Cervical joint position error and cervical range of motion of the individuals were assessed at baseline and 5 minutes later.

There was no difference in demographic variables such as age ( p = 0.764), Body Mass Index ( p = 0.917) and Neck Pain Disability Scale (NPDS) scores ( p = 0.436) at baseline outcomes between TMG and CGs. Joint position error outcomes between the two groups following intervention were similar in all directions at 30 and 50 degrees. Differences in range of motion following intervention in neck flexion ( p < 0.001) and right rotation ( p = 0.004) were higher in TMG compared to CG.

A single session of thoracic manipulation seems to be inefficient on joint position sense in individuals with mild mechanical neck pain. However, thoracic manipulation might be an effective option to increase flexion and rotation of the cervical region as an adjunctive to treatment.

Aquatic exercise can improve strength, flexibility, and aerobic function while safely providing partial weight-bearing support through viscosity and buoyancy.

The aim of the present study was to compare the effects of water-based exercise with land-based exercise before and after a 10-week exercise intervention and again at one-year follow-up.

Eighty participants aged 65 years and older were randomly assigned to either a water- or a land-based 10-week exercise program. Assessment included the Senior Fitness Test (SFT), the Modified Falls-Efficacy Scale, and the 36-Item Short-Form Health Survey (SF-36). Hip and knee strength was also measured. All assessments were completed at three time points: pre- (T1), post- (T2), and at 1-year follow-up (T3).

Significant differences were observed between the two groups on three parameters: the SFT timed up-and-go test; lower hip muscle strength in extension, adduction, and external rotation; and quality of life (QoL) measured by the SF-36 ( p < 0.05). No significant differences were observed in the SFT chair stand test, dominant arm curl test, two-minute step test, chair sit-and-reach test, back scratch test, and Modified Falls-Efficacy Scale.

Aquatic exercise provided greater improvement of physical health and QoL among older people than land-based exercise.

Due to a significant burden associated with training sessions and matches, female football players often suffer from lumbar pain. Physical exercise is considered an effective form of therapy for this condition. The exercises in the Kinetic Control concept are one of the forms of motor control training.

The aim of the study was to evaluate the effectiveness of motor control training according to the Kinetic Control concept on the level of lumbar spine pain, degree of disability, functional level and load distribution of lower limbs in football players.

The study included 18 football players, randomly divided into two study groups: A – female players implementing their training plan with additional Kinetic Control training ( n = 9) and B (control) – female players implementing their training plan only ( n = 9). Pain intensity was measured using Visual Analogue Scale (VAS) and Laitinen’s questionnaire. Functional disability was assessed using Oswestry Disability Index (ODI) and Back Pain Functional Scale (BPFS). The asymmetry index was assessed in a balance test with open and closed eyes and a countermovement jump (CMJ).

There was a significant statistical difference between the groups ( p < 0.05) in measurements using VAS, ODI and BPFS, in favor of group A. Asymmetry index values in tests on the dynamometer platform did not differ significantly between the groups ( p > 0.05). A statistically significant correlation was found between the asymmetry index score in the closed-eye balance test ( r = 0.567, p = 0.049) and the CMJ landing phase ( r = 0.641, p = 0.033), and the level of pain measured using VAS.

Motor control training in the Kinetic Control concept reduced the pain symptoms of the lumbar spine and the degree of disability and increased the functional level in football female players.

Symptomatic degenerative meniscus tears are common in middle and old age. Arthroscopic partial meniscectomy (APM), physical therapy (PT) and hyaluronic acid injection (HAI) are the most commonly used treatment options.

The aim of our study is to compare the effectiveness of APM and PT in degenerative meniscus tears and to investigate the effect of HAI with a prospective, randomized, single-blind study.

The study included 192 patients with symptomatic degenerative meniscus tears. The patients were randomly divided into the four groups. The first group consisted of patients who underwent APM, the second group received HAI with APM, the third group received PT, and the fourth group received HAI with PT. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS) scores, and range of motion (ROM) values were used for evaluation.

There was no difference between four groups according to age, gender, BMI, affected side, grade of osteoarthritis. In the 4 groups, WOMAC and VAS results at the 2nd and 6th months were better than pre-treatment. There was no difference between the groups in terms of WOMAC and VAS. In terms of ROM, the results were found better in PT group (Group 3, Group 4) at the 2nd and 6th months. However, the results were found worse in APM group (Group 1, Group 2). In addition, it was found that HAI applied with APM and PT had no effect on VAS, WOMAC, and ROM. It was determined that the increase of knee osteoarthritis negatively affected both the results of APM treatment and PT. VAS, WOMAC, and ROM results were found worse in patients with stage 3 osteoarthritis than grade 1 and 2, but there was no difference between grade 1 and 2.

APM and PT give good results in terms of pain and functional results. However, ROM limitation develops after APM. Conversely, there is an increase in ROM after PT. Administration of HAI with these treatments has no effect on the results. PT is an easily applicable noninvasive method. Adding HAI to the treatment has no effect on the results and increases the cost.

In 1973, Dr. Kenzo Kase developed Kinesio taping from the hypothesis that this external component could aid the functions of muscles and other tissues. There are different studies on this issue, but none has completely clarified the research question.

To study the application of Kinesio taping in the variation of isometric muscle strength of the hand extension and grip, isokinetic strength of the pronation and supination movements, and the time it takes to reach that strength in patients with lateral epicondylalgia.

An analytical, experimental, randomized study was carried out with 104 subjects with lateral epicondylalgia. The subjects were randomly distributed among two groups: one received Kinesio taping and the other a placebo material. A pre- and post-intervention measurement was performed. The post-measurement was carried out 24 hours later so as to completely eliminate the fatigue effect produced by the first day measurements, as well as to ensure that the intervention was effective, and not immediate. The measurements were made using a dynamometer.

No significant differences were found between the application of Kinesio taping and placebo material in subjects with lateral epicondylalgia regarding the variation of muscle strength in any of the study variables ( p > 0.05 for all studied variables).

Kinesio taping produces no change in strength after application and exerts an effect similar to that of a placebo.

The 6-minute walk test (6-MWT) is commonly used to measure functional capacity in clinical and research settings. The reference equations for predicting the 6-minute walk distance (6-MWD) in different populations have been established; however, there is a lack of information regarding healthy Saudi individuals over 50 years old.

This study aimed to establish the reference values of 6-MWD in a sample of healthy Saudi adults aged 50–80 years, develop regression equations for the established 6-MWD, and compare the measured 6-MWD in the present study with the predicted 6-MWD derived from the previously published regression equations.

In total, 210 healthy Saudi volunteers aged 50–80 years participated in this cross-sectional study. The 6-MWT was performed according to the American Thoracic Society (ATS) guidelines. Lung function, physical activity, blood pressure, heart rate, oxygen saturation, exertion level of leg fatigue, and sensation of dyspnea were measured.

The mean 6-MWD was 396.2 ± 69.4 m. It was significantly correlated with age, sex, height, body mass index (BMI), and physical activity. The predictors of 6-MWD were age and BMI for men, while they were age, BMI, and height for women. They accounted for 25% and 35% of the total variance of 6-MWD for men and women, respectively. The measured 6-MWD was significantly shorter than the predicted 6-MWD.

Saudi populations have significantly shorter 6-MWDs than those reported in other ethnic groups. The sex-specific equations developed in this study are expected to provide a useful measure of 6-MWT for Saudi adults. However, further investigation is required to validate the application of these equations to individuals living in different regions of Saudi Arabia.

Caring for a child with a disability affects musculoskeletal system pain, fatigue, sleep quality, and anxiety of the mothers. The purpose of the study was to determine the effectiveness of breathing exercises in mothers with chronic non-specific low back pain (NLBP).

Forty-three mothers with chronic NLBP were randomly assigned to the experimental group ( n = 23) and the control group ( n = 20). The experimental group received breathing exercises with core stabilization exercises (BSET) for three sessions a week for 8 weeks, and the control group performed stabilization exercises (SET) only, for the same period. Pain severity, fatigue, anxiety, and sleep quality were evaluated before and after the treatment programs.

After the treatment programs, significant differences were observed in pain, fatigue, and sleep quality in both groups ( p < 0.05). However, the BSET group showed a significantly better improvement in anxiety levels and sleep quality than the SET group ( p < 0.05).

The improvements in pain, fatigue and sleep quality were seen in both groups after treatment programs. It is recommended breathing exercises are added to core stabilization programs to provide greater improvements in anxiety level and sleep quality for mothers of children with disabilities, who have NLBP.

Transcutaneous electrical nerve stimulation (TENS) is one of the most common methods for managing shoulder pain, and high voltage pulsed currents (HVPS) may be used for reducing pain. However, their immediate effects on resting pain and pain-free active range of shoulder motion (pfROM) in patients with subacromial pain syndrome (SAPS) have not been studied comparatively, yet.

The aim of this study was to compare the immediate effects of TENS, HVPS and placebo stimulation on shoulder resting pain and pfROM in patients with SAPS.

Randomized, placebo-controlled, double-blind, crossover study. One hundred and six patients with SAPS received placebo (predetermined 1st day application), TENS and HVPS with 1-day interval, in a random sequence. Before and after each application, resting pain and pfROM were evaluated by 0–10 cm visual analogue scales and a digital inclinometer, respectively.

Intensity of pain decreased significantly after TENS, HVPS and placebo interventions ( p < 0.05). While pfROMs increased significantly after TENS and HVPS ( p < 0.05), remained unchanged after placebo, except for internal and external rotations ( p > 0.05). The most obvious effects on pain and pfROMs occurred after HVPS ( p < 0.05).

In patients with SAPS, both HVPS and TENS, but preferably HVPS can be used effectively to decrease pain and increase pfROM.

Lumbosacral radiculopathy is associated with a broad range of complaints; therefore, specific disability measurements should be validated for this condition.

The aim of this study was to investigate the validity and reliability of the Istanbul Low Back Pain Disability Index (ILBPDI) in lumbosacral radiculopathy.

Patients diagnosed with radiculopathy caused by a disc herniation were included. Disability and quality of life were evaluated with the Oswestry Disability Index (ODI) and Short Form-36 (SF-36), respectively. The severity of low back pain and leg pain were evaluated using a Numeric Rating Scale (NRS). The reliability of the ILBPDI was assessed using the Cronbach’s alpha coefficient. The relation of ILBPDI with SF-36, ODI, NRS-back and NRS-leg scores were analyzed for convergent validity. The relation of the ILBPDI with age, body mass index (BMI), and disease duration was analyzed for divergent validity. Factor analysis was used to establish the internal construct validity.

One hundred patients (55% female) were included in this study. The Cronbach’s alpha coefficient was 0.92. The ILBPDI was found to be correlated with the ODI (rho: 0.619, p < 0.005) and NRS-leg score (rho: 0.597, p < 0.005), but not with NRS-back score (rho: 0.164, p > 0.05). The ILBPDI was significantly correlated with physical functioning (rho: - 0.638, p < 0.005), bodily pain (rho: - 0.488, p < 0.005), general health (rho: - 0.264, p = 0.008) and social function (rho: - 0.372, p < 0.005) subscales of SF-36 (convergent validity). The ILBPDI was not correlated with age, BMI, or disease duration (divergent validity). Factor analysis showed that the scale had three-factors which were correlated to bending forward, standing, and sitting activities.

The ILBPDI is a valid and reliable instrument in patients with lumbosacral radiculopathy.

Idiopathic scoliosis is accompanied by postural alterations, instability of gait, and functional disabilities. The objective was to verify radiographic parameters (coronal and sagittal) of adolescents with idiopathic scoliosis (AIS) pre- and post-surgery with direct vertebral rotation (DVR), associated with type 1 osteotomies in all segments (except the most proximal) and type 2 in the periapical vertebrae of the curves.

A prospective study design was employed in which 41 AIS were evaluated and compared pre- and post-surgery. Scoliosis was confirmed by a spine X-ray exam (Cobb angle). Eight radiographic parameters were measured: Cobb angles (thoracic proximal and distal), segmental kyphosis, total kyphosis, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt.

The Cobb angle averaged 51.3 ∘ ± 14.9 ∘ . Post-surgery, there were significant reductions for the following spine measurement parameters: Cobb angle thoracic proximal ( p = 0.003); Cobb angle thoracic distal ( p = 0.001); Cobb angle lumbar ( p = 0.001); kyphosis (T5-T12, p = 0.012); and kyphosis (T1-T12, p = 0.002). These reductions showed the effectiveness of surgical correction to reduce Cobb angles and improve thoracic kyphosis. The values obtained for lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt were not significantly different pre- and post-surgery.

The surgical technique of DVR in AIS proved to be effective in the coronal and sagittal parameters directed at Cobb angles and thoracic kyphosis in order to favor the rehabilitation process.

Some patients with end-stage osteoarthritis of the knee remain unsatisfied after total knee arthroplasty (TKA). We postulated that to increase satisfaction, self-efficacy (SE) for physical activity should receive more attention in rehabilitative intervention, alongside the management of patient expectations, pain, and function.

We examined the relative impact of Physical Activity SE on Health-Related Quality of Life (HRQOL) alongside other factors such as pain and physical function which are well-addressed by current interventions.

One hundred and six first-TKA recipients (15 Male/91 Female, age 73.6 ± 7.2) were evaluated at 3 and 6 months post-operatively using the Medical Outcomes Study 36-Item Health Survey (SF-36v2) for HRQOL, knee extension strength measurement, Timed Up and Go test (TUG), One Leg Standing time test (OLS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain and function, and an instrument for measuring Physical Activity SE among the frail elderly in Japan.

Significant improvement over pre-operative values was found at 3 and 6 months in TUG, OLS, WOMAC Pain and Function, and the 8 subscales of the SF-36v2. Factors found to significantly impact SF-36v2 subscale scores at 6 months post-operatively were found to be knee pain, knee function, and SE for physical activity.

These results support our postulation that interventions to improve SE for physical activity could have comparable impact alongside interventions for knee pain and knee function, on the advancement of HRQOL among TKA recipients.

Reliable scapular upward rotation and anterior-posterior tilt data are required for patients with subacromial impingement syndrome (SIS). Only a few studies have explored the reliability of such measurements derived using a modified inclinometer.

To determine the relative and absolute reliability of scapular upward rotation and anterior-posterior tilt measurements derived using a modified digital inclinometer in patients with SIS.

Seventeen SIS patients were assessed twice within 1 week. We determined the relative and absolute measurement reliability by calculating the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal clinically important difference (MCID). Both intra- and interrater reliability were determined.

The intra-rater reliability (both measurements) was high (0.72–0.88), and the interrater ICC was high to excellent (0.72–0.98). Clinically acceptable SEM and MCID values were obtained for scapular upward rotation (SEM: 4.28–9.33 ∘ , MCID: 5.1–11.3 ∘ ) and anterior-posterior tilt (SEM: 3.72–7.55 ∘ , MCID: 2.5–10.8 ∘ ).

Measurements of scapular upward rotation and anterior-posterior tilt using a modified digital inclinometer reliably reveal scapular position and kinematics in patients with SIS.

Physical activity (PA) is essential in the management and rehabilitation of low back pain (LBP). However, it is not clear that PA interventions in the workplace can improve LBP.

This study aimed to investigate the effects of workplace counseling on PA and LBP among workers.

We recruited 37 people with 12 weeks of LBP who worked in a manufacturing company in Aichi, Japan. Participants were randomly assigned to the intervention ( n = 20) or control group ( n = 17). All participants of both groups were affixed with waist-worn accelerometers to monitor PA. The intervention group also received a program of face-to-face counseling with a physical therapist or nurse once a week for 12 weeks to reassure and encourage participants to maintain a high level of PA. PA and LBP severity were assessed at baseline, 3 and 6 months.

PA was significantly higher in the intervention group than in the control group at 3 and 6 months. In the intervention group, PA significantly increased at 3 and 6 months from baseline, and LBP severity at 6 months improved significantly from baseline.

Our data suggest that workplace PA intervention can increase PA and improve LBP among workers.

Our objective was to investigate the effects of clinical Pilates exercises (CPE), applied to the primary caregivers of special needs children, on cardiovascular endurance (CVE) and psychosomatic parameters in comparison to a control group.

Fifty-five primary caregivers of special needs children, divided into two groups as the CPE and control groups, were included in the study. The six-minute walk test, the Fatigue Severity Scale, the Coping Orientation for Problems Experienced (COPE) Inventory, the Beck Depression Inventory and the State-Trait Anxiety Inventory were used to measure CVE, fatigue severity, attitudes toward coping with problems, depression levels and anxiety levels, respectively.

Statistically significant differences between the groups in favor of the CPE group were found concerning the denial parameter of COPE, fatigue (which was the primary outcome), depression and anxiety (all p values < 0.05). Statistically significant intragroup comparison differences were only detected in the CPE group in the fatigue, depression, anxiety and COPE (use of instrumental and emotional social support and focus on and venting of emotions) questionnaire results (all p values < 0.05).

CPE are an applicable and effective method for the primary caregivers of special needs children in improving psychosomatic parameters, albeit not effective for CVE. It is recommended to investigate the long-term effects of clinical Pilates exercises on a similar group.

Vibration exercise has been investigated to enhance muscle activation, however, the effect of different amplitude vibratory exercises on cardiovascular stress is less understood.

Our study aims to explore the acute effect of shoulder vibratory exercises with different postures and amplitudes on the cardiovascular response in healthy adults.

Using a repeated measures randomized design, 36 subjects performed three different sessions with FLEXI-BAR exercise (FBE): (1) zero-amplitude, (2) small-amplitude, (3) large-amplitude. Each session included three different shoulder positions: 45-, 90- and 180-degree flexion. Heart rate variability (HRV), heart rate (HR) and rating of perceived exertion (RPE) were monitored continuously, while systolic blood pressure (SBP), diastolic blood pressure (DBP) and rate-pressure product (RPP) were measured before and after each exercise session.

Compared with zero-amplitude, both small- and large-amplitude FBE protocols induced higher SBP. By contrast, DBP decreased with small- and large-amplitude. The RPP immediately after the exercise session were higher than at baseline. For high frequency, low frequency of HRV and HR there was a main effect of amplitude.

Small- and large-amplitude FBE increased significantly SBP, RPE, HRV, HR and induced lower DBP, but the changes were modest, suggesting that FBE impose no extra threats to cardiovascular stress.

The purpose of this study was to investigate differences in regional lumbar lordosis (RLL) and global lumbar lordosis (GLL) angle during slumped sitting and upright sitting among three global subgroups.

A total of 48 young asymptomatic volunteers stood in a comfortable posture, sat upright, and sat in a slumped position for 5 seconds, with inertial measurement units attached to the T10, L3, and S2 vertebrae. According to standing measurement, the participants were categorized into flat-back (GLL < 20 ∘ ), normal lordosis (20 ∘ ⩽ GLL < 30 ∘ ), and hyper-lordosis (30 ∘ ⩽ GLL < 40 ∘ ) groups.

Both the GLL and RLL in the flat-back group were reduced lumbar lordosis in the upright sitting posture and increased lumbar kyphosis in the slumped sitting postures compared to the other groups ( p < 0.05), but the range of motion during the transition from upright sitting to slumped sitting was lower than that of the normal and hyper-lordosis groups ( p < 0.05). GLL in standing was a moderate correlation with GLL and RLL during upright sitting ( p < 0.05). However, there was a strong correlation between GLL and RLL kinematics during upright and slumped sitting ( p < 0.05).

Flat-back posture is a potential source of low back pain during both upright and slumped sitting compared to the normal and hyper-lordosis groups. Posture measurements in a standing and sitting position conducted to assess lordosis should consider the relationship between GLL and RLL.

The instant effect of a brace on pulmonary functions of patients with adolescent idiopathic scoliosis (AIS) is known. However, the permanent effects of its regular use are still unclear.

This study aimed to determine whether a brace in patients with AIS had a permanent effect on respiratory functions.

Fifteen patients with a mean age of 13.2 ± 1.6 years, and a major Cobb angle of 25.8 ∘ ± 7.7 ∘ participated in this study. Lung volumes and respiratory muscle strength were measured with and without thoracolumbosacral brace, at the end of first month and follow-up period after the patients started using the brace for 23 hours daily.

When the brace was on, the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1 ), ratio of FEV 1 /FVC, peak expiratory flow, and forced expiratory flow between 25% and 75% of vital capacity values were found to be lower at both first month and follow-up. After the follow-up, the measurement results did not differ from the results of the first month.

The brace had a momentary restrictive effect on patients with AIS. However, it did not cause a permanent change in pulmonary functions after the 8-month follow-up.

Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain (CLBP) requires a treatment period of ⩾ 6 weeks to decrease pain and disability and is ineffective as sole treatment. Instrument-assisted soft tissue mobilization (IASTM) has rapid effects in musculoskeletal disorders.

This study aimed to investigate the effects of a 3-week combined TENS and IASTM treatment (TICT) on CLBP.

Thirty-two young men with CLBP were randomly divided into the TICT and control groups ( n = 16 each). Patients were evaluated with the visual analog (VAS) and face pain-rating scales (FPRS) for pain, the Oswestry Disability Index (ODI) and passive straight leg raise (PSLR) test for flexibility, and the supine bridge test (SBT) for endurance before and after the treatment course. The TICT group received TICT on the lower back, glutes, and hamstrings, six times in 3 weeks.

Group, time, and group × time interaction effects on pain were significant (VAS and FPRS, all p < 0.001). Group × time interaction (ODI, p < 0.001; PSLR, p < 0.05; SBT, p < 0.01) and group (ODI, p < 0.05) and time main effects (ODI, p < 0.001; PSLR, p < 0.01; SBT, p < 0.001) on motor function were significant.

Thus, short-term TICT decreased pain level and increased motor function in CLBP patients, yet further investigation is needed on different age and gender groups.