Journal of Back and Musculoskeletal Rehabilitation

Low frequency vibrations from motorized vehicles and heavy equipment have been associated with musculoskeletal disorders. Spine degeneration on diagnostic imaging provides direct and objective measures of the possible effects of such exposures on the spine.

The objective of this systematic review was to evaluate the association of exposure to whole-body vibration (WBV) with spine degeneration on imaging.

We conducted electronic searches in MEDLINE, CINAHL, EMBASE, and Web of Science to July 2021. Two reviewers independently screened search results, assessed quality, and extracted data. Studies evaluating the exposure to WBV and lumbar spine degeneration on imaging were included.

Fifteen studies (16 manuscripts) were included. Seven studies including a meta-demonstrated moderate quality evidence of no association between WBV and disc degeneration. There was also moderate quality evidence of no association between WBV and disc height narrowing and osteophytes. Overall, there was low level evidence of no association between WBV and other degenerations findings.

There was moderate to low quality evidence suggesting no association between WBV exposures with spine degeneration on imaging. The results of this study currently do not support assertion that motorized vehicle and WBV exposure accelerates degeneration and causes structural damage to the spine.

Low back pain is a significant spinal disorder that affects much of the population at some point during their lives.

While proper diagnosis is key, diagnosing the underlying cause of low back pain may often be unclear.

In this review article, we discuss lumbar instability as an etiology of low back pain and its treatment by prolotherapy.

Spinal ligaments may be an underlying culprit in the development of lumbar instability with resultant low back pain and associated disorders.

In these cases, adequate treatment consisting of non-biologic prolotherapy or cellular prolotherapy, including platelet rich plasma (PRP), can be beneficial in restoring spinal stability and resolving chronic low back pain.

Pelvic girdle pain represents a group of musculoskeletal pain disorders associated with the sacroiliac joint and/or the surrounding musculoskeletal and ligamentous structures. Its physical management is still a serious challenge as it has been considered the primary cause of low back pain.

This review sought to determine the effectiveness of motor control exercises for two clinically relevant measures; i.e., pain and disability, on patients with pelvic girdle pain of sacroiliac joint origin.

This review covered only randomized controlled studies. Online databases, such as PubMed, Embase, Scopus, and Cochrane Library, were searched from January 1, 1990, to December 31, 2019. PEDro scale was used to assess the methodological quality of included studies, while Review Manager was employed to synthesize data in view of meta-analysis. The PRISMA guidelines were applied for this review.

Twelve randomized controlled trials of moderate-to-high quality were included in this review. The studies involved 1407 patients with a mean age ranging from 25.5 to 42.1 years as well as intervention and follow-up durations from 1 week to 2 years. Motor control exercises alone for pelvic girdle pain of sacroiliac joint origin were not effective in terms of pain reduction (SMD = 0.29 [ - 0.64,1.22]) compared to control interventions whereas they were slightly effective in terms of disability reduction (SMD = - 0.07 [ - 0.67, 0.53]) at short-term. The combination of motor control exercises with other musculoskeletal therapies, however, revealed to be more effective than control interventions in terms of pain reduction (SMD = - 1.78 [ - 2.49, - 1.07]; 95%CI) and lessened disability (SMD = - 1.80 [ - 3.03, - 0.56]; 95%CI) at short-term.

Motor control exercises alone were not found to be effective in reducing pain at short-term. However, their combination with other musculoskeletal therapies revealed a significant and clinically-relevant decrease in pain and disability at short-term, especially in peripartum period.

Therapeutic exercise (TE) is recommended in multimodal treatment for patients with non-specific chronic back pain (cLBP).

The aim of this study is to identify an exercise or a spectrum of exercises, well described and reproducible by the clinician, for cLBP patients.

Systematic review by researching in the databases MEDLINE, EMBASE, PEDro, CINAHL, and Scopus. Evidence from Randomized Controlled Trials (RCTs) supported the TE in patients with non-specific cLBP, provided that it was well described and could be repeated by another therapist. Methodological evaluation was performed using the PEDro scale and only studies with a score of ⩾ 6 were included. The assessment of the intervention description was carried out with the TIDieR checklist. The risk of bias was examined.

Twenty-one articles were included in this systematic review. The defective description and the poorly reporting of the intervention makes it more difficult for the clinician to include the TE into clinical practice.

The findings of this study showed that the reporting of the intervention in high quality RCT on chronic low back pain is low, threatening the external validity of the results.

Knee osteoarthritis (OA) is accompanied by inflammation and angiogenesis. Modifying angiogenesis through transcatheter arterial embolization (TAE) can be a potential treatment for knee OA.

We subjected five OA knees in three patients to TAE and report the results of our post-treatment observations.

Three patients that had experienced knee pain for a minimum of one year prior to the study, and whose pain had persisted despite conservative treatment, were included in this study. Patients more often chose conservative treatment over surgical treatment. Pain and functional scales were evaluated before, immediately, and 1 month after TAE using the Numeric Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). TAE was performed by an experienced interventional radiologist. The average values of NRS evaluated before and after 5 TAEs were 5.2 before TAE, 3 immediately after TAE, and 3.6 after 1 month of TAE, and the average values of WOMAC were 52, 38.4, and 36.4, respectively. There were no major adverse effects.

The examined cases support the conclusion that TAE is an effective treatment for patients with knee OA. Substantial pain relief and WOMAC improvement were observed both immediately and one month after TAE.

Due to the anatomical characteristics of the anterior epidural space, dorsal migration of material from herniated lumbar disc is quite rare. Also, bilateral foot drop due to unilateral dorsal migration of disc herniation is extremely rare. This report presents a case of sudden bilateral foot drop caused by the unilateral dorsal migration of material from a herniated lumbar disc.

A 51-year-old male presented with sudden onset severe leg pain with bilateral foot drop. The patient was referred to our emergency department by a local clinic. Neurological examination showed bilateral ankle and big toe dorsiflexion weakness grade 1. There was no perianal anesthesia, anal sphincter weaknesses, or voiding difficulty. Apart from essential hypertension, this patient’s medical history was unremarkable. Magnetic resonance imaging showed that intervertebral disc material in the dorsal extradural space at the L3-4 level had compressed the dural sac from the left side to the center. We performed an emergency operation. The pathologic result revealed fibrous cartilaginous materials. After the operation, the leg pain was markedly resolved. At postoperative three months, the patient showed improvement of foot drop.

We recommended emergent mass removal, which produced a favorable outcome.

Adaptations in glenohumeral range of motion may affect overhead athletes and lead to shoulder pathologies.

The purpose of this study was to evaluate glenohumeral internal rotation deficit (GIRD) and postero-superior impingement among male handball and volleyball players and the relationship between these pathologies and training level (amateur vs. professional), position (attack vs. no attack), experience ( > 5 years vs. < 5 years) and sports.

Sixty-seven handball players and 67 volleyball players with a mean age of 25 [ ± 5] years were included. The range of motion including external and internal rotation in 90 ∘ abduction of the dominant and non-dominant shoulder was measured of each examined athlete. Visual analogue scale, disabilities of the shoulder and hand score, constant score and subjective shoulder value were recorded. The athletes were examined for postero-superior impingement and abduction force was measured with an isokinetic dynamometer.

Internal rotation was significantly lower and external rotation was significantly greater in the dominant arm for both sports. 72% presented with GIRD. GIRD was more prevalent in athletes active for > 5 years (odds ratio (OR) 3), in those training > 3 times per week (OR 1.4) and in handball players (OR 2.7). 24% presented with postero-superior impingement. Players active for > 5 years (OR 1.22), professionals (OR 1.14), volleyball players (OR 1.19), offensive players (OR 2.2) and athletes with GIRD > 10 ∘ (OR 1.5) showed a higher prevalence of postero-superior impingement.

GIRD is a common phenomenon in handball and volleyball players. Offensive players are frequently suffering from postero-superior impingement. GIRD > 10 ∘ leads in nearly 75% of the athletes to a decrease of total range of motion and a high rate of postero-superior impingement. Thus, a decreased range of motion seems to be the turning point from adaptation to pathology. Therefore, regular controls of range of motion and countermeasures by means of stretching the posterior shoulder joint should be integrated in the training content.

Prolotherapy (PrT) is an increasingly popular regenerative injection treatment for the management of musculoskeletal injuries. The diagnostic injection is a method for selecting suitable patients to apply PrT using subcutaneous 5% dextrose solution.

The study aims to assess the PrT usage and modifications in the treatment of chronic low back pain and lumbar disc herniation and to define diagnostic injection procedure for PrT.

Two thousand three hundred and eighty-two patients with low back pain or lumbar disc herniation were evaluated at the Traditional and Complementary Medicine Practice Center in Ankara, Turkey. Six hundred fifty-four patients were included in the study. Diagnostic injections were performed on all patients who were thought to be eligible candidates for PrT indications. A 4-or-6 week interval was allowed between treatment sessions.

Xix hundred and fifty-four patient treatments were completed. The Visual Analogue Scale (VAS) scores decreased to 5.1 ± 1.4 while 7.2 ± 1.1 before the diagnostic injection ( p < 000.1). The VAS scores decreased from 7.2 ± 1.1 before the treatment to 0.9 ± 0.9 after 52 weeks of the treatment ( p < 000.1). Thirty-four patients’ treatments resulted in poor clinical results (5.2%), and 620 of the patients’ pain improved (94.8%).

PrT can be regarded as a safe way of providing a meaningful improvement in pain and musculoskeletal function compared to the initial status. Diagnostic injection is an easy way to eliminate patients and may become a favorite treatment modality. 5% dextrose is a more simple and painless solution for PrT and also has a high success.

Low back pain is an important health problem that may cause functional loss. Several back pain disability scales have been developed in different languages.

The present study evaluates the correlation between the Istanbul Low Back Pain Disability Index (ILBPDI) the Back Pain Functional Scale (BPFS) and other back pain disability scales in patients with mechanical low back pain.

Included in the study were 105 patients who presented to our outpatient clinics and who were diagnosed with mechanical low back pain. The ILBPDI, BPFS, Quebec back pain disability scale (QBPDS) and Oswestry low back pain disability questionnaire (ODI) were administered to all participants, and Visual analogue scale (VAS) scores were recorded.

A strongly negative correlation was identified between ILBPDI and BPFS ( p < 0.05), and a strongly positive correlation was noted between ILBPDI and QBPDS, ODI and VAS.

A strong correlation exists between ILBPDI and BPFS, and a further strong correlation between ILBPDI ODI and QBPDS. These questionnaires can be used interchangeably to evaluate disability associated with chronic mechanical low back pain.

Adherence to treatment is one of the most common problems in patients suffering from chronic disease such as osteoporosis, and special commitment is required to patients, especially regarding rehabilitation. There is increasing evidence that physical interventions aimed at relieving pain and reducing physical impairments could play a crucial role in improving the quality of life and reducing the risk of fractures in patients with severe osteoporosis.

The aim of this study was to assess the compliance and determine the acceptability of a home-self-managed exercises program in patients with vertebral fractures, one of the most frequent and serious consequences of osteoporosis.

We conducted a retrospective observational study of patients undergoing a home exercise program, monitoring them with clinical scales, questionnaires, and routine visits.

62.86% of the patients were compliant with the treatment; the absence of supervision by health personnel was the primary cause of non-compliance, followed by the lack of time and the lack of motivation. Compliant patients showed a significant reduction in lumbar pain ( p 0.011), an improvement in posture with a reduction of dorsal kyphosis (occipital-wall distance T0-T1, p -value = 0.02) and an improvement in QoL ( p -value = 0.001) and physical performance at the 20 m walking test ( p -value = 0.003).

A home exercise program is feasible and could improve signs and symptoms in patients with vertebral fractures due to OP.

The function of trunk muscles in chronic nonspecific low back pain (CNLBP) is controversially discussed, and trunk muscle function in sedentary occupation workers is poorly understood.

To investigate whether muscle function differs between sedentary occupation workers with and without CNLBP and to determine the association between functional limitations and muscle function.

This study included 32 sedentary occupation workers (16 workers with CNLBP and 16 age- and sex-matched workers without CNLBP). Group differences in isokinetic trunk flexion-extension strength, muscle cocontraction, endurance time (Biering-Sorensen test) and electromyographic muscle fatigue were assessed. The association of these parameters and Oswestry Disability Index (ODI) score were examined in the CNLBP group.

Participants with CNLBP had lower trunk extensor ( - 20%) and flexor ( - 18%) strength and less cocontraction ( - 22%) than participants without CNLBP, but due to large variability in both groups these differences were not statistically significant. Trunk muscle endurance and fatigue were comparable between groups. Variance in endurance time explained 28% of variance in the ODI-score in the CNLBP group ( R 2 = 0.277).

In patients with CNLBP, greater functional disability was associated with lower endurance. Further evidence is necessary to elucidate whether specifically training endurance performance may be beneficial for sedentary occupation workers.

Because regular visits to distant hospitals may be a burden to patients, both in terms of time and cost, some patients with chronic musculoskeletal pain may discontinue multidisciplinary pain treatment, unable to maintain motivation to attend.

To evaluate and compare the pre-program characteristics of patients who dropped out and patients who continued treatment, thereby clarifying the characteristics of patients at risk of dropping out.

A multidisciplinary pain management treatment program was implemented for patients at the Pain Management Center, Hoshi General Hospital. From April 2015 to March 2018, 23 patients participated in the program. Twelve of the 23 patients lived outside the prefecture where the hospital is located. Of these 12 patients, five completed the program, while seven did not. We compared the dropout and continuation groups in terms of patient characteristics, pain severity, pain-related psychosocial factors, and quality of life.

We found significant differences ( p < 0.05) in median age, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire walking ability dysfunction score, and Roland-Morris Disability Questionnaire score.

The characteristics of patients who dropped out were older age, walking ability dysfunction, and low quality of life associated with low back pain.

The first-line contact for patients seeking care for low back pain (LBP) can potentially change the disease course. The beliefs and attitudes of healthcare providers (HCPs) can influence LBP management. Although referring patients with LBP to physical therapy is common, the first-line contact for patients with LBP in Saudi Arabia is the primary care physician (PCP). Physical therapy will soon be integrated into primary care; therefore, it is rational to compare physical therapists’ (PTs) beliefs and attitudes regarding LBP with those of PCPs.

We compared PCPs’ and PTs’ attitudes and beliefs regarding LBP management.

We employed a cross-sectional, voluntary response sample research design using the Pain Attitudes and Beliefs Scale (PABS). Participants were PTs and PCPs practicing in Saudi Arabia.

In total, 153 participants completed the PABS (111 PTs and 52 PCPs). PCPs demonstrated significantly higher PABS biomedical subscale scores than did the PTs.

HCPs in Saudi Arabia should receive additional training to adopt a biopsychosocial approach to managing LBP. In this study, the HCPs’ treatment recommendations may not correspond with contemporary clinical guidelines. Research to facilitate the implementation of optimal professional education and training to adopt a biopsychosocial approach is an urgent priority.

Early full weight-bearing mobilization is controversial in osteoporotic patients who have undergone uncemented hemiarthroplasty (UCH).

The aim of the study was to compare the results of early full weight-bearing mobilization in CH and uncemented hemiarthroplasty (UCH). The effect of subsidence on the results was also evaluated.

Fifty-nine patients who underwent CH and UCH were evaluated. The mean age was 79.8 years (10 females, 15 males) for CH and 75.5 years (10 females, 24 males) for UCH. All patients started immediate full weight-bearing mobilization and weight-bearing exercises.

There was no difference between the groups according to the Harris Hip Score. Both groups were evaluated in subgroups according to whether there is varus in the femoral stem. There was no difference between subgroups according to the Harris Hip Score. The femoral subsidence was not determined in CH group. In the UCH group, the subsidence was 1.13 ± 1.03 mm in varus femoral stem subgroup and 0.81 ± 0.85 mm in without femoral stem varus subgroup. There was no difference in subsidence between femoral stem with varus and without varus. The subsidence did not affect the Harris Hip Score.

Full weight-bearing mobilization could be safely preferred in UCH, as in CH. Femoral stem varus below 5 degrees does not affect the results and subsidence.

Functional stability of the shoulder requires a balance of active forces, passive forces, and control subsystems of the joint complex. Although whole-body vibration enhances shoulder muscle function and proprioception, the impact of vibration on the sensorimotor control of the shoulder joint remains unclear.

To investigate the acute effect of vibratory stimuli on the sensorimotor control of the shoulder joint.

Fifteen male participants (age, 22.7 ± 2.3 years) were included and performed the exercise in a modified push-up position with partial weight-bearing on a vibration platform with and without vibratory stimuli. The vibration protocol included six sets lasting for 30 s each with a 30-s rest between sets. The main outcome measures included the upper limb static stability test, Upper Quarter Y Balance Test (UQYBT), and electromyography data of the upper limb.

Vibratory stimuli resulted in an increased UQYBT score (all directions; P < 0.01) and infraspinatus, serratus anterior, and lower trapezius muscle activity ( P < 0.05) between pre- and post-exercise versus the control condition. Stabilometric parameters showed no significant interaction between condition and time.

Vibratory stimuli could maximize training benefits while limiting injury risk for athletes. Our findings could guide the development of rehabilitation programs for patients with shoulder instability.

Upper limb lymphedema is one of the complications following breast cancer-related surgery. It is a fact that there are alterations in posture of the trunk following surgery, however, there is not much data on whether upper limb lymphedema has any effect on body posture.

The main purpose of the study was to investigate the effect of upper limb lymphedema in the trunk posture and spine mobility of patients following breast cancer surgery.

Twenty-seven women with lymphedema and 29 women without lymphedema with mastectomy or breast-conserving surgery participated in the study. Posture was evaluated by the New York Posture Rating Chart and spinal stability and thoracic mobility were evaluated by the Spinal Mouse device.

Posture and spine posture scores were significantly higher in the without lymphedema group ( p = 0.004; 0.041; respectively). There was a significant difference between the groups in terms of lateral ( p < 0.001) and posterior ( p < 0.001) view of shoulders, spine ( p = 0.027), upper ( p < 0.001) and lower back ( p = 0.009), and trunk postures ( p = 0.001).

Body posture and spine are more affected due to upper limb lymphedema following breast cancer surgery. Alterations of posture mainly occur on shoulders, spine, upper and lower back, and trunk, but not on head and neck postures.

To restore core stability, abdominal drawing-in maneuver (ADIM), abdominal bracing (AB), and dynamic neuromuscular stabilization (DNS) have been employed but outcome measures varied and one intervention was not superior over another.

The purpose of this study was to compare the differential effects of ADIM, AB, and DNS on diaphragm movement, abdominal muscle thickness difference, and external abdominal oblique (EO) electromyography (EMG) amplitude.

Forty-one participants with core instability participated in this study. The subjects performed ADIM, AB, and DNS in random order. A Simi Aktisys and Pressure Biofeedback Unit (PBU) were utilized to measure core stability, an ultrasound was utilized to measure diaphragm movement and measure abdominal muscles thickness and EMG was utilized to measure EO amplitude. Analysis of variance (ANOVA) was conducted at P < 0.05.

Diaphragm descending movement and transverse abdominis (TrA) and internal abdominal oblique (IO) thickness differences were significantly increased in DNS compared to ADIM and AB ( P < 0.05). EO amplitude was significantly increased in AB compared to ADIM, and DNS.

DNS was the best technique to provide balanced co-activation of the diaphragm and TrA with relatively less contraction of EO and subsequently producing motor control for efficient core stabilization.

The effectiveness of side-sling plank (SSP) exercises on trunk and hip muscle activation in subjects with gluteus medius (Gmed) weakness is unclear.

To quantify muscle activation of the rectus abdominis (RA), external oblique (EO), erector spinae (ES), lumbar multifidus (LM), Gmed, gluteus maximus (Gmax), and tensor fasciae latae (TFL) during SSP with three different hip rotations compared to side-lying hip abduction (SHA) exercise in subjects with Gmed weakness.

Twenty-two subjects with Gmed weakness were recruited. SHA and three types of SSP exercises were performed: SSP with neutral hip (SSP-N), hip lateral rotation (SSP-L), and hip medial rotation (SSP-M). Surface electromyography was used to measure the activation of the trunk and hip muscles.

The trunk and hip muscles activations were generally significantly higher level during three SSP than SHA. SSP-M showed significantly lower EO activation while significantly higher ES and LM activation than SSP-L. Gmed activation was significantly higher during SSP-M than during SSP-L. TFL activation was significantly lower during SSP-M than during SSP-N and SSP-L.

SSP could be prescribed for patients who have reduced Gmed strength after injuries. Especially, SSP-M could be applied for patients who have Gmed weakness with dominant TFL.

Persistent symptoms in patients with systemic joint laxity (SJL) are often equivalent with complications. Screening for SJL is an important part of the assessment of musculoskeletal phenotype. The common measuring tool, the Beighton score (BS), still has unclear evidence.

To assess the Beighton score in a clinical context for (1) ability to classify SJL as absent or present (criterion validity), and (2) interrater reliability (physician-physiotherapist), for a dichotomous cut-off (yes/no), as well as for interpretation in categories (no, some, clear SJL).

This real-world observational study included 149 consecutive patients seeking secondary care for investigation of possible myalgic encephalomyelitis/chronic fatigue syndrome. Assessment was done during a routine examination. Data were evaluated with Cohen’s kappa and Spearman’s rho.

BS criterion validity showed poor agreement with the assessment of SJL: percentage agreement was 74 % and kappa 0.39 (3-cut level), 73 % and kappa 0.39/0.45 (4-/5-cut level). The best interrater reliability was moderate (rho 0.66) for interpretation in categories.

The BS alone was not a reliable proxy for SJL and should be supplemented with a targeted history. Nevertheless, its interrater reliability was acceptable, and the categorised score appears to have greater clinical relevance than the dichotomous score.

An ankle sprain is a common joint sprain in sports injury, which is closely related to its physiological position and anatomical characteristics, and may progress into chronic ankle instability after improper early treatment or premature exercise.

To analyze the tertiary rehabilitation effect of acute lateral ankle sprain caused by sports training.

Ninety-six athletes with acute lateral ankle sprain diagnosed from January 2019 to June 2020 were included and divided into the control group and the rehabilitation group using the random number table grouping method, with 48 cases in each group. The two groups received standardized treatment, and the rehabilitation group additionally received tertiary rehabilitation. The American Orthopedic Foot and Ankle Society (AOFAS ) scores, degree of ankle swelling, pain, and re-injury rate were compared between the two groups.

The AOFAS scores of the two groups increased after treatment ( P < 0.05). The degree of swelling in both groups after treatment was improved ( P < 0.05). The Visual Analogue Scale (VAS) scores in both groups declined two weeks after treatment, with lower results observed in the rehabilitation group The two groups showed similar results of the follow-up visit ( P < 0.05).

Rehabilitation exercise on acute lateral ankle sprain effectively relieves ankle swelling and pain.

Juvenile spinal osteochondrosis (JSO) affects vertebral endplates and may cause intervertebral discs alterations. The condition is typically related to pain, and weakness and shortening of trunk muscles. Sling suspension therapy (SST) has been shown to reduce lumbar pain effectively. It is, however, unclear whether SST is superior to other treatment methods in reducing pain, correcting posture, and activating trunk stabilizers in JSO.

In this study, we intended to compare the effectiveness of two different exercise modalities; Sling Suspension Therapy and Gym Ball Exercise in the treatment of JSO in adolescent girls.

A randomised controlled single centre clinical trial was carried out in an inpatient rehabilitation unit at a sanatorium. Forty adolescent girls (age 16.3 ± 0.47 yrs.), who were diagnosed with JSO (according to ICD-10 Version: 2016 – M 42.0) were randomly assigned into two groups: Group 1 – Sling suspension therapy (SST), Group 2 – Gym ball exercises (GBE). Both groups received interventions for 3 weeks, 15 sessions, and 30 minutes a day for 5 consecutive days a week. Back pain, endurance of trunk muscles and standing posture were evaluated pre- and post-interventions.

Both groups demonstrated significant improvement in all measured outcomes. SST was more effective in reducing pain ( p < 0.05), increasing the endurance of trunk muscles ( p < 0.05) and improving the standing posture ( p < 0.05) compared to GBE ( p < 0.05).

Sling suspension therapy is more effective compared with Gym ball exercises in the treatment of juvenile spinal osteochondrosis in adolescent girls in terms of back pain, posture and endurance of trunk muscles.

Previous studies have reported increased kinesiophobia in adults with degenerative scoliosis or adolescents who have undergone spinal surgery. However, little is known about the phenomenon of kinesiophobia among adolescents with idiopathic scoliosis (IS).

The aim of this study was to investigate levels of kinesiophobia and its association with treatment choice in IS.

The study included 98 IS patients with a mean age of 14 years and 20 healthy controls. Participants with IS were divided into groups based on treatment conditions, as follows: (1) untreated ( n = 33); (2) treated with exercise ( n = 32); and (3) treated with a brace ( n = 33). Kinesiophobia was measured using the Tampa Scale for Kinesiophobia (TSK). Comparisons were made between four groups.

Untreated participants with IS were found to have greater kinesiophobia than healthy controls ( p < 0.001). Participants treated with a brace ( p = 0.046) and exercise ( p = 0.064) had similar kinesiophobia levels as the healthy control group.

Kinesiophobia was found to be higher in adolescents with IS compared to healthy peers. Brace or exercise treatment both had a positive impact on kinesiophobia. These findings should be considered when organizing rehabilitation programs to achieve the best results for adolescents with IS.

A framework to establish the biopsychosocial patient profile for persons with low back pain has been recently proposed and validated: The Pain and Disability Drivers Management model (PDDM). In order to facilitate its clinical integration, we developed the PDDM rating scale.

To determine the inter-rater agreement of the PDDM rating scale. A second objective was to determine if this inter-rater agreement varies according to the complexity of patients’ clinical presentation.

We recruited physiotherapists during one-day workshops on the PDDM. We asked each participant to assess two clinical vignettes using the rating scale. One vignette presented a typical clinical presentation (moderate level of difficulty) and one presented an atypical presentation (complex level of difficulty). We determined inter-rater agreement with the proportion of participants who gave the same answer for each PDDM domain.

For the typical vignette, the inter-rater agreement per domain was moderate to good (between 0.54 and 0.97). For the complex vignette, the inter-rater agreement per domain was poor to good (between 0.49 and 0.81). The comparison between the two vignettes showed a significant difference ( p < 0.01) for nociceptive and cognitive-emotional domains.

Overall performance indicates that the rating scale present adequate agreement for clinical use, but specific domains require further development.

Ultrasound is increasingly being utilized in the diagnosis and treatment of adhesive capsulitis.

To compare the therapeutic effects and advantages of combined handheld ultrasound and fluoroscopy-guided intra-articular corticosteroid injection with those of conventional ultrasound-guided corticosteroid injection in adhesive capsulitis of the shoulder.

A total of 39 patients diagnosed with adhesive capsulitis of the shoulder were randomly assigned into two groups. Group A patients ( n = 19) underwent combined handheld ultrasound and fluoroscopy-guided corticosteroid injection and group B patients ( n = 20) underwent conventional ultrasound-guided corticosteroid injection to the intra-articular space of the shoulder twice. Treatment efficacy was assessed at 2 and 6 weeks after the final injection, based on the verbal numeric pain scale, Shoulder Pain and Disability Index, and range of motion. Secondary outcome measures were the accuracy and procedure time.

Both injection methods were effective in the treatment of adhesive capsulitis. No significant differences in treatment efficacy and injection accuracy were observed between the two groups ( p > 0.05).

This study showed no statistical differences in treatment efficacy between 2 groups. However, the combined use of ultrasound and fluoroscopy can increase the accuracy of injection compared with conventional ultrasound alone.

Surf practice contributes to overuse injuries and musculoskeletal pain. Relationship between the type of surfing practiced and the onset of pain is not fully understood as well as the potential role of rehabilitation in preventing it.

To investigate musculoskeletal pain and to deepen whether the age and the anatomical region involved influenced the pain appearance in relation to four surfing disciplines.

A cross-sectional study was carried out. An online survey was addressed to a group of Italian surfers (practicing surf, kitesurf, windsurf and stand up paddle since at least 1 year), collecting demographic data, discipline practiced, location of musculoskeletal pain.

One hundred and twenty-six surfers were involved in the study. Spine and upper limbs pain was more frequent compared to lower limbs one in the surf ( p < 0.001) and in the windsurf groups ( p = 0.007). In the kitesurf group a greater prevalence of pain was observed in spine and lower limbs compared to upper limbs ( p = 0.017). Low back pain is the most represented among the spine pain subgroups ( p < 0.001). Pain was lower in younger athletes ( p = 0.007).

Understanding risk factors and biomechanics of musculoskeletal pain is essential to realize prevention training strategies. Rehabilitation in sinergy with specific training allows pain-free activity, optimizing its overall health benefits.