Journal of Back and Musculoskeletal Rehabilitation

Ischemic compression is widely used to clinically treat neck pain. However, no meta-analysis has been conducted to evaluate the effects of this process on neck pain.

This study aimed to evaluate the effects of ischemic compression on the myofascial trigger points for improving neck pain-related symptoms (mainly pain, joint mobility limitation and function limitation) and to compare ischemic compression with other therapies.

Electronic searches were conducted in PubMed, OVID, Web of Science, EBSCO, SCOUPS, Cochrane Library, PEDro, Wanfang, CNKI and Chinese VIP Database in June 2021. Only randomised controlled trials on the effects of ischemic compression on neck pain were included. The major outcomes were pain intensity, pressure pain threshold, pain-related disability and range of motion.

Fifteen studies involving 725 participants were included. Significant differences were observed between ischemic compression and sham/no treatment group in pain intensity, pressure pain threshold and range of motion immediately and in the short term. Significant effect sizes of dry needling were observed over ischemic compression in terms of improving pain intensity (SMD = 0.62; 95% CI: 0.08 to 1.16; P = 0.02), pain-related disability (SMD = 0.68; 95% CI: 0.19 to 1.17; P = 0.007) and range of motion (MD = - 2.12; 95% CI: - 2.59 to - 1.65; P < 0.001) immediately after treatment. Dry needling also showed a significant small effect size for the short-term reduction of pain (SMD = 0.44; 95% CI: 0.04 to 0.85; P = 0.03).

Ischemic compression can be recommended in the immediate and short-term pain relief and increase in the pressure pain threshold and range of motion. Dry needling is superior to ischemic compression in relieving pain and improving pain-related disability and range of motion immediately after treatment.

The benefits of combining supervised exercise in the non-surgical treatment of lumbar spinal stenosis (LSS) is unclear.

To compare the effectiveness of non-surgical treatments with and without supervised exercise for pain intensity, symptom severity, functional impairment/disability, walking distance, and quality of life (QOL) in LSS patients.

Randomized controlled trials (RCTs) evaluating combinations of supervised exercises were searched using four electronic databases up to August 13, 2020. Meta-analysis was conducted for immediate and long-term results.

Three studies were identified, including 244 participants. Immediate-term results showed that leg pain intensity (mean distance [MD]: - 0.94, 95% confidence intervals [95% CI]: - 1.60 to - 0.29, p < 0.01) and symptom severity (MD: - 0.29, 95% CI: - 0.50 to - 0.08, p < 0.01) were lower in the study group than in the control group, and walking distance (MD: 415.83, 95% CI: 298.15 to 533.50, p < 0.001) and QOL were higher in the study group. Long-term results showed that functional disability/impairment (MD: - 0.27, 95% CI: - 0.49 to - 0.04, p < 0.05) was lower in the study group than in the control group, and walking distance and QOL were higher in the study group.

The number of studies on this topic was small and limited. Combinations of non-surgical treatment and supervised exercise may not provide significant benefits.

In the treatment of knee osteoarthritis (KOA), there is a need for the long-term use of therapeutic drugs that reduce joint pain and have fewer adverse effects.

This study aimed to investigate the therapeutic effect of bean pressing on ear points on early KOA pain.

One hundred patients with KOA recruited at the Wenzhou Hospital of Traditional Chinese Medicine between February 2019 and May 2022 were divided randomly into a treatment group ( n = 50) and control group ( n = 50). Patients in the treatment group received regular rehabilitation combined with auricular bean-pressing treatment, while patients in the control group only received conventional rehabilitation treatment. The measurement indicators – knee swelling, tenderness, range of motion sign score, C-reactive protein, and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) indexes – were recorded before and after treatment.

On day 5 following the start of treatment, the visual analog scale (VAS) and WOMAC scores of the treatment group were significantly lower than those of the control group ( P < 0.05), and the VAS and WOMAC scores in the treatment group after treatment were significantly lower than those before treatment ( P < 0.05). At week 4 after the start of treatment, the dosage of nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment group was significantly lower than that in the control group ( P < 0.05). No adverse events were observed during the treatment.

Auricular bean-pressing therapy had an analgesic effect and could also alleviate mild to moderate KOA swelling, joint stiffness, and other symptoms, effectively reducing the demand for NSAIDs and improving both knee function and quality of life. The results suggested that auricular bean-pressing therapy has promising prospects in the treatment of early KOA pain.

Low back pain is a highly prevalent musculoskeletal disorder that leads to functional incapacity and absence from work.

To analyze warehouse workers’ prevalence and factors associated with low back pain.

Cross-sectional study design with 204 male warehouse workers (stocker, separator, checker, and packer) from motor parts companies. Age, body mass, marital status, education, the practice of physical exercise, presence of pain, low back pain intensity, comorbidities, time away from work, handgrip strength, flexibility, and trunk muscle strength were collected and analyzed. Data are presented as mean, standard deviation, absolute and relative frequency. A binary logistic regression was performed, with low back pain (yes or no) as the dependent variable.

24.0% of the workers reported low back pain with an average intensity of 4.7 ( ± 2.4) points. The participants were young, had completed high school education, were single and married, and had normal body weight. There was a more likely low back pain presence in separator tasks. Greater handgrip strength in the dominant (right) hand and trunk muscle is associated with no low back pain.

Low back pain prevalence was 24% among young warehouse workers, more likely in separation tasks. A greater handgrip and trunk strength can be a protective factor to no low back pain.

Electrical muscle stimulation (EMS) has been applied in many rehabilitation settings for muscle strengthening, facilitation of muscle contraction, re-education of muscle action, and maintenance of muscle strength and size during prolonged immobilization.

The purpose of this study was to investigate effect of 8 weeks of EMS training on abdominal muscle function and to determine whether the training effect could be maintained after 4 weeks of EMS detraining.

Twenty-five subjects performed EMS training for 8 weeks. Before and after 8 weeks of EMS training, and after 4 weeks of EMS detraining, muscle size (cross-sectional area [CSA] of the rectus abdominals [RA] and lateral abdominal wall [LAW]), strength, endurance, and lumbopelvic control (LC) were measured.

There were significant increases in CSA [RA ( p < 0.001); LAW ( p < 0.001)], strength [trunk flexor ( p = 0.005); side-bridge ( p < 0.05)], endurance [trunk flexor ( p = 0.010); side-bridge ( p < 0.05)], and LC ( p < 0.05) after 8 weeks of EMS training. The CSA of the RA ( p < 0.05) and the LAW ( p < 0.001) were measured after 4 weeks of detraining and they were greater than that of the baseline. There were no significant differences in abdominal strength, endurance, and LC between baseline measurements and post-detraining.

The study indicates that there is less of a detraining effect on muscle size than on muscle strength, endurance, and LC.

Low back pain (LBP) in sedentary workers is an increasing problem. Hyperlordosis or hypolordosis of the lumbar spine may be one of the causes of LBP. Various exercise programs are used in the prevention of LBP, but they do not consider individualization for diagnosed hyperlordosis or hypolordosis of the lumbar spine.

The purpose of this study was to evaluate the effect of the authors’ original exercise program aimed at reducing hyperlordosis or increasing hypolordosis.

Sixty women aged 26 to 40 working in a sedentary position participated in the study. The sagittal curvature and the range of motion of the lumbar spine flexion were measured with the Saunders inclinometer, and the level of LBP was evaluated using the VAS scale. Subjects were randomly divided into two groups that participated in a 3-month exercise program developed by the authors. The first group performed exercises adjusted to the diagnosed hyperlordosis or hypolordosis, and the second group performed the same exercises regardless of the lumbar lordosis angle. The study was conducted again after completing the exercises.

There was a statistically significant difference between the groups ( p < 0.0001) in the level of pain, with better results in the group where individualized exercise was used – 60% of the participants reported complete absence of LBP. The lumbar lordosis angle was within normal limits in 97% of the subjects in the first group, and in 47% of the subjects in the second group.

The results of this study confirm the validity of using individualized exercises with regard to diagnosed hyperlordosis or hypolordosis of the lumbar spine in order to achieve better analgesic and postural correction effects.

Low back pain (LBP) is a common musculoskeletal condition that necessitates public health concerns. It also attracts considerable research interest among physiotherapists.

This study conducted a bibliometric analysis to reveal the affinity of Indian physiotherapists toward research on LBP using the Scopus database.

An electronic search was performed on December 23, 2020, using specific keywords. The data was downloaded in a Scopus plain text file (.txt) format and were analyzed using R studio (biblioshiny) software.

Two hundred and thirteen articles concerning LBP published from 2003 to 2020 were retrieved from the Scopus database. Among those articles ( N = 213), 85.45% ( n = 182) were published between 2011 and 2020. An article published by “James SL (2018)” in the Lancet had the highest citation of 1439. The highest collaboration was between India and the United Kingdom, and India and the United States of America jointly accounted for 12.2% ( n = 26) of the entire articles ( N = 213).

Indian physiotherapists have shown an interest through gradually increasing their research output on LBP since 2015. They contributed effectively to various journals and international collaboration. Nevertheless, there is room to improve the quality and quantity of LBP articles in high-quality journals, thereby enhancing the citation count. This study recommends improving the scientific output of Indian physiotherapists on LBP by expanding their international networks.

Body composition decline, lower limb impairments, and mobility deficits affect independence of older people. The exploration for a practical measure involving upper extremities may offer an alternative tool to be used by primary healthcare (PHC) providers for these individuals.

To explore reliability and validity of seated push-up tests (SPUTs) among older participants when used by PHC providers.

Older participants ( n = 146) with an average age of > 70 years were cross-sectionally assessed using various demanding forms of SPUTs and standard measures to assess validity of the SPUTs. Reliability of the SPUTs were assessed in nine PHC raters, including an expert, health professionals, village health volunteers, and care givers.

The SPUTs demonstrated very good agreement, with excellent rater and test-retest reliability (kappa values > 0.87 and ICCs > 0.93, p < 0.001). Moreover, the SPUT outcomes significantly correlated with lean body mass, bone mineral contents, muscle strength and mobility of older participants ( r , r p ⁢ b = - 0.270 to 0.758, p < 0.05).

SPUTs are reliable and valid for older adults when used by PHC members. The incorporation of such practical measures is particularly important during this COVID-19 pandemic with limited people’s hospital access.

Scapular muscles changes, as increased upper trapezius activity and decreased middle and lower trapezius and serratus anterior muscle activity, have been demonstrated in shoulder pain specific or non-specific conditions. Shoulder external rotation exercises have been recommended to improve scapular activity in shoulder pain.

To evaluate the relative scapular muscles activity during multi-joint exercises combining shoulder external rotation, trunk rotation and scapular squeeze.

Forty-one participants with and without shoulder pain were assessed in a cross-sectional study. They performed isometric multi-joint exercises at 0 ∘ and 90 ∘ of shoulder abduction with and without support. The relative activity of upper, middle, and lower trapezius and serratus anterior (upper/middle and lower portions) was measured through electromyography. The scapular muscular balance was assessed by the ratio between relative activity of the upper trapezius and the other muscles.

Both groups presented similar results. The exercise at 90 ∘ abduction led to increased relative muscle activity against maximal voluntary contraction in both groups for upper trapezius (with support: 4% MVIC, p = 0.001 or 15% MVIC, p < 0.0001; and without support: 11% MVIC, p < 0.0001 or 13%, p < 0.0001, for asymptomatic and symptomatic group, respectively) and lower trapezius (with support: 66% MVIC, p < 0.0001 or 62% MVIC, p < 0.0001, for asymptomatic and symptomatic group,

Pregnancy-related low back pain (LBP) and pelvic girdle pain (PGP) significantly affect the quality of life of pregnant women. Understanding their severity and risk factors may help prevent and alleviate such pain and their resulting dysfunction.

This study investigated the prevalence, severity, and biopsychosocial risk factors of pregnancy-related LBP and PGP in Zhengzhou, China.

The Numeric Pain Rating Scale (NPRS), Chinese version of the Roland-Morris Disability Questionnaire (RMDQ), and other questionnaires were self-administered by 1020 pregnant women undergoing treatment at a tertiary hospital between July and December 2019. Binary logistic regression was used to identify factors associated with pregnancy-related LBP and/or PGP.

The prevalence of LBP and/or PGP during pregnancy was 63.0%, and most participants (80.4%) had both. The mean NPRS and RMDQ disability scores were 2.44 ± 2.10 and 6.66 ± 4.65, respectively. A higher gestational body mass index, LBP and/or PGP during menstruation, history of pregnancy-related LBP and/or PGP, and constant pressure were significantly associated with pregnancy-related LBP and/or PGP. Subjective support was a protective factor against LBP and/or PGP.

The prevalence of LBP and/or PGP was high. The risk factors should be included in routine prenatal care to identify patients at risk of LBP and/or PGP.

Videos uploaded to YouTube do not go through a review process. The educational aspect of these videos may be insufficient for patellofemoral pain syndrome (PFP).

To examine the reliability and educational quality of PFP videos on YouTube.

A standard search was performed in the YouTube database using the following terms: patellofemoral pain syndrome/anterior knee pain syndrome/anterior knee pain/patellofemoral pain. For each search term, the top 50 videos based on “relevance” assignment of YouTube’s algorithm were included in the examination. The remaining 96 videos after exclusion were included in the study. The educational quality and reliability of videos was analyzed using DISCERN, JAMA (The criteria of Journal of the American Medical Association), GQS (Global Quality Score) and PFPSS (Patellofemoral Pain Specific Score).

According to PFPSS, 81.2% of the videos were evaluated as low and very low quality. According to the DISCERN classification, 74.9% of the videos were evaluated as poor and very poor. According to GQS, 59.4% of the videos had scores of 2 or less, which were considered poor quality. According to JAMA, 41.7% of the videos scored 2 and below.

The information content of YouTube videos is inadequate. Video design should be created to be understandable by patients and to attract their attention while making these videos.

The population of older adults with knee osteoarthritis (OA)-related disabilities is increasing globally. However, studies regarding instrumental activities of daily living (IADL) in older adults with knee OA are limited.

This study investigated the psychological factors associated with IADL disability in older adults with moderate to severe knee OA.

A cross-sectional study was conducted on 179 patients with knee OA aged ⩾ 65 years. The six-item short form of the Pain Catastrophizing Scale (PCS-6), the four-item short form of the Pain Self-Efficacy Questionnaire (PSEQ-4), and the fifteen-item Geriatric Depression Scale (GDS-15) were used to assess psychological factors. The participants were divided into IADL disabled and non-disabled groups. Binary logistic regression analyses were performed with the IADL disability status as the dependent variable. The PCS-6, PSEQ-4, and GDS-15 tools were included as independent variables in the logistic regression model.

Of the 179 participants, 88 (49.1%) showed disability in conducting IADL. PSEQ-4 (odds ratio = 0.90, 95%; confidence interval = 0.82–0.99, p = 0.02) was a significant independent variable among all psychological factors.

Even after controlling for cofounders, our study found that self-efficacy, assessed using the PSEQ-4, was related to IADL disability in older adults with moderate to severe knee OA.

The pediatric Functional Assessment of Chronic Illness Therapy-Fatigue (PedsFACIT-F) measures fatigue in various clinical settings.

To verify the measurement properties of the Arabic version (PedsFACIT-F-Ar) in patients with cancer.

In this cross-sectional validation study, the PedsFACIT-F and the Pediatric Quality of Life Multidimensional Fatigue Scale (PedsQL-MFS) were administered to 114 participants (74 boys and 40 girls) aged 8–18. Exploratory factor analysis was used to test the structural validity of PedsFACIT-F-Ar. Its construct validity was investigated using the hypothesis testing method to predict a moderate correlation (rho ⩾ 0.4) with the PedsQL-MFS domains and the total score. Its reliability was also tested.

The PedsFACIT-F-Ar is a two-factor model that explains 67.38% of the total variance. It is significantly correlated with PedsQL-MFS (rho > 0.84). It displayed excellent internal consistency (Cronbach’s α = 0.93) and test-retest reliability (ICC 2.1 = 0.99; 95% CI: 0.96–0.99). Bland–Altman’s analysis revealed the absence of a systematic error between the two test sessions. The standard error of measurement, minimal detectable change (MDC 95 ), and MDC% were 0.92, 2.56 points, and 2.88%, respectively, with no floor or ceiling effects.

The PedsFACIT-F-Ar demonstrated excellent psychometric properties. The findings suggest the clinical usefulness of this scale.

The incidence rate of degenerative spinal deformity (DSD) has gradually increased in the elderly. Currently, the relationship between the functional status of trunk muscle and the spinal-pelvic parameters of DSD patients remains unclear.

This paper aims to explore the relationship between the two factors and provide new clues for exploring the mechanism of the occurrence and development of DSD.

A total of 41 DSD patients treated in our hospital (DSD group) and 35 healthy volunteers (control group) were selected. Muscle strength was evaluated using an IsoMed-2000 isokinetic dynamometer, and the trunk flexor and extensor peak torque (PT) of subjects was measured at a low, medium, and high angular velocity of 30 ∘ /s, 60 ∘ /s, and 120 ∘ /s, respectively. Hand grip strength (HGS) was assessed using an electronic grip dynamometer and Surgimap software was used to measure the spinal-pelvic parameters, including the sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence rate (PI), and PI-LL, and the relationship between trunk muscle function and various parameters was analyzed.

Under the three angular velocities, the flexor and extensor PT values in the DSD group were lower than those in the control group, and only the extensor PT showed a statistically significant difference ( P < 0.05). There was no significant difference in HGS between the two groups ( P > 0.05). In the DSD group, the extensor PT at 30 ∘ /s was significantly negatively correlated with SVA ( P < 0.05). At 60 ∘ /s and 120 ∘ /s, the extensor PT was significantly negatively correlated with SVA and PT ( P < 0.05).

Trunk extensor strength is significantly lower in DSD patients than in normal controls. The decline in trunk extensor strength in DSD patients is a type of local muscle dysfunction more closely related to the deformity, which is likely involved in the compensatory mechanism of DSD and may reflect the overall imbalance of the trunk.

Previous studies have reported altered neural activity in the motor cortex after short-term cast immobilization, even in healthy participants. However, the effects of short-term movement restriction on tissue structure are not well understood.

To investigate the effects of short-term lower limb immobilization on muscle tissue hardness.

Seventeen healthy participants were enrolled in the study. Each participant’s non-dominant lower limb was fixed with a soft bandage and medical splint for 10 h. Gastrocnemius muscle tissue hardness was measured using a tissue hardness meter before cast application and immediately after cast removal. Measurements were performed five times for each lower limb, and the three values with the lowest coefficient of variance were adopted as the value of muscle tissue hardness.

Gastrocnemius muscle tissue hardness in the immobilized limb was lower after cast removal than that before cast application (from 53.6 to 51.8; p < 0.01), whereas the non-fixed limb showed an increase in muscle tissue hardness at the end of the experiment (from 52.9 to 54.3; p = 0.03).

The findings indicate that 10 h movement restriction induced a reduction in muscle tissue hardness, suggesting acute adverse effects of cast immobilization for orthopedic treatment.

Different interventions are used during rehabilitation after hip replacement surgery, but it is unclear if task-oriented exercise is more effective than conventional physiotherapy.

This study compared the effectiveness of conventional physiotherapy (CPT) programme with task-oriented exercise (TOE) on hip pain, function, static and dynamic balance during the early rehabilitation stage after total hip replacement.

This randomized controlled parallel-group trial was executed in an inpatient physical medicine and rehabilitation centre. The study included 40 patients who were randomly classified into CPT and TOE groups ( n = 20 in each). Hip pain (assessed by visual analogue scale), function in the operated leg (assessed by modified Harris Hip Score, mHHS), static balance (assessed by Abili Balance analyser system) and dynamic balance (assessed by Berg Balance Scale) were evaluated at baseline and after 18 days of rehabilitation. Cohen’s effect size ( d ) was calculated.

Greater pain reduction ( p < 0.05; d = 0.08) was observed after TOE (1.6 ± 0.68 scores) compared with the CPT programme (2.2 ± 0.83 scores). Hip function assessed by the modified mHHS improved more ( p < 0.05; d = 0.30) in the TOE group (73.45 ± 6.23 scores) than in the CPT group (54.90 ± 6.28 scores). Static balance improved significantly in both groups after the interventions but did not differ significantly between the groups. The improvement in dynamic balance was significantly greater ( p < 0.05; d = 0.45) after TOE (50.55 ± 1.57 scores) than after CPT (38.55 ± 3.43 scores).

Both interventions reduced pain and improved function of the operated leg and static and dynamic balance. The effect on hip function was superior for TOE compared with CPT.

Recent evidence has suggested that reversal of gray or white matter abnormalities could be a criterion of recovery in patients with chronic pain.

To determine the effectiveness of exercise-based interventions in reversing gray and white matter abnormalities in patients with chronic musculoskeletal pain.

An electronic search was performed in the MEDLINE (Via PubMed), EMBASE, Web of Science, LILACS, SPORTDiscus, CINAHL, PEDro, and CENTRAL databases. Randomized clinical trials (RCTs) including patients with chronic musculoskeletal pain, which assessed the change in gray and white matter abnormalities after exercise-based interventions were selected. The risk of bias was assessed using the Risk of Bias II tool.

Four RCTs were included ( n = 386). Three studies showed reversal of abnormalities with exercise-based interventions compared to control groups. The reversal was observed in the gray matter volume in the medial orbital prefrontal cortex and in the supplementary motor area of patients with osteoarthritis, in the hippocampus, insula, amygdala and thalamus in fibromyalgia patients. Furthermore, in patients with chronic spinal pain, reversal was observed in the gray matter thickness of the frontal middle caudal cortex and in the caudate, putamen and thalamus gray matter volume.

There is insufficient evidence to determine the effectiveness of exercise-based interventions for reversing gray and white matter abnormalities in patients with chronic pain. Further studies are still needed in this field.

Kinesiotape application is one of the non-pharmacological methods frequently used in patients with knee OA. Guidelines do not have a consensus on its use in knee osteoarthritis (OA).

In this study, we aimed to investigate the acute effect of kinesiotape application on pain, balance, and gait performance in patients with knee OA.

We included 164 patients with grade 1–3 knee OA according to the Kellgren-Lawrence staging system in the study. Patients were evaluated with visual analog scale (VAS), 10-meter walking test (10MeWT), timed-up and go test (TUG-T), single leg stance test (SLST), and functional reach test (FRT) before and after taping.

There was a significant improvement in the post-taping scores of all evaluation parameters in the kinesiotaping group compared with pre-taping scores. Statistically significant improvement was found in all scores of evaluated parameters except FRT scores in the placebo taping group. We found a significant superiority in the mean recovery scores of the kinesiotaping group compared to the placebo-taping group in all parameters except for 10MeWT.

We found significant improvements in both groups. The mean improvement levels in pain and balance scores were better in the KT group than in the PT group.

Persistent and severe low back pain is challenging to treat. Multidisciplinary care with systematic follow-up may be more effective than usual care. However, such a model has yet to be developed and tested.

Our objectives were to develop and test the feasibility of a three-month multidisciplinary intervention with systematic follow-up in a specialized hospital spine center for patients with severe and persistent low back pain.

Using the Medical Research Council and National Institute for Health and Care Research framework for the development and testing of complex interventions, we developed a multidisciplinary intervention with systematic follow-up and tested its feasibility, using a-priori-determined outcomes during three months for 24 patients seen at a regional diagnostic spine center unit. As part of the evaluation, we conducted semi-structured interviews with participants and a focus-group interview with clinicians.

Of the 24 patients included, only 17 completed the course of care and provided complete data for feasibility assessment. We failed to reach our a-priori feasibility outcomes, had difficulty with inclusion, and participants did not find the intervention effective or satisfactory.

The intervention was not feasible as barriers existed on multiple levels (e.g., clinical, administrative, and patient). Excessive study moderations must be made before the intervention is feasible in a randomized trial.