Journal of Back and Musculoskeletal Rehabilitation最新文献

Background: Scoliosis is a complex three-dimensional deformity of the spine and causes spinal misalignment and pelvic structure changes.

Objective: This cross-sectional study was designed to investigate the relationship between postural deviation, scoliosis angle and pelvic floor dysfunctions in individuals with adolescent idiopathic scoliosis (AIS).

Methods: Twelve AIS aged between 12 and 18 years were included in the study. Standard scoliosis radiography was used for Cobb angle measurement. The posture screen mobile (PSM) application was used for determining postural deviation, and a real-time ultrasound image was obtained for pelvic floor muscle activity. The pelvic floor distress inventory was used for the evaluation of pelvic floor dysfunctions.

Results: There was a significant negative correlation between bladder base elevation and the following variables, including thoracic and lumbar Cobb angles (r = -0.640, p < 0.05; r = -0.779, p < 0.05), Dysfunctional Voiding Scoring System (DVSS) (r = -0.753, p < 0.05), Pelvic Floor Distress Inventory (PFDI) (r = -0.722, p < 0.05) and Urinary Distress Inventory (UDI) (r = -0.585, p < 0.05). The apical shift in the frontal plane was found to be positively correlated with DVSS (r = 0.701, p < 0.05), UDI (r = 0.641, p < 0.05) and PFDI-20 (r = 0.628, p < 0.05) and negatively correlated with bladder base elevation (r = -0,615, p < 0.05). The average pelvic shift in frontal plan was found to be positively correlated with DVSS (r = 0.810, p < 0.05), PFDI-20 (r = 0.722, p < 0.05), Pelvic Organ Prolapse Distress Inventory (POPDI) and UDI (r = 0.626, p < 0.05) and negatively correlated with bladder base elevation (r = -0.626, p < 0.05).

Conclusion: Scoliosis negatively affects pelvic floor muscle activity, and pelvic floor functions, resulting in urinary dysfunction. Pelvic floor assessment may be added to the evaluation process in patients with AIS.

Background: As the world's population ages, osteoporotic fractures have become a growing medical, social and economic problem.

Objective: Vertebral fractures (VFs) are the most common osteoporotic fractures and are a strong risk factor for subsequent VFs, leading to VF cascade (VFC). This study aimed to identify potential causes of and risk factors for VFC. At the same time, the factors influencing the time between fractures in patients with osteoporotic VFC were examined.

Methods: We retrospectively analysed the clinical data of 889 patients diagnosed with osteoporotic vertebral fracture at Beijing Shijitan Hospital affiliated to Capital Medical University from January 1, 2015, to December 31, 2022.

Results: The study included 193 patients with VFC. The multifactorial risk analysis showed that the independent risk factors for VFC included a history of diabetes mellitus (hazard ratio, 1.635; p value = 0.016), a history of oral corticosteroid therapy (hazard ratio, 1.798; p value = 0.001), chronic obstruction pulmonary disease (COPD, hazard ratio 1.666, p value = 0.036), thoracolumbar fracture (hazard ratio, 2.664, p value <0.001), and a body mass index (BMI) ≥ 28 (hazard ratio 1.421; p value = 0.045). Further study showed that glycated haemoglobin was also an important factor affecting the interval between fractures in patients with VFC.

Conclusion: Independent risk factors for VFC include a history of diabetes, prior oral corticosteroid therapy, COPD, thoracolumbar fracture, and BMI ≥ 28. The occurrence of fractures in the thoracolumbar segment is the most important risk factor. Additional research has shown that after the first vertebral fracture, the poorer the patient's blood sugar control, the faster the refracture rate.

Background: To selectively strengthen target muscles, resistance intensity as well as limb position should be considered.

Objective: This study aimed to identify the most effective exercise positions and the optimal resistance intensity to selectively strengthen the infraspinatus muscle.

Methods: This study included 18 healthy men who underwent four different external rotation (ER) exercises in prone external rotation (PER), side-lying wiper, sitting external rotation, and standing external rotation (STER) exercise by varying the shoulder positions under low, medium, and high resistance intensity conditions randomly. Infraspinatus and posterior deltoid muscle activities and the infraspinatus to posterior deltoid activity ratio were measured based on ER exercise positions and resistance intensities.

Results: This study revealed a significant interaction and main effects of exercise position and resistance intensity on muscle activity and muscle activity ratio. Both muscle activities were increased as the resistance intensity increased, but the muscle activity ratio was decreased. Infraspinatus muscle activity and muscle activity ratio were higher in the PER and STER exercises than in other exercises.

Conclusion: We indicate that PER and STER are effective exercises to selectively strengthen the infraspinatus muscle. Additionally, performing the exercise at low or medium resistance intensity rather than high resistance intensity is recommended to activate the infraspinatus selectively while minimizing the involvement of the posterior deltoid.

Background: Shoulder pain is often accompanied by disturbances in spinal posture, such as increased thoracic kyphosis. Moreover, a high prevalence of scapular dyskinesis has been observed in the majority of shoulder pain patients. However, these alterations seen in individuals with shoulder pain have not been thoroughly examined after arthroscopic rotator cuff repair (RCr).

Objective: To investigate alterations in spinal alignment and mobility, shoulder range of motion, and scapular dyskinesis (SD), to determine whether differences exist between patients with RCr and healthy individuals.

Methods: The study included 26 participants who had undergone RCr (the RCr group) and 29 healthy individuals (the healthy group). The Spinal Mouse device (IDIAG-M360) was utilized to measure spinal alignment (thoracic kyphosis, lumbar lordosis, sacral-hip angles, and pelvic inclination), and spinal mobility. The study also evaluated the presence of scapular dyskinesia (SD), and shoulder range of motion (ROM) using the observational SD test and a universal goniometer, respectively. All variables were compared between the groups.

Results: The RCr group had an increased mean thoracic kyphosis compared to the healthy group (p = 0.033). However, no significant differences in spinal mobility were observed between the groups (p > 0.05). The results from the scapular dyskinesia analysis revealed considerable variations between the groups (p = 0.001). Among shoulder ROM variables, only external rotation was reduced in the RCr group (p = 0.003). Further subgroup analysis based on trauma status revealed that individuals with non-traumatic rotator cuff tear exhibited an increased thoracic kyphosis angle (p = 0.037).

Conclusions: RCr patients exhibited an increased thoracic kyphosis angle and an increased presence of SD, despite showing similar spinal mobility when compared to healthy individuals. These findings may necessitate further research investigating the effectiveness of thoracic mobilization techniques and targeted strengthening exercises aimed at mitigating the increased thoracic kyphosis angle and SD observed in patients undergoing rehabilitation following RCr.

Background: This study aimed to examine the influence of real-time feedback on intentional abdominal muscle engagement in adults with chronic low back pain (CLBP) during daily activities. The research further sought to evaluate the outcomes of this training on neuromuscular control, pain perception, and functional capacity.

Objective: We compared a group of adults who received real-time feedback on changes in waist circumference with a group trained in abdominal contraction without real-time feedback.

Methods: Surface electromyographic (sEMG) signals were measured in the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and erector spinae (ES) muscles. Pain intensity was assessed using the visual analog scale (VAS), and functional outcomes were assessed using the Oswestry Disability Index (ODI).

Results: After the intervention, sEMG signals of the RA, EO, and IO muscles were significantly higher in the experimental group. There were no significant differences in ES muscle activity between the groups. Both the experimental and control groups showed significant decreases in VAS and ODI scores after the intervention.

Conclusion: Intentional abdominal contraction aided by real-time feedback can improve functionality in patients with chronic low back pain.

Background: Functional capacity at submaximal exercise levels has become more popular as an outcome measure in systemic sclerosis (SSc). However, it is necessary to know the ventilatory requirements of the different field tests.

Objectives: To verify the agreement of the ventilatory dynamics measured at submaximal exercise between the the Glittre-ADL test (TGlittre) and the 6-min walk test (6MWT) and, secondarily, to evaluate the correlations of these measurements with clinical and functional variables in women with SSc (wwSSc).

Methods: This was a cross-sectional study in which 30 wwSSc underwent the 6MWT and TGlittre while hooked to a device reading their ventilatory demand. Physical function was assessed on the Health Assessment Questionnaire Disability Index (HAQ-DI), and lung function was assessed by spirometry.

Results: The median 6-min walking distance (6MWD) was 344 (282-410) metres, and 25 (83.3%) participants did not reach 80% of the predicted distance. The median TGlittre time was 147 (107-188) seconds, and 18 (60%) participants exceeded 120% of the predicted time. There was agreement between the two tests on the following variables: heart rate (ICC = 0.883, P < 0.0001), breathing reserve (ICC = 0.816, P < 0.0001), peripheral oxygen saturation (ICC = 0.752, P = 0.0009), inspiratory capacity (ICC = 0.690, P < 0.0001), and peak minute ventilation (ICC = 0.433, P = 0.007). There was a weak correlation between 6MWD and TGlittre time (r_s=-0.353, P = 0.05). 6MWD correlated significantly with the HAQ-DI score (r_s=-0.606, P = 0.0004) and forced vital capacity (FVC, r_s= 0.427, P = 0.018). TGlittre time correlated significantly with HAQ-DI (r_s= 0.440, P = 0.015) and FVC (r_s=-0.404, P = 0.026).

Conclusion: In wwSSc, the 6MWT and TGlittre have almost the same ventilatory requirements, although these patients perform worse in the 6MWT. 6MWD and TGlittre time are weakly correlated. Both 6MWD and TGlittre time are associated with physical function and lung function. Therefore, both tests should be used in clinical practice for the monitoring of these patients as they are complementary.

Background: The pathogenesis of adolescent idiopathic scoliosis (AIS) remains unclear, with muscle imbalance being a widely discussed hypothesis.

Objective: This study examined the impact of muscle imbalance on AIS by injecting botulinum toxin A (BTX) into patients' unilateral muscles and investigating altered back muscle synergies.

Methods: Three AIS patients received BTX injections in the concave-side paraspinal muscles. High-density electromyogram arrays placed from T8 to L4 recorded signals during five spinal motions at four timepoints (one pre-BTX and three post-BTX). Muscle synergies were extracted using non-negative matrix factorization and compared with data from ten healthy and ten AIS subjects from our previous studies.

Results: Post-BTX, muscle activity maps during flexion/extension, sitting, and standing exhibited reduced symmetry, with concave/convex ratios decreasing and being statistically lower than those of healthy subjects at post-2 and post-3 follow-ups (p < 0.01). Muscles on the dominant side during lateral bending or axial rotation demonstrated decreased activation and differently distributed center of gravity positions on synergy maps compared to healthy subjects at all timepoints (p < 0.05). Post-BTX changes were particularly notable for the patient with mild deformity.

Conclusions: BTX affected the activation of paraspinal muscles, providing insights into the role of muscle imbalance in AIS and informing future therapeutic strategies.

Background: Osteoarthritis is the most common form of arthritis, causing pain, functional disability, and a reduction in terms of quality of life. Minimally invasive treatments like intra-articular hip injections are a therapeutic option and ultrasound guidance might improve the results of these injections.

Objective: To summarize the evidence about the effectiveness of ultrasound-guided hip injections in terms of pain and functioning in patients affected by hip osteoarthritis.

Methods: A systematic search of the literature was performed on three electronic databases: PubMed, Cochrane and PEDro, using a specific search strategy. We evaluated for inclusion all articles according to the following participants, intervention, comparison, and outcomes (PICO) model: P) Population: human patients affected by hip osteoarthritis; I) Intervention: intra-articular hip injections performed with a ultrasound-guidance; C) Comparator: sham therapy or every other conservative or oral, non-invasive, minimally invasive or surgical technique; O) Outcome measures: pain assessed by Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS); functional outcomes.

Results: At the end of the search, 43 articles were included in the review. Several drugs have been considered in the included studies: hyaluronic acid, platelet-rich plasma, corticosteroids, micro-fragmented adipose tissue, bone marrow concentrates, amniotic suspension allograft.

Conclusion: Ultrasound-guided injections of hyaluronic acid might be effective on pain relief and functioning in patients affected by hip osteoarthritis. Also, other rehabilitative infiltrative techniques (i.e., corticosteroids and platelet-rich plasma) showed a positive effect in the short-term period.

Background:: Given the growing population of the elderly, understanding how aging impacts pain, muscle strength, and balance, especially in individuals with chronic low back pain, is imperative.

Objective:: This study aims to investigate age-related differences in lower extremity muscle strength and balance in patients with chronic low back pain.

Methods:: In this cross-sectional study, 110 people with chronic low back pain were divided into two age groups (Group 1, age: 29.89 ± 6.82, Group 2, age: 51.42 ± 6.33). Both groups used Oswestry for low back pain and disability assessment, isokinetic device for muscle strength, and Biodex Balance System for balance assessment.

Results:: There were no significant differences between groups in terms of pain (p = 0.426) or disability (p = 0.056). In contrast, significant differences were observed in isokinetic muscle strength: peak torque for the dominant side at 60°/s for quadriceps (p = 0.003) and hamstring (p = 0.007), and at 180°/s for hamstring (p = 0.012) and quadriceps (p = 0.011). The balance assessment revealed significant differences in fall risk (p = 0.004) and postural stability (p = 0.006) variables. The most significant regression association was found between dominant side 60°/s quadriceps and fall risk variables across age groups.

Conclusion:: Understanding age-related differences in muscle strength and balance among patients with chronic low back pain is critical. Customizing rehabilitation interventions improves efficacy and quality of life. Further research is necessary to optimize clinical approaches and elucidate underlying mechanisms.

Background: Although lumbopelvic rotation control muscle is important to maintain pelvic neutral alignment during active straight leg raise (ASLR), pelvic rotator strength has not been evaluated. Thus, a novel method is needed to measure pelvic rotator strength and to determine whether pelvic rotator muscle asymmetry is related to side difference in transverse plane pelvic rotation angle (TrPRA) during ASLR.

Objective: To find average pelvic rotator strength, verify the reliability of pelvic rotator strength measurement method, and identify the correlation between pelvic rotator strength asymmetry and side difference in TrPRA during ASLR.

Methods: Forty healthy participants were enrolled. Pelvic rotator strength was measured using a hand-held dynamometer. TrPRA was measured using a smart KEMA motion sensor. Reliability was analyzed using intraclass correlation coefficient (ICC). The correlation between pelvic rotator strength asymmetry and side difference in TrPRA during ASLR was analyzed using Pearson's correlation coefficient.

Results: The average pelvic rotator strength was 120.3 N (72.9-202.2) for males and 94.4 N (58-125.8) for females. The reliability of pelvic rotator strength measurement demonstrated good to excellent intra- (ICC = 0.87-0.97) and inter-rater (ICC = 0.93-0.98) values. A significant moderate relationship existed between pelvic rotator strength asymmetry and side difference in TrPRA during ASLR (r = 0.39, p < 0.05).

Conclusion: The pelvic rotator muscle strength measurement method can be clinically used with good to excellent intra- and inter-rater reliability. Pelvic rotator strength asymmetry should be considered to evaluate and manage the pelvic rotation control during ASLR.