Pub Date : 2016-01-01Epub Date: 2016-11-28DOI: 10.1080/17536146.2016.1241525
Milad Vazirian, Linda R Van Dillen, Babak Bazrgari
Objectives: Abnormalities of lumbopelvic coordination have been suggested to relate to risk of developing low back pain. The objective of this study is to review and summarize the findings of studies that have implemented and reported on lumbopelvic rhythm during trunk forward bending and backward return.
Methods: The PUBMED and CINAHL databases were searched for studies related to LPR using appropriate keywords. The references of each study from the database search were further investigated to identify any missed study.
Results: The findings includes results related to lumbopelvic rhythm, and how it varies due to participant characteristics such as age, gender, and presence of low back pain as well as due to variations in the experimental procedures such as pace of motion, presence of external load, and muscle fatigue.
Conclusion: In general, the magnitude of lumbar contribution is smaller in people with low back pain, in the elderly and females, as well as with greater pace of motion, but is larger with greater external load or back muscle fatigue. The compiled data in this review are expected to serve as a foundation for implementation of this kinematic-based measure in the conduct of future research.
{"title":"Lumbopelvic rhythm in the sagittal plane: A review of the effects of participants and task characteristics.","authors":"Milad Vazirian, Linda R Van Dillen, Babak Bazrgari","doi":"10.1080/17536146.2016.1241525","DOIUrl":"https://doi.org/10.1080/17536146.2016.1241525","url":null,"abstract":"<p><strong>Objectives: </strong>Abnormalities of lumbopelvic coordination have been suggested to relate to risk of developing low back pain. The objective of this study is to review and summarize the findings of studies that have implemented and reported on lumbopelvic rhythm during trunk forward bending and backward return.</p><p><strong>Methods: </strong>The PUBMED and CINAHL databases were searched for studies related to LPR using appropriate keywords. The references of each study from the database search were further investigated to identify any missed study.</p><p><strong>Results: </strong>The findings includes results related to lumbopelvic rhythm, and how it varies due to participant characteristics such as age, gender, and presence of low back pain as well as due to variations in the experimental procedures such as pace of motion, presence of external load, and muscle fatigue.</p><p><strong>Conclusion: </strong>In general, the magnitude of lumbar contribution is smaller in people with low back pain, in the elderly and females, as well as with greater pace of motion, but is larger with greater external load or back muscle fatigue. The compiled data in this review are expected to serve as a foundation for implementation of this kinematic-based measure in the conduct of future research.</p>","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"38 2","pages":"51-58"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17536146.2016.1241525","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35452512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-10-02DOI: 10.1179/1753614615Z.000000000113
H. Biedermann, PrivatPraxis Huhnsgasse
One of the specifics of manual medicine is the fact that it deals with (dys-)function. First the functional disorders of the patient are analyzed, then the individual’s functional equilibrium is re-established as well as possible. Lewit remarked rather dryly ‘the central nervous system only knows about function, not about structure’ 1 and added ‘The clinical picture correlates better with the changes in function than with the structural pathology. Very frequently indeed, pathological changes do not manifest themselves so long as function is not impaired.’ The stage is thus set for a closer look at the interaction between these two phenomena. The term ‘form follows function’ was popularized by Buckminster Fuller and is traceable via Louis Sullivan back to the Roman architect, Vitruvius. All three meant it as a motto to build and design with function as the paramount consideration, a call to delete unnecessary embellishments. This paradigm was ‘exported’ to other venues, not the least of which was biology. On the phylogenetic level ‘form follows function’ certainly holds true for the human body, too. Our morphology is the result of evolutionary pressures exerted by the environment we are obliged to function within. The most efficient design generally trumps all else in this developmental picture. But: Is this rule true for ontogenetic development as well? Humans are born completely helpless and ‘physiologically immature,’ comprising immunology, metabolism and – last, but not least – the musculoskeletal system. This ‘unripe’ organism reacts and adapts more intensely to external stimuli, rendering the first months of life more important for the eventual shape of the individual than all the years that follow. The forming influence of the months around birth and the consequences of disturbances seen decades later are well documented. 2
{"title":"Form and function","authors":"H. Biedermann, PrivatPraxis Huhnsgasse","doi":"10.1179/1753614615Z.000000000113","DOIUrl":"https://doi.org/10.1179/1753614615Z.000000000113","url":null,"abstract":"One of the specifics of manual medicine is the fact that it deals with (dys-)function. First the functional disorders of the patient are analyzed, then the individual’s functional equilibrium is re-established as well as possible. Lewit remarked rather dryly ‘the central nervous system only knows about function, not about structure’ 1 and added ‘The clinical picture correlates better with the changes in function than with the structural pathology. Very frequently indeed, pathological changes do not manifest themselves so long as function is not impaired.’ The stage is thus set for a closer look at the interaction between these two phenomena. The term ‘form follows function’ was popularized by Buckminster Fuller and is traceable via Louis Sullivan back to the Roman architect, Vitruvius. All three meant it as a motto to build and design with function as the paramount consideration, a call to delete unnecessary embellishments. This paradigm was ‘exported’ to other venues, not the least of which was biology. On the phylogenetic level ‘form follows function’ certainly holds true for the human body, too. Our morphology is the result of evolutionary pressures exerted by the environment we are obliged to function within. The most efficient design generally trumps all else in this developmental picture. But: Is this rule true for ontogenetic development as well? Humans are born completely helpless and ‘physiologically immature,’ comprising immunology, metabolism and – last, but not least – the musculoskeletal system. This ‘unripe’ organism reacts and adapts more intensely to external stimuli, rendering the first months of life more important for the eventual shape of the individual than all the years that follow. The forming influence of the months around birth and the consequences of disturbances seen decades later are well documented. 2","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"139 - 140"},"PeriodicalIF":0.0,"publicationDate":"2015-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614615Z.000000000113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65717627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-10-02DOI: 10.1179/1753614615Z.000000000116
K. Lewit, R. Čihák, M. Lepšíková
Introduction: The basic function of the hand is prehension. The muscles of the forearm involved in prehension, the flexors and extensors of the wrist and fingers, attach at the epicondyles of the humerus, at the radius and ulna. Overstrain causes epicondylar pain. The cause of this phenomenon is passive insufficiency of muscles spanning several joints, in this case of the flexor digitorum profundus of the upper extremity, held in extension. Aim: To explore insufficiency of muscles electromyographically. Method and results: Activity of the flexors and extensors of the forearm was registered by surface electromyography, and this showed reduced activity when flexion of the end-phalanges was caused only by passive muscular insufficiency. Conclusion: These observations prove that carrying objects by the flexed end-phalanges keeping the muscles of the forearm relaxed is important for treatment and prevention of epicondylar pain. There is, however, an exception in extremely hypermobile subjects.
{"title":"Insufficiency of finger flexors and extensors and its importance for hand function: A clinical and electromyographic investigation","authors":"K. Lewit, R. Čihák, M. Lepšíková","doi":"10.1179/1753614615Z.000000000116","DOIUrl":"https://doi.org/10.1179/1753614615Z.000000000116","url":null,"abstract":"Introduction: The basic function of the hand is prehension. The muscles of the forearm involved in prehension, the flexors and extensors of the wrist and fingers, attach at the epicondyles of the humerus, at the radius and ulna. Overstrain causes epicondylar pain. The cause of this phenomenon is passive insufficiency of muscles spanning several joints, in this case of the flexor digitorum profundus of the upper extremity, held in extension. Aim: To explore insufficiency of muscles electromyographically. Method and results: Activity of the flexors and extensors of the forearm was registered by surface electromyography, and this showed reduced activity when flexion of the end-phalanges was caused only by passive muscular insufficiency. Conclusion: These observations prove that carrying objects by the flexed end-phalanges keeping the muscles of the forearm relaxed is important for treatment and prevention of epicondylar pain. There is, however, an exception in extremely hypermobile subjects.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"2 1","pages":"178 - 183"},"PeriodicalIF":0.0,"publicationDate":"2015-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614615Z.000000000116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65717822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-10-02DOI: 10.1179/1753614615Z.000000000114
M. Laupheimer, Asanga De Silva, S. Hemmings
Objective: Injection therapies are widely used as a treatment option in sports and musculoskeletal medicine, but with limited evidence. The aim of this systematic review was to review the literature to identify the different injection therapies used, their purpose and to suggest future areas of research. Methods: The following databases were searched up to April 2015 to identify studies using injection therapies for patients with muscle injuries: Medline via PubMed, CINAHL via EBSCO, Cochrane Library, SportDiscus via EBSCO, and Google Scholar. Results: A systematic search of all electronic databases identified 1177 articles. Ten studies on different injection treatments of acute muscle injuries were included: two studies on Actovegin, two on corticosteroid, five on platelet-rich plasma (PRP) and platelet-derived growth factor, and one on autologous conditioned serum. Five studies were randomized control trials (RCTs). Two studies on PRP injection were single case studies and two were case series. All studies included the time to return to sport or to competitive training as an outcome measure. In five studies, the intervention was compared to a control group. All studies reported the positive outcomes of the injection treatment or no effect. No side effects were reported in any publications after the intervention. Conclusion: More research has been published recently into the use of PRP in muscle injuries: one placebo controlled RCT using PRP concluded it to be no better than placebo. It is hard to compare different injections therapies due to different solutions, volumes and times between injections being used. Hence, more high-quality trials with standard treatment and rehabilitation protocol are warranted, including a reliable and valid outcome measure to evaluate clinical outcomes being needed.
{"title":"Injection therapies in muscle injuries: A systematic review","authors":"M. Laupheimer, Asanga De Silva, S. Hemmings","doi":"10.1179/1753614615Z.000000000114","DOIUrl":"https://doi.org/10.1179/1753614615Z.000000000114","url":null,"abstract":"Objective: Injection therapies are widely used as a treatment option in sports and musculoskeletal medicine, but with limited evidence. The aim of this systematic review was to review the literature to identify the different injection therapies used, their purpose and to suggest future areas of research. Methods: The following databases were searched up to April 2015 to identify studies using injection therapies for patients with muscle injuries: Medline via PubMed, CINAHL via EBSCO, Cochrane Library, SportDiscus via EBSCO, and Google Scholar. Results: A systematic search of all electronic databases identified 1177 articles. Ten studies on different injection treatments of acute muscle injuries were included: two studies on Actovegin, two on corticosteroid, five on platelet-rich plasma (PRP) and platelet-derived growth factor, and one on autologous conditioned serum. Five studies were randomized control trials (RCTs). Two studies on PRP injection were single case studies and two were case series. All studies included the time to return to sport or to competitive training as an outcome measure. In five studies, the intervention was compared to a control group. All studies reported the positive outcomes of the injection treatment or no effect. No side effects were reported in any publications after the intervention. Conclusion: More research has been published recently into the use of PRP in muscle injuries: one placebo controlled RCT using PRP concluded it to be no better than placebo. It is hard to compare different injections therapies due to different solutions, volumes and times between injections being used. Hence, more high-quality trials with standard treatment and rehabilitation protocol are warranted, including a reliable and valid outcome measure to evaluate clinical outcomes being needed.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"13 1","pages":"170 - 177"},"PeriodicalIF":0.0,"publicationDate":"2015-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614615Z.000000000114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65717676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-08-05DOI: 10.1179/1753614615Z.000000000112
B. Sweetman, S. Sweetman
Aim: To find out how, when, and why back pain causes sleep disturbance. This is the data analysis phase following a series of four literature reviews, which seek to find out whether different types of sleep disturbance can be caused by different sorts of back pain. Method: Discriminant analyses have been performed on 8 indices, 7 diagnoses, and 114 variables derived from a database of 88 clinical items collected prospectively from 1234 consultations for low back pain. Results: Difficulty getting off to sleep was essentially found to be an indication of back pain severity as shown by the correlations with PAIN index B (0.56), PAIN index A (0.47), pain visual analog scale (0.43), straight leg raising (SLR) ipselateral pain (0.40), SLR range (elevation −0.31), disability (ability −0.25), analgesic consumption yesterday (0.25), and the extent of pain down the leg (0.25). However, difficulty getting off to sleep showed some ‘non-severity’ aspects. It was seen relatively more in females; with direct lumbar trauma causing the first episode; and pain on resisted hip flexion. It was associated with less early morning stiffness in the back. Diagnostically it was a bit more indicative of the ‘anterior column’ symmetrical disc degeneration syndrome but also the ‘posterior column’ rotation back strain syndrome. Being awoken by back pain in the night also acted as a measure of back pain severity but not quite so effectively as difficulty getting off to sleep. Being awoken also seemed slightly more a ‘posterior column’ problem in the form of the facet joint syndrome, and slightly more so than rotation strain. Interestingly, being awoken was linked to asymmetry of the direction in which the feet pointed upwards when the patient was reclining. This observation probably reflects the relative degrees of rotation of opposite hips. This ‘foot’ aspect seemed equally linked to awakening with both pain turning and ache whilst remaining immobile. Awakening due to pain turning in bed was seen slightly more with the Facet joint syndrome. It was also linked more to being a male; with resisted hip internal rotation causing contralateral pain; with the sit up test inducing lopsided back pain; and lumbar extension standing causing unilateral pain. Awakening with ache or pain whilst immobile and remaining still was seen slightly more with S1 (and L5) prolapsed intervertebral disc (with nerve root deficit). It was also more common in females; and with resisted hip flexion painful; and lumbar flexion standing inducing bilateral back pain. Early morning stiffness in the back for an hour or more was seen more in the thoracolumbar junction level syndrome (which shows few signs in the low back). With regard to diurnal variation of back symptoms, the facet joint syndrome seemed worse in the mornings. Those worse in the afternoon, evening, or at the end of work were more often the older men; those that had the thoracolumbar syndrome who were also worse at night. Those worse at night ha
{"title":"Various types of sleep disturbance due to different sorts of low back pain: 5: A clinical database analysis","authors":"B. Sweetman, S. Sweetman","doi":"10.1179/1753614615Z.000000000112","DOIUrl":"https://doi.org/10.1179/1753614615Z.000000000112","url":null,"abstract":"Aim: To find out how, when, and why back pain causes sleep disturbance. This is the data analysis phase following a series of four literature reviews, which seek to find out whether different types of sleep disturbance can be caused by different sorts of back pain. Method: Discriminant analyses have been performed on 8 indices, 7 diagnoses, and 114 variables derived from a database of 88 clinical items collected prospectively from 1234 consultations for low back pain. Results: Difficulty getting off to sleep was essentially found to be an indication of back pain severity as shown by the correlations with PAIN index B (0.56), PAIN index A (0.47), pain visual analog scale (0.43), straight leg raising (SLR) ipselateral pain (0.40), SLR range (elevation −0.31), disability (ability −0.25), analgesic consumption yesterday (0.25), and the extent of pain down the leg (0.25). However, difficulty getting off to sleep showed some ‘non-severity’ aspects. It was seen relatively more in females; with direct lumbar trauma causing the first episode; and pain on resisted hip flexion. It was associated with less early morning stiffness in the back. Diagnostically it was a bit more indicative of the ‘anterior column’ symmetrical disc degeneration syndrome but also the ‘posterior column’ rotation back strain syndrome. Being awoken by back pain in the night also acted as a measure of back pain severity but not quite so effectively as difficulty getting off to sleep. Being awoken also seemed slightly more a ‘posterior column’ problem in the form of the facet joint syndrome, and slightly more so than rotation strain. Interestingly, being awoken was linked to asymmetry of the direction in which the feet pointed upwards when the patient was reclining. This observation probably reflects the relative degrees of rotation of opposite hips. This ‘foot’ aspect seemed equally linked to awakening with both pain turning and ache whilst remaining immobile. Awakening due to pain turning in bed was seen slightly more with the Facet joint syndrome. It was also linked more to being a male; with resisted hip internal rotation causing contralateral pain; with the sit up test inducing lopsided back pain; and lumbar extension standing causing unilateral pain. Awakening with ache or pain whilst immobile and remaining still was seen slightly more with S1 (and L5) prolapsed intervertebral disc (with nerve root deficit). It was also more common in females; and with resisted hip flexion painful; and lumbar flexion standing inducing bilateral back pain. Early morning stiffness in the back for an hour or more was seen more in the thoracolumbar junction level syndrome (which shows few signs in the low back). With regard to diurnal variation of back symptoms, the facet joint syndrome seemed worse in the mornings. Those worse in the afternoon, evening, or at the end of work were more often the older men; those that had the thoracolumbar syndrome who were also worse at night. Those worse at night ha","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"153 - 163"},"PeriodicalIF":0.0,"publicationDate":"2015-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614615Z.000000000112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65717489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-08-05DOI: 10.1179/1753615415Y.0000000010
A. Draz, A. Abdel-aziem
Purpose: To evaluate the ankle concentric dorsiflexors and plantarflexors’ strength in patients with knee osteoarthritis (OA). Methods: Forty subjects with knee OA were included in the study. The first group consisted of 20 subjects suffering from unilateral tibiofemoral knee OA, with mean age (57.60 ± 4.50 years), mean weight (88.95 ± 11.93 kg), and mean height (169.95 ± 5.84 cm). The second group consisted of 20 subjects with no prior history of knee pain or injury, forming a control group, with mean age (58.70 ± 5.15 years), mean weight (91.10 ± 10.23 kg), and mean height (171.25 ± 6.41 cm). Dorsiflexors and plantarflexors’ concentric peak torque was measured at angular velocities 60 and 120°/second by using an isokinetic dynamometer. Results: At angular velocity 60°/second, the peak torque of dorsiflexors and plantarflexors of the control group was significantly higher than that of the knee OA group (P = 0.001, 0.040, respectively). At angular velocity 120°/second, the peak torque of dorsiflexors and plantarflexors of the control group was significantly higher than in the knee OA group (P = 0.001, 0.010, respectively). At angular velocities 60 and 120°/second, the dorsiflexion/plantarflexion ratio of the knee OA group was significantly lower than of the control group (P = 0.003, 0.010, respectively). Conclusions: The knee OA group displayed weakness in ankle dorsiflexor and plantarflexor muscles and a decrease in the dorsiflexion/plantarflexion strength ratio. Clinicians should consider exercises to increase ankle dorsiflexor and plantarflexor muscles’ strength when developing rehabilitation programs for patients with knee OA.
{"title":"Isokinetic assessment of ankle dorsiflexors and plantarflexors strength in patients with knee osteoarthritis","authors":"A. Draz, A. Abdel-aziem","doi":"10.1179/1753615415Y.0000000010","DOIUrl":"https://doi.org/10.1179/1753615415Y.0000000010","url":null,"abstract":"Purpose: To evaluate the ankle concentric dorsiflexors and plantarflexors’ strength in patients with knee osteoarthritis (OA). Methods: Forty subjects with knee OA were included in the study. The first group consisted of 20 subjects suffering from unilateral tibiofemoral knee OA, with mean age (57.60 ± 4.50 years), mean weight (88.95 ± 11.93 kg), and mean height (169.95 ± 5.84 cm). The second group consisted of 20 subjects with no prior history of knee pain or injury, forming a control group, with mean age (58.70 ± 5.15 years), mean weight (91.10 ± 10.23 kg), and mean height (171.25 ± 6.41 cm). Dorsiflexors and plantarflexors’ concentric peak torque was measured at angular velocities 60 and 120°/second by using an isokinetic dynamometer. Results: At angular velocity 60°/second, the peak torque of dorsiflexors and plantarflexors of the control group was significantly higher than that of the knee OA group (P = 0.001, 0.040, respectively). At angular velocity 120°/second, the peak torque of dorsiflexors and plantarflexors of the control group was significantly higher than in the knee OA group (P = 0.001, 0.010, respectively). At angular velocities 60 and 120°/second, the dorsiflexion/plantarflexion ratio of the knee OA group was significantly lower than of the control group (P = 0.003, 0.010, respectively). Conclusions: The knee OA group displayed weakness in ankle dorsiflexor and plantarflexor muscles and a decrease in the dorsiflexion/plantarflexion strength ratio. Clinicians should consider exercises to increase ankle dorsiflexor and plantarflexor muscles’ strength when developing rehabilitation programs for patients with knee OA.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"164 - 169"},"PeriodicalIF":0.0,"publicationDate":"2015-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615415Y.0000000010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-08-05DOI: 10.1179/1753614615Z.000000000111
B. Sweetman
Recent IBM conference for SPSS users, it was suggested that this was the era of machine learning in which mass data screening could define models for examination and predictive analysis could further define such concepts. Our own team were able to start such studies nearly a third of a century ago with the help of the few existing mainframe computers in the world that could cope with the fledgling programs performing these tasks. We were able to examine the complexity of common forms of low back pain, often referred to as non-specific back pain, which in turn implied that the clinical picture was ‘indivisible.’ Within this spread of morbidity, we thought that we could identify half a dozen or so distinct pictures, one of which was subsequently considered to be the manifestation of the elusive facet (zygapophysial) joint syndrome. It would take up far too much room here to review all the work in this field that has been accumulating since the syndrome was originally posited a century ago. But whilst out for my walk earlier this morning, I noticed that my right-sided low back pain was worse. I have all along believed that this trouble has been due to a predominantly unilateral right-sided facet joint syndrome, particularly as the diagnostic system developed from our above-mentioned research had scored me for this explanation. As you do when out walking, I decided to check what was happening. Our existing main criterion for the diagnosis was the paradoxical demonstration of the right-sided low back pain being exacerbated by bending sideways or twisting in the opposite direction, i.e. moves towards the left side. The other syndromes do not do this. Any syndrome can hurt if you bend or twist to the side of the pain, but the ‘contralateral’ phenomenon is seemingly restricted to facet joint involvement. Up until now, I had thought that pain exacerbation on lateral flection, as opposed to rotational movement, might distinguish between involvement of the lowest lumbosacral facet joints and that twisting implicated the joints above at L4/5. On testing, this morning I seemed to get different answers on repeating the tests. I then realized that lateral flexion would induce the contralateral pain only if I was standing whilst doing the test when my posture was slightly bent forwards (flexed). In contrast, lateral rotation induced the contralateral pain if my posture standing was slightly bent backwards (extension). For me, this was an ‘Oh wow!’ moment. I thought I should share these ideas just in case any readers were deciding to set up a study to help differentiate the various forms of back pain presentation. Of the vast number of tests that have been proposed, it is difficult to select a shortlist for inclusion at the outset of such clinical research. A recent editorial criticized a lot of cluster analysis studies for involving an insufficient number of cases and carrying out inadequately sophisticated analytic work. But, whilst this morning’s observations
{"title":"Casual observations on the facet joint syndrome","authors":"B. Sweetman","doi":"10.1179/1753614615Z.000000000111","DOIUrl":"https://doi.org/10.1179/1753614615Z.000000000111","url":null,"abstract":"Recent IBM conference for SPSS users, it was suggested that this was the era of machine learning in which mass data screening could define models for examination and predictive analysis could further define such concepts. Our own team were able to start such studies nearly a third of a century ago with the help of the few existing mainframe computers in the world that could cope with the fledgling programs performing these tasks. We were able to examine the complexity of common forms of low back pain, often referred to as non-specific back pain, which in turn implied that the clinical picture was ‘indivisible.’ Within this spread of morbidity, we thought that we could identify half a dozen or so distinct pictures, one of which was subsequently considered to be the manifestation of the elusive facet (zygapophysial) joint syndrome. It would take up far too much room here to review all the work in this field that has been accumulating since the syndrome was originally posited a century ago. But whilst out for my walk earlier this morning, I noticed that my right-sided low back pain was worse. I have all along believed that this trouble has been due to a predominantly unilateral right-sided facet joint syndrome, particularly as the diagnostic system developed from our above-mentioned research had scored me for this explanation. As you do when out walking, I decided to check what was happening. Our existing main criterion for the diagnosis was the paradoxical demonstration of the right-sided low back pain being exacerbated by bending sideways or twisting in the opposite direction, i.e. moves towards the left side. The other syndromes do not do this. Any syndrome can hurt if you bend or twist to the side of the pain, but the ‘contralateral’ phenomenon is seemingly restricted to facet joint involvement. Up until now, I had thought that pain exacerbation on lateral flection, as opposed to rotational movement, might distinguish between involvement of the lowest lumbosacral facet joints and that twisting implicated the joints above at L4/5. On testing, this morning I seemed to get different answers on repeating the tests. I then realized that lateral flexion would induce the contralateral pain only if I was standing whilst doing the test when my posture was slightly bent forwards (flexed). In contrast, lateral rotation induced the contralateral pain if my posture standing was slightly bent backwards (extension). For me, this was an ‘Oh wow!’ moment. I thought I should share these ideas just in case any readers were deciding to set up a study to help differentiate the various forms of back pain presentation. Of the vast number of tests that have been proposed, it is difficult to select a shortlist for inclusion at the outset of such clinical research. A recent editorial criticized a lot of cluster analysis studies for involving an insufficient number of cases and carrying out inadequately sophisticated analytic work. But, whilst this morning’s observations ","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"133 - 134"},"PeriodicalIF":0.0,"publicationDate":"2015-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614615Z.000000000111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65717473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-28DOI: 10.1179/1753615415Y.0000000009
Konstantinos Zemadanis, Evaggelos Sykaras, S. Athanasopoulos, D. Mandalidis
Abstract Objectives Patellofemoral pain syndrome (PFPS) is a common musculoskeletal dysfunction presenting with pain at the anterior aspect of the knee joint. The purpose of this study was to investigate whether implementation of mobilization-with-movement (MWM) prior to hip or knee exercises can achieve early pain and functional ability improvements in patients with PFPS. Methods Fifteen males and 25 females, 18–40 years of age with PFPS, were randomly assigned into three treatment groups. Patients in Groups A and B received MWMs for 1 week and performed either hip or knee exercises, respectively, for five more weeks. Physiotherapeutic modalities were implemented for 6 weeks in patients of Group C, who served as control. Pain and function was measured pre-intervention, post-MWM application, and post-intervention, using the Visual Analogue Scale (VAS) and the Lower Extremity Functional Scale (LEFS). Results The study revealed significantly improved post-MWM VAS and LEFS scores compared to pre-intervention scores for both Groups A and B (P < 0.001). Patients in Groups A and B demonstrated significantly improved post-MWM and post-intervention VAS and LEFS scores compared to Group C (P < 0.001). Post-intervention VAS and LEFS scores, however, between Groups A and B were not statistically significant. Discussion Our findings suggest that MWMs improve pain and function in PFPS patients within 1 week of application. Further improvements may be achieved by implementing either hip or knee exercises.
{"title":"Mobilization-with-movement prior to exercise provides early pain and functionality improvements in patients with patellofemoral pain syndrome","authors":"Konstantinos Zemadanis, Evaggelos Sykaras, S. Athanasopoulos, D. Mandalidis","doi":"10.1179/1753615415Y.0000000009","DOIUrl":"https://doi.org/10.1179/1753615415Y.0000000009","url":null,"abstract":"Abstract Objectives Patellofemoral pain syndrome (PFPS) is a common musculoskeletal dysfunction presenting with pain at the anterior aspect of the knee joint. The purpose of this study was to investigate whether implementation of mobilization-with-movement (MWM) prior to hip or knee exercises can achieve early pain and functional ability improvements in patients with PFPS. Methods Fifteen males and 25 females, 18–40 years of age with PFPS, were randomly assigned into three treatment groups. Patients in Groups A and B received MWMs for 1 week and performed either hip or knee exercises, respectively, for five more weeks. Physiotherapeutic modalities were implemented for 6 weeks in patients of Group C, who served as control. Pain and function was measured pre-intervention, post-MWM application, and post-intervention, using the Visual Analogue Scale (VAS) and the Lower Extremity Functional Scale (LEFS). Results The study revealed significantly improved post-MWM VAS and LEFS scores compared to pre-intervention scores for both Groups A and B (P < 0.001). Patients in Groups A and B demonstrated significantly improved post-MWM and post-intervention VAS and LEFS scores compared to Group C (P < 0.001). Post-intervention VAS and LEFS scores, however, between Groups A and B were not statistically significant. Discussion Our findings suggest that MWMs improve pain and function in PFPS patients within 1 week of application. Further improvements may be achieved by implementing either hip or knee exercises.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"101 - 107"},"PeriodicalIF":0.0,"publicationDate":"2015-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615415Y.0000000009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-11DOI: 10.1179/1753615415Y.0000000008
Judith Robitaille, M. Guay, Y. Tousignant-Laflamme
Abstract Background String music students suffer from playing-related musculoskeletal pain. However, until now, no studies have documented this specific problem in ‘elite’ string students, whom are susceptible to carry this experience of pain (and its consequences) into their future careers as professional musicians. Aim This study describes the experience of playing-related pain in ‘elite’ bowed string music students. Method String music students enrolled in three summer music camps offering higher education programs [were conveniently recruited] using the Tailored Design Method (n = 132). Participants were required to complete a questionnaire designed for the study and inquiring about their experience with playing-related pain, their playing habits, and the impact of playing-related pain on their musical activities. Results Participants were 16.3 ± 3.9 years old on average and played on average [16.1 hours per week] during the schoolyear. A high prevalence of pain was observed (94.7%). The neck, shoulders, and thoracic area of the spine were the most painful locations. Maximum pain intensity was 33.6 ± 26.2 mm on the visual analogue scale. It took a median of 30 minutes for the pain to resolve. Playing-related pain had an impact on the participants' perceived ability to play. Discussion The results of this study highlight the extent of the pain experience in young string music students. This information is helpful to support targeted treatment and prevention activities of playing-related musculoskeletal pain in this group of musicians.
{"title":"Description of playing-related musculoskeletal pain in elite string students","authors":"Judith Robitaille, M. Guay, Y. Tousignant-Laflamme","doi":"10.1179/1753615415Y.0000000008","DOIUrl":"https://doi.org/10.1179/1753615415Y.0000000008","url":null,"abstract":"Abstract Background String music students suffer from playing-related musculoskeletal pain. However, until now, no studies have documented this specific problem in ‘elite’ string students, whom are susceptible to carry this experience of pain (and its consequences) into their future careers as professional musicians. Aim This study describes the experience of playing-related pain in ‘elite’ bowed string music students. Method String music students enrolled in three summer music camps offering higher education programs [were conveniently recruited] using the Tailored Design Method (n = 132). Participants were required to complete a questionnaire designed for the study and inquiring about their experience with playing-related pain, their playing habits, and the impact of playing-related pain on their musical activities. Results Participants were 16.3 ± 3.9 years old on average and played on average [16.1 hours per week] during the schoolyear. A high prevalence of pain was observed (94.7%). The neck, shoulders, and thoracic area of the spine were the most painful locations. Maximum pain intensity was 33.6 ± 26.2 mm on the visual analogue scale. It took a median of 30 minutes for the pain to resolve. Playing-related pain had an impact on the participants' perceived ability to play. Discussion The results of this study highlight the extent of the pain experience in young string music students. This information is helpful to support targeted treatment and prevention activities of playing-related musculoskeletal pain in this group of musicians.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"125 - 131"},"PeriodicalIF":0.0,"publicationDate":"2015-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615415Y.0000000008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-10DOI: 10.1179/1753614615Z.000000000108
J. Inklebarger, Tim Clarke
Abstract Objectives In the UK, serial cortisone injections (CSI) to manage lateral epicondylitis (LE) is a routine practice. This remains so despite LE histopathological studies reporting chronic common extensor origin degenerative tendonopathy rather than inflammatory change. Several RCT studies have also demonstrated a lack of clinical efficacy for using CSI for LE, with more favourable outcomes achieved through autologous blood and platelet-rich plasma injections. Methods This case study follows a presentation in which corticosteroid injection (CSI) for LE was followed by recurrence of pain after initial relief. Results/Discussion An assessment of other options discussed in the literature led to a resolution of symptoms with a combination of enforced abatement of flaring activities and physiotherapist supervised graded forearm eccentric loading program, rather than repetition of the CSI.
{"title":"Corticosteroid injections for tennis elbow – A hard habit to break","authors":"J. Inklebarger, Tim Clarke","doi":"10.1179/1753614615Z.000000000108","DOIUrl":"https://doi.org/10.1179/1753614615Z.000000000108","url":null,"abstract":"Abstract Objectives In the UK, serial cortisone injections (CSI) to manage lateral epicondylitis (LE) is a routine practice. This remains so despite LE histopathological studies reporting chronic common extensor origin degenerative tendonopathy rather than inflammatory change. Several RCT studies have also demonstrated a lack of clinical efficacy for using CSI for LE, with more favourable outcomes achieved through autologous blood and platelet-rich plasma injections. Methods This case study follows a presentation in which corticosteroid injection (CSI) for LE was followed by recurrence of pain after initial relief. Results/Discussion An assessment of other options discussed in the literature led to a resolution of symptoms with a combination of enforced abatement of flaring activities and physiotherapist supervised graded forearm eccentric loading program, rather than repetition of the CSI.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"37 1","pages":"108 - 110"},"PeriodicalIF":0.0,"publicationDate":"2015-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614615Z.000000000108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65717896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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