Comparison of lumbar muscle morphology in patients with chronic nonspecific low back pain with and without clinical lumbar segmental instability

OBJECTIVES

Evaluation of spinal muscle morphology may be critical because of its impact on segmental stability and control of the lumbar spine in the subset of patients with clinical lumbar segmental instability (LSI). The purpose of this study was to compare lumbar muscle morphology in CNLBP patients with clinical LSI, CNLBP patients without clinical LSI.

METHODS

This case-control study included 30 patients with CNLBP (15 with clinical LSI and 15 without clinical LSI) and 15 subjects without LBP. Axial magnetic resonance images from the L2 to S1 lumbar levels were used to evaluate the morphology of the lumbar muscles.

RESULTS

A significant increase in the muscle-to-fat infiltration index and a significant decrease in the relative muscle cross-sectional area (rmCSA) of the multifidus muscle at the L3-L4 to L5-S1 levels were observed in both CNLBP groups compared to the control group (p<0.05). The mean erector spinae mean rmCSA was significantly greater in the clinical LSI group compared to the control group (SMD = 0.853, 95% CI = 0.105 to -1.6, P = 0.044) and also compared to the CNLBP without clinical LSI (SMD = 0.894, 95% CI = -1.645 to -0.144, P = 0.030) at the L4-L5 level.

CONCLUSIONS

The atrophic changes of the multifidus muscle, in CNLBP patients with or without clinical LSI was observed. However, hypertrophic changes of the erector spinae muscle at the L4-L5 lumbar level were observed only in the clinical LSI group. Psaos major did not show significant atrophic or hypertrophic changes.

Radiographic Investigation of Lumbar Vertebrae in Patients with Flexion and Extension Movement Disorder Syndrome

Objectives

The kinesiopathology model is a new rehabilitation model classifying, evaluating, and treating patients with non-specific back pain. Sahrmann proposed this model based on movement disorder syndromes. The present cross-sectional study aimed to evaluate the radiograph of the linear and angular displacement of the lumbar spine in patients with lumbar flexion impairment syndrome (LFIS) and lumbar extension impairment syndrome (LEIS).

Methods

In this study, 50 adults aged 18-46 years were enrolled, including 25 patients with LFIS and 25 with LEIS. The eligible participants were referred to the radiology department for radiography in the common position of neutral, full extension, and full flexion position while standing. The White and Panjabi's method was used to measure the linear and angular displacements. Moreover, pain intensity was assessed using the visual analogue scale, and functional disability was investigated using a modified Oswestry Disability Questionnaire.

Results

The parameter of the linear displacement at the L3-L4 level was significantly different between the two groups (P=0.02). The mean duration of low back pain was longer in the LEIS, compared to the LFIS group (P=0.01).

Conclusion

In patients with LEIS, compensatory responses occur that cause less linear displacement at the L3-L4 level, compared to the patients with LFIS. Therefore, it is important to design appropriate exercises to better control the linear displacement at the L3-L4 level during the full range of motion in patients with LFIS.

Assessment Through Objective Structured Clinical Examination: How to Promote the Satisfaction of Physiotherapy Students

Introduction: This study aimed to assess the satisfaction of physiotherapy students with the general structure of objective structured clinical examination (OSCE). Materials and Methods: A researcher-made questionnaire consisting of eight items was distributed to 43 graduate and undergraduate physiotherapy students to evaluate the general structure of OSCE. Data analysis was done through SPSS software v. 20, considering a significance level of P<0.05. Results: Among 43 participants with a mean age of 23.7±2.4 years old, the percentage of desirable attitude toward attractiveness of the OSCE was 46.6%, being fair was 21%, identifying strengths and weaknesses was 53.5%, the ability to assess knowledge and information was 11.7%, good assessment of practical skills was 30.3%, good assessment of clinical diagnosis skills was 34.9%, and appropriateness was 34.9%. In total, 88.4% of the participants believed that OSCE increases students’ stress. The total satisfaction of all the participants with the OSCE was 2.7±0.8, with last year’s students significantly less than graduate ones (2.6±0.9 vs 2.9±0.3). Conclusion: The findings showed that the satisfaction of physiotherapy students regarding the general structure of the OSCE was not desirable, and OSCE was considered stressful. Therefore, due to the importance of OSCE in assessing clinical skills, it is better to improve the quality of holding the OSCE by fixing existent shortcomings, including shortness of time at each OSCE station and establishing training sessions.

Reliability of Upper Limb Neurodynamic Tests: Median, Radial, and Ulnar Nerves

Objective Upper limb neurodynamic tests are used to evaluate the mechanical sensitivity of the peripheral nerves. However, very little is known about the reliability of upper limb neurodynamic tests, especially for the radial and ulnar nerves. This study aimed to evaluate the reliability of neurodynamic tests of the upper extremities to test median, radial, and ulnar nerves. Materials & Methods In this observational cross-sectional study, 25 asymptomatic subjects aged 19-45 years participated. They were selected using simple non-random sampling. Then two examiners performed the neurodynamic tests on them on two successive days. The goal was to assess the reliability of median, radial, and ulnar neurodynamic tests. During the neurodynamic tests, the participants reported the initial stretching pain and the moment of submaximal pain (substantially obvious pain) in related areas of the nerve distribution, including the anterior side of the elbow and forearm for the median nerve, posterolateral aspect of the elbow and forearm for radial nerve, and medial side of elbow and forearm for the ulnar nerve. At the starting point of painful stretching and the submaximal pain, the angle of elbow extension (for median and radial nerve tests) and shoulder abduction angle (for ulnar nerve test) were measured using a mechanical goniometer. The range between these two points was used to analyze the reliability. The intraclass correlation coefficient (ICC) and the standard error of measurement (SEM) were calculated to examine the relative and absolute reliability, respectively. Using t-test, the difference in the mean of the measurements was calculated. Results No significant difference was found between the mean measurements of the two testers in intra-session and inter-session reliability. For examiners 1 and 2, was obtained 0.94 (SEM:2ο) and 0.89 (SEM:2.85ο) for the median nerve, 0.56 (SEM:6.36˚ ) and 0.93 (SEM:1.82ο) for radial nerve, and 0.42 (SEM:3.27ο) and 0.79 (SEM:1.42ο) for the ulnar nerve. Inter-tester intra-session reliability was obtained at 0.84 (SEM: 3.44ο), 0.54 (SEM: 6.1ο), and 0.55 (SEM: 2.75ο), respectively, for median, radial, and ulnar nerves. Inter-tester inter-session reliability was obtained at 0.97 (SEM:1.43ο), 0.69 (SEM:5.06ο), and 0.51 (SEM: 2.8˚ο), respectively, for median, radial, and ulnar nerves. Conclusion The upper limb neurodynamic tests and measurement of the range between the onset of stretching pain and the point of submaximal pain have moderate to excellent reliability. Therefore, these clinical tests can be used in diagnostic evaluations and treatment interventions. Also, the median nerve neurodynamic test has higher relative reliability than radial and ulnar nerve neurodynamic tests.

Effects of micro-amperage direct current stimulation on injury potential and its relation to wound surface area in guinea pig

INTRODUCTION

it is believed that the exogenous electrical stimulation via improving the natural endogenous bioelectric current, accelerate the wound healing. Up to now, this hypotheses has not been researched in acute surgically wounds.

MATERIALS AND METHODS

Thirty-nine male guinea pigs were randomly divided into one control and two experimental groups (DC anodal group and DC cathodal group). A full thickness skin incision, length of 2.5 cm, was made on the dorsum of each animal The differential surface skin potential was measured before and immediately after the injury and also through the healing process until 21st days.

RESULTS

Only in anodal group, there was not significant difference between the basal initial potential and the wound potential on days of 17, 19 and 21 (p>0.05). On days of 19 and 21, the wound potential decreased higher in anodal group than in control group (p<0.05). Wound surface area in two experimental groups decreased higher in 3rd weeks with respect to control group (p<0.05).

DISCUSSION AND CONCLUSION

Anodal micro-amperage direct current can accelerate bioelectric events of skin wound and return more rapidly the wound potential to its before injury natural level.