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PURPOSE: The role of thoracolumbar fascia (TLF) in the development of chronic low back pain (CLBP) has growing evidence in the literature. Although CLBP is reported in individuals with idiopathic scoliosis (IS), its relationship with the TLF has yet not been established. This study aims to evaluate the TLF and its relationship with CLBP in IS. METHODS: A total of 60 individuals were included in the study. They were divided into three groups as follows: painful scoliosis (n = 20, age: 17.1 ± 3.7 years, Cobb angle: 15-43°), non-painful scoliosis (n = 20, age: 16.4 ± 3.4 years, Cobb angle: 15-45°), and healthy group (n = 20, age: 16.4 ± 4.7 years). Pain was evaluated using the short form of the McGill Pain Questionnaire. TLF thickness was evaluated on the lumbar region using ultrasonography. Trunk range of motion was assessed using a universal goniometer, and flexibility was assessed with sit-and-reach test. RESULTS: The thickness of the right TLF was greatest in the painful group, followed by non-painful (p = 0.007) and healthy (p < 0.001) groups. The thickness of the left TLF in the non-painful and painful groups was greater compared to the healthy group (p < 0.001). In the painful group, right TLF thickness was negatively correlated with trunk flexion/extension (r = -0.540, p = 0.014/r = -0.514, p = 0.020) and left rotation (r = -0.499, p = 0.025) but positively correlated with pain (r = 0.562, p = 0.01). CONCLUSIONS: Thickening of the TLF was observed in IS, whereby, in the presence of CLBP, it was further intensified. We suggest considering fascial thickening as a potential contributing factor to both pain and limited motion in relevant patients.
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The paraspinal muscles of the cervical, thoracic, and lumbar spine are important pain generators because muscle strains or myofascial pain syndrome caused by trigger points are common during clinical practice. Ultrasonography is the most convenient imaging tool for evaluating these muscles due to its advantages, such as providing good delineation of soft tissues, easy accessibility, and zero radiation. Additionally, ultrasound can serve as a useful guiding tool for paraspinal muscle intervention to prevent inadvertent injuries to vital axial neurovascular structures. This pictorial essay presents ultrasound scanning protocols for the paraspinal and other associated muscles as well as a discussion of their clinical relevance. Axial magnetic resonance imaging has also been used to elucidate reciprocal anatomy. In conclusion, ultrasound imaging proves to be a valuable tool that facilitates the differentiation of individual paraspinal muscles. This capability significantly enhances the precision of interventions designed to address myofascial pain syndrome.
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BACKGROUND: Physiatrists are facing with survivors from disasters in both the acute and chronic phases of muscle and nerve injuries. Similar to many other clinical conditions, neuromusculoskeletal ultrasound can play a key role in the management of such cases (with various muscle/nerve injuries) as well. Accordingly, in this article, a recent single-center experience after the Turkey-Syria earthquake will be rendered. METHODS: Ultrasound examinations were performed for various nerve/muscle lesions in 52 earthquake victims referred from different cities. Demographic features, type of injuries, and applied treatment procedures as well as detailed ultrasonographic findings are illustrated. RESULTS: Of the 52 patients, 19 had incomplete peripheral nerve lesions of the brachial plexus (n=4), lumbosacral plexus (n=1), and upper and lower limbs (n=14). CONCLUSION: The ultrasonographic approach during disaster relief is paramount as regards subacute and chronic phases of rehabilitation. Considering technological advances (e.g., portable machines), the use of on-site ultrasound examination in the (very) early phases of disaster response also needs to be on the agenda of medical personnel.
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OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the influence of core muscle training (CMT) on throwing ball velocity among overhead throwing athletes. DESIGN: A literature search was performed from inception to July 2023 for randomized controlled trials (RCTs) investigating the effects of CMT on overhead throwing ball velocity. The primary outcome was the change in standing throwing ball velocity. The secondary outcome focused on the enhancement of step/jump throwing ball velocity. RESULTS: Seven RCTs were included, revealing a significant improvement in standing throwing ball-velocity in the group undergoing CMT (Hedges' g = 0.701, 95% confidence interval [CI] = 0.339 to 1.063, p < 0.001). Longer treatment duration and a higher frequency of CMT sessions per week contributed to improved standing throwing ball velocity. However, CMT did not show significant benefits for step (Hedge's g = 0.463, 95% CI = -0.058 to 0.985, p = 0.082) and jump throwing ball-velocity (Hedges' g = 0.550, 95% CI = -0.051 to 1.152, p = 0.073). CONCLUSION: CMT significantly enhanced standing ball throwing velocity. However, its effect on step/jump-throwing ball velocity was less certain. Further research is needed to explore the impact of CMT (especially its long-term effects) on throwing ball velocity.
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STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: This study aims to assess the effectiveness of lumbar segmental stabilization exercises (LSSE) in managing spondylolysis and spondylolisthesis. SUMMARY OF BACKGROUND DATA: Spondylolysis and spondylolisthesis are spinal disorders associated with lumbar segmental instability. LSSE have shown positive effects in treating these conditions; however, systematic reviews and meta-analyses are lacking. METHODS: A systematic search adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including studies from the inception of the databases used up to January 2024, was conducted. Disability improvement and pain intensity change were the primary and secondary outcomes, respectively, standardized using Hedges' g. Eligible articles underwent independent scrutiny by two authors, who also performed data extraction and quality assessment. Data pooling was accomplished using a random-effects model. RESULTS: In total, five randomized controlled trials comprising 198 participants were included, revealing a trend effect toward disability improvement in the LSSE group (Hedges' g=-0.598, 95% CI=-1.211 to 0.016, P=0.056, I2=75.447%). When the LSSE was administered as a single treatment, disability improvement became significant (Hedges' g=-1.325, 95% CI=-2.598 to -0.053, P=0.041, I2=80.020%). No significant effect of LSSE on pain reduction was observed (Hedges' g=-0.496, 95% CI=-1.082 to 0.090, P=0.097, I2=73.935%). CONCLUSION: In summary, our meta-analysis suggests that LSSE can potentially improve disability, especially when used as a single treatment. LSSE appears more beneficial in reducing disability than alleviating pain. Future research on different patient groups is needed to understand comprehensively LSSE's effects on other musculoskeletal disorders.
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