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PubMedDate not supplied

Phenotypic modification of arterial smooth muscle cells in response to medial dissection.

BACKGROUND: In the treatment of peripheral arteries, percutaneous transluminal angioplasty is commonly associated with intimal tears and dissections. OBJECTIVE: To investigate the influence of medial dissection on the remodelling of the vessel wall after balloon injury. METHODS: Aortae were obtained from 14 Fauve de Bourgogne rabbits that had been fed a normal diet. Seven days after the initial pull-back injury, the aortae were examined using morphometric and immunocytochemical methods. RESULTS: Eight rabbits (57%) had a tear that extended into the media. Morphometric measurements showed that the intima was significantly thinner when there was a medial dissection [(18.3 +/- 6.9) x 10(-3) versus (39.1 +/- 3.5) x 10(-3) mm without dissection, P < 0.001]. In the media of injured vessels, medial dissection was associated with a greater accumulation of extracellular matrix proteins (50.5 +/- 9.7 versus 12.4 +/- 2.2% of the surface area), a marked reduction in alpha-smooth muscle actin content (36.6 +/- 5.4 versus 47.4 +/- 7.5% of the surface area), a higher expression of a smooth muscle activation antigen (21.2 +/- 5.7 versus 8.9 +/- 1.5% of the 2P1A2-immunostained surface area) and an increase in the number of medial proliferating cell nuclear antigen-positive nuclei (8.2 versus 1.2% of labelled nuclei). CONCLUSION: These observations indicated that mechanical injury of the arterial wall induces a phenotypic activation of medial smooth muscle cells. In the case of acute distension, the response of the smooth muscle cells in the media was mainly responsible for wound healing in the presence of medial dissection; moreover, acute distension induced a significant higher state of activation and a medial repairing that could prevent migration towards the intimal space.

Actins↗
PubMed1995

The dominant role of psychosocial risk factors in the development of chronic low back pain disability.

STUDY DESIGN: An inception cohort design was used in which 421 patients were evaluated systematically with a standard battery of psychosocial assessment tests (Structured Interview for DSM-III-R Diagnosis, Minnesota Multiphasic Personality Inventory, and Million Visual Pain Analog Scale) within 6 weeks of acute back pain onset. OBJECTIVES: The present study evaluated the predictive power of a comprehensive assessment of psychosocial and personality factors in identifying acute low back pain patients who subsequently develop chronic pain disability problems (as measured by job-work status at 1-year follow-up evaluation). SUMMARY OF BACKGROUND DATA: There has been a relative paucity of prospective research in the United States comprehensively evaluating potential psychosocial risk factors that are associated with those injured workers who subsequently fail to return to work and productivity after 1 year because of low back pain disability. Such research has been quite limited because of the time and cost involved in conducting prospective studies. METHODS: All study patients were symptomatic with lumbar pain syndrome for no more than 6 weeks. These acute patients were tracked every 3 months, culminating in a structured telephone interview being conducted 1 year after the initial evaluation to document return-to-work status. RESULTS: Logistic regression analyses, conducted to differentiate between patients who were back at work after 1 year versus patients who were not because of the original back injury, revealed the importance of three psychosocial measures: self-reported pain and disability, scores on Scale 3 of the Minnesota Multiphasic Personality Inventory, and workers' compensation and personal injury insurance status. The model generated correctly classified 90.7% of the cases. Results revealed that major psychopathology, such as depression and substance abuse, did not precede or cause the development chronic pain disability. CONCLUSIONS: These results show the presence of a robust "psychosocial disability factor" that is associated with those injured workers who are likely to develop chronic low back pain disability problems. Based on these data, a statistical algorithm has been generated that can identify those acute patients who will require early intervention to prevent the development of chronic disability. The second major result is that preinjury or concomitant psychopathology does not appear to predispose patients to chronic pain disability, although high rates of psychopathology have been shown in chronic low back pain. Future research should be directed at emotional vulnerability and psychosocial events in the period after the injury that may lead to chronicity.

Adult↗
PubMed1992

Musculoskeletal pain and work disability.

Musculo-skeletal pain caused by neck and back injury, cumulative trauma to the upper extremities, fibromyalgia, and reflex dystrophy is an important cause of worker disability. Physicians are involved not only in the care of injured workers, but in providing independent medical opinions regarding such injuries. Advances in medical knowledge permit better understanding and management of these injuries, and it is the responsibility of all physicians to provide accurate diagnosis, treatment, and information to patients, employers, insurers, and the workers compensation system.

Back Pain↗
PubMed1996

Spinal compression at peak isometric and isokinetic exertions in simulated lifting in symmetric and asymmetric planes.

OBJECTIVE: To determine if the spinal compression can be used as a criterion for the safety of the back. DESIGN: Various lifting strength activities were analysed using a 3-D biomechanical model to determine spinal compression forces. BACKGROUND: Despite many standards being set and the use of varied strategies, low-back injuries continue to be common in our society. Since the injuries occur to the tissues in the body, it may be more appropriate to investigate the effects of external loads on the tissues. Therefore it was decided to determine the spinal compression in standardized lifting tasks. METHODS: Twenty young adults (12 males and 8 females) performed maximal stoop and squat lifts in sagittal, 30 degrees lateral, and 60 degrees lateral planes at half, three-quarters, and full horizontal reach distances. The stoop lifts were performed in isokinetic and isometric modes; the isometric mode was performed with the hip at 60 degrees and 90 degrees. The squat lifts were also performed in isokinetic and isometric modes; the isometric mode consisted of postures with knee at 90 degrees and 135 degrees of flexion. In addition, the subjects also performed isometric lifts in stoop and squat postures at a self-selected optimum posture. During these activities the strength was measured using a static dynamic strength tester employing a load cell and force monitor. Three-dimensional postural recording was made using a 3-D Peak Performance Technologies imaging system. Using the postural and force data as input to a 3-D biomechanical model, the lumbosacral spinal compression was calculated. The values of strength and spinal compression were analysed and compared. RESULTS: The strength was significantly affected by the gender, the type of lift, plane of lift and reach of lift (P < 0.01); whereas the spinal compression was not affected by the reach at all. Two-way and three-way interactions were significant for strength (P < 0.02) but not for spinal compression. CONCLUSION: It was concluded that the spinal compression was the ultimate cost function in the safety of the back and as such preventative strategies should be based on this. RELEVANCE: The use of an appropriate cost function in a manner in which it can maximize the safety of the back will be of considerable value. Since injuries are biomechanical perturbation of the tissues, it is argued that the cost function be used in a manner where tissue load be considered as the primary factor.

Journal Article↗
PubMed1991

Low back pain--back care through proper lifting technique.

The study was designed to evaluate the level of knowledge of the subjects about back care and proper lifting techniques. Two groups of subjects were taught correct lifting method and back care through practical demonstrations and illustrated diagrams. The subjects' knowledge was measured pre- and post-test, using written and practical tests. Subjects with low back pain and those without back pain both benefited from the training. The need for physiotherapists to teach back injury prevention to the general populace was highlighted.

Adolescent↗
PubMed1996

General management of vertebral fractures.

Vertebral fractures cause pain and disability. Four concepts should guide their comprehensive management: treat the patient, not the skeleton; use a multidisciplinary approach; engage the patient and his or her family in the treatment; and provide appropriate goals, education, encouragement, and support. The goals include procuring bone mass and preventing injury: back support, physical therapy, occupational therapy, psychosocial support, and prevention of falls. Initial treatment includes bed rest, pain management with local and systemic analgesia, bracing to improve comfort, and patient reassurance. Long-term management includes spinal stretching exercises and continuing ordinary activities within limits permitted by pain. A back school program is an effective addition to conventional concepts using physiotherapy exclusively. In certain selected patients, the indication for operative treatment of vertebral fracture depends on the additional injury, and extent and characteristics of cord compression; stability of the fracture; and the amount of deformity. Vertebroplasty can be effective in the control of pain and in obtaining stability of the spine.

Accidental Falls↗
PubMed2005

Epidemiology of lacrosse injuries in high school-aged girls and boys: a 3-year prospective study.

OBJECTIVE: To report the types, mechanisms, and circumstances of lacrosse injuries incurred by high school-aged girls and boys during organized interscholastic and summer camp games. STUDY DESIGN: Descriptive epidemiology study. METHODS: For 3 years, the authors gathered data on girls' and boys' lacrosse injuries for 359 040 high school and 28 318 summer camp athletic exposures using a lacrosse-specific computerized injury surveillance system. The most prevalent injuries were organized into multifactorial injury scenarios. RESULTS: In high school play, the injury rate for adolescent boys (2.89 per 1000 athletic exposures) was slightly higher than that for girls (2.54 per 1000 athletic exposures) (incidence rate ratio = 1.14; 95% confidence interval, 1.00-1.30). The most prevalent injuries for adolescent girls and boys were knee and ankle sprains resulting from noncontact mechanisms. Male players had significantly higher rates of shoulder, neck, trunk, and back injuries and higher game-to-practice injury ratios. In addition, they had higher rates of concussive events from player-to-player contact. Female players had higher rates of overall head injuries, many involving contusions and abrasions from stick and ball contact. CONCLUSIONS: The overall injury rates for boys' and girls' high school lacrosse were significantly lower than those for collegiate play. Significant differences existed between adolescent boys and girls with respect to injury mechanisms, body parts injured, and player and team activity at the time of injury.

Adolescent↗
PubMed2004

Low back pain in competitive rhythmic gymnasts.

AIM: It has been reported that rhythmic gymnasts are at risk of suffering from low back injuries, because of repetitive lumbar hyperextensions. On the other hand, this sport requires features of leanness, muscular strength and flexibility that should represent protective factors for back pain. METHODS: This cross-sectional study aimed to assess the prevalence of low back pain in 67 club-level competitive rhythmic gymnasts aged 13-19 years. A standardized questionnaire was used to evaluate back-pain symptoms. Anthropometric measurements, time spent in physical activity, psychological testing results, smoking habits and age of menarche were recorded. One hundred and four age-matched general females served as control group. RESULTS: Low back pain complaints were reported by 7 rhythmic gymnasts and by 27 controls (10.4% vs 26.0%, p<0.05); the prevalent location of back pain was bilateral in gymnasts and central in controls. Gymnasts had lower body weight, body mass index, fat body mass and delayed menarche. The females with low-back pain displayed higher body weight, body mass index, fat body mass, age, a greater smoking habit and more anxious/depressive behaviour, both in the gymnast and in the control group. CONCLUSION: Competitive, club-level rhythmic gymnasts show a reduced prevalence of low back-pain. Being younger in age, having greater leanness, not smoking, displaying less anxious/depressive behaviour, and developing increased muscle strength and flexibility, all can represent preventive factors for low back pain. This study suggests that rhythmic gymnastics is not a discipline at increased risk of low back pain.

Adolescent↗
PubMedDate not supplied

Mechanical low back pain: etiology and conservative management.

OBJECTIVE: To review literature pertaining to low back pain (including lumbar disk herniation) and its treatment by manipulative therapy and rehabilitative exercises. DATA SOURCES: A Medline literature search was performed. English and foreign language materials were reviewed. Key words included the following: manipulation, manipulative therapy, lumbar intervertebral disk herniation, lower back pain. STUDY SELECTION: The studies detailed the neurologic and biomechanical aspects of manipulative therapy, as well as the efficacy of manipulative and rehabilitative management of mechanical low back pain. Also included were studies detailing the etiology of mechanical low back pain. DATA SYNTHESIS: Recent studies have indicated there are certain activities that commonly precipitate lower back injuries. Several methods of treatment for these injuries are discussed. The review indicated the most effective form of treatment is manipulative therapy. The neurologic and biomechanical aspects of manipulation are discussed. CONCLUSION: Low back pain is a common cause of physical, emotional and financial distress. This paper concluded that manipulative therapy is an efficacious as well as cost-effective method of treatment in cases of mechanical low back pain.

Biomechanical Phenomena↗
PubMed1994

Pain and disability associated with new vertebral fractures and other spinal conditions.

Although vertebral fractures are common among older women, little is known about associations with pain and disability. In this prospective study, fractures which occurred after the initial radiograph were strong predictors of back pain and disability at the end of followup, with odds ratios (OR) of approximately 4-5. Other, independently significant predictors were self-reported history of (1) disk disease (OR = 3-9), (2) traumatic back injury (OR = 4-7), and (3) spinal arthritis (OR = 3-6). In longitudinal analyses, new fractures were associated (OR = 6.4; 95% CI = 2.6, 15.6) with increases in back pain frequency (relative to pre-fracture levels). The association with prevalent fractures was weaker, and not significant (OR = 1.7; 95% CI = 0.5, 5.6). The pain frequency index increased approximately 3-fold, relative to pre-fracture levels. At the end of followup (mean = 3.5 years), the index was still two times greater than baseline. We conclude that associations with back pain and disability are greater in magnitude for new vertebral fractures than for prevalent fractures.

Adult↗
PubMed2002

Survey of the injury rate for children in community sports.

OBJECTIVE: To determine the baseline injury rate for children ages 7 to 13 participating in community organized baseball, softball, soccer, and football. METHODS: In this observational cohort study, 1659 children were observed during 2 seasons of sports participation in an urban area. Data were collected by coaches using an injury survey tool designed for the study. A reportable injury was defined as one requiring on-field evaluation by coaching staff, or causing a player to stop participation for any period of time, or requiring first aid during an event. Logistic regression analyses were done within and across sports for injury rates, game versus practice injury frequencies, and gender differences where appropriate. RESULTS: The injury rates, calculated per 100 athlete exposures during total events (games plus practices), were: baseball, 1.7; softball, 1.0; soccer, 2.1; and football, 1.5. The injury rates for baseball and football were not significantly different. Across sports, contusions were the most frequent type of injury. Contact with equipment was the most frequent method of injury, except in football where contact with another player was the most frequent method. In baseball, 3% of all injuries reported were considered serious (fracture, dislocation, concussion); in soccer, 1% were considered serious; and in football, 14% were considered serious. The frequency of injury per team per season (FITS), an estimation of injury risk, was 3 for baseball and soccer, 2 for softball, and 14 for football for total events. For all sports, there were more game than practice injuries; this difference was significant except for softball. There were no significant gender differences in soccer for injury rates during total events. CONCLUSIONS: Given the classification of football as a collision sport, the high number of exposures per player, the FITS score, and the percentage of injuries considered serious, youth football should be a priority for injury studies. Health professionals should establish uniform medical coverage policies for football even at this age level. RECOMMENDATIONS FOR MODIFICATIONS: Injury surveillance for youth sports is gaining momentum as an important step toward formulating injury prevention methods. However, establishing patterns of injuries, taking preventive measures, and evaluating equipment and coaching modifications may take years. In addition to the objective findings of this study, our direct observations of community sports through 2 seasons showed areas where immediate modifications could reduce injury risk. The first recommendation is that youth sports leagues provide and require first aid training for coaches. Training could be done by sports medicine professionals and include recognition and immediate response to head, neck, and spine injuries, as well as heat-related illnesses. The second recommendation is that youth sports leagues have clear, enforceable return to play guidelines for concussions, neck and back injuries, fractures, and dislocations. The third recommendation is that baseball and softball leagues consider the injury prevention potential of face guards on batting helmets.

Athletic Injuries↗
PubMed1997

Factors associated with back pain in nursing staff: a survey in Athens, Greece.

Factors associated with self-reported back pain were investigated using questionnaire data on 407 female nurses from a large hospital in Athens, Greece. Factor analysis was used to construct indices of pain and its impact on normal life, and also to summarize work load descriptions. Pain factors were examined in relation to work load and personal characteristics by logistic regression. Statistically significant items, in relation both to pain and impact, were the existence of previous back injury, self-reported headaches and the 'carrying and lifting' factor of work load which principally included moving equipment. Age, height and weight were not associated with back pain. Compared to a similar study by Harber and colleagues in California, United States of America, the factors associated with back pain were quite similar in this study even though the prevalence of back pain was much higher among Greek nurses and their work load was physically much more demanding.

Back Pain↗
PubMed1991

Acute back pain: a psychological analysis.

A cross-sectional evaluation of 117 people who sustained acute back injuries was undertaken within 15 days of the first report of the pain. The subjects showed no discal or neural signs and had not experienced previous episodes of back or neck pain. All subjects were given a structured interview and filled in a series of psychological evaluation instruments. Results show acute pain reactions to be comparable to those seen in chronic pain groups. The predominant emotion is one of frustration rather than anxiety or depression and considerable behavioural disruption is evident from this early point. The extent to which these data undermine the model of gradual evolution of chronic back pain problems is discussed.

Acute Disease↗
PubMed1989

Injuries to carpenters.

Study of 208 consecutively treated injuries to carpenters in northwestern Vermont revealed an annual injury rate of 13.3 to 17.2/100 workers. Most injuries had an abbreviated injury score of 1 and 7% resulted in hospitalization. One quarter of the injuries resulted from falls, and one fifth each from use of construction materials or power tools. In contrast to injuries from most other power tools, which usually involved trauma from direct contact with the equipment, the majority of injuries from circular or "skill" saws were eye injuries from flying sawdust. Overall, 43% of injured persons had no disability for work, but almost one fifth were disabled for a month or longer, especially persons with back injuries, who usually required emergency department treatment only but then had prolonged disability and expensive care. Mean and median hospital costs for all injuries were $347 and $70, and mean and median total costs of care were $376 and $90. Only one third of payment came from workers' compensation. Self-employed carpenters comprised 17% of injured persons but 36% of those with unpaid bills.

Accidents, Occupational↗
PubMed1977

Descending optic nerve degeneration in primates.

We cut the optic nerve at the orbital apex in squirrel monkeys to study the descending degeneration of optic nerve axons and their ganglion cell bodies. We could not detect progressive disintegration of the axon from the site of injury back to the cell body. Instead, the entire length of individual axons seemed to degenerate simultaneously as early as 3 weeks and as late as 6 weeks after injury, as judged both by ultrastructural integrity and by continued slow axonal transport, a reflection of local physiologic function. We could not relate the time of degeneration to the distance of the injury from the cell body. Evidently there is a signal of injury to the cell body after axotomy, though the nature of the signal and the mechanism by which it leads to cell death are unknown.

Animals↗
PubMed1989

Return to work following back surgery: a review.

Nineteen articles published between 1980 and 1986 were reviewed to determine the prognosis for returning to previous employment following back surgery. Seventy-seven percent of the cases reviewed returned to their previous level of employment. Nearly 11% of cases had additional back surgery during the period of follow-up. Data from three articles suggest that 82% of patients are able to return to their previous level of employment following primary back surgery compared to 59% of patients who have had multiple back surgeries. Recommendations for work activity following back surgery should be individualized for each patient. A work-hardening program including assessment of cardiovascular fitness and task performance can be used to progressively increase activity to the highest achievable level. Prevention of back injuries in the workplace will increase employee morale and reduce employee turnover and workers' compensation costs.

Back Pain↗
PubMed2002

Low-back stiffness is altered with warm-up and bench rest: implications for athletes.

INTRODUCTION: General practice in many team sports is to have the athletes who do not start in a game sit on a bench while waiting to play. The purpose of this study was to examine the effect of a warm-up followed by bench rest on the stiffness of the lumbar spine in athletes. METHODS: Nine varsity-level volleyball players volunteered to have their lumbar-spine stiffness measured. The protocol consisted of an initial stiffness measurement followed by a 30-min warm-up, then another stiffness measurement, then 30 min of bench rest, and finally a third stiffness measurement. RESULTS: In general, lumbar spine stiffness increased as a result of bench rest after a warm-up. This effect was seen in both the spine extension and lateral bend axes but not in the flexion or axial twist axes. However, there was no decrease in stiffness associated with the active warm-up portion of the task. CONCLUSIONS: It was concluded that a warm-up followed by bench rest does lead to an increase in stiffness of the lumbar spine, suggesting this practice is not in the best interest of reducing the risk of back injury or optimal performance.

Adult↗
PubMed1986

The use of exercise and muscle testing in the rehabilitation of spinal disorders.

The isokinetic evaluation of trunk muscle strength (maximal and fatigue) provides very valuable information for establishing specific exercise programs for patients with low back disorders, and for preventing low back injury in industry by identifying employees with weak trunk muscles and with job-strength mismatches.

Back Pain↗