[Relations and vascularization of the posterior tibial muscle].
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Back Muscles↗
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Cartilage formation from free perichondrial grafts: an experimental study in rabbits.
To study whether free-grafted perichondrium would produce new cartilage, perichondrium taken from the rabbits' ears was transplanted to the subcutaneous tissues of the groin and the back, to the muscles of the back, to the areolar tissue in the neck, and to the parenchyma of the liver. A clot of blood was placed in close contact with the perichondrium at randomly selected recipient sites. Wherever the perichondrium was grafted in the presence of clotted blood new cartilage was produced, irrespective of age and weight of the rabbit. When blood was withheld, little or no cartilage formed. New formation of cartilage began in the first week after transplantation and the cartilage was mature within 7 weeks.
Animals↗
Lumbar muscle usage in chronic low back pain. Magnetic resonance image evaluation.
Methods for detecting recruitment patterns of the lumbar muscles during exercise in patients with chronic low back pain are limited. This article discusses the use of magnetic resonance imaging with Roman chair extension exercise to examine lumbar muscle usage in five normal volunteers, five chronic low back pain patients without surgery, and five chronic low back pain patients with surgery. Changes in signal intensities of psoas, multifidus, and longissimus/iliocostalis with graded exercise were measured at three lumbar disc levels. At rest, there was a difference between multifidus and longissimus/iliocostalis signal intensity in chronic low back pain subjects without surgery (P = 0.0162) and in chronic low back pain subjects with surgery (P = 0.0036), but not in normal subjects. At peak exercise, there was a difference in signal intensities between multifidus and longissimus/iliocostalis in all groups (normal volunteers, P = 0.0069; chronic low back pain patients without surgery, P = 0.0125; chronic low back pain patients with surgery, P = 0.0060). The exercise response was attenuated in chronic low back pain patients with surgery. Thus, MRI demonstrates static and dynamic differences in lumbar paraspinal musculature in chronic low back pain subjects compared to normal subjects.
Exercise↗
[Study of the elimination of residues and local tissue injury following intramuscular injection of a solution of the combination trimethoprim/sulfatroxazole in pigs].
Two different studies are described. The first study deals with the elimination of residues of trimethoprim (TMP), sulfatroxazole (STX) and its main metabolite N4-acetyl-sulfatroxazole (N4-acetyl-STX) in pigs. Thirty -six pigs were treated with trimethoprim/sulfatroxazole IM in the nec k at a dosage of 16 mg/kg body weight for five days. Groups of four pig s were slaughtered at different time intervals. The study showed that concentration of STX, N4-acetyl-STX and TMP in edible tissues and at the injection sites were below 0.1 ppm on day nine after the last injection. S TX was eliminated the slowest, and STX can therefore be selected as a marker for residues of the trimethoprim/sulfatroxazole formulation in the tissues. The second study deals with irritation aspects of this trimethoprim /sulfatroxazole formulation. Four pigs of 32-35 kg were treated IM w with trimethoprim/sulfatroxazole and benzylpenicillin sodium. Each pig received the same injection volume, namely four trimethoprim/sulfatroxazole injections (16 mg/kg body weight per injection site), two in the back and two in the neck muscle, and two benzylpenicillin sodium injections (20,000 I.U./kg body weight per injection site), in the back muscle. All pigs were slaughtered 14 days after treatment and the extent of the irritation was compared. There were no differences between trimethoprim/sulfatroxazole and benzylpenicillin sodium with regard to irritation at the injection site in the back muscle. The irritation in the neck site was statistically less prominent than that in the back muscle and was considered not to affect the quality of the meat.
Animals↗
Increased central drive during fatiguing contractions of the paraspinal muscles in patients with chronic low back pain.
In low back pain patients the paraspinal muscles demonstrate excess fatigability. Whether the cause is "central" as could result from impaired motor unit recruitment due to poor motivation or fear of pain, or "peripheral", and caused by defects in the contractile apparatus, is unknown. Using surface electromyography in conjunction with a standardized isometric fatigue test, this study investigates the mechanisms causing paraspinal muscle dysfunction in patients with both nonsurgical and postsurgical chronic low back pain. During the fatigue test normal subjects and both patient groups exhibited electromyographic increases. These were significantly greater in both patient groups, indicating increased central drive to their muscles. These findings may suggest that patients' excess fatigue is peripheral in origin, with increased central drive arising secondary to muscle wasting or denervation, although a central activation defect has not been excluded. Impaired physical performance in low back pain patients does not seem to be caused by lack of central drive.
Adult↗
EMG activity of trunk muscles and torque output during isometric axial rotation exertion: a comparison between back pain patients and matched controls.
Abnormal patterns of trunk muscle activity could affect the biomechanics of spinal movements and result in back pain. The present study aimed to examine electromyographic (EMG) activity of abdominal and back muscles as well as triaxial torque output during isometric axial rotation at different exertion levels in back pain patients and matched controls. Twelve back pain patients and 12 matched controls performed isometric right and left axial rotation at 100%, 70%, 50% and 30% maximum voluntary contractions in a standing position. Surface EMG activity of rectus abdominis, external oblique, internal oblique, latissimus dorsi, iliocostalis lumborum and multifidus were recorded bilaterally. The primary torque in the transverse plane and the coupling torques in sagittal and coronal planes were measured. Results showed that there was a trend (P = 0.08) of higher flexion coupling torque during left axial rotation exertion in back pain patients. Higher activity for external oblique and lower activity for multifidus was shown during left axial rotation exertion in back pain group when compared to the control group. In right axial rotation, back pain patients exhibited lesser activity of rectus abdominis at higher levels of exertion when compared with matched controls. These findings demonstrated that decreased activation of one muscle may be compensated by overactivity in other muscles. The reduced levels of activity of the multifidus muscle during axial rotation exertion in back pain patients may indicate that spinal stability could be compromised. Future studies should consider these alternations in recruitment patterns in terms of spinal stability and internal loading. The findings also indicate the importance of training for coordination besides the strengthening of trunk muscles during rehabilitation process.
Abdominal Muscles↗
Commonly used muscle relaxant therapies for acute low back pain: a review of carisoprodol, cyclobenzaprine hydrochloride, and metaxalone.
BACKGROUND: Low back pain is a leading reason for primary care visits. Many treatment options are available, but some lack scientific support. OBJECTIVE: The aim of this review was to discuss the etiology of low back pain and the relative risks and benefits of muscle relaxants commonly prescribed for the management of back pain. METHODS: We searched Intercontinental Marketing Services data for January 2003 through January 2004 to determine the most commonly prescribed agents for the management of musculoskeletal pain. Carisoprodol, cyclobenzaprine hydrochloride, and metaxalone represented >45% of all such prescriptions. Cochrane Library, MEDLINE, and EMBASE databases were searched (time frame: 1960 through January 2004; search terms: back pain, carisoprodol, cyclobenzaprine, metaxalone, muscle relaxants, and pharmacotherapy) and reference lists of identified articles were hand-searched. RESULTS: Three trials of carisoprodol (N = 197) were located in the Cochrane Library database. Two double-blind, randomized, placebo-controlled trials evaluating the safety and efficacy of cyclobenzaprine hydrochloride (N = 1405) were identified in the literature. Three double-blind, placebo-controlled trials were identified for metaxalone (N = 428) in 2 reports. The types of adverse events seen with these agents involved the central nervous system, including drowsiness/sedation, fatigue, and dizziness. However, the efficacy of cyclobenzaprine hydrochloride was shown to be independent of its sedative effects, which were dose related. The potential for abuse with carisoprodol is of growing concern. CONCLUSIONS: Analgesic pain management for low back pain due to muscle spasm may be combined with a muscle relaxant. Cyclobenzaprine hydrochloride has the most recent and largest clinical trials demonstrating its benefit, but carisoprodol and metaxalone also appear to be effective. However, carisoprodol's usefulness is mitigated by its potential for abuse.
Amitriptyline↗
Association between back pain and physical fitness in adolescents.
STUDY DESIGN: A cross-sectional study of 9413 adolescents. OBJECTIVES: To study the associations between back pain, physical activity, and physical fitness. SUMMARY OF BACKGROUND DATA: A high physical fitness level, and especially muscle endurance in the back muscles, is associated with lower risk of back pain, but little is known about other types of physical fitness and back pain in adolescents. METHODS: A cross-sectional study of 3956 boys and 5457 girls 17 years of age. The associations between self-reported back pain and different types of physical fitness and self-reported physical activity were analyzed in high schoolchildren in Denmark. RESULTS: Back pain was reported by 43% of the girls and 37% of the boys. Back pain was associated with low isometric muscle endurance in the back extensors, and the highest quartile had a lower risk of back pain (odds ratio = 0.71; 95% confidence interval, 0.62-0.82) within the last month. No associations were found to aerobic fitness, functional strength, flexibility, or physical activity level after adjustment for muscle endurance. More girls than boys experienced back pain, and it was more common in taller adolescents. CONCLUSION: Children with high isometric muscle endurance were less likely to report back pain. No other measures of physical fitness or level of self-reported physical activity were linked to back pain reporting.
Adolescent↗
The use of muscle relaxant medications in acute low back pain.
STUDY DESIGN: Prospective cohort study. OBJECTIVES: To determine the characteristics of patients who take muscle relaxants for back pain after seeking care and to determine the relationship of muscle relaxant use with recovery from the episode of low back pain. SUMMARY OF BACKGROUND DATA: Low back pain is a common condition with a generally favorable short-term prognosis. Physicians in the acute setting commonly prescribe muscle relaxants. The indications for use and outcomes are not clear. METHODS: We performed a secondary data analysis of a cohort of 1633 patients who sought care from a variety of practitioners (primary care, physician of chiropractic, orthopedic surgeon, Health Maintenance Organization) for low back pain. Patients were enrolled in the physician's office and interviewed at baseline, 2, 4, 8, 12, and 24 weeks. Pain, functional status, medication use, health care utilization, and satisfaction with care were assessed. RESULTS: Muscle relaxants were used by 49% of patients; among those who sought care from doctors, 64% used muscle relaxants. Muscle relaxant users were more impaired at baseline. Over time, among patients with greater functional status impairment (Roland disability score > 12) at baseline, muscle relaxant users had somewhat slower recovery from the episode of back pain. This finding persisted after controlling for baseline functional status, age, worker's compensation status, and use of nonsteroidal inflammatory agents. CONCLUSIONS: Use of muscle relaxants was very common among patients with acute low back pain. Muscle relaxant use was not associated with more rapid functional recovery.
Acute Disease↗
A retrospective comparison of abdominal muscle strength following breast reconstruction with a free TRAM or DIEP flap.
Abdominal weakness is a known potential complication of breast reconstruction with a pedicled or free TRAM flap. It has been presumed that the DIEP flap, which involves no muscle resection, does not compromise abdominal muscle strength but little objective research exists to substantiate this. The aims of this retrospective study were to compare abdominal muscle strength following free TRAM flap and DIEP flap, to compare both groups with a control group and to establish the effect of both procedures on functional activities. Fifty women (23 with a DIEP flap, 27 with a free TRAM flap) plus 32 non-operated controls underwent assessment of their abdominal and back extensor muscle strength on a KIN COM isokinetic dynamometer. Two questionnaires were used to establish the impact on function. The TRAM flap group had significant weakness of the abdominal and back extensor muscles compared with the DIEP flap group and the control group. The trend was for the DIEP flap group to have weaker abdominal muscles than the control group. There was a higher level of abdominal pain and a greater number of reported functional difficulties in the TRAM flap group than in the DIEP flap group. This study demonstrates that whilst the DIEP flap can reduce the strength deficit caused by the free TRAM flap, abdominal weakness can still result from the DIEP flap. A randomised controlled trial is currently underway to investigate the effect of preoperative abdominal exercises in preventing/minimising postoperative abdominal muscle weakness in this group.
Abdominal Muscles↗
Local back massage with an automated massage chair: general muscle and psychophysiologic relaxing properties.
OBJECTIVES: The objective of the present study was to test massage applied with an automated massage chair on the back muscles with regard to the effects on the tension of other muscles or on the neurovegetative tone, and to compare three different automated massage techniques. METHODS: Ten healthy volunteers participated in the study. The experiment consisted of an initial 5-minute period of relaxation without massage, and 5-minute periods of three different massage programs (roll-stretch massage, shiatsu massage, and beat massage). Subjects were randomized as to the presentation order. The following physiologic data were collected: frontalis and gastrocnemius electromyogram (EMG) activity, skin conductance, and peripheral skin temperature. Judgments of valence and arousal were registered using the pencil and- paper version of the five-point Self-Assessment Manikin. RESULTS: Roll-stretch and shiatsu massage were rated by participants as more pleasant than the relaxation period without massage or the beat massage. Whereas the four conditions were similar with regard to the mean frontal EMG values (reflecting primarily affective states), they differed regarding the gastrocnemius EMG (relating more to a general level of tension), roll-stretch massage, and shiatsu massage, resulting in less muscle tension than the control condition. Shiatsu massage was associated with significantly lower skin conductance than the control condition, whereas beat massage increased it significantly. A significant increase of skin temperature was found during the roll-stretch massage compared to the no-massage condition. CONCLUSIONS: Automated roll-stretch massage and shiatsu massage applied on the back can rapidly induce measurable relaxation in distant muscles not directly massaged, and is accompanied by signs of neurovegetative calming. Back massage applied by an automated massage chair may be an efficient and inexpensive general relaxation approach, and is especially interesting for patients who dislike to be touched.
Adult↗
In vivo measurement of the effect of intra-abdominal pressure on the human spine.
In humans, intra-abdominal pressure (IAP) is elevated during many everyday activities. This experiment aimed to investigate the extent to which increased IAP--without concurrent activity of the abdominal or back extensor muscles--produces an extensor torque. With subjects positioned in side lying on a swivel table with its axis at L3, moments about this vertebral level were measured when IAP was transiently increased by electrical stimulation of the diaphragm via the phrenic nerve. There was no electromyographic activity in abdominal and back extensor muscles. When IAP was increased artificially to approximately 15% of the maximum IAP amplitude that could be generated voluntarily with the trunk positioned in flexion, a trunk extensor moment (approximately 6 Nm) was recorded. The size of the effect was proportional to the increase in pressure. The extensor moment was consistent with that predicted from a model based on measurements of abdominal cross-sectional area and IAP moment arm. When IAP was momentarily increased while the trunk was flexed passively at a constant velocity, the external torque required to maintain the velocity was increased. These results provide the first in vivo data of the amplitude of extensor moment that is produced by increased IAP. Although the net effect of this extensor torque in functional tasks would be dependent on the muscles used to increase the IAP and their associated flexion torque, the data do provide evidence that IAP contributes, at least in part, to spinal stability.
Abdomen↗
Muscle relaxants for nonspecific low back pain: a systematic review within the framework of the cochrane collaboration.
STUDY DESIGN: A systematic review of randomized and/or double-blinded controlled trials. SUMMARY OF BACKGROUND DATA: The use of muscle relaxants in the management of nonspecific low back pain is controversial. It is not clear if they are effective, and concerns have been raised about the potential adverse effects involved. OBJECTIVES: The aim of this review was to determine if muscle relaxants are effective in the treatment of nonspecific low back pain. METHODS: A computer-assisted search of the Cochrane Library (Issue 2, 2002), MEDLINE (1966 up to October 2001), and EMBASE (1988 up to October 2001) was carried out. These databases were searched using the algorithm recommended by the Cochrane Back Review Group. References cited in the identified articles and other relevant literature were screened. Randomized and/or double-blinded controlled trials, involving patients diagnosed with nonspecific low back pain, treated with muscle relaxants as monotherapy or in combination with other therapeutic methods, were included for review. Two reviewers independently carried out the methodologic quality assessment and data extraction of the trials. The analysis comprised not only a quantitative analysis (statistical pooling) but also a qualitative analysis ("best evidence synthesis"). This involved the appraisal of the strength of evidence for various conclusions using a rating system based on the quality and outcomes of the studies included. Evidence was classified as "strong," "moderate," "limited," "conflicting," or "no" evidence. RESULTS: Thirty trials met the inclusion criteria. Twenty-three trials (77%) were of high quality; 24 trials (80%) were on acute low back pain. Four trials studied benzodiazepines, 11 nonbenzodiazepines, and 2 antispasticity muscle relaxants in comparison with placebo. Results showed that there is strong evidence that any of these muscle relaxants are more effective than placebo for patients with acute low back pain on short-term pain relief. The pooled relative risk for nonbenzodiazepines versus placebo after 2 to 4 days was 0.80 (95% confidence interval: 0.71 to 0.89) for pain relief and 0.49 (95% confidence interval: 0.25 to 0.95) for global efficacy. Adverse events, however, with a relative risk of 1.50 (95% confidence interval: 1.14 to 1.98) were significantly more prevalent in patients receiving muscle relaxants and especially the central nervous system adverse effects (relative risk 2.04; 95% confidence interval: 1.23 to 3.37). The various muscle relaxants were found to be similar in performance. CONCLUSIONS: Muscle relaxants are effective in the management of nonspecific low back pain, but the adverse effects require that they be used with caution. Trials are needed that evaluate if muscle relaxants are more effective than analgesics or nonsteroidal anti-inflammatory drugs.
Controlled Clinical Trials as Topic↗
Human corticospinal excitability in microgravity and hypergravity during parabolic flight.
INTRODUCTION: Spontaneous electromyographic (EMG) activity in the soleus muscle of the rat varies with the changing gravitational force in parabolic flight, presumably in an appropriate way to resist the load. We investigated how decreased and increased gravitational force affects EMG in human back and arm muscles and to what extent the motor cortex is responsible for any modulation seen. METHODS: Three healthy subjects stood during 10 parabolas consisting of periods (duration 20-25 s) of 1.8 G, then 0 G, and then 1.8 G. EMG recordings were made from right deltoid and left and right erector spinae (ES) muscles and transcranial magnetic stimulation (TMS) was applied to the motor cortex to produce motor evoked potentials (MEPs) in target muscles. RESULTS: In one exemplary subject, EMG levels and MEP areas increased in the left ES and right ES during periods of 0 G, which was less pronounced with the arm abducted. No significant changes were seen in EMG levels or MEP areas during periods of 1.8 G. Pooled data from the three subjects showed a similar pattern, revealing a facilitation of MEP responses in left and right ES muscles in periods of 0 G. DISCUSSION: EMG levels and MEP areas in ES muscles increased during periods of 0 G, suggesting that back muscle activity is "turned on" to stabilize the axial skeleton when the vertical compression forces present on Earth are removed. Further analysis suggested that microgravity produced activation of ES muscles through an increase in corticospinal excitability.
Acceleration↗
Anterior transposition of posterior tibial muscle in equinovarus.
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Back Muscles↗
Motor performance status in 10 to 17-year-old Estonian girls.
The improvement of motor abilities is associated with the periodical acceleration of changes in adolescents of both sexes. The present cross-sectional study is aimed at establishing smooth curves of motor performance status in 10 to 17-year-old girls. Motor performance was tested in 902 girls with the aid of 30 m dash, standing long jump, vertical jump, pushing a stuffed ball (2 kg), standing quintuplet jump, isometric strength of back extensor muscles, trunk forward flexion and 1-min ergocycling at the highest possible rate. Statistically significant differences of all studied motor abilities between the age groups of 10-12 were indicated. In height and body mass the most pronounced differences (on average 6.5 cm and 7.7 kg, respectively) appeared between the age groups of 12 and 13. At the age of 13 the group results were statistically higher than those at 12 in pushing a stuffed ball, vertical jump, quintuplet jump, strength of back extensors muscle, 30 m dash and ergocycling test, but not in standing long jump and trunk forward flexion. At the age of 14 the performance was not higher than at 13, except in the vertical jump and quintuplet jump. From 14 to 16 years of age differences reappeared in the results of vertical jump, quintuplet jump, pushing a stuffed ball, 1-min cycling and trunk forward flexion but not in the 30 m dash and standing long jump. The lack of significant differences between the age groups of 16 and 17 indicated the final stabilization of tested motor abilities. The obtained results suggest the existence of several periods in motor performance status in 10 to 17-year-old Estonian girls: 1) The biggest differences in the mean results of the tests on motor abilities occurred between ages 10-11, 11-12 and 12-13, which coincide with the biggest differences in height and weight at the same age. 2) The differences in the mean results of most tests on motor abilities stabilized between the age groups of 13 and 14. The mean results of 14-year-old girls were lower in some tests compared to the results of 13-year-olds. 3) The positive differences in the mean results remained between the age groups of 14-15 and 15-16 (excluding the sprint velocity and standing long jump). 4) The final stabilization of motor abilities occurred at the age of 16 to 17.
Adolescent↗
Is mitomycin effective in preventing muscle migration after hang-back recession in a rabbit model?
To investigate the effect of intraoperative mitomycin C (MMC) application on muscle insertion migration after adjustable surgery, hang-back recession was bilaterally performed for 4 mm on the inferior rectus muscle in 30 rabbits. The scleral wound of the insertion site of one eye of each pair was treated with a sponge soaked with a solution cotaining mitomycin at a concentration of either 0.4 or 1.0 mg/ml for 5 min. As a control, the contralateral eye was treated with a distilled-water-soaked sponge. Three, 6 and 12 weeks later, the distance from the anterior border of the reattached muscle to the original insertion was measured with in vivo and microscopic examination. Anterior migration of the muscle insertion was observed in both the MMC-treated and control eye. The measurement by the in vivo and histologic examinations revealed that MMC treatment did not significantly reduce the anterior migration relative to the control eye. Analysis of the time course in the MMC-treated eye revealed a significant increase during the observation period in anterior migration as measured by the histologic examination (p = 0.0267 for the 0.4 mg/ml group and p = 0.0408 for the 1.0 mg/ml group). Exposure to MMC has no significant inhibitory effect on the muscle migration compared to that in the control eyes.
Animals↗
Muscle flap closure for salvage of complex back wounds.
STUDY DESIGN: The use of muscle flaps for closing complex thoracolumbar and lumbar spine wounds was studied retrospectively. Five patients in whom traditional, conservative treatment modalities did not work underwent a variety of muscle flap closures with successful healing. OBJECTIVES: Patients with complicated back wounds ranging from exposed hardware to post-traumatic defects were treated initially with conservative treatments. The authors evaluated the efficacy of applying techniques and knowledge gained from complex lower extremity wound coverage of back wounds. SUMMARY OF BACKGROUND DATA: Six muscle transfer procedures were performed on five patients. All patients were closed with local muscle flaps using the trapezius and latissimus dorsi muscles. METHODS: Success was defined as a closed stable wound that needed no future surgery nor allowed the primary defect to heal before hardware removal. There was no evidence of chronic infection. Surgical hardware was salvaged in one of three patients. RESULTS: All were successfully closed and have been followed up to 30 months without evidence of recurrence. CONCLUSIONS: The cases presented illustrate the usefulness of rotation flaps when there is an extensive soft tissue defect that has exposed neural, osseous, and foreign structures. The use of local transposition muscle flaps as an adjunct in closing complex back wounds has been very successful in our experience. Although recurrent infection may occur, this technique has facilitated the establishment of a soft tissue envelope to achieve short- and long-term wound healing.
Adult↗