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PubMed1991

Cognitive-behaviour therapy in the treatment of chronic, occupational pain of the upper limbs: a 2 yr follow-up.

Nineteen Ss who experienced chronic, occupational pain of the upper limbs and who had previously completed a programme of either individual or group cognitive-behaviour therapy were followed up 2 yr later. Significant improvements on measures of depression, anxiety, coping strategies and interference in daily living were found following treatment. Such improvements were not evident for the waiting list control Ss and no difference was found between group vs individual applications of therapy. A 2 yr follow-up, significant improvements from pre-treatment levels were evident for depression, coping strategies, significant other report of disability, self monitored pain and distress caused by pain. While there was generally little evidence of relapse, a significant decline from post-treatment levels was found for the individual therapy condition compared to the group therapy condition on measures of self monitored pain and interference caused by pain. Since post-treatment levels tended to be somewhat superior for the individual therapy condition, the overall finding at 2 yr follow-up was of minimal difference in outcome for group vs individual forms of cognitive-behaviour therapy. Despite improvements from pre-treatment levels, the vast majority of Ss still reported significant and distressing levels of pain at 2 yr follow-up.

Adaptation, Psychological↗
PubMed1992

Site-specific muscle hyper-reactivity in musicians with occupational upper limb pain.

Fourteen musicians who reported a history of pain in the upper limb associated with the playing of their instruments were compared with a sample of pain-free musicians, matched for age, sex and musical instrument. Four tasks were presented in random order and included neutral, general stressor, personal stressor and pain stressor tasks. Ratings of stressfulness and recordings of skin conductance level confirmed the effectiveness of the experimental manipulations for both subject groups. No differences were found between groups or tasks for frontalis surface electromyograph (EMG) activity. Evidence was found, however, of EMG elevation in flexor and trapezius muscles on the pain side for the pain subjects, in response to the task involving recall of a pain experience. This elevation was not found for the pain-free controls or for other stressor tasks, although some elevation in response to the pain stressor task was found for pain subjects in the trapezius muscles of the non-pain side. The duration of return to baseline of EMG following the pain stressor task was found to be extended in pain subjects for the trapezius, but not for the flexor muscles of the pain side. The findings suggest that site-specific muscle hyper-reactivity may play a role in the development and maintenance of occupational upper limb pain in musicians.

Adult↗
PubMed1989

Stiffness and strain energy criteria to evaluate the threshold of injury to an intervertebral joint.

This study is focused to evaluate the threshold of injury to an intervertebral joint based on its mechanical response. The load-deflection behavior of the intervertebral joint indicated non-linear and sigmoidal characteristics with continuously changing stiffness (a measure of the ability to withstand external force). The load corresponding to the point of zero stiffness was identified, according to the classical theories of mechanics, as the maximum load carrying capacity. Further, the initiation of trauma was defined to occur at the point on the load-deflection curve at which the stiffness begins to decrease for the first time. The load, stiffness and energy absorbing capabilities of normal and degenerated intervertebral joints at the initiation of trauma was determined. Axial compressive load experiments were conducted on nine intervertebral joints of fresh human male cadavers and the resulting load-deflection responses were transformed into stiffness-deflection responses using the derivative principle. Energy characteristics were also derived. Load, stiffness and energy at the initiation of trauma were found to be 9.0 kN, 2850 N mm-1, and 10.2 J for normal and 4.4 kN, 1642 N mm-1, and 5.8 J for degenerated segments, respectively. The load and energy values at failure were 11.0 kN, and 18.0 J for normal and 5.3 kN and 5.7 J for degenerated intervertebral joints, respectively.

Biomechanical Phenomena↗
PubMed1990

Wrist loading patterns during pommel horse exercises.

Gymnastics is a sport which involves substantial periods of upper extremity support as well as frequent impacts to the wrist. Not surprisingly, wrist pain is a common finding in gymnasts. Of all events, the pommel horse is the most painful. In order to study the forces of wrist impact, a standard pommel horse was instrumented with a specially designed load cell to record the resultant force of the hand on the pommel during a series of basic skills performed by a group of seventeen elite male gymnasts. The highest mean peak forces were recorded during the front scissors and flair exercises (1.5 BW) with peaks of up to 2.0 BW for some gymnasts. The mean peak force for hip circles at the center or end of the horse was 1.1 BW. The mean overall loading rate (initial contact to first loading peak) ranged from 5.2 BWs-1 (hip circles) to 10.6 BW s-1 (flairs). However, many recordings displayed localized initial loading spikes which occurred during 'hard' landings on the pommel. When front scissors were performed in an aggressive manner, the initial loading spikes averaged 1.0 BW in magnitude (maximum 1.8 BW) with an average rise time of 8.2 ms; calculated localized loading rates averaged 129 BW s-1 (maximum 219 BW s-1). These loading parameters are comparable to those encountered at heel strike during running. These impact forces and loading rates are remarkably high for an upper extremity joint not normally exposed to weight-bearing loads, and may contribute to the pathogenesis of wrist injuries in gymnastics.

Adolescent↗
PubMed1993

Response of intersegmental knee loads to foot/pedal platform degrees of freedom in cycling.

The hypothesis tested in this article was that the three-dimensional intersegmental knee loads would be reduced in cycling by foot/pedal platforms which permitted relative motion between the foot and pedal. To test this hypothesis, pedal load and lower limb kinematic data were collected from 11 subjects who pedaled with four foot/pedal platforms mounted on a six-load-component dynamometer. One of the four platforms did not allow any relative foot/pedal movement while the other three permitted either medial/lateral translation, adduction/abduction rotation or inversion/eversion rotation. Three-dimensional intersegmental knee loads were computed for each of the four platforms using a previously reported biomechanical model. A number of quantities describing each of the intersegmental knee load components was computed and compared using analysis of variance techniques. The key results were that the medial/lateral translation platform did not cause significant differences in intersegmental knee load quantities relative to those for the fixed platform. However, both of the platforms permitting rotations significantly reduced many but did not significantly increase any intersegmental knee load quantities. Of these two platforms, the abduction/abduction platform significantly reduced both the axial and varus/valgus knee moments while the inversion/eversion platform significantly reduced only varus/valgus moments. These results have application to bicycle pedal design where the goal is to reduce intersegmental knee loads, hence possibly alleviating overuse knee injuries.

Bicycling↗
PubMed1996

An improved accuracy six-load component pedal dynamometer for cycling.

This paper describes a new six-load component pedal dynamometer designed for study of knee overuse injury in cycling. A unique capability of the dynamometer is the ability to interface with multiple pedal platforms of varying height while maintaining a desired elevation of the foot above the pedal spindle axis. The dynamometer was designed using a concept described in an earlier article by Quinn and Mote (1991, Exp. Mech. 30, 40-48) which measures shear strain across multiple, thin cross-sections. An optimal design technique was used for choosing dimensions of the load measuring cross-sections. A dynamometer was designed and built using the optimal results. Calibration, accuracy results, and sample data are presented. A comparison of accuracy reveals that the new dynamometer is more accurate than previously reported instruments.

Bicycling↗
PubMed1995

'Repetitive strain injury': from Australia to the UK.

The UK is now experiencing an epidemic of upper limb pain similar to that which affected Australia in the 1980s. The pain is often non-specific, and does not conform to the pattern of various well-recognized rheumatological entities. The syndrome is known by a number of terms, some of which imply an aetiological link to workplace activities unsubstantiated by hard evidence. The syndrome may well be largely psychosocial, and analogous to the chronic fatigue syndrome. It is currently the cause of many contentious and well-publicized medico-legal cases. Possible factors behind the epidemic will be discussed, and an approach to management suggested.

Australia↗
PubMed1988

Diagnosis and treatment of musculoskeletal running injuries.

In summary, musculoskeletal injuries occur in at least 60% of runners. Selfinduced training error accounts for the majority of running injuries. A review of the runner's mileage, training techniques, biomechanical examination, and shoes will provide clues to the accurate diagnosis and treatment. In most cases it is not correct to categorically advise the runner to stop running, since a modification of running techniques will usually get him or her painlessly "back on the road." The result will be a grateful patient.

Athletic Injuries↗
PubMed1989

A review of musculoskeletal problems in instrumental musicians.

Musculoskeletal problems are common in instrumental musicians. Most of these problems can be classified as musculotendinous overuse, nerve entrapment/thoracic outlet syndrome, or motor dysfunction. Also seen in musicians are problems related to hypermobility and degenerative arthritis. Although these problems are seen in all instrumentalists, their prevalence is highest in professional musicians, with string players most commonly affected by musculotendinous overuse. Keyboard players are the performers most commonly affected by motor dysfunction. History and physical examination performed with an understanding of the problems of musicians are usually adequate to make the correct diagnosis. Electrophysiological studies are often helpful in confirming or excluding a diagnosis of nerve entrapment. With the exception of motor dysfunction, once these problems are recognized, they can be adequately treated. Treatment should begin conservatively with rest, evaluation of technique and practice habits, and possibly nonsteroidal antiinflammatory drugs. Depending on the type and severity of the problem, physical therapy, adaptive devices, steroid injection, or surgery may be indicated. A strong partnership with music educators is important in the management and prevention of these musculoskeletal problems.

Cumulative Trauma Disorders↗
PubMed1988

Design and performance of a fracture monitoring transducer.

The answer to the question, 'when is a fracture healed?' is not simple, since the healing process is progressive and it is not possible to specify a time when the fracture can be said to have healed. In the past the assessment of fracture healing has, in the main, been subjective, relying upon the skill of the interpreter. A more objective method would be an advantage for many reasons, and since the bone is intended to be load bearing it is reasonable to assess healing by measuring the mechanical integrity of the bone. To do this a 'clamp on' transducer has been developed which, when fitted to the support column of an external fixator, enables the stiffness of a fracture to be determined during the healing process. Over the past 6 years this system has been used for both clinical and research work. It has enabled various forms of treatment to be evaluated in terms of 'rate of healing' and it also indicates the safe point at which the fixator can be removed.

Biomechanical Phenomena↗
PubMed1989

A review of the biomechanical properties of bone as a material.

Experimental studies on bone all reveal important difficulties in data interpretation. This paper proposes an analysis of experimental studies performed so far, with particular attention to the anisotropic characteristics of bone, its behaviour in the post-elastic phase, and its dependence on viscoelastic phenomena. Mechanical properties are also correlated with variables such as moisture, deformation rate during testing, density, variations in different regions of the bone, and the most relevant strength criteria are recalled. The investigation performed is also intended to provide an evaluation of the degree of refinement of biomechanical experimental data for use in a numerical approach to bone mechanics.

Biomechanical Phenomena↗
PubMed1991

Rupture of the extensor digitorum communis tendons caused by occupational overuse.

Spontaneous rupture of the extensor pollicis longus tendon in excessive exertion is well-recognised, but similar rupture is rare in the common extensor tendons of the fingers. Two cases caused by occupational overuse are reported. Mechanical attrition at the distal edge of the extensor retinaculum produced by excessive use was thought to be responsible for the rupture.

Adult↗
PubMed1994

Trauma-related thoracic outlet syndrome.

181 patients treated for thoracic outlet syndrome by first rib resection were reviewed. 88 (49%) indicated a single traumatic event which precipitated the thoracic outlet syndrome. 79% of patients with a history of a single traumatic episode had good to excellent results after first rib resection. A separate group of 18 patients developed work-related thoracic outlet syndrome due to repetitive activities. Ratings of good to excellent results were lower (66%) among workmen's compensation cases.

Adult↗