[Spontaneous hematomas of the rectus abdominis].
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Back Muscles↗
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[Drug management of low back pain].
NSAIDs and muscle relaxants effectively reduce acute nonspecific low back pain (LBP), different types of both drugs being equally effective. In general, there is no strong evidence for the effectiveness of medication for chronic nonspecific LBP. However, there is a possibility that administration of antidepressants is an intervention worthy of consideration in cases of LBP with no identifiable organic cause and resistant to other treatments.
Acute Disease↗
Back injuries in gymnastics.
The complaint of low back pain in the adolescent must never be taken lightly. A high index of suspicion should be particularly entertained in a child participating in gymnastic training or competition. As noted in this article, steps can now be taken, particularly if a specific diagnosis is made early, to institute specific treatment with a high likelihood of success. Young gymnasts complaining of back pain must never be passed off as having sustained a back strain or "muscle spasms" and treated symptomatically. Persistent back pain beyond two weeks warrants, in our opinion, a complete evaluation, careful history and physical examination, a four-view radiographic assessment of the spine, and, if necessary, bone scans or other more advanced techniques to make a specific diagnosis of the cause of the pain.
Adolescent↗
The Law of Laplace. Some clinical applications.
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Abdominal Muscles↗
Proceedings: A positive feed-back reflex to a crustacean muscle receptor.
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Animals↗
A comparison of two analgesic muscle relaxant combinations in acute back pain.
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Acetaminophen↗
[Malignant hyperthermia in swine during isoflurane anesthesia].
A case of porcine malignant hyperthermia (MH) is reported, which occurred during a cardiological animal experiment under general anaesthesia using isoflurane as inhalational anaesthetic. Initially, tachycardia (238 bpm) and a sudden increase of end-exspiratory pCO2 were noticed. Discontinuation of isoflurane followed by administration of dantrolene (7 mg/kg body weight) led to a rapid recovery. Two days later, no difference in clinical state was apparent in comparison with the remaining swine. After regular euthanasia, acute muscle necrosis was seen macroscopically in back and glutaeal muscles, which was confirmed by histological examination. The rise of end-tidal pCO2 was the striking symptom thus allowing the detection of the incipient malignant hyperthermia. Early onset of dantrolene therapy is shown to be sufficient in termination of this hyperacute complication, and may prevent its deleterious outcome. Therefore, the administration of dantrolene should be taken into account in case of porcine MH, especially in time-consuming and costly series of animal experiments.
Anesthesia, Inhalation↗
Options for donor sites for autogenous tissue breast reconstruction.
There are now a number of viable choices for autogenous tissue breast reconstruction. These include the TRAM flap, the LTTF flap, the gluteal flap, the latissimus flap, and the Ruben's flap. The criteria for choosing one site over another should include donor site deformity, ease or difficulty of technique, availability of tissue, ability to shape the tissue into a new breast, and patient acceptance. Using the author's experience and these criteria, each procedure is compared with the others to give the reader a schema for choosing the most appropriate donor site in future patients.
Abdominal Muscles↗
Paraspinal muscle evoked cerebral potentials in patients with unilateral low back pain.
Cerebral somatosensory evoked potentials (SEPs) were elicited by magnetic stimulation of paraspinal muscles unilaterally at the L2 and L5 levels in 20 healthy subjects and 16 patients with low back pain and unilateral muscle spasm. A magnetic coil with a mean diameter of 4.7 cm was placed tangentially to the skin. The stimulus strength was sufficient to induce a visible muscle twitch without producing muscle contraction in the legs. The potentials recorded over the scalp consisted of several components (P30, N40, P55, N70, and P90) and were elicited in all subjects. In both healthy and patient subjects, paraspinal muscle evoked potentials were readily elicited. Vibration applied to paraspinal muscles, as well as voluntary contraction of paraspinal muscles, was associated with attenuation of the evoked potentials. This finding suggests that muscle spindle receptors provide the afferent input responsible for the early components of the magnetically evoked cerebral potentials. In patients with unilateral muscle spasm, the amplitudes of P30-N40, N40-P50, and P50-N70 were decreased significantly on the affected side when compared with values on stimulation of the unaffected side, as well as those obtained from control subjects. The cerebral evoked potentials returned to normal amplitude when the muscle spasm subsided following a period of time and after the application of spinal manipulative therapy. The technique has potential for quantitative evaluation of muscle spasm in low back pain.
Adult↗
The effect of trunk muscle exercises in patients over 40 years of age with chronic low back pain.
Previous studies of trunk muscle strength in patients with chronic low back pain (CLBP) have mainly reported on patients aged younger than 40 years. However, no such investigation has yet been done in middle-aged patients. Trunk muscle strength and the effect of trunk muscle exercises were investigated in patients with CLBP aged more than 40 years. Trunk muscle strengths were measured in a LBP group (52 patients) and a control group (60 volunteers) and the results for the two groups were compared. The LBP group was divided into three subgroups. Group A had only age-related spondylosis and group B had disk herniation and spondylolisthesis with age-related spondylotic change. Both these groups were able to continue exercises. Group C was made up of patients who had abandoned the exercise program. Trunk muscle strength and symptoms were assessed in each group. Both flexion and extension strength were decreased in the LBP group compared with the control group, with the reduction in extension strength being most marked. In both groups A and B, muscle strength increased and clinical symptoms improved. In contrast, no change was seen in group C. In older patients with CLBP, reduction of muscle strength was more marked in the spinal extensors than in the spinal flexors. It was confirmed that trunk muscle strengthening exercises are useful for increasing muscle strength and improving symptoms in such patients.
Adult↗
[Effects of elastic lumbar belts on the effect of a muscle training program for patients with chronic back pain].
QUESTION: Aim of the study was to evaluate the influence of elastic lumbar belts on the effect of muscle training for patients with low back pain. METHODS: 97 male subjects aged from 23 to 42 years with and without low back pain participated in the investigation. The low back pain patients (n = 63) were randomized into a training group without and a training group with elastic lumbar belts and a control group. The subjects with healthy backs (n = 34) were divided age-matched into a training group with elastic lumbar belts and a control group. The three training groups took part in a muscle strenghtening program over 8 weeks. The control groups did not receive any alternative physiotherapeutic treatment. All groups were tested at the beginning, after 8 weeks and further 6 months later. RESULTS: The data obtained for the control groups remained virtually unchanged over the period of investigation. However, a significant increase of the muscle flexibility of the lower limbs could be proved for the training groups. Furthermore the coordination between the lumbar spine and pelvis when flexing the trunk deeply forward was more leveled out for the training groups with patients suffered low back pain. The results confirmed a reduction for pain severity and for limitations in activities of daily living as well. The modifications for the criteria investigated were significant stronger for the training group with patients using the elastic lumbar belt. CONCLUSIONS: The effectiveness of the muscle strengthening program for patients with low back pain could be improved significantly by means of the elastic lumbar belt as an applicable therapy instrument in the functional rehabilitation of spinal injuries.
Adult↗
[Ultrasonic Quantification of spinal configuration and postural capacity for evaluation of different muscle strengthening programs in the therapy of back pain].
AIM: The aim of this study was the evaluation of the effectiveness of different muscle strengthening programs in the therapy of back pain. METHODS: 102 male longshoremen aged from 29 to 63 years with chronic back pain since > two years, matched by pain intensity and functional limitations, were randomized to three test groups (TG) and one control group (CG). The test persons carried out a program for intensified muscle strengthening over a period of six months one to two times weekly in a therapeutic practice (TG1), in a health club (TG2) and in a gymnastic group (TG3). The CG did not complete any intervention. Ultrasound topometry for recording spinal configuration and postural capacity as well as the determination of pain intensity and functional limitations were used as instruments of assessment. RESULTS: The data obtained for the CG remained virtually unchanged over the period of investigation. In contrast a decrease of pain intensity and functional limitations could be proved for all TG. Furthermore, the training programs induced both an improved postural capacity while performing the arm-raising test and an increasingly erect sagittal spinal profile. The power of effectiveness was on a homogeneous level for the medical training therapy (0.41), the fitness training (0.4) and the spinal gymnastics (0.41). CONCLUSION: The three muscle strengthening programs investigated have equally favorable effects on the parameters evaluated and are qualified as effective strategies in the therapy for chronic spinal discomforts.
Adult↗
Myofascial origins of low back pain. 3. Pelvic and lower extremity muscles.
Gluteal, pelvic, and lower extremity muscles are common sites of origin of myofascial low back pain. Trigger points (TPs) in the gluteus maximus and medius muscles refer pain locally to the gluteal and sacral regions, while those in the gluteus minimus are likely to refer pain down the lower extremity as far as the ankle on the same side. TPs in intrapelvic muscles refer pain chiefly to the pelvic region. Besides producing referred myofascial pain, TPs in the piriformis muscle can cause symptoms of entrapment of the peroneal portion or all of the sciatic nerve. TPs in the soleus muscle may refer pain to the sacroiliac joint.
Buttocks↗
Relationship between hip muscle imbalance and occurrence of low back pain in collegiate athletes: a prospective study.
OBJECTIVE: To assess whether athletes with strength imbalance of the hip musculature would be more likely to require treatment for low back pain (LBP) over the ensuing year. DESIGN: The study population included 163 National Collegiate Athletic Association Division I college athletes (100 males and 63 females) undergoing preparticipation sports physicals. Institutional review board approval was obtained to acquire and analyze hip muscle strength data. A commercially available dynamometer (Chatillon, Lexington, KY) incorporated into a specially designed anchoring station was used for testing the hip extensors and abductors. The maximum force generated for the hip abductors and extensors was used to calculate a percentage difference between the right and left hip extensors and abductors. Treatment of athletes by the athletic trainers for LBP unrelated to blunt trauma over the ensuing year was recorded. RESULTS: Of all athletes, 5 of 63 females and 8 of 100 males required treatment for LBP. Logistic regression analysis indicated that for female athletes, the percentage difference between the right and left hip extensors was predictive of whether treatment for LBP was required over the ensuing year (P = 0.05). There was no significant association noted for the percentage difference between the right and left hip abductors in females and for the percentage difference between both the right and left hip abductors and right and left hip extensors in males requiring treatment for LBP. CONCLUSIONS: These data support our results from our previous cohort study, adding validity to the concept of hip muscle imbalance being associated with LBP occurrence in female athletes. This research further supports the need for the assessment and treatment of hip muscle imbalance in individuals with LBP.
Female↗
Abdominal muscle activation of elite male golfers with chronic low back pain.
PURPOSE: The purpose of this study was twofold: 1) to determine whether elite male golfers with chronic low back pain (CLBP) exhibit different abdominal muscle activity patterns during the golf swing than asymptomatic control (AC) golfers and 2) to determine whether elite male golfers with CLBP experience greater fatigue in the abdominal muscles than AC golfers after a typical practice session. METHODS: Surface EMG data were collected bilaterally from the rectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscles. Muscle activity during the golf swing was measured using the root mean square (RMS) of the EMG signal in various phases of the golf swing. Fatigue was assessed using the median frequency (MF) and RMS of the EMG signal during a 10-s submaximal isometric contraction. Low back pain was quantified with the McGill Pain Questionnaire before and after the practice session. RESULTS: No differences in the RMS of abdominal muscle activity were noted during the golf swing between AC and CLBP subjects. However, EO (lead) onset times were significantly delayed with respect to the start of the backswing in CLBP subjects. Low back pain in CLBP golfers increased significantly after the practice session. Abdominal muscle fatigue, as measured with MF or RMS, was not evident after the practice session for either AC or CLBP subjects. CONCLUSION: Abdominal muscle activity and muscle fatigue characteristics were quite similar between AC and CLBP subjects after repetitive golf swings. Despite this, it was clear that repetitive golf swings were aggravating some part of the musculoskeletal system in CLBP subjects, which resulted in increased pain in the low back area.
Abdominal Muscles↗
Large-array surface electromyography in low back pain: a pilot study.
STUDY DESIGN: A large-array surface electromyography device was used to collect data from healthy pain-free persons and from those with acute or chronic low back pain. Images of regional muscle electromyographic activity were assessed visually, and maximum root mean square values were compared statistically. OBJECTIVE: To determine whether data differs by patient type. SUMMARY OF BACKGROUND DATA: Whereas there is a good understanding of the anatomy and psychosocial aspects of low back pain, there is a need to understand better the physiology of low back pain. METHODS: Large-array surface electromyography data were collected from the low back muscles of 201 participants over a 3-month period using a 63-electrode fixed array and a standardized protocol. Color images representing the voltage root mean square difference of each electrode pair were created. Three images from each of three positions (standing upright, standing in 20 degrees of trunk flexion, standing holding weights) were collected from each participant. Serial studies were performed on the acute population over a 6-week follow-up period. RESULTS: Images of regional muscle activity from 92.7% of normal controls (n = 163) showed symmetrical activity. Patients with acute (n = 13) or chronic (n = 25) low back pain had multifocal and/or asymmetrical patterns. Symmetrical patterns returned in the three patients whose acute pain resolved during the study. Maximum root mean square values were higher among patients with acute (P = 0.03) and chronic (P = 0.04) pain than among control subjects. CONCLUSIONS: Large-array surface electromyography produced data from patients with back pain that differed from data on subjects without back pain. This method may be useful in evaluating patients with low back pain.
Acute Disease↗
Isokinetic measurement of trunk muscle strength in women with chronic low-back pain.
OBJECTIVES: To investigate the relationships among chronic low-back pain and obesity, total spinal range of motion, and trunk muscle strength. The short-term impact of trunk muscle strengthening exercises on this condition was also examined. DESIGN: A controlled, prospective study of trunk muscle strengths of patients with chronic low-back pain and the short-term impact of exercise on strength. The study group consisted of 25 female patients who had been experiencing low-back pain for at least 3 mo, and the control group included 20 age-matched women without known low-back trouble. The Davenport Index was used to calculate the body mass indexes of all subjects. The Oswestry Disability Questionnaire was used to assess pain in the study group. Full flexion and extension ranges of motion were measured, then isokinetic measurements of trunk muscles were performed at 60-, 120-, and 180-degrees/sec velocities. Isometric measurements were also recorded for both flexors and extensors at a 60-degree angle. RESULTS: Increased body mass index and decreased trunk muscle strength were found to be directly associated with chronic low-back pain (P < 0.05). After a 15-day standard trunk strengthening exercise program in the patient group, trunk muscle strength was found to be increased (P < 0.05). CONCLUSIONS: Obesity and decrease in trunk muscle strength are important factors in chronic low-back pain, and a trunk muscle strengthening program will be helpful in reducing the pain.
Abdominal Muscles↗