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PubMed1991

A controlled precursor add-back model of elastogenesis in smooth muscle cell cultures.

Neonatal rat aortic smooth muscle cell cultures are capable of synthesizing and accumulating relatively large amounts of insoluble elastin in the extracellular matrix. There are two major soluble elastin molecules in these cultures, one of 77 kDa (protropoelastin) and the other of 71 kDa (tropoelastin). We examined the ability of the cell culture system to insolubilize exogenously added soluble elastin precursor moieties into the elastin matrix. To accomplish this, cultures were allowed to develop an enriched elastic fiber matrix for approximately two weeks in first passage. This accumulated matrix then served as the "substrate" for the exogenously added precursor elastin molecules. Culture-derived radioactive soluble elastin was added to the "substrate" cultures and the presence of radioactivity in the insoluble elastin as well as in the lysine-derived crosslinks unique to elastin (desmosines) was measured. When purified [3H]-valine radiolabeled protropoelastin was used, more than 15% of the radioactivity added was detected in the alkali-resistant insoluble elastin within 24 hours. After an initial 4-hour incubation of the cells with [3H]-lysine-labelled soluble elastin, most of the radioactivity in the insoluble elastin was associated with the lysine and only a negligible amount was detected in the desmosines. However, during a 16-day chase period, the ratio of radioactive desmosines to lysine increased dramatically, suggesting that not only insolubilization, but crosslinking occurs as well. The add-back system described herein should provide a means to probe the molecular properties of protropoelastin and increase our understanding of the mechanisms of elastic fiber formation.

Animals↗
PubMed1984

Peculiarities of the bones, muscles, and nervous system of the conjoined twins.

The peculiarities of the skeletal, muscular, and nervous systems of conjoined female twins (2 spines, one pelvis) is described judging from the examination of the 2 skulls, 2 vertebral columns, shoulder girdle of the intermediate connection between the trunks, deep muscles of the back, 2 separate central nervous systems, lack of changes in the muscles, of the anterior aspect of the thorax and anterolateral muscles of the abdomen; from what we have observed it is suggested that this is a case of uniovary twins whose separation began in the superior dorsal side but was incomplete in the ventral inferior parts. It is possible that this arose from accidents of fusion or fission of embryos.

Abnormalities, Multiple↗
PubMed2002

[Evaluation of a swiveling seat to reduce the physical load on forklift drivers].

Many forklift drivers have musculoskeletal disorders such as low back pain related to poor work posture and whole-body vibration. With a forklift operator's seat capable of 45-degree swiveling, we evaluated the physical reduction in the load in 10 subjects working in a back-looking position by means of surface electromyography (EMG) and the angle of rotation of the trunk and neck regions. The amplitude of surface EMG on the trapezius, erector spinae, and latissimus dorsi muscles in looking back or maintaining a back-looking position decreased with a swiveling seat compared to the stationary seat. Nevertheless, there was little alleviation of the amplitude of surface EMG on the sternocleidomastoid muscle in maintaining a back-looking posture and no decrease in looking back. The angle of rotation of the trunk maintaining a back-looking position was decreased greatly with the swiveling seat, but no decrease in the rotation angle of the neck was seen. Our study suggests that a swiveling seat is effective in reducing the physical load on the forklift driver during back-looking operations, and this may lead to the prevention of low back pain.

Adult↗
PubMed2005

Delayed trunk muscle reflex responses increase the risk of low back injuries.

STUDY DESIGN: Prospective observational study with a 2- to 3-year follow-up. OBJECTIVES: To determine whether delayed muscle reflex response to sudden trunk loading is a result of or a risk factor for sustaining a low back injury (LBI). SUMMARY OF BACKGROUND DATA: Differences in motor control have been identified in individuals with chronic low back pain and in athletes with a history of LBI when compared with controls. However, it is not known whether these changes are a risk for or a result of LBI. METHODS: Muscle reflex latencies in response to a quick force release in trunk flexion, extension, and lateral bending were measured in 303 college athletes. Information was also obtained regarding their personal data, athletic experience, and history of LBI. The data were entered into a binary logistic regression model to identify the predictors of future LBI. RESULTS.: A total of 292 athletes were used for the final analysis (148 females and 144 males). During the follow-up period, 31 (11%) athletes sustained an LBI. The regression model, consisting of history of LBI, body weight, and the latency of muscles shutting off during flexion and lateral bending load releases, predicted correctly 74% of LBI outcomes. The odds of sustaining LBI increased 2.8-fold when a history of LBI was present and increased by 3% with each millisecond of abdominal muscle shut-off latency. On average, this latency was 14 milliseconds longer for athletes who sustained LBI in comparison to athletes who did not sustain LBI (77 [36] vs. 63 [31]). There were no significant changes in any of the muscle response latencies on retest following the injury. CONCLUSIONS: The delayed muscle reflex response significantly increases the odds of sustaining an LBI. These delayed latencies appear to be a preexisting risk factor and not the effect of an LBI.

Adolescent↗
PubMed2001

[Effects of Harpagophytum procumbens LI 174 (devil's claw) on sensory, motor und vascular muscle reagibility in the treatment of unspecific back pain].

PROBLEM: This randomised, double-blind, placebo controlled study was intended to investigate the effects of Harpagophytum procumbens (Devil's Claw) on sensory, motor and vascular mechanisms of muscle pain. In addition to clinical efficacy and tolerability, possible action mechanisms were analysed by means of experimental algesimetric methods. METHODOLOGY: The study was performed on patients with slight to moderate muscular tension or slight muscular pain of the back, shoulder and neck. On a double-blind randomised basis the verum group received 2x1 film tablets per day, i. e. 2x480 mg/day, of Harpagophytum extract LI 174 (Rivoltan(R)) at 8.00 a.m. and 8.00 p.m. over a certain period. The duration of the therapy was 4 weeks. Data recording at 14-day intervals was made using a visual analogue scale, pressure algometer test, recording of antinociceptive muscular reflexes, muscle stiffness test, EMG surface activity, muscular ischaemia test, clinical global score and subjective patient and physician ratings. RESULTS: A total of 31 patients in the verum group and 32 in the placebo group were treated. After four weeks of treatment there was found to be a clear clinical efficacy of the verum on the clinical global score and in the patient and physician ratings. Highly significant effects were found in the visual analogue scale, the pressure algometer test, the muscle stiffness test and the muscular ischaemia test. No difference from placebo was found in the recording of antinociceptive muscular reflexes or in the EMG surface activity. Tolerability was good; no serious adverse effects occurred. CONCLUSIONS: A highly significant clinical efficacy was achieved with a monotherapy of Harpagophytum dry extract LI 174 after four weeks' treatment at a dosage of 2x480 mg/day in cases of slight to moderate muscular pain. With regard to the action mechanisms investigated, it may be concluded that treatment with Harpagophytum extract LI 174 may be expected to have a significant influence on sensory and vascular muscular response and bring about a reduction in muscle stiffness. No central nervous effects were discovered.

Adult↗
PubMed2003

Muscle fatigue and fatigue-related biomechanical changes during a cyclic lifting task.

STUDY DESIGN: Electromyographic and biomechanical methods were utilized to investigate correlations between indexes of localized muscle fatigue and changes in the kinematics and kinetics of motion during a cyclic lifting task. SUMMARY OF BACKGROUND DATA: Recent advances in time-frequency analysis procedures for electromyographicic signal processing provide a new way of studying localized muscle fatigue during dynamic contractions. These methods provide a means to investigate fatigue-related functional impairments in patients with low back pain. OBJECTIVES: To study the relationship between localized muscle fatigue and the biomechanics of lifting and lowering a weighted box. Fatigue-related changes in the electromyographicic signal of trunk and limb muscles were evaluated and compared to kinematic and kinetic measures in order to determine whether lifting strategy is modified with fatigue. METHODS: A total of 14 healthy male subjects (26 +/- 5 years) cyclically lifted and lowered a 13 kg box (12 lifts/min) for 4.5 minutes. A 5-second static maximum lifting task was included immediately before and after the cyclic lifting task to measure changes in lifting strength and static electromyographicic fatigue indexes. Electromyographic signals from 14 muscle sites (including paravertebral and limb muscles) were measured. Changes in the electromyographicic Instantaneous Median Frequency, a fatigue index, were computed using time-frequency analysis methods. This index was compared with more standardized measures of fatigue, such as those based on electromyographicic median frequency acquired during a static trunk extension test, subjective fatigue measures, and maximal static lifting strength. Biomechanical measures were gathered using a motion analysis system to study kinematic and kinetic changes during the lifting task. RESULTS: During the cyclic lifting task, the electromyographic Instantaneous Median Frequency significantly decreased over time in the paravertebral muscles, but not in the limb muscles. Paravertebral electromyographicic Instantaneous Median Frequency changes were consistent with self-reports of fatigue as well as decreases in trunk extension strength. The magnitude of muscle-specific changes in electromyographicic Instantaneous Median Frequency was not significantly correlated with electromyographicic median frequency changes from the static trunk extension task. The load of the box relative to the maximal static lifting strength significantly affected the electromyographicic Instantaneous Median Frequency changes of paravertebral back muscles. Significant changes with fatigue during the task were found in the angular displacements at the knee, hip, trunk, and elbow. These biomechanical changes were associated with increased peak torque and forces at the L4-L5 vertebral segment. CONCLUSIONS: Our results demonstrate correlation between localized muscle fatigue and biomechanical adaptations that occur during a cyclic lifting task. This new technique may provide researchers and clinicians with a means to investigate fatigue-related effects of repetitive work tasks or assessment procedures that might be useful in improving education, lifting ergonomy, and back school programs. Although both the dynamic and static tasks resulted in spectral shifts in the electromyographicic data, the fact that these methods led to different muscle-specific findings indicates that they should not be considered as equivalent assessment procedures.

Adult↗
PubMed1998

Bone mass and muscle strength in female college athletes (runners and swimmers).

OBJECTIVE: To determine whether female college athletes had increased muscle strength and bone mass in comparison with age-matched nonathletic female subjects and, if so, whether participation in weight-bearing versus non-weight-bearing exercise made a difference. MATERIAL AND METHODS: We performed a comparative statistical analysis of the bone mineral density (BMD) of the total body, lumbar spine, and femoral neck, maximal oxygen uptake (VO2max), muscle strength, and level of physical activity in 21 runners, 22 swimmers, and 20 control subjects. The study participants were female college students, 18 to 24 years old, who had had more than 8 normal menstrual cycles during the past year. RESULTS: Statistical analyses showed significantly higher VO2max in the two athletic study groups than in the control subjects (P < 0.0001). No significant difference in BMD was noted among the three groups. Total body BMD (r = 0.30; P = 0.02) and femoral neck BMD (r = 0.39; P = 0.002) were positively correlated with weight-bearing activity but not with non-weight-bearing activity. VO2Max (an index of physical fitness) was positively correlated with femoral neck BMD (r = 0.33; P = 0.009) and trochanteric BMD (r = 0.29; P = 0.021). Shoulder muscle strength (determined by isokinetic dynamometry) was positively correlated with total body BMD (r = 0.34; P = 0.007) and lumbar spine BMD (r = 0.28; P = 0.028). Swimmers had higher muscle strength in the back and upper extremities than did runners and control subjects. Hip girdle muscle strength was not significantly different among the three groups. Total body BMD had a positive correlation with percentage of body fat and height. Lumbar spine BMD was higher in subjects who had previously used oral contraceptives. The athletes had a lower percentage of body fat, were less likely to have used oral contraceptives, and had fewer years of normal menses than did the control subjects. CONCLUSION: Our study shows that (1) total body BMD and femoral neck BMD were significantly higher in the study group that performed weight-bearing exercises than in control subjects, (2) swimming exercise had no effect on BMD, and (3) although swimming is not a bone-building exercise, it can significantly improve shoulder, back, and grip muscle strength.

Adult↗
PubMed1985

Comparison of electromyographic activity in the lumbar paraspinal muscles of subjects with and without chronic low back pain.

My purpose, in this study, was to test the reflex-spasm model of chronic pain by comparing the levels of muscle activity in the lumbar paraspinal muscles of subjects with and without chronic low back pain (CLBP). Each group, the CLBP group and the nonpain (NP) group, comprised 11 subjects who were matched by age and sex. I used surface electrodes to record integrated electromyographic (IEMG) activity from each side of the low back. All subjects performed three experimental tasks and a reference (normalizing) task. The three experimental tasks were quiet sitting, standing, and sitting during a repetitive unilateral upper extremity task (active sitting). The CLBP and NP groups showed no significant difference for any of the three experimental tasks. For both groups, the active sitting IEMG levels were significantly higher than the quiet sitting and standing IEMG levels. The quiet sitting and standing IEMG levels were not significantly different from each other. The findings of similar levels of IEMG activity in both the CLBP and NP groups while they performed these tasks suggested that the reflex-spasm cycle was not present and, therefore, was not a cause of pain in the subjects with CLBP.

Adult↗
PubMed2006

Electromyographic activity of selected trunk muscles during bicycle ergometer exercise and walking.

Recently, active treatment such as exercise has been increasingly advocated for CLBP (chronic low back pain). Specially, exercise to improve fitness has been recommended for the prevention of back injuries. The bicycle ergometer or walking have often been used to improve the fitness of CLBP patients. However, little is known about the activity levels of the trunk muscles during such exercise. In this study, the electromyographic (EMG) activities of the trunk muscles during bicycle ergometer exercises and walking were compared and the load level on these muscles during such exercises was investigated. The present study provides basic information concerning fitness exercise in CLBP patients. Eleven healthy male volunteers (21.7 +/- 2.5 years old) without low back pain participated in the study. Bipolar surface electrodes were attached to the right side of the rectus abdominis, the obliquus externus abdominis and lower back extensor muscles (L3). EMG signals were continuously recorded while walking and during gradual loading exercises and normalized to maximal voluntary contractions (% MVC). One way analysis of variance (ANOVA) was performed on the % MVC from each exercise and walking for each of the three trunk muscle sites (p < 0.05). The rectus abdominis muscle showed activity of about 6% MVC during any grade of exercise and walking and no significant differences were found between these forms of exercise. The obliquus externus abdominis muscle showed about 30% MVC during any grade of exercise and walking, but no significant difference was found between them. The low back muscles showed activity of about 12% MVC while walking, whereas activity level increased as the exercise load using the bicycle ergometer increased. More significant low back muscles activity was observed while walking than during exercises of 25 w and 50 w. The results of this study indicated that exercise using the bicycle ergometer should be useful for maintaining or improving fitness in CLBP patients, because it results in less load on the trunk muscles and relatively more oxygen uptake than walking.

Abdominal Muscles↗
PubMed1989

Postural synergies in axial movements: short and long-term adaptation.

Fast backward trunk movements are accompanied by hip, knee and ankle rotation which compensate for the backward shift of the center of gravity. The electromyographic pattern associated with the performance of these movements and the associated synergies consists of a fairly synchronous activation of the prime mover (erectores spinae) and the muscles situated at the back of the leg (hamstring, calf muscles). This pattern is called the "non anticipated pattern". The effect of training on the EMG pattern and on the subjects' mechanical performances was investigated by comparing a population of untrained subjects with one of highly trained gymnasts. A new EMG pattern was observed in the highly trained gymnasts, the "distally anticipated pattern" consisting of an early activation of the gastrocnemius, and in some subjects also of the hamstring, indicating that a long term adaptation had taken place. Performances expressed as a ratio between the displacement of the center of gravity projection onto the ground and the velocity of the movement were clearly better in the gymnasts. Short term adaptation was found to occur in the gymnasts and not in the untrained group when the movement was performed while standing on a narrow support. A suppression of the distal gastrocnemius burst occurred in the gymnasts from the first trial under the constrained standing condition whereas no change occurred in the untrained group. The flexibility of the EMG patterns associated with axial movements occurring either spontaneously or as a result of long or short term training is discussed.

Adaptation, Physiological↗
PubMed2001

[Treatment of low back pain--significance, principles and danger].

Today, a wide range of efficient analgesic and non-analgesic drugs for the treatment of back pain are available. However, drugs should never be the only mainstay of a back pain treatment program. Non-steroidal antiinflammatory drugs (NSAID) are widely used in acute back pain. NSAIDs prescribed at regular intervals are effective to reduce simple back pain. The different NSAIDs are effective for the reduction of this pain. They have serious adverse effects, particularly at high doses, in the elderly, and on long-term administration. The new cyclooxygenase II-inhibitors have less gastrointestinal complications. But the long-term experiences are limited up to now. Considerable controversy exists about the use of opioid analgesics in chronic noncancer pain. Many physicians are concerned about the effectiveness and adverse effects of opioids. Other clinicians argue that there is a role for opioid therapy in chronic noncancer pain, e. g. especially in chronic low back pain. There is a low incidence of organ toxicity in patients who respond to opioids. The incidence of abuse and addiction is likewise relatively low. The potential for increased function and improved quality of life seems to outweigh the risks. However, there is a lack of randomised controlled trials (RCT) on opioid therapy in a multimodal pain treatment approach. Clinical experience and some studies suggest administration of sustained release opioids because of better comfort for the patient and less risks for addiction. The opioids should be selected due to the specific side effects of the different drugs. For patients with pre-existing constipation transdermal fentanyl should be preferred. Antidepressant medications have been used for the treatment of chronic back pain, though there is only little scientific evidence for their effectiveness. There is no evidence for the use of antidepressants in acute low back pain. Trials of muscle relaxants for patients with acute back pain have used a wide range of agents, e. g. benzodiazepines. They mostly reduce acute back pain, but they have significant adverse effects including drowsiness and psychological and physical dependence even after relatively short treatment. Benzodiazepines are not indicated in the treatment of chronic back pain. Drugs are sometimes necessary for the patients to begin and persevere a multimodal treatment program. Drug therapy should be terminated as soon as other treatment strategies succeed. Unfortunately, no studies exist evaluating the place of analgesics within a multimodal treatment program.

Analgesics, Opioid↗
PubMed1993

The effects of resistance level on muscle coordination patterns and movement profile during trunk extension.

The objective of this research was to investigate the effects of varying resistance level on patterns of muscle activity and trunk motion during the performance of dynamic trunk extension. Twenty-five female subjects were tested at four resistance levels: nominal resistance, and 30%, 50%, and 70% of maximum isometric extension strength. Peak truncal velocity, acceleration, and deceleration decreased with increased resistance, although no difference existed between the nominal and 30% maximum voluntary contraction (MVC) conditions. Coactivation of abdominal muscles was present at all resistance levels, although it was greater for the nominal resistance condition than the other conditions. The timing of EMG activity of the extensor and abdominal muscles was significantly affected by resistance. The amplitude and time course of peak muscle activity are discussed in terms of the implications for spinal loading.

Abdominal Muscles↗
PubMed1993

Isometric maximal and submaximal trunk extension at different flexed positions in standing. Triaxial torque output and EMG.

Thirty-one healthy men were tested for the effects of trunk-flexion positions (0 degrees, 15 degrees, and 35 degrees) in standing on triaxial torques and electromyogram of 10 trunk muscles during voluntary maximal and submaximal isometric trunk extension. At a more flexed position, both erector spinae and latissimus dorsi showed significantly higher RMS-EMG. The abdominal obliques were coactivated only during 100% maximum voluntary exertion at each posture. In all tests, the rectus abdomini were quiet. Mean maximum extension torque increased significantly at 15 degrees and 35 degrees of trunk flexion. The ratio of extension torque over RMS-EMG of the trunk extensor muscles, called the neuromuscular efficiency ratio (NMER), also increased in the more flexed posture. However, NMER has to be interpreted with caution because it is affected both by posture and exertion levels. The effects of posture on the torque generation capability of the trunk question the validity of the current lifting recommendations.

Abdominal Muscles↗
PubMed1998

Muscle history, fusimotor activity and the human stretch reflex.

1. The previous history of contraction and length changes of a muscle influences the size of the stretch reflex and H reflex. Here we ask, is this dependence due to changes in mechanical properties of extrafusal fibres, intrafusal fibres of spindles, or both? 2. The soleus muscle of human subjects was conditioned using either a voluntary contraction or a contraction evoked by low-strength electrical stimulation, in the range 0-25 % of maximum. Following conditioning, reflexes were increased by more than twofold above the no-contraction value by a voluntary contraction of 5 % of maximum, or more, but not by electrical stimulation which presumably did not contract the intrafusal fibres of spindles. 3. When the muscle was conditioned with a contraction at a length shorter than the test length, rather than at the test length, a depressing effect on reflexes was attributed to both the burst of impulses generated in spindles when the muscle was stretched back to the test length and to a reduced stretch sensitivity of muscle spindles. 4. The experiments demonstrate the importance of keeping the muscle and its spindles in a defined mechanical state when measuring reflexes. They also point to the powerful facilitating influences of conditioning muscle contractions provided they recruit the intrafusal fibres of spindles.

Adult↗
PubMed1991

The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity.

Articles describing motor function in five chronic musculoskeletal pain conditions (temporomandibular disorders, muscle tension headache, fibromyalgia, chronic lower back pain, and postexercise muscle soreness) were reviewed. It was concluded that the data do not support the commonly held view that the pain of these conditions is maintained by some form of tonic muscular hyperactivity. Instead, it seems clear that in these conditions the activity of agonist muscles is often reduced by pain, even when this does not arise from the muscle itself. On the other hand, pain causes small increases in the level of activity of the antagonist. As a consequence of these changes, force production and the range and velocity of movement of the affected body part are often reduced. To explain how such changes in the behaviour come about, we propose a neurophysiological model based on the phasic modulation of excitatory and inhibitory interneurons supplied by high-threshold sensory afferents. We suggest that the "dysfunction" that is characteristic of several types of chronic musculoskeletal pain is a normal protective adaptation and is not a cause of pain.

Adaptation, Physiological↗
PubMed2004

Transdermal eperisone elicits more potent and longer-lasting muscle relaxation than oral eperisone.

Eperisone hydrochloride is widely used for the treatment of plasticity to relieve muscle stiffness and back pain. However, oral eperisone has a very low bioavailability and short muscle relaxant activity, because of the profound intestinal first-pass metabolism. To improve the efficacy and compliance of eperisone, we designed a new dosage form, a transdermal patch, and evaluated the efficacy of the eperisone patch with the muscle relaxant activity of rats. The muscle relaxant activity was assessed by the measurement of forelimb grip strength and hanging test in rats. The transdermal patch of eperisone showed significantly enhanced muscle relaxant activity at 0.5 1.5 and 3 cm2/200 g rat (1.39, 4.17 and 8.33 mg of eperisone hydrochloride/kg, respectively) in a dose-dependent manner and the effects lasted over 24 h. Even though oral eperisone hydrochloride showed significant muscle relaxant activity at 12.5, 25 and 50 mg/kg in a dose-dependent manner, the activity lasted only 1 or 2 h after administration. These results suggest that eperisone as transdermal patch form showed efficient absorption with more potent and longer-lasting muscle relaxant activity than oral solution. The transdermal patch form of eperisone will increase the efficacy and compliance in the clinical use of eperisone.

Administration, Cutaneous↗
PubMed1999

The effect of a tilting seat on back, lower back and legs during sitting work.

The purpose of this study was to examine the possible effects of a tilting seat on the back, lower back and legs. Ten healthy male subjects aged 22-28 performed word-processing operations while sitting on a chair for one hour under two different seating conditions: the rocking condition and the fixed condition. While the subjects were performing the task, measurements of lower leg swelling were taken using bioelectrical impedance plethysmography, and pain scores were recorded every five min for the neck, shoulders, back, lower back, hips and legs. Electromyograms (EMGs) of the back and lower back (at Th5-6, Th8-9, L1-2 and L3-4) were recorded every sec. In addition, the subjects were videotaped while using the rocking seat, in order to analyze the angle and frequency of seat tilting. At the end of the experiment, the subjects were asked to evaluate the two conditions with respect to localized fatigue and operational efficiency. There was no significant difference in lower leg swelling between the two conditions. EMGs were significantly different at Th5-6, Th8-9 and L1-2 between the two conditions. The rocking condition generated greater EMGs at Th5-6 and L1-2, whereas the fixed condition produced greater EMGs at Th8-9. The pain scores for the neck, shoulders, back and lower back were higher under the fixed condition, while those for the buttocks were higher under the rocking condition. The average tilting frequency was as low as 25.2 times per hour, with 15.6 times per hour for tilting angles ranging from 1 to 2 degrees, and 9.6 times per hour for tilting angles exceeding 2 degrees. As for the subjective evaluations of localized fatigue, seven of the ten subjects preferred the rocking condition, while two preferred the fixed condition and one subject had no preference. Thus, there was a significant difference in the subjective evaluations of the two chairs. These findings suggest that the rocking condition, in contrast to the fixed seating condition, reduced back and lower back pain as a result of its tilting capability. The results of EMGs suggest that the rocking condition reduced back and lower back pain by increasing the overall muscle activity of the back and lower back. The leg impedance measurements showed no effect of the rocking condition on the leg swelling, as compared with the fixed condition.

Adult↗
PubMed2005

Abdominal differential diagnosis in a patient referred to a physical therapy clinic for low back pain.

STUDY DESIGN: Resident's case problem. BACKGROUND: Acute back pain most often presents as musculoskeletal in nature; however, less frequently it may be the result of an underlying, or coexisting, systemic pathology. When present, the signs and symptoms of systemic pathology can mimic, or be masked by, musculoskeletal back pain, which may pose a diagnostic challenge during the clinical evaluation. The purpose of this resident's case problem is to describe the clinical reasoning process leading to a medical referral for a patient who presented to physical therapy with debilitating low back pain. DIAGNOSIS: The patient in this resident's case problem was a 67-year-old male referred to physical therapy with a 2-week history of severe low back pain and muscle spasms. The patient history and physical examination were suggestive of musculoskeletal back pain and physical therapy treatment was initiated. Abdominal pain was elicited during an introductory therapeutic exercise, which was recognized by the therapist as a potential sign of abdominal pathology. The therapist performed an additional review of systems and an abdominal screening examination, which established the necessity of an immediate medical referral. At the emergency department, ominous abdominal pathology was safely ruled out through diagnostic imaging and the patient was treated for secondary gastrointestinal effects of opioid analgesic medications. DISCUSSION: This resident's case problem provides an opportunity to discuss the clinical reasoning process leading to the suspicion of abdominal pathology. Specifically, this case reinforces the importance of recognizing potential signs of systemic pathology, executing an appropriate physical examination, including screening of the involved anatomical region, and providing an appropriate medical referral when indicated.

Abdominal Pain↗