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Running-related injuries are increasingly common, and most often due to overuse. This article briefly discusses the biomechanics of running, and a general review of stress lesions of bone; site-specific reviews of bony stress lesions and other running-related soft tissue injuries; and associated MR imaging findings.
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Stab wounds to the back present a diagnostic problem, since missed occult abdominal injuries can lead to serious morbidity. In a prospective study of 205 patients, the authors evaluated the usefulness of abdominal computed tomography (CT) in assessment of low-velocity penetrating injury to the back. CT results were classified into three groups. Category 1 included injuries limited to superficial subcutaneous tissue (n = 174); category 2, injuries to the retroperitoneal compartment (n = 18); and category 3, injuries within the peritoneal cavity (n = 13). Fifty patients underwent surgery, including 30 with category 1 injuries, nine with category 2 injuries, and eleven with category 3 injuries. CT categorization of injury, compared with surgical findings in these 50 patients, had a sensitivity of 85% and specificity of 93%. The CT interpretation was considered correct if it demonstrated peritoneal penetration or retroperitoneal injury potentially requiring surgery. The remaining 155 patients were managed nonoperatively, and none had late complications. Abdominal CT is a reliable diagnostic tool in the evaluation of penetrating injury to the back.
UNLABELLED: Most injuries in children's sports are minor and self-limiting, suggesting that children and youth sports are safe. A child's skeletal system shows pronounced adaptive changes to intensive sports training. Sports injuries affect both growing bone and soft tissues and could result in damage of the growth mechanisms with subsequent life-lasting damage. During growth there are significant changes in the biomechanical properties of bone. In young athletes, as bone stiffness increases and resistance to impact diminishes, sudden overload may cause bones to bow or buckle. Epiphyseal injuries are usually due to shearing and avulsion forces, although compression also plays a significant role. Given the remarkable healing potential of bone in youngsters, fractures that initially united with some deformity can completely remodel and appear totally normal in later life. CONCLUSION: As the risk of injuries sustained by young athletes can be significant, it is essential that training programmes take into account their physical and psychological immaturity, so that growing athletes can adjust to their own body changes.
Some 30 million Americans are involved in equestrian sports. Although there is significant literature regarding catastrophic injury, there is very little literature that addresses overuse injury and its effect on rider and horse. As the horse and rider function as a unit, overuse injuries to the rider can affect the horse's training and responsiveness. Sports physicians treating riders should understand correct posture in the saddle and its alteration by muscular imbalance and injury. This review discusses common equestrian events, and common overuse injuries in recreational and competitive riders.
STUDY DESIGN: Mixed, repeated measures design. OBJECTIVES: To determine if previous experience with loads of similar weight influences the anticipatory lifting force and postural adjustments during the squat lift. To examine a multijoint, functional task for coordination between stability and movement. To determine if lifting unexpected loads results in trunk loading patterns associated with greater injury risk. BACKGROUND: Workers are increasingly exposed to variability in materials handling thereby increasing the risk of injury. Understanding the control processes underlying lifting will support clinical decision making for preparing injured workers to return to realistic working conditions. METHODS AND MEASURES: Subjects (19 men, 4 women; mean age, 25.4 +/- 3.5 y) lifted a series of boxes weighing 5%, 20%, and 35% of their maximal lifting capacity. The loads were delivered via a gravity conveyor. The identical-appearing loads were ordered so that the subjects lifted several loads of similar weight, immediately followed by a lighter or heavier than expected load based on the previous lift. RESULTS: Generally, the vertical lifting force, force rate, horizontal momentum, and angular momentum increased with an increase in expected load. Higher peak lumbar extensor moments occurred with lighter than expected loads (expected 20% and lifted 5% load = 238.2 +/- 91.2 N-m; expected 35% and lifted 5% load = 278.2 +/- 101.8 N-m) compared to expected loads of similar weight (expected and lifted 5% load = 205.0 +/- 73.2 N-m). Heavier than expected loads led to eccentric trunk movements when there were large mismatches between the expected and actual loads. CONCLUSIONS: The vertical lifting forces and whole body momentum were predictively scaled according to the expected load. The loading phase relationships indicated coordination between the lifting force, force rate, horizontal momentum, and angular momentum. Trunk loading during the lifts with unexpected loads showed patterns associated with increased injury risk.
Instead of caring for patients, nurses and other healthcare workers at long term facilities are increasingly becoming patients themselves. Over the past decade, the injury rate among nursing home workers jumped by 55%, with more than 200,000 of these workers injured annually. This article discusses the types of injuries suffered and how they can be prevented.
Forensic pathologists have historically found several characteristics of the entrance wound invaluable in determining range of fire in gunshot fatalities. Among these characteristics are the pattern and constituents of any deposited material such as soot and/or gun powder residues. We describe a case in which the application of previously described characteristics, in the absence of laboratory testing and examination of the crime scene, would have led to an erroneous conclusion with potentially grave consequences. We suggest that all attempts be made to use available laboratory tests and to perform detailed examination of crime scenes in determining the circumstances surrounding fatal gunshot injuries.
Athletic performance is frequently compromised by disorders of the spine. This article discusses back and neck problems commonly seen in athletes and outlines effective treatment requirements.
Therapeutic stretching is a vital component of chronic musculoskeletal pain rehabilitation for increasing range of motion and counteracting the effects of physical deconditioning. Surface EMG biofeedback is currently being used to facilitate movement and to maximize effective stretching with patients in an interdisciplinary chronic pain rehabilitation program for disabled workers. A clinical protocol with case examples is presented.
Protective vasodilation in response to tissue injury and acid back diffusion is associated with release of bradykinin in the rat stomach. We hypothesized that bradykinin might be involved in mechanisms behind such vasodilation via influence on mast cells and sensory neurons. Acid back diffusion after mucosal barrier disruption with hypertonic saline evoked degranulation of mast cells in the rat stomach wall. Acid back diffusion was also associated with increased luminal release of histamine and gastric blood flow in normal rats, but not in mast cell-deficient rats. Bradykinin (BK(2)) receptor blockade inhibited degranulation of submucosal mast cells in the stomach and attenuated gastric vasodilation both in response to acid back diffusion and after stimulation of sensory neurons with capsaicin. Gastric vasodilation caused by mucosal injury with hypertonic saline alone was associated with degranulation of mucosal mast cells. These events were unaffected by inhibition of prostaglandin synthesis, whereas bradykinin (BK(2)) receptor blockade was associated with abolished vasodilation and inhibition of mucosal mast cell degranulation. We conclude that bradykinin is involved in gastric vasodilation caused by hypertonic injury alone via influence on mast cells, and by acid back diffusion via influence on both sensory neurons and mast cells.
OBJECTIVES: To report the incidence, site, and nature of injuries in amateur rugby league over three consecutive seasons. METHODS: Six hundred players registered with an amateur rugby league organisation were studied over three consecutive seasons. All injuries sustained during the amateur rugby league matches were recorded. Information recorded included the date and time of injury, name of injured player, anatomical site and nature of injury, and position of the player. RESULTS: The incidence of injury was 160.6 per 1000 player-position game hours, with forwards having a significantly higher incidence of injury than backs (182.3 per 1000 v 142.0 per 1000, chi2 = 14.60, df = 1, p<0.001). Over 25% of the total injuries (40.6 per 1000) sustained during the three year period were to the head and neck, while injuries to the face (21.3 per 1000, 13.3%), abdomen and thorax (21.3 per 1000, 13.3%), and knee (17.8 per 1000, 11.1%) were less common (chi2 = 21.83, df = 8, p<0.01). Muscular injuries (haematomas and strains) were the most common type of injury (45.7 per 1000, 28.5%, chi2 = 17.98, df = 7, p<0.05). Significantly more injuries occurred in the latter stages of the season (chi2 = 22.94, df = 1, p<0.001), with most injuries (70.8%, chi2 = 162.29, df = 1, p<0.001) sustained in the second half of matches. CONCLUSIONS: The results show that muscular injuries and injuries to the head and neck are the most commonly sustained injuries in amateur rugby league. Furthermore, injuries are more often sustained in the latter stages of the season and during the second half of matches. These findings suggest that fatigue or accumulative microtrauma, or both, may contribute to injuries in amateur rugby league players.
Nine cases of adolescent back pain show that a diagnosis of spondylolysis cannot be made on physical examination alone and that single photon emission computed tomography (SPECT) scanning revealed pars interarticularis stress lesions undiagnosable on planar technetium-99 bone scan. As management of spondylolysis differs from other lumbar dysfunctional problems SPECT scanning of children should be a sine qua non in extension related back pain with a normal radiograph and planar bone scintigraphy.
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BACKGROUND: Experimental findings have demonstrated a beneficial role of retrograde blood flow from hepatic veins that takes place during the Pringle maneuver in liver resections. The cytoprotective effect of hepatovenous back-perfusion has not been evaluated in humans. A randomized prospective study was designed to compare the response of liver cells to ischemic-reperfusion injury during the application of two different ischemic procedures: inflow versus inflow plus outflow vascular occlusion of the liver. STUDY DESIGN: Forty patients were randomly allocated to undergo liver resection using the continuous Pringle maneuver (n = 20) or inflow plus outflow vascular occlusion of the liver by selective hepatic vascular exclusion (n = 20). Liver function was assessed on postoperative days 1 to 6. Response of liver cells to I/R injury was evaluated by measuring interleukins IL-6 and IL-8 at 3, 12, 24, and 48 hours after reperfusion. Oxidative stress was assessed by measuring malondialdehyde levels. RESULTS: Both groups were comparable regarding ischemic time, operative time, and extent of liver resection. Patients in whom retrograde blood flow to the liver took place during the Pringle maneuver showed better liver function postoperatively and less severe hepatic I/R injuries compared with those undergoing liver resection using both inflow and outflow vascular occlusion. Oxidative stress was significantly lower in the Pringle maneuver group compared with the inflow plus outflow vascular occlusion group (mean [+/- SD] malondialdehyde 8 +/- 2.1 micromol/L in the Pringle group versus 14.7 +/- 1.8 micromol/L in the selective hepatic vascular exclusion group 30 min after reperfusion, p < 0.01). CONCLUSIONS: Back perfusion via hepatic veins contributes to attenuation of I/R damage during the Pringle maneuver and should be preferred if possible during liver resection.
PURPOSE: Research verifying the ability of various devices to reduce the forces required for transfers is virtually nonexistent. Therefore, we compared the push forces required to move passive seated subjects across a horizontal surface when four different methods were employed. SUBJECTS: 10 men and 14 women (weight 49.1-96.8 kg) served as subjects. METHODS AND MATERIALS: Passive subjects were moved horizontally across a treatment table that had a vinyl-covered foam mat on top. They sat either directly on the mat or on a vinyl sliding board (Ross Easy Glide), on a fabric tube (Ross Mini-Slide), or on a fabric tube on top of a sliding board on top of the mat. Subjects were pushed horizontally by each of the two authors via a hand-held dynamometer that was placed over their greater trochanter. ANALYSES: To examine interrater reliability of push forces, intraclass correlation coefficients (ICCs) were calculated for each transfer method using the two authors' measurements. Validity was confirmed using Pearson correlations to test the relationship between subjects' weights and the forces required to push them. A repeated measures analysis of variance (ANOVA) and pair-wise post hoc tests were used to compare the forces associated with the four methods. RESULTS: The ICCs for push forces ranged from 0.77 to 0.91 depending on the transfer method. The push forces associated with the four transfer methods (no device=200.7+/-40.8 N, sliding board=120.5+/-27.7 N, fabric tube=105.8+/-26.1 N, fabric tube and sliding board=84.2+/-13.4 N,) differed significantly (F=273.9, p<0.001). CONCLUSIONS: This study demonstrates that assistive devices can greatly reduce the forces required to move seated subjects horizontally. The sliding board and the fabric tube were most effective when used together. Such devices have the potential to make transfers easier for individuals performing seated transfers and to reduce the risk of injury among individuals assisting them.
Public health guidelines primarily focus on the promotion of physical activity and steady-state aerobic exercise, which enhances cardiorespiratory fitness and has some impact on body composition. However, research demonstrates that resistance exercise training has profound effects on the musculoskeletal system, contributes to the maintenance of functional abilities, and prevents osteoporosis, sarcopenia, lower-back pain, and other disabilities. More recent seminal research demonstrates that resistance training may positively affect risk factors such as insulin resistance, resting metabolic rate, glucose metabolism, blood pressure, body fat, and gastrointestinal transit time, which are associated with diabetes, heart disease, and cancer. Research also indicates that virtually all the benefits of resistance training are likely to be obtained in two 15- to 20-min training sessions a week. Sensible resistance training involves precise controlled movements for each major muscle group and does not require the use of very heavy resistance. Along with brief prescriptive steady-state aerobic exercise, resistance training should be a central component of public health promotion programs.