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PubMedDate not supplied

Biomechanics of the spine in the polevaulter as related to spondylolysis.

An athlete was filmed at high speed to anatomically plot the position of the vertebrae during several pole vaults. A computer analysis adapted from a previously described program (Gainor, BJ, et al: The kick: Biomechanics and collision injury. Am J Sports Med 6: 185-193, 1978) was used to quantify the kinematic data. The thoracic and lumbar vertebrae of the polevaulter began in a neutral position but rapidly hyperextended 40 degrees during pole plant. The spine subsequently flexed 130 degrees in 0.65 seconds as the pole uncoiled and the athlete was propelled towards the bar. Angular velocities of the spine reached a maximum of 6 radians/sec during both extension and flexion. More significantly, angular accelerations of 150 radians/sec2 occurred in hyperextension, and 180 radians/sec2 in hyperflexion. Torque about the spine was estimated to be 1,500 inch-pounds during extension and 1,800 inch-pounds during flexion. The maximum kinetic energy in the athlete's body was calculated to be 36,000 inch-pounds. We believe the magnitude of these torques and accelerations predispose the back to injury. These results were correlated with several cases of spondylolysis in competing polevaulters.

Adolescent↗
PubMed1991

Evaluation of the physical work load of bricklayers in the steel industry.

A study was made of work conditions suspected of being responsible for a greater prevalence of musculoskeletal disorders among 33 bricklayers. A standardized questionnaire was used to confirm a high 12-month prevalence of 73% for the low back and about 20% for the upper limbs. Physical work load was studied with the use of heart rate recordings and posture analyses. According to the heart rate data, the work load was "moderately heavy" (300 W). A diagnostic analysis identified work postures that could be considered as imposing a heavy strain on the musculoskeletal system. The risk associated with these postures was investigated with biomechanical models. This analysis procedure made possible elaborate ergonomic solutions that reduced the work load in general and the biomechanical constraints in particular.

Adult↗
PubMed2006

Friction-reducing devices for lateral patient transfers: a clinical evaluation.

The purpose of this study was to assess the performance of lateral transfer devices compared with the traditional draw sheet method in acute care settings through subjective feedback of caregivers actually using the devices. Every 2 weeks, the eight participating acute care units each received one of the devices, which had been randomly selected. Data were collected through caregiver surveys, which rated comfort, ease of use, perceived injury risk, time efficiency, and patient safety. An overall performance rating was calculated as the sum of these five categories. Caregivers rated air-assisted devices significantly higher (p < .05) than other devices. Lateral transfer devices are recommended over the traditional draw sheet method for performing lateral patient transfers. These friction-reducing devices are a cost-effective solution to the load of lateral patient transfers and should be favorably considered when purchasing patient-handling technologies.

Acute Disease↗
PubMed1989

Evaluation and treatment of common spine and trunk problems.

This article was written not with the intent of establishing a comprehensive list of all problems seen in the trunk and spine of athletes nor as a cookbook for the treatment of these problems. In addition to the simple muscular strains and contusions of the back the physician must be aware of the possibility of underlying spondylolysis, spondylolisthesis, Scheuerman's kyphosis, and variants of Scheuerman's. In addition to these basic pain-related problems the team doctor should keep the possibility of spinal deformities such as scoliosis and silent kyphosis in mind and observe for those during team physicals. Finally, we note that there are several entities such as disc protrusion, infection, tumors, and fractures that are not frequently seen in athletes but must be considered in the workup of those patients who are refractory to the usual simple conservative treatment.

Athletic Injuries↗
PubMed2006

Work-related injuries of doctors of chiropractic in the United States.

PURPOSE: This study was undertaken to determine the prevalence and types of work-related injuries among a nationwide sample of chiropractors and to identify factors associated with these injuries. METHODS: Using a survey, 1000 randomly selected doctors of chiropractic in the United States were asked to record their 3 most serious injuries. Details were obtained about the type of injury, area of the body affected, activity performed at that time, year of practice when the injury had occurred, if the doctor had needed to take time off from work, and what they had changed as a result of the injury. RESULTS: A total of 422 responses were obtained (42.2%), yielding 397 usable surveys. One hundred fifty-nine chiropractors (40.1%) reported experiencing a total of 252 injuries while working. Most injuries were classified as soft tissue injuries and occurred while either performing (66.7%) or positioning (11.1%) a patient for manipulation. Body parts most commonly injured were the wrist/hand/finger (42.9%), shoulder (25.8%), and low back (24.6%). The anatomic areas of the patient being manipulated in which the doctor was injured were the lumbosacral (37.1%) and thoracic spine (21.6%). Shoulder (P < .001) and low back (P < .001) injuries were significantly more likely to have been caused by adjustments of the lumbosacral spine with the patient in the side-lying position. Most commonly, injuries occurred in the first to fifth year of practice (37.3%). Of note, 5.4% of injuries reported occurred while attending chiropractic college. CONCLUSION: A high prevalence of upper extremity injuries was reported in the group surveyed. These injuries were most often related to side-posture manipulation to the lumbar spine. Because most injuries occurred early on in the career and required a change in technique, greater efforts toward injury prevention education should be aimed toward chiropractic students.

Back Injuries↗
PubMed1992

Ergonomic workplace assessment in a health care context.

Nurses, together with other groups in the caring professions, show a high incidence of musculoskeletal injuries as a consequence of the handling of equipment and patients. This is an internationally recognized consequence of the work in these professions, and studies worldwide have investigated these problems. The UK Health and Safety Executive, as well as the European Community (EC) Directives, require workplaces to be assessed for their hazardousness. Ergonomics is the recognized discipline in relation to assessing whether the work, equipment, or environment match the capacities of the people concerned. An assessment procedure is presented, together with proposals for its use, which can form the basis for the ergonomic assessment of workplaces in health care, and give guidance for their improvement.

Accidents, Occupational↗
PubMedDate not supplied

Continuing medical education: interests of former and current residents of a physical medicine and rehabilitation residency program.

To plan targeted, relevant continuing medical educational activities, a study was undertaken to assess demographic data, practice patterns, and current continuing medical educational needs of former graduates of the physical medicine and rehabilitation program. A survey was sent to the 168 physicians who had completed a physical medicine and rehabilitation residency program from 1961 to 1995 and to the 34 then current residents in the program. Questions were asked regarding gender, year of completion of residency, certification, fellowships, current employment situation, size of practice community, work time distribution, and busiest areas of clinical practice. In addition, from a list of 47 topics plus "other," the respondents indicated in which topics they had a current strong interest in continuing their education. They also responded to questions about their most important considerations when deliberating about attending an educational activity, the amount of notice required regarding an upcoming course, and the preferred duration of educational activities. The response rate of former residents was 56% and of then current residents was 100%. Topics of interest to greater than half of the respondents, in descending order, were musculoskeletal/soft tissue disorders, therapeutic injections/nerve blocks, industrial medicine, back and neck pain rehabilitation, and sports-related disorders. There were significant differences on some topics based on gender, year of residency completion, academic affiliation, private practice, and ratings of residency training in that topic. The most important consideration when deciding whether to attend an educational activity was, by far, interest in topic, followed by provision of continuing medical educational credits. There are among physiatrists several differences in educational interests that challenge continuing medical education planners to determine efficient, effective ways to deliver continuing medical education to meet these needs within the financial and time constraints imposed by today's clinical practice.

Athletic Injuries↗
PubMed1995

Reconstruction of posterior trunk defects.

A high rate of success can be expected in the management of posterior trunk defects with muscle flaps. The surgeon has to adhere closely to the basic reconstructive principles of adequate debridement of all necrotic or devitalized tissues; management of infection with local wound care and appropriate antibiotic therapy; and coverage with well-vascularized tissue to obliterate any residual dead space and to cover bone grafts, orthopedic hardware, and vital structures such as the dura and spinal cord. Flap selection is also of paramount importance for success, and only muscles with appropriate arc of rotation, vascularity (vascular pedicles outside the field of radiation injury, or intact vascularity following previous procedures) and bulk should be used. Adequate flap mobilization to obtain a tension-free closure and judicious use of drains and perioperative antibiotic agents are essential. Occasionally, microvascular free-tissue transfer may be necessary if local flaps are unavailable. The complications of flap reconstruction include partial flap loss, persistent dead space for lack of adequate muscle bulk, and persistent infection. Debridement and re-advancement of the flap is adequate in most cases. If there is significant or total flap loss, however, a second flap reconstruction is often necessary to obliterate the dead space and protect vital structures.

Back↗
PubMed1997

Changes in serum creatine phosphokinase MM isoenzyme after lumbar spine surgery.

STUDY DESIGN: Serum concentrations of creatine phosphokinase and its isoenzyme were measured serially in 47 patients who underwent lumbar surgery. OBJECTIVE: To analyze the significance of postoperative creatine phosphokinase MM levels as indicators of muscle trauma after lumbar surgery. SUMMARY OF BACKGROUND DATA: The authors of the present study previously have reported on iatrogenic back muscle injury in an animal model and in man. However, the relationship between the change of the creatine phosphokinase MM isoenzyme level and muscle injury after surgery has not been clarified. METHODS: Peripheral venous blood samples were collected serially before surgery, just after surgery, and at 1, 3, 7, 14, and 21 days after surgery. The serum concentration of total creatine phosphokinase and its isoenzymes was measured by agarose gel electrophoresis. The serial postoperative change of the creatine phosphokinase MM isoenzyme concentration was evaluated with respect to age, gender, body weight, types and levels of surgery, and surgery time. RESULTS: Creatine phosphokinase MM activity increased after surgery and reached a maximum value 1 day after surgery, followed by recovery to the normal value 1 week after surgery. The maximum concentration of creatine phosphokinase MM isoenzyme in posterior lumbar surgery was significantly higher than that in anterior surgery (P = 0.04). It was significantly higher in men than in women (P = 0.02). Serum concentration of creatine phosphokinase MM isoenzyme showed no significant correlation to the extent of muscle exposure and surgery time. CONCLUSION: The time course of postoperative serum creatine phosphokinase MM isoenzyme activity is correlated with the histologic changes of the back muscles after surgery. The concentration of creatine phosphokinase MM isoenzyme in posterior lumbar surgery was significantly higher than that in anterior surgery. It was also significantly higher in men than in women.

Adolescent↗
PubMed1988

Radiological findings in the lumbar spine of 39 young cross-country skiers with low back pain.

The lumbar spines of 39 active young cross-country skiers suffering from long lasting or frequently remitting low back pain (LBP) were examined by a new radiological method. Plain radiographs in lateral and anteroposterior views were taken. The spinal curves, anomalies, and possible degenerative changes were investigated. The radiological method chosen proved to be suitable for imaging the lumbar spine. There were various radiologically detectable abnormalities in the spine. The most common findings were functional scoliosis (in 49%) and different spinal anomalies (in 23%). The mean lumbar lordosis was 69 degrees (70 degrees in males and 64 degrees in females). The effect of abnormal lumbar posture on LBP should be further studied. None of the numerous radiological findings had an effect on therapy in these skiers.

Adolescent↗
PubMed2000

Manual handling injuries in health care workers.

Nursing aides are particularly susceptible to manual handling injuries because they have the primary responsibility for heavy lifting. The aim of this study was to determine why a specific group of nursing aides have the highest manual handling injury rate in their hospital. The study investigated the adequacy of the manual handling training program, knowledge of manual handling, mechanical aid availability, and use of mechanical aids. Results indicated that the nursing aides' manual handling knowledge was adequate but that they rarely used mechanical aids. This lack of use of aids was in part due to an over-reliance on their own strength and abilities. This may have been due to a lack of suitable mechanical aids on the wards or a lack of familiarity with the available aids. This study suggests that neither training alone nor the purchase of equipment alone is likely to resolve manual handling problems.

Accidents, Occupational↗
PubMed2006

Incidence of sports injuries in elite competitive and recreational windsurfers.

OBJECTIVE: To investigate the incidence of injury in windsurfing and to consider methods of prevention. METHODS: A total of 107 raceboard (RB) and wave/slalom (WS) national/international competitors and recreational (REC) windsurfers completed a questionnaire on injury incidence over two years. Recurrent injury, ability level, and any preventive measures taken were noted. RESULTS: Overall the injury incidence was 1.5/person/year. The WS group suffered more injuries (2.0/person/year) than the RB (1.0) or REC (1.2) group. The most common injury was muscle strain at 35% of new injuries, much higher than in earlier studies. Overall 45% of new injuries were muscle/tendon strains (RB 55%, WS 42%, and REC 43%) and 8% were ligament sprains. In the WS group cuts and abrasions were common. The WS and REC groups reported five and one case of concussion respectively. Nearly a quarter (22%) of new lower body injuries were lower back muscular strain, with 34% of recurrent injuries. Approximately 60% of the remaining lower body soft tissue injuries involved the knee or lower leg, with the ankle/foot most often involved. The shoulder, upper arm, and elbow were the sites of 41% of new upper body soft tissue injuries. The WS group reported 250% more recurrent muscular strains than the RB group. Recurrent ligament injuries (particularly knee) were most common in the WS group. The RB group reported recurrent serious bruising to the lower leg. CONCLUSION: The injury incidence was 1.5/person/year with a high incidence of new and recurrent muscular strain. Lower back muscular strain was prevalent, indicating the need for preventive measures. Wave/slalom was associated with more new and recurrent injuries and the need for head protection.

Adolescent↗
PubMed2002

Evaluation of influence of gender, occupational injury, and smoking on chronic low back pain of facet joint origin: a subgroup analysis.

The prevalence of persistent low back pain secondary to involvement of lumbosacral facet joints has been described in controlled studies as varying from 15% to 52% based on types of population and settings studied. Previous studies have shown variances in elderly populations, and postlumbar laminectomy patients. But no variations were observed in obese patients or patients with somatization disorder. Based on the individual results, it appears that facet joint pain may be less prevalent in patients with occupational injury and more prevalent in women and smokers. This analysis was based on a combination of the results of two previous studies with a total number of 320 patients to evaluate the influence of gender, occupational injury and smoking on prevalence of facet joint pain. Facet joints were investigated with diagnostic blocks initially using lidocaine 1%, followed by bupivacaine 0.25%, usually 2 to 4 weeks apart in these studies. The prevalence of facet joint pain in men was 38% (95% CI, 29% to 47%) compared to 43% (95% CI, 36% to 50%) in women; 43% (95% CI, 33% to 53%) in non-smokers, compared to 41% (95% CI, 30% to 52%) in heavy smokers; and 28% (95% CI, 18% to 38%) in occupational injury patients compared to 44% (95% CI, 36% to 52%) with a history of gradual onset. False-positive rates varied from 28% to 46%. In conclusion, based on the results of this evaluation, women and men, smokers and nonsmokers suffer with similar prevalence rates of facet joint pain in chronic low back pain; whereas occupational injury patients suffer with lesser prevalence (28%) compared to patients with gradual onset (44%) of low back pain.

Journal Article↗
PubMed2003

Addressing occupational strains and sprains: musculoskeletal injuries in hospitals.

Recognition related to the need for ergonomic design improvements among health care workers, management and administration, and equipment manufacturers is growing. The future should bring new concepts and innovations which can provide many benefits. Beyond the potential reduction in caregiver injuries, many possibilities exist to improve patient outcomes through better equipment design. As an additional benefit, applying the principles of ergonomics may enhance and increase caregiver productivity through a reduction of patient transfers required, and by minimizing staff required to ambulate patients. Another added value to applying ergonomics to equipment design is the development of convertible furnishing which could create a reduction in operating and capital expenses by reducing the need for some furnishings. Equipment such as cardiac chairs, sling scales, patient chairs, special rental surfaces, and other features might be incorporated into bed design. Ergonomic programs make sense and provide opportunities to create win-win situations throughout the health care industry. Current and future innovations will provide improvements resulting in outcomes from which everyone will benefit. These benefits include a higher quality of work life for health care workers and an improved quality of care for patients.

Accidents, Occupational↗
PubMedDate not supplied

[Changes of the locomotor system in sportsmen with back pain].

Sport of high achievements is a complex combination of stressful factors affecting physical and psycological condition of a sportsman. Figure skating is a multicoordinational kind of sports. The analysis of the practical experience shows that movements undue in amplitude in the lumbar spinal column coupled with becoming too cold result in microtraumatization and origination of the pain syndrome in the loin. A 3-yr follow-up of 42 sportsmen-figureskaters of a top class athletic mastery was carried out to develop a system of prophylaxis and effective treatment of lumbar pains in sportsmen-figure skaters. The clinical neurological and orthopedic examination, X-ray, myotonometry of the paravertebral muscules, and USI of the spinal column were all done during the sports season and in the process of treatment. The developed system of a multiple-modality treatment showed efficacy of use of medicamentous (nonsteroidal antiinflammatory agents, chondroprotectors, antihomotoxic therapy, vitamins, and biological stimulants) and non-medicamentous (massage, stretching, physiotherapy, remedial gymnastics, psychological training) treatment options in rehabilitation of those sportsmen presenting with the pain syndrome in the lumbar spine.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1998

[Hemorrhagic shock death caused by not so severe injury during the medication of anticoagulants].

A 73-year-old man receiving anticoagulants (warfarin potassium) orally with a history of prosthetic heart valve replacement was struck by a truck. When admitting to the hospital, he complained of lumbago with laboratory findings of anemia and prolongation of prothrombin times. Twenty-two hours after the accident, he died suddenly in the hospital and forensic autopsy was performed 9 hours after his death. Autopsy findings revealed marked subcutaneous and intramuscular hematoma in the lumbar and gluteal region and anemic change of viscera. Furthermore, 854 ng/ml of warfarin which was well accordance with the therapeutic levels was detected in the serum obtained from cadaver by using gas chromatography-mass spectrometry. Therefore, we concluded that the man had died of hemorrhagic shock caused by the force acting to the lumbar region accompanied by the influence of anticoagulant action of warfarin. To our knowledge, this is the first report to detect the warfarin from cadaver's serum. In dealing with the unnatural death of the patient receiving the anticoagulants, it is valuable to survey the medications and detect the presence of anticoagulants in cadaver.

Accidents, Traffic↗
PubMed2006

A field study investigating the effects of a rebar-tying machine on trunk flexion, tool usability and productivity.

A field study with a before-and-after experimental design was conducted to evaluate the potential reduction in the risk of musculoskeletal injuries to rodworkers when using an automatic rebar-tying machine. Eleven rodworkers participated in this experiment. All dependent variables (trunk posture, rebar-tying time and responses to a usability questionnaire) were first measured before introducing the rebar-tying machine and then after 3 months of usage all dependent variables were measured again. The results of the study indicated that working with a rebar-tying machine significantly reduced the magnitude, frequency and duration of exposure to awkward trunk posture. Tying time was reduced when participants used the machine. The usability questionnaire indicated that most participants preferred to use the rebar-tying machine for ground-level rebar construction. The field study also revealed that the rebar-tying machine is not limited to the reinforcing trade. The machine can be used for other purposes, such as tying electrical conduit and attaching radiant heat tube to steel mesh. Based on trunk posture exposure, rebar-tying time, usability and transferability, it is concluded that the rebar-tying machine can be an effective tool to reduce the frequency and duration of severe trunk flexion, improve usability and increase productivity among concrete reinforcement workers.

Adult↗
PubMed1997

Endothelial fibrinolytic reactivity and the risk of deep venous thrombosis after spinal cord injury.

Deep vein thrombosis (DVT) is a frequent event in patients with spinal cord injury, even with prophylactic anticoagulant therapy. Lower limb paralysis is a known major risk factor for venous thrombosis, supposedly due to the venostasis in relation with total immobility. The main goal of this study was to evaluate the endothelial response to anoxia to determine whether recovery of fibrinolytic potential occurs in patients subjected to forced bedrest because of a spinal cord injury and whether this recovery is related to the incidence and/or evolution of DVT. We evaluated vascular endothelium reactivity in the lower limbs no longer submitted to the hydrostatic pressure of the erected position in 15 patients with paraplegia or tetraplegia and in 10 normal volunteers after venous occlusion produced by the application of 10 cm Hg pressure to the lower limb for 15 min comparatively to the upper limb used as reference. Among the 15 patients, 10 whose spinal cord injury had occurred 1 to 6 months earlier were still receiving prophylactic anticoagulant therapy, whereas the five other patients were not receiving prophylactic anticoagulants because the injury dated back 6 months or more. After venostasis, tissue plasminogen activator (tPA) increased significantly in both patients and controls in the upper limb (tPA levels twofold and threefold respectively in controls and patients) but showed no significant changes in the lower limb; prolonged immobility did not allow recovery in the lower limbs of a level of fibrinolytic responsiveness identical to that in the upper limbs. The plasminogen activator inhibitor (PAI1) remained unchanged after anoxia, although wide interindividual variations were seen. Natural coagulation inhibitors and circulating blood stigmates of hypercoagulability were measured. None of the patients had abnormally low levels of coagulation inhibitors (ie, antithrombin III, protein C and protein S levels were normal). Seventy-five per cent of patients (prophylactically anticoagulated or not) had very high levels of fibrin degradation products (D. Dimer levels sevenfold to eightfold those of the controls), but all patients had normal levels of thrombin-antithrombin complexes and prothrombin fragments 1 + 2. The permanence of the thrombotic process characterized by an increase in D. Dimer levels without recovery of fibrinolytic potential suggests a proposal for the patients an indefinite antithrombotic treatment at curative doses.

Adolescent↗