[A single case of hydatid cyst located in the latissimus dorsi muscle].
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Animals↗
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Efficacy of aquatic exercises for patients with low-back pain.
We have studied 35 patients (25 female and 10 male) with low-back pain who were managed with aquatic exercises after an appropriate period of treatment for their condition in the medical institution. The exercises employed consisted of strengthening exercises for the abdominal, gluteal, and leg muscles, stretching of the back, hip, hamstrings, and calf muscles, walking in water, and swimming. All the patients had been participating in the exercise program for more than 6 months. The frequency of performing exercises was once a week for 7 patients, twice a week for 19, and 3 or more times a week for the remaining patients. The method used in this study was a survey questionnaire which was composed of questions about the patient's physical and psychological condition. Those patients who had performed exercises twice or more in a week showed a more significant improvement in the physical score than those who performed exercises only once a week. More than 90% of the patients felt they had improved after 6 months of participation in the program. The improvement in physical score was independent of the initial ability in swimming. The results obtained suggested that exercises in water may be one of the most useful modes of exercise for a patient with low-back pain.
Adult↗
An application of pattern recognition for the comparison of trunk muscles EMG waveforms between subjects with and without chronic low back pain during flexion-extension and lateral bending tasks.
The purpose of the study was twofold: (1) to evaluate the reliability of distance measures computed from a principal component analysis (PCA) of electromyographic (EMG) waveforms of trunk muscles recorded during standardized trunk movements and (2) to evaluate their sensitivity to the load lifted, the trunk range of motion (ROM) and to low back status. Thirty-three male subjects (18 normals, 15 suffering from non specific CLBP) aged between 35-45 years participated. The EMG signals from 12 trunk muscles and the kinematics of trunk segments were recorded during 12 tasks. The subjects performed flexion-extension and lateral bending (left and right) tasks (three complete cycles) with and without a 12 kg load and at different trunk ROM (maximal or at defined submaximal angles). Distance measures locating each subject relative to a reference PCA model were computed for each muscle and task. The reliability of these distance measures was evaluated for 10 subjects (five normals and five CLBP) who performed two tasks on three different days. The reliability of distance measures was acceptable for agonist muscles only. The distance measures were sensitive to the load lifted and to the trunk ROM for different muscles and tasks but poorly sensitive to low back status. Several reasons that could explain the low sensitivity of these measures to low back status are discussed and potential solutions are proposed. A procedure based on a reliability analysis is proposed to select the number of principal components to include in the reference PCA model. It is expected that the refinement of the method used in this study could provide an effective clinical tool to assess EMG waveforms of trunk muscles during dynamic tasks.
Biomechanical Phenomena↗
[Lumbar hypermobility: where swimming becomes hydrotherapy].
In this paper the authors discuss the clinical problem of lumbar hypermobility. The therapeutical possibilities are resumed briefly. The philosophy of medical training therapy ("Heilgymnastik") is described. More extensive the extra-advantages of hydrotherapy (methodical back-stroke swimming) are searched for in a theoretical deductive way. The authors found that: 1. swimming is a low-impact sport so far as the articulations are concerned, 2. back-stroke is done mainly in a lumbar kyphosis, 3. swimming is also an excellent cardiopulmonary training, 4. when swimming the muscles of the shoulder girdle and pelvic girdle are trained in a nearly isokinetic way (power-endurance), 5. the short transverso-spinal muscles are indirectly trained in their tonic more than phasic stretch reflex (posture function), 6. the muscles of the trunk are trained in a nearly isometric way in the appropriate angles (erect position), 7. the position of the head in the water facilitates the abdominal muscles (tonic neck reflex), 8. the cool temperature of the water generates training-enhancing stress-responses, 9. endurance-training is ideal for the postural function of the lower back muscles (especially the deeper layers near the spine) which are anatomical and physiological suited for this purpose, 10. warming-up and cooling-down procedures prepare the neuromuscular, the cardiovascular and metabolic functions before the workout-session (a cold shower afterwards acts to tonicize the skin and muscles).
Adult↗
[Muscle activities in the region of neck, shoulder and back during isometric horizontal jaw exercises in various postures].
Eleven healthy participants were made to perform isometric horizontal jaw movements with maximum voluntary efforts in various postures. Surface EMGs from the laterocervical, nucha, shoulder and back regions were bilaterally picked up, and simultaneously recorded with jaw force. The results obtained were as follows: 1. Electromyographic power value in these regions depended on the directions of the jaw exercises (posteriorly pull greater than posterolaterally pull greater than anteriorly push not equal to anterolaterally push, P less than 0.0001). 2. The directional effects mentioned above were significantly obvious in the inferior laterocervical (Electrode No. 2) and back Electrode No. 5) regions (P less than 0.0001). 3. The postural effects on the power value were varied with the directions of the jaw exercises (P not equal to 0.03); i.e., the highest value during jaw pull was observed in an upright position, while that during jaw push was found in a supine position. 4. From above results, it would be considered that occlusal habits with sustained isometric jaw retrusion might have higher probability to provoke the discomfortableness in the neck, shoulder and back regions than those with protrusion, and that the habits with the retrusion might be more injurious in a supine than in an upright position, while those with the protrusion more injurious in an upright position.
Adult↗
Elevation of the chronaxie of the extensor hallucis longus muscle; an objective sign of nerve root pressure in the low back.
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Back↗
Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles.
OBJECTIVES: To determine the interexaminer reliability of palpation of three characteristics of trigger points (taut band, local twitch response, and referred pain) in patients with subacute low back pain, to determine whether training in palpation would improve reliability, and whether there was a difference between the physiatric and chiropractic physicians. DESIGN: Reliability study. SETTING: Whittier Health Campus, Los Angeles College of Chiropractic. PARTICIPANTS: Twenty-six nonsymptomatic individuals and 26 individuals with subacute low back pain. INTERVENTION: Twenty muscles per individual were first palpated by an expert and then randomly by four physician examiners. MAIN OUTCOME MEASURES: Palpation findings. RESULTS: Kappa scores for palpation of taut bands, local twitch responses, and referred pain were .215, .123, and .342, respectively, between the expert and the trained examiners, and .050, .118, and .326, respectively, between the expert and the untrained examiners. Kappa scores for agreement for palpation of taut bands, twitch responses, and referred pain were .108, -.001, and .435, respectively, among the nonexpert, trained examiners, and -.019, .022, and .320, respectively, among the nonexpert, untrained examiners. CONCLUSIONS: Among nonexpert physicians, physiatric or chiropractic, trigger point palpation is not reliable for detecting taut band and local twitch response, and only marginally reliable for referred pain after training.
Adult↗
The myofascial pain dysfunction: dental symptoms and psychological and muscular function. An overview. A preliminary study by team approach.
Patients with myofascial pain dysfunction (MPD) are traditionally seen by dentists. No organic lesions are found, and there is accumulating evidence that psychological factors influence both the onset and the development of the disorder, thus calling for a multiprofessional investigation approach. This report presents a preliminary study by a team consisting of a psychiatrist, a dentist and a physiotherapist. 25 patients with MPD diagnosis were examined. Almost all of the patients had tense muscles in neck and back, indicating that muscular tension is not a local phenomenon in the masticatory muscles. It was possible to distinguish two main categories of MPD patients, the 'typical MPD patients' and the 'multiproblem patients'. Problems that need further investigation are pointed out.
Adolescent↗
A lumbar body support (KBS 2000) alters lumbar muscle recruitment patterns in patients with acute-upon-chronic lower back pain.
OBJECTIVE: To determine the effects of a locally designed lumbar body support (LBS) on integrated electromyographic (IEMG) activity of the lumbar erector spinae muscles, on heart rate and on ratings of discomfort in patients with low back pain. DESIGN: Non-randomised controlled trial. SETTING: Patients referred from general practitioners and back pain rehabilitation programmes in Cape Town. PATIENTS AND OTHER PARTICIPANTS: Ten patients with low back pain of diverse causes. Values were compared with those in 10 control subjects without low back pain. INTERVENTION: Patients and controls lay supine on (in random order) either a flat conventional mattress or a LBS placed on top of the flat mattress, for a 30-minute period (acute exposure), and every night for 2 weeks (chronic exposure). MAIN OUTCOME MEASURES: IEMG activity of the lumbar erector spinae muscles, heart rate, and perception of comfort. RESULTS: IEMG activity of the lumbar erector spinae muscles did not differ between controls and patients when lying on the LBS on top of the CM after either acute or chronic exposure. However, it was significantly greater (P < 0.05) in patients than in controls when lying on the flat mattress. Subjective ratings of discomfort and heart rates mirrored these changes and were higher in patients only when lying on the flat mattress (P < 0.05). Patients with low back pain also reported that sleeping overnight on the LBS on top of their own mattress significantly reduced discomfort ratings. CONCLUSIONS: When lying on a mattress with a flat surface, patients with chronic low back pain have higher IEMG activity of the erector spinae muscles, higher heart rates and higher subjective ratings of discomfort than do control subjects. These differences disappear when both groups use a specially designed lumbar body support placed on top of the flat surface. These preliminary studies suggest that a lumbar body support should be evaluated in the chronic management of low back pain.
Adult↗
The superficial dorsal muscle group in Formosan monkey. I. First layer of the superficial muscle group (m. trapezius and m. latissimus dorsi).
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Animals↗
Comparison of muscle spindle concentrations in large and small human epaxial muscles acting in parallel combinations.
A small short muscle acting across a joint in parallel with vastly larger and longer muscles is clearly unable to play more than a minimal mechanical role in such a "parallel muscle combination" (PMC). This research investigates a feed back role for the small muscles of PMCs, proposing a significantly higher muscle spindle concentration therein to be consistent with this role. Epaxial PMCs (semispinalis and multifidus versus rotatores brevis) from the C5-C6, T6-T7, and L4-L5 regions of three 36-week-old male fetuses and two adult cadavers were removed and fixed in Carnoy's fluid. Tissue samples were embedded in paraffin, cut into 10 microns thick sections perpendicular to the muscle's longitudinal axis and stained by Harris' hematoxylin and eosin. Representative tissue sections were projected onto a sterological grid and the percentage volume of spindles determined. Data were analyzed with Student's unpaired t test. In all PMCs, rotators brevis spindle percentage volumes ranged from 4.58 to 7.30 times higher than those of multifidus and semispinalis. Differences in mean spindle percentage volumes between large and small members of all PMCs were significant (P less than .0001). Our findings are consistent with the notion of a "kinesiological monitor" or feedback role for rotatores brevis.
Adult↗
The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain.
STUDY DESIGN: A two-group experimental design with repeated measures on one factor was used. OBJECTIVES: To investigate the role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain. SUMMARY OF BACKGROUND DATA: Proprioceptive deficits have been identified in patients with low back pain. The underlying mechanisms, however, are not well documented. METHODS: Lumbosacral position sense was determined before, during, and after lumbar paraspinal muscle vibration in 23 young patients with low back pain and in 21 control subjects. Position sense was estimated by calculating the mean absolute error, constant error, and variable error between six criterion and reproduction sacral tilt angles. RESULTS: Repositioning accuracy was significantly lower in the patient group than in healthy individuals (absolute error difference between groups = 2.7 degrees, P < 0.0001). Multifidus muscle vibration induced a significant muscle-lengthening illusion that resulted in an undershooting of the target position in healthy individuals (constant error = -3.1 degrees, P < 0.0001). Conversely, the position sense scores of the patient group did not display an increase in negative directional error but a significant improvement in position sense during muscle vibration (P < 0.05). No significant differences in absolute error were found between the first and last trial in the healthy individuals (P >/= 0.05) and in the patient group (P > 0.05). CONCLUSIONS: Patients with low back pain have a less refined position sense than healthy individuals, possibly because of an altered paraspinal muscle spindle afference and central processing of this sensory input. Furthermore, muscle vibration can be an interesting expedient for improving proprioception and enhancing local muscle control.
Adolescent↗
Isokinetic evaluation of trunk muscles.
The purpose of this study is to identify those individuals at risk who have weak trunk muscles and are prone to back pain. The overall thrust of this research is to develop a quantitative method to assess dynamic strength of the trunk muscles. Two unique isokinetic strength testing units in sitting and standing postures have been designed. Three groups of volunteers were tested at different times and places. Quantitative measurements of the maximum strength, fatigue behavior of the abdominal and paraspinal muscles, maximum strength in different age groups and the role of the iliopsoas muscle have been performed. The study shows that women have lower maximum strength but equal or better fatigue endurance than men. There is a significant change in maximum strength with age. The maximum abdominal strength change with age showed a bimodal distribution. The iliopsoas muscle approximately doubled the maximum back strength in flexion. The test in the sitting posture was tolerated better than the test in the standing posture. Isokinetic back strength testing in the sitting posture was found to be effective and safe.
Abdominal Muscles↗
[Function of the trunk musculature in elite rowers].
In sports medicine, disorders of muscle function and muscular imbalance play an important role in both risk of injury and lack of improvement. They are highly important for the trunk muscle function, since low back pain is one of the most common disorders of sportsmen and is usually diagnosed as "functional disorder" without further specification. Despite its relevance, little is known about the specific capabilities of trunk muscle function in elite sportsmen. This study describes the measurement of trunk muscle torque, velocity, endurance and coordination in elite sportsmen. The study was performed by clinical examination and an isoinertial testing device (ISOSTATION-B200, Isotechnologies, Hillsborough, NC, USA). The results of a study of 20 German elite male rowers are presented and the relevance of these results is discussed in respect of their implications for training and therapy in injured athletes. Mean torques in extension and flexion were 319 Nm and 295 Nm, respectively. Elite rowers were stronger in isometric torque in all planes compared to normals and other sports groups, such as tennis players and swimmers. The better the rowing performance was, the lower was the extension/flexion ratio, the coordination and the decrease in velocity during endurance testing. This testing procedure is a useful tool in the measurement of trunk performance in elite sportsmen.
Adult↗
Somatosympathetic reflexes from the low back in the anesthetized cat.
In the appendicular skeleton, substantial evidence demonstrates that somatosensory input from deep tissues including limb muscles and joints elicits somatosympathetic reflexes. Much less is known about the presence and organization of these reflexes from the axial skeleton. We determined if mechanical loading of the lumbar spine and lumbar paraspinal muscle irritation reflexively affects postganglionic sympathetic nerve discharge (SND) to the spleen and kidney. In 27 alpha-chloralose-anesthetized cats, the L2-4 multifidus muscles were injected with the inflammatory irritant mustard oil (20%, 60 microl total) and a vertebral load (100% body weight) was applied dorsal-ventral at the L3 spinous process. Mustard oil injection alone without vertebral loading (n = 7) increased mean splenic SND (60%), renal SND (30%), and heart rate (HR; 52 bpm). Mustard oil injection accompanied by the vertebral load (n = 7) increased mean splenic SND (55%), renal SND (16%), and HR (27 bpm). Blood pressure changes were biphasic and could not account for these changes. When the vertebral load accompanied mustard oil, the increases in splenic SND, renal SND, and HR remained elevated in a pattern significantly different from when the vertebral load was absent. Vehicle injection combined with the mechanical load (n = 3) did not change any of the autonomic responses. Similarly, mustard oil injection combined with a mechanical load did not change these responses when either the medial branches of the dorsal rami from T11-L5 had been cut (n = 4) or when the spinal cord had been transected between the second and third cervical vertebrae (n = 6). The results indicate that inflammatory stimulation of multifidus muscle in the low back evokes a somatosympathetic reflex integrated supraspinally in the upper cervical spinal cord or higher. The reflex's afferent arm travels in the medial branch of the dorsal ramus, and its efferent arm can affect sympathetic outflow to the spleen and the kidney as well as HR and BP. A static mechanical load applied to the lumbar spine accompanying the inflammatory stimulus appears to sustain the inflammatory-induced reflex activity.
Anesthesia↗
[The role of non-progressive myopathies in the spontaneous rupture of tendons (author's transl)].
A series of non-progressive myopathies have been found (central core disease, centronuclear myopathy, myofibrillar dysproportion) when muscles of patients with spontaneous tendon ruptures were examined. Pathological muscle actions, uneven pulling force on the tendons, disturbances in the nervous feed-back between tendons and muscles and the role of myopathies in the alteration of resting and working muscle tone by affecting the type--I. muscle fibers are thought to be pathogenic factors in the spontaneous tendon ruptures associated with non-progressive myopathies.
Adult↗
Baseball batting. An electromyographic study.
The muscle firing pattern in 12 muscles throughout the lower extremity, trunk, and upper extremity during the batting swing is described in this study. The two hamstring muscles studied and the gluteal muscle had a similar pattern of high muscle activity during pre-swing and early swing, and then rapidly diminished. The vastus medialis demonstrated peak activity between 95 and 110% maximum muscle test (MMT) throughout the swing phases and follow-through. The erector spinae demonstrated activity from 85 to 185% MMT during the swing phases. The abdominal obliques showed greater than 100% MMT during the swing phases and follow-through. The supraspinatus and serratus anterior showed relatively low muscle activity (less than 40% MMT). These results show that batting is a sequence of coordinated muscle activity, beginning with the hip, followed by the trunk, and terminating with the arms. Power in the swing is initiated in the hip, and therefore exercises that emphasize such strength development are indicated. The maintained, high muscle activity in the trunk muscles indicates a need for back and abdominal stabilization and rotation exercises. The relatively low level of activity in the four scapulohumeral muscles tested indicated that emphasis should be placed on the trunk and hip muscles for a batter's strengthening program.
Abdominal Muscles↗
In vivo erector spinae muscle blood volume and oxygenation measures during repetitive incremental lifting and lowering in chronic low back pain participants.
STUDY DESIGN: A case control study. OBJECTIVES: Using metabolic gas analysis and near infrared spectroscopy, a comparison was made between healthy controls and chronic low back pain (LBP) participants on cardiorespiratory, erector spinae muscle blood volume, and oxygenation responses, and these variables were used to determine factors that best predict peak oxygen consumption (VO2peak). SUMMARY OF BACKGROUND DATA: To date, it is unknown how the cardiorespiratory and erector spinae muscles of chronic LBP persons respond to repetitive incremental lifting and lowering. With the advent of near infrared spectroscopy technology, it is now possible to noninvasively examine erector spinae muscle oxygen supply and utilization in vivo. Thus, by using metabolic gas analysis and near infrared spectroscopy technology simultaneously, it is now possible to compare the cardiorespiratory and erector spinae muscle responses of chronic LBP participants to that of healthy controls (no history of LBP) during incremental work to volitional fatigue. METHODS: Thirty-four participants with chronic LBP and 34 healthy controls completed the repetitive incremental lifting and lowering (2.25 kg x min) protocol from floor to table (height 76 cm) at 10 lifts . min to voluntary fatigue. RESULTS: The healthy controls had significantly greater VO2peak (mL x kg x min) and VO2peak (mL x kgLBM x min), peak mass lifted, test duration, and breathing frequency. Furthermore, healthy controls showed significantly greater change in muscle oxygenation and faster one-half recovery times. Multiple regression analysis indicated that approximately 97% of the variance in absolute VO2peak was predicted by cardiorespiratory variables in both groups, while muscle oxygenation aided in predicting VO2peak relative in the LBP participants. CONCLUSIONS: The results indicated that the chronic LBP participants demonstrated a reduced cardiorespiratory and erector spinae muscle response during repetitive incremental lifting and lowering to volitional fatigue as compared to the healthy controls.
Adolescent↗