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PubMed2000

[Spine stabilizing muscles in golfers].

Although golf is perceived as a sport with low risk for injury, majority of golf players complain about problems along the spine. One possible reason could be poor physical condition. To see if golf players in general show deficits in spine-stabilizing muscles, twenty-three male golfers without back pain were examined with regard to their maximal isometric strength of trunk muscles. They were compared with persons of same age and constitution that do no sports. The Golf players have highly significant stronger lumbar extensors and show muscular dysbalance in lateral flexors and rotators of the spine. Specific training for well-balanced strengthening of spine-stabilizing muscles seem to be advisable, because muscular dysbalance can contribute to the development of back pain.

Back Pain↗
PubMed1985

Biomechanical aspects of lumbar spine injuries in athletes: a review.

One of the areas of the body which is very often injured by athletes is the lower lack, or the lumbar area of the spine. This problem is of some concern to physical educators, athletic therapists, coaches, athletes, and physicians. The type of injury which occurs in the lumbar spine is dependent on the direction, magnitude, and the point of application of the forces to the spine. This part of the body is susceptible to injury due to the large forces which must be supported, which include the body weight and any external weights, as well as the forces due to very high accelerations of the body parts. Since the lumbar spine is the only connecting column between the upper and lower parts of the body, all the forces must be transmitted via these structures. There are two general techniques of calculating the forces on the lumbar spinal structures, a static approach and a dynamic approach. The static approach may be useful to calculate compression and shear forces on the spine in stationary positions as may be seen in weightlifting. However, the dynamics approach should be used to calculate the effects of the various weights and inertial forces on spinal structures. The most common types of lower back injuries found in athletes were: muscle strains, ligament sprains, lumbar vertebral fractures, disc injuries, and neural arch fractures. The most common serious athletic injury to the lower back was found to be neural arch fractures at the pars interarticularis, or the isthmus between the superior and inferior articular processes. These fractures are known as spondylolysis, or defect in the pars interarticularis of one side of the vertebrae; and spondylolisthesis, a bilateral defect in the pars interarticularis, often accompanied by forward displacement of the vertebral body. The sports in which lower back injuries commonly occurred were also examined, and it was determined that gymnastics, weightlifting and football were the sports in which the lower back is at greatest risk. In order to help to reduce, the high incidence of injuries to this area of the body, athletes should attempt to increase the strength of the abdominal muscles, and to maximize the flexibility of the lower back.

Adolescent↗
PubMed2000

Back and hip extensor activities during trunk flexion/extension: effects of low back pain and rehabilitation.

OBJECTIVE: To compare lumbar paraspinal, gluteus maximus, and biceps femoris muscle function during sagittal trunk flexion and extension in patients with chronic low back pain and healthy control subjects, and to assess the influence of rehabilitation in the back pain patients. DESIGN: A cross-sectional study comparing chronic low back pain patients and healthy controls, and a prospective follow-up in back pain patients during rehabilitation. SETTING: Physical medicine and rehabilitation clinic. SUBJECTS: Nineteen women with chronic low back pain, and 19 women without pain (controls). INTERVENTION: Five-week active outpatient rehabilitation (1 hour three times a week) guided by a physiotherapist, followed by 5-week self-motivated exercise at home. OUTCOME MEASURES: Subjects performed sagittal trunk flexion and extension while surface electromyogram was bilaterally recorded of paraspinal (L1-L2 level), gluteus maximus, and biceps femoris muscles. The muscle activity was assessed from the average electromyogram and the relative muscle activation onsets and their duration were calculated. RESULTS: During early flexion, lumbar paraspinal and biceps femoris were activated simultaneously before gluteus maximus. At the end of flexion and during extension all investigated muscles were activated and relaxed in order. Lumbar paraspinal and biceps femoris muscles were activated in a similar order in low back pain patients and healthy controls during flexion and extension. However, the duration of gluteus maximus activity was shorter in the back pain patients than in controls during the trunk flexion (p<.05), and it ended earlier during extension. Active rehabilitation did not change the muscle activities of lumbar paraspinal and biceps femoris in the back pain patients, but in the measurements after rehabilitation the onset of gluteus maximus activity occurred later in flexion and earlier in extension. CONCLUSIONS: The activity of the gluteus maximus muscle during the flexion-extension cycle was reduced in patients with chronic low back pain. The gluteal muscles should be taken into consideration in the rehabilitation of these patients.

Adult↗
PubMed2002

Effects of a standing aid on loads on low back and legs during dishwashing.

In order to prevent low back pain during dishwashing, we developed a standing aid for supporting the forward bending posture, and then evaluated the effects of the standing aid on decreasing load on the low back and legs. Eight female volunteers were asked to wash plates for 60 minutes in each of three working postures: (a) without the standing aid, (b) with the standing aid under the thighs, and (c) with the standing aid under the shins. The following were measured: electromyogram (EMG), electrocardiogram (ECG), the force applied to the standing aid, the ground reaction force, the bending angle of the trunk, the bending angle of the knee, and local discomfort in body regions. While using the standing aid under the shins, the muscle load decreased in the low back and legs. While using the standing aid under the thighs, the muscle loads decreased in the low back but increased in the legs. It was suggested that the standing aid under the shins was more effective in decreasing the load on the low back and legs than the standing aid under the thighs.

Adolescent↗
PubMed1999

Learned maintenance of pain: muscle tension reduces central nervous system processing of painful stimulation in chronic and subchronic pain patients.

The effect of level of muscle tension on the perception of painful stimuli was assessed in 13 chronic back pain patients, 14 subjects at high risk for chronic back pain, and 14 matched healthy controls. Subjects received painful intracutaneous electric stimuli to the forearm or the lower back while they produced either high or low muscle tension levels. Visual analog scale (VAS) ratings of acute pain were obtained after each trial. Electroencephalograms, electromyograms, skin conductance levels, and blood pressure were measured during the trials. Although subjective pain ratings were not significantly affected by muscle tension levels, the chronic pain patients displayed elevated N150 and N150/P260 amplitudes of the somatosensory-evoked potentials in the low as compared to the high muscle tension condition. The high risk group showed a trend toward higher N150 amplitudes in the low as compared to the high tension condition. The results of this study partially support the hypothesis that increases in muscle tension might serve as a pain-reducing mechanism in chronic pain patients and those at risk for chronicity, thus leading to a vicious pain-tension cycle.

Adult↗
PubMed2004

Does anticipation of back pain predispose to back trouble?

Limb movement imparts a perturbation to the body. The impact of that perturbation is limited via anticipatory postural adjustments. The strategy by which the CNS controls anticipatory postural adjustments of the trunk muscles during limb movement is altered during acute back pain and in people with recurrent back pain, even when they are pain free. The altered postural strategy probably serves to protect the spine in the short term, but it is associated with a cost and is thought to predispose spinal structures to injury in the long term. It is not known why this protective strategy might occur even when people are pain free, but one possibility is that it is caused by the anticipation of back pain. In eight healthy subjects, recordings of intramuscular EMG were made from the trunk muscles during single and repetitive arm movements. Anticipation of experimental back pain and anticipation of experimental elbow pain were elicited by the threat of painful cutaneous stimulation. There was no effect of anticipated experimental elbow pain on postural adjustments. During anticipated experimental back pain, for single arm movements there was delayed activation of the deep trunk muscles and augmentation of at least one superficial trunk muscle. For repetitive arm movements, there was decreased activity and a shift from biphasic to monophasic activation of the deep trunk muscles and increased activity of superficial trunk muscles during anticipation of back pain. In both instances, the changes were consistent with adoption of an altered strategy for postural control and were similar to those observed in patients with recurrent back pain. We conclude that anticipation of experimental back pain evokes a protective postural strategy that stiffens the spine. This protective strategy is associated with compressive cost and is thought to predispose to spinal injury if maintained long term.

Adult↗
PubMed1997

Organization of lumbosacral motoneuronal cell groups innervating hindlimb, pelvic floor, and axial muscles in the cat.

In a study on descending pathways from the nucleus retroambiguus (NRA) to hindlimb motoneurons (see accompanying paper), it appeared impossible, using data from the literature, to precisely determine which muscles were innervated by the motoneurons receiving the NRA fibers. This lack of data made it necessary to produce a detailed map of the lumbosacral motoneuronal cell groups in the cat. Therefore, 50 different muscles or muscle compartments of hindlimb, pelvic floor and lower back were injected with horseradish peroxidase (HRP) in 135 cases. The respective muscles were divided into ten groups: I, sartorius and iliopsoas; II, quadriceps; III, adductors; IV, hamstrings; V, gluteal and other proximal muscles of the hip; VI, posterior compartment of the distal hindlimb; VII, anterior compartment of the distal hindlimb; VIII, long flexors and intrinsic muscles of the foot; IX, pelvic floor muscles; and X, extensors of the lower back and tail. The L4-S2 segments were cut and incubated, and labeled motoneurons were counted and plotted. A new method was developed that made it possible, despite variations in size and segmental organization between the different cases, to compare the results of different cases. The results show that the spatial interrelationship between the hindlimb and pelvic floor lumbosacral motoneuronal cell groups remains constant. This finding enabled the authors to compose an accurate overall map of the location of lumbosacral motoneuronal cell groups. The general distribution of the motoneuronal cell groups is also discussed in respect to their dorsoventral, mediolateral, and rostrocaudal position within the lumbosacral ventral horn.

Animals↗
PubMed1993

Cross-sectional study of the isokinetic muscle trunk strength among school children.

Our surveys have shown lifetime prevalence of L.BP. over 30% among schoolchildren. The purpose of this study was to evaluate the relationship between back and isokinetic trunk strength, anthropometric parameters, and sports activities. One hundred and seventeen healthy children aged 10-16 years were included. All these volunteers had semi-structured interview, anthropometric and dynamic strength measurements. Lifetime prevalence of back pain was 44.5% and point prevalence was 13%. In this cross-sectional study, anthropometric and strength profiles were significantly related to age and gender. Non specific low back pain was not correlated to trunk muscle strength and/or sports activities.

Adolescent↗
PubMed1998

Effect of a back massage and relaxation intervention on sleep in critically ill patients.

BACKGROUND: Critically ill patients are deprived of sleep and its potential healing qualities, although many receive medications to promote sleep. No one has adequately evaluated holistic nonpharmacological techniques designed to promote sleep in critical care practice. OBJECTIVES: To determine the effects of (1) a back massage and (2) combined muscle relaxation, mental imagery, and a music audiotape on the sleep of older men with a cardiovascular illness who were hospitalized in a critical care unit. METHODS: Sixty-nine subjects were randomly assigned to a 6-minute back massage (n=24); a teaching session on relaxation and a 7.5-minute audiotape at bedtime consisting of muscle relaxation, mental imagery, and relaxing background music (n=28); or the usual nursing care (controls, n=17). Polysomnography was used to measure 1 night of sleep for each patients. Sleep efficiency index was the primary variable of interest. One-way analysis of variance was used to test for difference in the index among the 3 groups. RESULTS: Descriptive statistics showed improved quality of sleep among the back-massage group. Initial analysis showed a significant difference among the 3 groups in sleep efficiency index. Post hoc testing with the Duncan procedure indicated a significant difference between the back-massage group and the control group; patients in the back-massage group slept more than 1 hour long than patients in the control group. However, the variance was significantly different among the 3 groups, and reanalysis of data with only 17 subjects in each group revealed no difference among groups (P=.06). CONCLUSIONS: Back massage is useful for promoting sleep in critically ill older men.

Aged↗
PubMed1997

[Injection treatment of non-radicular lumbalgia].

Low back pain is the most expensive condition in industrialized countries. Approximately 65-80% of the population will be afflicted with low back pain at some point during their life. Low back pain has many causes and can originate from any of several pain-sensitive foci, among which are facet joints, sacroiliac joint, muscle and ligaments. Primary care in the acute phase consists of nonsteroidal anti-inflammatory drugs to address the biochemical and inflammatory mediators of pain or skeletal muscle spasmolytics to reduce low back pain symptoms. Injection procedures should be reserved for the patients with low back pain who fail to respond to a directed, conservative treatment trial and have had pain for at least 2 weeks duration. Eliminating sensation from a certain pain source has been proposed as a way to allow an examiner to determine if that joint is responsible for the patient's pain. Injections of local anesthetic into the facet joint or around its nerve supply are clinical methods of eliminating pain from focal areas such as facet joints or myofascial trigger points. When a particular joint is determined to be the source of pain, long-term relief can be sought by directing therapeutic interventions at that joint. The anatomic accessibility of the most common pain sources of low back pain make diagnostic blocks and therapeutic instillation of corticosteroids particularly appealing. If used, their potential benefit for the individual case needs to be carefully weighed. They should be used to facilitate more aggressive conservative care and not as an isolated treatment. Certainly, if response to corticosteroids does not occur after the first injection, no further administration of corticosteroids is indicated.

Adrenal Cortex Hormones↗
PubMed1981

Reverse smooth muscle plasty: a new method of treating anorectal incontinence in infants with high anal and rectal atresia.

A new technique of treating anorectal incontinence in infants with high anal and rectal atresia is described. In the first stage of this new operation an abdominosacroperineal pull-through procedure according to Rehbein, Romualdi, and Kiesewetter is performed. In the next step of this new method the circular and longitudinal muscle layers of the pulled-through colon are turned back 180 degree and fixed to the pulled-through bowel. The mucosa of the turned back bowel is removed. Then the whole muscle cuff is re-pulled into the puborectalis sling. Pressure studies as well as X-ray investigations showed a good sphincter function of the newly established internal sphincter equivalent.

Anal Canal↗
PubMed2002

[Case of hemophagocytic syndrome associated with active dermatomyositis].

We report a case of dermatomyositis (DM) with hemophagocytic syndrome (HPS). The patient is a 60 year old male admitted to our hospital with muscle weakness, high fever, weight loss and pancytopenia. On physical examination, proximal muscle weakness and skin rash on the back were noted. Laboratory data revealed elevated serum levels of muscle enzymes, lactate dehydrogenase and ferritin. Serum levels of M-CSF, TNF-alpha, soluble IL 2 receptor were remarkably increased. Bone marrow aspiration showed histiocytosis of 7 to 10% with prominent hemophagocytosis. Gastroendoscopic examination revealed II-a gastric cancer. He was treated with methylprednisolone (m-PSL) pulse theraphy (1 g/ day x 3 days) followed by 60 mg/day oral prednisolone. He quickly responded to the treatment and laboratory data returned to normal in 20 days despite the remaining gastric cancer which was removed successfully 3 months later. HPS is a rare complication of DM and only three cases have been documented so far in the literature. Augmented cytokine in his serum is considered to be closely related to HPS in this case.

Biomarkers↗
PubMed2003

Provision of tricuspid valve leaflets by septal papillary muscles in the right ventricle of human and other mammal hearts.

Leaflets of the tricuspid valve are provided by tendinous cords extending from the papillary muscles. The situation is complicated with the septal muscles, which generally occur in two groups, one as constant musculus coni arteriosi and the second as other variable septal muscles. We tested whether there is a variability in the provision of the tricuspid valve in different taxonomical groups of mammals. The material examined consisted of 299 hearts of mammals (Primates, Ungulata, Carnivora, Lagomorpha, Rodentia, Marsupialia). The musculus coni arteriosi in the majority of mammals provided only the front leaflet, but among Ungulata and Rodentia it provided simultaneously the front and septal leaflet. The other septal muscles provided the front, septal and even back leaflets. The following regularity was observed: in the hearts of Primates provision of the front leaflet and the front part of the septal leaflet predominated, among Ungulata the muscles provided the middle part of the septal leaflet, but among the other mammals the rest of the septal muscles provided, significantly, the back part of the septal leaflet. Such a provision was characteristic for predators, hares, rodents and marsupials. These circumstances may allow the conclusion to be drawn that there is a taxonomical dependence in the provision of the tricuspid valve in the hearts of the mammals under examination.

Animals↗
PubMedDate not supplied

Long-term results of hemihang-back lateral rectus recession.

PURPOSE: To report our long-term results with the hemihang-back technique for lateral rectus muscle recession in moderate- and large-angle exotropia. PATIENTS AND METHODS: The medical records of 144 consecutive patients who underwent unilateral or bilateral hemihang-back lateral rectus recession between 1999 and 2002 were reviewed. The amount of surgery performed was based on the distance exotropic deviation. Surgical outcomes were analyzed for all patients included in the study. RESULTS: A total of 66 patients met the inclusion criteria. Sixteen patients had undercorrection, but 6 of these patients redeveloped an exodeviation 6 months after the surgery. No overcorrections were observed in this study. CONCLUSION: The hemihang-back technique is a safe and effective alternative to conventional lateral rectus recession in patients with moderate- or large-angle exotropia.

Adolescent↗
PubMed1999

Biomechanical analysis of materials handling manipulators in short distance transfers of moderate mass objects: joint strength, spine forces and muscular antagonism.

Although often suggested as a control measure to alleviate musculoskeletal stresses, the use of mechanical assistance devices (i.e. manipulators) in load transfers has not been extensively studied. Without data describing the biomechanical effects of such devices, justification for decisions regarding implementation of such tools is difficult. An experimental study of two types of mechanical manipulators (articulated arm and overhead hoist) was conducted to determine whether biomechanical stresses, and hence injury risk, would be alleviated. Short distance transfers of loads with moderate mass were performed both manually and with manipulator assistance under a variety of task conditions. Using analysis and output from new dynamic torso models, strength demands at the shoulders and low back, lumbar spine forces, and lumbar muscle antagonism were determined. Strength requirements decreased significantly at both the shoulders and low back when using either manipulator in comparison with similar transfers performed manually. Peak spine compression and anterior-posterior (a-p) shear forces were reduced by about 40% on average, and these reductions were shown to be primarily caused by decreases in hand forces and resultant spinal moments. Two metrics of muscular antagonism were defined, and analysis showed that torso muscle antagonism was largest overall when using the hoist. The results overall suggest that hoist-assisted transfers, although better in reducing spine compression forces, may impose relatively higher demands on coordination and/or stability at extreme heights or with torso twisting motions. The relatively higher strength requirements and spine compression associated with the articulated arm may be a result of the high inertia of the system. Potential benefits of practice and training are discussed, and conclusions regarding implementation of mechanical manipulators are given.

Adult↗
PubMed1992

Action of human respiratory muscles inferred from finite element analysis of rib cage.

The actions of several human respiratory muscles have been inferred from finite element analysis of the rib cage. The human model is based on anatomic and mechanical measurements in dogs and human cadavers. As in an earlier canine model, the external and internal (interosseous) intercostal muscles were found to cause, respectively, inspiratory and expiratory displacements of the rib cage, in agreement with the two-dimensional geometric analysis of Hamberger. When extended to three dimensions, Hamberger's analysis helps explain why muscles at the side of the rib cage produce changes in the anteroposterior diameter, whereas muscles at the front and back of the rib cage cause changes in the transverse diameter.

Humans↗
PubMed2001

Classification of problems, clinical findings and treatment goals in patients with low back pain using the ICIDH-2 beta-2.

PURPOSE: This study aimed to explore problems, clinical findings and treatment goals presented by patients with low back pain and their physiotherapists, and to which extent this information could be classified according to the ICIDH-2 Beta-2. METHOD: An explorative field trial of 12 physiotherapists and 28 patients with low back pain in outpatient practices. RESULTS: Pain and impairments related to muscles, joints and structures of the lower back, pelvis and hips were most often presented. Functioning related to daily activities and participation in society was often described in the treatment goals, but vaguely formulated. Most of the problems and clinical findings could be classified according to the ICIDH-2 Beta-2. However, several treatment goals could not be classified. CONCLUSIONS: There was a lack of specification in several of the detailed codes of the Body, Function and Structure Dimension, particularly regarding classification of pain and muscle functions. The main limitation concerned the detailed version of the Body Function and Structure Dimension, which provided no additional precision compared with the short version when classifying pain and other impairments. However, the ICIDH-2 offers a tool to enhance the precision of clinical findings and the possibilities for performing a multidimensional evaluation of functioning related to patients with low back pain.

Adult↗