Chronic Musculoskeletal Injury Research Articles

Sex, training variables, history of chronic disease, and chronic injury are risk factors associated with a history of exercise-associated muscle cramping in 10,973 ultramarathon race entrants: a safer XXXVIII study.

The prevalence of a history of exercise-associated muscle cramping (hEAMC) among ultramarathon runners is high. While the Comrades is one of the most popular mass community-based participation ultramarathons (90 km) globally, research on the epidemiology, clinical characteristics, and risk factors of entrants' lifetime hEAMC are scarce. This research aimed to describe the epidemiology, clinical characteristics, and risk factors of hEAMC among Comrades Marathon entrants. This was a retrospective, cross-sectional study in which 10973 race entrants of the 2022 Comrades Marathon participated. Entrants completed a prerace medical screening questionnaire that included questions related to the lifetime prevalence (%; 95% CI), severity, treatment and risk factors (demographics, training/racing variables, chronic disease/allergies, injury) for EAMC. One thousand five hundred eighty-two entrants reported hEAMC in their lifetime (14.4%; 95% CI: 13.77-15.09). There was a significantly (P<0.01) higher prevalence of male (16.10%; 95% CI:15.34-16.90) than female (8.31%; 95% CI: 7.27-9.50) entrants with hEAMC (PR=1.94; 95% CI:1.68-2.23). The prevalence of hEAMC was highest in entrants with a: 1) 1 disease increase in composite disease score (PR=1.31; 95% CI:1.25-1.39); 2) history of collapse (PR=1.87; 95% CI 1.47-2.38); 3) past chronic musculoskeletal (MSK) injury (PR=1.71; 95% CI 1.50-1.94); and 4) MSK injury in the previous 12 months (PR=2.38;95% CI: 2.05-2.77). Training-related risk factors included an increase of 10 km weekly running distance (PR=0.97; 95% CI:0.95-0.99) and a training pace increase of 1min/ km (slower) (PR=1.07; 95% CI:1.03-1.12). Future research should investigate the causal relationship between risk factors identified and hEAMC in ultramarathon runners. Findings from this study could assist in effective anticipation and adequate planning for treating EAMC encounters during community-based mass participation events.

Assessment of muscle activity and fatigue during laparoscopic surgery.

Cumulative musculoskeletal stress during operative procedures can contribute to the development of chronic musculoskeletal injury among surgeons. This is a concern in laparoscopic specialties where trainees may incur greater risk by learning poor operative posture or technique early in training. This study conducted an initial investigation of the physical stress encountered during the conduct of foregut laparoscopic surgery. Subjects were divided into two groups based on their surgical experience level, high experience (HE), consisting of two attending surgeons, and low experience (LE), consistingof two fellow surgeons and a surgical chief resident. Nine distinct foregut laparoscopic procedures were observed for data collection within these groups. Electromyographic (EMG) activity was collected at the bilateral neck, shoulders, biceps, triceps, and lower back for each procedure. Physical workload was measured using percent reference voluntary contractions (%RVC) for each surgeon's muscle activities. Fatigue development was assessed using the median frequency of EMG data between two consecutive cases. Subjects completed a NASA-TLX survey when surgery concluded. LE surgeons experienced higher levels of %RVC in the lower back muscles compared to HE surgeons. LE fatigue level was also higher than HE surgeons across most muscle groups. A decrease in median frequency in six of the ten muscle groups after performing two consecutive cases, the largest decrements being in the biceps and triceps indicated fatigue development across consecutive cases for both surgeon groups. Surgeons developed fatigue in consecutive cases while performing minimally invasive surgery (MIS). HE surgeons demonstrated a lower overall physical workload while also demonstrating different patterns in muscle work. The findings from this study can be used to inform further ergonomic studies and the data from this study can be used to develop surgical training programs focused on the importance of surgeon ergonomics and minimizing occupational injury risk.

Adding Ozone to Dextrose and Somatropin for Intra-articular Knee Prolotherapy: A Randomized Single-Blinded Controlled Trial.

BackgroundProlotherapy, as an alternative therapy, has emerged as an effective treatment for chronic musculoskeletal injury, including knee osteoarthritis (OA). Several studies have mention ozone as a potential treatment for these diseases, which is based on analgesic, anti-inflammatory, and anti-oxidant.ObjectivesThe current study aimed to investigate the effect of adding ozone gas to hypertonic dextrose and somatropin for knee prolotherapy in patients with knee OA. For this purpose, pain, knee stiffness, and physical activity are measured.MethodsSixty patients with chronic knee OA were randomly assigned into two groups of DS and DSO. The DS group received intra-articular hypertonic dextrose (10 ml) plus 4 IU somatropin (4 IU), and the DSO group received 10 ml ozone 25 mcg plus intervention in the DS group. This procedure was performed three times (first, third, and fifth weeks). WOMAC score was examined during the third, fifth, and sixteenth weeks.ResultsThe mean WOMAC score of the DS group was decreased significantly (P < 0.001) sixteen weeks after providing the intervention (before 64.9 ± 10.6, vs. after 49.2 ± 9.0). A similar decrease (P < 0.001) was observed in the DSO group (before 64.1 ± 11.3, vs. after 41.3 ± 8.0). The decrease of the WOMAC score in the third and sixteenth weeks after providing the intervention was significant in the DSO group compared to the DS group (P < 0.005).ConclusionsFor patients with knee OA, prolotherapy with ozone plus hypertonic dextrose and somatropin was more effective in sedating the pain and improving the stiffness and function of the knee than dextrose and somatropin alone.

Platelet-rich plasma in orthopaedic sports medicine: state of the art

Platelet-rich plasma (PRP) is one of the many new developments within the expanding field of regenerative medicine. It aims to improve the process of tissue repair through local delivery of autologous bioactive agents to influence critical physiological mechanisms such as inflammation, angiogenesis or extracellular matrix synthesis. Within orthopaedics and sports medicine, the use of PRP has been rapidly increasing in popularity as patients seek non-surgical approaches to acute and chronic musculoskeletal injury and disease. The popularity of this new treatment option has prompted a rapid increase in research endeavours. Although preclinical studies were encouraging, clinical studies often reported controversial results. The differences in the composition and application techniques of PRP have made comparisons regarding its efficacy difficult and somehow inconclusive. Although PRP appears to be a safe treatment option with potentially beneficial effects to injured musculoskeletal tissues, continuous efforts are needed to identify factors that influence the biological response to PRP treatment. It is likely that in the near future the PRP preparation will be tailored not only to the specific pathology of interest but also to stage of disease. However, the growing emphasis on an evidence-based approach in the sports medicine setting demands additional research efforts before incorporating this technology in routine clinical care. The current review explores the latest findings on PRP efficacy in several musculoskeletal conditions, focusing on results of the highest level of evidence available.

PO-293 Relationship Between Gross Motor Skill Proficiency and Health-Related Physical Fitness Among Children with Down Syndrome

PO-293 Relationship Between Gross Motor Skill Proficiency and Health-Related Physical Fitness Among Children with Down Syndrome

Acute and chronic musculoskeletal injury in para-sport: A systematic review

The health benefits of sport are myriad, but sport also carries an inherent risk of injury. This systematic review summarizes musculoskeletal injury epidemiology in elite and recreational para-athletes, and highlights research gaps. Five electronic databases were searched for relevant articles: Ovid Medline, Ovid Medline In Process & Other Non-Indexed Citations, Ovid Embase, Cumulative Index to Nursing and Allied Health (CINAHL), and Web of Science. Evaluation and data extraction were performed by two independent examiners. Inclusion criteria were: (a) written in English; (b) published in a peer-reviewed journal between January 1975 and June 2017; (c) describe para-athletes participating in recreational or elite sport; and (d) describe sports-related, acute traumatic or chronic overuse musculoskeletal injury. Fifty full-text manuscripts were reviewed. Seated para-athletes sustain upper extremity injuries more commonly, while ambulant para-athletes frequently sustain lower extremity injuries. The upper extremity, including shoulder, elbow, wrist/hand, is the most commonly injured anatomical area in all para-athletes, unlike able-bodied athletes for whom lower extremity injuries predominate. Increased age and spinal cord injury may increase risk of upper extremity injury. Sprains, strains, blisters and lacerations are the most common injuries among paralympians, but winter paralympic sports carry higher risk of head injury, fracture and contusion, possibly due to the high-velocity elements. Male and female summer paralympic athletes have similar overall injury rates, and football 5-a-side, para-powerlifting, goalball, wheelchair fencing, and wheelchair rugby are consistently highest-risk sports. Para-ice hockey, alpine skiing, and snowboarding are highest-risk winter sports. Upper and lower extremity injury rates match in winter sport, unlike summer sport trends. Injury data for recreational and youth para-athletes are sparse. MSK injury epidemiology data continues to mature. Recreational and youth athletes remain under studied. Updating such data may accelerate the development of injury prevention strategies and lifetime injury models for para-athletes.

Investigation on prevalence of chronic musculoskeletal injury among nursing staff of old-age welfare

Objective To investigate the prevalence and influencing factors of chronic musculoskeletal injury (CMI) among nursing staff of old-age welfare in Urumqi city, to find out the awareness and implementation of preventive measures for chronic musculoskeletal injury, and the demand on new life support technology. Methods This study looked after chronic musculoskeletal injury situation questionnaire, in April 2015 form 1st to 30th in urumqi 8 nursing work of old-age nursing staff to carry out the questionnaire. Results A total of the 200 old-age nursing staff, the effective response rate of 183 (91.5%). Old-age nursing researchers report in the past week have the CMI hair author 169 people (92.3%). Occurrence of CMI in gender, educational background, whether on the thought of leaving post was statistically different (χ2=8.36,16.14,14.05, P<0.05). Higher occurrence of CMI was found in the nursing process of showering and washing hair [81.4% (149/183)], transition between wheelchair and bed [63.9% (117/183)], and changing body position in bed [61.2% (112/183)]. The most common site of CMI occurrence were namely back [84.7% (155/183)], shoulder [54.1% (99/183)], lower limbs [35.0% (64/183)] and upper limbs [30.1% (55/183)].Only 31 (16.9%) knew new life support technology which can prevent and reduce CMI. 178(97.3%) reported having needs to use new life support technology, and 179 (97.8%) were willing to participate in relevant technology. Conclusions Prevalence of CMI among nursing staff of old-age welfare in Urumqi region was high. It was related to many factors. Most of nursing staff have needs on life support techniques. Measures should be taken to prevent and reduce the occurrence of CMI among nursing staff of old-age welfare to improve work efficiency. Key words: Nursing staff of old-age welfare; Chronic musculoskeletal injury; Awareness of preventive measures; Life support technology

The emerging use of platelet-rich plasma in musculoskeletal medicine.

Platelet-rich plasma (PRP) is one of many new developments within the expanding field of regenerative medicine. Specialists in areas such as orthopedics, physical medicine and rehabilitation, and rheumatology have been exploring the benefits of this novel therapy. Although PRP therapy remains controversial and has minimal clinical trial support, the use of orthobiologics such as PRP continues to advance as patients seek nonsurgical approaches to acute and chronic musculoskeletal injury and disease. However, academic acceptance as well as insurance reimbursement remain reliant on solid and repeatable positive results from large clinical trials. The authors summarize the evolution of PRP therapy and report on its status.

Common acute and chronic musculoskeletal injuries among female adolescent field hockey players in KwaZulu-Natal, South Africa

Objective. To document the prevalence and nature of musculoskeletal injuries among female adolescent hockey players over a 12-month period (1 November 2011 - 31 October 2012). Methods. Data were collected from 148 high school players who belonged to the KwaZulu-Natal Hockey League via voluntary, parentalinformed consent. Players completed a self-report musculoskeletal questionnaire probing the prevalence and nature of acute and chronic injuries. Probability was set at p ≤0.05. Results. Ninety-four players sustained acute musculoskeletal injuries in the 12-month study period, indicating the knee (23%) and lower back (18%) to be the most prevalent sites of injury ( p <0.001). The mechanisms producing the acute injuries were rapid rotational movement (36%) and physical trauma (63%) ( p <0.05). The hip/lower back was the most prevalent anatomical site of chronic musculoskeletal injury ( p <0.001). The intrinsic factors predisposing players to chronic hip/lower-back injury were hip flexion contractures and posture ( p <0.05). Conclusion. Hockey players experience a high prevalence of acute musculoskeletal knee injuries and chronic hip/lower-back injuries. The hockey fraternity should be educated about the various ways in which to prevent injury by complying with appropriate training regimes, alterations in technique and stretching exercises.

Effectiveness and Safety of Topical versus Oral Nonsteroidal Anti-inflammatory Drugs: A Comprehensive Review

Introduction: Topical nonsteroidal anti-inflammatory drugs (NSAIDs) represent a relatively recent alternative to oral NSAIDs. Topical NSAIDs are designed to target their therapeutic effect locally to damaged tissue while minimizing systemic exposure. To better inform patients considering topical NSAIDs as an alternative to oral NSAIDs, this is the first comprehensive review to present all available evidence comparing topical NSAIDs with oral NSAIDs in the treatment of both acute and chronic musculoskeletal injury. Methods: Six studies, including 600 subjects, compared the use of topical versus oral NSAIDs in the treatment of a variety of acute injuries. Nine trials, including 2403 subjects, studied topical versus oral NSAIDs for chronic injury treatment, almost exclusively for osteoarthritis (OA) of the knee. This review included all available comparative studies, the majority of which were well-designed, double-dummy, placebo-controlled trials. Relevant meta-analyses were also reviewed. Results: Topical and oral NSAIDs performed statistically better than placebo for chronic injury treatment. Limited evidence comparing topical NSAIDs with placebo for acute injury treatment was available in the included studies, but supported greater effectiveness for topical NSAIDs. In all head-to-head comparisons, topical and oral NSAIDs demonstrated similar efficacy for treatment of both acute and chronic injuries. There were more gastrointestinal side effects in patients receiving oral NSAIDs, while local skin reactions occurred more frequently in patients treated with topical NSAIDs. Conclusion: Overall, topical NSAIDs may be considered as comparable alternatives to oral NSAIDs and are associated with fewer serious adverse events (specifically GI reactions) when compared with oral NSAIDs. Caution should be exercised with the use of both topical and oral NSAIDs, including close adherence to dosing regimens and monitoring, particularly for patients with previous adverse reactions to NSAIDs.

Financial Strain and Loss of Psychosocial Benefits of Work Mediate the Relationship between Sickness Absence and Depression among People with Work Disability

This study examined the relationship between sickness absence from work, loss of the benefits of employment, and depression in injured workers. A sample of 112 clients of Australian occupational rehabilitation service providers were the participants: (men = 56; women = 56; mean age = 45.25 years, SD = 10.34). Each had a chronic (&gt;3 months) work-related musculoskeletal injury; 49% were sickness absent (n = 55) and 51% were partially fit and performing modified duties (n = 57). All completed self-report measures of the nature and duration of sickness absence, access to the benefits of employment, and severity of depression symptoms. Bootstrapping mediational analyses found that the relationship between duration of sickness absence and depression was fully mediated by financial strain and psychosocial benefits of employment. Financial strain was also the strongest predictor of depression in circumstances of sickness absence, but collective purpose was the strongest predictor when modified duties were being performed. These findings support injury management policies aimed at minimising injured workers' social and physical separation from the workplace and assisting sickness absent workers to maintain connections with their work team.

Post‐exercise massage affects skeletal muscle gene expression

Massage therapy is commonly prescribed for individuals that suffer from chronic pain, inflammation, or musculoskeletal injury. Despite the widespread belief that massage augments muscle repair and reduces inflammation, there is little objective, scientific evidence to support its practice. Therefore, the purpose of this study was to evaluate the molecular effects of massage following a single unaccustomed bout of exercise. Eleven recreationally active, healthy males (age 22±1 yrs, VO2peak 46±2 ml·kg−1·min−1) volunteered to participate in this study. Each subject completed an exhaustive endurance cycling protocol. After 15 mins of recovery, one quadricep was randomly chosen for 10 mins of massage (MASS) and the contralateral leg served as a control (CON). Muscle biopsies were acquired from the vastus lateralis at rest, immediately following massage, and 2.5h after massage was administered. Histology revealed that exercise induced significant muscle damage from rest at 2.5h (P&lt;0.05), however there was no effect of massage (P&gt;0.05). No differences were seen between CON or MASS in the oxidative stress markers 4HNE or protein carbonyls at any timepoint (P&gt;0.05). Gene microarray analysis displayed 4 genes that were differentially expressed (P&lt;0.05) for MASS vs CON immediately following massage as well as 11 genes at 2.5h that relate to pathways of inflammation and cellular remodeling. In summary, these data provide evidence that massage stimulates molecular events that may justify its use in the remediation of muscle injury. (Supported by NSERC Canada).

Response of Knee Ligaments to Prolotherapy in a Rat Injury Model

Background Prolotherapy is an alternative therapy for chronic musculoskeletal injury including joint laxity. The commonly used injectant, D-glucose (dextrose), is hypothesized to improve ligament mechanics and decrease pain through an inflammatory mechanism. No study has investigated the mechanical effects of prolotherapy on stretch-injured ligaments. Hypotheses Dextrose injections will enlarge cross-sectional area, decrease laxity, strengthen, and stiffen stretch-injured medial collateral ligaments (MCLs) compared with controls. Dextrose prolotherapy will increase collagen fibril diameter and density of stretch-injured MCLs. Study Design Controlled laboratory study. Methods Twenty-four rats were bilaterally MCL stretch-injured, and the induced laxity was measured. After 2 weeks, 32 MCLs Were injected twice, 1 week apart, with either dextrose or saline control; 16 MCLs received no injection. Seven uninjured rats (14 MCLs) were additional controls. Two weeks after the second injection, ligament laxity, mechanical properties (n = 8), and collagen fibril diameter and density (n = 3) were assessed. Results The injury model created consistent ligament laxity (P < .05) that was not altered by dextrose injections. Cross-sectional area of dextrose-injected MCLs was increased 30% and 90% compared with saline and uninjured controls, respectively (P < .05). Collagen fibril diameter and density were decreased in injured ligaments compared with uninjured controls (P < .05), but collagen fibril characteristics were not different between injured groups. Conclusion Dextrose injections increased the cross-sectional area of MCLs compared with saline-injected and uninjured controls. Dextrose injections did not alter other measured properties in this model. Clinical Relevance Our results suggest that clinical improvement from prolotherapy may not result from direct effects on ligament biomechanics.

Canadian Guidelines for Exercise in Pregnancy

The need for guidelines for exercise during pregnancy and the postpartum period was stimulated during the early 1980s when active women of the “baby boom” generation became interested in whether it was safe to continue their active lifestyles during pregnancy. As a result of the strong demand for information, important questions were raised concerning the risk/benefit ratio of such exercise. Postulated risks included the possibility that the fetus may be forced to compete with contracting maternal skeletal muscle for oxygenated blood flow (leading to fetal hypoxia and distress), essential substrates (leading to fetal growth restriction), and heat dissipation (leading to fetal hyperthermia and potential teratogenic effects). Concern was also expressed that exercise may increase the chance of early miscarriage, spontaneous abortion, and premature labor, as well as chronic fatigue and musculoskeletal injury. Putative benefits included maintenance of prenatal aerobic and musculoskeletal fitness levels, prevention of excessive maternal weight gain, facilitation of labor and recovery from labor, promotion of good posture, prevention of gestational glucose intolerance and low back pain, and improved psychological adjustment to the changes of pregnancy. As a result of the conflict between these postulated benefits and risks, the idea that a dose-response relationship existed between the quantity and quality of exercise and maternal/fetal well-being quickly emerged (Fig. 1). The concept that exercise is safe for some pregnant women but not others also led to the need for absolute and relative medical contraindications to exercise and the need for medical screening by a qualified health care provider before engaging in fitness training after becoming pregnant. As a result of a lack of scientific information, early guidelines for exercise during pregnancy were necessarily conservative and based primarily on common sense and Note: A copy of the Physical Activity Readiness Medical Examination for Pregnancy can be obtained from the Internet at: www.csep.ca/forms.asp Correspondence: Larry A. Wolfe, PhD, School of Physical and Health Education, Queen’s University, Kingston, Ontario K7L 3N6, Canada. E-mail: wolfel@post. queensu.ca CLINICAL OBSTETRICS AND GYNECOLOGY Volume 46, Number 2, 488–495 © 2003, Lippincott Williams & Wilkins, Inc.