Common Musculoskeletal Disorders Research Articles

Ferroptosis: A New Direction in the Treatment of Intervertebral Disc Degeneration.

Intervertebral disc degeneration (IVDD) is one of the most common musculoskeletal disorders in middle-aged and elderly people, and lower back pain (LBP) is the main clinical symptom [1, 2], which often causes significant pain and great economic burden to patients [3]. The current molecular mechanisms of IVDD include extracellular matrix degradation, cellular pyroptosis, apoptosis, necrotic apoptosis, senescence, and the newly discovered ferroptosis [4, 5], among which ferroptosis, as a new hot spot of research, has a non-negligible role in IVDD. Ferroptosis is an iron-dependent cell death caused by lipid peroxide accumulation [6]. Its main mechanism is cell death caused by lipid peroxidation by oxygen radicals due to iron overload and inhibition of pathways such as SLC7A11-GSH-GPX4. Currently, more and more studies have found a close relationship between IVDD and ferroptosis [7]. In the process of ferroptosis, the most important factors are abnormal iron metabolism, increased ROS, lipid peroxidation, and abnormal proteins such as GSH, GPX4, and system XC-. Our group has previously elucidated the pathogenesis of IVDD in terms of extracellular matrix degradation, myeloid cell senescence and pyroptosis, apoptosis, and inflammatory immunity. Therefore, this time, we will use ferroptosis as an entry point to discover the new mechanism of IVDD and provide guidance for clinical treatment.

Comparison of wrist range of motion and muscle strength in assembly workers with and without lateral epicondylitis.

Lateral epicondylitis (LE), also called tennis elbow, is a common musculoskeletal disorder that causes pain in the elbow area and is highly prevalent in assembly workers who repeatedly move their wrists. The purpose of this study was to compare the wrist ROM and muscle strength of assembly workers with and without LE. Forty-five male assembly line workers (23 with LE) participated in the study. Participants had their wrist range of motion (flexion, extension, ulnar deviation, and radial deviation) and strength (wrist flexors, extensors, and hand grip) measured using Smart KEMA sensors. Workers with LE showed significantly reduced wrist extension and radial deviation ROM compared to workers without LE, with no significant differences in wrist flexion and ulnar deviation ROM between groups. Workers with LE had significantly lower wrist extensor strength compared to workers without LE, and there was no significant difference in wrist flexor and grip strength between the two groups. For workers with LE, the difference in wrist ROM and muscle strength will be useful for planning intervention and evaluating treatment outcomes for assembly workers with LE.

A network pharmacology-based study to investigate the mechanism of curcumin-regulated regenerative repair of quadriceps femoris muscle in KOA rats

BackgroundKnee osteoarthritis (KOA) is a very common musculoskeletal disorder, and patients with KOA often exhibit significant quadriceps femoris muscle atrophy. It is well established that curcumin (CUR) exerts protective effects on skeletal muscle. However, the efficacy of CUR in treating KOA-induced quadriceps femoris muscle atrophy and its underlying mechanisms remain uncertain. In this study, we employed network pharmacology to investigate the mechanism by which CUR promotes regenerative repair of the quadriceps femoris muscle in rats with KOA. MethodsThe potential targets of CUR were obtained from Swiss Target Prediction. The targets of skeletal muscle regeneration were identified from GeneCard and OMIM. A Venn diagram was generated to visualize the intersection of CUR targets and skeletal muscle regeneration targets, and the core targets were identified using STRING. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were conducted using DAVID. Finally, the network pharmacology results were further validated by establishing a KOA rat model using the Hulth method. ResultsNetwork pharmacology analysis and molecular docking results revealed that CUR affects skeletal muscle regeneration through multiple targets and pathways. In vivo experimental results were validated by demonstrating that KOA causes atrophy and induces apoptosis in the quadriceps femoris muscle. Furthermore, CUR was shown to inhibit apoptosis in the quadriceps femoris muscle by regulating STAT3 and FOS, as well as the PI3K/AKT signaling pathway. ConclusionsOur study revealed the apoptosis-inhibiting effects of CUR and its underlying mechanisms. Consequently, CUR has the potential to improve quadriceps femoris muscle atrophy caused by KOA.

Adverse events in India’s Ayush interventions for cervical and lumbar spondylosis: a systematic review

IntroductionLow back and neck pain are common musculoskeletal disorders with multiple treatment options. India’s traditional medical systems, known as Ayush (Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy) offer range of interventions and are widely used. In view of limited documentation of adverse events following Ayush interventions for lumbar and cervical spondylosis, we synthesized evidence and estimated proportion of studies reporting adverse events.MethodsWe systematically searched all published documents from biomedical and multidisciplinary abstract and citation databases and Ayush-specific repositories from their inception to April 2021. We selected studies as per inclusion criteria and extracted information, adhering to PRISMA guidelines. We systematically reviewed the qualitative evidence form the selected studies.ResultsMajority (94%) of the selected 113 studies were interventional studies and included 77 (68.1%) journal articles and 35 (31%) academic dissertations. Among the Ayush systems, considerable proportion was from Ayurveda (32.7%), followed by Siddha (24.8%), Yoga (22.1%), Unani (15.9%) and Homoeopathy (4.4%). Almost three-fourths of the studies were on lumbar spondylosis (65%; n = 74), followed by cervical spondylosis (31%; n = 35), and the remaining four included both. Thirteen percent of the 113 studies described adverse events [Yoga = 9.7%; Unani = 1.8% and Homoeopathy = 1.8%]. More adverse events were reported among the studies on lumbar (9.7%) than cervical spondylosis (2.7%). The nature of interventions were non-pharmacological (10.6%; n = 12), pharmacological (n = 2; 1.8%) or combined (n = 1; 0.9%).ConclusionsOnly one in eight studies reported any adverse event following Ayush interventions for cervical and lumbar spondylosis. There could be certain degree of underreporting of adverse events and requires further exploration.PROSPERO Registration ID CRD42020167433.

Prevalence of Low Back Pain and Association Factors Among Operating Room Personnel of Ahvaz Hospitals: A Cross-Sectional Study

Background: Low back pain is a common musculoskeletal disorder among healthcare specialty nurses. Operating room staff are particularly susceptible to experiencing low back pain due to the nature of their work. Objectives: We conducted a study to investigate the prevalence of low back pain and the factors associated with it. Methods: A cross-sectional study was conducted on 323 operating room staff from five hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences. Data was collected using a questionnaire developed by Tavakol et al. This questionnaire included demographic information and assessed the prevalence and dimensions of low back pain. The data was analyzed using IBM SPSS v.26. Results: The results showed that the prevalence of low back pain (LBP) was 74.3%. In this study, 64.8% of the personnel were women, 63.5% were married, and 72.4% had a bachelor's degree. Additionally, 87% had no history of smoking. The average age was 33.83 ± 7.02 years. There was a significant relationship between the prevalence of LBP and gender (P = 0.044), marital status (P = 0.0001), BMI (P = 0.008), age (P = 0.0001), shift work (P = 0.001), work experience (P = 0.0001), and the average number of shifts (P = 0.037). Conclusions: We found a high prevalence of LBP among operating room personnel, which is related to both individual and occupational factors. Our recommendations for nursing managers include modifying work shifts, allocating less physically demanding tasks to senior personnel and females, and implementing educational programs that focus on improving ergonomics and reducing physical strain.

The Effect of Probiotics on the Management of Pain and Inflammation in Osteoarthritis: A Systematic Review and Meta-Analysis of Clinical Studies.

Osteoarthritis (OA) is one of the most common musculoskeletal disorders. Recently, research has focused on the role of intestinal microbiome dysbiosis in OA. The aim of this study was to systematically review randomized intervention clinical studies investigating the effect of probiotics on the management of OA-related pain and inflammation. Pre-clinical studies and non-randomized trials were excluded. A literature search was conducted using MEDLINE, EMBASE, and Web of Science. Study quality was assessed with the Cochrane risk of bias (RoB2) tool and the Risk of Bias in N-of-1 Trials (RoBiNT) scale. RevMan was used for the meta-analysis. Outcome measures assessed self-reported pain, stiffness and impediment, and serum hs-CRP. Three studies, with 501 participants, were considered eligible for qualitative synthesis and meta-analysis. A significant reduction in symptoms across all outcomes measured, except stiffness, was evident with Lactobacillus casei Shirota. However, all other probiotics reviewed did not seem to have any effect on the measured outcomes. Pre-clinical evidence, along with the RCTs reviewed, suggests that probiotics of the Lactobacillus strains might be of use for managing pain and inflammation in OA. Considering the small number of studies included in the present review and the possible risk of bias, we conclude that further studies on the role of probiotics in humans with OA are warranted.

Fibromyalgia: A Review of the Pathophysiological Mechanisms and Multidisciplinary Treatment Strategies.

Fibromyalgia is a syndrome characterized by chronic widespread musculoskeletal pain, which may or may not be associated with muscle or joint stiffness, accompanied by other symptoms such as fatigue, sleep disturbances, anxiety, and depression. It is a highly prevalent condition globally, being considered the third most common musculoskeletal disorder, following lower back pain and osteoarthritis. It is more prevalent in women than in men, and although it can occur at any age, it is more common between the ages of thirty and thirty-five. Although the pathophysiology and etiopathogenesis remain largely unknown, three underlying processes in fibromyalgia have been investigated. These include central sensitization, associated with an increase in the release of both excitatory and inhibitory neurotransmitters; peripheral sensitization, involving alterations in peripheral nociceptor signaling; and inflammatory and immune mechanisms that develop concurrently with the aforementioned processes. Furthermore, it has been determined that genetic, endocrine, psychological, and sleep disorders may influence the development of this pathology. The accurate diagnosis of fibromyalgia remains challenging as it lacks specific diagnostic biomarkers, which are still under investigation. Nonetheless, diagnostic approaches to the condition have evolved based on the use of scales and questionnaires for pain identification. The complexity associated with this pathology makes it difficult to establish a single effective treatment. Therefore, treatment is multidisciplinary, involving both pharmacological and non-pharmacological interventions aimed at alleviating symptoms. The non-pharmacological treatments outlined in this review are primarily related to physiotherapy interventions. The effectiveness of physical exercise, both on land and in water, as well as the application of electrotherapy combined with transcranial therapy and manual therapy has been highlighted. All of these interventions aim to improve the quality of life of patients highly affected by fibromyalgia.

Comparing autologous blood, corticosteroid, and a combined injection of both for treating lateral epicondylitis: a randomized clinical trial

BackgroundBecause lateral epicondylitis is a common musculoskeletal disorder that affects the forearm's extensor tendons, an effective therapeutic approach should reverse the degeneration and promote regeneration. This study aimed to compare the efficacies of autologous blood (AB) injection, corticosteroid (CS) injection, and a combined injection of both in treating lateral epicondylitis (LE), hypothesizing that the combined approach might offer immediate symptom resolution and a lower recurrence.Materials and methodsA total of 120 patients diagnosed with lateral epicondylitis were systematically distributed among three distinct therapeutic injection groups. Those in the AB group were administered 1 ml of autologous venous blood mixed with 2 ml of 2% prilocaine HCl. Participants in the CS category were given 1 ml of 40 mg methylprednisolone acetate mixed with 2 ml of 2% prilocaine HCl. Meanwhile, patients in the combined group received a mixture containing 1 ml each of autologous venous blood and 40 mg methylprednisolone acetate along with 1 ml of 2% prilocaine HCl. Prior to receiving their respective injections, a comprehensive assessment of all participants was carried out. Follow-up assessments were subsequently conducted on days 15, 30, and 90 utilizing metrics of the patient-rated tennis elbow evaluation (PRTEE) and measurements of hand grip strength (HGS).ResultsOne patient dropped out from the combined group, and 119 patients completed the trial. No complications were recorded during the course of follow-up. By day 15, all groups had demonstrated significant PRTEE improvement, with CS showing the most pronounced reduction (p = 0.001). However, the benefits of CS had deteriorated by day 30 and had deteriorated further by day 90. The AB and AB + CS groups demonstrated sustained improvement, with AB + CS revealing the most effective treatment, achieving a clinically significant improvement in 97.4% of the patients. The improved HGS parallelled the functional enhancements, as it was more substantial in the AB and AB + CS groups (p = 0.001), corroborating the sustained benefits of these treatments.ConclusionsThe study concluded that while AB and CS individually offer distinct benefits, a combined AB + CS approach optimizes therapeutic outcomes, providing swift and sustained functional improvement with a lower recurrence rate. These findings have substantial clinical implications, suggesting a balanced, multimodal treatment strategy for enhanced patient recovery in LE.Level of evidence: Randomized clinical trial, level 1 evidence.Trial registration: NCT06236178.

The effects of connective tissue massage and classical massage on pain, lumbar mobility, function, disability, and well-being in chronic low back pain: A three-arm randomized controlled trial

BackgroundChronic low back pain (CLBP) is a common musculoskeletal disorder. Effect of massage in the management of CLBP has been documented, but it is not clear which massage regimen is more effective. This study was carried out to compare the effect of connective tissue massage and classical massage on pain, lumbar mobility, function, disability, and well-being among patients with CLBP. MethodsThe study included 30 participants who were randomly assigned to one of three intervention groups: the connective tissue massage group (CTMG; n = 10), the classical massage group (CMG; n = 10), and a standard physiotherapy/control group (CG; n = 10). The interventions were administered three times a week for four consecutive weeks. Assessments were conducted at baseline and at the end of the fourth week. Pain severity (Visual Analog Scale), lumbar mobility (Modified Schober Test), function (Back Pain Functional Scale), disability (Roland Morris Disability Questionnaire), and well-being (Short Form-36/SF-36) was evaluated. ResultsAll groups exhibited improvements in pain, lumbar mobility, function, and disability after 4 weeks (p < 0.05). The CMG showed enhancements in physical function, bodily pain, role physical, and role emotional subgroups of SF-36. The CTMG demonstrated improvements in all subgroups of SF-36 except general health (p < 0.05), while the CG only improved in the physical function subgroup (p < 0.05). A 2-way repeated measures ANOVA revealed a significant group-time interaction for MST (p = 0.04), Bodily Pain (p = 0.025) and Role Physical (p = 0.015). ConclusionsThe findings obtained from this study showed that CTMG was superior to CMG and CG in increasing lumbar mobility, and both massage applications were superior to the CG in increasing the well-being.

Recommended exercises for lower back pain on YouTube videos; Are they useful or harmful?

ObjectiveLow back pain (LBP), a common public health problem affecting nearly 80 % of the population, causes disability and work absence, while exercise is recommended as an adjuvant treatment. YouTube is one of the most frequently used source of information, especially by patients. The aim of the study was to analyze clinically the reliability, feasibility and the content quality of exercises videos recommended for LBP on YouTube. channel. MethodsBased on the observational study of the number of views of YouTube videos, 154 videos worth evaluation were selected using the keywords "low back pain” and “exercises",. The content quality of each video was evaluated with a) the American Medical Association Journal (JAMA), b) DISCERN, c) Global Quality Score (GQS), and d) Medical Quality Video Assessment Tool (MQ-VET) scales, while Pearson correlation analysis was performed to determine the correlation between the JAMA, GQS, DISCERN, MQ-VET scale scores. ResultsAccording to the findings, the primary source for uploading exercise videos were physicians (32.5 %), with a high content quality. There was a statistically significant positive correlation between the total scores of all quality scales and the independent variables defined as view rates and number of comments (p < .05). The analysis of the video content showed that only 35 % (n = 54) of the videos explained the risks of the recommended exercises in detail ConclusionIt can be concluded that the relability and feasibility of exercise videos for LBP on YouTube depend highly on the upload source. Thus digital content in health should be created with a multi-disciplinary team including healthcare professionals and also standardized to inform patients with the risks and benefits to avoid the potential harm due to the complex causes of low back pain. Public Interest SummaryLow Back Pain, which a major health problem, is the most common musculoskeletal disorder leading to increased medical expenses and work absenteeism, while the most appropriate intervention remains elusive.. The therapeutic exercise program might differ according to patient's age, physical condition and the severity of the disease, while sustainability of the exercise program depends on the preference of exercise type of each patient. From this perspective, it is an important advantage that different exercise videos are available on YouTube. However, the content quality and reliability of exercise videos are the discriminators for the expected outcomes, since good quality content will benefit patients and prevent possible injuries and worsening of pain.

Prevalence of Neck Pain in Physiotherapist

Background: Neck pain is one of the most common musculoskeletal disorders among health professionals, including physiotherapists, who are often involved in activities that include holding a posture for a longer duration and performance of repetitive movements. The increased usage of smartphones and laptops enhances bad postures, particularly bending of the neck in flexion, adding to the problems related to neck pain. Objective: The present study has been taken up to assess the prevalence of neck pain among physiotherapists and their relation with gender and age. Methods: This was a cross-sectional study conducted on 100 physiotherapists, of which 63 were females and 37 were males. Neck pain prevalence was assessed with the Neck Disability Index questionnaire. Data collection was done in person from November 2023 to February 2024. Results were statistically analyzed, with descriptive statistics shown in tabulations, graphs, and figures. Results: The overall prevalence of neck pain among the participants was 64%. In accordance with the NDI scale, the physiotherapists self-reported 39% to have mild disability; 23%, moderate disability; only 2% were severely disabled and none with complete disability. On a gender basis, females revealed a slightly higher prevalence of neck pain, 25%, compared to their male counterparts, 24%. Conclusion: In this study, a high prevalence of neck pain was found among physiotherapists, with a slightly increased occurrence in females. These findings bring out the importance of increasing awareness toward ergonomic practices and health regarding posture to decrease neck pain in physiotherapists. The modifiable risk factors identified will have an emphasis on the promotion of good postures with lifestyle modifications to aid in the prevention of neck pain in physiotherapists. Making these changes and taking up appropriate treatments form an important aspect of the management of work-related musculoskeletal disorders.

Ultrasound imaging and guidance in the management of myofascial pain syndrome: a narrative review.

Myofascial pain syndrome (MPS) is a common musculoskeletal disorder characterized by muscle pain, tenderness, and trigger points. Ultrasonography has emerged as a key tool for diagnosing and treating MPS owing to its ability to provide precise, minimally invasive guidance. This review discusses the use of ultrasonography in various approaches to evaluate and manage MPS. Studies have shown that shear-wave sonoelastography can effectively assess muscle elasticity and offer insights into trapezius stiffness in patients with MPS. Ultrasound-guided interfascial hydrodissection, especially with visual feedback, has demonstrated effectiveness in treating trapezius MPS. Similarly, ultrasound-guided rhomboid interfascial plane blocks and perimysium dissection for posterior shoulder MPS have significantly reduced pain and improved quality of life. The combination of extracorporeal shockwave therapy with ultrasound-guided lidocaine injections has been particularly successful in reducing pain and stiffness in trapezius MPS. Research regarding various guided injections, including dry needling, interfascial plane blocks, and fascial hydrodissection, emphasizes the importance of ultrasonography for accuracy and safety. Additionally, ultrasound-guided delivery of local anesthetics and steroids to the quadratus lumborum muscle has shown lasting pain relief over a 6-month period. Overall, these findings highlight the pivotal role of ultrasonography in the assessment and treatment of MPS.

Role of Autologous Micro-Fragmented Adipose Tissue in Osteoarthritis Treatment.

Osteoarthritis (OA) is the most common complex musculoskeletal disorder, resulting from the degeneration of the articular cartilage and characterized by joint pain and dysfunction that culminate in progressive articular cartilage loss. We present our experience in the management of hip and knee OA by means of the intra-articular injection of fat micrograft, describing our approach, which was developed from the belief in the powerful reparative effect of autologous fat graft on damaged tissue, as well as its natural lubricating effect on the joints. Inclusion criteria were as follows: men and women, aged 20 to 80 years, that referred articular pain of the hips and/or knees, showing initial-stage degenerative OA. From October 2018 to July 2023, a total of 250 patients underwent treatment with the Sefficare® device (SEFFILINE srl, Bologna, Italy). The Superficial Enhanced Fluid Fat Injection device was used to perform autologous regenerative treatments in a safe, standardized, easy, and effective way on 160 women, 64%, and 90 men, 36%. A total of 190 procedures (76%) involved the knees, with 20 patients who were bilaterally treated, while 60 procedures, all unilateral, involved the hips (24%). The mean age at treatment was 52.4 years. Before treatment, each patient had undergone X-rays and Magnetic Resonance Imaging (MRI) of the painful hip/knee to evaluate and grade the articular OA. Postoperatively, each patient was assessed after one, three, six, and twelve months. The donor site postoperative course was uneventful other than minimal discomfort. Clinically, the ROM (range of motion) of the treated knee/hip increased an average of 10 degrees 3 months after treatment, but the stiffness was reduced, as reported by the patients. The VAS (Visual Analog Scale) was submitted at 3, 6, and 12 months, demonstrating a progressive reduction of pain, with the best score obtained at six months postoperatively. In total, 85% of patients were satisfied one year after treatment, with a considerable improvement in pain and quality of life. The satisfactory outcome of this minimally invasive procedure indicates that the intra-articular injection of fat micrograft can replace or considerably delay the need for the classical major joint replacement surgery, thanks to its impact on the quality of life of patients and financial cost.

Is device-measured physical activity associated with musculoskeletal disorders among young adult Finnish men?

Musculoskeletal (MSK) disorders represent a significant burden to society and can be unpleasant for the affected individuals. Physical activity (PA) can prevent MSK disorders while conferring other health benefits. The present study aimed to investigate associations between device-measured PA and perceived MSK disorders among young adult men. PA at different intensity levels, standing, and sedentary behavior were measured with a hip-worn accelerometer in a cohort of 422 young adult Finnish men aged 26 years on average. The incidences of three common MSK disorders (viz., knee pain, lumbar radicular pain, and lumbago pain) during the last month were inquired by a questionnaire. Binary logistic regression was used to examine the associations between the MSK outcomes and explanatory PA variables (PA times at different intensity levels, standing, and sedentary times). The models were controlled for age, education, smoking, BMI, and maximal oxygen uptake. PA, standing, and sedentary times were not significantly associated with the incidence of perceived MSK pain during the last month, except for lumbago pain. Lumbago pain was slightly more probable if the time spent in light PA increased, even after controlling for potential confounding factors, including moderate-to-vigorous PA, with an odds ratio (OR) of 1.07 (95% CI: 1.02-1.14). Sedentary time showed an opposite association, with an OR of 0.98 (95% CI: 0.96-1.00). There were neither positive nor negative clinically meaningful associations between PA and recent MSK disorders among young adult men. The result is surprising and requires further confirmation.

Combined Effects of Manual Therapy and Functional Electrical Stimulation on Torticollis among Adults

Background: Acquired muscular torticollis is a common musculoskeletal disorder that occurs after birth due to various etiologies. This condition is characterized by the abnormal tilt and twist of the neck muscles, causing significant discomfort and functional impairment. Objective: This study aimed to investigate the combined effects of manual therapy and functional electrical stimulation (FES) on adults with acquired torticollis. Methods: A 45-year-old male patient with acquired torticollis was evaluated using a detailed general movement assessment and an arthrodial goniometer to measure cervical ranges of motion. The patient exhibited tightness of the right sternocleidomastoid (SCM) muscle with limited ranges of motion. The treatment protocol included both manual therapy and electrotherapy for three months, with sessions conducted four days per week, each lasting 40 minutes. Manual therapy consisted of soft tissue mobilization, stretching of the right SCM, and isometric exercises for the left SCM. Electrotherapy included transcutaneous electrical nerve stimulation (TENS), DL2 stimulator, infrared radiation therapy (IRR), and ultrasonic therapy. The patient’s cervical ranges of motion were measured before and after the intervention to assess the effectiveness of the combined therapy. Results: Significant improvements were observed in the patient’s cervical ranges of motion after the 12-week treatment protocol. The mean lateral flexion of the affected right SCM improved from 35 degrees to 20 degrees, and the mean rotation improved from 43 degrees to 28 degrees. These changes indicate a noticeable improvement in both the ranges of motion and posture of the patient. Conclusion: The combined effects of manual therapy and functional electrical stimulation significantly improved the cervical ranges of motion and overall posture in an adult patient with acquired torticollis. These findings suggest that integrating multiple therapeutic modalities can enhance treatment outcomes for musculoskeletal deformities.

Effects of Gluteal Muscle Strengthening Exercise-Based Core Stabilization Training on Pain and Quality of Life in Patients with Chronic Low Back Pain.

Background: The World Health Organization reports that back pain is a major cause of disorder worldwide. It is the most common musculoskeletal disorder with limited pain, muscle tension, and stiffness, and 70-80% of all individuals experience it once in their lifetime, with higher prevalence in women than in men. This study aimed to investigate the effects of gluteal muscle strengthening exercise- based core stabilization training (GSE-based CST) on pain, function, fear-avoidance patterns, and quality of life in patients with chronic back pain. Methods: This study included 34 patients with non-specific chronic low back pain. Seventeen individuals each were included in GSE-based CST and control groups. The GSE-based CST group performed GSE and CST for 15 min, three times a week for four weeks, and the control group performed CST for 30 min a day, three times a week for four weeks. The numeric pain rating scale was used to evaluate pain before and after treatment, Roland-Morris disability questionnaire was used to evaluate function, fear-avoidance beliefs questionnaire was used to evaluate fear-avoidance patterns, and quality of life was measured using the short form-36. Results: In this study, pain, function, and fear-avoidance pattern decreased significantly in both groups (All p < 0.05). During the evaluation of quality of life, both groups showed significant increase in physical and mental factors (p < 0.05). There were significant differences in pain and quality of life (p < 0.05) between the GSE-based CST and control groups. Conclusions: Therefore, GSE-based CST can be used as a basis for effective intervention to enhance pain, function, fear-avoidance patterns, and quality of life, emphasizing the need for gluteal muscle strengthening exercises in patients with non-specific chronic back pain in the future.

Biomimetic gradient scaffolds for the tissue engineering and regeneration of rotator cuff enthesis.

Rotator cuff tear is one of the most common musculoskeletal disorders, which often results in recurrent shoulder pain and limited movement. Enthesis is a structurally complex and functionally critical interface connecting tendon and bone that plays an essential role in maintaining integrity of the shoulder joint. Despite the availability of advanced surgical procedures for rotator cuff repair, there is a high rate of failure following surgery due to suboptimal enthesis healing and regeneration. Novel strategies based on tissue engineering are gaining popularity in improving tendon-bone interface (TBI) regeneration. Through incorporating physical and biochemical cues into scaffold design which mimics the structure and composition of native enthesis is advantageous to guide specific differentiation of seeding cells and facilitate the formation of functional tissues. In this review, we summarize the current state of research in enthesis tissue engineering highlighting the development and application of biomimetic scaffolds that replicate the gradient TBI. We also discuss the latest techniques for fabricating potential translatable scaffolds such as 3D bioprinting and microfluidic device. While preclinical studies have demonstrated encouraging results of biomimetic gradient scaffolds, the translation of these findings into clinical applications necessitates a comprehensive understanding of their safety and long-term efficacy.

Preoperative handgrip strength can predict early postoperative shoulder function in patients undergoing arthroscopic rotator cuff repair

BackgroundRotator cuff tears (RCTs) are a common musculoskeletal disorder, and arthroscopic rotator cuff repair (ARCR) is widely performed for tendon repair. Handgrip strength correlates with rotator cuff function; however, whether preoperative grip strength can predict functional outcomes in patients undergoing ARCR remains unknown. This study aimed to investigate the correlation between preoperative grip strength and postoperative shoulder function following ARCR.MethodsA total of 52 patients with full-thickness repairable RCTs were prospectively enrolled. Baseline parameters, namely patient characteristics and intraoperative findings, were included for analysis. Postoperative shoulder functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) questionnaire and Constant–Murley scores (CMSs). Patients were followed up and evaluated at three and six months after ARCR. The effects of baseline parameters on postoperative outcomes were measured using generalized estimating equations.ResultsAt three and six months postoperatively, all clinical outcomes evaluated exhibited significant improvement from baseline following ARCR. Within 6 months postoperatively, higher preoperative grip strength was significantly correlated with higher CMSs (β = 0.470, p = 0.022), whereas increased numbers of total suture anchors were significantly correlated with decreased CMSs (β = − 4.361, p = 0.03). Higher body mass index was significantly correlated with higher postoperative QDASH scores (β = 1.561, p = 0.03) during follow-up.ConclusionsHigher baseline grip strength predicts more favorable postoperative shoulder function following ARCR. A preoperative grip strength test in orthopedic clinics may serve as a predictor for postoperative shoulder functional recovery in patients undergoing ARCR.

FIBROMYALGIA – AN UPDATE ON CLINICAL CHARACTERISTICS AND DIAGNOSTIC CRITERIA

The third most common musculoskeletal disorder is fibromyalgia, which becomes more common as people age. The most common symptoms of fibromyalgia are tiredness, sleep difficulties, persistent pain throughout the body, and functional problems. Etiopathogenesis, diagnostic standards, and classification criteria of this disorder are still up for debate. Despite the development of more reliable diagnostic criteria, a significant proportion of physicians continue to misdiagnose the illness. Familial experiences, emotional-cognitive factors, the mind-body connection, genetic predisposition, and a biopsychological capacity for stress management are some of the numerous variables that each individually contribute to the development of fibromyalgia. In this review, we present a comprehensive, critical assessment of fibromyalgia's burden and diagnosis, taking into account the most recent research, recommendations, and clinical experience. By utilizing clinical expertise and the most recent EULAR criteria for managing fibromyalgia, we want to offer doctors an innovative and useful management workflow that they may utilize in their routine clinical duties. Keywords: fibromyalgia, chronic pain, sleep disturbances, fatigue, autonomic disturbances, regional pain syndromes, tender points.

EXPLORING AYURVEDIC APPROACHES TO LOW BACK PAIN: A COMPREHENSIVE REVIEW

Introduction:Low back pain (LBP) is a common musculoskeletal disorder affecting individuals worldwide, causing significant disability and healthcare burden. While conventional treatments focus on symptomatic relief, Ayurveda, the ancient Indian system of medicine, offers a holistic approach that addresses the root cause of LBP. This comprehensive review aims to explore Ayurvedic perspectives, diagnostic methods, therapeutic interventions, and herbal formulations for managing LBP. Ayurvedic Perspective:Ayurveda views LBP as a manifestation of imbalances in the Tridosha (Vata, Pitta, and Kapha) and the Saptadhatus (seven body tissues). Vata dosha vitiation is predominantly implicated in LBP, leading to symptoms such as stiffness, spasms, and radiating pain. Pitta and Kapha imbalances may exacerbate inflammation and structural degeneration, respectively. Ayurvedic diagnosis of LBP involves assessing the individuals Prakriti (constitutional type), Vikriti (current imbalance), Agni (digestive fire), and Srotas (channels of circulation). Diagnostic Methods:Ayurvedic physicians employ a combination of clinical examination, palpation, and pulse diagnosis (Nadi Pariksha) to assess the underlying doshic imbalances and identify the specific etiology of LBP. Various factors such as lifestyle habits, occupation, dietary patterns, and psychological stressors are taken into account during the assessment. Therapeutic Interventions:Ayurvedic management of LBP is multifaceted, aiming to alleviate pain, reduce inflammation, restore musculoskeletal integrity, and prevent recurrence. Therapeutic interventions include: Panchakarma: Detoxification therapies such as Basti (medicated enema), Abhyanga (oil massage), and Swedana (herbal steam therapy) are utilized to eliminate ama (toxins) and pacify aggravated doshas. Ayurvedic Medications: Herbal formulations containing anti-inflammatory, analgesic, and muscle-relaxant herbs like Ashwagandha (Withania somnifera), Guggulu (Commiphora wightii), and Shallaki (Boswellia serrata) are prescribed to manage pain and inflammation. Yoga and Pranayama: Specific yoga asanas (postures) and pranayama (breathing exercises) are recommended to improve flexibility, strengthen the back muscles, and enhance prana (vital energy) flow to the affected area. Dietary Modifications: Dietary recommendations include consuming warm, light, and easily digestible foods, emphasizing anti-inflammatory spices like turmeric, ginger, and cinnamon, and avoiding cold, heavy, and processed foods that may aggravate Vata dosha. Lifestyle Management: Adopting a balanced daily routine (Dinacharya), practicing stress-reduction techniques such as meditation and mindfulness, and maintaining proper posture and ergonomics are crucial for long-term management of LBP. Clinical Evidence:Several clinical studies have investigated the efficacy of Ayurvedic interventions in LBP management. A randomized controlled trial comparing Ayurvedic treatment with conventional therapy demonstrated significant improvements in pain relief, functional disability, and quality of life among participants receiving Ayurvedic intervention. Furthermore, observational studies have reported favorable outcomes with Panchakarma therapies and herbal formulations in reducing pain intensity and enhancing mobility in patients with chronic LBP. Safety and Considerations:While Ayurvedic interventions are generally considered safe when administered under the guidance of a qualified practitioner, certain precautions should be observed. Individualized treatment plans based on the patients constitution, doshic imbalance, and overall health status are essential to optimize therapeutic outcomes and minimize potential adverse effects. Additionally, close monitoring and periodic reassessment are necessary to track progress and adjust treatment as needed. Conclusion:Ayurveda offers a holistic and individualized approach to managing low back pain, addressing not only the symptoms but also the underlying imbalances contributing to the condition. By incorporating Panchakarma therapies, herbal formulations, dietary modifications, and lifestyle interventions, Ayurvedic treatment aims to restore harmony within the body, promote self-healing, and prevent recurrence of LBP. Further research and collaboration between Ayurvedic and conventional healthcare systems are warranted to validate the efficacy and safety of Ayurvedic interventions and enhance their integration into mainstream healthcare for comprehensive LBP management.