Lower Back Region Research Articles

Musculoskeletal Pain among Different Dental Specialists in United ArabEmirates

Background: Musculoskeletal Disorder (MSD) is prevalent worldwide and is one of the commonest causes of long-term pain and disability affecting hundreds of millions of people. Prevalence of MSD among dental practitioners in UAE is not well documented. The present study aimed on studying the prevalence of musculoskeletal pain among different dental specialists in the UAE, and correlating the region of pain with the type of clinical work done by the specialists. Materials and Methods: A sample of more than 100 dentists was chosen randomly from different emirates in UAE. An interview questionnaire was administered regarding the number of years of experience and the presence, region, duration, and type of musculoskeletal pain they experienced. Results: Musculoskeletal pain is experienced by 67% of participants, 83.3% of them were periodontists, 80% were conservative dentists, 77.8% were endodontists, 72.7% were orthodontists, 70% were oral surgeons, 63.6% were prosthodontists, 63% were general dental practitioners, and 50% of pedodontists. The results have also indicated that the region of experienced musculoskeletal pain does vary according to the specialty. From those dentists who experienced work-related musculoskeletal pain, 80% of conservative dentists experience pain in neck and shoulders, 66.7% of periodontists and 54.5% of orthodontists experienced pain in the lower back region. More than 50% of endodontists experienced pain in the neck and shoulders regions, and 39% of general dental practitioners who experience pain in the neck region. Conclusion: Preventive measures need to be taken to decrease the risk of dentists and dental specialists developing work-related musculoskeletal pain.

Efficacy of mid-axillary approach to transversus abdominis plane block in each abdominal and back region

Objective To evaluate the efficacy of mid-axillary approach to transversus abdominis plane (TAP) block in each abdominal and back region. Methods Twenty patients of both sexes, aged 18-64 yr, with body mass index of 20-27 kg/m2, of American Society of Anesthesiologists physical status ⅠorⅡ, scheduled for elective laparoscopic cholecystectomy, who had expected operation time <1 h, were enrolled in the study.Ultrasound-guided TAP block was performed on the left side via the mid-axillary line with 0.25% levobupivacaine 0.5 ml/kg.TAP block was assessed by cold stimulation (75% alcohol) and acupuncture in each abdominal and back region (the left side of the body was divided into 19 regions using the anatomical landmarks on the body surface). The positive condition in each region at 20 min after administration was recorded. Results The regions in which the positive rate ≤5% were 11, 14, 17 and 18 regions.The regions in which the positive rate >5%-20% were 8, 15 and 19 regions.The regions in which the positive rate >20%-50% were 12, 13 and 16 regions.The regions in which the positive rate >50%-70% were 1 and 4 regions.The regions in which 70% < the positive rate < 95% were 7, 9 and 10 regions.The regions in which the positive rate ≥ 95% were 2, 3, 5 and 6 regions. Conclusion Mid-axillary approach to TAP block is effective in the left middle-lower regions of the anterior abdominal wall, however, it is ineffective in the left upper region between mid-axillary and posterior axillary lines and in the low back region. Key words: Nerve block; Abdominal muscles; Abdomen; Back

Comparison of 10-kHz High-Frequency and Traditional Low-Frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: 24-Month Results From a Multicenter, Randomized, Controlled Pivotal Trial.

BACKGROUND:Pain relief with spinal cord stimulation (SCS) has focused historically on paresthesias overlapping chronically painful areas. A higher level evidence supports the use of SCS in treating leg pain than supports back pain, as it is difficult to achieve adequate paresthesia coverage, and then pain relief, in the low back region. In comparison, 10-kHz high-frequency (HF10 therapy) SCS therapy does not rely on intraoperative paresthesia mapping and remains paresthesia-free during therapy.OBJECTIVE:To compare long-term results of HF10 therapy and traditional low-frequency SCS.METHODS:A pragmatic randomized, controlled, pivotal trial with 24-month follow-up was conducted across 11 comprehensive pain treatment centers. Subjects had Visual Analog Scale scores of ≥5.0/10.0 cm for both back and leg pain, and were assigned randomly (1:1) to receive HF10 therapy or low-frequency SCS. The primary end point was a responder rate, defined as ≥50% back pain reduction from baseline at 3 months with a secondary end point at 12 months (previously reported). In this article, 24-month secondary results are presented. Non-inferiority was first assessed, and if demonstrated the results were tested for superiority.RESULTS:In the study, 198 subjects were randomized (101 HF10 therapy, 97 traditional SCS). One hundred seventy-one subjects (90 HF10 therapy, 81 traditional SCS) successfully completed a short-term trial and were implanted. Subjects averaged 54.9 ± 12.9 years old, 13.6 ± 11.3 years since diagnosis, 86.6% had back surgery, 88.3% were taking opioid analgesics. At 3 months, 84.5% of implanted HF10 therapy subjects were responders for back pain and 83.1% for leg pain, and 43.8% of traditional SCS subjects were responders for back pain and 55.5% for leg pain (P < .001 for both back and leg pain comparisons, non-inferiority and superiority). At 24 months, more subjects were responders to HF10 therapy than traditional SCS (back pain: 76.5% vs 49.3%; 27.2% difference, 95% CI, 10.1%-41.8%; P < .001 for non-inferiority and superiority; leg pain: 72.9% vs 49.3%; 23.6% difference, 95% CI, 5.9%-38.6%; P < .001 for non-inferiority and P = .003 for superiority). Also at 24 months, back pain decreased to a greater degree with HF10 therapy (66.9% ± 31.8%) than traditional SCS (41.1% ± 36.8%, P < .001 for non-inferiority and superiority). Leg pain also decreased to a greater degree with HF10 therapy (65.1% ± 36.0%) than traditional SCS (46.0% ± 40.4%, P < .001 for non-inferiority and P = .002 for superiority).CONCLUSION:This study demonstrates long-term superiority of HF10 therapy compared with traditional SCS in treating both back and leg pain. The advantages of HF10 therapy are anticipated to impact the management of chronic pain patients substantially.ABBREVIATIONS:IPG, implantable pulse generatorMCID, minimal clinically important differencePI, permanent implantODI, Oswestry Disability IndexSCS, spinal cord stimulationVAS, Visual Analog Scale

Intra-session absolute and relative reliability of pressure pain thresholds in the low back region of vine-workers: ffect of the number of trials.

BackgroundPressure pain thresholds (PPT) are commonly used to quantify mechanical pain sensitivity of deep structures. Excellent PPT reliability has been previously reported among the low back of healthy subjects. However, there is a lack of studies assessing PPT over the low back of workers exposed to biomechanical risk factors of low back pain. Thus, the purpose of this study was threefold: (1) to evaluate the intra-session absolute and relative reliability as well as minimal detectable change (MDC) values of PPT within 14 locations covering the low back region of vine-workers and (2) to determine the number of trial required to ensure reliable PPT assessments and (3) to assess the effect of modifier factors such as gender, age, body mass index (BMI) and pain intensity on PPT reliability.MethodsTwenty-nine vine-workers voluntarily participated in this study. Twenty-two reported low intensity of low-back pain while seven were pain-free. PPTs were assessed among 14 anatomical locations in the lower back region. Three trials were performed on each location with an interval time of at least one minute. Reliability was assessed computing intraclass correlation coefficients (ICC), standard error of measurement (SEM) for all possible combinations between trials. Bland-Altman plots were also generated to assess potential bias in the dataset. Finally, a repeated measure analysis of variance (RM-ANOVA) with the number of trials used as within subject factor was performed on (1) PPT, (2) ICC and (3) SEM values.ResultsICC ranged from 0.86 to 0.99 for all anatomical locations and for all possible combinations between trials. SEM for comparison between trial 1–2, 2–3, 1–3 and, 1-2-3 ranged from respectively, 36.7–77.5, 27.8–77.7, 50–95.2 and, 39.3–80.8 kPa. ICC and SEM remained similar to the ones obtained for the entire population when taking modifier factors in consideration. The visual analysis of Bland-Altman plots suggested small measurement errors for all anatomical locations and for all possible combinations between trials.ConclusionsThe assessment of PPTs of the lower back among vine-workers was found to have excellent relative and absolute reliability. Moreover, reliable measurements can be equally achieved when using the mean of three PPT measurement or with the first one.

Is One Trial Sufficient to Obtain Excellent Pressure Pain Threshold Reliability in the Low Back of Asymptomatic Individuals? A Test-Retest Study.

The assessment of pressure pain threshold (PPT) provides a quantitative value related to the mechanical sensitivity to pain of deep structures. Although excellent reliability of PPT has been reported in numerous anatomical locations, its absolute and relative reliability in the lower back region remains to be determined. Because of the high prevalence of low back pain in the general population and because low back pain is one of the leading causes of disability in industrialized countries, assessing pressure pain thresholds over the low back is particularly of interest. The purpose of this study study was (1) to evaluate the intra- and inter- absolute and relative reliability of PPT within 14 locations covering the low back region of asymptomatic individuals and (2) to determine the number of trial required to ensure reliable PPT measurements. Fifteen asymptomatic subjects were included in this study. PPTs were assessed among 14 anatomical locations in the low back region over two sessions separated by one hour interval. For the two sessions, three PPT assessments were performed on each location. Reliability was assessed computing intraclass correlation coefficients (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) for all possible combinations between trials and sessions. Bland-Altman plots were also generated to assess potential bias in the dataset. Relative reliability for both intra- and inter- session was almost perfect with ICC ranged from 0.85 to 0.99. With respect to the intra-session, no statistical difference was reported for ICCs and SEM regardless of the conducted comparisons between trials. Conversely, for inter-session, ICCs and SEM values were significantly larger when two consecutive PPT measurements were used for data analysis. No significant difference was observed for the comparison between two consecutive measurements and three measurements. Excellent relative and absolute reliabilities were reported for both intra- and inter-session. Reliable measurements can be equally achieved when using the mean of two or three consecutive PPT measurements, as usually proposed in the literature, or with only the first one. Although reliability was almost perfect regardless of the conducted comparison between PPT assessments, our results suggest using two consecutive measurements to obtain higher short term absolute reliability.

An ergonomic intervention to reduce musculoskeletal discomfort among semiconductor assembly workers.

Work-related musculoskeletal disorders (MSDs) and ergonomics-related injuries are the single largest category of workplace injuries and are responsible for almost 30% of all worker's compensation costs. Awkward working posture refers to positions of the body that deviate significantly from the neutral position while job tasks are being performed and it is the primary ergonomic risk factor for developing musculoskeletal discomfort. This study was conducted among assembly workers of a semiconductor in Tehran province with the objective of implementing an interventional ergonomic program to minimize musculoskeletal discomfort. This study that was conducted on 105 male assembly workers of a semiconductor industry based on a census method. The standardized Nordic Musculoskeletal Questionnaire (NMQ) was used to determine the prevalence of MSDs. Corlett and Bishop's body part discomfort scale (BPD) was applied to evaluate body discomfort before and after the intervention (using a magnifying loupes to improve visibility of the parts). The results of NMQ showed the highest rate of MSDs were in neck, shoulder, upper arm and lower back regions (more than 75%). After ergonomic intervention, significant decrements of discomfort was observed in neck, shoulder, upper arm, elbows, lower arm, lower back and whole body discomfort (p < 0.05). It can be concluded that using magnifying loupes reduced discomfort in different body regions and the whole body. A conclusion of this research is that ergonomic interventions can decrease MSDs of at risk body regions in the long term.

Mechanisms of low back pain: a guide for diagnosis and therapy.

Chronic low back pain (CLBP) is a chronic pain syndrome in the lower back region, lasting for at least 3months. CLBP represents the second leading cause of disability worldwide being a major welfare and economic problem. The prevalence of CLBP in adults has increased more than 100% in the last decade and continues to increase dramatically in the aging population, affecting both men and women in all ethnic groups, with a significant impact on functional capacity and occupational activities. It can also be influenced by psychological factors, such as stress, depression and/or anxiety. Given this complexity, the diagnostic evaluation of patients with CLBP can be very challenging and requires complex clinical decision-making. Answering the question "what is the pain generator" among the several structures potentially involved in CLBP is a key factor in the management of these patients, since a mis-diagnosis can generate therapeutical mistakes. Traditionally, the notion that the etiology of 80% to 90% of LBP cases is unknown has been mistaken perpetuated across decades. In most cases, low back pain can be attributed to specific pain generator, with its own characteristics and with different therapeutical opportunity. Here we discuss about radicular pain, facet Joint pain, sacro-iliac pain, pain related to lumbar stenosis, discogenic pain. Our article aims to offer to the clinicians a simple guidance to identify pain generators in a safer and faster way, relying a correct diagnosis and further therapeutical approach.

Effect of MELT method on thoracolumbar connective tissue: The full study

Altered connective tissue structure has been identified in adults with chronic low back pain (LBP). A self-care treatment for managing LBP is the MELT method. The MELT method is a hands-off, self-treatment that is said to alleviate chronic pain, release tension and restore mobility, utilizing specialized soft treatments balls, soft body roller and techniques mimicking manual therapy. The objective of this study was to determine whether thickness of thoracolumbar connective tissue and biomechanical and viscoelastic properties of myofascial tissue in the low back region change in subjects with chronic LBP as a result of MELT. This study was designed using a quasi experimental pre-post- design that analyzed data from subjects who performed MELT. Using ultrasound imaging and an algorithm developed in MATLAB, thickness of thoracolumbar connective tissue was analyzed in 22 subjects. A hand-held digital palpation device, called the MyotonPRO, was used to assess biomechanical properties such as stiffness, elasticity, tone and mechanical stress relaxation time of the thoracolumbar myofascial tissue. A forward bending test assessing flexibility and pain scale was added to see if MELT affected subjects with chronic LBP. A significant decrease in connective tissue thickness and pain was observed in participants. Significant increase in flexibility was also recorded.

Lumbar Stress Injury or Not? - Cricket Player

HISTORY: An 18 year old male cricket player (fast bowler) presented with longstanding symptoms of stiff calves and hamstrings, and pain in the gluteal and lower back regions. He had been treated conservatively for a lumbar stress injury (including a full rehabilitation program) however his symptoms persisted. On further enquiry he had previous problems with his left Achilles tendon and a right-sided tennis elbow. His back pain felt better as he warmed up but did not respond to non-steroidal anti-inflammatory drugs. No further systemic complaints were elicited. He has a family history of an uncle diagnosed with Reiter’s Syndrome. PHYSICAL EXAMINATION: He had slight tenderness of the lower lumbar area to the left of the spinous process. Neurological examination was normal. The Schöber test and chest expansion were normal. The FABER test was positive on the right and left, and the sacroiliac joints were tender on palpation. DIFFERENTIAL DIAGNOSIS: 1. Lumbar spondylolysis 2. Ankylosing spondylitis 3. Vertebral disc lesion TEST AND RESULTS: Blood tests - Erythrocyte sedimentation rate: Normal - C-reactive protein: Normal - Human Leukocyte Antigen B27: Positive X-rays - Lumbar: No spondylolysis or spondylolisthesis. Slight narrowing noted of the L4/L5 intervertebral disc space. No vertebral body margin osteophytes or end plate changes identified. - Pelvis: Normal MRI - Sclerosis of the lower lumbar facets, left (L4/L5 and L5/S1). Thought to be due to overuse. - Slightly narrowed L4/L5 disc space, but no herniation or prolapse. - Reactive changes of the right sacroiliac joint, but no bony edema. TREATMENT AND OUTCOME: 1. Because of the clinical picture, inconclusive radiography and positive HLA B27, the athlete was treated for inflammatory arthritis. He was prescribed a course of prednisone to which he responded dramatically. 2. Following the significant improvement, a decision was made to treat for Ankylosing Spondylitis and include a stringent rehabilitation program for the other problems identified. 3. The athlete responded well, and after 20 weeks returned to full training. However this patient will need to be monitored frequently and remain on a rehabilitation program. FINAL DIAGNOSIS: Ankylosing spondylitis complicated by overuse of the lumbar facets possibly due to his sport.

The Impact of an Ergonomics Intervention on Psychosocial Factors and Musculoskeletal Symptoms among Thai Hospital Orderlies.

(1) Background: Musculoskeletal disorders have a multifactorial etiology that is not only associated with physical risk factors, but also psychosocial risk factors; (2) Objective: This study evaluated the effects of an ergonomic intervention on musculoskeletal disorders and psychosocial risk factors; (3) Material and Methods: This study took a participatory ergonomic (PE) approach with a randomized controlled trial (RCT) conducted at tertiary care hospitals during July to December 2014. A group of hospital orderlies in Thailand were randomly selected for examination. Fifty orderlies were placed in a case group and another 50 orderlies were placed in the control group. The Nordic Musculoskeletal Disorders Questionnaire (NMQ) and the Copenhagen Psychosocial Questionnaire (COPSOQ) were used for data collection before and after the intervention program; (4) Results: The most commonly reported problem among hospital orderlies was found to be lower back symptoms (82%). The study found significant differences in prevalence rates of reported musculoskeletal conditions in the arm, upper back, and lower back regions before and after intervention. Findings showed that psychosocial risk factors were affected by the intervention. COPSOQ psychosocial risk factors were significantly different pre/post intervention. These variables included: work pace, influence at work, meaning of work, predictability, rewards, role conflicts, and social support from supervisors. No other psychosocial risk factors were found to be significant; (5) Conclusions: Positive results were observed following the intervention in the work environment, particularly in terms of reducing physical work environment risk factors for musculoskeletal disorders and increasing promotion factors of the psychosocial work environment.

Low back skin sensitivity has minimal impact on active lumbar spine proprioception and stability in healthy adults.

The purpose of the current work was to (1) determine whether low back cutaneous sensitivity could be reduced through the use of a topical lidocaine-prilocaine anesthetic (EMLA(®)) to mirror reductions reported in chronic lower back pain (CLBP) patients, as well as to (2) identify whether reductions in cutaneous sensitivity resulted in decreased lumbar spine proprioception, neuromuscular control and dynamic stability. Twenty-eight healthy participants were divided equally into matched EMLA and PLACEBO treatment groups. Groups completed cutaneous minimum monofilament and two-point discrimination (TPD) threshold tests, as well as tests of sagittal and axial lumbar spine active repositioning error, seated balance and repeated lifting dynamic stability. These tests were administered both before and after the application of an EMLA or PLACEBO treatment. Results show that low back minimum monofilament and TPD thresholds were significantly increased within the EMLA group. Skin sensitivity remained unchanged in the PLACEBO group. In the EMLA group, decreases in low back cutaneous sensitivity had minimal effect on low back proprioception (active sagittal and axial repositioning) and dynamic stability (seated balance and repeated lifting). These findings demonstrate that treating the skin of the low back with an EMLA anesthetic can effectively decrease the cutaneous sensitivity of low back region. Further, these decreases in peripheral cutaneous sensitivity are similar in magnitude to those reported in CLBP patients. Within this healthy population, decreased cutaneous sensitivity of the low back region has minimal influence on active lumbar spine proprioception, neuromuscular control and dynamic stability.

Epidemiological and biomechanical evaluation of airline baggage handling

Objectives. Musculoskeletal disorders (MSDs) are prevalent among airline baggage handlers due to manual materials handling. In this study, the Nordic musculoskeletal questionnaire (NMQ), the revised National Institute for Occupational Safety and Health (NIOSH) lifting equation, and the University of Michigan 3D Static Strength Prediction Program™ (3DSSPP) were used to analyze MSDs among baggage handlers. Methods. The NMQ was filled out by 209 baggage handlers and 46 arbitrarily selected baggage handlers were evaluated using the NIOSH method and 3DSSPP. Results. The obtained results showed that the most common MSDs occurred in the lower back region. The next risky regions included knees, neck, and upper back, respectively. The NIOSH results confirmed that the subjects lifted loads heavier than the permitted limit and their lifting postures were inappropriate. The results of the 3DSSPP also indicated that compression forces exceeded the NIOSH limit in these awkward postures. Conclusions. Relying on this study, holding compulsory ergonomic lifting training courses could be proposed for workers and regulations adjusting an upper limit for maximum baggage weight must be also enacted in order to improve occupational health and prevent the prevalence of increasing MSDs.

Evaluation of Lumbar Spine Load by Computational Method in Order to Acknowledge Low-back Disorders as Occupational Diseases.

The aim of the study was to develop a computational module for the prediction of compressive force on the L4/L5 disc suitable for use in field settings. The value of compressive force is intended to be used as a proxy measure of the mechanical burden of low-back when performing work activities. The compressive force predicted by the module in a particular worker should be compared with the NIOSH limit value of 3,400 N for the assessment of lumbar spine load during manual lifting tasks. Exceeding the limit will be considered as the fulfilment of "hygienic criterion" that should be met to acknowledge low-back disorder as an occupational disease. To develop the computational module we used the ergonomic software TECNOMATIX Classic Jack taking into account the anthropometric parameters of a worker and ergonomic parameters of his/her work activity. We calculated compressive forces on the L4/L5 disc in about 1,300 simulated combinations of various factors influencing compressive force. Parameters which turned out to be crucial for the compression of L4/L5 disc were included in the computational algorithm. Our study was primarily aimed at the assessment of lumbar disorders as occupational diseases. Moreover, the study can contribute to the recommendation of preventive measures to decrease health risks in occupations associated with the overload of low-back region. The graphic maps generated by the computational module enable a fast and exact analysis of particular job.

Ageing and obesity indices influences the tactile acuity of the low back regions: A cross-sectional study

Background and aimsTwo-point discrimination threshold (TPDT) is increased in individuals with chronic low back pain. TPDT reference values and their determinants are required for clinical applications. Therefore, the aims of this research are to establish reference values for TPDT of the low back regions in healthy individuals, stratified for age, and to investigate the associations of demographic and anthropomorphic variables with TPDT. MethodsHealthy individuals (n = 79) across four decades (Group-I:18–29; Group-II:30–39; Group-III:40–49; and Group-IV:50–59years) were recruited. A mechanical calliper tool was used to determine the low back TPDT (mm) using an adaptive staircase method. Descriptive statistics were calculated for TPDT for each age group. Paired t-tests (p ≤ 0.05) were used to assess within group differences in TPDT between body sides. Univariate and weighted least squared linear regression analyses were performed to investigate associations between TPDT estimates and demographics, and body mass index (BMI), waist hip ratio (WHR). ResultsMean (SD) age = 38.3(12.2); 55 female; and 73 right lower limb dominant. Mean (SD) TPDT threshold for all age groups: right = 67.3(15.6), and left = 65.7(15.4). No significant differences between left and right sides of the low back except in group-IV (mean difference:5.6[0.7–10.5]; P = 0.028). A total of 18% of TPDT variance (adjusted R2 = 0.183; β = 0.6; p = ≤0.001) of low back regions was explained by age with BMI and WHR weighted independently. ConclusionsAge, BMI, and WHR were independently associated with TPDT of the low back, and the influence of age was significantly influenced by obesity indices.

Work-related Musculoskeletal Pain among Different Dental Specialists in United Arab Emirates.

Dentists are at a very high risk of developing work-related musculoskeletal pain. The present study aimed at studying the prevalence of musculoskeletal pain among different dental specialists in the United Arab Emirates (UAE), and correlating the region of pain with the type of clinical work done by the specialists. A sample of more than 100 dentists was chosen randomly from different emirates in UAE. An interview questionnaire was administered regarding the number of years of experience and the presence, region, duration, and type of musculoskeletal pain they experienced. Musculoskeletal pain is experienced by 83.3% of periodontists, 80% of conservative dentists, 77.8% of endodon-tists, 72.7% of orthodontists, 70% of oral surgeons, 63.6% of prosthodontists, 63% of general dental practitioners, and 50% of pedodontists. The results have also indicated that the region of experienced musculoskeletal pain does vary according to the specialty. From those dentists who experience work-related musculoskeletal pain, 80% of conservative dentists experience pain in neck and shoulders, 66.7% of periodontists, and 54.5% of orthodontists experience pain in the lower back region. More than 50% of endodontists experience pain in the neck and shoulders regions, and 39% of general dental practitioners who experience pain in the neck region. Preventive measures need to be taken to decrease the risk of dentists and dental specialists developing work-related musculoskeletal pain. The prevalence and distribution of musculoskeletal disorders (MSDs) among registered general dental practitioners and dental specialists in UAE was not clearly documented. The study results indicated that the region that experienced musculoskeletal pain does vary according to the specialty.

The Effectiveness of Instrument-assisted Soft Tissue Mobilization Technique (Ergon© Technique), Cupping and Ischaemic Pressure Techniques in the Treatment of Amateur Athletes΄ Myofascial Trigger Points

Objective: To compare the effectiveness of a novel Instrument-assisted soft tissue mobilization technique (Ergon© Technique), cupping therapy, and ischaemic pressure technique in the treatment of active myofascial Trigger-points (MTrPs) at the low-back region of amateur soccer players. Design: Randomised controlled clinical trial. Methods: Seventy (70) amateur soccer players (age=24.76 ± 4.39; height=174.98 ± 8.31 cm; weight=73.26 ± 11.21 kg) were evaluated for the presence of active MTrPs in their low-back region and were randomly allocated to three subgroups. The first group (N=20) was treated with Ergon-IASTM Technique©, the second (N=20) with a static application of cupping therapy and the third group (N=20) with ischaemic pressure. Ten (10) players received no treatment and served as controlsgroup. All athletes received one (1) therapeutic intervention per week for three (3) weeks. Outcome measures were MTrPs pain pressure threshold (PPT) and pain sensitivity (VAS). Results: All three therapeutic interventions led to a significant (p 0.05) was observed between cupping and ischaemic pressure techniques for their impact on MTrPs. Conclusions: The Ergon©-IASTM technique can serve as a first treatment options for sports physiotherapists when they manage Low-back MTrPs in amateur athletes. More research is needed in order definite conclusion to be drawn regarding the effects of this novel therapeutic intervention on MTrPs.

Role of Raktamokshana by Ghati Yantra in treatment of Gridhrasi (sciatica): A pilot study.

Introduction:The incidence rate of Gridhrasi (sciatica) is quite significant as more than three-quarters of the world's population are affected by the disease. It is characterized by the onset of Ruja (pain), Toda (pricking), and Stambha (stiffness), initially in Sphika (gluteal region) and then radiating distally to Kati-Prishtha (low back), Janu (knee), Jangha (thigh) till Pada (feet). The patients suffering from Gridhrasi have restricted movements due to painful limb, affecting the daily routine activities.Aim:To assess the role of Raktamokshana (blood letting) done by Ghatiyantra in the patients suffering from Gridhrasi.Materials and Methods:The study was conducted on twenty patients who had reported for the treatment of Gridhrasi at an Ayurvedic hospital. Raktamokshana was done on Sphik (gluteal region) or Kati (low back) region with the help of 18 no. needle and Ghatiyantra (Kanchapatra) in four settings (0, 5th, 10th and 15th day). The sign and symptoms, namely Ruka, Toda, Stambha, and Spandana (fasiculation) were given scores depending on their severity. The patients were also assessed for straight-leg raise (SLR) test. Follow-up was done at an interval of 5 days for three times and the scores were noted down before and after treatment. The scores were analyzed by SPSS 18 software using Student's t-test.Results:Marked reduction in severity of mean scores of Ruja, Toda, Stambha, and Spandana was seen in the patients after the use of Ghatiyantra for Raktamokshana, which was statistically significant.Conclusions:Ghatiyantra is the simple and effective treatment (in adjunct to other treatment) for reducing Ruka, Toda, Stambha, and Spandana in Gridhrasi.

Evaluation of Ergonomic Postures of Physical Education and Sport Science by REBA and Its Relation to Prevalence of Musculoskeletal Disorders

Postural abnormalities of regions predispose individuals to chronic pain. Because of improper position of students, who are growing, the risk of adopting abnormal postures is common. In order to establish appropriate strategies to prevent these impairments, having accurate information about them is necessary. The purpose of this study was to evaluation of ergonomic postures of physical education and sport science by REBA and its relation to prevalence of musculoskeletal disorders. In the present cross-sectional study, 260 subjects of physical education and sport science were selected randomly and interviewed. To determine the prevalence of musculoskeletal disorders and assessment of postures, we used Nordic Musculoskeletal Questionnaire (NMQ) and Rapid Entire Body Assessment (REBA) respectively. Using SPSS IBM 20 software, data were analyzed by chi-square and independent sample t-test. The Rapid Entire Body Assessment results indicated that 40% of participant, equivalent to 104 subjects obtained from 4 to 7 scores (very high risk level). Also, Results of the Nordic questionnaire indicated that the highest musculoskeletal disorder report was related to low back region with 50.8 % and the least common complaints were related to elbows and feet with prevalence rates of 20 and 26%, respectively. It seems that long duration of daily seating and repetitive its and maladjustment of the seat height in proportion were effective factors leading to the high prevalence of musculoskeletal disorders among physical education and sport science students of Gazi University-Turkey which was also confirmed by posture assessment results. Timely adjustment of the seat height through designing adjustable seats and following ergonomic principles in school might be useful strategies to reduce prevalence of musculoskeletal disorders.

WORK RELATED MUSCULOSKELETAL DISORDERS: A SURVEY OF PHYSIOTHERAPISTS IN TRICITY

Background:&nbsp;Musculoskeletal system disorders are common among health care workers worldwide. They are common causes of severe long-term pain and physical disability. Musculoskeletal disorders (MSDs) are defined as “regional impairments of the muscles, tendons, nerves and joints. Physiotherapy can lead to WRMSDs in physiotherapist because of the nature of their profession. Despite of having expert knowledge of musculoskeletal injuries and injury prevention strategies they still report a high incidence of work-related injuries during their professional practice due to their training and continuous professional developmentMethods: A total of 100 Physiotherapists which included 78 females and 22 males in the age group of 21 to 40 years were recruited in the study. The subjects were taken as per the inclusion and exclusion criteria from Tricity.Results:&nbsp;Pearson’s correlation and Chi square analysis was used to determine correlation and the association of prevalence of self-reported musculoskeletal symptoms with personal characteristics, job risk factors and coping strategies. The data obtained from this study documents that majority of Physiotherapists have experienced WRMSDs at some time. The prevalence of WRMSDs among Physiotherapists in Tricity is high (91%). The most common risk factors identified in the present study were dealing with an excessive number of patients in one day; continuing to work while injured or hurt; lifting or transferring dependent patients and work scheduling. In present study, the low back and neck regions were the most commonly affected site among physiotherapists (72.5%) each followed by upper back (28.6 %), shoulder (20.9%), wrist and hand (17.6%), knee (12.1%), ankle and foot (12.1%) and hip (7.70%)Conclusions:&nbsp;Work-related musculoskeletal disorders are an important health risk within the physiotherapy profession. The prevalence of work-related musculoskeletal disorders among the Physiotherapists in Tricity is high that is 91%. Hence, it supports the research hypothesis of the present study. It is also concluded that the low back and neck (72.5% each) are the most common sites susceptible to injury followed by upper back and shoulder

Analysis of musculoskeletal symptoms (pain) and characteristics of the anthropometric parameters in the military personnel

Musculoskeletal disorders are connected to external and internal factors. External conditions in the military environment are characterized with a high physical load and psychological load. Internal factors are connect to individual health capacity, anthropometric characteristics, posture and foot state or the deviation from the standard. The pain is a common subjective sign of musculoskeletal pathology. The pain symptoms could be the initial symptom of musculoskeletal pathology which is an important cause of morbidity in the military service [6, 7]. The nature of the musculoskeletal problems suggests that a combination of ergonomic and individual/organizational intrinsic and extrinsic factors are associated with the military environment. We have provided for the analysis of cadets of the national Defence Academy in the period 2013–2014 the anthropometric parameters, the calculation of the body fat range according to the Guidelines of WHO and the data of the standardized Nordic Questionnaire for the Analysis Musculoskeletal Symptoms. The analysis of the average value of the body mass index fixed differences between the respondents’ groups. The assessment of the range of the body mass index revealed that the number of the individuals related to the overweight problems increased with the age about 1.5 times. Evaluations of the body fat range have shown that the number of the individuals with the healthy assessment of the body fat range decreased about two times with the age. Military training conditions with the combination of the intrinsic (individual) factors form the risk for musculoskeletal disorders. The most common problematic areas of pain are the lower back region, the hip joint region, the knee joint region, but the largest problem is the combined pain for the lower back and the knee joint region. The analysis of anthropometric parameters and evaluation of data Questionnaire for Analysis Musculoskeletal Symptoms may be important to provide preventive measures to reduce the risk of musculoskeletal disorders linked to a specific job and the treatment at the early stage where the combination of the extrinsic factors condition and intrinsic factors is present.