Muscular-tonic Syndrome Research Articles

Occasional back pain in officers of the FFS of the EMERCOM of Russia depending on age, experience, professional workload and performance at work

Relevance: According to global studies, the prevalence of back pain in firefighters ranges from 30 to 71.1 %. Harsh working conditions lead to acute and chronic pain syndromes and limited range of motion in the spine, which can become critical in an emergency.The objective is to analyze the influence of age, length of service, professional workload, successful performance at work on the presence of pain and reduction of movements, as well as neurological vertebrogenic manifestations, taking into account the musculoskeletal system (MS) pathology (C13 IDC-10) in among fire service employees in general.Materials and methods: 117 subjects, aged 20 to 47 years, employed by the Federal Border Service of the State Fire Fighter Service of the EMERCOM of Russia, underwent traditional neurological examination, spine biomechanical testing, and pain syndrome assessment by the VAS scale. The results were split into groups and structured by age, length of service, professional workload, success at work, and pathology of the musculoskeletal system.Results: Occasional pain in the spine was observed in 59.2 % of firefighters, mostly in the subgroup with over 15 years of professional experience than in subgroups with 6 to 14 years and under 5 years (p < 0.05) of professional record. Musculartonic syndrome was detected in 34 % and was more pronounced in the subgroup with high professional workload, than in those with light and moderate (p < 0.05) workload and in workers aged 40 to 50 years, rather than in younger subgroups (p < 0.05). Static and static/dynamic disorders in the spine were detected in 45 % of employees and were prevalent mostly in the subgroup with a service record of over 15 years (p < 0.001), as well as in the subgroup with high professional load (p < 0.05). A decrease in reflexes was mostly observed in the subgroup aged 31 to 39 years old (p < 0.05) and in the ODS impairment subgroup (p < 0.001), while root tension symptoms dominated in the subgroup aged 40 to 50 years (p < 0.05). Sensitivity disorders (p < 0.005; p < 0.05) and root tension symptoms (p < 0.01; p < 0.005) were more often detected in subgroups with low and average professional success compared to the subgroup of successful performers. According to the regression analysis model that considered age, length of service, professional workload, successful performance at work, and ODS pathology, work experience was an only parameter showing a significant cause-and-effect correlation with static/ dynamic spine disorders: OR = 3.66; 95 % CI = 1.25–10.7 (p < 0.05).Conclusion: In firefighters, the major factors influencing pain and reduction of movements in the spine include work experience in extreme conditions and professional workload; transformed perception of painful stimuli and radicular sensory disturbances are more pronounced in employees with limited professional success. Ergonomic interventions and a biopsychosocial approach are key in the treatment and prevention of dorsopathy in fire service personnel.

Experience of application of emotion-image therapy in the treatment of muscular tonic back pain

he article is devoted to the issues of clinical algology. A study of the effectiveness of N.D. Linde’s psychotherapy method (emotion-image therapy) in patients with muscular tonic syndrome in the lumbar region is carried out.

Патогенетичні та терапевтичні аспекти застосування препарату Мускомед при вертеброгенних м’язово-тонічних синдромах

Проведено відкрите клінічне дослідження з вивчення ефективності та переносимості лікарського засобу Мускомед виробництва компанії World Medicine у пацієнтів з м’язово-тонічними синдромами. Препарат Мускомед містить активну речовину тіоколхікозид, напівсинтетичний міорелаксант, що отримується з натурального глікозиду колхікозиду. Справляє міорелаксуючу дію. Знижує або усуває м’язові спазми, зумовлені впливом з боку центральної нервової системи. Мета дослідження: оцінити ефективність і переносимість препарату Мускомед виробництва компанії World Medicine у пацієнтів з м’язово-тонічними синдромами. Завдання дослідження: вивчити терапевтичну ефективність препарату Мускомед, його вплив на вираженість м’язово-тонічного синдрому; вивчити переносимість та можливі побічні явища досліджуваного препарату; порівняти терапевтичний ефект препарату Мускомед і препарату Толперіл-Здоров’я при лікуванні м’язово-тонічного синдрому. Об’єкт дослідження: 60 пацієнтів обох статей у віці від 18 до 65 років з м’язово-тонічними синдромами, які перебували на стаціонарному та/або амбулаторному лікуванні у відділенні судинної патології головного мозку ДУ «Інститут неврології, психіатрії та наркології НАМН України». Залежно від одержуваної терапії всі пацієнти були розділені на 2 рівні групи: 1-ша — 30 осіб, які отримували Мускомед 2 мл 2 рази на добу в/м протягом 5 днів на тлі загальноприйнятої стандартної терапії; 2-га — 30 осіб, які отримували Толперіл-Здоров’я 1 мл 2 рази на добу на тлі загальноприйнятої стандартної терапії. Методи обстеження: загальноклінічні, клініко-неврологічне та ней­ропсихологічне дослідження з використанням шкал (проба Шобера, опитувальник Роланда — Морріса, візуальна аналогова шкала, госпітальна шкала тривоги і депресії, Мак-Гілловський больовий опитувальник, опитувальник якості життя EuroQOL 5D), інструментальні (рентгенографія, магнітно-резонансна томографія), біохімічні, клініко-лабораторні, статистичні. Результати й обговорення. Р езультати проведеного дослідження дозволили зробити висновок, що препарат Мускомед справляє досить виражений терапевтичний вплив на м’язово-тонічні синдроми, зручний у використанні, а також призводить до поліпшення фізичного благополуччя, підвищення працездатності та якості життя пацієнтів.

Новий метод виконання міжфасціальної блокади м’язів — випрямлячів спини (erector spine plane block) для лікування больового синдрому

Актуальність. Остеохондроз хребта є однією з найбільш частих причин появи больового синдрому в спині та кінцівках. Методи лікування варіюють від лікувальної фізкультури та масажу до складних транспедикулярних фіксацій хребта з декомпресією спинного мозку та його корінців. У найскладніших випадках, незважаючи на адекватно проведене оперативне втручання, больовий синдром повертається з не меншою інтенсивністю. Метою нашої роботи було описати клінічний випадок лікування больового синдрому при поширеному остеохондрозі хребта з післяопераційним м’язово-тонічним синдромом. Результати. Хронічний біль не піддавався лікуванню нестероїдними протизапальними препаратами та прегабаліном, проте його ефективно купірували за допомогою техніки регіонарної анестезії: міжфасціальної блокади м’язів — випрямлячів спини. Основною складністю і небезпекою при проведенні блокади було те, що вже наявна в пацієнта металоконструкція змінила анатомічні орієнтири, а метал, з якого вона складалася, розсіював ультразвукові промені, тому зображення на моніторі ультразвукового апарату стало недостатньо якісним для безпечного та ефективного виконання регіонарної анестезії. Блокаду м’язів — випрямлячів спини було виконано під контролем цифрової рентгенографії. Висновки. Блокада м’язів — випрямлячів спини може бути використана для лікування болю незалежно від його етіології. Альтернативою ультразвукової навігації при проведенні блокад може бути цифрова рентгенографія, особливо в разі, коли ультразвукове дослідження є технічно складним чи неможливим.

Acute musculoskeletal neck and back pain

Back and neck pain is widespread in the population. Preferably, patients of working age are sick, which leads to serious economic losses. The transition of pain from acute to chronic increases financial costs, so effective treatment of back pain is an important medical, social and economic problem. Musculoskeletal pain (MSP) prevails among all types of back pain. The source of the MSP can be various structures of the musculoskeletal system: bones, joints, muscles, fascia, tendons, ligaments, intervertebral discs. The provoking factors for the development of the MSP are static and dynamic overloads arising from physical work, long stay in a fixed posture, unprepared movements, hypothermia, vibrations. The leading diagnostic method for the MSP is a physical research of a patient which includes a detailed collection of complaints and anamnesis, inspection in statics and dynamics, carrying out global and special tests, neuroorthopedic and neurological research. In most cases, the analysis of the results obtained allows you to set a clinical diagnosis without appointing additional research methods. Two cases of acute MSP with different localization, clinical manifestations and flow are offered to the discussion. In the first case, the process was localized in the muscles of the law back. In the second patient, the muscular tonic syndrome developed in the muscles of the neck and shoulder belt and was supported by functional blockades of the vertebral motor segments. For the treatment of both patients, NSAID, muscle relaxant, glucocorticoid, as well as non-drug therapy methods were used. For local injection therapy, a drug group of glucocorticoids was used, having a sodium phosphate and betamethazone dipropionate as part of the sodium betamethasone. The combination of two betamethazone salts provides both the rapid and prolonged effect of the drug, which makes it reasonable to use it with acute musculoskeletal pain.

Біль у тазу як міждисциплінарна проблема: деякі аспекти

Однією з найчастіших причин болю спини є міофасціальний больовий синдром (МФБС). Близько 84,0 % дорослого населення хоча б раз у житті мають епізод болю у попереку, а 40,0–70,0 % — у шиї. Частка скелетно-м’язового болю серед хронічних больових синдромів становить близько 30,0 %. МФБС може виникати як самостійно, так і у структурі вертеброгенного рефлекторного м’язово-тонічного синдрому, він є другою за частотою (після респіраторних захворювань) причиною звернення до лікарів і третьою за частотою причиною госпіталізації. Високий рівень тимчасової і постійної втрати праце­здатності серед хворих із МФБС зумовлює велику соціальну значущість цієї проблеми.

Tolperisone in the combination treatment of muscular tonic syndrome in individuals with a high level of physical activity

Introduction. Dorsalgia is one of the most common diseases in individuals practising regular physical training and sports Rationale. Because of the growth of the number of physically active individuals expected to rise by 2024, the improvement of drug and physical rehabilitation methods comes into sharp focus.The objective of the study is to evaluate the clinical efficacy of the use of a centrally acting muscle tolperisone-containing relaxant in the combined treatment of dorsalgia accompanied by a muscular tonic syndrome.Materials and methods. In the study, two groups of patients (30 people each) with muscular tonic syndrome received therapy that included NSAIDs and a neurotropic vitamin complex (in the comparison group), and additionally a centrally acting muscle relaxant (in the treatment group).The treatment outcome was assessed by changes in complaints and the objective neurological status of patients, the degree of muscle soreness upon palpation, and the evaluation of pain syndrome using a visual analogue scale.The shear wave elastography (SWE) of defunct muscles was used as an objective assessment method.Earlier in clinical practice, muscle tension in patients was usually assessed using manual palpation, i.e., only qualitatively and subjectively. SWE is an operator-independent, relatively reproducible, and quantitative method for assessing tendons and muscles. SWE was used in this study to obtain more objective assessment and comparison of the elasticity of “affected” and “healthy” symmetrical back muscles before and after the use of drugs.Results. The study showed a high clinical efficacy of tolperisone in the combination therapy of the lower back pain accompanied by muscular tonic syndrome, which was confirmed by a more significant decreased muscle-tonic syndrome based on the evaluation of complaints and the degree of muscle soreness upon palpation, a more pronounced regression of pain syndrome according to VAS in the treatment group of patients vs the comparison group. According to the elastography findings before and after treatment, the group receiving tolperisone showed a more significant decrease in muscular tonic syndrome.Сonclusion. The study confirmed the clinical efficacy of tolperisone manufactured by Sotex pharmaceutical company. On these grounds we recommend that the drug is used in combination therapy for dorsalgias (dorsopathies) accompanied by a muscular tonic (myofascial) syndrome both in patients without a proper level of physical activity, and in those practising regular physical training and sports.

Back pain: from diagnosis to treatment

In today ‘s world, back pain is a heavy burden and leads to a decrease in the working capacity, quality of life of people. The choice of tactics of treatment of pain in a back is defined by the pain reason: nonspecific pain, the specific pain caused by serious diseases or a compression of a root. The most frequent cause of back pain is nonspecific pain due to myofascial, muscular-tonic syndrome, facet syndrome, and sacral-iliac joint dysfunction in lower back pain. The article presents clinical symptoms of these syndrome, as well as techniques of neuroorthopedic examination, which allow to detect one or more abrasions of back pain. To prevent acute non-specific pain, it is recommended to prescribe non-steroidal anti-inflammatory drugs (NSAID) and muscle relaxants. Along with pharmacological treatments, treatment of patients with back pain should be more comprehensive and include cognitive-behavioral therapy and kinesiotherapy. Determination of the source of back pain in neuroorthopedic examination makes it possible to carry out local therapy in stages using blockages with local anesthetics and glucocorticoids. In case of insufficient effectiveness of blockades, it is possible to carry out radiofrequency denervation of facet joints or sacral-iliac). Clinical and neuroorthopedic examination of a patient with back pain with identification of sources of pain, analysis of the causes that led to its development, adequate treatment and recommendations to prevent repeated exacerbations can significantly reduce the risk of chronization of back pain and improve the quality of life of patients.

Phenomenon of text neck in higher education students

In the modern world almost all young people use smartphones and now most of the time using mobile phones belongs to additional functions. Regrettably, consequences for the musculokeletal system are not considered. It is a known fact that long-term use of the gadgets causes excessive cervical spine bending, improper posture and the formation of muscular-tonic syndrome accompanied by the pain and discomfort that is so-called “Text neck” syndrome. The aim of the research was to study the impact of using gadgets on the formation pain syndrome in the neck and shoulders, as well as headache. The research involved 90 respondents, 60 female and 30 males, the age of the participants was in a range from 18 to 28 years old. Using a self-created questionnaire, applying in Google docs, Text neck symptoms such as headache, pain/discomfort in the neck and shoulder, as well as awareness of this phenomenon have been evaluated. The study has shown the primary role of the shoulder pain/discomfort among respondents, thus 59 (66%) of the participants suffer from shoulder pain/discomfort in different degrees with the gender distribution as follows: 46 women (76%) and 13 men (43%). Headache was noted by 56% of the participants and 50% suffer from neck pain/discomfort. The average phone usage time was 5.3 hours. Only one third (32%) of respondents associated their symptoms with the use of gadgets, so the study has demonstrated low awareness about this syndrome among students. Young people do not realize devastating impact of the gadgets on the health condition, in particular musculoskeletal system. Thus, the authors believe that an integrated approach is needed on the part of the family, educational establishments and health care with a view to build awareness in young people and prevent Text neck formation. Seems like a reasonable implementation of the course on the possible impact of excessive gadgets use on the health condition of the students at higher education institutions.

The use of low-intensity laser radiation in the treatment of occupational diseases of the peripheral nervous system

Introduction. Laser radiation, discovered in the mid-twentieth century, is actively used in modern medicine. Along with the effects of high-energy lasers, researchers are attracting more and more attention to the methods of low-intensity laser therapy in the treatment of various diseases of the peripheral nervous system. At the same time, there are very few works in which the effectiveness of low-intensity laser radiation action in occupational diseases of the nervous system would be assessed.The aim of study was searching for information on the modern understanding of the mechanisms of action of low-intensity laser radiation and on its use in the treatment of occupational diseases of the nervous system in Russian and foreign scientific literature.Materials and methods: The article presents an overview of available scientific Russian and foreign literary sources. Search and selection of sources was carried out using open databases PubMed and RSCI.Results. Low-intensity laser therapy has anti-inflammatory, analgesic, immunocorrective and reflexogenic effects. There are described cases of successful application of low-intensity laser radiation in the treatment of vibration disease, radicular and muscular tonic syndromes, carpal tunnel syndrome. At the same time, there are no works in which the influence of low-intensity laser radiation on the dynamics of professional polyneuropathy of the upper limbs would be assessed.Conclusions: The biological effect of low-intensity laser radiation is complex and many-sided. Low-intensity laser therapy has a wide spectrum of action on various pathogenesis pathways, it is a common method of treating diseases of the peripheral nervous system, including professional aetiology. The urgent task is to substantiate and develop a technique for using low-intensity laser radiation to treat patients with professional polyneuropathies of the upper limbs (as the most common occupational disease of the peripheral nervous system) and to evaluate its effectiveness during dynamic observation.

Myofascial syndrome as a pathogenetic mechanism for formation of scoliosis in people with multiple sclerosis

The purpose of this research was to conduct a comprehensive analysis of clinical changes and electroneuro­myographic indices in people with multiple sclerosis in combination with various types of functional disorders of posture. The study involved 105 people with multiple sclerosis aged 26–58 who were undergoing rehabilitation at a specialized medical center. The degree of spasticity of the muscles was determined by the modified Ashworth scale. To assess the intensity and nature of pain, a neurologic examination was performed using a visual analogue scale and a McGilovsky pain questionnaire. Interference and stimulation electroneuromyography was used to characterize the functional state of the peripheral neuromotor apparatus of skeletal muscles, the results of which determined the maximum arbitrary contraction of the muscle using quantitative analysis of time, amplitude and frequency parameters, and also determined the speed of the pulse, the amplitude and duration of the F wave, latent period and polyphase M-wave, monosynaptic testing (H-reflex) was carried out. The percentage of Hmax/Mmax was calculated from the electroneuro­myographic results. By the ratio between the maximum and minimum amplitude of the M-response, the number of motor units was calculated. To analyze the denervation-reinvational processes of motor units and degenerative-restorative changes in the muscle fibers, spontaneous fibrillation potentials and positive acute waves were recorded. By the stage of manifestation of pain myofascial syndrome, all patients were divided into three groups, in which the force characteristics decreased by 10.2%, 25.0% and 30.2%, respectively. It is well understood in clinic-instrumental research, that in 67.3% cases of multiple sclerosis the patient also suffers from functional scoliosis. This pathological symptom complex contributes to the creation of not only muscular, but also fascial-ligamental trigger points. They, in turn, are the source of the formation of secondary trigger loci. In terms of the degree of manifestation of subjective pain in the presence of myo-fascial syndrome, all patients were divided into three groups, and depending on the value of individual indicators, three stages of spontaneous fibrillation potentials were identified that clearly correlate with the degree of fibromyalgic syndrome and manifest specific electroneuromyographic disorders in each of these stages. The main pathogenetic mechanism that contributes to the formation of pathological bends of the spine in people with multiple sclerosis is a painful muscular-fascial syndrome. It is provoked by myofascial hypertonia and takes part in the development of cross syndromes, which is also manifested by clear changes in electroneuromyographic parameters in the form of asymmetric muscle tone. This article discusses clinical variants of the course of local muscular-tonic syndromes. Pathogenetic approaches to the prevention of posture disorders in patients with multiple sclerosis are presented here.

ФУНКЦИОНАЛЬНАЯ ДИАГНОСТИКА И ИГЛОРЕФЛЕКСОТЕРАПИЯ У ПАЦИЕНТОВ С ОСТЕОХОНДРОЗОМ ШЕЙНОГО ОТДЕЛА ПОЗВОНОЧНИКА

We developed an algorithm for spinal diagnostics to optimize the diagnosis and treatment of patients with cervical osteochondrosis. This algorithm includes physical and neurological examination of a patient, radiological methods, multi-layer spiral CT (MRI) of cervical spine, densitometry and electroneuromyography (ENMG) and is used in practical work of neurosurgical unit of Irkutsk Scientific Center of Surgery and Traumatology. We managed 40patients with cervical osteochondrosis in period I–III localized in CIII–CIV, CIV–CV, CV–CVI, CVI–CVII segments and with severe muscular tonic syndrome (cervicalgia, cervical cranialgia, cervicobrachialgia). Patients with osteochondrosis in period I–II had medium decreased conduction of peripheral nerve motor fibers on both sides of spine, which indicates the lesion of some motor fibers. In patients with osteochondrosis in period III in case of protrusion and herniation of intervertebral discs the ENMG values corresponded to the increase in neurility and conduction velocity of motor nerve and muscle fibers in diseased segment.Conservative treatment was conducted up to the Standard approved by the Ministry of Health of the Russian Federation and was supplemented with acupuncture (9–10 sessions) based on the changes in ENMG values. Performed treatment caused significant decrease in pain syndrome, reduction of neurological manifestations and, as a consequence, positive dynamics of ENMG values. Proposed algorithm for management of patients with osteochondrosis allowed to diagnose the localization of diseased functional spinal unit, to reveal problem peripheral nerves and, as a result, to choose adequate treatment tactics and to estimate its effectiveness.

Prevalence and causes of back pain syndromes in children

We present a review of literature devoted to epidemiology, and the nosological and syndromal structure of back pain in children. The data of our own study of school-aged children with back pain are presented. The structure of back pain syndromes in 105 children has been analyzed using the medical aid appealability data. The results of a comprehensive clinical and instrumental study demonstrated that the children mostly had lumbosacral pain (52.4% of cases); neck pain was observed in 29.5% of cases; while thoracic pain syndromes were observed in 18.1% of cases. Congenital defect of the connective tissue was diagnosed in 16.19% of children; congenital abnormalities of the spine, in 15.2%; scoliosis (idiopathic and secondary), in 8.6%; and Scheuermann-Mau's disease, in 5.71%. The conclusion has been made about the high prevalence of back pain in schoolchildren. Muscular tonic syndromes were prevailing in the clinical structure in children; radicular syndromes were less frequent. Musculoskeletal disorders were the main causes of back pain. Congenital defect of the connective tissue was often observed, which was revealed as functional instability of the vertebral motor segment, spondylolisthesis due to weak ligaments, and disc protrusions. Congenital abnormalities of the spine, scoliosis, and Scheuermann-Mau' disease were observed less often.

Clinical and neurological characteristics of patients with somatic referred back pain at the lumbosacral level

Referred pain is a painful sensation in the peripheral regions during pathological processes in deep tissues or viscera. There are two types of referred pain: 1) somatic referred pain (from spinal structures to adjacent areas); 2) visceral referred pain (from pelvic and abdominal viscera). Patients and methods. The investigation enrolled 80 patients with nonspecific chronic and subacute lumbosacral spine pain. All the patients underwent standard neurological examination. Pain intensity was determined on a visual analog scale (VAS) using the DN4, PainDETECT, and short-form McGill questionnaires; the wind-up phenomenon was evaluated; the degree of muscular tonic syndrome was estimated applying the Khabirov questionnaire. The health-activity-mood (HAM), SF-36, and Roland-Morris questionnaires were used to assess quality of life. Results. Somatic referred pain was found in 62% of the examinees. In these patients, the clinical picture showed a set of characteristics for neuropathic (allodynia (31%), hyperesthesia (12%), and nociceptive (grades 1 and 2 muscular tonic syndrome 41 and 59%, respectively) pain; a high wind-up index was noted in 89% of the patients.

Correction of a muscular-tonic syndrome at a cervical osteochondrosis by device Multi-Cervical Unit «Hanoun medical»

Neurologic, radiological inspection of 30 men (middle age is 36,5 ± 7,5) with a muscular-tonic syndrome at a cervical osteochondrosis. According to an index of a muscular syndrome on 3 degrees of weight 3 groups of patients are allocated. Diagnostics by device MСU allows to reveal authentically and precisely dysfunction in the certain group of muscles of a neck and to spend their adequate training, promoting duly correction. The medical technique of device MCU leads to full recourse muscular-tonic and liquidations of a painful syndrome at muscular-tonic syndrome I and to II degree, significant recourse of expressiveness of syndromes at sick of a cervical osteochondrosis with muscular-tonic a syndrome of III degree. Formation of a correct muscular stereotype provides achievement of proof medical effect, preventive maintenance of a reflex painful syndrome in a cervical department of a backbone and prevention of chronic disease.