Postural Pain Research Articles

Rectus muscle diastasis in Italian women: determinants of disease severity, and associated disorders.

Diastasis of rectus abdominis (DRA) refers to a separation of the rectus abdominis from the linea alba, which is common in the female population during pregnancy and in the postpartum period. The present study aimed at investigating DRA severity, risk factors and associated disorders. In the present cross-sectional study, a web-based questionnaire was addressed to the 23,000 members of the Women's Diastasis Association. The questionnaire comprised three parts, dedicated respectively to diastasis characteristics, possible risk factors, and related disorders. Faecal and urinary incontinences were assessed using the Wexner and ICIQ-SF score, respectively. Risk factors for diastasis severity (<3, 3-5, >5 cm) were evaluated by a multinomial regression model. Four thousand six hundred twenty-nine women with a mean age (SD) of 39.8 (6.5) years and a median BMI of 23.7 kg/m2 (range 16.0-40.0) responded to the questionnaire. Proportion of DRA >5 cm increased from 22.8% in norm weight women to 44.0% in severely obese women, and from 10.0% in nulliparous women to 39.3% in women with >3 pregnancies. These associations were confirmed in multivariable analysis. DRA severity was associated with the risk of abdominal hernia and pelvic prolapse, whose prevalence more than doubled from women with DRA <3 cm (31.6% and 9.7%, respectively) to women with DRA >5 cm (68.2% and 20.2%). In addition, most patients reported postural pain and urinary incontinence, whose frequency increased with DRA severity. The present study confirmed that DRA severity increases with increasing BMI and number of pregnancies. Larger separation between rectal muscles was associated with increased risk of pain/discomfort, urinary incontinence, abdominal hernia and pelvic prolapse. Prospective studies are needed to better evaluate risk factors.

Musculoskeletal pain symptoms in users performing smartphone texting: A preliminary study on institute environment

Nowadays, smartphones have become an integral part of our lives as the advancement of technologies leads the world to use such devices as a mode of communication. Everyone relies on their smartphones for our daily activities, irrespective of adopted painful postures leading to musculoskeletal pain symptoms. The present study investigates the possible factors associated with musculoskeletal pain among institute students performing smartphone texting in various postural conditions. A cross-sectional study was conducted on Indian Institute students (N = 447; female = 194; male = 253) using a self-administered online questionnaire to gather a self-report measure of musculoskeletal pain. Various postures adopted while freely performing smartphone texting were considered in four institute environment conditions: sitting on a chair, sitting on a staircase, standing and walking. Multi nominal regression analysis was used to identify the occurrence of musculoskeletal pain with associated factors. Significant associations found included musculoskeletal pain in the neck (odds ratio 2.16, 95% confidence interval 0.86–3.47), and the shoulder (2.11, 0.67–5.93) for the time spent on smartphone texting of 6–9 h on a typical day. The pain in the neck (2.06, 0.49–3.17) and the back (2.11, 0.65–4.38) was also statistically significant for the users' texting condition while sitting on a staircase. It was observed that students mostly acquire excessive flexed neck-trunk posture during smartphone texting, causing pain symptoms and is mostly of major concern to heavy users.

추나요법을 동반한 한방복합치료로 호전된 요추 전만각 1례: 증례보고

Objectives :To introduce a case of a traffic accident trauma in a patient with lumbar kyphosis and straightened lumbar curvature, where the Korean medicine treatment with Chuna manual therapy (CMT) improved lumbar lordotic angle(LLA) and lower back pain.&#x0D; Methods : Chuna manual therapy and other Korean medicine treatments; were pro- vided to patient with a flat back posture and low back pain due to the trauma from a traffic accident. Cobb’s angle to evaluate LLA and numeric rating scale (NRS) to eval- uate pain were compared before and after the treatment.&#x0D; Results : There was a significant increase in LLA to reach the normal range and a de- crease in low back pain NRS after Korean medicine treatment with CMT for 9 days of admission treatment and 3 weeks of outpatient treatment.&#x0D; Conclusions :This study suggests that Korean medicine treatment, including CMT, may improve low back pain as well as LLA of straightened lumbar curvatures in patients.

Relationship between the level of knowledge about ergonomic postures and perception of postural pain in dental professionals

Relationship between the level of knowledge about ergonomic postures and perception of postural pain in dental professionals

Development of a Vibration Based-Heating Neckband for Cervical Spondylosis

The post-pandemic working pattern has changed a lot due to the change in the mode of working and ease of flexibility as almost all the works are done online. This is affecting the lifestyle of the human due to continuing online working and due to this many health issues are being recorded. The main problem seen is in the postural change of the neck which results in minor or major neck pain problems. According to a study currently, the rate of neck pain is around 30% in adults, around 50% of individuals are facing a minor neck problem to some extent and 20% of humans experienced this neck pain in their daily activities. Different types of neck diseases can be occurred due to this such as osteoarthritis, pinched nerves, postural pain, and also some problems related to cervical vertebrae, for the same the existing collar belt is modified and tried to make an affordable massager belt to have relief during this pain which helps the blood flow to maintain and can stimulate nerves. Advanced treatment is embedded in this collar which has vibration motions and a heating pad that helps for the neck. According to their requirement, we can adjust the intensity of the motion. And also, this helps the improvement in the neck posture. Keywords: [Cervical Spondylosis, Neck pain, Physiotherapy, Healthcare, Ultrasonic Heating Pad, Vibration effect]

Correlation Between Forward Head Posture and neck pain in IT Professionals by using Postural Screen Mobile App

Neck pain is a type of pain that starts inside the neck and can radiate down to one or both arms. Neck discomfort can be caused by a variety of disorders or illnesses affecting any of the neck structures, nerve fibers, bones, joints, connective or contractile tissue. Forward head position is described as the skull being bent forward over the atlas by more than one inch. Objective: To assess the correlation of neck pain with forward head posture in IT Professionals by using the postural screen mobile app (sit screen). Methods: It was a cross-sectional survey. The sample size was 150. The study was conducted at TkXel Software Company and UMT IT department and UOL IT department in Lahore. Males of age 20-60 were included in the study. The tool used was the Posture Screen Mobile app iPhone 7plus and neck disability pain index questionnaire. Results: The cross-tabulation of NPAD SCORE and CV angle resulted in negative co-relation with r=-0.680 p&lt;0.05 i.e., the smaller CV angle showed the worst FHP along with greater NPAD SCRORE showed the worst becomes neck pain. Cross-tabulation of working hours and CV angle result in negative co-relation with r= -0.450, p&lt;0.05 i.e., worst FHP with working hours greater than 6 hours. Cross-tabulation of working hours and NPAD SCORE result in positive co-relation with r= 0.477, p&lt;0.05 i.e., the greater the NPAD SCRORE the worst becomes neck pain with working hours greater than 6 hours. All calculations showed that FHP and neck pain are positively correlated with each other as working hours increased, with the result being statistically significant. Conclusions: Our findings have revealed that IT employees had a defective posture and improper posture was more severe while working more than 6 hours per/day. The ratio of moderate pain with FHP was found in the majority of IT professionals

The Correlation Between Posture, Duration of Gadget Usage and Physical Activity during COVID-19 Pandemic to The Occurrence of Neck Pain among Medical Students in Udayana University

ABSTRACT&#x0D; Increased duration of gadget usage since COVID-19 pandemics can cause various negative impacts if implemented without considering ergonomic factors, especially body and neck posture. One of those impacts that often found is musculoskeletal disorders like neck pain due to excessive cervical flexion load. However, incidence of neck pain also affected by many other factors, such as physical activity and exercise habit. This study aims to determine the correlation between posture, duration of gadget usage, and physical activity during COVID-19 pandemic to the occurrence of neck pain among Medical Students in Udayana University. An analytical observational study was conducted with cross-sectional approach using questionnaire adapted from Nordic Musculoskeletal Questionnaire to measure quantity and quality of neck pain of 106 medical students in Udayana University. The correlation between variables was then analyzed by Chi-square test. Results of this study showed that 77.4% of medical students in Udayana University usually use gadget ?56 hours a week and 61.3% of medical students have experienced neck pain in last 12 months during COVID-19 pandemic. Analytical study showed that correlation between posture and neck pain has p-value = 0.016 (&lt;0.05), physical activity and neck pain has p-value = 0.012 (&lt;0.05), while duration of gadget usage and neck pain has p-value = 0.733 (&gt;0.05). It can be concluded that there are significant correlations between posture while using gadget and physical activity to neck pain, but there is no significant correlation between duration of gadget usage and neck pain during COVID-19 pandemic among medical students in Udayana University.&#x0D; Keywords : posture; duration; gadget; physical activity; neck pain; medical students

Therapeutic routine with respiratory exercises improves posture, muscle activity, and respiratory pattern of patients with neck pain: a randomized controlled trial

Neck pain and forward head posture (FHP) are typical in prolonged smartphone users and need to be targeted for treatment. We aimed to compare the effect of a routine therapeutic program with and without respiratory exercises on smartphone users with FHP and non-specific chronic neck pain (NSCNP). Sixty patients (aged 24.7 ± 2.1 years) with FHP and NSCNP were randomly assigned to the routine therapeutic program (n = 20), combined respiratory exercises with a routine therapeutic program (n = 20), or control (n = 20) groups. At baseline, there was no difference among groups at all variables. Each programme was implemented three times a week for eight weeks. Primary Outcome was pain measured by visual analogue scale (VAS), and secondary ones were forward head angle, the activity of specific muscles, and respiratory patterns, measured by photogrammetry, electromyography and manual, respectively. All outcomes were measured at baseline and eight weeks post-treatment. We used the repeated measures analysis of variance to examine the interaction between time and group, paired t-test for intragroup comparison, one-way analysis of variance for intergroup comparison, and Tukey post hoc test at a significant level 95% was used. There were significant differences in the combined group compared with the routine therapeutic group (P = 0.03) for diaphragm muscle activation, respiratory balance (P = 0.01), and the number of breaths (P = 0.02). There were significant within-group changes from baseline to post-treatment in the combined group for all outcomes above, but no changes in the therapeutic exercise routine group. Despite respiratory pattern, none of the secondary outcomes proved to be superior in the combination group compared to the routine therapeutic program in smartphone users with FHP and NSCNP. Future studies with longer follow-up assessments could strengthen these results.Trial registration: Current Controlled Trials using the IRCT website with ID number of, IRCT20200212046469N1 “Prospectively registered” at 04/03/2020.

Back pain and body posture of non-professional Brazilian Jiu-Jitsu practitioners.

BackgroundThe aim of the study was to assess the prevalence of back pain in non-professional Brazilian Jiu-Jitsu practitioners (NP-BJJ practitioners), and to assess the relationship between their back pain and postural disorders.MethodsThe study involved 61 subjects (age: 30.7 ± 4.9 years old; body mass: 79.4 ± 12.9 kg; body height: 179.6 ± 8.4 cm; 8 woman and 53 man), 31 who trained Brazilian Jiu-Jitsu (BJJ) and 30 subjects who had never trained any combat sport. The mean time of training BJJ in the study population was 3.9 ± 4.1 years. Postural assessments were conducted with the use of the photogrammetric method. The assessment of back pain and injuries was conducted with the Oswestry Disability Index (ODI) and with our proprietary questionnaire.ResultsAmong both populations, 37 subjects reported back pain. There were no differences in back pain location between the two groups or in functional state on the ODI. Significant differences between the groups in the values of the postural parameters (spinal height, length of kyphosis, length of lordosis, pelvis inclination angle) were observed. Statistically significant differences between the NP-BJJ practitioners with and without back pain in the length of the thoracic kyphosis and the differences in the height of the waist triangles were found.ConclusionsBoth in the study population and in the control group the spinal pain was minimal or moderate on the ODI. BJJ practitioners who reported back pain had characteristic postural changes in some of the analysed postural parameters in comparison to BJJ practitioners who did not report back pain.

Association of heavy bag lifting time with postural pain in secondary school students

To determine the association between heavy bag lifting with posture among secondary school students. METHODS: This study was a cross sectional survey. Based on sample of convenience, total 380 Students of both gendersbelonging to Beaconhouse School System, KIPS School System,Educators School and The Punjab School System were included with an age 14 to 17 years (school grade 9 to 12). The data was collected using the Reedco scale and Grimmer’s Questionnaire for assessment of posture and, use of heavy bags andits associated pain, respectively. RESULTS: The majority of participants in this consisted of young adults above 12 years (39%) and below 12years (34%) with male predominant (54%). 370 students out of 380 were carrying heavy bags. The types of bags they mostly carry were backpacks (51%), satchel (34%) and others (15%). 48% of these students never used lockers and 40% of them often use locker 55% of them never use waist belt to carry bag. Most of the students 48% spend 11 to 20 minutes for carrying bag per day.61% of them carry extra load (water bottles, lunch boxes, guide books) with them also. Out of 380 students 246 had pain in different body regions due to heavy bags 64% had neck pain and 53% had upper back pain while 19% had shoulder pain. Out of 184 students that carry bag from 11 to 20 minutes, 115 had poor neck posture, 133 had poor shoulder posture 25 had poor head posture and 5 had poor upper back pain and that carry from 21 to 30 minutes out of 167 students 122 had bad neck posture and 132 had poor shoulder posture 50 had poor head posture 105 had poor upper back posture. CONCLUSION: There was found significant association between heavy bag lifting and poor posture with related pain in regions of cervical followed by upper back in secondary school students.

Short-term effects of postural taping on pain and forward head posture: a randomized controlled trial

BackgroundBalance Body Tape (BBT) is a recently developed taping-method with the aim to reduce pain and improve posture through change in movement behavior. However, the potential effects of a treatment with BBT are scarcely documented. Therefore, the aim with this study was to investigate the effect of a three-week Balance body tape-treatment on the intensity of perceived neck, shoulder and back pain and forward head posture.MethodsIn this RCT study, subjects (n = 26), who reported being university students or having a sedentary work and experiencing pain in neck, back or shoulders, were randomized to either an intervention (n = 12) or control group (n = 14). The intervention group received a three-week treatment with BBT, the control group received no treatment. A questionnaire regarding pain, including a Numeric Rating Scale (NRS) measuring pain intensity, and a Photographic posture analysis measurement (PPAM) regarding the craniovertebral (CV) angle were assessed before and after the intervention for both groups. Wilcoxon’s signed rank test and Mann-Whitney U test was used to assess intra- and between group differences respectively. The relationship between pain intensity and CV angle was assessed using Spearman’s correlation.ResultsNo difference in demographic and physical characteristics between the groups were noted at baseline (p > 0.05). Pain intensity at baseline was 5 for the intervention group and 4 for the control group (p = 0.330). At follow up, the intervention group reported a lower score (NRS = 2.5, p = 0.003) whereas the control group had no significant difference in pain intensity (NRS = 3, p = 0.086). No significant change was found in the CV angle (p = 0.058) and no correlation was found between NRS and the CV angle (r = 0.102, p = 0.619).ConclusionA short treatment period with BBT may, compared to no treatment, have a small reducing effect on pain intensity in neck, back and/or shoulders. However, no effect was found on forward head posture in this study.Trial registrationRegistered retrospectively on 08/11/2021. NCT05111704.Trial registration page link:

Association of heavy bag lifting time with postural pain in secondary school students

To determine the association between heavy bag lifting with posture among secondary school students. METHODS: This study was a cross sectional survey. Based on sample of convenience, total 380 Students of both gendersbelonging to Beaconhouse School System, KIPS School System,Educators School and The Punjab School System were included with an age 14 to 17 years (school grade 9 to 12). The data was collected using the Reedco scale and Grimmer’s Questionnaire for assessment of posture and, use of heavy bags andits associated pain, respectively. RESULTS: The majority of participants in this consisted of young adults above 12 years (39%) and below 12years (34%) with male predominant (54%). 370 students out of 380 were carrying heavy bags. The types of bags they mostly carry were backpacks (51%), satchel (34%) and others (15%). 48% of these students never used lockers and 40% of them often use locker 55% of them never use waist belt to carry bag. Most of the students 48% spend 11 to 20 minutes for carrying bag per day.61% of them carry extra load (water bottles, lunch boxes, guide books) with them also. Out of 380 students 246 had pain in different body regions due to heavy bags 64% had neck pain and 53% had upper back pain while 19% had shoulder pain. Out of 184 students that carry bag from 11 to 20 minutes, 115 had poor neck posture, 133 had poor shoulder posture 25 had poor head posture and 5 had poor upper back pain and that carry from 21 to 30 minutes out of 167 students 122 had bad neck posture and 132 had poor shoulder posture 50 had poor head posture 105 had poor upper back posture. CONCLUSION: There was found significant association between heavy bag lifting and poor posture with related pain in regions of cervical followed by upper back in secondary school students.

Implication of online learning on the physical and mental well-being of students

All universities and colleges worldwide had been closed due to the coronavirus outbreak. Due to the unexpected growth of online education, many teachers now conduct classes remotely using electronic devices like laptops and mobile phones to deliver instruction on digital platforms. Numerous studies have linked excessive or extended screen time to negative psychological and physiological outcomes. Stress, sadness, sleep difficulties, effects on eyesight, posture pain, hand limitations, and musculoskeletal issues are all mental and physical ailments. This research aims to examine how the COVID-19 epidemic has affected students' attendance and performance in online courses. The survey was administered online using Google forms. Undergraduates of both sexes between the ages of 18 and 25 who were enrolled in online courses for at least one month were considered for participation. In contrast, their physical health was evaluated using the Neck disability index and the Oswestry low back pain disability index. Statistical Methods Understood Karl Pearson's correlation coefficient was used to examine the relationship between the duration of an online course and feelings of anxiety, depression, and pain in the neck, shoulders, and back. Researchers showed that online learning harmed students' mental and physical health, with 57.3% of the student body reporting high levels of stress, 32.5% reporting mild depression, 48.5% reporting mild neck aches, and 41.3% reporting moderate back pain. Students' emotional and physical well-being has suffered due to the increased time they spend online for completing their work on computers and smartphones.

Breast hypertrophy, forward head posture, neck and shoulder pain-related disabilities and selected anthropometrics variables of female undergraduate students

Introduction and aim. Large breast sizes frequently contribute to women presenting with severe pain symptoms. This study determined the association between breast hypertrophy, forward head posture (FHP), neck and shoulder pain related disabilities and selected anthropometric variables of female undergraduate students of College of Medicine, University of Lagos. Material and methods. A cross-sectional analytical study was conducted among 89 female undergraduate students (mean age = 21.45±1.29 years) with breast hypertrophy (cup size D and above). Breast cup sizes, neck and shoulder pain related disabilities, forward head posture were measured using a measuring tape, neck pain disability scale, shoulder pain disability index and craniovertebral angle (CVA) using photography method. Results. The prevalence of forward head posture among the participants was 43(48.3%). Twenty-eight (31.3%) participants had a “DD” cup size, twenty-six (29.2%) participants had a “DDD” cup size. Sixty-five (73%) of the participants had neck pain related disabilities and 10 (11.2%) of the participants had shoulder pain related disabilities. There was association among weight, forward head posture (p=0.027) and breast hypertrophy (p=0.016). Conclusion. Neck, shoulder pain related disabilities, and forward head posture is prevalent among undergraduates with breast hypertrophy and weight has an influence on forward posture and breast hypertrophy.

Myofascial Treatment for Microcirculation in Patients with Postural Neck and Shoulder Pain.

Vascular impairment is a crucial factor associated with chronic muscle pain, but relevant research from the microcirculatory aspect is lacking. Here, we investigated the differences in neck muscle microcirculation detected through laser-doppler flowmetry (LDF) and cervical biomechanics by a videofluoroscopic image in asymptomatic participants and patients with postural neck and shoulder pain. To understand the mechanism behind the effect of myofascial treatment, transverse friction massage (TFM) was applied and the immediate effects of muscular intervention on microcirculation were monitored. In total, 16 asymptomatic participants and 22 patients (mean age = 26.3 ± 2.4 and 25.4 ± 3.2 years, respectively) were recruited. Their neck muscle microcirculation and spinal image sequence were assessed. The differences in the baseline blood flow between the asymptomatic and patient groups were nonsignificant. However, the standard deviations in the measurements of the upper trapezius muscle in the patients were significantly larger (p < 0.05). Regarding the TFM-induced responses of skin microcirculation, the blood flow ratio was significantly higher in the patients than in the asymptomatic participants (p < 0.05). In conclusion, postintervention hyperemia determined through noninvasive LDF may be an indicator for the understanding of the mechanism underlying massage therapies and the design of interventions for postural pain.

Patients' and Health Care Workers' Perception of Migraine Images on the Internet: Cross-sectional Survey Study.

BackgroundThe representation of migraine in the media is stereotypical. Standard images of migraine attacks display stylish young women holding their head in a pain pose. This representation may contribute to the social stigmatization of patients with migraine.ObjectiveWe aimed to analyze how patients with migraine and health care workers perceive online images of migraine.MethodsThe study consisted of an anonymous web-based survey of patients with migraine at the Headache Center of Charité – Universitätsmedizin Berlin (migraine group) and employees and students at our university (health care group). A total of 10 frequently used Adobe Stock photos of migraine attacks were presented to the participants. Each photo was rated on a scale of 0% to 100% based on how closely it resembled a realistic migraine attack (realism score). Patients with migraine also indicated how much each photo corresponded to their own experience of migraine as a percentage (representation score). We calculated the mean realism and representation scores for all photos and conducted further analyses using the categories male or female models, younger or older models, and unilateral or bilateral pain pose.ResultsA total of 367 patients with migraine and 331 health care employees and students completed the survey. In both groups, the mean realism score was <50% (migraine group: 47.8%, SD 18.3%; health care group: 46.0%, SD 16.2%). Patients with migraine identified their own migraine experience in these photos to a lesser degree (mean representation score 44.4%, SD 19.8%; P<.001 when compared to the realism score). Patients and health care workers considered photos with male models to be more realistic than photos with females (P<.001) and photos with older models to be more realistic than those with younger people (P<.001). In the health care group only, a bilateral pain posture was deemed more realistic than a unilateral pose (P<.001).ConclusionsStandard images of migraine attacks are considered only slightly or moderately realistic by patients and health care workers. Some characteristics perceived as more realistic such as male sex or older age are in contrast with migraine epidemiology. A more accurate representation of migraine in the media could help to raise awareness for migraine and reduce the associated stigma.

Core Stabilization Exercise on the Lumbar Lordosis and Pelvic Inclination Among Chronic Nonspecific Low Back Pain Patients

Introduction: Chronic low back pain (CLBP) is one of the most common musculoskeletal disorders and it is documented that &gt;90% of the cases have no defined cause for pain, called nonspecific low back pain (NSLBP). Alteration in the joint position, abnormal posture, and impaired muscle recruitment may result in recurrent CLBP. Lumbar lordosis (LL) provides strength against the compressive forces of gravity and it also protects the posterior spinal ligament and acts as a shock absorber for vertical forces. Increased LL is considered as a reason for radiculopathy, facet pain, and postural pain. Spinal posture and pelvic position were analyzed and documented as altered in CLBP patients. Anatomically, the anterior and posterior tilt of the back and pelvis by the force of different muscles can alter the spinal curvature. Posterior pelvic tilt in a standing position can decrease the LL. The pelvic inclination is related to the lumbar curve, and both are related to the performance and length of the back and abdominal muscles. Therefore, in this study, we aimed to evaluate the effect of core stabilization exercise on pain intensity, functional disability, LL, and pelvic inclination in NSLBP.&#x0D; Methodology: A total of 63 patients aged between 20 and 60 years who met the selection criteria were included. All participants gave their written consent to participate in this study. Demographic data such as age, weight, height, and duration of the back pain were documented. Patients were asked to report their pain using the Visual Analogue Scale (VAS) and Disability in Roland Morris Disability Questionnaire (RMDQ). Exclusion criteria were participants with musculoskeletal disorders (osteoarthritis and rheumatoid arthritis) and a history of previous fractures and systemic diseases. DIERS Formetric 4D spine and posture analyzer were used to assess spinal alignment using the light-optical scanning method on the back of patient in standing position. Angle of LL: the angle formed by the apex of LL and the T12 and L5 spinous processes. Pelvic tilt is the orientation of the pelvis in respect to the thighbones and the rest of the body. Core stabilization exercises were given for 30 min, five days a week, for 12 sessions. Pre- and posttest values were documented and analyzed.&#x0D; Result: In this experimental study, we used Pearson’s correlation coefficient to find the correlation between LL and pelvic inclination angle and found a strong positive correlation (r = 0.76; P = 0.001). The study showed that core stabilization exercise for 12 weeks’ duration had statistically significant reduction in the pain intensity (p &lt; 0.01), functional disability (p &lt; 0.002), LL (p &lt; 0.05), and pelvic inclination angle (p &lt; 0.05) among patients with chronic NSLBP.&#x0D; Conclusion: From this research, we conclude that core stabilization exercises decrease the pain intensity, functional disability, LL, and pelvic inclination angle in patients with chronic NSLBP. Thus, evaluation of the lumbar curvature and pelvic inclination, and designing the appropriate exercise is recommended in the management of NSLBP.

Repair of an iatrogenic posterolateral diaphragmatic hernia after pedicled omentoplasty for chronic empyema in an immunocompromised patient: taking down the omentum or not?—A case report

: Iatrogenic diaphragmatic hernias (IDHs) are rare, but the incidence is potentially rising due to the increased implementation of laparoscopy. In case of complications i.e. perforation, bleeding, and/or incarceration, urgent exploration is mandated. However, treatment algorithms lack. We present a case of a 49-year old immunocompromised male patient who developed an IDH with gastric herniation 1 year after performing a pedicled thoracic omentoplasty in the treatment of a recurrent pleurocutaneous fistula. An emergency laparoscopy with 3-trocar approach was performed and the stomach could successfully be reduced. In order to preserve the existing omentoplasty a gastropexy was performed to cover the large diaphragmatic defect (5 cm × 5 cm). Though, due to persisting postural pain, laparoscopic reintervention with detachment of the gastropexy and omentoplasty took place 6 weeks postoperatively. Diaphragmatic repair was executed using a polypropylene mesh. Further postoperative course was uneventful. One year postoperatively neither chronic pain nor signs of hernia recurrence or empyema are noted. In the repair of IDH caused by a pedicled omentoplasty a laparoscopic approach with mesh repair might be preferred considering previous thoracic surgery and/or infections, overview of the abdominal cavity and diaphragm, and visualization of the pedicle. Nevertheless, the need to preserve the omentoplasty in immunocompromised and other patients should be further investigated, as repair after detachment is technically less complex.

Relationship between obesity and musculoskeletal disorders: systematic review and meta-analysis

Introduction: Obesity is considered a public health problem and it is associated with various musculoskeletal disorders, that haven´t been reviewed systematically. Therefore, the objective of this study was to describe the relationship between these changes in individuals with obesity. Methods: Lilacs, PubMed, Scielo, Scopus and Web of Science electronic databases were systematically reviewed until July 2018, conducted according to Cochrane guidelines for the development of meta-analysis. Eligibility criteria: inclusion (studies with humans; with a BMI greater than 30 Kg/m² or above the 85th and 95th percentile for children and adolescents; articles published in Portuguese, English, and Spanish; articles with validated evaluation methods); exclusion (duplicate, non-indexed articles; special populations; meeting summaries, editorials, letters to the editor and reviews). Results: Based on moderate evidence, knee postural changes in patients with obesity were found in two studies (n=158) (OR 14,26, IC 95% 4,98-40,80), I2 = 0% (p = 0,000), foot postural changes were found in 3 studies (n =338) (OR 3,20, IC 95% 2,08-4,94), I2=0% (p=0,000). Two studies were identified for arthritis (n=1331) (OR 3,38, IC 95% 0,72-1582), I2=38,95% (p=0,122). Pain was reported in the lower limb and the spine. Four studies were found for the former (n=1560) (OR 5,51 IC 95% 2,07-14,61), I2=81,02% (p=0,001), and three for the latter (n=499) (OR 9,78 IC 95% 2,59-36,93), I2=86,58% (p=0,000). Conclusion: Results show that obesity has a negative impact on musculoskeletal health, with results statistically significant for knee and foot postural changes, arthritis, and pain in the spine and lower limbs.

A multiparametric approach to assessing residual pain experienced by dairy cows undergoing digestive tract surgery under multimodal analgesia

This study assessed residual pain responses of dairy cows undergoing fistulation surgery under multimodal analgesia using a multiparametric method combining behavioural and physiological indicators. A longitudinal study was conducted on five dairy cows, each acting as her own control. The surgery consisted of implanting a ruminal and a duodenal cannula in each cow. The multimodal drug protocol consisted of a combination of N-Methyl-D aspartic Acid antagonists, α2-agonists, and local anaesthetic during surgery, and non-steroidal anti-inflammatory drugs (NSAIDs) and opioid treatment postsurgery. Cow responses to surgery were monitored by direct behavioural observation, physiological assay indicators, and milk production from day (D) −6 days before surgery (D-6) to D13 postsurgery. From the data recorded, the variables that contributed most to the discrimination of days pre- and postsurgery were identified using factorial discriminant analysis. Components 1 and 2 of the factorial discriminant analysis explained 68.2% and 17.9%, respectively, of the total variance. Component 1 was mainly explained by haptoglobin (contribution to axis: 0.885), oxidative stress (ratio of oxidized gluthatione to reduced glutathione (GSH/GSSG), −0.746; vitamin E, −0.683; vitamin A, −0.597; malondialdehyde (MDA), 0.416), and behavioural indicators (general attitude, 0.594). On this axis, the higher the score, the higher were the apathy and haptoglobin and MDA concentrations, and the lower were the GSH/GSSG ratio and concentrations of vitamins A and E. This axis opposed cows on D-6 to cows on D3 and D5; cows on D1 and D13 were intermediate. Component 2 was mainly explained by the Hypothalamic-pituitary-adrenal axis (non-esterified fatty acid (NEFA), 0.686; cortisol, 0.669), milk yield (−0.725), oxidative stress (MDA, −0.584; nitric oxide (NO), 0.454), and behavioural indicators of pain (ear position, 0.467; leg postures, 0.431). On this axis, the higher the score, the higher the NEFA, cortisol, and nitric oxide concentrations; the more the ear and leg pain postures; and the lower the milk production and MDA concentrations. This axis opposed cows on D13 to cows on D1. These results suggest that cows may experience some pain only on D1, whereas on subsequent days, the inflammatory response and oxidative stress did not seem to be associated with pain. Our results should be considered for different surgeries to improve analgesia immediately after surgery, and to provide antioxidants along with NSAIDs to promote recovery.