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In response to the World Health Organization (WHO) statements and international concerns regarding the coronavirus disease 2019 (COVID-19) outbreak, the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is issuing the following guidance for management during pregnancy and puerperium. The epidemics of the two -coronaviruses, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), have caused more than 10 000 cumulative cases in the past two decades, with mortality rates of 10% for SARS-CoV and 37% for MERS-CoV[[5], [7]]. Breslin I et al i .[18] observed similar COVID-19 severity in pregnant patients (86.0% mild disease, 9.3% severe disease and 4.7% critical disease) to that reported in non-pregnant patients[16]. Because of the logistics involved in performing a CT scan on critically ill patients, and the need for thorough cleaning of the CT unit after imaging a COVID-19 patient, a portable chest X-ray is an acceptable alternative to a CT scan. When concern is raised about a potential COVID-19 patient, i.e. due to symptoms and/or TOCC risk factors, a surgical facemask should be put on the patient and she should be separated from other patients, preferably in an isolated COVID-19 unit. [Extracted from the article]

Pain serves to protect against bodily threat, and therefore initiates protective responses such as attending toward threat-relevant information. Since pain is often exacerbated by executing movements, these motor actions may serve as cues for pain. Up to date, however, pain-related attention during movement remains largely unexplored. While it has been shown that the preparation of a pain-related movement leads to enhanced processing of somatosensory information, it is unclear how the actual execution of a movement interacts with somatosensory attention. In the current study, we examined whether somatosensory processing is enhanced at a moving body part when the movement is expected to be associated with pain. Participants were asked to execute hand movements which were occasionally followed by a pain stimulus. To measure somatosensory attention, a task-irrelevant, innocuous tactile probe was presented on either hand to evoke a somatosensory evoked potential (SEP). The results showed an elevation of the N120 SEP at the hand performing a potentially painful movement, indicating heightened attention toward tactile information at the threatened moving hand compared to the non-threatened hand. Additionally, the P200 SEP also showed enlarged responses when performing a pain-related movement compared to a no-pain-related movement. These results show that not only the anticipation, but also the execution of pain-related movements, may modulate the processing of somatosensory input, driven by attentional processes. [ABSTRACT FROM AUTHOR]

The aims of this study were to research the amplitude and median frequency characteristics of selected abdominal, back, and hip muscles of healthy subjects during a prone bridging endurance test, based on surface electromyography (sEMG), (a) to determine if the prone bridging test is a valid field test to measure abdominal muscle fatigue, and (b) to evaluate if the current method of administrating the prone bridging test is reliable. Thirty healthy subjects participated in this experiment. The sEMG activity of seven abdominal, back, and hip muscles was bilaterally measured. Normalized median frequencies were computed from the EMG power spectra. The prone bridging tests were repeated on separate days to evaluate inter and intratester reliability. Significant differences in normalized median frequency slope (NMFslope) values between several abdominal, back, and hip muscles could be demonstrated. Moderate‐to‐high correlation coefficients were shown between NMFslope values and endurance time. Multiple backward linear regression revealed that the test endurance time could only be significantly predicted by the NMFslope of the rectus abdominis. Statistical analysis showed excellent reliability (ICC=0.87‐0.89). The findings of this study support the validity and reliability of the prone bridging test for evaluating abdominal muscle fatigue. [ABSTRACT FROM AUTHOR]

Introduction: In 2013, a study showed low guideline adherence regarding chronic low back pain (CLBP) in physiotherapy students concerning activity and work recommendations (47% and 16%)1. The aim of this study is to investigate if the 2020' physiotherapy students'attitudes and beliefs regarding CLBP and osteoarthritis (OA) and the guideline adherence have changed since 2013, by using the same protocol. Methods: Physiotherapy students in their 2nd and 4th year of education from 6 Belgian and 2 Dutch institutions participated. The attitudes and beliefs regarding CLBP and OA were measured using the Pain attitudes and beliefs scale (BAPS), the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and a questionnaire regarding therapeutic exercise and knee OA. A clinical case vignette was used to measure the guideline adherence regarding CLBP. Results: In total, 2738 students participated, 1624 in 2013 and 1114 in 2020. Compared to 2013, students in 2020 scored lower on a biomedical orientation (p < 0.001) and higher on psychosocial orientations (p < 0.001) regarding CLBP and OA. Medium effect size (cohens'd = 0.548) was found on the psychosocial orientation of the PABS, other differences only had small effect sizes. In 2020, 54% provided clinical guidelines' consistent recommendations for activity and 28% for work, which significantly improved compared to 2013. Discussion: A positive shift occurred towards a more biopsychosocial approach between students of 2013 and 2020. However, the improved guideline adherence concerning activity and work recommendations remains low. Process evaluation: Additional clinical case vignette to measure clinical recommendations regarding OA would have strengthen this study. [ABSTRACT FROM AUTHOR]

Introduction: Although a positive correlation between patients' expectations and outcome after surgery appears evident, evidence is rather conflicting. This can be attributed to the lack of uniform, validated, and reliable methods to assess patients' expectations. A valid and reliable questionnaire to assess patients' expectations of lumbar spine surgery is not yet available in Dutch. Methods: The forward-backward translation method will be applied to the original Hospital for Special Surgery Lumbar Spine Surgery Expectations Survey [1]. The translations will be revised by an expert committee, including translators, methodologist, spinal surgery experts and psychology experts. The pre-final Dutch survey will be piloted in a sample (n = 50) of patients scheduled for lumbar surgery. Based on these results, the expert committee will improve the survey. The final survey will then be administered in a sample (n = 300) of patients twice before their spinal surgery. Based on the acquired data, validity (i.e. content, construct, and discriminative validity) and reliability (i.e. internal consistency and test-retest reliability) will determined. Results: Not applicable. Discussion: A Dutch validated survey for assessment of expectations of lumbar surgery patients may assist clinicians in determining the quality of spinal surgical care and any discrepancies that might exist between clinician and patient. Researchers will benefit as well, as uniform and valid surveys are essential to unravel the relation between pre-surgical patients' expectations and satisfaction following spinal surgery. Process evaluation: The study is currently in the backward-translation stage. Finding translators with the appropriate requirements according to the WHO guidelines proves to be challenging. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Whiplash Associated Disorders (CWAD) are characterized by long-lasting symptoms of neck pain occurring after an acceleration-deceleration injury. Central sensitization (CS) has been suggested as the possible underlying mechanism for these symptoms, and is characterized by changes in the central nervous system. Besides CS, psychological factors are believed to play an important role in the experience of (chronic) pain. Methods: 72 CWAD patients and 55 healthy controls underwent electrical stimuli-based quantitative sensory testing (QST). Detection and pain thresholds (EPT), temporal summation (TS) and conditioned pain modulation (CPM) were examined. Spearman correlations and linear mixed models analyses were performed to assess respectively the hypothesized associations with and group differences in QST. Results: The Pain Catastrophizing magnification subscale correlated with left wrist EPT (r = -0.332; p = 0.004), and the Pain Anxiety Symptom Scale-20 with left wrist (r = -0.325; p = 0.005) and ankle (r = -0.330; p = 0.005) EPT. TS at the ankle correlated with the CS Inventory (r = 0.303; p = 0.010), Short Form 36 pain subscale (r = -0.325; p = 0.005), and Illness Perception Questionnaire revised consequences subscale (r = 0.325; p = 0.005). EPTs of left (p = 0.011) and right wrist (p = 0.023) were lower in the CWAD group, but CPM and TS did not differ between groups. Discussion: QST outcomes relate to psychological constructs, rather than to self-reported pain intensity and distribution. Local hyperalgesia was found in CWAD patients, but no differences in endogenous pain facilitation nor inhibition. Process evaluation: Both CWAD patients reporting unilateral as bilateral neck pain were included, which complicated the interpretation of distal hyperalgesia. [ABSTRACT FROM AUTHOR]

Introduction: There is abundant evidence for compromised movement performance in non-specific low back pain (NSLBP)1,2. It has been proposed that not only pain severity, but also cognitive-affective factors such as attention might influence movement3. The objective of this study is to review current knowledge concerning the effects of attention on movement-related outcomes in NSLBP. Methods: A systematic search was performed and reported following the PRISMA-guidelines. A comprehensive search strategy was used by using five electronic databases. Possible risk-of-bias was evaluated by using the adjusted version of the Newcastle-Ottawa Scale. Levels of evidence and conclusion were assigned according to guidelines of the Dutch Institute for Healthcare Improvement. Results: Twenty-two articles were included (ROB 18.2% -72.7%), the majority (77%) performed in chronic LBP.Limited evidence indicated attentional suppression (measured with coping strategy questionnaire) to be negatively associated with activity of the trunk muscles in acute NSLBP. Furthermore, limited evidence indicated that when attention is divided over tasks (i.e. dual-tasks) this results in lower variability of postural strategies in recurrent NSLBP and lower/delayed anticipatory trunk muscle activation in chronic NSLBP. Discussion: Ignoring pain effects trunk muscle activity in acute NSLBP. When attention is divided (i.e. dual-tasks), individuals with recurrent/chronic NSLBP are less capable to control their trunk muscles. Process evaluation: The different possibilities to operationalize 'attention' posed a difficulty. Included studies used two main operationalizations: 'attentional control of pain' (i.e. attention focus, attentional suppression/distraction) and 'attention as a capacity' (i.e. cognitive load of pain competes for available attentional resources for postural control). [ABSTRACT FROM AUTHOR]

All muscles of the neck have a role in motion and postural control of the cervical region. The aim of this study was to investigate the difference in muscle/fat index between (1) cervical flexors and extensors and (2) deep and superficial neck muscles. Twenty-six healthy subjects participated in the study. Magnetic resonance imaging (MRI) was used to quantify muscle fat indices in different cervical flexor and extensor muscles at the C4-C5 level. Overall, the ventral muscles had a significantly lower fat content compared with the dorsal muscles (P < or = 0.001). For the cervical extensors, significant differences between the muscle/fat index of the deep and superficial muscles were found (P < or = 0.001). For the cervical flexors, there were no significant differences between the different muscles. The higher fat content in the dorsal muscles can be explained by a discrepancy in function between the spine extensors and flexors, reflected in a different muscle fiber distribution. The rather small differences between superficial and deep neck muscles are in line with recent findings that have demonstrated that both muscles groups exhibit phasic activity during isometric muscles contractions and the presumption that there is no difference in fiber type distribution between superficial and deep neck muscles. [ABSTRACT FROM AUTHOR]

Little is known about the relationship between sport participation and body adaptations during growth. Our aim was to investigate whether soccer participation in youth is associated with the degree of genu varum. The design was a retrospective cohort study. Three hundred and thirty-six male soccer players, and 458 male non-soccer players (aged from 8 to 18) were recruited and included in the study. The intercondylar (IC) or intermalleolar (IM) distance were clinically measured with a specifically designed instrument. The results of this study revealed a statistically significant increase in degree of genu varum in both groups from the age of 14. However, at the age of 16-18 years a significant higher degree of genu varum was observed in the soccer players compared to the non-soccer players (P = 0.028). Intense soccer participation increases the degree of genu varum in males from the age of 16. Since genu varum predisposes to injuries, efforts to reduce the development of genu varum in male soccer players are warranted. [ABSTRACT FROM AUTHOR]

For several years Transcutaneous Electrical Nerve Stimulation (TENS) has been used in the management of chronic and acute pain. The aim of this trial was to determine its effectiveness in providing pain relief during labour as well as its influence on the incidence of requests for epidural analgesia. The experimental group (receiving TENS by a burst - conventional obstetric TENS-apparatus) and the control population (not receiving TENS) consisted of 24 and 35 women respectively. In the experimental group the TENS application was switched off for a period of 15 min. The 24 women were asked to point out the intensity of their pain on a visual analogue scale before, during and after this temporary interruption. Two days postpartum the parturient's satisfaction was evaluated by two questions, a procedure which revealed that 96% degree of satisfaction. The incidence of epidural analgesia in the experimental group was compared to the control-group. During TENS application the pain scores were significantly lower (p<0.0001), but no statistically significant difference in incidence of epidural analgesia was found between the experimental group and the control group. [ABSTRACT FROM AUTHOR]

Increasing documentation on the size and appearance of muscles in the lumbar spine of low back pain (LBP) patients is available in the literature. However, a comparative study between unoperated chronic low back pain (CLBP) patients and matched (age, gender, physical activity, height and weight) healthy controls with regard to muscle cross-sectional area (CSA) and the amount of fat deposits at different levels has never been undertaken. Moreover, since a recent focus in the physiotherapy management of patients with LBP has been the specific training of the stabilizing muscles, there is a need for quantifying and qualifying the multifidus. A comparative study between unoperated CLBP patients and matched control subjects was conducted. Twenty-three healthy volunteers and 32 patients were studied. The muscle and fat CSAs were derived from standard computed tomography (CT) images at three different levels, using computerized image analysis techniques. The muscles studied were: the total paraspinal muscle mass, the isolated multifidus and the psoas. The results showed that only the CSA of the multifidus and only at the lowest level (lower end-plate of L4) was found to be statistically smaller in LBP patients. As regards amount of fat, in none of the three studied muscles was a significant difference found between the two groups. An aetiological relationship between atrophy of the multifidus and the occurrence of LBP can not be ruled out as a possible explanation. Alternatively, atrophy may be the consequence of LBP: after the onset of pain and possible long-loop inhibition of the multifidus a combination of reflex inhibition and substitution patterns of the trunk muscles may work together and could cause a selective atrophy of the multifidus. Since this muscle is considered important for lumbar segmental stability, the phenomenon of atrophy may be a reason for the high recurrence rate of LBP. [ABSTRACT FROM AUTHOR]

Introduction: Up to 37% of lumbar radiculopathy patients experience residual pain and disability following lumbar discectomy. Although it is assumed that dysfunctional pain processing may play a mechanistic role in symptom persistence, research in this area is lacking. Therefore, this study will evaluate pain processing in lumbar radiculopathy patients prior to and 3 months following lumbar discectomy. Methods: Lumbar radiculopathy patients (n = 122) scheduled for discectomy will be recruited through Flemish hospitals. At follow-up, patients with =1.5/10 average pain intensity on a visual analogue scale and <20% improvement on the Oswestry Disability Index will be categorized as having residual complaints. These will be compared to matched patients without residual complaints and pain-free controls. Pain sensitivity will be evaluated using Quantitative Sensory Testing including thermal, mechanical, and electrical perception and pain thresholds. Spinal modulation will be assessed using nociceptive flexion reflex thresholds; pain facilitation by the presence of psychocognitive factors through questionnaires and temporal summation of mechanical stimuli and the NFR; and pain inhibition using a conditioned pain modulation paradigm. Results: Not applicable. Discussion: We hypothesize that pre-operative pain characteristics are predictive of residual complaints and that patients with residual complaints exhibit dysfunctional pain processing compared to individuals without residual complaints as expressed by impaired pain inhibition and enhanced spinal modulation, pain sensitivity and facilitation. The findings will provide the potential to identify patients at risk of poor surgical outcome and explore treatment strategies according to dysfunctions in pain processing. Process evaluation: Currently recruiting and completing ethical committee applications for multicentric recruitment. [ABSTRACT FROM AUTHOR]

The present study examined the activity levels of the thoracic and lumbar extensor muscles during different extension exercise modalities in healthy individuals. Therefore, 14 subjects performed four different types of extension exercises in prone position: dynamic trunk extension, dynamic-static trunk extension, dynamic leg extension, and dynamic-static leg extension. Pre- and post-exercise muscle functional magnetic resonance imaging scans from the latissimus dorsi, the thoracic and lumbar parts of the longissimus, iliocostalis, and multifidus were performed. Differences in water relaxation values ( T2-relaxation) before and after exercise were calculated ( T2-shift) as a measure of muscle activity and compared between extension modalities. Linear mixed-model analysis revealed higher lumbar extensor activity during trunk extension compared with leg extension ( T2-shift of 5.01 ms and 3.55 ms, respectively) and during the dynamic-static exercise performance compared with the dynamic exercise performance ( T2-shift of 4.77 ms and 3.55 ms, respectively). No significant differences in the thoracic extensor activity between the exercises could be demonstrated. During all extension exercises, the latissimus dorsi was the least activated compared with the paraspinal muscles. While all extension exercises are equivalent effective to train the thoracic muscles, trunk extension exercises performed in a dynamic-static way are the most appropriate to enhance lumbar muscle strength. [ABSTRACT FROM AUTHOR]

The thoracolumbar fascia (TLF) consists of aponeurotic and fascial layers that interweave the paraspinal and abdominal muscles into a complex matrix stabilizing the lumbosacral spine. To better understand low back pain, it is essential to appreciate how these muscles cooperate to influence lumbopelvic stability. This study tested the following hypotheses: (i) pressure within the TLF's paraspinal muscular compartment (PMC) alters load transfer between the TLF's posterior and middle layers (PLF and MLF); and (ii) with increased tension of the common tendon of the transversus abdominis (CTrA) and internal oblique muscles and incremental PMC pressure, fascial tension is primarily transferred to the PLF. In cadaveric axial sections, paraspinal muscles were replaced with inflatable tubes to simulate paraspinal muscle contraction. At each inflation increment, tension was created in the CTrA to simulate contraction of the deep abdominal muscles. Fluoroscopic images and load cells captured changes in the size, shape and tension of the PMC due to inflation, with and without tension to the CTrA. In the absence of PMC pressure, increasing tension on the CTrA resulted in anterior and lateral movement of the PMC. PMC inflation in the absence of tension to the CTrA resulted in a small increase in the PMC perimeter and a larger posterior displacement. Combining PMC inflation and tension to the CTrA resulted in an incremental increase in PLF tension without significantly altering tension in the MLF. Paraspinal muscle contraction leads to posterior displacement of the PLF. When expansion is combined with abdominal muscle contraction, the CTrA and internal oblique transfers tension almost exclusively to the PLF, thereby girdling the paraspinal muscles. The lateral border of the PMC is restrained from displacement to maintain integrity. Posterior movement of the PMC represents an increase of the PLF extension moment arm. Dysfunctional paraspinal muscles would reduce the posterior displacement of the PLF and increase the compliance of the lateral border. The resulting change in PMC geometry could diminish any effects of increased tension of the CTrA. This study reveals a co-dependent mechanism involving balanced tension between deep abdominal and lumbar spinal muscles, which are linked through the aponeurotic components of the TLF. This implies the existence of a point of equal tension between the paraspinal muscles and the transversus abdominis and internal oblique muscles, acting through the CTrA. [ABSTRACT FROM AUTHOR]

Introduction: Individuals with movement coordination impairment (MCI) experience poor control of spine and pelvis and often develop a compensatory movement strategy. Currently there is a paucity of information on differences in segmental kinematics to help understand the adopted movement strategy and its link to commonly used clinical assessment. Objective: The current pilot study is aimed at investigating the usability of a cluster spine model to assess the clinically relevant assessment, such as one-leg standing. Methods: After necessary ethical approval, nine healthy subjects, (6 men, 3 female, 22±2.0 years, 177±7.4 cm, 69±8.7 kg) were recruited to participate in the study. The marker configuration was in accordance with Needham et al.[1]. Subjects were instructed to complete 2 variants of a one-leg standing task. In both tasks they stood relaxed on both feet and were either instructed to flex the knee (90°) without hip extension (backward lifting) or to flex both hip and knee to 90° (forward lifting), starting with the right leg and followed by the left leg. Data were collected with an 8 camera opto-electronic system (Oqus, Qualisys, Göteborg, Sweden) at 100 HZ and processed in Visual3D (C-Motion Inc., Germantown, MD, USA). Motion from the upper (T3) versus lower thoracic spine (T8), from lower thoracic versus lumbar spine (L3) and between the lumbar spine and the pelvis was analyzed for 3 valid trials per subject. Results and Discussion: In the sagittal plane the main differences are seen (Figure 1) in the lumbar spine versus the pelvis, while at the higher regions, the spine is quite stable only showing minor differences. In the frontal plane the upper thoracic region shows (Figure 1) little movement, where the lower thoracic and the lumbar regions bend to the opposite side of the lifted leg. This is more pronounced during forward lifting. Rotational movements are seen in all three regions. The direction of rotation for forward leg lifting is opposed to the one during backward lifting. This is the first study to document the spine kinematics of different regions during tasks suggested for clinical assessment, e.g. two variants of one-leg standing. Future research should aim at testing more subjects, other clinically relevant movements and comparing healthy subjects with patient populations. Conclusions and Significance: Whilst the 3D cluster spine model seems to be a useful tool to document the spine kinematics, the results highlight quantitative differences which needs be considered to develop effective clinical management. [ABSTRACT FROM AUTHOR]

Introduction: Movement control (MC) tests are used in clinical practice to subgroup patients with non-specific chronic low back pain to adapt the treatment strategy based on whether they have a flexion or extension pattern. The underlying hypothesis is that impaired movement control and a lack of awareness of mal-adaptive movement pattern perpetuates LBP. It has already been shown that patients with LBP have impaired movement control.[1] Although these patterns can be assessed by some clinical tests, the validity of those tests has never been described by means of kinematics. Hence the purpose of this study was to examine the validity of these tests and to elucidate differences in spinal kinematics across participants. This will help explore if we can possibly use flexion MC tests from the Luomajoki test-battery to identify a Flexion Movement Pattern (FMP) in a wider population. Objectives: The objective of this study was to compare spinal and pelvic kinematics between healthy participants with and without a FMP when completing a “waiters bow” assessment. Methods: After necessary ethical approval, a sample of 29 adults (n=29, 14♀, 15♂, age 23.34 ± 2.32 year) were recruited to participate in this study. Based on a test-battery of 6 movement control tests designed by Luomajoki [1] they were divided into two groups: FMP group (n=16, 6♀, 10♂); No FMP group (n=13, 8♀,5♂). Spinal kinematics whilst the participants performing a waiters bow (WB) were collected using a previously published protocol.[2] Results and Discussion: There are differences in MC when the FMP and no-FMP group were compared (Figure 1). The lower thoracic region is more flexed in the FMP group during WB. Nevertheless, the results contradict the hypothesis that an earlier and more distinct flexion would show up in the lumbar region WB. In addition, there are clear variances in coordination pattern. Findings of the lumbar region contradict the hypothesis of a more flexed spine in the FMP since the FMP has more extension than the no-FMP. Conclusion and Significance: Differences in spinal kinematics between participants of the FMP group and the non-FMP group exist, which demonstrate that the flexion MC tests from the Luomajoki test-battery could be used to identify a FMP in a wider group of patients. In addition, the individual variances could be used to design effective clinical management and assess the clinical outcome in a quantitative fashion. [ABSTRACT FROM AUTHOR]

This article focuses on the (functional) anatomy and biomechanics of the pelvic girdle and specifically the sacroiliac joints ( SIJs). The SIJs are essential for effective load transfer between the spine and legs. The sacrum, pelvis and spine, and the connections to the arms, legs and head, are functionally interrelated through muscular, fascial and ligamentous interconnections. A historical overview is presented on pelvic and especially SIJ research, followed by a general functional anatomical overview of the pelvis. In specific sections, the development and maturation of the SIJ is discussed, and a description of the bony anatomy and sexual morphism of the pelvis and SIJ is debated. The literature on the SIJ ligaments and innervation is discussed, followed by a section on the pathology of the SIJ. Pelvic movement studies are investigated and biomechanical models for SIJ stability analyzed, including examples of insufficient versus excessive sacroiliac force closure. [ABSTRACT FROM AUTHOR]

In this overview, new and existent material on the organization and composition of the thoracolumbar fascia (TLF) will be evaluated in respect to its anatomy, innervation biomechanics and clinical relevance. The integration of the passive connective tissues of the TLF and active muscular structures surrounding this structure are discussed, and the relevance of their mutual interactions in relation to low back and pelvic pain reviewed. The TLF is a girdling structure consisting of several aponeurotic and fascial layers that separates the paraspinal muscles from the muscles of the posterior abdominal wall. The superficial lamina of the posterior layer of the TLF (PLF) is dominated by the aponeuroses of the latissimus dorsi and the serratus posterior inferior. The deeper lamina of the PLF forms an encapsulating retinacular sheath around the paraspinal muscles. The middle layer of the TLF (MLF) appears to derive from an intermuscular septum that developmentally separates the epaxial from the hypaxial musculature. This septum forms during the fifth and sixth weeks of gestation. The paraspinal retinacular sheath (PRS) is in a key position to act as a 'hydraulic amplifier', assisting the paraspinal muscles in supporting the lumbosacral spine. This sheath forms a lumbar interfascial triangle (LIFT) with the MLF and PLF. Along the lateral border of the PRS, a raphe forms where the sheath meets the aponeurosis of the transversus abdominis. This lateral raphe is a thickened complex of dense connective tissue marked by the presence of the LIFT, and represents the junction of the hypaxial myofascial compartment (the abdominal muscles) with the paraspinal sheath of the epaxial muscles. The lateral raphe is in a position to distribute tension from the surrounding hypaxial and extremity muscles into the layers of the TLF. At the base of the lumbar spine all of the layers of the TLF fuse together into a thick composite that attaches firmly to the posterior superior iliac spine and the sacrotuberous ligament. This thoracolumbar composite (TLC) is in a position to assist in maintaining the integrity of the lower lumbar spine and the sacroiliac joint. The three-dimensional structure of the TLF and its caudally positioned composite will be analyzed in light of recent studies concerning the cellular organization of fascia, as well as its innervation. Finally, the concept of a TLC will be used to reassess biomechanical models of lumbopelvic stability, static posture and movement. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate if there is a change in oxygen saturation and blood flow in the different parts of the trapezius muscle in office workers with and without trapezius myalgia during a standardized computer task. Twenty right-handed office workers participated; ten were recruited based on pain in the trapezius and ten as matching controls. Subjects performed a combination of typing and mousing tasks for 60 min at a standardized workstation. Muscle tissue oxygenation and blood flow data were collected from the upper trapezius (UT), the middle trapezius (MT) and the lower trapezius (LT), both on the left and right side at seven moments (at baseline and every tenth minute during the 1-h typing task) by use of the oxygen to see device. In all three parts of the trapezius muscle, the oxygen saturation and blood flow decreased significantly over time in a similar pattern ( p < 0.001). Oxygenation of the left and right UT was significantly higher compared to the other muscle parts ( p < 0.001). Oxygen saturation for the MT was significantly lower in the cases compared to the control group ( p = 0.027). Blood flow of the UT on the right side was significantly lower than the blood flow on the left side ( p = 0.026). The main finding of this study was that 1 h of combined workstation tasks resulted in decreased oxygen saturation and blood flow in all three parts of the trapezius muscle. Future research should focus on the influence of intervention strategies on these parameters. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the long-term effectiveness of a spine care education programme conducted in 9- to 11-year-old schoolchildren. The study sample included 96 intervention subjects and 98 controls (9- to 11-year-olds at baseline). Intervention consisted of a 6-week school-based back education programme (predominantly biomechanically oriented) and was implemented by a physical therapist. Self-reported outcomes on back care knowledge, spinal care behaviour, self-efficacy towards favourable back care behaviour, prevalence of back and neck pain during the week and fear-avoidance beliefs were evaluated by the use of questionnaires. Post-tests were performed within 1 week after programme completion, after 1 year and after 8 years. Whereas the educational back care programme resulted in increased back care knowledge up to adulthood (P < 0.001), intervention did not change spinal care behaviour or self-efficacy. Pain prevalence figures increased less in the experimental group compared to the controls over the 8-year time span, yet statistical significance was not reached. Dropout analysis revealed spinal pain prevalence rates to be different in both groups throughout the study, including at baseline. Back education at young age did not reinforce fear-avoidance beliefs up to adulthood. Predominantly biomechanical oriented back education in elementary schoolchildren is effective in improving the cognitive aspect of back care up to adulthood, yet not in changing actual behaviour or self-efficacy. The current study does not provide evidence that educational back care programmes have any impact on spinal pain in adulthood. The true long-term impact of school-based spinal health interventions on clinically relevant outcome measures merits further attention. [ABSTRACT FROM AUTHOR]

All muscles of the neck have a role in motion and postural control of the cervical region. The aim of this study was to investigate the difference in muscle/fat index between (1) cervical flexors and extensors and (2) deep and superficial neck muscles. Twenty-six healthy subjects participated in the study. Magnetic resonance imaging (MRI) was used to quantify muscle fat indices in different cervical flexor and extensor muscles at the C4–C5 level. Overall, the ventral muscles had a significantly lower fat content compared with the dorsal muscles ( P ≤ 0.001). For the cervical extensors, significant differences between the muscle/fat index of the deep and superficial muscles were found ( P ≤ 0.001). For the cervical flexors, there were no significant differences between the different muscles. The higher fat content in the dorsal muscles can be explained by a discrepancy in function between the spine extensors and flexors, reflected in a different muscle fiber distribution. The rather small differences between superficial and deep neck muscles are in line with recent findings that have demonstrated that both muscles groups exhibit phasic activity during isometric muscles contractions and the presumption that there is no difference in fiber type distribution between superficial and deep neck muscles. [ABSTRACT FROM AUTHOR]

Little is known about the relationship between sport participation and body adaptations during growth. Our aim was to investigate whether soccer participation in youth is associated with the degree of genu varum. The design was a retrospective cohort study. Three hundred and thirty-six male soccer players, and 458 male non-soccer players (aged from 8 to 18) were recruited and included in the study. The intercondylar (IC) or intermalleolar (IM) distance were clinically measured with a specifically designed instrument. The results of this study revealed a statistically significant increase in degree of genu varum in both groups from the age of 14. However, at the age of 16–18 years a significant higher degree of genu varum was observed in the soccer players compared to the non-soccer players ( P = 0.028). Intense soccer participation increases the degree of genu varum in males from the age of 16. Since genu varum predisposes to injuries, efforts to reduce the development of genu varum in male soccer players are warranted. [ABSTRACT FROM AUTHOR]

Work related neck disorders are common problems in office workers, especially among those who are intensive computer users. It is generally agreed that the etiology of work related neck disorders is multidimensional which is associated with, and influenced by, a complex array of individual, physical and psychosocial factors. The aim of the current study was to estimate the one-year prevalence of neck pain among office workers and to determine which physical, psychological and individual factors are associated with these prevalences. Five hundred and twelve office workers were studied. Information was collected by an online questionnaire. Self-reported neck pain during the preceding 12 months was regarded as a dependent variable, whereas different individual, work-related physical and psychosocial factors were studied as independent variables. The 12 month prevalences of neck pain in office workers was 45.5%. Multivariate analysis revealed that women had an almost two-fold risk compared with men (OR = 1.95, 95% CI 1.22–3.13). The odds ratio for age indicates that persons older than 30 years have 2.61 times more chance of having neck pain than younger individuals (OR = 2.61, 95% CI 1.32–3.47). Being physically active decreases the likelihood of having neck pain (OR = 1.85, 95% CI 1.14–2.99). Significant associations were found between neck pain and often holding the neck in a forward bent posture for a prolonged time (OR = 2.01, 95% CI 1.20–3.38), often sitting for a prolonged time (OR = 2.06, 95% CI 1.17–3.62) and often making the same movements per minute (OR = 1.63, 95% CI 1.02–2.60). Mental tiredness at the end of the workday (OR = 2.05, 95% CI 1.29–3.26) and shortage of personnel (OR = 1.71, 95% CI 1.06–2.76) are significantly associated with neck pain. The results of this study indicate that physical and psychosocial work factors, as well as individual variables, are associated with the frequency of neck pain. These association patterns suggest also opportunities for intervention strategies in order to stimulate an ergonomic work place setting and increase a positive psychosocial work environment. [ABSTRACT FROM AUTHOR]

There have been numerous reports about the use of knee braces to prevent traumatic knee injuries. Despite the frequent use of braces, very few prospective studies have been performed to study the effect of knee braces for preventing anterior knee pain syndrome (AKPS). The purpose of this study was to assess the effectiveness of a dynamic patellofemoral brace (On-Track System, dj Orthopedics) in the prevention of AKPS. 167 military recruits without history of knee pain were randomized into two groups prior to the start of their 6-week basic military training (BMT) program. The first group (brace group) consisted of 54 recruits who wore the braces for all physical activities during these 6 weeks. 113 recruits served as a control group, and followed the same 6-week strenuous training program. Chi square statistics (Fisher exact test) were used to compare the number of AKPS patients in the brace group and in the non-brace group. Our results indicated that recruits in the brace group appeared to develop significantly less anterior knee pain compared to the recruits in the control group (p=0.020). Out of the 54 recruits in the brace group, ten (18.5%) developed anterior knee pain during this study. In the control group (n=113), 42 recruits (37%) developed anterior knee pain. We conclude that the result of the present study suggests that the use of a dynamic patellofemoral brace is an effective way to prevent the development of anterior knee pain in persons undergoing a strenuous training program. [ABSTRACT FROM AUTHOR]

The purpose of this prospective randomized intervention study was to evaluate the effect of two exercise protocols on reflex response time of vastus medialis obliquus (VMO), vastus lateralis (VL), in patients with anterior knee pain. Sixty patients were randomized into a 5-week treatment program, which consisted of only open kinetic chain tonification exercises (group I) (n = 30), or only closed kinetic chain tonification exercises (group II) (n = 30). Assessment of an aspect of neuromotor control was obtained by measuring the reflex response times of VMO and VL at the time of initial clinical examination, at the end of the exercise period (five weeks), and three months after the completion of the exercise period. At these evaluation occasions, the intensity and the number of times that the patients experienced anterior knee pain during daily life was recorded on a Visual Analog Scale (VAS). No alterations in reflex response times of VMO and VL were observed in either group. Changes of anterior knee pain over time were statistically significant in both groups. Only small and not statistically supported differences in anterior knee pain were found between the two groups. These results suggest that the reflex response times of the two vasti muscles can not be altered after a five week open or closed kinetic chain exercise program. In contrast, knee pain decreased significantly in both groups . [ABSTRACT FROM AUTHOR]

BACKGROUND: Muscular tightness is frequently postulated as an intrinsic risk factor for the development of a muscle injury. However, very little prospective data exist to prove this. HYPOTHESIS: Increased muscle tightness identifies a soccer player at risk for a subsequent musculoskeletal lesion. STUDY DESIGN: Prospective cohort study. METHODS: We examined 146 male professional soccer players before the 1999-2000 Belgian soccer competition. None of the players had a history of muscle injury in the lower extremities in the previous 2 years. The flexibility of the hamstring, quadriceps, adductor, and calf muscles of these players was measured goniometrically before the start of the season. All of the examined players were monitored throughout the season to register subsequent injuries. RESULTS: Players with a hamstring (N = 31) or quadriceps (N = 13) muscle injury were found to have significantly lower flexibility in these muscles before their injury compared with the uninjured group. No significant differences in muscle flexibility were found between players who sustained an adductor muscle injury (N = 13) or a calf muscle injury (N = 10) and the uninjured group. CONCLUSIONS: These results indicate that soccer players with an increased tightness of the hamstring or quadriceps muscles have a statistically higher risk for a subsequent musculoskeletal lesion. CLINICAL SIGNIFICANCE: Preseason hamstring and quadriceps muscle flexibility testing can identify male soccer players at risk of developing hamstring and quadriceps muscle injuries. [ABSTRACT FROM AUTHOR]

The goal of this prospective study was to determine the outcome-predictive role of various parameters in the nonoperative treatment of chronic anterior knee pain patients. Thirty patients followed a five-week treatment program, which consisted out of only closed kinetic chain exercises. Prior to this treatment all subjects were evaluated on muscular characteristics, subjective symptoms, weight, sex, duration of symptoms and functional performance. A multiple stepwise regression analysis revealed that the reflex response time of m. vastus medialis obliquus (VMO) ( P=0.041; 0.026), and the duration of symptoms ( P=0.019; 0.045) were the only two parameters which were significantly associated with the outcome (evaluated by the Kujala score) at five weeks, and at three months. The shorter the duration of symptoms, or the faster the reflex response time of VMO prior to the treatment, the better the outcome after a closed kinetic chain exercise program. The statistical significance of these parameters in this study may be seen as an indication of the importance of these variables as predictors of the outcome of a closed kinetic chain strengthening program. Using this information, it seems clinically important to begin the treatment program before the anterior knee pain becomes more chronic and treatment results become less good. [ABSTRACT FROM AUTHOR]

The present study was carried out to examine possible mechanisms of back muscle dysfunction by assessing a stabilising and a torque-producing back muscle, the multifidus (MF) and the iliocostalis lumborum pars thoracis (ICLT), respectively, in order to identify whether back pain patients showed altered recruitment patterns during different types of exercise. In a group of healthy subjects (n=77) and patients with sub-acute (n=24) and chronic (51) low back pain, the normalised electromyographic (EMG) activity of the MF and the ICLT (as a percentage of maximal voluntary contraction) were analysed during coordination, stabilisation and strength exercises. The results showed that, in comparison with the healthy subjects, the chronic low back pain patients displayed significantly lower (P=0.013) EMG activity of the MF during the coordination exercises, indicating that, over the long term, back pain patients have a reduced capacity to voluntarily recruit the MF in order to obtain a neutral lordosis. In contrast, during the stabilisation exercises, no significant differences between patients and controls were found for the normalised EMG activity of the two muscles. These findings indicated that, during low-load exercises, no insufficiencies in back muscle recruitment were evident in either subacute or chronic back pain patients. During the strength exercises, the normalised activity of both back muscles was significantly lower in chronic low back pain patients (P=0.017 and 0.003 for the MF and ICLT, respectively) than in healthy controls. Pain, pain avoidance and deconditioning may have contributed to these lower levels of EMG activity during intensive back muscle contraction. The possible dysfunction of the MF during coordination exercises and the altered activity of both muscles during strength exercises may be of importance in symptom generation, recurrence or maintenance of low back pain. [ABSTRACT FROM AUTHOR]

Objectives: To determine the effect of different training schedules on the cross sectional area (CSA) of the lumbar multifidus muscle in patients with chronic low back pain.Methods: Each of 59 nine patients was randomly assigned to one of three programmes: 10 weeks of stabilisation training (group 1; n = 19); 10 weeks of stabilisation training combined with dynamic resistance training (group 2; n = 20); 10 weeks of stabilisation training combined with dynamic-static resistance training (group 3; n = 20). Before and after 10 weeks of training, multifidus CSAs were measured from standard computed tomography images at three different levels (upper end plate of L3 and L4, and lower end plate of L4).Results: The CSA of the multifidus muscle was significantly increased at all levels after training in group 3. In contrast, no significant differences were found in groups 1 and 2.Conclusions: General stabilisation exercises and dynamic intensive lumbar resistance training have no significant effect on the CSA of the lumbar multifidus muscle in patients with chronic low back pain. The static holding component between the concentric and eccentric phase was found to be critical in inducing muscle hypertrophy during the first 10 weeks. Treatment consisting of stabilisation training combined with an intensive lumbar dynamic-static strengthening programme seems to be the most appropriate method of restoring the size of the multifidus muscle. [ABSTRACT FROM AUTHOR]

Objectives-To determine the effect of different training schedules on the cross sectional area (CSA) of the lumbar multifidus muscle in patients with chronic low back pain. Methods-Each of 59 nine patients was randomly assigned to one of three programmes: 10 weeks of stabilisation training (group 1; n = 19); 10 weeks of stabilisation training combined with dynamic resistance training (group 2; n = 20); 10 weeks of stabilisation training combined with dynamic-static resistance training (group 3; n = 20). Before and after 10 weeks of training, multifidus CSAs were measured from standard computed tomography images at three different levels (upper end plate of L3 and L4, and lower end plate of L4). Results--The CSA of the multifidus muscle was significantly increased at all levels after training in group 3. In contrast, no significant differences were found in groups 1 and 2. Conclusions-General stabilisation exercises and dynamic intensive lumbar resistance training have no significant effect on the CSA of the lumbar multifidus muscle in patients with chronic low back pain. The static holding component between the concentric and eccentric phase was found to be critical in inducing muscle hypertrophy during the first 10 weeks. Treatment consisting of stabilisation training combined with an intensive lumbar dynamic- static strengthening programme seems to be the most appropriate method of restoring the size of the multifidus muscle. [ABSTRACT FROM AUTHOR]

Retrospective studies have suggested various factors that might cause a disposition to develop patellar tendinitis, but no prospective data exist to determine any relationships. The purpose of this study was to determine the intrinsic risk factors for the development of patellar tendinitis in an athletic population. Before the study, 138 male and female students of physical education were evaluated for anthropometric variables, leg alignment characteristics, and muscle tightness and strength parameters. During the 2-year study, 19 of the 138 students developed patellar tendinitis. In all cases the diagnosis was confirmed by the presence of a hypoechogenic nodular lesion in the proximal region of the patellar tendon. Univariate and stepwise discriminant function analyses were performed comparing the various measurements. These analyses revealed that the only significant determining factor was muscular flexibility, with the patellar tendinitis patients being less flexible in the quadriceps and hamstring muscles (P < 0.05). The results of this study demonstrate that lower flexibility of the quadriceps and hamstring muscles may contribute to the development of patellar tendinitis in an athletic population. Therefore, the prevention of this condition in athletes should be focused on screening for and treating poor quadriceps and hamstring muscle flexibility. [ABSTRACT FROM AUTHOR]

Background Recent guidelines emphasise the importance of functional kinetic chain exercises during injury prevention training. Knowledge of muscle activation levels during various unilateral rowing exercises is lacking. Objective To describe and compare the activation levels of scapulothoracic and lumbopelvic muscle parts during eight variations of the high rowing exercise. Design Descriptive study. Exercise performance was standardised and individualised based on height, age and body weight. Setting Controlled laboratory study at Ghent University (Belgium). Participants 30 young healthy volunteers with a history of being active in sports and able to perform the exercises correctly. Interventions Activation levels of the upper trapezius (UT) and lower trapezius (LT) muscles of the dominant shoulder, and multifidus (MF) and erector spinae (ES) muscles at both sides of the trunk were investigated. Exercises were performed in front of a pulley apparatus. Main outcome measurements Individual muscle activation levels captured by surface Electromyography. Results Shoulder muscle activation was characterised by superior LT (>12.5% MVIC) over UT (<7.12% MVIC) muscle activation across exercises. Rowing in a static unipedal squat position revealed highest LT muscle activation (18.33% MVIC). Upright exercises (squatted or lunged) showed generally higher trunk muscle activation levels compared to a sitting or standing execution. Superior MF (>21% MVIC) over ES (<30.13% MVIC) muscle activation was found during all upright exercises, except during static bipedal squatting. Highest MF muscle activation was found heterolateral to arm movement during the dynamic single leg squat version of the exercise (33.26% MVIC; p<0.05). Conclusion High rowing exercises recruit posterior shoulder and trunk muscles relevant in injury prevention training. Unilateral rowing during a single leg squat position or movement seems most favourable for athletic injury prevention training purposes. [ABSTRACT FROM PUBLISHER]

Reference data for children using the Balance Master may be of clinical interest and use in the management of postural control in a wide range of conditions. [ABSTRACT FROM AUTHOR]