Sep
5
2023
The taut band and other mysteries of the trigger point: An examination of the mechanisms relevant to the development and maintenance of the trigger point
Author(s): Gerwin RD (Gerwin, Robert D.)1,2
Source: JOURNAL OF MUSCULOSKELETAL PAIN Volume: 16 Issue: 1-2 Pages: 115-121 Published: 2008
Objective: To examine the mechanisms that underlie the development of the myofascial trigger point [TrP].
Results: The TrP represents chronically dysfunctional muscle, but initiation and persistence of the TrP taut band have not been fully explained. Studies suggest that the initiating factors are excessive mechanical forces generated by muscle. Supramaximal muscle contraction, overloaded eccentric contraction, or repetitive activity are consistent with Simons’ hypothesis of an energy crisis as a critical event. Ischemia, hypoxia, and cell damage occur, leading to the release of cytokines, bradykinin, substance P, and calcitonin-gene-related peptide, all of which activate peripheral nociceptors. The taut band, chronically contracted, displays a sympathetic nervous system [SNS] modulated, localized, excessive endplate potential activity that produces a localized, nonpropagated contraction. The net effect is an excess of acetylcholine [ACh] at the motor end plate. This results from a combination of excess spontaneous release of ACh modulated by calcitonin-gene-related peptide and the SNS, inhibition of acetylcholinesterase, and upregulation of ACh receptors in the endplate zone. Postsynaptic events in the muscle cell that promote prolonged contraction are those that increase the concentration of calcium in the cytosol. Excessive release of calcium from the sarcoplasmic reticulum through a dysfunctional Ryanidine Receptor calcium channel, by a second messenger system mediated by the SNS, or by mitochondria. could result in persistent muscle fiber contraction.
Conclusion: Pre- and postsynaptic modulation of ACh release and intracellular Ca2+ can explain many of the features of the TrP.
Sep
5
2023
Myofascial force transmission via extramuscular pathways occurs between antagonistic muscles
Author(s): Huijing PA (Huijing, Peter A.)1,2, Baan GC (Baan, Guus C.)1
Source: CELLS TISSUES ORGANS Volume: 188 Issue: 4 Pages: 400-414 Published: 2008
Most often muscles (as organs) are viewed as independent actuators. To test if this is true for antagonistic muscles, force was measured simultaneously at: (1) the proximal and distal tendons of the extensor digitorum muscle (EDL) to quantify any proximo-distal force differences, as an indicator of myofascial force transmission, (2) at the distal tendons of the whole antagonistic peroneal muscle group (PER) to test if effects of EDL length changes are present and (3) at the proximal end of the tibia to test if myofascially transmitted force is exerted there. EDL length was manipulated either at the proximal or distal tendons. This way equal EDL lengths are attained at two different positions of the muscle with respect to the tibia and antagonistic muscles. Despite its relatively small size, lengthening of the EDL changed forces exerted on the tibia and forces exerted by its antagonistic muscle group. Apart from its extramuscular myofascial connections, EDL has no connections to either the tibia or these antagonistic muscles. Proximal EDL lengthening increased distal muscular forces (active PER Delta F approximate to +1.7%), but decreased tibial forces (passive from 0.3 to 0N; active Delta F approximate to -5%). Therefore, it is concluded that these antagonistic muscles do not act independently, because of myofascial force transmission between them. Such a decrease in tibial force indicates release of pre-strained connections. Distal EDL lengthening had opposite effects (tripling passive force exerted on tibia; active PER force Delta F approximate to -3.6%). It is concluded that the length and relative position of the EDL is a co-determinant of passive and active force exerted at tendons of nearby antagonistic muscle groups.
These results necessitate a new view of the locomotor apparatus, which needs to take into account the high interdependence of muscles and muscle fibres as force generators, as well as proximo-distal force differences and serial and parallel distributions of sarcomere lengths that are consequences of such interaction. If this is done properly, the effects of integrating a muscle fibre, muscle or muscle group into higher levels of organisation of the body will be evident.
Sep
5
2023
Needles are often equated with pain and discomfort; however, for a horse named Gypsy the tiny sharp objects brought about much needed relief as Dr. Mark Crisman, a professor in the Department of Large Animal Clinical Sciences in the Virginia-Maryland Regional College of Veterinary Medicine at Virginia Tech, administered acupuncture therapy.
Gypsy had an infection in her ankle and Crisman was using acupuncture — along with traditional therapy — to help strengthen her bones and immune system, and provide pain relief.
Acupuncture, which has its roots in eastern countries, is a technique of inserting and manipulating very fine needles into specific points on the body with the intention of relieving pain and other therapeutic purposes. This ancient practice has long been used among human patients and, over the past few decades, has gained popularity and recognition in veterinary medicine.
“Acupuncture has proven to be a safe and relatively painless treatment for a variety of illnesses in animals,” said Crisman who has been practicing the therapy for over a decade on equine patients and now teaches others who desire certification.
The Virginia-Maryland Regional College of Veterinary Medicine’s Veterinary Teaching Hospital offers this therapy to both large and small animals. Conditions that respond well to acupuncture range from skin disorders to musculoskeletal issues to neurological problems.
“While pain and osteoarthritis are common conditions we treat with acupuncture in small animals,” said Dr. Bess Pierce, an associate professor in the Department of Small Animal Clinical Sciences, who is leading the hospital’s community practice, “we certainly provide therapy for a multitude of problems.”
Veterinarians who wish to practice acupuncture most undergo an additional training process. With the recent completion of her certification, Dr. Beverley Purswell, a professor in the Department of Large Animal Clinical Sciences, brings the total of certified veterinary acupuncturists in the college to four.
“Acupuncture certainly does not replace traditional veterinary medicine,” said Purswell who plans to use the therapy in her work in theriogenology, the specialized field of veterinary medicine that focuses on reproduction. “It can, however, compliment the therapies we already use.”
In addition to Crisman, Pierce, and Purswell, Dr. Scott Pleasant, associate professor in the Department of Large Animal Clinical Sciences, is also a certified acupuncturist.
Virginia Tech (2008, October 27). Acupuncture Used For Animal Ailments. ScienceDaily. Retrieved October 28, 2008, from http://www.sciencedaily.com /releases/2008/10/081026100516.htm
Sep
5
2023
US medics have found the Bee Gees’ 1977 hit Stayin’ Alive is an ideal beat to follow to perform chest compressions on a victim of a cardiac arrest. Research says it contains 103 beats per minute, close to the recommended rate of 100 chest compressions per minute.
An author of the study said many people were put off performing cardiopulmonary resuscitation (CPR)as they were not sure about keeping the correct rhythm. He said CPR could triple cardiac arrest survival rates when performed properly.
The study by the University of Illinois College of Medicine saw 15 doctors and students performing CPR (cardiopulmonary resuscitation) on mannequins while listening to Stayin’ Alive. They were asked to time their chest compressions with the beat.
Five weeks later, they did the same drill without the music, but were told to think of the song while doing compressions. The average number of compressions the first time was 109 per minute; the second time it was 113 – more than recommended by the American Heart Association, but better than too few, according to Dr Matlock. “It drove them and motivated them to keep up the rate, which is the most important thing,” he told the Associated Press.
A spokesman for the American Heart Association, Dr Vinay Nadkarni, said it had been using Stayin’ Alive as a training tip for CPR instructors for about two years, although it was not aware of any previous studies that tested the song.
http://news.bbc.co.uk/1/hi/health/7678371.stm
Sep
5
2023
Size counts – more evidence about multifidus in back pain
Brett Vaughan, Lecturer, School of Biomedical & Health Sciences, Victoria University, Australia
A growing number of studies have identified that lumbar multifidus undergoes atrophy with low back pain with a predictable pattern of atrophy in an acute low back pain population. The location and the extent of atrophy of multifidus in a chronic low back pain population are still debated. Hides et al.1 investigated the size and symmetry of the multifidus bilaterally, comparing a chronic low back pain population (mean age 47 years) with a sample of convenience of people with no back pain (mean age 28 years). A secondary aim of this study was to compare the pattern of atrophy in different chronic low back pain presentations. Clinical records of 42 patients presenting to a hospital low back pain clinic were assessed with the clinical presentation data coded to indicate a bilateral or unilateral low back pain presentation. Cross-sectional area of the multifidus muscle was measured at levels L2–L5 using ultrasound imaging apparatus. Results of this study demonstrated a difference in multifidus cross-sectional area, with the chronic low back pain population demonstrating a decrease in diameter, particularly evident at the L4 and L5 vertebral levels. This result was not dependent upon the age of the patient. Unilateral low back pain patients demonstrated an asymmetry in the cross-sectional area at L4 and L5; however, this was not demonstrated in the bilateral low back pain or asymptomatic populations. The results of this study suggest that multifidus does atrophy in a chronic low back pain population and this is most evident at L4 and L5 levels indicating localized rather than generalised muscle change. Single sided pain is associated with asymmetry in patients with chronic low back pain. The authors suggest that their findings re-inforce the need for clinicians to provide exercise therapy that is designed for individual patients tailored to their impairments and that assessment should address comparisons between segmental levels and between sides.
Further research is required to contextualise the growing body of knowledge about specific muscle changes in patients with low back pain with current guidelines for treatment which suggest non-specific exercise interventions.
Reference
1. Hides J, Gilmore C, Stanton W, Bohlscheid E. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther 2008;13:14–19.
International Journal of Osteopathic Medicine
Volume 11, Issue 3, September 2008, Pages 114-119
Sep
5
2023
At a spa–carnivorous plant farm in northern Israel, you can get a snake massage for just $80. Spa mistress Ada Barak came up with the idea after visitors who came to scope out her carnivorous plants (which eat schnitzel, among other things) enjoyed the sensation of holding the garden snakes she’d pass around after the tour. For the snake massage, she basically plops a mass of entwined snakes of various sizes on your stomach and lets them slither all over you. This is supposed to have “calming and curative effects.” Time sent a writer to try out this treatment. “After some experimenting” Barak perfected her treatment with a combination of big snakes which produce a kneading sensation and little snakes “whose passage over the skin is a trembling flutter.” How big is big?
Just as I am psyching myself up for the treatment, I see one of the little snakes, with a string of brick-colored diamonds along its spine, open its mouth impossibly wide. Is it going to strike? No — it coughs up a half-digested mouse, leading me to assume that the snake is as queasy about giving me a massage as I am about getting one.
Wow, gross? To top that off, once the snakes get to work, one nibbles on the subject’s eyelashes. The writer emerges from the “massage” feeling “relaxed and curiously lightheaded.” You know, if snakes that ate mice had a nibble of our eyelashes from the comfort of our stomach, we’d feel a little lightheaded, too.
http://nymag.com/daily/fashion/2008/09/the_latest_spa_craze_snake_mas.html
Sep
5
2023
Pelvic floor exercises have long been recommended for women – now researchers say they could help men too. The exercises were found to help men with erectile dysfunction as much as taking in Viagra.
The researchers say the findings mean men have an alternative to drug therapy.
For around 50 years, women have been advised to perform pelvic floor exercises to strengthen their muscles for childbirth.
The pelvic floor is a “hammock” of muscles which support the bowel and bladder.
Pelvic floor, or Kegel, exercises involve clenching the muscles you would use to prevent yourself urinating.
This latest research indicates it is also important for men to maintain the muscle tone and function of their pelvic floor muscles with the exercises.
The team from the University of the West of England in Bristol studied 55 men with an average age of 59 who had experienced erectile dysfunction for at least six months.
The men, all patients at the Somerset Nuffield Hospital, Taunton, Somerset, were given five weekly sessions of pelvic floor exercises and assessed at three and six months, and asked to practise the exercises daily at home.
It was found 40% of the men regained normal erectile function – some of who had severe erectile dysfunction, and another 35% showed some improvement.
Two thirds of the men had said they also had problems with urination. These improved significantly after they began the exercises.
Dr Grace Dorey, a specialist continence physiotherapist who carried out the research, told BBC News Online: “The exercises were found to be equally as effective as taking Viagra.
“Pelvic floor exercises improve function in a physical way, in a more natural way.
“Men should be doing preventative exercise. It really is use it or lose it.”
She said men should be exercising their pelvic floor exercises from puberty onwards.
A spokesperson for the Impotence Association said: “The value and effectiveness of pelvic floor exercises should not be underestimated when considering the management of sexual problems such as impotence and premature ejaculation.
“The exercises are thought to strengthen the muscles that surround the penis and improve the blood supply in the pelvis, which is an important factor in relation to erectile dysfunction.”
http://news.bbc.co.uk/2/hi/health/3036188.stm
Sep
5
2023
Women are paying the price for fashion in the form of broken bones and sprained ankles, a doctor has warned.
The warm weather has led to a spate of injuries caused by women falling from their high-heeled sandals.
Rupert Evans, an accident and emergency doctor at University Hospital of Wales in Cardiff said injuries could lead to long-term problems.
Women should stick to shoes with heels less than 4cm (1.5in) if they wanted to avoid a trip to hospital, he advised.
Dr Evans said he has seen an increase in the number of women being admitted to hospital with injuries caused by the fashionable footwear.
Injuries ranged from sprained ankles to broken bones and dislocations – and in some cases caused permanent damage.
He estimated that up to half a dozen women were now being admitted to his department with shoe-related injuries on weekend evenings.
Drinking alcohol added to the problem, he said.
“I suspect it’s something to do with the weather we’ve been having.
“Women are dressing differently and a lot of them are coming in with high-heel shoe injuries.”
Sensible shoes
He added that shoes which did not have a back or a strap could cause particular problems.
“Try to have shoes with a strap and keep the heel height down to 4cm (1.5in),” he said.
He said he was not advising that women should stop wearing high heels altogether, but advocating wearing them in moderation.
“There can be serious consequences, but we are not trying to ban them,” he said.
Martin Shalley, president of the British Association for Emergency Medicine said he had not spotted a recent increase, but he reiterated that high heels could definitely lead to serious injuries.
“That is something we see and I have seen a few breaks over the years. Falling off a high heel can cause much more serious injuries.”
He added that Dr Evans’ advice was very reasonable.
“Of course it could be a problem associated with alcohol. Alcohol and heels are a bad mix,” he said.
http://news.bbc.co.uk/2/hi/health/5235630.stm
Sep
5
2023
AUSTRALIAN cancer experts have supported a study by the American Institutes of Health which found massage therapy may have immediate benefits on pain and mood among patients with advanced cancer.
The Cancer Council of New South Wales said scientific research had shown that massage could reduce pain, fatigue, anxiety, depression and nausea as well as improving sleep, quality of life and mental clarity and alertness.
The council’s Professor Jim Bishop said massage therapy could benefit the physical, emotional and mental state of people at all stages of cancer.
“Many people with cancer wonder whether any complementary therapies can help them. Massage and other gentle bodywork techniques that focus on the positive effects of human touch are very popular complementary therapies,” Professor Bishop said.
“Instead of being used to work out knots, detoxify the body, or increase one’s range of motion, massage may become a way to lower anxiety and pain, improve energy, or decrease nausea.
“It is a way to feel more loved and helps to re-establish a connection with oneself and others. It may ease the discomfort of a medical procedure or help pass the time while waiting for a consultation with the doctor.
“Some benefits people have described from receiving massage include feeling whole again, being able to share feelings in an informal setting, re-establishing a positive body image and rebuilding hope.”
Nepean Hospital oncologist Dr Georgette Danyal said different types of massage could be administered to cancer patients.
“There has been a lot of work that has been done on the introduction of massage therapies as part of the service for cancer patients,” Dr Danyal said.
“Just general massage therapy is recommended where appropriate as a relaxation strategy. A lot of cancer patients are quite anxious when they’re undergoing treatment or just after they’ve been diagnosed, so sometimes gentle massage is done to help a lot with relaxation for these patients.
“If patients have had breast cancer and they’ve had their lymph nodes removed they are at risk of developing lymphoedema and if they do develop it then we do a very specialised lymphatic massage.
“Lymphatic massage will basically assist in stimulating lymphatic drainage in the system and that will assist in reduction of a swollen oedema – they will be able to feel relief from their discomfort.
“Another effect of the massage is relaxation too because it is a very gentle type of massage – a lot of the patients that come to see us after lymphatic massage say they feel so calm and relaxed.”
Dr Danyal said frequency of treatment varied from patient to patient.
“Some patients go weekly to have [massage therapy] done and they feel that by doing it weekly it helps and it is frequent enough but it does vary,” she said.
“Cost of course is a big issue with it as well because a lot of the patients that come in are not in a financial position to be able to access this service at a reasonable cost.”
Professor Bishop said while massage therapy had proved beneficial, it was most successful when administered in conjunction with conventional medicines.
http://www.consultmagazine.net/StoryView.asp?StoryID=337389
Sep
5
2023
Adding protein to a sports drink won’t make you race faster, suggests findings from researchers at McMaster University.
“Sports drinks improve performance during prolonged exercise because of two key ingredients: carbohydrate, which provides fuel for working muscles, and sodium, which helps to maintain fluid balance,” says Martin Gibala, an associate professor of kinesiology at McMaster. “Research also supports the practice of consuming protein after exercise to promote muscle recovery. However, the alleged benefit of consuming protein during exercise is controversial.”
The study, which is published in the August edition of Medicine & Science in Sports & Exercise, found that adding protein to a carbohydrate-electrolyte sports drink did not improve cycling time trial performance compared to the sports drink alone.
The research was conducted on 10 trained cyclists who performed a simulated 80 km bicycle race on three occasions. During exercise, the subjects were given a sports drink, a sports drink supplemented with protein, or a placebo drink that provided no energy. The drinks were similarly flavored and neither the subjects nor the researchers knew what drink was consumed during a given test. The study found that the sports drink improved performance compared to the placebo drink – confirming prior research – but there was no additional benefit of protein supplementation.
“Previous studies that suggested protein was beneficial used ‘ride to exhaustion’ tests that do not resemble normal athletic competition. In addition, the subjects in those studies received less than the optimal recommended amount of carbohydrate,” says Gibala. “Our study shows that protein confers no performance benefit during ‘real life’ exercise when athletes consume sufficient amounts of a sports drink.”
The study, which was funded by Gatorade, comes at a time when the sports drink industry is under pressure to create new products by adding ingredients that might further enhance performance. Some companies have heavily marketed protein-laced sports drinks as the next magic bullet, but Gibala’s research disputes such claims.
“Eating a little protein after exercise is important to help repair damaged muscles and promote training adaptations,” says Gibala, “but no compelling evidence suggests that endurance athletes need protein during exercise.”
McMaster University (2006, August 3). Protein-added Sports Drinks Don’t Boost Performance During Exercise, Study Finds. ScienceDaily.
