The onset of deep abdominal muscles activity during tasks with different trunk rotational torques in subjects with non-specific chronic low back pain

BackgroundAlthough delayed onset of the deep abdominal muscles activity in subjects with non-specific chronic low back pain (CLBP) has been suggested to be related to trunk rotational torque, no study has examined the onsets associated with non-specific CLBP during a variety of tasks with different trunk rotational torque. The aim of this study is to compare the onsets of deep abdominal muscles activity among tasks with different trunk rotational torques in subjects with and without non-specific CLBP.MethodsTwelve subjects with non-specific CLBP and 13 control subjects were included. They performed 8 types of upper limb movements. The onsets of muscular activity of bilateral internal oblique-transversus abdominis (IO-TrA) and trunk rotational torque due to the upper limb movements were measured using a surface electromyography and a three-dimensional motion analysis system.ResultsIn non-specific CLBP group, right IO-TrA activities were significantly delayed during tasks with left trunk rotational torque compared with the control (P < 0.05), while onsets of the left IO-TrA activities were significantly later than those of the control during tasks with right rotational torque of the trunk (P < 0.05). There were no significant differences in onsets of both sides IO-TrA during tasks without trunk rotational torque between non-specific CLBP and control groups (P > 0.05).ConclusionsThe onsets of IO-TrA activities in subjects with non-specific CLBP were delayed during tasks with rotational torque of the trunk in the opposite direction, suggesting a possibility that delayed onset of the deep abdominal muscles during rotational torque of the trunk might be etiology of chronic low back pain.     

Reduction of post-operative opioid use in neonates following open congenital diaphragmatic hernia repairs: A quality improvement initiative

BackgroundA limited number of post-operative opioid reduction strategies have been implemented in the neonatal population. Given the potential neurodevelopment effects of prolonged opioid use, we created a quality improvement initiative to reduce opioids in our NICU and evaluated the intervention in our CDH population.MethodsOur opioid reduction intervention was based on standing post-operative IV acetaminophen, standardizing post-surgical sign-out between the surgical, anesthesia and NICU teams and a series of education seminars with NICU providers on post-operative pain control management. A historical control was used to perform a retrospective cohort analysis of opioid prescribing patterns in addition to a utilizing process control charts to investigate time trends in prescribing patterns.ResultsForty-five children with CDH underwent an operation were included in our investigation- 18 in our pre-intervention cohort, 6 in a roll-out cohort and 21 in our post-intervention cohort. Each cohort was clinically similar. The intervention reduced total post-operative opioid use (morphine equivalents) from 82.2 (mg/kg) to 2.9 (mg/kg) in our post-intervention group (p < 0.0001). Our maximum Neonatal Pain and Agitation Sedation Score over the first 48 post-operative hours were equivalent (p = 0.827). Safety profiles were statistically equivalent. The opioid reduction intervention reduced post-operative intubation length from 156 to 44 h (p = 0.021).ConclusionA multi-tiered intervention can decrease opioid use in post-surgical neonates with complex surgical pathology including CDH. The intervention proposed in this investigation is safe and does not increase pain or sedation scores in neonates, while lessening post-operative intubation length.Evidence levelLevel II     

Immediate effect of mechanical lumbar traction in patients with chronic low back pain: A crossover,repeated measures,randomized controlled trial

BackgroundLumbar traction is a treatment method traditionally used for chronic low back pain (CLBP) in many countries. However, its clinical effectiveness has not been proven in medical practice. The purpose is to conduct a multi-center, crossover, randomized controlled trial (RCT) to prove the efficacy and safety of traction on CLBP patients, using equipment capable of precise traction force control and of reproducibility of the condition based on the previous biomechanical and pre-clinical studies.MethodsNinety-five patients with non-specific CLBP from 28 clinics and hospitals were randomly assigned to either the intermittent traction with vibration (ITV) first group (A: sequence ITV to ITO) or the intermittent traction only (ITO) first group (B: sequence ITO to ITV); the former was treated with repeated traction and vibration force added to preload. All patients were followed up weekly for 2 periods after study-initiation. The primary outcome measures were disability level including pain and quality of life (based on Japan Low back pain Evaluation Questionnaire; JLEQ), and JLEQ was measured repeatedly. Statistical analysis was performed using linear mixed model.ResultsComparing to pre-traction data, both traction modes significant improvement except the first intervention of ITO treatment. The differences in JLEQ scores over time showed significant improvements in the treatment to which vibrational force was added in contrast to the conventional traction treatment; Mean difference was significant to compare ITV treatment and ITO treatment (−1.75 (p = 0.001), 95% CI; −2.69 to −0.80). However, neither difference between the two sequences (p = 0.884) nor carryover effect (p = 0.527) was observed.ConclusionsAltogether, the results indicate that lumbar traction was able to improve the pain and functional status immediately in patients with CLBP. This study contributes to add some evidence of the efficacy of lumbar traction.     

The effect of thoracic spine high-velocity low-amplitude thrust manipulation on myoelectric activity of the lower trapezius and posterior deltoid muscles during treadmill walking

ObjectivesTo investigate the effect of thoracic spine thrust manipulation on the EMG activity of posterior deltoid and lower trapezius during treadmill walking.MethodsVolunteers (n = 40; 19 males and 21 females) were randomly assigned to a ‘sham ultrasound’ control group (n = 20) or a thoracic spine high-velocity thrust (HVLAT) manipulation group (n = 20). Surface EMG recordings were collected from the right posterior deltoid and lower trapezius muscles whilst participants walked on a treadmill for 2 min, at 2.8 mph, both prior to and immediately post-intervention. EMG recordings were analysed by evaluating the difference of integral values for pre and post data using repeated measures ANOVA.ResultsBoth control (sham ultrasound) and experimental groups (HVLAT) exhibited small non-significant reductions in post-intervention EMG activity of lower trapezius (p = 0.201) and a significant reduction in posterior deltoid (p = 0.003) during treadmill walking. No significant difference was found in the integrated EMG (IEMG) power between control and experimental group in either the ‘before’ or ‘after’ measurements for both target muscles.ConclusionsManipulation of the thoracic spine does not significantly alter the myoelectric activity of lower trapezius and posterior deltoid muscles during treadmill walking.     

Isokinetic trunk-strength deficits in people with and without low-back pain: a comparative study with consideration of effort.

The purposes of this study were to determine (a) the degree and distribution of isokinetic trunk strength deficits in people with chronic low-back pain (CLBP) and (b) to what degree subject effort during testing affects those deficits. We measured the isokinetic trunk strengths of three subject groups on the Cybex Trunk Extension/Flexion machine. Groups 1 and 2 consisted of 155 men and women with CLBP who were divided into maximal (n = 115) and submaximal (n = 40) groups according to their torque/position curve variability. Group 3 was made up of 32 back-healthy men and women who served as controls. The results demonstrated that men had higher flexion and extension torques than women did for all groups. The control group had higher flexion and extension torques than the maximal-effort CLBP group did. The extensors had a proportionally greater deficit than the flexors did in this LBP group. Comparing the two groups with CLBP, the maximal-effort group had higher flexion and extension torques than the submaximal effort group did, and the extensors showed a greater deficit. Degree of effort during testing does affect the results. Therapists should consider extensor strengthening and reeducation exercises when designing exercise programs to restore normal function in people with chronic CLBP.     

A novel approach to improving the interpretation of CT brain in trauma

BackgroundComputed tomography of the brain (CTB) has a fundamental role in the diagnosis and management of traumatic brain injury (TBI). There may be substantial discordance between initial CTB interpretation by emergency clinicians and the final radiology report. This study aimed to assess the utility of a structured reporting template in improving the accuracy of CTB interpretation by emergency clinicians.MethodA prospective pre- and post-intervention cohort study was undertaken using a study population of emergency medicine trainees. The CTB reporting template was created with consultation from radiology, emergency medicine and trauma specialists. Participants reported on a set of randomly selected trauma CTBs first without, and then with, the reporting template. Each case was independently assessed for concordance with the radiology report by two blinded assessors (including a radiologist) and the proportion of concordant reports in each phase calculated.ResultsThere were 26 participants recruited to the study who reported on a total of 320 CTBs. In the pre-intervention phase, 121 (76%) cases were concordant with the radiology report compared to 147 (92%) post-intervention (p < 0.01). The AUROC was 0.84 (95% CI: 0.78–0.89) pre-intervention and improved to 0.94 (95% CI: 0.88–0.99) with the intervention (p = 0.01). A higher level of baseline accuracy was observed in advanced trainees (78%) compared to basic trainees (72%), but both improved to a similar level of 92% with the use of the CTB reporting template. There was a marked reduction in false negative errors, with increased identification of critical diagnoses such as cerebral herniation and diffuse axonal injury.ConclusionThe use of the CTB reporting template significantly increased the accuracy of emergency medicine trainees and reduced the number of missed critical diagnoses. Reporting templates may represent an effective strategy to improve CTB interpretation and enhance the initial care of head injured patients.     

Trunk-muscle strength during concentric and eccentric contraction: a comparison between healthy subjects and patients with chronic low-back pain.

The physical evaluation and exercise program of trunk muscles in patients with chronic low-back pain (CLBP) is still controversial. Many studies have been performed in the isometric and/or concentric contraction mode. Few data, however, have been reported on trunk-muscle strength during eccentric contraction, which plays a significant role in functional activities. To evaluate whether trunk-muscle strength on eccentric contraction could be applicable to the assessment and exercise of the patients with CLBP, trunk strength was measured in 20 healthy men and 16 healthy women, as well as 15 male and 10 female patients with CLBP. Maximum voluntary concentric and eccentric strength was measured during attempted flexion and extension in a seated position. In the healthy subjects, the maximum torque of extensors was greater than that of the flexors during both concentric and eccentric contraction (p less than 0.05). In flexors and extensors, maximum torque exerted on the eccentric contraction was always greater than that on the concentric contraction (p less than 0.05). Although strength was likely to be weaker in the patients with CLBP than in the healthy subjects, there were no statistical differences between the two groups. In terms of the flexor/extensor ratio of maximum torque, there were also no statistical significances between the two groups in either contraction mode. In the flexors, correlation coefficient (r) between concentric and eccentric torque was 0.84 for the healthy subjects and 0.48 for the CLBP subjects (p less than 0.05). In the extensors, the coefficient was 0.90 for the healthy patients and 0.71 for the CLBP patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Reducing Acute Hospitalization Length of Stay After Total Knee Arthroplasty: A Quality Improvement Study

BackgroundThe introduction of bundled funding for total knee arthroplasty (TKA) has motivated hospitals to improve quality of care while minimizing costs. The aim of our quality improvement project is to reduce the acute hospitalization length of stay to less than 2 days and decrease the percentage of TKA patients discharged to inpatient rehabilitation using an enhanced recovery after surgery bundle.MethodsThis study used a before-and-after design. The pre-intervention period was January to December 2017 and the post-intervention period was January 2018 to August 2019. A root cause analysis was performed by a multidisciplinary team to identify barriers for rapid recovery and discharge. Four new interventions were chosen as part of an improvement bundle based on existing local practices, literature review, and feasibility analysis: (1) perioperative peripheral nerve block; (2) prophylactic antiemetic medication; (3) avoidance of routine preoperative urinary catheterization; and (4) preoperative patient education.ResultsThe pre-intervention and post-intervention groups included 232 and 383 patients, respectively. Mean length of stay decreased from 2.82 to 2.13 days (P < .001). The need for inpatient rehabilitation decreased from 20.2% to 10.7% (P = .002). Mean 24-hour oral morphine consumption decreased from 60 to 38 mg (P < .001). The percentage of patients experiencing moderate-to-severe pain and postoperative nausea and vomiting within the first 24 hours decreased by 25% and 15%, respectively (P < .001). Thirty-day emergency department visits following discharge decreased from 12.9% to 7.3% (P = .030).ConclusionSignificant improvements in the recovery of patients after TKA were achieved by performing a root cause analysis and implementing a multidisciplinary, patient-centered enhanced recovery after surgery bundle.Level of EvidenceLevel III     

Prevention of central venous catheter-related bloodstream infections: is it time to add simulation training to the prevention bundle?

Study ObjectiveTo study the impact of adding simulation-based education to the pre-intervention mandatory hospital efforts aimed at decreasing central venous catheter-related blood stream infections (CRBSI) in intensive care units (ICU).DesignPre- and post-intervention retrospective observational investigation.Setting24-bed ICU and a 562-bed university-affiliated, urban teaching hospital.PatientsICU patients July 2004-June 2008 were studied for the development of central venous catheter related blood stream infections (CRBSI).MeasurementsICU patients from July 2004-June 2008 were studied for the development of central venous catheter-related blood stream infections (CRBSI).Pre-Interventionmandatory staff and physician education began in 2004 to reduce CRBSI. The CRBSI-prevention program included online and didactic courses, and a pre- and post-test. Elements in the pre-intervention efforts included hand hygiene, full barrier precautions, use of Chlorhexidine skin preparation, and mask, gown, gloves, and hat protection for operators. A catheter-insertion cart containing all supplies and checklist were was a mandatory element of this program; a nurse was empowered to stop the procedure for non-performance of checklist items.InterventionAs of July 1, 2006, a mandatory simulation-based program for all intern, resident, and fellow physicians was added to teach central venous catheter (CVC) insertion.MeasurementsData collected pre- and post-intervention were CRBSI incidence, number of ICU catheter days, mortality, laboratory pathogen results, and costs.Main ResultsThe pre-intervention CRBSI incidence of 6.47/1,000 catheter days was reduced significantly to 2.44/1,000 catheter days post-intervention (58%; P < 0.05), resulting in a $539,902 savings (USD; 47%), and was attributed to shorter ICU and hospital lengths of stay.ConclusionsFollowing simulation-based CVC program implementation, CRBSI incidence and costs were significantly reduced for two years post-intervention.     

Characteristics affecting cervical sagittal alignment in patients with chronic low back pain

BackgroundSagittal spino-pelvic malalignment in patients with chronic low back pain (CLBP) have been reported in the past, which may also affect cervical spine lesions. The purpose of this study is to investigate the cervical alignment in patients with CLBP.MethodOf the patients who visited an orthopedic specialist due to low back pain lasting more than three months, 121 cases (average 71.5-years-old, 46 male and 75 female) with whole standing spinal screening radiographs were reviewed (CLBP group). Cervical parameters included cervical lordosis (CL), C2–C7 sagittal vertical axis (C2-7 SVA), and the T1 slope minus CL (T1S-CL). Cervical spine deformity was defined as C2-7 SVA >4 cm, CL <0°, or T1S-CL ≧20°. We compared the cervical alignment of these patients with 121 age and gender matched volunteers (control group).ResultsThe prevalence of cervical spine deformity was significantly higher in the CLBP group than in the control group (20.7% vs. 10.7%, P = 0.034). The mean CL was smaller in the CLBP group than in the control group (16.1° vs. 21.4°, P = 0.002). The mean C2-7 SVA was 17.6 mm vs. 18.7 mm in the CLBP group and in the control group, respectively (P = 0.817). The mean T1S-CL was larger in the CLBP group than in the control group (9.1° vs. 3.5°, P < 0.001). Multivariate analysis showed that people with CLBP were more likely to have cervical deformities than people without CLBP (odds ratio 2.16, 95% confidence interval 1.006 to 4.637).ConclusionsThis study results suggest that people with CLBP present with worse cervical sagittal alignment and higher prevalence of cervical spine deformities than age and gender matched volunteers with no CLBP. This means CLBP impacts cervical spine lesions negatively.Level of evidenceⅣ     

Randomised controlled pilot trial of high-velocity,low-amplitude manipulation on cervical and upper thoracic spine levels in asymptomatic subjects

BackgroundHigh-velocity, low-amplitude (HVLA) manipulation techniques are habitually used on the cervical spine but the effects are not completely clear. The aim of this prospective comparative trial was to evaluate effects of an indiscriminate manipulation on the C5 (AMC5) a manipulation treatment based on a previous evaluation (MT) and a sham intervention (ST) on cervical spine range of motion (ROM); cervical flexion isometric peak force; EMG activation of sternocleidomastoid muscle (SCM) during the cranio-cervical flexion test (CCFT); and EMG signals of right and left biceps at rest were analyzed.Methods/DesignRandomised controlled pilot study and intention-to-treat analysis was performed.SettingThe study was conducted at an osteopathic clinic.MethodsThe outcomes were measured pre and immediately post intervention.ParticipantsA total of 36 asymptomatic subjects (18 male, mean age 30 years) were randomly enrolled into 3 groups: AMC5 (n = 12), MT (n = 12), and ST (n = 12).ResultsSignificant changes (p < 0.1) were found in the cervical flexion isometric peak force (−13.15%), however, the effect size was considered moderate (d = 0.52). The extension (10.44%) and left rotation ROM (12.25%) showed significant improvement in MT group. During CCFT significant changes were not reported.ConclusionsThe current pilot study suggested that a tendency toward a decrease in the isometric strength peak in the cervical flexion of the MT group may appear. In cervical ROM the MT group achieved significant effects in extension and left rotation movement.     

Flexor hallucis longus tendon branch test: Development and validation of a new method to assess anatomical variation of the tendinous slip

BackgroundThe flexor hallucis longus (FHL) muscle often has a tendinous slip with a variable number of branches. We aimed at developing the FHL branch test to determine the number of FHL branches.MethodsIn anatomical validation study, 6 intact cadavers were used. The toe flexion angles were measured while the FHL and flexor digitorum longus (FDL) were manually pulled individually. For electrophysiological studies, 4 healthy men participated. The FHL was electrically stimulated, and electromyography (EMG) of the FHL and FDL were recorded during the FHL branch test.ResultsThe toe flexion angles’ changes in the FHL pulling condition were equivalent with pulling FDL in toes with FHL branching. The electrical stimulation of the FHL produced similar flexion as the FHL branch test. EMG of the FHL was higher than FDL during the FHL branch test (p = 0.036).ConclusionsThe FHL branch test could be used to evaluate the number of FHL branches.     

Angular stable locking in a novel intramedullary nail improves construct stability in a distal tibia fracture model

IntroductionIntramedullary nails are frequently used for treatment of unstable distal tibia fractures. However, insufficient fixation of the distal fragment could result in delayed healing, malunion or nonunion. Recently, a novel concept for angular stable nailing was developed that maintains the principle of relative stability and introduces improvements expected to reduce nail toggling, screw migration and secondary loss of reduction. The aim of this study was to investigate the biomechanical competence of the novel angular stable intramedullary nail concept for treatment of unstable distal tibia fractures, compared to a conventional nail locking in a human cadaveric model under dynamic loading.Materials and methodsTen pairs of fresh-frozen human cadaveric tibiae with a simulated AO/OTA 42-A3.1 fracture were assigned to 2 groups for reamed intramedullary nailing using either a conventional (non-angular stable) Expert Tibia Nail (ETN) with 3 distal screws or the novel Tibia Nail Advanced (TNA) system with 2 distal angular stable locking low-profile retaining screws. The specimens were biomechanically tested under conditions including initial quasi-static loading, followed by progressively increasing combined cyclic axial and torsional loading in internal rotation until failure of the bone-implant construct. Both tests were monitored by means of motion tracking.ResultsInitial nail toggling of the distal tibia fragment in varus and flexion under axial loading was lower for TNA compared to ETN, being significant in flexion, P = 0.91 and P = 0.03. After 5000 cycles, interfragmentary movements in terms of varus, flexion, internal rotation, axial displacement, and shear displacement at the fracture site were all lower for TNA compared to ETN, with flexion and shear displacement being significant, P = 0.14, P = 0.04, P = 0.25, P = 0.11 and P = 0.04, respectively. Cycles to failure until both interfragmentary 5° varus and 5° flexion were significantly higher for TNA compared to ETN, P = 0.04.ConclusionFrom a biomechanical perspective, the novel angular stable intramedullary nail concept provides increased construct stability and maintains it over time while reducing the number of required locking screws without impeding the flexibility of the nail itself and resists better towards loss of reduction under dynamic loading, compared to conventional locking in intramedullary nailed unstable distal tibia fractures.     

Unilateral Quadriceps Fatigue Induces Greater Impairments of Ipsilateral versus Contralateral Elbow Flexors and Plantar Flexors Performance in Physically Active Young Adults

Non-local muscle fatigue (NLMF) studies have examined crossover impairments of maximal voluntary force output in non-exercised, contralateral muscles as well as comparing upper and lower limb muscles. Since prior studies primarily investigated contralateral muscles, the purpose of this study was to compare NLMF effects on elbow flexors (EF) and plantar flexors (PF) force and activation (electromyography: EMG). Secondly, possible differences when testing ipsilateral or contralateral muscles with a single or repeated isometric maximum voluntary contractions (MVC) were also investigated. Twelve participants (six males: (27.3 ± 2.5 years, 186.0 ± 2.2 cm, 91.0 ± 4.1 kg; six females: 23.0 ± 1.6 years, 168.2 ± 6.7 cm, 60.0 ± 4.3 kg) attended six randomized sessions where ipsilateral or contralateral PF or EF MVC force and EMG activity (root mean square) were tested following a dominant knee extensors (KE) fatigue intervention (2×100s MVC) or equivalent rest (control). Testing involving a single MVC (5s) was completed by the ipsilateral or contralateral PF or EF prior to and immediately post-interventions. One minute after the post-intervention single MVC, a 12×5s MVCs fatigue test was completed. Two-way repeated measures ANOVAs revealed that ipsilateral EF post-fatigue force was lower (-6.6%, p = 0.04, d = 0.18) than pre-fatigue with no significant changes in the contralateral or control conditions. EF demonstrated greater fatigue indexes for the ipsilateral (9.5%, p = 0.04, d = 0.75) and contralateral (20.3%, p < 0.01, d = 1.50) EF over the PF, respectively. There were no significant differences in PF force, EMG or EF EMG post-test or during the MVCs fatigue test. The results suggest that NLMF effects are side and muscle specific where prior KE fatigue could hinder subsequent ipsilateral upper body performance and thus is an important consideration for rehabilitation, recreation and athletic programs.Key points

• Non-local muscle fatigue effects were found in the elbow flexors ipsilateral to the fatigued knee extensors but not in the contralateral elbow flexors.
• Non-local muscle fatigue effects were not apparent in ipsilateral or contralateral plantar flexors to the fatigued knee extensors.
• Ipsilateral elbow flexors displayed single MVC as well as fatigue index performance deficits.
• The results of this study suggest that non-local muscle fatigue effects are muscle specific.

Key words: Quadriceps, plantar flexors, elbow flexors, crossover fatigue, force, electromyography     

手法加载对慢性下腰痛模型大鼠降钙素基因相关肽和神经生长因子的影响

目的:观察手法加载对慢性下腰痛(chronic low back pain,CLBP)模型大鼠的镇痛效应以及腰大肌组织相关炎性因子表达的影响,探索手法对局部炎性微环境状态的改善情况。方法:选取体质量为340～360 g的SPF级雄性SD大鼠32只,随机分为空白组、假手术组、慢性下腰痛模型组、治疗组,每组8只。模型组大鼠腰椎L4-L6植入外部链接固定系统(external link fixation system,ELFS),假手术组不植入ELFS,仅行切开缝合,空白组不作任何处理,治疗组植入ELFS后,在脊柱两侧用力量为5 N,频率为2 Hz的刺激量进行手法干预,15 min/次,1次/d,连续干预14 d,分别在造模前、干预后第1、3、7、10、14天检测四组大鼠机械刺激反应阈值(paw with drawl threshold,PWT),热刺激反应阈值(paw withdrawl latency,PWL),治疗周期结束后,酶联免疫吸附测定法(enzyme-linked immunosorbent assay,ELISA)检测腰大肌组织中降钙素基因相关肽(calcitonin gene-related peptide,CGRP)和神经生长因子(nerve growth factor,NGF)的浓度值。结果:空白组与假手术组的PWT、PWL在造模后均无显著差异(P0.05);模型成模后,CLBP模型组和治疗组PWT、PWL明显降低(P0.01);手法加载后第1、3天,治疗组的PWT较CLBP模型组改善不明显(P0.05);手法加载后第7天,治疗组与CLBP模型大鼠相比,痛阈值呈现出升高的趋势,但二者相比无统计学意义(P=0.0560.05),至治疗第10、14天,治疗组大鼠的机械痛阈值开始上升,且与CLBP模型大鼠相比有统计学意义,分别为(P0.05,P0.01);手法治疗后第1、3天,治疗组的PWL较CLBP模型组改善同样不明显(P0.05);待第7天比较,治疗组与CLBP模型组的PWL有统计学意义(P=0.0160.05),手法加载对CLBP大鼠热痛觉过敏现象有了改善直到实验结束。CLBP模型组腰大肌中CGRP和NGF含量均高于空白组和假手术组(P0.01),治疗后两者的含量均有明显下降(P0.01)。结论:局部按揉手法加载对CLBP大鼠有镇痛作用,同时可以抑制CLBP大鼠腰大肌组织CGRP、NGF的含量,改善局部炎性微环境状态。     

Lumbosacral Muscle Energy Technique produces immediate decreases in corticospinal and spinal reflex excitability in asymptomatic participants

BackgroundLumbosacral HVLA has been reported to produce an immediate decrease in corticospinal and spinal reflex excitability, but muscle energy technique (MET), a commonly used technique involving voluntary isometric contraction, has not yet been explored. This study examined the effects of an application of MET to the lumbosacral joint on corticospinal excitability, as measured by motor evoked potentials (MEPs) using transcranial magnetic stimulation (TMS), and spinal reflex excitability, as measured by the Hoffman reflex (H-reflex).MethodsIn a controlled, repeated measure design, 12 asymptomatic volunteers (mean age = 26 ± 9.5 years; n = 5 males, n = 7 females) were measured for MEPs via TMS (10% above motor threshold) using a 110 mm double cone coil placed over the motor area of the brain, and H-reflexes from the tibial nerve using electrical stimulation, measured via surface electrodes over the gastrocnemius muscle. Data was collected at three time intervals: pre-intervention, following a control condition, and following the MET intervention. The MET intervention was performed bilaterally and engaged the rotation barrier at L5/S1 and used a light rotatory contraction force by the participant. Data for H-reflex and MEP amplitudes were normalised to the M-max amplitude, silent period (SP) duration was measured from the initial deflection of the MEP waveform until return of uninterrupted EMG and analysed using a one-way repeated measures ANOVA.ResultsA significant increase was found in evoked potential SP duration (F_2,22 = 7.64; p = 0.03) over time. Post hoc analysis, with Bonferroni adjustment, revealed this significant change occurred following MET but not the control intervention, producing a medium effect size for MET (d = 0.52), but a small effect size for the control (d = 0.04). A significant change was found in H-reflex (F_1.3,14.4 = 13.8; p = 0.01) over time, and post hoc analyses, with Bonferroni adjustment, showed that a decrease occurred after the MET intervention (p = 0.005). A medium effect size for MET was found (d = 0.59), whereas the effect following the control was small (d = 0.19). There were no significant changes in MEP/M-max ratio or MEP latency.ConclusionsAn application of MET applied to the lumbosacral joint produced a significant decrease in corticospinal and spinal reflex excitability, and no significant change occurred following the control intervention. The changes in SP duration and H-reflexes concur with previous results using HVLA, suggesting that both forms of manipulation may produce decreased motor excitability.