Needle EMG Response of Lumbar Multifidus to Manipulation in the Presence of Clinical Instability

Abstract

A proposed mechanism for the persistence of low back pain due to clinical instability is a decrease in control of local spinal musculature, more specifically decreased recruitment of multifidus. Altered segmental mechanoreceptor input has been proposed as a contributing factor responsible for a decrease in local muscle recruitment. In this case report, immediate changes in the recruitment of the deep multifidus following manipulation were examined using needle EMG and isometric testing of trunk rotational force. Trunk rotational force appeared to improve while the multifidus demonstrated a decrease in activity as measured by needle EMG. No specific conclusions can be drawn from this report; however, the results do suggest that immediate multifidus function may be influenced with manipulation, resulting in improved muscular control of the trunk.     

改良外固定法治疗髌骨骨折24例疗效观察

采用改良外固定法治疗髌骨骨折24例,随访18例,疗效满意,现报道如下。临床资料24例中男13例,女11例;年龄最小20岁,最大62岁;屈膝跌倒致伤者21例,直接撞击伤3例;横型骨折20例,粉碎型骨折2例,下极骨折2例,均属新鲜骨折。     

Past and Future: Responsibility and Opportunity

Abstract

Identification and management of chronic lumbar spine instability is a clinical challenge for manual physical therapists. Chronic lumbar instability is presented as a term that can encompass two types of lumbar instability: mechanical (radiographic) and functional (clinical) instability (FLI). The components of mechanical and FLI are presented relative to the development of a physical therapy diagnosis and management. The purpose of this paper is to review the historical framework of chronic lumbar spine instability from a physical therapy perspective and to summarize current research relative to clinical diagnosis in physical therapy.     

后路全椎板减压椎间融合术治疗腰椎间盘突出症合并椎间不稳的疗效观察

【目的】探讨腰椎间盘突出症合并椎间不稳手术适应症的选择及手术疗效。【方法】对58例经系统保守治疗或单纯开窗减压髓核摘除术治疗后效果不佳的腰椎间盘突出症合并椎间不稳患者,均行后路全椎板减压椎间植骨融合椎弓根螺钉内固定术治疗。【结果】54例获得随访,平均随访13个月,根据日本骨科学会(JOA)评分标准评估:优37例,良13例,一般4例,优良率达92.59%。术后3个月经X线摄片检查,52例椎间植骨融合,植骨融合率达96.30%。【结论】腰椎间盘突出症合并椎间不稳患者,宜行后路全椎板减压椎间植骨融合椎弓根螺钉内固定术,其疗效令人满意。     

Does Mutation of Transforming Growth Factor-β Type II Receptor Gene Play an Important Role in Colorectal Polyps?

Mutations in the transforming growthfactor- type II receptor (RII) gene that remainuncorrected due to mutation and inactivation of mismatchrepair genes play an important role in hereditarynonpolyposis colorectal cancer (HNPCC) and in a subset ofsporadic colorectal cancers. Some colorectal cancersdevelop from colorectal polyps. To elucidate the role ofthe RII gene in the generation of colorectal polyps, we analyzed 137 colorectal polyps from 100patients for RII mutations and microsatelliteinstability (MSI). MSI was detected in three of 36polyps from 25 patients. For one of these three polyps,the mobilities of the PCR products between polyp and nonpolyptissues was different for only one microsatellitemarker, and for the other two polyps the mobilities weredifferent for more than two markers. These two polyps were obtained from one patient with ascendingcolon carcinoma and suspected HNPCC based on hisclinical profile and family history. An RII mutation wasdetected in only one of these two polyps. RII may play a minor role in sporadic colorectalpolyps. RII gene analysis in colorectal polyps may be auseful screening measure for potential HNPCCpatients.     

Physiotherapy education in a digital era: blending and flipping

Abstract

The evidence base for changes in electromyographic (EMG) onset and intensity of vastus medialis (VM) and vastus lateralis (VL) in patients with patellar instability is systematically reviewed. The databases AMED, CINAHL, the Cochrane Library, EMBASE, Ovid Medline, Physiotherapy Evidence Database (PEDro), Pubmed and Zetoc were searched from their inception to March 2008, in addition to a manual search of relevant journals. All English-language papers assessing the relative EMG onset and intensity of vastus medialis oblique (VMO) and VL, in patients with patellar dislocation, subluxation and general instability were included. Five papers, consisting of 73 knees with patellar instability, were reviewed. No studies were identified assessing VMO–VL onset in patients with patellar instability. Four studies reported no difference in relative EMG intensity of VMO and VL in patients with patellar instability compared with asymptomatic control subjects. One study reported some evidence of a difference in VM to VL EMG intensity in one cohort of patients with patellar subluxation. The CASP appraisal of the evidence base highlighted a number of methodological weaknesses. There was no robust evidence for any difference in the relative intensity of EMG activity between the VMO and VL in patients with patellar instability. There is no good-quality research evidence to suggest that abnormal vastii EMG intensity or onset are aetiological factors associated with patellar instability.     

小针刀治疗退变性腰椎不稳症35例疗效观察

采用小针刀疗法治疗退变性腰椎不稳症３５例，并对临床疗效及Ｘ线片改善情况进行评定。结果临床疗效远期有效率与近期相比无显著差异（Ｐ＞０．０５），Ｘ线片远期改善率与近期相比有极显著差异（Ｐ＜０．０１）。笔者认为腰椎椎体间相互位移及小关节突半脱位是退变性腰椎不稳症主要的诊断依据，但不是引起症状的主要原因。下腰及臀部软组织的退变劳损才是引起症状的关键所在。小针刀疗法治疗本症具有消除疼痛，剥离软组织粘连，恢复脊柱力学平衡，促进腰椎椎体及小关节突复位等作用。     

Rehabilitation for Clinical Lumbar Instability in a Female Adolescent Competitive Diver with Spondylolisthesis

Abstract

Few studies have investigated conservative lumbar stabilization approaches with adolescent athletes, specifically those with radiographic evidence of a unilateral pars interarticularis fracture. The purpose of this case study was to describe a lumbar stabilization strengthening intervention for an adolescent competitive diver. A 12-year-old female was diagnosed with a grade-I, traumatic, unilateral, dysplastic spondylolisthesis, accompanied by ensuing symptoms of lumbar spine instability. Symptom provocation occurred during extension and torsion motions as well as long-term sitting and standing. A comprehensive lumbar stabilization program was associated with a reduction of symptoms, improvement in trunk stabilization, and a quick return to competitive diving. Because the case report involved one highly motivated subject, the results are not generalizable to all adolescent divers. Future studies should investigate the treatment of spine instability on a sample of adolescent athletes.     

Patellar taping,the theory versus the evidence: a review

Abstract

Although taping of the patella is a cheap and easy clinical procedure used on patients with patellofemoral pain, the reasons for its success have not yet been established. The original rationale was that taping could realign the patella, enhance the contraction of the vastus medialis oblique muscle, and as a consequence alleviate the patient's pain. This paper reviews the literature available on this technique to ascertain whether the theories for its success can be substantiated by objective evidence.