PubMed Health⌕ Search

Biomedical subjects

Thomas M Best

Publications and source records attributed to Thomas M Best.

At least 19 recordsLinked to original sources
PubMed2006

The effect of stretch rate and activation state on skeletal muscle force in the anatomical range.

BACKGROUND: The effects of stretch rate and activation state on muscle mechanics require further clarification. This subject is of particular interest because of the role of skeletal muscle undergoing eccentric contractions in musculoskeletal injuries. METHODS: The present study investigated the force-displacement behavior of rabbit tibialis anterior muscle at three stretch rates (2.5, 10, 25 cm/s) and three activation states (passive, tetanic, denervated). A phenomenological power law model and a dynamic systems model were used to describe the mechanical responses. FINDINGS: The power law model showed excellent agreement with the passive and denervated responses to stretch (R(mean)=0.97). Repeated measures analysis of variance found a difference (P=0.042) in peak force between the passive and denervated states at a stretch rate of 2.5 cm/s. The dynamic systems model closely fit the tetanized muscle responses (R(mean)=0.95). There was no difference in the displacement at yield (P=0.83) for the three stretch rates of the tetanized muscle undergoing stretch. INTERPRETATION: Differences between the passive and denervated responses suggest that mechanoreceptors may play a role in stimulating the muscle as it is stretched through the anatomical range. The displacement at yield did not change significantly over a decade range of stretch velocities, suggesting that a strain threshold exists beyond which cross bridges cannot remain bound. The power law and dynamic systems models presented offer mathematically tractable approaches to interpret the response of lengthening skeletal muscle. These findings on active, passive, and denervated muscle point to a possible role of the muscle spindle to tissue mechanical behavior that should be accounted for in future studies of force-elongation behavior of skeletal muscle.

Animals↗
PubMed2006

Is iliotibial band syndrome really a friction syndrome?

Iliotibial band (ITB) syndrome is regarded as an overuse injury, common in runners and cyclists. It is believed to be associated with excessive friction between the tract and the lateral femoral epicondyle-friction which 'inflames' the tract or a bursa. This article highlights evidence which challenges these views. Basic anatomical principles of the ITB have been overlooked: (a) it is not a discrete structure, but a thickened part of the fascia lata which envelops the thigh, (b) it is connected to the linea aspera by an intermuscular septum and to the supracondylar region of the femur (including the epicondyle) by coarse, fibrous bands (which are not pathological adhesions) that are clearly visible by dissection or MRI and (c) a bursa is rarely present-but may be mistaken for the lateral recess of the knee. We would thus suggest that the ITB cannot create frictional forces by moving forwards and backwards over the epicondyle during flexion and extension of the knee. The perception of movement of the ITB across the epicondyle is an illusion because of changing tension in its anterior and posterior fibres. Nevertheless, slight medial-lateral movement is possible and we propose that ITB syndrome is caused by increased compression of a highly vascularised and innervated layer of fat and loose connective tissue that separates the ITB from the epicondyle. Our view is that ITB syndrome is related to impaired function of the hip musculature and that its resolution can only be properly achieved when the biomechanics of hip muscle function are properly addressed.

Athletic Injuries↗
PubMed2006

Classification and return-to-play considerations for stress fractures.

Stress fractures are common injuries, particularly in endurance athletes. Stress fracture management should take into consideration the injury site (low risk versus high risk), the grade (extent of microdamage accumulation), and the individual's competitive situation. The authors briefly discuss the pathophysiology and diagnostic process of stress fractures and expand on the classification of stress fractures and its impact on return-to-play decision making based on the relative risk of the fracture.

Athletic Injuries↗
PubMed2006

Upper limb dynamic responses to impulsive forces for selected assembly workers.

This study evaluated the upper limb, dynamic, mechanical response parameters for 14 male assembly workers recruited from selected jobs based on power tool use. It was hypothesized that the type of power tool operation would affect stiffness, effective mass, and damping of the upper extremity; and workers with symptoms and positive physical examination findings would have different mechanical responses than asymptomatic workers without physical examination findings. Participants included operators who regularly used torque reaction power hand tools, such as nutrunners and screwdrivers, and nontorque reaction power hand tools, such as riveters. The mechanical parameters of the upper limb were characterized from the loading response of an apparatus having known dynamic properties while worker grasps an oscillating handle in free vibration. In addition, all workers underwent a physical examination, magnetic resonance imaging, and completed a symptom survey. Workers were categorized as controls or cases based on reported forearm symptoms and physical exam findings. A total of seven workers were categorized as cases and had less average mechanical stiffness (46%, p > 0.01), damping (74%, p > 0.01), and effective mass (59%, p > 0.05) than the seven workers categorized as controls. Magnetic resonance imaging (MRI) findings suggestive of muscle edema were observed for two workers classified as cases and who regularly used torque reaction power tools. No MRI enhancement was observed in the seven subjects who did not regularly use torque reaction power tools. The ergonomic consequences of less stiffness, effective mass, and damping in symptomatic workers may include reduced capacity to react against rapidly building torque reaction forces encountered when operating power hand tools.

Adult↗
PubMed2006

The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome.

Iliotibial band (ITB) syndrome is a common overuse injury in runners and cyclists. It is regarded as a friction syndrome where the ITB rubs against (and 'rolls over') the lateral femoral epicondyle. Here, we re-evaluate the clinical anatomy of the region to challenge the view that the ITB moves antero-posteriorly over the epicondyle. Gross anatomical and microscopical studies were conducted on the distal portion of the ITB in 15 cadavers. This was complemented by magnetic resonance (MR) imaging of six asymptomatic volunteers and studies of two athletes with acute ITB syndrome. In all cadavers, the ITB was anchored to the distal femur by fibrous strands, associated with a layer of richly innervated and vascularized fat. In no cadaver, volunteer or patient was a bursa seen. The MR scans showed that the ITB was compressed against the epicondyle at 30 degrees of knee flexion as a consequence of tibial internal rotation, but moved laterally in extension. MR signal changes in the patients with ITB syndrome were present in the region occupied by fat, deep to the ITB. The ITB is prevented from rolling over the epicondyle by its femoral anchorage and because it is a part of the fascia lata. We suggest that it creates the illusion of movement, because of changing tension in its anterior and posterior fibres during knee flexion. Thus, on anatomical grounds, ITB overuse injuries may be more likely to be associated with fat compression beneath the tract, rather than with repetitive friction as the knee flexes and extends.

Adult↗
PubMed2006

The role of neutrophils in injury and repair following muscle stretch.

Stretch injury to the myotendinous junction is a common problem in competitive athletes and those involved in regular physical activity. The major risk factor for recurrent injury appears to be the primary injury itself. Physicians, physical therapists, athletic trainers and athletes alike continue to search for optimal treatment and prevention strategies. Acute inflammation is regarded as the body's generalized protective response to tissue injury. An especially important and unexplored aspect of inflammation following injury is the role of inflammatory cells in extending injury and possibly directing muscle repair. It has been suggested that the inflammatory reaction, although it typically represents a reaction to damage and necrosis, may even bring about some local damage of its own and therefore increase the possibility for scarring and fibrosis. Limiting certain aspects of inflammation may theoretically reduce muscle damage as well as signals for muscle scarring. Here we focus on the role of neutrophils in injury and repair of stretch-injured skeletal muscle. A minimally invasive model that generates a reproducible injury to rabbit skeletal muscle is presented. We present a plausible theory that neutrophil-derived oxidants resulting from the initial stretch injury are responsible for extending the damage. An anti-CD11b antibody that blocks the neutrophil's respiratory burst is employed to reduce myofibre damage. An intriguing area that is currently being explored in our laboratory and others is the potential role for neutrophils to contribute to muscle growth and repair. It may be possible that neutrophils facilitate muscle repair through removal of tissue debris as well as by activation of satellite cells. Recent and ongoing investigations point to interleukin-6 as a possible key cytokine in muscle inflammation and repair. Studies to elucidate a clearer understanding of this possibility will be reviewed.

Animals↗
PubMed2006

Fatigue and muscle-tendon stiffness after stretch-shortening cycle and isometric exercise.

The purpose of the present study was to compare vertical jump performance after 2 different fatigue protocols. In the first protocol, subjects performed consecutive sets of 10 repetitions of stretch-shortening cycle (SSC) contractions. In the second protocol, successive sets of 10 repetitions of isometric contractions were performed for 10 s with the knee at 90 degrees of flexion. The exercises were stopped when the subjects failed to reach 50% of their maximum voluntary isometric contractions. Maximal isometric force and maximal concentric power were assessed by performing supine leg presses, squat jumps, and drop jumps. Surface EMG was used to determine changes in muscle activation before and after fatigue. In both groups, the fatigue exercises reduced voluntary isometric force, maximal concentric power, and drop jump performance. Kinematic data showed a decrease in knee muscle-tendon stiffness accompanied by a lengthened ground contact time. EMG analysis showed that the squat and drop jumps were performed similarly before and after the fatigue exercise for both groups. Although it was expected that the stiffness would decrease more after SSC than after isometric fatigue (as a result of a greater alteration of the reflex sensitivity SSC), our results showed that both protocols had a similar effect on knee muscle stiffness during jumping exercises. Both fatigue protocols induced muscle fatigue, and the decrease in jump performance was linked to a decrease in the strength and stiffness of the knee extensor muscles.

Adult↗
PubMed2005

Rapid intravascular injection into limb skeletal muscle: a damage assessment study.

We have recently developed a simple and highly efficient methodology for delivering plasmid DNA (pDNA) to skeletal muscle cells of mammalian limbs. The procedure involves the rapid intravascular injection of a large volume of saline (containing pDNA) into the vasculature of the distal limb. As a result of the robust delivery methodology involved, it is important to understand the effects of the injection procedure on the skeletal muscle tissue in the targeted limb. In previous studies, only modest and transient muscle damage was noted. In this study we quantitatively assessed the degree of muscle damage in rat limbs following intravascular injections using muscle histology (H&E staining), membrane integrity (Evans blue staining), and leukocyte infiltration (immunohistochemistry) assays. The rapid extravasation of fluid during the injection process resulted in edema of the muscle tissue of the targeted limb; however, the edema was transient and resolved within 24 h. Consistent with observations from previous studies, minimal levels of myofiber damage were detected. Immunohistochemical labeling indicated that increased numbers of neutrophils (CD43+) and macrophages (ED1+ and ED2+) were present in the muscle tissue interstitium shortly after injection but that elevations were relatively modest and resolved by 2 weeks postinjection.

Animals↗
PubMed2005

Common overuse tendon problems: A review and recommendations for treatment.

There is a common misconception that symptomatic tendon injuries are inflammatory; because of this, these injuries often are mislabeled as "tendonitis."' Acute inflammatory tendinopathies exist, but most patients seen in primary care will have chronic symptoms suggesting a degenerative condition that should be labeled as "tendinosus" or "tendinopathy." Accurate diagnosis requires physicians to recognize the historical features, anatomy, and useful physical examination maneuvers for these common tendon problems. The natural history is gradually increasing load-related localized pain coinciding with increased activity. The most common overuse tendinopathies involve the rotator cuff, medial and lateral elbow epicondyles, patellar tendon, and Achilles tendon. Examination should include thorough inspection to assess for swelling, asymmetry, and erythema of involved tendons; range-of-motion testing; palpation for tenderness; and examination maneuvers that simulate tendon loading and reproduce pain. Plain radiography, ultrasonography, and magnetic resonance imaging can be helpful if the diagnosis remains unclear. Most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months, and outpatient treatment should consist of relative rest of the affected area, icing, and eccentric strengthening exercises. Although topical and systemic nonsteroidal anti-inflammatory drugs are effective for acute pain relief, these cannot be recommended in favor of other analgesics. Injected corticosteroids also can relieve pain, but these drugs should be used with caution. Ultrasonography, shock wave therapy, orthotics, massage, and technique modification are treatment options, but few data exist to support their use at this time. Surgery is an effective treatment that should be reserved for patients who have failed conservative therapy.

Adrenal Cortex Hormones↗
PubMed2005

Changes in nitric oxide and inducible nitric oxide synthase following stretch-induced injury to the tibialis anterior muscle of rabbit.

This study investigated the changes in nitric oxide (NO) together with inducible nitric oxide synthase (iNOS) content and enzyme activity at 0, 4, 12, 24, and 48 h following acute muscle stretch injury. A single stretch injury was induced to the tibialis anterior muscle of 30 male New Zealand white rabbits (n = 6 at each time point). Injured and uninjured contralateral sham-operated muscles were harvested and analyzed for NO levels, iNOS content, and iNOS activity at each time point. Furthermore, three animals were used to estimate baseline NO levels and iNOS activity. There was a progressive reduction in NO content in the injured and the sham-operated muscles up to 24 h postoperation and stretch injury (p < 0.05). At 48 h postinjury, however, NO levels were 146% higher in injured muscles than in sham-operated muscles (p < 0.05). iNOS protein content was higher at 4 h and 48 h in injured versus shamoperated muscles (p < 0.05). Similarly, iNOS activity was higher at 4 h (p < 0.05) and at 48 h (p < 0.01) in injured versus sham-operated muscles. These results suggest that NO may play an active role during the postinjury recovery of skeletal muscle modulated by iNOS expression.

Animals↗
PubMed2005

Anatomical and mechanical changes following repetitive eccentric exertions.

BACKGROUND: Submaximal eccentric exertions occur occupationally when rapidly rising tool-generated forces exceed the operator's capacity to react against them. The purpose of this study was to investigate the effects of short duration repetitive submaximal eccentric forearm exertions at levels comparable to industrial power hand tool use on dynamic mechanical properties (stiffness, effective mass and damping) and on forearm edema. METHODS: This study investigated changes following short term repetitive submaximal eccentric exertions comparable to occupational levels. Eight male participants exercised eccentrically for 30 min at 50% of isometric maximum voluntary contraction forearm supination in a posture and loading similar to power hand tool use in the workplace. Dynamic mechanical properties (stiffness, effective mass and damping) of the upper limb were measured before, immediately following, and daily for three days after the activity. An MRI scan to assess edema was also performed for five of the participants before, on day one and day three following the activity. FINDINGS: Mechanical stiffness decreased 51% (P < 0.05) and effective mass decreased 43% (P = 0.052) immediately following eccentric exercise. Average isometric strength also decreased 42% immediately following exercise (P < 0.01) and pain persisted for two days. The recovery of static strength however was not correlated with changes in mechanical stiffness (r = 0.56) or effective mass (r = 0.30). The exercised arms had a 360% increase (P < 0.01) in supinator-extensor T(2) relaxation time difference, a quantifiable measure of edema, one day after exercise while the non-exercised arms had no significant changes. INTERPRETATION: Changes in both T(2) relaxation time, indicative of edema, and forearm mechanical properties, were observed following short duration submaximal repetitive exercise. If similar changes in dynamic mechanical properties of the upper extremity occur following repetitive submaximal eccentric activity in the workplace, they could negatively impact the ability of the arm to react to rapid forceful loading during repetitive industrial work activities and increase mechanical loading of the upper limb.

Adaptation, Physiological↗
PubMed2005

A systematic review of prolotherapy for chronic musculoskeletal pain.

OBJECTIVE: Prolotherapy, an injection-based treatment of chronic musculoskeletal pain, has grown in popularity and has received significant recent attention. The objective of this review is to determine the effectiveness of prolotherapy for treatment of chronic musculoskeletal pain. DATA SOURCES: We searched Medline, PreMedline, Embase, CINAHL, and Allied and Complementary Medicine with search strategies using all current and historical names for prolotherapy and injectants. Reference sections of included articles were scanned, and content area specialists were consulted. STUDY SELECTION: All published studies involving human subjects and assessing prolotherapy were included. MAIN RESULTS: Data from 34 case reports and case series and 2 nonrandomized controlled trials suggest prolotherapy is efficacious for many musculoskeletal conditions. However, results from 6 randomized controlled trials (RCTs) are conflicting. Two RCTs on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy. Two RCTs on low back pain reported significant improvements in pain and disability compared with control subjects, whereas 2 did not. All studies had significant methodological limitations. CONCLUSIONS: There are limited high-quality data supporting the use of prolotherapy in the treatment of musculoskeletal pain or sport-related soft tissue injuries. Positive results compared with controls have been reported in nonrandomized and randomized controlled trials. Further investigation with high-quality randomized controlled trials with noninjection control arms in studies specific to sport-related and musculoskeletal conditions is necessary to determine the efficacy of prolotherapy.

Anesthetics, Local↗
PubMed2005

Return to play following muscle strains.

OBJECTIVE: To assess return to play strategies following muscle strains with the desired outcomes of decreased competition play lost and minimized risk for recurrent injury. METHODS: Literature review of previous studies that examine return to play criteria for the commonly seen muscle strain injuries in sport. RESULTS: There have been no studies directly comparing different return to play approaches. Studies have instead concentrated on recurrence risk factors and prognosis assessment, particularly for hamstring injuries. There is some literature support for risk factors for recurrence such as persisting strength deficits, larger injuries seen on diagnostic imaging, players in high-risk positions or sports, inability to complete functional tasks without pain, and strains of specific high-risk muscles (biceps femoris, central tendon of rectus femoris, medial head of gastrocnemius, adductor longus or magnus). CONCLUSIONS: There are no consensus guidelines or agreed-upon criteria for safe return to sport following muscle strains that completely eliminate the risk for recurrence and maximize performance. At this time, it may be a sensible strategy to allow earlier return to play in team sports and accept a low to moderate injury recurrence rate. Improved prognostic assessment of muscle strains with injury identification (MRI) and injury assessment (isokinetic testing) may be assist practitioners to lower, but not eliminate, recurrent injuries.

Athletic Injuries↗
PubMed2005

Hamstring muscle kinematics during treadmill sprinting.

INTRODUCTION/PURPOSE: The objective of this study was to characterize hamstring muscle kinematics during sprinting, so as to provide scientific data to better understand injury mechanisms and differences in injury rates between muscles. METHODS: We conducted three-dimensional motion analyses of 14 athletes performing treadmill sprinting at speeds ranging from 80 to 100% of maximum. Scaled musculoskeletal models were used to estimate hamstring muscle-tendon lengths throughout the sprinting gait cycle for each speed. We tested the hypothesis that the biceps femoris (BF) long head would be stretched a greater amount, relative to its length in an upright posture, than the semitendinosus (ST) and semimembranosus (SM). We also tested the hypothesis that increasing from submaximal to maximal sprinting speed would both increase the magnitude and delay the occurrence of peak muscle-tendon length in the gait cycle. RESULTS: Maximum hamstring lengths occurred during the late swing phase of sprinting and were an average of 7.4% (SM), 8.1% (ST), and 9.5% (BF) greater than the respective muscle-tendon lengths in an upright configuration. Peak lengths were significantly larger in the BF than the ST and SM (P < 0.01), occurred significantly later in the gait cycle at the maximal speed (P < 0.01), but did not increase significantly with speed. Differences in the hip extension and knee flexion moment arms between the biarticular hamstrings account for the intermuscle variations in the peak lengths that were estimated. CONCLUSIONS: We conclude that intermuscle differences in hamstring moment arms about the hip and knee may be a factor contributing to the greater propensity for hamstring strain injuries to occur in the BF muscle.

Adolescent↗