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PubMed2005

Botulinum toxin A versus bupivacaine trigger point injections for the treatment of myofascial pain syndrome: a randomised double blind crossover study.

The treatment of myofascial pain syndrome (MPS) is diverse and includes trigger point injections of various substances including local anesthetics, steroids and Botulinum toxin A (BTX A). The purpose of this study was to compare the effectiveness of trigger point injections using BTX A versus bupivacaine, both in combination with a home-based rehabilitation program. To be enrolled, subjects first had to demonstrate responsiveness to bupivacaine trigger point injection. In this single center, double blind, randomized, cross-over trial, 18 patients with MPS received trigger point injections of either 25 units Botulinum toxin A or 0.5 ml of 0.5% bupivacaine per trigger point. A maximum of eight trigger points were injected per subject. Subjects were followed until their pain returned to 75% or more of their pre-injection pain for two consecutive weeks, after which there was a 2 week wash-out period. The subjects then crossed over and had the same trigger points injected with the other agent. All subjects participated in a home exercise program involving static stretches of the affected muscles. Both treatments were effective in reducing pain when compared to baseline (P=0.0067). There was, however, no significant difference between the BTX A and 0.5% bupivacaine groups in duration or magnitude of pain relief, function, satisfaction or cost of care (cost of injectate excluded). Considering the high cost of BTX A, bupivacaine is deemed a more cost-effective injectate for MPS.

Anesthetics, Local↗
PubMed1994

The determinants of treatment duration for congenital muscular torticollis.

BACKGROUND AND PURPOSE: Although the success of conservative management of congenital muscular torticollis has been well documented, relatively little is known about the determinants of response to treatment, such as treatment duration. The purpose of this study was to determine how factors such as severity of restriction of range of motion, age at initiation of treatment, and presence of a palpable intramuscular fibrotic sternocleidomastoid muscle mass affect treatment duration. SUBJECTS: One hundred one children (mean age = 4 months, SD = 2.87, range = 0.5-15.5) who were diagnosed with congenital muscular torticollis and referred to physical therapy at British Columbia's Children's Hospital (Vancouver, British Columbia, Canada) prior to 2 years of age were included in the study. METHODS: Following a standardized initial assessment, parents were taught the home treatment program, which included passive stretches of the affected sternocleidomastoid muscle and strengthening exercises for the contralateral side, and positioning and handling skills. Evaluation at 2-week intervals included measurement of passive neck rotation and lateral flexion using an adapted standard goniometer. Treatment duration was defined as the time between initiation of treatment and achievement of full passive neck range of motion. RESULTS: Complete recovery (full passive range of motion) was achieved in all but one of the children in this sample. The mean treatment duration was 4.7 months (SD = 5.06, range = 1-36). Correlations were noted between severity of restriction and treatment duration (r = .31) as well as between presence of a mass and treatment duration (r = .26). Multiple regression analysis revealed that severity of restriction was the strongest predictor of treatment duration. CONCLUSION AND DISCUSSION: The results of this study will make it possible for therapists to better predict treatment duration at the time of the initial assessment. By providing parents with more precise information about the length of treatment, parents may be more willing to adhere to the exercise program. [Emery C. The determinants of treatment duration for congenital muscular torticollis.

Age Factors↗
PubMed2005

An exercise programme for the management of lateral elbow tendinopathy.

BACKGROUND: Home exercise programmes and exercise programmes carried out in a clinical setting are commonly advocated for the treatment of lateral elbow tendinopathy (LET), a very common lesion of the arm with a well-defined clinical presentation. The aim of this study is to describe the use and effects of strengthening and stretching exercise programmes in the treatment of LET. ECCENTRIC EXERCISES: Slow progressive eccentric exercises for LET should be performed with the elbow in extension, forearm in pronation, and wrist in extended position (as high as possible). However, it is unclear how the injured tendon, which is loaded eccentrically, returns to the starting position without experiencing concentric loading and how the "slowness" of eccentric exercises should be defined. Nor has the treatment regimen of the eccentric exercises of a supervised exercise programme been defined. STRETCHING EXERCISES: Static stretching is defined as passively stretching a given muscle-tendon unit by slowly placing and maintaining it in a maximal position of stretch. We recommend the position should be held for 30-45 s, three times before and three times after eccentric exercises during each treatment session with a 30 s rest interval between each procedure. The treatment region of static stretching exercises when a supervised exercise programme is performed is unknown. DISCUSSION: A well designed trial is needed to study the effectiveness of a supervised exercise programme for LET consisting of eccentric and static stretching exercises. The issues relating to the supervised exercise programme should be defined so that therapists can replicate the programme.

Exercise Therapy↗
PubMed2001

The use of electrical stimulation to increase quadriceps femoris muscle force in an elderly patient following a total knee arthroplasty.

BACKGROUND AND PURPOSE: Persistent residual quadriceps femoris muscle force deficits after total knee arthroplasty (TKA) are commonly reported and can prevent patients from returning quickly and fully to functional activities. Neuromuscular electrical stimulation offers a potentially more effective means of increasing muscle force than current rehabilitation protocols. CASE DESCRIPTION: The patient was a 66-year-old man. Neuromuscular electrical stimulation for increasing quadriceps femoris muscle force was initiated 3 weeks after TKA for 11 sessions to supplement stretching exercises and a high-intensity volitional strengthening program. OUTCOME: The patient's isometric quadriceps femoris muscle force increased from 50% (involved/uninvolved) at 3 weeks after surgery to 86% at 8 weeks after surgery. A concurrent increase in his uninvolved quadriceps femoris muscle force concealed the patient's true increase in his involved quadriceps femoris muscle force in a side-to-side comparison. The patient's final involved quadriceps femoris muscle force (10 weeks after surgery) was 93% of the initial uninvolved quadriceps femoris muscle force. DISCUSSION: Our patient was able to return to independent activities of daily living and recreational activities, with force gains that surpassed those reported in the literature.

Aged↗
PubMed2001

Static stretch increases c-Jun NH2-terminal kinase activity and p38 phosphorylation in rat skeletal muscle.

Physical exercise and contraction increase c-Jun NH2-terminal kinase (JNK) activity in rat and human skeletal muscle, and eccentric contractions activate JNK to a greater extent than concentric contractions in human skeletal muscle. Because eccentric contractions include a lengthening or stretch component, we compared the effects of isometric contraction and static stretch on JNK and p38, the stress-activated protein kinases. Soleus and extensor digitorum longus (EDL) muscles dissected from 50- to 90-g male Sprague-Dawley rats were subjected to 10 min of electrical stimulation that produced contractions and/or to 10 min of stretch (0.24 N tension, 20-25% increase in length) in vitro. In the soleus muscle, contraction resulted in a small, but significant, increase in JNK activity (1.8-fold above basal) and p38 phosphorylation (4-fold). Static stretch had a much more profound effect on the stress-activated protein kinases, increasing JNK activity 19-fold and p38 phosphorylation 21-fold. Increases in JNK activation and p38 phosphorylation in response to static stretch were fiber-type dependent, with greater increases occurring in the soleus than in the EDL. Immunohistochemistry performed with a phosphospecific antibody revealed that activation of JNK occurred within the muscle fibers. These studies suggest that the stretch component of a muscle contraction may be a major contributor to the increases in JNK activity and p38 phosphorylation observed after exercise in vivo.

Animals↗
PubMed2000

Techniques used by manipulative physiotherapists in the management of headaches.

This study aimed to identify the techniques used by manipulative physiotherapists in the management of headaches. Two hundred and two patients with headache presented to 44 Victorian trained manipulative physiotherapists (MPTs) who completed questionnaires to determine techniques used. Upper cervical (O-C3) passive accessory intervertebral movement was the most frequently used technique (84.7 per cent). Techniques such as manipulation (42.1 per cent), soft tissue massage (35.6 per cent), postural education/advice (30.2 per cent), muscle stretches (29.2 per cent), traction (26.7 per cent) and postural exercises (21.3 per cent) were usually introduced during the initial consultation, whereas passive physiological intervertebral movements (17.3 per cent), muscle retraining (16.8 per cent) and neural techniques (5.4 per cent) were more commonly introduced in later sessions. The low incidence of muscle retraining was surprising and may not reflect contemporary practice. The results indicate that the clinicians studied employ a diverse range of techniques in the management of headaches.

Journal Article↗
PubMed1954

Spasticity; its nature and treatment.

There are a number of physiological means of relaxing spasticity, including active resistive exercise, cold hydrotherapy, heat, electrical stimulation of antagonistic muscles, passive stretch in diagonal movement patterns, and the Von Bechterew reflex. Although none of them will cure spasticity, temporary relaxation may permit a patient to achieve better functioning of an affected joint. The choice of procedure will depend on the nature of the lesion and the muscular distribution of the spasticity.

Exercise Therapy↗
PubMedDate not supplied

Managing arthritis with exercise.

Almost half of all older adults have arthritis, either degenerative or inflammatory. Regular exercise is an important therapeutic intervention for all types of arthritis. Specifically, regular exercise can prevent deconditioning of the muscles, keep the joints stable, improve joint function and flexibility, decrease pain, enhance aerobic fitness, improve balance, and decrease falls. A comprehensive exercise program should include stretching exercises followed by a range-of-motion program for joints, muscle strengthening, and aerobic exercise, if possible. Unfortunately, despite these known benefits, most older adults with arthritis do not engage in regular exercise. The Seven Step Approach was developed to provide a practical framework to help overcome barriers and improve exercise activity in older adults with arthritis.

Accidental Falls↗
PubMed2001

Randomized trial of progressive resistance training to counteract the myopathy of chronic heart failure.

Chronic heart failure (CHF) is characterized by a skeletal muscle myopathy not optimally addressed by current treatment paradigms or aerobic exercise. Sixteen older women with CHF were compared with 80 age-matched peers without CHF and randomized to progressive resistance training or control stretching exercises for 10 wk. Women with CHF had significantly lower muscle strength (P < 0.0001) but comparable aerobic capacity to women without CHF. Exercise training was well tolerated and resulted in no changes in resting cardiac indexes in CHF patients. Strength improved by an average of 43.4 +/- 8.8% in resistance trainers vs. -1.7 +/- 2.8% in controls (P = 0.001), muscle endurance by 299 +/- 66% vs. 1 +/- 3% (P = 0.001), and 6-min walk distance by 49 +/- 14 m (13%) vs. -3 +/- 19 m (-3%) (P = 0.03). Increases in type I fiber area (9.5 +/- 16%) and citrate synthase activity (35 +/- 21%) in skeletal muscle were independently predictive of improved 6-min walk distance (r2 = 0.78; P = 0.0024). High-intensity progressive resistance training improves impaired skeletal muscle characteristics and overall exercise performance in older women with CHF. These gains are largely explained by skeletal muscle and not resting cardiac adaptations.

Adaptation, Physiological↗
PubMed2006

Excitability of the soleus reflex arc during intensive stretch-shortening cycle exercise in two power-trained athlete groups.

In several explosive types of sport events the leg extensor muscles are subjected to very high impact loads. Thus, extreme requirements exist for the neuromuscular system to develop sufficient muscle stiffness in the lower extremities in order to tolerate these high impact loads. Therefore, it would be challenging to measure reflex modulation during high impact activities, and with different athlete populations. In the present experiment, H-reflex and short latency reflex (M1) sensitivity was measured during drop jump exercises among high jumpers and sprinters. The changes in both reflex peak-to-peak amplitudes showed a significant (P < 0.05) reduction towards the end of the exercise for the sprinters. In addition, the same subject group showed a remarkable increase in serum creatine kinase (CK) activity 2 h after the jumps. Similar changes could not be observed for the high jumpers. These results clearly indicate different neural adaptation strategies for the two athlete groups. Reduction in H-reflex sensitivity and an increase in CK-activity in sprinters were taken as evidence for presynaptic inhibition, probably induced by substances related to muscle damage. Since high jump training includes more high impact loading, it was assumed that it could lead to some structural adaptation and, thus, prevents exercise induced reflex modification to a certain extent.

Adult↗
PubMed1993

Stretch-shortening drills for the upper extremities: theory and clinical application.

Enhanced athletic performance emphasizes the muscle's ability to exert maximal force output in a minimal amount of time. Exaggerated maximal muscular force develops due to athletic movements producing a repeated series of stretch-shortening cycles. The stretch-shortening cycle occurs when elastic loading, through an eccentric muscular contraction, is followed by a burst of concentric muscular contraction. A form of exercise called plyometrics employs a quick, powerful movement involving a prestretch of the muscle, followed by a shortening, concentric muscular contraction, thus utilizing the stretch-shortening muscular cycle. The literature contains numerous references to plyometric training for the lower extremity, but there is a lack of information on the upper extremity plyometric program. Overhead activities, such as throwing, necessitate elastic loading to produce maximal, explosive, concentric muscular contractions. Plyometric exercise employs the concept of the stretch-shortening muscular cycle. The rehabilitation concept of specificity of training suggests plyometric exercise drills should be performed by the throwing athlete. This paper discusses the basic neurophysiological science and theoretical basis for plyometric exercise, and it describes an upper extremity stretch-shortening exercise program for the throwing athlete.

Arm↗
PubMed2001

Changes in passive tension of muscle in humans and animals after eccentric exercise.

1. This is a report of experiments on ankle extensor muscles of human subjects and a parallel series on the medial gastrocnemius of the anaesthetised cat, investigating the origin of the rise in passive tension after a period of eccentric exercise. 2. Subjects exercised their triceps surae of one leg eccentrically by walking backwards on an inclined, forward-moving treadmill. Concentric exercise required walking forwards on a backwards-moving treadmill. For all subjects the other leg acted as a control. 3. Immediately after both eccentric and concentric exercise there was a significant drop in peak active torque, but only after eccentric exercise was this accompanied by a shift in optimum angle for torque generation and a rise in passive torque. In the eccentrically exercised group some swelling and soreness developed but not until 24 h post-exercise. 4. In the animal experiments the contracting muscle was stretched by 6 mm at 50 mm s(-1) over a length range symmetrical about the optimum length for tension generation. Measurements of passive tension were made before and after the eccentric contractions, using small stretches to a range of muscle lengths, or with large stretches covering the full physiological range. 5. After 150 eccentric contractions, passive tension was significantly elevated over most of the range of lengths. Measurements of work absorption during stretch-release cycles showed significant increases after the contractions. 6. It is suggested that the rise in passive tension in both human and animal muscles after eccentric contractions is the result of development of injury contractures in damaged muscle fibres.

Adult↗
PubMed1991

Long-term results of functional treatment in intraarticular knee fractures and multifragment fractures of the shaft of femurs.

Functional treatment of fractures is a nonoperative technique used in intraarticular knee fractures and multifragment and multilevel fractures of the shaft of femurs since 1974. The basic principle of this technique is placement of the fractured extremity in the specially designed rehabilitation splint, with skeletal traction fixed above the ankle joint through both tibia and fibula. Traction reduces the fracture while stretching of muscles provides conditions favorable for callus formation. Exercises are first isometric and then isotonic. During exercises, muscle tone and moments of force in each muscle group are measured to evaluate effects of exercises. Exercises in traction and rehabilitation splints are continued until clinical signs of healing are observed (i.e., for six to eight weeks with intraarticular knee fractures and ten to 12 weeks with fractures of the shaft of femur). Alternative flexion of bone fragments with their compression by the contracted muscles facilitate absorption of hemorrhage, reduces swelling, and accelerates osteogenesis by replacing passive-tissue congestion with the active-tissue metabolism. Seven hundred fifty-seven intraarticular knee fractures with 76% excellent and good results, 20% average, and 4% poor were observed with this treatment. Functional treatment was also used in 320 multifragment and multilevel fractures of the shaft of femurs, with approximately 81% excellent and good results, 17% average, and 2% poor. Functional treatment of fractures is simple and safe, promotes healing, prevents muscle atrophy, reduces contracture formation, and minimizes functional loss.

Adult↗
PubMed1987

Orthopedic aspects of competitive swimming.

Orthopedic problems related to competitive swimming are rarely disabling, but can be problematic in preventing training and competition. Most problems are related to the shoulder and knee. Treatment is primarily nonsurgical and directed at relieving symptoms and allowing the athlete to continue with swimming practice. Treatment aids such as ice packing, anti-inflammatory medications, muscle stimulation and electrogalvanic stimulation, strengthening exercises, and static stretching are encouraged; upper arm bands and patellar-stabilizing supports can be adapted to training routines.

Athletic Injuries↗
PubMed1990

Evaluation of animal models for the study of exercise-induced muscle enlargement.

Skeletal muscle is known to enlarge in response to high-resistance training programs in humans. Study of the cellular mechanisms of muscle enlargement and the adaptations of muscle to strength-training programs has been difficult because of the need to analyze entire muscles. This precludes the use of human subjects in many experiments of this nature. Several animal models have been developed for the study of muscle enlargement; these models basically fall into three categories: 1) stretch hypertrophy, 2) compensatory hypertrophy, and 3) exercise-induced hypertrophy. This review attempts to analyze these models as models of muscle enlargement produced by strength training in humans. Three areas must be considered when evaluating animal models of human muscle enlargement produced by strength training: 1) response topography, 2) magnitude of enlargement, and 3) muscle fiber adaptations produced as a result of the enlargement. Based on these considerations, it is concluded that none of the animal models currently in use truly represents the human strength-training situation under all conditions. All three models, however, provide valuable information about the plasticity of skeletal muscle in response to a broad spectrum of muscle enlargement.

Animals↗