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Objective A test-retest cohort study was conducted to assess the use of a novel computer-aided, combined movement examination (CME) to measure change in low back movement after pain management intervention in 17 cases of lumbar spondylosis. Additionally we desired to use a CME normal reference range (NRR) to compare and contrast movement patterns identified from 3 specific structural pathologic conditions: intervertebral disc, facet joint, and nerve root compression. Methods Computer-aided CME was used before and after intervention, in a cohort study design, to record lumbar range of movement along with pain, disability, and health self-report questionnaires in 17 participants who received image-guided facet, epidural, and/or rhizotomy intervention. In the majority of cases, CME was reassessed after injection together with 2 serial self-reports after an average of 2 and 14 weeks. A minimal clinically important difference of 30% was used to interpret meaningful change in self-reports. A CME NRR (n = 159) was used for comparison with the 17 cases. Post hoc observation included subgrouping cases into 3 discrete pathologic conditions, intervertebral disc, facet dysfunction, and nerve root compression, in order to report intergroup differences in CME movement. Results Seven of the 17 participants stated that a “combined” movement was their most painful CME direction. Self-report outcome data indicated that 4 participants experienced significant improvement in health survey, 5 improved by ≥30% on low back function, and 8 reported that low back pain was more bothersome than stiffness, 6 of whom achieved the minimal clinically important difference for self-reported pain. Subgrouping of cases into structure-specific groups provided insight to different CME movement patterns. Conclusion The use of CME assists in identifying atypical lumbar movement relative to an age and sex NRR. Data from this study, exemplified by representative case studies, provide preliminary evidence for distinct intervertebral disc, facet joint, and nerve root compression CME movement patterns in cases of chronic lumbar spondylosis.

Objectives This randomised controlled crossover trial examined the efficacy of botulinum toxin type A (BoNT-A) injection, plus an exercise programme, to remediate chronic anterior knee pain (AKP) associated with quadriceps muscle imbalance. Methods 24 individuals with refractory AKP received either BoNT-A (500 U Dysport) or the same volume saline injection to the vastus lateralis (VL) muscle and performed home exercises focusing on re-training the vastus medialis (VM) muscle. All subjects were offered open-label injection at 12 weeks. Knee-related disability (anterior knee pain scale; AKPS) and activity-induced pain (10 cm visual analogue scale) at 12 weeks were the primary outcomes. Peak isometric extensor force was recorded and normalised VL:VM ratios were derived from simultaneous surface electromyography. Selfreported pain and disability measures were collected at six time points to a mean of 20±8 months. Results 14 subjects received BoNT-A and 10 placebo injection. Improvement at 12 weeks was significantly greater for BoNT-A compared with placebo-injected subjects for the AKPS (p

Human thoracic discs were analyzed for collagen and collagen cross-links to determine the distribution due to segmental, age, and gender influences. Thoracic discs from 26 cadaveric spines (1 to 90 years old) were graded macroscopically, then separated into anular and nuclear samples. Only grade I (i.e., normal) disc samples were selected (n ¼ 209). Pyridinoline and deoxypyridinoline cross-links were initially separated by column chromatography and analyzed by reverse-phase high-pressure liquid chromatography. The collagen content was lower and the extent of pyridinoline and deoxypyridinoline were significantly higher in the nucleus compared with the anulus (p , .001). The collagen content and extent of pyridinoline were significantly lower with increasing age in the anulus and nucleus (p , .001). Young male discs had a significantly higher extent of pyridinoline compared with females (p , .001). Age, gender, and disc region differences were found to have a significant influence on the biochemical composition of the normal disc extracellular matrix.

The interest in electro-motor stimulation as a strengthening modality has prompted many recent studies. Unfortunately, ambiguity rather than clear directions for future research and clinical practice have emerged. Problems are identified with strength testing methods, and in non-standardized training programmes and stimulus parameters, suggesting the need for minimum requirements when reporting these studies. It is hoped that suggestions presented in this paper will result in more careful research designs, improved inter-study comparison and more appropriate clinical protocols.

There are limited data detailing the pattern of age and gender-related changes to the thoracic vertebral bodies and intervertebral discs. A retrospective MR investigation, involving T1-weighted midsagittal images from 169 cases, was undertaken to examine age influences on the anterior wedge (anteroposterior height ratio or Ha/Hp), biconcavity (midposterior height ratio or Hm/Hp), and compression indices (posterior height/anteroposterior diameter or Hp/D) of the thoracic vertebral bodies. Disc degenerative changes in the annulus, nucleus, end-plate and disc margin were noted on T2-weighted sagittal images for the 169 cases, based on a 3-level grading system. A linear age-related decline in the Ha/Hp and Hm/Hp indices was noted. The Hp/D index increased during the first few decades of life, then decreased gradually thereafter. The prevalence of abnormal findings in the annuli, nuclei and disc margins increased with increasing age, particularly in the mid and lower thoracic discs. Greater disc degenerative changes were observed in males. These findings provide further insight into the nature of thoracic vertebral shape changes across the lifespan, and the typical patterns of degeneration of the thoracic intervertebral discs.

Whilst there are numerous studies examining aspects of sagittal plane motion in the lumbar spine, few consider coronal plane range of motion and there are no in vivo reports of nucleus pulposus (NP) displacement in lateral flexion. This study quantified in vivo NP deformation in response to side flexion in healthy volunteers. Concomitant lateral flexion and axial rotation range were also examined to evaluate the direction and extent of NP deformation. Axial T2- and coronal T1-weighted magnetic resonance images (MRI) were obtained from 21 subjects (mean age, 24.8 years) from L1 to S1 in the neutral and left laterally flexed position. Images were evaluated for intersegmental ranges of lateral flexion and axial rotation. A novel methodology derived linear pixel samples across the width of the disc from T2 images, from which the magnitude and direction of displacement of the NP was determined. This profiling technique represented the relative hydration pattern within the disc. The NP was displaced away from the direction of lateral flexion in 95/105 discs (p

Increased calf muscle stiffness is a common impairment following acquired brain injury. This study examined the immediate effects of cyclic ankle stretching at two stretch velocities on calf stiffness in individuals with hemiparesis (n=17) and control subjects (n=10).Cyclic ankle stretching was applied for 3min at velocities of 5 degrees s(-1) and 25 degrees s(-1) using a purpose-built dynamometer. Surface electromyography was employed to ensure stretches were passive. Peak plantarflexor resistive torque was derived from torque-angle curves. Comparisons were made between groups, velocities, and between limbs for hemiparetic subjects.At baseline, mean peak plantarflexor resistive torque was greater in the affected limbs of hemiparetic subjects than their contralateral limbs (P0.001), however there was no significant difference between groups. Plantarflexor resistive torque was reduced in all limbs following cyclic stretching regardless of stretch velocity (P0.005). Two distinct patterns of response were observed in hemiparetic subjects. In nine cases the affected limb responses did not differ from the contralateral limb or control data. In the remaining eight cases mean peak plantarflexor resistive torque in the affected limb was greater than the contralateral limb and control values. In this subgroup, peak plantarflexor resistive torque was significantly affected by stretch velocity and showed the greatest reduction following cyclic stretching.Cyclic stretching has been shown to produce a short term reduction in calf stiffness in a subgroup of individuals with hemiplegia. Further investigation is required to elaborate the characteristics of those most likely to respond optimally to this intervention.

The use of electrical stimulation in rehabilitation is a long established procedure for the management of a wide variety of musculoskeletal problems. This paper reviews important findings from studies on the electro-motor stimulation (EMS) of human muscles. It is particularly concerned with the results of EMS in normal subjects and in the rehabilitation setting, focusing on the stimulus parameters and training protocols used by various authors. A brief account is also given of some of the physiological effects of EMS on muscle. Attention is drawn to the urgent need for a more systematic approach to establish the optimal stimulation and training parameters. These factors must be considered when evaluating studies concerned with the efficacy of EMS-based rehabilitation programmes.

The efficacy of electrical muscle stimulation to restore motor function was investigated in fifteen males who described prior knee surgery/injury. Persisting strength imbalance between limbs related also to reduction in cross-sectional area of the affected quadriceps, as assessed by computed tomography of the midthigh. Subjects underwent a four-week programme of daily electro-motor stimulation with repeated assessment of force production by the knee extensors, correlated with surface electro-myography. Results showed no change in quadriceps cross-sectional area over the course of the study, however, significant improvements in force production for both limbs were achieved, accompanied by alteration in motor unit activity patterns to suggest that neural efficiency of motor unit activation (synchronization) may account for the improvements, as opposed to a marked morphological contribution.

The estimation of muscle cross-sectional area (CSA) by anthropometric measurements is insensitive for objective clinical research. However computed tomography (CT) enables specific muscle imaging for accurate CSA determination. This study, involving 15 males with previous knee injuries, examined the repeatability of bilateral CT in calculating mid-thigh muscle densities (Houndsfield units: HU) and quadriceps atrophy. Significant differences between limbs in strength (p

The utility of functional electrical stimulation regimens depend on an understanding of movement strategies and muscle activation patterns. The purpose of this study was to describe the electromyographic (EMG) profiles of the lateral transfer in individuals with spinal cord injury. Two movement strategy groups were examined: translatory ( n = 9) and rotatory ( n = 4). Transfer event markers were identified from force platform data. EMG signal profiles (100ms Root Mean Square envelopes) of triceps and latissimus dorsi bilaterally were generated for each group. Rotatory movement strategy demonstrates greater muscle synchronisation than do individuals who translate. The results provide evidence of different phasic characteristics of muscle activity during the lateral transfer using two possible movement strategies. The implications for intervention regimens are discussed.