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Objectives: 1) To study if limb length explains variability in appendicular and total muscle mass better than height and 2) if muscle mass adjusted for limb length rather than height correlates better with grip and knee extension strength. Methods: 400 healthy women aged 20-40 were recruited as a reference population. Body composition, limb length, grip strength and knee extension strength were measured. New relative muscle mass indexes were computed by adjusting upper limb muscle mass for upper limb length (ULRSMI) and lower limb muscle mass for lower limb length (LLRSMI). Results: Height correlated strongest with all muscle mass measures. Height had the highest R2 values for predicting variability in appendicular skeletal muscle mass (0.33), upper limb skeletal muscle mass (0.20), lower limb skeletal muscle mass (0.34) and total skeletal muscle mass (0.36). Correlation of relative skeletal muscle mass index (RSMI) with grip and knee extension strength (r=0.47 and 0.43) was higher when compared with correlation of ULRSMI and LLRSMI with these measures. Conclusion: Compared to limb length, height correlates better with regional and total muscle mass. Muscle mass adjusted for height correlates better with grip strength and knee strength when compared with muscle mass adjusted for limb length.

Recent debate regarding the possibility for decreasing the risk of accidents within the construction industry has emphasized the need for innovative training methods. Training should combine behavior- and culture-based approaches, simulate real-life situations, and involve multiple methods. The concept of Safety Training Park (STP) has been developed to meet these challenges. Eighty stakeholders from the Finnish construction industry have been involved in the construction and financing of the STP in northern Finland (STPNF). This unique cooperation has contributed to the immediate success of the park. However, little is known regarding the creation process and how the utilization of the STPNF could be improved. This article presents as a case study the concept, joint creation process and lessons learned this far. Detailed descriptions of the STPNF, findings from focus group interviews, and evidence from the literature are presented with a focus on the pros and cons of the STPNF. The STP is a new and innovative method for safety training that stimulates different learning styles and inspires changes in individuals’ behavior and in the organizations’ safety climate. The stakeholders’ high commitment, a long-term perspective, and a strong safety climate are identified as preconditions for the STP concept to work.

Modic change (MC) is considered an independent risk factor for low back pain (LBP) but its aetiology remains unclear. In this cross-sectional, large-scale population-based study we sought to characterise associations between endplate defect (ED) and MC in a population sample of broad age range. The study population consisted of 831 twin volunteers (including 4155 discs and 8310 endplates) from TwinsUK. Lumbar T2-weighted MR images were coded for ED and MC. Total endplate (TEP) score was calculated at each intervertebral disc while receiver operating curves (ROC) were calculated to define critical endplate values predictive of MC. MC was detected in 32.1% of the subjects, with a significantly higher prevalence at lower lumbar levels (3.5% at L1/2-L3/4 vs. 15.9% at L4/5-L5/S1, p

Modic change (MC) is considered an independent risk factor for low back pain (LBP) but its aetiology remains unclear. In this cross- sectional, large-scale population-based study we sought to characterise associations between endplate defect (ED) and MC in a population sample of broad age range. The study population consisted of 831 twin volunteers (including 4155 discs and 8310 endplates) from TwinsUK. Lumbar T2-weighted MR images were coded for ED and MC. Total endplate (TEP) score was calculated at each intervertebral disc while receiver operating curves (ROC) were calculated to define critical endplate values predictive of MC. MC was detected in 32.1% of the subjects, with a significantly higher prevalence at lower lumbar levels (3.5% at L1/2-L3/4 vs. 15.9% at L4/5-L5/S1, p < 0.001). TEP score was strongly and independently associated with MC at each lumbar level (risk estimates from 1.49 to 2.44 ; all p ≤ 0.001) after adjustment for age, sex, BMI and twin pairing. ROC analysis showed a TEP score cut-off of 6 above which there was a significantly higher prevalence of MC. In conclusion, ED were strongly associated with MC at every lumbar level. These findings support the hypothesis that endplate defect is a major initiating factor for the cascade of events that may include disc degeneration (DD) and MC.

The Safety Training Park (STP) concept is a unique Finnish safety training innovation. The STP provides different actors of the construction industry and other branches a practical occupational safety and health (OSH) training area. To the authors’ knowledge, no such parks exist in Europe besides Finland. Objec-tive was to study the effectiveness of the STP trainings at a large case company which participated in this study and which has actively trained its personnel in the park. The study was conducted from February 2015 to Feb-ruary 2017. Several key success factors were identified in the interviews of this case study. In addition, the company OSH statistics (2010 – 2016) showed a positive development at safety level. However, The Nordic Safety Climate Questionnaire did not show any significant change of results in a one year period. According to the results of the group interviews the learning possibilities in the STP was evaluated positive most of the per-sons in groups. Especially it was seen very useful for students and for everyone who needs introduction for safety.

The purpose of this investigation was to provide a full set of normal data describing neural biomechanics within the vertebral canal in all three planes with unilateral and bilateral SLR tests to allow for clinical comparison with clinical cases. This is done following the notion that, due to neural continuum, tensile forces are transmitted through the lumbosacral nerve roots and dura to the conus medullaris (linear dependency principle). In this controlled radiologic study 10 asymptomatic volunteers were scanned with 1.5T magnetic resonance scanner (Siemens Magnetom Aera, Erlangen, Germany) using different scanning sequences for planning and for measurement purposes. Conus displacement in both antero-posterior direction (sagittal slices) and lateral direction (axial slices) was quantified during unilateral passive left, right SLR, and bilateral SLR and compared with the position of the conus in the neutral (anatomic) position. It is shown that the conus medullaris displaced laterally and anteroposteriorly in response to unilateral and bilateral SLRs. Pearson's correlations were higher than 0.95 for both intra- and inter-observer reliability. The observed power was higher than 0.99 for all the variables tested. Following this, the authors conclude that lateral and antero-posterior displacement of conus medullaris into the vertebral canal occurs consistently with unilateral and bilateral SLRs following directions predicted by tension vectors. Summative information collected in this line of research in neuroradiology is here presented. We believe we have presented the first conclusive and complete full set of normal data on non- invasive, in vivo, normative measurement of spinal cord displacement with the SLR ever presented.

Study design: Controlled radiological study. Objective: Verify (1) whether conus medullaris displacement varies with the range of hip flexion and (2) whether the acquired data support the "principle of linear dependence." Summary of background data: We have previously quantified normal displacement of the conus with unilateral and bilateral straight leg raise (SLR) and have described the "principle of linear dependence." However, we have since effected methodological advances that have produced data that surpass previous studies. Methods: Ten asymptomatic volunteers were scanned with a 1.5-T magnetic resonance scanner using T2- weighted spc 3-dimensional scanning sequences and a device that permits greater ranges of SLR. Displacement of the conus medullaris during the unilateral and bilateral SLRs was quantified reliably with a randomized procedure. Results: Pearson correlations were higher than 0.99 for both intra- and interobserver reliability and the observed power was 1 for each tested maneuver. The conus displaced caudally in the spinal canal by 3.54 ± 0.87 mm (μ ± SD) with unilateral (P ≤ 0.001) and 7.42 ± 2.09 mm with bilateral SLR (P ≤ 0.001). Conclusion: To the authors' knowledge, these are the first data on noninvasive, in vivo, normative measurement of spinal cord displacement with the SLR test at 60° of hip flexion. Conus medullaris displacement increased with hip flexion angle, while maintaining the relationship between magnitude of conus displacement and number of nerve roots involved into the movement, supporting the "principle of linear dependence." The use of T2-weighted spc 3-dimensional sequence allows for better reliability testing, which is important for future clinical utility. Level of evidence: 5.

Study design: Part 1: A randomized, single-blind study on the effect of contralateral knee extension on sensations produced by the slump test (ST) in asymptomatic subjects. Part 2: A cadaver study simulating the nerve root behavior of part 1. Objective: Part 1: Test if contralateral knee extension consistently reduces normal stretch sensations with the ST.Part 2: Ascertain in cadavers an explanation for the results. Summary of background data: In asymptomatic subjects, contralateral knee extension reduces stretch sensations with the ST. In sciatica patients, contralateral SLR also can temporarily reduce sciatica. We studied this methodically in asymptomatic subjects before considering a clinical population. Methods: Part 1: Sixty-one asymptomatic subjects were tested in control (ST), sham, or intervention (contralateral ST) groups and their sensation response intensity compared.Part 2: Caudal tension was applied to the L5 nerve root of 3 cadavers and tension behavior of the contralateral neural tissue recorded visually. Results: Part 1: Reduction of stretch sensations occurred in the intervention group but not in control and sham groups (P ≤ 0.001).Part 2: Tension in the contralateral lumbar nerve roots and dura reduced in a manner consistent with the responses in the intervention (contralateral ST) group. Conclusion: Part 1: In asymptomatic subjects, normal thigh stretch sensations with the ST reduced consistently with the contralateral ST, showing that this is normal and may now be compared with patients with sciatica.Part 2: Contralateral reduction in lumbar neural tension with unilateral application of tension-producing movements also occurred in cadavers, supporting the proposed explanatory hypothesis.

Study design: Controlled radiological study. Objective: Ascertain if a difference exists in the mechanical effects on the cord between the unilateral and bilateral straight leg raise (SLR) and to verify whether the effect on the spinal cord may be cumulative between the two. Summary of background data: To the authors' knowledge these are the first data on noninvasive, in vivo, normative measurement of spinal cord displacement with bilateral SLR test. Methods: Sixteen asymptomatic volunteers were scanned with 1.5-T magnetic resonance scanner (Siemens Avanto, Erlangen, Germany) using T2- weighted turbo spin- echo fat-saturation sequence. The displacement of the medullar cone relative to the vertebral endplate of the adjacent vertebra during the passive bilateral SLR was quantified and compared with the position of the conus in the neutral (anatomic) position and with unilateral SLR. Each movement was performed twice for evaluation of reproducibility. The measurements were repeated by 2 observers. Four practitioners performed the maneuvers in a random sequence to avoid series effects. Results: Compared with the neutral (anatomic) position, the medullar cone displaced caudally in the spinal canal by 2.33 ± 1.2 mm (μ ± SD) with unilateral (P ≤ 0.001) and 4.58 ± 1.48 mm with bilateral SLR (P ≤ 0.001). Statistical significance was also reached for bilateral versus unilateral SLR (P ≤ 0.001). Spearman correlations proved higher than 0.99 for intra and interobserver reliability, and 0.984 for results reproducibility in bilateral SLR. Conclusion: The caudal displacement of the medullar cone was significantly greater (almost double) with the bilateral SLR than the unilateral SLR. We hypothesize that this greater movement may be because more force was transmitted to the cord through a larger number nerve roots with the bilateral than unilateral SLR. The high correlation values in this study show that these movements are consistent and reproducible. This study offers baseline measurements on which further studies in diagnosis and treatment of lumbar disc protrusion and radiculopathy may be developed.

Study design: Controlled radiological study. Objective: To investigate noninvasively in vivo spinal cord displacement in the vertebral canal during the passive straight leg raise (SLR) in asymptomatic subjects. The basic assumption is that the cord follows L5 and S1 nerve roots displacement by similar magnitude and direction (principle of linear dependence). Summary of background data: It is generally accepted that the SLR produces some caudal movement mainly of L5 and S1 nerve roots, but the magnitude of this displacement is still a matter of debate. Methods: Sixteen asymptomatic volunteers were scanned with 1.5-T magnetic resonance scanner (Siemens Avanto, Erlangen, Germany) using T2- weighted turbo spin-echo fat-saturation sequence. The displacement of the medullar cone relative to the vertebral endplate of the adjacent vertebra during the passive SLR was quantified and compared with the position of the conus in the neutral (anatomic) position. Each movement was performed twice for evaluation of reproducibility. The measurements were repeated by 2 observers. Four practitioners performed the maneuvers in a random sequence to avoid series effects. Results: Compared with the neutral (anatomic) position, the medullar cone displaced caudally in the spinal canal by 2.31 ± 1.2 mm with right (P ≤ 0.001) and 2.35 ± 1.2 mm with left SLR (P ≤ 0.001). Spearman correlations proved higher than 0.99 for intra and interobserver reliability, as well as results reproducibility testing for each maneuver. Conclusion: The data show that the spinal cord in the thoracolumbar region slides distally in response to the clinically applied SLR test. The high correlation values in this study show that these movements are consistent and reproducible. Because of the neural continuum, the authors speculate that this movement might be directly proportional to the sliding of the L5 and S1 neural roots. This study offers baseline measurements on which further studies in diagnosis of lumbar disc protrusion and radiculopathy may be developed.

Background It is generally accepted that muscles may activate via the common nociceptive flexion reflex (NFR) in response to painful stimuli associated with tensile or compressive forces on peripheral nerves. Following the basic assumption that the radial nerve may be stressed around the elbow during the execution of the Mills manipulation, t wo positions considered to have different mechanical effects on the radial nerve and the brachial plexus were tested in order to i) explore whether muscles are activated in certain patterns with concomitant changes in nerve tension, ii) establish whether muscle responses can be modified with mechanical unloading of the brachial plexus. Methods Muscle responses were quantified bilaterally in eight subjects (N = 16) during Mills Manipulation (MM) pre-manipulative positioning and a Varied position that putatively produces less mechanical tension in the brachial plexus. End range pre- manipulative stretch was used in order to simulate the effects of Mills manipulation. Electromyographic signals were recorded with a 16 channel portable EMG unit and correlated with kinematic data from three charge-coupled device adjustable cameras which allowed for precise movement tracking. Results Compared with the Standard Mills manipulation position, the Varied position produced significantly reduced myoelectric activity (P ≤ .001) in all test muscles. Additional subjective data support the notion that certain muscle activity patterns were protective. Conclusion It seems that protective muscles are selectively activated in a specific pattern in order to protect the radial nerve from mechanical tension by shortening its pathway, suggesting integration of muscle and neural mechanisms. Furthermore, the significantly decreased myoelectric activity with reduced mechanical tension in the brachial plexus may help controlling collateral effects of the Mills manipulation itself, making it potentially safer and more specific.

Objectives: (A) Describe a new method of investigation of the possible muscular effects of the commonly practiced Mills manipulation for lateral elbow pain (epicondylalgia), (B) ascertain if myoelectric activity is influenced during the pre-manipulative stretch for Mills manipulation, (C) establish whether muscle responses are influenced by ipsilateral lateral flexion of the cervical spine which reduces mechanical tension in the peripheral nerves of the upper limb. Sample: Eight asymptomatic subjects were tested bilaterally (N=16). Methods: Myoelectric measurements - EMG signals were recorded with a 16 channel pocket EMG patient unit and processed off-line. Measurement of joint positions-three CCD adjustable cameras sensitive to 10mm reflective passive markers applied at specific locations on the subjects' bodies were used to reconstruct and verify accuracy of body movements and were correlated with EMG recordings. Results: Compared with the standard (anatomical) position of the cervical spine in which Mills manipulation is typically performed, cervical spine ipsilateral lateral flexion produced significantly reduced activity in muscles that restrain the manipulation movement (elbow extension), namely biceps brachii (P=0.018) and brachioradialis (P=0.000). The affected muscles may therefore produce protective effects during the manipulation. Conclusions: Changes in myoelectric activity were in a pattern that suggests that muscle and neural mechanisms may be an integral part of the Mills manipulation. Cervical spine ipsilateral lateral flexion may be used to reduce mechanical stresses in the peripheral nerves and extraneous muscle activity, making Mills' manipulation potentially safer and more specific.

A parallel, double-blind, placebo controlled and randomized study in a single center was done with ketoprofen 2.5% gel to treat acute soft tissue injuries. Patients applied the gel twice a day for seven days, corresponding to 250 mg of ketoprofen per day. Assessments were made on the third and seventh day by VAS, subjective evaluation and pain threshold algometry. The study group consisted of 29 patients and the control group 27 patients. Pain at rest was significantly relieved in the ketoprofen group, whereas in the placebo group the difference was not significant. In terms of side-effects, no difference between the groups was noticed. In both groups, local dermal irritation was found. Our results suggested that ketoprofen 2.5% gel was safe and superior to placebo in the treatment of soft tissue injuries.

This report outlines the most essential characteristics of low power lasers commonly used in physical medicine. The optical output power of two Helium-Neon (HeNe) lasers (CW scanner) and two collimated Infrared (IR) laser diodes was measured with a CoherentR Model 212 meter designed to measure output power and its power density. The energy of two collimated IR lasers was measured with a Laser Precision Energy Meter equipped with an RJP-735 probe. The difficulties arising from the large divergence of the laser beam in diode lasers and the importance of the scattering and absorption of laser beams are discussed. The criteria for the evaluation of the lasers as well as the essential parameters for an adequate characterization of laser therapy are given.