Performance of repetitive tasks induces decreased grip strength and increased fibrogenic proteins in skeletal muscle: role of force and inflammation.

BACKGROUND: This study elucidates exposure-response relationships between performance of repetitive tasks, grip strength declines, and fibrogenic-related protein changes in muscles, and their link to inflammation. Specifically, we examined forearm flexor digitorum muscles for changes in connective tissue growth factor (CTGF; a matrix protein associated with fibrosis), collagen type I (Col1; a matrix component), and transforming growth factor beta 1 (TGFB1; an upstream modulator of CTGF and collagen), in rats performing one of two repetitive tasks, with or without anti-inflammatory drugs. METHODOLOGY/RESULTS: To examine the roles of force versus repetition, rats performed either a high repetition negligible force food retrieval task (HRNF), or a high repetition high force handle-pulling task (HRHF), for up to 9 weeks, with results compared to trained only (TR-NF or TR-HF) and normal control rats. Grip strength declined with both tasks, with the greatest declines in 9-week HRHF rats. Quantitative PCR (qPCR) analyses of HRNF muscles showed increased expression of Col1 in weeks 3-9, and CTGF in weeks 6 and 9. Immunohistochemistry confirmed PCR results, and also showed greater increases of CTGF and collagen matrix in 9-week HRHF rats than 9-week HRNF rats. ELISA, and immunohistochemistry revealed greater increases of TGFB1 in TR-HF and 6-week HRHF, compared to 6-week HRNF rats. To examine the role of inflammation, results from 6-week HRHF rats were compared to rats receiving ibuprofen or anti-TNF-α treatment in HRHF weeks 4-6. Both treatments attenuated HRHF-induced increases in CTGF and fibrosis by 6 weeks of task performance. Ibuprofen attenuated TGFB1 increases and grip strength declines, matching our prior results with anti-TNFα. CONCLUSIONS/SIGNIFICANCE: Performance of highly repetitive tasks was associated with force-dependent declines in grip strength and increased fibrogenic-related proteins in flexor digitorum muscles. These changes were attenuated, at least short-term, by anti-inflammatory treatments.

Exposure to repetitive tasks induces motor changes related to skill acquisition and inflammation in rats.

The authors elucidate exposure-response relationships between repetitive tasks, inflammation, and motor changes with work-related musculoskeletal disorders. Using a rat model of reaching and handle pulling, they examined effects of performing a high-repetition, low-force (HRLF); low-repetition, high-force (LRHF); or high-repetition, high-force (HRHF) task (2 hr/day, 3 days/week, 12 weeks) on reach rate and force, percentage of successful reaches, duration of participation, and grip strength. Reach rate and reach force improved with HRLF, and percentage success increased in all groups in Week 9, and in HRLF and HRHF in Week 12, indicative of skill acquisition. Duration and grip strength showed force-dependent declines with task performance. A subset of HRHF rats received ibuprofen in Weeks 5-12. Ibuprofen significantly improved reach rate, reach force, and duration in treated rats, indicative of an inflammatory influence on reach performance. Ibuprofen improved percentage of successful reaches in Week 9, although this increase was not sustained. However, declines in grip strength, a nocifensive behavior, were not prevented by ibuprofen. Examination of cervical spinal cords of untreated and ibuprofen treated HRHF rats showed increased IL-1beta, an inflammatory cytokine, in neurons. These findings suggest that only a preventive intervention could have addressed all motor declines.

Joint inflammation and early degeneration induced by high-force reaching are attenuated by ibuprofen in an animal model of work-related musculoskeletal disorder.

We used our voluntary rat model of reaching and grasping to study the effect of performing a high-repetition and high-force (HRHF) task for 12 weeks on wrist joints. We also studied the effectiveness of ibuprofen, administered in the last 8 weeks, in attenuating HRHF-induced changes in these joints. With HRHF task performance, ED1+ and COX2+ cells were present in subchondral radius, carpal bones and synovium; IL-1alpha and TNF-alpha increased in distal radius/ulna/carpal bones; chondrocytes stained with Terminal deoxynucleotidyl Transferase- (TDT-) mediated dUTP-biotin nick end-labeling (TUNEL) increased in wrist articular cartilages; superficial structural changes (e.g., pannus) and reduced proteoglycan staining were observed in wrist articular cartilages. These changes were not present in normal controls or ibuprofen treated rats, although IL-1alpha was increased in reach limbs of trained controls. HRHF-induced increases in serum C1,2C (a biomarker of collagen I and II degradation), and the ratio of collagen degradation to synthesis (C1,2C/CPII; the latter a biomarker of collage type II synthesis) were also attenuated by ibuprofen. Thus, ibuprofen treatment was effective in attenuating HRHF-induced inflammation and early articular cartilage degeneration.

Aging enhances serum cytokine response but not task-induced grip strength declines in a rat model of work-related musculoskeletal disorders.

BACKGROUND: We previously reported early tissue injury, increased serum and tissue inflammatory cytokines and decreased grip in young rats performing a moderate demand repetitive task. The tissue cytokine response was transient, the serum response and decreased grip were still evident by 8 weeks. Thus, here, we examined their levels at 12 weeks in young rats. Since aging is known to enhance serum cytokine levels, we also examined aged rats. METHODS: Aged and young rats, 14 mo and 2.5 mo of age at onset, respectfully, were trained 15 min/day for 4 weeks, and then performed a high repetition, low force (HRLF) reaching and grasping task for 2 hours/day, for 12 weeks. Serum was assayed for 6 cytokines: IL-1alpha, IL-6, IFN-gamma, TNF-alpha, MIP2, IL-10. Grip strength was assayed, since we have previously shown an inverse correlation between grip strength and serum inflammatory cytokines. Results were compared to naïve (grip), and normal, food-restricted and trained-only controls. RESULTS: Serum cytokines were higher overall in aged than young rats, with increases in IL-1alpha, IFN-gamma and IL-6 in aged Trained and 12-week HRLF rats, compared to young Trained and HRLF rats (p < 0.05 and p < 0.001, respectively, each). IL-6 was also increased in aged 12-week HRLF versus aged normal controls (p < 0.05). Serum IFN-gamma and MIP2 levels were also increased in young 6-week HRLF rats, but no cytokines were above baseline levels in young 12-week HRLF rats. Grip strength declined in both young and aged 12-week HRLF rats, compared to naïve and normal controls (p < 0.05 each), but these declines correlated only with IL-6 levels in aged rats (r = -0.39). CONCLUSION: Aging enhanced a serum cytokine response in general, a response that was even greater with repetitive task performance. Grip strength was adversely affected by task performance in both age groups, but was apparently influenced by factors other than serum cytokine levels in young rats.

Role of TNF alpha and PLF in bone remodeling in a rat model of repetitive reaching and grasping.

We have previously developed a voluntary rat model of highly repetitive reaching that provides an opportunity to study effects of non-weight bearing muscular loads on bone and mechanisms of naturally occurring inflammation on upper limb tissues in vivo. In this study, we investigated the relationship between inflammatory cytokines and matricellular proteins (Periostin-like-factor, PLF, and connective tissue growth factor, CTGF) using our model. We also examined the relationship between inflammatory cytokines, PLF and bone formation processes. Rats underwent initial training for 5 weeks, and then performed a high repetition high force (HRHF) task (12 reaches/min, 60% maximum grip force, 2 h/day, 3 days/week) for 6 weeks. We then examined the effect of training or task performance with or without treatment with a rat specific TNFalpha antibody on inflammatory cytokines, osteocalcin (a bone formation marker), PLF, CTGF, and behavioral indicators of pain or discomfort. The HRHF task decreased grip strength and induced forepaw mechanical hypersensitivity in both trained control and 6-week HRHF animals. Two weeks of anti-TNFalpha treatment improved grip strength in both groups, but did not ameliorate forepaw hypersensitivity. Moreover, anti-TNFalpha treatment attenuated task-induced increases in inflammatory cytokines (TNFalpha, IL-1alpha, and MIP2 in serum; TNFalpha in forelimb bone and muscles) and serum osteocalcin in 6-week HRHF animals. PLF levels in forelimb bones and flexor digitorum muscles increased significantly in 6-week HRHF animals, increases attenuated by anti-TNFalpha treatment. CTGF levels were unaffected by task performance or anti-TNFalpha treatment in 6-week HRHF muscles. In primary osteoblast cultures, TNFalpha, MIP2 and MIP3a treatment increased PLF levels in a dose dependent manner. Also in primary osteoblast cultures, increased PLF promoted proliferation and differentiation, the latter assessed by measuring Runx2, alkaline phosphatase (ALP) and osteocalcin mRNA levels; ALP activity; as well as calcium deposition and mineralization. Increased PLF also promoted cell adhesion in MC3T3-E1 osteoblast-like cell cultures. Thus, tissue loading in vivo resulted in increased TNFalpha, which increased PLF, which then induced anabolic bone formation, the latter results confirmed in vitro.

Exposure-dependent increases in IL-1beta, substance P, CTGF, and tendinosis in flexor digitorum tendons with upper extremity repetitive strain injury.

Upper extremity tendinopathies are associated with performance of forceful repetitive tasks. We used our rat model of repetitive strain injury to study changes induced in forelimb flexor digitorum tendons. Rats were trained to perform a high repetition high force (HRHF) handle-pulling task (12 reaches/min at 60 +/- 5% maximum pulling force [MPF]), or a low repetition negligible force (LRNF) reaching and food retrieval task (three reaches/min at 5 +/- 5% MPF), for 2 h/day in 30 min sessions, 3 days/week for 3-12 weeks. Forelimb grip strength was tested. Flexor digitorum tendons were examined at midtendon at the level of the carpal tunnel for interleukin (IL)-1beta, neutrophil, and macrophage influx, Substance P, connective tissue growth factor (CTGF), and periostin-like factor (PLF) immunoexpression, and histopathological changes. In HRHF rats, grip strength progressively decreased, while IL-1beta levels progressively increased in the flexor digitorum peritendon (para- and epitendon combined) and endotendon with task performance. Macrophage invasion was evident in week 6 and 12 HRHF peritendon but not endotendon. Also in HRHF rats, Substance P immunoexpression increased in week 12 peritendon as did CTGF- and PLF-immunopositive fibroblasts, the increased fibroblasts contributing greatly to peritendon thickening. Endotendon collagen disorganization was evident in week 12 HRHF tendons. LRNF tendons did not differ from controls, even at 12 weeks. Thus, we observed exposure-dependent changes in flexor digitorum tendons within the carpal tunnel, including increased inflammation, nociceptor-related neuropeptide immunoexpression, and fibrotic histopathology, changes associated with grip strength decline.

Gait variability detects women in early postmenopause with low bone mineral density.

BACKGROUND: Women in early postmenopause and with low bone mineral density (BMD) may exhibit early markers for physical frailty as a result of sarcopenia and osteopenia. OBJECTIVE: The purpose of this study was to determine whether women in early postmenopause and with low BMD exhibit decreased physical performance and differences in gait variability and fall and fracture rates. DESIGN: This study was an observational cohort design with participants assigned to groups on the basis of BMD status. METHODS: Fifty-four women, 31 with low BMD and 23 with normal BMD, participated. This study was conducted in a university research facility. Physical performance was measured by assessment of dynamic balance (timed backward tandem walk test), strength (handheld dynamometry of isometric quadriceps muscle force production), and free gait speed. Gait variability was assessed on the basis of the coefficient of variation for temporal-spatial gait characteristics. Falls and fractures were assessed for the year after initial testing. RESULTS: Significant between-group differences were found for step time and stance time variability. LIMITATIONS: The limitations of this study included group assignment on the basis of the results of the most recent bone density scan within the preceding 2 years. CONCLUSIONS: Women in early postmenopause and with low BMD exhibited increased gait variability in step time and stance time but did not exhibit differences in balance, strength, or gait speed. Gait variability may be more sensitive for detecting differences in women in early postmenopause and with or without low BMD than more typical measures of physical performance.

Peripheral and central changes combine to induce motor behavioral deficits in a moderate repetition task.

Repetitive motion disorders, such as carpal tunnel syndrome and focal hand dystonia, can be associated with tasks that require prolonged, repetitive behaviors. Previous studies using animal models of repetitive motion have correlated cortical neuroplastic changes or peripheral tissue inflammation with fine motor performance. However, the possibility that both peripheral and central mechanisms coexist with altered motor performance has not been studied. In this study, we investigated the relationship between motor behavior changes associated with repetitive behaviors and both peripheral tissue inflammation and cortical neuroplasticity. A rat model of reaching and grasping involving moderate repetitive reaching with negligible force (MRNF) was used. Rats performed the MRNF task for 2 h/day, 3 days/week for 8 weeks. Reach performance was monitored by measuring reach rate/success, daily exposure, reach movement reversals/patterns, reach/grasp phase times, grip strength and grooming function. With cumulative task exposure, reach performance, grip strength and agility declined while an inefficient food retrieval pattern increased. In S1 of MRNF rats, a dramatic disorganization of the topographic forepaw representation was observed, including the emergence of large receptive fields located on both the wrist/forearm and forepaw with alterations of neuronal properties. In M1, there was a drastic enlargement of the overall forepaw map area, and of the cortex devoted to digit, arm-digits and elbow-wrist responses. In addition, unusually low current amplitude evoked digit movements. IL-1 beta and TNF-alpha increased in forearm flexor muscles and tendons of MRNF animals. The increases in IL-1 beta and TNF-alpha negatively correlated with grip strength and amount of current needed to evoke forelimb movements. This study provides strong evidence that both peripheral inflammation and cortical neuroplasticity jointly contribute to the development of chronic repetitive motion disorders.

Induction of periostin-like factor and periostin in forearm muscle, tendon, and nerve in an animal model of work-related musculoskeletal disorder.

Work-related musculoskeletal disorders (WMSDs), also known as repetitive strain injuries of the upper extremity, frequently cause disability and impairment of the upper extremities. Histopathological changes including excess collagen deposition around myofibers, cell necrosis, inflammatory cell infiltration, and increased cytokine expression result from eccentric exercise, forced lengthening, exertion-induced injury, and repetitive strain-induced injury of muscles. Repetitive tasks have also been shown to result in tendon and neural injuries, with subsequent chronic inflammatory responses, followed by residual fibrosis. To identify mechanisms that regulate tissue repair in WMSDs, we investigated the induction of periostin-like factor (PLF) and periostin, proteins induced in other pathologies but not expressed in normal adult tissue. In this study, we examined the level of PLF and periostin in muscle, tendon, and nerve using immunohistochemistry and Western blot analysis. PLF increased with continued task performance, whereas periostin was constitutively expressed. PLF was located in satellite cells and/or myoblasts, which increased in number with continued task performance, supporting our hypothesis that PLF plays a role in muscle repair or regeneration. Periostin, on the other hand, was not present in satellite cells and/or myoblasts.

Spinal substance P and neurokinin-1 increase with high repetition reaching.

Musculoskeletal injury and inflammation is associated with performance of repetitive and forceful tasks. In this study, we examined the effects of performing a voluntary, highly repetitive, negligible force (HRNF) reaching task on spinal cord neurochemicals involved in nociception. To our knowledge, no other laboratories are examining spinal cord nociceptive neurochemicals in response to repetitive motion-induced injury and inflammation. The purpose of this study was to extend our earlier findings related to central neurotransmitters from a low demand task to a higher demand task. Specifically, this study determined immunoreactivity of a peptidergic pro-nociceptive transmitter (substance P) and one of its receptors, neurokinin-1 (NK-1) receptor, in spinal cord dorsal horns in rats performing a HRNF reaching task for 6-10 weeks. The relationship of these spinal cord changes with the number of TNFalpha immunopositive cells in flexor forelimb muscles and with previously observed forearm grip strength changes from these same rats were examined. Performance of the HRNF task resulted in significantly increased substance P and NK-1 receptor immunoreactivity in the superficial lamina of spinal cord dorsal horns at 6 and 10 weeks compared to trained controls (p<0.01). The increased substance P and NK-1 receptor immmunoreactivity were positively correlated with declines in forearm grip strength, an assay of movement-related hyperalgesia (r=0.70, p<0.01 and r=0.64, p<0.05, respectively). The increased substance P and NK-1 receptor immmunoreactivity were also positively correlated with increased TNF immunopositive cells in forelimb flexor muscles (r=0.85, p<0.001 and r=0.88, p<0.001, respectively). Thus, our highly repetitive task leads to increased spinal cord pro-nociceptive neurochemicals that are most likely directed by forelimb muscle inflammation and pain.

Periostin-like-factor and Periostin in an animal model of work-related musculoskeletal disorder.

Work-related musculoskeletal disorders (WMSDs), also known as overuse injuries, account for a substantial proportion of work injuries and workers' compensation claims in the United States. However, the pathophysiological mechanisms underlying WMSDs are not well understood, especially the early events in their development. In this study we used an animal model of upper extremity WMSD, in which rats perform a voluntary repetitive reaching and pulling task for a food reward. This innovative model provides us an opportunity to investigate the role of molecules which may be used either as markers of early diagnosis of these disorders, and/or could be targeted for therapeutic purposes in the future. Periostin-like-factor (PLF), and Periostin were examined in this study. Both belong to a family of vitamin K-dependent gamma carboxylated proteins characterized by the presence of conserved Fasciclin domains and not detected in adult tissues except under conditions of chronic overload, injury, stress or pathology. The spatial and temporal pattern of PLF and Periostin localization was examined by immunohistochemistry and western blot analysis in the radius and ulna of animals performing a high repetition, high force task for up to 12 weeks and in controls. We found that PLF was present primarily in the cellular periosteum, articular cartilage, osteoblasts, osteocytes and osteoclasts at weeks 3 and 6 in all distal bone sites examined. This increase coincided with a transient increase in serum osteocalcin in week 6, indicative of adaptive bone formation at this time point. PLF immunoexpression decreased in the distal periosteum and metaphysis by week 12, coincided temporally with an increase in serum Trap5b, thinning of the growth plate and reduced cortical thickness. In contrast to PLF, once Periostin was induced by task performance, it continued to be present at a uniformly high level between 3 and 12 weeks in the trabeculae, fibrous and cellular periosteum, osteoblasts and osteocytes. In general, the data suggest that PLF is located in tissues during the early adaptive stage of remodeling but not during the pathological phase and therefore might be a marker of early adaptive remodeling.

Roles of reflex activity and co-contraction during assessments of spasticity of the knee flexor and knee extensor muscles in children with cerebral palsy and different functional levels.

BACKGROUND AND PURPOSE: Spasticity is a common impairment in children with cerebral palsy (CP). The purpose of this study was to examine differences in passive resistive torque, reflex activity, coactivation, and reciprocal facilitation during assessments of the spasticity of knee flexor and knee extensor muscles in children with CP and different levels of functional ability. SUBJECTS: Study participants were 20 children with CP and 10 children with typical development (TD). The 20 children with CP were equally divided into 2 groups: 10 children classified in Gross Motor Function Classification Scale (GMFCS) level I and 10 children classified in GMFCS level III. METHODS: One set of 10 passive movements between 25 and 90 degrees of knee flexion and one set of 10 passive movements between 90 and 25 degrees of knee flexion were completed with an isokinetic dynamometer at 15 degrees /s, 90 degrees /s, and 180 degrees /s and concurrent surface electromyography of the vastus lateralis and medial hamstring muscles. RESULTS: Children in the GMFCS level III group demonstrated significantly more peak knee flexor torque with passive movements at 180 degrees /s than children with TD. Children in the GMFCS level I and level III groups demonstrated significantly more repetitions with medial hamstring muscle activity, vastus lateralis muscle activity, and co-contraction than children with TD during the assessment of knee flexor spasticity at a velocity of 180 degrees /s. DISCUSSION AND CONCLUSION: Children with CP and more impaired functional mobility may demonstrate more knee flexor spasticity and reflex activity, as measured by isokinetic dynamometry, than children with TD. However, the finding of increased reflex activity with no increase in torque in the GMFCS I group in a comparison with the TD group suggests that reflex activity may play a less prominent role in spasticity.

Peripheral neuritis and increased spinal cord neurochemicals are induced in a model of repetitive motion injury with low force and repetition exposure.

Performance of high repetition tasks with or without force is associated with peripheral tissue inflammation, decreased nerve function and motor dysfunction. Here, we examined whether a low repetition task with negligible force (LRNF) produces fewer tissue and behavioral pathologies than previously observed with high repetition tasks using our rat model of repetitive motion injury (RMI). Thirty-seven rats were randomized into control or LRNF groups, the latter reaching and grasping a 45 mg food pellet at a rate of 3 reaches/min. This task was performed in 4, 0.5 5 h sessions with 1.5 5 h rest periods for 3 days/week for up to 12 weeks. Examination of distal median nerve, forelimb flexor tendons and bones for ED1-positive cells (macrophages and osteoclasts) revealed increases in nerve and bone in week 12. The nerve also contained increased TNF-alpha expressing cells in week 12. Examination of spinal cord dorsal horns revealed increased immunoexpression of Substance P in week 8 and neurokinin-1 in weeks 8 and 12 in the superficial lamina. Motor behavioral analyses showed no changes in reach rate across weeks, slightly reduced task duration (a measurement of voluntary task participation) in week 12, but significantly increased extra arm movement reversals during reaching in week 8. These extra movement reversals were corrections for missed food pellets during a reach. Thus, performance of even a low repetition, negligible force upper extremity task for 3 months can induce mild peripheral tissue inflammation, neurochemical increases in spinal cord dorsal horns, and declines in fine motor control.

Serum and tissue cytokines and chemokines increase with repetitive upper extremity tasks.

We investigated inflammation in rats performing a low repetition, negligible force (LRNF) or high repetition, negligible force (HRNF) task of reaching and retrieving food pellets at target rates of two or four reaches/min for 2 h/day, for 6-8 weeks. Serum was assayed for 11 cytokines and chemokines; forelimb tissues for four cytokines. Macrophages were counted in forelimb tissues of LRNF rats to add to results from our previous studies of HRNF rats. In HRNF rats, serum IL-1 alpha, IL-1 beta, TNFalpha, MIP2, MIP3a, and RANTES were elevated in weeks 6 and 8. In contrast, only MIP2 and MIP3a increased in serum of LRNF rats. In 8 week HRNF reach limb tissues, IL-1 alpha, IL-1beta, TNFalpha, and IL-10 increased in distal bones, IL-1 alpha and -beta in muscles, and TNFalpha in tendons. Only IL-10 increased in LRNF reach limb muscles in week 8. Serum IL-1 alpha and MIP2 correlated with macrophages in LRNF loose connective tissues, serum MIP3a and MIP2 correlated negatively with grip strength, while serum TNFalpha, MIP3a, and MIP2 correlated positively with total number of reaches. Thus, several tissue and circulating cytokines/chemokines increase in an exposure dependent manner following short-term performance of repetitive reaching tasks and correlate with macrophage infiltration and decreasing grip strength.

Perceived musculoskeletal symptoms among dental students in the clinic work environment.

Musculoskeletal symptoms are a major concern among dental practitioners. Dental students perform the same clinical tasks as dentists in private practice, yet only recently has scientific evidence suggested a relationship between the tasks and musculoskeletal symptoms. This study investigates the clinical tasks that place students at physical risk and the relationship between the tasks and musculoskeletal symptoms. Student perceptions of physical symptoms were established with a questionnaire identifying variables on general health, tasks, physical demands, workload and environment. A total of 61% (358/590) reported that during the past year they experienced musculoskeletal symptoms related to work at dental school (second year (n = 212), third year (n = 201) and fourth year (n = 177)). Of those students, the neck represented 48%, shoulder 31%, back 44% and hands 20% (p < 0.001). Third year students reported the highest occurrence of symptoms in every body area (p < 0.001). Third and fourth year students reported significant relationships between the occurrence of symptoms and equipment utilisation, work efficiency and general health. Further studies are recommended to evaluate types and levels of potential risk factors. A total of 75% of dental practitioners are at risk for developing work-related musculoskeletal disorders. Results from this study have found that dental students were no exception. Third year dental students reported the highest level of musculoskeletal symptoms with the prevalence of pain in the neck, shoulder and lower back.

Serum biomarkers as signals for risk and severity of work-related musculoskeletal injury.

Work-related musculoskeletal disorders (MSDs) have accounted for a significant proportion of work injuries and workers' compensation claims in industrialized nations since the late 1980s. Despite epidemiological evidence for the role of repetition and force in the onset and progression of work-related MSDs, complete understanding of these important occupational health problems requires further elucidation of the underlying pathogenesis. Results from several clinical and experimental studies indicate that pathological and/or adaptive tissue changes occur as a consequence of performing repetitive and/or forceful tasks. Here, we review evidence of these tissue changes as revealed by the testing of serum biomarkers. Biomarkers of inflammation (inflammatory cytokines and C-reactive protein), cell stress or injury (malondialdehyde and creatine kinase), and collagen synthesis and degradation (collagen I carboxy-terminal propeptide and type-I collagen cross-linked C-telopeptide, respectively) and their association with MSDs will be reviewed.

Biomechanics of recumbent cycling in adolescents with cerebral palsy with and without the use of a fixed shank guide.

New stationary cycles can decrease motion in the frontal and transverse planes with a shank guide. However, there are no studies comparing cycling with and without this guide. The purpose of this study was to compare cycling with and without a shank guide for adolescents with cerebral palsy (CP). Three males and seven females (15.6+/-1.8 years) with CP, classified as levels III and IV with the Gross Motor Functional Classification System, underwent biomechanical analysis of stationary recumbent cycling with and without a shank guide at 30 and 60 rpm if able. Data collected included three-dimensional lower extremity joint kinematics using motion analysis, surface electromyography of eight lower extremity muscles, cocontraction of six agonist/antagonist pairings, efficiency (power output divided by oxygen consumption), and perceived exertion (OMNI Scale of Perceived Exertion). Non-circular data were analyzed via ANOVAs, and circular data were analyzed using circular t-tests. The shank guide altered joint kinematics in all three planes (p<0.008), had a minor impact on muscle activity (p<0.006), and had no impact on cocontraction (p>0.008), efficiency (p=0.920), or perceived exertion (p=0.318). The results suggest that a shank guide during cycling may be beneficial for individuals with CP to decrease the amount of hip and knee frontal and transverse plane motion. Knee movement in these planes has been associated with pain in healthy adults; therefore the guide may help to prevent long-term complications from cycling for adolescents with CP.

Co-contraction during passive movements of the knee joint in children with cerebral palsy.

BACKGROUND: Co-contraction is an impairment commonly reported in children with cerebral palsy. However, co-contraction has not been investigated during passive movements which may be used to assess spasticity in children with cerebral palsy. The purpose of this study was to examine the frequency of co-contraction and the relationship between reflex activity and co-contraction during passive movements of the knee joint in children with cerebral palsy. METHODS: Twenty children with cerebral palsy participated in this study. One set of ten continuous passive movements from 90 degrees of knee flexion to 25 degrees of knee flexion and from 25 degrees of knee flexion to 90 degrees of knee flexion was completed at 15 degrees /s, 90 degrees /s, and 180 degrees /s. The mean percentage of the range of motion of each movement and mean percentage of the number of movements which exhibited electromyographic activity of the vastus lateralis, medial hamstrings, and co-contraction were calculated for each set of movements. FINDINGS: The number of the movement repetitions and the percentage of the range of motion which exhibited co-contraction were considerable regardless of the direction and speed of motion. Significant positive correlations were found between the percentage of the passive range of motion with medial hamstrings activation, vastus lateralis activation, and co-contraction during passive movements into both knee flexion and knee extension at a velocity of 15 degrees /s, 90 degrees /s, and 180 degrees /s (P<0.001). INTERPRETATION: Co-contraction commonly occurs during passive movements of the knee in children with cerebral palsy. The presence of co-contraction may influence measurements of spasticity which use passive movements to assess spasticity.

Biomechanics of submaximal recumbent cycling in adolescents with and without cerebral palsy.

BACKGROUND AND PURPOSE: The purpose of this study was to compare the biomechanics of recumbent cycling between adolescents with cerebral palsy (CP) classified at Gross Motor Function Classification System (GMFCS) levels III and IV and adolescents with typical development (TD). SUBJECTS: Twenty subjects, ages (X+/-SD) 15.2+/-1.6 years (10 with TD, 10 with CP), participated. METHODS: Lower-extremity kinematics and muscle activity were measured at 30 and 60 rpm while subjects pedaled on a recumbent cycle. Energy expenditure and perceived exertion were measured during a 5-minute test, and efficiency was calculated. Noncircular data were analyzed with analyses of variance. Circular data were analyzed using circular t tests. RESULTS: Differences were found between groups for joint kinematics for all motions. Subjects with CP displayed earlier onsets and later offsets of muscle activity, increased co-contraction of agonist and antagonist muscles, and decreased efficiency compared with subjects with TD. There were no differences in perceived exertion. DISCUSSION AND CONCLUSION: Differences in cycling biomechanics between children with CP and children with TD may be due to decreased strength and motor control in the children with CP.

Inflammatory biomarkers increase with severity of upper-extremity overuse disorders.

MSDs (musculoskeletal disorders) from overuse are common occupational health problems that cause pain, functional loss and loss of work time. The aim of the present study was to determine whether a relationship exists between the severity of early-onset overuse-related MSDs of the upper extremity and serum levels of IL-1beta (interleukin-1beta), TNF-alpha (tumour necrosis factor-alpha), IL-6 (interleukin-6) and CRP (C-reactive protein). Twenty-two subjects with upper-extremity MSDs due to overuse for no longer that 12 weeks were stratified according to the severity of upper-extremity signs and symptoms as determined by a UBMA (upper-body musculoskeletal assessment). Nine asymptomatic subjects also participated. Serum cytokines were analysed using ELISA, and CRP was analysed using a laser nephelometry technique. CRP was strongly correlated, and TNF-alpha, IL-1beta and IL-6 were moderately correlated, with UBMA scores. Only CRP and TNFalpha were significantly associated with UBMA scores in an ordinal logistic regression analysis in which age and BMI (body mass index) were covariates. These results are of clinical importance as they suggest that early-onset overuse-related MSDs may have an inflammatory component. The possibility of using a combination of serum biomarkers to follow the progression of overuse-related MSDs or their response to therapeutic intervention may be of interest to clinical practitioners and should be the focus of future research.