Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points.

BACKGROUND AND PURPOSE: Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs. SUBJECTS: Forty adults (17 male, 23 female), aged 23 to 58 years (mean=30.6, SD=9.3), with one or more TPs in the neck or upper back participated in this study. METHODS: Subjects were randomly divided into 2 groups receiving a 5-day home program of either ischemic pressure followed by general sustained stretching of the neck and upper back musculature or a control treatment of active range of motion. Measurements were obtained before the subjects received the home program instruction and on the third day after they discontinued treatment. Trigger point sensitivity was measured with a pressure algometer as pressure pain threshold (PPT). Average pain intensity for a 24-hour period was scored on a visual analog scale (VAS). Subjects also reported the percentage of time in pain over a 24-hour period. A multivariate analysis of covariance, with the pretests as the covariates, was performed and followed by 3 analyses of covariance, 1 for each variable. RESULTS Differences were found between the treatment and control groups for VAS scores and PPT. No difference was found between the groups for percentage of time in pain. CONCLUSION AND DISCUSSION: A home program, consisting of ischemic pressure and sustained stretching, was shown to be effective in reducing TP sensitivity and pain intensity in individuals with neck and upper back pain. The results of this study indicate that clinicians can treat myofascial TPs through monitoring of a home program of ischemic pressure and stretching.

Energy costs of walking on a dual-action treadmill in men and women.

The physiological responses of normal walking and walking on a dual action treadmill which incorporates arm exercise were compared in 29 men and 37 women. Subjects completed six, 5-min steady-state exercises at 2.0, 3.0, and 4.0 mph (0.89, 1.34, 1.79 m.s-1) and 3% incline with and without arms. Estimated METs calculated according to the ACSM equations were compared with the actual METs. The men's ventilation (VE), and VO2 (l.min-1, ml.kg-1.min-1, and METs) were significantly (P < 0.001) higher at all speeds and for both conditions than the women's. There were no gender differences (P > 0.05) in heart rates (HR), respiratory exchange ratio, and ratings of perceived exertion (RPE) for each condition. The arm conditions yielded significantly (P < 0.001) higher responses at each speed for VE, l.min-1, ml.kg-1.min-1, METs, RPE, and HR. Although there were no significant (P < 0.05) differences in HR between men and women for each condition, the relationships between ml.kg-1.min-1 and HR differed. The actual METs obtained during the arm conditions were significantly (P < 0.05) higher than those estimated for both the men and women at all speeds. It was concluded that using the arms while walking on a dual action treadmill increases the energy costs an average of 55% above normal walking.

Effect of stepping rate on energy costs during StairMaster exercise.

The responses to a self-selected stepping pattern (random) on a StairMaster 4000PT were compared with those obtained in response to the rates established by the manufacturer (cadence) in men (N = 14) and women (N = 14). During the random test the subjects stepped at their own natural, self-selected rate and distance. In cadence trial the subjects were required to step in time with a metronome at a predetermined rates of 60, 77, 95, and 112 steps.min-1. Each trial consisted of four, 5-min continuous workloads during which HRs were recorded and expired air was analyzed using an automated open-circuit gas system each minute. All size dependent variables (i.e., VE and lO2.min-1) as well as relative VO2 (mlO2.kg-1.min-1) were significantly (P < 0.01) higher for the men across all stages and between methods. Although the random test produced slightly higher oxygen consumption values than the cadence trial, these differences were not significant (P > 0.05). The actual METs were significantly (P < 0.01) higher at all stages except at the lowest stepping rate for both methods compared with those estimated by the manufacturer. Equations were established to estimate actual MET costs: Men's METs = 2.675 + 0.935 (rate); women's METs = 2.934 + 0.817 (rate). Cross-validations of 0.975 and 0.957 were obtained on an additional group of men (N = 8) and women (N = 11), respectively.

Physiologic responses to maximal treadmill and deep water running in men and women.

Maximal physiologic responses to treadmill running and deep water running using a flotation device were compared in 12 trained men and 12 trained women. Although the men had significantly higher ventilation volumes, VO2max (liters of oxygen per minute and milliliters of oxygen per kilogram per minute), there were no significant differences in maximal heart rates or respiratory exchange ratios between the sexes. Significantly lower ventilation volumes, VO2max (LO2.min-1 and mlO2.kg-1.min-1), and heart rates were obtained in response to maximal water running compared to treadmill running, regardless of gender. Neither the men's nor women's maximal respiratory exchange ratios were significantly different between modes. The analysis of variance indicated that there were no significant interactions for any of the maximal responses to the tests between the sexes. The magnitude of these differences is similar to that found between treadmill running and cycling ergometry and should not preclude deep water running as a training technique. Caution, however, is advised if the training intensity is to be prescribed on the basis of land-determined heart rates.

Correlations between VO2max and performance times of recreational triathletes.

Twenty-three recreational triathletes, 16 male and 7 female (mean = 21.7 yrs), performed max tethered swim (TS), cycle ergometer (CE), and treadmill run (TR) tests prior to participation in a competitive triathlon (0.91 km swim, 40 km cycle, 10 km run). The VO2max values on the TS, CE and TR were similar to those reported for trained athletes in each sport. As a group, cycling times were significantly correlated to both absolute (p less than 0.01) and relative (p less than 0.001) cycling VO2max (r = -0.57 and r = -0.78, respectively); running times significantly correlated with relative (p less than 0.001, r = -0.84) but not absolute (p greater than 0.05) running VO2max; and swimming times significantly correlated with absolute (p less than 0.01, r = -0.49) but not relative (p greater than 0.05) swimming VO2max. With the exception of absolute swim VO2max, the total performance times were significantly correlated to all VO2max values when expressed in both absolute and relative values. This study indicates the important role a moderately trained individual's aerobic power has in determining performances in endurance events such as the triathlon.

A comparison of the training responses to aerobic dance and jogging in college females.

The purpose of this study was to compare the physiological alterations that occur in college females as a result of a 7-wk jogging and aerobic dance-training program. Forty-six subjects (18-29 yr) volunteered to participate and included 15 dancers, 19 joggers, and 12 controls. All subjects were given a pre- and post-VO2max treadmill test. The joggers and dancers trained 4 d/wk, 30 min/d for 7 wk at an intensity that represented approximately 83 and 84% of their initial maximal heart rates, respectively. Both experimental groups significantly (P less than 0.05) increased their VO2max, VEmax, and maximal treadmill running times and significantly (P less than 0.05) decreased their maximal heart rates as a result of the training. The control group showed no significant (P greater than 0.05) changes in any of the variables measured. It was concluded that both aerobic dance and jogging were equally effective (P less than 0.05) exercise modalities for improving cardiorespiratory endurance when performed at similar intensities, frequencies, and durations.

Colleagues' responses to the pregnant psychiatric resident.

A number of researchers have suggested that the pregnant psychiatrist has many intrapsychic conflicts, as a result of the pregnancy, which influence her interactions with colleagues. In contrast, the authors suggest that colleagues' reactions to the pregnancy may be based on their intrapsychic conflicts, which create internal conflicts for the pregnant psychiatrist and affect her relationships with her colleagues. The authors present case reports involving psychiatric residents that illustrate their thesis.

Autofellatio: a power and dependency conflict.

The literature concerning autofellatio is reviewed, and two additional cases are reported. A third case of a neurotic patient in whom there was a reversal of an autofellatio fantasy is presented. These cases seem to involve narcissism, dependency, and power conflicts as have those cases previously reported in the literature.

Fatherhood and emotional illness.

The authors describe four cases in which men developed emotional illnesses related to their wives' pregnancies. In all of the cases, the patients had experienced sibling rivalry at a significant time in their lives. This factor seemed to be more important dynamically in understanding their feelings about fatherhood than previously proposed factors, such as envy of the wife's childbearing capacity, dependence on the wife, and neurotic conflict with the oedipal father. The authors suggest that in men with neuroses, the issue of sibling rivalry is an important determinant of reactions to fatherhood.