Back foot influence on dorsiflexion using three different positions of the weight bearing lunge test.

OBJECTIVES: To determine whether back foot (BF) position influences dorsiflexion range of motion (DFROM) during three different positions of the weight bearing lunge test (WBLT). DESIGN: Randomised, repeated measures design. SETTING: Sports clubs. PARTICIPANTS: 52 athletes participating in cutting and pivoting sports. MAIN OUTCOME MEASURES: DFROM was obtained using a WBLT in three different BF positions: BF heel in full contact with the floor, BF heel raised off the floor and BF was non weight bearing (NWB). All measurements were obtained using three methods: inclinometer at the tibial tuberosity, toe to wall distance and goniometer angle from the lateral malleolus to the fibula head. Differences between testing positions were determined using a repeated measures one-way ANOVA and reliability analysis was performed using the Intraclass Correlation Coefficient (ICC). RESULTS: DFROM was statistically significantly different for all three positions of the WBLT for each measurement technique (P < .001). These results were associated with large effect sizes for all BF positions and measurement techniques. Reliability ICC values were excellent for all measurements (ICC 0.94-0.99). CONCLUSIONS: Results show that DFROM differs depending upon the position of the BF during the WBLT. Further research is needed to establish the reproducibility of these three BF positions due to the variability observed.

A randomised controlled trial using the Epidrum for labour epidurals.

The aim of our study was to determine if using the Epidrum to site epidurals improves success and reduces morbidity. Three hundred parturients requesting epidural analgesia for labour were enrolled. 150 subjects had their epidural sited using Epidrum and 150 using standard technique. We recorded subject demographics, operator experience, number of attempts, Accidental Dural Puncture rate, rate of failure to site epidural catheter, rate of failure of analgesia, Post Dural Puncture Headache and Epidural Blood Patch rates. Failure rate in Epidrum group was 9/150 (6%) vs 0 (0%) in the Control group (P = 0.003). There were four (2.66%) accidental dural punctures in the Epidrum group and none in the Control group (P = 0.060), and 2 epidurals out of 150 (1.33%) in Epidrum group were re-sited, versus 3/150 (2%) in the control group (P = 1.000). The results of our study do not suggest that using Epidrum improves success or reduces morbidity.

Spinal anaesthesia for caesarean section: an ultrasound comparison of two different landmark techniques.

BACKGROUND: Spinal anaesthesia performed at levels higher than the L3-4 intervertebral space may result in spinal cord injury. Our aim was to establish a protocol to reduce the chance of spinal anaesthesia performed at or above L2-3. METHODS: One hundred and ten consenting patients at 32weeks of gestation or greater scheduled for non-emergency caesarean section under spinal anaesthesia were randomly allocated to have needle insertion performed at an intervertebral space determined by one of two landmark techniques. In Group A, if the intercristal line intersected an intervertebral space, this space was selected or if the intercristal line intersected a spinous process the space immediately above was selected. In Group B, if the intercristal line intersected an intervertebral space or a spinous process, the intervertebral space immediately below was chosen. The actual intervertebral space chosen was identified using ultrasound by a blinded investigator. RESULTS: In Group A, an intervertebral space at or above L2-3 was marked in 25 (45.5%) patients compared with 4 (7.3%) in Group B (P <0.001). In 5/55 (9.1%) patients in Group A, the intervertebral space initially chosen was L1-2 whereas this occurred in no patient in Group B. There was no difference between groups in number of needle passes or attempts, onset of block at 5, 10 and 15min or need for rescue analgesia. CONCLUSION: Our data suggest that when performing spinal anaesthesia in pregnant patients, if the intercristal line intersects an intervertebral space then the space below should be chosen and if the intercristal line intersects a spinous process then the interspace below should be chosen. This will reduce the incidence of spinal anaesthesia performed at or above L2-3.

Anaesthesia for parturients with severe cystic fibrosis: a case series.

Cystic fibrosis affects 1 in 1600-2500 live births and is inherited in an autosomal recessive manner. It primarily involves the respiratory, gastrointestinal and reproductive tracts, with impaired clearance of, and obstruction by, increasingly viscous secretions. Severe respiratory disease, diabetes and gastro-oesophageal reflux may result. Improvements in medical management and survival of cystic fibrosis patients means more are committing to pregnancies. Although guidance for anaesthesia in this patient group is available, management and outcome data associated with more severe cases are sparse. Patients with severe cystic fibrosis require multidisciplinary input and should be managed in a tertiary referral centre. Close monitoring of respiratory function and preoperative optimisation during pregnancy are mandatory. The risk of preterm labour and delivery is increased. Pregnancy and delivery can be managed successfully, even in patients with FEV1 <40% predicted. Neuraxial anaesthesia and analgesia should be the technique of choice for delivery. Postoperative care should be carried out in a critical care setting with the provision of postoperative ventilation if necessary.

'Nordic' hamstrings exercise - engagement characteristics and training responses.

The present study examined the neuromuscular activation characteristics of the hamstrings during the 'Nordic' hamstrings exercise (NHE) and changes in the eccentric strength of the knee flexors with NHE training. Initially, the normalised root mean square electromyographic (EMG) activity of the hamstrings of both limbs during various phases (90-61°, 60-31° and 30-0° of knee extension) of the NHE were determined in 18 soccer players. Subsequently participants were randomly allocated to either a training (n=10) or control group. The isokinetic eccentric peak torques of the dominant and non-dominant limbs were recorded at 60, 120 and 240°/s pre- and post-training. The EMG values of both limbs were comparable (P=0.184) and greater EMG activity was recorded at more extended knee positions of the NHE (P=0.001). 4 weeks of NHE training significantly improved peak torque by up to 21% in all assessment conditions. Data indicate the hamstrings of both limbs are engaged identically during the NHE and training results in gains in the eccentric peak torque of the hamstrings of both limbs; these gains may augment the force that the hamstrings can withstand when forcefully stretched, attenuating injury risk.

Functional eccentric-concentric ratio of knee extensors and flexors in pre-pubertal children, teenagers and adult males and females.

The purpose of this study was to examine the age and sex associated differences in the eccentric/concentric functional ratio for the knee. Isokinetic concentric and eccentric knee extension and flexion was measured at 0.52 rad x s (-1) and 3.14 rad x s (-1) in 121 subjects. Other than mass there were no significant age-by-sex interaction effects for all variables examined. A significant velocity-by-age group effect was demonstrated for ECC (KF)/CON (KE) with higher ratios at 3.14 compared to 0.52 rad x s (-1). Females' CON (KF)/ECC (KE) was significantly lower than males at both velocities. Adults demonstrated significantly lower CON (KF)/ECC (KE) than the teenagers at 0.52 rad x s (-1) and lower than the prepubertal and teenager groups at 3.14 rad x s (-1). However, for ECC (KF)/CON (KE) at 3.14 rad x s (-1), prepubertal ratios were significantly lower than teenagers and adults. The results of the current study suggest that functional rather than conventional ratio should be used when examining knee stability. During fast velocity movements, prepubertal children have a lower capacity for generating eccentric compared to concentric torque. The lower CON (KF)/ECC (KE) ratio in adults appears to be due to a greater ability to generate large eccentric torques at all slow and fast movement velocities. The lower CON (KF)/ECC (KE) ratio in females is a product of lower concentric torque as opposed to high eccentric torque producing capability as previously thought.

Measurement of maximal muscle cross-sectional area of the elbow extensors and flexors in children, teenagers and adults.

The aims of this study were to examine age and sex differences in elbow extensor and flexor anatomical muscle cross-sectional area (mCSA) measured by magnetic resonance imaging (MRI) and the location of maximal mCSA as a percentage of the distance from the distal to the proximal end of the humerus. Ninety-five individuals spread across the age groups 9 - 10 years, 16 - 17 years and ?21 years participated in the study. Muscle cross-sectional area derived from the manual MRI tracing proved to be highly reliable in terms of limits of agreement (-2.5 to 1.5 cm(2)) and the intraclass correlation coefficient (ICC = 0.998). A sex-by-age group analysis of variance revealed significant effects (P < 0.01) of sex, group and a sex-by-group interaction, the latter reflecting a greater increase in males than females of upper arm mCSA from childhood to adulthood. Extensor mCSA was more proximal (55 +/- 6%) than that of the flexors (28 +/- 6%). A significant effect (P < 0.01) of group was found for location of maximal extensor mCSA, reflecting its more distal position with increasing age. Measurements of muscle size should be made at the individually determined position of maximal mCSA if interpreting data collected during growth and maturation, especially if the muscle group of interest is the elbow extensors and if different age groups are being monitored.