The Intramuscular Circulation Is Affected by Neck and Shoulder Pain.

The purpose of this study was to investigate the effects of neck and shoulder pain (NSP) and the position of the head and neck on the intramuscular circulation of the cervical muscles such as the trapezius and levator scapulae muscles in young females. Ten NSP subjects (mean age: 20.9 ± 0.5 years) and ten non-NSP subjects (mean age: 20.6 ± 0.7 years) were recruited to this study. Near-infrared spectroscopy (NIRS) was used to non-invasively measure total haemoglobin (Total-Hb), oxygenated haemoglobin (Oxy-Hb), and deoxygenated haemoglobin (Deoxy-Hb) of the trapezius and levator scapulae muscles. The measurements of Total-Hb, Oxy-Hb, and Deoxy-Hb were taken in the neutral position, immediately after the maximally flexed (extended) position, and after 30 s in the maximally flexed (extended) position. In flexion, no significant main effect or interaction was observed with Total-Hb and Oxy-Hb. A significant interaction was observed with Deoxy-Hb (p < 0.01). There was no significant difference in the changes over time in the NSP group (p = 0.91). However, in the non-NSP group, a significant increase was noted at the neutral position to immediately after the maximally flexed position (p < 0.01) and at the end of maintaining the maximally flexed position (p < 0.01). In extension, no significant main effect or interaction was observed with Total-Hb and Oxy-Hb. A significant interaction was observed with Deoxy-Hb (p < 0.01). In the NSP group, no significant difference was observed in the changes over time (p = 0.91). In the non-NSP group, however, a significant decrease was observed from the neutral position to immediately after the maximally extended position (p < 0.01). The results of this study indicate that maintaining either maximal cervical flexion or extension may affect venous blood flow on non-NSP group. However, no effect on NSP group was observed due to existing diminished intramuscular circulation.

Role of Ultrasound in Low Back Pain: A Review.

Low back pain is one of most common musculoskeletal disorders around the world. One major problem clinicians face is the lack of objective assessment modalities. Computed tomography and magnetic resonance imaging are commonly utilized but are unable to clearly distinguish patients with low back pain from healthy patients with respect to abnormalities. The reason may be the anisotropic nature of muscles, which is altered in function, and the scans provide only structural assessment. In view of this, ultrasound may be helpful in understanding the disease as it is performed in real-time and comprises different modes that measure thickness, blood flow and stiffness. By the use of ultrasound, patients with low back pain have been found to differ from healthy patients with respect to the thickness and stiffness of the transversus abdominis, thoracolumbar fascia and multifidus. The study results are currently still not conclusive, and further study is necessary to validate. Future work should focus on quantitative assessment of these tissues to provide textural, structural, hemodynamic and mechanical studies of low back pain. This review highlights the current understanding of how medical ultrasound has been used for diagnosis and study of low back pain and discusses potential new applications.

Multivector functioning muscle transfer using superficial subslips of the serratus anterior muscle for longstanding facial paralysis.

Various donor muscles have been identified for restoring facial function due to longstanding facial paralysis. Donor muscles such as the gracilis and latissimus dorsi are frequently used and often produce one or two reliable vectors of force. However, there are drawbacks of using these muscles, including the instability of separating multivector functioning muscle units and limited amount of muscle contraction. Serratus anterior muscle transfer has the advantages of multiple independently functioning motor units that can be created with a single neurovascular pedicle. This article describes multivector muscle transfer using two or three superficial subslips of the serratus anterior muscle on a single neurovascular pedicle to produce an esthetic smile that is customized to imitate the function of the contralateral mimetic muscles. Twelve patients who had longstanding unilateral facial paralysis underwent muscle transfer consisting of multivector superficial subslips of the serratus anterior muscle innervated by the ipsilateral masseteric nerve. The procedure had an uneventful postoperative course, and patients obtained excellent results, with sufficient upper lip excursion, mouth angle, and lower lip working simultaneously. Functioning muscle transfer using multivector superficial subslips of the serratus anterior muscle is effective for treating longstanding facial paralysis. This technique avoids postoperative bulkiness of the cheek muscle and achieves a more natural and symmetrical smile.

Changes in Spinal Muscle Oxygenation and Perfusion During the Biering-Sørensen Test: Preliminary Results of a Study Employing NIRS-Based Muscle Oximetry.

Low back pain (LBP) is suggested to be related to deconditioning of back muscles by a decreased capacity for hyperemia in exercising muscles. However, only inconsistent evidence exists regarding back muscle perfusion and oxygen saturation in healthy subjects and patients suffering from (chronic) LBP. AIM: We measured muscle perfusion in healthy subjects during the Biering-Sørensen (BS) test (the gold standard for evaluating back muscle endurance) using a commercial near-infrared spectroscopy (NIRS) device. We analysed data sets of five female healthy subjects (age: 34 ± 15 years) who reached the maximum of 4 min during the BS test. Muscle oxygenation (SmO2) and perfusion ([tHb]) were measured using the Moxy NIRS device (Fortiori Design LLC, Hutchinson, USA). Probes were set unilaterally on M. longissimus, M. iliocostalis and M. multifidus. Additionally, mean arterial blood pressure (MAP), pulse pressure (PP), heart rate (HR), arterial oxygen saturation (SpO2) and lactate (pre, task, post) were measured. We observed (i) a large inter-subject variability in the SmO2 and [tHb] responses in the three muscles (i.e., SmO2 desaturations in the in M. longissimus across subjects during the task ranging from 1.1% to -56.6%), and (ii) a consistent response of the systemic signals in all subjects (i.e., increase in MAP, PP and HR). Lactate changes (post task minus task period) correlated with changes in PP and SmO2 of the multifidus muscle. Our preliminary results showed that during the BS test the response in the peripheral muscles was more variable than the central systemic response. A goal for future investigations is to explain this variability in the periphery by considering, for example, subject-specific changes in systemic cardiovascular activity, lactate and in the microvascular perfusion of muscle tissue.

The Effects of Blood Flow Restriction on Upper-Body Musculature Located Distal and Proximal to Applied Pressure.

Blood flow restriction (BFR) training has been shown to increase muscle size and strength when combined with low-load [20-30 % one-repetition maximum (1RM)] resistance training in the lower body. Fewer studies have examined low-load BFR training in combination with upper body exercise, which may differ as some musculature cannot be directly restricted by the BFR stimulus (chest, shoulders). The objective of this study was to examine muscle adaptations occurring in the upper body in response to low-load BFR training. Google Scholar, PubMed, and SPORTDiscus were searched through July 2015 using the key phrases 'blood flow restriction training', 'occlusion resistance training', and 'KAATSU'. Upper body training studies implementing the BFR stimulus and providing a pre and post measure of muscle size and/or strength were included. A total of 19 articles met the inclusion criteria for this review. The effectiveness of low-load BFR training appears to be minimally impacted by alterations to the intensity and restrictive pressures used; however, the ability to quantitatively analyze our results was limited by unstandardized protocols. Low-load BFR training increased muscle size and strength in limbs located proximal (chest, shoulders) and distal (biceps, triceps) to the restrictive stimulus; while volume-matched exercise in the absence of BFR did not elicit beneficial muscle adaptations. Some of the musculature in the upper body cannot be directly restricted by the application of BFR. Despite this, increases in muscle size and strength were observed in muscles placed under direct and indirect BFR.

ATP is not involved in α1-adrenoceptor-mediated vasoconstriction in resistance arteries.

Recent publications suggest that α1-adrenoceptor stimulation by exogenous agonists such as phenylephrine in resistance arteries cause contraction through the release of ATP from within the vascular smooth muscle cells. This ATP exits the cell through pannexin-1 channels to act back "autocrine-like" on P2 receptors on the smooth muscle that cause the contraction. In this work we directly test this hypothesis by using a selective P2X1 purinoceptor antagonist NF449 (1-10µM) against phenylephrine and ATP concentration-response curves in small mesenteric arteries of the rat and thoracodorsal arteries of the mouse. We show that NF449 is a simple competitive antagonist of ATP with a pKB of 6.43 and 6.41 in rat and mouse arteries, respectively, but did not antagonise phenylephrine concentration-response curves. This work cautions against the growing overstated role of the reputed pannexin-1/ATP release axis following α1-adrenoceptor activation in small resistance arteries.

Effects of acupotomylysis on basic fibroblast growth factor and CD34 levels in rabbits with third lumbar vertebral transverse foramen syndrome.

This study observed the local tissue homogenates in rabbits with third lumbar vertebral transverse foramen syndrome and explored the mechanism of acupotomylysis in local tissue revascularization. Thirty Japanese white rabbits were randomly divided into the following 5 groups of 6 rabbits each: normal, model, acupotomy, electroacupuncture (EA), and acupotomy-EA groups. All except the normal group were comprised of animal models of third lumbar vertebral transverse foramen syndrome prepared by embedding sponge in the left third lumbar transverse process. The rabbits in the acupotomy and EA groups underwent bilateral acupotomylysis intervention; those in the acupotomy-EA group underwent acupotomylysis and EA interventions. On the 28th day after modeling, the double-antibody ELISA was used to detect b-FGF and CD34 levels in the serum and homogenates of a muscle tissue sample from the left side of the third lumbar transverse process. The b-FGF levels in local muscle homogenates were significantly higher in the modeled rabbits than in the normal rabbits (P < 0.01), and the CD34 levels in the modeled group were significantly lower than in the normal group (P < 0.01). The b-FGF and CD34 levels in the EA, acutopomy, and acutopomy-EA groups were significantly lower than those in the modeled group (P < 0.01); the CD34 levels were significantly higher in the acupotomy-EA group than in the model group (P < 0.05); and the differences among the EA, acupotomy, and acupotomy-EA groups were not significant (P > 0.05). In conclusion, acupotomylysis regulates the levels of b-FGF and CD34 levels in serum and muscle tissue as well as local tissue revascularization.

Age-related structural and functional changes of low back muscles.

During aging declining maximum force capacity with more or less unchanged fatigability is observed with the underlying mechanisms still not fully understood. Therefore, we compared morphology and function of skeletal muscles between different age groups. Changes in high-energy phosphate turnover (PCr, Pi and pH) and muscle functional MRI (mfMRI) parameters, including proton transverse relaxation time (T2), diffusion (D) and vascular volume fraction (f), were investigated in moderately exercised low back muscles of young and late-middle-aged healthy subjects with (31)P-MR spectroscopy, T2- and diffusion-weighted MRI at 3T. In addition, T1-weighted MRI data were acquired to determine muscle cross-sectional areas (CSA) and to assess fat infiltration into muscle tissue. Except for pH, both age groups showed similar load-induced MR changes and rates of perceived exertion (RPE), which indicates comparable behavior of muscle activation at moderate loads. Changes of mfMRI parameters were significantly associated with RPE in both cohorts. Age-related differences were observed, with lower pH and higher Pi/ATP ratios as well as lower D and f values in the late-middle-aged subjects. These findings are ascribed to age-related changes of fiber type composition, fiber size and vascularity. Interestingly, post exercise f was negatively associated with fat infiltration with the latter being significantly higher in late-middle-aged subjects. CSA of low back muscles remained unchanged, while CSA of inner back muscle as well as mean T2 at rest were associated with maximum force capacity. Overall, applying the proposed MR approach provides evidence of age-related changes in several muscle tissue characteristics and gives new insights into the physiological processes that take place during aging.

Blood circulation in muscles of the back in scoliosis deformity of the lumbar spine and under conditions of its correction.

Experiments performed on dogs showed that the formation of scoliotic deformity of the lumbar spine sharply affects the hemodynamics of the back muscles, which manifested in asymmetric arterial blood fl ow, increased blood supply to the tissues, and impaired venous outflow. The changes were more pronounced on the apex of epy developing deformity. Correction of scoliotic deformity gradually restored blood circulation in muscles of the back. The use of methods of functional diagnostic for evaluation of the status of blood circulation in the tissues of the back has diagnostic value and allows evaluation of the treatment efficiency.

[Therapeutic options for reconstruction of the dorsal trunk wall]. / Therapieoptionen zur Rekonstruktionen der dorsalen Rumpfwand.

Posterior trunk defects represent a major reconstructive problem, which require the entire armamentarium of the reconstructive surgeon. Given the special anatomy of the back, flap selection includes transposition flaps, perforator flaps, muscle flaps, turn-over flaps and free flaps, eventually with interposition of vein grafts. The majority of the defects can be closed with pedicled muscle or musculocutaneous flaps. In our patient collective, sufficient closure could be obtained with all procedures, except the latissimus dorsi turn-over flap. Based on our clinical experience, we propose an algorithm for closure of posterior trunk defects related to the anatomical region.

Effects of Kinesio® Tape in low back muscle fatigue: randomized, controlled, doubled-blinded clinical trial on healthy subjects.

BACKGROUND: Muscle fatigue of the trunk extensor musculature plays a considerable role in chronic low back pain (LBP). The underlying physiology of fatigue is complex and not fully understood. The Kinesio® Taping (KT) supports damaged structures while allowing mobility and at the same time may influence some of the mechanisms associated with muscle fatigue such as blood flow and proprioception. OBJECTIVE: The aim of this study is to determine the influence of KT on the resistance to fatigue of the lumbar extensor musculature in a sample of young healthy subjects. METHODS: A randomized, controlled, doubled-blinded clinical trial was conducted. Ninety nine healthy subjects were randomized in to the three arms of the study Kinesio® Tape (KT), placebo (P) and control (C). Directly after application of KT we measured lumbar extensor musculature endurance with the Biering-Sorensen test. Subjects and researchers were blinded to the intervention. Time achieved (seconds) was compared between groups with one-way ANOVA with confidence intervals of 95%. RESULTS: There were significant differences between the time achieved in the KT group versus the control group (p < 0.05). The placebo group performed better than the control group but worse than the KT group, these were not significant in either case. CONCLUSIONS: KT appears to improve the time to failure of the extensor muscle of the trunk obtained using the Biering-Sorensen test. These findings suggest that KT influences processes that lead to muscle fatigue and that KT could be effective in the management of LBP.