The Use of Photomedicine in Musculoskeletal Pain

Musculoskeletal pain is a major cause of disability. Myofascial trigger points (MTrPs) in particular are a common source of pain in a substantial number of patients presenting at a pain clinic. Many different invasive and non-invasive forms have been advocated to the treatment of MTrPs. However, favourable outcome rates are inconsistent and some of these treatment forms described are often painful and have potentially dangerous side effects. Photomedicine including the coherent light sources (lasers) and more recently, non-coherent light sources have been reported to be beneficial in soft tissue lesions including MTrPs. Their beneficial therapeutic effects can be obtained without undesired effects. The main intentions of this chapter are to bring the attention of the doctors and physical therapists to the scientific approach of photomedicine, in particular laser therapy for the relief of pain arising from MTrPs, and to demonstrate how this type of therapy can be utilized in a rational manner for the relief of musculoskeletal pain. In addition, it has been found necessary to include or to start with an overview of the recently recognized diagnostic and therapeutic importance of MTrPs. Attention will therefore first be drawn mainly to incidence, types, aetiology, clinical diagnostic criteria and conventional forms of MTrPs

Clinical and histopathological responses to bee venom phonophoresis in treating venous and diabetic ulcers: a single-blind randomized controlled trial

IntroductionChronic venous and diabetic ulcers are hard to treat that cause patients long time of suffering as well as significant healthcare and financial costs.PurposeThe conducted study was to evaluate the efficacy of bee venom (BV) phonophoresis on the healing of chronic unhealed venous and/or diabetic foot ulcers Also, to compare the healing rate of diabetic and venous ulcers.MethodologyThe study included 100 patients (71 males and 29 females) with an age range of 40-60 years' old who had chronic unhealed venous leg ulcers of grade I, grade II, or diabetic foot ulcers with type II diabetes mellitus. They randomly assigned into four equal groups of 25: Group A (diabetic foot ulcer study group) and group C (venous ulcer study group) who both received conservative treatment of medical ulcer care and phonophoresis with BV gel, in addition to group B (diabetic foot ulcer control group) and group D (venous ulcer control group) who both received conservative treatment of medical ulcer care and received ultrasound sessions only without BV gel. Wound surface area (WSA) and ulcer volume measurement (UVM) were used to assess the ulcer healing pre-application (P0), post-6 weeks of treatment (P1), and after 12 weeks of treatment (P2). In addition to Ki-67 immunohistochemistry was used to evaluate the cell proliferative in the granulation tissue of ulcers pre-application (P0) and after 12 weeks of treatment (P2) for all groups.ResultsThis research revealed a statistical significance improvement (p ≤ 0.0) in the WSA, and UVM with no significant difference between study groups after treatment. Regarding Ki-67 immunohistochemistry showed higher post treatment values in the venous ulcer group in comparison to the diabetic foot ulcer group.ConclusionBee venom (BV) provided by phonophoresis is effective adjuvant treatment in accelerating venous and diabetic foot ulcer healing with higher proliferative effect on venous ulcer.Clinical trial registrationwww.ClinicalTrials.gov, identifier: NCT05285930

Effect of Low Versus High-Heeled Footwear on Spinopelvic Alignment at Different Phases of Menstrual Cycle in Young Adult Women: A Biopsychosocial Perspective

High-heeled shoes adversely affect spinal curvature, increase the risk of low back pain, and disturb the normal gait pattern. The purpose of this study was to examine, from a biopsychosocial point of view, the combined effect of wearing two different heel heights and of hormonal oscillation throughout different phases of the menstrual cycle on spinopelvic alignment. Notably, 70 females with an average age of 20.42 ± 1.51 years participated in this study, wearing each female two different heel heights as follows: low (2.5 cm) and high (7 cm). Spinopelvic alignment was evaluated by rasterstereography formetric 3D analysis during early follicular, ovulatory, and mid-luteal phases of the menstrual cycle. Statistical analysis showed that there was no significant difference (p > 0.05) on spinopelvic alignment [kyphotic angle (KA), trunk inclination (TI), and pelvic inclination] between wearing low- or high-heeled shoes during early follicular, ovulatory, and mid-luteal phases of the menstrual cycle. Considering that high-heeled shoes are traditionally associated with femininity, body image, beauty, and charm, this research has important biopsychosocial implications that should be explored in detail in future studies

CROSS-VALIDATION OF ANTHROPOMETRIC MEASURES AGAINST BODY MASS INDEX FOR THE ASSESSMENT OF OBESITY IN CHILDREN

Background: It goes without saying that central or upper body adiposity leads to increased risks of obesity-associated metabolic complications. Direct methods of measurement of central obesity are not practical for field studies due to technical difficulties and cost. Thus, the urge to depend on anthropometry is going larger. The purposes of the study were to evaluate the relations between different anthropometry and to predict and cross-validate these measures. Methods: Subjects participating in the study included only 71 boys from different grades (aged 6-12 years). The following anthropometric measurements were measured and calculated: body mass index(BMI), waist circumference(WC), waist to hip ratio(WHR), and waist to height ratio(WHtR). Results: WC was the best single predictor of obesity, explaining 67.4% (r=0.67)of its variance while WHR explained 0.6% (r=0.006)and WHtR explained 7.3%.(r=0.07) Following quadratic regression and cross-validation techniques, it was obvious that WC better explained 77.3%(r=0.77) with p<0.05 of the variance of BMI, while WHtR explained 11.5% (r=0.11) with p<0.961, and WHR explained 16.7% (r=0.16)with p<0.546. Conclusion: Collinearity between body mass index(BMI) and waist circumference (WC) does exist, but it is recommended to use Waist circumference associated with body mass index at a young age due to the period of intense growth

EFFECT OF PULSED MAGNETIC FIELD ON PEAK TORQUE OF QUADRICEPS/HAMSTRING MUSCLES AND KNEE PROPRIOCEPTION IN ATHLETIC SUBJECTS: A RANDOMIZED CONTROLLED STUDY

Background: Many therapeutic uses for Pulsed magnetic fields have been extensively studied. Beneficial effects on the musculoskeletal system were established including bone healing, pain relief, and inflammatory conditions. The study aimed at investigating the possible effects of the pulsed magnetic field on quadriceps muscle torque, hamstring muscle torque and knee proprioception accuracy in athletic subjects. Methods: A randomized controlled trial which was carried out at the Faculty of Medical Rehabilitation Sciences, Taibah University, Saudi Arabia. Thirty healthy male athletic subjects, aging from 18 – 24 years were divided into two groups, study group (15 subjects) & control group (15 subjects). The pulsed magnetic field was applied for subjects of intervention group, while control group participants received sham pulsed magnetic field for 12 sessions over a period of 4 weeks. Quadriceps muscle torque, hamstring muscle torque & knee proprioception accuracy were measured before & after treatment for all participants using Biodex system 4 pro isokinetic dynamometer. Results: Multiway ANOVA was carried out to detect any significant differences within and between groups. Statistically significant differences between study and control groups were found after pulsed magnetic field application in quadriceps peak torque (at 60 and 120deg/sec) & hamstring peak torque (at 60 and 120deg/sec) and in knee proprioception accuracy (p-value was 0.004, 0.0001, 0.02, 0.03, 0.0001 respectively). Conclusion: Pulsed magnetic field has beneficial effects on quadriceps muscle peak torque, hamstring muscle peak torque and knee proprioception accuracy in healthy athletic subjects and can be advised as an adjunctive tool in rehabilitation programs

Effect of high intensity laser in the treatment of myofascial trigger points in symptomatic knee osteoarthritis: A randomized single-blinded controlled trial

Background: Osteoarthritis (OA) is one of the most prevalent causes of musculoskeletal pain and disability among the middle age and elderly population. It significantly affects the overall quality of life of the affected individuals. Objectives: To find out the impact of high intensity laser therapy (HILT) on myofascial trigger points (MTrPs) in symptomatic knee OA. Methods: This is a single-blinded pre–post randomized experimental trial. A total of 40 patients, both male and female, falling within the age group of 35-55 years, BMI 25–29.9 Kg/Cm2, diagnosed with bilateral knee osteoarthritis (grade 2), were recruited as participants of the study. All the participants were clinically evaluated for the signs and symptoms of myofascial pain, tenderness over the vastus medialis muscle and the medial head of the gastrocnemius muscle. The participants were randomly allocated into two groups with n=20 in each group. The participants of the experimental group received high-power laser therapy and underwent exercises on the MTrPS of the vastus medialis and the medial head of the gastrocnemius muscle. The participants of the control group received placebo laser "sham laser" and underwent exercises for the vastus medialis and the medial head of the gastrocnemius muscle. A blood cortisol level test, pressure algometer, digital electronic goniometer, and the KOOS-PS questionnaire were used to measure the pain level, pain threshold, knee ROM, and knee function. Outcome assessment was done at Day 0 and post intervention at the end of 4 weeks. Results: The MANOVA test revealed that both groups improved significantly in all parameters at week 4, with the HILT group improving more than the sham group in blood cortisol levels, pressure algometer measures, knee passive ROM, and KOOS scores (P < .05). Conclusion: HILT is an efficient approach in the treatment of MTrPs in knee OA

Level of disability and associated factors with musculoskeletal disorders among supermarket cashiers

ObjectivesThis study aimed to determine the severity of symptoms and the level of disability or difficulty associated with MSDs in the neck, shoulders, upper limbs, lower back, and lower limbs as well as the factors associated with MSDs.Material and MethodsThis investigation collected demographic, health (36-Item Short Form Survey [SF-36]), and occupational related-factors for supermarket cashiers through the administration of several questionnaires, including the Oswestry Disability Index (ODI), Disabilities of the Arm, Shoulder and Hand (DASH), Neck Disability Index (NDI), Lower Extremity Functional Scale (LEFS), and Numeric Rating Scale (NRS) for pain.ResultsOne hundred ninety-three supermarket cashiers participated in this study. The mean scores for disability levels included NDI (M±SD 18.62±14.57), ODI (M±SD 20.74±13.89), DASH (M±SD 15.08±13.90), and LEFS (M±SD 63.06±14.24). Regression analyses demonstrated the existence of significant relationships between the experience of MSDs and several other factors, including the number of working days per week, the preferred working position, marital status and the need for awkward positions.ConclusionsThe results indicate MSDs that signified a mild disability level among young participants. The number of working days per week, the preferred working position, the need to assume awkward positions, and marital status were significantly associated with MSDs. The findings indicated the need for preventive to avoid or minimize the prevalence of MSDs among supermarket cashiers