Physical modalities in musculoskeletal disorders: evidence-based?

Učinkovitost različitih fizikalnih modaliteta koji se primjenjuju u liječenju i rehabilitaciji mišićnokoštanih poremećaja je još uvijek dvojbena. Unatoč poznatim fiziološkim učincima kliničkih podataka o učinkovitosti mnogih tehnika koje se rabe u okviru elektroterapije nema ili su nedostatni. Zbog toga za specifične intervencije često ne možemo dati kliničke preporuke. Zbog tih razočaravajućih rezultata temeljenih na dokazima istraživanja iz područja elektroterapije belgijska vlada je odlučila ne nadoknađivati većinu terapija iz ovoga područja. Vrlo je malo intervencija za mišićnokoštane poremećaje s dobrim odnosnom rizika i dobrobiti za koje je dokazana jasna učinkovitost u randomiziranim kliničkim istraživanjima. Većina studija o niskofrekventnim, srednjefrekvennim i visokofrekventnim strujama pokazala je nedostatak kliničkih znanstvenih dokaza, što je u suprotnosti s njihovom čestom uporabom u cijeloj Europi. Primjena ovih terapija zahtijeva daljnju evaluaciju. Problem većine studija je nedostatak praktične uniformnosti. Dvostruko slijepe studije nisu uvijek moguće, a niti dijagnoza nije uvijek sasvim jasna. Stoga postoji potreba za objektivnijim kliničkim strategijama. Također treba relativizirati neke od rezultata, jer kada nema jasnih dokaza za specifično liječenje, to ne znači da ono ne djeluje.A variety of physical modalities are applied in the treatment and rehabilitation of musculoskeletal disorders, but the efficacy of these passive interventions is still controversial. Despite the well-known physiological effects, there are either no clinical data or there is insufficient clinical information on the effectiveness of many techniques used in electrotherapy. As a consequence, we are often unable to make clinical recommendation regarding specific interventions. Because of these often disappointing results based on evidence-based research in electrotherapy, the Belgian government has decided not to reimburse a large number of treatments in this sector. Interventions that have been demonstrated effective through clear evidence in randomised clinical trials and with a good risk-benefit ratio are rather limited as far as musculoskeletal disorders are concerned. Most studies on low-frequency, medium-frequency (including interferential current) and high-frequency currents show the lack of clinical scientific evidence, which is in contrast with the frequent use of electrotherapy all over Europe. The application of these therapies should be further evaluated. The problem in most studies is the lack of practical uniformity (parameters, frequency, duration, etc.). Double-blind studies are not always possible and the diagnosis is not always very clear. Therefore, there is a need for more objective clinical strategies. We should also relativise some of the results because when there is no clear evidence for a specific treatment, it does not mean that this therapy does not work

Posterior muscle chain activity during various extension exercises: An observational study

Background: Back extension exercises are often used in the rehabilitation of low back pain. However, at present it is not clear how the posterior muscles are recruited during different types of extension exercises. Therefore, the present study will evaluate the myoelectric activity of thoracic, lumbar and hip extensor muscles during different extension exercises in healthy persons. Based on these physiological observations we will make recommendations regarding the use of extensions exercises in clinical practice. Methods. Fourteen healthy subjects performed four standardized extension exercises (dynamic trunk extension, dynamic-static trunk extension, dynamic leg extension, dynamic-static leg extension) in randomized order at an intensity of 60% of 1-RM (one repetition maximum). Surface EMG signals of Latissimus dorsi (LD), Longissimus thoracis pars thoracic (LTT) and lumborum (LTL), Iliocostalis lumborum pars thoracic (ILT) and lumborum (ILL), lumbar Multifidus (LM) and Gluteus Maximus (GM) were measured during the various exercises. Subsequently, EMG root mean square values were calculated and compared between trunk and leg extension exercises, as well as between a dynamic and dynamic-static performance using mixed model analysis. During the dynamic exercises a 2 second concentric contraction was followed by a 2 second eccentric contraction, whereas in the dynamic-static performance, a 5 second isometric interval was added in between the concentric and eccentric contraction phase. Results: In general, the muscles of the posterior chain were recruited on a higher level during trunk extension (mean ± SD, 56.6 ± 30.8%MVC) compared to leg extension (47.4 ± 30.3%MVC) (p ≤ 0.001). No significant differences were found in mean muscle activity between dynamic and dynamic-static performances (p = 0.053). The thoracic muscles (LTT and ILT) were recruited more during trunk extension (64.9 ± 27.1%MVC) than during leg extension (54.2 ± 22.1%MVC) (p = 0.045) without significant differences in activity between both muscles (p = 0.138). There was no significant differences in thoracic muscle usage between the dynamic or dynamic-static performance of the extension exercises (p = 0.574).Lumbar muscle activity (LTT, ILL, LM) was higher during trunk extension (70.6 ± 22.2%MVC) compared to leg extension (61.7 ± 27.0%MVC) (p = 0.047). No differences in myoelectric activity between the lumbar muscles could be demonstrated during the extension exercises (p = 0.574). During each exercise the LD (19.2 ± 13.9%MVC) and GM (28.2 ± 14.6%MVC) were recruited significantly less than the thoracic and lumbar muscles. Conclusion: The recruitment of the posterior muscle chain during different types of extension exercises was influenced by the moving body part, but not by the type of contraction. All muscle groups were activated at a higher degree during trunk extension compared to leg extension. Based on the recruitment level of the different muscles, all exercises can be used to improve the endurance capacity of thoracic muscles, however for improvement of lumbar muscle endurance leg extension exercises seem to be more appropriate. To train the endurance capacity of the LD and GM extension exercises are not appropriate

Nef interferes with development of thymic T cell precursors: differential mechanisms in HIV and SIV

BioMed Central Open acces

Spectrum of topics for World congresses and other activities of the International Society for Physical and Rehabilitation Medicine (ISPRM): A first proposal

Background: One of the objectives of the International Society for Physical and Rehabilitation Medicine is to improve the continuity of World Congresses. This requires the development of an abstract topic list for use in congress announcements and abstract submissions. Methods: An abstract topic list was developed on the basis of the definitions of human functioning and rehabilitation research, which define 5 main areas of research (biosciences in rehabilitation, biomedical rehabilitation sciences and engineering, clinical Physical and Rehabilitation Medicine (PRM) sciences, integrative rehabilitation sciences, and human functioning sciences). For the abstract topic list, these research areas were grouped according to the proposals of congress streams. In a second step, the first version of the list was systematically compared with the topics of the 2003 ISPRM World Congress. Results: The resulting comprehensive abstract topic list contains 5 chapters according to the definition of human functioning and rehabilitation research. Due to the high significance of clinical research, clinical PRM sciences were placed at the top of the list, comprising all relevant health conditions treated in PRM services. For congress announcements a short topic list was derived. Discussion: The ISPRM topic list is sustainable and covers a full range of topics. It may be useful for congresses and elsewhere in structuring research in PRM