The beneficial effect of physiotherapy on the cervical spine mobility of ACDF patients and healthy individuals: An original observational cohort comparison research protocol

Purpose: Population aging and certain behaviors associated with modern life are contributing factors for the increasing incidence of degenerative cervical spine conditions (DCSC), and the number of cervical spine surgeries every year is. Our aim was to determine, with an original research protocol, the impact of ACDF and physiotherapy on the range of motion and EMG parameters of patients suffering from DCSC. Patients and Methods: Two comparable subgroups of 29 patients each were recruited for the present investigation. The first cohort was composed of ACDF patients, whereas the second cohort was composed by healthy subjects. Inclinometry/Range of Motion (RoM) analyses of the neck, and cervical muscles electromyography (EMG) were used to evaluate the neck mobility. We investigated the effects of physiotherapy on ROM and EMG results in order to identify possible significant differences between healthy subjects and ACDF patients. Results: A total of 58 patients were included in the final cohort. Extensive statistical analysis disclosed that higher NDI values were associated with a reduction of the Extension and Rotation movements, NDI scores, were found to be negatively associated to EMG voltages for Rotation, independently of the physiotherapy performed either. Extension, Lateral Bending, and Rotation showed significant improvement after just one session of physiotherapy, whereas Flexion and Extension proved to be those that contributed most to the overall neck mobility. Conclusion: The cervical spine fusion contributes to an overall reduction of cervical mobility. This data is confirmed by inclinometer and EMG parameters. Physiotherapy increases neck mobility thus possibly improving the clinical status of patients

Effects of long-term immobilisation on endomysium of the soleus muscle in humans

New Findings: What is the central question of this study? While muscle fibre atrophy in response to immobilisation has been extensively examined, intramuscular connective tissue, particularly endomysium, has been largely neglected: does endomysium content of the soleus muscle increase during bed rest? What is the main finding and its importance? Absolute endomysium content did not change, and previous studies reporting an increase are explicable by muscle fibre atrophy. It must be expected that even a relative connective tissue accumulation will lead to an increase in muscle stiffness. Abstract: Muscle fibres atrophy during conditions of disuse. Whilst animal data suggest an increase in endomysium content with disuse, that information is not available for humans. We hypothesised that endomysium content increases during immobilisation. To test this hypothesis, biopsy samples of the soleus muscle obtained from 21 volunteers who underwent 60 days of bed rest were analysed using immunofluorescence-labelled laminin γ-1 to delineate individual muscle fibres as well as the endomysium space. The endomysium-to-fibre-area ratio (EFAr, as a percentage) was assessed as a measure related to stiffness, and the endomysium-to-fibre-number ratio (EFNr) was calculated to determine whether any increase in EFAr was absolute, or could be attributed to muscle fibre shrinkage. As expected, we found muscle fibre atrophy (P = 0.0031) that amounted to shrinkage by 16.6% (SD 28.2%) on day 55 of bed rest. ENAr increased on day 55 of bed rest (P < 0.001). However, when analysing EFNr, no effect of bed rest was found (P = 0.62). These results demonstrate that an increase in EFAr is likely to be a direct effect of muscle fibre atrophy. Based on the assumption that the total number of muscle fibres remains unchanged during 55 days of bed rest, this implies that the absolute amount of connective tissue in the soleus muscle remained unchanged. The increased relative endomysium content, however, could be functionally related to an increase in muscle stiffness