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Introduction: Hamstring injuries are among the most common injuries in soccer players. Especially the danger of hamstring injuries increases in the final third of each half, with the biceps femoris muscle being highly susceptible, but currently there is no supporting evidence in soccer players. It is important to investigate to provide a basis for further clinical investigations in order to reduce the risk of hamstring injuries.
Objective: To investigate a soccer-specific muscle fatigue protocol has an effect on the activation patterns of the biceps and semitendinosus muscles and correlates with the subjectively perceived exertion of the soccer players.
Methods: 19 healthy soccer players aged 19 - 35 years were included and underwent a standardized procedure that included: (1) performance of the nordic hamstring curls (NHC) and a 10m sprint (pre-test), (2) a soccer-specific muscle fatigue loading protocol for 30 minutes with subsequent rating of perceived exertion (RPE), (3) re-assessed like pre-assessment (post- test). Electromyography (EMG) data were recorded the biceps and
semitendinosus muscles of both legs. Two parameters were analyzed: the peak amplitude during the NHC and the mean amplitude during the 10m sprint.
Results: The RPE score (9.5, p<0.001) and 10m sprint shows significant differences between pre- and post- test for the biceps (standing leg: -82.45, kicking leg: -81.77; p<0.01) and semitendinosus muscle (standing leg: -60.08, p=0.001); kicking leg: -65.30, p=0.03). Significant correlation exists between RPE score and biceps muscles at posttest (standing leg: r=-0.54, kicking leg: r=-0.51; p<0.05).
Conclusion: Muscle fatigue leads to significant changes in the activation behavior of the hamstring muscles. In particular, the biceps muscle shows a correlation with perceived exertion, the higher the exertion, the lower the muscle activity. This may help explain the higher prevalence of the biceps muscle in hamstring injuries and offers a basis for further clinical investigations
Comparison of quantitative sensory testing profles between people living in Germany and Australia
(2021)
Abstract
Background
The clinical presentation of neck-arm pain is heterogeneous with varying underlying pain types (nociceptive/neuropathic/mixed) and pain mechanisms (peripheral/central sensitization). A mechanism-based clinical framework for spinally referred pain has been proposed, which classifies into (1) somatic pain, (2) neural mechanosensitivity, (3) radicular pain, (4) radiculopathy and mixed pain presentations. This study aims to (i) investigate the application of the clinical framework in patients with neck-arm pain, (ii) determine their somatosensory, clinical and psychosocial profile and (iii) observe their clinical course over time.
Method
We describe a study protocol. Patients with unilateral neck-arm pain (n = 180) will undergo a clinical examination, after which they will be classified into subgroups according to the proposed clinical framework. Standardized quantitative sensory testing (QST) measurements will be taken in their main pain area and contralateral side. Participants will have to complete questionnaires to assess function (Neck Disability Index), psychosocial factors (Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Depression, anxiety and stress scale), neuropathic pain (Douleur Neuropathique 4 Questions, PainDETECT Questionnaire) and central sensitization features (Central Sensitization Inventory). Follow-ups at three, six and 12 months include the baseline questionnaires. The differences of QST data and questionnaire outcomes between and within groups will be analyzed using (M)AN(C)OVA and/or regression models. Repeated measurement analysis of variance or a linear mixed model will be used to calculate the differences between three, six, and 12 months outcomes. Multiple regression models will be used to analyze potential predictors for the clinical course.
Conclusion
The rationale for this study is to assess the usability and utility of the proposed clinical framework as well as to identify possible differing somatosensory and psychosocial phenotypes between the subgroups. This could increase our knowledge of the underlying pain mechanisms. The longitudinal analysis may help to assess possible predictors for pain persistency.
Currently, the treatment of musicians is an interprofessional approach. Playing-related health complaints may impact the performance of a musician. In Germany, a medical consulting hour for musicians exists, but those for athletes in sports medicine are not so common. The diagnosing and treatment procedure within the physiotherapy consultation for musicians follows a specific concept-b and requires knowledge of instruments and musician-specific complaints. Based on the consulting hour in a clinic in Osnabrueck, 614 case reports were part of this sample, of which 558 data sets were complete. The focus of the analysis is the instrument and the primary complaint. Also, the type of therapy is characterized, and the amount is calculated. Primary complaints of musicians, in general, are found most frequently in the spine and upper extremity. Musician complaints are different between instruments. Instrumentalists have a significantly higher chance to suffer from a primary complaint in the area of the upper extremity. Furthermore, the groups without an instrument (e.g., singing or dancing) are developing complaints in the anatomical area which they primarily use. Therefore, these types of therapy were used: physiotherapy, manual therapy, and osteopathy with an average of 5.9 treatment units. This study underpinned the importance of musician-specific physiotherapy as a profession to treat musicians. Also, an interdisciplinary approach is necessary to treat all aspects of complaints.
BACKGROUND: Muscle fatigue seems to be a risk factor in the development of performance-related musculoskeletal disorders (PRMDs) in musicians, but it is unclear how muscle activity characteristics change between musicians with and without PRMDs over a prolonged playing period.
PURPOSE: To investigate muscle activity patterns in muscles of the arms, shoulder, and back of high string musicians during prolonged performance.
METHODS: Fifteen professional or university high string musicians were divided into PRMD and non-PRMD groups. All musicians played a chromatic scale, then an individual “heavy” piece for 1 hr, and finally the chromatic scale again. Surface electromyography (sEMG) data were recorded from 16 muscles of the arm, shoulder, and trunk on both sides of the body. Two parameters were analyzed: the percentage load in relation to the respective maximum force during the chromatic scale, and the low-frequency spectrum to determine the fatigue behavior of muscles during the 1-hr play.
RESULTS: Changes in muscle activation patterns were observed at the beginning and end of the trial duration; however, these varied depending on whether musicians had PRMDs or no PRMDs. In addition, low-frequency spectrum changes were observed after 1 hr of playing in the PRMD musicians, consistent with signs of muscular fatigue.
CONCLUSION: Differences in muscle activity appear between high string musicians with and without PRMDs as well as altered frequency spectrum shifts, suggesting possible differential muscle fatigue effects between the groups. The applied sEMG analysis proved a suitable tool for detailed analysis of muscle activation characteristics over prolonged playing periods for musicians with and without PRMDs.
AIM: In this prospective longitudinal study, the physical and psychological health status of music students is assessed at the beginning of their university music study and tracked over time. Analysis strategies and interim results from the first-year cohort, including 1-year incidences, monthly prevalences, and predictors of developing musculoskeletal health complaints (MHC), are presented.
METHODS: This prospective longitudinal study is calculated to enlist a total sample of 370 participants, including musicians and non-musicians, over 5 years. Baseline measurements include a self-designed questionnaire, core strength endurance, hypermobility, finger-floor-distance, motor control, mechanosensitivity, health-related quality of life (SF36), and stress and coping inventory (SCI). The occurrence of MHC is based on monthly online questionnaires.
RESULTS: The first-year subcohort enrolled 33 music students and 30 non-music control students. The mean monthly completion rate for the questionnaire was 55.7±8.7%. At baseline, music students showed significantly more stress symptoms, reduced physical function¬ing, and increased bodily pain compared to control students. The 1-year incidence of MHC was 59% for music students and 44% for controls. Risk factors for MHC included being a music student, previous pain, reduced physical functioning, stress symptoms, reduced emotional functioning, and mechanosensitivity. Being a music student, physical functioning, sleep duration, positive thinking, and general mechanosensitivity had a predictive ability of 0.77 (ROC curve) for MHC.
CONCLUSION: A total of 63 students enrolled in the first cohort is in line with the precalculated sample size. This prospective study design enables the measurement of MHC incidence and provides insight into mechanisms in the development of MHC among music students, including the interaction of physical, psychological, and psychosocial factors.
BACKGROUND: The Craniofacial Pain and Disability Inventory (CF-PDI) is a cross-culturally adapted instrument designed from a biopsychosocial perspective to measure pain, disability, and function in orofacial head and neck pain with shown psychometric properties; however, the German cross-cultural adaption is lacking.
OBJECTIVES: To carry out a transcultural translation of CF-PDI into German and assess its psychometric properties in patients with painful temporomandibular disorders (TMD) with respect to construct and clinical validity, internal consistency and reproducibility.
STUDY DESIGN: Multicenter, prospective, cross-sectional design.
SETTING: Patients (n = 398) were recruited from dental and physical therapy clinics in middle and south Germany.
METHODS: Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). We investigated know-group validity by means of the scale’s potential to discriminate between affected and unaffected subjects. Multiple linear regression analysis was used to estimate convergent validity. We tested test-retest reliability by the intraclass correlation coefficient and the Internal consistency by Cronbach’s alpha, or each dimension separately, and the total score. Multiple linear regression analysis was used to estimate convergent validity.
RESULTS: Two hundred forty-six heterogeneous chronic craniofacial pain patients and 152 patients without complaints were recruited from the middle and south of Germany. The German version CF-PDI-G presents 21 items, 4 factors, and adequate psychometric properties. The test-retest reliability and internal consistency of the CF-PDI-G were both excellent for the entire instrument and also for all sub-scales (intraclass correlation coefficient [ICC] > 0.90) except for the comorbidities and interference with work which was acceptable (ICC = 0.69). Standard error of the measurement (SEM) and minimal detectable change values are sufficiently low. Assessment of clinical validity shows good potential of discrimination and classification into categories “no,” “mild,” “moderate,” and “severe.” The multiple linear regression model showed a strong association between neck disability index, Visual Analog Scale, and anamnestic questionnaire (supporting the scale’s convergent validity).
LIMITATIONS: Our sample has a higher prevalence of women and the sample was not recruited consecutively, which may lead to a biased estimation of psychometric properties.
CONCLUSIONS: The CF-PDI-G represents valid and reliable instrument to assess pain and disability in patients with orofacial pain and headache suitable for research and clinical practice.
Objective
To identify assessment tools used to evaluate patients with temporomandibular disorders (TMD) considered to be clinically most useful by a panel of international experts in TMD physical therapy (PT).
Methods
A Delphi survey method administered to a panel of international experts in TMD PT was conducted over three rounds from October 2017 to June 2018. The initial contact was made by email. Participation was voluntary. An e-survey, according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), was posted using SurveyMonkey for each round. Percentages of responses were analysed for each question from each round of the Delphi survey administrations.
Results
Twenty-three experts (completion rate: 23/25) completed all three rounds of the survey for three clinical test categories: 1) questionnaires, 2) pain screening tools and 3) physical examination tests. The following was the consensus-based decision regarding the identification of the clinically most useful assessments. (1) Four of 9 questionnaires were identified: Jaw Functional Limitation (JFL-8), Mandibular Function Impairment Questionnaire (MFIQ), Tampa Scale for Kinesiophobia for Temporomandibular disorders (TSK/TMD) and the neck disability index (NDI). (2) Three of 8 identified pain screening tests: visual analog scale (VAS), numeric pain rating scale (NRS) and pain during mandibular movements. (3) Eight of 18 identified physical examination tests: physiological temporomandibular joint (TMJ) movements, trigger point (TrP) palpation of the masticatory muscles, TrP palpation away from the masticatory system, accessory movements, articular palpation, noise detection during movement, manual screening of the cervical spine and the Neck Flexor Muscle Endurance Test.
Conclusion
After three rounds in this Delphi survey, the results of the most used assessment tools by TMD PT experts were established. They proved to be founded on test construct, test psychometric properties (reliability/validity) and expert preference for test clusters. A concordance with the screening tools of the diagnostic criteria of TMD consortium was noted. Findings may be used to guide policymaking purposes and future diagnostic research.
Objectives
To develop a time-efficient motor control (MC) test battery while maximising diagnostic accuracy of both a two-level and three-level classification system for patients with non-specific low back pain (LBP).
Design
Case–control study.
Setting
Four private physiotherapy practices in northern Germany.
Participants
Consecutive males and females presenting to a physiotherapy clinic with non-specific LBP (n=65) were compared with 66 healthy-matched controls.
Primary outcome measures
Accuracy (sensitivity, specificity, Youden index, positive/negative likelihood ratio, area under the curve (AUC)) of a clinically driven consensus-based test battery including the ideal number of test items as well as threshold values and most accurate items.
Results
For both the two and three-level categorisation system, the ideal number of test items was 10. With increasing number of failed tests, the probability of having LBP increases. The overall discrimination potential for the two-level categorisation system of the test is good (AUC=0.85) with an optimal cut-off of three failed tests. The overall discrimination potential of the three-level categorisation system is fair (volume under the surface=0.52). The optimal cut-off for the 10-item test battery for categorisation into none, mild/moderate and severe MC impairment is three and six failed tests, respectively.
Conclusion
A 10-item test battery is recommended for both the two-level (impairment or not) and three-level (none, mild, moderate/severe) categorisation of patients with non-specific LBP.