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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.
Die Lumbale Spinalkanalstenose (LSS) bezeichnet eine symptomatische Verengung des Spinalkanals aufgrund einer kongenitalen Erkrankung (primäre LSS) oder eines degenerativen Prozesses (sekundäre LSS). Laut Schätzungen unterziehen sich 40 % aller von LSS betroffenen Patienten innerhalb der ersten 10 Jahre einem chirurgischen Eingriff. Ziel dieses Reviews ist, die Effektivität einer Rehabilitation, einschließlich individualisierter Physiotherapie, mit der herkömmlichen Versorgung nach einer Operation der LSS zu vergleichen.
Die Datenbanken CENTRAL, MEDLINE, DIMDI, PEDro und PubMed wurden systematisch nach randomisierten kontrollierten Studien durchsucht, die bis November 2018 durchgeführt wurden. Vier Studien wurden in den Review eingeschlossen. Die Gesamtqualität der Evidenz erwies sich dabei als moderat. Die Interventionen erfolgten unmittelbar während des Krankenhausaufenthalts oder innerhalb von 6–12 Wochen postoperativ und beinhalteten statt individualisierter Physiotherapie lediglich unspezifische Gruppentherapie. Die Kontrollgruppen erhielten herkömmliche Versorgung oder Empfehlungen zum postoperativen Verhalten. Die Analyse ergab keine Unterschiede zwischen den Gruppen in Bezug auf funktionellen Status und Rückenschmerzen kurz- und langfristig. Lediglich bezüglich Beinschmerzen zeigte sich eine signifikante Differenz zugunsten der Interventionsgruppe (SMD –0,22, 95 % KI –0,43 bis –0,01).
Nicht individuelle Physiotherapie zeigt demnach im Vergleich zur herkömmlichen Versorgung keine kurzfristigen Effekte hinsichtlich Funktion und Schmerz, jedoch einen kleinen klinisch relevanten und signifikanten langfristigen Effekt im Hinblick auf Beinschmerzen. Die geringe Anzahl an eingeschlossenen Studien und die moderate Qualität der Evidenz unterstreichen die dringende Notwendigkeit qualitativ hochwertiger Studien, die die Wirkung einer individualisierten, patientenzentrierten und evidenzbasierten Physiotherapie untersuchen.
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.
The primary objective of this study was to determine the structural and known-group validity as well as the inter-rater reliability of a test battery to evaluate the motor control of the craniofacial region. Seventy volunteers without TMD and 25 subjects with TMD (Axes I) per the DC/TMD were asked to execute a test battery consisting of eight tests. The tests were video-taped in the same sequence in a standardised manner. Two experienced physical therapists participated in this study as blinded assessors. We used exploratory factor analysis to identify the underlying component structure of the eight tests. Internal consistency (Cronbach's α), inter-rater reliability (intra-class correlation coefficient) and construct validity (ie, hypothesis testing-known-group validity) (receiver operating curves) were also explored for the test battery. The structural validity showed the presence of one factor underlying the construct of the test battery. The internal consistency was excellent (0.90) as well as the inter-rater reliability. All values of reliability were close to 0.9 or above indicating very high inter-rater reliability. The area under the curve (AUC) was 0.93 for rater 1 and 0.94 for rater two, respectively, indicating excellent discrimination between subjects with TMD and healthy controls. The results of the present study support the psychometric properties of test battery to measure motor control of the craniofacial region when evaluated through videotaping. This test battery could be used to differentiate between healthy subjects and subjects with musculoskeletal impairments in the cervical and oro-facial regions. In addition, this test battery could be used to assess the effectiveness of management strategies in the craniofacial region.
Zielsetzung
Bis dato konnte keine Studie eine Veränderung der Druckempfindlichkeit der myofaszialen Tender- oder Triggerpunkte (MTrP) bei Patienten mit kraniomandibulärer Dysfunktion (CMD) im extratrigeminalen Versorgungsgebiet nachweisen. Ziel dieser Studie war herauszufinden, ob die Druckempfindlichkeit der MTrP bei CMD-Patienten sowohl im trigeminalen als auch im extratrigeminalen Versorgungsgebiet im Vergleich zu gesunden Kontrollen erhöht ist. Außerdem sollte untersucht werden, inwieweit MTrP als Marker geeignet sind, eine Hyperalgesie bei CMD-Patienten zu diagnostizieren.
Probanden und Methoden
Für die Studie wurden 34 CMD-Patienten und 30 Probanden ohne CMD rekrutiert. In beiden Gruppen wurde die mechanische Schmerzschwelle an trigeminalen und extratrigeminalen MTrP gemessen und verglichen. Zusätzlich wurde mittels ROC-Kurve untersucht, welcher Marker am besten geeignet ist, CMD-Patienten als hyperalgetisch zu klassifizieren.
Ergebnis
Die Druckempfindlichkeit aller MTrP der trigeminalen und extratrigeminalen Körperregionen war in der CMD-Gruppe signifikant erhöht. Selbst nach Korrektur für multiples Testen blieben die meisten Effekte signifikant. Von den untersuchten MTrP war der M. trapezius am besten geeignet, CMD-Patienten als hyperalgetisch zu klassifizieren. Bei einer falsch-positiven Rate <5 % wurden ca. 42 % der CMD-Patienten als hyperalgetisch klassifiziert.
Schlussfolgerung
Die signifikanten Unterschiede der Druckempfindlichkeit der MTrP in trigeminalen und extratrigeminalen Körperregionen lassen auf eine Hyperalgesie bei CMD-Patienten schließen. Diese kann möglicherweise mit dem Marker des M. trapezius diagnostiziert werden. Hierzu sind jedoch weitere Studien notwendig, die u. a. geschlechts- und altersspezifische Referenzwerte ermitteln.
Introduction
Tests to evaluate the integrity of the alar ligaments are important clinical tools for manual therapists, but there is limited research regarding their validity.
Method
A single blinded examiner assessed alar ligament integrity using the lateral shear test (LST), rotation stress test (RST) and side-bending stress test (SBST) on a sample of convenience comprising 7 subjects with MRI confirmed alar ligament lesions and 11 healthy people. Alar ligament lesions were identified using both supine and high-field strength upright MRI.
Results
The RST had a sensitivity of 80% and a specificity of 69.2%. The SBST and the LST both showed a sensitivity of 80% and a specificity of 76.9%. In cases where all three tests were positive, the specificity increased to 84.6%.
Discussion
Tests of manual examination of alar ligament integrity have some diagnostic utility; however, these findings require further corroboration in a larger sample.
Rationale: Three-dimensional (3D) motion analysis has proved helpful in the diagnosis of different musculoskeletal syndromes and identifying injurious movement patterns in high string players. Furthermore, an optoelectronic 3D motion capture system allows an accurate and objective assessment of upper body posture and motion during violin and viola performance. However, no reference upper body model of high string players has been proposed as yet. Moreover, a more physiological shoulder model that separates the joints of the shoulder complex has not been reported. Especially in view of given the role of the scapula in the normal movement of the humerus, it cannot be disregarded when evaluating musculoskeletal strain in the shoulder.
The International Society of Biomechanics recommends definitions of joint coordinate systems for the report of upper body joint motion using anatomical landmarks as reference for the placement of surface markers. Using markers on the skin for some of the proposed locations is, however, inappropriate when an instrument is being played. There are skin movement artifacts, e. g. caused by the movement of the scapula underneath the skin, whereas some markers interfere with the instrument on the shoulder or might be occluded by the bowing arm in motion.
Purpose: The aim of this study was to develop a marker-based method for quantifying 3D upper body kinematics of high string players and to demonstrate its clinical feasibility in violin and viola performance. The method is intended to provide an objective evaluation of high string players’ motor strategies, especially in the shoulder complex, while minimizing skin movement artifacts, marker occlusions and limitations in instrument placement.
Methods: A custom marker set was developed consisting of thirty-one single markers to define the anatomical coordinate systems of sixteen upper body segments including the pelvis, thorax, spine and head, as well as both scapulae, upper arms, forearms and hands. Twenty-one of these markers as well as two pre-built and four custom-made rigid marker clusters were used for tracking the segment motions.
Twelve professional violinists without history of musculoskeletal or neurological problems were recruited for assessing the clinical feasibility of the method. They were asked to perform a single sequence of two consecutive musical notes on each of two adjacent strings (G- and D-string) in real time, played at 50 bpm with tempo audibly regulated by a metronome, and using a standardized violin and bow. The participants played up- and down-bow alternately using the whole length of the bow.
A custom biomechanical model was applied to the motion capture data and the rotation angles of fifteen joints were calculated. The location of each glenohumeral joint rotation center was computed by upper arm movements with respect to the scapula based on a functional method. For a description of the motion patterns, minimum, maximum and range of angular motion were averaged across participants for each string and rotation. Inter-subject variability was assessed by calculating the standard deviation (SD) at each sample of the angle-time series between participants for each rotation and for both strings. Then SD was averaged over sequences for each rotation and string. For comparing mean rotation angles between strings over time, random effect models were used.
Results: The highest range of motion was observed in the right elbow flexion and right wrist flexion/extension. Also, high ranges of motion (> 10°) were found in all right glenohumeral rotations and right wrist deviation and pronation/supination. In conclusion, lumbar and thoracic spine, thorax, neck, and left upper limb were quite static, while large motion occurred in the right upper limb during up and down bowing.
Most rotation angles showed a reasonable inter-subject variability except for left and right glenohumeral plane of elevation as well as left glenohumeral internal/external rotation, and left and right wrist pronation/supination (> 10°).
Significant differences in the rotation angles between G- and D-string bowing were detected especially in the left wrist and right shoulder joints.
Conclusions: This is the first study that used quantitative 3D analysis to explore the upper body kinematics of high string players during performance, providing a detailed view of the motor control in the shoulder as well as in the lumbar and thoracic spine. The biggest advantage over previously published methods is the more physiological shoulder and spine models while providing a simple application.
The method was found to give consistent motion patterns across participants and to be sensitive to differences between adjacent strings. Although the method appears to be valid, more rigorous validation is necessary. Since there is no gold standard with which we could compare results, we were only able to assess the clinical feasibility. We believe that our method represents a good compromise between accuracy and practicability for clinical application.
Due to the inclusion of multi-segmented shoulder and spine models, it will improve understanding of the motor strategies adopted by high string players and may contribute to injury prevention, diagnosis and treatment.
Despite normal neurological bedside and electrodiagnostic, some patients with non-specific neck arm pain (NSNAP) have heightened nerve mechanosensitivity upon neurodynamic testing [1, 2]. It remains however unclear whether this is associated with a minor nerve injury. The aim of this study was to evaluate potential differences in somatosensory function among patients with unilateral NSNAP with and without positive neurodynamic tests and healthy controls.
Quantitative sensory testing was performed in 40 patients with unilateral NSNAP; 23 with positive upper limb neurodynamic tests (ULNTPOS) and 17 with negative neurodynamic tests (ULNTNEG). The protocol comprised thermal and mechanical detection and pain thresholds as well as mechanical pain sensitivity, wind-up ratio and dynamic mechanical allodynia. All parameters were measured in the maximal pain area on the affected side as well as over the corresponding area on the unaffected side. Symptom severity, functional deficits, psychological parameters, quality of life and sleep disturbance were also recorded.
Fifty-seven percent of patients with NSNAP had positive neurodynamic tests despite normal bedside neurological integrity tests and nerve conduction parameters. Clinical profiles did not differ between patient groups. Somatosensory profiling revealed a more pronounced loss of function phenotype in ULNTPOS patients compared to healthy controls. Hyperalgesia (cold, heat and pressure pain) was present bilaterally in both NSNAP group. The ULNTNEG subgroup represented an intermediate phenotype between ULNTPOS patients and healthy controls in both thermal and pressure pain thresholds as well as mechanical detection thresholds.
In conclusion, heightened nerve mechanosensitivity was present in over half of patients with NSNAP. Our data suggest that NSNAP presents as a spectrum with some patients showing signs suggestive of a minor nerve dysfunction.
[1] Elvey RL. Physical evaluation of the peripheral nervous system in disorders of pain and dysfunction. J Hand Ther 1997;10:122-129.
[2] van der Heide B, Bourgoin C, Eils G, Garnevall B, Blackmore M. Test-retest reliability and face validity of a modified neural tissue provocation test in patients with cervicobrachial pain syndrome. J Man Manip Ther 2006;14:30-36.
Background: Muscle fatigue has been reported as a risk factor for the
development of performance-related musculoskeletal disorders (PRMD) in
musicians. However, little research exists to support this claim. The aim of
this study was to investigate whether changes occur in muscle activity
patterns during high string performance over a prolonged playing period, and
whether this is influenced by PRMD.
Methods: High string musicians were divided into a PRMD and a non-PRMD
group. They played a chromatic scale pre and post and a self-chosen “hard”
(Borg scale 16-17) piece of music for one hour. Electromyography data
recorded from arm, shoulder and trunk muscles was analyzed: the amplitude
to measure muscle activity characteristics and the lower frequency to
measure muscle fatigue. Differences between and within groups and the
frequency spectrum were analyzed using linear mixed models.
Results: Fifteen musicians participated (7 PRMD: 22.8 years, 2 male/5 female
and 8 non-PRMD: 34.3 years, 2 male/6 female). Changes in muscle activation
patterns were observed between and within both groups, however changes
varied significantly depending on group affiliation. Significant low frequency
spectrum changes between groups were observed in overall muscles of the
right arm (p=0.04) and left forearm flexors (p=0.05) following one hour of
playing.
Conclusions: Muscle activity and frequency spectrum shifts differ in high
string musicians with and without PRMD, suggesting possible differential
muscle fatigue effects between the groups.