1. Avoiding back injury.

This article looks at healthcare professionals, in particular midwives, and considers how to maintain back health and prevent injury through principles of good practice. Knowledge of back pain, mindfulness in working conditions and modifications of current practice will reduce the risk of repetitive injury, and present management options in the short- and long term. Considerations on improving the 'working lifestyle' rather than quick fixes are ultimately the long-term goal.

Spa-drain entrapment complicated by suspicions of nonaccidental trauma and epilepsy onset.

We present here the case of an adolescent female near-drowning victim who was reportedly discovered submerged and unconscious by family members in a whirlpool spa. Physical examination revealed extensive posterior soft tissue bruising, which raised the suspicion of nonaccidental trauma. Detailed forensic evaluation of the injuries and the scene proved that the soft tissue findings represented an unusual manifestation of whirlpool-spa suction-vent injury. Medical evaluation indicated that epilepsy onset might have contributed to the near-drowning, although forensic evaluation of this possibility was less convincing. In this article we review these rare but important injuries, which have the potential to be confused with child abuse, and detail the atypical presentation and clinically presumed etiologic event in our case.

Prevalence of musculoskeletal injuries sustained by students while attending a chiropractic college.

OBJECTIVE: The purpose of this study was to assess the prevalence, distribution, severity, risk factors of, and response to musculoskeletal injuries to the low back, hand/wrist, and neck/shoulder among chiropractic students while receiving and/or administering adjustments/manipulation while attending a chiropractic college. METHODS: The study was an epidemiologic survey of chiropractic students at all levels of training (n = 890) at one chiropractic college. A self-administered anonymous 3-paged questionnaire was used. The questionnaire was divided into sections for collecting data separately on injuries associated with receiving or administering chiropractic adjustments. RESULTS: The response rate was 64.3% with 62.6% male respondents. The overall prevalence of injuries sustained in college was 31.5%, 44.4% of which was exacerbations of prior complaints. Injuries from receiving adjustments/manipulation were most prevalent to neck/shoulder (65.7%), whereas hand/wrist injuries were most common when administering adjustments (45.6%). The risk difference among students receiving adjustments was 81.6/1000 neck/shoulder injuries, and the etiologic fraction was 76.6%. The risk difference was 170/1000 hand/wrist injuries with etiologic fraction of 96.5% among students administering adjustments. Diversified, Gonstead, and upper cervical adjusting techniques were perceived to be the most injury-related. CONCLUSION: Some students enroll in a chiropractic college with preexisting injuries that can easily be exacerbated. Others sustain new injuries of moderate severity from receiving and administering adjustments. Potential risk factors may include height, body mass index, and nonexercising. The risk factors and mechanisms responsible for the high levels of hand/wrist injuries need further examination. This research identifies an important need to design a comprehensive and logical protocol to prevent injury to chiropractic students.

Erector spinae muscle changes on magnetic resonance imaging following lumbar surgery through a posterior approach.

STUDY DESIGN: Prospective randomized study of patients undergoing lumbar arthrodesis. OBJECTIVES: To quantify MRI changes of the erector spinae following lumbar surgery through a posterior approach and the possible protection of these muscles during surgery by the use of cholinergic blockade. SUMMARY OF BACKGROUND DATA: It has been shown that lumbar spine surgery through a posterior approach can induce iatrogenic lesions in the erector spinae. We have shown in a previous study that histologic changes on muscular biopsy performed in the multifidus at the end of the surgical procedure were not modified by the use of cholinergic blockade during surgery. METHODS: Twenty patients scheduled to undergo pedicle-screw enhanced L4-L5 arthrodesis were enrolled in this study. Ten patients received curare during anesthesia and 10 patients did not. MRI was obtained the day before the operation and at 6 months of follow-up on the same MR scanner. T1-weighted images were obtained in the axial plane. The 2 slices immediately proximal and distal to the pedicle screw construct on the postoperative MRI were selected. The corresponding slices were selected on the preoperative MRI. Each erector spinae on the 4 slices was surrounded using a mouse-guided tool. The contractile component of the cross-sectional area (CCSA) was calculated from the number of pixels surrounded and the signal intensity of each pixel. RESULTS: There was only slight changes in the erector spinae CCSA proximal to a posterior lumbar arthrodesis. Erector spinae CCSA decreased by 27% distal to the arthrodesis. Curare showed no efficacy in preventing muscle damage. CONCLUSIONS: Erector spinae muscle alterations mainly occur distal to posterior lumbar surgical procedures.

Injuries at the Canadian National Tae Kwon Do Championships: a prospective study.

BACKGROUND: The purpose of this prospective study was to assess the injury rates in male and female adult Canadian Taekwondo athletes relative to total number of injuries, type and body part injured. METHODS: Subjects (219 males, 99 females) participated in the 1997 Canadian National Taekwondo Championships in Toronto, Canada. Injuries were recorded on an injury form to documents any injury seen and treatment provided by the health care team. These data were later used for this study. The injury form describes the athlete and nature, site, severity and mechanism of the injury. RESULTS: The overall rate of injuries was 62.9/1,000 athlete-exposures (A-E). The males (79.9/1,000 A-E) sustained significantly more injuries than the females (25.3/1,000 A-E). The lower extremities were the most commonly injured body region in the men (32.0 /1,000 A-E), followed by the head and neck (18.3/1,000 A-E). Injuries to the spine (neck, upper back, low back and coccyx) were the third most often injured body region in males (13.8/1,000 A-E). All injuries to the women were sustained to the lower extremities. The most common type of injury in women was the contusion (15.2/1,000 A-E). However, men's most common type of injury was the sprain (22.8/1,000 A-E) followed by joint dysfunction (13.7/1,000 A-E). Concussions were only reported in males (6.9/1,000 A-E). Compared to international counterparts, the Canadian men and women recorded lower total injury rates. However, the males incurred more cerebral concussions than their American colleagues (4.7/1,000 A-E). CONCLUSIONS: Similar to what was found in previous studies, the current investigation seems to suggest that areas of particular concern for preventive measures involve the head and neck as well as the lower extremities. This is the first paper to identify spinal joint dysfunction.

A petroleum company's experience in implementing a comprehensive medical fitness for duty program for professional truck drivers.

Aggregate health risk appraisal data from Chevron Texaco's truck driver workforce revealed that approximately 50% of the truck drivers who completed a health risk appraisal were found to be at risk for a back injury. Lost time records revealed that this population had 65% more lost workdays attributed to cumulative trauma injuries compared with acute trauma injuries. Chevron Texaco addressed the issue by implementing a medical fitness for duty program consisting of three components: physical examination (physical examination mandated by the Department of Transportation and a functional capacity evaluation), education (on safe body mechanics), and physical fitness. After a 1-year development period, the fitness for duty program was implemented for Chevron Texaco's professional truck drivers in North America. In the first year of the program, 109 functional capacity evaluations were completed by trained clinicians, and 88% of candidates were found "able to work without restrictions," whereas 6% were found "able to work with caution." The article describes the program results to date, and also describes the follow-up program for drivers found to be at risk for a back injury.

Knowledge and reported use of sport science by elite New Zealand Olympic class sailors.

OBJECTIVE: This study enquired about the knowledge and reported use of sport science in elite Olympic class sailors. EXPERIMENTAL DESIGN: The sailors responded to a simple questionnaire. SETTING: The questionnaire was administered as part of an introductory seminar on sport science during a training camp. PARTICIPANTS: The participants were 28 (22 male, 6 female) elite New Zealand Olympic class sailors. INTERVENTIONS: None. MEASURES: The questionnaire asked whether or not they used a training race diary, enquired about their current and past injuries and their knowledge and use of sport science in the areas of nutrition, psychology and physical training. RESULTS: Only ten (36%) of the sailors kept a training/race diary. Whilst only four (14%) had a current injury, sixteen (57%) reported an injury in the previous three years. The injuries were in the lower back (45%), knee (22%), shoulder (18%), and arm (15%). Although nineteen (68%) of the sailors had experienced dehydration during racing, the average volume of fluid reported to be taken on a four hour sail was only 0.9 litre, of which only an average of 0.7 litres (77%) was reported to be drunk. All the sailors reported being sometimes (46%) to very often (3%) anxious before races and sometimes (43%) to always (7%) being frustrated with their own mistakes. Only one sailor reported never having negative thoughts whilst fifteen (53%) reported having them sometimes, and seven (25%) often or very often. Twenty-four (86%) of the sailors reported that they sometimes had a loss of concentration near the end of the race. Whilst eighteen (64%) reported practising relaxation and seventeen (61%) reported practising visualisation as a mental skill, only five (18%) practised progressive mental relaxation, two (7%) practised meditation and none practised yoga. Seventeen (61%) undertook strength/circuit training, ten (36%) flexibility and twenty-one (75%) off water aerobic training. Twenty-four (86%) reported undertaking on-water aerobic training. CONCLUSIONS: The results indicate that there is considerable scope for improvement in the knowledge and use of sports science amongst elite New Zealand Olympic class sailors.