Lower thoracic spine extension mobility is associated with higher intensity of thoracic spine pain.

OBJECTIVES: To evaluate the association of thoracic spine (TS) posture and mobility with TS pain. METHODS: Participants with TS pain reported maximum, average, and night pain in TS area, and pain summary score was calculated. Upright and sitting TS postures were evaluated by inspection. TS posture and mobility (flexion and extension) were recorded using an inclinometer and a tape measure, respectively. Correlations between posture and mobility assessments were calculated using Spearman rank correlation, the association of TS posture and mobility with TS pain by logistic regression analysis. RESULTS: The participants' (n = 73, 52 females, age range 22-56) TS pain duration was 12 weeks on average. The correlations for measurements of TS posture and flexion mobility were higher than correlations of other TS measurements being between 0.53 and 0.82. Decreased extension mobility of the upper (from 1st to 6th TS segments; Th1-Th6) TS was associated with higher worst pain (OR 1.04, 95% CI 1.00-1.07) and whole TS with pain sum score (OR 1.05, 95% CI 1.01-1.08). Less kyphotic whole TS was associated with lower pain sum score (OR 0.96, 95% CI 0.92-1.00). Greater flexion mobility of upper and lower (Th6-Th12) TS were associated with lower pain sum score (OR 0.96, 95% CI 0.91-1.00, and OR 0.96, 95% CI 0.91-1.00, respectively). CONCLUSIONS: Reduced thoracic extension mobility was associated with higher pain scores and the greater flexion mobility with lower pain scores. Future research is warranted to evaluate if treatments geared toward TS extension mobility improvements would result in lower TS pain.

Intra- and inter-rater reliability of thoracic spine mobility and posture assessments in subjects with thoracic spine pain.

BACKGROUND: The thoracic spine (TS) has been neglected in the study of the spine despite its essential role in the stability and posture of the entire spinal complex. Therefore, there is an inevitable need to investigate the reproducibility of different thoracic spinal posture measures used in subjects with TS pain. METHODS: Thirty-two subjects (16 females and 16 males, mean age 39 years) were evaluated by two physiotherapists on the same day to gauge inter-rater reliability and on two consecutive days to gauge intra-rater reliability. TS posture was assessed by observation, and thoracic spine mobility was measured by manual assessment of segmental flexion and extension mobility in a seated position. Additionally, posterior-to-anterior accessory mobility in a prone position was assessed manually. Moreover, cervicothoracic flexion in a seated position, thoracic posture, and thoracic flexion and extension mobility in a standing position were assessed with a tape measure, and flexion and extension mobility in a seated position and TS posture in seated and standing positions were measured with an inclinometer. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), mean difference (MD), Bland-Altman (B&A) plot features and coefficient of repeatability (CR) were calculated. RESULTS: The mean and standard deviation (SD) of the duration of TS pain was 22 (SD 45) months, with the intensity of pain being rated at 27 (SD 21) mm on a visual analogue scale (VAS). Intra-rater reliability was very strong (ICC ≥ 0.80) for the evaluation of seated and standing upper TS posture, standing whole TS posture and seated lower TS posture with an inclinometer. Moreover, TS posture evaluation with a measuring tape, posture inspection in a seated position, and manual assessment of segmental extension were found to have very strong intra-rater reliability. Inter-rater reliability was very strong for inclinometer measurements of standing and seated upper TS posture as well as standing whole TS posture. CONCLUSION: Intra-rater reliability was higher than inter-rater reliability in most of the evaluated measurements. Overall, posture measurements with an inclinometer were more reliable than mobility measurements with the same instrument. The manual assessments can be used reliably when same evaluator performs the examination. TRIAL REGISTRATION: Clinical Trials, NCT01884818. Registered 24 June 2013, https://clinicaltrials.gov/ct2/show/NCT01884818?cond=thoracic+spine&cntry=FI&rank=1.

Physical workload and risk of low back pain in adolescence.

OBJECTIVES: To evaluate the role of physical workload in low back pain (LBP) among adolescents. METHODS: Working history and physical workload factors at 18 years were assessed for 1984 members of the Northern Finland Birth Cohort 1986. The associations between work characteristics and LBP were analysed by multinomial logistic regression. Those with and without LBP at 18 years of age were compared in two subsamples. The incidence of LBP was studied among the 986 subjects without LBP at 16 years of age. Persistence of LBP was studied among the 728 subjects with LBP at 16 years of age. Latent class analysis (LCA) was used to form natural clusters of workload factors and their associations with LBP were investigated using log-binomial regression. RESULTS: 753 (75%) subjects without LBP at 16 years of age had been working during the 2-year follow-up period. The average duration of work was 6.2 months. In adolescent girls, working regularly or irregularly and duration of work exposure were associated with incident LBP. Of specific physical workload factors, only awkward trunk postures were associated with incident LBP in both genders (RR 1.2 in girls and 1.7 in boys). The work exposure patterns in adolescent girls and boys were different. In the LCA, subjects in a cluster with high exposure to awkward trunk postures or an overall physically demanding job had a higher likelihood of incident LBP in both genders (RR 1.3-1.9). None of the specific workload factors or clusters was associated with persistent LBP. CONCLUSIONS: Physical workload factors constitute a risk for LBP even in adolescents.

Widespread pain in chronic epicondylitis.

We studied the associations of widespread pain with other pain and functional measures among patients with chronic epicondylitis. A total of 190 patients (66% females) participated in the study; with a mean age 43.7, mean duration of symptoms 48weeks, chronic lateral (n=160) and medial (n=30) epicondylitis. We analysed clinical status, grip strength and cubital pain thresholds and interviewed pain and disability, leisure time physical activity, strenuous hobby activities for arms, duration of symptoms, other systemic and upper extremity disorders, arm operations, and work ability. The location of pain was analysed using a whole-body pain drawing, categorized into three groups; the highest of which was classified as widespread pain. A total of 85 patients (45%) reported widespread pain. It was highly associated with female gender, high pain scores, decreased grip strength and pain thresholds (p<0.001 for all), with increased number of positive manual tests, low level of hobby strain for arms and physical activity, long duration of symptoms, and sick leave (p for all <0.05). It was also related to upper extremity disorders and arm surgery, but not with operated epicondylitis, other systemic diseases, workload or work ability. In addition, 39% of patients without other disease reported widespread pain. Widespread pain is common in chronic epicondylitis with and without other diseases, and is related to high pain scores, decreased function of the arm, long duration of symptoms, sick leave, and with a low level of physical activity.

Muscular activity and thermal responses in men and women during repetitive work in cold environments.

Thermal responses and muscular activity in repetitive work were studied in eight women and eight men at 19 degrees C (thermoneutral) and at 4 degrees C (cold). Furthermore, effect of a heating vest was studied at 4 degrees C. Women had lower (p < 0.05) mean skin temperature compared with men at each thermal condition. Muscular activity (microV) was generally higher in women compared with men, being significantly higher in m. deltoideus (p < 0.05). Women had lower (p < 0.01) maximal isometric strength compared with men, which may have influenced the observed higher muscular activity during work in women. However, compared with thermoneutral, working in cold increased (p < 0.05) muscular activity in the forearm and upper arm extensors only in men. The vest did not significantly counteract the increase in muscular activity. In conclusion, sex differences should be considered when evaluating cold protection and work load reduction in repetitive work in cold environments. Present results indicate that in identical work, sex affects thermal responses and muscular activity during repetitive work in conditions comparable with cooled departments in the food-processing industry. Sex differences should be considered when evaluating cold protection and preventive measures for work load reduction.

Factors associated with self-estimated work ability and musculoskeletal symptoms among male and female workers in cooled food-processing facilities.

This questionnaire study evaluates how work ability and musculoskeletal symptoms associate with physical work factors and individual characteristics of the workers in cooled food-processing facilities. A total of 1,117 workers (response rate 85%) responded to the study. Poor work ability was significantly associated with longer work duration, experience of draught at the workplace, absence from work due to health reasons, and physical inactivity during free time. The amount of local cooling experienced was significantly associated with the risk for musculoskeletal symptoms in the neck-shoulder region, shoulders, wrists and lower back. Additionally, female gender, longer work duration and poor work ability were associated with the increased prevalence of the symptoms. The prevalence of musculoskeletal symptoms was significantly higher among older employees (40 to 64 yr) than among younger employees (18 to 39 yr) for all regions except wrists. Cold discomfort and unpleasant sensations due to the physical factors of work were significantly more common among females than males. The results showed that, in addition to individual characteristics of workers, factors related to work in a cool environment (experience of draught and cooling and long exposure to cold) are associated with poor work ability and musculoskeletal symptoms.

Three-phase bone scintigraphy in chronic epicondylitis.

OBJECTIVE: To assess the utility of 3-phase bone scintigraphy as a complementary diagnostic method in chronic epicondylitis. DESIGN: A cross-sectional study. SETTING: Hospital outpatient clinic admitting patients with musculoskeletal disorders. PARTICIPANTS: Patients (N=59; 68% women) with unilateral chronic epicondylitis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three-phase bone scintigraphy was performed after an intravenous injection of 550MBq (99m)technetium-labeled hydroxymethyline diphosphonate ((99m)Tc-HDP) in the patients. Blood flow and blood pool phases were graded visually as normative or abnormal. In the bone metabolic phase, the scintigraphic radiograph images were evaluated using a transmission densitometer. The ratio between maximal bone uptake of (99m)Tc-HDP in each epicondyle and the mean of that in the adjacent humerus was used as a bone uptake measure, which was compared with clinical data (pain questionnaire, pain drawing, cubital pain thresholds, muscle strength) and with work ability and lifestyle factors. RESULTS: The bone uptake of (99m)Tc-HDP of the affected epicondyle was 33% and 17% higher in men and women, respectively, compared with the corresponding healthy epicondyle (P<.001 and P=.007). High bone uptake of (99m)Tc-HDP was associated with better work ability, grip strength, and muscle performance in both sexes but was not correlated with the pain measures. Blood flow phases had a positive correlation with the duration of symptoms and a negative correlation with the bone uptake of (99m)Tc-HDP, grip strength, and work ability. CONCLUSIONS: High bone uptake of (99m)Tc-HDP among patients with chronic epicondylitis was associated with better muscle strength, work ability, and arm function. In chronic cases, a higher degree of bone uptake of (99m)Tc-HDP may thus indicate a healing response in the bone tissue.

Associations between pain, grip strength, and manual tests in the treatment evaluation of chronic tennis elbow.

OBJECTIVE: The objective was to assess the associations between changes in pain and grip strength and manual tests among patients with chronic tennis elbow. DESIGN: Measurements for 45 consecutive patients with unilateral tennis elbow were made before and after an exercise intervention. SETTING: The setting was a physiatric outpatient clinic. PATIENTS: The patients were 45 persons with chronic unilateral tennis elbow: 32 women and 13 men. The mean age was 44 (31-54) years; mean duration of symptoms was 35 (10-66) weeks. OUTCOME MEASURES: Manual tests, pressure pain thresholds at three cubital points, a pain questionnaire, a pain drawing, and grip strength measurements were assessed. RESULTS: Grip strength became normal during the treatment. Pressure pain thresholds reached 66% of that of the healthy arm. Lowered pain thresholds and changes in pain thresholds of the lateral epicondyle were strongly associated with the findings in the manual tests. Mills test and resisted wrist extension tests were associated with perceived pain, and resisted wrist extension tests also were associated with decreased grip strength. Pain on palpation was associated with lowered pain thresholds at the lateral epicondylus and with perceived pain under physical load. After the treatment, for 13 patients all 4 manual tests were still positive; for 17 patients, 3 were still positive; and for 5 patients, all were negative. Positive clinical tests were associated with lowered pain thresholds, decreased grip strength, and high perceived pain scores. CONCLUSIONS: Pain thresholds at the lateral epicondyles are strongly associated with pain on palpation and with a positive Mills test. Resisted wrist extension test results reflect decreased grip strength. Impaired function of the hand is associated with the number of positive clinical tests. Pain threshold evaluation is a simple, easy, inexpensive method that provides useful additional quantitative data on pain and disability among patients with chronic tennis elbow.

Cold exposure and musculoskeletal disorders and diseases. A review.

The aim of this study was to investigate how cold exposure may be associated with musculoskeletal problems either on symptomatic or disease level based on available relevant scientific literature. The data collection resulted in ten scientific articles, from which nine were epidemiological and one a case report consisting of three cases. The results indicated that musculoskeletal symptoms are more frequent in cold store work and in related conditions than in normal temperature work and symptoms seems to be increased when the working time in cold environment increases. In cold store work low back pain and knee pain are more frequent problems than in normal temperature working environment. The association between cold exposure and shoulder pain is still unclear and has been poorly studied. Meteorological conditions, principally low ambient temperature may have an effect of reported low back pain in a remarkable part of population. In the etiology of tenosynovitis cold exposure has a specific role either as a causative or a contributing factor. The risk for carpal tunnel disease is 2.2-fold in repetitive wrist movements compared with no repetition and 9.4-fold when cold exposure added. Cold exposure in work seems to be is associated with a little increased risk (Odds ratio 2.2) for degenerative discopathies of lower back in men. However, this risk is small and seems to be associated with other physical factors in the background. In conclusion, the associations between cold exposure and musculoskeletal complaints or diseases are shown in some studies and the need of further research is apparent.

Chronic medial and lateral epicondylitis: a comparison of pain, disability, and function.

OBJECTIVES: To investigate pain, disability, and muscle function of the arm in medial epicondylitis and to compare the results with those in chronic lateral epicondylitis. DESIGN: Cross-sectional, case-control study. SETTING: University hospital clinic admitting chronic hand patients. PARTICIPANTS: Twenty-five patients with chronic unilateral medial epicondylitis and 25 age- and gender-matched patients with chronic unilateral lateral epicondylitis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pain drawing (PD) and a pain questionnaire with 7 items of pain and disability on visual analog scale (VAS). Dolorimeter measurements of pressure pain thresholds (PPT) on 3 defined cubital points. The isometric grip strength and isokinetic performance of wrist and forearm at a radial velocity of 90 degrees/s. RESULTS: Patients with medial epicondylitis had significantly less pain under strain (6.7 vs 7.9cm on VAS, P =.03) and a smaller PD (1.9 vs 2.5, P =.02) than patients with lateral epicondylitis. The PPTs of medial epicondyles were 54% (P =.0000) lower in medial epicondylitis. In lateral epicondylitis, all 3 cubital points showed significant decreases in PPTs. The isometric grip strength (mean and maximal) decreased by 6.2% and 3.6%, compared with the patients' healthy arms (P =.03,.16) and by 11.4% and 8.9% (P =.008,.02), respectively, compared with the expected value; in lateral epicondylitis, the grip strength decreased by 11.8% and 10.6% (P =.005,.01) and by 15% and 14% (P =.003,.007), respectively, when compared with the expected grip strength. Peak torque and produced work in wrist flexion were significantly reduced by 13% and 17% (P =.005,.0001), respectively, in both diseases. In lateral epicondylitis, supination and pronation were also reduced by 10% and 15% (P =.03). CONCLUSIONS: In chronic medial epicondylitis, muscle function and pain measures showed a lesser impaired function of the arm than in chronic lateral epicondylitis. The results may be useful in rehabilitation and treatment of epicondylitis.