An Experimental Study to determine the Impact of Active Release Technique, Core Strengthening on Pain, Muscle Stiffness, Hardness and Quality of Life on Non- Specific Low Back Pain

Introduction: Active Release Technique (ART), works by releasing adhesions and repairing the integrity of soft tissue, thereby extending and restoring functional flexibility entirely. Core stabilization workout (CSE) aims to treat back pain by boosting your muscular strength and stamina, strengthening muscle motor patterns to relieve low-back pain. Aim: Aim of the study was to evaluate impact of active release technique and core strengthening on pain, mobility and quality of life on non-specific low-back pain. Study Design: Simple random convenient sampling, envelope method Place and Duration: A study of 40 people with non-specific low back pain and aging between 18 and 25 years was conducted at Musculoskeletal OPD, Ravi Nair Physiotherapy College, DMIMS(DU), Sawangi (Meghe), and Wardha in the duration of one year. Procedure: In this experimental investigation, the influence of active released and impacting non-specific low back pain on suffering, muscular soreness, hardness, strength, ODI, and quality of life was determined. Both groups received hot fomentation and core strengthening, but only the ART group was actively released. The findings have been obtained from NPRS to algometer, durometer, press biofeedback, ODI, and EQ-5D-5L in pre-treatment, post-treatment, and after four weeks of data to analysed impacts. Results: in this study both the groups showed reduction in pain, muscle tenderness, muscle hardness as well as increase in core strength and quality of life. When compared ART group shows significant improvement with p value of 0.001. Conclusion: In this study we find that the pain threshold, muscular hardness, muscle tenderness, deficiency and quality of life of both groups improved. The ART group was proven to be more effective than the Hpk group when the two groups were compared. In the two groups, the core strength did not change greatly, perhaps after four weeks, from pre- treatment to post- treatment to 4 weeks after.

Effect of Strumming Manipulation in Pain Parameters in Myofascial Pain Syndrome of the Para-scapular Region in Males of the Age Group of 20-30 Years

Background: Treatment of myofascial trigger points can be considered a promising approach for the treatment of patients with myofascial pain syndrome. It would be worthwhile to identify predictors/means of successful myofascial trigger point treatment and to investigate whether the treatment is more successful when used alone or combined such as electrotherapy, thermotherapy and manual therapy. Previous studies have examined the effect of single ischemic compression and a combination of ischemic compression and stretching and concluded that both interventions had positive effects on patients' recovery. However the effects of single component of deep tissue massage such as a brief strummimg manipulation in pain parameters is not understood completely in clinical decision making. Objective: To study the effects of brief strumming manipulation in pain parameters in myofascial pain of the para-scapular region in males of the age group of 20-30 years. Materials and Methods: Experimental study design with 25 male participants were recruited on the basis of inclusion and exclusion criteria for the study, active trigger point either over the rhomboid or levator scapulae was identified and marked as per diagnostic criteria described by Simon DG (1999 and 2002). Baseline readings for VAS and PPT were recorded on day one before the intervention and final readings were taken 10 minutes after the sixth session (3 days a week on alternate day basis for two weeks). Each treatment session of strumming manipulation was for 2 - 3 minutes followed by a rest period of 2 - 3 minutes and repeated 3 times (total duration of the session was for 12 - 15 minutes) followed by 10 - 15 minutes of Ice compression over the manipulated area. Subjects were instructed to continue ice compression at home 2 - 3 times a day for 10 - 15 minutes each session during the non-interventional days and not to carry out any unaccustomed work like lifting heavy things, straining activities of upper limb during study period. Data collected as pre and post intervention values are analysed statistically. Result: The Pre-VAS mean of 6.88±0.78 and the Post-VAS mean of 2.44±1.29 and the paired t-test mean difference of 4.44±1.15 with t (24) =19.17 with pre and post statistical significance of p=0.000. The Pre-PPT mean of 2.79±1.13 and the Post-PPT mean of 4.98±1.22 and the paired t-test mean difference of -2.18±1.30 with t (24) = -8.39 with pre and post statistical significance of p=0.000. Conclusion: Strumming manipulation followed by ice compression is efficacious in reducing pain and muscle tenderness in male patients with para-scapular region with active MTrPs. Its immediate and short-term effects established in this combination may serve as a prime treatment plan in the clinical setting to counteract pain and muscle tenderness due to active MTrPs. Key words: myofascial pain syndrome; trigger points; manipulation; massage; visual analog pain scale; pain threshold.

Electrical stimulator voltage settings minimally influences beef longissimus muscle tenderness

The objective of the current study was to evaluate the effect of differing electrical stimulation (ES) voltage levels on beef longissimus muscle (LM) tenderness, postmortem temperature, and pH decline, and carcass quality. Beef carcasses from three commercial beef processing plants (A, B, C) were exposed to three varying voltage levels: 1) control (no ES) 2) high ES (60-Hz for 17s each at 25, 35, 45, and 55 V) 3) low-ES (60-Hz for 17s each at 16, 20, 24, and 28 V). Ninety beef carcasses were selected from the three plants, and within a carcass, paired sides were randomly assigned to one of three ES treatments. The results indicated that ES affected (P < 0.05) muscle pH at 3 h postmortem in two of the three plants. However, ES did not affect (P > 0.05) pH at the time of grading (post rigor). Although the slice shear force (SSF) values were lower (P < 0.05) for ES steaks compared to controls, it was not (P < 0.05) influenced by the voltage levels. Variation in tenderness was observed among the plants (P < 0.05), with Plant C having the toughest steaks, whereas Plant A and B exhibited similar (P > 0.05) tenderness. Overall, the lack of difference in postmortem tenderness between high- and low-voltage settings indicated the ES-voltage minimally influenced tenderness. 

MRI-Based Assessment of Masticatory Muscle Changes in TMD Patients after Whiplash Injury

Objective: to investigate the change in volume and signal in the masticatory muscles and temporomandibular joint (TMJ) of patients with temporomandibular disorder (TMD) after whiplash injury, based on magnetic resonance imaging (MRI), and to correlate them with other clinical parameters. Methods: ninety patients (64 women, 26 men; mean age: 39.36 ± 15.40 years), including 45 patients with symptoms of TMD after whiplash injury (wTMD), and 45 age- and sex-matched controls with TMD due to idiopathic causes (iTMD) were included. TMD was diagnosed using the study diagnostic criteria for TMD Axis I, and MRI findings of the TMJ and masticatory muscles were investigated. To evaluate the severity of TMD pain and muscle tenderness, we used a visual analog scale (VAS), palpation index (PI), and neck PI. Results: TMD indexes, including VAS, PI, and neck PI were significantly higher in the wTMD group. In the wTMD group, muscle tenderness was highest in the masseter muscle (71.1%), and muscle tenderness in the temporalis (60.0%), lateral pterygoid muscle (LPM) (22.2%), and medial pterygoid muscle (15.6%) was significantly more frequent than that in the iTMD group (all p < 0.05). The most noticeable structural changes in the masticatory muscles occurred in the LPM with whiplash injury. Volume (57.8% vs. 17.8%) and signal changes (42.2% vs. 15.6%) of LPM were significantly more frequent in the wTMD group than in the iTMD group. The presence of signal changes in the LPM was positively correlated with the increased VAS scores only in the wTMD group (r = 0.346, p = 0.020). The prevalence of anterior disc displacement without reduction (ADDWoR) (53.3% vs. 28.9%) and disc deformity (57.8% vs. 40.0%) were significantly higher in the wTMD group (p < 0.05). The presence of headache, sleep problems, and psychological distress was significantly higher in the wTMD group than in the iTMD group. Conclusion: abnormal MRI findings and their correlations with clinical characteristics of the wTMD group were different from those of the iTMD group. The underlying pathophysiology may differ depending on the cause of TMD, raising the need for a treatment strategy accordingly.

Rhabdomyolysis: an unusual complication following diclofenac and amitraz consumption

Amitraz is a pesticide with central alpha 2 agonistic action and diclofenac is a non- steroidal anti-inflammatory drug. Rhabdomyolysis is not commonly associated with either compound consumption. We report the case of a 28-year-old male who after presenting to us following 25ml of amitraz consumption, developed diffuse myalgia, muscle tenderness, cola coloured urine with oliguric acute renal failure which was followed by altered sensorium. Further probing revealed that he had also consumed 10 tablets of unknown dose of tablet diclofenac along with the amitraz. Rhabdomyolysis was suspected which was confirmed by an elevated creatinine phosphokinase. He was hydrated with IV fluids, given bicarbonate and N-acetylcysteine and in view of deteriorating renal function underwent 6 sessions of hemodialysis. Following the same, sensorium improved, urine output normalised, renal function improved and creatinine phosphokinase levels showed a decreasing trend indicating a reduction of the rhabdomyolysis. In poisoning cases it is often difficult to reliably confirm the drug consumed at the time of presentation. Therefore, like in our case, in addition to initial supportive measures, a periodic review of history, examination, regular monitoring of vitals and timely appropriate blood investigations can help confirm the nature of the poison and detect early the possible complications, and thus enable the early initiation of life saving treatment with improved patient outcomes.

MRI-Based Assessment of Masticatory Muscle Changes in TMD Patients After Whiplash Injury

Objective To investigate the change in volume and signal in the masticatory muscles and temporomandibular joint (TMJ) of patients with temporomandibular disorder (TMD) after whiplash injury based on magnetic resonance imaging (MRI) and to correlate them with other clinical parameters. Methods Ninety patients (64 women, 26 men; mean age: 39.36 ± 15.40 years), including 45 patients with symptoms of TMD after whiplash injury (wTMD), and 45 age- and sex-matched controls with TMD due to idiopathic causes (iTMD) were included. TMD was diagnosed using the study diagnostic criteria for TMD Axis I, and MRI findings of the TMJ and masticatory muscles were investigated. To evaluate the severity of TMD pain and muscle tenderness, we used a visual analog scale (VAS), palpation index (PI), and neck PI. Results TMD indexes, including VAS, PI, and neck PI were significantly higher in the wTMD group. In the wTMD group, muscle tenderness was highest in the masseter muscle (71.1%), and muscle tenderness in the temporalis (60.0%), lateral pterygoid muscle (LPM) (22.2%), and medial pterygoid muscle (15.6%) was significantly more frequent than that in the iTMD group (all p < 0.05). The most noticeable structural changes in the masticatory muscles occurred in the LPM with whiplash injury. Volume (57.8% vs. 17.8%) and signal changes (42.2% vs. 15.6%) of LPM were significantly more frequent in the wTMD group than in the iTMD group. The presence of signal changes in the LPM was positively correlated with the increased VAS scores only in the wTMD group (r = 0.346, p = 0.020). The prevalence of anterior disc displacement without reduction (ADDWoR) (53.3% vs. 28.9%) and disc deformity (57.8% vs. 40.0%) were significantly higher in the wTMD group (p < 0.05). The presence of headache, sleep problems, and psychological distress was significantly higher in the wTMD group than in the iTMD group. Conclusion Abnormal MRI findings and their correlations with clinical characteristics of the wTMD group were different from those of the iTMD group. The underlying neuropathophysiology may differ depending on the cause of TMD, raising the need for a treatment strategy accordingly.

MRI-based Assessment of Masticatory Muscle Changes in TMD Patients After Whiplash Injury

Objective: To investigate the change in volume and signal in the masticatory muscles and temporomandibular joint (TMJ) of patients with temporomandibular disorder (TMD) after whiplash injury based on magnetic resonance imaging (MRI) and to correlate them with other clinical parameters. Methods: Ninety patients (64 women, 26 men; mean age: 39.36±15.40 years), including 45 patients with symptoms of TMD after whiplash injury (wTMD), and 45 age- and sex-matched controls with TMD due to idiopathic causes (iTMD) were included. TMD was diagnosed using the study diagnostic criteria for TMD Axis I, and MRI findings of the TMJ and masticatory muscles were investigated. To evaluate the severity of TMD pain and muscle tenderness, we used a visual analog scale (VAS), palpation index (PI), and neck PI. Results: TMD indexes, including VAS, PI, and neck PI were significantly higher in the wTMD group. In the wTMD group, muscle tenderness was highest in the masseter muscle (71.1%), and muscle tenderness in the temporalis (60.0%), lateral pterygoid muscle (LPM) (22.2%), and medial pterygoid muscle (15.6%) was significantly more frequent than that in the iTMD group (all p<0.05). The most noticeable structural changes in the masticatory muscles occurred in the LPM with whiplash injury. Volume (57.8% vs. 17.8%) and signal changes (42.2% vs. 15.6%) of LPM were significantly more frequent in the wTMD group than in the iTMD group. The presence of signal changes in the LPM was positively correlated with the increased VAS scores only in the wTMD group (r=0.346, p=0.020). The prevalence of anterior disc displacement without reduction (ADDWoR) (53.3% vs. 28.9%) and disc deformity (57.8% vs. 40.0%) were significantly higher in the wTMD group (p<0.05). The presence of headache, sleep problems, and psychological distress was significantly higher in the wTMD group than in the iTMD group. Conclusion: Abnormal MRI findings and their correlations with clinical characteristics of the wTMD group were different from those of the iTMD group. The underlying neuropathophysiology may differ depending on the cause of TMD, raising the need for a treatment strategy accordingly.

Reduced concentrations of vaginal metabolites involved in steroid hormone biosynthesis are associated with increased vulvar vestibular pain and vaginal muscle tenderness in provoked vestibulodynia: An exploratory metabolomics study

Provoked vestibulodynia (PVD) is a chronic vulvar pain disorder characterized by hypersensitivity and severe pain with pressure localized to the vulvar vestibule. Knowledge regarding pathophysiological mechanisms contributing to the etiology and production of symptoms in PVD remains incomplete but is considered multifactorial. Using a cross-sectional observational study design, data from untargeted metabolomic profiling of vaginal fluid and plasma in women with PVD and healthy women was combined with pain testing and brain imaging in women with PVD to test the hypotheses that women with PVD compared to healthy women show differences in vaginal and plasma metabolites involved in steroid hormone biosynthesis. Steroid hormone metabolites showing group differences were correlated with vulvar vestibular pain and vaginal muscle tenderness and functional connectivity of brain regions involved in pain processing in women with PVD to provide insight into the functional mechanisms linked to the identified alterations. Sensitivity analyses were also performed to determine the impact of hormonal contraceptive use on the study findings. Women with PVD compared to healthy controls had significant reductions primarily in vaginal fluid concentrations of androgenic, pregnenolone and progestin metabolites involved in steroidogenesis, suggesting localized rather than systemic effects in vagina and vulvar vestibule. The observed reductions in androgenic metabolite levels showed large effect size associations with increased vulvar vestibular pain and vulvar muscle tenderness and decreases in androgenic and progestin metabolites were associated with decreased connectivity strength in primary sensorimotor cortices. Women with PVD showed symptom-associated reductions in vaginal fluid concentrations of metabolites involved in the biosynthesis of steroid hormones previously shown to affect the integrity of vulvar and vaginal tissue and nociceptive processing. Deficiency of certain steroids may be an important mechanism contributing to the pathophysiology of symptoms in PVD may provide potential diagnostic markers that could lead to new targets for therapeutic intervention.