Whether from heaving, twisting, bending or bad lifting postures, it’s well known that caring for the sick or elderly can lead to back pain. This often results in time off work or dropping out of caring professions altogether. Now Danish research published in the online open access journal BMC Musculoskeletal Disorders suggests that the fear of getting back pain from care work is predictive of actually developing it.

Among healthcare workers, studies have found LBP rates during a 12-month period of 45-63 percent compared with 40-50 percent in the general population. Rather than avoiding physical activity, medical guidelines based on LBP research recommend staying active and continuing normal daily life, including going to work.

Jette Nygaard Jensen and colleagues from the National Research Centre for the Working Environment, Copenhagen, Denmark set out to investigate the association between physical work load and lower back pain (LBP), and whether fear-avoidance beliefs had a predictive effect on developing LBP. Fear-avoidance beliefs involve avoiding physical activities that are expected to cause pain, although ironically these beliefs are often associated with developing chronic pain.

2,677 female healthcare workers were given questionnaires that measured both fear-avoidance beliefs about work and fear-avoidance beliefs about physical activity. The researchers found that the picture differed among those who had already suffered from LBP versus those who had not.

For those who had a previous history of LBP, both workload and fear-avoidance beliefs played a part in new episodes of LBP. In general, a greater workload was associated with more LBP, and workload had a greater role to play than fear-avoidance beliefs.

For those without an LBP history, workload was not a significant factor in developing LBP during the study, but fear-avoidance beliefs were. For both groups, fear-avoidance beliefs could be used to predict LBP – this included fears that both work and physical activity would lead to pain. Specifically, both types of fear-avoidance belief were prospectively associated with a higher number of days with LBP (30 days or more).

“From a treatment perspective, focusing on changing fear-avoidance beliefs among those with more or less chronic LBP may be beneficial,” says Jensen. “Health care professionals may benefit from additional education or information about how to cope with acute or chronic LBP. Particularly information about the potentially harmful effect of avoidance-behaviour could be useful.”

SAN ANTONIO (Feb. 12, 2010) — Hey guys, remember the muscle shirts we wore in our teens and 20s? After the age of 40 that meager part of our wardrobes usually is obsolete. Yes, at the big 4-0 we begin to lose muscle, and by age 80 up to a third of it may be gone. It’s an inevitable process of aging called sarcopenia.

Why does sarcopenia happen and can it be stopped? A study conducted in mice with accelerated muscle loss at The University of Texas Health Science Center at San Antonio provides this insight: Less protection from antioxidants and more damage from oxidative stress results in impairment to cells’ energy centers, which slowly leads to death of muscle cells.

A team directed by Holly Van Remmen, Ph.D., associate professor with the university’s Barshop Institute for Longevity and Aging Studies and the Department of Cellular and Structural Biology, found that without a certain antioxidant enzyme to balance the formation of harmful reactive oxygen species (ROS), cellular energy centers called mitochondria fail to work properly. The mitochondria even add to the spate of ROS molecules and release factors leading to cell death.

“The impaired function of mitochondria also has a detrimental effect on the way motor neurons ‘talk’ to the muscle to achieve muscle contraction,” Dr. Van Remmen said. “This interaction occurs at a specialized synapse where the nerve and muscle come in close contact.” This key structure is called the neuromuscular junction, she said.

Smaller and weaker muscles

Youngmok C. Jang, Ph.D., a leading author in the study, investigated mice that were genetically engineered to lack an antioxidant enzyme called copper-zinc superoxide dismutase. He compared mitochondria from these mice and normal mice and found reduced function of the energy centers in the enzyme-deficient mice. This contributed to more cell death and muscle atrophy in the rodents. “As a result, their muscles were a lot smaller and weaker,” Dr. Van Remmen said.

Insights gleaned about muscle loss can help scientists better understand other neuromuscular diseases such as amyotrophic lateral sclerosis (Lou Gehrig’s disease). “Age-related muscle atrophy is a complex process and involves multiple systems,” Dr. Van Remmen said. “There are, however, common mechanisms occurring in sarcopenia and other neuromuscular diseases. By understanding the mechanisms underlying age-related muscle atrophy and alterations at the neuromuscular junction, we should be able to gain insight that will help us to discover new therapeutic interventions.”

If a muscle-preserving therapy is one day developed, future generations of young men will be able to keep their muscle shirts a bit longer.

Note: A grant from the National Institute on Aging supported this project, along with a Julie Martin Mid-Career Award in Aging Research to Dr. Van Remmen from the American Federation for Aging Research. Co-authors from the UT Health Science Center are Youngmok Jang, Ph.D.; Michael Lustgarten, Ph.D.; Yuhong Liu; Florian Muller, Ph.D.; Arunabh Bhattacharya, Ph.D.; Hanyu Liang, Ph.D.; Adam Salmon, Ph.D.; and Arlan Richardson, Ph.D. Other co-authors are Susan Brooks, Ph.D., and Lisa Larkin, Ph.D., of The University of Michigan and Christopher Hayworth, Ph.D., of The University of Texas at Austin. Drs. Van Remmen and Richardson have joint appointments with the South Texas Veterans Health Care System. This paper was published online by The FASEB Journal on Dec. 29, 2009.

About the UT Health Science Center San Antonio

The University of Texas Health Science Center at San Antonio, one of the country’s leading health sciences universities, ranks in the top 2 percent of all U.S. institutions receiving federal funding. Research and other sponsored program activity totaled a record $259 million in fiscal year 2009. The university’s schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced 27,000 graduates. The $753 million operating budget supports six campuses in San Antonio, Laredo, Harlingen and Edinburg. For more information on the many ways “We make lives better®,” visit www.uthscsa.edu.

Focusing on prevention in such manually-intensive work environments, the poultry industry implemented an ergonomics, medical intervention and training  program called “MET” tailored for both employees and their supervisors. The industry also encouraged formal communication amongst professionals in the trade as well as in ergonomics/organizational health groups including OSHA.

To read the white paper “Ergonomics in the Poultry Industry: A Review of 25 Years of the Industry Efforts” click here

What is Osteoarthritis?

Osteoarthritis, or OA, is a degenerative arthritis – or joint disease. OA is the leading cause of disability in the United States, affecting over 27 million people in the United States. It is also the second leading cause of disability and is positively correlated with aging. By age 65, roughly 80% of the population will have evidence of OA, however only 60% will show symptoms.  OA is the most prevalent chronic condition among women, affecting between 35-45% of the gender by age 65.

Causes and Symptoms

Osteoarthritis results from the aging process – a loss of resilience in cartilage in major weight-bearing joints including hips and knees, as well as hands, feet and spine. Other causes related to OA include diabetes, inflammatory disease, obesity and congenital disorders. Symptoms of osteoarthritis include joint stiffness or pain, nodes on smaller joints and bunions on toes. OA is typically diagnosed through x-ray.

What is the Study?

The Multidimensional Intervention for the Early Osteoarthritis of the Knee (Knee Study) took place at the University of Arizona Arthritis Center in Tucson, AZ over the course of 24-months with 273 participants between the ages of 35-65 that reported pain and disability due to knee pain.

As sourced in the news release, participants were randomly assigned to 1 of 3 treatment groups. The strength training group engaged in a 9-month initial phase designed to improve the core areas of stretching and balance, range of motion and flexibility, and isotonic muscle strength. The second, 15-month phase of this group concentrated on developing independent, long-term exercise habits. The second study group participated in a 2-phase self-management program designed to educate participants and provide one-on-one treatment advice. The combined group participated in both the complete strength training and self-management programs. A total of 201 out of 273 participants completed the 2-year trial, with the self-management group achieving the highest compliance rates.

The study team set out to demonstrate that a combination of OA treatment programs would prove most effective, however, the study failed to uncover significant differences in results among the 3 study participant groups. All 3 groups demonstrated improvements in physical function tests and decreased self-reported pain and disability. “The logic behind the combined treatment was that the different factors addressed in physical and psychological treatments might produce an additive effect if administered together,” said Dr. McKnight. “These results suggest otherwise. Instead, the comparison of the 3 treatment arms showed no difference, suggesting similar benefits for all 3 over a 2-year period.”

In conclusion, the study suggested that middle-aged people with mild symptoms of osteoarthritis benefited from the combination in utilizing both a strength training and self management program, however the greatest compliance occurred for those individuals assigned to using a self management program.

At the initial visit of a patient with low back pain, the physician must set a positive tone, emphasizing that the problem is common in the human body and can be remedied. Initial treatment is 1 or 2 days of rest, a short course of analgesics, and stretches and other exercises. The 5% to 10% of patients who do not improve within 3 months (chronic-pain patients) or have a relapse frequently require an active functional rehabilitation program. Exercises are helpful only if they…..  continue reading article.

Sixty-eight healthy young adult runners (37 women), who run in typical, currently available running shoes, were selected from the general population. None had any history of musculoskeletal injury and each ran at least 15 miles per week. A running shoe, selected for its neutral classification and design characteristics typical of most running footwear, was provided to all runners. Using a treadmill and a motion analysis system, each subject was observed running barefoot and with shoes. Data were collected at each runner’s comfortable running pace after a warm-up period.

The researchers observed increased joint torques at the hip, knee and ankle with running shoes compared with running barefoot. Disproportionately large increases were observed in the hip internal rotation torque and in the knee flexion and knee varus torques. An average 54% increase in the hip internal rotation torque, a 36% increase in knee flexion torque, and a 38% increase in knee varus torque were measured when running in running shoes compared with barefoot.

These findings confirm that while the typical construction of modern-day running shoes provides good support and protection of the foot itself, one negative effect is the increased stress on each of the 3 lower extremity joints. These increases are likely caused in large part by an elevated heel and increased material under the medial arch, both characteristic of today’s running shoes.

Writing in the article, lead author D. Casey Kerrigan, MD, JKM Technologies LLC, Charlottesville, VA, and co-investigators state, “Remarkably, the effect of running shoes on knee joint torques during running (36%-38% increase) that the authors observed here is even greater than the effect that was reported earlier of high-heeled shoes during walking (20%-26% increase). Considering that lower extremity joint loading is of a significantly greater magnitude during running than is experienced during walking, the current findings indeed represent substantial biomechanical changes.” Dr. Kerrigan concludes, “Reducing joint torques with footwear completely to that of barefoot running, while providing meaningful footwear functions, especially compliance, should be the goal of new footwear designs.”

Source Citation:

Cited from materials provided by ErekAlert!

The article is “The Effect of Running Shoes on Lower Extremity Joint Torques” by D. Casey Kerrigan, MD, Jason R. Franz, MS, Geoffrey S. Keenan, MD, Jay Dicharry, MPT, Ugo Della Croce, PhD, and Robert P. Wilder, MD. It appears in PM&R: The journal of injury, function and rehabilitation, Volume 1, Issue 12 (December 2009), published by Elsevier.

Repetitive strain injury has become increasingly common. The authors cited two recent Danish surveys, one of which found that more than half of female office workers reported frequent neck pain. The other found that more than two-thirds of female office workers who reported neck pain suffered from trapezius myalgia.

Five Exercises Confirm Benefit for Office-Related Strains in Women

The team’s latest finding confirms that that five strength exercises — the one-arm row, shoulder abduction, shoulder elevation, reverse fly and upright row — can substantially reduce perceived pain. By finding out more about how the muscle function has been impaired and how it improves with exercise, the team has developed a way to assess the muscle in the rehabilitation setting. In particular, the Danish team found that the women who had diminished ability to activate the muscle quickly and forcefully could benefit from the strength training.

Lars L. Andersen, Jesper L. Andersen, Charlotte Suetta, Michael Kjaer, Karen Sogaard and Gisela Sjogaard conducted the study. Lars Andersen is with the National Research Centre for the Working Environment in Copenhagen; Jesper Andersen, Charlotte Suetta and Michael Kjaer are with the Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen; and Karen Søgaard and Gisela Sjøgaard are with the University of Southern Denmark, Odense, Denmark. The study appears in the Journal of Applied Physiology.

Five exercises

Forty-two women who worked in offices on repetitive tasks and did computer work participated in the 10-week study. They all had reported chronic or frequent pain in the neck area, and tightness and tenderness of the upper trapezius muscle. The researchers randomly divided the women into three groups:

• Specific strength training. This group of 18 women did five exercises with dumbbells — one-arm row, shoulder abduction, shoulder elevation, reverse fly and upright row. Photos showing these exercises are found by going to: http://bit.ly/F86Mw. These exercises strengthen the shoulder and the neck muscles, including the trapezius. The women in this group did three sets of three of these exercises three times per week. The amount of weight lifted depended upon each woman’s strength level and was progressively increased throughout the 10 weeks.
• General fitness training. This group of 16 women cycled upright on a stationary exercise bicycle. Other studies have shown that general fitness training can help alleviate a variety of ailments. In addition, the researchers earlier established that all round physical exercise including cycling can help reduce pain. The researchers wanted to see whether the general fitness exercise would help improve rapid force capacity (the ability to activate the muscle quickly and forcefully) among those suffering trapezius myalgia. The women in this group bicycled three sessions per week for 20 minutes per session.
• Reference (Control). This group of eight women received individual and group counseling on ergonomics, diet, health, relaxation and stress management for a total of one hour per week. They did not receive any physical training.

The participants from all three groups performed shoulder abductions before the 10-week intervention began and after it ended. During this pre- and post-test, the participants were required to contract the muscles as fast and hard as they could. The researchers measured the force and speed of the lift. In particular, they wanted to measure rapid force capacity, that is, how quickly the women could activate their muscles to generate force.

They also obtained muscle biopsy samples to analyze how the training affected the muscle fibers and pain levels at each of the sessions. The pain data was compared to performance.

Results

In this study, bicycling did not significantly affect rapid force capacity. The significant changes on this variable occurred only in the strength-training group. Strength training reduced pain levels by more than 50%, and also:

• improved rapid force capacity
• increased number of type II muscle fibers, the fibers important in generating power

The authors speculate that strength training reduced the pain, which then enhanced the body’s ability to rapidly activate the muscle. Activating the muscle depends upon rapid coordination of nerve signals and it was the nerve signaling that seemed to have improved. The researchers also said that the strength training may have encouraged the women to set aside the fear of pain and thus helped improve performance.

In addition to providing further evidence that these five exercises can help women who suffer trapezius myalgia, the study also showed that reduced rapid force capacity can be a good screening tool to determine who would benefit from this type of rehabilitation, the authors said.

The Danish Medical Research Council and the Danish Rheumatism Association supported this study.

Source:

1. Andersen et al. Effect of contrasting physical exercise interventions on rapid force capacity of chronically painful muscles. Journal of Applied Physiology, 2009; 107 (5): 1413 DOI

Researchers measured the length of telomeres — the DNA that bookends the chromosomes and protects the ends from damage — in blood samples from two groups of professional athletes and two groups who were healthy nonsmokers, but not regular exercisers.

The telomere shortening mechanism limits cells to a fixed number of divisions and can be regarded as a “biological clock.” Gradual shortening of telomeres through cell divisions leads to aging on the cellular level and may limit lifetimes. When the telomeres become critically short the cell undergoes death. The 2009 Nobel Prize in Physiology or Medicine was awarded to researchers who discovered the nature of telomeres and how chromosomes are protected by telomeres and the enzyme telomerase.

“The most significant finding of this study is that physical exercise of the professional athletes leads to activation of the important enzyme telomerase and stabilizes the telomere,” said Ulrich Laufs, M.D., the study’s lead author and professor of clinical and experimental medicine in the department of internal medicine at Saarland University in Homburg, Germany.

“This is direct evidence of an anti-aging effect of physical exercise. Physical exercise could prevent the aging of the cardiovascular system, reflecting this molecular principle.”

Essentially, the longer telomere of athletes is an efficient telomere. The body’s cells are constantly growing and dividing and eventually dying off, a process controlled by the chromosomes within each cell. These chromosomal “end caps” — which have been likened to the tips of shoelaces, preventing them from fraying — become shorter with each cell division, and when they’re gone, the cell dies. Short telomeres limit the number of cell divisions, Laufs said. In addition, the animal studies of Laufs and colleagues show that the regulation of telomere stabilizing proteins by exercise exerts important cellular functions beyond the regulation of telomere length itself by protecting from cellular deterioration and programmed cell death.

In the clinical study, researchers analyzed 32 professional runners, average age 20, from the German National Team of Track and Field. Their average running distance was about 73 kilometers (km), a little over 45 miles, per week.

Researchers compared the young professional athletes with middle-aged athletes with a history of continuous endurance exercise since their youth. Their average age was 51 and their average distance was about 80 km, or almost 50 miles, per week.

The two groups were evaluated against untrained athletes who were healthy nonsmokers, but who did not exercise regularly. They were matched for age with the professional athletes.

The fitness level of the athletes was superior to the untrained individuals. The athletes had a slower resting heart rate, lower blood pressure and body mass index, and a more favorable cholesterol profile, researchers said.

Long-term exercise training activates telomerase and reduces telomere shortening in human leukocytes. The age-dependent telomere loss was lower in the master athletes who had performed endurance exercising for several decades.

“Our data improves the molecular understanding of the protective effects of exercise on the vessel wall and underlines the potency of physical training in reducing the impact of age-related disease,” Laufs said.

The German Research Association and the University of Saarland funded the study.

Co-authors are: Christian Werner, M.D.; Tobias Furster, medical student; Thomas Widmann, M.D.; Janine Pöss, M.D.; Christiana Roggia, Ph. D.; Milad Hanhoun, M.D.; Jürgen Scharhag, M.D.; Nicole Buchner, Ph. D.; Tim Meyer, M.D.; Willfried Kindermann, M.D.; Judith Haendeler, Ph. D. and Michael Böhm, M.D.

Source: Christian Werner, Tobias Fürster, Thomas Widmann, Janine Pöss, Cristiana Roggia, Milad Hanhoun, Jürgen Scharhag, Nicole Büchner, Tim Meyer, Wilfried Kindermann, Judith Haendeler, Michael Böhm, and Ulrich Laufs. . Circulation, 2009; DOI: Physical Exercise Prevents Cellular Senescence in Circulating Leukocytes and in the Vessel Wall 10.1161/CIRCULATIONAHA.109.861005

Patellofemoral pain syndrome is a condition in which pain occurs at the front of the knee during or after exercise and is a common reason to visit the doctor. Women are more likely to be affected than men, and symptoms usually start during adolescence when participation in sporting activities is high.

General advice is to rest during periods of pain and to avoid pain provoking activities. This “wait and see” approach is considered usual care.

A recent study reported only limited evidence for the effectiveness of exercise therapy with respect to pain reduction, while there is conflicting evidence with respect to functional improvement.

So researchers based in the Netherlands investigated the effectiveness of supervised exercise therapy compared with usual care in 131 patients aged between 14 and 40 years with patellofemoral pain syndrome.

A total of 131 participants were included in the study, 65 to a supervised exercise program (intervention group) and 66 to usual care (control group). Both groups received similar written information about the syndrome and similar instructions for home exercises, as well as advice to refrain from painful activities.

Patients rated their recovery, pain at rest, pain on activity, and function scores at the start of the study and again at three and 12 months.

After three months, the intervention group reported significantly less pain and better function than the control group. At 12 months, the intervention group continued to show better outcomes than the control group with regard to pain at rest and pain on activity, but not function.

A higher proportion of patients in the exercise group than in the control group reported recovery (42% v 35% at three months and 62% v 51% at 12 months), but these results were not significantly different between the two groups.

This study provides evidence that supervised exercise therapy for patellofemoral pain syndrome in general practice is more effective than usual care for pain at rest, pain on activity, and function at three and 12 months, say the authors. However, supervised exercise therapy had no effect on perceived recovery.

Further research is needed to understand how exercise therapy results in better outcome, they conclude.

Source: Adapted from materials provided by BMJ-British Medical Journal, via Eurekalert!, a service of AAAS.

“It’s clear that pain is not just a normal part of aging and that pain is often undertreated in older adults,” explains lead author Suzanne Leveille, PhD, RN, who conducted the research while a member of the Division of Primary Care at Beth Israel Deaconess Medical Center (BIDMC) and is currently on the faculty at the University of Massachusetts Boston. “Our findings showed that older adults who reported chronic musculoskeletal pain in two or more locations — mainly in the joints of the arms and legs — as well as individuals who reported more severe pain or pain that interfered with daily activities were more likely to experience a fall than other individuals.”

Leveille used data gathered as part of MOBILIZE Boston (Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly), a cohort study headquartered at the Institute for Aging Research at Hebrew SeniorLife and led by Principal Investigator Lewis Lipsitz, MD. One of the goals of the study is to gain a better understanding of what causes falls in older adults in order to develop new ways to prevent falls from occurring.

Between September 2005 and January 2008, 749 adults over the age of 70 enrolled in the MOBILIZE study were interviewed about their health, including being asked questions about pain. They also underwent a physical assessment by a nurse. Over the next 18 months, the participants recorded any falls they had on monthly calendar postcards that were then mailed to the Institute for Aging Research.

“At the beginning of the study, 40 percent of the participants reported experiencing chronic pain in more than one joint area and 24 percent reported chronic pain in a single joint,” explains Leveille. “During the 18-month study period, the 749 participants reported a total of 1,029 falls, with more than half the participants falling at least once during this period.” Data analysis revealed that compared with study participants who reported no pain, the participants who experienced chronic pain in two or more joints had a 50 percent greater risk of falling.

“Our results suggest that pain should be added to the list of risk factors for falls, as persons who have chronic pain in two or more joints, and those who have moderate to severe pain or disabling pain, are at significantly higher risk,” says Leveille. “Assessment and management of chronic pain is a key part of health care for many older adults.”

This study was funded by a grant from the National Institute on Aging and support from Pfizer, Inc.

Study coauthors include Robert Shmerling, MD, of BIDMC; Hebrew SeniorLife Institute for Aging Research investigators Richard Jones, ScD, Dan Kiely, MPH, Douglas Kiel, MD, and Lewis Lipsitz, MD; Jonathan Bean, MD, of Spaulding Rehabilitation Hospital; Jeffrey Hausdorff, PhD, of Tel-Aviv Sourasky Medial Center; and Jack Guralnik, MD, PhD, of the National Institute on Aging.

Source: Leveille et al. Chronic Musculoskeletal Pain and the Occurrence of Falls in an Older Population. JAMA The Journal of the American Medical Association, 2009; 302 (20): 2214 DOI: 10.1001/jama.2009.1738