Musculoskeletal Science and Practice最新文献

When not treated adequately, neuromusculoskeletal, tendinous, and joint tissue injuries may become chronic, leading to impaired tissue function due to fibrosis, extracellular matrix densification, and fatty connective tissue accumulation, ultimately resulting in reduced joint and muscle mobility. Timely treatment involving the mobilization of fascia and targeted muscle exercise has been shown to enhance and promote tissue regeneration. Key phases in tissue regeneration after injury include the activation of the innate immune system, followed by its resolution. Although several treatment modalities are effective in restoring tissue function, their success rate and time to recovery may still need optimization. Over recent decades, increasing attention has been given to the role of fascia in neuromuscular tissue function, adaptation, and regeneration. However, the complex interactions between fasciae, myofibers, and the immune system remain insufficiently understood, particularly regarding the mechanisms underlying fibrosis, extracellular matrix densification, and chronic pain. Fasciae are interconnected connective tissue sheaths that maintain anatomical organization, allow tissue gliding, and facilitate mechanical force transmission between structures. Because of their mediating role in mechanical and biochemical signalling, fascial tissues are also involved in injury and regeneration processes. Pathological stiffening of fascial connections may impair regeneration by limiting mobility and disrupting mechanotransduction. Therefore, treatment strategies that target both muscle and fascial tissues may offer improved outcomes in the recovery of neuromusculoskeletal function.

Background: Work-related musculoskeletal disorders (WMSDs) are a prevalent issue, associated with a complex interaction of occupational risk factors that can be linked to lower quality of work life (QWL). While these relationships are well-established, it remains unclear how age-based differences mediate them, as younger and older workers may respond differently to various workplace hazards. Understanding these age-specific pathways is crucial for developing targeted interventions.

Objective: This study aimed to investigate the relationships between occupational risk factors, WMSDs, and QWL across different age groups to identify key differences and inform ergonomic practice.

Methods: A sample of 312 workers, divided into young (under 45 years) and older (45 years and above) groups, was analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to test hypotheses linking biomechanical, psychosocial, and organizational risk factors to WMSDs and QWL.

Results: Significant differences were observed between age groups. Tight deadlines were associated with occupational stress (OS) only in older workers, whereas WMSDs were significantly associated with lower QWL only among younger workers. Physical job demands and OS were associated with WMSDs in both groups, and OS was related to their QWL. The findings indicate that worker age significantly influences how occupational risks are associated with WMSDs and QWL, and that these associations are not uniform.

Conclusion: This study validated a model that examined the relationships among occupational risk factors, WMSDs, and QWL across age groups. The model demonstrated robust psychometric properties, enabling the identification of significant differences between young and older workers.

Background: Neck-specific exercises are commonly used in the management of temporomandibular disorders (TMD); however, the additional role of aerobic training remains unclear. Given the involvement of central pain mechanisms in TMD and the effects of aerobic exercise on pain modulation, its potential adjunctive value warrants further investigation.

Objective: To evaluate the additional effects of aerobic training to neck exercises on pain intensity, neck disability, and related outcomes in women with chronic TMD.

Design: Randomized controlled trial.

Methods: Fifty-eight women with chronic TMD were randomized into: (1) neck exercises (CG; n = 30); or (2) neck exercises plus aerobic training (EG; n = 28). Primary outcomes were orofacial pain intensity (VAS) and neck disability (NDI). Secondary outcomes were pressure pain thresholds (PPTs), jaw function (MFIQ), self-efficacy (CPSS), and oral health-related quality of life (OHIP-14). Repeated-measures ANOVA and multilevel mixed modelling (MLM) were used for analysis.

Results: Both groups improved over time in pain intensity, neck disability, and secondary outcomes, with no statistically significant differences between groups. Within-group effect sizes for pain intensity were large in the EG (g = 1.43) and in the CG (g = 1.08) after treatment. The MLM models indicated that NDI, CPSS and OHIP-14 explained part of the variation in pain intensity, and central sensitization, OHIP-14, and CPSS explained part of the variation for neck disability.

Conclusion: Moderate-intensity aerobic exercise did not yield statistically significant additional benefits compared with performing neck exercises alone. However, it remains important to explore other types of aerobic exercise for managing TMD.

Objective: To identify reliable, valid, and feasible outcome measures that could be used to assess outcomes of participating in supervised exercise programs for adults aged 50 years or older with hip or knee osteoarthritis (OA).

Methods: A scoping review was conducted in accordance with Joanna Briggs Institute and PRISMA-ScR guidelines. Six databases were searched on July 18, 2024. Eligible studies were systematic, literature, or integrative reviews evaluating at least one psychometric property (reliability, validity, or feasibility) of outcome measures for adults aged ≥50 years with hip or knee OA, including those awaiting or having undergone total joint arthroplasty.

Results: Sixteen reviews were included, identifying 102 outcome measures (35 self-report, 67 performance-based). Nine reviews used the COSMIN methodology, while others applied alternative or narrative frameworks. Commonly supported measures included the WOMAC, KOOS, HOOS, LEFS, 6-Minute Walk Test, 40-m fast-paced walk, and Timed Up and Go, which showed strong reliability (ICC ≥0.80) and construct validity. Feasibility was discussed narratively in 13 reviews; none used formal criteria. Only three mentioned exercise, and none evaluated measures in supervised programs.

Conclusion: Multiple outcome measures demonstrated acceptable reliability and validity for adults with hip or knee OA, but feasibility data were limited, and no tools were validated in the context of supervised exercise. Consequently, no measure fulfilled all three psychometric criteria for this setting. Future research should include structured feasibility assessments and evaluate measures within exercise-based interventions.

Although classically considered from a neuro-centric vantage point, is now well known that pain involves interaction between the immune and nervous systems. Neuro-immune interactions occur all along the pain axis from the tissues to the peripheral neurons, the dorsal root ganglia, the spinal cord and supraspinal centres. Immune cells from mast cells, macrophages, T cells and B cells, to the Schwann cells of neurons, and the glia cells in the spinal cord and brain, release diverse inflammatory mediators including cytokines and chemokines. Fundamental mechanisms underlying pain enhancement by immune cells are diverse and differ between nociceptive, neuropathic and nociplastic pain conditions. The involvement of the immune system in pain provides enormous potential for interventions to address pain by targeting these mechanisms. These interventions include pharmacological and genetic treatments, as well as non-pharmacological treatments with the potential to impact systemic and CNS immune activity, such as exercise, diet and treatments targeting psychosocial and behavioural features (e.g., sleep and stress). Logically, treatment efficacy should depend on matching the treatment to the relevant neuro-immune mechanism. The aim of this review is to provide a foundation to understand the relevance of neuro-immune interactions to the development and persistence of chronic pain, and its implications for treatment. We provide an overview of the role of neuroinflammation in pain, evidence that this contributes to human pain conditions, and how this can guide matching the right treatments to the right person.

Background: There is increasing interest in uncovering working mechanisms of physiotherapy interventions. Advanced medical imaging enables in-vivo visualisation and quantification of neuroinflammation. This case report reveals for the first time how neuroinflammation in the nervous system may change following neural tissue management.

Case description: A 56-year-old man presented with a 9-month history of left C7 painful radiculopathy. He reported arm and neck pain, and numbness in the C7 dermatome. Elbow extension strength was reduced. The neurodynamic test (median nerve) was positive. MRI confirmed nerve root compression due to disc herniation C6/C7. Dynamic [¹¹C]DPA713 PET/CT imaging revealed neuroinflammation at the neuroforamen and spinal cord. While being on the surgical waitlist, he received six weeks of neural tissue management, which included 12 sessions of nerve and joint mobilisation, and a home program of neurodynamic exercises.

Outcome: At 6-weeks follow-up, arm and neck pain intensity had markedly reduced, which was maintained at 6 months. These improvements coincided with a substantial decrease in neuroinflammation at the affected neuroforamen (PET/CT: V_T: from 12.96 to 6.21). No meaningful decrease was observed in the spinal cord (V_T: from 6.43 to 5.38).

Discussion: Following six weeks of neural tissue management, in vivo measures of neuroinflammation reduced substantially at the affected nerve roots and dorsal root ganglion, which coincided with decreased neck and arm pain.

Conclusion: Changes in neuroinflammation exceeding the smallest detectable difference can be measured following neural tissue management in a patient with painful cervical radiculopathy. A randomised trial to validate these findings is warranted.

Introduction: Manual therapy and therapeutic exercise are both recommended for chronic non-specific low back pain, the additional benefit of combining them is uncertain.

Objective: To systematically review the effects of adding manual therapy to therapeutic exercise compared to exercise alone on pain intensity and functional disability in adults with chronic non-specific low back pain.

Methods: A systematic review and meta-analysis of randomized controlled trials included adults aged 18-65 years with chronic non-specific low back pain (≥12 weeks). Interventions combined joint-based manual therapy (spinal mobilization and/or manipulation) with therapeutic exercise involving stretching, strengthening, motor control, and endurance training. Main outcomes were pain intensity and functional disability at short-, medium-, and long-term follow-up. PubMed, PEDro, Cochrane Library, CINAHL, and Web of Science were searched up to February 2025. Evidence certainty was rated using GRADE.

Results: Five trials (n = 260) were included. Low-quality evidence indicated no significant short-term pain reduction with manual therapy plus exercise versus exercise alone (SMD = -0.87, 95 % CI: -1.87 to 0.12, I² = 90 %). Moderate-to low-certainty evidence showed greater improvement in disability with combined therapy at short- (SMD = -0.73, 95 % CI: -1.05 to -0.42, I² = 0 %) and long-term follow-up (SMD = -1.13, 95 % CI: -2.06 to -0.19, I² = 80 %).

Conclusion: Manual therapy combined with therapeutic exercise does not appear to provide substantial additional short-term improvements in pain intensity when compared to exercise alone. However, significant benefits were identified for functional disability in both short- and long-term outcomes PROSPERO REGISTRATION: CRD42023413778.

Background: Sarcopenia and pain catastrophizing(PC) are prevalent physiological and psychological comorbidities in knee osteoarthritis(KOA). They may collectively burden patients' quality of life. Nevertheless, their potential association remains inadequately explored.

Objectives: To explore the association between PC and sarcopenia in KOA patients, adjusting for demographic, lifestyle, and disease-related covariates (e.g., sex, BMI, affected site, disease duration, physical activity and other relevant factors.) To examine whether this association varies across subgroups defined by age and sedentary behavior.

Design: Cross-sectional study.

Methods: This study recruited 390 KOA patients aged ≥45 years from orthopedic surgery departments. PC was assessed using the PC scale. Sarcopenia was defined by concurrent low muscle mass and muscle strength, measured via bioelectrical impedance analysis and electronic handgrip dynamometry. Logistic regression was used to describe the relationship between PC and sarcopenia, adjusting for covariates.

Results: Among the patients, 24.9 % were diagnosed with sarcopenia and 21.5 % with PC, with 10.3 % had both. Adjusted analyses showed PC was independently associated with sarcopenia (OR = 1.036; 95 % CI: 1.012, 1.061; P = 0.003). Subgroup analyses revealed stronger associations in patients aged 60-69 years (aOR = 1.036; 95 % CI: 1.001, 1.073; P = 0.045), those aged ≥70 years (aOR = 1.095; 95 % CI: 1.050, 1.143; P < 0.001), and individuals with prolonged sedentary time (aOR = 1.051; 95 % CI: 1.016, 1.086; P = 0.004).

Conclusions: PC was significantly associated with higher odds of sarcopenia in KOA patients, and this association was stronger in older individuals and those with prolonged sedentary behavior. Comprehensive management of elderly KOA patients should address both psychological and physical comorbidities.