3: Rehabilitation principles for treating chronic musculoskeletal injuries

Evaluation of patients for rehabilitation after musculoskeletal injury involves identifying, grading and assessing the injury and its impact on the patient's normal activities. Management is guided by a multidisciplinary team, comprising the patient, doctor and physical therapist, with other health professionals recruited as required. Parallel interventions involving the various team members are specified in a customised management plan. The key component of the plan is active mobilisation utilising strengthening, flexibility and endurance exercise programs. Passive physical treatments (heat, ice, and manual therapy), as well as drug therapy and psychological interventions, are used as adjunctive therapy. Biomechanical devices or techniques (eg, orthotic devices) may also be helpful. Coexisting conditions such as depression and drug dependence are treated at the same time as the injury. Effective team communication, simulated environmental testing and, for those employed, contact with the employer facilitate a staged return to normal living, sports and occupational activities.

Avaliação do risco de lesões músculo-esqueléticas ligadas ao trabalho nos serventes da construção civil: contributos da análise macro-postural

Mestrado em Segurança e Higiene no Trabalho

O impacto (custo) das LMELT decorrente de acidentes de trabalho numa organização de saúde

RESUMO - A morbilidade associada às lesões músculoesqueléticas ligadas ao trabalho (LMELT) origina uma elevada perda de produtividade (absentismo e presentismo) em organizações de saúde, o que induz um substantivo impacto (custo) económico. Nesse contexto, os profissionais de saúde, como grupo vulnerável à ocorrência de LMELT, nomeadamente aqueles que mobilizam os doentes diariamente, apresentam elevadas taxas de acidentes de trabalho com absentismo. Considerando a importância do capital humano em saúde e tendo em conta o contexto actual de contenção da despesa no sector da saúde português, o despiste de situações de perda de produtividade e seu impacto económico em instituições de saúde, assume um papel fundamental na gestão dessas organizações. O presente estudo teve como objetivo avaliar o impacto (custo) das LMELT por acidente de trabalho em enfermeiros e assistentes operacionais do CMRA durante o período de 2009 a 2013. Partindo da identificação dos acidentes de trabalho (AT) ocorridos nestes grupos profissionais entre 2009 e 2013, da lesão musculoesquelética resultante e do absentismo registado os participantes no estudo responderam aos itens da escala WQL-8 e SPS-6, para se determinar também os níveis de presentismo. Este estudo adotou a metodologia do capital humano para estimar os custos indiretos ou perda de produtividade das LMELT. Constatou-se que são as transferências a maior causa das LMELT, com uma sintomatologia mais prevalente na região lombar. Existe perda de produtividade nesta instituição entre 2009 e 2013 com um custo total estimado em 222.015,98€, absentismo e presentismo, sendo a Distração Evitada a dimensão que apresenta maiores valores.

Physical activity and pregnancy

SUMMARY : The traditional medical advice for pregnant women has been to reduce their physical activity (PA) levels. The advice was based on concerns that exercise could affect pregnancy outcomes by increasing core body temperature, by increasing the risk of maternal musculoskeletal injury and by altering the transplacental transport of oxygen and nutrients to maternal skeletal muscle rather than to the developing foetus. In the meantime, several studies have provided new information on adaptation of the pregnant woman and her foetus to moderate PA. New investigations have shown no adverse maternal or neonatal outcomes, abnormal foetal growth, increase in early pregnancy loss, or late pregnancy complications. Moreover, enrolment in moderate PA has proven to result in marked health benefits including improved maternal cardiovascular function, reduction of excessive weight gain and fat retention, less complicated labour, improved foetal stress tolerance and neurobehavioral maturation. In view of the beneficial effects, current recommendations encourage healthy pregnant women to engage in 30 minutes of moderate PA on most, if not all, days of the week. This thesis work addressed several questions. Firstly, it examined whether compliance with the recommended levels of PA during pregnancy results in better preparedness for the sudden physical exertion of labour and delivery. Secondly, it measured PA during pregnancy as compared to postpartum. Lastly, it assessed the influence of pre-pregnancy body mass index on gestational resting metabolic rate. Data collection was conducted on healthy women living in Switzerland during the third trimester of pregnancy and postpartum. Total and activity energy expenditure was assessed through 24-hour heart rate and accelerations recordings, and cardiovascular fitness through an individual step-test. Information related to pregnancy, labour and delivery was collected from medical records. The results indicate that a minimum 30 min of moderate PA per day during pregnancy are associated with better cardiovascular fitness and lower risk of operative delivery with no negative effects on maternal and foetal conditions (study 1). Despite these benefits, a substantial proportion of pregnant women (39%) living in Switzerland do not meet the PA recommendations. The decrease in activity related energy expenditure during pregnancy compared to postpartum was measured to be around 100 kcal/day (~13%), whereas the total energy expenditure was found to increase by 300 kcal/day (study 2). Thus, the energy cost of late pregnancy in Switzerland corresponds to 200 kca/day. These findings are based on average values of the study group. It should be noted, however, that large variations in individual energy expenditure may occur depending on the pre-pregnancy body mass index (study 3). When adjusted to body weight, gestational resting metabolic rate is significantly lower among women of high pre-pregnancy body mass index compared to women of normal or low pre-pregnancy body mass index. This can be explained by the fact that resting metabolic rate is primarily a function of fat-free mass, and when expressed per kg body weight, it decreases as the percentage of body fat increases. If energy intake is not modified appropriately in order to match lower energy cost per kg body weight in overweight and obese women it will result in positive energy balance, thus contributing to the current trend towards increasing adiposity in affluent society. The results of these studies go beyond the current state of knowledge on PA and pregnancy (study 4) and provide valid evidence to guide clinical practice. In view of the current epidemic of sedentary behaviour and obesity related pathology, the findings contribute new and reliable information to public health policies regarding the effects of PA in pregnancy, an important period of life for both mother and infant.

Lesiones osteomusculares en tejedores de máquinas circulares de una empresa textil.

Objetivo. Describir factores sociodemográficos, ocupacionales y extraocupacionales en un grupo de trabajadores tejedores del área de circulares, quienes operan máquinas marca Monarch en una Empresa Textil en Bogotá entre Octubre 2011 y Junio de 2012. Materiales y Métodos: Estudio descriptivo. La población fueron trabajadores tejedores mayores de edad que presentan lesiones osteomusculares, que operan máquinas MONARCH en el Área de Circulares de una Empresa Textil en Bogotá. De 300 trabajadores, 150 presentaron síntomas, 94 cumplieron criterios de inclusión. Resultados: La edad mediana fue 41 años. La mayoría fue sexo masculino. La mayoría estuvo en el mismo cargo 6-10 años. Menos de la mitad reportó realizar actividad física y la mayoría tenía estado nutricional normal. La minoría consumía cigarrillo. Se encontró que el 68.1% presentó dolor lumbar. Se presentó en 72% una lesión osteomuscular. El dolor lumbar fue más frecuente entre 31-45 años. Conclusiones: La lesión osteomuscular más frecuente fue dolor lumbar. Se presentó con mayor frecuencia una sola lesión osteomuscular. La población no es homogénea lo que puede ser un sesgo para los resultados obtenidos para edad y presencia de lesiones osteomusculares. Los trabajadores realizaban actividad física en 40.9% ya usan bicicleta como medio de transporte. No se pudo establecer relación entre estado nutricional y lesiones osteomusculares. Los trabajadores desempeñan actividades que requieren posturas, manipulación de carga y movimientos repetitivos que son constantes en un mismo cargo lo que pude estar relacionado con presencia de lesiones osteomusculares. Sería importante realizar estudios que determinen factores protectores y de riesgo.

Morbilidad laboral en el sector agrícola en trabajadores afiliados a una administradora de riesgos laborales (ARL) de Colombia, durante el periodo 2011-2012.

Este estudio muestra la prevalencia por enfermedad laboral de un grupo de trabajadores afiliados a una ARL en Colombia. Compara la morbilidad laboral entre dos grupo de trabajadores expuestos y no expuestos al trabajo agrícola y al interior del grupo de trabajadores agrícolas agrupados en las actividades de corte de caña, cultivo de banano y flores. Se realizó un estudio descriptivo de tipo transversal durante el periodo 2011-2012, mediante la revisión de una base de datos de morbilidad laboral. Se realizó un análisis uni-variado y Bi-variado y se comparó la morbilidad con datos sociodemográficos, grupos de trabajadores agrícolas y no agrícolas, y actividad productiva del sector agrícola. Se revisaron 3129 diagnósticos de enfermedad profesional durante el periodo de estudio, 433 diagnósticos fueron trabajadores agrícolas y 2696 pertenecieron a otros grupos de trabajadores. Los desórdenes Osteomusculares fueron los diagnósticos más prevalentes en el grupo Agro 92% y No Agro 86% y en las actividades de corte de caña, cultivo de banano y flores. Entre el grupo Agrícola y no agrícola se encontraron diferencias significativas en los siguientes diagnósticos: Síndrome del túnel del carpo, Síndrome de manguito rotador, Otras sinovitis y tenosinovitis, Lumbago no Especificado, Hipoacusia Neurosensorial Bilateral y epicondilitis lateral; de igual manera se encontraron diferencias entre las actividades de corte de caña y cultivo de banano y flores en los diagnósticos de: Epicondilitis, Sinovitis, Síndrome del túnel del Carpo y Trastorno lumbar. El factor de riesgo más prevalente en el grupo agrícola fue el Ergonómico con el 92.8% de los casos

Efecto de una intervención sobre la carga física durante el proceso de coquización en una empresa de Colombia

Se realizó estudio cuasi experimental con el fin de comparar el efecto sobre la carga física de una intervención tecnológica y en la organización del trabajo en trabajadores en el cargo de horneros en la tarea de extracción de coque en Colombia. Se midió la carga física mediante frecuencia cardiaca e índice de costo cardiaco relativo en una población de trabajadores expuestos (37) y no expuestos (66) a una intervención tecnológica. La monitorización de la frecuencia cardiaca se realizó con 7 pulsímetros Polar RS 800cx debidamente calibrados. Las variables numéricas se describieron con base en la media aritmética, su desviación estándar, y el rango. Para evaluar la diferencia entre las medias de los grupos con respecto a la frecuencia cardiaca en reposo, media, máxima, índice de costo cardiaco relativo, gasto energético de trabajo se aplicó análisis de varianza de una vía. Se estableció a priori un nivel de significación estadística α = 0,05. Se encontraron diferencias estadísticamente significativas en el comportamiento de la frecuencia cardiaca media, frecuencia cardiaca máxima e índice de costo cardiaco relativo, entre los grupos de estudio. Se concluyó que este estudio valida la frecuencia cardiaca como una variable sensible para la medición del riesgo por carga física y a su utilidad en la evaluación intervenciones ergonómica. El estudio demostró que la intervención ergonómica logró controlar la carga física con una disminución significativa la frecuencia cardiaca, en el grupo de intervención.

Prevalencia de desordenes musculo-esqueléticos y su asociación con factores ergonómicos en trabajadores administrativos de una institución educativa de nivel superior 2015

Objetivo. Establecer la prevalencia de Desordenes Musculo Esqueléticos(DME) y su asociación con factores ergonómicos (postura, manipulación de carga y trabajo repetitivo) en trabajadores administrativos de una Institución Educativa de Nivel Superior (IENS). Métodos. Se realizó un estudio descriptivo de corte transversal a 146 trabajadores de una IENS de la ciudad de Neiva (Huila), entre Abril y Mayo de 2015. Para la recolección de la información se utilizaron dos instrumentos: un instrumento para la caracterización sociodemográfica y ocupacional y el cuestionario estandarizado para identificar daños y exposición a riesgos ergonómicos en el trabajo (ERGOPAR). Resultados. El 90,4 % de los trabajadores presentaron molestia o dolor en alguna de las áreas del cuerpo, dentro de las cuales las más afectadas fueron las zonas del Cuello, hombros y/o espalda dorsal con el 79,9%, la espalda lumbar con el 65,8% y las manos y/o muñecas con el 49,3%. Conclusiones. Se encontró una asociación entre la exposición a factores ergonómicos y la presencia de DME, indicando que las posturas de trabajo forzadas o prolongadas y la manipulación de cargas representan un alto riesgo biomecánica para los trabajadores, lo cual se puede ver reflejado a mediano o largo plazo con el desarrollo de trastornos o enfermedades que pueden llegar a ser incapacitantes para los trabajadores, afectando su calidad de vida y su productividad laboral.

TRATAMENTO DA HIPERTENSAO ARTERIAL LEVE E MODERADA COM FOSINOPRIL. COMPARACAO DE EFEITOS ADVERSOS COM OUTROS ANTI-HIPERTENSIVOS

Purpose - To evaluate the adverse reactions of fosinopril with other antihypertensives used as monotherapy. Methods - Out-patients (n = 2,568) with diagnostic of mild to moderate hypertension, diastolic blood pressure (DBP) 95-115 mmHg, with no antihypertensive treatment for 15 days, were included to treatment initially with fosinopril (F) 10mg, once daily, for six weeks. After this period, patients with DBP >95mmHg had the dosage, once daily, increased to 20 mg, while the others were maintained with the same dosage for six more weeks. Adverse reactions of 822 patients treated as monotherapy were grouped as absent, musculoskeletal, cardiovascular, cough, gastrointestinal, neurological, genital-urinary dysfunctions and dermatological and compared with 1,568 with F. Monotherapy consist in α-methyldopa (100 patients); β-blocker (129); calcium blocker (106); diuretic (394); and another ACE inhibitors (93). Results - At the end of the period without treatment, the blood pressure (BP), 165 ± 16/105 ± 7 mmHg decreased significantly at 6(th) week to 144 ± 15/91 ± 9 mmHg (p < 0.05 vs week 0) with further lowering to 139 ± 13/86 ± 7 mmHg till the end of 12(th) week. BP response (DBP ≤90 mmHg) was obtained in 89% of the patients with F. Absence of adverse reactions were ≥70% in patients with F compared to other drugs. Conclusion - Fosinopril has demonstrated therapeutic efficacy and less adverse reactions compared to antihypertensives used previously as monotherapy.

Efeitos do suster-relaxar na cinemática tridimensional, função neuromuscular e sintomatologia álgica de um atleta de crossfit com dor lombar

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciado em Fisioterapia

Musculoskeletal effects and injury risk in collegiate Indian classical and ballet dancers

Dancers of all forms often engage in aesthetic yet challenging movements. Their training, choreography, and performances require strength, stamina, flexibility, grace, passion, and emotion. Ballet and Bharatanatyam (an Indian classical dance form) dancers utilize two movements in each of their dance forms that are similar—a half-sitting pose and a full-sitting pose, both requiring external rotation of the legs and bending at the knee joints. The purpose of this study was to examine and compare the biomechanics of joint reaction forces and knee angles in both styles of dance for these particular poses. The study included nine female ballet dancers and seven female Bharatanatyam dancers. Hamstring and gastrocnemius flexibility were measured for each dancer. Knee angles, vertical peak forces, and moments were determined for dancers at the lowest point of their bending positions. Mann-Whitney U tests found significant differences in hamstring flexibility, right gastrocnemius flexibility, and knee angles for the full-sitting poses between ballet and Bharatanatyam dancers. No significant difference was found in the vertical peak forces as a ratio to total body weight and moments between the two styles of dance. Further research can be done to more directly assess a difference in injury risk between the ballet and Bharatanatyam dancers.

Musculoskeletal Conditions Briefing

Musculoskeletal conditions (MSCs) are a group of diseases that affect the body’s bones, joints, muscles and the tissues that connect them. Common MSCs include back pain, rheumatoid arthritis, osteoarthritis, osteoporosis, and spinal disorders. MSCs are the most common cause of severe long term pain and physical disability in developed countries. They significantly affect the psychosocial wellbeing of individuals as well as their families and carers. They are responsible for substantial costs to the health and social care system and the economy. They are a leading cause of absence from work and lost productivity at work. MSCs comprise a diverse group of conditions. Some have a specific medical diagnosis (eg rheumatoid arthritis) but others have no clear medical diagnosis (eg back pain). Risk factors for the development and progression of MSCs include age, sex, family history, obesity, physical inactivity, injury and biomechanical occupational health issues.

Musculoskeletal Conditions Briefing: Technical Documentation

Musculoskeletal conditions (MSCs) are a group of diseases that affect the body’s bones, joints, muscles and the tissues that connect them. Common MSCs include back pain, rheumatoid arthritis, osteoarthritis, osteoporosis, and spinal disorders. MSCs are the most common cause of severe long term pain and physical disability in developed countries. They significantly affect the psychosocial wellbeing of individuals as well as their families and carers. They are responsible for substantial costs to the health and social care system and the economy. They are a leading cause of absence from work and lost productivity at work. MSCs comprise a diverse group of conditions. Some have a specific medical diagnosis (eg rheumatoid arthritis) but others have no clear medical diagnosis (eg back pain). Risk factors for the development and progression of MSCs include age, sex, family history, obesity, physical inactivity, injury and biomechanical occupational health issues. This document details the methods used to calculate the estimates and forecasts.

Musculoskeletal disorders (MSDs) in dancers and former dancers participating in the largest dance festival in the world

Objective: To verify the presence of musculoskeletal disorders (MSD) in dancers and former dancers participating in the 27th Joinville Dance FestivalMaterial and methods: The research was conducted at the 27th Joinville Dance Festival in Santa Catarina, Brazil, with 173 participants in the competition, where 139 were dancers and 34 were former dancers with at least ten years of practiceIn order to obtain information related to MSDs, dancers answered a specific questionnaireResults: The study group consisted of adults (28±9 years) with body mass index within the normal range (21.3±2.3) with high weekly training time (955.7±837.2) and featuring long-time experience in dancing (18±7years)The lumbar spine and knees were the most affected by MSDsThe pain of high intensity was the symptom that most often appeared in reports among survey participantsConclusion: It is important to have deeper knowledge of the prevalence of pain among professional dancers, the factors associated with pain conditions and its impact on everyday life in order to plan new forms of prevention and plan new forms of prevention and treatment within a multidisciplinary approach© 2012 Elsevier Masson SAS.

Modeling and Simulation of Upper Brachial Plexus Injury

This article presents the first musculoskeletal model and simulation of upper plexus brachial injury. From this model is possible to analyse forces and movement ranges in order to develop a robotic exoskeleton to improve rehabilitation. The software that currently exists for musculoskeletal modeling is varied and most have advanced features for proper analysis and study of motion simulations. Whilst more powerful computer packages are usually expensive, there are other free and open source packages available which offer different tools to perform animations and simulations and which obtain forces and moments of inertia. Among them, Musculoskeletal Modeling Software was selected to construct a model of the upper limb, which has 7 degrees of freedom and 10 muscles. These muscles are important for two of the movements simulated in this article that are part of the post-surgery rehabilitation protocol. We performed different movement animations which are made using the inertial measurement unit to capture real data from movements made by a human being. We also performed the simulation of forces produced in elbow flexion-extension and arm abduction-adduction of a healthy subject and one with upper brachial plexus injury in a postoperative state to compare the force that is capable of being produced in both cases.