Submitted in fulfillment of the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Mid-back pain (mbp) is defined as pain occurring within the limits of the third thoracic (T3) and ninth thoracic (T9) vertebrae, caused by the dysfunction of the musculoskeletal structures in the thoracic spine. It can present as pain and/ burning between the shoulder blades with reduced thoracic spine mobility and increased muscle tension. Congenital disorders such as scoliosis and Scheuermann’s disease, or acquired disorders such as thoracic facet and costovertebral joint dysfunction may cause mbp. The thoracic facet and costovertebral joints are similar in anatomy and share a mutually dependent biomechanical relationship. There were a handful of controlled studies that highlighted the effectiveness of thoracic facet manipulation on mbp, but there were none on the effects of costovertebral manipulation on mbp. Objectives The aim of this study was to investigate the immediate effects of the combination of thoracic facet and costovertebral joint manipulation on mbp in terms of pain perception, pressure pain thresholds (PPT) and thoracic spine range of motion (ROM). Design A prospective single-blind randomised comparative clinical trial. Setting This study was conducted in a university setting at the Durban University of Technology Chiropractic Day Clinic Participants Fifty participants were recruited via responses to advertisements placed around the Durban University of Technology (DUT) campuses and individuals presenting at the Chiropractic Day Clinic (CDC). Intervention The participants were divided into two groups of twenty-five. Group A received the thoracic facet joint manipulations and Group B received a combination of the thoracic facet and costovertebral joint manipulations. Outcome measures All subjective and objective measurements were taken before and after the application of the manipulations. Pain perception i.e. subjective measurement) was measured by the Numerical Pain Rating Scale (NPRS), pressure pain thresholds (PPT) (i.e. objective measurement) were measured by the Wagner’s FDK Force Gage Algometer and thoracic spine range of motion (ROM) i.e. objective measurement was measured by the Saunders Digital Inclinometer. Results The data was analyzed using the latest version of SPSS and a p-value = 0.05 was used to determine statistical significance. Descriptive statistics in the form of univariate analysis described the data in terms of measures of central tendency and measures of dispersion. Data that was distributed normally was analyzed using the t-test and ANOVA. Data that was distributed abnormally was analyzed using the non-parametric Wilcoxon ranked and Mann Whitney tests. Nominal and ordinal data was analyzed using the Chi squared test. The results of the intra-group analysis indicated a statistically significant decrease in pain perception (p ≤ 0.000), increase in PPT (p ≤ 0.05) and decrease in thoracic spine ROM (p ≤ 0.000). However, the results for the inter-group analysis indicate there was no statistically significant difference in pain perception (p = 0.386), PPT (p > 0.05) and thoracic spine ROM (p >0.05) between Group A and Group B. Conclusions These results showed that the combination of thoracic facet and costovertebral joint manipulation was as effective as thoracic facet joint manipulation alone, in the treatment of mbp. These findings suggested that manipulation of the costovertebral joints may not be necessary for the effective treatment of mbp. / M

Thesis (MSpor)--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: The prevalence of lower back disorders and the high costs involved are an ongoing problem in industrialised countries. Research indicates an estimated 70-80% of all individuals will experience lower back pain (LBP) during the course of their lives (Manek & MacGregor, 2005; Kent & Keating, 2005; Dunn & Croft, 2004; Takeyachi et al., 2003; Carter & Birrel, 2000:6; Nourbakhsh & Arab, 2003; Bernard, 1997:374). It is widely accepted that occupational demands and physical work contribute greatly towards onset, recovery and recurrence of symptoms (Carter & Birrel, 2000:6). Rubber Tyred Gantry (RTG) crane drivers are particularly at risk, as their working posture forces them into various prolonged non-neutral trunk positions (Fehrsen-Du Toit, 2005:24; Rohlmannt et al., 2001; Nachemson, 1963) and extreme trunk flexion (Seider et al., 2003; Hoogendoorn et al., 2000). Intrinsic factors such as trunk strength (O'Sullivan et al., 2005; Bayramoglu et al., 2001) and trunk stability (Hitt & Lie, 2006; MacDonald et al., 2006; Barker et al., 2006; Hodges et al., 2005; Hodges, 2003; Hodges & Richardson, 1996) as well as anthropometric variables (Franklin et al., 2000:64), can play different roles in incidences of lumbar pain or injury. A job such as RTG crane driving is dependant on a certain amount of strength or physical fitness. A deficit in on or more of these areas can lead to compensation, overload and eventually symptoms and injury. Research has yet to identify factors that predispose certain drivers to injury, and factors determining a quick, safe recovery and return to work. The purpose of this study was to investigate possible morphological variables as risk factors for RTG crane drivers, for Hutchison Whampoa, at the Port of Felixstowe, UK. The study design was based on a cross sectional, analytical epidemiological study. A sample of 43 RTG drivers completed testing. They were divided into a group of drivers who had never had lower back pain or symptoms (n=22), and a group of drivers who had had a previous history of lower back pain (n=21). All subjects were asymptomatic at the time of testing. Although not significant (p > 0.05), the results of the study showed that average performance deficit (the power needed to maintain or repetitively produce a force) tended to be higher in those subjects without a previous history of pain. The flexion/extension ratio also tended to be better for this group. The subjects without a past history of lower back pain were, surprisingly, found to be older than the other group. This explains the higher body weight, waist-to-hip-circumference, body mass index, and fat percentage for this group, as these measurements all tend to increase with age. It also explains the lower peak torque to body weight values for that group, as peak torque would decrease with increased body weight. This is the first study to look at morphological variables and isokinetic testing of RTG crane drivers, and the relationship between these variables and lower back pain. / AFRIKAANSE OPSOMMING: Die hoë koste verbonde aan, asook die hoeveelheid voortdurende lae-rug beserings in industriële lande, is ‘n aaneenlopende probleem. Navorsing toon dat 70-80% van alle individue laer-rugpyn sal ervaar deur die loop van hul lewens (Manek & MacGregor, 2005; Kent & Keating, 2005; Dunn & Croft, 2004; Takeyachi et al., 2003; Carter & Birrel, 2000:6; Nourbakhsh & Arab, 2003; Bernard, 1997:374). Dit is aanvaar dat werksvereistes en fisiese werk grootliks bydra tot die oorsaak, herstel en herhaling van simptome (Carter & Birrel, 2000:6). RTG hyskraan bestuurders is veral individue wat ‘n groter risiko toon ten opsigte van laer-rug beserings weens werkspostuur wat hul noodsaak om verskeie langdurige nie-neutrale mid-rug posisies (Fehrsen-Du Toit, 2005:24; Rohlmannt et al., 2001; Nachemson, 1963), asook ekstreme mid-rug fleksie handhaaf (Seider et al., 2003; Hoogendoorn et al., 2000). Sekere individuele intrinsieke faktore soos mid-rug krag (O'Sullivan et al., 2005; Bayramoglu et al., 2001) mid-rug stabiliteit (Hitt & Lie, 2006; MacDonald et al., 2006; Barker et al., 2006; Hodges et al., 2005; Hodges, 2003; Hodges & Richardson, 1996), en antrpometriese veranderlikes (Franklin et al., 2000:64), kan ‘n aansienlike verhoging in moontlike laer-rug pyn of –beserings meebring. ‘n Werk soos RTG hyskraan bestuur is afhanklik van sekere hoeveelheid krag of fisiese fiksheid. ‘n Tekortkoming in enige van hierdie areas kan lei tot oorkompensering, oorbelading en uiteindelike simptome van besering. Vrae wat navorsing nog moet antwoord is onder andere die faktore wat aanleiding gee tot beserings asook wat vinnige en veilige terugkeer na werk vir bestuurders bepaal. Die doel van die studie was om moontlike morfologiese veranderlikes en risiko faktore te bestudeer vir RTG hyskraan bestuurders, vir Hutcinson Whampoa, te Felixstowe hawe, VK. Die rol wat hierdie faktore speel in die oorsaak en ontwikkeling van rugpyn word ook ondersoek. ‘n Protokol van toetse is gekies om moontlike morfologiese risiko faktore uit te lig en daardeur bestuurders wat meer geneig is om laer-rugpyn te ontwikkel te identifiseer. ‘n Totaal van 43 RTG bestuurders het die toets voltooi. Hierdie bestuurders is verdeel in ‘n groep wat nog nooit laer-rugpyn of simptome getoon het nie (n=22) en ‘n groep bestuuders wat wel vorige geskiedenis van laer-rugpyn het (n=21). Alle deelnemers was asimptomaties met die aanvang van die toetsing. Alhoewel resultate van die toets nie noemenswaardig was nie (p>0.05), het dit wel getoon dat algemene prestasie tekortkoming (spierkrag benodig om kraguitset te handhaaf of om herhaaldelik uit te voer) geneig was om hoër te wees in individue sonder ‘n vorige geskiedenis van rug besering. Die fleksie/ekstensie verhouding het ook beter vertoon in hierdie groep. Individue sonder vorige geskiedenis van laer-rugpyn is interessant genoeg, ouer as die met geskiedenis van laer-rug beserings. Dit verduidelik die hoër liggaamsgewig, middelheup- verhouding en liggaamsmassa indeks en vet persentasie van hierdie groep weens die feit dat al reedsgenoemde geneig is om met ouderdom toe te neem. Dit kan ook piekkraguitset tot liggaamsmassa waardes van hierdie groep verduidelik omdat piekkraguitset sal verminder met toename in liggaamsmassa. Hierdie is die eerste studie wat die uitkyk bied op morfologiese veranderlikes tesame met isokinetiese toetsing van RTG hyskraan bestuurders en die verhouding tussen hierdie veranderlikes en laer-rugpyn.

No description available.

The use of the Minnesota Multiphasic Personality Inventory (MMPI) and the Health Attribution Test (HAT) for predicting referral compliance to a state vocational rehabilitation program was evaluated. Subjects included 53 patients (26 males, 27 females) who were chosen at random three to 18 months following discharge from an inpatient chronic and spinal pain center. Subjects were administered the MMPI and HAT upon hospital admission and seven outcome measures of referral compliance were obtained. A discriminant analysis was performed to test the hypothesis that certain items would best discriminate compliance. Most discriminative of compliance was the MMPI validity scale K (Wilks Lambda = .751, p ≤ .033). A regrouping of data into two groups, active and inactive, yielded ego strength (MMPI, ES) and ability to trust others (PA) as significant differentiating variables.

No description available.

The abstract of the diploma thesis is focused on the acupressure and its influence of backache of medical staff. We chose the theme of acupressure because it is a non-invasive treatment method which can be practiced by everyone in the comfort of the home and no aid is necessary to have, just the basic knowledge and training how to perform acupressure. Acupressure is not physically or time consuming and that is why it is considered as a suitable means as an additional treatment of pain and other health disorders. It can improve nursing care. The theoretical part deals with pain and pain of medical staff who are the highest risk group of backache in the lumbar region. The backache is the most frequent cause of incapacity for work. Furthermore, in the theoretical part we deal with acupressure, one of the methods of alternative medicine. For the processing of the theoretical part, we used the available foreign and Czech literary sources. The empirical part of the diploma thesis is a quantitative method. The results obtained from the research were processed in the overview tables and case reports. For the thesis we set two research objectives. The first objective was to find out the experience of medical staff with acupressure. The second objective was to verify the influence of the techniques of acupressure for backache of medical staff. On the basis of the aim two hypotheses were created. The first hypothesis should show whether the backache will be softened by application of the acupressure techniques. The second one shows whether there is the difference in approach of nurses and doctors to perform acupressure.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Background: Chronic non-specific low back pain (CNSLBP) is a common ailment treated by chiropractors. Most chiropractors focus on the localised lumbar area of pain. Other chiropractors focus on restoring function to compensating articulations in the ‗full kinematic chain‘ by assessing and treating the lower extremity in conjunction to the low back. Patients with LBP often exhibit decreased hip-related ranges of motion that may result in future LBP, relapse and a prolonged recovery time. Studies investigating the effect of treating the kinematic chain in relation to LBP are limited and the literature, although widely taught and practiced, is largely anecdotal. Chiropractic manipulation has shown to be effective in the treatment of LBP and many lower extremity conditions. Objectives: This study set out to determine if a combination of low back and hip manipulation would result in a more beneficial outcome for the participant, suffering with CNSLBP, than low back manipulation alone in terms of objective and subjective outcomes. Method: The study was a randomised controlled clinical trial which, through purposive sampling, consisted of 50 participants with CNSLBP and hip joint dysfunction. The participants were randomly divided into two groups of 25 each [A and B]. Group A received low back manipulation alone and Group B received combined low back and hip manipulation. Subjective data was obtained through the Oswestry Low Back Pain Disability Index (ODI) and the Numerical Pain Rating Scale (NPRS). Objective data was obtained through the use of a Force Dial Algometer and an Inclinometer. Data collection occurred at the first, third and fifth consultations and was coded and analysed using IBM SPSS version 24.0. A p-value value of less than 0.05 was considered to be statistically relevant. Results: Intra-group testing showed that there was a significant difference over time, within both groups, with regards to internal rotation and external rotation of the hip, flexion of the lumbar spine, increased pain tolerance in Algometer tests, decreased NPRS values and decreased ODI scores. Within Group A, the mean scores for hip flexion reflected a more significant increase over time than those of Group B. Within Group B, the mean scores for left and right rotation of the lumbar spine reflected a more significant change over time than those of Group A. Inter-group testing showed no significantly differential treatment effect for any of the subjective and objective outcomes. This means that both treatments were equally effective and the hypothesis, that suggested that Group B would improve more than Group A, was incorrect. Conclusion: Both treatment groups improved subjectively and objectively with regards to CNSLBP. Inter-group testing showed that statistically, and for all outcome measurements, there were no significant differences between the two treatment group‘s results. This suggested that there was no additional benefit in combining hip joint manipulation with low back manipulation in the treatment of CNSLBP. / M

Uma das aplicações da ergonomia é a prevenção de patologias músculo esqueléticas, dentre as quais a dor na região lombar é uma das mais prevalentes. Pedalar não é um movimento natural na ergonomia humana e, consequentemente, irregularidades no posicionamento levam a desequilíbrios. A postura inadequada altera as características de recrutamento muscular, principalmente na região lombar e nos membros inferiores durante o ato de pedalar, o que torna relevante a investigação das queixas de dor e desconforto na coluna vertebral. O objetivo deste estudo foi de analisar o impacto das adequações ergonômicas no sistema homem-bicicleta na dor lombar de ciclistas, a partir de registros eletromiográficos. Para isso, um estudo descritivo com 35 ciclistas avaliou três protocolos para o ajuste da altura do selim: (a) um protocolo de referência (REF), altura do selim inicialmente apresentada pelo atleta ;(b) P1 baseado em Burke, relacionou a altura do entrepernas multiplicado pela constante 1,09;(c) P2,onde a altura do selim foi regulada pela flexão de joelho quando o pedal encontra-se na parte mais baixa do ciclo da pedalada (PMI). Todos os protocolos foram avaliados por meio da eletromiografia (EMG System do Brasil, modelo 1600-U12) dos músculos quadrado lombar, eretor da coluna lombar, eretor da coluna torácica, reto abdominal, reto femoral, vasto lateral, vasto medial, isquiotibiais, gastrocnêmio. Adicionalmente, foi avaliada a geometria do posicionamento angular das articulações de membros inferiores durante as pedaladas, por meio da Biofotogrametria, onde foram medidos os ângulos de movimento do tornozelo, do joelho e do quadril em duas fases do ciclo da pedalada: (1) no ponto motor superior (PMS); e (2) no PMI. O impacto das recomendações foi avaliado antes do ajuste e em 30 dias e 5 meses após a recomendação ergonômica, pela aplicação da escala visual analógica de dor. Os resultados mostraram uma redução significativa dos relatos de dor pós ajustes, aos 30 dias (p=0,000), que perdurou até os 5 meses (p=0,023). Na comparação eletromiográfica do recrutamento muscular entre os protocolos, foram encontrados: (1) entre REF e P1, um índice significativamente menor de recrutamento muscular para : lombar (p=0,006); posterior de membro inferior (p=0,003) e abdominal (p=0,002);(2) entre REF e P2, recrutamento muscular significativamente menor na região abdominal (p=0,009); (3) entre P1 e P2, menor recrutamento muscular para membro inferior posterior em P1 (p=0,030). Na análise da geometria do movimento, diferenças significantes para o ângulo de joelho no PMS (p=0,003) e no PMI (p=0,012) em P1, apenas. A partir dos resultados encontrados, a hipótese inicial do estudo foi confirmada, uma vez que a média do sinal do traçado eletromiográfico, mostrou-se eficaz na quantificação das modificações do recrutamento muscular específico do esporte, para os diferentes métodos de ajuste do selim, e serviu como base para a recomendação de adequações ergonômicas, visto que foi após estas, foi diminuído a sobrecarga muscular na região lombar. As evidências permitiram concluir que P1 foi o protocolo mais eficaz na recomendação ergonômica de ajuste do selim, e o mesmo pode ser a referência de recomendação para os praticantes de ciclismo em mesmas condições antropométricas e de treinamento que a amostra aqui estudada. Ainda foi possível estabelecer que os músculos eletromiograficamente mais recrutados devem ser o foco do treinamento de força, na preparação dos atletas, de modo a diminuir o risco biomecânico para o desenvolvimento de lesões em treinos e competições. / One of the applications of ergonomics is the prevention of musculoskeletal disorders, among which the low back pain is one the most prevalent. Pedaling isn’t a natural movement in the human ergonomics and, consequently irregularities in the positioning leads to imbalances. The inappropriate posture changes the characteristics of muscle recruitment, especially in the lumbar region and lower limbs during the act of cycling, which makes relevant the investigation of complaint of pain and discomfort in the spine. The objective of this study was to analyze the impact of ergonomic adjustments in man-bike system in low back pain of cyclists, from electromyographic records. For this, a descriptive study of 35 cyclists evaluated three protocols for adjusting the saddle height: (a) a protocol of reference (REF), saddle height initially presented by the athlete;(b) P1 based on Burke, related to the crotch height multiplied by the constant 1.09; (c) P2 where the seat height is adjusted by knee flexion when the pedal is in the lower part of the pedal cycle (PMI). All protocols were evaluated using electromyography (EMG System of Brazil, model 1600-U12) of the quadratus lumborum muscles, erector lumbar spine, thoracic spine erector, rectus abdominis, rectus femoris, vastus lateralis, vastus medialis, hamstrings, gastrocnemius . Additionally, the geometry of the angular positioning of the joints of the lower limbs during pedaling was evaluated by means of photogrammetry, where were measured angles of movement of the ankle, knee and hip in two phases of the pedaling cycle: (1) the upper motor point (SMP), and (2) the PMI.The impact of the recommendations was evaluated before adjustment and 30 days and 5 months after the ergonomic recommendation by applying visual analogue pain scale. Results showed a significant reduction in reported pain after adjustments at 30 days (p = 0.000), which lasted until 5 months (p = 0.023).In the electromyography comparison of muscle recruitment between the protocols were found: (1) between REF and P1, a significantly lower level of muscle recruitment for: lumbar (p = 0.006), posterior lower limb (p = 0.003) and abdominal (p = 0.002), (2) between REF and P2, significantly less muscle recruitment in the abdominal region (p = 0.009), (3) between P1 and P2, reduced muscle recruitment for subsequent lower limb in P1 (p = 0.030). The analysis of the movement geometry, significant differences for the knee angle of PMS (p = 0.003) and PMI (p = 0.012) P1 only. From these results, the initial study hypothesis was confirmed, since the mean signal of the EMG tracing, was effective in quantifying changes in specific muscle recruitment of the sport, for the different methods of adjusting the saddle, and served as basis for the recommendation of ergonomic adjustments, since it was after them, was decreased muscle overload in the lumbar region. The evidence allowed to conclude that P1 was the most effective protocol in ergonomic tuning recommendation of the saddle, and the same can be the reference of recommendation for athletes in the same cycling conditions anthropometric and training like on this studied here. It has been possible to establish that recruited more muscles electromyography should be the focus of strength training, the preparation of athletes in order to decrease the biomechanical risk for developing injuries during training and competitions.

Uma das aplicações da ergonomia é a prevenção de patologias músculo esqueléticas, dentre as quais a dor na região lombar é uma das mais prevalentes. Pedalar não é um movimento natural na ergonomia humana e, consequentemente, irregularidades no posicionamento levam a desequilíbrios. A postura inadequada altera as características de recrutamento muscular, principalmente na região lombar e nos membros inferiores durante o ato de pedalar, o que torna relevante a investigação das queixas de dor e desconforto na coluna vertebral. O objetivo deste estudo foi de analisar o impacto das adequações ergonômicas no sistema homem-bicicleta na dor lombar de ciclistas, a partir de registros eletromiográficos. Para isso, um estudo descritivo com 35 ciclistas avaliou três protocolos para o ajuste da altura do selim: (a) um protocolo de referência (REF), altura do selim inicialmente apresentada pelo atleta ;(b) P1 baseado em Burke, relacionou a altura do entrepernas multiplicado pela constante 1,09;(c) P2,onde a altura do selim foi regulada pela flexão de joelho quando o pedal encontra-se na parte mais baixa do ciclo da pedalada (PMI). Todos os protocolos foram avaliados por meio da eletromiografia (EMG System do Brasil, modelo 1600-U12) dos músculos quadrado lombar, eretor da coluna lombar, eretor da coluna torácica, reto abdominal, reto femoral, vasto lateral, vasto medial, isquiotibiais, gastrocnêmio. Adicionalmente, foi avaliada a geometria do posicionamento angular das articulações de membros inferiores durante as pedaladas, por meio da Biofotogrametria, onde foram medidos os ângulos de movimento do tornozelo, do joelho e do quadril em duas fases do ciclo da pedalada: (1) no ponto motor superior (PMS); e (2) no PMI. O impacto das recomendações foi avaliado antes do ajuste e em 30 dias e 5 meses após a recomendação ergonômica, pela aplicação da escala visual analógica de dor. Os resultados mostraram uma redução significativa dos relatos de dor pós ajustes, aos 30 dias (p=0,000), que perdurou até os 5 meses (p=0,023). Na comparação eletromiográfica do recrutamento muscular entre os protocolos, foram encontrados: (1) entre REF e P1, um índice significativamente menor de recrutamento muscular para : lombar (p=0,006); posterior de membro inferior (p=0,003) e abdominal (p=0,002);(2) entre REF e P2, recrutamento muscular significativamente menor na região abdominal (p=0,009); (3) entre P1 e P2, menor recrutamento muscular para membro inferior posterior em P1 (p=0,030). Na análise da geometria do movimento, diferenças significantes para o ângulo de joelho no PMS (p=0,003) e no PMI (p=0,012) em P1, apenas. A partir dos resultados encontrados, a hipótese inicial do estudo foi confirmada, uma vez que a média do sinal do traçado eletromiográfico, mostrou-se eficaz na quantificação das modificações do recrutamento muscular específico do esporte, para os diferentes métodos de ajuste do selim, e serviu como base para a recomendação de adequações ergonômicas, visto que foi após estas, foi diminuído a sobrecarga muscular na região lombar. As evidências permitiram concluir que P1 foi o protocolo mais eficaz na recomendação ergonômica de ajuste do selim, e o mesmo pode ser a referência de recomendação para os praticantes de ciclismo em mesmas condições antropométricas e de treinamento que a amostra aqui estudada. Ainda foi possível estabelecer que os músculos eletromiograficamente mais recrutados devem ser o foco do treinamento de força, na preparação dos atletas, de modo a diminuir o risco biomecânico para o desenvolvimento de lesões em treinos e competições. / One of the applications of ergonomics is the prevention of musculoskeletal disorders, among which the low back pain is one the most prevalent. Pedaling isn’t a natural movement in the human ergonomics and, consequently irregularities in the positioning leads to imbalances. The inappropriate posture changes the characteristics of muscle recruitment, especially in the lumbar region and lower limbs during the act of cycling, which makes relevant the investigation of complaint of pain and discomfort in the spine. The objective of this study was to analyze the impact of ergonomic adjustments in man-bike system in low back pain of cyclists, from electromyographic records. For this, a descriptive study of 35 cyclists evaluated three protocols for adjusting the saddle height: (a) a protocol of reference (REF), saddle height initially presented by the athlete;(b) P1 based on Burke, related to the crotch height multiplied by the constant 1.09; (c) P2 where the seat height is adjusted by knee flexion when the pedal is in the lower part of the pedal cycle (PMI). All protocols were evaluated using electromyography (EMG System of Brazil, model 1600-U12) of the quadratus lumborum muscles, erector lumbar spine, thoracic spine erector, rectus abdominis, rectus femoris, vastus lateralis, vastus medialis, hamstrings, gastrocnemius . Additionally, the geometry of the angular positioning of the joints of the lower limbs during pedaling was evaluated by means of photogrammetry, where were measured angles of movement of the ankle, knee and hip in two phases of the pedaling cycle: (1) the upper motor point (SMP), and (2) the PMI.The impact of the recommendations was evaluated before adjustment and 30 days and 5 months after the ergonomic recommendation by applying visual analogue pain scale. Results showed a significant reduction in reported pain after adjustments at 30 days (p = 0.000), which lasted until 5 months (p = 0.023).In the electromyography comparison of muscle recruitment between the protocols were found: (1) between REF and P1, a significantly lower level of muscle recruitment for: lumbar (p = 0.006), posterior lower limb (p = 0.003) and abdominal (p = 0.002), (2) between REF and P2, significantly less muscle recruitment in the abdominal region (p = 0.009), (3) between P1 and P2, reduced muscle recruitment for subsequent lower limb in P1 (p = 0.030). The analysis of the movement geometry, significant differences for the knee angle of PMS (p = 0.003) and PMI (p = 0.012) P1 only. From these results, the initial study hypothesis was confirmed, since the mean signal of the EMG tracing, was effective in quantifying changes in specific muscle recruitment of the sport, for the different methods of adjusting the saddle, and served as basis for the recommendation of ergonomic adjustments, since it was after them, was decreased muscle overload in the lumbar region. The evidence allowed to conclude that P1 was the most effective protocol in ergonomic tuning recommendation of the saddle, and the same can be the reference of recommendation for athletes in the same cycling conditions anthropometric and training like on this studied here. It has been possible to establish that recruited more muscles electromyography should be the focus of strength training, the preparation of athletes in order to decrease the biomechanical risk for developing injuries during training and competitions.

Indiana University-Purdue University Indianapolis (IUPUI) / While the majority of chronic pain patients report receiving inadequate care, there is evidence that female and Black patients receive less analgesic medications and treatment for their chronic pain compared to male and White patients, respectively. While treatment disparities have been evidenced in the literature, there is little understanding of provider-factors, such as their decision-making awareness and attitudes, which may contribute to the differences in treatment. This investigation employed quantitative and qualitative procedures to examine the relationship between patient demographics and chronic pain treatment variability, providers’ awareness of these non-medical influences on their decisions, and the extent to which providers’ gender and racial attitudes associate with their treatment decisions. Twenty healthcare trainees made pain treatment decisions (opioid, antidepressant, physical therapy, pain specialty referral) for 16 computer-simulated patients presenting with chronic low back pain; patient sex and race were manipulated across vignettes. Participants then selected among 9 factors, including patient demographics, to indicate which factors influenced their treatment decisions for the simulated patients and completed gender and racial attitude measures. After online study completion, follow-up semi-structured interviews were conducted to discuss the medical/non-medical factors that influence trainees’ clinical treatment decisions. Quantitative analysis indicated that 5%-25% of trainees were actually influenced (p<0.10) by patient sex and race in their treatments, and on the whole, trainees gave higher antidepressant ratings to White than Black patients (p<.05). Fifty-five percent demonstrated concordance, or awareness, between their actual and reported use of patient demographics. Follow-up McNemar’s test indicated trainees were generally aware of the influence of demographics on their decisions. Overall, gender and racial attitudes did not associate with trainees’ treatment decisions, except trainees’ complementary stereotypes about Black individuals were positively associated with their opioid decisions for White patients. During qualitative interviews, aware and unaware trainees discussed similar themes related to sex and racial/ethnic differences in pain presentation and tailoring treatments. We found that (1) a subset of trainees were influenced by patient sex and race when making chronic pain treatment decisions, (2) trainees were generally aware of the influence of patient demographics, and (3) trainees discussed differences in pain presentation based on patients’ sex and ethnic origin. These findings suggest trainees’ are influenced by patient demographics and hold stereotypes about patient populations, which may play a role in their decision-making.