背景：肱骨外上髁炎（ Lateral epicondylitis, LP ），又名網球肘、肘勞等，是一種以肘外側疼痛、肘關節功能下降為主要臨床表現的運動系統疾病。溫針被廣泛運用於肱骨外上髁炎的臨床治療，但目前未有專門的文獻研究與系統評價，其臨床研究的開展情況、療效與安全性尚不明確。 目的：(1）運用計量分析的方法，分析總結溫針治療肱骨外上棵炎臨床研究的開展情況、使用規律與理論依據﹔（ 2 ）運用系統評價的方法，評估當前臨床隨機對照試驗(Randomized Controlled Trial, RCT)的開展質量，評估溫針治療肱骨外上髁炎的療效與安全性。方法：系統檢索中國知網、Pubmed 等12 個電子數據庫，將符合計量分析納入標準的文獻進行統計與分析。同時，對符合系統評價納入標準的RCT使用PEDro 、Cochrane 偏倚風險評估工具與STRICTA 進行質量評價，並根據干預措施的不同以分組的形式對溫針治療肱骨外上髁炎進行療效與安全性評價。結果：計量分析共納人文獻81 篇，結果顯示： (1) 《中醫病證診斷療效標準》為臨床試驗中最主要的診斷與療效標準（ n＝48，59.25% ﹔ n=68, 83. 95% ）﹔（ 2 ）臨床試驗中溫針與其它乾預措施聯合的比例為92.59%(n=75 ），且聯合特殊針刺方法較為普遍( n=34, 41. 98% ）﹔ (3 ）溫針取穴頻數前6 的穴位為：阿是穴（ n=61, 34.27% ）、曲池（ n=37, 20. 79% ）、手三里（ n=27, 15 . 17% ）、外關（ n=ll, 6.18%) 、肘膠(n＝10, 5.62% ）、合谷（n=lO, 5.62% ）,穴位歸經以手三陽經為主。系統評價共納入文獻12 篇，計患者1177 例，主要結果顯示：(1 ）根據PEDro 量表3 篇RCT被評估為「良好」, 偏倚風險評估結果，顯示所有RCT 至少含有1 項高風險或不詳風險﹔（ 2) 2 篇RCT顯示溫針療效優於普通針刺，合併治癒率RR=3 .84, 95%CI﹝ 1.85, 7.96](P = 0.0003 ），合併總有效率RR=l.29, 95%CI ﹝ 1.10, 1. 52] ( P=O. 002 ），均有統計學差異﹔ (3) 2 篇RCT顯示溫針療效優於電針，合併治癒率RR=l. 47, 95%CI [1.18, 1.84 ﹞, P=0.0008 ，合併總有效率RR=l.06, 95%CI [1. 00, 1.3]，p = 0.03 ，均有統計學差異﹔（ 4 ）溫針優於其他替代療法，包括推拿、封閉、TDP 照射﹔（ 5) 1 篇RCT報告不良事件，包括暈針、出針後出血。結論：(1 ）溫針治療肱骨外上髁炎具有豐富的中醫理論基礎﹔（ 2 ）阿是穴、手三里、外關、曲池、合谷、肘膠是臨床上溫針治療肱骨外上髁炎的優選穴位，並主要從手三陽經論治﹔（ 3 ）溫針治療肱骨外上髁炎優於其他替代療法，包括普通針刺、電針、TDP照射、推拿與穴位注射，但證據等級較低。由於不良事件報告過少，暫無法就溫針的安全性得到確切結論。確切的結論尚需更多高質量的RCT以求證，建議將來開展設計科學的大樣本、多中心RCT。關鍵字：肱骨外上髁炎，網球肘，溫針，系統評價

M.Tech. (Somatology) / Osteoarthritis (OA) is considered a degenerative form of arthritis that affects the smooth cartilage covering the ends of bone (Sharma, 2006; Flynn & Ohnson, 2007). It is currently estimated to be the leading cause of musculoskeletal disability and pain amongst those 65 years and older (McKay et al., 2012; Vuolteenaho et al., 2013). Disease progression is slow as smooth cartilage at the ends of bone is worn away causing painful bone on bone friction. Any joint may be affected, the hips, spine, knees, small bones of the fingers and the base of the thumbs are commonly affected. Massage therapy is an age old practice that may be dated back to the ancient Roman, Geek and Egyptian dynasties (Braun & Simonson, 2008). Massage once formed a significant part of mainstream medical and nursing occupations, forming the basis for present day physiotherapy. To this day, numerous occupations still incorporate various aspects of massage (Casanelia & Stelfox, 2010). Swedish massage or Remedial massage, as still used today, found its origins in the early 19th century during the “Swedish Movement Cure”. Henrik Ling coined the phrase “Swedish Massage” when he developed a series of movements that he used in the treatment of various conditions and ailments. Ling did however not intend for these movements to be done for extended and frequent periods of time, which is necessary when it is ones occupation, and by the conclusion of the 19th century it was found that therapists were already presenting with strain injuries (Prichard, 2007). Western massage has been adapted into numerous forms over the past 100 years. Pyves (2001) explains that the early techniques were not intended to be used for prolonged and frequent sessions. Such massage sessions, he feels, may be to the detriment of the therapist. Prichard (2007) explains that the massage therapist experiences physical problems that arise mostly from cumulative effects. Cumulative joint stress may be caused by the awkward, physically stressful and/ or repetitive movements whilst applying pressure. Individual injuries or strains may over months or years accumulate into an overuse injury (Prichard, 2007). Many other occupations have been identified as inducing a greater risk for the development of OA, such as the agricultural sector (Thelin et al., 2004), the housekeeping industry (Caspi et al., 2001; Rossignol et al., 2003 and Vingard et al., 1991), the construction industry (Dillon et al., 2002; O’Reilly et al., 2000 and Sandmark et al., 2000), the clothing industry (Rossignol et al., 2005) and the occupation of physiotherapy (Snodgrass & Rivett, 2002)...

Our purpose was to evaluate effects of cadence manipulation on plantar loading during running. Participants (n=38) ran on a treadmill at their preferred speed in 3 conditions: preferred, 5% increased, and 5% decreased while measured using in-shoe sensors. Data (contact time [CT], peak force [PF], force time integral [FTI], pressure time integral [PTI] and peak pressure [PP]) were recorded for 30 right footfalls. Multivariate analysis was performed to detect differences in loading between cadences in the total foot and 4 plantar regions. Differences in plantar loading occurred between cadence conditions. Total foot CT and PF were lower with a faster cadence, but no total foot PP differences were observed. Faster cadence reduced CT, pressure and force variables in both the heel and metatarsal regions. Increasing cadence did not elevate metatarsal loads; rather, total foot and all regions were reduced when healthy runners increased their cadence. If a 5% increase in cadence from preferred were maintained over each mile run the impulse at the heel would be reduced by an estimated 565 body weightss (BWs) and the metatarsals 140-170 BWs per mile run despite the increased steps taken. Increasing cadence may benefit overuse injuries associated with elevated plantar loading.

PURPOSE: Muscle overuse is characterized by inflammation, reduced strength and muscle damage. It has been proposed that calcium (Ca2+) accumulation during muscle contraction, is responsible for muscle damage. Muscle contractile properties are regulated by calcium regulatory excitation contraction coupling mechanisms. Therefore, the main aim of the present study was to investigate the effects of voluntary repetitive tasks during six weeks on the rate of sarcoplasmic reticulum (SR) Ca2+-uptake, and Ca2+-release, in young female Sprague-Dawley rats. Secondly, this study aims to evaluate the effect of the training on muscular strength and the relationship between SR Ca2+-kinetics and grip strength test performance. METHODS: Six rats were trained (EXP), using a well-established model of reaching and handle pulling with the upper extremities (2 hr/day, 3days/week, 6 weeks), six control rats (KON) were included that were not exposed to the task. Grip strength were evaluated using a grip strength meter for rodents, two weeks prior the training was initiated, and two days after the training period was concluded. Tissue samples were obtained from the supraspinatus and trapezius muscle, and the rate of SR Ca2+-uptake and SR Ca2+-release were analysed using the fluorescent Ca2+ indicator indo 1. RESULTS: The analysis revealed that EXP had a significant higher rate of SR Ca2+-uptake, in both supraspinatus (33%, P < 0,05) and trapezius (14%, P < 0,05), compared to KON. However, no significant differences in SR Ca2+-release rate were found between groups, in neither of the muscles. A decline in grip strength were found in both EXP and KON, with no significant differences between groups. No significant correlation between grip strength and the Ca2+ release uptake variables could be found. CONCLUSION: The present results suggests that repetitive voluntary reaching and handle pulling with the upper extremities during six weeks, induce extant changes in SR Ca2+-uptake rate in rats.

Due to a proliferation of health and social advantages, the popularity of running among the more mature members of the female population is expanding steadily. However, with both age and gender acting as possible risk factors, the incidence of running related injuries and associated conditions is high among this group. With the predominance of debilitating conditions such as knee joint osteoarthritis acting at the knee joint, knowledge of lower limb biomechanics during running will provide insight into possible risk factors and potential management strategies. Three biomechanical and one magnetic resonance imaging study focussed on the specific running gait of mature females and the effect of footwear on lower limb joint kinematics and loading. The biomechanical studies used synchronised ground reaction force and lower extremity kinematic data to provide three dimensional running data and knee moments for each female. The long term study objectives were to 1) determine whether the running gait of mature females could be a predisposing factor to injuries and conditions at the knee joint, and 2) determine if changes in footwear could modify biomechanical variables associated with the development of injuries and overuse conditions among this group. In Study One, a direct comparison of mature and young female running gait was used to identify any biomechanical movement characteristics specific to the mature group that could predispose to injuries and debilitating conditions. It was found that rearfoot eversion, ankle dorsiflexion, knee internal rotation, and knee external adductor moment that are associated with increased loading of the lateral knee joint and possible medial knee joint osteoarthritis development, were significantly higher among the mature females compared to the younger group (p<0.05). A common management strategy for running related conditions is the adaption of footwear. Therefore Study Two investigated the effect of a motion control running shoe on the running gait of young and mature females, with a specific focus on the variables associated with knee joint injury and osteoarthritis development. The results showed a motion control shoe to reduce certain biomechanical variables (rearfoot eversion and knee internal rotation) associated with mature female runners. However, one variable (knee external adductor moment) commonly associated with increased medial knee loading and osteoarthritis development, remained high among the mature females. One specific method used to reduce the knee external adductor moment, is the implementation of a lateral wedge in running shoes. Therefore, Study Three assessed the singular effects of a medial wedge, a lateral wedge, and then the effect of an orthotic combining both interventions on the running gait of mature females. Results demonstrated non significant changes in any kinematic variable with the medial or lateral wedge, although the lateral wedge was shown to reduce the knee external adductor moment. The orthotic intervention however produced significant reductions in rearfoot eversion, knee internal rotation, and knee external adductor moment previously found to be high among mature female runners. Although all mature females studied had previously been characterised as free from symptoms of knee injury or osteoarthritis, a final investigation was undertaken to assess the condition of the knee joint (Study Four). Magnetic resonance imaging scans of the knee were taken for ten of the mature females. Results indicated that eight out of the ten females had early stage osteoarthritis present, with an average 79% of features presenting on the medial side of the knee joint. Additionally, there was a strong positive correlation between knee osteoarthritis and the knee external adductor moments measured in the ongoing biomechanical study (Study Three). These studies have shown that the running gait of mature females is significantly different to that of younger female runners, and could predispose the mature group to injury and knee osteoarthritis development. The trends in kinematic adaption to a motion control shoe have shown promising results, and indicated the potential for footwear to reduce rearfoot eversion and knee internal rotation among mature female runners. However, a specific orthotic, incorporating both medial and lateral support has been found to reduce biomechanical features of gait associated with overloading at both the medial and lateral knee joint. The positive correlation between the knee adductor moment and signs of osteoarthritis for an asymptomatic population suggests that the knee adductor moment may be a useful predictive tool for identifying female runners at risk of osteoarthritis development.

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute Of Technology, 2006. / Purpose Repetitive strain injuries, especially rotator cuff tendonitis, are increasing and reaching epidemic proportions in certain industries and in most industrialized countries (Yassi et al. 1996). Fatigue of the rotator cuff allows the humeral head to translate anteriorly, with resultant mechanical impingement of the supraspinatus tendon. At this point inflammatory changes become evident (Fu et al. 1995). According to Greenman (1996), muscle energy technique (MET) is a 'manual medicine treatment procedure that involves the voluntary contraction of a patients muscle in a precisely controlled direction, at varying levels of intensity, against a distinctively executed counterforce applied by the operator.' It has been hypothesized that MET can be used to lengthen and strengthen muscles, to increase fluid mechanics and decrease local edema, and to mobilize a restricted articulation (Greenman 1996). However, these statements have been made in the absence or appropriate research in order to support such statements, therefore. the aim of this study was to assess the efficacy of Muscle Energy Technique in the treatment of rotator cuff tendonitis in terms of subjective and objective clinical findings. Methods Objective measures included: Diagnostic ultrasound which was used to evaluate changes in inflammation and thickness of the involved tendon, the algometer was used to assess point tenderness, whilst inclinometer readings were taken to evaluate the associated changes in range of motion that may have taken placei / M

Bakgrund: Det finns begränsat med forskning genomförd på sprintkanotister. De studier som genomförts rapporterade att ländrygg, bröstrygg och skuldra är de vanligaste skadelokalisationerna. Hittills har inte rapporterats hur skadorna påverkar träningsmängd och prestation. Syfte: Syftet var att kartlägga förekomsten av överbelastningsskador och dess påverkan på prestationsförmåga och träning för svenska elitsatsande sprintkanotister. Metod: En kvantitativ enkät användes för att genomföra en tvärsnittsstudie. Enkäter delades ut till 30 kvinnor och 42 män på en tävling som var uttagningsgrundande för landslaget. Enkäten som användes var en modifierad version av den svenska översättningen av OSTRC Overuse Injury Questionnaire. Datan analyserades med hjälp av statistikprogrammet SPSS där analysmetoderna Mann-whitney och Kruskall-wallis användes. Resultat: Totalt delades 75 enkäter ut och 72 svar kom in. Femtio (69%) kanotister rapporterade att de hade en överbelastningsskada. Den vanligaste skadelokalisationen var hand/underarm följt av skuldra, ländrygg och bröstrygg. Åtskilliga kanotister tränade trots överbelastningsskada och detta var mer vanligt bland kvinnor än män. Det fanns ett samband mellan mindre träningsmängd och mer smärta. Konklusion: En hög andel av kanotisterna rapporterade överbelastningsskador. Hand/underarm var den skadelokalisation som var vanligast bland kanotister medan ländrygg och skuldra var de som hade störst påverkan på träning och prestation. / Introduction: There is limited research on injury prevalence among sprint kayakers. The previous studies reported a high prevalence of overuse injuries located in the lumbar and thoracic spine and the shoulders. The injury impact on performance and training has not yet been reported. Purpose: The aim of this study was to investigate the prevalence of overuse injuries among elite sprint kayakers in Sweden and the impact of these on performance and training. Method: A quantitative questionnaire was used to perform a cross-sectional study. Questionnaires were distributed to 30 women and 42 men during a sprint kayak competition during wich the national team was to be selected. A modified version of the Swedish translated questionnaire OSTRC Overuse Injury Questionnaire was used. The statistic program SPSS was used for data analysis, and Mann-Whitney and Kruskall-Wallis were perfomed. Results: Seventy-five questionnaires were distributed and 72 kayakers responded. Fifty (69%) kayakers reported an overuse injury. The most common reported injury location was hand/forearm followed by shoulder, lumbar and thoracic spine. Several kayakers participated despite overuse injury, something which is more common among women than men. There was a correlation between less training hours and more pain among the kayakers. Conclusion: There is a high prevalence of overuse injuries reported among the sprint kayakers. Hand/forearm was the most common location of injury among the sprint kayakers, while the lumbar spine and shoulders had the biggest impact on performance and training.

Work-related musculoskeletal disorders (WMDs) are a major public health problem in terms of the considerable amount of disability, impairment, and associated economic cost. Among these disorders, the occurrence of WMD symptoms of the neck is prevalent and has been associated with significant disability, long periods of sick leave and loss of productivity in occupational settings. Risk factors for WMDs are multifactorial, and studies have typically focused on ergonomic factors. Psychosocial factors in the work environment have been recently considered; however, findings across these studies have not been consistent. Despite the evidence associated with ergonomic factors on the occurrence of WMDs, widespread prevention and treatment efforts have not been successfully implemented. Psychosocial factors such as high psychological demands, low decision latitude and low social support may play a role in WMD occurrence. The demand-control-support model has been widely used to predict job strain. Particularly for disorders of the neck, job strain seems to play a strong role in their occurrence. The psychosocial work environment and WMDs are listed as research priorities of the National Occupational Research Agenda developed by the National Institute for Occupational Safety and Health. This cross-sectional study looked at job strain and neck symptoms, while controlling for confounders. This project was carried out on a group of semiconductor manufacturing workers. The prevalence of neck symptoms was measured by a self-administered questionnaire. A Chinese version of the Job Content Questionnaire was included to assess psychosocial factors and to test the demand-control-support model. An observational checklist was developed and used to assess ergonomic exposures on individual workers' jobs. The participation rate was 86.5%. The final sample of semiconductor workers consisted of 373 female participants. Their mean age was 28.4 years ranging from 18 to 41 years. The mean length of employment was 4.3 years. The prevalence of symptoms of neck disorders in the semiconductor manufacturing population was 23.9%. It was concluded that the prevalence rates of neck symptoms of WMDs in this study were high, especially given the very conservative outcome definition that was used. The study findings partially supported the job strain model, showing an increase in prevalence of neck symptoms with psychological and physical job demands; however, association with decision latitude and social support were not supported. Further studies with more comprehensive measurements of work-related psychosocial factors are implicated and effective prevention strategies for neck symptoms of WMDs are suggested.

Lower limb injury incidence is high amongst Royal Marine recruits. Tibial and metatarsal stress fractures are particularly problematic. The regular load carriage activities undertaken throughout training have been implicated, but mechanisms by which these injuries develop are poorly understood. The aim of this thesis was to improve understanding of the mechanisms by which the most prevalent Royal Marine training injuries develop. The first experimental chapter was a prospective study of 1065 Royal Marine recruits. Anthropometric and dynamic biomechanical variables (during barefoot running at 3.6 m.s-1) were recorded at the start of training. A smaller calf girth and bimalleolar breadth were found to predispose recruits to tibial stress fractures and ankle inversion injuries. Recruits who sustained tibial stress fractures demonstrated greater heel loading than those who remained injury-free. Recruits who sustained metatarsal stress fractures demonstrated later peak metatarsal pressures than those who remained injury-free. A review of the 32-week Royal Marine recruit training programme found an association between prolonged load carriage activities and injury occurrence. The second experimental study identified gait changes following a prolonged load carriage activity (12.8 km, 35.5 kg load). Biomechanical variables were recorded during barefoot running (3.6 m.s-1) in 32 recruits pre- and post-activity. Recruits demonstrated increased rearfoot loading, and later peak metatarsal pressures post-activity, indicative of a reduced ability to push-off. The final study examined the influence of the same load carriage activity on gait changes during walking (1.4 m.s-1) in 32 recruits, allowing assessment of the independent influence of load carriage. Kinetic and electromyographic variables provided further explanation of changes observed in the previous study. During load carriage there were increased plantar flexor and knee extensor moments and corresponding increases in muscle activity. There were reduced knee extensor moments, and evidence of plantar flexor muscle fatigue post-activity. A reduced ability to push off during stance due to muscular fatigue was suggested as a key contributor to tibial and metatarsal stress fracture development. This may explain the association between a smaller calf girth and tibial stress fracture development.

Introduction: Irish dance has evolved to become more athletically demanding, thus making the art form very hard on dancers' bodies. Irish dancers must land from difficult moves without letting their knees bend or heels touch the ground, causing large amounts of force to be absorbed by the body. Past studies have found dancers landing with a range of 4.5–6 times body weight, potentially causing high amounts of overuse injury. The majority of injuries incurred by Irish dancers are due to overuse (79.6%). The landings that occur in Irish dance have been minimally evaluated in current literature. Obtaining values of vertical ground reaction forces (GRFs) produced by Irish dancers will assist in understanding the causes of overuse injuries, fill significant gaps in the current literature, and identify which Irish dance moves should be used less frequently to possibly reduce the chance for overuse injury. Purpose: To determine vertical GRFs produced by female Irish dancers in hard and soft shoes during common movements. The purpose of this study was to determine peak force, rise rate of force, and impulse in selected Irish hard shoe and soft shoe dance movements. Materials and Methods: Sixteen female Irish dancers between 14 and 25 years of age were recruited from the 3 highest competitive levels. Each performed a warm-up, reviewed 8 common Irish dance moves, and then performed each move 3 times upon a force plate. Four moves each were performed in soft and hard shoes. GRFs were measured using a 3-dimensional force plate running at 1000 Hz. Peak force, rise rate, and vertical impulse were all calculated. It was hypothesized that the 8 moves would produce different GRFs. Results: Peak forces normalized by each dancer's body weight were significantly different across moves (F = 65.4, p < 0.01; F = 65.0, p < 0.01; and F = 67.4, p < 0.01 respectively). Years of experience was not correlated with peak force, rise rate, or impulse (p < 0.40). Conclusion: There is a large range in peak forces created by Irish dancers. Moves that have high average peak forces may have a higher risk in causing overuse injuries. All dancers should take care to limit the use of these moves in their choreography to prevent such injury.