Earticle

In ESWT using low-energy shock waves serves as a regenerative medicine that induces angiogenesis and tissue regeneration in the musculoskeletal system. The indications of ESWT are musculoskeletal diseases such as calcified tendonitis (calcified tendonitis of the rotator cuff band, gluteus medius calcified tendonitis), patellar tendonitis, Achilles tendonitis, medial and lateral epicondylitis, foot fasciitis, shoulder-neck pain syndrome, and knee arthritis. In general, in the case of radial ESWT, the frequency is 5Hz, the intensity is 1.0bars, and the frequency is 1500 strokes. For Focus ESWT, 1500 strokes are performed with an energy of 4Hz and 0.3 mJ/mm2. The period was the most common for four weeks, twice a week. ESWT generally corresponds to contraindication if you are pregnant, taking anticoagulants, have coagulation disorders or hypersensitivity to local anesthetics, have heartbeats, hemorrhagic diseases, and have acute inflammation, arthrosis, or neuropathy. Currently, the commonly used ESWT area is the pain area complained by the patient. In particular, muscles and tendons are the main applications of ESWT, and the origin or insertion of those muscles and tendons are the main applications of ESWT. However, research on various application strengths is required depending on the disease or region, and further research on the application period or number of applications is also considered necessary.

Background Strengthening the gluteus medius (Gmed) is vital to provide functional movement of the lower extremities and lateral stability of the pelvis. The clam exercise (CE) effectively activates the Gmed. To perform the CE effectively, it is essential to control the lumbar-pelvic movement, which is influenced by the stability of the lumbar pelvis. Purpose The purpose of this study was to compare the effects on muscle activity of the internal oblique (IO), Gmed, gluteus maximus (Gmax), and tensor fascia lata (TFL) between men with weak abdominal muscles (WAM) and healthy men during the CE after performing the abdominal draw-in maneuver (ADIM). Study design Cross-sectional study. Methods Participants in this study included 11 men with WAM and 11 healthy men. The IO, Gmed, Gmax, and TFL activities were measured on all participants using wireless electromyography during the CE before the intervention. Both groups performed ADIM for 10 minutes, and each muscle activity was measured again similarly. A paired t-test was used to compare before and after intervention within groups, and an independent t-test was used to compare between groups. Results In the intra-group comparison of the WAM group, the muscle activity of IO, Gmed, and Gmax significantly increased and the TFL activity significantly decreased during CE after performing ADIM. In contrast to groups before the intervention, TFL activity was significantly higher in the WAM group than in the control group. In a comparison between groups, the amount of change in the activity of Gmed and TFL was more significant in the WAM group than in the control group. Conclusions Results suggested that for men with WAM, performing the ADIM before the CE is an effective exercise method for reducing the compensatory action of TFL and increasing the selective activity of Gmed and Gmax.

Objective To investigate the effects of asymptomatic back muscle weakness and spinal deformity on low back pain (LBP).Methods Sixty healthy subjects without LBP participated in this study. Radiography and an isokinetic/isometric dynamometer were used to respectively measure spinal scoliosis/lordosis and the strength of the trunk flexors/extensors. After 2 years, 48 subjects visited the hospital again and LBP episodes, its severity and the Korean version of the Oswestry Disability Index were assessed. Differences between the group with LBP and the group without LBP were evaluated and the association with LBP incidence and severity was determined. Results Sex, age, and trunk strength were significantly different in both group. Sex and age were significantly positive associated with LBP incidence. The isometric trunk flexor and extensor strength, maximum isokinetic trunk flexor and extensor strength were significantly and negatively associated with the LBP severity. The maximum isokinetic trunk extensor and maximum isometric trunk extensor strength was significantly negative associated with the LBP incidence.Conclusion LBP incidence is associated with isometric and isokinetic trunk extensor weakness, whereas LBP severity is associated with age, sex, isokinetic trunk extensor and flexor weakness, isometric trunk extensor and flexor weakness.

Chronic lumbosacral radiculopathy usually presents with neurogenic muscular atrophy. Hypertrophic changes in accordance with neuropathy are rare. This case report introduces a case of unilateral pseudohypertrophy of calf muscle as a clinical manifestation of chronic lumbosacral radiculopathy due to denervation. The patient presented pseudohypertrophy of muscle resulting from right L5 and S1 radiculopathy due to idiopathic spinal epidural lipomatosis (SEL). Physicians should be aware that muscle hypertrophy, which usually has been regarded as a sign of myopathy, may denote the clinical sign of radiculopathy. Electromyography can be a valuable tool for differential diagnosis in such cases.

Objective To assess the cross-sectional area (CSA) of the muscles for investigating the occurrence of asymmetry of the paraspinal (multifidus and erector spinae) and psoas muscles and its relation to the chronicity of unilateral lumbar radiculopathy using magnetic resonance imaging (MRI).Methods This retrospective study was conducted between January 2012 to December 2014. Sixty one patients with unilateral L5 radiculopathy were enrolled: 30 patients had a symptom duration less than 3 months (group A) and 31 patients had a symptom duration of 3 months or more (group B). Axial MRI measured the CSA of the paraspinal and psoas muscles at the middle between the lower margin of the upper vertebra and upper margin of the lower vertebra, and obtained the relative CSA (rCSA) which is the ratio of the CSA of muscles to that of the lower margin of L4 vertebra.Results There were no differences in the demographics between the two groups. In group B, rCSA of the erector spinae at the L4-5 level, and that of multifidus at the L4-5 and L5-S1 levels, were significantly smaller on the involved side as compared with the uninvolved side. In contrast, no significant muscle asymmetry was observed in group A. The rCSA of the psoas was not affected in either group.Conclusion The atrophy of the multifidus and erector spinae ipsilateral to the lumbar radiculopathy was observed only in patients suffering from unilateral radiculopathy for 3 months or more.

Objective To assess the impact of aging on masticatory muscle function according to changes in hardness of solid food.Methods Each of fifteen healthy elderly and young people were selected. Subjects were asked to consume cooked rice, which was processed using the guidelines of the Universal Design Foods concept for elderly people (Japan Care Food Conference 2012). The properties of each cooked rice were categorized as grade 1, 2, 3 and 4 (5×103, 2×104, 5×104, and 5×105 N/m2) respectively. Surface electromyography (sEMG) was used to measure masseter activity from food ingestion to swallowing of test foods. The raw data was normalized by the ratio of sEMG activity to maximal voluntary contraction and compared among subjects. The data was divided according to each sequence of mastication and then calculated within the parameters of EMG activities.Results Intraoral tongue pressure was significantly higher in the young than in the elderly (p<0.05). Maximal value of average amplitude of the sequence in whole mastication showed significant positive correlation with hardness of food in both young and elderly groups (p<0.05). In a comparisons between groups, the maximal value of average amplitude of the sequence in whole mastication and peak amplitude in whole mastication showed that mastication in the elderly requires a higher percentage of maximal muscle activity than in the young, even with soft foods (p<0.05).Conclusion sEMG data of the masseter can provide valuable information to aid in the selection of foods according to hardness for the elderly. The results also support the necessity of specialized food preparation or products for the elderly.

Objective To examine the correlation between ultrasonographic trunk muscle parameters and balance scales in mild acute stroke patients. Methods A total of 55 stroke patients with hemiparesis and motor power grade ≥4 in the manual motor test were included. The Scale for the Assessment and Rating of Ataxia (SARA), Berg Balance Scale (BBS), Timed Up and Go Test (TUG), and Trunk Control Test (TCT) were used to evaluate patient balance function. Ultrasonographic parameters were measured on both non-paretic and paretic sides of the rectus abdominis, external oblique, internal oblique, transversus abdominis, and erector spinae muscles. Resting thickness and contraction thickness were measured in all muscles, and contractility and contractility ratio were calculated based on measured thicknesses. The differences between paretic and non-paretic muscle parameters, and the correlation between ultrasonographic parameters and balance scales were analyzed. Stroke patients were divided into two groups according to their fall risk. Ultrasonographic measurements between the two groups were compared. Results All muscles’ contraction thickness and contractility were significantly different between paretic and non-paretic sides (p<0.001). Contractility ratios of all trunk muscles showed a significant correlation with SARA, BBS, TUG, and TCT (p<0.05). Contractility ratios of all muscles were significantly different between high- and low-risk fall groups (p<0.05). Conclusion The contractility ratio in stroke patients reflects their balance disturbance and fall risk and it may serve as a new parameter for ultrasound imaging of trunk muscles.

Background: Cooking temperature and consequently doneness of beef muscles are most important for the palatability and consumer acceptability. Current study assessed the response of mechanical texture of Hanwoo muscles as a function of cooking temperature at different ageing days. Six muscles (Psoas major (PM), Longissimus thoracics (LT), Gluteus medius (GM), Semimembranosus (SM), Biceps femoris (BF) and Triceps brachii (TB)) were collected from each 10 Hanwoo steers. Warner-Bratzler WB-shear force (WBSF) and texture profile analysis (TPA) texture profiles were determined after 3 or 21 days of chiller, and randomly assigned to four groups; non-cooked, cooked at 55, 70 or 85 °C. Results: Toughness of WBSF and TPA hardness of Hanwoo muscles were presence in the order of LT = PM = GM= SM< BF = TB (p < 0.001) for non-cooked raw muscle, and PM< LT = GM= SM < TB=BF (p < 0.001) for cooked meat aged for 3 days. WBSF linearly increased in 3 days aged meats after cooked at a higher temperature (P < 0.05). On the other hand, toughening of the muscles were significantly (P < 0.05) differed at various temperature when muscles were aged for 21 days. WBSF of PM and LT muscles were significantly increased at a higher cooking temperature, while other muscles (i.e., GM, SM, BF, TB) showed the lowest values at 70 °C. In the case of TPA hardness, the effect of cooking temperature was very less in the toughness of themuscle (P> 0.05). Conclusion: Taken together, these findings clearly showed that the toughness of the muscle highly depends and varies upon the temperature and ageing of the muscle. Moreover, the effect of cooking temperature was very limited on aged muscles. The results mirror the importance of cooking temperature for objective measurements which ultimately estimate sensory tenderness and other quality traits.

Suprahyoid muscles play an important role in normal swallowing by providing muscle contractions involved in airway protection and upper esophageal sphincter opening. However, these muscles can be weakened by neurological disease or aging, which can result in pharyngeal dysphagia. Therefore, strengthening of the suprahyoid muscles is a clinically important treatment. In addition, it is important to know exactly how and which method is optimal. Many therapeutic exercise methods have been reported to strengthen the suprahyoid muscles, and new methods related to this have recently been reported. Therefore, this study will briefly summarize the representative traditional methods and the recently reported, relatively new methods for strengthening the suprahyoid muscles.

ABSTRACT Background Although there are many exercises to selectively strengthen the thoracic extensor, general trunk extensor strengthening exercises lead to pain and excessive lumbar extension. Purpose We investigated the most effective exercise among three thoracic extensor strengthening exercises (active prone thoracic extension, active prone thoracic hyper-extension, and active sitting thoracic extension) based on selective activity of the thoracic spine extensors. Study design Comparative, repeated measures design. Methods Sixteen healthy participants performed three thoracic extensor strengthening exercises. Electromyograph (EMG) activity was measured in the longissimus thoracis (LT), iliocostalis thoracis (ICT), and iliocostalis lumborum (ICL) muscles. Results The ICT/ICL and LT/ICL composition ratios were greatest in active sitting thoracic extension compared to other exercises. Conclusions We recommend active sitting thoracic extension exercise for selective strengthening of the thoracic spine extensor.

Objective To investigate the changes of activation of the abdominal muscles depending on exercise angles and whether the activation of rectus abdominis differs according to the location, during curl up and leg raise exercises, by measuring the thickness ratio of abdominal muscles using ultrasonography. Methods We examined 30 normal adults without musculoskeletal problems. Muscle thickness was measured in the upper rectus abdominis (URA), lower rectus abdominis (LRA), obliquus externus (EO), obliquus internus (IO), and transversus abdominis (TrA), at pre-determined angles (30o, 60o, 90o) and additionally at the resting angle (0o). Muscle thickness ratio was calculated by dividing the resting (0o) thickness for each angle, and was used as reflection of muscle activity. Results The muscle thickness ratio was significantly different depending on the angles in URA and LRA. For curl up?URA p=0 (30o<60o), p=0 (60o>90o), p=0.44 (30o<90o) and LRA p=0.01 (30o<60o), p=0 (60o>90)o, p=0.44 (30o>90o), respectively, by one-way ANOVA test?and for leg raise?URA p=0 (30o<60o), p=0 (60o<90o), p=0 (30o<90o) and LRA p=0.01 (30o<60o), p=0 (60o<90o), p=0 (30o<90o), respectively, by one-way ANOVA test?exercises, but not in the lateral abdominal muscles (EO, IO, and TrA). Also, there was no significant difference in the muscle thickness ratio of URA and LRA during both exercises. In the aspect of muscle activity, there was significant difference in the activation of RA muscle by selected angles, but not according to location during both exercises. Conclusion According to this study, exercise angle is thought to be an important contributing factor for strengthening of RA muscle; however, both the exercises are thought to have no property of strengthening RA muscle selectively based on the location.

Objective To investigate changes in lumbar multifidus (LM) and deep lumbar stabilizing abdominal muscles (transverse abdominis [TrA] and obliquus internus [OI]) during transcutaneous neuromuscular electrical stimulation (NMES) of lumbar paraspinal L4-L5 regions using real-time ultrasound imaging (RUSI).Methods Lumbar paraspinal regions of 20 healthy physically active male volunteers were stimulated at 20, 50, and 80 Hz. Ultrasound images of the LM, TrA, OI, and obliquus externus (OE) were captured during stimulation at each frequency.Results The thicknesses of superficial LM and deep LM as measured by RUSI were greater during NMES than at rest for all three frequencies (p<0.05). The thicknesses in TrA, OI, and OE were also significantly greater during NMES of lumbar paraspinal regions than at rest (p<0.05).Conclusion The studied transcutaneous NMES of the lumbar paraspinal region significantly activated deep spinal stabilizing muscle (LM) and the abdominal lumbar stabilizing muscles TrA and OI as evidenced by RUSI. The findings of this study suggested that transcutaneous NMES might be useful for improving spinal stability and strength in patients having difficulty initiating contraction of these muscles.

Objective To evaluate the motor innervation of trunk muscles in traumatic brain injury patients. Method Twenty patients (12 men and 8 women) with traumatic brain injury were enrolled in this study. Their mean age was 41 years. Motor evoked potentials (MEPs) were performed on the motor cortex. Electromyographic activities were recorded from the bilateral rectus abdominis muscles, the external oblique abdominal muscles, and the 4th and 9th thoracic erector spinae muscles. The onset latency and amplitude of contralateral and ipsilateral MEPs were measured. All patients were assessed by the Korean version of the Berg Balance Scale (K-BBS) to investigate the relationship between the frequency of MEPs in trunk muscles and gait ability. Results The mean frequency of ipsilateral MEPs was 23.8% with more damaged hemisphere stimulation, while the contralateral MEPs showed a mean frequency of 47.5% with more damaged hemisphere stimulation in traumatic brain injury patients. The latencies and amplitudes of MEPs obtained from the more damaged hemisphere were not significantly different from those of the less damaged hemisphere. There was no correlation between the manifestation of MEPs in trunk muscles and gait ability. Conclusion The ipsilateral and contralateral corticospinal pathways to trunk muscles are less likely to be activated in traumatic brain injury patients because of direct injury of the descending corticospinal motor tract or decreased excitability of the corticospinal tract from prefrontal contusion.

Objective To investigate the therapeutic eff ects of repetitive electrical stimulation of the suprahyoid muscles in brain-injured patients with dysphagia. Method Twenty-eight brain-injured patients who showed reduced laryngeal elevation and supraglottic penetration or subglottic aspiration during a videofluoroscopic swallowing study (VFSS) were selected. The patients received either conventional dysphagia management (CDM) or CDM with repetitive electrical stimulation of the suprahyoid muscles (ESSM) for 4 weeks. The videofluoroscopic dysphagia scale (VDS) using the VFSS and American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS)swallowing scale (ASHA level) was used to determine swallowing function before and after treatment. Results VDS scores decreased from 29.8 to 17.9 in the ESSM group, and from 29.2 to 16.6 in the CDM group. However, there was no signifi cant diff erence between the groups (p=0.796). Six patients (85.7%) in the ESSM group and 14 patients (66.7%) in the CDM group showed improvement according to the ASHA level with no signifi cant diff erence between the ESSM and CDM groups (p=0.633). Conclusion Although repetitive neuromuscular electrical stimulation of the suprahyoid muscles did not further improve the swallowing function of dysphagia patients with reduced laryngeal elevation, more patients in the ESSM group showed improvement in the ASHA level than those in the CDM group. Further studies with concurrent controls and a larger sample group are required to fully establish the effects of repetitive neuromuscular electrical stimulation of the suprahyoid muscles in dysphagia patients.

Background Full-can exercise was associated with a significantly higher scapulohumeral rhythm than empty-can exercise. These findings suggest that the movements of the scapula and glenohumeral joint are affected by the position of the arm. Purpose We investigated the effect of arm position on the muscle activity of scapular upward rotators during prone arm lift exercise. Study design Cross-sectional study Methods Thirty-two healthy subjects were participated in this study. The muscle activity of the serratus anterior (SA), upper trapezius (UT), lower trapezius (LT), and infraspinatus (IS) were measured using a surface electromyography device. All subjects were asked to perform prone arm lift exercise according to the three arm positions: palm down (PD), neutral (NT), and palm up (PU). One-way repeated analysis of variance was conducted. Results The EMG activities of the UT, LT, and SA were significantly different among three conditions (PU vs. NT vs. PD; p<0.05). The muscle activities of the UT and LT were significantly higher in the PD than in the PU (p<0.017). The muscle activity of SA was significantly higher in the PU than in the PD (p<0.017). However, the activity of the IS muscle was not significantly different among the three conditions (p>0.05). Conclusions Prone arm lift exercise for SA strengthening is recommended to be performed in a PU position.

Objective To investigate the prognostic value of cross-sectional areas (CSA) of paraspinal (multifi dus and erector spinae) and psoas muscles on magnetic resonance imaging (MRI) in chronicity of low back pain. Method Thirty-eight subjects who visited our hospital for acute low back pain were enrolled. Review of their medical records and telephone interviews were done. Subjects were divided into two groups; chronic back pain group (CBP) and a group showing improvement within 6 months after onset of pain (IBP). The CSA of paraspinal and psoas muscles were obtained at the level of the lower margin of L3 and L5 vertebrae using MRI. Results CSA of erector spinae muscle and the proportion of the area to lumbar muscles (paraspinal and psoas muscles) at L5 level in the CBP group were signifi cantly smaller than that of the IBP group (p<0.05). Th e mean value of CSA of multifi dus muscle at L5 level in the CBP group was smaller than that of the IBP group, but was not statistically signifi cant (p>0.05). CSA of psoas muscle at L5 level and all values measured at L3 level were not signifi cantly diff erent between the groups (p>0.05). Conclusion CSA of erector spinae muscle at the lower lumbar level and the proportion of the area to the lumbar muscles at the L5 level can be considered to be prognostic factors of chronicity of low back pain.

Objective To investigate intrinsic viscoelastic changes using shear wave velocities (SWVs) of spastic lower extremity muscles in patients with early spinal cord injury (SCI) via acoustic radiation force impulse (ARFI) imaging and to evaluate correlation between the SWV values and spasticity.Methods Eighteen patients with SCI within 3 months and 10 healthy adults participated. We applied the ARFI technique to measure SWV of gastrocnemius muscle (GCM) and long head of biceps femoris muscle. Spasticity of ankle and knee joint was assessed by original Ashworth Scale.Results Ten patients with SCI had spasticity. Patients with spasticity had significantly faster SWV for GCM and biceps femoris muscle than those without spasticity (Mann-Whitney U test, p=0.007 and p=0.008) and normal control (p=0.011 and p=0.037, respectively). The SWV values of GCM correlated with the ankle spasticity (Spearman rank teat, p=0.026). There was significant correlation between the SWV values for long head of biceps femoris muscle and knee spasticity (Spearman rank teat, p=0.022).Conclusion ARFI demonstrated a difference in muscle stiffness in the GCM between patients with spastic SCI and those without spasticity. This finding suggested that stiffness of muscles increased in spastic lower extremity of early SCI patients. ARFI imaging is a valuable tool for noninvasive assessment of the stiffness of the spastic muscle and has the potential to identify pathomechanical changes of the tissue associated with SCI.

Meat derived from skeletal muscles of animals is a highly nutritious type of food, and different meat types differ in nutritional, sensory, and quality properties. This study was conducted to compare the results of previous studies on the muscle fiber characteristics of major porcine skeletal muscles to the end of providing basic data for understanding differences in physicochemical and nutritional properties between different porcine muscle types (or meat cuts). Specifically, the muscle fiber characteristics between 19 major porcine skeletal muscles were compared. The muscle fibers that constitute porcine skeletal muscle can be classified into several types based on their contractile and metabolic characteristics. In addition, the muscle fiber characteristics, including size, composition, and density, of each muscle type were investigated and a technology based on these muscle fiber characteristics for improving meat quality or preventing quality deterioration was briefly discussed. This comparative review revealed that differences in muscle fiber characteristics are primarily responsible for the differences in quality between pork cuts (muscle types) and also suggested that data on muscle fiber characteristics can be used to develop optimal meat storage and packaging technologies for each meat cut (or muscle type).

Thirty Hanwoo cattle including bulls, cows, and steers (n = 10 each) were slaughtered and investigated for carcass traits (weight, meat color, fat color, yield index, maturity, marbling score, back-fat thickness, and firmness) and meat quality. The meat quality such as: pH, color, cooking loss, fatty acid, thiobarbituric acid reactive substance, warner-bratzler shear force, tensile tests, and texture profiles were analyzed on longissimus lumborum (LL) muscles of the carcasses at different aging times (3 d and 21 d). The results showed that steers and cows had higher back-fat thickness and marbling score, and a lower firmness (p < 0.001) than bulls. Bulls exhibited a lower meat quality indicating by higher cooking loss, thiobarbituric acid reactive substance content, warner-bratzler shear force and tensile test values (p < 0.01). Regarding the sensory property, the bull meat also had higher hardness, and lower tenderness, juiciness and flavor scores than the cow or steer meat (p < 0.01). Additionally, the bull meat had a higher polyunsaturated fatty acid and a lower monounsaturated fatty acid contents (p < 0.01). With increased aging time, the meat tenderness was improved in all the genders. Taken together, the present study demonstrated that the gender and aging time affected the carcass traits, fatty acid and sensory quality of beef. Postmortem aging could improve the meat tenderness of all genders especially bulls.

Background Particular attention has been paid to the core muscles because they serve as a muscular corset that works as a unit to stabilize the body and spine. Training programs for improving core stability often target improving core strength and endurance. Increased muscle size is also an expected effect of training programs. However, the relationship between core muscle cross-sectional area (CSA) and strength, stability, and clinical core test scores has not been identified. Purpose To investigate the relationship between core muscle CSA and muscle functions (strength, endurance, and stability). Study design A cross-sectional study Methods Fifty healthy participants (24 men, 26 women) participated in this study. The CSA of core muscle was measured using MRI. Maximal isometric trunk flexor strength, endurance, the score of double leg loading test were used to measure core muscle function. The relationship between core muscle CSA and muscle function was examined by Pearson’s correlation coefficient and Spearman rho correlation coefficient. Results Maximal isometric trunk flexor strength and side bridge strength were positively correlated with core muscle CSA. The isometric endurance test scores also showed a positive correlation with core muscle CSA except for the score of trunk flexor endurance test. Conclusions Only core strength showed moderate to excellent correlation with core muscle CSA. These findings indicate that core training to achieve muscle hypertrophy could lead to improved core strength but not core endurance.