Dr Satyajit Mohanty blogs

Most biomechanical studies link the concepts of stooped postures and buckling instability of the spine under high compressive load. However everyday situations lumbar spine is subjected to small or neglectable compressive spinal load. Snijders et tried to find a mechanical cause of acute low back pain (LBP) in everyday situations. Hence their study in 2008 described strain on the iliolumbar ligaments (ILs) when slouching from standing upright. This study show that 1. Dynamic slouching, driven by upper body weight and rectus abdominis muscle force may produce failure load of the spinal column and the ILs. 2. There is a significant increase of IL elongation with rectus abdominis muscle force. 3. Contraction of erector spinae or multifidus muscle tension ease the ILs. 4. Sudden slouching of the upright trunk may create failure risk for the spine and ILs. This loading mode may be prevented by controlling loss of lumbar lordosis with erector spinae and multifidus muscle force. ...

Because pain caused by sacroiliac joint dysfunction can mimic discogenic or radicular low back pain diagnosis of sacroiliac joint dysfunction is frequently overlooked, as common practice is to the link low back pain with protruding disc even when neurological signs are absent (1). The prevalence reported of SI joint caused pain is some where between 1. International Association for the Study of Pain (IASP) criteria demonstrated the prevalence of pain of sacroiliac joint origin in 19% to 30% of the patients suspected to have sacroiliac joint pain. 2. Hansen et al: the sacroiliac joint has been shown to be a source of pain in 10% to 27% of suspected cases with chronic low back pain utilizing controlled comparative local anesthetic blocks. 3. Rupert et al: prevalence of sacroiliac joint pain is estimated to range between 10% and 38% SI joint anatomy: The sacroiliac joint is a diarthrodial (freely moveable joint) synovial joint with abundant innervation and capability of being a ...

* LPSL = long posterior sacroiliac ligament In many patients with non-specific low back pain or peripartum pelvic pain, pain is experienced in the region in which the long dorsal sacroiliac ligament is located (3,1). 25 sides of the pelvis from 16 cadavers were studied by McGrath et al (2005) revealed that 1. LPSL is penetrated by the lateral branches of the dorsal sacral rami of predominantly S3 & and S2. Only in few cases LPSL is innervated by S4 and rarely by S1. 2. Some of the penetrating lateral branches give off nerve fibres that disappear within the LPSL ligament. These findings provide an anatomical basis for the notion that the LPSL is a potential pain generator in the posterior sacroiliac region. Same researcher McGrath et al in 2009 (2) reported few more interesting aspects of LPSL & it’s anatomical relationships 1. The LPSL was observed to have proximal and distal regions of osseous attachment. 2. Between these regions of attachment the middle LPSL was observed as a...

Introduction to approaches to investigating strategies in musculoskeletal conditions The approach is a comprehensive approach called physioanatomic approach that combines both anatomic approaches & physiological approach of investigation. Either the patient's pain pattern is categorized into a nonspecific pattern or into one of 4 recognizable pathway patterns i.e. radicular, dorsal ramus, polyneuropathy, and sympathetic. The goal of anatomic component of physioanatomic (both noninvasive and invasive) evaluation is to increase specificity by differentiating pain generators from asymptomatic underlying pathologic conditions. The physiologic component deals with function, reactivity & responsiveness of the designated or speculated pathologic tissues. There are 2 types of anatomic imaging approach i.e. invasive & noninvasive. Example of noninvasive anatomic imaging is computed tomography, single-photon emission-computed tomographic bone scan, and magnetic resonance im...

Persons with LBP often have reduced muscle strength and endurance, which may compromise the functional capacity of the spine and increase the likelihood of re-injury (Andersson, 1989). Historically, paraspinal muscle impairment has been quantitatively assessed by the use of dynamometers to supplement standard clinical assessment procedures (Roy SH, 1992). Assessments based on surface electromyographic (EMG) techniques have been proposed to overcome some of the problems inherent in the use of dynamometers for back muscle evaluation and classification (Merletti R, 1994). Recent approach of EMG variable is derived from the frequency rather than from signal amplitude of the signal. This is partly due to the fact that during a sustained contraction, the EMG signal propagates at a slower velocity and undergoes an alteration in shape associated with changes to the depolarization zone of the muscle membrane (De Luca CJ, 1985). These phenomena are referred to as "myoelectric manifestations...