The purpose of this study was to investigate the effect of concurrent strength and endurance training on strength, endurance, endocrine status and muscle fibre properties. A total of 45 male and female subjects were randomly assigned to one of four groups; strength training only (S), endurance training only (E), concurrent strength and endurance training (SE), or a control group (C). Groups S and E trained 3 days a week and the SE group trained 6 days a week for 12 weeks. Tests were made before and after 6 and 12 weeks of training. There was a similar increase in maximal oxygen consumption (VO2max) in both groups E and SE (P < 0.05). Leg press and knee extension one repetition maximum (1 RM) was increased in groups S and SE (P < 0.05) but the gains in knee extension 1 RM were greater for group S compared to all other groups (P < 0.05). Types I and II muscle fibre area increased after 6 and 12 weeks of strength training and after 12 weeks of combined training in type II fibres only (P < 0.05). Groups SE and E had an increase in succinate dehydrogenase activity and group E had a decrease in adenosine triphosphatase after 12 weeks of training (P < 0.05). A significant increase in capillary per fibre ratio was noted after 12 weeks of training in group SE. No changes were observed in testosterone, human growth hormone or sex hormone binding globulin concentrations for any group but there was a greater urinary cortisol concentration in the women of group SE and decrease in the men of group E after 12 weeks of training (P < 0.05). These findings would support the contention that combined strength and endurance training can suppress some of the adaptations to strength training and augment some aspects of capillarization in skeletal muscle.

Following spinal cord injury (SCI), upper motor neuron paralysed muscles lose the normal type I (slow) and II (fast) ®bre mosaic pattern and become predominantly composed of type II (fast glycolytic) ®bres). The majority of the research demonstrating this ®bre type shift was based on pH sensitive myo®brillar ATPase staining techniques on muscle from longstanding paraplegics and quadriplegics. The purpose of this study was to describe muscle ®bre type changes over a wide time spectrum post SCI using immuno¯uorescent techniques which may be more sensitive to change. A total of 19 vastus lateralis muscle biopsy specimens were obtained from 12 SCI subjects representing time points of 0.5 ± 219 months post SCI. Fast and slow myosin heavy chain isoform distribution was determined on single muscle ®bres for each of the biopsy specimens. Early post SCI (51 month) myosin heavy chain (MCH) isoform composition remained relatively stable. A transitional period was seen between 1 and 20 months post SCI wherein there was a progressive drop in the proportion of slow MHC isoform ®bres and a rise in the proportion that co-expressed both the fast and slow MHC isoform. By approximately 70 months post SCI a new steady state had been reached characterized by almost exclusively fast MHC isoform expression. This research has demonstrated that post SCI muscle type II transformation occurs in stages and commences earlier than previously appreciated. Interventions aimed at preventing or minimizing the transformation would need to be instituted within weeks post SCI.

Shoulder rotator cuff impingement syndrome is a common and disabling problem for the wheelchair athlete. In this study we investigated the role of shoulder strength imbalance as a factor for the development of this syndrome. Nineteen paraplegic male athletes underwent clinical and isokinetic examination of both shoulders with peak torque values measured in abduction, adduction, and internal and external rotation. Twenty athletic, able-bodied men without shoulder problems were tested as controls. Ten (26%) of the paraplegic athletes had rotator cuff impingement syndrome. The results of the isokinetic testing demonstrated that 1) the paraplegics' shoulders were stronger than the controls in all directions (P < 0.05); 2) the strength ratio of abduction: adduction was higher for paraplegic athletes (P < 0.05); 3) paraplegics' shoulders with rotator cuff impingement syndrome were weaker in adduction and external and internal rotation than the paraplegic athletes without impingement syndrome (P < 0.05); and 4) paraplegics' shoulders with rotator cuff impingement syndrome had higher abduction:adduction and abduction:internal rotation strength ratios than the shoulders of paraplegics without impingement syndrome (P < 0.05). We concluded that shoulder muscle imbalance, with comparative weakness of the humeral head depressors (rotators and adductors), may be a factor in the development and perpetuation of rotator cuff impingement syndrome in wheelchair athletes.

: Bridging maneuvers seem to be practical, reliable, and valid methods of reflecting lumbar spine-stabilization endurance capability. Prone bridging preferentially challenges core flexors, whereas supine bridging recruits primarily the core extensors; both are compromised in patients with low-back pain.

Knee and hip problems account for up to 40% of injuries in classical ballet. Despite apparent flexibility, many dancers appeared to have tight iliotibial bands that contributed to lower limb problems. Thirty senior female ballet dancers were contrasted with thirty age-matched active volunteers for hip and knee range of motion, and the information derived was correlated with their orthopaedic medical histories. Dancers spent a reasonable period of time warming up, but it was usually with an unbalanced routine that emphasized hip abduction and external rotation to the exclusion of adduction work. This was reflected in the significantly lower range of passive hip adduction and internal rotation compared to the controls. Furthermore, the older and more experienced the dancer, the more this trend was exaggerated. This unbalanced flexibility may play a role in the production of lateral knee pain (30% of the dancers) and anterior hip pain (33% of the dancers). It is suggested that more attention should be given to a balanced stretching regimen as part of the dancers' warmup in an effort to reduce the frequency of some of the chronic hip and knee complaints.

RF sensory ablation of the SIJ using bipolar strip lesions is a technically uncomplicated and low-risk procedure. The resulting effects on pain, disability, and satisfaction are promising. Further evaluation of this technique, including randomized controlled trials, is recommended.

The treatment of myofascial pain syndrome (MPS) is diverse and includes trigger point injections of various substances including local anesthetics, steroids and Botulinum toxin A (BTX A). The purpose of this study was to compare the effectiveness of trigger point injections using BTX A versus bupivacaine, both in combination with a home-based rehabilitation program. To be enrolled, subjects first had to demonstrate responsiveness to bupivacaine trigger point injection. In this single center, double blind, randomized, cross-over trial, 18 patients with MPS received trigger point injections of either 25 units Botulinum toxin A or 0.5 ml of 0.5% bupivacaine per trigger point. A maximum of eight trigger points were injected per subject. Subjects were followed until their pain returned to 75% or more of their pre-injection pain for two consecutive weeks, after which there was a 2 week wash-out period. The subjects then crossed over and had the same trigger points injected with the other agent. All subjects participated in a home exercise program involving static stretches of the affected muscles. Both treatments were effective in reducing pain when compared to baseline (P=0.0067). There was, however, no significant difference between the BTX A and 0.5% bupivacaine groups in duration or magnitude of pain relief, function, satisfaction or cost of care (cost of injectate excluded). Considering the high cost of BTX A, bupivacaine is deemed a more cost-effective injectate for MPS.

Study Design: Longitudinal training. Objectives: To determine the eects of functional electrical stimulated (FES) leg cycle ergometer training on muscle histochemical characteristics in individuals with motor-complete spinal cord injury (SCI). Setting: University of Alberta, Edmonton, Alberta, Canada. Methods: Six individuals with motor-complete SCI (age 31 ± 50 years; 3 ± 25 years postinjury) trained using FES leg cycle ergometry for 30 min, 3 days per week for 8 weeks. Biopsies of the vastus lateralis muscle were obtained pre-and post-training and analyzed for ®bre composition, ®bre size and capillarization. Results: The majority of muscle ®bres were classi®ed as type 2 pre-and post-training. Average ®bre area increased 23% (P50.05) and capillary number increased 39% (P50.05) with training. As a result of these proportional increases, capillarization expressed relative to ®bre area was unchanged with training. Conclusions: FES leg cycle ergometer training results in proportional increases in ®bre area and capillary number in individuals with SCI. Sponsorship: Supported by the Glenrose Rehabilitation Hospital.