Bulent Bayraktar

The frequency and associated factors of low back pain among a younger population in Turkey.

Study Design. Open design cross-sectional questionnaire. Objectives. The aims of this study are to determine the frequency of low back pains in the younger population and the factors that have an influence on this frequency. Summary of Background Data. Low back pain is one of the most important social problems that causes injuries in the younger population. Low back pain frequency is around 30% among adolescents, and 88% of those with low back pain experiences in adolescence have low back pain in later years. Therefore, identifying and, if possible, preventing the associated factors in adolescence and young adulthood is essential for the solution of this social problem. Methods. A total of 1,552 students from a total of 8,000 who had come from all parts of Turkey for university registration accepted to participate in the study and were given a questionnaire about low back pain experiences, disability, and possible associated factors. Results. Low back pain frequency was found to be 40.9%. This rate increases with age. Abandonment of moderate level physical activity and traumas such as slipping on ice and falling down the stairs were identified as associated factors. Conclusions. Regular physical activity and the prevention of falls might be ways for decreasing the frequency of low back pain experiences among the youth and significantly influencing the frequency of low back pain in adult population.

Morphometric evaluation of subaxial cervical vertebrae for surgical application of transpedicular screw fixation.

Study Design. A morphometric evaluation of pedicle projections in 29 cervical spinal columns (C3–C7) for three-dimensional surgical anatomy for safe surgery was proposed. Objective. In this study, pedicles and intimate structures of the subaxial vertebrae from C3 to C7 were evaluated to provide some morphometric data for cervical transpedicular screw fixation. Summary of Background Data. Detailed knowledge of surgical anatomy and variation of the subaxial vertebrae is a must for safe and effective surgery of the region. Although there are several clinical studies of transpedicular fixation, few studies have been performed on cervical pedicle measurements and their projection. Methods. In 29 dried bone cervical spinal columns (C3–C7), pedicle dimensions (pedicle height, width, length), measurements of lateral mass and pedicle length distance and pedicle axis length, investigation of distances of superior facet-midpedicle axis and inferior facet-midpedicle axis, and transverse and sagittal angles of the pedicles were performed in linear and angular measurements. Results. The obtained data from the series revealed that the mean values were approximately ranging from 6.7 to 7.2 mm for pedicle height, 4.4 to 4.9 mm for pedicle width, 5.3 to 6.2 mm for pedicle length, 15.3 to 16.0 mm for lateral mass and pedicle length, 22.2 to 27.7 mm for pedicle axis length, 3.8 to 5.3 mm for superior facet-midpedicle axis distance, 9.9 to 12.0 mm for inferior facet-midpedicle axis distance, 42.3° to 51.5° for transverse angle, and 5.2° to 14.1° for sagittal angle. Conclusions. Linear measurements of pedicle dimensions and also axial angles from horizontal and vertical planes may provide some anatomic limitations for subaxial cervical transpedicular screw fixation, and also contribute to the safety of the surgical procedure. One should also rely on tomographic data and computer-assisted guidance systems.

The mendosal suture

Purpose. The knowledge regarding the mendosal suture is still on debate in the literature. Though reports of the closure of this childhood suture are variable, a few reports show the presence of the suture in the adults. This study was conducted to determine the occurrence and a better topographic location of the mendosal suture. Methods. We used 129 dry skulls for this study. In the specimens, which were determined to have a mendosal suture, the morphometric traits of the mendosal suture and the angle between the mendosal suture line and lambdoidal suture line (α angle) were measured. Results. We found mendosal suture on 18 specimens, 11 of them were bilateral and 7 were unilateral. The length of these sutures ranged from 10.4 to 23.8 mm on the right side and 10.8 to 31.6 mm on the left side, respectively. The angle between two suture lines ranged from 36 to 68° on the right side and 32 to 75° on the left side. Conclusions. We believe that, these data will be of use to clinicians in order to avoid any misinterpretation of the mendosal suture with cranial fractures.

The effects of compression garments and electrostimulation on athletes’ muscle soreness and recovery

In this study, we explained the effects of compression garment and electrostimulation on athletes’ recovery period by evaluating blood lactate and isokinetic peak torque parameters. Twenty volunteers (15.55± 0.51 yr) were included to study. At recovery period, blood samples was taken for lactate values at 0th, 3rd, 5th, 15th, 30th min. The isokinetic strength test was performed on right ankle at 15th min and on the left ankle at 30th min. The same protocol was performed for compression garment on 2 weeks and for electrostimulation on third weeks and results were compared. There wasn’t any significant difference on blood lactate levels within groups. At women; there was not any significant difference on isokinetic peak torques within two groups. but at electro-stimulation usage we found significant increases on right plantar flexion (P<0.1), right dorsal flexion (RDF) (P<0.1) and left plantar flexion (LPF) (P<0.1) values compared to control measurements. At men; with compression garment usage, there was significant increase on LPF values compared to control measurements. At electrostimulation usage, we found significant increases on RDF (P<0.1) and left dorsal flexion (P<0.1) values compared to control measurements. During recovery, there is not any beneficial effect seen on blood lactate level within two groups. When compared to passive rest, compression garments and electrostimulation interventions effects on force generation capacity at recovery are statically significant. Also in terms of force generation capacity; usage of electrostimulation during 15 min and compression garments during 30 min were statically more significant.

Prevalence of femoroacetabular impingement and effect of training frequency on aetiology in paediatric football players

Purpose: The aim of this study was to determine the prevalence of asymptomatic radiographic findings of femoroacetabular impingement (FAI) in paediatric football players in different age groups and to investigate aetiological factors. Methods: Paediatric male athletes between 10 and 17 years of age from 8 soccer teams were recruited. In addition to an annual control check-up, anteroposterior pelvis and frog-leg radiographs as well as the curriculum vitae of the athletes, their injuries, and real-time complaints were recorded. The alpha angle, lateral centre-edge angle, Tönnis angle, and collodiaphyseal angle were measured and morphological abnormalities were noted. Results: There were 214 male football players with a mean age of 13.4 ± 3.2 years included in the study. In the morphological analysis of hips, there was FAI in 30% of the athletes. In the analysis of FAI prevalence in 3 subgroups based on age (Group 1: 10–12 years [n = 25], Group 2: 13–15 years [n = 104], Group 3: 16–17 years [n = 85]), there was 0% FAI in Group 1, 19.1% in Group 2 and 60% in Group 3. In the analysis of aetiological factors, there was no significant difference between the right and left hips of players regarding alpha angles and FAI prevalence. However, the prevalence of FAI was higher in players who had been playing football for 3 years or more and who had been training for 12.5 hours/week or more. Conclusion: Training for 12.5 hours or more per week in paediatric football players doubled the risk development of FAI morphology.

Etiological importance of training frequency, age and prevalance of Femoroacetabular İmpingement(FAİ) in pediatric male athletes

Femoroacetabular impingement (FAİ) is a prearthrozic disease that causes hip pain in adolescent-adult patients. The aim of the study is, determining the prevalence of asymptomatic radiographic findings of FAİ, to examine the evaluation of prevalence difference according to age groups and the impact of the levels of physical activity at developmental period on the development of asymptomatic FAİ. Materials-Methods: In our study, we included 214 pediatric athletes from 8 football teams operating in Istanbul between 11-18 years of age in September 2015- January 2016. Ethics Committee approval was obtained for our study. AP pelvis and Frog-leg radiographs, curriculum vitae of the athletes, their injuries, and their realtime complaints have been questioned. The alpha angle, CE angle, Tonnis angle, collodiaphyseal angle is measured from the resulting AP and Frog leg radiographs and terms of morphological abnormalities (FAİ, dysplasia and coxa vara…) was noted. Also athletes dominant feet, weekly training period and the years they play soccer was noted. The obtained data were analyzed by one-way ANOVA and Student-T test. Results: The average age of the 214 pediatric male athletes that included was 15(10-18). Asymptomatic FAİ prevalence of all ages was %29.9, % 0 in the range of 10-12 years, %13.1 in the range of 13-15 years, %45.7 in the 15-18 age range. These findings showed that significantly increased prevalence of FAİ in line with age in pediatric athletes statistically (p <0.05). The mean right hip alpha angle of all athletes was 50.7, left alpha angle was 50.3, right-CE angle was 28.6, left CE angle was 29.5, right Tönnis Angle 6.6, left Tönnis angle 5.0, right neck-shaft angle 133.9, left neck-shaft angle 134.7 degrees found. There was 7 acetabular dysplasia, 56 athletes with CAM type FAS, 4 athletes Pincer type FAS, and 4 combined FAS was found. There was no significant statistical relationship in the prevalences of FAİ between the number of years he worked as an athlete or the side which they hit the ball. However a positive correlation was found between weekly training hours (p <0.05). There were no statistical relationship between morphological abnormalities and previous injuries. Discussion: Among the etiology oriented researches, investigation for developmental factors still continues. İn our study, it is found that the sports activities in the pediatric period that are accused can be a factor in FAİ development due to the positive correlation between pediatric athletes age ang training frequency.

Effects of special exercise programs on functional movement screen scores and injury prevention in preprofessional young football players

To increase movement capacity and to reduce injury risk in young soccer players by implementing a special functional exercise program based on functional movement screen (FMS) and correctives. 67 young male athletes 14–19 years of age from a Super League Football Club Academy participated in the study. Functional movement patterns were evaluated with FMS assessment protocol. Deep squat, hurdle step, inline lunge, shoulder mobility, active straight leg raise, trunk stability push-up, and rotatory stability were examined in FMS. Considering the FMS scores the number of intervention and control groups were defined as 24 and 43, respectively. Intervention program was composed of 1 hr twice a week sessions in total of 12 weeks with 4 weeks of mobility, 4 weeks of stability, and 4 weeks of integration exercises. At the end of 12-week intervention and control groups were re-evaluated with FMS protocol. Contact and noncontact sports injuries recorded during one season. In intervention group there was statistically significant difference in increase in total FMS scores (P<0.01), deep squat (P≤0.001), hurdle step (P<0.05), inline lunge (P<0.01), and trunk stability push-up (P<0.01). In control group total FMS, deep squat, and trunk stability push-up scores increased with a statistical difference (P<0.01, P<0.05, P≤0.01, respectively). The incidence of noncontact injury in control group was higher than intervention group (P<0.05). Periodic movement screening and proper corrections with functional training is valuable in order to create better movement capacity to build better physical performance and more effective injury prevention.

P-63 Subacute effects of self-myofascial release on isometric force production capabilities of the agonist (HAMSTRING) and antagonist (QUADRICEPS) knee muscles, a randomised controlled study

Aim Myofascial release is a manual therapeutic method aiming to relax the muscles and their surrounding fascia. The release method originally involves a therapist, moving the fascia against its surroundings primarily with tangential forces applied by their hands. More recently, a self-applied method of release has been proposed where an individual uses semi-rigid round materials in order to achieve the release effect. Many studies have shown acute effects of release on range-of-movement and particular functional performance tests along with muscle strength measurements, wherease only few investigated the agonist and the antagonist muscle in combination. Methods 22 healthy male, aged between 18-35 volunteered for the study, with moderate or high level physical activity. Demographics, physical acitivity (international physical activity questionnaire) and life quality (Short Form-36) scores of subjects were noted and participants were divided into two groups (11, 11) randomly. First group was allocated into static stretching, and second group into self-myofascial release group. In the following week, groups interchanged (cross-over design). In both groups, volunteers first warmed-up at a stationary bicycle for 10 minutes at 65 rpm, followed by a 5 second isometric strength testing (3 repetitions) of the knee for both muscle groups performed at 60 degrees of knee flexion, with Cybex II isokinetic dynamometer. After applying the protocol consisting of 1 minute of application (stretching or release) and 30 seconds of rest for 4 cycles; subjects rested for 10 minutes followed by a second isometric strength testing. Peak torque, average torque, peak torque slope, time to half peak torque and time to peak torque was noted in order to analyse any statistically significant difference. Istanbul University, Istanbul Faculty of Medicine Ethical Committee approved the study. Results Average torque for knee extensor mucles and peak torque slope for flexors increased significantly 10 minutes after static stretching (p < 0.05) (Table 1). Time to peak torque for extensors and average torque for flexors increased significantly 10 minutes after myofascial release (p < 0.05) (Table 2). Abstract P-63 Table 1 Isometric testing results before and after static stretching protocol (*p<0.05) STRETCHING PROTOCOL BEFORE (mean±SD) AFTER (mean±SD) p Extensors Peak Torque (N.m) 217,91 ± 40,72 226,23 ± 41,73 0,074 Peak Torque%BodyWeight (BW) 283,27 ± 46,15 293,64 ± 45,42 0,092 Mean Torque (N.m) 188,23 ± 37,79 197,41 ± 37,89 0,023* Mean Torque%BW 244,45 ± 42,31 256,18 ± 43,27 0,025* Peak Torque Slope (N.m/s) 123,59 ± 56,81 130,59 ± 157,89 0,372 Peak Torque Slope%BW 161,32 ± 78,61 169,45 ± 194,97 0,372 Time to Half Peak Torque (s) 0,25 ± 0,16 0,2 ± 0,08 0,157 Time to Peak Torque (s) 2,44 ± 1,1 2,88 ± 1,19 0,163 Flexors Peak Torque (N.m) 116,73 ± 17,61 120 ± 17,61 0,14 Peak Torque%BodyWeight (BW) 152,95 ± 24,83 156,23 ± 21,11 0,231 Mean Torque (N.m) 101,32 ± 16,68 105,14 ± 17,49 0,099 Mean Torque%BW 132,68 ± 22,85 137,14 ± 20,84 0,091 Peak Torque Slope (N.m/s) 86,68 ± 29,82 102,64 ± 31,28 0,016* Peak Torque Slope%BW 113,14 ± 38,9 135,86 ± 48,45 0,015* Time to Half Peak Torque (s) 0,21 ± 0,09 0,18 ± 0,11 0,268 Time to Peak Torque (s) 1,85 ± 0,64 1,66 ± 0,66 0,291 Abstract P-63 Table 2 Isometric testing results before and after myofascial release protocol (*p<0.05) MYOFASCIAL RELEASE PROTOCOL BEFORE (mean±SD) AFTER (mean±SD) p Extensors Peak Torque (N.m) 214,45 ± 42,96 219 ± 51 0,807 Peak Torque%BodyWeight (BW) 279,05 ± 50,63 284,77 ± 60,36 0,688 Mean Torque (N.m) 184,91 ± 39,25 192,14 ± 44,93 0,144 Mean Torque%BW 240,59 ± 46,95 249,77 ± 53,85 0,116 Peak Torque Slope (N.m/s) 121,32 ± 50,54 107,86 ± 62,21 0,291 Peak Torque Slope%BW 158,91 ± 68,24 141,64 ± 83,2 0,299 Time to Half Peak Torque (s) 0,28 ± 0,2 0,21 ± 0,09 0,167 Time to Peak Torque (s) 2,45 ± 1,01 2,86 ± 1,05 0,021* Flexors Peak Torque (N.m) 112,32 ± 21,67 116,45 ± 22,55 0,135 Peak Torque%BodyWeight (BW) 146,95 ± 28,27 152,14 ± 29,24 0,125 Mean Torque (N.m) 97,18 ± 18,57 103,59 ± 22,02 0,03* Mean Torque%BW 126,82 ± 24,59 134,82 ± 28,78 0,031* Peak Torque Slope (N.m/s) 86,55 ± 43,46 77,91 ± 28,14 0,330 Peak Torque Slope%BW 112,59 ± 55,2 101,82 ± 37,37 0,297 Time to Half Peak Torque (s) 0,21 ± 0,17 0,2 ± 0,11 0,903 Time to Peak Torque (s) 1,94 ± 0,78 2,02 ± 0,71 0,733 Conclusions Myofascial release seems to lengthen peak torque time for antagonist muscles, whereas positively effect average torque generation for 5 seconds even after 10 minutes of application. Considering the muscles that will be involved, an individual with the need of isometric contraction for a particular physical activity may benefit from myofascial release. However, it should be noted that sudden torque production seems to delay for the antagonist muscles. References Halperin I, Aboodarda SJ, Button DC, Andersen LL, Behm DG. Roller massager improves range of motion of plantar flexor muscles without subsequent decreases in force parameters. International journal of sports physical therapy, 2014 Feb;9(1), 92–102. MacDonald GZ, Penney MDH, Mullaley ME, Cuconato AL, Drake CDJ, Behm DG, Button DC. An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force. The Journal of Strength & Conditioning Research, 2013 Mar;27(3), 812–821. Yucesoy CA, Baan G, Huijing PA. Epimuscular myofascial force transmission occurs in the rat between the deep flexor muscles and their antagonistic muscles. Journal of Electromyography and Kinesiology, 2010 Feb;20(1), 118–126.

M. SOLEUS'TA AKSESUAR KEMİK VEYA MYOSİTİS OSSIFICANS?

Istanbul Tip Fakultesi Anatomi Anabilim Dali’ndaki rutin disseksiyonlar sirasinda, 78 yasindaki bir erkek kadavranin sag m. soleus’unda kemiksi bir yapi ile karsilasildi. Bu kemiksi yapinin hicbir kemik, kapsuler ya da ligamentoz yapi ile iliskisi yoktu. Bu yapinin gercek bir kemik oldugunu ve bacagin kemiklerinden kopan bir kemik segment olmadigini ispatlamak icin bu bolgenin radyografisi cekildi. Radyografide bacak kemiklerinin kirilmis olduguna dair bir bulguya rastlanmadi. Ayrica bu kemik yapida normal trabekuler kemik goruntusu saptandi. Ikinci olarak bu yapi cikarilarak, uygun bir kesiti alinarak mikroskopik olarak incelendi. Mikroskopik olarak matur kemik lamelleri gozlendigi icin, bu yapinin gercek bir kemik oldugundan emin olundu. Bu alisilmadik yapi icin iki olasilik vardi. M. gastrocnemius’ta bulunabilen fabella gibi bir aksesuar kemigin m. soleus’ta bulunmasi veya bu kadavrada yasarken bu bolgede bir myositis ossificans gelismis olmasiydi. Kesin ayirici tani makroskopik, mikroskopik veya radyografik tetkiklere ragmen yapilamadi. Bugune kadar kadavralarda bildirilmis olan myositis ossificans vakasina literaturde rastlamadigimiz icin, bildirdigimiz olgunun, Anatomik calismalar sirasinda yumusak dokularda saptanan kemik kitlelerin ayirici tanisi acisindan yararli olacagi dusuncesindeyiz.