Purpose: To explore the capability and reliability of diffusion tensor magnetic resonance imaging (DTI) in the evaluation of human skeletal muscle injury.Materials and Methods: DTI of four patients with gastrocnemius and soleus muscles injuries was compared to eight healthy controls. Imaging was performed using a GE 3.0T short‐bore scanner. A diffusion‐weighted 2D spin echo echo‐planar imaging (EPI) pulse sequence optimized for skeletal muscle was used. From a series of axially acquired diffusion tensor images the diffusion tensor eigenparameters (eigenvalues and eigenvectors), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were calculated and compared for injured and healthy calf muscles. Two dimensional (2D) projection maps of the principal eigenvectors were plotted to visualize the healthy and pathologic muscle fiber architectures.Results: Clear differences in FA and ADC were observed in injured skeletal muscle, compared to healthy controls. Mean control FA was 0.23 ± 0.02 for medial and lateral gastrocnemius (mg and lg) muscles, and 0.20 ± 0.02 for soleus (sol) muscles. In all patients FA values were reduced compared to controls, to as low as 0.08 ± 0.02. The ADC in controls ranged from 1.41 to 1.31 × 10^–9 m²/second, while in patients this was consistently higher. The 2D projection maps revealed muscle fiber disorder in injured calves, while in healthy controls the 2D projection maps show a well organized (ordered) fiber structure.Conclusion: DTI is a suitable method to assess human calf muscle injury. J. Magn. Reson. Imaging 2006.

Introduction In chronic pain conditions, the pressure pain threshold (PPT) has been utilized to investigate the presence of central sensitization (CS). Methods A systematic review and meta-analysis was conducted to compare the threshold in chronic pain patients and healthy individuals. Ovid MEDLINE and Embase up to July 2019 was used to conduct the search. Search strategy included terms and sets of terms that describe the concepts ‘sensory testing’ and ‘pain measurement’. Results The included studies consisted of 24 were case-control studies and 12 cross-sectional studies. The pooled total sample size was 1,280 cases of patients with different diagnoses of chronic pain and 1,463 healthy controls. Among the included studies, 32 reported a significant decrease of the PPT among patients compared to the controls and 4 reported no statistically significant difference. The pooled PPT mean difference was−1.17 (95 % CI : − 1.45, −0.90). There was, however, evidence of significant heterogeneity across the studies (I² = 87.42%, P<0.001). Conclusions Patients who suffer from chronic pain have a significantly lower PPT compared with healthy controls. Future research is needed to elucidate factors attributed to the change in PPT among patients with chronic pain, as well as the time that the CS occurs.

Protein and other compounds can exert anabolic effects on skeletal muscle, particularly in conjunction with exercise. The objective of this study was to evaluate the efficacy of twice daily consumption of a protein-based, multi-ingredient nutritional supplement to increase strength and lean mass independent of, and in combination with, exercise in healthy older men. Forty-nine healthy older men (age: 73 ± 1 years [mean ± SEM]; BMI: 28.5 ± 1.5 kg/m²) were randomly allocated to 20 weeks of twice daily consumption of either a nutritional supplement (SUPP; n = 25; 30 g whey protein, 2.5 g creatine, 500 IU vitamin D, 400 mg calcium, and 1500 mg n-3 PUFA with 700 mg as eicosapentanoic acid and 445 mg as docosahexanoic acid); or a control (n = 24; CON; 22 g of maltodextrin). The study had two phases. Phase 1 was 6 weeks of SUPP or CON alone. Phase 2 was a 12 week continuation of the SUPP/CON but in combination with exercise: SUPP + EX or CON + EX. Isotonic strength (one repetition maximum [1RM]) and lean body mass (LBM) were the primary outcomes. In Phase 1 only the SUPP group gained strength (Σ1RM, SUPP: +14 ± 4 kg, CON: +3 ± 2 kg, P < 0.001) and lean mass (LBM, +1.2 ± 0.3 kg, CON: -0.1 ± 0.2 kg, P < 0.001). Although both groups gained strength during Phase 2, upon completion of the study upper body strength was greater in the SUPP group compared to the CON group (Σ upper body 1RM: 119 ± 4 vs. 109 ± 5 kg, P = 0.039). We conclude that twice daily consumption of a multi-ingredient nutritional supplement increased muscle strength and lean mass in older men. Increases in strength were enhanced further with exercise training. Trial Registration: ClinicalTrials.gov NCT02281331

Myofascial pain syndrome (MPS) is a chronic regional pain condition characterized by trigger points—hyperirritable spots within taut bands of muscle fibers that cause both localized and referred pain. The pathogenesis, diagnostic criteria, and classification of MPS are still under investigation, which complicates the development of standardized treatment protocols. Although diagnostic tools have improved, MPS often remains underrecognized due to symptom overlap with other pain disorders, such as fibromyalgia, neuropathic pain, and joint disorders. Factors contributing to its onset and persistence include muscle overuse, postural imbalance, systemic conditions, and psychological and behavioral influences. This narrative review explores the primary risk factors, current hypotheses on pathogenesis, diagnosis and differential diagnosis, and both conventional and emerging treatments. Sufficient evidence supports the use of local anesthetic injections for MPS. Some evidence suggests that dry needling, acupuncture, magnetic stimulation, ultrasound therapy, laser therapy, extracorporeal shock wave therapy, and manual therapy may be effective, particularly compared to sham or placebo. However, non‐steroidal anti‐inflammatory drugs, diclofenac, botulinum toxin, and transcutaneous electrical nerve stimulation show insufficient evidence, while the effectiveness of muscle relaxants, antidepressants, gabapentin, opioids, topical lidocaine, capsaicin, EMLA cream, and kinesio taping remains inconclusive. Effective management of MPS requires a patient‐centered approach that integrates empirically supported and evidence‐based treatments tailored to individual needs. This review synthesizes the current understanding of MPS and highlights the need for high‐quality research to improve clinical decision‐making in managing this complex condition.

Purpose: The present article summarises the characteristics of Rasch's theory, providing an original metrological model for persons' measurements. Properties describing the person “as a whole” are key outcome variables in Medicine. This is particularly true in Physical and Rehabilitation Medicine, targeting the person's interaction with the outer world. Such variables include independence, pain, fatigue, balance, and the like. These variables can only be observed through behaviours of various complexity, deemed representative of a given “latent” person's property. So how to infer its “quantity”? Usually, behaviours (items) are scored ordinally, and their “raw” scores are summed across item lists (questionnaires). The limits and flaws of scores (i.e., multidimensionality, non-linearity) are well known, yet they still dominate the measurement in Medicine. Conclusions: Through Rasch's theory and statistical analysis, scores are transformed and tested for their capacity to respect fundamental measurement axioms. Rasch analysis returns the linear measure of the person's property (“ability”) and the item's calibrations (“difficulty”), concealed by the raw scores. The difference between a person's ability and item difficulty determines the probability that a “pass” response is observed. The discrepancy between observed scores and the ideal measures (i.e., the residual) invites diagnostic reasoning. In a companion article, advanced applications of Rasch modelling are illustrated.