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  • 1.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
    Forsgren, Sture
    Umeå University, Faculty of Medicine, Integrative Medical Biology, Anatomy.
    Thorsen, Kim
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
    Johansson, Håkan
    Lorentzon, Ronny
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
    Glutamate NMDAR1 receptors localised to nerves in human Achilles tendons. Implications for treatment?2001In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 9, no 2, p. 123-126Article in journal (Refereed)
    Abstract [en]

    In this investigation, we show the presence of both free glutamate (microdialysis) and glutamate NMDAR1 receptors (immunohistochemical analyses of tendon biopsies), in tendons from patients with chronic Achilles tendon pain (Achilles tendinosis) and in controls (pain-free tendons). The NMDAR1 immunoreaction was usually confined to acetylcholinesterase-positive structures, implying that the reaction is present in nerves. Glutamate is a potent pain mediator in the human central nervous system, and in animals it has been shown that peripherally administered glutamate NMDA receptor antagonists diminish the response to formalin-induced nociception. Our present finding of glutamate NMDA receptors in human Achilles tendons might have implications for pain treatment.

  • 2.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Zeisig, Eva
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    No normalisation of the tendon structure and thickness after intratendinous surgery for chronic painful midportion Achilles tendinosis.2009In: British journal of sports medicine, ISSN 1473-0480, Vol. 43, no 12, p. 948-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To characterise Achilles tendon structure and thickness a minimum of 8 years after intra-tendinous surgery. Material and METHODS: Fourteen patients (16 tendons; 9 men and 5 women, mean age 43 years, range 27-55) surgically treated (intra-tendinous surgery) for chronic painful midportion Achilles tendinosis, were followed with clinical examination and grey-scale ultrasonography for a minimum of 8 years (range 8-16 years, mean 13 years). RESULTS: All patients were satisfied with the result of surgery and were active in Achilles tendon loading activities without restrictions. In all operated tendons, structural abnormalities remained and tendons remained thicker than normal tendons. CONCLUSIONS: Resection of tendinosis is associated with persistent structural abnormalities and thickening of the tendon 13 years after surgery, despite successful clinical outcomes.

  • 3. Couppe, C
    et al.
    Thorborg, K
    Hansen, M
    Fahlstrom, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Bjordal, JM
    Nielsen, D
    Baun, M
    Storgaard, M
    Magnusson, SP
    Shoulder rotational profiles in young healthy elite female and male badminton players2014In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 24, no 1, p. 122-128Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to profile shoulder passive range of motion (ROM) and isometric strength for external (ER) and internal (IR) rotation as part of a preseason screening in adolescent national badminton players. Passive external range of motion (EROM) and internal range of motion (IROM) were examined on the dominant and nondominant shoulder in 31 adolescent national badminton players (12 females and 19 males) with a standard goniometer. Muscle strength was examined with a hand-held dynamometer in ER and IR. Total range of motion (TROM=EROM+IROM) was lower on the dominant side compared with the nondominant side in both groups (P<0.001). Males were generally stronger than females in all strength measurements except for IR on the dominant side (P<0.01). In females, IR dominant side strength was greater compared with IR on the nondominant side (P<0.05). TROM was reduced on the dominant side compared with the nondominant side in young elite badminton players, irrespective of gender. No rotational strength differences existed between the dominant and nondominant side in male players, but in female players a higher IR strength on the dominant side was not balanced by a higher ER strength.

  • 4. Crenshaw, Albert
    et al.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Lyskov, Eugene
    A gender comparison of electromyography (EMG) during repetitive arm work with and without mental stress2013In: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 27, p. 1152.21-Article in journal (Other academic)
  • 5.
    Elcadi, Guilherme H.
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Forsman, Mikael
    Public Health Sciences, Karolinska Institute, Centre for Musculoskeletal Research, University of Gävle.
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Crenshaw, Albert G.
    Department of Occupational and Public Health , University of Gävle.
    Shoulder and forearm oxygenation and myoelectric activity in patients with work related muscle pain and healthy subjects2013In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 113, no 5, p. 1103-1115Article in journal (Refereed)
    Abstract [en]

    We tested hypotheses of (i) reduced oxygen usage, oxygen recovery, blood flow and oxygen consumption; and (ii) increased muscle activity for patients diagnosed with work related muscle pain in comparison to healthy controls. Oxygenation was measured with near infrared spectroscopy (NIRS), and muscle activity with EMG for the extensor carpi radialis (ECR) and trapezius descendens (TD) muscles. Eighteen patients with diffuse neck-shoulder-arm pain and seventeen controls (matched in age and sex) were equipped with NIRS and EMG probes. After determining an individual’s maximum voluntary contraction (MVC) force, short term (20 sec) isometric contractions for the ECR and TD of 10%, 30%, 50% and 70% MVC generated ∆StO2% and StO2% recovery (Rslope) from NIRS, and RMS%max from EMG signals. In addition, upper arm venous (VO) and arterial (AO) occlusions generated slopes of total hemoglobin (HbTslope) and deoxyhemoglobin (HHbslope) for the resting ECR as surrogates of blood flow and oxygen consumption, respectively. Mixed Model analyses, t-tests, and Mann-Whitney test were used to assess differences between groups. There was no significant difference in MVC between groups for either muscle. Also, ∆StO2%, Rslope for either muscle, and ECR-HbTslope were not different between groups, thus our hypotheses of reduced oxygen use, recovery, and blood flow for patients were not confirmed. However, patients had a significantly lower ECR-HHbslope confirming our hypothesis of reduced consumption. Further, there was no difference in RMS%max during contractions meaning that the hypothesis of increased activity for patients was not confirmed. When taking into account the number of NIRS variables studied, differences we found between our patient group and healthy controls (i.e. in forearm oxygen consumption and shoulder oxygen saturation level) may be considered modest. Overall our findings may have been impacted by the fact that our patients and controls were similar in muscle strength, which is in contrast to previous studies.

  • 6.
    Elcadi, Guilherme H
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Forsman, Mikael
    Public Health Sciences, Karolinska Institute, Centre for Musculoskeletal Research, University of Gävle.
    Hallman, David
    Department of Occupational and Public Health, University of Gävle .
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Crenshaw, Albert G
    Department of Occupational and Public Health, University of Gävle .
    No differences in oxygenation in the forearm and shoulder of patients with work-related muscle pain and healthy subjects during a low-load sustained contractionManuscript (preprint) (Other academic)
    Abstract [en]

    A frequently ascribed symptom associated to work-related muscle pain (WRMP) is muscle fatigue. Studies investigating oxygenation and hemodynamics in association to fatigue development in the muscles of patients with WRMP are sparse. Inadequate oxygen consumption and/or inadequate blood supply can influence the ability of the muscles to withstand fatigue. In this study we applied near-infrared spectroscopy (NIRS) and electromyography (EMG) to investigate oxygenation, hemodynamics and muscle activity in the extensor carpi radialis (ECR) and trapezius (TD) muscles of patients with WRMP and healthy controls. Eighteen patients with diffuse neck-shoulder-arm pain and 17 controls (matched in age and sex) were equipped with NIRS and EMG probes. After determination of maximal voluntary contraction (MVC) a sustained contraction of 15% MVC was performed with a cutoff for the maximum time of 12 min. Variables generated were StO2% and HbT from NIRS and RMS%max and MPF from EMG during the contraction. T tests and Mann-Whitney tests were used for analyzes of differences in MVC and endurance times. Full factorial repeated measures analyses of variance (ANOVA) were used to assess differences between patients and controls in NIRS and EMG parameters over time. Results showed no differences in MVC between patients and controls. We found, however, a shorter endurance time for patients compared to controls. There were no significant differences in StO2%, HbT, RMS and MPF responses during contraction between groups for the ECR. For the TD there was a group effect for StO2% with patients showing a lower level at rest and throughout the contraction. For the ECR and TD oxygenation, hemodynamics, RMS and MPF there were no straightforward differences between patients and controls that could explain the differences in endurance time. Therefore, we conclude that the shorter endurance time seen in the present study was not measurable by physiological indicators investigated in this group of patients.

  • 7.
    Elcadi, Guilherme H
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Högskolan Gävle.
    Forsman, Mikael
    Högskolan Gävle; Karolinska institutet Stockholm.
    Hallman, David M
    Högskolan Gävle.
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Fahlstrom, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Crenshaw, Albert G
    Högskolan Gävle.
    Oxygenation and hemodynamics do not underlie early muscle fatigue for patients with work-related muscle pain.2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 4, article id e95582Article in journal (Refereed)
    Abstract [en]

    Patients suffering from work-related muscle pain (WRMP) fatigue earlier during exercise than healthy controls. Inadequate oxygen consumption and/or inadequate blood supply can influence the ability of the muscles to withstand fatigue. However, it remains unknown if oxygenation and hemodynamics are associated with early fatigue in muscles of WRMP patients. In the present study we applied near-infrared spectroscopy (NIRS) on the extensor carpi radialis (ECR) and trapezius (TD) muscles of patients with WRMP (n = 18) and healthy controls (n = 17). Our objective was to determine if there were group differences in endurance times for a low-level contraction of 15% maximal voluntary contraction (MVC)--sustained for 12-13 min, and to see if these differences were associated with differences in muscle oxygenation and hemodynamics. At baseline, oxygen saturation (StO2%) was similar between groups for the ECR, but StO2% was significantly lower for TD for the WRMP patients (76%) compared to controls (85%) (P<0.01). Also, baseline ECR blood flow was similar in the two groups. For both muscles there were a larger number of patients, compared to controls, that did not maintain the 15% MVC for the allotted time. Consequently, the endurance times were significantly shorter for the WRMP patients than controls (medians, ECR: 347 s vs. 582 s; TD: 430 s vs. 723 s respectively). Responses in StO2% during the contractions were not significantly different between groups for either muscle, i.e. no apparent difference in oxygen consumption. Overall, we interpret our findings to indicate that the early fatigue for our WRMP patients was not associated with muscle oxygenation and hemodynamics.

  • 8.
    Fahlström, M
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Fahlström, P G
    Lorentzon, Ronny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Henriksson-Larsén, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Positive short-term subjective effect of sports drink supplementation during recovery.2006In: J Sports Med Phys Fitness, ISSN 0022-4707, Vol. 46, no 4, p. 578-84Article in journal (Refereed)
  • 9.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Badminton and the Achilles tendon2001Doctoral thesis, comprehensive summary (Other academic)
  • 10.
    Fahlström, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Ultrasound and Doppler findings in the Achilles tendon among middle-aged recreational floor-ball players in direct relation to a match.2010In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 44, no 2, p. 140-143Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In this study, structure, blood flow and thickness in the Achilles tendon related to tendon-loading activity were investigated. DESIGN: Examination by ultrasound (US) and colour Doppler (CD) immediately before and after 1 h of floor-ball matchplay. SETTING: Sports Medicine Unit, Umeå University, Sweden. PARTICIPANTS: 36 Achilles tendons in 18 middle-aged (mean 39 years) recreational male floor-ball players. MAIN OUTCOME MEASUREMENTS: Structure and high blood flow (HBF)/neovessels (NV) in the tendons were registered. Tendon thickness was measured 3 and 4.5 cm above the upper calcaneus and at the thickest part of the tendon. RESULTS: The US examination showed that 11/36 tendons (30.5%) in nine individuals had structural changes before and after the floor-ball match. In 7/36 tendons (five with structural changes), there were HBF/NV before, and after, the match. In six of these seven tendons, the blood flow was higher after than before the match. In three more tendons (two with structural changes), there were HBF/NV after, but not before, the match. After the match, mean tendon thickness had decreased significantly in both normal tendons and tendons with structural changes at the 3-cm level (6.0 (1.0) mm to 5.8 (0.9) mm; p<0.019), at the 4.5-cm level (5.7 (1.1) mm to 5.5 (1.0) mm; p<0.044), and at the thickest part (6.6 (1.1) mm to 6.3 (1.2) mm; p<0.000). CONCLUSIONS: In about 1/3 of the tendons, there were structural changes, about half of those tendons also had HBF/NV, which was higher after, than before, the match. Mean tendon thickness in both normal tendons and tendons with structural changes had decreased significantly after a 1-h floor-ball match.

  • 11.
    Fahlström, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Lorentzon, Ronny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Acute Achilles tendon rupture in badminton players1998In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 26, no 3, p. 467-470Article in journal (Refereed)
    Abstract [en]

    All patients with badminton-related acute Achilles tendon ruptures registered during 1990 to 1994 at the University Hospital of Umeå were retrospectively followed up using a questionnaire. Thirty-one patients (mean age, 36.0 years), 27 men and 4 women, were included. Thirty patients (97%) described themselves as recreational players or beginners. The majority of the injuries (29 of 31, 94%) happened at the middle or end of the planned game. Previous local symptoms had been noticed by five patients (16%). Long-term results showed that patients treated with surgery had a significantly shorter sick leave absence than patients treated without surgery (50 versus 75 days). There was no obvious selection favoring any treatment modality. None of the surgically treated patients had reruptures, but two reruptures occurred in the nonsurgically treated group. There seemed to be fewer remaining symptoms and a higher sports activity level after the injury in the surgically treated group. Our results indicate that local muscle fatigue may interfere with strength and coordination. Preventive measures such as specific treatment of minor injuries and adequate training of strength, endurance, and coordination are important. Our findings also indicate that surgical treatment and careful postoperative rehabilitation is of great importance among badminton players of any age or sports level with Achilles tendon rupture.

  • 12.
    Fahlström, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Lorentzon, Ronny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Acute badminton injuries1998In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 8, no 3, p. 145-148Article in journal (Refereed)
    Abstract [en]

    During 1990-1994, 1.2% of all sports injuries that required emergency care at the University Hospital of Umeå were caused by badminton. In 90.7% of the cases the patients described themselves as recreational players or beginners. There were 51.3% minor injuries (AIS 1) and 48.7% moderate injuries (AIS 2). The lower extremities were affected in 92.3% of the cases. Achilles tendon ruptures (34.6%) and ankle sprains and fractures (29.5%) were the most frequent. By the time of the follow-up (10-69 months), 52.6% of the players still had symptoms from the injuries and 39.5% had not been able to return to playing badminton. Our data indicate the importance of adequate treatment and rehabilitation after acute badminton injuries.

  • 13.
    Fahlström, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Bränström, Harriet
    Kinesiophobia in patients with chronic muskuloskeletal pain - differences between men and women2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081Article in journal (Refereed)
  • 14.
    Fahlström, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Jonsson, Per
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Lorentzon, Ronny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Chronic Achilles tendon pain treated with eccentric calf-muscle training2003In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 11, no 5, p. 327-333Article in journal (Refereed)
    Abstract [en]

    Injuries involving the Achilles tendon and manifested as chronic tendon pain are common, especially among recreational athletes. In a pilot study on a small group of patients with chronic painful midportion Achilles tendinosis, eccentric calf-muscle training was shown to give good clinical results. The aim of this prospective study was to investigate if the previously achieved good clinical results could be reproduced in a larger group of patients, and also to investigate the effects of eccentric calf-muscle training in patients with chronic insertional Achilles tendon pain. Seventy-eight consecutive patients, having chronic painful Achilles tendinosis at the mid-portion (2–6 cm level) in a total of 101 tendons (55 unilateral and 23 bilateral), and thirty consecutive patients with chronic insertional Achilles tendon pain in 31 tendons (29 unilateral and one bilateral) were treated with eccentric calf-muscle training for 12 weeks. Most patients were recreational athletes. Evaluation of the amount of tendon pain during activity was recorded on a visual analogue scale (VAS), before and after treatment. In 90 of the 101 Achilles tendons (89%) with chronic painful mid-portion Achilles tendinosis, treatment was satisfactory and the patients were back on their reinjury activity level after the 12-week training regimen. In these patients, the amount of pain during activity, registered on the VAS-scale (mean±SD), decreased ignificantly from 66.8±19.4 to 10.2±13.7. On the contrary, in only ten of the tendons (32%) with chronic insertional Achilles tendon pain was treatment satisfactory, with a significant decrease on the VAS-scale (mean±SD), from 68.3±7.0 to 13.3±13.2. Our conclusion is that treatment with eccentric calf-muscle training produced good clinical results in patients with chronic painful mid-portion Achilles tendinosis, but not in patients withchronic insertional Achilles tendon pain.

  • 15.
    Fahlström, Martin
    et al.
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Lorentzon, Ronny
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
    Painful conditions in the Achilles tendon region: a common problem in middle-aged competitive badminton players.2002In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 10, no 1, p. 57-60Article in journal (Refereed)
    Abstract [en]

    Overuse injuries are the most frequent type in badminton, generally localized in the legs. An earlier study found 32% of young Swedish elite badminton players to have experienced disabling pain in the Achilles tendon region during the previous 5 years. The present investigation examined the prevalence and characteristics of painful conditions in the Achilles tendon region in 32 middle-aged competitive badminton players by means of questionnaire and physiotherapist's examination. Pain in the Achilles tendon region was reported by 44%, either presently or during the past 5 years, generally localized in the middle portion of the tendon. Symptoms had lasted 2 weeks-1 year (96 days). On the competition days 22% of the reported pain currently in the region. Age was found to be correlated to Achilles tendon pain, but there was no relationship between symptoms of pain and body mass index, gender, training quantity, or years of playing badminton. In conclusion, Achilles tendon pain seems to be relatively common among Swedish middle-aged competitive badminton players, particularly in the older ones.

  • 16.
    Fahlström, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Lorentzon, Ronny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Painful conditions in the Achilles tendon region in elite badminton players.2002In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 30, no 1, p. 51-54Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate the prevalence and characteristics of painful conditions in the Achilles tendon region in elite badminton players. The study group consisted of 66 players in the Swedish elite division (highest level) in badminton, 41 men (mean age, 24.4 years) and 25 women (mean age, 21.9 years). Twenty-one players (32%) reported the occurrence of a disabling painful condition in the Achilles tendon region during the previous 5 years, and 11 players (17%) had an ongoing painful condition. A majority of the painful conditions (12 of 21, or 57%) were described as involving the midportion of the Achilles tendon. The players who had a painful condition reported a significantly higher weekly training load as measured by the number of hours spent in total training, badminton training, and endurance and strength training. There were no differences in age, sex, and body mass index between the players with and without painful conditions in the Achilles tendon region.

  • 17.
    Fahlström, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Söderman, Kerstin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Decreased shoulder function and pain common in recreational badminton players.2007In: Scand J Med Sci Sports, ISSN 0905-7188, Vol. 17, no 3, p. 246-51Article in journal (Refereed)
  • 18.
    Fahlström, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Yeap, Joo Seng
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Söderman, Kerstin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Shoulder pain -- a common problem in world-class badminton players.2006In: Scandinavian journal of medicine & science in sports, ISSN 0905-7188, Vol. 16, no 3, p. 168-73Article in journal (Refereed)
  • 19.
    Flank, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Boström, Carina
    Lewis, John E.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Wahman, Kerstin
    Self-reported physical activity and risk markers for cardiovascular disease after spinal cord injury2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 9, p. 886-890Article in journal (Refereed)
    Abstract [en]

    Objective:

    To examine whether self-reported physical activity of a moderate/vigorous intensity influences risk markers for cardiovascular disease in persons with paraplegia due to spinal cord injury.

    Design:

    Descriptive, cross-sectional study.

    Subjects:

    A total of 134 wheelchair-dependent individuals (103 men, 31 women) with chronic (>= 1 year) post-traumatic spinal cord injury with paraplegia.

    Methods:

    Cardiovascular disease markers (hypertension, blood glucose and a blood lipid panel) were analysed and related to physical activity.

    Results:

    One out of 5 persons reported undertaking physical activity >= 30 min/day. Persons who were physically active >= 30 min/day were significantly younger than inactive persons. Systolic and diastolic blood pressures were lower in the physically active group. When adjusting for age, the association between systolic blood pressure and physical activity disappeared. Physical activity >= 30 min/day had a tendency to positively influence body mass index and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. Men had significantly higher systolic and diastolic blood pressures than women, lower high-density lipoprotein cholesterol, higher low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and higher triglycerides. No other significant differences between men and women were found.

    Conclusion:

    Self-reported physical activity >= 30 min/day in persons with spinal cord injury positively influenced diastolic blood pressure. No other reductions in cardiovascular disease risk markers were seen after controlling for age. These results indicate a positive effect of physical activity, but it cannot be concluded that recommendations about physical activity in cardiovascular disease prevention for the general population apply to wheelchair-dependent persons with spinal cord injury.

  • 20.
    Flank, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Ramnemark, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Wahman, Kerstin
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Dyslipidemia is common after spinal cord injury - independent of clinical measures2015In: Jacobs Journal of Physical Rehabilitation Medicine, ISSN 2469-3103, Vol. 1, no 1Article in journal (Refereed)
    Abstract [en]

    Objective: To survey the incidence of clinical risk markers and its correlation with established clinical measurements for cardiovascular disease (CVD) in a heterogeneous spinal cord injured (SCI) patient population.

    Design: Descriptive, cross-sectional study.

    Subjects: 78 patients with SCI, at different injury and functional level.

    Methods: Anthropometric data, blood pressure, a blood lipid panel, blood glucose and a questionnaire were analyzed.

    Results: Eighty-one percent of all patients had dyslipidemia (DL) and a majority of the patients with abdominal measures below the recommended cut-off levels had DL. Self-reported physical activity above the cut-off level was reported by 32.1%of the patients. There were no differences in clinical measures, serum lipid values and blood glucose between physically active and not active patients. No differences were seen between men/women, tetraplegia/paraplegia and wheelchair dependent/not wheelchair dependent patients.

    Conclusion: DL is common and seems to be not treated or undertreated in the studied SCI patient group with different neurological lesion and functional levels. General anthropometric clinical measures do not seem to be valid for evaluating risk for CVD in this patient group.

  • 21.
    Flank, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Ramnemark, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Wahman, Kerstin
    Department of Neurobiology, Care Sciences and Society, Division of Neurodegeneration, Section Neurorehabilitation, Karolinska Institutet, Sweden; Rehab Station, Stockholm/Spinalis R&D Unit, Sweden.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Pain, anxiety and depression in spinal cord injured patients2017In: Jacobs Journal of Physical Rehabilitation Medicine, ISSN 2469-3103, Vol. 3, no 1, article id 028Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the prevalence of pain, anxiety and depression in a sample of chronic SCI patients in Northern Sweden.

    Design: Descriptive, cross-sectional study.

    Setting: Specialist Clinic at a University Hospital.

    Participants: 78 patients with chronic spinal cord injury, at different injury and functional level.

    Outcome measures: Patients registered presented pain above, at or below injury level on a Visual Analogue Scale (VAS). Patients currently on pain medication were also registered as having pain. Depression and anxiety were assessed by the Hospital Anxiety and Depression Rating Scale (HADS).

    Results: Out of 78 patients, 58 (74%) indicated current presence of pain or were on continuous pain medication. Pain above injury level was present in 32% of the patients, with a mean VAS of 15.9±20.1, range 0-60mm. Pain at injury level were present in 24% of the patients, mean VAS 11.0±17.0, range 0-50mm and 58% had pain below injury level with a mean VAS 31.4±22.3, range 0-80mm.

    Clinically significant psychological disorders were reported in 4 patients (5%) for both anxiety and depression.

    Conclusions: Pain is very common in persons with chronic SCI, but, at least in a drug-treated population, the pain is at a mild or moderate level. Anxiety and depression were found much less common than reported in other studies. Medication effects have been considered. Even in a presumably well-medicated and well-rehabilitated population, there is still a need for further optimization of pain management, including both pharmacological and non-pharmacological methods.

    Keywords: Tetraplegia; Paraplegia; Psychological Disorders; Visual Analogue Scale; Hospital Anxiety and Depression Scale

  • 22.
    Flank, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Wahman, Kerstin
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Prevalence of risk factors for cardiovascular disease stratified by body mass index categories in patients with wheelchair-dependent paraplegia after spinal cord injury2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 5, p. 440-443Article in journal (Refereed)
    Abstract [en]

    Objective: To assess risk factors for cardiovascular disease at different body mass index values in persons with wheelchair-dependent paraplegia after spinal cord injuries. Design: Cross-sectional study. Subjects: A total of 135 individuals, age range 18-79 years, with chronic (>= 1 year) post-traumatic paraplegia. Methods: Body mass index was stratified into 6 categorical groups. Cardiovascular disease risk factors for hypertension, diabetes mellitus and a serum lipid profile were analysed and reported by body mass index category. Results: More than 80% of the examined participants had at least one cardiovascular disease risk factor irrespective of body mass index level. Hypertension was highly prevalent, especially in men. Dyslipidaemia was common at all body mass index categories in both men and women. Conclusion: Higher body mass index values tended to associate with more hypertension and diabetes mellitus, whereas dyslipidaemia was prevalent across all body mass index categories. Studies that intervene to reduce weight and or percentage body fat should be performed to determine the effect on reducing modifiable cardiovascular disease risk factors.

  • 23.
    Flodgren, Gerd
    et al.
    Centre for Musculoskeletal Research, University of Gävle, Sweden.
    Crenshaw, AG
    Centre for Musculoskeletal Research, University of Gävle, Sweden.
    Gref, Margareta
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Changes in interstitial noradrenaline, trapezius muscle activity and oxygen saturation during low-load work and recovery2009In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 107, no 1, p. 31-42Article in journal (Refereed)
    Abstract [en]

    Both physical as well as mental demands result in an increased activity in the sympathetic nervous system (SNS) with changes in blood-pressure and heart-rate. Through local release of catecholamines, e.g. noradrenaline (NAd) SNS exerts various actions at the muscle level. The aims of this study were to investigate the effects of low-load repetitive work alone and in combination with mental demands on local muscle interstitial noradrenaline concentration [NAd]i, muscle activity and oxygenation, assessed with microdialysis, surface electromyography, and near-infrared spectroscopy, respectively. Healthy females (n = 15) were exposed to (1) 30 min repetitive work (RW) and (2) 30 min repetitive work with superimposed mental load (RWML) on two different occasions. Muscle [NAd]i and muscle activity increased significantly in response to RW, but did not increase further during RWML. For RW, [NAd]i was found to be inversely correlated to muscle activity. Oxygenation decreased significantly during work, independently of occasion. Our findings indicate that low-load work causes significantly increased trapezius muscle [NAd]i in healthy females, and short periods of superimposed mental load do not add to this increase and further, that both muscle activity and oxygenation were unaffected by the superimposed mental load.

  • 24.
    Flodgren, Gerd
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Hellström, FB
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Crenshaw, AG
    Effects of 30 versus 60 minutes of low-load work on intramuscular lactate, pyruvate, glutamate, prostaglandin E2 and oxygenation in the trapezius muscle of healthy females2006In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 97, no 5, p. 557-565Article in journal (Refereed)
  • 25.
    Flodgren, Gerd M
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Crenshaw, Albert G
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Idrottsmedicin.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Hellström, Fredrik B
    Bronemo, Lars
    Djupsjöbacka, Mats
    Glutamate and prostaglandin E2 in the trapezius muscle of female subjects with chronic muscle pain and controls determined by microdialysis.2005In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 9, no 5, p. 511-515Article in journal (Refereed)
  • 26.
    Flodgren, Gerd M
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Crenshaw, Albert G
    Hellström, Fredrik
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Combining microdialysis and near-infrared spectroscopy for studying effects of low-load repetitive work on the intramuscular chemistry in trapezius myalgia.2010In: Journal of Biomedicine and Biotechnology, ISSN 1110-7243, E-ISSN 1110-7251, Vol. 2010, p. 513803-Article in journal (Refereed)
    Abstract [en]

    Epidemiological research provides strong evidence for a link between repetitive work (RW) and the development of chronic trapezius myalgia (TM). The aims were to further elucidate if an accumulation of sensitising substances or impaired oxygenation is evident in painful muscles during RW. Females with TM (n = 14) were studied during rest, 30 minutes RW and 60 minutes recovery. Microdialysate samples were obtained to determine changes in intramuscular microdialysate (IMMD) [glutamate], [PGE(2)], [lactate], and [pyruvate] (i.e., [concentration]) relative to work. Muscle oxygenation (%StO(2)) was assessed using near-infrared spectroscopy. During work, all investigated substances, except PGE(2), increased significantly: [glutamate] (54%, P < .0001), [lactate] (26%, P < .005), [pyruvate] (19%, P < .0001), while the %StO(2) decreased (P < .05). During recovery [PGE(2)] decreased (P < .005), [lactate] remained increased (P < .001), [pyruvate] increased progressively (P < .0001), and %StO(2) had returned to baseline. Changes in substance concentrations and oxygenation in response to work indicate normal increase in metabolism but no ongoing inflammation in subjects with TM.

  • 27.
    Hadrevi, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Bjorklund, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Kosek, E.
    Hallgren, Solveig
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Antti, Henrik
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Fahlstrom, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Hellstrom, F.
    Systemic differences in serum metabolome: a cross sectional comparison of women with localised and widespread pain and controls2015In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 5, article id 15925Article in journal (Refereed)
    Abstract [en]

    Chronic musculoskeletal pain exists either as localised to a single region or as widespread to multiple sites in several quadrants of the body. Prospective studies indicate that widespread pain could act as a far end of a continuum of musculoskeletal pain that started with chronic localised pain. The mechanism by which the transition from localised pain to widespread occurs is not clear, although many studies suggest it to be an altered metabolism. In this study, systemic metabolic differences between women with chronic localised neck-shoulder pain (NP), women with chronic widespread pain (CWP) and women who were healthy (CON) were assessed. Blood samples were analysed taking a metabolomics approach using gas chromatography mass spectrometry (GC-MS) and orthogonal partial least square discriminant analysis (OPLS-DA). The metabolomics analysis showed a clear systematic difference in the metabolic profiles between the subjects with NP and the CON but only a weak systematic difference between the subjects with CWP and the CON. This most likely reflects a difference in the portion of the metabolome influenced by the two pain conditions. In the NP group, the overall metabolic profile suggests that processes related to energy utilisation and lipid metabolism could be central aspects of mechanisms maintaining disorder.

  • 28.
    Hällgren, Solveig
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Specialistteam och primärvård i glesbygd: ett smärtfritt samarbete2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 34, p. 1560-1562Article in journal (Refereed)
    Abstract [en]

    Long-term non-malignant pain from the locomotive system and generalised pain are common health problems, leading to absence from work and causing huge costs for the society. There is evidence that multimodal rehabilitation can lead to reduced influence of pain and increased work ability. Multimodal rehabilitation is often performed in rehabilitation clinics, where patients from sparsely populated areas must stay away from social environment. Rehabilitation of these patients could be easier if rehabilitation facilities were located closer to their homes. In Sweden, there is a political ambition that rehabilitation teams should be formed in primary health care. Different kinds of education programs are used. The results of this project suggest that team-based assessment by specialised pain teams performed together with primary care staff seems to be a valuable way of transferring knowledge in teamwork.

  • 29.
    Jonsson, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Sunding, Kerstin
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Cook, Jill
    New regimen for eccentric calf muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot-study2008In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 42, no 9, p. 746-749Article in journal (Refereed)
  • 30. Kalawy, Hatem
    et al.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Öhberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Linetsky, Felix
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    New objective findings after whiplash injuries: High blood flow in painful cervical soft tissue: An ultrasound pilot study2013In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 4, no 4, p. 173-179Article in journal (Refereed)
    Abstract [en]

    Background

    The presence of high blood flow in the structurally abnormal and painful regions of tendinosis, but not in the normal pain-free tendons, was recently confirmed by colour Doppler (CD) ultrasound (US). Biopsies from the regions with high blood flow demonstrated the presence of sympathetic and sensitive nerve fibres juxtapositioned to neovessels. Grey-scale US and CD are reliable methods used to evaluate structural homogeneity, thickness, and blood flow in the peripheral tendons. The aim of this study was to utilize CD to qualitatively evaluate for the presence of abnormal high blood flow in paravertebral tissues after whiplash injuries in patients with chronic neck pain.

    Methods

    Twenty patients with chronic neck pain after whiplash-associated disorder (WAD) and 20 pain-free control subjects were included in the study. The same experienced radiologist performed all grey-scale US and CD examinations.

    Results

    More regions with high blood flow were observed in the patient group than in the control group. At all levels, the high blood flow pattern was detected at the enthesis of the spinous processes and bilaterally juxtapositioned to the facet joints.

    Conclusion

    All regions identified by the patients as painful and tender corresponded to the positive high blood flow found during the CD examination.

    Implications

    These findings document increased blood-flow/neovascularisation at insertions of neck muscles which may indicate that there are pathological neovascularisation with accomanying pain- and sympathetic nerves, similar to what has been found in Achilles-tendinosis. These findings promise that similar treatments that now is successful with Achilles tendinosis, may be effective in the WAD-painful muscle insertions of the neck.

  • 31.
    Martin, Fahlström
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Fahlström, P G
    Lorentzon, Ronny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Henriksson-Larsén, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Positive short-term subjective effect of sports drink supplementation during recovery.2006In: J Sports Med Phys Fitness, ISSN 0022-4707, Vol. 46, no 4, p. 578-84Article in journal (Refereed)
  • 32.
    Pietilä Holmner, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    The effects of interdisciplinary team assessment and a rehabilitation program for patients with chronic pain2013In: American Journal of Physical Medicine & Rehabilitation, ISSN 0894-9115, E-ISSN 1537-7385, Vol. 92, no 1, p. 77-83Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to evaluate the effects of interdisciplinary team assessment and a 4-wk rehabilitation program in chronic pain patients.

    Design: This was a longitudinal cohort study evaluating interdisciplinary pain rehabilitation measures in a specialist care setting. A total of 93 women (42.2 +/- 9.5 yrs) with chronic musculoskeletal pain (median pain duration, 8 yrs) were evaluated at assessment and at the start and end of the rehabilitation program. Pain intensity measured with a visual analog scale, pain dimensions measured with the Multidimensional Pain Inventory, and anxiety and depression measured with the Hospital Anxiety and Depression Scale were registered.

    Results: The participants exhibited significantly improved results of pain and pain-related measures. The results were seen both after the short-term intervention in the form of the interdisciplinary assessment and after the 4-wk rehabilitation program. The improvements seen after the assessment were not related to specific interventions, such as change of medication, and therefore seem to be a result of the interdisciplinary assessment concept as such.

    Conclusions: Both interdisciplinary assessment and rehabilitation program seem to be effective in chronic pain rehabilitation, at least for women. Further studies are needed to investigate potential sex differences, as well as content and duration for optimal pain rehabilitation programs.

  • 33.
    Sjödin, Fredrik
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Noise Exposure and Hearing Related Risks for Technical Officials during a Major Badminton Tournament2018In: Jacobs Journal of Physical Rehabilitation Medicine, ISSN 2469-3103, Vol. 4, no 1, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of the study was to investigate the noise exposure for different technical officials during a major badminton tournament.

    Methods: Individual noise exposure for technical officials was measured during the 23rd BWF World Championship, 2017 in Glasgow, Scotland during all days of the tournament.

    Results: Umpires and on-court-doctors had equivalent noise exposure, when working longer shifts, that exceeded the exposure limit according to the EU 2003/10/EC noise directive. Exposure limits regarding impulse sound was also exceeded during several work shifts during the tournament.

    Conclusions: Technical officials are exposed to noise levels that exceed current occupational health leg-islation within the EU, and may therefore be at risk of developing hearing related disorders. It is of high importance for the organizers of sports events to reduce the noise exposure for the technical officials by scheduling shorter work periods, but also by providing individual hearing protectors.

  • 34. Sunding, Kerstin
    et al.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Werner, Suzanne
    Forssblad, Magnus
    Willberg, Lotta
    Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler: using a four-grade scale2016In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, no 6, p. 1988-1996Article in journal (Refereed)
    Abstract [en]

    PURPOSE: In tendon research, using ultrasound (US), studies often refer to tendon thickness, structural abnormalities and neovascularisation. The reliability concerning these measurements and evaluations is seldom reported. The aim of this study was to assess the intra- and inter-observer reliability for quantitative measures (thickness) and qualitative evaluations (structure and neovascularisation) of symptomatic and asymptomatic Achilles and patellar tendons with US and colour Doppler using a modified Öhberg score.

    METHODS: Twenty-eight consecutive patients with symptomatic and asymptomatic Achilles (n = 27) and patellar tendons (n = 26) were included. Tendon anteroposterior thickness was measured. Tendon structure and neovascularisation were evaluated using a modified Öhberg score. US-images were evaluated twice by four independent observers.

    RESULTS: Mean thickness for Achilles and patellar tendons was 8.4 mm (±2.0) and 5.5 mm (±1.7), respectively. The reliability for measures of distance was high all over (ICC = 0.963-0.999). A moderate-strong correlation was found between observers concerning evaluation of neovascularisation (r = 0.767-0.992) and poor-moderate correlation concerning evaluation of structural changes (r = 0.379-0.837). Intra-observer reliability was moderate strong for evaluations of both tendon structure (k = 0.537-0.873) and neovascularisation (k = 0.639-0.864).

    CONCLUSIONS: With a strict method for how to measure tendon thickness and set criteria for evaluating structural changes and amount and distribution of neovascularisation, US and colour Doppler is a reliable method for evaluating Achilles and patellar tendons. The modified, 4-graded, Öhberg score was found to be a reproducible instrument for assessment of tendon structure and neovascularisation.

  • 35. Sunding, Kerstin
    et al.
    Willberg, Lotta
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Werner, Suzanne
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Forssblad, Magnus
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Sclerosing injections and ultrasound-guided arthroscopicshaving for patellar tendinopathy: good clinical results and decreased tendon thickness after surgery-a medium-term follow-up study2015In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 23, no 8, p. 2259-2268Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Treatment of patellar tendinopathy/jumper's knee with ultrasound-guided sclerosing injections or ultrasound-guided arthroscopic shaving has shown good clinical short-term results. Former studies indicate that the tendon thickness and structure stays unaffected after successful treatment. The aim of this study was to evaluate the sonographic findings and clinical outcome 3-5 years after treatment of patellar tendinopathy with ultrasound-guided sclerosing injections or arthroscopic shaving.

    METHODS: Fifty-seven patellar tendons (43 patients) with chronic patellar tendinopathy were evaluated, with ultrasound, colour Doppler (CD) and visual analogue scale (VAS) for pain and satisfaction with treatment, 3-5 years after treatment. Functional status was evaluated with a single question-"Back in full loading activity?" yes or no.

    RESULTS: At endpoint (mean 46 months), there was a significant decrease in anteroposterior thickness of the proximal patellar tendon in patients treated with ultrasound-guided arthroscopic shaving but not after sclerosing injections. Tendon structure had improved, and CD local blood flow had diminished significantly in both groups. There were good clinical results with a significant decrease in VAS for pain after sclerosing injections (VAS 64 ± 18 → 17 ± 23) with 74 % satisfied patients and also after arthroscopic shaving (VAS 77 ± 16 → 13 ± 23) with 80 % satisfied patients. There were no significant differences in VAS between groups. A significant correlation between low local blood flow and high patient satisfaction was found.

    CONCLUSIONS: Tendon thickness decreased over time after ultrasound-guided arthroscopic shaving, and tendon structure and local blood flow decreased after both treatments. There were good, and similar, clinical results with both methods. LEVEL OF EVIDENCE: III.

  • 36. Sunding, Kerstin
    et al.
    Willberg, Lotta
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Werner, Suzanne
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Forssblad, Magnus
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Treatment of patellar tendinopathy with sclerosing injections or ultrasound-guided arthroscopic shaving: a long term follow-up of ultrasound findings and clinical resultsManuscript (preprint) (Other academic)
  • 37. Wiitavaara, Birgitta
    et al.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Djupsjöbacka, Mats
    Prevalence, diagnostics and management of musculoskeletal disorders in primary health care in Sweden: an investigation of 2000 randomly selected patient records2017In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, no 2, p. 325-332Article in journal (Refereed)
    Abstract [en]

    RATIONALE, AIMS AND OBJECTIVES: The aims of this study is to investigate the prevalence of patients seeking care due to different musculoskeletal disorders (MSDs) at primary health care centres (PHCs), to chart different factors such as symptoms, diagnosis and actions prescribed for patients that visited the PHCs due to MSD and to make comparisons regarding differences due to gender, age and rural or urban PHC.

    METHODS: Patient records (2000) for patients in working age were randomly selected equally distributed on one rural and one urban PHC. A 3-year period was reviewed retrospectively. For all patient records' background data, cause to the visit and diagnosis were registered. For visits due to MSD, type and location of symptoms and actions to resolve the patients problems were registered. Data was analysed using cross tabulation, multidimensional chi-squared.

    RESULTS: The prevalence of MSD was high; almost 60% of all patients were seeking care due to MSD. Upper and lower limb problems were most common. Symptoms were most prevalent in the young and middle age groups. The patients got a variety of different diagnoses, and between 13 and 35% of the patients did not receive a MSD diagnose despite having MSD symptoms. There was a great variation in how the cases were handled.

    CONCLUSIONS: The present study points out some weaknesses regarding diagnostics and management of MSD in primary care.

  • 38.
    Willberg, Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Sunding, Kerstin
    Forssblad, Magnus
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Sclerosing polidocanol injections or arthroscopic shaving to treat patellar tendinopathy/jumper's knee?: a randomised controlled study2011In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 5, p. 411-415Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Proximal patellar tendinopathy/jumper's knee (PT/JK) is well known to be difficult to treat. Recent studies using an ultrasound and colour Doppler-based treatment approach on the dorsal side of the tendon, sclerosing polidocanol injections and ultrasound-guided arthroscopic shaving, have shown promising clinical results.

    OBJECTIVES: To compare the clinical effects after treatment with sclerosing polidocanol injections and arthroscopic shaving.

    MATERIAL AND METHODS: 52 patellar tendons (43 men and two women) with ultrasound and colour Doppler-verified diagnosis of PT/JK were randomly assigned to treatment with ultrasound and colour Doppler-guided sclerosing polidocanol injections (group A) or ultrasound and colour Doppler-guided arthroscopic shaving (group B). All patients were involved in patellar tendon loading sports or recreational activities, and had had a long duration of pain symptoms from the proximal patellar tendon. Pain during patellar tendon loading activity, and at rest, before and after treatment (visual analogue scale; VAS), and patient satisfaction with the result of the treatment, was registered.

    RESULTS: After treatment, the patients treated with arthroscopic shaving had a significantly lower VAS score at rest and during activity, and were significantly more satisfied compared with the patients in the sclerosing injection group.

    CONCLUSIONS: Both treatment with ultrasound and colour Doppler-guided sclerosing polidocanol injections and arthroscopic shaving showed good clinical results, but patients treated with arthroscopic shaving had less pain and were more satisfied with the treatment result. Because surgical treatment is a one-stage treatment return to sports was faster in this group.

  • 39.
    Willberg, Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Sunding, Kerstin
    Öhberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Forssblad, Magnus
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Sclerosing injections to treat midportion Achilles tendinosis: a randomised controlled study evaluating two different concentrations of Polidocanol.2008In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 16, no 9, p. 859-864Article in journal (Refereed)
    Abstract [en]

    Two to three ultrasound (US) and colour Doppler (CD)-guided injections of the sclerosing substance Polidocanol (5 mg/ml) have been demonstrated to give good clinical results in patients with chronic midportion Achilles tendinopathy. This study aimed to investigate if a higher concentration of Polidocanol (10 mg/ml) would lead to a less number of treatments, and lower volumes, needed for good clinical results. Fifty-two consecutive Achilles tendons (48 patients, mean age 49.6 years) with chronic painful midportion Achilles tendinopathy, were randomised to treatment with Polidocanol 5 mg/ml (group A) or 10 mg/ml (group B). The patients and treating physician were blinded to the concentration of Polidocanol injected. All patients had structural tendon changes and neovascularisation in the Achilles midportion. Treatment was US + CD-guided injections targeting the region with neovascularisation (outside ventral tendon). A maximum of three treatments (6-8 weeks in between) were given before evaluation. Patients not satisfied after three treatments were given additional treatment with Polidocanol 10 mg/ml, up to five treatments. For evaluation, the patients recorded the severity of Achilles tendon pain during activity on a visual analogue scale (VAS), before and after treatment. Patient satisfaction with treatment was also assessed. At follow-up (mean 14 months) after three treatments, 18/26 patients in group A and 19/26 patients in group B were satisfied with the treatment and had a significantly reduced level of tendon pain (P < 0.05). After completion of the study, additional treatments with Polidocanol 10 mg/ml in the not satisfied patients resulted in 26/26 satisfied patients in both groups A and B. In summary, we found no significant differences in the number of satisfied patients, number of injections or volumes given, between patients treated with 5 or 10 mg/ml Polidocanol.

  • 40.
    Zeisig, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Öhberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    A 2-year sonographic follow-up after intratendinous injection therapy in patients with tennis elbow2010In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 44, no 8, p. 584-587Article in journal (Refereed)
    Abstract [en]

    Background Tennis elbow is a tendinopathy affecting the upper extremity. Recent studies have shown high sensitivity for ultrasound (US) examination and high specificity for colour Doppler (CD) examination. There are no mid- or long-term follow-up investigations of the tendon structure and blood flow using these techniques.

    Objective To use US and CD to study structure and blood flow in the extensor origin in patients with tennis elbow treated with intratendinous injections.

    Design Follow-up study

    Setting Sports Medicine Unit, Umeå University.

    Patients 25 patients (28 elbows), mean age 46 years (range 27–66), treated with intratendinous injections due to chronic pain from tennis elbow.

    Method US and CD examination of the extensor origin was carried out at inclusion and at follow-up two years after intratendinous injection treatment with polidocanol and/or a local anaesthetic.

    Main outcome measurements US (structure) and CD (blood flow) findings.

    Results All patients had structural tendon changes and high blood flow at inclusion when given the injection treatment. At the two-year follow-up, structural tendon changes were seen in 20/28 elbows and high blood flow was seen in 4/28 elbows. The majority of patients with a good clinical result after treatment had no visible blood flow (17/20), but the structural changes showed no relation to a good result (13/20 remaining changes).

    Conclusions Doppler findings, but not structure, might be related to the clinical result after intratendinous injection treatment of tennis elbow.

  • 41.
    Zeisig, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Öhberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Pain relief after intratendinous injections in patients with tennis elbow: results of a randomised study2008In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 42, no 4, p. 267-271Article in journal (Refereed)
1 - 41 of 41
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