But when these muscles are unable to develop sufficient strength rapidly enough at the appropriate moment spasms colon buy 4mg tizanidine with mastercard, urine escapes from the bladder muscle relaxant vs pain killer tizanidine 2mg. The objective of any treatment of this type of incontinence is to strengthen the sphincter muscle relaxant and pregnancy 2 mg tizanidine otc. In order to do this spasms just below rib cage buy tizanidine 2mg lowest price, it is necessary to use a programme that brings about tetanic contractions of the paraurethral components of the pelvic floor musculature spasms spasticity muscle tizanidine 2 mg on line, using fast fibre tetanization frequencies back spasms 35 weeks pregnant order tizanidine 2mg visa. It is therefore important to regularly increase the energy level during the session every 3 or 4 contractions. The therapist plays a decisive role in reassuring the patient and encouraging her to work with the strongest possible contractions. Often a mixture of the two forms is present in varying proportions; it is difficult in these situations to establish which is the predominant symptom. Electrical stimulation treatment is particularly advantageous in this type of incontinence, particularly with Compex equipment. The stimulator is able to provide combined treatment to inhibit the detrusor and strengthen urethral closure in the same session and using the same stimulation programme. The sphincter urethrae is strengthened by means of tetanic contractions with the optimum fast fibre tetanization frequency. Between the tetanic contractions, during the resting phase, a very low frequency pulse (5 Hz) allows for detrusor inhibition. Then between contractions, the energy level of the tetanic reinforcement contractions is adjusted. The energy will gradually be increased until the patient feels 5 pulses per second. Once this threshold value has been determined, the energy will gradually be increased until three times the initial energy is reached. Therefore, it is important to regularly increase the energy during the session every 3 or 4 contractions. The therapist plays a decisive role in reassuring the patient and encouraging her to work with the strongest possible contractions. The consequences of this trauma are varied: strained muscles, torn muscles, partial denervation, loss of body image, loss of strength and control of the striated muscles of the pelvic floor, etc. Urinary incontinence is a relatively common problem in this situation, which is why prophylactic pelvic re-training treatment by neuromuscular electrostimulation is indicated. It is therefore important to regularly increase the energy level during the session every 3 or 4 contractions. The therapist plays a decisive role in reassuring the patient and encouraging him/her to work with the strongest possible contractions. The distance between the injury and the motor point of the deltoid can be assessed at 6/8 cm. A positive electrode is placed on the motor point of the medial part, a few centimetres below the outer edge of the acromion. Another positive electrode is centred on the fleshy body of the anterior fascicle. The two negative connections are connected to a large electrode positioned on the shoulder. Whatever is done, a denervated muscle without any hope of re-innervation will always end up atrophying and sclerosing. The distance between the injury and the motor points of the muscles of the anteroexternal part of the leg can be estimated at 65 or 70 cm. Testing for total or partial denervation of the muscles of the antero-external part of the leg 16. The small, positive electrode is placed under the head of peroneous where the lateral popliteal nerve passes through. The negative electrode (large) is placed crosswise at mid-height of the outside of the leg. In fact, denervated fibres with no hope of re-innervation will always end up atrophying and sclerosing. On the other hand, it might be worthwhile to work on the innervated part of the paretic muscles by means of neurostimulation with rectangular biphasic pulses in order to achieve hypertrophy of the innervated fibres to compensate for the denervated ones (compensating hypertrophy). The live electrode (the smallest one) is placed under the head of peroneous where the lateral popliteal nerve passes through. The negative electrode (large) is placed crosswise at mid-height on the outside of the leg. Then, maintenance of what has been achieved at a rate of one session every two weeks. The distance between the injury and the motor points of the extensor muscles of the wrist and fingers can be estimated at about twenty centimetres; the reinnervation time will therefore be around 7 months (9 months at most); as the trauma only goes back 4 months, we are within the re-innervation time. Testing for total or partial denervation of the extensor muscles of the wrist and fingers 16. The small positive electrode is placed on the fleshy part of the epicondylus muscles, a small negative electrode is placed a few centimetres below on the dorsal side of the forearm. Here the preferred technique is going to be stimulation of the extensor muscles of wrist and fingers by means of Denervated programmes. To stimulate a fully denervated muscle wide rectangular pulses will be used (between 50 and 200 ms) as the denervated fibre can only be slightly excited. It therefore needs a large amount of electrical charge to reach its excitation threshold. It is preferable to use soft carbon electrodes, the size of which should be chosen so that the electrodes can cover all the fibres of the muscle you need to stimulate. After being coated with gel, the two electrodes will be positioned crosswise on the fleshy part of the muscle (thus avoiding the tendinous parts); the size of the electrodes will have been previously determined so that they cover the muscle fibres as much as possible; they must therefore cover the full width of the muscle. For safety reasons, in the Denervated programme, the maximum intensity strength is limited to 30 mA. During rehabilitation, it is desirable to test the denervated muscles regularly with the Disuse atrophy programme in order to check for the possible start of reinnervation, in which case it is appropriate to choose triangular shaped pulses, i. The distance between the injury and the motor points of the muscles of the antero-external part can be assessed at about fifteen centimetres; the re-innervation time will therefore be around 5 months. As the injury only goes back a month and a half, we are within the re-innervation time. Testing for total or partial denervation of the muscles of the antero-external part of the leg 16. A small, positive electrode is placed under the head of peroneous where the lateral popliteal nerve passes through. The negative electrode (large) is placed crosswise at mid-height on the outside of the leg. Depending on the clinical circumstances and the school we subscribe to , we can work on the innervated part of the muscle using the short duration rectangular biphasic pulses supplied by the Neurostimulation programmes. However, it seems necessary to try to prevent atrophy and limit the phenomenon of sclerosis of denervated fibres. To do this, use the sloped pulses of the Partial automatic or Partial manual programmes. Unless the exact stimulation parameters are known (for that one would have to have the precise results of a recent electromyograph), it is recommended that the Partial automatic programme be used (Physio will work with default figures). It is preferable to use soft carbon electrodes, the sizes of which should be chosen so that the electrodes cover all the fibres of the muscle you need to stimulate. After being coated with gel, the two electrodes will be positioned crosswise on the fleshy part of the muscle (therefore avoiding the tendinous parts); their size will previously have been determined so that they cover the muscle fibres as much as possible. The programme begins with an automatic ramp search on each stimulation channel in turn. The automatic ramp search works as follows: every half second (500 ms) the stimulator creates a 100 ms wide pulse, the ramp of which increased progressively. It is thus possible to work with 4 channels, and each stimulation channel will have the ramp appropriate to the state of the stimulated muscle. For safety reasons, in the Denervated programme, the maximum intensity is limited to 30 mA. By increasing the intensity strength, Compex 3 adjusts the pulse width so that the ramp remains constant. If re-innervation is only partial, once the time has elapsed, a disuse atrophy treatment on card 1 must be used in order to achieve compensating hypertrophy (see Situation 2). No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording or otherwise, without prior written permission from the Publisher. Experimental pelvic pain facilitates pain provocation tests and causes regional hyperalgesia. Experimental pelvic pain impairs the performance during the Active Straight Leg Raise test and causes excessive muscle stabilization. Lumbopelvic pain in pregnancy is characterised by widespread deep-tissue sensitivity, a facilitated response to manual orthopedic tests and poorer self-reported health. This thesis is based on work which has been made possible by the help and support from a number of people to whom I am most thankful and wish to express my gratitude. First of all, Professor Thomas Graven-Nielsen, the supervisor of this thesis, who has provided encouragement and support from the very first day. With an extensive overview, patience and great mentoring skills he has guided the project into the right direction with constant focus on the scientific quality of the work without losing focus on the clinical relevance. Thanks to Max Zusman, a great inspiration and a good friend who always provided valuable comments on the working process but has sadly passed away. Administration, technical and academic staff at the Department of Health Science and Technology, Aalborg University also deserve to be thanked for all the help and assistance they have provided. Rogerio Pessoto Hirata for technical assistance and the design of software for data analysis. The financial support from the Danish ministry of Science, Innovation and Higher Education is kindly acknowledged. Thanks to all my family for the support and encouragement during the process and to my father for great graphical assistance. You helped me to see the big picture and this process would never have been the same without you. Experimental pelvic pain facilitates pain provocation tests and causes regional hyperalgesia. Experimental pelvic pain impairs the performance during the active straight leg raise test and causes excessive muscle stabilization. This, more than anything indicates that our understanding of the mechanisms underlying the pain condition is either lacking or the ability to convey the knowledge gained from clinical or experimental pain studies to clinical practice needs improvement. In pregnancy, this is evident in a recent review (Pennick and Liddle 2013) which demonstrated that the effect sizes from various treatment options are small and that no single intervention is superior to the other. This may relate to the multifactorial nature of pain in general which clinicians and researchers are encouraged to acknowledge in the current guidelines for pelvic girdle (Vleeming et al. One of the key factors in understanding pain is the mechanism underlying it, its evolvement in the transition from acute into chronic pain and the contribution of peripheral and facilitated central mechanisms in the maintenance of the given pain condition. Such an understanding can to some extent be gained by investigating how healthy subjects react to a short duration of experimental ~7~ pain. In an experimental setting, pain is often induced using exogenous (chemical, mechanical and electrical) methods which have proven useful in investigating the sensory (Sinclair et al. In pregnancy, widespread pain sensitivity has been demonstrated, becoming less prominent towards the end of third trimester which is considered to be related with an increased activity of descending pain inhibiting mechanisms (Draisci et al. However, it still is unclear what mechanisms underlie pregnancy-related pain and increased pain sensitivity, why it seems to naturally accompany pregnancy and how/if changes in sensitivity of the peripheral and central nervous system are a part of this process. In this model, quantitative sensory testing was used to assess the pain intensity, pain referral patterns and pain sensitivity in local and referred pain areas. Furthermore, these findings were compared with the outcome of manual clinical tests to see if pain per se could change their outcome. Although it is outside the scope of the current findings to comment on clinical intervention, it is clearly demonstrated that the pain and pain sensitivity are important factors to consider in clinical decision making. An improved understanding of this complex interaction may result in improved mechanisms-based treatment and management strategies with hopefully improved outcomes for this clinical population. This can be related with many factors such as the complexity of diagnosing the problem, a large overlap in gross-anatomy and neuro-anatomy and close proximity of structures capable of producing pain in the area. The distinction between low back pain and pain from the posterior aspect of the pelvic girdle is not clear with different terminology being used when investigating the painful condition in pregnant and non-pregnant populations. This is perhaps best reflected in the two separate guidelines that exist for pelvic girdle pain (Vleeming et al. In the current thesis, the term lumbopelvic pain is chosen as it is not the intention to make a clear distinction between pain originating in the pelvic girdle or low back (Wu et al. However, 7-10% of women suffer from varying degrees of pain and disability beyond the time when all pregnancy related changes are expected have returned to normal (Wu et al. It is possible that prolonged pain and suffering after delivery is related with increased sensitivity of pain mechanisms which may be affected by several factors (see section 2. The sacroiliac joint has often been implicated as the origin of pain in this area in both pregnant and non-pregnant populations (Maigne and Planchon, 2005, Katz et al. In pregnancy, the clinical history usually involves an insidious onset of symptoms where levels of pain and disability do not seem to be related with gestation week (Gutke et al.
The small bony bumps located immediately above and below the glenoid cavity are the supraglenoid tubercle and the infraglenoid tubercle muscle relaxers to treat addiction generic tizanidine 2mg overnight delivery, respectively spasms toddler proven 4mg tizanidine. At the shoulder spasms in abdomen purchase 2mg tizanidine with mastercard, the coracoid process is located inferior to the lateral end of the clavicle back spasms 36 weeks pregnant tizanidine 4 mg low price. It is anchored to the clavicle by a strong ligament and serves as the attachment site for muscles of the anterior chest and arm spasms in spanish generic 4 mg tizanidine mastercard. On the posterior aspect spasms 2 order 2mg tizanidine fast delivery, the spine of the scapula is a long and prominent ridge that runs across its upper portion. Extending laterally from the spine is a flattened and expanded region called the acromion or acromial process. The acromion forms the bony tip of the superior shoulder region and articulates with the lateral end of the clavicle, forming the acromioclavicular joint (Figure 13. Together, the clavicle, acromion, and spine of the scapula form a V-shaped bony line that provides for the attachment of neck and back muscles that act on the shoulder, as well as muscles that pass across the shoulder joint to act on the arm. The scapula has three depressions, each of which is called a fossa (plural = fossae). Two of these are found on the posterior scapula, above and below the scapular spine. Superior to the spine is the narrow supraspinous fossa, and inferior to the spine is the broad infraspinous fossa. All of these fossae provide large surface areas for the attachment of muscles that cross the shoulder joint to act on the humerus. A hard fall onto the elbow or outstretched hand can stretch or tear the acromioclavicular ligaments, resulting in a moderate injury to the joint. However, the primary support for the acromioclavicular joint comes from a very strong ligament called the coracoclavicular ligament (Figure 13. This connective tissue band anchors the coracoid process of the scapula to the inferior surface of the acromial end of the clavicle and thus provides important indirect support for the acromioclavicular joint. Following a strong blow to the lateral shoulder, such as when a hockey player is checked into the boards, a complete dislocation of the acromioclavicular joint can result. In this case, the acromion is thrust under the acromial end of the clavicle, resulting in ruptures of both the acromioclavicular and coracoclavicular ligaments. The scapula then separates from the clavicle, with the weight of the upper limb pulling the shoulder downward. This dislocation injury of the acromioclavicular joint is known as a "shoulder separation" and is common in contact sports such as hockey, football, or martial arts. These consist of the arm (between the shoulder and elbow joints), the forearm (between the elbow and wrist joints), and the hand (distal to the wrist). The humerus is the single bone of the upper arm, and the ulna (medially) and the radius (laterally) are the paired bones of the forearm. The base of the hand contains eight bones, each called a carpal bone, and the palm of the hand is formed by five bones, each called a metacarpal bone. The head articulates with the glenoid cavity of the scapula to form the glenohumeral (shoulder) joint. Located on the lateral side of the proximal humerus is an expanded bony area called the greater tubercle. The smaller lesser tubercle of the humerus is found on the anterior aspect of the humerus. Both the greater and lesser tubercles serve as attachment sites for muscles that act across the shoulder joint. Passing between the greater and lesser tubercles is the narrow intertubercular groove (sulcus), which is also known as the bicipital groove because it provides passage for a tendon of the biceps brachii muscle. The surgical neck is located at the base of the expanded, proximal end of the humerus, where it joins the narrow shaft of the humerus. The deltoid tuberosity is a roughened, V-shaped region located on the lateral side in the middle of the humerus shaft. It articulates with the radius and ulna bones of the forearm to form the elbow joint. The prominent bony projection on the medial side is the medial epicondyle of the humerus. The much smaller lateral epicondyle of the humerus is found on the lateral side of the distal humerus. The roughened ridge of bone above the lateral epicondyle is the lateral supracondylar ridge. All of these areas are attachment points for muscles that act on the forearm, wrist, and hand. The powerful grasping muscles of the anterior forearm arise from the medial epicondyle, which is thus larger and more robust than the lateral epicondyle that gives rise to the weaker posterior forearm muscles. The distal end of the humerus has two articulation areas, which join the ulna and radius bones of the forearm to form the elbow joint. The more medial of these areas is the trochlea, a spindle- or pulley-shaped region (trochlea = "pulley"), which articulates with the ulna bone. Immediately lateral to the trochlea is the capitulum ("small head"), a knob-like structure located on the anterior surface of the distal humerus. Superior to the trochlea is the coronoid fossa, which receives the coronoid process of the ulna, and above the capitulum is the radial fossa, which receives the head of the radius when the elbow is flexed. Similarly, the posterior humerus has the olecranon fossa, a larger depression that receives the olecranon process of the ulna when the forearm is fully extended. It runs parallel to the radius, which is the lateral bone of the forearm (Figure 13. The proximal end of the ulna resembles a crescent wrench with its large, Cshaped trochlear notch. This region articulates with the trochlea of the humerus as part of the elbow joint. The inferior margin of the trochlear notch is formed by a prominent lip of bone called the coronoid process of the ulna. Just below this on the anterior ulna is a roughened area called the ulnar tuberosity. To the lateral side and slightly inferior to the trochlear notch is a small, smooth area called the radial notch of the ulna. This area is the site of articulation between the proximal radius and the ulna, forming the proximal radioulnar joint. The posterior and superior portions of the proximal ulna make up the olecranon process, which forms the bony tip of the elbow. The ulna is located on the medial side of the forearm, and the radius is on the lateral side. The lateral side of the shaft forms a ridge called the interosseous border of the ulna. This is the line of attachment for the interosseous membrane of the forearm, a sheet of dense connective tissue that connects the ulna and radius bones. Projecting from the posterior side of the ulnar head is the styloid process of the ulna, a short bony projection. This serves as an attachment point for a connective tissue structure that connects the distal ends of the ulna and radius. In anatomical position, with the elbow fully extended and the palms facing forward, the arm and forearm do not form a straight line. It allows the forearm and hand to swing freely or to carry an object without hitting the hip. The Radius the radius runs parallel to the ulna, on the lateral side of the forearm (Figure 13. The small depression on the surface of the head articulates with the capitulum of the humerus as part of the elbow joint, whereas the smooth, outer margin of the head articulates with the radial notch of the ulna at the proximal radioulnar joint. The neck of the radius is the narrowed region immediately below the expanded head. Inferior to this point on the medial side is the radial tuberosity, an oval-shaped, bony protuberance that serves as a muscle attachment point. The shaft of the radius is slightly curved and has a small ridge along its medial side. This ridge forms the interosseous border of the radius, which, like the similar border of the ulna, is the line of attachment for the interosseous membrane that unites the two forearm bones. The distal end of the radius has a smooth surface for articulation with two carpal bones to form the radiocarpal joint or wrist joint (Figure 13. This shallow depression articulates with the head of the ulna, which together form the distal radioulnar joint. The lateral end of the radius has a pointed projection called the styloid process of the radius. This provides attachment for ligaments that support the lateral side of the wrist joint. Compared to the styloid process of the ulna, the styloid process of the radius projects more distally, thereby limiting the range of movement for lateral deviations of the hand at the wrist joint. The Carpal Bones the wrist and base of the hand are formed by a series of eight small carpal bones (see Figure 13. The carpal bones are arranged in two rows, forming a proximal row of four carpal bones and a distal row of four carpal bones. The bones in the proximal row, running from the lateral (thumb) side to the medial side, are the scaphoid ("boat-shaped"), lunate ("moon-shaped"), triquetrum ("three-cornered"), and pisiform ("peashaped") bones. The small, rounded pisiform bone articulates with the anterior surface of the triquetrum bone. The pisiform thus projects anteriorly, where it forms the bony bump that can be felt at the medial base of your hand. The distal bones (lateral to medial) are the trapezium ("table"), trapezoid ("resembles a table"), capitate ("head-shaped"), and hamate ("hooked bone") bones. The hamate bone is characterized by a prominent bony extension on its anterior side called the hook of the hamate bone. A helpful mnemonic for remembering the arrangement of the carpal bones is "So Long To Pinky, Here Comes the Thumb. This can be seen in the radiograph (X-ray image) of the hand that shows the relationships of the hand bones to the skin creases of the hand (Figure 13. Within the carpal bones, the four proximal bones are united to each other by ligaments to form a unit. Only three of these bones, the scaphoid, lunate, and triquetrum, contribute to the radiocarpal joint. The scaphoid and lunate bones articulate directly with the distal end of the radius, whereas the triquetrum bone articulates with a fibrocartilaginous pad that spans the radius and styloid process of the ulna. The distal end of the ulna thus does not directly articulate with any of the carpal bones. The proximal and distal rows of carpal bones articulate with each other to form the midcarpal joint (Figure 13. Together, the radiocarpal and midcarpal joints are responsible for all movements of the hand at the wrist. A strong ligament called the flexor retinaculum spans the top of this U-shaped area to maintain this grouping of the carpal bones. The flexor retinaculum is attached laterally to the trapezium and scaphoid bones, and medially to the hamate and pisiform bones. Together, the carpal bones and the flexor retinaculum form a passageway called the carpal tunnel, with the carpal bones forming the walls and floor, and the flexor retinaculum forming the roof of this space (Figure 13. The tendons of nine muscles of the anterior forearm and an important nerve pass through this narrow tunnel to enter the hand. Overuse of the muscle tendons or wrist injury can produce inflammation and swelling within this space. This produces compression of the nerve, resulting in carpal tunnel syndrome, which is characterized by pain or numbness, and muscle weakness in those areas of the hand supplied by this nerve. The Metacarpal Bones the palm of the hand contains five elongated metacarpal bones. These bones lie between the carpal bones of the wrist and the bones of the fingers and thumb (see Figure 13. The proximal end of each metacarpal bone articulates with one of the distal carpal bones. The expanded distal end of each metacarpal bone articulates at the metacarpophalangeal joint with the proximal phalanx bone of the thumb or one of the fingers. The first metacarpal bone, at the base of the thumb, is separated from the other metacarpal bones. This allows it a freedom of motion that is independent of the other metacarpal bones, which is very important for thumb mobility. The second and third metacarpal bones are firmly anchored in place and are immobile. However, the fourth and fifth metacarpal bones have limited anterior-posterior mobility, a motion that is greater for the fifth bone. The anterior movement of these bones, particularly the fifth metacarpal bone, increases the strength of contact for the medial hand during gripping actions. The Phalanges the fingers and thumb contain 14 bones, each of which is called a phalanx bone (plural = phalanges), named after the ancient Greek phalanx (a rectangular block of soldiers). The thumb (pollex) is digit number 1 and has two phalanges, a proximal phalanx, and a distal phalanx bone (see Figure 13. Digits 2 (index finger) through 5 (little finger) have three phalanges each, called the proximal, middle, and distal phalanx bones. An interphalangeal joint is one of the articulations between adjacent phalanges of the digits (Figure 13. You are provided a list of terms below and you are expected to use every term provided. Using colored tape or post-it notes, please write the number that corresponds to the term from the list and place them on your model.
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To maintain reasonable aerobic fitness spasms right abdomen order 2mg tizanidine fast delivery, spend 30 to 40 minutes 3 days each week hiking briskly spasms near sternum buy tizanidine 2mg online, walking at an easier pace the rest of the week spasms near sternum discount tizanidine 4mg visa. The simplest way to maintain fitness is to be sure that you find a job that you would classify as moderately hard to hard or train for 40 to 60 minutes every other day spasms upper left abdomen generic tizanidine 2mg amex. When smokejumpers perform initial attack muscle relaxant radiolab discount tizanidine 2 mg on-line, they work long muscle relaxant medication over the counter buy cheap tizanidine 2mg on line, hard days for 2 to 4 days, then come back to the smokejumper base for a few days off before the next fire jump. Crew bosses need to cycle the work, whenever possible, making sure that their crews have an easier day or two after 2 to 3 days of hard work. When crews have extended periods of light work, crewmembers need to do physical training or find jobs to maintain their fitness. The ability of the human body to adapt is amazing: fitness is lost when work decreases and regained when work increases. If you work extended hard shifts for too many days in a row, your body may begin to break down. To maintain your aerobic and muscular fitness, find some time for physical training, including running and upper body work. One of the last fires of the season required greater fitness with lots of steep hiking, line digging, and long days. Many members of the crew regretted they were not as fit then as they had been earlier in the season (sustainable fitness is the maximum day-long work rate). Crew leaders, division supervisors, and incident management team members should try to cycle work intensity to maintain crew safety, function, and health. Studies show that crews who practice this principle have missed fewer days of work and have been more effective than crews who become overfatigued. The less fit group also monitors worn throughout the period had significantly depressed levels of allowed the total energy expended each salivary IgA on the morning of day 10. Energy expenditure was very high (more than 3,800 kilocalories per day) for 5 days out of 6. EatingandHydration the fatigue index on the morning of day 6, after the easier activity on day 5 (1,800-kilocalorie energy expenditure), was just slightly elevated in both groups (lower and higher fitness), suggesting that the crew had recovered overnight. Both groups had high fatigue indexes on the 9th morning, after high-intensity work on days 6, 7, and 8, showing that they had not recovered. The following morning, the fitter group had nearly recovered to baseline levels on the fatigue index, while the less fit group appeared to Supervisors can make food and drink available, but the firefighters themselves are responsible for making sure they eat and drink enough. Supervisors should schedule fluid replacement every 30 minutes during hot conditions and workers should eat frequently. The old adage "Drink Often" should be replaced with the new adage "Eat and Drink Often. Fatigue-Exhaustion makes firefighters more susceptible to upper respiratory infections. To prevent fatigue, maintain fitness, eat enough, keep hydrated, take frequent breaks, and get enough sleep. This figure shows the total work activity (measured by activity counts) for the entire day with and without regular snacking. Maintaining Weight-While most fire crews and incident management teams do not bring a bathroom scale with them, checking weight each morning is a good way to ensure that firefighters are maintaining hydration. Gradual weight loss during fire assignments can indicate the firefighters are not eating HandWashing,Water Bottles,andCleanliness When you are living in a crowded fire camp, or even when you are spiked out with your crew, be careful not to spread germs. Studies have found high concentrations of bacteria and other micro-organisms in water bottles that are not regularly washed. Firefighters who use sipping hydration systems need to wash the reservoirs, hose, and mouthpiece. To avoid encouraging the growth of micro-organisms, never mix flavored beverages containing sugar in sipping hydration systems (see "Hydration Strategies for Firefighters," Domitrovich and Sharkey 2008). While training provides the foundation for fitness, training is no substitute for job-specific work hardening. Work hardening ensures that the muscles and connective tissues used on the job are tough and ready to go. Feet, hands, back, joints, and muscles need to adjust to prolonged arduous field work. The early season training programs in chapter 8 incorporate examples of work-specific training. Blisters, sprains, strains, and muscle soreness are indications that you need more work hardening. Come to the job hardened and ready to go, but be prepared to treat blisters and other problems that hinder performance. Blisters form when friction separates layers of skin, allowing fluid to accumulate between them. Schedule training and project activities that prepare workers for the job and the environmental conditions they will face. During this period, you can focus on developing good habits-including safety awareness, hydration, and nutrition-while building crew morale, cohesion, and teamwork. During the fire season, crew bosses should pay attention to signs of fatigue in each crewmember. Fit workers tend to recover faster and experience less fatigue, but they may also work harder. Breaks- After a short illness or injury resulting short or long-are one defense against in absence from work, an employee may After prolonged illness, a worker should fatigue, sleep is another. The shift should allow time for Neck Check eating, showering, and getting ready Should you train or work with an upper respiratory for work. Night crews need If symptoms are above the neck, such as a stuffy nose, protection from noise, light, dust, and sneezing, or a scratchy throat, try exercising at half your other conditions that interfere with restnormal pace. If you feel better after 10 minutes, you can increase the pace and finish the workout. If symptoms are below the neck, with aching muscles or coughing, or if you have a fever, nausea, or diarrhea, take the day off. You can return to training when the fever is gone for at least 24 hours without the use of aspirin or other fever medications. The right food sources, properly timed, provide energy and nutrients that help sustain work and maintain the immune system. Supplemental high-energy foods delay fatigue and enhance immune function while helping firefighters maintain their ability to think and make decisions during periods of hard work. To ensure their health and performance, firefighters need to eat like endurance athletes. Firefighters require twice as many calories as normal-or more- when they are working on the fireline. This chapter is for wildland firefighters, incident management team members, support personnel, and those interested in good nutrition for health and performance. The chapter includes information on energy and nutrient needs, the timing of food intake, vitamin and mineral supplements, and weight management. Intermittent feeding (shift food) maintains blood glucose, work output, immune function, mood, and the ability to make decisions throughout the work shift. Firefighters who do not consume enough calories will become fatigued and lose body weight and muscle. Consuming too few calories during a busy fire season can impair immune function and lead to illness. Muscle glycogen fuels the muscles during work; liver glycogen maintains blood glucose, the primary fuel for the brain and nervous system. When blood glucose levels drop during extended physical activity, carbohydrates from the food we eat can provide blood glucose. If your diet does not include enough carbohydrate, the body will make blood glucose from muscle protein, a poor alternative because muscle is needed for the work at hand. Field studies of For ultraendurance sports or very hard firefighters show that carbohydrate work, the carbohydrate requirement energy supplements improve work could be even higher. Carbohydrate-rich foods include wholegrain products, beans, rice, corn, peas, potatoes, fruit, fruit juice, milk, yogurt, Fat energy bars, and sports drinks. Fat should provide 20 to 35 percent of So-called energy drinks contain little daily calories with a minimum recomcarbohydrate. Food 1 slice bread 1 cup beans 1 cup rice 1 cup corn 1 medium apple 1 energy bar 1 cup sports drink 1 cup milk 1 cup yogurt Grams (ounces) of Kilocarbohydrate calories 12 (0. No more than one-third of the fat should come from saturated and trans fats such as butter, lard, dairy fat, and some processed fats-read the labels. The balance of fat should come from monounsaturated and polyunsaturated fats (such as olive, canola, and peanut oils or nuts such as almonds and hazelnuts). If a firefighter needs 4,000 kilocalories per day when fighting fire, one-quarter of those calories (1,000 kilocalories) can come from fat. Because each gram of fat has about 9 kilocalories, 111 grams of fat would provide about 1,000 kilocalories. Firefighters doing light work (2,200 kilocalories) only need 56 grams of fat per day. Field studies of firefighters show that intermittent feeding throughout the shift maintains blood glucose and work output. Firefighters consuming shift food performed more work, especially during the last 4 hours of the shift, compared to firefighters who had a traditional sack lunch. Nutrients: Vitamins and Minerals Nutrition needs: Determine your caloric and nutrient needs by using the Web site. This site suggests daily caloric and micronutrient (mineral and vitamin) needs based on your age, gender, and level of physical activity. Remember, the protein and carbohydrate requirements underestimate the needs of wildland firefighters. Firefighters do not need vitamin and mineral supplements if their diets include a variety of nutrient-rich foods and beverages and provide enough energy to maintain body weight. For more information on vitamin and mineral needs, see "Wildland Firefight- 47 Chapter 10-Nutrition and Performance er Health and Safety Report: No. Related Issues the following issues are related to energy, nutrition, and weight management. Immune Function-Psychological stress, exhaustion, smoke exposure, sleep deprivation, and dehydration can degrade immune function. A wellbalanced diet with adequate calories, meat, shellfish, fruits, and vegetables enhances immunity. Research has demonstrated that adding carbohydrate energy supplements during work helps maintain the immune function of wildland firefighters. Ergogenic Aids-Ergogenic aids are products that are thought by some to improve performance. For information on ergogenic aids, consult a registered dietitian-not Internet sites. Special Needs of Incident Management Team Members-Incident management team members do less arduous work than wildland firefighters. Weight Management -When fire season is over, eat less because your energy needs will be lower. This chapter focuses on heat stress, altitude, and smoke, the ways these factors affect performance and health, and what firefighters can do to minimize their impact. Field workers suffer heat stress when the air temperature, humidity, radiant heat, and lack of air movement combine with hard work and protective clothing to raise the body temperature (figure 11. Heat Cramps-Painful muscle cramps sometimes strike workers who perform prolonged strenuous effort in the heat. Treatment involves electrolyte drinks (tomato juice, sport drinks, lightly salted water) or electrolyte tablets and stretching to relieve the cramps. The risk is minimized when fluid intake is adequate, when sport drinks are available to replace electrolytes lost in sweat, and when the diet includes bananas, oranges, and salt (sodium) with meals. Heat Exhaustion-This disorder is characterized by weakness; fatigue; dry, hot, and flushed skin; headache; nausea; and, sometimes, collapse. Army and the American College of Sports Medicine recommend drinking up to 1 liter (1. Wildland firefighting generates about 400 kilocalories of heat per hour, with another 180 kilocalories of heat being generated by the environment and the fire (400 + 180 = 580 kilocalories of heat gain per hour). Intersect readings to find the apparent temperature, what the temperature feels like. Treatment includes rest in a cool place with legs elevated and electrolyte drinks. Heat Stroke-Most persons experiencing heat stroke have sweat-soaked and pale skin, hyperthermia (body temperature above 104 degrees Fahrenheit), and central nervous system disturbances. The symptoms of heat stroke include disorientation, confusion, dizziness, irrational or unusual behavior, inappropriate comments, and loss of balance and muscle function. Heat stroke is a life-threatening medical emergency that requires immediate cooling of the whole body.
Sturek Prevalence of Antibodies to Selected Disease Agents in an Insular Population of Feral Swine D muscle relaxant vitamin buy cheap tizanidine 4 mg online. Ross Hinkle and Marc Epstein a 329 331 341 353 357 365 379 387 Papers presented at the 2004 Wild Pig Symposium in Augusta spasms around the heart tizanidine 4mg online, Georgia iv Wild Pigs Wild Pigs: Introduction John J muscle relaxant over the counter generic tizanidine 2mg on line. Droves of these animals also ravaged cultivated crops of maize and sugarcane on islands in the West Indies during this same time period muscle relaxant name brands cheap 2 mg tizanidine amex. These wild pigs reportedly were very aggressive and often attacked Spanish soldiers hunting rebellious Indians or escaped slaves on these islands muscle relaxant with painkiller discount 4mg tizanidine overnight delivery, especially when these animals were cornered muscle relaxant parkinsons disease tizanidine 4 mg lowest price. The documentation of such impacts by introduced populations of this species in the United States has subsequently increased in recent years, and continued up through the present (Towne and Wentworth. In spite of a fairly constant history in this country since the early 1900s, wild pigs have had a dramatic recent increase in both distribution and numbers in the United States. Between 1989 and 2009, the number of states reporting the presence of introduced wild pigs went from 19 up to as many as 44. This increase, in part natural, but largely manmade, has caused an increased workload and cost for land and resource managers in areas where these new populations are found. The cost of both these impacts and control efforts has been estimated to exceed a billion dollars annually (Pimentel 2007). The complexity of this problem has been further complicated by the widespread appeal and economic potential of these animals as a big game species (Tisdell 1982, Degner 1989). Wild pigs are a controversial problem that is not going away and will likely only get worse with time. They reproduce at a rate faster than any other mammal of comparable size, native or introduced; they can eat just about anything; and, they can live just about anywhere. On top of that, wild pigs are both very difficult to control and, with the possible exception of island ecosystems, almost impossible to eradicate (Dickson et al. The ultimate answer as to how to control these animals has not been found to date. All of which means that wild pigs are a veritable nightmare for land and resource managers trying to keep the numbers of these animals and the damage that they do under control. Since the more that one knows about an invasive species, the easier it is to deal with and hopefully control. For wild pigs then, it is better to "know thy enemy" than to not, especially if one expects to be able to successfully control them. In an effort to better "know thy enemy," a two-day symposium was held in Augusta, Georgia, on April 21-22, 2004. The goal of this symposium was to assemble researchers and land managers to first address various aspects of the biology and damage of wild pigs, and then review the control techniques and management of this invasive species. The result would then be a collected synopsis of what is known about wild pigs in the United States. Unfortunately, with all of that work, the ultimate answer to controlling wild pigs and their impacts still has not been found. This volume represents the collected synopsis that was the goal of the aforementioned symposium. Collectively, this report presents a detailed source of information on the biology, damage, control techniques and management case studies on wild pigs in the United States. April 27-29, Orlando, Florida, Livestock Conservation Institute, Madison, Wisconsin. Wild pigs in the United States: Their history, comparative morphology, and current status. Environmental and economic costs of vertebrate species invasions into the United States. In fact, the same is true for all species within the swine family, Suidae (Mayer et al. The only pig-like mammals native to the Nearctic and Neotropical zoogeographic realms are the peccaries (Family Tayassuidae) (Mayer and Brandt 1982, Sowls 1984, Mayer and Wetzel 1986, 1987). Excluding the polar regions, similar introductions of this species have also been made throughout other non-native areas. Such introductions date back at least as far as 3,000 years ago with the human colonization of Oceania (Allen et al. The Recent native distribution of the Eurasian wild boar extends from Western Europe to the Maritime Territory of eastern Siberia, extending southwards as far the Atlas Mountain region of North Africa, the northern Mediterranean Basin and the Middle East north of the Arabian Peninsula, through India, IndoChina, Japan (including the Ryukyu Islands), Taiwan and the Greater Sunda Islands of Southeast Asia. In addition, fossil and subfossil specimens of this species are known only from the Paleartic, Oriental, and Ethiopian realms (Mayer and Brisbin 1991). In the last four centuries, wild boar have become scarce or rare in parts of their range as a result of both habitat loss. During that period, this species was even completely extirpated in the British Isles, Denmark, Scandinavia, the Japanese island of Hokkaido, and parts of North Africa and the Russian Federation (Tisdell 1982, Oliver et al. Restocking efforts have been undertaken to restore depleted wild boar populations in a number of locations. Well-established populations of reintroduced wild boar now exist in the southern portions of both Sweden and England (Hansson and Fredga 1996, Goulding 2003, Lemel et al. The Eurasian wild boar is the single wild ancestor to most ancient and modern domestic swine breeds (Clutton-Brock 1981, Oliver et al. In addition, these analyses suggest a much earlier divergence from the wild ancestral forms than had been previously estimated. Further, a subsequent introgression of European and Asian domestic stocks occurred ~200 years ago. The global dispersal of this species has been a combination of both the spread of domestic stock as well as the translocation of wild boar. These wild boar, along with domestic swine that have either escaped or been released from captivity and become wild-living. Taxonomy the taxonomic hierarchy of the Eurasian wild boar is as follows: Domain: Eukaryota, Kingdom Animalia, Phylum Chordata, Subphylum Vertebrata, Class Mammalia, Subclass Theriformes, Infraclass Holotheria, Cohort Placentalia, Order Artiodactyla, Suborder Suina, Superfamily Suoidea, Family Suidae, and Subfamily Suinae. Based on both geographic and morphological criteria, Groves and Grubb (1993) have distinguished four "subspecies groupings" of Eurasian wild boar. These include the following: (1) "Western races" of Europe, and the Middle East, extending at least as far as Central Asia; (2) "Indian races" of the Sub-Himalayan region from Iran in the west to northern India in adjacent countries as far east as Burma and west Thailand, and southern India and Sri Lanka; (3) "Eastern races" of Mongolia and the Far East, Japan, Taiwan, to southeastern China and Viet Nam; and (4) "Indonesian races" from the Malay Peninsula, Sumatra, Java, Bali and certain offshore islands. The recently recognized geographic races of Eurasian wild boar have varied in number from 14 to 23 described subspecies (Martys 1991). These subspecies are largely based on morphological characteristics with a notable variation in size (Groves 1981, Mayer and Brisbin 1991, Kusatman 1992). Aside from 6 Wild Pigs names synonymized due to the rules of nomenclatural priority, both morphological and genetic analyses. This was followed by an initial dispersal into India, and then subsequent radiations into East Asia, with a final, progressive spread across Eurasia into Western Europe (Larson et al. This progression is consistent with the clinal morphological data, with wild boar increasing in size somewhat to the north, and more significantly decreasing to the west (Groves 1981, Mayer and Brisbin 1991, Kusatman 1992, Mayer et al. As the single wild ancestor of domestic swine, the Eurasian wild boar and its domesticated counterpart are considered to be conspecifics. Aside from the debate over the use of scientific nomenclature for domestic animals. History All wild pigs found in the United States belong to the species Sus scrofa. Basically, two types of Sus scrofa, Eurasian wild boar and domestic swine, were introduced into this country. Because these two types are conspecifics, wherever both of them were found together in the wild, interbreeding occurred. However, because this situation represents a very diverse hybrid complex, the distinguishing lines among these three general types are not always clear morphologically (Mayer and Brisbin 1993). Genetic analyses may be necessary to sort out the ancestry of a specific population of unknown origin. An additional taxonomic question concerning this species in the United States exists regarding the initial ancestry of the wild pig in Hawaii. However, it has also been suggested that the original stock brought to this Pacific island archipelago could have been a mixture of two Sus species, S. Whatever the initial taxonomic source, it is also likely that the more recent introductions, beginning with the one made by Capt. Cook in 1778, have altered or even completely swamped-out the early Polynesian stock that might have represented a hybrid ancestry (Baker 1975, Mayer and Brisbin 1991, Allen et al. Because such new introductions are ongoing on relatively a constant basis, and the vast majority are not reported, and in some cases, are clandestine in nature, it is would extremely difficult, if not virtually impossible, to attempt to develop a comprehensive history of what types of wild pigs were introduced where, when and by whom. Detailed accounts of the history of many of these introductions can be found in Mayer and Brisbin (1991). Additionally, the apparent presence of remains of swine in pre-Columbian Indian sites has led to at least one theory that S. In contrast to these theories, most paleozoologists attribute these specimens to the incorporation of recent material into older assemblages (Mayer and Brisbin 1991). These animals were carried there by the early Polynesian immigrants who first colonized these islands. Pigs were abundant on all of the islands within this archipelago at the time of the first European contact in the 18th Century. The first pigs to be brought to continental North America were of European origin. Such introductions were followed by similar actions by the French and English explorers and then colonists in the New World (Mayer and Brisbin 1991). Origin of Feral Hogs - Of the two types of Sus scrofa that were originally brought into the United States from the Old World, the initial introductions of domestic swine predated that of the first Eurasian wild boar by almost fifteen centuries. The pig, one of the favorite domesticated animals found in prehistoric Oceanic societies, was carried along on these early voyages during the settlement of east Polynesia. In addition to being an important food source, pigs also played a crucial cultural role in rituals, politics, and rites of passage throughout the region (Allen et al. As had been done elsewhere, the early Polynesian colonists in Hawaii released their domestic pigs to wander the forests surrounding the newly established settlements. These free-ranging stocks formed the initial basis of the feral hog populations found in this island group (Mayer and Brisbin 1991). The next important importation of domestic swine into the Western Hemisphere came with the second voyage of Christopher Columbus in 1493. In contrast to his first voyage, the fleet assembled for this second effort consisted of seventeen ships and 1,500 men and boys, including sailors, soldiers, colonists, priests, officials, gentlemen of the court, as well as a number of horses (Daegan and Cruxent 1993). To outfit such a large expedition, the "Grand Fleet" stopped at the Canary Islands to obtain provisions. Among the livestock acquired were eight "selected" domestic pigs that were taken onboard at the island of Gomera (Lewinsohn 1964, Donkin 1985). These animals and their offspring became the stock that populated the newly formed settlements and outposts on the islands of Cuba, Hispaniola and Jamaica (Towne and Wentworth 1950). In the absence of competing species, these pigs rapidly multiplied with enormous success in Hispaniola, and quickly became a pest (Crosby 1972, Sauer 1966). An official proclamation was even issued by the Spanish Crown in 1505 to reduce the numbers of wild pigs found in the West Indies at that time (Zadik 2005). In 1506, thirteen years after Columbus first introduced domestic swine to the West Indies, the Spanish colonists had to begin hunting the feral descendents of the eight original animals because the then present droves of wild pigs were killing cattle and ravaging cultivated crops of maize and sugarcane (Ensminger 1961, Donkin 1985). La Navidad was the doomed settlement of 39 Spanish sailors established by Columbus in 1492 after his flagship, the Santa Maria, was wrecked off the north coast of Haiti. Upon his return in November of 1493, Columbus found all of his men dead, the fort burned, and the supplies dispersed among the Indians over a distance of several kilometers. Columbus abandoned the area, and left to establish La Isabela 113 kilometers to the east. Stable isotopic analysis of that individual pig tooth indicates that the animal was most likely raised in the area around Seville in Spain (Daegan 1992, Daegan and Cruxent 1993). If accurate, and assuming that this animal was not a recent transplant from Spain to the Canary Islands, this would appear to be counter to the largely accepted source of the first domestic pigs being brought by Columbus from Gomera to the West Indies on his second voyage. When the Spanish explorers provisioned expeditions headed to the North American mainland, they captured some of these free-ranging pigs on the Caribbean islands to take with them (Mayer and Brisbin 1991). In other instances, pen-raised domestic pigs were acquired from the Spanish colonists on some of 8 Wild Pigs these islands. For example, long-legged Spanish herding pigs were bartered from Cuban plantation owners for some of these expeditions (Clayton et al. It was from these ambulatory stocks of swine used by these initial expeditions that the first welldocumented feral populations of wild pigs originated in the continental United States (Mayer and Brisbin 1991). The paucity of information about this failed expedition does not include any information as to whether or not the Spaniards had time to unload the livestock after landing in the Port Charlotte area of the west coast of Florida (Davis 1935, Mayer and Brisbin 1991). The expedition of Hernando de Soto is attributed as the first documented source that introduced pigs into the continental United States. Based on his travels on the mainland (1528-1536), Cabeza de Vaca had reported a northern sea to De Soto. The latter thought it was the Pacific Ocean, the sea which Balboa had discovered earlier in Panama while accompanied by a younger De Soto. The number typically cited is thirteen sows, which was stated by "A Gentleman of Elvas," the anonymous chronicler of the expedition.
