BackgroundEvidence regarding Blood Flow Restriction (BFR) training for the management of lateral epicondylitis (LE) remains limited and conflicting, although BFR has shown potential to improve muscle strength in other musculoskeletal rehabilitation settings.ObjectiveTo investigate the short-term effects of adding low-load BFR training to a conventional physiotherapy (CPT) program on handgrip strength (HGS), function, and pain intensity during rest and activity, in patients with LE.DesignA single-blind, randomized clinical trial.MethodsFifty-two participants with LE were randomly allocated to either the CPT group or the CPT + BFR group. Both groups received 12 sessions over 6 weeks. The primary outcome was HGS using a hand-held dynamometer. Secondary outcomes were Patient-Rated Tennis Elbow Evaluation (PRTEE) scores, Numerical Pain Rating Scale (NPRS) scores, and satisfaction with treatments. These outcome measures were reassessed at the end of the six-week intervention period.ResultsBoth groups demonstrated statistically significant within-group improvements in HGS, PRTEE, and NPRS outcomes (all p < 0.001). Mean HGS increased by 17.50 ± 2.53 lb in the CPT group and by 35.54 ± 0.71 lb in the CPT + BFR group. The post-treatment HGS difference strongly favoured CPT + BFR (Mann-Whitney U = 30.0, p < 0.001; rank-biserial correlation r_rb = 0.911, 95% CI 0.800 to 0.984). PRTEE also favoured CPT + BFR, whereas no statistically significant between-group differences were observed for NPRS pain scores or treatment satisfaction.ConclusionIn patients with LE, addition of low-load BFR training to CPT resulted in greater short-term improvements in HGS and function, while pain reduction was comparable between groups.

BackgroundDespite widespread digital device use, the relationships of Fear of Missing Out (FoMO) with postural awareness and neck disability remain poorly understood.ObjectiveThis study examined the associations among FoMO, postural awareness, and neck disability, testing whether an indirect association existed through the need for attention regulation in posture.MethodA cross-sectional study included 1634 young adult social media users aged 18-25 years. Data were collected using the Fear of Missing Out Scale (FoMO), the Postural Awareness Scale (PAS) (sub-dimensions: Need for Attention Regulation with Postural Awareness-NARPA and Ease/Familiarity with Postural Awareness-EFPA), and the Neck Disability Index (NDI). Pain intensity and psychological distress were recorded as covariates. Data were analyzed using hierarchical regression and Hayes' PROCESS Macro.ResultsHierarchical regression analysis showed that FoMO was independently associated with neck disability, accounting for an additional 5.8% of the variance (ΔR2= .058, p < .001), even after controlling for pain intensity and psychological distress. While NARPA was a significant predictor of NDI (β = -.107, p < .001), EFPA was not (β = .012, p > .05). Mediation analysis indicated a statistically significant indirect effect of FoMO on NDI through NARPA (Indirect effect = .0098; 95% CI [.0053, .0150]).ConclusionsHigher FoMO was independently associated with greater neck disability, with a significant indirect association through NARPA. Findings suggest that a greater need for conscious cognitive effort in posture may link FoMO to neck disability among young adult social media users. Longitudinal studies are needed to establish temporal causality.

BackgroundPregnancy induces physiological and biomechanical changes that may affect connective tissue properties. Given the functional relationship between the plantar fascia (PF) and Achilles tendon (AT), these tissues may exhibit trimester-specific changes.ObjectiveThis study aimed to investigate the biomechanical and viscoelastic properties of PF and AT in pregnant women at different trimesters.MethodsThis cross-sectional study included primigravida women aged 18-40 years with a pre-pregnancy BMI <30 kg/m2. Participants were grouped by trimester (G1: n = 64; G2: n = 52; G3: n = 55). Biomechanical and viscoelastic properties of PF and AT were assessed using myotonometry, and navicular drop was measured bilaterally.ResultsPF elasticity and navicular drop increased significantly in both feet in parallel with the progression of pregnancy (p ≤ 0.05). In contrast, Achilles tendon tissue properties showed no significant differences between the three trimesters (p > 0.05).ConclusionsIncreased PF elasticity accompanied by reduced medial longitudinal arch stability may increase plantar fascia strain under load, potentially predisposing pregnant women to microtrauma and foot-related pathologies such as plantar fasciitis and persistent foot pain. Monitoring navicular drop and PF tissue properties throughout pregnancy may facilitate early identification of individuals at risk.

IntroductionLow back pain (LBP) is a common and significant occupational health problem affecting nurses.MethodsA stratified sampling method was employed to select 2,012 healthcare workers from four hospitals in China between September 2022 and September 2023. To investigate the current status of and factors influencing low back pain (LBP) in nurses. Individuals were assessed using the General Information Questionnaire, Oswestry Disability Index (ODI) to assess LBP, and Leuven Knowledge Questionnaire (LKQ) to evaluate LBP-related knowledge. The occurrence of LBP in the previous year was recorded, and multivariate logistic regression analysis was conducted to screen for factors influencing the occurrence of LBP in healthcare workers.ResultsAmong the 2012 nurses surveyed, 1267 had experienced LBP in the past year, with a prevalence rate of 62.97%. Multivariate logistic regression analysis revealed that sex, higher BMI, working in an inpatient department, longer years of service, longer weekly working hours, higher frequency of night shifts, non-standard work posture, lack of participation in LBP training, and lower LKQ scores were significant factors associated with an increased risk of LBP (P<0.05).ConclusionNurses suffer from a high prevalence of LBP, which is related to sex, BMI, working department, years of service, weekly working hours, frequency of night shifts, work posture, participation in training on LBP, and LKQ scores. Therefore, enhanced monitoring is crucial.

If I could do it again, I would-without hesitation. A life in surgery has never been only about perfection, but about purpose. Hippocrates' words remind us that success is not measured only in cures, but in the many ways we sustain life: Relieving pain, restoring dignity, listening, encouraging, and offering comfort when a cure is no longer possible. Looking back, I cannot say I have any regrets, but a landscape of victories both great and small-some measured in decades of survival, others in a hug or a single grateful smile. Now, at this stage of reflection, what remains with me is not the sting of what might have been, but the richness of what I have so thoroughly enjoyed. The victories of surgery are not confined to the textbook definition of "success." They are found in the quiet resilience of a patient whose pain was eased with a return to health, the relief in a family's eyes seeing their loved one return home, and the knowledge that I gave all I had, each time I entered the operating room. If I could live this career once more, I would-because it was worth it.

Paragangliomas are rare neuroendocrine tumors, with spinal involvement representing a small minority of cases. Lumbar spinal paragangliomas are especially uncommon and may present with nonspecific symptoms, often mimicking more common intradural tumors. We describe a 49-year-old female who presented with chronic low back and sacral pain, along with bilateral lower extremity symptoms. Lumbar MRI demonstrated an intrathecal, homogeneously enhancing mass at L3 causing canal stenosis. The patient underwent lumbar laminectomy with gross total resection of an intradural, extramedullary lesion. Histopathology confirmed a paraganglioma, with immunohistochemical positivity for chromogranin A, synaptophysin, and S100. Postoperatively, she reported substantial relief of pain and radiculopathy, with no neurological deficits. Surveillance MRI at seven weeks and 4.5 months showed no residual or recurrent tumor. Although rare, lumbar paragangliomas should be considered in the differential diagnosis of intradural, extramedullary masses. Gross total surgical resection offers effective symptom relief and favorable short-term outcomes. Given the potential for delayed recurrence, we recommend close postoperative surveillance with MRI every three to six months during the initial follow-up period.

Chronic low back pain (CLBP) presents a major challenge in pain management, often persisting despite standard therapies. Peripheral nerve field stimulation (PNFS), also known as subcutaneous stimulation, offers a minimally invasive neuromodulation approach that may improve outcomes for these patients. This systematic review evaluates the evidence on PNFS, alone or combined with spinal cord stimulation (SCS), for CLBP, focusing on pain relief, functional outcomes, and safety. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases including Cochrane, Embase, MEDLINE (PubMed), and the Université Laval Library were searched for studies from January 2014 to April 2025. Nineteen studies (randomized controlled trials, cohort studies, and case series) were included. Outcomes assessed included pain intensity, disability (Oswestry Disability Index), quality of life (36-Item Short Form Health Survey, EuroQol 5-Dimension), and adverse events. Across study-level estimates, PNFS monotherapy most commonly produced approximately 40% to 60% reductions in pain intensity, although reported effects varied across studies and were not pooled because of heterogeneity. Functional gains included reduced disability and improved mobility. Quality of life measures and medication use often improved. Peripheral nerve field stimulation combined with SCS yielded mixed results, providing benefits particularly for patients unresponsive to SCS alone. Reported complication rates were generally modest, with infections and lead migrations being the most common. Peripheral nerve field stimulation appears to be a promising and generally well-tolerated option for selected patients with CLBP, although evidence certainty remains limited, and larger controlled studies are needed.

Chronic low back pain secondary to intervertebral disc degeneration (IVDD) is the leading cause of disability across all musculoskeletal disorders worldwide. For decades, gut-disc crosstalk research has been framed almost exclusively by a systemic inflammatory paradigm, in which circulating pro-inflammatory cytokines (e.g., TNF-α, IL-1β) act as obligate mediators linking gut microbial dysbiosis to intervertebral disc degeneration. However, multi-cohort two-sample Mendelian randomization (MR) analyses have not identified significant mediation by the circulating inflammatory factors tested to date, exposing a gap in current mechanistic frameworks. A null indirect effect indicates that the measured mediators did not statistically explain the exposure-outcome association; it does not exclude a contribution from untested systemic pathways. Two core protective commensal taxa, Akkermansia muciniphila (Akk) and Eubacterium coprostanoligenes, have been genetically validated to reduce IVDD risk, yet their beneficial effects cannot be explained by systemic immune activation. Focusing on mucosal immunology and tissue-localized immune homeostasis, this review integrates human genetic data, in vitro nucleus pulposus experiments, in vivo bacterial extracellular vesicle (EV) evidence, and clinical endplate microbiome profiles to delineate three candidate gut mucosa-derived immune regulatory axes that are not explained by the circulating cytokines measured to date: (1) microbe-derived soluble metabolites-which are themselves circulating mediators-reshape local disc metabolic and immune responses via epigenetic modulation and receptor signaling; (2) EVs secreted by A. muciniphila act as cross-barrier immune messengers targeting the avascular disc tissue; (3) gut bacterial fragments translocate across damaged endplate barriers to trigger site-specific immune remodeling without elevating systemic inflammatory markers. This three-pathway framework offers one possible reconciliation of the null mediation findings from MR studies with the collapse of intrinsic disc immune privilege. Each proposed axis remains incompletely validated, and the available evidence does not establish that they operate independently of untested systemic immune pathways. We further summarize methodological limitations of gut-spine microbiome research and outline mucosa-targeted microbial immunotherapies for chronic low back pain. Collectively, this framework helps shift the field away from over-reliance on systemic inflammation as the sole mechanistic explanation for IVDD pathogenesis.