Pay for Performance Update
1970-01-01 00:59:59
The New York Times recently published an article on the Medicare's plan to provide healthcare professionals the ability to qualify for a 1.5 percent bonus in the second half of 2007 if they report data on the quality of their care, using measures specified by the government.The American Physical Therapy Association released a statement in the PT Bulletin regarding the eligibility of physical therapists to participate in this program. The APTA is currently working to define what quality measures PTs would be eligible to report or how those measures will be developed. Save This Page
Read more: Performance
, Update
OrthoSportsRehab Year in Review
1970-01-01 00:59:59
With the end of 2006 quickly approaching, it only seems appropriate to summarize the year for the OrthoSportsRehab team. (Not quite a top ten list, but it will do.)So Dave, Heather, and Brian decided to create the blog sometime in March as a way to share information between physical therapists, and discuss topics related to the field of orthopaedics and sports medicine. Once we came up with a name, the blog was born and our first post was in April of this year. Since that initial posting, there has been over 100 posts ranging on any number of topics from the world of sports medicine and physical therapy. My recap of a few of the more interesting posts from 2006 (in case you missed them):A review on the treatment of hamstring injuriesQuick summary of soreness rulesRib stress fractures in rowersA patellofemoral classification systemThe complicated ankle sprainEvidence for manual physical therapy for hip osteoarthritisLumbar disc injuriesACL injury rates in the NFLThe number of page vi
Video Gamer's Thumb
1970-01-01 00:59:59
THIS HOLIDAY SEASON, PHYSICAL THERAPISTS ADVISE PARENTS TO BE AWARE OF INJURIES CAUSED BY OVERUSE OF VIDEO GAMES APTA Offers Free Downloadable Tips as Useful Stocking Stuffers ALEXANDRIA, VA, December 19, 2006 — Children who receive the must-have gifts of the holiday season, Sony's™ PlayStation 3 or Microsoft's™ XBox 360, may get something that they didn't wish for -- sore thumbs and hands -- says the American Physical Therapy Association (APTA). "Video Gamer
's Thumb
" is a very real condition that can have long-term effects on children's hands and upper arms if they don't take proper precautions, says Cindy Miles, PT, MEd, PCS, owner of a pediatrics physical therapy private practice in Whitehall, PA. Continued stress on tendons, nerves, and ligaments in children's hands and arms can lead to long-term consequences such as tendinitis, bursitis, and carpel tunnel syndrome, explains Miles. "Video Gamer's Thumb" refers to a repetitive stress injury (RSI) that
Happy 2007 (and a few links)
1970-01-01 00:59:59
Happy New Year! Just a few medical/health related news links
I recently looked at which may be of interest to you.At NPR.org, there is an audio clip on a story indicating a higher risk of hip fractures in individuals on proton-pump inhibitors. These medications, which include Nexium, Prevacid, and Prilosec, may cause a decrease in bone loss in patients over the age of 50. The higher the dosage, the higher the risk of hip fractures. The study was published in December issue of the Journal of the American Medical Association. You can also read about this at CNN.com.From BBC news, there is a story linking a Thursday admission into the hospital as the worst day to be admitted. There is reduced service on weekends, and often delays in patients receiving treatment and diagnostic test. Patients were found to stay in the hospital an extra day longer compared to those admitted on a Sunday.One final article from CNN.com discusses the dangers of overtraining/exercising too much. It report
Read more: Happy
Epidemiological Study of Sports Related Ankle Injuries
1970-01-01 00:59:59
In this month's publication of Sports
Medicine, Fong et al. examine the epidemiology of sports related ankle injuries using data spanning the past 28 years. The authors report that sports related ankle injuries, specifically ankle sprains, are typically the most common ankle injuries in a variety of sports included for study by the authors. In addition, the ankle was the most commonly injured body part in approximately 34% of all sports identified by the authors. The authors also report that the incidence of ankle injuries is high in team sports such as soccer, rugby and basketball.Epidemiology information such as this may be used in the prevention of ankle injuries that occur in athletes, with focus on those involved in sports that have higher incidence of ankle injury.Fong DT, Hong Y, Chan LK, Yung PS, Chan KM.A systematic review on ankle injury and ankle sprain in sports.Sports Med. 2007;37(1):73-94.PMID: 17190537 [PubMed - in process] Save This Page
Read more: Study
, Ankle
, Injuries
Vitamin Deficiency Linked to Poor Athletic Performance
1970-01-01 00:59:59
A recent study from Oregon State University has demonstrated that poor athletic performance may be linked to a deficiency of B-vitamins.Active individuals lacking in B-vitamins - including college athletes and other elite competitors -- may perform worse during high-intensity exercise and have a decreased ability to repair and build muscle than counterparts with nutrient-rich diets, according to recent Oregon State University research published in the International Journal of Sport Nutrition and Exercise Metabolism.The B-vitamins include thiamin, riboflavin, vitamin B-6, B-12 and folate. These micronutrients are necessary during the body's process for converting proteins and sugars into energy, and are used during the production and repair of cells, including red blood cells.Read the rest of this press release here.Article abstract here. Save This Page
Read more: Vitamin
, Deficiency
, Performance
Healthcare for Everyone?!
1970-01-01 00:59:59
Governor Arnold Schwartzenegger announced a plan early this week that would provide healthcare for all of California's residents, which, if enacted, would make California the largest state to provide such comprehensive medical benefits. An article that appeared in the New York Times yesterday outlined some of the details of this plan which include:coverage for approximately 6.5 million persons including adults and children coverage for illegal immigrants, currently ineligable for federal coveragecosts for the plan estmated to be 12 billion dollarsfunds for the plan to come from a variety of sources including employers, physicians and hospitalsCurrently, only three states, Massachusetts, Maine and Vermont, offer universal healthcare to their residents. Save This Page
Read more: Healthcare
Clinical Question for Achilles Tendon Rupture
1970-01-01 00:59:59
I received a very interesting email today, and the author is hoping to get some insight into their clinical question from the readers of this blog. Feel free to post your thoughts and comments and participate in the discussion.Here is the text:I am looking on information concerning surgery/rehabilitation of neglected Achilles
tendon rupture (pretty much painless and nontraumatic, so far as I can judge) in a 68 year old. Mostly I need help with the following paradox:1. This must be a frequent injury as old people exercise more. 20 percent of all Achilles ruptures are missed on first contact with a doctor and the window of immediate repair is only six weeks or so.2. There appears to be a definitive repair, involving peeling down a portion of the gastrocnemius. First publication 1975. 3. None of the fancy people I have talked to admit to having done many of these. Who every you talk to, you get the impression that it is a surgery done somewhere else.4. I have been prescribed a bra
Read more: Question
Achilles Tendon Ruptures in the Elderly
1970-01-01 00:59:59
After following up Brian's posted question with a comment response (see posted comment in "Clinical Question for Achilles
Tendon Rupture"), I did a little extra digging and found a research article published by Wong et al. in 2005 that discusses the use of Flexor Hallucis Longus tendon transfers to repair Achilles tendon ruptures in the elderly. The article demonstrates good functional outcomes including decreased pain, increased strength and improved ambulation for this surgical technique, but only examines five patient cases.Wong MW, Ng VW.Modified flexor hallucis longus transfer for Achilles insertional rupture in elderly patients.Clin Orthop Relat Res. 2005 Feb;(431):201-6. Save This Page
Rest Versus Exercise
1970-01-01 00:59:59
Dealing with injured athletes brings the inevitable question...Should I rest or can I exercise? The NY Times featured an article this week (available for 7 days) on this very topic. (I am not sure why this article is posted in the Fashion and Style section of the Times.)From the orthopaedic surgeons consulted in the article, the consensus seems to be that exercise in moderation may be beneficial. Whether it is cutting back on distance, intensity, or adding cross-training, the "injured tissue may heal better if it's under some sort of stress."The article also reports on tendonitis research coming out of the University of Pittsburgh, which recommends small repeated stretching of inflamed tendons may lead to the production of molecules that heal inflammation, suggesting moderate exercise can actually speed healing.When It's O.K. to Run HurtBy Gina KolataNY Times1/11/2007 Save This Page
Read more: Exercise
A meta-analysis on ACL prevention programs
1970-01-01 00:59:59
The aim of this study was to determine the numbers needed to treat (NNT) and relative risk reduction (RRR) of neuromuscular training programs for the prevention
of noncontact ACL injuries in female athletes.Five studies met the inclusion criteria and were independently rated from 4 to 7 (avg: 4.8) out of 10 using the PEDro scale. Using the pooled NNT estimates, 89 athletes (95% CCI: 66-136) would need to participate in the prophylactic training program to prevent 1 ACL injury over the course of 1 competitive season. The pooled RRR was 70% (95% CCI: 54-80%) among athletes who participated in the training program.The five articles used in this study: Hewett et al. The results of this study were later developed into the Sportsmetrics program. Mandelbaum et al. This is the PEP (Prevent Injury, Enhance Program) program out of Santa Monica, CA. The other three articles were produced in Europe using female handball players. Myklebust et al. and Olsen et al. were conducted at the Oslo S
Link of the Week
1970-01-01 00:59:59
Another journal offering free content for those interested in orthopaedic manual physical therapy. The Journal of Manual and Manipulative Therapy has free access to several articles in the current January 2007 issue. The articles focus on primarily on myofascial pain and myofascial trigger points. (Saw this post on the MyPhysicalTherapySpace message board.) Save This Page
Concussion, Brain Damage, and Suicide?
1970-01-01 00:59:59
The suicide of Andre Walters, former NFL player and Philadelphia Eagles star, may have been caused by brain damage he sustained during his professional football career. An article published in the NY Times reports that new autopsy findings suggest that post traumatic brain damage caused by multiple concussions, may have led to Mr. Walter's depression and suicide.A neuropathologist and forensic expert at the University of Pittsburgh, Dr. Bennet Omalu, found extensive degenerative changes of Mr. Walters brain that he believes were caused by repeated concussions. These findings are similar to the degenerative tissues changes seen in two other retired professional football players who had suffered from cognative and depressive symptoms, Mike Webster and Terry Long, both of whom were also examined by Dr. Omalu post mortem.The article goes on to report that a study to be published later this year, from the Center for the Study of Retired Athletes, found that those athletes sustaining thr
Read more: Brain
, Damage
, Suicide
, Brain Damage
Web content to guide medical decisions
1970-01-01 00:59:59
I recently came across a webcast video editoral on online content for physicians for point-of-care to guide decisions at Medscape. What struck me first was the use of video to augment the text. At first, it was refreshing to see video providing content, however, it was apparent that it was the same content as the video.While searching Medscape, they also provide continuing education units. This was an integration of video with a Powerpoint presentation on evidence-based exercise medicine. However, the video didn't provide any additional content that audio could have provide. It was three professors speaking (like a news cast), along with the presentation. Audio would have been more than adequate to augment the presentation. Video would be helpful if there was something physical to show.As the web continues to expand and more content is provide online, healthcare providers, consumers, and third-party stakeholders will be able to readily access this information. Being able to p
Read more: medical
, Web content
Evaluation and Treatment of AC Joint Injuries
1970-01-01 00:59:59
The February 2007 issue of the American Journal of Sports Medicine features a great review article on the evaluation and treatment of AC joint injuries. It covers anatomy, injury classification, diagnosis/examination, and treatment of the 6 types of AC joint injuries. The authors also describe the various surgical techniques utilized for these injuries. Great reference. Evaluation
and Treatment
of Acromioclavicular Joint
Injuries
Mazzocca AD, Arciero RA, & Bicos JThe American Journal of Sports Medicine 35:316-329 (2007) Save This Page
Health Care Workers Job Forecast
1970-01-01 00:59:59
Just saw this post on the Yahoo Finance section and thought some of you may be interested on the current job satisfaction trends of your health care colleagues. According to a recent internet survey (methodology?), 57 percent of health-care employees report that better pay and/or career advancement opportunities are the main factors that would drive them to leave their current place of employment.Health
-Care Workers
Eye Better PayWednesday January 24, 4:10 pm ET Save This Page
Read more: Forecast
, Health Care
OrthoSports Net
1970-01-01 00:59:59
As Internet technology continues to "creep" into healthcare, and orthopaedic and sports medicine in general, COSMR is striving to provide the most up-to-date information to providers. We have added a new service to the right side of the blog page called OrthoSports Net . This site brings in news feeds from several different sports medicine and orthopaedic sites, blogs, and journals. Save This Page
Site of hamstring injury predicts return to performance time
1970-01-01 00:59:59
Hamstring injuries are a common injury in sports, especially during sprinting. A recent study investigated the anatomical location and extent of the injury to predict the prognosis for return to high-level performance.Eighteen elite sprinters with acute first-time hamstring injuries were examined, clinically and with MRI. All injuries occurred in the long head of the biceps femoris muscle. The results showed that injury to the proximal tendon, and closeness to the ischial tuberosity, were associated with longer time to return to pre-injury level.The authors suggest that accurate palpation during the first 3 weeks and MRI during the first 6 weeks post injury can provide valuable information regarding the prognosis for return to high-level performance.Personally, I have incurred several hamstring strains playing competitive and recreational sports. I have injuried my distal bicep femoris tendon, muscle belly of the semitendinous, and most recently the proximal tendon just off the isc
Hand-Washing Poison?
1970-01-01 00:59:59
Sorry for the lack of posts recently. The entire blogging staff at COSMR are all currently entrenched in schoolwork, furthering their education in and out of the physical therapy world. It is getting tough to try to add some new content when there are chapters to read and papers to write.Anyhow, I am linking an article from CNN.com on those hand sanitizers that seem to be more prevalent than toilet paper at our facility. Here is proof that one can truly abuse their hand-washing compliance. Enjoy.U.S. doctors warn of poisoning from hand gelscnn.com Save This Page
Read more: Poison
Looking for a Physical Therapist...
1970-01-01 00:59:59
Can anyone assist with this request? Please post in the Comments section."I recently suffered a bilateral calcaneal fracture during a ski accident in Breckenridge, CO. I live in Northern VA but chose to stay in Denver and have my surgery which was performed by Dr. John Schwappach at Swedish Medical Center. I have a titanium plate and 7 screws in each foot and am currently waiting for my wounds to seal. I am trying to find out about/get a reference to a physical therapist with great facilities that treats mostly professional/collegiate athletes in my area.I appreciate any assistance or suggestions that you might be able to provide." Save This Page
Read more: Therapist
The Sports Hernia Part 1
1970-01-01 00:59:59
Last week I attended a presentation at one of the local hospitals here in Philadelphia on the topic of sports hernias. The standard format for the meeting is a review of selected articles on a particular topic in sports medicine, followed by a 'lively' discussion. This is often well attended by physicians, physical therapists, athletic trainers, etc. At this meeting, three guest speakers were invited to present their current research in the area of the sports hernia. The speakers included Dr. Alan Schuricht, Dr. William Meyers, and Dr. Adam Zoga. The first two have previously published on this topic (see below), while Dr. Adam Zoga from Jefferson University Hospital presented his unpublished research on the use of MRI to diagnose sports hernia.I will try to post my summary of the evening later this weekend, but in the meantime I have attached links to the articles discussed.Groin Pain in AthletesMacintyre J, Johnson C, Schroeder ELCurrent Sports
Medicine Reports 2006, 5:293-29
Read more: Hernia
Female Lacrosse Players At Higher Risk Than Males for Head, Face, and Eye Injuries
1970-01-01 00:59:59
Released: 2/1/2007 Study supports use of protective eyewear for female players in high school, college Rosemont, Ill. - February 1, 2007 - Despite playing a game with less physical contact, female lacrosse players in high school and college sustain a higher rate of injuries to the head, face, and eye than their male counterparts, according to a study published in the February issue of The American Journal of Sports Medicine."Although high school injury rates are lower than those of college, the nature of the injuries, body parts affected, and mechanisms of injury are similar," writes Andrew E. Lincoln, ScD. MS, of the Medstar Research Institute, Hyattsville, Md., and coauthors. "Female
players sustained more head, face, and eye (HFE) injuries partly because of a lack of protective equipment. Before 2005, protective eyewear was not required for females at any level of play. Our findings offer support to US Lacrosse
's (2005) mandate of protective eyewear for all
Read more: Players
, Higher
, Males
, Injuries
STUDY LINKS SOCIAL CLASS AND PHYSICAL INACTIVITY
1970-01-01 00:59:59
FOR IMMEDIATE RELEASEJanuary 16, 2007Indianapolis - Education, family income, employment status, and other factors related to social class tend to moderate the effect of race/ethnicity on physical inactivity, according to new research published in this month's issue of Medicine & Science in Sports & Exercise®, the official journal of the American College of Sports Medicine (ACSM). While research is just beginning to look at how social class affects leisure-time rates of physical activity in various ethnic and racial groups, previous studies have shown cultural trends such as blacks and Hispanics being more inactive during their leisure time than whites. The study also indicates education level—particularly for women—is related to physical inactivity. And, physical demands of one's occupation play a lesser role than previously thought in leisure-time inactivity levels, after adjusting for age and social status. "This is the first study to look at the effe
Read more: INACTIVITY
, STUDY LINKS
Female Athletes Cut Risk Of Stress Fractures with Calcium and Vit. D
1970-01-01 00:59:59
Saw this news brief in the Washington Post:Calcium
, Vitamin D May Cut FracturesVery active young women who took higher-than-recommended doses of calcium and Vitamin D supplements for eight weeks had fewer stress fractures than women who were given a placebo, a study of Navy recruits showed. Experts called the results encouraging and of interest to young female athletes as well as women in the military."What really surprised us is that calcium-Vitamin D supplements made a significant difference in such a short period of time," said lead researcher Joan Lappe of Creighton University.The Creighton University study found that women who took 2,000 milligrams of calcium and 800 international units of Vitamin D daily had 27 percent fewer stress fractures than those who did not. Save This Page
Read more: Female
The Sports Hernia Part 2
1970-01-01 00:59:59
In a previous post I mentioned that I had been to a presentation on the topic of sports hernias, which featured three guest speakers who presented current research/information on the topic. The speakers included Dr. Alan Schuricht, Dr. William Meyers, and Dr. Adam Zoga. The first two have previously published on the sports hernia (see reference articles below), while Dr. Adam Zoga from Jefferson University Hospital presented his unpublished research on the use of MRI to diagnose sports hernia. Here is my summary of the event...So what exactly is a sports hernia? From my understanding, each speaker seemed to have a slightly different opinion on what specifically a sports hernia is, but it seems to be more of a 'catch-all' term to describe any pain localized to the lower abdominal region (ie. athletic pubalgia). Pain is located in the lower abdominal or inguinal region (localized to the rectus abdominus and adductor longus insertion on the pubic symphysis), often with exertion whi
Read more: Sports
, Hernia
EXERCISE AND FLUID REPLACEMENT POSITION STAND NOW AVAILABLE
1970-01-01 00:59:59
For immediate releaseFebruary 8, 2007American College of Sports Medicine releases new, revised hydration recommendationsINDIANAPOLIS - The American College of Sports Medicine (ACSM) today released an updated Position Stand, "Exercise and Fluid Replacement", placing emphasis on customized or individualized hydration regimens and offering details on hydration before, during, and after exercise. The official ACSM pronouncement is published in the February 2007 issue of Medicine & Science in Sports & Exercise®, the official journal of the American College of Sports Medicine. The new guidelines represent a summary of research and knowledge of fluid replacement (fluid-electrolyte needs) and the impact of fluid replacement on exercise performance and health. New to this version, a Strength of Recommendation Taxonomy (SORT) is included to document the strength of evidence for each conclusion and recommendation. "Exercise and Fluid Replacement" replaces the prior stat
Physical Therapy Job Outlook=Good?
1970-01-01 00:59:59
While I was unable to attend this year's Combined Sections Meeting of the APTA in Boston, one of the few topics my colleagues have discussed upon their return was the career outlook for the field of physical therapy. Fortunately, the outlook for job growth of physical therapists ranks in the top 5 of 50 according to CNNmoney.com. Given that I graduated from physical therapy school in 1999, where there were no jobs to be had (who do I blame for this...the APTA, medicare, etc), this is a welcome change for the profession.However, upon looking at the salaries for the top 50 best jobs in America, where do you think physical therapists rank? It turns out that the average pay for physical therapists is $54,883, placing our profession in the bottom 5 of CNNmoney.com's list.How is our profession going to maintain and recruit high quality individuals when the compensation may not be sufficient for some. While this seems disturbing, I guess it is better to be on their list than not recogni
Read more: Therapy
, Outlook
More Evidence Against the Hormone Theory in Women's Sports Injuries
1970-01-01 00:59:59
Women's Sports
Injuries
: It's Not Just The HormonesFrom ScienceDaily.comThe long-held belief that women have more sports injuries than men because of the difference in hormones is just not true. Hormones certainly play a role according to orthopaedic surgeon Kimberly J. Templeton, MD, spokesperson for the American Academy of Orthopaedic Surgeons and Associate Professor with the University of Kansas Medical Center, Department of Orthopedics. "There is definitely input from the hormones but there are other musculoskeletal differences between men and women."Dr. Templeton points out how men land differently than women after taking that basketball shot. "Men flex their hips and knees when they land. Women tend to land with their hips and knees straight -- causing increased tension on the ACL. That's one of the reasons why women have more ACL ("anterior cruciate ligament') injuries than do men." Templeton points out that these types of injuries can be "career enders" to young female athl
Read more: Evidence
, Theory
, Women
CSM 2007 Update
1970-01-01 00:59:59
The American Physical Therapy Association (APTA) recently held the 2007 Combined Sections Meeting (CSM) in Boston from Feb 14-17, 2007. It was very well attended by students and professionals from all over the country, despite the snowy and icy weather. Here are a few highlights from presentations I attended.Use of the International Classification of Functioning (ICF) to Develop Evidence-Based Treatment Guidelines for Common Musculoskeletal ConditionsThis was presented by Joe Godges, Jay Irrgang, Douglas White, and John Childs. They discussed the project methodology of the ICF, as well as, current and investigative guidelines for several musculoskeletal conditions. I am looking forward to more of these and the increased transparency of therapists who do or don't subscribe to these changes.Sports Section - Excellence in Research (The Effectiveness of a Balance Training Intervention in Reducing the Incidence of Non-Contact Ankle Sprains in High School Football Players) by Tim TylerT
Read more: Update
AJSM Top 50 List
1970-01-01 00:59:59
I just saw a new feature up on the American Journal of Sports Medicine website this evening while looking for an article. Their site now features the 50 Most-Frequently Read Articles and the 50 Most-Frequently Cited Articles for the previous month. I have listed here the top 3 in each category. Thought it was interesting to see what articles topped their lists...The 50 Most-Frequently Read Articles1. Kyle Anderson, Sabrina M. Strickland, Russell Warren Hip and Groin Injuries in Athletes Am J Sports Med Jul 01, 2001; 29: 521-533.2. Michael Bahk, Ekavit Keyurapan, Atsushi Tasaki, Eric L. Sauers, Edward G. McFarland Laxity Testing of the Shoulder: A Review Am J Sports Med Jan 01, 2007; 35: 131-144. 3. Håkan Alfredson, Tom Pietilä, Per Jonsson, Ronny Lorentzon Heavy-Load Eccentric Calf Muscle Training For the Treatment of Chronic Achilles Tendinosis Am J Sports Med May 01, 1998; 26: 360-366.The 50 Most-Frequently Cited Articles 1
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