Owner: Concepts in Orthopaedic and Sports Medicine Rehab URL:http://orthosportsrehab.blogspot.com Join Date: Mon, 14 Aug 2006 13:30:49 -0500 Rating:1 Site Description: Forum for evidence-based medicine in orthopaedic and sports medicine rehab. Created and maintained by physical therapists to improve knowledge and communication in the field of orthopaedics and sports physical therapy. Site statistics:Click here
Ulnar Collateral Ligamant Reconstruction of the Elbow in Throwers 2007-03-03 14:19:00 A recent article featured in the American Journal of Sports Medicine looked at the results of a modified technique to reconstruct the Ulnar Collateral
Ligament of the elbow in throwers. The study looked at 100 throwers who underwent a docking technique for reconstruction of the medical elbow ligament, with a mean follow-up of 36 months.Traditionally, athletes have undergone the Tommy John surgery or Jobe surgery, in which a tendon from the individual's forearm is grafted into the elbow. This docking technique, was modified from the Jobe procedure where a muscle-splitting approach is used through the posterior one third of the common flexor pronator mass. The muscles are not detached and thus the ulnar nerve is untouched, minimizing the risk for post-operative ulnar nerve symptoms.Postoperatively, the arm was maintained in a plaster splint for 1 week, then the elbow was placed in a hinged brace. Initially, motion was allowed from 30° of extension to 90° of flexion, then advanced Read more:Elbow
American Heart Association Pushing Physical Therapy over NSAIDs 2007-03-05 01:07:00 The AmericanHeart
Association issued guidelines this past week which encourages physicians to limit drug therapy for pain, especially NSAIDs. Their statement reports that there is strong evidence that NSAIDs (excluding aspirin) are associated with an increased risk of heart attacks and stroke. Part of their statement notes that 'patients should be treated first with nonmedicinal measures such as physical therapy, hot or cold packs, exercise, weight loss, and orthotics before doctors even consider medication, said the AHA scientific statement published in the journal Circulation.' Great press for the use of physical therapy!Doctors Warned About Common Drugs for PainNSAIDs Tied to Risk of Heart Attack, StrokeBy Shankar VedantamWashington Post Staff WriterTuesday, February 27, 2007; Page A08 Save This Page Read more:Pushing
, Therapy
Knee dislocations 2007-03-08 21:13:00 If you had a chance to see Shaun Livingston dislocate his knee (tibiofemoral joint) and tear his anterior and posterior cruciate ligaments, medial collateral ligament and lateral meniscus, along with a dislocated patella, you can understand the severity of this injury (not for the faint of heart).Daunte Culpepper tore 3 ligaments in his knee in Oct 2005 and Willis McGahee dislocated his knee in the Fiesta Bowl in 2002. Both have returned to professional football, although, Culpepper struggled last year and McGahee has had a good career with the Bills (recently traded to the Ravens).Knee dislocations can be a devastating injury. In addition to the multiple ligament and soft-tissue damage, a host of other primary injuries can be involved such as: fractures, popliteal artery damage, and peroneal nerve damage. Secondary injuries that may manifest later are: compartment syndrome, infections, and regional complex pain syndrome. Surgery is the recommended treatment to restore knee stabili
Dwyane Wade Chooses Rehab First 2007-03-10 19:50:00 Basketball superstar, Dwyane
Wade recently dislocated his left shoulder during a game for the Miami Heat. With the NBA playoffs approaching, he has decided to undergo physical therapy/rehabilitation rather than opt for surgery. So, what are his chances of making a comeback without reinjury? Looking at the literature, the reported rate of recurrence is as high as 96% in young adults and adolescents. The younger the individual, the higher the reinjury rate. Wade will be out for 5-7 weeks, but most likely will have surgery in the off season if he does make it back.I guess you can't walk after this injury happens?Related research articles:Primary Anterior Dislocation of the Shoulder in Young Patients. A Ten-Year Prospective Study Hovelius L, et al. The Journal of Bone and Joint Surgery 78:1677-84 (1996)Traumatic Anterior Shoulder Dislocation in Adolescents Deitch J, et al.The American Journal of Sports Medicine 31:758-763 (2003)Related news stories:Wade says he'll try to return f Read more:Rehab
, First
Caution for Aspirin Users 2007-03-15 00:41:00 Not to deviate much from the sports/orthopaedic focus of this blog, but I came across another article on the caution for patients taking Aspirin
. We posted last week on the American Heart Association's new guidelines which encourages physicians to limit drug therapy for pain, especially NSAIDs. Today there was a new report that people at average risk for colon cancer should not take aspirin or ibuprofen and similar painkillers to try to prevent the disease because of the risk of developing bleeding and other problems. Just something else to think about regarding patient care in states with direct access to physical therapy services.Washington PostTuesday, March 6, 2007; Page A08Aspirin Taken as Cancer Preventative Has Risks Save This Page Read more:Caution
Update on DPT as Regulatory Designator 2007-03-14 02:20:00 Here is a little midweek update from the APTA Bulletin Online regarding the use of DPT:Board Provided Update
on DPT as Regulatory
Designator As part of its meeting on Saturday, the Board of Directors summarized APTA's activities from September 2006 to February 2007 related to the Plan to Promote Discussion of the DPT as Regulatory Designator. Discussion included the outcomes of various presentations and forums, and a survey that was made available on the State Government Affairs Web page.Based on the information available, the Board recommends that the title "PT" be maintained as the regulatory designator for physical therapists at this time, encourages state chapters to pursue title protection for "DPT," is committed to ensuring that all physical therapists fulfill the expectations of the elements of Vision 2020, and will monitor the environment for indications that the designator should change. Save This Page
Are you listening to your patients? 2007-03-18 16:23:00 I came across this interesting news story on NPR.org, which discusses the importance of the medical interview to establishing a diagnosis, specifically by listening to the patient. It is about a physician, Dr. Jerome Groopman, who developed wrist pain and ended up seeking 6 different opinions from orthopaedic surgeons. Check out the story and audio here. Since I am currently working on my transitional DPT, I found this very relevant to some of the discussions we have been having about errors in clinical decision-making.-Brian Save This Page Read more:patients
Link of the Week 2007-03-21 03:27:00 The website for the American Council on Exercise features a small, but detailed library of strengthening, balance, and stabilization exercises. It is free to access, with the specific exercises featuring pictures and descriptions of how each exercise should be performed. Enjoy.American Council on Exercise Home PageACE Fitness Library Save This Page
USA Olympic Volunteer Medical Program 2007-03-22 23:14:00 Announced by the Sports Section at Combined Section Meeting 2007 in Boston, the United States Olympic
Committee is now allowing physical therapists to provide services as medical staff at Olympic Training Centers and serve at USOC-sponsored events.Previously, limited to physicians, athletic trainers, massage therapists, and chiropractors, physical therapists now have an opportunity to fulfill their own Olympic dreams working with elite athletes.If you are interested, you can find the necessary application and criteria athttp://www.usolympicteam.com/sportsmed/apps.html Save This Page Read more:Volunteer
, Program
Traction for Low-Back Pain? 2007-03-26 02:52:00 I am currently enrolled in a transitional-Doctor of Physical Therapy program, and we recently began discussing the systematic reviews that make up the Cochrane Library. If you have not had a chance to browse the Cochrane database, it is a great reference tool for those individuals who want to stay current with evidence-based medicine.So, I came across a recent review on the effectiveness of traction for low-back pain with or without sciatica. I just had a patient the other week, who asked me about traction since it helped her symptoms in the past. Although we do not have a mechanical traction table at our facility, I just ran a quick search on the effectiveness of traction for low-back symptoms. You can read the review here (need login to access full-text). Basically, the reviewers found 24 randomized-control trials, with five ranked as high quality. They found that 'neither continuous nor intermittent traction by itself was more effective in improving pain, disability or work a Read more:Traction
So What Exercises Is Dwyane Wade Doing? 2007-03-30 02:03:00 A reader of this blog had emailed me this week asking what exercises Dwyane
Wade is doing as part of his rehabilitation. Apparently he is undergoing a couple hours of physical therapy per day to get ready for his return. While I do not know specifically what exercises he is doing (since I do not work with him or the Miami Heat-but maybe one day I will get to my dream job), a classic research article for rehabilitation of shoulder instability is from Burkhead & Rockwood. Their initial exercise program for patients included five different resistance band exercises (shoulder extension, shoulder flexion, shoulder internal and external rotation, and shoulder abduction) progressing the strength level. My guess is that he most likely is performing a combination of range of motion exercises, rotator cuff/deltoid/scapular strengthening, proprioceptive activities, and functional neuromuscular reeducation of the shoulder complex.Treatment of instability of the shoulder with an exercise pr Read more:Exercises
Consensus statement on sudden cardiac arrest in athletes 2007-04-06 21:24:00 In the most recent issue of the Journal of Athletic Training, the National Athletic Trainer's Association released a consensus statement
on emergency preparedness and management of sudden cardiac
arrest in high school and college athletic programs. The lead author, Jonathan Drezner (a former UPenn sports medicine physician), discussed with CBS Early Show anchor Russ Mitchell regarding this new statement. Here is a link to the video.http://www.cbsnews.com/sections/i_video/main500251.shtml?id=2650325n Save This Page
Neurocognitive function and ACL injuries 2007-04-11 23:42:00 With much attention given to the biomechanical and neuromuscular components as the primary focus of research in non-contact anterior cruciate ligament injuries (NCACL), neurocognitive influences have not been investigated. Swanik et al used a case-control design to compare neurocognitive test scores from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and NCACL injuries. 80 athletes who sustained an NCACL and 80 matched controls participated in the study. Preseason baseline ImPACT test scores prior to the injury were used for analysis. Higher and faster scores within the ImPACT scores were indicators of better performance. Compared to controls, athletes with NCACL injuries had significantly slower reaction times and processing speeds and performed significantly worse on visual memory and verbal memory composite scores. Interestingly, the athletes with NCACL injuries had “normal” scores but ranged in the low average to average scores and were char Read more:function
Physical Therapy Is Not All The Same 2007-04-14 02:06:00 I received this email from a reader in Cleveland, OH and I thought this would make a great discussion topic on our blog. Looking forward to everyone's comments.Just discovered it last night - I am a rowing coach and sculler and have had many experiences w/ your profession between some of my own injuries and those of my athletes. As with any profession, quality and skill varies widely; I would be very interested to read what you and your blogmates have to say regarding ways laypeople can (a) find more talented ones and (b) determine if they should switch to another practitioner. For example, I have seen patients complaining of medial knee pain immediately assigned a kind of prepackaged set of knee exercises (i.e. tke, 1-legged 1/2 squuats, etc.) without any attempt (by referring m.d. or p.t.) to determine whether the knee pain might arise from some other issue or joint.I realize that a p.t.'s initial approach will vary w/ the nature of the complaint, and that favored modalities can v Read more:Therapy
Changes... 2007-04-14 01:57:00 Just a quick post to apologize for the absence in my posting to this blog, but there have been some changes in my career. For those who have not heard, I recently resigned from my physical therapy position at the University of Pennsylvania. I took some time off to travel and now I am back in the US. Currently, I am beginning a new chapter in my PT career and am excited to get it started.Looking forward to continuing the blogging...-Brian Save This Page
One Year and Counting... 2007-04-17 05:10:00 We hit our one year anniversary of this blog yesterday! Thank you to our contributers and readers. Save This Page Read more:Counting
Change for the Better 2007-04-28 05:01:00 I have been fortunate to have had the opportunity to assist the medical staff at this years Penn Relays, held annually at the University of Pennsylvania in Philadelphia, PA. What makes this year different is that for the first time in the 113 year history of the Penn Relays, athletes with disabilities were able to participate in the competition. Both wheelchair and amputee competitors took to the track today in what hopes to be a continued tradition at the relays.The Philadelphia Daily News featured a great article on Paralympic hopeful Kortney Clemons, who lost his right leg serving as a U.S. Army combat medic in Iraq.While it is great to see these individuals overcome their deficits and participate in athletic endeavors, the reality is that people with disabilities often face many barriers to achieving better health. The Centers for Disease Control and Prevention (CDC) found that people with disabilities were more than four times more likely to be in fair or poor health than those w Read more:Change
Evidence-based Practice 2007-04-25 16:18:00 Now that we just had our first anniversary, I hope you have enjoyed the content. I thought I would discuss our purpose of exploring evidence-based practice in sports medicine.I just finished reading "Junk Science" by Dan Agin. Excellent read. He discusses several topics from science to medicine to religion. I found the sections on medicine and science fascinating. He discusses how science is twisted for political, corporate, or financial gain at the public's expense. One topic he brings up that science and medicine are so specialized now, that it is difficult for even other scientists to discuss topics not in their field. In the section on medicine, he brings up the one research article in New England Journal of Medicine, published in 1998 that compared chiropractic treatment, McKenzie approach, and booklet education in the treatment of acute low back pain. The results were that there was no differences in outcomes between treatments but the cost of chiropractic treatment and Read more:Evidence
, Practice
Link of the Week 2007-04-25 04:07:00 The link of the week is the website for the American Society for Shoulder and Elbow Therapists (ASSET) which features some great rehabilitation guidelines for...you guessed it-shoulder and elbow nonoperative and operative procedures. Looks like a great resource as some of the guidelines come complete with references. Enjoy.http://www.asset-usa.org/ Save This Page
New issue JMMT online with free content 2007-05-02 03:11:00 Got this email the other day from the Peter Huijbregts Editor-in-Chief of JMMT. Go check out the journal, as it has some great articles.We have posted the latest issue
of the Journal of Manual and Manipulative Therapy online
at http://jmmtonline.com/. Once again, the issue has an abundance of both subscriber-only and open-access material. Open access material includes the AAOMPT John McMillan Mennell Award speech delivered by Ann Porter Hoke at the last AAOMPT Conference and a review article on the relationship between running, meniscectomy, and OA by Bob Baumgarten. Other free material includes a PhD thesis review, book and multimedia reviews, and an editorial where I discuss my (humble) opinion on the implications of the recent clinical prediction rules with regard to spinal manipulation on the predominantly biomechanical models at the basis of so many schools of thought in OMPT. To conclude the free material, Jim Doree, our website designer and PT colleague, provides a how-to on us
The McKenzie Versus the World Debate 2007-05-04 05:05:00 Some food for thought. Looking forward to reading everyone's comments on this topic I received this week:Do you or your co-bloggers have opinions re McKenzie
? I realize it's not fair to generalize based on experiences w/only three practitioners, but I feel as those certified in the technique have an almost slavish devotion to it, i.e. pressups (or, as I believe McKenzie calls them, extensions) answer all...Thoughts? Save This Page Read more:World
, Debate
News For Thought 2007-05-08 05:25:00 Here are a couple links to some recent interesting news articles in the world of orthopaedics and sports medicine:Smokers and the obese banned from UK hospitals news-medical.net Published: Wednesday, 2-May-2007Risk For Stress Fractures And Pain Under Kneecap Lowered By Biofeedback On Abnormal Mechanics From medicalnewstoday.com Article Date: 04 May 2007 Save This Page
Wireless technology 2007-05-16 15:12:00 I just finished reading an commentary published in the British Journal of Sports Medicine on the use of wireless technology in health and sports monitoring. With new advancement in wireless technology, sports medicine practitioners and scientists should have available to them the ability to monitor athletes in their sports setting (see Figure). Two wireless technologies currently in use are Bluetooth and Zigbee. The authors provide examples on how these technologies are being used in sports, such as rowing.Reproduced from Armstrong S, British Journal of Sports Medicine 2007;41:285-289Related to this, the International Journal of Electronic Healthcare (IJEH) published a special issue on: “Integrating Mobility into the Healthcare Sector: the Next Generation of Mobile Health Applications". Although I don't have access to this journal, it provides an additional source of the increasing use of technology in healthcare. Physical therapy programs are even starting to use personal dig Read more:Wireless
The Hip Outcome Score 2007-05-18 20:52:00 I recently attended a symposium on hip pain in the athlete, and at the conference, the presenters made mention of the Hip Outcome Score
for which they utilize for measuring subjective patient progress. With the push towards measuring outcomes in our patients, I looked up the evidence behind this tool (boy, my professors would be proud).Martin, Kelly, and Philippon created a 19-item ADL scale of hip function related questions, which was trimmed down to 17 items after analyzing their questions. They also make mention of a 9 itme sports subscale, which was not included in the paper (it would be interesting to see their questions on the sports portion). The questions are scored from 0 to 4 with 4 indicating “No Difficulty” and 0 indicating “Unable”. The total items answered are multiplied by 4 to obtain the highest potential score. The item score is divided by the highest potential score then multiplied by 100. The ADL scale had an internal consistency of 0.96 and SEM=±2.8.
Active release technique - Science or voodoo? 2007-05-18 12:00:00 Having the pleasure to work at a facility like Penn Sports Medicine Center and being involved with sports medicine on a larger scale as with the Penn Relays, I have an opportunity to be exposed to some of the new, exciting, and even controversial topics related to sports medicine. For the past two years, one of our non-operative sports medicine physicians has been requesting that someone in our facility be trained in "Active
Release Techniques (ART)". And recently, a sports medicine physician who worked at the Penn Relays asked if any of us were trained in ART.ART has been developed, refined, and patented by P. Michael Leahy, DC, CCSP for the treatment of soft tissue dysfunctions. He states on his website that "90% of his patients’ problems" are consistently resolved with this technique. However, after a search on PubMed, only two articles have been published on ART, one on quadriceps inhibition and strength and the other on hamstring flexibility. Neither of which address Dr. Le Read more:Science
Out With the ACL Reconstruction? 2007-05-22 20:16:00 Some interesting research developments in the field of anterior cruciate healing via this article on webmd.com. Yes, it is still experimental and they have only performed it on pigs, but who knows? Stay tuned.Torn Knee Ligament: Can It Be Healed?New Technique May Some Day Allow Torn ACL to Be Healed, Not Just ReplacedBy Daniel J. DeNoonWebMD Medical News Save This Page
Running News 2007-05-27 15:25:00 Just a couple of interesting news bites on running to share. The first is an article on running mechanics and how to reduce stress fractures and anterior knee pain through physical therapy by retraining how patients run. The research comes out of the Running Injury Lab at the University of Delaware using a biofeedback device with runners on a treadmill.Risk For Stress Fractures And Pain Under Kneecap Lowered By Biofeedback On Abnormal Mechanics from medicalnewstoday.comWith all of the constant changes to running sneakers, it is tough to stay on top of what is new on the market. I recently found out about Newton Running, which has developed their running sneakers which contain a rubber membrane in the forefoot. This Newton Active Membrane Technology store the energy from ground impact and releases it on toe off. They report that this technology adds greater cushioning, up to 58% energy return, and less injury. While I have yet to read the research behind these claims, the sneakers
A Little Housekeeping... 2007-05-31 22:20:00 1) The National Football League has agreed to provide monetary aid to 35 former football players to help with the care of players afflicted with dementia or related brain problems. (Read the story here. 35 ex-NFL players qualify for dementa-Alzheimer's assistance). Is the NFL admitting to a link between brain injury and impact sports?2) For anyone in the Bucks County are of Pennsylvania, Dave and I will be taking the show on the road this coming Wednesday. We will be speaking on the use of Web 2.0 in Physical Therapy for the Bucks County Sub-District of the Pennsylvania Physical Therapy Association. Here are the details of the event:When: Wednesday June 6, 2007 @ 7PMWhere: Doylestown Hospital, Conference Room BTopic: With the evolving functionality of the web, online technology is changing the user's approach to staying current in physical therapy. Learn how to make the Internet work for you, stay current on issues and research topics in the field of physical therapy, and imp
NCAA Injury Surveillance System (ISS) 2007-06-04 16:11:00 The NATA and the NCAA recently published a summary on the past 16 years of injury surveillance data collected by athletic trainers from 15 different sports. The NCAA, in collaboration with the NATA, has created the largest ongoing collegiate sports injury database in the world.“The comprehensive information in this ongoing report has and will continue to shape key decisions regarding health and sports safety issues across the U.S.,” said Randall (Randy) W. Dick, MS, FACSM, associate director of research for the NCAA’s Injury
Surveillance System
and a lead author of the report. “The findings can help improve athletic programs and the quality of care received by student athletes.”For more information on this report, please visit www.nata.org/collegiateinjurystats07 and http://www2.ncaa.org/portal/media_and_events/press_room/. Save This Page
Patient Clinical Question? 2007-06-09 13:30:00 I recieved this email yesterday for posting on this blog:I am trying to find some exercises I can use to help strengthen my foot and allow me to walk on it again. I have been off of it completely for two months in a 'crow's boot'. I have just finished two weeks of putting weight on my foot with the boot and am preparing to go with weight in a shoe. I find that I am experiencing pain in walking, kind of like I am walking on it wrong. I would like to do some exercises that will help with my range of motion and decrease the discomfort. I need to be back to work in less than a month. I am limited to having physical therapy due to lack of transportation. Can you help me? Is there a site I can go to where I can find exercises to help get me back on my feet (no pun intended).Thank you for your help! Save This Page Read more:Question
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