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
Is Running a Marathon Bad for Your Heart? 2006-12-07 15:52:00 Running has long been considered to be an excellent form of aerobic exercise, however, an article published in a recent issue of Circulation, a Journal of the American Heart
Association, uncovers a startling risk of damage to the heart muscle of runners post-marathon. The study, by Neilan et al., examined nonelite runners pre and post the running of the Boston Marathon
and found increases in cardiac related biomarkers as well as echocardiographic abnormalities following the completion of the run, both indicators of heart injury and dysfunction. In fact, the changes in these markers were detected in 60% of the runners tested, with 40% of those tested demonstrating levels indicating definitive cardiac cell destruction. Additionally, the authors noted that these risks are higher for those runners who have had less pre-marathon training preparation.The article highlights significant risks that may be associated with endurance running, such as marathons. According to a recent New York Times
Serratus Anterior EMG Activity Study 2006-12-07 02:34:00 Just read an article in this month's Journal of Orthopaedic and Sports Physical Therapy, which compared the EMG activity of the serratus anterior muscle during the wall slide, wall push up, and scapular plane elevation. The role of the serratus anterior is to upwardly rotate and posterior tilt the scapula with humeral elevation, as well as maintain the scapula on the thorax. Impaired scapular kinematics have been demonstrated in individuals with shoulder pathology. Hardwick et al examined 20 healthy adults and had them perform the wall slide, wall push up, and scapular plane elevation while looking at serratus anterior (SA), lower trapezius (LT), upper trapezius (UT), and latissimus dorsi muscle activity with surface EMG. Here is the description of the wall slide as per the article (since I was not doing it with my patients quite this way): Subjects stood facing a smooth wall with the dominant foot against the base of the wall and with the opposite foot shoulder-width apart and Read more:Activity
, Study
Return to Competition in the NFL After ACL Injury 2006-12-03 16:19:00 With the number of NFL players sustaining ACL injuries recently (see post ACL Injury
Rates in the NFL), the December 2006 issue of the American Journal of Sports Medicine, which is the journal of the American Orthopaedic Society for Sports Medicine, features a timely article on the performance levels of NFL players after returning from an ACL injury. This study finds that NFL players who do return to play in the league come back with one-third diminished performance. This will have huge implications for players' contracts, agents, and team owners. Here is the press release from the American Orthopaedic Society for Sports Medicine.MOST NFL PLAYERS RETURN TO COMPETITION AFTER ACL INJURY, BUT AT A REDUCED PERFORMANCE LEVELPerformance of wide receivers, running backs post-ACL injury falls by one thirdRosemont, Ill. - November 30, 2006 - The good news for NFL players who sustain an injury to their anterior cruciate ligament (ACL) is that they'll likely play again in the NFL. The ba Read more:Return
Sit Up Straight. Or Not? 2006-11-29 03:28:00 Saw this posting on LiveScience.com regarding a report on the the effect of different postures on the lumbar spine. Although the data has not been published, I thought it was an interesting/intriguing read. (Sounds like they are establishing some defense if case you get caught sleeping on the job.)New Advice: Don't Sit Up Straight
By Sara GoudarziLiveScience Staff Writer
Lumbar Disc Injuries: Conservative Versus Surgical Management 2006-11-24 15:32:00 Low back pain effects millions of Americans each year and management of these patients may be conservative, surgical or a combination of both, with the most common surgical intervention being the diskectomy.In a randomized, multi-center study published in the Journal of the American Medical Association (JAMA) this month, Surgical
versus Nonoperative Treatment for Lumbar Disc Herniation: The Spine Patient Research Outcomes Trial (SPORT) A Randomized Trial, research has found that both conservative and surgical management of sciatica patients yields similar long-term outcomes in which 70% of patients reported significant improvement of symptoms over a two year follow-up, with no statistical significance found between the surgical versus the conservative patient groups. Patients included in this study had to present with ridiculer symptoms greater than six weeks duration. The authors of the study reported a high crossover rate amongst treatment groups which muddy the intent-to-treat ana Read more:Injuries
, Management
How Much Rest After A Marathon? 2006-11-23 01:29:00 With a number of patients at our clinic running in marathons over the past couple months, the question arises as to how much rest should runners take after a marathon?After consulting several books and websites, there seems to be a lot of opinions from no rest (a short run the next day) to taking a month off (a days rest for every mile ran in the race). The consensus seems to be that you should take a week off from running, with cross-training to maintain cardiovascular fitness.Mileage in the second week should be no more than 25 to 50 percent of normal and no more than 50 to 75 percent during the third and fourth post-marathon weeks. The links below have progressive training programs and feature tips to help recovery.And for those super-motivated runners, Tim Noakes, MD suggests running no more than two marathons per year, with four to six months between these races.Selected Resourceswww.teamoregon.comwww.nycrr.comwww.marathontraining.comLore of Running by Tim Noakes Read more:Marathon
ACL Injury Rates in the NFL 2006-11-20 05:13:00 Seems like the bad luck of being a Philadelphia sports fan continues.Philadelphia Eagles quarterback, Donovan McNabb's season ended in the second quarter today when he went down ACL tear in his right knee. With a number of high profile football players (Carson Palmer, Amani Toomer, Javon Kearse, etc.) sustaining an ACL injury, what are the injury rates for this at the professional level?The most current information I found comes from a peer-reviewed journal from Arthroscopy in 2002. Bradley et al utilized data collected from the NFL Injury
Surveillance System from 1994 through 1998 (why the abstract cited 1986 to 1995...I don't know). Anyhow, the NFL averaged 2,100 injuries per year during that time span, with knee injuries representing 20% of all injuries reported. Knee sprains accounted for 11% of reportable injuries, and ACL injuries comprised 2% of all injuries reported.Over the five years investigated, there was a total of 209 ACL injuries in the NFL, with more than twice as Read more:Rates
Chocolate Milk...The Next Gatorade? 2006-11-20 04:37:00 Chocolate Milk...The Next Gatorade? Not really. But, according to a study in the February 2006 issue of the International Journal of Sports Nutrition and Exercise Metabolism it may be an effective drink to help athletes recover from bouts of exercise.The single-blind, randomized design study looked at 9 subjects who exercised on a stationery bicycle, then drank low-fat chocolate milk, a fluid-replacement drink like Gatorade and a carbohydrate replacement drink like Endurox R4. The cyclists were able to go between 49 and 54 percent longer on a second cycling stint after drinking chocolate milk than with the carbohydrate drink. The difference between the milk and the fluid-replacement drink was not significant.Read the internet articles:SI.comYahoo NewsPub Med Entry Read more:Chocolate
The MySpace of Physical Therapy 1970-01-01 00:59:59 While I am NOT on the MySpace
bandwagon, our friends at Evidence in Motion have just unveiled their newest creation of an online physical therapy community: MyPhysicalTherapy
Space.com. It is free to sign up, and all information is confidential and secure.Although the site has been up for about one week, it seems like a great way to network with other physical therapists with similar interests. It took me about 5 minutes to complete the registration and profile information (no photo as of yet). The site features a number of communities based on practice interest and allows you to share information and participate in online meetings with colleagues.Check it out and let us know what you think. Save This Page
Operative Results for UCL Injuries in Females 1970-01-01 00:59:59 From the American Journal of Sports Medicine, a recent article reports on the post operative results for UCL injuries of the elbow in female athletes. Argo, Trenhaile, Savoie, & Field looked at 19 females who underwent a surgical procedure for ulnar collateral ligament (UCL) insufficiency. From the literature (which I have seen), this is the first study of its kind to document its findings specifically in females. UCL injuries are most common in overhead athletes, with baseball being the most frequently cited. The subjects in this study participated in a variety of sports including softball (42%), gymnastics, and tennis. All subjects all failed conservative management and had symptoms of medial elbow instability for greater than 3 months. Following surgery, active range of motion was started after 1 week and strengthening exercises for the scapula, rotator cuff, wrist, and forearm were started at 3 to 4weeks. Full upper extremity rehabilitation with the brace at full range Read more:Injuries
, Females
Effective treatment for quadriceps contusions 1970-01-01 00:59:59 A recent case series out of the United States Naval Academy demonstrated that immediate immobilization at 120 degrees of knee flexion following a quadriceps contusion resulted in earlier return to unrestricted athletic activities and a low incidence of myositis ossificans.A prospective study of 47 midshipmen who sustained a quadriceps contusion were immediately (within 10 mins of injury) treated with immobilization at 120 degrees of knee flexion. The immobilization was discontinued after 24 hours and the subjects were instructed to perform active, pain-free quadriceps stretching frequently and to initiate pain-free isometric quadriceps strengthening ASAP.The mean return to unrestricted full athletic activities with no disability was 3.5 days. Radiologic examinations revealed 1 case of myositis ossificans in the first 23 cases at 3 and 6 months post injury. Aronen JG, Garrick J, Chronister R, McDevitt E. Quadriceps Contusions: Clinical Results of Immediate Immobilization in 12
Open The Door to Evidence Based Practice 1970-01-01 00:59:59 The American Physical Therapy Association has recently developed Open Door, a portal to allow for easy access to journals and other resources to help meet the goals of the APTA's Vision Statement for Physical Therapy 2020. Members now have access to two research journal collections: ProQuest and Cumulative Index to Nursing and Allied Health Literature® (CINAHL®).So if you are a member of the APTA, you now have access to research journals and resources as an effective way to enhance your evidence-based practice. Save This Page Read more:Evidence
, Practice
Articular Cartilage and Meniscal Lesions - Special Issue 1970-01-01 00:59:59 The October 2006 issue of the Journal of Orthopaedic and Sports Physical Therapy is dedicated to issues related to articular cartilage and meniscal lesions.It provides an excellent overview of the different types of articular cartilage damage and meniscal injuries, operative techniques and rehabilitation guidelines based on the most current knowledge in the treatment of these disorders.Articular Cartilage and Meniscal Lesions - Special
Issue. J Orthop Sports Phys Ther 36(10), Oct 2006. Save This Page
Free Basic Health Care? 1970-01-01 00:59:59 In an effort to reduce incurred costs such as repetitive emergency room visits and hospitalizations, some hospitals are now trying to reduce these costs by providing patients with free basic health care. Several hospital groups and health systems across the nation have begun to tag patients that are "frequent flyers" to determine which of those patients, in combination with other factors such as diagnosis and income, would benefit from free basic health costs. Often patients with chronic conditions such as diabetes and heart issues benefit from preventative care thereby decreasing the overall heathcare costs to the patient and the hospital.New York Times. Wednesday, October 25, 2006. Health
Section. Save This Page Read more:Basic
, Health Care
Innovative treatment for tennis elbow pain 1970-01-01 00:59:59 Researchers at Stanford University have completed a pilot study on the use of platelet-rich plasma injections for the relief of lateral epicondylalgia. This is a link to a short interview with the lead researcher on this study (http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=14738)This study was published in the American Journal of Sports Medicine 2006; 34:1774-1778. Save This Page Read more:Innovative
Product Placement 1970-01-01 00:59:59 Working in an outpatient physical therapy clinic, vendors come by, trying to interest us in the newest applications of modalities (InterX Sport) in rehabilitation. Even patients ask us about different modalities or products they have seen (The Stretching Pole).However, the many new clinical modalities have very little peer-reviewed research to substantiate their claims (plenty of abstracts, though). And of course, the products marketed to the public have almost no literature to back their claims and even continuing to perpetiate myths about exercise and fitness that research has remuted (but has not reached public knowledge).One thing both groups have in common is the use of patient success stories or testimonials. This is one of the basic tenets of marketing. Get endorsements from top names in the field and use their image and brand name to market their product. However, each of these patients have different diagnoses and different characteristics that make it difficult, if not Read more:Placement
The Non-Invasive EMG Debate 1970-01-01 00:59:59 Along the lines of the last post on product placement, I saw this article in the NY Times on the Neurometrix, a FDA approved non-invasive EMG test. Read about the debate.This is another example of the importance of the almighty dollar in healthcare. The manufacturer of this device promotes a $250 profit for a 15-minute test according to the article. Interestingly, Medicare and many other insurers, including some Blue Cross/Blue Shield plans, have paid for this test, with some large insurers, including Aetna and Cigna, not covering the costs. They cite 'inadequate clinical evidence to support it'.New York TimesOctober 20, 2006New Nerve Test, a Moneymaker, Divides Doctors Save This Page Read more:Invasive
, Debate
Legislative Action Needed! 1970-01-01 00:59:59 On September 28. 2006, Senators Craig Thomas (R-WY) and Arlen Spector (R-PA) introduced legislatation (S. 3963 The Access to Physical Medicine and Rehabilitation Services Improvement Act of 2006) that would allow non-physical therapists (athletic trainers, lymphedema therapists) to provide 'incident to' therapy services to Medicare patients in physician offices. Currently, under the 'incident to' rule of Medicare , individuals providing therapy services must be graduates of physical therapy professional education programs. With this introduced legislation, Medicare would allow athletic trainers and other non-qualified personnel to provide physical therapy services to Medicare patients in physician offices.If this passes, this will greatly affect the physical therapy profession as we know it.I have attached several links for more information regarding this issue. Through the APTA's website, you can access a sample letter to send to your senators. **Of note, that when doing a Read more:Legislative
, Action
Stents: Are they Safe? 1970-01-01 00:59:59 An article in the New York Times on Saturday presented disturbing news with respect to the safety of drug coated heart stents which are used commonly in the United States. The Food and Drug Administration will be meeting this December to discuss whether or not new guidelines should be institued for the use of such stents following several reports of increased long-term clotting risks. Research presented at a medical meeting in Spain this August indicated that there was in increased risk of long-term clotting associated with drug coated stents. In addtion, Boston Scientific, one of the leading manufactures of drug coated stents in the United States, apporached the FDA in late August to report similar finds of such complications in their most recent data. Implications of these new findings will effect patients as well as medical manufactures, if in fact, the new data is accurate. Save This Page
Marathon Myths 1970-01-01 00:59:59 With the NYC marathon this past week, the New York times featured an article on myths on marathon running. The full text article is available here, but you need to register for free access to read it. The author had interviews several researchers in the sports medicine and performance field and here are some of the interesting points:The Weather FactorElite runners ran fastest in the coldest conditions — 41 to 50 degrees. But the slowing effect with heat was not as great as had been previously reported. For every five-degree increase in temperature, times slowed by 0.4 percent.Warmer weather had a greater effect on slower runners. On a 77-degree day, an elite runner would be about 5 percent slower than on a 41-degree day. But a runner who finished in three hours on a 41-degree day would be slowed by about 12 percent on a 77-degree day, finishing in 3 hours 21 minutes.The theories for this include that slower runners spend more time on the course, and the temperature generally rises Read more:Marathon
, Myths
Lighter Baseballs=Injury Prevention in Young Athletes 1970-01-01 00:59:59 From the American College of Sports Medicine website, there is a post on the evidence for switching to lighter baseballs in youth leagues to promote proper throwing mechanics and decrease injury risk. Here are some excerpts from the posting:Using a baseball just one ounce lighter than the standard major league size could help young pitchers better learn the skills of the game while reducing force and strain on the arm which commonly lead to injury."Most other youth sports leagues have reduced the size of the equipment used by the younger age groups, but in baseball, a nine-year-old is typically pitching the same ball thrown by grown men like Roger Clemens or Randy Johnson," said lead researcher Randy Phillips of Arkansas State University. "The younger players are trying to throw the ball just as hard, which makes safety a concern"Researchers tested 34 young pitchers, ages 9-12, in a biomechanics laboratory. Each threw 10 pitches with both the four and five ounce baseballs. Spe Read more:Injury
100 Posts!!! 1970-01-01 00:59:59 Concepts in Orthopaedic and Sports Medicine Rehab has now reached the century mark! Our blog is now at the 100 post mark! Thank you to all of our contributers and our readers. We look forward to the next 100 (and beyond).-Brian Save This Page
The Impact of Knee Angular Impules on Patellofemoral Pain in Runners 1970-01-01 00:59:59 While reviewing some articles this evening I ran across an article titled Knee Angular Impulses as a Predictor of Patellofemoral Pain in Runners
by Stefanyshyn, DJ et al found in the November issue of The American Journal of Sports Medicine . I found this article interesting since it attempted to determine whether greater knee abduction moments played a role in the development of patellofemoral pain in runners. The November 2003 edition of the Journal of Orthopaedic and Sports Physical Therapy provides an excellent framework with which to appreciate lower extremity dynamic positioning and its effect on patellofemoral joint kinematics. The study utilized a both retrospective case control study and a prospective study to help gain insight. The retrospective case control study utilized a patellofemoral pain group and a asymptomatic group. Both study groups had shown the runners with patellofemoral pain displayed significantly greater mean knee abduction impulses than asymptomatic r
The Meniscus Tear 1970-01-01 00:59:59 The current issue of the American Journal of Sports Medicine features a descriptive laboratory investigation on the pathologic characteristics of the human meniscus.The authors looked at the cellularity of torn meniscus tissue. They hypothesized that the cellularity is related to the age of the patient, length of time since injury, and tear type. This information could be used to establish a pathophysiologic basis for the higher rates of repair failure in specific groups of patients.Forty-four torn menisci were collected at the time of arthroscopic meniscectomy, and 10 intact menisci were collected from total knee replacement patients to serve as a control. Gross and histological evaluations were conducted on the samples. Here is a summary of the authors findings...Patients older than 40 years had a decreased intrinsic and perimeniscal cellularity in the torn menisci compared with younger patients. Prior research has demonstrated that older patient populations have lower rates of
Clinical prediction rules 1970-01-01 00:59:59 I have increasingly become more interested in the use of clinical prediction rules in non-surgical orthopaedic injuries. In the November issue of JOSPT, Lesher et al examined 50 individuals with patellofemoral pain syndrome (PFPS). Using a 50% reduction in pain or a moderate improvement on the global rating scale, they found that individuals responded immediately to patellar taping when they presented with a positive patella tilt test and tibial varum > 5 degrees (Lesher et al, JOSPT, 2006).Clinical prediction rules are going to become much more prevalent in clinical practice to help provide evidence based guidance in helping to determine which patients respond best to which interventions. Beattie and Nelson recently published a review on clinical prediction rules, discussing the role of clinical prediction rules in physical therapy and potential limitations that can occur if use inappropriately (Beattie and Nelson, Aust J Physiother, 2006).I am very excited about these studies. As
Clinical Prediction of Meniscal Tears 1970-01-01 00:59:59 Meniscus tears are a common injury seen in the physical therapy clinic/sports medicine facility. However, the detection of a menicus tear through clinical tests can be difficult. Lowery et al, prospectively examined the data on 635 knees seen with the primary complaint of a knee injury. Primary data investigated included a positive or negative result for the following 5 tests:(1) patient history of "catching" or "locking"(2) pain with forced hyperextension(3) pain with maximum flexion(4) McMurray's sign(5) joint line tenderness to palpationLooking at the patients who underwent a knee arthroscopic surgery (n=209), McMurray's testhad an 84% PPV, which was the highest among the individual tests, followed by a history of mechanical symptoms, pain with hyperextension, joint line tenderness, and pain with forced flexion.The authors calculated a composite score for meniscal pathology, looking at the 5 clinical measures noted above. Lowery et al found that for the surgical grou Read more:Prediction
, Tears
Whole body vibration training 1970-01-01 00:59:59 The use of vibration
training has been recently investigated in individuals from the elite athlete to postmenopausal women. The individual stands on the platform and the vibration is propagated from distal to proximal links of muscle groups. Exercises are commonly performed on the platform during the vibration. Training frequencies should be within the range of 30-50 Hz.Positive training effects have been noted in strength and power enhancement during acute and chronic training protocols (Luo et al, Sports Med, 2005). Whole
body vibration training also appears to enhance postural control in community dwelling older individuals (Bogaerts et al, Gait Posture, 2006).However, current findings suggest vibration training may have some negative effects. Excessive vibration has been shown to damage the lungs, GI tract, and heart in animals. Physiological and biomechanical models demonstrate that the sensorimotor and musculoskeletal systems may be severely altered following vibration over
Knee Osteoarthritis Worse in Smokers 1970-01-01 00:59:59 One more reason to encourage patients to quit. Recent research findings have found that men who smoke have greater cartilage loss and higher pain levels than nonsmokers. There was a 2.3 fold increased risk of cartilage loss at the medial tibiofemoral joint and a 2.5 fold increased risk of cartilage loss at the patellofemoral joint. See the links for the full article.ScienceDaily.com MedicalNewsToday.com Save This Page Read more:Smokers
Link of the Week 1970-01-01 00:59:59 Here is a link for the website of the American Academy of Podiatric Sports Medicine. It features a lot of tips and articles, but the portion I find most interesting as a physical therapist and runner is a running shoe listing. The AAPSM reviews the current running shoes and lists them based on type of stability control and cushioning. The next time a patient is looking to change their running sneakers, make sure they get the right fit. Save This Page
2006 Medical Weblog Awards 1970-01-01 00:59:59 Medgadget.com is again sponsoring the Medical Weblog Awards
. Feel free to nominate Concepts in Orthopaedic and Sports Medicine Rehab as the Best New Medical Weblog.Welcome to the third annual Medical Weblog Awards! These awards are designed to honor the very best in the medical blogosphere, and to highlight the diverse world of medical blogs. The categories for this year's awards will be: -- Best Medical Weblog -- Best New Medical Weblog (established in 2006) -- Best Literary Medical Weblog -- Best Clinical Sciences Weblog -- Best Health Policies/Ethics Weblog -- Best Medical Technologies/Informatics Weblog -- Best Patient's Blog (a new category this year) Nominations are now accepted in the comment section of this post. When nominating, please indicate blog's name and URL. A blog can participate in more than one category, so please indicate which one(s). The following timeline will be observed: -- Nominations will be accepted until Sunday, December 31, 2006. -- Poll
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