Concepts in Orthopaedic and Sports Medicine Rehab

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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 di...
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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
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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
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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...
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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 thos...
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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 ...
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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
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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
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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 ca...
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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
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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 chara...
More About: Injuries , Function

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_v ideo/main500251.shtml?id=2650325n Save This Page
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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...
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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 wor...
More About: Pain , Back , Back Pain , Trac

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
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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
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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
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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
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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
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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 retur...
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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 stab...
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American Heart Association Pushing Physical Therapy over NSAIDs
2007-03-05 01:07:00
The American Heart 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
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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...
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AJSM Top 50 List
2007-03-01 03:39:00
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 ...
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CSM 2007 Update
2007-02-26 22:00:00
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 Tyl...
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More Evidence Against the Hormone Theory in Women's Sports Injuries
2007-02-26 00:36:00
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 a...
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Physical Therapy Job Outlook=Good?
2007-02-24 00:23:00
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 reco...
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EXERCISE AND FLUID REPLACEMENT POSITION STAND NOW AVAILABLE
2007-02-20 12:00:00
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...
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The Sports Hernia Part 2
2007-02-18 21:35:00
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 ...
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Female Athletes Cut Risk Of Stress Fractures with Calcium and Vit. D
2007-02-18 18:07:00
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
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