Concepts in Orthopaedic and Sports Medicine Rehab

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Is Running a Marathon Bad for Your Heart?
2006-12-08 15:18:03
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 Hear t 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 Ti...
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Serratus Anterior EMG Activity Study
2006-12-07 15:17:03
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 ...
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Return to Competition in the NFL After ACL Injury
2006-12-04 03:15:03
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 bad n...
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Open The Door to Evidence Based Practice
2006-12-02 15:14:21
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.
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ACL Injury Rates in the NFL
2006-12-02 15:14:21
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...
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Sit Up Straight. Or Not?
2006-12-02 15:14:21
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 Stra ightBy Sara GoudarziLiveScience Staff Writer
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Lumbar Disc Injuries: Conservative Versus Surgical Managemen
2006-12-01 23:39:05
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 ...
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The Impact of Knee Angular Impules on Patellofemoral Pain in
2006-12-01 23:39:05
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 asymptomati...
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The Meniscus Tear
2006-12-01 23:39:05
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...
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Clinical prediction rules
2006-12-01 23:39:05
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. ...
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Chocolate Milk...The Next Gatorade?
2006-12-01 23:39:05
Chocolate Milk ...The N ext 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
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100 Posts!!!
2006-12-01 23:39:05
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
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Lighter Baseballs=Injury Prevention in Young Athletes
2006-12-01 23:39:05
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. Specia...
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Marathon Myths
2006-12-01 23:39:05
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 rise...
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Effective treatment for quadriceps contusions
2006-12-01 23:39:05
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...
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Articular Cartilage and Meniscal Lesions - Special Issue
2006-12-01 23:39:05
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 Cart ilage and Men iscal Lesions - Special Issue. J Orthop Sports Phys Ther 36(10), Oct 2006.
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The MySpace of Physical Therapy
2006-12-01 23:39:05
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: MyPhysical Therapy 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.
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How Much Rest After A Marathon?
2006-12-01 23:39:05
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.comw ww.marathontraining.comLore of Running by Tim Noakes
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