Concepts in Orthopaedic and Sports Medicine RehabConcepts in Orthopaedic and Sports Medicine RehabForum 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. 
Articles
Thank You, Farewell, and Goodnight
2007-09-06 02:47:00 To the readers of this blog:There comes a time for all things to come to an end, and unfortunately, the time is up for this blog. First, I want to thank all of our readers and participants in making this an interesting year and a half. Without your support, we really would not have made it past a couple of months.Several reasons for the conclusion to end this blog include the time required to maintain this blog has become too burdensome with a majority of the primary authors choosing to further their physical therapy education by returning to school. The interest and fun in posting on what we are passionate about (yes...physical therapy) was dwindling. And recent events, which have transpired over the past 48 hours, have completely jaded my perception of the physical therapy community. Again, thank you for being a part of this site. I will be deleting all previous posts through today, and after one week orthosportsrehab will be officially retired.Thank You, Fare well , and Goodni... More About: Well , Hank
Prognosis for return to sports
2007-08-09 16:33:00 I have recently started to look at the prognosis for return to sports in athletes following acute injuries. We have a good bit of data on athletes who return to sports following surgical procedures, such as ACL reconstruction, ankle stabilization procedures, shoulder surgery, etc. However, little is known following acute injury, such as hamstring strains or knee sprains.Askling et al evaluated 18 elite sprinters with first-time hamstrings strains.They were examined on 4 occasions using both a clinical exam and MRI. An association was found between the time to return to previous level of function and the extent of the injury. Proximal hamstring injuries were associated with longer times for return to pre-injury level (COSMR 2/7/07).Fuller and Walker examined the rehab data of 118 injuries in 55 football (soccer) players. They found that the average time in functional rehabilitation was depended upon time in pre-functional rehabilitation and the type and location of the injury.Alt... More About: Sports , Return , Turn , Spor , Ports
A little feedback request...
2007-08-03 03:31:00 A common problem with blogs is the lack of reader feedback. We have had over 20,000 visitors to this blog, yet receive very little reader comments to posts. This blog is meant to be an interactive forum for the sports medicine community. Also, I have been leaning towards taking a hiatus from posting as my interest in maintaining this site seems to be diminishing. It is hard to keep up the frequent posting without support. Not sure... "How about a Fresca?"-Judge Smails Save This Page More About: Request , Feedback , Litt
I'll take 'Weakness' for $100, Alex.
2007-07-28 18:50:00 Recently, I attended a running expo prior to a road race and took the photo below. (Please disregard the bad photography skills as it was taken with a cell phone.)Anyhow, this picture is of a booth one of the exhibitor's, which just happened to be for chiropractic care. The dry erase board in the center was what I was trying to capture, as it certainly got me to notice (and chuckle). What caught my attention was that the written sign read something like: "We will give you $100 cash if we cannot find a weak muscle on you!"Does anybody else find this funny or ridiculous? Given the fact that I have treated numerous runners/athletes all with an injury, they all have presented with some lower extremity muscle group weakness. And I am sure, that if I did not find any deficits with the larger muscle groups, I would most likely find at least a 4+ somewhere. That counts as weakness right? And, don't most healthy people have some weakness somewhere? (Abductor digiti minimi anyone?)... More About: Alex
Pose Running Method
2007-07-24 22:07:00 While I was treating a runner in my clinic, a colleague of mine brought up the Pose Method as a alternate way of running. The idea is that by landing on the ball of your foot, the tissues are better positioned to accept the load from the body, as opposed to the heel. Aside from decreasing the load bearing forces placed on the lower extremities during conventional running, this new technique claims to shave off running times. While I understand the physiological principle behind this, I am skeptical. There is already more than enough plantar fasciitis and calcaneal tendinitis patients to be seen. Do we really want to risk creating more overuse injuries? Your thoughts would be appreciated. Save This Page More About: Running
i-Limb Hand in Action
2007-07-24 16:51:00 Touch Bionics, a leading developer of advanced upper-limb prosthetics, has announced that its i-Limb prosthetic is now commercially available. "This replacement hand looks and acts like a real human hand." Two small surface electrodes pick up the electrical signals generated by the remaining muscles in the patient's limb and send the information to the myoelectric controls located in the hand. The controls then create the desired movement. This prosthetic is considered groundbreaking, in that it gives the patient back the ability to perform a key grip, power grip, precision grip, and index point.Another great innovation from this group is that each digit has it's own part and screw. This may seem trivial, but, now, if a finger or digit malfunctions, all the patient has to do is take that piece off and send it back to Touch Bionics to be serviced instead of sending the entire prothesis to the company. Therefore, while the patient is awaiting the return of the serviced part, h... More About: Action , Hand
Spinal Abnormalities in Young Tennis Players
2007-07-24 04:03:00 A recent study in the British Journal of Sports Medicine has looked at lumbar spine MRI findings of 33 tennis players (age 16-23) without any symptoms of pain. Of these, twenty-eight subjects showed signs of lumbar degenerative changes including spinal disc degeneration, herniated discs, complete fractures, stress fractures (pars lesions), and 23 with early signs of arthropathy. The rate of facet joint arthropathy was 70%, which is four/five times higher than the general population.MRI findings in the lumbar spine of asymptomatic adolescent elite tennis playersFaisal Alyas, Michael Turner, and David Connell Save This Page More About: Players , Tennis , Young , Layer , Normal
More on the Sports Hernia Front
2007-07-19 00:52:00 Research out of the Washington University School of Medicine in St. Louis has demonstrated that the surgical repair of sports hernias successfully returned athletes to competition in 93 percent of cases. The results of 61 sports hernia repair surgeries and a follow-up rehab program were presented at the annual meeting of the American Orthopaedic Society of Spor ts Medicine, held in Calgary, Alberta, Canada.This topic has been covered by this blog in the past, so it is interesting to note that they were able to get athletes back to their sport in five weeks after surgery. Hmmmmmmm... Save This Page More About: Front , Ports , Hern
Gender Differences in Marathon Runners
2007-07-15 01:05:00 Just a quick news update from the ACSM on marathon training and performance strategies. Read the press release or just cruise through my quick summary. Have a great weekend!Male runners had faster race times than female runners, due to men?s greater aerobic capacity and ability to pump more blood through the heart than women.Although a high per-week mileage was not necessary to merely finish the race, greater mileage increases aerobic fitness and usually leads to faster race times.Years of running experience did not play a significant role in race success.Non-serious past injuries and physical symptoms during the race, such as nausea, also had no significant bearing on outcome.The fastest marathon times were run in cool conditions of approximately 50 degrees Fahrenheit.The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 20,000 international, national, and regional members are dedicated to advancing and i... More About: Gender , Marathon , Differences , Gender Differences , Ender
Core Strength and Athletic Performance?
2007-07-08 16:13:00 A preliminary study out of the Indiana State University has demonstrated a poor correlation between core strength and strength and power in sports performance. The news article cites Thomas Nesser who stated that "the results are not showing that greater core strength is going to help you -- across the board -- with your sport. Only certain areas of the core showed a correlation with specific performance-based activities, and even then, the correlation was slight."Their core testing consisted of hold time for each of four different trunk positions: back extension, trunk flexion, and left and right bridge. Strength variables measures included bench press, squat, and power clean; and performance variables measured were vertical jump, 20- and 40-yard sprints, and a 10-yard shuttle run. From these variables, they found that core stability is only moderately related to strength and performance.What are the implications for this? Well, since this study has not been published in a pe... More About: Performance , Core , Perform , Athletic
Case Series on Drop-Out Casting for Knee Extension Loss After ACL Reconstru
2007-06-30 04:15:00 Let me be the first to congratulate fellow blog contributer Dave Logerstedt, for putting this interesting case series together for the Journal of Orthopaedic and Sports Physical Therapy. It is a great accomplishment and I look forward to his future research projects. Great job Dave!Read the article at the JOSPT website (subscription required).Case Series Utilizing Drop-out Casting for the Treatment of Knee Joint Extension Motion Loss Following Anterior Cruciate Ligament ReconstructionDavid Logerstedt, Brian J. SennettJ Orthop Sports Phys Ther. 2007;37(7):404-411 Save This Page
Web site for upper extremity surgery and conditions
2007-06-26 18:16:00 Dr. Matt Tomaino, Professor of Orthopaedics at the University of Rochestor has a user friendly site for patients. There are slides and video clips of surgical procedures and exercises. (You will note that some of the sections are not yet complete)Check it out at www.drtomaino.com Save This Page More About: Site , Surgery , Conditions , Condi , Web site
Gender Bias in ACL Injuries
2007-06-26 02:08:00 The February 2007 issue of the Journal of Orthopaedic and Sports Physical Therapy (JOSPT) featured an informative report on the differences of gender in anterior cruciate ligament injuries. There seems to be growing evidence towards a multi-factoral answer for why females are more prone to ACL tears, at a reported rate of 2 to 8 times more than males. While the differences may not be purely gender specific, females tend to exhibit a movement pattern which places them at increased risk for injury.Here are some highlights of mission statement from the retreat which produced the JOSPT report:-Biomechanical FactorsFemales demonstrate higher knee valgus angles and moments during a variety of cutting, landing, and squatting tasks; and these increased valgus forces have been shown to be associated with ACL injury risk.-Neuromuscular FactorsFemales are weaker (normalized to body weight) in hip strength as well as quadriceps and hamstring strength measures than males.Muscle activation pat... More About: Gender , Injuries , Bias , Ender
Medical Technologies
2007-06-22 17:00:00 In my search for adding additional content to our blog, I came across Medgadget.com. Medgadget.com is an independent, fast-growing on-line journal of the latest medical gadgets and technologies.What I like about this is the wide variety of specialties that use medical technology, both in the clinic and research lab. Recent posts in the sports medicine section has been on physiological monitoring and thermal cooling. If you are into gadgets, this is a great site to get the latest update on medical technology.Subsequently, I just finished reading a post from the Evidence in Motion blog about a PhD (non-physical therapist) promoting the end all be all cure to back pain. The blog makes some great points on a non-physical therapist providing a modality described as physical therapy and the legal and ethical issues that the Texas state association and state licensing board need to address immediately. Save This Page More About: Medical , Technologies , Logies , Logi
SiCKO
2007-06-20 22:40:00 Whether you are a fan of Michael Moore or not, his new movie, SiCKO, opens next week. It is a look at the current state of the health care system in the United States, and should definitely stir up some controversy. Working in the health care industry, I am sure we all experience the effects the insurance companies and the almighty dollar has on patient care. "Sick o paints a sobering picture of health care in America. It shows sick patients being dumped on skid row in Los Angeles; an accident victim who has to choose which finger to have reattached because he can't afford to pay for both. Some of the worst stories involve those who have insurance but are denied coverage, or who are overwhelmed by high deductibles. In his film, Moore says the consequences are undeniable." -NPR.orgWatch the Trailer Save This Page
Cyber Surgery
2007-06-18 03:32:00 Orthopedic surgeons are joining other disciplines in using virtual reality simulators to train novice surgeons in arthroscopic techniques. This training technique has been used previously for laparoscopy, vascular surgery, and other procedures. Recently, AJSM published an article (May 2007, Vol. 35, No. 6) to see if virtual arthroscopic shoulder surgery was comparable to real-life surgery. Surgical performance was quantified by time to completion, average probe velocity, probe distance travelled with respect to computer-determined optimal distance, and number of probe collisions with tissue. The researchers did indeed confirm their hypothesis: performance on a virtual reality simulator correlates with actual surgical experience. This may very well be a useful tool for the future of orthopedic surgical training.Will physical therapy (maybe manual techniques) ever join world of virtual training? Save This Page More About: Surgery , Cyber , Urge
Healthcare top 100 blogs
2007-06-15 15:52:00 Here is a link to a site that ranks the top 100 Heal thcare blogs that I found through Medgadget. Although the site has a ranking system that may not be the most scientific, it does provide the reader with a chance to survey all the healthcare blogs now available.Remember, blogs are written by individuals or groups of individuals that are usually expressing an opinion about a particular topic. In the case of medical, healthcare, or scientific blogs, these have not undergone the scrunity of peer-review to help determine its contribution to the scientific literature. They, however, can be thought-provoking and challenging to our assumptions.Dave Save This Page More About: Blogs , Logs , Top 100
Test for functional performance of upper extremity and neck
2007-06-14 17:36:00 BMC Musculoskeletal Disorders, a free-online-access journal published"Validation of a new test that assesses functional performance of the upper extremity and neck (FIT-HaNSA) in patients with shoulder pathology" on May 17, 2007. The lead author, Dr. Joy MacDermid is a physiotherapist and epidemiologist from McMaster University.( http://www.biomedcentral.com/1471-2474/8/ 42)You go to the BMC Musculoskeletal Disorders website and sign up for article updates. You will be e-mailed regular notification of that on-line journal's new/recent publications. Save This Page More About: Performance , Test , Form , Function , Trem
Open Access to JMMT Online!
2007-06-13 04:49:00 Forwarding this email I received from the editor of JMMT. There is a lot of great content available on their site, so go check it out. It is great that they are opening their information to the entire physical therapy community. I truly appreciate their efforts to share knowledge. Thanks!Just wanted to let you and the readers of your excellent blog know that we have a new issue available online of JMMT at http://jmmtonline.com/current/. This issue again has some open access content including a rather lengthy (for which my apologies) editorial I wrote discussing chiropractic challenges to the PT scope of practice (http://jmmtonline.com/documents/v15n2/Ed itorialV15N2.pdf). FYI, I am open to receiving and perhaps publishing letters to the editor on this topic.Open access content also includes an historical review paper by Dr. Thomas Terlouw on the early history of physical therapy in Europe and specifically in the Netherlands(http://jmmtonline.com/documen ts/v15n2/TerlouwV15N2E.pdf)... More About: Online , Access , Line
Patient Clinical Question?
2007-06-09 20:30:00 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 More About: Question , Patient
Shaken. Not Stirred.
2007-06-09 04:04:00 In a previous post, the use of whole body vibration training was discussed, along with a few interesting comments on the use of vibration training in the rehabilitation setting. Well, the APTA just posted a link to an article in the Washington Post on the risks involved with whole body vibration training:Scientists Urge Caution on Using Vibration Workout MachineAdvocates of a new type of vibration machine claim that it makes workouts more effective and reduces exercise time by two-thirds, but researchers say the science is thin and too little is known about the long-term effects of such powerful vibrations. Read the rest of the story here.Thoughts? Save This Page
Sports Injury Epidemiology
2007-06-08 00:00:00 May 2007 issue of Clinical Journal of Spor ts Medicine has been dedicated to epidemiological study of sports injuries. Topics range from managing the risk of sport to the Orchard Sports Injury Classification System (OSICS) to the development of a model using dynamics approach to determine the etiology of sports injuries.This issue happens to coincide with the recent article published in the Journal of Athletic Training on 16 years of data collected through the Injury Surveillance Survey (see June 4 edition)These reviews and summaries can provide exercise and sports scientists valuable information on collecting appropriate data and using that data to develop innovative preventative and treatment approaches for the athlete. Save This Page More About: Ology , Demi
Tennis Elbow or Acute Wiiitis???
2007-06-07 18:42:00 For all of you PTs out there treating a patient with an insidious onset of tennis elbow, you may want to ask your patient one question...do they own a Nintendo Wii?In the June 2007 issue of the New England Journal of Medicine, Dr. Julio Bonis wrote an editorial explaining a case of "Acute Wiitis." In the editorial, Dr. Bonis reports of a 29-year-old medical resident who woke one morning with severe right shoulder pain. The patient had no history of recent injury or physical activity; however, upon inspection, had positive tests consistent with acute infraspinatus tendonitis. After thorougly scrutinizing all of his activities over the past day, the patient remembered that he was playing a tennis video game on his new Nintendo Wii for several hours. "The final diagnosis for the isolated right shoulder pain was Nintendinitis. However, the variant in this patient can be labeled more specifically as 'Wiiitis'."For those who are not familiar with the new Nintendo Wii, it is an interacti... More About: Tennis , Elbow
NCAA Injury Surveillance System (ISS)
2007-06-04 23:11:00 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_eve nts/press_room/. Save This Page More About: Lance , Veil
A Little Housekeeping...
2007-06-01 05:20:00 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 ... More About: Housekeeping , Ping , Ouse , Litt
Running News
2007-05-27 22:25:00 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 sneak... More About: News
Out With the ACL Reconstruction?
2007-05-23 03:16:00 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 More About: Reconstruction , Const , Econ , The A , Cons
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. The sp... More About: Come
Active release technique - Science or voodoo?
More articles from this author: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 Technique s (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. L... More About: Science , Ique , Lease 1, 2, 3 |
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