This series was written by my friend and colleague, Dr. Shawn Thistle of Research Review Service.

If you are a health care practitioner, strength coach, or individual who works with this population/demographic, I highly suggest you take the time to read.

Here’s the link.

Low Back Pain – A Contemporary Healthcare Crisis

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Related posts:

1. The Role of Diagnostic Imaging for Low Back Pain R. Chou, A. Qaseem, DK. Owens et al. (2011). Diagnostic...
2. Movement Patterns of the Lumbar Spine and Sacrum During the Back Squat McKean MR et al. (2010). The lumbar and sacrum movement...
3. Controversy or Responsibility Disappointment....

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Authors: R. Chou, A. Qaseem, DK Owens et al.

Journal: Annals of Internal Medicine

Date: 2011

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Summary:

• My full review of this paper was recently posted on Research Review Service but since I feel strongly about its message, I thought it would be a good idea to provide you with a brief introduction. In concert with the high incidence of low back pain in today’s society lies a relatively high rate of requisitions for diagnostic imaging of neuromusculoskeletal conditions pertaining to the lumbar spine. Unfortunately, the appropriateness of such imaging studies may be questionable at best for many of these conditions owing to the fact that the outcome of care often leads to similar results in those patients who have undergone “routine” imaging and those who have not regardless of whether such tests were performed. Certainly, such imaging may be required for those patients suffering from severe and /  or progressive neurological deficits as well as for those presenting with serious underlying conditions however, more often than not, those patients presenting in general family, chiropractic or rehabilitation practices may do well without the unnecessary doses of radiation and costs to the health care systems. This best practice advice paper provided by the Clinical Guidelines Committee of the American College of Physicians provides the medical reader with a summary of the current literature pertaining to the utility of diagnostic imaging for low back pain and advises on the rationale behind evidence-informed decision making when a patient presents with low back pain symptoms. Utilizing results from high-quality studies, suggestions are made for cost worthy diagnostic protocols and advice is given on the potential harms and benefits of radiological procedures. Additionally, a valuable summary for patients has also been provided of which can be easily accessed here.

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R. Chou, A. Qaseem, DK. Owens et al. (2011). Diagnostic imaging for low back pain: Advice for high-value health care from the american college of physicians. Annals of Internal Medicine, 154; 181-189

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Related posts:

1. Movement Patterns of the Lumbar Spine and Sacrum During the Back Squat McKean MR et al. (2010). The lumbar and sacrum movement...

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Research Review Service is an online resource for fitness professionals as well as manual and rehabilitative therapists provided by Dr. Shawn Thistle of which I contribute to. This website provides practical and clinically applicable reviews on a weekly basis enabling subscribers to stay up to date with the most current literature. From therapeutic approaches to low back pain to orthopaedic testing to physiological principles of exercise interventions, Research Review Service not only keeps you up to date with the published literature but also provides a critical approach to the methods by which these studies have been performed. For those of you who are unfamiliar with this service, I highly suggest you take a peek at the 10 20 research summaries that Dr. Thistle graciously provided. Have a look and tell me what you think.

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Just recently, my good friend Mark Young launched his new product, How to Read Fitness Research. I was fortunate to have had the opportunity to take an early look at this valuable and inexpensive resource and while I hold a graduate degree myself, it was nice to be able to utilize the time to refresh my memory on some of the important principles surrounding the research process. Mark introduces the purpose of and foundation upon which research lies as well as provides simple strategies for accessing published literature. Additionally, he devotes and entire presentation to explaining statistical principles, concepts of which we all must understand if we are going to make a living providing our services in health related industries. As a side note, I cannot stress enough that the most important section of a research article is its “methods” and Mark takes the time to share the same sentiments. If you are new to the fitness field or simply want a refresher on how to interpret the literature, then I highly suggest you take a look at what this product has to offer.

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If you have any questions on any of the above services, please don’t hesitate to ask. If you read this blog on a regular basis then you will understand how important evidence and education plays in the implementation of your services. I, myself, will continue to provide you with the regular “looking at the literature” summaries but if you want to take that next step then I highly suggest you have a look at both Research Review Service and How to Read Fitness Research.

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*Please note that while I fully endorse each of the above, they are both affiliate-based links.

Related posts:

1. Ten Research Summaries from Research Review Service A free download from Dr. Shawn Thistle...

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Dr. Shawn Thistle and his team of writers provides this site full of “clinically applicable, evidence-informed information for manual medicine providers and personal training professionals”.

He recently provided us with a free document that summarized 10 important research articles published in the past year ranging from topics pertaining to headaches, chronic low back pain, femoral-acetabular impingement, glucosamine, pain science, etc. This document can be downloaded here.

If you are a clinician or fitness professional, and value research and evidence in your practice, I highly encourage you to check out his site.

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Study Title: Cryotherapy to Treat Persistent Muscle Weakness After Joint Injury

Authors: C. Kuenze & J.M. Hart

Journal: The Physician and Sportsmedicine

Date: October, 2010

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Summary:

• This paper reviewed the potential beneficial effect of cryotherapy on a common clinical entity beyond that of pain or inflammation…muscle weakness. While muscle weakness following joint injury may be a product of a multitude of factors upstream of simple reflex inibition mechanisms, “arthrogenic muscle inhibition” caused by structural damage and / or effusion may nonetheless persist throughout post-injury rehabilitation and recover. Of particular concern is the potential for high-threshold or compensatory muscle activity when specific muscles being exercised are unable to fully activate. The authors of this paper reviewed several studies looking at the approach of cryotherapy on AMI. From the limited existing literature available, it was revealed that pre-rehabilitative cryotherapy may have a transient, disinhibitory efect on muscle recruitment ability. That while the mechanism of such intervention has still yet to be ascertained with certainty, the application of 20-30 minutes of “cryotherapy prior to therapeutic exercise (may) provide a method for clinicians to open the motoneuron pool prior to exercise to maximize effectiveness.”

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Kuenze, C. & Hart, J.M. (2010). Cryotherapy to treat muscle weakness after joint injury. The Physician and Sportsmedicine, 3 (38), 38-42.

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Here’s a brief summary of the study:

Study Purpose:

• To determine the presence of a relationship between hamstring length and PFJ stress at 3 specific knee joint angles of flexion.

Study Population:

• 16 recreationally active males divided into two groups based on knee joint angle-measured hamstring length.

Methodology:

• A biomechanical model incorporating knee joint angle, knee extensor moment, and PFJ contact area was used to quantify PFJ stress.
• MRI and 3D motion analyses were also utilized in this study.
• A one-way ANOVA to determine the variations in PFJ stress between the 2 groups (with and without reduced hamstring length) was used.

Main Findings:

• Patellofemoral Joint stresses differed significantly between the two groups at specific angles of knee flexion.
• No significant differences in hip angles between the two groups.

Clinical Application:

• This study demonstrated that subjects with reduced hamstring lengths have increased PFJ stress during various positions of the squatting movement.  As a result, such a decrease in length MAY contribute to the pathogenesis of various conditions relating to the knee.
• These results enable us to consider another factor when managing those with knee pathology.

For a complete and “evidence-informed” understanding of the study, check out my review. I have obviously left out specifics from this study in this post as Research Review Service is a paid membership site. However, if you would like more information, please do not hesitate to ask.

Photo source

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*note: the above link for RRS is an affiliate link

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So for those of you looking to stay up to date with your prescribed training programs and exercises, I highly suggest you subscribe to this service. If you would like to see some brief examples of my written contributions, just type in “Research Review Service” in the search panel above, or click here.

Disclaimer: As mentioned above, I am a contributer to this service and am part of the affiliate program

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This review integrated the results of two studies that investigated the effect of pain, tear size, location and humeral head migration on the clinical outcomes and risk of progression in patients with rotator cuff tears.

As always, for a complete understanding of the study, please read the articles below. To access my review, please visit Research Review Service

The two studies reviewed:

1. Proximal Humeral Migration in Shoulders with Symptomatic and Asymptomatic Rotator Cuff Tears
2. Outcome of Nonoperative Treatment of Symptomatic Rotator Cuff Tears Monitored by Magnetic Resonance Imaging

Main findings:

• Proximal humeral migration was significantly related to rotator cuff tear size and the involvement of the infraspinatus tendon.
• Progression of rotator cuff tears was more likely to occur in patients older than 60 years, those involving a full-thickness tear, and in shoulders demonstrating fatty infiltration upon magnetic resonance imaging.

Clinical application:

Conservative management alone may not be sufficient in those individuals presenting with the specific characteristics described above. Therefore, simultaneous referral for orthopaedic consultation would be warranted in prudent case management.

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Hopefully mid-January isn’t too late to wish you a HAPPY, HEALTHY and PROSPEROUS 2010!

You may not be sad to see the end of 2009…the economic downturn continued and took its toll on many businesses.  Luckily (for us anyway), pain and injury are not economic variables, and our patients will always need us.  In the current economic climate, many patients are more discerning than ever with their health care dollar.  Accept this challenge and continue providing evidence-informed,  contemporary care for your patients.  Arm yourself with current knowledge and stay ahead of your competition!

In 2009, we posted 59 new reviews on research you need to know about…here are some important highlights:

…WE REVIEWED CLINICAL CONDITIONS including:

Cauda equina syndrome
Greater trochanter pain syndrome (bursitis) – *Short summary here
Neurovascular conditions in athletes - *Short summary here
Adhesive capsulitis
Biceps tendon injuries
Concussion – *Short summary here
Internal shoulder impingement
Sudden cardiac arrest in athletes

THERE WERE UPDATES IN BACK PAIN RESEARCH including:

Dr. Shawn Thistle
(e: shawn@researchreviewservice.com)

*NOTE: for those of you in the FITNESS / STRENGTH & CONDITIONING industry, there’s also Research Review Service FITNESS

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Background Information

• Although rare, neurovascular conditions of the upper extremity occasionally present themselves in elite athletes. These may be challenging to detect, but are certainly important for their potential to cause limb-threatening consequences. Early recognition, proper initial treatment, and urgent surgical referral increase the likelihood of rapid return to pre-injury levels of performance and more importantly, decreases the likelihood of serious complications.

Neurogenic Thoracic Outlet Syndrome

• Arm and/or hand pain, numbness, and paresthesia that results from compression, irritation, and chronic injury affecting the roots of the brachial plexus.
• May be caused by cervical ribs and hypertrophy of the scalene and pectoralis muscles.
• Exacerbated with direct palpation and arm elevation.
• Severe cases rarely seen in elite athletes

Subclavian Artery Aneurysms

• Stenosis and aneurysm formation of the subclavian artery.
• Typically associated with cervical ribs and atypical first ribs.
• Thrombus and subsequent embolization, travelling to the distal arteries causing symptoms of exertional arm fatigue and/or acute digital ischemia.
• Full return to activity generally within several months.

Axillary Artery Aneurysms and Occlusions

• Most exclusively in baseball pitchers.
• Humeral head translates forward during end-range extension and elevation, resulting in compression and stretching of the axillary artery combined with fixation against the tendon of the pectoralis minor.
• Extreme repetitive motion
• Symptoms are similar to that of subclavian artery aneurysms and include exertional arm fatigue and/or acute digital ischemia.
• Full return to activity generally within three months.

Digital Ischemia with or without Thromboembolism and Vasospasm

• Numbness, tingling, cold and painful sensations
• Cyanosis or pale discoloration and delayed capillary refill.
• Radial and ulnar pulses may be absent or decreased, and blood pressure may be diminished
• Digital artery thrombosis: due to localized repetitive trauma associated with index and/or middle finger pressure when gripping and throwing the ball.
• Digital artery thromboembolism: seen in catchers and results from chronic repetitive trauma to the base of the hand.
• Digital artery spasm: seen in baseball due to the rampant use of vasoconstrictive tobacco products.

Effort Thrombosis of the Subclavian Vein

• Paget-Schrotter syndrome: the most commonly seen vascular disorder in young competitive athletes.
• Compression of the subclavian vein between the clavicle and first rib.
• Combination of positional compression and arm exertion in elevation.
• Involves the formation of scar tissue, collateral vessels, and subsequently thrombosis
• Swelling, cyanosis, pain, heaviness and/or fatigue.
• Suspected if presenting with sudden onset of arm swelling and cyanosis, especially in overhead athletes (throwers, weightlifters, swimmers).
• Urgent surgical referral is essential for full return to activity

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Don’t worry, for those of you in the strength and conditioning world, there’s something for you too…Research Review Service FITNESS!

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For my first post, I would like to summarize the developments of the most recent symposium on concussion in sport. This was held in Zurich last year and brought together the “big dawgs” in sports concussion. Since this is merely a summary, I ask that you all read the original document in its entirety as well as my summary found at Research Review Service.

Here’s the summary:

The 3^rd and most recent symposium was based on the need to address issues pertaining to acute simple concussion, return-to-play, complex concussion and long-term issues, pediatric concussion, and future directions.  Additionally, this statement examined and addressed the management issues discussed in the first and second symposia.

• Updated classification of concussion in sport: The use of the terms “simple” and “complex” to classify concussion were abandoned at this symposium.
• Sideline evaluation of acute concussion: While the need for a thorough, post-injury evaluation was established since the first consensus statement, it was agreed that an appropriate medical assessment be performed in all cases and that rule modifications may be necessary in some sports in order for this to occur. Such modifications would enable a proper assessment to be performed without disrupting the game in play (e.g.. rugby) or punishing the team involved (e.g.. soccer).
• Concussion management and same-day return to play: It was recognized that certain settings in adult athletics may have experienced personnel, such as neuropsychologists, and resources (neuroimaging) at their immediate disposal. In such situations, return to play may follow a more rapid process based in part on evidence collected from research in professional football. However, was the conservative treatment of younger athletes (<18 yoa) was strongly suggested.
• Modifying factors: Identified at this symposium were a range of specific modifiers with the potential to complicate cases and therefore, warrant advanced care and attention. Prolonged LOC (> 1 minute) was an example of such a modifier. Gender on the other hand, was reported inconclusive as a modifier; however, sex was accepted as a potential risk factor and/or influence of injury severity. Further, the presence of immediate motor signs and/or convulsions were reported to warrant no more than standard concussion management.
• Children and adolescents: Updating from the previous developments of the Vienna and Prague statements was the statement that the standard evaluation and management recommendations be applicable only to those aged 10 and older. All assessments performed on younger athletes must include age-appropriate symptom checklists. In addition, cognitive testing was recommended to be developmentally sensitive, especially in those presenting with learning disorders and/or ADHD. A more conservative RTP approach was also reiterated in this population.
• Elite athletes: All organized high-risk sports should incorporate these formal baseline neuropsychological screening assessments regardless of age or level of play.
• The sport concussion assessment tool 2 (SCAT2): The original SCAT card was revised and includes a “pocket” SCAT2.

The SCAT2 now boasts four pages of examination resources to aid in the concussion assessment protocol. Specifically, the previously integrated evaluation components have been expanded to its original sources and the SCAT2 now incorporates the Glasgow Coma Scale (GCS), the Modified Maddocks Questionnaire and the Standardized Assessment of Concussion (SAC) as separate entities within. Identified in this tool is its potential use for baseline testing.  The quantification of injury evaluation plays a significant role in the updated SCAT2 and permits the tabulation of an “overall” test score. Unfortunately, however, a definitive “cut-off” score has yet to be determined. Useful though is the ability to isolate and quantify the SAC score for use in the management of a particular concussive event.

A section devoted to balance testing (based on the modified Balance Error Scoring System) was also incorporated. This protocol utilized the double leg, single leg, and tandem stances. A finger-to-nose task was also included to isolate upper limb coordination. Finally, a detachable section on the final page permits the provision of advice to those sustaining a concussive injury.

…well there you have it. Again, I advise you to read both the document in its entirety as well as my review posted on www.researchreviewservice.com

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