.This week my review on Predictive Factors for Management of Rotator Cuff Tears was posted on Research Review Service.
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:
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.
The Sleeper Stretch has been one of the most commonly prescribed interventions for athletes presenting with Glenohumeral Internal Rotation Deficit (GIRD) of the shoulder.
But is this the most effective way to apply strain to the posterior capsule?
Using a cadaver-based study, Izumi et al examined and measured posterior capsule strain of 8 different shoulder positions.
What you need to know:
More information pertaining to this study's methodology:
Glenohumeral positions that significantly stretched the posterior capsule:
It should be noted that joint capsule strain seen in aged cadavers may not be similar to that seen in younger adults. In fact, strain rates in younger populations may indeed be larger.
CERVICAL ZYGAPOPHYSEAL JOINT PAIN PATTERNS II: A clinical evaluation (Aprill et. al., Spine, 1990)
A study testing the reliability of their pain charts by a clinical trial
Guiding principle: if the pain patterns could correctly identify the source of neck pain, they could then be used as diagnostic aids in the clinical assessment of neck pain.
10 subjects used and were administered diagnostic blocks according to the above pain patterns. A positive response was recorded if within 10 minutes, the blocks provided complete relief of pain lasting for the duration of action of the local anesthetic agent used
The diagnostic blocks used were cervical medial branch blocks performed under image intensifier using a lateral approach
In eight cases, there was complete concordance in the predicted levels between the first and second observers
In nine of ten patients, there was complete concordance between the predicted level and the positive response to blocks
Most patients reported areas that were more extensive than those seen in normal volunteers. Therefore, it appears that with stronger stimuli, the pain can spread beyond the core area, overlapping into adjacent zones
Results demonstrated that the segmental pain charts could be used with good accuracy to predict the segmental location of the symptomatic joint
This one's for the manual therapists out there. A brief little review of 2 landmark papers pertaining to fact joint pain and referral patterns.
CERVICAL ZYGAPOPHYSEAL JOINT PAIN PATTERNS I: A study in normal volunteers (Dwyer et. al., Spine, 1990)
A study determining whether or not pain from a given joint assumed a characteristic distribution…where the pain pattern in a given patient
might be used as an accurate indicator for clinically diagnosing the symptomatic joint
4 asymptomatic subjects were used
A contrast medium was injected into the joints, acting in a prevocational matter (experimental stimulus). Subjects were then examined for tenderness in both the cervical and shoulder regions
The distributions of evoked pain were recorded and a visual analog scale was completed
The medial branches of the dorsal primary rami were also blocked
The pain felt was deep and achy in quality
Following the analgesic blocks, the subjects unexpectedly demonstrated a slight hypesthesia over the area coinciding with the previous recorded area of invoked pain and tenderness
Concluded that the cervical z-joints can be sources of pain, including referred pain and that a physiological mechanism must exist whereby pain stemming from a z-joint can be referred into the related limb or limb girdle
Further, cervical z-joint pain is distributed in a pattern characteristic of its segmental origin
The Journal of Bodywork & Movement Therapies published an article by Eyal Lederman: The Myth of Core Stability. The following information is a summary of Lederman's conclusions.
ASSUMPTIONS ABOUT STABILITY AND THE ROLE OF CORE MUSCULATURE
Despite the role of the core musculature in creating spinal stability...
Despite the exponential number research studies conducted in the last decade...
While the control of specific core musculature has been highly regarded in its "relationship" to low back pain...
While it is known that trunk muscle strength may decrease as a result of low back pain and injury...
CORE MUSCLE ACTIVATION
There are still many practitioners that still follow the single core muscle activation concept (TrA), unfortunately...
THE RELATIONSHIP BETWEEN CORE STABILITY TRAINING AND MOTOR LEARNING
While training for an activity often leads to skill development in that activity (i.e. piano)...
Although many novel core exercises are now performed in more "functional" positions (i.e. standing, moving)...
Furthermore, while individuals are constantly reminded to continuously tighten their core musculature...
CORE STABILITY FOR INJURY PREVENTION AND THERAPY
While an asymptomatic individual may present with weak abdominals...
CORE STABILITY AND ITS RELATIONSHIP TO THE CAUSE OF LOW BACK PAIN
While our understanding of the aetiology of back pain has increased tremendously over the last decade...
POTENTIAL DAMAGING EFFECTS OF CORE STABILITY
Although compressive forces on the lumbar spine may contribute to low back pain...
While core training may be aimed at biomechanical dysfunction...
TAKE HOME POINTS
If accessible, I strongly encourage you to read the paper in full. While Lederman makes some valid points, it was quite interesting that of the 200+ references cited, only one was primarily authored by Stu McGill, a 2003 study at best. Further, much of the points Lederman alludes to have already been elaborated upon by McGill in his book, Ultimate Back Fitness and Performance (also available in my "Educational Resources" above). Again, the above information are merely a summary of Lederman's conclusions.
Make sure you leave a comment and let me know what you think!
For those of you who are still using the Smith Machine to Squat, here is another reason why you should set yourself "free".
A recent study published in the Journal of Strength and Conditioning Research, examined the electromyographic activity (EMG) of various muscles during the squat exercise when performed using the Smith machine as well as using free weights. This was performed as a follow up to a 2005 study by Anderson and Behm that demonstrated higher EMG activity of the quadriceps muscles during the Smith Machine squat.
The major difference between this and that of its predecessor was that a weight equal to an 8RM for EACH exercise (to facilitate relative intensity) was utilized in comparison to a fixed, absolute weight for both exercises used by Anderson and Behm.
EMG activity was collected for the following musculature:
A relatively low "N" was used: 3 men, 3 women. All were active in sports and familiar with the use of both free weights and the Smith machine.
The average absolute EMG activity for the free weight squat was:
Interestingly, no significant differences in EMG activity of the trunk musculature were found between the two exercises. I will keep my opinions to myself on this, especially when only 6 subjects were used.
Additionally, I was both surprised and disappointed the authors failed to include the gluteal musculature within this study since hip extension is one major component of the squat exercise.
These findings likely represent a increased stabilizing role of the above musculature for the hip, knee and ankle during free weight squats.
If you are a strength coach or manual therapist, I can say with 99.9% certainty that you have at one point or another recommended a Standing Wall Stretch to a client or patient. You may have done so for various reasons, including improved triceps surae length, but have you recommended this stretch with external assistance?
The external assistance that I speak of actually comes from a medial arch support.
A recent study published in JOSPT, examined the effect of Standing Wall Stretching on a number of variables in subjects with "neutral" foot alignment and in those with "flat" feet. The variables examined were:
The main finding of this study was that following the stretching protocol, the difference in DMTJ was significantly greater in those with flat feet (pes planus). Therefore, for those of you who recommend the Standing Wall Stretch to improve gastrocnemius length, it may be wise to use a medial arch support in those athletes presenting with Pes Planus.
The following is a summary of a recent article in The Journal of Manual & Manipulative Therapy answering the question "Does manual lymphatic drainage actually do what its meant to do?"
Systematic Review of Efficacy for Manual Lymphatic Drainage Techniques in Sports Medicine and Rehabilitation: An Evidence-Based Practice Approach (Vairo et al: 2009)
Dating back to at least the days of Andrew Still, the founder of Osteopathy, Manual Lymphatic Drainage Techniques (MLDTs) have been utilized in manual therapy settings in an attempt to theoretically:
Unfortunately however, as with many manual therapy techniques, the efficacy of MLDTs in the sport medicine realm lacks solid scientific evidence and therefore, must simply be appreciated for its empirical evidence.
Specifically speaking, Vairo et al, recently published their systematic review that can be outlined as follows:
"a light massage therapy technique that involves moving the skin in particular directions based on the structure of the lymphatic system. This helps encourage drainage of the fluid and waste through the appropriate channels."
RESULTS & DISCUSSION
Several modes of MLDTs have been described including the Vodder method, as well as lymphatic pump techniques. From this published review, it was revealed that solid scientific evidence to support MLDTs in sport medicine is lacking and therefore, its use can be attributed primarily to anecdotal evidence. However, to date, the strongest evidence in support of MLDTs, based on this review, lies merely in 3 RCTs; suggesting it potential efficacy in regulating serum levels of enzyme associated with acute muscle damage, as well as reducing edema induced by distal radius fracture and acute ankle sprain. As such, caution must be taken when making definitive recommendations for clinical practice guidelines in the management of sports injuries with manual lymphatic drainage. Yet from a scientific standpoint, a call for consistency of MLDT protocols in intervention research is necessary in order to effectively make comparisons across studies so that the efficacy, optimal treatment durations, and an ideal rate and frequency of MLDTs for sport injuries can be determined.
It goes without saying that the "commonly" held belief about stretching entering 2010 is that an athlete should not perform static stretches immediately prior to competition.
We have a long way to go before we can convincingly tell ourselves when and when not to stretch, but before you proceed with forming an opinion, here's another study to add to your growing list of research papers pertaining to stretching and performance. In particular, feel free to throw this paper in the "Yes" (to stretching) basket.
Negative effect of static stretching restored when combined with a sport specific warm-up component (Taylor et al, 2009)
Static stretches: calves (standing), achilles tendon (kneeling), hamstring (seated), gluteus maximus (seated with forward lean), quadriceps (standing), lower back (lying), groin (seated), hip flexor (kneeling), quadratus lumborum. All stretches were held for 30s.
Dynamic stretches: high knees, butt flicks, carioca, hamstring swings, groin swings, arm swings, rapid high knees, side stepping, spiderman walks, upper body rotations, vertical jumps, countermovement jumps, and sprints.
Netball-specific skill warm up: short sprints, shuffling, accelerations, direction changes, single and double legged jumps. THese were performed at game intensity or just slightly below.
The authors admit that the initial differences may be due to differences in muscle temperature between the static and dynamic groups. (This was not confirmed)
My opinions on this study:
The ability to perform well during a triathlon is dictated by one’s ability to perform optimally in each of its three disciplines: swimming, biking, and running. Previous research has demonstrated that running performance during a triathlon is affected by cycling intensity, cadence, bicycle frame geometry, power output consistency, and drafting. However, very little research, if any, has looked at the relative contributory effect of swimming on overall performance in a triathlon. As such, Peeling & Landers conducted a review of the literature pertaining to Swimming intensity during triathlon that was recently published in the Journal of Sports Sciences.
The authors of this review cited previously conducted research by Vleck, Laurse, Kreider, Delextrat, McCole, Bentley, Chatard, themselves, and several others. Based on this review, the current state of the literature can be summarized as follows:
It was no secret that the various strategies mentioned above are utilized during the swim leg of a triathlon in order to increase the likelihood of a optimal results. However, Peeling & Landers were perhaps the first to document all variables through this review in its entirety. It should be noted, however, that the majority of research has solely focused on the Sprint and Olympic distances and therefore, the recommendations pertaining to long course races (70.3 and Ironman) may differ.