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: METHODS
"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.
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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) Purpose:
Outcome measures:
Subjects:
Methods:
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. Results:
Notes: 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. The following post highlights some of the key points provided in the most recent position paper on Nutrition and Athletic Performance. It should be noted that this position paper was produced based on the the current state of the literature and that an Evidence Analysis Process (American Dietetic Association) was utilized to standardize this review. This paper was jointly provided by the Dietitians of Canada, the American College of Sports Medicine, and the American Dietetic Association, and it was their position that physical activity, athletic performance, and recovery from exercise are enhanced by optimal nutrition. These organizations recommend appropriate selection of food and fluids, timing of intake, and supplement choices for optimal health and exercise performance. Highlights of this Position paper Carbohydrate recommendations: 6-10g/kg (2.7-4.5 g/lb) BW per day or ~60% of total energy intake Protein recommendations: 1.2-1.7 g/kg (0.5-0.8 g/lb) BW per day
Fat recommendations: 20%-35% of total energy intake.
Dehydration occurs when there is a water deficit > 2%-3% body mass.
Fuel during exercise: carbohydrates approx. 30-60g per hour especially in endurance events After Exercise: carbohydrates approx. 1.0-1.5 g/kg (0.5-0.7 g/lb) BW during first 30 min. Also every 2 hours for 4 to 6 hours Multivitamin/mineral supplement may be appropriate if athlete is dieting, lacking in a particular food group, sick or injured, or has a specific deficiency. Athletic vegetarians may be at risk for low intakes of energy, protein, fat and key micronutrients (i.e. iron, calcium, vit. D, riboflavin, zinc, and B-12). Therefore, athletes who are at greatest risk for poor micronutrient status and MAY benefit from a daily supplement are those: Who restrict energy intake or have severe weight loss practices Who eliminate one or more of the food groups from their diet Who consume unbalanced and low macronutrient dense diets
Endurance athletes may require much more than the tolerable upper intake level for sodium (2.3g/day) and chloride (3.6 g/day). Sports drinks containing 0.5-0.7 g/L of sodium and 0.8-2.0 g/L of potassium, as well as carbohydrates are recommended for endurance sports > 2hr Pre-exercise
During Exercise
Classification of Supplements and Ergogenic Aids Those that perform as claimed
That may perform as claimed by evidence is still insufficient
That DO NOT perform as claimed
That are dangerous, banned or illegal
Vegetarian Athletes
Therefore, female, vegetarian athletes may be at greater risk for developing iron deficiency anemia and need routine monitoring This review is a summary of my submission to Research Review Service. The information below was derived from Thompson & Driskill’s Neurovasular Problems in the Athlete’s Shoulder, recently published in Clinics in Sports Medicine. For a greater understanding of the following information, including the etiology and management strategies of the various conditions, I strongly encourage you to read my full review.
Background Information
Neurogenic Thoracic Outlet Syndrome
Subclavian Artery Aneurysms
Axillary Artery Aneurysms and Occlusions
Digital Ischemia with or without Thromboembolism and Vasospasm
Effort Thrombosis of the Subclavian Vein
"Certain athletes are at higher risk of knee pain and non-contact knee injury than others."
The above statement is well known but unfortunately, not many of us know exactly why. Thankfully, the American Journal of Sports Medicine gave us some input into the biomechanical reasons some athletes are at risk of patellofemoral pain syndrome (sorry Mike) and potentially at risk of non-contact ACL injury. The information below is taken from two VERY recently published papers from the large scale Joint Undertaking to Monitor and Prevent ACL Injury (JUMP-ACL) study. This study examined the biomechanical variables involved in a jump-landing-rebound task. Biomechanical Factors Potentially Involved with Risk of Non-Contact ACL Injury
Biomechanical Factors Potentially Involved with Patellofemoral Pain Syndrome
This is what I think:
The preceeding information was derived from the two most recent issues of AJSM. It is strongly suggested that for a complete understanding, readers view the papers in their entirety as Padua et al was based on validating the Landing Error Scoring System and Boling et al interestingly found higher hip ER strength and lower ground reaction forces as risk factors. The use of compression garments have increased in popularity in recent years. Research has trended toward positive results for these compression garments indicating that they may, in fact, have performance-improving qualities. Below is a brief summary of a recently published paper looking at the Effect of Compression Stockings on Running Performance in Men Runners.
Study Methods
Study Results
Although it is difficult to pinpoint with 100% accuracy the exact mechanism of operation (previous studies have looked at venous hemodynamics, arterial perfusion, tissue oxygenation, muscle oscillation, lactate clearance, and DOMS), the results of this study suggest that compression socks may actually play a role in improving various aspects of run performance through mechanical efficiency. Of course, many factors may have influenced this study’s results (psychological effects, lack of placebo, etc) and most certainly does one study not preclude theoretical confirmation, however, many other studies have shown statistical significance and I have yet to read a paper that has demonstrated negative impacts on sport performance. Scientific knowledge expands daily. This article was published in 2008. THEREFORE…the information you are about to read MAY contain concepts that are obsolete…READER DISCRETION IS ADVISED!
The following is a summary of the IOC current concepts statement published in the British Journal of Sports Medicine. Contained within this summary are the general principles that were established based on decades of research pertaining to ACL injuries in female athletes. Since the amount of potential factors associated with injury are plentiful, this review is limited to only those concepts with conclusive evidence. Epidemiology
Risk Factors
Mechanism of Non-Contact Injury
Evaluation
Rehabilitation
Prevention
There you have it. My generalized summary of the IOC current concepts statement. Since published research on ACL injuries literally come out daily, please be reminded that some of the above concepts may have been updated. Although the assessment and treatment of myofascial and kinetic chain dysfunction has been used for numerous years, its presence in therapy clinics and performance centres have increased over the last decade times. Clinicians and strength coaches are well adept at developing the functional kinetic chain, however, very few understand importance of the fascial system. In order to adequately assess imbalance and dysfunction, a battery of tests may be performed.
An article by de Witt and Venter was published recently in the Journal of Bodywork and Movement Therapies and describes the “Bunkie” test for assessing functional strength. While “functional strength” encompases MUCH more than the myofascial system, let’s look at this testing procedure for assessing proposed fascial lines. The Bunkie test has generally been used as the main assessment tool in the Lyno Method and is derived from the Afrikaans word ‘bankie’ for little bench. This testing procedure is comprised of 5 different tests for specific fascial lines.
The bench height should correspond with the length of the humerus (~ 25 -30cm) Test position should be held for 20 - 40s (40s is preferred for endurance athletes) While this testing procedure still warrants validation, it may be useful in challenging cases to reveal areas of “locked-long” fascia along the specific line examined. A positive test for “locked-long” fascia is indicated by immediate pain upon testing, bodily rotation, and or inability to hold the correct position. The assessment of “locked-short” fascia must also be performed but is not directly related to the “Bunkie” testing procedure. I will discuss the assessment of such fascia as well as treatment of “locked-long” fascia (weak) lines in a future post. Here is a summary of the developments of the 3rd symposium on concussion in sport. This was held in Zurich 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 3rd 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.
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 |