by ptfadmin | Dec 22, 2021 | Health Tips
by Logan Swisher, PT, DPT, OCS
Introduction
Fibromyalgia syndrome is characterized by chronic and diffuse musculoskeletal pain. The exact cause of fibromyalgia is unknown but abnormalities of the pain processing in the nervous system, such as hyper-responsiveness and hyper-excitability, may explain the chronic pain. Myofascial trigger point pain is defined as pain from one or more hyperirritable or hypersensitive palpable nodules in skeletal muscle which can refer pain locally and globally over the body. Myofascial release is a therapeutic intervention aimed at providing pain relief by restoring impaired soft tissue function. Dry needling, on the other hand, is a minimally invasive technique where an acupuncture needle is inserted directly into myofascial trigger points with the end goal of decreasing local and referred pain. This article aimed to compare the effectiveness of dry needling vs. myofascial release for patient with fibromyalgia.
Participants
64 total participants (58 women and 6 men)
-32 participants assigned to the dry needling group
-32 participants in the myofascial release group
Methods
In this single-blind randomized controlled trial patients were assigned to a dry needling or myofascial release group. Pain pressure thresholds of trigger points in the cervical muscles were assessed as well as quality of life, impact of fibromyalgia symptoms, quality of sleep, intensity of pain, anxiety and depression symptoms, and impact of fatigue at baseline and 4 weeks post treatment.
Results
Significant improvement was found in most pain pressure thresholds of the myofascial trigger points in cervical muscles in the dry needling group as compared to the myofascial release group. Dry needling also demonstrated higher improvements in quality of life, quality of sleep, anxiety, depression, fatigue and intensity of pain, whereas, myofascial release demonstrated significant improvement in intensity of pain and impact of fibromyalgia symptoms.
Clinical Relevance
When appropriate, dry needling therapy should be strongly considered with myofascial release techniques for patients with fibromyalgia. Here at Physical Therapy First, we have therapists trained in dry needling and myofascial release techniques. We will complete a thorough evaluation and comprise a multimodal treatment plan to address your current functional limitations and pain levels to help you restore your previous level of activity.
Reference
Castro Sánchez AM, García López H, Fernández Sánchez M, Pérez Mármol JM, Aguilar-Ferrándiz ME, Luque Suárez A, Matarán Peñarrocha GA. Improvement in clinical outcomes after dry needling versus myofascial release on pain pressure thresholds, quality of life, fatigue, pain intensity, quality of sleep, anxiety, and depression in patients with fibromyalgia syndrome. Disabil Rehabil. 2019 Sep;41(19):2235-2246. doi: 10.1080/09638288.2018.1461259. Epub 2018 Apr 23. PMID: 29681188.
by ptfadmin | Dec 13, 2021 | Health Tips
by Logan Swisher, PT, DPT, OCS
Introduction
Osteoarthritis (OA) is the most common cause of disability in adults and it is estimated that 14 million individuals in the US have symptomatic knee OA. Total knee arthroplasty (TKA) has been proven as an effective and cost-efficient intervention for end- stage knee osteoarthritis. Most people who undergo a TKA have marked improvements in function and reduction of pain compared to their preoperative condition, however, others have varied recovery of their functional abilities and not all patients experience significant improvements after surgery. The aim of this study was to examine if preoperative measures could predict functional ability at 1 year and 2 years after surgery.
Participants
-155 participants at initial evaluation
-155 participants at 1 year follow up
-125 participants at 2 years follow up
Methods
Measurements of participants age, height, weight, bilateral quadriceps muscle strength, knee flexion and extension range of motion, the Timed “Up and Go” test (TUG), stair-climbing task (SCT), and two subsets of the Knee Outcome Survey (KOS) which were the activities of daily living and pain subsets.
Results
The TUG, SCT and KOS scores at 1 and 2 years showed significant improvement over the scores at the initial evaluation. A weak quadriceps muscle in the limb that did not undergo the surgery was related to poorer 1-and 2-year outcomes. It was also found that older participants with higher body masses also had poorer outcomes at 1 and 2 years.
Clinical Relevance
The study revealed the importance of rehabilitation regimens after TKA incorporating exercises to improve strength of the non-operated limb as well as treat the deficits imposed by surgery. If left untreated, weakness in the non-operated limb may continue to impede functional ability and result in poorer postsurgical outcomes. There should also be an emphasis on treating age-related impairment, such as poor balance and strength, and reducing body mass to help improve long-term outcomes. At Physical Therapy First, our physical therapists will perform a thorough 1-on-1, hour long appointment and work with you to create a plan of care that helps you reach your goals.
References
Zeni JA Jr, Snyder-Mackler L. Early postoperative measures predict 1- and 2-year outcomes after unilateral total knee arthroplasty: importance of contralateral limb strength. Phys Ther. 2010 Jan;90(1):43-54. doi: 10.2522/ptj.20090089. Epub 2009 Dec 3. PMID: 19959653; PMCID: PMC2802824
by ptfadmin | Nov 23, 2021 | Health Tips
by Nick Mattis, SPT
Intro
Netball is a popular court-based game in Australia and New Zealand that is rapidly gaining popularity in the United States. The game involves a lot of movement with rapid change of direction and immediate stopping when in possession of the ball. These rapid movements and immediate stopping can place excessive amounts of force and stress on the joints of the body, specifically the lower extremity. Netball has several rules, with one being the footwork rule. Once receiving the ball, if the player lands on one-foot, single leg landing (SLL), they are allowed to place the opposite foot on the ground to slow their momentum and pivot. If a player lands with both feet on the ground, double leg landing (DLL), they are allowed to pivot around one foot. The footwork rule in netball may result in vertical ground reaction forces in which of the following ranges? The footwork rule results in the body absorbing vertical ground reaction forces (VGRFs) of up to 5.7 times the players bodyweight. This rapid absorption and stabilization of the forces by the soft tissues in the leg can stress the tissues to injury. One of the most injured joints in netball is the knee. A range of 4.5-32.7% of tears occur in which tissue? The meniscus is most common soft tissue injury in the knee (4.5-32.7%) with the Anterior Cruciate Ligament (ACL) following closely behind (17.2–22.4%). Due to the common occurrence of these injuries, it is important for practitioners to understand how the injury occurred and the level of activity required to return to sport to formulate an appropriate rehabilitation plan.
Situation and Mechanism of Knee Injury
Since netball requires a lot of agility and due to the high impact movements, there is a risk of soft tissue injury from the excessive loads. Medical professionals need to understand how, where, and when the injury occurred. So, it is important to look at statistics to get an idea of how the injuries frequently occur. Most netball soft tissue injuries of the knee happen during which of the following? The majority of netball injuries occur in match play compared to training. Incidence reports injuries occur 7 times more frequently in match play than in training. Which of the following statements is true regarding netball soft tissue knee injuries? Most netball soft tissue knee injuries occur on outdoor courts, specifically asphalt. There are not nearly as many reported injuries with the indoor courts. Most netball soft tissue injuries occur in which maneuver? Landing from a jump causes the highest frequency of soft tissue knee injuries in comparison to change of direction and deceleration. There have also been patterns of body kinematics that have been associated with knee injuries. Knee abduction and trunk aberrant motion occurs in as many as 83% of noncontact ACL injuries in netball. One of the patterns is knee abduction combining with ipsilateral lateral trunk flexion. This causes a knee valgus and puts the knee at a more susceptible position of injury to the ACL, MCL, and valgus collapse. Injuries are classified in three ways: contact, indirect contact, and noncontact. Contact injuries occur at the knee through an opposing player or object making direct contact with the players knee (1). A netball soft tissue knee injury that occurs after contacting another player’s foot would be an example of which type of injury? An indirect contact injury to the knee would occur through an opposing player contacting the player in another location besides the knee that results in injury to the knee. An example of this would be stepping on an opposing player’s foot (1). A noncontact injury to the knee would occur when there is an injury at the knee without an external factor such as contact from an opposing player or object (1).
Screening
As stated before, landing from a jump causes the highest occurrence of soft tissue injury to the knee. It is important to use and apply a screening tool to identify those at risk or who have sustained soft tissue knee injuries. This tool is called the Landing Error Scoring System (LESS) (1). Concerning movement screening, the real time landing error scoring system (LESS) evaluates which physical characteristic? The LESS is used to grade generic DLL movement patterns (1). This is a 17-question examination of movement identifying the landing movement from the head down to the toes. Through this assessment one can make predictions of those at risk of a soft tissue knee injury. Limitations on this measure include it only examining DLL and does not examine SLL that is often occurring in netball; therefore, it cannot be related specifically to netball requirements (1).
Prevention Training
There are several types of training that can be applied and useful to the netball athlete including strength, balance, and plyometrics. There has been one specific type of training though that has been found to assist netball players and be sport specific to their requirements. Which of the following types of training have resulted in decreased vertical ground reaction forces, increased knee flexion angles, and decreased knee abduction angles during single-leg and double-leg landings? Plyometric training has been found to be extremely effective in improving the biomechanics (listed previously) of netball to allow for softer landings that place less stress throughout the knee; therefore, reducing the risk of soft tissue knee injury. During which of the following should landing mechanics that carry over to match play be emphasized? Netball landing mechanics should be emphasized when performing plyometric training. It is important to make the training sport specific to strengthen the musculature and surrounding soft tissue to meet the demand of sport to reduce the risk of injury when playing.
Here at Physical Therapy First, our team of skilled therapists are able to assess, educate, and rehabilitate you in the recovery from a soft tissue knee injury. Our therapists are also trained in injury prevention and can offer athlete specific consultations to help reduce the risk of injuries. Through manual techniques and other sport-specific interventions, we can restore your ROM, increase strength, and help you return back to activity. Your therapist can help you improve your biomechanics to get you back to your individual functional needs. Call today to schedule an appointment.
References
1) Clark NC. Noncontact Knee Ligament Injury Prevention Screening in Netball: A Clinical Commentary with Clinical Practice Suggestions for Community-Level Players. Int J Sports Phys Ther. 2021;16(3):911-929. Published 2021 Jun 1. doi:10.26603/001c.23553
by ptfadmin | Nov 10, 2021 | Health Tips
by Nick Mattis, SPT
Introduction:
The glenohumeral joint (shoulder) has a high level of mobility which comes at a price of low stability. Due to the extensive range of motion of the shoulder, the shoulder is not as stable as several other joints in the body (i.e. elbow, knee). Passive stabilizers of the glenohumeral joint include which of the following? There are several passive stabilizers of the joint such as the glenoid labrum, the ligamentous structures, and the bony articulation of the joint (2). Active stabilizers of the glenohumeral joint include which of the following? Then there are active stabilizers of the joint such as rotator cuff muscles, deltoid, biceps brachii, and latissimus dorsi. These active stabilizers are able to contract to assist with keeping the humeral head in the glenoid fossa. Active and passive stabilizers can become strained/torn/ruptured when the humeral head enters abnormal positioning outside the center of the glenoid cavity. During the dip exercise the humerus often reaches the end range of extension and can place the humeral head in an abnormal position. Which of the following describes the movement of the humeral head at the end of a range of movement during a dip exercise? As the humerus rotates posteriorly as the arm goes back, the head of the humerus translates anteriorly. To keep the humerus from slipping out of the glenoid cavity, the active and passive stabilizers resist excessive anterior movement of the humeral head. The main active stabilizer preventing the excessive anterior translation in the dip is the clavicular head of the Pectoralis Major (PM). The passive stability to the anterior translation is produced by the Anterior Band of the Inferior Glenohumeral Ligament (AB-IGHL). During the dip exercise, which of the following tissues are of particular concern regarding injury and subsequent lack of joint stability? The PM and the anteroinferior joint capsule are the tissues of highest concern to be injured. The Pectoralis Major and the AB-IGHL receive the highest amount of stress on them in the bottom of the dip position. Damage to these structures can result in Anterior Instability of the glenohumeral joint.
Pectoralis Major:
Damage to the PM can result in a strain of the muscle. The clavicular head of the PM is assists in flexion of the GH joint. Which muscle is responsible for controlling the depth of the movement during the dip exercise? When performing a dip, this portion of the PM is actively elongating to eccentrically control the speed and depth at which the dip is performed. Glenohumeral movements that are at the highest risk of injury include which of the following three events? There have been three risk factors identified that can result in injury of the PM: 1) external rotation of the shoulder while in the end range of extension, 2) moderate to maximal loads placed on the PM, 3) eccentric contraction of the muscle (3).
Anterior Shoulder Instability:
Anterior Instability (AI) occurs when there is laxity either the active and/or passive stabilizers on the anterior surface of the GH joint. This can result in an anterior dislocation or subluxation of the joint. Repetitive loading of the passive AB-IGHL (performing dips frequently at high loads) can result in deformation of the ligament and lead to AI due to the excessive load at end ranges of extension combined with and externally rotated positioning. Similarly, injury to the active stabilizers can also result in AI. During exercise when the humeral head is pushed forward (anteriorly), which of the following rotator cuff muscles is responsible for actively contracting to resist this movement? The subscapularis and teres minor of the rotator cuff are recruited in end ranges of extension to reduce the amount of anterior translation of the humeral head.
The Dip:
Which of the following accurately describes the dip exercise? The dip is classified as a closed-kinetic-chain exercise that is performed at body weight, with the use of a band to reduce body weight, or the addition of a weight belt to add body weight. When considering the potential risk of injury during and prescription of the dip exercise, which of the following is recommended by the authors? Tips for the prescription of dips include limiting the depth of the dip to avoid the end range positon to reduce stress placed on the PM and AB-IGHL. The authors recommend within session programming variation for the purpose of? Repetitions, load, frequency, and rest time should all be managed and to reduce muscular fatigue. Reducing muscular fatigue will prolong the technique of the dip. Poor technique can often result in the 3 risk factors mention before that result in the highest risk of injury.
Physical Therapy First:
Here at Physical Therapy First, our team of skilled therapists are able to assist you in the recovery from shoulder instability. Through manual techniques and other interventions, we can restore your ROM, increase strength, and return you back to activity. Your therapist can help you properly decide whether exercises such as the dip are appropriate for you based on your individual functional needs. Call today to schedule an appointment.
References:
1) McKenzie, Alec K. BClinSci; Crowley-McHattan, Zachary J. PhD; Meir, Rudi PhD, CSCS; Whitting, John W. PhD; Volschenk, Wynand BA (HMS Hons) Sports Science, CSCS Glenohumeral Extension and the Dip: Considerations for the Strength and Conditioning Professional, Strength and Conditioning Journal: February 2021 – Volume 43 – Issue 1 – p 93-100 doi: 10.1519/SSC.0000000000000579
2) Terry GC, Hammon D, France P, Norwood LA. The stabilizing function of passive shoulder restraints. Am J Sports Med 19: 26–34, 1991.
3) Provencher CMT, Handfield K, Boniquit NT, et al. Injuries to the pectoralis major muscle: Diagnosis and management. Am J Sports Med 38: 1693–1705, 2010.
by ptfadmin | Nov 1, 2021 | Health Tips
by Ray Moore PT, DPT, OCS, FAAOMPT
Introduction
Total hip arthroplasty (THA), otherwise known as total hip replacement, is a common surgery performed to relieve pain in patients with hip osteoarthritis. Hip replacements have been well documented as successful procedures with good long-term outcomes. Patient’s expectations of hip replacements have increased, with many patients desiring to return to high levels of activity following hip replacements. There is a lack of consensus among orthopedic surgeons regarding what levels of athletic activity should be allowed or recommended after a hip replacement. According to Healy et al,2,3 jogging is classified as a “high-impact” and “not recommended” activity following hip replacements due to the high hip contact forces generated. However, jogging is known to have significant health benefits, including improving cardiovascular endurance and strength. Jogging is generally recommended for people with several different health conditions, including cardiovascular disease, however research on the benefits and risks of jogging post-hip replacement is lacking.
There is limited research on jogging after hip replacements and the impact on component survival. There is also limited research on participation rates, jogging parameters, and the reasons people choose not to participate in jogging post-hip replacement. The authors state that the purpose of this study is to investigate the number of patients who participated in jogging after a hip replacement, the reasons given by those who were interested in but did not participate in jogging, the parameters surrounding post-operative jogging, short-term clinical and radiographic results for post-operative joggers, and factors related to post-operative jogging.
Participants
This study included 804 hips from 608 patients who underwent primary total hip replacements at two separate hospitals. The patients who answered a self-completed questionnaire during a routine follow-up visit were included in the study.
- 804 hips from 608 total patients (85 men and 523 women):
- Mean age: 62 years (range: 26-98 years)
- Mean body mass index (BMI): 23.2 (range: 14.7-34.2)
- Mean post-operative follow-up duration: 4.8 years (range: 2.3-7.8 years)
- Bilateral hip replacement (both hips): 196 patients
- Unilateral hip replacement (one hip): 412 patients
- Hip resurfacing arthroplasty (HRA): performed in 97 hips of 81 patients
- Conventional total hip arthroplasty (THA): performed in 707 hips of 527 patients
Methods
Participants were selected from two local participating hospitals after filling out a survey at a routine follow-up appointment. Participants underwent either bilateral (both hips) or unilateral (one hip) total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA) procedures. Several different HRA and THA components were used per surgeon’s choice in each patient as listed in the article. Five patients were excluded from the study due to other medical reasons or declining the survey. The post-operative rehabilitation protocol is as follows below:
- Post-Operative Rehabilitation Protocol
- All patients were allowed to walk with full weightbearing on post-operative day 1
- Most patients could walk without a cane at post-operative week 1-3
- Most patients returned to usual daily activities at post-operative month 1
- Patients who wanted to jog were allowed to do so at 6 months post-operatively
- Patients were also allowed to participate in sports activities at 6 months post-operatively, with the exception of contact sports and martial arts (soccer, baseball, basketball, volleyball, rugby, judo, and karate)
All patients were asked to give information about pre-operative and post-operative jogging habits. Those who jogged after their hip replacement answered additional questions about jogging frequency, distance, duration, velocity, and symptoms. Those who did not jog after their hip replacement were asked to provide reasons as to why they did not. Patients were asked to complete two questionnaires: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) self-assessment questionnaire for pain, stiffness, and physical function (higher score indicates worse pain, stiffness, and physical function) and University of California-Los Angeles (UCLA) activity scale (higher score indicates higher activity levels). The researchers evaluated serial radiographs (X-rays) to identify any implant loosening, weight-bearing wear, and bone degeneration around the components.
Results
Of the 608 patients, 33 patients (5.4%) were habitual pre-operative joggers and 23 (3.8%) continued habitual post-operative jogging. The 23 post-operative jogger group was comprised of 13 men and 10 women with mean age of 57 +/- 12 years. Ten of 81 patients (12.3%) who underwent hip resurfacing and 13 of 527 patients (2.5%) who underwent hip replacement regularly participated in post-operative jogging. Post-operative jogging was performed on average 4 times per week (range: 1-7 times per week) for a distance of 3.6 km (range: 0.5-15 km) over a duration of 29 minutes (range: 5-90 minutes) with a velocity of 7.7 km/hour (range: 3-18 km/hour). Additionally, 5 of 23 patients (21.7%) regularly jogged more than 10 km/week.
Of the 585 patients who did not participate in post-operative jogging, 511 (87%) stated they had no interest and 74 patients (13%) stated they are interested in jogging but do not currently. Reasons provided by the non-jogging group were anxiety (45 patients, 61%), that jogging was impossible because of pain, decreased range of motion, and muscle weakness (18 patients, 24%), and low back or knee pain (11 patients, 15%).
On the WOMAC questionnaire, joggers had significantly lower mean scores (which is more desirable) of both pain and physical function than non-joggers, with no significant difference in stiffness between the two groups. On the UCLA activity score, joggers had significantly higher scores (which is more desirable) than non-joggers. Of the jogging group, no patients complained of pain during post-operative jogging, no patient’s hips showed evidence of osteolysis, implant loosening, abnormal component migration, or excessive wear at an average 5-year follow-up on X-ray imaging, and no patient had a history of post-operative hip dislocation.
Summary
In this research study, 3.8% of total hip replacement patients participated in post-operative jogging. This study found no negative influences of jogging on implant survival at a short-term post-operative follow-up. The findings of this study do have some limitations, as stated in their conclusion section. One notable limitation is that this study had a short follow-up period of an average of 4.8 years, therefore additional research is needed to understand the longer-term effects of jogging on total hip replacements. Additional key findings include that 65.2% of post-operative joggers were not pre-operative joggers. The most common reason for avoiding post-operative jogging was anxiety, which could hopefully be improved through education and more definitive guidelines on post-hip replacement activity participation and safety.
At Physical Therapy First, our goal is to assist members of our community in returning to their desired activity level and improving quality of life. Our physical therapists are trained to assist patients maximize their post-operative performance which may include jogging for previous runners. Returning to higher impact activities will depend on the individual’s recovery in conjunction with their surgeon’s recommendations. In conclusion, at short-term follow-up participation in post-operative jogging did not lead to any significant poor outcomes in patients with total hip replacements. Longer follow-up periods are needed to fully understand the effects of habitual jogging on hip replacements.
References
- Abe H, Sakai T, Nishii T, Takao M, Nakamura N, Sugano N. Jogging after total hip arthroplasty. Am J Sports Med. 2014;42(1):131-137. doi:10.1177/0363546513506866
- Healy WL, Iorio R, Lemos MJ. Athletic activity after joint replacement. Am J Sports Med. 2001;29(3):377-388. doi:10.1177/03635465010290032301
- Healy WL, Sharma S, Schwartz B, Iorio R. Athletic activity after total joint arthroplasty. J Bone Joint Surg Am. 2008;90(10):2245-2252. doi:10.2106/JBJS.H.00274
