April 16th, 2013
As Minnesotans, we have been struggling the past few months with this SLOW transition into warmer weather. Let’s be honest; it doesn’t look like it is going to get warm any time soon. That be said, many avid walkers and runners are well into their spring training. If this applies to you, hopefully your training has been going well and you have been free of aches or pains. For those individuals who have not been as fortunate, there is an alternative walking/running treadmill in the Twin Cities.
The Alter G Anti-Gravity Treadmill originally was developed for NASA astronauts. It has now been tailored to assist every day athletes to train with minimal weight-bearing pressure on their joints. According to the Alter G website, the machine uses Differential Air Pressure (DAP) to rehab lower extremity injuries, neurological conditions, weight reduction, aerobic conditioning, and general training for combating age-related injuries. Clinical studies have found that unloading by 20-80% can encourage protection/healing of tissues, promote joint/muscle range of motion, prevent muscle atrophy, and encourage return of lost motor control.
If any of the issues listed above apply to you, this could be a great training alternative to give those joints a break. Not injured? Perhaps you would like to switch up your training regimen or see what it feels like to run on the moon.
More information on the clinical case studies supporting Alter G use can be found on their website: http://www.alter-g.com/rehabilitation-treadmill-clinical-research
Posted in Injury Prevention, Rehabilitation | Email Us
April 4th, 2013
Hip pain… who hasn’t had hip pain? The real question is what is it and how do you get rid of it? There are a plethora of hip injuries, but the most common that I see clinically is the infamous Gluteus Medius Tendinopathy. Let’s call it “Glute Med Tendinopathy” for short.
Tendon-what, you ask? Tendinopathy translates as “pathology of the tendon”. Once a tendon is injured, inflammation and fluid starts to accumulate around the strained tendon. This initial injury is called “tendonitis” or inflammation of the tendon. If you are lucky and your musculoskeletal system is in tiptop shape, the tendonitis will heal and you will continue with your activity pai- free in one to two weeks.
If the tendonitis does not heal properly, then you are left with a tendinopathy. Glute Med Tendinopathy consists of chronic nagging posterior hip pain worsened by activity. This is commonly linked to bursitis of the hip. A bursa is a fluid filled sack that helps the tendons glide smoothly over the joints. This is the type of injury that you don’t want to “wait it out.” The best time to take care of a tendinopathy is to address it right away.
Now that we know what it is, how do you get rid of it? Contrary to belief, a tendinopathy is easily treatable. Seeking early treatment and a proper diagnosis is the biggest hurdle with this injury. Deep tissue sports massage, active release technique, PRP injections, Prolo therapy injections, or, the beloved, foam roller will help heal this chronic injury by causing micro trauma to the injured tendon. The controlled (key word here) injury sustained from this type of treatment will cause swelling and inflammation to occur at the targeted damaged site. This is a key factor in the natural healing process of the body. Surprise! Inflammation is not all bad.
The second, and equally important, treatment for Glute Med Tendinopathy is to strengthen it. Strengthening the gluteus medius muscle correctly and all the other hip muscles, as well as the core, will give the injured tissue a break and allow it to heal without complications.
If you suspect that you are suffering from Gluteus Medius Tendinopathy and two weeks of “at home treatment” doesn’t seem to be working, it is time to seek treatment from a sports provider.
Posted in Clinical Research, General, Injury Prevention, Rehabilitation | Email Us
March 3rd, 2011
| ABSTRACT |
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Traditional exercise order dictates large muscle group or multijoint exercises should be performed before small muscle group or single joint exercises. The purpose of this study was to examine the influence of exercise order on strength and muscle thickness (MT) in untrained men after 12 weeks of linear periodized resistance training. The participants were randomly assigned into three groups. One group began with large and progressed toward small muscle group exercises (LG-SM) while another started with small and advanced to large muscle group exercises (SM-LG). The exercise order for LG-SM was bench press (BP), lat pull-down (LPD), triceps extension (TE), and biceps curl (BC). The order for the SM-LG was BC, TE, LPD, and BP. The third group served as a control group (CG). Training frequency was two sessions/week with at least 72 hours between sessions. One repetition maximum (1RM) for all exercises, biceps and triceps MT (assessed by ultrasound techniques) were collected at baseline and after 12 weeks. After 12 weeks, all exercises for both training groups presented significant 1RM strength gains when compared to CG with exception of BC in LG-SM. Between baseline and post training, all exercises for both training groups presented significant strength gains with exception of BC in LG-SM and BP in SM-LG. Triceps MT for both training groups were significantly higher when compared to the CG, but with no significant differences between them (p > 0.05). Significant differences in MT from pre- to post-training were found only for the SM-LG group (p < 0.05), while the biceps MT presented significant differences only between LG-SM and CG (p < 0.05), Effect size data demonstrated differences in 1RM and triceps MT based on exercise order. In conclusion, if an exercise is important for specific training goals, it should be performed at the beginning of the training session, whether or not it is a large or a small muscle group exercise.
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Posted in General | Email Us
March 3rd, 2011
| ABSTRACT |
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| During a day of skiing thousands of repeated contractions take place. Previous research on prolonged recreational alpine skiing show that physiological changes occur and hence some level of fatigue is inevitable. In the present paper the effect of prolonged skiing on the recruitment and coordination of the muscle activity was investigated. Six subjects performed 24 standardized runs. Muscle activity during the first two (PREskiing) and the last two (POSTskiing) runs was measured from the vastus lateralis (VL) and rectus femoris (RF) using EMG and quantified using wavelet and principal component analysis. The frequency content of the EMG signal shifted in seven out of eight cases significantly towards lower frequencies with highest effects observed for RF on outside leg. A significant pronounced outside leg loading occurred during POSTskiing and the timing of muscle activity peaks occurred more towards turn completion. Specific EMG frequency changes were observed at certain time points throughout the time windows and not over the whole double turn. It is suggested that general muscular fatigue, where additional specific muscle fibers have to be recruited due to the reduced power output of other fibers did not occur. The EMG frequency decrease and intensity changes for RF and VL are caused by altered timing (coordination) within the turn towards a most likely more uncontrolled skiing technique. Hence, these data provide evidence to suggest recreational skiers alter their skiing technique before a potential change in muscle fiber recruitment occurs. |
Posted in General | Email Us
February 8th, 2011
Abstract
Background: Hamstring muscle strains often recur. The authors studied the effect of the grade of initial injury on the subsequent risk of reinjury.
Hypothesis: No difference in reinjury rate between acute low-grade (grades I and II) and high-grade (III and IV) hamstring muscle strains would be seen.
Study Design: Cohort study (prognosis); Level of evidence, 1.
Methods: Between 1999 and 2007, the authors managed 165 elite track and field athletes with acute, first-time unilateral hamstring muscle strains. Strains were classified into 4 grades (I, II, III, and IV) based on knee active range of motion deficit at 48 hours. The same rehabilitation protocol was prescribed, and the rate of reinjury was recorded during the following 24 months.
Results: The average time to return to sport after initial injury was 7.4 days for grade I injuries, 12.9 days for grade II injuries, 29.5 days for grade III injuries, and 55.0 days for grade IV injuries. At follow-up, 23 of the 165 athletes (13.9%) had experienced a second hamstring muscle strain. Of the 75 athletes with a grade I injury, 7 (9.3%) had experienced a recurrence after 24 months. Of the 58 athletes with a grade II injury, 14 (24.1%) experienced a recurrence. Of the 26 athletes with a grade III injury, 2 (7.7%) experienced a recurrence, and of the 6 athletes with a grade IV injury, none had experienced a recurrence after 24 months.
Conclusion: Low-grade hamstring muscle lesions appear to lead to a higher risk of reinjury than high-grade hamstring muscle lesions. However, there were disproportionately fewer high-grade injuries than low-grade injuries. Objective clinical findings can accurately determine the risk of reinjury after acute hamstring muscle strains in elite track and field athletes.
Posted in Clinical Research | Email Us
February 8th, 2011
Abstract
Background: Clinical studies claim that platelet-rich plasma (PRP) shortens recovery times because of its high concentration of growth factors that may enhance the tissue repair process. Most of these studies obtained PRP using different separation systems, and few analyzed the content of the PRP used as treatment.
Purpose: This study characterized the composition of single-donor PRP produced by 3 commercially available PRP separation systems.
Study Design: Controlled laboratory study.
Methods: Five healthy humans donated 100 mL of blood, which was processed to produce PRP using 3 PRP concentration systems (MTF Cascade, Arteriocyte Magellan, Biomet GPS III). Platelet, white blood cell (WBC), red blood cell, and fibrinogen concentrations were analyzed by automated systems in a clinical laboratory, whereas ELISA determined the concentrations of platelet-derived growth factor αβ and ββ (PDGF-αβ, PDGF-ββ), transforming growth factor β1 (TGF-β1), and vascular endothelial growth factor (VEGF).
Results: There was no significant difference in mean PRP platelet, red blood cell, active TGF-β1, or fibrinogen concentrations among PRP separation systems. There was a significant difference in platelet capture efficiency. The highest platelet capture efficiency was obtained with Cascade, which was comparable with Magellan but significantly higher than GPS III. There was a significant difference among all systems in the concentrations of WBC, PDGF-αβ, PDGF-ββ, and VEGF. The Cascade system concentrated leukocyte-poor PRP, compared with leukocyte-rich PRP from the GPS III and Magellan systems.
Conclusion: The GPS III and Magellan concentrate leukocyte-rich PRP, which results in increased concentrations of WBCs, PDGF-αβ, PDGF-ββ, and VEGF as compared with the leukocyte-poor PRP from Cascade. Overall, there was no significant difference among systems in the platelet concentration, red blood cell, active TGF-β1, or fibrinogen levels.
Clinical Relevance: Products from commercially available PRP separation systems produce differing concentrations of growth factors and WBCs. Further research is necessary to determine the clinical relevance of these findings.
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February 8th, 2011
Abstract
Background: The risk of elbow or shoulder injury for young baseball pitchers is unknown.
Purpose/Hypothesis: The purpose of this study was to quantify the cumulative incidence of throwing injuries in young baseball pitchers who were followed for 10 years. Three hypotheses were tested: Increased amount of pitching, throwing curveballs at a young age, and concomitantly playing catcher increase a young pitcher’s risk of injury.
Study Design: Cohort study; Level of evidence, 3.
Methods: In sum, 481 youth pitchers (aged 9 to 14 years) were enrolled in a 10-year follow-up study. Participants were interviewed annually. Injury was defined as elbow surgery, shoulder surgery, or retirement due to throwing injury. Fisher exact test compared the risk of injury between participants who pitched at least 4 years during the study and those who pitched less. Fisher exact tests were used to investigate risks of injury for pitching more than 100 innings in at least 1 calendar year, starting curveballs before age 13 years, and playing catcher for at least 3 years.
Results: The cumulative incidence of injury was 5.0%. Participants who pitched more than 100 innings in a year were 3.5 times more likely to be injured (95% confidence interval = 1.16 to 10.44). Pitchers who concomitantly played catcher seemed to be injured more frequently, but this trend was not significant with the study sample size.
Conclusion: Pitching more than 100 innings in a year significantly increases risk of injury. Playing catcher appears to increase a pitcher’s risk of injury, although this trend is not significant. The study was unable to demonstrate that curveballs before age 13 years increase risk of injury.
Clinical Relevance: The risk of a youth pitcher sustaining a serious throwing injury within 10 years is 5%. Limiting the number of innings pitched per year may reduce the risk of injury. Young baseball pitchers are encouraged to play other positions as well but might avoid playing catcher.
Posted in Injury Prevention | Email Us
February 6th, 2011
Adolescence is a critical period for attainment of PBM, an important predictor of future fracture risk. Encouraging adolescents to consume adequate calories and nutrients, such as calcium and vitamin D, is important for healthy progression through puberty and for optimal skeletal health. Enhancement of normal skeletal development can be achieved with the addition of frequent weight bearing exercise in the presence of adequate nutrition. While we do not yet have an ideal exercise prescription, it is now widely believed that activities that confer high-impact forces in unusual loading patterns are osteogenic. Ground reaction forces in addition to the pull of muscles on bone can enhance bone building during adolescence and beyond. Because prevention is better understood and has fewer potential negative side effects than adult treatments for low bone density, we need to enforce good habits early to prevent development of any of the components of the female athlete triad, and to optimize bone mass acquisition in adolescent athletes.
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February 6th, 2011
Abstract: Platelet-rich plasma (PRP) is an autologous blood-derived product with an increased concentration of platelets in plasma, which are used to deliver supraphysiological levels of growth factors. Platelet-rich plasma has been used in many fields, including oral, maxillofacial, and plastic surgery. Its use in sports medicine has been increasing after recent evidence and media publicity suggest that it may augment the treatment of muscle strains, as well as tendon and ligament healing. Basic science and animal studies show promising results, but high-level clinical trials have yet to prove its efficacy. With increasing media coverage on the use of PRP in athletes, it is paramount that orthopedic surgeons and sports medicine physicians understand the various methods of preparation and administration, potential clinical applications, and available clinical results to best counsel patients on its advantages and disadvantages.
There remains limited evidence for or against the clinical efficacy of PRP therapy. Continued research is needed to establish the potential clinical uses and biological effects of PRP and to assess whether PRP is more effective than conventional approaches in the treatment of sports injuries. Whether the established molecular and cellular effects of PRP on human tendon cells and chondrocytes translate to a clinical benefit remains to be determined. Furthermore, due to qualitative differences in methods of preparation, it is difficult to generalize results of clinical studies without an in-depth understanding of the specific method of preparation and administration, and if these factors affect the outcome of PRP use. Although PRP may provide an alternative to surgical intervention for many common orthopedic sports injuries, more evidence is needed to confirm preliminary results and validate its efficacy to support its current widespread use. Until then, its clinical use should be approached cautiously with appropriate indications.
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February 6th, 2011
Douglas R. Arnold, MD; James S. Keene, MD; Donna G. Blankenbaker, MD; And Arthur A. DeSmet, MD
Abstract: Background Fluoroscopically guided intra-articular (FGIA) anesthetic hip joint injections have been used to determine whether the hip joint is the source of a patient’s hip pain. However, there have been no reports documenting the efficacy of their use for defining the pain referral patterns (PRPs) of patients with labral tears. The aim of this study was to determine the PRPs of patients with labral tears and evaluate a new pain “circle” diagram (PCD) developed for this analysis. Methods Fifty-two patients were evaluated at our institution who had: 1) a preoperative FGIA anesthetic hip joint injection; 2) completed our PCD and a visual analog pain scale pre- and postinjection; 3) significant (≥ 80%) pain reduction after their FGIA injection; and 4) a labral tear and minimal (≤ grade II) degenerative joint disease, as documented by hip arthroscopy. The PCD had circles in which patients put an “X” in to indicate pain in the following locations: anterior superior spine, lateral peritrochanteric area, central groin, symphysis pubis, proximal inner thigh, anterior thigh, posterior iliac crest, sacroiliac joint, sciatic notch, and ischial tuberosity. Results Based on the percentage of patients with significant (≥ 80%) pain reduction after administration of FGIA, 2 areas demonstrated substantially more and consistent presence of pain, which improved after injection. These were the central groin (P < 0.001) and the lateral peritrochanteric area (P = 0.02). Conclusion The most common locations of pain were the central groin and the lateral peritrochanteric area. The least common were the ischial tuberosity and the anterior thigh, which are 2 areas often associated with osteoarthritis of the hip. The use of the PCD combined with an FGIA anesthetic injection may help physicians reconcile the expectations of those patients with labral tears who believe that hip arthroscopy will treat their multiple areas of “hip” pain.
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