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Archive for the ‘Rehabilitation’ Category

Alternative Training Methods for the Injured & Non-Injured: Alter G Anti-Gravity Treadmill

Tuesday, 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

Hip Pain… Who Hasn’t Had Hip Pain?

Thursday, 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

Shockwave Therapy for the Treatment of Chronic Proximal Hamstring Tendinopathy in Professional Athletes

Wednesday, January 5th, 2011

*Angelo Cacchio, MD, Dipartimento di Medicina Fisica e Riabilitativa, Università di Roma “La Sapienza,” p. le A. Moro 5, 00185 Roma, Italy (e-mail: angelo.cacchio@tin.it).

Abstract

Background: Chronic proximal hamstring tendinopathy is an overuse syndrome that is usually managed by nonoperative methods. Shockwave therapy has proved to be effective in many tendinopathies.

Hypothesis: Shockwave therapy may be more effective than other nonoperative treatments for chronic proximal hamstring tendinopathy.

Study Design: Randomized controlled clinical study; Level of evidence, 1.

Methods: Forty professional athletes with chronic proximal hamstring tendinopathy were enrolled between February 1, 2004, and September 30, 2006. Patients were randomly assigned to receive either shockwave therapy, consisting of 2500 impulses per session at a 0.18 mJ/mm2 energy flux density without anesthesia, for 4 weeks (SWT group, n = 20), or traditional conservative treatment consisting of nonsteroidal anti-inflammatory drugs, physiotherapy, and an exercise program for hamstring muscles (TCT group, n = 20). Patients were evaluated before treatment, and 1 week and 3, 6, and 12 months after the end of treatment. The visual analog scale (VAS) score for pain and Nirschl phase rating scale (NPRS) were used as primary outcome measures.

Results: The patients were observed for a mean of 10.7 months (range, 1-12 months). Six patients were lost to follow-up because they underwent a surgical intervention: 3 (all in TCT group) were lost at 3 months; 2 (1 in each group), at 6 months; and 1 (in the TCT group), at 12 months. Primary follow-up was at 3 months after the beginning of treatment. The VAS scores in the SWT and TCT groups were 7 points before treatment (P = .84), and 2 points and 5 points, respectively, 3 months after treatment (P < .001). The NPRS scores in the SWT and TCT groups were 5 points in either group before treatment (P = .48), and 2 points and 6 points, respectively, 3 months after treatment (P < .001). At 3 months after treatment, 17 of the 20 patients (85%) in the SWT group and 2 of the 20 patients (10%) in the TCT group achieved a reduction of at least 50% in pain (P < .001). There were no serious complications in the SWT group.

Conclusion: Shockwave therapy is a safe and effective treatment for patients with chronic proximal hamstring tendinopathy.

Posted in Clinical Research, Rehabilitation | Email Us

Arthroscopic Labral Repair and Treatment of Femoroacetabular Impingement in Professional Hockey Players

Sunday, January 31st, 2010

Marc J. Philippon, MD†*, Douglass R. Weiss, MD‡, David A. Kuppersmith†, Karen K. Briggs, MPH† and Connor J. Hay†

Abstract

Background Hip injuries are common among professional hockey players in the National Hockey League (NHL).

Hypothesis Professional hockey players will return to a high level of function and ice hockey after arthroscopic labral repair and treatment of femoroacetabular impingement.

Study Design Case series; Level of evidence, 4.

Methods Twenty-eight professional hockey players (NHL) were unable to perform at the professional level due to unremitting and debilitating hip pain. Players underwent arthroscopic labral repair and were treated for femoroacetabular impingement from March 2005 to December 2007. Players who had bilateral hip symptoms were excluded. Athletes completed the Modified Harris Hip Score preoperatively and postoperatively and also completed a patient satisfaction questionnaire postoperatively. Return to sport was defined as the player resuming skating for training or participation in the sport of ice hockey.

Results The average age at the time of surgery was 27 years (range, 18–37). There were 11 left hips and 17 right hips. Player positions included 9 defensemen, 12 offensive players, and 7 goaltenders. All players had labral lesions that required repair. In addition, all patients had evidence of femoroacetabular impingement at the time of surgery. The average time to return to skating/hockey drills was 3.4 months. The average time to follow-up was 24 months (range, 12–42). The Modified Harris Hip Score improved from 70 (range, 57–100) preoperatively to an average of 95 (range, 74–100) at follow-up. The median patient satisfaction was 10 (range, 5–10). Two players had reinjury and required additional hip arthroscopy.

Conclusion Treatment of femoroacetabular impingement and labral lesions in professional hockey players resulted in successful outcomes, with high patient satisfaction and prompt return to sport.

Posted in Rehabilitation | Email Us

Knee Immobilization for Pain Control After a Hamstring Tendon Anterior Cruciate Ligament Reconstruction A Randomized Clinical Trial

Wednesday, January 27th, 2010

Abstract

Background This study will attempt to evaluate the efficacy of knee immobilization on patient pain levels after an anterior cruciate ligament reconstruction.

Hypothesis There is no difference in visual analog scale pain scores 2 days after anterior cruciate ligament reconstruction between patients who wear a knee immobilizer and those who do not wear a knee immobilizer.

Study Design Randomized clinical trial; Level of evidence, 1.

Methods Patients aged 18 to 40 years who met study inclusion criteria were eligible. Patients meeting intraoperative inclusion critiera were randomized (immobilizer or no immobilizer) after wound closure. The immobilizer used was a soft, unhinged brace with Velcro® straps. Preoperative, intraoperative, and postoperative protocols were standardized. The primary outcome was patient self-assessed pain using a 0-to-100-mm visual analog scale at day 2 after surgery. Secondary outcomes included pain and analgesic use in the first 14 days after surgery, complications, and range of motion (approximately 3 weeks postoperatively). A sample size estimate was calculated and resulted in the need for 44 patients per group.

Results A total of 102 patients were enrolled; 88 patients were randomized, and 14 were excluded intraoperatively. There was no difference in mean visual analog scale pain scores at 2 days after surgery between immobilized and nonimmobilized patients (32.6 and 35.2, respectively; P = .59; difference, −2.6; 95% confidence interval, −12.2 to 6.9). There were no differences between groups in medication consumed, range of motion, or complications. Pain and analgesic use were the same for both groups at 7 and 14 days postoperatively.

Conclusion No differences in pain or any of the secondary outcomes were detected between immobilized and nonimmobilized patients at any point during the first 14 days after anterior cruciate ligament reconstruction.

  1. Laurie A. Hiemstra, MD, PhD, FRCS(C)*†,
  2. S. Mark Heard, MD, FRCS(C)†,
  3. Treny M. Sasyniuk, MSc†‡,
  4. Greg L. Buchko, MD, FRCS(C)†,
  5. Jeremy G. Reed, MD, FRCS(C)† and
  6. Bradley J. Monteleone, MD, MSc, PhD, Dip Sport Med‡

Posted in Rehabilitation | Email Us

Does Intensive Rehabilitation Permit Early Return to Sport Without Compromising the Clinical Outcome After Arthroscopic Autologous Chondrocyte Implantation in Highly Competitive Athletes?

Wednesday, January 27th, 2010

Abstract

Background Despite improvement in treatment for articular cartilage lesions, prolonged recovery still precludes early return to competitive sports. The challenge of postoperative rehabilitation is to optimize return to preinjury activities without jeopardizing the graft.

Hypothesis Intensive rehabilitation after second-generation arthroscopic autologous cartilage implantation (Hyalograft C) facilitates graft maturation and safely allows for early return to competition without jeopardizing clinical outcome at longer follow-up.

Study Design Cohort study; Level of evidence, 3.

Methods The outcome of 31 competitive male athletes with International Cartilage Repair Society grade III–IV cartilaginous lesions of the medial or lateral femoral condyle or trochlea were evaluated at 1-, 2-, and 5-year follow-up. The athletic cohort was compared with a similar control cohort of 34 nonathletic patients who were treated with autologous chondrocyte implantation. The athletic cohort followed a 4-phase intensive rehabilitation protocol. Eleven of the patients in this cohort were also treated with an isokinetic exercise program and on-field rehabilitation. The patients in the control cohort completed only phase 1 of rehabilitation.

Results When comparing the 2 groups, a greater improvement in the group of athletes was achieved at 5-year follow-up (P = .037) in the self-assessment of quality of life and International Knee Documentation Committee subjective evaluation at 12 months and at 5 years of follow-up (P = .001 and P = .002, respectively). When analyzing the return to sports activity, 80.6% of the athletes returned to their previous activity level in 12.4 ± 1.6 months; athletes treated with the on-field rehabilitation and isokinetic exercise program had faster recovery and an even earlier return to competition (10.6 ± 2.0 months).

Conclusion For optimal results, autologous chondrocyte implantation rehabilitation should not only follow but also facilitate the process of graft maturation. Intensive rehabilitation may safely allow a faster return to competition and also influence positively the clinical outcome at medium-term follow-up.

  1. Stefano Della Villa, MD*,
  2. Elizaveta Kon, MD‡†,
  3. Giuseppe Filardo, MD‡,
  4. Margherita Ricci, MD*,
  5. Ferruccio Vincentelli, MD*,
  6. Marco Delcogliano, MD§ and
  7. Maurilio Marcacci, PhD‡

Posted in Rehabilitation | Email Us

Effects of Low-Level Laser Therapy and Eccentric Exercises in the Treatment of Recreational Athletes With Chronic Achilles Tendinopathy

Sunday, December 6th, 2009

Abstract

Background: Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect from EE has a slow onset.

Hypothesis: The addition of low-level laser therapy (LLLT) to EE may cause more rapid clinical improvement.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 52 recreational athletes with chronic Achilles tendinopathy symptoms were randomized to groups receiving either EE + LLLT or EE + placebo LLLT over 8 weeks in a blinded manner. Low-level laser therapy (λ = 820 nm) was administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm2 and a total dose of 5.4 J per session.

Results: The results of the intention-to-treat analysis for the primary outcome, pain intensity during physical activity on the 100-mm visual analog scale, were significantly lower in the LLLT group than in the placebo LLLT group, with 53.6 mm versus 71.5 mm (P = .0003) at 4 weeks, 37.3 mm versus 62.8 mm (P = .0002) at 8 weeks, and 33.0 mm versus 53.0 mm (P = .007) at 12 weeks after randomization. Secondary outcomes of morning stiffness, active dorsiflexion, palpation tenderness, and crepitation showed the same pattern in favor of the LLLT group.

Conclusion: Low-level laser therapy, with the parameters used in this study, accelerates clinical recovery from chronic Achilles tendinopathy when added to an EE regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks.

  1. Apostolos Stergioulas, PT, PhD*,
  2. Marianna Stergioula, PT*,
  3. Reidar Aarskog, PT, MSc†,
  4. Rodrigo A. B. Lopes-Martins, MPharm, PhD‡, and
  5. Jan M. Bjordal, PT, PhD†,||,§

Posted in General, Rehabilitation | Email Us

Conservative Treatment for Osteochondrosis of the Humeral Capitellum

Sunday, December 6th, 2009

Abstract

Background: Conservative treatment is recommended for the early stage of osteochondrosis of the humeral capitellum. However, the outcome of conservative treatment has not been well documented.

Hypothesis: Osteochondrosis of the humeral capitellum detected at an early stage responds well to conservative treatment.

Study Design: Cohort study; Level of evidence, 3.

Methods: We retrospectively reviewed 176 patients with osteochondrosis of the humeral capitellum. There were 134 lesions that were stage I (radiolucent area) in patients with a mean age of 11.5 years and 42 lesions that were stage II (nondisplaced fragments) in patients with a mean age of 13.9 years based on anteroposterior radiographs of the elbow in 45° of flexion. Conservative treatment was performed on 101 patients. The remaining 75 patients did not follow the authors’ advice. Conservative treatment consisted of discontinuation of heavy use of the elbow for at least 6 months. Follow-up radiographs were taken at 1-month intervals. At a mean follow-up of 24 months, all patients were evaluated clinically and radiographically.

Results: Conservative management produced healing in 90.5% of stage I lesions and 52.9% of stage II lesions. The mean period required for healing was 14.9 months in stage I and 12.3 months in stage II. Sixty-six of 84 (78.6%) stage I patients and 9 of 17 (52.9%) stage II patients returned to competitive-level baseball. Of the 75 patients who did not follow our advice, healing was observed in 17 (22.7%). The healing rate was higher for the 101 patients who followed our advice as opposed to the 75 patients who did not.

Conclusion: Osteochondrosis of the humeral capitellum can be successfully treated conservatively if treatment is begun in an early stage of the disease.

  1. Tetsuya Matsuura, MD†,*,
  2. Shinji Kashiwaguchi, MD‡,
  3. Takenobu Iwase, MD§,
  4. Yoshitsugu Takeda, MD||, and
  5. Natsuo Yasui, MD†

Posted in Rehabilitation | Email Us

Defining Safe Rehabilitation for Ulnar Collateral Ligament Reconstruction of the Elbow: A Biomechanical Study

Monday, November 30th, 2009

Background Ulnar collateral ligament reconstruction of the elbow using a variety of techniques has been successful in enabling overhead athletes with ulnar collateral ligament insufficiency to return to competition. Most current postoperative rehabilitation programs begin with a period of motion restriction, including limiting elbow extension, that is followed by a transition from elbow strengthening to an interval throwing program, to competition. Motion restrictions early in the postoperative period may increase the risk for contractures. There is limited information to support current motion restrictions.

Purpose (1) To determine strain on the reconstructed ulnar collateral ligament during a rehabilitation protocol that includes passive range of motion, isometric muscle contraction, and varus and valgus torques. (2) To develop guidelines for a safe initial rehabilitation protocol.

Study Design Controlled laboratory study.

Methods Eight cadaveric elbows underwent ulnar collateral ligament reconstruction with the docking technique using a gracilis tendon graft. Differential variable reluctance transducers on the anterior and posterior bands of the reconstructed anterior bundle of the ulnar collateral ligament were used to measure strain, while an optical motion tracking system monitored elbow motion. Strain was measured in the following 3 settings: passive range of motion, 22.2 N isometric flexion and extension contractions, and 3.34 N·m varus and valgus torques with the arm at 90° of flexion.

Results Range of motion from maximum extension to 50° of flexion produced 3% or less strain in both bands of the reconstructed ligament. Forearm rotation did not significantly affect strain in the anterior or posterior bands (P = .336 and P = .357). Strain at 90° approached 7% in the posterior band (upper 95% confidence interval). Isometric muscle contractions had no measurable effect on strain. Varus torques decreased and valgus torques increased strain significantly (P < .05).

Conclusion In the immediate postoperative period, full extension is safe, while flexion beyond 50° may place deleterious strain on the reconstruction. Isometric flexion and extension exercises do not increase ligament strain but may be unsafe at 90° of flexion, while valgus exercises (internal rotation at the shoulder) can increase strain in the reconstructed ligament.

Clinical Relevance The results have implications for the development of appropriate rehabilitation protocols after ulnar collateral ligament reconstructive surgery.

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The Long-term Effect of 2 Postoperative Rehabilitation Programs After Anterior Cruciate Ligament Reconstruction

Wednesday, September 30th, 2009

Abstract

Background There is no consensus regarding the optimal postoperative rehabilitation program after anterior cruciate ligament (ACL) reconstruction.

Purpose The purpose of this study was to examine the long-term outcome of a 6-month neuromuscular exercise (NE) training program versus a traditional strength exercise (SE) training program after ACL reconstruction.

Study Design Randomized controlled trial; Level of evidence, 1.

Methods Seventy-four patients were randomly assigned to either a NE program or a SE program and tested preoperatively and at 6 months, 1 year, and 2 years after ACL reconstruction. Outcome measurements were as follows: Cincinnati knee score, visual analog scale for pain and global function, Short Form 36, functional knee tests, and isokinetic muscle strength tests.

Results There were no significant differences between the NE and SE programs 1 and 2 years after ACL reconstruction for the primary outcome measurement (Cincinnati knee score). There were significantly improved knee function (global function) and reduced pain during activity for the NE group, compared with the SE group, and significantly improved hamstring muscle strength for the SE group, compared with the NE group, 2 years after ACL reconstruction.

Conclusion On the basis of these results, a postoperative program combining both NE and SE should be included after ACL reconstruction to improve knee function.

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