Chronic Pain| Groin Muscles
July 4, 2008 5:54 pmFriday, July 04, 2008
Hip stiffness in athletes is associated with later development of chronic groin injury and as such may be a risk factor for this condition. "Sports hernia," pubic bone edema, and entrapment neuropathies-are potential causes of chronic groin pain in assessing athletes.
Groin injury is among the most common cited injuries in the sports of ice hockey, soccer, Australian Rules football, calisthenics and cricket. There are very few prospective studies examining risk factors for groin strain injury in sport. There is support for an association of previous injury and greater abductor to adductor strength ratios as well as sport specificity of training and pre-season sport-specific training, as individual risk factors in groin strain injury in athletes. Core muscle weakness or delayed onset of transversus abdominal muscle recruitment may increase the risk of groin strain injury. Debate exists in the literature regarding the role of adductor strength and length as well as age and/or sport experience as risk factors for groin injury. There is no strong evidence to support a causal association for any of these risk factors and groin injury. (Maffey L. Emery C. What are the risk factors for groin strain injury in sport? A systematic review of the literature. Sports Medicine. 37(10):881-94, 2007).
MR imaging studies in 141 patients (134 male patients, seven female patients; mean age, 30.1 years; range, 17-71 years) who had been referred to a subspecialist because of groin pain showed MR imaging to have more sensitive and specific for rectus abdominis tendon injury and for adductor tendon injury. Injury in each of these structures was significantly more common in the patient group than in the control group. Only two patients had hernias at surgery. (Zoga AC. Kavanagh EC. Omar IM. Morrison WB. Koulouris G. Lopez H. Chaabra A. Domesek J. Meyers WC. Athletic pubalgia and the "sports hernia": MR imaging findings. Radiology. 247(3):797-807, 2008).
Adductor dysfunction is a condition that can cause groin pain in competitive athletes. A single pubic cleft injection of local anesthetic and steroid into the adductor enthesis (tendon thickening) had been used. This single injection gave at least one year of relief of adductor-related groin pain in a competitive athlete with normal findings on a magnetic resonance imaging scan; however, it should be employed only as a diagnostic test or short-term treatment for a competitive athlete with evidence of adductor longus tendon thickening (enthesopathy) on magnetic resonance imaging. (Schilders E. Bismil Q. Robinson P. O'Connor PJ. Gibbon WW. Talbot JC. Adductor-related groin pain in competitive athletes. Role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. Journal of Bone & Joint Surgery - American Volume. 89(10):2173-8, 2007).
eToims has been useful in the treatment of groin pain related to adductor dysfunction since it can be used repeatedly and regularly without side-effects. Treatments have to be directed to all hip muscles supplied by multiple nerve roots as well as to muscles segments supplied by spinal nerve roots above and below the hip joint.
www.stopmusclepain.com Chronic Pain| Groin Muscles
Knee pain| Anterior cruciate ligament injury
June 26, 2008 10:41 pmThursday, June 26, 2008
Increased knee-laxity measures may contribute to increased risk of anterior cruciate ligament injury. Female soccer and basketball players had an anterior cruciate ligament injury rate seven times that of male players. The integrative effects of fatigue and decision making may represent a worst case scenario in terms of anterior cruciate ligament injury risk during dynamic single leg landings. Females display knee moments and kinematics that may place them at greater risk for ACL injury during a stop-cut task. Females should be coached to perform stop cuts with more knee flexion and a more neutral knee rotation angle upon foot contact in an effort to reduce moments that may place the ACL at risk (Wallace BJ. Kernozek TW. Bothwell EC. Lower extremity kinematics and kinetics of Division III collegiate baseball and softball players while performing a modified pro-agility task. Journal of Sports Medicine & Physical Fitness. 47(4):377-84, 2007). Women with anterior cruciate ligament reconstruction have neuromuscular strategies that allow them to land from a jump similar to healthy women, but they exhibit joint moments that could predispose them to future injury if they participate in sports that require jumping and landing. (Ortiz A. Olson S. Libby CL. Trudelle-Jackson E. Kwon YH. Etnyre B. Bartlett W. Landing mechanics between noninjured women and women with anterior cruciate ligament reconstruction during 2 jump tasks. American Journal of Sports Medicine. 36(1):149-57, 2008. Altered equilibrium position of the tibiofemoral joint associated with reduced patellar ligament insertion angle and adaptations of gait patterns following anterior cruciate ligament injury may be associated with degenerative changes in the articular cartilage (Shin CS. Chaudhari AM. Dyrby CO. Andriacchi TP. The patella ligament insertion angle influences quadriceps usage during walking of anterior cruciate ligament deficient patients. Journal of Orthopaedic Research. 25(12):1643-50, 2007 Dec. Revision anterior cruciate ligament surgery allowed approximately 60% of patients to go back to sports, most of them at lower levels than their prerevision function. Instrumented laxity of <3 mm was associated with a better result. Radiographic arthritis was associated with duration of instability symptoms after primary failure. Patients who undergo revision anterior cruciate ligament surgery should be counseled as to the expected outcome and cautioned that this procedure probably represents a salvage situation and may not allow them to return to their desired levels of function. Battaglia MJ 2nd. Cordasco FA. Hannafin JA. Rodeo SA. O'Brien SJ. Altchek DW. Cavanaugh J. Wickiewicz TL. Warren RF. Results of revision anterior cruciate ligament surgery. American Journal of Sports Medicine. 35(12):2057-66, 2007
Strength training as a single intervention method may not be sufficient to reduce the risk of noncontact anterior cruciate ligament injury in female recreational athletes.
www.stopmusclepain.com Knee pain| Anterior cruciate ligament injury
Muscle fatigue| Stress fractures
June 21, 2008 11:07 amSaturday, June 21, 2008
Stress fracture is a common musculoskeletal problem affecting athletes and soldiers. Repetitive high bone strains and strain rates are considered to be its etiology. The strain level necessary to cause fatigue failure of bone ex vivo is higher than the strains recorded in humans during vigorous physical activity.
A study was performed to prove that during fatiguing exercises, bone strains may increase and reach levels exceeding those measured in the non-fatigued state. To test this hypothesis, this study was performed in 4 subjects to measure tibial strains, the maximum gastrocnemius isokinetic torque and ground reaction forces before and after two fatiguing levels of exercise: a 2km run and a 30km desert march. Strains were measured using strain-gauged staples inserted percutaneously in the medial aspect of their mid-tibial diaphysis. There was a significant decrease in the peak gastrocnemius isokinetic torque of all four subjects' post-march as compared to pre-run indicating the presence of gastrocnemius muscle fatigue. Tension strains increased 26% post-run and 29% post-march as compared to the pre-run phase. Tension strain rates increased 13% post-run and 11% post-march and the compression strain rates increased 9% post-run and 17% post-march. The fatigue state increases bone strains well above those recorded in rested individuals and may be a major factor in the stress fracture etiology. (Milgrom C. Radeva-Petrova DR. Finestone A. Nyska M. Mendelson S. Benjuya N. Simkin A. Burr D. The effect of muscle fatigue on in vivo tibial strains. Journal of Biomechanics. 40(4):845-50, 2007.
Consider stress fracture as a diagnosis in adolescent athletes complaining of worsening vague pain without a clear mechanism of injury. Remember that initial radiographs may be normal, especially early in the clinical course. If the fracture is of low risk for delayed or non-union, conservative management is indicated, with repeat radiographs 2 weeks after initiation of treatment. If a high-risk fracture is suspected, early diagnosis with MRI, bone scan, and, in some cases, CT is important for surgical decision making. (Logan K. Stress fractures in the adolescent athlete. Pediatric Annals. 36(11):738-9, 742, 744-5, 2007)
www.stopmusclepain.com Muscle fatigue| Stressfractures
Knee pain | Self Care
June 13, 2008 7:25 pmFriday, June 13, 2008
A study was performed to describe the treatment of knee pain in older adults in primary care and to compare reported practice with published evidence. A semi-structured interview was performed of older adults with knee pain about their use of 26 interventions for knee pain.
201 adults were interviewed. A median of six interventions had been advised for each participant:
- heat and ice (84%) the most frequently advised
- followed by paracetamol (71%)
- compound opioid analgesics (59%)
- non-selective non-steroidal anti-inflammatory drugs (59%).
- surgery
Three core treatments for knee pain consists of self care:
- written information (16%)
- exercise (46%)
- weight loss( 39%)
Most core treatments had not been initiated before second-line interventions had been used, paracetamol being the exception. Referral to surgery was commonly initiated before more conservative options had been tried.
The conclusions were that interventions recommended as core treatment for knee pain in older adults were underused-in particular, exercise, weight loss and the provision of written information. There appeared to be early reliance on pharmacological treatments with underuse of non-pharmacological interventions in early treatment choices. Self care played an important role in the management of this condition.
The study provides clear evidence on the need to improve the delivery of core treatments for osteoarthritis and highlights the need to support and encourage self care.
(Porcheret M. Jordan K. Jinks C. Croft P. Primary Care Rheumatology Society. Primary care treatment of knee pain–a survey in older adults. [Journal Article] Rheumatology. 46(11):1694-700, 2007)
Hip| Stretch| Muscle Performance
June 8, 2008 12:38 amSunday, June 08, 2008
AIM: There is an emerging body of knowledge indicating static stretching (SS) acutely and adversely affects muscle performance. The purpose of this study was to determine if SS using more representative stretch durations affects muscle performance and to establish if changes in muscle performance were influenced by the duration of stretch.
METHODS: Following 2 familiarization sessions, 16 recreationally trained males and females participated in 2 randomly ordered experimental sessions. In each session maximal effort hamstring performance was assessed prior to and immediately after 1 of 2 stretching protocols. During one of the protocols participants were required to hold each stretch for 15 s while stretch duration in the second protocol was 30 s. Both protocols consisted of 3 repetitions of 2 stretching exercises. A Kincom isokinetic dynamometer was used to assess hamstring performance during isometric, concentric, and eccentric actions. RESULTS: For each of the three muscle actions a repeated measures ANOVA revealed a significant main effect of time (pre- vs poststretch, P<0.05) but no interaction effect (time x SS protocol). Furthermore, the stretch-induced deficits in muscle performance were consistent across muscle action type.
CONCLUSIONS: SS incorporating stretch durations typical of those employed pre-exercise were sufficient to impair muscle performance and the duration of stretch did not influence the degree of force loss. Inclusion of SS, even with short stretch durations, in preparation for strength activities is not appropriate. (Brandenburg JP. Duration of stretch does not influence the degree of force loss following static stretching. Journal of Sports Medicine & Physical Fitness. 46(4):526-34, 2006 ).
www.stopmusclepain.com Hip| Stretch| Muscle Performance
Knee Pain| Basketball Injuries
May 31, 2008 10:05 pmMay 31, 2008
A study to describe the mechanisms of anterior cruciate ligament injury in basketball based on videos of injury situations showed the following:
There was contact at the assumed time of injury in 11 of the 39 cases (5 male and 6 female players). Four of these cases were direct blows to the knee, all in men. Eleven of the 22 female cases were collisions, or the player was pushed by an opponent before the time of injury. The estimated time of injury, based on the group median, ranged from 17 to 50 milliseconds after initial ground contact.
The mean knee flexion angle was higher in female than in male players, both at initial contact (15 degrees vs 9 degrees , P = .034) and at 50 milliseconds later (27 degrees vs 19 degrees , P = .042). Valgus knee collapse occurred more frequently in female players than in male players (relative risk, 5.3; P = .002).
It was found that female players landed with significantly more knee and hip flexion and had a 5.3 times higher relative risk of sustaining a valgus collapse than did male players. Movement patterns were frequently perturbed by opponents.
Preventive programs to enhance knee control should focus on avoiding valgus motion and include distractions resembling those seen in match situations. (Krosshaug T, Nakamae A, Boden BP, Engebretsen L, Smith G, Slauterbeck JR, Hewett TE, Bahr R: Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. American Journal of Sports Medicine. 35(3):359-67, 2007).
www.stopmusclepain.com Knee Pain| Basketball Injuries
Pain| Basketball Injuries
May 25, 2008 12:06 amSunday, May 25, 2008
An estimated 326396 ankle injuries occurred nationally in 2005-2006, yielding an injury rate of 5.23 ankle injuries per 10 000 athlete-exposures. Ankle injuries occurred at a significantly higher rate during competition (9.35 per 10 000 athlete-exposures) than during practice (3.63) (risk ratio = 2.58; 95% confidence interval = 2.26, 2.94; P < .001). Boys' basketball had the highest rate of ankle injury (7.74 per 10 000 athlete-exposures), followed by girls' basketball (6.93) and boys' football (6.52). In all sports except girls' volleyball, rates of ankle injury were higher in competition than in practice. Overall, most ankle injuries were diagnosed as ligament sprains with incomplete tears (83.4%). Ankle injuries most commonly caused athletes to miss less than 7 days of activity (51.7%), followed by 7 to 21 days of activity loss (33.9%) and more than 22 days of activity loss (10.5%). Sports that combine jumping in close proximity to other players and swift changes of direction while running are most often associated with ankle injuries. (Nelson AJ. Collins CL. Yard EE. Fields SK. Comstock RD. Ankle injuries among United States high school sports athletes, 2005-2006. Journal of Athletic Training. 42(3):381-7, 2007. Female professional basketball athletes who did not wear an external ankle support, who played in the key area, or who functioned as centers had a higher risk for ankle sprain than did other players. (Kofotolis N. Kellis E. Ankle sprain injuries: a 2-year prospective cohort study in female Greek professional basketball players. Journal of Athletic Training. 42(3):388-94, 2007).
From 1988-1989 through 2003-2004, 12.4% of schools across Divisions I, II, and III that sponsor varsity women's basketball programs participated in annual Injury Surveillance System data collection. Game and practice injury rates exhibited significant decreases over the study period. The rate of injury in a game situation was almost 2 times higher than in a practice (7.68 versus 3.99 injuries per 1000 athlete-exposures, rate ratio = 1.9, 95% confidence interval = 1.9, 2.0). Preseason-practice injury rates were more than twice as high as regular-season practice injury rates (6.75 versus 2.84 injuries per 1000 athlete-exposures, rate ratio = 2.4, 95% confidence interval = 2.2, 2.4). More than 60% of all game and practice injuries were to the lower extremity, with the most common game injuries being ankle ligament sprains, knee injuries (internal derangements and patellar conditions), and concussions. In practices, ankle ligament sprains, knee injuries (internal derangements and patellar conditions), upper leg muscle-tendon strains, and concussions were the most common injuries. (Agel J. Olson DE. Dick R. Arendt EA. Marshall SW. Sikka RS. Descriptive epidemiology of collegiate women's basketball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. Journal of Athletic Training. 42(2):202-10, 2007).
www.stopmusclepain.com Pain| Basketball Injuries
Pain| Man-made disasters
May 18, 2008 12:04 amMay 18, 2008 There is limited research on the connection between the Holocaust and chronic pain, despite evidence suggesting that medical and psychological sequelae are common in survivors. The goals of this study were: (1) to define Holocaust survivors' (n = 33) chronic pain characteristics as manifested 50 years after the war, (2) to compare survivors with controls (n = 33) who did not experience World War II atrocities, and (3) to investigate the connection between past trauma and chronic pain. Data were collected through questionnaires that included a detailed medical and pain history, visual analog scale (VAS), McGill Pain Questionnaire (MPQ), Beck Depression Inventory (BDI), Symptom Check List-90 (SCL-90), and Pain Disability Index (PDI). A comparison of variables between the two groups was conducted using multivariate analysis of variance (MANOVA) and ANOVA, and canonical discriminant analysis. Results showed that Holocaust survivors reported higher pain levels (73 +/- 18 vs. 56 +/- 21; P < 0.005), more pain sites (4.5 6 2.8 vs. 2.7 6 1.4; P < 0.05), and significantly higher depression scores (17.6 +/- 8.4 vs. 9.2 +/- 4.6; P < 0.001); they tended to utilize more medical services (5.9 +/- 3.0 vs. 5.1 +/- 2.8). Nonetheless, survivors did not regard themselves more disabled as compared with controls. They reported a higher activity level as measured by walking distance capacity, and spent significantly fewer hours resting (4.3 +/- 3.6 vs. 7 +/- 4.6; P < 0.05). This paradoxical combination of high pain intensity, moderate to severe depression, and high activity level characterizes Holocaust survivors' chronic pain. It is conceivable that by remaining active Holocaust survivors fight back their pain, distress, and depression. These findings suggest that Holocaust atrocities affect survivors' chronic pain even years later. (Yaari A. Eisenberg E. Adler R. Birkhan J. Chronic pain in Holocaust survivors. Journal of Pain & Symptom Management. 17(3):181-7, 1999).
Fifty years after their Holocaust trauma, survivors still displayed significant psychosocial and functional impairment.Stesssman J. Cohen A. Hammerman-Rozenberg R. Bursztyn M. Azoulay D. Maaravi Y. Jacobs JM. Holocaust survivors in old age: the Jerusalem Longitudinal Study. (Journal of the American Geriatrics Society. 56(3):470-7, 2008).
As President of the Alumni Myanmar Institutes of Medicine Association (AMIMA), I urge you to to support of the victims of Cyclone Nargis who also are subjected to man-made disasters in Myanmar.
Please donate by clicking on the link below: http://www.amima.net/projects4
www.stopmusclepain.com Pain| Man-made disasters
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Pain | Natural Disasters
May 11, 2008 12:21 amSunday, May 11, 2008 The effects of the cyclone Nargis in Myanmar that killed over 100,000 people, with displacement of over 2 million people prompted my search of the effects of natural disasters in the causation of musculoskeletal pain and psychological trauma.
Of most frequent types of Physical Medicine and Rehabilitation (PMR) conditions of patients treated in the Astrodome Clinic after a historic hurricane Katrina showed the majority (75%) of PMR conditions presented in the first week. Most frequent were swollen feet and legs (22%), leg pain and cramps (17%), headache (12%), and neck and back pain (10%). Persons with headaches were younger than those without (41.3 vs. 46.3 yrs, P = 0.048). Persons with neck and/or back pain were older than those without those conditions (51.3 vs. 44.8 yrs, P = 0.004). Women had more headaches (20.9%) than did men (6.7%, P = 0.002). There were no Caucasians with leg pain/cramps, whereas 20.2% of African Americans had this condition (P = 0.028). (Chiou-Tan FY. Bloodworth DM. Kass JS. Li X. Gavagan TF. Mattox K. Rintala DH. Physical medicine and rehabilitation conditions in the Astrodome clinic after hurricane Katrina. American Journal of Physical Medicine & Rehabilitation. 86(9):762-9, 2007).
Severe natural disasters can cause long-term psychological impact on the survivors. This study aimed to examine the prevalence and risk factors of posttraumatic stress symptoms and psychiatric morbidity among survivors of the severe earthquake that occurred in Chi-Chi, Taiwan, in September 21, 1999. A total of 6412 earthquake survivors whose houses were destroyed by earthquake were recruited about 2 years after the disaster. The estimated rates of posttraumatic stress disorder and psychiatric morbidity were 20.9% and 39.8%, respectively. Psychiatric morbidity occurred mainly in survivors who were female, older, with low education level, and currently living in a prefabricated house and experienced complete destruction of property. The findings of risk factors suggest avenues for targeting postdisaster interventions (Chen CH. Tan HK. Liao LR. Chen HH. Chan CC. Cheng JJ. Chen CY. Wang TN. Lu ML. Long-term psychological outcome of 1999 Taiwan earthquake survivors: a survey of a high-risk sample with property damage).
The post-tsunami health and nutritional statuses of survivors were surveyed three months after the disaster struck. The study group still suffered from injuries after the disaster, and complained of back pain, stress, and sleep disorders. Most in the study group had unsatisfactory health behaviors, and obesity was an increasing problem among female participants. (Kwanbunjan K. Mas-ngammueng R. Chusongsang P. Chusongsang Y. Maneekan P. Chantaranipapong Y. Pooudong S. Butraporn P. Health and nutrition survey of tsunami victims in Phang-Nga Province, Thailand. Southeast Asian Journal of Tropical Medicine & Public Health. 37(2):382-7, 2006).
At present, saving the lives of the survivors of the Myanmar Cyclone is of paramount importance since there is scarcity of food, water, clothing and shelter. These victims living under deplorable conditions need dire help. At a time when international aid organizations and United Nations is unable to supply age to these victims, we as native physicians are able to help these victims at Ground Zero level and at this very moment as we speak, we have physicians saving lives.
As President of the Alumni Myanmar Institutes of Medicine Association, we urge assistance in our endeavors. To donate, please visit:
http://www.amima.net/projects4
Organization summary
Alumni Myanmar Institutes of Medicine (AMIMA) is a PA, USA incorporated, nonprofit 501(c)(3) organization. It is organized for the purpose of providing charitable giving to nonprofit organizations promoting health, economic development and humanitarian aid in Myanmar. We have 750 physician members world-wide and have donated in 2007 to the Myanmar Dengue Hemorrhagic Fever Project and for the establishment of the medical school library of the Institute of Medicine in Yangon.
Involvement in Myanmar cyclone disaster relief.
AMIMA can reach the people needing the most help since as native physicians we are able to co-ordinate and work with members of the Myanmar Medical Council (local non-governmental organization). AMIMA has already donated $40,000 to Emergency Medical Relief Team for Cyclone Areas headed by Professor U Hla Myint, President, Myanmar Medical Council assisted by Dr. Kyi Minn, adviser, World Vision. This established Myanmar traveling medical team has dealt with previous epidemics, such as Dengue hemorrhagic fever and will provide medical care, clean water and food to prevent infectious diseases, as well as provide psychological counseling.
Donate at: http://www.amima.net/projects4
www.stopmusclepain.com Pain | Natural Disasters
pain
Pain| Disc Degeneration
May 3, 2008 11:33 pmSunday, May 04, 2008
A recent report in the Lancet medical journal reports that in a survey of 3,982 Americans, 29% of men and 27% women reported feeling some pain. Those who have higher levels of pain are usually those with lower income and less education working in manual labor and other blue-collar jobs. About $60 billion in productivity is lost each year because of workers experiencing pain and about $13.8 billion was spent on prescription medicines in 2004.
Pain can start as early as the teen years and increases to the mid-40s and then plateau to increase again after age 75. The degenerative changes seen in autopsies confirm the reason for these pain symptoms (see below).
The intervertebral discs lies between the vertebral bodies, linking them together. The components of the disc are nucleus pulposus, annulus fibrosus and cartilagenous end-plates. The blood supply to the disc is only to the cartilagenous end-plates. The nerve supply is basically through the sinovertebral nerve. The important components of the disc are collagen fibers, elastin fibers and aggrecan. As the disc ages, degeneration occurs, the nucleus dries up, and the disc flattens. During these changes, pain producing nuclear material tracks and leaks through the outer rim of the annulus. This is the main source of disc related pain. While this is occurring, the degenerative disc, having lost its height, effects the structures close by, such as ligamentum flavum, facet joints, and the shape of the neural foramina. This is the main cause of spinal stenosis and radicular pain due to the disc degeneration in the aged populations. (Raj PP. Intervertebral disc: anatomy-physiology-pathophysiology-treatment. Pain Practice. 8(1):18-44, 2008).
In a study of 248 sections of lumbar disc and vertebral bodies from 41 routine autopsies (range, 7 months to 88 years), these degenerative changes were noted: fibrous transformation starts in the nucleus, then annular disorganization, endplate, and vertebral body alterations progress. These changes occur predominantly in the first 2 decades and in the 5th to 7th decades. In the 3rd and 4th decades, little progression occurs. Nuclear clefts and annular tears appear later, mostly starting in the 2nd decade, with clefts preceding formation of tears. Radial and concentric tears develop similarly over time, whereas rim lesions mostly develop after the sixth decade. Significant differences are observed between upper and lower lumbar spine. Haefeli M. Kalberer F. Saegesser D. Nerlich AG. Boos N. Paesold G. The course of macroscopic degeneration in the human lumbar intervertebral disc. [Journal Article. Research Support, Non-U.S. Gov't] Spine. 31(14):1522-31, 2006.
www.stopmusclepain.com Pain| Disc Degeneration
