Archive for May, 2008
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
