Archive for the 'Lower Body Topics' category
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
Low Back Pain| Running
March 28, 2008 12:50 pmFriday, March 28, 2008
This study was to investigate the incidence, prevalence, and possible risk factors for low back pain among a group of runners and walkers. A survey with 539 responses who participated in either a 10-kilometer run or 4-mile recreational walk showed previous history of low back pain in 74% of respondents. Prevalence of low back pain at the time of survey completion was 13.6%. Low back pain was experienced more frequently by obese runners and by those who reported certain patterns of shoe wear. Regular participation in aerobics correlated with a reduced lifetime risk for low back pain. (Woolf SK. Barfield WR. Nietert PJ. Mainous AG 3rd. Glaser JA. The Cooper River Bridge Run Study of low back pain in runners and walkers. Journal of the Southern Orthopaedic Association. 11(3):136-43, 2002).
Another study evaluated whether athletes with a history of low back pain would, on average, perform slower on a timed 20-m shuttle run as compared with a normal athletic population. Of 211 athletes evaluated, 27 had been treated for low back pain during the previous year. Currently asymptomatic athletes with a recent history of low back pain were slower (6.3s vs 5.8s) during performance of the timed 20-m shuttle run than athletes without low back pain (P=.0002). (Nadler SF. Moley P. Malanga GA. Rubbani M. Prybicien M. Feinberg JH. Functional deficits in athletes with a history of low back pain: a pilot study. Archives of Physical Medicine & Rehabilitation. 83(12):1753-8, 2002)
The same authors found significantly slower response time on the 20-meter shuttle run in college freshman athletes with a history of a lower extremity injury, as compared with freshmen without a previous injury (p = 0.01). No significant difference was noted in non-freshman collegiate athletes regardless of injury history (p = 0.98). They concluded that kinetic chain deficits may exist long after symptomatic recovery from injury resulting in functional deficits, which may be missed on a standard physical assessment. Clinical relevance of the study was that there are residual functional deficits in incoming college athletes, which may be related to inadequate care in the high school setting. (Nadler SF. Malanga GA. Feinberg JH. Rubanni M. Moley P. Foye P. Functional performance deficits in athletes with previous lower extremity injury. Clinical Journal of Sport Medicine. 12(2):73-8, 2002 Mar).
Comments: The application of findings from these studies involve that even though injuries may have been presumed to be healed through absence of symptoms such as pain, subclinical involvement of motor components of the spinal nerve roots may still be ongoing. When pain fibers are not involved, that will be no pain symptoms. Athletes should be examined for presence of muscle stiffness and tightness presenting as limitation of joint range of motion. The most important sign of subclinical irritation of spinal nerve roots is presence of muscle tenderness at palpable myofascial bands or nodules. These points are known as trigger points. Athletes with such findings will be prone to injuries and it is essential that myofascial treatments that help heal the active trigger points be done prior to sporting activities. The most effective stimulation of deep myofascial trigger points is best achieved with such as eToims Twitch Relief Method.
www.stopmusclepain.com Low Back Pain| Running
lower body topics
Neck and Back Pain| Cycling
March 21, 2008 10:50 amFriday, March 21, 2008
30-70% of cyclists suffer from cervical, dorsal, or lumbar back pain. There is a tendency towards hyperextension of the pelvic/spine angle which resulted in an increase in tensile forces at the sacral promontory. These forces can easily be reduced by appropriate adjustment of the seat angle–that is, by creating an anterior inclining angle. The incidence and magnitude of back pain in cyclists can be reduced by appropriate adjustment of the angle of the saddle. (Salai M. Brosh T. Blankstein A. Oran A. Chechik A. Effect of changing the saddle angle on the incidence of low back pain in recreational bicyclists. British Journal of Sports Medicine. 33(6):398-400, 1999).
It has been found that many of these cyclists suffer from discogenic disease. The number of previous sports-related injuries, was predictive of neck and back pain, and a strong tendency toward neck and back pain was observed for athletes with more total years of participation in sports due to overuse injuries. Causative factors are thought to be prolonged forward flexion, flexion-relaxation or overactivation of the erector spinae, mechanical creep and generation of high mechanical loads while being in a flexed and rotated position. A pilot study was performed to examine whether differences existed in spinal kinematics and trunk muscle activity in 9 cyclists with and 9 cyclists without non-specific chronic low back pain using electromagnetic tracking system and EMG was recorded bilaterally from selected trunk muscles. Data were collected every five minutes until back pain occurred or general discomfort prevented further cycling. Cyclists in the pain group showed a trend towards increased lower lumbar flexion and rotation with an associated loss of co-contraction of the lower lumbar multifidus. This muscle is known to be a key stabiliser of the lumbar spine. The findings suggest altered motor control and kinematics of the lower lumbar spine are associated with the development of LBP in cyclists. (Burnett AF. Cornelius MW. Dankaerts W. O'sullivan PB. Spinal kinematics and trunk muscle activity in cyclists: a comparison between healthy controls and non-specific chronic low back pain subjects-a pilot investigation. Manual Therapy. 9(4):211-9, 2004).
Inappropriate saddle positions may also be a cause of lower back pain. Partial and complete cutout saddle designs may increase anterior pelvic tilt, and saddles with a complete cutout design may increase trunk flexion angles under select cycling conditions. A saddle with a partial cutout design may be more comfortable than a standard or complete cutout saddle design. (Bressel E. Larson BJ. Bicycle seat designs and their effect on pelvic angle, trunk angle, and comfort. (Medicine & Science in Sports & Exercise. 35(2):327-32, 2003 Feb).
A radiographic study conducted to evaluate dorso-lumbar angular values (angle between the mid-back at T12 and lower back at L3) to define the most physiological sitting position during cycling. Two different pedal unit positions were tested; the first one in a bicycle frame type with pedals in front of the saddle axis and the second one with the pedals behind the saddle axis, in order. The findings showed that the incidence and importance of low back pain in cyclists can be reduced with appropriate pedal unit position; the position with pedals behind the saddle axis permits more physiological spine angles in comparison with the classic one having the pedals in front of the saddle axis; this fact is due to a different pelvic position which coincides with lumbar angles. (Fanucci E. Masala S. Fasoli F. Cammarata R. Squillaci E. Simonetti G. Cineradiographic study of spine during cycling: effects of changing the pedal unit position on the dorso-lumbar spine angle. Radiologia Medica. 104(5-6):472-6, 2002).
www.stopmusclepain.com Neck and Back Pain| Cycling
Low Back Pain| Sitting| Stiffness
March 15, 2008 12:42 amMarch 15, 2008
Prolonged sitting may alter the passive stiffness of the lumbar spine. Consequently, performing full lumbar flexion movements after extended periods of sitting may increase the risk of low back injury.
A study was performed on 12 normal subjects to quantify time-varying changes in the passive flexion stiffness of the lumbar spine with exposure to prolonged sitting and to link these changes to lumbar postures and trunk extensor muscle activation while sitting. The participants performed deskwork for 2 hours while sitting on the seat pan of an office chair. Moment-angle relationships for the lumbar spine were derived by pulling participants through their full voluntary range of lumbar flexion on a customized frictionless table.
It was found that lumbar spine stiffness increased in men after only 1 hour of sitting, whereas the responses of women were variable over the 2-hour trial. Men appeared to compensate for this increase in stiffness by assuming less lumbar flexion in the second hour of sitting. Changes in the passive flexion stiffness of the lumbar spine may increase the risk of low back injury after prolonged sitting and may contribute to low back pain in sitting. (Beach TA. Parkinson RJ. Stothart JP. Callaghan JP. Effects of prolonged sitting on the passive flexion stiffness of the in vivo lumbar spine. Spine 5(2):145-54, 2005
Here is a study showing how to treat low back pain by drawing in the abdominal wall as a specific exercise for the transversus abdominis muscle (in cocontraction with the multifidus). Clinical effectiveness has been demonstrated to be a reduction of 3-year recurrence from 75% to 35%.
Biomechanical effect of this specific exercise on the mechanics of the sacroiliac joint was examined on 13 healthy individuals in the prone position during the two abdominal muscle patterns by means of Doppler imaging of vibrations and simultaneous electromyographic recordings.
Contraction of the transversus abdominis significantly decreases the laxity of the sacroiliac joint. This decrease in laxity is larger than that caused by a bracing action using all the lateral abdominal muscles supporting the use of independent transversus abdominis contractions for the treatment of low back pain. (Richardson CA. Snijders CJ. Hides JA. Damen L. Pas MS. Storm J. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine. 27(4):399-405, 2002
This is a very simple exercise that can be performed while sitting, standing, walking or lying down for those who have low back pain as well as very useful as a preventive exercise for those who are not in pain.
www.stopmusclepain.com Low Back Pain| Sitting| Stiffness
Back Pain| Alternative Medicine|eToims Differences
March 7, 2008 2:58 pmMarch 7, 2008
An article by Sherman KJ. Cherkin DC. Deyo RA, et al, discusses that patients frustrated with conventional care for back pain, turn increasingly to complementary and alternative medicine. Between 10% and 20% of visits to chiropractors, massage therapists, and acupuncturists is due to chronic back pain. Also back pain is the most common condition these providers treat.
Treatments given by each of these professions share certain similarities. Each has a hands-on technique at the core of its treatments (ie, needling the body, manipulating the spine, or massaging the soft tissues), although many different variations of these techniques are used. These techniques are repeatedly used during successive visits, often in conjunction with various adjunctive modalities.
Each profession has a prototypical approach. For acupuncture, the typical approach includes assessments that are foreign to the biomedical community (eg, tongue diagnosis), regular body acupuncture using the approach of Traditional Chinese Medicine, and heat. Chiropractic typically includes spinal and soft tissue examinations at the first office visit followed by spinal adjustment, most often using the “diversified technique.” Massage therapy usually includes tissue assessment and a massage involving three major treatment styles: deep tissue, Swedish, and trigger point. Self-care recommendations are also a standard part of visits to acupuncture and massage practice and chiropractors. All three professions make self-care recommendations, with exercise being part of those recommendations for all professions.
Implications for Physicians: The article also states that in advising patients about the use of CAM therapies, physicians should be guided by evidence on effectiveness and safety. The amount and quality of evidence on effectiveness varies for these therapies. Spinal manipulation appears to be superior to sham and known ineffective therapies but not superior to effective conventional treatments for chronic low back pain. Previous acupuncture studies are generally of poor quality, so the effectiveness of acupuncture for treating low back pain is unclear. Although only three studies have evaluated massage for back pain, all three studies were positive.
While there is some variability in the treatment provided to chronic back pain patients by acupuncturists, chiropractors, and massage therapists, physicians may be reassured by this study’s data that the treatments used by these practitioners are relatively well characterized and “mainstream” for these professions and rarely include modalities that can be dangerous. (Sherman KJ. Cherkin DC. Deyo RA. Erro JH. Hrbek A. Davis RB. Eisenberg DM. The diagnosis and treatment of chronic back pain by acupuncturists, chiropractors, and massage therapists. Clinical Journal of Pain. 22(3):227-34, 2006)
eToims Twitch Relief Method is an individualized therapy with similarities to the work and soft tissue healing effects provided by acupuncturists, chiropractor and massage therapists. We emphasize on self-care techniques and guided exercise to prevent or limit further trauma to already injured nerves and muscles that can occur because of activities of daily living, work, sports, recreation, etc.
However, the practice of eToims Twitch Relief Method vastly differs from the above three alternative medicine practices since eToims Twitch Relief Method is a medical system that requires a sound knowledge of anatomy and electro-physiology. The eToims practitioner has to undergo significant training to be able to have skills to be able to locate and noninvasively stimulate irritable neuromuscular junctions (trigger points) within the time affordable by the patient for a treatment session.
The treatment results are determined by the patient's ability to have immediate reduction in pain, improvement in range of motion and other measured physiologic parameters compatible with pain reduction. Muscles are individually exercised in eToims and different body positions are used so that even the deep layers of muscles can be stimulated and exercised. Tight and problematic muscles are individually stretched through active twitch muscle contraction with the stretch emanating from the neuromuscular junctions where most of the shortened muscle fibers concentrate. This relieves pain through releasing the constricting effect of the tight muscles on intramuscular nerves, blood vessels, bone surfaces and joints.
The twitch induced exercise also aids in the circulation of fresh blood to the areas where blood could not flow previously due to muscles in spasm and removes stagnant fluids and pain producing chemicals from the same region. This removes pain and encourages nerves and muscles to heal.
eToims Twitch Relief Method is safe and efficacious and is the only treatment that delivers reproducible pain relieving results in neuromuscular pain such that patients are willing to pay out of pocket for chronic durations for increasing their quality of life. After three weekly sessions of eToims Twitch Relief Method, our retention rate is 85% for weekly return visits with self-pay patients.
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