| | The Relationship Between Additional Heads of the Quadriceps Femoris, the Vasti Muscles, and the Patellar Ligament | The Relationship Between Additional Heads of the Quadriceps Femoris, the Vasti Muscles, and the Patellar Ligament
The Relationship Between Additional Heads of the Quadriceps Femoris, the Vasti Muscles, and the Patellar Ligament
Overview
The quadriceps femoris consists of four muscles: the rectus femoris, vastus medialis, vastus intermedius, and vastus lateralis. However, the effect of additional quadriceps femoris heads on the vasti muscles and patellar ligaments is unknown. The quadriceps femoris muscle (QF) is important in locomotion; the rectus femoris (RF) swings the leg forward when a step is taken. During walking or running, quadriceps muscles such as the vastus medialis (VM) stabilize the patella and knee joint. The QF is important in sport owing to its potential for injury, which can be painful and debilitating.
The aims of the present study are to determine the relationship between additional quadriceps femoris heads and the vasti muscles and patellar ligaments and to review the morphology of the vastus lateralis, vastus medialis, and vastus intermedius.
Journal
Hindawi BioMed Research International
| 3 | | R465.00 |  |
| | Exercise Interventions in Child and Adolsecent Mental Health Care: An overview of the evidence and recommendations for implementation | Exercise Interventions in Child and Adolsecent Mental Health Care: An overview of the evidence and recommendations for implementation
Exercise Interventions in Child and Adolsecent Mental Health Care: An overview of the evidence and recommendations for implementation
Overview
The poor physical health of people with mental illness has long been established. A 15–20-year mortality gap arises from factors such as the likelihood of developing noncommunicable diseases, unhealthy lifestyle behaviors, reduced access to and provision of physical health care, and side-effects of medication.
This has been labeled an international human rights scandal, since a large proportion of this risk is preventable. In recognition of these disparities, international health bodies have produced guidance to address poor physical health, including the World Health Organization, World Psychiatric Association, and a Lancet Psychiatry Commission.
The use of physical activity interventions in mental health care for adults has a large academic evidence base and numerous examples of real-world implementation. However, the use of physical activity within mental health care for children and young people (CYP) has received less attention to date.
The key conclusions from this article, suggest there is an increasingly strong evidence base for the benefits of using physical activity interventions to improve, prevent, and manage physical and mental health outcomes in CYP with mental illness. However, more work needs to be done to improve the evidence base, refine its implementation into standard mental health care, and develop strategies for large-scale dissemination of such interventions across various care and cultural contexts.
The Association for Child and Adolescent Mental Health JCPP Advances
| 3 | | R485.00 |  |
| | Joint-Preserving Surgery for Hyperextension Deformity of the Hallux Interphalangeal Joint in a Patient with Rheumatoid Arthritis | Joint-Preserving Surgery for Hyperextension Deformity of the Hallux Interphalangeal Joint in a Patient with Rheumatoid Arthritis
Joint-Preserving Surgery for Hyperextension Deformity of the Hallux Interphalangeal Joint in a Patient with Rheumatoid Arthritis
Overview Sesamoiditis secondary to gout is an extremely rare condition with few case reports in the literature. It is an important differential diagnosis because the treatment depends on targeted therapy, unlike the main causes of sesamoiditis that often involves immobilization with special orthoses and prescription of anti-inflammatory drugs. This here is a case of a 38-year-old male, athlete, with bipartite medial sesamoid, who had insidious pain in the base of the left hallux. Laboratory tests showed no alterations, and imaging examinations demonstrated sesamoiditis with suspicion of stress fracture. The patient was initially prescribed an immobilization boot and analgesic and anti-inflammatory drugs, but he did not respond to the measures taken. After the onset of the same condition in the contralateral foot and getting the same imaging findings, an investigation of systemic disease began, focusing on gout, because of a positive family history, which was confirmed by dual-energy computed tomography.
Authors Takumi Matsumoto, Yuki Shimizu, Song Ho Chang, Taro Kasai, Jun Hirose and Sakae Tanaka
Journal Hindawi Case Reports in Orthopedics
| 3 | | R430.00 |  |
| | Bilateral Sesamoiditis as First Manifestation of Gout | Bilateral Sesamoiditis as First Manifestation of Gout
Bilateral Sesamoiditis as First Manifestation of Gout
Overview Sesamoiditis secondary to gout is an extremely rare condition with few case reports in the literature. It is an important differential diagnosis because the treatment depends on targeted therapy, unlike the main causes of sesamoiditis that often involves immobilization with special orthoses and prescription of anti-inflammatory drugs. This here is a case of a 38-year-old male, athlete, with bipartite medial sesamoid, who had insidious pain in the base of the left hallux. Laboratory tests showed no alterations, and imaging examinations demonstrated sesamoiditis with suspicion of stress fracture. The patient was initially prescribed an immobilization boot and analgesic and anti-inflammatory drugs, but he did not respond to the measures taken. After the onset of the same condition in the contralateral foot and getting the same imaging findings, an investigation of systemic disease began, focusing on gout, because of a positive family history, which was confirmed by dual-energy computed tomography.
Authors Daniel de Oliveira Beraldo, Sasha Duarte, Gustavo Pacheco, Rodrigo Barbosa, Carolina Mendes, Marcela Silva, Fabiana Beraldo, Andrei Alkmim, Ricardo Teixeira and Alexandre Bonfim Journal Hindawi Case Reports in Orthopedics
| 3 | | R420.00 |  |
| | Congenital Unilateral Hypertrophy of the Plantar Musculature with Multiple Toe Deformities: A Case Report and Literature Review | Congenital Unilateral Hypertrophy of the Plantar Musculature with Multiple Toe Deformities: A Case Report and Literature Review
Congenital Unilateral Hypertrophy of the Plantar Musculature with Multiple Toe Deformities: A Case Report and Literature Review
Overview Congenital unilateral hypertrophy of the plantar musculature is a rare condition of unknown incidence. This article reports the unusual case of a 17-year-old man with this rare condition in combination with multiple toe deformities: hallux valgus, claw toe (second toe), and laterally abducted digitus quintus.
This case study is aimed at reporting a detailed description of the present patient and explains the rationale behind our chosen surgical procedure. Moreover, a review of the current literature related to congenital hypertrophy of the plantar musculature is presented to discuss its possible etiology as well as diagnostic and therapeutic regimen.
In summary, the procedure is aimed at relieving the hallux valgus symptoms, correcting its triggering factor, and preventing the patient from further symptomatic foot deformities, while restoring—and not destroying—the physiological muscular function by partial resection.
Authors Matthias Holzbauer, Stefan Rick, Marco Götze and Sébastien Hagmann Journal Hindawi Case Reports in Orthopedics
| 3 | | R420.00 |  |
| | Fabella Syndrome and Common Peroneal Neuropathy following Total Knee Arthroplasty | Fabella Syndrome and Common Peroneal Neuropathy following Total Knee Arthroplasty
Fabella Syndrome and Common Peroneal Neuropathy following Total Knee Arthroplasty
Overview The fabella is a sesamoid bone in the lateral gastrocnemius that is present in 10-30% of the population. Despite its high prevalence, the fabella rarely causes pathology leading to delayed diagnoses and prolonged patient discomfort when symptomatic. The fabella syndrome is often associated with a snapping or clicking sensation that is exacerbated by aerobic activates. Fabella pathology is rare but increasingly recognized as a source of posterolateral knee pain following TKA.
Initially believed to be unique to adolescents, fabella syndrome also affects older adults. When conservative interventions fail, surgical excision for treatment of fabella syndrome or fabella-associated common peroneal neuropathy has improved patient reported outcomes and returns to preinjury level of activities.
Significant mechanical alignment changes may create eccentric mechanical loads across the gastrocnemius tendon and embedded fabella. Furthermore, the correction of a flexion contracture with TKA may affect soft tissues posterior to the knee including the gastrocnemius tendon.
Authors Connor C. Diaz, Avinesh Agarwalla and Brian Forsythe Journal Hindawi Case Reports in Orthopedics
| 3 | | R460.00 |  |
| | Analysis of Dynamic Plantar Pressure before and after the Occurrence of Neurogenic Intermittent Claudication in Patients with Lumbar Spinal Stenosis: An observational study | Analysis of Dynamic Plantar Pressure before and after the Occurrence of Neurogenic Intermittent Claudication in Patients with Lumbar Spinal Stenosis: An observational study
Analysis of Dynamic Plantar Pressure before and after the Occurrence of Neurogenic Intermittent Claudication in Patients with Lumbar Spinal Stenosis: An observational study
Overview Lumbar spinal stenosis (LSS) refers to the nerve compression syndrome, in which the spinal canal narrows and compresses the dural sac, spinal cord, or nerve root. The prevalence of LSS increases with age; it is about 9.3% in the general population and up to 47% in individuals older than 60 years.
Patients with LSS usually seek medical treatment because of walking disorders. The poor walking ability indicates severe compression of the spinal cord and nerve. Many recent studies investigated the gait patterns of patients with LSS. The findings revealed that the walking patterns of patients with LSS were different from those of ordinary subjects, mainly manifested by wide-based gait, increased gait variability, and balance disturbances.
In conclusion the results revealed that differences in the distribution of plantar pressure include patients with LSS that could present the posture of the lumbar forward flexion when walking and that the occurrence of NIC could affect the plantar pressure distribution of the patients with LSS, predicting the patient’s risk of falling to the anterior direction and to the symptomatic side. It is promising to provide a new objectively method for evaluating the walking capabilities of patients with LSS.
Authors Wei Wei, Chao Xu, Xiao-Jiang Yang, Chang-Bo Lu, Wei Lei and Yang Zhang. Journal Hindawi BioMed Research International
| 3 | | R425.00 |  |
| | Amygdala pathology in amyotrophic lateral sclerosis and primary lateral Sclerosis | Amygdala pathology in amyotrophic lateral sclerosis and primary lateral Sclerosis
Amygdala pathology in amyotrophic lateral sclerosis and primary lateral Sclerosis
Overview Temporal lobe studies in motor neuron disease overwhelmingly focus on white matter alterations and cortical grey matter atrophy. Reports on amygdala involvement are conflicting and the amygdala is typically evaluated as single structure despite consisting of several functionally and cytologically distinct nuclei. A prospective, single-centre, neuroimaging study was undertaken to comprehensively characterise amygdala pathology in 100 genetically stratified ALS patients, 33 patients with PLS and 117 healthy controls. Our findings highlight that the amygdala is affected in ALS and our study demonstrates the selective involvement of specific nuclei as opposed to global atrophy. The genotype-specific patterns of amygdala involvement identified by this study are consistent with the growing literature of extra-motor clinical features. Mesial temporal lobe pathology in ALS is not limited to hippocampal pathology but, as a key hub of the limbic system, the amygdala is also affected in ALS.
Authors Rangariroyashe H. Chipikaa, Foteini Christidia, Eoin Finegan, Stacey Li Hi Shing, Mary Clare McKenna, Kai Ming Chang, Efstratios Karavasilis, Mark A. Doherty, Jennifer C. Hengeveld, Alice Vajda, Niall Pender, Siobhan Hutchinson, Colette Donaghy, Russell L. McLaughlin, Orla Hardiman, Peter Bede
| 3 | | R380.00 |  |
| | Effectiveness of an Eye-Cervical Re-Education Program in Chronic Neck Pain: A Randomized Clinical Trial | Effectiveness of an Eye-Cervical Re-Education Program in Chronic Neck Pain: A Randomized Clinical Trial
Effectiveness of an Eye-Cervical Re-Education Program in Chronic Neck Pain: A Randomized Clinical Trial
Overview:
Proprioceptive training is popularly applied as a therapeutic exercise method in physiotherapy. Its effects on pain and range of motion are only poorly evaluated. Adults with neck pain commonly experience hyperalgesia of cervical muscles, as evidenced by a reduced pressure pain threshold (PPT). Pain symptoms are thought to worsen in response to prolonged static muscle activity and/or repetitive job tasks, causing muscle metabolic disturbances. The reduced range of neck motion (ROM) is another objective finding widely investigated in CNP. It could be argued that the optimal functioning of the cervical musculature is related to the ROM; changes in neck muscle activation that result in an altered stiffness distribution may affect cervical passive stability as well as the passive and active ROM.
This study assesses the effectiveness of proprioceptive training with an Eye-Cervical Re-education Program to decrease pain and increase the joint range in chronic neck pain patients. All patients were treated with a multimodal physiotherapy intervention. The experimental group was supplemented with an exercise program that included eye-cervical proprioception.
In conclusion the eye-cervical re-education program is effective at relieving pain pressure thresholds in the upper trapezius, right levator scapula, and left splenius capitis and especially effective for increasing the cervical range of motion.
Acknowledgments: Authors: Veronica Perez-Cabezas, Carmen Ruiz-Molinero, Jose Jesus Jimenez-Rejano, Gema Chamorro Moriana, Gloria Gonzalez-Medina and Raquel Chillon-Martinez
Journal: Evidence-Based Complementary and Alternative Medicine
| 3 | | R410.00 |  |
| | Previous History of Knee Arthroscopy in Patients Undergoing Total Knee Arthroplasty: An Examination of the Effect of the Literature and American Academy of Orthopaedic Surgeons 2013 Arthroscopy Guidelines on Clinical Practice | Previous History of Knee Arthroscopy in Patients Undergoing Total Knee Arthroplasty: An Examination of the Effect of the Literature and American Academy of Orthopaedic Surgeons 2013 Arthroscopy Guidelines on Clinical Practice
Previous History of Knee Arthroscopy in Patients Undergoing Total Knee Arthroplasty: An Examination of the Effect of the Literature and American Academy of Orthopaedic Surgeons 2013 Arthroscopy Guidelines on Clinical Practice
Overview The purpose of this study was to compare the rate of previous knee arthroscopy in patients undergoing total knee arthroplasty (TKA) before (2005-2006) and after (2018) publication of landmark studies that examined the effectiveness of knee arthroscopy as well as the American Academy of Orthopaedic Surgeons 2013 knee arthroscopy guidelines. In this study a retrospective chart review of 214 patients who underwent a TKA between 2005 and 2006 (Group 1) and 213 patients who underwent a TKA in 2018 (Group 2) was performed. The medical records were to determine whether previous knee arthroscopy was performed. The findings suggests that the recommendations set forth by landmark clinical trials that examined the effectiveness of knee arthroscopy and the AAOS 2013 knee arthroscopy guidelines did not have a sudden impact within the geographic region, however there is significant evidence to suggest a gradual shift in treatment, where knee arthroscopy is withheld near imminent knee arthroplasty.
Authors Melissa A. Kluczynski, M.S.., Griffin Lunn, Matthew J. Phillips, M.D., andJohn M. Marzo, M.D
Journal Arthroscopy, Sports Medicine, and Rehabilitation
| 3 | | R485.00 |  |
| | Analgesic Effect of Extracorporeal Shock Wave Treatment Combined with Fascial Manipulation Theory for Adhesive Capsulitis of the Shoulder: A Retrospective Study | Analgesic Effect of Extracorporeal Shock Wave Treatment Combined with Fascial Manipulation Theory for Adhesive Capsulitis of the Shoulder: A Retrospective Study
Analgesic Effect of Extracorporeal Shock Wave Treatment Combined with Fascial Manipulation Theory for Adhesive Capsulitis of the Shoulder: A Retrospective Study
Overview: Shoulder pain is a common musculoskeletal malady, and one of the most prevalent causes of shoulder pain is adhesive capsulitis of the shoulder (AC), which may be associated with minor trauma, environmental stresses, autoimmune processes, or disease like diabetes mellitus.
During recent years, the critical role of the fascia in the pathogenesis of musculoskeletal pain and dysfunction has gradually been accepted, and there is a prevailing view that the myofascial system is a three-dimensional continuum wherein musculoskeletal disorders may be caused by changes in the deep muscle fascia, such as lack of sliding, stretching, and appropriate adaptation.
This study aims to explore whether extracorporeal shockwave treatment (ESWT) based on the theory of fascial manipulation (FM) at select treatment points is superior to traditional local ESWT for pain relief in adhesive capsulitis of the shoulder.
Acknowledgments: Authors: Xiangnan Yuan, Fenghua Zhou, Lixin Zhang, Zhiqiang Zhang and Jianjun Li
Journal: BioMed Research International 2018
| 3 | | R420.00 |  |
| | Acupuncture at Tiaokou (ST38) for Shoulder Adhesive Capsulitis: What Strengths Does It Have? A Systematic Review and Meta-Analysis of Randomized Controlled Trials | Acupuncture at Tiaokou (ST38) for Shoulder Adhesive Capsulitis: What Strengths Does It Have? A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Acupuncture at Tiaokou (ST38) for Shoulder Adhesive Capsulitis: What Strengths Does It Have? A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Overview: Shoulder adhesive capsulitis (SAC), which is also known as scapulohumeral periarthritis or frozen shoulder, usually refers to a chronic aseptic inflammation caused by injury or degeneration of the shoulder joint and articular capsule. The main symptoms of SAC are chronic shoulder pain and restricted range of shoulder movements. Despite the steady accumulation of evidence concerning the therapeutic effectiveness of acupuncture for SAC over the past several decades, the available reports are still contradictory. Tiaokou (ST38) is used as a crucial distal acupoint for treating shoulder adhesive capsulitis (SAC) in traditional Chinese medicine.
The objective of this study was to assess the effectiveness and safety of acupuncture at Tiaokou for treating SAC. Eight electronic databases without language restrictions were searched. All the literature was processed to identify RCTs comparing acupuncture at Tiaokou with other therapies (e.g., acupuncture at local shoulder acupoints and nonsteroidal anti-inflammatory drugs). Two reviewers extracted trials and collected outcome data independently. A meta-analysis was performed following a strict methodology.
This review found encouraging evidence for the effectiveness of acupuncture at Tiaokou for SAC.
Acknowledgments: Authors: Chao Yang, TaoTao Lv, TianYuan Yu, Steven Wong, MengQian Lu, and YiZhen Li Journal: Evidence-Based Complementary and Alternative Medicine
| 3 | | R440.00 |  |
| | Effect of Deep Cervical Flexor Muscle Training Using Pressure Biofeedback on Pain and Forward Head Posture in School Teachers with Neck Pain: An Observational Study | Effect of Deep Cervical Flexor Muscle Training Using Pressure Biofeedback on Pain and Forward Head Posture in School Teachers with Neck Pain: An Observational Study
Effect of Deep Cervical Flexor Muscle Training Using Pressure Biofeedback on Pain and Forward Head Posture in School Teachers with Neck Pain: An Observational Study
Overview: Teaching is one of the professions where incidence and prevalence of neck pain is high. Prolonged use of computers, which has further increased due to online teaching amid pandemic, is known to cause neck pain and alter posture, while people with forward head posture (FHP) are prone to develop neck pain and related disability. Research has shown that impairment of deep cervical flexor (DCF) muscles leads to insufficiency in coordination, activation, overload, and poor support on cervical structures that further lead to development of neck pain and altered neck posture. The objective of this study was to see the effect of DCF muscle training using pressure biofeedback on pain and FHP in schoolteachers with neck pain.
This observational study was conducted at medical center in school premises. Fifty-five schoolteachers aged between 25 and 40 years with experience of more than 5 years were invited to participate in this study. Pain and FHP were assessed using NPRS and cranio-vertebral angle using digital photograph technique, respectively, at baseline and end of four weeks of treatment.
This study shows that although pain and FHP improved following conventional exercises in schoolteachers with neck pain, mean improvement was more significant among those who received additional DCF muscle training using pressure biofeedback.
Acknowledgments:
Authors: Ahmad H. Alghadir and Zaheen A. Iqbal
Journal: BioMed Research International
| 3 | | R465.00 |  |
| | HIV and Aids | HIV and Aids
Overview
HIV disease is caused by infection with HIV-1 or HIV-2, which are retroviruses in the Retroviridae family, Lentivirus genus. Human immunodeficiency virus (HIV) is a blood-borne virus typically transmitted via sexual intercourse, shared intravenous drug paraphernalia, and mother-to-child transmission (MTCT), which can occur during the birth process or during breastfeeding. The patient with HIV may present with signs and symptoms of any of the stages of HIV infection. No physical findings are specific to HIV infection; the physical findings are those of the presenting infection or illness. Examples of manifestations include acute seroconversion manifests as a flulike illness, consisting of fever, malaise, generalized rash, generalized lymphadenopathy is common and may be a presenting symptom. This course covers the screening, diagnosis, medication and management of Aids.
Author: Sharespike
| 3 | | R425.00 |  |
| | Hypertension Part 3 | Hypertension Part 3
Overview Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment. As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike
| 3 | | R420.00 |  |
| | Hypertension Part 2 | Hypertension Part 2
Overview Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment. As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike
| 3 | | R420.00 |  |
| | Bee Sting and Anaphylaxis | Bee Sting and Anaphylaxis
Bee Sting and Anaphylaxis
Overview Hymenoptera stings account for more deaths in the United States than any other envenomation. The order Hymenoptera includes Apis species, ie, bees (European, African), vespids (wasps, yellow jackets, hornets), and ants. Most deaths result from immediate hypersensitivity reactions and anaphylaxis. Severe anaphylactoid reactions occur occasionally when toxins directly stimulate mast cells. In addition to immunologic mechanisms, some injury occurs from direct toxicity. While most stings cause only minor problems, stings cause a significant number of deaths.
Target organs are the skin, vascular system, and respiratory system. Pathology is like other immunoglobulin E (IgE)–mediated allergic reactions. Anaphylaxis is a common and life-threatening consequence of Hymenoptera stings and is typically a result of sudden systemic release of mast cells and basophil mediators. Urticaria, vasodilation, bronchospasm, laryngospasm, and angioedema are prominent symptoms of the reaction. Respiratory arrest may result in refractory cases
This study aims to discuss the different stings, prognosis and emergency reactions and treatment thereto.
Author Sharespike
| 3 | | R410.00 |  |
| | Effects of the Multidimensional Treatment on Pain, Disability, and Sitting Posture in Patients with Low Back Pain: A Randomized Controlled Trial | Effects of the Multidimensional Treatment on Pain, Disability, and Sitting Posture in Patients with Low Back Pain: A Randomized Controlled Trial
Effects of the Multidimensional Treatment on Pain, Disability, and Sitting Posture in Patients with Low Back Pain: A Randomized Controlled Trial
Overview The purpose of this study was to investigate the effects of multidimensional approach model on the pain, disability, and sitting posture in patients with nonspecific low back pain (LBP). Sixty LBP patients were recruited and were randomly divided into two groups: multidimensional treatment (MT) group and unimodal treatment (UT) group. All participants underwent 48 sessions of treatment (40 min/session, two sessions per day, 2 days per week) for 12 weeks. The MT group conducted a core stability exercise twice a day and additionally provided training on pain principles and management methods. The UT group only performed a core stability exercise twice a day. The visual analogue scale (VAS) and Oswestry Disability index (ODI) were used to measure pain intensity and disability. Thoracolumbar kyphosis and lumbar lordosis in the sitting position were measured using a motion capture system. After training, the pain and disability in the MT group improved significantly greater than the UT group (p < 0.05). In the MT group, the pain relief effect persisted 3 months after the end of training. Thoracolumbar kyphosis and lumbar lordosis in the MT group were significantly improved compared to the UT group (p < 0.05). Thus, MT combined with core stability exercise may be used to improve the pain, disability, and sitting posture in patients with LBP.
Authors Tae-Sung In, Jin-Hwa Jung, Kyoung-Sim Jung and Hwi-Young Cho
Journal Hindawi Pain Research and Management
| 3 | | R465.00 |  |
| | Studying the Bulging of a Lumbar Intervertebral Disc: A Finite Element Analysis | Studying the Bulging of a Lumbar Intervertebral Disc: A Finite Element Analysis
Studying the Bulging of a Lumbar Intervertebral Disc: A Finite Element Analysis
Overview The nucleus pulposus is a crucial compartment of the intervertebral disc. Low back pain is usually connected to the disc situation, how healthy the disc is, and it is also associated with the nucleus pulposus condition. Besides, the bulging (deformation) at the disc plays a vital role in patients suffering from disc degeneration. Increasing bulging causes to increase shear stresses at the annulus fibrosus and eventually leads to surgical intervention if classical treatments do not alleviate the pain. Therefore, knowing the behaviour of bulging in the intervertebral disc helps to prevent severe damage to the disc and contributes to finding a feasible treatment for damaged discs. In this study, a three-dimensional finite element (FE) model was used to investigate the bulging in the lumbar disc due to changing the nucleus pulposus status. The model resembles the overall anatomic geometry of the human spinal functional unit of the lumbar region, but without the posterior element. The findings showed that bulging direction in the disc agrees with literature data and removing the nucleus pulposus significantly affects the response of the disc
Authors Hassan Mansour Raheema, Mohanad Aljanabi
Journal Procedia Structural Integrity
| 3 | | R410.00 |  |
| | Pain Management through Neurocognitive Therapeutic Exercises in Hypermobile Ehlers–Danlos Syndrome Patients with Chronic Low Back Pain | Pain Management through Neurocognitive Therapeutic Exercises in Hypermobile Ehlers–Danlos Syndrome Patients with Chronic Low Back Pain
Pain Management through Neurocognitive Therapeutic Exercises in Hypermobile Ehlers–Danlos Syndrome Patients with Chronic Low Back Pain
Overview The hypermobile type of Ehlers–Danlos syndrome (hEDS) is likely the most common hereditary disorder of connective tissue mainly characterized by joint hypermobility. Patients with hEDS suffer joint pain, in particular low back pain, commonly resistant to drug therapy. The aim of this research was to evaluate a neurocognitive rehabilitation approach based not only on the motion and function recovery but also on the pain management. In this nonrandomized clinical trial, eighteen hEDS patients (4 males and 14 females) with mean age 21 years (range 13-55) were recruited and evaluated before and after three months of rehabilitation treatment. The clinical results observed in this study seem to confirm the role of a specific neurocognitive rehabilitation program in the chronic pain management in the Ehlers–Danlos syndrome; the rehabilitation treatment should be tailored on patient problems and focused not only in the recovery of movement but also on pain perception.
Authors Claudia Celletti, Teresa Paolucci , Loredana Maggi, Giordana Volpi, Mariangela Billi, Roberta Mollica,and Filippo Camerota
Journal Hindawi BioMed Research International
| 3 | | R435.00 |  |
| | Tissue Stiffness is Not Related to Pain Experience: An Individually Controlled Study in Patients with Chronic Neck and Back Pain | Tissue Stiffness is Not Related to Pain Experience: An Individually Controlled Study in Patients with Chronic Neck and Back Pain
Tissue Stiffness is Not Related to Pain Experience: An Individually Controlled Study in Patients with Chronic Neck and Back Pain
Overview Massage therapies such as cupping are often applied in patients with chronic neck and back pain with the assumption that they can reduce increased tissue stiffness and, therefore, improve pain. The aim of this study was to clarify whether tissue stiffness is related to pain experience in patients with chronic (>3 months) back and neck pain and whether it can be altered by a cupping massage.
The stiffness of the point of subjectively felt maximum pain intensity of 40 patients with neck (n = 20) or lower back pain (n = 20) was measured by a myometer. Exact contralateral side served as an individual control. Side of higher stiffness was then treated with a cupping massage. 5, 10, 15, and 20 minutes as well as 24 hours after treatment, tissue stiffness was measured again. Patients rated their pain on a standardized pain questionnaire (neck pain disability score (NDI) or Oswestry disability index (ODI), respectively) before and 24 hours after treatment. Results. Compared to the contralateral control side, the more painful side did not exhibit an increased stiffness of myofascial tissue before treatment (p = 0.827). The tissue stiffness and the side difference between treated and nontreated control sides decreased significantly after cupping but returned to baseline after 24 hours. NDI and ODI scores significantly decreased 24 hours after cupping
It was found that tissue stiffness might not be related to pain experience in patients with chronic neck and lower back pain.
Authors Ann-Kathrin Lederer, Christian Maly, Tomas Weinert, and Roman Huber Journal Hindawi Evidence-Based Complementary and Alternative Medicine
| 3 | | R410.00 |  |
| | Differences in Nonspecific Low Back Pain Between Young Adult Females with and without Lumbar Scoliosis | Differences in Nonspecific Low Back Pain Between Young Adult Females with and without Lumbar Scoliosis
Differences in Nonspecific Low Back Pain Between Young Adult Females with and without Lumbar Scoliosis
Overview There is no consensus as to whether NSLBP in scoliosis patients is related to scoliosis per se or is just a normal symptom that could happen in anyone. The aim of this study was to compare the differences in NSLBP between young adult female patients with and without lumbar scoliosis and to provide a theoretical basis for differential treatment of NSLBP in patients with and without lumbar scoliosis.
Ninety female young adults with NSLBP were divided into scoliosis and non-scoliosis groups. Characteristics of pain, lumbar mobility, muscle strength, Cobb angle, axial trunk rotation (ATR) angle, and surface electromyography (SEMG) signal were compared between the two groups. After the various results, it was concluded that the characteristics of NSLBP experienced by patients with lumbar scoliosis were distinct from those of NSLBP experienced by non-scoliotic patients. The treatment of NSLBP in scoliotic patients should be different from that in non-scoliotic patients.
Authors WangshuYuan1 JianxiongShen2 LixiaChen1 HaiWang2 Keyi Yu2 HuiCong1 Jingya Zhou3 and Youxi Lin2
Journal Hindawi Pain Research and Management
| 3 | | R435.00 |  |
| | Comparison of Whole-Body Electromyostimulation versus Recognized Back-Strengthening Exercise Training on Chronic Nonspecific Low Back Pain: A Randomized Controlled Study | Comparison of Whole-Body Electromyostimulation versus Recognized Back-Strengthening Exercise Training on Chronic Nonspecific Low Back Pain: A Randomized Controlled Study
Comparison of Whole-Body Electromyostimulation versus Recognized Back-Strengthening Exercise Training on Chronic Nonspecific Low Back Pain: A Randomized Controlled Study
Overview Due to changing living and working conditions the incidence of nonspecific low back pain (LBP) is increasing continuously worldwide. Low back pain (LBP) affects almost everyone at least once in their lifetime. Various meta-analyses show promising effects on pain reduction for conventional exercise. However, the lack of time and, especially for pain patients, a fear of movement (“kinesiophobia”) as well as functional limitations often oppose participation in such activities. The aim of this randomized controlled trial is to compare WB-EMS with a recognized back-strengthening exercise protocol to determine the corresponding effects on chronic, nonspecific LBP in people suffering from this.
This randomized, controlled multicenter study is focused on novel and time-effective training technologies and LBP. In this contribution, the focus is primarily on the comparison of WB-EMS against a comparable conventional exercise training (CT). Two groups were chosen to complete a12-week program (WB-EMS: 1 × 20 min/week vs. CT: 1 × 45 min/week) specifically dedicated to LBP. The selection of the content of the active control group was based on the principles of WB-EMS training, which uses electrical stimulation to train mainly strength and stabilization in a very short time. Exercises were similar in all groups, with the focus on strengthening and stabilizing the trunk. Outcome measures were assessed by a four-week pain diary (before and during the last four weeks of intervention) as well as an isometric maximum strength measurement of the trunk muscles at baseline and after 12 weeks of intervention.
In summary, both, WB-EMS and conventional back-strengthening protocol are comparably effective in reducing nonspecific chronic LBP in this dedicated cohort. The result is particularly positive in terms of time effectiveness and offers an adequate alternative for people with limited time resources or other barriers to conventional training methods.
Authors WangshuYuan1 JianxiongShen2 LixiaChen1 HaiWang2 Keyi Yu2 HuiCong1 Jingya Zhou3 and Youxi Lin2
Journal Hindawi Pain Research and Management
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| | Comparison of Treatments for Frozen Shoulder | Comparison of Treatments for Frozen Shoulder
Comparison of Treatments for Frozen Shoulder
Overview There is a myriad of available treatment options for patients with frozen shoulder, which can be overwhelming to the treating health care professional. To assess and compare the effectiveness of available treatment options for frozen shoulder to guide musculoskeletal practitioners and inform guidelines, DATA SOURCES Medline, EMBASE, Scopus, and CINHAL were searched in February 2020. Pain and function were the primary outcomes, and external rotation range of movement (ER ROM) was the secondary outcome. Results of pairwise metanalyses were presented as mean differences (MDs) for pain and ER ROM and standardized mean differences (SMDs) for function. Length of follow-up was divided into short-term (12 weeks), mid-term (>12 weeks to 12 months), and long-term (>12 months) follow-up. From a total of 65 eligible studies with 4097 participants that were included in the systematic review, 34 studies with 2402 participants were included in pairwise meta-analyses and 39 studies with 2736 participants in network meta-analyses. Despite several statistically significant results in pairwise meta-analyses, only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short term for pain (vs no treatment or placebo. The findings of this study suggest that the early use of IA corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes. This treatment should be accompanied by a home exercise program to maximize the chance of recovery Authors Dimitris Challoumas, MD; Mairiosa Biddle, MD; Michael McLean, MD; Neal L. Millar, MD, PhD Journal JAMA Network Open.
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| | A Randomized Comparative Study between High-Intensity and Low-Level Laser Therapy in the Treatment of Chronic Nonspecific Low Back Pain | A Randomized Comparative Study between High-Intensity and Low-Level Laser Therapy in the Treatment of Chronic Nonspecific Low Back Pain
A Randomized Comparative Study between High-Intensity and Low-Level Laser Therapy in the Treatment of Chronic Nonspecific Low Back Pain
Overview Chronic nonspecific low back pain (chronic nsLBP) is one of the most common musculoskeletal disorders leading to disabilities and physical inactivity. Laser therapy was used in chronic nsLBP treatment; however, no previous studies have assessed the impacts of high-intensity laser therapy (HILT) versus low-level laser therapy (LLLT) on chronic nsLBP.) This study compared the effects of HILT versus LLLT on individuals suffering from chronic nsLBP. Methods.) The study was a randomized control trial. Sixty individuals with chronic nsLBP were enrolled between May and November 2019. All participants were clinically diagnosed with chronic nsLBP.) They were assigned randomly into three groups, 20 in each group.) The first group received a program of LLLT, the second group received a program of HILT, and the third did not receive laser therapy (control group). Pain severity, disability, lumbar mobility, and quality of life were assessed before and after 12-week intervention. It was concluded that there are no different influences of LLLT versus HILT on chronic nsLBP patients. Both LLLT and HILT reduce pain and disability and improve lumbar mobility and quality of life in chronic nsLBP patients. Authors Walid Kamal Abdelbasset, Gopal Nambi, Saud F. Alsubaie, AhmedM. Abodonya, Ayman K. Saleh, Nahla N. Ataalla, Ahmed A. Ibrahim, Sayed A. Tantawy, Dalia M. Kamel, Anju Verma and Samah A. Moawd Journal Hindawi Evidence-Based Complementary and Alternative Medicine
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| | Intra-Articular versus Subacromial Corticosteroid Injection for the Treatment of Adhesive Capsulitis: A Meta-Analysis and Systematic Review | Intra-Articular versus Subacromial Corticosteroid Injection for the Treatment of Adhesive Capsulitis: A Meta-Analysis and Systematic Review
Intra-Articular versus Subacromial Corticosteroid Injection for the Treatment of Adhesive Capsulitis: A Meta-Analysis and Systematic Review
Overview Adhesive capsulitis is one of the most well-known causes of pain and stiffness of the shoulder. Corticosteroid injections have been used for many years. However, it is still controversial where corticosteroid should be injected, whether subacromial or intra-articular. The objective of this meta-analysis was to compare the effects of intra-articular (IA) and subacromial (SA) corticosteroid injections for the treatment of adhesive capsulitis. The Cochrane risk of bias tool and PEDro score were used to evaluate the quality of the studies. The primary clinical outcomes including VAS, Constant score, ASES score, and ROM were collected. The secondary outcome of corticosteroid-related adverse reactions was also compared between the two groups. The results were evaluated and compared at five time points. All studies were of low risk of bias and medium-high quality with the PEDro score =5 points. It was concluded that when corticosteroid injection is used to treat adhesive capsulitis, both injection sites can be selected. Authors Xiaoke Shang, Zhong Zhang, Xuelin Pan, Jian Li and Qi Li Journal Hindawi Biomedical Research International
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| | Incidence and Risk Factors of Low Back Pain in Marathon Runners | Incidence and Risk Factors of Low Back Pain in Marathon Runners
Incidence and Risk Factors of Low Back Pain in Marathon Runners
Overview The occurrence of low back pain (LBP) in marathon runners has been poorly understood. This study aimed to describe the risk factors and identify whether these factors can cause LBP in these athletes by using a self-developed questionnaire which was randomly distributed to 850 runners of running a half or a full marathon. Participants responded with the questionnaire focusing on previous training and running conditions after their competitions. In the final models, risk factors, including warm-up activities, fatigue, running gait posture, and environmental temperature, were significantly associated with LBP in marathoners. It was concluded that although LBP was uncommon in marathoners, it was linked to the factors such as insufficient warm-up activities, fatigue, poor running gait posture, and uncomfortable environmental temperature. Although future studies may be necessary these findings could still be useful for protecting the lower back area of runners clinically. Authors Bao Wu, 1,2 Chang-Cheng Chen , 2 Juan Wang , 2 and Xue-Qiang Wang Journal Hindawi Pain Research and Management Volume 2021, Article ID 666030
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| | Preretinal hemorrhage following chiropractor neck manipulation | Preretinal hemorrhage following chiropractor neck manipulation
Preretinal hemorrhage following chiropractor neck manipulation
Overview The purpose of this study is to report a case of a new complication following complementary and alternative medicine chiropractor neck manipulation with multiple preretinal haemorrhages. A 59-year-old Caucasian female presented with the acute, painless constant appearance of 3 spots in her vision immediately after a chiropractor performed cervical spinal manipulation using the high-velocity, low-amplitude technique. Examination multiple unilateral preretinal haemorrhages with no retinal tears. The preretinal haemorrhages were self-limited and resolved by 2 months later. In conclusion, the Chiropractor neck manipulation has previously been reported leading to complications related to the carotid artery and arterial plaques. This presents the ?rst case of multiple unilateral preretinal haemorrhages immediately following chiropractic neck manipulation. This suggests that chiropractor spinal adjustment cannot only a?ect the carotid artery, but also could lead to preretinal haemorrhages.
Acknowledgement Authors Yannis M. Paulusa and Nicholas Belillb Journal American Journal of Ophthalmology
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| | Locked-In Syndrome Following Cervical Manipulation by a Chiropractor: A Case Report | Locked-In Syndrome Following Cervical Manipulation by a Chiropractor: A Case Report
Locked-In Syndrome Following Cervical Manipulation by a Chiropractor: A Case Report
Overview Vertebrobasilar occlusion poses difficult diagnostic issues and even when properly diagnosed has a poor prognosis. Newer studies highlight a better outcome when thrombectomy was carried out between six and twenty-four hours after an initial diagnosis of stroke. This paper reports a case where a patient suffered a vertebrobasilar stroke secondary to a traumatic bilateral vertebral arteries dissection was treated with late thrombectomy. A 34-year-old woman was manipulated on the cervical spinal column by a chiropractor. Following three weeks of cervical pain, she presented with severe aphasia and quadriplegia (NIHSS = 28). An MRI scan indicated ischemia of the vertebrobasilar system. Thirty-one hours after the onset of these symptoms, a thrombectomy was performed. After one month, the patient could move her head and the proximal part of her limbs but remained confined to bed (NIHSS = 13). In conclusion, the current case illustrates the benefit of late mechanical thrombectomy for a posterior cerebral circulation infarct. Although there was a delay in treatment, partial recovery ensued. Acknowledgments
Authors Guillaume Giordano Orsini, Giorgios-Emmanouil Metaxas, Vincent Legros Journal
The Journal of Critical Care
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| | Experiences with Chiropractic Care for Patients with Low Back or Neck Pain | Experiences with Chiropractic Care for Patients with Low Back or Neck Pain
Experiences with Chiropractic Care for Patients with Low Back or Neck Pain
Overview Musculoskeletal disorders are the second leading cause of disability worldwide. The objective is to examine experiences of chiropractic patients in the United States with chronic low back or neck pain. Observational study of 1853 chronic low back pain and neck pain patients (74% female) who completed an online questionnaire at the 3-month follow-up that included Consumer Assessment of Healthcare Providers and Systems (CAHPS) items assessing their experiences with care. Similar reports of communication for the chiropractic sample and patients in the 2016 CAHPS National Database was found, but 85% in the database versus 79% in the chiropractic sample gave the most positive response to the time spent with provider item. More patients in the CAHPS database rated their provider at the top of the scale (8 percentage points). More chiropractic patients reported always getting answers to questions the same day (16 percentage points) and always being seen within 15 minutes of their appointment time (29 percentage points). In conclusion the positive experiences of patients with chronic back and neck pain are supportive of their use of chiropractic care. Acknowledgement
Authors: Ron D Hays, PhD1, Cathy D Sherbourne, PhD2, Karen L Spritzer, BS1, Lara G Hilton, PhD, MPH2,3, Gery W Ryan, PhD2, Ian D Coulter, PhD2,4, and Patricia M Herman, ND, PhD2
Journal Journal of Patient Experience
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| | Dyspnea: Pathophysiology and a clinical approach - EMT | Dyspnea: Pathophysiology and a clinical approach - EMT
Dyspnea: Pathophysiology and a clinical approach - EMT
Overview
Dyspnea is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity and may either be acute or chronic. This is a common and often distressing symptom reported by patients, and accounts for nearly half of hospital admissions. The distinct sensations often reported by patients include effort/work of breathing, chest tightness, and air hunger (a feeling of not enough air on inspiration). Dyspnea should be assessed by the intensity of these sensations, the degree of distress involved, and its burden or impact on instrumental activities. Dyspnea is a common and often distressing symptom and a frequent reason for general practitioner and clinic visits. Dyspnea is symptom, and its experience is subjective and varies greatly among individuals exposed to the same stimuli or with similar pathologies. This differential experience of Dyspnea among individuals emanates from interactions among multiple physiological, psychological, social, and environmental factors that induce secondary physiological and behavioural responses. The management of Dyspnea will depend on the underlying cause.
Author
Sharespike
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| | Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma | Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma
Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma
Overview Emphysema and chronic bronchitis are airflow-limited states contained within the disease state known as chronic obstructive pulmonary disease (COPD). Just as asthma is no longer grouped with COPD, the current definition of COPD put forth by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) also no longer distinguishes between emphysema and chronic bronchitis.
Emphysema is pathologically defined as an abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of alveolar walls and without obvious fibrosis. This process leads to reduced gas exchange, changes in airway dynamics that impair expiratory airflow, and progressive air trapping. Clinically, the term emphysema is used interchangeably with chronic obstructive pulmonary disease, or COPD.
The theory surrounding this definition has been around since the 1950s, with a key concept of irreversibility and/or permanent acinar damage. However, new data posit that increased collagen deposition leads to active fibrosis, which inevitably is associated with breakdown of the lung’s elastic framework.
Discussions on how obstructive diseases share similar phenotypes have been emerging and evolving within the literature. This course provides a particularly good outline.
Author Sharespike
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| | Hypertension Part 1 | Hypertension Part 1
Overview Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment. As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike
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| | PRP Injections for the Treatment of Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials | PRP Injections for the Treatment of Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials
PRP Injections for the Treatment of Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials
Overview Blood derivatives are increasingly used to modulate the intraarticular environment, aiming at reducing inflammatory distress and stimulating anabolism in different tissues. In particular, products with an increased concentration of platelets have been developed to address osteoarthritis (OA), based on positive in vitro findings suggesting the potential of platelet-derived growth factors (GFs). Platelet concentrates (platelet-rich plasma [PRP]) are therefore a simple, low-cost, and minimally invasive way to obtain a natural concentration of these GFs and bioactive molecules.
The purpose of these trials was to evaluate effectiveness, in terms of patient-reported outcome measures, of platelet-rich plasma (PRP) injections for knee osteoarthritis compared to placebo and other intraarticular treatments.
It was conclusive that the effect of platelet concentrates goes beyond its mere placebo effect, and PRP injections provide better results than other injectable options. This benefit increases over time, being not significant at earlier follow-up but becoming clinically significant after 6 to 12 months.
Authors Giuseppe Filardo, Davide Previtali, Francesca Napoli, Christian Candrian, Stefano Zaffagnini, and Alberto Grassi
Journal Sage Journals - Cartilage
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| | Sleep and the athlete: narrative review and 2021 expert consensus recommendations | Sleep and the athlete: narrative review and 2021 expert consensus recommendations
Sleep and the athlete: narrative review and 2021 expert consensus recommendations
Overview An ever-growing volume of peer-reviewed Publications speaks to the recent and rapid growth in scope and understanding of sleep for optimal athlete health and performance.
Herein, a panel of international experts review the current knowledge on sleep and the athlete, briefly covering the background, exploring continued controversies, highlighting fruitful avenues for future research and providing practical recommendations. The introduction section covers the need for sleep, including sleep architecture and the restorative benefits of sleep for the brain and body.
Pitfalls and challenges measuring athlete sleep are reviewed, and practical recommendations provided. The following section, entitled sleep and the athlete, covers the influence of sleep inadequacy and sleep extension on athletic performance. This article reviews the evidence that elite athletes are particularly susceptible to sleep inadequacy, for example, during intensified training and in those reporting symptoms of over-reaching and overtraining. The final section, entitled strategies to improve sleep, provides practical recommendations to alleviate the symptoms of jet lag, nutritional strategies to enhance sleep and a toolbox for practitioners to manage and optimise athlete sleep.
Authors Neil P Walsh et al.
Journal British Journal Sports Med 2020
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| | Improvement of activity-related knee joint discomfort following supplementation of specific collagen peptides. | Improvement of activity-related knee joint discomfort following supplementation of specific collagen peptides.
Improvement of activity-related knee joint discomfort following supplementation of specific collagen peptides.
Overview The aim of the study was to evaluate the use of specific collagen peptides in reducing pain in athletes with functional knee problems during sport. The primary outcome of the study was in change in pain intensity during activity, which was evaluated by the participants and the attending physicians using a visual analogue scale. As secondary endpoints, pain intensity under resting conditions, the range of motion of the knee joint, and the use of additional therapeutic options were assessed. Due to the high joint mobility at baseline, no significant changes of this parameter could be detected. The use of additional treatment options was significantly reduced after BCP intake. The study demonstrated that the supplementation of specific collagen peptides in young adults with functional knee problems led to a statistically significant improvement of activity related joint pain.
Authors: Denise Zdzieblik, Steffen Oesser, Albert Gollhofer and Daniel König
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| | Extracorporeal Shock Wave Therapy for Achilles Tendinopathy | Extracorporeal Shock Wave Therapy for Achilles Tendinopathy
Extracorporeal Shock Wave Therapy for Achilles Tendinopathy
Overview
Achilles tendinopathy is confirmed by a clinical symptom triad of pain, swelling, and limited function. Achilles tendon injuries are classified by the anatomical area into non-insertional and insertional. The major symptom of non-insertional tendinopathy is pain located 2 to 6 cm proximal to the insertion of the tendon into the calcaneus. Patients suffering from insertional pathology usually present with lesions in the distal portion of the structure, i.e., posterosuperior calcaneal protuberance. Extracorporeal shock wave therapy (ESWT) is among the conservative treatments for Achilles tendinopathy. Unfortunately, no optimal application parameters have been determined that would ensure ESWT effectiveness in this condition. +e aim of the paper is to use research reports on ESWT in patients with Achilles tendinopathy to help practising physiotherapists establish the most effective intervention parameters. The two modalities of shock wave therapy used for Achilles tendinopathy are focused shock waves and radial shock waves. The literature contains reports presenting mainly beneficial effects of ESWT in patients with Achilles tendinopathy.
Authors Magdalena Stania, Grzegorz Juras, Daria Chmielewska, Anna Polak, Cezary Kucio, and Piotr Król
Journal BioMed Research International / 2019 / Article
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| | Brain Connectivity Changes after Osteopathic Manipulative Treatment: A Randomized Manual - Placebo Controlled Trial | Brain Connectivity Changes after Osteopathic Manipulative Treatment: A Randomized Manual - Placebo Controlled Trial
Brain Connectivity Changes after Osteopathic Manipulative Treatment: A Randomized Manual - Placebo Controlled Trial
Overview
The effects of osteopathic manipulative treatment (OMT) on functional brain connectivity in healthy adults is missing in the literature. The main advantage for patients is the effective relief of acute and chronic pain. Indeed, OMT was proved effective on conditions and disorders beyond the sensory and motor system, including the reduction of hospitalization length in a large population of preterm infants, effects in anxiety and fatigue in people with Multiple Sclerosis and on autonomic and neuroendocrine responses. The neurophysiological effects underlying clinical improvements are still under debate. Although models explaining the therapeutic effects of OMT include potential brain mechanisms, few studies have been carried out to investigate brain mechanism changes after OMT. Magnetic resonance imaging (MRI) research includes several different approaches to estimate cortical functions. Several of these approaches have demonstrated functional brain changes associated with OMT. Using Arterial Spin Labeling MRI, we recently demonstrated that the treatment of somatic dysfunctions induces cerebral perfusion changes in asymptomatic young participants. This research provides the first preliminary evidence of brain network connectivity changes due to OMT, opening further insights into potential effects of OMT on brain functional activity. Moreover, it suggests future investigations in this unexplored field, particularly on symptomatic subjects.
Authors Marco Tramontano, Francesco Cerritelli, Federica Piras, Barbara Spanò, Federica Tamburella, Fabrizio Piras, Carlo Caltagirone, and Tommaso Gili Journal Brain Sci. 2020 Dec; 10(12): 969.
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| | Acute Physiological Response of Lumbar Intervertebral Discs to High-load Deadlift Exercise | Acute Physiological Response of Lumbar Intervertebral Discs to High-load Deadlift Exercise
Acute Physiological Response of Lumbar Intervertebral Discs to High-load Deadlift Exercise
Overview
A deadlift is a popular exercise that is frequently incorporated into athletic training programs. This exercise is effective in strengthening the back and lower extremity muscles, but the lumbar spine is subject to mechanical stress such as shear and compression forces during deadlift. The stress is expected to become greater with increasing exercise weight. Therefore, the lumbar region is most susceptible to injury during high-load deadlift. In addition, the repeated lifting of heavy weights has been identified as a risk factor for lumbar intervertebral disc degeneration/herniation. The lumbar intervertebral discs are thought to gradually degenerate through high-load deadlift training. However, to the best of our knowledge, little is known about the acute physiological changes of the lumbar intervertebral discs resulting from high-load deadlift exercise.
This study aimed to evaluate the acute physiological effects of high-load deadlift exercise on the lumbar intervertebral discs using MR diffusion-weighted imaging. Fifteen volunteers (11 men and 4 women;) without lumbar intervertebral disc degeneration performed deadlift exercise.
It was concluded that the movement of water molecules within the lumbar intervertebral discs is suppressed by high-load deadlift exercise, which would be attributed to mechanical stress on the lumbar intervertebral discs during deadlift exercise. In particular, the L5/S1 disc is subjected to greater mechanical stress than the other lumbar intervertebral discs.
Authors Osamu Yanagisawa, Tomoki Oshikawa, Naoto Matsunaga, Gen Adachi and Koji Kaneoka Journal J-STAGE
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| | Guideline summary review an evidence-based clinical guideline for the diagnosis and treatment of low back pain | Guideline summary review an evidence-based clinical guideline for the diagnosis and treatment of low back pain
Guideline summary review an evidence-based clinical guideline for the diagnosis and treatment of low back pain
Overview
To improve the knowledge base concerning the diagnosis and treatment of nonspecific low back pain in adult patients, the Low Back Pain Work Group of the North American Spine Society’s (NASS) Evidence-Based Guideline Development Committee developed an evidence-based clinical guideline on this topic. When employing the principles of evidence-based medicine, the clinical literature is extensively searched to answer specific clinical questions about a disease state or medical condition. The evidence with the highest possible levels of evidence obtained from the searches is utilized to answer the specific clinical questions. As a final step, the answers to clinical questions are reformulated as recommendations. Recommendations are then assigned a recommendation grade according to the level of evidence for the best clinical evidence available at the time of answering each question. The intent of the grade of recommendation is to indicate the strength of evidence used by the work group in answering the question asked. Eighty-two clinical questions were addressed in this guideline. Work group members engaged in a two-step screening process to determine article eligibility, including title and abstract screening and evidentiary review. The total number of articles retrieved, eligible for critical appraisal, 1000 D.S. Kreiner et al. / The Spine Journal 20 (2020) 998-1024 and meeting inclusion criteria for each individual clinical question can be accessed in the technical report. A total of 119 recommendations and two work group consensus statements were issued.
Authors D Scott Kreiner et al
Journal Spine J 2020 Jul;20(7):998-1024.
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| | Neuromuscular Function of the Knee Joint Following Knee njuries: Does It Ever Get Back to Normal? A Systematic Review with Meta Analyses | Neuromuscular Function of the Knee Joint Following Knee njuries: Does It Ever Get Back to Normal? A Systematic Review with Meta Analyses
Neuromuscular Function of the Knee Joint Following Knee njuries: Does It Ever Get Back to Normal? A Systematic Review with Meta Analyses
Overview
Knee injury is an independent risk factor for the development of knee osteoarthritis (OA) in young adults. The prevalence of post-traumatic OA (PTOA) can be as high as 80% at 10+years after the initial injury, with 4–6 times higher odds compared to a non-injured knee. PTOA mainly affects a younger and more active population when compared to non-traumatic OA, resulting in longer years lived with disability [5], and surgical interventions 7–9 years earlier in life. Therefore, prevention strategies for PTOA development require particular attention.
There is also evidence of bilateral neuromuscular changes following unilateral knee injury, suggesting a requirement for healthy control groups instead of using the contralateral ‘healthy leg’ for an unbiased evaluation of post-traumatic neuromuscular alterations. Therefore, this study aimed to determine how neuromuscular function of the knee joint changes over time following knee injuries involving ligament, meniscus or cartilage compared to healthy controls.
Neuromuscular deficits persist for years post-injury/surgery, though most evidence is from ACL injured populations. Muscle strength deficits are accompanied by neural alterations and changes in control and timing of muscle force, but more studies are needed to fill the evidence gaps we have identified. Better characterisation and therapeutic strategies addressing these deficits could improve rehabilitation outcomes, and potentially prevent PTOA.
Authors Beyza Tayfur, Chedsada Charuphongsa, Dylan Morrissey, Stuart Charles Miller
Journal Sports Medicine
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| | Application of tele-podiatry in diabetic foot management: A series of illustrative cases | Application of tele-podiatry in diabetic foot management: A series of illustrative cases
Application of tele-podiatry in diabetic foot management: A series of illustrative cases
Overview Telemedicine had been proposed as a tool to manage diabetes, but its role in management of diabetic foot ulcer is still evolving. The COVID-19 pandemic and related social restrictions have necessitated the use of telemedicine in the management of diabetic foot disease (tele-podiatry), particularly of patients classified as low-risk.
This article is a report of three cases of varied diabetic foot problems assessed during the present pandemic using different forms of telemedicine for triaging, management of low-risk cases and for follow-up. Telemedicine is a good screening tool for diagnosing and managing low-risk subjects with diabetic foot problems and enables a triaging system for deciding on hospital visits and hospitalization.
Telemedicine offers several benefits in the management of diabetic foot disease, although it also has some limitations. Based on the experience during the pandemic it is recommended its judicious use in the triaging of patients of diabetic foot disease and management of low-risk cases. Future innovation in technology and artificial intelligence may help in better tele-podiatry care in the time to come.
Acknowledgements Authors Karakkattu V. Kavitha, Shailesh R. Deshpande, Anil P. Pandit, Ambika G. Unnikrishnan
Journal Diabetes & Metabolic Syndrome: Clinical Research & Reviews
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| | Adolescent knee pain: fracture or normal? A case report. | Adolescent knee pain: fracture or normal? A case report.
Adolescent knee pain: fracture or normal? A case report.
Overview Knee injuries are the second to fourth most common injuries in youth soccer. In this population, sprains/strains, fractures and contusions are most common. Due to variations in the developing skeleton, it can be difficult to rule out fractures. We present a case of a 13-year-old presenting to the emergency department (ED) with patellar pain after pivoting during a soccer game. After radiographic clearance, he was allowed to return to sport. Following another fall and ED visit, his full leg was casted. He presented to a chiropractor after cast removal, who made recommendations for progressive rehabilitation owing to the lack of evidence for fracture on radiographs. We suggest a thorough history, physical and Ottawa knee rules to determine whether We suggest a thorough history, physical and Ottawa knee rules to determine whether radiographs are indicated in the management of a pediatric knee injury. Due to normal skeletal variance, we recommend bilateral radiographs and if findings are ambiguous, consultation with a radiologist to confirm clinical suspicions.
Authors: Melissa Corso and Scott Howitt
Journal: The Journal of the Canadian Chiropractic Association Volume 62 Issue 2
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| | Skydiving: The audiological perspective | Skydiving: The audiological perspective
Skydiving: The audiological perspective
Overview
The main aim of this study was to explore the relationship between skydiving and audiology in South Africa. The sub-aims of the study focused on determining if skydivers were provided with safety precautions before they commenced with the dive, determining the middle ear pressure before and after the skydive and identifying the audiological symptoms that were present post-dive. This study also aimed at scrutinising the South African sports and recreation policy. Thirty-one skydivers were purposefully recruited to undergo a pre- and post-dive tympano-metric assessment. There is no information within the clearance forms that pertain to the audiological risks related to skydiving. There was a lack of information related to the risks of skydiving in the clearance forms at both dive schools. A statistically significant pressure change was noted in regular skydivers, regardless of the ability to equalise effectively during the skydive. This study identified the gaps in policy and clearance forms, highlighting the need for the inclusion of safety measures and risks in the documentation and legislation that governs the sport. Audiologists, sportspeople and medical advisors should be cognisant of the negative consequences that may be evident within the auditory system of skydivers.
Acknowledgement
Authors Dhanashree Pillay and Shaaista Dada
Journal South African Journal of Communication Disorders
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| | Use of steroid and nonsteroidal anti-inflammatories in the treatment of rheumatoid arthritis | Use of steroid and nonsteroidal anti-inflammatories in the treatment of rheumatoid arthritis
Use of steroid and nonsteroidal anti-inflammatories in the treatment of rheumatoid arthritis
Overview
Rheumatoid arthritis (RA) is a chronic, autoimmune, and systemic inflammatory disease of unknown etiology, which mainly affects joints and is characterized by symmetrical synovial inflammation, resulting in destruction of joint cartilage, significant pain, and severe disability. This study will evaluate the effectiveness and the safety of steroid and non-steroidal anti-inflammatory drugs for the treatment of patients with rheumatoid arthritis. Randomized clinical trials eligible for our systematic review will enrol adults with rheumatoid arthritis treated with anti-inflammatory drugs compared with a control group (placebo or active control) at any dose, duration, and route of administration and double blind studies.
Dichotomous data will be summarized as risk ratios; continuous data will be given as standard average differences with 95% confidence intervals. The evidence derived by this study will increase awareness of the effectiveness and safety of steroid and non-steroidal anti-inflammatory drugs for the treatment of rheumatoid arthritis. The results could guide patients and healthcare practitioners and help facilitate evidence-based shared care decision making.
Acknowledgement Author Mariana Del Grossi Moura, Luciane Cruz Lopes, Marcus Tolentino Silva, Sílvio Barberato-Filho, Rogério Heládio Lopes Motta and Cristiane de Cássia Bergamaschi,
Journal Medicine Baltimore 2018
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| | Motor and Psychosocial Impact of Robot-assisted Gait Training in A Real-world Rehabilitation Setting: A pilot study | Motor and Psychosocial Impact of Robot-assisted Gait Training in A Real-world Rehabilitation Setting: A pilot study
Motor and Psychosocial Impact of Robot-assisted Gait Training in A Real-world Rehabilitation Setting: A pilot study
Overview
In the last decade robotic devices have been applied in rehabilitation to overcome walking disability in neurologic diseases with promising results. Robot assisted gait training (RAGT) using the Lokomat seems not only to improve gait parameters but also the perception of well-being. Data on the psychosocial patient-robot impact are limited, in particular in the real-world of RAGT, in the rehabilitation setting.
The primary aim of this pilot study was to evaluate the psychosocial impact of the Lokomat in an in-patient rehabilitation setting using the PIADS; secondary aims were to assess whether the psycho-social impact of RAGT is different between pathological subgroups and if the Lokomat influenced functional variables. Thirty-nine consecutive patients were assessed with the FIM before and after rehabilitation with Lokomat, and the PIADS was administered after the rehabilitative period with Lokomat. This pilot study indicates that Lokomat, in a real-world in-patient setting, may have a generalised approval, independent of disease, underlining the importance of the psycho-social framework for patients training with assistive robotic-devices.
Acknowledgement
Authors: Cira Fundarò, Anna Giardini, Roberto Maestri, Silvia Traversoni, Michelangelo Bartolo and Roberto Casale
Journal PLoS ONE
Publisher Cross Mark
| 3 | | R430.00 |  |
| | Effects of Aerobic Exercise on Brain Metabolism and Grey Matter Volume in Older Adults: Results of the Randomised Controlled SMART Trial | Effects of Aerobic Exercise on Brain Metabolism and Grey Matter Volume in Older Adults: Results of the Randomised Controlled SMART Trial
Effects of Aerobic Exercise on Brain Metabolism and Grey Matter Volume in Older Adults: Results of the Randomised Controlled SMART Trial
Effects of Aerobic Exercise on Brain Metabolism and Grey Matter Volume in Older Adults: Results of the Randomised Controlled SMART Trial
Overview
There is mounting evidence that aerobic exercise has a positive effect on cognitive functions in older adults. The present study used magnetic resonance spectroscopy and quantitative MRI to systematically explore the effects of physical activity on human brain metabolism and grey matter (GM) volume in healthy aging. The main outcomes were the change in cerebral metabolism and its association to brain-derived neurotrophic factor (BDNF) levels as well as changes in GM volume. We found that cerebral choline concentrations remained stable after 12 weeks of aerobic exercise in the intervention group, whereas they increased in the waiting control group.
No effect of training was seen on cerebral N-acetylaspartate concentrations, nor on markers of neuronal energy reserve or BDNF levels. Further, we observed no change in cortical GM volume in response to aerobic exercise. The finding of stable choline concentrations in the intervention group over the 3 month period might indicate a neuro-protective effect of aerobic exercise. Choline might constitute a valid marker for an effect of aerobic exercise on cerebral metabolism in healthy aging.
Acknowledgement
S Matura, J Fleckenstein, R Deichmann, T Engeroff, E Füzéki, E Hattingen, R Hellweg, B Lienerth, U Pilatus, S Schwarz, VA Tesky, L Vogt, W Banzer and J Pantel.
Journal Nature Translational Psychiatry (2017) 7, e1172
Publisher Unknown Creative Commons, Open Access doi:10.1038/tp.2017.135
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538117/pdf/tp2017135a.pdf
| 3 | | R445.00 |  |
| | Systemic low-grade inflammation in post-traumatic stress disorder: a systematic review Journal of Inflammation Research | Systemic low-grade inflammation in post-traumatic stress disorder: a systematic review Journal of Inflammation Research
Systemic low-grade inflammation in post-traumatic stress disorder: a systematic review Journal of Inflammation Research
Systemic low-grade inflammation in post-traumatic stress disorder: a systematic review
Overview
Studies examining post-traumatic stress disorder (PTSD) have either emphasized a relationship between PTSD and a systemically pro-inflammatory state or identified a link between PTSD and chronic disease. The aim of this study was to evaluate the evidence for a relationship between individuals with PTSD and systemic low-grade inflammation that has been proposed to underlie chronic disease development in this population.
Nine studies measuring systemic inflammation and discussing its role in chronic disease development were selected for inclusion in this review. The association between markers of systemic inflammation and PTSD was evaluated by the measurement of a variety of systemic inflammatory markers including acute-phase proteins, complement proteins, pro- and anti-inflammatory cytokines, natural killer cells, and white blood cells. In general, systemic inflammatory biomarkers were elevated across the studies in the PTSD groups.
There is evidence that PTSD is underpinned by the presence of a systemic low-grade inflammatory state. This inflammation may be the mechanism associated with increased risk for chronic disease in the PTSD population. From this, future research should focus on interventions that help to reduce inflammation, such as exercise. Acknowledgement
Author
Kathryn Speer, Dominic Upton, Stuart Semple and Andrew McKune
Journal
Journal of Inflammation Research 2018
Publisher
Dove Press
| 3 | | R450.00 |  |
| | The effect of group exercise frequency on health-related quality of life in institutionalised elderly. | The effect of group exercise frequency on health-related quality of life in institutionalised elderly.
The effect of group exercise frequency on health-related quality of life in institutionalised elderly.
Overview
The study aimed to determine the effect of group exercise frequency on health related quality of life in institutionalized elderly. One hundred participants were recruited for voluntary participation from five aged care facilities, with inclusion being based on the outcome of a medical assessment by a sports physician. A quasi-experimental design was used to compare the effect of a 12 week group exercise programme on two groups of participants using pre-test and post-test procedures.
Mental health and social health benefits can be obtained irrespective of exercise frequency 2X/week or 3X/week. The exercise intervention at a frequency 3X/ week was more effective in improving mental component summary due to a larger effect size obtained compared to the exercise frequency of 2X/week. Additional benefits in vitality were achieved by exercising 3X/week. This may assist the elderly in preserving their independence.
Further targeted longitudinal intervention based studies are required to investigate the impact of intensity, frequency, duration and type of physical activity that is required to obtain mental and physical health benefits.
Acknowledgement
Author Nivash Rugbeer, Serela Ramklass, Andrew Mckune, Johan van Heerden Journal
Pan African Medical Journal Publisher
Cross Mark URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398226/pdf/PAMJ-26-35.pdf
| 3 | | R400.00 |  |
| | How Does Physical Activity Intervention Improve Self-Esteem and Self-Concept in Children and Adolescents? Evidence from a Meta-Analysis. | How Does Physical Activity Intervention Improve Self-Esteem and Self-Concept in Children and Adolescents? Evidence from a Meta-Analysis.
How Does Physical Activity Intervention Improve Self-Esteem and Self-Concept in Children and Adolescents? Evidence from a Meta-Analysis.
Overview The objective of this course is to perform a systematic review and meta-analysis for the effects of physical activity intervention on self-esteem and self-concept in children and adolescents, and to identify moderator variables by meta-regression. Relevant studies were identified through a comprehensive search of electronic databases. Study inclusion criteria were: (1) intervention should be supervised physical activity, (2) reported sufficient data to estimate pooled effect sizes of physical activity intervention on self-esteem or self-concept, (3) participants' ages ranged from 3 to 20 years, and (4) a control or comparison group was included. There was no significant effect of intervention of physical activity alone on any outcomes in non-RCTs, as well as in studies with intervention of physical activity combined with other strategies. It was concluded that intervention of physical activity alone is associated with increased self-concept and self-worth in children and adolescents. And there is a stronger association with school-based and gymnasium-based intervention compared with other settings. Acknowledgement Author: Liu M, Wu L, Ming Q Journal: PLoS One.
| 3 | | R410.00 |  |
| | Medical Tourism. | Medical Tourism.
Overview
BACKGROUND: Medical tourism is a burgeoning industry in our region. It involves patients travelling outside of their home country for medical treatment. OBJECTIVE:
This article provides an outline of the current research around medical tourism, especially its impact on Australians. DISCUSSION:
Patients are increasingly seeking a variety of medical treatments abroad, particularly those involving cosmetic surgery and dental treatment, often in countries in South-East Asia. Adverse events may occur during medical treatment abroad, which raises medico-legal and insurance issues, as well as concerns regarding follow-up of patients. General practitioners need to be prepared to offer advice, including travel health advice, to patients seeking medical treatment abroad Acknowledgement
Author: Leggat P
Journal: Australian family physician.
Publisher: Focus Environmental
| 3 | | R360.00 |  |
| | Acute Effects of Breaking up Prolonged Sitting on Fatigue and Cognition. | Acute Effects of Breaking up Prolonged Sitting on Fatigue and Cognition.
Acute Effects of Breaking up Prolonged Sitting on Fatigue and Cognition.
Overview
There are many evidences that prolonged sitting has a negative effect or consequence on health. As a matter of fact, findings from previous experimental studies demonstrated that uninterrupted sitting is deleteriously associated with metabolic parameters, blood pressure and markers of haemostasis when compared to sitting that is interrupted with short bouts of physical activity.
The objective of this study was therefore to compare the acute effects of uninterrupted sitting with sitting interrupted by brief bouts of light-intensity walking on self-reported fatigue, cognition, neuroendocrine biomarkers and cardio metabolic risk markers in overweight/obese adults. The study was conducted in a laboratory in Melbourne, Australia meanwhile the design was a randomized two-condition crossover trial. The study was conducted on 19 overweight or obese adults between the ages of 45 and 75 years old.
Results from the study revealed that during the active condition, fatigue levels were lower whereas heart rates were higher compared to the sedentary condition. The conclusion was that interrupting prolonged sitting with light intensity walking breaks may be an effective fatigue counter measure acutely.
ACKNOWLEDGEMENT
AUTHORS: Patrik Wennberg, Carl-Johan Boraxbekk, Michael Wheeler, Bethany Howard, Paddy C Dempsey, Gavin Lambert, Nina Eikelis, Robyn Larsen, Parneet Sethi, Jessica Occleston, Jenny Hernestål- Boman, Kathryn A Ellis, Neville Owen, David W Dunstan JOURNAL: BMJ Open PUBLISHERS: BMJ URL: http://bmjopen.bmj.com/
| 3 | | R380.00 |  |
| | Body Psychotherapeutic Treatment for Anxiety Disorders. | Body Psychotherapeutic Treatment for Anxiety Disorders.
Body Psychotherapeutic Treatment for Anxiety Disorders.
Edited By: David Wilson
An introduction to the field of body psychotherapy, which aims to address anxiety by intervening at the bodily level rather than the traditional reliance on verbal talking cures. Modern attachment theory has accumulated a rich source of data based on decades of audio-visual recordings, documenting the genesis of our earliest non-verbal patterns of interpersonal relating. It is hoped that this introduction will pave the way for clinicians frustrated with the limits of the talking cure to undertake further exploration in both theory and techniques suggested by body psychotherapeutic traditions as an adjunct to their existing clinical repertoire.
| 3 | | R400.00 |  |
| | Patellofemoral Pain Syndrome: Biomechanics of the Patellofemoral Joint. | Patellofemoral Pain Syndrome: Biomechanics of the Patellofemoral Joint.
Patellofemoral Pain Syndrome: Biomechanics of the Patellofemoral Joint.
OVERVIEW
At last! ….. An easy to understand insight into the applied biomechanics of the patella. Along with discussions of various exercise and treatment modalities make this online course immediately applicable in your clinical practice
Some authors believe that the patella is not very important in extensor mechanism mechanics (1) and therefore readily recommended patellectomy. Others, on the contrary, attribute to the patella a more prominent role2,3 recommending its preservation whenever possible. The patella acts as a guide for the quadriceps tendon in centralizing the divergent input from the four muscles of the quadriceps, transmitting these forces to the patellar tendon.
Finally, the patella plays a role in the aesthetic appearance of the knee. This can be appreciated in the patellectomized knee in which the flattened ends of the condyles are easily visible with the knee flexed. Of all these functions, the most important role of the patella is in extension of the knee. Patellectomy results in weakened extension of the knee or even incomplete knee extension.
| 3 | | R400.00 |  |
| | Patellofemoral Pain Syndrome: Selection of Taping Techniques for Knee Pain. | Patellofemoral Pain Syndrome: Selection of Taping Techniques for Knee Pain.
Patellofemoral Pain Syndrome: Selection of Taping Techniques for Knee Pain.
OVERVIEW
This article offers you clinical tips for selection of taping techniques for knee pain based on the author’s clinical experience using the McConnell method. Patellofemoral pain syndrome (PFPS) is a common condition presenting to physiotherapists and orthopedic surgeons (Fulkerson & Hungerford 1990). Despite its prevalence, the etiology, pathogenesis, and recommended treatment remain unclear (Insall et al 1976).
The success rate of treatment regimens for this condition has been very poor and in the long-term, the condition frequently recurs (McConnell 1996). In the past, the only available options were surgery or curtailing physical activity.
Jenny McConnell, an internationally renowned physiotherapist, has developed an easy, painless, safe and inexpensive alternative (McConnell 1986). The treatment involves a unique method of taping the painful knee to realign the patella within the femoral trochlea. Once the patient is pain free, specific quadriceps and pelvic motor control training is under-taken. This is accompanied by stretching of tight muscles and correction of the lower limb and foot position. Read further to see the success of various selections of taping
| 3 | | R400.00 |  |
| | Practice Issues. | Practice Issues.
OVERVIEW
It is important to note that the responses to the various questions are the views independently expressed and are not necessarily opinions shared by cpdexpress.co.za. As matters involving Ethics and the law are subject to interpretation, the responses cannot, in any way, be regarded as binding or necessarily endorsed by the regulatory authorities.
There are ethical dilemmas regarding patients, colleagues and associates that one doesn’t even consider until they become issues in their practice. There are many questions to be asked regarding ethics, touting, canvassing, advertising, competition and many other issues that need to be addressed and this article addresses most of them.
| 3 | | R450.00 |  |
| | Private Practice: The Do's And Don'ts. | Private Practice: The Do's And Don'ts.
Private Practice: The Do's And Don'ts.
OVERVIEW
You have studied extensively to become a healthcare professional in your field of study. You have learned and become adept at identifying a vast range of conditions. You can diagnose and effectively treat those conditions within the scope of the discipline.
Now you are faced with a plethora of dilemmas. What is fair value for your services? What appliances are appropriate and reasonable? What commercial and legal structures are appropriate for you? What influence may these commercial and legal structures have on your clinical recommendations? Who may have access to your record cards? What responsibility can you delegate to your staff? Who carries final responsibility for payment of your claims – member or medical aid? What constitutes anti-competitive behavior?
This is a very informative article that will help you to run your practice within the various guidelines.
| 3 | | R400.00 |  |
| | Running Mechanics and Gate Analysis: Common Overuse Injuries in Running. | Running Mechanics and Gate Analysis: Common Overuse Injuries in Running.
Running Mechanics and Gate Analysis: Common Overuse Injuries in Running.
OVERVIEW
Running is a hugely popular activity – but many runners overdo it, suffer injuries as a result and then turn to us as physiotherapists to sort them out – as quickly as possible. This course will help you learn about the common risk factors for running overuse and how to prevent them. Also described in this course are the most common running-related injuries which include patellofemoral pain and iliotibial band syndromes and their biomechanics and prevention.
Although runners occasionally sustain acute injuries such as ankle sprains and muscle strains, the majority of running injuries can be classified as cumulative micro trauma (overuse) injuries. Running is one the most popular activities, and overuse injuries of the lower extremity occur regularly. There is no agreed-on or standardized definition of an overuse running injury, but several authors have defined it as a musculoskeletal ailment attributed to running that causes a restriction of running speed, distance, duration, or frequency for at least 1 week.
The runners in these studies vary considerably in their running experience and training habits – read further to discover about running mechanics.
| 3 | | R400.00 |  |
| | Sports Injuries and Rehabilitation - Part 1: Shoulder Pain in the Sportsperson. | Sports Injuries and Rehabilitation - Part 1: Shoulder Pain in the Sportsperson.
Sports Injuries and Rehabilitation - Part 1: Shoulder Pain in the Sportsperson.
OVERVIEW
In recent years, there have been many advances in the assessment and treatment of shoulder pain. Part one of these on-line courses reviews: such as the functional anatomy of the shoulder complex; the key features of the clinical history; how to conduct a swift and effective physical examination; investigations; treatment of important shoulder conditions;
"This was an arthroscopic and, as much as possible, non-invasive procedure. With aggressive rehabilitation, I expect to be back in form for the Shark Shootout (in December 2009)". Confident golfer Greg Norman after having an arthroscopic superior labral repair (SLAP lesion) and a partial rotator cuff repair (October 2009) "Having made the decision to have surgery in September in order to facilitate my playing the Shark, Shootout, I am disappointed. At the same time, I understand it would not be prudent to rush my return to competitive golf.” Norman's new plan was to return to practice in February 2010 and competition in the following months.
This course will cover the various reviews in detail together with graphic illustrations of the reviews. It is very important to follow up this course with Part 2 as well as.
| 3 | | R400.00 |  |
| | Sports Injuries and Rehabilitation - Part 2: Shoulder Pain in the Sportsperson. | Sports Injuries and Rehabilitation - Part 2: Shoulder Pain in the Sportsperson.
Sports Injuries and Rehabilitation - Part 2: Shoulder Pain in the Sportsperson.
OVERVIEW
In recent years, there have been many advances in the assessment and treatment of shoulder pain. Part one of these on-line courses reviews: such as the functional anatomy of the shoulder complex; the key features of the clinical history; how to conduct a swift and effective physical examination; investigations; treatment of important shoulder conditions;
"This was an arthroscopic and, as much as possible, non-invasive procedure. With aggressive rehabilitation, I expect to be back in form for the Shark Shootout (in December 2009)". Confident golfer Greg Norman after having an arthroscopic superior labral repair (SLAP lesion) and a partial rotator cuff repair (October 2009) "Having made the decision to have surgery in September in order to facilitate my playing the Shark, Shootout, I am disappointed. At the same time, I understand it would not be prudent to rush my return to competitive golf.” Norman's new plan was to return to practice in February 2010 and competition in the following months.
Part 2 focuses on mechanism of injury, assessment and rehabilitation of the rotator cuff starting with impingement.
| 3 | | R400.00 |  |
| | Sports Injuries and Rehabilitation: Acute Ankle Injuries: Part 1. | Sports Injuries and Rehabilitation: Acute Ankle Injuries: Part 1.
Sports Injuries and Rehabilitation: Acute Ankle Injuries: Part 1.
OVERVIEW
What is said to be the most common sport injury? Which of the many different sports injuries is most likely to recur? Answer: Ankle injuries. Is there anything you can do to reduce the pain, improve the function and prevent recurrence of a sprained ankle – or should you just tell your patient to let the natural recovery process take its course?
Ankle injury is arguably the most common sport injury. It ranked number 1 among 24 of the 70 sports for which there are quality data.1 In sports such as volleyball, ankle injuries make up almost half of all injuries.1 Ankle injuries include, but are not limited to “ankle sprains.”
Part one and two of this home study focuses on anatomy, clinical assessment, and management of lateral ligament injuries after ankle sprain. We also discuss two less common sequelae of ankle sprain – medial ligament injury and Pott’s fracture. This two-part course provides valuable answers to these important questions.
| 3 | | R400.00 |  |
| | Sports Injuries and Rehabilitation: Acute Ankle Injuries: Part 2. | Sports Injuries and Rehabilitation: Acute Ankle Injuries: Part 2.
Sports Injuries and Rehabilitation: Acute Ankle Injuries: Part 2.
OVERVIEW
What is said to be the most common sport injury? Which of the many different sports injuries is most likely to recur? Answer: Ankle injuries. Is there anything you can do to reduce the pain, improve the function and prevent recurrence of a sprained ankle – or should you just tell your patient to let the natural recovery process take its course?
Ankle injury is arguably the most common sport injury. It ranked number 1 among 24 of the 70 sports for which there are quality data.1 In sports such as volleyball, ankle injuries make up almost half of all injuries.1 Ankle injuries include, but are not limited to “ankle sprains.”
The presentation of a “sprained ankle” can mask damage to other structures – such as subtle fractures around the ankle joint, osteochondral fractures of the dome of the talus, and dislocation or longitudinal rupture of the peroneal tendons. Such injuries persist much longer than would be expected with a straightforward lateral ligament sprain. This is often referred to as “the problem ankle” – it is discussed in Part 2 of this online course
This two-part course provides valuable answers to these important questions.
| 3 | | R400.00 |  |
| | Sports Injuries and Rehabilitation: NSAIDS and Sports Injuries. | Sports Injuries and Rehabilitation: NSAIDS and Sports Injuries.
Sports Injuries and Rehabilitation: NSAIDS and Sports Injuries.
OVERVIEW
For many years the prescription of NSAIDs for all kinds of sport injuries (soft tissue injuries, tendon injuries and bone fractures) has been a staple of sports medicine. NSAIDs have well established analgesic effects, but also have proven side effects. Despite the risks, the medical community has considered the safety/efficiency ratio satisfactory enough to accept the administration of NSAIDs. But does this conventional wisdom still hold true? This course looks at recent research around NSAIDs – some of which has produced surprising results. This information is important to every medical professional who frequently prescribes or recommends NSAIDs to deal with sports injuries.
| 3 | | R400.00 |  |
| | Sports Injuries and Rehabilitation: Part 1 Hip Pain in the Sportsperson: Functional Anatomy and Biomechanics | Sports Injuries and Rehabilitation: Part 1 Hip Pain in the Sportsperson: Functional Anatomy and Biomechanics
Sports Injuries and Rehabilitation: Part 1 Hip Pain in the Sportsperson: Functional Anatomy and Biomechanics
OVERVIEW
Until recently, the hip joint was not thought to be a significant cause of problems in the athletic population. Now, thanks to MRI, and hip arthroscopy we have been able to learn more about some of the common underlying causes of groin pain. This course covers the clinical assessment and treatment of labral tears, ligamentum teres tears, synovitis, chondropathy, surgical management, os acetabulare and lateral hip pain. Rehabilitation of the injured hip requires careful consideration of the interplay between pain and loading (including progression of exercises and activities). Importantly, due to its role in all activities of daily living, including simple activities such as sit-to-stand, standing, and walking, it is hard to "reset" the hip. It is vital that the patient and the clinician have a good understanding around monitoring joint loads and the loading response. This discusses each of these general principles, and then applies them to commonly seen conditions of the hip. We then outline the application of these principles of management to patient’s post-hip arthroscopy surgery. This on-line course includes ample photos of exercises for hip rehabilitation.
| 3 | | R400.00 |  |
| | Sports Injuries and Rehabilitation: Part 2 Hip Pain in the Sportsperson: Predisposing Factors | Sports Injuries and Rehabilitation: Part 2 Hip Pain in the Sportsperson: Predisposing Factors
Sports Injuries and Rehabilitation: Part 2 Hip Pain in the Sportsperson: Predisposing Factors
OVERVIEW
Until recently, the hip joint was not thought to be a significant cause of problems in the athletic population. Now, thanks to MRI, and hip arthroscopy we have been able to learn more about some of the common underlying causes of groin pain. This course covers the clinical assessment and treatment of labral tears, ligamentum teres tears, synovitis, chondropathy, surgical management, os acetabulare and lateral hip pain. This on-line course includes ample photos of exercises for hip rehabilitation4. It covers factors that may contribute to the development of hip-related pain. These factors all alter the loads of the hip joint, thus placing structures within and around the hip joint under duress, which may eventuate in pain. These contributing factors can be classed as either extrinsic or intrinsic factors.
| 3 | | R400.00 |  |
| | Sports Injuries and Rehabilitation: Part 3 Hip Pain in the Sportsperson: Functional Anatomy and Biomechanics | Sports Injuries and Rehabilitation: Part 3 Hip Pain in the Sportsperson: Functional Anatomy and Biomechanics
Sports Injuries and Rehabilitation: Part 3 Hip Pain in the Sportsperson: Functional Anatomy and Biomechanics
Until recently, the hip joint was not thought to be a significant cause of problems in the athletic population. Now, thanks to MRI, and hip arthroscopy we have been able to learn more about some of the common underlying causes of groin pain.
These will be covered in part one and two of this course.
| 3 | | R400.00 |  |
| | Sports Injuries and Rehabilitation: Principles for Shoulder Rehabilitation: Part 1. | Sports Injuries and Rehabilitation: Principles for Shoulder Rehabilitation: Part 1.
Sports Injuries and Rehabilitation: Principles for Shoulder Rehabilitation: Part 1.
OVERVIEW
This course is based on the physiology and biomechanics of the shoulder. It will provide very effective rehabilitation protocols in terms of return to play. This course will assist you to diagnose not only local anatomical lesions, such as rotator cuff tear or Bankart lesion, but also the biomechanical deficits that exist in the shoulder girdle and spine However, that’s not all! Distant disorders such as inflexibilities of hip rotation, short hamstrings, or the stiff back also often contribute to shoulder abnormalities. There are no definitive studies on the most effective rehabilitation protocols for the shoulder. However, in practice, certain protocols based on physiology and biomechanics have provided very good outcomes in terms of return to play. The course will enable you to make a complete diagnosis and to look beyond the injured tissues to tissues that may be overloaded. You will also learn to detect functional biomechanical deficits as well as the subclinical adaptations that sports people use to try to maintain performance.
| 3 | | R400.00 |  |
| | Sports Injuries and Rehabilitation: Principles for Shoulder Rehabilitation: Part 2. | Sports Injuries and Rehabilitation: Principles for Shoulder Rehabilitation: Part 2.
Sports Injuries and Rehabilitation: Principles for Shoulder Rehabilitation: Part 2.
OVERVIEW
This course is based on the physiology and biomechanics of the shoulder. It will provide very effective rehabilitation protocols in terms of return to play. This course will assist you to diagnose not only local anatomical lesions, such as rotator cuff tear or Bankart lesion, but also the biomechanical deficits that exist in the shoulder girdle and spine However, that’s not all! Distant disorders such as inflexibilities of hip rotation, short hamstrings, or the stiff back also often contribute to shoulder abnormalities. There are no definitive studies on the most effective rehabilitation protocols for the shoulder. However, in practice, certain protocols based on physiology and biomechanics have provided very good outcomes in terms of return to play. There are two parts to this course. The course will enable you to make a complete diagnosis and to look beyond the injured tissues to tissues that may be overloaded. You will also learn to detect functional biomechanical deficits as well as the subclinical adaptations that sports people use to try to maintain performance OVERVIEW
This course is based on the physiology and biomechanics of the shoulder. It will provide very effective rehabilitation protocols in terms of return to play. This course will assist you to diagnose not only local anatomical lesions, such as rotator cuff tear or Bankart lesion, but also the biomechanical deficits that exist in the shoulder girdle and spine However, that’s not all! Distant disorders such as inflexibilities of hip rotation, short hamstrings, or the stiff back also often contribute to shoulder abnormalities. There are no definitive studies on the most effective rehabilitation protocols for the shoulder. However, in practice, certain protocols based on physiology and biomechanics have provided very good outcomes in terms of return to play. There are two parts to this course. The course will enable you to make a complete diagnosis and to look beyond the injured tissues to tissues that may be overloaded. You will also learn to detect functional biomechanical deficits as well as the subclinical adaptations that sports people use to try to maintain performance.
| 3 | | R400.00 |  |
| | Sports Injuries and Rehabilitation: Sprained Ankle – Integrated Approach. | Sports Injuries and Rehabilitation: Sprained Ankle – Integrated Approach.
Sports Injuries and Rehabilitation: Sprained Ankle – Integrated Approach.
OVERVIEW
Did you know that ankle injury is arguably the most common sport injury? And did you know that a sprained ankle also has a high frequency of recurrence? Is there anything you can do to reduce the pain and improve the function of a sprained ankle or should you just tell your patient to let the natural recovery process take its course?
This online course presents two cases in the framework of a case study design, but with some additional clinical reasoning commentary included. The single case study design is the next level of evidence up from case reports and provided that the patient is willing it is a feasible and practical design that can be used by practitioners to report the outcomes of their treatments in specific patients. One or more case studies may then be combined to provide guidance to practitioners in managing patients or they can be used in the development of other experiments, grant applications and randomised clinical trials, all of which lead to the development of the evidence base. To provide readers with an example of a case study design, two male patients, Rohan and Cameron, who each had sustained a recent plantarflexion and inversion ankle injury and had no previous history of ankle sprains, are presented as single case studies.
This course demonstrates approaches that provide rapid and significant improvement and provoke some interesting food for thought.
| 3 | | R400.00 |  |
| | Sports Injuries and Rehabilitation: The Sporting Hip – Integrated Approach. | Sports Injuries and Rehabilitation: The Sporting Hip – Integrated Approach.
Sports Injuries and Rehabilitation: The Sporting Hip – Integrated Approach.
OVERVIEW
Bree is a 27-year–old single female working in a law firm presenting with anterior left hip (groin) pain. She has a very busy lifestyle outside work, mainly occupied with training for and playing her primary sport of field hockey. She currently plays as a goalie in club, national and international field hockey which involves up to six training sessions per week, along with playing games and attending gym training sessions.
Bree’s main symptom was localised left anterior hip pain which did not extend further afield. She described this pain (pain A) as sharp and which, on a numerical rating scale, reached 7/10 at its worst. She also reported a second pain (pain B) which was a residual dull ache associated with a ‘weak’ feeling that lingered after undertaking aggravating activities. The symptoms are outlined on the body chart (Figure 1). Pain A was aggravated by general use of the hip and leg, including activities such as running and stair climbing, but also by end range hip movements, such as squatting and lunging.
Pain B was aggravated by prolonged sitting. Bree commented that she felt better in the mornings and did not complain of any symptoms of pins and needles, clicking or catching in the hip. There were no issues with her hip related to work.
Take this online course and learn about Bree’s treatment and the outcomes thereof.
| 3 | | R400.00 |  |
| | Sports Injuries Prevention and Rehabilitation: Anterior Knee Pain in the Sporting Population: Part 2 - Integrated Treatment. | Sports Injuries Prevention and Rehabilitation: Anterior Knee Pain in the Sporting Population: Part 2 - Integrated Treatment.
Sports Injuries Prevention and Rehabilitation: Anterior Knee Pain in the Sporting Population: Part 2 - Integrated Treatment.
OVERVIEW
Increase your success rate in treating patients with anterior knee pain. AKP can be one of the most difficult conditions to manage. The success rate of most treatment regimens has been poor and the condition frequently recurs. This three-part, online course will equip you with the latest tools to deal effectively with this and other related sports injuries. You’ll learn about assessing the knee in part one; part two will introduce you to the new integrated treatment approach; and part three deals with patellar tendinopathy this course, the authors:
In this course, you will learn to outline the clinical approach to assessing the patient with anterior knee pain, particularly with a view to distinguishing the common conditions, patellofemoral pain and patellar tendinopathy; details contemporary management integrating high-level evidence with the best of clinical experience; and discusses other common causes of anterior knee pain such as fat pad impingement, which may mimic features of both patellofemoral pain and patellar tendinopathy.
In Part 2 of this course you will learn about the Integrated Treatment
OVERVIEW
Increase your success rate in treating patients with anterior knee pain. AKP can be one of the most difficult conditions to manage. The success rate of most treatment regimens has been poor and the condition frequently recurs. This three-part, online course will equip you with the latest tools to deal effectively with this and other related sports injuries. You’ll learn about assessing the knee in part one; part two will introduce you to the new integrated treatment approach; and part three deals with patellar tendinopathy this course, the authors:
In this course, you will learn to outline the clinical approach to assessing the patient with anterior knee pain, particularly with a view to distinguishing the common conditions, patellofemoral pain and patellar tendinopathy; details contemporary management integrating high-level evidence with the best of clinical experience; and discusses other common causes of anterior knee pain such as fat pad impingement, which may mimic features of both patellofemoral pain and patellar tendinopathy.
In Part 2 of this course you will learn about the Integrated Treatment.
| 3 | | R400.00 |  |
| | Sports Injuries Prevention and Rehabilitation: Anterior Knee Pain in the Sporting Population: Part 3 - Patellar Tendinopathy. | Sports Injuries Prevention and Rehabilitation: Anterior Knee Pain in the Sporting Population: Part 3 - Patellar Tendinopathy.
Sports Injuries Prevention and Rehabilitation: Anterior Knee Pain in the Sporting Population: Part 3 - Patellar Tendinopathy.
OVERVIEW
In this course, you will learn to outline the clinical approach to assessing the patient with anterior knee pain, particularly with a view to distinguishing the common conditions, patellofemoral pain and patellar tendinopathy; details contemporary management integrating high-level evidence with the best of clinical experience; and discusses other common causes of anterior knee pain such as fat pad impingement, which may mimic features of both patellofemoral pain and patellar tendinopathy.
Patellar tendinopathy was first referred to as “jumper’s knee” due to its frequency in jumping sports (e.g. basketball, volleyball, and high, long and triple jumps).1 However, the condition also occurs in sportspeople who change direction, and may occur in sportspeople who do not perform either jumping or change of direction. The term “patellar tendonitis” is a misnomer as the pathology underlying this condition is not an inflammatory “tendonitis”.2 On balance, “patellar tendinopathy” is probably the most appropriate general label for this condition.3
In Part 3 of this course you will learn about the Patellar Tendinopathy
| 3 | | R400.00 |  |
| | Supporting the Body’s Recovery Process Following Injury, Surgery or Immobilisation. | Supporting the Body’s Recovery Process Following Injury, Surgery or Immobilisation.
Supporting the Body’s Recovery Process Following Injury, Surgery or Immobilisation.
Dr Eyal Lederman DO, PhD.
Recovery of range of movement (ROM) can be effected by pain, swelling, protective motor response and movement – related anxiety.
The recovery process following loss of range of motion, injury or surgery is associated with three processes:
- Repair,
- Adaptation,
- Modulation of symptoms.
The success of rehabilitation depends on skilfully addressing these intrinsic mechanism.
| 3 | | R400.00 |  |
| | The Effect of Exercise on Respiratory Resistance in Athletes with and without Paradoxical Vocal Fold Motion Disorder. | The Effect of Exercise on Respiratory Resistance in Athletes with and without Paradoxical Vocal Fold Motion Disorder.
The Effect of Exercise on Respiratory Resistance in Athletes with and without Paradoxical Vocal Fold Motion Disorder.
OVERVIEW
In people with exercise-induced paradoxical vocal fold motion disorder (PVFMD), breathing is abnormally impeded at the level of the larynx during exercise. This situation can result to dyspnea and the reduced ability to continue strenuous activity.
The purpose of this study was thus to assess inspiratory (Ri) and expiratory (Re) resistances during resting tidal breathing (RTB), post-exercise breathing (PEB), and recovery breathing (RB) in athletes with and without paradoxical vocal fold motion disorder (PVFMD). In the course of this study, twenty-four teenage female athletes, (12 with and 12 without PVFMD), breathed into the Airflow Perturbation Device for baseline measures of respiratory resistance for two successive 1-min trials after treadmill running for up to 12 min. It is worth mentioning that the exercise duration and dyspnea ratings were collected and compared across groups.
Results of this study indicated that athletes with PVFMD had lower than control Ri and Re values during RTB that significantly increased at PEB and decreased during RB.
ACKNOWLEDGEMENT
AUTHORS: Sally J. K. Gallena, Nancy Pearl Solomon, Arthur T. Johnson, Jafar Vossoughi, and Wei Tian JOURNAL: American Journal of Speech-Language Pathology PUBLISHER: American Speech-Hearing Association (ASHA) URL: http://www.asha.org
| 3 | | R350.00 |  |