Utilization rates of Active Release Techniques® in the workplace: A descriptive study.

BACKGROUND: Workplace safety is a necessary and frequent topic of discussion for researchers, employers, and workers. It is estimated that annual losses caused by work-related injuries cost the United States $140 to $145 billion. Specifically, work-related musculoskeletal disorders (WMSD) have risen from just over 10% to 50% of the total claims from 1952 to 1996, accounting for more than 345,00 days lost and more than $57 million in WSIB costs in 2015. Novel approaches to managing WMSDs, such as Active Release Techniques®, need to be explored to ensure the ongoing health of workers. OBJECTIVE: This descriptive study provides the details of the 697,002 onsite treatments across 448 sites in North America between 2014-2018 provided by Active Release Techniques® Corporate Solutions (ARTCS) practitioners. The objective was to calculate the total number of treatments, cost per closed case, percent improvement, and the number of cases referred to worker's compensation. METHODS: All charting was done on the ARTCS EMR portal. The lead author was given a spreadsheet of the results sanitized of all identifying data in order to perform the aforementioned calculations. RESULTS: From 2014 to 2018, ARTCS providers opened 199,077 new cases, with an average cost to the employer of $306.69 USD per case and an average percent improvement in pain (VNPS) of 87.2%. The most frequently treated areas were the shoulder (32,574 cases), hip (6,633 cases), and low back (27,873 cases), respectively. A total of 48,946 cases were work-related pain/discomfort, of which 1,110 (2.27%) went on to worker's compensation. CONCLUSION: ARTCS in the workplace has shown a positive trend in terms of reducing pain intensity. The cost was low as compared to worker's compensation claims, as was the rate of cases (2.27%) referred to worker's compensation. Additional studies, including prospective data collection and a control group, are warranted to substantiate this.

Conservative management of femoral anterior glide syndrome: a case series.

BACKGROUND: Femoral anterior glide syndrome is a movement impairment syndrome, which presents with anterior hip pain aggravated by hip flexion and extension. It is believed to occur because of altered muscle activation patterns contributing to altered gliding of the femoral head within the acetabulum and constant overloading and irritation of the joint structures. STUDY DESIGN: Case series. CASE DESCRIPTION: Three elite athletes diagnosed with femoral anterior glide syndrome were treated conservatively with the main goal of improving posterior femoral glide. Rehabilitative exercises were completed to gain independent articular control of the hip and improve hip and low back dissociation. OUTCOMES: Patients received complete symptom resolution allowing them to continue participating in their sport at full capacity. They were able to perform the femoral anterior glide tests without pain and aberrant movement patterns. DISCUSSION: This case series provides data to support further investigation of treatment of femoral anterior glide syndrome.

CONTEXTE: Le syndrome du glissement antérieur de la tête fémorale est un conflit fémoro-acétabulaire se manifestant par une douleur antérieure de la hanche aggravée par la flexion et l'extension de la hanche. Ce conflit serait causé par des altérations de l'activation musculaire qui contribuent au glissement de la tête fémorale dans l'acétabulum et à une surcharge et une irritation des structures articulaires. MÉTHODOLOGIE DE L'ÉTUDE: Série de cas. DESCRIPTION DES CAS: Trois athlètes d'élite présentant le syndrome du glissement antérieur de la tête fémorale ont suivi un traitement conservateur visant principalement à améliorer le glissement postérieur de la tête fémorale. Des exercices de rééducation ont été effectués pour améliorer le contrôle moteur au niveau de l'articulation de la hanche et améliorer le recrutement des fibres musculaires de la hanche par rapport à celles de la colonne lombaire. RÉSULTATS: La disparition complète des symptômes a permis aux patients de recommencer à pratiquer leurs sports à pleine capacité suite à ces interventions. De plus, les tests du glissement antérieur de la tête fémorale ne déclenchaient aucune douleur et ne causaient aucun mouvement aberrant. DISCUSSION: Cette série de cas fournit des données montrant qu'il faut mener d'autres études sur le traitement du syndrome du glissement antérieur de la tête fémorale.

Conservative care of sports hernias within soccer players: a case series.

OBJECTIVE: To detail the progress of 2 high-level soccer players and 1 recreational soccer player with chronic groin pain that was exacerbated by participation in sports and relieved by rest. The patients under went a conservative treatment plan featuring manual therapy, therapeutic modalities, and plyometric training. CLINICAL FEATURES: The most important examination findings were palpable tenderness over the internal oblique fascia and anterior pubic tubercle, pain with resisted hip adduction, and pain with a resisted abdominal curl-up. Conventional treatment aimed at decreasing healing time of the injury through manual therapy, including soft tissue and modality techniques; rehabilitative exercises, focusing on the pelvic muscles; and plyometric training, aiming at sport specific functional improvement. INTERVENTION: The conservative treatment approach utilized in this case series involved manual therapy, 1-2 times a week for 6-8 weeks, consisting of soft tissue, laser, microcurrent, and acupuncture; rehabilitative exercise and plyometric training, 3 times a week for 8 weeks, to help improve strength, coordination, and correct pelvic muscle imbalances. Outcome measures included visual analog scale scores and resisted muscle testing. SUMMARY: Three soccer players, of varying levels of ability, presenting with a suspected sports hernia (chronic groin pain exacerbated by sports and relieved by rest) were relieved of their pain after 8 weeks of conservative care featuring manual therapy, rehabilitative exercises, and plyometric training.

Femoral neck stress fracture in a female athlete: a case report.

OBJECTIVE: The purpose of this case report is to describe chiropractic rehabilitation of a master's-level athlete with proximal femoral stress fracture and provide a brief discussion of stress fracture pathology. CLINICAL FEATURES: A 41-year-old female master's-level endurance athlete presented with chronic groin pain later diagnosed and confirmed by magnetic resonance imaging as a stress fracture of the femoral neck. After diagnosis, the patient was referred to a doctor of chiropractic at week 1 of the non-weight-bearing physical rehabilitation process. At that time, the patient presented with sharp and constant groin pain rated 6/10 on a numeric rating scale. INTERVENTION AND OUTCOME: This patient avoided weight-bearing activity for 8 weeks while cross-training and was able to return to her sport after this period. The patient was progressed through a series of non-weight-bearing strengthening exercises for the lower extremity. Myofascial release therapy was performed on the gluteal, hip flexor, and groin muscle groups to improve range of motion. Motion palpation testing the lumbar and sacroiliac joints was performed during each session, and manipulative therapy was performed when necessary. The patient was seen once a week for 8 weeks. Reevaluation was performed at week 8; at that time, the patient reported no groin pain (0/10). The patient was discharged from care and referred back to the supervising physician for clearance to return to sporting activities. One month after discharge, she reported that she was pain free and had fully returned to sport activities. CONCLUSION: This case report demonstrates the importance of a through clinical history, physical examination, and magnetic resonance imaging in the accurate diagnosis of a patient with chronic groin pain and that chiropractic care can contribute to rehabilitation programs for these injuries.

Utilization of Vascular Restriction Training in post-surgical knee rehabilitation: a case report and introduction to an under-reported training technique.

INTRODUCTION: The objective of this paper is to introduce a new and reportedly safe training technique, utilizing a vascular restriction stimulus during low intensity rehabilitative exercise and provide a case example within a post-surgical rehabilitation scenario. A brief review of the most commonly reported mechanisms of action behind the purported success of the training stimulus is included. METHODS: 19-year-old athlete presented for an accelerated post-operative knee rehabilitation program. She received a commonly utilized rehabilitation program that was supplemented with vascular restriction stimulus. RESULTS: The patient maintained muscle cross-sectional area and had improved function at a 12-week follow-up. CONCLUSION: Low intensity exercise supplemented with vascular restriction may prove to be an efficient and effective means of maintaining post-surgical muscle size and subjective knee function.

Immediate effect on pain thresholds using active release technique on adductor strains: Pilot study.

BACKGROUND: Pain pressure thresholds (PPT) have not been investigated when Active Release Techniques (ART(®)) is directed at treating soft tissue injuries. AIM: To investigate the immediate effects of ART(®) employed in the management of adductor muscle strains to modulate pain threshold. METHODS: Patients were administered ART(®) commensurate with the extent and nature of their adductor muscle injury. The outcome measureused was PPT over the adductor muscle strain which was assessed pre-intervention and 2min post-intervention. RESULTS: Within group effect sizes were calculated using a paired samples t-test to assess clinical effect. The mean pre-intervention and 2min post-intervention PPT values were 4.2±0.83 and 5.3±0.99 significantly different (p<0.001). CONCLUSION: The application of ART(®) to treat groin strains may be of benefit in increasing pain thresholds amongst ice-hockey players. Future research requires sufficient sample sizing, a control group, and correlations with objective outcome measures (VAS and range of motion) to validate the therapeutic effect of ART(®).

Passive ranges of motion of the hips and their relationship with pitching biomechanics and ball velocity in professional baseball pitchers.

BACKGROUND: Pelvis and trunk motions during baseball pitching are associated with ball velocity. Thus, limits in hip flexibility may adversely affect pitching biomechanics and the ability to generate ball velocity. HYPOTHESES: Professional baseball pitchers will have less passive range of motion in the nondominant hip and the measured ranges of motion of both the nondominant and dominant hips will correlate with biomechanical parameters of the lower extremity among professional pitchers. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Nineteen healthy professional baseball pitchers volunteered for testing. Fluid goniometry was used to measure passive range of motion of adduction (ADD), abduction (ABD), internal rotation, external rotation, total arc of rotation, and total arc of ADD + ABD. Pitching biomechanical data were collected using an automated 3-dimensional motion analysis system while participants threw fastballs. RESULTS: Pitchers possessed significantly less passive range of motion in the nondominant hip when compared with the dominant hip for all ranges. Total arc of rotation of the nondominant hip correlated with ball velocity (r = .50). Total arc of ADD + ABD in the nondominant hip and ABD in the nondominant hip were correlated with stride length (r = -.72 and .70, respectively). Dominant hip ABD (r = .63), total arc of rotation in the nondominant hip (r = -.45), and total arc of ADD + ABD of the dominant hip (r = .44) were correlated with trunk separation. Total arc of ADD + ABD of the nondominant hip (r = -.52) and total arc of rotation of the dominant hip (r = -.44) were correlated with pelvic orientation. CONCLUSION: Passive range of motion is smaller in the nondominant hip than the dominant hip among professional pitchers. The measured disparity between the hips is significantly correlated with various pitching biomechanical parameters of the trunk and pelvis. Future research is required to investigate a causal relationship between less hip passive range of motion and both ball velocity and pitching biomechanics.

Rehabilitation of distal tibiofibular syndesmosis sprains: a case report.

OBJECTIVE: To present the epidemiology, etiology, diagnostic criteria and therapeutic interventions for an important clinical entity - tibiofibular syndesmosis or "high ankle" sprains. CLINICAL FEATURES: The most common mechanism of injury is forced external rotation in a dorsiflexed foot. Pain is located anteriorly over the anterior tibiofibular ligament, and is elicited through a variety of tests designed to stress this articulation through diastatic forces. Pain with ambulation is typical, and is usually present during the push-off phase of gait. Radiographs may be useful in determining the extent of this injury, as syndesmotic sprains with malleolar fractures are more common than those without. INTERVENTION AND OUTCOME: Convalescence is generally protracted compared with a lateral ankle sprain, and care must be taken to avoid stressing the supporting ligaments during the early course of therapy. Initial treatment is aimed at reducing pain and inflammation using modalities such as microcurrent, electroacupuncture and P.R.I.C.E. principles. Treatment over subsequent weeks involves progressive resistance exercises, proprioceptive challenges, plyometric exercises and sport-specific agility drills, while maintaining cardiovascular fitness. CONCLUSION: The practitioner should also be cognizant of the indolent nature of this injury and possibility for sequelae. Anterior ankle pain and pain with a deep squat or during the push-off phase of gait are typical of this injury. Radiographs to rule out fracture and evaluate the extent of the injury may be warranted. Conservative therapy involving rehabilitation and tissue injury care is appropriate for Grade I and II injuries, while Grade III injuries require a surgical intervention.

The stubborn hip: idiopathic avascular necrosis of the hip.

OBJECTIVE: To highlight the unusually indolent course of avascular necrosis in this patient, the risk factors of which chiropractors should be aware, the necessity of and means to an early diagnosis, the limitations of plain film radiographs, as well as the current medical treatments. CLINICAL FEATURES: A 27-year-old male professional soccer player had a tight and achy right hip for approximately 6 years, a condition that increased with physical activity. His active range of motion was limited by 25% in extension and abduction, and all resisted ranges of motion produced pain. After an equivocal radiograph and bone scan, magnetic resonance imaging revealed a subchondral defect located on the superior aspect of the right femoral head, consistent with avascular necrosis of the femoral head. INTERVENTION AND OUTCOME: Presurgical management included Cybex testing, massage, myofascial release, interferential current, muscle strengthening, and muscle balancing exercises 3-5 times per week for 5 months. The patient underwent a curette procedure. Six weeks later, he returned to the chiropractic office for postsurgical rehabilitation, in which he is still involved today. He has made progress with respect to flexibility, strength, and muscle coordination. CONCLUSIONS: Idiopathic avascular necrosis of the hip is a clinical entity characterized by pain in the hip made worse with activity and at night, which may radiate to the groin, back, or thigh. Often, physical exam and radiographic findings are equivocal, at which point advanced imaging such as magnetic resonance imaging should be ordered to identify the disease in its earliest stages.