Static Stretch Training versus Foam Rolling Training Effects on Range of Motion: A Systematic Review and Meta-Analysis.

BACKGROUND: Long-term static stretching as well as foam rolling training can increase a joint's range of motion (ROM). However, to date, it is not clear which method is the most effective for increasing ROM. OBJECTIVE: The purpose of this systematic review and meta-analysis was to compare the effects of static stretching and foam rolling training on ROM. METHODS: The literature search was performed in PubMed, Scopus, and Web of Science to find the eligible studies. Eighty-five studies (72 on static stretching; and 13 on foam rolling) were found to be eligible with 204 effect sizes (ESs). For the main analyses, a random-effect meta-analysis was applied. To assess the difference between static stretching and foam rolling, subgroup analyses with a mixed-effect model were applied. Moderating variables were sex, total intervention duration, and weeks of intervention. RESULTS: Static stretch (ES = - 1.006; p < 0.001), as well as foam rolling training (ES = - 0.729; p = 0.001), can increase joint ROM with a moderate magnitude compared with a control condition. However, we did not detect a significant difference between the two conditions in the subgroup analysis (p = 0.228). When the intervention duration was ≤ 4 weeks, however, a significant change in ROM was shown following static stretching (ES = - 1.436; p < 0.001), but not following foam rolling (ES = - 0.229; p = 0.248). Thus, a subgroup analysis indicated a significant favorable effect with static stretching for increasing ROM compared with foam rolling (p < 0.001) over a shorter term (≤ 4 weeks). Other moderator analyses showed no significant difference between static stretch and foam rolling training on ROM. CONCLUSIONS: According to the results, both static stretching and foam rolling training can be similarly recommended to increase joint ROM, unless the training is scheduled for ≤ 4 weeks, in which case static stretching demonstrates a significant advantage. More studies are needed with a high-volume foam rolling training approach as well as foam rolling training in exclusively female participants.

Post-Activation-Performance Enhancement: Possible Contributing Factors.

This study aimed to narrow down the possible mechanisms of Post-Activation Performance Enhancement (PAPE), especially if they are exclusively found in the muscle. It was therefore investigated whether (1) the PAPE effect is influenced by neural factors and (2) if Post-Activation-Potentiation (PAP) influences PAPE. Thirteen strength-trained participants (26.5 ± 3.2 years) took part in at least one of three interventions (PAP, PAPE-Electrical (PAPEE), and PAPE-Voluntary (PAPEV)). Conditioning contractions (CC) and testing involved isometric knee extensions performed on an isokinetic device at an 80° knee flexion angle. The CC was either performed voluntarily (PAP, PAPEV) or was evoked through electrical stimulation (PAPEE). Testing was performed at baseline and after two seconds, four minutes, eight minutes, and twelve minutes of the CC. Maximum voluntary isometric contractions (MVIC) for the PAPE trials and supramaximal twitches for the PAP trial were used for testing. Parameters of interest were peak torque and rate of torque development (RTD), and electromyography (EMG) amplitude of the quadriceps (only PAPE). Repeated measures ANOVA and simple contrast comparisons were used for statistical analysis. Peak torque (p < 0.001, η2p = 0.715) and RTD (p = 0. 005, η2p = 0.570) increased significantly during the PAP protocol immediately two seconds after the CC and decreased to near baseline values for the following time points (p > 0.05). Peak torque, RTD, and peak EMG showed no significant differences during PAPEE and PAPEV trials (p > 0.05). Due to the lack of a visible PAPE effect, the question of whether neural mechanisms influence PAPE cannot be answered. Due to the time course of the PAP analysis, it is questionable if these mechanisms play a role in PAPE. The assumption that the PAP mechanism influences PAPE cannot be confirmed for the same reason.

The non-local effects of 7-week foot sole static stretching and foam rolling training on shoulder extension range of motion.

Static stretching and foam rolling can increase the range of motion (ROM) of a joint acutely as well as chronically. Although studies have reported ROM increases of a non-stretched heterologous muscle (non-local) following an acute static stretching or foam rolling session, these effects have not been studied for long-term training interventions. Therefore, the purpose of this study was to investigate the effects of a comprehensive 7-week static stretching and foam rolling training program of the foot sole on shoulder extension ROM. A total of 33 healthy, physically active participants (20 male) were assigned to either the intervention (n = 19) or control (n = 14) group. The intervention group performed a 7-week combined static stretching and foam rolling intervention comprising three sessions a week, including three exercises of the foot sole for 5 min each. Before and after the intervention period, the shoulder extension ROM was tested with three-dimensional (3D) motion caption. The level of significance for all statistical analyses was set to ρ ≤ 0.05. There was no significant time (p = 0.70, F1, 31 = 0.157; η2 = 0.005) or time×group effect (p = 0.38, F1, 31 = 0.785; η2 = 0.025) in shoulder extension ROM, indicating no ROM changes in the intervention or the control group. Although previous studies on the acute effects of stretching and foam rolling reported non-local increases in ROM in heterologous muscles, this study could show that such effects do not occur after chronic SS and foam rolling training for 7 weeks. Consequently, if the goal is to chronically increase the ROM of a specific joint, it is recommended to directly treat the muscles of interest.

Two senior surgeons' view: prevention of surgical site infection associated with colorectal operations.

Preventing surgical site infection is perhaps the most direct method of decreasing medical expenses. The following is an attempt at comprehensive ways of decreasing surgical site infection as well as decreasing patient discomfort.

Hernia repair: why do we continue to perform mesh repair in the face of the human toll of inguinodynia?

Fifteen to 20 years ago, transversalis and Shouldice Hospital repairs were standard, with a 4% to 6% rate of recurrence. With a focus on recurrence, various mesh repairs were proposed to reduce the incidence of recurrence. With these repairs, an increased incidence of inguinodynia due to the entrapment of the nerves proximate (adjacent) to the mesh has been observed. Many surgeons doubted its existence; however, there is sufficient evidence that with mesh repair in which the affected nerves are resected, the incidence of severe pain is lessened considerably. Triple neurectomy has been proposed as a therapy, but only 80% of patients are relieved of pain. Recurrence is insufficient to make patients' lives miserable, with mesh repair reporting up to a 21% incidence of inguinodynia. Although few surgeons today perform this procedure and most residents have never seen it, the author proposes that mesh repairs be abandoned and the transversalis or Shouldice Hospital repair be adopted.

The implications for the surgical community of bariatric surgery as a "cure" for type 2 diabetes.

The United States is in the throes of an epidemic of morbid obesity and, parenthetically, type 2 diabetes. Recent data indicate that bariatric surgery, notably Roux-en-Y gastric bypass, is valid not only for weight loss but also for a high success rate in the amelioration and perhaps "cure" of type 2 diabetes. It clearly is not weight loss alone, because the amelioration of type 2 diabetes occurs before weight loss. The mechanism needs to be elucidated and researched. For the first time since tuberculosis--before antitubercular drugs, when surgical procedures were the principal mechanism for dealing with tuberculosis--surgery has the opportunity to participate in the amelioration and perhaps cure of this epidemic and to regain its professional stature. Included in this article are the author's thoughts and suggestions on how we can keep control of weight loss and bariatric procedures that are valid treatments for morbid obesity and related type 2 diabetes. We should use this opportunity to stop the current conversion of surgeons from professionals to employees.

Staying alive: strategies for accountable health care.

The Patient Protection and Affordable Care Act signed into law in March 2010, has led to sweeping changes to the US health care system. The ensuing pace of change in health care regulation is unparalleled and difficult for physicians to keep up with. Because of the extraordinary challenges that have arisen, the public policy committee of the Society for Surgery of the Alimentary tract conducted a symposium at their 52nd Annual Meeting in May 2011 to educate participants on the myriad of public policy changes occurring in order to best prepare them for their future. Expert speakers presented their views on policy changes affecting diverse areas including patient safety, patient experience, hospital and provider fiscal challenges, and the life of the practicing surgeon. In all areas, surgical leadership was felt to be critical to successfully navigate the new health care landscape as surgeons have a long history of providing safe, high quality, low cost care. The recognition of shared values among the diverse constituents affected by health care policy changes will best prepare surgeons to control their own destiny and successfully manage new challenges as they emerge.

Nutritional support: we have failed in our ability to support patients with sepsis and cancer.

Despite the success of both parenteral and enteral nutrition in supporting patients who cannot eat, patients with either sepsis or cancer cannot be adequately supported. A proposed mechanism by which aerobic glycolysis leads to a shortage of energy production in the liver is discussed. According to this hypothesis, the proximity of sodium-potassium ATPase and glycogen, its fuel source, leads to the continuation of gluconeogenesis with continued proteolysis and muscle wasting. Myostatin and lipokine, newly discovered factors, may also play a role.

Edward D. Churchill as a combat consultant: lessons for the senior visiting surgeons and today's military medical corps.

In World War II, Edward D. Churchill volunteered as a combat consultant. In this role, he mentored many junior surgeons and challenged the Army leadership to treat hemorrhagic shock with blood rather than plasma. These lessons have continued relevance for today's Senior Visiting Surgeons and our military medical corps.

Historical perspectives in the care of patients with enterocutaneous fistula.

Evidence can be found throughout surgical history of how devastating an enterocutaneous fistula (ECF) can be for both patient and surgeon. From antiquity, this complication of abdominal surgery, malignancy, radiation, trauma, or inflammatory processes has been a significant challenge to surgeons due to high associated mortality and significant morbidity. An ECF causes dehydration, malnutrition, skin excoriation, and sepsis, and has profound psychological effects on the patient. Recent mortality rates of patients suffering an ECF approach 20%. The authors illustrate the history of management of patients with ECF and discuss advances in perioperative care including parasurgical care, nutrition, wound care, and the history of surgical techniques.

How I do it: gastrointestinal cutaneous fistulas.

INTRODUCTION: Gastrointestinal cutaneous fistulas are among the more complex surgical conditions, with mortalities in the current series between 6% and 20%, and in some non-U.S. series, up to 40%. The series of principles of recognition, preparation of the abdominal wall, enteral and parenteral nutrition, and support, is outlined. Diagnosis in the absence of signs of sepsis is usually obtained by a fistulagram done by collaboration between the senior surgeon and the senior radiologist and followed to make certain that there is no intestinal obstruction. If spontaneous (nonoperative) closure does not occur in 5 to 6 weeks, it is unlikely to occur and an operation will be required. In our experience, obliterative peritonitis does not subside until a minimum of 4 months, and so an elective operative approach should take place when required after 4 months since the previous operation (when the fistula occurred). METHODS: A technical approach to operation is described. Avoiding enterotomies is critical. The abdomen should be entered in a fresh area, either by an extended incision, or in a virgin area transversely, if the previous incision was vertical and occupied the entire length of the abdomen. It often takes between 1.5 and 2 h to get into the abdomen without making additional enterotomies. The goal is to dissect laterally in one area until one enters a free lateral space which is free of adhesions. One then proceeds from lateral to medial to take down the adhesions from the previous incisions. When one is finished taking down these adhesions, it is usual that only 12 to 18 in. of bowel of the fistula and the surrounding enterotomies requires resection. An end-to-end anastomosis should be performed. Our practice is a two-layer silk-interrupted anastamosis. Adjunctive steps following the operation usually include a gastrostomy and a catheter jejunostomy. In order to be successful, the best results are obtained with a native abdominal wall closure with either component separation or an Abrahamson-type closure. If this cannot be achieved, multiple layers of vicryl are used, which usually enables the fistula to heal; a hernia usually results, but that can be dealt with at some future time. Using these principles, the last 50 cases at our personal series have been done without mortality.

Is damage to the common bile duct during laparoscopic cholecystectomy an inherent risk of the operation?

Laparoscopic cholocystectomy has been practiced for close to 20 years. The rate of common duct injury remains somewhere between 0.4 to 0.7 percent and is approximately the same around the world. Recent papers have stressed ways in which laparoscopic common duct injury can be avoided, but none of the methods mentioned is foolproof. In addition, this complication can occur to even the most experienced laparoscopic surgeon. The author believes that injury to the common duct during laparoscopic cholocystectomy is not a result of the practice below the standard, but an inherent risk of the operation. This injury needs to be emphasized by the surgical community as an inherent risk of the operation, and patients should be fully informed of this potential complication.

The importance of reconstruction of the abdominal wall after gastrointestinal fistula closure.

Operation for gastrointestinal cutaneous fistula almost always requires resection and anastomosis. Those of use who do this surgery frequently have learned the hard way that closure of the abdominal wall, preferably with native tissue, is essential for refistulization to not occur. What is one to do when component separation or an Abramson type of approach is insufficient and flaps either can not be done or are not available? Recently, it has been proposed that inert biological material may be the answer for abdominal closure and somehow it is more resistant to infection and less likely to fistulize than totally synthetic material. However, data has slowly been coming available that suggests that use of inert biological material may in fact not be satisfactory and may in fact have an increased tendency to infection, wound breakdown, and refistulization.

A cautionary note: the use of vacuum-assisted closure systems in the treatment of gastrointestinal cutaneous fistula may be associated with higher mortality from subsequent fistula development.

During the past several years, vacuum-assisted closure (VAC) systems have been increasingly used in the treatment of gastrointestinal cutaneous fistulas, particularly those associated with open abdomen. Recently, I experienced 2 cases in which the original fistula closed after treatment by the VAC system. However, these patients, who had exposed bowel, developed an additional fistula that required surgery. In a recent article from an intestinal-failure unit in the United Kingdom, Rao et al(1) reported on a series of 29 patients treated with VAC, 6 of whom developed new gastrointestinal cutaneous fistulas. Four of these 6 patients died. My own experiences, plus the report of Rao et al,(1) suggest the possibility that the use of the VAC system in patients with exposed bowel and an open abdomen may be associated with subsequent fistula development. Although the numbers are small, it also raises the question that development of a fistula in a patient treated with VAC may result in higher mortality.