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1.
J Manipulative Physiol Ther ; 44(5): 420-431, 2021 06.
Article in English | MEDLINE | ID: mdl-34376321

ABSTRACT

OBJECTIVE: The purpose of the present study was to determine the neuroendocrine response after a thoracic spinal manipulation in people with Achilles tendinopathy. METHODS: This was a randomized 2-sequence, 2-period crossover trial. A total of 24 participants, mean (standard deviation) age of 48 (7) years, with a diagnosis of Achilles tendinopathy (>3 mo) were randomly assigned into sequence 1 (sham intervention and then thoracic spinal manipulation) or sequence 2 (thoracic spinal manipulation and then sham intervention). The trial was conducted at a university laboratory with a washout period of 1 week. The primary outcome measure was the testosterone/cortisol (T/C) ratio (salivary samples). The secondary outcome measures included heart rate variability (measured with electrocardiography) and total oxygenation index (nmol/L) of calf muscle and Achilles tendon (measured with near-infrared spectroscopy). A 2-way mixed-model analysis of variance was performed. The statistic of interest was the condition by time interaction. RESULTS: A statistically significant condition by time interaction was found for the T/C ratio (mean difference: -0.16; confidence interval: -0.33 to 0.006; interaction: P < .05) and the total oxygenation index (mean difference: 1.35; confidence interval: -1.3 to 4.1; interaction: P < .05) of calf muscle but not for Achilles tendon (P = .6); however, no difference was found for heart rate variability (P = .5). CONCLUSION: In people with Achilles tendinopathy, thoracic spinal manipulation resulted in immediate increase in the total oxygenation index in the calf muscle followed by an increase in the T/C ratio 6 hours post-intervention.


Subject(s)
Achilles Tendon , Manipulation, Spinal , Tendinopathy , Cross-Over Studies , Humans , Middle Aged , Muscle, Skeletal , Tendinopathy/therapy
2.
BMC Health Serv Res ; 21(1): 695, 2021 Jul 15.
Article in English | MEDLINE | ID: mdl-34266436

ABSTRACT

BACKGROUND: Clinical practice guidelines commonly recommend adopting a biopsychosocial (BPS) framework by practitioners managing musculoskeletal pain. However, it remains unclear how osteopaths implement a BPS framework in the management of musculoskeletal pain. Hence, the objective of this review was to systematically appraise the literature on the current practices, barriers and facilitators experienced by osteopaths in implementing a BPS framework of care when managing people with musculoskeletal pain. METHODS: The following electronic databases from January 2005 to August 2020 were searched: PubMed, CINAHL, Science Direct, Google Scholar, ProQuest Central and SCOPUS. Two independent reviewers reviewed the articles retrieved from the databases to assess for eligibility. Any studies (quantitative, qualitative and mixed methods) that investigated the use or application of the BPS approach in osteopathic practice were included in the review. The critical appraisal skills program (CASP) checklist was used to appraise the qualitative studies and the Mixed Methods Appraisal Tool (MMAT) was used to appraise quantitative or mixed methods studies. Advanced convergent meta-integration was used to synthesise data from quantitative, qualitative and mixed methods studies. RESULTS: A total of 6 studies (two quantitative, three qualitative and one mixed methods) were included in the final review. While two key concepts (current practice and embracing a BPS approach) were generated using advanced meta-integration synthesis, two concepts (barriers and enablers) were informed from qualitative only data. DISCUSSION: Our review finding showed that current osteopathic practice occurs within in the biomedical model of care. Although, osteopaths are aware of the theoretical underpinnings of the BPS model and identified the need to embrace it, various barriers exist that may prevent osteopaths from implementing the BPS model in clinical practice. Ongoing education and/or workshops may be necessary to enable osteopaths to implement a BPS approach.


Subject(s)
Musculoskeletal Pain , Osteopathic Physicians , Attitude of Health Personnel , Health Personnel , Humans , Musculoskeletal Pain/therapy , Qualitative Research
3.
J Man Manip Ther ; 29(5): 318-331, 2021 Oct.
Article in English | MEDLINE | ID: mdl-34279185

ABSTRACT

OBJECTIVE: To describe individual long-term outcomes of people with persistent symptoms following a concussion who received neck treatment as part of multidisciplinary concussion care. A secondary objective is to report on how participants describe the outcomes of neck treatmentMethods: Long-term follow-up for a subgroup of participants in a prospective case series (n = 11). Data were collected at initial assessment, completion of neck treatment, 6 and 12 months including standard questionnaires (Rivermead post-concussion symptoms questionnaire, neck disability index, dizziness handicap inventory); patient-reported measures of headache, dizziness and neck pain and participant descriptions of the effects of neck treatmentResults: Grouped measures of post-concussion symptoms were further improved or sustained at 6 and 12 months. Ten of the 11 participants reported neck treatment as a beneficial part of their care and described the effects on the neck, multiple symptoms and their overall recovery. However, seven participants experienced recurrent headache, neck pain or dizziness at 6- or 12-month follow-up. CONCLUSION: Long-term follow-up of individuals receiving neck treatment shows improvement across a range of patient reported outcomes, yet highlights frequent recurrence of symptoms. Neck treatment can play a valuable role in people's recovery that extends beyond local effects on the neck.

4.
PLoS One ; 16(5): e0250685, 2021.
Article in English | MEDLINE | ID: mdl-33939740

ABSTRACT

BACKGROUND: Chinese herbal footbaths are an external therapy of traditional Chinese medicine that has been widely used to treat dysmenorrhea. This review aims to systematically evaluate its efficacy and safety for the treatment of dysmenorrhea. METHODS: Databases of PubMed, EMBASE, Cochrane Library, CIHAHL, Web of Science, Chinese National Knowledge Infrastructure(CNKI), Chinese Scientific Journals Database (VIP), Wanfang Database, China Biomedical Literature Database(CBM), and Chinese Biomedical Literature Service System (SinoMed) will be searched from the inception to September 30, 2020. The eligible randomized controlled trials (RCTs) will be identified and included. The primary outcomes include pain intensity measured by validated scales of visual analog scale, numeric rating scale, and response rate of symptom reduction. The secondary outcomes are scores on validated pain questionnaires, quality of life measured by SF-36 or other validated scales, and adverse events. Study selection, data extraction, and assessment of bias risk will be conducted by two reviewers independently. RevMan software (V.5.3.5) will be utilized to perform data synthesis. Subgroup and sensitivity analysis will be performed when necessary. The strength of the evidence will be evaluated with the Grading of Recommendations Assessment, Development and Evaluation System. RESULTS: A high-quality synthesis of current evidence of Chinese herbal footbaths for patients with dysmenorrhea will be provided in this study. CONCLUSION: This systematic review will provide evidence of whether Chinese herbal footbaths are an effective and safe intervention for the treatment of dysmenorrhea. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020188256.


Subject(s)
Baths , Drugs, Chinese Herbal/therapeutic use , Dysmenorrhea/therapy , Foot , Female , Humans
6.
BMC Complement Med Ther ; 21(1): 63, 2021 Feb 13.
Article in English | MEDLINE | ID: mdl-33583417

ABSTRACT

BACKGROUND: The prevalence of CAM use is increasing. This integrative review investigated New Zealand healthcare professionals' practice of, attitudes toward, and knowledge about complementary and alternative medicine (CAM). METHODS: Literature search was conducted in four databases from inception to April 2020. Studies were included if they reported results from primary data collection on practice of, attitudes toward, or knowledge about CAM amongst New Zealand healthcare professionals. RESULTS: Eleven studies (two of 'high-quality', seven of 'moderate-quality', and two of 'low-quality') were identified with 2060 healthcare professionals including general practitioners (GPs), nurses, midwives, pharmacists, physiotherapists, and medical specialists. New Zealand healthcare professionals were generally positive regarding CAM use, but have concerns on the scientific evidence, regulation, safety, financial costs of CAM, and encourage an evidence-based CAM practice and stronger CAM regulation. Findings indicated that around 25% of GPs practise CAM, and 82.3% refer patients to CAM practitioners. When treating pregnant women, 48.4% of physiotherapists practise acupuncture, and 37.3% of midwives recommend CAM. GPs believe that acupuncture is the most helpful CAM modality, and most commonly practiced and referred patients to acupuncture. Up to 58% of GPs and Plunket nurses wanted to receive further education on CAM, and up to 66.7% GPs favour the idea CAM should be included in medical curriculums. CONCLUSIONS: Nine of the 11 included studies were of moderate to high quality, thus enhancing the reliability of the review findings. In order to better manage CAM in New Zealand New Zealand clinical settings, there is a need to invest in CAM research and education, and enhance CAM regulation. This review is a first step in developing an evidence base to offer insights for further development of effective CAM policies regarding safety, efficacy, regulation and integration in New Zealand.


Subject(s)
Complementary Therapies/statistics & numerical data , Health Knowledge, Attitudes, Practice , Health Personnel/statistics & numerical data , Adult , Delivery of Health Care/statistics & numerical data , Female , Humans , Male , Middle Aged , New Zealand , Surveys and Questionnaires , Young Adult
7.
Spine (Phila Pa 1976) ; 46(15): 1026-1032, 2021 Aug 01.
Article in English | MEDLINE | ID: mdl-33395023

ABSTRACT

STUDY DESIGN: Case-control study. OBJECTIVE: The aim of this study was to establish an algorithm to distinguish acute lumbar spondylolysis (LS) from nonspecific low back pain (NSLBP) among patients in junior high school by classification and regression tree (CART) analysis. SUMMARY OF BACKGROUND DATA: Rapid identification of acute LS is important because delayed diagnosis may result in pseudarthrosis in the pars interarticularis. To diagnose acute LS, magnetic resonance imaging (MRI) or computed tomography is necessary. However, not all adolescent patients with low back pain (LBP) can access these technologies. Therefore, a clinical algorithm that can detect acute LS is needed. METHODS: The medical records of 223 junior high school-aged patients with diagnosed acute NSLBP or LS verified by MRI were reviewed. A total of 200 patients were examined for establishing the algorithm and 23 were employed for testing the performance of the algorithm. CART analysis was applied to establish the algorithm using the following data; age, sex, school grades, days after symptom onset, history of LBP, days of past LBP, height, passive straight leg raising test results, hours per week spent in sports activities, existence of spina bifida, lumbar lordosis angle, and lumbosacral joint angle. Sensitivity and specificity of the algorithm and the area under the ROC curve were calculated to assess algorithm performance. RESULTS: The algorithm revealed that sex, days after symptom onset, days of past LBP, hours per week spent in sports activities, and existence of spina bifida were key predictors for identifying acute LS versus NSLBP. Algorithm sensitivity was 0.64, specificity was 0.92, and the area under the ROC curve was 0.79. CONCLUSION: The algorithm can be used in clinical practice to distinguish acute LS from NSLBP in junior high school athletes, although referral to MRI may be necessary for definitive diagnosis considering the algorithm's sensitivity.Level of Evidence: 4.


Subject(s)
Algorithms , Athletes , Low Back Pain/diagnosis , Spondylolysis/diagnosis , Case-Control Studies , Decision Support Systems, Clinical , Diagnosis, Differential , Humans , Low Back Pain/physiopathology , Regression Analysis , Retrospective Studies , Spondylolysis/physiopathology
8.
Pain Pract ; 21(2): 226-261, 2021 Feb.
Article in English | MEDLINE | ID: mdl-32696604

ABSTRACT

OBJECTIVE: Alteration in somatosensory function has been linked to pain experience in individuals with joint pain. In this systematic review we aimed to establish the level of evidence of associations between psychological, social, physical activity, and sleep measures and somatosensory function that were assessed via quantitative sensory testing (QST) among individuals with joint pain. METHODS: A comprehensive literature search was conducted in 6 electronic databases from their inception to July 2019. Two reviewers independently assessed the methodological quality using a modified Quality in Prognostic Studies (QUIPS) tool and supplemented with recommendations from the Critical Appraisal and Data Extraction for Systematic Review of Prediction Modelling Studies (CHARMS) checklist and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Data were pooled to evaluate the strength of the relationships of interest. RESULTS: Seventeen studies related to joint pain were included. Pain catastrophizing, depression, anxiety, and physical activity level have been shown to have a significant (small to fair) association with several QST measures. Pressure pain threshold (PPT) is the only measure that was found to be consistently correlated with all the domains. The overall quality of evidence for all factors ranged from very low to moderate. Subgroup analysis revealed a stronger association for depression and pain catastrophizing and PPT and temporal pain summation in individuals with shoulder pain. CONCLUSION: Psychological factors and physical activity levels are associated with somatosensory function in people with joint pain. These factors need to be adjusted when establishing predictive relationships between somatosensory function and pain outcomes in individuals with joint pain.

9.
Oral Dis ; 27(5): 1115-1126, 2021 Jul.
Article in English | MEDLINE | ID: mdl-32964596

ABSTRACT

The objective was to explore the effectiveness of photobiomodulation therapy for treating patients who suffer xerostomia and/or hyposalivation due to the most prevalent clinical diagnoses. We searched PubMed, Scopus, Web of Science, CINAHL and Cochrane Library for randomized or clinical controlled trials published until 31 October 2019. Risk of bias assessment and meta-analysis were conducted using the Cochrane tools. A total of 274 records were retrieved, and 11 met the inclusion criteria. Interventions whose parameters ranged between wavelengths of 790-830 nm (infrared), 30-120 mW of power and an energy density below 30 J/cm-2 were associated with improvements in xerostomia/hyposalivation. As for the assessment of methodological quality, 10 of the 11 articles included had a high risk of overall bias. Only 3 articles provided sufficient information to conduct a meta-analysis for quality of life, compared with placebo in patients with burning mouth syndrome, showing a standardized mean difference between groups from baseline of -0.90 (-1.48; -0.32). The present review and meta-analysis suggest that photobiomodulation therapy is an effective, non-invasive and safe approach in patients with xerostomia. However, despite the potential, it is not possible to reach a reliable consensus on the parameters to be used, and future studies should be conducted by standardizing intervention protocols.


Subject(s)
Burning Mouth Syndrome , Low-Level Light Therapy , Xerostomia , Humans , Quality of Life , Xerostomia/etiology , Xerostomia/therapy
10.
Medicine (Baltimore) ; 99(40): e22401, 2020 Oct 02.
Article in English | MEDLINE | ID: mdl-33019415

ABSTRACT

BACKGROUND: A growing body of clinical trials has demonstrated that traditional Chinese medicine Shaoyao Gancao Tang may improve restlessness leg syndrome (RLS). This review aims to systematically assess its effectiveness and safety in the treatment of patients with RLS. METHODS: Eight databases will be searched from the inception to 31 August 2020, including the Chinese Biological Medicine Database, China National Knowledge Infrastructure, Wanfang Database, VIP Information Database, the Cochrane Library, PubMed, EMBASE, and the Web of Science. All published randomized controlled trials that meet the prespecified eligibility criteria will be included. The primary outcomes include the changes in the International Restless Legs Syndrome Rating Scale and the restless sensation assessed by visual analog scales, and the secondary outcomes include effective rate, adverse event rate, quality of life measures, and improvement in the sleep quality index. Study selection, data extraction, and assessment of bias risk will be conducted independently by 2 reviewers. Data synthesis will be carried out with RevMan software (V.5.3.5). Subgroup and sensitivity analysis will be performed when necessary. The strength of the evidence will be assessed by the Grading of Recommendations Assessment, Development and Evaluation System. RESULTS: A high-quality synthesis of current evidence of Shaoyao Gancao Tang's effectiveness and safety for patients with RLS will be provided. CONCLUSION: This systematic review will provide evidence of whether Shaoyao Gancao Tang is an effective and safe intervention for RLS.


Subject(s)
Drugs, Chinese Herbal/therapeutic use , Restless Legs Syndrome/drug therapy , Drugs, Chinese Herbal/administration & dosage , Drugs, Chinese Herbal/adverse effects , Humans , Medicine, Chinese Traditional , Quality of Life , Randomized Controlled Trials as Topic , Research Design , Sleep/physiology
11.
J Eval Clin Pract ; 2020 Sep 17.
Article in English | MEDLINE | ID: mdl-32941698

ABSTRACT

RATIONALE: Decision-making in musculoskeletal health care is complex, with discrepancy among clinical providers and variation in the per cent of referrals for specialist care. To date, there is an increased focus on specialist referrals, risking overuse of expensive testing and contributing to unnecessary treatment. AIMS AND OBJECTIVES: This report will considerer the difficulties of primary care musculoskeletal decision-making using shoulder injuries as an example, presenting a solution based on multi-criteria decision-making analysis with online software. The associated issues involved in clinical decision-making are complex. Contributing to the components of complexity are; the multifaceted aetiology of shoulders, the experience and knowledge of providers, and the burden of patient demands. Notwithstanding, funding considerations, resource allocation availability and other associated issues around clinical decision-making. Considering the many facets and complexities of clinical decision-making, this is an area where multi-criteria decision-making analysis (MCDM) may be appropriate. The MCDM analysis approach is increasingly being used in health care and can assist in the organizing and weighting of identified key clinical factors. MCDM could be applied to the challenges of musculoskeletal care with the potential to decrease decision-making variability. Furthermore, the significance of each key clinical factor that musculoskeletal decision-making is based on are to date unclear. CONCLUSION: Therefore, this preliminary report offers a start towards clarifying key factors and an approach for implementing improved shoulder clinical care decision-making which could then be adapted and applied to other body sites.

12.
J Prim Health Care ; 12(3): 195-198, 2020 09.
Article in English | MEDLINE | ID: mdl-32988440

ABSTRACT

Low back pain (LBP) is the leading contributor to years lived with disability, and imposes an enormous burden on individuals and on health-care systems. General practitioners and physiotherapists are generally the front-line health professionals dealing with patients with LBP, and have a key role in minimising its effect. Here we review six key issues associated with LBP including its effects, diagnosis and management in primary care, and highlight the importance of the biopsychosocial model and matched care for patients with LBP.

13.
Medicine (Baltimore) ; 99(29): e21166, 2020 Jul 17.
Article in English | MEDLINE | ID: mdl-32702872

ABSTRACT

INTRODUCTION: Insomnia is a major public health problem. Due to the side effects of pharmacological therapy, people are seeking to choose complementary and alternative therapies for insomnia disorder. Traditional Chinese herbal bath therapy is an important complementary therapy which combines advantages of Chinese herbs and bathing therapy. This protocol describes the methodology of a systematic review assessing the effectiveness and safety of traditional Chinese herbal bath therapy for insomnia. METHODS AND ANALYSIS: Reporting of this review will be adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We will electronically search the following seven databases from inception to January 23, 2020: PubMed, Cochrane database (CENTRAL), EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP Database, and Wanfang Database. Parallel randomized controlled trials evaluating the effectiveness and safety of traditional Chinese herbal bath therapy for insomnia will be included. Study selection, data extraction and assessment of risk of bias will be performed independently by two researchers. The sleep quality will be assessed as the primary outcome. Global symptom improvement, anxiety and depression, and adverse events will be evaluated as secondary outcomes. The Cochrane's risk of bias tool will be utilized for assessing the methodological quality of included studies. Revman software (v.5.3) will be used for data synthesis and statistical analysis. Data will be synthesized by either fixed-effects or random-effects model according to a heterogeneity test. If it is not appropriate for a meta-analysis, a descriptive analysis will be conducted. GRADE system will be used to assess the quality of evidence. PROSPERO REGISTRATION NUMBER: CRD42020168507.


Subject(s)
Baths/standards , Clinical Protocols , Sleep Initiation and Maintenance Disorders/drug therapy , Baths/methods , Herbal Medicine/methods , Herbal Medicine/standards , Humans , Medicine, Chinese Traditional/methods , Medicine, Chinese Traditional/standards , Sleep Initiation and Maintenance Disorders/physiopathology , Systematic Reviews as Topic
14.
Phys Ther Sport ; 44: 47-52, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32416581

ABSTRACT

OBJECTIVES: To determine normal temperatures over the Patella tendon over eleven weeks. DESIGN: A prospective cohort study with eleven weeks of observation. SETTING: University's Human Biomechanics and Physiology Laboratory. PARTICIPANTS: Male or female collegiate runners running at least 25 miles per week who did not report pain in the region of the Patella tendon over 11 weeks of data collection. MAIN OUTCOME MEASURES: Thermal images taken at the same time and day of the week, were used to measure the temperature of the skin over the Patella tendon. RESULTS: Eighteen athletes were eligible for analysis. The mean temperature of the Patella tendon was 30.13 °C (SD = 1.51 °C). Patella tendon temperature changes over time were insignificant (right p = 0.66, left p = 0.90) with ICC right = 0.92, left = 0.94. Mean temperature difference side to side was 0.14 °C (SD = 0.60 °C). Mixed-model Linear regression for mean temperature differences found the effect of (i) time (t = 0.39, p = 0.70, df = 361) and (ii) side (t = -0.89, p = 0.38, df = 361) to be insignificant. CONCLUSIONS: This is the first report of normal thermal profiles of collegiate runners over an extended period. Temperature variation above 1.20 °C may represent an abnormal asymmetry in the running population. Variations in Patella tendon temperatures left to right, and over time were not significant.


Subject(s)
Athletes , Body Temperature/physiology , Patellar Ligament/physiology , Seasons , Universities , Adult , Female , Follow-Up Studies , Humans , Male , Prospective Studies , Thermography/methods , Young Adult
15.
Clin J Pain ; 36(2): 124-134, 2020 02.
Article in English | MEDLINE | ID: mdl-31764166

ABSTRACT

OBJECTIVE: Somatosensory abnormalities are linked to clinical pain outcomes in individuals with spinal pain. However, a range of factors might confound the relationship between altered somatosensory function and clinical pain outcomes. This systematic review aimed to evaluate the literature to assess the level of evidence of associations between psychological, social, physical activity, and sleep measures and somatosensory function (assessed via sensory psychophysical testing) among individuals with spinal pain. METHODS: A comprehensive literature search was performed in 6 electronic databases from their inception to June 2018. Two reviewers independently assessed the methodological quality using a modified Quality in Prognostic Studies (QUIPS) tool and supplemented with recommendations from the Critical Appraisal and Data Extraction for the Systematic Review of Prediction Modelling Studies (CHARMS) checklist and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The level of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Data were pooled to evaluate the strength of the relationships of interest. RESULTS: Among the 17 factors identified in the included studies, pain catastrophizing, depression, and pain-related fear have significant negative (small to fair) associations with pain thresholds. A "very low" to "moderate" quality of evidence was found for all the investigated factors. Subgroup analysis showed a smaller effect size for pain catastrophizing/fear of movement and pain thresholds in individuals with low back pain. CONCLUSIONS: Psychological factors are associated negatively with pain thresholds and they need to be adjusted when establishing predictive relationships between somatosensory function and pain outcomes in individuals with spinal pain.

16.
Article in English | MEDLINE | ID: mdl-31485246

ABSTRACT

As part of traditional Chinese medicine, acupoints are considered a dynamic functional area, which can reflect the internal condition of the body. When the body is suffering from disease or injury, corresponding acupoints are believed to be activated and manifest in several sensitized forms, including expansion of the receptive field, pain sensitization, and heat sensitization. Such phenomena are believed to gradually disappear concomitantly with recovery from the disease. Acupoint states are therefore changeable according to health status, a phenomenon known as acupoint sensitization. This review aims to provide an overview of acupoint sensitization based on existing research results and determine priorities for future research. Systematic literature retrieval was conducted in Medline, Embase, Cochrane Library, CINAHL, and AMED from inception to 18 July 2018. Current evidence from research findings to date indicate that acupoint sensitization is based on neurogenic inflammation and that stimulation of sensitized acupoints presents a potential trend of generating a better clinical effect when compared with stimulation of unsensitized points.

17.
J Orthop Sports Phys Ther ; 49(11): 845-854, 2019 11.
Article in English | MEDLINE | ID: mdl-31154952

ABSTRACT

BACKGROUND: Persistent symptoms post concussion can arise from a range of sources, including the neck. There is little description of neck assessment findings in people with persistent symptoms post concussion. OBJECTIVES: To assess people with persistent symptoms following a concussion and determine whether the neck has also been injured, and to evaluate the potential of the neck to contribute to their symptoms. METHODS: A consecutive series of participants (n = 20) referred for neck assessment were prospectively recruited by 2 providers of a multidisciplinary concussion service for people with persistent symptoms. Data were collected at initial assessment and on completion of neck treatment, which included standard questionnaires (Rivermead Post Concussion Symptoms Questionnaire, Neck Disability Index, Dizziness Handicap Inventory); patient-reported measures of headache, dizziness, and neck pain; physical examination findings; and details of comorbidities. RESULTS: Participants were evaluated at a mean of 7.5 weeks post concussion (median, 5 weeks). On neck assessment, 90% were considered by the clinician to have a neck problem contributing to their current symptoms. Multiple findings were consistent with this view, including moderate-to-severe Neck Disability Index scores (mean ± SD, 33.4 ± 9.5 points), frequent neck pain (85%), frequent moderate-to-severe pain on occiput-C4 segmental assessment (85%), a positive flexion-rotation test (45%), and muscle tenderness (50%-55%). CONCLUSION: Multiple findings were indicative of concurrent neck injury, particularly involving the upper cervical spine. These neck-related findings are important to recognize, as they have the potential to contribute to persistent symptoms post concussion and may respond to neck treatment. This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616001183471). J Orthop Sports Phys Ther 2019;49(11):845-854. Epub 1 Jun 2019. doi:10.2519/jospt.2019.8547.


Subject(s)
Brain Concussion/physiopathology , Brain Concussion/therapy , Neck Injuries/physiopathology , Neck Injuries/therapy , Post-Concussion Syndrome/physiopathology , Post-Concussion Syndrome/therapy , Adolescent , Adult , Aged , Cervical Vertebrae/physiopathology , Disability Evaluation , Female , Humans , Male , Middle Aged , Pain Measurement , Physical Examination , Prospective Studies , Range of Motion, Articular , Young Adult
19.
Phys Ther Sport ; 36: 110-115, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30716561

ABSTRACT

OBJECTIVES: To determine normal temperatures over the Achilles tendon over nine weeks. DESIGN: A prospective cohort study with nine weeks of observation. SETTING: University's Human Biomechanics and Physiology Laboratory. PARTICIPANTS: Male or female competitive runners running at least 25 miles per week who did not report pain in the region of the Achilles over 9 weeks of data collection. MAIN OUTCOME MEASURE: Thermal images taken at the same time and day of the week, were used to measure the temperature of the skin over the Achilles tendon. RESULTS: Seventeen athletes were eligible for analysis. The Achilles tendon temperatures were right 28.7 °C ±â€¯1.3 °C, left 28.8 °C ±â€¯1.3 °C. ICC demonstrated a very high consistency and minimal variations in temperatures (right 0.86 (95% CI = 0.58, 0.98), left 0.79 (95% CI = 0.38, 0.97). The mean difference between sides over the season was 0.50 °C ±â€¯0.43 °C (p = 0.681). A decreasing trend in the Achilles tendon temperatures as the season progressed was observed. CONCLUSION: This is the first report of normal thermal profiles over an extended period. Variations in Achilles temperatures left to right, and over time were not significant. The decreasing temperature trend over the season warrants further investigation.


Subject(s)
Achilles Tendon/diagnostic imaging , Achilles Tendon/physiology , Body Temperature/physiology , Running/physiology , Thermography , Adolescent , Adult , Athletes , Cohort Studies , Female , Humans , Male , Young Adult
20.
BMJ Open ; 9(2): e022864, 2019 02 20.
Article in English | MEDLINE | ID: mdl-30787077

ABSTRACT

OBJECTIVE: The fifth metatarsal stress fracture is a common injury among football players. Although several risk factors have been proposed, the association between the playing surface and development of fifth metatarsal stress fractures (MT-5) has not been evaluated. We conducted an epidemiological study using a computer-based survey to investigate the association between the playing surface and development of MT-5. METHODS: This study included 1854 football players, of which 41 experienced MT-5 within the past 24 months. Baseline demographic data and the percentage of time spent playing on artificial turf and clay fields were compared between the non-MT-5 and MT-5 player groups, and the risks for development of MT-5 associated with the playing surfaces were estimated by univariate and multivariate analyses. RESULTS: There were significant differences in body mass index, years of play, playing categories and playing time on artificial turf between non-MT-5 and MT-5 groups (p<0.05). Generalised estimating equations analyses adjusted for multiple confounders demonstrated that relative to the risk of playing <20% of the time on each surface, the OR (OR: 95% CI) for MT-5 for playing on artificial turf >80% of the time increased (3.44: 1.65 to 7.18), and for playing on a clay field 61%-80% of the time, the OR decreased (0.25: 0.11 to 0.59). CONCLUSIONS: A higher percentage of playing time on an artificial turf was a risk factor for developing MT-5 in football players. This finding could be beneficial for creating strategies to prevent MT-5.


Subject(s)
Fractures, Stress/etiology , Metatarsal Bones/injuries , Soccer/injuries , Adolescent , Adult , Body Mass Index , Case-Control Studies , Child , Female , Floors and Floorcoverings , Fractures, Stress/epidemiology , Humans , Japan/epidemiology , Male , Middle Aged , Retrospective Studies , Risk Factors , Young Adult
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