Sitting may increase risk for radiographic incidence and progression of knee osteoarthritis over 2 years: Data from a large cohort study.

OBJECTIVES: To examine the association of leisure-time sitting with radiographic incidence and progression of knee osteoarthritis (OA) over 2 years, and to determine whether worktime sitting modifies this association. METHODS: We included adults with or at high risk for knee OA who enroled in the Osteoarthritis Initiative (OAI). Participants reported leisure-time sitting (≤4 vs. >4 h/day) and worktime sitting (frequent vs. infrequent) at enrolment, and had bilateral knee radiographs at enrolment and 2 years later. Our outcome, radiographic knee OA incidence/progression (yes/no), was defined as any increase in Kellgren-Lawrence grade over 2 years. We examined the association of leisure-time sitting (≤4 vs. >4 h/day) with risk of radiographic knee OA incidence/progression using binary linear regression, adjusting for potential confounders. We stratified by worktime sitting (frequent vs. infrequent) and repeated our analysis. RESULTS: We included 4254 adults (mean age 61 years; 58% women; mean body mass index 29 kg/m2 ) who contributed a total of 8127 knees. Adults with >4 h/day of leisure-time sitting had 25% higher risk (adjusted risk ratio [RR] 1.25, 95% confidence interval [95% CI] 1.08-1.50) for radiographic knee OA incidence/progression compared with adults with ≤4 h/day of leisure-time sitting (referent group). Importantly, this association was intensified (RR 1.60, 95% CI 1.19-2.33) among adults with frequent worktime sitting, but was attenuated (RR 1.11, 95% CI 0.89-1.39) among adults with infrequent worktime sitting. CONCLUSIONS: Higher leisure-time sitting (>4 h/day) may be associated with greater risk for radiographic knee OA incidence/progression over 2 years. Furthermore, this association was intensified among adults who also reported frequent worktime sitting.

Sleep quality and nocturnal pain in patients with shoulder disorders.

BACKGROUND: Nocturnal shoulder pain resulting in poor sleep quality is a common finding in patients with shoulder disease. The purpose of this paper was to describe and to compare the sleep quality, pain, and function in adult subjects who have been diagnosed with rotator cuff disorders, osteoarthritis, or adhesive capsulitis (AC). METHODS: Patients completed a clinical assessment and comprehensive questionnaire regarding their current medical health history, shoulder symptoms, and impact of their symptoms on activities of daily living and quality of sleep. RESULTS: The study analyzed 343 patients with an average age of 57.4 years. The mean Single Assessment Numeric Evaluation score for AC was 34%, which was significantly lower than the score for the subacromial impingement syndrome group of 53% (P = .007). The mean American Shoulder and Elbow Surgeons scale score for AC was 38, which was also significantly lower than the score for the subacromial impingement syndrome group of 51 (P = .007). There were no significant differences in pain, with mean scores ranging from 4.90 to 5.82 for diagnostic subgroups on a visual analog scale (P = .28). Sleep quality was significantly poorer in the AC group (P = .008), with a mean Pittsburgh Sleep Quality Index score of 12.07. Specific subcomponents of the Pittsburgh Sleep Quality Index that had a significant impact on sleep interruption included sleep quality, sleep duration, and habitual sleep efficiency in the AC group (P < .05). CONCLUSION: This study shows that whereas many patients with shoulder disease may have sleep-related issues, patients with adhesive capsulitis are particularly vulnerable to reduced sleep quality.

Evaluation and management of greater trochanter pain syndrome.

Greater trochanteric pain syndrome is an enigmatic but common cause of lateral hip symptoms in middle-aged active women. The most common manifestation of this syndrome is a degenerative tendinopathy of the hip abductors similar to the intrinsic changes seen with rotator cuff pathology in the shoulder. There are no definitive tests to isolate the underlying pathology and palpation is a non-specific means by which to differentiate the source of the pain generator. The physical examination must comprehensively evaluate for a cluster of potential impairments and contributing factors that will need to be addressed to effectively manage the likely functional limitations and activity challenges the syndrome presents to the patient. Compressive forces through increased tension in the iliotibial band should be avoided. Intervention strategies should include education regarding postural avoidance, activity modifications, improvement of lumbopelvic control, and a patient approach to resolving hip joint restrictions and restoring the tensile capabilities of the deep rotators and abductors of the hip. A number of reliable and validated hip-specific self-report outcome tools are available to baseline a patient's status and monitor their progress. Further investigations to identify the epidemiological risk factors, establish effective treatment strategies, and predict prognosis are warranted.

Comprehensive strength training program for a recreational senior golfer 11-months after a rotator cuff repair.

BACKGROUND AND PURPOSE: Golf is a popular sport played by hundreds of thousands of individuals of all ages and of varying skill levels. An orthopedic or sports-related injury and/or surgery may limit an individual's sport participation, require him/her to complete a course of rehabilitation, and initiate (or resume) a sport-specific training program. Unlike the availability of evidence to guide postsurgical rehabilitation and sport-specific training of athletes from sports other than golf, there have only been two reports describing outcomes after surgery and for golfers. The purpose of this case report is to present a post-rehabilitation return to sport-training program for a recreational golfer 11-months after a rotator cuff repair. CASE DESCRIPTION: The subject, a 67-year old female, injured her right shoulder requiring a rotator cuff repair 11-months prior to her participation in a golf fitness training program. The subject participated in six training sessions over seven week period consisting of general strengthening exercises (including exercises for the rotator cuff), exercises for the core, plyometrics, and power exercises. OUTCOMES: The subject made improvements in power and muscular endurance of the core. She was able to resume golf at the completion of the training program. DISCUSSION: The subject was able to make functional improvements and return to golf after participation in a comprehensive strength program. Additional studies are necessary to improve program design for golfers who wish to return to sport after shoulder surgery.

Incorporating kettlebells into a lower extremity sports rehabilitation program.

The primary goal of a sports rehabilitation program is to return the injured athlete back to competition as quickly and as safely as possible. Sports physical therapists utilize a variety of exercise equipment to help an athlete restore function after an injury. An injured athlete's therapeutic exercise program frequently includes the prescription of functional strengthening and power exercises during the later stages of rehabilitation. One piece of exercise equipment, the kettlebell, has gained popularity for its ability to allow the user to perform functional power exercises. The unique exercises that can be performed with kettlebells may have utility in sports physical therapy practice. This clinical suggestion outlines the clinical rationale for the inclusion of kettlebell exercises when rehabilitating an athlete with a lower extremity injury.