Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report.

OBJECTIVE: To present the clinical management of inguinal disruption in a professional hockey player and highlight the importance of a multidisciplinary approach to diagnosis and management. CLINICAL FEATURES: A professional hockey player with recurrent groin pain presented to the clinic after an acute exacerbation of pain while playing hockey. INTERVENTION: The patient received a clinical diagnosis of inguinal disruption. Imaging revealed a tear in the rectus abdominis. Management included two platelet-rich plasma (PRP) injections to the injured tissue, and subsequent manual therapy and exercise. The patient returned to his prior level of performance in 3.5 weeks. DISCUSSION: This case demonstrated the importance of a multidisciplinary team and the need for advanced imaging in athletes with groin pain. SUMMARY: Research quality concerning the non-surgical management of inguinal disruption remains low. This case adds evidence that PRP, with the addition of manual therapy and exercise may serve as a relatively quick and effective non-surgical management strategy.

OBJECTIF: Présenter la prise en charge clinique d'une perturbation inguinale chez un joueur de hockey et mettre en évidence l'importance que revêt une approche multidisciplinaire pour le diagnostic et la prise en charge. CARACTÉRISTIQUES CLINIQUES: Un joueur de hockey professionnel souffrant d'une douleur récurrente au niveau de l'aine s'est présenté à la clinique à la suite d'une exacerbation aiguë de la douleur survenue au cours de la pratique de son sport. INTERVENTION: Le patient a reçu un diagnostic clinique d'une perturbation inguinale. L'imagerie médicale a révélé la présence d'une déchirure au niveau du grand droit de l'abdomen. La prise en charge comprenait deux injections de plasma riche en plaquettes (PRP) dans le tissu lésé, ainsi qu'une thérapeutique manuelle et des exercices ultérieurs. Le patient a retrouvé son niveau de performance antérieur en 3,5 semaines. DISCUSSION: Ce cas prouve l'importance de recourir à une équipe pluridisciplinaire et la nécessité d'utiliser des technologies d'imagerie de pointe chez les athlètes souffrant de douleurs récurrentes au niveau de l'aine. RÉSUMÉ: La qualité des recherches relatives à la prise en charge non-chirurgicale des perturbations inguinales demeure faible. Ce cas est une preuve supplémentaire que le PRP, associé à une thérapeutique manuelle et à des exercices, peut constituer une stratégie de prise en charge non-chirurgicale relativement rapide et efficace.

ENSO drove 2500-year collapse of eastern Pacific coral reefs.

Cores of coral reef frameworks along an upwelling gradient in Panamá show that reef ecosystems in the tropical eastern Pacific collapsed for 2500 years, representing as much as 40% of their history, beginning about 4000 years ago. The principal cause of this millennial-scale hiatus in reef growth was increased variability of the El Niño-Southern Oscillation (ENSO) and its coupling with the Intertropical Convergence Zone. The hiatus was a Pacific-wide phenomenon with an underlying climatology similar to probable scenarios for the next century. Global climate change is probably driving eastern Pacific reefs toward another regional collapse.

Catastrophe and the life span of coral reefs.

A strong earthquake in the western Caribbean in 2009 had a catastrophic impact on uncemented, unconsolidated coral reefs in the central sector of the shelf lagoon of the Belizean barrier reef. In a set of 21 reef sites that had been observed prior to the earthquake, the benthic assemblages of 10 were eradicated, and one was partially damaged, by avalanching of their slopes. Ecological dynamics that had played out over the previous 23 years, including the mass mortalities of two sequentially dominant coral species and a large increase in the cover of an encrusting sponge, were instantaneously rendered moot in the areas of catastrophic reef-slope failure. Because these prior dynamics also determined the benthic composition and resilience of adjacent sections of reef that remained intact, the history of disturbance prior to the earthquake will strongly influence decadal-scale recovery in the failed areas. Geological analysis of the reef framework yielded a minimum return time of 2000-4000 years for this type of high-amplitude event. Anthropogenic degradation of ecosystems must be viewed against the backdrop of long-period, natural catastrophes, such as the impact of strong earthquakes on uncemented, lagoonal reefs.

Pudendal nerve entrapment in an Ironman athlete: a case report.

OBJECTIVE: To present the diagnostic and clinical features of pudendal nerve entrapment and create awareness amongst clinicians of this rare and painful condition. CLINICAL FEATURES: A 41-year old male ironman athlete complaining of insidious constant penis pain 12-24h after long distance cycling and pain after sexual intercourse. A diagnosis of "cyclist syndrome" also known as pudendal nerve entrapment was made. INTERVENTION AND OUTCOME: Patient was treated twice a week for four weeks using the soft tissue protocol described by Active Release Technique(®) to the obturator internus muscle. After two weeks of treatment his pain decreased to a 5/10 on the pain intensity scale and he began to cycle again. After four weeks of treatment his pain had decreased to 1/10 in intensity and he continued to cycle. At follow-up, approximately 8 weeks and 12 weeks later the patient communicated that his pain is resolved and he has began to train for Ironman Lake Placid 2010. CONCLUSION: Pudendal nerve entrapment is a rare, painful condition and is often misdiagnosed due to the fact that the clinical manifestations can mimic other pathologies. It is important to be aware of the clinical features to obtain appropriate diagnosis and treatment of this condition promptly.

Posterior tibialis tendonopathy in an adolescent soccer player: a case report.

OBJECTIVE: Detail the progress of an adolescent soccer player with right-sided chronic medial foot pain due to striking an opponent's leg while kicking the ball. The patient underwent diagnostic ultrasound and a conservative treatment plan. CLINICAL FEATURES: The most important features were hindfoot varus, forefoot abduction, flatfoot deformity, and inability to single leg heel raise due to pain. Conventional treatment was aimed at decreasing hypertonicity and improving function of the posterior tibialis muscle and tendon. INTERVENTION AND OUTCOME: Conservative treatment approach utilized soft tissue therapy in the form of Active Release Technique(®), and eccentric exercises designed to focus on the posterior tibial muscle and lower limb stability. Outcome measures included subjective pain ratings, and resisted muscle testing. CONCLUSION: A patient with posterior tibialis tendonopathy due to injury while playing soccer was relieved of his pain after 4 treatments over 4 weeks of soft tissue therapy and rehabilitative exercises focusing on the lower limb, specifically the posterior tibialis muscle.

Treatment of posttraumatic arthrofibrosis of the radioulnar joint with vibration therapy (VMTX Vibromax Therapeutics): a case report and narrative review of literature.

OBJECTIVE: To present the clinical features of post traumatic arthrofibrosis and response to treatment with Vibromax Therapeutics (VMTX) in 28 year old male soccer player. RATIONALE: Many studies have reported an increase in muscle performance after whole-body vibration, but to date none have evaluated the possibility of vibration application as a therapy for functional restoration after injury. CONCLUSIONS: Vibration training is being utilized in, strength training, performance enhancement and rehabilitation. Despite the lack of research in this area, the literature that is currently available and the results of this case study imply that vibration therapy has the potential to aid in the management of acute soft tissue injury and the sequela of disuse and immobilization.

Calcitonin and prednisolone display antagonistic actions on bone and have synergistic effects in experimental arthritis.

We tested here the hypothesis that calcitonin and glucocorticoids, known to modulate bone metabolism, could have opposite actions on bone cells regulating expression of cytokine receptor activator of nuclear factor-kappaBeta ligand (RANKL) and osteoprotegerin (OPG). In the U2OS osteosarcoma cell line, calcitonin (10(-11) to 10(-9) mol/L) reduced RANKL and augmented OPG both at the mRNA and protein levels. Cell incubation with prednisolone (10(-8) to 10(-6) mol/L), the glucocorticoid chosen for this study, produced opposite results. These molecular studies prompted more functional analyses whereby osteoclast bone resorptive activity was determined. Calcitonin (10(-10) mol/L) abrogated the stimulating effect of 10 ng/ml RANKL or 10(-9) mol/L prednisolone; similar results were obtained with OPG. Assessment of calcitonin and prednisolone effects in an in vivo model of rheumatoid arthritis revealed partially surprising results. In fact, calcitonin not only preserved bone morphology (as assessed on day 18) in rats subjected to arthritis and treated with prednisolone (0.8 to 4 mg/kg daily from day 13) but also synergized with the steroid to elicit its antiarthritic effects. These results suggest that calcitonin could be used as a novel cotreatment to augment efficacy and reduce side effects associated with the prolonged use of steroids.

Shoulder muscle EMG activity during push up variations on and off a Swiss ball.

BACKGROUND: Surface instability is a common addition to traditional rehabilitation and strength exercises with the aim of increasing muscle activity, increasing exercise difficulty and improving joint proprioception. The aim of the current study was to determine if performing upper body closed kinetic chain exercises on a labile surface (Swiss ball) influences myoelectric amplitude when compared with a stable surface. METHODS: Thirteen males were recruited from a convenience sample of college students. Surface electromyograms were recorded from the triceps, pectoralis major, latissimus dorsi, rectus abdominis and external oblique while performing push up exercises with the feet or hands placed on a bench and separately on a Swiss ball. A push up plus exercise was also evaluated with hands on the support surface. RESULTS AND DISCUSSION: Not all muscles responded with an increase in muscle activity. The pectoralis major muscle was not influenced by surface stability. The triceps and rectus abdominis muscles showed increases in muscle activity only when the hands were on the unstable surface. The external oblique muscle was only influenced by surface stability during the performance of the push up plus exercise. No muscle showed a change in activation level when the legs were supported by the Swiss ball instead of the bench. CONCLUSION: Muscle activity can be influenced by the addition of surface instability however an increase in muscle activity does not influence all muscles in all conditions. The relationship between the participant's center of mass, the location of the unstable surface and the body part contacting the Swiss ball may be important factors in determining the muscle activation changes following changes in surface stability.