A review of treatment for carpal tunnel syndrome.

PURPOSE: A common disorder encountered by healthcare specialists is carpal tunnel syndrome (CTS). CTS is a neuropathy disorder caused by compression on the median nerve. METHOD: Currently, there are several treatment methods for CTS such as: (1) non-steroidal anti-inflammatory drugs (NSAIDs); (2) injection of medications; (3) immobilization by splinting; (4) rehabilitation modalities (therapeutic ultrasound, ASTM AdvantEDGE, stretching and strengthening); and (5) surgery by carpal tunnel release. RESULTS: While NSAIDs, injections, and splinting have shown promise in relieving symptoms, long-term outcomes have been poor. CONCLUSION: This article provides a background in current treatment methods and an insight into the focal point of the future.

Anterior knee pain: a clinical comparison of rehabilitation methods.

OBJECTIVE: To compare different types of rehabilitation for anterior knee pain. DESIGN: Prospective, randomized, blinded, and controlled study of 64 participants with anterior knee pain. SETTING: Outpatient rehabilitation clinic and testing laboratory. PARTICIPANTS: Participants were assigned in randomized fashion to three rehabilitation groups: traditional home rehabilitation (n = 20); physical therapy (n = 21); and home rehabilitation with a modified vastus medialis obliquis (VMO) specific straight leg raise (Muncie method; n = 23). INTERVENTIONS AND MAIN OUTCOME MEASURES: Clinical data was obtained at 0, 2, 6, and 12 weeks. Cybex testing was performed at 0, 6, and 12 weeks. RESULTS: Clinical outcome for the Muncie method indicated a statistically significant improvement in subjective pain and functional impairment ratings. Cybex testing in patients using the Muncie method demonstrated a statistically significant improvement in pain-free isometric contractions and maximum voluntary contraction. There were no significant differences between traditional home therapy and physical therapy. CONCLUSION: Findings suggest that the Muncie method results in improved clinical outcome at a lower cost than traditional home and physical therapy and possibly improved VMO/quadriceps muscle balance. Patients with anterior knee pain may benefit from applying the Muncie method in a home therapy program.

Treating lateral epicondylitis.

Lateral epicondylitis is a common problem among physically active individuals. One of the most important roles of the clinician is to provide the most effective rehabilitation intervention for the injured athlete and the physically active individual. Over 40 different treatment methods for lateral epicondylitis have been reported in the literature. Initially, lateral epicondylitis can be treated with rest, ice, tennis brace and/or injections. Injections are one of the most popular methods utilised, with a high success rate. However, when the condition is chronic or not responding to initial treatment, physical therapy is initiated. Common rehabilitation modalities utilised are ultrasound, phonophoresis, electrical stimulation, manipulation, soft tissue mobilisation, neural tension, friction massage, augmented soft tissue mobilisation (ASTM) and stretching and strengthening exercise. ASTM is becoming a more popular modality due to the detection of changes in the soft tissue texture as the patient progresses through the rehabilitation process. Other new modalities include laser and acupuncture. As a last resort for chronic or resistant cases, lateral epicondylitis may undergo surgery. Scientific research has found that all these methods have been inconsistently effective in treating lateral epicondylitis. Therefore, further research efforts are needed to determine which method is more effective.

Chronic ankle pain and fibrosis successfully treated with a new noninvasive augmented soft tissue mobilization technique (ASTM): a case report.

This clinical case report demonstrates the clinical effectiveness of a new form of soft tissue mobilization in the treatment of excessive connective tissue fibrosis (scar tissue) around an athlete's injured ankle. The scar tissue was causing the athlete to have pain with activity, pain on palpation of the ankle, decreased range of motion, and loss of function. Surgery and several months of conventional physical therapy failed to alleviate the athlete's symptoms. As a final resort, augmented soft tissue mobilization (ASTM) was administered. ASTM is an alternative nonsurgical treatment modality that is being researched at Performance Dynamics (Muncip, IN). ASTM is a process that uses ergonomically designed instruments that assist therapists in the rapid localization and effective treatment of areas exhibiting excessive soft tissue fibrosis. This is followed by a stretching and strengthening program. Upon the completion of 6 wk of ASTM therapy, the athlete had no pain and had regained full range of motion and function. This case report is an example of how a noninvasive augmented form of soft tissue mobilization (ASTM) demonstrated impressive clinical results in treating a condition caused by connective tissue fibrosis.

Rat tendon morphologic and functional changes resulting from soft tissue mobilization.

Augmented Soft Tissue Mobilization (ASTM) is a new non-invasive soft tissue mobilization technique which has been used successfully to treat a variety of musculoskeletal disorders. The purpose of this study was to determine the effects of ASTM therapy on the morphological and functional characteristics of enzyme induced injured rat Achilles tendons. Four groups of five rats were allocated as follows: (A) control, (B) tendinitis, (C) tendinitis plus ASTM, and (D) ASTM alone. Collagenase injury was induced, and the surgical site was allowed to heal for 3 wk. ASTM was performed on the Achilles tendon of groups C and D for 3 min on postoperative days 21, 25, 29, and 33 for a total of four treatments. Gait data were gathered prior to each treatment. The Achilles tendons of each group were harvested 1 wk after the last treatment. Specimens were prepared for light and electron microscopy, and immunostaining for type I and type III collagen and fibronectin was performed. Light microscopy showed increased fibroblast proliferation in the tendinitis plus ASTM treatment group. Although healing in rats may not translate directly to healing in humans, the findings of this study suggest that ASTM may promote healing via increased fibroblast recruitment.

Osteoporosis in active women: prevention, diagnosis, and treatment.

Insufficient estrogen can cause osteoporosis in young female athletes, like the 17-year-old runner described here, as well as in postmenopausal women, whose management is also detailed. The most common technique for diagnosis is dual-energy x-ray absorptiometry. Prevention and treatment depend on a woman's age but may include increased calcium intake, weight gain, weight-bearing and resistance exercise, and estrogen replacement therapy. Alendronate and/or calcitonin may be used as alternatives to estrogen therapy.

Sport, exercise, and the common cold.

Upper respiratory illness may cause more disability among athletes than all other diseases combined. This paper presents the essential epidemiology, risks of infection, and transmission features of upper respiratory illness. Those who provide health care for athletes must understand the subsequent implications of an upper respiratory illness on sport performance and should be familiar with participation and clinical management guidelines for athletes with an upper respiratory illness. The literature suggests that regular, rigorous exercise increases both the incidence and severity of upper respiratory illness, yet the immune system appears to have a distinct level at which moderate exercise promotes optimum health. Although research indicates that upper respiratory illness infections are surprisingly reluctant transmitters, upper respiratory illness transmission may escalate during winter sports seasons. The impact of upper respiratory illness on selected pulmonary, cardiac, and skeletal muscle functions may lead to illness complications in athletes, and sport performance during illness may also decline. Athletes should monitor symptoms, adjust training schedules, and rest during an upper respiratory illness.

Infectious disease in athletes.

The objective of this article has been to focus on the more common infectious diseases that the physician caring for athletes may encounter in the office practice of sports medicine. Clearly the physician plays a critical role in treatment and prevention through early recognition and intervention when appropriate. Fortunately, being a fairly young, healthy athletic population, these patients respond well to treatment. It is critical that physicians caring for athletes take an active role to educate and counsel their patients on appropriate preventive measures and give clear return to participation recommendations. Advice should be based on consideration of each athlete's unique situation as well as up-to-date knowledge concerning the particular infectious disease process involved and appropriate treatment options.