Back Injuries.

When searching for evidence-based answers about treating athletes with low back injury/pain, there are some difficulties. The first is defining who is an athlete. The second problem is that the lifetime prevalence of low back pain in the general population in our country approaches 100. Last, most studies published only deal with a narrow population of athletes, often performing very different types of physical activity. We searched the literature for studies that specifically evaluated athletes longitudinally. This article reviews the demographics, diagnostic challenges, history and physical examination, imaging choices, treatment, and controversies encountered when treating this population.

Air-fluidized therapy in the treatment of severe burns: A retrospective study from a burn intensive care unit in Austria.

INTRODUCTION: Air-fluidized therapy (AFT) has long been used in the treatment of severe burns. In patients with extensive burns involving the posterior trunk, we aim to keep affected posterior areas dry and to postpone their treatment, initially applying available split-thickness skin grafts in functionally more important regions. We retrospectively assessed the impact of AFT on the survival of patients treated in the burn intensive care unit (ICU) of the Medical University of Vienna, Austria, between 2003 and 2016. METHODS: This retrospective single-center study included patients aged ≥18 years with burned total body surface area (TBSA) ≥20% and IIb-III° thermal injuries on the posterior trunk who received AFT. Survival rates were compared with those predicted by the abbreviated burn severity index (ABSI). Demographic, clinical, and surgical data were analyzed. RESULTS: Seventy-five of 110 patients with posterior trunk burns received AFT. Their survival rate exceeded that predicted by the ABSI score (mean ABSI, 10.0 ± 2.0; 73.3% (95% CI: 62-83%) survival rate vs. 20-40% predicted; p < 0.0001); no such difference was observed in the non-AFT group (mean, 8.8 ± 1.9; 65.7% (95% CI: 48-81%) survival rate vs. 50-70% predicted). Patients receiving AFT had significantly greater TBSA (median, 50% (35-60) vs. 30% (25-45) and longer ICU stays (median, 63 (36-92) vs. 18 (9-52) days; both p < 0.0001). Fifty-one (68.0%) patients in the AFT group and 26 (74.3%) patients in the non-AFT group underwent posterior trunk surgery (p = 0.66) a median of 16 (10-26) and 5 (2.5-9.5) days, respectively, after admission (p < 0.0001). CONCLUSIONS: Patients receiving AFT had significantly better survival than predicted by ABSI score in contrast to patients not receiving AFT although burn injuries in this group were more severe (greater TBSA, higher ABSI). As intensive care was similar in these groups aside from AFT, the better survival could be attributed to this additional therapy.

Psychometric Properties of the Dance Functional Outcome Survey (DFOS): Reliability, Validity, and Responsiveness.

BACKGROUND: There are no outcomes measures that focus on the unique functional requirements of dancers. OBJECTIVES: To evaluate test-retest reliability, internal consistency, construct validity, sensitivity, and responsiveness of the Dance Functional Outcome Survey (DFOS) in professional and preprofessional adult dancers. METHODS: This prospective cohort study examined test-retest reliability of the DFOS in 198 healthy and injured dancers over 2 weeks, using intraclass correlation coefficients (ICC2,1). In a sample of 725 healthy and injured dancers, the following were examined: (1) construct validity, by comparing the DFOS to the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) using Pearson correlations; (2) exploratory factor analysis and internal consistency; and (3) sensitivity, by generating receiver operating characteristic curves and determining area under the curve (AUC). In a subgroup of 47 injured dancers, we determined internal responsiveness across 4 time points using repeated-measures analysis of variance (P<.05). Injured dancers' scores were analyzed for floor and ceiling effects. RESULTS: The DFOS demonstrated high test-retest reliability (ICC≥0.93). Single-factor loading in exploratory factor analysis supported unidimensionality of the scale, with high internal consistency (α = .96). The DFOS total score and activities-of-daily-living (ADL) and dance technique subscores had strong construct validity compared with scores on the SF-36 physical component summary (r≥0.77). This study found excellent sensitivity, with high AUC values (AUC≥0.91). There were significant differences across time for DFOS scores (P<.001), demonstrating responsiveness to change. There were no floor or ceiling effects. CONCLUSION: The DFOS demonstrates acceptable psychometric performance as an outcome and screening measure for dancers. The DFOS is a useful tool to monitor both healthy state and functional limitation following lower extremity or low back injury in adult ballet and modern dancers. J Orthop Sports Phys Ther 2019;49(2):64-79. Epub 27 Jul 2018. doi: 10.2519/jospt.2019.8247.

Medical Folk Remedy: Two Cases of Garlic Burns.

Over the years, many cultures have used herbs for serious health problems. Garlic (Allium sativum) pose hypocholesterolemic, fibrinolytic, antidiabetic, and antibiotic actions. However, it has unusual adverse effects such as chemical burns and contact dermatitis when used topically. In this case report, the authors present two cases of topical garlic burn caused after the use of crushed garlic with a bandage for pain relief due to arthritis.

Occupational lumbar back accidents in the private sector: prevalence and factors associated with their severity and sequelae in central Tunisia.

In Tunisia, few studies have been focused on occupational lumbar back accidents. We conducted a descriptive retrospective study of private sector employees in central Tunisia who were victims of lumbar back accidents, reported during a 5-year period from 2010 to 2014, to determine the prevalence and factors associated with their severity and sequelae. Data were collected from the regional centre of the National Health Insurance Fund of Sousse. We identified 293 cases, a prevalence of 14.2% in relation to all occupational accidents reported during this period. More than two thirds of the injured (69.2%) were victims of serious occupational lumbar back accidents and 33.8% of victims reported serious sequelae. After adjustment by binary logistic regression, the occupational category persisted as an associated factor with the severity of occupational lumbar back accidents (P = 0.001, OR = 2.86 [1.50-5.47]). Surgical treatment appeared as an associated factor of severity (P < 0.001, OR = 9.06 [3.09-26.56]) and prominent after effects resulting from these accidents (P < 0.001 OR = 54.72 [18.84-158.93]). Occupational lumbar back accidents are a real health problem. Thus, a preventive strategy should be implemented to reduce their socio-economic consequences.

Golf Injuries: Epidemiology, Pathophysiology, and Treatment.

Increasing numbers of people are playing golf. Golf is a unique sport in that the ability to participate at a high level is not limited by age. In addition, participants tend to play more rather than less as they grow older. Injuries can occur at any point during the golf swing, from takeaway through follow-through. Upper extremity injuries can affect the hands, elbow, and shoulder and are usually a result of the golf swing at impact. Injuries are also common in the lower back as well as the lower extremities. Most injuries are the result of overuse and poor swing mechanics. When treating golfers, it is important to have a good understanding of the biomechanics and forces of the golf swing to diagnose and manage the vast spectrum of injuries incurred in this sport.

Effects of the New York State Workers Compensation Board Medical Treatment Guidelines on Return to Work.

OBJECTIVE: Examine the association between New York State Workers' Compensation Medical Treatment Guidelines (Guidelines) adherence and return-to-work after occupational low back injuries. Assess adherence to Guidelines by examining diagnostic and treatment utilization. METHOD: Retrospective chart review of cases. Outcomes of interest were lost time duration and diagnostic/treatment utilization rates. Time to event analyses performed using Kaplan-Meier plots and Cox proportional hazard model. RESULTS: Care received after implementation of Guidelines resulted in decreased lost time. Treatment rates were consistent, while diagnostic imaging use was inconsistent with Guidelines recommendations. CONCLUSIONS: Guidelines use positively influenced return-to-work after acute occupational low back injuries. Inconsistencies in following Guidelines were observed for diagnostic tests, having a potential paradoxical effect on lost time. Further studies are necessary to test for additional hypotheses.

Use of Physical Therapists to Identify and Treat Musculoskeletal Injuries at "The Tip of the Trident".

Musculoskeletal injuries continue to be the most common cause of decreased readiness and loss of productivity in all military environments. In commands with smaller footprints, such as Naval Special Warfare (NSW), every asset is critical for mission success. Studies have shown that early intervention by a medical provider can enhance healing and maintain unit readiness by preventing medical evacuations. Reports are limited with regard to Special Forces commands, especially during deployment. This article describes the injury characteristics and treatment of injuries seen by a physical therapist while deployed at forward operation commands embedded with NSW Group 2 Team 4. Over 4 months, 282 patients were evaluated and treated in southeast Afghanistan. In descending order, the three most common injured body regions were the lumbar/sacral spine (n = 82), shoulder (n = 59), and knee (n = 28). Therapy exercises (n = 461) were the most frequently performed treatment modality, followed by mobilization/manipulation (n = 394) and dry needling (n = 176). No patient evaluated was medically evacuated from the area or sent to an advanced medical site. Our data are similar to other published data reported on deployed units in terms of mechanisms and locations of injuries; thus, Special Forces commands do not appear to have unique injury patterns. These results support continued use of physical therapists in forward operations because of their ability to evaluate injuries and provide treatment modalities that help maintain the integrity of small commands at the site of injury.

Spine Conditions: Mechanical and Inflammatory Low Back Pain.

Mechanical low back pain (LBP) is an injury or derangement of an anatomic structure in the low back. When evaluating patients with LBP, clinicians should maintain clinical suspicion for vertebral fracture, cancer, and cauda equina syndrome. Management includes patient education focused on exercise, massage, and behavioral approaches such as cognitive behavioral therapy. Acupuncture can be an effective alternative and specific herbal supplements may provide short-term pain relief. The prognosis for patients with mechanical LBP is good. Inflammatory LBP is pain resulting from a systemic inflammatory condition, often referred to as axial spondyloarthritis. Ankylosing spondylitis is chronic inflammatory LBP characterized by early onset (mean age 24 years), with a higher prevalence in men. Five clinical parameters can help identify inflammatory LBP: improvement with exercise, pain at night, insidious onset, onset at younger than 40 years, and no improvement with rest. Management of inflammatory LBP typically includes nonsteroidal anti-inflammatory drugs and structured exercise programs, with emphasis on the involvement of a rheumatology subspecialist. Spondyloarthritis is associated with other rheumatic or autoimmune conditions, including rheumatoid arthritis, inflammatory bowel disease, and psoriasis. These should be considered when evaluating patients with inflammatory LBP.

Common Ice Hockey Injuries and Treatment: A Current Concepts Review.

Injuries are common in ice hockey, a contact sport where players skate at high speeds on a sheet of ice and shoot a vulcanized rubber puck in excess of one hundred miles per hour. This article reviews the diagnoses and treatment of concussions, injuries to the cervical spine, and lower and upper extremities as they pertain to hockey players. Soft tissue injury of the shoulder, acromioclavicular joint separation, glenohumeral joint dislocation, clavicle fractures, metacarpal fractures, and olecranon bursitis are discussed in the upper-extremity section of the article. Lower-extremity injuries reviewed in this article include adductor strain, athletic pubalgia, femoroacetabular impingement, sports hernia, medial collateral and anterior cruciate ligament tears, skate bite, and ankle sprains. This review is intended to aid the sports medicine physician in providing optimal sports-specific care to allow their athlete to return to their preinjury level of performance.

Rehabilitation effect of exercise with soft tissue manipulation in patients with lumbar muscle strain.

OBJECTIVE: To study the rehabilitation effect of exercise with soft tissue manipulation therapy for patients with lumbar muscle strain. METHODS: Patients with lumbar muscle strain who met the inclusion criteria for study were randomly divided into control and experimental groups. Conventional therapy (i.e., triple therapy of needle, moxibustion, and cupping jar) was implemented for control group patients with lumbar muscle strain, whereas the combination therapy of exercise with manipulation was implemented for experimental group patients with lumbar muscle strain. Pain levels of the two groups of patients were graded using the VAS score, and finally, the rehabilitation effect of the two groups of patients was evaluated. Comparative analysis was performed using SPSS17.0 software, t-test, variance and χ2 test, and other statistical methods. RESULTS: After treatment, there is a significant difference in average visual analogue scale (VAS) score between experimental group and control group, which meets P < 0.05; difference in joint range of motion between experimental group patients and control group patients was P < 0.05; the total treatment efficiency of experimental group patients was 99%, whereas that of control group was 79%. CONCLUSION: Rehabilitation effect of exercise with soft tissue manipulation therapy for lumbar muscle strain is more significant.

Gender differences in load carriage injuries of Australian army soldiers.

BACKGROUND: With the removal of gender restrictions and the changing nature of warfare potentially increasing female soldier exposure to heavy military load carriage, the aim of this research was to determine relative risks and patterns of load carriage related injuries in female compared to male soldiers. METHODS: The Australian Defence Force Occupational Health, Safety and Compensation Analysis and Reporting workplace injury database was searched to identify all reported load carriage injuries. Using key search terms, the narrative description fields were used as the search medium to identify records of interest. Population estimates of the female: male incident rate ratio (IRR) were calculated with ninety-five percent confidence interval (95% CI) around the population estimate of each IRR determined. RESULTS: Female soldiers sustained 10% (n = 40) of the 401 reported injuries, with a female to male IRR of 1.02 (95% CI 0.74 to 1.41). The most common site of injury for both genders was the back (F: n = 11, 27%; M: n = 80, 22%), followed by the foot in female soldiers (n = 8, 20%) and the ankle (n = 60, 17%) in male soldiers. Fifteen percent (n = 6) of injuries in female soldiers and 6% (n = 23) of injuries in males were classified as Serious Personal Injuries (SPI) with the lower back the leading site for both genders (F: n = 3, 43%: M: n = 8, 29%). The injury risk ratio of SPI for female compared to male soldiers was 2.40 (95% CI 0.98 to 5.88). CONCLUSIONS: While both genders similarly have the lower back as the leading site of injury while carrying load, female soldiers have more injuries to the foot as the second leading site of injury, as opposed to ankle injuries in males. The typically smaller statures of female soldiers may have predisposed them to their observed higher risk of suffering SPI while carrying loads.

Morel-Lavallee seroma (post-traumatic pseudocyst) of back: a rarity with management conundrum.

Morel-Lavallee seroma (MLS) or post-traumatic pseudocyst is a soft tissue seroma developing due to closed degloving injury by a shearing force that causes separation of subcutaneous fatty layer from the deeper muscular fascia resulting in collection of fluid in the created space. Presentation is usually fluctuant swelling following history of injury. More frequently described in orthopaedic literature, it occurs more commonly over gluteal and trochanteric regions, knee and flanks with occurrence over back, thorax being a rare entity. Despite mimicking several other similar presenting conditions, diagnosis of MLS can be made by meticulous history and physical examination with classical findings on ultrasonography, CT scan and MRI. Treatment modality may vary from conservative management to open surgical debridement of the wound with percutaneous aspiration and sclerodhesis forming useful adjuncts to conservative management.

Rigid removable cover for dorsal wound protection and tube fixation in pigs.

OBJECTIVE: To report the design and benefits of a rigid polyethylene cover 'shell' for the protection of dorsal torso wounds and tube fixation in pigs. METHODS: Open C-shaped polyethylene shells were designed to protect wounds and dressings on the dorsum of pigs used in research into negative pressure dressing-assisted wound healing. The shells were designed to resist trauma and contamination, to be comfortable and expansible, and to facilitate tube fixation and management. Strap fixation was optimised during experimentation. Efficacy was assessed by direct observation of dressing and wound protection, tube integrity and by macroscopic and microscopic assessments of wound healing. RESULTS: The shells effectively protected the wounds against blunt and sharp trauma, were simple to remove and reapply, were well tolerated and allowed for growth of the pigs. Circumferential neck straps attached by lateral straps to the shells proved critical. There was no wound infection or inflammation underlying the shells. Porting tubing via mid-dorsal holes in the shells and affixing the tubing just cranial to these holes prevented tube damage and traction, permitted tube management from outside the cages and allowed the pigs to move freely without becoming entangled. CONCLUSION: These shells effectively protected dorsal skin wounds and dressings, prevented tube damage and facilitated tube management in pigs. Similar systems may be useful for other production animals for wound management and for tube management with negative pressure wound healing, drain tubes or the delivery of nutrition, fluids or medications.

Evaluating Clinical Practice Guidelines Based on Their Association with Return to Work in Administrative Claims Data.

OBJECTIVE: To examine the association between non-adherence to clinical practice guidelines (CPGs) and time to return to work (RTW) for patients with workplace injuries. DATA SOURCES/STUDY SETTING: Secondary analysis of medical billing and disability data for 148,199 for shoulder and back injuries from a workers' compensation insurer. STUDY DESIGN: Cox proportional hazard regression is used to estimate the association between time to RTW and receipt of guideline-discordant care. We test the robustness of our findings to an omitted confounding variable. DATA COLLECTION: Collected by the insurer from the time an injury was reported, through recovery or last follow-up. PRINCIPAL FINDINGS: Receiving guideline-discordant care was associated with slower RTW for only some guidelines. Early receipt of care, and getting less than the recommended amount of care, were correlated with faster RTW. Excessive physical therapy, bracing, and injections were associated with slower RTW. CONCLUSIONS: There is not a consistent relationship between performance on CPGs and RTW. The association between performance on CPG and RTW is difficult to measure in observational data, because analysts cannot control for omitted variables that affect a patient's treatment and outcomes. CPGs supported by observational studies or randomized trials may have a more certain relationship to health outcomes.

Lag Times in Reporting Injuries, Receiving Medical Care, and Missing Work: Associations With the Length of Work Disability in Occupational Back Injuries.

OBJECTIVE: The aim of this study is to examine the associations between lag times following occupational low back injury and the length of work disability. METHODS: In a retrospective cohort study using workers' compensation claims, random effects Tobit models were used to explore how disability length relates to three lag times: the number of days from the date of injury to reporting the injury, the number of days from the date of injury to medical care, and the number of days from the date of injury to initiating work disability. RESULTS: In general, shorter lag times for each of the different lags were related to shorter lengths of disability. CONCLUSIONS: Decreasing the length of the lag times in reporting injuries, receiving medical care, and missing work may help to decrease the length of work disability for workers after low back injury.

Isolated rupture of teres major in a goalkeeper.

A complete rupture of the teres major is an extremely rare injury and rarely described in the literature. We report the first case of an isolated rupture of the teres major in a professional football goalkeeper. The diagnosis requires a high degree of suspicion and complementation by image examinations. Conservative treatment has a high success rate with early return to sport.

Lower thoracic syndrome - a differential screen for back pain following vertical compression injury: a case report.

A 36-year-old male experienced left sided back and radiating flank pain, following a fall on his buttock. A detailed medical evaluation ruled out the presence of red flags. Initial examination revealed positive findings of comparable local tenderness over the left T11, T12 and left paraspinal area, and a 2 cm shortening of the left leg. 8 treatment visits for a period of 4 weeks addressed mechanical dysfunction at the T11, T12, lumbar and pelvic region, comprising manual therapy, therapeutic exercise and pain relieving modalities. Reduction of local tenderness, back and radiating flank pain was observed. Additionally, resolution of the persistent apparent shortening of his left leg was observed, following a high velocity thrust (HVT) manipulation of the T11, T12 segments. The vertebral motion segment of T11, T12, the thoracoabdominal nerves, the 12th rib, the quadratus lumborum and the serratus posterior inferior are speculated to be potential symptom mediators. The findings in the case report suggest the lower thoracic region to be included during the evaluation process of back pain, especially when the mechanism of injury is a vertical compression.

Geographic variability of adherence to occupational injury treatment guidelines.

OBJECTIVES: To determine the geographic variability and relationship between six occupational injury practice guidelines. METHODS: Guidelines were developed by an expert panel and evaluated using workers' compensation claims data from a large, national insurance company (1999 to 2010). Percentage compliance for each guideline was adjusted for age and sex using linear regression and mapped by hospital referral region. Regions with the lowest compliance were identified, and correlations between guidelines were calculated. RESULTS: Compliance to the unnecessary home care guideline showed the lowest geographic variation (interquartile range: 97.3 to 99.0), and inappropriate shoulder bracing showed the highest variation (interquartile range: 77.7 to 90.8). Correlation between the guidelines was weak and not always positive. CONCLUSIONS: Different guidelines showed different degrees of geographic variation. Lack of correlation between guidelines suggests that these indicators were not associated with a single underlying health care quality or patient severity construct.