Intrinsic Foot Muscle Exercises With and Without Electric Stimulation.

CONTEXT: Exercising intrinsic foot muscles (IFMs) can improve dynamic balance and foot posture. The exercises are not intuitive and electrotherapy (neuromuscular electrical stimulation [NMES]) has been suggested to help individuals execute the exercises. The aim of this study was to evaluate the effects of training IFM program on dynamic balance and foot posture and compare traditional training methods (TRAIN) with traditional training plus NMES on the perceived workload of the exercises, balance, and foot posture. DESIGN: Randomized controlled trial. METHODS: Thirty-nine participants were randomized to control, TRAIN, or NMES. TRAIN and NMES performed IFM exercises daily for 4 weeks; NMES received electrotherapy during the first 2 weeks of training. The Y-Balance test and arch height index were measured in all participants at baseline. The training groups were measured again at 2 weeks; all participants were measured at 4 weeks and 8 weeks, after 4 weeks of no training. Perceived workload (National Aeronautics and Space Administration Task Load Index) of exercises was assessed throughout the first 2 weeks and at 4 weeks. RESULTS: A 4-week IFM training program demonstrated increases in Y-Balance (P = .01) for TRAIN and in arch height index (seated P = .03; standing P = .02) for NMES, relative to baseline. NMES demonstrated improvement in Y-Balance (P = .02) and arch height index standing (P = .01) at 2 weeks. There were no significant differences between the training groups. Groups were similar in the number responding to exercises in excess of minimal detectable change on all clinical measures. Perceived workload of the exercises decreased during the first 2 weeks of training (P = .02), and more notably at 4 weeks (P < .001). The groups did not differ in how they perceived the workload. CONCLUSIONS: A 4-week IFM training program improved dynamic balance and foot posture. Adding NMES in early phases of training provided early improvement in dynamic balance and foot posture, but did not affect perceived workload.

Effects of Short-Term Docosahexaenoic Acid Supplementation on Markers of Inflammation after Eccentric Strength Exercise in Women.

The omega-3 fatty acid docosahexaenoic acid (DHA) has anti-inflammatory and anti-nociceptive (pain inhibiting) effects. Because strenuous exercise often results in local inflammation and pain, we hypothesized that DHA supplementation attenuates the rise in markers of local muscle inflammation and delayed onset muscle soreness (DOMS) that occur after eccentric strength exercise. Twenty-seven, healthy women (33 ± 2 y, BMI 23.1±1.0 kg·m(-2)) were randomized to receive 9d of 3000 mg/d DHA or placebo in a double-blind fashion. On day 7 of the supplementation period, the participants performed 4 sets of maximal-effort eccentric biceps curl exercise. Before and 48h after the eccentric exercise, markers of inflammation were measured including measures of muscle soreness (10-point visual analog pain scale, VAS), swelling (arm circumference), muscle stiffness (active and passive elbow extension), skin temperature, and salivary C-reactive protein (CRP) concentrations. As expected, muscle soreness and arm circumference increased while active and passive elbow extension decreased. The increase in soreness was 23% less in the DHA group (48h increase in VAS soreness ratings: 4.380.4 vs. 5.600.5, p=0.02). Furthermore, the number of subjects who were able to achieve full active elbow extension 48h after eccentric exercise was greater in the DHA group (71% vs. 15%, p = 0.006), indicating significantly less muscle stiffness. No between-group differences were observed for passive elbow extension (p = 0.78) or arm swelling (p = 0.75). Skin temperature and salivary CRP concentrations did not change from baseline to 48h after exercise in either group. These findings indicate that short-term DHA supplementation reduces exercise-induced muscle soreness and stiffness. Therefore, in addition to other health benefits that n-3 fatty acids have been associated with, DHA supplementation could be beneficial for improving tolerance to new and/or strenuous exercise programs and thereby might facilitate better training adaptations and exercise adherence. Key pointsSeven days of 3000 mg/day supplementation with algae-derived docosahexaenoic acid (DHA) attenuates the delayed onset muscle soreness and stiffness, and protects against the loss of joint range of motion that is caused by strenuous eccentric exercise.This benefit was observed in women, and supports the findings from other studies that were conducted on men or a combination of men and womenThe benefits from algae-derived DHA appear to be similar to those reported in other studies that used a combination of DHA and eicosapentaenoic acid (EPA) derived from fish oilThe findings of better recovery from strenuous exercise with DHA supplementation, paired with other research which demonstrated that DHA and EPA protect against chronic diseases suggest that DHA is an attractive optionThese findings have relevance to athletic populations, in that DHA would be expected to facilitate recovery and allow for better performance during training and competition. However, DHA supplementation might also benefit non-athletic populations, such as individuals starting new exercise programs and patient populations that are prone to muscle soreness (e.g. physical therapy patients).

A neuromuscular intervention for exercise-related medial leg pain.

CONTEXT: Exercise-related medial leg pain (ERMLP) is a common complaint among athletes, and efforts toward rehabilitation are often unsuccessful. OBJECTIVE: To evaluate the efficacy of a therapeutic intervention in ERMLP localized to soft tissue. DESIGN: A quasi-experimental, nonequivalent control-group study. SETTING: Athletic training facility. PATIENTS: 20 volunteer male and female athletes (18-22 y old) with ERMLP. Complete data were available for 13 participants. INTERVENTION: Treatment group (TRE, n = 7) received therapeutic intervention focused on relieving muscle hypertonicity in the deep compartment of the lower leg and restoring balance of the toe flexors and extensors. Control group (CON, n = 6) received no intervention. MAIN OUTCOME MEASURES: Self-reported pain intensity, pain threshold, and extensor hallucis longus to extensor digitorum brevis (EHL:EDB) electromyography ratio. RESULTS: There were no significant differences in age, duration of symptoms, or pain measures between the 2 groups at baseline. CON demonstrated no significant changes in any of the outcome measures in posttreatment testing, but significant between-groups differences were identified for pain during activity (CON mean = 6.5, 95% CI 5.05, 7.95; TRE mean = 3.5, 95% CI 1.67, 5.33; P = .01), change scores for pain during activity (CON mean = 0.33, 95% CI -1.25, 1.91; TRE mean = -3.43, 95% CI:-4.6, -2.25; P < .001), change scores in pressure threshold (CON mean = -0.25, 95% CI -0.74, 0.23; TRE mean = 0.72, 95% CI 0.22, 1.37; P = .006), and change in EHL:EDB ratios (CON mean = 0.05, 95% CI -0.22, 0.33; TRE mean = 1.07, 95% CI 0.75, 2.07; P < .046). CONCLUSION: Therapeutic interventions focused on restoring muscle balance appear to be effective in resolving ERMLP.

Disability law and health care education.

Health care education programs, regardless of the discipline, will face similar challenges and issues related to students with disabilities. These are likely to include issues related to admission, retention, and academic adjustments, auxiliary aids, and services. A review of the literature reveals limited information beyond medical and nursing education programs, although students with disabilities are enrolled in education programs in other health care disciplines. Recent research indicates that students with disabilities are enrolling in health care education programs with increasing frequency. Educators and administrators will benefit from a better understanding of disability law and how it impacts education programs. Further, this knowledge should allow health care educators to be more proactive in regard to students with disabilities and to maintain a greater degree of autonomy over their respective programs. This report reviews pertinent legislation and case law as it applies to students with disabilities in health care education.

Athletic training students with disabilities: a survey of entry-level education programs.

CONTEXT: The Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 created and expanded protection for people with disabilities. OBJECTIVE: To identify the proportion of students with disabilities enrolled in entry-level athletic training education programs (ATEPs), to examine the nature of the disabilities reported by these students, and to assess the number of ATEPs with policies (beyond technical standards) for admitting students with disabilities. DESIGN: I distributed a survey via e-mail and the US Postal Service. The survey instrument was adapted from a tool used in similar research on medical education programs. SETTING: Entry-level ATEPs. PATIENTS OR OTHER PARTICIPANTS: The survey was distributed to program directors at 292 Commission on Accreditation of Allied Health Education Program-accredited entry-level ATEPs. MAIN OUTCOME MEASURE(S): Using frequency analysis, I determined the rate at which students with disabilities enrolled in entry-level ATEPs and the types of disabilities represented. Disabilities represented in the study were related to learning, auditory, visual, emotional, orthopaedic, mobility, and motor skill impairments. RESULTS: Of the 283 surveys delivered, 105 (37%) were completed and returned. A total of 70% of respondents reported enrollment of students with disabilities in their ATEPs. The number of students with disabilities in entry-level ATEPs increased during the 4-year period of this study, and the proportion of students with disabilities has also increased annually (from 1.8% to 2.6%). The most common type of impairment was a learning disability, accounting for more than 80% of all disabilities reported. Fewer than 10% of the ATEPs had a specific enrollment policy for students with disabilities. CONCLUSIONS: The number of students with disabilities in entry-level ATEPs is increasing, yet this figure is well below the 9% reported for the general student population. Most institutions rely on technical standards or student disability officers to determine if a student with a disability is otherwise qualified for selection into the ATEP.

A case study on osteoporosis in a male athlete: looking beyond the usual suspects.

After presenting with chronic low back pain, a male track athlete was diagnosed with bilateral lysis at L5, slight listhesis at L5 on S1; asymmetrical lysis at L4; and right L5/S1 disc bulge with minimal S1 nerve root contact. Conservative treatment was chosen. After participating in a bone density pilot study using dual-energy X-ray absorptiometry (DEXA) investigating alcohol consumption patterns in intercollegiate athletes, he was diagnosed with osteopenia and osteoporosis in his lumbar spine. Therapeutic drug intervention and rehabilitation were initiated.Athletes with normal physiologic functions can have idiopathic osteoporosis, which may or may not be related to alcohol consumption. Although the relationship among chronic alcoholism (South-Paul, 2001), weight-bearing exercise (Kalsson, 2001), and bone density have been established, the relationship among binge drinking, intercollegiate athletic participation, and bone density has not. Despite suspected normal presentation, nonresponsive low back pain should be investigated thoroughly for advanced bone conditions.

Recurrent popliteal cyst in an adult: a case report and review.

Popliteal cysts are typically secondary to an intra-articular pathology in adults but may occur as primary lesions unrelated to knee injury. Careful examination of any mass forming on the posterior aspect of the knee is needed to differentiate benign from malignant conditions. Asymptomatic cysts are often treated conservatively, whereas surgical intervention is recommended for troublesome cysts and for those related to intra-articular derangements. Surgical intervention focused on amelioration of intra-articular derangements and the communication between the knee and the popliteal cyst results in cyst recurrence of less than 5%. A report of a recurrent popliteal cyst, in spite of aggressive surgical intervention, is presented.

Comparison of rectal and tympanic thermometry during exercise.

BACKGROUND: Heat-related deaths are among the most preventable injuries in athletics. We sought to examine two methods of monitoring body temperature during exercise as a means of preventing heat-related illnesses. METHODS: Ten adult subjects exercised in hot, humid conditions while body temperature was monitored by rectal (Tre) and tympanic (Tty) thermometry. RESULTS: Our results indicate that increase in Tty was significantly greater than increase in Tre during exercise. However, rectal temperatures continued to increase after exercise cessation and peak temperatures were not significantly different. Temperature readings of the two devices during exercise had a strong correlation. There was a poor correlation between the two methods of measurement in the recovery phase. CONCLUSIONS: Tympanic thermometry is reliable for monitoring changes in body temperature during exercise. This could be valuable for monitoring individuals during long exercise in an effort to prevent heat exhaustion or heat stoke.

Paradoxical Vocal-Cord Dysfunction: Management in Athletes.

OBJECTIVE: To describe a treatment strategy for paradoxical vocal-cord dysfunction (PVCD) as it applies to an athletic population. BACKGROUND: Paradoxical vocal-cord dysfunction has been identified as a cause of dyspnea and stridor in athletes. The basic element of PVCD is an inappropriate closure of the vocal cords during respiration, resulting in airway obstruction. This condition is familiar to speech-language pathologists and otolaryngologists yet remains poorly understood in the sports medicine community. Treatment strategies are even less understood. A therapeutic exercise program designed to promote diaphragmatic breathing may allow an athlete to gain control during episodes of dyspnea. Elimination of contributing or concomitant conditions is critical to resolution of the condition. DESCRIPTION: The treatment of PVCD requires an understanding of the pathoanatomy of the condition. The focus of the exercise program is on relaxation of the larynx and conscious activation of the diaphragm and abdominal muscles during respiration. The athlete must have a sense of laryngeal control while performing the exercises. In addition, the patient and practitioner must realize the amount of neuromuscular reeducation required to change breathing patterns. CLINICAL ADVANTAGES: This therapy may allow the athlete to gain control over episodic dyspnea, participate in athletic activities with fewer complications, and, perhaps, reduce or eliminate medications prescribed to treat suspected bronchospasm.