Radial Tunnel Syndrome: Assessment and Management

Lateral elbow pain is a common complaint in many sports physiotherapy and physical therapy practices around the world. It is likely that this will surprise no-one. Lateral epicondylalgia, the most common cause of lateral elbow pain, has an annual prevalence of 1% to 2% in the general public (Shiri et al., 2006). Such a complaint is even more common in many groups of athletes (Hume et al., 2006; Mackay et al., 2003). However, this is not an article about tennis elbow. It is about radial tunnel syndrome, a condition which has been suggested to be the main aetiopathogenetic (what a word) element in 4% of lateral epicondylalgia cases (Jalovaara & Lindholm, 1989). Interestingly, it causes headaches for the therapist in 100% of cases. This is because whilst radial tunnel syndrome is rare, it is challenging to differentially diagnose and can be a monster to manage. If you have a recalcitrant case of tennis elbow then this post will interest you! This article discusses the best available evidence for assessment and management of this condition.

For detailed article, visit-
http://www.thesportsphysiotherapist.com/radial-tunnel-syndrome-evidence-based-assessment-management/ 

Snapping Scapula Syndrome (Scapulothoracic Bursitis): Assessment and Management

Whilst this condition is more common than we may think, it seems to be underappreciated within the world of physiotherapy. This is a disorder that ranges from inconvenience for some to truly disabling to others (Manske et al., 2004). Of even greater interest is that it is related to many sports including swimming, baseball pitching and weight-training. Thus, this article will discuss snapping scapula syndrome including what it is, why it occurs and what you need to do to fix it!

For the details on the topic, visit-
http://www.thesportsphysiotherapist.com/snapping-scapula-syndrome-scapulothoracic-bursitis-assessment-and-management/ 

University of Calgary scientist finds physiotherapy can speed up concussion recovery

Before Jon Cornish’s head hit the ground and the Calgary Stampeders running back was left motionless on the McMahon Stadium turf, there was a terrifying moment when his neck snapped back.

The concussion that followed has kept the Stamps star sidelined ever since.

While common medical practice suggests the best way for athletes to recover from similar injuries is rest and a gradual build-up of physical exertion, a new study from the University of Calgary suggests hands-on physiotherapy could speed up the road to recovery.

The study was conducted by Kathryn Schneider, a researcher and physiotherapist at U of C’s Faculty of Kinesiology and Sport Injury Prevention Research Center.

Its findings could change the way concussions are treated, as they suggest that people suffering from prolonged post-concussion symptoms could have their recovery times decreased through a combined physiotherapy treatment of the vestibular (balance) system, the cervical spine and vertebrae in the neck.
“We specifically targeted the individuals who had dizziness, neck pain and/or headaches following concussions,” said Schneider, whose study was published in the British Journal of Sport Medicine.
“The general consensus is an initial period of rest is of benefit, and the majority of people do recover in that initial seven-to-10 day period, so it would be following that initial time period where if individuals still had symptoms that persisted this would be a treatment that would be of benefit.”

The study focused on 31 patients who were still suffering from symptoms after the initial seven-to-10 day recovery period. They were divided into two groups: One that went through a standard vestibular rehabilitation, and another that combined the vestibular rehabilitation with cervical spine physiotherapy.
The findings were striking.
The group that went through the combined treatment saw 73% of participants medically cleared within eight weeks, compared with just 7% of the standard group.
“I started to see a lot of athletes in the clinic and could see some positive results within a clinical environment but there’s no research currently evaluating the response to forms of physiotherapy treatment following concussions,” Schneider said. “We weren’t sure of the magnitude of the effect we might see.
“We did see a large difference between the groups — it was greater than what we had initially hypothesized it might be.”

Despite the clear difference between the two groups, there’s still lots of research that’s needed. After all, 31 people is a small sample size, and Schneider says future studies will need to examine how variables like age and gender might have on outcomes, as well as the ideal timing and dosage.

Concussions are also highly individual-specific, so no one at the U of C is suggesting they’ve stumbled on a one-size-fits-all treatment.

One major variable that can affect recovery time is whether a patient’s had a history of concussions, as symptoms often get worse and recoveries take longer when a patient’s been concussed before.
The U of C research, however, seemed to work just as well on those with a concussion history as those who were suffering through the injury for the first time.
“We don’t have the numbers to really understand the effects that a previous concussion has on the effects of this study, but in the treatment group everybody that recorded a previous history of concussion was medically cleared to return to sport,” Schneider said.



via- http://www.calgarysun.com/2014/07/30/university-of-calgary-scientist-finds-physiotherapy-can-speed-up-concussion-recovery

Rehab for age-related loss of vision cuts depression risk in half

There is an associated risk of depression in people who experience loss of vision due to conditions such as age-related macular degeneration. New research suggests that a particular type of rehabilitation therapy called behavior activation could now reduce this risk by 50% .

A previous study published in JAMA Opthalmol. has reported that there is a significant association between vision loss and depression, but now new research has found that a form of rehabilitation therapy can reduce this risk in people with AMD by half.

The new study tested an approach called "behavior activation." According to study co-author Robin Casten, PhD, associate professor of psychiatry and human behavior at Thomas Jefferson University, Philadelphia, behavior activation is a method that involves helping people to recognize that the loss of enjoyed activities could lead to depression, and then helping them re-engage with those activities.


For more info, kindly visit : http://www.medicalnewstoday.com/articles/279366.php

Rehabilitation After Hallux Valgus Surgery: Importance of Physical Therapy to Restore Weight Bearing

Postoperative physical therapy and gait training lead to improved function and weight bearing of the first ray after hallux valgus surgery.

Here is the full access to the study-

http://ptjournal.apta.org/content/89/9/934.short

Study suggests new rehab. methods for amputees, stroke patients

New research into how a patient compensates after losing a dominant hand might lead to new rehabilitation techniques for those recovering from stroke or amputation.

When use of a dominant hand is lost by amputation or stroke, a patient is forced to compensate by using the nondominant hand exclusively for precision tasks like writing or drawing. Presently, the behavioral and neurological effects of chronic, forced use of the nondominant hand largely are understudied and unknown.

A new study, conducted by investigators at the University of Missouri in Columbia, looked closely at changes in behaviors and brain function in amputees who lost their dominant hands.

Half of the work in our lab focuses on amputees, particularly upper limb amputees, who are out of the acute phase of their recoveries; the other half involves those who have suffered the loss of function due to stroke or neurological disorders,” Scott Frey, PhD, professor of psychological sciences and director of the university’s Brain Imaging Center, said in a news release. “Our project analyzed the consequences of losing your dominant hand and how behaviors change for amputees. We also used functional magnetic resonance imaging to study brain function in people adapting to those situations.”

In the study, eight adult amputees who had been coping with the absence of their dominant right hands for an average 33 years performed simple drawing tests with their nondominant hands. A control group of right-handed adults also completed the same tests. The drawing tests were checked for speed and accuracy.

Frey and Benjamin Philip, PhD, a postdoctoral research fellow in the Department of Psychological Sciences, found individuals who were forced to compensate with their nondominant left hands performed precision tasks as well as the control group did with their dominant right hands.

The same tests were then repeated while brain function was observed using fMRI. Researchers found the brain areas formerly devoted to motor and sensory functions of the amputated hand actually contributed to compensation for the loss on the nondominant side.

“Most people know that the left side of your brain controls the right hand and vice versa,” Frey said in the release. “We found that when amputees were forced to use their nondominant hands for years or decades, they exhibited performance-related increases in both the right and left hemispheres.”

In other words, their ability to compensate with the left hand appears to involve exploiting brain mechanisms that previously were devoted to controlling their now absent dominant hands,” Frey said in the release. “This compensatory reorganization raises the hope that, through targeted training, nondominant hand functions can be vastly improved, enabling a better quality of life for those who have lost dominant hand functions due to bodily or brain injury or disease.”

Although more research is needed, the study’s findings might help develop rehab interventions for stroke patients who do not regain precision control of the dominant hand during acute and subacute phases of recovery. For some patients in the first seven to 18 months after a stroke, it may make sense to train the less affected nondominant side, researchers said.

Abstract:- http://www.jneurosci.org/content/34/10/3622

Ref.- TodayinPT

Overuse Injuries and Burnout in Youth Sports

There are many children and young athletes are affected by overuse injuries. Adolescent girls are most prone to such injuries. Early specialization in sports may put young athletes at risk for overuse injuries, and doesn't necessarily lead to long term success in their sport.

Parents, coaches, teachers, trainers, and doctors can work together to encourage young athletes to listen to their bodies and to rest and cross-train, that can decrease the phenomenon of overuse injuries and burnout in youth sports.

Overuse injuries - causes

Organized youth sports: Left to themselves, children engaged spontaneous and unstructured sport and recreational activity are generally free of overuse injury. It is when adults step into the picture that "injury free" status seems to change.

Elite-level travel teams: Increased emphasis on competitive success, often driven by goals of elite-level travel team selection, collegiate scholarships, Olympic and National team membership, and even professional contracts, has become widespread, resulting in increased pressure to begin high-intensity training at young ages. Excessive focus on early intensive training and competition at young ages rather than skill development can lead to overuse injury and burnout.

Overuse injuries - risk factors

Risk factors for overuse injuries are often grouped into two categories: intrinsic (e.g. individual biological characteristics and psychosocial traits) and extrinsic (e.g. external forces related to the sport type, the biomechanics of the activity, and the sporting environment), some of which are capable of being modified (e.g. strength, neuromuscular function) and others are not (age, gender).

IntrinsicPrior injury: is the strongest predictor of future overuse injury. Repeated overuse injury may occur as a result of inadequate rehabilitation of the injury and/or a failure to recognize the factors that contributed to the original injury.

Adolescent growth spurt: Overuse injuries may be more common during the adoloscent growth spurt.

Menstrual irregularity: a history of amenorrhea (irregular periods), especially in sports that emphasize leanness (e.g. gymnastics, figure skating, dance) is a significant risk factor for bone stress injury, although there is little data on younger adolescents.

Extrinsic

Workload:
Higher training volumes have consistently been shown to increase the risk of overuse injury in multiple sports.A study of high school athletes found a linear relationship between hours of sports participation and risk of injury, with training more than 16 hours per week associated with a significant increased risk of injury requiring medical care.

Volume (amount of activity in single session) and intensity (number of sessions per week/month/year) is correlated with overuse injury risk): i.e.- Number of pitches per game in youth baseball, More than 100 innings per year, Wrist pain in young gymnasts related to training intensity, as measured by skill level and number of hours training per week.

Year-round play. 42% increase in self-reported overuse injuries in high school athletes who participated all year versus 3 or less seasons per year. (Cuff, 2010).

More organized sports/less free play. There is emerging evidence to suggest that athletes who spend most of their time in organized sports and little time in free play or recreation are more likely to be injured. One study (Jayanthi, 2012), for instance, found that the athletes who suffered sport-related injuries spent an average of 12.6 hours per week in tennis and only 2.4 hours per week in free play or recreation, while the uninjured players spent only 9.7 hours per week in organized tennis and 4.3 hours in unstructured free play.

BurnOut- risk factors

Environmental-
Extremely high training volumes

Extremely high time demands

Demanding performance expectations (imposed by self or significant others)

Frequent intense competition

Inconsistent coaching practices

Personal characteristics-
Perfectionism

Need to pleases others

Nonassertiveness

Unidimensional self-conceptualization (focusing only on one's athletic involvement)

Low self-esteem

High perception of stress (high anxiety)

Early specialization-
Several studies have suggested that athletes who had early specialized training withdrew from their sport either due to injury or burnout.

A study of swimmers found that those who specialized early spent less time on the national team and retired earlier than those who specialized later.

Early specialization also seems to be correlated with reports of decreased general health and psychological well-being.

What We Don't Know

Incidence and prevalence: Research on overuse injuries in children and adolescents is sparse. Becauses aged-based data is lacking, recommendations for participation and training is often based on extrapolations derived from limited high school and college data, extrapolation which, says one expert (Roberts WO, 2014), is hazard."

Reasons kids drop out of sports: The issue is complicated issue, with a lack of reliable data hampering informed public opinion and sports polcies. "Ironically," says one Roberts, the source of the oft-quoted statistic that '80% of youth athletes drop out by age 13' is impossible to find."

Effect of tournaments and showcases: Despite the absence of data to link these activities with overuse injuries, longer rest periods between matches and games have been proposed in an effort to improve athlete safety and performance, enhance recovery, and minimize the "carryover" effects from previous competitions. In terms of overuse injuries, scheduling may simply be a marker for a high ratio of workload-to-recovery time.

The relationship between sports specialization and injuries: While there are both theoretical and measurable risks associated with intense, specialized training, the relationship has not been clearly demonstrated. A large study of competitive junior tennis players found that those who competed only in tennis were 1.5 times more likely to have reported an injury, but did not account for training intensity (e.g. weekly training hours). Early data from a clinical study comparing young athletes with sports-related injuries to healthy, uninjured athletes presenting for sports physicals suggests that more specialized athletes were more likely to be injured, but further research, both studies controlling for training intensity and year-round training and evaluating multi-sport athletes over time (e.g. longitudinally) compared to specialized athletes and stages of development to determine the effects of sports diversification with specialization, are needed.

The path forward

National research agenda needs to be developed to more carefully examine all aspects of youth sport programs;

Holistic approach needed which considers how youth sports either contributes to or detracts from the overall health of the child, physical/physiological, psychological, cognitive/academic, social and spiritual;

Future research needs to focus on age groups (6-10, 11-15, 16-18, 19-25 years); even better, group children by developmental stage (prepubuscent, pubescent, postpubuscent, and late-stage maturation), with different age groupings to account for earlier maturation of girls compared to boys.

Concerted effort from sports community to develop a funding stream to support research is needed.

Sources:

Cuff S, Loud K, O'Riordan MA. Overuse injuries in high school athletes. Clin Pediatr. 2010;49:731-736.

DiFiori JP, Benjamin HJ, Brenner J, Gregory A, Jayanthi N, Landry GL, Luke A. Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine. Clin J Sports Med. 2014;24(1):3-20.

DiFiori JP, Puffer JC, Mandelbaum BR, et al. Factors associated with wrist pain in the young gymnast. Am J Sports Med. 1996;24:9-14.

Dun S, Loftice J, Fleisig GS, et al. A biomechanical comparison of youth baseball pitches: is the curveball potentially harmful? Am J Sports Med. 2008;36:686-692.

Fleisig GS, Andrews JR, Cutter GR, et al. Risk of serious injury for young baseball pitchers: a 10-year prospective study. Am J Sports Med. 2011;39:253-257.

Jayanthi N. Injury risks of sport specialization and training in junior tennis players: a clinical study. Paper presented to the Society for Tennis and Medicine Science North American Regional Conference, Atlanta GA. December 2012.

Parks ED, Ray TR. Prevention of overuse injuries in young baseball pitchers. Sports Health. 2009;1:514-517.

Roberts WO. Overuse Injuries and Burnout in Youth Sports. Clin J Sports Med. 2014;24(1):1-2.

With ref. from Momsteam

Physiotherapy- Even Helped the SUPERMAN !!!

We all grew up knowing him as SUPER MAN..THE SAVIOR...The RESCUER...the ROLE MODEL of every child...Christopher Reeve achieved fame for his portrayal of Superman - the man that was invincible and a national hero for many - as well as starring in many other hit films.

After being thrown from a horse in 1995, however, the actor shattered the first two vertebrae in his spine and was paralyzed from the neck down. Upon first finding out he was a quadriplegic; Reeve stated he was very depressed and contemplated suicide.

However, his time in physical and occupational rehabilitation inspired him, and he spent the rest of his life campaigning on behalf of progressive research and was even named TIME Person of the Year. Although he has since passed away from medical complications in 2004, the Christopher Reeve Paralysis Foundation still carries on his legacy of advocacy and research. The Christopher & Dana Reeve Foundation is dedicated to curing spinal cord injury by funding innovative research, and improving the quality of life for people.

Prosthetics Helping a Dog in Rehabilitation

A 9-month-old boxer pup named Duncan barrelled down a beach in Oregon, running full tilt on soft sand into YouTube history and showing more than 4 million viewers that he can revel in a good romp despite lacking back legs.

"It’s a heartwarming, wonderful thing to see,” said Dr. Bonnie Beaver, a professor at Texas A&M University’s College of Veterinary Medicine and executive director of the American College of Veterinary Behaviorists. More veterinarians are using wheelchairs, orthotics and prosthetics to improve the lives of dogs that have lost limbs to deformity, infection or accident, experts say. There have been great strides in technology to keep up with U.S. soldiers returning wounded from war, and veterinarians have adapted the materials and know-how for the rising demand from clients.

“There are so many things we can do to solve mechanical problems. ... If you have broken parts, we can replace them,” said Martin Kaufmann, co-owner of Veterinary Orthotics and Prosthetics in Denver, also known as OrthoPets, which helps about 2,000 animals a year. Most devices range from $150 to $2,000 but can cost more, Kaufmann said. Duncan’s owners, Amanda Giese and Gary Walters, are co-founders of Panda Paws Rescue for special needs and hospice dogs in Vancouver, Washington. Of the 3,500 dogs they have placed in the last 19 months, 10 were two-legged. Nine of them adapted to wheelchairs and found homes.Only 19-pound (8.6-kilogram) Duncan, whose deformed back legs were amputated, refused to take to wheels.But they have seen successes even in challenging cases, Kaufmann said. Orthopets helped mixed-breed puppy Naki’o after his four legs and tail were frozen in ice. What frostbite didn’t do, a surgeon did, amputating all four legs. Then, Kaufmann outfitted him with four prosthetics. "To see Naki’o at the beginning, he was protective and guarded,” he said. “Six months after all this was done, he was just a fun-loving guy who likes to socialize.” Another dog, a Labrador-golden retriever mix named Pirelli had a back paw that never developed. Pirelli uses a prosthetic limb, and with it is a “happy, expressive dog, able to run and play, retrieve things and eat his food,” said Dudley Arnold, Pirelli’s handler.

With ref. from- The Hindu.

Significant new guidance on physical therapists' responsibilities in emergency zones

What are the responsibilities of physical therapists involved in emergency zones? New plain-language guidance from the International Committee of the Red Cross sets out the rights and responsibilities of health personnel in conflict and other situations of danger. It has been welcomed by physical therapists who specialise in this area.

The document deals with some of the issues that arise when providing health care to people who are wounded or sick as a result of having been involved in armed conflicts or other emergencies. It covers the protection of health personnel, the sick and the wounded, standards of practice, the health needs of particularly vulnerable people, health records, imported health care (including military health care), data gathering and health personnel as witnesses to violations of international law, working with the media etc.

According to Pete Skelton, a British physiotherapist who has worked in emergency situations in Haiti, the Middle East and Africa, this is a significant update for physical therapists, because it is framed in the context of humanitarian law and human rights law, taking into consideration the UN Convention on the Rights of Persons with Disabilities.

“There is a move away from ‘medical ethics’ towards ‘health care ethics’ with specific references to physiotherapists and rehabilitation,” he says.

Of particular relevance to physical therapists is a section on health care for people with particular vulnerabilities, which outlines the need to address access to health care and rehabilitation for people with disabilities, he says. The report also addresses issues around importing health care, which have relevance for physical therapists when considering the provision of locally appropriate wheelchairs or prosthetics.

“It also addresses an issue which frequently proves challenging for physiotherapists during emergencies – the responsibility of all health professionals to keep accurate records,” says Pete Skelton. “Time and again rehabilitation in conflict and emergencies can be hindered either by a lack of appropriate medical records or by physiotherapists themselves failing to document interventions appropriately due to time constraints. Emphasising our responsibility to maintain appropriate records, even in an emergency, is invaluable.”

Barbara Rau, who is responsible for Physiotherapy within the physical rehabilitation department of the International Committee of the Red Cross (ICRC), said physical therapists should use such guidelines, and those published by organisations such as WCPT, the World Health Organization and Medecins sans Frontieres (MSF), and periodically review their performance to guarantee optimal quality of care.

“Physical therapists and other health care professionals have important responsibilities in emergency situations while giving special attention to women, children, elderly people and people with disabilities – indeed, they are experts for these specific populations,” she said.

“They are delivering services within a team of health professionals whose structure and organisation might be more challenging than the usual hospital or rehabilitation-based interdisciplinary team.”

“In providing effective and impartial health care, physical therapists have rights (based on humanitarian rights law) and responsibilities, the first one being to look after oneself. Other responsibilities are that they offer, given constraints and if security is provided, an appropriate standard of care – meaning that they use adequate material and technology, and apply professional knowledge and expertise within a relationship of trust.”

WCPT provides a range of resources and guidance for physical therapists working in disaster zones or emergency situations.

“Physical therapists working or interested in working in disaster zones should be aware of WCPT policy statements that apply to practice in emergency response situations, such as those on disaster management, ethical responsibilities, patients’/clients’ rights and the consequences of armed violence, landmines and other weapons of war,” said Catherine Sykes, WCPT’s Professional Policy Consultant.

With ref. from- WCPT.