Arthroscopic partial meniscectomy

Arthroscopic partial meniscectomy is one of the most common orthopeadic procedures, yet rigorous evidence of its efficacy is lacking. In this heavily promoted paper, a multicentre, randomised, double-blind, sham-controlled trial in 146 patients, 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis were randomly assigned to arthroscopic partial meniscectomy or sham surgery. 

In the intention-to-treat analysis, there were no significant between-group differences in the change from baseline to 12 months in any primary outcome. There were no significant differences between groups in the number of patients who required subsequent surgery. In this trial, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure. 

Despite strong trial procedures, the study rationale and inclusion/exclusion criteria limit the results of this study, and in turn has not added to the body of knowledge greatly despite large media and professional attention.

Lower leg injuries are believed to affect balance capacity

Lower leg injuries are believed to affect balance capacity. Balance training during rehabilitation is a common approach to restore this problem. The uniaxial balance board is one of the devices used for this. It is suggested that foot orientation on the board has effect on muscle activation levels of different ankle stabilizing muscles. The aim of this study is to investigate the effect of foot orientation on the different muscle activation levels during a single-legged balance protocol. 

Sixty-nine healthy subjects were tested on 4 different foot orientation position (frontal-, sagittal-. diagonal- and subtalar axes). Muscle activity of the m tibialis anterior (TA), m peroneus longus (PL), medial (MG) and lateral (LG) m gastrocnemius was measured with surface EMG. Highest muscle activation of the TA and LG were registered with the foot along the diagonal axis, for the PL along the frontal axis and for the MG with the foot along the sagittal axis. This information can be useful in determine foot orientation adapted to the specific needs of the patient.

More postural support is needed for disabled people than is offered in a normal chair.

More postural support is needed for disabled people than is offered in a normal chair. The majority of users label the seating system the most important component, therefore it must be suitable for the individual. 

Cushions for wheelchairs are commonly filled with water, gel, foam, air or a combination of these. A new air cushion was trialed using Urethane foam and air holes, the movement of air within this cushion allows it to change to suit the subject’s body. 

Looking at the distribution of pressure across the wheelchair seat, a comparison can be drawn between no cushion, foam cushion and this new air cushion. Although the new cushion brought the subjects nearer to a symmetry index of 0 (equal distribution) and a lower pressure reading overall there was no significant difference to the foam cushion. 

This test was with non-wheelchair users and may show improvement if true patients were used.

Barefoot running is often being prescribed as a treatment mode for injuries

Barefoot running is often being prescribed as a treatment mode for injuries, strength and conditioning. This review aims to critically evaluate the theory and evidence of barefoot running. 

Conclusive evidence of the advantages or disadvantages of barefoot running has yet to be shown. Four major factors contribute tot his. 1) The complexity of injury aetiology 2) Large variability in biomechanics between individual’s 3) differences in study designs 4) analysis of data often not analysed appropriately.

The review concludes that as yet little is known on the subject of barefoot running. The current understanding of barefoot running is over simplified and poorly understood. The review recognises that barefoot running does have significant impact on the kinematics of running, however it has yet to be proven if there is any casual connection between injury and barefoot running. 

Running barefooted needs the acquisition of this specific skill it is unclear how this adaption can be made and if it can be expected that all runners can make this adaption. > From: Tam et al., Br J Sports Med 48 (2014) 349-355. All rights reserved to BMJ Publishing Group Ltd.

Subacromial Impingement Syndrome

In recent literature, exercise therapy has an important role in achieving improvements in muscle strength and flexibility and optimizing coordinative patterns of the scapular and rotator cuff musculature in patients with Subacromial Impingement Syndrome (SIS). It is generally believed that the addition of manual therapy directed at influencing structural components of the shoulder girdle and spine results in an even more effective treatment. 

The current RCT compared the effects of individually adapted exercises and individualized manual therapy (IAEX+IMPT) vs. an individualized exercise programme alone (IAEX) among 90 patients with SIS. Outcome measures included the SPADI, Patient’s Global Impression of Change, the Generic Patient-Specific Scale, the mean weekly pain score and Patients’ Satisfaction with Treatment. 

It was found that both groups improved significantly during the 12-week intervention period, but that no additional treatment effect was present in the group receiving both IAEX+IMPT, except for a small extra benefit in weekly pain at evaluation after 5 weeks. More research is needed to investigate the optimal composition of exercise programmes for SIS. > From: Kromer et al., J Rehabil Med 45 (2013) 488-497. All rights reserved to The Author(s).

Scoliosis is an abnormal lateral curvature

Scoliosis is an abnormal lateral curvature of the spine greater than 10 degrees with vertebral rotation. The most common type is adolescent idiopathic scoliosis with males and females equally affected but females 5-10 times more likely to progress to severe disease. 

Scoliosis screening can be done during routine school physical exams. The main test used for scoliosis evaluation is the Adams forward bend test, which consists of the patient standing and bending forward at the waist, and the examiner assesses for symmetry of the back from behind and beside the patient. Patients with scoliosis will have a rib hump which is visible on exam. The examiner can then use a scoliometer to determine the amount of spinal curve and rotation. For official diagnosis of scoliosis a Cobb angle measurement using radiography is needed.

The 3 major factors that determine whether scoliosis will progress are female sex, greater magnitude of curve on presentation and growth potential ie younger age. Treatment options include observation, bracing and surgery. > From: Horne et al., Am Fam Physician 89 (2014) 193-198. Copyright American Academy of Family Physicians.

Adhesive capsulitis (a “frozen shoulder”)

Adhesive capsulitis (a “frozen shoulder”) is characterized by a gradual onset of complaints, and subsequently progressive pain and limitations in ROM, particularly towards external rotation in 0 degrees of abduction. Mobility deficits can persist even after 12 to 18 months, although patients do not report any disabilities. Individuals suffering from diabetes or thyroid disease are at increased risk of developing a frozen shoulder, as are patients ranging from 40 to 65 years of age, women and those who have had earlier episodes. 

When assessing outcomes, the DASH, the ASES and the SPADI are recommended – on top of that, an individual’s limitations in activities and physical impairments should be documented. Patient education concerning the course of the disorder and possible activity modifications and exercises to minimize irritation and increase functional ROM is a cornerstone of the treatment. Intra-articular corticosteroid injections may provide short term pain relief and improved function, but always in combination with exercises to increase shoulder mobility and, if necessary, joint mobilization procedures performed by a therapist. > From: Kelley et al., J Orthop Sports Phys Ther 43 (2013) A1-A31. All rights reserved to the Journal of Orthopaedic & Sports Physical Therapy.

Achilles and patellar tendinopathy treatments

Achilles and patellar tendinopathy treatments usually include tendon loading, to promote tissue healing and return to activity. This review compares the clinical outcomes (improved neuromuscular performance, improved imaging, ) of different tendon loading programmes. 

Although the Alfredson protocol (isolated eccentric loading, 3x15reps 2/day, 12 weeks) is the most popular, evidence seems to question its superiority in terms of clinical outcomes. 

For Achilles tendinopathies, the Silbernagel-combined programme (exercises progressing from eccentric-concentric to eccentric while increasing speed and load, including balance and plyometrics, 1/day, 12 weeks) seems at least equivalent to the Alfredson protocol. For both programmes, there does not seem to be any correlation between clinical outcomes (jump performance, torque, work, endurance) and imaging results (measured tendon thickness, intra-tendinous vascularisation). 
For patellar tendinopathies, there is more evidence for the Heavy-Slow-Resistance programme described by Kongsgaard (slow loaded double-leg squats and leg press exercises, progressing from 15RM to 6RM, 3/week, 12 weeks). Moreover, HSR loading clinical outcomes were associated with imaging improvements as well as measured tendon adaptations (collagen turnover).

Iliotibial syndrome (ITBS)

Iliotibial syndrome (ITBS) is the leading cause of lateral knee pain amongst runners, accounting for 5-14% of running related injuries. Despite its prevalence, the etiology of the condition remains somewhat elusive. Intrinsic factors including flexibility, strength and running mechanics are commonly implicated as fundamental causes of ITBS – however, these variables have not been evaluated in this population. 

The current study investigated differences in hip strength, ITB length and hip and knee mechanics whilst running in thirty-four males (17 controls, 17 ITBS). The investigators determined that participants with ITBS had a significantly lower Ober’s measurement, weaker hip external rotators, and greater hip internal rotation and knee adduction range-of-motion. 

Whilst these findings may offer some useful insight into the pathomechanics of ITBS, caution must be used when inferring to clinical practice due the cross-sectional study design. Future studies adopting a prospective design would likely offer more rigorous evidence to differentiate between variables that are cause or effect

What is physiotherapy?

 

What is physiotherapy?

Physiotherapy helps restore movement and function when someone is affected by injury, illness or disability.

Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice. 

They maintain health for people of all ages, helping patients to manage pain and prevent disease.

The profession helps to encourage development and facilitate recovery, enabling people to stay in work while helping them to remain independent for as long as possible.

What physiotherapists do

Physiotherapy is a science-based profession and takes a ‘whole person’ approach to health and wellbeing, which includes the patient’s general lifestyle.

At the core is the patient’s involvement in their own care, through education, awareness, empowerment and participation in their treatment.

You can benefit from physiotherapy at any time in your life. Physiotherapy helps with back pain or sudden injury, managing long-term medical condition such as asthma, and in preparing for childbirth or a sporting event.

Why physiotherapy?

Physiotherapy is a degree-based healthcare profession. Physios use their knowledge and skills to improve a range of conditions associated with different systems of the body, such as:

• Neurological (stroke, multiple sclerosis, Parkinson's)
• Neuromusculoskeletal (back pain, whiplash associated disorder, sports injuries, arthritis)
• Cardiovascular (chronic heart disease, rehabilitation after heart attack)
• Respiratory (asthma, chronic obstructive pulmonary disease, cystic fibrosis).

Physiotherapists work in a variety of specialisms in health and social care. Additionally, some physiotherapists are involved in education, research and service management.

Know Why Infections Trigger Asthma Symptoms

Sometimes a virus or bacterial infection is an asthma trigger. For instance, you might have a cold virus that triggers your asthma symptoms. Or your asthma can be triggered by a bacterial sinus infection. Sinusitis with asthma is common.

It’s important to know the signs and symptoms of respiratory tract infections and to call your health care provider immediately for diagnosis and treatment. For instance, you might have symptoms of increased shortness of breath, difficulty breathing, or wheezing with a bronchial infection. In people who don’t have asthma, the bronchial infection may not trigger the same debilitating symptoms. Know your body and understand warning signs that an infection might be starting. Then take the proper medications as prescribed to rid the infection and regain control of your asthma and health.

Know the Asthma Symptoms in Children

Asthma affects as many as 10% to 12% of children in the United States and is the leading cause of chronic illness in children. For unknown reasons, the incidence of asthma in children is steadily increasing. While asthma symptoms can begin at any age, most children have their first asthma symptoms by age 5.

Not all children with asthma wheeze. Chronic coughing with asthma may be the only obvious sign, and a child’s asthma may go unrecognized if the cough is attributed to recurrent bronchitis.

For more detail, see WebMD’s Asthma in Children. 

Know About Unusual Asthma Symptoms

Not everyone with asthma has the usual symptoms of cough, wheezing, and shortness of breath. Sometimes individuals have unusual asthma symptoms that may not appear to be related to asthma. Some "unusual" asthma symptoms may include the following:

• rapid breathing
• sighing
• fatigue
• inability to exercise properly (called exercise-induced asthma)
• difficulty sleeping or nighttime asthma
• anxiety
• difficulty concentrating
• chronic cough without wheezing

Also, asthma symptoms can be mimicked by other conditions such as bronchitis, vocal cord dysfunction, and even heart failure.

It's important to understand your body. Talk with your asthma doctor and others with asthma. Be aware that asthma may not always have the same symptoms in every person.

For more detail, see WebMD’s article Unusual Asthma Symptoms.

Know the Symptoms of an Asthma Attack continued...

The severity of an asthma attack can escalate rapidly, so it's important to treat these asthma symptoms immediately once you recognize them.

Without immediate treatment, such as with your asthma inhaler or bronchodilator, your breathing will become more labored. If you use a peak flow meter at this time, the reading will probably be less than 50%.

As your lungs continue to tighten, you will be unable to use the peak flow meter at all. Gradually, your lungs will tighten so there is not enough air movement to produce wheezing. This is sometimes called the "silent chest," and it is an ominous sign. You need to be transported to a hospital immediately. Unfortunately, some people interpret the disappearance of wheezing as a sign of improvement and fail to get prompt emergency care.

If you do not receive adequate asthma treatment, you will eventually be unable to speak and will develop a bluish coloring around your lips. This color change, known as cyanosis, means you have less and less oxygen in your blood. Without aggressive treatment for this asthma emergency, you will lose consciousness and eventually die.

If you are experiencing an asthma attack, follow the "Red Zone" or emergency instructions in your asthma action plan immediately. These symptoms occur in life-threatening asthma attacks. You need medical attention right away.