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Is the Outcome of ACL Surgery really better than Conservative Management?

If you have sustained an ACL ( Anterior Cruciate Ligament of  the knee) tear and is considering an ACL surgery, you would find it useful to know more about the latest research discussion on ACL surgery versus Physical therapy management.

Why high-heel wearers hurt walking flat foot?

If you know of women who wear high-heels most of the time, you will notice that they often stand and walk tip-toe even when barefooted. This is because the women complain that it hurts to walk flat footed. This feeling of pain has been often theorized to be the result of a shrunken calf muscle. So Marco Narici from Manchester Metropolitan University, UK and Robert Csapo, from the University of Vienna, Austria sought to test the theory.

But what Csapo and Narici found was not shrunken calf muscles that causes pain when stretched. Using MRI scans, they found the volume of calf muscle between women who wore high-heel shoes were about the same as those of women who wore flat shoes. But what they did find was shorter muscles fibers in women who wore high-heels. About 13% shorter on average. While this would imply poor function, does it make it harder for the high-heeled women to walk flat footed? It didn't appear so.

Turning to the achilles tendon, the tendon attachment the calf muscles to the heel. What Csapo and Narici found were thicker and stiffer tendon in women who wore high-heels. While the tendon was not stretched longer than the other group, the thicker-stiffer tendon helped compensate for the shorter calf muscle.

It is this thicker and stiffer tendon that causes the discomfort when walking flat-footed as it cannot stretch enough.

References

Csapo, R., Maganaris, C. N., Seynnes, O. R. and Narici, M. V. (2010). On muscle, tendon and high heels. J. Exp. Biol. 213, 2582-2588.[Abstract/Full Text]

Eccentric ankle evertor muscle strengthening is better than concentric strengthening after a lateral ankle sprain

Higher Risk of Low Back Pain for Competitive Youths

A recent study published in the American Journal of Sports Medicine by researchers from the Institute of Clinical Medicine, University of Tsukuba in Japan found that excessive exposure to competitive sports activities during youth was associated with low back pain and symptoms in the lower extremities, with the severity varying with the sport.

The researchers suggested that to reduce low back pain in youth, factors that may be causing low back pain, such as sport-specific postures and motions, thought these suggestions need to be investigated.

Reference:

1. Relationship between low back pain and competitive sports activities during youth., Am J Sports Med. 2010 Apr;38(4):791-6. Epub 2010 Jan 5.

The Mechanics of Barefoot Running

Dr William Roberts, "The Sports Doc" over at Runner's World recently wrote about barefoot running and the mechanics of it. Read his whole article here, "The Mechanics of Barefoot Running"

It complements our two articles, Running Economy and Professor Daniel Lieberman's video (The Barefoot Professor: by Nature Video)

Stability Walking Shoes Not Necessarily Good for Arthritic Knees

In a recent report of a study published in the journal Arthritis Care & Research, found flip-flops and sneakers with flexible soles are easier on the knees than clogs or even special (stability) walking shoes,

"Traditionally, footwear has been engineered to provide maximum support and comfort for the foot, with little attention paid to the biomechanical effects on the rest of the leg," said Dr. Najia Shakoor, a rheumatologist at Rush and the primary author of the study. "But the shoes we wear have a substantial impact on the load on the knee joints, particularly when we walk."

In our past MCR articles on knee pains, you often find causes that a few steps away from the pain site such as the ankle,hip or lower back but utlimately link back bio-mechanically to the knee.

 

And this bio-mechanical chain sometimes make treatment or support choices difficult. Shakoor cautioned that knee loading is not the only consideration in any clinical recommendations based on her study. "For the elderly and infirm individuals, flip-flops could contribute to falls because of their loose-fitting design. Factors like these need to be taken into account," Shakoor said.

Journal Reference:

1. Najia Shakoor, Mondira Sengupta, Kharma C. Foucher, Markus A. Wimmer, Louis F. Fogg, Joel A. Block. The effects of common footwear on joint loading in osteoarthritis of the knee. Arthritis Care & Research, 2010; DOI: 10.1002/acr.20165

Predicting Running Related Injuries in Male and Female Novice Runners

In a study of 532 novice runners (226 men, 306 women) preparing for a recreational 4-mile (6.7-km) running event. After completing a baseline questionnaire and undergoing an orthopaedic examination, they were followed during the training period of 13 weeks.  Running Related Injuries (RRI) was defined as any self-reported running-related musculoskeletal pain of the lower extremity or back causing a restriction of running for at least 1 week.

Twenty-one percent of the novice runners had at least one RRI during follow-up. Male and female novice runners have different risk profiles

The model for male participants showed that body mass index (BMI) , previous injury in the past year , and previous participation in sports without axial load  were associated with RRI.

In female participants, only navicular drop remained a significant predictor for RRI. Type A behavior and range of motion (ROM) of the hip and ankle did not affect risk.

Source: Am J Sports Med February 2010 38:273-280;  doi:10.1177/0363546509347985

Who needs bone-building drugs?

Osteoporosis is a common debilitating condition that contributes to increase risk of fractures. To prevent possible risk of fractures, bone building drugs are available to improve bone density. However, they can have side effects and are only 50 percent effective in preventing fractures. Therefore, World Health Organisation has come up with a tool to find out who will benefit from bone building drugs.

FRAX is an online risk calculator which helps the doctors and patients to determine the possibility of potential fracture and determine whether the drug therapy might prevent fractures. The list consists of questions looking at risk factors of osteoporosis. The factors analyze the lifestyle, conditions, diseases and medications that can contribute to the risk of osteoporosis and fractures.

The formula is applicable to both men and women. It can be used independently without a person’s bone density score but having a bone density score can further enhance the accuracy of the prediction.

 

References

www.shef.ac.uk/FRAX/index.htm

http://mobile.nytimes.com/2009/12/29/health/29brod.xml

TENS – Not effective for Chronic Low Back Pain according to latest guidelines

The American Academy of Neurology (AAN) recently published an evidence-based guidelines on the use of TENS ( transcutaneous electric nerve stimulation) is not recommended for the treatment of chronic low-back pain due to lack of proven efficacy. This supports our views at Core Concepts as a large number of chronic back pain cases is mechanical in nature. 

"The strongest evidence showed that there is no benefit for people using TENS for chronic low-back pain," said guideline author Richard M. Dubinsky, MD, MPH, of Kansas University Medical Center in Kansas City and a Fellow of the American Academy of Neurology. "Doctors should use clinical judgment regarding TENS use for chronic low-back pain. People who are currently using TENS for their low-back pain should discuss these findings with their doctors."

TENS however, continues to be recommended for TENS can be effective in treating diabetic nerve pain.

Reference:

1. Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology
2. American Academy of Neurology (2009, December 31). Widely used device for pain therapy not recommended for chronic low back pain. ScienceDaily. Retrieved January 1, 2010, from http://www.sciencedaily.com­ /releases/2009/12/091230174120.htm

Newly Discovered Sensory System in the Skin May Explain Fibromyalgia

A newly discovered sensory system hidden in a network located throughout our blood vessels and sweat glands, separate from the usual nerves that gives us the ability to touch and feel, may explain difficult to treat pain conditions like Fibromyalgia Read more

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Ultrasound Therapy, Imaging and Shockwaves

"Hi MCR, I keep hearing about ultrasound therapy but I get confused with the seemingly different answers I get about them. There appears to be one for healing... Read more »



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