News Category: General

Doctors report that healing tissue may be helped or hurt by nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are used to reduce pain and swelling. If a broken bone is painful, an NSAID taken for pain may reduce or delay bone healing.

Likewise, bone growth in and around a joint implant can be affected by the newer NSAIDS called COX-2 inhibitors. COX-2s are used to reduce inflammation without causing stomach upset.

In this study doctors reviewed the results of many animal and human studies. They report that indomethacin, aspirin, and ibuprofen all decrease the amount of bone growth around joint implants. They also show how spinal fusion is affected by NSAIDs. Studies show that the fusion rate can drop by as much as half in patients who take NSAIDs for more than three months after spinal fusion surgery. Patients who smoke have an even greater risk of nonunion when using NSAIDs.

On the other hand, COX-2s may have a positive effect on soft tissue and ligament healing. Some studies show that NSAIDs work well for sprains and strains. Patients have less pain when taking these drugs. Injured athletes can train at a higher level when taking them.

More research is needed to study the effects of COX-2 inhibitors on sports-related tendon or ligament injuries. In the meantime, these authors advise doctors to avoid NSAID use when fracture healing or bone fusion is needed.

Sometimes after a leg fracture or surgery the doctor tells the patient to put only part of his or her weight on that leg. Using a bathroom scale to test the limits is a common practice. But does this method really work? The authors of this study say that using a bathroom scale to practice partial weight bearing isn’t accurate.

Two groups of people were tested. One group of 23 patients was compared with a control group of six healthy people. The patients either had a leg fracture or surgery. The six people in the control group were put in a cast. Everyone in the control group was trained to put 20 to 40 percent of his or her body weight on the leg. The patients were given a limit by their doctors depending on their condition.

A physical therapist trained each person to use a bathroom scale to help determine how much weight to bear. Crutches were used to help during walking. Later in the week both groups walked on a special force platform that measures how much weight is applied through the foot.

All the members of the control group used more or less than the required body weight. No one was accurate. Almost all of the patients used more than the prescribed amount of weight. Two patients used less than required. Overall the control group did better than the patients. No one in either group could actually use the amount of weight they had trained with.

The authors conclude that partial weight bearing is hard to learn. Bathroom scales aren’t a good way to teach patients how to use partial weight bearing when walking. The type of force platform used in this study to measure actual force is 2.7 times more accurate than other methods. A force platform should be used for the best results and when it is especially important not to overload the injured leg.

The Internet isn’t used by orthopedic doctors to teach patients as much as it could be. That’s the conclusion made by researchers at the University of Pennsylvania. They carried out a study on Internet use among doctors.

The purpose of this study was to look at websites and compare information posted by private practice versus academic sources. The specific topic was orthopedic patient education.

Information was gathered on 154 websites related to orthopedic surgery. All academic sites were sponsored by orthopedic departments. These departments were approved by the Accreditation Council for Graduate Medical Education (ACGME). Researchers rated the sites on the following criteria:

In this study, ultrasound (US) was used and compared in two different ways to treat one-sided neck pain in 72 patients. US is a form of heat energy generated in the muscles and soft tissues. It’s applied through the skin with a special machine.

All patients in the study had shoulder and neck trigger points and pain on one side. Trigger points are irritable spots in the muscle that cause pain and spasm.

The control group had standard US over the area of pain. The applicator was moved in small circles over the area. Each treatment lasted five minutes. In the study group, high-power pain threshold (HPPT) US was used. In this method the US was turned up to the point patients could feel pain. Then it was turned down to half the intensity. This cycle was repeated three times. The probe was held motionless over the trigger point.

The authors report the results of these two methods using pain and neck range of motion as measures. Patients were followed for one month. US done with HPPT reduced pain much faster than standard US. Range of motion was equal in both groups after treatment.

The researchers suggest that HPPT may save money since fewer treatments are needed. This method is painful, but the pain intensity can be controlled by the physical therapist applying the US.

Impairments and limitations. These are words used in the medical world to describe what’s wrong and how it affects us. In this study, physical therapists report on the link between impairments and limitations in patients with a condition called type I complex regional pain syndrome (CRPS).

CRPS was formerly known as reflex sympathetic dystrophy. It’s a poorly understood problem. It occurs after trauma or surgery and affects the arms or legs. Patients have mild to severe pain, dry or flaking skin, hair loss or hair growth, and hot or cold skin temperature.

Patients with CRPS vary in how severe the problem (impairment) is as measured by range of motion and grip strength. But does this impairment always lead to limitations in what patients can actually do in normal daily life? That’s what these researchers tried to find out.

They used a special tool called the upper-limb activity monitor (ULAM) to measure arm activity. This device gives data on what patients can actually do, not just what they say they can do. Thirty patients wore the ULAM for 24 hours. The results showed activity patterns (whether or not the arms were active) and what activities were performed.

The authors report that everyone had a loss of motion (impairment). The involved limb was less active than the “normal” arm. This was especially true when the patient was sitting. However, this impairment didn’t appear to limit the patients’ general mobility. The ULAM did show that the patients with CRPS of the dominant arm had more activity limitations than patients with CRPS of the nondominant side.

Does impairment lead to activity limitation? According to this study, yes. The more impairment, the more limits there were on activity.

Previous studies have shown that Tai Chi is good for balance and joint sense. Tai Chi is an ancient Chinese exercise that involves slow, deliberate movements. It is easy on the joints and not physically demanding. This makes it a good exercise for older people. Joint sense and balance get worse with age, leading to falls, so an exercise that improves these qualities is important.

Golf is another sport that older people can enjoy. This study, done in Hong Kong, tested whether golf could improve joint sense, too. The authors studied balance and joint sense in the knee in four groups: men over age 60 who had practiced Tai Chi for at least three years; men over 60 who had golfed for at least three years; a control group of healthy men over 60 who did not do a regular activity; and university-age men.

As expected, the group of young university students had better joint sense and balance than any of the other groups. The control group had the worst joint sense and balance. The Tai Chi group had scores that were closer to the young people. And the golfers had scores nearly as good as the Tai Chi group.

The results are clear. Golf and Tai Chi are both excellent ways for older people to maintain good balance and joint sense.

True or false: Stretching before sports or recreational activities prevents injuries. True or false: Stretching before competitive sports improves performance.

There isn’t enough proof to answer either of these questions. It’s not clear if routine stretching before or after exercise prevents injuries among athletes at any level. In fact, stretching and increased flexibility might even increase the rate of muscle injury.

Researchers found 361 articles on stretching published between 1966 and 2002. Six of these reports compared stretching with other methods to prevent injury. Results of these six reports are the focus of this study. The authors give information on the following four topics:

In a perfect world, your entire medical history would be accurately described in your medical records. But how reliable are doctors’ medical records? You may not care if your records are 100 percent complete. But much medical research relies on doctors’ records. That means those records are used to understand important medical issues. This makes accuracy very important.

These authors wanted to see how accurate surgeon’s records are. They looked at the records for 166 patients who had cervical spine surgery. The authors wanted to see if post-surgery problems with talking and swallowing were reported equally by surgeons and patients. Records were studied from appointments six weeks, three months, and six months after surgery. The records were then compared to a survey given to patients.

Surgeons’ records reported far fewer problems than the patients did. The records showed that only 11 percent of patients had problems swallowing, and only five percent of patients had problems talking. The patient surveys showed that 57 percent of patients had problems swallowing, and 30 percent had problems talking. The results didn’t match well for any surgeon. Mild and moderate problems were most often missing in the medical records. But even severe problems went unreported.

This is not very good news for medical researchers. It is impossible to tell if these results are also true for other types of surgery. And this study had some limitations. But it certainly makes a case that surgeons’ records may not be the best way to get a true picture of complications after surgery.

The authors suggest the lack of accuracy may be why different outcome studies can get such different results. They recommend that patient reports should be included in any study of outcomes after surgery.

In this report, doctors at Baylor College of Medicine look at a condition called coccygodynia. Coccygodynia is defined as pain in the coccyx (the tailbone). The pain is often sharp. It’s usually made worse by sitting.

Women are affected five times more often than men. Women often have past trauma such as a difficult vaginal birth. Obesity and trauma are the most common risk factors. There are other causes such as tumors, spastic muscles, and arthritis.

The authors describe the normal anatomy in the coccyx. They discuss causes of coccygodynia in detail. Patient symptoms, findings on exam, and the results of imaging studies are also presented. Dynamic X-rays offer the best understanding of the problem and what’s causing it. These images are taken while sitting and standing.

Nonsurgical treatments may include anti-inflammatory medicine, hot packs, ultrasound, and instructions to sit on a pillow or cushion. Patients may also benefit with hands-on treatments, such as massage, joint mobilization, or manipulation. If symptoms continue despite these measures, steroid injections into the problem area may be recommended.

If patients still have pain and problems, surgery may then be recommended. The main procedure described in this review is called coccygectomy, which is the surgical removal of the coccyx. Possible problems after surgery include wound infection and delayed healing. In some cases pain is not relieved, and the bones of the sacrum (just above the coccyx) may stick out. Treatment is most successful when there’s normal motion of the coccygeal spinal segments.

Many adults have a work-related injury. Most return to work quickly. What happens to the workers who don’t get better and end up with a long-term (chronic) musculoskeletal problem? How are they different from the workers who go back to work with little lost time?

That’s the subject of this study from the Productive Rehabilitation Institute of Dallas for Ergonomics (PRIDE). A large number of patients (over 1,000) were put into two groups: those who finished rehab without further health care visits, and those who didn’t. The second group visited at least one new health care provider after rehab was over.

The results of this study are important because chronic cases of disability account for a large amount of the money spent on health care for musculoskeletal problems. Some patients see many doctors for the same problem. Studies show there are many reasons why patients go “doctor shopping.” All of them lead to one thing: increased health-care costs.

The authors found that 90 percent of the group who didn’t visit a new health care provider (group zero) returned to work. They were still working a year later. On the other hand, 78 percent of the group who did seek more health care (group one) went back to work. Only 68 percent were still at work a year later.

Group zero settled all legal and financial issues linked to the injury. Only 77 percent of group one was able to do the same. The researchers noticed lower socioeconomic groups tend to use the health care system more. Group one had a much higher number of patients who had another operation at the site of injury. Overall, 25 percent of the patients in group one lost the most work, used the health care system the most, and had more legal problems than group zero.

The authors say these findings will help us understand workers’ compensation costs. Patients who stop working also look for other sources of money, such as continued workers’ compensation, Social Security disability, and welfare. The patients may use the ongoing health care visits as a way to prove they are disabled. In this way they try to qualify for more benefits.

The authors also say there is a need for more research. If we can tell who will develop chronic problems, it may be possible to prevent them early on. Finding risk factors for treatment failure can help doctors screen patients ahead of time and prevent disability.

You may not have heard of it, but wakeboarding is a popular new water sport. Wakeboarders are pulled behind motor boats just like water skiers. But wakeboarders ride on boards that are more like snowboards. Tight boot-like bindings keep their feet on the boards. Wakeboarders jump the wake of the boat. They can also do tricks like flipping, spinning, and jumping off ramps. Jumps can go up to 20 feet above the water.

Doing these tricks at high rates of speed, with feet tightly attached to the board, sounds dangerous. And as this doctor reports, it sure can be. This survey of wakeboarders and orthopedic surgeons turned up some serious wakeboarding injuries. Of the wakeboarders who returned the survey, 77 percent reported being injured while wakeboarding. Most of the wakeboarders reported tears of the anterior cruciate ligament (ACL) in the knee and ankle sprains. Most of the injuries happen from hitting the water during a trick that went wrong. It is unusual for injuries to happen from hitting a ramp, dock, or other structure.

About half of the surgeons reported seeing wakeboard injuries. Most were ACL tears. ACL tears accounted for 31 percent of the injuries. Shoulder dislocations made up 15 percent of the injuries. Twenty-one percent were fractures, including breaks in the spine, leg bones, feet, and ribs. These fractures were often very serious. Skull fractures have also been reported. Injuries seemed to happen in all levels of wakeboarders, from novices to professionals.

This study has many limitations. Finding a way to contact doctors and wakeboarders is difficult because it is a recreational sport that isn’t organized by official leagues. Very few wakeboarders returned the survey. The study can’t show what percentage of wakeboarders actually get injured.

Still, the author feels the research clearly shows that wakeboarding can cause serious injuries. He recommends that safety features be studied, including better bindings, helmets, and strength training.

Injuries on the slopes are less common than most people think. These authors report that, on average, downhill skiers and snowboarders only get injured once every 300 days of hitting the slopes. Still, there are a lot of ski injuries. And most of these injuries happen to beginning skiers.

The authors looked at injury patterns at three ski areas in Scotland. Injuries were divided up between skiers, snowboarders, and skiboarders. Skiboarding (often called snowblading) is a new sport. Snowbladers use short skis with bindings that can’t detach. The short skis are easy to maneuver, but the bindings make injuries more likely.

The authors collected information on injured skiers and a control group who did not get injured. As expected, the authors found that first-day skiers, snowboarders, and snowbladers were much more likely to be injured than the more experienced people on the slopes. The authors found some interesting facts about the injuries:

About half of all pregnant women will have low back and pelvic pain during pregnancy. For most women, the pain may go away a couple months after the baby is born. For some women, it doesn’t go away at all. They may be unable to complete daily tasks. They may not be able to go back to work. Serious disability can occur.

Researchers are looking for a way to treat this problem with exercise. Physical therapists from the University of Oslo in Norway report on the success of one exercise program for postpartum pelvic pain. They used a series of exercises called stabilizing exercises. Women did the exercises for 20 weeks. Pain levels, function, and quality of life were measured before and after the exercise program.

Eight-one women with pelvic pain were put in one of two groups. Both groups had an exercise program. Group one did the specific stabilizing exercises (SSEG). Group two (the control group) had physical therapy but not the special exercises. Each woman in group two had treatment just for her specific problem. Treatments may have included heat, electrotherapy, posture and body mechanics, or joint mobilization.

The authors report a difference in the results between the two groups. Group one (SSEG) had much less pain, better function, and a higher quality of life compared to the control group. Disability in the SSEG group went down by 50 percent. These good results lasted even after 12 months. No changes occurred in the control group.

The authors conclude that the specific exercises given to postpartum women with pelvic pain improved motor control and stability in the pelvic area. These changes helped transfer some of the load away from the pelvis. The program was low in cost. Very little equipment was needed, and all exercises could be done at home.

What’s best when lifting a heavy object? Should you hold your breath and bear down as you lift? Is it better to let your breath out slowly while lifting? Studies of breath control during lifting are few and far between.

This study looks at the effect of breath control on intra-abdominal pressure (IAP) during lifting tasks. Four types of breathing were used:

Any time a muscle is immobilized, it wastes away (atrophies). Serious illness, injuries, and fractures all involve some type of immobilization. So may surgeries such as total knee and hip replacements. One of the most important tasks of recovery in all these cases is to rebuild muscle.

The problem is, scientists don’t understand all the mechanisms of how muscles regrow. This article details the chemical and cellular changes that happen when muscles atrophy and regrow. Much of the research has been done in lab rats. One of the interesting findings is that muscle cells in older lab rats often have a great deal of trouble regrowing. Sometimes the cells don’t seem to be able to regrow at all. There are also differences in the ways that regrowth happens in the different types of muscle fibers.

This type of research can be the foundation for finding better ways to regrow atrophied muscles. Some day, this research may help doctors and physical therapists design even better rehab programs for their patients.

Sprains, strains, and fractures are the most common musculoskeletal injuries. They make up one of the biggest reasons patients go to the doctor. Degenerative joint disease that comes with aging is also a common condition. Most patients with these problems see their primary care doctor or an orthopedic doctor.

Sometimes patients with musculoskeletal problems are sent to a physical therapist (PT). In many states the patient can go the therapist without seeing a doctor first. This is called direct access. In every state, a doctor can refer patients to PT.

In this study, therapists try to find out which doctors send patients to PT. They looked for ways to tell which doctors are more likely to make a PT referral. The goal is to understand the doctor’s role in the use of physical therapy for musculoskeletal conditions. Do orthopedic doctors refer more often than primary care doctors? Why or why not?

The authors of this study found out:

Attention, office workers and office managers! Do you use a computer? Have your workers lost time in the past year from repetitive motion injuries? Researchers from Texas and Canada announce new findings for your immediate use.

Providing adjustable chairs and training in how to use them can reduce lost time on the job because of pain and disability from overuse. Training in how to change the workspace to find the best “comfort zone” is also important. Just giving workers training in using workspace more effectively isn’t always enough.

These are the results of studying 192 employees from a state department of revenue service. Workers were placed in one of three study groups: (1) adjustable chair with training, (2) training only, and (3) control group. The control group was trained at the end of the study.

The researchers thought training alone would be enough to increase understanding of office ergonomics and make workers change their habits. They expected the employees to change work postures, rest break patterns, and work layout. However, the study results did not show that. Workers in the training only group did have less pain than the control group. But workers in the chair-with-training group had the best results. Their average pain levels were reduced. Workers with neck and shoulder symptoms had the greatest decrease in pain. Workers with upper and lower back pain had the second greatest pain decrease.

The authors conclude that there’s a need to know what really works in an office setting to reduce workers’ painful symptoms. With more and more workers sitting six to eight hours (or more) in front of a computer, preventing musculoskeletal symptoms is very important. Symptoms, injuries, and sick days can be reduced by giving workers an adjustable chair and training in how to use it. It’s estimated that each chair-with-training worker showed $354 more in productivity than other workers.

Physical therapists (PTs) often treat patients with work-related musculoskeletal disorders (WMSD). But what happens when the therapist suffers a WMSD? How common is this? What’s it like for these therapists?

Researchers in Australia are studying these and other questions. The first study showed that 91 percent of all PTs surveyed had a WMSD at one time or another. Only 7.4 percent filed for worker’s compensation (WC). A close look showed many PTs were unable to work because of the WMSD and could have asked for WC benefits.

In the first study, a group of 18 PTs were found who had to change their career because of WMSDs. The second part of this study looked at six of those 18 who filed WC claims. What was their experience like? Were they treated as if they didn’t have a real problem? Did they feel judged by coworkers or thought of as less capable than an uninjured therapist?

All six therapists reported having a negative experience with WC. The therapists described it as a “nightmare” and “worse than the pain from my injury.” They summarized their experiences as follows:

Muscles can be stimulated electrically by putting current to the muscles. Special pads, called electrodes, are placed on the skin over the muscle. When the electrical current is used to get muscles to contract, it’s called neuromuscular electrical stimulation (NMES). NMES is sometimes used to help patients gain strength after some types of knee surgery. It is also used by some elite athletes as part of training programs.

Studies have shown how intense NMES needs to be. But it is unclear how many NMES sessions a week are the most effective. These authors tested 27 healthy people who were doing no physical training. The subjects were divided into three groups. The control group got no NMES treatments. The second group got two NMES sessions each week for four weeks. The third group got three NMES sessions a week. NMES was applied to the quadriceps muscles on the front of the thigh. All NMES sessions lasted 10 minutes.

The subjects were tested for quadriceps strength every week. Strength increased significantly only in the group who got NMES three times a week. This group saw a strength increase of about 13 percent. The authors conclude that three NMES sessions a week may be needed to build strength. They also note that the relationship between intensity and number of sessions is very important. A different combination of intensity and sessions could change the results. The authors call for more research on people with weak thigh muscles.

Osteoporosis is a disease of low bone mineral density (BMD). People with osteoarthritis (OA) tend to have high BMD. That means people with OA don’t usually have osteoporosis–or so doctors have thought.

These authors looked at BMD, vitamin D and calcium levels, and health habits of 68 women. All the women were past menopause. All were getting hip replacement surgery because of severe OA. This means none of the women should have had osteoporosis, right? Wrong. Results showed that 25 percent of the women had both OA of the hip and osteoporosis. Apparently, the old theory is a myth.

The results also showed that 22 percent of all the women (both with and without osteoporosis) had too little vitamin D. The body produces vitamin D when exposed to sunlight. Vitamin D can also be found in some foods, including eggs. Vitamin D deficiencies did not seem to be related to osteoporosis, however.

The main message of this research is that doctors need to be aware that OA doesn’t protect women against osteoporosis. It is possible to for patients to have both conditions at the same time.