Archives: News

Getting Hurlers Back in the Game after Elbow Ligament Injuries

Athletes who throw as part of their sport sometimes injure the ligament that crosses the inside edge of their elbow. This ligament is called the ulnar collateral. Its role is to keep the elbow from angling too far outward as the arm picks up speed for the throw. Throwers who injure this ligament face a choice between surgery and non-operative treatments.

This study examined how long it took athletes to return to their sports after non-operative treatment. A total of 31 athletes completed the year-long study. At first, the program involved resting the athletes’ elbows and treatments to control their symptoms. The second part of rehabilitation included strengthening exercises and progressive throwing.
 
Thirteen athletes (42%) returned to their sport within an average of just under six months. These findings give players a ray of hope about their chances for returning to full-level play. The authors also suggest that the results can help estimate how long it might take a player to get back to throwing sports after non-operative treatment.

The authors also looked at factors that could potentially help predict whether non-operative treatment would let players return to full competition. These factors included the players’ ages, the amount of time between injury and treatment, and whether symptoms were caused by a specific injury or developed gradually. The study found that none of these factors consistently predicted a player’s return to competition.

Acute Surgical Stabilization for First-Time Shoulder Dislocation

The military is a good place to study injuries in young athletes. The need to return soldiers to their line of duty sometimes means they are treated more aggressively than is common in the civilian population. In this study, a group of 48 soldiers were treated surgically for a first-time anterior (forward) shoulder dislocation. The long-term results of this approach are investigated.

First-time shoulder dislocations are often treated conservatively without surgery. A rehab program of exercises to strengthen and stabilize the shoulder is recommended. Soldiers (and athletes) get back into action after several weeks to months. But there’s always the risk of another shoulder dislocation. Recurrent dislocations occur most often with extreme activity such as volleyball, football, water skiing, and military training.

First-time dislocations with severe damage to the shoulder are more likely to be repaired surgically. This is often the case when there has been a capsulolabral avulsion. This type of injury refers to the fact that the labrum has pulled away from the bone. The labrum is a dense ring of fibrous cartilage around the shoulder socket. It gives the shoulder socket some depth and provides the shoulder with increased stability.

If the labral tear extends up far enough, it will even pull some of the biceps tendon away from where it inserts into the labrum. The surgical procedure used most often to treat this type of injury is called the Bankart repair. During the procedure, the surgeon repairs each of the soft tissues damaged by the dislocation. Suture anchors are used to hold the biceps in place.

Studies show that early results of surgical stabilization are excellent. This study attempted to report on the long-term results. They followed their patients for at least nine years (some as long as 14 years). They used patient questionnaires to ask about shoulder/arm function, pain levels, and patient satisfaction with the results.

Because this was mostly a military group, return to athletic activity and physical conditioning (such as doing push-ups) were also monitored. Only one person left the military for medical reasons and that was not for a shoulder problem. About 40 per cent of the group had recurring instability (partial or complete dislocation). A small number of these patients went on to have a second (revision) surgery to stabilize the shoulder.

Good shoulder function was reported for all patients in the study — even those who had recurrent dislocations. Good shoulder function means they returned to unrestricted physical activity required by their jobs and daily activities. That was important as this group of patients had a vested interest in returning to active duty status or returning to military academy in order to graduate.

The authors acknowledge this treatment of surgical stabilization for first-time acute anterior shoulder dislocation is considered too aggressive by some experts. But they defend this practice because their studies and records show very poor results for soldiers with conservative care for this injury. They make note of the fact that this population is unique in that they cannot modify their activities.

This more aggressive approach made it possible for military patients to resume full activities and complete their military obligation. Long-term follow-up revealed the patients were satisfied with the results. Most of them said they would do it over again the same way if given the choice.

The authors also note that the system used in a Bankart repair for these patients treated in the mid-1990s was a tack system (Suretac device), which has since been replaced by the suture anchors used today. It’s unknown how the long-term results compare between the tack system and suture anchors.

The Rat Race Proves Good for Immune Function

We all know that exercise is good for us. It tones the body and improves cardiovascular function. Researchers have also found that exercise may even boost your immune function–unless you exercise too intensely.

Swedish researchers tested rats to see how different levels of exercise affected the immune system. The rats were kept in separate cages. One group had cages without exercise wheels. Cages of the other rats had exercise wheels. Researchers tracked how much and how far each rat ran.

Those in the rat race followed a running schedule. They ran every day for either five or 11 weeks straight. Or they started out running every day for five weeks and then ran only four days a week for the final six weeks. At the end of the study period, the rats were injected with cancer cells that congregate in the lungs. Researchers then checked the rats’ lungs to see how well their immune systems had managed to clear the cancer cells.

All of the running groups showed better immune function than the sedentary group. The rats that ran every day for 11 weeks showed the poorest clearance of cancer cells of all the running groups. The researchers also grouped the rats by how far they ran each day. All of the runners showed better immune function than the sedentary group. And the rats that ran more often showed better immune function than the rats that ran the least.

The authors conclude that exercise–at least in rats–does seem to boost immune function. But the study also shows that doing too much training for too long seems to erode the benefits. It’s hard to make conclusions for humans based on animal studies. But the authors say that their results suggest there should be more research on “the important role of adequate rest in prevention and treatment of overtraining in humans.”

Pumping Iron to Pump Up Bone Health

Weight lifting has been shown to help reduce the bone loss that often happens with menopause. Until lately, however, it was not clear which method of weight lifting helped bones the most: lifting small amounts of weight with a lots of repetitions, or using more weight and fewer repetitions.

The question of osteoporosis is on the minds of many women over forty. Menopause signals a significant drop in estrogen and other hormones that support and maintain bone strength throughout a woman’s lifetime. It is estimated that in the early years after these hormones drop, a woman may loose up to 5% of her bone density per year. Though there are medications that can reverse some bone loss, much of this loss is irreversible.

One way of preventing this loss is through muscle strengthening exercises. The bones respond to muscles tugging on them by releasing bone-building chemicals, resulting in denser bones. Or at least that’s the hypothesis.

So is it better to lift in the style of Arnold Schwarzenegger–or will a Pee Wee Herman approach suffice? Researchers addressed this question to see which kind of weight lifting impacted bone density the most.

Twenty-five women with an average age of 51 (all from one to seven years postmenopausal) were selected. There were two main requirements for participation in the study. Participants could not be on estrogen replacement therapy, and they were not to have done any resistance training in the past six months. The women were divided into three groups. One group served as a control group and didn’t do or change a thing. The other two groups began an exercise program. High-intensity exercisers did twice as much weight and half as many repetitions as the women doing low-intensity exercises.
 
Subjects were trained on proper upper and lower body weight lifting techniques. Both groups trained three days a week for six months. Their workouts included a 10-minute warm-up, a 45-minute weight lifting session, and a five-minute cool down. 

How did the exercisers fare? Both groups ended up having stronger muscles, but not stronger bones. Yet neither group showed a loss of bone. Past studies spanning nine to 12 months have shown measurable improvements in bone density. This made the authors question whether the women in their study would have shown higher bone densities had this study lasted longer.

The fact that these women gained stronger muscles is still good news. Better muscle strength means better balance and coordination, which helps lower the chances of falling and fracturing a bone. So the bottom line is that the styles of lifting used by Pee Wee and Arnold both seem to help keep women’s bones strong.

Old Man and the Knee

Who says you’re too old for knee surgery to reconstruct a torn anterior cruciate ligament (ACL)? Doctors Miller and Sullivan recently reported on a rancher who had a successful surgery on his ACL. Nothing new, right? Except that the patient was 84 years old at the time of surgery.

Surgery to reconstruct a torn ACL is usually only done on younger patients. Most doctors consider 40 to be old for an ACL surgery. The authors were unaware of anyone older than 62 having this type of surgery.

According to the doctors, the patient had been trying to get along without surgery, but ranching was too much of a challenge. Walking around on the uneven ground caused his knee to give out on him. Rather than change his lifestyle, he opted for surgery.

The surgery was a success. Three months later, the patient was back to his normal activities. When he went back to the doctor for a six-month recheck, he had full knee movement and near normal strength in his leg muscles. He also scored nearly 100% on a questionnaire about knee surgery results.

The authors conclude that “physiologic age and activity level is more important than chronologic age when considering ACL reconstruction.”

Combinations of Factors Can Increase Risks for Low Back Pain

What triggered my low back pain (LBP)? Simple question–complicated answer. Studies have found several factors that raise the risk of developing LBP. Known risk factors include:


  • previous episodes of back pain

  • injuries

  • smoking

  • sedentary work.

  • poor social support

  • lack of social confidence

  • work that involves whole-body vibrations

  • dealing with heavy loads at work

  • low education levels

  • low off-work exercise levels

  • low levels of influence over work conditions

  • high demands during off-work time

  • high amounts of overtime work

  • work with a high risk of accidents

  • social disturbances at work

  • technical disturbances at work.

This new study looked at all these factors over a period of 24 years in people with LBP. Researchers found that a combination of some of these risk factors made the overall risk for LBP significantly higher.

For men, the risks of LBP were excessively high when they dealt with heavy loads at work, had many demands outside of work, did sedentary work, or had a combination of poor social relationships and lots of overtime work.

Women were at especially high risk for LBP when they worked with heavy loads, did sedentary work, smoked, or had a combination of work that involved whole-body vibrations and a lack of influence over work conditions.

Spines Hold Steady after Intradiscal Electrothermal Therapy

New advances in medicine and science are making it possible to narrow down and locate pain-causing tissues in people with chronic low back pain. Frequently, the lumbar disc is the source of pain. Scientists have also discovered that the outer ring of the disc is rich in pain sensors.  

Intradiscal electrothermal therapy (IDET) is a newer surgical procedure that lets doctors work on the painful disc without causing harm to the other tissues in the area. During the procedure, a special heating element called a catheter is placed inside the sore disc using a special needle. The element is heated for about 17 minutes. The heat treatment is believed to shrink the disc fibers and cauterize pain sensors.

Does it work?  Resources say that more than 75% of the people treated with IDET are highly satisfied. But does the procedure weaken the spine? This is the question the authors sought to answer in this study.

Researchers tested how well four human cadaver spines could withstand movements before and after IDET treatment. They set up a testing device that put pressure on to the spine similar to the forces caused by routine activities. Then the spines were tested for three types of movement: bending forward and back, bending side to side, and turning in each direction. 

The spines held steady. In fact, IDET didn’t change the spines’ ability to withstand pressures and movements common with daily activities.

The authors acknowledge that their study has limitations. They tested few cadavers, had a short time between IDET and retesting the spines, and tested only the middle and upper joints of the lumbar spine. The authors stressed that future studies will need to look at the effect of IDET on the tissues inside the disc. Nevertheless, their research suggest that IDET doesn’t appear to weaken spinal segments of the lumbar spine.

Honey, I Shrunk the Joint Capsule

When a joint is unstable, surgeons sometimes tighten the joint by sewing the tissues of the joint capsule together. The joint capsule is a watertight sac that holds fluids that lubricate the joint. Now doctors have another way to tighten the joint capsule. The procedure is done using a laser beam.

A major benefit of using the laser for this surgery is that the surgery can be done using an arthroscope. An arthroscope is a tiny TV camera that is inserted into the joint through a very small incision. This allows the surgeon to watch what he or she is doing on a TV screen during surgery. The small incision allows quicker healing times.

Multidirectional instability (MDI) of the shoulder is a common and serious type of joint instability. In this study, researchers followed up with patients who had been treated for shoulder MDI by using lasers to shrink the joint capsules.

All 26 patients in this study had tried conservative treatments and physical therapy before getting surgery. Because one patient had surgery on both shoulders, the study actually followed 27 surgeries. Of these, 26 were stable and showed no symptoms at least two years after surgery. Fourteen of the patients had been athletes before surgery, and 12 of them were eventually able to return to their sports at the same level.

The authors conclude that laser shrinkage can be an effective treatment for MDI. However, they point out that certain parts of the capsule resist shrinking with the laser. This means that some sutures may still be necessary, even when the laser is used. The authors say that more long-term studies are needed. They are continuing to follow the original patients and plan to report on how these patients are doing four to six years after having surgery.

The Art and Science of Knee Surgeries

Knee surgeries are becoming more and more common. In the past few decades, there have been many advances in technology, knowledge, and procedures. Knee surgery is no longer a last-ditch effort to relieve pain. More and more middle-aged patients are looking at knee surgery as a way to remain active despite osteoarthritis of the knee.

Middle-aged, active patients can pose a challenge for orthopedic doctors and surgeons. Surgery results need to last these patients for many years of hard use. The authors of this article stress that an effective knee surgery depends on good surgical technique and picking the best type of surgery for the patient. The authors highlight several factors to weigh when choosing a procedure, including:


  • the underlying condition that caused the damage

  • the patient’s goals for life after surgery

  • other problems with the joint or leg

  • complications of the procedure

  • how long the repair or reconstruction needs to last

  • the ability to do more surgeries or a joint replacement in the future

  • the skill of the surgeon in the particular technique.

The authors reviewed and summarized many studies on some types of knee surgeries for middle-aged patients with osteoarthritis. The procedures discussed are:

  • arthroscopic debridement

  • ligament reconstruction

  • realignment osteotomy

  • unicompartmental arthroplasty

  • total knee arthroplasty.

Looking for information on the benefits and problems of different types of knee surgeries? If so, this news is for you.

New Evidence Supports Meniscal Repair in People Who Are 40-Something

Over 40 with a meniscus tear in your knee? Nowadays, doctors will probably choose to repair–rather than remove–your injured tissue. Repair is now possible even when the tear is in the avascular zone, the part of the meniscus without blood supply. In the past, doctors hesitated to do repairs in the avascular zone, for fear that lack of blood would keep it from healing.

The meniscus is a crescent-shaped piece of cartilage in the knee. The meniscus acts like a shock absorber to help spread out the forces that press on the knee joint. Without a meniscus, the forces are concentrated onto a smaller area. The meniscus is very important to the long-term health of the knee. Doctors have become aware that surgically removing the meniscus can lead to early arthritis in the knee joint.

This study was designed to test the long-term affect of surgically repairing the avascular zone of the meniscus in a group of 30 patients who were 40 years and older. Rehabilitation treatments after the surgery proceeded cautiously. Patients started out with treatments to help get the knee moving again, but only in a limited zone of movement. They had to wait up to six weeks to work the full amount of knee bend. They were also limited for up to six weeks in the amount of weight they could bear when walking. To further protect the repaired meniscus, they were not allowed to squat down for four months and had to wait at least six months before running, jumping, or twisting the knee.

Researchers followed up on all but one of the patients an average of 33 months after surgery. Six patients needed additional arthroscopic knee surgery for various reasons, so the researchers were able to actually look at the repaired meniscus with the arthroscope. All patients filled out surveys about their sports, work, and general activities, their symptoms, and how they felt about their knee’s recovery.

Fears about poor surgical results in the avascular zone appear to have been unfounded. An astounding 87% of the repairs were symptom-free at follow-up. And 76% of the patients reported that their overall knee condition was “normal to very good.” The authors attribute this success to new advances in knee surgery and the precautions taken during rehabilitation.

Getting Real about Meniscus Surgery

Asking patients about their pain or symptoms after meniscus surgery doesn’t always give a complete picture of their recovery. A recent study showed that after three months, patients reported that their pain and symptoms had improved–but their capabilities, activity levels, and quality of life hadn’t.

The authors first wanted to get a picture of what doctors expected from recovery after meniscus surgery. They asked 17 surgeons how long it should take patients to recover. Answers varied between two and 12 weeks. The surgeons were also asked what made recovery time longer. Opinions on this topic varied as well. Most surgeons felt that an accompanying injury to ligaments or articular cartilage lengthens recovery time. Others thought that tears in the lateral meniscus, gender, and a longer period of time from injury to surgery could make a difference. One doctor even reported that not being physically active before surgery made the recovery time slower.

The authors then submitted questions to 79 patients who underwent meniscus surgery. This is the first study using specialized surveys to measure patients’ activity levels, quality of life, and ability to function both before and after surgery. The patients answered the surveys before surgery and 14 weeks after surgery.

Results showed that most patients had improved knee movement, swelling, and pain. However, the researchers were startled by the patients’ lack of activity after surgery. Only 30% of patients were active in sports after the surgery, compared to 63% who were active before surgery. Almost 40% reported that they were sedentary after surgery, compared to only 9% before the surgery.

As some surgeons predicted, people with injured articular cartilage and those with significant problems before their surgeries ended up with lower quality of life scores three months after the surgery. But factors like gender, age, and a longer period of problems before surgery didn’t seem to have any impact.

In the final analysis, the authors suggest that having less pain and symptoms doesn’t necessarily tell the whole story about the recovery process. Measurements of function, quality of life, and activity levels gave a much better idea about how patients were doing after surgery. The authors conclude that these types of surveys should be used for patients undergoing meniscus surgery. And based on the results of this study, the authors feel that patients should be given a more realistic idea of what to expect after meniscus surgery.

Testing the “Sixth Sense” in Patients with Knee Arthritis

The ability to tell where your joints are positioned or how they are moving is called proprioception. Tiny sensors, called proprioceptors, are located in muscles, ligaments, tendons, and joint capsules. They send signals to the central nervous system to keep you in tune with your body’s whereabouts.

This “sixth sense” gets a little fuzzy as we age or when we get fatigued. Scientists thank that joint problems like osteoarthritis can impair proprioception. This recent study investigated whether knee osteoarthritis disturbs sensory signals from the knee.

Researchers used a dynamometer to get precise measurements of joint proprioception. The dynamometer is a machine that can be set to move a joint at a certain speed through a preset arc of motion. It then gives a computer readout of speed, direction, and joint angle. Patients are tested to see if they can tell where their joint is positioned or which direction it is moving.

The authors tested 117 patients who were scheduled for knee replacement surgery because of knee arthritis. First, they compared the results of the patients to people of the same age without arthritis. Second, they compared signals between knees in patients who had one healthy knee and one arthritic knee. Third, they tested whether joint sense was worse in the most arthritic knees.

People with arthritis scored significantly lower than people with healthy knees, supporting the theory that osteoarthritis impairs joint sense. Unexpectedly, people with knee osteoarthritis in one knee showed impairments in the other knee, too, even when it appeared normal on X-rays. And joint sense didn’t necessarily decline as osteoarthritis worsened.

These results made the authors question whether the muscle and ligament problems from osteoarthritis really are responsible for problems with proprioception. The authors speculate that impairments in joint sense might start even before the problems of knee osteoarthritis can be seen. They conclude that further studies are necessary to understand the relationship between problems with joint sense and osteoarthritis.

The Total Truth about Total Joints

Total joint replacement is very successful for most people. As a result, it has become much more common–and its drawbacks are becoming more obvious. One of the major problems with artificial joints is called creep. Creep is a gradual change in the shape of the plastic as it is pressed down. Creep tends to happen within the first 18 months of surgery.

A bigger problem is joint wear, erosion of the replacement parts that happens over the life of the joint. As the parts rub or move against each other, the joint starts to wear, causing small wear particles to build up in the joint. The wear particles are like the sawdust that results from sanding a piece of wood.

Today’s replacement parts are affected by different causes of wear. Adhesion happens when the bonded surfaces get pressed together, causing one of them to loosen up. Abrasion is when the harder surface rubs the softer one like sandpaper, releasing wear particles into the joint. Fatigue is when the components get overstressed from heavy or repeated activity, contributing to wear particles and to possible failure of the artificial joint.

Some types of joint wear are unavoidable. Other types of wear happen when the parts rub and move in unintended ways. The authors highlight some of the causes of wear, including problems with anchoring the replacement joint, unusual stresses, and methods of sterilizing the components.

The authors also addressed the problem of bone loss in the bone that connects to the replacement parts. This bone loss is called bone resorption. It happens from a reaction to the small wear particles that build up. It can also happen if the artificial joint somehow allows the bone to come in contact with joint fluid.

The authors conclude that improving the durability of artificial joints requires finding ways to limit wear and the resulting wear particles. It will also require finding ways to keep joint fluid from coming into contact with the underlying bone.

The Great Exercise Debate

People should exercise from 20 to 60 minutes, at least three days a week. No debate there, right? Wrong. Recently, the health world has been debating whether exercise periods need to be done all in one chunk, or whether smaller amounts of exercise can be added up over the course of a day to equal 20 to 60 minutes of exercise.

There hasn’t been much research to clarify the debate. The goal of this study was to test the theory that exercise results in the same energy
expenditure (EE) whether done all at once or over the whole day. Thirty women wore a device to measure their EE over three days. On one of the days, they took a brisk 30-minutes walk. On another, they took three brisk 10-minute walks. On the third day, they didn’t do any exercise.

As expected, the walking days resulted in higher EE. But the researchers found that the days of continuous 30-minute walking resulted in significantly higher EE than the days of three 10-minute walks. In fact, the women’s EE rates were higher throughout the day when they took a 30-minute walk, even when they were done exercising.

The authors related a separate study that was recently published. It was done with very overweight subjects and showed opposite results.
It found that breaking the exercise sessions into smaller amounts of time is at least as good as one longer exercise period. The authors of this study aren’t sure what accounts for the differences between the two studies. They suggest more research will be needed to find out which variables affect how, why, and when people exercise. 

Elderly People Are Hip, Except When They Fall

It’s one thing to design prevention programs to help elderly people avoid a serious fall. It’s another to figure out why some folks have have a greater risk of having such a fall. Knowing the root of the problem could help refine treatments and reduce the cost and suffering associated with falls.

Researchers used three-dimensional technology to see if hip tightness could be related to fall risk in the elderly. Healthy elderly people were compared to a group of peers who’d fallen at least twice in the previous year. The measurements were also compared to the scores of a group of healthy young people.

All subjects were analyzed while they walked at a comfortable pace. The two elderly groups were also scored as they walked quickly. Calculations were taken of how far the hip, knee, and ankle joints moved. Researchers saw the most difference in extension of the hip joint. (While walking, the hip extends when the leg is back.)

Hip extension angles stayed the same in the elderly subjects, even when they walked faster. This is significant, because it means their hips didn’t extend nearly as far as younger subjects. Another major discovery was that hip extension was most limited in the elderly people who’d fallen in the past. Could this be a factor in why some elderly people are at risk falling? If it is, a stretching program to improve hip extension might lower the chances of an elderly person having a fall.

The authors suggest that future studies need to test whether a stretching program to help improve hip extension could help elderly people walk better and keep them from falling.

Right or Left? Neck Surgeons Don’t Have to Choose Sides

When operating on the spine through the front of the neck, surgeons have to decide whether to make the incision on the right or left side of the neck. It used to be that they went in through the left to avoid hurting the recurrent laryngeal nerve, or RLN.

The RLN hooks up with the voice box (larynx). The nerve takes a windier path getting there on the right side of the neck. Some doctors think this puts the nerve at risk for injury when surgery is done through the right side. Damage to this nerve can cause hoarseness or even loss of speech if the vocal cord is paralyzed.

To determine whether surgery on the right or left side was more likely to lead to RLN injury, the authors examined the cases of 328 patients who had surgery to fuse the spine through the front of their necks. One hundred eighty-six of the patients were men; 142 were women. Their ages ranged from 7 to 82 years old. Four different surgeons performed the operations. One hundred seventy-three surgeries were from the right; 155 were from the left.

Patients were said to have RLN injury if they had hoarseness lasting at least two weeks after surgery. Out of 328 patients, nine (2.9 percent) had RLN injuries. Seven patients’ symptoms went away within three months. The other two patients had ongoing symptoms that were identified as vocal cord paralysis. These two patients had been operated on from the left.

Overall, though, whether the surgery was on the right or left side didn’t make much difference for RLN injuries. The percentage of patients with injuries was 2.3 percent for those operated on from the right and 3.2 percent for those operated on from the left. In other words, the level of risk was nearly the same for both sides.

Patients’ chance of RLN injury didn’t depend on the type of procedure they had or whether special medical instruments were used. Chances of RLN injury didn’t change if patients were having more than two discs fused. However, patients who were on their second operation of this type were more prone to RLN injury than those who hadn’t had this kind of procedure before. For patients having their second surgery, the risk of RLN injury rose to 9.5 percent.

In general, this study suggests that surgeons can safely operate from whichever side of the neck they choose. In the case of repeat surgeries, surgeons should make their choice based on a thorough patient evaluation to reduce risk of injury.

Recovering Your Balance after ACL Surgery

Many parts of the body are involved in balance, including the eyes, inner ear, neck, trunk, and legs. Balance depends on the reflexes of each of these parts and the communication between them. An injury anywhere in this system can impact balance.

As a major stabilizer of the knee joint, the anterior cruciate ligament (ACL) is crucial to balance. If you tear your ACL, standing on one foot may be difficult. This is because the ligament loses its ability to steady the joint, and the tiny sensors in the knee ligaments, joints, and muscles have difficulty sending information about the joint’s position. Balancing becomes a challenge. But what if you have ACL surgery? Will your balance return to normal?

This study involved 25 patients with mainly sports-related ACL injuries. Eight of the patients were women; 17 were men. Their average age was 27. All of the patients had ACL reconstruction surgery. After surgery, half of them wore casts, and the other half wore braces and started exercises right away to improve knee movement. They all had six to eight months of rehabilitation training to restore the reflexes in their injured legs.

About three years after surgery, patients did a series of balance tests. First, they balanced on one or both feet with their eyes open and then with their eyes closed. Special sensors detected how much patients swayed back and forth in these positions. Next, the patients stood on one foot on a moving surface with their eyes open. Sensors recorded patients’ reaction times and how long it took for them to correct their balance. As a comparison, a group of people the same age with uninjured knees did these same tests.

Since one goal of ACL surgery is to restore the stability of the injured knee, the patients’ knees were also tested for looseness. Their injured knees were still looser three years after surgery than their uninjured knees or the knees of the comparison group.

Even though the operated knees were looser, balance was nearly the same between patients who had ACL injuries and the comparison group–with two exceptions. Patients who had ACL surgery had slower reaction times when the surface beneath them moved. But compared to the other group, they regained their balance faster. This may be because the ACL patients had learned to compensate for their injury.

The results of this study suggest that balance can be restored after ACL surgery. This goal is maximized with a rehabilitation program that focuses on retraining balance in the knee.

Mapping the Body’s Response to Exercise

Some research doesn’t offer much practical information for the general public. But it does expand our knowledge of how the body works. Some day, this knowledge may help us take better care of ourselves.

This is one of those studies. Researchers in Japan used positron emission tomography (PET) to study how the body burns energy at rest and during exercise. PET technology involves using radioactive tracers that show up on a special kind of film. Doctors and scientists use PET tests to measure the activity, or metabolism, of tissues in the body. Tissues that show a high uptake of the radioactive tracers are very active, with a high metabolism.

The authors divided 12 healthy men into two groups. One group sat quietly in a comfortable chair for 35 minutes. The other group ran for 35 minutes, stopping only to have the radioactive tracer injected into their bloodstream. Both groups then had whole-body PET scans.

Researchers found that the active tissues in the resting group were the heart, the brain, and the organs in the abdomen, including the intestines, liver, and kidneys. The running group had markedly different PET scans. The scan showed a much higher uptake in the leg and heart muscles. There was much less activity in the abdominal organs. Only the brain showed the same metabolic activity, whether running or at rest.

So what does this mean for you? Nothing right now. But it provides a fascinating glimpse of how our bodies adjust to the demands we place on them.

Take a Load off Your Knees while Hiking Uphill: Use Hiking Poles

Carrying a heavy pack can take a heavy toll on a backpacker’s knees, ankles, and hips. Many backpackers believe that hiking poles can make hiking easier and take strain off the knees. Hiking poles are like ski poles that adjust in length. They are commonly used by backpackers in Europe.

Researchers designed this study to test the physical effects of using hiking poles on uphill climbs. Five men and five women, all frequent backpackers, walked for an hour on a treadmill set to a 5% grade. They carried packs that weighed about 30% of their body mass. They were each tested twice, once with and once without poles. Researchers measured heart rate, oxygen consumption, muscle activity, and movements of the trunk and lower limbs.

The results showed that backpackers used longer and fewer strides when using the poles, and they put less stress on their trunk and legs. Using the poles caused the triceps muscles to work harder. And even though pole use increased heart rate slightly, oxygen consumption was the same with or without poles. All participants reported feeling like they were actually working less hard when using poles.

The researchers conclude that using hiking poles for uphill climbs definitely eases the load on the knees and other joints of the legs. They suggest that taking the idea to the mountains might show even better results than simply using a treadmill. This is because the even and steady treadmill doesn’t require nearly as much work with the poles as the uneven ground of the backcountry. Pole use might also help backpackers avoid falls, another cause of injuries associated with backpacking. 

If you plan to try a pair of hiking poles, make sure the equipment fits. In this study, the poles were set to a length where the elbow was bent at a 90-degree angle when standing straight with the pole touching the ground.

Taping Ankles Back to Health

Rehabilitation programs have proven successful in helping people regain stability after an ankle sprain. A hallmark of ankle rehabilitation has been the use of proprioception exercises. Proprioception refers to the awareness of positioning and balance that is sort of like a sixth sense. Proprioception exercises are designed to help patients become aware of joint alignment and positioning. By improving proprioception, the joint’s stability improves.

One type of proprioception exercise involves using a disk platform with a rounded undersurface–sort of like a flying saucer. Patients do special exercises while balancing on the disk. The exercises are designed to work the nerve receptors in and around the injured ankle, leading to improved ankle stability.

In this study, the researchers tested two groups of people with ankle instability. Both groups did exercises on the disk. However, one group also had two small strips of tape on their lower leg, from the outside edge of the foot to midway up the calf. Exercises were done for 10 minutes, five days a week. After 10 weeks, researchers measured ankle instability of the two test groups and a group of people with no ankle problems.

The group wearing tape showed dramatically better stability within four weeks. By six weeks, they were nearly as stable as the healthy group. Remarkably, their recovery rate was about two weeks faster than the group who did exercises without wearing the tape.

That may sound wacky, but there is a scientific reason behind the tape. The sural nerve supplies the sensation to the skin under the tape. Scientists think that the tape pulls on the skin, which stimulates the nerve. The stimulated nerve then keeps the surrounding muscles and ligaments alert to the position of the ankle joint.

Low-tech and unglamorous though it is, the tape definitely appeared to work in this study. This is good news for patients with ankle sprains who need to get back to their regular activities quickly.