Functional Knee Brace after Anterior Cruciate Ligament Reconstruction not recommended.
I have often expressed my personal dislike of the over use of bracing in general and feel that in most cases it is over utilized. This study supports my previous statements that functional knee brace's are not helpful and we should focus on Rehabilitation not bracing.
A Randomized Controlled Trial Comparing the Effectiveness of Functional Knee Brace and Neoprene Sleeve Use After Anterior Cruciate Ligament Reconstruction
Trevor B. Birmingham, PhD†,‡,*,
Dianne M. Bryant, PhD†,‡,
J. Robert Giffin, MD, FRCS(C)†,‡,
Robert B. Litchfield, MD, FRCS(C)†,‡,
John F. Kramer, PhD‡,
Allan Donner, PhD‡, and
Peter J. Fowler, MD, FRCS(C)†,‡
+
Author Affiliations
From the †Fowler Kennedy Sport Medicine Clinic, and the ‡University of Western Ontario, London Ontario, Canada
Address correspondence to Trevor B. Birmingham, PhD, School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada N6G 1H1 (e-mail: tbirming@uwo.ca).
Abstract
Background: Despite a lack of evidence for their effectiveness, functional knee braces are commonly prescribed to patients after anterior cruciate ligament (ACL) reconstruction.
Purpose: This trial was conducted to compare postoperative outcomes in patients using an ACL functional knee brace and patients using a neoprene knee sleeve.
Hypothesis: Patients using a brace will have superior outcomes than those using a sleeve.
Study Design: Randomized controlled clinical trial; Level of evidence, 1.
Methods: One hundred fifty patients were randomized to receive a brace (n = 76) or neoprene sleeve (n = 74) at their 6-week postoperative visit after primary ACL reconstruction with hamstring autograft. Patients were assessed preoperatively, then 6 weeks and 6, 12, and 24 months postoperatively. Outcome measures included disease-specific quality of life (Anterior Cruciate Ligament–Quality of Life [ACL-QOL] Questionnaire), anterior tibial translation (KT-1000 arthrometer side-to-side difference), the single-limb forward hop test (limb symmetry index), and Tegner Activity Scale. Outcomes at 1 and 2 years were compared after adjusting for baseline scores. Subjective ratings of how patients felt while using the brace/sleeve were also collected for descriptive purposes using a questionnaire. Four a priori directional subgroup hypotheses were evaluated using tests for interactions.
Results: There were no significant differences between brace (n = 62) and sleeve (n = 65) groups for any of the outcomes at 1- and 2-year follow-ups. Adjusted mean differences at 2 years were as follows: −0.94 (95% confidence interval [CI], −7.52 to 5.64) for the ACL-QOL Questionnaire, −0.10 mm (95% CI, −0.99 to 0.81) for KT-1000 arthrometer side-to-side difference, −0.87% (95% CI, −8.89 to 7.12) for hop limb symmetry index, and −0.05 (95% CI, −0.72 to 0.62) for the Tegner Activity Scale. Subjective ratings of confidence in the knee provided by the brace/sleeve were higher for the brace group than the sleeve group. Subgroup findings were minimal. Adverse events were few and similar between groups.
Conclusions: A functional knee brace does not result in superior outcomes compared with a neoprene sleeve after ACL reconstruction. Current evidence does not support the recommendation of using an ACL functional knee brace after ACL reconstruction.
Keywords:
anterior cruciate ligament (ACL) reconstruction
functional knee brace
neoprene sleeve, randomized clinical trial (RCT)
Footnotes
Wednesday, November 30, 2011
Friday, November 18, 2011
Dangers of backpacks just around the corner!
Back to school time, physician visits, school supplies and floods of backpacks
Elementary, High School and College students alike will all be heading off again to school with those famous backpacks strapped to their backs.
Parents start gearing up for the school year wondering how severe flu season will be or if there will be another chicken pox outbreak. Among all those health concerns drifting in and out of the minds of parents everywhere, backpacks should be the top of the list.
Overweight backpack strapped around the shoulders worn on the back can not only cause pain, fatigue and lead to bad posture other serious conditions can occur like early wear and tear syndrome and spine compression.Health practitioners agree that should not carry a backpack that is more than 15% of their body weight. Other recommended guidelines include; backpack straps should be padded and contoured to fit them. Both straps need to be worn to distribute the weight evenly. The Orthopedic Connection has Backpack Safety page filled with valuable information for parents concerning backpack safety for their children.
Most worries concerning these backpacks are the unnecessary weight of the packs. As the child grows older not only does the grade level go up but so do the amount of text books the child needs for school. Schools today now choose not to use lockers and if they do a child does not have enough time in between classes to go to the locker, unload books and reload. More and more low back pain in children is being seen. Adding to the list of that heavy back children tend to add in their personal items. These heavy backpacks at times have the child arching the back which can lead the spine to compress in an unnatural manner. Then there is that “cool look” of wearing that backpack over one shoulder. Little do they realize this action can cause them lower and upper back pain not to mention a strain in their neck or shoulders. Walking with this heavy pack increases their risk of falling especially on stairs or other areas where it is uneven.
A survey conducted by Backpack Safety International™ was to determine the volume of injuries due to heavy backpacks on patients aged five to eighteen years old. The survey was answered by North American Chiropractors and some of the results are as follows;
181 chiropractors saw patients aged 5 to 18 who reported back, neck or shoulder pain due to heavy backpacks. The most common diagnoses were subluxations.
Chiropractors can offer more for that beginning school year for children by providing preventive wellness care and maintain the body’s structure. Plus chiropractors deal with a variety of conditions for children including asthma, colic, sports injuries and more.
When your child goes off to school and you begin to notice any of the following:
They are having difficulty putting on or removing the backpack.
Complaints of tingling or numbness in the arm.
Complain their back hurts.
You notice their posture has changed with or without the backpack.
You notice a red mark on back, neck or shoulders.
They have discomfort in shoulder, arm, legs, back or neck.
It is time to your call your chiropractor before any more problems arise or the current ones worsen. Chiropractors are licensed and trained. When it comes to children they receive that extra special care. Many states now consider chiropractors as a general practitioner.
Among all the health checks and shopping runs it may not be a bad idea to stop at your chiropractor and make sure your child’s spine is in top condition for the upcoming school year.
- examiner.com
Elementary, High School and College students alike will all be heading off again to school with those famous backpacks strapped to their backs.
Parents start gearing up for the school year wondering how severe flu season will be or if there will be another chicken pox outbreak. Among all those health concerns drifting in and out of the minds of parents everywhere, backpacks should be the top of the list.
Overweight backpack strapped around the shoulders worn on the back can not only cause pain, fatigue and lead to bad posture other serious conditions can occur like early wear and tear syndrome and spine compression.Health practitioners agree that should not carry a backpack that is more than 15% of their body weight. Other recommended guidelines include; backpack straps should be padded and contoured to fit them. Both straps need to be worn to distribute the weight evenly. The Orthopedic Connection has Backpack Safety page filled with valuable information for parents concerning backpack safety for their children.
Most worries concerning these backpacks are the unnecessary weight of the packs. As the child grows older not only does the grade level go up but so do the amount of text books the child needs for school. Schools today now choose not to use lockers and if they do a child does not have enough time in between classes to go to the locker, unload books and reload. More and more low back pain in children is being seen. Adding to the list of that heavy back children tend to add in their personal items. These heavy backpacks at times have the child arching the back which can lead the spine to compress in an unnatural manner. Then there is that “cool look” of wearing that backpack over one shoulder. Little do they realize this action can cause them lower and upper back pain not to mention a strain in their neck or shoulders. Walking with this heavy pack increases their risk of falling especially on stairs or other areas where it is uneven.
A survey conducted by Backpack Safety International™ was to determine the volume of injuries due to heavy backpacks on patients aged five to eighteen years old. The survey was answered by North American Chiropractors and some of the results are as follows;
181 chiropractors saw patients aged 5 to 18 who reported back, neck or shoulder pain due to heavy backpacks. The most common diagnoses were subluxations.
Chiropractors can offer more for that beginning school year for children by providing preventive wellness care and maintain the body’s structure. Plus chiropractors deal with a variety of conditions for children including asthma, colic, sports injuries and more.
When your child goes off to school and you begin to notice any of the following:
They are having difficulty putting on or removing the backpack.
Complaints of tingling or numbness in the arm.
Complain their back hurts.
You notice their posture has changed with or without the backpack.
You notice a red mark on back, neck or shoulders.
They have discomfort in shoulder, arm, legs, back or neck.
It is time to your call your chiropractor before any more problems arise or the current ones worsen. Chiropractors are licensed and trained. When it comes to children they receive that extra special care. Many states now consider chiropractors as a general practitioner.
Among all the health checks and shopping runs it may not be a bad idea to stop at your chiropractor and make sure your child’s spine is in top condition for the upcoming school year.
- examiner.com
Wednesday, November 16, 2011
Cold Laser Therapy, Shingles Post Herpatic Neuralgia
Cold Laser Therapy, Shingles Post Herpatic Neuralgia
Laser Therapy and Pain Relief
Laser Therapy and Pain Relief
By James White, DC and Kendra Kaesberg-White, DC
Light amplification of stimulated emission of radiation (laser) is a light beam from the electromagnetic spectrum. Unlike conventional light sources a laser beam travels in only one direction and is monochromatic with its photons (little packets of energy) which are all identical in size, traveling equidistant in time and space.
Low-level laser therapy (LLLT) has been investigated and used clinically for over 30 years, mostly in Eastern Europe and Asia. The ability of lasers to cut, cauterize and destroy tissue is well known. These same or similar lasers at lower powers can nonthermally and nondestructively alter cellular function. This phenomenon, known as laser biostimulation, is the basis for the current use of lasers to treat a variety of articular, neural and soft tissue conditions.1
A variety of names have been used to describe the same type of low-level laser: biostimulation, low energy, low reactive, low intensity, soft and or cold laser. In current practice, LLLT uses low output levels (15100 mW), short treatment times (10-240 seconds), and low energy levels (1-4 J/cm2).1
The mechanism and effectiveness of LLLT has been compared with ultrasound therapy,2 and should be considered as an extension to the accepted physiotherapy modalities that currently utilize parts of the electromagnetic spectrum, such as shortwaves, microwaves, infrared, and ultraviolet therapy.1
Lasers produce nonionizing, electromagnetic radiation that is extremely monochromatic, polarized and coherent.3 Laser light has been reported to penetrate human tissue in the ranges of .8-15mm,4,5 but the majority of the light will be absorbed within the first 4mm.6,7 Although this may seem superficial, it should be noted that chemical processes may be initiated and mediate physiological effects at a deeper level.8
The initial studies utilizing LLLT on nerve tissue produced mixed results regarding nerve conduction velocity and distal latency. These earlier studies utilized low powered HeNe lasers (<=1mW) and resultant low energy densities (<=.012 J/cm2).1 More recent studies utilizing higher energy densities and deeper penetrating lasers have found alterations in distal nerve latency and conduction velocity by a few to many percent, and which can last for periods of 30 minutes or greater.1,9-11
It appears that nerve tissue has a photosensitive component, which results in a biostimulation blockade response following laser exposure.12 It is felt that LLLT reduces the excitability of the nerve cells by an interruption of the fast pain fibers with a resultant reduction in pain.12-15 LLLT has also been shown to accelerate the repair process of crush damaged nerves and improve function in both the CNS and peripheral nerves after injury.1,16-18 Laser Safety LLLT is a relatively safe procedure. Due to the low level, nonthermal nature of the laser, there is no tissue destruction or other hazards that you would find associated with the higher powered lasers. The FDA has classified the most commonly used low level lasers as a class III, nonsignificant risk, medical device for investigations use only.19 Because of the coherent nature of the laser beam, ocular damage is the main concern for the LLLT user. The operator should not attempt to stare directly into the beam. Suitable goggles to attenuate the wavelengths would be used by both the operator and patient.20 Other suggested contraindications would be to avoid exposure to sensitive tissue such as fetus, gonads and malignancy.20 Clinical Studies A number of papers have shown a reduction of pain with laser treatments directed over acupuncture points.21-24 Altered skin resistance with a reduction of pain were also noted in subjects who receive LLLT over muscular trigger points.25-26 A group of subjects with chronic tendinopathies, that had been previously treated unsuccessfully with physical therapy, NSAIDS, local injections, and or surgery, had an 87 percent success rate in pain reduction following the application of LLLT.27 In a study involving over 4,000 subjects who had suffered from conditions such as degenerative arthritis; muscle pain; tendinitis and tension myalgia. More than 80 percent of the subjects found a marked lessening of their symptoms following irradiation with an IR laser.28-30 In a study involving a total of 69 subjects and 302 total laser treatment sessions, more that 80 percent of the subjects with chronic radiculopathies and over 90 percent of the subjects with chronic neuropathies experienced a greater than 50 percent total relief of pain following LLLT.14
In a similar study involving 60 total patients and 111 total laser treatments, it was shown that LLLT produced an immediate reduction of pain in 79 percent of the subjects.15 In a study involving over 100 subjects and over 500 laser treatments, it was observed that acute soft tissue pain syndromes showed a dramatic response following the initial laser treatment with a marked reduction in tissue swelling, bruising and good pain relief.31 Subsequent treatments (2-3) produced further improvement.31 It was also noted that chronic pain syndromes were slower to respond to LLLT (average of eight treatments), although 75 percent of the subjects noted significant pain relief.31 A two-stage survey of 116 chartered physiotherapists in Northern Ireland, who utilize LLLT as part of their clinical practice, ranked LLLT effective for the treatment of myofascial and postoperative pain syndromes; rheumatoid arthritis; muscle tears; hematomas; tendinitis; shingles; herpes simplex; scarring; burn and would healing.32 In this same survey, LLLT was ranked first, on the basis of relative effectiveness, when compared with four other modalities (interferential therapy, shortwave diathermy, ultrasound, and pulsed electromagnetic therapy), for use in pain relief and wound healing.32
Suggested Mercy Conference Review Low Level Laser Therapy: Low level laser therapy (LLLT) is a conservative procedure that utilized visible red and/or infrared regions of the electromagnetic spectrum. It is used as a physiotherapy modality for a variety of articular, neural and soft tissue conditions. Rating: Investigational to promising, awaiting FDA approval.
Evidence: Class I, II, III. Conclusions Laser therapy is gaining laboratory and clinical data to prove its effectiveness. LLLT has gained acceptance for treating a variety of osseous, neural and soft tissue conditions in many parts of the world. The acceptance in the U.S. has been limited because of the rigors of the FDA approval process. Many of the earlier studies involving laser use lacked proper scientific controls. Today there are many controlled studies that are well-designed and multicentered. These studies include the use of modern electrodiagnostic and magnetic resonance imaging to monitor the subjects response in an effort to objectively study the role of LLLT in treating neuromusculoskeletal pain. There is a current need for clinical investigators to research these new laser medical devices. Additional research is required to obtain data concerning success rates in treating specific conditions, length of exposure, frequency of treatments, and related therapeutic protocols. James J. White, DC Kendra Kaesberg-White, DC Belleville, Illinois http://www.rosachiropractictemplehills.com/
Laser Therapy and Pain Relief
By James White, DC and Kendra Kaesberg-White, DC
Light amplification of stimulated emission of radiation (laser) is a light beam from the electromagnetic spectrum. Unlike conventional light sources a laser beam travels in only one direction and is monochromatic with its photons (little packets of energy) which are all identical in size, traveling equidistant in time and space.
Low-level laser therapy (LLLT) has been investigated and used clinically for over 30 years, mostly in Eastern Europe and Asia. The ability of lasers to cut, cauterize and destroy tissue is well known. These same or similar lasers at lower powers can nonthermally and nondestructively alter cellular function. This phenomenon, known as laser biostimulation, is the basis for the current use of lasers to treat a variety of articular, neural and soft tissue conditions.1
A variety of names have been used to describe the same type of low-level laser: biostimulation, low energy, low reactive, low intensity, soft and or cold laser. In current practice, LLLT uses low output levels (15100 mW), short treatment times (10-240 seconds), and low energy levels (1-4 J/cm2).1
The mechanism and effectiveness of LLLT has been compared with ultrasound therapy,2 and should be considered as an extension to the accepted physiotherapy modalities that currently utilize parts of the electromagnetic spectrum, such as shortwaves, microwaves, infrared, and ultraviolet therapy.1
Lasers produce nonionizing, electromagnetic radiation that is extremely monochromatic, polarized and coherent.3 Laser light has been reported to penetrate human tissue in the ranges of .8-15mm,4,5 but the majority of the light will be absorbed within the first 4mm.6,7 Although this may seem superficial, it should be noted that chemical processes may be initiated and mediate physiological effects at a deeper level.8
The initial studies utilizing LLLT on nerve tissue produced mixed results regarding nerve conduction velocity and distal latency. These earlier studies utilized low powered HeNe lasers (<=1mW) and resultant low energy densities (<=.012 J/cm2).1 More recent studies utilizing higher energy densities and deeper penetrating lasers have found alterations in distal nerve latency and conduction velocity by a few to many percent, and which can last for periods of 30 minutes or greater.1,9-11
It appears that nerve tissue has a photosensitive component, which results in a biostimulation blockade response following laser exposure.12 It is felt that LLLT reduces the excitability of the nerve cells by an interruption of the fast pain fibers with a resultant reduction in pain.12-15 LLLT has also been shown to accelerate the repair process of crush damaged nerves and improve function in both the CNS and peripheral nerves after injury.1,16-18 Laser Safety LLLT is a relatively safe procedure. Due to the low level, nonthermal nature of the laser, there is no tissue destruction or other hazards that you would find associated with the higher powered lasers. The FDA has classified the most commonly used low level lasers as a class III, nonsignificant risk, medical device for investigations use only.19 Because of the coherent nature of the laser beam, ocular damage is the main concern for the LLLT user. The operator should not attempt to stare directly into the beam. Suitable goggles to attenuate the wavelengths would be used by both the operator and patient.20 Other suggested contraindications would be to avoid exposure to sensitive tissue such as fetus, gonads and malignancy.20 Clinical Studies A number of papers have shown a reduction of pain with laser treatments directed over acupuncture points.21-24 Altered skin resistance with a reduction of pain were also noted in subjects who receive LLLT over muscular trigger points.25-26 A group of subjects with chronic tendinopathies, that had been previously treated unsuccessfully with physical therapy, NSAIDS, local injections, and or surgery, had an 87 percent success rate in pain reduction following the application of LLLT.27 In a study involving over 4,000 subjects who had suffered from conditions such as degenerative arthritis; muscle pain; tendinitis and tension myalgia. More than 80 percent of the subjects found a marked lessening of their symptoms following irradiation with an IR laser.28-30 In a study involving a total of 69 subjects and 302 total laser treatment sessions, more that 80 percent of the subjects with chronic radiculopathies and over 90 percent of the subjects with chronic neuropathies experienced a greater than 50 percent total relief of pain following LLLT.14
In a similar study involving 60 total patients and 111 total laser treatments, it was shown that LLLT produced an immediate reduction of pain in 79 percent of the subjects.15 In a study involving over 100 subjects and over 500 laser treatments, it was observed that acute soft tissue pain syndromes showed a dramatic response following the initial laser treatment with a marked reduction in tissue swelling, bruising and good pain relief.31 Subsequent treatments (2-3) produced further improvement.31 It was also noted that chronic pain syndromes were slower to respond to LLLT (average of eight treatments), although 75 percent of the subjects noted significant pain relief.31 A two-stage survey of 116 chartered physiotherapists in Northern Ireland, who utilize LLLT as part of their clinical practice, ranked LLLT effective for the treatment of myofascial and postoperative pain syndromes; rheumatoid arthritis; muscle tears; hematomas; tendinitis; shingles; herpes simplex; scarring; burn and would healing.32 In this same survey, LLLT was ranked first, on the basis of relative effectiveness, when compared with four other modalities (interferential therapy, shortwave diathermy, ultrasound, and pulsed electromagnetic therapy), for use in pain relief and wound healing.32
Suggested Mercy Conference Review Low Level Laser Therapy: Low level laser therapy (LLLT) is a conservative procedure that utilized visible red and/or infrared regions of the electromagnetic spectrum. It is used as a physiotherapy modality for a variety of articular, neural and soft tissue conditions. Rating: Investigational to promising, awaiting FDA approval.
Evidence: Class I, II, III. Conclusions Laser therapy is gaining laboratory and clinical data to prove its effectiveness. LLLT has gained acceptance for treating a variety of osseous, neural and soft tissue conditions in many parts of the world. The acceptance in the U.S. has been limited because of the rigors of the FDA approval process. Many of the earlier studies involving laser use lacked proper scientific controls. Today there are many controlled studies that are well-designed and multicentered. These studies include the use of modern electrodiagnostic and magnetic resonance imaging to monitor the subjects response in an effort to objectively study the role of LLLT in treating neuromusculoskeletal pain. There is a current need for clinical investigators to research these new laser medical devices. Additional research is required to obtain data concerning success rates in treating specific conditions, length of exposure, frequency of treatments, and related therapeutic protocols. James J. White, DC Kendra Kaesberg-White, DC Belleville, Illinois http://www.rosachiropractictemplehills.com/
Tuesday, November 1, 2011
Stretching and Jump performance whats the best method? New Study takes a look.
The Acute Effects of Different Stretching Exercises on Jump Performance
by Pacheco, Laura; Balius, Ramon; Aliste, Luisa; Pujol, Montse; Pedret, Carles
Pacheco, L, Balius, R, Aliste, L, Pujol, M, and Pedret, C. The acute effects of different stretching exercises on jump performance. J Strength Cond Res 25(11): 2991–2998, 2011—
The purpose of this study was to demonstrate the short-term effects of different stretching exercises during the warm-up period on the lower limbs.
A controlled, crossover clinical study involving 49 volunteers (14 women and 35 men; mean age: 20.4 years) enrolled in a "physical and sporting activities monitor" program. The explosive force was assessed using the Bosco test. The protocol was as follows:
The test involved a (pre) jump test, general warm-up, intervention and (post) jump test. Each volunteer was subjected to each of the 5 interventions (no stretching [NS] and stretching: static passive stretching [P]; proprioceptive neuromuscular facilitation [PNF] techniques; static active stretching in passive tension [PT]; static active stretching in active tension [AT]) in a random order. The jump test was used to assess the squat jump, countermovement jump (CMJ), elasticity index (EI), and drop jump.
An intragroup statistical analysis was performed before and after each intervention to compare the differences between the different stretching exercises. An intergroup analysis was also performed. Significant differences (p < 0.05) were found between all variables for the interventions "P," "PNF," and "TA" in the intragroup analysis, with each value being higher in the postjump test. Only the "P" intervention showed a significant difference (p = 0.046) for "EI," with the postvalue being lower. Likewise, significant differences (p < 0.05) were observed for the "CMJ" measurements during the intergroup analysis, especially between "NS" and the interventions "P," "PNF," "AT," and "PT," with each value, particularly that for "AT," being higher after stretching.
The results of this study suggest that static active stretching in AT can be recommended during the warm-up for explosive force disciplines.
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