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April’s issue of sportEX dynamics features an overview of the following studies with sportEX “take home” messages.
- LEISURE TIME PHYSICAL ACTIVITY OF MODERATE TO VIGOROUS INTENSITY AND MORTALITY: A LARGE POOLED COHORT ANALYSIS. Moore SC, Patel AV, et al. PLOS Medicine 2012;9(11):e1001335
- ATHLETES’ OPINIONS OF FOOD PROVISION AT THE 2010 DELHI COMMONWEALTH GAMES: THE INFLUENCE OF CULTURE AND SPORT. Burkhart S, Pelly SE. International Journal of Sport Nutrition and Exercise Metabolism 2013;23(1):11–23
- EFFECT OF REDUCING TOTAL FAT INTAKE ON BODY WEIGHT: SYSTEMATIC REVIEW AN AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS AND COHORT STUDIES. Hooper L, Abdelhamid A, et al. BMJ 2012;345:e7666
- BILATERAL MYOFASCIAL TRIGGER POINTS AND PRESSURE PAIN THRESHOLDS IN THE SHOULDER MUSCLES IN PATIENTS WITH UNILATERAL SHOULDER IMPINGEMENT SYNDROME: A BLINDED, CONTROLLED STUDY. Alburquerque-Sendín F, Camargo PR. The Clinical Journal of Pain 2013; doi: 10.1097/ AJP.0b013e3182652d65
- THE 21ST CENTURY HAZARDS OF SMOKING AND BENEFITS OF STOPPING: A PROSPECTIVE STUDY OF ONE MILLION WOMEN IN THE UK. Pirie K, Peto R et al. The Lancet, 2013;381(9861):133–141
- WALKING, RUNNING, AND RESTING UNDER TIME, DISTANCE, AND AVERAGE SPEED CONSTRAINTS: OPTIMALITY OF WALK–RUN– REST MIXTURES. Long LL, Srinivasan MJR. Journal of the Royal Society Interface 2013;10(81):20120980
- SCAPULAR POSITIONING ASSESSMENT: IS SIDE-TO-SIDE COMPARISON CLINICALLY ACCEPTABLE? Morais NV, Pascoal AG. Manual Therapy 2013;18(1):46–53
- HUMOR USE IN POWER-DIFFERENTIATED INTERACTIONS. Dunbar N, Banas J, et al. Humor. 2012;25(4):469–489
This journal watch is now live online and available in full through a subscription to leading manual therapy journal, sportEX dynamics. The articles are all written by leading massage practitioners from around the world. The publication is available in print and online as well as on the Apple, Android and Kindle Fire platforms.
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During recent decades, private and national sport organisations have been fostering the creation of multidisciplinary teams in order to give support to their athletes so that they can achieve their objectives with high levels of efficiency. These multidisciplinary teams of specialists, also called high performing teams (HPTs), invariably include masseurs and/or physiotherapists who provide their services in coordination mainly with sport coaches and strength and conditioning (S&C) coaches, but occasionally also with sport scientists, nutritionists and sport psychologists. A clear example of a highly efficient multidisciplinary sport team is British Cycling (BC). We have seen the remarkable success that they have had in the last ten years by winning dozens of medals in the Beijing and London Olympic and Paralympic games, several world championships and the last Tour de France (2012). Every member of that team works toward a common goal (ie. the highest possible performance). But what exactly makes and affects these HPTs?
Sporting success – it’s down to the right people surrounding the most talented athletes
With regard to the elements that influence HPTs, Castka et al. (1) identified two sets of factors which seemed crucial for the successful implementation of HPTs; system factors and human factors (HFs); in turn HFs include: knowledge and skills, needs of the individual and group culture. Pertaining to these HFs, Brian Cookson, BC president, argues that their success, “it’s down to the right people surrounding the most talented athletes who pay that attention to detail in every aspect of their performance and development” (2). Therefore, given the central aspect that HFs have in HPTs, it is appropriate to ask: what human factors and behaviours do team members in HPTs have and show while providing their services to elite athletes?
The author: Noe Orozco, MBPsS and MSc in Psychology of Sport and Exercise.
Noe is from Loughborough University, has provided sport psychological advice for a number of years to national sport bodies, university and local sport clubs, as well as individual athletes in a wide range of sports whether in the heat of the competition or in the consultation room across Europe and North America.
This article “Emotional Intelligence: The Human Factors Needed for Effective Multidisciplinary Teams” is now live online and available in full through a subscription to leading international physical therapy journal, sportEX medicine. The articles are written by leading physical therapists and sports medicine specialists from around the world. The publication is available in print and online as well as on the Apple, Android and Kindle Fire platforms.
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Neck pain is a common and costly diagnosis to the United States (US) and European healthcare systems. It has been predicted that the 1-year prevalence of an onset ranges between 16.7 to 75.1% of US population. Many seek medical attention for treatment and Physical Therapy is often ordered as one of the first approaches in it’s management. An article published in the August edition of the Journal of Orthopaedic and Sports Physical Therapy (JOSPT) compared the effectiveness of two clinical interventions, which Physical Therapists use to treat mechanical neck pain, kinesiotaping and manipulation. You may be surprised with the results.
The authors of this study performed a randomized-controlled trial. Eighty subjects with complaints of mechanical, idiopathic neck pain were randomly assigned into one of two interventional groups. The first group had kinesiotape applied to their posterior neck. The second group received two thrust manipulations directed at the mid-cervical spine and cervicothoracic junction.
Kinesiotape:
This was done by placing one piece of tape extending vertically from the dorsal region of T1-2 to C1-2. A second piece was placed perpendicular, over the midcervical region (C3-6). The subjects were instructed to leave this on for 1 week.
Manipulation:
The mid-cervical manipulation was performed with the patient supine and resting their neck in the therapists hands. The therapist put a finger over the zygapophyseal joint of C3 and gently induced ipsilateral cervical sideflexion and contralateral rotation until slight tension was perceived. The therapist then applied a high-velocity, low amplitude thrust upward and medially in the direction of the subjects contralateral eye.
The cervicalthoracic junction manipulation was applied bilaterallu. The subject was prone with their head and neck rotated to one side (in this case, let’s say left). The therapist stood on the left side, and placed their right thumb against the right side of the spinous process of T1. The therapist’s left hand supported the subject’s head. The head and neck were then gently flexed laterally to the right, until slight tension was perceived. A high-velocity low amplitude thrust was then applied toward the patient’s left side.
Out of the eighty subjects, five reported adverse events from the applied interventions. Three patients in the manipulation group experienced a minor increase in neck pain or fatigue after the manipulations and two patients reported cutaneous irritation related to the tape. These symptoms resolved within 24 hours.
The results of this study demonstrated that kinesiotape and cervical manipulation had similar short-term effects in reducing pain and disability (measured on a Numeric Pain Rating Scale and Neck Disability Index (NDI)). The mean NDI reduction was near 6 points and pain was 2.7 points. Improved ROM also occurred, for both groups, in all planes expect rotation.
My Impression:
I am not surprised by the results of this study. Both interventions undoubtedly have cutaneous effects on the skin. The kinesiotape “pulls” it and the manipulation “stretches” it. We are learning from a neurophysiological perspective that the skin plays a vital role in communicating with the brain, which is responsible for producing the perception of pain. By changing the brain’s perception of that region of the body, it may become less defensive and produce less pain.
I also suspect a placebo effect and expectation for recovery played a role in the results. If one believes something will work, it will likely work. In this case, the participants were consenting to have one of two interventions, which have demonstrated some effectiveness in reducing pain and disability. There was no chance of being a control or receiving a sham intervention (which was likely explained during an informed consent). If you are told you will receive an intervention which has been shown to be effective, then you will likely think it’s effective.
Overall, I believe the study has questionable clinical significance. It looked at and compared the short-term effects of two interventions performed in isolation. Most physical therapists do not perform a single intervention, once a week. A control group was also not included, which would have been beneficial in assessing for placebo effects. I believe this study is a start, but further research needs to be conducted to compare these interventions when used in conjunction with a more typical plan of care.
The author: Joe Brence, physical therapist
Joseph Brence is a doctor of physical therapy from Pennsylvania, USA. He is currently a director of two facilities in Pittsburgh and takes a manual approach to patient care. He is also a contributor to www.physiotherapyinfo.com and www. theptproject.com and is currently working on multiple research projects which he will present to the sportEX community as they are published. To read Joseph’s monthly contributions, click the following link http://eepurl.com/bRGmj
Saavedra-Hernandez M, Castro-Sanchez AM, Arroyo-Morales M, et al. Short-term effects of kinesio taping versus cervical thrust manipulation in patients with mechanical neck pain: a randomized clinical trial. JOSPT 2012; 42: 724-730.
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 This article provides an overview of the increasingly popular treatment modality of whole body cryotherapy (WBC), where athletes are exposed to extremely cold air (−110 to −140 degrees Celcius) for a short duration in order to enhance their recovery and wellbeing. This is a very contemporary subject, with a number of high-profile athletes being reported in the press as using WBC. Within this article, the treatment protocols that are commonly used in cryotherapeutic chambers are outlined, and contraindications and precautions are summarised. The suggested physiological and psychological benefits of the treatment, including pain relief and haemodynamic responses, are explored. Finally, the scientific literature surrounding the use of WBC is reviewed and analysed, with particular focus on WBC in athletic populations.
Whole body cryotherapy: an overview
Protocols vary, but having a WBC treatment involves a short period of exposure to very cold air (usually between 1 and 3 minutes), whilst wearing minimal clothing. Generally, users first enter one or more antechambers which have a temperature in the region of −600C, before entering the main chamber where temperatures range from between −1,100C to −1,400C (see Table 1 for an example treatment protocol). To achieve these extremely low temperatures, the air in the chambers is cooled using liquid nitrogen. At this temperature range, there is a risk of frostbite to tissues, which is controlled by wearing appropriate protective clothing that includes face mask and headband to cover the mouth and ears, and gloves, socks and clogs for the extremities. It is imperative that the skin is completely dry as at these temperatures water freezes instantly, which can damage body tissues. Despite these risks, WBC is considered a safe treatment to use if operational protocols are followed correctly and contraindication guidelines are followed (Table 2).
This article “Whole Body Cryotherapy: A ‘Cool’ Therapeutic Technology” is now live online and available in full through a subscription to leading manual therapy journal, sportEX dynamics. The publication is available in print as well as on the Apple, Android and Kindle Fire platforms.
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 This is a case study demonstrating a functional process to the assessment, treatment and rehabilitation of a client with low back pain, using the principles of Applied Functional Science (AFS) from the Gray Institute to provide a biomechanical rationale for the assessment and treatment plan, for not only the symptoms but also the causes of the dysfunction. Most physiotherapy assessment is table based, which gives an idea of joint motion but it tells nothing about how that joint reacts when compressed by gravity or how much of the available motion the body can use or control. The AFS model looks at mobility and stability as part of a chain reaction within the body, isolating particular movements at certain joints but in an integrated scenario. AFS is based on the scientific principles of gravity, ground reaction force, mass and momentum, chain reaction biomechanics and 3-dimensional muscle functions. I look at motion and stability in all three planes, sagittal (SP), frontal (FP) and transverse plane (TP).
Low back pain is a multifaceted problem and on many occasions is classed as non-specific, this may be due to the problems not being located in the spine, but rather another part of the body causing excess stress in certain motions. In this case study I will present my approach to a client with low back pain (facet joint) and how I applied a biomechanical model to treat the cause and the symptoms.
The AFS model of assessment gives a biomechanical rationale to the client’s dysfunction and pain. In this instance there was a top-down (thoracic) restriction in combination with a bottom-up (hips and right ankle) restriction causing an increase compressive load to the right side lumbar facet joints. This may well have come on due to ongoing restrictions after the left hamstring tear, causing a left hip flexion restriction and affecting the whole kinetic chain OR the restriction in the right ankle may have caused the original hamstring tear?
This article is now live online and available in full through a subscription to sportEX dynamics that includes online access. It is also available in print as well as on the iOS (iPad/iPhone), Android and Kindle Fire platforms. For more information click here >
 This article is the first in a series that will present the rationale for an alternative approach to exercise prescription in the fields of physiotherapy, sports rehabilitation and general fitness training. The overall aim of the article is to allow all medical and fitness specialists to implement fitness training programmes that will further aid recovery and improve both sporting performance and daily activities. Instructional in nature, this series is designed to challenge the way that you currently prescribe exercise and offer step-by-step instructions for a more effective model. Subsequent articles will examine each of the human movement patterns, with example exercises and practical programming considerations.
Currently there often exists a disparity between the rehabilitation process and a patient’s return to (or the commencement of) a regular exercise programme. Whereas patients are assessed and prescribed exercises in the rehabilitation process with a large degree of accuracy, it is often the case that discharge brings with it a more general recommendation of increasing activity. It is proposed that general recommendations for exercise can:
- Reduce the effectiveness of the existing rehabilitation process
- Increase the chance of injury recurrence
- Have a reduced impact on the broad aims of the programming.
Instead, an exercise prescription model that accounts for these factors and has the broad aim of improving competency in a range of basic human movements can be more effective. Although we see functional training applications in professional sports (1), it is still commonplace for exercise to be prescribed independently of any broad consideration of basic functional human movement. Rather than considering what an individual needs to be able to do, in relation to both rehabilitation and daily activity, we typically select exercises and programming elements based on:
- Body-part matching; eg. if we know that our patient needs to strengthen a certain muscle group then we’ll select an exercise that we know works that muscle group
- Common practice; eg. we include exercises that are traditionally part of a fitness training programme
- Exercise and activity familiarity; eg. we prescribe exercises that the patient has experience of and will likely adhere to
- Referral to a specific activity; eg. to a sport that may or may not be supportive of an individual’s specific functional requirements.
None of the above will necessarily correlate with an increased competency in healthy, comfortable movement – an important factor for all. At this juncture it is also important to address the issue of transition between rehabilitation and fitness activities. Historically, there has been a void between the two disciplines and professions. The movement-based exercise prescription model proposed here has the potential to help fill that void, not least because it can offer a common language with which to communicate.
This article proposes that rehabilitation and fitness should be more closely aligned and that an integrated spectrum that includes rehabilitation, fitness and pre-habilitation would work more effectively as a broad model of exercise prescription (2).
This article is now live online and available in full through a subscription to sportEX dynamics that includes online access. It is also available in print as well as on the iOS (iPad/iPhone), Android and Kindle Fire platforms. For more information click here >
 Many athletes and patients attend the clinic every day with pain somewhere in their body. The question the therapist needs to ask is, ‘Can the gluteal muscles be partly or wholly responsible for the pain that the patient is presenting with?’ If the answer is yes, then we need to know why this muscle group, out of all the other muscles we have in the body, can be the key to the problem.
This article is split into two parts. Part 1, presented here, discusses the functional anatomy of the gluteus maximus and describes how to identify if weakness or misfiring of the muscles is responsible for the athletes problems. Part 2, to be published in April, will discuss the treatment needed in order to correct the misfiring sequence, and will look at muscle length testing and the use of muscle energy techniques (METs) to treat shortened and tight tissues.
The Gmax is relatively neglected in the eyes of most physical therapists, maybe for the reason that the Gmax itself does not normally present as painful. In my experience, around 30–40% of a rowing squad have back pain, and typically for 50–60% of those rowers, the GMAX is the main culprit of their perceived symptoms. The case study covered in this article is a common presentation in my clinic.
After reading Part 1 you will have a better understanding of the role of the Gmax in terms of its function and the potential effect it can have on all areas of the body if the Gmax is found to be weak or misfiring.
You will be aware that an athlete can present with any of the following:
- Tight/painful hamstrings or lumbar paraspinal muscles
- Insufficient forward or upward power production from the legs
- Pelvic position dropped when running
- Tight/painful adductor magnus (inner thigh)
- Asymmetrical body orientation
- Better balance one side than the other
- Excessively tight latissimus dorsi on the contralateral side to the weak/misfiring Gmax,
and that this 1) can imply a faulty posterior chain muscle activation pattern, and that 2) the likely finding is Gmax weakness or delayed timing due to the misfiring sequence. Part 2 will further discuss the case study, and describe how to re-educate the firing of the Gmax by looking specifically at the antagonistic muscles and then using advanced soft tissue techniques that will help correct the mal-alignment of the pelvis and lumbar spine.
This article is now live online and available in full through a subscription to sportEX dynamics that includes online access. It is also available in print as well as on the iOS (iPad/iPhone), Android and Kindle Fire platforms. For more information click here >
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