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Pain & Therapy Bibliography

Crunching quite a bit of data! This can be a bit slow.

How slow? 5-10 seconds on fast machines, 20–30 seconds on slower ones. Once the page is fully loaded, it gets faster — a lot of the slow is in “setting up” the page. It may still be sluggish for several seconds after this disappears, but it really does smooth out after that.

The Pain Bibliography was asked to show an item that doesn’t exist. All records are shown below.

The Pain & Therapy Bibliography

A large, quirky database of scientific sources about common pain, injury & treatment, constantly updated & annotated since 1997

  • completely free
  • charmingly annotated
  • searchable & sortable
  • maintained & updated
  • a unique resource
  • moreSome people collect stamps; I collect science about painful problems. I have been building this database for about 17 years now. It does not pretend to be comprehensive — there are huge institutional databases for that (especially the Physiotherapy Evidence Database). What makes this repository special is that its contents were hand-picked, each record chosen for a reason, and a great many of them are also described and “translated,” their significance emphasized, with links to related articles. In short, it has depth and character. Please explore! help
Loadin’ & sortin’ a rather large database…
Rating Type Title Tags Quote? Author Url Notes Abstract Vol No. Pages Month Year Publisher
NO DATA article 1987 Volvo Award in Clinical Sciences back NO DATA Waddell PubMed #2961080. An excellent summary of medical knowledge of low back pain. Waddell is a respected authority in the field, and a good writer.

Because there is increasing concern about low-back disability and its current medical management, this analysis attempts to construct a new theoretic framework for treatment. Observations of natural history and epidemiology suggest that low-back pain should be a benign, self-limiting condition, that low back-disability as opposed to pain is a relatively recent Western epidemic, and that the role of medicine in that epidemic must be critically examined. The traditional medical model of disease is contrasted with a biopsychosocial model of illness to analyze success and failure in low-back disorders. Studies of the mathematical relationship between the elements of illness in chronic low-back pain suggest that the biopsychosocial concept can be used as an operational model that explains many clinical observations. This model is used to compare rest and active rehabilitation for low-back pain. Rest is the commonest treatment prescribed after analgesics but is based on a doubtful rationale, and there is little evidence of any lasting benefit. There is, however, little doubt about the harmful effects — especially of prolonged bed rest. Conversely, there is no evidence that activity is harmful and, contrary to common belief, it does not necessarily make the pain worse. Experimental studies clearly show that controlled exercises not only restore function, reduce distress and illness behavior, and promote return to work, but actually reduce pain. Clinical studies confirm the value of active rehabilitation in practice. To achieve the goal of treating patients rather than spines, we must approach low-back disability as an illness rather than low-back pain as a purely physical disease. We must distinguish pain as a purely the symptoms and signs of distress and illness behavior from those of physical disease, and nominal from substantive diagnoses. Management must change from a negative philosophy of rest for pain to more active restoration of function. Only a new model and understanding of illness by physicians and patients alike makes real change possible.

12 NO DATA 632–44 NO DATA 1987 NO DATA
4 article [Acupuncture massage vs Swedish massage and individual exercise vs group exercise in low back pain sufferers--a randomized controlled clinical trial in a 2 x 2 factorial design] back+acu NO DATA Franke et al PubMed #11155022. This study attempted to determine how Acupuncture massage compared to Swedish massage, and how individual therapy compared to group therapy. From the abstract, the conclusion was: “Given the fact that even the treatments considered to be the best available achieve at best moderate effects, the observed effect sizes with APM are promising and warrant further investigation in replication studies. In contrast to common view, no superiority of individual versus group exercises could be found in the present study”

OBJECTIVE: Rehabilitation programs for low back pain (LBP) almost always contain massage and exercise therapy in one form or another.

AIM: This study aimed to quantify the effectiveness of therapeutic 'Acupuncture' massage (APM; i.e. tonic stimulation of entire meridians) according to Penzel versus Swedish massage (SM) and individual medical exercises (IE) versus group exercises (GE) in LBP sufferers.

PATIENTS AND METHODS: 109 patients participating in a complex in-patient rehabilitation program were randomised to four groups in a 2 x 2 factorial design. Main outcome measures were functional ability/disability (Functional Questionnaire Hanover, FFbH) and pain intensity (10 cm visual analogue scale, VAS). Pre/post changes were evaluated by means of 2-way analysis of variance (ANOVA). Additionally, lumbar motility was measured by a 2-inclinometer technique.

RESULTS: Baseline mean FFbH score was 66 (SD = 18)%, mean pain intensity on VAS was 4.5 (SD = 2.4) cm. Lumbar flexion and extension were 49 (13) and 13 (7). Because of some differences between groups at baseline, group-standardized outcomes were used for analysis. APM showed beneficial effects for both disability and pain compared with SM (group differences: delta FFbH 7.0% [95% confidence interval (CI) 2.5-11.6], p = 0.003; delta VAS 0.8 cm [95% CI: 2-15], p = 0.024). Standardized response means were SRMFFbH = 0.5 and SRMVAS = 0.8 for APM, as opposed to SRMFFbH = -0.01 and SRMVAS = 0.4 for SM. Neither significant group differences between both exercise groups [delta FFbH -0.5% (95% CI -5.2 to 4.2); delta Vas 0.4 cm (95% CI 0.3 to 1.1)] nor significant interactions between medical exercise and massage were found.

CONCLUSIONS: Given the fact that even the treatments considered to be the best available achieve at best moderate effects, the observed effect sizes with APM are promising and warrant further investigation in replication studies. In contrast to common view, no superiority of individual versus group exercises could be found in the present study.

7 6 286-93 Dec 2000 NO DATA
NO DATA article [Capsular distension and physical therapy in treatment of adhesive capsulitis] NO DATA NO DATA Koubâa et al PubMed #17193853. NO DATA

OBJECTIVE: to evaluate the efficacy of capsular distension combined with intraarticular glucocorticoid injections and immediate physical therapy in the treatment of adhesive capsulitis.

METHOD: a prospective open study of patients with adhesive capsulitis. Clinical and radiological criteria was used for diagnosis. Clinical evaluation was realized before treatment, at the end of the treatment, after 1 month, 3 months and 6 months. It carried on: the measure of pain and handicap intensity by an Visual Analogue Scale, the algo-functional score of Constant, the measure of passive articular mobilities. We ended in a success of the treatment when the visual analogue scale of handicap < 30, the score of Constant>70, the passive abduction>90 and the external rotation (RE)>45 degrees.

RESULTS: 19 patients were included, mean aged 56 years with capsular retraction evolving on average for 8.5 months. The parameters of evaluation of pain function and handicap improved significantly since the end of treatment. This improvement continued until 6 months after the treatment. Earning in articular amplitudes was significant since the end of treatment for forward extension and internal rotation. However, the improvement in abduction and internal rotation was significant only at 3 months. In spite of this early significant improvement in external rotation, 6 patients had an important limitation of the RE (<20 degrees). A subacromial bursography with steroid injection was proposed to them because subacromial bursa is almost consistently involved by retraction. Only, 4 patients among them accepted it. Out come was favorable in every case with a external rotation>45 degrees at I month of the treatment. The rate of success which was only 47.3% at the end of the treatment, is crossed in 73.6% at 1 month and reaches 89.4% at 6 months.

CONCLUSION: The therapeutic association capsular distension, intraarticular steroid injections and physical therapy allows to shorten the course of adhesive capsulitis. Burso-infiltration seems to be effective as therapeutic complement in case of persistence of an articular limitation.

84 10 621-5 Oct 2006 NO DATA
2 article [Does exercise therapy for chronic lower-back pain require daily isokinetic reinforcement of the trunk muscles?] back+exercise NO DATA Olivier et al PubMed #18394742. Researchers wanted to determine if participants (who all had low back pain) would improve with a particular exercise program with or without using the trunk muscles. From the abstract: “Regardless of the protocol, the patients improved in both physical and psychological terms and these improvements were maintained over a short period, at least. Our results confirmed that one functional recovery programme is not superior to another for patients with lower-back pain”

OBJECTIVE: The goal of this study was to determine the benefits of a functional retraining programme (with or without daily isokinetic reinforcement of the trunk muscles) in patients with lower-back pain.

METHOD: Two groups of 30 patients took part in the study. The control group (CG) underwent a four-week reconditioning program in a day hospital, whereas a second interventional group (IG) additionally performed daily isokinetic training of the trunk muscles. Three evaluations were carried out: before hospitalization (T1), immediately after hospitalization (T2) and three months postrehabilitation (T3).

RESULTS: We observed an improvement in each parameter after rehabilitation, regardless of the group. A decrease in the DALLAS scores revealed a reduced impact of lower-back pain on the patients' lives. Pain experienced fell by 24%, analgesic treatment was significantly decreased (CG: -53%; IG: -56%), muscle endurance was improved (quadriceps: +30%, abdominal muscles: +20%, paraspinal muscles: +23%, quadratus lumborum: +33%) and the patients were more supple, as revealed by a decrease in the finger-to-ground distance (at T1, CG: 12.9+/-6.1cm; IG: 13.6+/-5.5 cm at T1; CG: 2.2+/-5.4 cm; IG: 2.8+/-5.1cm at T2). The sole difference for CG and IG at T2 resulted from an improvement in the performance of the trunk extensor muscles, which was significantly greater in the IG (CG: +14%; IG: +20%). Three months after rehabilitation, the benefits were still present for the two groups and, indeed, were even greater for certain parameters.

CONCLUSION: Regardless of the protocol, the patients improved in both physical and psychological terms and these improvements were maintained over a short period, at least. Our results confirmed that one functional recovery programme is not superior to another for patients with lower-back pain.

51 4 284-91 May 2008 NO DATA
4 article [Efficacy of Arnica in varicose vein surgery homeo+quack NO DATA Wolf et al PubMed #14605480. This study tried to study the efficacy of arnica D12 in patients who had just had varicose vein surgery. 60 patients were either given arnica D12 or a placebo. Significantly, the results don’t say much: “The results of this pilot study showed a trend towards a beneficial effect of ARNICA D12 with regard to reduction of hematoma and pain during the postoperative course. For a statistically significant proof of efficacy of ARNICA D12 in patients following varicose vein surgery a larger sample size is necessary.”

INTRODUCTION: In homeopathy ARNICA is widely used as a woundhealing medication and for the treatment of hematomas.

OBJECTIVE: In this pilot study the efficacy and safety of ARNICA D12 in patients following varicose vein surgery were investigated.

DESIGN: Prospective, randomized, double-blind, placebo-controlled pilot trial according to ICH GCP guidelines.

SETTING: The study was conducted by a surgeon at the Angiosurgical Clinic, Berlin- Buch.

INTERVENTION: After randomized allocation, 60 patients received either ARNICA D12 or placebo. Start of medication occurred the evening before operation with 5 globules. On the operation day one preoperative and hourly postoperative dosages after awakening were given. On days 2-14 of the study 5 globules 3 times a day were given.

OUTCOME CRITERIA: Surface (in cm(2) and using a three-point verbal rating scale) and intensity of hematomas induced by operation, complications of wound healing, and intensity of pain (five-point verbal rating scale) as well as efficacy and safety of the study medication were assessed.

RESULTS: Hematoma surface was reduced (from day 7 to day 14) under ARNICA by 75.5% and under placebo by 71.5% (p = 0.4726). The comparison of hematoma surface (small, medium, large) using the verbal rating scale yielded a value of p = 0.1260. Pain score decreased by 1.0 +/- 2.2 points under ARNICA and 0.3 +/- 0.8 points under placebo (p = 0.1977). Remission or improvement of pain was observed in 43.3% of patients in the ARNICA group and in 27.6% of patients in the placebo group. Tolerability was rated as very good in all cases.

CONCLUSION: The results of this pilot study showed a trend towards a beneficial effect of ARNICA D12 with regard to reduction of hematoma and pain during the postoperative course. For a statistically significant proof of efficacy of ARNICA D12 in patients following varicose vein surgery a larger sample size is necessary.

10 5 242-7 Oct 2003 NO DATA
NO DATA article [Epidemiology of occupationally-caused carpal tunnel syndrome in the province of Alicante, Spain 1996-2004] NO DATA NO DATA Roel-Valdés et al PubMed #16913614. NO DATA

BACKGROUND: Carpal tunnel syndrome is one of the major health problems of workers who perform tasks entailing intense manual stress and repetitive movements of the upper limbs. The implementation of regulations and social changes, as well as the incorporation of women into the working world bring to bear the need of ascertaining whether any changes have taken place in the pattern of occurrence of this syndrome and in the factors conditioning the same. The objectives of this study are to know the frequency with which this syndrome occurs in the province of Alicante, to discover the work-related characteristics of those individuals affected thereby, to analyze the procedure followed for treatment and rehabilitation and to delve into the situation of those affected upon their return to work.

METHODS: Descriptive, cross-sectional study. The population studies was comprised of all those workers for whom an occupational disease report was remitted to the Safety and Health Commission within the 1996-2004 period.

RESULTS: A total of 266 reports of occupational disease due to carpal tunnel syndrome were filed. The incidence rate was 4.2 cases per 100,000 workers. A total of 62.8% of the cases were females, 25% of whom were under 30 years of age. The average length of employment at the company was 132.3 months.

CONCLUSIONS: The risk factors most often mentioned are performing repetitive movements and activities requiring manual strength.

80 4 395–409 Jul-Aug 2006 NO DATA
3 article [Promoting effect of massage on quadriceps femoris repair of rabbit in vivo] NO DATA NO DATA Hou et al PubMed #22506476. Animal studies don’t come up all that often in my work days, and I find them rather macabre. In this study, rabbits were injured, and then some of them received a lot of daily automated massage during recovery, from — I love this bit — an “intelligent massage device.” Their tissues were put under a microscope before and after, and apparently “histomorphology and cytoskeletal structure can be significantly improved after massage, which may help to repair muscle injury by up-regulation of Desmin and alpha-Actin expressions.” Sounds good. Any study of tissue involves substantial complexities of observation and interpretation, and so it’s basically impossible to know whether the experiment was actually conducted competently and its results are trustworthy, unless other researchers do the same thing and get similar results. But it’s interesting, and promising, and consistent with the fairly sensible notion that moderate stimulation helps tissues recover from damage.

OBJECTIVE: To investigate the effect of massage on quadriceps femoris repair and the expressions of Desmin and alpha-Actin in rabbits so as to explore the possible molecular mechanisms of massage in repair of muscle injury.

METHODS: Twenty-seven New Zealand white rabbits, weighing (2.0 +/- 0.5) kg, were randomly divided into 3 groups: groups A (n = 3), B (n = 12), and C (n = 12). In group A, the rabbits were not treated as controls; in groups B and C, the rabbit models of quadriceps femoris injury were prepared by self-made beater. In group B, no massage therapy was given as nature recovery controls; in group C, RT-N2 intelligent massage device was used for massage therapy at 8 days after injury, at 3 000-3 100 r/min for 15 minutes, every day for 7 days or for 14 days. The quadriceps femoris specimens were taken from 6 rabbits of groups B and C at 14 days and 21 days, respectively. HE staining was employed to detect the histomorphological change. Immunohistochemistry staining and Western blot were used to detect Desmin and alpha-Actin expressions. The massage therapy effect was evaluated by the histomorphological change and Desmin and alpha-Actin expressions.

RESULTS: All rabbits survived to the end of experiment in groups B and C. No histological change was found with regular order of muscle fibers and no connective tissue in group A; obvious tissue necrosis was seen with broken muscular fibers, muscle atrophy, and irregular order in group B; and in group C, the skeletal muscle morphology and musle atrophy were obviously improved with regenerated muscle fibers when compared with group B. Immunohistochemistry staining showed that the Desmin and alpha-Actin expressions obviously reduced in groups B and C, which were significantly weaker than that in group A (P < 0.05); the Desmin and alpha-Actin expressions were significantly stronger in group C than in group B (P < 0.05), and at 21 days than at 14 days in group C (P < 0.05). Western blot results showed that the Desmin and alpha-Actin expressions were significantly higher in group A than in groups B and C (P < 0.05), and the expressions were lowest at 14 days in group B.

CONCLUSION: The histomorphology and cytoskeletal structure can be significantly improved after massage, which may help to repair muscle injury by up-regulation of Desmin and alpha-Actin expressions.

26 3 346-51 Mar 2012 NO DATA
NO DATA article [Traumatic myositis ossificans. Posttraumatic non-neoplastic heterotopic ossification] NO DATA NO DATA Jacobsen PubMed #7483051. NO DATA

Myositis ossificans traumatica (MOT) is a nonneoplastic, heterotopic ossification of soft tissues i.e. skeletal muscle, tendons, aponeuroses and fascia. It is often encountered in young male athletes participating in contact sports as a result of a single or repeated contusion. MOT tends to be solitary, localized and well circumscribed with a self-limited growth potential that may culminate in regression. The pathogenesis of MOT is still enigmatic. Recent animal experiments have led to a theory that mesenchymal connective tissue cells, undergo metaplasia induced by trauma and probably osteogenic proteins, to fibroblasts and osteoblasts. These cells deposit and structure osteoid centripetally in the lesion. As the lesion matures, cancellous bone develops into mature, lamellar bone in the periphery of the lesion. In its earlier stages MOT is easily cytologically and radiologically confused with osteogenic sarcoma. The management of MOT is largely conservative and the principles are of considerable value to physicians and physiotherapists engaged in the treatment of sports injuries. This article reviews the various forms of myositis ossificans as well as the pathology, diagnosis and treatment options.

157 39 5385–5388 Sep 1995 NO DATA
NO DATA article [Utility of joint distension during arthrography in treatment of adhesive capsulitis of the shoulder in a study of 20 patients] NO DATA NO DATA Chatti et al PubMed #18064983. NO DATA

AIM: The aim of our study is to evaluate the efficacy of joint distension during arthrography followed by an intra articular corticosteroid injection.

METHODS: This procedure associated to a physical therapy started immediately after joint distension and performed during 3 months in the treatment of 20 patients suffering from adhesive capsulitis of the shoulder were assessed.

RESULTS: Patients were evaluated on D 90:90% of them have regression of pain, 70% have an improvement of deficiency and ranges of motion of the shoulder. Adhesive capsulitis of the shoulder is a disabling pathology but, generally, with good evolution. It is a clinical diagnosis.

CONCLUSION: Joint distension associated to physical therapy has an interest in treatment because of therapeutic and antalgic effect and also restoration of range of movement.

85 7 546-8 Jul 2007 NO DATA
3 article The Ability of Clinical Tests to Diagnose Stress Fractures tx+dx+tools+shin+fun NO DATA Schneiders et al PubMed #22813530. This science attacks something I care deeply about: tuning fork diagnosis of stress fractures. Yeah, you read that right. Supposedly a humming tuning fork applied to a stress fracture will make it ache. This analysis of studies since the 1950’s tried to determine if either ultrasound or tuning forks are actually useful in finding lower-limb stress fractures. Neither technique was found to be accurate; “it is recommended that radiological imaging should continue to be used” instead. Fortunately (for the sake of the elegant quirkiness of the tuning fork idea), they aren’t saying that a tuning fork actually can’t work … just that’s it not reliable for confirmation, which kind of a “well, duh” conclusion. I don’t suppose I ever thought it was a slam dunk diagnosis, just an easy and quirky clue generator.

STUDY DESIGN: Systematic literature review and meta-analysis.

OBJECTIVES: To evaluate the diagnostic accuracy of clinical tests to identify stress fractures in the lower limb.

BACKGROUND: Stress fractures are a bone-related overuse injury primarily occurring in the lower limb and commonly affecting running athletes and military personnel. Physical examination procedures and clinical tests are suggested for diagnosing stress fractures; however, data on the diagnostic accuracy of these tests have not been investigated through a systematic review of the literature.

METHODS: A systematic review was conducted in 8 electronic databases to identify diagnostic accuracy studies, published between January 1950 and June 2011, that evaluated clinical tests against a radiological diagnosis of lower-limb stress fracture. Retrieved articles were evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool, and a meta-analysis was performed where appropriate.

RESULTS: Nine articles investigating 2 clinical procedures, therapeutic ultrasound (n = 7) and tuning fork testing (n = 2), met the study inclusion criteria. Meta-analysis was used to statistically analyze the data extracted from the ultrasound articles and demonstrated a pooled sensitivity of 64% (95% confidence interval [CI]: 55%, 73%), specificity of 63% (95% CI: 54%, 71%), positive likelihood ratio of 2.1 (95% CI: 1.1, 3.5), and negative likelihood ratio of 0.3 (95% CI: 0.1, 0.9). Tuning fork test data could not be pooled; however, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio ranged from 35% to 92%, 19% to 83%, 0.6 to 3.0, and 0.4 to 1.6, respectively.

CONCLUSION: The results of this systematic review do not support the specific use of ultrasound or tuning forks as standalone diagnostic tests for lower-limb stress fractures. As the overall diagnostic accuracy of the tests investigated is not strong, based on the calculated likelihood ratios, it is recommended that radiological imaging should continue to be used for the confirmation and diagnosis of stress fractures of the lower limb.

42 9 760-71 NO DATA 2012 NO DATA
5 article A close look at therapeutic touch mx NO DATA Rosa et al 1 This paper is an entertaining chapter in the history of the science of alternative medicine: a child’s science fair project published in the Journal of the American Medical Association, showing that “twenty-one experienced therapeutic touch practitioners were unable to detect the investigator's ‘energy field.’ Their failure to substantiate TT's most fundamental claim is unrefuted evidence that the claims of TT are groundless and that further professional use is unjustified.” Therapeutic touch practitioners could not demonstrate any ability to detect a person by feeling their aura, let alone manipulating it therapeutically. The test made them look ridiculous.

CONTEXT: Therapeutic Touch (TT) is a widely used nursing practice rooted in mysticism but alleged to have a scientific basis. Practitioners of TT claim to treat many medical conditions by using their hands to manipulate a "human energy field" perceptible above the patient's skin.

OBJECTIVE: To investigate whether TT practitioners can actually perceive a "human energy field."

DESIGN: Twenty-one practitioners with TT experience for from 1 to 27 years were tested under blinded conditions to determine whether they could correctly identify which of their hands was closest to the investigator's hand. Placement of the investigator's hand was determined by flipping a coin. Fourteen practitioners were tested 10 times each, and 7 practitioners were tested 20 times each.

MAIN OUTCOME MEASURE: Practitioners of TT were asked to state whether the investigator's unseen hand hovered above their right hand or their left hand. To show the validity of TT theory, the practitioners should have been able to locate the investigator's hand 100% of the time. A score of 50% would be expected through chance alone.

RESULTS: Practitioners of TT identified the correct hand in only 123 (44%) of 280 trials, which is close to what would be expected for random chance. There was no significant correlation between the practitioner's score and length of experience (r=0.23). The statistical power of this experiment was sufficient to conclude that if TT practitioners could reliably detect a human energy field, the study would have demonstrated this.

CONCLUSIONS: Twenty-one experienced TT practitioners were unable to detect the investigator's "energy field." Their failure to substantiate TT's most fundamental claim is unrefuted evidence that the claims of TT are groundless and that further professional use is unjustified.

279 13 1005–10 NO DATA 1998 NO DATA
3 article Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation back+surgery+nerve+psb NO DATA Boden et al The authors found that 22% of pain-free adults under 60 had herniated disks. A whopping 93% of asymptomatic volunteers over 60 had signs of disk degeneration.

We performed magnetic resonance imaging on sixty-seven individuals who had never had low-back pain, sciatica, or neurogenic claudication. The scans were interpreted independently by three neuro-radiologists who had no knowledge about the presence or absence of clinical symptoms in the subjects. About one-third of the subjects were found to have a substantial abnormality. Of those who were less than sixty years old, 20 per cent had a herniated nucleus pulposus and one had spinal stenosis. In the group that was sixty years old or older, the findings were abnormal on about 57 per cent of the scans: 36 per cent of the subjects had a herniated nucleus pulposus and 21 per cent had spinal stenosis. There was degeneration or bulging of a disc at at least one lumbar level in 35 per cent of the subjects between twenty and thirty-nine years old and in all but one of the sixty to eighty-year-old subjects. In view of these findings in asymptomatic subjects, we concluded that abnormalities on magnetic resonance images must be strictly correlated with age and any clinical signs and symptoms before operative treatment is contemplated.

72 3 403–408 NO DATA 1990 NO DATA
NO DATA book Abominable science! Origins of the Yeti, Nessie, and other famous cryptids NO DATA NO DATA Loxton et al NO DATA NO DATA NO DATA NO DATA NO DATA NO DATA 2012 Columbia University Press
NO DATA article Achilles tendon rupture surgery NO DATA Sorrenti PubMed #16764795. From the abstract: “Surgery combined with early mobilization reduces range of motion loss, increases blood supply, and reduces the degree of muscle atrophy that typically occurs after Achilles tendon rupture, thereby decreasing the time to resumption of normal activities.”

BACKGROUND: Surgical and nonsurgical treatments of Achilles tendon ruptures are available. Nonsurgical treatment using immobilization does not have the varying degrees of infection as seen with surgical procedures, but it frequently is linked to muscle atrophy, weakness, and higher rates of rerupture than surgical treatment. This study reports the results of 64 patients with Achilles tendon ruptures treated surgically and with early mobilization.

METHODS: Surgery of the ruptured tendon involved dividing the proximal stump into two separate strands and the distal stump into a single strand. The repair was advanced to a V-Y formation, and nonabsorbable sutures were used for repair. After wound closure, an early mobilization rehabilitation program was initiated, which consisted of wearing a moveable ankle brace for 4 to 6 weeks in 0 to 15 degrees of dorsiflexion and 10 weeks of regular exercises.

RESULTS: All 64 patients resumed normal activities in an average of 3.3 months regardless of whether the rupture was acute or chronic. Tendons healed with no reruptures. There were 13 complications, all wound infections, which healed when treated with antibiotics. The infection rate dropped markedly when wounds were inspected and dressings changed 1 week postoperatively, instead of at 2 weeks.

CONCLUSION: Surgery combined with early mobilization reduces range of motion loss, increases blood supply, and reduces the degree of muscle atrophy that typically occurs after Achilles tendon rupture, thereby decreasing the time to resumption of normal activities. Applying tension to the tendon also improved strength of the calf muscles and improved ankle movement. The main concern with early mobilization is rerupture, but this was lessened by patients carefully following the weightbearing and early mobilization protocols. The results of this study strengthen the argument to employ early mobilization rehabilitation after surgical repair.

27 6 407–410 Jun 2006 NO DATA
NO DATA article A combined approach to a medical problem back+exercise+psb NO DATA Robinson PubMed #6447538. This Canadian study of 2200 people with back pain showed a surprising distribution of ages: back pain after age fifty is much less common than it is between thirty and fifty. Back pain in the teens and twenties is rarer still.

The Canadian Back Education Unit represents a team approach to a medical problem. Orthopedic surgeons, psychiatrists, psychologists and physiotherapists give a course of four lectures to patients with low back pain. The patients are taught the anatomy and physiology of their pain, proper postures and exercise, the way in which emotions can complicate their physical problem, and relaxation techniques. Of 934 completing the six-month review course, 77% rated themselves as improved and 96% felt the course had been helpful. There was also found to be a 62% decrease in the number of patients seeing doctors about their back pain. It is felt that this is a method by which psychiatrists, orthopedic surgeons and paramedical personnel are able to work together to provide an effective and cost-efficient way of helping patients cope with a chronic physical problem.

25 2 138–42 Mar 1980 NO DATA
NO DATA article A comparative electromyographical investigation of muscle utilization patterns using various hand positions during the lat pull-down exercise NO DATA Signorile et al PubMed #12423182. NO DATA NO DATA 16 NO DATA 539–546 NO DATA 2002 NO DATA
NO DATA article Accuracy of Self-Reported Footstrike Paterns and Loading Rates Associated With Traditional and Minimalist Running Shoes NO DATA NO DATA Goss et al This test of running styles found that actual style — rearfoot or forefoot striking — was variable regardless of shoe type, and that runners can’t accurately report their own style, suggesting that “lots of people are fooling themselves about how they’re running” (Hutchinson). What you put on your feet does not necessarily change how you run. NO DATA NO DATA NO DATA NO DATA NO DATA 2012 NO DATA
NO DATA article Acoustic shock generation by ultrasonic imaging equipment tools NO DATA Duck et al PubMed #6697084. NO DATA

The pulses generated by ultrasonic imaging equipment have been observed to form acoustic shocks in water within a range of a few centimetres under normal operating conditions. The commonly held view of pulse propagation from ultrasonic imaging equipment is that the acoustic pulse has the form of a damped sine wave which will project largely unchanged in waveform. Any waveform changes which do occur result from diffraction effects and from the scattering and attenuation properties of tissue. The theory on which this understanding is based assumes that propagation laws are linear. This paper presents experimental evidence that this assumption is quite invalid at the pressures generated by commercial pulse-echo imaging equipment in common use. Measurements in water of the pulse waveforms using a calibrated broad-band polymer hydrophone have demonstrated that pulse distortion and shock formation commonly occur due to the inherent non-linearity of the propagation medium. This fact must be considered during the calibration of pulse-echo equipment. In addition, the conditions under which shock formation might occur during normal clinical procedures should be reviewed and any associated biological effects assessed.

57 675 231-40 Mar 1984 NO DATA
4 article Active neck muscle training in the treatment of chronic neck pain in women neck+psb+exercise+mind NO DATA Ylinen et al 1 This experiment intriguingly found a significant benefit to strength training for neck pain patients, where other studies have failed to find much. The authors acknowledge and discuss this interesting difference. Assuming their data is good instead of being a fluke or artifact, the implications are that strength training done in some way probably helps patients of a certain kind — but the mix of variables that produces a favourable result is still a matter of speculation.

CONTEXT: Active physical training is commonly recommended for patients with chronic neck pain; however, its efficacy has not been demonstrated in randomized studies.

OBJECTIVE: To evaluate the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles on pain and disability in women with chronic, nonspecific neck pain.

DESIGN: Examiner-blinded randomized controlled trial conducted between February 2000 and March 2002.

SETTING: Participants were recruited from occupational health care systems in southern and eastern Finland.

PATIENTS: A total of 180 female office workers between the ages of 25 and 53 years with chronic, nonspecific neck pain.

INTERVENTIONS: Patients were randomly assigned to either 2 training groups or to a control group, with 60 patients in each group. The endurance training group performed dynamic neck exercises, which included lifting the head up from the supine and prone positions. The strength training group performed high-intensity isometric neck strengthening and stabilization exercises with an elastic band. Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells. All groups were advised to do aerobic and stretching exercises regularly 3 times a week.

MAIN OUTCOME MEASURES: Neck pain and disability were assessed by a visual analog scale, the neck and shoulder pain and disability index, and the Vernon neck disability index. Intermediate outcome measures included mood assessed by a short depression inventory and by maximal isometric neck strength and range of motion measures.

RESULTS: At the 12-month follow-up visit, both neck pain and disability had decreased in both training groups compared with the control group (P<.001). Maximal isometric neck strength had improved flexion by 110%, rotation by 76%, and extension by 69% in the strength training group. The respective improvements in the endurance training group were 28%, 29%, and 16% and in the control group were 10%, 10%, and 7%. Range of motion had also improved statistically significantly in both training groups compared with the control group in rotation, but only the strength training group had statistically significant improvements in lateral flexion and in flexion and extension.

CONCLUSIONS: Both strength and endurance training for 12 months were effective methods for decreasing pain and disability in women with chronic, nonspecific neck pain. Stretching and fitness training are commonly advised for patients with chronic neck pain, but stretching and aerobic exercising alone proved to be a much less effective form of training than strength training.

289 19 2509-16 May 2003 NO DATA
NO DATA article Active patellar tracking measurement pfps+run+knee+tools+etio+psb NO DATA Shih et al NO DATA

BACKGROUND: Many patients suffer patellar instability that may relate to transient patellar tracking abnormalities.

OBJECTIVE: To develop and test a technique to measure dynamic patellar tracking.

STUDY DESIGN: Controlled laboratory and in vivo study.

METHOD: A functional knee brace was modified to allow an ultrasound transducer to be mounted laterally to the femur, following the path of the patella during knee movement. An ultrasound system was used to measure patellar mediolateral position parallel to the femoral transepicondylar axis. Ten subjects with no patellar instability were studied to obtain patellar tracking and accuracy data.

RESULTS: The interobserver and intraobserver reproducibility ranged from 0.2 +/- 0.1 mm to 1.0 +/- 0.5 mm. The accuracy of the ultrasound measurement was checked against magnetic resonance imaging and was 0.6 +/- 1.9 mm. The patella moved medially then laterally from extension to flexion when sitting. Squatting and stepping produced a more lateral path, without the initial medial translation. The patella was more lateral during knee extension than during flexion.

CONCLUSIONS: This novel method for measurement of dynamic patellar mediolateral tracking was found to have good intraobserver and interobserver reproducibility, and the measurements matched closely with those obtained from magnetic resonance imaging reconstructions of static patellar positions. Some preliminary data for tracking in 3 activities were obtained from 10 normal knees.

32 5 1209–1217 NO DATA 2004 NO DATA
1 article Acupuncture for Chronic Low Back Pain back+acu+quack+sbm NO DATA Berman et al NO DATA A bizarre and already infamous paper: bizarre because the authors clearly acknowledge that acupuncture is no better than a placebo, and bizarre because they conclude that it should be recommended, and most bizarre of all because it is published in The New England Journal of Medicine. Truly, one of the lowest moments in the history of that famous journal! The best criticisms of the NEJM’s editorial choices here can both be found on Science-Based Medicine, by Drs. Crislip (NEJM and Acupuncture: Even the best can publish nonsense) and Novella (Acupuncture Pseudoscience in the New England Journal of Medicine). Dr. Crislip’s post is really quite funny.

This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the authors' clinical recommendations.

NO DATA 363 454-461 July 29 2010 NO DATA
5 article A controlled trial of arthroscopic surgery for osteoarthritis of the knee knee+run+surgery+arthritis+mind+sbm+quack NO DATA Moseley et al 1 In this landmark and fascinating study, people with osteoarthritis improved equally well regardless of whether they received a real surgical procedure or a sham, which is a particularly striking example of the placebo effect and implies that belief can have an effect even on a “mechanical” knee problem. From the abstract: “In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic debridement were no better than those after a placebo procedure.” In 2008, these findings were fully supported by a Cochrane Collaboration review (Laupattarakasem) which concluded that “there is ‘gold’ level evidence that arthoscopic debridement has no benefit,” and by New England Journal of Medicine (Kirkley) which reported that “surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.”

BACKGROUND: Many patients report symptomatic relief after undergoing arthroscopy of the knee for osteoarthritis, but it is unclear how the procedure achieves this result. We conducted a randomized, placebo-controlled trial to evaluate the efficacy of arthroscopy for osteoarthritis of the knee.

METHODS: A total of 180 patients with osteoarthritis of the knee were randomly assigned to receive arthroscopic debridement, arthroscopic lavage, or placebo surgery. Patients in the placebo group received skin incisions and underwent a simulated debridement without insertion of the arthroscope. Patients and assessors of outcome were blinded to the treatment-group assignment. Outcomes were assessed at multiple points over a 24-month period with the use of five self-reported scores--three on scales for pain and two on scales for function--and one objective test of walking and stair climbing. A total of 165 patients completed the trial.

RESULTS: At no point did either of the intervention groups report less pain or better function than the placebo group. For example, mean (+/-SD) scores on the Knee-Specific Pain Scale (range, 0 to 100, with higher scores indicating more severe pain) were similar in the placebo, lavage, and debridement groups: 48.9+/-21.9, 54.8+/-19.8, and 51.7+/-22.4, respectively, at one year (P=0.14 for the comparison between placebo and lavage; P=0.51 for the comparison between placebo and debridement) and 51.6+/-23.7, 53.7+/-23.7, and 51.4+/-23.2, respectively, at two years (P=0.64 and P=0.96, respectively). Furthermore, the 95 percent confidence intervals for the differences between the placebo group and the intervention groups exclude any clinically meaningful difference.

CONCLUSIONS: In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic debridement were no better than those after a placebo procedure.

347 2 81–8 Jul 11 2002 NO DATA
NO DATA article Activity in the primary somatosensory cortex induced by reflexological stimulation is unaffected by pseudo-information quack+mx+acu NO DATA Miura et al 1 Reflexology will probably get a big PR boost from this bogus science, already “highly accessed,” which creates the appearance of validity where there is probably is none. It has a shiny, hard protective shell of superficial legitimacy. That is, it sounds good and fancy, and there’s nothing obviously wrong with the paper. And yet fMRI studies are notoriously prone to producing research artifacts, and the results just happen — coincidence, I’m sure — to give a lot of comfort and aid to one of the most implausible and scientifically bankrupt treatment claims in all of alternative medicine. Dr. Christopher Moyer: “There is no good theory for reflexology. In the absence of a good theory, a single study that connects a twitch of the toe to the blink of an eye is as close to worthless as it gets.” Without high quality replicaiton, this gets no more than a Spock eyebrow raise from me.

BACKGROUND: Reflexology is an alternative medical practice that produces beneficial effects by applying pressure to specific reflex areas. Our previous study suggested that reflexological stimulation induced cortical activation in somatosensory cortex corresponding to the stimulated reflex area; however, we could not rule out the possibility of a placebo effect resulting from instructions given during the experimental task. We used functional magnetic resonance imaging (fMRI) to investigate how reflexological stimulation of the reflex area is processed in the primary somatosensory cortex when correct and pseudo-information about the reflex area is provided. Furthermore, the laterality of activation to the reflexological stimulation was investigated.

METHODS: Thirty-two healthy Japanese volunteers participated. The experiment followed a double-blind design. Half of the subjects received correct information, that the base of the second toe was the eye reflex area, and pseudo-information, that the base of the third toe was the shoulder reflex area. The other half of the subjects received the opposite information. fMRI time series data were acquired during reflexological stimulation to both feet. The experimenter stimulated each reflex area in accordance with an auditory cue. The fMRI data were analyzed using a conventional two-stage approach. The hemodynamic responses produced by the stimulation of each reflex area were assessed using a general linear model on an intra-subject basis, and a two-way repeated-measures analysis of variance was performed on an intersubject basis to determine the effect of reflex area laterality and information accuracy.

RESULTS: Our results indicated that stimulation of the eye reflex area in either foot induced activity in the left middle postcentral gyrus, the area to which tactile sensation to the face projects, as well as in the postcentral gyrus contralateral foot representation area. This activity was not affected by pseudo information. The results also indicate that the relationship between the reflex area and the projection to the primary somatosensory cortex has a lateral pattern that differs from that of the actual somatotopical representation of the body.

CONCLUSION: These findings suggest that a robust relationship exists between neural processing of somatosensory percepts for reflexological stimulation and the tactile sensation of a specific reflex area.

13 NO DATA 114 NO DATA 2013 NO DATA
1 article Acupuncture for Chronic Pain tx+acu+pain+neck+back+arthritis+head NO DATA Vickers et al PubMed #22965186. The conclusion of this acupuncture meta-analysis sure sounds positive, but it’s the usual hard-spun, garbage-in-garbage-out, damned-with-faint-praise-anyway nonsense. The conclusion indicates that “acupuncture is more than a placebo” but the differences are too minimal to care, or to attribute to anything more than a sloppy, biased meta-analysis. An editorial for the Huffington Post confidently, absurdly declares of this study, “It turns out acupuncture works. It's not a placebo, and it's not a scam. It's a technique with documented efficacy,” but the author’s next statement is “I have little to say about the evidence involved.” Clearly! What do actual experts say? Dr. Edzard Ernst: “In my view, this meta-analysis is the most compelling evidence yet to demonstrate the ineffectiveness of acupuncture for chronic pain.” Dr. Steven Novella: “The Vickers acupuncture meta-analysis, despite the authors’ claims, does not reveal anything new about the acupuncture literature, and does not provide support for use of acupuncture as a legitimate medical intervention.”

BACKGROUND: Although acupuncture is widely used for chronic pain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain.

METHODS: We conducted a systematic review to identify randomized controlled trials (RCTs) of acupuncture for chronic pain in which allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible RCTs, with a total of 17 922 patients analyzed.

RESULTS: In the primary analysis, including all eligible RCTs, acupuncture was superior to both sham and no-acupuncture control for each pain condition (P < .001 for all comparisons). After exclusion of an outlying set of RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs. These results were robust to a variety of sensitivity analyses, including those related to publication bias.

CONCLUSIONS: Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.

NO DATA NO DATA 1-10 Sep 2012 NO DATA
NO DATA article Acupuncture for insomnia acu NO DATA Cheuk et al NO DATA

BACKGROUND: Although conventional non-pharmacological and pharmacological treatments for insomnia are effective in many people, alternative therapies such as acupuncture are still widely practiced. However, it remains unclear whether the existing evidence is rigorous enough to support its use.

OBJECTIVES: To determine the efficacy and safety of acupuncture in people with insomnia. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts International, CINAHL, AMED (the Allied and Complementary Medicine Database), TCMLARS (Traditional Chinese Medical Literature Analysis and Retrieval System), National Center for Complementary and Alternative Medicine, the National Institute of Health Clinical Trials Database, the Chinese Acupuncture Trials Register, the Trials Register of the Cochrane Complementary Medicine Field, from inception to 2006, and the sleep bibliography, which is available at www.websciences.org/bibliosleep. We searched reference lists of retrieved articles, and contacted trial authors and experts in the field for information on ongoing/completed trials. SELECTION CRITERIA: Randomised controlled trials evaluating any form of acupuncture involving participants of any age with any type of insomnia were included. Included trials compared acupuncture with placebo or sham or no treatment, or acupuncture plus other treatments compared with the same other treatments. Trials that compared only acupuncture methods or compared acupuncture alone against other treatments alone were excluded, since they did not yield the net effect of acupuncture. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed quality according to a set of criteria for risk of selection bias, performance bias, attrition bias and detection bias. Relative risk (RR) and standardised mean difference (SMD) with 95% confidence intervals were used for binary and continuous outcomes respectively. Data were combined in meta-analyses (on an intention-to-treat basis), where more than one trial without significant clinical heterogeneity presented the same outcome.

MAIN RESULTS: Seven trials met the inclusion criteria. The studies included 590 participants with insomnia, of whom 56 dropped out. Participant age ranged from 15 to 98 years, and the duration of insomnia varied from 6 months to 19 years. Co-existing medical conditions contributing to insomnia included stroke, end-stage renal disease and pregnancy. Apart from conventional needle acupuncture, different variants of acupuncture such as acupressure, auricular magnetic and seed therapy, and transcutaneous electrical acupoint stimulation (TEAS) were evaluated. Meta-analysis was limited because of considerable heterogeneity between comparison groups and between outcome measures.Based on the findings from individual trials, the review suggested that acupuncture and acupressure may help to improve sleep quality scores when compared to placebo (SMD = -1.08, 95% CI = -1.86 to -0.31, p=0.006) or no treatment (SMD -0.55, 95% CI = -0.89 to -0.21, p=0.002). TEAS also resulted in better sleep quality score in one trial (SMD = -0.74, 95% CI = -1.22 to -0.26, p=0.003). However, the efficacy of acupuncture or its variants was inconsistent between studies for many sleep parameters, such as sleep onset latency, total sleep duration and wake after sleep onset. The combined result from three studies reporting subjective insomnia improvement showed that acupuncture or its variants was not more significantly effective than control (RR = 1.66, 95% CI = 0.68 to -4.03) and significant statistical heterogeneity was observed. Only one study reported an adverse event, with one out of 16 patients (6.3%) withdrawing from acupuncture because of pain.

AUTHORS' CONCLUSIONS: The small number of randomised controlled trials, together with the poor methodological quality and significant clinical heterogeneity, means that the current evidence is not sufficiently extensive or rigorous to support the use of any form of acupuncture for the treatment of insomnia. Larger high quality clinical trials employing appropriate randomisation concealment and blinding with longer follow-up are needed to further investigate the efficacy and safety of acupuncture for the treatment of insomnia.

NO DATA 3 CD005472 NO DATA 2007 NO DATA
2 article Acupuncture for migraine prophylaxis tx+acu+sbm NO DATA Li et al 1 This is a disturbing and typical example of sloppy modern acupuncture research, methologically flawed in several ways with clearly negative results, despite the fact that it was clearly built to give acupuncture an unfair advantage, by researchers who wanted to prove that acupuncture works. They concluded that acupuncture has only “a clinically minor effect on migraine,” damning with (very) faint praise, but even that is a biased exaggeration — cherry-picking the best results, and ignoring the more important negative ones. As summarized by Dr. Steven Novella for ScienceBasedMedicine.org: “Despite all of these shortcomings, all of which would bias the study in the direction of being positive, the study was negative. For the primary outcome measure there was no statistically significant difference between any of the acupuncture groups and the sham acupuncture group.”

BACKGROUND: Acupuncture is commonly used to treat migraine. We assessed the efficacy of acupuncture at migraine-specific acupuncture points compared with other acupuncture points and sham acupuncture.

METHODS: We performed a multicentre, single-blind randomized controlled trial. In total, 480 patients with migraine were randomly assigned to one of four groups (Shaoyang-specific acupuncture, Shaoyang-nonspecific acupuncture, Yangming-specific acupuncture or sham acupuncture [control]). All groups received 20 treatments, which included electrical stimulation, over a period of four weeks. The primary outcome was the number of days with a migraine experienced during weeks 5-8 after randomization. Our secondary outcomes included the frequency of migraine attack, migraine intensity and migraine-specific quality of life.

RESULTS: Compared with patients in the control group, patients in the acupuncture groups reported fewer days with a migraine during weeks 5-8, however the differences between treatments were not significant (p> 0.05). There was a significant reduction in the number of days with a migraine during weeks 13-16 in all acupuncture groups compared with control (Shaoyang-specific acupuncture v. control: difference -1.06 [95% confidence interval (CI) -1.77 to -0.5], p = 0.003; Shaoyang-nonspecific acupuncture v. control: difference -1.22 [95% CI -1.92 to -0.52], p < 0.001; Yangming-specific acupuncture v. control: difference -0.91 [95% CI -1.61 to -0.21], p = 0.011). We found that there was a significant, but not clinically relevant, benefit for almost all secondary outcomes in the three acupuncture groups compared with the control group. We found no relevant differences between the three acupuncture groups.

INTERPRETATION: Acupuncture tested appeared to have a clinically minor effect on migraine prophylaxis compared with sham acupuncture.

184 4 401-10 Mar 2012 NO DATA
NO DATA book A Gentle Death ot NO DATA Seguin NO DATA NO DATA NO DATA NO DATA NO DATA NO DATA 1994 Key Porter Books
5 article A benefit of spinal manipulation as adjunctive therapy for acute low back pain back+chiro+smt NO DATA Hadler et al PubMed #2961085. From the abstract, “In the first week following [spinal] manipulation, these patients improved to a greater degree ... and more rapidly ....”

Fifty-four subjects volunteered to participate in a controlled study contrasting spinal manipulation with spinal mobilization without the rotational forces and leverage required to move facet joints. All suffered from regional low-back pain for less than 1 month, were ages 18-40, had never previously undergone any form of spinal manipulation, and denied a prior episode of backache within the previous 6 months. Randomization was stratified at outset into those who suffered for less than 2 weeks and those whose discomfort had persisted for 2-4 weeks. Outcome was monitored by a questionnaire assessing functional impairment. A treatment effect of manipulation was demonstrated only in the strata with more prolonged illness at entry. In the first week following manipulation, these patients improved to a greater degree (P = .009, t test) and more rapidly (P less than .025, Wilcoxon rank-sum test).

12 NO DATA 702–6 NO DATA 1987 NO DATA
NO DATA article Acupuncture for neck disorders acu+neck NO DATA Trinh et al 1 This Cochrane review of the acupuncture for neck pain sounds somewhat positive, with conclusions like “moderate evidence that acupuncture relieves [chronic neck] pain better than some sham treatments.” But read the fine print! You have got to admire the weasily phrasing there: “better than some sham treatments,” meaning that acupuncture wasn’t better than some other sham treatments. A therapy than can only “beat” some fake substitutes cannot possibly be very good! Would you take a drug if it was better than one kind of fake remedy, but no better than another? The more you read of this poor quality review, the more you start to realize that the data reviewed is of generally poor quality, and that the “positive” conclusions derived from it are actually “limited” and “moderate” at best: indeed, those are the strongest words used to describe the evidence of efficacy.

BACKGROUND: Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are the perceptions of benefits. Acupuncture has been used as an alternative to more traditional treatments for musculoskeletal pain. This review summarizes the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain.

OBJECTIVES: To determine the effects of acupuncture for individuals with neck pain.

SEARCH STRATEGY: We searched CENTRAL (2006, issue 1) and MEDLINE, EMBASE, MANTIS, CINAHL from their beginning to February 2006. We searched reference lists and the acupuncture database TCMLARS in China.

SELECTION CRITERIA: Any published trial using randomized (RCT) or quasi-randomized (quasi-RCT) assignment to the intervention groups, either in full text or abstract form, were included.

DATA COLLECTION AND ANALYSIS: Two reviewers made independent decisions for each step of the review: article inclusion, data abstraction and assessment of trial methodological quality. Study quality was assessed using the Jadad criteria. Consensus was used to resolve disagreements. When clinical heterogeneity was absent, we combined studies using random-effects meta-analysis models.

MAIN RESULTS: We did not find any trials that examined the effects of acupuncture for acute or subacute pain, but we found 10 trials that examined acupuncture treatments for chronic neck pain. Overall, methodological quality had a mean of 2.3/5 on the Jadad Scale. For chronic mechanical neck disorders, there was moderate evidence that acupuncture was more effective for pain relief than some types of sham controls, measured immediately post-treatment. There was moderate evidence that acupuncture was more effective than inactive, sham treatments measured immediately post-treatment and at short-term follow-up (pooled standardized mean difference (SMD) -0.37, 95% confidence interval (CI) -0.61 to -0.12). There was limited evidence that acupuncture was more effective than massage at short-term follow-up. For chronic neck disorders with radicular symptoms, there was moderate evidence that acupuncture was more effective than a wait-list control at short-term follow-up.

AUTHORS' CONCLUSIONS: There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment. There is moderate evidence that those who received acupuncture reported less pain at short term follow-up than those on a waiting list. There is also moderate evidence that acupuncture is more effective than inactive treatments for relieving pain post-treatment and this is maintained at short-term follow-up.

3 NO DATA CD004870 NO DATA 2006 NO DATA
3 article Acupuncture for shoulder pain tx+acu+quack NO DATA Green et al 1 Acupuncture is damned with faint praise by the results of this review, as with most other reviews. The authors do bend over backwards to conclude that “there may be short-term benefit with respect to pain and function,” but this token positivity is based on scraps of unimpressive data: “The improvements with acupuncture for pain and function were about the same as the effects of receiving a fake therapy for 2 to 4 weeks.” Emphasis mine. “There is little evidence to support or refute the use of acupuncture for shoulder pain,” the authors conclude. Little evidence to specifically refute it, perhaps … but plenty of reasons to refute it.

BACKGROUND: There are many commonly employed forms of treatment for shoulder disorders. This review of acupuncture is one in a series of reviews of varying interventions for shoulder disorders including adhesive capsulitis (frozen shoulder), rotator cuff disease and osteoarthritis. Acupuncture to treat musculoskeletal pain is being used increasingly to confer an analgesic effect and to date its use in shoulder disorder has not been evaluated in a systematic review.

OBJECTIVES: To determine the efficacy and safety of acupuncture in the treatment of adults with shoulder pain.

SEARCH STRATEGY: The Cochrane Controlled Trials Register, MEDLINE, EMBASE and CINAHL were searched from inception to December 2003, and reference lists from relevant trials were reviewed.

SELECTION CRITERIA: Randomised and quasi-randomised trials, in all languages, of acupuncture compared to placebo or another intervention in adults with shoulder pain. Specific exclusions were duration of shoulder pain less than three weeks, rheumatoid arthritis, polymyalgia rheumatica, cervically referred pain and fracture.

DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted trial and outcome data. For continuous outcome measures where the standard deviations were not reported it was either calculated from the raw data or converted from the standard error of the mean. If neither of these was reported, authors were contacted. Where results were reported as median and range, the trial was not included in the meta-analysis, but presented in Additional Tables. Effect sizes were calculated and combined in a pooled analysis if the study end-points population and intervention were homogenous. Results are presented separately for rotator cuff disease, adhesive capsulitis, full thickness rotator cuff tear and mixed diagnoses, and, where possible, combined in meta-analysis to indicate effect of acupuncture across all shoulder disorders.

MAIN RESULTS: Nine trials of varying methodological quality met the inclusion criteria. For all trials there was poor description of interventions. Varying placebos were used in the different trials. Two trials assessed short-term success (post intervention) of acupuncture for rotator cuff disease and could be combined in meta analysis. There was no significant difference in short-term improvement associated with acupuncture when compared to placebo, but due to small sample sizes this may be explained by Type II error. Acupuncture was of benefit over placebo in improving the Constant Murley Score (a measure of shoulder function) at four weeks (WMD 17.3 (7.79, 26.81)). However, by four months, the difference between the acupuncture and placebo groups, whilst still statistically significant, was no longer likely to be clinically significant (WMD 3.53 (0.74, 6.32)). The Constant Murley Score is graded out of 100, hence a change of 3.53 is unlikely to be of substantial benefit. The results of a small pilot study demonstrated some benefit of both traditional and ear acupuncture plus mobilization over mobilization alone. There was no difference in adverse events related to acupuncture when compared to placebo, however this was assessed by only one trial.

AUTHORS' CONCLUSIONS: Due to a small number of clinical and methodologically diverse trials, little can be concluded from this review. There is little evidence to support or refute the use of acupuncture for shoulder pain although there may be short-term benefit with respect to pain and function. There is a need for further well designed clinical trials.

NO DATA 2 CD005319 NO DATA 2005 NO DATA
NO DATA article Acupuncture for treatment of climacteric syndrome — a report of 35 cases acu+ot NO DATA Shen et al PubMed #15889510. NO DATA NO DATA 25 1 3–6 Mar 2005 NO DATA
4 article Acupuncture in patients with acute low back pain tx+acu+quack NO DATA Vas et al PubMed #22770838. Yet another study of acupuncture with predictably disappointing results. This part sounds good: “all 3 modalities of acupuncture were better than conventional treatment alone.” But that means only that people find the ritual of acupuncture gives good placebo. The real story is told by this: “there was no difference among the 3 acupuncture modalities [true/sham/placebo], which implies that true acupuncture is not better than sham or placebo acupuncture.” In other words, it doesn’t matter if acupuncture is real, just that it seems to the patient like an impressive ancient Chinese healing ritual with needles.

Reviews of the efficacy of acupuncture as a treatment for acute low back pain have concluded that there is insufficient evidence for its efficacy and that more research is needed to evaluate it. A multicentre randomized controlled trial was conducted at 4 primary-care centres in Spain to evaluate the effects of acupuncture in patients with acute nonspecific low back pain in the context of primary care. A total of 275 patients with nonspecific acute low back pain (diagnosed by their general practitioner) were recruited and assigned randomly to 4 different groups: conventional treatment either alone or complemented by 5 sessions over a 2-week period of true acupuncture, sham acupuncture, or placebo acupuncture per patient. Patients were treated from February 2006 to January 2008. The primary outcome was the reduction in Roland Morris Disability Questionnaire scores of 35% or more after 2 weeks' treatment. The patients in the 3 types of acupuncture groups were blinded to the treatments, but those who received conventional treatment alone were not. In the analysis adjusted for the total sample (true acupuncture relative risk 5.04, 95% confidence interval 2.24-11.32; sham acupuncture relative risk 5.02, 95% confidence interval 2.26-11.16; placebo acupuncture relative risk 2.57 95% confidence interval 1.21-5.46), as well as for the subsample of occupationally active patients, all 3 modalities of acupuncture were better than conventional treatment alone, but there was no difference among the 3 acupuncture modalities, which implies that true acupuncture is not better than sham or placebo acupuncture.

153 9 1883-9 Sep 2012 NO DATA
4 article Acupuncture transmitted infections acu+quack+ot NO DATA Woo et al 1 What’s the harm in acupunture? A small but real risk of infection — as with anything that breaks the skin. Acupuncture has not only failed to prove that it works, but this British Medical Journal editorial presents new evidence that it also involves a risk of mycobacteria infection, and even that “… outbreaks of acupuncture transmitted infections may be the tip of the iceberg. The first reports of meticillin resistant S aureus (MRSA) transmitted by acupuncture appeared in 2009. The emergence of community associated MRSA infections may aggravate the problem.” A common objection to Woo’s article has been that it is “mongers fear” and that he cites old evidence, from the 1970s and 1980s, before sterized needles were widely used. But critics conveniently overlook that Woo also cite modern evidence of infection — about as blatant a case of biased interpretation as you could ask for. And is Woo a fear mongerer? He does not claim that the risk is great: he just reports what is known and titles his piece neutrally. It is always worthwhile to examine treatment risks, and especially when treatment benefits are also hotly disputed. It hardly constitutes “fear-mongering” to report risk data in a medical journal! If not there, then where?

Acupuncture transmitted infections are underdiagnosed, so clinicians should have a high index of suspicion.

Acupuncture, which is based on the theory that inserting and manipulating fine needles at specific acupuncture points located in a network of meridians will promote the harmonious flow of “Qi,” is one of the most widely practised modalities of alternative medicine. Because needles are inserted up to several centimetres beneath the skin, acupuncture may pose risks to patients. One of the most important complications is transmission of pathogenic micro-organisms, from environment to patient or from one patient to another.

340 NO DATA c1268Oh, I Mar 18 2010 NO DATA
4 article Acupuncture treatment for pain acu+pain+sbm+quack NO DATA Madsen et al The reviews concludes that “a small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear.” Remember, in the context of treating pain, a “small analgesic effect” is worthless — hopelessly damned by faint praise, and that’s assuming it’s even a genuine effect of acupuncture. In fact, it’s vastly more likely to be an effect of being handled and taken care of (“the treatment ritual”).

OBJECTIVES: To study the analgesic effect of acupuncture and placebo acupuncture and to explore whether the type of the placebo acupuncture is associated with the estimated effect of acupuncture.

DESIGN: Systematic review and meta-analysis of three armed randomised clinical trials.

DATA SOURCES: Cochrane Library, Medline, Embase, Biological Abstracts, and PsycLIT. Data extraction and analysis Standardised mean differences from each trial were used to estimate the effect of acupuncture and placebo acupuncture. The different types of placebo acupuncture were ranked from 1 to 5 according to assessment of the possibility of a physiological effect, and this ranking was meta-regressed with the effect of acupuncture.

DATA SYNTHESIS: Thirteen trials (3025 patients) involving a variety of pain conditions were eligible. The allocation of patients was adequately concealed in eight trials. The clinicians managing the acupuncture and placebo acupuncture treatments were not blinded in any of the trials. One clearly outlying trial (70 patients) was excluded. A small difference was found between acupuncture and placebo acupuncture: standardised mean difference -0.17 (95% confidence interval -0.26 to -0.08), corresponding to 4 mm (2 mm to 6 mm) on a 100 mm visual analogue scale. No statistically significant heterogeneity was present (P=0.10, I(2)=36%). A moderate difference was found between placebo acupuncture and no acupuncture: standardised mean difference -0.42 (-0.60 to -0.23). However, considerable heterogeneity (P<0.001, I(2)=66%) was also found, as large trials reported both small and large effects of placebo. No association was detected between the type of placebo acupuncture and the effect of acupuncture (P=0.60).

CONCLUSIONS: A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear.

338 NO DATA a3115 NO DATA 2009 NO DATA
4 article Acupuncture tx+acu+quack+mind NO DATA Ernst et al PubMed #21440191. A dozen of the best scientific studies of acupuncture treatments for pain were carefully analyzed. The acupuncture treatments were for conditions like osteoarthritis, headache and migraine, low back pain, fibromyalgia, and more. The authors of the paper found a statistically significant but “small difference between acupuncture and placebo acupuncture.” They concluded that “the apparent analgesic effect of acupuncture seems to be below a clinically relevant pain improvement.” Pain invited a well-known voice of reason in medicine, Dr. Harriet Hall, to write an editorial about this paper. Dr. Hall’s editorial is an easy-reading summary for both patients and professionals. It is reproduced in full on ScienceBasedMedicine.org: see Acupuncture Revisited.

Acupuncture is commonly used for pain control, but doubts about its effectiveness and safety remain. This review was aimed at critically evaluating systematic reviews of acupuncture as a treatment of pain and at summarizing reports of serious adverse effects published since 2000. Literature searches were carried out in 11 databases without language restrictions. Systematic reviews were considered for the evaluation of effectiveness and case series or case reports for summarizing adverse events. Data were extracted according to predefined criteria. Fifty-seven systematic reviews met the inclusion criteria. Four were of excellent methodological quality. Numerous contradictions and caveats emerged. Unanimously positive conclusions from more than one high-quality systematic review existed only for neck pain. Ninety-five cases of severe adverse effects including 5 fatalities were included. Pneumothorax and infections were the most frequently reported adverse effects. In conclusion, numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain. Serious adverse effects continue to be reported. Numerous reviews have produced little convincing evidence that acupuncture is effective in reducing pain. Serious adverse events, including deaths, continue to be reported.

152 4 755-64 Apr 2011 NO DATA
3 article Acute effects of stretching exercise on the heart rate variability in subjects with low flexibility levels tx+stretch+exercise NO DATA Farinatti et al PubMed #21386722. This study of stretching found that
multiple-set flexibility training sessions enhanced the vagal modulation and sympathovagal balance [that’s good] in the acute postexercise recovery, at least in subjects with low flexibility levels. … stretching routines may contribute to a favorable autonomic activity change in untrained subjects.
This seems like a fairly straightforward bit of good-news science about stretching. It’s not a surprising idea that movement would have some systemic regulatory effects (motion is lotion, use it or lose it), but it’s nice to see some corroboration of that common sensical notion, and it’s also nice to know that perhaps just stretching did this (to the extent we can learn anything from a single study). If true, it makes for nice evidence to support a general stretching habit, yoga, mobilizations, really any kind of “massaging with movement,” and probably even massage itself.

The study investigated the heart rate (HR) and heart rate variability (HRV) before, during, and after stretching exercises performed by subjects with low flexibility levels. Ten men (age: 23 ± 2 years; weight: 82 ± 13 kg; height: 177 ± 5 cm; sit-and-reach: 23 ± 4 cm) had the HR and HRV assessed during 30 minutes at rest, during 3 stretching exercises for the trunk and hamstrings (3 sets of 30 seconds at maximum range of motion), and after 30 minutes postexercise. The HRV was analyzed in the time ('SD of normal NN intervals' [SDNN], 'root mean of the squared sum of successive differences' [RMSSD], 'number of pairs of adjacent RR intervals differing by>50 milliseconds divided by the total of all RR intervals' [PNN50]) and frequency domains ('low-frequency component' [LF], 'high-frequency component' [HF], LF/HF ratio). The HR and SDNN increased during exercise (p < 0.03) and decreased in the postexercise period (p = 0.02). The RMSSD decreased during stretching (p = 0.03) and increased along recovery (p = 0.03). At the end of recovery, HR was lower (p = 0.01), SDNN was higher (p = 0.02), and PNN50 was similar (p = 0.42) to pre-exercise values. The LF increased (p = 0.02) and HF decreased (p = 0.01) while stretching, but after recovery, their values were similar to pre-exercise (p = 0.09 and p = 0.3, respectively). The LF/HF ratio increased during exercise (p = 0.02) and declined during recovery (p = 0.02), albeit remaining higher than at rest (p = 0.03). In conclusion, the parasympathetic activity rapidly increased after stretching, whereas the sympathetic activity increased during exercise and had a slower postexercise reduction. Stretching sessions including multiple exercises and sets acutely changed the sympathovagal balance in subjects with low flexibility, especially enhancing the postexercise vagal modulation.

25 6 1579-85 Jun 2011 NO DATA
NO DATA article Acute effects of the Protonics system on patellofemoral alignment pfps+run+knee+surgery NO DATA Sathe et al NO DATA

This study used magnetic resonance imaging (MRI) to determine whether changes in patellofemoral alignment occur after initial treatment with the Protonics exercise device. The first scan was obtained before the device was used. After performing a set of exercises with no resistance on the device the device was removed, and a second scan was obtained. The same set of exercises was again performed with resistance on the device set at the appropriate level, and a final scan was obtained with the device removed. An isometric leg press was maintained as each image was obtained to simulate more closely a functional weight-bearing activity. Subjects were 26 women with complaints of patellofemoral pain. The main outcome measures were: patellar tilt angle, bisect offset, and lateral facet angle. Nonparametric repeated measures analysis of variance tests showed no differences between test conditions for any of the three measures of patellofemoral alignment. We conclude that after an initial treatment session using the Protonics system there is no change in patellofemoral alignment as determined by MRI.

10 1 44–48 NO DATA 2002 NO DATA
3 article Acute first-time hamstring strains during slow-speed stretching strain NO DATA Askling et al PubMed #17567821. NO DATA

BACKGROUND: Hamstring strains can be of 2 types with different injury mechanisms, 1 occurring during high-speed running and the other during stretching exercises.

HYPOTHESIS: A stretching type of injury to the proximal rear thigh may involve specific muscle-tendon structures that could affect recovery time.

STUDY DESIGN: Case series (prognosis); Level of evidence, 2.

METHODS: Fifteen professional dancers with acute first-time hamstring strains were prospectively included in the study. All subjects were examined, clinically and with magnetic resonance imaging, on 4 occasions after injury: at day 2 to 4, 10, 21, and 42. The clinical follow-up period was 2 years.

RESULTS: All dancers were injured during slow hip-flexion movements with extended knee and experienced relatively mild acute symptoms. All injuries were located proximally in the posterior thigh close to the ischial tuberosity. The injury involved the semimembranosus (87%), quadratus femoris (87%), and adductor magnus (33%). All injuries to the semimembranosus involved its proximal free tendon. There were no significant correlations between clinical or magnetic resonance imaging parameters and the time to return to preinjury level (median, 50 weeks; range, 30-76 weeks).

CONCLUSION: Stretching exercises can give rise to a specific type of strain injury to the posterior thigh. A precise history and careful palpation provide the clinician enough information to predict a prolonged time until return to preinjury level. One factor underlying prolonged recovery time could be the involvement of the free tendon of the semimembranosus muscle.

35 10 1716-24 Oct 2007 NO DATA
3 article Adding ultrasound in the management of soft tissue disorders of the shoulder tools NO DATA Gürsel et al 1 From the abstract: “The results suggest that true ultrasound, compared with sham ultrasound, brings no further benefit when applied in addition to other physical therapy interventions in the management of soft tissue disorders of the shoulder.”

BACKGROUND AND PURPOSE: There is still a lack of evidence about the beneficial effects of ultrasound (US) intervention for the management of soft tissue problems. Thus, this study was designed to assess the effectiveness of US over a placebo intervention when added to other physical therapy interventions and exercise in the management of shoulder disorders.

SUBJECTS AND METHODS: Forty patients who were diagnosed by ultrasonography or magnetic resonance imaging to have a periarticular soft tissue disorder of the shoulder were randomly assigned to either a group that received true US (n=20; mean time since onset of pain=8.7 months, SD=8.8, range=1-36) or a group that received sham US (n=20; mean time since onset of pain=8.1 months, SD=10.8, range=1-42). Besides true or sham US (10 minutes), superficial heat (10 minutes), electrical stimulation (15 minutes), and an exercise program (15-30 minutes) were administered to both groups 5 days each week for 3 weeks.

RESULTS: Subjects showed within-group improvements in pain, range of motion, Shoulder Disability Questionnaire scores, and Health Assessment Questionnaire scores with the intervention, but the differences did not reach significance when compared between the groups.

DISCUSSION AND CONCLUSION: The results suggest that true US, compared with sham US, brings no further benefit when applied in addition to other physical therapy interventions in the management of soft tissue disorders of the shoulder.

84 4 336-43 Apr 2004 NO DATA
1 article A comparison of cathartics in pediatric ingestions ot NO DATA James et al PubMed #7630676. This paper compared the effectiveness of different laxatives, showing that Epsom salts do indeed move the bowels along … but not as quickly as sorbitol.

OBJECTIVE: To compare the mean time to first stool, number of stools, and side effects of three commonly used cathartics in pediatric ingestions.

DESIGN: This prospective clinical trial was a randomized, double-blinded comparison of sorbitol, magnesium citrate, magnesium sulfate, and water, administered with activated charcoal in the treatment of pediatric patients 1 to 5 years of age with acute ingestions. Outcome parameters were mean time to first stool, mean number of stools during 24 hours, and side effects.

RESULTS: One hundred sixteen patients completed the study. Significant differences in mean time to the first stool were detected among cathartic agents (F = 9.29), with sorbitol-treated patients having a shortest mean time to the first stool (mean, 8.48 hours). Sorbitol produced a significantly higher number of stools (mean, 2.79) in the 24-hour follow-up period than other cathartics (F = 3.49). The most common side effect of cathartic administration was emesis, which occurred more commonly in sorbitol-treated patients.

CONCLUSION: Sorbitol, when administered with activated charcoal in the treatment of children with acute ingestions, produced a shorter time to first stool and more stools than magnesium citrate, magnesium sulfate, or water.

96 2 Pt 1 235–238 Aug 1995 NO DATA
NO DATA article Adequacy of education in musculoskeletal medicine back+neck+sbm NO DATA Matzkin et al PubMed #15687152. From the abstract: “… training in musculoskeletal medicine is inadequate in both medical school and nonorthopaedic residency training programs.”

BACKGROUND: Basic musculoskeletal knowledge is essential to the practice of medicine. A validated musculoskeletal cognitive examination was given to medical students, residents, and staff physicians in multiple disciplines of medicine to assess the adequacy of their musculoskeletal medicine training.

METHODS: The examination was given to 334 volunteers consisting of medical students, residents, and staff physicians. Analysis of the data collected and comparisons across disciplines were performed.

RESULTS: The average cognitive examination score was 57%. Sixty-nine participants (21%) obtained a score of >/=73.1%, the recommended mean passing score. Of the sixty-nine with a passing score, forty (58%) were orthopaedic residents and staff physicians with an overall average score of 94%. Differences in the average scores for the orthopaedic residents compared with all other specialties were significant (p < 0.001). The average score was 69% for the 124 participants who stated that they had taken a required or an elective course in orthopaedics during their training compared with an average score of 50% for the 210 who had not taken an orthopaedic course (p < 0.001). When the scores of those in orthopaedics were excluded, the average score for the participants who had taken an orthopaedic course was 59%; this difference remained significant (p < 0.001).

CONCLUSIONS: Seventy-nine percent of the participants failed the basic musculoskeletal cognitive examination. This suggests that training in musculoskeletal medicine is inadequate in both medical school and nonorthopaedic residency training programs. Among the nonorthopaedists, scores were significantly better if they had taken a medical school course or residency rotation in orthopaedics, suggesting that a rotation in orthopaedics would improve the general level of musculoskeletal knowledge.

87 2 310–314 Feb 2005 NO DATA
NO DATA article Adhesive capsulitis NO DATA NO DATA Tasto et al PubMed #18004221. NO DATA

Adhesive capsulitis is a common problem seen in the general population by orthopedic surgeons. It is a problem that causes patients pain and disability, and symptoms can last up to 2 years and longer. The questions of when and how to treat the frozen shoulder can present challenges. Most treatments are conservative; however, indications for surgery do exist. Arthroscopic capsular release has gained popularity over the years and offers a predictably good treatment in patients with adhesive capsulitis. The purpose of this paper is to review the orthopedic literature on adhesive capsulitis, to provide background information on this topic, and to describe our technique in arthroscopic capsular release.

15 4 216-21 Dec 2007 NO DATA
NO DATA article Adhesive capsulitis of the shoulder in human immunodeficiency virus-positive patients during highly active antiretroviral therapy NO DATA NO DATA Ponti et al PubMed #16517362. NO DATA

Many adverse events have been described in patients treated with highly active antiretroviral therapy (HAART). Recently, among these, adhesive capsulitis of the shoulder has been described in some patients using protease inhibitors. We report our experience with 6 human immunodeficiency virus-positive patients in whom adhesive capsulitis of the shoulder developed during HAART. All 6 patients were treated with the same antiretroviral drug combination (HAART) including nucleoside reverse transcriptase (stavudine and lamivudine) and protease inhibitors (indinavir). The clinical pattern of adhesive capsulitis during HAART is similar to the classical form of adhesive capsulitis. Examining our case studies, we postulate a correlation between HAART and adhesive capsulitis. Discontinuation or reduction of the dosage of protease inhibitors associated with conventional conservative treatment is effective in reducing the symptoms and resolving the disease.

15 2 188-90 NO DATA 2006 NO DATA
5 article Adverse events and manual therapy harms+mx+chiro+quack+tps+back+neck NO DATA Carnes et al PubMed #20097115. The sound bite in this study is that 20-40% of all manual therapy treatments — massage, chiropractic, physiotherapy — will cause some kind of unpleasantness, side effect or “adverse event” in medicalspeak. In a word: yikes! Perspective cuts both ways here. On the one hand, it’s not as bad as it sounds: these “events” are minor and moderate in severity; only 1 or 2 per thousand visits causes a serious problem; and drugs are actually relatively worse. That is, you are modestly more likely to have an “adverse event” if you are given a pill. This just refers to typical side effects, such as ibuprofen’s tendency to cause indigestion. But when you take a pill, the side effect is usually unrelated to the problem (i.e. it doesn’t make the problem you’re treating worse), you are generally trading those side effects for some pretty clear benefits, and it’s usually cheap. In manual therapy, most adverse events are backfires — that is, you go for a neck adjustment at the chiropractor, and you come out with more neck pain instead of less. Other data shows this is 25% more likely than if you did nothing at all (see Carlesso). And you pay through the nose for this! Manual therapy is much more expensive than most drug therapy. Manual therapists routinely claim that their services are much safer and more effective than drug therapies. Yet this data pretty clearly shows that the difference is really not great. Depending on how you look at it, drugs are only a little worse in some ways, or maybe a little better in other ways. But no matter how you slice it, 20-40% is a pretty unpleasant rate of harm — especially at $60–120/hour!

OBJECTIVE: To explore the incidence and risk of adverse events with manual therapies.

METHOD: The main health electronic databases, plus those specific to allied medicine and manual therapy, were searched. Our inclusion criteria were: manual therapies only; administered by regulated therapists; a clearly described intervention; adverse events reported. We performed a meta-analysis using incident estimates of proportions and random effects models.

RESULTS: Eight prospective cohort studies and 31 manual therapy RCTs were accepted. The incidence estimate of proportions for minor or moderate transient adverse events after manual therapy was approximately 41% (CI 95% 17-68) in the cohort studies and 22% (CI 95% 11.1-36.2%) in the RCTs; for major adverse events approximately 0.13%. The pooled relative risk (RR) for experiencing adverse events with exercise, or with sham/passive/control interventions compared to manual therapy was similar, but for drug therapies greater (RR 0.05, CI 95% 0.01-0.20) and less with usual care (RR 1.91, CI 95% 1.39-2.64).

CONCLUSIONS: The risk of major adverse events with manual therapy is low, but around half of manual therapy patients may experience minor to moderate adverse events after treatment. The relative risk of adverse events appears greater with drug therapy but less with usual care.

15 4 355-63 Aug 2010 NO DATA
5 article Adverse events associated with the use of cervical manipulation and mobilization for the treatment of neck pain in adults neck+smt+chiro+quack NO DATA Carlesso et al PubMed #20227325. This study analysed the scientific literature looking for evidence of harm from spinal manipulative therapy (SMT) in the neck, and found a statistically insignificant trend towards the negative, an uncertain number that leaned in the direction of bad news: increased neck pain might be 25% more likely with SMT than if you did nothing, or if you just stuck to safe and neutral treatments. The same murky data could also suggest basically the opposite: the absence of a clear signal constitutes “strong evidence that neck manipulation or mobilization does not result in an increase in neck pain,” according to the authors. Debatable, but noted. (There are just too many ways the data could be missing the truth entirely here. And this is acknowledged in the paper, practically in the next sentence: “However, the limitations of the Strunk study and the low GRADE rating remain, affecting confidence in the estimate.”) What about non-pain syptoms? More spectacularly, patients are 100% more likely to have “transient neurological symptoms” (which can range from dizziness all the way up to serious unpleasantness, such as severe dizziness, nausea and vomitting, as described in What Happened To My Barber?). (These are relative risk measurements: the risk compared to not getting treated — not the overall likelihood, which cannot be measured from this kind of data.) And how about injury or death? The authors could not calculate the relative risk from this evidence. Here be statistical dragons. At first glance this might seem to indicate that such serious harm is unlikely — wouldn’t a problem show up if it were serious? Only if the research was actually designed to detect it. These authors were simply going through data from many small studies of neck adjustment, in which some rotten reactions were noted (while many other studies were disqualified for not tracking harms at all). It remains entirely possible that the phenomenon is real but rare, and simply didn’t occur, or wasn’t noted, in any of the studies considered here. Similarly, you could analyze dozens of studies of the health effects of hiking, but probably none of them would have data about bear attacks — yet bears do attack people!

Adverse events (AE) are a concern for practitioners utilizing cervical manipulation or mobilization. While efficacious, these techniques are associated with rare but serious adverse events. Five bibliographic databases (PubMed, CINAHL, PEDro, AMED, EMBASE) and the gray literature were searched from 1998 to 2009 for any AE associated with cervical manipulation or mobilization for neck pain. Randomized controlled trials (RCTs), prospective or cross-sectional observational studies were included. Two independent reviewers conducted study selection, method quality assessment and data abstraction. Pooled relative risks (RR) were calculated. Study quality was assessed using the Cochrane system, a modified Critical Appraisal Skills Program form and the McHarm scale to assess the reporting of harms. Seventeen of 76 identified citations resulted in no major AE. Two pooled estimates for minor AE found transient neurological symptoms [RR 1.96 (95% CI: 1.09-3.54) p<0.05]; and increased neck pain [RR 1.23 (95% CI: 0.85-1.77) p>.05]. Forty-four studies (58%) were excluded for not reporting AE. No definitive conclusions can be made due to a small number of studies, weak association, moderate study quality, and notable ascertainment bias. Improved reporting of AE in manual therapy trials as recommended by the CONSORT statement extension on harms reporting is warranted.

15 5 434-444 Oct 2010 NO DATA
NO DATA book A short history of nearly everything biolit NO DATA Bryson NO DATA NO DATA NO DATA NO DATA NO DATA NO DATA 2003 Broadway Books
NO DATA article Adhesive capsulitis and dynamic splinting NO DATA NO DATA Gaspar et al PubMed #19735563. NO DATA

BACKGROUND: Adhesive Capsulitis (AC) affects patient of all ages, and stretching protocols are commonly prescribed for this condition. Dynamic splinting has been shown effective in contracture reduction from pathologies including Trismus to plantar fasciitis. The purpose of this study was to examine the efficacy of dynamic splinting on patients with AC.

METHODS: This controlled, cohort study, was conducted at four physical therapy, sports medicine clinics in Texas and California. Sixty-two patients diagnosed with Stage II Adhesive Capsulitis were grouped by intervention. The intervention categories were as follows: Group I (Control); Group II (Physical Therapy exclusively with standardized protocols); Group III; (Shoulder Dynasplint system exclusively); Group IV (Combined treatment with Shoulder Dynasplint and standardized Physical Therapy). The duration of this study was 90 days for all groups, and the main outcome measures were change in active, external rotation.

RESULTS: Significant difference was found for all treatment groups (p < 0.001) following a one-way ANOVA. The greatest change with the smallest standard deviation was for the combined treatment group IV, (mean change of 29 degrees ).

CONCLUSION: The difference for the combined treatment group was attributed to patients' receiving the best PT combined with structured "home therapy" that contributed an additional 90 hours of end-range stretching. This adjunct should be included in the standard of care for adhesive Capsulitis. TRIAL REGISTRATION: Trial Number: NCT00873158.

10 NO DATA 111 NO DATA 2009 NO DATA
2 article Advice for the management of low back pain back+exercise NO DATA Liddle et al PubMed #17395522. A systematic review of Randomised Controlled Trials (RCTs) using advice, either alone or with another intervention. Advice as an adjunct to exercise was most effective for improving pain, back-specific function and work disability in chronic LBP but, for acute LBP, was no more effective for improving these outcomes than simple advice to stay active. Advice as part of a back school was most effective for improving back-specific function in subacute LBP; these trials generally demonstrated long-term positive results. Advice as an adjunct to exercise was the most common form of treatment for acute and chronic LBP; advice as part of a back school was most commonly used for subacute LBP. Fifteen percent of acute LBP trials had a positive outcome, compared to 86% and 74% of subacute and chronic LBP trials respectively. The findings of this review have important implications for clinical practice, and for the design of further clinical trials in this area.

To synthesise the evidence relating to the effectiveness of advice, the relevance of its content and frequency, and to compare the advice being offered to acute, subacute and chronic low back pain (LBP) patients. A systematic review of Randomised Controlled Trials (RCTs) using advice, either alone or with another intervention. The QUOROM guidelines and the Cochrane Collaboration Back Review Group Guidelines for Systematic Reviews were followed throughout: methodological assessment identified RCTs of 'high' or 'medium' methodological quality, based on their inclusion of at least 50% of the specified internal validity criteria. Outcome measures were analysed based on five recommended core outcome domains; pain, work disability, back-specific function, generic health status and satisfaction with care. Relevant RCTs (n=56) were scored for methodological quality; 39 RCTs involving 7347 patients qualified for inclusion, based upon their methodological quality. Advice as an adjunct to exercise was most effective for improving pain, back-specific function and work disability in chronic LBP but, for acute LBP, was no more effective for improving these outcomes than simple advice to stay active. Advice as part of a back school was most effective for improving back-specific function in subacute LBP; these trials generally demonstrated long-term positive results. Advice as an adjunct to exercise was the most common form of treatment for acute and chronic LBP; advice as part of a back school was most commonly used for subacute LBP. Fifteen percent of acute LBP trials had a positive outcome, compared to 86% and 74% of subacute and chronic LBP trials respectively. A wide variety of outcome measures were used, making valid comparisons between treatment outcomes difficult. The advice provided to patients with LBP within RCTs varied considerably depending on symptom duration. The findings of this review have important implications for clinical practice, and for the design of further clinical trials in this area. Advice to stay active is sufficient for acute LBP; however, it appears that RCTs do not commonly reflect these recommendations. No conclusions could be drawn as to the content and frequency of advice that is most effective for subacute LBP, due to the limited number and poor quality of RCTs in this area: this review provides preliminary support for advice as part of a back school approach. Given that the effectiveness of treatment for subacute symptoms will directly influence the development of chronicity, these results would suggest that education and awareness of the causes and consequences of back pain may be a valuable treatment component for this patient subgroup. For chronic LBP there is strong evidence to support the use of advice to remain active in addition to specific advice relating to the most appropriate exercise, and/or functional activities to promote active self-management. More investigation is needed into the role of follow-up advice for chronic LBP patients.

12 4 310-27 Nov 2007 NO DATA
NO DATA book Advice to a young scientist sbm+ot NO DATA Medawar NO DATA

I cannot give any scientist of any age better advice than this: the intensity of the conviction that a hypothesis is true has no bearing on whether it is true or not.

NO DATA NO DATA NO DATA NO DATA 1979 Harper & Row
4 article Affective massage therapy tx+manual+mx+mind+back NO DATA Moyer 1 Dr. Christopher Moyer explains that the only confirmed benefits of massage are its effects on mood (“affect”), specifically depression and anxiety. “Together, these effects on anxiety and depression are the most well-established effects in the MT research literature. They are especially important for us to understand not only for their own sake, but also because anxiety and depression exacerbate many other specific health problem.” He proposes that “the time is right to name a new subfield for massage therapy research and practice: affective massage therapy.”

Two general effects [of massage, MT] are well-supported by scientific data and widely agreed-upon by MT researchers. Quantitative research reviews show that a series of MT treatments consistently produces sizable reductions of depression in adult recipients. The effects of MT on anxiety are even better understood. Single sessions of MT significantly reduce state anxiety, the momentary emotional experiences of apprehension, tension, and worry in both adults and in children, and multiple sessions of MT, performed over a period of days or weeks, significantly reduce trait anxiety, the normally stable individual tendency to experience anxiety states, to an impressive degree in adults.

Together, these effects on anxiety and depression are the most well-established effects in the MT research literature. They are especially important for us to understand not only for their own sake, but also because anxiety and depression exacerbate many other specific health problems. In other words, it is reasonable to theorize that quite a few specific health benefits associated with MT may actually be “second-order” effects that are a consequence of MT’s “first-order” effects on anxiety and depression.

1 2 3-5 NO DATA 2008 NO DATA
4 article Against All Reason — Effects of Acupuncture and Tens Delivered to an Artificial Hand pain+quack+acu NO DATA Bulley et al Fascinating, head-trippy study — I have not considered all of its implications yet!

Purpose: To determine whether non-specific treatment effects can be imparted when the treatment is cognitively implausible but the perceptual cues are credible. Relevance: That a patient believes a treatment will work is thought to be the critical determinant of non-treatment, or 'placebo' effects. If so, a treatment that both patient and clinician know is futile will not induce non-treatment effects. Although it is widely accepted, this position has not, until now, been tested. That visual illusions by definition induce perceptual effects in the absence of reason, raises the possibility that illusions in other domains might also. Participants: There were two experiments. The first involved 14 and the second 26 healthy volunteers, recruited via advertisement. Methods: Experiment 1: The extant literature on perceptual effects of acupuncture was reviewed. Key perceptual descriptive terms, collectively described as 'Deqi' were identified. For the experiment, synchronous stimulation of the participant's hand, held out of view, and an artificial hand, placed in view, induces a sense of ownership over the artificial hand, but participants know the rubber hand is not theirs. This so-called 'rubber hand illusion' was induced using the established method and then participants were asked to report any perceptual effects of acupuncture delivered only to the rubber hand. Participants were naïve to acupuncture. The frequency of the key perceptual descriptive terms was compared to a database of terms reported during the illusion alone. Experiment 2: After a conditioning session using TENS delivered to the real hand, participants were randomly allocated to real or sham TENS delivered to the rubber hand, during a rubber hand illusion. Perceptual effects were reported. Primary outcome measure was pressure pain threshold (PPT) on the actual hand before and after real or sham TENS to the rubber hand. Analysis: Experiment 1: The frequency of acupuncture-specific terms was compared to existing data using a Fischer exact test. Experiment 2: A two (time) x two (condition) ANOVA compared PPT between real and sham TENS. Results: Experiment 1: Twelve of 14 participants reported perceptual effects, characteristic of 'Deqi', after acupuncture to the rubber hand, effects that are seldom reported in association with the illusion alone (Fischer's p <0.01). All participants reported that they strongly believed the rubber hand was not their own. Experiment 2: Real TENS, but not sham TENS, was associated with an increase in PPT to the real hand (no main effects, time x condition interaction, p <0.05). Conclusions: It is not necessary to believe that a treatment can work for it to induce perceptual or analgesic effects. Implications: That belief in a treatment is necessary to impart non-treatment effects needs to be reconsidered. Clearly, if the non-specific sensory cues are credible, they seem to be able to induce analgesia even when to do so is logically impossible. Key-words: 1. placebo 2. analgesia 3. expectation Funding acknowledgements: None.

97 Supplement S1 NO DATA NO DATA 2011 NO DATA
4 article Aging and factors related to running economy run+biolit+etio NO DATA Quinn et al PubMed #21982960. This study showed that runner’s do not get less efficient as they age, which is a bit surprising. Performance degrades with age because reduced cardiovascular fitness and strength, not due to reduced running economy. Phrased more technically by the researchers, “The results from this cross-sectional analysis suggest that age-related declines in running performance are associated with declines in maximal and submaximal cardiorespiratory variables and declines in strength and power, not because of declines in running economy.” See analysis in the New York Times.

The purpose of this study was to investigate the relationship that age has on factors affecting running economy (RE) in competitive distance runners. Fifty-one male and female subelite distance runners (Young [Y]: 18-39 years [n = 18]; Master [M]: 40-59 years [n = 22]; and Older [O]: 60-older [n = 11]) were measured for RE, step rate, lactate threshold (LT), VO2max, muscle strength and endurance, flexibility, power, and body composition. An RE test was conducted at 4 different velocities (161, 188, 215, and 241 m·min(-1)), with subjects running for 5 minutes at each velocity. The steady-state VO2max during the last minute of each stage was recorded and plotted vs. speed, and a regression equation was formulated. A 1 × 3 analysis of variance revealed no differences in the slopes of the RE regression lines among age groups (y = 0.1827x - 0.2974; R2 = 0.9511 [Y]; y = 0.1988x - 1.0416; R2 = 0.9697 [M]; y = 0.1727x + 3.0252; R2 = 0.9618 [O]). The VO2max was significantly lower in the O group compared to in the Y and M groups (Y = 64.1 ± 3.2; M = 56.8 ± 2.7; O = 44.4 ± 1.7 mlO2·kg(-1)·min(-1)). The maximal heart rate and velocity @ LT were significantly different among all age groups (Y = 197 ± 4; M = 183 ± 2; O = 170 ± 6 b·min(-1) and Y = 289.7 ± 27.0; M = 251.5 ± 32.9; O = 212.3 ± 24.6 m·min(-1), respectively). The VO2max @ LT was significantly lower in the O group compared to in the Y and M groups (Y = 50.3 ± 2.0; M = 48.8 ± 2.9; O = 34.9 ± 3.2 mlO2·kg(-1)·min(-1)). The O group was significantly lower than in the Y and M groups in flexibility, power, and upper body strength. Multiple regression analyses showed that strength and power were significantly related to running velocity. The results from this cross-sectional analysis suggest that age-related declines in running performance are associated with declines in maximal and submaximal cardiorespiratory variables and declines in strength and power, not because of declines in running economy.

25 11 2971-9 Nov 2011 NO DATA
NO DATA book All In My Head head+pain+ot NO DATA Kamen NO DATA Like SaveYourself.ca, this book offers an unusual combination of both humour and information about pain. Kamen is a completely engaging writer, and tells her story with both journalist rigour and personality. NO DATA NO DATA NO DATA NO DATA NO DATA 2005 Da Capo Lifelong
2 article Altered abdominal muscle recruitment in patients with chronic back pain following a specific exercise intervention back+exercise NO DATA O'Sullivan et al PubMed #9475135. This randomized controlled trial attempted to see whether training the contraction of deep abdominal muscles at the same time would be possible. But whether or not it works for treating chronic back pain conditions has not been tested. The group which had specific exercises showed an increase (significiant) in the ability to activate the internal oblique and the rectus abdominis together. But the control group showed no significant change. Conflusion from the abstract: “The study findings provide evidence that the conscious and automatic patterns of abdominal muscle activation can be altered by specific exercise interventions.“

The efficacy of specific exercise interventions that advocate training the co-contraction of the deep abdominal muscles with lumbar multifidus for treating chronic back pain conditions has not been tested.

A randomized controlled trial involving 42 subjects with a specific chronic back pain condition investigated whether this form of intervention results in changes to the ratio of activation of the internal oblique relative to the rectus abdominis. Data were collected before and after the intervention, using surface electromyography, while subjects performed different abdominal maneuvers. Subjects were randomly allocated to either a specific exercise group or control group.

Following intervention, the specific exercise group showed a significant (p < 0.05) increase in the ratio of activation of the internal oblique relative to the rectus abdominis. The control group showed no significant change.

The study findings provide evidence that the conscious and automatic patterns of abdominal muscle activation can be altered by specific exercise interventions.

27 2 114-24 Feb 1998 NO DATA
NO DATA article Alternative Medicine and the Biology Departments of New York’s Community Colleges quack+sbm+chiro+iceheat NO DATA Reiser Frank Reiser is clearly hostile to chiropractors, and relies heavily on the baldly foolish assumption that chiropractors are, by definition, “anti-science.” Obviously, some progressive chiropractors are interested in practicing evidence-based health care. Unfortunately, I believe it’s equally obvious that many other chiropractors, perhaps most, actually are anti-scientific ... exactly as Reiser charges. To the extent that the charge is justified, the rest of the article is right on target in decrying the invasion of pseudoscientists into community colleges. NO DATA 28 5 46 Sep/Oct 2004 NO DATA
3 article American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism ot+harms+tps NO DATA Baskin et al PubMed #15260011. These guidelines summarize what the American Association of Clinical Endocrinologists do to evaluate and treat hyperthryoidism and hypothyroidism.

These clinical practice guidelines summarize the recommendations of the American Association of Clinical Endocrinologists for the diagnostic evaluation of hyperthyroidism and hypothyroidism and for treatment strategies in patients with these disorders. The sensitive thyroid-stimulating hormone (TSH or thyrotropin) assay has become the single best screening test for hyperthyroidism and hypothyroidism, and in most outpatient clinical situations, the serum TSH is the most sensitive test for detecting mild thyroid hormone excess or deficiency. Therapeutic options for patients with Graves' disease include thyroidectomy (rarely used now in the United States), antithyroid drugs (frequently associated with relapses), and radioactive iodine (currently the treatment of choice). In clinical hypothyroidism, the standard treatment is levothyroxine replacement, which must be tailored to the individual patient. Awareness of subclinical thyroid disease, which often remains undiagnosed, is emphasized, as is a system of care that incorporates regular follow-up surveillance by one physician as well as education and involvement of the patient.

8 6 457-69 NO DATA 2002 NO DATA
3 article An Acute Bout of Self Myofascial Release Increases Range of Motion Without a Subsequent Decrease in Muscle Activation or Force tx+mx+knee+tools+psb+itbs+pfps NO DATA Macdonald et al PubMed #22580977. In this study, foam rolling was put the test… barely. Foam rolling is a popular form of self-massage using a firm foam tube. This relatively straightforward experiment is more a test of massage (“self-myofascial release”) than “foam rolling” per se. However, because foam rolling is often used in a sports massage context, the study focussed on muscle function and joint range of motion. A small group of healthy, active men used a foam roller application on their quadriceps to see of their knee range of motion would increase. It seemed to do so by as much as 8%, ten minutes after the activity. The researchers concluded that “an acute bout of SMR of the quadriceps was an effective treatment to acutely enhance knee joint range of motion” — but measuring only 10 minutes after the activity, these results seem less than exciting. And it was hardly a perfect study. Greg Lehman points out several key flaws: (1) the control group was not a true therapeutic control group, (2) the warm up was not consistent with standard practice, (3) the experimenters were not blind to the interventions, (4) the ROM testing was too subjective. The significance of this paper was so well summarized by Jason Silvernail, PT, that it’s worth quoting him in full:

Here’s a small study about foam rolling in typical exercise science style: done on a very small number of healthy people. It’s an important first step, but the size of the study and it’s design limits what we conclusions we can draw. My prediction is that those who love foam rolling will talk about this like this is a big deal. It’s not.

Anyone who says “foam rolling works and this study supports it” is demonstrating their inability to appraise research well. Anyone who says “foam rolling doesn’t work and this study shows it’s useless” is also demonstrating that inability as well as their bias against this tool. The only rational response is a shrug and an acknowledgement that this is only a first step and that the core clinical claims for rolling remain unlikely from a mechanism standpoint and untested/unproven fom a clinical research standpoint.

Foam rolling is thought to improve muscular function, performance, overuse and joint range of motion (ROM), however, there is no empirical evidence demonstrating this. Thus, the objective of the study was to determine the effect of self-myofascial release (SMR) via foam roller application on knee extensor force and activation and knee joint range of motion. Eleven healthy male (height 178.9 ± 3.5 cm, mass 86.3 ± 7.4 kg, age 22.3 ± 3.8 years) subjects who were physically active participated. Subjects' quadriceps maximum voluntary contraction force, evoked force and activation, and knee joint ROM were measured prior to, two minutes, and 10 minutes following two conditions; 1) two, one minute trials of SMR of the quadriceps via a foam roller and 2) no SMR (Control). A two-way ANOVA (condition x time) with repeated measures was performed on all dependent variables recorded in the pre- and post-condition tests. There were no significant differences between conditions for any of the neuromuscular dependent variables. However, following foam rolling, subjects' ROM significantly (ρ < 0.001) increased by 10 and 8% at 2 and 10 minutes, respectively. There was a significant (ρ < 0.01) negative correlation between subjects' force and ROM prior to foam rolling, which no longer existed following foam rolling. In conclusion an acute bout of SMR of the quadriceps was an effective treatment to acutely enhance knee joint range of motion without a concomitant deficit in muscle performance.

NO DATA NO DATA NO DATA May 2012 NO DATA
3 article An anatomic study of the iliotibial tract itbs+run+knee+surgery NO DATA Vieira et al NO DATA

PURPOSE: To identify the structure of the iliotibial tract at knee level, as well as its insertions, layer arrangement, and relationship with other structures of the lateral region of the knee and to compare the findings with available literature.

METHODS: Ten detailed anatomic dissections were performed by using incisions as recommended by the literature in fresh cadaver knees identifying the iliotibial tract components.

RESULTS: The authors observed an iliotibial tract arrangement in superficial, deep, and capsular-osseous layers. Insertions have been described as follows: at linea aspera, at the upper border of the lateral epicondyle, at the patella, and at Gerdy's tibial tuberculum and across the capsular-osseous layer.

CONCLUSIONS: The iliotibial tract (ITT) has important interconnections to the femur, the patella, and the lateral tibia; the iliopatellar band joins the ITT to the patella through the superficial oblique retinaculum and the lateral femoropatellar ligament, and the ITT capsular-osseous layer presents differentiated fibers in an arched arrangement that borders the femoral condyle and inserts laterally to the Gerdy's tubercle. CLINICAL RELEVANCE: The iliotibial tract can be considered as an anterolateral knee stabilizer, particularly its capsular-osseous layer, which, together with the anterior cruciate ligament, constitutes a functional unit forming a spatial "horseshoe" form. The detailed description of the structures forming iliotibial tract plays an important role in the study of knee instabilities. Its important tibial, femoral, and patellar connections are described so that better understanding of tibial femoral instability on the lateral side as well as patellofemoral instability can be achieved and mechanisms of repair can be conceived.

23 3 269–274 NO DATA 2007 NO DATA
4 article An arthroscopic technique to treat the iliotibial band syndrome surgery+knee+itbs+run+etio+tx NO DATA Michels et al PubMed #18985317. See the updated 2011 report, “The iliotibial band syndrome treated with an arthroscopic technique in 40 patients”.

Iliotibial band syndrome (ITBS) is an overuse injury mainly affecting runners. The initial treatment is conservative. Only in recalcitrant cases surgery is indicated. Several open techniques have been described. The purpose of this study is to evaluate the results of a standardized arthroscopic technique for treatment of a resistant ITBS. Thirty-six athletes with a resistant ITBS were treated with a standardized arthroscopic technique, limited to the resection of lateral synovial recess. Thirty-three patients were available for follow-up (mean 2 years 4 months). Thirty-two patients (34 knees) had good or excellent results. All patients went back to sports after 3 months. In two patients a meniscal lesion was found, which required treatment. One patient with only a fair result had associated cartilage lesions of the femoral condyle. Our results show that arthroscopic treatment of resistant ITBS is a valid option with a consistently good outcome. In addition, this arthroscopic approach allows excluding or treating other intra-articular pathology.

17 3 233–236 Nov 5 2009 NO DATA
3 article A Biomechanical Perspective of Predicting Injury Risk in Running itbs+psb+run+pfps+shin+exercise+etio+knee NO DATA Hreljac et al NO DATA

PURPOSE: Provide a current review of the literature concerning the epidemiology and risk factors for injuries in runners.

DATA SOURCES: The information in this paper is taken from a review of articles and book chapters (Source: PubMed and MEDLINE, years covered 1966-2006).

CONCLUSIONS: Understanding the precise causative nature of risk factors in running populations remains a challenging task. Comparison of various works in the literature is impeded by large variations in injury definition, subject population and study design. Weekly running volume continues to be considered a strong risk factor, however more work is needed to determine whether it is the absolute volume, or the increase in volume that is deleterious. Recent research has provided greater insight into the risks that previous injury and lack of full rehabilitation may play in recreational runners starting a training program. Variables related to excessive rear-foot eversion and pronation are frequently sited in combination with the incidence of specific injuries; however, the role of impact characteristics remains in debate. Isokinetic research of hip muscle function is helping to link our understanding of lower extremity kinematics, but requires more research to be proven as a causative factor. Future research in joint coupling and functional training of the complete lower extremity will be beneficial in implementing preventative interventions for running populations.

7 2 98–108 NO DATA 2006 NO DATA
4 article An epidemiological examination of the subluxation construct using Hill's criteria of causation chiro+smt+ot NO DATA Mirtz et al 1 This landmark paper penned by four chiropractors is a strong indictment of a philosophical pillar of their own profession. Although a bit of a moving target over the years, subluxation theory generally refers to idea that spinal joint dysfunctions have broad health significance, which has been a major component of chiropractic thought since the founding of the profession. The authors analyze and condemn it: “No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation.” And yet it’s been there for more than a century, I’d like to add. Dr. Harriet Hall explained the significance of the paper in an article for ScienceBasedMedicine.org, The End of Chiropractic.

BACKGROUND: Chiropractors claim to locate, analyze and diagnose a putative spinal lesion known as subluxation and apply the mode of spinal manipulation (adjustment) for the correction of this lesion.

AIM: The purpose of this examination is to review the current evidence on the epidemiology of the subluxation construct and to evaluate the subluxation by applying epidemiologic criteria for it's significance as a causal factor.

METHODS: The databases of PubMed, Cinahl, and Mantis were searched for studies using the keywords subluxation, epidemiology, manipulation, dose-response, temporality, odds ratio, relative risk, biological plausibility, coherence, and analogy.

RESULTS: The criteria for causation in epidemiology are strength (strength of association), consistency, specificity, temporality (temporal sequence), dose response, experimental evidence, biological plausibility, coherence, and analogy. Applied to the subluxation all of these criteria remain for the most part unfulfilled.

CONCLUSION: There is a significant lack of evidence to fulfill the basic criteria of causation. This lack of crucial supportive epidemiologic evidence prohibits the accurate promulgation of the chiropractic subluxation.

17 1 13 Dec 2009 NO DATA
5 article An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle pain+back+neck+tps NO DATA Shah et al 1 This is an important research attempt to analyze the tissue chemistry of myofascial trigger points. For details and analysis, however, see the improved 2008 follow-up study (Shah), Dr. David Simons’ summary (Simons), and my own article, Toxic Muscle Knots.

Myofascial pain associated with myofascial trigger points (MTrPs) is a common cause of nonarticular musculoskeletal pain. Although the presence of MTrPs can be determined by soft tissue palpation, little is known about the mechanisms and biochemical milieu associated with persistent muscle pain. A microanalytical system was developed to measure the in vivo biochemical milieu of muscle in near real time at the subnanogram level of concentration. The system includes a microdialysis needle capable of continuously collecting extremely small samples (approximately 0.5 microl) of physiological saline after exposure to the internal tissue milieu across a 105-microm-thick semi-permeable membrane. This membrane is positioned 200 microm from the tip of the needle and permits solutes of <75 kDa to diffuse across it. Three subjects were selected from each of three groups (total 9 subjects): normal (no neck pain, no MTrP); latent (no neck pain, MTrP present); active (neck pain, MTrP present). The microdialysis needle was inserted in a standardized location in the upper trapezius muscle. Due to the extremely small sample size collected by the microdialysis system, an established microanalytical laboratory, employing immunoaffinity capillary electrophoresis and capillary electrochromatography, performed analysis of selected analytes. Concentrations of protons, bradykinin, calcitonin gene-related peptide, substance P, tumor necrosis factor-alpha, interleukin-1beta, serotonin, and norepinephrine were found to be significantly higher in the active group than either of the other two groups (P < 0.01). pH was significantly lower in the active group than the other two groups (P < 0.03). In conclusion, the described microanalytical technique enables continuous sampling of extremely small quantities of substances directly from soft tissue, with minimal system perturbation and without harmful effects on subjects. The measured levels of analytes can be used to distinguish clinically distinct groups.

99 5 1977–1984 NO DATA 2005 NO DATA
3 article An independent review of NCCAM-funded studies of chiropractic tx+chiro+smt NO DATA Ernst et al PubMed #21207089. Dr. Edzard Ernst is a highly qualified critic of sloppy researchers in alternative medicine. In this review of The National Center for Complementary and Alternative Medicine (NCCAM) studies of chiropractic therapy, he finds that “their quality was frequently questionable. Several randomized controlled trials failed to report adverse effects and the majority was not described in sufficient detail to allow replication.” But if NCCAM cannot produce the best quality studies of alternative medicine, who can? No organization has ever been better funded (or motivated) to validate alternative therapies. Ernst concludes: “It seems questionable whether such research is worthwhile.”

To promote an independent and critical evaluation of 11 randomised clinical trials (RCTs) of chiropractic funded by the National Centre for Complementary and Alternative Medicine (NCCAM). Electronic searches were conducted to identify all relevant RCTs. Key data were extracted and the risk of bias of each study was determined. Ten RCTs were included, mostly related to chiropractic spinal manipulation for musculoskeletal problems. Their quality was frequently questionable. Several RCTs failed to report adverse effects and the majority was not described in sufficient detail to allow replication. The criticism repeatedly aimed at NCCAM seems justified, as far as their RCTs of chiropractic is concerned. It seems questionable whether such research is worthwhile.

NO DATA NO DATA NO DATA Jan 2011 NO DATA
4 article A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain back+mx+chiro NO DATA Cherkin et al 1 From the article: “For patients with low back pain, the McKenzie method of physical therapy and chiropractic manipulation had similar effects and costs, and patients receiving these treatments had only marginally better outcomes than those receiving the minimal intervention of an educational booklet. Whether the limited benefits of these treatments are worth the additional costs is open to question.”

Background and Methods There are few data on the relative effectiveness and costs of treatments for low back pain. We randomly assigned 321 adults with low back pain that persisted for seven days after a primary care visit to the McKenzie method of physical therapy, chiropractic manipulation, or a minimal intervention (provision of an educational booklet). Patients with sciatica were excluded. Physical therapy or chiropractic manipulation was provided for one month (the number of visits was determined by the practitioner but was limited to a maximum of nine); patients were followed for a total of two years. The bothersomeness of symptoms was measured on an 11-point scale, and the level of dysfunction was measured on the 24-point Roland Disability Scale.

Results After adjustment for base-line differences, the chiropractic group had less severe symptoms than the booklet group at four weeks (P=0.02), and there was a trend toward less severe symptoms in the physical-therapy group (P=0.06). However, these differences were small and not significant after transformations of the data to adjust for their non-normal distribution. Differences in the extent of dysfunction among the groups were small and approached significance only at one year, with greater dysfunction in the booklet group than in the other two groups (P=0.05). For all outcomes, there were no significant differences between the physical-therapy and chiropractic groups and no significant differences among the groups in the numbers of days of reduced activity or missed work or in recurrences of back pain. About 75 percent of the subjects in the therapy groups rated their care as very good or excellent, as compared with about 30 percent of the subjects in the booklet group (P<0.001). Over a two-year period, the mean costs of care were $437 for the physical-therapy group, $429 for the chiropractic group, and $153 for the booklet group.

Conclusions For patients with low back pain, the McKenzie method of physical therapy and chiropractic manipulation had similar effects and costs, and patients receiving these treatments had only marginally better outcomes than those receiving the minimal intervention of an educational booklet. Whether the limited benefits of these treatments are worth the additional costs is open to question.

339 NO DATA 1021–9 NO DATA 1998 NO DATA
NO DATA article After an episode of acute low back pain, recurrence is unpredictable and not as common as previously thought NO DATA NO DATA Stanton et al NO DATA

STUDY DESIGN: Inception cohort study.

OBJECTIVE: To provide the first reliable estimate of the 1-year incidence of recurrence in subjects recently recovered from acute nonspecific low back pain (LBP) and to determine factors predictive of recurrence in 1 year.

SUMMARY OF BACKGROUND DATA: Previous studies provide potentially flawed estimates of recurrence of LBP because they do not restrict the cohort to those who have recovered and are therefore eligible for a recurrence.

METHODS: We identified 1334 consecutive patients who presented to primary care with acute LBP; of these 353 subjects recovered before 6 weeks and entered the current study. The primary outcome measure was recurrence of LBP in the next year. Specifically, an episode of recurrence was defined in 2 ways: recall of recurrence at the 12-month follow-up and report of pain at the 3- or 12-month follow-up. Risk factors for recurrence were assessed at baseline. Pain intensity was assessed at 6 weeks, 3 months, and 12 months and recurrence at 12 months. Factors that could plausibly affect recurrence were chosen a priori and evaluated using a multivariable regression analysis.

RESULTS: Recurrence of LBP was found to be much less common than previous estimates suggest, ranging from 24% (95% CI = 20%-28%) using "12-month recall" definition of recurrence, to 33% (95% CI = 28%-38%) using "pain at follow-up" definition of recurrence. However, only 1 factor, previous episode(s) of LBP, was consistently predictive of recurrence within the next 12 months (odds ratio = 1.8-2.0, P = 0.00-0.05).

CONCLUSION: This study challenges the assumption that the majority of subjects will have a recurrence of LBP in a 1-year period. After the resolution of an episode of acute LBP, about 25% of subjects will have a recurrence in the next year. It is difficult to predict who will have a recurrence within the next year.

33 26 2923–2928 Dec 15 2008 NO DATA
NO DATA article A biomechanical approach to the prevention, treatment and rehabilitation of plantar fasciitis pf+run+foot NO DATA Chandler et al PubMed #8100639. Chandler and Kibler report a 10% occurrence rate of plantar fasciitis in runners.

Plantar fasciitis is a repetitive microtrauma overload injury of the attachment of the plantar fascia at the inferior aspect of the calcaneus. The diagnosis of plantar fasciitis is common among athletes in many sports, primarily those sports that involve running. Common treatments for plantar fasciitis, including ice, stretching, ultrasound, and shoe inserts are helpful in reducing the symptoms. However, recurrence of the problem is common. By understanding the potential biomechanical causes of this disorder it may be possible to correct the anatomical and biomechanical variables that cause plantar fasciitis and reduce the rate of recurrence as well as speed the rehabilitation process. It may also be possible to identify predisposing maladaptations that can be corrected, therefore, preventing the initial occurrence of plantar fasciitis.

15 NO DATA NO DATA NO DATA 1993 NO DATA
NO DATA article A Cochrane review of manipulation and mobilization for mechanical neck disorders chiro+neck NO DATA Gross et al NO DATA

STUDY DESIGN AND OBJECTIVES: Our systematic review of randomized trials assessed whether manipulation and mobilization relieve pain or improve function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders.

SUMMARY OF BACKGROUND DATA: Neck disorders are common, disabling, and costly.

METHODS: Computerized bibliographic databases were searched up to March 2002. Two independent reviewers conducted study selection, data abstraction, and methodologic quality assessment. Relative risk and standardized mean differences were calculated. In the absence of heterogeneity, pooled effect measures were calculated using a random effects model.

RESULTS: Of the 33 selected trials, 42% were high quality trials. Single or multiple (3-11) sessions of manipulation or mobilization showed no benefit in pain relief when assessed against placebo, control groups, or other treatments for acute/subacute/chronic mechanical neck disorders with or without headache. There was strong evidence of benefit favoring multimodal care (mobilization and/or manipulation plus exercise) over a waiting list control for pain reduction [pooled standardized mean differences -0.85 (95% CI: -1.20 to -0.50)], improvement in function [pooled SMD -0.57 (95% CI: -0.94 to -0.21)] and global perceived effect [standardized mean differences -2.73 (95% CI: -3.30 to -2.16)] for subacute/chronic mechanical neck disorders with or without headache.

CONCLUSIONS: Mobilization and/or manipulation when used with exercise are beneficial for persistent mechanical neck disorders with or without headache. Done alone, manipulation and/or mobilization were not beneficial; when compared to one another, neither was superior. There was insufficient evidence available to draw conclusions for neck disorder with radicular findings. Factorial design would help determine the active agent(s) within a treatment mix.

29 14 1541–1548 NO DATA 2004 NO DATA
NO DATA article An initial application of computerized adaptive testing (CAT) for measuring disability in patients with low back pain NO DATA NO DATA Elhan et al NO DATA

BACKGROUND: Recent approaches to outcome measurement involving Computerized Adaptive Testing (CAT) offer an approach for measuring disability in low back pain (LBP) in a way that can reduce the burden upon patient and professional. The aim of this study was to explore the potential of CAT in LBP for measuring disability as defined in the International Classification of Functioning, Disability and Health (ICF) which includes impairments, activity limitation, and participation restriction.

METHODS: 266 patients with low back pain answered questions from a range of widely used questionnaires. An exploratory factor analysis (EFA) was used to identify disability dimensions which were then subjected to Rasch analysis. Reliability was tested by internal consistency and person separation index (PSI). Discriminant validity of disability levels were evaluated by Spearman correlation coefficient (r), intraclass correlation coefficient [ICC(2,1)] and the Bland-Altman approach. A CAT was developed for each dimension, and the results checked against simulated and real applications from a further 133 patients.

RESULTS: Factor analytic techniques identified two dimensions named "body functions" and "activity-participation". After deletion of some items for failure to fit the Rasch model, the remaining items were mostly free of Differential Item Functioning (DIF) for age and gender. Reliability exceeded 0.90 for both dimensions. The disability levels generated using all items and those obtained from the real CAT application were highly correlated (i.e.>0.97 for both dimensions). On average, 19 and 14 items were needed to estimate the precise disability levels using the initial CAT for the first and second dimension. However, a marginal increase in the standard error of the estimate across successive iterations substantially reduced the number of items required to make an estimate.

CONCLUSIONS: Using a combination approach of EFA and Rasch analysis this study has shown that it is possible to calibrate items onto a single metric in a way that can be used to provide the basis of a CAT application. Thus there is an opportunity to obtain a wide variety of information to evaluate the biopsychosocial model in its more complex forms, without necessarily increasing the burden of information collection for patients.

9 1 166 Dec 18 2008 NO DATA
NO DATA article An internet survey of 2,596 people with fibromyalgia pain+meds NO DATA Bennett et al A questionnaire was completely by 2500 fibromyalgia sufferers. They reported that their most common problems were “morning stiffness, fatigue, nonrestorative sleep, pain, concentration, and memory.” The factors that made their problems worse were “emotional distress, weather changes, insomnia, and strenuous activity.”

BACKGROUND: This study explored the feasibility of using an Internet survey of people with fibromyalgia (FM), with a view to providing information on demographics, sources of information, symptoms, functionality, perceived aggravating factors, perceived triggering events, health care utilization, management strategies, and medication use.

METHODS: A survey questionnaire was developed by the National Fibromyalgia Association (NFA) in conjunction with a task force of "experts in the field". The questionnaire underwent several rounds of testing to improve its face validity, content validity, clarity and readability before it was mounted on the internet. The questionnaire consisted of 121 items and is available online at the website of the National Fibromyalgia Association.

RESULTS: The questionnaire was completed by 2,569 people. Most were from the United States, with at least one respondent from each of the 50 states. Respondents were predominantly middle-aged Caucasian females, most of whom had FM symptoms for > or = 4 years. The most common problems were morning stiffness, fatigue, nonrestorative sleep, pain, concentration, and memory. Aggravating factors included: emotional distress, weather changes, insomnia, and strenuous activity. Respondents rated the most effective management modalities as rest, heat, pain medications, antidepressants, and hypnotics. The most commonly used medications were: acetaminophen, ibuprofen, naproxen, cyclobenzaprine, amitriptyline, and aspirin. The medications perceived to be the most effective were: hydrocodone preparations, aprazolam, oxycodone preparations, zolpidem, cyclobenzaprine, and clonazepam.

CONCLUSION: This survey provides a snap-shot of FM at the end of 2005, as reported by a self-selected population of people. This descriptive data has a heuristic function, in that it identifies several issues for further research, such as the prescribing habits of FM health care providers, the role of emotional precipitants, the impact of obesity, the significance of low back pain and the nature of FM related stiffness.

8 NO DATA 27 NO DATA 2007 NO DATA
NO DATA article An MRI evaluation of carpal tunnel dimensions in healthy wrists NO DATA NO DATA Bower et al PubMed #16814908. NO DATA

BACKGROUND: Deviated wrist postures and pinch grip use have been linked to the development of carpal tunnel syndrome and are likely related to the size and shape of the carpal tunnel. The purpose of this study was to quantify carpal tunnel dimensions with changes in wrist posture and pinch grip.

METHODS: Eight healthy volunteers (4 male, 4 female) underwent magnetic resonance imaging of their dominant wrists under seven conditions which included: 30 degrees wrist extension, neutral and 30 degrees flexion (with and without a 10N pinch force) and a fist with a neutral wrist. Cross-sectional area of the carpal tunnel and its contents were calculated at 3mm increments along the length of the tunnel and integrated to calculate volumes. Ratios were calculated between the contents of the tunnel to the tunnel itself for area and volume. FINDINGS: The use of a correction factor significantly reduced volume and distal carpal tunnel area in flexed and extended wrists. Carpal tunnel areas were largest in neutral and smallest at the distal end with wrist flexion. An extended wrist resulted in the smallest carpal tunnel and content volumes as well as the smallest carpal tunnel content volume to carpal tunnel volume ratios. While men had significantly larger areas and volumes than women for both the carpal tunnel and it contents, there were no differences in ratios between the contents and tunnel size.

INTERPRETATION: A simple correction factor for non-perpendicular magnetic resonance images proved useful in relating volume changes to known pressure changes within the carpal tunnel. More inclusive and detailed evaluation of the carpal tunnel and its contents is required to fully understand mechanisms for median nerve compression in the carpal tunnel.

21 8 816–825 Oct 2006 NO DATA
NO DATA article An outcome study of chronic patellofemoral pain syndrome. Seven-year follow-up of patients in a randomized, controlled trial pfps+run+knee+surgery NO DATA Kannus et al NO DATA

BACKGROUND: We determined prospectively the long-term outcomes of nonoperative treatment of chronic patellofemoral pain syndrome.

METHODS: Of forty-nine patients in a prospective, randomized, double-blind study of unilateral chronic patellofemoral pain syndrome in the knee, forty-five were reexamined seven years after the initial trial of treatment. In the earlier trial, the short-term (six-month) effects of intra-articular injections of glycosaminoglycan polysulfate combined with intensive quadriceps-muscle exercises were compared with those of injections of a placebo combined with exercises and with those of exercises alone. At seven years, the follow-up consisted of standardized subjective, functional, and clinical assessments and muscle-strength measurements as well as magnetic resonance imaging, radiography, and bone-densitometry measurements of the knee.

RESULTS: At six months, complete subjective, functional, and clinical recovery had occurred in almost three-fourths of the patients and, with the numbers available for study, neither significant nor clinically important differences among the three initial treatment groups were detected. The subjective and functional parameters showed few changes between six months and seven years; almost three-fourths of the patients still had full subjective and functional recovery at the time of the latest follow-up. However, according to the physician's clinical evaluation, the number of patients who had no symptoms on the patellar compression and apprehension tests decreased over time, from forty-two (93 percent) and forty (89 percent) of forty-five patients at six months to thirty (67 percent) and thirty-one (69 percent) at seven years; these changes were significant (p = 0.002 and p = 0.023, respectively). The number of patients who had crepitation on the patellar compression test increased over time, from twenty-six (58 percent) at six months to thirty-six (80 percent) at seven years (p = 0.021). The physician's overall assessment showed a similar trend, with thirty-four patients (76 percent) having had complete recovery at six months compared with thirty (67 percent) at seven years; however, with the numbers available, this change was not significant (p = 0.420). Magnetic resonance imaging, performed for thirty-seven patients, revealed no abnormalities in twenty-four (65 percent), mild abnormalities in four (11 percent), moderate abnormalities (a 25 to 75 percent decrease in the thickness of the cartilage) in seven (19 percent), and overt patellofemoral osteoarthritis in two (5 percent) at seven years.

CONCLUSIONS: The seven-year overall outcome was good in approximately two-thirds of the patients. However, the remaining patients still had symptoms or objective signs of a patellofemoral abnormality.

81 3 355–363 NO DATA 1999 NO DATA
2 article An unusual complication tx+mx+iceheat+harms NO DATA Tanriover et al PubMed #19668045. This paper tells the horror story of one person’s awful experience with a severe reaction to (apparently) infrared heat and regular massage over several days. The trouble started after several days. His neck and arms became swollen, the pain “unbearable,” and his “serum muscle enzymes were increased” — probably some form or degree of rhabdomyolysis, which implicates the massage itself as a mechanism of injury. Massage is not likely to “blame,” however — it was probably interacting with some unidentified vulnerability in the patient, such a muscle disease or a complication caused by a medication. Clearly massage and heat alone do not normally cause such severe side effects.

A 66-year-old male presented with swelling of the neck and arms, which was limiting his daily activities. Serum muscle enzymes were increased. A detailed history revealed that the patient received 10 cycles of infrared heat and massage therapy approximately 1 month before his first visit to the outpatient clinic. The swelling of the extremities began on day 11 of therapy, and the pain became unbearable. He was followed up with analgesics. There was a significant decrease in the muscle enzymes and a subjective improvement of 60-70% one month after discharge. Alternative therapies may have serious complications, and patients usually do not report them unless asked specifically.

102 9 966-8 Sep 2009 NO DATA
NO DATA article Analgesia through the looking-glass? A randomized controlled trial investigating the effect of viewing a 'virtual' limb upon phantom limb pain, sensation and movement NO DATA NO DATA Brodie et al PubMed #16857400. NO DATA

The extent to which viewing a 'virtual' limb, the mirror image of an intact limb, modifies the experience of a phantom limb, was investigated in 80 lower limb amputees before, during and after repeated attempts to simultaneously move both intact and phantom legs. Subjects were randomly assigned to one of two conditions, a control condition in which they only viewed the movements of their intact limb and a mirror condition in which they additionally viewed the movements of a 'virtual' limb. Although the mirror condition elicited a significantly greater number of phantom limb movements than the control condition, it did not attenuate phantom limb pain and sensations any more than the control condition. The potential of a 'virtual' limb as a treatment for phantom limb pain was discussed in terms of its ability to halt and/or reverse the cortical re-organisation of motor and somatosensory cortex following acquired limb loss.

11 4 428-36 May 2007 NO DATA
NO DATA article The analgesic effect of magnesium sulfate in patients undergoing thoracotomy NO DATA NO DATA Kogler PubMed #19623867. NO DATA

Magnesium can act as an adjuvant in analgesia due to its properties of calcium channel blocker and N-methyl-D-aspartate antagonist. The aim of our study was to determine if magnesium sulfate reduces perioperative analgesic requirements in patients undergoing thoracotomy procedure. Our study included 68 patients undergoing elective thoracotomy that received a bolus of 30-50 mg/kg MgSO4 followed by continuous infusion of 500 mg/h intraoperatively and 500 mg/h during the first 24 hours after the operation, or the same volume of isotonic solution (control group). Intraoperative analgesia was achieved with fentanyl and postoperative analgesia with a mixture of fentanyl and bupivacaine through epidural catheter. The level of pain was estimated using Visual Analog Scale (VAS) and TORDA pain scales. Fentanyl consumption during the operation was significantly lower in the magnesium treated group compared to control group. There was no statistically significant difference in epidural bupivacaine and fentanyl consumption during 48 hours postoperatively between the magnesium treated and control group. The measured VAS score at all intervals was similar in both groups. Postoperative TORDA scores were similar in both groups during the first 24 hours; however, a statistically significant difference was recorded in 40-48 h measurements. Results of our study revealed that magnesium reduced intraoperative analgesic requirements and also contributed to effective control of the static component of postthoracotomy pain.

48 1 19-26 Mar 2009 NO DATA
5 article Analgesic effects of treatments for non-specific low back pain tx+sbm+manual+back NO DATA Machado et al 1 This is a meticulous, sensible, and readable analysis of the very best studies of back pain treatments that have ever been done: the greatest hits of back pain science. There is a great deal of back pain science to review, but authors Machado, Kamper, Herbert, Maher and McCauley found that shockingly little of it was worth their while: just 34 acceptable studies out of a 1031 candidates, and even among those “trial quality was highly variable.” Their conclusions are derived from only the best sort of scientific experiments: not just the gold-standard of randomized and placebo-controlled tests, but carefully choosing only the “right” kind of placebos (several kinds of placebos were grounds for disqualification, because of their known potential to skew the results). They do a good job of explaining exactly how and why they picked the studies they did, and pre-emptively defending it from a couple common concerns. The results were sad and predictable, robust evidence of absence: “The average effects of treatments … are not much greater those of placebos.”

OBJECTIVE: Estimates of treatment effects reported in placebo-controlled randomized trials are less subject to bias than those estimates provided by other study designs. The objective of this meta-analysis was to estimate the analgesic effects of treatments for non-specific low back pain reported in placebo-controlled randomized trials.

METHODS: Medline, Embase, Cinahl, PsychInfo and Cochrane Central Register of Controlled Trials databases were searched for eligible trials from earliest records to November 2006. Continuous pain outcomes were converted to a common 0-100 scale and pooled using a random effects model.

RESULTS: A total of 76 trials reporting on 34 treatments were included. Fifty percent of the investigated treatments had statistically significant effects, but for most the effects were small or moderate: 47% had point estimates of effects of <10 points on the 100-point scale, 38% had point estimates from 10 to 20 points and 15% had point estimates of>20 points. Treatments reported to have large effects >20 points) had been investigated only in a single trial.

CONCLUSIONS: This meta-analysis revealed that the analgesic effects of many treatments for non-specific low back pain are small and that they do not differ in populations with acute or chronic symptoms.

48 5 520-7 May 2009 NO DATA
NO DATA article Analysis of hip strength in females seeking physical therapy treatment for unilateral patellofemoral pain syndrome NO DATA NO DATA Robinson et al NO DATA

STUDY DESIGN: Cross-sectional.

OBJECTIVES: To investigate whether females seeking physical therapy treatment for unilateral patellofemoral pain syndrome (PFPS) exhibit deficiencies in hip strength compared to a control group.

BACKGROUND: Decreased hip strength may be associated with poor control of lower extremity motion during weight-bearing activities, leading to abnormal patellofemoral motions and pain. Previous studies exploring the presence of hip strength impairments in subjects with PFPS have reported conflicting results.

METHODS AND MEASURES: Twenty females, aged 12 to 35 years, participated in the study. Ten subjects with unilateral PFPS were compared to 10 control subjects with no known knee pathologies. Hip abduction, extension, and external rotation strength were tested using a handheld dynamometer. A limb symmetry index (LSI) was used to quantify physical performance for all tests.

RESULTS: The symptomatic limbs of subjects with PFPS exhibited impairments in hip strength for all variables tested. LSI values in subjects with PFPS (range, 71%-79%) were significantly lower than those in control subjects (range, 93%-101%) (P< or =.007). A secondary analysis of data normalized to body mass demonstrated that the symptomatic limbs of subjects with PFPS had 52% less hip extension strength (P<.001), 27% less hip abduction strength (P = .007), and 30% less hip external rotation strength (P= .004) when compared to the weaker limbs of control subjects.

CONCLUSION: Females aged 12 to 35 presenting with unilateral PFPS demonstrate significant impairments in hip strength compared to control subjects when LSI values or body mass normalized values are used to quantify physical performance of the symptomatic limb.

37 NO DATA 232–238 NO DATA 2007 NO DATA
NO DATA article Anatomical variations within the deep posterior compartment of the leg and important clinical consequences shin+run+psb+etio NO DATA Hislop et al NO DATA

The management of musculoskeletal conditions makes up a large part of a sports medicine practitioner's practice. A thorough knowledge of anatomy is an essential component of the armament necessary to decipher the large number of potential conditions that may confront these practitioners. To cloud the issue further, anatomical variations may be present, such as supernumerary muscles, thickened fascial bands or variant courses of nerves and blood vessels, which can themselves manifest as acute or chronic conditions that lead to significant morbidity or limitation of activity. There are a number of contentious areas within the literature surrounding the anatomy of the leg, particularly involving the deep posterior compartment. Conditions such as chronic exertional compartment syndrome, tibial periostitis (shin splints), peripheral nerve entrapment and tarsal tunnel syndrome may all be affected by subtle anatomical variations. This paper primarily focuses on the deep posterior compartment of the leg and uses the gross dissection of cadaveric specimens to describe definitively the anatomy of the deep posterior compartment. Variant fascial attachments of flexor digitorum longus are documented and potential clinical sequelae such as chronic exertional compartment syndrome and tarsal tunnel syndrome are discussed.

7 NO DATA 392–399 NO DATA 2004 NO DATA
4 book Anatomy of Movement biolit NO DATA Calais-Germaine This book is simply the best resource there is for understanding functional musculoskeletal anatomy. NO DATA NO DATA NO DATA NO DATA NO DATA 1993 Eastland Press
NO DATA article The annual incidence and course of neck pain in the general population neck NO DATA Côté et al PubMed #15561381. NO DATA

Although neck pain is a common source of disability, little is known about its incidence and course. We conducted a population-based cohort study of 1100 randomly selected Saskatchewan adults to determine the annual incidence of neck pain and describe its course. Subjects were initially surveyed by mail in September 1995 and followed-up 6 and 12 months later. The age and gender standardized annual incidence of neck pain is 14.6% (95% confidence interval: 11.3, 17.9). Each year, 0.6% (95% confidence interval: 0.0-1.1) of the population develops disabling neck pain. The annual rate of resolution of neck pain is 36.6% (95% confidence interval: 32.7, 40.5) and another 32.7% (95% confidence interval: 25.5, 39.9) report improvement. Among subjects with prevalent neck pain at baseline, 37.3% (95% confidence interval: 33.4, 41.2) report persistent problems and 9.9% (95% confidence interval: 7.4, 12.5) experience an aggravation during follow-up. Finally, 22.8% (95% confidence interval: 16.4, 29.3) of those with prevalent neck pain at baseline report a recurrent episode. Women are more likely than men to develop neck pain (incidence rate ratio=1.67, 95% confidence interval 1.08-2.60); more likely to suffer from persistent neck problems (incidence rate ratio=1.19, 95% confidence interval 1.03-1.38) and less likely to experience resolution (incidence rate ratio=0.75, 95% confidence interval 0.63-0.88). Neck pain is a disabling condition with a course marked by periods of remission and exacerbation. Contrary to prior belief, most individuals with neck pain do not experience complete resolution of their symptoms and disability.

112 3 267-73 Dec 2004 NO DATA
NO DATA article Annual incidence of inflammatory joint diseases in a population based study in southern Sweden ot NO DATA Soderlin et al 1 From the abstract: “The incidence figures compare well with figures reported from other countries.” NO DATA 61 10 911–5 Oct 2002 NO DATA
NO DATA article Annular tears and disk herniation back+nerve NO DATA Stadnik et al NO DATA 29 of 36 asymptomatic people nevertheless had “bulging disk and focal disk portrusion.” From the abstract: “Annular tears and focal disk protrusions on MR images ... are frequently found in an asymptomatic population.” Indeed, the researchers found that a whopping 81% of pain-free adults had bulging disks, and an equally amazing 56% of them had annular tears (ripping of connective tissue near the disk).

PURPOSE: To evaluate the prevalence and radiologic findings of annular tear (especially of contrast material enhancement), bulging disk, and disk herniation on T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images in people without low back pain (LBP) or sciatica.

MATERIALS AND METHODS: Thirty-six volunteers without LBP and/or sciatica (18 with no symptoms in their lifetime and 18 who were pain free for at least 6 months) were examined with sagittal and axial T2-weighted fast spin-echo (SE) and sagittal gadolinium-enhanced T1- weighted fast SE imaging. The prevalence and MR findings of bulging disk, focal protrusion, extrusion, and nonenhancing or enhancing annular tears were assessed.

RESULTS: The prevalence of bulging disk and focal disk protrusion was 81% (29 volunteers) and 33% (12 volunteers), respectively. There were no extrusions. Twenty-eight annular tears were found in 20 patients (56%); 27 tears (96%) also showed contrast enhancement.

CONCLUSION: Annular tears and focal disk protrusions on MR images, with or without contrast enhancement, are frequently found in an asymptomatic population. Extruded disk herniation, displacement of nerve root, and interruption of annuloligamentous complex are unusual findings in an asymptomatic population and can be more closely related to patients with LBP or sciatica.

206 NO DATA 49–55 NO DATA 1998 NO DATA
3 article Anti-inflammatory activity of Arnica montana 6cH homeo+meds+quack NO DATA Macêdo et al PubMed #15139092. Two models — acute and chronic inflammation — were used to test the anti-inflammatory abilities of Arnica Montana 6cH. In the acute model., the group showed 30% imhibition compared to the control group. In the chornic model, the group treated with Arnica Montana 67cH had less inflammation six hours after the agent was applied. When treatment was given six hours after Nystatin treatment, there was no significant inhibitory effect. This small study would suggest that Arnica Montana 6cH can block the histamine effects of swelling.

The anti-inflammatory effect of Arnica montana 6cH was evaluated using acute and chronic inflammation models. In the acute, model, carrageenin-induced rat paw oedema, the group treated with Arnica montana 6cH showed 30% inhibition compared to control (P < 0.05). Treatment with Arnica 6cH, 30 min prior to carrageenin, did not produce any inhibition of the inflammatory process. In the chronic model, Nystatin-induced oedema, the group treated 3 days previously with Arnica montana 6cH had reduced inflammation 6 h after the inflammatory agent was applied (P < 0.05). When treatment was given 6 h after Nystatin treatment, there was no significant inhibitory effect. In a model based on histamine-induced increase of vascular permeability, pretreatment with Arnica montana 6cH blocked the action of histamine in increasing vascular permeability.

93 2 84-7 Apr 2004 NO DATA
3 article Anti-inflammatory and combined anti-inflammatory/analgesic medication in the early management of iliotibial band friction syndrome. A clinical trial tx+itbs+meds+inflam NO DATA Schwellnus et al PubMed #2028354. “All three treatment modalities are effective in the early treatment of ITBFS.”

Forty-three athletes presenting with unilateral iliotibial band friction syndrome (ITBFS) were randomly divided into three groups for the first 7 days of treatment (placebo-controlled, double-blind): 1--placebo (N = 13); 2--anti-inflammatory medication (N = 14) (Voltaren; Geigy); and 3--analgesic/anti-inflammatory combined medication (N = 16) (Myprodol; Rio Ethicals). All subjects rested from day 0 to day 7 and all groups received the same physiotherapy outpatient treatment programme from day 3 to day 7. On days 0, 3 and 7 the subjects performed a functional treadmill running test (maximum 30 minutes) during which they reported pain (scale 0-10; 0 = no pain, 10 = unbearable pain) each minute. Total running distance, total running time and the area under the pain v. time curve was calculated. Daily 24-hour recall pain scores were also recorded. The 24-hour recall pain scores decreased significantly for all the groups over the treatment period. This method of assessing efficacy of treatment therefore failed to show differences between groups. In contrast, during the running test only group 3 improved their total running time and distance from day 0 to day 7, whereas in all the groups the area under the pain v. time curve decreased from day 0 to day 7. All the other groups improved total running time and running distance from day 3 to day 7. All three treatment modalities are effective in the early treatment of ITBFS but physiotherapy in combination with analgesic/anti-inflammatory medication is superior.(ABSTRACT TRUNCATED AT 250 WORDS)

79 10 602-6 May 1991 NO DATA
3 article Anti-inflammatory treatment of muscular injuries in sport. An update of recent studies tx+meds+exercise+inflam NO DATA Almekinders PubMed #10623981. “Studies on anti-inflammatory treatment of DOMS have yielded conflicting results. However, the effect of NSAIDs on DOMS appears small at best. Future research may have to focus on different aspects of these injuries as the emphasis on anti-inflammatory treatment has yielded somewhat disappointing results.”

Stretch-induced muscle injuries or strains, muscle contusions and delayed-onset muscle soreness (DOMS) are common muscle problems in athletes. Anti-inflammatory treatment is often used for the pain and disability associated with these injuries. The most recent studies on nonsteroidal anti-inflammatory drugs (NSAIDs) in strains and contusions suggest that the use of NSAIDs can result in a modest inhibition of the initial inflammatory response and its symptoms. However, this may be associated with some small negative effects later in the healing phase. Corticosteroids have generally been shown to adversely affect the healing of these acute injuries. Animal studies have suggested that anabolic steroids may actually aid in the healing process, but clinical studies are not yet available and the exact role of these drugs has yet to be determined. Studies on anti-inflammatory treatment of DOMS have yielded conflicting results. However, the effect of NSAIDs on DOMS appears small at best. Future research may have to focus on different aspects of these injuries as the emphasis on anti-inflammatory treatment has yielded somewhat disappointing results.

28 6 383-8 Dec 1999 NO DATA
4 article Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes) tx+etio+fun+back NO DATA Albert et al PubMed #23404353. This study shows weirdly good, strong results treating low back pain with antibiotics, but was mired in controversy soon after publication when it came to light that the authors may have had serious, undeclared commercial conflict of interest. In the unlikely event that the COI had no effect on the study, there are still some significant caveats. In particular, the study focussed on a specific sort of back pain in rather carefully chosen subjects — so it’s probably not going to work on the average frustrated back pain patient. Also: there was a suspicious lack of response in the placebo group, a possible red flag that something was wrong with the methodology; the connection to the mouth is basically speculative (they didn’t culture the painful sites); and there are other ways to explain the effect (perhaps an immunomodulation effect of antibiotics).

PURPOSE: Modic type 1 changes/bone edema in the vertebrae are present in 6 % of the general population and 35-40 % of the low back pain population. It is strongly associated with low back pain. The aim was to test the efficacy of antibiotic treatment in patients with chronic low back pain >6 months) and Modic type 1 changes (bone edema).

METHODS: The study was a double-blind RCT with 162 patients whose only known illness was chronic LBP of greater than 6 months duration occurring after a previous disc herniation and who also had bone edema demonstrated as Modic type 1 changes in the vertebrae adjacent to the previous herniation. Patients were randomized to either 100 days of antibiotic treatment (Bioclavid) or placebo and were blindly evaluated at baseline, end of treatment and at 1-year follow-up.

OUTCOME MEASURES: Primary outcome, disease-specific disability, lumbar pain. Secondary outcome leg pain, number of hours with pain last 4 weeks, global perceived health, EQ-5D thermometer, days with sick leave, bothersomeness, constant pain, magnetic resonance image (MRI).

RESULTS: 144 of the 162 original patients were evaluated at 1-year follow-up. The two groups were similar at baseline. The antibiotic group improved highly statistically significantly on all outcome measures and improvement continued from 100 days follow-up until 1-year follow-up. At baseline, 100 days follow-up, 1-year follow-up the disease-specific disability-RMDQ changed: antibiotic 15, 11, 5.7; placebo 15, 14, 14. Leg pain: antibiotics 5.3, 3.0, 1.4; placebo 4.0, 4.3, 4.3. Lumbar pain: antibiotics 6.7, 5.0, 3.7; placebo 6.3, 6.3, 6.3. For the outcome measures, where a clinically important effect size was defined, improvements exceeded the thresholds, and a trend towards a dose-response relationship with double dose antibiotics being more efficacious.

CONCLUSIONS: The antibiotic protocol in this study was significantly more effective for this group of patients (CLBP associated with Modic I) than placebo in all the primary and secondary outcomes.

NO DATA NO DATA NO DATA Feb 2013 NO DATA
3 article Antibiotics for back pain tx+etio+fun+back NO DATA McCartney NO DATA Margaret McCartney investigates an alleged conflict of interest that may explain strangely good results in a study of antibiotic therapy for back pain (Albert et al). NO DATA NO DATA NO DATA NO DATA NO DATA 2013 NO DATA
4 article Antidepressant drug effects and depression severity mind NO DATA Fournier et al PubMed #20051569. This study was completed to try to determine if antidepressant medications actually helped depressive patients compared to a placebo. Various databases were searched from January 180 through march 2009. The trials chosen were included if the original data was included, if they included adult outpatients, and they compared the medication to a placebo for at least six weeks. It was discovered that “the medication vs placebo differences varied substantially as a function of baseline severity.” The conclusion of the researchers was: “The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.”

CONTEXT: Antidepressant medications represent the best established treatment for major depressive disorder, but there is little evidence that they have a specific pharmacological effect relative to pill placebo for patients with less severe depression.

OBJECTIVE: To estimate the relative benefit of medication vs placebo across a wide range of initial symptom severity in patients diagnosed with depression.

DATA SOURCES: PubMed, PsycINFO, and the Cochrane Library databases were searched from January 1980 through March 2009, along with references from meta-analyses and reviews.

STUDY SELECTION: Randomized placebo-controlled trials of antidepressants approved by the Food and Drug Administration in the treatment of major or minor depressive disorder were selected. Studies were included if their authors provided the requisite original data, they comprised adult outpatients, they included a medication vs placebo comparison for at least 6 weeks, they did not exclude patients on the basis of a placebo washout period, and they used the Hamilton Depression Rating Scale (HDRS). Data from 6 studies (718 patients) were included.

DATA EXTRACTION: Individual patient-level data were obtained from study authors.

RESULTS: Medication vs placebo differences varied substantially as a function of baseline severity. Among patients with HDRS scores below 23, Cohen d effect sizes for the difference between medication and placebo were estimated to be less than 0.20 (a standard definition of a small effect). Estimates of the magnitude of the superiority of medication over placebo increased with increases in baseline depression severity and crossed the threshold defined by the National Institute for Clinical Excellence for a clinically significant difference at a baseline HDRS score of 25.

CONCLUSIONS: The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.

303 1 47-53 Jan 2010 NO DATA
3 book The Antidepressant Fact Book ot+meds+mind+pain NO DATA Breggin If you are on SSRI antidepressants, you need to seriously consider getting off them — they may be a major barrier to health and vitality. Breggin is persuasive and interesting, but unfortunately his credibility is in question and its not clear NO DATA NO DATA NO DATA NO DATA NO DATA 2001 Perseus Publishing
1 article Application Possibilities of Traumeel S Injection Solution homeo+quack+inflam NO DATA Metelmann et al This is an ancient, poor quality, scientifically pointless survey, which is one of the the lowest forms of evidence even when done properly. It was published in 1992 in a “journal” owned by the manufacturer of Traumeel (Heel), but is being cited on their website 20 years later to support one of the world’s best-selling products. The “risk of bias” here is off the charts, and it has too many serious flaws to count. However, a particularly glaring problem is that almost half of the cases involved other medications, which muddies the waters too much for the results to mean anything, and that alone would be render the results largely meaningless. Another major flaw is that those ratings were supplied by physicians … not patients rating their own results. Not only is this paper unpersuasive, it is actually a fine example of how not to do science. This is one of ten studies cited on Traumeel.com to substantiate that Traumeel has therapeutic effects. See Does Arnica Cream Work for Pain? for a full discussion of these references as a set.

A drug monitoring trial conducted on 3,241 documented cases of therapy investigated the effectiveness, the patient tolerance, and the mode of application of a homeopathic ampule preparation (Traumeel S injection solution). The study determined that arthrosis — especially cases of gonarthrosis and coxarthrosis — was the chief area of application for the homeopathic medication under examination. Within this area of indication, the study included detailed analyses of the mode and frequency of application of the preparation. In addition, patients suffering from myogelosis, sprains, periarthropathia humeroscapularis, epicondylitis, and tendovaginitis were also frequently among those treated with Traumeel S injection solution. Of all the patients, 47.0% received adjuvant medicamentous therapy, and 65% obtained nonmedicamentous therapy which included massage, applications of heat and cold, and electrotherapy. In 78.6% of the treated cases, the results of therapy were formally assessed as “very good” or “good.” The patients’ tolerance to the preparation was good.

10 4 301 NO DATA 1992 NO DATA
NO DATA article Are tender point injections beneficial NO DATA NO DATA Staud NO DATA

Characteristic symptoms of fibromyalgia syndrome (FM) include widespread pain, fatigue, sleep abnormalities, and distress. FM patients show psychophysical evidence for mechanical, thermal, and electrical hyperalgesia. To fulfill FM criteria, the mechanical hyperalgesia needs to be widespread and present in at least 11 out of 18 well-defined body areas (tender points). Peripheral and central abnormalities of nociception have been described in FM and these changes may be relevant for the increased pain experienced by these patients. Important nociceptor systems in the skin and muscle seem to undergo profound changes in FM patients by yet unknown mechanisms. These changes may result from the release of algesic substances after muscle or other soft tissue injury. These pain mediators can sensitize important nociceptor systems, including the transient receptor potential channel, vanilloid subfamily member 1 (TRPV1), acid sensing ion channel (ASIC) receptors, and purino-receptors (P2X3). Subsequently, tissue mediators of inflammation and nerve growth factors can excite these receptors and cause substantial changes in pain sensitivity. FM pain is widespread and does not seem to be restricted to tender points (TP). It frequently comprises multiple areas of deep tissue pain (trigger points) with adjacent much larger areas of referred pain. Analgesia of areas of extensive nociceptive input has been found to provide often long lasting local as well as general pain relief. Thus interventions aimed at reducing local FM pain seem to be effective but need to focus less on tender points but more on trigger points (TrP) and other body areas of heightened pain and inflammation.

12 1 23–27 NO DATA 2006 NO DATA
3 article Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials NO DATA NO DATA Linde et al PubMed #9310601. Homeopathy damned with faint praise.

BACKGROUND: Homeopathy seems scientifically implausible, but has widespread use. We aimed to assess whether the clinical effect reported in randomised controlled trials of homeopathic remedies is equivalent to that reported for placebo.

METHODS: We sought studies from computerised bibliographies and contracts with researchers, institutions, manufacturers, individual collectors, homeopathic conference proceedings, and books. We included all languages. Double-blind and/or randomised placebo-controlled trials of clinical conditions were considered. Our review of 185 trials identified 119 that met the inclusion criteria. 89 had adequate data for meta-analysis, and two sets of trial were used to assess reproducibility. Two reviewers assessed study quality with two scales and extracted data for information on clinical condition, homeopathy type, dilution, "remedy", population, and outcomes.

FINDINGS: The combined odds ratio for the 89 studies entered into the main meta-analysis was 2.45 (95% CI 2.05, 2.93) in favour of homeopathy. The odds ratio for the 26 good-quality studies was 1.66 (1.33, 2.08), and that corrected for publication bias was 1.78 (1.03, 3.10). Four studies on the effects of a single remedy on seasonal allergies had a pooled odds ratio for ocular symptoms at 4 weeks of 2.03 (1.51, 2.74). Five studies on postoperative ileus had a pooled mean effect-size-difference of -0.22 standard deviations (95% CI -0.36, -0.09) for flatus, and -0.18 SDs (-0.33, -0.03) for stool (both p < 0.05).

INTERPRETATION: The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic.

350 9081 834-43 Sep 1997 NO DATA
4 article Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy homeo+quack NO DATA Shang et al PubMed #16125589. Even though homeopathy is widely used, there is BIA in the conduct and reporting of trials. This study analysed trials of homeopathy and conventional medicine and estimated treatment effects in trials which were least likely to be affected by bias. There were placebo-controlled trials identified by a comprehensive literature search, which covered 19 electronic databases. 110 homeopathy trials and 110 matched conventional-medicine trials were analyzed. The final interpretation of the study said: “Biases are present in placebo-controlled trials of both homoeopathy and conventional medicine. When account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.”

BACKGROUND: Homoeopathy is widely used, but specific effects of homoeopathic remedies seem implausible. Bias in the conduct and reporting of trials is a possible explanation for positive findings of trials of both homoeopathy and conventional medicine. We analysed trials of homoeopathy and conventional medicine and estimated treatment effects in trials least likely to be affected by bias.

METHODS: Placebo-controlled trials of homoeopathy were identified by a comprehensive literature search, which covered 19 electronic databases, reference lists of relevant papers, and contacts with experts. Trials in conventional medicine matched to homoeopathy trials for disorder and type of outcome were randomly selected from the Cochrane Controlled Trials Register (issue 1, 2003). Data were extracted in duplicate and outcomes coded so that odds ratios below 1 indicated benefit. Trials described as double-blind, with adequate randomisation, were assumed to be of higher methodological quality. Bias effects were examined in funnel plots and meta-regression models.

FINDINGS: 110 homoeopathy trials and 110 matched conventional-medicine trials were analysed. The median study size was 65 participants (range ten to 1573). 21 homoeopathy trials (19%) and nine (8%) conventional-medicine trials were of higher quality. In both groups, smaller trials and those of lower quality showed more beneficial treatment effects than larger and higher-quality trials. When the analysis was restricted to large trials of higher quality, the odds ratio was 0.88 (95% CI 0.65-1.19) for homoeopathy (eight trials) and 0.58 (0.39-0.85) for conventional medicine (six trials).

INTERPRETATION: Biases are present in placebo-controlled trials of both homoeopathy and conventional medicine. When account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.

366 9487 726-32 NO DATA 2005 NO DATA
3 article Are we facing a new paradigm of inactivity physiology? exercise NO DATA Bak et al NO DATA From the introductory paragraphs:

Recent, observational studies have suggested that prolonged bouts of sitting time and lack of whole-body muscular movement are strongly associated with obesity, abnormal glucose metabolism, diabetes, metabolic syndrome, cardiovascular disease (CVD) risk and cancer, as well as total mortality independent of moderate to vigorous-intensity physical activity.

Accordingly, a possible new paradigm of inactivity physiology is suggested, separate from the established exercise physiology, that is, molecular and physiological responses to exercise.

This new way of thinking emphasises the distinction between the health consequences of sedentary behaviour, that is, limiting everyday life non-exercise activity and that of not exercising. Until now, the expression “sedentary behaviour” has misleadingly been used as a synonym for not exercising. Sedentary time should be defined as the muscular inactivity rather than the absence of exercise.

NO DATA NO DATA NO DATA NO DATA Feb 2010 NO DATA
3 article Arginine-initiated release of human growth hormone. Factors modifying the response in normal man tx+self-tx+meds+exercise+nutrition NO DATA Merimee et al 1 Some ancient, basic physiology science demonstrating that arginine supplementation may stimulated production of growth hormone — which is still used by as a rationale for arginine supplementation for bodybuilders to this day.

To improve the usefulness of testing pituitary function by the response of human growth hormone (HGH) to I.V. arginine loads, arginine infusions were given under a variety of conditions to healthy subjects aged 17 to 35. The minimum effective arginine load causing release of HGH was 1/6 gm per pound of body weight in men and 1/12 gm per pound of body weight in women. At each of three dosage schedules used, women responded with greater increases in plasma HGH than men. Treatment of men with diethylstilbestrol augmented their HGH response to arginine, whereas methyltestosterone pretreatment did not decrease the response in women. The HGH response to arginine was not abolished by acute hyperglycemia but was attenuated or delayed by a previous stimulus for HGH release.

In the use of this test of pituitary function, it is necessary to use a proper dose of arginine, to avoid other stimuli of HGH release, and to pretreat men with estrogens.

280 26 1434-8 Jun 1969 NO DATA
4 article Arnica for bruising and swelling homeo+meds+quack NO DATA Kouzi et al PubMed #18029949. This is a review of arnica both as an herbal remedy and a homeopathic one (as in Traumeel). It concludes: “The majority of randomized clinical trials suggest that homeopathic arnica is no better than placebo in treating bruising, swelling, and pain. Data from existing clinical and basic science research studies do not support a favorable risk:benefit ratio for arnica therapy and offer no advantages over the use of conventional treatments.”

Excerpt from introduction: Arnica, also known as mountain daisy, mountain tobacco, and leopard’s bane, is a perennial herb of the family Asteraceae. The herb, which has orange-yellow daisy-like flower heads, is native to the meadows and mountainous regions of Europe and western North America. Europeans and Native Americans have used it for centuries to reduce the inflammation and pain of sprains, bruises, and wounds. Today, arnica is a popular homeopathic remedy in both Europe and the United States for the treatment of acne, bruises, sprains, and muscle aches and as a general topical counterirritant. European arnica is obtained from Arnica montana and Arnica chamissonis, while American arnica is obtained from Arnica fulgens, Arnica sororia, and Arnica cordifolia. The dried flower head is the most widely used part of the plant in commercially available dosage forms of arnica.

64 23 2434-43 Dec 2007 NO DATA
3 article Arthroscopic debridement for knee osteoarthritis tx+arthritis+knee+surgery NO DATA Laupattarakasem et al In 2002, Moseley published the results of a fascinating experiment that showed that people who received a fake arthroscopic knee surgery had results just as good as people who received the real surgery for osteoarthritis. Six years later, The Cochrane Collaboration published this report, concluding that “there is ‘gold’ level evidence that arthoscopic debridement has no benefit.” A few months later in the summer of 2008, New England Journal of Medicine (Kirkley) added more experimental evidence to the pile, reporting that “surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.”

BACKGROUND: Knee osteoarthritis (OA) is a progressive disease that initially affects the articular cartilage. Observational studies have shown benefits for arthroscopic debridement (AD) on the osteoarthritic knee, but other recent studies have yielded conflicting results that suggest AD may not be effective.

OBJECTIVES: To identify the effectiveness of AD in knee OA on pain and function. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006); MEDLINE (1966 to August, 2006); CINAHL (1982 to 2006); EMBASE (1988 to 2006) and Web of Science (1900 to 2006) and screened the bibliographies, reference lists and cited web sites of papers. SELECTION CRITERIA: We included randomised controlled trials (RCT) or controlled clinical trials (CCT) assessing effectiveness of AD compared to another surgical procedure, including sham or placebo surgery and other non-surgical interventions, in patients with a diagnosis of primary or secondary OA of the knees, who did not have other joint involvement or conditions requiring long term use of non-steroidal anti-inflammatory drugs (NSAIDs). The main outcomes were pain relief and improved function of the knee. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. Results are presented using weighted mean difference (WMD) for continuous data and relative risk (RR) for dichotomous data, and the number needed to treat to benefit (NNTB) or harm (NNTH).

MAIN RESULTS: Three RCTs were included with a total of 271 patients. They had different comparison groups and a moderate risk of bias. One study compared AD with lavage and with sham surgery. Compared to lavage the study found no significant difference. Compared to sham surgery placebo, the study found worse outcomes for AD at two weeks (WMD for pain 8.7, 95% CI 1.7 to 15.8, and function 7.7, 95% CI 1.1 to 14.3; NNTH=5) and no significant difference at two years. The second trial, at higher risk of bias, compared AD and arthroscopic washout, and found that AD significantly reduced knee pain compared to washout at five years (RR 5.5, 95% CI 1.7 to 15.5; NNTB=3). The third trial, also at higher risk of bias, compared AD to closed-needle lavage, and found no significant difference.

AUTHORS' CONCLUSIONS: There is 'gold' level evidence that AD has no benefit for undiscriminated OA (mechanical or inflammatory causes).

NO DATA 1 CD005118 NO DATA 2008 NO DATA
3 article Arthroscopic evaluation of refractory knee pain pfps+run+knee NO DATA Anand et al In this study of 50 patients with stubborn knee pain, “Three patients were clinically diagnosed as chondromalacia patellae; however the same was diagnosed in 30 patients (60%) arthroscopically.” In other words, 10 times as many patients actually had chondromalcia patellae as had been diagnosed with it!

The aim of this study was to evaluate the conditions of the articular cartilage and other intra-articular structures in patients with refractory knee pain. A total of 50 patients were taken up for this study based on specific inclusion criteria. Arthroscopy was done using a 30 degrees scope and was introduced most commonly via anterolateral approach after a thorough clinical and radiological evaluation of the affected joint. It was observed that majority (76%) had grade I articular lesion and 10% had grade IV lesion. Arthroscopically 78% of the patients had a meniscal tear while 12% had cyst of lateral meniscus while clinically, meniscal tear was present in 22% of the cases and cyst in 2% cases only. Arthroscopy also detects other intra-articular lesions, which are missed clinically, thus modifying further management of the patient.

102 2 80, 84-5 NO DATA 2004 NO DATA
NO DATA article Arthroscopic release of adhesive capsulitis NO DATA NO DATA Berghs et al PubMed #14997096. NO DATA

Twenty-five patients with primary adhesive capsulitis underwent an arthroscopic release of the capsule of the shoulder joint. They were reviewed after a mean of 14.8 months (range, 3-40 months). Night pain and awakening were a feature in all 25 patients preoperatively but were only found in 3 postoperatively. There was marked improvement in pain from a preoperative visual analog scale score of 3.1 to a postoperative visual analog scale score of 12.6 on a scale of 15. Passive movement of the joint improved significantly, with mean passive elevation changing from 73.7 degrees preoperatively to 163 degrees postoperatively, mean passive external rotation changing from 10.6 degrees preoperatively to 46.8 degrees postoperatively, and passive internal rotation improving by a mean of 9 levels. The mean preoperative Constant score of 25.3 improved to 75.5 postoperatively, and the Constant score adjusted for age and gender averaged 91%. All patients completed the Short Form-36 questionnaire at their review, revealing a norm-based physical summary score of 48.7, falling within 1 SD of a normal population sample. This arthroscopic surgical technique is derived from the open surgical release. It is founded upon an understanding of the pathology of this condition. It appears to yield rapid relief of pain and dramatic improvement in movement and function in this painful and otherwise protracted condition.

13 2 180-5 NO DATA 2004 NO DATA
3 article A randomized controlled trial of a mixed Kinesio taping-compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency tools+ot NO DATA Aguilar-Ferrándiz et al PubMed #23426563. “Compression socks with tape,” quipped @exuberantdoc, and that’s probably all the commentary on this paper that’s really called for. I would only be surprised by a measurable circulatory effect on fit people, and downright shocked if it was a robust enough effect to affect performance, let alone elite performance.

OBJECTIVES: To investigate the effect of a mixed Kinesio taping treatment in women with chronic venous insufficiency.

DESIGN: A double-blinded randomized clinical trial.

SETTING: Clinical setting.

PARTICIPANTS: One hundred and twenty postmenopausal women with mild-moderate chronic venous insufficiency were randomly assigned to an experimental group receiving standardized Kinesio taping treatment for gastrocnemius muscle enhancement and ankle functional correction, or to a placebo control group for simulated Kinesio taping.

Main outcomes variables: Venous symptoms, pain, photoplethysmographic measurements, bioelectrical impedance, temperature, severity and overall health were recorded at baseline and after four weeks of treatment.

RESULTS: The 2 × 2 mixed model ANCOVA with repeated measurements showed statistically significant group * time interaction for heaviness (F = 22.99, p = 0.002), claudication (F = 8.57, p = 0.004), swelling (F = 22.58, p = 0.001), muscle cramps (F = 7.14, p = 0.008), venous refill time (right: F = 9.45, p = 0.023; left: F = 14.86, p = 0.001), venous pump function (right: F = 35.55, p = 0.004; left: F = 17.39 p = 0.001), extracellular water (right: F = 35.55, p = 0.004; left: F = 23.84, p = 0.001), severity (F = 18.47, p = 0.001), physical function (F = 9.15, p = 0.003) and body pain (F = 3.36, p = 0.043). Both groups reported significant reduction in pain.

CONCLUSION: Mixed Kinesio taping-compression therapy improves symptoms, peripheral venous flow and severity and slightly increases overall health status in females with mild chronic venous insufficiency. Kinesio taping may have a placebo effect on pain.

NO DATA NO DATA NO DATA Feb 2013 NO DATA
NO DATA article Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee pfps+arthritis+surgery+tx+knee NO DATA Kon et al Small trial of a new surgical technique for osteoarthritis, chondocyte implantation. Researchers compared chondrocyte implantation to microfracture repair technique at the five year mark in eighty patients. Both procedures were beneficial, but chondrocyte implantation was found to be superior. Although subjective improvements were significant, patients were not “cured.” Later in 2009, Gobbi found very similar results.

BACKGROUND: Various approaches have been proposed to treat articular cartilage lesions, which are plagued by inherent limited healing potential.

PURPOSE: To compare the clinical outcome of patients treated with second-generation autologous chondrocyte implantation implants with those treated with the microfracture repair technique at 5-year follow-up.

STUDY DESIGN: Cohort study; Level of evidence, 2.

METHODS: Eighty active patients (mean age, 29.8 years) and grade III to IV cartilage lesions of the femoral condyles or trochlea were treated with arthroscopic second-generation autologous chondrocyte implantation Hyalograft C or microfracture (40 patients per group). Patients achieved a minimum 5-year follow-up and were prospectively evaluated.

RESULTS: Both groups showed statistically significant improvement of all clinical scores from preoperative interval to 5-year follow-up. There was a significant improvement for the International Knee Documentation Committee subjective score from pre-operative to 5-year follow-up (Wilcoxon test, P < .001). In the microfracture group, the International Knee Documentation Committee objective score increased from 2.5% normal and nearly normal knees before the operation to 75% normal and nearly normal knees at 5-year follow-up, and the subjective score increased from 41.1 +/- 12.3 preoperatively to 70.2 +/- 14.7 at 5-year follow-up. In the group treated with Hyalograft C, the International Knee Documentation Committee objective score increased from 15% normal and nearly normal knees before the operation to 90% normal and nearly normal knees at 5-year follow-up, and its subjective score increased from 40.5 +/- 15.2 preoperatively to 80.2 +/- 19.1 at 5-year follow-up (Wilcoxon test, P < .001). When comparing the groups, better improvement of the International Knee Documentation Committee objective (P < .001) and subjective (P = .003) scores was observed in the Hyalograft C group at 5-year follow-up. The return to sports at 2 years was similar in both groups and remained stable after 5 years in the Hyalograft C group; it worsened in the microfracture group.

CONCLUSION: Both methods have shown satisfactory clinical outcome at medium-term follow-up. Better clinical results and sport activity resumption were noted in the group treated with second-generation autologous chondrocyte transplantation.

37 1 33–41 Jan 2009 NO DATA
NO DATA article Assessing the Unreliability of the Medical Literature NO DATA NO DATA Goodman et al NO DATA NO DATA

A recent article in this journal (Ioannidis JP (2005) Why most published research findings are false. PLoS Med 2: e124) argued that more than half of published research findings in the medical literature are false. In this commentary, we ex- amine the structure of that argument, and show that it has three basic components:

  1. An assumption that the prior probability of most hypotheses explored in medi- cal research is below 50%.
  2. Dichotomization of P-values at the 0.05 level and introduction of a “bias” factor (produced by significance-seeking), the combination of which severely weakens the evidence provided by every design.
  3. Use of Bayes theorem to show that, in the face of weak evidence, hypothe- ses with low prior probabilities cannot have posterior probabilities over 50%.

Thus, the claim is based on a priori assumptions that most tested hypotheses are likely to be false, and then the inferential model used makes it impossible for evidence from any study to overcome this handicap. We focus largely on step (2), explaining how the combination of dichotomization and “bias” dilutes ex- perimental evidence, and showing how this dilution leads inevitably to the stated conclusion. We also demonstrate a fallacy in another important component of the argument –that papers in “hot” fields are more likely to produce false findings.

We agree with the paper’s conclusions and recommendations that many medical research findings are less definitive than readers suspect, that P-values are widely misinterpreted, that bias of various forms is widespread, that multiple approaches are needed to prevent the literature from being systematically biased and the need for more data on the prevalence of false claims. But calculating the unreliability of the medical research literature, in whole or in part, requires more empirical evidence and different inferential models than were used. The claim that “most research findings are false for most research designs and for most fields” must be considered as yet unproven.

NO DATA Paper 135 NO DATA NO DATA 2007 NO DATA
2 article Assessment of the effect of L-glutamine supplementation on DOMS tx+nutrition+exercise+pain NO DATA Namdar et al NO DATA “These results suggest that L-glutamine supplementation attenuates DOMS effects, muscle damage and downfall of performance in flexor of hip.” However, it’s a weak study, and I don’t think the results do much more than “suggest”: it was a small experiment, and they measured range of motion only (not pain or strength, both of which would have been better choices — DOMS does not particularly limit range of motion, just makes it uncomfortable). Nevertheless, this is a shred of evidence that glutamine might, possibly, help with DOMS a little.

Glutamine is an amino acid and is not considered one of the eight essential aminos. Amino acid supplementation outspreaded to enhancing athletic performance, preparation, removal fatigue and minimising risk of injures. Delayed onset muscle soreness (DOMS) is result of a combination of unaccustomed muscle contraction (especially lengthening of the muscle under load) and poor motor neuron recruitment. This study investigated the effect of L-glutamine supplementation on DOMS after 30 min ergometric exercise by comparing two metabolic enzymes (aldolase and creatine kinase) and hip flexors range of motion. Experimental double blind design was used. This study included 20 non-athletic girl with 22.8±2.6 years old and 21.45±3.1 body mass index. The subjects randomise to glutamine and placebo supplementations. The supplement group was ingested 4 weeks, three times in week and twice a day (5 g per time). The control group use placebo same as experimental group. analyses of variance and t test use for data analyses. Aldolase increased 36 h after activity than after activity time in experimental group, but in control group it was reverted. There is a significant difference in aldolase level between control and experimental group (p> 0.05). The creatine kinase increased significantly in 36 h after activity than after activity time in experimental group. Range of motion of hip joint decreased in T3 in both of them significantly, but it was recovered for experimental group 36 h after activity. These results suggest that L-glutamine supplementation attenuates DOMS effects, muscle damage and downfall of performance in flexor of hip.

44 NO DATA NO DATA NO DATA 2010 NO DATA
4 article Assessment of the potential role of muscle spindle mechanoreceptor afferents in chronic muscle pain in the rat masseter muscle pain+etio+tps NO DATA Lund et al PubMed #20559566. Researchers injected the jaw muscles of rats to induce pain and then studied neurological changes. They focussed on the nerve receptors that detect changes of length in muscle (muscle spindles), which are not normally associated with painful phenomenon. However, the electrical properties of the spindles changed in the painful rat muscle. In particular, nerve impulses began to “leak” (ectopic action potentials) instead of staying nicely within the muscle spindle, possibly stimulating nearby pain receptors. The researchers suggest that this nerve-ending behaviour could explain how muscle pain can become chronic.

BACKGROUND: The phenotype of large diameter sensory afferent neurons changes in several models of neuropathic pain. We asked if similar changes also occur in "functional" pain syndromes.

METHODOLOGY/PRINCIPAL FINDINGS: Acidic saline (AS, pH 4.0) injections into the masseter muscle were used to induce persistent myalgia. Controls received saline at pH 7.2. Nocifensive responses of Experimental rats to applications of Von Frey Filaments to the masseters were above control levels 1-38 days post-injection. This effect was bilateral. Expression of c-Fos in the Trigeminal Mesencephalic Nucleus (NVmes), which contains the somata of masseter muscle spindle afferents (MSA), was above baseline levels 1 and 4 days after AS. The resting membrane potentials of neurons exposed to AS (n = 167) were hyperpolarized when compared to their control counterparts (n = 141), as were their thresholds for firing, high frequency membrane oscillations (HFMO), bursting, inward and outward rectification. The amplitude of HFMO was increased and spontaneous ectopic firing occurred in 10% of acid-exposed neurons, but never in Controls. These changes appeared within the same time frame as the observed nocifensive behaviour. Ectopic action potentials can travel centrally, but also antidromically to the peripheral terminals of MSA where they could cause neurotransmitter release and activation of adjacent fibre terminals. Using immunohistochemistry, we confirmed that annulospiral endings of masseter MSA express the glutamate vesicular transporter VGLUT1, indicating that they can release glutamate. Many capsules also contained fine fibers that were labelled by markers associated with nociceptors (calcitonin gene-related peptide, Substance P, P2X3 receptors and TRPV1 receptors) and that expressed the metabotropic glutamate receptor, mGluR5. Antagonists of glutamatergic receptors given together with the 2(nd) injection of AS prevented the hypersensitivity observed bilaterally but were ineffective if given contralaterally.

CONCLUSIONS/SIGNIFICANCE: Low pH leads to changes in several electrical properties of MSA, including initiation of ectopic action potentials which could propagate centrally but could also invade the peripheral endings causing glutamate release and activation of nearby nociceptors within the spindle capsule. This peripheral drive could contribute both to the transition to, and maintenance of, persistent muscle pain as seen in some "functional" pain syndromes.

5 6 e11131 NO DATA 2010 NO DATA
3 article Assessment of the safety of glutamine and other amino acids tx+self-tx+nutrition+harms NO DATA Garlick PubMed #11533313. Four studies of the safety of glutamine supplementation in a medical context found that it was “safe in adults and in preterm infants,” but that data was not relevant to concerns about “chronic consumption by healthy subjects.” The authors attempted reviewed more literature on high dietary intake of proteins and amino acids in general, and found more problems, particularly neurological damage in preterm infants. Infants are particularly sensitive to neurological effects, so if they have problems, it certainly means trouble for adults too — just less dramatically. “Because glutamine is metabolized to glutamate and ammonia, both of which have neurological effects, psychological and behavioral testing may be especially important.” In other words, a high dietary intake of glutamine may mess with your head.

Glutamine is used to supplement intravenous and enteral feeding. Although there have been many human studies of its efficacy, there have been very few studies with safety as a primary goal. This article analyzes the literature on the safety of glutamine and also examines the available information on high intakes of total protein and other amino acids, so that additional indicators of potentially adverse effects can be suggested. Four studies that specifically addressed glutamine safety were identified, from which it was concluded that glutamine is safe in adults and in preterm infants. However, the published studies of safety have not fully taken account of chronic consumption by healthy subjects of all age groups. To help identify potential undetected hazards of glutamine intake, the literature on adverse effects of high dietary intake of protein and other amino acids was examined. High protein is reputed to cause nausea, vomiting and ultimately death in adults, and has been shown to result in neurological damage in preterm infants. Individual amino acids cause a variety of adverse effects, some of them potentially fatal, but neurological effects were the most frequently observed. Because glutamine is metabolized to glutamate and ammonia, both of which have neurological effects, psychological and behavioral testing may be especially important.

131 9 Suppl 2556S-61S Sep 2001 NO DATA
3 article A survey of patient's perceptions of what is "adverse" in manual physiotherapy and predicting who is likely to say so tx+manual+harms+back+chiro NO DATA Carlesso et al PubMed #23856189. In this Canadian survey, low back pain patients were generally much more likely (51%) to report some kind of unpleasant reaction to therapy than patients with a problem anywhere else in the body, generally suggesting that back pain makes people nervous, or actual harm from therapy is more common, or both. Patient expectations, for better or worse, are a major factor in what is considered a “bad reaction” to therapy. For instance, back pain patients who expected to be “sore” after therapy were somewhat less likely (8.5%) to report a serious reaction. In 2010 Carlesso et al reported that “harms have either been neglected or poorly defined in much of the available studies on the efficacy of orthopaedic physical therapy.” This paper focusses on the patient perspective, which is totally neglected in the study of adverse events and, of course, “important to consider.” See Carlesso.

OBJECTIVES: The primary objective was to describe the patient perspective regarding the identification and occurrence of adverse responses related to manual therapy. A secondary objective evaluated predictors of the incidence rate of adverse responses identified by patients receiving manual physiotherapy. STUDY

DESIGN AND SETTING: A cross-sectional survey of patients receiving manual physiotherapy recruited by physiotherapists in Canada was conducted. The survey included questions about the symptoms patients identified as adverse, causal associations with treatment, and the impact of contextual factors. Descriptive statistics are reported, and Poisson modeling predicted factors associated with identification of adverse responses.

RESULTS: A response rate of 76.2% (324 of 425) was obtained. Having lumbar spine dysfunction was a significant predictor of all adverse responses (incidence rate ratio [IRR] 95% confidence interval [CI] = 1.513 [1.025, 2.235], P = 0.037) and was associated with 51% greater identification of adverse responses compared with those with an extremity disorder. Expectation of soreness was "protective" against identifying major adverse responses (IRR [95% CI] = 0.915 [0.838, 0.999], P = 0.047); they had an 8.5% lower rate of identifying major adverse responses relative to those without this expectation.

CONCLUSIONS: The patient perspective is important to consider if a comprehensive framework for defining adverse responses in manual therapies is to be developed.

66 10 1184-91 Oct 2013 NO DATA
4 article Assessment back+pain NO DATA Dubinsky et al 1 This review of transcutaneous electric nerve stimulation (TENS) for neurologic disorders found that it showed benefit only in lower quality (class II) studies, and not even in all of those. When tested proper-like in better quality (class I) studies … nada. Thus TENS “is not recommended for the treatment of chronic low back pain.” I’m shocked.

OBJECTIVE: To determine if transcutaneous electric nerve stimulation (TENS) is efficacious in the treatment of pain in neurologic disorders.

METHODS: We performed a systematic literature search of Medline and the Cochrane Library from inception to April 2009.

RESULTS: There are conflicting reports of TENS compared to sham TENS in the treatment of chronic low back pain, with 2 Class II studies showing benefit, but 2 Class I studies and another Class II study not showing benefit. Because the Class I studies are stronger evidence, TENS is established as ineffective for the treatment of chronic low back pain (2 Class I studies). TENS is probably effective in treating painful diabetic neuropathy (2 Class II studies).

RECOMMENDATIONS: Transcutaneous electric nerve stimulation (TENS) is not recommended for the treatment of chronic low back pain (Level A). TENS should be considered in the treatment of painful diabetic neuropathy (Level B). Further research into the mechanism of action of TENS is needed, as well as more rigorous studies for determination of efficacy.

74 2 173-6 Jan 2010 NO DATA
4 article Associates of physical function and pain in patients with patellofemoral pain syndrome pfps+knee+psb+etio+itbs NO DATA Piva et al PubMed #19236982. Researchers tested 74 patients diagnosed with patellofemoral pain syndrome for the presence of several factor that are commonly suspected to be associated with that condition, the “usual biomechanical suspects”: muscle weakness and tightness, coordination, and postural and anatomical abnormalities. They also considered psychological factors, which is quite unusual for a study of knee pain. They found no correlation at all with between the biomechanical factors and chronic anterior knee pain. (Interestingly, the researchers did find that “psychologic factors [anxiety and fear-avoidance beliefs about work and physical activity] were the only associates of function and pain in patients with PFPS.”)

OBJECTIVES: To explore whether impairment of muscle strength, soft tissue length, movement control, postural and biomechanic alterations, and psychologic factors are associated with physical function and pain in patients with patellofemoral pain syndrome (PFPS).

DESIGN: Cross-sectional study.

SETTING: Rehabilitation outpatient.

PARTICIPANTS: Seventy-four patients diagnosed with PFPS.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Measurements were self-reported function and pain; strength of quadriceps, hip abduction, and hip external rotation; length of hamstrings, quadriceps, plantar flexors, iliotibial band/tensor fasciae latae complex, and lateral retinaculum; foot pronation; Q-angle; tibial torsion; visual observation of quality of movement during a lateral step-down task; anxiety; and fear-avoidance beliefs.

RESULTS: After controlling for age and sex, anxiety and fear-avoidance beliefs about work and physical activity were associated with function, while only fear-avoidance beliefs about work and physical activity were associated with pain.

CONCLUSIONS: Psychologic factors were the only associates of function and pain in patients with PFPS. Factors related to physical impairments did not associate to function or pain. Our results should be validated in other samples of patients with PFPS. Further studies should determine the role of other psychologic factors, and how they relate to anxiety and fear-avoidance beliefs in these patients.

90 2 285-95 Feb 2009 NO DATA
4 article The association between cervical spine curvature and neck pain neck+psb+chiro+exercise NO DATA Grob et al 1 Perhaps this paper should be titled: “The lack of association between cervical spine curvature and neck pain.” In 2007, Swiss researchers examined “the correlation between the presence of neck pain and alterations of the normal cervical lordosis,” and this was probably “the first study to explicitly examine these relationships in detail.” Many therapists assume that there is not only a correlation but a causal relationship, a classic example of structuralism. However, looking at more than 50 patients with and 50 without neck pain — a large enough study to be meaningful — the researchers found “no significant difference between the two groups could be found in relation to the global curvature, the segmental angles, or the incidence of straight-spine or kyphotic deformity.” Thus they concluded that “the presence of such structural abnormalities in the patient with neck pain must be considered coincidental, i.e. not necessarily indicative of the cause of pain.” See also some substantive criticism of this paper.

Degenerative changes of the cervical spine are commonly accompanied by a reduction or loss of the segmental or global lordosis, and are often considered to be a cause of neck pain. Nonetheless, such changes may also remain clinically silent. The aim of this study was to examine the correlation between the presence of neck pain and alterations of the normal cervical lordosis in people aged over 45 years. One hundred and seven volunteers, who were otherwise undergoing treatment for lower extremity problems in our hospital, took part. Sagittal radiographs of the cervical spine were taken and a questionnaire was completed, enquiring about neck pain and disability in the last 12 months. Based on the latter, subjects were divided into a group with neck pain (N = 54) and a group without neck pain (N = 53). The global curvature of the cervical spine (C2-C7) and each segmental angle were measured from the radiographs, using the posterior tangent method, and examined in relation to neck complaints. No significant difference between the two groups could be found in relation to the global curvature, the segmental angles, or the incidence of straight-spine or kyphotic deformity (P> 0.05). Twenty-three per cent of the people with neck pain and 17% of those without neck pain showed a segmental kyphosis deformity of more than 4 degrees in at least one segment--most frequently at C4/5, closely followed by C5/6 and C3/4. The average segmental angle at the kyphotic level was 6.5 degrees in the pain group and 6.3 degrees in the group without pain, with a range of 5-10 degrees in each group. In the group with neck pain, there was no association between any of the clinical characteristics (duration, frequency, intensity of pain; radiating pain; sensory/motor disturbances; disability; healthcare utilisation) and either global cervical curvature or segmental angles. The presence of such structural abnormalities in the patient with neck pain must be considered coincidental, i.e. not necessarily indicative of the cause of pain. This should be given due consideration in the differential diagnosis of patients with neck pain.

16 5 669–678 NO DATA 2007 NO DATA
3 article The association between incident self-reported fibromyalgia and nonpsychiatric factors pain+etio+tps NO DATA Choi et al PubMed #20400378. What might cause fibromyalgia? Lifestyle factors? Health behaviours? Research done in 1976 was used to follow-up with these questions. More than three thousand women participated in the original study (the Adventist Health Study). These women were followed-up and asked about their lifestyle and medical history questionnaire. Certain lifestyle habits seem to indicate a stronger likelihood of developing fibromyalgia. The conclusions: “Smoking as well as prevalent allergies, and a history of hyperemesis gravidarum, seem to predict development of FM in women during 25 years of follow-up. This information may help in identifying persons at high risk of developing FM and thus initiate effective prevention strategies.”

The purpose of the study was to investigate the association between incident self-reported fibromyalgia (FM) and prior somatic diseases, lifestyle factors, and health behaviors among 3,136 women who participated in 2 cohort studies 25 to 26 years apart (the Adventist Health Study 1 and 2). The women completed a comprehensive lifestyle and medical history questionnaire at baseline in 1976. Information on new diagnosis of doctor-told FM was obtained at the second survey in 2002. A total of 136 women reported a diagnosis of FM during 25 years of follow-up, giving a period incidence of 43/1,000 or 1.72/1000 per year. In multivariable logistic regression analyses, a significant, dose-response association was found with number of allergies with OR of 1.61 (95% CI: .92-2.83) and 3.99 (95% CI: 2.31-6.88), (P[trend] < .0001), respectively, for 1 and 2 or more allergies versus none. A history of hyperemesis gravidarum was also associated with FM with OR of 1.32 (95% CI: .75-2.32) and 1.73 (95% CI: .99-3.03), (P[trend] < .05), respectively, for some or all pregnancies versus none. A positive association with smoking was also found with OR of 2.37 (95% CI: 1.33-4.23) for ever smokers versus never smokers. No significant association was found with number of surgeries, history of peptic ulcer, or taking medications to control various symptoms.

PERSPECTIVE: Smoking as well as prevalent allergies, and a history of hyperemesis gravidarum, seem to predict development of FM in women during 25 years of follow-up. This information may help in identifying persons at high risk of developing FM and thus initiate effective prevention strategies.

11 10 994-1003 Oct 2010 NO DATA
5 article A Cochrane review of patient education for neck pain neck NO DATA Haines et al PubMed #19596214. The effectiveness of education for neck pain (and probably any pain problem) depends a lot on the causes of the pain and the type of education, making it very hard to study. This Cochrane review found only 10 studies to review, and only two were rated as high quality. The authors conclude that these studies show little promise in educational therapy. I have to acknowledge that this does not look good, and there’s no reason to be particularly optimistic about educational therapy. And yet I admit to a hopeful bias: I think further research could change this picture, given the complexity of the problem and the lack of good quality research done so far. There are too many reasons to believe that confidence is relevant to recovery to dismiss educational therapy just yet. It doesn’t look good, but it isn’t over! Bear in mind that another review of the subject in Spine (Hurwitz) from just a year earlier concluded that, “For whiplash-associated disorders, there is evidence that educational videos … more beneficial than usual care or physical modalities.”

BACKGROUND CONTEXT: Neck pain is common, disabling, and costly. The effectiveness of patient education strategies is unclear.

PURPOSE: To assess whether patient education strategies are of benefit for pain, function/disability, global perceived effect, quality of life, or patient satisfaction, in adults with neck pain with or without radiculopathy.

STUDY DESIGN: Cochrane systematic review.

METHODS: Computerized bibliographic databases were searched from their start to May 31, 2008. Eligible studies were randomized trials investigating the effectiveness of patient education strategies for neck pain. Paired independent reviewers carried out study selection, data abstraction, and methodological quality assessment. Relative risk and standardized mean differences were calculated. Because of differences in intervention type or disorder, no studies were considered appropriate to pool.

RESULTS: Of the 10 selected trials, two (20%) were rated as of high quality. Patient education was assessed as follows: 1) eight trials of advice focusing on activation compared with no treatment, or to various active treatments, including therapeutic exercise, manual therapy, and cognitive behavioral therapy, showed either inferiority or no difference for pain, spanning a full range of follow-up periods, acuity and disorder types. When compared with rest, two trials that assessed acute whiplash-associated disorder showed moderate evidence of no difference for advice focusing on activation; 2) two trials studying advice focusing on pain and stress coping skills found moderate evidence of no benefit for chronic neck pain at intermediate- to long-term follow-up; and 3) one trial compared the effects of neck school to no treatment, yielding limited evidence of no benefit for pain, at intermediate-term follow-up in mixed acute/subacute/chronic neck pain.

CONCLUSIONS: This review has not shown effectiveness for educational interventions for neck pain of various acuity stages and disorder types and at various follow-up periods, including advice to activate, advice on stress coping skills, and neck school. In future research, further attention to methodological quality is necessary. Studies of multimodal interventions should consider study designs, such as factorial designs, that permit discrimination of specific educational components.

NO DATA NO DATA NO DATA Jul 2009 NO DATA
4 article Association between serum ferritin level and fibromyalgia syndrome nutrition+harms+pain+tps NO DATA Ortancil et al PubMed #20087382. This study aimed to investigate the association of ferritin with FMS. Conclusions: “Our study implicates a possible association between FM and decreased ferritin level, even for ferritin in normal ranges. We suggest that iron as a cofactor in serotonin and dopamine production may have a role in the etiology of FMS.”

BACKGROUND/OBJECTIVES: Iron is essential for a number of enzymes involved in neurotransmitter synthesis. Analysis of cerebrospinal fluid in fibromyalgia syndrome (FMS) has shown a reduction in the concentration of biogenic amine metabolites, including dopamine, norepinephrine and serotonin. This study aimed to investigate the association of ferritin with FMS.

SUBJECTS/METHODS: A total of 46 patients with primary FMS participated in this case-control study, and 46 healthy females who were age matched to the patients were used as the control group. Venous blood samples collected from all subjects were used to evaluate serum ferritin, vitamin B12 and folic acid levels.

RESULTS: The mean serum ferritin levels in the fibromyalgia (FM) and control groups were 27.3+/-20.9 and 43.8+/-30.8 ng/ml, respectively, and the difference was statistically significant (P=0.003). Binary multiple logistic regression analysis with age, body mass index, smoking status and vitamin B12, as well as folic acid and ferritin levels showed that having a serum ferritin level <50 ng/ml caused a 6.5-fold increased risk for FMS.

CONCLUSIONS: Our study implicates a possible association between FM and decreased ferritin level, even for ferritin in normal ranges. We suggest that iron as a cofactor in serotonin and dopamine production may have a role in the etiology of FMS.

64 3 308-12 Mar 2010 NO DATA
NO DATA article Association Between Sleep and Blood Pressure in Midlife NO DATA NO DATA Knutson et al NO DATA Reduced sleep duration and quality are associated with elevated blood pressure, according to researchers with the CARDIA study. They used wrist activity monitors to monitor associations between sleep behaviors and BP among more than 500 adults in their 30s and 40s, finding that shorter sleep duration and poorer sleep maintenance were each associated with increased systolic and diastolic BP. The authors say the sleep-BP link is supported by previous research and “laboratory evidence of increased sympathetic nervous activity as a likely mechanism underlying the increase in BP after sleep loss.”

BACKGROUND: Epidemiological studies have reported an association between self-reported short sleep duration and high blood pressure (BP). Our objective was to examine both cross-sectional and longitudinal associations between objectively measured sleep and BP.

METHODS: This study is ancillary to the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study. Blood pressure was measured in 2000 and 2001 and in 2005 and 2006. Sleep was measured twice using wrist actigraphy for 3 consecutive days between 2003 and 2005. Sleep duration and sleep maintenance (a component of sleep quality) were calculated. Analyses included 578 African Americans and whites aged 33 to 45 years at baseline. Outcome measures were systolic BP (SBP) and diastolic BP (DBP) levels, 5-year change in BP, and incident hypertension.

RESULTS: After we excluded the patients who were taking antihypertensive medications and adjusted for age, race, and sex, shorter sleep duration and lower sleep maintenance predicted significantly higher SBP and DBP levels cross-sectionally as well as more adverse changes in SBP and DBP levels over 5 years (all P < .05). Short sleep duration also predicted significantly increased odds of incident hypertension (odds ratio, 1.37; 95% confidence interval, 1.05-1.78). Adjustment for 16 additional covariates, including snoring and daytime sleepiness, slightly attenuated the associations between sleep and BP. Sleep duration appeared to mediate the difference between African Americans and whites in DBP change over time (P = .02).

CONCLUSION: Reduced sleep duration and consolidation predicted higher BP levels and adverse changes in BP, suggesting the need for studies to investigate whether interventions to optimize sleep may reduce BP.

169 11 1055-1061 NO DATA 2009 NO DATA
3 article Association of Biopsychosocial Factors With Degree of Slump in Sitting Posture and Self-Report of Back Pain in Adolescents back+psb NO DATA O'Sullivan et al PubMed #21350031. Does the way we sit affect back pain? Teens slouch a lot, and they do get back pain (though much less than adults). If posture is an important factor in back pain, it shouldn’t be too hard to find a connection, but this big study did not. Researchers looked for a correlation between sitting posture and back pain and the results were (predictable) rather unexciting. “This study demonstrated that a greater degree of slump in sitting was only weakly associated with adolescent back pain made worse by sitting after adjustment for other physical and psychosocial factors.” Hardly a smoking gun there…

BACKGROUND: Conflicting evidence exists regarding relationships among sitting posture, factors that influence sitting posture, and back pain. This conflicting evidence may partially be due to the presence of multiple and overlapping factors associated with both sitting posture and back pain.

OBJECTIVE: The purpose of this study was to determine whether the degree of slump in sitting was associated with sex and other physical, lifestyle, or psychosocial factors. Additionally, the relationship between the report of back pain made worse by sitting and the degree of slump in sitting and other physical, lifestyle, or psychosocial factors was investigated.

DESIGN: This was a cross-sectional study.

METHODS: Adolescents (n=1,596) completed questionnaires to determine lifestyle and psychosocial profiles and the experience of back pain. Sagittal sitting posture, body mass index (BMI), and back muscle endurance (BME) were recorded. Standing posture subgroup categorization was determined.

RESULTS: Multivariate analysis revealed that the most significant factor associated with the degree of slump in sitting was male sex, followed by non-neutral standing postures, lower perceived self-efficacy, lower BME, greater television use, and higher BMI. Multivariable analysis indicated poorer Child Behaviour Checklist scores were the strongest correlate of report of back pain made worse by sitting, whereas degree of slump in sitting, female sex, and BME were more weakly related.

LIMITATIONS: Causality cannot be determined from this cross-sectional study, and 60% of sitting posture variation was not explained by the measured variables.

CONCLUSIONS: Slump in sitting was associated with physical correlates, as well as sex, lifestyle, and psychosocial factors, highlighting the complex, multidimensional nature of usual sitting posture in adolescents. Additionally, this study demonstrated that a greater degree of slump in sitting was only weakly associated with adolescent back pain made worse by sitting after adjustment for other physical and psychosocial factors.

NO DATA NO DATA NO DATA Feb 2011 NO DATA
4 article The association of physical deconditioning and chronic low back pain back+exercise NO DATA Smeets et al PubMed #16809211. This 2006 review of scientific literature is painfully vague about the importance of low back muscle condition in chronic low back pain. Although there is certainly some evidence that suggests that core stability training is good for back pain (see O'Sullivan for instance), it’s nowhere near as strong as it should be, considering how popular the concept has been for the last fifteen years. Consider that the authors found that “no study examined the effectiveness of cardiovascular training specifically” — an incredible and frustrating gap. They also conclude that “general and lumbar muscle strengthening are equally effective as other active treatments,” meaning (I think) that researchers have not yet been able to show whether or not strength training and core stability training is any more worthwhile than any kind of activity — which does not exactly encourage me to tell my clients to try to strengthen their backs, especially when I know full well that some of them may have adverse reactions caused by irritation of their trigger points. They point out that there is “only moderate evidence” that intense strength training in the lumber muscles is more useful than moderate training, another strange gap. And the authors believe that it is “more promising” to study “the interplay between biological, social and psychological factors.” Not exactly a resounding endorsement of going to the gym for your low back pain!

PURPOSE: Does physical deconditioning (loss of cardiovascular capacity and strength/endurance of paraspinal muscles) exist in patients with chronic low back pain (CLBP) and are treatments specifically aimed to reduce these signs effective?

METHOD: Systematic literature search in PUBMED, MEDLINE, EMBASE and PsycINFO until December 2004 to identify observational studies regarding deconditioning signs and high quality RCTs regarding the effectiveness of cardiovascular and/or muscle strengthening exercises. Internal validity of the RCTs was assessed by using a checklist of nine methodology criteria in accordance with the Cochrane Collaboration.

RESULTS: There is conflicting evidence that cardiovascular deconditioning is present in CLBP and limited evidence for wasting of the multifidus muscle. No study examined the effectiveness of cardiovascular training specifically. General and lumbar muscle strengthening are equally effective as other active treatments. Only moderate evidence is available for the effectiveness of intensive low back extensor muscle strengthening compared to less intensive strengthening.

CONCLUSION: Probably reactivation caused by active treatment and not the reconditioning itself is the important factor in the reduction of disability. Further prospective and evaluative research into the role of physical deconditioning is necessary. It seems more promising to further explore the interplay between biological, social and psychological factors.

28 11 673–693 Jun 2006 NO DATA
2 article A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy tx+tendinosis NO DATA Plas et al 1 This follow-up study showed that patients were doing pretty well five years after a program of eccentric training (heel drop) exercises for Achilles tendinitis. However, the results are of questionable value due to the fact that many patients had received other treatments in the interim. What we really need to know is not how well these patients did, but how well they did compared to patients who did no heel drop exercises.

BACKGROUND: Eccentric exercises have the most evidence in conservative treatment of midportion Achilles tendinopathy. Although short-term studies show significant improvement, little is known of the long-term >3 years) results.

AIM: To evaluate the 5-year outcome of patients with chronic midportion Achilles tendinopathy treated with the classical Alfredson's heel-drop exercise programme.

STUDY DESIGN: Part of a 5-year follow-up of a previously conducted randomised controlled trial. Methods 58 patients (70 tendons) were approached 5 years after the start of the heel-drop exercise programme according to Alfredson. At baseline and at 5-year follow-up, the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire score, pain status, alternative treatments received and ultrasonographic neovascularisation score were recorded.

RESULTS: In 46 patients (58 tendons), the VISA-A score significantly increased from 49.2 at baseline to 83.6 after 5 years (p<0.001) and from the 1-year to 5-year follow-up from 75.0 to 83.4 (p<0.01). 39.7% of the patients were completely pain-free at follow-up and 48.3% had received one or more alternative treatments. The sagittal tendon thickness decreased from 8.05 mm (SD 2.1) at baseline to 7.50 mm (SD 1.6) at the 5-year follow-up (p=0.051).

CONCLUSION: At 5-year follow-up, a significant increase of VISA-A score can be expected. After the 3-month Alfredson's heel-drop exercise programme, almost half of the patients had received other therapies. Although improvement of symptoms can be expected at long term, mild pain may remain.

46 3 214-8 Mar 2012 NO DATA
5 book Atlas of Human Anatomy biolit NO DATA Netter The best of the anatomy texts, I believe: Frank’s anatomical paintings are a miraculous life’s work. He knew what to include and emphasize, what to leave out. It’s an accomplishment that may never be matched. NO DATA NO DATA NO DATA NO DATA NO DATA 1997 Novartis
NO DATA article Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients chiro NO DATA Bakris et al NO DATA

Anatomical abnormalities of the cervical spine at the level of the Atlas vertebra are associated with relative ischaemia of the brainstem circulation and increased blood pressure (BP). Manual correction of this mal-alignment has been associated with reduced arterial pressure. This pilot study tests the hypothesis that correcting mal-alignment of the Atlas vertebra reduces and maintains a lower BP. Using a double blind, placebo-controlled design at a single center, 50 drug naive (n=26) or washed out (n=24) patients with Stage 1 hypertension were randomized to receive a National Upper Cervical Chiropractic (NUCCA) procedure or a sham procedure. Patients received no antihypertensive meds during the 8-week study duration. The primary end point was changed in systolic and diastolic BP comparing baseline and week 8, with a 90% power to detect an 8/5 mm Hg difference at week 8 over the placebo group. The study cohort had a mean age 52.7+/-9.6 years, consisted of 70% males. At week 8, there were differences in systolic BP (-17+/-9 mm Hg, NUCCA versus -3+/-11 mm Hg, placebo; P<0.0001) and diastolic BP (-10+/-11 mm Hg, NUCCA versus -2+/-7 mm Hg; P=0.002). Lateral displacement of Atlas vertebra (1.0, baseline versus 0.04 degrees week 8, NUCCA versus 0.6, baseline versus 0.5 degrees , placebo; P=0.002). Heart rate was not reduced in the NUCCA group (-0.3 beats per minute, NUCCA, versus 0.5 beats per minute, placebo). No adverse effects were recorded. We conclude that restoration of Atlas alignment is associated with marked and sustained reductions in BP similar to the use of two-drug combination therapy.

21 NO DATA 347–352 NO DATA 2007 NO DATA
4 article The attitudes, beliefs and behaviours of GPs regarding exercise for chronic knee pain knee NO DATA Cottrell et al 1 Older adults often suffer from chronic pain and limitation of function, specifically in the knee. Exercise is often recommended as a first line of treatment, yet researchers of this study believed that healthcare practitioners often did not know about (or believe in) the benefits of exercise. Researchers wanted to see if they could determine what the attitudes and beliefs of the GPs were regarding the use of exercvise for chronic knee pain. Four databases were searched. Studies referring to pfps or chronic knee pain secondary to other causes were excluded. From 2135 potentially relevant articles, 20 we chosen as suitable for inclusion. Although 99% of GPs agreed that exercise should be used to treat chronic knee pain, up to 29% believed that rest was the best management approach. It was found that GPs rarely recommended exercise or physiotherapy. The researchers concluded that the attitudes and beliefs of GPs is widely variable. Further investigation, the report says, is needed to determine the roles of GPs in using exercise to manage chronic knee pain.

BACKGROUND: Joint pain, specifically chronic knee pain (CKP), is a frequent cause of chronic pain and limitation of function and mobility among older adults. Multiple evidence-based guidelines recommend exercise as a first-line treatment for all patients with CKP or knee osteoarthritis (KOA), yet healthcare practitioners' attitudes and beliefs may limit their implementation. This systematic review aims to identify the attitudes, beliefs and behaviours of General Practitioners (GPs) regarding the use of exercise for CKP/KOA.

METHODS: We searched four electronic databases between inception and January 2008, using subject headings to identify studies examining the attitudes, beliefs or behaviours of GPs regarding the use of exercise for the treatment of CKP/KOA in adults aged over 45 years in primary care. Studies referring to patellofemoral pain syndrome or CKP secondary to other causes or that occurring in a prosthetic joint were excluded. Once inclusion and exclusion criteria were applied, study data were extracted and summarised. Study quality was independently reviewed using two assessment tools.

RESULTS: From 2135 potentially relevant articles, 20 were suitable for inclusion. A variety of study methodologies and approaches to measuring attitudes beliefs and behaviours were used among the studies. Quality assessment revealed good reporting of study objective, type, outcome factors and, generally, the sampling frame. However, criticisms included use of small sample sizes, low response rates and under-reporting of non-responder factors. Although 99% of GPs agreed that exercise should be used for CKP/KOA and reported ever providing advice or referring to a physiotherapist, up to 29% believed that rest was the optimum management approach. The frequency of actual provision of exercise advice or physiotherapy referral was lower. Estimates of provision of exercise advice and physiotherapy referral were generally higher for vignette-based studies (exercise advice 9%-89%; physiotherapy referral 44%-77%) than reviews of actual practice (exercise advice 5%-52%; physiotherapy referral 13-63%). Advice to exercise and exercise prescription were not clearly differentiated.

CONCLUSIONS: Attitudes and beliefs of GPs towards exercise for CKP/KOA vary widely and exercise appears to be underused in the management of CKP/KOA. Limitations of the evidence base include the paucity of studies directly examining attitudes of GPs, poor methodological quality, limited generalisability of results and ambiguity concerning GPs' expected roles. Further investigation is required of the roles of GPs in using exercise as first-line management of CKP/KOA.

11 NO DATA 4 NO DATA 2010 NO DATA
NO DATA article Atypical chronic head and neck pain NO DATA NO DATA Casale et al PubMed #18575165. NO DATA

We report a case of an adult woman with an Eagle's Syndrome (ES) treated with medical therapy. ES is characterized by an aspecific orofacial pain secondary to calcification of the stylohyoid ligament or elongated styoid process. In about 4% of general population an elongated styloid process occurs, while only about 4% of these patients are symptomatic. We report a case of a 49-year-old lady with a 1-year history of oro-pharyngeal foreign body sensation localized at the left tonsillar fossa, associated with a dull intermittent pain. A bony projection was palpable with bimanual transoral exploration. A lateral radiograph and a computed tomography scan of head and neck showed an elongated styloid process of 57 mm on the left side and 48 mm on the right one. The patient refused surgical treatment as first choice. She underwent a non-steroidal anti-inflammatory local treatment, with progressive disappearance of symptoms. After 6 months she had no recurrence of symptoms. In conclusion, a precise differential diagnosis is crucial in order to choose the most adequate treatment, which can be either surgical or non surgical. Medical treatment represents the first choice, followed by surgical styloid process resection, in the case of persistence or ingravescence of the complaint.

12 2 131-3 NO DATA 2008 NO DATA
NO DATA article Atypical presentation of plantar fasciitis secondary to soft-tissue mass infiltration pf+run+foot NO DATA Ng et al PubMed #11266484. NO DATA

This article describes a patient with plantar fascial pain who presented to the office of one of the authors. Physical examination and the patient’s description of the history of symptoms revealed classic signs and symptoms of plantar fasciitis. The patient was treated with numerous conservative modalities, including ultrasound, nonsteroidal anti-inflammatory medications, trigger-point injections, over-the-counter orthoses, and stretching exercises. When the pain was not relieved by these conservative measures, magnetic resonance imaging of the area was performed. Visualization of the insertional area of the plantar fascia revealed a mass inferior to, as well as infiltrated into, the plantar fascia. Surgical excision of the lesion resulted in complete elimination of the patient’s pain.

91 2 89–92 Feb 2001 NO DATA
3 article Augmented soft tissue mobilization vs natural history in the treatment of lateral epicondylitis mx+tools NO DATA Blanchette et al PubMed #21334545. A small clinical trial comparing treatment of tennis elbow with augmented soft tissue mobilization (tool massage) to “advice on the natural evolution of lateral epicondylitis, computer ergonomics, and stretching exercise.” Both helped a bit, and tools were no better.

OBJECTIVE: The purpose of this study was to evaluate the effect of augmented soft tissue mobilization (ASTM) on the treatment of lateral epicondylitis.

METHODS: This randomized clinical study assessed 27 subjects (12 men and 15 women) with lateral epicondylitis and were divided randomly into 2 groups. The experimental group (n = 15) received ASTM twice a week for 5 weeks. The subjects of the control group (n = 12) received advice on the natural evolution of lateral epicondylitis, computer ergonomics, and stretching exercises. Patient-rated outcome was assessed at baseline and after 6 weeks and 3 months using a visual analog scale and the Patient-Rated Tennis Elbow Evaluation. The function was assessed using the pain-free grip strength at baseline and after 6 weeks.

RESULTS: Both groups showed improvements in pain-free grip strength, visual analog scale, and Patient-Rated Tennis Elbow Evaluation. Sample size for larger future randomized clinical trial was 116 participants.

CONCLUSION: A larger study investigating the same hypothesis is warranted to detect difference in the effects of these treatments strategies. The study design is feasible, and minor improvements will help to minimize the potential bias.

34 2 123-30 Feb 2011 NO DATA
NO DATA article Autistic children’s attentiveness and responsivity improved after touch therapy mx+ot NO DATA Field et al PubMed #9229263. NO DATA NO DATA 27 NO DATA 329–334 NO DATA 1986 NO DATA
3 article Back pain study failed to disclose COI tx+etio+fun+back NO DATA Wood NO DATA An allegation of a serious conflict of interest that may explain strangely good results in a study of antibiotic therapy for back pain (Albert et al). NO DATA NO DATA NO DATA NO DATA May 31 2013 NO DATA
NO DATA article Back surgery--who needs it? back+surgery+nerve NO DATA Deyo NO DATA NO DATA 356 NO DATA 2239–2243 NO DATA 2007 NO DATA
3 article Backward Walking back+tx+self-tx+exercise+fun NO DATA Janet et al NO DATA Backward walking, eh? Huh. Didn’t see that one coming. “Results suggest that backward walking may reduce LBP and enhance function for athletes. Further investigation is warranted.” Of course, this study also takes “small sample size” about as far as it can go.

Specific pathologies that associate with low back pain (LBP) challenge athletic trainers and other healthcare professionals with techniques to treat stricken athletes. The primary purpose of this study was to investigate the effectiveness of a backward walking exercise program in alleviating LBP and enhancing function in athletes. A secondary purpose was to identify which aspects of backward walking performance may be beneficial to the alleviation of LBP. Subjects, who included NCAA Division I athletes experiencing LBP (n = 5) and healthy, active individuals not experiencing LBP (n = 5), performed a pre-test, 3-week intervention of backward walking, and post-test. Low back range of motion, stride parameters, shock attenuation and pain scores were measured and/or recorded during each test session. Group results for 2 (group) x 2 (time) ANOVAs identified significant (p < 0.05) differences between groups and time for all stride parameters. The LBP group exhibited significantly greater sagittal plane low back motion and lesser coronal plane motion versus the healthy group. Single subject analyses identified unique participant responses with most reducing shock attenuation (17.2 ± 5.9%), and increasing sagittal (3.9 ± 1.6 deg) and coronal (5.0 ± 4.2 deg) plane range of motion following the intervention while one participant elicted responses that were opposite. Results suggest that backward walking may reduce LBP and enhance function for athletes. Further investigation is warranted.

1 14 17-26 NO DATA 2011 NO DATA
NO DATA book Bad pharma NO DATA NO DATA Goldacre British science journalist Ben Goldacre is fascinating and awesome. Read this book, or at least watch this TED talk about it. [munches popcorn] NO DATA NO DATA NO DATA NO DATA NO DATA 2013 NO DATA
NO DATA book Bad Science sbm+quack NO DATA Goldacre NO DATA NO DATA NO DATA NO DATA NO DATA NO DATA 2008 Fourth Estate
NO DATA article The barefoot debate NO DATA NO DATA Rixe et al PubMed #22580495. A summary of the state of barefoot-minimalist running science, much shorter than Lieberman’s early 2012 summary, with the same conclusion: on the one hand, “A growing body of biomechanics research has emerged to support the advantages of ‘barefoot’ running,” but unfortunately, “No clinical studies have been published to substantiate the claims of injury reduction using a ‘minimalist’ style.”

Running has evolved throughout history from a necessary form of locomotion to an athletic and recreational pursuit. During this transition, our barefoot ancestors developed footwear. By the late 1970s, running popularity surged, and footwear manufacturers developed the running shoe. Despite new shoe technology and expert advice, runners still face high injury rates, which have yet to decline. Recently, "minimalist" running, marked by a soft forefoot strike and shorter, quicker strides, has become increasingly popular within the running community. Biomechanical studies have suggested that these features of barefoot-style running may lead to a reduction in injury rates. After conducting more outcomes-based research, minimalist footwear and gait retraining may serve as new methods to reduce injuries within the running population.

11 3 160-5 May 2012 NO DATA
3 article Barefoot running run+rsi+exercise+psb NO DATA Tam et al PubMed #24108403. NO DATA

Barefoot running has become a popular research topic, driven by the increasing prescription of barefoot running as a means of reducing injury risk. Proponents of barefoot running cite evolutionary theories that long-distance running ability was crucial for human survival, and proof of the benefits of natural running. Subsequently, runners have been advised to run barefoot as a treatment mode for injuries, strength and conditioning. The body of literature examining the mechanical, structural, clinical and performance implications of barefoot running is still in its infancy. Recent research has found significant differences associated with barefoot running relative to shod running, and these differences have been associated with factors that are thought to contribute to injury and performance. Crucially, long-term prospective studies have yet to be conducted and the link between barefoot running and injury or performance remains tenuous and speculative. The injury prevention potential of barefoot running is further complicated by the complexity of injury aetiology, with no single factor having been identified as causative for the most common running injuries. The aim of the present review was to critically evaluate the theory and evidence for barefoot running, drawing on both collected evidence as well as literature that have been used to argue in favour of barefoot running. We describe the factors driving the prescription of barefoot running, examine which of these factors may have merit, what the collected evidence suggests about the suitability of barefoot running for its purported uses and describe the necessary future research to confirm or refute the barefoot running hypotheses.

48 5 349-55 Mar 2014 NO DATA
3 article Basic science and clinical studies coincide strain NO DATA Kannus et al PubMed #12753486. NO DATA

The basic response to injury at the tissue level is well known and consists of acute inflammatory phase, proliferative phase, and maturation and remodeling phase. Knowing these phases, the treatment and rehabilitation program of athletes' acute musculoskeletal injuries should use a short period of immobilization followed by controlled and progressive mobilization. Both experimental and clinical trials have given systematic and convincing evidence that this program is superior to immobilization - a good example where basic science and clinical studies do coincide - and therefore active approach is needed in the treatment of these injuries.

13 3 150-4 Jun 2003 NO DATA
3 article Before/after study to determine the effectiveness of the align-right cylindrical cervical pillow in reducing chronic neck pain severity neck+head+tx NO DATA Hagino et al PubMed #9502063. From the abstract: “The results suggest that the ARCP has clinically important beneficial effects on the neck pain severity of most chronic neck-pain sufferers.”

OBJECTIVE: To determine the effectiveness (at the 0.1 level of statistical significance) of the Align-Right (roll-shaped) cervical pillow (ARCP) on neck pain severity and headache/neck pain medication use in chronic neck pain subjects.

DESIGN: The design was a "before/after" (i.e., a "pre/post" trial).

SUBJECTS: Twenty-eight subjects, 25-45 yr of age with cervical spine pain of biomechanical origin of> 2 on an 11-point ordinal pain scale.

OUTCOME MEASURES: The primary outcome measure was severity of morning and evening neck pain. The secondary outcome measure was daily quantity of analgesics ingested. The data were analyzed descriptively and inferentially for clinically and statistically significant pre/post intervention differences.

METHODS: Eligible subjects who successfully finished a 2-wk baseline data-gathering period by mailing in two properly completed diaries each received a pillow and four more diaries (to be filled in over the subsequent 4 wk). Three repeated-measures analyses of variance were performed using the Bonferroni-corrected level of statistical significance of 0.03. Ninety-five percent confidence intervals (for paired-samples mean differences) were also calculated for those pre/post differences that seemed descriptively clinically important.

RESULTS: The clinically and statistically significant reductions in neck/shoulder pain severity in this sample of chronic neck pain subjects suggest that the ARCP is an effective therapy for target populations with the same profile as this sample. Patient characteristics predicting suitability were not studied in this project.

CONCLUSION: The results suggest that the ARCP has clinically important beneficial effects on the neck pain severity of most chronic neck-pain sufferers. Further randomized clinical trial research comparing the ARCP with other commonly used cervical pillows is recommended.

21 2 89–93 Feb 1998 NO DATA
4 article Behavioural treatment for chronic low-back pain tx+back+mind NO DATA Henschke et al PubMed #20614428. This review of the results of dozens of scientific studies shows that behavioural therapies for low back pain have generally been failing the “impress me” test. It is possible that behavioural therapy is more effective for a certain kind of patient. However, if so, apparently there are not enough of those kinds of patients, or the effect is not big enough, to have any discernible effect on the average results of experiments. If evidence of a benefit is being “washed out,” it is being washed out rather easily. Behavioural therapy might work, a little, for some, but scraps of efficacy hardly seem worth fighting over. See Neil O’Connell’s erudite analysis.

Background: Behavioural treatment is commonly used in the management of chronic low-back pain (CLBP) to reduce disability through modification of maladaptive pain behaviours and cognitive processes. Three behavioural approaches are generally distinguished: operant, cognitive, and respondent; but are often combined as a treatment package.

Objectives: To determine the effects of behavioural therapy for CLBP and the most effective behavioural approach.

Search strategy: The Cochrane Back Review Group Trials Register, CENTRAL, MEDLINE, EMBASE, and PsycINFO were searched up to February 2009. Reference lists and citations of identified trials and relevant systematic reviews were screened.

Selection criteria: Randomised trials on behavioural treatments for non-specific CLBP were included.

Data collection and analysis: Two review authors independently assessed the risk of bias in each study and extracted the data. If sufficient homogeneity existed among studies in the pre-defined comparisons, a meta-analysis was performed. We determined the quality of the evidence for each comparison with the GRADE approach.

Main results: We included 30 randomised trials (3438 participants) in this review, up 11 from the previous version. Fourteen trials (47%) had low risk of bias. For most comparisons, there was only low or very low quality evidence to support the results. There was moderate quality evidence that: i) operant therapy was more effective than waiting list (SMD -0.43; 95%CI -0.75 to -0.11) for short-term pain relief; ii) little or no difference exists between operant, cognitive, or combined behavioural therapy for short- to intermediate-term pain relief; iii) behavioural treatment was more effective than usual care for short-term pain relief (MD -5.18; 95%CI -9.79 to -0.57), but there were no differences in the intermediate- to long-term, or on functional status; iv) there was little or no difference between behavioural treatment and group exercise for pain relief or depressive symptoms over the intermediate- to long-term; v) adding behavioural therapy to inpatient rehabilitation was no more effective than inpatient rehabilitation alone.

Conclusions: For patients with CLBP, there is moderate quality evidence that in the short-term, operant therapy is more effective than waiting list and behavioural therapy is more effective than usual care for pain relief, but no specific type of behavioural therapy is more effective than another. In the intermediate- to long-term, there is little or no difference between behavioural therapy and group exercises for pain or depressive symptoms. Further research is likely to have an important impact on our confidence in the estimates of effect and may change the estimates.

NO DATA 7 CD002014 NO DATA 2010 NO DATA
4 article Bio-psychosocial determinants of persistent pain 6 months after non-life-threatening acute orthopaedic trauma pain NO DATA Clay et al PubMed #20439055. How often does injury lead to chronic pain? Why do some injured people develop chronic pain and others do not? Researchers kept tabs on 168 patients who suffered non-life-threatening orthopaedic injuries. 54% reported persistent pain six months after the injury and 87% reported that this pain interfered with their normal work activities. Long-term pain was more likely to the extent that pain was acute at the beginning (independently of injury severity), if patients felt responsible for the injury, and if they were pessimistic or emotionally traumatized. “Psychosocial factors strongly predicted persistent pain, pain-related work disability, and pain severity,” the researchers concluded, and noted that “many of these factors are potentially modifiable and should alert the clinician about the need for interventions in order to prevent the development of pain chronicity.”

The study quantifies the association between a range of bio-psychosocial factors and the presence of persistent pain, pain severity and pain interfering with normal work activities in a cohort of 168 patients with a range of non-life-threatening orthopaedic injuries. Participants were recruited following presentation to 1 of 4 Victoria hospitals for treatment for their injury and followed until 6 months postinjury.

Multivariate analysis was employed to determine factors associated with pain outcomes, 6 months postinjury. The prevalence of pain was common; 54% of participants reported the presence of persistent pain at 6 months, with the majority (87%) reporting that pain interfered to an extent with their normal work activities. High initial pain, external attributions of responsibility for the injury, and psychological distress were found to be significant independent predictors of the presence of all 3 outcomes. In addition, poor recovery expectations was found to be a significant predictor of pain-related work disability and being injured at work a significant predictor of pain severity. Many of these factors are potentially modifiable and should alert the clinician about the need for interventions in order to prevent the development of pain chronicity.

PERSPECTIVE: This study has quantified determinants of pain, 6 months after non-life-threatening acute orthopaedic trauma. Psychosocial factors strongly predicted persistent pain, pain-related work disability, and pain severity. These findings may assist clinicians to determine the need for, and likely effectiveness of, individual pain-management approaches in this population.

11 5 420-30 May 2010 NO DATA
5 article Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points pain+back+neck+tps NO DATA Shah et al PubMed #18164325. This important paper demonstrates that the biochemical milieu of trigger points is acidic and contains a lot of pain-causing metabolites: good evidence in support of the energy crisis theory of trigger point formation and/or perpetuation. It’s an improvement on an earlier paper from 2005 (Shah), with improved methods. It is cogently summarized by Simons, and in my short article Toxic Muscle Knots.

OBJECTIVES: To investigate the biochemical milieu of the upper trapezius muscle in subjects with active, latent, or absent myofascial trigger points (MTPs) and to contrast this with that of the noninvolved gastrocnemius muscle.

DESIGN: We used a microanalytic technique, including needle insertions at standardized locations in subjects identified as active (having neck pain and MTP), latent (no neck pain but with MTP), or normal (no neck pain, no MTP). We followed a predetermined sampling schedule; first in the trapezius muscle and then in normal gastrocnemius muscle, to measure pH, bradykinin, substance P, calcitonin gene-related peptide, tumor necrosis factor alpha, interleukin 1beta (IL-1beta), IL-6, IL-8, serotonin, and norepinephrine, using immunocapillary electrophoresis and capillary electrochromatography. Pressure algometry was obtained. We compared analyte concentrations among groups with 2-way repeated-measures analysis of variance.

SETTING: A biomedical research facility.

PARTICIPANTS: Nine healthy volunteer subjects.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Preselected analyte concentrations.

RESULTS: Within the trapezius muscle, concentrations for all analytes were higher in active subjects than in latent or normal subjects (P<.002); pH was lower (P<.03). At needle insertion, analyte concentrations in the trapezius for the active group were always higher (pH not different) than concentrations in the gastrocnemius muscle. At all times within the gastrocnemius, the active group had higher concentrations of all analytes than did subjects in the latent and normal groups (P<.05); pH was lower (P<.01).

CONCLUSIONS: We have shown the feasibility of continuous, in vivo recovery of small molecules from soft tissue without harmful effects. Subjects with active MTPs in the trapezius muscle have a biochemical milieu of selected inflammatory mediators, neuropeptides, cytokines, and catecholamines different from subjects with latent or absent MTPs in their trapezius. These concentrations also differ quantitatively from a remote, uninvolved site in the gastrocnemius muscle. The milieu of the gastrocnemius in subjects with active MTPs in the trapezius differs from subjects without active MTPs.

89 1 16–23 NO DATA 2008 NO DATA
4 article A randomized controlled trial for the effect of passive stretching on measures of hamstring extensibility, passive stiffness, strength, and stretch tolerance tx+self-tx+stretch+psb+etio+back NO DATA Marshall et al PubMed #21636321. A nicely done experiment showing that regular hamstring stretching substantially increased range of motion in normal university kids. Specifically, after “a 4-week stretching program consisting of 4 hamstring and hip stretches performed 5 times per week,” their range increased about 16˚ or 20%. That is, when stretched with the same force (torque) applied, to the same level of discomfort, they could go 20% farther. The take-home message is that stretching can definitely increase range of motion — for whatever that’s worth. The authors followed this data into an overinterpretation about how range increased, perhaps trying to score points for Team Plasticity — that is, for the idea that the body adapts physically to stretch, rather than neurologically. Because range increased, but pain at the end of the range did not, they unwisely concluded that, although they “cannot completely rule out volitional stretch tolerance as a possible explanation for changes in extensibility, it does seem that hamstring pain elicited during a passive stretch has little involvement in explaining training related improvements.” But an increase in range with no change in pain does constitute an increase in tolerance! Although it wasn’t measured, it’s safe to assume the subjects’ pain would have been less if stretched only to the end of their original range. But the study is actually agnostic about mechanism. The authors place their bet on tissue plasticity, while I put mine on tolerance, but this experiment cannot actually settle the bet — it demonstrated only greater range and reduced stiff, and not whether it was due to neural or structural adaptations.

To measure hamstring extensibility, stiffness, stretch tolerance, and strength following a 4-week passive stretching program. Randomized controlled trial. Twenty-two healthy participants were randomly assigned to either a 4-week stretching program consisting of 4 hamstring and hip stretches performed 5 times per week, or a non-stretching control group. Hamstring extensibility and stiffness were measured before and after training using the instrumented straight leg raise test (iSLR). Stretch tolerance was measured as the pain intensity (visual analog scale; VAS) elicited during the maximal stretch. Hamstring strength was measured using isokinetic dynamometry at 30 and 120° s(-1). Hamstring extensibility increased by 20.9% in the intervention group following 4 weeks of training (p<0.001; d=0.86). Passive stiffness was reduced by 31% in the intervention group (p<0.05; d=-0.89). Stretch tolerance VAS scores were not different between groups at either time point, and no changes were observed following training. There were no changes in hamstring concentric strength measured at 30 and 120° s(-1). Passive stretching increases hamstring extensibility and decreases passive stiffness, with no change in stretch tolerance defined by pain intensity during the stretch. Compared to previous research, the volume of stretching was higher in this study. The volume of prescribed stretching is important for eliciting the strong clinical effect observed in this study.

14 6 535-40 Nov 2011 NO DATA
3 article Belief reinforcement mind+psb+back NO DATA Zusman 1 Why is back pain still a huge problem? Maybe this: “It is extremely difficult to alter the potentially disabling belief among the lay public that low back pain has a structural mechanical cause. An important reason for this is that this belief continues to be regularly reinforced by the conditions of care of a range of ‘hands-on’ providers, for whom idiosyncratic variations of that view are fundamental to their professional existence.” Well said. If only I could edit it, though, I would say that it is difficult to alter that belief in anyone, patient or professional. The belief isn’t just reinforced by the practices of manual therapists, it’s the reason for them.

Recent figures show that there has been no change in the upward trend of direct and indirect costs for the largely benign symptom of low back pain in Western societies. This is despite greater understanding and the recommendation of a much more conservative and independent approach to its management. Moreover, in recent years, several large-scale education programs that aim to bring knowledge of the public (including general practitioners) more in line with evidence-based best practice were carried out in different countries. The hope was that the information imparted would change beliefs, ie, dysfunctional patient behavior and biomedical practice on the part of clinicians. However, these programs had no influence on behavior or costs in three out of the four countries in which they were implemented. It is argued that one reason for the overall lack of success is that it is extremely difficult to alter the potentially disabling belief among the lay public that low back pain has a structural mechanical cause. An important reason for this is that this belief continues to be regularly reinforced by the conditions of care of a range of "hands-on" providers, for whom idiosyncratic variations of that view are fundamental to their professional existence.

6 NO DATA 197-204 NO DATA 2013 NO DATA
4 article A systematic review of the passive straight leg raising test as a diagnostic aid for low back pain (1989 to 2000) tx+self-tx+stretch+psb+etio+back NO DATA Rebain et al PubMed #12221373. NO DATA

STUDY DESIGN: A systematic review.

OBJECTIVES: This systematic review sought papers (January 1989-January 2000) on the passive straight leg raising test (PSLR) as a diagnostic component for low back pain (LBP) to identify, summarize, and assess developments in the test procedure, the factors influencing PSLR outcome, and the clinical significance of that outcome.

SUMMARY OF BACKGROUND DATA: Previous studies suggested that the PSLR tractioned the sciatic nerve and that diminished leg elevation with reproduced pain indicated low lumbar intervertebral disc pathology.

METHODS: Searches on six computerized bibliographic databases identified publications written about the PSLR. Papers were excluded if they were published before January 1989, were non-English language papers, or employed either an active SLR or a PSLR for purposes other than LBP diagnosis. The references of qualifying papers (and the references of references) were searched. Contact with primary authors, and others known to be active in this field, was attempted.

RESULTS: The PSLR procedure remains unchanged. The influence of hip rotation during the PSLR was discussed without consensus. Biomechanical devices improved intra- and interobserver reliability and so increased test reproducibility. Hamstrings were found to have a defensive role in protecting nerve roots by limiting PSLR range in cases of nerve root inflammation. A small diurnal variation in the PSLR may imply a poorer prognosis. A positive PSLR at 4 months after lumbar intervertebral disc surgery predicted poor reoperative outcome, and a negative 4-month PSLR predicted excellent outcome. The influence of psychosocial factors was not discussed, neither was the diagnostic significance of a negative PSLR outcome.

CONCLUSIONS: There remains no standard PSLR procedure, no consensus on interpretation of results, and little recognition that a negative PSLR test outcome may be of greater diagnostic value than a positive one. The causal link between LBP pathology and hamstring action remains unclear. There is a need for research into the clinical use of the PSLR; its intra- and interobserver reliability; the influences of age, gender, diurnal variation, and psychosocial factors; and its predictive value in lumbar intervertebral disc surgery.

27 17 E388-95 Sep 2002 NO DATA
NO DATA article Behavioral and hypnotic treatments for insomnia subtypes NO DATA NO DATA Waters et al From the text: “There are good theoretical and empirical reasons to believe that SHE [sleep hygiene education] improves sleep.” In other words, reading this will put you to sleep!

This investigation compared progressive muscle relaxation plus cognitive distraction (PMR/CD), hypothesized to better improve sleep onset, versus sleep restriction and stimulus control (SR/SC), hypothesized to better improve sleep maintenance, versus a flurazepam (Dalmane) positive contrast condition (MED) and a sleep hygiene education minimal treatment control condition (SHE). Participants with chronic insomnia (N = 53), completed 2 baseline weeks of sleep diaries, and were randomly assigned to a treatment group for 2 more weeks. In the second phase, PMR/CD participants were assigned to 2 weeks of PMR/CD + SR/SC + SHE while SHE participants continued SHE. Results indicated that PMR/CD had greater effect upon sleep onset than SR/SC and SHE, SR/SC had greater effect on sleep maintenance than PMR/CD, and MED was better than the other treatments. In the second phase, the treatment package produced modest additional improvements and SHE performed superior to expectations.

1 2 81–101 NO DATA 2003 NO DATA
NO DATA article The biological effects of a pulsed electrostatic field with specific reference to hair mind+sbm+quack NO DATA Maddin et al PubMed #2397975. NO DATA

This comparative, controlled study demonstrates the positive biologic effect on hair regrowth of a pulsed electrical field administered according to a regularized treatment schedule over 36 weeks. Mean hair count comparisons within the groups significantly favor the treatment group, which exhibited a 66.1% hair count increase over baseline. The control group increase over baseline was 25.6%. It is notable also that 29 of the 30 treatment subjects (96.7%) exhibited regrowth or no further hair loss. The process is without side effects and untoward reactions. The rationale of this phenomenon is unclear but is considered to be due to an electrophysiologic effect on the quiescent hair follicle, similar to that documented with respect to bone fracture and soft tissue repair enhancement. The electrical pulse may cause increased cell mitosis through calcium influx, involving both the hair follicle sheath and dermal papilla cells.

29 6 446–50 Jul-Aug 1990 NO DATA
2 article Biomechanical approach to rehabilitation of lower extremity musculoskeletal injuries in runners itbs+psb+run+pfps+shin+exercise+knee NO DATA Ferber et al This research was completed in June 2007 and has never been published to the best of my knowledge. The authors claim that their work shows that hip strengthening will relieve the pain of ITBS. See “Does Hip Strengthening Work for IT Band Syndrome?” for a critical analysis of this conclusion conclusions and overzealous media reports about it (Edwards).

CONTEXT: Biomechanically, hip muscle strength and flexibility are necessary to control and facilitate proper distal limb motion while running. Only one study has investigated the effectiveness of rehabilitation of running injuries via hip muscle strengthening and only involved iliotibial band syndrome.

OBJECTIVE: To determine if increases in hip muscle strength and flexibility are associated with a significant reduction in pain associated with running injuries. It was hypothesized that patients would demonstrate a significant improvement in hip muscle strength and flexibility and a minimum 50% reduction in pain following a 4-6 week rehabilitation program.

DESIGN: Pre-test/post-test.

SETTING: Patients presenting to the Running Injury Clinic.

PATIENTS OR OTHER PARTICIPANTS: 284 consecutive patients presenting to the Clinic for various musculoskeletal running injuries (females: 183; males: 101; age: 37 years±8.3; weekly running mileage 35.7 km±9.4).

INTERVENTIONS: Patients were asked to report the average amount of pain they were experiencing while running using a 10cm visual analog scale (VAS). Hip internal and external rotator muscle flexibility was measured using a goniometer. The Thomas and Ober clinical tests were used to determine hip flexor and IT band flexibility. Hip muscle strength was measured using a standard 0-5 manual muscle scale. For statistical analysis, strength values were converted from a 0-5 scale to a percentage score assuming 5/5 equalled 100% and 3/5 equalled 50% of maximum isometric force. Minimum standards for each strength and flexibility measure were established through pilot work and literature. A rehabilitation program was prescribed to improve hip strength and/or flexibility where necessary. Paired t-tests (alpha=0.05) were used for statistical comparisons.

MAIN OUTCOME MEASURES: Pre-post comparisons of VAS and hip strength and flexibility measures following 4-6 weeks of rehabilitation.

RESULTS: Patellofemoral pain syndrome (n=54), iliotibial band syndrome (n=40), medial tibial stress syndrome (n=13), Achilles tendinopathy (n=10), and plantar fasciitis (n=10) accounted for the majority of injuries. 165 patients (58%) returned for follow-up assessment and reported a significant improvement in pain (VAS pre: 6.11cm±0.87 post: 0.89cm±1.22; P=0.01) and 89% reported at least a 50% improvement in pain. These patients also exhibited significant improvements in hip abductor (pre: 78.55%±11.07 post: 95.32%±7.81; P=0.02), flexor (pre: 77.11%±13.92 post: 91.94%±6.78; P=0.03), and external rotator (pre: 76.06%±14.94 post: 90.48%±10.70; P=0.03) muscle strength. Significant increases in hip internal rotator (pre: 39.67 deg±6.29 post 45.39 deg ±4.99; P=0.01) and external rotator (pre: 36.71 deg ±4.26 post: 44.16 deg ±3.74 deg; P=0.01) muscle flexibility was measured. 86% of patients who exhibited a positive Thomas or Ober’s test prior to the rehabilitation program exhibited no tissue inflexibility at follow-up.

CONCLUSIONS: The results from this study suggest that a hip strength and flexibility rehabilitation program, based on the biomechanics of running and specific clinical criteria, can effectively resolve pain associated with various musculoskeletal running injuries.

NO DATA NO DATA NO DATA June 2007 NO DATA
NO DATA article Biomechanical consequences of total plantar fasciotomy tx+surgery+pf+foot+run+rsi NO DATA Tweed et al PubMed #19767549. Nicholl et al summarize: complete surgical fasciotomies have been “shown to cause multiple degenerative changes and pathologies due to loss of integrity of normal foot structure. A total fasciotomy predisposes posterior tibial tendon dysfunction, loss of active supination during the propulsive phase of gait, flat foot, calcaneal cuboid ligament strain, increased loading of the metatarsal heads and decreased toe function with toe deformities. It is not recommended for the treatment of plantar fasciitis.” Yikes.

BACKGROUND: Plantar fascia release for chronic plantar fasciitis has provided excellent pain relief and rapid return to activities with few reported complications. Cadaveric studies have led to the identification of some potential postoperative problems, most commonly weakness of the medial longitudinal arch and pain in the lateral midfoot.

METHODS: An electronic search was conducted of the MEDLINE, ScienceDirect, SportDiscus, EMBASE, CINAHL, Cochrane, and AMED databases. The keywords used to search these databases were plantar fasciotomy and medial longitudinal arch. Articles published between 1976 and 2008 were identified.

RESULTS: Collectively, results of cadaveric studies suggested that plantar fasciotomy leads to loss of integrity of the medial longitudinal arch and that total plantar fasciotomy is more detrimental to foot structure than is partial fasciotomy. In vivo studies, although limited in number, concluded that although clinical outcomes were satisfactory, medial longitudinal arch height decreased and the center of pressure of the weightbearing foot was excessively medially deviated postoperatively.

CONCLUSIONS: Plantar fasciotomy, in particular total plantar fasciotomy, may lead to loss of stability of the medial longitudinal arch and abnormalities in gait, in particular an excessively pronated foot. Further in vivo studies on the long-term biomechanical effects of plantar fasciotomy are required.

99 5 422-30 NO DATA 2009 NO DATA
NO DATA book The Biomechanics of Back Pain NO DATA NO DATA Bogduk et al A comprehensive look at the management, treatment, and prevention of back pain through the use of biomechanics from four top researchers in the field. NO DATA NO DATA NO DATA NO DATA NO DATA 2003 Churchill Livingstone
3 article A comparison of once versus twice per week training on leg press strength in women exercise NO DATA Burt et al PubMed #17369792. Burt et al compared “strength differences between 2 groups of untrained women, who performed a single set of the leg press exercise once or twice per week.” There was no difference in their results. “These results indicate that performing a single set of the leg press once or twice per week results in statistically similar strength gains in untrained women.”

AIM: The purpose of this study was to compare strength differences between 2 groups of untrained women, who performed a single set of the leg press exercise once or twice per week.

METHODS: Twenty-one women were divided randomly into 2 groups: Group 1 (n=10) performed a single set of the leg press exercise once per week, while Group 2 (n=11) performed a single set of the leg press exercise twice per week for a period of 8 weeks. Throughout the duration of the study, an amount of resistance was utilized that allowed for a single set of 6 to 10 repetitions to muscular failure. At the conclusion of the study, subjects were tested for their 6-RM strength. A 2x2 ANOVA was used to compare strength differences. The a level was set at 0.05 in order for differences to be considered significant.

RESULTS: The 2x2 ANOVA demonstrated that strength increases were significant between tests (P=0.0001), but not significant between groups (P=0.757).

CONCLUSIONS: These results indicate that performing a single set of the leg press once or twice per week results in statistically similar strength gains in untrained women.

47 1 13-7 Mar 2007 NO DATA
3 article Biomechanics of iliotibial band friction syndrome in runners itbs+run+knee+etio NO DATA Orchard et al Orchard et al proposed that “sprinting and faster running on level ground are less likely to cause or aggravate iliotibial band friction syndrome because, at footstrike, the knee is flexed beyond the angles at which friction occurs.” It’s a reasonable speculation, but please note that they didn’t actually prove this (or anything else) about running speed as a risk factor for ITBS: they didn’t do an experiment here. They simply looked at the anatomy and mechanics of knee movement in runners, and found that they “had an average knee flexion angle of 21.4 degrees,” which is somewhat less than the angle at which IT band presses hardest on the side of the knee (“the 30 degrees of flexion traditionally described in the literature.”) Extrapolating from this, they suggested that running downhill and more slowly involves more knee flexion in the “danger zone” around 30˚ and therefore “adjustments to running gait that cause the knee to be in a more flexed position at footstrike may prevent ITBFS from occurring.”

We propose a biomechanical model to explain the pathogenesis of iliotibial band friction syndrome in distance runners. The model is based on a kinematic study of nine runners with iliotibial band friction syndrome, a cadaveric study of 11 normal knees, and a literature review. Friction (or impingement) occurs near footstrike, predominantly in the foot contact phase, between the posterior edge of the iliotibial band and the underlying lateral femoral epicondyle. The study subjects had an average knee flexion angle of 21.4 degrees +/- 4.3 degrees at footstrike, with friction occurring at, or slightly below, the 30 degrees of flexion traditionally described in the literature. In the cadavers we examined, there was substantial variation in the width of the iliotibial bands. This variation may affect individual predisposition to iliotibial band friction syndrome. Downhill running predisposes the runner to iliotibial band friction syndrome because the knee flexion angle at footstrike is reduced. Sprinting and faster running on level ground are less likely to cause or aggravate iliotibial band friction syndrome because, at footstrike, the knee is flexed beyond the angles at which friction occurs.

24 3 375–379 NO DATA 1996 NO DATA
3 article The biomechanics of the lumbosacral region in acute and chronic low back pain patients etio+back+psb NO DATA Nakipoğlu et al PubMed #18690279. This study show no difference in thoracic kyphosis (hunchback curve), lumbar lordosis (low back curve) and sacral inclination between people with acute low back pain and chronic low back pain.

BACKGROUND: A previous study examined the relationship between the sacral inclination angle (SIA), lumbosacral angle (LSA) and sacral horizontal angle (SHA) and spinal mobility in acute low back pain and chronic low back pain patients. We chose to investigate the lumbar lordosis angle, segmental lumbar lordosis angle, SIA, LSA and SHA in acute and chronic low back pain (LBP) patients as well as the correlation between spinal stability and these angles.

OBJECTIVES: To investigate the biomechanics of the lumbosacral spine region in acute and chronic LBP patients, as well as to examine the correlation between spinal stability and lumbosacral angles.

STUDY DESIGN: Randomized controlled evaluation.

SETTING: Physical Medicine and Rehabilitation outpatient clinic.

METHODS: Sixty participants with LBP were recruited and categorized as either acute LBP (pain < 3 months) or chronic LBP (pain> 6 months), with 30 subjects in each group. All subjects underwent standing, lateral lumbosacral x-rays, which were analyzed for lumbar stability, SIA, LSA, SHA, lumbar lordosis angle and segmental lumbar lordosis angles.

RESULTS: The mean age of the ALBP subjects was 41.00 +/- 11.63 (18 - 66) and that of the chronic LBP subjects 49.26 +/- 15.6 (22-74), with females comprising 50% of the acute LBP group and 73.3% of the chronic LBP group. Lumbar stability was observed in 62.1% of acute LBP patients and 36.8% of chronic LBP patients. A statistically significant difference was found between the 2 groups in terms of age, gender, and lumbar stability. There was no statistical difference regarding SIA, LSA, SHA, total and segmental lordosis angles between acute and chronic LBP patients (p>0.05).

CONCLUSION: We were unable to find a difference between the radiological values for the shape of the SIA, LSA, SHA, and total and segmental lordosis as noted on screening x-ray techniques regarding the occurrence of acute or chronic LBP, but a statistically significant difference was found for lumbar stability. Further extensive studies are needed to examine lumbar stability and its relationship between angles of lumbosacral region.

11 4 505-11 NO DATA 2008 NO DATA
NO DATA article BJSM reviews exercise+nutrition NO DATA Burke et al NO DATA An extensive review of the subject.

See link.

43 10 728-9 Oct 2009 NO DATA
NO DATA book Body by Science NO DATA NO DATA McGuff et al NO DATA Five stars! This book reads like one of my own: science translated into practice. I learned more from this book than I have from any other book I can think of in years. The mind-blowing factor is high. Many myths well-busted.

In Body By Science, bodybuilding powerhouse John Little teams up with fitness medicine expert Dr. Doug McGuff to present a scientifically proven formula for maximizing muscle development in just 12 minutes a week. Backed by rigorous research, the authors prescribe a weekly high-intensity program for increasing strength, revving metabolism, and building muscle for a total fitness experience.

NO DATA NO DATA NO DATA NO DATA 2009 McGraw-Hill
5 book The Body Electric biolit+ot NO DATA Becker et al A fascinating exploration of the most under-rated, neglected mysteries in biology. NO DATA NO DATA NO DATA NO DATA NO DATA 1985 Morrow
NO DATA book Body Worlds biolit NO DATA Hagens et al NO DATA NO DATA NO DATA NO DATA NO DATA NO DATA 2006 Arts and Sciences
3 article Bone marrow edema patterns in the ankle and hindfoot dx+etio+pf+pfps NO DATA Rios et al 1 NO DATA

OBJECTIVE: Many disorders produce similar or overlapping patterns of bone marrow edema in the ankle. Bone marrow edema may present in a few hindfoot bones simultaneously or in a single bone. The purpose of this pictorial essay is to provide guidelines based on clinical history and specific MRI patterns and locations to accurately identify the cause of ankle bone marrow edema. We will first focus on bone marrow edema in general disease categories involving multiple bones, such as reactive processes, trauma, neuroarthropathy, and arthritides. A discussion of bone marrow edema in individual bones of the ankle and hindfoot including the tibia, fibula, talus, and calcaneus will follow. Helpful hints for arriving at the correct diagnosis will be provided in each section.

CONCLUSION: After review of this article, radiologists should be able to use their knowledge of clinical history and specific MRI patterns and locations to accurately distinguish between the various causes of bone marrow edema in the ankle and hindfoot.

197 4 W720-9 Oct 2011 NO DATA
NO DATA book Bonica’s Management of Pain pain NO DATA Loeser et al NO DATA Bonica’s Management of Pain is the gold standard text in pain management, though not primarily the sort of musculoskeletal (and generally more minor) pain problems that interest me. It is primarily concerned with cancer pain, surgical pain, and visceral pain. The first of three parts covers the fundamental aspects of pain, its anatomy, physiological and psychological bases. The second part addresses the techniques that alleviate pain and, though the primary focus is on analgesic block, other methods are covered. Clinical impressions and observations of diseases and disorders with painful syndromes constitute the third part of the book. NO DATA NO DATA NO DATA NO DATA NO DATA 2001 Lippincott Williams & Wilkins
3 article Book review of Muscle Pain tps+back+pain+meds NO DATA Evans NO DATA This is an excellent review of an important text, Muscle Pain: Understanding Its Nature, Diagnosis and Treatment, that every physical therapist should read. I particularly appreciate the review for its credible acknowledgement that, “Low back pain is of myofascial origin [in many cases].” Naturally, the text he is referring to thoroughly defends the same idea.

Muscle pain is common. Fibromyalgia occurs in 2 percent of the general population (in 0.5 percent of males and 1.5 percent of females) and is diagnosed in approximately 15 percent of patients seen in rheumatology clinics and up to 10 percent of those seen in general internal-medicine clinics. Low back pain, which in many cases is of myofascial origin, has a lifetime prevalence as high as 80 percent and accounts for 20 million sick days per year in the United States. Twenty percent of persons in the general population have chronic regional pain. Nocturnal muscle cramps are common in all age groups, with an especially high prevalence among elderly persons (50 percent) and pregnant women (81 percent).

The high prevalence of muscle pain is not surprising, since more than 200 paired skeletal muscles (the exact count depends on the extent of muscle subdivision), each with free nociceptors at nerve endings, account for 40 percent or more of body weight.

Muscle Pain is a well-written book with comprehensive, up-to-date references and many useful figures. The nine chapters clearly review the neurobiologic, pathophysiologic, and clinical manifestations of muscle pain. Helpful features of the book include a summary and outline at the beginning of each chapter; specific treatment recommendations, with a brief review of the pharmacologic characteristics of each drug at the end of most chapters; and a glossary of key words and terms, which nonneurologists will find especially useful. Almost a third of the book is devoted to the most common causes of muscle pain: myofascial pain and the fibromyalgia syndrome.

Myofascial pain denotes both the symptoms caused by myofascial trigger points and a regional pain syndrome characterized by the presence of trigger points. A trigger point is a tender, localized hardening in a skeletal muscle that can evoke referred pain in a characteristic pattern involving different locations in a particular muscle. The concept of myofascial pain has evolved considerably since Arthur Steindler introduced the term in 1939. The late Janet Travell, who had suffered from myofascial pain herself, was largely responsible for putting the disorder and its treatment on the medical map, with publications over a 50-year period. (Travell was the White House physician for Presidents John F. Kennedy and Lyndon B. Johnson; she administered trigger-point injections to President Kennedy for his chronic low back pain and recommended that he use a rocking chair. Travell published two influential books on myofascial pain with David Simons, one of the authors of Muscle Pain.) The chapter on myofascial pain reviews its pathophysiologic features, including electromyographic findings reportedly due to dysfunctional motor end plates and the histogenesis of trigger points. Characteristic patterns of pain and effective treatments, such as trigger-point injections, are summarized.

Fibromyalgia is a chronic condition of increasing sensitivity characterized by widespread pain and confirmed by the induction of pain with 4 kg of palpation pressure in at least 11 of 18 (9 bilateral) soft-tissue tender points in various locations from the occiput to the knees. In contrast to trigger points, tender points cause local pain when pressed but do not refer pain. (The term "tender point" was first used by Smythe and Moldofsky in 1972 and "fibromyalgia" by Hench in 1977.) In the chapter on the fibromyalgia syndrome, I. Jon Russell reviews data supporting the theory that widespread allodynia is due to central nervous system amplification of nociception in general, not to a specific muscle disorder. Medications such as tricyclic antidepressants, nonsteroidal antiinflammatory agents, cyclobenzeprine, and tramadol may help some patients. Even if such treatment is not effective, the physician can help the patient by providing information about the syndrome and by having an accepting attitude.

Not surprisingly, myofascial pain and fibromyalgia are two of the most controversial topics in medicine. Critics note that the criteria for their diagnosis are subjective and that the applicability of the criteria is problematic for several reasons, including poor interexaminer reliability. Various studies that have been reported to demonstrate a pathophysiologic substrate have been subject to vociferous attacks. There is also concern that these diagnoses medicalize psychiatric disorders or encourage unjustified legal claims of injury or disability. Suggested nonhistologic terms for these disorders include aches and pains, the chronic pain syndrome, somatoform pain disorder, the pain amplification syndrome, somatic dysthymia, the hypervigilance syndrome, affective spectrum disorder, and diffuse suffering. Terminology aside, I believe that most of my patients who report pain actually experience pain that has a biologic, albeit often poorly understood, basis.

I highly recommend Muscle Pain to any physician who treats these disorders or wishes to review the growing body of knowledge about their neurobiologic and pathophysiologic features. This book will be of special interest to pain specialists, neurologists, neurosurgeons, rheumatologists, orthopedists, and physiatrists.

344 13 1026–1027 NO DATA 2001 NO DATA
NO DATA book Born to Run run+rsi+shoes NO DATA McDougall NO DATA

McDougall reveals the secrets of the world's greatest distance runners--the Tarahumara Indians of Copper Canyon, Mexico--and how he trained for the challenge of a lifetime: a fifty-mile race through the heart of Tarahumara country pitting the tribe against an odd band of super-athletic Americans

NO DATA NO DATA NO DATA NO DATA 2009 Alfred A. Knopf
4 article Botulinum toxin A for myofascial trigger point injection pain+tps NO DATA Ho et al PubMed #17071119. This 2007 review paper shows pretty clearly that “current evidence does not support the use of Botulinum toxin A (BTA) injection in trigger points [muscle knots].” The truth is never bad news, of course, and I’m going to use this as an example of honouring the evidence even when it irritates me. But damn … this study rocked my boat a bit when I found it in Aug 2009. For years I was under the impression that Botox injection flipped the switch on trigger points, just turned ‘em off completely, zap, done — no more trigger point until the Botox wears off. That didn’t necessarily make it a good treatment option for patients: it’s invasive, there are risks, it’s difficult to reliably inject the actual trigger point, and so on. But the evidence of the effect of Botox on trigger points was terribly important theoretically, because it showed something vital about the physiology of trigger points. (Botox blocks the release of the neurotransmitter acetylcholine, making it impossible for muscle to contract.) If Botox stops a trigger point, it proves that a trigger point is contractile. If you know how to break a trigger point, then you know how it works. It really helped to push back the scientific darkness around muscle pain. Only I guess it didn’t! This paper doesn’t necessarily show that Botox doesn’t do anything to trigger points, or that it has no relevance. (For instance, Botox may do exactly what I thought it did, but it’s so difficult for practitioners to reliably inject it into exactly the right place that it is highly unreliable as a treatment.) But it does mean that it’s effectiveness and significance is no longer certain, no longer reliable. It is, at best, debatable.

Botulinum toxin injection is used to treat various pain conditions including muscle spasticity, dystonia, headache and myofascial pain. Results are conflicting regarding the use of Botulinum toxin for trigger point injection in terms of improvement in pain. The aim of this study was to carry out a systematic review to assess the evidence for efficacy of Botulinum toxin A (BTA) compared with placebo for myofascial trigger point injection. Electronic databases on Medline, Cochrane Library, Scopus, CINAHL were queried using key words such as "botulinum toxin", "myofascial pain", "trigger point", "chronic pain" and "musculoskeletal pain". Relevant published randomized controlled trials that described the use of BTA as injection therapy for trigger points were considered for inclusion. The five-item 0-16 point Oxford Pain Validity Scale (OPVS) was used as a selection criteria for suitable clinical trials. Trials were also assessed based on quality using the Oxford Rating Scale. Data extracted from qualified trials included outcome measures such as pain intensity and pain pressure threshold. All studies were ranked according to the OPVS and the authors' conclusions were compared. Five clinical trials met the inclusion criteria. One trial concluded that BTA was effective, and four concluded that it was not effective for reducing pain arising from trigger points. OPVS scores ranged from 8 to 14 with the negative studies corresponding with higher validity scores. The current evidence does not support the use of BTA injection in trigger points for myofascial pain. The data is limited and clinically heterogeneous.

11 5 519-27 Jul 2007 NO DATA
5 article Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults tx+head+meds+inject NO DATA Jackson et al PubMed #22535858. This review of many scientific studies found that having Botox injections for chronic daily headaches or migraines was only slightly more beneficial than using a placebo. Not dramatic results at all. Disappointing, in fact, after years of believing that Botox was “probably” a good evidence-based option for migraine. Sigh.

CONTEXT: Botulinum toxin A is US Food and Drug Administration approved for prophylactic treatment for chronic migraines.

OBJECTIVE: To assess botulinum toxin A for the prophylactic treatment of headaches in adults.

DATA SOURCES: A search of MEDLINE, EMBASE, bibliographies of published systematic reviews, and the Cochrane trial registries between 1966 and March 15, 2012. Inclusion and exclusion criteria of each study were reviewed. Headaches were categorized as episodic (<15 headaches per month) or chronic (≥15 headaches per month) migraine and episodic or chronic daily or tension headaches.

STUDY SELECTION: Randomized controlled trials comparing botulinum toxin A with placebo or other interventions for headaches among adults.

DATA EXTRACTION: Data were abstracted and quality assessed independently by 2 reviewers. Outcomes were pooled using a random-effects model.

DATA SYNTHESIS: Pooled analyses suggested that botulinum toxin A was associated with fewer headaches per month among patients with chronic daily headaches (1115 patients, -2.06 headaches per month; 95% CI, -3.56 to -0.56; 3 studies) and among patients with chronic migraine headaches (n = 1508, -2.30 headaches per month; 95% CI, -3.66 to -0.94; 5 studies). There was no significant association between use of botulinum toxin A and reduction in the number of episodic migraine (n = 1838, 0.05 headaches per month; 95% CI, -0.26 to 0.36; 9 studies) or chronic tension-type headaches (n = 675, -1.43 headaches per month; 95% CI, -3.13 to 0.27; 7 studies). In single trials, botulinum toxin A was not associated with fewer migraine headaches per month vs valproate (standardized mean difference [SMD], -0.20; 95% CI, -0.91 to 0.31), topiramate (SMD, 0.20; 95% CI, -0.36 to 0.76), or amitriptyline (SMD, 0.29; 95% CI, -0.17 to 0.76). Botulinum toxin A was associated with fewer chronic tension-type headaches per month vs methylprednisolone injections (SMD, -2.5; 95% CI, -3.5 to -1.5). Compared with placebo, botulinum toxin A was associated with a greater frequency of blepharoptosis, skin tightness, paresthesias, neck stiffness, muscle weakness, and neck pain.

CONCLUSION: Botulinum toxin A compared with placebo was associated with a small to modest benefit for chronic daily headaches and chronic migraines but was not associated with fewer episodic migraine or chronic tension-type headaches per month.

307 16 1736-45 Apr 2012 NO DATA
3 article A study on the morphology of the suprascapular notch and its distance from the glenoid cavity anat+nerve NO DATA Sangam et al 1 A nice example of anatomical variation: the size and shape of a notch in the top of the shoulder blade is quite variable, and nerve impingement is much more likely if you’ve got the wrong type of notch.

Introduction: A suprascapular nerve entrapment can occur at the suprascapular notch or at the spinoglenoid notch. So, the size and shape of the suprascapular notch are associated with suprascapular entrapment neuropathy as well as with an injury to the suprascapular nerve in arthroscopic procedures. The knowledge on the variations along the course of the nerve is important in understanding the source of the entrapment syndrome. Material and Methods: The present study was carried out on 104 scapulae which were obtained from the Department of Anatomy, NRI Medical College and from other nearby medical colleges. The suprascapular notches in the scapulae were classified, based on the descriptions of Rengachary et al and Ticker et al. The distance between the suprascapular notch and the supraglenoid tubercle, and the distance between the posterior rim of the glenoid cavity and the medial wall of the spinoglenoid notch at the base of the scapular spine, were determined. The data were analyzed statistically. Results: Based on the Rengachary classification, the type III notch was more common. The suprascapular foramen was observed in 2 scapulae. In 56.73% scapulae, the superior transverse diameter was greater than the maximum depth. The U shaped notch (69.23%) was more common. 2.88% and 8.65% scapulae fell short of the mentioned respective safe zone distances from the margin of the glenoid cavity. Conclusion: Such studies may be useful in understanding the role of the notch in causing nerve entrapment and to prevent iatrogenic nerve injuries while posterior approaches are made to the shoulder joint.

7 2 189-92 Feb 2013 NO DATA
NO DATA article Botulinum toxin type A injections NO DATA NO DATA Cote et al NO DATA

BACKGROUND: Botulinum toxin type A (BTA) (Botox) received Food and Drug Administration (FDA) approval for therapeutic treatment of strabismus and blepharospasm in 1989, cervical dystonia in 2000, and cosmetic treatment of glabellar wrinkles (Botox Cosmetic) in 2002. In 2002 alone there were approximately 1.1 to 1.6 million patients using cosmetic BTA. Our objective was to review adverse event (AE) reporting to the FDA after BTA administration.

METHODS: We reviewed all (therapeutic and cosmetic use) serious (per FDA regulations) AEs reported to the FDA for the 13.5 years since licensure of the product (December 1989-May 2003) and nonserious AEs reported from December 2001 to November 2002. AEs are reported to the FDA through the MedWatch system.

RESULTS: We reviewed 1437 AE reports; 406 followed therapeutic use of BTA (217 serious and 189 nonserious) and 1031 followed cosmetic use (36 serious and 995 nonserious). Reported AEs occurred predominantly in female patients, with a median age of 50 years. In the year December 2001 to November 2002, when both serious and nonserious reports were evaluated, the proportion of reports classified as serious was 33-fold higher for therapeutic than for cosmetic cases. The 217 serious AEs reported in therapeutic cases involved a wide spectrum of events and included all 28 reported deaths. Among cosmetic users, no deaths were reported and, of the 36 serious AEs, 30 were included as possible complications in the FDA-approved label. The remaining 6 serious AEs did not display a pattern suggesting a common causal relationship to BTA. Among the 995 cosmetic cases reported to have nonserious AEs, most commonly noted were lack of effect (623, 63%), injection site reaction (190, 19%), and ptosis (111, 11%).

CONCLUSIONS: Serious AEs were more likely to be reported for therapeutic than for cosmetic use, which may be related to higher doses, complicated underlying diseases, or both. Among cosmetic cases, few serious AEs were reported, and these were predominantly events that were previously recognized in clinical trials of BTA for the labeled use. This study is limited primarily by the incomplete nature of AE reporting by clinicians. Numerous departures from FDA-approved recommendations for drug dose, dilution, handling, site of injection, and storage were noted in these AE reports.

53 3 407–415 NO DATA 2005 NO DATA
4 article Braces do not reduce loads on internal spinal fixation devices back NO DATA Rohlmann et al PubMed #10619096. To determine how much a back brace really braces, German researchers used “telemeterized” implants — steel fixation rods with meters on them! so cyborgy! — to measure the effect of common braces on spinal forces. This is a good experiment. If you have implants stabilizing your spine internally, measuring the stresses on them directly is a pretty clever way of checking to see if an external brace is doing anything. Three types of braces were examined: Boston overlap brace, reclination brace, and a lumbotrain harness. Unsurprisingly, they found that “none of the braces studied were able to markedly reduce the loads” on the implants. There was some reduction — just not “marked,” nothing to write home about. More surprisingly, some of their measurements showed that bracing increased loading on the implants! That does seem possible. The spine is an extraordinarily dynamic structure. Somewhat like slouching into a comfortable chair, a brace may actually cause some sloppiness of spinal function, resulting in “resting” on the fixations, rather than using muscle to support and control the spine. That’s just a guess, but it seems like a reasonable one to me.

OBJECTIVE: To determine the effect of a brace or harness on loads on internal spinal fixation devices.

DESIGN: The implant loads were measured in vivo using telemeterized internal spinal fixators.

BACKGROUND: Only limited information exists regarding the load reduction due to a brace or harness.

METHODS: A Boston overlap brace, a reclination brace, and a lumbotrain harness were examined to determine how they affect the loads on internal spinal fixation devices. The implant loads were measured using telemeterized fixators in six patients for several positions and activities, including sitting, standing, walking, bending forward, and lifting an extended leg in a supine position.

RESULTS: None of the braces studied were able to markedly reduce the loads on the fixators. Frequently even higher fixator loads were measured when wearing a brace or harness.

CONCLUSIONS: It does not seem helpful to brace patients after mono- or bisegmental stabilization of the lumbar spine.

14 2 97-102 Feb 1999 NO DATA
3 article Bracing of patients after fusion for degenerative problems of the lumbar spine--yes or no? back NO DATA Connolly et al PubMed #9654635. This research is really just asking two experienced surgeons their opinion on the value of bracing after back surgery (for non-traumatic back problems). They disagree. “Dr. Connolly argues that an external orthosis is advisable in many cases; Dr. Grob feels that the rigidity of internal fixation should be adequate to obviate the need for external bracing.”

The majority of spine fusions currently performed are for degenerative conditions. Controversy exists regarding whether to routinely brace patients during the postoperative period. The benefits of a rigid orthosis have yet to be documented in a scientific study, and the cost of a custom-molded orthosis can be quite high. An extensive literature search reveals few articles dealing with the subject, and none with an adequate study design to convincingly support or refute the use of external braces. In addition to the questions of whether an external brace is effective, the mechanism of action also remains unclear. It has been difficult to document mechanical effectiveness, so perhaps the effect is psychologic. In addition, it is possible that some, not all, fusion patients may benefit from a brace--yet our ability to select such a patient is poor. As a result, we have solicited the views of two experienced surgeons on the topic. Dr. Connolly argues that an external orthosis is advisable in many cases; Dr. Grob feels that the rigidity of internal fixation should be adequate to obviate the need for external bracing.

23 12 1426-8 Jun 1998 NO DATA
3 article Breaking up prolonged sitting reduces postprandial glucose and insulin responses exercise+self-tx NO DATA Dunstan et al PubMed #22374636. In this small study, it was shown that very overweight adults who get up and walk every 20 minutes can improve their glucose and insulin levels. This, in turn, “may improve glucose metabolism and potentially be an important public health and clinical intervention strategy for reducing cardiovascular risk.”

OBJECTIVE: Observational studies show breaking up prolonged sitting has beneficial associations with cardiometabolic risk markers, but intervention studies are required to investigate causality. We examined the acute effects on postprandial glucose and insulin levels of uninterrupted sitting compared with sitting interrupted by brief bouts of light- or moderate-intensity walking.

RESEARCH DESIGN AND METHODS: Overweight/obese adults (n = 19), aged 45-65 years, were recruited for a randomized three-period, three-treatment acute crossover trial: 1) uninterrupted sitting; 2) seated with 2-min bouts of light-intensity walking every 20 min; and 3) seated with 2-min bouts of moderate-intensity walking every 20 min. A standardized test drink was provided after an initial 2-h period of uninterrupted sitting. The positive incremental area under curves (iAUC) for glucose and insulin (mean [95% CI]) for the 5 h after the test drink (75 g glucose, 50 g fat) were calculated for the respective treatments.

RESULTS: The glucose iAUC (mmol/L) · h after both activity-break conditions was reduced (light: 5.2 [4.1-6.6]; moderate: 4.9 [3.8-6.1]; both P < 0.01) compared with uninterrupted sitting (6.9 [5.5-8.7]). Insulin iAUC (pmol/L) · h was also reduced with both activity-break conditions (light: 633.6 [552.4-727.1]; moderate: 637.6 [555.5-731.9], P < 0.0001) compared with uninterrupted sitting (828.6 [722.0-950.9]).

CONCLUSIONS: Interrupting sitting time with short bouts of light- or moderate-intensity walking lowers postprandial glucose and insulin levels in overweight/obese adults. This may improve glucose metabolism and potentially be an important public health and clinical intervention strategy for reducing cardiovascular risk.

35 5 976-83 May 2012 NO DATA
4 article Brief psychosocial education, not core stabilization, reduced incidence of low back pain etio+tx+exercise+mind+psb+back NO DATA George et al 1 Despite good general fitness, soldiers get back pain: do they get less if they train their “core” muscles more in basic training? They should! As the authors note, “Core stabilization has been advocated as preventative.” However, core training “offered no such benefit when compared to traditional lumbar exercise in this trial” — none at all. Although the results might be better with civilians, a good prevention method for us shouldn’t fail completely with soldiers. And although a different, more perfect training program might have worked, even a suboptimal one should have worked at least a little. The null result is therefore significant. Headlines about the study have focussed on the fact that soldiers who got a little extra back pain education reported less back pain over the next two years. (They measured the number of medical follow-ups.) However, it was a minor effect (17% relative risk reduction), and might be due to a fairly obvious (and acknowledged) limitation of the study — the education was “designed to reduce…threat and fear” and may have persuaded soldiers to seek less medical care. Of course, that is a win-win situation, good news either way, whether it was actually preventing back pain, or merely reassuring people and reducing the load on the health care system.

BACKGROUND: Effective strategies for the primary prevention of low back pain (LBP) remain elusive with few large-scale clinical trials investigating exercise and education approaches. The purpose of this trial was to determine whether core stabilization alone or in combination with psychosocial education prevented incidence of low back pain in comparison to traditional lumbar exercise.

METHODS: The Prevention of Low Back Pain in the Military study was a cluster randomized clinical study with four intervention arms and a two-year follow-up. Participants were recruited from a military training setting from 2007 to 2008. Soldiers in 20 consecutive companies were considered for eligibility (n = 7,616). Of those, 1,741 were ineligible and 1,550 were eligible but refused participation. For the 4,325 Soldiers enrolled with no previous history of LBP average age was 22.0 years (SD = 4.2) and there were 3,082 males (71.3%). Companies were randomly assigned to receive traditional lumbar exercise, traditional lumbar exercise with psychosocial education, core stabilization exercise, or core stabilization with psychosocial education, The psychosocial education session occurred during one session and the exercise programs were done daily for 5 minutes over 12 weeks. The primary outcome for this trial was incidence of low back pain resulting in the seeking of health care.

RESULTS: There were no adverse events reported. Evaluable patient analysis (4,147/4,325 provided data) indicated no differences in low back incidence resulting in the seeking of health care between those receiving the traditional exercise and core stabilization exercise programs. However, brief psychosocial education prevented low back pain episodes regardless of the assigned exercise approach, resulting in a 3.3% (95% CI: 1.1 to 5.5%) decrease over two years (numbers needed to treat (NNT) = 30.3, 95% CI = 18.2 to 90.9).

CONCLUSIONS: Core stabilization has been advocated as preventative, but offered no such benefit when compared to traditional lumbar exercise in this trial. Instead, a brief psychosocial education program that reduced fear and threat of low back pain decreased incidence of low back pain resulting in the seeking of health care. Since this trial was conducted in a military setting, future studies are necessary to determine if these findings can be translated into civilian populations.

9 NO DATA 128 NO DATA 2011 NO DATA
NO DATA article Bromelain as a Treatment for Osteoarthritis arthritis+pain+meds+nutrition NO DATA Brien et al 1 A 2004 review of one dozen studies of bromelain in Evidence-based Complementary & Alternative Medicine. Despite a blatant conflict of interest (Brien works for a bromelain manufacturer), the review seems balanced, and the authors do not fail to point out weaknesses in the evidence or concerns about adverse effects. They appropriately emphasize that alternative medications must not just be effective, but also safer than existing medications. Their conclusion is cautiously positive, and it does seem to be justified by the evidence reviewed: clearly bromelain does something to help people with painful osteoarthritis. “The currently available data do indicates the potential of bromelain in treating osteoarthritis.”

Bromelain, an extract from the pineapple plant, has been demonstrated to show anti-inflammatory and analgesic properties and may provide a safer alternative or adjunctive treatment for osteoarthritis. All previous trials, which have been uncontrolled or comparative studies, indicate its potential use for the treatment of osteoarthritis. This paper reviews the mechanism of its putative therapeutic actions, those clinical trials that have assessed its use in osteoarthritis to date, as well as considering the safety implications of this supplement for osteoarthritis and reviewing the evidence to date regarding the dosage for treating this condition. The data available at present indicate the need for trials to establish the efficacy and optimum dosage for bromelain and the need for adequate prospective adverse event monitoring in such chronic conditions as osteoarthritis.

1 3 251–257 Dec 2004 NO DATA
NO DATA article Caffeine Improves Physical and Cognitive Performance during Exhaustive Exercise ot+exercise NO DATA Hogervorst et al NO DATA Caffeine really will “significantly improve” not only endurance performance, but “complex cognitive ability during and after exercise.” Sign me up! I’ve already pretty much embraced caffeine as one of those rare pleasures in life that has minimal downside — this is just gravy! The researchers studied 24 well-trained cyclists, giving them either 100mg of caffeine or a placebo and then testing their endurance and their mental function during and after workouts. The signal was loud and clear: caffeine consumption boosted their performance. NO DATA 40 10 1841-1851 October 2008 NO DATA
2 article Calcaneal osteomyelitis following steroid injection pf+inject+foot NO DATA Gidumal et al PubMed #4043891. NO DATA

A 71-year-old male presented with unremitting heel pain in the region of his calcaneal tuberosity. He had been previously treated with steroid injections for plantar fasciitis. Diagnostic workup revealed a calcaneal osteomyelitis which was treated with a partial calcanectomy. This case underlines the need to rule out this expected but previously unreported complication.

6 1 44-6 Aug 1985 NO DATA
NO DATA article Calcaneal spurs and plantar heel pad pain pf+run+foot NO DATA Onwuanyi From the abstract: “Calcaneal spurs cause plantar heel pad pain, but the roles of other co-morbid factors are significant. The excision of these spurs does not necessarily abolish pain.”

Calcaneal spurs may cause plantar heel pad pain. Their excision does not, however, abolish this pain. A number of co-morbid factors, such as increase in weight, advancing age, diabetes, elevated uric acid levels, and heel pad compressibility index, have been identified. This study evaluates 123 patients with calcaneal spurs and plantar heel pad pain in association with these factors.

METHODS: A prospective evaluation of 123 patients with calcaneal spurs in 136 heels and plantar heel pad pain in association with diabetes mellitus, body mass index>27, elevated uric acid and heel pad compressibility index, were matched with a control group of 141 patients (136 heels) without heel pad pain or co-morbid factors. This study was carried out between February 1997 and September 1999 in three hospitals. There were 91 females and 32 males in the study group, while the control group had 86 females and 55 males.

RESULTS: All patients in the study cohort presented with calcaneal spurs and plantar heel pad pain. The mean age for the males was 38.1 ± 2.4 and females 43.3 ± 0.8. 78.04% (96 patients) had body mass index (BMI) of over 27, in 48 patients (39.02%) uric acid levels were elevated above two standard deviations from the mean and 59 patients (47.96%) were diabetic, some with more than a single factor. The heel pad compressibility index of 0.54 ± 1.06 in males and 0.62 ± 0.02 in females of the study population was significantly greater than in the control population (males: 0.49 ± 0.4, females: 0.56 ± 1.8). The study and control groups were comparable with respect to age.

CONCLUSION: Calcaneal spurs cause plantar heel pad pain, but the roles of other co-morbid factors are significant. The excision of these spurs does not necessarily abolish pain. It is evident that heel pad compressibility increases with advancing age, weight gain, and diabetes mellitus, and contributes to the pathogenesis of plantar heel pain. This has an impact on the management of these patients, by de-emphasizing the role of surgical excision of these spurs.

10 NO DATA NO DATA NO DATA 2000 NO DATA
NO DATA article Can apparent increases in muscle extensibility with regular stretch be explained by changes in tolerance to stretch? stretch+exercise NO DATA Folpp et al NO DATA

The aim of this study was to determine whether an intensive stretch program increases muscle extensibility or subjects' tolerance to an uncomfortable stretch sensation. Twenty healthy able-bodied individuals with limited hamstring muscle extensibility were recruited. A within-subjects design was used whereby one leg of each subject was randomly allocated to the experimental condition and the other leg was allocated to the control condition. The hamstring muscles of each subject's experimental leg were stretched for 20 minutes each weekday for four weeks. Hamstring muscle extensibility (angle of hip flexion corresponding with a standardised torque) and stretch tolerance (angle of hip flexion corresponding with maximal torque tolerated) were assessed on both legs at the beginning and end of the study. The intervention did not increase the extensibility of the hamstring muscles (mean change in hip flexion was -1 degree, 95% CI -4 to 3 degrees) but did increase subjects' tolerance to an uncomfortable stretch sensation (mean change in hip flexion was 8 degrees, 95% CI 5 to 12 degrees). These results highlight the importance of distinguishing between real and apparent increases in muscle extensibility when assessing the effectiveness of stretch, and indicate that whilst a four-week stretch program increases subjects' tolerance to an uncomfortable stretch sensation it does not increase hamstring muscle extensibility.

52 1 45–50 NO DATA 2006 NO DATA
NO DATA article Can Chiropractors and Evidence-Based Manual Therapists Work Together? chiro+quack+neck+back+smt NO DATA Homola 1 Dr. Sam Homola covers the topics of subluxation theory and spinal manipulative therapy in this 2006 article, managing to be precise and thorough without losing his amiable tone — exactly what I aim for on this website, actually. It’s still a bit heavy going for patients, but it’s worthwhile for anyone who’s really keen to understand the subject matter.

Use of manual therapy in the form of manipulation and massage is evident in the earliest recordings of history. Today, manual therapy is an evidence-based practice that can be used with predictable results in the treatment of a variety of neuromusculoskeletal problems. However, for some manual therapists, treatment is still based on a belief system that incorporates vitalism, energy healing, and other metaphysical concepts. Cooperation of practitioners in researching the effects of manual therapy would require uniformity based upon the guidelines of science, following rules for selection of an evidence-based therapy that produces predictable and replicable results. Such an approach would not allow contamination by dogma or by an agenda that is designed more to support a belief system than to find the truth. The chiropractic profession, which began with a founding father in 1895, is identified primarily by its use of manipulation. But chiropractic is based upon a vertebral subluxation theory that is generally categorized as supporting a belief system. The words "manipulation" and "subluxation" in a chiropractic context have meanings that are different from the meanings in evidence-based literature. An orthopedic subluxation, a partial dislocation or displacement of a joint, can sometimes benefit from manipulation or mobilization when there are joint-related symptoms. A chiropractic subluxation, however, is often an undetectable or asymptomatic "spinal lesion" that is alleged to be a cause of disease. Such a subluxation, which has never been proven to exist, is "adjusted" by chiropractors, who manipulate the spine to restore and maintain health. The reasons for use of manipulation/ mobilization by an evidence-based manual therapist are not the same as the reason for use of adjustment/manipulation by most chiropractors. Only evidence-based chiropractors, who have renounced subluxation dogma, can be part of a team that would research the effects of manipulation without bias.

14 2 E14–E18 NO DATA 2006 NO DATA
3 article Can custom-made biomechanic shoe orthoses prevent problems in the back and lower extremities? A randomized, controlled intervention trial of 146 military conscripts back+tools+shin+knee+tendinosis NO DATA Larsen et al From the abstract: “This study shows that it may be possible to prevent certain musculoskeletal problems in the back or lower extremities …”

BACKGROUND: Shock-absorbing and biomechanic shoe orthoses are frequently used in the prevention and treatment of back and lower extremity problems. One review concludes that the former is clinically effective in relation to prevention, whereas the latter has been tested in only 1 randomized clinical trial, concluding that stress fractures could be prevented.

OBJECTIVES: To investigate if biomechanic shoe orthoses can prevent problems in the back and lower extremities and if reducing the number of days off-duty because of back or lower extremity problems is possible.

DESIGN: Prospective, randomized, controlled intervention trial.

STUDY SUBJECTS: One female and 145 male military conscripts (aged 18 to 24 years), representing 25% of all new conscripts in a Danish regiment.

METHOD: Health data were collected by questionnaires at initiation of the study and 3 months later. Custom-made biomechanic shoe orthoses to be worn in military boots were provided to all in the study group during the 3-month intervention period. No intervention was provided for the control group. Differences between the 2 groups were tested with the chi-square test, and statistical significance was accepted at P <.05. Risk ratio (RR), risk difference (ARR), numbers needed to prevent (NNP), and cost per successfully prevented case were calculated.

OUTCOME VARIABLES: Outcome variables included self-reported back and/or lower extremity problems; specific problems in the back or knees or shin splints, Achilles tendonitis, sprained ankle, or other problems in the lower extremity; number of subjects with at least 1 day off-duty because of back or lower extremity problems and total number of days off-duty within the first 3 months of military service because of back or lower extremity problems.

RESULTS: Results were significantly better in an actual-use analysis in the intervention group for total number of subjects with back or lower extremity problems (RR 0.7, ARR 19%, NNP 5, cost 98 US dollars); number of subjects with shin splints (RR 0.2, ARR 19%, NNP 5, cost 101 US dollars); number of off-duty days because of back or lower extremity problems (RR 0.6, ARR < 1%, NNP 200, cost 3750 US dollars). In an intention-to-treat analysis, a significant difference was found for only number of subjects with shin splints (RR 0.3, ARR 18%, NNP 6 cost 105 US dollars), whereas a worst-case analysis revealed no significant differences between the study groups.

CONCLUSIONS: This study shows that it may be possible to prevent certain musculoskeletal problems in the back or lower extremities among military conscripts by using custom-made biomechanic shoe orthoses. However, because care-seeking for lower extremity problems is rare, using this method of prevention in military conscripts would be too costly. We also noted that the choice of statistical approach determined the outcome.

25 5 326–331 NO DATA 2002 NO DATA
NO DATA article Can patients with low energy whiplash associated disorder develop low back pain? neck+back NO DATA Beattie et al PubMed #19625019. NO DATA

800 consecutive claimant generated medicolegal reports were analysed for symptomatology of whiplash associated disorder (WAD) including the presence of mid and low back pain. We aimed to establish whether the two were linked and if so if there were correlations between accident vector and severity. We also aimed to establish if a low back injury could result from a vehicular accident in the absence of a neck injury. In addition we examined if occupant bracing and occupant neutral position at the time of the accident affected symptom patterns. We found that a claimed back injury following WAD was independent of both accident severity and accident vectors, approximately 40% claiming injury in low, medium and high violence groups and with rear, frontal and side impact. We established that it was unusual to have a back injury in the absence of a neck injury (18 out of 325, 5.5%) without a past medical history of back pain (72.2% of this group having previous back pain). Occupant bracing was not protective. We also showed that occupant neutral position was not protective against a back injury. We were surprised that patients with next to no car damage had the same incidence of back pain as those involved in more violent crashes when biomechanically unlikely. The complex biopsychosocial response and the relationship to constitutional factors are discussed. The literature concerning forces across the lumbar spine and possibilities of injury is reviewed.

NO DATA NO DATA NO DATA Jul 2009 NO DATA
NO DATA article Canadian chiropractors’ attitudes towards chiropractic philosophy and scope of practice chiro NO DATA Biggs et al NO DATA From the abstract: “We found that 18.6% of [chiropractors] held conservative views .... Conservative chiropractic philosophy rejects traditional chiropractic philosophy as espoused by D.D. and B.J. Palmer, and emphasizes the scientific validation of chiropractic concepts and methods.” That’s a scandalously low number of chiropractors rejecting Palmer and emphasizing science.

The development of effective implementation strategies for chiropractic clinical practice guidelines (CPGs) presumes knowledge about the attitudes of the Canadian chiropractic profession. The purpose of this study was to explore the attitudes of Canadian chiropractors to philosophy and scope of practice. We hypothesized that given most Canadian chiropractors are trained at one school, the Canadian Memorial Chiropractic College (CMCC) in Toronto, there would be a reasonable degree of consensus about the practice of chiropractic in Canada, and therefore, effective implementation strategies could be developed.

Drawing on a stratified random sample of Canadian chiropractors (n = 401), we found that 18.6% of respondents held conservative views, 22% held liberal views and 59.4% held moderate views. Conservative chiropractic philosophy rejects traditional chiropractic philosophy as espoused by D.D. and B.J. Palmer, and emphasizes the scientific validation of chiropractic concepts and methods. A conservative philosophy is associated with a narrow scope of practice in which chiropractic practice is restricted to musculoskeletal problems. A liberal chiropractic philosophy adheres to traditional chiropractic philosophy (offered either by D.D. or B.J. Palmer ) and is associated with a broad scope of practice which includes the treatment of non-musculoskeletal conditions. Liberal-minded respondents are more likely to identify chiropractic as an alternate form of health care.

Using ANOVA and MCA, the best predictors of the philosophy index were college of training and province of practice. Chiropractors who trained at the CMCC held more conservative views than those who were trained elsewhere. Moreover, we found significant provincial differences among the provinces on the philosophy index. Saskatchewan chiropractors held the most conservative views on the philosophy index; Quebec chiropractors held the most liberal views. We concluded that given the divergence of opinions among Canadian chiropractors, one implementation strategy would not be effective. We also questioned whether CPGs are the most efficacious method of changing clinical behaviour.

41 3 145–154 NO DATA 1997 NO DATA
3 article A pilot study comparing two manual therapy interventions for carpal tunnel syndrome mx+tools NO DATA Burke et al PubMed #17224356. A small clinical trial comparing treatment of carpal tunnel syndrome with standard “soft-tissue mobilization” to “instrument-assisted soft-tissue mobilization” (specifically Graston Technique tools). Both appeared to have modest benefits, but using tools was no better: “the clinical improvements were not different between the 2 manual therapy techniques.”

OBJECTIVE: The purpose of this study was to determine the clinical efficacy of manual therapy interventions for relieving the signs and symptoms of carpal tunnel syndrome (CTS) by comparing 2 forms of manual therapy techniques: Graston Instrument-assisted soft tissue mobilization (GISTM) and STM administered with the clinician hands.

METHODS: The study was a prospective comparative research design in the setting of a research laboratory. Volunteers were recruited with symptoms suggestive of CTS based upon a phone interview and confirmed by electrodiagnostic study findings, symptom characteristics, and physical examination findings during an initial screening visit. Eligible patients with CTS were randomly allocated to receive either GISTM or STM. Interventions were, on average, twice a week for 4 weeks and once a week for 2 additional weeks. Outcome measures included (1) sensory and motor nerve conduction evaluations of the median nerve; (2) subjective pain evaluations of the hand using visual analog scales and Katz hand diagrams; (3) self-reported ratings of symptom severity and functional status; and (4) clinical assessments of sensory and motor functions of the hand via physical examination procedures. Parametric and nonparametric statistics compared treated CTS hand and control hand and between the treatment interventions, across time (baseline, immediate post, and at 3 months' follow-up).

RESULTS: After both manual therapy interventions, there were improvements to nerve conduction latencies, wrist strength, and wrist motion. The improvements detected by our subjective evaluations of the signs and symptoms of CTS and patient satisfaction with the treatment outcomes provided additional evidence for the clinical efficacy of these 2 manual therapies for CTS. The improvements were maintained at 3 months for both treatment interventions. Data from the control hand did not change across measurement time points.

CONCLUSIONS: Although the clinical improvements were not different between the 2 manual therapy techniques, which were compared prospectively, the data substantiated the clinical efficacy of conservative treatment options for mild to moderate CTS.

30 1 50-61 Jan 2007 NO DATA
4 article Can We Explain Heterogeneity Among Randomized Clinical Trials of Exercise for Chronic Back Pain? A Meta-Regression Analysis of Randomized Controlled Trials back NO DATA Ferreira et al PubMed #20671101. Generally speaking, studies of exercise for low back pain are a bit underwhelming: some of them show some benefit, but it’s never a big deal. We’re always left wondering if another kind of exercise might have been more effective. There are so many ways to exercise, and the science of exercise therapy is generally plagued by this complexity: no matter what the research says, there’s always the real possibility that you might get better results by dialing up a different combination of variables. This statistical analysis of six exercise experiments tried to determine which variables matter. This is quite different than testing to see what kinds of exercise work. The point was to see which variables affect the outcome. If any. In fact, they found only one: “only dosage was found to be significantly associated with effect sizes.” Nothing else mattered: just how much exercise was done. And even that didn’t matter much. The effect of exercise was small in any case — real, but small. In other words, according to these results, exercise therapy for low back pain is a fool’s errand for most people, most of them time: it doesn’t matter what kind of exercise you do, just that you do it. If you do enough, you’ll probably get some benefit. But there’s a real problem of diminishing returns: no matter how much you do, the benefits taper off fast.

BACKGROUND: Exercise programs may vary in terms of duration, frequency, and dosage; whether they are supervised; and whether they include a home-based program. Uncritical pooling of heterogeneous exercise trials may result in misleading conclusions regarding the effects of exercise on chronic low back pain (CLBP).

PURPOSE: The purpose of this study was to establish the effect of exercise on pain and disability in patients with CLBP, with a major aim of explaining between-trial heterogeneity.

DATA SOURCES: Six databases were searched up to August 2008 using a computerized search strategy.

STUDY SELECTION: Eligible studies needed to be randomized clinical trials evaluating the effects of exercise for nonspecific CLBP.

OUTCOMES: Of interest were pain and disability measured on a continuous scale.

DATA EXTRACTION: Baseline demographic data, exercise features, and outcome data were extracted from all included trials.

DATA SYNTHESIS: Univariate meta-regressions were conducted to assess the associations between exercise effect sizes and 8 study-level variables: baseline severity of symptoms, number of exercise hours and sessions, supervision, individual tailoring, cognitive-behavioral component, intention-to-treat analysis, and concealment of allocation.

LIMITATIONS: Only study-level characteristics were included in the meta-regression analyses. Therefore, the implications of the findings should not be used to differentiate the likelihood of the effect of exercise based on patient characteristics.

CONCLUSIONS: The results show that, in general, when all types of exercise are analyzed, small but significant reductions in pain and disability are observed compared with minimal care or no treatment. Despite many possible sources of heterogeneity in exercise trials, only dosage was found to be significantly associated with effect sizes.

NO DATA NO DATA NO DATA Jul 2010 NO DATA
NO DATA article Capillary diameter and geometry in cardiac and skeletal muscle studied by means of corrosion casts biolit NO DATA Potter et al PubMed #6835100. I went looking for this paper because I wanted to know how big capillaries are, and how that compares to thinks like spider silk and human hairs. Both hair and silk come in a wide variety of thicknesses, but this fact is routinely ignored. For instance, spider silk will be described as being a tenth the thickness of a human hair. Which spider? Who’s hair? I haven’t documented my sources because it’s a trivial, gee-whiz point, but the process of clearing this up was interesting. Turns out that human hair diameter ranges from about 15 micrometres at its finest, all the way up to 200 micrometres at the thickest: a full order of magnitude difference! Capillaries, on the other hand, are more consistent at around 4-6 micrometres: something like a third to a fortieth the thickness of hair, depending on the hair. Definitely smaller! Now spider silk turns out to have a really wide range of sizes. The very thinnest is measured in nanometres, just 10 of them, which is really impressive (nanometres are used to measure things on the molecular scale). At the other end of the range, spiders sometimes pump out silk as thick as 150 micrometres, a relatively gargantuan tenth of a millimetre and about the same size as the heaviest hairs. So, capillaries can be up to 500 times larger than really fine spider silk, or about thirty times smaller than than the thickest. NO DATA 25 1 68–84 Jan 1983 NO DATA
3 article Capsaicin-induced central sensitization evokes segmental increases in trigger point sensitivity in humans tps+pain+etio NO DATA Srbely et al PubMed #20015704. Researchers found that “increases in central sensitization evoke increases in trigger point pressure sensitivity in segmentally related muscles.”

This study investigated whether inducing central sensitization evokes segmental increases in trigger point pressure sensitivity. We evoked central sensitization at the C(5) segment and validated its presence via mechanical cutaneous sensitivity (brush allodynia) testing.

Trigger point pressure sensitivity was quantified using the pain pressure threshold (PPT) value. A 50 cm(2) area of the C(5) dermatome at the right lateral elbow was pretreated with 45 degrees heat for 10 minutes. Test subjects (n = 20) then received topical capsaicin cream (0.075%; Medicis, Toronto, Canada) to the C(5) dermatome, whereas control subjects (n = 20) received a topical placebo cream (Biotherm Massage, Montreal, Canada). PPT readings were recorded from the infraspinatus (C(5,6)) and gluteus medius (L(4,5)S(1)) trigger points at zero (pre-intervention), 10, 20, and 30 minutes after intervention; all PPT readings were normalized to pre-intervention (baseline) values. The difference between the PPT readings at the 2 trigger point sites represents the direct influence of segmental mechanisms on the trigger point sensitivity at the infraspinatus site (PPT(seg)). Test subjects demonstrated statistically significant increases in Total Allodynia scores and significant decreases in PPT(seg) at 10, 20, and 30 minutes after application, when compared with control subjects. These results demonstrate that increases in central sensitization evoke increases in trigger point pressure sensitivity in segmentally related muscles.

PERSPECTIVE: Myofascial pain is the most common form of musculoskeletal pain. Myofascial trigger points play an important role in the clinical manifestation of myofascial pain syndrome. Elucidating the role of central sensitization in the pathophysiology of trigger points is fundamental to developing optimal strategies in the management of myofascial pain syndrome.

11 7 636-43 Jul 2010 NO DATA
2 article Carotid dissection associated with a handheld electric massager tx+mx+harms+tools NO DATA Grant et al PubMed #15646768. NO DATA

The extracranial internal carotid artery (ICA) is susceptible to injury and dissection from external shear forces applied to the neck. Traumatic ICA dissection usually occurs in the setting of a sudden, high amplitude force causing significant distortion of surrounding soft tissues. Weaker, repetitive forces applied for longer intervals may also pose a risk for ICA dissection. A 38-year-old woman with no significant stroke risk factors had sudden onset of severe dysarthria and left hemiparesis several days after receiving an approximately 20-minute neck massage with a handheld electric massager. The moving elements consisted of two approximately 2-cm-diameter spheres that percuss the skin with low amplitude and high frequency. Magnetic resonance imaging and angiography demonstrated acute infarction in the right middle cerebral artery territory and dissection of the extracranial right ICA. Handheld electric massager units may cause ICA dissection and disabling stroke.

97 12 1262-3 Dec 2004 NO DATA
NO DATA article Carpal tunnel syndrome in pregnancy ot NO DATA Stolp-Smith et al NO DATA

OBJECTIVE: To determine the frequency, severity, prognosis, and patterns of carpal tunnel syndrome (CTS) in pregnancy.

DESIGN: Descriptive retrospective chart review using the Rochester Epidemiology Project medical record diagnostic indexing system to identify patients with new CTS occurring during pregnancy from 1987 to 1992 at our institution.

SETTING: Obstetrical practice, where two thirds of pregnant women in the county receive primary obstetrical care.

PATIENTS: Women pregnant during 1987 to 1992 who had a new diagnosis of CTS. Women with pregnancies at other dates or women who had CTS with onset before or after pregnancy were excluded.

OUTCOME MEASURES: Age, underlying medical problems, gestation interval, weight gain, number of pregnancies, presenting symptoms, onset and duration of symptoms before diagnosis, trimester of CTS diagnosis, treatment and response, and results of electrophysiologic studies are described.

RESULTS: Of 10,873 pregnant patients receiving antenatal care for 14,579 pregnancies, 50 (.34%) fulfilled the inclusion criteria. Their mean age was 30.5 +/- 4.0 yrs. Twelve patients (24%) were primigravid. Mean weight gain was 12.1 +/- 5.7 kg. CTS was diagnosed most frequently during the third trimester (n = 25, 50%). Symptom onset, when recorded, occurred with even distribution during each trimester: first, n = 11 (32%); second, n = 11 (32%); third, n = 12 (35%). For 37 patients in whom symptom duration was recorded, duration before diagnosis was 9.3 +/- 9.0 weeks. Paresthesia (88%) was most often bilateral (68%), and 67% of patients had pain. The Tinel sign was present over the median nerve at the wrist in 95%. Only nine patients had nerve conduction studies performed. During pregnancy, 37 women were treated nonsurgically with wrist orthoses, steroid injections, or both. Of treated patients for whom follow-up data were available, 25 of 26 improved, and 4 of 26 required surgery. Thirteen women had no treatment during pregnancy; three underwent surgery in the postpartum period. All 7 women in whom conservative treatment failed who underwent surgery had resolution of symptoms.

CONCLUSION: These results represent the frequency and patterns of clinically significant CTS in a large population of pregnant women. CTS severe enough to warrant treatment occurs infrequently in pregnancy and generally resolves spontaneously postpartum or responds to conservative treatment.

79 10 1285–1287 NO DATA 1998 NO DATA
3 article Catastrophic medical events with exhaustive exercise etio NO DATA Knochel PubMed #2232508. NO DATA NO DATA 38 4 709-19 Oct 1990 NO DATA
3 article Causes of excitation-induced muscle cell damage in isometric contractions biolit+ot+strain+tps NO DATA Fredsted et al 1 Intense and unfamiliar exercise damages muscle cell membranes and correlates with a flood of calcium into the cells, causing fatigue. But what causes the damage and starts the flood? Mechanical damage has never been ruled out. This experiment chemically blocked 90% of contraction strength in rats, effectively eliminating physical strain from the contraction equation. The rats’ muscles were then electrically stimulated to simulate exercise without mechanical stress. Unfortunately for the rats — actually, nearly everything about this was unfortunate for the rats — their muscle cell membranes were damaged just exactly as they would have been in a normal, intense rat workout. The implication is clear: cell membranes are damaged in exercise by metabolic stress not mechanical stress. The authors concluded that “cell membrane damage depends on Ca2+ influx and energy status and not on mechanical stress.”

Prolonged or unaccustomed exercise leads to muscle cell membrane damage, detectable as release of the intracellular enzyme lactic acid dehydrogenase (LDH). This is correlated to excitation-induced influx of Ca2+, but it cannot be excluded that mechanical stress contributes to the damage. We here explore this question using N-benzyl-p-toluene sulfonamide (BTS), which specifically blocks muscle contraction. Extensor digitorum longus muscles were prepared from 4-wk-old rats and mounted on holders for isometric contractions. Muscles were stimulated intermittently at 40 Hz for 15-60 min or exposed to the Ca2+ ionophore A23187. Electrical stimulation increased 45Ca influx 3-5 fold. This was followed by a progressive release of LDH, which was correlated to the influx of Ca2+. BTS (50 microM) caused a 90% inhibition of contractile force but had no effect on the excitation-induced 45Ca influx. After stimulation, ATP and creatine phosphate levels were higher in BTS-treated muscles, most likely due to the cessation of ATP-utilization for cross-bridge cycling, indicating a better energy status of these muscles. No release of LDH was observed in BTS-treated muscles. However, when exposed to anoxia, electrical stimulation caused a marked increase in LDH release that was not suppressed by BTS but associated with a decrease in the content of ATP. Dynamic passive stretching caused no increase in muscle Ca2+ content and only a minor release of LDH, whereas treatment with A23187 markedly increased LDH release both in control and BTS-treated muscles. In conclusion, after isometric contractions, muscle cell membrane damage depends on Ca2+ influx and energy status and not on mechanical stress.

292 6 R2249-58 Jun 2007 NO DATA
4 article Central sensitization etio+pain+biolit NO DATA Woolf 1 Pain itself often modifies the way the central nervous system works, so that a patient actually becomes more sensitive and gets more pain with less provocation. That sensitization is called “central sensitization” because it involves changes in the central nervous system (CNS) in particular — the brain and the spinal cord. Victims are not only more sensitive to things that should hurt, but also to ordinary touch and pressure as well. Their pain also “echoes,” fading more slowly than in other people For a more information about this paper, see Pain Changes How Pain Works.

Nociceptor inputs can trigger a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways, the phenomenon of central sensitization. Central sensitization manifests as pain hypersensitivity, particularly dynamic tactile allodynia, secondary punctate or pressure hyperalgesia, aftersensations, and enhanced temporal summation. It can be readily and rapidly elicited in human volunteers by diverse experimental noxious conditioning stimuli to skin, muscles or viscera, and in addition to producing pain hypersensitivity, results in secondary changes in brain activity that can be detected by electrophysiological or imaging techniques. Studies in clinical cohorts reveal changes in pain sensitivity that have been interpreted as revealing an important contribution of central sensitization to the pain phenotype in patients with fibromyalgia, osteoarthritis, musculoskeletal disorders with generalized pain hypersensitivity, headache, temporomandibular joint disorders, dental pain, neuropathic pain, visceral pain hypersensitivity disorders and post-surgical pain. The comorbidity of those pain hypersensitivity syndromes that present in the absence of inflammation or a neural lesion, their similar pattern of clinical presentation and response to centrally acting analgesics, may reflect a commonality of central sensitization to their pathophysiology. An important question that still needs to be determined is whether there are individuals with a higher inherited propensity for developing central sensitization than others, and if so, whether this conveys an increased risk in both developing conditions with pain hypersensitivity, and their chronification. Diagnostic criteria to establish the presence of central sensitization in patients will greatly assist the phenotyping of patients for choosing treatments that produce analgesia by normalizing hyperexcitable central neural activity. We have certainly come a long way since the first discovery of activity-dependent synaptic plasticity in the spinal cord and the revelation that it occurs and produces pain hypersensitivity in patients. Nevertheless, discovering the genetic and environmental contributors to and objective biomarkers of central sensitization will be highly beneficial, as will additional treatment options to prevent or reduce this prevalent and promiscuous form of pain plasticity.

152 2 Suppl S2-15 Oct 2010 NO DATA
NO DATA article Cervical articular contribution to posture and gait neck NO DATA Wyke NO DATA NO DATA 8 4 251–8 Nov 1979 NO DATA
NO DATA article Cervical medial branch blocks for chronic cervical facet joint pain NO DATA NO DATA Manchikanti et al NO DATA

STUDY DESIGN: A double-blind, randomized, controlled trial.

OBJECTIVE: To determine the clinical effectiveness of therapeutic local anesthetic cervical medial branch blocks with or without steroid in managing chronic neck pain of facet joint origin.

SUMMARY OF BACKGROUND DATA: The prevalence of persistent neck pain, secondary to involvement of cervical facet or zygapophysial joints, has been described in controlled studies as varying from 39% to 67%. Intra-articular injections, medial branch nerve blocks, and neurolysis of medial branch nerves have been described in managing chronic neck pain of facet joint origin.

METHODS: A total of 120 patients were included, with 60 patients in each of the local anesthetic and steroid groups. All the patients met the diagnostic criteria of cervical facet joint pain by means of comparative, controlled diagnostic blocks, and the inclusion criteria. Group I consisted of medial branch blocks with bupivacaine. Group II consisted of cervical medial branch blocks with bupivacaine and steroid. Numerical pain scores, Neck Disability Index, opioid intake, and work status were evaluated at baseline, 3 months, 6 months, and 12 months.

RESULTS: Significant pain relief (>or=50%) and functional status improvement was observed at 3 months, 6 months, and 12 months in over 83% of patients. The average number of treatments for 1 year was 3.5 +/- 1.0 in the nonsteroid group and 3.4 +/- 0.9 in the steroid group. Duration of average pain relief with each procedure was 14 +/- 6.9 weeks in the nonsteroid group, and it was 16 +/- 7.9 weeks in the steroid group. Significant relief and functional improvement was reported for 46 to 48 weeks in a year.

CONCLUSION: Therapeutic cervical medial branch nerve blocks, with or without steroids, may provide effective management for chronic neck pain of facet joint origin.

33 17 1813–1820 Aug 2008 NO DATA
5 article Cervical medial branch blocks for chronic cervical facet joint pain neck+tx NO DATA Manchikanti et al PubMed #18670333. This test of needles for neck pain — nerve blocks with either steroids or anaesthetic — has been used to justify quite a bit of enthusiasm about the technique. The evidence is only of moderate quality, however, and there are numerous caveats: although many patients undoubtedly did improve, they didn’t necessarily improve a lot, some did not improve at all, benefits last only 2–6 months, patients received 2-5 treatments over a year, and it’s a minimally invasive strategy. In short, despite improvements, most patients continued to have some degree of erratic symptoms … just like untreated patients. Nerve blocks for neck pain are well worth considering, but are no miracle cure.

STUDY DESIGN: A double-blind, randomized, controlled trial.

OBJECTIVE: To determine the clinical effectiveness of therapeutic local anesthetic cervical medial branch blocks with or without steroid in managing chronic neck pain of facet joint origin.

SUMMARY OF BACKGROUND DATA: The prevalence of persistent neck pain, secondary to involvement of cervical facet or zygapophysial joints, has been described in controlled studies as varying from 39% to 67%. Intra-articular injections, medial branch nerve blocks, and neurolysis of medial branch nerves have been described in managing chronic neck pain of facet joint origin.

METHODS: A total of 120 patients were included, with 60 patients in each of the local anesthetic and steroid groups. All the patients met the diagnostic criteria of cervical facet joint pain by means of comparative, controlled diagnostic blocks, and the inclusion criteria. Group I consisted of medial branch blocks with bupivacaine. Group II consisted of cervical medial branch blocks with bupivacaine and steroid. Numerical pain scores, Neck Disability Index, opioid intake, and work status were evaluated at baseline, 3 months, 6 months, and 12 months.

RESULTS: Significant pain relief (>or=50%) and functional status improvement was observed at 3 months, 6 months, and 12 months in over 83% of patients. The average number of treatments for 1 year was 3.5 +/- 1.0 in the nonsteroid group and 3.4 +/- 0.9 in the steroid group. Duration of average pain relief with each procedure was 14 +/- 6.9 weeks in the nonsteroid group, and it was 16 +/- 7.9 weeks in the steroid group. Significant relief and functional improvement was reported for 46 to 48 weeks in a year.

CONCLUSION: Therapeutic cervical medial branch nerve blocks, with or without steroids, may provide effective management for chronic neck pain of facet joint origin.

33 17 1813-20 Aug 2008 NO DATA
2 article Cervical pain neck+head+tx NO DATA Lavin et al NO DATA From the abstract: “Proper selection of a pillow can significantly reduce pain and improve quality of sleep.” The value of this study is questionable, however, because it was financed by Mediflow Water Pillow, Ltd.

OBJECTIVE: To compare three pillows with regard to pain intensity, pain relief, quality of sleep, disability, and overall satisfaction in subjects with benign cervical pain. The three pillows evaluated were the subjects' usual pillow, a roll pillow, and a water-based pillow.

STUDY DESIGN: Subjects used their usual pillows for the first week of this 5-week randomized crossover design study. They were subsequently randomly assigned to use each of the other two pillows for 2-week periods.

SETTING: Outpatient neurology and physiatry clinics.

PATIENTS: Forty-one subjects with benign cervical pain syndromes and free of cognitive impairments.

MAIN OUTCOME MEASURES: Visual analog scale (VAS), Sleep Questionnaire, Sickness Impact Profile (SIP), and a satisfaction scale rating the pillows.

RESULTS: The water-based pillow was associated with reduced morning pain intensity, increased pain relief, and improved quality of sleep. The duration of sleep was significantly shorter for the roll pillow. Overall SIP findings showed a significant advantage for the water-based pillow over the roll pillow and standard pillow.

CONCLUSIONS: Proper selection of a pillow can significantly reduce pain and improve quality of sleep but does not significantly affect disability outcomes measured by the SIP.

78 2 193–8 Feb 1997 NO DATA
3 article Cervical Spine Disorders neck NO DATA Zylbergold et al PubMed #3914085. A straightforward experiment: four groups of about 25 patients each received one of three different types of traction or no traction, and although everyone “regardless of group assignment, improved significantly” one group stood out: “patients receiving intermittent traction performed significantly better than those assigned to the no traction group.” That sounds really great, but remember that it just takes a couple of odd cases to throw the stats out of whack with test groups that small.

A randomized clinical trial was conducted to evaluate the efficacy of three commonly employed forms of traction in the treatment of cervical spine disorders. One hundred consenting men and women with disorders of the cervical spine were randomly assigned to one of four treatment groups, static traction, intermittent traction, manual traction, or no traction. All patients, regardless of group assignment, were seen twice weekly. The four groups were shown to be similar with regard to age, sex, diagnosis, chronicity, and prescores on the seven outcome measures. Although the entire cohort of neck patients, regardless of group assignment, improved significantly on all the outcome variables over the 6-week period, patients receiving intermittent traction performed significantly better than those assigned to the no traction group in terms of pain (P = 0.03), forward flexion (P = 0.01), right rotation (P = 0.004) and left rotation (P = 0.05).

292 NO DATA 867–871 NO DATA 1985 NO DATA
3 article Cervical spine manipulation neck+chiro+quack+smt NO DATA Leon-Sanchez et al PubMed #17330693. According to these authors, “Stroke as a complication of cervical manipulation … of the vertebral arteries (VAD) is a rare but well recognized problem.”

There are multiple reports in the literature of serious and at times fatal complications after cervical spine manipulation therapy (CSMT), even though CSMT is considered by some health providers to be an effective and safe therapeutic procedure for head and neck pain syndromes. We report a case of a young female with cervicalgia and headache with fatal posterior circulation cerebrovascular accident after CSMT. Serious complications are infrequent, with a reported incidence between one per 100,000 to one in 2 million manipulations. The most frequent injuries involve artery dissection or spasm. Stroke as a complication of cervical manipulation and dissection of the vertebral arteries (VAD) is a rare but well recognized problem. Neck pain, headache, vertigo, vomiting and ataxia are typical symptoms of VAD, but this vascular injury also can be asymptomatic. The most common risk factors are migraine, hypertension, oral contraceptive pills and smoking. Stroke following CSMT is more common than the literature reports. The best values derive from retrospective surveys. The lack of identifiable risk factors place those who undergo CSMT at risk of neurologic damage. Accurate patient information and early recognition of the symptoms are important to avoid catastrophic consequences.

100 2 201–203 NO DATA 2007 NO DATA
4 article Challenging the American College of Sports Medicine 2009 Position Stand on Resistance Training exercise+quack NO DATA Carpinelli 1 Ralph Carpinelli strongly criticized the American College of Sports Medicine’s old position on “more is better” strength training advice, and he does so again with their 2009 position. It’s generally dry reading by necessity — refuting official positions published by major professional organizations requires tedious, thorough academic analysis — but the Discussion and Conclusions sections are almost entertaining. After presenting numerous examples of incredibly sloppy citing, Carpinelli fairly concludes:
Because ACSM Position Stands are so bereft of any science and apparently not open to criticism, there is very little expectation that the ACSM or its Position Stands will gain any respect from those who carefully read the studies and evaluate all the evidence. Readers can decide on the validity of the ACSM’s claims and recommendations and whether those claims and recommendations belong in a Position Stand supported by science or perhaps in an Opinion Statement supported by opinions.
Zing! Carpinelli also discloses the rather sordid details of the ACSM’s reaction to his criticisms: in 2002, he was “removed from the review process after challenging many of the references” and his criticisms have been ignored ever since, despite the fact that they are clearly substantive. (This paper is discussed in quite a bit more detail in Strength Training Frequency.)
NO DATA 13 2 1734-2260 June 2009 NO DATA
NO DATA article Changes in lumbar muscle activity because of induced muscle pain evaluated by muscle functional magnetic resonance imaging NO DATA NO DATA Dickx et al NO DATA

STUDY DESIGN: Experimental study of changes in muscle recruitment during trunk extension exercise at 40% of the repetition maximum, because of induced muscle pain.

OBJECTIVE: To investigate the effect of lumbar muscle pain on muscle activity of the trunk muscles using muscle functional magnetic resonance imaging.

SUMMARY OF BACKGROUND DATA: Changed muscle recruitment in patients has an important impact on the etiology and recurrence of low back pain. The mechanisms of these changes in muscle activity are still poorly understood. An experimental study investigating the cause-effect relationship of muscle pain on muscle recruitment patterns can help to clarify these mechanisms.

METHODS: In 15 healthy subjects, the muscle activity of the lumbar multifidus, lumbar erector spinae, and psoas muscles was investigated with muscle functional magnetic resonance imaging. Measurements at rest and after trunk extension exercise at 40% of repetition maximum were performed without and with induced pain.

RESULTS: The lumbar multifidus and lumbar erector spinae were significantly active during the trunk extension exercise, whereas the psoas showed no significant activity. The activity of the lumbar multifidus, lumbar erector spinae, and psoas muscles, was reduced bilaterally and multilevel during the exercise with unilateral low back muscle pain.

CONCLUSION: These data demonstrate that unilateral muscle pain can cause hypoactivity of muscles during trunk extension at 40% of the repetition maximum. The changes were not limited to the side and level of pain. Moreover, the inhibition was not limited to the multifidus muscle; also the lumbar erector spinae and psoas muscles showed decreased activity during the pain condition. Further research has to assess possible compensation mechanisms for this reduced activity in other muscles.

33 26 E983-9 Dec 15 2008 NO DATA
3 article Changes in muscle mass depending on training frequency and level of experience exercise NO DATA Wirth et al This study shows that strength and muscle mass increase proportionately with more frequent training bouts. This is a notable exception: most such studies show that increased training frequency does not deliver proportionately greater results. However, in this experiment “all groups showed significant gains in muscle mass with a tendency of better training results when doing two or three training sessions a week. No difference could be found between the groups (beginners/advanced) with the same training frequency.”

The major goal of this study was to find a training frequency that promises optimum success in the proliferation of muscle mass by measu- ring muscle size before and 2 weeks after an 8-week training cycle. 30 men with at least half a year (beginner = A) and 30 with at least 2 years (advanced = F) of strength training experience participated in this study. The subjects were divided into six groups of 10 individuals each, who had to go through a hypertrophy training program for arm bends with a frequency of one (A1 / F1), two (A2 / F2) and three (A3 / F3) training sessions per week up to 8 weeks altogether. The size of the elbow flexors was determined by magnetic resonance imaging (MRI). 96 transversal images with a thickness of 1.67 mm were collected per subject. Thus a region 16.03 cm of the upper arm was examined. The statistical handling of the data consisted of an analysis of variance (with a repetition of the measurements) and the Scheffé-test (p < 0.05) as a post-hoc test. Except for the group of advanced athletes and a training frequency of once a week, all groups showed significant gains in muscle mass with a tendency of better training results when doing two or three training sessions a week. No difference could be found between the groups (beginners/advanced) with the same training frequency.

56 6 NO DATA NO DATA 2007 NO DATA
5 article Changes in nerve root motion and intraradicular blood flow during an intraoperative straight-leg-raising test back+surgery+nerve NO DATA Kobayashi et al PubMed #1283810. Kobayashi et al. surgically examined blood flow to a lumbar nerve root while the leg was in a position that caused pain. (They studied twelve people with symptomatic disk herniations and nerve pain.) They found that “the intraoperative reverse SLR test showed that the hernia compressed the nerve roots, and that there was marked disturbance of gliding, which was reduced to only a few millimeters,” and that “During the test, intraradicular blood flow showed a sharp decrease [40 to 98%] at the angle that produced sciatica.” In this case, it’s probably the physical distortion of the nerve root that caused the loss of circulation, and the combination of the two that was painful. “After removal of the hernia, all the patients showed smooth gliding of the nerve roots during the second intraoperative test, and there was no marked decrease in intraradicular blood flow.”

STUDY DESIGN: An intraoperative straight-leg-raising (SLR) test was conducted to investigate patients with lumbar disc herniation to observe the changes in intraradicular blood flow, which then were compared with the clinical features.

OBJECTIVE: The legs of each patient were hung down from the operating table as a reverse SLR test during surgery, and intraradicular blood flow was measured.

SUMMARY OF BACKGROUND DATA: It is not known whether intraradicular blood flow changes during the SLR test in patients with lumbar disc herniation.

METHODS: The subjects were 12 patients with lumbar disc herniation who underwent microdiscectomy. The patients were asked to adopt the prone position immediately before surgery, so that their legs hung down from the operating table. A reverse SLR test was performed to confirm the angle at which sciatica developed. During the operation, the nerve roots affected by the hernia were observed under a microscope. Then the needle sensor of a laser Doppler flow meter was inserted into each nerve root immediately above the hernia. The patient's legs were allowed to hang down to the angle at which sciatica had occurred, and the change in intraradicular blood flow was measured. After removal of the hernia, a similar procedure was repeated, and intraradicular blood flow was measured again.

RESULTS: Intraoperative microscopy showed that the hernia was adherent to the dura mater of the nerve roots in all patients. The intraoperative reverse SLR test showed that the hernia compressed the nerve roots, and that there was marked disturbance of gliding, which was reduced to only a few millimeters. During the test, intraradicular blood flow showed a sharp decrease at the angle that produced sciatica, which lasted for 1 minute. Intraradicular flow decreased by 40% to 98% (average, 70.6% +/- 20.5%) in the L5 nerve root, and by 41% to 96% (average, 72.0% +/- 22.9%) in the S1 nerve roots relative to the blood flow before the test. At 1 minute after completion of the test, intraradicular blood flow returned to the value obtained at baseline. After removal of the hernia, all thepatients showed smooth gliding of the nerve roots during the second intraoperative test, and there was no marked decrease in intraradicular blood flow.

CONCLUSIONS: This study demonstrated that the blood flow in the nerve root is reduced when the nerve root is compressed in vivo.

28 13 1427–34 Jul 1 2003 NO DATA
NO DATA article Changes in serum leptin and beta endorphin levels with weight loss by electroacupuncture and diet restriction in obesity treatment acu+ot+nutrition NO DATA Cabyoglu et al PubMed #16173527. NO DATA NO DATA 34 1 1–11 NO DATA 2006 NO DATA
NO DATA book Chiropractic Fraud and Abuse chiro+quack NO DATA Long SBM’s review by Dr. Hall calls A Chiropractor’s Lament a “valuable addition to the literature on chiropractic, combining Long’s personal story with everything you never wanted to know about chiropractic. It’s fun to read and packed with information. Even if you think you’ve heard it all before, there are revelations here that will be new to you, that will elicit surprise, indignation, and laughter.” NO DATA NO DATA NO DATA NO DATA NO DATA 2013 American Council on Science & Health
NO DATA article Chiropractic smt+chiro NO DATA Ernst PubMed #18280103. NO DATA

Chiropractic was defined by D.D. Palmer as "a science of healing without drugs." About 60,000 chiropractors currently practice in North America, and, worldwide, billions are spent each year for their services. This article attempts to critically evaluate chiropractic. The specific topics include the history of chiropractic; the internal conflicts within the profession; the concepts of chiropractic, particularly those of subluxation and spinal manipulation; chiropractic practice and research; and the efficacy, safety, and cost of chiropractic. A narrative review of selected articles from the published chiropractic literature was performed. For the assessment of efficacy, safety, and cost, the evaluation relied on previously published systematic reviews. Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today. Currently, there are two types of chiropractors: those religiously adhering to the gospel of its founding fathers and those open to change. The core concepts of chiropractic, subluxation and spinal manipulation, are not based on sound science. Back and neck pain are the domains of chiropractic but many chiropractors treat conditions other than musculoskeletal problems. With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition. Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence. Its cost-effectiveness has not been demonstrated beyond reasonable doubt. The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.

35 5 544-62 May 2008 NO DATA
4 article A Clinical Trial of Neuromuscular Electrical Stimulation in Improving Quadriceps Muscle Strength and Activation Among Women With Mild and Moderate Osteoarthritis tx+arthritis+pfps+knee+tools NO DATA Palmieri-Smith et al PubMed #20671100. NMES (Neuromuscular electrical stimulation) has already shown that it can be effective in improving the strength and activatation of quadriceps following knee replacement. But it is not known if this same treatment is effective in people with early radiographic osteoarthritis. In a randomized controlled trial, thirty women with mild and moderate knee osteoarthritis were assigned to receive either no treatment or NMES treatments 3 times per week for 4 weeks. The results showed no difference between the two groups, but there were limitations to the study.

BACKGROUND: Neuromuscular electrical stimulation (NMES) has demonstrated efficacy in improving quadriceps muscle strength (force-generating capacity) and activation following knee replacement and ligamentous reconstruction. Yet, data are lacking to establish the efficacy of NMES in people with evidence of early radiographic osteoarthritis.

OBJECTIVE: The purpose of this study was to determine whether NMES is capable of improving quadriceps muscle strength and activation in women with mild and moderate knee osteoarthritis.

DESIGN: This study was a randomized controlled trial.

METHODS: Thirty women with radiographic evidence of mild or moderate knee osteoarthritis were randomly assigned to receive either no treatment (standard of care) or NMES treatments 3 times per week for 4 weeks. The effects of NMES on quadriceps muscle strength and activation were evaluated upon study enrollment, as well as at 5 and 16 weeks after study enrollment, which represent 1 and 12 weeks after cessation of NMES among the treated participants. The Western Ontario and McMaster Universities Osteoarthritis Index and a 40-foot (12.19-m) walk test were used at each testing session.

RESULTS: Improvements in quadriceps muscle strength or activation were not realized for the women in the intervention group. Quadriceps muscle strength and activation were similar across testing sessions for both groups.

LIMITATIONS: Women were enrolled based on radiographic evidence of osteoarthritis, not symptomatic osteoarthritis, which could have contributed to our null finding. A type II statistical error may have been committed despite an a priori power calculation. The assessor and the patients were not blinded to group assignment, which may have introduced bias into the study.

CONCLUSIONS: Four weeks of NMES delivered to women with mild and moderate osteoarthritis and mild strength deficits was insufficient to induce gains in quadriceps muscle strength or activation. Future research is needed to examine the dose-response relationship for NMES in people with early radiographic evidence of osteoarthritis.

NO DATA NO DATA NO DATA Jul 2010 NO DATA
NO DATA article Chiropractic Science and Antiscience and Pseudoscience Side by Side chiro NO DATA Keating NO DATA

Many [chiropractic] schools are magnets for New Agers, theosophists, magical and mystical thinkers, and those attracted y the low admissions standards and the lure of a lucractive private practice .... Moreover, since the largest chiropractic colleges tend to have the strongest commitment to dogma, fuzzy thinkers are likely to fill the chiropractic ranks for decades to come.

21 4 37–43 NO DATA 1997 NO DATA
NO DATA article Chiropractic chiro+quack+neck+back+smt NO DATA Homola NO DATA

Chiropractic is one of the most controversial and poorly defined healthcare professions with recognition and licensure in the United States. Chiropractic was started by D. D. Palmer, a magnetic healer who formulated the vertebral subluxation theory. The profession was developed by his son, B. J. Palmer. Although the definition of chiropractic as a method of correcting vertebral subluxations to restore and maintain health is questionable, spinal manipulation is of value in the treatment of some types of back pain. The chiropractic profession is still based on the vertebral subluxation theory, and has the confusing image of a back specialty capable of treating a broad scope of health problems. Despite opposition to use of spinal manipulation as a method of treating a broad scope of health problems (as opposed to the generally accepted use of manipulation in the treatment of back pain), chiropractors seek support as primary care providers in alternative medicine. It is essential to understand the theories, philosophies, and methods of chiropractic for an objective evaluation.

444 NO DATA 236–242 Mar 2006 NO DATA
5 article Chondromalacia of the patella knee+run NO DATA Stougard PubMed #1199720. Here’s the salient excerpt from the abstract: “In a post-mortem series of 59 persons aged 10-50 years, 91 of the 118 patellae exhibited cartilaginous changes.” Wow! That’s a lot of degenerating kneecaps! NO DATA 46 5 809–22 Nov 1975 NO DATA
NO DATA article Choosing a skeletal muscle relaxant meds+back NO DATA See et al 1 From the abstract: “These drugs have not been proven to be superior to acetaminophen or nonsteroidal anti-inflammatory drugs for low back pain.”

Skeletal muscle relaxants are widely used in treating musculoskeletal conditions. However, evidence of their effectiveness consists mainly of studies with poor methodologic design. In addition, these drugs have not been proven to be superior to acetaminophen or nonsteroidal anti-inflammatory drugs for low back pain. Systematic reviews and meta-analyses support using skeletal muscle relaxants for short-term relief of acute low back pain when nonsteroidal anti-inflammatory drugs or acetaminophen are not effective or tolerated. Comparison studies have not shown one skeletal muscle relaxant to be superior to another. Cyclobenzaprine is the most heavily studied and has been shown to be effective for various musculoskeletal conditions. The sedative properties of tizanidine and cyclobenzaprine may benefit patients with insomnia caused by severe muscle spasms. Methocarbamol and metaxalone are less sedating, although effectiveness evidence is limited. Adverse effects, particularly dizziness and drowsiness, are consistently reported with all skeletal muscle relaxants. The potential adverse effects should be communicated clearly to the patient. Because of limited comparable effectiveness data, choice of agent should be based on side-effect profile, patient preference, abuse potential, and possible drug interactions.

78 3 365-70 Aug 2008 NO DATA
4 article Choosing between NSAID and arnica for topical treatment of hand osteoarthritis in a randomised, double-blind study homeo+quack NO DATA Widrig et al 1 A small study of the use of topical preparations for relief of osteoarthritis. Ibuprofen and arnica tincture were used with 204 patients to ascertain differences in pain relief and hand function after 21 days of treatment. Conclusion: “There were no differences between the two groups in pain and hand function improvements, or in any secondary end points evaluated. Adverse events were reported by six patients (6.1%) on ibuprofen and by five patients (4.8%) on arnica. Our results confirm that this preparation of arnica is not inferior to ibuprofen when treating osteoarthritis of hands.”

The use of topical preparations for symptom relief is common in osteoarthritis. The effects of ibuprofen (5%) and arnica (50 g tincture/100 g, DER 1:20), as gel preparations in patients with radiologically confirmed and symptomatically active osteoarthritis of interphalangeal joints of hands, were evaluated in a randomised, double-blind study in 204 patients, to ascertain differences in pain relief and hand function after 21 days' treatment. Diagnosis was according to established criteria; primary endpoints were pain intensity and hand function; statistical design was as per current regulatory guidelines for testing topical preparations. There were no differences between the two groups in pain and hand function improvements, or in any secondary end points evaluated. Adverse events were reported by six patients (6.1%) on ibuprofen and by five patients (4.8%) on arnica. Our results confirm that this preparation of arnica is not inferior to ibuprofen when treating osteoarthritis of hands.

27 6 585-91 Apr 2007 NO DATA
4 article A review of mechanics and injury trends among various running styles run+shoes+rsi+itbs+pfps+pf+shin NO DATA Goss et al PubMed #22815167. Can any running style or shoe type prevent running injuries? This is one of those reviews of the virtually non-existent literature. The authors speculate, as many others have, that styles and shoes probably involve risk trade-offs: less risk of one kind of injury, but more of another. But mostly the paper inevitably confirms that, as of 2012, there is no hard data about this and “more research is needed.”

CONTEXT: Running related overuse injuries are a significant problem with half of all runners sustaining an injury annually. Many medical providers and coaches question how to advise their running clients to prevent injuries. Alternative running styles with a more anterior footstrike such as barefoot running, POSE running, and Chi running are becoming more popular. Little information, however, has been published comparing the mechanics and injury trends of different running styles.

OBJECTIVE: The original purpose of this paper was to examine evidence concerning the biomechanics and injury trends of different running styles. Little to no injury data separated by running style existed. Therefore, we discuss the biomechanics of different running styles and present biomechanical findings associated with different running injuries.

DATA SOURCES: English language articles published in peer reviewed journals were identified by searching PubMed, CINAHL, and SPORTDiscus databases. Nearly all of the studies identified by the search were observational studies.

RESULTS: A more anterior initial foot contact present in barefoot or other alternative running styles may decrease or eliminate the initial vertical ground reaction peak or "impact transient," possibly reducing knee joint loads and injuries. A more anterior foot strike, however, may increase mechanical work at the ankle and tensile stress within the plantarflexors. Wearing minimal footwear may also increase contact pressure imposed on the metatarsals.

CONCLUSION: More research is needed to determine which individuals with certain morphological or mechanical gait characteristics may benefit from alternative running styles that incorporate a more anterior initial foot contact with or without shoes.

NO DATA NO DATA 62-71 NO DATA 2012 NO DATA
NO DATA article Chronic exertional compartment syndrome in a collegiate soccer player shin+surgery+tx NO DATA Farr et al NO DATA

Chronic exertional compartment syndrome is a relatively rare condition among running athletes. In those who engage in repetitive activity, it can cause severe, debilitating leg pain. The diagnosis can be made with a thorough workup that includes history and physical examination, radiologic studies (x-rays, magnetic resonance imaging, bone scan), and compartment pressure monitoring. Most patients do not respond well to nonoperative intervention. Fasciotomy provides satisfactory relief of symptoms and helps patients return to their sports. We present the case of a high-level collegiate soccer player with chronic exertional compartment syndrome.

37 7 374–377 Jul 2008 NO DATA
NO DATA article Chronic insomnia as a risk factor for developing anxiety and depression ot+mind NO DATA Neckelmann et al The results of this very large and well-conducted survey are “consistent with insomnia being a risk factor for the development of anxiety disorders.”

OBJECTIVE: To study prospectively the relations of insomnia to the development of anxiety disorders and depression in a population-based sample.

DESIGN: Cohort study based on data from 2 general health surveys of the adult population.

SETTING: Two general health surveys in the adult population in Nord-Trondelag County of Norway, HUNT-1 performed in 1984-6 and HUNT-2 in 1995-7 participants: participants without significant anxiety and depression in HUNT-1 were categorized according to the presence and absence of insomnia in the 2 surveys (N=25,130).

MEASUREMENTS AND RESULTS: Anxiety disorders and depression in HUNT-2 were assessed by the Hospital Anxiety and Depression Scale and analyzed using multivariate logistic regression analysis adjusted for age, gender, education, comorbid depression/anxiety, and history of insomnia. Anxiety disorders in HUNT-2 were significantly associated with the group with insomnia in HUNT-1 only (OR 1.6; 95% CI, 1.1-2.3), the group with insomnia in HUNT-2 only (OR 3.4; 95% CI, 3.1-3.8), as well as with the group with insomnia in both surveys (OR 4.9; 95% CI, 3.8-6.4). Depression in HUNT-2 was significantly associated with the group with insomnia in HUNT-2 only (OR 1.8; 95% CI, 1.6-2.0), but not with the groups with insomnia in HUNT-1 only or with insomnia in both surveys.

CONCLUSIONS: Only a state-like association between insomnia and depression was found. In addition to being a state marker, insomnia may be a trait marker for individuals at risk for developing anxiety disorders. Results are consistent with insomnia being a risk factor for the development of anxiety disorders.

30 7 873–880 NO DATA 2007 NO DATA
3 article Chronic mechanical neck pain in adults treated by manual therapy neck+chiro+smt+mx+exercise+tx+tps NO DATA Vernon et al 1 “There is moderate-to-high quality evidence that immediate clinically important improvements are obtained from a single session of spinal manipulation. The evidence for mobilization is less substantial, with fewer studies reporting smaller immediate changes.”

We report a systematic analysis of group change scores of subjects with chronic neck pain not due to whiplash and without headache or arm pain, in randomized clinical trials of a single session of manual therapy. A comprehensive literature search of clinical trials of chronic neck pain treated with manual therapies up to December 2006 was conducted. Trials that scored above 60% on the PEDro Scale were included. Change scores were analyzed for absolute, percentage change and effect size (ES) whenever possible. Nine trials were identified: 6 for spinal manipulation, 4 for spinal mobilization or non-manipulative manual therapy (2 overlapping trials), and 1 trial using ischemic compression. No trials were identified for massage therapy or manual traction. Four manipulation trials (five groups) reported mean immediate changes in 100-mm VAS of -18.94 (9.28) mm. ES for these changes ranged from .33 to 2.3. Two mobilization trials reported immediate VAS changes of -11.5 and -4 mm (ES of .36 and .22, respectively); one trial reported no difference in immediate pain scores versus sham mobilization. The ischemic compression study showed statistically significant immediate decreases in 100-mm pain VAS (average = -14.6 mm). There is moderate-to-high quality evidence that immediate clinically important improvements are obtained from a single session of spinal manipulation. The evidence for mobilization is less substantial, with fewer studies reporting smaller immediate changes. There is insufficient evidence for ischemic compression to draw conclusions. There is no evidence for a single session of massage or manual traction for chronic neck pain.

16 2 E42-52 NO DATA 2008 NO DATA
NO DATA article Chronic neck pain and whiplash neck NO DATA Freeman et al PubMed #16770448. From the abstract: “… it is reasonable to infer that a significant proportion of individuals with chronic neck pain in the general population were originally injured in a motor vehicle accident.” See also Atherton.

The authors undertook a case-control study of chronic neck pain and whiplash injuries in nine states in the United States to determine whether whiplash injuries contributed significantly to the population of individuals with chronic neck and other spine pain. Four hundred nineteen patients and 246 controls were randomly enrolled. Patients were defined as individuals with chronic neck pain, and controls as those with chronic back pain. The two groups were surveyed for cause of chronic pain as well as demographic information. The two groups were compared using an exposure-odds ratio. Forty-five per cent of the patients attributed their pain to a motor vehicle accident. An OR of 4.0 and 2.1 was calculated for men and women, respectively. Based on the results of the present study, it is reasonable to infer that a significant proportion of individuals with chronic neck pain in the general population were originally injured in a motor vehicle accident.

11 2 79–83 NO DATA 2006 NO DATA
2 article Chronic neck pain neck+acu NO DATA Borenstein Just about the only thing I agree with in this review of neck pain interventions from Current Pain & Headache Reports is that “there are few evidence-based studies that document efficacy of therapies for neck pain.” In spite of acknowledging this, Borenstein goes on to make unjustified positive conclusions about several neck pain therapies for which there is, in fact, no compelling evidence — especially acupuncture and corticosteroid injections, which are not actually promising treatments at all.

Chronic neck pain is a common patient complaint. Despite its frequency as a clinical problem, there are few evidence-based studies that document efficacy of therapies for neck pain. The treatment of this symptom is based primarily on clinical experience. Preventing the development of chronic neck pain can be achieved by modification of the work environment with chairs that encourage proper musculoskeletal movement. The use of neck supports for sleep and active neck exercises together can improve neck pain. Passive therapies, including massage, acupuncture, mechanical traction, and electrotherapy, have limited benefit when measured by clinical trial results. NSAIDs, muscle relaxants, and pure analgesics are the mainstays of therapy. Local injections of anesthetics with or without soluble corticosteroid preparations offer additional pain relief. The purpose of these agents is to diminish pain to facilitate normal neck movement. Surgical therapy with cervical spine fusion is indicated for the rare patient with intractable neck pain resistant to all nonsurgical therapies.

11 6 436–439 Dec 2007 NO DATA
3 article Chronic pain, overweight, and obesity etio+back+pain+mind+psb NO DATA Wright et al PubMed #20338816. Does it hurt to be heavy? It seems possible, and in this study “obese twins were more likely to report low back pain.” But it’s not that simple: there are many variables involved. For instance, several other pain problems were also more likely: “migraine headaches, fibromyalgia, abdominal pain, and chronic widespread pain.” Weight is associated with more pain in general, not low back pain specifically, as you’d expect if the problem were simply due to compression of the spine. Clearly that typical assumption is not a safe one, and indeed the apparent connection between weight and pain weakened when the data were adjusted for common denominators like depression, a strongly confirmed risk factor for low back pain. In other words, if you factored out the depressed cases, the remaining subjects were not all that likely to have back pain. Given such complexity, the researchers made it clear that more and different research is needed to figure out what, exactly, is causing what. No kidding!

Chronic pain and obesity, and their associated impairments, are major health concerns. We estimated the association of overweight and obesity with 5 distinct pain conditions and 3 pain symptoms, and examined whether familial influences explained these relationships. We used data collected from 3,471 twins in the community-based University of Washington Twin Registry.

Twins reported sociodemographic data, current height and weight, chronic pain diagnoses and symptoms, and lifetime depression. Overweight and obese were defined as body mass index of 25.0 to 29.9 kg/m(2) and >or= 30.0 kg/m(2), respectively. Generalized estimating equation regression models, adjusted for age, gender, depression, and familial/genetic factors, were used to examine the relationship between chronic pain, and overweight and obesity.

Overall, overweight and obese twins were more likely to report low back pain, tension-type or migraine headache, fibromyalgia, abdominal pain, and chronic widespread pain than normal-weight twins after adjustment for age, gender, and depression. After further adjusting for familial influences, these associations were diminished. The mechanisms underlying these relationships are likely diverse and multifactorial, yet this study demonstrates that the associations can be partially explained by familial and sociodemographic factors, and depression. Future longitudinal research can help to determine causality and underlying mechanisms.

PERSPECTIVE: This article reports on the familial contribution and the role of psychological factors in the relationship between chronic pain, and overweight and obesity. These findings can increase our understanding of the mechanisms underlying these 2 commonly comorbid sets of conditions.

11 7 628-35 Jul 2010 NO DATA
2 article Chronic shoulder pain of myofascial origin mx+tps NO DATA Hains et al PubMed #20605555. In this clinical trial, researchers evaluated the effect of 15 treatments of ischemic compression — pressing and holding trigger points (muscle knots) — for patients with shoulder pain. Trigger points in the supraspinatus, infraspinatus, deltoid and biceps muscles were treated in 41 patients, and the results compared to 18 who received the same treatment but in other muscles (the cervical and upper thoracic areas). A score measuring shoulder discomfort went down a whopping 75% in those treated, compared to a mere 30% reduction in people who received treatment in a nearby location. The authors concluded: “The results of this study suggest that myofascial therapy using ischemic compression on shoulder trigger points may reduce the symptoms of patients experiencing chronic shoulder pain.” This study may show only that poking people’s trigger points gives great placebo. An obvious problem with this experiment is that it compared treatment in the right place to treatment in the wrong place. Patients in the control group would have been well aware that pressure was being applied in muscles mostly irrelevant to their shoulder pain, probably decreasing their satisfaction and expectation of benefit. Meanwhile, people getting treatment in the “right” place will likely feel much better about the treatment and have a much higher hopes: rich soil for a placebo effect.

OBJECTIVE: The aim of this clinical trial was to evaluate the effect of 15 myofascial therapy treatments using ischemic compression on shoulder trigger points in patients with chronic shoulder pain.

METHODS: Forty-one patients received 15 experimental treatments, which consisted of ischemic compressions on trigger points located in the supraspinatus muscle, the infraspinatus muscle, the deltoid muscle, and the biceps tendon. Eighteen patients received the control treatment involving 15 ischemic compression treatments of trigger points located in cervical and upper thoracic areas. Of the 18 patients forming the control group, 16 went on to receive 15 experimental treatments after having received their initial control treatments. Outcome measures included a validated 13-question questionnaire measuring shoulder pain and functional impairment. A second questionnaire was used to assess patients' perceived amelioration, using a scale from 0% to 100%. Outcome measure evaluation was completed for both groups at baseline after 15 treatments, 30 days after the last treatment, and finally for the experimental group only, 6 months later.

RESULTS: A significant group x time interval interaction was observed after the first 15 treatments, indicating that the experimental group had a significant reduction in their Shoulder Pain and Disability Index (SPADI) score compared with the control group (62% vs 18% amelioration). Moreover, the patients perceived percentages of amelioration were higher in the experimental group after 15 treatments (75% vs 29%). Finally, the control group subjects significantly reduced their SPADI scores after crossover (55%).

CONCLUSION: The results of this study suggest that myofascial therapy using ischemic compression on shoulder trigger points may reduce the symptoms of patients experiencing chronic shoulder pain.

33 5 362-9 Jun 2010 NO DATA
NO DATA article Classification of sagittal thoraco-lumbo-pelvic alignment of the adolescent spine in standing and its relationship to low back pain etio+back+psb NO DATA Smith et al PubMed #18758367. NO DATA

STUDY DESIGN: A prospective study of the sagittal standing posture of 766 adolescents.

OBJECTIVE: To determine whether posture subgroups based on photographic assessment are similar to those used clinically and to previous, radiographically determined subgroups of sagittal standing posture, and whether identified subgroups are associated with measures of spinal pain.

SUMMARY OF BACKGROUND DATA: Relatively little research has been performed toward a classification of subjects according to sagittal spinal alignment. Clinical descriptions of different standing posture classifications have been reported, and recently confirmed in a radiographic study. There is limited epidemiological data available to support the belief that specific standing postures are associated with back pain, despite plausible mechanisms. As posture assessment using radiographic methods are limited in large population studies, successful characterization of posture using 2-dimensional photographic images will enable epidemiological research of the association between posture types and spinal pain. METHODS.: Three angular measures of thoraco-lumbo-pelvic alignment were calculated from lateral standing photographs of subjects with retro-reflective markers placed on bony landmarks. Subgroups of sagittal thoracolumbar posture were determined by cluster analysis of these 3 angular measures. Back pain experience was assessed by questionnaire. The associations between posture subgroups and spinal pain variables were evaluated using logistic regression.

RESULTS: Postural subtypes identified by cluster analysis closely corresponded to those subtypes identified previously by analysis of radiographic spinal images in adults and to those described clinically. Significant associations between posture subgroups and weight, height, body mass index, and gender were identified. Those adolescents classified as having non-neutral postures when compared with those classified as having a neutral posture demonstrated higher odds for all measures of back pain, with 7 of 15 analyses being statistically significant.

CONCLUSION: Meaningful classifications exist for adolescent sagittal thoraco-lumbo-pelvic alignment, and these can be determined successfully from sagittal photographs. More neutral thoraco-lumbo-pelvic postures are associated with less back pain.

33 19 2101-7 Sep 2008 NO DATA
3 article Clinical application of electrotherapeutic modalities tools NO DATA Robinson et al 1 This paper is primarily because it was the only available American survey of the prevalence of electrotherapies (such as ultrasound and TENS) for 20 years, until Wong in 2007.

The purposes of this survey study were 1) to determine the frequency of use of eight forms of electrical stimulation and ultrasound in clinical practice and 2) to determine the factors that influence how and when these forms of electrical stimulation are used. A survey questionnaire was distributed to 490 physical therapists in clinics affiliated with the academic programs of Ithaca College and Temple University. Forty-five percent (221) of the distributed surveys were returned. Descriptive statistics and chi-square calculations were used in the data analysis. Respondents frequently used two forms of pulsed current and rarely used two forms of alternating current. No form of electrical current was used as frequently as ultrasound. The frequency and type of electrical stimulation used depended on the availability of electrical stimulators and the adequacy of entry-level training in electrotherapy. The results of this study suggest the need for additional electrical stimulators in physical therapy clinics, training for physical therapists, and research in electrotherapy.

68 8 1235-8 Aug 1988 NO DATA
3 article Clinical assessment of patients with suspected Lyme borreliosis ot+harms+tps NO DATA Ogrinc et al NO DATA NO DATA 298(supplement 1) NO DATA 156-260 NO DATA 2008 NO DATA
4 article A comparison of the effects of 2 types of massage and usual care on chronic low back pain tx+self-tx+back+mx+psb NO DATA Cherkin et al 1 This is one of the only large, long duration studies of massage that has ever been done. Four hundred patients with chronic low back pain were split into three groups: one group got weekly hour-long relaxation massages, another got more advanced therapeutic massage, and patients in a third group got nothing. Unfortunately, the unmassaged patients knew that they were missing out — a serious flaw in the study that the authors believe made massage “seem more superior than it really is” in comparison, and so they found it “difficult to determine the true magnitude of the benefits of massage observed in this trial.” Nevertheless, 60% of massage patients seemed to improve about 30% — about a 2-point drop on a 10-point pain scale, compared to a 1-point drop for patients who did nothing — which is just barely a large enough improvement to be clinically significant with a wee bit of wiggle room. Their gains were lost steadily after the last massage, and there were only small differences between groups after six months, and none after a year. The most useful result from this study is that there was “no clinically meaningful difference between relaxation and structural massage” whatsoever. This was a serious blow to many supposedly “advanced” massage techniques. For an extremely detailed analysis of this research, see: Massage Therapy Kinda, Sorta Works for Back Pain: It works, but not very well, and “advanced” techniques are no better than relaxation massage.

BACKGROUND: Few studies have evaluated the effectiveness of massage for chronic low back pain.

OBJECTIVE: To compare the effectiveness of 2 types of massage and usual care for chronic back pain.

DESIGN: Parallel-group randomized, controlled trial. Randomization was computer-generated, with centralized allocation concealment. Participants were blinded to massage type but not to assignment to massage versus usual care. Massage therapists were unblinded. The study personnel who assessed outcomes were blinded to treatment assignment. (ClinicalTrials.gov registration number: NCT00371384)

SETTING: An integrated health care delivery system in the Seattle area.

PATIENTS: 401 persons 20 to 65 years of age with nonspecific chronic low back pain.

INTERVENTION: Structural massage (n = 132), relaxation massage (n = 136), or usual care (n = 133).

MEASUREMENTS: Roland Disability Questionnaire (RDQ) and symptom bothersomeness scores at 10 weeks (primary outcome) and at 26 and 52 weeks (secondary outcomes). Mean group differences of at least 2 points on the RDQ and at least 1.5 points on the symptom bothersomeness scale were considered clinically meaningful.

RESULTS: The massage groups had similar functional outcomes at 10 weeks. The adjusted mean RDQ score was 2.9 points (95% CI, 1.8 to 4.0 points) lower in the relaxation group and 2.5 points (CI, 1.4 to 3.5 points) lower in the structural massage group than in the usual care group, and adjusted mean symptom bothersomeness scores were 1.7 points (CI, 1.2 to 2.2 points) lower with relaxation massage and 1.4 points (CI, 0.8 to 1.9 points) lower with structural massage. The beneficial effects of relaxation massage on function (but not on symptom reduction) persisted at 52 weeks but were small.

LIMITATION: Participants were not blinded to treatment.

CONCLUSION: Massage therapy may be effective for treatment of chronic back pain, with benefits lasting at least 6 months. No clinically meaningful difference between relaxation and structural massage was observed in terms of relieving disability or symptoms.

PRIMARY FUNDING SOURCE: National Center for Complementary and Alternative Medicine.

155 1 1-9 Jul 2011 NO DATA
NO DATA article Clinical course and prognostic factors in acute low back pain back+nerve NO DATA Coste et al 1 From the abstract: “90% of patients recovered within two weeks and only two developed chronic low back pain.”

OBJECTIVE: To describe the natural course of recent acute low back pain in terms of both morbidity (pain, disability) and absenteeism from work and to evaluate the prognostic factors for these outcomes.

DESIGN: Inception cohort study.

SETTING: Primary care.

PATIENTS: 103 patients with acute localised non-specific back pain lasting less than 72 hours.

MAIN OUTCOME MEASURES: Complete recovery (disappearance of both pain and disability) and return to work.

RESULTS: 90% of patients recovered within two weeks and only two developed chronic low back pain. Only 49 of 100 patients for whom data were available had bed rest and 40% of 75 employed patients lost no time from work. Proportional hazards regression analysis showed that previous chronic episodes of low back pain, initial disability level, initial pain worse when standing, initial pain worse when lying, and compensation status were significantly associated with delayed episode recovery.These factors were also related to abseteeism from work. Absenteeism from work was also influenced by job satisfaction and gender.

CONCLUSIONS: The recovery rate from acute low back pain was much higher than reported in other studies. Those studies, however, did not investigate groups of patients enrolled shortly after the onset of symptoms and often mixed acute low back pain patients with patients with exacerbations of chronic pain or sciatica. Several sociodemographic and clinical factors were of prognostic value in acute low back pain. Factors which incluenced the outcome in terms of episode recovery (mainly physical severity factors) were only partly predictive of absenteeism from work. Time off work and return to work depended more on sociodemographic and job related incluences.

308 NO DATA 577–80 NO DATA 1994 NO DATA
4 article Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee pain+knee+nutrition NO DATA Sawitzke et al PubMed #20525840. Even though osteoarthritis in the knee causes severe pain and dysfunction for many older adults, long-term studies of treatment are few and far between. This research evaluated the efficacy and safety of two popular “supplements_for_pain” — glucosamine, chrondroitin sulphate — as well as the painkiller celecoxib by comparing them to a placebo in over 600 patients over 2 years. None of the treatments worked — less than 2% of patients enjoyed even a 20% improvement. The study authors conclude: “..no treatment achieved a clinically important difference in … pain or function as compared with placebo.” As well, adverse reactions were similar in all groups; serious adverse reactions were rare for all treatments. This adds considerable weight to the already substantial evidence that the popular supplements_for_pain are ineffective.

BACKGROUND: Knee osteoarthritis (OA) is a major cause of pain and functional limitation in older adults, yet longer-term studies of medical treatment of OA are limited.

OBJECTIVE: To evaluate the efficacy and safety of glucosamine and chondroitin sulphate (CS), alone or in combination, as well as celecoxib and placebo on painful knee OA over 2 years.

METHODS: A 24-month, double-blind, placebo-controlled study, conducted at nine sites in the US ancillary to the Glucosamine/chondroitin Arthritis Intervention Trial, enrolled 662 patients with knee OA who satisfied radiographic criteria (Kellgren/Lawrence grade 2 or 3 changes and baseline joint space width of at least 2 mm). This subset continued to receive their randomised treatment: glucosamine 500 mg three times daily, CS 400 mg three times daily, the combination of glucosamine and CS, celecoxib 200 mg daily, or placebo over 24 months. The primary outcome was a 20% reduction in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain over 24 months. Secondary outcomes included an Outcome Measures in Rheumatology/Osteoarthritis Research Society International response and change from baseline in WOMAC pain and function.

RESULTS: Compared with placebo, the odds of achieving a 20% reduction in WOMAC pain were celecoxib: 1.21, glucosamine: 1.16, combination glucosamine/CS: 0.83 and CS alone: 0.69, and were not statistically significant.

CONCLUSIONS: Over 2 years, no treatment achieved a clinically important difference in WOMAC pain or function as compared with placebo. However, glucosamine and celecoxib showed beneficial but not significant trends. Adverse reactions were similar among treatment groups and serious adverse events were rare for all treatments.

69 8 1459-64 Aug 2010 NO DATA
NO DATA book Clinical guide to sports injuries NO DATA NO DATA Bahr et al NO DATA NO DATA NO DATA NO DATA NO DATA NO DATA 2004 Human Kinetics
2 article Clinical hypogonadism and androgen replacement therapy ot+harms+tps NO DATA Ohl et al PubMed #16939042. Since testosterone has a complex variety of roles to play in male physiology, this overview looks at testosterone. There are guidelines to help diagnose if testosterone or other endocrine components are contributing to the patient’s symptoms. It’s possible that testosterone replacement can improve overall qualify of life.

Testosterone has a complex variety of roles in male physiology. It is a common belief that testosterone in men declines with age. While this is true, there are several aspects to this decline which make it difficult to diagnose definitively, as other endocrine components can contribute to a patient's symptoms. There are some guidelines to help determine when to begin treatment, based on laboratory assays and symptomatology. Testosterone replacement in men can improve overall quality of life, can reverse some of the effects of hypogonadism, and can be done very safely with available pharmacologic agents.

26 4 253-9, 269; quiz 260 Aug 2006 NO DATA
NO DATA article Clinical outcome of surgical intervention for recalcitrant infero-medial heel pain tx+surgery+pf+foot+run+rsi NO DATA Sinnaeve et al PubMed #18811031. NO DATA

A retrospective review was conducted in 28 patients (31 feet) with recalcitrant infero-medial heel pain, to assess the clinical outcome of a combined release of the first branch of the lateral plantar nerve and the plantar fascia. All patients were questioned by telephone interview on their pre- versus post-operative level of pain and function (based on the Kitaoka mid-foot scale and the visual analog scale), and their satisfaction with the result of the intervention. Limitations of functional activity decreased, maximum walking distance increased and the level of pain decreased from 8.9 to 1.4 on the visual analog scale. The majority of patients was satisfied with the surgery (90.3%) and would undergo the same procedure again or would recommend it (92.9%). While conservative management remains the gold standard for treatment of infero-medial heel pain and/or plantar fasciitis, patients with recalcitrant disease usually can be effectively treated surgically with a combined release of the plantar fascia and the first branch of the lateral plantar nerve.

74 4 483-8 Aug 2008 NO DATA
NO DATA article Clinical perspectives on secular trends of intervertebral foramen diameters in an industrialized European society back NO DATA Ruhli et al PubMed #1505755. From the abstract: “A secular trend of the increase in ‘maximum intervertebral foramen width’ is found for most levels, with females showing a more prominent alteration.” NO DATA NO DATA NO DATA NO DATA Apr 1 2004 NO DATA
3 article Clinical predictors of time to return to competition and of recurrence following hamstring strain in elite Australian footballers dx+self-tx+exercise+run+strain NO DATA Warren et al PubMed #18653619. After a hamstring injury, when is it “safe” to return to competition? This study suggests that “time to walk pain-free and previous hamstring injury are predictors of time to return to competition and recurrence, respectively, and should be included in a clinical assessment to aid in prognosis.”

OBJECTIVE: To investigate early clinical predictors of time to return to competition and of recurrence following hamstring strain.

DESIGN: Prospective observational study.

SETTING: Elite level of Australian football competition.

PARTICIPANT: 59 players who suffered a hamstring strain in 2002 season.

PREDICTORS: Clinical assessment by a physiotherapist and questionnaire.

MAIN OUTCOME MEASURES: Time taken to return to play and recurrence of hamstring injury within 3 weeks.

RESULTS: Players taking more than 1 day to walk pain-free were significantly more likely (p=0.018) to take longer than 3 weeks to return to competition (adjusted odds ratio 4.0; 95% CI 1.3 to 12.6). Nine players (15.2%) experienced an injury recurrence, all involving the biceps femoris. Recurrence was more likely in players who reported a hamstring injury in the past 12 months (adjusted odds ratio 19.6; 95% CI 1.5 to 261.0; p=0.025).

CONCLUSION: Time to walk pain-free and previous hamstring injury are predictors of time to return to competition and recurrence, respectively, and should be included in a clinical assessment to aid in prognosis.

44 6 415-9 May 2010 NO DATA
NO DATA article Clinical trends in ulcer diagnosis in a population with high prevalence of Helicobacter pylori infection ot+back NO DATA Pérez-Aisa et al 1 From the article: “This study agrees with previous reports that suggest that the prevalence of peptic ulcer disease has decreased significantly over the last decade in western countries …. The reasons for this decline are not clear ….”

BACKGROUND: It is unknown whether the incidence of peptic ulcer changes in areas with a high prevalence of Helicobacter pylori infection.

AIM: To determine trends in peptic ulcer complications in a community with a high prevalence of H. pylori infection.

METHODS: New endoscopic diagnoses of peptic ulcers and their complications from 1985 to 2000 were obtained. H. pylori infection in the adult population, the number of prescriptions for anti-secretory drugs and non-steroidal anti-inflammatory drugs were also evaluated.

RESULTS: Although the global prevalence of H. pylori infection remains high in this population >60%), a 41.4 to 25.4% decrease in the incidence of peptic ulcers and ulcer complications was observed. This was associated with a decrease in the prevalence of H. pylori infection in people under 65 years of age, a 3.5-fold increase in the number of prescriptions of proton-pump inhibitors and an increase in the number of prescriptions of non-steroidal anti-inflammatory drugs, especially coxibs.

CONCLUSIONS: In an area with a high prevalence of H. pylori infection, the incidence of peptic ulcer and associated complications is declining rapidly. This was associated with a reduction of the prevalence of H. pylori infection in the young and a widespread use of proton-pump inhibitors. The increase in the use of non-steroidal anti-inflammatory drugs, especially coxibs, has not changed the tendency.

21 1 65–72 Jan 2005 NO DATA
3 article Clinical trial of intensive muscle training for chronic low back pain back+exercise NO DATA Manniche et al PubMed #2904582. Presents unusually favourable evidence that “intensive dynamic back extensor exercises” reduced pain and improved function in patients with low back pain better than lower intensity exercises or a combination of massage, mild exercise and heat.

105 patients who had chronic low back pain without clinical signs of lumbar nerve root compression or radiological evidence of spondylolysis or osteomalacia were randomised to three treatments: 30 sessions of intensive dynamic back extensor exercises over three months; a similar programme at one-fifth the exercise intensity; or one month of thermotherapy, massage, and mild exercises. The results consistently favoured intensive exercise, which had no adverse effects. Since these exercises can be conducted in groups, the intensive programme is no more costly than conventional strategies that require individual attention.

NO DATA NO DATA 1473–6 Dec 24 1988 NO DATA
NO DATA article Clinically significant placebo analgesic response in a pilot trial of botulinum B in patients with hand pain and carpal tunnel syndrome NO DATA NO DATA Breuer et al PubMed #16533192. NO DATA

OBJECTIVE: We conducted a pilot trial to assess the effect of botulinum toxin B on palmar pain and discomfort in carpal tunnel syndrome (CTS) patients. Design. Randomized, double-blind, placebo-controlled.

PATIENTS: Twenty ambulatory CTS patients. Intervention. Botulinum toxin B or placebo injections into three hypothenar muscles anatomically linked or attached to the carpal tunnel and its tentorium, that is, the Opponens Digiti Minimi and Flexor Digiti Minimi, located with electromyography (EMG), and the Palmaris Brevis Muscle, anatomically located without EMG.

SETTING: New York City hospital.

OUTCOME MEASURES: Outcomes were measured with numeric ratings, with higher scores indicating worse outcomes. Daily, subjects recorded their 0-10 numeric ratings of overall pain levels and pain-related sleep disturbances. During weekly telephone calls, they reported their 0-10 ratings for overall pain, pain-related sleep disturbance, and CTS-related tingling during the night and day as experienced over the preceding 24 hours. For each of four clinic visits, we averaged each subject's ratings of nine quality of life indicators from the West Haven-Yale Multidimensional Pain Inventory (WHYMPI), each measured on a 0-6 numeric scale.

RESULTS: Over the 13-week trial, compared to baseline scores, the following outcomes predominantly showed decreases of statistical significance (P < or = 0.050) or borderline significance (0.050 < P < or = 0.10) for weeks 2 through 8: overall pain per daily diary entries and per weekly telephone reports, and pain-related sleep disturbance in the placebo group per phone report and in the botulinum toxin B group per diary report. CTS painful night tingling and day tingling, as well as the average scores of the WHYMPI quality of life indicators, showed improvements with statistical or borderline significance for almost each follow-up week. Between-group analyses, however, demonstrated that at each follow-up week, there was no statistically significant difference between the two study groups regarding changes from baseline in any study outcome.

CONCLUSION: Botulinum toxin B is not dramatically superior to placebo for the relief of CTS symptoms. Possible explanations of the improvements in each study group are explored.

7 1 16–24 Jan-Feb 2006 NO DATA
NO DATA article The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis back+surgery+nerve NO DATA Gibson et al PubMed #1048851. This is a valuable review of all “evidence on surgical management for lumbar-disc prolapse and degenerative lumbar spondylosis.” From the conclusions: “There is now strong evidence on the relative effectiveness of surgical discectomy versus chemonucleolysis versus placebo. There is considerable evidence on the clinical effectiveness of discectomy for carefully selected patients with sciatica caused by lumbar disc prolapse that fails to resolve with conservative management. There is no scientific evidence on the effectiveness of any form of surgical decompression or fusion for degenerative lumbar spondylosis compared with natural history, placebo, or conservative management.” The claim of discectomy being compared with placebo via chemonucleolysis is dubious, however: as Sarno writes, “The effectiveness of a placebo is directly proportional to the impression it makes on the patient’s subconscious mind ….” I believe it’s fair to say that discectomy makes a greater impression, which is a more elaborate surgical procedure than chemonucleolysis. In other words, just because discectomy seems to produce better results than a procedure that is no better than placebo doesn’t mean that discectomy doesn’t simply produce a stronger placebo effect.

STUDY DESIGN: A Cochrane review of randomized controlled trials.

OBJECTIVES: To collate the scientific evidence on surgical management for lumbar-disc prolapse and degenerative lumbar spondylosis.

SUMMARY OF BACKGROUND DATA: Surgical investigations and interventions account for as much as one third of the health care costs for spinal disorders, but the scientific evidence for most procedures still is unclear.

METHODS: A highly sensitive search strategy identified all published randomized controlled trials. Cochrane methodology was used for meta-analysis of the results.

RESULTS: Twenty-six randomized controlled trials of surgery for lumbar disc prolapse and 14 trials of surgery for degenerative lumbar spondylosis were identified. Methodologic weaknesses were found in many of the trials. Only one trial directly compared discectomy and conservative management. Meta-analyses showed that surgical discectomy produces better clinical outcomes than chemonucleolysis, which is better than placebo. Three trials showed no difference in clinical outcomes between microdiscectomy and standard discectomy, but in three other studies, both produced better results than percutaneous discectomy. Three trials showed that inserting an interposition membrane after discectomy does not significantly reduce scar formation or alter clinical outcomes. Five heterogeneous trials on spinal stenosis and degenerative spondylolisthesis permit very limited conclusions. There were nine trials of instrumented versus noninstrumented fusion: Meta-analysis showed that instrumentation may facilitate fusion but does not improve clinical outcomes.

CONCLUSIONS: There is now strong evidence on the relative effectiveness of surgical discectomy versus chemonucleolysis versus placebo. There is considerable evidence on the clinical effectiveness of discectomy for carefully selected patients with sciatica caused by lumbar disc prolapse that fails to resolve with conservative management. There is no scientific evidence on the effectiveness of any form of surgical decompression or fusion for degenerative lumbar spondylosis compared with natural history, placebo, or conservative management. The Cochrane reviews will be updated continuously as other trials become available.

24 17 1820–32 Sep 1 1999 NO DATA
NO DATA article Coding of pleasant touch by unmyelinated afferents in humans biolit+mx NO DATA Loken et al NO DATA Bio-medicine.org reports: “Nerve signals that tell the brain that we are being slowly stroked on the skin have their own specialised nerve fibres in the skin. The discovery may explain why touching the skin can relieve pain.” This discovery is important to touch therapies, of course. It strongly implies that neurological responses to touch have considerable complexity.

Pleasant touch sensations may begin with neural coding in the periphery by specific afferents. We found that during soft brush stroking, low-threshold unmyelinated mechanoreceptors (C-tactile), but not myelinated afferents, responded most vigorously at intermediate brushing velocities (1-10 cm s(-1)), which were perceived by subjects as being the most pleasant. Our results indicate that C-tactile afferents constitute a privileged peripheral pathway for pleasant tactile stimulation that is likely to signal affiliative social body contact.

12 5 547–548 May 2009 NO DATA
NO DATA article Cognitive behavior therapy and pharmacotherapy for insomnia NO DATA NO DATA Jacobs et al From the abstract: “These findings suggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from cognitive-behavioral insomnia therapy (CBT) than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia. Increased recognition of the efficacy of CBT and more widespread recommendations for its use could improve the quality of life of a large numbers of patients with insomnia.”

BACKGROUND: Chronic sleep-onset insomnia is a prevalent health complaint in adults. Although behavioral and pharmacological therapies have been shown to be effective for insomnia, no placebo-controlled trials have evaluated their separate and combined effects for sleep-onset insomnia. The objective of this study was to evaluate the clinical efficacy of behavioral and pharmacological therapy, singly and in combination, for chronic sleep-onset insomnia.

METHODS: This was a randomized, placebo-controlled clinical trial that involved 63 young and middle-aged adults with chronic sleep-onset insomnia. Interventions included cognitive behavior therapy (CBT), pharmacotherapy, or combination therapy compared with placebo. The main outcome measures were sleep-onset latency as measured by sleep diaries; secondary measures included sleep diary measures of sleep efficiency and total sleep time, objective measures of sleep variables (Nightcap sleep monitor recorder), and measures of daytime functioning.

RESULTS: In most measures, CBT was the most sleep effective intervention; it produced the greatest changes in sleep-onset latency and sleep efficiency, yielded the largest number of normal sleepers after treatment, and maintained therapeutic gains at long-term follow-up. The combined treatment provided no advantage over CBT alone, whereas pharmacotherapy produced only moderate improvements during drug administration and returned measures toward baseline after drug use discontinuation.

CONCLUSIONS: These findings suggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia. Increased recognition of the efficacy of CBT and more widespread recommendations for its use could improve the quality of life of a large numbers of patients with insomnia.

164 17 1888–1896 NO DATA 2004 NO DATA
NO DATA article Cognitive behavioral therapy for treatment of chronic primary insomnia NO DATA NO DATA Edinger et al From the abstract: “[Cognitive-behavioral insomnia therapy] leads to clinically significant sleep improvements within 6 weeks and these improvements appear to endure through 6 months of follow-up.”

CONTEXT: Use of nonpharmacological behavioral therapy has been suggested for treatment of chronic primary insomnia, but well-blinded, placebo-controlled trials demonstrating effective behavioral therapy for sleep-maintenance insomnia are lacking.

OBJECTIVE: To test the efficacy of a hybrid cognitive behavioral therapy (CBT) compared with both a first-generation behavioral treatment and a placebo therapy for treating primary sleep-maintenance insomnia.

DESIGN AND SETTING: Randomized, double-blind, placebo-controlled clinical trial conducted at a single academic medical center, with recruitment from January 1995 to July 1997.

PATIENTS: Seventy-five adults (n = 35 women; mean age, 55.3 years) with chronic primary sleep-maintenance insomnia (mean duration of symptoms, 13.6 years).

INTERVENTIONS: Patients were randomly assigned to receive CBT (sleep education, stimulus control, and time-in-bed restrictions; n = 25), progressive muscle relaxation training (RT; n = 25), or a quasi-desensitization (placebo) treatment (n = 25). Outpatient treatment lasted 6 weeks, with follow-up conducted at 6 months.

MAIN OUTCOME MEASURES: Objective (polysomnography) and subjective (sleep log) measures of total sleep time, middle and terminal wake time after sleep onset (WASO), and sleep efficiency; questionnaire measures of global insomnia symptoms, sleep-related self-efficacy, and mood.

RESULTS: Cognitive behavioral therapy produced larger improvements across the majority of outcome measures than did RT or placebo treatment. For example, sleep logs showed that CBT-treated patients achieved an average 54% reduction in their WASO whereas RT-treated and placebo-treated patients, respectively, achieved only 16% and 12% reductions in this measure. Recipients of CBT also showed a greater normalization of sleep and subjective symptoms than did the other groups with an average sleep time of more than 6 hours, middle WASO of 26.6 minutes, and sleep efficiency of 85.1%. In contrast, RT-treated patients continued to report a middle WASO of 43.3 minutes and sleep efficiency of 78.8%.

CONCLUSIONS: Our results suggest that CBT represents a viable intervention for primary sleep-maintenance insomnia. This treatment leads to clinically significant sleep improvements within 6 weeks and these improvements appear to endure through 6 months of follow-up.

285 14 1856–1864 NO DATA 2001 NO DATA
4 article Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise tx+self-tx+iceheat+exercise NO DATA Bleakley et al PubMed #22336838. This review of the evidence for ice bathing to deal with muscle soreness was mostly inconclusive. Either it has been studied well enough, or there’s just not that much of an effect to find.

BACKGROUND: Many strategies are in use with the intention of preventing or minimising delayed onset muscle soreness and fatigue after exercise. Cold-water immersion, in water temperatures of less than 15°C, is currently one of the most popular interventional strategies used after exercise.

OBJECTIVES: To determine the effects of cold-water immersion in the management of muscle soreness after exercise.

SEARCH METHODS: In February 2010, we searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library (2010, Issue 1), MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), British Nursing Index and archive (BNI), and the Physiotherapy Evidence Database (PEDro). We also searched the reference lists of articles, handsearched journals and conference proceedings and contacted experts.In November 2011, we updated the searches of CENTRAL (2011, Issue 4), MEDLINE (up to November Week 3 2011), EMBASE (to 2011 Week 46) and CINAHL (to 28 November 2011) to check for more recent publications.

SELECTION CRITERIA: Randomised and quasi-randomised trials comparing the effect of using cold-water immersion after exercise with: passive intervention (rest/no intervention), contrast immersion, warm-water immersion, active recovery, compression, or a different duration/dosage of cold-water immersion. Primary outcomes were pain (muscle soreness) or tenderness (pain on palpation), and subjective recovery (return to previous activities without signs or symptoms).

DATA COLLECTION AND ANALYSIS: Three authors independently evaluated study quality and extracted data. Some of the data were obtained following author correspondence or extracted from graphs in the trial reports. Where possible, data were pooled using the fixed-effect model.

MAIN RESULTS: Seventeen small trials were included, involving a total of 366 participants. Study quality was low. The temperature, duration and frequency of cold-water immersion varied between the different trials as did the exercises and settings. The majority of studies failed to report active surveillance of pre-defined adverse events.Fourteen studies compared cold-water immersion with passive intervention. Pooled results for muscle soreness showed statistically significant effects in favour of cold-water immersion after exercise at 24 hour (standardised mean difference (SMD) -0.55, 95% CI -0.84 to -0.27; 10 trials), 48 hour (SMD -0.66, 95% CI -0.97 to -0.35; 8 trials), 72 hour (SMD -0.93; 95% CI -1.36 to -0.51; 4 trials) and 96 hour (SMD -0.58; 95% CI -1.00 to -0.16; 5 trials) follow-ups. These results were heterogeneous. Exploratory subgroup analyses showed that studies using cross-over designs or running based exercises showed significantly larger effects in favour of cold-water immersion. Pooled results from two studies found cold-water immersion groups had significantly lower ratings of fatigue (MD -1.70; 95% CI -2.49 to -0.90; 10 units scale, best to worst), and potentially improved ratings of physical recovery (MD 0.97; 95% CI -0.10 to 2.05; 10 units scale, worst to best) immediately after the end of cold-water immersion. Five studies compared cold-water with contrast immersion. Pooled data for pain showed no evidence of differences between the two groups at four follow-up times (immediately, 24, 48 and 72 hours after treatment). Similar findings for pooled analyses at 24, 48 and 72 hour follow-ups applied to the four studies comparing cold-water with warm-water immersion. Single trials only compared cold-water immersion with respectively active recovery, compression and a second dose of cold-water immersion at 24 hours.

AUTHORS' CONCLUSIONS: There was some evidence that cold-water immersion reduces delayed onset muscle soreness after exercise compared with passive interventions involving rest or no intervention. There was insufficient evidence to conclude on other outcomes or for other comparisons. The majority of trials did not undertake active surveillance of pre-defined adverse events. High quality, well reported research in this area is required.

2 NO DATA CD008262 NO DATA 2012 NO DATA
NO DATA article The Columbia University ‘Miracle’ Study ot+quack+sbm NO DATA Flamm 1 A Columbia University paper published in a peer-reviewed scientific journal claimed clear evidence of the efficacy of remote prayer, and was reported with great enthusiasm by the American media in the aftermath of post-9/11, and continues to be widely cited routinely in support of similar claims. Yet the first-named author “doesn’t respond to inquires,” the “lead author said he didn’t learn of the study until months after it was completed,” and then the third author, “indicted by a federal grand jury, has pleaded guilty to conspiracy to commit fraud” — not with regards to the study, but several other charges of fraud. NO DATA 28 5 25 Sep/Oct 2004 NO DATA
2 article A History of Manipulative Therapy mx+chiro+smt+quack+neck+back NO DATA Pettman 1 A fairly detailed and scholarly article about the history of manual therapy.

Manipulative therapy has known a parallel development throughout many parts of the world. The earliest historical reference to the practice of manipulative therapy in Europe dates back to 400 BCE. Over the centuries, manipulative interventions have fallen in and out of favor with the medical profession. Manipulative therapy also was initially the mainstay of the two leading alternative health care systems, osteopathy and chiropractic, both founded in the latter part of the 19th century in response to shortcomings in allopathic medicine. With medical and osteopathic physicians initially instrumental in introducing manipulative therapy to the profession of physical therapy, physical therapists have since then provided strong contributions to the field, thereby solidifying the profession's claim to have manipulative therapy within in its legally regulated scope of practice.

15 3 165-174 NO DATA 2007 NO DATA
1 article Commentary and perspective on ‘Low-back pain following surgery for lumbar disc herniation back+surgery NO DATA Vaccaro 1 From the article, “It is important to educate patients that the outcome of disc excision that is performed as a treatment for back pain alone is often unpredictable and that the operation may, in fact, result in a worsening of axial pain.” NO DATA NO DATA NO DATA NO DATA NO DATA 2004 NO DATA
2 article Comparative study on the effectiveness of myofascial release manual therapy and physical therapy for venous insufficiency in postmenopausal women tx+mx NO DATA Ramos-González et al PubMed #22863643. This study compared the effects of massage and minimal exercise therapy on poor circulation (venous insufficiency) in post-menopausal women. Superficially it looks like a good news story for massage, and in some ways it is. Massage did have a statistically significant positive effect and seems to have “increased circulation” in one sense (something I have often called a myth). But there’s a lot to consider here. Only the statistical significance of the results is touted in the abstract, not their size. This almost always means a real effect that was too small to emphasize. So I read the full paper and, sure enough, the effects of massage were positive but modest at best (and in many cases trivial). There were a lot of measures of success, and none changed all that much. The phrase “damned with faint praise” comes to mind, as it so often does in massage science. Also, some of the measures also seemed barely useful. If I got that much massage, I’d probably feel like my quality of life had improved too — but I’m not sure that would have much to do with improving my mild venous insufficiency. And it was really a lot of massage (expensive in the real world). And the pure “kinesiotherapy” treatment was super basic — this control group barely did more than wiggle their toes and clench their thighs, so it’s hardly surprising that they didn’t improve much. I wish the study had included a third group doing more exercise, perhaps a half hour of brisk walking per day. I think there’s an excellent chance walkers would have performed as well or even far better than massage. And walking is notably a lot cheaper than massage.

OBJECTIVES: Venous insufficiency is present in a large number of postmenopausal women, increasing their risk of disability. The objective of this study was to determine the effects of myofascial release therapy and conventional kinesiotherapy on venous blood circulation, pain and quality of life in postmenopausal patients with venous insufficiency.

METHODS: A randomised controlled trial was undertaken. We enrolled 65 postmenopausal women with stage I or II venous insufficiency on the clinical, aetiological, anatomical and physiopathological (CEAP) scale of venous disorders, randomly assigning them to a control (n=32) or experimental (n=33) group. The control and experimental group patients underwent physical venous return therapy (kinesiotherapy) for a 10-week period, during which the experimental group patients also received 20 sessions of myofascial release therapy. Main outcome measures determined pre- and post-intervention were blood pressure, cell mass, intracellular water, basal metabolism, venous velocity, skin temperature, pain and quality of life.

RESULTS: Basal metabolism (P<0.047), intracellular water (P<0.041), diastolic blood pressure (P<0.046), venous blood flow velocity (P<0.048), pain (P<0.039) and emotional role (P<0.047) were significantly higher in the experimental group than in the control group after the 10-week treatment programme.

CONCLUSION: The combination of myofascial release therapy and kinesiotherapy improves the venous return blood flow, pain and quality of life in postmenopausal women with venous insufficiency.

20 5 291-8 Oct 2012 NO DATA
NO DATA article Compared imaging of the rheumatoid cervical spine neck+arthritis NO DATA Younes et al PubMed #19303343. Disease-driven erosion of cervical joints is often painless. Rheumatoid arthritis — a nasty disease, different from garden variety “wear and tear” osteoarthritis — commonly attacks the joints of the neck, causing significant deformity of the joints. Of course, this does sometimes cause severe problems. However, it’s fascinating to note that such deformed joints often do not cause pain — X-ray and MRI can show substantial degradation in patients who have no pain.

INTRODUCTION: Cervical spine involvement is common and potentially severe in patients with rheumatoid arthritis (RA). The objectives of this study were to compare the prevalences of cervical spine abnormalities detected by standard radiography, computed tomography (CT), and magnetic resonance imaging (MRI) in patients with RA; and to identify factors associated with cervical spine involvement.

METHODS: We studied 40 patients who met American College of Rheumatology criteria for RA and had disease durations of 2 years or more. Each patient underwent a physical examination, laboratory tests, standard radiographs (anteroposterior, lateral, open-mouth, flexion, and extension views), MRI with dynamic maneuvers in (if not contraindicated), and CT.

RESULTS: Cervical spine involvement was found by at least one imaging technique in 29 (72.5%) patients (standard radiography, 47.5%; CT, 28.2%; and MRI, 70%) and was asymptomatic in 5 (17.2%) patients. C1-C2 pannus was the most common lesion (62.5% of cases), followed by atlantoaxial subluxation (AAS, 45%). The most common AAS pattern was anterior subluxation (25%), followed by lateral subluxation (15%) then by vertical, rotatory, and subaxial subluxations (10% each). Erosions of the dens were seen in 67.5% of patients by MRI, 41% by CT, and 12.5% by standard radiography. Of the 10 cases of anterior AAS by any modality, 9 were detected by standard radiography and 7 by MRI. CT was the best technique for visualizing atypical rotatory or lateral AAS. MRI was best for assessing the C1-C2 pannus, dens erosions, and neurologic impact of the rheumatoid lesions. The comparison of patients with and without cervical spine lesions suggested that higher modified Sharp score and C-reactive protein values predicted cervical spine involvement (P=0.002 and P=0.004, respectively).

CONCLUSION: Cervical spine involvement is common and may be asymptomatic, indicating that routine cervical spine imaging is indicated in patients with RA. Standard radiography including dynamic views constitutes the first-line imaging method of choice. Sensitivity and comprehensiveness of the assessment are greatest with MRI. MRI and CT are often reserved for selected patients. Cervical spine involvement is associated with disease activity and with rapidly progressive joint destruction.

76 4 361-368 July 2009 NO DATA
4 article Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees arthritis+knee+tools NO DATA Cetin et al PubMed #18496246. The goal of this research was to “investigate the therapeutic effects of physical agents (such as hot packs, short-wave diathermy, and ultrasound)” on women with knee osteoarthritis. The conclusions were that “using physical agents before isokinetic exercises in women with knee osteoarthritis leads to augmented exercise performance, reduced pain, and improved function. Hot pack with a transcutaneous electrical nerve stimulator or short-wave diathermy has the best outcome.”

OBJECTIVE: To investigate the therapeutic effects of physical agents administered before isokinetic exercise in women with knee osteoarthritis.

DESIGN: One hundred patients with bilateral knee osteoarthritis were randomized into five groups of 20 patients each: group 1 received short-wave diathermy + hot packs and isokinetic exercise; group 2 received transcutaneous electrical nerve stimulation + hot packs and isokinetic exercise; group 3 received ultrasound + hot packs and isokinetic exercise; group 4 received hot packs and isokinetic exercise; and group 5 served as controls and received only isokinetic exercise.

RESULTS: Pain and disability index scores were significantly reduced in each group. Patients in the study groups had significantly greater reductions in their visual analog scale scores and scores on the Lequesne index than did patients in the control group (group 5). They also showed greater increases than did controls in muscular strength at all angular velocities. In most parameters, improvements were greatest in groups 1 and 2 compared with groups 3 and 4.

CONCLUSIONS: Using physical agents before isokinetic exercises in women with knee osteoarthritis leads to augmented exercise performance, reduced pain, and improved function. Hot pack with a transcutaneous electrical nerve stimulator or short-wave diathermy has the best outcome.

87 6 443-51 Jun 2008 NO DATA
NO DATA article Comparing yoga, exercise, and a self-care book for chronic low back pain back+exercise+mind NO DATA Sherman et al PubMed #16365466. From the abstract: “Yoga was more effective than a self-care book for improving function and reducing chronic low back pain, and the benefits persisted for at least several months.” However, it was not more effective than a “conventional therapeutic exercise class.” Note that the authors conducted a similar study in 2011, comparing yoga and stretching classes, with essentially identical results: see Sherman for more detail.

BACKGROUND: Chronic low back pain is a common problem that has only modestly effective treatment options.

OBJECTIVE: To determine whether yoga is more effective than conventional therapeutic exercise or a self-care book for patients with chronic low back pain.

DESIGN: Randomized, controlled trial.

SETTING: A nonprofit, integrated health care system.

PATIENTS: 101 adults with chronic low back pain.

INTERVENTION: 12-week sessions of yoga or conventional therapeutic exercise classes or a self-care book.

MEASUREMENTS: Primary outcomes were back-related functional status (modified 24-point Roland Disability Scale) and "bothersomeness" of pain (11-point numerical scale). The primary time point was 12 weeks. Clinically significant change was considered to be 2.5 points on the functional status scale and 1.5 points on the bothersomeness scale. Secondary outcomes were days of restricted activity, general health status, and medication use.

RESULTS: After adjustment for baseline values, back-related function in the yoga group was superior to the book and exercise groups at 12 weeks (yoga vs. book: mean difference, -3.4 [95% CI, -5.1 to - 1.6] [P < 0.001]; yoga vs. exercise: mean difference, -1.8 [CI, -3.5 to - 0.1] [P = 0.034]). No significant differences in symptom bothersomeness were found between any 2 groups at 12 weeks; at 26 weeks, the yoga group was superior to the book group with respect to this measure (mean difference, -2.2 [CI, -3.2 to - 1.2]; P < 0.001). At 26 weeks, back-related function in the yoga group was superior to the book group (mean difference, -3.6 [CI, -5.4 to - 1.8]; P < 0.001).

LIMITATIONS: Participants in this study were followed for only 26 weeks after randomization. Only 1 instructor delivered each intervention.

CONCLUSIONS: Yoga was more effective than a self-care book for improving function and reducing chronic low back pain, and the benefits persisted for at least several months.

143 12 849–856 Dec 2005 NO DATA
3 article Comparison of 1 Day and 3 Days per Week of Equal-Volume Resistance Training in Experienced Subjects exercise NO DATA McLester et al NO DATA McLester et al studied experienced recreational weight trainers, producing the only data I know of that shows that more frequent training produces better results. However, the study does show that reduced training frequency is still surprisingly effective: it produced about 60% of the strength gains as training three times more often.
The findings suggest that a higher frequency of resistance training, even when volume is held constant, produces superior gains in 1RM. However, training only 1 day per week was an effective means of increasing strength, even in experienced recreational weight trainers.
So less was less here … but not a lot less, and that is pretty important. I imagine that a great many people would happily sacrifice some of their progress in exchange for reclaiming the time spent on two workouts per week.

There is not a strong research basis for current views of the importance of individual training variables in strength training protocol design. This study compared 1 day versus 3 days of resistance training per week in recreational weight trainers with the training volume held constant between the treatments. Subjects were randomly assigned to 1 of 2 groups: 1 day per week of 3 sets to failure (1DAY) or 3 days per week of 1 set to failure (3DAY). Relative intensity (percent of initial 1 repetition maximum [1RM]) was varied throughout the study in both groups by using a periodized repetition range of 3-10. Volume (repetitions x mass) did not differ (p <= 0.05) between the groups over the 12 weeks. The 1RMs of various upper-and lower-body exercises were assessed at baseline and at weeks 6 and 12. The 1RMs increased (p <= 0.05) significantly for the combined groups over time. The 1DAY group achieved ~62% of the 1RM increases observed in the 3DAY group in both upper-body and lower-body lifts. Larger increases in lean body mass were apparent in the 3DAY group. The findings suggest that a higher frequency of resistance training, even when volume is held constant, produces superior gains in 1RM. However, training only 1 day per week was an effective means of increasing strength, even in experienced recreational weight trainers. From a dose-response perspective, with the total volume of exercise held constant, spreading the training frequency to 3 doses per week produced superior results.

14 NO DATA 273-281 NO DATA 2000 NO DATA
3 article Comparison of ballistic and static stretching on hamstring muscle length using an equal stretching dose tx+stretch+knee NO DATA Covert et al PubMed #20375742. This was a comparison of static vs ballistic stretching on the hamstring. Conclusion: "The static stretching group demonstrated a statistically greater increase in hamstring muscle length than the ballistic stretching group."

The purpose of this investigation was to determine which stretching technique, static or ballistic, is most effective for increasing hamstring muscle length when delivered at the same stretching dose over a 4-week training program. A single-blind, randomized controlled trial design was used in this investigation. Thirty-two participants (16 women and 16 men) between the ages of 18 and 27 years participated in the study. All participants who had a pre-training knee extension angle of less than 20° were excluded from the study. Subjects were randomly assigned to one of 3 groups: ballistic stretching, static stretching, or control group. Participants in the experimental stretching groups (ballistic and static stretching) performed one 30-second stretch 3 times per week for a period of 4 weeks. Statistical analysis consisted of a 2-way analysis of variance (group × sex) with an a priori alpha level of 0.05. No interaction between group and sex was identified (p = 0.4217). The main effect of sex was not statistically significant (p = 0.2099). The main effect for group was statistically significant at p < 0.0001. Post hoc analysis revealed that both static and ballistic stretching group produced greater increases in hamstring length than the control group. The static stretching group demonstrated a statistically greater increase in hamstring muscle length than the ballistic stretching group. No injuries or complications were attributed to either stretching program.

24 11 3008-14 Nov 2010 NO DATA
NO DATA article Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis pf+run+tools+nerve+back+foot NO DATA Pfeffer et al PubMed #10229276. From the abstract: “We conclude that, when used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device.”

Fifteen centers for orthopaedic treatment of the foot and ankle participated in a prospective randomized trial to compare several nonoperative treatments for proximal plantar fasciitis (heel pain syndrome). Included were 236 patients (160 women and 76 men) who were 16 years of age or older. Most reported duration of symptoms of 6 months or less. Patients with systemic disease, significant musculoskeletal complaints, sciatica, or local nerve entrapment were excluded. We randomized patients prospectively into five different treatment groups. All groups performed Achilles tendon- and plantar fascia-stretching in a similar manner. One group was treated with stretching only. The other four groups stretched and used one of four different shoe inserts, including a silicone heel pad, a felt pad, a rubber heel cup, or a custom-made polypropylene orthotic device. Patients were reevaluated after 8 weeks of treatment. The percentages improved in each group were: (1) silicone insert, 95%; (2) rubber insert, 88%; (3) felt insert, 81%; (4)stretching only, 72%; and (5) custom orthosis, 68%. Combining all the patients who used a prefabricated insert, we found that their improvement rates were higher than those assigned to stretching only (P = 0.022) and those who stretched and used a custom orthosis (P = 0.0074). We conclude that, when used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device.

20 4 214–21 Apr 1999 NO DATA
3 article A Reverse J-Shaped Association of All-Cause Mortality with Serum 25-Hydroxyvitamin D in General Practice tx+self-tx+nutrition+pain NO DATA Durup et al PubMed #22573406. “I think the message is pretty clear: think twice before you megadose.” — Alex Hutchinson (Sweat Science). Amen. The low to nil risks of “high“ doses of D mat be justified by the evidence for the specific case of patients with chronic pain. But “mega” doses? Not sure that was ever a good idea for anyone.

CONTEXT: Optimal levels of vitamin D have been a topic of heavy debate, and the correlation between 25-hydroxyvitamin D [25(OH)D] levels and mortality still remains to be established.

OBJECTIVE: The aim of the study was to determine the association between all-cause mortality and serum levels of 25(OH)D, calcium, and PTH.

DESIGN AND SETTING: We conducted a retrospective, observational cohort study, the CopD Study, in a single laboratory center in Copenhagen, Denmark.

PARTICIPANTS: Serum 25(OH)D was analyzed from 247,574 subjects from the Copenhagen general practice sector. In addition, serum levels of calcium, albumin-adjusted calcium, PTH, and creatinine were measured in 111,536; 20,512; 34,996; and 189,496 of the subjects, respectively.

MAIN OUTCOME MEASURES: Multivariate Cox regression analysis was used to compute hazard ratios for all-cause mortality.

RESULTS: During follow-up (median, 3.07 yr), 15,198 (6.1%) subjects died. A reverse J-shaped association between serum level of 25(OH)D and mortality was observed. A serum 25(OH)D level of 50-60 nmol/liter was associated with the lowest mortality risk. Compared to 50 nmol/liter, the hazard ratios (95% confidence intervals) of all-cause mortality at very low (10 nmol/liter) and high (140 nmol/liter) serum levels of 25(OH)D were 2.13 (2.02-2.24) and 1.42 (1.31-1.53), respectively. Similarly, both high and low levels of albumin-adjusted serum calcium and serum PTH were associated with an increased mortality, and secondary hyperparathyroidism was associated with higher mortality (P < 0.0001).

CONCLUSION: In this study from the general practice sector, a reverse J-shaped relation between the serum level of 25(OH)D and all-cause mortality was observed, indicating not only a lower limit but also an upper limit. The lowest mortality risk was at 50-60 nmol/liter. The study did not allow inference of causality, and further studies are needed to elucidate a possible causal relationship between 25(OH)D levels, especially higher levels, and mortality.

97 8 2644-52 Aug 2012 NO DATA
3 article Comparison of glutamate-evoked pain between the temporalis and masseter muscles in men and women tx+head+pain+inject NO DATA Castrillon et al PubMed #22336721. Pain-inducing injections into two different chewing muscles showed two key results: women found it much more painful than men, and the temporalis muscle causes a lot more pain referral than the masseter.

Pain in myofascial temporomandibular disorder (TMD) can affect both the masseter and temporalis muscles. Glutamate injection into the masseter muscle evokes pain that is greater in men than in women and this pain is attenuated by co-injection of the N-methyl-d-aspartate (NMDA) receptor antagonist ketamine (10mmol/L) in men. Animal studies suggested that pain induced by peripheral NMDA receptor activation could differ between the temporalis and masseter muscles and between men and women. The study aims were to investigate differences in glutamate-evoked pain between these muscles and the effectiveness of ketamine to attenuate glutamate-evoked pain in both genders. Pain and mechanical sensitivity were induced in 2 sessions of an experiment in 14 women and 16 men by repeated injections of glutamate (0.5mol/L) with and without ketamine (20mmol/L) into the masseter and temporalis muscles. Two injections were applied into the same masseter muscle and 2 injections into the same anterior temporalis muscle at each session. Visual analogue scale (VAS) pain intensities and pain drawing areas were assessed. Glutamate-evoked pain and pain drawing area were significantly greater from the temporalis muscle than from the masseter muscle (P<.02) in both genders. Women reported significantly greater glutamate-evoked masseter muscle pain than men (P<.03). Co-injection of ketamine, at higher dose than previously used, was equally effective in attenuating glutamate-evoked pain from both muscles in both genders (P<.01). The current findings indicate that the characteristics of pain generated by intramuscular injection of glutamate vary for different masticatory muscles and may be partially generated through activation of peripheral NMDA receptors.

153 4 823-9 Apr 2012 NO DATA
2 article Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder NO DATA NO DATA Vermeulen et al PubMed #16506872. From the abstract: “In subjects with adhesive capsulitis of the shoulder, [high grade mobilization techniques] appear to be more effective in improving glenohumeral joint mobility and reducing disability than [low grade mobilization techniques], with the overall differences between the 2 interventions being small.”

BACKGROUND AND PURPOSE: In many physical therapy programs for subjects with adhesive capsulitis of the shoulder, mobilization techniques are an important part of the intervention. The purpose of this study was to compare the effectiveness of high-grade mobilization techniques (HGMT) with that of low-grade mobilization techniques (LGMT) in subjects with adhesive capsulitis of the shoulder.

SUBJECTS: One hundred subjects with unilateral adhesive capsulitis lasting 3 months or more and a > or =50% decrease in passive joint mobility relative to the nonaffected side were enrolled in this study.

METHODS: Subjects randomly assigned to the HGMT group were treated with intensive passive mobilization techniques in end-range positions of the glenohumeral joint, and subjects in the LGMT group were treated with passive mobilization techniques within the pain-free zone. The duration of treatment was a maximum of 12 weeks (24 sessions) in both groups. Subjects were assessed at baseline and at 3, 6, and 12 months by a masked assessor. Primary outcome measures included active and passive range of motion and shoulder disability (Shoulder Rating Questionnaire [SRQ] and Shoulder Disability Questionnaire [SDQ]). An analysis of covariance with adjustments for baseline values and a general linear mixed-effect model for repeated measurements were used to compare the change scores for the 2 treatment groups at the various time points and over the total period of 1 year, respectively.

RESULTS: Overall, subjects in both groups improved over 12 months. Statistically significant greater change scores were found in the HGMT group for passive abduction (at the time points 3 and 12 months), and for active and passive external rotation (at 12 months). A statistically significant difference in trend between both groups over the total follow-up period of 12 months was found for passive external rotation, SRQ, and SDQ with greater change scores in the HGMT group.

DISCUSSION AND CONCLUSION: In subjects with adhesive capsulitis of the shoulder, HGMTs appear to be more effective in improving glenohumeral joint mobility and reducing disability than LGMTs, with the overall differences between the 2 interventions being small.

86 3 355–368 Mar 2006 NO DATA
NO DATA article Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder NO DATA NO DATA Vermeulen et al PubMed #16506872. NO DATA

BACKGROUND AND PURPOSE: In many physical therapy programs for subjects with adhesive capsulitis of the shoulder, mobilization techniques are an important part of the intervention. The purpose of this study was to compare the effectiveness of high-grade mobilization techniques (HGMT) with that of low-grade mobilization techniques (LGMT) in subjects with adhesive capsulitis of the shoulder.

SUBJECTS: One hundred subjects with unilateral adhesive capsulitis lasting 3 months or more and a > or =50% decrease in passive joint mobility relative to the nonaffected side were enrolled in this study.

METHODS: Subjects randomly assigned to the HGMT group were treated with intensive passive mobilization techniques in end-range positions of the glenohumeral joint, and subjects in the LGMT group were treated with passive mobilization techniques within the pain-free zone. The duration of treatment was a maximum of 12 weeks (24 sessions) in both groups. Subjects were assessed at baseline and at 3, 6, and 12 months by a masked assessor. Primary outcome measures included active and passive range of motion and shoulder disability (Shoulder Rating Questionnaire [SRQ] and Shoulder Disability Questionnaire [SDQ]). An analysis of covariance with adjustments for baseline values and a general linear mixed-effect model for repeated measurements were used to compare the change scores for the 2 treatment groups at the various time points and over the total period of 1 year, respectively.

RESULTS: Overall, subjects in both groups improved over 12 months. Statistically significant greater change scores were found in the HGMT group for passive abduction (at the time points 3 and 12 months), and for active and passive external rotation (at 12 months). A statistically significant difference in trend between both groups over the total follow-up period of 12 months was found for passive external rotation, SRQ, and SDQ with greater change scores in the HGMT group.

DISCUSSION AND CONCLUSION: In subjects with adhesive capsulitis of the shoulder, HGMTs appear to be more effective in improving glenohumeral joint mobility and reducing disability than LGMTs, with the overall differences between the 2 interventions being small.

86 3 355-68 Mar 2006 NO DATA
5 article Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain meds+neck+strain NO DATA Khwaja et al PubMed #20078917. A new study in the Canadian Journal of Emergency Medical Care compared ibuprofen and a muscle relaxant (cyclobenzaprine or Flexeril) for patients with serious soft-tissue injury in the neck. Groups of about 20 patients received one, the other, or both. Results were statistically identical for all patients. This test showed no benefit to using or adding a muscle relaxant for acute muscle strain in the neck. The study is too small to be powerful, but it certainly shows that there’s no strong advantage to muscle relaxants in a situation where they are often assumed to be an important medication, and the results are consistent with other research results.

OBJECTIVE: We compared pain severity and time to resumption of activities in patients with cervical strains treated with a nonsteroidal anti-inflammatory drug (NSAID), a centrally acting muscle relaxant or both.

METHODS: We performed a double-blinded, randomized controlled trial of adults with cervical strains from motor vehicle collisions or from falls who presented to a suburban academic emergency department (ED). Patients were randomly assigned to receive ibuprofen 800 mg, cyclobenzaprine 5 mg or both, 3 times daily as needed for up to 7 days. Outcome measures included a pain score on a 100-mm visual analog scale, pain relief scores, the time to resumption of normal activities, the use of rescue medications, and adverse outcomes. We used repeated-measures analysis of variance to compare pain relief over time. Our sample size of 20 patients in each group had a power of 80% to detect a difference of 15 mm in pain relief scores between the highest and lowest groups.

RESULTS: We randomly assigned 61 patients to receive ibuprofen (n = 20), cyclobenzaprine (n = 21) or both (n = 20). Mean (standard deviation) age was 34 (11) years; 58% were women and 72% were white. Although pain scores improved over time in all groups, there were no significant differences between the groups in any of the outcome measures. The rate of adverse events was also similar between groups.

CONCLUSION: Our study suggests that there is little benefit to routinely using or adding cyclobenzaprine to NSAIDs for ED patients with acute cervical strain.

12 1 39-44 Jan 2010 NO DATA
1 article Comparison of Massage Based on the Tensegrity Principle and Classic Massage in Treating Chronic Shoulder Pain quack+psb NO DATA Kassolik et al PubMed #23891481. Here’s a study that compares two kinds of massage for shoulder pain: regular Swedish versus “tensegrity-based” massage, which I have literally never heard of in 15 years of studying massage (although I can easily guess what they think they mean.) I smell a pet theory. “Tensegrity-based” massage is not actually a thing. There is no TBM® or standard definition. It means about as much as “anatomy-based.” Tensegrity refers to a principle of biomechanical organization (see Ten Trillion Cells Walked Into a Bar). Massage “based on the tensegrity principle” is wide open to interpretation to the point of absurdity. And yet the defining characteristic of tensegrity-based treatment offered in the abstract of this paper is merely where massage was applied (not how): “directing treatment to the painful area and the tissues … that structurally support the painful area.” As opposed to foot massage, perhaps? Meanwhile, the control group massaged “tissues surrounding the glenohumeral joint.” So, shoulder massage compared to … shoulder massage. This comparison may be about as meaningful as a taste-test of tomatoes and tomahtoes. Giving these researchers a little benefit of the doubt, perhaps they were trying to describe the size of the treated area, also known as “less thorough” and “more thorough.” That would be a somewhat interesting comparison, though not really useful for validating a treatment idea as vague as “tensegrity-based massage.” I can think of a few (about 17) non-tensegrity-based reasons why more thorough massage might work well. “Be thorough” is pretty much the first lesson in massage school. And the shocking conclusion? They found that “more thorough” worked much better.

OBJECTIVE: The purpose of this study was to compare the clinical outcomes of classic massage to massage based on the tensegrity principle for patients with chronic idiopathic shoulder pain.

METHODS: Thirty subjects with chronic shoulder pain symptoms were divided into 2 groups, 15 subjects received classic (Swedish) massage to tissues surrounding the glenohumeral joint and 15 subjects received the massage using techniques based on the tensegrity principle. The tensegrity principle is based on directing treatment to the painful area and the tissues (muscles, fascia, and ligaments) that structurally support the painful area, thus treating tissues that have direct and indirect influence on the motion segment. Both treatment groups received 10 sessions over 2 weeks, each session lasted 20 minutes. The McGill Pain Questionnaire and glenohumeral ranges of motion were measured immediately before the first massage session, on the day the therapy ended 2 weeks after therapy started, and 1 month after the last massage.

RESULTS: Subjects receiving massage based on the tensegrity principle demonstrated statistically significance improvement in the passive and active ranges of flexion and abduction of the glenohumeral joint. Pain decreased in both massage groups.

CONCLUSIONS: This study showed increases in passive and active ranges of motion for flexion and abduction in patients who had massage based on the tensegrity principle. For pain outcomes, both classic and tensegrity massage groups demonstrated improvement.

NO DATA NO DATA NO DATA Jul 2013 NO DATA
3 article Comparison of once-weekly and twice-weekly strength training in older adults exercise NO DATA DiFrancisco-Donoghue et al PubMed #17062657. DiFrancisco-Donoghue et al tested 18 older adults in two groups for several weeks. Half of them trained twice per week, the other half once. Once again, they found no difference at all.
One set of exercises performed once weekly to muscle fatigue improved strength as well as twice a week in the older adult. Our results provide information that will assist in designing strength-training programmes that are more time and cost efficient in producing health and fitness benefits for older adults.

BACKGROUND: Strength training has been shown to benefit the health and function of older adults.

OBJECTIVE: To investigate whether one set of exercises performed once a week was as effective in increasing muscle strength as training twice a week.

METHODS: 18 subjects (7 women and 11 men) aged 65-79 years were randomly assigned to two groups. Both groups performed one set of exercises to muscular fatigue; group 1 trained 1 day/week and group 2 trained 2 days/week on three lower and three upper body exercises for 9 weeks. The data were analysed using a mixed model 2 x 2 analysis of variance.

RESULTS: A significant main effect of time (p<0.001), but not group, on one-repetition maximum scores was observed. No significant interaction was observed between time and group and therefore no difference in strength changes between training once a week versus twice a week after 9 weeks.

CONCLUSIONS: One set of exercises performed once weekly to muscle fatigue improved strength as well as twice a week in the older adult. Our results provide information that will assist in designing strength-training programmes that are more time and cost efficient in producing health and fitness benefits for older adults.

41 1 19-22 Jan 2007 NO DATA
2 article Comparison of Rehabilitation Methods in the Treatment of Patellar Tendinitis mx+tools NO DATA Wilson et al It’s doubtful that this tiny trial was actually of high quality. However, it is notable for being one of the only clinical trials of provocation therapy with instrument massage, and the results were positive. Noted, with a huge grain of salt.

Objective: To compare outcomes of 2 rehabilitation protocols on patellar tendinitis subjects. Design: Prospective, randomized, blinded, controlled clinical trial. Setting: Outpatient rehabilitation clinic. Subjects: Randomized into 2 rehabilitation groupsÑtraditional (n = 10) and ASTM AdvantEDGE (n = 10). Main Outcome Measures: Clinical data and self-reported questionnaires collected at 0, 6, and 12 weeks. Results: On completion of the 6th week, 100% of the ASTM AdvantEDGE group and 60% of the traditional group had resolved. The unresolved subjects were crossed over to the ASTM AdvantEDGE for additional therapy. At the end of the additional therapy, 50% of the crossover subjects had resolved. The ASTM AdvantEDGE group's clinical outcomes and weekly journals indicated a statistically significant (P = .04) improvement in subjective pain and functional-impairment ratings. Conclusions: Findings suggest that ASTM AdvantEDGE resulted in improved clinical outcomes in treating patellar tendinitis.

9 4 304-314 NO DATA 2000 NO DATA
NO DATA article Comparison of splinting, splinting plus local steroid injection and open carpal tunnel release outcomes in idiopathic carpal tunnel syndrome NO DATA NO DATA Ucan et al PubMed #16871409. NO DATA

The objective of this study was to compare the short- and long-term efficacies of splinting (S), splinting plus local steroid injection (SLSI), and open carpal tunnel release (OCTR) in mild or moderate idiopathic carpal tunnel syndrome (CTS). Patients with mild or moderate idiopathic CTS who experienced symptoms for over 6 months were included in the study. The patients were evaluated for the baseline and the third and sixth month scores after treatment. Follow-up criteria were ENMG parameters, Boston Questionnaire, and patient satisfaction. Fifty-seven hands completed the study. Twenty-three hands had been splinted for 3 months. Twenty-three hands were given a single steroid injection and splinted for 3 months, and 11 hands were operated. In the first 3 months, all treatment methods provided significant improvements in both clinical and EMG parameters in which OCTR had better outcomes on median sensorial nerve velocity at palm wrist segment. In the second 3 months, while the clinical and EMG parameters began to deteriorate in S and SLSI group, OCTR group continued to improve, and BQ functional capacity score of OCTR group was statistically better than that in conservative methods (P = 0.03). S and SLSI treatments improved clinical and EMG parameters comparable to OCTR in short term. However, these beneficial effects were transient in the sixth month follow-up and OCTR was superior to conservative treatments.

NO DATA NO DATA NO DATA Jul 2006 NO DATA
4 article Comparison of symptoms and clinical findings in subgroups of individuals with patellofemoral pain dx+etio+run+pfps+psb NO DATA Näslund et al PubMed #16848349. Researchers bone scanned and x-rayed 80 patients diagnosed with PFPS and with many common similar diagnoses eliminated, a nice “pure” selection of unexplained knee pain patients. They divided them into three groups: 17 with pathology, 29 with “hot” kneecaps (metabolically active), and 29 without any findings (5 dropped out). All patients and 48 healthy subjects without any knee pain were then interviewed and examined by a surgeon and a physical therapist. They could not diagnose the pathologies without the scans — all patients with pain tested about the same, and their symptoms were indistinguishable. Q-for-quadriceps angles were about 4˚ bigger in the afflicted, but the authors carefully explain that 4˚ too small to be reliably detected. The most interesting result of the study is that almost half the PFPS patients had kneecaps throbbing with metabolic activity — that’s a fairly strong pattern.

Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal disorders. However, no consensus on the definition, classification, assessment, diagnosis, or management has been reached. We evaluated symptoms and clinical findings in subgroups of individuals with PFPS, classified on the basis of the findings in radiological examinations and compared the findings with knee-healthy subjects. An orthopedic surgeon and a physical therapist consecutively examined 80 patients clinically diagnosed as having PFPS and referred for physical therapy. The examination consisted of taking a case history and clinical tests. Radiography revealed pathology in 15 patients, and scintigraphic examination revealed focal uptake in 2 patients indicating pathology (group C). Diffusely increased uptake was present in 29 patients (group B). In the remaining 29 patients radiographic and scintigraphic examinations were normal (group A). Knee-healthy controls (group D) reported no clinical symptoms. No symptom could be statistically demonstrated to differ between the three patient groups. Knee-healthy subjects differed significantly from the three patient groups in all clinical tests measuring pain in response to the provocations; compression test, medial and lateral tenderness, passive gliding of the patella, but they also differed in Q angle. Differences in clinical tests between the patient groups were nonsignificant. The main finding in our study on patients clinically diagnosed with PFPS is that possible pathologies cannot be detected from the patient's history or from commonly used clinical tests.

22 3 105-18 Jun 2006 NO DATA
NO DATA article A critical review of controlled clinical trials for peripheral neuropathic pain and complex regional pain syndromes NO DATA NO DATA Kingery PubMed #9415498. NO DATA

The purpose of this review was to identify and analyze the controlled clinical trial data for peripheral neuropathic pain (PNP) and complex regional pain syndromes (CRPS). A total of 72 articles were found, which included 92 controlled drug trials using 48 different treatments. The methods of these studies were critically reviewed and the results summarized and compared. The PNP trial literature gave consistent support (two or more trials) for the analgesic effectiveness of tricyclic antidepressants, intravenous and topical lidocaine, intravenous ketamine, carbamazepine and topical aspirin. There was limited support (one trial) for the analgesic effectiveness of oral, topical and epidural clonidine and for subcutaneous ketamine. The trial data were contradictory for mexiletine, phenytoin, topical capsaicin, oral non-steroidal anti-inflammatory medication, and intravenous morphine. Analysis of the trial methods indicated that mexiletine and intravenous morphine were probably effective analgesics for PNP, while non-steroidals were probably ineffective. Codeine, magnesium chloride, propranolol, lorazepam, and intravenous phentolamine all failed to provide analgesia in single trials. There were no long-term data supporting the analgesic effectiveness of any drug and the etiology of the neuropathy did not predict treatment outcome. Review of the controlled trial literature for CRPS identified several potential problems with current clinical practices. The trial data only gave consistent support for analgesia with corticosteroids, which had long-term effectiveness. There was limited support for the analgesic effectiveness of topical dimethylsulfoxyde (DMSO), epidural clonidine and intravenous regional blocks (IVRBs) with bretylium and ketanserin. The trial data were contradictory for intranasal calcitonin and intravenous phentolamine and analysis of the trial methods indicated that both treatments were probably ineffective for most patients. There were consistent trial data indicating that guanethidine and reserpine IVRBs were ineffective, and limited trial data indicating that droperidol and atropine IVRBs were ineffective. No placebo controlled data were available to evaluated sympathetic ganglion blocks (SGBs) with local anesthetics, surgical sympathectomy, or physical therapy. Only the capsaicin trials presented data which allowed for meta-analysis. This meta-analysis demonstrated a significant capsaicin effect with a pooled odds ratio of 2.35 (95% confidence intervals 1.48, 3.22). The methods scores were higher (P < 0.01) for the PNP trials (66.2 +/- 1.5, n = 66) than the CRPS trials (57.6 +/- 2.9, n = 26). The CRPS trials tended to use less subjects and were less likely to use placebo controls, double-blinding, or perform statistical tests for differences in outcome measures between groups. There was almost no overlap in the controlled trial literature between treatments for PNP and CRPS, and treatments used in both conditions (intravenous phentolamine and epidural clonidine) had similar results.

73 2 123-39 Nov 1997 NO DATA
NO DATA article Comparison of the early response to two methods of rehabilitation in adhesive capsulitis NO DATA NO DATA Guler-Uysal et al PubMed #15318285. NO DATA

PRINCIPLE: A randomised, comparative prospective clinical trial was planned to compare the early response to different rehabilitation methods for adhesive capsulitis taking into consideration the clinical efficacy and the cost effectiveness of the methods.

METHODS: Forty patients with adhesive capsulitis were randomised into two treatment groups. The first group (CYR) received the Cyriax approach of deep friction massage and mobilisation exercises three times weekly. The second group (PT) had daily physical therapy including hot pack and short wave diathermy application. Both groups concluded their treatments with stretching exercises and were also instructed to a daily home exercise program. The primary end point of the study was to reach 80% of the normal passive range of motion (ROM) of the shoulder in all planes within a period of two weeks. Secondary end points were the overall ROM and pain response (spontaneous pain, night pain and pain with motion) to each treatment.

RESULTS: 19 patients in the CYR group (95%) and 13 patients in the PT group (65%) reached sufficient ROM at the end of the second week (p <0.05). The improvement in shoulder flexion, inner and outer rotation values and the decrease in pain with motion were significantly better in the CYR group after the first week of treatment.

CONCLUSION: The Cyriax method of rehabilitation provides a faster and better response than the conventional physical therapy methods in the early phase of treatment in adhesive capsulitis. The method is non-invasive, effective and requires fewer hospital visits for a sufficient early response.

134 23-24 353-8 Jun 2004 NO DATA
NO DATA article Comparison of the efficacy of local corticosteroid injection and physical therapy for the treatment of adhesive capsulitis NO DATA NO DATA Arslan et al PubMed #11678298. NO DATA

Adhesive capsulitis is a common musculoskeletal disorder mainly affecting middle aged adults. It is associated with generalized pain and tenderness in the shoulder joint with severe loss of active and passive ranges of motion in all planes. The aim of this study was to compare the efficacy of local steroid injection and physical therapy measures for treating this disorder. Ten male and 10 female patients were enrolled in the study. The patients were divided randomly into two groups and treated with either 40 mg methylprednisolone acetate injection with local anesthetic (group A) or physical therapy measures plus nonsteroidal anti-inflammatory drugs (group B). The mean ages of the patients were 55.6+/-12.2 years in group A and 56.4+/-7.1 years in group B. Clinical assessment was performed on initial visit and at the 2nd and 12th weeks. Active and passive range of motion was recorded and the visual analogue scale was used to evaluate pain intensity. At initial visit, these data in both groups of patients were not statistically different. Although both treatment regimens resulted in significant improvement in range of motion, the differences between mean external rotation at the 2nd and 12th weeks were not statistically significant in either group. The improvement in range of motion at the end of the study was similar in both groups (P>0.05). All patients reported improvement during the study. The differences between mean VAS scores at the 2nd and 12th weeks were statistically significant in both groups. In conclusion, local steroid injection therapy was found to be as effective as physical therapy for the treatment of adhesive capsulitis.

21 1 20-3 Sep 2001 NO DATA
3 article Comparison of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures tx+back NO DATA Bailey et al PubMed #19769510. This trial tested braces for thoracolumbosacral injuries, and could not determine if they were effective. “However, the authors contend that a thoracolumbar burst fracture, in exclusion of an associated posterior ligamentous complex injury, is inherently a very stable injury and may not require a brace.” For a thorough summary of this research, see Is a Back Brace Really Needed for a Burst Fracture of the Spine?

OBJECT: The authors compared the outcome of patients with thoracolumbar burst fractures treated with and without a thoracolumbosacral orthosis (TLSO).

METHODS: As of June 2002, all consecutive patients satisfying the following inclusion criteria were considered eligible for this study: 1) the presence of an AO Classification Type A3 burst fractures between T-11 and L-3, 2) skeletal maturity and age < 60 years, 3) admission within 72 hours of injury, 4) initial kyphotic deformity < 35 degrees, and 5) no neurological deficit. The study was designed as a multicenter prospective randomized clinical equivalence trial. The primary outcome measure was the score based on the Roland-Morris Disability Questionnaire assessed at 3 months postinjury. Secondary outcomes are assessed until 2 years of follow-up have been reached, and these domains included pain, functional outcome and generic health-related quality of life, sagittal alignment, length of hospital stay, and complications. Patients in whom no orthotic was used were encouraged to ambulate immediately following randomization, maintaining "neutral spinal alignment" for 8 weeks. The patients in the TLSO group began being weaned from the brace at 8 weeks over a 2-week period.

RESULTS: Sixty-nine patients were followed to the primary outcome time point, and 47 were followed for up to 1 year. No significant difference was found between treatment groups for any outcome measure at any stage in the follow-up period. There were 4 failures requiring surgical intervention, 3 in the TLSO group and 1 in the non-TLSO group.

CONCLUSIONS: This interim analysis found equivalence between treatment with a TLSO and no orthosis for thoracolumbar AO Type A3 burst fractures. The influence of a brace on early pain control and function and on long-term 1- and 2-year outcomes remains to be determined. However, the authors contend that a thoracolumbar burst fracture, in exclusion of an associated posterior ligamentous complex injury, is inherently a very stable injury and may not require a brace.

11 3 295-303 Sep 2009 NO DATA
NO DATA article Comparison of three conservative treatment protocols in carpal tunnel syndrome NO DATA NO DATA Baysal et al PubMed #16704676. NO DATA

The aim of this study was to investigate and compare the therapeutic effect of three different combinations in the conservative treatment of carpal tunnel syndrome (CTS) by means of clinical and electrophysiological studies. The combinations included tendon- and nerve-gliding exercises in combination with splinting, ultrasound treatment in combination with splinting and the combination of ultrasound, splinting, tendon- and nerve-gliding exercises. A total 28 female patients (56 wrists) with clinical and electrophysiologic evidence of bilateral CTS were studied. In all patient groups, the treatment combinations were significantly effective immediately and 8 weeks after the treatment. The results of the long-term patient satisfaction questionnaire revealed that symptomatic improvement is more prominent in the group treated with splinting, exercise and ultrasound therapy combination. Our results suggest that a combination of splinting, exercise and ultrasound therapy is a preferable and an efficacious conservative type of treatment in CTS.

60 7 820–828 Jul 2006 NO DATA
2 article Comparison of ultrasound-, palpation-, and scintigraphy-guided steroid injections in the treatment of plantar fasciitis pf+inject+foot NO DATA Yucel et al PubMed #17015890. NO DATA

BACKGROUND: The aim of the study was to compare the efficacies of steroid injections guided by scintigraphy, ultrasonography, and palpation in plantar fasciitis.

METHODS: A total of 35 heels of 27 patients were randomly assigned to three steroid injection groups: palpation-guided (pg), ultrasound-guided (ug), and scintigraphy-guided (sg). Patients were evaluated for pain intensity before the injections and at the last follow-up of 25.3 months with a 100-mm visual analog scale (VAS).

RESULTS: There were significant improvements in plantar fascia thickness, fat pad thickness, and VAS. Among the three groups of ug-pg, ug-sg, and pg-sg there were no statistically significant differences after treatment (P = 0.017, MWU = 36.5; P = 0.023, MWU = 29.5; and P = 0.006, MWU = 13, respectively).

CONCLUSIONS: The ug, pg, and sg injections were effective in the conservative treatment of plantar fasciitis. We are of the opinion that steroid injections should be performed, preferably with palpation or ultrasonographic guidance.

129 5 695-701 May 2009 NO DATA
NO DATA article Competence levels in musculoskeletal medicine back+neck+sbm NO DATA Stockard et al 1 From the abstract: “82% of allopathic graduates ... failed to demonstrate basic competency in musculoskeletal medicine.”

BACKGROUND: Consistent with osteopathic principles and practice, the nation's colleges of osteopathic medicine (COMs) have emphasized the significance of the musculoskeletal system to the practice of medicine. The authors hypothesized that graduating COM students would, therefore, demonstrate superior knowledge and competence in musculoskeletal medicine when compared with graduates of allopathic medical schools.

METHODS: The authors asked graduating COM students to complete a standardized and previously validated 25-question basic competency examination on musculoskeletal medicine in short-answer format. Originally developed and validated in the late 1990s, the examination was distributed to allopathic medical residents at the beginning of their residencies. The authors compare their results with those reported by Freedman and Bernstein for allopathic residents.

RESULTS: When the minimum passing level as determined by orthopedic program directors was applied to the results of these examinations, 70.4% of graduating COM students (n=54) and 82% of allopathic graduates (n=85) failed to demonstrate basic competency in musculoskeletal medicine. Similarly, the majority of both groups failed to attain the minimum passing level established by the directors of internal medicine programs (graduating COM students, 67%; allopathic graduates, 78%).

CONCLUSION: In an examination of competence levels for musculoskeletal medicine, students about to graduate from a COM fared only marginally better than did their allopathic counterparts. To ensure that all graduating COM students have attained a level of basic competence in musculoskeletal medicine, the authors recommend further study as a prelude to evaluation of the didactic and clinical curriculum at all 22 COMs and their branch campuses.

106 6 350–355 Jun 2006 NO DATA
2 article Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics etio+self-tx+itbs+psb NO DATA Ferber et al PubMed #20118523. This study is a fishing expedition to confirm the (pet) theory that hip strength is a significant factor in ITBS. It is not surprising in a general sense that it found some indications of abnormal running mechanics. What is notable is that the abnormalities do not correspond well or cleanly to the notion that “weak hips” are the problem. Also, typical of studies with results that aren’t that interesting, only the statistical significance of the abnormalities is mentioned, and not their actual size — which was probably small.

STUDY DESIGN: Cross-sectional experimental laboratory study. OBJECTIVE: To examine differences in running mechanics between runners who had previously sustained iliotibial band syndrome (ITBS) and runners with no knee-related running injuries. BACKGROUND: ITBS is the second leading cause of knee pain in runners and the most common cause of lateral knee pain. Despite its prevalence, few biomechanical studies have been conducted to better understand its aetiology. Because the iliotibial band has both femoral and tibial attachments, it is possible that atypical hip and foot mechanics could result in the development of ITBS. METHODS: The running mechanics of 35 females who had previously sustained ITBS were compared to 35 healthy age-matched and running distance-matched healthy females. Comparisons of hip, knee, and ankle 3-dimensional kinematics and internal moments during the stance phase of running gait were measured. RESULTS: The ITBS group exhibited significantly greater peak rearfoot invertor moment, peak knee internal rotation angle, and peak hip adduction angle compared to controls. No significant differences in peak rearfoot eversion angle, peak knee flexion angle, peak knee external rotator moment, or peak hip abductor moments were observed between groups. CONCLUSION: Females with a previous history of ITBS demonstrate a kinematic profile that is suggestive of increased stress on the iliotibial band. These results were generally similar to those reported for a prospective study conducted within the same laboratory environment.

40 2 52-8 Feb 2010 NO DATA
NO DATA book Complementary therapies for pain management pain+tps NO DATA Ernst et al NO DATA NO DATA NO DATA NO DATA NO DATA NO DATA 2007 Elsevier/Mosby Ltd.
4 article Compliance with a comprehensive warm-up programme to prevent injuries in youth football pfps+itbs+shin+pf+exercise+knee+foot NO DATA Soligard et al 1 Researchers found that injury rates were significantly lower in soccer (football) teams that diligently performed warmup exercises (“The 11+”, a warmup program recommended by FIFA, which notably does not include stretching). On the one hand, there was not much difference between a little warming up (low participation) and a bit more warming up (average participation). But players and teams that did an especially good job of warming up (“twice as many injury prevention sessions”) got solid results: “the risk of overall and acute injuries was reduced by more than a third among players with high compliance compared with players with intermediate compliance.” That extra enthusiasm went a long way!

BACKGROUND: Participants' compliance, attitudes and beliefs have the potential to influence the efficacy of an intervention greatly.

OBJECTIVE: To characterise team and player compliance with a comprehensive injury prevention warm-up programme for football (The 11+), and to assess attitudes towards injury prevention among coaches and their association with compliance and injury risk.

STUDY DESIGN: A prospective cohort study and retrospective survey based on a cluster-randomised controlled trial with teams as the unit of randomisation.

METHODS: Compliance, exposure and injuries were registered prospectively in 65 of 125 football teams (1055 of 1892 female Norwegian players aged 13-17 years and 65 of 125 coaches) throughout one football season (March-October 2007). Standardised telephone interviews were conducted to assess coaches' attitudes towards injury prevention.

RESULTS: Teams completed the injury prevention programme in 77% (mean 1.3 sessions per week) of all training and match sessions, and players in 79% (mean 0.8 sessions per week) of the sessions they attended. Compared with players with intermediate compliance, players with high compliance with the programme had a 35% lower risk of all injuries (RR 0.65, 95% CI 0.46 to 0.91, p=0.011). Coaches who had previously utilised injury prevention training coached teams with a 46% lower risk of injury (OR 0.54, 95% CI 0.33 to 0.87, p=0.011).

CONCLUSIONS: Compliance with the injury prevention programme was high, and players with high compliance had significantly lower injury risk than players with intermediate compliance. Positive attitudes towards injury prevention correlated with high compliance and lower injury risk.

44 11 787-93 Sep 2010 NO DATA
5 book Complications biolit+surgery+back NO DATA Gawande A dazzlingly lucid tour of the impossible dilemmas in the practice of health care in general and surgery in particular, including a chapter on low back pain and another on modern pain science (see Gawande) that are of particular interest to me and amongst the best writing I’ve ever come across on the subject. An extremely entertaining and informative book which I recommend without any reservations whatsoever — an unusually strong endorsement, coming from me! (I am usually outspokenly critical of even the best books.) NO DATA NO DATA NO DATA NO DATA NO DATA 2002 Metropolitan Books/Henry Holt
4 article Comprehensive warm-up programme to prevent injuries in young female footballers stretch+pfps+itbs+shin+pf+exercise+knee+foot NO DATA Soligard et al 1 Research has shown for years now that good ol’ stretching doesn’t really prevent athletic injuries. So what does? Warmups that “improve strength, awareness, and neuromuscular control” might just do the trick. Practicing coordination and control, basically (see Panics et al). In 2008, Norwegian researchers compared injuries in over a thousand female footballers who participated in such a warmup for a season, to another several hundred who didn’t. Athletes who warmed up had fewer traumatic injuries and fewer overuse injuries. Moreover, the injuries they did have were less severe. Static stretching was not part of the warmup, but “active” stretching was (i.e. Mobilize!).

OBJECTIVE: To examine the effect of a comprehensive warm-up programme designed to reduce the risk of injuries in female youth football.

DESIGN: Cluster randomised controlled trial with clubs as the unit of randomisation.

SETTING: 125 football clubs from the south, east, and middle of Norway (65 clusters in the intervention group; 60 in the control group) followed for one league season (eight months).

PARTICIPANTS: 1892 female players aged 13-17 (1055 players in the intervention group; 837 players in the control group).

INTERVENTION: A comprehensive warm-up programme to improve strength, awareness, and neuromuscular control during static and dynamic movements.

MAIN OUTCOME MEASURE: Injuries to the lower extremity (foot, ankle, lower leg, knee, thigh, groin, and hip).

RESULTS: During one season, 264 players had relevant injuries: 121 players in the intervention group and 143 in the control group (rate ratio 0.71, 95% confidence interval 0.49 to 1.03). In the intervention group there was a significantly lower risk of injuries overall (0.68, 0.48 to 0.98), overuse injuries (0.47, 0.26 to 0.85), and severe injuries (0.55, 0.36 to 0.83).

CONCLUSION: Though the primary outcome of reduction in lower extremity injury did not reach significance, the risk of severe injuries, overuse injuries, and injuries overall was reduced. This indicates that a structured warm-up programme can prevent injuries in young female football players.

337 NO DATA a2469 NO DATA 2008 NO DATA
3 article Computer-aided design of customized foot orthoses tx+shoes+tools+psb NO DATA Telfer et al PubMed #22541310. Foot orthotics are made from basic measurements and captured images of the foot (plaster casting, foam box impressions, or three-dimensional computer images). None of these techniques is very accurate (<80%), especially with measuring the peak arch height. Skilled 3D computer imaging may be the most accurate. Basic measurement is particularly inaccurate.

OBJECTIVE: To determine, for a number of techniques used to obtain foot shape based around plaster casting, foam box impressions, and 3-dimensional scanning, (1) the effect the technique has on the overall reproducibility of custom foot orthoses (FOs) in terms of inter- and intracaster reliability and (2) the reproducibility of FO design by using computer-aided design (CAD) software in terms of inter- and intra-CAD operator reliability for all these techniques.

DESIGN: Cross-sectional study.

SETTING: University laboratory.

PARTICIPANTS: Convenience sample of individuals (N=22) with noncavus foot types.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Parameters of the FO design (length, width at forefoot, width at rearfoot, and peak medial arch height), the forefoot to rearfoot angle of the foot shape, and overall volume match between device designs.

RESULTS: For intra- and intercaster reliability of the different methods of obtaining the foot shape, all methods fell below the reproducibility quality threshold for the medial arch height of the device, and volume matching was <80% for all methods. The more experienced CAD operator was able to achieve excellent reliability (intraclass correlation coefficients>0.75) for all variables with the exception of forefoot to rearfoot angle, with overall volume matches of>87% of the devices.

CONCLUSIONS: None of the techniques for obtaining foot shape met all the criteria for excellent reproducibility, with the peak arch height being particularly variable. Additional variability is added at the CAD stage of the FO design process, although with adequate operator experience good to excellent reproducibility may be achieved at this stage. Taking only basic linear or angular measurement parameters from the device may fail to fully capture the variability in FO design.

93 5 863-70 May 2012 NO DATA
2 article Concentric and eccentric torque of the hip musculature in individuals with and without patellofemoral pain knee+pfps+psb+exercise+etio NO DATA Boling et al 1 Twenty patients with patellofemoral pain were tested and found to have “weakness in eccentric hip abduction and hip external rotation.” The weakness could be either a symptom of knee pain and/or a cause of it: this study was designed only to attempt to detect the correlation, and is too tiny to do even that convincingly, much like a previous paper from this author (see Boling 2006).

CONTEXT: Individuals suffering from patellofemoral pain have previously been reported to have decreased isometric strength of the hip musculature; however, no researchers have investigated concentric and eccentric torque of the hip musculature in individuals with patellofemoral pain.

OBJECTIVE: To compare concentric and eccentric torque of the hip musculature in individuals with and without patellofemoral pain.

DESIGN: Case control.

SETTING: Research laboratory.

PATIENTS OR OTHER PARTICIPANTS: Twenty participants with patellofemoral pain (age = 26.8 +/- 4.5 years, height = 171.8 +/- 8.4 cm, mass = 72.4 +/- 16.8 kg) and 20 control participants (age = 25.6 +/- 2.8 years, height = 169.5 +/- 8.9 cm, mass = 70.0 +/- 16.9 kg) were tested. Volunteers with patellofemoral pain met the following criteria: knee pain greater than or equal to 3 cm on a 10-cm visual analog scale, insidious onset of symptoms not related to trauma, pain with palpation of the patellar facets, and knee pain during 2 of the following activities: stair climbing, jumping or running, squatting, kneeling, or prolonged sitting. Control participants were excluded if they had a prior history of patellofemoral pain, knee surgery in the past 2 years, or current lower extremity injury that limited participation in physical activity.

INTERVENTION(S): Concentric and eccentric torque of the hip musculature was measured on an isokinetic dynamometer. All volunteers performed 5 repetitions of each strength test. Separate multivariate analyses of variance were performed to compare concentric and eccentric torque of the hip extensors, abductors, and external rotators between groups.

MAIN OUTCOME MEASURE(S): Average and peak concentric and eccentric torque of the hip extensors, abductors, and external rotators. Torque measures were normalized to the participant's body weight multiplied by height.

RESULTS: The patellofemoral pain group was weaker than the control group for peak eccentric hip abduction torque (F(1,38) = 6.630, P = .014), and average concentric (F(1,38) = 4.156, P = .048) and eccentric (F(1,38) = 4.963, P = .032) hip external rotation torque.

CONCLUSIONS: The patellofemoral pain group displayed weakness in eccentric hip abduction and hip external rotation, which may allow for increased hip adduction and internal rotation during functional movements.

44 1 7-13 NO DATA 2009 NO DATA
NO DATA article Concurrent Periostalgia and Chronic Proximal Deep Posterior Compartment Syndrome in a Collegiate Track and Field Athlete shin NO DATA Heinrichs et al “In addition to the more widely publicized anterior compartment syndrome,” the authors believes that posterior compartment syndrome is also “one of the most common causes of exercise-induced leg pain in aerobic athletes.”

OBJECTIVE: Exercise-induced leg pain may be triggered by abnormally high compartment pressure. In addition to the more widely publicized anterior compartment syndrome, the deep posterior compartment syndrome can just as frequently occur, resulting in severe pain and disability due to muscle and nerve ischemia.

BACKGROUND: Obtaining a thorough history and compartmental pressure measurements are the usual components in the accurate diagnosis of compartment syndromes. While few other disorders mimic compartment syndromes, differential diagnoses must be considered. Surgical management of deep compartment syndrome, consisting of fasciotomy or fasciectomy, or both, is successful for most patients. DIFFERENTIAL DIAGNOSIS: Tibial stress fracture or microfracture, tibial periostitis, tibial periostalgia, distal deep posterior chronic compartment syndrome, proximal deep chronic compartment syndrome, superficial lateral compartment syndrome, deep venous thrombosis, popliteal artery entrapment, or chronic compartment syndrome. UNIQUENESS: Chronic deep compartment syndrome is one of the most common causes of exercise-induced leg pain in aerobic athletes. Therefore, the athletic trainer must be able to recognize the condition. Signs, symptoms, diagnosis, and surgical management of chronic deep compartment syndrome, chronic periostalgia, and superficial lateral compartment syndrame in a 21-year-old Division IA track and field athlete are presented.

CONCLUSIONS: With the correct diagnosis, persistent and methodical reevaluation, and appropriate management, the athlete can expect a successful treatment outcome.

35 4 450–452 Oct 2000 NO DATA
NO DATA article Conscious neurosensory mapping of the internal structures of the human knee without intraarticular anesthesia surgery NO DATA Dye et al NO DATA

The conscious neurosensory characteristics of the internal components of the human knee were documented by instrumented arthroscopic palpation without intraarticular anesthesia. With only local anesthesia injected at the portal sites, the first author (SFD) had both knees inspected arthroscopically. Subjectively, he graded the sensation from no sensation (0) to severe pain (4), with a modifier of either accurate spatial localization (A) or poor spatial localization (B). The nature of the intraarticular sensation was variable, ranging from 0 on the patellar articular cartilage to 4A on the anterior synovium, fat pad, and joint capsule. The sensation arising from the cruciate ligaments ranged from 1 to 2B in the midportion, and from 3 to 4B at the insertion sites. The sensation from the meniscal cartilages ranged from 1B on the inner rim to 3B near the capsular margin. Innervation of most intraarticular components of the knee is probably crucial for tissue homeostasis. Failure of current intraarticular soft tissue reconstructions of the knee may be due, in part, to the lack of neurosensory restoration. Research studies of the knee designed to delineate factors that restore neurosensory characteristics of the musculoskeletal system may lead to techniques that result in true restoration of joint homeostasis and function.

26 6 773–777 NO DATA 1998 NO DATA
3 article Conservative treatment of a female collegiate volleyball player with costochondritis mx+pain+chiro NO DATA Aspegren et al PubMed #17509441. For eight months, a 21-year-old female volleyball player had suffered from right anterior chest pain and midthoracic back stiffness. High-relocity, low-amplitude mainpulation was attempted as well as the Graston technique. Pain levels improved. The athlete seemed to respond well to three techniques: manipulation, soft tissue mobilization, and taping.

OBJECTIVE: This study was conducted to discuss the conservative care used to treat a female collegiate volleyball player with acute costochondritis.

CLINICAL FEATURES: A 21-year-old collegiate volleyball player had right anterior chest pain and midthoracic stiffness of 8 months duration.

INTERVENTION AND OUTCOME: High-velocity, low-amplitude manipulation was performed to the associated hypokinetic costovertebral, costotransverse, and intervertebral zygapophyseal thoracic joints. Instrument-assisted soft tissue mobilization was performed by using the Graston technique. Pain levels improved on numeric pain scale, as did functional status identified on Dallas Pain Questionnaire and Functional Rating Index.

CONCLUSION: This athlete seemed to respond positively to manipulation, soft tissue mobilization, and taping.

30 4 321-5 May 2007 NO DATA
4 article Conservative treatment of a tibialis posterior strain in a novice triathlete mx+run+strain NO DATA Howitt et al 1 An inexperienced triathlete developed Tibialis posterior strain and came to the clinic for treatment. This condition often causes swelling and edema as well as pain and an weight-bearing difficulties. It is a common injury in runners. Several techniques were used: 1) Graston Technique; 2) medical acupuncture; 3) Active Release Technique; 4) ultrasound therapy. The conclusion was that this athlete’s symptoms were very quickly relieved by these treatments.

OBJECTIVE: To detail the progress of a novice triathlete with an unusual mechanism of a tibialis posterior strain who underwent successful conservative treatment and rehabilitation. Tibialis posterior tendon dysfunction will be discussed as it relates to the case.

CLINICAL FEATURES: The clinical features of tibialis posterior dysfunction are swelling and edema posterior to the medial malleolus with pain and an inability to weight bear. This injury may occur in endurance athletes such as triathletes, most often occurring during running.

INTERVENTION AND OUTCOME: The conservative treatment approach used in this case consisted of medical acupuncture with electrical stimulation, Graston Technique((c)) a soft tissue instrument assisted mobilization technique, Active Release Technique((R)), ultrasound therapy with Traumeel, and rehabilitation. Gait analysis and orthotic prescription was completed when the patient was ready to return to play. Outcome measures included subjective pain rating and return to pre-injury activities. Objective measures included swelling and manual muscle testing.

CONCLUSION: A novice triathlete with a grade I tibialis posterior strain was quickly relieved of his symptoms and able to return to his triathlon training with conservative treatment. Practitioners treating this type of injury could consider including the soft tissue techniques, modalities and rehabilitation employed in our case for other patients with lower leg strains and/or tibialis posterior dysfunction.

53 1 23-31 Mar 2009 NO DATA
3 article Conservative treatment of plantar fasciitis pf+run+tx+tools+foot NO DATA Lynch et al PubMed #9735623. NO DATA

A randomized, prospective study was conducted to compare the individual effectiveness of three types of conservative therapy in the treatment of plantar fasciitis. One hundred three subjects were randomly assigned to one of three treatment categories: anti-inflammatory, accommodative, or mechanical. Subjects were treated for 3 months, with follow-up visits at 2, 4, 6, and 12 weeks. For the 85 patients who completed the study, a statistically significant difference was noted between groups, with mechanical treatment with taping and orthoses proving to be more effective than either anti-inflammatory or accommodative modalities.

88 NO DATA 375–80 NO DATA 1998 NO DATA
2 article Conservative treatment of plantar heel pain pf+run+foot NO DATA Wolgin et al PubMed #7951946. Rest was cited by 25 percent of patients with plantar fasciitis as the treatment that worked best.

In order to evaluate the long-term results of patients treated conservatively for plantar heel pain, a telephone follow-up survey was conducted. After eliminating those patients with worker's compensation-related complaints and those with documented inflammatory arthritides, data on 100 patients (58 females and 42 males) were available for review. The average patients was 48 years old (range 20-85 years). The average follow-up was 47 months (24-132 months). Clinical results were classified as good (resolution of symptoms) for 82 patients, fair (continued symptoms but no limitation of activity or work) for 15 patients, and poor (continued symptoms limiting activity or changing work status) in 3 patients. The average duration of symptoms before medical attention was sought was 6.1, 18.9, and 10 months for the three groups, respectively. The three patients with poor results all had bilateral complaints, but had no other obvious risk factors predictive of their poor result. Thirty-one patients stated that, even with the understanding that surgical treatment carries significant risk, they would have seriously considered it at the time medical attention was sought; twenty-two of these patients eventually had resolution of symptoms. Although the treatment of heel pain can be frustrating due to its indolent course, a given patient with plantar fasciitis has a very good chance of complete resolution of symptoms. There is a higher risk for continued symptoms in over-weight patients, patients with bilateral symptoms, and those who have symptoms for a prolonged period before seeking medical attention.

15 NO DATA 97–102 NO DATA 1994 NO DATA
4 article The conservative treatment of Trigger Thumb using Graston Techniques and Active Release Techniques(R) mx+chiro NO DATA Howitt et al 1 Two techniques — Graston and Active Release Therapy — were used in this study with one patient who had unresolved symptoms of Trigger Thumb. These were both conservative treatments. The patient had painful snapping and restriction of movement in their thumb. The patient appeared to be relieved of his “pain and disability” after these two treatments.

OBJECTIVE: To detail the progress of a patient with unresolved symptoms of Trigger thumb who underwent a treatment plan featuring Active Release Technique (ART) and Graston Technique.

CLINICAL FEATURES: The most important feature is painful snapping or restriction of movement, most notably in actively extending or flexing the digit. The cause of this flexor tendinopathy is believed to be multi-factorial including anatomical variations of the pulley system and biomechanical etiologies such as exposure to shear forces and unaccustomed activity. Conventional treatment aims at decreasing inflammation through corticosteroid injection or surgically removing imposing tissue.

INTERVENTION AND OUTCOME: The conservative treatment approach utilized in this case involved Active Release Technique (ART(R)) and Graston Technique (GT). An activity specific rehabilitation protocol was employed to re-establish thumb extensor strength and ice was used to control pain and any residual inflammation. Outcome measures included subjective pain ratings with range of motion and motion palpation of the first right phalangeal joint. Objective measures were made by assessing range of motion.

CONCLUSION: A patient with trigger thumb appeared to be relieved of his pain and disability after a treatment plan of GT and ART.

50 4 249-54 Dec 2006 NO DATA
NO DATA article Conservative treatment of work-related upper limb disorders--a review NO DATA NO DATA Crawford et al PubMed #16905621. NO DATA

Aim The literature review was carried out to identify and summarize the evidence-base for conservative clinical management of upper limb disorders (ULDs) including specific disorders and non-specific ULDs. Method Keywords were identified through a scoping study and guidance from the project sponsor. A number of databases were searched including Web of Knowledge, Pub Med, Medline, Ergonomics Online, the Cochrane Library and BMJ Clinical Evidence for the years 1993-2004. Abstracts were obtained for papers identified in the search and full papers were obtained for literature, which included diagnostic methods, conservative treatments, new data or results or systematic reviews. Results The review identified that there is evidence for the efficacy of conservative treatments for the management of carpal tunnel syndrome, epicondylitis, rotator cuff tendonitis and bicipital tendonitis and tension neck syndrome. There was no evidence found to support or refute conservative treatment of tenosynovitis, tendonitis, de Quervain's disease or diffuse non-specific ULDs. Conclusion The evidence reviewed was not always of good quality and data gaps including methodological design issues need to be addressed by future research.

NO DATA NO DATA NO DATA Aug 2006 NO DATA
NO DATA book Consumer Health quack+chiro+acu+ot+sbm NO DATA Barrett NO DATA NO DATA NO DATA NO DATA NO DATA NO DATA NO DATA 2007 McGraw-Hill Higher Education
NO DATA article Continuous passive motion provides good pain control in patients with adhesive capsulitis NO DATA NO DATA Dundar et al PubMed #19011582. NO DATA

Painful stiffening of the shoulder, 'frozen shoulder' is a common cause of shoulder pain and disability. Continuous passive motion (CPM) is an established method of preventing joint stiffness and of overcoming it. A randomized, comparative prospective clinical trial was planned to compare the early response with different rehabilitation methods [CPM vs. conventional physiotherapy treatment (CPT) protocol] for adhesive capsulitis taking into consideration the clinical efficacy. A total of 57 patients with frozen shoulder were included in this study. Patients were assigned randomly to receive daily CPM treatments or CPT protocol. Parameters were measured at baseline, and at weeks 4 and 12. All patients were evaluated with respect to pain (visual anologue scale) at rest, pain at movement, pain at night, measurement of range of motion (shoulder flexion, abduction, internal-external rotation were assessed), constant functional shoulder score and the shoulder pain and disability index. The first group (n=29) (CPM group) received CPM treatments for 1 h once a day for 20 days during a period of 4 weeks. The second group (n=28) (CPT group) had a daily physiotherapy treatment protocol including active stretching and pendulum exercises for 1 h once a day for 20 days during a period of 4 weeks. All patients in both groups were also instructed in a standardized home exercise programme consisting of passive range of motion and pendulum exercises to be performed every day. In both groups, statistically significant improvements were detected in all outcome measures compared with baseline. Pain reduction, however, evaluated with respect to pain at rest, at movement and at night was better in CPM group. In addition the CPM group showed better shoulder pain index scores than the CPT group. CPM treatment provides better response in pain reduction than the conventional physiotherapy treatment protocol in the early phase of treatment in adhesive capsulitis.

32 3 193-8 Sep 2009 NO DATA
NO DATA article Contrast therapy—a systematic review iceheat NO DATA Hing et al PubMed #19083715.