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Jeremy R. Hawkins, Kayla E. Gonzalez, and Kristin J. Heumann

Clinical Scenario:

Concussions are a prevalent topic in medicine. Concussion symptoms include headaches, dizziness, nausea, neuropsychiatric symptoms, and cognitive impairments, the persistence of which is referred to as postconcussion syndrome. Hyperbaric oxygen therapy (HBOT) has been proposed and evaluated as an additional treatment of these symptoms. HBOT is an innovative approach that has been considered by many but has received both criticism and acceptance.

Clinical Question:

Is HBOT an effective means of reducing symptoms for individuals suffering from postconcussion syndrome (persistence of symptoms for >3 mo)?

Summary of Search:

The literature was searched for studies that were relevant to the clinical question. Literature provided 5 level 1 studies that were relevant enough to be considered.

Clinical Bottom Line:

Based on the research that is available, the authors conclude that there is more evidence to refute the use of HBOT for postconcussion syndrome than to support it.

Strength of Recommendation:

Four studies disprove the use of HBOT; 1 study supported the use of HBOT. These 5 studies are the same level of evidence (level 1) and provide significant findings in their studies. The strength of this recommendation is a B according to the Centre for Evidence-Based Medicine.

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Timothy J. Demchak, Stephen J. Straub, and Lennart D. Johns


Ultrasound heating rates are known to differ between various manufacturers; it is unknown whether this difference exists within a manufacturer.


Determine if intramuscular heating differences exist between transducers from the same manufacturer.

Study Design:

3 × 10 repeated measures. Independent variables were Transducer (A, B, and C) and Time (10-min time points during the treatment).


Controlled laboratory.


Twelve volunteers (M = 4, F = 8; age: 23 ± 4 years; calf-girth: 37.94 ± 4.16 cm; calf-skinfold: 27 ± 17 mm).


Three 10-min 1MHz continuous ultrasound treatments performed at an intensity of 1.2 W/cm2, over an area 2x transducer.

Main Outcome Measures:

Calf temperature increase.


Heating curve generated for each transducer were significantly different (P = .034) but the overall temperature increases following 10 minutes of treatment were within 0.1°C (F = 1.023 P = .573).


Heating curves differ between transducers from the same manufacturer but peak heating at 10 minutes was similar.

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Justin L. Rush, David A. Sherman, David M. Bazett-Jones, Christopher D. Ingersoll, and Grant E. Norte

restrict the patient’s functional capabilities. However, this intervention is warranted prior to therapeutic exercise in the acute and subacute phases of recovery, where activation of the effected muscle is lacking. We hypothesized that lack of time and access to therapeutic modalities would have been the

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Michelle A. Sandrey


Tendons have biomechanical properties based on collaborative remodeling of all their cells through normal lysis and synthesis. This review assesses factors that affect the healing response and presents solutions for rehabilitating acute and chronic tendon injuries.

Data Sources:

MEDLINE (1970–2002) and SPORTDiscus (1970–2002). Key words searched were tendon, tendinitis, tendinosis, tendinopathy, rehabilitation, ultrasound, NSAIDs, exercise, mobilization, aging, immobilization, and healing.

Data Synthesis:

The biomechanical roles tendons play change throughout one’s lifetime and are influenced by maturation and aging, injury and healing, immobilization, exercise, medications, and therapeutic modalities. Suggestions from animal, case, and clinical studies are varied but provide solutions in the treatment of acute and chronic tendon injuries.

Conclusions and Recommendations:

All factors that affect the tendon structure should be considered in a rehabilitation program. Therapeutic exercise, medications, or therapeutic modalities should never be used as a stand-alone therapy.

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Marcin Grzes´kowiak, Zbigniew Krawiecki, Wojciech Łabe˛dz´, Jacek Kaczmarczyk, Jacek Lewandowski, and Dawid Łochyn´ski

, it seems that the 7-day period of KT application was too short or the tension to small (we used paper-off tension of the KT) to induce adaptive normalization of paraspinal muscle activity. Kinesio taping is considered as a therapeutic modality for managing painful myofascial disorders. 50 In our

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William R. Holcomb

Electrical therapy is a popular therapeutic modality for the management and rehabilitation of athletic injuries. Electrical stimulation is commonly used to elicit muscle contraction, reduce edema, and control pain. However, electrical therapy can also be a tremendous challenge for clinicians. The purpose of this paper is to present current and accurate information that will serve as a guide In the use of electrical therapy for the effective management of athletic injuries. With an understanding of the basic current types provided by various electrical stimulators and the modifications of the currents that are available, electrical therapy becomes an invaluable tool for injury management and rehabilitation.

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Oded Bar-Or

This review is intended to critically examine the notion that physical training, in addition to its nonspecific effects on fitness, can induce disease-specific benefits in the child with a chronic disease. Conditions included in this analysis are asthma, cerebral palsy, coronary risk, cystic fibrosis, diabetes mellitus, hypertension, myopathies, and obesity. Most of the published intervention studies are deficient in design by not including randomly assigned (or matched) controls. Other constraints stem from the need to simultaneously maintain other therapeutic modalities, the progressive nature of some of the diseases, and the small pool of suitable subjects.

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Curt L. Lox, Edward MeAuley, and R. Shawn Tucker

The purpose of the present study was to examine the role of regular exercise participation as an intervention for enhancing subjective well-being in an HIV-1 population. Specifically, this study investigated the effects of a 12-week exercise intervention on physical self-efficacy, positive and negative mood, and life satisfaction. Participants (N = 33) were randomly assigned to either an aerobic exercise training group (n = 11), a resistance weight-training group (n = 12), or a stretching/flexibility control group (n = 10). Results indicated that both aerobic and weight-training exercise interventions enhanced physical self-efficacy, positive and negative mood, and satisfaction with life. Conversely, control participants experienced declines in each of these variables. Taken together, the findings seem to suggest that exercise may be one therapeutic modality capable of enhancing components of subjective well-being and should be considered a complimentary therapy for treating the psychological and emotional manifestations associated with a positive HIV-1 diagnosis.

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Matthew Hanson and James Day


Therapeutic modalities are routinely administered to increase fexibility, but the relative effects of different modes of tissue heating on passive range of motion (PROM) are unknown.


To assess the relative effects of active exercise on a stationary bicycle, moist hot pack treatment, and warm whirlpool treatment on hip fexion PROM.


Repeated measures.


24 males and 20 females between the ages 18 and 24 years.

Main Outcome Measure

Hip fexion PROM measured by an inclinometer.


Repeated measures analysis of variance identified a significant difference among the heating methods, F(1, 43) = 32.41; p < .001. Active exercise produced the greatest change in hip fexion PROM.


All three treatment methods produced an increase in hip fexion PROM, but active exercise produced a significantly greater increase than moist hot pack and warm whirlpool treatments.

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Jeffrey J. Dueweke, Tariq M. Awan, and Christopher L. Mendias

Eccentric-contraction-induced skeletal muscle injuries, included in what is clinically referred to as muscle strains, are among the most common injuries treated in the sports medicine setting. Although patients with mild injuries often fully recover to their preinjury levels, patients who suffer moderate or severe injuries can have a persistent weakness and loss of function that is refractory to rehabilitation exercises and currently available therapeutic interventions. The objectives of this review were to describe the fundamental biophysics of force transmission in muscle and the mechanism of muscle-strain injuries, as well as the cellular and molecular processes that underlie the repair and regeneration of injured muscle tissue. The review also summarizes how commonly used therapeutic modalities affect muscle regeneration and opportunities to further improve our treatment of skeletal muscle strain injuries.