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Nicole Vetroczky and Christine A. Lauber

Clinical Question:

In patients with cervical radiculopathy and associated pain, is there a benefit to including intermittent, mechanical cervical traction to a multimodal treatment approach to reduce cervical pain and disability?

Clinical Bottom Line:

The majority of best evidence suggests favorable outcomes regarding decreasing cervical pain and disability with the inclusion of intermittent, mechanical cervical traction into a multimodal treatment approach.

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Christopher D. Brown, Christine A. lauber and Thomas Cappaert

Clinical Scenario:

Iontophoresis is a method of local transfer of ionized medicated and nonmedicated substances through the skin and into the target tissues using magnetic polarization. The anti-inflammatory properties exhibited by dexamethasone sodium phosphate (DEX) combined with iontophoresis make it a potentially desirable treatment for clinicians wishing to administer a noninvasive localized drug concentration without having a large systemic concentration of that drug. Since concurrent treatments are commonly used in clinical practice, many of the published studies that included the use of DEX also used concurrent treatments. However, this may make it difficult for clinicians to determine the individual effectiveness of DEX iontophoresis in treating musculoskeletal conditions.

Focused Clinical Question:

Does DEX iontophoresis, alone, decrease pain and improve function in patients with musculoskeletal conditions when compared with placebo or control?

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Katherine R. Newsham, Matthew D. Beekley and Christine A. Lauber


Exercise-related medial leg pain (ERMLP) is a common complaint among athletes, and efforts toward rehabilitation are often unsuccessful.


To evaluate the efficacy of a therapeutic intervention in ERMLP localized to soft tissue.


A quasi-experimental, nonequivalent control-group study.


Athletic training facility.


20 volunteer male and female athletes (18–22 y old) with ERMLP. Complete data were available for 13 participants.


Treatment group (TRE, n = 7) received therapeutic intervention focused on relieving muscle hypertonicity in the deep compartment of the lower leg and restoring balance of the toe flexors and extensors. Control group (CON, n = 6) received no intervention.

Main Outcome Measures:

Self-reported pain intensity, pain threshold, and extensor hallucis longus to extensor digitorum brevis (EHL:EDB) electromyography ratio.


There were no significant differences in age, duration of symptoms, or pain measures between the 2 groups at baseline. CON demonstrated no significant changes in any of the outcome measures in posttreatment testing, but significant between-groups differences were identified for pain during activity (CON mean = 6.5, 95% CI 5.05, 7.95; TRE mean = 3.5, 95% CI 1.67, 5.33; P = .01), change scores for pain during activity (CON mean = 0.33, 95% CI −1.25, 1.91; TRE mean = −3.43, 95% CI:−4.6, −2.25; P < .001), change scores in pressure threshold (CON mean = −0.25, 95% CI −0.74, 0.23; TRE mean = 0.72, 95% CI 0.22, 1.37; P = .006), and change in EHL:EDB ratios (CON mean = 0.05, 95% CI −0.22, 0.33; TRE mean = 1.07, 95% CI 0.75, 2.07; P < .046).


Therapeutic interventions focused on restoring muscle balance appear to be effective in resolving ERMLP.

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Connor A. Burton and Christine A. Lauber

Clinical Question: Is there evidence to support precooling with cold water immersion prior to endurance cycling and running in hot, humid environments to enhance performance? Clinical Bottom Line: There is moderate evidence suggesting cold water immersion (CWI) as a precooling intervention improves endurance performance in cyclists and runners in a hot, humid environment. All five included studies reported significant improvements in endurance performance regarding time to exhaustion or distance traveled. In all included studies, core temperature was significantly decreased in the CWI group versus the control group during the fifth and twentieth minutes of exercise. No significant differences were reported for the rating of perceived exertion (RPE) between the CWI and control groups.

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Christine A. Lauber and Jeffrey W. Wimer

Edited by Malissa Martin

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Christine A. Lauber and Clyde B. Killian

Edited by Shane Caswell

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Christine A. Lauber

Edited by Malissa Martin

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Christopher D. Brown and Christine A. Lauber

Edited by Tricia Hubbard

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Michael E. Lynch and Christine A. Lauber

Clinical Question:

Is it beneficial to add neuromuscular electrical stimulation (NMES) to a strengthening program after anterior cruciate ligament (ACL) reconstruction surgery?

Clinical Bottom Line:

There is sufficient evidence to support the inclusion of NMES in a rehabilitation strengthening program post ACL reconstruction. All three included studies reported significant quadriceps strength gains (p < .05) in favor of the group that completed both NMES and strengthening exercises compared with a strength-only group. Two studies initiated NMES within 4 days of surgery. One study found significant quadriceps strength increases when NMES was implemented 6 months after surgery.

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Larry A. Howard and Erika A. Smith-Goodwin

Edited by Christine Lauber