Chronic knee pain is a prevalent health problem of old and middle age. The authors’ objective was to determine whether a topical analgesic would reduce knee pain and improve the function of a group of 40- to 65-year-old people with chronic knee pain. The experimental design was a double-blind, randomized, placebo-controlled clinical trial. The dependent variables were knee pain, active range of motion, and isometric strength. Forty-six men and women volunteered, of whom 3 dropped out, leaving 23 in the treatment group and 20 in the placebo group. Knee pain was assessed with a visual analogue scale and the knee-pain scale for frequency and severity. Testing took place before treatment and after 21 and 35 days of treatment. The results indicated that although both groups experienced improved pain scores, there were no differences between groups over the treatment period for any of the dependent variables.
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J. William Myrer, J. Brent Feland, and Gilbert W. Fellingham
Blaine C. Long, Kenneth L. Knight, Ty Hopkins, Allen C. Parcell, and J. Brent Feland
Context:
It is suggested that postinjury pain is difficult to examine; thus, investigators have developed experimental pain models. To minimize pain, cryotherapy (cryo) is applied, but reports on its effectiveness are limited.
Objective:
To investigate a pain model for the anterior knee and examine cryo in reducing the pain.
Design:
Controlled laboratory study.
Setting:
Therapeutic modality laboratory.
Participants:
30 physically active healthy male subjects who were free from any lower extremity orthopedic, neurological, cardiovascular, or endocrine pathologies.
Main Outcome Measures:
Perceived pain was measured every minute. Surface temperature was also assessed in the center of the patella and the popliteal fossa.
Results:
There was a significant interaction between group and time (F68,864 = 3.0, P = .0001). At the first minute, there was no difference in pain between the 3 groups (saline/cryo = 4.80 ± 4.87 mm, saline/sham = 2.80 ± 3.55 mm, no saline/cryo = 4.00 ± 3.33 mm). During the first 5 min, pain increased from 4.80 ± 4.87 to 45.90 ± 21.17 mm in the saline/cryo group and from 2.80 ± 3.55 to 31.10 ± 20.25 mm in the saline/sham group. Pain did not change within the no-saline/cryo group, 4.00 ± 3.33 to 1.70 ± 1.70 mm. Pain for the saline/sham group remained constant for 17 min. Cryo decreased pain for 16 min in the saline/cryo group. There was no difference in preapplication surface temperature between or within each group. No change in temperature occurred within the saline/sham. Cooling and rewarming were similar in both cryo groups. Ambient temperature fluctuated less than 1°C during data collection.
Conclusion:
Intermittent infusion of sterile 5% hypertonic saline may be a useful experimental pain model in establishing a constant level of pain in a controlled laboratory setting. Cryotherapy decreased the induced anterior knee pain for 16 min.
Ulrike H. Mitchell, J. William Myrer, J. Ty Hopkins, Iain Hunter, J. Brent Feland, and Sterling C. Hilton
Context:
Some researchers have suggested that an alteration of stretch perception could be responsible for the success of the contract-relax (CR) stretch, a stretch technique derived from proprioceptive neuromuscular facilitation (PNF).
Objective:
This study was conducted to determine if the alteration of the stretch perception is a possible explanation for the range of motion (ROM) gains of the CR stretch.
Participants:
Eighteen subjects performed two stretches in randomized order: the slow stretch and the CR stretch.
Main Outcome Measure:
The stretch intensity was controlled. The stretch force was measured and compared between the slow stretch and CR stretch.
Results:
There was a significant difference between the stretch force that could be applied in the PNF stretch (126.0 N) and the slow stretch (108.4 N); P = 0.00086. The average stretch tolerance progressively increased with successive trials from 120.6 N in the first trial to 132.4 N in the fourth trial.
Conclusion:
The alteration of stretch perception plays a role in the success of the CR form of PNF stretching. At least four repetitions of the CR stretch are recommended to get the greatest ROM gain.
Ulrike H. Mitchell, J. William Myrer, J. Ty Hopkins, Iain Hunter, J. Brent Feland, and Sterling C. Hilton
Background and Purpose:
Proprioceptive neuromuscular facilitation (PNF) stretches are widely used in athletics and rehabilitation. Although it has been shown that they produce better range-of-motion (ROM) increases than the slow or static stretch, the mechanisms responsible remain an enigma. This study was conducted to determine whether the previously proposed neurophysiological mechanisms of reciprocal inhibition and autogenic inhibition are responsible for the success of PNF stretches. In addition, the authors assessed the existence of the phenomenon of successive induction because it is used to strengthen reciprocal inhibition.
Methods:
Eighteen subjects 17–44 y performed the PNF stretches contract-relax (CR) and contract-relax, agonist contract (CRAC). EMG data were collected from the medial hamstring muscles via surface and indwelling wire electrodes and analyzed for reciprocal inhibition and successive induction, as well as autogenic inhibition (surface electrodes only).
Results:
Reciprocal inhibition was not evident. The results indicated an elevated rather than an inhibited EMG during the antagonist contraction, possibly representing cocontraction. The authors did confirm the presence of successive induction. Autogenic inhibition was also not evident, and the expected inhibition and therefore lower EMG values after muscle contraction were not observed; instead, they were higher than baseline.
Conclusion:
Previous neurophysiological explanations for mechanisms of PNF stretching appear to be inadequate. This study corroborates previous findings that a muscle’s tone increases during its antagonist’s contraction. Other explanations should be considered regarding the mechanism for the effectiveness of the CRAC and CR PNF techniques in a nonneurologically impaired population.
