The purpose of this study was to determine the clinical efficacy of dexametha-sone-lidocaine (DX-L) phonophoresis on perceived pain associated with symptomatic tendinitis. Twenty-four subjects were randomly assigned to a DX-L or placebo phoresis group. All subjects received strengthening, stretching, and cryotherapy. Five double-blind sessions were administered over a 5- to 10-day period, with 24 to 48 hr between sessions. Perceived pain was quantified using a visual perceived pain scale (VPPS) and a punctate tenderness gauge (PTG). Data were collected before stretching, strengthening, and DX-L/placebo phoresis treatments, 1 min after treatment, and 10 min after cryotherapy. There were no significant differences for VPPS or PTG between groups. There was a significant difference between treatment sessions, regardless of group or test, and there were significant decreases in perceived pain between Tests 1 and 3 and between Treatment Sessions 1 and 5. It was concluded that stretching, strengthening, and cryotherapy significantly decreased the levels of perceived pain associated with symptomatic tendinitis regardless of whether the subjects received phonophoresis.
Caroline E. Penderghest, Iris F. Kimura and Dawn T. Gulick
Kevin M. Guskiewicz, Gregory G. Degnan and Thomas L. Schildwachter
Ligamentous injuries of the wrist and hand are the most common upper extremity injuries seen in young athletes. Unfortunately, these injuries are also the most frequently misdiagnosed. The “sprained wrist” often becomes the diagnosis of convenience, especially once a fracture has been ruled out. In many cases the athlete is treated symptomatically with cryotherapy, immobilization, and rest, and returns to activity as pain allows. Concern, however, has increased recently over potential complications related to associated ligamentous injuries in young athletes. The most common recognized, carpal instability is between the scaphoid and the lunate, the so-called scapholunate dissociation (3).
Dawn T. Gulick and Iris F. Kimura
Muscle soreness, a familiar phenomenon to most athletes, has been differentiated into “acute” and “delayed onset.” The etiology of acute muscle soreness has been attributed to ischemia and the accumulation of metabolic by-products. However, the etiology of delayed onset muscle soreness (DOMS) is not so clear. Six theories have been proposed: lactic acid, muscle spasm, torn tissue, connective tissue, enzyme efflux, and tissue fluid theories. The treatment of DOMS has also been investigated. Studies in which anti-inflammatory medications have been administered have yielded varying results based on the dosage and the time of administration. Submaximal concentric exercise may alleviate soreness but does not restore muscle function. Neither cryotherapy nor stretching abates the symptoms of DOMS. Transcutaneous electrical stimulation has been shown to decrease soreness and increase range of motion, but the effect on the recovery of muscle function is unknown. Therefore, the treatment of DOMS remains an enigma.
Carrie B. Scherzer, Britton W. Brewer, Allen E. Cornelius, Judy L. Van Raalte, Albert J. Petitpas, Joseph H. Sklar, Mark H. Pohlman, Robert J. Krushell and Terry D. Ditmar
To examine the relationship between self-reported use of psychological skills and rehabilitation adherence.
Prospective correlational design.
Outpatient physical-therapy clinic specializing in sports medicine.
Fifty-four patients (17 women and 37 men) undergoing rehabilitation after anterior-cruciate-ligament reconstruction.
Main Outcome Measures:
An abbreviated version of the Sports Injury Survey (Ievleva & Orlick, 1991) was administered approximately 5 weeks after surgery to assess use of goal setting, imagery, and positive self-talk. Four adherence measures were obtained during the remainder of rehabilitation: attendance at rehabilitation sessions, practitioner ratings of patient adherence at rehabilitation sessions, patient self-reports of home exercise completion, and patient self-reports of home cryotherapy completion.
Goal setting was positively associated with home exercise completion and practitioner adherence ratings. Positive self-talk was positively correlated with home exercise completion.
Use of certain psychological skills might contribute to better adherence to sport-injury rehabilitation protocols.
Aimee L. Thornton, Cailee W. McCarty and Mollie-Jean Burgess
Shoulder pain is a common musculoskeletal condition that affects up to 25% of the general population. Shoulder pain can be caused by any number of underlying conditions including subacromial impingement syndrome, rotator-cuff tendinitis, and biceps tendinitis. Regardless of the specific pathology, pain is generally the number 1 symptom associated with shoulder injuries and can severely affect daily activities and quality of life of patients with these conditions. Two of the primary goals in the treatment of these conditions are reducing pain and increasing shoulder range of motion (ROM).3 Conservative treatment has traditionally included a therapeutic exercise program targeted at increasing ROM, strengthening the muscles around the joint, proprioceptive training, or some combination of those activities. In addition, these exercise programs have been supplemented with other interventions including nonsteroidal anti-inflammatory drugs, corticosteroid injections, manual therapy, activity modification, and a wide array of therapeutic modalities (eg, cryotherapy, EMS, ultrasound). Recently, low-level laser therapy (LLLT) has been used as an additional modality in the conservative management of patients with shoulder pain. However, the true effectiveness of LLLT in decreasing pain and increasing function in patients with shoulder pain is unclear.
Focused Clinical Question:
Is low-level laser therapy combined with an exercise program more effective than an exercise program alone in the treatment of adults with shoulder pain?
Daniel H. Huffman, Brian G. Pietrosimone, Terry L. Grindstaff, Joseph M. Hart, Susan A. Saliba and Christopher D. Ingersoll
Motoneuron-pool facilitation after cryotherapy may be mediated by stimulation of thermoreceptors surrounding a joint. It is unknown whether menthol counterirritants, which also stimulate thermoreceptors, have the same effect on motoneuron-pool excitability (MNPE).
To compare quadriceps MNPE after a menthol-counterirritant application to the anterior knee, a sham counterirritant application, and a control treatment in healthy subjects.
A blinded, randomized controlled laboratory study.
Thirty healthy subjects (16 m, 14 f; 24.1 ± 3.9 y, 170.6 ± 11.4 cm, 72.1 ± 15.6 kg) with no history of lower extremity surgery volunteered for this study.
Two milliliters of menthol or sham counterirritant was applied to the anterior knee; control subjects received no intervention.
Main Outcome Measures:
The average vastus medialis normalized Hoffmann reflex (Hmax:Mmax ratio) was used to measure MNPE. Measurements were recorded at 5, 15, 25, and 35 minutes postintervention and compared with baseline measures.
Hmax:Mmax ratios for all groups significantly decreased over time (F 4,108 = 10.52, P < .001; menthol: baseline = .32 ± .20, 5 min = .29 ± .18, 15 min = .27 ± .18, 25 min = .28 ± .19, 35 min = .27 ± .18; sham: baseline = .46 ± .26, 5 min = .36 ± .20, 15 min = .35 ± .19, 25 min = .35 ± .20, 35 min = .34 ± .18; control: baseline = .48 ± .32, 5 min = .37 ± .27, 15 min = .37 ± .27, 25 min = .37 ± .29, 35 min = .35 ± .28). No significant Group × Time interaction or group differences in Hmax:Mmax were found.
Menthol did not affect quadriceps MNPE in healthy subjects.
Jihong Park, Terry L. Grindstaff, Joe M. Hart, Jay N. Hertel and Christopher D. Ingersoll
Weight-bearing (WB) and non-weight-bearing (NWB) exercises are commonly used in rehabilitation programs for patients with anterior knee pain (AKP).
To determine the immediate effects of isolated WB or NWB knee-extension exercises on quadriceps torque output and activation in individuals with AKP.
A single-blind randomized controlled trial.
30 subjects with self-reported AKP.
Subjects performed a maximal voluntary isometric contraction (MVIC) of the quadriceps (knee at 90°). Maximal voluntary quadriceps activation was quantified using the central activation ratio (CAR): CAR = MVIC/(MVIC + superimposed burst torque). After baseline testing, subjects were randomized to 1 of 3 intervention groups: WB knee extension, NWB knee extension, or control. WB knee-extension exercise was performed as a sling-based exercise, and NWB knee-extension exercise was performed on the Biodex dynamometer. Exercises were performed in 3 sets of 5 repetitions at approximately 55% MVIC. Measurements were obtained at 4 times: baseline and immediately and 15 and 30 min postexercise.
Main Outcome Measures:
Quadriceps torque output (MVIC: N·m/Kg) and quadriceps activation (CAR).
No significant differences in the maximal voluntary quadriceps torque output (F 2,27 = 0.592, P = .56) or activation (F 2,27 = 0.069, P = .93) were observed among the 3 treatment groups.
WB and NWB knee-extension exercises did not acutely change quadriceps torque output or activation. It may be necessary to perform exercises over a number of sessions and incorporate other disinhibitory interventions (eg, cryotherapy) to observe acute changes in quadriceps torque and activation.
Jan Kodejška, Jiří Baláš and Nick Draper
. The effect of post-exercise cryotherapy on recovery characteristics: a systematic review and meta-analysis . PLoS ONE . 2015 ; 10 ( 9 ): 0139028 . doi:10.1371/journal.pone.0139028 10.1371/journal.pone.0139028 2. Crampton D , Donne B , Warmington S , Egana M . Cycling time to failure is
Matt Hausmann, Jacob Ober and Adam S. Lepley
athlete • I ntervention (or Assessment): deep oscillation therapy • C omparison: cryotherapy AND compression • O utcome(s): reduction in swelling, pain Sources of Evidence Searched • The Cochrane Library • PubMed • PEDro Database • MEDLINE • CINAHL • SPORTDiscus Inclusion and Exclusion Criteria Inclusion
Jesús Seco-Calvo, Juan Mielgo-Ayuso, César Calvo-Lobo and Alfredo Córdova
Several physical therapy methods were used as postexercise recovery strategies, alleviating musculoskeletal alterations secondary to training and competition. Among these interventions, contrast therapy—which alternates between hot and cold treatment modalities 1 —whole-body cryotherapy, and cold