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Tannus Quatre

Column-editor : Robert D. Kersey

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Kenneth L. Knight and David O. Draper

Column-editor : David O. Draper

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Jennifer A. Stone

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Column-editor : David O. Draper

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Hawley Chase Almstedt and Zakkoyya H. Lewis

Context:

Intermittent pneumatic compression (IPC) is a common therapeutic modality used to reduce swelling after trauma and prevent thrombosis due to postsurgical immobilization. Limited evidence suggests that IPC may decrease the time needed to rehabilitate skeletal fractures and increase bone remodeling.

Objective:

To establish feasibility and explore the novel use of a common therapeutic modality, IPC, on bone mineral density (BMD) at the hip of noninjured volunteers.

Design:

Within-subjects intervention.

Setting:

University research laboratory.

Participants:

Noninjured participants (3 male, 6 female) completed IPC treatment on 1 leg 1 h/d, 5 d/wk for 10 wk. Pressure was set to 60 mm Hg when using the PresSsion and Flowtron Hydroven compression units.

Main Outcome Measures:

Dual-energy X-ray absorptiometry was used to assess BMD of the hip in treated and nontreated legs before and after the intervention. Anthropometrics, regular physical activity, and nutrient intake were also assessed.

Results:

The average number of completed intervention sessions was 43.4 (± 3.8) at an average duration of 9.6 (± 0.8) wk. Repeated-measures analysis of variance indicated a significant time-by-treatment effect at the femoral neck (P = .023), trochanter (P = .027), and total hip (P = .008). On average, the treated hip increased 0.5–1.0%, while the nontreated hip displayed a 0.7–1.9% decrease, depending on the bone site.

Conclusion:

Results of this exploratory investigation suggest that IPC is a therapeutic modality that is safe and feasible for further investigation on its novel use in optimizing bone health.

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Aimee L. Thornton, Cailee W. McCarty, and Mollie-Jean Burgess

Clinical Scenario:

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?

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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.

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Jeremy R. Hawkins and Shawn W. Hawkins

Cryotherapy is commonly used by athletic trainers, although evidence is inconsistent to support its usage. Data are also lacking as to how athletic trainers treat common injuries with cryotherapy. The purpose of this study was to ascertain how collegiate athletic trainers approach the use of cryotherapy and whether that usage reflects what little we know about the modalities. Survey results indicated great variability in respondents’ approaches to the treatment of an acute and subacute ankle sprain. Additional data are needed to create clear treatment guidelines with respect to cryotherapy. Certain aspects of the application of cryotherapy should be reviewed and use adjusted accordingly.

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Jeremy R. Hawkins and Shawn W. Hawkins

Thermotherapy is commonly used by athletic trainers. Data are lacking as to how athletic trainers treat common injuries with thermotherapy. The purpose of this study was to ascertain how collegiate athletic trainers approach the use of thermotherapy and whether that usage reflects what current knowledge we have of thermotherapy. Survey results indicated respondents took three different approaches to the treatment of three different types of injuries. The majority of their approaches were applied according to current knowledge. Treatment guidelines could be strengthened with additional clinical outcomes data. Certain aspects of the application of the different thermotherapies should be reviewed and use adjusted accordingly.