Ng GY, Fung DT

This study looks at the effects of ultrasound intensity on the ultrastructural morphology of Achilles tendon healing. 20 Sprague-Dawley rats with surgically hemi-transected Achilles tendons were randomly assigned into four groups of 0 (control), 0.5, 1.2 and 2 W/cm(2) for ultrasound treatment, with 5 rats in each group. The treatments all used 1 MHz continuous ultrasound every day starting from day 5 after injury. On day 30, ultrathin slides of the Achilles tendons were prepared and examined. Results showed that the mean collagen fibril size of all treatment groups (0.5, 1, 2)  was higher than the control. There was no significant difference in the collagen fibril size among the treatment groups.

Therapeutic ultrasound can enhance the maturation of collagen fibrils of repairing tendons, and is not dependent on the intensity of ultrasound applied.

Ultrasound Med Biol. 2007 Nov;33(11):1750-4

Bakhtiary AH, Fatemi E

This study compares the effects of straight leg raise (SLR) and semi-squat exercises on patellar chondromalacia. 32 individuals with patellar chondromalacia were  assigned randomly to either the SLR or semi-squat exercise group.

Both groups subsequently followed a 3-week programme of quad muscle strengthening exercises starting with 20 exercises twice a day and increasing each session by 5 exercises every other day. A smaller Q angle and less crepitation, and an increase in the MIVCF (maximal isometric contraction strength)  of the quadriceps and thigh circumference were found in semi-squat group compared with SLR group. However, patellofemoral pain was decreased significantly in both groups.

The results of this study suggest that semi-squat exercises (closed kinetic chain) are more effective than SLR exercise (open kinetic chain) in the treatment of patellar chondromalacia.

British Journal of Sports Medicine, 2008, 42(2), 99-102

Jean-Louis Croisier, Sebastien Ganteaume, Johnny Binet, Marc Genty, Jean-Marcel Ferret

The relationship between hamstring injury and strength disorders remains controversial. Professional soccer players performed a preseason isokinetic test to determine whether strength variables are predictors of hamstring strain and if normalisation of imbalances reduces the incidence of hamstring strain.

A standardised concentric and eccentric isokinetic assessment was used to determine which subjects had strength imbalances. Recording subsequent hamstring injuries allowed us to define injury frequencies and relative risks between groups.

Of 687 players tested, a complete follow-up was obtained in 462 players, for whom 35 hamstring injuries were recorded. The rate of muscle injury was significantly increased in subjects with untreated strength imbalances in comparison with players showing no imbalance in preseason. The risk of injury remained significantly higher in players with strength imbalances who had subsequent compensating training but no final isokinetic control test than in players without imbalances.

The outcomes showed that the preseason detection of strength imbalances is a highly useful exercise highlight those athletes with muscle imbalances. Restoring a normal strength profile decreases the muscle injury incidence.

Am J Sports Med. 2008 Apr 30; : 18448578

Maria L Zampagni, I Corazza, A Paladini Molgora, M Marcacci

Risk factors that may determine knee and ankle injuries are multifactorial. One explanation could be the temporary inhibition of muscular control following a change of proprioceptive regulation due to the muscle imbalance pathology.

Fifteen male soccer players with ankle muscle imbalance (AIG) and 14 healthy controls (CG) were tested after (TEST) and before (NO-TEST) a manual percussion in subtalus joint (SAT). The strength activation of TFL was meaured in variuos positions. Two trials for each subject were performed, separated by at least one 4-min resting interval.

In NO-TEST conditions both AIG and CG showed a progressive adaptation of the subject to the force imposed by operator. No reduction in mean force, mean peak force, and muscle force duration (p>0.5). in TEST conditions AIG presented significant differences (mean difference 0.92+/-0.46s; p=0.000) in muscle force duration .

Our results indicated that “wrong” proprioceptive stimuli coming from the subtalus joint in AIG might induce inhibition in terms of duration of TFL muscle altering the knee stability. This kinesiological evaluation might be useful to prevent ankle and knee injuries.

J Electromyogr Kinesiol. 2008 Apr 30; : 18455436

Patterson, C.

Previous research has found an alteration of motor control in subjects with shoulder impingements. Taping the shoulder musculature in various ways has been thought to alter motor activity, although research is now conflicting.

The effect of taping directly over the fibres of upper trapezius has been examined by two studies, which produced contradictory results. The first showing no beneficial effect and the second demonstrating decreased activity in the upper trapezius. Unfortunately both studies used pain-free subjects, which limits the external validity of the results.

Taping parallel to the fibres of lower trapezius has been investigated, showing inhibition of the lower fibres of trapezius. Inhibition using parallel taping has also been shown over the gastrocnemius muscle.

Taping in a clinical setting is supported by other literature in which reduced scapula winging, improved scapula setting and reduced downward rotation of the scapula were reported following tape application. When combined with scapula retraining exercises, a reduction in pain with functional activities was noted. However, the use of other treatment methods in conjunction with taping limits the ability to see the effects of taping alone. Nevertheless, observations of improved function by the clinicians involved, supports the use of taping as a method to improve scapula positioning and control, allowing rehabilitation to progress more rapidly.

SportEX Medicine 2008:36(Apr):18-20. 

Patterson, C.

Techniques including manual therapy, myofascial treatment, exercise and strengthening programmes and taping have all previously been used in the treatment of shoulder impingement. Two types of shoulder impingement have been identified, primary (decrease in the subacromial space due to anatomical factors such as a hooked acromion) and secondary (physiological factors such as shoulder joint instability, poor posture & scapula dyskinesia). Secondary impingements are due to altered motor recruitment and muscle imbalances.

Dysfunction of the scapula stabilisers and rotator cuff has been shown in patients with impingement symptoms in a clinical setting. Increased glenohumeral instability has been associated with poor scapula stability and reduced firing of the rotator cuff, further increasing the joint instability. Previous studies into scapula muscle activity repeatedly highlight a significant decrease in Serratus Anterior firing and increases in upper and lower Trapezius activity in impingement patients.

Most previous research has been conducted in athletic populations, especially those athletes whose sports demand repeated overhead activities. The author calls for more research into impingement syndromes in non-athletes.

SportEX Medicine 2008:36(Apr):14-17 

Hides JA, Stanton WR, McMahon S, Sims K, Richardson CA

The study looked at the cross-sectional area (csa) of Multifidus (at L2,3,4 & 5) and the effect of a 13 week staged stabilisation exercise program on csa in elite cricket players 7 players with and 14 without low back pain (lbp).

The stabilisation program involved voluntary contraction of the multifidus, transversus abdominis, and pelvic floor muscles, progressed from non-weight-bearing to weight-bearing positions and movement training.

The CSA at L5 increased in all 7 players with lbp. Muscle symmetry improved in those subjects with lbp and a 50% decrease in pain was also reported.

The study demonstrates that even elite athletes can be subject to multifidus muscle wasting and that stabilisation training can decrease muscle wasting and associated pain.

Journal of Orthopedic and Sports Physical Therapy, 2008, 38(3), 101-8

Julie Hides, Craig Gilmore, Warren Stanton and Emma Bohlscheid

A group of 50 subjects with lower back pain were compared against 40 healthy, asymptomatic subjects for Multifidus size and  symmetry.  Results showed that the lower back pain group had significantly smaller Multifidus size than the control group. The Multifidus on the ipsilateral (same) side as the reported back pain was smaller in all cases.

The results of this study are in agreement with previous research and highlights the need for Multifidus assessment and rehabilitation in patients with chronic lower back pain.

Manual Therapy, 2008, 13(1), 43-49

Tennis elbow or ‘chronic extensor tendinosis’ is a common injury. An Australian study recently looked at the application of topical nitric oxide would aid rehabilitation. Nitric oxide has been used successfully to treat fractures and skin wounds in animals.

86 patients with extensor tendinosis were divided into 2 groups. One group was given a placebo patch and the other an active glycerol trinitrate patch on the skin.

The study concluded that application of nitric oxide improved early pain with activity, late functional measures, and outcomes of patients with extensor tendinosis.

From: American Journal of Sports Medicine Nov / Dec 2003

J. Vas, C. Ortega, V. Olmo, F. Perez-Fernandez, L. Hernandez, I. Medina, A. Herrera, F. Luna, E. Perea-Milla, C. Mendez, F. Madrazo, C. Jimenez, M. A. Ruiz and I. Aguilar

425 patients with a clinical diagnosis of unilateral subacromial syndrome were recruited and divided into two groups. Both groups received 15 sessions of physiotherapy over a period of three weeks. One group also received single-point acupuncture once a week in addition to their physiotherapy treatments.

The Constant–Murley Score (CMS) was used as a predictor of function, during the fourth week.  The mean CMS score increased 16.6 points among the combined group, compared with only 10.6 points in the physiotherapy alone group.  At the end of the study 53% of patients in the combined group had decreased their intake of analgesics compared to only 30% of the physio group.

Combining physiotherapy treatment with acupuncture improves shoulder function and reduces the intake of analgesics in patients with unilateral subacromial syndrome

Rheumatology, Apr 10 2008, online advance access