The beneficial effects of adding low level laser to ultrasound and exercise in Iranian women with shoulder tendonitis: a randomized clinical trial
Otadi K, Hadian M-R, Olyaei G, Jalaie S
Journal of Back and Musculoskeletal Rehabilitation 2012;25(1):13-19
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: Yes; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*
OBJECTIVES: A randomized, double-blind, clinical trial study was conducted with the aim of determining the efficacy of adding laser (830 nm) to ultrasound (US) and exercise for the management of shoulder tendonitis.
METHODS: 42 subjects (n = 21, in adding laser group and n = 21, in US and exercise group) received a course of 10 sessions treatment over one month in the shoulder region. Outcome measures such as visual analogue scale (VAS), tenderness severity scale (TSS), Constant Murley Score (CMS) and manual muscle testing (MMT) were performed before treatment and at the end of 4 weeks treatment. In addition, follow up were performed 2 months after the end of treatment based on the degree of pain improvement.
RESULTS: VAS, TSS and CMS improved significantly (p = 0.001) in both groups, however the muscle strengths only improved significantly in adding laser group (p < 0.01).
CONCLUSION: It seems that both protocols of physical therapy interventions were effective in relieving the signs and symptoms of shoulder tendonitis. Furthermore, adding low level laser therapy (LLLT) to the US and exercise was more efficient in improving the muscle strength in patients with shoulder tendonitis over a period of three months. However, it should be emphasized that, the current results might be due to the effects of laser and exercise instead of laser, us and exercise (as we had no independent group for US).
Diercks R, Bron C, Dorrestijn O, Meskers C, Naber R, de Ruiter T, Willems J, Winters J, van der Woude HJ [Netherlands Orthopedic Society, Koninklijk Nederlands Genootschap voor Fysiotherapie, Netherlands Association of General Practitioners, Netherlands Society of Rehabilitation Medicine, Netherlands Association of Occupational Medicine, Netherlands Society of Radiology]
Acta Orthopaedica 2014;85(3):314-322
Treatment of "subacromial impingement syndrome" of the shoulder has changed drastically in the past decade. The anatomical explanation as "impingement" of the rotator cuff is not sufficient to cover the pathology. "Subacromial pain syndrome", SAPS, describes the condition better. A working group formed from a number of Dutch specialist societies, joined by the Dutch Orthopedic Association, has produced a guideline based on the available scientific evidence. This resulted in a new outlook for the treatment of subacromial pain syndrome. The important conclusions and advice from this work are as follows:
(1) the diagnosis SAPS can only be made using a combination of clinical tests.
(2) SAPS should preferably be treated non-operatively.
(3) Acute pain should be treated with analgetics if necessary.
(4) Subacromial injection with corticosteroids is indicated for persistent or recurrent symptoms.
(5) Diagnostic imaging is useful after 6 weeks of symptoms. Ultrasound examination is the recommended imaging, to exclude a rotator cuff rupture.
(6) Occupational interventions are useful when complaints persist for longer than 6 weeks.
(7) Exercise therapy should be specific and should be of low intensity and high frequency, combining eccentric training, attention to relaxation and posture, and treatment of myofascial trigger points (including stretching of the muscles) may be considered.
(8) Strict immobilization and mobilization techniques are not recommended.
(9) Tendinosis calcarea can be treated by shockwave (ESWT) or needling under ultrasound guidance (barbotage).
(10) Rehabilitation in a specialized unit can be considered in chronic, treatment resistant SAPS, with pain perpetuating behavior. (11) There is no convincing evidence that surgical treatment for SAPS is more effective than conservature management.
(12) There is no indication for the surgical treatment of asymptomatic rotator cuff tears.
The subacromial impingement syndrome (SIS) includes the rotator cuff syndrome, tendonitis and bursitis of the shoulder. Treatment includes surgical and non-surgical modalities. Non-surgical treatment is used to reduce pain, to decrease the subacromial inflammation, to heal the compromised rotator cuff and to restore satisfactory function of the shoulder. To select the most appropriate non-surgical intervention and to identify gaps in scientific knowledge, we explored the effectiveness of the interventions used, concentrating on the effectiveness of physiotherapy and manual therapy.
The Cochrane Library, PubMed, EMBASE, PEDro and CINAHL were searched for relevant systematic reviews and randomised clinical trials (RCTs). Two reviewers independently extracted data and assessed the methodological quality. A best-evidence synthesis was used to summarise the results.
Two reviews and 10 RCTs were included. One RCT studied manual therapy as an add-on therapy to self-training. All other studies studied the effect of physiotherapy: effectiveness of exercise therapy, mobilisation as an add-on therapy to exercises, ultrasound, laser and pulsed electromagnetic field. Moderate evidence was found for the effectiveness of hyperthermia compared to exercise therapy or ultrasound in the short term. Hyperthermia and exercise therapy were more effective in comparison to controls or placebo in the short term (moderate evidence). For the effectiveness of hyperthermia, no midterm or long-term results were studied. In the midterm, exercise therapy gave the best results (moderate evidence) compared to placebo or controls. For other interventions, conflicting, limited or no evidence was found.
Some physiotherapeutic treatments seem to be promising (moderate evidence) to treat SIS, but more research is needed before firm conclusions can be drawn.
André E. Bussières, DC, PhDCorrespondence information about the author DC, PhD André E. BussièresEmail the author DC, PhD André E. Bussières, Gregory Stewart, BPE, DC, Fadi Al-Zoubi, PT, MSc, Philip Decina, DC, Martin Descarreaux, DC, PhD, Jill Hayden, DC, PhD, Brenda Hendrickson, BN, MN, Cesar Hincapié, DC, PhD, Isabelle Pagé, DC, MSc, Steven Passmore, DC, PhD, John Srbely, DC, PhD, Maja Stupar, BSc, DC, PhD, Joel Weisberg, BSc, DC, Joseph Ornelas, DC, PhD
The objective was to develop a clinical practice guideline on the management of neck pain–associated disorders (NADs) and whiplash-associated disorders (WADs). This guideline replaces 2 prior chiropractic guidelines on NADs and WADs.
Pertinent systematic reviews on 6 topic areas (education, multimodal care, exercise, work disability, manual therapy, passive modalities) were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and data extracted from admissible randomized controlled trials. We incorporated risk of bias scores in the Grading of Recommendations Assessment, Development, and Evaluation. Evidence profiles were used to summarize judgments of the evidence quality, detail relative and absolute effects, and link recommendations to the supporting evidence. The guideline panel considered the balance of desirable and undesirable consequences. Consensus was achieved using a modified Delphi. The guideline was peer reviewed by a 10-member multidisciplinary (medical and chiropractic) external committee.
For recent-onset (0-3 months) neck pain, we suggest offering multimodal care; manipulation or mobilization; range-of-motion home exercise, or multimodal manual therapy (for grades I-II NAD); supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD). For persistent (>3 months) neck pain, we suggest offering multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioner’s advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For workers with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD).
A multimodal approach including manual therapy, self-management advice, and exercise is an effective treatment strategy for both recent-onset and persistent neck pain.
Oliveira HAV, Jones A, Moreira E, Jennings F, Natour J
The Journal of Rheumatology 2015 May;42(5):870-878
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*
OBJECTIVE: To assess the effectiveness of total contact insoles (TCI) in patients with plantar fasciitis (PF).
METHODS: A double-blind randomized controlled trial was carried out with intention-to-treat analysis. Seventy-four patients were randomly allocated to use a TCI made of ethylene vinyl acetate (study group, n = 37) or a flat insole (control group, n = 37). The following assessment tools were used: visual analog scale for pain while walking and at rest, Medical Outcomes Study Short Form-36 (SF-36) for quality of life, Foot Function Index and Foot Health Status Questionnaire for foot function, 6-min walk test (6MWT), and baropodometer FootWalk Pro for plantar pressure analysis. The groups were evaluated by a blinded assessor at baseline and after 45, 90, and 180 days.
RESULTS: The groups were homogeneous for the majority of variables at baseline. The over-time comparisons show a statistical difference between the groups for pain while walking (p = 0.008) and the 6MWT (p = 0.010). Both groups showed significant improvements in pain at rest, foot function, and some quality of life variables (physical functioning, bodily pain, vitality, and social functioning), with no significant statistical differences between them. The baropodometer recorded no changes from the use of the insoles.
CONCLUSION: A TCI can be used to reduce pain while walking and to increase walking distance in individuals with PF.
By Matthew Walsh, PT | Athletic Training, Physical Therapy | December 14, 2016
A runner’s ability to maintain a relaxed posture and fluid running form requires a complex interaction of mileage, intensity, postural awareness, strength, stability, and mobility. Devoting time to training each of these components can be a catalyst to improving running economy, reducing injury risk, and increasing speed.
The Fundamental 5The series of running-specific motions outlined below aims to challenge balance and control. The five exercises focus on building a runner’s postural awareness. Successful runners train this ability to maintain great body shape/postural alignment and control, through all the phases of a running cycle and even when they are fatigued.
Shown in the video below are the most basic exercise forms for the fundamental 5. Once mastered, volume can be added, then load, and finally greater complexity and speed. This is an adjunct, not a substitute, to regular training, dynamic warm-ups, lifting and mobility programs. Make sure patients pay close attention to form as quality is critical to success.
Changes and AdaptionMost patients see clear changes in form and efficiency after one month on this program. If it’s really hard at first, try reducing repetitions or instructing patients to use a stick to assist in balance. Remember to remind patients that if anything is painful, poorly controlled or just plain doesn’t feel right, back off and request modification.
Effectiveness of knee injury and anterior cruciate ligament tear prevention programs: a meta-analysis
Donnell-Fink LA, Klara K, Collins JE, Yang HY, Goczalk MG, Katz JN, Losina E
PLoS ONE 2015 Dec;10(12):e0144063
OBJECTIVE: Individuals frequently involved in jumping, pivoting or cutting are at increased risk of knee injury, including anterior cruciate ligament (ACL) tears. We sought to use meta-analytic techniques to establish whether neuromuscular and proprioceptive training is efficacious in preventing knee and ACL injury and to identify factors related to greater efficacy of such programs. METHODS: We performed a systematic literature search of studies published in English between 1996 and 2014. Intervention efficacy was ascertained from incidence rate ratios (IRRs) weighted by their precision (1/variance) using a random effects model. Separate analyses were performed for knee and ACL injury. We examined whether year of publication, study quality, or specific components of the intervention were associated with efficacy of the intervention in a meta-regression analysis.
RESULTS: Twenty-four studies met the inclusion criteria and were used in the meta-analysis. The mean study sample was 1,093 subjects. Twenty studies reported data on knee injury in general terms and 16 on ACL injury. Maximum Jadad score was 3 (on a 0 to 5 scale). The summary incidence rate ratio was estimated at 0.731 (95% CI 0.614 to 0.871) for knee injury and 0.493 (95% CI 0.285 to 0.854) for ACL injury, indicating a protective effect of intervention. Meta-regression analysis did not identify specific intervention components associated with greater efficacy but established that later year of publication was associated with more conservative estimates of intervention efficacy.
CONCLUSION: The current meta-analysis provides evidence that neuromuscular and proprioceptive training reduces knee injury in general and ACL injury in particular. Later publication date was associated with higher quality studies and more conservative efficacy estimates. As study quality was generally low, these data suggest that higher quality studies should be implemented to confirm the preventive efficacy of such programs.