Sports Medicine Research: In the Lab & In the Field: February 2011 (Sports Med Res)

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Monday, February 28, 2011

Treatment Expectations Influence Treatment Outcomes

The effect of treatment expectation on drug efficacy: imaging the analgesic benefit of the opioid remifentanil.

Bingel UWanigasekera VWiech KNi Mhuircheartaigh RLee MCPloner MTracey I. Sci Transl Med. 2011 Feb 16;3(70):70ra14.

A little over a month ago we posted an article that suggested there was a clinical benefit to placebos when patients are instructed 1) that they are taking placebos and 2) that the placebos are beneficial.  The study highlighted the importance of explaining the benefits of treatments to patients, even if it is a placebo. Bingel et al. took this a step further by evaluating how different expectations (both positive and negative) may alter the effect of a prescription analgesic in healthy volunteers.
Friday, February 25, 2011

Does Physical Activity Promote Knee Osteoarthritis?

What is the effect of physical activity on the knee joint? A systematic review.

Urquhart DM, Tobing JF, Hanna FS, Berry P, Wluka AE, Ding C, Cicuttini FM.
Med Sci Sports Exerc. 2011 Mar;43(3):432-42.

How does physical activity influence the development of osteoarthritis? This is a question that continues to linger in medical fields associated with physical activity. On the one hand, physical activity increases the amount of loading our weight-bearing joints experience, but on the other hand our bodies are designed to be active and adapt to repetitive loading (when given adequate recovery time). Urquhart et al attempted to address this question by performing a systematic review examining the relationships between physical activity and specific joint structures of the knee (specifically the tibiofemoral joint).
Wednesday, February 23, 2011

Platelet Rich Plasma Injections Do Not Improve Achilles Tendon Healing



Autologous Platelets Have No Effect on the Healing of Human Achilles Tendon Rutures:  A Randomized Single-Blind Study
Schepull T, Kvist J, Norrman H, Trinks M, Berlin G, Aspenberg P.  Am J Sports Med. 2011 39(1):  38-47. 

In the past few years platelet rich plasma (PRP) injections have taken the scene in sports medicine for treatment of both acute and chronic injuries.  PRP use skyrocketed when several high-profile professional athletes used this new therapy to try to accelerate healing and decrease the amount of time out of play.  Many people perceive PRP as the answer to all injuries for returning athletes to the field faster, however there is minimal research investigating the true effect it has on the rate and effectiveness of tissue healing.
Tuesday, February 22, 2011

NCAA Division 1 Football Players' Misuse of Nonprescription Medication

National Collegiate Athletic Association Division 1 Athletes’ Use of Nonprescription Medication
Wolf DA, Miller TW, Pescatello LS, Barnes C. Sports Health 2011; 3(1):25-8.

There is a growing concern about how patients take medication and their level of understanding about the medication. For example, in a recent post we discussed misuse of prescription analgesics among retired-NFL players. Last May, Kahanov et al. reported the adherence to drug-dispensation and drug administration laws and guidelines in collegiate athletic training rooms. Kahanov reported that athletic trainers’ compliance with federal and state laws has improved since 2001 but that overall athletic trainers in most collegiate athletic training rooms complied poorly with federal laws regulating the administration of medication (full text is available online). What is less clear is how college and high school athletes use medication. This study attempted to fill this void by surveying 144 NCAA Division 1-A football athletes (from 8 schools) about nonprescription analgesic use.  
Sunday, February 20, 2011

Ask the Researcher (02/20 to 02/25): Osteoarthritis

Ask the Researcher
Jeffery Driban, PhD, ATC, CSCS
Novel Assessment Strategies for Osteoarthritis

Osteoarthritis is characterized by multi-tissue organ failure of synovial joint(s) and is the most common form of arthritis. If a patient has a history of a knee injury then they are four times more likely to develop knee osteoarthritis (another way to think of this: if you tear your ACL or meniscus there is roughly a 50% chance you will have symptomatic osteoarthritis within 20 years). Globally, over 77 million people have symptomatic osteoarthritis and by 2050 it estimated that over 195 million people will suffer osteoarthritis. To mitigate the global burden of OA, researchers are pursuing disease-modifying interventions to slow, halt, or reverse disease progression. Unfortunately, there is still no FDA approved disease modifying osteoarthritis intervention. There are  numerous theories for why disease modifying interventions, which may work in animals, fail in humans (for example, the animal models don’t reflect human osteoarthritis, the measurements of osteoarthritis are not sensitivity enough, we treat patients to late in the disease process when we can no longer save the joint). Another reason why the treatments might not work is that osteoarthritis can be very variable among patients: some progressing faster than others, some with more severe pain, etc. Some researchers have proposed that osteoarthritis might not even be one disease but a collection of diseases with a common end-point.

My research interest is in exploring new quantitative assessment strategies for osteoarthritis using magnetic resonance imaging and biochemical markers. I have done research with animals and humans to explore how osteoarthritis develops and progresses as well as what might make one group of patients unique from another. I believe that by understanding the characteristics of each patient (or subset of patients) and their osteoarthritis we can target treatments more effectively to the correct patients and eventually find ways to prevent or at least slow the progression of osteoarthritis.

This week I will be glad to answer questions about osteoarthritis; including but not limited to risk factors for osteoarthritis, clinical evidence for interventions, disease progression, and emerging trends. I will try to answer your questions with objective responses and links to articles but some of these answers will represent my opinions on the available data and do not represent the opinions of SMR, the other collaborators to the blog, my research collaborators, or my medical institution.

I look forward to hearing from you and answering your questions.

Sample articles:
In the November 2010 NATA News Dr. Ryan Tierney and I also wrote an article discussing the need for sports medicine clinicians to take an active role in promoting our patient’s long-term quality of life.

Written by:  Jeffery Driban
Reviewed by:  Stephen Thomas
Saturday, February 19, 2011

Barefoot Versus Shod Runners

Foot Strike Patterns and Collision Forces in Habitually Barefoot Versus Shod Runners

Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D’Andrea S, Davis IS, Mang’Eni RO, Pitsiladis Y. Nature 2010; 463(7280):531-5.

Although millions of dollars are put into running shoe research, a time did exist when humans survived without the comfortable, lightweight, and ultimately, very expensive running shoes. In fact there was a time when we didn’t rely on shoes at all, even though our nomadic ancestors ran and walked hundreds of miles to hunt food and survive climate change. So how did they do it? A paper published last year by Lieberman et al., attempted to explore this topic. 
Wednesday, February 16, 2011

Foot Orthoses Reduce Injury Rates

Foot Orthoses in the Prevention of Injury in Initial Military Training:  A Randomized Controlled Trial. 
Franklin-Millar A, Wilson C, Bilzon J, McCrory.  Am J Sports Med. 2011 39(1): 30-37.

The use of foot orthoses have been a topic of much debate.  Both the literature and anecdotal findings often have mixed results for the prevention of lower extremity overuse injuries.  Nonetheless, orthotics are prescribed for a variety of lower extremity injuries and biomechanical abnormalities.  There have been no randomized-controlled trials to examine the effect of orthotics on preventing overuse lower-extremity injuries.  This study attempted to fill that void and provided more evidence to aid clinicians in the prescription of orthotics.
Monday, February 14, 2011

Improving Ankle Range of Motion may be a Key Factor in Reducing ACL Injuries

Ankle-Dorsiflexion Range of Motion and Landing Biomechanics

Chun-Man Fong, LAT, ATC; J. Troy Blackburn, PhD, ATC; Marc F. Norcross, MA, ATC; Melanie McGrath, PhD, ATC; Darin A. Padua, PhD, ATC

Anterior Cruciate Ligament (ACL) injuries account for a large portion of athletic knee injuries. Although the ACL can be repaired arthroscopically and some patients can resume sporting activities without surgery, this injury has been reported to lead to symptomatic osteoarthritis within a few years of the injury. Therefore, preventative strategies to reduce the incidence of ACL injury are exceptionally important at preserving the integrity of the knee joint. ACL ruptures often occur during landing or jump-landing motions when the athlete assumes a dynamic valgus position of the knee joint. Inability to absorb the shock during landing (by flexing the knee) can increase this abnormal valgus motion and also increase the rate and magnitude of the ground reaction force.
Friday, February 11, 2011

Manual Therapy Combined with Self-Stretching to Manage Heel Pain

Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial.

Renan-Ordine R, Alburquerque-Sendí N F, Rodrigues de Souza DP, Cleland JA, Fernández-de-Las-Peñas C. J Orthop Sports Phys Ther. 2011 Feb;41(2):43-50.

This is a nice study investigating an intervention for plantar heel pain (a.k.a. plantar fascitis or plantar fasciopathy) that many clinicians may use in treatments without a lot of objective evidence to indicate whether or not the treatment is effective. The investigators evaluated the effects of trigger point manual therapy combined with a self-stretching program among 60 patients with plantar heal pain in a randomized, controlled, clinical trial (comparative efficacy trial).
Thursday, February 10, 2011

Cross-Body Adduction Does not Create the Greatest Strain in the Posterior Capsule

Quantifying Strain on Posterior Shoulder Tissues During 5 Simulated Clinical Tests:  A Cadaver Study
Borstad JD, Dashottar A.  J Orthop Sports Phys Ther. 2011 Feb;41(2):90-9.

Clinically, the shoulder joint is one of the most difficult joints to evaluate due to its complex anatomy.  Now, throw in overhead athletes and it adds an even deeper layer of complexity due to the structural adaptations that occur due to the stress of throwing.
Tuesday, February 8, 2011

Evaluating Symptoms: Symptom Checklists or Expanded Descriptions

Development and preliminary validation of a meniscal symptom index.
Niu NN, Losina E, Martin SD, Wright J, Solomon DH, Katz JN. Arthritis Care Res (Hoboken). 2011 Feb;63(2):208-15.

Many of us were trained to ask patients with knee symptoms if they experience “popping”, “giving way”, or “catching”; potential signs of a meniscal tear. Surprisingly, there is little research exploring the diagnostic value of these questions. The authors of this study describe the development of expanded descriptions/questions of meniscal symptoms. 
Sunday, February 6, 2011

Exercise May Promote Bone Healing


Exercise Enhances Angiogenesis During Bone Defect Healing in Mice

Holstein JH, Becker SC, Fiedler M, Scheuer C, Garcia P, Histing T, Klein M, Pohlemann T, Menger MD. J Orthop Res. 2011 Jan 21. doi: 10.1002/jor.21352. [Epub ahead of print]

Many clinicians have adopted the concept that while a patient has a musculoskeletal injury it is important to exercise the rest of the body to avoid detraining. We’ve also seen research suggesting that strengthening a limb can prevent muscle atrophy on the other limb. The authors in this animal study provide further support to the notion that patients should exercise the rest of their body when they experience a fracture.
Thursday, February 3, 2011

Multiple Concussions Cause Long-Term Symptoms in High School Athletes

Early Indicators of Enduring Symptoms in High School Athletes with Multiple Previous Concussions
Schatz P, Moser RS, Covassin T, Karpf R. Neurosurgery. 2011 Jan 6. [Epub ahead of print] DOI: 10.1227/NEU.0b013e31820e382e
Concussions have been receiving significant amounts of media attention in the past several months in addition to the NFL lending support to adolescent athletes with increased awareness campaigns. Keeping with that trend, this was a multi-center study that examined 616 high school athletes. Each athlete had completed baseline neuropsychological tests using the IMPACT system. Athletes were assigned to groups after data collection based on their history of concussion (none, one, or multiple). Several cognitive, emotional, and physical symptoms were examined and compared across groups. The researchers found that athletes with two or more concussions (105 athletes) had higher ratings of physical symptoms, which included headache, balance problems, dizziness, nausea, and fatigue. Athletes with two or more concussions also had higher ratings of cognitive and sleep symptoms.
Wednesday, February 2, 2011

Symptomatic vs. Radiographic Osteoarthritis: What difference does it make?

The association between knee joint biomechanics and neuromuscular control and moderate knee osteoarthritis radiographic and pain severity.

Astephen Wilson JL, Deluzio KJ, Dunbar MJ, Caldwell GE, Hubley-Kozey CL. Osteoarthritis and Cartilage 2010;19:186-193

It is well-known that radiographic severity of knee osteoarthritis is not strongly related to symptomatic presentation of the disease. In other words, the amount of cartilage deterioration is not associated with the magnitude of functional impairments or pain levels. To help understand what factors are related to structural changes in the knee joint and what factors are related to pain experienced by persons with osteoarthritis, the authors evaluated a set of biomechanical and neuromuscular variables in 40 patients with moderate knee osteoarthritis.