Acute and Chronic Tendon Injuries: Factors Affecting the Healing Response and Treatment

2003 ◽  
Vol 12 (1) ◽  
pp. 70-91 ◽  
Author(s):  
Michelle A. Sandrey
Keyword(s):  
Biomechanical Properties ◽  
Rehabilitation Program ◽  
Tendon Injuries ◽  
Data Sources ◽  
Therapeutic Exercise ◽  
Data Synthesis ◽  
Factors Affecting ◽  
Therapeutic Modalities ◽  
Healing Response ◽  
Type Data

Objective:Tendons have biomechanical properties based on collaborative remodeling of all their cells through normal lysis and synthesis. This review assesses factors that affect the healing response and presents solutions for rehabilitating acute and chronic tendon injuries.Data Sources:MEDLINE (1970–2002) and SPORTDiscus (1970–2002). Key words searched weretendon, tendinitis, tendinosis, tendinopathy, rehabilitation, ultrasound, NSAIDs, exercise, mobilization, aging, immobilization,andhealing.Data Synthesis:The biomechanical roles tendons play change throughout one’s lifetime and are influenced by maturation and aging, injury and healing, immobilization, exercise, medications, and therapeutic modalities. Suggestions from animal, case, and clinical studies are varied but provide solutions in the treatment of acute and chronic tendon injuries.Conclusions and Recommendations:All factors that affect the tendon structure should be considered in a rehabilitation program. Therapeutic exercise, medications, or therapeutic modalities should never be used as a stand-alone therapy.

Recovery and Return to Activity Following Exertional Heat Stroke: Considerations for the Sports Medicine Staff

2007 ◽  
Vol 16 (3) ◽  
pp. 163-181 ◽  
Author(s):  
Brendon P. McDermott ◽  
Douglas J. Casa ◽  
Susan W. Yeargin ◽  
Matthew S. Ganio ◽  
Lawrence E. Armstrong ◽  
...  
Keyword(s):  
Data Extraction ◽  
Heat Stroke ◽  
Data Sources ◽  
Exertional Heat Stroke ◽  
Data Synthesis ◽  
Residual Symptoms ◽  
Study Selection ◽  
Initial Care ◽  
Type Data ◽  
Return To Activity

Objective:To describe the current scientific evidence of recovery and return to activity following exertional heat stroke (EHS).Data Sources:Information was collected using MEDLINE and SPORTDiscus databases in English using combinations of key words, exertional heat stroke, recovery, rehabilitation, residual symptoms, heat tolerance, return to activity, and heat illness.Study Selection:Relevant peer-reviewed, military, and published text materials were reviewed.Data Extraction:Inclusion criteria were based on the article’s coverage of return to activity, residual symptoms, or testing for long-term treatment. Fifty-two out of the original 554 sources met these criteria and were included in data synthesis.Data Synthesis:The recovery time following EHS is dependent on numerous factors, and recovery length is individually based and largely dependent on the initial care provided.Conclusion:Future research should focus on developing a structured return-to-activity strategy following EHS.

Effectiveness of Physical Therapy Treatments on Lateral Epicondylitis

2008 ◽  
Vol 17 (2) ◽  
pp. 119-136 ◽  
Author(s):  
Mohamed Kohia ◽  
John Brackle ◽  
Kenny Byrd ◽  
Amanda Jennings ◽  
William Murray ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Treatment Options ◽  
Lateral Epicondylitis ◽  
Data Sources ◽  
Cochrane Library ◽  
Future Research ◽  
Data Synthesis ◽  
Study Selection ◽  
Type Data ◽  
Therapy Interventions

Objective:To analyze research literature that has examined the effectiveness of various physical therapy interventions on lateral epicondylitis.Data Sources:Evidence was compiled with data located using the PubMed, EBSCO, The Cochrane Library, and the Hooked on Evidence databases from 1994 to 2006 using the key words lateral epicondylitis, tennis elbow, modalities, intervention, management of, treatment for, radiohumeral bursitis, and experiment.Study Selection:The literature used included peer-reviewed studies that evaluated the effectiveness of physical therapy treatments on lateral epicondylitis. Future research is needed to provide a better understanding of beneficial treatment options for people living with this condition.Data Synthesis:Shockwave therapy and Cyriax therapy protocol are effective physical therapy interventions.Conclusions:There are numerous treatments for lateral epicondylitis and no single intervention has been proven to be the most efficient. Therefore, future research is needed to provide a better understanding of beneficial treatment options for people living with this condition.

Defining and Measuring Functional Limitations and Disability in the Athletic Shoulder

2001 ◽  
Vol 10 (3) ◽  
pp. 221-231 ◽  
Author(s):  
Douglas R. Keskula ◽  
Jason Lott
Keyword(s):  
Outcome Measures ◽  
English Language ◽  
Functional Limitations ◽  
Self Report ◽  
Data Sources ◽  
Measurement Properties ◽  
Data Synthesis ◽  
Shoulder Dysfunction ◽  
Study Selection ◽  
Type Data

Objective:To define, identify, and briefly describe functional outcome measures for assessing functional limitations and disability in athletes with shoulder conditions.Data Sources:The MEDLINE and CINAHL databases were searched for English-language articles published from 1982 to 2000, using the termsfunctional outcomes, shoulder, questionnaires, disability,andfunctional limitations,among others.Study Selection:The authors identified disease-specific self-report questionnaires that assess functional limitations and disability in patients with shoulder dysfunction.Data Synthesis:When describing outcome measures, the authors considered the items to be assessed, the measurement properties, and the practicality of the test. They categorized the available measures designed to assess patients with shoulder instability or general shoulder conditions.Conclusions:The ability to define and measure function is a fundamental consideration in managing athletes with shoulder dysfunction. The measures described might be useful in assessing functional limitations and disability in such athletes.

Rehabilitation After Oswestry Autologous-Chondrocyte Implantation: The OsCell Protocol

2003 ◽  
Vol 12 (2) ◽  
pp. 104-118 ◽  
Author(s):  
Andrea Bailey ◽  
Nicola Goodstone ◽  
Sharon Roberts ◽  
Jane Hughes ◽  
Simon Roberts ◽  
...  
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
Weight Bearing ◽  
Critical Role ◽  
Data Sources ◽  
Cartilage Defects ◽  
Postoperative Rehabilitation ◽  
Data Synthesis ◽  
Chondrocyte Implantation ◽  
Type Data ◽  
Autologous Chondrocyte

Objective:To develop a postoperative rehabilitation protocol for patients receiving autologous-chondrocyte implantation (ACI) to repair articular-cartilage defects of the knee.Data Sources:careful review of both basic science and clinical literature, personal communication with colleagues dealing with similar cases, and the authors’ experience and expertise in rehabilitating numerous patients with knee pathologies, injuries, and trauma.Data Synthesis:Postoperative rehabilitation of the ACI patient plays a critical role in the outcome of the procedure. The goals are to improve function and reduce discomfort by focusing on 3 key elements: weight bearing, range of motion, and strengthening.Conclusions:The authors present 2 flexible postoperative protocols to rehabilitate patients after an ACI procedure to the knee.

Etiology of Patellar Tendinopathy in Athletes

2005 ◽  
Vol 14 (3) ◽  
pp. 259-272 ◽  
Author(s):  
Sheri A. Hale
Keyword(s):  
Clinical Management ◽  
Data Sources ◽  
Patellar Tendinopathy ◽  
Extrinsic Factors ◽  
Data Synthesis ◽  
Medline Search ◽  
Complex Process ◽  
Study Selection ◽  
Joint Dynamics ◽  
Type Data

Objective:To review the etiology of patellar tendinopathy as it relates to clinical management of chronic patellar-tendon disease in athletes.Data Sources:Information was gathered from a MEDLINE search of literature in English using the key wordspatellar tendinitis, patellar tendonitis, patellar tendinosis, patellar tendinopathy,andjumper’s knee.Study Selection:All relevant peer-reviewed literature in English was reviewed.Data Synthesis:The etiology of patellar tendinopathy is multifactorial, incorporating both intrinsic and extrinsic factors. Age, muscle flexibility, training program, and knee-joint dynamics have all been associated with patellar tendinopathy. The roles of gender, body morphology, and patellar mobility in patellar tendinopathy are unclear.Conclusions:The pathoetiology of patellar tendinopathy is a complex process that results from both an inflammatory response and degenerative changes. There is a tremendous need for research to improve our understanding of the pathoetiology of patellar tendinopathy and its clinical management.

Identification of Risk Factors for Exertional Heat Illness: A Brief Commentary on Genetic Testing

2007 ◽  
Vol 16 (3) ◽  
pp. 222-226 ◽  
Author(s):  
Sheila Muldoon ◽  
Rolf Bunger ◽  
Patricia Deuster ◽  
Nyamkhishig Sambuughin
Keyword(s):  
Risk Factors ◽  
Genetic Testing ◽  
Sports Medicine ◽  
Data Extraction ◽  
Data Sources ◽  
Hereditary Diseases ◽  
Heat Illness ◽  
Data Synthesis ◽  
Exertional Heat Illness ◽  
Type Data

Objective:This commentary discusses known links between Exertional Heat Illness (EHI), Malignant Hyperthermia (MH), and other hereditary diseases of muscle. Genetic and functional testing is also evaluated as measures of fitness to return to duty/play.Data Sources:Reviews and research articles from Sports Medicine, Applied Physiology, and Anesthesiology.Data Extraction:Detailed comparisons of existing literature regarding clinical cases of EHI and MH and the potential utility of genetic testing, specifically the ryanodine receptor (RYR1) gene and other genes related to disorders of skeletal muscle.Data Synthesis:EHI is a complex disorder wherein physiological, environmental, and hereditary factors interact to endanger an individual’s ability to maintain thermal homeostasis.Conclusions:Individuals’ genetic background is likely to play an important role, particularly when EHI recurs. Recurrent EHI has been associated with MH and other genetic disorders, highlighting the importance of identification and exclusion of individuals with known high risk factors.

Predisposing Risk Factors on Susceptibility to Exertional Heat Illness: Clinical Decision-Making Considerations

2007 ◽  
Vol 16 (3) ◽  
pp. 204-214 ◽  
Author(s):  
Michelle Cleary
Keyword(s):  
Relative Risk ◽  
High Risk ◽  
Data Extraction ◽  
Heat Stroke ◽  
Data Sources ◽  
Heat Illness ◽  
Potential Health ◽  
Data Synthesis ◽  
Exertional Heat Illness ◽  
Type Data

Objective:To present strategies for identifying predisposing conditions, susceptibility, and incidence reduction for the most common exertional heat illnesses (EHI): heat cramps, heat exhaustion, and most importantly, heat stroke.Data Sources:A comprehensive literature review of MEDLINE and 1996 to 2006, including all retrospective, controlled studies of EHI risk using the following keywords: exertional heat illness risk, exertional heat stroke risk, and exercise-induced dehydration risk. Search limits included the following: English language, published in the last 10 years, clinical trial, meta-analysis, practice guideline, randomized controlled trial, review, and humans. A manual review was conducted of relevant position statements and book chapters including the reference lists.Data Extraction:To evaluate the quality of the empirical studies to be included in this review, each study must have scored at least 17/22 or 77% of items included when reporting a randomized trial using the CONSORT checklist.Data Synthesis:Many cases of EHI are preventable and can be successfully treated if the ATC® identifies individuals at increased relative risk and implement appropriate prevention strategies. The ability to objectively identify individuals at increased relative risk of EHI and to provide appropriate monitoring is critical in EHI prevention and reduction of repeated incidents of EHI.Conclusions:For any heat illness prevention program to be effective, greater attention and continued observation is needed for athletes at high risk for EHI. For many athletic teams or programs, because of the sheer numbers and associated catastrophic injury potential, health care professionals must implement a system by which high-risk individuals are monitored during activity with the highest level of vigilance for prevention of EHI.

Rehabilitation after Hip Arthroscopy

2000 ◽  
Vol 9 (1) ◽  
pp. 77-88 ◽  
Author(s):  
Karen M. Griffin ◽  
Cindy O. Henry ◽  
J. W. Thomas Byrd
Keyword(s):  
Hip Arthroscopy ◽  
Treatment Plan ◽  
Pathological Process ◽  
Data Sources ◽  
Postoperative Rehabilitation ◽  
Data Synthesis ◽  
Rehabilitation Process ◽  
Hip Disease ◽  
Common Goals ◽  
Type Data

Objective:To explain the basic fundamentals of patient assessment after hip arthroscopy, formulation of a treatment plan, and detailed essentials of postoperative rehabilitation.Data Sources:Established literature and the evolution of a protocol developed in treating over 150 hip-arthroscopy patients and numerous patients with symptomatic hip disease.Data Synthesis:Although the pathological process being addressed and the surgical technique employed in its management influence the protocol, the common goals of rehabilitation are to reduce discomfort and improve function. These common goals, first realized in the postoperative rehabilitation process, have been found to have similar application in the conservative management of patients with symptomatic hip disease.Conclusions:Arthroscopy has necessitated the development of a postoperative rehabilitation protocol. Principles previously employed in other joints are now finding application in the hip.

Rehabilitation for Functional Ankle Instability

2003 ◽  
Vol 12 (2) ◽  
pp. 133-142 ◽  
Author(s):  
Diane Madras ◽  
J. Bradley Barr
Keyword(s):  
Ankle Instability ◽  
Data Sources ◽  
Ankle Sprains ◽  
Training Methods ◽  
Review Of The Literature ◽  
Data Synthesis ◽  
Study Selection ◽  
Single Leg Stance ◽  
Type Data ◽  
Balance Problems

Objective:The article presents a focused review of the literature surrounding training methods for addressing the proprioceptive loss and subsequent balance problems that result from inversion ankle sprains.Data Sources:The authors searched the MEDLINE and CINAHL databases for the period 1985 through December 2001 using the key wordsankle, ankle sprain,andrehabilitation.Study Selection:Any study investigating a rehabilitation or prevention program for the proprioceptive or balance aspects of ankle instability was included.Data Synthesis:Key components of the training regimen used in each study are described, and major findings are summarized.Conclusions:Based on the literature reviewed, there is evidence to suggest that training programs for individuals with ankle instability that include ankle-disk or wobble-board activities help improve single-leg-stance balance and might decrease the likelihood of future sprains.

Effects of Acute and Chronic Pathomechanics on the Normal Histology and Biomechanics of Tendons: A Review

2000 ◽  
Vol 9 (4) ◽  
pp. 339-352 ◽  
Author(s):  
Michelle A. Sandrey
Keyword(s):  
Healing Process ◽  
Tendon Injury ◽  
Data Sources ◽  
Repetitive Movement ◽  
Chronic Injury ◽  
Data Synthesis ◽  
Composition And Structure ◽  
Frictional Forces ◽  
Type Data ◽  
Loading Modes

Objective:To present the basic concepts of normal composition and structure of tendons and indicate how they are affected by acute and chronic tendon-injury pathomechanics.Data Sources:MEDLINE (1970-1999) and SPORTDiscus (1970-1999) were searched using the key words pathoanatomic, tendinitis, tendinosis, biomechanics, pathomechanics, histology, chronic, and mechanical behavior.Data Synthesis:Acute loading modes to tendons are based on the response of tendons to tensile and compressive stress. Chronic loading modes are based on frictional forces and repetitive movement.Conclusions and Recommendations:With an appreciation of the pathologic changes in acute tendon injuries, the clinician can better understand injury mechanics and the healing process. Until we know more about what is happening in and around the tendon, principally in the early and late phases of chronic injury we will not be able to adequately address injury classification of structures and, hence, the pathomechanics of chronic injury

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