Apostolos Stergioulas

A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow)

BackgroundRecent reviews have indicated that low level level laser therapy (LLLT) is ineffective in lateral elbow tendinopathy (LET) without assessing validity of treatment procedures and doses or the influence of prior steroid injections.MethodsSystematic review with meta-analysis, with primary outcome measures of pain relief and/or global improvement and subgroup analyses of methodological quality, wavelengths and treatment procedures.Results18 randomised placebo-controlled trials (RCTs) were identified with 13 RCTs (730 patients) meeting the criteria for meta-analysis. 12 RCTs satisfied half or more of the methodological criteria. Publication bias was detected by Eggers graphical test, which showed a negative direction of bias. Ten of the trials included patients with poor prognosis caused by failed steroid injections or other treatment failures, or long symptom duration or severe baseline pain. The weighted mean difference (WMD) for pain relief was 10.2 mm [95% CI: 3.0 to 17.5] and the RR for global improvement was 1.36 [1.16 to 1.60]. Trials which targeted acupuncture points reported negative results, as did trials with wavelengths 820, 830 and 1064 nm. In a subgroup of five trials with 904 nm lasers and one trial with 632 nm wavelength where the lateral elbow tendon insertions were directly irradiated, WMD for pain relief was 17.2 mm [95% CI: 8.5 to 25.9] and 14.0 mm [95% CI: 7.4 to 20.6] respectively, while RR for global pain improvement was only reported for 904 nm at 1.53 [95% CI: 1.28 to 1.83]. LLLT doses in this subgroup ranged between 0.5 and 7.2 Joules. Secondary outcome measures of painfree grip strength, pain pressure threshold, sick leave and follow-up data from 3 to 8 weeks after the end of treatment, showed consistently significant results in favour of the same LLLT subgroup (p < 0.02). No serious side-effects were reported.ConclusionLLLT administered with optimal doses of 904 nm and possibly 632 nm wavelengths directly to the lateral elbow tendon insertions, seem to offer short-term pain relief and less disability in LET, both alone and in conjunction with an exercise regimen. This finding contradicts the conclusions of previous reviews which failed to assess treatment procedures, wavelengths and optimal doses.

Effects of Low-Level Laser Therapy and Eccentric Exercises in the Treatment of Recreational Athletes with Chronic Achilles Tendinopathy

Background Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect from EE has a slow onset. Hypothesis The addition of low-level laser therapy (LLLT) to EE may cause more rapid clinical improvement. Study Design Randomized controlled trial; Level of evidence, 1. Methods A total of 52 recreational athletes with chronic Achilles tendinopathy symptoms were randomized to groups receiving either EE + LLLT or EE + placebo LLLT over 8 weeks in a blinded manner. Low-level laser therapy (Λ = 820 nm) was administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm2 and a total dose of 5.4 J per session. Results The results of the intention-to-treat analysis for the primary outcome, pain intensity during physical activity on the 100-mm visual analog scale, were significantly lower in the LLLT group than in the placebo LLLT group, with 53.6 mm versus 71.5 mm (P = .0003) at 4 weeks, 37.3 mm versus 62.8 mm (P = .0002) at 8 weeks, and 33.0 mm versus 53.0 mm (P = .007) at 12 weeks after randomization. Secondary outcomes of morning stiffness, active dorsiflexion, palpation tenderness, and crepitation showed the same pattern in favor of the LLLT group. Conclusion Low-level laser therapy, with the parameters used in this study, accelerates clinical recovery from chronic Achilles tendinopathy when added to an EE regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks.

Low-level laser treatment can reduce edema in second degree ankle sprains.

OBJECTIVE Low-level laser therapy (LLLT) has been used for the last few years to treat sports injuries. The purpose of this study was to compare three therapeutic protocols in treating edema in second degree ankle sprains that did not require immobilization with a splint, under placebo-controlled conditions. MATERIALS AND METHODS Forty-seven soccer players with second degree ankle sprains, selected at random, were divided into the following groups: The first group (n = 16) was treated with the conventional initial treatment (RICE, rest, ice, compression, elevation), the second group (n = 16) was treated with the RICE method plus placebo laser, and the third group (n = 15) was treated with the RICE method plus an 820-nm GaA1As diode laser with a radiant power output of 40 mW at 16 Hz. Before the treatment, and 24, 48, and 72 h later, the volume of the edema was measured. RESULTS A three by three repeated measures ANOVA with a follow up post hoc test revealed that the group treated with the RICE and an 820-nm GaA1As diode laser presented a statistically significant reduction in the volume of the edema after 24 h (40.3 +/- 2.4 mL, p < 0.01), 48 h (56.4 +/- 3.1 mL, p < 0.002), and 72 h (65.1 +/- 4.4 mL, p < 0.001). CONCLUSIONS LLLT combined with RICE can reduce edema in second-degree ankle sprains.

EPIDEMIOLOGY OF TRACK & FIELD INJURIES: A ONE YEAR EXPERIENCE IN ATHLETIC SCHOOLS

The purpose of this study was to record injuries in track & field events that were sustained by students who attended the athletic schools during a one-year period. From September 2009 to May 2010, the researchers observed 2045 students (883 males and 1163 females), who were participating in track and field events at the mentioned schools. During the study period 150 injuries were recorded, which accounted for 13.3% of all injuries sustained by students. Most of the injuries (34%) according to the diagnosis were sprains and strains and occurred during the months of February, December and January. A large percentage of the injuries (45.4%) were sustained by students who attended the Athletic Schools, which operated in the urban region. Students who attended the second class sustained more injuries than the other classes (first and third). Students who were practising or competing on a tartan playing surface were more likely to sustain an injury. Knee and ankle were the most frequent anatomical sites in which injuries (43.9%) occurred. Additionally, 80.0% of injuries occurred in students who were practising or competing in running events. No statistical differences were observed in all above mentioned parameters amongst male and female students. Physical education (P.E.) teachers should place more emphasis on prevention measures. These measures should include proper supervision of students during training, warming up and cooling down sessions with stretching techniques. By following these suggestions students will compete in a safe and healthy environment.

Effectiveness and Safety of Shockwave Therapy in Tendinopathies

Introduction: People suffering from tendinopathies exhibit reduced mobility due to the pain caused by the movement of the tendons involved. Recently, shockwave therapy has been used as a treatment option, which is non-invasive, simpler, faster and safer. Aims: To record the intensity of the pain, the functionality of the upper and lower limbs and quality of life before treatment with shock waves, immediately after the treatment and the 4-week follow-up. Methodology: The sample consisted of 384 patients, suffering from a tendinopathy. 326 patients constituted the shockwave intervention groups and 58 patients made up the control groups. The researchers created a self-administered questionnaire (University of Peloponnese Pain, Functionality and Quality of Life Questionnaire) in which the intensity of pain, functionality and quality of life were evaluated on a five-point Likert scale, before, immediately after the treatment and at a 4-week follow-up. Results: The pain reduction and the improvement of functionality and quality of life after shockwave treatment increased by at least two points on the five-point Likert scale both post-treatment (p<0,001) and at a 4-week follow-up (p<0,001) compared to post-treatment in elbow tendinopathy, Achilles tendinopathy, plantar fasciitis and rotator cuff tendinopathy. Conclusions: Shockwave therapy significantly reduced the pain that accompanies tendinopathies and improves functionality and quality of life. It might be first choice because of its effectiveness and safety.

Isokinetic characteristics of amateur boxer athletes

Aim: The kinetic chain of the punch of boxers is characterized by the contribution of the shoulder; however, the isokinetic muscle strength of shoulder’s rotators muscles has not been well studied so far, especially with regards to performance. Therefore, the aim of the present study was (a) to profile the isokinetic muscle strength of rotators of the glenohumeral joint, bilateral (BL), unilateral (UL) and functional ratios in amateur boxers, and (b) to examine the variation of these muscle strength characteristics by performance level. Methods: Forty male amateur Greek boxers from three division levels (elite, n = 22; second division, n = 11; and third division, n = 7), and 10 non-athletes (control group) were tested, using the isokinetic dynamometer Kin-ComTM in the scapular seated position under standard conditions. We examined (i) peak torque (PT) of internal (IR) and external (ER) rotators during concentric (CON) and eccentric (ECC) contractions at low (60°/s), medium (120°/s), and high speed (180°/s), (ii) BL, (iii) UL, and (iv) functional ratios of dominant (D) and non-dominant (ND) limbs. Results: Boxers were stronger than control group in IR and ER at all speeds, and D outscored ND limb (p < 0.05). Elite boxers were stronger than group B and C (p < 0.05); however, when peak torque was expressed in relative to body mass values, these differences were attenuated. The BL ratios for the men athletes were under 10% at 60 and 180°/s, the UL ratios were lower at 60 and higher at 180°/s and significant lower in the dominant limb at all speeds. The functional ratios of IR ECC / ER CON were higher between the control group at all speeds and the ER ECC/IR CON ratios were between 60 and 180°/s, and the two limbs with higher values at 180°/s. Conclusion: Boxers had the strongest dominant limb and their BL ratios were normal at all speeds except of 120°/s ECC. The UL ratios of ECC at 120 and 180°/s of ND were normal, and at the other speeds abnormal due to high IR. In addition, the functional ratios may be related to the kinetic chain of the punch, which in turn correlates with the contribution of ER of both limbs.

Musculoskeletal Problems Among Greek Perioperative Nurses in Regional Hospitals in Southern Peloponnese

The surgery unit is a particularly labor-intensive environment in the hospital. Studies reflect the correlation of labor risk factors for musculoskeletal injuries among nurses but few have investigated the relationship to perioperative nurses. The purpose of this study is the identification and definition of ergonomic risk factors in the operating room and their connection with musculoskeletal disorders in perioperative nurses in regional hospitals in Greece. Forty four Greek perioperative nurses working in regional hospitals in southern Peloponnese participated. Anonymous self-administered questionnaire was used to collect the data, which consisted of three parts (investigating musculoskeletal symptoms, description of work, psychometric evaluation). The analysis was done with the statistical program SPSS.19. Symptoms of musculoskeletal problems emerged. Specifically, 54.4% in the lumbar, 47.7% in the neck, 45.5% in the shoulder, followed by smaller percentages of the hip, knee, elbow and ankle. 6.8% of participants indicated no musculoskeletal symptoms in the last year while 74.9% of those who had symptoms presented them in two or more areas. Activities rated as a major problem among others were the manual handling, tools with weight and vibration etc. 100% of respondents agreed that the work in the surgery unit is demanding and has anxiety. The lack of support from the government (81.8%), combined with the low perioperative nurses (6.8%) having the opportunity to participate in administrative decisions concerning them were related to problems in the organization and management of work. Apart from engineers target factors, a main aim should be the organization of work within the framework of a national policy based on European directives on the protection and promotion of the health and safety of workers.

THE IMPACT OF BOXING EXPERIENCE ON SHOULDER INTERNAL ROTATOR MUSCLES CONCENTRIC AND ECCENTRIC STRENGTH.

Ioannis Tasiopoulos 1 , Alexandra Tripolitsioti 2 , Pantelis Nikolaidis 3 and Apostolos Stergioulas 4 . 1. MS, PhDc Faculty of Human Movement & Quality of Life, Peloponnese University, Efstathiou & Stamatikis Balioti & Plateon, 23100, Sparta, Laconia, Greece. 2. Special staff, Faculty of Human Movement & Quality of Life, Peloponnese University, Efstathiou & Stamatikis Balioti & Plateon, 23100, Sparta, Laconia, Greece. 3. Professor, Director Lab of Health, Fitness and Disability Management, Faculty of Human Movement & Quality of Life, Peloponnese University, Efstathiou & Stamatikis Balioti & Plateon, 23100, Sparta, Laconia, Greece. 4. Exercise Physiology Laboratory,Thermopilon 7, 18450, Nikaia, Athens, Greece. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History