Carey E. Rothschild

The Risks and Benefits of Running Barefoot or in Minimalist Shoes A Systematic Review

Context: The popularity of running barefoot or in minimalist shoes has recently increased because of claims of injury prevention, enhanced running efficiency, and improved performance compared with running in shoes. Potential risks and benefits of running barefoot or in minimalist shoes have yet to be clearly defined. Objective: To determine the methodological quality and level of evidence pertaining to the risks and benefits of running barefoot or in minimalist shoes. Data Sources: In September 2013, a comprehensive search of the Ovid MEDLINE, SPORTDiscus, and CINAHL databases was performed by 2 independent reviewers. Study Selection: Included articles were obtained from peer-reviewed journals in the English language with no limit for year of publication. Final inclusion criteria required at least 1 of the following outcome variables: pain, injury rate, running economy, joint forces, running velocity, electromyography, muscle performance, or edema. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Two reviewers appraised each article using the Downs and Black checklist and appraised each for level of evidence. Results: Twenty-three articles met the criteria for this review. Of 27 possible points on the Downs and Black checklist, articles scored between 13 and 19 points, indicating a range of evidence from very limited to moderate. Moderate evidence supports the following biomechanical differences when running barefoot versus in shoes: overall less maximum vertical ground reaction forces, less extension moment and power absorption at the knee, less foot and ankle dorsiflexion at ground contact, less ground contact time, shorter stride length, increased stride frequency, and increased knee flexion at ground contact. Conclusion: Because of lack of high-quality evidence, no definitive conclusions can be drawn regarding specific risks or benefits to running barefoot, shod, or in minimalist shoes.

Running Barefoot or in Minimalist Shoes: Evidence or Conjecture?

SUMMARY RUNNING BAREFOOT OR IN MINIMALIST FOOTWEAR HAS BECOME A POPULAR TREND. WHETHER THIS TREND IS SUPPORTED BY EVIDENCE OR CONJECTURE HAS YET TO BE DETERMINED. THIS ARTICLE WILL REVIEW THE BIOMECHANICAL DIFFERENCES BETWEEN RUNNING BAREFOOT AND IN SHOES THAT HAVE BEEN IDENTIFIED IN THE LITERATURE. IT WILL ALSO PROVIDE AN EVIDENCE-BASED PREPARATORY EXERCISE PROGRAM FOR THE INDIVIDUAL TRANSITIONING TO THE BAREFOOT STYLE OF RUNNING.

The Influence of Exercise on Perceived Pain and Disability in Patients With Lumbar Spinal Stenosis: A Systematic Review of Randomized Controlled Trials

Lumbar spinal stenosis (LSS) is an increasingly prevalent condition that has major health and economic implications. While there are many options for the treatment of LSS, exercise is widely considered a first-line intervention as it is associated with reduced complications and cost as compared to more invasive options. Currently, it is not clear if exercise is an effective approach to managing pain and perceived disability in patients with symptomatic LSS. Therefore, the purpose of this systematic review is to evaluate the published literature that has investigated exercise as a primary intervention for LSS. A search was conducted in electronic databases including PubMed, PEDro, SPORTDiscus, CINAHL, and AMED using the key words lumbar spinal stenosis, exercise, physical therapy, rehabilitation, and conservative treatment. Inclusion criteria consisted of published randomized controlled trials written in English that included exercise as the primary treatment in at least one of the groups, and had reported measures of pain and disability clearly stated. The search identified 310 studies of which 5 met all the inclusion parameters. Exercise appears to be an efficacious intervention for pain, disability, analgesic intake, depression, anger, and mood disturbance among patients with LSS. Further research is needed to determine which type of exercise is the most effective in managing symptoms associated with lumbar spinal stenosis.

The Efficacy of Yoga as an Intervention for Chronic Low Back Pain A Systematic Review of Randomized Controlled Trials

Chronic low back pain (cLBP) is common and has a tremendous economic impact. With the prevalence and incidence of low back pain (LBP) on the rise, individuals often seek alternative treatments. Yoga is a widely used complementary and alternative medicine treatment for LBP. However, its efficacy as an intervention for LBP has not been thoroughly investigated. Therefore the purpose of this study was to systematically review the current literature for randomized controlled trials that assess the outcomes of Yoga as an intervention for individuals with cLBP. An electronic database search was performed for studies related to the efficacy of yoga in treatment for cLBP. Studies included were randomized control trials, published in English, from a peer-reviewed journal that identified yoga as the primary treatment focus for LBP in at least one group and included participants with at least a 12-week (3-month) history of symptoms. Our search revealed 185 articles. Of these, 10 met the inclusion criteria. We concluded Yoga intervention appears to be an efficacious intervention in alleviating cLBP. Yoga was demonstrated to significantly improve quality of life and reduce disability, stress, depression, and medication usage associated with cLBP in 8 of the 10 analyzed trials when compared with usual care, self-care book, or exercises. However, more research is necessary before recommendations can be made.

Rotator cuff repair: considerations of surgical characteristics and evidence based interventions for improving muscle performance

Abstract Background: Rotator cuff tears may lead to significant limitations in function, pain and disability. The extent of recovery from surgical intervention and subsequent rehabilitation can vary depending on the complexities of the tear, repair procedure, and post-operative patient management. Evidence suggests that tear and surgical characteristics will influence patient presentation in terms of strength and function, and thus need to be considered when healthcare professionals design rehabilitation programs. Objectives: The objective of this manuscript is to present evidence-based rehabilitation guidelines for management of patients following repair of full-thickness rotator cuff tears, while taking into consideration the method of repair and the characteristics of the rotator cuff defect. Major findings: Many studies have examined different characteristics of rotator cuff tears, various surgical procedures to correct the deficits, and physical interventions that target the specific range of motion and strength deficits post rotator cuff repair. A significant number of investigations have reported muscle activation levels with exercises and daily activities, which may offer a prescriptive utility to the clinician providing post-operative management. However, there are insufficient evidence-based rehabilitation programs that consider the characteristics of the rotator cuff tear defect or method of repair when addressing the post-operative clinical presentation, related impairments, functional limitations and interventions. Conclusion: Rotator cuff tears and repairs have various characteristics that can impact patient recovery. Optimal recovery is dependent on appropriate communication among healthcare professionals and a rehabilitation professional’s understanding of how the tear classifications and surgical management can influence the standard treatment plan for rotator cuff repair.

The Short-Term Effect of Kettlebell Swings on Lumbopelvic Pressure Pain Thresholds: A Randomized Controlled Trial

Abstract Keilman, BM, Hanney, WJ, Kolber, MJ, Pabian, PS, Salamh, PA, Rothschild, CE, and Liu, X. The short-term effect of kettlebell swings on lumbopelvic pressure pain thresholds: a randomized controlled trial. J Strength Cond Res 31(11): 3001–3009, 2017—The purpose of this study was to investigate the short-term effect of kettlebell swings (KBSs) on lumbopelvic pressure pain thresholds (PPTs) in healthy adults. Sixty participants (male = 23, female = 37, mean age = 25.12 ± 2.86 years, height = 170.73 ± 9.2 cm, mass = 70.49 ± 13.32 kg) were randomized into one of 2 groups. The experimental group performed a warm-up followed by 8 consecutive 20-second rounds of KBS with 10-second rest periods. The control group performed the warm-up alone. An evaluator blinded to group assignment, assessed PPTs immediately before and after the intervention using a handheld pressure algometer. The algometer was applied to the regions of the right paravertebral (PVM), quadratus lumborum (QL), and piriformis (PF) muscles perpendicular to the skin based on standardized palpation procedures. The participants were instructed to report when sensation changed from “comfortable pressure” to “slightly unpleasant pain.” No significant group differences existed at baseline for PPTs (PVM p = 0.068; QL p = 0.134, & PF p = 0.105). Significant group by time interactions existed for each site after the interventions (PVM, p = 0.018; QL, p = 0.004; PF, p = 0.026) favoring the KBS group. Results suggest that KBSs create a reduction in muscle sensitivity to noxious pressure based on pressure algometry measurements. These findings may be due to the unique cyclic muscle contraction associated with KBSs, which has been proposed to facilitate removal of muscle metabolites. The findings of this study provide a foundation for future studies to examine the use of this type of training in patients with low back pain of a muscular etiology or postexercise muscle soreness. Furthermore, future studies should evaluate specific mechanisms for these effects.

The effects of a standardized belly dance program on perceived pain, disability, and function in women with chronic low back pain

BACKGROUND An alternative approach to facilitate movement and control through the trunk and pelvis is belly dancing. Investigations of belly dancing mechanics indicate similar muscular activation patterns of those known to influence chronic low back pain (cLBP). However, no documented studies have examined its effectiveness as a treatment for cLBP. OBJECTIVE The purpose of this study was to investigate the influence of a standardized belly dance program in women with cLBP. METHODS A single subject design was used to evaluate weekly outcomes during a three-week baseline period, six-week belly dance program, and again at a two-month follow-up. Outcome measures for pain, disability, function, and fear-avoidance beliefs were utilized. RESULTS Two subjects completed the program. No significant differences were noted during the baseline assessment period. At two months, subject one demonstrated change scores of -1.12, -1%, and 2.2 for pain, disability, and function respectively while subject two demonstrated change scores of 5.4, 5%, and 1.1 for pain, disability, and function, respectively. Subject one showed a clinically significant change score for both fear avoidance of work and physical activity, with score changes of 4 and 3.3, respectively. CONCLUSION The results of this study suggest a standardized belly dance program may positively influence pain and function in women with cLBP.

The Influence of an Active Treatment Approach in Patients With Low Back Pain: A Systematic Review

Introduction. Low back pain (LBP) is one of the most common medical conditions in the United States. Clinical practice guidelines recommend active treatment approaches; however, there continues to be a significant disparity in how patients with LBP are treated. Therefore, the purpose of this systematic review is to evaluate the reported efficacy of active treatment approaches as recommended by clinical practice guidelines on LBP treatment on patient outcomes. Methods. Between the months of June and August 2015, a comprehensive search of the PubMed, Medline (EBSCO Host), and CINAHL (EBSCO Host) databases was performed. The search was restricted to articles that were published in a peer-reviewed journal, published in the English language, examined patient outcomes with a determined scale, determined the usage of an established clinical practice guideline for LBP treatment, reported at least one outcome measure, and specified either nonspecific or acute LBP. Results. Fifty-three articles were initially identified, with 4 articles ultimately meeting the criteria after screening. Articles scored between 17 and 20 points based on a maximum total score of 26 on the modified Downs and Black checklist. Conclusion. Studies identified in this review indicate that adherence to an active treatment approach as recommended by clinical practice guidelines may result in improved patient outcomes.

Prevalence of Musculoskeletal Injury Among Collegiate Marching Band and Color Guard Members.

OBJECTIVE To investigate the prevalence of musculoskeletal injury (MSI) in collegiate marching band and color guard members and the associated factors. METHODS An electronic survey was developed and delivered via the Qualtrics survey platform to collegiate marching band and color guard members in the United States. Information collected included demographics; years of experience; training and performance characteristics; footwear worn; instrument played/equipment used; participation in stretching/strengthening programs; injury prevalence and type; treatment sought for injury; and participation time lost due to injury. RESULTS There were 1,379 (792 female, 587 male) members of 21 collegiate marching bands who completed the survey. Respondents had an average age of 19.8 yrs, height 171.9 cm, weight 72.3 kg, and BMI 24.4 kg/m2. Twenty-five percent of respondents reported sustaining a MSI as a result of participating in marching band or color guard. Females were 20% more likely to sustain a MSI and 87.7% of MSI involved the lower extremity. A significant difference in BMI was found between those who did and did not sustain a MSI (p=0.014). CONCLUSIONS Members of collegiate marching band and color guard may be at risk of sustaining a MSI due to the repetitive nature of the activities performed during practice and performance. The lower extremity is more prone to injury, and a higher BMI may be a risk factor for MSI in this population.

Accelerated Rehabilitation After Minimally Invasive Knee Arthroplasty

Knee arthroplasty (KA) is a well know surgical option for individuals with advanced joint pathology. Few areas in orthopedics have advanced so dramatically over the past few decades as KA, with minimally invasive surgery (MIS) approaches affording patients decreased postoperative pain and surgical trauma as well as faster recovery times and earlier hospital discharge. Given advances in surgical technology favoring MIS and early recovery, it is not unreasonable to question whether traditional rehabilitation programs are providing the necessary prescription intensity for maximizing outcomes. This article discusses MIS KA and presents an accelerated rehabilitation protocol designed to compliment MIS approaches for KA.