Cindy Montero

Hyaluronic Acid (HA) Viscosupplementation on Synovial Fluid Inflammation in Knee Osteoarthritis: A Pilot Study

Objective: This study examined the changes in synovial fluid levels of cytokines, oxidative stress and viscosity six months after intraarticular hyaluronic acid (HA) treatment in adults and elderly adults with knee osteoarthritis (OA). Design: This was a prospective, repeated-measures study design in which patients with knee OA were administered 1% sodium hyaluronate. Patients (N=28) were stratified by age (adults, 50-64 years and elderly adults, ≥65 years). Ambulatory knee pain values and self-reported physical activity were collected at baseline and month six. Materials and Methods: Knee synovial fluid aspirates were collected at baseline and at six months. Fluid samples were analyzed for pro-inflammatory cytokines (interleukins 1β, 6,8,12, tumor necrosis factor-α, monocyte chemotactic protein), anti-inflammatory cytokines (interleukins 4, 10 13), oxidative stress (4-hydroxynonenal) and viscosity at two different physiological shear speeds 2.5Hz and 5Hz. Results: HA improved ambulatory knee pain in adults and elderly groups by month six, but adults reported less knee pain-related interference with participation in exercise than elderly adults. A greater reduction in TNF-α occurred in adults compared to elderly adults (-95.8% ± 7.1% vs 19.2% ± 83.8%, respectively; p=.044). Fluid tended to improve at both shear speeds in adults compared to the elderly adults. The reduction in pain severity correlated with the change in IL-1β levels by month six (r= -.566; p=.044). Conclusion: Reduction of knee pain might be due to improvements in synovial fluid viscosity and inflammation. Cartilage preservation may be dependent on how cytokine, oxidative stress profiles and viscosity change over time.

Functional Pain Severity and Mobility in Overweight Older Men and Women with Chronic Low Back Pain: Part I

ObjectiveThis study determined whether mobility and functional pain were different among older men and women with chronic low-back pain and varying body mass index levels. DesignThis was a comparative, descriptive study of older adults with obesity with low-back pain (N = 55; 60–85 yrs). The participants were stratified on the basis of body mass index: overweight (25–29.9 kg/m2), obese (30–34.9 kg/m2), and severely obese (35 kg/m2). The participants completed a functional test battery (walking endurance, chair rise, stair climb, 7-day activity monitoring, and gait parameters) and pain ratings with activity (“functional pain”). ResultsThe functional pain scores during walking and stair climb were highest in the severely obese group compared with the overweight group (P < 0.05), but the functional test scores were not found to be significantly different by body mass index. Gait base of support was 36% greater and single/double support times were 3.1%–6.1% greater in the severely obese group compared with the overweight group (P < 0.05). The women had slower chair rise and stair climb times and had slower walking velocity than did the men. Daily step numbers were lowest in the severely obese group compared with the obese and overweight groups (2971 vs. 3511 and 4421 steps per day; P < 0.05) but were not different by sex. Normalized lumbar extensor, abdominal curl, and leg press strength values were lowest in the severely obese group, and the women had 18%–34% lower strength values than did the men for all three exercises (P < 0.05). Lumbar strength was associated with stair climb, chair rise, and walking endurance times. Body mass index was an independent predictor of walking endurance time but not of steps taken per day. ConclusionsIn this study, the persons with obesity reported higher functional pain values during walking and stair climb and had lower lumbar strength compared with the overweight participants. Rehabilitation strategies that include lumbar extensor strengthening may help improve functional mobility and walking duration, both of which can help with weight management in older adults with obesity with chronic low-back pain.

Kinesiophobia and Fear Avoidance Beliefs in Overweight Older Adults with Chronic Low Back Pain, Relationship to Walking Endurance: Part II

ObjectiveThis study determined whether kinesiophobia levels were different among older adults with chronic low back pain (LBP) and varying body mass index and whether kinesiophobia predicted perceived disability or walking endurance. DesignThis study was a secondary analysis from a larger interventional study. Older adults with obesity with LBP (N = 55; 60–85 yrs) were participants in this study. Data were stratified on the basis of body mass index: overweight (25–29.9 kg/m2), obese (30–34.9 kg/m2), and severely obese (35 kg/m2). The participants completed a battery of surveys (the modified Tampa Scale of Kinesiophobia [TSK-11], the Fear-Avoidance Beliefs Questionnaire, the Pain Catastrophizing Scale, and the perceived disability measures of the Oswestry Disability Index and the Roland Morris Disability Questionnaire). Walking endurance time was captured using a symptom-limited graded walking treadmill test. The peak LBP ratings were captured during the walk test. ResultsWalking endurance times did not differ by body mass index group, but the peak LBP ratings were higher in the moderately and severely obese groups compared with the overweight group (3.0 and 3.1 vs. 2.1 points; P < 0.05). There was no difference in the kinesiophobia scores (the TSK-11, the Pain Catastrophizing Scale, and the Fear-Avoidance Beliefs Questionnaire work and activity subscores) or the perceived disability scores (the Oswestry Disability Index and the Roland Morris Disability Questionnaire). However, adjusted regression analyses revealed that the TSK-11 scores contributed 10%–21% of the variance of the models pain with walking and perceived disability caused by back pain. Kinesiophobia was not a significant contributor to the variance of the regression model for walking endurance. ConclusionsIn the older population with obesity with LBP, the TSK-11 might be a quick and simple measure to identify patients at risk for poor self-perception of functional ability. The TSK and the Oswestry Disability Index may be quick useful measures to assess initial perceptions before rehabilitation. Kinesiophobia may be a good therapeutic target to address to help affected older adults with obesity fully engage in therapies for LBP.

“Functional Pain,” Functional Outcomes, and Quality of Life After Hyaluronic Acid Intra-articular Injection for Knee Osteoarthritis

To compare the effect of hyaluronic acid (HA) intra‐articular knee injections on pain and functional outcomes in persons with knee osteoarthritis (OA) over 6 months, and to determine whether or not changes in functional pain are related to improvements in quality of life.

Metabolic, Cardiopulmonary, and Gait Profiles of Recently Injured and Noninjured Runners

To examine whether runners recovering from a lower body musculoskeletal injury have different metabolic, cardiopulmonary, and gait responses compared with healthy runners.

Bioavailability of Herbs and Spices in Humans as Determined by ex vivo Inflammatory Suppression and DNA Strand Breaks

Objective: The aim of this work was to determine the bioavailability of herbs and spices after human consumption by measuring the ability to protect lymphocytes from an oxidative injury and by examining the impact on inflammatory biomarkers in activated THP-1 cells. Methods: Ten to 12 subjects in each of 13 groups consumed a defined amount of herb or spice for 7 days. Blood was drawn from subjects before consumption and 1 hour after taking the final herb or spice capsules. Subject serum and various extractions of the herbs and spices were analyzed for antioxidant capacity by oxygen radical absorbance capacity (ORAC) analysis or by 1,1-diphenyl-2-picrylhydrzyl (DPPH). Subject peripheral blood mononuclear cells (PBMCs) in medium with10% autologous serum were incubated with hydrogen peroxide to induce DNA strand breaks. Subject serum was also used to treat activated THP-1 cells to determine relative quantities of 3 inflammatory cytokine (tumor necrosis factor-α [TNF-α], interleukin-1α [IL-1α], and IL-6) mRNAs. Results: Herbs and spices that protected PBMCs against DNA strand breaks were paprika, rosemary, ginger, heat-treated turmeric, sage, and cumin. Paprika also appeared to protect cells from normal apoptotic processes. Of the 3 cytokine mRNAs studied (TNF-α, IL-1α, and IL-6), TNF-α was the most sensitive responder to oxidized LDL-treated macrophages. Clove, ginger, rosemary, and turmeric were able to significantly reduce oxidized LDL-induced expression of TNF-α. Serum from those consuming ginger reduced all three inflammatory biomarkers. Ginger, rosemary, and turmeric showed protective capacity by both oxidative protection and inflammation measures. Conclusions: DNA strand breaks and inflammatory biomarkers are a good functional measure of a foods bioavailability.

Role of Pain and Playing Position on Shoulder Motion during Lacrosse Passing in Boys Aged 14-18 Years

tendonosis or a partial tear of a gluteus medius and/or minimus tendon. The patients were then contacted and asked to complete questionnaires to assess their pain, function, and satisfaction with treatment. Main Outcome Measures: Improvement in pain, patient satisfaction and function following PRP injection. These were measured by follow-up questionnaires that included the Visual Numerical Scale, Functional Rating Index, and North American Spine Society patient satisfaction index. Results or Clinical Course: 10 patients met criteria (9 female, 1 male). Average age was 64.7 years. Mean duration of pain prior to injection was 46 months (range 8 to 120 mo). Mean follow up was 10.2 months (range 6 to 26 mo). The average pain score (as measured by VAS) was 8.10 (SD 1.7) pre-injection and 3.8 (SD 2.7) post-injection (p 1⁄4 .002). Overall patient satisfaction was 80% (as measured by NASS). Two patients reported no improvement. Of the 8 patients who reported improvement, their mean Functional Rating Index (FRI) score was 62.4 (out of 100) before their PRP injection and 21.3 six months post-injection (p 1⁄4 .001). The average pain score (VAS) among these 8 patients was 8.7 (SD 1.1) pre-injection and 2.7 (SD 2.1) post-injection. Conclusions: The results from this small retrospective case series suggest that PRP may be an efficacious conservative treatment option for patients with symptomatic gluteus medius tears, degeneration, and tendinosis. More robust prospective studies are needed to better evaluate this treatment.

Age and Disease Severity Interactions with Hyaluronic Acid (HA) Viscosupplementation on Synovial Fluid Inflammatory Proteins in Knee Osteoarthritis

Disclosures: K. Lee, No Disclosures: I Have Nothing To Disclose. Objective: The purpose of this study was to evaluate the effect of hamstring stretching exercise on gait pattern. Setting: Thirty healthy male adults were tested for hamstring flexibility and gait pattern before and after intermittent hamstring stretching exercise (stretching and resting for 30 seconds each, alternatively, 3 times). The hamstring flexibility was measured with four different methods including straight leg raise test (SLRT), popliteal angle test (PA), modified popliteal angle test (MPA) and sitting popliteal angle test (SPA). We analyzed gait pattern by measuring peak plantar pressures and ground contact times during walking by EMED system. Results or Clinical Course: There were significant increases in hamstring flexibility in all 4 methods after stretching exercise (p<.05). In gait pattern analysis, there were significant decreases in the ground contact time that takes from the leaving point of center of pressure from hindfoot to the end of heel off (p<.05). Also, the peak plantar pressure of the end of heel off was also significantly decreased (p<.05). Conclusions: When we analyzed gait patterns after the stretching exercise, there were significant reduction in mid stance duration and peak plantar pressure. We assumed that changes in the gait patterns are caused by eased ankle dorsiflexion in mid stance, and it might be related to improved flexibility of gastrocnemius as well as hamstring.

Shoulder Passive Range of Motion in High School Lacrosse Players: An Exploratory Pilot Study of Arm Dominance and Presence of Pain

Disclosures: J. L. Zaremski, No Disclosures: I Have Nothing To Disclose. Objective: Lacrosse forward passing has some joint motion components similar to that of a baseball throw. However, glenohumeral range of motion patterns have not yet been studied in lacrosse players. As high school lacrosse participation increases in in the United States, it is expected that injuries, including shoulder injuries, will increase. We currently understand little about the shoulder range of motion and its relationship to pain and arm dominance in high school lacrosse players. Our objective was to determine the differences in dominant (D) versus non-dominant (ND) shoulder external (ER) and internal (IR) range of motion (ROM), whether ROM is different in presence of shoulder pain. Design: Cross sectional study. Setting: High school lacrosse field. Participants: High school male lacrosse players (N1⁄418; 5.2 1.8 years of play, 14-19 years old). Interventions: Not Applicable. Main Outcome Measures: D and ND ER and IR of shoulder. Results or Clinical Course: Passive ER and IR in the D shoulder were 98.4 and 60.4 , respectively (total arc of motion 158.8 ). Passive ER and IR in the ND shoulder were 96.1 and 64.8 , respectively (total arc of motion 160.9 ). In three players with shoulder pain (average pain severity 1⁄4 3 points out of 10), ER was less than in players without pain (ND ER1⁄482 versus 98.9 , p 1⁄4.026). D ER with pain was 95.7 compared to 99 in ND ER without pain (p>.05). Conclusions: During an overhead lacrosse shot, there was an increase in D shoulder ER while maintaining total arc of motion. This pattern was similar to that reported in the baseball throwing literature. Players with shoulder pain had a lower ER than those without pain. These data infer that a pre-participation examination period and pre-habilitation programs to address ROM and strength asymmetries might be useful to prevent shoulder injury in lacrosse.

Poster 140 Sex Differences in Associations of Physical Function, Gait Parameters and Fear Avoidance in Older Adults with Low Back Pain

of the abductor digiti minimi (ADM) after ulnar nerve stimulation was recorded using a new placement (or montage) of the E1 and E2 electrodes, and compared to the traditional method (ADM-D5) in each dominant hand. The new montage (ADM-D1) places E2 over the metacarpo-phalangeal joint of the thumb (D1) with E1 in its usual location at the motor point of ADM. Supramaximal stimulation was delivered to the ulnar nerve at the wrist (W), below the elbow (BE) and above the elbow (AE). Main Outcome Measures: The mean( s.d) amplitude of the CMAP was measured for each method. The amplitude change when comparing the AE and W responses was also calculated. Reduced mean difference of AE-W, and reduced variance of the measure are interpreted as more stable measures for the population. Results: 25 subjects, with mean age of 39. For ADM-D1 the amplitude (mean s.d.) was 8.2 mV (1.9) with wrist stimulation and the amplitude change with AE stimulation was -0.39mV (0.84). For the standard ADM-D5 montage the amplitude (mean s.d.) was 10.9 mV (2.88) with wrist stimulation and the amplitude change with AE stimulation was -0.93mV (1.05). The reduction in amplitude change (0.39 v 0.93) was statistically significant at P .037. Conclusions: The ADM-D1 method reduced the AE-W CMAP amplitude change in normal subjects and also reduced the variance of amplitude change when compared to the ADM-D5 method. The ADM-D1 electrode setup has the potential to reduce the normal reference range for this parameter and may be a more useful measure of amplitude change for assessment of compression neuropathy.