Giampietro L. Vairo

Systematic Review of Efficacy for Manual Lymphatic Drainage Techniques in Sports Medicine and Rehabilitation: An Evidence-Based Practice Approach

Abstract Manual therapists question integrating manual lymphatic drainage techniques (MLDTs) into conventional treatments for athletic injuries due to the scarcity of literature concerning musculoskeletal applications and established orthopaedic clinical practice guidelines. e purpose of this systematic review is to provide manual therapy clinicians with pertinent information regarding progression of MLDTs as well as to critique the evidence for e cacy of this method in sports medicine. We surveyed English-language publications from 1998 to 2008 by searching PubMed, PEDro, CINAHL, the Cochrane Library, and SPORTDiscus databases using the terms lymphatic system, lymph drainage, lymphatic therapy, manual lymph drainage, and lymphatic pump techniques. We selected articles investigating the effects of MLDTs on orthopaedic and athletic injury outcomes. Nine arti- cles met inclusion criteria, of which 3 were randomized controlled trials (RCTs). We evaluated the 3 RCTs using a validity score (PEDro scale). Due to di erences in experimental design, data could not be collapsed for meta-analysis. Animal model experiments reinforce theoretical principles for application of MLDTs. When combined with concomitant musculoskeletal therapy, pilot and case studies demonstrate MLDT e ectiveness. e best evidence suggests that the efficacy of MLDT in sports medicine and rehabilitation is specific to resolution of enzyme serum levels associated with acute skeletal muscle cell damage as well as reduction of edema following acute ankle joint sprain and radial wrist fracture. Currently, there is limited high-ranking evidence available. Well-designed RCTs assessing outcome variables following implementation of MLDTs in treating athletic injuries may provide conclusive evidence for establishing applicable clinical practice guidelines in sports medicine and rehabilitation.

The effects of two therapeutic patellofemoral taping techniques on strength, endurance, and pain responses

OBJECTIVE To compare the effects of taping techniques on clinical measures in patellofemoral pain syndrome (PFPS) patients. DESIGN Crossover experimental design. SETTING Controlled laboratory. PARTICIPANTS Twenty physically active PFPS patients. MAIN OUTCOME MEASURES Isokinetic strength and endurance, and perceived pain. RESULTS Bilateral baseline differences existed for strength (involved = 1.8 ± 0.5 Nm/kg; uninvolved = 2.1 ± 0.5 Nm/kg; p = 0.001) and endurance (involved = 35.6 ± 14.0 J/kg; uninvolved = 40.2 ± 12.9 J/kg; p = 0.013). Strength (McConnell = 2.1 ± 0.6 Nm/kg, 95% SCI = (1.1, 4.2); Spider(®) = 2.1 ± 0.5 Nm/kg, 95% SCI = (0.9, 4.0)) and endurance (McConnell = 42.9 ± 13.8 J/kg, 95% SCI = (2.9, 11.6); Spider(®) = 42.5 ± 11.0 J/kg, 95% SCI = (2.6, -11.3)) increased when taped compared to baseline. Pain decreased during strength (baseline = 3.0 ± 2.2 cm; McConnell = 1.9 ± 1.7 cm, 95% SCI = (-1.8, -0.4); Spider(®) = 1.6 ± 2.0 cm, 95% SCI = (-2.0, -0.5)) and endurance (baseline = 2.5 ± 2.0 cm; McConnell = 1.5 ± 1.8 cm, 95% SCI = (-1.6, -0.4); Spider(®) = 1.1 ± 0.8 cm, 95% SCI = (-1.7, -0.5)) measurements when taped. Differences between taping techniques were insignificant. CONCLUSIONS Taping improved clinical measures in PFPS patients. No differences existed between Spider(®) and McConnell techniques.

Cocoa-based protein and carbohydrate drink decreases perceived soreness after exhaustive aerobic exercise: a pragmatic preliminary analysis.

McBrier, NM, Vairo, GL, Bagshaw, D, Lekan, JM, Bordi, PL, and Kris-Etherton, PM. Cocoa-based protein and carbohydrate drink decreases perceived soreness after exhaustive aerobic exercise: A pragmatic preliminary analysis. J Strength Cond Res 24(8): 2203-2210, 2010-The purpose of this pragmatic preliminary analysis was to examine the effectiveness of a cocoa-based protein and carbohydrate prototype drink on skeletal muscle damage and perceived soreness after exhaustive exercise. A repeated-measures experimental design was used. Common biomarkers indicative of skeletal muscle damage included creatine kinase (CK), urinary isoprostanes and inflammatory markers (IL-6, IL-8, C-Reactive Protein [CRP]). Self-reported perception of postexercise soreness was also evaluated. Seven men participated in an exercise session consisting of a 30-minute run on a declined treadmill (−10% grade). Running speed was adjusted accordingly so that participants consistently maintained 75% maximal heart rate. Drinks were ingested immediately after exercise, 2 hours postexercise, and before bed. Blood draws were sampled 30, 60, 120, and 360 minutes postexercise; urine was collected 24 and 48 hours postexercise. A perceived soreness questionnaire was administered 24 and 48 hours postexercise. The test drink had no effect on IL-6, CK, IL-8, CRP, or urinary isoprostanes (p > 0.05). However, the drink decreased the change in perceived soreness from 24 to 48 hours (p = 0.03). Consuming the drink after exercise resulted in a mean change of 2.6 ± 6 compared to 13.7 ± 10 for the control. In summary, the drink was effective in decreasing the level of self-reported perceived soreness after exhaustive exercise.

Knee Flexor Strength and Endurance Profiles After Ipsilateral Hamstring Tendons Anterior Cruciate Ligament Reconstruction

OBJECTIVES To profile knee flexor strength and endurance responses to ipsilateral hamstring tendon autograft anterior cruciate ligament reconstruction in patients, and to describe knee flexor strength and endurance as predictors of subjective outcomes. The hypothesis was that the involved leg would demonstrate deficits compared with uninvolved and matched legs. DESIGN Retrospective cohort. SETTING Controlled laboratory. PARTICIPANTS Women (n=15; mean age, 20.47±1.96y; height, 1.69±.08m; weight, 68.51±12.64kg), who were a mean ± SD of 25.93±11.25 months postsurgery, were matched to 15 sex-matched controls (mean age, 20.93±1.22y; height, 1.65±.06m; weight, 66.52±10.69kg). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Concentric peak flexor moment over the entire isokinetic joint range of motion, peak flexor moment at 105° of joint flexion, and knee flexor total work, normalized to body mass, and subjective questionnaire scores for the involved leg. RESULTS Significantly lesser peak flexor moment over the entire isokinetic joint range of motion (P=.034) and total work (P=.048) existed for the involved leg (.959±.186Nm/kg; 21.933±5.881J/kg) compared with the matched leg (1.108±.134Nm/kg; 27.431±6.499J/kg). Significantly lesser peak flexor moment at 105° of joint flexion (P=.002) existed between the involved (.221±.116Nm/kg) and uninvolved (.40±.234Nm/kg) and matched (.475±.183Nm/kg) legs. Significantly greater strength deficits (P≤.001) existed at peak flexor moment at 105° of joint flexion compared with peak flexor moment over the entire isokinetic joint range of motion for side (53.83%±38.8%; 9.87%±10.77%) and group (77.61%±44.14%; 18.09%±11.73%) differences. Peak flexor moment at 105° of joint flexion was a significant predictor of subjective pain (P=.007), symptoms (P=.006), function (P=.011), and sports (P=.022) outcomes. CONCLUSIONS Knee flexor strength and endurance deficits suggest susceptibility to reinjury, and strength in a deep joint angle predicts subjective outcomes.

An Evidence-Based Practice Approach to the Efficacy of Kinesio Taping for Improving Pain and Quadriceps Performance in Physically-Active Patellofemoral Pain Syndrome Patient

Background: Patellofemoral Pain Syndrome (PFPS) is the most commonly diagnosed musculoskeletal condition in physically active patients. Sports medicine clinicians typically use physical rehabilitation and therapeutic taping techniques to control pain and improve muscular performance in patients with PFPS. Recently, Kinesio Tape (KT) has gained popularity among sports medicine clinicians and athletes for the treatment of various musculoskeletal disorders; however, its efficacy in the treatment of most orthopedic conditions, including PFPS, has not been widely investigated. Objective: The purpose of this review was to critique evidence for the efficacy of KT in improving clinical outcomes in PFPS patients. Methods: English-language publications from 2003 to 2013 were surveyed by searching PubMed, CINAHL, SPORTDiscus, and the Cochrane Library databases using the terms Kinesio tape, Kinesio taping, and knee. Studies focused on generally healthy, physically-active individuals with PFPS who had KT applied at the knee were selected. Pain during activity and/or knee extensor performance was the measures of interest. Results: Conflicting results found in studies of varying methodological quality show that KT application does not differ significantly from McConnell medial glide taping technique with regard to pain reduction or knee extensor performance, and that pain may decrease and knee extensor performance may increase with KT application. Conclusions: The best evidence suggests that KT may be used in place of or in conjunction with traditional therapies to resolve pain and improve performance of the knee extensors. Currently, there is limited high level, high quality evidence available.

Injury/Illness Physician Referral Profile From a Youth University-Sponsored Summer Sport Camp Program

Participation at university-sponsored summer sport camps is popular among youth athletes; however, there is a dearth of information to describe the injuries/illnesses experienced by camp participants. Data from a university-sponsored sport camp program from 2008 to 2011 were accessed retrospectively. The sport camp program had approximately 80 camps for 28 sports over 12 weeks annually. Male and female participants were 10 to 17 years old. Athletic trainers maintained medical documentation and provided medical referrals. Referrals were made for 9.9% (n = 478) of all injuries/illnesses. Emergency department referrals were made for 2.9% of injuries/illnesses. University health services received 42.5% of referrals. There were 1.1 referrals per 100 participants. Boys comprised 60.7% of referrals. Rugby had the highest referral rate—5.0 per 100 participants. These data help increase physician preparedness and guide the delivery of sports medicine services for related sport camp programs as a means to improve quality of care delivered to participants.

The Comparative Effects of Ankle Bracing on Functional Performance

Ankle sprains represent a common musculoskeletal injury that clinicians are tasked with preventing and treating. Because of the prevalence of this injury, ankle braces have been designed to prophylactically protect the joint and reduce the incidence of repetitive sprains. Although an abundance of literature exists focusing on the efficacy of braces in preventing ankle sprains in young, healthy, and physically active populations, there is a scarcity of evidence specific to the impact of these apparatuses on functional performance; therefore, the purpose of this critically appraised topic (CAT) is to investigate the effects of ankle braces on functional performance measures in such individuals. The outcomes of this CAT will assist sport rehabilitation specialists with informed clinical decision making in managing young, healthy, and physically active populations using ankle braces. Do ankle braces hinder functional performance measures when compared with an unbraced condition in a young, healthy, and physically active population? A minimum of level II evidence research studies were surveyed for this CAT. For this CAT, 1 randomized controlled trial and 3 prospective cohort studies were selected. One study found a statistically significant main effect of increased agility run times while participants wore ankle braces. Another study demonstrated a statistically significant decrease in vertical jump height and ankle range of motion while wearing braces. No other statistically significant findings were reported among studies comparing unbraced with braced conditions. Current data indicate that young, healthy, and physically active individuals may experience varied performance effects when executing specific functional performance tasks while wearing ankle braces. In general, bracing does not appear to significantly impair performance on most functional tasks; however, decrements were noted to increases in agility run time and decreases in vertical jump height. Subsequent analysis indicated that a brace may result in decreased ankle plantarflexion, dorsiflexion, eversion, and inversion range of motion, which may underpin noted performance deficits.

Injury and Illness Epidemiology at a Summer Sport-Camp Program, 2008 Through 2011

CONTEXT University-sponsored summer sport camps often employ athletic trainers; however, there is a dearth of epidemiologic studies describing the injury and illness experience of sport-camp participants to guide clinicians. OBJECTIVE To describe the injury and illness experience of youth participants at a university-sponsored summer sport-camp program during a 4-year period. DESIGN Descriptive epidemiology study. SETTING A National Collegiate Athletic Association Division I university that sponsored 76 to 81 camps for 28 sports each summer. PATIENTS OR OTHER PARTICIPANTS A total of 44, 499 camp participants enrolled during the 4 years. Male and female participants ranged in age from 10 to 17 years and in athletic skill from novice to elite. MAIN OUTCOME MEASURE(S) Data from handwritten injury and illness log books, maintained by sports health care personnel, were accessed retrospectively, entered into an electronic spreadsheet, and coded. Data were applied to the National Athletic Injury/Illness Reporting System. Participant-personnel contacts, defined as any instance when a participant sought health care services from personnel, were calculated per 100 participants. Injury and illness rates were calculated per 10 ,000 exposures, measured in participant-days. The distribution of injury and illness conditions and affected body regions were calculated. RESULTS There were 11 ,735 contacts, for an overall rate of 26 per 100 participants, and 4949 injuries and illnesses, for a rate of 1 per 10, 000 participant-days. Participants at single-sex camps were less likely to sustain injuries and illnesses than participants at coeducational camps (rate ratio [RR] = 0.49; 95% confidence interval = 0.45, 0. 35; P < .001, and RR = 0.47; 95% confidence interval = 0.43, 0.51; P < .001, respectively). The lower extremity was injured most frequently (27.9%). Most injury and illness conditions were dermatologic (37.1%). CONCLUSIONS The contact and injury and illness differences observed among sports and between sexes demonstrated potential differences in the sports health care needs of camp participants. These data can be used to make evidence-based clinical decisions, such as determining injury-prevention strategies and sports health care staffing needs.