Mark D. Bracker

The Role of Active Release Manual Therapy for Upper Extremity Overuse Syndromes—A Preliminary Report

The study was carried out to evaluate the efficacy of a specific protocol for treatment of overuse syndromes known as Active Release. This treatment protocol was taught to an athletic trainer who had six months experience before initiating a prospective study. Most of the 28 patients who were in the study had failed previous medical treatment for epicondylitis, tendonitis, and carpal tunnel. These patients refused to be randomized as to routine medical care. Results at one month and three months demonstrated a 71% efficacy rate, which when compared to similar studies in literature was superior. As a result of this study, recommendation of further use of this innovative technique is justified.

Using an experimental bicycle seat to reduce perineal numbness

ABSTRACT BACKGROUND: Perineal numbness and erectile dysfunction are emerging as health concerns among bicyclists. Three studies indicate that between 7% and 21% of male cyclists experience genital area numbness after prolonged riding. OBJECTIVE: To evaluate the effect of an experimental seat design on perineal numbness. DESIGN: Fifteen experienced male cyclists exercised for 1 hour on a stationary spin cycle using either an experimental or standard bicycle seat. Several days later they repeated the trial using the other seat type. Before and after each 1-hour exercise session, perineal sensation was tested using the Weinstein Enhanced Sensory Testing (WEST)-hand esthesiometer. Cyclists were also asked to report their perception of numbness after each exercise bout. RESULTS: Cyclists reported more numbness with the standard seat than with the experimental seat (79% vs 14%; P=0.009). Similarly, sensory testing at all perineal sites yielded greater hypoesthesia with the standard seat than with the experimental seat (P=0.05). This difference was most marked at the dorsal penis (P=0.04). CONCLUSION: The experimental bicycle seat produced significantly less subjective and objective numbness than the standard cycle seat in 1 hour of stationary cycling. Bicycle seat design and innovation may decrease or eliminate perineal numbness.

Decompression Sickness in Sport Scuba Diving.

In brief: Sport scuba diving in inland bodies of water has gained in popularity, and travelers to remote areas can fly home soon after a diving trip. Thus it is not unusual to see a case of decompression sickness in an emergency care facility, regardless of its location. Symptoms of decompression sickness may occur minutes or hours after diving with compressed gas. They include marked fatigue, pruritic mottled skin lesions, pain (joints, back, abdomen), weakness or paralysis of isolated or regional muscle groups, paresthesia, urinary retention, loss of anal sphincter control, dyspnea, coughing, vertigo, and substernal pain. Most patients respond quickly to prompt treatment in hyperbaric chambers, and the symptoms resolve completely.

Effects of a preventive cardiology curriculum on behavioral cardiovascular risk factors and knowledge of medical students

We evaluated a Preventive Cardiology Academic Award (PCAA) program designed to integrate preventive cardiology concepts into the medical school curriculum. Diet, preventive cardiology knowledge, preventive cardiology attitudes, exercise behavior, and body mass index were compared at entrance to medical school and during the graduation year. Complete data were available on 94 students (65 men and 29 women). Similar data from students who graduated in 1987, prior to the introduction of the PCAA curriculum, served as a control. Women showed a significant enhancement in attitude towards cardiovascular disease (CVD) prevention, while both men and women significantly increased their knowledge about CVD prevention. The frequency of planned physical activity decreased significantly in both sexes and men showed a significant increase in body mass index. Men significantly reduced total calories, percent of calories from fat and saturated fat and dietary cholesterol and increased fiber intake. In women, the only significant reduction was in total calories. In comparison to the control class that did not have the program, men receiving the PCAA curriculum reduced dietary cholesterol, dietary fat, saturated fat and monounsaturated fat. Changes in these dietary parameters were nonsignificant for women in comparison to the control class women. Additional analyses showed no systematic secular trends in dietary or other variables in classes entering from 1986 to 1990. We conclude that the PCAA curriculum changes have favorably affected the preventive cardiology knowledge, attitudes and diet of medical students.

Signs, Symptoms, and Management of Jellyfish Envenomation

In brief: Millions of divers, swimmers, and other ocean-goers may encounter jellyfish. If they are stung, they may need either first aid if the case is mild, or extensive treatment if they suffer anaphylaxis, cardiorespiratory problems, or long-term reactions. Some severe cases may even be fatal. The author describes the mechanisms of envenomation and tissue reaction and discusses how to recognize and treat both the immediate and late sequelae.

Musculoskeletal Problems of Children

Rotational problems resulting in gait abnormalities are the most common orthopedic conditions in the pediatric age group. Parents are frequently concerned that their child will grow up deformed or be unable to play sports as they observe in-toeing or out-toeing and seek medical attention. Recent studies, however, have shown athletes with internal tibial torsion are faster than age-matched controls.1 Most rotational abnormalities resolve spontaneously as musculature develops, and knowing this fact is reassuring to parents. Rarely, conditions remain fixed and require surgical correction at an older age. Torsional deformities may be due to problems in the foot (metatarsus adductus), tibia (torsion), or femur and hip (femoral anteversion). Angular abnormalities (bowlegs, knock-knees) generally resolve spontaneously as well. Certain terminology has been recommended as well as specific testing used to evaluate gait (Fig. 20.1).

Failure of dietary zinc supplementation to improve the antibody response to influenza vaccine

Abstract The effect of administering zinc gluconate on the immune response of elderly subjects to influenza vaccine was studied. Sixty health men and women aged 64 to 90 years (mean=74) were randomly assigned to two groups and asked to discontinue all mineral and vitamin supplements for a period of one month. Members of each group were then started on either 50 mg of elemental zinc as zinc gluconate or an identical appearing and tasting placebo in a double blinded manner for one month. Blood samples were then obtained to determine serum zinc and copper levels, and antibody titers to A/Philippines, A/Chile, B/USSR, B/Ann Arbor strains of influenza virus. All individuals were then immunized using trivalent influenza vaccine (Fluogen, Park-Davis), and continued on either zinc or placebo for one month. A second blood sample was then obtained and similarly analyzed. Serum zinc levels increased in both groups, however in the group receiving zinc gluconate supplementation there was a 5.8-fold greater increase than in the control group (p

College Wrestler With Unilateral Gynecomastia

A group of experts met to discuss a case from the University of California, San Diego, School of Medicine. This case conference is part of a series featuring a variety of sports medicine topics.

Chronic Shoulder Pain in a Volleyball Player

In brief A high school girl had pain in her right shoulder when she played volleyball. X-rays revealed the cause: diffuse multiple loose calcifications throughout the synovium of the shoulder. The calcifications were removed arthroscopically, and a partial synovectomy of the shoulder joint was performed. The patients prognosis was considered fair because this disorder can recur; however, it sometimes resolves with no further problems. This disorder-synovial chrondomatosis-is especially rare in young athletes, occurring primarily in middle-aged men, with 60% of cases occurring in the knee.

Cluster Headache Among Athletes

A group of experts met to discuss a case from the University of California, San Diego, School of Medicine. This case conference is part of a series featuring a variety of sports medicine topics.