Monica Rho

Efficacy of lumbosacral transforaminal epidural steroid injections: a systematic review.

To critically review the best available studies evaluating the efficacy of lumbosacral transforaminal epidural steroid injections (TFESIs) in the treatment of radicular pain.

The Efficacy of Lumbar Epidural Steroid Injections: Transforaminal, Interlaminar, and Caudal Approaches

Conservative management of low back pain includes the use of lumbar epidural steroid injections, which have become increasingly more popular in the last 20 years. The body of literature regarding the efficacy of these injections is vast, conflicting, and difficult to summarize. This article reviews the updated evidence for efficacy and the indications for these injections.

Gender Differences on Ultrasound Imaging of Lateral Abdominal Muscle Thickness in Asymptomatic Adults: A Pilot Study

To describe gender and side‐to‐side differences in lateral abdominal wall muscle thickness at rest and during contraction in asymptomatic adults.

Conservative Treatment of Subacute Proximal Hamstring Tendinopathy Using Eccentric Exercises Performed With a Treadmill: A Case Report

STUDY DESIGN Case report. BACKGROUND Proximal hamstring tendinopathy in runners is characterized by pain with passive hip flexion with the knee extended, active hip extension, and pain with sitting. Relatively little literature exists on the condition, and publications on nonsurgical treatment protocols are even more scarce. Surgical intervention, which comprises the majority of literature for treatment of this condition, is an option for cases that fail to respond to nonsurgical treatment. CASE DESCRIPTION The patient was a 34-year-old, otherwise healthy male triathlete with unilateral proximal hamstring tendinopathy diagnosed by ultrasound, who had pain only with running and prolonged sitting. After he failed to respond to 4 weeks of eccentric knee flexion and lumbopelvic musculature strengthening exercises, an eccentric hip extensor strengthening program using a treadmill was initiated. This treadmill exercise was performed on a daily basis, in addition to a lumbopelvic musculature strengthening program. OUTCOMES The patient noted a decrease in pain within 2 weeks of initiating the new exercise, and was able to return to gradual running after 4 weeks and to speed training after 12 weeks. He returned to competition shortly thereafter and had no recurrence for 12 months after the initiation of therapy. His score on the Victorian Institute of Sport Assessment-proximal hamstring tendons improved from 23 on initial presentation to 83 at 12 weeks after the initiation of therapy. DISCUSSION We described the management of a triathlete with subacute proximal hamstring tendinopathy, who responded well to nonsurgical treatment using eccentric hip extension strengthening using a treadmill. LEVEL OF EVIDENCE Therapy, level 4.

Hamstring Injuries in the Athlete: Diagnosis, Treatment, and Return to Play.

Hamstring injuries are very common in athletes. Acute hamstring strains can occur with high-speed running or with excessive hamstring lengthening. Athletes with proximal hamstring tendinopathy often do not report a specific inciting event; instead, they develop the pathology from chronic overuse. A thorough history and physical examination is important to determine the appropriate diagnosis and rule out other causes of posterior thigh pain. Conservative management of hamstring strains involves a rehabilitation protocol that gradually increases intensity and range of motion, and progresses to sport-specific and neuromuscular control exercises. Eccentric strengthening exercises are used for management of proximal hamstring tendinopathy. Studies investigating corticosteroid and platelet-rich plasma injections have mixed results. Magnetic resonance imaging and ultrasound are effective for identification of hamstring strains and tendinopathy but have not demonstrated correlation with return to play. The article focuses on diagnosis, treatment, and return-to-play considerations for acute hamstring strains and proximal hamstring tendinopathy in the athlete.

Is Hip Abduction Strength Asymmetry Present in Female Runners in the Early Stages of Patellofemoral Pain Syndrome

Background: The current literature indicates that hip abduction weakness in female patients is associated with ipsilateral patellofemoral pain syndrome (PFPS) as part of the weaker hip abductor complex. Thus, it has been suggested that clinicians should consider screening female athletes for hip strength asymmetry to identify those at risk of developing PFPS to prevent the condition. However, no study to date has demonstrated that hip strength asymmetry exists in the early stages of PFPS. Purpose: To determine whether hip abduction strength asymmetry exists in female runners with early unilateral PFPS, defined as symptoms of PFPS not significant enough to cause patients to seek medical attention or prevent them from running at least 10 miles per week. Study Design: Controlled laboratory study. Methods: This study consisted of 21 female runners (mean age, 30.5 years; range, 18-45 years) with early unilateral PFPS, who had not yet sought medical care and who were able to run at least 10 miles per week, and 36 healthy controls comparably balanced for age, height, weight, and weekly running mileage (mean, 18.5 mi/wk). Study volunteers were recruited using flyers and from various local running events in the metropolitan area. Bilateral hip abduction strength in both a neutral and extended hip position was measured using a handheld dynamometer in each participant by an examiner blinded to group assignment. Results: Patients with early unilateral PFPS demonstrated no significant side-to-side difference in hip abduction strength, according to the Hip Strength Asymmetry Index, in both a neutral (mean, 83.5 ± 10.2; P = .2272) and extended hip position (mean, 96.3 ± 21.9; P = .6671) compared with controls (mean, 87.0 ± 8.3 [P = .2272] and 96.6 ± 16.2 [P = .6671], respectively). Hip abduction strength of the affected limb in patients with early unilateral PFPS (mean, 9.9 ± 2.2; P = .0305) was significantly stronger than that of the weaker limb of control participants (mean, 8.9 ± 1.4; P = .0305) when testing strength in a neutral hip position; however, no significant difference was found when testing the hip in an extended position (mean, 7.0 ± 1.4 [P = .1406] and 6.6 ± 1.5 [P =.1406], respectively). Conclusion: The study data show that early stages of unilateral PFPS in female runners is not associated with hip abduction strength asymmetry and that hip abduction strength tested in neutral is significantly greater in the affected limb in the early stages of PFPS compared with the unaffected limb. However, when tested in extension, no difference exists. Further studies investigating the early stages of PFPS are warranted. Clinical Relevance: Unlike patients with PFPS seeking medical care, early PFPS does not appear to be significantly associated with hip abduction strength asymmetry.

Resident Accuracy of Electromyography Needle Electrode Placement Using Ultrasound Verification.

Electromyography (EMG) and musculoskeletal (MSK) ultrasound (US) are core learning objectives during physical medicine and rehabilitation (PM&R) training. However, there have been no prior studies using MSK US to assess the acquisition of EMG procedural skills during residency training. This study aims to demonstrate the differences in skillful needle placement between junior and senior physiatry residents. The integration of both EMG and MSK US may have tremendous potential for additional learning opportunities related to electrodiagnostic education.

Performance trends in large 10-km road running races in the United States.

Abstract Cushman, DM, Markert, M, and Rho, M. Performance trends in large 10-km road running races in the United States. J Strength Cond Res 28(4): 892–901, 2014—Our study examines the current trends of runners participating in 10-km road races in the United States. Finish times and ages of all runners participating in 10 of the largest 10-km running races in the United States between 2002–2005 and 2011 were recorded. Linear regression analysis was performed to examine the trends for age, sex, and finishing time for all participants completing the course in <1 hour. A total of 408,296 runners were analyzed. There was a significant annual decrease in the ratio of men to women finishers (p < 0.001, r2 = 0.976). The average finishing time of the top 10 (men, p ⩽ 0.05), 100 (men and women, p ⩽ 0.05), and 1,000 (men and women, p < 0.01) significantly decreased annually. The total number of subhour finishers increased annually across all races (194 men per year, r2 = 0.584, p = 0.045; 161 women per year, r2 = 0.779, p = 0.008), whereas the percentage of overall finishers completing the course in less than an hour significantly declined for men and women (p ⩽ 0.003). There was a significant trend toward younger men in all top groups except for the single fastest runner (p ⩽ 0.017). Our study demonstrates that for large 10-km U.S. races: the top men and women seem to be getting faster; there are more subhour finishers, with increasingly more women accomplishing this feat compared with men; an increasingly lower percentage of overall finishers is finishing in <1 hour; and the fastest men are also increasingly younger.

Scoping review to develop common data elements for lumbar spinal stenosis

BACKGROUND CONTEXT Common data elements (CDE) represent an important tool for understanding and classifying health outcomes across settings. Although CDEs have been developed for a number of disorders, to date CDEs for lumbar spinal stenosis (LSS) have not been fully developed. To facilitate the identification of CDEs and measures to assess them, this technical study leverages the International Classification of Functioning, Disability and Health (ICF), peer-reviewed research, and a panel of experts to identify CDEs specific to LSS. PURPOSE The study aimed to define CDEs for disease characteristics and outcomes of LSS using the World Health Organizations ICF taxonomy, and to facilitate the selection of assessment instruments for research and clinical care. DESIGN This is a scoping review using a modified Delphi approach with a technical expert panel composed of clinicians and scientists representing the academia, policy and advocacy stakeholders, and professional associations with expertise in LSS. METHODS This is a scoping review to identify measures that assess LSS symptoms. Thirty-one subject matter experts (SMEs) prioritized ICF codes and evaluated instruments measuring specific domains. We used a modified Delphi technique to evaluate item-level content and achieve consensus. RESULTS SMEs prioritized 53 ICF codes; 3 received 100% endorsement, 27 received ≥90% endorsement, whereas the remaining 23 received ≥80% endorsement. Prioritized ICF codes represent diverse domains, including pain, activities and participation, and emotional well-being. The review yielded 58 instruments; we retained 24 for content analysis. CONCLUSIONS The retained instruments adequately represent the ICFs activities and participation, and body function domains. Body structure and environmental factors were assessed infrequently. Adoption of these CDEs may guide clinical decision making and facilitate comparative effectiveness trials for interventions focused on LSS.

Anxiety and Insomnia in Young and Middle-Aged Adult Hip Pain Patients With and Without Femoroacetabular Impingement and Developmental Hip Dysplasia

In young and middle‐aged adults with and without hip deformity, hip pain receives treatment focused primarily related to hip structure. Because this hip pain may be chronic, these patients develop other coexisting, modifiable disorders related to pain that may go undiagnosed in this young and active population, including insomnia and anxiety.