Patrick S. Pabian

The Influence of Education and Exercise on Neck Pain

Neck pain is a significant contributor to worldwide disability and poses a considerable financial burden to its stakeholders. The prognosis for chronic neck pain is generally poor, and the associated disability seems to be more persistent than low back pain. It has been suggested that the goals of a rehabilitation program are to maximize return to function, limit progression of degenerative changes, and prevent further injury. The variety of treatment options can make it difficult for clinicians to agree on the most effective treatment intervention. This article reviews noninvasive treatment considerations for patients with neck pain. Exercise-based interventions, including aerobic conditioning, stretching, and strengthening, are addressed. Moreover, concepts related to education are covered, including the effects of posture and ergonomic counseling.

Factors contributing to rehabilitation outcomes following hip arthroplasty

Abstract Background: Hip arthroplasty (HA) is a common surgical procedure with estimated 230 000 procedures performed in the USA in 2008. Projections indicate that the number of procedures will increase to 572 000 by 2030, thus it is important for rehabilitation professionals involved in the care of these individuals to recognize factors that may influence outcomes a priori. Objectives: The objective of this manuscript is to review variables that influence patient outcomes following HA. All relevant literature will be reviewed for interpretation by the healthcare provider to design optimal plans of care and for determining an accurate patient prognosis. Major findings: Evidence suggests that age, gender, body mass index, depression, and smoking status may influence outcomes. Additionally, pre-operative functional ability, type of pain medication, and the use of a clinical pathway appear to influence post-operative outcomes. Further research is needed to determine the effect of specific interventions commonly employed in the rehabilitation setting. Conclusions: Evidence suggests that no one factor may determine an individual’s prognosis following HA. Rather, an individual’s ability to achieve outcomes must be viewed from a multifactorial perspective that takes into account both intrinsic and extrinsic variables.

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.

Sport Concussion: Implications for the Strength and Conditioning Professional

ABSTRACT THE TOPIC OF SPORT CONCUSSION IS ONE OF THE MOST DISCUSSED ISSUES IN SPORTS MEDICINE OVER THE PAST FEW YEARS. ALL HEALTH CARE, MEDICAL, AND STRENGTH AND CONDITIONING PROFESSIONALS SHOULD HAVE A SOUND WORKING KNOWLEDGE OF THE DEVELOPMENTS ON THE TOPICS OF SPORTS CONCUSSION BECAUSE IT IS LIKELY THAT ALL PRACTITIONERS MAY ENCOUNTER ATHLETES, BOTH COMPETITIVE AND RECREATIONAL, WITH SYMPTOMS OF CONCUSSION.

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.

Interprofessional management of concussion in sport

Due to the high incidence of sports concussion, various health and medical providers are likely to encounter athletes who have sustained such an injury. Management of concussion necessitates coordinated care by the members of the sports medicine team due to its pathophysiology and complexity of management during recovery. All members of the sports medicine team must possess contemporary knowledge of concussion management as well as strong interprofessional communication skills to ensure effective care and safe return to sports participation. Therefore, the aim of this manuscript is to review the current best practices in interdisciplinary management of sports concussion with a special emphasis on the required interprofessional communication among the sports medicine team.

Endurance Times of the Thoracolumbar Musculature: Reference Values for Female Recreational Resistance Training Participants.

Abstract Hanney, WJ, Kolber, MJ, Pabian, PS, Cheatham, SW, Schoenfeld, BJ, and Salamh, PA. Endurance times of the thoracolumbar musculature: Reference values for female recreational resistance training participants. J Strength Cond Res 30(2): 588–594, 2016—The assessment of thoracolumbar muscle endurance (TLME) is common among strength and conditioning professionals and clinicians desiring to quantify baseline muscle performance and determine injury risk. Reference values for such assessments are documented in the literature; however, their utility may be of limited value due to heterogeneous participant selection and limited demographic reporting. Moreover, active cohorts who engage in resistance training (RT) may reach a ceiling effect on existing reference values when testing routinely trained muscles. Thus, the purpose of this study was to establish reference values for standardized TLME tests among women who participate in recreational RT and to determine whether imbalances or asymmetries exist. Participants included 61 women aged 18–59 years who engaged in RT for at least 1 year. Flexor, extensor, and lateral flexor TLME was isometrically assessed using standardized procedures with documented reproducibility (r ≥ 0.93). Results identified significant differences (p < 0.001) between mean TLME times of flexors (163 ± 106 seconds) and extensors (105 ± 57 seconds). Left (66 ± 38 seconds) and right side bridges (61 ± 33 seconds) were comparable (p = 0.06). Flexor to extensor imbalances were more pronounced among RT participants when compared with previously reported general population reference values, suggesting a training effect or bias. Moreover, similar imbalances favoring the flexors are a documented risk factor for low back pain. Thus, training considerations inclusive of the extensors may benefit women who engage in RT as a means of mitigating risk. Individuals evaluating muscle performance should consider reference values that represent the population of interest.

Aquatic Exercise for Treatment of Low-Back Pain: A Systematic Review of Randomized Controlled Trials

Low-back pain (LBP) is a medical condition that affects most people at some point in their lives. Exercise therapy has been found to be efficacious in treating LBP in some individuals; however, it is unclear which form of exercise demonstrates superior outcomes. It has been postulated that exercise combined with the unique properties of water may demonstrate favorable outcomes. Moreover, studies have evaluated the effectiveness of aquatic therapy as an intervention for patients with LBP. This review aims to explore the efficacy of aquatic therapy as an intervention for LBP. The findings from this review suggest that aquatic therapy is superior to no treatment; however, it did not always prove more effective when compared with other forms of conservative treatment. Whereas the outcome of this review supports aquatic therapy as an effective treatment for LBP, further research is needed to determine if it is superior to other interventions.

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 immediate effects of manual stretching and cervicothoracic junction manipulation on cervical range of motion and upper trapezius pressure pain thresholds

INTRODUCTION Myofascial pain is a common impairment treated with various manual interventions including spinal thrust manipulation and stretching; however, the comparative efficacy of each intervention is uncertain. Therefore, the purpose of this investigation was to evaluate thrust manipulation targeting the cervicothoracic junction compared to a manual stretch of the upper trapezius muscle on cervical range of motion and upper trapezius pressure pain thresholds (PPTs). METHODS Healthy participants with no significant history of neck pain were randomized into a thrust manipulation group, a stretching group, or a control group. Within group differences were evaluated via a dependent t-test, and group by time interactions were evaluated by a two-way repeated measures ANOVA. RESULTS One hundred and two participants were recruited to participate. Baseline demographics revealed no significant differences between groups. Significant group by time interactions were found for changes in PPTs for both the right and left upper trapezius. Also, significant differences were found for changes in cervical extension, as well as right and left cervical side bending favoring the treatment groups. DISCUSSION This study demonstrates the potential independent effectiveness of spinal thrust manipulation or stretching for reducing PPTs at the upper trapezius. Future research should further evaluate the limitation of PPTs as a measure of muscle sensitivity as well as factors that may contribute to variability in the measurements among individuals seeking care.