Venu Akuthota

Yoga and pilates in the management of low back pain

Many interventions for the management of low back pain exist, however most have modest efficacy at best, and there are few with clearly demonstrated benefits once pain becomes chronic. Therapeutic exercise, on the other hand, does appear to have significant benefits for managing patients with chronic low back pain (CLBP) in terms of decreasing pain and improving function. In addition, because chronic pain is complex and does not fit a simple model, there have also been numerous trials investigating and demonstrating the efficacy of multidisciplinary pain programs for CLBP. It follows that interventions that treat more than one aspect of LBP would have significant benefits for this patient population. Yoga and Pilates which have, both been gaining in popularity over the last decade are two mind–body exercise interventions that address both the physical and mental aspects of pain with core strengthening, flexibility, and relaxation. There has been a slow evolution of these nontraditional exercise regimens into treatment paradigms for LBP, although few studies examining their effects have been published. The following article will focus on the scientific and theoretical basis of using yoga and Pilates in the management of CLBP.

The Diagnostic Validity of Hip Provocation Maneuvers to Detect Intra-Articular Hip Pathology

To determine which hip provocation maneuvers best predict the presence of an intra‐articular hip pathology.

Utilization characteristics of spinal interventions

BACKGROUND CONTEXT Several investigators have identified an explosive increase in spinal injection rates in the Veterans Administration and Medicare populations. Furthermore, utilization of spinal injection procedures appears to vary by geographic location, subspecialty, and practice setting. Medicare claims analysis has shown that a small percentage of physicians perform a disproportionately large number of injections. Although Medicare utilization has been well characterized, the utilization patterns for privately insured individuals are not clearly known. PURPOSE The primary purpose of this article was to investigate whether relatively few providers are responsible for a disproportionately high percentage of interventional spine procedures in privately insured plans and to quantify any such findings. The secondary purpose was to determine if provider specialty is a relevant variable in any identified patterns of disproportionate utilization. STUDY DESIGN A descriptive analysis of utilization patterns using the Medstat MarketScan database was conducted between 2003 and 2007. The database contains deidentified medical, pharmacy, and enrollment claims representing 12 to 14 million individuals. PATIENT SAMPLE A data set was generated based on the following inclusion criteria: all patients aged between 18 and 99 years receiving at least one spinal interventional procedure between 2003 and 2007: epidural steroid injections, intra-articular facet or medial branch blocks, medial branch radio frequency neurotomy, sacroiliac joint injections, and discography. Our inclusion criteria yielded data on nearly 200,000 patients treated by over 20,000 providers. OUTCOME MEASURES Not applicable. METHODS The number of procedures was tallied for a 12-month period beginning with a patients first procedure claim. The total number of procedures per patient and the mean number of procedures per patient were calculated for the study sample. Within each specialty, all spinal procedures were summed for each individual provider within each procedure category and as an overall total. The overall mean number of therapeutic procedures per patient for all physicians within a specialty was calculated. Within each specialty, the total number of procedures performed by each physician was analyzed in percentiles to highlight any disparity between high- and low-using providers. RESULTS The final therapeutic procedure data set contained 196,332 patients who received 875,627 procedures. The principal nine specialties performing these procedures were anesthesiology (49.2% of the total number of procedures in the final data set), physiatry (12.5%), pain management (12.0%), family practice (10.2%), orthopedics (5.5%), radiology (3.0%), neurology (2.8%), internal medicine (2.8%), and neurosurgery (1.9%). The overall mean number of procedures across all categories performed per patient during the 12-month inclusion period was 4.46±6.44. Neurologists and pain management specialists were the only provider groups in which the mean number of procedures per patient exceeded the overall mean. The highest 10% of providers, which encompasses those providers performing a mean greater than or equal to 5.08 procedures per patient per year, perform 36.6% of the total spinal procedures performed. The highest 20% of providers, which encompasses those providers with a mean greater than or equal to 3.75, account for 57.6% of all spinal procedures. The highest 10% of providers perform nine times more procedures per patient compared with the lowest 10% and 4.5 times more procedures than the median. This same pattern of high utilization by disproportionately few providers was observed across all nine specialties. CONCLUSIONS These findings demonstrate that relatively few providers are responsible for a disproportionately high percentage of interventional spine procedures. This pattern of marked overutilization by a minority of providers is the dominant characteristic of utilization within all specialties.

Pathogenesis of lumbar spinal stenosis pain: why does an asymptomatic stenotic patient flare?

This article discusses the pathogenesis of lumbar spinal stenosis pain and presents a theory on why asymptomatic stenotic patients flare.

The Effects of Epidural Betamethasone on Blood Glucose in Patients with Diabetes Mellitus

To determine the effects of lumbosacral transforaminal and caudal epidural betamethasone injections on blood glucose levels in diabetic subjects. The hypothesis is that epidural steroid injections result in transient elevation of blood glucose levels in diabetic subjects.

Evidence-informed management of chronic low back pain with adjunctive analgesics.

The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.

Nerve and vascular injuries in sports medicine

Nerve and vascular injuries in sports medicine / , Nerve and vascular injuries in sports medicine / , کتابخانه دیجیتال جندی شاپور اهواز

Physical Medicine and Rehabilitation Resident Use of iPad Mini Mobile Devices.

Previous research on the use of tablet devices in residency programs has been undertaken in radiology and medicine or with standard‐sized tablet devices. With new, smaller tablet devices, there is an opportunity to assess their effect on resident behavior. This prospective study attempts to evaluate resident behavior after receiving a smaller tablet device.

The use of epidural corticosteroids for cervical radiculopathy: an interlaminar versus transforaminal approach.

A 43-year-old right-handed man presents with left shoulder pain and left arm pain and numbness. His symptoms began 6 weeks previously while weightlifting, performing repetitive shoulder abductions with a 10-pound dumbbell in each hand. He noticed a sudden cramp in his neck and left shoulder and immediately stopped his workout. While driving home from the gym, he noticed a temporary jolting pain into his left arm to the hand and fingers. He awoke the following morning with sharply increased pain. His primary care physician initially prescribed ibuprofen, cyclobenzaprine, and hydrocodone, and later gabapentin. Ibuprofen was helpful, and each of the remaining medications ameliorated a portion of his pain but caused either somnolence or vertigo. Within the first week, the patient developed numbness in left hand and thumb whereas the overall severity of his pain decreased. Cervical magnetic resonance imaging (MRI) was ordered, and physical therapy prescribed including 12 sessions of traction, mobilization, and stretching, resulting in temporary improvement only. He attempted a few home exercises but was limited by increased pain while performing sit-ups and weakness of his left arm while performing push-ups and pull-ups. He denied problems with walking or balance and had no changes in his bladder or bowel function except for some constipation associated with use of hydrocodone. The patient works for the phone company, installing and repairing phone lines. The job involves phone line work from a bucket as well as ground work for building installations. Aside from his tools, there is no heavy lifting. During installations, he is required to maintain awkward neck and arm positions that significantly aggravate his arm pain and numbness more than neck pain. He has missed 4 of the last 6 weeks of work and has exhausted his paid sick leave and is concerned about losing his job. He is cooperative and pleasant during the examination. He has a positive Spurling maneuver to the left, a diminished left brachioradialis tendon reflex, subtle weakness of the left biceps, and reduced pin-prick sensation in the left lateral hand and thumb. The remainder of the neurologic examination is normal. His MRI taken 2 weeks previously demonstrates a left paracentral disc herniation at C5–C6 (Figs. 1 and 2). While the physician discusses these findings with the patient, the patient states that he is “willing to have surgery or do whatever it takes to get better quickly.” Guest Discussants:

Why Disability and Rehabilitation Specialists Should Lead the Way in Patient-Reported Outcomes

From the Department of Rehabilitation Medicine and the Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, WA; Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, CO; University of Washington Center on Outcomes Research in Rehabilitation, Seattle, WA; and Seattle Quality of Life Group, University of Washington, Seattle, WA.