Isometric Contractions for In-Season Treatment of Patellar Tendinopathy

image2

Guest blogger Dr. Napolitano grinding it out on the water.

One of the great features of modern medical journals like CJSM is the ability to publish studies ahead of print – we call it “Published Online First.”

With the flexibility  allowed by the internet and emerging media, we are able to get studies that have gone through peer review and are in the queue for printing out to the reading public months before they otherwise would see the light of day.

We have one of our “Published Online First” studies burning things up on emerging media.  At CJSM we follow the Altmetrics on the studies in our pages, and this new one — Isometric Contractions Are More Analgesic Than Isotonic Contractions for Patellar Tendon Pain: An In-Season Randomized Clinical Trial — currently has a very hot rating of 107 (and climbing).

The treatment of such a common condition will be of inherent interest to those who practice sports medicine. Moreover, managing this nagging condition in mid-season can prove to be a Sisyphean task for the athlete and clinician.  This study has great promise to make a significant impact on your care of the athletes you see.

I asked the physician fellow working with me at NCH sports medicine, Jonathan Napolitano, MD, to do a guest post on this study authored by Rio et al.  Dr. Napolitano’s commentary, forthwith:

________________________________________________________

Basketball season is upon us and our clinics have begun to fill with athletes ailing from patellar tendinopathy, seeking pain relief and a quick return to the hardwood.  As a sports medicine fellow with a residency background in physical medicine and rehabilitation I have used this time to step back and review the therapeutic exercises we prescribe for tendinopathies.  I have always paired the concept of eccentric strengthening with tendon repair.  However, various other types of muscle contraction and strengthening exercises can (and perhaps should be) prescribed as well.

image3

In between isotonic beer curls at World Series 2017 game (L – R): Drs. Stephen Cuff, Reno Ravindran, Jonathan Napolitano

As an educational exercise I would like to take a moment to review the types of muscle contractions.  Isometric contraction occurs without any movement of the joint on which the muscle acts.  Isokinetic contraction occurs at a constant speed across a joint range of motion with variable resistance.  Finally, isotonic exercises are performed through normal joint range of motion with a consistent resistance at variable speed.  Isotonic contractions are further divided into concentric (muscle shortening) and eccentric (muscle lengthening).

Tendon pain is a factor that limits participation and performance in athletes.  Eccentric strengthening has shown good clinical outcomes in the long-term; however, this intervention can lead to increased pain in the short-term, and in 2005 Visnes et al showed eccentric strengthening to be of no benefit for in-season athletes.

Recent research by Dr. Rio et al [including senior author Dr. Jill Cook] compared rehabilitation programs for in-season athletes with patellar tendon pain.  Read more of this post

A Twitter Journal Club

casemI want to alert you to a very interesting innovation which was instituted at the end of 2016 and will continue into this new year:  the Canadian Academy of Sport and Exercise Medicine (CASEM) Twitter-based journal club.

You read that right — a journal club, on Twitter.

We’re all familiar with journal clubs.  In fact, the fellowship in which I teach (Nationwide Children’s Hospital Sports Medicine) just completed its monthly journal club yesterday, with the fellow (sports medicine physician in training, Jonathan Napolitano) leading the group of doctors through a study published in our January 2017 CJSM: Reliability Testing of the Balance Error Scoring System in Children Between the Ages of 5 and 14.

I recently wrote of the vital, and increasing, importance social media plays in the dissemination of sports medicine research.  A Twitter journal club is an example of that phenomenon.

The CASEM Journal Club just got off the ground at the end of 2016, and had as its first selection another CJSM study: Physical Exam Risk Factors for Lower Extremity Injuries in High School Athletes:  A Systematic Review. Seems like both CASEM and I found this to be particularly intriguing.  To wit, I cajoled the lead author of that study, Jimmy Onate, into recording a podcast with me.  And then he pulled duty on the CASEM Journal Club as the guest author, interacting on Twitter with folks from around the globe.  What a great opportunity — to get to ask the author directly the questions one has after reading his/her study.

The study for this month’s CASEM journal club is the same one we deconstructed in our fellowship yesterday:  the reliability of the BESS in a pediatric population  It hits close to my heart.   Read more of this post

Head guards in boxing — the podcast

mike-loosmore

Dr. Mike Loosemore, lead author of new CJSM boxing study

We open 2017 with a new podcast on the new (non)-intervention in Olympic-style boxing:  head guards, or the lack thereof.

Our guest is Dr. Mike Loosemore MBBS MSc PhD FFSEM(UK), a consultant in sport and exercise medicine at the Institute of Sport, Exercise and Health, University College London.  Dr. Loosemore is currently the doctor to the British Olympic Boxing team, and a well known figure in the boxing medicine world.

He is, as well, the lead author of a highlighted study in our January 2017 issue: The Use of Head Guards in AIBA Boxing Tournaments — A Cross-Sectional Observational Study.  The team of researchers included Julian Bailes, whose name will be familiar to most people who study and treat sport-related concussions [or familiar to those who watched the movie Concussion in 2016].

Rio 2016 was the first Olympic competition since the 1984 games in Los Angeles where male boxers did not wear head guards , a rules change which generated a lot of controversy. Research like Dr. Loosemore’s was instrumental in making the determination to stop 52 years of practice.jsm-podcast-bg-1

Just before Christmas, we chatted with Dr. Loosemore, and he shared what he and his team found in their study and the back story behind the use, and now discontinuation, of headguards in Olympic-style boxing.

Be sure to listen to the podcast here and read the study (free access currently) here…..and, as ever, let us know what you think, or give Dr. Loosemore a shout out on Twitter @doctorloosemore

 

Echocardiography as a screen to prevent SCD in athletes — 5 Questions with CJSM

 

cbs1

Dr. Gian Corrado performing screening cardiac ultrasound

For our first “5 Questions with CJSM” of 2017, we have a special guest:  Dr. Gianmichel Corrado, of Boston Children’s Hospital and Northeastern University.

Dr. Gian Corrado  is a doubly special guest for me: he is the lead author of a ‘published-ahead-of-print’ CJSM study and is someone who trained me in sports medicine at Boston Children’s Hospital.

I have fond memories of working alongside him, the head team physician for Northeastern University in Boston, as we cared for hockey and football athletes.  And I remember the work he was just beginning to do in his now-blossoming area of research.

The new study reports the findings of a novel ‘take’ on a controversial aspect of sports medicine: how might we screen for underlying disorders that predispose our athletes to sudden cardiac death (SCD)?

By the way, don’t let Dr. Gian Corrado’s name fool you — this is not that Dr. Corrado, (Domenico Corrado), who also has published on screening for SCD; but both Drs. Corrado share a similar concern: the primary prevention of this catastrophic event.

Dr. Gian Corrado’s approach is to use ‘screening echocardiography in front-line providers,’ and his findings can be found here:  ‘Early Screening for Cardiovascular Abnormalities with Pre-Participation Echocardiography:  Feasibility Study.’

Dr. Corrado has this to say about his important work:

_____________________________________________________________________

1. CJSM: What was the principal outcome measure you were looking at in this study? What were the secondary outcome measures?

GC: Central in the debate as to how to best identify athletes at risk for sudden death (SD) is cost-effectiveness.  The American Heart Association continues to recommend a history and physical (H&P) as the sole method for screening young athletes for the cardiac conditions that can cause SD.  The H&P has been shown to be a poor test to apply to the above dilemma as it misses athletes whom have potentially deadly cardiac conditions and falsely identifies those that do not.  Many feel that, given this reality, an electrocardiogram (ECG) screening program should be implemented.  This approach has been shown to have significant limitations as it too yields high false positive rates.  The Northeastern Group has suggested and demonstrated that with advances in portable ultrasound frontline providers (FLP) can obtain limited echocardiographic images pertinent to the structural conditions that dominate in culpability with SD. Read more of this post

%d bloggers like this: