Neck Pain: Revision 2017.

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to neck pain. J Orthop Sports Phys Ther. 2017;47(7):A1-A83. doi:10.2519/jospt.2017.0302.

The effects of myofascial release with foam rolling on performance.

In the last decade, self-myofascial release has become an increasingly common modality to supplement traditional methods of massage, so a masseuse is not necessary. However, there are limited clinical data demonstrating the efficacy or mechanism of this treatment on athletic performance. The purpose of this study was to determine whether the use of myofascial rollers before athletic tests can enhance performance. Twenty-six (13 men and 13 women) healthy college-aged individuals (21.56 ± 2.04 years, 23.97 ± 3.98 body mass index, 20.57 ± 12.21 percent body fat) were recruited. The study design was a randomized crossover design in which subject performed a series of planking exercises or foam rolling exercises and then performed a series of athletic performance tests (vertical jump height and power, isometric force, and agility). Fatigue, soreness, and exertion were also measured. A 2 × 2 (trial × gender) analysis of variance with repeated measures and appropriate post hoc was used to analyze the data. There were no significant differences between foam rolling and planking for all 4 of the athletic tests. However, there was a significant difference between genders on all the athletic tests (p ≤ 0.001). As expected, there were significant increases from pre to post exercise during both trials for fatigue, soreness, and exertion (p ≤ 0.01). Postexercise fatigue after foam rolling was significantly less than after the subjects performed planking (p ≤ 0.05). The reduced feeling of fatigue may allow participants to extend acute workout time and volume, which can lead to chronic performance enhancements. However, foam rolling had no effect on performance.

Intra-articular anesthesia and knee muscle response.

BACKGROUND: Many receptors located within the intra-articular knee structures contribute to the neuromuscular responses of the knee. The purpose was to compare the automatic postural response induced by a perturbation at the foot before and after an intra-articular injection of a local anesthetic (bupivicaine), after a saline (sham) injection, and after no intra-articular injection (control) in the knee. METHODS: Muscle onset latencies and automatic response magnitudes for the vastus medialis, vastus lateralis, biceps femoris, medial hamstrings, tibialis anterior, and gastrocnemius were measured using electromyography (EMG) when anteriorly directed perturbations were applied to the feet of 30 subjects. All subjects then received a lidocaine skin injection followed by: an intra-articular bupivicaine injection (treatment group); an intra-articular saline injection (sham group); or no injection (control group), depending on their randomized group assignment. The perturbation tests were then repeated. FINDINGS: Muscle onset latencies and automatic response magnitudes did not change as a result of the intra-articular injections. Latencies were significantly greater for the vastus medialis and vastus lateralis when compared to the medial hamstrings, biceps femoris and tibialis anterior (P<0.001). Automatic response magnitudes for the tibialis anterior were significantly greater than those of the hamstrings, which were greater than those of the quadriceps (P<0.001). INTERPRETATION: There were no differences in muscle response when anteriorly directed perturbations were applied to the foot with or without an injection of local anesthetic in the knee. Intra-articular receptors were either unaffected by the anesthetic or the extra-articular receptors or receptors of the other joints were able to compensate for their loss.

Flexible foil exercise and shoulder internal and external rotation strength.

CONTEXT: The efficacy of exercise using a flexible foil to increase strength in the shoulder rotator muscles is unknown. OBJECTIVE: To compare the effects of exercises using a flexible foil (Bodyblade) with exercises using elastic bands on shoulder internal and external rotator muscle strength. DESIGN: We used a randomized, controlled pretest-posttest design. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Forty young adults with no previous shoulder injury. INTERVENTION(S): Experimental subjects participated in an 8-week program of internal and external rotation exercises consisting of 3 sessions per week. MAIN OUTCOME MEASURE(S): Strength was tested by internal and external rotation isometric and isokinetic strength tests at 60 degrees .s (-1) and 120 degrees .s (-1). RESULTS: The group exercising with elastic bands had a greater pretest-posttest increase in maximal internal rotation isometric torque at 10 degrees of internal rotation and greater maximal external rotation isometric torque at 65 degrees of external rotation than the control group. The group using a flexible foil did not show an increase in strength significantly different from either the control or elastic band groups. We found no other statistically significant differences. CONCLUSIONS: Our results do not support the use of a flexible foil for strength gains in shoulder internal and external rotation in the asymptomatic young adult population.

Reaction times and electromechanical delay in reactions of increasing and decreasing force.

The purpose of this study was to compare reaction times and electromechanical delay between reactions to increase force from rest and reactions to decrease force from an active state in the quadriceps femoris of healthy young adults. Force, position, and electromyographic data were recorded from 35 subjects reacting to a forced knee-flexion perturbation. Electromechanical delay was assessed through cross-correlation of the filtered EMG and force data. Reaction time to increase force (M= 159.9 msec., 95% CI= 149.9-169.9 msec.) was significantly longer than RT to decrease force (M= 124.4 msec., 95% CI= 118.7-130.1 msec.). This difference was partially caused by a difference in electromechanical delay (RT to increase force electromechanical delay was 63 msec., 95% CI=60-67 msec., greater than the RT to decrease force electromechanical delay of 49 msec., 95% CI=46-52 msec.). This difference in reaction time could be important in identifying and interpreting physiologically meaningful changes in muscle force and in intermuscular coordination during movement.

Effectiveness of two Arthritis Foundation programs: Walk With Ease, and YOU Can Break the Pain Cycle.

OBJECTIVE: To evaluate the effectiveness of two Arthritis Foundation programs: Walk With Ease (WWE) and YOU Can Break The Pain Cycle (PC). DESIGN: Quasi-experimental, repeated measures design. Retested at six weeks and four months. SETTING: Community based intervention. PARTICIPANTS: Volunteer sample of 163 adults with arthritis recruited through mailings, newspapers, and flyers. INTERVENTIONS: Subjects participated in a 90 minute seminar (PC, Group A), a six-week walking program (WWE, Group B), or both programs (Group C). MAIN OUTCOME MEASURES: Survey assessment of arthritis knowledge, general health, self-management activities, confidence, physical abilities, depression, health distress, and how arthritis affects their life. A Squat Test, a Six Minute Walk test, and a Timed Functional Walk Test were also administered. RESULTS: Subjects in Group B were more confident, less depressed, had less health distress, and less pain than subjects in Group A. Scores of Group C were between Group A and B scores. Differences in groups over time indicated that the WWE resulted in increased confidence, physical abilities, time spent in self-management activities and decreased pain and fatigue. All groups increased in walking endurance at six weeks, and increased in health distress at four months. CONCLUSION: Subjects in different programs differed on impact of arthritis. These programs provide effective arthritis management opportunities.