Menthol-Based Topical Analgesic Induces Similar Upper and Lower Body Pain Pressure Threshold Values: A Randomized Trial.

CONTEXT: Both health professionals and consumers use menthol-based topical analgesics extensively for the temporary relief of pain from musculoskeletal ailments or injury. However, there are no reports of differences in the pain pressure threshold (PPT) or the relative effectiveness of topical analgesics to reduce pain in the upper and lower body muscles and tendons. The objective of this study was to investigate whether differences existed in PPT and relative pain attenuation associated with a menthol-based topical analgesic over a variety of upper and lower body muscles and tendons. DESIGN: Randomized allocation, controlled, intervention study. METHODS: Sixteen participants (10 females and 6 males) were tested on their dominant or nondominant side. The order of specific muscle/tendon testing was also randomized, which included upper body (middle deltoid, biceps brachii, and lateral epicondylar tendon) and lower body locations (quadriceps, hamstrings, gastrocnemius, lumbosacral erector spinae muscles, and patellar and Achilles tendons). The PPT was monitored before and 15 minutes following the application of a menthol-based topical analgesic. RESULTS: A menthol-based topical analgesic increased PPT (decreased pain sensitivity) overall (P = .05; 11.6% [2.4%]; d = 1.05) and PPT was higher (P < .0001; 31.5%-44.2%; d = 1.03-1.8) for lower versus upper body locations. CONCLUSIONS: Health professionals and the public can be assured of similar reductions in pain sensitivity independent of the location of application of a menthol-based topical analgesic.

Chronic leg pain in a division ii field hockey player: a case report.

UNLABELLED: Exertional compartment syndromes in athletes represent a diagnostic and management challenge for clinicians. The clinical presentation of exertional compartment syndrome is similar to other more common musculoskeletal disorders. A lack of special tests or unique diagnostic identifiers for use in decision making by out-patient clinicians complicates early recognition of this disorder and may delay optimal management. The purpose of this case report is to retrospectively explore the clinical presentation and the decision-making during the course of care of a field hockey athlete eventually determined to have exertional compartment syndrome. Suggestions to assist in recognition and guidance in patient management are included as well as the procedures required for differential diagnosis. Procedures utilized during conservative care are also described in detail. LEVEL OF EVIDENCE: 5 (Single Case Report).

Objectively measured physical activity and balance among U.S. adults.

The purpose of this study was to examine the association between objectively measured physical activity (PA) and balance in a nationally representative sample of U.S. adults 40 years of age and older. Data from the 2003-2004 National Health and Nutrition Examination Survey were used. Physical activity was measured over a 7-day period using accelerometry, and balance was assessed using the Romberg test. Participants completed a questionnaire regarding their subjective views on difficulty with falling in the past 12 months. For every 60-minute increase in light-intensity PA, participants were 10% (p = 0.04) more likely to have functional balance. Similarly, for every 1-minute increase in log-transformed moderate-to-vigorous physical activity, participants were 23% (p = 0.04) more likely to have functional balance. Regular PA, regardless of intensity, may have health benefits for older adults and is associated with functional balance.

Prehabilitation influences exercise-related psychological constructs such as self-efficacy and outcome expectations to exercise.

Osteoarthritis (OA) is a clinical condition affecting more than 27 million Americans. There is no known cure for OA other than replacing the diseased joint with a joint prosthesis, a process called total knee arthroplasty (TKA). The TKA projections for the year 2016 are 1,046,000, and this number is predicted to increase by 600% to more than 3.4 million cases by 2030. The purpose of this study was to determine whether knee OA patients who engage in guided exercise (prehabilitation) before their TKA report higher levels of self-efficacy to exercise (SEE) and higher outcome expectations for exercise (OEE) than those who do not. Thirty-one participants were randomized into 2 groups (16 in prehabilitation group [PRE] and 15 in control group [CON]), all participants completed the protocol (22 women and 9 men). The PRE group participated in an exercise intervention (prehabilitation) 3 times per week for 8 weeks before TKA. One-way repeated measures analysis of variance was used to investigate the effects of group (PRE vs. CON), time (baseline T1, T2, T3, and T4), and the interaction of group and time on the dependent variables of SEE and OEE. This analysis indicated that SEE did not change over time (p = 0.62) or between the groups (p = 0.86). The analysis of the OEE indicated a significant time effect (p = 0.008). Post hoc analysis indicated that the CON group significantly declined between T2 and T4. The PRE group did not significantly change their OEE over the 4 data collection points of the study.

Examining the role of service-learning on development of professionalism in doctor of physical therapy students: a case report.

Service-learning (SL) is a pedagogical tool that has several purported benefits. In the health sciences, we have established an integrated curricular SL thread that includes self-contained course experiences and the provision of pro bono physical therapy services in on- and off-campus Service-Learning Clinics (SLC). SL is integrated across the curriculum through four SL courses. Student provision of pro bono services is the centerpiece of the SL course series with students providing patient management in on- and off-campus clinics. The purpose of this case report is to examine how participation in the off-campus SLC may impact the development of professionalism in a sample of eight students. In this project, student perceptions of the role of the off-campus SLC experiences in the development of professionalism and core values were assessed through three methods: student interviews, completion of the physical therapy Core Values Self-Assessment form, and analysis of student reflection papers. Students reported core values compassion/caring and accountability most frequently in the context of their off-campus SL experiences. Student responses suggest SL is a beneficial learning model in providing a framework to the curricular emphasis on professionalism. While the role of SL in the development of professionalism and core values is not entirely clear, this pedagogical model appears to have a positive impact on the professional education of these students.

Relationship between scores from the Knee Outcome Survey and a single assessment numerical rating in patients with patellofemoral pain.

OBJECTIVE: To determine the relationship between patient-reported single numeric ratings and actual scores obtained from a validated instrument, the Knee Outcome Survey (KOS). BACKGROUND: Patient-reported outcome (PRO) measures are an important component of patient management. Information obtained from PRO measures can be used to prioritize goal setting, assist with clinical decision-making, provide evidence for effectiveness of interventions, monitor progress, and assess organizational or clinician performance. METHODS: Scores from the KOS activity of daily living (ADL) and Sports subscales completed at the time of initial examination of patients with patellofemoral pain (n = 29) were retrospectively analyzed and compared to a single assessment numerical rating. RESULTS: Bi-variate Pearson product correlation was used to determine association between the KOS-ADL and KOS-Sports with respective single assessment numerical ratings. A high correlation was observed between the KOS-ADL (0.85, p < 0.01) and KOS-Sports (0.88, p < 0.01) with a single assessment numerical rating. CONCLUSIONS: Administration and scoring of standardized outcome measures such as the KOS-ADL and KOS-Sports require several minutes to administer but correlate well with a single assessment numerical ratings. The high correlation of single assessment numerical scores to actual KOS-ADL and KOS-Sports scores may provide support for discretionary use of single numerical ratings during interim patient care visits and/or in instances when time is limited. Additional studies are needed with larger patient populations and specific diagnostic subgroups to determine additional clinical relevance.

The effect of either topical menthol or a placebo on functioning and knee pain among patients with knee OA.

Osteoarthritis (OA) is a common health problem with symptoms including reduced functioning and joint pain. Protracted pharmacological management of knee OA is associated with side effects including gastrointestinal, renal, and neurological dysfunction. Menthol gels have been used with limited empirical support to relieve pain and improve functioning among individual with OA. The purpose of this study was to compare the ability to complete functional tasks and knee pain while completing functional tasks among patients with knee OA after topical application of either 3.5% menthol gel or an inert placebo gel. Twenty individuals with knee OA volunteered to complete 2 data collection visits 1 week apart. Subjects underwent the same data collection at each visit including the performance of functional tasks and self-reporting knee pain while performing each task. The functional tasks included a 6-Minute Walk (6-MW), the Timed Get Up and Go (TUG), 30-second timed chair stand (TCS), and time to ascend (Up stairs) and descend (Down stairs) a flight of stairs. Subjects reported their knee pain immediately following each functional task using a 100-mm visual analog scale. These assessments of pain and functioning were measured twice at each subject visit: upon arrival at the facility without any intervention and again during the same visit after random application to the OA knee of 5 mL of 3.5% menthol gel or 5 mL of an inert gel. There were no significant between-group differences or time by treatment interaction in performance of any of the functional tasks, or measures of pain, at any of the data collection time points. However, there were significant within-group differences. Scores on the 6-MW, TCS, and Down stairs functional tasks improved significantly following the application of menthol gel. Scores on the Down stairs functional task improved significantly following application of the placebo gel. The menthol intervention resulted in significant reductions in pain during the TUG, TCS, Up stairs, and Down stairs tasks. The placebo condition did not result in any significant changes in pain during the functional tasks. There were no differences detected in functional tasks or pain following the placebo and menthol conditions. These findings provide partial support regarding the efficacy of menthol gel to improve functioning and reduce pain among knee OA patients.

Prehabilitation and quality of life three months after total knee arthroplasty: a pilot study.

Knee osteoarthritis (OA), which affects over 27 million Americans, decreases the individual's quality of life through decreasing mobility, deconditioning, reducing functional ability, and increasing knee pain. The present aim was to assess whether such patients engaging in exercise prior to surgery ("prehabilitation"; preoperative exercise intervention) rate higher quality of life 3 mo. after their surgery compared with ratings by patients who did not engage in prehabilitation. Standard populations consist of OA patients that do not participate in any preoperative exercise programs, such as a prehabilitation exercise intervention. 18 knee osteoarthritis patients were randomly assigned to a control or a prehabilitation group. The latter group participated in an exercise intervention three times per week, once at home and twice at the physical therapy lab, for 8 wk. prior to their surgery. The control group participated in their usual preoperative care prescribed by the physician for all patients. Eight health-related quality of life domains were assessed at 3 mo. post surgery. These preliminary findings suggest efficacy of prehabilitation in facilitating quality of life of total knee arthroplasty (TKA) patients 3 mo. after surgery.

Rehabilitation following anterior approach total hip arthroplasty in a 49-year-old female: a case report.

Over 230,000 total hip arthroplasties (THA) are performed annually, and many of these patients will seek or be referred to a physical therapist to assist them in their recovery. Improvements in understanding of joint replacement technology have allowed earlier weight bearing and return to function. With the anterior surgical approach, patients are permitted weight bearing as tolerated immediately after surgery and can resume nearly all prior activities upon returning home. This case report describes the home-based physical therapy management of a 49-year-old female following a left THA using an anterior surgical approach. This report also includes a description of the functional based protocol and hip assessment scale used. The rehabilitation program was initiated 4 days postoperatively and consisted of a patient-oriented and functional approach. Seventeen days after surgery and seven home visits, the patient exhibited a normal gait pattern, was walking 20 minutes continuously, safely negotiating stairs, and had resumed normal household activities. The subject of this case report was relatively young, highly motivated, and the outcomes presented may not be generalized or expected of other patients following anterior approach THA. Additional studies are needed to determine long-term effects of this surgical approach and postoperative home-based rehabilitation program.

Selected Musculoskeletal and Performance Characteristics of Members of a Women's Professional Football Team: Application of a Pre-participation Examination.

BACKGROUND: Although it is common practice to administer pre-participation examinations (PPE) of athletes prior to training, there are no clearly established formats. Elements integral to the PPE fall within the scope of physical therapist practice, and are often categorized as a form of primary prevention for musculoskeletal disorders as defined in the Guide to Physical Therapist Practice. PURPOSE: The purpose of this study is to describe the design and implementation of a PPE for a women's professional (gridiron) football team. The results and findings from this PPE provide one of the first musculoskeletal profiles and information about selected physical characteristics from members of a female professional football team. METHODS: Players from the Kentucky Karma women's football team, a member of the National Women's Football League (NWFA), volunteered to participate in a PPE. Of twenty-five eligible team members, thirteen consented to participate. The PPE consisted of a health history questionnaire, a musculoskeletal screening, and a series of physical performance and agility tests. RESULTS: The players' average (± SD) age, height, weight, body mass index (BMI), and body fat percentage were 29.6 (± 5.6) yrs., 1.66 (± .05) m, 66.8 (± 12.6) kg, 24.1 (± 3.7), and 27.4 (± 6.6) %, respectively. Commonly reported injuries were similar to those reported in men's collegiate football. CONCLUSION: This is one of the first papers to report on a model PPE for a women's professional football team. Future research is needed to establish a standard PPE, recognize common injuries, and develop prevention strategies unique to women's professional football.

Methodological report: dynamic field tests used in an NFL combine setting to identify lower-extremity functional asymmetries.

Side-to-side differences in lower-extremity biomechanics may be predictive of increased risk of lower-extremity injuries in athletes. The purpose of this report is to provide field testing methodology for tests designed to isolate lower-extremity asymmetry and to demonstrate the potential for these tests to provide reliable measures. Six athletes (3 females, 3 males) were tested on 2 consecutive days for activities incorporated into a replicated National Football League (NFL) combine setting. Vertical hop power (VHP) and jump height were measured on a portable force platform as athletes performed maximum effort hops for 10 seconds. The modified agility T-test (MAT) incorporates two 90-degree single-leg cuts during the trial and was measured as total time for completion. Intraclass correlations (within ICC [3,k], between ICC [3,1]) were calculated. The VHP test had good to excellent within-session reliability for peak power of both the right (ICC = 0.942) and left (ICC = 0.895) sides. Jump height showed excellent within-session reliability for both the right (ICC = 0.963) and left (ICC = 0.940) sides. The between-session reliability for peak power between jumps was good for the right (ICC = 0.748) and left (ICC = 0.834) sides. Jump height showed good to excellent between-session reliability on the right (ICC = 0.794) and left (ICC = 0.909) sides. The MAT also showed good reliability between days (ICC = 0.825).The results indicate that the VHP test provides reliable assessment of both within- and between-session jump height and power production. The MAT also provides good reliability between testing days. Both the VHP and the MAT may be useful for clinicians to identify the presence of lower-limb asymmetry and potential injury risk factors in athletic populations.

Determining the minimal number of cyclic passive stretch repetitions recommended for an acute increase in an indirect measure of hamstring length.

The purpose of this study was to determine the minimal number of cyclic passive stretch repetitions required to induce an acute increase in hamstring length via an indirect measure of hamstring length. Eighteen healthy males (aged 19-37 years) were placed in a standardized position. Knee flexion range of motion (ROM) measurements were recorded following ten 15-second passive stretch repetitions. Analysis of variance measures (p < 0.05) and post hoc analysis showed that significant increases in knee extension ROM diminished at the fifth stretch repetition. The greatest single increase in knee extension ROM occurred after the first stretch. The results of this study indicate that passive stretching beyond five repetitions results in insignificant gains in hamstring length (measured via knee extension ROM) and are probably unnecessary.

Professional competence in physical therapy.

Defining, assessing, and measuring ongoing or continuing professional competence in physical therapy has been receiving more attention, perhaps due in part to the increasing reality of direct access (e.g., examination and treatment of patients without referral), increased professional autonomy, and the transition to the doctor of physical therapy as the entry-level degree. The purpose of this paper is to review recent initiatives related to competence beyond initial licensure and give examples of the multidimensional nature of assessing continuing professional competency in physical therapy.