Sustained acoustic medicine treatment of discogenic chronic low back pain: A randomized, multisite, double-blind, placebo-controlled trial.

BACKGROUND: Sustained acoustic medicine (SAM) is a noninvasive long-term treatment that provides essential mechanical and thermal stimulus to accelerate soft tissue healing, alleviate pain, and improve physical activity. SAM increases localized deep tissue temperature, blood flow, cellular proliferation, migration, and nutrition exchange, resulting in reduced inflammation and an increased rate of tissue regeneration. OBJECTIVE: To assess the efficacy of SAM treatment of discogenic back pain in the lower spinal column to reduce pain, improve quality of life, and lower pharmacotherapy use. METHODS: Sixty-five subjects with chronic low back pain were randomly assigned to SAM (N= 33) or placebo (N= 32) groups. Subjects self-applied SAM device bilaterality on the lower lumbar region for 4 hours daily for 8 weeks and completed daily pain diaries before, during, and after treatment. Subjects recorded pain reduction using a numeric rating scale (NRS), medication use, and physical activity using the Global Rating of Change (GROC) and Oswestry Disability Index (ODI). RESULTS: SAM treatment significantly reduced chronic lower back pain from baseline relative to placebo treatment (p< 0.0001). SAM treated subjects reported significantly lower back pain at 4 weeks, with the highest pain reduction (-2.58 points NRS, p< 0.0001) reported at 8 weeks. Similar trends were observed in improved physical activity (3.48 GROC, p< 0.0001, 69-88% ODI, p< 0.0001) and 22.5% (15.2 morphine milligram equivalent) reduction in the use of opioid medication from baseline to 8 weeks. CONCLUSION: Daily, home-use SAM treatment significantly improves the clinical symptoms of chronic lower back pain, improves physical mobility, and reduces daily medication use. SAM treatment is well-tolerated by patients and may be considered a safe, non-invasive treatment option for chronic discogenic, lower back pain.

Nutritional Supplement Use and Athletic Characteristics among a Sample of NCAA Division I and Division III Student-Athletes.

Due to documented adverse events, understanding the prevalence of nutritional supplements commonly used by athletes is essential. This cross-sectional study used data from a web-based survey conducted in February-March 2022. Participants were Division I (DI) and Division III (DIII) student-athletes of the National Collegiate Athletic Association (NCAA). Chi-square tests were conducted to identify the differences in the prevalence of demographic and athletic characteristics between the divisions. Multivariable odds ratios and 95% confidence intervals were calculated using logistic regression adjusting for potential confounders to determine the predictors of supplement usage. A total of 247 NCAA student-athletes (72.5% Division I, 27.5% Division III) completed the survey, yielding a 24.5% response rate. There were no significant differences between nutritional supplementation and NCAA divisions. Instead, all student-athletes used supplements regardless of division. There were significant differences in race, ethnicity, sports dietitian access, name, image, and likeness (NIL), advisement to consume NS, and knowledge of NS between the divisions (all P-values < 0.01). Unadjusted regression models showed that being in an upper-level academic standing was associated with higher odds of using sports food and ergogenic supplements than student-athletes with a lower-level academic standing. However, multivariable logistic regression analysis revealed that none of the demographic and athletic characteristics significantly affected supplement usage. Allocating resources for access to sports dietitians and supplement education for all divisions may benefit student-athletes knowledge and safety.

Long Duration Ultrasound Combined with Platelet-Rich Plasma Injection for Return to Sport after Soft Tissue Injury: A Single Center Study.

Objective: The use of Long-Duration Ultrasound (LDU) and Platelet-Rich Plasma (PRP) treatments to facilitate injury healing and pain relief are typically utilized independently in sports medicine. Our study aimed to investigate the combined regenerative effect of daily LDU with high-concentration single-injection PRP for treating sport-related musculoskeletal injuries. Methods: In total, thirty-five competitive athletes (n=35) with grade II sprains and strains and tendinopathies injured during sport and unable to continue to play were sequentially administered PRP (n=20, 20.4 yoa, 18 male, 2 female) or PRP+LDU (n=15, 20.27 yoa, 14 male, 1 female). In the PRP treatment group, each subject was treated with a single injection of PRP consisting of 1.28 billion platelets/mL under ultrasound-image guidance to the injury site. The PRP+LDU treatment group received the same PRP injection procedure with a 14-day, 4 hr per day, 18,720 J ultrasound treatment applied over the injection site. The Numeric Ration pain Scale (NRS, 0-10), Range of Motion (ROM, 0-100%), Clinical Strength numeric score (CS, 0-5), and time of injury to return to sport (days) were measured at baseline and Return to Play (RTP). The global health improvement score (GROC -7 to +7) was measured upon RTP. Results: All patients completed rehabilitation and returned to the sport after debilitating injuries. PRP+LDU returned athletes to play 21.33 days quicker (p<0.0001), decreased injury pain by 0.88 NRS points (p=0.0086), and improved patient global health by 1.28 points GROC (p<0.0001) over PRP treatment alone (95% Confidence interval, 11.26 to 31.40 days faster). There were no significant differences in strength (p=0.498) or range of motion (p=0.8581) improvement between PRP and PRP+LDU at the RTP or baseline patient demographic variables. Conclusion: Adding LDU at-home treatment to PRP injection therapy significantly reduces the time to return to sport, increases pain reduction, and improves overall health for patients recovering from sport-related injury. The daily LDU treatment facilitates and enhances regenerative medicine therapies such as PRP.

Post-COVID-19 Cardiovascular Evaluation in National Collegiate Athletic Association Division I Athletes.

OBJECTIVE: To evaluate the necessity of cardiac testing after a COVID-19 diagnosis as it relates to myocarditis in collegiate athletes. DESIGN: Cross-sectional retrospective case series. SETTING: National Collegiate Athletic Association Division I University. PATIENTS: One hundred sixty-five collegiate athletes diagnosed with COVID-19 by reverse transcriptase-polymerase chain reaction or immunoglobulin G antibody between August and December 2020 without exclusion. INTERVENTIONS: All participants underwent cardiac workup consisting of serum troponin, electrocardiogram, transthoracic echocardiogram, and cardiac magnetic resonance (CMR). All results were reviewed by team physicians and sports cardiologists. MAIN OUTCOME MEASURES: Prevalence of myocarditis and abnormality on cardiac testing after COVID-19 infection at a single institution. RESULTS: One (0.61% [95% CI, 0.02%-3.3%] asymptomatic athlete had CMR findings of an age-indeterminate myocardial injury with further cardiac testing being otherwise normal. No athlete had CMR abnormalities consistent with acute myocarditis by the modified Lake Louise Criteria. CONCLUSIONS: Occurrence of myocarditis was lower in this population compared with other studies. No student athlete was permanently disqualified from participation because of testing. A stratified, risk-based testing strategy with CMR may be more appropriate than a universal screening strategy.

Evaluation of a Preparticipation Cardiovascular Screening Program Among 1,686 National Collegiate Athletic Association Division I Athletes: Comparison of the Seattle, Refined, and International Electrocardiogram Screening Criteria.

OBJECTIVES: To: (1) analyze the results of 5 years of preparticipation cardiac screening including 12-lead electrocardiogram (ECG) of National Collegiate Athletic Association (NCAA) Division I athletes; and (2) assess the rates of ECG screening abnormalities and false-positive rates among 3 ECG screening criteria. DESIGN: Retrospective chart review. SETTING: National Collegiate Athletic Association Division I University. PARTICIPANTS: One thousand six hundred eighty-six first-year athletes presenting for their preparticipation examination including 12-lead resting ECG. INTERVENTIONS: At the completion of the study period, all ECGs were retrospectively reviewed using the Seattle, Refined, and International Criteria. MAIN OUTCOME MEASURES: (1) Prevalence of pathologic cardiac conditions identified by screening; and (2) number of ECG screening abnormalities by criteria. RESULTS: Three athletes (0.2%) were found to have conditions that are associated with sudden cardiac death. Retrospective review of ECGs using Seattle, Refined, and International criteria revealed an abnormal ECG rate of 3.0%, 2.1%, and 1.8%, respectively. International criteria [odds ratios (OR), 0.58; P = 0.02] demonstrated a lower false-positive rate compared with the Seattle criteria. There was no significant difference in false-positive rates between the Seattle and Refined (OR, 0.68; P = 0.09) or the International and Refined criteria (OR, 0.85; P = 0.5). CONCLUSIONS: There was a low rate of significant cardiac pathology in this population, and no athletes were permanently restricted from play as a result of screening. Our results suggest that the International criteria have the lowest false-positive rate of athlete-specific ECG criteria, and thus, it is the preferred method for preparticipation ECG screening in NCAA athletes.