The effectiveness of soft-tissue therapy for the management of musculoskeletal disorders and injuries of the upper and lower extremities: A systematic review by the Ontario Protocol for Traffic Injury management (OPTIMa) collaboration.

BACKGROUND: Soft-tissue therapy is commonly used to manage musculoskeletal injuries. OBJECTIVE: To determine the effectiveness of soft-tissue therapy for the management of musculoskeletal disorders and injuries of the upper and lower extremities. DESIGN: Systematic Review. METHODS: We searched six databases from 1990 to 2015 and critically appraised eligible articles using Scottish Intercollegiate Guidelines Network (SIGN) criteria. Evidence from studies with low risk of bias was synthesized using best-evidence synthesis methodology. RESULTS: We screened 9869 articles and critically appraised seven; six had low risk of bias. Localized relaxation massage provides added benefits to multimodal care immediately post-intervention for carpal tunnel syndrome. Movement re-education (contraction/passive stretching) provides better long-term benefit than one corticosteroid injection for lateral epicondylitis. Myofascial release improves outcomes compared to sham ultrasound for lateral epicondylitis. Diacutaneous fibrolysis (DF) or sham DF leads to similar outcomes in pain intensity for subacromial impingement syndrome. Trigger point therapy may provide limited or no additional benefit when combined with self-stretching for plantar fasciitis; however, myofascial release to the gastrocnemius, soleus and plantar fascia is effective. CONCLUSION: Our review clarifies the role of soft-tissue therapy for the management of upper and lower extremity musculoskeletal disorders and injuries. Myofascial release therapy was effective for treating lateral epicondylitis and plantar fasciitis. Movement re-education was also effective for managing lateral epicondylitis. Localized relaxation massage combined with multimodal care may provide short-term benefit for treating carpal tunnel syndrome. More high quality research is needed to study the appropriateness and comparative effectiveness of this widely utilized form of treatment.

Quantifying strain in the vertebral artery with simultaneous motion analysis of the head and neck: a preliminary investigation.

BACKGROUND: Spontaneous vertebral artery dissection has significant mortality and morbidity among young adults. Unfortunately, causal mechanisms remain unclear. The purpose of this study was to quantify mechanical strain in the vertebral artery while simultaneously capturing motion analysis data during passive movements of the head and neck relative to the trunk during spinal manipulation and cardinal planes of motion. METHODS: Eight piezoelectric crystals (four per vertebral artery) were sutured into the lumen of the left and right vertebral arteries of 3 cadaveric specimens. Strain was then calculated as changes in length between neighboring crystals from a neutral head/neck reference position using ultrasound pulses. Simultaneously, passive motion of the head and neck on the trunk was captured using eight infrared cameras. The instantaneous strain arising in the vertebral artery was correlated with the relative changes in head position. FINDINGS: Strain in the contralateral vertebral artery during passive flexion-rotation compared to that of extension-rotation is variable ([df=32]: -0.61

Addressing the risk factors and prevention of Sudden Cardiac Death in young athletes: a case report.

BACKGROUND: Mandatory prescreening for the identification of risk factors and prevention of sudden cardiac death (SCD) is a widely debated topic within academic literature. In addition, the effective emergency management of sudden cardiac arrest (SCA) has reported lower survival outcomes (9% with bystander CPR, 24% with AED application) although improvements, such as strategic placements of AED units and Hands-Only (compression only) CPR, are being made. PURPOSE: This case will outline the importance of establishing a true SCD incidence rate and the increased need for trained personal with proper equipment available to deliver immediate emergency cardiac management. CONCLUSION: Given the lack of overall expert consensus and the low survival outcomes associated with SCD, a true incidence rate will need to be determined prior to developing a widely accepted policy. Since pre-screening all young athletes does not appear to prevent all SCD's, having properly trained personnel and easily accessible equipment at sporting venues, especially in remote locations, appears to be key.

CONTEXTE: le dépistage obligatoire pour l'identification des facteurs de risque et la prévention de la mort subite par arrêt cardiaque est un sujet largement débattu dans la documentation spécialisée. En outre, la gestion efficace des urgences d'un arrêt cardiaque soudain s'est traduite par des taux de survie plus faibles (9 % avec les RCP de spectateurs, 24 % à l'aide de DEA) bien que des améliorations, comme les placements stratégiques des unités DEA et des RCP manuelles (pression uniquement), soient effectuées. OBJECTIF: ce cas va souligner l'importance d'établir un taux d'incidence réel des morts subites par arrêt cardiaque et le besoin accru de personnel qualifié doté d'équipement adéquat accessible pour assurer une gestion d'urgence immédiate des arrêts cardiaques. CONCLUSION: compte tenu de l'absence de consensus global d'experts et les faibles taux de survie associés aux morts subites par arrêt cardiaque, il faut définir un taux d'incidence réel avant d'élaborer une politique largement acceptée. Étant donné que le dépistage préliminaire de tous les jeunes athlètes ne semble pas empêcher toutes les morts subites par arrêt cardiaque, il semble qu'avoir un personnel bien formé et du matériel facilement accessible sur les sites sportifs, en particulier dans les régions éloignées, est essentiel.

Impact of dual-polarization radar technology and Twitter on the Hattiesburg, Mississippi tornado.

OBJECTIVE: Dual-Polarization Radar and Twitter were analyzed to determine the impact on injuries sustained by the Hattiesburg EF-4 tornado. METHOD: Tracking data provided from the Dual-Pol radar systems in National Weather Service Jackson were reviewed. Twitter data from four local Twitter handles were obtained. The change in tweets and followers for the day of the storm were compared to historical averages. A Student t-test was utilized in determining statistical significance (p<0.05). Medical records from two local emergency departments were reviewed for patients treated up to 24 hours after the tornado. An Injury Severity Score (ISS) was calculated for trauma records related to the tornado. RESULTS: Radar detection of the tornado gave approximately 30 minutes of advanced warning time. Statistical significance in follower growth was seen in all four Twitter handles. Out of 50 patients, the average ISS was 3.9 with a range of 1 to 29. There were zero fatalities. CONCLUSIONS: An ISS average of 3.9 was significantly less than two previous tornadoes of similar strength that occurred prior to increased usage of Dual-pol radar and Twitter as a means for communicating severe weather information. Early detection from Dual-pol radar improved warning time. Tweets informed citizens to seek appropriate shelter. (Disaster Med Public Health Preparedness. 2013;7:585-592).

Management approaches to acute muscular strain and hematoma in National level soccer players: a report of two cases.

OBJECTIVE: To detail the presentation of two elite female soccer players with right thigh pain that occurred during training. This article will outline the investigation, diagnosis and management of their cases. CLINICAL FEATURES: The patients presented with anterior thigh pain following injuries incurred during training camp. Both were diagnosed with acute muscular strain and associated muscular hematomas. The plans of management included rest and removal from sport, cryotherapy, and interferential current. Treatment progressed to soft tissue therapy and rehabilitative exercises. The patient in the first case received additional treatment from another practitioner that involved aggressive soft tissue therapy and a strengthening program in the initial stages of recovery. OUTCOME MEASURES: For both athletes, outcome measures included return to play and re-injury. SUMMARY: Two female elite soccer players presented with acute muscle strain and hematoma. These case reports attempt to highlight the differences in treatment options in female soccer players.

A 14-year-old competitive, high-level athlete with unilateral low back pain: case report.

OBJECTIVE: To detail the presentation of a male adolescent competitive high-level soccer player with left sided low back pain that occurred while playing soccer. This case will outline the importance of early detection, risk of progression and management of active spondylolysis in adolescent athletes. CLINICAL FEATURES: The patient initially presented to a chiropractic sport specialist with left sided low back pain (9/10 on numeric pain scale rating) while kicking soccer balls with his left leg of one month duration. He was initially diagnosed with mechanical low back pain and successfully treated for acute pain management including removal from sport specific training and competition, soft tissue therapy and advice to rest. The chief complaint returned however, when the athlete resumed training and competition. A plain film imaging report suggested only postural alterations in an otherwise normal study of the lumbar spine. Computed tomography images taken three months later revealed a fracture at the left L5 pars interarticularis. SUMMARY: The early detection of spondylolysis combined with an effective plan of management including rest and conservative therapy with a progressive return to play may allow competitive athletes to resume participation at an elite level.