Flotation-Restricted Environmental Stimulation Technique: A Proposed Therapy for Improving Performance and Recovery in Special Forces Operators - A Narrative Review.

The flotation-restriction environmental stimulation technique (FR) may have utility as a recovery tool for improving performance in elite competitive athletes and Special Operations Forces Operators (SOs). Studies suggest that FR may ameliorate various neurophysiological disorders and improve performance in recreational and elite athletic populations. We sought to understand whether there is evidence to support the use of FR to enhance physiological and psychological performance parameters in the SO population and to provide postulations as to the mechanisms of action of FR therapy. We performed an online literary search of publications dating from 1982 to 2021 and identified 34 sources addressing the aims, depending on population and condition or conditions, being treated. The reported physiological and psychological benefits of FR range from immediate to lasting 4 months. Overall, eight to twelve FR treatment sessions of from 40 to 90 minutes each may provide variable long-term benefits. The associated synergistic benefits of FR may be attributed to its thermal, chemical, and mechanical effects but deserve further exploration. Based on the current evidence, FR may serve as an effective performance-recovery therapy for improving pain, sleep, and performance measures (e.g., marksmanship and physical performance) in trained, untrained, and healthy adults. Future research focusing on FR as a unimodal recovery intervention is warranted in a specialized group of SOs.

Physiological and Psychological Stressors Affecting Performance, Health, and Recovery in Special Forces Operators: Challenges and Solutions. A Scoping Review.

INTRODUCTION: Special Operations Forces (SOF) Operators (SOs) are exposed to high levels of physiological and cognitive stressors early in their career, starting with the rigors of training, combined with years of recurring deployments. Over time, these stressors may degrade SOs' performance, health, and recovery. OBJECTIVES: (1) To evaluate sources identifying and describing physiological and psychological stressors affecting performance, health, and recovery in SOs, and (2) to explore interventions and phenomena of interest, such as the biological mechanisms of overtraining syndrome (OTS). METHODS: This review followed the recommendations and methodology of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A database search from December 1993 to December 2021 was performed in PubMed, the Cochrane Library, and the Defense Technical Information Center (DTIC). Potential articles were identified using search terms from their titles, abstracts, and full texts. Articles effectively addressing the review questions and objectives were eligible. RESULTS: After 19 articles were excluded for not meeting established inclusion criteria, a total of 92 full-text articles were assessed for eligibility. After the final analysis, 72 articles were included. CONCLUSIONS: Allostatic imbalance may occur when supra-maximal demands are prolonged and repeated. Without adequate recovery, health and performance may decline, leading to nonfunctional overreaching (NFO) and OTS, resulting in harmful psychological and hormonal disruptions. The recurring demands placed on SOs may result in a chronically high burden of physical and mental stress known as allostatic overload. Future investigation, especially in the purview of longitudinal implementation, health, and recovery monitoring, is necessary for the health and readiness of the SOF population.

Fluoroscopically-guided injections to treat "kissing spine" disease.

BACKGROUND: Any spine structure that is innervated by afferent nociceptive nerve fibers is a potential pain generator. In the lumbar spine, the most studied pain generators include: sacroiliac joints, the zygapophysial joints, the intervertebral discs, myofascial structures. Anomalous lumbosacral articulations, the spinous processes, and lumbar spine osteophytes are less commonly reported. OBJECTIVE: To describe the diagnostic and therapeutic features of "kissing spine" disease or Baastrup's Sign with particular attention to MRI findings and fluoroscopically-guided injection therapy. DESIGN: A series of 3 patients with axial low back pain presented with exam findings and MRI changes suggestive of pain emanating from adjacent spinous processes that appeared to be in direct contact or very closely opposed. This has been described in the literature as "kissing spine" disease or Baastrup's sign. Fluoroscopically-guided injections were performed and the responses were studied. RESULTS: The 3 patients had MRI findings consisting of inflammation and/or edema in the spinous processes and surrounding soft tissues. Fluoroscopically-guided injections provided pain relief in all 3 patients. One patient with recurrent pain eventually underwent successful surgical resection of the involved spinous processes. CONCLUSION: Painful adjacent and closely opposed spinous processes can be a source of axial low back pain. We have described MRI features and the responses to fluoroscopically-guided injections in 3 patients with this condition.

Clostridial sacroiliitis in a patient with fecal incontinence: a case report and review of the literature.

INTRODUCTION: Image-guided sacroiliac joint injections are frequently employed for both diagnostic and therapeutic relief of low back pain. CASE REPORT: An 83-year-old male with chronic lumbrosacral pain previously responsive to right sacroliac joint injections presented for repeat injection. His medical history included Parkinsonism and stool incontinence. Forty-two hours after the injection, he developed fever, dyspnea, and crepitus on the right buttock and thigh. Surgical debridement was recommended, but the family wished for comfort care only. The patient died hours later. The autopsy revealed Gram positive bacilli consistent with Clostridial myonecrosis. DISCUSSION: Pyogenic sacroiliitis is rare and usually occurs in the setting of trauma, drug abuse, or extraspinal infections. Joint infections with Clostridium have been reported after traumatic events including puncture, surgery, and abrasions. Clostridium spores are resistant to chemical preparations used for skin sterilization and require high heat for destruction. Possible practice guidelines with patients that are stool incontinent include mechanical wash prior to sterile preparation and placement of an occlusive sterile dressing after injection to prevent stool contamination of the needle puncture site. As with all rare complications, large scale studies are needed to better identify risk factors to formulate practice management strategies.

The use of spinal cord stimulation in refractory abdominal visceral pain: case reports and literature review.

Patients will commonly seek medical attention for refractory abdominal pain. The many causes of abdominal pain include pathologies of the gastrointestinal, genitourinary, musculoskeletal, and nervous systems. Unfortunately, a large number of patients will develop chronic abdominal pain that is recalcitrant to definitive therapies and nonspecific treatments such as cognitive-behavioral, physical, and pharmacologic therapies. Although spinal cord stimulation is classically used for neuropathic and ischemic conditions, a growing number of reports describe its efficacy in visceral disease. We describe our experience with spinal cord stimulation in two patients with refractory abdominal pain. Although the exact etiology in these complex patients is not defined, it is theorized that visceral hypersensitivity is at least one component. Finally, we will summarize the applicable literature in order to explain a possible mechanism of analgesia in visceral disease.

Review of spinal cord stimulation in peripheral arterial disease.

Ever since its initial development in the late 1960s, spinal cord stimulation (SCS) has been used to treat a number of painful conditions. European practice, in contrast to that in North America, has used peripheral arterial disease (PAD) as a primary indication for SCS. First employed in patients with PAD in 1976, SCS was shown by Cook et al. to heal chronic leg ulcers. Numerous subsequent retrospective studies of SCS in PAD show improvements in multiple outcomes such as exercise tolerance, limb salvage, and pain. Previous retrospective studies are likely flawed with respect to author bias, inadequate sample size, and possible placebo effects. Further, they have not identified clinical criteria for selecting SCS therapy. Recent randomized prospective studies have questioned some of the conclusions from these preceding retrospective data. In addition to the questions related to outcomes, theories regarding exact mechanisms by which SCS improves circulatory parameters remain unclear. A thorough Medline literature review on the subject of SCS in peripheral vascular disease was thus undertaken to attempt to clarify questions regarding which patients are best suited for SCS therapy, pinpoint possible methodologic flaws in previous studies, and to review the background, outcomes, mechanisms of action, complications, and alternatives for SCS in patients with PAD.

Hemoptysis following extracorporeal shock wave lithotripsy: a case of lithotripsy-induced pulmonary contusion in a pediatric patient.

We present an unusual case in which a pediatric patient sustained iatrogenic pulmonary contusion resulting in severe hemoptysis. Aside from being a rare complication of pediatric extracorporeal shock wave lithotripsy, our case is unique in regard to the timing and apparent severity of hemoptysis.