Return to Competition in a Chronic Low Back Pain Runner: Beyond a Therapeutic Exercise Approach, a Case Report.

Chronic low back pain (CLBP) is a disabling condition affecting both quality of life and performance in athletes. Several approaches have been proposed in the field of physiotherapy, manual therapy, physical exercise and counseling. None apparently is outdoing the other with the exception of trunk stability exercises in specific conditions. The present paper describes a clinical success in managing a CLBP runner affected by MRI documented disk herniation via dietary change. Dietary changes allowed our patient that had failed with previous standard therapeutic approaches, to regain an optimal pain-free condition. We advance the hypothesis that a visceral-autonomic concomitant or primary disturbance possibly generating mild gastrointestinal discomfort in CLBP patients should be ruled out as a possible cause of pain and disability at the somato-motor level.

Biomechanical evaluation after five and ten millimeter anterior glenohumeral capsulorrhaphy using a novel shoulder model of increased laxity.

Anterior instability of the shoulder is classically treated with a capsulolabral repair, but in cases of capsular redundancy, shortening or shifting of the capsule is added. This study compared glenohumeral translations in intact shoulders after rotational stretching of the capsule and after progressive increasing of anterior-inferior capsular shifts. Seven cadaveric shoulders were mounted on a custom biomechanical testing apparatus. Rotational range of motion and glenohumeral translations were measured. To create laxity, the shoulders were rotationally stretched an additional 30% from the intact rotational range of motion about the axis of the humerus in external and internal rotation. Anterior-inferior capsular shifts of 5 and 10 mm were performed. Rotational stretching of the shoulder capsule created anterior laxity. A 5 mm capsular shift was ineffective, but a 10 mm shift restored anterior and total anteroposterior translation to the intact condition.

A cadaveric model of the throwing shoulder: a possible etiology of superior labrum anterior-to-posterior lesions.

BACKGROUND: It has been speculated that a shift of the throwing arc commonly develops in athletes who perform overhead activities, resulting in greater external rotation and decreased internal rotation caused by anterior capsular laxity and posterior capsular contracture, respectively. Osseous adaptation in the form of increased humeral and glenoid retroversion may provide a protective function in the asymptomatic athlete but cannot explain the pathological changes seen in the shoulder of the throwing athlete. Therefore, the objective of the present study was to examine the biomechanical effects of capsular changes in a cadaveric model. METHODS: Ten cadaveric shoulders were tested with a custom shoulder-testing device. Humeral rotational range of motion, the position of the humerus in maximum external rotation, and glenohumeral translations in the anterior, posterior, superior, and inferior directions were measured with the shoulder in 90 degrees of abduction. Translations were measured with the humerus secured in 90 degrees of external rotation. To simulate anterior laxity due to posterior capsular contracture, the capsule was nondestructively stretched 30% beyond maximum external rotation with the shoulder in 90 degrees of abduction. This was followed by the creation of a 10-mm posterior capsular contracture. Rotational, humeral shift, and translational tests were performed for the intact normal shoulder, after anterior capsular stretching, and after simulated posterior capsular contracture. RESULTS: Nondestructive capsular stretching resulted in a significant increase in external rotation (average increase, 18.2 degrees 2.1 degrees ; p < 0.001), and subsequent simulated posterior capsular contracture resulted in a significant decrease in internal rotation (average decrease, 8.8 degrees +/- 2.3 degrees ; p = 0.02). There also was a significant increase in anterior translation with the application of a 20-N anterior translational force after nondestructive capsular stretching (average increase, 1.7 +/- 0.3 mm, p = 0.0006). The humeral head translated posteroinferiorly when the humerus was rotated from neutral to maximum external rotation. This did not change significantly in association with anterior capsular stretching. Following simulated posterior capsular contracture, there was a trend toward a more posterosuperior position of the humeral head with the humerus in maximum external rotation in comparison with the position in the stretched conditions, although these differences were not significant. CONCLUSIONS: A posterior capsular contracture with decreased internal rotation does not allow the humerus to externally rotate into its normal posteroinferior position in the cocking phase of throwing. Instead, the humeral head is forced posterosuperiorly, which may explain the etiology of Type-II superior labrum anterior-to-posterior lesions in overhead athletes.