Vascular disorder in a competitive cyclist: a case report.

The purpose of this case report was to alert the physical therapist (PT) to the possibility of vascular disorders in endurance athletes with apparent musculoskeletal symptoms. A 33-year-old female injured her knee in a fall and described a history of progressive unilateral lower extremity (LE) pain and weakness, especially with running and cycling. She received LE stretching and strengthening but her symptoms persisted, so she stopped all activity. When she became symptomatic with minimal exertion, she went to a neurologist, but electromyographic (EMG)/nerve conduction velocity (NCV) studies were normal. Eventually, she was referred for vascular studies, which confirmed a diagnosis of external iliac artery endofibrosis. The patient underwent a right common iliac to common femoral artery bypass graft approximately 3 years after onset of initial symptoms. She ran a 5K race 3 weeks after surgery and returned to cycling after 4 weeks. Endofibrosis of the external iliac artery is an uncommon disorder but is most frequently diagnosed in high-performance athletes, especially cyclists. Physical therapists who practice in orthopedic settings should be aware of vascular conditions that mimic musculoskeletal disorders in endurance athletes. Vascular consult or referral may be necessary if PT interventions are ineffective in treating athletes with exercise-induced LE pain and weakness.

The effect of shoulder immobilization on balance in community-dwelling older adults.

PURPOSE: Shoulder immobilization devices are commonly used in the treatment of older adults following proximal humeral fractures. Immobilization of the shoulder may have a negative effect on balance, which could increase risk for falls. The purpose of this study was to examine the effect of shoulder immobilization on balance in the community-dwelling older adult population as measured by the Berg Balance Scale (BBS). METHODS: Fifty-three subjects (14 men and 39 women, mean age = 75.4 years) participated in the study. The BBS was administered twice to each participant. Subjects were tested once while wearing a shoulder immobilizer and once without a shoulder immobilizer. The immobilizer positioned the elbow at 90 degrees of flexion and anchored the arm to the trunk. The Wilcoxon signed-ranks test was used to evaluate differences in BBS scores. A 2-tailed test was performed with a set at .05. RESULTS: Mean (SD) BBS scores were 53 (4.0) without the immobilizer and 52 (4.7) with the immobilizer. BBS change scores (score with immobilizer minus score without immobilizer) ranged from +1 to -7, with a mean change score of -1.02. The Wilcoxon signed-ranks test indicated a significant difference between paired observations (negative ranks = 29, positive ranks = 6, P < .0001). Balance was impaired (significantly lower BBS scores) when subjects wore the device compared with the testing sessions without the device. CONCLUSIONS: The results indicate that immobilizing the shoulder may have a negative effect on balance as measured by the BBS. If shoulder immobilization places an individual at greater risk for falls, early balance screening by a physical therapist to determine the appropriateness of a fall prevention program may be indicated.

The effect of monochromatic infrared energy on sensation in patients with diabetic peripheral neuropathy: a double-blind, placebo-controlled study.

OBJECTIVE: The purpose of this study was to determine the effect of monochromatic infrared energy (MIRE) on plantar sensation in subjects with diabetic peripheral neuropathy. RESEARCH DESIGN AND METHODS: In this randomized, double-blind, placebo-controlled study, 39 subjects with diabetic peripheral neuropathy completed the 8-week study. Subjects received 30 min of active or placebo MIRE three times a week for 4 weeks. Plantar sensation was tested with monofilaments at the beginning of the study (M1), following 4 weeks of treatment (M2), and after an additional 4 weeks of nontreatment (M3). The number of sites that could sense the 5.07 monofilament was totaled at M1, M2, and M3. Data were analyzed using a special repeated-measures statistic followed by a post hoc Tukey-Kramer test. RESULTS: The average number of sites that patients could sense the 5.07 monofilament increased for both the active and placebo groups. There were significant gains from M1 to M2 (P < 0.002), no significant gains from M2 to M3 (P = 0.234), and significant gains from M1 to M3 (P < 0.002) for both the active and placebo groups. There were no significant differences between active and placebo groups at any measurement. CONCLUSIONS: Thirty minutes of active MIRE applied 3 days per week for 4 weeks was no more effective than placebo MIRE in increasing sensation in subjects with diabetic peripheral neuropathy. Clinicians should be aware that MIRE may not be an effective modality for improving sensory impairments in patients with diabetic neuropathy.