Publications by authors named "Adam S Tenforde"

96 Publications

Functional Gains Using Radial and Combined Shockwave Therapy in the Management of Achilles Tendinopathy.

J Foot Ankle Surg 2021 Jun 24. Epub 2021 Jun 24.

Associate Professor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA. Electronic address:

Achilles tendinopathy is a common condition and many patients have functional limitations after initial conservative treatment. Shockwave therapy has been shown to improve function within patients; however, comparative outcomes for different forms of shockwave are poorly described. In this retrospective cohort study, we describe findings from a quality improvement initiative evaluating safety and functional outcomes after treatment with radial shockwave therapy (n = 58) or combined radial and focused shockwave therapy (n = 29) for patients with Achilles tendinopathy refractory to exercise therapy. All patients were prescribed an eccentric exercise program. We hypothesized both groups would see improvements in function quantified using the Victorian Institute of Sports Assessment-Achilles with similar safety outcomes. Overall, the minimal clinically important difference (defined at 7 for insertional and 12 for noninsertional Achilles tendinopathy) was met in a greater proportion of patients treated with combined shockwave compared to radial shockwave (26 [89.7%] vs 37 [63.8%], p = .022). The change in Victorian Institute of Sports Assessment-Achilles from baseline to final treatment was not different between combined and radial-only groups (23.3 ± 12.6 vs 19.9 ± 18.7, p = .2). Within group differences from baseline to final follow-up measures (mean duration 17.9 ± 14.8 weeks) demonstrated overall functional improvement for both groups (both p < .0001). No serious adverse effects were observed. Our findings suggest combined radial and focused shockwave therapy may provide more predictable functional gains for treatment of Achilles tendinopathy compared to radial shockwave therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.jfas.2021.06.014DOI Listing
June 2021

Prevalence and Factors Associated with Bone Stress Injury in Middle School Runners.

PM R 2021 Jul 12. Epub 2021 Jul 12.

California State University, Long Beach, California.

Introduction: Bone stress injury (BSI) in youth runners are clinically important during times of skeletal growth and are not well studied.

Objective: Evaluate the prevalence, anatomical distribution, and factors associated with running-related BSI in boy and girl middle school runners.

Design: Retrospective cross-sectional study.

Setting: Online survey distributed to middle school runners.

Methods: Survey evaluated BSI history, age, grade, height, weight, eating behaviors, menstrual function, exercise training, and other health characteristics.

Main Outcome Measurements: Prevalence and characteristics associated with history of BSI, stratified by cortical-rich (eg, tibia) and trabecular-rich (pelvis and femoral neck) locations.

Participants: 2107 runners (n = 1250 boys, n = 857 girls), age 13.2 ± 0.9y.

Results: One hundred-five (4.7%) runners reported a history of 132 BSIs, with higher prevalence in girls than boys (6.7% vs 3.8%, P = 0.004). The most common location was the tibia (n = 51). Most trabecular-rich BSIs (n = 16, 94% total) were sustained by girls (pelvis: n = 6; femoral neck: n = 6; sacrum: n = 4). In girls, consuming <3 daily meals (OR = 18.5, 95%CI = 7.3, 47.4), eating disorder (9.8, 95%CI = 2.0, 47.0), family history of osteoporosis (OR = 6.9, 95%CI = 2.6, 18.0), and age (OR = 1.6, 95%CI = 1.0, 2.6) were associated with BSI. In boys, family history of osteoporosis (OR = 3.2, 95%CI = 1.2, 8.4), prior non-BSI fracture (OR = 3.2, 95%CI = 1.6, 6.7), and running mileage (OR = 1.1, 95%CI = 1.0, 1.1) were associated with BSI. Participating in soccer or basketball ≥2 years was associated with lower odds of BSI for both sexes.

Conclusion: While family history of osteoporosis and prior fracture (non-BSI) were most strongly related to BSI in the youth runners, behaviors contributing to an energy deficit, such as eating disorder and consuming<3 meals daily, also emerged as independent factors associated with BSI. While cross-sectional design limits determining causality, our findings suggest promoting optimal skeletal health through nutrition and participation in other sports including soccer and basketball may address factors associated with BSI in this population. This article is protected by copyright. All rights reserved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pmrj.12673DOI Listing
July 2021

Extracorporeal Shockwave Therapy in the Management of Sports Medicine Injuries.

Curr Sports Med Rep 2021 Jun;20(6):298-305

Orthopedic Surgery and Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.

Abstract: Treatment of musculoskeletal conditions in athletes with extracorporeal shockwave therapy (ESWT) is gaining popularity as greater evidence supports its use. ESWT protocols (describing energy flux density, number of impulses, type of shockwave (focused or radial), number/frequency/duration of treatment session, area of application, and postprocedural therapy protocols) can be adjusted in the clinical setting. Protocols vary across studies, and optimal protocols for most indications are yet to be determined. ESWT can safely be used to treat various musculoskeletal conditions in athletes, including rotator cuff tendinopathy, lateral elbow epicondlyopathy, greater trochanteric pain syndrome, hamstring tendinopathy, patellar tendinopathy, Achilles tendinopathy, other tendinopathies, plantar fasciopathy, bone stress injuries, and medial tibial stress syndrome. ESWT can be used to treat in-season athletes, as it often requires no/minimal time away from sport and may result in rapid benefits. ESWT should be used in conjunction with physical therapy to facilitate longer-term gains in function and to optimize healing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1249/JSR.0000000000000851DOI Listing
June 2021

Performance and Health Decrements Associated With Relative Energy Deficiency in Sport for Division I Women Athletes During a Collegiate Cross-Country Season: A Case Series.

Front Endocrinol (Lausanne) 2021 12;12:524762. Epub 2021 May 12.

Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.

The purpose of this case series was to evaluate the presence of low Energy Availability (EA) and its impact on components of Relative Energy Deficiency in Sport (RED-S) in a population of female collegiate runners. Seven female NCAA Division I athletes (age: 22.3 ± 1.5 yrs; height: 169.7 ± 5.7 cm; weight: 58.3 ± 4.1 kg) were tracked from August until February, covering the beginning (Pre XC), end (Post XC) of their competitive cross country season, and beginning of the following track season (Pre Track). The athletes were assessed for female athlete triad (Triad) risk, energy availability, body composition, resting metabolic rate (RMR), nutritional intake, and blood markers (including vitamin D, ferritin, and triiodothyronine (T3)). From Pre XC to Post XC there were no significant differences in body mass, fat free mass or body fat percentage. At Pre XC, mean EA was 31.6 ± 13.3 kcal/kg FFM∙d. From Post XC to Pre Track, there was a significant increase in body mass (59.1 ± 5.1 to 60.6 ± 5.7 kg, p<0.001,d=0.27). From Post XC to Pre Track, there was a significant increase in RMR (1466 ± 123.6 to 1614.6 ± 89.1 kcal·d, p<0.001,d=2.6). For 25(OH) vitamin D, there was a significant reduction from Pre XC to Post XC (44.1 ± 10.6 39.5 ± 12.2 ng·mL, p=0.047,d=-0.4), and a significant increase from Post XC to Pre Track (39.5 ± 12.2 48.1 ± 10.4 ng·mL, p=0.014,d=0.75). For ferritin, there was a trend towards a decrease from Pre XC to Post XC (24.2 ± 13.2 15.7 ± 8.8 ng·mL, p=0.07, d=-0.75), as well as a trend toward an increase from Post XC to Pre Track (15.7 ± 8.8 34.1 ± 18.0 ng·mL, p=0.08, d=1.3). No differences in T3 were observed across time points. Average Triad risk score was 2.3 ± 1.4. Notably, 5 of 7 athletes met criteria for moderate risk. Despite many athletes meeting criteria for low EA and having elevated Triad risk assessment scores, most were able to maintain body mass and RMR. One athlete suffered severe performance decline and a reduced RMR. Surprisingly, she was the only athlete above the recommended value for ferritin. Following increased nutritional intake and reduced training volume, her performance and RMR recovered. Changes in body mass and body composition were not indicative of the presence of other concerns associated with RED-S. This exploratory work serves as a guide for future, larger studies for tracking athletes, using RMR and nutritional biomarkers to assess RED-S.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fendo.2021.524762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149996PMC
May 2021

Running-related injuries in middle school cross-country runners: Prevalence and characteristics of common injuries.

PM R 2021 May 30. Epub 2021 May 30.

Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.

Background: Understanding the prevalence and factors associated with running-related injuries in middle school runners may guide injury prevention.

Objective: To determine the prevalence of running-related injuries and describe factors related to a history of injury.

Design: Retrospective cross-sectional study.

Setting: Survey distributed online to middle school runners.

Methods: Participants completed a web-based survey regarding prior running-related injuries, training, sleep, diet, and sport participation.

Main Outcome Measurements: Prevalence and characteristics differentiating girls and boys with and without running-related injury history adjusted for age.

Participants: Youth runners (total: 2113, average age,  13.2 years; boys: n = 1255, girls: n = 858).

Results: Running-related injuries were more prevalent in girls (56% vs. 50%, p = .01). Ankle sprain was the most common injury (girls: 22.5%, boys: 21.6%), followed by patellofemoral pain (20.4% vs. 7.8%) and shin splints (13.6% vs. 5.9%); both were more prevalent in girls (p < .001). Boys more frequently reported plantar fasciitis (5.6% vs. 3.3%, p = .01), iliotibial band syndrome (4.1% vs. 1.4%, p = .001) and Osgood-Schlatter disease (3.8% vs. 1.2%, p = .001). Runners with history of running-related injuries were older, ran greater average weekly mileage, ran faster, had fewer average hours of sleep on weekends, skipped more meals, missed breakfast, and consumed less milk (all p < .05). Girls with history of running-related injuries reported higher dietary restraint scores, later age of menarche, more menstrual cycle disturbances, and higher likelihood of following vegetarian diets and an eating disorder diagnosis (all p < .05). Runners with no history of running-related injuries were more likely to have participated in ≥2 years of soccer or basketball (p < .001).

Conclusions: Most middle school runners reported a history of running-related injuries and certain injuries differing by gender. Modifiable factors with the greatest association with running-related injuries included training volume, dietary restraint, skipping meals, and less sleep. Sport sampling, including participation in ball sports, may reduce running-related injury risk in this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pmrj.12649DOI Listing
May 2021

Similar Functional Gains Using Radial Versus Combined Shockwave Therapy in Management of Plantar Fasciitis.

J Foot Ankle Surg 2021 Apr 14. Epub 2021 Apr 14.

Assistant Professor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA. Electronic address:

Plantar fasciitis is a common condition that causes foot pain. While shockwave therapy has been shown to provide successful results, comparative outcomes from different forms of shockwave therapy have yet to be described for this condition. In this retrospective cohort study, we describe findings from a quality improvement initiative assessing safety and functional outcomes for patients with plantar fasciitis treated with radial shockwave therapy (n = 20) or radial and focused shockwave therapy (combined shockwave, n = 18). Most were runners (n = 31, 81.6%), mean age was 43.3 ± 12.9 years, and average symptom duration 12.1 ± 11.1 months. All patients were prescribed an exercise program focusing on foot intrinsic strengthening. We hypothesized both groups would have improvement in function using the foot and Ankle Ability Measure, with a similar safety profile. Both radial and combined groups received similar number of total treatments (4.9 ± 2.5 and 4.1 ± 2.4, respectively; p = .33). Within group score changes for the Activities of Daily Living and Sports subscales were observed for both the radial (16.5 ± 16.3, p < .001; 31.7 ± 23.1, p < .001) and combined groups (19.8 ± 10.8, p = .001; 26.0 ± 21.5, p = .003). There was no difference in proportion of patients meeting the minimal clinically important difference between radial and combined groups regarding the Activities of Daily Living (14 (70%) vs 14 (77.8%), p = .58) and Sports subscales (17 (85%) vs 12 (75%), p = .45). Collectively, these findings suggest that a majority of patients with chronic plantar fasciitis may achieve functional gains using either form of shockwave therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.jfas.2021.04.013DOI Listing
April 2021

Drastic Reductions in Mental Well-Being Observed Globally During the COVID-19 Pandemic: Results From the ASAP Survey.

Front Med (Lausanne) 2021 26;8:578959. Epub 2021 Mar 26.

Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA, United States.

Most countries affected by the COVID-19 pandemic have repeatedly restricted public life to control the contagion. However, the health impact of confinement measures is hitherto unclear. We performed a multinational survey investigating changes in mental and physical well-being (MWB/PWB) during the first wave of the pandemic. A total of 14,975 individuals from 14 countries provided valid responses. Compared to pre-restrictions, MWB, as measured by the WHO-5 questionnaire, decreased considerably during restrictions (68.1 ± 16.9 to 51.9 ± 21.0 points). Whereas 14.2% of the participants met the cutoff for depression screening pre-restrictions, this share tripled to 45.2% during restrictions. Factors associated with clinically relevant decreases in MWB were female sex (odds ratio/OR = 1.20, 95% CI: 1.11-1.29), high physical activity levels pre-restrictions (OR = 1.29, 95% CI 1.16-1.42), decreased vigorous physical activity during restrictions (OR = 1.14, 95% CI: 1.05-1.23), and working (partially) outside the home vs. working remotely (OR = 1.29, 95% CI: 1.16-1.44/OR = 1.35, 95% CI: 1.23-1.47). Reductions, although smaller, were also seen for PWB. Scores in the SF-36 bodily pain subscale decreased from 85.8 ± 18.7% pre-restrictions to 81.3 ± 21.9% during restrictions. Clinically relevant decrements of PWB were associated with female sex (OR = 1.62, 95% CI: 1.50-1.75), high levels of public life restrictions (OR = 1.26, 95% CI: 1.18-1.36), and young age (OR = 1.10, 95% CI: 1.03-1.19). Study findings suggest lockdowns instituted during the COVID-19 pandemic may have had substantial adverse public health effects. The development of interventions mitigating losses in MWB and PWB is, thus, paramount when preparing for forthcoming waves of COVID-19 or future public life restrictions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fmed.2021.578959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032868PMC
March 2021

Physical Activity, Menstrual History, and Bone Microarchitecture in Female Athletes with Multiple Bone Stress Injuries.

Med Sci Sports Exerc 2021 Apr 7. Epub 2021 Apr 7.

Massachusetts General Hospital, Boston, MA United States Army Research Institute of Environmental Medicine, Natick MA Harvard Medical School, Boston MA Spaulding Rehabilitation Hospital, Cambridge MA Boston Children's Hospital, Boston MA Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA.

Bone stress injuries (BSIs) occur in up to 20% of runners and military recruits and those with a history of BSI have a 5-fold higher risk for a subsequent BSI. Yet, little is known about prior training, menstrual status and bone structure in runners who experience multiple BSIs.

Purpose: To determine differences in health and physical activity history, bone density, microarchitecture, and strength among female athletes with a history of multiple BSI, athletes with ≤1 BSI, and non-athletes.

Methods: We enrolled 101 women (ages 18-32 years) for this cross-sectional study: non-athlete controls (n=17) and athletes with a history of ≥ 3 BSIs (n=21) or ≤1 BSI (n=63). We collected subjects' health and training history and measured bone microarchitecture of the distal tibia via high-resolution peripheral quantitative computed tomography (HR-pQCT) and areal bone mineral density (aBMD) of the hip and spine by dual-energy X-ray absorptiometry (DXA).

Results: Groups did not differ according to age, BMI, age at menarche, aBMD, or tibial bone microarchitecture. Women with multiple BSIs had a higher prevalence of primary and secondary amenorrhea (p<0.01) compared to other groups. Total hours of physical activity in middle school were similar across groups; however, women with multiple BSIs performed more total hours of physical activity in high school (p=0.05), more hours of uniaxial loading in both middle school and high school (p=0.004, p=0.02) and a smaller proportion of multiaxial loading activity compared to other groups.

Conclusion: These observations suggest that participation in sports with multiaxial loading and maintaining normal menstrual status during adolescence and young adulthood may reduce the risk of multiple bone stress injuries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1249/MSS.0000000000002676DOI Listing
April 2021

A Narrative Review Evaluating Extracorporeal Shockwave Therapy as a Potential Regenerative Treatment for Musculoskeletal Conditions in Military Personnel.

Mil Med 2021 07;186(7-8):682-706

Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation Charlestown, MA 02138, USA.

Introduction: Extracorporeal shockwave therapy (ESWT) has a wide variety of clinical applications ranging from urology to orthopedics. Extracorporeal shockwave therapy is of particular interest to military medicine in the treatment of diverse musculoskeletal injuries, including recalcitrant tendinopathy. Much of the evidence for ESWT is from studies in the civilian population, including athletes. A few investigations have been conducted within military personnel. Musculoskeletal conditions within military personnel may contribute to pain and physical limitations. Optimal functional outcomes could be achieved through ESWT. The purpose of this narrative review is to summarize the current evidence on the efficacy of ESWT the in management of lower extremity musculoskeletal injuries in the military. Further, we explore the relative efficacy of ESWT compared to regenerative medicine procedures, including studies with treatment using platelet-rich plasma.

Materials And Methods: A literature review was performed in April 2020 to identify studies evaluating the use of ESWT for lower extremity conditions commonly observed in military personnel, including plantar fasciitis, Achilles tendinopathy, patellar tendinopathy, medial tibial stress syndrome, and knee arthritis. The literature search was completed by two researchers independently, using PubMed and Embase databases and same search terms. Disagreements were adjudicated by a senior author. Due to the paucity of relevant search results, the search term parameters were expanded to incorporate active participants.

Results: Two studies evaluated the use of ESWT in a military population for lower extremity injuries. This included a randomized control trial in active military with medial tibial stress syndrome and an unblinded retrospective study for the chronic plantar fasciitis condition. Both studies in the military had favorable outcomes in the use of ESWT compared to other treatment arms. The remaining studies predominantly included athletes. Although heterogeneity on the quality of the studies may prevent meta-analysis and limit the generalization of the findings, the majority of studies demonstrated an improvement in pain and return to activity using ESWT. Two studies using platelet-rich plasma as a treatment arm identified similar short-term outcomes compared to ESWT for Achilles tendinopathy and patellar tendinopathy.

Conclusion: Our findings suggest that ESWT is a safe and well-tolerated intervention with positive outcomes for lower extremity conditions commonly seen in the military. The few studies comparing ESWT to PRP suggest regenerative benefits similar to orthobiologics in the shorter term. More robust quality designed research may enable the evaluation of ESWT efficacy within the military population. In summary, the use of ESWT may provide pain reduction and improved function in active populations with lower extremity musculoskeletal injuries. Further research in the military is needed to evaluate shockwave efficacy in order to advance musculoskeletal care and improve outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/milmed/usab106DOI Listing
July 2021

Markers of Low Iron Status Are Associated with Female Athlete Triad Risk Factors.

Med Sci Sports Exerc 2021 Mar 12. Epub 2021 Mar 12.

University of Michigan Medical School, Ann Arbor, MI Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.

Purpose: The Female Athlete Triad (Triad) is common in female athletes. The Triad is caused by low energy availability (EA), which is often difficult to measure and has been postulated to be associated with low iron status. Here, we explore whether markers of low iron status may be associated with indicators of low EA including Triad risk factors.

Methods: 239 female NCAA Division I athletes completed pre-participation examinations that included Triad risk factors, medication/supplement use, diagnosis of anemia, and elected to complete dual-energy x-ray absorptiometry scan to measure bone mineral density (BMD). Association of markers of low iron (defined as self-report of iron supplementation and/or history of anemia) with each component of the Triad risk assessment score were assessed by stratifying low iron status across different levels of Triad risk category. Differences across iron status groups were assessed using Fisher exact testing.

Results: Every component of the Triad risk assessment score excluding delayed menarche was associated with low iron status. 11.5% of women reported low iron in the low-risk EA group, compared to 50% in the moderate-risk and 66.7% in the high-risk EA groups (P=0.02); respectively, these numbers were 11.6%, 25.0%, and 66.7% (P=0.02) for body mass index, 9.7%, 16.7%, and 25.0% (P<0.05) for oligomenorrhea, 10.3%, 45.5%, and 50.0% (P<0.01) for BMD, and 10.4%, 20.8%, and 30.8% (P=0.03) for history of stress reaction or fracture. Lean/endurance athletes were more likely to have low iron status than other athletes (15.5% vs. 3.4%, P=0.02).

Conclusion: Markers for low iron status were associated with Triad risk factors. Our study suggests that female athletes with history of anemia or iron supplementation may require further screening for low EA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1249/MSS.0000000000002660DOI Listing
March 2021

Does Magnetic Resonance Imaging Grading Correlate With Return to Sports After Bone Stress Injuries? A Systematic Review and Meta-analysis.

Am J Sports Med 2021 Mar 15:363546521993807. Epub 2021 Mar 15.

Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts, USA.

Background: While some studies have failed to reveal any significant relationship between magnetic resonance imaging (MRI) grading and return to sports after bone stress injuries, others have reported either a linear or nonlinear relationship.

Purpose: To evaluate the prognostic value of MRI grading for time to return to sports and rate of return to sports after bone stress injuries.

Study Design: Systematic review and meta-analysis.

Methods: A systematic search was performed in PubMed, Web of Science, SPORTDiscus, and Google Scholar. Studies reporting return to sports data after bone stress injuries using MRI grading systems were included in this review. The risk of bias was evaluated using the Quality in Prognosis Studies tool. Meta-analyses were performed to summarize the mean time to return to sports. The Pearson correlation was used to determine the relationship between time to return to sports and MRI grade. A meta-analysis of proportions was conducted to determine the percentage of athletes who successfully returned to sports.

Results: A total of 16 studies with 560 bone stress injuries met inclusion criteria. Higher MRI-based grading was associated with an increased time to return to sports ( < .00001). Pooled data revealed that higher MRI-based grading correlated with a longer time to return to sports ( = 0.554; = .001). Combining all anatomic locations, the mean time to return to sports was 41.7 days (95% CI, 30.6-52.9), 70.1 days (95% CI, 46.9-93.3), 84.3 days (95% CI, 59.6-109.1), and 98.5 days (95% CI, 85.5-112.6) for grade 1, 2, 3, and 4 injuries, respectively. Trabecular-rich sites of injury (eg, pelvis, femoral neck, and calcaneus) took longer to heal than cortical-rich sites of injury (eg, tibia, metatarsal, and other long-bone sites of injury). Overall, more than 90% of all athletes successfully returned to sports.

Conclusion: The findings from this systematic review indicate that MRI grading may offer a prognostic value for time to return to sports after the nonsurgical treatment of bone stress injuries. Both MRI grade and location of injury suggest that individually adapted rehabilitation regimens and therapeutic decisions are required to optimize healing and a safe return to sports.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0363546521993807DOI Listing
March 2021

Recommendations on Youth Participation in Ultra-Endurance Running Events: A Consensus Statement.

Sports Med 2021 Jun 11;51(6):1123-1135. Epub 2021 Mar 11.

University of Washington and Seattle Children's Sports Medicine, Seattle, WA, USA.

Participation in ultra-endurance running (UER) events continues to grow across ages, including youth athletes. The 50- and 100-km are the most popular distances among youth athletes. Most youth athletes are between 16-18 years; however, some runners younger than 12 years have successfully completed UER events. Parents, athletes, coaches, race directors, and medical professionals often seek advice regarding the safety of youth athletes participating in these events, especially with regard to potential short and long-term health consequences. UER may impact key organ systems during growth and development. We propose a decision-making process, based on current knowledge and the experience of the consensus group that addresses age regulations, medical and psychological well-being, training status and race-specific factors (such as distance, elevation change, remoteness, ambient temperatures, level of medical assistance, and type of provisions provided by the race organizers) to use until evidence of long-term consequences of UER in youth athletes is available. These recommendations are aimed at safe participation in UER events for youth athletes with a proper and individualized assessment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40279-021-01441-wDOI Listing
June 2021

A Pandemic within the Pandemic? Physical Activity Levels Substantially Decreased in Countries Affected by COVID-19.

Int J Environ Res Public Health 2021 02 24;18(5). Epub 2021 Feb 24.

Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA 02129, USA.

Governments have restricted public life during the COVID-19 pandemic, inter alia closing sports facilities and gyms. As regular exercise is essential for health, this study examined the effect of pandemic-related confinements on physical activity (PA) levels. A multinational survey was performed in 14 countries. Times spent in moderate-to-vigorous physical activity (MVPA) as well as in vigorous physical activity only (VPA) were assessed using the Nordic Physical Activity Questionnaire (short form). Data were obtained for leisure and occupational PA pre- and during restrictions. Compliance with PA guidelines was calculated based on the recommendations of the World Health Organization (WHO). In total, n = 13,503 respondents (39 ± 15 years, 59% females) were surveyed. Compared to pre-restrictions, overall self-reported PA declined by 41% (MVPA) and 42.2% (VPA). Reductions were higher for occupational vs. leisure time, young and old vs. middle-aged persons, previously more active vs. less active individuals, but similar between men and women. Compared to pre-pandemic, compliance with WHO guidelines decreased from 80.9% (95% CI: 80.3-81.7) to 62.5% (95% CI: 61.6-63.3). Results suggest PA levels have substantially decreased globally during the COVID-19 pandemic. Key stakeholders should consider strategies to mitigate loss in PA in order to preserve health during the pandemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph18052235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967678PMC
February 2021

Individual and cumulative health afflictions are associated with greater impairment in physical and mental function in former professional American style football players.

PM R 2021 Feb 28. Epub 2021 Feb 28.

Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.

Background: Former American style football players (ASF players) have recognized health concerns associated with prior sport participation. It remains unknown whether categorizations of current health conditions, referred to in this report as afflictions (conceptually framed as neurocognitive, cardiovascular, cardiometabolic, sleep apnea, and chronic pain) are associated with physical and mental function.

Objective: To evaluate the association of afflictions to physical and mental function. It was hypothesized that former National Football League players with any affliction would have worse function compared to unafflicted participants. It was anticipated that multiple afflictions would result in cumulative loss of function.

Design: Cross-sectional retrospective design.

Setting: Academic medical multisite hospital system.

Participants: A total of 3913 of 15,611 former ASF players who played professionally from 1960 to 2019 (response rate 25%). Assessment of Risk Factors Self-report survey.

Main Outcome Measures: Each participant completed the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale and Physical Function questionnaires. Responses were used to generate two physical function and one mental function subscale scores. Raw scores were converted to T-scores categorized as impaired (T-score < 40) or unimpaired (T-score ≥ 40). Primary analyses measured the association of affliction to function (impaired or unimpaired).

Results: After adjusting for confounders (age, race, position, number of seasons, age of first exposure to football, alcohol use, smoking history, and current body mass index), each affliction was associated with reduced physical function on the Global physical function subscale (risk ratio [RR] = 1.23-2.45, all P < .005), physical function scale (RR = 1.24-2.75, all P < .01), and mental function scale (RR = 1.34-2.87, all P < .001), except that cardiovascular affliction was not associated with mental function (RR = 1.15, P = .15). The lowest functional measures were observed in those afflicted by chronic pain. Cumulative afflictions were associated with worse function.

Conclusions: Afflictions are associated with cumulative reduction of function. Research evaluating how afflictions interact may help elucidate mechanisms for illness and develop interventions to optimize function.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pmrj.12581DOI Listing
February 2021

Defining a Research Agenda for Youth Sport Specialization in the United States: The AMSSM Youth Early Sport Specialization Summit.

Clin J Sport Med 2021 Mar;31(2):103-112

Musculoskeletal Clinical Program, Intermountain Healthcare, Salt Lake City, Utah; and.

Abstract: Sport specialization is becoming increasingly common among youth and adolescent athletes in the United States and many have raised concern about this trend. Although research on sport specialization has grown significantly, numerous pressing questions remain pertaining to short- and long-term effects of specialization on the health and well-being of youth, including the increased risk of overuse injury and burnout. Many current elite athletes did not specialize at an early age. Methodological and study design limitations impact the quality of current literature, and researchers need to prioritize pressing research questions to promote safe and healthy youth sport participation. The American Medical Society for Sports Medicine hosted a Youth Early Sport Specialization Summit in April 2019 with the goal of synthesizing and reviewing current scientific knowledge and developing a research agenda to guide future research in the field based on the identified gaps in knowledge. This statement provides a broad summary of the existing literature, gaps and limitations in current evidence, and identifies key research priorities to help guide researchers conducting research on youth sport specialization. Our goals are to help improve the quality and relevance of research on youth sport specialization and to ultimately assure that opportunities for healthy and safe sport participation continue for all youth.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JSM.0000000000000900DOI Listing
March 2021

High Prevalence of Hip and Knee Arthroplasty in Former Professional American Style Football Players: A Call to Action.

Curr Sports Med Rep 2021 Feb;20(2):67-68

Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1249/JSR.0000000000000804DOI Listing
February 2021

Defining a research agenda for youth sport specialisation in the USA: the AMSSM Youth Early Sport Specialization Summit.

Br J Sports Med 2021 Feb;55(3):135-143

Musculoskeletal Clinical Program, Intermountain Health Care Inc, Salt Lake City, Utah, USA.

Sport specialisation is becoming increasingly common among youth and adolescent athletes in the USA and many have raised concern about this trend. Although research on sport specialisation has grown significantly, numerous pressing questions remain pertaining to short-term and long-term effects of specialisation on the health and well-being of youth, including the increased risk of overuse injury and burnout. Many current elite athletes did not specialise at an early age. Methodological and study design limitations impact the quality of current literature, and researchers need to prioritise pressing research questions to promote safe and healthy youth sport participation. The American Medical Society for Sports Medicine hosted a Youth Early Sport Specialization Summit in April 2019 with the goal of synthesising and reviewing current scientific knowledge and developing a research agenda to guide future research in the field based on the identified gaps in knowledge. This statement provides a broad summary of the existing literature, gaps and limitations in current evidence and identifies key research priorities to help guide researchers conducting research on youth sport specialisation. Our goals are to help improve the quality and relevance of research on youth sport specialisation and to ultimately assure that opportunities for healthy and safe sport participation continue for all youth.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjsports-2020-102699DOI Listing
February 2021

Changes in Volumetric Bone Mineral Density Over 12 Months After a Tibial Bone Stress Injury Diagnosis: Implications for Return to Sports and Military Duty.

Am J Sports Med 2021 01 1;49(1):226-235. Epub 2020 Dec 1.

Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.

Background: Bone stress injuries (BSIs) occur in up to 20% of runners and military personnel. Typically, after a period of unloading and gradual return to weightbearing activities, athletes return to unrestricted sports participation or military duty approximately 4 to 14 weeks after a BSI diagnosis, depending on the injury location and severity. However, the time course of the recovery of the bone's mechanical competence is not well-characterized, and reinjury rates are high.

Purpose: To assess the bone microarchitecture and volumetric bone mineral density (vBMD) over 12 months after a tibial BSI diagnosis.

Study Design: Case-control study; Level of evidence, 3.

Methods: We enrolled 30 female athletes from the local community (aged 18-35 years) with a tibial BSI (grade ≥2 of 4 on magnetic resonance imaging) for this prospective observational study. Participants completed a baseline visit within 3 weeks of the diagnosis. At baseline and 6, 12, 24, and 52 weeks after the BSI diagnosis, we collected high-resolution peripheral quantitative computed tomography scans of the ultradistal tibia (4% of tibial length) of the injured and uninjured legs as well as pain and physical activity assessment findings.

Results: From baseline to 12 weeks after the diagnosis, total, trabecular, and cortical vBMD declined by 0.58% to 0.94% ( < .05 for all) in the injured leg. Total and trabecular vBMD also declined by 0.61% and 0.67%, respectively, in the uninjured leg ( < .05 for both). At 24 weeks, mean values for all bone parameters were nearly equivalent to baseline values, and by 52 weeks, several mean values had surpassed baseline values. Of the 30 participants, 10 incurred a subsequent BSI during the course of the study, and 1 of these 10 incurred 2 subsequent BSIs. Participants who suffered an additional BSI were younger and had a later age of menarche, a greater incidence of previous fractures, and lower serum parathyroid hormone levels ( < .05 for all).

Conclusion: Bone density declined in both the injured and the uninjured legs and, on average, did not return to baseline for 3 to 6 months after a tibial BSI diagnosis. The observed time to the recovery of baseline vBMD, coupled with the high rate of recurrent BSIs, suggests that improved return-to-sports and military duty guidelines may be in order.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0363546520971782DOI Listing
January 2021

A comparison of attachment methods of skin mounted inertial measurement units on tibial accelerations.

J Biomech 2020 12 8;113:110118. Epub 2020 Nov 8.

Spaulding National Running Center, Dept. of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA, United States.

Peak tibial accelerations during running are of interest because of their correlation with vertical ground reaction force load rates and association with running injury. Previous work has demonstrated systematically lower accelerations measured with a bone- compared to skin-mounted accelerometer. However, no studies have assessed the effects of more or less secure attachment methods for skin mounted sensors. Our purpose was to compare two methods of attaching a skin mounted sensor on mean tibial accelerations, stride-to-stride variability, and correlations with vertical load rates. 18 injury-free runners were recruited as participants. An inertial measurement unit, containing a tri-axial accelerometer, was used to record tibial accelerations while participants ran at a self-selected speed on an instrumented treadmill to collect ground reaction forces. The two attachment methods for securing the sensor to the skin were a manufacturer-provided strap (strap condition) and a combination of tape and elastic wraps (wrap condition). Mean vertical accelerations were significantly lower in the wrap condition (p = 0.02, d = 0.57). No differences were detected in resultant accelerations, vertical loading rates, or stride-to-stride variability. Correlations between tibial accelerations and vertical loading rates were strong (r = 0.79-0.91) and similar between conditions. These results provide two key findings of evidence. Evidenced by systematically lower vertical accelerations, a more secure attachment method may be necessary for capturing the most representative measure of tibial accelerations during running. However, a less secure method (i.e. the strap) is sufficient for capturing tibial accelerations as a surrogate for impact loading forces.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jbiomech.2020.110118DOI Listing
December 2020

Sport Specialization and Low Bone Mineral Density in Female High School Distance Runners.

J Athl Train 2020 Dec;55(12):1239-1246

Department of Family Medicine and Public Health, University of California San Diego, La Jolla.

Context: Sport specialization may contribute to sport injury and menstrual dysfunction in female high school distance runners. Despite the recent growth in sport specialization, including among high school-aged runners, the association of sport specialization with bone mineral density (BMD) remains poorly described.

Objective: To evaluate whether sport specialization was associated with BMD in female high school distance runners.

Design: Cross-sectional study.

Setting: Six high schools.

Patients Or Other Participants: Sixty-four female runners (age = 15.6 ± 1.4 years) who competed in cross-country or track distance events and were not currently on birth control medication.

Main Outcome Measure(s): Each runner completed a survey on menstrual history and sport participation. Height and weight were measured, and dual-energy x-ray absorptiometry was used to measure whole-body, spine, and hip BMD. Each runner was assigned a sport specialization status: low (participation in ≥1 nonrunning sport and distance-running sport(s) for ≤8 mo/y); moderate (participation in both distance-running sport(s) ≥9 mo/y and ≥1 nonrunning sport(s) or limited to distance-running sport(s) for ≤8 mo/y); or high (participation only in distance-running sport(s) for ≥9 mo/y). Multivariable logistic regression was performed to determine the adjusted odds ratio and 95% confidence interval for sport specialization to BMD values, adjusting for body mass index and gynecological age.

Results: Overall, 21.9%, 37.5%, and 40.6% of participants were high, moderate, or low sport specializers, respectively. Low BMD (spine or whole-body BMD z score < -1.0 [standardized by age and sex normative values]) was present in 23 (35.9%) runners. Compared with low sport specializers, high sport specializers were 5 times more likely (adjusted odds ratio = 5.42, 95% confidence interval = 1.3, 23.3; P = .02) to have low BMD.

Conclusions: A high level of sport specialization in high school female distance runners may be associated with a heightened risk for low BMD. Further investigation of this association is warranted due to the health concerns about low BMD in adolescent female runners.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4085/1062-6050-0547.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7740056PMC
December 2020

A Narrative Review of Metatarsal Bone Stress Injury in Athletic Populations: Etiology, Biomechanics, and Management.

PM R 2020 Nov 6. Epub 2020 Nov 6.

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA.

Metatarsal bone stress injuries (BSIs) are common in athletic populations. BSIs are overuse injuries that result from an accumulation of microdamage that exceeds bone remodeling. Risk for metatarsal BSI is multifactorial and includes factors related to anatomy, biology, and biomechanics. In this article, anatomic factors including foot type, metatarsal length, bone density, bone geometry, and intrinsic muscle strength, which each influence how the foot responds to load, are discussed. Biologic factors such as low energy availability and impaired bone metabolism influence the quality of the bone. Finally, the influence of biomechanical loads to bone such as peak forces, load rates, and loading cycles are reviewed. General management of metatarsal BSI is discussed, including acute care, rehabilitation, treatment of refractory metatarsal BSI, and evaluation of healing/return to sport. Finally, we identify future research priorities and emerging treatments for metatarsal BSI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pmrj.12518DOI Listing
November 2020

Youth running consensus statement: minimising risk of injury and illness in youth runners.

Br J Sports Med 2021 Mar 29;55(6):305-318. Epub 2020 Oct 29.

Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA.

Despite the worldwide popularity of running as a sport for children, relatively little is known about its impact on injury and illness. Available studies have focused on adolescent athletes, but these findings may not be applicable to preadolescent and pubescent athletes. To date, there are no evidence or consensus-based guidelines identifying risk factors for injury and illness in youth runners, and current recommendations regarding suitable running distances for youth runners at different ages are opinion based. The International Committee Consensus Work Group convened to evaluate the current science, identify knowledge gaps, categorise risk factors for injury/illness and provide recommendations regarding training, nutrition and participation for youth runners.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjsports-2020-102518DOI Listing
March 2021

Prevalence of total hip and knee arthroplasty in former National Football League players: comparison with the general US population and other populations of professional athletes.

BMJ Open Sport Exerc Med 2020 7;6(1):e000833. Epub 2020 Sep 7.

Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.

Objectives: To evaluate the prevalence of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a population of former National Football League (NFL) players.

Methods: Participants were 3913 former NFL players (participation in years 1960-2019) who completed either an online or mailed survey that included self-reported TKA and THA, year(s) of surgery and date of birth. The prevalence of TKA and THA was reported by age category and compared to published cohorts of athlete populations and general population of non-athletes in the USA.

Results: 12.3% and 8.1% of sample reported TKA and THA, respectively. The prevalence of both TKA and THA was higher in former NFL players compared to US non-athletes across all ages. Prevalence of TKA was not statistically higher than in other former athlete cohorts but performed at younger ages. The prevalence of TKA and THA was higher than in other cohorts of former NFL players.

Conclusion: Former NFL players had higher prevalence of arthroplasty than the general population, suggesting prior participation in American-style football may contribute to elevated risk for arthroplasty at younger ages. Understanding risk factors in style of play, lifestyle and other contributors is important to improve joint health of this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjsem-2020-000833DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520548PMC
September 2020

Lower Trabecular Bone Score and Spine Bone Mineral Density Are Associated With Bone Stress Injuries and Triad Risk Factors in Collegiate Athletes.

PM R 2020 Oct 10. Epub 2020 Oct 10.

Boswell Human Performance Laboratory, Department of Orthopaedic Surgery, Stanford, CA.

Introduction: Determinants of bone health and injury are important to identify in athletes. Bone mineral density (BMD) is commonly measured in athletes with Female Athlete Triad (Triad) risk factors; the trabecular bone score (TBS) has been proposed to predict fracture risk independent of BMD. Evaluation of TBS and spine BMD in relation bone stress injury (BSI) risk has not been studied in female collegiate athletes.

Objective: We hypothesized that spine BMD and TBS would each independently predict BSI and that the combined measures would improve injury prediction in female collegiate athletes. We also hypothesized that each measure would be correlated with Triad risk factors.

Design: Retrospective cohort.

Setting: Academic Institution.

Methods: Dual energy x-ray absorptiometry (DXA) of the lumbar spine was used to calculate BMD and TBS values. Chart review was used to identify BSI that occurred after the DXA measurement and to obtain Triad risk factors. We used logistic regression to examine the ability of TBS and BMD alone or in combination to predict prospective BSI.

Results: Within 321 athletes, 29 (9.0%) sustained a BSI after DXA. BMD and TBS were highly correlated (Pearson correlation r = 0.62, P < .0001). Spine BMD and TBS had similar ability to predict BSI; the C-statistic and 95% confidence intervals were 0.69 (0.58 to 0.81) for spine BMD versus 0.68 (0.57 to 0.79) for TBS. No improvement in discrimination was observed with combined BMD + TBS (C-statistic 0.70, 0.59 to 0.81). Both TBS and BMD predicted trabecular-rich BSI (defined as pelvis, femoral neck, and calcaneus) better than cortical-rich BSI. Both measures had similar correlations with Triad risk factors.

Conclusion: Lower BMD and TBS values are associated with elevated risk for BSI and similar correlation to Triad risk factors. TBS does not improve prediction of BSI. Collectively, our findings suggest that BMD may be a sufficient measure of skeletal integrity from DXA in female collegiate athletes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pmrj.12510DOI Listing
October 2020

Impact-Related Ground Reaction Forces Are More Strongly Associated With Some Running Injuries Than Others.

Am J Sports Med 2020 10 11;48(12):3072-3080. Epub 2020 Sep 11.

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.

Background: Inconsistent associations have been reported for impact-related ground reaction force variables and running injuries when grouping all injuries together. However, previous work has shown more consistent associations when focusing on specific injuries.

Purpose: To compare ground reaction force variables between healthy and injured runners as a group and within specific common injuries.

Study Design: Controlled laboratory study.

Methods: A total of 125 runners presenting with patellofemoral pain, tibial bone stress injury, plantar fasciitis, Achilles tendinopathy, or iliotibial band syndrome and 65 healthy controls completed an instrumented treadmill assessment at a self-selected speed. Impact-related ground reaction force variables included vertical average (VALR) and instantaneous (VILR) load rates, posterior and medial/lateral instantaneous load rates, and vertical stiffness at initial loading (VSIL). Mean comparisons were made between the general and specific injury and control groups (α = .05). Cutoff thresholds were established and evaluated using several criteria.

Results: VALR (+17.5%; < .01), VILR (+15.8%; < .01), and VSIL (+19.7%; < .01) were significantly higher in the overall injured versus control groups. For individual injuries, VALR, VILR, and VSIL were significantly higher for patellofemoral pain (+23.4%-26.4%; < .01) and plantar fasciitis (+17.5%-29.0%; < .01), as well as VSIL for Achilles tendinopathy (+29.4%; < .01). Cutoff thresholds showed better diagnostic criteria for individual versus grouped injuries.

Conclusion: Impact variables (VALR, VILR, and VSIL) were significantly higher when assessing the injured group as a whole. However, these findings were driven by specific injury groups, highlighting the importance of taking an injury-specific approach to biomechanical risk factors for running injury.

Clinical Relevance: These results suggest that practitioners may want to address impact loading in their treatment of injured runners, especially in those with patellofemoral pain and plantar fasciitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0363546520950731DOI Listing
October 2020

Restrictercise! Preferences Regarding Digital Home Training Programs during Confinements Associated with the COVID-19 Pandemic.

Int J Environ Res Public Health 2020 09 7;17(18). Epub 2020 Sep 7.

Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), Sao Paulo 03071-000, Brazil.

Confinement measures during the COVID-19 pandemic have caused substantial reductions in global physical activity (PA) levels. In view of the manifold health benefits of PA, the development of interventions counteracting this trend is paramount. Our survey with 15,261 participants (38 ± 15 years, 58.5% females) examined preferences towards digital home exercise programs in 14 countries affected by COVID-19. More than two-thirds of the sample (68.4%, = 10,433) indicated being interested in home exercise, and most participants were willing to work out at least three times per week (89.3%, = 9328). Binary logistic regression revealed that female sex, working part-time, younger age, and being registered in a gym were associated with willingness to exercise. Flexibility (71.1%, = 7377), resistance (68.6%, = 7116), and endurance training (62.4%, = 6478) were the most preferred types of exercise. Our results may guide health providers in developing individually tailored PA interventions during the current and future pandemics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17186515DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559166PMC
September 2020

Management of Hamstring Pain in an Elite Female Para-Swimming Athlete Using Radial Shockwave Therapy: A Case Report.

PM R 2020 Sep 5. Epub 2020 Sep 5.

Spaulding Rehabilitation Hospital, Charlestown, MA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pmrj.12482DOI Listing
September 2020

Evidence-Based Physiatry: Treatment of Midportion Achilles Tendinopathy.

Am J Phys Med Rehabil 2020 12;99(12):1189-1190

From the Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts (AST); and Harvard University T.H. Chan School of Public Health, Boston, Massachusetts (HCR).

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PHM.0000000000001583DOI Listing
December 2020

Outpatient Physical, Occupational, and Speech Therapy Synchronous Telemedicine: A Survey Study of Patient Satisfaction with Virtual Visits During the COVID-19 Pandemic.

Am J Phys Med Rehabil 2020 11;99(11):977-981

From the Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (AST, HB, GP, HS, ISD, JKS); Spaulding Rehabilitation Hospital, Boston, Massachusetts (AST, HB, GP, HS, ISD, JKS); Brigham and Women's Hospital, Boston, Massachusetts (GP, JKS); Spaulding Outpatient Center Wellesley, Wellesley, Massachusetts (KC); Spaulding Outpatient Center for Children Lexington, Lexington, Massachusetts (MO); and Massachusetts General Hospital, Boston, Massachusetts (JKS).

The COVID-19 pandemic transformed health care delivery, including rapid expansion of telehealth. Telerehabilitation, defined as therapy provided by physical therapy, occupational therapy, and speech and language pathology, was rapidly adopted with goals to provide access to care and limit contagion. The purpose of this brief report was to describe the feasibility of and satisfaction with telerehabilitation. A total of 205 participants completed online surveys after a telerehabilitation visit. Most commonly, participants were women (53.7%), 35-64 yrs old, and completed physical therapy (53.7%) for established visits of 30-44 mins in duration for primary impairments in sports, lower limb injuries, and pediatric neurology. Overall, high ratings ("excellent" or "very good" responses) were observed for all patient-centered outcome metrics (range, 93.7%-99%) and value in future telehealth visit (86.8%) across telerehabilitation visits. Women participated more frequently and provided higher ratings than male participants did. Other benefits included eliminating travel time, incorporating other health care advocates, and convenience delivering care in familiar environment to pediatric patients. Technology and elements of hands-on aspects of care were observed limitations. Recognizing reduced indirect costs of care that telerehabilitation may provide along with high patient satisfaction are reasons policy makers should adopt these services into future health care delivery models.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PHM.0000000000001571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526401PMC
November 2020

Improved Function in a Runner With Hereditary Spastic Paraparesis With Use of Extracorporeal Shockwave Therapy: Personal Clinical Experience.

Am J Phys Med Rehabil 2021 05;100(5):e66-e68

From the Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, Massachusetts (CR, SP, AST); and Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts (SB).

Abstract: A 59-yr-old male marathon runner presented with recent diagnosis of hereditary spastic paraplegia in the setting of gait deviation and spasticity. He noted asymmetric wear pattern of his right shoe and toe drag, with recent development of left lower limb pain and cramping attributed to spasticity. He elected to proceed with radial extracorporeal shockwave treatment targeting the affected muscles. The night following initial treatment, he was able to run 2 mins per mile faster over a 4-mile run with resolution of toe drag. He completed six sessions of radial extracorporeal shockwave treatment along with maintaining regular cardiovascular exercise and strength training. He was seen 6 wks after a series of treatment with recent worsening and toe drag that recurred. He completed further sessions with return to improved function seen after his initial series of shockwave and ability to return to running up to 13 miles. His neurologic symptoms remained controlled without noted progression. This case illustrates the potential use of radial extracorporeal shockwave treatment in spasticity management of hereditary spastic paraplegia and that more frequent sessions may be required to maintain benefits of treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PHM.0000000000001547DOI Listing
May 2021
-->