Lower limb stress fractures are common injuries in runners. In terms of treatment, much of the medical literature has focused primarily on rest and cessation of running, but little has been written about the rehabilitation and functional progression of runners following a lower limb stress fracture. This article reviews the scientific evidence behind common rehabilitation concepts used for runners recovering from these injuries and also discusses sport-specific training modalities such as deep water running and antigravity treadmill training. Overall this article is intended to be a practical resource for clinicians to guide runners in functional rehabilitation and return to running following lower limb stress injury.
Acetabular labral tear is an uncommon cause of hip pain in the skeletally immature athlete. Treatment outcomes have mostly been described in the surgical literature. We present a case report of a premenarchal 12-year-old figure skater who was diagnosed with an isolated acetabular labral tear without hip deformity. With nonoperative treatment, she was able to return to pain-free competitive figure skating 4 months after her onset of symptoms. Our findings suggest that acetabular labral tears in the skeletally immature athlete can respond to a trial of nonoperative management.
Background:Conservative management plays an important role in the treatment of carpal tunnel syndrome. Non-surgical options include physical and occupational therapy, splints, steroid injections, yoga, carpal bone mobilization, and anti-inflammatory drugs. Clinical experience demonstrates that acupuncture should be considered among these treatments as it may provide symptomatic relief to patients with this disorder. Objective: To demonstrate an acupuncture protocol for the treatment of carpal tunnel syndrome. Design, Setting, and Patients: Seventeen patients with electrodiagnostically confirmed carpal tunnel syndrome treated by a solo medical acupuncture practitioner for carpal tunnel syndrome. Patients were seen between 1998 and 2007 at the practitioner's New York office. Intervention: Needling of PC 6, PC 7, TH 5, and Baxie 1 and 2 points. Most patients additionally received osteopathic manual therapy. Main Outcome Measure: Patient-reported symptom relief. Results: Twelve of 17 patients had partial or complete symptom relief with treatment. Two patients' symptoms were considered too severe for acupuncture treatment. The remaining 3 patients had no appreciable change in their symptoms. Conclusion: The acupuncture method described herein can be an effective treatment for mild to moderate carpal tunnel syndrome. This report should prompt a larger prospective trial.
Resting VO2 for adults with motor-complete paraplegia is 3.0 mL O2/kg/min, which is lower than standard resting VO2 in able-bodied individuals. Progressively more energy is required to perform MWP, LBD, and POTs, respectively. Use of the standard METs formula may underestimate the level of intensity an individual with SCI uses to perform physical activities.
Medicine recommendations for duration and intensity of exercise are based on the amount of energy expenditure required to maintain cardiovascular health in able body individuals; 1000 Kilocalories (Kcals) per week of energy expenditure has been demonstrated to achieve this effect. Manual wheelchair propulsion (MWP) represents a practical and accessible form of exercise for individuals with paraplegia. Objective: To describe a method to determine the duration of MWP required to expend 1000 Kcals, when performed by individuals with paraplegia due to motor-complete spinal cord injury (SCI). Study Design: Cross-sectional study. Setting: Rehabilitation Research Laboratory. Participants: Sixteen adults with motor complete T3-T12 paraplegia (body mass index < 35, duration of paraplegia > 3 months). Interventions: Not applicable. Main Outcome Measures: Indirect calorimetry during MWP was measured in order to calculate caloric expenditure per minute. These data were used to calculate the number of minutes of MWP required to expend 1000 Kcal in one week. Results: During MWP, participants expended 3.3 ± 1.0 Kcal/minute. Based on this figure, 1000 Kcal of energy expenditure in one week would require 303 minutes of MWP per week, or 43.3 minutes per day, 7 days per week. Conclusions: Our data suggest that it is feasible to create a practical and accessible exercise recommendation based on manual wheelchair propulsion for individuals with paraplegia due to motor-complete SCI. Larger studies are needed in order to develop accurate exercise recommendations for persons with SCI.
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