Physical Therapy Newswire

Epidemiology study finds rise in weight-training injuries

More than 970,000 weight training-related injuries nationwide were treated in hospital emergency departments from 1990 to 2007 suggesting an almost 50% increase during the 18-year period, according to results of a study conducted by researchers from the Center for Injury Research and Policy (CIRP) at the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio.

Dawn Comstock, PhD, and colleagues at CIRP used the National Electronic Injury Surveillance System data for their study which was published in the American Journal of Sports Medicine.

Comstock and her colleagues found that men and youth aged 13 to 24 years incurred the greatest proportion of weight training-related injuries among the general U.S. population during the study period.

The study analyzed the epidemiology of injuries directly related to weight training across all age groups of the general population treated in U.S. emergency departments during the last 2 decades, according to a Nationwide Children’s Hospital press release.

Seek professional advice

“Before beginning a weight-training program, it is important that people of all ages consult with a health professional, such as a doctor or athletic trainer, to create a safe training program based on their age and capabilities,” Comstock, a faculty member of the Ohio State University College of Medicine, stated in the release.

The study confirmed that weight-training injuries affect men more than women, but detected a larger increase in the rates of injury among women.

“The increase in incidence among female participants is likely the result of more women weight training as it becomes a more accepted fitness activity for women,” Comstock noted.

Take care with free weights

The study also noted the following:

that 90% of injuries occurred during the use of free weights;
the most common mechanism of injury was a weight dropping on a person (65%);
the most frequently occurring injuries were to the upper (25%) and lower trunk (20%);
a 19% incidence of hand injuries; and
that sprains and strains were diagnosed most often (46%), followed by soft tissue injuries (18%).

The investigators found that injury rates increased the most in weight trainers aged 45 years and older, but those aged 55 or older were more likely to be injured on weight-training machines or from overexerting themselves. Young people, however, appeared more vulnerable to injury from using free weights.

Reference:

Kerr ZY, Collins CL, Comstock RD. Epidemiology of weight training-related injuries presenting to United States emergency departments, 1990 to 2007. Am J Sports Med. 2010;38:765-771.

Source: http://www.orthosupersite.com/view.aspx?rid=63374

*************

Avoiding Surgery for Low Back Pain

Many patients may benefit more from non-invasive treatments:

ROSEMONT, Ill., Feb. 2 /PRNewswire-USNewswire/ -- The simplest method for treating low back pain may actually be the best method. A literature study published in the February 2009 issue of The Journal of the American Academy of Orthopaedic Surgeons (http://www.jaaos.org/) finds that in most cases of symptomatic lumbar degenerative disk disease, a common cause of low back pain, the most effective treatment is simply a combination of physical therapy and anti-inflammatory medication.
Symptomatic lumbar degenerative disc disease occurs when a disc weakens, often due to the effects of aging, repetitive strain or injury to the disc space. The result is that the disc cannot hold the vertebrae as well as it used to, and that lack of stability can cause low back pain. In some cases, the pain is great enough that the patient may seek treatment from an orthopaedic surgeon. These treatments can include a range of noninvasive and invasive/surgical options.
According to the review findings:

1. 90 percent of patients with low back pain will see their symptoms fade on their own within three months.

2. Most of those patients will recover within six weeks.

Therefore, the researchers determined that, barring an emergency, the initial treatment of all patients with low back pain should be noninvasive.

"Recently, disc replacement surgery has been proposed as a cure or treatment for symptomatic lumbar disc disease," says Luke Madigan, M.D., an attending physician at Knoxville Orthopaedic Clinic, Knoxville, TN, and the lead author of the review. "But the FDA studies on lumbar disc replacement have only so far shown equivalence to fusion for discogenic disease. Long-term outcomes are still to be published and caution should be exercised with their use." Madigan also notes that in the past, surgical fusion was used to treat this condition, and the success rate was 50-60 percent.

Meanwhile, noninvasive treatments have brought about greater success by helping patients strengthen the injured area and prevent further strain:

1. Physical therapy that focuses on strengthening core muscle groups in the abdominal area and the lower back has demonstrated positive effects in patients with disc-related pain.

2. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen have been found effective for short-term relief of low back pain, and no NSAID was found to be any more effective than the others.

3. Educating patients on better body mechanics -- for example, lifting with the legs instead of the back -- is found to lessen the strain that is placed on the lumbar region.

4. Another recent literature review advocated mobilization or activity in the treatment of low back pain as opposed to bed rest, and exercise has been shown to improve function and decrease pain in adult patients with chronic low back pain.

5. Braces have not been found to be effective in treating low back pain, although whether patients actually wear the brace in the prescribed manner may be a factor.

Invasive treatment should only be explored if these and other noninvasive treatments have not been effective.

"Surgery should be the last option, but too often patients think of surgery as a cure all and are eager to embark on it," Madigan says. "Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it."

Source:

JAAOS (http://www.jaaos.org)

AAOS (http://www.aaos.org/)

Orthoinfo.org (http://www.orthoinfo.org/)

Low back pain (http://orthoinfo.aaos.org/topic.cfm?topic=A00311)

***********************************************

APTA'S Tips for Avoiding Bike-Fit Related Injuries (source: www.apta.org)

Postural Tips

Change hand position on the handlebars frequently for upper body comfort.
Keep a controlled but relaxed grip of the handlebars.
When pedaling, your knee should be slightly bent at the bottom of the pedal stroke. Avoid rocking your hips while pedaling.

Common Bicycling Pains

Anterior (Front) Knee Pain. Possible causes are having a saddle that is too low, pedaling at a low cadence (speed), using your quadriceps muscles too much in pedaling, misaligned bicycle cleat for those who use clipless pedals, and muscle imbalance in your legs (strong quadriceps and weak hamstrings).
Neck Pain. Possible causes include poor handlebar or saddle position. A poorly placed handlebar might be too low, at too great a reach, or at too short a reach. A saddle with excessive downward tilt can be a source of neck pain.
Lower Back Pain. Possible causes include inflexible hamstrings, low cadence, using your quadriceps muscles too much in pedaling, poor back strength, and too-long or too-low handlebars.
Hamstring Tendinitis. Possible causes are inflexible hamstrings, high saddle, misaligned bicycle cleat, and poor hamstring strength.
Hand Numbness or Pain. Possible causes are short-reach handlebars, poorly placed brake levers, and a downward tilt of the saddle.
Foot Numbness or Pain. Possible causes are using quadriceps muscles too much in pedaling, low cadence, faulty foot mechanics, and misaligned bicycle cleat for those who use clipless pedals.
Ilio-Tibial Band Tendinitis. Possible causes are too-high saddle, leg length difference, and misaligned bicycle cleat for those who use clipless pedals.

****

NIH Study Shows Overweight Youth More Likely to Have Joint and Muscle Pain (source: PT Bulletin)

Children and adolescents who are overweight are more likely than their normal weight counterparts to suffer bone fractures and have joint and muscle pains, according to a study conducted at the National Institutes of Health (NIH).

The researchers found that the overweight youth were more likely to experience bone fractures and muscle and joint pain than were the non-overweight group. The most common self-reported joint complaint was knee pain, with 21.4% of overweight youth reporting knee pain and 16.7% of non-overweight youth reporting knee pain. The overweight youth also were more likely to report impaired mobility than the non-overweight youth. DXA scans showed that overweight youth were more likely to experience changes in how the bones of the thigh and leg meet at their knees, than were non-overweight youth.

The study appears in the June 2006Pediatrics.

Waist-to-Hip Ratio Better Indicator of Health Risk (source: PT Bulletin)

The relationship between waist size and hip size appears to be a more useful measure of health risk than body mass index (BMI), a measure of weight relative to height, says an article in The Washington Post based on a study published in The Lancet.

The findings suggest that men with waist-to-hip ratios greater than 0.95 are at heightened risk for a heart attack; women with ratios above 0.8 are at increased risk. A man with a 36-inch waist and 35-inch hips has a waist-to-hip ratio of 1.03 and an elevated risk for heart attack, says the article.If he were to reduce his waist to less than 33 inches (assuming his hip measure remained unchanged), his ratio would drop to 0.94, putting him at lower risk.

There may also be another, more surprising way to reduce risk: increase hip circumference. The study found a "protective effect" tied to a larger hip measurement; other, smaller studies have noted a similar phenomenon.

Still, while waist-to-hip ratio was found to be more predictive than waist circumference alone, the waist measurement appears to be a key component of the calculation. Other studies have found a link between that measure and elevated risk for metabolic syndrome and cardiovascular disease, says the Post.

People Eat More, Exercise Less, in Fall and Winter Months (source: PT Bulletin)

People's eating habits vary according to the season, with people eating more in the fall and winter. During those same months, physical activity levels decrease and weight increases, says a recent article from Reuters's News.

In a study published in the December 7 issue ofEuropean Journal of Clinical Nutrition, researchers examined seasonal variations in all three areas: food intake, physical activity, and body weight. The participants were 593 men and women whose average age was 48 and who were primarily recruited from a central Massachusetts health maintenance organization; most were either overweight or obese.

At the start of the study, researchers recorded the participants' body weight and reported dietary and exercise levels during the previous 24 hours. Similar information was recorded quarterly during the 1-year study period.

Calorie intake was highest during the fall, during which participants reported consuming 86 kilocalories more per day than during the spring, when their calorie intake was the lowest. They also showed seasonal variation in the distribution of these calories, the report indicates. Their carbohydrate intake appeared to peak in the spring, for example, while intake of total fat and saturated fat was the highest during the fall.

Further, the participants' body weight fluctuated by about 1 pound throughout the year-long study period, but was the highest during the winter, when they also reported the least amount of physical activity. Participants reported their highest level of physical activity during the spring.

FL Department of Health Warns Fitness Club on Use of "PT" (source: PT Bulletin)

The Florida Department of Health recently issued a verbal warning to Bally Total Fitness of Boca Raton for its use of the initials "PT" (referring to a personal trainer) in one of its advertisements. The department noted that under Florida law, the initials "PT" indicate "physical therapy." Bally has since removed the advertisement in question. The department's warning followed its investigation of a complaint filed by APTA member Mark E S Bartlett, PT. APTA and Bartlett view this as an important victory in the effort to preserve the integrity of the initials "PT" and to protect the public from being misled. The Palm Beach Post carried a brief report on the department's action.

Heart Association Revises CPR Guidelines (source: PT Bulletin)

New emergency care guidelines include "dramatic changes" to cardiopulmonary resuscitation (CPR) and put an emphasis on chest compressions, according to authors of the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The guidelines were published Wednesday in Circulation: Journal of the American Heart Association.

The guidelines provide recommendations for how lay rescuers and emergency health care providers should resuscitate people with cardiovascular emergencies. Topics include CPR, the use of automated external defibrillators, and recommendations for advanced cardiovascular life support and pediatric advanced life support. The 2005 guidelines emphasize that high-quality CPR, particularly effective chest compressions, contributes significantly to the successful resuscitation of patients with cardiac arrest. The guidelines recommend that rescuers minimize interruptions to chest compressions and suggest that they "push hard and push fast" when giving chest compressions.

The most significant change to CPR is to the ratio of chest compressions to rescue breaths — from 15 compressions for every two rescue breaths in the 2000 guidelines to 30 compressions for every two rescue breaths in the 2005 guidelines. The 30-to-2 ratio is the same for CPR that a single lay rescuer provides to adults, children, and infants (excluding newborns). The change resulted from studies showing that blood circulation increases with each chest compression in a series and must be built back up after interruptions.

Staff On Your First Visit Frequently Asked Questions About PT Services What is a Physical Therapist? Choosing a Physical Therapist Newsletter Archive Physical Therapy Newswire Patient Testimonials Your Health Links Student Affiliation Information Japanese Sports Medicine Exchange Program	Physical Therapy Newswire Epidemiology study finds rise in weight-training injuries More than 970,000 weight training-related injuries nationwide were treated in hospital emergency departments from 1990 to 2007 suggesting an almost 50% increase during the 18-year period, according to results of a study conducted by researchers from the Center for Injury Research and Policy (CIRP) at the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio. Dawn Comstock, PhD, and colleagues at CIRP used the National Electronic Injury Surveillance System data for their study which was published in the American Journal of Sports Medicine. Comstock and her colleagues found that men and youth aged 13 to 24 years incurred the greatest proportion of weight training-related injuries among the general U.S. population during the study period. The study analyzed the epidemiology of injuries directly related to weight training across all age groups of the general population treated in U.S. emergency departments during the last 2 decades, according to a Nationwide Children’s Hospital press release. Seek professional advice “Before beginning a weight-training program, it is important that people of all ages consult with a health professional, such as a doctor or athletic trainer, to create a safe training program based on their age and capabilities,” Comstock, a faculty member of the Ohio State University College of Medicine, stated in the release. The study confirmed that weight-training injuries affect men more than women, but detected a larger increase in the rates of injury among women. “The increase in incidence among female participants is likely the result of more women weight training as it becomes a more accepted fitness activity for women,” Comstock noted. Take care with free weights The study also noted the following: that 90% of injuries occurred during the use of free weights; the most common mechanism of injury was a weight dropping on a person (65%); the most frequently occurring injuries were to the upper (25%) and lower trunk (20%); a 19% incidence of hand injuries; and that sprains and strains were diagnosed most often (46%), followed by soft tissue injuries (18%). The investigators found that injury rates increased the most in weight trainers aged 45 years and older, but those aged 55 or older were more likely to be injured on weight-training machines or from overexerting themselves. Young people, however, appeared more vulnerable to injury from using free weights. Reference: Kerr ZY, Collins CL, Comstock RD. Epidemiology of weight training-related injuries presenting to United States emergency departments, 1990 to 2007. Am J Sports Med. 2010;38:765-771. Source: http://www.orthosupersite.com/view.aspx?rid=63374 *********** Avoiding Surgery for Low Back Pain Many patients may benefit more from non-invasive treatments: ROSEMONT, Ill., Feb. 2 /PRNewswire-USNewswire/ -- The simplest method for treating low back pain may actually be the best method. A literature study published in the February 2009 issue of The Journal of the American Academy of Orthopaedic Surgeons (http://www.jaaos.org/) finds that in most cases of symptomatic lumbar degenerative disk disease, a common cause of low back pain, the most effective treatment is simply a combination of physical therapy and anti-inflammatory medication. Symptomatic lumbar degenerative disc disease occurs when a disc weakens, often due to the effects of aging, repetitive strain or injury to the disc space. The result is that the disc cannot hold the vertebrae as well as it used to, and that lack of stability can cause low back pain. In some cases, the pain is great enough that the patient may seek treatment from an orthopaedic surgeon. These treatments can include a range of noninvasive and invasive/surgical options. According to the review findings: 1. 90 percent of patients with low back pain will see their symptoms fade on their own within three months. 2. Most of those patients will recover within six weeks. Therefore, the researchers determined that, barring an emergency, the initial treatment of all patients with low back pain should be noninvasive. "Recently, disc replacement surgery has been proposed as a cure or treatment for symptomatic lumbar disc disease," says Luke Madigan, M.D., an attending physician at Knoxville Orthopaedic Clinic, Knoxville, TN, and the lead author of the review. "But the FDA studies on lumbar disc replacement have only so far shown equivalence to fusion for discogenic disease. Long-term outcomes are still to be published and caution should be exercised with their use." Madigan also notes that in the past, surgical fusion was used to treat this condition, and the success rate was 50-60 percent. Meanwhile, noninvasive treatments have brought about greater success by helping patients strengthen the injured area and prevent further strain: 1. Physical therapy that focuses on strengthening core muscle groups in the abdominal area and the lower back has demonstrated positive effects in patients with disc-related pain. 2. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen have been found effective for short-term relief of low back pain, and no NSAID was found to be any more effective than the others. 3. Educating patients on better body mechanics -- for example, lifting with the legs instead of the back -- is found to lessen the strain that is placed on the lumbar region. 4. Another recent literature review advocated mobilization or activity in the treatment of low back pain as opposed to bed rest, and exercise has been shown to improve function and decrease pain in adult patients with chronic low back pain. 5. Braces have not been found to be effective in treating low back pain, although whether patients actually wear the brace in the prescribed manner may be a factor. Invasive treatment should only be explored if these and other noninvasive treatments have not been effective. "Surgery should be the last option, but too often patients think of surgery as a cure all and are eager to embark on it," Madigan says. "Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it." Source: JAAOS (http://www.jaaos.org) AAOS (http://www.aaos.org/) Orthoinfo.org (http://www.orthoinfo.org/) Low back pain (http://orthoinfo.aaos.org/topic.cfm?topic=A00311) ******************************************* APTA'S Tips for Avoiding Bike-Fit Related Injuries (source: www.apta.org) Postural Tips Change hand position on the handlebars frequently for upper body comfort. Keep a controlled but relaxed grip of the handlebars. When pedaling, your knee should be slightly bent at the bottom of the pedal stroke. Avoid rocking your hips while pedaling. Common Bicycling Pains Anterior (Front) Knee Pain. Possible causes are having a saddle that is too low, pedaling at a low cadence (speed), using your quadriceps muscles too much in pedaling, misaligned bicycle cleat for those who use clipless pedals, and muscle imbalance in your legs (strong quadriceps and weak hamstrings). Neck Pain. Possible causes include poor handlebar or saddle position. A poorly placed handlebar might be too low, at too great a reach, or at too short a reach. A saddle with excessive downward tilt can be a source of neck pain. Lower Back Pain. Possible causes include inflexible hamstrings, low cadence, using your quadriceps muscles too much in pedaling, poor back strength, and too-long or too-low handlebars. Hamstring Tendinitis. Possible causes are inflexible hamstrings, high saddle, misaligned bicycle cleat, and poor hamstring strength. Hand Numbness or Pain. Possible causes are short-reach handlebars, poorly placed brake levers, and a downward tilt of the saddle. Foot Numbness or Pain. Possible causes are using quadriceps muscles too much in pedaling, low cadence, faulty foot mechanics, and misaligned bicycle cleat for those who use clipless pedals. Ilio-Tibial Band Tendinitis. Possible causes are too-high saddle, leg length difference, and misaligned bicycle cleat for those who use clipless pedals. ** NIH Study Shows Overweight Youth More Likely to Have Joint and Muscle Pain (source: PT Bulletin) Children and adolescents who are overweight are more likely than their normal weight counterparts to suffer bone fractures and have joint and muscle pains, according to a study conducted at the National Institutes of Health (NIH). The researchers found that the overweight youth were more likely to experience bone fractures and muscle and joint pain than were the non-overweight group. The most common self-reported joint complaint was knee pain, with 21.4% of overweight youth reporting knee pain and 16.7% of non-overweight youth reporting knee pain. The overweight youth also were more likely to report impaired mobility than the non-overweight youth. DXA scans showed that overweight youth were more likely to experience changes in how the bones of the thigh and leg meet at their knees, than were non-overweight youth. The study appears in the June 2006Pediatrics. Waist-to-Hip Ratio Better Indicator of Health Risk (source: PT Bulletin) The relationship between waist size and hip size appears to be a more useful measure of health risk than body mass index (BMI), a measure of weight relative to height, says an article in The Washington Post based on a study published in The Lancet. The findings suggest that men with waist-to-hip ratios greater than 0.95 are at heightened risk for a heart attack; women with ratios above 0.8 are at increased risk. A man with a 36-inch waist and 35-inch hips has a waist-to-hip ratio of 1.03 and an elevated risk for heart attack, says the article.If he were to reduce his waist to less than 33 inches (assuming his hip measure remained unchanged), his ratio would drop to 0.94, putting him at lower risk. There may also be another, more surprising way to reduce risk: increase hip circumference. The study found a "protective effect" tied to a larger hip measurement; other, smaller studies have noted a similar phenomenon. Still, while waist-to-hip ratio was found to be more predictive than waist circumference alone, the waist measurement appears to be a key component of the calculation. Other studies have found a link between that measure and elevated risk for metabolic syndrome and cardiovascular disease, says the Post. People Eat More, Exercise Less, in Fall and Winter Months (source: PT Bulletin) People's eating habits vary according to the season, with people eating more in the fall and winter. During those same months, physical activity levels decrease and weight increases, says a recent article from Reuters's News. In a study published in the December 7 issue ofEuropean Journal of Clinical Nutrition, researchers examined seasonal variations in all three areas: food intake, physical activity, and body weight. The participants were 593 men and women whose average age was 48 and who were primarily recruited from a central Massachusetts health maintenance organization; most were either overweight or obese. At the start of the study, researchers recorded the participants' body weight and reported dietary and exercise levels during the previous 24 hours. Similar information was recorded quarterly during the 1-year study period. Calorie intake was highest during the fall, during which participants reported consuming 86 kilocalories more per day than during the spring, when their calorie intake was the lowest. They also showed seasonal variation in the distribution of these calories, the report indicates. Their carbohydrate intake appeared to peak in the spring, for example, while intake of total fat and saturated fat was the highest during the fall. Further, the participants' body weight fluctuated by about 1 pound throughout the year-long study period, but was the highest during the winter, when they also reported the least amount of physical activity. Participants reported their highest level of physical activity during the spring. FL Department of Health Warns Fitness Club on Use of "PT" (source: PT Bulletin) The Florida Department of Health recently issued a verbal warning to Bally Total Fitness of Boca Raton for its use of the initials "PT" (referring to a personal trainer) in one of its advertisements. The department noted that under Florida law, the initials "PT" indicate "physical therapy." Bally has since removed the advertisement in question. The department's warning followed its investigation of a complaint filed by APTA member Mark E S Bartlett, PT. APTA and Bartlett view this as an important victory in the effort to preserve the integrity of the initials "PT" and to protect the public from being misled. The Palm Beach Post carried a brief report on the department's action. Heart Association Revises CPR Guidelines (source: PT Bulletin) New emergency care guidelines include "dramatic changes" to cardiopulmonary resuscitation (CPR) and put an emphasis on chest compressions, according to authors of the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The guidelines were published Wednesday in Circulation: Journal of the American Heart Association. The guidelines provide recommendations for how lay rescuers and emergency health care providers should resuscitate people with cardiovascular emergencies. Topics include CPR, the use of automated external defibrillators, and recommendations for advanced cardiovascular life support and pediatric advanced life support. The 2005 guidelines emphasize that high-quality CPR, particularly effective chest compressions, contributes significantly to the successful resuscitation of patients with cardiac arrest. The guidelines recommend that rescuers minimize interruptions to chest compressions and suggest that they "push hard and push fast" when giving chest compressions. The most significant change to CPR is to the ratio of chest compressions to rescue breaths — from 15 compressions for every two rescue breaths in the 2000 guidelines to 30 compressions for every two rescue breaths in the 2005 guidelines. The 30-to-2 ratio is the same for CPR that a single lay rescuer provides to adults, children, and infants (excluding newborns). The change resulted from studies showing that blood circulation increases with each chest compression in a series and must be built back up after interruptions.

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