- Your Bridge to Health -

More than 1/3 of older adults with frailty are also depressed
December 11, 2018

Difficult to evaluate this connection with the evidence available

Statistics suggest that about 10-20% of adults over the age of 65 are depressed. The number of older adults that are frail—which essentially means being weak and having a higher chance of getting injured—is also estimated to be similar. Both depression and frailty are associated with a number of negative effects in older age, such as a lower quality of life, increased use of health insurance and a higher chance of experiencing other health issues or dying. When both of these conditions are present at the same time, the effects can be even worse, with many of these individuals experiencing accelerated mental decline and disability. This shows why it’s important to understand the connection between depression and frailty, as it can help identify patients who are affected by either or both conditions, as well as to develop strategies to address them. Although there is some data available on this association, there are no large-scale studies that have focused on the two conditions exclusively. For this reason, a high-quality pair of studies called a systematic review and meta-analysis was conducted to determine how many older adults with frailty also have depression and vice versa.

Three major databases searched for relevant studies

To conduct the review, researchers performed a search of three major medical databases for studies that investigated depression and frailty in adults with an average age of 60 years and older. To be included, studies also had to utilize respectable criteria for defining both depression and frailty, and had to include a control group of patients who did not have these conditions for comparison purposes. This search led to 63 studies being screened and 24 of these meeting the necessary criteria for inclusion into the review. Once collected, the findings from these 24 studies were evaluated and compared to one another to determine how common frailty and depression were in older adults.

Exercise can be helpful for treating both frailty and depression

Results showed that there were 8,023 older adults that had frailty, and of these, 38.6% were also depressed. Similarly, 2,167 older adults were found to have depression, and 40.4% of them were also frail. Further analysis from five studies showed that when patients with depression were compared to individuals without depression, there was a significantly higher risk of also having frailty. Finally, the overall quality of the included studies was found to be good, which shows that these findings can be considered reliable. Taken together, this systematic review and meta-analysis show that a significant portion of older adults who are frail are also depressed, and vice versa. While this finding is alarming, the good news is this: treatment that targets either of these conditions can actually lead to improvements in both of them at the same time. Exercise, in particular, is an effective tool to manage both depression and frailty, as it leads to positive changes in both mental and physical health. This is one of the primary reasons physical therapy is highly recommended for older adults with any type of impairment, since it is based on helping individuals move better and more frequently. With this in mind, elderly individuals who are frail or depressed—or both—are strongly encouraged to seek out the services of a physical therapist. Doing so can result in lasting changes in both their physical and mental health, and in turn, improve their overall quality of life.

-As reported in the July ’17 issue of Ageing Research Reviews

Exercise found to decrease anxiety and other stress-related disorders
December 5, 2018

Updated analysis needed in light of new studies and flaws in prior research

Anxiety disorders are a group of mental health conditions that include generalized anxiety disorder, panic disorder, and phobias. Together with stress-related issues like post-traumatic stress disorder (PTSD), these conditions have all been found to have negative impact on patients’ lives, such as a reduced quality of life and increased risk for heart disease and early death. Targeted medications and a psychiatric intervention called cognitive behavioral therapy (CBT) are typically recommended as the primary treatments for patients with anxiety and stress disorders, but the outcomes are not always positive. About one-third of patients do not respond to medications or CBT, and these interventions are not available in certain parts of the world. Exercise is considered an alternative for the patients that are either unable or unwilling to try medications or CBT, but there has only been one high-quality study (meta-analysis) on the topic. At the time, this study concluded that there was not enough information to recommend exercise for anxiety disorders. Since then, however, additional research has been published, and researchers have pointed out certain flaws in the original meta-analysis. For this reason, an updated meta-analysis was conducted to evaluate the effects of exercise on symptoms in patients with anxiety or stress disorders.

Seven databases searched for relevant studies

The investigators performed a search of seven major medical databases for randomized-controlled trials (RCTs) that investigated the effectiveness of exercise in adults with an anxiety or stress-related disorder. RCTs evaluate specific interventions by randomly assigning patients to different groups, and they are considered the gold standard for determining if a treatment is beneficial. This search led to 62 studies being screened, and six RCTs fit the necessary criteria to be included in the meta-analysis. Once collected, the findings of these six RCTs were evaluated and compared to one another to assess the impact of exercise on patients.

Based on positive results, exercise should be considered a treatment option for anxiety

The six included RCTs contained data on 262 participants, with 132 undergoing an exercise treatment program and the other 130 serving as the control group, who did not undergo exercise and were used for comparison. Results showed that exercise significantly reduced symptoms of anxiety in these patients, who had a variety of disorders that included PTSD, generalized anxiety disorder, panic disorder, or social phobia. When compared to the control group, the effect size of exercise was found to be in the medium range.

Physical therapists can help promote exercise in patients with anxiety

These findings support the use of exercise for patients with anxiety or stress disorder, and the researchers suggested that it should therefore be considered a viable option for these patients. Physical therapists are movement specialists that promote and prescribe exercise for a wide variety of conditions. While they are often viewed as professionals that only treat physical problems, this study shows why they can also be utilized to help overcome mental health issues like anxiety. Patients with anxiety or stress-related disorders are therefore encouraged to seek out the services of a physical therapist for an exercise therapy program that can help them better manage their symptoms while also improving their health and fitness in the process.

-As reported in the March ’17 issue of Psychiatry Research

Older adults with knee arthritis benefit from a home-exercise program
November 27, 2018

Better treatments are needed to target this at-risk population

Knee osteoarthritis (OA) is a condition in which cartilage that normally protects the ends of bones in the knee joint gradually wears away over time, which leads to pain and disability. It is particularly common in older individuals and makes it challenging for them to perform many basic everyday tasks. This is why effective treatments and prevention methods are needed to target these patients and help them manage their condition, but there are currently no established interventions in place to accomplish this. Exercise therapy that focuses on improving the strength and flexibility of various muscles is one treatment that has been proven to be effective for knee OA patients, and it can be administered either at a physical therapy clinic or as part of a home-exercise program. Home-exercise programs are inexpensive and do not require special equipment, but some patients may have difficulty following exercises when not guided by a physical therapist. With this in mind, researchers decided to conduct a powerful study called a randomized-controlled trial (RCT) to determine how effective a home-exercise program was for older adults with knee OA and how closely they adhered to this program.

Patients are randomly assigned to one of two groups

Older adults with a history of knee pain in one or both knees were recruited for the study and screened to determine if they were eligible. This led to 52 individuals with knee OA being accepted and then randomly assigned to either the multiple exercise group or control group. All participants were taught a home-exercise program by a physical therapist and provided with an instructional booklet to help them better understand its components. Participants in the exercise group were instructed to perform three out of 10 possible exercises, all of which were strengthening or stretching exercises for muscles surrounding the thighs or hips. The specific exercises that were found to be appropriate for each patient in this group were based on an interview conducted by the physical therapist at the start of the trial. Participants in the control group were instructed to only follow one exercise, which was a chair-sitting strengthening exercise for the quadriceps muscles in the front of the thigh. All participants were instructed to perform three sets of 10 repetitions of each assigned exercise, five times per week for four weeks, and they were assessed before and after this intervention for various outcomes related to knee pain and function.

Home-exercise program leads to superior results, with most patients adhering to it

Results showed that participants in the home-exercise group experienced significant improvements in knee pain, stiffness and strength compared to the control group. Exercise group participants also reported superior scores in their ability to complete daily physical activities, social activities and general health conditions. In addition, it was found that 96.6% of participants in the home-exercise group and 100% of control group participants adhered to their assigned programs. Taken together, these findings suggest that a home-exercise program consisting of strengthening and stretching exercises for various hip and thigh muscles can lead to a number of benefits for older adults with knee OA. The individualized nature of these programs—since they selected exercises based on each patient’s abilities—may have also had a positive impact on these results and improved patients’ adherence. Based on these results, patients with knee OA are urged to see a physical therapist, who can provide either a home-based or supervised exercise program depending on which is more suitable for them. Visiting a physical therapy clinic this time of year is a particularly good idea for those who have already met their insurance deductible or out-of-pocket maximum for 2018, as their visits may be covered for the rest of the year.

-As reported in the August ’18 issue of Clinical Rheumatology

Low back pain patients who see PT first spend less
November 20, 2018

Patients with low back pain who see a physical therapist first spend less on care and have a lower risk of being prescribed opioids

Low back pain (LBP) is the most common painful condition in the U.S. Recent statistics have shown that about 25% of the population has reported being affected by LBP for at least one full day within the past three months, and LBP is therefore also listed as the number one contributor to years lived with a disability in the country. The guidelines for treating LBP not related to a more serious cause of pain is to at first take non-steroidal anti-inflammatory drugs (NSAIDs) while avoiding imaging tests like X-rays and MRIs. If patients do not improve, the next step is to undergo treatments like physical therapy and exercise therapy rather than being treated with prescription medications. But despite these guidelines, far too many patients are still being prescribed drugs like opioids and being sent to have advanced imaging tests for their LBP, while not nearly enough are taking advantage of services like physical therapy. Research has suggested that seeing a physical therapist early may reduce patients’ usage of healthcare services and costs by helping them to recover without dangerous or unnecessary interventions; however, there are no large-scale studies that have compared healthcare costs between patients seeing a physical therapist first compared to other health providers. Therefore, a review was conducted to investigate these values and determine what the advantages are of seeing a physical therapist first for LBP.

Data is collected on nearly 150,000 patients

To conduct the review, investigators searched a private health insurance database with claims-related information on 50 million individuals for patients who had a new diagnosis of LBP over a three-year span. Patients who had a prior history of LBP, back surgery or any other serious conditions were excluded. This search led to 148,866 patients fitting the necessary criteria and serving as the study sample. These patients were then categorized into three groups depending on their physical therapy (PT) access: 1) “PT First,” which means they saw a physical therapist before seeing any other medical professional, 2) “PT Later,” meaning they eventually visited a physical therapist at some point, but not initially, and 3) “No PT,” meaning they never visited a physical therapist. In some cases, groups 1 and 2 were placed together for statistical purposes. Researchers then analyzed data between these groups to gauge the effect of having physical therapy at any point for LBP.

PT First is associated with benefits across the board

Based on the data collected, it was found that the incidence rate of LBP was 82.7 for every 1,000 patients. Of the patients who had LBP, about 80% had no physical therapy, while 8.7% saw a physical therapist first and 11.5% saw a physical therapist later. For those in the PT Later group, the average amount of time they waited to do so was 38.3 days. When compared to one another, it was found that patients in the PT First group had significantly lower opioid prescription rates, advanced imaging tests and visits to the emergency department (ED) compared to those in the PT Later and No PT groups. When the PT First and PT Later groups were compared directly, these values were slightly lower but still significant in favor of PT First. In addition, overall healthcare costs were significantly lower for patients in the PT First group over the PT Later and No PT groups, which was based on outpatient, pharmacy and out-of-pocket costs. The PT Later group was generally found to have the highest rates and average costs across all categories.

Patients with LBP are strongly encouraged to see a physical therapist for treatment

These findings clearly show that seeing a physical therapist as the first line of treatment for LBP comes with several advantages over seeing one later or not at all. Patients who do so experience lower overall healthcare costs while also reducing their risk for being prescribed drugs like opioids, having unnecessary imaging tests or going to the ED. Therefore, individuals who are currently dealing with an episode of LBP are strongly encouraged to see a physical therapist if they have not already done so. Now is also a particularly good time to schedule an appointment, especially for those who have already met their deductible or out of pocket maximum for 2018. If this is the case, insurance might cover the physical therapy visits for the rest of the year before healthcare deductibles renew in January.

-As reported in the May ’18 issue of Health Services Research

Review shows exercise therapy one of the best shoulder treatments
November 13, 2018

Comprehensive study needed to pull together all research on the topic

Complaints related to shoulder pain are the third-most common after those of the back and neck. About 29 out of every 1,000 individuals will have an issue with shoulder pain each year, and it has the highest incidence in women and people between the ages of 45-64. About 36% of these individuals have a condition called shoulder impingement syndrome (SIS), which is a generic term for several shoulder disorders that all lead to pain, disability and a reduced quality of life. There are many conservative (non-surgical) treatments available for SIS and an abundance of research on their effectiveness, but there is yet to be a comprehensive overview that has pulled all of these studies together and compared them to one another. For this reason, a powerful pair of studies called a systematic review and meta-analysis was conducted to provide this needed overview on various conservative treatments for SIS.

Six databases searched for relevant studies

Investigators performed a search of six major medical databases for high-quality studies called randomized-controlled trials (RCTs) that evaluated the effectiveness of a conservative treatment for SIS. RCTs randomly assign participants to a treatment group and then compare them to one—or more—other groups to gauge how well an intervention works, and they are considered the gold standard of individual research studies. This search led to 324 RCTs being screened and 200 of these being accepted into the final analysis. Conservative treatments evaluated in these studies included exercise therapy, a form of hands-on therapy called manual therapy, steroid injections, taping and non-steroidal anti-inflammatory drugs (NSAIDs), among others. Once collected, the findings from these RCTs were compared to one another and the quality of each study was assessed to determine how reliable these findings actually were.

Despite low quality of evidence, exercise is still recommended for patients with SIS

On the whole, results were supportive of both exercise therapy and manual therapy for SIS patients. For pain alone, studies showed that manual therapy was superior to no treatment or a sham treatment, and that when combined with exercise, it was more effective than exercise alone. Manual therapy was also found to have immediate effects. Regarding pain and function, exercise therapy was found to be superior to no treatment, and specific exercises were found to be more effective than non-specific exercises. Finally, studies also showed that exercise therapy was superior to non-exercise modalities—like ultrasound and electrical stimulation—for improving flexibility. Unfortunately, the quality of the research was deemed very low, which was due to lack of consistency across studies and a high risk of bias. But in spite of this shortcoming, the researchers still concluded that exercise therapy should be recommended as the first line of treatment for SIS patients, and that adding manual therapy may lead to even better results. Individuals dealing with SIS symptoms are therefore encouraged to see a physical therapist for a comprehensive treatment program that is sure to include various exercises and manual therapy. Patients should also be aware that visiting a physical therapy clinic now can be especially advantageous if they already met their insurance deductible or out-of-pocket maximum for 2018, since these visits may be covered for the rest of the year.

-As reported in the September ’17 issue of the British Journal of Sports Medicine

Exercise found to reduce risk of experiencing episodes of neck pain
November 6, 2018

All reviews on the topic up to this point suffered from certain flaws

Neck pain is one of the most common and significant health problems throughout the world. It ranks as the fourth leading cause of disability, and it’s estimated that about 48.5% of the population will deal with neck pain at some point in their lives. Individuals with neck pain generally improve over time, but in many cases the pain comes back and can end up becoming a long-term problem. This shows why it’s important to establish measures that will prevent neck pain from developing in the first place, but the available guidelines for neck pain treatment don’t include any specific recommendations for prevention. In addition, although there are large-scale reviews—systematic reviews—on the topic, they all suffer from some flaws and limitations, which means that better quality evidence is needed. For these reasons, researchers decided to conduct a powerful pair of studies called a systematic review and meta-analysis to determine what strategies were most effective for preventing an initial episode of neck pain in individuals without symptoms.

Five databases searched for relevant studies

Investigators used five medical databases to search for randomized-controlled trials (RCTs) that evaluated the effectiveness of prevention strategies for neck pain, and only accepted those that fit specific criteria. RCTs randomly assign participants to a treatment group and then compare them to one—or more—other groups to gauge how well an intervention works, and they are considered the gold standard of individual research studies. This search led to 5 RCTs being accepted into the systematic review and meta-analysis, which contained data on 3,852 participants. Once collected, the findings of these five RCTs were compared to one another, and their quality was assessed to better indicate if these findings were reliable.

Exercise identified as an effective strategy for preventing neck pain

Two of the five RCTs investigated the use of exercise programs, and researchers deemed that there was moderate-quality evidence that exercise does substantially reduce the risk of a new episode of neck pain. These exercise programs lasted for 9-12 months and consisted of various exercises that were intended to improve the strength and flexibility of the neck muscles and improve body awareness, stability and aerobic abilities. The individuals who participated in these programs reduced their risk for developing neck pain by about half. The three other RCTs investigated the use of ergonomic programs, which instruct patients make modifications to their workstations and homes that are intended to improve posture. Researchers concluded that there was low-quality evidence that these ergonomic programs do not reduce the risk of a new episode of neck pain. Based on these findings, it appears that exercise is a particularly effective strategy for reducing the risk of developing neck pain. Individuals who work a desk job and are concerned that neck pain may be a problem in the future are therefore encouraged to see a physical therapist for a preventative exercise program, which can put them ahead of the game. Now is also a great time of year to visit a physical therapist for those who have already met their insurance deductible or out-of-pocket maximum for 2018, as treatment may be covered for the rest of the year under some healthcare plans.

-As reported in the July ’18 issue of the Journal of Physiotherapy

Spine strengthening exercises lead to improvements
November 1, 2018

Condition generally tends to progress with age

Kyphosis is a disorder in which an excessive outward curvature of the spine results in an abnormal rounding of the upper back. Kyphosis generally tends to get worse with age, and once the angle progresses past 40°, it’s referred to as hyperkyphosis. Up to 40% of adults over the age of 65 have hyperkyphosis, and those with severe cases are at an increased risk for falls and fractures. Many older adults with hyperkyphosis suffer from poor and worsening quality of life and physical function due to their condition, and it’s therefore important to develop strategies to address their disorder. Previous research has shown that strengthening exercises for the back muscles can lead to improvements in patients with hyperkyphosis, but most of the included studies on the topic suffered from limitations of some sort. For this reason, a powerful study called a randomized-controlled trial (RCT) was conducted to evaluate if strengthening exercises were, in fact, effective for patients with hyperkyphosis. In the research world, RCTs are considered the gold standard for determining the benefits of a particular treatment.

99 older adults are randomly assigned to one of two groups

Individuals over the age of 60 diagnosed with hyperkyphosis were invited to participate in the study and screened by the team of researchers. In order to be accepted to the RCT, they had to be able to walk one block without an assistive device, climb one flight of stairs and rise from a chair without the use of their arms. From a pool of 598 individuals, 99 were deemed eligible and then randomly assigned to one of two groups. Half the participants were placed in the treatment group, which consisted of three hour-long weekly exercise sessions every week for six months. These sessions were led by a physical therapist and included various exercises that targeted muscle impairments that were known to be associated with hyperkyphosis. In particular, the exercises focused on strengthening and improving the flexibility of certain back muscles, and participants were also given the training to help improve their posture. The other half of participants were placed in the control group, which attended an education session every month for four months. All patients were assessed at the start of the study and then six months later for the curvature of the spine and several other outcomes.

Treatment leads to significant improvements

Results showed that patients who followed the physical therapist-led exercise program experienced several significant improvements when compared to the control group. Most importantly, the angle of the curvature of the spine reduced by an average of 3.3° in the treatment group, compared to only 0.3° in the control group. In addition, the treatment group reported better self-image and satisfaction with their appearance after completing their treatment. The findings of this RCT suggest that a treatment program that consists of strengthening exercises for the spine and posture training can lead to physical improvements in patients with hyperkyphosis, which appears to boost their confidence in turn. Individuals with hyperkyphosis interested in improving should, therefore, think about seeking out the services of a physical therapist to address their condition.

-As reported in the July ’17 issue of the Osteoporosis International

Reducing elbow injury in young pitchers requires effective prevention
October 30, 2018

Far too many players are being encouraged to ‘play through their pain’

Participation in youth sports has been increasing at a rapid rate throughout the country, and there are now more young players involved in Little League baseball than ever before. But unfortunately, the growth in popularity of baseball has also led to an epidemic of arm injuries in young throwers: recent statistics suggest that between 30-40% of 7-18 year-old baseball players experience elbow and shoulder pain during each season. To make matters worse, it’s been found that about 46% of these injured adolescents are encouraged to stay active and “play through the pain,” as it were. This is incredibly dangerous for young, developing athletes, as failing to recognize and treat an injury can lead to a far worse problems later in a career. Of particular interest are overuse injuries, which result from too much time playing one sport-like baseball-without enough rest. Tears of the ulnar collateral ligament (UCL) in the elbow are one of the more common overuse injuries in youth baseball, and the rate for surgery to treat these injuries is increasing significantly. Together, this highlights the need for a better understanding of why the number of elbow injuries in youth baseball is so high and for appropriate, effective strategies to prevent and treat them. With this in mind, two surgeons authored a commentary on the topic and their opinion on how to address the issue.

Why specializing in one sport is so risky

Perhaps the biggest factor that contributes to the high rate of injuries in youth baseball is specializing in one sport. This essentially means that these young players are involved in baseball exclusively-or nearly exclusively-and do not participate in other sports as well. Studies have shown that young athletes who play a single sport for more than nine months in a year have a 36% increase in risks associated with severe overuse injury compared to those who do not. The reason is that baseball is a demanding sport, and without sufficient time to let the body recover, the repeated trauma can lead to small damage that will grow into a more serious injury over time.

Conditioning programs created by physical therapists can help prevent overuse injuries

Due to this issue with one-sport specialization, one of the most effective ways to prevent overuse injuries is by educating baseball players about these dangers and encouraging them to not overdo it. This can be accomplished by enforcing pitch counts for young players and regulating the number of leagues and number of months that they participate in baseball throughout the year. In addition, conditioning programs that improve the strength and flexibility of the hips, back and legs can actually reduce strain on the arms and therefore reduce the risk of elbow injuries. Physical therapists are movement experts that can create these types of conditioning programs for any level of play and can modify them according to the demands of the team. Finally, young players should be urged to engage in other sports aside from baseball to increase their fitness levels and protect them from overuse injuries.

Injured players must adhere to their rehabilitation programs and take them seriously

If an injury of any sort does occur, it’s important to carefully discuss the details of it with the player, and to include their parents. Although many players and parents may have difficulty accepting that playing time needs to be stopped for a period of time or that surgery is required, these recommendations need to be taken seriously. Fortunately, most partial UCL tears can be successfully treated without surgery through a course of rehabilitation administered by a physical therapist. These programs typically include a variety of stretching and strengthening exercises, baseball-specific movements and recommendations to take some time off from throwing. In more severe cases, surgery may be needed to repair a completely torn UCL, but physical therapy will still be needed during the recovery afterwards. Regardless of the recommended treatment, it’s essential that young patients adhere to the rehabilitation program given to them and do not rush their return to baseball until they are given the OK to do so. Together, following these guidelines will reduce the risk of throwing-related elbow injuries in youth baseball and help to ensure longer, healthier careers for these developing athletes.

-As reported in the May ’18 issue of JOSPT

Two types of strength exercises lead to improvements for tennis elbow
October 23, 2018

Unclear whether one intervention is superior to the other

Lateral epicondylitis, or tennis elbow, is a common condition that results from inflammation of the tendons that join the forearm muscles on the outside of the elbow. Tennis elbow develops from overuse in sports and is frequently seen in athletes that play tennis and other racquet sports, but it can also develop in anyone that repeatedly performs activities that require the elbow and wrist. Although the majority of individuals that develop tennis elbow will improve after some basic treatments and lifestyle changes, about 20% will continue to have symptoms one year later. When tennis elbow does not improve after three months, it’s referred to as “chronic,” which is more difficult to treat. There are many treatment options available for chronic tennis elbow, including a variety of exercises guided by physical therapists, such as eccentric and concentric elbow exercises. Eccentric exercises use the elongation phase of muscle activity, which occurs while lowering weights, while concentric exercises use the contraction phase that occurs when lifting weights. It’s not clear which of these—or a combination of the two—is better, and research is limited on the topic. For this reason, a powerful study called a randomized controlled trial (RCT) was conducted to determine if eccentric or concentric exercises led to better outcomes in pain and function for patients with chronic tennis elbow.

Patients are evaluated regularly over the course of one year

Individuals who had symptoms of tennis elbow for at least three months and a verified diagnosis were recruited and asked to participate in the RCT, which led to 120 of them being accepted. These participants were then randomly and evenly assigned to either the eccentric or concentric exercise group. Both groups were instructed to perform an at-home exercise program designed by a physical therapist for the next three months. The “weight” used for the exercises was a plastic water container with a handle that weighed 1 kg (2.2 lbs) for women and 2 kg (4.4 lbs) for men. Both groups were instructed to hold the handle of the container using a clenched fist with their forearm on the armrest or adjacent table. The eccentric exercise group was instructed to lower the weight downwards while flexing their wrist, while the concentric group was instructed to lift the weight while extending the wrist, both for three sets of 15 repetitions. Participants were to perform these exercises once a day for three months, and the load was increased each week by one dL (0.22 lbs). All participants were evaluated at the start of the study and then one, two, three, six and 12 months later for pain, strength, function and several other outcomes.

Both interventions are beneficial, but eccentric exercises lead to better results

After one year, results showed that patients in both groups improved in their scores for pain and muscle strength, but the eccentric exercise group experienced greater overall improvements. This was based on the fact that the eccentric group reported a faster decrease in pain during muscle contraction and elongation, as well as a faster increase in muscle strength compared to the concentric group. This difference between groups was most noticeable at two months, but the trend continued up to the final follow-up at one year. Regarding the other outcomes of disability, function and quality of life, there were no significant differences between the two groups, which suggests that they both improved to a similar extent. Based on these findings, it appears that both an eccentric and concentric exercise program are beneficial for patients with chronic tennis elbow for up to one year, but an eccentric program provides a slight advantage of faster and greater improvements in pain and strength. Both of these exercises are routinely included in treatment programs provided by physical therapists in order to elicit positive changes. Patients currently dealing with symptoms of tennis elbow are therefore encouraged to seek out treatment at a local physical therapy clinic to help them start the path to recovery and better overall functioning.

-As reported in the September ’14 issue of Clinical Rehabilitation

Elbow injuries of the ulnar collateral ligament don’t require surgery
October 16, 2018

The number of surgeries for these injuries is increasing significantly at all levels of play

The ulnar collateral ligament (UCL) is a band of tissue that connects the inside of the upper arm bone to the inside of the forearm at the elbow. It helps to support and stabilize the arm during movements like throwing a ball, but is commonly injured in sports that require lots of overhead motions, particularly baseball. In fact, UCL injuries are often considered the most prevalent overuse injury in baseball, meaning it results from too much time throwing without enough rest. The number of UCL injuries in baseball has been steadily increasing in recent years, and along with it, so has the rate of surgeries to address them. This is true on all levels of play, as the incidence of UCL reconstruction (surgery for UCL injuries) is increasing in the major leagues and down to the level of 15-19-year-olds. However, it’s important to point out that the majority of injuries to the UCL do not actually require surgery. Research has shown that 84% of professional baseball players with partial UCL tears have been able to successfully return to play after completing non-surgical treatment like physical therapy, yet many players continue to have surgery. For this reason, a review was published to explain why non-surgical treatment should be used for most UCL injuries and what can be done to ensure a safe return to baseball.

Players should be carefully examined to confirm the UCL injury

After a baseball player is injured, an athletic trainer, physical therapist or some other medical professional must examine him to diagnose the problem. Common symptoms of a UCL injury include swelling, tenderness, loss of throwing speed or control, and pain in the middle of the elbow that is particularly strong while throwing. UCL tears usually develop gradually over time and are noticed by a gradual decline in the ability to throw, although some players experience them suddenly during play with a “popping” sensation. If a UCL injury is suspected, an imaging test like an X-ray, MRI or ultrasound is often needed to confirm it.

Non-surgical rehabilitation usually broken down into three phases

Most experts recommend that non-surgical care should be used at first to treat most UCL injuries. Non-surgical rehabilitation of these injuries is usually guided by a course of physical therapy and broken down into three phases. The goals of phase 1 are to reduce pain and restore pain-free elbow and shoulder motion through a variety of strengthening exercises. Once the patient can perform certain movements with no pain and minimal tenderness, they may progress to phase 2, in which the goals are to normalize strength and to start performing sport-specific activities. In this phase, the intensity of the strengthening exercises should be increased and patients should begin preparing for throwing again with medicine ball exercises. Finally, phase 3 is the return-to-sport phase, which can begin once the patient has a satisfactory exam, usually after about six weeks. The central part of phase 3 is a return-to-sport interval-throwing program (ITP), in which players are instructed on how to throw and pitch properly in order to avoid future injuries, which may last several weeks. This should also be accompanied with the physical therapist identifying any other factors that may increase the risk for injury-such as pitching too many fastballs, pitching through pain and not taking enough time off each year-and offering advice on how to address them. If all of these components are followed, most patients with UCL injuries can expect to recover safely and return to baseball at a similar level as before the injury. Baseball players with these injuries are therefore encouraged to visit a physical therapist for an evaluation and treatment recommendations before considering surgery.

-As reported in the September ’17 issue of The Physician and Sportsmedicine