motion for shoulder

Shoulder injuries can have different causes:

And are common in:

Acute: such as a direct blow or fall; trauma

Chronic

Overuse: muscle imbalance is the key to overuse injuries; microtrauma due to repetition

-common in swmming and raquet sports

Keep the following in mind when considering injuries:

1)      the mechanism of injury: what causes the injury

2)      Sx: symptoms and signs

3)      Dx: diagnosis: what do you do to establish whats wrong

4)      Rx: treatment

5)      Rehab/prevention 

Risk Factors for Shoulder and Elbow Injuries in Adolescent Baseball Pitcher

-Hypothesis: Pitching practices of adolescent pitchers without history of arm injury will be significantly different from those of adolescent pitchers who required shoulder or elbow surgery.

-Methods: Ninety-five adolescent pitchers who had shoulder or elbow surgery and 45 adolescent pitchers who never had a significant pitching-related injury completed a survey. responses compared

-Results: The injured group pitched more months/ yr, games/yr, innings/game, pitches/game, pitches/yr. These pitchers were more frequently starting pitchers, pitched with higher velocity

-Conclusion: Pitching practices were significantly different between the groups. The factors with the strongest associations with injury were overuse and fatigue. High pitch velocity and participation in showcases were also associated with increased risk for injury.

Repair of Full-Thickness Rotator Cuff Tears in Professional Baseball Players

-Hypothesis: Return to competitive baseball is difficult after surgical treatment of a full-thickness rotator cuff tear (proven)

-Methods: evaluated the results of 16 professional baseball players after a mini-open repair of a full-thickness rotator cuff tear. Twelve patients were pitchers. 4 patients were position players; 2 had injuries of their dominant shoulders, and 2 had injuries to their nondominant shoulders.

-Results: only 1 player was able to return to competitive baseball. Of the 2 position players with injury to their dominant shoulders, 1 was able to return. Of the 2 position of their nondominant shoulders, both were able to return to professional baseball.

Magnetic Resonance Imaging of the Asymptomatic Shoulder of Overhead Athletes

A 5-Year Follow-up Study

-Hypothesis: Asymptomatic dominant shoulders of elite overhead athletes may have a higher incidence of magnetic resonance imaging abnormalities than either their nondominant shoulder or shoulders of asymptomatic voluntee

-methods: did MRI of dominant and non dominant shoulder to see if abnormalities appeared. Had players fill out survey 5 years later to see if they were injured 

-Results: 40% dominant shoulders had findings consistent with partial- or full-thickness tears of the rotator cuff as compared with none of the nondominant shoulders. None of the athletes interviewed 5 years later had any symptoms or required any evaluation or treatment for shoulder-related problems during the study period. (specificity is low)

Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers.

STUDY DESIGN: Prospective cohort study. METHODS: 476 young (ages 9 to 14 years) baseball pitchers were followed for one season. Data were collected from pre- and postseason questionnaires, injury and performance interviews after each game, pitch count logs, and video analysis of pitching mechanics. RESULTS: Half of the subjects experienced elbow or shoulder pain during the season. The curveball was associated with a 52% increased risk of shoulder pain and the slider was associated with an 86% increased risk of elbow pain. There was a significant association between the number of pitches thrown in a game and during the season and the rate of elbow pain and shoulder pain. CONCLUSIONS: Pitchers in this age group should be cautioned about throwing breaking pitches (curveballs and sliders) because of the increased risk of elbow and shoulder pain. Limitations on pitches thrown in a game and in a season can also reduce the risk of pain. Further evaluation of pain and pitching mechanics is necessary.

Athoscopy

diagnostic tests

-x-ray: gives picture of bone; evidence of injury to other structures

-antrhogram: picture of joint using dy to outline soft tissue structures

-ct scan: (computerized tomography): shows ones and soft tissue: allows visualization of he labrum and its associated injuries 

-arthfroscopy: looking into a joint with a small camera

-EMG: electropyogram: detetcs nerve injury by masuring nerve conduction in order to determine the site of injury 

-MRI: magnetic resonance imaging: shows soft tissue

Clinical diagnosis for soft tissue injury

1. direct tenderness over site of problem

2. pain with passive stretching of the injured part

3. pain with active contraction of the muscles (with or without resistence

Elbow and wrist basics

the elbow is a hnge joint which are the most stable because they only move in one plane. Dislocation is very serious due to the potential damage to nerves and blood vessels whch run on the inside of the joint. The humerus is a long bone that flares out at the end. Flares are epicondyles (lateral and medial). Extensors attatch to the lateral epi. and flexors attatch to the medial epi. Thus overhead throwing sports put a lot of stress on the medial epi as well as the anterior part of the shoulder. 

ligaments of the shoulder are the collaterals. The radial and ulnar collateral ligaments run on either side of the elbow stabalizing the joint. Muscles of the forearm attatch to the epicondyles of the humerus . the tendons of these muscles pass under a fibrous structure of the wrist called the retinaculum which makes them prone to injury from friction. 

-wrist goes side to side: toward the thumb is radial deviation and toward the pink is ulnar deviation

Bursitis (elbow)

Mech: trauma; direct blow or fall

Sx: pain, swelling of the olecranon bursa

Dx: clinical exam-its important to distinguish between an inflammed and an infected bursa

Rx: decrrease inflammation; padding around the joint to protect it from reinjury (Especially in contact sports)

Epicondylitis

-can be either medial epicondylitis (Especially in throwing sports) or lateral epicondylitis (a typical oberuse injury especially in raquet sports-tennis elbow)

-ex: lateral epicondylitis:

Mech: repetitive use of wrist extensors

Sx: pain with gripping/picking something up; localized pain at the elbow, extending down the arm

Dx: clinical examination

Rx: biomechanical factors: change in activity pattern, stroke technique, increase strength of wrist extensors, equipment factors: raquet weight, size of grip, materials of the requet frame, string tension for vibration transfer, raquet size (a larger raquet has a larger sweet spot and therefore less vibration)

Elbow dislocation

mech: blow/force in an abnormal plan of motion

-this is a serious injury due to potential damage to nerves and blood vessels. urgent evaluation needed

Ulnar Collateral Ligament Reconstruction in High School Baseball Players

Clinical Results and Injury Risk Factors

Hypothesis: Ulnar collateral ligament injury in high school baseball players is associated with overuse, high-velocity throwing, early throwing of breaking pitches, and improper warm-ups.

Methods: Follow-up physical examination and questionnaire data were collected 35 months after reconstruction from 27 former high school baseball players. Six potential risk factors were evaluated: year-round throwing, seasonal overuse, event overuse, throwing velocity more than 80 mph, throwing breaking pitches before age 14, and inadequate warm-ups.

Results: Overall, 74% returned to baseball at the same or higher level. 

Conclusions: success rate of  reconstruction in high school players is nearly equal to that in more mature groups of throwers. Overuse of the throwing arm and throwing breaking pitches at an early age may be related to their injuries.

-68 major league baseball players who had reconstruction of this ligament were looked at

-82% returned to major league play 18 months after surgery with little difference in their quality compared to normal players 

Forearm, hand and wrist general

-motion of protination and supination occurs at the elbow joint. Two bones of forearm are the radius and the ulna. The unlna is responsble for flexiona and extension while the ulna is responsible for protination and supination. The annular ligament holds the radius and the ulna together. 

-hand and wrist problems are common in all sports (3-9% of athletic injuries); they can be traumatic or overuse injuries. Tramatic injuries include fractures, dislocations and ligament sprains which are often seen in contact sports. Overuse injuries are seen in gynastics, raquet sports and golf

-hand injuries need particular attention becuase they can lead to significant disability. All skin injuries should be protected from infection with proper cleansing

Tendonitis (general)

-remove person from stressor that is causing the problem

-give anitinflammatories 

-evaluate biomechanical problems to see what is wrong and prevent it from reaccuring 

-restore strength, mobility and range of motion 

Wrist tendonitis

mech: overuse

Rx: anti-inflammation treatment (medication, physical therapy)

evaluate biomechanical factors

restores strength and range of motion

Dx: clinical 

Subungual hematoma

nail avulsion

1. Blood collection under the fingernai

Mech: trauma resulting in the breakage of blood vessels

Rx: relevive pressure by making a hole in the fingernail

2. Mech: trauma

the nail may die if the blood supply is disrupted

Paronychia

Felon

1. infection of the skin around the nail bed

Rx: antibiotics, drainage

2. Infection of the fingertip due to a puncture wound. May need surgcal drainage. medical evaluation needed

Mallet Finger

Proximal finger injuries

boutinerre deformity

1. avulsion/rupture of extensor tendon at distal interphalangeal joint (DIP)

mech: blow to fingertip

Rx: put back in normal anatomical position; splint in extension (heals in 6 weeks)

- it is important to treat this injury immediately or chronic problems may result

2. dislocation

mech: force/blow

Rx: relocate, splint, referral 

3. mech: forceful flexion at the proximal interphalangeal joint (PIP) causing rupture of the extensor tendon

Rx: surgery 

Navicular Fracture

-fracture of the navicular/scaphoid bone of the wrist. It has limited blood supply and therefore poor healing ability. If the injury is not diagnosed and properly treated immediately, arthritic changes and poor healing can occur

Mech: fall on outstretched hand (palm down) cuasing compression of the navicular bone

Dx: clinical exam: if you suspect a navicular fracture, you should treat it as such; an x-ray is unreliable, t may appear normal when in fact the bone is fractured.

Rx:: cast to immobilize bone; may need surgery

Game keepers thumb

Mech: trauma; forcible abduction of the thumb from the palm causing injury/sprain to the ulnar collateral ligaments

Sx: pain, decreased stability and grib

Dx: clinical exam-its important to properly diagnose this injury

Rx: surgery is often necessary

it is important to immediately treat this injury ir chronic problems may result 

-injury onset

-acute: muscle strains. esp adductor, rectus femorus: contusion, apopyseal, dislocation, labral, racture

-Slow onset: groin pain, osteitis, stress fracture, arthrities

-duration of injury, cause if know, prior injury, how long running, competitive level, other training activities, distance, frequency warms ups, stretches, changes in training  (volume, intensity, shoes, terrain)

Pelvis (general)

The pelvis is a large stable structure that provides protection to internal structures. Therefore pelvic injuries have potential for major blood loss if these internal structures (Such as the aorta) are damaged. Pelvic injuries in a genera sports medicine clinical setting are relatively uncommon-they account for 5% of all injuries 

-80% are due to overuse and 20% are due to trauma

-the most common sport for people to have hip and pelvic injuries is running

Pelvic fracture

stress fracture

1. mech: direct compression of bone; potential for significant blood loss

2. mech: repetitive stress loading (at the site of attatchment of the hip addutors)

Dx: x-ray, bone scan

-injury is slow to heal 

3. (bone contusion, usually at anterior illiac spine) mech: direct blow/contusion to iliac crest resulting in interference with the muscle function (many muscle groups attatch to the illiac crest)

Sx: pain, disability

Dx: clinical exam, x-ray for possible fracture

Apophyseal injuries

-traction injury where tendon inserts on the bone; common in ages 14-25

-can be avulsionn injury (when bone comes off with tendon), bursitis, tendinitis 

-ex: anterior, superior iliac crest, anterior inferior iliac spine, ishial tuberosity, iliac crest, lesser trochanter

-rehab: rest/protect, active and passive range of motion, progressive resistance when range of motion is 75% and strength is 50%, stretch, exercises 

Hip (general)

Trochanteric bursitis

-greater trochanter: upper femur that sticks out, muscle over this bone. in between the bone and muscle is the brusa

-mech: direct trauma or overuse

-Sx: inflammation, swelling, lateral pan (may also be felt in groin or lateral thigh)

-Dx: clinical exam, pain with resisted abduction, external rotation and abduction, x-ray for possible fracture

Rx: RICE, decrease inflammation, restore strength and mobility, return person to their specific activity. 

-This can be a disabling injury due t the pain which can be low grade and persistent

Iliotibial band syndrome

-mech: overuse due to the frction of the it band (a connective tissue covering the muscles on the lateral side of the leg) against the bondy structure of the leg

-this injury is most likley to cause problems over the greater trochanter and the lateral aspect of the knee

Adductor strain (groin strain) 

-common in timed sports and stop and go sports

-adolescent with groin pain may have underlying problems (ie avascular necrosis which is caused by interuption of blood supply)

-factors contributing to this injury: poor warm up, lack of flexibility/poor stretching, cold environment, inadequate recovery from previous injury

-Sx: a bad sound; sudden severe pain, difficulty walking

-Dx: clinical exam, pain with passive abbduction, active adductor, local tenderness; x-ray to rule out avulsion fracture; for chronic syndroms do a bone scan to rule out sress fracture

-Rx: RICE, decrease inflammation, restore mobility and strength, rehab to return to specific activity

Contusion

-mech: direct blow to muscle

-Dx: clinical exam

Rx: RICE, decrease inflammation, restore mobility and strength, rehab to return to specific activity 

-Such a blow to a large muscle group is potentialy serious injury. Muscles have rich blood supply, therefore, internal bleeding may occur which may not be visible. However, there may be swellling and direct tenderness over the site.

Myositis Ossificans

-calcium deposition in muscle tissue due to a contusion 

-Mech: to early aggressive rehab from an injury. May require surgical treatment 

Hamstring Strain

common in running sports

-mech: large muscle forces muscle inbalance between the hamstring an the quad contributes to this injury

-Sx: pain, decreased function

-Dx: clincical exam

-Factors contributing to this injury: fatigure, poor warm up, poor flexibility, cold environment

-Rx: RICE, restore strength and range of motion, correct muscle imbalance, return to specific activity; compare injured side to the uninjured side in order to monitor rehab; mild injury healing time (10-21 days), severe injury healing time (2-6 months)

-muscle imbalance (more specifically, overdevelopment of the quad muscle) such that the quad to hamstring ratio in stregth is greater than 2:1 makes a person prone to hmastring strains

The Association of Hip Strength and Flexibility With the Incidence of Adductor Muscle Strains in Professional Ice Hockey Players

Epidimiology of cycling

-cycling accidents: 500,000 ER visits/year

1000 deaths/year

2/3 of all deaths occur in children <15 yr

75% of deaths due to head injuries

-epidimiology studies should look at age group, location

An urban study in the adult population

-study done on high mileage adult riders wh avg 48 mi/week. The data on riders injuries is as follows:

-42% had upper extremtity injuries

-27 % contusions

-19% fractures

-1/4 injuries involved the ride being struck by a motor vehichle

-1/4 involved the rider ebing struck by another cyclist

-1/4 involved the rider falling on his own

-overall the study found that the environment was not frequently a factor in cycing accidents. It was also estimated that in 27% of the accidents, cyclist's carelessness played a role

-study involved 193 children seeking medical attention

-2/3 of all accidents occured on bike paths, sidewalks or in parks

-24% of the accidents occured because the bike was in poor condition 

-36% of the accidents occured because the riders were going to fast or doing stunts

-36% of the accidents involved the ridin surface playing a role 

-overall the study concluded that the environment played more of a role in pediatric accidents 

Young cyclists need the following in order to prevent accidents:

1) competence in making a quick stop

2) competence in riding on a narrow path safely

3) competence in stopping and dismounting safely

4) competence in riding close to a curb safely 

5) safe routes of travel

6) no additional passengers on a bike

7) helmets

1. main goal of a bike helmet

2. design elements of a bike helmet

1. The main goal of a bike helmet is to protect the head without compromising the rider’s vision, hearing, balance or thermal regulation 

2a. shell: a rigid surface to disperse chock and prevent penetration by a sharp object. The material used to make a shell are usualy light weight but strong such as polycarbonate or fiberglass

b. liner: a crushable semi-rigid foam to absorb energy and shock (1/2 inch thick)

c. comfort pads: to allow for a snug fit and air flow for thermal regulation

d. retention system: straps or similar devices to keep the helmet sitting properly on the head

Testing standards for bike helmets

Effectivness of helmets and design studies to test effectiveness

-the function of the skull is to protect the brain. Nevertheless, a blow to the head has the potential to cause brain injury due to the following mechanisms

1. direct axonal damage: trama to the nerves themselves

2. edema: swelling causing an increase in pressure inside the skull and therefore compromised brain function 

3. bleeding: also puts pressure on the brain 

Concussion (mech, epidiiology)

300,000 sports related concussions/year (125,000 from football)

6% will devlop post concussive syndrome 

-mech: a force/blow to the head causing immedate post-trauma neurologic disturbance but the outcome is full recovery 

-Dx: the diagnosis is a working diagnosis-it is what you understand at the time 

Concussion: Sx (And grading systems)

-acute symptoms: amnesia, altered cognition/memory/concentration, headache, nausea/vomiting, photophobia, impaired balance

-delayed symptopms: any acute symptoms, sleep disturbance, fatigue, depresssion, foggy, slowed fown

-grading systems: they look at loss of conciousness, amnesia and confusion; there are more than 16 grading systems (ex, Cantu, colorado, american academy of neurology). The goal is to identify severity and guide return to play decisions 

-airway, breathing, circulation

-mental status ( standard assesment of conciousness)

     -orientation (name, date, day, year)

     -immediate memory: retrograde amnesia: who are we playing, what's the score

     -concentration: subtraction, state months backwards, remeber 3 words

-general appearance (dazed or blank look, mumbling/incoherent speech, change in emotional status) 

-physical exam: pupils, cranial nerves (nerves for face), stregnth, , reaction time, motor/sensation, reflexes, gait, balance/coordination (stand on one foot, tandem walk, finger to nose), tinnitus, blurred vision

-Mech: direct blow causing internal bleeding (bleeding within the substance of the brain  itself) and loss of conciousness

-Sx: paralysis (due to compromised brain function), altered vital signs (breathing, Heart beat and blood pressure); typically when the brain is injured, people lose  higher brain functions first such as concioussness, memory and intellectual function. When the vital signs are compromised, it is life threatening

-Rx: supportive care; transport to hospital setting 

Cerebral hematoma: collection of blood between the skull and the brain

-Mech: trauma, direct blow

-Rx: surgery may be needed to relieve intracranial pressure

2 types

1. epidural hematoma: bleeding on top of the dura, the tough fibrous covering of the brain

-arterial bleeding on the side side of injury

-arteries have high pressure therefore there is rapid increase in intracranial pressure usually resulting in a rapid neurological decline 10-20 min after injury

2. Subdural hematoma: bleeding underneath the dura

-venous bleeding on the opposite side of impact

-since venous bleeding is under low pressure symptoms develop over hours, days, weeks. 

Head Injury evaluation

-football: remove face protector, leave helmet on

-epidural hematoma is very rare in helmeted athletes

-unconcious: transport to hospital

-assume possible neck injury

-axial load: direct blow to top of head: transport to hospital

-if awake, no neck pain, no paralysis, likely no significant neck injury

-bilaterla symptoms imply central cord injury

-unilateral symptoms imply nerve root/brachial plexus injury

-fracture/dislocation: loss of function below the injury 

Increased Intracranial pressure

-due to bleeding and swelling

-signs and syptoms of this are:

-persistent or severe headaches

-nausea/vomiting

-slowing of pulse

-altered blood pressure (increased systolic and decreased diastolic

-irregular/unequal pupils: this may suggest but does not prove that there is an increase inn intracranial pressure. Pressure on one side of the brain may compromise the optic nerve on that side. However, 10% of people have a slight difference in pupil size.

2nd impact syndrome

Diagnostic tests

Neck injuries 

football data

-with any head injury there is a possibility of a coexxisting neck injury. Therefore, special care needs to be taken to keep the head and neck stabilized when treating and transporting athletes with such injuries. 

-from 1971-1975 there were 95 cases nationall of permanet paralysis due to neck injuries and 60 cases of death due to brain injuries in all levels of play. In 1976 there were 32 cases o permanet paralysis due to neck injuries suffered whle playing football. The following year, a change in the rules was made that prohibited the use of head as the intial contact point for blocking or tackling. Subsequently, the number of cases of permanent paralysis dropped from 32/year to 11/year. It is important to note that 3/4 of the injuries are suffered by defensive players trying to make a tackle. It is perhaps the most dangerous aspect of the game. 

Catastrophic Cervical Spine Injuries in High School and College Football Players

Purpose: To update the incidence of catastrophic cervical injuries in scholastic football players and identify new injury patterns.

Methods: The authors retrospectively reviewed 196 incidents of catastrophic high school and collegiate football injuries reported to the National Center for Catastrophic Sports Injury Research during 13 academic years (September 1989 through June 2002).

Results: There were 15 direct catastrophic cervical spine injuries in scholastic football participants per year (1/2 returned to play). 76 athletes had quadriplegia Spear tackling by players on defense continued to be the predominant mechanism of injury causing quadriplegia. 43 had diagnosed cervical cord neurapraxia.  16 of the 43 athletes returned to football after a cervical cord neurapraxia episode, and none suffered a permanent quadriplegic event. 

The vertebral column: 

The vertebral column looks like a stack of bricks. It is composed of 24 moveable vertebrae. The vertebral column functions to provide support and to protect the spinal cord. Between the vertebrae there are intervertebrael discs which act like shock absorbers. The intervertebrael discs consist of an annulus fibrosis (a tough fibrous protective covering) and a nucleus. The vertebral column can flex, extend, rotate and move laterally.

Cervical spine fracture: 

 A cervical spine fracture is perhaps the most serious neck injury because it has the potential for a spinal cord injury.

-Mech: compression or flexion of the neck causing fracture of a vertebrae. With extension and lateral deviation, the body can absord some of the shock to the neck. However, with compression and flexion the neck doesn’t have far to go and therefore a fracture can result 

Cervical spine fracture

 A cervical spine fracture is perhaps the most serious neck injury because it has the potential for a spinal cord injury.

-Mech: compression or flexion of the neck causing fracture of a vertebrae. With extension and lateral deviation, the body can absord some of the shock to the neck. However, with compression and flexion the neck doesn’t have far to go and therefore a fracture can result 

Muscle strain in the neck:

Dx: clinical exam. However, it is important to determine if there is also a neurologic injury involved. Neurologic symptoms include numbness, tingling and pain along the site of the nerve. If such symptoms do present themselves, it is probable that the nerves of the neck are under stress. 

Stinger

-mech: forced lateral deviation of the neck causing stretching of the nerve roots, most commonly at the nerves exiting at the c5-c6 level.

-Sx: pain, numbness, tingling, weakness

-Rehab: improve technique, increase muscle strength for more neck support

low back pain

spondylolysis

spondylololisthesis

1. fracture of the pars interarticularis (transverse arch) due to hyperextension of the back (stress fracture)

-not common in non athletic settings

2. slippage forward of one vertebra in relation to the next thus compromising the foramen where nerve roots exit

-most likely due to repetitive stress or congenital factors

mechanical low back pain

chronic low back pain

1. pain coming from structures other than the discs or the nerves.

2. There is a poor correlation between the aount of pain and disability and what you can actually find with diagnostic studies. Imaging studies such as x-rays and MRI are limited-often times the tests come out normal because there are other sites responsible for low back pain that do not show up on these studies. Even more confusing is the fact that there is a high rate of abnormal study results in people who do not have any back pain.. 

Risk factors for back pain

1. age: the older you are the more cumulative trauma there is. There is also a decrease in the elasticity of the discs with age 

2. race: low back pain is more common in caucasions 

3. smoking: coughing puts high forces on the spinal column

4. driving: the sitting position puts a lot of pressure on the intervertebrael discs

5. physical labor: increases the wear and tear on the back

6. psychological stress and job satisfaction: people who are unhappy often develop chronic problems 

7. previous episodes of back pain

Evaluation for back pain

Imaging for low back pain

Imaging studies are only helpful if they g along with the clinical findings.

-x-rays show just bine structures which are odten OK in cases of low back pain. Nevertheless, X-ray will show cases of spondolysis and spondolisthesis, scoliosis, osteoarthritis and narrowing of the disc spaces.  

-MRIs are good for looking at soft tissues such as ligaments and nerves. However, they have a high percentage of false positive tests and a low specificity. Therefore imaging is very imprecise when it is used for the back 

Magnetic resonance imaging of the lumbar spine in people without back pain.

Treatment for low back pain (1)

1. rest: rest can be both a god and a bad thing since bed resr can lead to loss of muclce tone. Therefore it can acually compound the problem by weakening the back muscles. In general, the sooner the person gets mobilized (in a way that's not going to make the injury worse) the quicker rehab is going to be. Therefore its best to stay as active as tolerated

2. medication: anti-nflammatories are helpful for releiving pain for the first couple of weeks. Non-narcotic anti-inflammatories, in particular, can give good pain releif but still allow the person to function. However, they are less helpful for chronic pain. 

3. physical therapy: can help to reduce inflammation and restore strength and mobility

4. injections: epidural cortisone injections at the nerve root can help to releive the pain in appropriate cases; epidural nerve block, facet syndrome injection, IDET procedure

Treatment for low back pain (2)

5. chiropractic manipulation: this can provide short term relief for some people. However, it is hard to know who will benefit from this kind of treatment. For the most part, people who have non-disc related back pain seem to be the ones whol benefit the most, especially for short term relief.

6. Surgery: only 1% of people with low back pain are potential canidates for surgery. Surgery is usually a last resort. Only about 50% of people who have surgery actually have significant improvements. surgery is usually considered when the above methods have failed or when neurologic damage has been shown 

-90% of people suffering from low back pain get better within 2-3 months, naturally;  

Prevention

The prevention of low back pain includes modifying risk factors; lowering body weight, teaching good posture and lifting techniques; increasing strength and flexibility; getting people active (general conditioning seems to help more than just doing back exercises); quitting smoking to decrease coughing 

shoulder muscles:

1. flexion

2. extension

3. abduction

4. adduction

1.primary: anterior deltoid/ coracobracialis

secondary: perctoralis major/biceps

2.primary: lats/teres major/posterior deltoid

3. primary: middle deltoid/supraspinatus

secondary: ant and post deloid/serratus anterior 

4. primary: perctoralis major/ lat

secondary: poast deltoid

shoulder muscles

1. external rotation

2. internal rotation

1. primary: infraspinatus/teres minor

secondary: posterior deltoid

2. primary: subscapularis/pect major/lat.teres major 

3. primary: anterior deltoid

Elbow muscles

1. flexion

2.extension

3. supination

4. pronation

1. primary: brachialis/biceps

secondary: brachioradialis/supinator

2. extension: primary: triceps

secondary: anconeus

3. primary: beceps/supinator

seconday: brachioradialis

4. primary: pronator teres/pronator quadratus

secondary: flexor carpi radialis

Wrist muscles

1. flexion

2. extension

1. primary: flexor carpi radialis and ulnaris

2. extensor carpi radials (longus and brevis) and extensor carpi ulnaris

Hip muscles

1. flexion

2. extension

3. abduction

4. adduction

1. primary: iliopsoas

secondary: rectus femoris/ adductor group

2. primary: glueteus maximus

secondary: hamstrings

3. primary: gluteus medius

secondary: gluteus minimus

4. primary: adductor longus

secondary: adductor brevis and magnus/pectineus/gracilis

1. jeremy morris, britain 1954

2. 1970 longshoreman study

3. harvard alumni study 

1. drivers vs conductors on double decker buses; study of 31,000 London transport workers found that conductors (ticket collectors) had lower disease rates than drivers

2. study of 3000 workers found that those with more sedentaty jobs had higher heart disease rates

3.study of 17,000 alumni using a questionaire on physical activity,, found that those in the lower exercise category had increased heart disease rates by 64%; at any level of work activity, those playing vigorous sports had lower risk

risk of exercise 

A seattle study found that out of1250 cases of sudden death over 2 years, 80% of the cases were men and the age range was from 25-75 years old. They found that the risk of a heartattack during exercise was 56 times greater than during rest in the sedentary group and only 5 times greater in the active group. The study also found that the active group had 40% of the risk of heart problems than the sedentary group. 

sudden death in young athletes 

-12 cases per year nationally in apparently health young people with no known heart problems dying suddenly when exercising

-a rhode island study found that 80-90% of people who died suddenly or during or soon after exercise had known CV disease or had clear warning signs. Most deaths occur due to myocardial infarction. The risk of sudden death is low in people with healthy hearts

-sudden death in apparently healthy younf athletes under age 40 is usually due to some undiagnosed congenital heart disease. Ex is Marfan's syndrome which causes weakening of connective tissues, frequently in the aorta. The most common cardiac problem causing sudden death in young athletes is hypertrophic cardiomyopathy. 

Fitness testing

-these tests are progressive usually done on a treadmill. Speed and elevation are increased until the person reaches exaustion. Person's respirations are measured and analyzed in order todetermine oxygen consumption and an EKG is taken to monitor heart rhythem and look for abnormalities.

-the goal is to determine sonmeone's current fitness level.

-measure cardiovascular capacity (how well the lungs and heart are suited to provide oxygen to working muscles) and body composition 

lung function

cardiovascular function 

CO

adaptations toexercise

1. lung function evaluation not commnly done in a fitness setting since the lungs are not a limiting factor to one's CV fitness

2. main thing we want to access. access by looking at VO2. (ml/kg/min). VO2max is how much oxygen is consummed and processed at maximal levels of exercise. Differences between untrained men and women, but differences decrease with training. VO2max decreases with age. Exercise can increase it by 20%xSV

3. exercise can increase SV by 20% but doesnt change max HR. 

CO=HR

4. adaptations t exercise include an increase in SV, o2 extraction by muscles, decrease in resting HR; acute responses include: increase O2 uptake, CO, HR, SV, O2 extraction

overuse syndrome