Creatine supplementation does not alter neuromuscular recovery after eccentric exercise

Introduction: The purpose of this study was to investigate the effects of creatine (CR) supplementation on recovery after eccentric exercise (ECC). Methods: Fourteen men were assigned randomly to ingest 0.3 g/kg of CR or placebo (PL) before and during recovery (48 hours) from 6 sets of 8 repetitions of ECC. Maximal voluntary contraction (MVC), voluntary activation (VA), muscle thickness (MT), electromyography (EMG), contractile properties, and soreness were assessed. Results: MVC, evoked twitch torque, and rate of torque development decreased for both groups immediately after ECC and recovered at 48 hours. MT increased and remained elevated at 48 hours for both groups. Soreness increased similarly for both groups. EMG activation was higher for CR versus PL only at 48 hours. There were no group differences for torque, total work, or fatigue index during ECC. Conclusions: CR supplementation before and during recovery from ECC had no effect on strength, voluntary activation, or indicators of muscle damage. Muscle Nerve 54 : 487–495, 2016     

Diagnosis and Management of the Painful Ankle/Foot. Part 2: Examination, Interpretation, and Management

? Abstract: Diagnosis, interpretation, and subsequent management of ankle/foot pathology can be challenging to clinicians. A sensitive and specific physical examination is the strategy of choice for diagnosing selected ankle/foot injuries and additional diagnostic procedures, at considerable cost, may not provide additional information for clinical diagnosis and management. Because of a distal location in the sclerotome and the reduced convergence of afferent signals from this region to the dorsal horn of the spinal cord, pain reference patterns are low and the localization of symptoms is trustworthy. Effective management of the painful ankle/foot is closely linked to a tissue‐specific clinical examination. The examination of the ankle/foot should include passive and resistive tests that provide information regarding movement limitations and pain provocation. Special tests can augment the findings from the examination, suggesting compromises in the structural and functional integrity of the ankle/foot complex. The weight bearing function of the ankle/foot compounds the clinician's diagnostic picture, as limits and pain provocation are frequently produced only when the patient attempts to function in weight bearing. As a consequence, clinicians should consider this feature by implementing numerous weightbearing components in the diagnosis and management of ankle/foot afflictions. Limits in passive motion can be classified as either capsular or non‐capsular patterns. Conversely, patients can present with ankle/foot pain that demonstrates no limitation of motion. Bursitis, tendopathy, compression neuropathy, and instability can produce ankle/foot pain that is challenging to diagnose, especially when they are the consequence of functional weight bearing. Numerous non‐surgical measures can be implemented in treating the painful ankle/foot, reserving surgical interventions for those patients who are resistant to conservative care. ?     

Disc Related and Non-Disc Related Disorders of the Thoracic Spine

Abstract: Different anatomical structures and pathophysiological functions can be responsible for lumbar pain, each producing a distinctive clinical profile. Pain can arise from the intervertebral disc, either acutely as a primary disc related disorder, or as result of the degradation associated with chronic internal disc disruption. In either case, greatest pain provocation will be associated with movements and functions in the sagittal plane. Lumbar pain can also arise from afflictions within the zygapophyseal joint mechanism, as a result of synovitis or chondropathy. Either of these conditions will produce the greatest pain provocation during three-dimensional movements, due to maximal stress to either the synovium or joint cartilage. Finally, patients can experience different symptoms associated with irritation to the dural sleeve, dorsal root ganglion, or chemically irritated lumbar nerve root. Differential diagnosis of these conditions requires a thorough examination and provides information that can assist the clinician in selecting appropriate management strategies.     

Rehabilitation after revision anterior cruciate ligament reconstruction: Practice guidelines and procedure-modified, criterion-based progression

Reconstructive surgery has become a more common solution for patients after rupture of the anterior cruciateligament (ACL) as a result of better surgical technique and more efficient and effective rehabilitation. As the incidence of ACL reconstruction surgery increases, the number of reconstructions that ultimately fail also increases. Failure of the primary reconstruction, whether caused by technical error during the surgery or an outside factor such as traumatic rerupture, often necessitates revision of the ACL reconstruction to restore joint integrity and optimize function. We have previously described criterion-based and procedure-modified rehabilitation after primary ACL reconstruction. The same principles that drive rehabilitation after primary reconstruction are factors after revision surgery; however, the progression must be modified. The major difference between the two surgeries lies in the ability of the surgeon to achieve adequate fixation of the new graft within the joint during a revision reconstruction. The second controlled trauma of revision surgery further compromises the bony structures that serve as the foundation for the new graft. Therefore, less rigid fixation after revision ACL reconstruction must be assumed. This necessitates a longer period of controlled weight bearing for every-day activities and slower progression of weight-bearing exercise during rehabilitation to ensure that biological healing can proceed without being compromised by the presence of forces that exceed the strength of the new graft fixation. Other factors such as staging of the revision surgery and concurrent bony procedures will also require modification of the rehabilitation. Understanding these factors and implementing the modifications that they necessitate into rehabilitation should lead to a more predictable return to high functional levels after revision ACL reconstruction.     

A Novel Externally Applied Neuromuscular Stimulator for the Treatment of Stress Urinary Incontinence in Women—A Pilot Study

Objectives: Neuromuscular electrical stimulation (NMES) is commonly used to treat lower urinary tract dysfunctions. This study evaluated the efficacy of a novel externally applied stimulator in the treatment of stress urinary incontinence (SUI). Materials and Methods: Nine women were included in this study. Provocative tests included a cough and jumping jack test assessed via pad weight. Ultrasound (US) imaging assessed pelvic floor muscle (PFM) contraction. A bladder filling protocol allowed for delineation of the bladder from the pelvic floor and standardized volume. External electrodes were used during 30 min, at least four times per week treatment protocol at home for eight weeks. Participants were blinded to US and were not instructed regarding pelvic floor contractions. Results: At week 1, participants could perform PFM contractions verified with US. More importantly, an 87.43% decrease in leakage was noted. At week 8, participants reported a 97.71% decrease in leakage (p= 0.0001). Changes noted in Incontinence Impact Questionnaire and Modified Oxford scores were significant (p= 0.0001 and p= 0.0001). Conclusions: NMES is frequently used to promote muscle strength and coordination. Studies have shown NMES to be effective in decreasing symptoms associated with SUI; however, few, if any, have used it as a primary treatment modality. The novel device in this study was shown to be effective in improving muscle strength, reducing or ablating the symptoms associated with SUI, and in eliciting PFM contractions. The device is noninvasive and can be used as a home treatment.