Study to assess hip exercises as treatment for osteoarthritis in the knee joints
Goal is to prevent the disease from progressing
Researchers at Rush University Medical Center are testing a novel regimen of hip-muscle exercises to decrease the load on the knee joints in patients with osteoarthritis. The goal is not only to relieve pain but also, possibly, to halt progression of the disease.
"Each time you take a step, a load, or force, is placed on the knee joints. How much load depends not just on your weight, but also on the way you walk and the alignment of your leg," said Laura Thorp, PhD, assistant professor of anatomy and cell biology at Rush Medical College and principal investigator for the study. "If we can appropriately alter the gait patterns of patients with osteoarthritis, we can minimize the load and relieve pain.
"Ultimately, we're hoping we can prevent the disease from advancing. No treatment currently exists that can stop osteoarthritis from progressing in the knees, other than joint replacement surgery."
Osteoarthritis is the most common form of arthritis and a significant source of disability and impaired quality of life. A higher-than-normal load on the knees during walking is a hallmark of the disease, associated with both the severity of the osteoarthritis and its progression, according to Thorp.
Thorp is enrolling patients with mild to moderate osteoarthritis in their knees in a research study to determine the effectiveness of certain hip exercises in treating the disease. Study participants have their knees x-rayed and undergo an initial assessment in Rush's Human Motion Laboratory to measure the load on their knee joints while walking. Participants then follow a specific regimen of hip exercises for four weeks under the direction of Charles Cranny, clinical manager of outpatient physical therapy.
The exercises focus on strengthening the hip abductor muscles, such as the gluteus medius, a broad, thick, radiating muscle that helps to stabilize the pelvis during ambulation. In patients with osteoarthritis in the knees, these muscles tend to be weak, causing the pelvis to tilt toward the side of the swing leg when walking, instead of remaining level with the ground, which increases the load on the knee joints. Strengthening these muscles helps the pelvis and the knee remain in better alignment, and thereby lessens the load.
After the four weeks of supervised physical therapy, participants are reassessed to determine whether the load on the knees has decreased, and whether the pain has subsided.
The trial continues for another four weeks, with patients exercising at home to determine whether the adjustments in gait can be maintained.
According to Thorp, exercise regimens to date have focused largely on strengthening the quadriceps and hamstring muscles, which stabilize the knee joint but likely do little to correct alignment with the rest of the leg or alter the load on the joint.
Preliminary evidence in the present trial has already shown that a decrease in load is attained with hip-muscle exercises.
"By lessening the load on the knees, we can remove one of the major known risk factors for the progression of osteoarthritis," Thorp said.
Thursday, July 16, 2009
Monday, April 13, 2009
Osteoarthritis of the Knee: A Guide for Adults
1. Introduction
Treatments for osteoarthritis of the knee can help reduce pain. They can also help you stay active. Most people can find a treatment plan that works for them. A combination of treatments often works best.
This guide can help you learn about options. It can help you come up with a treatment plan that works for you. This guide covers ways to help you feel better. It also covers research about treatments that usually don’t help.
2. About Osteoarthritis
Osteoarthritis is common in the knee joint. It happens when cartilage in the joint wears down.
Cartilage is a rubbery tissue at the end of bones that allows the joint to move easily. With osteoarthritis, cartilage breaks down over time. The knee can become painful, stiff, and swollen.
The knee contains a small amount of fluid that lubricates the cartilage. It also helps cushion the joint. With osteoarthritis, this fluid does not work as well, so it can be hard to move your joints.
3. Fast Facts for Treatments That Help
Fast Facts on Pain Relievers
There is no cure for osteoarthritis.
Staying active and losing weight are ways to help you feel better.
Some people need to take pain medicine to stay active and control the pain.
4. Treatments That Help
Getting active and staying at a healthy weight are important for everyone with osteoarthritis of the knee. Some people also may need to take pain medicine to help lower pain and keep them moving.
Getting Active
Exercise is a great way to improve your health. You may think that exercise is not good for osteoarthritis. But it is. Being more active and staying active can help you have less pain and move more easily.
Walking, swimming, and water aerobics are good choices for people with osteoarthritis. Talk with your doctor or nurse about making an exercise plan that works for you.
Your doctor also may recommend physical therapy. Physical therapy is a special exercise program done with a trained professional. The exercises help you move and be flexible. They also can help reduce knee pain.
Getting to a Healthy Weight
Losing weight can help take the stress off of your knees. Each pound lost will help. Staying at a healthy weight can help keep you more active and moving.
Pain Medicine
Medicines can help relieve the pain of knee osteoarthritis. Some people need to take pain medicine to stay active. There are pain medicines that work for osteoarthritis. Your doctor or nurse may recommend over-the-counter or prescription drugs.
If you want to learn more about choosing pain medicine for osteoarthritis, the Agency for Healthcare Research and Quality has published another guide that may be useful to you. That guide is called Choosing Pain Medicine for Osteoarthritis: A Guide for Consumers (2007).
5. Fast Facts for Treatments That Usually Do Not Help
Fast Facts for Treatments That Usually Do Not Help
Glucosamine and chondroitin usually do not reduce pain or improve knee movement.
Joint lubricant shots (not the same as cortisone shots) usually do not reduce pain or improve knee movement.
Arthroscopic knee surgery usually does not reduce pain or improve knee movement.
6. Treatments That Usually Do Not Help
This information comes from a government-funded review of research about three treatments for osteoarthritis of the knee. Research shows that these treatments often do not help people who have knee osteoarthritis.
Glucosamine and Chondroitin
Glucosamine and chondroitin are nutritional supplements. People take them to help build new cartilage. Glucosamine and chondroitin are not regulated as drugs in the United States, so their quality may vary. Minor side effects include upset stomach, diarrhea, and headache.
Research studies tell us that more than half the people with osteoarthritis taking glucosamine and chondroitin improve. They have less pain and better movement. But in these studies, the same number of people who do not take the supplements also improve. This means that glucosamine and chondroitin are not the reason that some people improve.
Joint Lubricant Shots
Joint lubricant shots are not the same as cortisone shots. In this treatment, a gel-like material is given by a shot into the knee joint. Usually three to five shots are given over a few weeks. It is also called viscosupplementation (VIS-co-SUP-luh-men-TAY-shun).
Possible side effects from joint lubricant shots include minor infection, pain, and swelling. These side effects last a short time and go away without treatment. It is rare, but these shots also can cause swelling and pain that do not go away on their own. This happens with about 2 out of 100 people who get the shots. If it happens, medicines or another procedure may be needed.
Many research studies have compared people getting the shots with those who do not. These studies have found that most people getting the shots do not have much improvement. The shots usually do not reduce pain or improve knee movement.
Arthroscopic Surgery for Osteoarthritis
Arthroscopic (ahr-thruh-SKOP-ik) knee surgery is a minor surgery. Doctors insert a flexible tool into the knee joint. They then rinse the joint. Sometimes they smooth out the cartilage and remove loose pieces. Possible problems can happen after surgery, like pain, swelling, and infection. Blood clots in the legs also can happen.
Research shows that arthroscopic knee surgery usually does not reduce the pain of knee osteoarthritis. Doctors may use arthroscopic surgery for other types of knee problems, like sports injuries. It is sometimes helpful for those problems but not for knee osteoarthritis.
7. Things to Think About
Am I getting the right amount of exercise?
A small increase in activity several times a week can increase your strength and help with osteoarthritis symptoms.
The goal is to help with joint movement. Exercise does not need to be difficult. What’s important is to get moving.
Find a kind of exercise that fits your lifestyle.
How can I get the most out of my doctor visits?
Plan for the visit by writing down what you want to talk about.
Make sure your doctor or nurse knows all the medicines, vitamins, and supplements you take.
Take a list of questions you want to ask.
What should I ask my doctor or nurse?
How bad is my knee osteoarthritis?
What options are available to decrease my knee pain?
How will this treatment help me?
How will I know the treatment is working?
What are all the possible side effects?
8. Source
The information in this guide comes from a detailed review of 86 research reports. The review is called Treatment of Primary and Secondary Osteoarthritis of the Knee (2008) and was written by Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center.
Treatments for osteoarthritis of the knee can help reduce pain. They can also help you stay active. Most people can find a treatment plan that works for them. A combination of treatments often works best.
This guide can help you learn about options. It can help you come up with a treatment plan that works for you. This guide covers ways to help you feel better. It also covers research about treatments that usually don’t help.
2. About Osteoarthritis
Osteoarthritis is common in the knee joint. It happens when cartilage in the joint wears down.
Cartilage is a rubbery tissue at the end of bones that allows the joint to move easily. With osteoarthritis, cartilage breaks down over time. The knee can become painful, stiff, and swollen.
The knee contains a small amount of fluid that lubricates the cartilage. It also helps cushion the joint. With osteoarthritis, this fluid does not work as well, so it can be hard to move your joints.
3. Fast Facts for Treatments That Help
Fast Facts on Pain Relievers
There is no cure for osteoarthritis.
Staying active and losing weight are ways to help you feel better.
Some people need to take pain medicine to stay active and control the pain.
4. Treatments That Help
Getting active and staying at a healthy weight are important for everyone with osteoarthritis of the knee. Some people also may need to take pain medicine to help lower pain and keep them moving.
Getting Active
Exercise is a great way to improve your health. You may think that exercise is not good for osteoarthritis. But it is. Being more active and staying active can help you have less pain and move more easily.
Walking, swimming, and water aerobics are good choices for people with osteoarthritis. Talk with your doctor or nurse about making an exercise plan that works for you.
Your doctor also may recommend physical therapy. Physical therapy is a special exercise program done with a trained professional. The exercises help you move and be flexible. They also can help reduce knee pain.
Getting to a Healthy Weight
Losing weight can help take the stress off of your knees. Each pound lost will help. Staying at a healthy weight can help keep you more active and moving.
Pain Medicine
Medicines can help relieve the pain of knee osteoarthritis. Some people need to take pain medicine to stay active. There are pain medicines that work for osteoarthritis. Your doctor or nurse may recommend over-the-counter or prescription drugs.
If you want to learn more about choosing pain medicine for osteoarthritis, the Agency for Healthcare Research and Quality has published another guide that may be useful to you. That guide is called Choosing Pain Medicine for Osteoarthritis: A Guide for Consumers (2007).
5. Fast Facts for Treatments That Usually Do Not Help
Fast Facts for Treatments That Usually Do Not Help
Glucosamine and chondroitin usually do not reduce pain or improve knee movement.
Joint lubricant shots (not the same as cortisone shots) usually do not reduce pain or improve knee movement.
Arthroscopic knee surgery usually does not reduce pain or improve knee movement.
6. Treatments That Usually Do Not Help
This information comes from a government-funded review of research about three treatments for osteoarthritis of the knee. Research shows that these treatments often do not help people who have knee osteoarthritis.
Glucosamine and Chondroitin
Glucosamine and chondroitin are nutritional supplements. People take them to help build new cartilage. Glucosamine and chondroitin are not regulated as drugs in the United States, so their quality may vary. Minor side effects include upset stomach, diarrhea, and headache.
Research studies tell us that more than half the people with osteoarthritis taking glucosamine and chondroitin improve. They have less pain and better movement. But in these studies, the same number of people who do not take the supplements also improve. This means that glucosamine and chondroitin are not the reason that some people improve.
Joint Lubricant Shots
Joint lubricant shots are not the same as cortisone shots. In this treatment, a gel-like material is given by a shot into the knee joint. Usually three to five shots are given over a few weeks. It is also called viscosupplementation (VIS-co-SUP-luh-men-TAY-shun).
Possible side effects from joint lubricant shots include minor infection, pain, and swelling. These side effects last a short time and go away without treatment. It is rare, but these shots also can cause swelling and pain that do not go away on their own. This happens with about 2 out of 100 people who get the shots. If it happens, medicines or another procedure may be needed.
Many research studies have compared people getting the shots with those who do not. These studies have found that most people getting the shots do not have much improvement. The shots usually do not reduce pain or improve knee movement.
Arthroscopic Surgery for Osteoarthritis
Arthroscopic (ahr-thruh-SKOP-ik) knee surgery is a minor surgery. Doctors insert a flexible tool into the knee joint. They then rinse the joint. Sometimes they smooth out the cartilage and remove loose pieces. Possible problems can happen after surgery, like pain, swelling, and infection. Blood clots in the legs also can happen.
Research shows that arthroscopic knee surgery usually does not reduce the pain of knee osteoarthritis. Doctors may use arthroscopic surgery for other types of knee problems, like sports injuries. It is sometimes helpful for those problems but not for knee osteoarthritis.
7. Things to Think About
Am I getting the right amount of exercise?
A small increase in activity several times a week can increase your strength and help with osteoarthritis symptoms.
The goal is to help with joint movement. Exercise does not need to be difficult. What’s important is to get moving.
Find a kind of exercise that fits your lifestyle.
How can I get the most out of my doctor visits?
Plan for the visit by writing down what you want to talk about.
Make sure your doctor or nurse knows all the medicines, vitamins, and supplements you take.
Take a list of questions you want to ask.
What should I ask my doctor or nurse?
How bad is my knee osteoarthritis?
What options are available to decrease my knee pain?
How will this treatment help me?
How will I know the treatment is working?
What are all the possible side effects?
8. Source
The information in this guide comes from a detailed review of 86 research reports. The review is called Treatment of Primary and Secondary Osteoarthritis of the Knee (2008) and was written by Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center.
Thursday, March 5, 2009
Knee Warm-Ups
Pick an option: the prospect of months on crutches and a season on the sidelines, versus taking 10 minutes to do a short, simple, structured warm up. For athletes, particularly school-aged athletes, the choice should be clear.
What’s more, the choice appears to be even clearer for young players whose movements and biomechanics make them more susceptible than their teammates to potentially devastating knee injuries, according to a study involving young soccer players conducted by researchers at the University of North Carolina at Chapel Hill.
“Soccer players and other young athletes have a fairly high incidence of injuries, especially involving the anterior cruciate ligament, or ACL, a ligament critical for knee stability,” said Darin Padua, Ph.D., associate professor of exercise and sport science in the UNC College of Arts and Sciences. “For some reason, girls seem to be at greater risk of ACL injuries. You hear about a lot of these injuries in basketball, too.”
Padua and his team from the exercise and sport science department and from the UNC Gillings School of Global Public Health worked with the Triangle United Soccer Association and 173 youth soccer players (boys and girls, ages 10-17) on 27 teams in Durham and Chapel Hill, N.C., to see how their movements might contribute to injury risk. They videotaped the players jumping and landing, both before a new warm-up routine was introduced, and afterwards, to see what changes had occurred.
They found that those who had the poorest movement quality at the beginning of the study were the most likely to benefit from the exercises, according to the study, published in the March issue of the American Journal of Sports Medicine.
The intervention involved warm-up activities designed to increase players’ flexibility, balance and strength, as well as their foot planting, jumping and cutting skills, since previous research has shown that approximately 70 percent of ACL injuries are the result of such noncontact movements. The routine took 10 to 12 minutes before every game and practice, and was used in place of the jogging and stretching warm ups the players had been using previously. Details about the exercises are available at http://www.unc.edu/sportmedlab/publications.htm (under the “Knee Injury” section); or at http://www.unc.edu/sportmedlab/docs/knee/distefano/Appendix%201.pdf and http://www.unc.edu/sportmedlab/docs/knee/distefano/Appendix%202.pdf.
“The players who had the poorest movement quality at the start of the study — those who landed stiff-kneed or knock-kneed when they jumped, or who landed on their heels or one foot before the other — benefitted the most from the intervention,” Padua said. “This was true for both boys and girls.”
“This shows that warm-up exercises that enhance flexibility, balance and strength can double as injury prevention programs by successfully modifying players’ movements,” he said.
The study was designed to see if a general, or “one-size-fits-all,” warm-up routine was effective for all team members, or if individualized programs were more effective. They found similar results for players in both the general and individualized programs. Both were effective, Padua said.
Researchers also noticed that the older children in the study responded better to the warm-up exercises than the younger ones did.
“That’s a take away from this study,” Padua said. “The younger kids may need to be trained differently. Things that are successful in older populations may not work in younger children.”
Other authors on the paper, all from UNC, are Lindsay DiStefano, doctoral candidate in human movement science; Michael DiStefano, social research specialist in exercise and sport science; and Stephen W. Marshall, Ph.D., associate professor of epidemiology.
For more information, visit: www.unc.edu/sportmedlab or http://ajs.sagepub.com/.
What’s more, the choice appears to be even clearer for young players whose movements and biomechanics make them more susceptible than their teammates to potentially devastating knee injuries, according to a study involving young soccer players conducted by researchers at the University of North Carolina at Chapel Hill.
“Soccer players and other young athletes have a fairly high incidence of injuries, especially involving the anterior cruciate ligament, or ACL, a ligament critical for knee stability,” said Darin Padua, Ph.D., associate professor of exercise and sport science in the UNC College of Arts and Sciences. “For some reason, girls seem to be at greater risk of ACL injuries. You hear about a lot of these injuries in basketball, too.”
Padua and his team from the exercise and sport science department and from the UNC Gillings School of Global Public Health worked with the Triangle United Soccer Association and 173 youth soccer players (boys and girls, ages 10-17) on 27 teams in Durham and Chapel Hill, N.C., to see how their movements might contribute to injury risk. They videotaped the players jumping and landing, both before a new warm-up routine was introduced, and afterwards, to see what changes had occurred.
They found that those who had the poorest movement quality at the beginning of the study were the most likely to benefit from the exercises, according to the study, published in the March issue of the American Journal of Sports Medicine.
The intervention involved warm-up activities designed to increase players’ flexibility, balance and strength, as well as their foot planting, jumping and cutting skills, since previous research has shown that approximately 70 percent of ACL injuries are the result of such noncontact movements. The routine took 10 to 12 minutes before every game and practice, and was used in place of the jogging and stretching warm ups the players had been using previously. Details about the exercises are available at http://www.unc.edu/sportmedlab/publications.htm (under the “Knee Injury” section); or at http://www.unc.edu/sportmedlab/docs/knee/distefano/Appendix%201.pdf and http://www.unc.edu/sportmedlab/docs/knee/distefano/Appendix%202.pdf.
“The players who had the poorest movement quality at the start of the study — those who landed stiff-kneed or knock-kneed when they jumped, or who landed on their heels or one foot before the other — benefitted the most from the intervention,” Padua said. “This was true for both boys and girls.”
“This shows that warm-up exercises that enhance flexibility, balance and strength can double as injury prevention programs by successfully modifying players’ movements,” he said.
The study was designed to see if a general, or “one-size-fits-all,” warm-up routine was effective for all team members, or if individualized programs were more effective. They found similar results for players in both the general and individualized programs. Both were effective, Padua said.
Researchers also noticed that the older children in the study responded better to the warm-up exercises than the younger ones did.
“That’s a take away from this study,” Padua said. “The younger kids may need to be trained differently. Things that are successful in older populations may not work in younger children.”
Other authors on the paper, all from UNC, are Lindsay DiStefano, doctoral candidate in human movement science; Michael DiStefano, social research specialist in exercise and sport science; and Stephen W. Marshall, Ph.D., associate professor of epidemiology.
For more information, visit: www.unc.edu/sportmedlab or http://ajs.sagepub.com/.
Saturday, February 28, 2009
ACL Reconstruction with Different Techniques
Studies Evaluate the Anatomy and Stability of ACL Reconstruction with Different Techniques
An improved understanding of the anatomy of the anterior cruciate ligament (ACL) in recent years has generated a renewed interest in the evaluation of surgical techniques to repair the knee ligament. In a study to be presented at the 2009 American Orthopaedic Society of Sports Medicine Specialty Day in Las Vegas, researchers analyzed various aspects of two of the most common ACL reconstruction techniques.
“Studies have demonstrated improved movement and stability with restoration of the native anatomy of the knee. However, the surgical technique to achieve the best movement and stability outcomes remains controversial”, says lead author Asheesh Bedi, MD of the Hospital for Special Surgery in New York City.
Bedi worked with senior mentors Dr. David W. Altchek and Dr. Riley J. Williams on studying the anatomy and stability of ACL reconstructions using transtibial versus anteromedial portal drilling techniques on 19 cadaveric knees. Femoral socket position was characterized using high-resolution 3D-fluoroscopy with transtibial and anteromedial portal drilling. “While anteromedial portal drilling allows for excellent access and restoration of the femoral ACL footprint, there is a significant learning curve. There can be an increased risk of shorter femoral tunnels and wall blow-out intraoperatively” says Dr. Riley Williams, the senior author and Associate Attending Surgeon at the Hospital for Special Surgery.
Follow-up studies have evaluated the biomechanical stability of ACL reconstructions completed with transtibial and anteromedial portal techniques. “The anteromedial portal drilling technique allowed for better restoration of native ACL anatomy and knee stability compared to conventional transtibial techniques. We also found that re-reaming of the tibial tunnel is a bigger issue than has been previously recognized with transtibial drilling” says Dr. David Altchek, senior author and Co-Chief of the Sports Medicine Service at the Hospital for Special Surgery.
Bedi and Altchek will be presenting the second part of their study at the 2009 AOSSM Annual Meeting in Keystone, CO. “Continued research into the best techniques for ACL stabilization are ongoing and a vital part of getting athlete’s back into play at a quicker rate. We are working to define these techniques in the lab and have them translated into the operating room” says Altchek.
An improved understanding of the anatomy of the anterior cruciate ligament (ACL) in recent years has generated a renewed interest in the evaluation of surgical techniques to repair the knee ligament. In a study to be presented at the 2009 American Orthopaedic Society of Sports Medicine Specialty Day in Las Vegas, researchers analyzed various aspects of two of the most common ACL reconstruction techniques.
“Studies have demonstrated improved movement and stability with restoration of the native anatomy of the knee. However, the surgical technique to achieve the best movement and stability outcomes remains controversial”, says lead author Asheesh Bedi, MD of the Hospital for Special Surgery in New York City.
Bedi worked with senior mentors Dr. David W. Altchek and Dr. Riley J. Williams on studying the anatomy and stability of ACL reconstructions using transtibial versus anteromedial portal drilling techniques on 19 cadaveric knees. Femoral socket position was characterized using high-resolution 3D-fluoroscopy with transtibial and anteromedial portal drilling. “While anteromedial portal drilling allows for excellent access and restoration of the femoral ACL footprint, there is a significant learning curve. There can be an increased risk of shorter femoral tunnels and wall blow-out intraoperatively” says Dr. Riley Williams, the senior author and Associate Attending Surgeon at the Hospital for Special Surgery.
Follow-up studies have evaluated the biomechanical stability of ACL reconstructions completed with transtibial and anteromedial portal techniques. “The anteromedial portal drilling technique allowed for better restoration of native ACL anatomy and knee stability compared to conventional transtibial techniques. We also found that re-reaming of the tibial tunnel is a bigger issue than has been previously recognized with transtibial drilling” says Dr. David Altchek, senior author and Co-Chief of the Sports Medicine Service at the Hospital for Special Surgery.
Bedi and Altchek will be presenting the second part of their study at the 2009 AOSSM Annual Meeting in Keystone, CO. “Continued research into the best techniques for ACL stabilization are ongoing and a vital part of getting athlete’s back into play at a quicker rate. We are working to define these techniques in the lab and have them translated into the operating room” says Altchek.
Tuesday, February 10, 2009
Exercises To Prevent ACL Injuries
The nation’s first – and only – program aimed at taking a wide-scale community prevention approach to decrease non-contact anterior cruciate ligament (ACL) tears among female high school athletes is working, and as a result, is being expanded in Rochester, New York. The program, called PEP (Prevent injury, Enhance Performance), targets the prevention of one of the most serious knee injuries that can sideline athletic careers among females, who are at six to nine times greater risk than males to sustain an ACL tear.
Organized by University Sports Medicine (USM), the PEP program is being rolled out to 119 high schools in Section V, an area that covers all Monroe, Ontario, Seneca, Livingston, Allegany, Steuben and Wayne counties in upstate New York. The expansion, made possible by a $161,000 grant from the Greater Rochester Health Foundation (GRHF), will cover junior varsity and varsity female athletes playing soccer, volleyball and basketball – the three main sports with high incidences of ACL tears. USM officials expect to train about 11,180 athletes on nearly 700 teams during the two-year program.
GRHF provided the seed money for USM to introduce the program to Monroe County high school athletes in January 2007. Since that time, USM athletic trainers have worked with 1,137 female athletes on 71 teams, and preliminary results are promising.
“We would typically expect to see about two ACL tears per 100 participants, or about 58 non-contact ACL tears for the 2,900 athletes we have been working with,” Michael Maloney, M.D., director of USM, said. “To date, we’ve seen only 10 non-contact ACL tears, so this data is very promising. I’m grateful that with additional funding from the Greater Rochester Health Foundation, we are able to significantly expand the reach of our program, and help even more female athletes stay in the game and attain their goals, whatever they may be.”
The program has steadily been gaining national attention. In 2008, the NCAA posted an interactive segment on ACL injuries to its website, which included a feature on USM’s PEP program.
Mystery Surrounds Female ACL Tears
The numbers on female ACL tears are astounding. Over 1.4 million women have been afflicted in the past 10 years alone — twice the rate of the previous decade. It is estimated that more than 30,000 high school and college age females will rupture their ACL every year. In the last 15 years, ankle sprains have decreased by 86 percent while knee ligament injuries have increased by 172 percent.
Much speculation exists on the cause of the higher non-contact ACL injury rate in females, with hormones, biomechanics and environment some of the common culprits named. While researchers have been unable to definitively pinpoint the exact cause for the increased incidence in females, they have been able to develop a series of specific stretching, strengthening, flexibility and balance exercises that have been shown to significantly reduce injury rates.
“PEP works by retraining the nervous and muscle system in female athletes to be more efficient, and as a result, reduce the potential for non-contact ACL tears,” said Andy Duncan, P.T., A.T.C., director of sports rehabilitation at USM.
It consists of a specialized warm-up program that must be completed two to three times a week, and includes exercises and training to increase muscle strength, plyometrics (active strengthening like jumps), agility, balance and flexibility. The program takes about 20-25 minutes to complete.
“We stress quality versus quantity with the girls. These exercises are so precise that they must be done properly or they will not receive any benefit at all,” Duncan said. “In effect, we are re-teaching the muscles how to fire and respond to signals from the nervous system. At the end of six weeks, if the program is done correctly and consistently, these athletes will have a much better chance at preventing an ACL tear.”
Beginning in the summer of 2009 USM athletic trainers will use a “train-the-trainer” approach to educate team coaches/representatives on the benefits and components of the PEP program. The sessions will be interactive, including demonstration and participation. Videos detailing each exercise will be given to each team to help guide the athletes through the program.
Sample PEP Exercises
• Warm-ups: Jog, slides, backpedals
• Strengthening: Lunge walk, ball bridge, calf raise
• Plyometrics: Lateral, front/back and single leg hops, rebound jumps, scissor jumps
• Agility: Shuttle and pivot runs
• Stretching Hamstrings, quads, calves, groin and hip flexors
Organized by University Sports Medicine (USM), the PEP program is being rolled out to 119 high schools in Section V, an area that covers all Monroe, Ontario, Seneca, Livingston, Allegany, Steuben and Wayne counties in upstate New York. The expansion, made possible by a $161,000 grant from the Greater Rochester Health Foundation (GRHF), will cover junior varsity and varsity female athletes playing soccer, volleyball and basketball – the three main sports with high incidences of ACL tears. USM officials expect to train about 11,180 athletes on nearly 700 teams during the two-year program.
GRHF provided the seed money for USM to introduce the program to Monroe County high school athletes in January 2007. Since that time, USM athletic trainers have worked with 1,137 female athletes on 71 teams, and preliminary results are promising.
“We would typically expect to see about two ACL tears per 100 participants, or about 58 non-contact ACL tears for the 2,900 athletes we have been working with,” Michael Maloney, M.D., director of USM, said. “To date, we’ve seen only 10 non-contact ACL tears, so this data is very promising. I’m grateful that with additional funding from the Greater Rochester Health Foundation, we are able to significantly expand the reach of our program, and help even more female athletes stay in the game and attain their goals, whatever they may be.”
The program has steadily been gaining national attention. In 2008, the NCAA posted an interactive segment on ACL injuries to its website, which included a feature on USM’s PEP program.
Mystery Surrounds Female ACL Tears
The numbers on female ACL tears are astounding. Over 1.4 million women have been afflicted in the past 10 years alone — twice the rate of the previous decade. It is estimated that more than 30,000 high school and college age females will rupture their ACL every year. In the last 15 years, ankle sprains have decreased by 86 percent while knee ligament injuries have increased by 172 percent.
Much speculation exists on the cause of the higher non-contact ACL injury rate in females, with hormones, biomechanics and environment some of the common culprits named. While researchers have been unable to definitively pinpoint the exact cause for the increased incidence in females, they have been able to develop a series of specific stretching, strengthening, flexibility and balance exercises that have been shown to significantly reduce injury rates.
“PEP works by retraining the nervous and muscle system in female athletes to be more efficient, and as a result, reduce the potential for non-contact ACL tears,” said Andy Duncan, P.T., A.T.C., director of sports rehabilitation at USM.
It consists of a specialized warm-up program that must be completed two to three times a week, and includes exercises and training to increase muscle strength, plyometrics (active strengthening like jumps), agility, balance and flexibility. The program takes about 20-25 minutes to complete.
“We stress quality versus quantity with the girls. These exercises are so precise that they must be done properly or they will not receive any benefit at all,” Duncan said. “In effect, we are re-teaching the muscles how to fire and respond to signals from the nervous system. At the end of six weeks, if the program is done correctly and consistently, these athletes will have a much better chance at preventing an ACL tear.”
Beginning in the summer of 2009 USM athletic trainers will use a “train-the-trainer” approach to educate team coaches/representatives on the benefits and components of the PEP program. The sessions will be interactive, including demonstration and participation. Videos detailing each exercise will be given to each team to help guide the athletes through the program.
Sample PEP Exercises
• Warm-ups: Jog, slides, backpedals
• Strengthening: Lunge walk, ball bridge, calf raise
• Plyometrics: Lateral, front/back and single leg hops, rebound jumps, scissor jumps
• Agility: Shuttle and pivot runs
• Stretching Hamstrings, quads, calves, groin and hip flexors
Tuesday, February 3, 2009
Exercises to strengthen your quadriceps
It may be uncomfortable at first, but doing exercises to strengthen your quadriceps after you’ve had knee replacement surgery due to osteoarthritis is critical to your recovery. In fact, it can boost the function of your new knee to nearly that of a healthy adult your age.
That’s the finding of a University of Delaware study published in the February issue of Arthritis Care & Research.
The authors include Lynn Snyder-Mackler, Alumni Distinguished Professor of Physical Therapy at the University of Delaware, Stephanie Petterson, clinical faculty at Columbia University, Ryan Mizner, an assistant professor at Eastern Washington University, Jennifer Stevens, an assistant professor at the University of Colorado at Denver, and Drs. Leo Raisis, Alex Bodenstab, and William Newcomb of First State Orthopaedics in Newark, Delaware.
“It sounds logical that exercises to strengthen your knee should be a component of your post-operative physical therapy after a total knee replacement, but it’s not the convention at all,” says Snyder-Mackler.
“There are all of these old wives’ tales that strength training is a detriment to the patient and that the new knee should be treated delicately,” Snyder-Mackler notes. “Our study demonstrates that intensive strength exercise as outpatient therapy is critical to begin three to four weeks after surgery.”
Nearly 500,000 knee replacements, also known as total knee arthroplasties, are performed every year in the United States to treat severe knee osteoarthritis, the loss of the cushiony cartilage padding the knee. The joint disease leaves its sufferers with persistent pain and limited function, resulting in an overall diminished quality of life.
While knee replacement alleviates the pain of osteoarthritis and improves function, patients exhibit impaired quadriceps strength and function for such activities as walking and climbing stairs, and the levels remain below those of healthy people of the same age.
In a randomized controlled trial at the University of Delaware’s Physical Therapy Clinic conducted between 2000 and 2005, 200 patients who had undergone knee replacements were given six weeks of progressive strength training two or three times a week starting four weeks after surgery. Half of the group also received neuromuscular electrical stimulation (NMES).
Their function was compared to that of 41 patients who received conventional rehabilitation and home physical therapy. Quadriceps strength, knee range of motion, and gait were measured in such tests as timed up and go, stair climbing and a six-minute walk.
The group in the progressive strength-training program showed significant improvement in quadriceps strength and functional performance. They also demonstrated substantially greater quadriceps strength and functional performance after 12 months than the group that underwent conventional rehabilitation.
“This study clearly demonstrates the importance of surgeons encouraging their patients to be compliant with progressive quadriceps strengthening during their rehabilitation to enhance their clinical improvement and function post-total knee replacement,” notes Dr. Leo Raisis, a total joint surgeon and adjunct associate professor at the University of Delaware.
“Why undergo a $25,000 elective surgery and then not do as much as you can to get the most out of it and improve your quality of life?” Snyder-Mackler says. “Older people are incredibly motivated—they hurt after the surgery and they want to be better. They need to do this.”
That’s the finding of a University of Delaware study published in the February issue of Arthritis Care & Research.
The authors include Lynn Snyder-Mackler, Alumni Distinguished Professor of Physical Therapy at the University of Delaware, Stephanie Petterson, clinical faculty at Columbia University, Ryan Mizner, an assistant professor at Eastern Washington University, Jennifer Stevens, an assistant professor at the University of Colorado at Denver, and Drs. Leo Raisis, Alex Bodenstab, and William Newcomb of First State Orthopaedics in Newark, Delaware.
“It sounds logical that exercises to strengthen your knee should be a component of your post-operative physical therapy after a total knee replacement, but it’s not the convention at all,” says Snyder-Mackler.
“There are all of these old wives’ tales that strength training is a detriment to the patient and that the new knee should be treated delicately,” Snyder-Mackler notes. “Our study demonstrates that intensive strength exercise as outpatient therapy is critical to begin three to four weeks after surgery.”
Nearly 500,000 knee replacements, also known as total knee arthroplasties, are performed every year in the United States to treat severe knee osteoarthritis, the loss of the cushiony cartilage padding the knee. The joint disease leaves its sufferers with persistent pain and limited function, resulting in an overall diminished quality of life.
While knee replacement alleviates the pain of osteoarthritis and improves function, patients exhibit impaired quadriceps strength and function for such activities as walking and climbing stairs, and the levels remain below those of healthy people of the same age.
In a randomized controlled trial at the University of Delaware’s Physical Therapy Clinic conducted between 2000 and 2005, 200 patients who had undergone knee replacements were given six weeks of progressive strength training two or three times a week starting four weeks after surgery. Half of the group also received neuromuscular electrical stimulation (NMES).
Their function was compared to that of 41 patients who received conventional rehabilitation and home physical therapy. Quadriceps strength, knee range of motion, and gait were measured in such tests as timed up and go, stair climbing and a six-minute walk.
The group in the progressive strength-training program showed significant improvement in quadriceps strength and functional performance. They also demonstrated substantially greater quadriceps strength and functional performance after 12 months than the group that underwent conventional rehabilitation.
“This study clearly demonstrates the importance of surgeons encouraging their patients to be compliant with progressive quadriceps strengthening during their rehabilitation to enhance their clinical improvement and function post-total knee replacement,” notes Dr. Leo Raisis, a total joint surgeon and adjunct associate professor at the University of Delaware.
“Why undergo a $25,000 elective surgery and then not do as much as you can to get the most out of it and improve your quality of life?” Snyder-Mackler says. “Older people are incredibly motivated—they hurt after the surgery and they want to be better. They need to do this.”
Saturday, January 31, 2009
Supplements no better than placebo
Supplements no better than placebo in slowing cartilage loss in knees of osteoarthritis patients
In a two-year multicenter study led by University of Utah doctors, the dietary supplements glucosamine and chondroitin sulfate performed no better than placebo in slowing the rate of cartilage loss in the knees of osteoarthritis patients.
This was an ancillary study concurrently conducted on a subset of the patients who were enrolled in the prospective, randomized GAIT (Glucosamine/chondroitin Arthritis Intervention Trial). The primary objective of this ancillary study was to investigate whether these dietary supplements could diminish the structural damage of osteoarthritis. The results, published in the October issue of Arthritis & Rheumatism, show none of the agents had a clinically significant effect on slowing the rate of joint space width loss —the distance between the ends of joint bones as shown by X-ray.
However, in line with other recent studies, the researchers observed that all the study's participants had a slower rate of joint space width loss than expected, making it more difficult to detect the effects of the dietary supplements and other agents used in the study.
Rheumatologist Allen D. Sawitzke, M.D., associate professor of internal medicine at the University of Utah School of Medicine, was lead investigator. "At two years, no treatment achieved what was predefined to be a clinically important reduction in joint space width loss," Sawitzke said. "While we found a trend toward improvement among those with moderate osteoarthritis of the knee in those taking glucosamine, we were not able to draw any definitive conclusions."
More than 21 million Americans have osteoarthritis, with many taking glucosamine and chondroitin sulfate, separately or in combination, to relieve pain. The original GAIT, led by University of Utah rheumatologist Daniel O. Clegg, M.D., professor of internal medicine, was a multicenter, randomized, national clinical trial that studied whether these dietary supplements provided significant pain relief to people with osteoarthritis in the knees. GAIT found that the supplements produced no more pain relief than placebo (New England Journal of Medicine, February 2006), although a subset of the original GAIT participants with moderate to severe osteoarthritis knee pain appeared to receive significant pain relief when they took a combination of glucosamine and chondroitin sulfate.
In this ancillary study, GAIT patients were offered the opportunity to continue their original study treatment for an additional 18 months, for a total of two years. Participants remained on their originally assigned GAIT treatment: 500 mg of glucosamine three times a day; or 400 mg of chondroitin sulfate three times a day; or a combination of the two supplements; or 200 mg of celecoxib daily; or a placebo.
X-rays were obtained at study entry and again at one and two years. Joint space width was measured on 581 knees from 357 patients. None of the trial groups showed significant improvement. The group taking glucosamine had the least change in joint space width, followed by the groups taking chondroitin sulfate, celecoxib, placebo and the combination of both dietary supplements.
The total joint space width loss over two years for each group was:
0. 0.013mm (glucosamine)
0. 0.107mm (chondroitin sulfate)
0. 0.111mm (celecoxib)
0. 0.166mm (placebo)
0. 0.194mm (glucosamine and chondroitin sulfate)
The interpretation of the results was problematic because the placebo group's joint space width loss was much less at two years than the 0.4mm the researchers' expected. Based on other large studies published in scientific journals, the researchers hypothesized that a loss of 0.2mm or less at two years would mean a slowed rate of cartilage loss. However, because the reduction in rate of joint space loss for all the groups was under the 0.2mm threshold, the researchers concluded none of the agents significantly slowed the loss of joint space width.
Josephine P. Briggs, M.D., director of the National Center for Complementary and Alternative Medicine, one of the study's funders, said although no definitive conclusions can be drawn about the two dietary supplements yet, "the results of the study provide important insights for future research."
Clegg said the trial shed light on osteoarthritis progression, techniques that can more reliably measure joint space width loss, possible effects of glucosamine and chondroitin sulfate, and on identifying patients who may respond best as further studies are pursued.
In a two-year multicenter study led by University of Utah doctors, the dietary supplements glucosamine and chondroitin sulfate performed no better than placebo in slowing the rate of cartilage loss in the knees of osteoarthritis patients.
This was an ancillary study concurrently conducted on a subset of the patients who were enrolled in the prospective, randomized GAIT (Glucosamine/chondroitin Arthritis Intervention Trial). The primary objective of this ancillary study was to investigate whether these dietary supplements could diminish the structural damage of osteoarthritis. The results, published in the October issue of Arthritis & Rheumatism, show none of the agents had a clinically significant effect on slowing the rate of joint space width loss —the distance between the ends of joint bones as shown by X-ray.
However, in line with other recent studies, the researchers observed that all the study's participants had a slower rate of joint space width loss than expected, making it more difficult to detect the effects of the dietary supplements and other agents used in the study.
Rheumatologist Allen D. Sawitzke, M.D., associate professor of internal medicine at the University of Utah School of Medicine, was lead investigator. "At two years, no treatment achieved what was predefined to be a clinically important reduction in joint space width loss," Sawitzke said. "While we found a trend toward improvement among those with moderate osteoarthritis of the knee in those taking glucosamine, we were not able to draw any definitive conclusions."
More than 21 million Americans have osteoarthritis, with many taking glucosamine and chondroitin sulfate, separately or in combination, to relieve pain. The original GAIT, led by University of Utah rheumatologist Daniel O. Clegg, M.D., professor of internal medicine, was a multicenter, randomized, national clinical trial that studied whether these dietary supplements provided significant pain relief to people with osteoarthritis in the knees. GAIT found that the supplements produced no more pain relief than placebo (New England Journal of Medicine, February 2006), although a subset of the original GAIT participants with moderate to severe osteoarthritis knee pain appeared to receive significant pain relief when they took a combination of glucosamine and chondroitin sulfate.
In this ancillary study, GAIT patients were offered the opportunity to continue their original study treatment for an additional 18 months, for a total of two years. Participants remained on their originally assigned GAIT treatment: 500 mg of glucosamine three times a day; or 400 mg of chondroitin sulfate three times a day; or a combination of the two supplements; or 200 mg of celecoxib daily; or a placebo.
X-rays were obtained at study entry and again at one and two years. Joint space width was measured on 581 knees from 357 patients. None of the trial groups showed significant improvement. The group taking glucosamine had the least change in joint space width, followed by the groups taking chondroitin sulfate, celecoxib, placebo and the combination of both dietary supplements.
The total joint space width loss over two years for each group was:
0. 0.013mm (glucosamine)
0. 0.107mm (chondroitin sulfate)
0. 0.111mm (celecoxib)
0. 0.166mm (placebo)
0. 0.194mm (glucosamine and chondroitin sulfate)
The interpretation of the results was problematic because the placebo group's joint space width loss was much less at two years than the 0.4mm the researchers' expected. Based on other large studies published in scientific journals, the researchers hypothesized that a loss of 0.2mm or less at two years would mean a slowed rate of cartilage loss. However, because the reduction in rate of joint space loss for all the groups was under the 0.2mm threshold, the researchers concluded none of the agents significantly slowed the loss of joint space width.
Josephine P. Briggs, M.D., director of the National Center for Complementary and Alternative Medicine, one of the study's funders, said although no definitive conclusions can be drawn about the two dietary supplements yet, "the results of the study provide important insights for future research."
Clegg said the trial shed light on osteoarthritis progression, techniques that can more reliably measure joint space width loss, possible effects of glucosamine and chondroitin sulfate, and on identifying patients who may respond best as further studies are pursued.
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