Jan 29, 2015
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Emotions and ACL Recovery

While recovering from ACL reconstruction surgery is far from routine, advances in the procedure have reduced the number of physical complications that hinder recovery. The psychological aspects of recovery, however, remain a factor in determining an athlete’s chances of making a full return to action. A pair of presentations at the American Physical Therapy Association’s 2013 Combined Sections Meeting in February provided some insight into the topic.

One study, led by Terese Chmielewski, PhD, PT, SCS, Associate Professor at the University of Florida, looked at athletes’ fear and confidence levels during the rehab process. The study found that athletes’ confidence in their knee typically increased during the first three months of rehab as well as the following three months. Fear of re-injury, however, decreased only during the initial three-month recovery period. Over the next three months, the athletes’ fear level tended to not decrease. “It also appears that fear may be accentuated when patients begin advanced rehabilitation and return to sports, maybe because people start doing activities that make them fearful,” Chmielew-ski told Lower Extremity Review (LER).

Another study examined the effectiveness of the ACL-Return to Sport After Injury Scale (ACL-RSI), a 12-item questionnaire developed seven years ago that queries athletes about their emotions regarding their knee injury, confidence in their knee, and perceived risk of re-injury. Ryan Mizner, Assistant Professor at the University of Montana, compared the ACL-RSI to the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), which was developed in 1987 and focuses on an athlete’s view of their knee’s performance.

Mizner found significant correlation between an athlete’s ACL-RSI score and physical outcome measures, including single-leg hop test, quadriceps strength, and peak knee extension during a single-leg landing test. Meanwhile there was no significant correlation between their IKDC score and those same outcome measures.

In the study’s abstract, the authors reported the ACL-RSI “might prove to be a preferential measure compared to the IKDC when making clinical decisions related to readiness for return to sport or discharge from physical therapy. Our results suggest that the ACL-RSI, or similar psychological assessments, should be included as part of standardized outcomes assessments.”

Shoe Switch Changes Running Motion

Most competitive runners train wearing running sneakers that have thick, cushioned heels but compete in track spikes or flats. A study presented at the 2013 Annual Meeting of the American Academy of Orthopedic Surgeons found that switching between practice and competition footwear could alter an athlete’s biomechanics and cause a performance decrease, at least in adolescent runners.

Researchers from The University of Kansas Hospital asked 12 adolescent athletes from competitive track teams to run on a treadmill at four different speeds in training sneakers, racing flats, and barefoot. Using a motion capture system, measurements were taken for stride length, heel height during posterior swing phase, and strike pattern.

Results showed that when wearing sneakers, participants landed heel first 70 percent of the time at all speeds. However, when these same athletes wore racing flats, the heel was the initial point of contact less than 35 percent of the time, and the runners instead landed on the forefoot or midfoot. Barefoot tests showed the heel hitting first less than 30 percent of the time.

Study authors Scott Mullen, MD, and E.B. Toby, MD, concluded that footwear dramatically altered the biomechanics of the adolescent subjects. “What we found is that simply by changing their footwear, the runners’ foot strike would change,” Mullen told Medical News Today. “When they ran in the cushioned heel or an average running shoe–even when running a five-minute mile–the athletes landed on their heel first.”

These findings could affect the performance of adolescent runners. Mullen told Medical News Today that he believes practicing and racing using different biomechanics “may give them less of a [competitive] advantage.”

To view the abstract of the study, search “Adolescent Runners: The Effect of Training Shoes upon Running Kinematics,” at: www.abstractsonline.com/plan/ AdvancedSearch.aspx.

ATC Buys a Vowel

On Tuesday, June 4, athletic trainers around the country can cheer on one of their own as Ben Bowles, ATC, Head Athletic Trainer at Centennial High School in Burleson, Texas, will appear as a contestant on Wheel of Fortune. Bowles said being on the popular television game show, which taped in January, is the culmination of a lifelong dream.

“I’ve been watching Wheel of Fortune since I was two with my grandmother,” Bowles told the Burleson Star. “So I was really excited to be picked for the show.”

Bowles’ path to Fortune began in November–on the day of his grandmother’s funeral–when he heard a radio ad announcing an open audition for the show in Dallas. At the tryout, Bowles spent two days alongside 300 other potential contestants being evaluated for puzzle-solving acumen, stage presence, and enthusiasm.

Having impressed the judges, Bowles was invited to participate in a second Dallas-based audition about a month later. Along with completing more word puzzles, Bowles and other hopefuls participated in sample rounds of the show using a smaller version of the wheel.

On Dec. 29, Bowles, a father of three, received the call he’d been dreaming about. He’d been chosen to spin the big wheel. Two weeks later, he was at the Sony Studios in Culver City, Calif., filming shows that will run during Wheel of Fortune’s “Dad’s Week,” with the final episode airing on Father’s Day.

A strict confidentiality policy prohibits him from revealing how he finished, but Bowles told the Star, “I think I’m going to make Burleson proud.” And no matter the results, Bowles described his appearance as the fulfillment of a lifelong goal that he can scratch off his bucket list.

To find the show’s time and channel listing for your area, click the “Show Guide” box on the menu bar at: www.wheeloffortune.com.

Tennis Elbow Treatments Questioned

New research into tennis elbow has found that two common treatments–a corticosteroid shot and physical therapy–may be of little help. In fact, a corticosteroid shot may hinder recovery.

For the study, published in the Feb. 6 issue of the Journal of the American Medical Association, researchers randomly assigned 165 adults who had suffered from tennis elbow for more than six weeks into one of four groups. Two groups received corticosteroid injections while the other two received placebos. Within both the placebo and corticosteroid groups, half the participants received an average of eight weekly physical therapy sessions. The individuals were then examined a year later.

While 83 percent of individuals who received the corticosteroid shot experienced what the study called “complete recovery or much improvement,” 96 percent of the placebo group experienced those same results. Additionally, 54 percent of those who got the corticosteroid shot experienced a recurrence of tennis elbow, compared to only 12 percent of those who received the placebo.

Those numbers don’t surprise Marc Kowalsky, MD, an orthopedic surgeon at Lenox Hill Hospital in New York City. “[Tennis elbow] is really not an inflammatory condition, so it wouldn’t make sense that a cortisone injection would work,” he told U.S. News.

Of the subjects who also received physical therapy, 91 percent of patients reported “complete recovery or much improvement.” Meanwhile, 88 percent of individuals who did not receive physical therapy reported the same long-term results. However, researchers found that therapy was more effective early on. “In the absence of the corticosteroid, [physiotherapy] provided short-term benefit across all outcomes, as well as the lowest recurrence rates,” they wrote in the study.

To read the abstract of the study, “Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients With Unilateral Lateral Epicondylalgia: A Randomized Controlled Trial,” go to http://jama.jamanetwork.com and click on “All Issues” to find the Feb. 6 issue.


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