Article

Jumping on bandwagons: Taking the right clinical message from research

Authors:
If you want to read the PDF, try requesting it from the authors.

Abstract

None.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the author.

... I welcome this opportunity to comment on the opinions and interpretations of Allison et al 1 and Cook. 2 As indicated by Allison et al in their paper published in JOSPT, 3 it is not the data that are questioned; it is the interpretation. It seems that we have a recurrence of the issue of the six blind men and the elephant, where we see the same animal, but from different perspectives, and draw different conclusions. ...
... There are a number of assumptions that require consideration to challenge the interpretation of Allison et al 1 and the opinion of Cook. 2 A key issue is that to conclude that a single observation from a single task refutes the conclusion of a whole range of different methodologies/tasks seems unfounded. ...
Article
Full-text available
It is good to see that clinical and research hypotheses are debated in the literature. The purpose of science is to challenge ideas and to consider alternative interpretations of observations. Within this, the place for neurophysiological/biomechanical studies in clinical research is not to predict the potential efficacy of a clinical approach, but to try to understand the mechanisms that underlie it. This is helpful as it provides a means to refine, improve, and direct intervention and provides a platform to develop rationales for intervention, particularly when we are faced with complex patients who do not fit the clinical prediction rule or the narrow criteria adopted for inclusion in clinical trials. If we understand the mechanisms we have a powerful tool to rationalise and test interventions. The developing debate about the role of transversus abdominis is healthy for rational consideration of motor control interventions for back pain. I welcome this opportunity to comment on the opinions and interpretations of Allison et al 1 and Cook.2 As indicated by Allison et al in their paper published in JOSPT,3 it is not the data that are questioned; it is the interpretation. It seems that we have a recurrence of the issue of the six blind men and the elephant, where we see the same animal, but from different perspectives, and draw different conclusions. There are a number of assumptions that require consideration to challenge the interpretation of Allison et al 1 and the opinion of Cook.2 A key issue is that to conclude that a single observation from a single task refutes the conclusion of a whole range of different methodologies/tasks seems unfounded. In response to the editorial by Cook,2 the first thing to consider is that the results of physiological/biomechanical studies cannot be used to challenge the outcomes …
... This exercise approach was established some two decades ago and has been relatively well accepted until recently [17] . Several studies have now questioned the reliability of the scientific findings in relation to function and symptomology181920 which in turn challenges the concept of graded introduction of the functional components following a foundation of stability [21]. Perhaps more significantly, to date no study has found evidence that training the stability system in isolation can be attributed to long-term symptomatic relief in subjects with LBP222324 . ...
... This exercise approach was established some two decades ago and has been relatively well accepted until recently [17]. Several studies have now questioned the reliability of the scientific findings in relation to function and symptomology [18][19][20] which in turn challenges the concept of graded introduction of the functional components following a foundation of stability [21]. Perhaps more significantly, to date no study has found evidence that training the stability system in isolation can be attributed to long-term symptomatic relief in subjects with LBP [22][23][24]. ...
Article
Full-text available
Novel theoretical models of movement have historically inspired the creation of new methods for the application of human movement. The landmark theoretical model of spinal stability by Panjabi in 1992 led to the creation of an exercise approach to spinal stability. This approach however was later challenged, most significantly due to a lack of favourable clinical effect. The concepts explored in this paper address and consider the deficiencies of Panjabi's model then propose an evolution and expansion from a special model of stability to a general one of movement. It is proposed that two body-wide symbiotic elements are present within all movement systems, stability and mobility. The justification for this is derived from the observable clinical environment. It is clinically recognised that these two elements are present and identifiable throughout the body in different joints and muscles, and the neural conduction system. In order to generalise the Panjabi model of stability to include and illustrate movement, a matching parallel mobility system with the same subsystems was conceptually created. In this expanded theoretical model, the new mobility system is placed beside the existing stability system and subsystems. The ability of both stability and mobility systems to work in harmony will subsequently determine the quality of movement. Conversely, malfunction of either system, or their subsystems, will deleteriously affect all other subsystems and consequently overall movement quality. For this reason, in the rehabilitation exercise environment, focus should be placed on the simultaneous involvement of both the stability and mobility systems. It is suggested that the individual's relevant functional harmonious movements should be challenged at the highest possible level without pain or discomfort. It is anticipated that this conceptual expansion of the theoretical model of stability to one with the symbiotic inclusion of mobility, will provide new understandings on human movement. The use of this model may provide a universal system for body movement analysis and understanding musculoskeletal disorders. In turn, this may lead to a simple categorisation system alluding to the functional face-value of a wide range of commonly used passive, active or combined musculoskeletal interventions. Further research is required to investigate the mechanisms that enable or interfere with harmonious body movements. Such work may then potentially lead to new and evolved evidence based interventions.
Chapter
The bandwagon effect within medical practice is one that can easily be misunderstood for updated practice and the implementation of new evidence in the delivery of healthcare. Notwithstanding this, the bandwagon effect, in the right circumstance and with the correct understanding, can have very positive effects on healthcare provision as new evidence becomes incorporated into practice.
Article
Full-text available
Aircraft cabins are pressurised to maximum effective altitudes of 2440 metres, resulting in significant decline in oxygen saturation in crew and passengers. This effect has not been studied in athletes. To investigate the degree of decline in oxygen saturation in athletes during long-haul flights. A prospective cross-sectional study. National-level athletes were recruited. Oxygen saturation and heart rate were measured with a pulse oximeter at sea level before departure, at 3 and 7 hours into the flight, and again after arrival at sea level. Aircraft cabin pressure and altitude, cabin fraction of inspired oxygen and true altitude were also recorded. 45 athletes and 18 healthy staff aged between 17 and 70 years were studied on 10 long-haul flights. Oxygen saturation levels declined significantly after 3 hours and 7 hours (3-4%), compared with sea level values. There was an associated drop in cabin pressure and fraction of inspired oxygen, and an increase in cabin altitude. Oxygen saturation declines significantly in athletes during long-haul commercial flights, in response to reduced cabin pressure. This may be relevant for altitude acclimatization planning by athletes, as the time spent on the plane should be considered time already spent at altitude, with associated physiological changes. For flights of 10-13 hours in duration, it will be difficult to arrive on the day of competition to avoid the influence of these changes, as is often suggested by coaches.
Article
Full-text available
The purpose of this review is to describe the evolution of hydration research and advice on drinking during exercise from published scientific papers, books and non-scientific material (advertisements and magazine contents) and detail how erroneous advice is likely propagated throughout the global sports medicine community. Hydration advice from sports-linked entities, the scientific community, exercise physiology textbooks and non-scientific sources was analysed historically and compared with the most recent scientific evidence. Drinking policies during exercise have changed substantially throughout history. Since the mid-1990s, however, there has been an increase in the promotion of overdrinking by athletes. While the scientific community is slowly moving away from "blanket" hydration advice in which one form of advice fits all and towards more modest, individualised, hydration guidelines in which thirst is recognised as the best physiological indicator of each subject's fluid needs during exercise, marketing departments of the global sports drink industry continue to promote overdrinking.
Article
Full-text available
Changes in body composition of college wrestlers undergoing rapid weight reduction were evaluated over time using magnetic resonance imaging (MRI). This study evaluated 12 wrestlers (male, 18-22 years of age) who participated in Japan's 2005 intercollegiate wrestling tournament. For this study, MRI (of the right femoral region and the trunk), as well as measurements of body weight, body fat percentage and body water content, were performed 1 month and 1 week prior to the weigh-in, on the day of the weigh-in, on the day of the match (after the match), and 1 week after the weigh-in. A survey of food and fluid intake was also conducted. Several variables were significantly lower on the day of the weigh-in than one month prior: body weight (p<0.01, -7.3% (SD 1.6%)); body fat (p<0.05, -9.3 (5.8)%); body water content (p<0.01, -5.9 (1.6)%); trunk cross-section (p<0.01, -13.2 (4.4)%), including separate measurements of trunk viscera, trunk muscle, and trunk fat; quadriceps muscle; lower subcutaneous; and food intake (p<0.01, 122 (20)). At 1 week after the match, all metrics had recovered to their levels measured 1 month before the weigh-in. Certain variables that were highly sensitive to hydration recovered more rapidly: they had reached their initial levels when measured immediately after the match. Rapid weight reduction reduced the wrestlers' cross-sectional areas of muscle and fat tissues, which tended to recover through rehydration after the weigh-in. These results suggest that rapid weight reduction of wrestlers induced changes in different regions of the body.
Article
Full-text available
Petrissage is assumed to influence circulation as well as interstitial drainage of both superficial and deep tissues. To study its effect it was applied between consecutive bouts of supramaximal exercise performed by the lower leg muscles. Subjects were 11 healthy female students actively engaged in sports. Exercise bouts of ergometer cycling at loads determined individually (0.075 kp x body weight (kg)) for 5 s repeated eight times at intervals of 20 s had to be performed twice on an experimental day with 35 min intermittent bed rest. Each subject was investigated on two occasions with a minimum interval of 1 week, once without (control, CO) and once with 10 min petrissage (massage, MA) of the exercising lower leg during the bed rest phase. Effects of exercise bouts on blood lactate, muscle stiffness and perceived lower limb fatigue and their recovery before and after the second exercise bout were determined. For the first exercise bouts total power did not differ between MA and CO. Courses of blood lactate did not differ between MA and CO. However, recovery from measured muscle stiffness (p<0.05) and perceived lower limb fatigue (p<0.05) were more pronounced and total power during the second exercise bout was enhanced (p<0.01) in MA as compared with CO subjects. Petrissage improved cycle ergometer pedalling performance independent of blood lactate but in correlation with improved recovery from muscle stiffness and perceived lower limb fatigue.
Article
Full-text available
Good cardiorespiratory fitness has been associated with a reduced risk for clinical events of atherosclerotic vascular diseases. It is still unclear how this relates to a slower progression of the early atherosclerosis wall process. Method: Using a dynamic model, we generated new parameters for describing the pathologic wall process in the carotid artery, based on an automatic layer detection system. In this study, we scrutinised the influence of two ultrasonographic parameters, intima-media thickness (IMT) and roughness, by comparing two groups: a healthy inactive group (PIP) (mean (SD) age 64.37 (5.10) years; n = 50) and a healthy lifelong physically active group (PA) (mean (SD) age 64.48 (3.45) years; n = 51). All subjects underwent a blood test, spiroergometry, echocardiography and carotid ultrasound examination. There was a significant difference in the well known risk factors for cardiovascular disease (for example, high density lipoprotein cholesterol, triglyceride) between groups. PIP compared to PA had a significantly higher roughness (PIP 0.073 (0.015) vs PA 0.065 (0.0156); p<0.01). No significantly higher IMT was found for PIP (PIP 0.89 (0.18) vs PA 0.90 (0.22); p = 0.63) compared to PA. In this cross sectional study of middle aged men, Vo(2)max was inversely associated with carotid atherosclerotic parameters. In this study, good cardiorespiratory fitness was associated with an increase of the proven risk factors and a reduction of atherosclerosis in the common carotid artery. Roughness seems to be significantly more sensitive than IMT for characterising the changes of the arterial wall. We suggest measuring roughness in addition to IMT to gain additional information about the atherosclerotic wall.
Article
Full-text available
To assess possible ergogenic properties of corticosteroid administration. A balanced, double-blind, placebo-controlled design was used. 28 well-trained cyclists and rowers. 4 weeks' daily inhalation of 800 microg budesonide or placebo. The subjects performed three incremental cycle ergometer tests until exhaustion, before and after 2 and 4 weeks of placebo or budesonide administration, to measure maximal power output (W(max)). Once a week they filled in a profile of mood state (POMS) questionnaire. There was no significant difference in W(max) between the placebo (376 (SD 25) W) and the corticosteroid group (375 (36) W) during the preintervention test, and there were no significant changes in either group after 2 and 4 weeks of intervention. No effect of the intervention on mood state was found. 4 weeks of corticosteroid or placebo inhalation in healthy, well-trained athletes did not affect maximal power output or mood state. Hence no ergogenic properties of 4 weeks' corticosteroid administration could be demonstrated, which corroborates previous studies of short-term corticosteroid administration.
Article
Full-text available
To determine the diagnostic accuracy of power Doppler and grey scale ultrasonography, assess the relationship between severity measures and neovascularity, and describe the intra-tendon distribution of neovascularity in chronic tennis elbow. Between group cross sectional study. Sports medicine clinic and radiology centre. 32 affected elbows (median and range of duration: 10; 3-120 months) and 18 unaffected contralateral elbows in 25 patients (mean age 50 years) with lateral elbow pain, and 38 unaffected elbows in 19 asymptomatic participants (mean age 45 years) underwent a clinical examination (reference standard test) and grey scale and power Doppler ultrasonographic examination. Ultrasound examination with power Doppler identified neovascularity and grey scale ultrasound changes (lateral epicondyle bony spurring or irregularity, maximum anterior-posterior thickness, and echo characteristics) of the common extensor tendon. Power Doppler had a strong positive likelihood ratio of 45.39, whereas a combined null finding in power Doppler and grey scale ultrasonography resulted in a robust negative likelihood ratio of 0.05. Grey scale changes were generally not as diagnostically accurate. Common extensor tendon neovascularity was equally distributed between the superficial and deep part of the tendon, and clinical severity measures did not correlate with neovascularity scores. Neovascularity identified with power Doppler ultrasonography when compared to grey scale changes (alone or in combination with Doppler) was diagnostically superior in identifying chronic tennis elbow. The lack of both neovascularity and grey scale changes on ultrasound examination also substantially increase the probability that the condition is not present and should prompt the clinician to consider other causes for lateral elbow pain.
Article
Full-text available
To identify the effects of an automated stride assistance system (SAS) on walking scores and muscle activities in the lower extremities of elderly people. Seven healthy elderly men (73-81 years) participated in this study. Subjects walked continuously at a constant speed for 50 min on a treadmill with and without the SAS, which is a device to control the walk ratio (step length/cadence) and to add support power to the thigh during walking. A step counter equipped with an infrared device was used to record walking data. The average speeds during treadmill walking were 2.89-3.82 km/h without the SAS and 3.03-4.03 km/h with the SAS. Positron emission tomography (PET) and [18F]fluorodeoxyglucose (FDG) evaluation of glucose metabolism were conducted on each subject twice after walking with and without the SAS. Walk ratio, walking speed and step length were significantly improved in all subjects by the SAS, while cadence was significantly decreased by the SAS in all subjects except one. The SAS did not have a significant effect on glucose metabolism of the muscles of the lower extremities. There were no significant correlations between change in walking speed and change in glucose metabolism in each muscle without the SAS and with the SAS. In contrast, significant correlations between walking speed and glucose metabolism were shown in gluteus minimus (r = -0.929), hip-related muscles (r = -0.862), soleus (r = -0.907), and medial gastrocnemius (r = -0.952) without the SAS. With the SAS, there were significant correlations in gluteus medius (r = -0.899), hip-related muscles (r = -0.819), and medial gastrocnemius (r = -0.817) in the elderly subjects. The SAS increases walking scores in elderly people without increasing energy consumption of lower-extremity muscles. The elderly subjects with low walking speed showed higher glucose metabolism in hip-related muscles and triceps surae. Thus, this association suggested that decreased walking speed in elderly adults has a higher metabolic cost in these muscle regions.
Article
Full-text available
To examine whether inspiratory muscle training (IMT) is a useful additional technique with which to augment cardiovascular exercise training adaptations. 16 healthy untrained males agreed to participate in the study and were randomly assigned to training (TRA; n = 8) and placebo (PLA; n = 8) groups. Pre- and post-training measurements of spirometry and maximal inspiratory mouth pressure (MIP) were taken in addition to i) maximal aerobic power (VO(2max)) and ii) 5000 m run time-trial. All subjects completed the same 4 week cardiovascular training programme which consisted of three running sessions (CV1: 5 x 1000 m, CV2: 3 x 1600 m, SP1: 20 min run) in each of the 4 weeks. IMT was performed daily by both groups using an inspiratory muscle trainer (POWERbreathe). TRA completed 30 maximal inspirations while PLA inspired 30 times against a negligible resistance. Mean MIP increased significantly in both groups (TRA: 14.5 (SD 6.8)% change, PLA: 7.8 (7.4)% change) from pre- to post-training (p<0.01) but was not significantly related to changes in running performance. Mean CV1 training-repetition runs improved similarly in both groups, but RPE evaluations were significantly reduced in TRA (15.7 (0.7)) compared with PLA (16.6 (0.8)) at week 4 (p<0.05). Pre- to post-training changes in VO(2max) were well-matched between both TRA (+2.1 (2.3)%) and PLA (+1.3 (2.4)%) while post-intervention 5000 m performance was significantly augmented in TRA compared with PLA (TRA: 4.3 (1.6)%, PLA: 2.2 (1.9)%, p<0.05). The addition of IMT to a cardiovascular training programme augments 5000 m running performance but exerts no additional influence over VO(2max) compared with a cardiovascular-training group. This is probably due to IMT-induced reduction in perceived effort at high ventilatory rates, which is of greater consequence to longer duration time-trial performances than incremental tests of VO(2max).
Article
There is a growing body of literature describing severe surfing-related ocular injuries that result in permanent vision loss. We describe three severe surfing-related ocular injuries that occurred on beaches in northern California. One particular case stresses the need to tailor treatment to the patient and injury because of the possibility of good outcomes despite severe injury. Attention should also be directed towards commercially available safety gear and providing additional safety measures to prevent other orbital and ocular injuries.
Article
Paradoxical gas embolism through right-to-left (R/L) shunts is considered as a potential cause of certain types of decompression sickness. To assess whether 4 months of repetitive diving and strenuous exercises would lead to an increased prevalence of R/L shunting in a group of military divers. Using a standardised contrast-enhanced transcranial Doppler technique, 17 divers were re-examined for the presence of a R/L shunt 4 months after their initial examinations. R/L shunts were classified as type I if observed only after a straining manoeuvre, and type II if present at rest. Initial prevalence of R/L shunt was 41%: six type I shunts and one type II. At the second examination, prevalence was 47%, with the appearance of one type I shunt that was not previously present. We found no significant increase in the prevalence and size of R/L shunts. It is speculated that diving-related phenomena, such as variations in right atrial pressures during the end stages of or events immediately after a dive could generate an R/L shunt. However, extreme conditions of repetitive diving and strenuous exercises do not cause permanent modification in R/L permeability over a period of 4 months.
Article
Full-text available
The purpose of this study was to measure physiological responses during exercise performed until exhaustion at the exercise intensity corresponding to the maximal lactate steady state (MLSS) in order to determine why subjects stopped. Eleven male trained subjects performed a test at MLSS on a cycle ergometer until exhaustion. Time to exhaustion was 55.0 (SD 8.5) min. No variation was observed between the 10th and the last minute for arterial pyruvate, bicarbonate, and haemoglobin concentrations, redox state, arterial oxygen pressure, arterial oxygen saturation, osmolality, haematocrit, oxygen uptake, carbon dioxide output, and gas exchange ratio (p>0.05). Arterial lactate concentration and arterial carbon dioxide pressure decreased significantly whereas pH, base excess and the Ratings of Perceived Exertion (RPE) increased significantly (p<0.05). Although respiratory rate, minute ventilation and heart rate increased significantly until exhaustion (p<0.05), values at termination of the MLSS test were significantly lower than values measured during a maximal exercise test (p<0.05). Blood ammonia concentrations rose progressively during the MLSS test. However, there is no known mechanism by which this change could cause peripheral fatigue. Exercise termination was not associated with evidence of failure in any physiological system during prolonged exercise performed at MLSS. Thus the biological mechanisms of exercise termination at MLSS were compatible with an integrative homoeostatic control of peripheral physiological systems during exercise.
Article
Full-text available
To determine if asymmetry of trunk muscles and deficits of motor control exist among elite cricketers with and without low back pain (LBP). Single-blinded observational quasi-experimental design study Assessments were conducted in a hospital setting. Among a total eligible sample of 26 male elite cricketers (mean age 21.2 (SD 2.0) years), selected to attend a national training camp, 21 participated in the study. Risk factors: The independent variables were 'group' (LBP or asymptomatic) and 'cricket position' (fast bowler versus the rest of the squad). Main outcome measurements: The dependent variables were the cross-sectional areas (CSA) of the quadratus lumborum (QL), lumbar erector spinae plus multifidus (LES + M) and psoas muscles, the thickness of the internal oblique (IO) and transversus abdominis (TrA) muscles, and the amount of lateral slide of the anterior abdominal fascia. The QL and LES + M muscles were larger ipsilateral to the dominant arm. In the subgroup of fast bowlers with LBP, the asymmetry in the QL muscle was the greatest. The IO muscle was larger on the side contralateral to the dominant arm. No difference between sides was found for the psoas and TrA muscles. Cricketers with LBP showed a reduced ability to draw in the abdominal wall and contract the TrA muscle independently of the other abdominal muscles. This study provides new insights into trunk muscle size and function in elite cricketers, and evidence of impaired motor control in elite cricketers with LBP. Rehabilitation using a motor control approach has been shown to be effective for subjects with LBP, and this may also benefit elite cricketers.
Article
A few studies on small patient series have investigated the relationship between gastroesophageal reflux and bronchial responsiveness as expressed by exercise-induced bronchoconstriction (EIB), with non-conclusive results. The aim of this study was to evaluate whether the presence of acid in the oesophagus may influence EIB. 45 patients with bronchial asthma underwent spirometry, exercise challenge on bicycle ergometer and 24 h oesophageal pH monitoring. Subjects with EIB (Forced expiratory volume in the first second (FEV1)) percentage decrease after exercise (DeltaFEV1) > or =15%, n = 28) were retested after a 2 week treatment course with omeprazole 40 mg/daily. Exercise at baseline was performed at the same time as oesophageal pH monitoring. In basal condition, there was no difference in FEV1, acid exposure time or number of refluxes measured during 24 h pH monitoring between patients with and without EIB. There was no relationship between spirometry results and DeltaFEV1 on one hand, and parameters of gastroesophageal reflux on the other. Nine patients with EIB (31.0%) and six patients without EIB (37.5%) had one or more episodes of GER during exercise challenge, without significant differences between the two groups. After gastric acid inhibition by omeprazole, DeltaFEV1 did not change significantly. The results indicate that acid in the oesophagus, or its short-term inhibition by proton pump inhibitors, has no influence on exercise-induced bronchoconstriction.
Article
This paper describes a well-conducted, well-designed, well-referenced and well-written investigation of the impact of oesophageal reflux on exercise-induced bronchospasm.Reflux on exertion has been documented in exercising individuals (10 in study) particularly in running or weight training (reference …
Article
Full-text available
To examine temporal trends in participation in sport and exercise activities in England between 1997 and 2006 while taking into account wider societal changes. A series of annual cross-sectional surveys. Nationally representative samples of men (n = 27 217) and women (n = 33 721) aged >or=16 years. Any (more than once every 4 weeks) and regular (more than once a week) participation in overall sport and exercise and a number of sport and exercise groupings (eg cycling, swimming, gym and fitness club-based activities (G/FC), racquet sports). Time point (1997/98, 2003/04, 2006) was the main dependent variable. Age-standardised overall regular participation changed from 40.8% in 1997/98 to 41.2% in 2006 for men (multivariable-adjusted participation OR = 1.11 in 2006, 95% CI 1.03 to 1.19, p<0.001) and from 31.2% to 33.9% for women (1.21, 1.13 to 1.29, p<0.001). Regular G/FC increased from 17.0% to 19.2% for men (1.19, 1.09 to 1.30) and from 15.9% to 18.7% for women (1.23, 1.14 to 1.33) and regular running increased from 2.4% to 4.0% for women only (1.84, 1.56 to 2.18). Overall increases were apparent only in older adults (>or=45 years) (1.25, 1.16 to 1.35, p<0.001). Young men (16-29 years) had reduced ORs for cycling (0.72, 0.58 to 0.88, p = 0.008), dancing (0.60, 0.45 to 0.82, p = 0.001), running (0.78, 0.64 to 0.94, p<0.001) and racquet sports (0.60, 0.42 to 0.86, p = 0.003). In men, increases were pronounced only among men from non-manual social classes, higher income households and white ethnic backgrounds. Sports and exercise participation in England has changed between 1997 and 2006 as the result of increases among middle-aged and older adults and decreases among young men. There are no signs that the participation gap between less and more advantaged population groups is narrowing.
Article
Full-text available
Low back pain (LBP) is the second greatest cause of disability in the USA.1 USA data supports that in spite of an enormous increase in the health resources spent on LBP disorders, the disability relating to them continues to increase.2 The management of LBP is underpinned by the exponential increase in the use of physical therapies, opiod medications, spinal injections as well as disc replacement and fusion surgery.2 This is maintained by the underlying belief that LBP is fundamentally a patho-anatomical disorder and should be treated within a biomedical model.1 This is in spite of calls over a number of years to adopt a bio-psycho-social approach, and evidence that only 8–15% of patients with LBP have an identified patho-anatomical diagnosis, resulting in the majority being diagnosed as having non-specific LBP.3 Of this population, a small but significant group becomes chronic and disabled, labelled non-specific chronic low back pain (NSCLBP), consuming a disproportionate amount of healthcare resources.4 1. Over the past decade, the traditional biomedical view of LBP has been greatly challenged. This is a result of: the failure of simplistic single-dimensional therapies to show large effects in patients with NSCLBP5–8; 2. the results of clinical trials testing commonly prescribed interventions demonstrating that no management approaches are clearly superior5–7 9; 3. the stories of NSCLBP patients relating their own ongoing pain experiences of multiple failed treatments, conflicting diagnoses, lost hope and ongoing suffering10; 4. the indisputable evidence supporting the multidimensional nature of NSCLBP as a disorder, where disability levels are more closely associated with cognitive and behavioural aspects of pain rather than sensory and biomedical ones11 12; 5. positive outcomes in randomised controlled trials (RCTs) are best predicted by changes in psychological distress, fear avoidance beliefs, self-efficacy in …
Article
To describe Pilates exercise according to peer-reviewed literature, and compare definitions used in papers with healthy participants and those with low back pain. A systematic review of literature was conducted. A search for "pilates" within the maximal date ranges of the Cochrane Library, Medline, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, ProQuest: Nursing and Allied Health Source, Proquest: Medical and Health Complete, Scopus, Sport Discus, and Web of Science, was undertaken. To be included, papers needed to describe Pilates exercise, and be published in English within an academic, peer-reviewed journal. There were no restrictions on the methodological design or quality of papers. Content analysis was used to record qualitative definitions of Pilates. Frequencies were calculated for mention of content categories, equipment, and traditional Pilates principles. Frequencies were then compared statistically in papers with healthy participants and those with low back pain. 119 papers fulfilled inclusion criteria. Findings suggest that Pilates is a mind-body exercise that focuses on strength, core stability, flexibility, muscle control, posture and breathing. Exercises can be mat-based or involve use of specialised equipment. Posture was discussed statistically significantly more often in papers with participants with low back pain compared to papers with healthy participants. Traditional Pilates principles of centering, concentration, control, precision, flow, and breathing were discussed on average in 23% of papers. Apart from breathing, these principles were not mentioned in papers with low back pain participants. There is a general consensus in the literature of the definition of Pilates exercise. A greater emphasis may be placed on posture in people with low back pain, whilst traditional principles, apart from breathing, may be less relevant.
Article
RAPID EXPANSION OF THE STRENGTH AND CONDITIONING FIELD, THE NUMBER OF PROFESSIONALS, AND SOURCES OF AVAILABLE INFORMATION HAVE RESULTED IN A “CHAOS” SITUATION. THE ROLES OF EDUCATION, TRAINING, AND EXPERIENCE SHOULD BE ASSESSED TO MAINTAIN OR ENHANCE THE QUALITY AND STANDARD OF PRACTICE. THE ACTIONS OF EACH INDIVIDUAL IN THE FIELD CONTRIBUTE, EITHER POSITIVELY OR NEGATIVELY, TO THE DEVELOPMENT OF STRENGTH AND CONDITIONING AS A PROFESSION.
Article
Pilates exercise is recommended for people with chronic low back pain (CLBP). In the literature, however, Pilates exercise is described and applied differently to treat people with CLBP. This makes it difficult to evaluate its effectiveness. The aim of this study was to establish a consensus regarding the definition and application of Pilates exercise to treat people with CLBP. A panel of 30 Australian physiotherapists, experienced in treating people with CLBP using Pilates exercise, were surveyed using the Delphi technique. Three electronic questionnaires were used to collect opinions. Answers to open-ended questions were analysed thematically, combined with systematic literature review findings, and translated into statements about Pilates exercise for people with CLBP. Participants then rated their level of agreement with these statements using a six-point Likert scale. Consensus was achieved when 70% of panel members strongly agreed, agreed, or somewhat agreed with an item, or strongly disagreed, disagreed, or somewhat disagreed. Thirty physiotherapists completed all 3 questionnaires and reached a consensus on the majority of items. Participants agreed that Pilates exercise requires body awareness, breathing, movement control, posture, and education. It was recommended that people with CLBP should undertake supervised sessions for 30-60 minutes twice per week for 3-6 months. Participants also suggested that people with CLBP would benefit from individualized assessment and exercise prescription, supervision and functional integration of exercises, and use of specialised equipment. These findings contribute to a better understanding of Pilates exercise and how it is utilised by physiotherapists to treat people with CLBP. This information provides direction for future research into Pilates exercise but findings need to be interpreted within the context of study limitations.
Article
Full-text available
Patellofemoral pain syndrome (PFPS) is a common clinical presentation. Various neuromuscular factors have been reported to contribute to its aetiology. Systematic review A literature search was carried out from 1998 up to December 2007. Eligible studies were those that: (1) examined the effects of hip strengthening in subjects with PFPS; (2) examined the effects of physiotherapy treatment aimed at restoring muscle balance between the vastus medialis oblique (VMO) and vastus lateralis (VL) in subjects with PFPS; (3) examined the effect of taping on electromyogram (EMG) muscle amplitude in subjects with PFPS; and (4) compared the effects of open versus closed kinetic chain exercises in the treatment of subjects with PFPS. Results and No randomised controlled trials exist to support the use of hip joint strengthening in subjects with PFPS. Physiotherapy treatment programmes appear to be an efficacious method of improving quadriceps muscle imbalances. Further studies are required to determine the true efficacy of therapeutic patellar taping. Both open and closed kinetic chain exercises are appropriate forms of treatment for subjects with PFPS.
Article
Full-text available
Article
Full-text available
Aircraft cabins are pressurised to maximum effective altitudes of 2440 metres, resulting in significant decline in oxygen saturation in crew and passengers. This effect has not been studied in athletes. To investigate the degree of decline in oxygen saturation in athletes during long-haul flights. A prospective cross-sectional study. National-level athletes were recruited. Oxygen saturation and heart rate were measured with a pulse oximeter at sea level before departure, at 3 and 7 hours into the flight, and again after arrival at sea level. Aircraft cabin pressure and altitude, cabin fraction of inspired oxygen and true altitude were also recorded. 45 athletes and 18 healthy staff aged between 17 and 70 years were studied on 10 long-haul flights. Oxygen saturation levels declined significantly after 3 hours and 7 hours (3-4%), compared with sea level values. There was an associated drop in cabin pressure and fraction of inspired oxygen, and an increase in cabin altitude. Oxygen saturation declines significantly in athletes during long-haul commercial flights, in response to reduced cabin pressure. This may be relevant for altitude acclimatization planning by athletes, as the time spent on the plane should be considered time already spent at altitude, with associated physiological changes. For flights of 10-13 hours in duration, it will be difficult to arrive on the day of competition to avoid the influence of these changes, as is often suggested by coaches.
Article
Full-text available
To identify the effects of an automated stride assistance system (SAS) on walking scores and muscle activities in the lower extremities of elderly people. Seven healthy elderly men (73-81 years) participated in this study. Subjects walked continuously at a constant speed for 50 min on a treadmill with and without the SAS, which is a device to control the walk ratio (step length/cadence) and to add support power to the thigh during walking. A step counter equipped with an infrared device was used to record walking data. The average speeds during treadmill walking were 2.89-3.82 km/h without the SAS and 3.03-4.03 km/h with the SAS. Positron emission tomography (PET) and [18F]fluorodeoxyglucose (FDG) evaluation of glucose metabolism were conducted on each subject twice after walking with and without the SAS. Walk ratio, walking speed and step length were significantly improved in all subjects by the SAS, while cadence was significantly decreased by the SAS in all subjects except one. The SAS did not have a significant effect on glucose metabolism of the muscles of the lower extremities. There were no significant correlations between change in walking speed and change in glucose metabolism in each muscle without the SAS and with the SAS. In contrast, significant correlations between walking speed and glucose metabolism were shown in gluteus minimus (r = -0.929), hip-related muscles (r = -0.862), soleus (r = -0.907), and medial gastrocnemius (r = -0.952) without the SAS. With the SAS, there were significant correlations in gluteus medius (r = -0.899), hip-related muscles (r = -0.819), and medial gastrocnemius (r = -0.817) in the elderly subjects. The SAS increases walking scores in elderly people without increasing energy consumption of lower-extremity muscles. The elderly subjects with low walking speed showed higher glucose metabolism in hip-related muscles and triceps surae. Thus, this association suggested that decreased walking speed in elderly adults has a higher metabolic cost in these muscle regions.
Article
Paradoxical gas embolism through right-to-left (R/L) shunts is considered as a potential cause of certain types of decompression sickness. To assess whether 4 months of repetitive diving and strenuous exercises would lead to an increased prevalence of R/L shunting in a group of military divers. Using a standardised contrast-enhanced transcranial Doppler technique, 17 divers were re-examined for the presence of a R/L shunt 4 months after their initial examinations. R/L shunts were classified as type I if observed only after a straining manoeuvre, and type II if present at rest. Initial prevalence of R/L shunt was 41%: six type I shunts and one type II. At the second examination, prevalence was 47%, with the appearance of one type I shunt that was not previously present. We found no significant increase in the prevalence and size of R/L shunts. It is speculated that diving-related phenomena, such as variations in right atrial pressures during the end stages of or events immediately after a dive could generate an R/L shunt. However, extreme conditions of repetitive diving and strenuous exercises do not cause permanent modification in R/L permeability over a period of 4 months.
Article
Regular physical activity is associated with a reduction of cardiovascular morbidity and mortality; however, evidence of unfortunate cardiovascular events accompanying elite sport involvement continues to accumulate. To date, no information is available on possible peculiarities of the cardiovascular risk profile in athletes. The aim of this study was to evaluate plasma homocysteine levels in a group of athletes and to search for relationship with vitamin status and other metabolic variables in order to confirm the existence of a "sport-related hyperhomocysteinaemia" and to explain its clinical significance. The study population was composed of 82 athletes (59 male and 23 female) practising different sports and 70 healthy age-matched subjects (40 male and 30 female) as a control group. Besides the general clinical and analytical determinations, the assessed variables included homocysteine, folate, vitamin B12, total and high-density lipoprotein (HDL) cholesterol, lactate dehydrogenase (LDH), creatine kinase (CPK) and interleukin-6 (IL-6). The prevalence of hyperhomocysteinaemia (>15 micromol/l) in athletes and controls was 47% and 15%, respectively. No correlation was found between homocysteine and any of the other investigated variables, in particular plasma folate, blood pressure, LDH, CPK, total and HDL cholesterol and IL-6. The results of this study confirm the existence of a sport-related hyperhomocysteinaemia which appears linked neither to the same variables found in the general population, nor to specific training-related variables. We suggest that it would represent an adaptation to training but the possibility of a secondary vascular damage cannot be excluded.
should be Schwellnus M. SportsMedUpdate
  • M Schwellnus
  • Sportsmedupdate
Schwellnus M. SportsMedUpdate. Br J Sports Med 2008;42:637–8. should be Schwellnus M. SportsMedUpdate. Br J Sports Med 2008;42:937–8.