Strengthening Quadriceps Muscles with Neuromuscular Electrical Stimulation Following Total Hip Replacement: a Review Abstract Purpose of Review Functional recovery from total hip replacement can be suboptimal and deficits in quadriceps muscle strength may hinder the return to activities of daily living. Neuromuscular electrical stimulation (NMES) devices have long been used to preserve and restore skeletal muscle mass and function following periods of muscle atrophy due to immobilisation. Here, we evaluate the potential role of NMES for strengthening the quadriceps muscles following hip replacement. Recent Findings Two studies have investigated the effects of NMES on quadriceps strength following hip replacement. NMES in addition to exercise training is reported to reduce length of stay and improve gait speed, stair climbing performance and sit-to-stand scores in one study. Conversely, the other study reports no significant effect of NMES on length of stay or gait speed, but instead, benefits to knee extensor strength of the operated side, functional status and independence. The benefits of NMES for the treatment of atrophic musculature following knee replacement are better established. Summary Although it is not possible to offer best-practice recommendations for clinical rehabilitation, the promising approach of NMES following total hip replacement requires further investigation. When used as an adjunctive treatment to standard care physiotherapy, NMES may facilitate recovery and, when used immediately post-surgery, can enable a high exercise volume, with little effort, at a time point where muscle inhibition and atrophy are most prevalent.

Patellar Tendinopathy in Athletes Abstract Purpose of Review This review discusses the current practice of evaluation and treatment of patellar tendinopathy with emphasis on rehabilitation. Recent Findings The latest studies revolve primarily around implementation of isometric and heavy slow resistance (HSR) exercises in the rehabilitation of patellar tendinopathy rather than the traditional rehabilitation method of eccentric exercise. Summary Patellar tendinopathy is a common injury of the inferior anterior knee seen in athletes but predominantly in jumping athletes. Onset is insidious and frequently noted in a loaded position with knee flexion. Physical exam finds tenderness along the patellar tendon with pain recreated while squatting. Treatment initially includes conservative measures such as guided physical therapy, medical therapy, and modalities. If recalcitrant, injections may be warranted, or rarely surgery may be considered.

Outcome Measures of Free-Living Activity in Spinal Cord Injury Rehabilitation Abstract Purpose of Review The purpose of this article was to describe the utilization of body-worn activity monitors in the spinal cord injury (SCI) population and discuss the challenges of using body-worn sensors in rehabilitation research. Recent Findings Many activity monitor-based measures have been used and validated in the SCI population including stroke number, push frequency, upper limb activity counts, and wheelchair propulsion distance measured from a sensor attached to the wheelchair. Summary The ability to accurately measure physical activity in the free-living environment using body-worn sensors has the potential to enhance the understanding of barriers to adequate activity and identify possible effective interventions. As the use of activity monitors used in SCI rehabilitation research continues to grow, care must be taken to overcome challenges related to participant adherence and data quality.

Review of Musculoskeletal Injury Prevention in Female Soccer Athletes Abstract Purpose of Review This paper aims to review the recent literature regarding the prevention of musculoskeletal injuries in female soccer athletes. Recent Findings Female soccer players are at risk for many musculoskeletal injuries, mostly involving the lower extremities, due to anatomic, hormonal, and biomechanical factors. Various programs are available that target overall injury prevention, as well as specifically the prevention of anterior cruciate ligament (ACL), ankle, and overuse injuries. The Fédération Internationale de Football Association (FIFA) 11+ is the most well-studied program for overall injury prevention and has been shown to have modest but significant effects in injury incidence. Prevention of ACL injuries is also well studied, and multiple programs have been shown to significantly reduce incidence, especially in youth athletes. Fewer current studies are available regarding ankle and overuse injuries. Summary Musculoskeletal injury prevention programs are available for female soccer players and may be effective in decreasing the incidence of certain injuries. There are clear differences in injury patterns in females compared to males, and further research is needed to specifically look at injury prevention in this population.

Knee Osteoarthritis and Meniscal Injuries in the Runner Abstract Purpose of Review This paper aims to review new evidence regarding the epidemiology, pathophysiology, and treatment of knee osteoarthritis and meniscal injuries in the recreational and professional running population. Recent Findings Though conservative measures remain the mainstay of treatment, increasing evidence shows a role for platelet-rich plasma as a conservative management option for osteoarthritis and meniscal injury, though further studies need to be performed. Cell-based therapy, such as mesenchymal stem cells, remains a controversial topic without clear evidence of their efficacy. Newer surgical options, such as collagen scaffolding and synthetic implants are under study, but surgical meniscal repair still remains the primary treatment for meniscal tears that have not responded to conservative treatment. Summary There is no association or causality between running low and moderate distances and knee OA. There is no causality between running and meniscal injury. There is a multitude of conservative and operative management options for both osteoarthritis and meniscal injury in runners. Platelet-rich plasma is one of the most recently studied interventions that has promising results.

Evidence Analysis of Sympathetic Blocks for Visceral Pain Abstract Purpose of Review This paper aims to review common sympathetic nerve blocks to treat visceral pain. Recent Findings Extensive reviews exist exploring the approach to care for those with visceral pain due to malignancy. These often include interventional pain procedures. Research demonstrates these procedures may reduce opioid use. Research is ongoing to assess the efficacy when treating non-malignant source of visceral pain. Recently, several case reports and small-scale studies demonstrate benefits for non-painful entities, such as improved cardiac function after such procedures. Summary The management of visceral algesia is complex. The approach to visceral pain should recognize the benefit of early discussions for the use of sympathetic blocks. Additionally, since most procedures have multiple techniques, analgesia can be achieved even in the setting of distorted anatomy due to tumor mass effects or post-radiation fibrosis, among other etiologies.

Ultramarathon Comprehensive Injury Prevention Abstract Purpose of Review This paper aims to review injury prevention for ultramarathon runners during training, race day, and recovery. Recent Findings Injury prevention starts with a training plan that emphasizes a gradual increase in distance interspersed with speed work, long runs, strength training, and active recovery. Pre-race training environment that mirrors race day terrain and climate is preferred. Customized nutrition and hydration strategies are recommended. Further research is needed regarding various carbohydrate/fat nutrition strategies. Summary There are numerous reviews of ultramarathon running-related injuries, which often include discussion on symptoms, treatment options, and how to improve race day performance. This review rather focuses on recent findings in ultramarathon injury prevention including pre-participation screening, training recommendations, shoe selection, foot strike patterns, blisters, and environmental issues. Pre-race and race day nutrition is highlighted with a discussion on high-carbohydrate low-fat diet vs. low-carbohydrate high-fat diets. Prevention of gastrointestinal distress and exercise-associated hyponatremia are also reviewed.

Extracorporeal Shockwave Therapy in Lower Limb Sports Injuries Abstract Purpose of Review To outline current evidence on the use of ESWT for the treatment of lower limb sports injuries. Recent Findings There is growing evidence to support the use of extracorporeal shockwave therapy (ESWT) for a variety of musculoskeletal conditions in the general population. However, research focused on the use of ESWT specifically for lower extremity injuries in the athletic population is more limited. Athletes represent a subgroup of patients that may benefit from ESWT. Compared with injections or surgical interventions, athletes undergoing ESWT often are able to continue sports participation with fewer limitations in activity during treatment. Summary The review identifies considerable variability in study design and treatment protocols that affect the overall quality of evidence. Sports participation was allowed in most studies. One case of plantar fascia tear was identified during ESWT treatment; this injury was self-limited. Most studies report pain-relieving and/or functional benefit with the use of ESWT for common lower extremity tendinopathies, plantar fasciitis, and medial tibial stress syndrome. This review highlights the need for further investigations on optimal methods of ESWT use in athletes given the high prevalence of lower extremity injuries and favorable safety profile for treatment.

A Review of Hip-Spine Syndrome Abstract Purpose of Review This review is aimed at summarizing our current understanding of hip-spine syndrome. In particular, the review discusses the clinical assessment and diagnosis of commonly implicated conditions to help a practitioner realize an efficient and organized approach to the evaluation and management of pain in the setting of hip-spine syndrome. Recent Findings While initially described as the concurrent presence of hip osteoarthritis and lumbar spinal stenosis, the catalog of diagnoses associated with hip-spine syndrome has expanded and includes femoroacetabular impingement, acetabular dysplasia, hip osteoarthritis, sacroiliac joint-mediated pain, facet arthropathy, and lumbar spinal stenosis. There is a limited body of evidence describing clinical findings and treatment recommendations when these diagnoses present concurrently. From the available literature, it seems that patients may be successfully managed with a multimodal approach, although absolute resolution of symptoms is not always plausible. Summary In the context of hip-spine syndrome, identification of a primary pain generator or etiology, when present, is important to guide successful management. Lingering symptoms may persist and can suggest the presence of a more co-dependent relationship between the hip and the spine (so-called complex hip-spine syndrome). Further research is needed to clarify the influences that underlie hip-spine syndrome, particularly in these more complex cases, and in turn better define diagnostic and treatment algorithms.

Sarcopenia: a Muscle Disease with Decreased Functional Capacity and an Increased Risk of Adverse Health Outcomes Abstract Purpose of Review This paper aims to provide an overview of sarcopenia, an enigmatic skeletal muscle disease where age, disuse, injury, and chronic disease can all contribute to the accelerated loss of mass and strength beyond normal variation, and that can negatively affect a person’s physical function and quality of life. Recent Findings A rapid and pervasive “graying” of societies worldwide is expected to continue in the coming decades. Due to this projected increase in the number of older adults, sarcopenia and its associated costs will be a significant public health concern. New international guidelines address the need for clinic-based approaches to identify vulnerable patients through quick and simple screening, while lifestyle-based interventions including resistance exercise training, general physical activity, and adequate nutrition remain the mainstays of treatment. The development of new, viable treatment options, including nutrition products and pharmacotherapy, are progressing with results expected in the near future. Summary The refinement of diagnostic criteria, recent designation as an internationally recognized medical condition, and the introduction of evidence-based treatment, is advancing sarcopenia as a treatable disease for a rapidly growing population of patients.