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Enjoy the outdoors, Today is Earth Day!
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Opioids are not found to be more effective for relieving pain: These addictive drugs have been commonly prescribed despite a lack of supporting data Since the late '80s and early '90s, opioids have been commonly prescribed to individuals with chronic-or long-lasting-pain. Over the years, prescribing these drugs has become a standard practice that many doctors assumed was safe and effective, even though there has always been a lack of high-quality research on the benefits and harms of opioids. As a result, opioids have been overprescribed for pain on a massive scale, and at least 300,000 people have died of an opioid overdose since the epidemic started. The epidemic has brought light to the situation and raised questions about prescribing these drugs to patients with chronic pain, and current guidelines now discourage their use in favor of other, safer alternatives; however, studies are still lacking that evaluate the long-term effects of opioids on pain, function and quality of life. For this reason, a powerful study called a randomized-controlled trial (RCT) was conducted to compare opioid therapy to non-opioid therapy for patients with back, knee or hip pain over one year. Veterans dealing with pain serve as the study group Veterans with chronic low back pain (LBP) or moderate-to-severe hip or knee osteoarthritis were invited to participate in the RCT. These individuals were screened to determine if they were eligible, and 240 were accepted and then randomly assigned to either the opioid or non-opioid therapy group. Patients in the opioid group received a combination of different drugs at various times over one year that included morphine, oxycodone, hydrocodone and fentanyl. Patients in the non-opioid group received a completely different combination of drugs that included acetaminophen, non-steroidal anti-inflammatory drugs and lidocaine, amongst others. All patients were monitored regularly over one year, and at the end of the study they were evaluated for pain-related function and intensity of pain, both of which were assessed on a scale from 0-10 (higher score indicates more pain). Opioids and non-opioids lead to very similar outcomes Overall, results showed that patients who received opioids improved to a very similar extent compared to those who received non-opioids. In particular, the opioid group improved from a score of 5.4 at the start of the study to 3.4 one year later in pain-related function, while the non-opioid group improved from 5.5 to 3.3. Regarding pain intensity, both groups reported a 5.4 at the study start, but the opioid group improved to 4.0 and the non-opioid group improved to a 3.5. This means that the non-opioid group actually improved by 0.5 points more than the opioid group, which was considered a small but significant difference. In addition, opioid group patients experienced significantly more negative symptoms related to their medications than the non-opioid group. This is the first study to compare opioids versus non-opioids in the long-term, and it provides strong evidence that opioids should not be the first line of treatment for chronic musculoskeletal pain. Additional research is now needed to confirm these results, but this study is considered a major breakthrough that has filled a gap in the evidence on opioids for chronic pain. Determining the best way to prescribe opioids will continue to be a controversial topic, but these findings will likely be referenced in any related discussion. The study should also urge doctors to prescribe alternatives to opioids like physical therapy, which is a risk-free treatment that has been proven to help many painful conditions such as back pain and osteoarthritis. Patients should be aware that they can see a physical therapist directly, without a referral, if they are in pain and seeking out a safer alternative to opioids. - As reported in the March '18 issue of JAMA
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Guidelines recommend education, physical therapy, and exercise: Guidelines are necessary to assist doctors with treatment recommendations Low back pain (LBP) is one of the most common of all sources of disability. More than 80% of people will experience LBP at least once in their lives, and it has become the number one reason people visit a doctor for pain that affects the muscles or bones. There are many treatments available for LBP, and it may be difficult for some doctors to determine which is the best possible approach for each patient. To help with this process, a number of guidelines have been developed, which include various recommendations that are intended to create the best possible outcomes for patients. Unfortunately, the quality of some of these guidelines is not very high, which can lead to medical professionals recommending treatments that are ineffective, expensive, or even harmful. For this reason, a team of researchers decided to conduct a study called a systematic review of all the treatment guidelines available. The goal of the review was to identify which conservative (non-surgical) treatments were found to be most effective for LBP and which should not be recommended. 13 studies are analyzed in the review Researchers searched through 10 major medical databases for studies that included guidelines on the best treatments for LBP. They only accepted studies that targeted adults and/or children with guidelines on conservative treatments or treatment protocols for LBP. Out of 2,504 studies identified, 75 were assessed in greater detail, and 13 of these fit the necessary criteria for the review. All accepted guidelines were then analyzed in detail and compared to one another to determine which treatments are best for LBP. The quality of each study was also assessed and given a rating to indicate how reliable their guidelines were. Education, activity, and therapy are all central to effective treatment for LBP The results of this study identified a number of treatments that were recommended by all of the guidelines reviewed. For acute LBP (pain that has only lasted for up to six weeks), the following recommendations were found in all the guidelines: advice and/or education, returning to activities or staying active, acetaminophen (Tylenol) and a hands-on form of physical therapy called spinal manipulation. The same treatments were also recommended for chronic LBP (pain that lasts for longer than six weeks), and additional recommendations for specific back exercises were found in the guidelines as well. The researchers also reported that of the 13 guidelines reviewed, 10 were found to be of high quality. Finally, it was pointed out that a recent study challenged the effectiveness of acetaminophen for treating acute LBP, which calls this recommendation into question. Based on these findings, it appears that education and advice, staying active, physical therapy that includes spinal manipulation and performing specific back exercises are the most commonly recommended treatments for LBP based on available guidelines. The fact that most of these guidelines were of high quality also indicates that their recommendations are strongly supported and reliable. Medical professionals treating patients with LBP should, therefore, consult these guidelines and recommend treatments accordingly in order to produce the best possible results. -As reported in the February '17 issue of the European Journal of Pain
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14 Tips to keep kids away from common baseball injuries. #SeeAPT1st: 14 Tips to keep kids away from common baseball injuries. #SeeAPT1st Click Here for the Article
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Patients receiving expensive and risky treatment for knee surgery: Knee condition is one of the leading causes of disability in the country Osteoarthritis is a painful condition that develops when cartilage breaks down over the course of time. This is why it's often called "wear and tear" arthritis. Osteoarthritis can occur in any joint in the body, but the hips and knees are affected most frequently. Knee osteoarthritis is a very common condition that affects more than 10% of the adult population, and it's considered a leading cause of disability in the U.S. Conservative (non-surgical) treatment that includes physical therapy is typically recommended as the first line of treatment for knee osteoarthritis, but surgery may be necessary for patients that fail to improve. Total knee replacement is the most common surgical procedure used to treat these patients, and it often leads to successful outcomes with less pain and better knee function afterward. Before getting to the point when surgery is needed, knee osteoarthritis patients may undergo a variety of different treatments. There is a set of treatment guidelines from the American Academy of Orthopaedic Surgeons (AAOS) that all doctors should be following when making these decisions, but many doctors continue to prescribe treatments that are not recommended. To get a better idea of what types of treatments doctors are prescribing knee osteoarthritis patients before surgery and how much it's costing, a study was conducted. Large database examined for patterns in treatment recommendations A large database used for recording information on patients who had a total knee replacement surgery served as the main source of data for the study. Researchers identified 86,081 patients who fit the necessary criteria for the study and examined the treatments that they received prior to having surgery. Based on the guidelines for treating knee osteoarthritis, they chose to analyze the use of eight treatments, which included physical therapy, braces, injections and both over the counter and prescription pain medications, including opioids. None of the top three treatments used are supported as effective Results showed that in the year prior to having knee replacement surgery, most patients (66%) received at least one of the analyzed treatments for their knee osteoarthritis, which cost an average of $506 per patient. The three most commonly used treatments were corticosteroid injections, hyaluronic injections, and opioids. For the injections, one of two different chemicals—either a corticosteroid or hyaluronic acid—is injected directly into the knee to reduce pain. In total, these three treatments accounted for about 43% of the costs associated with managing knee osteoarthritis; however, none of them are recommended by the guidelines as effective interventions for this condition. In addition, the hyaluronic injections were responsible for approximately 30% of patients' costs, even though the guidelines strongly recommend against using them. This shows that many patients with knee osteoarthritis are being given treatments that are not recommended, which could cost them more and do not even lead to successful outcomes. Patients dealing with knee osteoarthritis should, therefore, seek out only treatments that follow the AAOS guidelines, which will help them experience the best possible outcomes and avoid surgery unless it is completely necessary. -As reported in the January '17 issue of The Journal of Arthroplasty
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Physical therapy found to be more effective for carpal tunnel: Debate still exists on which treatment is better Carpal tunnel syndrome (CTS) is a condition that causes numbness, tingling and weakness in the hand due to too much pressure on a particular nerve in the wrist. Between 6-12% of the population deals with the symptoms of CTS on a regular basis, which causes many individuals to miss work as a result. Treatment for CTS can be either surgical or conservative (non-surgical), and there is still a fair amount of debate on which treatment is more beneficial. Although surgery has been found to lead to better long-term results in some studies, it's also been shown that 33% of individuals who have surgery do not return to work two months later. In addition, physical therapy is commonly used as a conservative treatment for CTS, but there is not a great deal of evidence to support it. For these reasons, a powerful study called a randomized-controlled trial (RCT) was conducted to compare the effectiveness of surgery to a hands-on form of physical therapy called manual therapy for patients with CTS. Patients randomly assigned to one of two treatment groups Individuals diagnosed with CTS were invited to participate in the study, and a total of 95 fit the necessary criteria. These participants were then randomly assigned to one of two groups: the manual therapy group or the surgery group. Patients in the manual therapy group attended three 30-minute treatment sessions over three weeks to address their condition. The manual therapy consisted of the physical therapist performing a series of movements and maneuvers with their hands to the wrist and other areas of the body that may have affected nerves in the wrist. This included the hand, biceps, pectoral and shoulder muscles. The final session focused exclusively on education, and participants were instructed to perform certain exercises twice a day for one month. Patients in the surgery group were treated with a surgical procedure called endoscopic decompression and release of the carpal tunnel and then attended the same education session as the manual therapy group afterward. All participants were evaluated before treatment, and then again three, six, nine and 12 months later for pressure pain threshold—the minimum force applied that causes pain—and several other outcomes. Manual therapy leads to greater improvements than surgery After one year, results showed that patients in both groups experienced improvements from their treatments. In particular, these patients reported less intense pain and less sensitivity to pain at both six and 12 months after treatment. The manual therapy group, however, showed even greater improvements than the surgery group in their pain intensity at three months and their pressure pain threshold at three, six and nine months. These findings suggest that surgery and manual therapy seem to be beneficial to a similar degree for patients with CTS, but manual therapy may be slightly more effective. In addition, manual therapy comes with far fewer risks and is significantly less expensive than surgery. For these reasons, manual therapy could be considered a preferable treatment option for CTS, but each patient should make their decision individually after carefully weighing the pros and cons of each approach. -As reported in the March '17 issue of the European Journal of Pain
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Surgery and therapy lead to very similar outcomes for hip conditions: Studies directly comparing these two treatments are lacking Femoroacetabular impingement syndrome (FAIS), also known as hip impingement, is a condition in which extra bone grows along one or both bones of the hip joint. This causes the bones to rub against each other during movement and results in painful symptoms in the hip and groin area. Conservative (non-surgical) interventions like physical therapy may be recommended as the first line of treatment for FAIS, but some patients have hip surgery either right away or after conservative methods don't lead to improvements. The rate of hip surgery has been growing at a rapid rate in recent years, and it is now considered the standard treatment for FAIS in the U.S.; however, high-quality evidence is actually lacking on the best treatment for this condition. No studies have directly compared surgery and physical therapy for patients with FAIS, and a better understanding of the long-term effect of these interventions is needed. Therefore, a powerful study called a randomized-controlled trial (RCT) was conducted that compared the outcomes of physical therapy to surgery for FAIS patients in the long term. 80 patients randomly assigned to one of two treatment groups Individuals seeking care for FAIS were invited to participate in the RCT and screened to determine if they were eligible. This process led to 80 patients being accepted and then randomly assigned to either the physical therapy or surgery group. Patients in the physical therapy group attended two 45-minute treatment sessions per week for six weeks, for 12 sessions total. Treatment was based on each patient's specific impairments and consisted of a variety of stretching and therapeutic exercises for the hip and lower back. These patients were also instructed to follow a home-exercise program. Surgery was performed within four months, and was followed by a physical therapy program. All patients were assessed at the start of the study and then six months, one year and two years later for a number of outcomes related to hip pain and function. Despite its popularity, surgery does not lead to better outcomes than physical therapy Over the course of two years, the results primarily showed that physical therapy and surgery led to very similar outcomes for patients. In particular, there were no significant differences between the surgery and physical therapy groups in overall hip function at any of the time points of six months, one year and two years. In addition, the physical therapy group actually reported significantly better scores than the surgery group in their ability to perform daily activities at the one- and two-year follow-ups. The surgery group also had higher rates of complications from their treatment, as well as hip arthritis, compared to the physical therapy group. These findings suggest that patients with FAIS can experience similar benefits with both surgery and physical therapy. Despite its popularity, surgery may not be the best option for all of these patients, especially because physical therapy is less expensive and comes with far fewer risks. So if you're dealing with hip pain that may be due to FAIS or a similar condition, it may be best to try physical therapy as your first course of treatment. Physical therapy can be helpful for many patients, but if it doesn't help you experience significant improvements over time, then you may want to consider surgery. - As reported in the February '18 issue of The American Journal of Sports Medicine
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Happy Easter!
Happy Easter!
Happy Easter!
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Prevention program reduces ankle sprains in the athletic population: Experiencing one ankle sprain increases the risk for additional sprains in the future Ankle sprains are the most common injuries that occur in the athletic population, and the risk for these injuries is particularly high in individuals that participate in sports with lots of jumping, changing direction and/or pivoting. After an athlete experiences an ankle sprain, several structures in the ankle become weakened, which increases the risk for another ankle sprain in the future. For this reason, some individuals who sprain their ankle once go on to deal with repeated ankle sprains and long-term problems that can seriously interfere with their participation in sports. One way to address this is by reducing the risk for ankle sprains in the first place with certain preventive strategies, such as proprioceptive training. Proprioception allows one to know where their body is in space, and it allows us to take in sensory input from the outside world and integrate it into a particular movement. A prime example of proprioceptive training for the ankle is balance exercise, which can enhance the body's ability to adapt to a changing environment and protect it from injury. To develop a better idea of how effective this type of training could be, researchers conducted a review on all available literature on the topic. Four databases searched for relevant studies Investigators performed a search of four major medical databases for studies on the topic. In particular, they were looking for powerful studied called randomized-controlled trials (RCTs) that evaluated the protective effect of proprioceptive training for preventing ankle sprains in active individuals. This search led to a total of seven RCTs being included into the review, and these studies contained data on 3,726 participants. Once the studies were collected, investigators reviewed their findings and compared them to one another to determine if the programs actually reduced the risk for ankle sprains. Proprioceptive training found to be effective for reducing patients' risk for ankle sprains The results of this review generally showed that the proprioceptive training was in fact effective for reducing the risk for ankle sprains in active individuals. In particular, they found that individuals who completed the training had a 35% reduction in the risk of ankle sprain compared to those who did not. In addition, it was determined that if 17 patients underwent the training, at least one ankle sprain would be prevented. Another analysis found that participants with a history of ankle sprains who completed the training had a 36% reduction in risk for future ankle sprains. These findings show that a proprioceptive training program may be a beneficial method for reducing ankle sprains in athletes, regardless of their history of ankle sprains. Additional research is now needed to further investigate these programs to determine which exercises are best and how long they should last, but patients should still view this as a smart strategy to reduce their risk for an ankle sprain. Those who are interested in keeping their ankles protected should also consider seeing a physical therapist to receive an appropriate treatment program. - As reported in the November '17 issue of the Journal of Athletic Training
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Surgery and physical therapy lead to similar result for carpal tunnel: Patients are advised to have surgery if condition is severe or other treatment fails Carpal tunnel syndrome (CTS) is a painful condition affecting the hands that is particularly common in the workplace. The prevalence of CTS is approximately 6-12% in the general population, but it accounts for nearly 50% of all work-related injuries. CTS is the result of a pinched nerve in the wrist, and patients who develop it usually experience numbness, tingling and weakness in their affected hand. Treatment for CTS can be either surgical or non-surgical (conservative) depending on the patient's condition. Conservative treatment is typically recommended at first, but if symptoms are severe or the patient fails to improve after attempting this treatment, surgery may be recommended. Physical therapy is commonly used to treat patients with CTS and often consists of a number of different interventions, including manual therapy, in which the therapist performs various mobilizations and manipulations with their hands. Studies comparing the benefits of surgery and physical therapy have produced mixed results, and it's not completely clear which is the better choice for patients. Therefore, a powerful study called a randomized-controlled trial was conducted to determine whether manual therapy or surgery was more effective for treating patients with CTS. 140 patients randomly assigned to one of two groups Individuals diagnosed with CTS were invited to participate in the study and screened to determine if they were eligible. Of the 140 patients screened, 94 fit the necessary criteria and were randomly assigned to one of two groups: the manual therapy group or the surgery group. Patients in the manual therapy group received one 30-minute treatment session per week over three weeks, for three sessions total. These treatment sessions consisted of various manual therapies that targeted the elbow, forearm, wrist, fingers and shoulder, as well as the neck, which is commonly impaired in patients with CTS. At the final session, patients were educated on how to perform the exercises at home and told to perform them if their symptoms got worse. Participants in the surgery group underwent surgery based on a decision made between them and the surgeon, and then received the same educational session on exercises as the manual therapy group after the procedure. All patients were evaluated before the treatments and then again one, three, six and 12 months later for a number of different outcomes, including overall symptoms and function. Manual therapy leads to greater improvements at first, but results are similar in long term Results showed that after one month, patients in the manual therapy group experienced significantly greater improvements in function, the seriousness of their symptoms and pinch grip strength than those in the surgery group. After six and 12 months, the two groups reported similar scores in most outcomes measured. Nonetheless, these findings are supportive of manual therapy, since they suggest that patients can expect to have better short-term outcomes with manual therapy compared to surgery. This can be particularly important for office workers, who will be able to return to work and perform their necessary duties quicker after undergoing manual therapy. It's also important to point out that manual therapy is significantly less expensive and comes with far fewer risks than surgery, which makes it the more attractive option of the two considering both led to very similar results. For these reasons, patients with CTS should continue to try physical therapy—especially manual therapy—as the first line of treatment for their condition before considering surgery, since it leads to superior short-term and similar long-term outcomes. -As reported in the March '17 issue of JOSPT
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