JOURNAL WATCH

CLINICAL EVALUATION AND TREATMENT OF POSTERIOR IMPINGEMENT IN DANCERS. Albisetti W, Ometti M, Pascale V, Bartolomeo O. American Journal of Physical Medicine and Rehabilitation 2009;88:349-354

In this case series on ankle pain, the authors considered

186 young trainee ballet dancers over a 12-month period. Twelve of the dancers had posterior ankle pain, and six of these had os trigona. This is a frequent cause of posterior ankle pain in ballet dancers because they place themselves into extreme plantar flexion during the execution of relevé in demipointe and en pointe positions.

Results: Clinical examination and standard and modified X-rays and magnetic resonance imaging (MRI) should be carried out to clearly identify the site and entity of the impingement. If this is properly diagnosed, then good results can be obtained through a non-operative approach in a majority of cases. onservative treatment failed in only three cases after 1–4 months of physical and medical therapies, and, in these cases, good results were obtained through surgical excision

MUSCULAR LOAD TO THE THERAPIST’S SHOULDER DURING THREE ALTERNATIVE TECHNIQUES FOR TRIGGER POINT THERAPY. Smith EK, Magarey M, Argue S, Jaberzadeh S. Journal of Bodywork and Movement Therapies 2009;13:171–81

Seven massage therapy students applied a predetermined level of force to an artificial contact surface. Changes in five pairs of superficial shoulder muscles

(indicated by surface electromyography) were recorded while the student performed the single-arm technique (SAT), the double-arm technique (DAT) and the treatment-tool technique (TTT) using TriggerMate, a new treatment tool. Results: For the contact arm, muscle activity was significantly decreased using the TTT compared with the SAT but was not significantly different between the TTT and DAT. For the non-contact arm, none of the test techniques led to significant differences in muscle activity.

sportEX comment This is a very small study and uses students, who can’t be expected to have perfected techniques, but it points towards the levels of muscle use by the therapist during treatment. The moral of the story is: protect yourself from harm. The same force can be generated using single arms, double arms or tools. The effect on the patient is the same, so choose the one that is the least likely to result in your repetitive strain.

IS PHYSICAL THERAPY MORE BENEFICIAL THAN UNSUPERVISED HOME EXERCISE IN TREATMENT OF POST SURGICAL KNEE DISORDERS? A SYSTEMATIC REVIEW. Coppola SM, Collins SM. Knee 2009;16:171–175

The purpose of this systematic review was to consider the existing evidence regarding benefit following knee surgery and to evaluate the quality and internal and external validity of such evidence. Ten studies, all randomised control

trials, were found to be applicable. Using the PEDro scale, all studies were considered to be at least moderate in quality. Many of the studies had designs that biased the home exercise group, providing supervision similar to that provided by outpatient physical therapy. Results: In select young and healthy populations with few co-morbidities, supervised physical therapy is no more beneficial than a home exercise programme following relatively simple knee surgical procedures (arthroscopic menisectomy). However, there is a lack of evidence regarding older populations with co-morbidities or for more complicated knee surgical procedures (anterior cruciate ligament reconstruction, total knee arthroplasty), prohibiting a conclusion at this time for these populations or procedures.

sportEX comment This is one of those studies that physical therapists don’t believe. How can leaving the

patient alone be better than the attentions of a trained therapist? Where is the standard of care? Well, evidence rules these days, and there is similar stuff around on bad backs. The therapy profession needs to prove its worth, otherwise the accountants will win the day and follow the cheaper alternative.

6 of the accessory ossicle.

sportEX comment The case study comes towards the bottom of the hierarchy of evidence, but its use in manual therapy is nevertheless valid given the difficulties of producing the gold standard of randomised controlled trials. They are an excellent medium for sharing practice.

THE EFFECT OF QUANTITY OF ICE AND SIZE OF CONTACT AREA ON ICE PACK/SKIN INTERFACE TEMPERATURE. Prawit J. Physiotherapy 2009;95:Issue2:120-125

An ice pack was applied to the right thigh with compression using an elastic bandage to 20 healthy males aged 18–22 years. The effects of three packs measuring 18cm x 23cm containing 0.3kg, 0.6kg and 0.8kg of ice, and one pack measuring 20cm x 25cm containing 0.6kg of ice, were compared. The reduction in temperature at the ice pack/ skin interface during 20-min ice applications was monitored at 1-min intervals. Results: The application of 0.8kg and 0.6kg ice packs led to a significantly greater decrease in the interface temperature compared with the 0.3kg ice pack. No significant difference in temperature was found between the 0.6kg and 0.8kg ice packs. The size of the contact area did not alter the degree of cooling significantly. The lowest temperature during ice application was reached after 8–9 min of cooling. Application of an ice pack containing

at least 0.6kg of ice leads to a greater magnitude of cooling compared with application of a 0.3kg ice pack, regardless of the size of the contact area. Thus, clinicians should consider using ice packs weighing at least 0.6kg for cold treatment.

sportEX comment So, size is everything! Future research in this field might explore the amount of compression used and question whether it is this restricting blood flow and therefore limiting heat dissipation.

sportEX medicine 2009;41(Jul):4-6