Posts tagged risk prevention
Hip Strength Shown To Have Protective Effect Against Worsening Of Knee Arthritis
knee-arthritis-hip-strengthening-progression

Knee arthritis will affect many older adults limiting their ability to participate in their daily, occupational, and recreational activities. Lost independence and function is one of the most common concerns among patients with knee arthritis who are treated in our Boulder Physical Therapy practice. In addition to manual therapy to the involved joints, exercise remains the gold standard of conservative treatment for this condition. Specifically strength training has been shown to both reduce knee pain and improve function and independence among older adults. New research suggests this form of exercise may also prevent progression of arthritis.

Chang and colleagues examined the association between hip abductor strength on both cartilage injury progression and patient function in patients with knee arthritis (Osteoarthritis and Cartilage. 2019). They enrolled 275 knee in 164 patients with knee arthritis. All patients were given baseline strength and functional assessments, as well as, x rays of their knees. Authors reported patients who had greater hip abduction strength at baseline demonstrated reduced progression of their arthritis at 2 year follow up. In addition, these stronger individuals had a reduced risk of disability and an improved functional level at 5 year follow up. Authors reported these findings provide support for the important role of hip strengthening in modifying the disease progression of arthritis.

Which Muscle's Weakness Predicts Future Knee Pain?
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Patellofemoral Pain Syndrome, pain under the knee cap, is the most common diagnosis of knee pain affecting both sedentary and active individuals. Muscle weakness in the hip and knee are often present in individuals with this diagnosis, but a cause and effect relationship between strength and knee pain has been difficult to established. In short, the research is divided on this relationship especially within the variable of hip weakness. Thus questions remain on which muscle imbalances may predispose an otherwise pain free individual for future patellofemoral pain.

A recent systematic review of the available evidence on the development of patellofemoral pain syndrome reviewed 18 studies of 4818 research participants (Neal et al. Br J Sp Med. 2019). Authors found three common groups of research subjects including military recruits, adolescents, and runners. They reported moderate to strong evidence body mass index, age, and leg alignment were not predictive of future knee pain. Interestingly, although common in clinical patients, moderate evidence reported hip weakness was not predictive of future knee pain. Authors reported quadricep weakness, especially among military recruits, was associated with future onset of knee pain.

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Reducing Your Risk Of Alpine Skiing Injuries
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Alpine skiing remains one of the most popular outdoor winter sports in Colorado. It is estimated over 6.8 million skiers participated in the sport over the 2016/2017 winter season. There are inherent risks of death and injury in both skiing and snowboarding, but thankfully due to technological updates and innovations overall injuries have fallen by half over the last 30-40 years. Although injuries on the whole have decreased some traumatic cases, such as ACL tears, remain common today. A recent article summarized the available evidence on the most common ACL tears, as well as, offered an update on injury prevention strategies in alpine or downhill skiing.

Davey and colleagues published the review article recently in the journal Sports Health (2018). Authors reviewed the available evidence on ski injury prevalence including injury location, known risk factors, and ski injury prevention. Data was available from a total of 64,667 ski injuries over a 25 year period. They reported the average age of skiers injured was 30 years old with a range of 24 to 35 years. Those found at highest risk included both the young, adolescents and children, as well as, older adults (>55 years). While males were more likely to experience lower extremity fracture, consistent with other sports females are more prone to ACL tears.

As expected, the lower extremity remains the most commonly injured area of the body accounting for up to 77% of all injuries. Further, 14% of injuries involve the thumb and shoulder and 13% involve the head and neck. The knee ligaments (ACL and MCL) remain the most common injury followed by thumb and head and facial injuries. Trend data showed a drop in tibial fracture, but an increase in ACL tears. Most common mechanisms included deep knee flexion with rotation or knee hyper extension and forward movement of the thigh over the stationary leg in the boot. In addition, despite advances in helmet use and technology, the number of traumatic skiing fatalities remained constant.

Ski technological advances, including helmets, bindings, and ski poles, deserve the most credit for the 50% reduction of ski injuries. Helmet use has increased to 80% of all skiers and has been a significant advancement in the safety of participants and reduction of head and face injuries. As expected, helmets have consistently been shown to reduce both the prevalence and severity of head injuries without a subsequent increase in “risky skiing”. The risk of death with head injury has stayed relatively constant either because the forces of impact exceed the protective capacity of the helmet or the skier sustained other bodily injury causing death despite sparing their head and face.

Ski boot binding systems have contributed to the large decrease in leg fractures and contusions due to improved release mechanisms. In addition, skiers who routinely have their bindings checked by certified ski shops sustain fewer injuries than those who ski without inspected bindings. These bindings are designed to prevent fracture and leg injuries, not knee ligaments, and bindings often do not release with common ACL injury mechanisms in skiing.

Established programs such as “lids on kids” and “heads up” remain effective at improving the awareness and utilization of helmets. ACL prevention programs (Vermont Ski Safety Equipment) have focused on educating skiers to avoid situations most associated with knee sprain, as well as, instructions in how to fall with decreased risk to your knee. These programs have been shown to reduce a skier’s risk of knee injury by 60%. Interestingly, ski lessons have not been shown to reduce the risk of knee injury among skiers. In our practice, strength also remains a key component of injury prevention programs. Skiers are recommended to work with a local Physical Therapist to design an effective ski injury prevention exercise program.

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One Strength Session Per Week Reduces Cardiovascular Disease Risk
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Aerobic exercise has long been known to reduce an active individuals risk of chronic mental, emotional, and physical diseases. The majority of the publicity regarding the benefits of aerobic exercise has been related to the prevention of cardiovascular diseases and premature death due to these diagnoses. Government and professional medical organizations recommend 120-150 minutes of moderate exercise per week. These minutes should be at least 10 minutes in duration to receive the cardiovascular benefits of exercise. Interesting new research on strength training is being conducted on the benefits of this mode of exercise on the prevention of chronic disease and premature death.

Authors in the journal Medicine and Science in Sport and Exercise conducted an examination of the relationship of strength training, independent of aerobic exercise, and the development of cardiovascular disease (Liu et al. 2018). Authors included 12,591 participants who self reported their resistance training and disease status over a 16 year period. They reported a 40-70% disease risk reduction for all cardiovascular events with weekly resistance training frequencies of 1-3 sessions per week. No additional benefits were found with strength training frequencies of greater than 4 session per week. Interestingly, one session of up to 60 minutes of strength training was associated with decreased disease risk and early death independent of aerobic exercise participation. A patient’s body mass index (BMI) was found to significantly impact the impact of resistance training benefits.

This study supports the importance of strength training for cardiovascular health and wellness.

Lack Of Exercise Shown To Be Greatest Risk Factor For Premature Death
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Exercise remains one of the most powerful interventions to improve your mental, emotional, and physical health. Specifically, aerobic exercise, when performed consistent with medical experts prescriptions, has been shown to effectively treat 26 chronic conditions and diagnoses. Despite the clinically and cost effective benefits of aerobic exercise 80% of Americans to not reach the CDC’s recommendations of 2.5 hours of moderate exercise or 75 minutes of vigorous exercise. This sedentary behavior not only contributes to our countries 40% obesity rate, but also put these Americans at risk for serious health conditions and premature death. A new study shows this sedentary behavior may be more dangerous than high blood pressure or diabetes.

A new article published in the Journal of the American Medical Association followed 122,000 participants over an 8 year period (Mandsager et al. 2018). At the beginning of the study, participants were given a symptom limited treadmill test to determine their cardiovascular fitness. They were then placed into percentiles based on their performance and then followed to determine their how their aerobic performance impacted their development of chronic disease and premature death.

As expected, the authors found participants levels of cardiovascular fitness were inversely associated with life expectancy. Thus, fitter patients had the lowest risk of death without any upper limits to this benefit. Authors reported the most sedentary participants. were had a 500% higher risk of death compared to the most fit peers. Participants who exercise inconsistently, not meeting CDC guidelines, were still at close to 400% greater risk of early death compared to those who do exercise regularly. Amazingly, sedentary behavior was found to have a worse prognosis than high blood pressure, smoking, or being a diabetic (type II).

Reducing Your Risk for Knee Pain
knee-pain-exercises-prevention

Patellofemoral pain (PFP) is characterized by diffuse pain behind or around the patella or knee cap. It occurs when the knee is loaded and bent with activities such as: running, jumping, squatting or ascending/descending stairs. The prevalence of PFP is 22.7% in both adults and adolescents, and with the inherit link between PFP and Knee Osteoarthritis, further investigation is warranted to look at the factors contributing to PFP in order to develop successful injury prevention programs. A recent article was published on predictive variables for future development PFP (Bradley et al. BJSM 2018).

The authors reviewed 18 prospective studies, including over 4,800 participants (Military, Runners, Adolescents) to investigate factors contributing to PFP. Factors contributing included: weakness in quadriceps and increased baseline hip abduction strength. Contrary to past evidence, there is no change in likelihood of developing PFP with sex, BMI or Q angle of hips and knees.  Targeting quadriceps and hip strengthening exercises, as well as, assessing movement mechanics are appropriate interventions and preventative treatments for PFP.

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