The Journal of Bone and Joint Surgery has a new review article titled ‘What’s New in Adult Reconstructive Knee Surgery.’ The review primarily discusses articles that appeared in The Journal of Bone and Joint Surgery (American Volume), The Journal of Arthroplasty, and select articlesfrom Clinical Orthopaedics and Related Research in 2008.
A study published in the British Medical Journal BMJ suggests that a semi-hard collar or physiotherapy / physical therapy was found to be more effective than a ‘wait and see’ approach to care for radiating neck pain. The study was a randomized trial of 205 patients with early onset radiculopathy and was held in three Dutch hospitals.
The patients were in one of three groups, all of whom were allowed to use painkillers:
1) wore a semi-hard collar for 3-6 weeks
2) physiotherapy with home exercises for 6 weeks
3) wait and see
Physiotherapy treatment consisted primarily of mobilising and stabilising the cervical spine using ‘hands-off’ methods.
The recommedation coming out of the study was to choose the semi-hard collar over physiotherapy / physical therapy treatment as these two options both offered significantly better results than the wait and see policy for pain reduction but the collar was less expensive than the physiotherapy treatments. The study only looked at short term pain relief; it would be interesting to see what the more long term effects would be. It would also be interesting to see if a ‘hands-on’ physical therapy approach would produce even greater benefits to the patients.
The Wii has been a top seller in the game console market for years and continues to become more prevalent in homes around the world. Unlike gaming systems such as the Xbox and the PS3, playing games on the Wii often involves more gross motor skills than fine motor skills. Used correctly this makes the Wii potentially effective in improving coordination, balance, range of motion as well as general strength.
Physical therapists are increasingly bringing the Wii into the rehabilitation setting. Patients see it as a great alternative to often boring and repetitive exercises programs. The incorporation of gross limb and body movements into a game setting seems to keep patients much more engaged.
Popular therapy games include tennis and bowling as well as games like ‘Wii Fit’ which directly focused on actual balance and strength training. Not only can these games can be played individually but they can also be played by multiple players at the same time, which can increase engagement even more.
The Wii is being used in many different rehabilitation settings such as basic health maintenance in the elderly, youth physical therapy, stroke rehabilitation, post-surgical rehabilitation and brain injury rehabilitation. Clinicians feel that the benefits are even more broad and may aid in stress reduction as well as offering benefits to the treatment of diabetes, asthma and even heart disease. An early case study in PT Journal found that the rehabilitation program of a of a cerebral palsy when augmented with the Wii resulted in “positive outcomes at the impariment and functional levels”.
The price point on the gaming systems is very appealing as well. In an industry where equipment is usually very expensive, the appeal of the small $250 cost of a console, a cost that includes several games and a controller, is hard to deny. Most equipment in a rehab setting is very specialized for the small rehabilitation market; small in relation the the mass appeal of a commercial product like the Wii.
As the Nintendo Wii becomes more prevalent in the treatment programs for many conditions there is one condition that we may see begin to proliferate; the dreaded ‘Nintendonitis.’
A small trial recently showed that a simple eccentric wrist twist exercise can be very effective in the treatment of ‘tennis elbow’ ( lateral epicondylitis ). Adding these simple exercises to a home program dramatically improved functional scores and pain reduction.
The exercise can be performed anywhere and serves the same purpose as very expensive isokinetic machines. Instead of expensive machines the exercise involves the use of a small rubber bar similar in size and shape to a baton used in running relay races. Using the rubber bar, “twist with the wrist of their uninjured arm and then slowly untwist with eccentric wrist extension of the injured arm over a period of about four seconds. Three sets of 15 repetitions were scheduled each day.”
The trial was reported at the annual meeting of the American Orthopaedic Society for Sports Medicine in Keystone, Colo.
A recent article on Dynamic Chiropractic entitled “Update on Manipulation and Exercise – What the Research Says” discusses research examining the connection and synergistic effects of combining spinal manipulation with exercise. While the article does state that not all research finds a positive synergistic effect between the two, it goes on to state that it is “purely logical” that spinal manipulation will have a positive effect on exercise.
A number of studies are briefly discussed, including studies that involved participation of chiropractors, physical therapists and osteopaths performing the spinal manipulations and/or administering exercises. It is interesting to note that one study of patients with chronic low back pain (CLBP) or chronic neck pain (CNP) found “Sixty-four percent of physical therapy patients were prescribed exercise, compared to 33.1 percent of DCs and only 14.4 percent of MDs/DOs.”