Patellofemoral pain: challenging current practice – a case report

Patellofemoral pain (PFP) is a common problem in young people, with 1 in 6 suffering at any one time. It is unclear which management approach is the optimal method for treating PFP in the long term, with traditional physiotherapy examination focusing on assessing for specific structural dysfunction. A rationale for a different assessment and treatment approach, one that moves the focus away from a biomedical/tissue pathology model towards one directed at the neurophysiology of pain, has been suggested. The patient was a 21 year old male with a 6 year history of PFP with previous failed physiotherapeutic treatment. He reported previous multiple healthcare practitioners' advice to avoid activities that were painful as reasons for being unable to participate in sporting activities. No specific structural testing was performed, such as specific muscle strength, length, foot position, patella movement and position, or movement patterns. Descriptions of tissue based pathology models of pain, e.g. patella mal-tracking, were actively discouraged and challenged. The patient was taught to perform one uncomfortable/painful exercise as part of his rehabilitation programme twice a day. The patient achieved 80% improvement in his symptoms over 7 appointments and a return to physical activity following a 5 month rehabilitation programme purposively designed to elicit pain by means of gradually exercising and loading the tissues. This case report highlights the need for further research into exercise protocols for patients suffering with PFP based upon neurophysiology models of pain

The epidemiology of major incidents in the Western Cape Province, South Africa

Background. Major incidents put pressure on any health system. There are currently no studies describing the epidemiology of major incidents in South Africa (SA). The lack of data makes planning for major incidents and exercising of major incident plans difficult.Objective. To describe the epidemiology of major incidents in the Western Cape Province, SA.Methods. A retrospective analysis of the Western Cape Major Incident database was conducted for the period 1 December 2008 - 30 June 2014. Variables collected related to patient demographics and incident details. Summary statistics were used to describe all variables.Results. Seven hundred and seventy-seven major incidents were reviewed (median n=11 per month). Most major incidents occurred in the City of Cape Town (57.8%, n=449), but the Central Karoo district had the highest incidence (11.97/10 000 population). Transport-related incidents occurred most frequently (94.0%, n=730). Minibus taxis were involved in 312 major incidents (40.2%). There was no significant difference between times of day when incidents occurred. A total of 8 732 patients were injured (median n=8 per incident); ten incidents involved 50 or more victims. Most patients were adults (80.0%, n=6 986) and male (51.0%, n=4 455). Of 8 440 patients, 630 (7.5%) were severely injured. More than half of the patients sustained minor injuries (54.6%, n=4 605).Conclusion. Major incidents occurred more often than would have been expected compared with other countries, with road traffic crashes the biggest contributor. A national database will provide a better perspective of the burden of major incidents

Should exercises be painful in the management of chronic musculoskeletal pain?: a systematic review and meta-analysis

Background: Chronic musculoskeletal disorders are a prevalent and costly global health issue. A new form of exercise therapy focused on loading and resistance programmes that temporarily aggravates a patient’s pain has been proposed. The object of this review was to compare the effect of exercises where pain is allowed/encouraged, compared with non-painful exercises on pain, function or disability in patients with chronic musculoskeletal pain within randomised controlled trials. Methods: Two authors independently selected studies and appraised risk of bias. Methodological quality was evaluated using the Cochrane risk of bias tool and the GRADE system was used to evaluate the quality of evidence. Results: The literature search identified 9,081 potentially eligible studies. Nine papers (from seven trials) with 385 participants met the inclusion criteria. There was short term significant difference in pain, with moderate quality evidence for a small effect size of -0.27 (-0.54 to -0.05) in favour of painful exercises. For pain at medium and long term; and function and disability at short, medium and long term there was no significant difference. Conclusion: Protocols using painful exercises offer a small, but significant benefit over pain-free exercises at short term, with moderate quality of the evidence. At medium and long term there is no clear superiority of one treatment over another. Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes. Further research is warranted to fully evaluate the effectiveness of loading and resistance programmes into pain for chronic musculoskeletal disorders. PROSPERO Registration: CRD4201603888

The experience of living with patellofemoral pain: loss, confusion and fear-avoidance: a UK qualitative study

Objectives: To investigate the experience of living with patellofemoral pain. Design: Qualitative study design using semi-structured interviews, and analysed thematically using the guidelines set out by Braun and Clarke. Setting: A National Health Service (NHS) physiotherapy clinic within a large UK teaching hospital. Participants: A convenience sample of ten participants, aged between 18 and 40, with a diagnosis of patellofemoral pain and on a physiotherapy waiting list, prior to starting physiotherapy. Results: Participants offered rich and detailed accounts of the impact and lived experience of patellofemoral pain, including: loss of physical and functional ability; loss of self - identity; pain related confusion and difficulty making sense of their pain ; pain related fear, including fear -avoidance and ‘damage’ beliefs; inappropriate coping strategies and fear of the future. The five major themes that emerged from the data were: (1) impact on self; (2) uncertainty, confusion and sense making; (3) exercise and activity beliefs; (4) behavioural coping strategies and (5) expectations of the future. Conclusions: These findings offer an insight into the lived experience of individuals with patellofemoral pain. Previous literature ha s focused on pain and biomechanics, rather than the individual experience, attached meanings and any wider context within a sociocultural perspective. Our findings suggest future research is warranted into biopsychosocial targeted interventions aimed at the beliefs and pain related fear for people with patellofemoral pain. The current consensus that best - evidence treatments consisting of hip and knee strengthening may not be adequate to address the fears and beliefs identified in the current study. Further qualitative research may be warranted on the impact and interpretation of medical terminology commonly used with this patient group, for example, ‘weakness’ and ‘patellar mal-tracking’ and its impact and interpretation by patients

Mixed-Morphology Supernova Remnants in X-rays: Isothermal Plasma in HB21 and Probable Oxygen-Rich Ejecta in CTB 1

(Abridged) We present an analysis of X-ray observations made of the Galactic supernova remnants (SNRs) HB21 (G89.0+4.7) and CTB 1 (G116.9+0.2), two well-known mixed-morphology (MM) SNRs. We find a marked contrast between the X-ray properties of these SNRs: for HB21, the extracted ASCA spectra of the northwest and southeast regions of the X-ray emitting plasma can be fit with a single thermal model with marginally enhanced silicon and sulfur abundances. For both of these regions, the derived column density and temperature are N_H~0.3x10^22 cm^-2 and kT~0.7 keV, respectively. No significant spatial differences in temperature or elemental abundances between the two regions are detected and the X-ray-emitting plasma in both regions is close to ionization equilibrium. Our Chandra spectral analysis of CTB 1 reveals that this source is likely an oxygen-rich SNR with enhanced abundances of oxygen and neon. The extracted ASCA spectra for the southwestern and northeastern regions of CTB 1 cannot be fit with a single thermal component. Based on our fits to these spectra, we derive a column density N_H~0.6x10^22 cm^-2 and a temperature for the soft thermal component of kT_soft~0.28 keV. The hard emission from the southwest may be modeled with either a thermal component (kT_hard~3 keV) or by a power law component (Gamma~2-3) while the hard emission from the northeast may be modeled with a power law component (Gamma~1.4). We have also extracted ASCA GIS spectra of the discrete X-ray source 1WGA J0001.4+6229 which is seen in projection toward CTB 1. These spectra are best fit using a power-law model with a photon index Gamma=2.2^{+0.5}_{-1.2} which is typical for featureless power-law continua produced by rotation-powered pulsars. This source may be a neutron star associated with CTB 1.Comment: 46 pages, 16 figures, accepted for publication in the Astronomical Journa

Musculoskeletal pain and exercise - challenging existing paradigms and introducing new: an educational review

Traditional pain models that describe tissue pathology as a source of nocioceptive input directly linked with pain expression, have been insufficient for assessing and treating musculoskeletal pain. The need for pain to be avoided or alleviated as much as possible during physical activity has recently been challenged, with a paradigm shift from traditional biomedical models of pain towards a biopsychosocial model of pain. The aim of the review is to provide an understanding on the potential mechanisms behind exercise, and to build on this into discussing the additional theoretical mechanisms of painful exercises. Central and peripheral pain mechanisms, the immune system and affective aspects of pain are described. This review focuses on these three mechanisms as these systems appear to respond differently to painful stimulus, compared with necessitating pain-free exercises. They are discussed in relation to the biological effect of exercise for people with chronic pain, with a broader overview of possible mechanisms behind the potentially additional beneficial effect of allowing painful exercises for individuals with chronic musculoskeletal pain. This additional mechanistic consideration could be used to help clinicians in the prescription of therapeutic exercise and for researchers to advance knowledge for such a globally burdensome condition

MC generators in CHORUS

This note presents an overview of general-purpose and specific Monte-Carlo event generators used in the simulation of the CERN - CHORUS experiment, aiming to search for $\nu_{\mu} \to \nu_{\tau}$ oscillations and charm particle decays in an emulsion target.Comment: 6 pages, LaTeX two-column format, 2 encapsulated postscript figures Proceedings of NuInt01 Workshop (KEK, Tsukuba, Japan, 13-16.12.2001

The Functional Relevance of the Heteromeric Structure of Corticosteroid Receptors a

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73195/1/j.1749-6632.1994.tb39213.x.pd