OPEN FILE !!!!

DUE SATURDAY FEBRUARY 15, 2020

APA FORMAT

RESPOND TO THE 7 POST BELOW. 150-200 WORDS PER POST. 4-5 SOURCES TOTAL

APA FORMAT (NO TITLE PAGE NEEDED)

DUE Saturday February 15, 2020

1. Adam J

One acute shoulder injury that I think is the “worst” to manage is a rotator cuff tear, especially when occurring in an older population.  According to a study by Haviv, et al. (2019), when patients with a mean age of 55.5 (+/- 9.3) arthroscopic surgery to repair a torn rotator cuff, a minimum of 12 months was required for significant improvement in the patient, however an average of 3 years was typically required.  Additionally, Haviv, et al. indicate that it took an average of 4.9 months post-op before the patients began to experience a significant reduction in pain.  When coupled with a decline in function post-op that is amplified as the tear size increases, I feel that motivation in these patients can be low.  In my opinion, patient adherence is crucial to the success of a rehabilitation program, so slower progress and increase pain levels can make this a difficult process, and therefore could be considered one of the “worst” in regard to managing.

 In switching my mindset to a chronic shoulder injury, frozen shoulder immediately comes to mind as one that I feel would be difficult to treat.  In their review of the frozen shoulder condition, Cho, Bae, and Kim (2019) tell us that although one of the most common disorders presented to orthopedic surgeons, the cause is not fully understood or known at this time.  I have always felt that a major aspect of rehabilitation is determining and correcting biomechanical deficiencies or lifestyle factors that result in the pains and disorders experienced by our patients.  When we are unable to determine the cause of the issue, however, I think appropriate corrections become difficult.  In addition, Cho, Bae, and Kim suggest that frozen shoulder is a “self-limiting and benign disease” that can be alleviated; however they are also quick to point out that full recovery can take a long time.  Cho, Bae, and Kim suggest that 50% of frozen shoulder patients still struggle through recovery around 7 years after they initially begin to have issues, and only around 39% were fully recovered after a follow-up 5-10 years later.  This extended time dealing with a chronic condition like frozen shoulder presents unique challenges that I feel would be difficult to deal with. 

2. Josh Y

Worst acute injury: In my opinion, the worst acute injuries to the acromioclavicular (AC) joint. Starkey and Brown (2015) write that acute injuries of the AC joint occur either directly or indirectly. Direct injuries occur when an external load is applied to the AC joint itself, while an indirect injury is when a force is applied through the long axis of the upper limb which essentially displaces the AC joint, such as falling on an outstretched arm (Starkey & Brown, 2015). I’ve seen and treated both types of AC joint injuries and neither one is easy to work with. For one thing, patients are usually very hesitant to move their arm, which makes rehab difficult. Trying to convince patients to move their shoulder when all they want to do is keep it still can be challenging. Secondly, because movement can be so painful, patients tend to compensate for certain movements in order to move their shoulder. Now, not only are we working with the initial injury, we are also dealing with compensatory movements that are likely present. Rehab should focus on both issues so that the patient doesn’t learn bad movement patterns. The process can be slow, especially if the patient can only move their shoulder slightly before compensations start and they have to stop the movement. This can lead to frustration from the patient, which definitely doesn’t help in their willingness to do their rehab.

Worst chronic injury: The worst chronic injury to rehab has got to be subacromial impingement impingement. It’s a tough condition to rehab in anyone, but especially in office workers and students – those who sit behind a desk all day with bad posture. Starkey and Brown (2015) say that altered scapular positioning can lead to impingement. This is especially a problem for people who are seated for long periods of time. Cools et al., 2014 say that tightness in the pec minor muscle leads to poor scapular movements. When the pec minor becomes hypertonic, as is commonly seen in patients who sit behind a desk, the shoulders roll forward, which can cause impingement (Starkey & Brown, 2015). These cases are hard to deal with because as much as patients want to be out of pain, the cause of their pain comes from their job where they sit behind a desk. Patients can do their at-home rehab, but sitting at their desk for eight or more hours per day only delays their healing. In situations like this, we have to think outside of the box and get creative with at-home exercises that are easy to replicate at the patient’s desk throughout the day.

3. Antoine W

Altitude training masks manufactures have made several claims in regards to the benefits of the using the mask during training. Some of these said claims include the mask helps with weight loss. In addition the mask increases stamina while decreasing fatigue which ultimately improves fitness, training and endurance. “ The Elevation Training Mask 2.0 (ETM) purportedly simulates altitude training and has been suggested to increase aerobic capacity (VO2max), endurance performance, and lung function.”(Porcari, 2016) However, when tested it was concluded that “Wearing the Elevation Training Mask while participating in a 6-week high-intensity cycle ergometer training program does not appear to act as a simulator of altitude, but more like a respiratory muscle training device.”(Porcari, 2016) Another study done looking at the effects of an elevation training mask on the VO2 max of male reserve officers training corps cadets found “that the ETM did not cause a significant increase in VO2max under the training conditions of this study.” (Warren, 2017) These two studies show that the altitude training mask are beneficial increasing anaerobic capacity but isn’t too beneficial for aerobic capacity.

4. Riley S

In regards to the claims made by the manufacturers of the Altitude Masks, there are some claims that have more truth than the others. According to Porcari et al. (2016), the purpose of the altitude training mask is to be used for a respiratory training device and not simulate altitude. There was a study conducted that tested 24 moderately trained individuals, 12 using an altitude mask and 12 not using an altitude mask, who completed 6 weeks of high-intensity cycle ergometer training. These subjects were given a pre and post training test which included VO2max, pulmonary function, maximal inspiration pressure, hemoglobin and hematocrit. After the 6 weeks was up, there were no significant differences were found in pulmonary function or hematological variables between or within groups but there was a significant improvement in significant improvement in VO2max and PPO in both the control (13.5% and 9.9%) and mask (16.5% and 13.6%) groups. (Porcari et al. 2016). In the mask group, there was improvements in in ventilatory threshold (VT) (13.9%), power output (PO) at VT (19.3%), respiratory compensation threshold (RCT) (10.2%), and PO at RCT (16.4%) from pre to post-testing. Overall, training with an altitude mask may improve specific markers of endurance performance which go beyond the improvements seen with interval training alone. (Porcari et al. 2016)

5. Kristin H

A study was done to show how wearing an elevation mask will effect aerobic capacity, lung function, and hematological variables. This study put people through a 6 week training program and tested their levels at baseline and then after the program.

Some of the most significant finding from this test showed that the mask did not effect men or women any differently from each other. Also, pre and post training tests show that there was no change in pulmonary function or hematological variables between or within the groups. In addition, there were significant improvements in VO2 max and peak power output in both the control group and the mask group. The improvements between the two groups were not significantly different.

This research does show some improvements in the mask group that were not seen in the control group. These improvements include ventilatory threshold, power output, and respiratory compensation threshold.

The results from this study show that the mask can help with training, but it does not necessarily mimic altitude or elevation training. What the mask can do is help to further increase endurance training beyond the changes that are seen in training without the mask. The article describes the changes as respiratory muscle training.

6. Cornell A

In my personal opinion, I have always thought that the Altitude Masks never really made your cardiovascular system better or made you a more conditioned athlete. Although I have utilized them while coaching without doing further research on them, I believe that the only way to make your cardiovascular system or VO2 better is just time. According to an article that researched 14 male ROTC cadets using the elevation training masks, it stated that there was not any significant difference between the masked group and the non-masked group, (Warren et al., 2017). The cadets met 3 days out of the week for seven weeks, in which on the first day it was a 2 mile run, interval style 60 seconds jog and 10 second sprint, the 2nd day the cadets performed an 8- station body movement rotation, and the 3rd day was the longest being a 4 mile run. Resistance on the mask was turned up during weeks 2,3 and 4 but not 5-7 based off of minimizing risks. Like stated before that was not any significant change amongst the control group and the experimental group from pre and post testing.

7. Kaitlyn K

As you may already know altitude training and respiratory muscle training are known to help your performance in the most elite athletes. Altitude masks were designed for this very thing. They say it helps athletes gain the competitive edge. “The elevation training masks 2.0 (ETM) purportedly stimulates altitude training and has been suggested to increase aerobic capacity (VO2 max), endurance, performance and lung function. In the study I read over it said how the VO2 max improved significantly. Overall, the VO2 max increased by 13.5%.  However, it didn’t improve the magnitude. It improved in VT, PO at VT, RCT, and PO at RCT from pre to post testing. They also noted that there was no significant differences in training HR nor in lung function/capacity. Although there was no lung capacity change there was improvement in maximal voluntary ventilation in the resistive breathing group only. As far as increase stamina and fitness there was not much change.