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No. 346 Effects of Focal Muscle Vibration on Physical Functioning in Patients With Knee Osteoarthritis
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No. 342 Extremely High Weight Lifting: Injuries and Outcomes in a Middle Age Population. David T. Burke, MD; Daniel P. Burke; Regina B. Bell; Ariel Alexandroni. Objective: To determine the risk of injury and the likely benefits from weightlifting using the gravitational wellness method. Design: A retrospective review of consecutive patients seen at a gravitational wellness facility. Setting: A wellness center in a community setting. Participants: Participants were consecutive patients seen over a one-year period in a wellness center. Interventions: the intervention was a weightlifting program involving high weights lifted in four stations during a 30 minute session repeated weekly. Outcomes: The weights lifted at each station were retrieved from the patient chart. Follow-up questionnaires were administered by phone to determine injuries incurred during participation as well as specific and general health benefits as measured on a five point Likert scale. Level of Evidence: Level I. Results: Participants ranged in age from 18 years to 69 years with a mean age of 48.6 years. The mean final weight lifted was 1114.85 pounds (505.69 kg) for the belt lift, 399.13 pounds (181.04 kg) for the hand lift, 306.029 pounds (138.81 kg) for the chest lift, and 860.83 pounds (390.46 kg) for the leg press. Of the participants, 42 (59%) presented to the gym with the objective of improving a defined musculoskeletal issue. The modal of these was chronic low back pain. The subjects realized improvement on a five point Likert scale of 4.2/5 in their presenting complaint and improved by 4.27/5 in their overall subjective health. Discussion: These results indicate that using extremely high weights lifted 30 minutes per week can result in dramatic improvements in weights lifted with improvement in musculoskeletal well-being and overall subjective health. Conclusion: This study adds to the literature demonstrating that weightlifting with gravitational wellness system can allow for high weights to be lifted with no significant risk of injury.
No. 344 Rehabilitation Treatment in a Case of Advanced Tumor Induced Osteomalacia: A Case Report. Delia P. Ceballos-Sáenz; Sophia B. Gutiérrez-Casillas; Hugo A. Ávila-Ramos; Paola E. Ruiz-Padilla. Setting: Tertiary care center. Patient: A 41-year-old female with tumorinduced osteomalacia (TIO). Case description: The patient started her illness at age 27 with a right hip fracture, muscular weakness, pain, and anthropometric changes. During the evolution of her disease she presented 3 more bilateral hip fractures and low impact mechanism fractures in all 4 extremities. At 40, endocrinology diagnosed TIO secondary to a phosphaturic mesenchymal tumor (PMT) in the right heel. After surgical excision of the tumor she was referred to rehabilitation with multiple joint contractures, bone deformities, postural changes, incapacity to walk nor stand, pain, severe motion range limitation, and muscle weakness, restricted lung capacity and disability in most activities of daily living (Barthel score 35). Assessment: We started rehabilitation treatment with the aim of optimizing functional mobility, improving aerobic capacity, and strengthening to promote bone mineralization. All based on physical therapy with hydrotherapy, therapeutic ultrasound, mobilizations, aerobic and resistance exercise, pulmonary manual and occupational therapy. Nowadays she is showing significant improvement since the diagnosis achieving independence in activities of daily living (Barthel 75). Discussion: TIO is a paraneoplastic syndrome (337 reported cases) caused by abnormal renal phosphate wasting. It is due to an increased expression of fibroblast growth factor 23 stimulated by a PMT. It is characterized by chronic evolution with bone and muscle pain, weight loss, multiple fractures, progressive weakness, and fatigue. The treatment of choice is surgical excision of the tumor. The diagnosis is still a challenge which delayed the treatment of our patient for 14 years. Conclusion: TIO is a rare disease and we did not find any reports in the literature with this severity or rehabilitation treatment. In this case our management has been essential because it has achieved independence of the patient and also a great improvement in her life quality.
PRESENTATIONS
No. 345 Spontaneous Iliopsoas Tendon Rupture in an Elderly Female: A Case Report. Joseph David; Manish Mammen; Jack Mensch; Paul Pipia. Setting: Acute rehabilitation unit at a tertiary care hospital. Patient: 74year-old female with past medical history of end-stage renal disease on hemodialysis, coronary artery disease status post coronary artery bypass graft, hypertension, and atrial fibrillation. Case Description: The patient was admitted with swelling, redness, and pain in the right knee following recent total knee replacement. She underwent knee debridement had a vacuum dressing placed and was treated with intravenous antibiotics including cefazolin and vancomycin. While on the acute inpatient rehabilitation unit the patient complained of pain and weakness in the proximal left lower extremity and groin. Computed tomography (CT) scan of the left lower extremity did not reveal any fracture hematoma or fluid collection. Magnetic resonance imaging (MRI) of the left lower extremity revealed a full thickness tear of the distal iliopsoas tendon. She was managed conservatively and restarted on physical therapy. Results: The patient made progress in acute rehabilitation. She was discharged home ambulating approximately one hundred feet with modified independence using rolling walker. Discussion: Iliopsoas tendon ruptures are rare. They more commonly occur following trauma and in elderly females. Tendon injuries are also frequently seen in patients with metabolic diseases and in patients with renal disease on hemodialysis. Iliopsoas tendon ruptures can present with groin pain and patients may have difficulty with ambulation. Treatment consists of relative rest, physical therapy, and pain control. Conclusions: Iliopsoas tendon ruptures should be included in the differential diagnosis of anterior groin pain in elderly females. MRI is used to make the diagnosis. Treatment is generally conservative with favorable outcomes.
No. 346 Effects of Focal Muscle Vibration on Physical Functioning in Patients With Knee Osteoarthritis. Alessandro De Sire; Francesca Gimigliano; Alessia Rabini; Diana Barbara Piazzini. Objective: The aim of the present pilot study was to evaluate the effects of focal muscle vibration on physical functioning in patients with symptomatic knee OA. Setting: Outpatients clinic university hospital. Population: Men and women aged 60 years or older with radiographic diagnosis of mild to moderate monolateral knee OA (Kellgren-Lawrence grade II or III) and chronic knee pain. Patients were randomized in two groups (treatment group and placebo control group). The treatment group received focal muscle vibration treatment according to the “repeated muscle vibration” protocol. The control group received a sham treatment. Main Outcome Measures: The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcome measures were the short physical performance battery (SPPB) and the performance-oriented mobility assessment (POMA). Follow up evaluations were done at 3 and 6 months. Results: Fifty patients were recruited and randomly assigned to either the study or control group. There was a statistical significant difference between the two groups both for primary and secondary outcomes. Conclusions: In this pilot study focal muscle vibration therapy has proven to be effective and safe in improving functioning of patients affected by mild to moderate chronic knee OA.
No. 348 Shockwave Therapy in Delayed Union in the Treatment of Forefoot Fractures: A Case Report. Carmen Teresa Esquivia Pajaro; Catalina Urrego Chinome. Disclosure: None. Setting: Central military hospital. Patient: A 24-year-old man with a forefoot fracture. Case Description: Patient with a forefoot fracture after stepping on an anti-personnel mine. Left foot radiographs show nondisplaced second metatarsal fracture, comminuted first metatarsal and proximal phalanx of the hallux fracture, transverse fourth and third metatarsal fracture being managed with débridement and
No. 342 Extremely High Weight Lifting: Injuries and Outcomes in a Middle Age Population. David T. Burke, MD; Daniel P. Burke; Regina B. Bell; Ariel Alexandroni. Objective: To determine the risk of injury and the likely benefits from weightlifting using the gravitational wellness method. Design: A retrospective review of consecutive patients seen at a gravitational wellness facility. Setting: A wellness center in a community setting. Participants: Participants were consecutive patients seen over a one-year period in a wellness center. Interventions: the intervention was a weightlifting program involving high weights lifted in four stations during a 30 minute session repeated weekly. Outcomes: The weights lifted at each station were retrieved from the patient chart. Follow-up questionnaires were administered by phone to determine injuries incurred during participation as well as specific and general health benefits as measured on a five point Likert scale. Level of Evidence: Level I. Results: Participants ranged in age from 18 years to 69 years with a mean age of 48.6 years. The mean final weight lifted was 1114.85 pounds (505.69 kg) for the belt lift, 399.13 pounds (181.04 kg) for the hand lift, 306.029 pounds (138.81 kg) for the chest lift, and 860.83 pounds (390.46 kg) for the leg press. Of the participants, 42 (59%) presented to the gym with the objective of improving a defined musculoskeletal issue. The modal of these was chronic low back pain. The subjects realized improvement on a five point Likert scale of 4.2/5 in their presenting complaint and improved by 4.27/5 in their overall subjective health. Discussion: These results indicate that using extremely high weights lifted 30 minutes per week can result in dramatic improvements in weights lifted with improvement in musculoskeletal well-being and overall subjective health. Conclusion: This study adds to the literature demonstrating that weightlifting with gravitational wellness system can allow for high weights to be lifted with no significant risk of injury.
No. 344 Rehabilitation Treatment in a Case of Advanced Tumor Induced Osteomalacia: A Case Report. Delia P. Ceballos-Sáenz; Sophia B. Gutiérrez-Casillas; Hugo A. Ávila-Ramos; Paola E. Ruiz-Padilla. Setting: Tertiary care center. Patient: A 41-year-old female with tumorinduced osteomalacia (TIO). Case description: The patient started her illness at age 27 with a right hip fracture, muscular weakness, pain, and anthropometric changes. During the evolution of her disease she presented 3 more bilateral hip fractures and low impact mechanism fractures in all 4 extremities. At 40, endocrinology diagnosed TIO secondary to a phosphaturic mesenchymal tumor (PMT) in the right heel. After surgical excision of the tumor she was referred to rehabilitation with multiple joint contractures, bone deformities, postural changes, incapacity to walk nor stand, pain, severe motion range limitation, and muscle weakness, restricted lung capacity and disability in most activities of daily living (Barthel score 35). Assessment: We started rehabilitation treatment with the aim of optimizing functional mobility, improving aerobic capacity, and strengthening to promote bone mineralization. All based on physical therapy with hydrotherapy, therapeutic ultrasound, mobilizations, aerobic and resistance exercise, pulmonary manual and occupational therapy. Nowadays she is showing significant improvement since the diagnosis achieving independence in activities of daily living (Barthel 75). Discussion: TIO is a paraneoplastic syndrome (337 reported cases) caused by abnormal renal phosphate wasting. It is due to an increased expression of fibroblast growth factor 23 stimulated by a PMT. It is characterized by chronic evolution with bone and muscle pain, weight loss, multiple fractures, progressive weakness, and fatigue. The treatment of choice is surgical excision of the tumor. The diagnosis is still a challenge which delayed the treatment of our patient for 14 years. Conclusion: TIO is a rare disease and we did not find any reports in the literature with this severity or rehabilitation treatment. In this case our management has been essential because it has achieved independence of the patient and also a great improvement in her life quality.
PRESENTATIONS
No. 345 Spontaneous Iliopsoas Tendon Rupture in an Elderly Female: A Case Report. Joseph David; Manish Mammen; Jack Mensch; Paul Pipia. Setting: Acute rehabilitation unit at a tertiary care hospital. Patient: 74year-old female with past medical history of end-stage renal disease on hemodialysis, coronary artery disease status post coronary artery bypass graft, hypertension, and atrial fibrillation. Case Description: The patient was admitted with swelling, redness, and pain in the right knee following recent total knee replacement. She underwent knee debridement had a vacuum dressing placed and was treated with intravenous antibiotics including cefazolin and vancomycin. While on the acute inpatient rehabilitation unit the patient complained of pain and weakness in the proximal left lower extremity and groin. Computed tomography (CT) scan of the left lower extremity did not reveal any fracture hematoma or fluid collection. Magnetic resonance imaging (MRI) of the left lower extremity revealed a full thickness tear of the distal iliopsoas tendon. She was managed conservatively and restarted on physical therapy. Results: The patient made progress in acute rehabilitation. She was discharged home ambulating approximately one hundred feet with modified independence using rolling walker. Discussion: Iliopsoas tendon ruptures are rare. They more commonly occur following trauma and in elderly females. Tendon injuries are also frequently seen in patients with metabolic diseases and in patients with renal disease on hemodialysis. Iliopsoas tendon ruptures can present with groin pain and patients may have difficulty with ambulation. Treatment consists of relative rest, physical therapy, and pain control. Conclusions: Iliopsoas tendon ruptures should be included in the differential diagnosis of anterior groin pain in elderly females. MRI is used to make the diagnosis. Treatment is generally conservative with favorable outcomes.
No. 346 Effects of Focal Muscle Vibration on Physical Functioning in Patients With Knee Osteoarthritis. Alessandro De Sire; Francesca Gimigliano; Alessia Rabini; Diana Barbara Piazzini. Objective: The aim of the present pilot study was to evaluate the effects of focal muscle vibration on physical functioning in patients with symptomatic knee OA. Setting: Outpatients clinic university hospital. Population: Men and women aged 60 years or older with radiographic diagnosis of mild to moderate monolateral knee OA (Kellgren-Lawrence grade II or III) and chronic knee pain. Patients were randomized in two groups (treatment group and placebo control group). The treatment group received focal muscle vibration treatment according to the “repeated muscle vibration” protocol. The control group received a sham treatment. Main Outcome Measures: The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcome measures were the short physical performance battery (SPPB) and the performance-oriented mobility assessment (POMA). Follow up evaluations were done at 3 and 6 months. Results: Fifty patients were recruited and randomly assigned to either the study or control group. There was a statistical significant difference between the two groups both for primary and secondary outcomes. Conclusions: In this pilot study focal muscle vibration therapy has proven to be effective and safe in improving functioning of patients affected by mild to moderate chronic knee OA.
No. 348 Shockwave Therapy in Delayed Union in the Treatment of Forefoot Fractures: A Case Report. Carmen Teresa Esquivia Pajaro; Catalina Urrego Chinome. Disclosure: None. Setting: Central military hospital. Patient: A 24-year-old man with a forefoot fracture. Case Description: Patient with a forefoot fracture after stepping on an anti-personnel mine. Left foot radiographs show nondisplaced second metatarsal fracture, comminuted first metatarsal and proximal phalanx of the hallux fracture, transverse fourth and third metatarsal fracture being managed with débridement and