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Br J Sports Med. 2007 October; 41(10): 699–700.
PMCID: PMC2465187


Treatment of chronic elbow tendinosis with buffered platelet‐rich plasma

Mishra A, Pavelko T. Am J Sports Med 2006;34:1774–8

Professor Martin P Schwellnus, University of Cape Town, South Africa

BackgroundA small percentage of patients with chronic epicondylar tendinosis of the elbow do not respond to non‐operative treatment; however, many are still considering non‐operative treatment options.

Research question/sDoes local infiltration with buffered platelet‐rich plasma reduce pain and increase function in patients suffering from chronic severe elbow tendinosis who are considering surgery?

MethodologySubjects: 20 of 140 patients presenting with chronic elbow epicondylar pain that has not responded to non‐operative treatment following a standardised physical therapy protocol and other non‐operative treatments.

Experimental procedure: 20 patients with significant persistent (mean 15 months) pain (mean of 82; 60–100 pain on VAS 0–100 scale) and who were considering surgery were allocated in a non‐randomised fashion to either a single percutaneous injection of platelet‐rich plasma (PRP = 15) or bupivacaine (LA group = 5). Subjects were assessed before and after 1, 2 and 6 months after intervention.

Measures of outcome: Pain (VAS 0–100), elbow function (Mayo elbow score, best = 100).

Main finding/s:

  • 3 of the 5 subjects in the LA group withdrew or sought other treatments after the 8‐week period, which prevented further analysis.
  • Subjects in the PRP group reported significantly higher Mayo elbow scores at 2 months compared with the LA group.

Conclusion/sIn a non‐randomised pilot study, treatment of patients with chronic elbow tendinosis with buffered platelet‐rich plasma reduced pain significantly.

Evidence based rating6/10

Clinical interest rating8.5/10

Type of studyNon‐randomised clinical trial

Methodological considerationsSmall sample size, non‐randomised allocation of subjects, subjective measures of outcome

Keywordspilot study, platelet‐rich plasma (PRP), tennis elbow, lateral epicondylitis, tendonitis, tendinosis

Unstable shoe construction and reduction of pain in osteoarthritis patients

NiggBM, EmeryC, HiemstraLA. Med Sci Sports Exerc 2006;38:1701–8

BackgroundFootwear can alter forces around the knee joint and may therefore alter pain experienced by patients suffering from osteoarthritis (OA) of the knee joint.

Research question/sDoes a Masai Barefoot Technology (MBT) shoe reduce knee pain and alter balance, range of motion and ankle strength in patients suffering from OA of the knee joint?

MethodologySubjects: 123 subjects (male = 56, mean age 57 yrs) with documented OA of the knee (clinically and on x‐ray).

Experimental procedure: Subjects were randomised to either a MBT shoe (MBT = 57) or a control high‐end walking shoe (CON = 66) for 12 weeks. Subjects were assessed at 0, 3, 6, 9 and 12 weeks.

Measures of outcome: Pain and function (Western Ontario and McMaster Universities (WOMAC), OA index), BMI, balance (static balance test time with eyes closed), active ROM, and ankle torque (isokinetic).

Main finding/s:

  • In both groups, there were similar improvements in most outcome measures (total pain, stiffness, physical function score, total WOMAC score) over the 12‐week period, but between weeks 3 and 6 there was a significant reduction in total pain for the MBT group only.
  • Static balance: There was an increase in the static balance from 0 to 12 weeks in the MBT group only, although the difference between groups was not significant.

Conclusion/sIn a randomised clinical trial over 12 weeks, special shoe interventions can reduce pain in subjects with moderate OA of the knee.

Evidence based rating8/10

Clinical interest rating7.5/10

Type of studyRandomised controlled clinical trial

Methodological considerationsWell conducted study

Keywordsunstable footwear, osteoarthritis, knee, stability, knee pain, muscle training

Physical activity augments bone mineral accrual in young children: The Iowa bone development study

JanzKF, GilmoreJM, BurnsTL. J Pediatr 2006;148:793–9

BackgroundThere is some evidence to suggest that the biggest adaptive response of bone to physical activity is in childhood and adolescence.

Research question/sDoes regular physical activity over a 3‐year period increase bone mineral content (BMC) in adolescents and does physical activity augment BMC accrual?

MethodologySubjects:370 children (mean age at baseline  = 5.3 yrs).

Experimental procedure: All the subjects underwent baseline BMC assessment using dual energy x‐ray absorptiometry. Physical activity was measured using 4‐day accelerometry, and subjects were followed over mean 8.6 years.

Measures of outcome: BMC in different regions of the skeleton, physical activity, anthropometry.

Main finding/s:

  • Mean physical activity predicted follow‐up BMC at the hip, trochanter, spine and whole body (boys) and at the trochanter and whole body (girls) after adjusting for baseline BMC, age and body size.
  • Children who maintained high levels of physical activity accrued, on average, 14% more trochanteric BMC and 5% more whole‐body BMC relative to peers who only maintained low levels of physical activity.

Conclusion/sChildren and adolescents who maintain high levels of everyday physical activity increase their bone mineral content, particularly at the trochanter of the femur.

Evidence based rating7/10

Clinical interest rating7/10

Type of studyProspective cohort study

Methodological considerationsSingle population (limited wider application), diet not controlled for (calcium), physical activity measured by accelerometry

Keywordsadolescents, bone, physical activity, BMD

The effects of aerobic and resistance exercises in obese women

SarsanA, ArdicF, OzgenM. Clin Rehabil 2006;20:773–82

BackgroundIt is well accepted that exercise training is beneficial for obese patients; however, the effects of either resistance or aerobic exercise in obese patients who are not on a energy‐restricted diet are not known.

Research question/sDoes 12 weeks' aerobic or resistance exercise improve weight, blood pressure, muscle strength, cardiovascular fitness and mood in obese women who were not on an energy‐restricted diet?

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MethodologySubjects: 60 obese women.

Experimental procedure: Subjects were assigned to one of three groups for 12 weeks' intervention: aerobic exercise (AEX = 20, performing walking and cycling with increasing duration and frequency), resistance exercise (REX = 20, progressive weight‐resistance exercises for upper and lower body) or a control group (CON = 20). Anthropometric measurement, rating of mood, cardiorespiratory capacity and maximum strength of trained muscles were evaluated before and after the intervention period.

Measures of outcome: Anthropometry (height, weight, waist and hip), muscle strength (1 repetition maximum of muscles), endurance (VO2 max), mood (Beck depression scale), blood pressure.

Main finding/s:

  • Anthropometry: Changes in weight, BMI and hip/waist circumference were significantly improved in the REX and the AEX groups over time, but did not differ between groups.
  • Muscle strength: Following 12‐weeks' training, subjects in the REX group had significant improvements in hip abductors, quadriceps, biceps and pectoral muscle strength compared with the CON group (p<0.001).
  • Endurance: VO2 max increased (0.51±0.40) in the AEX group compared with the CON group.

Conclusion/s12 weeks of both aerobic exercise and resistance exercise improved performance and exercise capacity in obese women. Aerobic exercise is more beneficial in improving depressive symptoms and endurance, whereas resistance exercise is more beneficial in increasing muscle strength.

Evidence based rating7.5/10

Clinical interest rating7.5/10

Type of studyRandomised controlled clinical trial

Methodological considerationsWell conducted study

Keywordsexercise, obesity, resistance exercise, aerobic exercise, mood, blood pressure, muscle strength

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