How Much Is That Stress Fracture Worth?

About $1.3 million!

That’s how much in grant money a Physical Therapy professor from The University of Delaware was awarded to study the prevention of these stress fractures. Irene Davis, PT, PhD, the director of the university’s Running Injury Laboratory and director of research for Drayer Physical Therapy was awarded the grants from the NIH and the Dept. of Defense.

Stress fractures are a real cost and challenge to the military. Its not uncommon for a soldier that suffers a stress fracture to be off-line for 6 months or more. Considering the enormous cost of training soldiers and the high frequency of stress fracture occurrence, I’d say the DOD is getting a real deal on this!

The study is really quite interesting, incorporating biofeedback and gait re-training to reduce impact forces during running at levels much greater than what a cushioning sneaker could provide. Remember, just because we all learn how to run does not imply we all know how to run correctly.

Stay tuned for more on this topic, I have a feeling that this could be one of those studies where I walk into work at the Army clinic one day and I’m met with a biofeedback device that I have no idea what to do with!

Free, Open Information

As an avid fan a peer reviewed journals, I get very excited when a journal does not charge a fee for its content. A new medical journal has recently been introduced, Open Medicine, from Canada. Its authors are the martyr type, having recently been fired from another open source journal over issues of editorial freedom. I wish them well in this new endeavor.

The Directory of Open Access Journals provides a very comprehensive listing of open journals, not just from the medical field, but from a variety of scientific disciplines. Of course, you can always conduct your search queries in the Pub Med Central engine, where all results are going to be free public domain.

I'm Officially Sensitive!

As some of you may know, I recently was involved as a tester in a research study at USC. As testers, we were required to perform repeated muscle tests on subjects quadriceps using 4 different types of tests. I was reviewing the final manuscript and found the following paragraph:

“The sensitivity of both the isometric and dynamic manual muscle tests found in the current study was much lower than would be desired for an adequate screening test. This finding was also most likely contributable to the overwhelming tendency of tester two to find no difference in strength, on both the isometric and dynamic tests, when one was detected by the Biodex dynamometer. When analyzed separately, the sensitivity of manual muscle testing as determined by tester one (Se range of 56% to 100%) was much greater than that determined by tester two (Se range of 11% to 33.3%). This means that tester one was much more likely than tester two to correctly identify those individuals with quadriceps weakness. “

I was tester one.

This is good, as I performed the data collection in fear that I would be proved to be a poor muscle tester.

To be fair, I also had a high level of false positives, finding a difference when one was not detectable on a machine. Maybe I’m more sensitive than the machine???

In all seriousness, part of my training was unique in that I had a couple of instructors who placed a large emphasis on developing expertise in palpation skills. I was guided and praised often in this area and I am proud of my ability to feel different movements with a high degree of sensitivity. I was very lucky to have teachers so focused on palpation skills.

I wonder what the other professions or even other schools do to improve a student’s ability to sense movement.

What Are You Looking For?

Perhaps you may have noticed, perhaps not, but for the past several weeks, a new functionality has been added to this blog. I created my own custom search engine using Google Custom Search. The premise behind my search is that I attempted to combine a mix of high quality consumer and professional information sources into one comprehensive rehabilitation search.

I browsed through many sites and it is a work in progress. My hope is that when you search for something like, “back pain, “the results you get will be from high quality, evidence-supported web sites. Google has been steadily improving their medical search as well, but the search results are still targeted to a wide audience.

Run your own test search. Pick a condition like, “TMJ,” and search Google Regular and my search and compare the results. I would love any feedback or site suggestions you might have on this. Enjoy!

Who are the Experts in Musculoskeletal Care?

This interesting article published in Military Medicine, a smallish peer-reviewed journal asked just that question. The investigators administered a standardized examination that assesses knowledge in managing musculoskeletal conditions to uniformed Physical Therapists. They then compared the results to other healthcare providers. The results:

  1. Orthopedic Surgeons
  2. Physical Therapists
  3. Everyone else.

Everyone else consisted of: medical students, physician interns and residents, active duty military physicians, and all physician specialists except for orthopedists.

As as side note, Physical Therapists who were not trained in the Army system or had not attended their specialized training did not as well as those therapists who had.

The lack of musculoskeletal education for generalized physicians is well documented. This study tells us a couple things: Not all healthcare providers are the same. The Army is very proud of its program.

As a first hand observer of this issue: I concur.