Exercise-related Pain Research Articles

Comparative Analysis of Radial Corrective Osteotomy and Sauvé–Kapandji Procedure for Malunited Distal Radius Fractures in Older Adults

Malunited distal radius fractures frequently occur in the older population, posing a dilemma in selecting ideal management for symptomatic patients. Radial corrective osteotomy (RCO) and the Sauvé-Kapandji procedure (SK) have been used to treat this challenging condition. However, it remains unknown which approach is better for the older population. The objective of this study was to compare the outcomes of RCO with those of SK for the treatment of symptomatic distal radius malunion in older adults. Thirty-three patients aged ≥60 years, with malunited distal radius fractures, were randomized to be treated with either RCO or SK and followed for a minimum of 2 years. The primary evaluation parameter was grip strength, and secondary outcome parameters were surgical time, range of motion of the wrist, exercise-related wrist pain assessment using visual analog scale scores, radiographic results, patient-reported outcomes evaluated using the Disability of the Arm, Shoulder, and Hand (DASH), and Patient-Related Wrist Evaluation (PRWE) scores. The average follow-up duration was 36.7 ± 10.2 months. The grip strength was significantly higher in the RCO group. The surgical time was shorter in the SK group than in the RCO group. The postoperative wrist range of motion and visual analog scale scores for exercise-related pain alleviation were similar in both groups. The ulnar variance decreased in both groups and was similar when compared with the postoperative images. The DASH and PRWE scores were similar between the RCO and SK groups. Radial corrective osteotomy and SK surgeries have similar clinical and functional outcomes in patients aged ≥60 years. Grip strength is higher in the RCO group than in the SK group. However, the operating time to accomplish SK is shorter than RCO. Therapeutic II.

The good, the bad and the ugly – a Swedish qualitative interview study about the landscape of meaning-imbued, exercise-related physical pain, as experienced by ‘normal’ gym-users

BackgroundThe gym is a well-known place for health promoting or rehabilitating exercise whose availability to all is regarded significant for people’s personal health work and the public’s health. In this context, physical pain is usually discussed as something negative that people seek to dispose of. However, certain painful experiences appear to be an appreciated part of the gym experience. To investigate this seemingly contradictory landscape of meaning-imbued physical pain, the study aims to explore the different kinds of physical pain present at the gym and their significance for exercising, as experienced by ‘normal’ gym-users.Methods24 semi-structured in-depth interviews with active, dedicated, reasonably healthy (= normal) adult gym-users have been analyzed using qualitative content analysis from a hermeneutical stance.ResultsParticipants differentiate between three kinds of physical pain: the good pain of enhancement (often connected to muscle soreness and effort burn), the bad pain of impediment (primarily related to acute damage) and the composite, neutral pain of acceptance (potentially linked to all pains).ConclusionWhen pursuing the goal of personal health development, normal gym-users argue that exercising at the gym means to expose yourself to pain and to do so willingly, even longingly. Refusing to share this understanding may diminish people’s chances to occupy the gym space and, hence, reduce their chances to promote their health.

Exercise in patients with acetabular retroversion and excessive anterior pelvic tilt: A feasibility and intervention study

BackgroundAcetabular retroversion is associated with femoroacetabular impingement syndrome (FAIS). Anterior pelvic tilt enhances risk of FAIS. ObjectivesTo investigate feasibility and change in patient-reported symptoms of a home-based exercise intervention in patients with acetabular retroversion and excessive anterior pelvic tilt, in comparison with a prior control period. DesignProspective intervention study. MethodsPatients (18–40 years) not eligible for surgery, with radiographic signs of acetabular retroversion and excessive anterior pelvic tilt were recruited. An 8-week control period was followed by an 8-week training period. The home-based intervention consisted of education and exercises for core stability, muscle strengthening and stretching for reducing anterior pelvic tilt. Feasibility assessments were dropout (≤10%), adherence (≥75% of sessions), exercise-related pain, and adverse events. Primary outcome was change in the Copenhagen Hip and Groin Outcome Score (HAGOS) pain-subscale. Pelvic tilt was measured by EOS scanning. ResultsForty-two patients (93% female, mean age 22.2 ± 4.2 years) were included. Dropout rate was 7% and satisfactory adherence was demonstrated by 85%. Exercise-related pain and adverse events were acceptable. Between-period mean change score for HAGOS-PAIN was 5.2 points (95% CI: −0.3–10.6) and −1.6° (95% CI: −3.9–0.7) of anterior pelvic tilt. Patients responding positively (≥10 points) (n = 10, 26%), had pre-exercise moderate pain (HAGOS-PAIN 47.5–70 points). ConclusionsCurrent exercise intervention was feasible. However, we found no clinically relevant changes in self-reported hip-related pain or anterior pelvic tilt. Post hoc responder analysis revealed that patients with moderate pain at baseline might benefit from this exercise.

Efficacy of a Combination of Conservative Therapies vs an Education Comparator on Clinical Outcomes in Thumb Base Osteoarthritis

A combination of conservative treatments is commonly used in clinical practice for thumb base osteoarthritis despite limited evidence for this approach. To determine the efficacy of a 6-week combination of conservative treatments compared with an education comparator. Randomized, parallel trial with 1:1 allocation ratio among people aged 40 years and older with symptomatic and radiographic thumb base osteoarthritis in a community setting in Australia. The intervention group (n = 102) received education on self-management and ergonomic principles, a base-of-thumb splint, hand exercises, and diclofenac sodium, 1%, gel. The comparator group (n = 102) received education on self-management and ergonomic principles alone. Intervention use was at participants' discretion from 6 to 12 weeks. Hand function (Functional Index for Hand Osteoarthritis; 0-30) and pain (visual analog scale; 0-100 mm) were measured at week 6 (primary time point) and week 12. An α of .027 was used at week 6 to account for co-primary outcomes. Of the 204 participants randomized, 195 (96%) and 194 (95%) completed follow-ups at 6 and 12 weeks, respectively; the mean (SD) age of the population was 65.6 (8.1) years, and 155 (76.0%) were female. At week 6, hand function improved significantly more in the intervention group than the comparator (between-group difference, -1.7 units; 97.3% CI, -2.9 to -0.5; P = .002). This trend was sustained at 12 weeks (-2.4 units; 95% CI, -3.5 to -1.3; P < .001). Pain scores improved similarly at week 6 (between-group difference, -4.2 mm; 97.3% CI, -11.3 to 3.0; P = .19). At week 12, pain reduction was significantly greater in the intervention group (-8.6 mm; 95% CI, -15.2 to -2.0; P = .01). There were 34 nonserious adverse events, all in the intervention group-mostly skin reactions and exercise-related pain exacerbations. In this randomized clinical trial of people with thumb base osteoarthritis, combined treatments provided small to medium and potentially clinically beneficial effects on hand function but not pain. Australian New Zealand Clinical Trials Registry Identifier: ACTRN12616000353493.

The Influence of Specific Bioactive Collagen Peptides on Knee Joint Discomfort in Young Physically Active Adults: A Randomized Controlled Trial.

First evidence indicates that the supplementation of specific collagen peptides is associated with a significant reduction in activity-related joint pain in young adults. The purpose of the current investigation was to confirm the efficacy of the same collagen peptides in a comparable study population. In total, 180 active men and women aged between 18 and 30 years with exercise-related knee pain but no diagnosed joint disease completed the trial over a period of 12 weeks. Participants were randomly assigned to the group receiving 5 g of specific collagen peptides (CP-G) or to the placebo group (P-G). For the primary outcome, changes in pain during or after exercise from pre- to post-intervention were assessed by the participants using the Visual Analog Scale (VAS). These changes were additionally evaluated by the examining physician by means of anamnesis and physical examination of the affected knee joint. As secondary outcomes, pain under resting conditions and after 20 squats were compared between the study groups. In addition, the mobility of the knee joint and the use of alternative therapies (e.g., ointments or physiotherapy) were recorded. The supplementation of specific collagen peptides derived from type I collagen with a mean molecular weight of 3 kDa led to a significantly (p = 0.024) higher reduction of exercise-induced knee pain (−21.9 ± 18.3 mm) compared with the placebo group (−15.6 ± 18.5 mm). These findings were consistent with the physician’s evaluation (−23.0 ± 19.2 mm vs. −14.6 ± 17.9 mm, p = 0.003). The decrease in pain under resting conditions and after squats did not significantly differ between the groups, as only a small number of participants suffered from pain under these conditions. Due to the clinically unremarkable baseline values, the mobility of the knee joint did not change significantly after the intervention. In conclusion, the current investigation confirmed that the oral intake of bioactive collagen peptides used in the current investigation led to a statistically significant reduction of activity-related joint pain in young active adults suffering from knee joint discomfort.

Motion-Control Shoes Reduce the Risk of Pronation-Related Pathologies in Recreational Runners: A Secondary Analysis of a Randomized Controlled Trial.

To investigate whether motion-control shoes reduce the risk of pronation-related injuries in recreational runners. Secondary analysis of a randomized controlled trial of the effect of shoes on running injuries. Three hundred seventy-two recreational runners were randomized to receive either standard neutral or motion-control shoes and were followed up for 6 months regarding running activity and injury. Running injuries that occurred during this period were registered and classified as pronation-related injuries (Achilles tendinopathy, plantar fasciopathy, exercise-related lower-leg pain, and anterior knee pain) or other running-related injuries. With the use of competing risk analysis, the relationship between pronation-related and other running-related injuries and shoe type was evaluated by estimating the cause-specific hazard, controlling for other possible confounders like age, sex, body mass index, previous injury, and sport participation pattern. Twenty-five runners sustained pronation-related running injuries and 68 runners sustained other running-related injuries. Runners wearing the motion-control shoes had a lower risk of pronation-related running injuries compared with runners who wore standard neutral shoes (hazard ratio = 0.41; 95% confidence interval: 0.17, 0.98). There was no effect of shoe type (hazard ratio = 0.68; 95% confidence interval: 0.41, 1.10) on the risk of other running-related injuries. Motion-control shoes may reduce the risk of pronation-related running injuries, but did not influence the risk of other running-related injuries. J Orthop Sports Phys Ther 2021;51(3):135-143. Epub 11 Dec 2020. doi:10.2519/jospt.2021.9710.

Assoсiation analysis of gene polymorphisms col1a, mct1, col12a1 with sports hernia in football players

Sports hernias are diagnosed in over 80% of athletes presenting with chronic groin pain. The genotype distributions of the examined polymorphisms were studied in 95 football players, all males, using the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire. DNA extracted from buccal epithelium. Statistical calculations were performed in the R statistical environment (r-project.org) and Odds ratios (OR) were used to estimate genotype associations. Multifactor dimensionality reduction was used to identify multiple sports hernia susceptibility loci.Two single nucleotide polymorphisms MCT1 rs1049434 and COL1A1 rs1800012 are associated with sports hernias (63% testing accuracy shown by random forest). According to the HAGOS questionnaire outcomes, exercise-related pain, reduced mobility, and range of motion in the groin and thigh are typically associated with sports hernia diagnosis (75% testing accuracy shown by random forest).The combination of genetic research and HAGOS questionnaire helped obtain a sensitivity of 93% for the detection of sports hernia. Active engagement in sport is the most important risk factor for sports hernia, so the identification genes SNP in footballers may contribute to taking timely preventive actions. This study is the first demonstration of an association between sports hernia and COL1A1 rs1800012 genotype. The study discovered a synergistic interaction between the indicated polymorphism and the gene polymorphism MCT1 rs1049434. Further investigations are required to study the association between COL12A1 rs240736 gene SNP and sports hernia.

The Limits of Cognitive Reappraisal: Changing Pain Valence, but not Persistence, during a Resistance Exercise Task

Physiological discomfort is commonly cited as a barrier for initiating and persisting with exercise. Although individuals may think of physiological discomfort as determined by physical sensations, it can also be influenced by cognitive and emotional factors. We explored the impacts of interpreting the purpose of pain as a sign of muscle building (helpful) vs. a sign of muscle tearing and possible injury (harmful) and tested the effect of cognitive reappraisals, or shifting interpretations of pain, on exercise persistence and the subjective experience of discomfort during exercise. Seventy-eight participants were randomized to listen to voice recordings that framed exercise-related pain as helpful vs. harmful before participating in a standard muscular endurance test using the YMCA protocol. Although the two experimental groups did not differ in the overall number of resistance training repetitions achieved, participants who were asked to think about the benefits (rather than the negative consequences) of pain reported less negative pain valence during exercise. Thus, the experience of pain was influenced by appraisals of the meaning of pain, but differences in pain valence did not impact exercise persistence. Theoretical implications and applications for affect-based exercise interventions are discussed.

Hand and Wrist: A Kaleidoscopic View of Accessory Ossicles, Variants, Coalitions, and Others.

Accessory bones, variants, and coalitions are not uncommon at the hand-wrist region. They are often overlooked because they are usually asymptomatic and found incidentally on imaging. However, they may sometimes present as a (painful) swelling or mimic a (sequel of a) fracture. Other symptoms may be attributed to impingement and exercise-related pain. Thorough knowledge of the anatomy, systematic imaging analysis, and the awareness of their existence are the clues to a correct identification. Plain radiography and magnetic resonance imaging (MRI) play a pivotal role in the correct diagnosis. In general, signal intensity on MRI is similar to the normal bony structures. However, concomitant bone marrow edema may indicate the presence of impingement. Therefore, MRI sequences with fat suppression should be included in case of symptomatic findings. This article provides a kaleidoscopic overview of some of the prevalent bony anomalies of the hand-wrist region and their potential pathogenic nature.

Muscle pain in mitochondrial diseases: a picture from the Italian network.

Muscle pain may be part of many neuromuscular disorders including myopathies, peripheral neuropathies and lower motor neuron diseases. Although it has been reported also in mitochondrial diseases (MD), no extensive studies in this group of diseases have been performed so far. We reviewed clinical data from 1398 patients affected with mitochondrial diseases listed in the database of the "Nation-wide Italian Collaborative Network of Mitochondrial Diseases", to assess muscle pain and its features. Muscle pain was present in 164 patients (11.7%). It was commonly observed in subjects with chronic progressive external ophthalmoplegia (cPEO) and with primary myopathy without cPEO, but also-although less frequently-in multisystem phenotypes such as MELAS, MERFF, Kearns Sayre syndrome, NARP, MNGIE and Leigh syndrome. Patients mainly complain of diffuse exercise-related muscle pain, but focal/multifocal and at rest myalgia were often also reported. Muscle pain was more commonly detected in patients with mitochondrial DNA mutations (67.8%) than with nuclear DNA changes (32.2%). Only 34% of the patients showed a good response to drug therapy. Interestingly, patients with nuclear DNA mutations tend to have a better therapeutic response than patients with mtDNA mutations. Muscle pain is present in a significant number of patients with MD, being one of the most common symptoms. Although patients with a myopathic phenotype are more prone to develop muscle pain, this is also observed in patients with a multi system involvement, representing an important and disabling symptom having poor response to current therapy.

Don't Just Blame it on the Veins: An Update on Vascular Exertional Limb Pain.

Exertional limb pain is a common problem encountered in recreational and competitive athletes. Affecting both the upper and lower extremities, this broad entity can be musculoskeletal, vascular, neurologic, oncologic, or infectious in origin. This article focuses on the vascular causes of exercise-related extremity pain, which encompass a cadre of elusive diagnoses. Specifically, we examine arterial endofibrosis, popliteal artery entrapment syndrome, and chronic exertional compartment syndrome of both the upper and lower extremities. For each of these conditions, we offer updates regarding the respective epidemiology, common signs and symptoms, worthwhile diagnostic modalities, and pertinent treatment options, all based on evidence and reports published over the past year.

Gait Pattern, Impact to the Skeleton and Postural Balance in Overweight and Obese Children: A Review.

The article reviews the biomechanical factors that may cause overweight/obese children to reduce their level of physical activity, while increasing their risk of overuse injuries and exercise-related pain. Recommendations would be to screen those children for any gait or postural impairments before they join any exercise program, and to provide them with specific gait treatments and/or physical exercise programs, in order to decrease their risk for future musculoskeletal injuries and pain.

Accessory Muscles of the Extremities.

Accessory muscles and variations are not uncommon at the upper and lower extremity. They are often overlooked because they are asymptomatic and present as incidental findings on imaging. However, they may present as a soft tissue swelling, thereby mimicking soft tissue tumors. Other symptoms are attributed to impingement on neurovascular structures and to exercise-related pain. Thorough knowledge of the anatomy, systematic imaging analysis, and the awareness of it are the clues to correct identification. On ultrasound, accessory muscles have a similar echotexture as other muscles, whereas the signal intensity on magnetic resonance imaging (MRI) is similar to muscle. Because of the intrinsic contrast with the adjacent intermuscular fat, accessory muscles are best depicted on MRI without fat suppression. This article provides a short overview of the anatomy of most prevalent accessory muscles of the upper and lower limb and its potential pathogenic nature.

Magnetic resonance imaging in exertional compartment syndrome of the forearm: Case-based pictorial review and approach to management.

Exercise-related limb pain poses a management dilemma to the clinician. The term ‘chronic exertional compartment syndrome’ (CECS) (previously known as ‘anterior tibial syndrome’) refers to a condition characterised by exercise-induced pain in one or more muscle groups and is more commonly seen in the lower limbs. Much less has been reported about the upper limbs where the muscular compartments are variably noted to be involved. A high index of clinical suspicion should therefore be maintained to avoid missing the diagnosis. Although commonly noted in athletes, CECS can occur in any age group with any level of exercise activity. In addition, there is no age predilection and the syndrome may be bilateral. The exact prevalence is not known as many athletes modify their training methods, thus delaying or avoiding medical assistance and imaging. The pathophysiology of compartment syndrome is complex. In this review of the syndrome, we describe the cycle of intracellular events leading to CECS and the eventual destruction of muscle. There is considerable overlap with the many possible causes of limb pain. Even the most experienced clinicians experience some difficulty in making this diagnosis of CECS, but with increasing awareness of this entity and availability of good-quality magnetic resonance imaging to confirm the suspicion, upper limb CECS is being more commonly diagnosed and patients more timeously managed.

P.07.3: Median Arcuate Ligament Syndrome: A Case of an 18-Year-Old Boy with Exercise-Related Pain

P.07.3: Median Arcuate Ligament Syndrome: A Case of an 18-Year-Old Boy with Exercise-Related Pain

Femoral Neck Stress Fractures in Sport: A Current Concepts Review.

Femoral neck stress fractures (FNSFs) account for 3% of all sport-related stress fractures. The commonest causative sports are marathon and long-distance running.The main types of FNSF are compression-sided, tension-sided and displaced. The most common reported symptom is exercise-related groin pain. Radiographs form the first line of investigation, with MRI the second-line investigation.The management of FNSFs is guided by the location and displacement of the fracture. Delay in diagnosis is common and increases the likelihood of fracture displacement. Sporting outcomes are considerably worse for displaced fractures. Education programmes and treatment protocols can reduce the rates of displaced FNSFs.This article aims to provide a current concepts review on the topic of FNSFs in sport, assess the current evidence on the epidemiology and pathophysiology of these injuries, detail the current recommendations for their imaging and management, and review the recorded sporting outcomes for FNSFs in the existing literature.From this study, we conclude that although FNSFs are a rare injury, they should be considered in all athletes presenting with exercise-related hip pain, because delay in diagnosis and subsequent fracture displacement can significantly impair future return to sport. However, when detected early, FNSFs show promising results in terms of return-to-sport rates and times.

Exercise therapy in patients with hip osteoarthritis: Effect on hip muscle strength and safety aspects of exercise—results of a randomized controlled trial

Purpose: To evaluate the effect of an exercise therapy concept (the Tübingen exercise therapy approach THüKo) for increasing hip muscle strength (HMS) in patients with hip osteoarthritis (OA), and to investigate whether patients do adhere to the intervention and if there are any adverse events related to the intervention.Methods: A total of 210 hip OA patients (89 females, 121 males) were randomized into a 12-week exercise intervention (THüKo) including group sessions (1/week) and home exercising (2/week), a placebo ultrasound group (1/week) or a control group (no treatment). HMS was measured as isometric peak torque of hip abduction, adduction, flexion, and extension. Adherence to exercise and safety aspects were monitored as additional outcomes.Results: Baseline adjusted post intervention HMS of the THüKo group were higher compared to the control group (differences of 0.11–0.27 Nm/kg, p < 0.01) and to the placebo ultrasound group (differences of 0.09–0.19 Nm/kg, p < 0.01). Adherence to exercise was high (about 90%). No subject had to refuse from training because of an exercise related adverse event and exercise related pain was only of intermittent nature without sustainable adverse effects.Conclusions: The Tübingen exercise therapy approach has shown to have a significant positive effect on HMS. Its implementation has shown to be feasible and safe according to the percentage of exercise participation and the absence of sustainable adverse events.

The Role of Exercise Therapy in Exercise-Related Groin Pain by Athletes

The Role of Exercise Therapy in Exercise-Related Groin Pain by Athletes

Protocolo clínico de evaluación de las mialgias

Muscle pain is a non-specific symptom, very common in the normal population. It is most frequently due to metabolic, endocrine, toxic or infectious conditions. Myalgia is not a common symptom in primary muscle conditions, however, metabolic myopathies and some other myopathies can present with muscle pain. Myalgia due to primary muscle conditions is usually related to exercise and other symptoms or signs are present, such as weakness, muscle atrophy or hypertrophy or elevation of the CK. In patients with metabolic myopathies due to abnormalities in the glycolytic pathway symptoms will arise after brief and intense exercise. Fatty acid oxidation defects lead to muscle pain and other symptoms after prolonged exercise, or in association with fasting or febrile illnesses. It is important to consider ischemic pain among the differential in exercise-related muscle pain due to its different management and implications.

Targeting pain catastrophization in patients with fibromyalgia using virtual reality exposure therapy: a proof-of-concept study.

[Purpose] Pain catastrophizing is a key predictor of poor compliance to exercises among patients with fibromyalgia syndrome. Alteration of pain catastrophizing in this group is thus warranted. This study aimed to provide proof-of-concept of a novel virtual reality exposure therapy program as treatment for exercise-related pain catastrophizing in patients with fibromyalgia syndrome. [Subjects and Methods] An exploratory, case-controlled study was conducted (fibromyalgia syndrome group and matched control group). Functional magnetic resonance imaging was used to acquire neural correlates. The functional magnetic resonance imaging task consisted of two stimuli: active (exercise activity visuals) and passive (relaxing visuals). Structural images and blood-oxygenation-level-dependent contrasts were acquired for the conditions and compared within subjects/groups and between groups. Statistic images were thresholded using corrected clusters (determined by Z>2.3; level of significance: 0.05). [Results] Thirteen fibromyalgia syndrome subjects and nine healthy matched controls were included. The right inferior frontal gyrus, right middle frontal gyrus, right posterior cerebellum, left thalamus, and left supramarginal gyrus were activated in the fibromyalgia syndrome subjects. [Conclusion] The study results provide preliminary proof indicating that exposing patients with fibromyalgia syndrome to visuals of exercises elicits neurophysiological changes in functional brain areas associated with pain catastrophization and add to the current body of knowledge regarding the possibility of objectively identifying cognitive behavioral strategies like pain catastrophization.