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Biomedical subjects

W D Stanish

Publications and source records attributed to W D Stanish.

At least 19 recordsLinked to original sources
PubMed2005

Neuromuscular alterations during walking in persons with moderate knee osteoarthritis.

This paper compared the neuromuscular responses during walking between those with early-stage knee osteoarthritis (OA) to asymptomatic controls. The rationale for studying those with mild to moderate knee OA was to determine the alterations in response to dynamic loading that might be expected before severe pain, joint space narrowing and joint surface changes occur. We used pattern recognition techniques to explore both amplitude and shape changes of the surface electromyograms recorded from seven muscles crossing the knee joint of 40 subjects with knee OA and 38 asymptomatic controls during a walking task. The principal patterns for each muscle grouping explained over 83% of the variance in the waveforms. This result supported the notion that the main neuromuscular patterns were similar between asymptomatic controls and those with OA, reflecting the specific roles of the major muscles during walking. ANOVA revealed significant (p<0.05) differences in the principal pattern scores reflecting both amplitude and shape alterations in the OA group and among muscles. These differences captured subtle changes in the neuromuscular responses of the subjects with OA throughout different phases of the gait cycle and most likely reflected changes in the mechanical environment (joint loading, instability) and pain. The subjects with OA attempted to increase activity of the lateral sites and reduce activity in the medial sites, having minimal but prolonged activity during late stance. Therefore, alterations in neuromuscular responses were found even in this high functioning group with moderate knee OA.

Adult↗
PubMed2001

The increasing need for nonoperative treatment of patients with osteoarthritis.

Osteoarthritis affects more patients than almost any other musculoskeletal disorder. The number of patients suffering joint pain and stiffness as a result of this disease will increase rapidly in the next decade. Although operative treatments of patients with osteoarthritis will continue to improve and the number of operative procedures will increase slightly in the next decade, only a small fraction of the patients with osteoarthritis will require operative procedures. The most pressing healthcare need for the majority of patients with osteoarthritis is nonoperative care that helps relieve symptoms and improve function, and in some instances slows progression. In rare instances, the symptoms of osteoarthritis improve spontaneously, but most patients need nonoperative care for decades. Orthopaedists need to improve their ability to provide nonoperative care for patients with osteoarthritis. They should be skilled in the early diagnosis of osteoarthritis and in the use of current common nonoperative treatments including patient education, activity modification, shoe modifications, braces, oral analgesics, oral nonsteroidal antiinflammatory medications, oral dietary supplements, and intraarticular injections. Furthermore, orthopaedists should be prepared to incorporate new nonoperative treatments for patients with osteoarthritis into their practice.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2001

Chronic occupational repetitive strain injury.

OBJECTIVE: To review common repetitive strain injuries (RSIs) that occur in the workplace, emphasizing diagnosis, treatment, and etiology of these conditions. QUALITY OF EVIDENCE: A MEDLINE search from January 1966 to June 1999 focused on articles published since 1990 because RSIs are relatively new diagnoses. MeSH headings that were explored using the thesaurus included "cumulative trauma disorder," "overuse injury," and "repetitive strain injury." The search was limited to English articles only, and preference was given to randomized controlled trials. MAIN MESSAGE: Repetitive strain injuries result from repeated stress to the body's soft tissue structures including muscles, tendons, and nerves. They often occur in patients who perform repetitive movements either in their jobs or in extracurricular activities. Common RSIs include tendon-related disorders, such as rotator cuff tendonitis, and peripheral nerve entrapment disorders, such as carpal tunnel syndrome. A careful history and physical examination often lead to the diagnosis, but newer imaging techniques, such as magnetic resonance imaging and ultrasound, can help in refractory cases. Conservative management with medication, physiotherapy, or bracing is the mainstay of treatment. Surgery is reserved for cases that do not respond to treatment. CONCLUSION: Repetitive strain injury is common; primary care physicians must establish a diagnosis and, more importantly, its relationship to occupation. Treatment can be offered by family physicians who refer to specialists for cases refractory to conservative management.

Chronic Disease↗
PubMed2000

The young athlete with physical challenges.

This article is intentionally broad in scope, as a result of a collaboration from the fields of primary care sports medicine, orthopedic surgery, and kinesiology. What has been borne out in the process is a true appreciation of the benefits of a multidisciplinary approach toward providing care for the young athlete with a physical disability. To name a few, joint involvement of parents, coaches, trainers, physical therapists, orthotists, prosthetists, wheelchair engineers, neurologists, physiatrists, nutritionists and most importantly, the athletes themselves, should be further encouraged because each discipline provides a unique perspective in the identification and management of health-related issues. It is the intent of this article to provide readers with at least some new insight that they can carry into their future practice.

Adolescent↗
PubMed1999

Eccentric kinetic chain exercise as a conservative means of functionally rehabilitating chronic isolated insufficiency of the posterior cruciate ligament.

OBJECTIVE: To determine the efficacy of a home eccentric kinetic chain exercise program in improving isokinetic strength, knee function, and symtomatology in athletes with isolated posterior cruciate ligament (PCL) injury. DESIGN: Experimental design. SETTING: Allan McGavin Sports Medicine Centre, University of British Columbia, Vancouver, British Columbia, Canada. PARTICIPANTS: The study included 13 athletes with isolated PCL injury (n = 13) and 13 healthy sedentary subjects (n = 13). All participants were men and between 18 and 35 years of age. The group with isolated PCL injury all had been diagnosed at the Allan McGavin Sports Medicine Centre, all had been treated without surgery, and had been injured at least 6 months ago. Diagnosis was based on presentation of a positive posterior sag and posterior drawer. INTERVENTION: The group with isolated PCL injury (treatment group) underwent 12 weeks of eccentric kinetic chain exercise. The control group of healthy sedentary individuals did not undergo any form of rigorous training during the course of this study. Both groups were tested for isokinetic strength, knee function, and symptomatology at weeks 0, 6, and 12. Compliance was insured through frequent phone contact and progressive journal records of completion of daily exercise. Only those who completely executed the 12-week exercise program were included in the study. MAIN OUTCOME MEASURES: Hamstring and quadriceps isokinetic torque (Nm) at constant velocities of 60 and 120 degrees per second (degrees/s), Tegner Hop Test (meters), and Lysholm Knee Scale scores. RESULTS: A subject-versus-treatment data analysis clearly indicated significant increases in eccentric and concentric torque over the 12-week period in the treatment group. Tegner Hop Test and Lysholm Knee Scale scores also increased significantly after the eccentric squat exercise program. Quadriceps eccentric/concentric ratios at both testing velocities increased significantly after 12 weeks of rehabilitation. There were no significant differences in strength between extremities in the treatment group at any time during the course of this study. Before rehabilitation, there were no significant differences between eccentric and concentric torque values in either muscle group (quadriceps and hamstrings) of the treatment group. After the eccentric exercise program, the quadriceps in the injured extremity did exhibit significantly greater eccentric than concentric torque. The treatment group was significantly weaker than the control group in eccentric torque at both testing velocities at week 0. After the 12-week exercise program, however, there were no significant differences between groups in eccentric quadriceps strength. CONCLUSION: The results of this investigation support the eccentric squat program as a viable means of functionally rehabilitating chronic PCL insufficiency.

Adolescent↗
PubMed1997

Rehabilitation of tendon injuries in sport.

Clinicians are faced with a growing number of athletes with injured tendons. Treatment of both acute and chronic injuries has proven to be quite complex. It is difficult to maintain the balance between resting the injured tendon and preventing atrophy of the surrounding muscles and joints. Questions also arise as to when the tendon should be strengthened and when the athlete is ready to return to full activity in sport. Through an awareness of the structural and mechanical properties of the tendon, an exercise programme for the rehabilitation of tendon injuries has been developed. It is recommended that this programme be used in combination with ice and other physical modalities. This approach will resolve most tendon injuries within 6 weeks of its implementation. The use of anti-inflammatory medications and surgery can only be recommended in select situations where more conservative measures are inadequate.

Acute Disease↗
PubMed1997

Lower leg, foot, and ankle injuries in young athletes.

Most injuries to the young athlete do have a benign natural course-complete resolution of the difficulty without sequelae. In order to develop a contemporary program of management of the more serious disorders in this active population, the practitioner must be certain to carefully analyze the injury and initiate a rapid course of action. A fracture of the tibia must be reduced, held aligned, and then rehabilitated. A compartment syndrome commonly demands early fasciotomy; the young athlete and his or her parents warrant a sensitive understanding from physicians to quell the anxiety that is paramount to all of these disorders.

Adolescent↗
PubMed1995

Shoulder arthroscopy and nerve injury: pitfalls and prevention.

Shoulder arthroscopy has become a very useful diagnostic and therapeutic modality. Unfortunately, like many other invasive procedures it can have complications. One of the most worrisome complications, for both the patient and surgeon, is that of nerve injury. Nerve injury during shoulder arthroscopy is often a transient phenomenon although a more severe injury has been documented. We review much of the literature on this subject and discuss some of the many pitfalls and preventative strategies that have been reported.

Arthroscopy↗
PubMed1995

Lower leg, foot, and ankle injuries in young athletes.

Most injuries to the young athlete do have a benign natural course--complete resolution of the difficulty without sequelae. In order to develop a contemporary program of management of the more serious disorders in this active population, the practitioner must be certain to carefully analyze the injury and initiate a rapid course of action. A fracture of the tibia must be reduced, held aligned, and then rehabilitated. A compartment syndrome commonly demands early fasciotomy; the young athlete and his or her parents warrant a sensitive understanding from physicians to quell the anxiety that is paramount to all of these disorders.

Adolescent↗
PubMed1993

Overuse tendonitis and rehabilitation.

Tendon injuries are often caused by overuse during sport or day-to-day activities. Knowledge of these injuries has grown greatly during the last several decades. We review recent literature on the structure and mechanical properties of tendons, the cause of overuse injury, and rehabilitation.

Biomechanical Phenomena↗
PubMed1993

New concepts of rehabilitation following anterior cruciate reconstruction.

Can a knee joint with a torn ACL of 2 years' duration ever be able to return to high performance? Very unlikely indeed. Some realistic expectations follow: 1. The knee joint can never be normal after an ACL reconstruction. 2. Surgery must take place as early after the injury as possible, before secondary joint degeneration takes place. 3. The surgery must employ a tissue that best matches the normal ACL in strength and structure. 4. The surgery must involve as little trauma as possible while restoring knee joint mechanics. 5. Stress, although guarded, must be faced by the knee joint as soon as possible after surgery. 6. Progressive weight bearing starts immediately, combined with quadriceps isometrics. ROM of the knee joint, particularly full extension, is conserved and protected. 7. Progressive active ROM without formal resistance continues for 4 weeks. 8. Progressive formal resistance exercises continue for at least 1 year. 9. Sport-specific tasks commence at 16 weeks, depending on the requirement of the sport and the response of the individual athlete. 10. Recovery will plateau at several stages, with the final plateau at approximately 18 months. Knee instability is an exciting but perplexing problem. Although we have advanced profoundly from the era of Jones, Smiley, and others, we still face many of the same challenges as our predecessors. New technology should not fool us. We are still addressing a major structural failure within the knee joint. Our attempts have been non-surgical and surgical, with repair, reconstruction, and replacement. However, fundamental to all of these hopes has been the reconditioning of the extremity after ACL surgery. Can we do better than our forefathers like Licht and others? No one is certain. This article offers an approach, in some areas our approach, but should not be perceived as a cookbook. Individual responses by our patients, athletes, dictate whether any protocol is too hasty or tardy. It is fundamental that we listen to our patients objectively and analyze the knee as it returns from the surgical aggression. The ultimate success of the rehabilitation process will be based on the marriage of science and realistic expectations.

Analgesia↗
PubMed1992

The use of eccentric training and stretching in the treatment and prevention of tendon injuries.

Tendon injuries are a common consequence of either sports or daily routine activity. Most people will suffer at least one tendon injury in his or her lifetime. It is therefore prudent to understand the different ways to load tendon and the ways in which the muscle-tendon-bone unit responds to these stresses. By maximizing tendon training and rehabilitation, one can maximize the stresses (eccentric) a tendon will withstand. This article provides an explanation of these principles.

Achilles Tendon↗
PubMed1991

Chronic compartment syndrome caused by aberrant fascia in an aerobic walker.

The following is a case presentation of a 36-yr-old female athlete who presented with the symptoms and signs of chronic anterior compartment syndrome. Pre-exercise and post-exercise tissue pressure measurements revealed increased compartment pressures in both of her anterior leg compartments. Aberrant fascial bands overlying and compressing the anterior compartments were discovered at the time of surgery. Fasciotomies led to complete recovery and return to previous levels of athletic activity. This is the first report of aberrant fascia as a cause of chronic anterior compartment syndrome.

Adult↗
PubMed1988

Emergencies in sports: the young athlete.

Accidents are the leading cause of death in children over the age of 1 year. Owing to the prevalence of injury, especially sports related, the attending physician should always be alert for the plausibility of serious medical emergencies in the young athlete.

Adolescent↗
PubMed1986

Eccentric exercise in chronic tendinitis.

Chronic tendinitis, particularly of the Achilles tendon, frequently outwits traditional programs of therapy including surgery and/or prolonged immobilization. A hypothesis proposes that disruption of the tendon, micro or macro, occurs under specific conditions of eccentric loading. In order for the healing tendon to be adequately rehabilitated, the treatment program must include specific eccentric strength rebuilding exercises.

Chronic Disease↗
PubMed1986

Posterior cruciate ligament tears in wrestlers.

Two cases of isolated injury to the posterior cruciate ligament of the knee are presented. These injuries both occurred in elite wrestlers, members of the Canadian Pan American Team. The mechanism of injury was identical in both cases--the ligament rupture being a result of forced flexion with combined internal rotation of the tibia on femur. A review of the literature is added with a suggestion for conservative treatment as the initial and perhaps definitive management for this problem.

Adult↗
PubMed1985

Tendinitis: the analysis and treatment for running.

The material presented has been designed to offer an approach to the diagnosis and treatment of chronic tendinitis in the runner. Although there is a paucity of experimental data dealing with the behavior of the muscle-tendon unit during lengthening contractions as compared with the volume that exists concerning shortening contractions, results indicate that force increases with length from both eccentric and concentric contractions. The literature also suggests that eccentric contraction is a means by which muscles can maximize their force production while minimizing time delays and energy expenditure. Using this information in our clinical experience, we have developed an exercise program to treat chronic tendinitis. Pain, the cardinal sign of tendinitis, is used as both a way to classify the severity of the tendinitis and a yardstick for the progress of treatment.

Adrenal Cortex Hormones↗