I have developed "tennis elbow" from lugging this book around the past four weeks, but it is worth the pain, the effort, and the aspirin. It is also worth the (relatively speaking) bargain price. Including appendixes, this book contains 894 pages of text. The entire panorama of the neural sciences is surveyed and examined, and it is comprehensive in its scope, from genomes to social behaviors. The editors explicitly state that the book is designed as "an introductory text for students of biology, behavior, and medicine," but it is hard to imagine any audience, interested in any fragment of neuroscience at any level of sophistication, that would not enjoy this book. The editors have done a masterful job of weaving together the biologic, the behavioral, and the clinical sciences into a single tapestry in which everyone from the molecular biologist to the practicing psychiatrist can find and appreciate his or

Principles of Neural Science

Objective: To review 16 years of National Collegiate Athletic Association injury surveillance data for women’s lacrosse and identify potential areas for injury prevention initiatives. Background: Women’s lacrosse is a fast-paced, primarily noncontact sport. Participation in collegiate women’s lacrosse almost doubled between the 1988–1989 and 2003–2004 seasons. Lacrosse equipment consists of sticks made of wood or a synthetic material and a hard rubber ball. Until recently, mouth guards were the only required protective equipment. Main Results: Collegiate women’s lacrosse game injury rates increased over the 16-year study period. More than 60% of all severe game injuries were lower extremity sprains and strains and knee internal derangements, most frequently the result of noncontact incidents. The most common injury scenarios by injury mechanism and player activity were no contact while ball handling (16.4%) and contact from a stick while ball handling (10.5%). Contact from a stick or a ball accounted for 5.6% and 5.2% of injuries sustained during shooting activities, respectively. Approximately 22% of all game and 12% of all practice injuries involved the head and neck. Contact from a stick accounted for the majority (56.0%) of above-the-neck injuries in games; contact from the ball accounted for 20.0% of these injuries. Participants had 5 times the risk of sustaining a concussion in a game as in a practice (0.70 versus 0.15 injuries per 1000 athletic-exposures, rate ratio 4.7, 95% confidence interval 3.8, 6.5). Recommendations: To reduce the lower extremity injuries that comprise the greatest injury burden in women’s lacrosse, future researchers should evaluate proprioceptive, plyometric, and balance training interventions designed specifically for female players. Other research areas of great interest involve determining whether protective eyewear (mandated in 2004) reduces injuries to the eye, orbit, and nasal area and identifying any unintended consequences of the mandate, such as increased risk of injuries to other areas of the face or more aggressive play.

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Descriptive epidemiology of collegiate men's football injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

Placebo

Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index.

Gout

BACKGROUND: Conditioned pain modulation paradigms are often used to assess the diffuse noxious inhibitory control (DNIC) system DNICs provide one of the main supraspinal pain inhibitory pathways and are impaired in several chronic pain populations Only one previous study has examined the psychometric properties of the conditioned pain modulation technique and this study did not evaluate intersession reliability

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Reliability of the conditioned pain modulation paradigm to assess endogenous inhibitory pain pathways.

Background
Stress reaction in bone, which may proceed to a fracture, is a significant problem in military recruits and in athletes, particularly long distance runners.

Objectives
To evaluate the evidence from randomised controlled trials of interventions for prevention or management of lower-limb stress fractures and stress reactions of bone in active young adults.

Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (April 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to September week 1, 2004), EMBASE, CINAHL, Index to UK Theses, reference lists of relevant articles and contacted trialists.

Selection criteria
Any randomised or quasi-randomised trials evaluating interventions for preventing or treating lower limb stress reactions of bone or stress fractures in active young adults.

Data collection and analysis
We independently selected trials for inclusion, assessed trial quality and extracted data. Only limited data pooling was undertaken.

Main results
We included 16 trials. All 13 prevention trials involved military recruits undergoing training. Participants of two of the three treatment trials were military personnel. 

Ten prevention trials tested the effects of various foot inserts and other footwear modifications. While pooling of data was not possible, the four trials evaluating the use of "shock-absorbing" boot inserts versus control found fewer stress injuries of the bone in their intervention groups. However, the only trial showing a significant benefit lacked important information about trial design. A key issue in several trials was the acceptability, in terms of practicality and comfort, of the boot inserts. Two cluster-randomised prevention trials found no significant effect of leg muscle stretching during warm up before exercise.

Pooled data from three small but very different trials testing the use of pneumatic braces in the rehabilitation of tibial stress fractures showed a significant reduction in the time to recommencing full activity (weighted mean difference -33.39 days, 95% confidence interval -44.18 to -22.59 days). These results were highly heterogeneous (I squared = 90%), which is likely to reflect the underlying differences of the trials, including differences in the control group interventions and definitions of outcomes.

Authors' conclusions
The use of shock absorbing inserts in footwear probably reduces the incidence of stress fractures in military personnel. There is insufficient evidence to determine the best design of such inserts but comfort and tolerability should be considered.

Rehabilitation after tibial stress fracture may be aided by the use of pneumatic bracing but more evidence is required to confirm this.

/pdf/interventions-for-preventing-and-treating-stress-fractures-24k719rzh5.pdf

Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults

The pediatric flat foot is a frequent presentation in clinical practice, a common concern to parents and continues to be debated within professional ranks As an entity, it is confused by varied classifications, the notion of well-intended prevention and unsubstantiated, if common, treatment The available prevalence estimates are all limited by variable sampling, assessment measures and age groups and hence result in disparate findings (06-779%) Consistently, flat foot has been found to normally reduce with age The normal findings of flat foot versus children's age estimates that approximately 45% of preschool children, and 15% of older children (average age 10 years) have flat feet Few flexible flat feet have been found to be symptomatic Joint hypermobility and increased weight or obesity may increase flat foot prevalence, independently of age Most attempts at classification of flat foot morphology include the arch, heel position and foot flexibility Usual assessment methods are footprint measures, X-rays and visual (scaled) observations There is no standardized framework from which to evaluate the pediatric flat foot The pediatric flat foot is often unnecessarily treated, being ill-defined and of uncertain prognosis Contemporary management of the pediatric flat foot is directed algorithmically within this review, according to pain, age, flexibility; considering gender, weight, and joint hypermobility When foot orthoses are indicated, inexpensive generic appliances will usually suffice Customised foot orthoses should be reserved for children with foot pain and arthritis, for unusual morphology, or unresponsive cases Surgery is rarely indicated for pediatric flat foot (unless rigid) and only at the failure of thorough conservative management The assessment of the pediatric flatfoot needs to be considered with reference to the epidemiological findings, where there is consensus that pediatric flexible flat foot reduces with age and that most children are asymptomatic Globally, there is need for a standard by which the pediatric flat foot is assessed classified and managed Until then, assessment should utilize the available evidence-based management model, the p-FFP Future research needs to evaluate the pediatric flat foot from representative samples, of healthy and known disease-group children prospectively, and using validated assessment instruments The preliminary findings of the benefits of foot exercises, and discrete investigation into the effects of shoes and footwear use are also warranted

A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet.

Risk factors associated with the development of plantar heel pain in athletes

This study investigated the reliability of three goniometers, the universal, fluid, and electro-goniometers, in the measurement of ankle dorsiflexion. Intra- and interobserver reliability were assessed using 10 healthy volunteers and five observers. A standardized ankle position was used to measure full range of active dorsiflexion. Intraobserver reliability was assessed using one observer over two successive occasions. Interobserver reliability was assessed among five observers over five separate occasions. A one-factor analysis of variance to examine intraobserver reliability demonstrated no significant difference between each of the devices on the two occasions. A multifactorial analysis of variance demonstrated significant differences among observers and again among devices (P < 0.001). Secondary analysis for interdevice reliability demonstrated significant differences among the three devices (p < 0.1). The study suggests that each device cannot be used reliably among observers or be used interchangeably, and clinical judgment based on angular changes of less than 10 degrees are invalid if rigid protocols are not followed.

Keith Rome

Papers

Reliability of the conditioned pain modulation paradigm to assess endogenous inhibitory pain pathways.

Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults

A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet.

Risk factors associated with the development of plantar heel pain in athletes

A Reliability Study of the Universal Goniometer, Fluid Goniometer, and Electrogoniometer for the Measurement of Ankle Dorsiflexion: