Association of participation in the American Board of Physical Medicine and Rehabilitation Maintenance of Certification program and physician disciplinary actions Objective The study analyzed the relationship between participation in the American Board of Physical Medicine and Rehabilitation (ABPMR) maintenance of certification (MOC) program and the incidence of disciplinary actions (DAs) by state medical boards over a physician's career. The hypothesis is that physicians who do not maintain their board certification have a higher likelihood of state medical board DAs. Design This retrospective cohort study analyzed ABPMR MOC data from all board-certified physiatrists who were enrolled in the ABPMR MOC program from 1993-2007. Results Matching examination and license data were available for 4,794 physicians, who received a total of 212 disciplinary action reports through the Federation of State Medical Boards (FSMB). The results showed that physicians who have a lapse in completing the ABPMR MOC program have a 2.5-fold higher incidence of receiving a DA report through the FSMB (95% confidence interval 1.76 - 3.63) and had higher severity violations (X(2) = 7.14, p < 0.05) than physicians whose certificate never lapsed. Conclusions For physicians in physical medicine and rehabilitation (PM&R), loss of board certification through failure to fulfill the MOC program requirements is associated with an increased risk of disciplinary action from a state medical licensing board. Dr. Kinney and Dr. Raddatz are employees of the American Board of Physical Medicine and Rehabilitation. Drs. Sliwa, Driscoll and Robinson are directors of the American Board of Physical Medicine and Rehabilitation. No other disclosures. No funding was received for this study. Corresponding author: Carolyn L. Kinney, MD, American Board of Physical Medicine and Rehabilitation, 3015 Allegro Park Ln SW, Rochester, MN 55902, Phone : 507-282-1776, Ext. 1743, Fax : 507-282-9242, Email : ckinney@abpmr.org No funding was received for this study. Association of participation in the American Board of Physical Medicine and Rehabilitation Maintenance of Certification program and physician disciplinary actions Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Recommendations for Enhancing Sports Medicine Fellowship Training Physical medicine and rehabilitation (PM&R) trained physicians are increasingly interested in caring for patients with musculoskeletal and sports disorders. Sports medicine fellowships are designed to provide competency in sports medicine and musculoskeletal care. The authors, with endorsement from the Association of Academic Physiatrists (AAP), provide a framework and tools that Accreditation Council for Graduate Medical Education (ACGME) accredited sports medicine fellowship programs can use to enhance and meet the ACGME program requirements. Based on the position statement from the American Medical Society for Sports Medicine (AMSSM), we propose recommendations for ACGME accredited sports medicine programs to achieve standards of excellence. We also provide recommendations for research requirements during the course of a sports fellowship. With the proposed recommendations, a sports medicine fellowship program can achieve excellence and enhance fellowship training by increasing proficiency in PM&R-based skills relevant to sports and musculoskeletal medicine. Given the multi-disciplinary nature of musculoskeletal and sports medicine, it is also key that fellowship programs (regardless of the department that they are accredited through) have faculty members that represents these disciplines and accept applicants with residency training in PM&R, internal medicine, family medicine, pediatrics, and emergency medicine. Corresponding Author: Nitin B. Jain, MD, MSPH, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 Children’s Way, Suite 1318, Nashville, TN 37212, United States of America, Phone: (615) 936-8508; Fax: (615) 322-7454, Email: nitin.jain@vumc.org Funding: None Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Sternocleidomastoid Tendinopathy in a Pediatric Athlete: A Case Report To our knowledge, this case report describes the first known case of sternocleidomastoid tendinopathy, occurring in a pediatric athlete who had gone undiagnosed for a period of two years. She presented to our pain clinic with bilateral otalgia, occipital headaches, and occasional bouts of tinnitus and dizziness. An extensive workup by ENT including CT imaging of the head, ear pressure equalization, and an attempt at therapeutic tonsillectomy left her with no diagnosis and no symptom relief. A clinical diagnosis of sternocleidomastoid (SCM) tendinopathy was made at the initial visit based on history and physical exam findings, after excluding other diagnoses. Conservative treatment with physical therapy, acupuncture, and a short course of meloxicam and gabapentin resulted in total symptom resolution. This case is a unique reminder to clinicians that head, neck, and ear pain may precipitate from musculoskeletal origins. It emphasizes the importance of understanding local anatomy, obtaining a thorough history, and performing a detailed physical examination in arriving at an accurate diagnosis. Correspondence: Matthew Delbert, 132 Humphrey Avenue, Bayonne, NJ 07002; Phone Number: 201-618-4137, mcd200@njms.rutgers.edu Author Disclosures: None of the authors involved in the creation of this case report have identified any competing interests. This project was not funded by any organization, and there is no financial incentive for any of the authors. This case was previously presented at the AAPM&R conference in October 2018 in Orlando, Florida, as an MSK case presentation. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Effect of Dextrose Prolotherapy on Pain Intensity, Disability and Plantar Fascia Thickness in Unilateral Plantar Fasciitis: A Randomized, Controlled, Double-Blind Study Objective To evaluate the efficacy of dextrose prolotherapy in the treatment of chronic resistant plantar fasciitis (PF) through comparison with a control group. Design In this double-blind, randomized, controlled study, the patients were divided into two groups. The prolotherapy group (n=30) was administered 5 cc 30% dextrose, 4 cc saline, 1cc 2% lidocaine mixture (15% dextrose solution) and the control group was given 9 cc saline and 1 cc 2% lidocaine mixture twice at a three-week interval. During the fifteen-week follow-up period, pain intensity was measured using the visual analog scale during activity (VAS-A) and at rest (VAS-R). The foot function index (FFI) was used to measure pain and disability. The plantar fascia thickness was measured by ultrasonography. The measurements were undertaken before treatment and at post-treatment weeks 7 and 15. Results Improvements in VAS-A, VAS-R, FFI (all subgroups), and plantar fascia thickness measured at the 7th and 15th weeks were significantly higher in the prolotherapy group compared to the control group (p>0.001). Conclusion Dextrose prolotherapy has efficacy up to 15 weeks and can be used as an alternative method in the treatment of chronic resistant PF. Corresponding Author: Basak Mansiz-Kaplan, University of Health Sciences, Ankara Training and Research Hospital, Department of physical Medicine and Rehabilitation, Ankara, Turkey, E-mail: basakmansiz@hotmail.com, Telephone number: +903125953392, Fax number: +903123633396 Ethics approval and consent to participate: The ethics committee of Ankara Numune Training and Research Hospital reviewed and approved the research protocol (E171615). All participants provided written informed consent prior to data collection. Competing interests: The authors declare that they have no competing interests. Funding: No funding was received. Trial registration: NCT03731897 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Upper Extremity Three-Dimensional Reachable Workspace Analysis Using the Kinect Sensor in Hemiplegic Stroke Patients: A Cross-Sectional Observational Study Objective A reachable workspace evaluation using the Kinect sensor was previously introduced as a novel upper extremity outcome measure in neuromuscular and musculoskeletal conditions. This study investigated its usefulness in hemiplegic stroke patients. Design Forty-one patients with hemiplegic stroke were included. Kinect-based reachable workspace analysis was performed on both paretic and nonparetic sides. Upper extremity impairment was measured using the Fugl-Meyer Assessment and the Motricity Index on the paretic side. Disability was assessed using the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire. Correlations between the relative surface areas, impairment scores, and disability were analyzed. Results Quadrants 1, 3, and 4 as well as the total relative surface area of the paretic side were significantly reduced compared to the non-paretic side. The total relative surface area of the paretic side correlated with the Fugl-Meyer Assessment scores, the Motricity Index for Upper Extremity, and the Disabilities of the Arm, Shoulder, and Hand questionnaire score. Furthermore, quadrant 3 was the most important determinant of upper extremity impairment and disability. Conclusion A reachable workspace (a sensor-based measure that can be obtained relatively quickly and unobtrusively) could be a useful and alternative outcome measure for upper extremity in hemiplegic stroke patients. Correspondence: Jongmin Lee, MD, PhD, Department of Rehabilitation Medicine, Konkuk University Medical Center, 120-1, Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 05030, South Korea. Tel: +82-2-2030-5345, Fax:+82-2-2030-5379, e-mail: leej@kuh.ac.kr Author Disclosure Funding: Not applicable. Conflict of Interest: All authors declare that there are no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

EFFECTS OF DIFFERENT EXERCISE INTENSITIES ON HEADACHE: A SYSTEMATIC REVIEW The benefits of the regular exercise on quality of life of individuals living with a headache are well known. However, whether the benefits of the exercise training on headache parameters (i.e., intensity, frequency and pain duration) occur in an intensity-dependent fashion remains unknown. Objective To investigate the effects of different exercise intensities on headache parameters. Design A systematic review of clinical trials that analyzed the effect of physical exercise on headache, without time or language restriction. The TESTEX scale was used to evaluate the methodological quality of the articles. Results Sixteen (16) articles were included with interventions with aerobic training (AT) and resistance training (RT). Primary results are positive effects of exercise on migraine symptoms, tension-type headache among others, and a decrease in the use of headache-related medications. On the other hand, the studies did not provide information on exercise intensity, especially studies with aerobic exercises. The intensities used for AT was mostly controlled subjectively and the RT ranged from 10 to 80% of 1MR (Maximum Repetition). Conclusion Exercise had a positive influence on the frequency and severity of headache crises, although the studies presented inconclusive data regarding the exercise parameters. Adress correspondence to: Yumie Okuyama da Silva Gauto, Av. Brasil, 1247 AP 402 BL 102. Bairro Universitário – Caruaru/PE. Zip code: 55016-260. Phone number: +55 (81)995068736. Email address: yumie_okuyama@yahoo.com.br Competing interests: none of the authors has any competing interests. Funding source: The research had no specific support. Financial disclosure statement: The authors have no financial relationships to this article to disclosure. Conflict of Interest: Nothing to declare. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Conservative treatment of tendon injuries Tendon injuries or tendinopathy are common painful and disabling conditions resulting from overuse and aging. Tendinopathy remains a challenging clinical problem since response to different treatment modalities is usually unsatisfactory and recovery is slow. We performed an extensive literature review focusing on non-surgical treatment options for tendinopathies, including nonsteroidal anti-inflammatory drugs, corticosteroid, eccentric exercise, extracorporeal shock wave therapy, therapeutic ultrasound, hyaluronic acid, platelet-rich plasma, prolotherapy, polydeoxyribonucleotide and stem cells, aimed at providing the most updated evidence as a guideline for caregivers. Corresponding author: Wen-Shiang Chen, MD, PhD Author Disclosures: No conflicts of interest are reported by the authors or by any individuals in control of the content of this article. The authors received no financial support for the publication of this article. No financial benefits will be received. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Electrophysiological Changes Following Human Muscle Tear: A Potential Confounder The goal of this prospective electrophysiologic study is to describe the chronological electromyographic findings observed in a human gastrocnemius muscle following a traumatic tear. A 30-year-old man sustained a tear of the medial gastrocnemius. Needle electromyography was performed serially at 5, 15, and 26 weeks post-injury, with the contralateral gastrocnemius muscle serving as a control. Audiovisual recordings of the studies were analyzed in a blinded manner. Five weeks post-injury, the affected gastrocnemius displayed increased insertional activity on electromyography. By 15 weeks post-injury, insertional activity had diminished. However, motor unit action potentials showed chronic neurogenic morphological changes not previously observed. These changes persisted 26 weeks post-injury. The study findings reveal a chronological trajectory of increased insertional activity followed by reinnervation changes in a human muscle after local trauma, paralleling a course previously observed in a rat model. Electrodiagnosticians unaware of this phenomenon are at risk for making erroneous interpretations when examining patients with a history of muscle trauma. Corresponding Author: Sandra L Hearn, Burlington Office Center, 325 E. Eisenhower Parkway, Suite 100, Ann Arbor, MI 48108. Phone: 617-233-2578, Fax: 734-764-9439. SLHEARN@MED.UMICH.EDU No funding was received for this research. The authors each declare no competing interests and this work does not provide any financial benefits to the authors. This study involved use of a medical device: a diagnostic electromyograph (Carefusion Nicolet EDX with Viking 4 Software, FDA 510(K) #K112052), used on-label to conduct electromyography and nerve conduction studies on subjects. Part of this research has been presented as a poster at an American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Annual Assembly. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Can Pelvic Floor Muscle Training Versus No Treatment or Inactive Control Treatments Reduce or Cure Urinary Incontinence in Women?: A Cochrane Review Summary with Commentary No abstract available

Effects of elastic resistance exercise after total knee replacement on muscle mass and physical function in elderly women with osteoarthritis: A randomized controlled trial OBJECTIVE Knee osteoarthritis (KOA) and age are associated with high sarcopenia risk, especially in patients who have received total knee replacement (TKR). The purpose of this study was to identify the effects of elastic resistance exercise training (RET) after TKR on muscle mass and physical outcomes in older women with KOA. DESIGN Sixty older women who received unilateral primary TKR surgery were randomized to an experimental group (EG), which received 12 weeks of postoperative elastic RET, or a control group (CG), which received standard care. The outcome measures included physical function performance (i.e., Timed Up & Go [TUG], gait speed [GS], forward reach, single-leg stance, timed chair rise), appendicular lean mass (ALM), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The assessment time points were 2 weeks prior to surgery (T0), 1 month after surgery (T1; before RET), and 4 months after surgery (T2; upon completion of RET). RESULTS After 12 weeks of postoperative elastic RET, the EG exhibited a significantly greater change in ALM (mean difference [MD], 0.81 kg; P = .004) than the CG. Elastic RET also exerted significant effects on TUG and GS with MDs of 0.28 m/s (P < .001) and -2.66 s (P < .001), respectively. CONCLUSION A 12-week elastic RET program after TKR exerted benefits on muscle mass, mobility, and WOMAC functional outcomes in older women with KOA. Address correspondence: Tsan-Hon Liou, MD, PhD, Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan No. 250, Wu-Hsing Street, Taipei, Taiwan. Tel: 886-2-2249-0088 ext. 1600. Fax: 886-2-2248-0577. Email: peter_liou@s.tmu.edu.tw Shih-Wei Huang and Tsan-Hon Liou contributed equally to this study Funding: This study was funded by the Ministry of Science and Technology, Taiwan (grant number MOST 107-2314-B-038-28); Taipei Medical University (grant number IIT-1072-3); and Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, Taiwan (grant number W107HCP-04). The funding sources played no role in the design, implementation, data analysis, interpretation, or reporting of the study. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official view of the funding sources. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.