Papers by Leonid Kalichman
Seminars in Arthritis and Rheumatism, Jun 1, 2011
Objectives: Lateral epicondylitis can be chronic and difficult to manage with conservative measur... more Objectives: Lateral epicondylitis can be chronic and difficult to manage with conservative measures such as physical therapy and corticosteroid injection. We attempted to determine the efficacy of botulinum toxin for the treatment of chronic lateral epicondylitis. Methods: We searched PubMed, MEDLINE, CINAHL, Google Scholar, EMBASE, PEDro, and ISI web of Science databases from inception until November 2009. Studies were included if they used any formulation of botulinum toxin A for treatment of chronic lateral epicondylitis and reported at least 1 pain outcome. One author extracted the relevant data using a standardized data extraction sheet and a second author checked the data. We performed a meta-analysis by computing effect sizes for each study separately for pain and grip strength at 3 months after injection. Impact of bias was assessed independently by 2 authors. Results: The search found 10 studies relevant to the question. Four of these were randomized controlled trials that could be pooled in a meta-analysis. Results showed a moderate effect for pain favoring botulinum toxin (effect size Ϫ0.5, 95% CI Ϫ0.9, Ϫ0.1, I 2 ϭ 56%) at 3 months and a no effect for grip strength. Qualitative analysis of the studies that could not be pooled also showed improvement in pain, but was limited by potential bias. Conclusions: Present literature provides support for use of botulinum toxin A injections into the forearm extensor muscles (60 units) for treatment of chronic treatment-resistant lateral epicondylitis. It is minimally invasive and can be performed in an outpatient setting.
Annals of musculoskeletal medicine, Mar 20, 2017
Background A tension-type headache (TTH) is the most common form of a headache, and what many peo... more Background A tension-type headache (TTH) is the most common form of a headache, and what many people consider as their 'normal' a headache, in contrast with a migraine. Episodic TTH is characterized by a bilateral, pressing, tightening pain of mild to moderate intensity [1]. Chronic TTH is a disorder that evolves from episodic TTH, with daily or very frequent episodes of a headache lasting minutes to days. The 2004 International Headache Society criteria for chronic TTH are: headaches on 15 or more days a month (180 days/year) for at least three months; pain which does not worsen with routine physical activity (such as walking or climbing stairs); presence of no more than one additional clinical feature (mild nausea, photophobia, or phonophobia) and without moderate/severe nausea or vomiting [2]. Among many types of headache disorders, TTH is the most frequent in adults. Population-based studies suggest 1-year prevalence rates of 38.3% for episodic TTH and 2.2% for chronic TTH [3]. To quantify the impact of a headache on daily living, the Henry Ford Hospital has developed in 1994 a 25item headache disability inventory (HDI). The alpha version of
Myofascial component of cancer pain review
Journal of Bodywork and Movement Therapies, Apr 1, 2019
BACKGROUND Pain is a common complaint of cancer patients, experienced by 38%-85% of patients. Som... more BACKGROUND Pain is a common complaint of cancer patients, experienced by 38%-85% of patients. Some studies have shown a high incidence of myofascial pain syndrome (MPS) in cancer patients. AIMS 1) To estimate the prevalence of MPS in cancer patients; 2) to examine the efficacy of current treatment options for MPS in cancer patients. METHODS Narrative review. PubMed, CINAHL, PEDro, and Google Scholar databases were searched from inception until November 2017, for the keywords: cancer; cancer pain; breast cancer; mastectomy; lumpectomy; myofascial pain; trigger points. Trials of any methodological quality were included. All published material with an emphasis on randomized control trials was analyzed. RESULTS MPS is prevalent in cancer patients who suffer from pain, with a prevalence of between 11.9% and 44.8% in those diagnosed either with neck or head or breast cancer. Clinical studies showed conflicting results. Four interventional studies found that specific treatment for MPS may reduce the prevalence of active myofascial trigger points and therefore decrease pain level, sensitivity, and improve range of motion (in shoulder) in cancer patients. Two recent randomized control trials showed that pressure release of trigger points provides no additional beneficial effects to a standard physical therapy program for upper limb pain and function after breast cancer surgery. CONCLUSIONS We recommend including the evaluation of myofascial pain in routine clinical examination of cancer patients suffering from pain. Future studies are needed to investigate the long- and short-term effect of MPS treatments in cancer patients.
International Journal of Environmental Research and Public Health, May 11, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Finger length ratio in Chuvashians
Вестник Московского университета. Серия 23. Антропология, 2014
Journal of Bodywork and Movement Therapies, Oct 1, 2016
Objective: To evaluate the effect of a past ankle sprain (AS) on postural control and fascial cha... more Objective: To evaluate the effect of a past ankle sprain (AS) on postural control and fascial changes in the adjacent body segment. Methods: 20 young, healthy subjects with a history (≥6 months) of significant (Grades 2, 3) lateral ASs and 20 controls with no history of AS were recruited to cross-sectional case-control study. All subjects performed the Star Excursion Balance Test (SEBT). The Stecco method was used to evaluate fascial densification in the calf and upper foot areas. Results: The leg with the AS in the study group vs. the right leg in the control group exhibited significant differences (lower scores of SEBT test in the AS group) for the following directions: anterior (p <0.001), antero-lateral (p <0.001), posterior (P = 0.028), postero-medial (P = 0.001), medial (P = 0.001), antero-medial (p <0.001). A comparison between the leg with an AS in the study group and the right leg in the control group showed a significantly high prevalence of fascial densification for the talus internal rotation (p= 0.014), talus retromotion (p=0.001), talus lateral (p=0.040) and pes external rotation (p=0.060) points. Conclusions: There are long term effects of an AS on postural control and on the sensitivity and movability of the fascia in the calf and foot.
Archives of Medicine, Aug 2, 2019
Revue du Rhumatisme, Jul 1, 2008
Mise au point Déterminants génétiques de la discopathie dégénérative. Prédisposition familiale et... more Mise au point Déterminants génétiques de la discopathie dégénérative. Prédisposition familiale et estimation de l'héritabilité ଝ
Skeletal Radiology, Jul 30, 2019
Objective To estimate the effect of the knee bolster use during an MRI on lumbar spinal stenosis ... more Objective To estimate the effect of the knee bolster use during an MRI on lumbar spinal stenosis parameters and low back painrelated disability. Methods A repeated-measurement study of 27 males and 19 females with mean age 55.78 ± 14.36, referred for an MRI of the lumbar spine due to low back pain, performed with and without standard knee bolster. A radiologist evaluated the lumbar lordosis Cobb's angle, the cross-sectional area of the right and left intervertebral foramina and spinal canal at L1-L2, L2-L3, L3-L4 spinal levels. Spinal symptoms were evaluated by the Oswestry Disability Questionnaire. Results The Cobb angle of lumbar lordosis was found significantly greater on an MRI performed without knee bolster than with bolster (47.30 ± 9.90 vs. 42.57 ± 10.62, p < 0.001). The cross-sectional area of the intervertebral foramina and spinal canal at all evaluated levels was smaller when performed without knee bolster than with bolster. However, differences were significant only at the L1-L2 level and in the spinal canal at all evaluated levels. The Cobb angle, measured with and without knee bolster, showed significant positive correlations with back pain while standing and walking. The spinal canal area without knee bolster showed greater correlations with the Oswestry score parameters than with knee bolster. Conclusions MR images at evaluated spinal levels taken without knee bolster showed greater correlations of the spinal canal cross-sectional area with the Oswestry score than ones with knee bolster. Thus, one may prefer MR images acquired without a bolster below the knee compared to an MRI with a knee bolster.
Asian Spine Journal, Jun 30, 2020
Cross-sectional and follow-up nested study. Purpose: To assess the reliability of the L5-kyphosis... more Cross-sectional and follow-up nested study. Purpose: To assess the reliability of the L5-kyphosis apex line (L5-KAL) evaluation and determine the association between changes in L5-KAL, changes in radiological parameters, and changes in clinical symptoms. Overview of Literature: Scheuermann's disease is the most common cause of hyperkyphosis of the thoracolumbar and thoracic spine during adolescence. Scheuermann's disease patients usually show compensatory hyperlordosis of the lumbar spine, which is usually flexible, and express an anterior translation of the lumbar section. The L5-KAL was developed on the basis of our clinical experience, displaying the horizontal distance between the thoracic and lumbar curves. Methods: In the cross-sectional segment, 150 initial lateral X-rays of patients with Scheuermann's disease and postural kyphosis were analyzed, and 80 additional X-rays were analyzed in the follow-up segment. The data taken from the X-rays of the whole spinal column included the thoracic kyphosis angle, the C7 plumb line, and the L5-KAL. Clinical data included a numerical rating scale of self-perceived body image, pain, and a Scoliosis Research Society-22 questionnaire (SRS-22). Results: Significant positive associations were observed in a cross-sectional study between the L5-KAL and thoracic kyphosis, lumbar lordosis, C7 line, and self-perceived body image. In the follow-up nested study, in a mixed analysis of variance, the main effect of time was significant for the L5-KAL, kyphotic deformity and SRS-22, which indicated a change in these parameters after treatment of Scheuermann's disease patients. Significant positive associations were observed between the changes in L5-KAL and the changes in thoracic kyphosis. Conclusions: Our evidence suggests that the L5-KAL can serve as an indicator of the thoracic curve change in Scheuermann's disease and postural kyphosis patients and should be considered in clinical practice.
Journal of Bodywork and Movement Therapies, Apr 1, 2015
Background: Scheuermann's disease is the most common cause of hyperkyphosis of the thoracolumbar ... more Background: Scheuermann's disease is the most common cause of hyperkyphosis of the thoracolumbar spine. Few case reports have demonstrated the effectiveness of Schroth therapy in improving the thoracic angle curve in Scheuermann's patients; however, additional verification is needed. Case description: A 14-year-old female patient presented with Scheuermann's disease. On X-ray, thoracic kyphosis was 55 and lumbar lordosis 55. The self-rated cosmetic disturbance was graded 10/10 on a verbal numeric scale. The patient received a course of seven weekly Schroth therapy sessions, in addition to daily home exercises tailored specifically for the patient's posture. Five months later, follow-up X-rays revealed thoracic kyphosis of 27 and lumbar lordosis 35. The patient graded the degree of her cosmetic disturbance as 3/10. Conclusions: Schroth therapy seems to be able to decrease the thoracic curve angle of Scheuermann's patients; however, efficacy and effectiveness of this method should be investigated in future prospective controlled clinical trials.
Clinical Rheumatology, Jan 23, 2009
The objective of the study was to review the association between fibromyalgia (FM) and sexual dys... more The objective of the study was to review the association between fibromyalgia (FM) and sexual dysfunction in women and possible mechanisms of such association. PubMed, MEDLINE, and EMBASE databases (1950-2008) were searched for the key words "fibromyalgia", "chronic pain", "sexual dysfunction", "female", "sexuality", "depression", and "quality of life". All relevant articles in English and secondary references were reviewed. All reviewed studies showed that FM is associated with sexual dysfunction in women. The major findings were as follows: decreased sexual desire and arousal, decreased experience of orgasm, and increased pain with intercourse. FM, sexual dysfunction, and depression may be interrelated with the depressive mood responsible for desire and arousal problems. On the other hand, in FM patients, the threshold at which sensory input becomes painful is lower than normal that can explain pain on intercourse. Additional studies are needed to evaluate the casual relationship and mechanism of association between FM and sexual dysfunction in women.
JAMA, Dec 15, 2010
Context-The clinical syndrome of lumbar spinal stenosis (LSS) is a common diagnosis in older adul... more Context-The clinical syndrome of lumbar spinal stenosis (LSS) is a common diagnosis in older adults presenting with lower extremity pain. Objective-To systematically review the accuracy of the clinical examination for the diagnosis of the clinical syndrome of LSS. Data Sources-MEDLINE, EMBASE, and CINAHL searches of articles published from January 1966 to September 2010. Study Selection-Studies were included if they contained adequate data on the accuracy of the history and physical examination for diagnosing the clinical syndrome of LSS, using a reference standard of expert opinion with radiographic or anatomic confirmation.
Journal of women's health physical therapy, Feb 3, 2023
The instrument was administered to a total sample of 249 participants and retested in a sub-sampl... more The instrument was administered to a total sample of 249 participants and retested in a sub-sample of 45 after three months. Cutoffs were defined using the modified Angoff procedure. Construct validity was assessed through association with educational attainment and health-related occupation. Results: Exploratory factor analysis revealed two dimensions of the instrument, one for words and another for non-words. METER showed a high degree of internal consistency, and acceptable test-retest reliability. Adequate health literacy was defined as scoring at least 35/40 in words and 18/30 in nonwords. Physicians scored higher than any other group, followed by health researchers, researchers from other areas and by people with progressively lower levels of education (p < 0.001). Conclusion: We culturally adapted a brief and simple instrument for health literacy assessment, and showed it was valid and reliable. Practice implications: The Portuguese version of METER can be used to assess health literacy in Portuguese adults and to explore associations with health outcomes.
Pm&r, Aug 1, 2014
There has been no proper indication of arm sling for stroke patients. This study was designed to ... more There has been no proper indication of arm sling for stroke patients. This study was designed to determine the proper arm sling for stroke patients according to the motor recovery state by comparing the differences in the effectiveness and satisfaction between Kenny-Howard (KH) type and extension (EXT) type sling. Hemiparetic and hemiplegic stroke patients who were within 3 months from stroke onset were enrolled in this study. We excluded the patients who had a history of shoulder trauma or chronic stroke. We compared KH type sling and EXT type sling in hemiplegic patients group. Also we compared these slings in hemiparetic patients group. The vertical distance (VD), horizontal distance (HD), and joint distance (JD) of the shoulders on the plain AP views were measured initially and 3 weeks after. Twenty four hemiplegic patients and twenty one hemiparetic patients were included in this study. There were no significant differences between the groups on baseline evaluation in hemiplegic group. The results were same in hemiparetic group. After the treatment all patients showed improvement in VD, HD and JD. There were no significant differences of upper limb tone between hemiplegic and hemiparetic patients after 3 weeks. When the treatment effects were compared between the groups in hemiplegic patients changes of VD significant improved in patients wearing KH type sling. There were no significant differences among changes of VD, HD and JD in hemiparetic group when KH or EXT type slings were applied.
American Journal of Physical Medicine & Rehabilitation, Sep 1, 2012
Treger I, Aidinof L, Lehrer H, Kalichman L: Constraint-induced movement therapy alters cerebral b... more Treger I, Aidinof L, Lehrer H, Kalichman L: Constraint-induced movement therapy alters cerebral blood flow in subacute post-stroke patients. Am J Phys Med Rehabil 2012;91:804Y809. We attempted to evaluate patterns of hemispheric activation, according to cerebral blood flow changes, in post-stroke patients during motor tasks with and without arm restriction. Bilateral continuous middle cerebral artery monitoring of 6 healthy subjects (control group) and 28 post-stroke patients by transcranial Doppler sonography was executed while performing three simple motor tasks using the paretic or nondominant (in controls) hand: ball grasping, pegs insertion, and Beating[ with a spoon. The nonaffected or dominant (in controls) arm was free and thereafter restricted. Mean blood flow velocity and flow velocity changes during the tests were estimated. No significant mean blood flow velocity changes were found in the healthy subjects. Significant elevation of mean blood flow velocity in damaged middle cerebral artery was recorded in post-stroke patients after restricting the undamaged hand. This may explain the positive effect of constraint-induced movement therapy on upper limb function.
Journal of Bodywork and Movement Therapies, Apr 1, 2018
Background: Massage is a common treatment in complementary and integrative medicine. Deep tissue ... more Background: Massage is a common treatment in complementary and integrative medicine. Deep tissue massage, a form of therapeutic massage, has become more and more popular in recent years. Hence, the use of massage generally and deep tissue massage specifically, should be evaluated as any other modality of therapy to establish its efficacy and safety. Aim: To determine the definitions used for deep tissue massage in the scientific literature and to review the current scientific evidence for its efficacy and safety. Methods: Narrative review. Results: There is no commonly accepted definition of deep tissue massage in the literature. The definition most frequently used is the intention of the therapist. We suggest separating the definitions of deep massage and deep tissue massage as follows: deep massage should be used to describe the intention of the therapist to treat deep tissue by using any form of massage and deep tissue massage should be used to describe a specific and independent method of massage therapy, utilizing the specific set of principles and techniques as defined by Riggs: "The understanding of the layers of the body, and the ability to work with tissue in these layers to relax, lengthen, and release holding patterns in the most effective and energy efficient way possible within the client's parameters of comfort". Heterogeneity of techniques and protocols used in published studies have made it difficult to draw any clear conclusions. Favorable outcomes may result from deep tissue massage in pain populations and patients with decreased range of motion. In addition, several rare serious adverse events were found related to deep tissue massage, probably as a result of the forceful application of massage therapy. Conclusions: Future research of deep tissue massage should be based on a common definition, classification system and the use of common comparators as controls.
New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine
Journal of Bodywork and Movement Therapies, 2016
Cupping is an ancient technique used in treating pain and various disorders. Different techniques... more Cupping is an ancient technique used in treating pain and various disorders. Different techniques have been developed over time, however, applying a cup to create suction over a painful area, is common to all. Dry or fire cupping, used on the intact skin, leaves bluish circular hematomas. Recently, interest in cupping has re-emerged and subsequently, several studies have begun to investigate the mechanisms of cupping therapy. Mechanically, cupping increases blood circulation, whereas physiologically it activates the immune system and stimulates the mechanosensitive fibers, thus leading to a reduction in pain. There is initial scientific evidence that dry cupping is able to reduce musculoskeletal pain. Since cupping is an inexpensive, noninvasive and low-risk (if performed by a trained practitioner) therapeutic modality, we believe that it should be included in the arsenal of musculoskeletal medicine. It is essential to perform additional studies clarifying the biological mechanism and clinical effects of cupping.
European Spine Journal, Nov 17, 2007
Degenerative spondylolisthesis (DS) is a disorder that causes the slip of one vertebral body over... more Degenerative spondylolisthesis (DS) is a disorder that causes the slip of one vertebral body over the one below due to degenerative changes in the spine. Lumbar DS is a major cause of spinal canal stenosis and is often related to low back and leg pain. We reviewed the symptoms, prognosis and conservative treatments for symptoms associated with DS. PubMed and MEDLINE databases (1950-2007) were searched for the key words ''spondylolisthesis'', ''pseudospondylolisthesis'', ''degenerative spondylolisthesis'', ''spinal stenosis'', ''lumbar spine'', ''antherolisthesis'', ''posterolisthesis'', ''low back pain'', and ''lumbar instability''. All relevant articles in English were reviewed. Pertinent secondary references were also retrieved. The prognosis of patients with DS is favorable, however, those who suffer from neurological symptoms such as intermittent claudication or vesicorectal disorder, will most probably experience neurological deterioration if they are not operated upon. Nonoperative treatment should be the initial course of action in most cases of DS, with or without neurologic symptoms. Treatment options include use of analgesics and NSAIDs to control pain; epidural steroid injections, and physical methods such as bracing and flexion strengthening exercises. An up-to-date knowledge on diagnosis and prevention of lumbar DS can assist in determination of future research goals. Additional studies are required to establish treatment protocols for the conservative treatment of DS.
Uploads
Papers by Leonid Kalichman