The sidelying procedure described in this investigation appears to be a reliable and valid means for quantifying PST when strict measurement protocols are adhered to. An advantage of this procedure lies in the ability to control scapular position to ensure motion is limited to the glenohumeral joint. Moreover, the use of inclinometry provides an absolute angle of tightness that may be used for intersubject comparison, documenting change, and to determine reference values. Clinicians and researchers should consider the MDC values presented when interpreting change values during subsequent measurement sessions.
STUDY DESIGN:Resident's case report BACKGROUND:There have been only a few case reports in the literature mentioning sciatic nerve injury following a hamstring tear. In previous cases surgical intervention was performed to debride scar tissue around the sciatic nerve with the goal of full return to function for the patient. OBJECTIVES:The purpose of this case report is to describe the conservative interventions that allowed for recovery from a hamstring tear with sciatic nerve involvement. CASE DESCRIPTION:The subject was a 53 year old female who developed foot drop and weakness in the common fibular nerve distribution following a grade 3 hamstring injury sustained during Nordic skiing. Nerve function and strength gradually returned over the course of several months of conservative rehabilitation which included on neural gliding and strengthening exercises. OUTCOMES:At 18 months post injury, the subject had returned to 95% of full sport function and 98% of full function with activities of daily living, as rated by the Hip Outcome Scale, and had full strength with manual muscle testing. Isokinetic testing revealed strength deficits of 11-23% in knee flexion peak torque at 60 degrees/second and 180 degrees/second respectively. DISCUSSION:Sciatic nerve injury is a rare, but important potential consequence of severe hamstring strains. Clinicians should be cognizant of the potential injury to the nerve tissue following hamstring strains, so they may be dealt with in a prompt and appropriate manner. The use of neural gliding may be worth considering for a prophylactic effect following hamstring strains.
Frozen shoulder syndrome, clinically known as adhesive capsulitis, is a painful and debilitating condition affecting up to 5% of the population. Adhesive capsulitis is considered fibrosis of the glenohumeral joint capsule with a chronic inflammatory response. Patients experience pain, limited range of motion, and disability generally lasting anywhere from 1 to 24 months. The purpose of this clinical suggestion is to review the pathophysiolgy of adhesive capsulitis and discuss physical therapy interventions which are supported by evidence, thereby enhancing evidence-based practice.
Due to complex movements and high physical demands, dance is often associated with a multitude of impairments including pain of the low back, pelvis, leg, knee, and foot. This case report provides an exercise progression, emphasizing enhancement of strength and neuromuscular performance using the concept of regional interdependence in a 17 year old female dancer with patellofemoral pain syndrome.
BACKGROUND:Sport specific ergometers are important for laboratory testing (i.e. peak oxygen consumption (VO(2))) and out of season training.OBJECTIVES:The purpose of this study was to compare cardiorespiratory variables during exercise on a double poling ergometer to a field test in elite sit skiers.METHODS:Three male and four female athletes from the Canadian National / Developmental team (17-54 years of age, six with complete paraplegia and one with cerebral palsy) completed a field test and a double poling ergometer protocol separated by at least 24 hours. Both protocols consisted of three maximal trials of skiing of three minutes duration separated by 1.5 minutes of rest. A wireless metabolic system and heart rate monitor were used to measure cardiorespiratory responses [peak heart rate, peak VO(2), and peak respiratory exchange ratio (RER)] during each test. Arterialized blood lactate was measured before the beginning of exercise, after each trial and at 5, 10 and 15 minutes post exercise.RESULTS:No significant differences existed between the field and ergometer tests for peak oxygen consumption (VO(2)) (field=34.7±5.5 mL·kg-1·min-1 vs. ergometer=33.4±6.9 mL·kg-1·min-1). Significantly higher peak heart rate and RER were found during the ergometer test. Significantly higher lactates were found during the ergometer test after trial 2 and trial 3.CONCLUSION:The double poling ergometer is similar to a field test for evaluating peak VO(2) in elite cross country sit skiers; however, the ergometer test elicits a higher heart rate and anaerobic response.
Suboptimal breathing patterns and impairments of posture and trunk stability are often associated with musculoskeletal complaints such as low back pain. A therapeutic exercise that promotes optimal posture (diaphragm and lumbar spine position), and neuromuscular control of the deep abdominals, diaphragm, and pelvic floor (lumbar-pelvic stabilization) is desirable for utilization with patients who demonstrate suboptimal respiration and posture. This clinical suggestion presents a therapeutic exercise called the 90/90 bridge with ball and balloon. This exercise was designed to optimize breathing and enhance both posture and stability in order to improve function and/or decrease pain. Research and theory related to the technique are also discussed.
BACKGROUND.: Although rare in occurrence, a dorsal dislocation of the 1st metatarsophalangeal (MTP) joint has been successfully treated using surgical and/or non-operative treatment. No descriptions of conservative intervention following a dorsal dislocation of the MTP joint in an athlete participating in a high contact sport are present in the literature. OBJECTIVES.: The purpose of this case report is to describe the intervention and clinical reasoning during the rehabilitative process of a collegiate football player diagnosed with a 1st MTP joint dorsal dislocation. The plan of care and return to play criteria used for this athlete are presented. CASE DESCRIPTION.: The case involved a 19-year-old male Division IA football player, who suffered a traumatic dorsal dislocation of the 1st MTP joint during practice. The dislocation was initially treated on-site by closed reduction. Non-operative management included immobilization, therapeutic exercises, non-steroidal anti-inflammatories, manual treatment, modalities, prophylactic athletic taping, gait training, and a sport specific progression program for full return to Division IA football. OUTCOMES.: Discharge from physical therapy occurred after six weeks of treatment. At discharge, no significant deviations existed during running, burst, and agility related drills. At a six-month follow-up, the patient reported full return to all football activities including contact drills without restrictions. DISCUSSION.: This case describes an effective six-week rehabilitation intervention for a collegiate football player who sustained a traumatic great toe dorsal dislocation. Further study is suggested to evaluate the intervention strategies and timeframe for return to contact sports.
BACKGROUND:There is no consensus among the existing published evidence as to whether closed kinetic chain (CKC) or open kinetic chain (OKC) exercises should be the intervention of choice following an anterior cruciate ligament (ACL) injury or reconstruction. The commonly held belief has been that OKC exercises cause increased strain on the ACL as well as increased joint laxity and anterior tibial translation.OBJECTIVE:To investigate the effects of OKC and CKC exercises on the knees of patients with ACL deficiency or reconstruction.DATA SOURCES:MEDLINE, ProQuest Medical Library, and CINAHL STUDY SELECTION: Six articles were chosen for inclusion in the systematic review. The authors narrowed 50 articles down to 6 by review of titles and abstracts. Included articles were randomized controlled trials written in English, published during 2000-2008, that evaluated the effects of OKC and CKC exercises on ACL deficient or reconstructed knees.DATA EXTRACTION:Quality of the included studies was defined by the PEDro scale(1), which has been found to be reliable.(2)DATA SYNTHESIS:Scores on the PEDro scale(1) ranged from 4-6/10. One article found positive significant effects with inclusion of OKC exercises in the rehabilitation program and another found significant benefits with combining OKC and CKC exercises. CKC exercises alone were not found by any studies to be superior to OKC exercises.CONCLUSION:These studies reveal favorable results for utilization of both open and closed kinetic chain exercises for intervention with ACL deficient or reconstructed knees. However, further research needs to be completed.
BACKGROUND:Many sports involve movements during which the lower extremity functions as a closed kinetic chain, requiring weight-bearing (WB) range of motion (ROM). Assessment of the capacity for internal and external rotation motion at the hip is typically performed with the individual in a prone, supine, or seated position. Such measurements represent ROM in a non-weight bearing (NWB) position, and, as a result, may not appropriately assess the capacity of the joint to meet the demands of the athlete's sport. To date, no research exists which documents WB hip ROM in golfers relative to the ROM demands of the golf swing or the symmetry of weight-bearing hip rotation ROM in female golfers.OBJECTIVES:Weight-bearing hip rotation ROM was measured in female golfers and compared to the actual hip rotation ROM that occurred during a full golf swing.METHODS:Fifteen right-handed, female collegiate golfers participated in the study. The WB hip rotation ROM was measured during three different stance conditions and during full golf swings using a custom-built testing device. These actions were captured using a 3-D motion analysis system.RESULTS:The golfers WB ROM was symmetrical for external rotation and internal rotation, p = 0.648 and p = 0.078, respectively. During the backswing, the golfers used approximately 20-25% of their available WB right internal rotation, and 50-75% of their available WB left external rotation. For the downswing, the golfers used approximately 34-37% of their available WB right external rotation and 84-131% of their available WB left internal rotation. The golfers used significantly more external and internal hip rotation ROM on the left (lead) hip during both phases of the full golf swing (p < 0.001), demonstrating an asymmetrical movement pattern.DISCUSSION:In general, golfers did not exceed the measured WB ROM limits during the golf swing but did demonstrate decreased WB internal rotation on the lead hip.CONCLUSION:Clinicians need to pay special attention to functional (WB) hip rotation ROM in female golfers in order to assess injury risk related to the rotational hip asymmetry present during the golf swing.
Eccentric exercise has been effectively used in the management of tendinopathies in multiple regions of the body. Lateral epicondylosis ("tennis elbow") is a common tendinopathy that has shown improvement following treatment utilizing isokinetic eccentric exercise. A novel exercise was developed for home-based eccentric exercise that has shown promise for use with patients with lateral epicondylosis. Clinicians should be aware of this exercise and consider it as an evidence-based intervention.
BACKGROUND:Although it is common practice to administer pre-participation examinations (PPE) of athletes prior to training, there are no clearly established formats. Elements integral to the PPE fall within the scope of physical therapist practice, and are often categorized as a form of primary prevention for musculoskeletal disorders as defined in the Guide to Physical Therapist Practice.PURPOSE:The purpose of this study is to describe the design and implementation of a PPE for a women's professional (gridiron) football team. The results and findings from this PPE provide one of the first musculoskeletal profiles and information about selected physical characteristics from members of a female professional football team.METHODS:Players from the Kentucky Karma women's football team, a member of the National Women's Football League (NWFA), volunteered to participate in a PPE. Of twenty-five eligible team members, thirteen consented to participate. The PPE consisted of a health history questionnaire, a musculoskeletal screening, and a series of physical performance and agility tests.RESULTS:The players' average (± SD) age, height, weight, body mass index (BMI), and body fat percentage were 29.6 (± 5.6) yrs., 1.66 (± .05) m, 66.8 (± 12.6) kg, 24.1 (± 3.7), and 27.4 (± 6.6) %, respectively. Commonly reported injuries were similar to those reported in men's collegiate football.CONCLUSION:This is one of the first papers to report on a model PPE for a women's professional football team. Future research is needed to establish a standard PPE, recognize common injuries, and develop prevention strategies unique to women's professional football.
BACKGROUND:Quadriceps activation failure is common in patients with tibiofemoral osteoarthritis (TFOA) and has been reported to occur bilaterally following acute and chronic knee injuries. Sensory transcutaneous electrical stimulation (TENS) applied to the knee has increased ipsilateral quadriceps activation, yet it remains unknown if repeated sensory TENS treatments affect activation in the contralateral quadriceps.OBJECTIVE:To determine the effects of unilateral TENS treatment to the involved leg, in conjunction with 4-weeks of therapeutic exercise, on volitional quadriceps activation in the contralateral leg.METHODS:Thirty-three patients with radiographically diagnosed TFOA were randomly assigned to the TENS, placebo, and the control groups. The involved leg was defined as the knee with highest degree of radiographically assessed TFOA. All participants completed a supervised 4-week lower extremity exercise program for the involved leg only. TENS and placebo TENS were worn throughout the rehabilitation sessions as well as during daily activities for those groups on the involved leg. Quadriceps central activation ratio (CAR), a measure of volitional muscular activation, was assessed in the uninvolved leg at baseline, 2-weeks and 4-weeks following the initiation of the intervention.RESULTS:There were no differences between groups for quadriceps CAR (P=0.3).DISCUSSION:Although significant differences were not found, strong to moderate within group effect sizes were calculated for the TENS group at 2 (d = .87) and 4 weeks (d = .54), suggesting that significant differences may be found in a larger population.CONCLUSIONS:Contralateral quadriceps CAR was not affected following a 4-week unilateral disinhibitory intervention in this sample.
Surfing is enjoyed by many people around the world. A common problem in surfers is back pain during the "take-off," specifically the "pop-up." This article describes each part of the "take-off, and introduces an alternative to the "prone pop up" - called the "knee pop-up." This alternative is a suggested technique to alleviate the stress in the lumbar spine during surfing.
BACKGROUND AND PURPOSE:Limited research suggests that an effect of whole body vibration (WBV) on the central nervous system (CNS) is suppression. An indirect measure used to assess CNS level of activation is the Soleus H-reflex. If true suppression does occur, other factors such as range of motion may be impacted. The purpose of this study was to examine the impact of WBV on H-reflex amplitude and passive ankle dorsiflexion.SUBJECTS AND METHODS:Twenty-seven healthy volunteers between the ages of 21-41 participated. Subjects were randomly assigned to a control group (n=13) or WBV group (n=14). H-reflex and ankle dorsiflexion measures were assessed before and after a three minute WBV perturbation (40 μHz, amplitude 2-4 mm). These measurements were repeated every five minutes up to twenty minutes following the intervention.RESULTS:The H-reflex amplitude showed a significant decrease (p<.05) between pre-test and initial post-test for both groups. The H-reflex returned to baseline within five minutes following the intervention. The dorsiflexion range of motion showed significant interaction (p<.05). All changes were less than 5 degrees; therefore, no clear clinical impact was evident.CONCLUSIONS:The observed decrease in H-reflex amplitude immediately following WBV agreed with previous research indicating a lower level of CNS activation. However, since the control group also showed this change, WBV does not appear to be a key cause of suppression. Range of motion was not clinically significant for either group.
Rehabilitation following lateral side knee ligament repair or reconstruction has traditionally utilized a conservative approach. An article outlining a new concept in rehabilitation following ACL reconstruction called the Knee Symmetry Model was recently published(13). The Knee Symmetry Model can also be applied to rehabilitation of other knee pathologies including a knee dislocation with a lateral side injury.This Clinical Commentary describes the rehabilitation procedures used with patients who underwent surgery to repair lateral side ligaments, based upon the Knee Symmetry Model. These procedures were used previously to rehabilitate a group of patients with lateral side ligament repair as reported by Shelbourne et al(10). Outcome data and subjective knee scores for these patients were recorded via the International Knee Documentation Committee (IKDC) guidelines and modified Noyes survey scores and are summarized in this paper, as previously published. Rehabilitation following lateral side knee ligament repair using guidelines based upon the Knee Symmetry Model appears to provide patients with excellent long-term stability, normal ROM and strength, and a high level of function.
BACKGROUND:Contusions are common injuries that occur in athletics. If repeated, complications like myositis ossificans can occur. This case describes the examination and treatment of an athlete with an acute soft tissue injury.OBJECTIVE:To describe the treatment approach used with a hockey player who sustained a soft tissue injury in his upper extremity.CASE DESCRIPTION:A 19 year old male sustained a soft tissue injury to his upper arm while playing hockey. The athlete complained of pain rated a 2-3 out of 10. He had a well circumscribed, firm, 8 by 5 centimeter palpable mass present along the lateral arm, and was able to passively flex his elbow from 56° to 135°, demonstrating a 56° loss of elbow extension. Functionally, he was able to perform most activities of daily living, but he was unable to play hockey. Over 29 days, the athlete was treated one time with pulsed ultrasound and ice and nine times with iontophoresis using a 2% acetic acid solution. Additionally, the athlete performed pain-free active range of motion exercises for the elbow.OUTCOME:Following treatment, the athlete's pain resolved, the palpable mass disappeared, and his passive range of motion at the elbow was 0° to 135°. Most importantly, the athlete was able to resume playing hockey.DISCUSSION:Acetic acid iontophoresis may be a successful intervention for soft tissue injuries of the upper extremity. In this case, it appeared helpful in decreasing the athlete's impairments and contributed to quicker resumption of all functional activities in less time than previously reported in the literature using traditional treatment interventions.
OBJECTIVE To demonstrate a comparative diagnostic approach between magnetic resonance imaging (MRI) and musculoskeletal ultrasound for detecting UCL trauma of the elbow in a collegiate baseball pitcher. BACKGROUND A 19 year-old male baseball pitcher with no previous history of an elbow injury presented with left medial elbow pain after experiencing a popping sensation during a bull pen throwing session. Patient initially demonstrated palpable tenderness directly over the UCL and a positive milking maneuver. Minimal swelling and no observable discoloration were noted upon examination. Diagnostic ultrasound was utilized to assess the elbow anatomical structures. The differential diagnosis included medial epicondylitis, flexor pronator muscle strain, ulnar collateral ligament tear TREATMENT Initial treatment was conservative while preparing for a ligament reconstruction. Goals included pain control, restoration of range of motion, and reduction of inflammation. UNIQUENESS Accurate diagnosis of UCL disruption was made using dynamic diagnostic musculoskeletal ultrasound despite a negative MRI. The ability to accurately identify the injury contributed to the timeliness of the appropriate surgical intervention and the facilitation of a timely and successful rehabilitation program. CONCLUSIONS Dynamic musculoskeletal ultrasound may offer an effective option for diagnosing UCL tears of the elbow. Diagnostic musculoskeletal ultrasound is an affordable, accessible, and portable option that provides a clinician with real-time information and accurate observations in the hands of a skilled operator. Diagnostic musculoskeletal ultrasound may play an increased role as a diagnostic tool in the sports medicine community.
A number of sporting and daily activities involve rotation of the spine. The ability to quantify motion of the spine in a clinical setting usually relies on the use of a device to measure angles (goniometer or inclinometer) or visual assessment. Standardized measurement criteria exist for measuring rotation at the cervical and lumbar spine. Little has been written regarding established methods for measuring thoracic spine rotation. Thoracic rotation may be measured in a seated position, half-kneeling position, or quadruped position. Steps should be taken to minimize motion of surrounding segments such as the shoulder and hips, which may improve measurement accuracy. Key words: inclinometer, goniometer, range of motion.
The primary goal of a sports rehabilitation program is to return the injured athlete back to competition as quickly and as safely as possible. Sports physical therapists utilize a variety of exercise equipment to help an athlete restore function after an injury. An injured athlete's therapeutic exercise program frequently includes the prescription of functional strengthening and power exercises during the later stages of rehabilitation. One piece of exercise equipment, the kettlebell, has gained popularity for its ability to allow the user to perform functional power exercises. The unique exercises that can be performed with kettlebells may have utility in sports physical therapy practice. This clinical suggestion outlines the clinical rationale for the inclusion of kettlebell exercises when rehabilitating an athlete with a lower extremity injury.
This invited clinical commentary summarizes the current state of knowledge in the area of prevention of anterior cruciate ligament (ACL) injuries. ACL injuries occur with a four to six fold greater incidence in female compared to male athletes playing the same high risk sports. The combination of increased risk of ACL injury and a 10-fold increase in sports participation since the enactment of Title IX in 1972 has led to an almost epidemic rise in ACL injuries in female athletes. Examination of the mechanisms responsible for this sex disparity in ACL rupture accelerated in the last two decades. A summary of these findings and a synthesis and framework for understanding the results of the intense investigation of this research are detailed herein. This clinical commentary focuses on the current understanding, identification and interventional targeting of the primary neuromuscular and biomechanical risk factors associated with the ACL injury mechanism in high-risk individuals.
