bluuebunny/crossref_metadata_2025 huggingface dataset:
The 12-Minute Stationary Cycle Ergometer Test: An Efficacious VO2peak Prediction Test for the Injured
Authors: Vanderburgh Paul M.
Published: August 2016

Previously there existed no efficacious maximal effort, VO2peak prediction test for subjects who, because of injury, can exercise at high intensity only on a device such as a cycle ergometer. This study's purpose was to develop and validate such a test, a 12-Minute Stationary Cycle Ergometer Test (12MSCET), for college-age physically active men and women. For 60 college-age men and women, and a gender-based resistance setting, the total work done on the 12MSCET and body weight were found to be highly predictive of VO2peak, measured via open circuit spirometry. Furthermore, the torques required for such a test are, for this sample, approximately 50% of those required in other predictive protocols. To date, the 12MSCET has been used for VO2peak assessment of over 300 military cadets who, because of injury, found cycling their only efficacious high-intensity aerobic modality.
Entrapment Neuropathy of the Inferior Suprascapular Nerve in a Weight Lifter
Authors: Wilson Rick W.
Published: August 2016

Suprascapular nerve palsy has been frequently reported in athletes, particularly baseball pitchers, volleyball players, and weight lifters, but it is easily overlooked during the evaluation of shoulder pain. Entrapment of the suprascapular nerve is usually suspected only after atrophy is noted. The presence of painless weakness of the external rotator muscles should alert the clinician to the presence of nerve damage, which can be confirmed by electromyography. This case study demonstrates the usefulness of isokinetic testing and magnetic resonance imaging in identifying cystic lesions causing neuropathy among athletes who have failed conservative treatment for shoulder pain.
Interval Throwing Program for Football Quarterbacks
Authors: Konin Jeff , Axe Michael J. , Courson Ron
Published: August 2016

The implementation of interval throwing programs during rehabilitation has been suggested in the literature to allow for a quicker and safer return of the throwing athlete to competition. Many programs have clearly focused on baseball players. This program is specifically designed for the football quarterback. The program encompasses a sound flexibility and strength training regime and provides for a supervised step-by-step progression of throwing. Although the authors have found success with early results, practitioners should apply this program with caution, as it may need to be modified for each athlete. The purpose of this paper is to establish a foundation for future work in the area of the throwing shoulder for the football quarterback.
No Difference Between Doses in Skin Anesthesia After Lidocaine Delivered via Iontophoresis
Authors: Glaviano Neal R. , Selkow Noelle M. , Saliba Ethan , Hertel Jay , Saliba Susan
Published: August 2016

Context:

Iontophoresis is a method of administering medications transcutaneously using galvanic current. Dose is the product of current amplitude and treatment duration. It is assumed that higher doses of iontophoresis are more effective in delivering medication, yet research supporting this claim is insufficient.

Objective:

To compare high-dose lidocaine iontophoresis (80 mA-min), standard-dose lidocaine iontophoresis (40 mA-min), and 2 sham treatments indirectly by measuring skin anesthesia.

Design:

Double-blind crossover study.

Setting:

Research laboratory.

Participants:

15 healthy volunteers (10 women, 5 men: age 24.06 ± 2 y, height 169.7 ± 8.3 cm, weight 72.5 ± 14.2 kg).

Intervention:

Four treatments were counterbalanced and applied on the anterior forearm: 2 true interventions (40 and 80 mA-min) and 2 sham interventions separated by at least 24 h. The true-intervention doses were applied at a current of 2 mA with 2.5 ml 2% lidocaine HCL for 20 and 40 min. The sham treatments were 2.5 ml of lidocaine without galvanic current (intensity = 0 mA, 40 min) and 2.5 ml of saline solution (galvanic current of 2 mA for 40 min).

Main Outcome Measures:

Semmes-Weinstein monofilament scores were taken preintervention and postintervention (at 0, 20, 40, and 60 min) to measure skin anesthesia.

Results:

A significant interaction between treatment and time (F = 4.137, P < .01) was identified. The 40-mA-min dose produced greater anesthesia than the lidocaine and saline shams at all times. The 80-mA-min dose produced greater anesthesia than saline sham at all times. There was a significant difference noted, with 40 mA-min over 80 mA-min, at the 20-min posttest, but there were no other significant differences between the 40- and 80-mA-min doses at 0, 40, or 60 min posttreatment or between the 2 sham treatments at any time.

Conclusions:

The 40-mA-min treatment was just as effective as the 80-mA-min treatment, suggesting that shorter treatments may be more time efficient for clinicians and patients.
Metabolic Energy Expenditure During Spring-Loaded Crutch Ambulation
Authors: Seeley Matthew K. , Sandberg Ryan P. , Chacon Joshua F. , Funk Merrill D. , Nokes Neil , Mack Gary W.
Published: August 2016

Context:

Individuals using traditional axillary crutches to ambulate expend approximately twice as much energy as individuals who perform able-bodied gait. A relatively novel spring-loaded crutch now being marketed may reduce metabolic energy expenditure during crutch ambulation. This idea, however, had not yet been tested.

Objective:

To determine whether the novel spring-loaded crutch reduces oxygen consumption during crutch ambulation, relative to traditional-crutch ambulation. A secondary purpose was to evaluate the design for subject-perceived comfort and ease of use.

Design:

Within-subject.

Setting:

Indoor track.

Participants:

10 able-bodied men and 10 able-bodied women.

Interventions:

The independent variable was crutch design. Each subject ambulated using 3 different crutch designs (traditional, spring-loaded, and modified spring-loaded), in a randomized order.

Main Outcome Measures:

The primary dependent variable was oxygen consumption. Secondary dependent variables were subject-perceived comfort and ease of use, as rated by the subjects using a 100-mm visual analog scale. Dependent variables were compared among the 3 crutch designs using a 1-way repeated-measures ANOVA (α = .05).

Results:

Oxygen consumption during spring-loaded-crutch ambulation (17.88 ± 2.13 mL · kg−1 · min−1) was 6.2% greater (P = .015; effect size [ES] = .50) than during traditional axillary-crutch ambulation (16.84 ± 2.08 mL · kg−1 · min−1). There was no statistically significant difference (P = .068; ES = −.45) for oxygen consumption between spring-loaded-crutch ambulation and ambulation using the modified crutch (17.03 ± 1.61 mL · kg−1 · min−1). Subjects perceived the spring-loaded crutch to be more comfortable (P < .001; ES = .56) than the traditional crutch. There was no difference (P = .159; ES = −.09) between the spring-loaded and traditional crutches for subject-perceived ease of use.

Conclusions:

Compared with traditional axillary crutches, the novel spring-loaded crutch may be more comfortable but does not appear to benefit subjects via reduced metabolic energy expenditure.
Altered Plantar-Receptor Stimulation Impairs Postural Control in Those With Chronic Ankle Instability
Authors: McKeon Patrick O. , Stein Alex J. , Ingersoll Christopher D. , Hertel Jay
Published: August 2016

Context:

Postural control as assessed via time-to-boundary (TTB) measures has been shown to be impaired in those with chronic ankle instability (CAI). Foot orthotics have been shown to improve postural control, although it is not clear if this is via mechanical or sensorimotor mechanisms.

Objective:

To assess the effect of textured shoe inserts that provide no mechanical support on postural control as assessed by TTB measures in subjects with CAI.

Design:

A crossover design to examine the effects of a textured insole on postural control in individuals with unilateral CAI. The independent variables were vision (eyes open, eyes closed) and texture (textured insole, sham insole, control).

Setting:

Laboratory.

Participants:

20 physically active individuals, 12 men, 8 women, age 18–45 y (21.5 ± 5.51) with self-reported CAI.

Intervention:

Each subject balanced in shod single-limb stance with eyes open and eyes closed under 3 conditions (control, sham, and textured insole). The order of testing under the 3 shoe conditions and 2 vision conditions was counterbalanced.

Main Outcome Measures:

The mean of TTB minima and the standard deviation of TTB minima in the mediolateral (ML) and anteroposterior directions.

Results:

There were significant reductions in TTB ML magnitude and variability found in the textured condition compared with the control and sham conditions. In the textured condition, subjects failed significantly more trials than any other condition.

Conclusions:

Stimulating the plantar surface of the foot, via a textured insole, has an effect in the broad spectrum of postural-control maintenance in individuals with CAI.
No Effect of Scapular Position on 3-Dimensional Scapular Motion in the Throwing Shoulder of Healthy Professional Pitchers
Authors: Seitz Amee L. , Reinold Michael , Schneider Robert A. , Gill Thomas J. , Thigpen Charles
Published: August 2016

Context:

Differences in 3-dimensional (3D) scapular motion have been reported between healthy baseball position players and healthy nonoverhead athletic controls, as well as players diagnosed with shoulder impingement syndrome. These alterations are theorized to be the result of adaptations due to the demands of repetitive throwing. However, comparisons between the throwing and nonthrowing shoulders are commonly used to infer normal motion.

Objective:

The purpose of this study was to compare 3D scapular kinematics between the throwing and nonthrowing shoulders in asymptomatic professional male baseball pitchers.

Design:

Cross-sectional study.

Setting:

Laboratory.

Participants:

45 asymptomatic professional baseball pitchers participating without restrictions during preseason training.

Interventions:

An electromagnetic tracking system was used to assess 3D scapular orientation at rest and during weighted (2.3-kg) shoulder flexion across discrete humeral-flexion angles (rest, 30°, 60°, 90°, 120°, and maximum).

Main Outcome Measure:

3D scapular upward/downward rotation (UR/DR), anteroposterior (AP) tilt, and internal/external rotation (IR/ER). Separate mixed-model ANOVAs (Side × Angle) for each scapular motion were used to compare the throwing and the nonthrowing shoulder across all angles.

Results:

There were significant side-to-side differences with scapular UR/DR (P < .001), AP tilt (P < .001), and IR/ER (P < .001). The throwing scapula displayed greater mean UR (increase = 3.6°, SE = 0.50) and anterior/posterior tilt (increase = 2.1°, SE = 0.60) and less mean IR (decrease = 2.1°, SE = 0.66) than the nonthrowing shoulder averaged across all arm angles.

Conclusions:

In asymptomatic professional pitchers, the throwing shoulder’s scapular position differs across all arm angles from that of the nonthrowing shoulder, but the motion does not differ. Scapular asymmetry that is consistent throughout arm elevation may be indicative not of pathology but, potentially, of a normal adaptation of the pitching shoulder.
Lack of Neuromuscular Origins of Adaptation After a Long-Term Stretching Program
Authors: Hayes Bradley T. , Harter Rod A. , Widrick Jeffrey J. , Williams Daniel P. , Hoffman Mark A. , Hicks-Little Charlie A.
Published: August 2016

Context:

Static stretching is commonly used during the treatment and rehabilitation of orthopedic injuries to increase joint range of motion (ROM) and muscle flexibility. Understanding the physiological adaptations that occur in the neuromuscular system as a result of long-term stretching may provide insight into the mechanisms responsible for changes in flexibility.

Objective:

To examine possible neurological origins and adaptations in the Ia-reflex pathway that allow for increases in flexibility in ankle ROM, by evaluating the reduction in the synaptic transmission of Ia afferents to the motoneuron pool.

Design:

Repeated-measures, case-controlled study.

Setting:

Sports medicine research laboratory.

Participants:

40 healthy volunteers with no history of cognitive impairment, neurological impairment, or lower extremity surgery or injury within the previous 12 mo.

Intervention:

Presynaptic and postsynaptic mechanisms were evaluated with a chronic stretching protocol. Twenty subjects stretched 5 times a wk for 6 wk. All subjects were measured at baseline, 3 wk, and 6 wk.

Main Outcome Measures:

Ankle-dorsiflexion ROM, Hmax:Mmax, presynaptic inhibition, and disynaptic reciprocal inhibition.

Results:

Only ROM had a significant interaction between group and time, whereas the other dependent variables did not show significant differences. The experimental group had significantly improved ROM from baseline to 3 wk (mean 6.2 ± 0.9, P < .001), 3 wk to 6 wk (mean 5.0 ± 0.8, P < .001), and baseline to 6 wk (mean 11.2 ±0.9, P < .001).

Conclusions:

Ankle dorsiflexion increased by 42.25% after 6 wk of static stretching, but no significant neurological changes resulted at any point of the study, contrasting current literature. Significant neuromuscular origins of adaptation do not exist in the Ia-reflex-pathway components after a long-term stretching program as currently understood. Thus, any increases in flexibility are the result of other factors, potentially mechanical changes or stretch tolerance.
Effects of Calisthenics and Pilates Exercises on Coordination and Proprioception in Adult Women: A Randomized Controlled Trial
Authors: Kaya Derya Ozer , Duzgun Irem , Baltaci Gul , Karacan Selma , Colakoglu Filiz
Published: August 2016

Objective:

To assess and compare the effects of 6 mo of Pilates and calisthenics on multijoint coordination and proprioception of the lower limbs at the 3rd and 6th mo of training.

Design:

Randomized, controlled, assessor-blinded, repeated-measures.

Setting:

University research laboratory.

Participants and Intervention:

Healthy, sedentary, female participants age 25–50 y were recruited and randomly divided into 3 groups: a calisthenic exercise group (n = 34, mean age ± SD 40 ± 8 y, body-mass index [BMI] 31.04 ± 4.83 kg/m2), a Pilates exercise group (n = 32, mean age ± SD 37 ± 8 y, BMI 31.04 ± 4.83 kg/m2), and a control group (n = 41, mean age ± SD 41 ± 7 y, BMI 27.09 ± 4.77 kg/m2). The calisthenics and Pilates groups underwent related training programs for 6 mo, while the controls had no specific training.

Main Outcome Measures:

Coordination and proprioception of the lower extremities with concentric and eccentric performances in the closed kinetic chain assessed with the monitored rehab functional squat system at baseline and at the 3rd and 6th mo of training.

Results:

For the within-group comparison, coordinative concentric and eccentric deviation values were significantly decreased for both dominant and nondominant lower limbs at pretraining and at the 3rd and 6th mo posttraining in the calisthenics group (P < .05). In contrast, there was no improvement in the Pilates group throughout the training. However, for comparisons between groups, the baseline values of coordinative concentric and eccentric deviations were different in the calisthenics group than in Pilates and the controls (P < .05). There were no differences in the proprioception values of either visible or nonvisible movement in any group throughout the training (P > .05).

Conclusions:

It seems that calisthenic exercises are more likely to improve coordination of the lower extremity after 3 and 6 mo of training than Pilates exercises. Calisthenic exercises may be useful for individuals who require improved coordination.
Ultrasound Assessment of Adductor Muscle Size Using Muscle Thickness of the Thigh
Authors: Ogawa Madoka , Mitsukawa Naotoshi , Bemben Michael G. , Abe Takashi
Published: August 2016

Context:

Previous studies investigated the relationship between ultrasound-derived anatomical muscle thickness (MTH) and individual muscle cross-sectional area (CSA) and muscle volume in several limb and trunk muscles; however, the adductor muscle that contributes to hip adduction and pelvic stabilization, as well as balance ability, has not been studied.

Objective:

To examine the relationship between MTH of the lower, middle, and upper thigh measured by B-mode ultrasound and the muscle CSA and volume of adductor muscle obtained by magnetic resonance imaging (MRI) to confirm the possibility of predicting adductor muscle CSA/volume using ultrasound-derived MTH.

Setting:

University research laboratory.

Subjects:

10 men and 10 women (20–41 y old) volunteered to participate in this study.

Main Outcome Measures:

A series of continuous muscle CSAs along the thigh were measured by MRI scans (1.5-T scanner, GE Signa). In each slice, the anatomical CSA of the adductors was analyzed, and the muscle volume was calculated by multiplying muscle CSA by slice thickness. Thigh MTH was measured by B-mode ultrasound (Aloka SSD-500) at 5 sites (anterior 30%, 50%, and 70% and posterior 50% and 70% of thigh length).

Results:

A strong correlation was observed between anterior 30% MTH and 30% adductor CSA in men (r = .845, P < .002) and women (r = .952, P < .001) and in both groups combined (r = .922, P < .001). Anterior 30% MTH was also strongly correlated to adductor muscle volume when combined with thigh length (n = 20, r = .949, P < .001). However, there were moderate or nonsignificant correlations between anterior and posterior 50% and 70% MTH and adductor muscle CSA/volume.

Conclusions:

The results suggest that MTH in the upper portion of anterior thigh best reflects adductor muscle CSA or muscle volume, while the lower portions of the anterior and posterior sites are least likely to predict adductor muscle size.
Effects of Arthroscopic Partial Meniscectomy on Quadriceps Strength: A Systematic Review
Authors: McLeod Michelle M. , Gribble Phillip , Pfile Kate R. , Pietrosimone Brian G.
Published: August 2016

Context:

Arthroscopic partial meniscectomy (APM) after meniscal tear has been widely accepted and associated with quick return to activity. Unfortunately, meniscectomy is associated with risk for knee osteoarthritis, which may be attributed to postsurgical quadriceps weakness. This has important implications, as the quadriceps play a prominent role in knee stabilization and energy attenuation in the lower extremity.

Objective:

To determine the magnitude of interlimb quadriceps strength deficits in people with unilateral APM by systematically reviewing the current literature.

Evidence Acquisition:

The Web of Knowledge databases were searched on September 22, 2010, using terms meniscus OR meniscectomy AND quadriceps strength OR quadriceps weakness. Included articles were written in English, reporting means and SDs of isokinetic peak torque at 60° and 180°/s for both limbs.

Evidence Synthesis:

Four articles were included in the final analysis. Effect sizes and 95% confidence intervals (CI) were calculated between limbs for periods less than 1 mo, 1–3 mo, 3–6 mo, and more than 6 mo.

Conclusion:

Homogeneous effect sizes indicate quadriceps weakness in the involved limb. Effects were strong at less than 1 mo (d = −1.01 to −1.62), while weak to strong effects were found for 1–3 mo (d = −0.40 to −8.04) and 3–6 mo (d = −0.40 to −5.11). Weak effects were found at more than 6 mo (d = −0.30 to −0.37). Definitive effects with a CI not crossing zero were found in 65% of the data. Although APM patients return to function within weeks after surgery, prolonged quadriceps strength deficits may increase the risk of knee-joint degeneration. Furthermore, evidence of bilateral dysfunction after unilateral injury may suggest that neuromuscular deficits post-APM are greater than the interlimb differences found in this review. Further research should be conducted to determine the nature of strength deficits and the best methods for restoring strength after APM.
Differences in Static- and Dynamic-Balance Task Performance After 4 Weeks of Intrinsic-Foot-Muscle Training: The Short-Foot Exercise Versus the Towel-Curl Exercise
Authors: Lynn Scott K. , Padilla Ricardo A. , Tsang Kavin K.W.
Published: August 2016

Context:

Proper functioning of the intrinsic foot musculature (IFM) is essential in maintaining the integrity of the medial longitudinal arch (MLA). Improper functioning of the IFM leads to excessive pronation of the foot, which has been linked to various pathologies. Therefore, training the IFM to avoid excessive pronation may help prevent some of these pathologies; however, it is not clear how to train these muscles optimally.

Objective:

To investigate the effects of 2 different types of IFM training on the height of the MLA and static- and dynamic-balance task performance.

Design:

Randomized controlled trial, repeated-measures mixed-model design.

Setting:

University biomechanics laboratory for testing and a home-based training program.

Participants:

24 healthy, university-age volunteers (3 groups of 8) with no history of major lower limb pathology or balance impairment.

Interventions:

One experimental group performed 4 wk of the short-foot exercise (SFE) and the other performed 4 wk of the towel-curl exercise (TCE). Participants were asked to perform 100 repetitions of their exercise per day.

Main Outcome Measures:

Navicular height during weight bearing, the total range of movement of the center of pressure (COP) in the mediolateral (ML) direction for a static-balance test and a dynamic-balance test.

Results:

There were no differences in the navicular height or static-balance tests. For the dynamic-balance test, all groups decreased the ML COP movement on the dominant limb by a small amount (~5 mm); however, the SFE group was able to decrease COP movement much more than the TCE group in the nondominant limb.

Conclusions:

The SFE appeared to train the IFM more effectively than the TCE; however, there were differing results between the dominant and nondominant legs. These imbalances need to be taken into consideration by clinicians.
Scapular Kinematics and Subacromial-Impingement Syndrome: A Meta-Analysis
Authors: Timmons Mark K. , Thigpen Chuck A. , Seitz Amee L. , Karduna Andrew R. , Arnold Brent L. , Michener Lori A.
Published: August 2016

Context:

The literature does not present a consistent pattern of altered scapular kinematics in patients with shoulder-impingement syndrome (SIS).

Objectives:

To perform meta-analyses of published comparative studies to determine the consistent differences in scapular kinematics between subjects with SIS and controls. In addition, the purpose was to analyze factors of the data-collection methods to explain the inconsistencies in reported kinematics. The results of this study will help guide future research and enable our understanding of the relationship between scapular kinematics and SIS.

Evidence Acquisition:

A search identified 65 studies; 9 papers met inclusion criteria. Sample sizes, means, and SDs of 5 scapular-kinematic variables were extracted or obtained from each paper’s lead author. Standard difference in the mean between SIS and controls was calculated. Moderator variables were plane of arm elevation, level of arm elevation (ARM) and population (POP).

Evidence Synthesis:

Overall, the SIS group had less scapular upward rotation (UR) and external rotation (ER) and greater clavicular elevation (ELE) and retraction (RET) but no differences in scapular posterior tilt (PT). In the frontal plane, SIS subjects showed greater PT and ER, and in the scapular plane, less UR and ER and greater ELE and RET. There was also greater ELE and RET in the sagittal plane. There was less UR at the low ARM and greater ELE and RET at the high ARM with SIS. Athletes and overhead workers showed less UR, while athletes showed greater PT and workers showed less PT and ER. The general population with SIS had greater ELE and RET only.

Conclusions:

Subjects with SIS demonstrated altered scapular kinematics, and these differences are influenced by the plane, ARM, and POP. Athletes and overhead workers have a different pattern of scapular kinematics than the general population. The scapular plane is most likely to demonstrate altered kinematics. These factors should be considered when designing futures studies to assess the impact of altered kinematics in patients with SIS.
The Effectiveness of Prophylactic Ankle Braces in Reducing the Incidence of Acute Ankle Injuries in Adolescent Athletes: A Critically Appraised Topic
Authors: Farwell Kelley E. , Powden Cameron J. , Powell Meaghan R. , McCarty Cailee W. , Hoch Matthew C.
Published: August 2016

Clinical Scenario:

Ankle injuries constitute a large number of injuries sustained by adolescent athletes participating in high school athletics. Prophylactic ankle bracing may be an effective and efficient method to reduce the incidence of ankle injuries in adolescent athletes in the secondary-school setting.

Clinical Question:

Do prophylactic ankle braces reduce the incidence of acute ankle injuries in adolescent athletes?

Summary of Key Findings:

Two of the three included studies reported that prophylactic ankle braces reduced the incidence of ankle injuries compared with no ankle bracing.

Clinical Bottom Line:

There is moderate evidence to support the use of prophylactic ankle braces in adolescent athletes, particularly those who participate in football and basketball, to reduce the incidence of acute ankle injuries.

Strength of Recommendation:

Grade B evidence exists that prophylactic ankle braces reduce the incidence of acute ankle injuries in adolescent athletes.
Assessment of Subacromial Space and Its Relationship With Scapular Upward Rotation in College Baseball Players
Authors: Thomas Stephen John , Swanik Charles Buz , Kaminski Thomas W. , Higginson Jill S. , Swanik Kathleen A. , Nazarian Levon N.
Published: August 2016

Context:

Subacromial impingement is a common injury in baseball players and has been linked to a reduction in the subacromial space. In addition, it has been suggested that decreases in scapular upward rotation will lead to decreases in the subacromial space and ultimately impingement syndrome.

Objective:

The objective of this study was to evaluate the relationship between acromiohumeral distance and scapular upward rotation in healthy college baseball players.

Design:

Posttest-only study design.

Setting:

Controlled laboratory setting.

Participants:

24 healthy college baseball players.

Intervention:

Participants were measured for all dependent variables at preseason.

Main Outcome Measures:

Acromiohumeral distance at rest and 90° of abduction was measured with a diagnostic ultrasound unit. Scapular upward rotation at rest and 90° of abduction was measured with a digital inclinometer.

Results:

Dominant-arm acromiohumeral distance at rest and 90° of abduction (P = .694, P = .840) was not significantly different than in the nondominant arm. In addition, there was not a significant correlation between acromiohumeral distance and scapular upward rotation at rest and 90° of abduction for either the dominant or the nondominant arm.

Conclusions:

These results indicate that the acromiohumeral distance is not adapting in the dominant arm in healthy throwing athletes. In addition, a relationship was not identified between acromiohumeral distance and scapular upward rotation, which was previously suggested. These results may suggest that changes that are typically seen in an injured population may be occurring due to the injury and are not preexisting. In addition, scapular upward rotation may not be the only contributing factor to acromiohumeral distance.
The Effect of Ice immersion on Joint Position Sense
Authors: LaRiviere Jane , Osternig Louis R.
Published: August 2016

Ice-induced anesthesia is often used to permit pain-free activity. However, icing before a skilled performance may distort the ability to acknowledge sensory stimuli and may thereby mask certain protective mechanisms. Inadequate peripheral feedback regarding position of a limb in space could expose the joint to injury. This study was designed to determine the effect of ice immersion on ankle joint position sense. Three different pretest conditions of no ice immersion, 5 min of ice immersion, and 20 min of ice immersion were administered to 31 subjects prior to joint angle replication testing with an electrogoniometer. Subjects completed eight repositioning trials (four at each of two test angles) following each condition. An analysis of variance (ANOVA) revealed no statistically significant difference between conditions, trials, or angles. The results suggest that joint position receptors in the ankle are resilient to this type of ice treatment, or that the affected receptors (i.e., skin and muscle) were adequately compensated for by other sensors such as joint receptors.
Balance and Proprioceptive Training for Rehabilitation of the Lower Extremity
Authors: Irrgang James J. , Whitney Susan L. , Cox Emily D.
Published: August 2016

Recently there has been emphasis on including balance and proprioceptive training in the rehabilitation of sports-related lower extremity injuries. It is believed that injury to joint and musculotendinous structures results in altered somatosensory information that adversely affects motor control. This may result in increased risk for recurrent injury, decreased performance, or both. Balance and proprioceptive training have been advocated to restore motor control to the lower extremity. This paper will review the current scientific rationale for use of balance and proprioceptive training in the rehabilitation of sports-related lower extremity injuries. Additionally, guidelines for training to improve balance and proprioception will be discussed.
Thoughts for the Future of Athletic Training: The William E. “Pinky” Newell Address
Authors: Donley Phillip B.
Published: August 2016

This is a review of historical considerations for the profession of athletic training and a look at some of our current issues and possible implications for the future of the profession.
Fracture Dislocation of the Ankle in a High School Football Player: A Case Study
Authors: Carroll Michael J.
Published: August 2016

Dislocation with an associated fracture of the ankle is a rare injury. A medial dislocation of the subtalar joint is uncommon, because the normal direction of the subtalar dislocation is lateral. This paper discusses a fracture medial dislocation of the ankle in a high school football player. Initial treatment of the injury included on-the-field management and referral to a hospital and an orthopedic surgeon. Rehabilitation of this injury was very slow and conservative in the initial stage after surgery. This included range of motion exercises for the ankle, full leg conditioning, and ice. After the fracture site was found stable the injury was treated much the same as a Grade II ankle sprain. The goal of rehabilitation was to return the range of motion, strength, and girth measurements of the affected side to those of the contralateral side as quickly as possible, so the athlete could resume athletics. When the affected side met these criteria, there was little to no pain with activity, and the orthopedic physician granted clearance, the athlete was allowed to return to competition.
Biofeedback and Visualization for Peak Performance
Authors: Farmer Kathleen U.
Published: August 2016

Peak performance is trainable through biofeedback, autogenic relaxation or quieting the mind, and visualization while in a theta brain wave state. How to achieve this integration of body, mind, and spirit is described in the following article. Research substantiates that mental practice in a receptive mind activates specific parts of the brain and ultimately enhances performance when the physical movements are acted out. Because most athletes are kinesthetic learners, their “visualizations” need to be complete experiences, encompassing sights, sounds, tastes, smells, and muscular sensations. This article presents techniques that clinicians can learn and pass on to athletes in their care.
Cognitive Strategies and Pain Tolerance in Subjects with Muscle Soreness
Authors: Pen Lorette J. , Fisher Craig , Sforzo Gary A. , McManis Beth G.
Published: August 2016

The effects of cognitive strategies on pain tolerance and performance in subjects with muscle soreness were investigated. Female (n = 18) and male (n =12) subjects were matched for strength and then randomly assigned to dissociation, association, or control groups. Muscle soreness was induced in the quadriceps and hamstrings muscle groups by repeated eccentric contractions against heavy resistance, which resulted in significant decrements in peak torque (PT) and total work (TW). ANOVAs revealed no significant group differences (p < .05) in muscle soreness, state anxiety, and estimated strength and endurance performance 48 hr following the soreness induction. Association strategy subjects increased their quadriceps strength performance following cognitive intervention, whereas strength performance in the dissociation and control groups was not affected. No significant treatment effects were observed for hamstrings strength or quadriceps and hamstrings endurance. Both dissociation and association groups perceived that using the strategies enhanced their performance. This illusory efficacy effect may have implications for performance enhancement, particularly in injury rehabilitation.
Rehabilitation Following Medial Meniscal Transplant: A Case Study
Authors: Keskula Doyglas R. , Duncan Jewell B. , Davis Virginia L.
Published: August 2016

This paper describes the rehabilitation of a patient following a medial meniscus transplant. Both preoperative and postoperative history and relevant physical findings are presented. Rehabilitation goals and the corresponding treatment plan are discussed, with an emphasis on functional outcomes. A general framework for treatment addressing impairment and functional goals is outlined. Progression of the rehabilitation program was based on surgical precautions and the patient's tolerance to the exercise progression. This case study demonstrates that appropriate surgical intervention combined with a properly designed rehabilitation program contributed to the improved functional abilities of this patient.
The Reliability and Validity of Ankle Inversion and Everson Torque Measurements from the Kin Com II Isokinetic Dynamometer
Authors: Kaminski Thomas W. , Perrin David H. , Mattacola Carl G. , Szczerba Joseph E. , Bernier Julie N.
Published: August 2016

This study examined the test-retest reliability of a prototype device used to measure ankle inversion and eversion isokinetic average torque values. The purpose of this paper was to illustrate a situation where common isokinetic measures were reliable but not valid. Concentric and eccentric average torque was assessed at 90 deg/s on the Kin Com II dynamometer using 14 healthy subjects in two sessions; a manufactured prototype ankle inversion/eversion attachment device was used. Reliability was assessed by performing separate intraclass correlations (ICC 2,1) on the results. The data indicated that the average torque calculated from the clockwise direction was consistently higher than those values from the counterclockwise direction, regardless of ankle movement or side measured. The validity of this prototype device to accurately measure average torque for these two ankle motions is questionable. This finding demonstrates a situation where the measures appear to be reliable while the validity of the device used to obtain the measures is suspect.
Clinical Rationale for Closed Kinetic Chain Activities in Functional Testing and Rehabilitation of Ankle Pathologies
Authors: Harter Rod A.
Published: August 2016

Ankle injuries are the most common type of injury in sport worldwide, with ankle sprains accounting for 15% of all injuries. In this paper, the most recent, significant clinical research findings related to closed chain functional testing and rehabilitation of the ankle will be summarized. Biomechanical, physiological, and neurological rationales for integrated utilization of open and closed chain rehabilitation for the ankle will be discussed.
Research and Clinical Applications of Assessing Balance
Authors: Guskiewicz Kevin M. , Perrin David H.
Published: August 2016

Returning athletes to competition following injury often creates a dilemma for athletic trainers and team physicians. Most clinicians gather as much data as possible before deciding whether to return an athlete to competition following injury. The status of the postural control system and balance is important for certain pathologies and therefore should be considered in these clinical decisions. As more high-tech balance systems become available, it is important for clinicians to understand not only what is available but what these devices measure. This paper will review the relationship between the postural control system and the kinetic chain, traditional and contemporary techniques for assessing balance, and ways in which clinicians can bridge the gap between balance research and clinical practice.
Effect of Lateral Ankle Joint Anesthesia on Center of Balance, Postural Sway, and Joint Position Sense
Authors: Hertel Jay N. , Guskiewicz Kevin M. , Kahler David M. , Perrin David H.
Published: August 2016

The purpose of this study was to investigate the effects of induced anesthesia of the lateral ankle joint on proprioception as assessed in weight-bearing and non-weight-bearing conditions. Sixteen subjects were assessed under normal conditions and following an 8-cc injection of lidocaine into the anterior talofibular ligament of the ankle being tested. Center of balance and postural sway measurements were analyzed, revealing a significant lateral adjustment of center of balance during the stable tests compared to a medial adjustment during the dynamic tests under the anesthetized condition. ANOVA of postural sway scores revealed no main effect for condition (anesthesia vs. no anesthesia), but sway scores were higher during the two dynamic conditions as compared to the stable condition. ANOVA of joint position error scores revealed no main effect for condition. Findings suggest that inhibition of the joint receptor afferent fibers adversely affected joint proprioception as assessed while subjects were weight bearing but not while they were non-weight bearing.
Clinical, Functional, and Radiographic Assessment of Arthroscopic Abrasion Chondroplasty of the Knee
Authors: Ra Michael , Sitler Michael , Ryan Jeff , Moyer Raymond , Marchetto Paul , Kelly John , Kimura Iris
Published: August 2016

Chondral lesions often occur in the knee as isolated defects or part of more complex injuries. Articular cartilage defects decrease the ability of the knee to sustain weight-bearing loads and may accelerate degeneration of the joint when left untreated. The purpose of this study was to determine the clinical, functional, and radiographic outcome of arthroscopic abrasion chondroplasty of the knee. The Articular Cartilage Rating System was used to assess the location, size, depth, and description of the articular lesion. The Standard Knee Evaluation Form and Cincinnati Knee Rating Scale were used to assess the clinical, functional, and radiographic outcome of the procedure. Average time to postsurgery follow-up was 46 ± 26.69 months. Within the constraints of the present study, arthroscopic abrasion chondroplasty of the knee had a favorable clinical, functional, and radiographic outcome. However, more study is needed with larger samples and longer follow-up before definitive conclusions about the efficacy of the procedure can be made.
A Review of Topically Applied Dimethyl Sulfoxide
Authors: Cross Kevin M.
Published: August 2016

Dimethyl sulfoxide (DMSO) was introduced to the medical community in the mid-1960s as a powerful anti-inflammatory agent. Clinical studies and subjective claims abounded about its healing effects on a variety of musculoskeletal injuries. Unfortunately, soon after the incorporation of DMSO into rehabilitation routines, the American Medical Association (AMA) denounced many of the studies of DMSO as being unscientific in nature, and the possibility of toxic effects on the optical lens was noted in an experiment using primates as subjects. As a result, the use of DMSOin the medical community was halted. The exact mechanisms by which DMSO affects the healing process are unknown; however, several studies from the 1980s noted specific effects during various phases of the inflammatory process, such as monocyte and fibroblast activity. Presently, DMSO is considered an investigational drag and has not been approved by the Food and Drag Administration for use with musculoskeletal disorders.
Growth Hormone: Myths and Misconceptions
Authors: Wirth Valerie J. , Gieck Joe
Published: August 2016

Growth hormone is one of the many dangerous and illegal ergogenic aids currently used by athletes. In those who suffer from a growth hormone deficiency, supplementation does produce positive results: Muscle volume increases while adipose tissue volume is significantly reduced. Growth hormone supplementation can also lead to strength increases in the deficient population (2, 6, 13) as well as in the elderly population (16, 18, 25). In healthy young men, growth hormone supplementation has been shown to increase fat-free mass and to decrease fat mass. However, these changes are not accompanied by strength gains (5, 7, 23, 24). This finding, coupled with the numerous side effects associated with the drug, presents a strong case for athletes to abandon its use as an ergogenic aid.
The Multiply Injured versus the First-Time-Injured Athlete during Rehabilitation: A Comparison of Nonphysical Characteristics
Authors: Johnson Urban
Published: August 2016

Research on rehabilitation of multiply injured athletes shows no convincing evidence that physiological factors exclusively can explain injury-proneness in sport. Neither can any single psychological factor characterize the injury-prone athlete. Injury-proneness seems to be best explained by a complex web of extrinsic and intrinsic risk factors. The present study focused on a comparison of mental factors and coping strategies of high-level athletes with sport injuries. A psychological profile of 25 multiply injured athletes was compared to 14 first-time seriously injured athletes. Factors such as impulsiveness, risk-taking attitude, introaggression, and psychic anxiety did not differentiate multiply injured athletes from other athletes with injuries. The first-time-injured group, however, had psychological difficulties associated with long-term injuries or other serious life crises. The first-time-injured athletes tended to experience the rehabilitation period as stressful, and they showed less self-confidence and scored lower on an overall mood scale than the multiply injured athletes.
The Role of Ankle Strength in Functional Ankle Instability
Authors: McKnight Cynthia M. , Armstrong Charles W.
Published: August 2016

The purpose of this study was to determine if there were any differences in ankle range of motion, strength, or work between persons with normal ankles (Normal,n= 14), those with functional ankle instability (FAI,n= 15), and those with a history of FAI who have been through formal proprioceptive rehabilitation (Rehab,n= 14). A second puipose was to determine normative values for ankle strength and work measurements using the Biodex® isokinetic system. There were no significant differences between groups for ankle range of motion or for any strength or work measurements. The overall strength/work averages were 11.75/3.42 for plantar flexion, 339/1.48 for dorsiflexion, 3.30/2.40 for inversion, and 2.62/1.79 for eversion. Dorsiflexion torque overall was 31.43% of plantar flexion, and the evertors produced 75.42% of the torque produced by the invertors. It is recommended that clinicians continue to rehabilitate ankles with strength and proprioceptive exercises but do not rely on ankle strength/work testing as the only criteria for determining an athlete's readiness to return to full activity.
Prevention of ACL Injuries
Authors: Ryder Steven H. , Johnson Robert J. , Beynnon Bruce D. , Ettlinger Carl F.
Published: August 2016

Athletes are particularly at risk for anterior cruciate ligament injury, and there is some evidence that female athletes are more at risk than males. The conflicting principles of stability and mobility are at odds within the knee, setting the stage for potentially serious injuries. Some investigators suggest that the size of the intercondylar notch should be used to identify athletes at risk for ACL damage, but more research is required before clinical decisions can be based on notch width measurements. Athletic shoe modifications and artificial playing surfaces may influence the incidence of ACL injures. Functional knee braces appear to have beneficial strain shielding effect on the ACL for anterior directed loads and internal–external torques applied to the tibia, but this effect appears to decrease as the magnitude of these anterior directed loads and torques increases. Ski equipment is often pointed to as a contributing factor in ACL injuries, but there is no evidence that modifications in ski equipment will decrease ACL disruptions. An education program based on recognizing the events that lead to ACL injury in skiing may reduce knee injuries in the future.
ACL Injuries in the Female Athlete
Authors: Ireland Mary Lloyd , Gaudette Michael , Crook Scott
Published: August 2016

The high rate of noncontact ACL injuries in female athletes has become a prominent and controversial subject. This article attempts to provide insight into this trend in athletic injuries. Anatomic, physiological, and biomechanical differences are discussed as possible causative factors. Epidemiological data regarding ACL injuries are reviewed, comparing the genders. The discussion also includes anecdotal findings that support current research. This review is intended to raise awareness of the problem and promote screening for risk factors and implementation of more thorough and aggressive preventive programs.
Loss of Motion Following ACL Reconstruction: A Second Look
Authors: Irrgang James J. , Harner Christopher D. , Fu Freddie H. , Silbey Mark B. , DiGiacomo Robbie
Published: August 2016

The purpose of this study was to determine the effects of preoperative, intraoperative, and postoperative intervention on the incidence of loss of motion (LOM) following ACL reconstruction. A retrospective review of patients undergoing ACL reconstruction between 1990 and 1991 was conducted to identify those with LOM. Factors potentially related to loss of motion were recorded. The results were compared to the findings of a similar group of patients who underwent ACL reconstruction between 1987 and 1989. In 1990 to 1991, less concomitant ligament surgery was performed, the incidence of loss of extension was significantly reduced, and the incidence of loss of flexion was significantly increased. It appears the risk for loss of extension can be minimized by delaying surgery following acute injury, performing less concomitant ligament surgery, paying meticulous attention to notchplasty and anatomic placement of the graft, and placing early emphasis on restoration of full extension following surgery.
A Practical Guide to Electrical Therapy
Authors: Holcomb William R.
Published: August 2016

Electrical therapy is a popular therapeutic modality for the management and rehabilitation of athletic injuries. Electrical stimulation is commonly used to elicit muscle contraction, reduce edema, and control pain. However, electrical therapy can also be a tremendous challenge for clinicians. The purpose of this paper is to present current and accurate information that will serve as a guide In the use of electrical therapy for the effective management of athletic injuries. With an understanding of the basic current types provided by various electrical stimulators and the modifications of the currents that are available, electrical therapy becomes an invaluable tool for injury management and rehabilitation.