bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Fatigue on Neuromuscular Function at the Ankle
Authors: Gutierrez Gregory M. , Jackson Nicole D. , Dorr Kristin A. , Margiotta Sarah E. , Kaminski Thomas W.
Published: August 2016

Context:

Lateral ankle sprains occur more frequently than any other orthopedic injury. Athletes often report sustaining more injuries late in competition when fatigue is present.

Objective:

To evaluate neuromuscular function of the ankle musculature after fatigue. Design: Experimental, pretest-posttest.

Setting:

Research laboratory.

Participants:

Ten female and 9 male college-aged subjects.

Intervention:

Fatigue was induced via continuous concentric and eccentric muscle actions of the ankle: inversion (INV), eversion (EV), plantar flexion (PF), and dorsiflexion (DF).

Main Outcome Measures:

Peak torque (PT), peak EMG, and median frequency (MF) were calculated prefatigue and postfatigue in the tibialis anterior (TA), peroneus longus (PER), and lateral gastrocnemius (GAS) muscles.

Results:

Main effects were noted for test (P < 0.0125) in all statistical tests performed indicating changes in PT, peak EMG, and MF after fatigue.

Conclusions:

A significant decrease in MF of the PER muscle after PF fatigue and corresponding with a decreased firing rate, may be of importance, especially with regard to the role in countering the violent moment seen with inversion ankle sprains.
Analyses of Isokinetic and Closed Chain Movements for Hamstring Reciprocal Coactivation
Authors: Miller John P. , Croce Ronald V.
Published: August 2016

Context:

Researchers have postulated that coactivation of the hamstrings during active knee extension assists the anterior cruciate ligament in maintaining knee joint stability by exerting an opposing force to anterior tibial translation.

Objective:

To compare the reciprocal coactivation of the hamstrings while performing low and high velocity isokinetic movements and two closed chain movements.

Design:

Within subject’s comparison of isokinetic and closed chain exercises.

Setting:

Biomechanics laboratory utilizing a Cybex norm isokinetic dynamometer and Biopac Data Collection system.

Participants:

12 healthy women.

Main Outcome Measures:

The root mean square of the Electromyogram (rmsEMG) was used as a measure of overall muscle activity.

Results:

The rmsEMG for hamstring coactivation during knee extension showed significant differences between the isokinetic movements and the closed chain exercises with greater coactivation when performing the isokinetic movements. In addition, greater activity was seen at the higher isokinetic velocity and during the one legged squat.

Conclusions:

These results suggest isokinetic movements, particularly at high speed, can more effectively increase the coactivation activity of the hamstrings when compared to two closed chain activities.
The Effect of Textured Insoles on Postural Control in Double and Single Limb Stance
Authors: Corbin Dawn M. , Hart Joseph M. , McKeon Patrick O. , Ingersoll Christopher D. , Hertel Jay
Published: August 2016

Context:

Increased plantar cutaneous afferent information may improve postural control.

Objective:

To compare postural control measures between balance conditions with and without textured insoles.

Design:

crossover trial.

Setting:

Research Laboratory.

Patients or Other Participants:

33 healthy subjects (27.4 ± 9.1yrs, 172.6 ± 10.3 cm, 75.4 ± 16.4 kg).

Intervention(s):

Subjects performed 24, 10-second bipedal and unilateral stance balance trials with eyes opened and eyes closed, with and without a textured insole in subjects’ shoes.

Main Outcome Measures:

Average velocity and area of center of pressure (COP) excursions.

Results:

We observed an interaction among balance conditions during bilateral stance, but not during unilateral stance. On average, subjects exhibited greater area and velocity of COP excursions with eyes closed compared to eyes opened. Significant differences in area and velocity of COP excursions were observed during bilateral stance only when subjects were not wearing textured insoles. There were no significant differences while subjects balanced in bilateral stance with textured insoles.

Conclusions:

Increased afferent information from textured insoles improves postural control in bilateral stance.
Hip Abductor Weakness and Lower Extremity Kinematics during Running
Authors: Heinert Becky L. , Kernozek Thomas W. , Greany John F. , Fater Dennis C.
Published: August 2016

Objective:

To determine if females with hip abductor weakness are more likely to demonstrate greater knee abduction during the stance phase of running than a strong hip abductor group.

Study Design:

Observational prospective study design.

Setting:

University biomechanics laboratory.

Participants:

15 females with weak hip abductors and 15 females with strong hip abductors.

Main Outcome Measures:

Group differences in lower extremity kinematics were analyzed using repeated measures ANOVA with one between factor of group and one within factor of position with a significance value of P < .05.

Results:

The subjects with weak hip abductors demonstrated greater knee abduction during the stance phase of treadmill running than the strong group (P < .05). No other significant differences were found in the sagittal or frontal plane measurements of the hip, knee, or pelvis.

Conclusions:

Hip abductor weakness may influence knee abduction during the stance phase of running.
Compensatory Mechanisms in Basketball Players with Jumper’s Knee
Authors: Siegmund Julie A. , Huxel Kellie C. , Swanik C. Buz
Published: August 2016

Context:

Determining whether there are compensations in those with jumper’s knee (JK) might further our understanding of the condition.

Objective:

Comparing lower extremity kinematics and jump performance of basketball athletes with JK with those of healthy controls (C).

Design:

Repeated-measures control-match design.

Setting:

University laboratory.

Participants:

24 male basketball players (12 JK, 12 C) matched by height, weight, position, experience, and frequency of play.

Interventions:

Standing countermovement and running layup jumps.

Main Outcome Measures:

Maximum vertical-jump height, footfall landing, and lower extremity sagittal-plane kinematics.

Results:

There were no significant group differences (P > .05) in vertical-jump height (JK = 64.3 ± 8.6 cm, C = 63.0 ± 9.8 cm) or layup height (JK = 71.3 ± 11.6 cm, C = 73.3 ± 11.0 cm). JK subjects landed flat footed (50%) more than controls (8%). JK subjects showed significantly more hip flexion (JK = 105° ± 24.8°, C = 89.8° ± 14.1°; P = .039) with decreased hip acceleration during the countermovement (JK = −3039 ± 1392°/s2, C = −4229 ± 1765°/s2; P = .040). When landing from the countermovement jump, JK subjects had significantly less knee acceleration (JK = −4960 ± 1512°/s2, C = −6736 ± 2009°/s2; P = 023) and in the layup showed significantly less ankle dorsiflexion (JK = 106.5° ± 9.0°, C = 112.5° ± 7.7°; P = .048) and hip acceleration (JK = − 2841 ± 1094°/s2, C = −3912 ± 1575°/s2; P = .033).

Conclusion:

Compensatory strategies observed in JK subjects might help maintain performance, because their jump height was similar to that of healthy controls.
Acute-Exercise-Induced Alterations in Calpain and Calpastatin Expression in Rat Muscle
Authors: Wang Lijing , Duan Ligong , Li Xukun , Li Guoping
Published: August 2016

Context:

Calpains and calpastatin can degrade muscle proteins, but no research has investigated the expression pattern of calpains and calpastatin after exhaustive exercise.

Objective:

To investigate the alterations in expression of μ-, m-, and n-calpain and calpastatin after exhaustive exercise and its association with muscle injury.

Method:

64 rats divided into 2 groups, a nonexercise control group and an acute-exhaustive-exercise (AEE) group. Biopsies in the AEE group were taken at different times after exercise.

Results:

Calpastatin protein expression and m-calpain activity increased early after exercise, but both n-calpain protein expression and μ-calpain activity generally decreased with time. n-Calpain mRNA expression was down- regulated from late after exercise.

Conclusions:

The increased m-calpain activity might promote muscle-protein degradation and muscle injury. On the contrary, calpastatin might execute a protective function against muscle injury. The change in p-calpain activity was found earlier than muscle injury and therefore might serve as a useful predictor of muscle injury.
Changes in Active Ankle Dorsiflexion Range of Motion after Acute Inversion Ankle Sprain
Authors: Youdas James W. , McLean Timothy J. , Krause David A. , Hollman John H.
Published: August 2016

Context:

Posterior calf stretching is believed to improve active ankle dorsiflexion range of motion (AADFROM) after acute ankle-inversion sprain.

Objective:

To describe AADFROM at baseline (postinjury) and at 2-wk time periods for 6 wk after acute inversion sprain.

Design:

Randomized trial.

Setting:

Sports clinic.

Participants:

11 men and 11 women (age range 11–54 y) with acute inversion sprain.

Intervention:

Standardized home exercise program for acute inversion sprain.

Main Outcome Measure:

AADFROM with the knee extended.

Results:

Time main effect on AADFROM was significant (F3,57 = 108, P < .001). At baseline, mean active sagittal-plane motion of the ankle was 6° of plantar flexion, whereas at 2, 4, and 6 wk AADFROM was 7°, 11°, and 11°, respectively.

Conclusions:

AADFROM increased significantly from baseline to week 2 and from week 2 to week 4. Normal AADFROM was restored within 4 wk after acute inversion sprain.
Acute Effects of Scapular Mobilization in Shoulder Dysfunction: A Double-Blind Randomized Placebo-Controlled Trial
Authors: Surenkok Ozgur , Aytar Aydan , Baltaci Gul
Published: August 2016

Objective:

The aim of this study was to evaluate the initial effects of scapular mobilization (SM) on shoulder range of motion (ROM), scapular upward rotation, pain, and function.

Design:

Pretest–posttest for 3 groups (SM, sham, and control).

Setting:

A double-blinded, randomized, placebo-controlled trial was conducted to evaluate the initial effect of the SM at a sports physiotherapy clinic.

Participants:

39 subjects (22 women, 17 men; mean age 54.30 ± 14.16 y, age range 20-77 y).

Interventions:

A visual analog scale, ROM, scapular upward rotation, and function were assessed before and just after SM. SM (n = 13) consisted of the application of superoinferior gliding, rotations, and distraction to the scapula. The sham (n = 13) condition replicated the treatment condition except for the hand positioning. The control group (n = 13) did not undergo any physiotherapy and rehabilitation program.

Main Outcome Measures:

Pain severity was assessed with a visual analog scale. Scapular upward rotation was measured with a baseline digital inclinometer. Constant Shoulder Score (CSS) was used to measure shoulder function.

Results:

After SM, we found significant improvements for shoulder ROM, scapular upward rotation, and CSS between pretreatment and posttreatment compared with the sham and control groups. In the sham group, shoulder-ROM values increased or decreased for the shoulder and scapular upward rotation was not changed. Pain, ROM, and physical function of the shoulder were not significantly different in the sham group than in controls (P > .05).

Conclusions:

SM may be a useful manual therapy technique to apply to participants with a painful limitation of the shoulder. SM increases ROM and decreases pain intensity.
Effect of Stretching on Ankle and Knee Angles and Gastrocnemius Activity during the Stance Phase of Gait
Authors: Johanson Marie A. , Cuda Brian J. , Koontz Jonathan E. , Stell Julia C. , Abelew Thomas A.
Published: August 2016

Context:

Stretching exercises are commonly prescribed for patients and healthy individuals with limited extensibility of the gastrocnemius muscle.

Objective:

To determine effects of gastrocnemius stretching on ankle dorsiflexion, knee extension, and gastrocnemius muscle activity during gait.

Design:

Randomized-control trial.

Setting:

Biomechanical laboratory.

Participants:

Sixteen volunteers (9 men and 7 women, mean age = 27 y) with less than 5° of passive ankle-dorsiflexion range of motion randomly assigned to an experimental or control group.

Intervention:

The experimental group performed gastrocnemius stretching for 3 wk.

Main Outcome Measures:

Maximum ankle dorsiflexion, maximum knee extension, and EMG amplitude of the gastrocnemius muscles were measured between heel strike and heel-off before and after intervention.

Results:

No significant effect of group or time was found on maximum ankle dorsiflexion, maximum knee extension, or EMG activity of the medial or lateral gastrocnemius muscles between heel strike and heel-off. The experimental group had significantly greater passive ankle-dorsiflexion range of motion bilaterally at posttest than the control group.

Conclusions:

Stretching did not alter joint angles or gastrocnemius muscle activity in the early to midstance phase of gait.
Isometric Hip-Rotator Torque Production at Varying Degrees of Hip Flexion
Authors: Johnson Sam , Hoffman Mark
Published: August 2016

Context:

Hip torque production is associated with certain knee injuries. The hip rotators change function depending on hip angle.

Objective:

To compare hip-rotator torque production between 3 angles of hip flexion, limbs, and sexes.

Design:

Descriptive.

Setting:

University sports medicine research laboratory.

Participants:

15 men and 15 women, 19-39 y.

Intervention:

Three 6-s maximal isometric contractions of the hip external and internal rotators at 10°, 40°, and 90° of hip flexion on both legs.

Main Outcome Measure:

Average torque normalized to body mass.

Results:

Internal-rotation torque was greatest at 90° of hip flexion, followed by 40° of hip flexion and finally 10° of hip flexion. External-rotation torque was not different based on hip flexion. The nondominant leg’s external rotators were stronger than the dominant leg’s, but the reverse was true for internal rotators. Finally, the men had more overall rotator torque.

Conclusions:

Hip-rotation torque production varies between flexion angle, leg, and sex. Clinicians treating lower extremity problems need to be aware of these differences.
Functional Isokinetic Strength Ratios in Baseball Players With Injured Elbows
Authors: Lin Yin-Chou , Thompson Angela , Kung Jung-Tang , Chieh Liang-Wei , Chou Shih-Wei , Lin Jung-Charng
Published: August 2016

Context:

Elbow injuries are widely reported among baseball players. The elbow is susceptible to injury when elbow-flexor and -extensor forces are imbalanced during pitching or throwing. Assessment of muscle-strength ratios may prove useful for diagnosing elbow injury.

Objective:

The purpose of this study was to assess the relationship between the elbow-flexor and -extensor functional isokinetic ratios and elbow injury in baseball players.

Design:

Retrospective study.

Setting:

Biomechanics laboratory.

Participants:

College baseball players with (n = 9) and without (n = 12) self-reported elbow pain or loss of strength were recruited.

Intervention and Main Outcome Measures:

Trials were conducted using a dynamometer to assess dominant-arm flexor and extensor concentric and eccentric strength at angular velocities of 60° and 240°/s. Functional isokinetic ratios were calculated and compared between groups.

Results:

Regression analysis revealed that a ratio of biceps concentric to triceps concentric strength greater than 0.76 (the median value) significantly predicted elbow injury (P = .01, odds ratio of injury = 24). No other ratios or variables (including position played) were predictive of injury status.

Conclusions:

These findings suggest that the ratio of biceps concentric to triceps concentric functional strength strongly predicts elbow-injury status in baseball players. Assessment of this ratio may prove useful in a practical setting for training purposes and both injury diagnosis and rehabilitation.
The Relationship Between Wearing Incorrectly Sized Shoes and Foot Dimensions, Foot Pain, and Diabetes
Authors: de Castro Alessandra Paiva , Rebelatto José Rubens , Aurichio Thaís Rabiatti
Published: August 2016

Context:

Wearing inappropriate shoes can cause biomechanical imbalance, foot problems, and pain and induce falls.

Objective:

To verify the prevalence of wearing incorrectly sized shoes and the relationship between incorrectly sized shoes and foot dimensions, pain, and diabetes among older adults.

Design:

A cross-sectional study.

Participants:

399 older adults (227 women and 172 men) age 60 to 90 y.

Main Outcome Measures:

The participants were asked about the presence of diabetes, pain in the lower limbs and back, and pain when wearing shoes. Foot evaluations comprised the variables of width, perimeter, height, length, first metatarsophalangeal angle, the Arch Index, and the Foot Posture Index. The data analysis was performed using a 2-sample t test and chi-square test.

Results:

The percentage of the participants wearing shoe sizes bigger than their foot length was 48.5% for the women and 69.2% for the men. Only 1 man was wearing a shoe size smaller than his foot length. The older adults wearing the incorrect shoe size presented larger values for foot width, perimeter, and height than those wearing the correct size, but there were no significant differences between the groups with respect to the Arch Index and the Foot Posture Index. Incorrectly sized shoes were associated with ankle pain in women but not with diabetes. Men were more likely to wear incorrectly fitting shoes. The use of correctly sized shoes was associated with back pain in women.

Conclusions:

The use of incorrectly sized shoes was highly prevalent in the population studied and was associated with larger values for foot width, perimeter, and height and with ankle pain.
Effects of Saddle Height, Pedaling Cadence, and Workload on Joint Kinetics and Kinematics During Cycling
Authors: Bini Rodrigo R. , Tamborindeguy Aline C. , Mota Carlos B.
Published: August 2016

Context:

It is not clear how noncyclists control joint power and kinematics in different mechanical setups (saddle height, workload, and pedaling cadence). Joint mechanical work contribution and kinematics analysis could improve our comprehension of the coordinative pattern of noncyclists and provide evidence for bicycle setup to prevent injury.

Objective:

To compare joint mechanical work distribution and kinematics at different saddle heights, workloads, and pedaling cadences.

Design:

Quantitative experimental research based on repeated measures.

Setting:

Research laboratory.

patients:

9 healthy male participants 22 to 36 years old without competitive cycling experience.

Intervention:

Cycling on an ergometer in the following setups: 3 saddle heights (reference, 100% of trochanteric height; high, + 3 cm; and low, − 3 cm), 2 pedaling cadences (40 and 70 rpm), and 3 workloads (0, 5, and 10 N of braking force).

Main Outcome Measures:

Joint kinematics, joint mechanical work, and mechanical work contribution of the joints.

Results:

There was an increased contribution of the ankle joint (P = .04) to the total mechanical work with increasing saddle height (from low to high) and pedaling cadence (from 40 to 70 rpm, P < .01). Knee work contribution increased when saddle height was changed from high to low (P < .01). Ankle-, knee-, and hip-joint kinematics were affected by saddle height changes (P < .01).

Conclusions:

At the high saddle position it could be inferred that the ankle joint compensated for the reduced knee-joint work contribution, which was probably effective for minimizing soft-tissue damage in the knee joint (eg, anterior cruciate ligament and patellofemoral cartilage). The increase in ankle work contribution and changes in joint kinematics associated with changes in pedaling cadence have been suggested to indicate poor pedaling-movement skill.
Progression of Secondary Injury After Musculoskeletal Trauma—A Window of Opportunity?
Authors: Merrick Mark A. , McBrier Nicole M.
Published: August 2016

Context:

Acute musculoskeletal-injury management largely focuses on inhibiting secondary injury, although the data describing secondary injury and the timeline for its progression are sparse.

Objective:

To describe the timeline and early progression of secondary injury in skeletal muscle over the first 5 h after blunt trauma.

Design:

A controlled laboratory study with 2 independent variables (injury status and postinjury time point) in a 2 × 21 factorial.

Setting:

University research laboratory.

Subjects:

168 male Sprague Dawley rats (250 to 275 g).

Interventions:

Uniform blunt-contusion injury was caused to the right triceps surae using a drop-weight method; the contralateral limb served as an uninjured control. Both triceps surae were excised and flash frozen at 21 intervals across 5 h postinjury (8 animals, each 15 min).

Main Outcome Measures:

Cytochrome-c oxidase activity via reduction of triphenyltetrazolium chloride (TTC) to triphenyl-formazan.

Results:

There was an interaction effect (P = .041) between and main effects for both injury status (P < .0005) and postinjury time point (P = .038). In the first 30 min after injury, uninjured tissues did not differ from injured tissues, and both displayed TTC reduction rates in the vicinity of 7.1 ± 0.94 μg · mg−1 · h−1. Statistical differences between uninjured and injured tissues became evident starting at 30 min. TTC reduction for uninjured tissues did not change, but injured tissues declined in a roughly linear fashion across the entire 5-h period to 4.8 ± 1.04 μg · mg−1 · h−1.

Conclusions:

Cytochrome-c oxidase activity, an indicator of oxidative phosphorylation and mitochondrial viability, is diminished by events that follow muscle trauma. Loss of this enzymatic activity becomes statistically evident at 30 min postinjury and continues linearly for at least 5 h. This suggests that secondary injury is a slowly developing problem of more than 5 h duration. A window of opportunity for intervention may lie somewhere within the first 30 min after injury.
Rehabilitation of a Lateral Ankle Sprain with Cryokinetics and Functional Progressive Exercise
Authors: Pincivero Danny , Gieck Joe H. , Saliba Ethan N.
Published: August 2016

A treatment and rehabilitation protocol was implemented on a university football player sustaining a second-degree lateral ankle sprain. The initial treatment plan involved the application of the RICE principle (rest, ice, compression, and elevation). This particular rehabilitation protocol was aimed at restoring range of motion and function at the earliest possible time with the use of a cryokinetic technique developed by Knight and with progressive exercise. The subject in this case study returned to full participation 6 days postinjury. The results from this report indicate that a program of cryokinetics and functional progressive exercise performed within pain-free limits can greatly enhance the return of an athlete to competition.
Using Might Splints in the Treatment of Plantar Fasciitis in the Athlete
Authors: Pezzullo David J.
Published: August 2016

Plantar fasciitis is one of the most common foot injuries athletes sustain. The painful heel is the result of overloading and inflammation of the plantar fascia at its insertion into the medial process of the tuberosity of the calcaneus. Many different treatment approaches have been used to address this overuse problem. Treatment for plantar fasciitis has included decreased weight bearing, nonsteroidal anti-inflammatory drugs (NSAIDs), orthotics, arch taping, weight loss, steroid injections, ultrasound, ice, physical therapy, and surgical release. Clinically the use of night splints has been found to be very successful in the treatment of plantar fasciitis, as described in this case study.
Responsiveness of the Numeric Pain Rating Scale in Patients With Shoulder Pain and the Effect of Surgical Status
Authors: Michener Lori A. , Snyder Alison R. , Leggin Brian G.
Published: August 2016

Context:

The Numeric Pain Rating Scale (NPRS) is commonly used to assess pain. Change in the NPRS across time can be interpreted with responsiveness indices.

Objective:

To determine the minimal clinically important difference (MCID) of the NPRS.

Design:

Single-group repeated measures.

Setting:

Outpatient rehabilitation clinics.

Patients:

Patients with shoulder pain (N = 136).

Main Outcome Measures:

At the initial evaluation patients completed the Penn Shoulder Score (PSS), which includes pain, satisfaction, and function sections. Pain was measured using an 11-point NPRS for 3 conditions of pain: at rest, with normal daily activities, and with strenuous activities. The NPRS average was calculated by averaging the NPRS scores for 3 conditions of pain. The final PSS was completed after 3–4 wk of rehabilitation. To determine the MCID for the NPRS average, the minimal detectible change of 8.6 points for the PSS function scale (0–60 points) was used as an external criterion anchor to classify patients as meaningfully improved (≥8.6 point change) or not improved (<8.6-point change). The MCID for the NPRS average was also determined for subgroups of surgical and nonsurgical patients. Cohen’s effect sizes were calculated as a measure of group responsiveness for the NPRS average.

Results:

Using a receiver-operating-characteristic analysis, the MCID for the average NPRS for all patients was 2.17, and it was 2.17 for both the surgical and nonsurgical subgroup: area-under-the-curve range .74–.76 (95%CI: .55–.95). The effect size for all patients was 1.84, and it was 1.51 and 1.94 for the surgical and nonsurgical groups, respectively.

Conclusions:

The NPRS average of 3 pain questions demonstrated responsiveness with an MCID of 2.17 in patients with shoulder pain receiving rehabilitation for 3–4 wk. The effect sizes indicated a large effect. However, responsiveness values are not static. Further research is indicated to assess responsiveness of the NPRS average in different types of patients with shoulder pain.
Patient- and Clinician-Rated Outcome Measures for Clinical Decision Making in Rehabilitation
Authors: Michener Lori A.
Published: August 2016

Outcome measures can be classified as clinician rated and patient rated. Clinician-rated measures predominantly assess impairments, whereas patient-rated measures, also known as patient-based measures, are designed to evaluate the impact of the injury on a patient’s daily activities, work, and recreation. Currently, there is a greater reliance on clinician-rated impairment measures for clinical decision making, specifically with treatment planning and assessing outcomes of care. To comprehensively evaluate the effect of an injury, patient-rated outcome measures must be used because they allow for the assessment of a patient’s ability to perform daily activities and participate in work and recreation that is affected by an injury. Clinician-rated impairment measures should be used to guide the development of a treatment program, and patient-rated measures should be used for both treatment-program development and assessing treatment outcomes in daily clinical practice. The purposes of this article are to describe patient- and clinician-rated outcome measures and to provide guidance and illustrate the benefits of the use of these measures in clinical decision making and documenting outcomes of care.
Clinical Assessment of Upper Extremity Injury Outcomes
Authors: Thigpen Charles , Shanley Ellen
Published: August 2016

Patient Scenario:

The patient presented is a high school baseball pitcher who was unable to throw because of shoulder pain. He subsequently failed nonoperative management but was able to return to pitching after surgery and successful rehabilitation.

Clinical Outcomes Assessment:

The Disabilities of Arm, Shoulder and Hand (DASH) and the Pennsylvania Shoulder Score (PENN) were selected as clinical outcome assessment tools to quantify the patient’s perceived ability to perform common daily tasks and sport tasks and current symptoms such as pain and patient satisfaction.

Clinical Decision Making:

The DASH and PENN provide important information that can be used to target specific interventions, set appropriate patient goals, assess between-sessions changes in patient status, and quantify patients’ functional loss.

Clinical Bottom Line:

Best clinical practice involves the use of clinical outcome assessment tools to garner an objective measure of the impact of a patient’s disease process on functional expectations. This process should facilitate a patient-centered approach by clinicians while they select the optimal intervention strategies and establish prognostic timelines.
Clinical Assessment of Low-Back-Pain Treatment Outcomes in Athletes
Authors: Vela Luzita I. , Haladay Douglas E. , Denegar Craig
Published: August 2016

Patient Scenario:

A 21-year-old male rodeo athlete complains of acute low back pain (LBP) after a bareback event. The athlete wishes to compete in a rodeo event in 4 d.

Clinical Outcomes Assessment:

Given the questionable validity and reliability of traditional clinical examination techniques for LBP, a treatment subgroup classification system combined with clinical outcomes assessment provides greater insight into suitable clinical interventions and patient response to treatment. Four LBP treatment subgroups based on the patient’s clinical presentation and symptoms have been established: manipulation, stabilization, specific exercise, and traction. Manipulation subgroup research has produced a valid clinical prediction rule (CPR). The Visual Analog Scale, Numeric Rating Scale (NRS), Oswestry Low Back Pain Disability Index (ODI), Roland Morris Disability Questionnaire, Short Form 36 (SF-36), and Global Rating of Change Scale are valid, reliable, and responsive outcomes instruments with established values for minimum clinically important difference (MCID). These instruments document important changes in disablement and health-related quality of life in patients with low back injury, as well as demonstrate treatment outcomes.

Clinical Decision Making:

On examination the athlete presents with moderate pain and disability as measured by the NRS, ODI, and SF-36 and meets all 5 criteria for the manipulation subgroup, indicating a high likelihood of success with manipulative therapy when following the guidelines presented in the CPR. Expected outcomes values, based on MCID values, were met after 1 treatment. Preferred outcomes, based on physical activity requirements for sport, were met on day 4.

Clinical Bottom Line:

LBP generators are difficult to establish using traditional clinical examination techniques. The combined use of clinical criteria, using an LBP subgroup system, and baseline outcomes measures should guide treatment. Benchmarks should be guided by established MCID values for each instrument.
Clinical Assessment of Ankle Injury Outcomes: Case Scenario Using the Foot and Ankle Ability Measure
Authors: Cosby Nicole L. , Hertel Jay
Published: August 2016

Patient Scenario:

A 20-y-old male Division 1 college basketball player sustained a grade 2 inversion ankle sprain during preseason that is preventing him from practicing and competing.

Clinical Outcomes Assessment:

The Foot and Ankle Ability Measure (FAAM) was administered to the injured athlete as an evaluative tool to provide the clinician with valuable subjective information on the patient’s self-reported function. The FAAM consists of 2 subscales: the activities of daily living (ADL) subscale and the sports subscale. Together the 2 subscales contain 29 questions (21 questions on the ADL and 8 on the sports subscale), which assess self-reported function and disability in the foot and ankle.

Clinical Decision Making:

The addition of the self-reported functional measures provides the clinician with more quantitative data to make clinical decisions than is possible with typical clinical exams. Self-reported functional assessments should not replace thorough clinical examination or sound clinical judgment; instead they should be an adjunct to them.

Clinical Bottom Line:

In addition to our objective assessment tools, the FAAM provides clinicians with a tool that can be used to assess function and disability through our patients’ self-reported responses. When used for evaluative purposes the FAAM can measure an individual’s changes in function and disability over time.
Validation of the Short Form-36 Health Survey Supported With Isokinetic Strength Testing After Sport Knee Injury
Authors: Marn-Vukadinovic Dusa , Jamnik Helena
Published: August 2016

Context:

Valid patient-based outcome instruments are necessary for comprehensive patient care that focuses on all aspects of health, from impairments to participation restrictions.

Objective:

To validate the Slovenian translation of Medical Outcome Survey (MOS) Short Form Health Survey (SF-36) and to assess relations among various knee measurements, activity tested with Oxford Knee Score (OKS) and health-related quality of life as estimated with SF-36 domains.

Design:

Descriptive validation study.

Setting:

Isokinetic laboratory in outpatient rehabilitation unit.

Participants:

101 subjects after unilateral sport knee injury.

Interventions:

All subjects completed the SF-36 and OKS, and isokinetic knee-muscle strength output at 60°/s was determined in 78 participants. Within a 3-d period, 43 subjects completed the SF-36 and OKS questionnaires again.

Main Outcome Measures:

Reliability testing included internal consistency and test–retest reliability. Correlations between SF-36 subscales and OKS were calculated to assess construct validity, and correlation between SF-36 subscales and muscle strength was calculated to assess concurrent validity.

Results:

Chronbach α was above .78 for all SF-36 subscales. ICCs ranged from .80 to .93. The correlation between OKS and the physical-functioning subscale, showing convergent construct validity, was higher (r = .83, P < .01) than between OKS and mental health (r = .50, P < .01), showing divergent construct validity. Knee-extensor weakness negatively correlated with physical-functioning (r = −.59, P < .01) and social-functioning (r = −.43, P < .01) subscales.

Conclusions:

The Slovenian translation of the SF-36 is a reliable and valuable tool. The relationships between knee-muscle strength and activity and between knee-muscle strength and SF-36 subscales in patients after sport knee injury were established.
The Effects of Anthropometric Scaling Parameters on Normalized Muscle Strength in Uninjured Baseball Pitchers
Authors: Hurd Wendy J. , Morrey Bernard F. , Kaufman Kenton R.
Published: August 2016

Context:

Muscle force must be normalized for between-subjects comparisons of strength to be valid. The most effective method for normalizing muscle strength has not, however, been systematically evaluated.

Objective:

To evaluate the effects of normalizing muscle strength using a spectrum of anthropometric parameters.

Design:

Cross-sectional.

Setting:

Laboratory.

Participants:

50 uninjured high-school-age baseball pitchers.

Interventions:

Shoulder-rotation strength was tested at 0° and 90° abduction with a handheld dynamometer. Muscle force was normalized to parameters including subject height, weight, height × weight, body-mass index (BMI), forearm length, and forearm length × height.

Outcome Measures:

Statistical analysis included evaluating the coefficient of variation, skewness, and kurtosis of the nonnormalized and normalized muscle force. The most effective normalization method was determined based on the scaling factor that yielded the lowest variability for the data set and promoted the most normal distribution of the data set.

Results:

Using body weight to scale muscle force was the most effective anthropometric parameter for normalizing strength values based on the group of statistical measures of variability. BMI, height × weight, and forearm length × weight as scaling factors also yielded less variable values for muscle strength compared with nonnormalized strength, but less consistently than body weight. Height and forearm length were least effective in reducing the variability of the data set relative to nonnormalized muscle force.

Conclusion:

This study provides objective support for scaling muscle strength to subject body weight. This approach to normalizing muscle strength uses methods readily accessible to clinicians and researchers and may facilitate the identification of differences in strength between individuals with diverse physical characteristics.
Measurement of Ankle Dorsiflexion: A Comparison of Active and Passive Techniques in Multiple Positions
Authors: Krause David A. , Cloud Beth A. , Forster Lindsey A. , Schrank Jennifer A. , Hollman John H.
Published: August 2016

Context:

Limited ankle DF (DF) range of motion (ROM) resulting from restricted gastrocnemius and soleus mobility is associated with a variety of lower extremity pathologies. Several techniques are used clinically to measure ankle DF.

Objectives:

To evaluate the reliability and minimal detectable change of DF ROM measurement, determine whether there is a difference in measured DF between techniques, and quantify the electromyographic (EMG) activity of the soleus and tibialis anterior muscles associated with the techniques.

Design:

Repeated measures.

Setting:

Controlled laboratory setting.

Participants:

39 healthy subjects, age 22–33.

Main Outcome Measures:

DF measurements using 5 different techniques including active and passive DF with the knee extended and flexed to 90° and a modified lunge. EMG activity of the soleus and anterior tibialis muscles.

Results:

Intrarater reliability values (ICC3,1) ranged from .68 to .89. Interrater reliability (ICC2,1) ranged from .55 to .82. ICCs were the greatest with the modified lunge. The minimal detectable change (MDC95) ranged from 6° to 8° among the different techniques. A significant difference in DF ROM was found between all methods. Measurements taken with active DF were greater than the same measures taken passively. The lunge position resulted in greater DF ROM than both active and passive techniques. EMG activity of the soleus was greater with active DF and the lunge than with passive DF.

Conclusions:

The modified lunge, which demonstrated excellent intrarater and interrater reliability, may best represent maximal DF. Active end-range DF was significantly greater than passive end-range DF when measured at either 0° or 90° knee flexion. Greater active DF was not explained by inhibition of the soleus. Finally, using the modified lunge, a difference between 2 measurements over time of 6° or more suggests that a meaningful change has occurred.
Fatigue’s Effect on Eversion Force Sense in Individuals With and Without Functional Ankle Instability
Authors: Wright Cynthia J. , Arnold Brent L.
Published: August 2016

Context:

Force sense (FS), the proprioceptive ability to detect muscle-force generation, has been shown to be impaired in individuals with functional ankle instability (FAI). Fatigue can also impair FS in healthy individuals, but it is unknown how fatigue affects FS in individuals with FAI.

Objective:

To assess the effect of fatigue on ankle-eversion force-sense error in individuals with and without FAI. Design: Case control with repeated measures.

Setting:

Sports medicine research laboratory.

Participants:

32 individuals with FAI and 32 individuals with no ankle sprains or instability in their lifetime. FAI subjects had a history of ≥1 lateral ankle sprain and giving-way ≥1 episode per month.

Interventions:

Three eversion FS trials were captured per load (10% and 30% of maximal voluntary isometric contraction) using a load cell before and after a concentric eversion fatigue protocol.

Main Outcome Measures:

Trial error was the difference between the target and reproduction forces. Constant error (CE), absolute error (AE), and variable error (VE) were calculated from 3 trial errors. A Group × Fatigue × Load repeated-measures ANOVA was performed for each error.

Results:

There were no significant 3-way interactions or 2-way interactions involving group (all P > .05). CE and AE had a significant 2-way interaction between load and fatigue (CE: F1,62 = 8.704, P = .004; AE: F1,62 = 4.024, P = .049), and VE had a significant main effect for fatigue (F1,62 = 5.130, P = .027), all of which indicated increased FS error with fatigue at 10% load. However, at 30% load only VE increased with fatigue. The FAI group had greater error as measured by AE (F1,62 = 4.571, P = .036) but not CE or VE (P > .05).

Conclusions:

Greater AE indicates that FAI individuals are less accurate in their force production. Fatigue impaired force sense in all subjects equally. These deficits provide evidence of impaired proprioception with fatigue and in individuals with FAI.
Effect of Limiting Ankle-Dorsiflexion Range of Motion on Lower Extremity Kinematics and Muscle-Activation Patterns During a Squat
Authors: Macrum Elisabeth , Bell David Robert , Boling Michelle , Lewek Michael , Padua Darin
Published: August 2016

Context:

Limitations in gastrocnemius/soleus flexibility that restrict ankle dorsiflexion during dynamic tasks have been reported in individuals with patellofemoral pain (PFP) and are theorized to play a role in its development.

Objective:

To determine the effect of restricted ankle-dorsiflexion range of motion (ROM) on lower extremity kinematics and muscle activity (EMG) during a squat. The authors hypothesized that restricted ankle-dorsiflexion ROM would alter knee kinematics and lower extremity EMG during a squat.

Design:

Cross-sectional.

Participants:

30 healthy, recreationally active individuals without a history of lower extremity injury.

Interventions:

Each participant performed 7 trials of a double-leg squat under 2 conditions: a nowedge condition (NW) with the foot flat on the floor and a wedge condition (W) with a 12° forefoot angle to simulate reduced plantar-flexor flexibility.

Main Outcome Measures:

3-dimensional hip and knee kinematics, medial knee displacement (MKD), and ankle-dorsiflexion angle. EMG of vastus medialis oblique (VMO), vastus lateralis (VL), lateral gastrocnemius (LG), and soleus (SOL). One-way repeated-measures ANOVAs were performed to determine differences between the W and NW conditions.

Results:

Compared with the NW condition, the wedge produced decreased peak knee flexion (P < .001, effect size [ES] = 0.81) and knee-flexion excursion (P < .001, ES = 0.82) while producing increased peak ankle dorsiflexion (P = .006, ES = 0.31), ankle-dorsiflexion excursion (P < .001, ES = 0.31), peak knee-valgus angle (P = .02, ES = 0.21), and MKD (P < .001, ES = 2.92). During the W condition, VL (P = 0.002, ES = 0.33) and VMO (P = .049, ES = 0.20) activity decreased while soleus activity increased (P = .03, ES = 0.64) compared with the NW condition. No changes were seen in hip kinematics (P > .05).

Conclusions:

Altering ankle-dorsiflexion starting position during a double-leg squat resulted in increased knee valgus and MKD, as well as decreased quadriceps activation and increased soleus activation. These changes are similar to those seen in people with PFP.
Functional Recovery After Hip Resurfacing and Rehabilitation
Authors: Benedetti Maria Grazia , Berti Lisa , Frizziero Antonio , Ferrarese Donata , Giannini Sandro
Published: August 2016

Context:

Surface replacement of the hip is aimed especially at active patients, and it seems to achieve optimal functional results in a short time if associated with a tailored rehabilitation protocol.

Objective:

To assess the functional outcome in a group of active patients after hip resurfacing.

Design:

Clinical measurement and controlled laboratory study in a case series.

Setting:

Gait-analysis laboratory.

Participants:

8 patients and a control group of 10 subjects.

Interventions:

Patients treated with Birmingham hip-resurfacing system and a tailored rehabilitation protocol

Main Outcome Measures:

Clinical assessment (Harris Hip Score [HHS]) and instrumented gait analysis including muscular electromyographic assessment. Patients were assessed preoperatively and at 3 and 9 mo follow-up after surgery.

Results:

HHS showed a significant increase from the baseline to 3- (P = .008) and 9-month (P = .014) follow-up; 5 patients returned to sport. Gait pattern in the presented case series of patients improved substantially 3 mo postoperatively, and minimal further changes were present 9 months postoperatively. Residual abnormalities of time-distance and hip-kinematics parameters were consistent with a slow gait. A complete restoration of the muscle-activation pattern during gait was achieved.

Conclusion:

Hip resurfacing associated with a rehabilitation protocol based on the characteristics of the implant provides excellent clinical and functional outcome, especially for very active patients.
Shoulder- and Back-Muscle Activation During Shoulder Abduction and Flexion Using a Bodyblade Pro Versus Dumbbells
Authors: Parry Joseph S. , Straub Rachel , Cipriani Daniel J.
Published: August 2016

Context:

The Bodyblade Pro is used for shoulder rehabilitation after injury. Resistance is provided by blade oscillations—faster oscillations or higher speeds correspond to greater resistance. However, research supporting the Bodyblade Pro’s use is scarce, particularly in comparison with dumbbell training.

Objective:

To compare muscle activity, using electromyography (EMG), in the back and shoulder regions during shoulder exercises with the Bodyblade Pro vs dumbbells.

Design:

Randomized crossover study.

Setting:

San Diego State University biomechanics laboratory.

Participants:

11 healthy male subjects age 19–32 y.

Intervention:

Subjects performed shoulder-flexion and -abduction exercises using a Bodyblade Pro and dumbbells (5, 8, and 10 lb) while EMG recorded activity of the deltoid, pectoralis major, infraspinatus, serratus anterior, and erector spinae.

Main Outcome Measures:

Average peak muscle activity (% maximum voluntary isometric contraction) was separately measured for shoulder abduction and flexion in the range of 85° to 95°. Differences among exercise devices were separately analyzed for the flexed and abducted positions using 1-way repeated-measures ANOVA.

Results:

The Bodyblade Pro produced greater muscle activity than all the dumbbell trials. Differences were significant for all muscles measured (all P < .01) except for the erector spinae during shoulder flexion with a 10-lb dumbbell. EMG activity for the Bodyblade Pro exceeded 50% of the MVIC during both shoulder flexion and abduction. For the dumbbell conditions, only the 10-lb trials approached this effect.

Conclusions:

Using a Bodyblade during shoulder exercises results in greater shoulder- and back-muscle recruitment than dumbbells. The Bodyblade Pro can activate multiple muscles in a single exercise and thereby minimize the need for multiple dumbbell exercises. The Bodyblade Pro is an effective device for shoulder- and back-muscle activation that warrants further use by clinicians interested in its use for rehabilitation.