bluuebunny/crossref_metadata_2025 huggingface dataset:
Glenoid Labrum Lesion in an Elite Tennis Player: A Clinical Challenge in Diagnosis
Authors: Chan Romy H. , Lam James J.
Published: August 2016

Shoulder pain among overhead-sport athletes is common and often presents a challenge to clinicians in making an accurate diagnosis. A case report of a young college tennis player is presented, with emphasis on the clinical examination process leading to the diagnosis of a superior labrum anteroposterior lesion. The current literature regarding the clinical diagnosis of glenoid labrum lesion in the shoulder with respect to specific clinical tests was reviewed. It is recommended that clinicians consider glenoid labral lesions in the context of shoulder instability. Glenohumeral internal-rotation deficit should be routinely evaluated and corrected in high-performance tennis players.
Views of Chartered Physiotherapists on the Psychological Content of Their Practice: A Follow-Up Survey in the UK
Authors: Arvinen-Barrow Monna , Hemmings Brian , Weigand Daniel , Becker Caryl , Booth Lynn
Published: August 2016

Objective:

To assess, on a national level, the views of chartered physiotherapists with regard to the psychological content of physiotherapy practice.

Design:

A postal survey to a national list of sport injury and physiotherapy clinics was employed.

Participants:

A total of 361 responses were included in the descriptive statistical and qualitative analyses.

Measurements:

The Physiotherapist and Sport Psychology Questionnaire (PSPQ).

Results:

On average, physiotherapists felt that athletes were psychologically affected 83% of the time when injured. Key psychological characteristics were also identified in athletes who cope/do not cope successfully with their injuries. Physiotherapists reported using psychological techniques in their work and expressed the need for further training in the field. Only 24.1% of the physiotherapists stated having accesses to accredited sport psychologists.

Conclusions:

Results suggest that UK physiotherapists possess practical experiences and good awareness for psychological aspects of injuries and acknowledge the importance of treating a range of psychological conditions.
Rehabilitation Adherence in Sport Injury: Sport Physiotherapists’ Perceptions
Authors: Niven Ailsa
Published: August 2016

Context:

Athlete’s adherence behavior can influence the outcome of a rehabilitation program.

Objective:

To draw on sport physiotherapists’ expert knowledge to increase understanding of adherence issues in practice and identify factors that influence adherence and strategies that can be used to enhance adherence.

Design:

An interview design with inductive content analysis.

Participants:

Nine (6 women and 3 men) experienced sports physiotherapists.

Results:

Under-adherence and over-adherence were issues in practice for some practitioners, and adherence was viewed as important for successful recovery from injury. Three higher order themes emerged relating to the influence of athlete characteristics, situational characteristics, and characteristics of the injury and rehabilitation on both facilitating and preventing rehabilitation adherence. Strategies to improve adherence in practice emerged from the data and broadly addressed the key determinants of adherence.

Conclusion:

Adherence to rehabilitation is influenced by a number of factors and strategies to enhance adherence are identified.
A Case Report of Idiosyncratic Hyperthermia and Review of U.S. Army Heat Stroke Hospitalizations
Authors: Carter Robert , Cheuvront Samuel N. , Sawka Michael N.
Published: August 2016

Objectives:

We report our observations on one soldier with abnormal hyperthermia during exercise in the heat compared with prior exercise and following acute local (non-febrile) infection. Also, we report on 994 heat stroke hospitalizations in the U.S. Army. It is known that prior infection is a risk factor for heat illness and some of the 37 heat stroke deaths cited infections (eg, pneumonia, influenza) in the medical records.

Results:

This case report illustrates complete recovery from abnormal hyperthermia, which occurred in a laboratory setting during mild, low intensity exercise. In a field setting, this case may have resulted in serious heat illness. As with most of the heat stroke cases, rapid medical attention (ie, cooling and rehydration) and the age group (19 to 26) that represents majority of the heatstroke cases in U.S. Army are likely factors that contribute successful treatment of heatstroke in the field environment.

Conclusions:

We conclude that acute inflammatory response can augment the hyperthermia of exercise and possibly increase heat illness susceptibility. Furthermore, it is important for health care providers of soldiers and athletes to monitor acute local infections due to the potential thermoregulatory consequences during exercise in the heat.
Tibiofemoral Joint Kinetics during Squatting with Increasing External Load
Authors: Sahli Sonia , Rebai Haithem , Elleuch Mohamed Habib , Tabka Zouheir , Poumarat Georges
Published: August 2016

Context:

There is limited information about the effects of increasing load while squatting

Objective:

To quantify tibiofemoral joint kinetics during squatting with variable loads.

Setting:

Research laboratory.

Participants:

20 male students.

Intervention:

Tibiofemoral joint kinetics and electromyographic (EMG) activity of four involved muscles were determined by recording the half squat with variable external loads.

Main Outcome Measures:

Tibiofemoral joint force and external moment components and EMG activity of four involved muscles.

Results:

Throughout the exercise, a posterior direction for the antero-posterior shear force and a net extension for the external moment were observed. They increased with knee flexion reaching peak force of 29% of the subject body weight (BW) and moment of 88Nm (without external load). All force and moment components and muscle activities increased as the external load increased.

Conclusion:

These findings suggest that half squat may be safe to use for quadriceps strengthening with very low potential loading on the anterior cruciate ligament (ACL). Our data can help clinicians choose the appropriate external load.
Effect of Trunk-Muscle Fatigue and Lactic Acid Accumulation on Balance in Healthy Subjects
Authors: Surenkok Ozgur , Kin-Isler Ayse , Aytar Aydan , Gültekin Zuhal
Published: August 2016

Objective:

This study sought to determine the effects of trunk-muscle fatigue and blood lactic acid elevation on static and dynamic balance.

Intervention:

Fatigue was induced by an isokinetic protocol, and static and dynamic balance were assessed during bilateral stance using a Kinesthetic Ability Trainer. Subjects participated in a fatigue protocol in which continuous concentric movements at 60°/s were performed until the torque output for both trunk flexion and extension dropped below 25% of the calculated peak torque for 3 consecutive movements.

Measures:

Before and immediately after the fatigue protocol, blood lactic acid measurements and static- and dynamic-balance measurements were recorded.

Results:

An increase in lactic acid levels was detected in all subjects. According to a dependent-samples t test, significant differences in balance and lactic acid values were found after the fatigue protocol. There was no correlation between lactic acid accumulation (change between prefatigue and postfatigue levels) and balance-score differences.

Conclusion:

Trunk-muscle fatigue has an adverse effect on static and dynamic balance.
Inside the Clinic: Health Professionals’ Role in Their Clients’ Psychological Rehabilitation
Authors: Tracey Jill
Published: August 2016

Context:

Health professionals (ie, physical therapists, athletic trainers) can play an integral role in the psychological recovery from injury.

Objective:

To examine health professionals’ perceptions of the roles they play and their influence on the psychological recovery of their clients.

Design:

A qualitative design using semistructured interviews that were transcribed and analyzed using interpretational analyses to reveal themes.

Setting:

4 rehabilitation clinics specializing in sport- and physical-activity-related injuries.

Participants:

18 participants (17 physical therapists, 1 athletic trainer) with a mean age of 36 years.

Results:

Using thematic coding of the interview data, general-dimension data themes identified were centered on the roles of rapport builder, educator, and communicator. Health professionals perceive that they play important roles in the psychological recovery of their clients in spite of a lack of professional training in psychology and strive to create a caring and supportive environment. Results demonstrate the perceptions of the roles they play and the influence they have on the psychological component of the recovery process.
Hip Function’s Influence on Knee Dysfunction: A Proximal Link to a Distal Problem
Authors: Reiman Michael P. , Bolgla Lori A. , Lorenz Daniel
Published: August 2016

The purpose of this commentary is to describe the multifactorial relationships between hip-joint strength, range of motion, kinetics/kinematics, and various knee pathologies, specifically as they relate across an individual’s life span. Understanding the interdependence between the hip and knee joints in respect to functional activity is a necessary and relevant aspect for clinicians to investigate to ameliorate various pathological presentations at the knee that might have a proximal relationship.
Lower Extremity Strength and Mechanics during Jumping in Women with Patellofemoral Pain
Authors: Willson John D. , Davis Irene S.
Published: August 2016

Context:

Lower extremity (LE) weakness might be associated with altered mechanics during weight bearing in subjects with patellofemoral pain syndrome (PFPS).

Objective:

To analyze LE strength, mechanics, and the association between these variables among women with and without PFPS during a simulated athletic task.

Design:

Case control.

Setting:

Motion-analysis laboratory.

Subjects:

20 women with PFPS and 20 healthy women.

Main Outcome Measures:

Peak isometric lateral trunk-flexion, hip-abduction, hip external-rotation, knee-flexion, and knee-extension strength, as well as hip- and knee-joint excursions and angular impulses during single-leg jumps.

Results:

PFPS subjects produced less hip-abduction, hip external-rotation, and trunk lateral-flexion force than the control group. The PFPS group also demonstrated greater hip-adduction excursion and hip-abduction impulses. The association between the strength measurements and LE mechanics was low.

Conclusions:

Women with PFPS demonstrate specific weaknesses and altered LE mechanics. Weakness is not, however, highly correlated with observed differences in mechanics.
Laboratory Gait Analysis in Patients with Low Back Pain before and after a Pilates Intervention
Authors: da Fonseca Juliana Limba , Magini Marcio , de Freitas Thais Helena
Published: August 2016

Objective:

To evaluate the influence of pain on vertical ground-reaction force (VGRF) in patients with low back problems and the effect of the Pilates method on the gait of these patients.

Design:

A single-blind randomized controlled trial.

Participants:

28 individuals assigned to a control group (n = 11) and a low-back group (n = 17), the latter of which was subdivided into a Pilates group (n = 8) and a no-Pilates group (n = 9).

Intervention:

The Pilates group undertook 15 sessions of Pilates.

Main Outcome Measures:

The VGRF parameters were recorded during preferred and faster walking speeds. The data were collected before and after the intervention.

Results:

The weight-acceptance rate and push-off rate were significantly less in the right lower limb of low-back group than of the control group at preferred speed. Improvements were seen in the Pilates group postintervention, with increased middle-support force for the left lower limb at faster walking speed and decreased pain; this did not occur in the no-Pilates group.

Conclusions:

These results suggest that patients with low back pain use strategies to attenuate the amount of force imposed on their body. The Pilates method can improve weight discharge in gait and reduce pain compared with no intervention.
Electroacupuncture-Enhanced Differentiation of Bone Marrow Stromal Cells into Neuronal Cells
Authors: Sun Zhongren , Li Xiaoning , Su Zhiqiang , Zhao Ying , Zhang Li , Wu Mingyuan
Published: August 2016

Context:

Bone marrow stromal cells (BMSCs) can be differentiated into neuronal cells and are used to treat spinal cord injury (SCI).

Objective:

This study investigated whether electroacupuncture enhances BMSC’s effects on SCI in rats.

Design:

The effects of transplantation of phosphate-buffered saline or BMSC, electroacupuncture, and a combination of BMSC transplantation and electroacupuncture on SCI were evaluated using a combined behavioral score (CBS). Expressions of neuronal marker neuron-specific enolase (NSE) and gliocyte-specific marker glial fibrillary acidic protein (GFAP) of transplanted BMSC were detected using immunohistochemistry to assess the effect of electroacupuncture on differentiation of BMSC into neuronal cells.

Results:

The combination of BMSC transplantation and electroacupuncture significantly alleviated CBS in rats with SCI compared with the separate treatment of BMSC or electroacupuncture. In addition, electroacupuncture increased the NSE- and GFAP-positive transplanted BMSCs in spinal cord.

Conclusion:

Combined treatment showed a better effect, and the mechanisms may be partially caused by enhanced differentiation of BMSC into neuronal cells. Future studies are needed to confirm this.
Hydration Status, Sweat Rates, and Rehydration Education of Youth Football Campers
Authors: McDermott Brendon P. , Casa Douglas J. , Yeargin Susan W. , Ganio Matthew S. , Lopez Rebecca M. , Mooradian Elizabeth A.
Published: August 2016

Context:

Previous field research has not identified sweat rates (SR), fluid consumption (FC), or the efficacy of an educational intervention (EI) for youth during football camp.

Objective:

To measure hydration status and rehydration performance and examine EI using these data.

Design:

Observational with EI randomized comparison.

Participants:

Thirty-three boys (mean ± SD: 12 ± 2 y, 52.9 ± 13.6 kg, 156 ± 12 cm) volunteered during a 5-d camp with 3 (~2-h) sessions per day (WBGT: 25.6 ± 0.5°C).

Main Outcome Measures:

Hydration status, SR, and FC.

Results:

Urine osmolality averaged 796 ± 293 mOsm/L for days 2-5. Game SR (1.30 ± 0.57 L/h) was significantly greater than practice SR (0.65 ± 0.35 L/h; P = .002). Subjects dehydrated during free time but matched fluid losses with FC (0.76 ± 0.29 L/h) during football activities.

Conclusions:

Subjects arrived at camp hypohydrated and maintained this condition. They matched FC and SR during, but dehydrated when not playing, football. This may impair recovery and subsequent performance. Hydration EI seemed to have a positive influence on hydration practices.
Insulin-Sensitivity Response to a Single Bout of Resistive Exercise in Type 1 Diabetes Mellitus
Authors: Jimenez Carolyn , Santiago Mayra , Sitler Michael , Boden Guenther , Homko Carol
Published: August 2016

Context:

Little is known about the acute effects of resistance exercise on insulin sensitivity in people with type 1 diabetes.

Design:

Repeated-measures design with 2 independent variables: group (exercise and nonexercise control) and time (preexercise and 12 and 36 h postexercise).

Setting:

General Clinical Research Center, Temple University Hospital, Philadelphia, PA.

Patients:

14 physically active subjects (11 men and 3 women) with type 1 diabetes.

Intervention:

The exercise group completed 5 sets of 6 repetitions of strenuous (80% 1-RM) quadriceps and hamstring exercises while the control group performed only activities of daily Living.

Main Outcome Measures:

Insulin sensitivity was assessed with the euglycemic-hyperinsulinemic-clamp technique preexercise and 12 and 36 h postexercise.

Results:

Insulin-sensitivity values were not significantly different between the exercise and control groups (P = .92) or over time (P = .67).

Conclusions:

A single bout of strenuous resistance exercise does not alter insulin sensitivity in people with type 1 diabetes.
Strength and Contractile Adaptations in the Human Triceps Surae after Isotonic Exercise
Authors: Moss Crayton L. , Grimmer Scott
Published: August 2016

The purpose of this study was to determine whether twitch contractile properties and strength of the triceps surae could be altered by 8 weeks of low-repetition or high-repetition isotonic exercise. Subjects were randomly assigned to either the low- or high-repetition group. Before- and after-training measurements were recorded for strength and contractile properties. The contractile variables of the muscle twitch were latency, time to peak force, peak force, half-contraction time, and half-relaxation time. Strength measurements were determined utilizing a one repetition maximal (1-RM) heel-raise testing device. A two-way ANOVA with repeated measures was used to test the effect of training on each variable. Both groups showed a significant increase in 1-RM and half-relaxation time and a decrease in electrical stimulation current after the 8-week training period. It was concluded that if high-repetition exercises develop slow-twitch Type I muscle fibers and low-repetition exercises develop fast-twitch Type II fibers, training programs must be designed specifically according to the desired outcome.
Comparison of Functional Ability Following Percutaneous and Open Surgical Repairs of Acutely Ruptured Achilles Tendons
Authors: Steele Gregory J. , Harter Rod A. , Ting Arthur J.
Published: August 2016

The purpose of our study was to evaluate the functional outcomes of two methods of surgical treatment of acute closed raptures of the Achilles tendon, specifically, the primary open repair and the percutaneous repair techniques, utilizing (a) isokinetic plantar flexion strength, (b) midcalf girth, (c) ankle joint proprioception, and (d) ankle range of motion values. As a secondary purpose, the frequency of reruptures and postsurgical complications were compared between techniques. Twenty male patients (mean age, 43.8 ± 9.4 years) who sustained complete, closed ruptures of the Achilles tendon participated in this study. Results of pairedttests revealed significant differences between postsurgical and contralateral normal limbs for 6 of 12 variables. Results of the ANOVAs revealed no significant differences between the open repair group and percutaneous repair group for any of the evaluative parameters. The significant deficits in postoperative isokinetic plantar flexion strength and midcalf girth measurements, irrespective of surgical technique, suggest an incompleteness of rehabilitation or, more likely, the physiological inability to regain these characteristics postoperatively.
Acute Care for Exercise-Induced Hyperthermia to Avoid Adverse Outcome from Exertional Heat Stroke
Authors: Marom Tal , Itskoviz David , Lavon Haim , Ostfeld Ishay
Published: August 2016

Introduction:

Exertional heat stroke (EHS) is a major concern in military trainees performing intense physical exercise, with substantial morbidity rates. Prehospital diagnosis of EHS is essentially clinical. Thus, soldiers, command personnel, and medical staff are taught to recognize this injury and immediately begin aggressive treatment to prevent further deterioration.

Patients and Methods:

During 2007, 5 otherwise healthy Israeli Defense Forces (IDF) soldiers were diagnosed with EHS while performing strenuous exercise. They were treated vigorously according to the IDF EHS-treatment protocol and were referred to the emergency department.

Results:

On arrival at the emergency department, physical examination including rectal temperature was unremarkable in all soldiers. Blood and urine workup showed near-normal values. No other medical conditions that could have explained the clinical presentation were found. All soldiers were discharged shortly afterward, with no further consequences. A heat-tolerance test was performed several weeks after the event and was interpreted as normal. All soldiers returned to active service.

Conclusion:

Because the initial clinical findings were very suggestive of EHS and because no other condition could have explained the prehospital transient hyperthermia, we suggest that these soldiers were correctly diagnosed with EHS, and we propose that rapid vigorous cooling prevented further deterioration and complications. We suggest calling this condition aborted heat stroke.
Comparison of the Effects of Ice and 3.5% Menthol Gel on Blood Flow and Muscle Strength of the Lower Arm
Authors: Topp Robert , Winchester Lee , Mink Amber M. , Kaufman Jeremiah S. , Jacks Dean E.
Published: August 2016

Context:

Soft-tissue injuries are commonly treated with ice or menthol gels. Few studies have compared the effects of these treatments on blood flow and muscle strength.

Objective:

To compare blood flow and muscle strength in the forearm after an application of ice or menthol gel or no treatment.

Design:

Repeated-measures design in which blood-flow and muscle-strength data were collected from subjects under 3 treatment conditions.

Setting:

Exercise physiology laboratory.

Participants:

17 healthy adults with no impediment to the blood flow or strength in their right arm, recruited through word of mouth.

Intervention:

Three separate treatment conditions were randomly applied topically to the right forearm: no treatment, 0.5 kg of ice, or 3.5 mL of 3.5% menthol gel. To avoid injury ice was only applied for 20 min.

Main Outcome Measures:

At each data-collection session blood flow (mL/min) of the right radial artery was determined at baseline before any treatment and then at 5, 10, 15, and 20 min after treatment using Doppler ultrasound. Muscle strength was assessed as maximum isokinetic flexion and extension of the wrist at 30°/s 20, 25, and 30 min after treatment.

Results:

The menthol gel reduced (−42%, P < .05) blood flow in the radial artery 5 min after application but not at 10, 15, or 20 min after application. Ice reduced (−48%, P < .05) blood flow in the radial artery only after 20 min of application. After 15 min of the control condition blood flow increased (83%, P < .05) from baseline measures. After the removal of ice, wrist-extension strength did not increase per repeated strength assessment as it did during the control condition (9−11%, P < .05) and menthol-gel intervention (8%, P < .05).

Conclusions:

Menthol has a fast-acting, short-lived effect of reducing blood flow. Ice reduces blood flow after a prolonged duration. Muscle strength appears to be inhibited after ice application.
Reliability of Force-Platform Measures of Postural Sway and Expertise-Related Differences
Authors: Meshkati Zohreh , Namazizadeh Mehdi , Salavati Mahyar , Mazaheri Masood
Published: August 2016

Context:

Although reliability is a population-specific property, few studies have investigated the measurement error associated with force-platform parameters in athletic populations.

Objective:

To investigate the skill-related differences between athletes and nonathletes in reliability of center-of-pressure (COP) summary measures under eyes-open (EO) and eyes-closed (EC) conditions.

Design:

Test–retest reliability study.

Setting:

COP was recorded during double-leg quiet standing on a Kistler force platform before and after a fatiguing treadmill exercise, with EO and EC.

Participants:

31 male participants including 15 athletes practiced in karate and 16 nonathletes.

Main Outcome Measures:

Standard deviation (SD) of amplitude, phase-plane portrait, SD of velocity, mean total velocity, and area were calculated from 30-s COP data. Intraclass correlation coefficient (ICC), standard error of measurement, and coefficient of variation (CV) were used as estimates of reliability and precision.

Results:

Higher ICCs were found for COP measures in the athlete (compared with the nonathlete) group, postfatigued (compared with prefatigued) condition, and EC (compared with EO) tests. CVs smaller than 15% were obtained for most of the COP measures. SD of velocity in the anteroposterior direction showed the highest reliability in most conditions.

Conclusions:

Tests with EC and to a lesser extent tests performed in the athlete group and in the postfatigued condition showed better reliability.
Effects of Exercise on Lower Extremity Muscle Function After Anterior Cruciate Ligament Reconstruction
Authors: Kuenze Christopher , Hertel Jay , Hart Joseph M.
Published: August 2016

Purpose:

Persistent quadriceps weakness due to arthrogenic muscle inhibition (AMI) has been reported after anterior cruciate ligament (ACL) reconstruction. Fatiguing exercise has been shown to alter lower extremity muscle function and gait mechanics, which may be related to injury risk. The effects of exercise on lower extremity function in the presence of AMI are not currently understood. The purpose of this study was to compare the effect of 30 min of exercise on quadriceps muscle function and soleus motoneuron-pool excitability in ACL-reconstructed participants and healthy controls.

Methods:

Twenty-six (13 women, 13 men) healthy and 26 (13 women, 13 men) ACL-reconstructed recreationally active volunteers were recruited for a case-control laboratory study. All participants completed 30 min of continuous exercise including alternating cycles of inclined-treadmill walking and bouts of squats and step-ups. Knee-extension torque, quadriceps central activation ratio (CAR), soleus H:M ratio, and soleus V:M ratio were measured before and after 30 min of exercise.

Results:

There was a significant group × time interaction for knee-extension torque (P = .002), quadriceps CAR (P = .03), and soleus V:M ratio (P = .03). The effect of exercise was smaller for the ACL-R group than for matched controls for knee-extension torque (ACL-R: %Δ = −4.2 [−8.7, 0.3]; healthy: %Δ = −14.2 [−18.2, −10.2]), quadriceps CAR (ACL-R: %Δ = −5.1 [−8.0, −2.1]; healthy: %Δ = −10.0 [−13.3, −6.7]), and soleus V:M ratio (ACL-R: %Δ = 37.6 [2.1, 73.0]; healthy: %Δ = −24.9 [−38.6, −11.3]).

Conclusion:

Declines in quadriceps and soleus volitional muscle function were of lower magnitude in ACL-R subjects than in healthy matched controls. This response suggests an adaptation experienced by patients with quadriceps AMI that may act to maintain lower extremity function during prolonged exercise.
Increased Active Hamstring Stiffness After Exercise in Women With a History of Low Back Pain
Authors: Bedard Rebecca J. , Kim Kyung-Min , Grindstaff Terry L. , Hart Joseph M.
Published: August 2016

Objective:

To compare active hamstring stiffness in female subjects with and without a history of low back pain (LBP) after a standardized 20-min aerobic-exercise session.

Design:

Case control.

Setting:

Laboratory.

Participants:

12 women with a history of recurrent episodes of LBP (age = 22.4 ± 2.1 y, mass = 67.1 ± 11.8 kg, height = 167.9 ± 8 cm) and 12 matched healthy women (age = 21.7 ± 1.7 y, mass = 61.4 ± 8.8 kg, height = 165.6 ± 7.3 cm). LBP subjects reported an average 6.5 ± 4.7 on the Oswestry Disability Index.

Interventions:

Participants walked at a self-selected speed (minimum 3.0 miles/h) for 20 min. The treadmill incline was raised 1% grade per minute for the first 15 min. During the last 5 min, participants adjusted the incline of the treadmill so they would maintain a moderate level of perceived exertion through the end of the exercise protocol.

Main Outcome Measures:

During session 1, active hamstring stiffness, hamstring and quadriceps isometric strength, and concurrently collected electromyographic activity were recorded before and immediately after the exercise protocol. For session 2, subjects returned 48–72 h after exercise for repeat measure of active hamstring stiffness.

Results:

Hamstring active stiffness (Nm/rad) taken immediately postexercise was not significantly different between groups. However, individuals with a history of recurrent LBP episodes presented significantly increased hamstring stiffness 48–72 h postexercise compared with controls. For other outcomes, there was no group difference.

Conclusions:

Women with a history of recurrent LBP episodes presented greater active hamstring stiffness 48–72 h after aerobic exercise.
Effect of Balance Training on Postural Stability in Subjects With Chronic Ankle Instability
Authors: Wortmann Maraike Alice , Docherty Carrie L.
Published: August 2016

The lateral ligament complex of the ankle is a frequently injured structure in sports and recreational activities, which often results in chronic ankle instability (CAI). Balance exercise training has become a common component of clinical rehabilitation for CAI to address postural deficits. To determine the effect of balance training on postural stability, this critically appraised topic presents a summary and analysis of 4 relevant studies that address the effectiveness of balance training in subjects with CAI. Information about the methods and sources used in the article is provided. The findings imply that there is moderate evidence that 4–6 wk of balance training can enhance static and dynamic postural stability in subjects with CAI.
Fatigue’s Lack of Effect on Thigh-Muscle Activity in Anterior Cruciate Ligament–Reconstructed Patients During a Dynamic-Landing Task
Authors: Lepley Lindsey K. , Thomas Abbey C. , McLean Scott G. , Palmieri-Smith Riann M.
Published: August 2016

Context:

As individuals returning to activity after anterior cruciate ligament reconstruction (ACLr) likely experience fatigue, understanding how fatigue affects knee-muscle activation patterns during sport-like maneuvers is of clinical importance. Fatigue has been suggested to impair neuromuscular control strategies. As a result, fatigue may place ACLr patients at increased risk of developing posttraumatic osteoarthritis (OA).

Objective:

To determine the effects of fatigue on knee-muscle activity post-ACLr.

Design:

Case control.

Setting:

University laboratory.

Participants:

12 individuals 7–10 mo post-ACLr (7 male, 5 female; age 22.1 ± 4.7 y; 1.8 ± 0.1 m; mass 77.7 ± 11.9 kg) and 13 controls (4 male, 9 female; age 22.9 ± 4.3 y; 1.7 ± 0.1 m; mass 66.9 ± 9.8 kg).

Interventions:

Fatigue was induced via repetitive sets of double-leg squats (n = 8), which were interspersed with sets of single-leg landings (n = 3), until squats were no longer possible.

Main Outcome Measures:

2 × 2 repeated-measures ANOVA was used to detect the main effects of group (ACLr, control) and fatigue state (prefatigue, postfatigue) on quadriceps:hamstring cocontraction index (Q:H CCI).

Results:

All subjects demonstrated higher Q:H CCI at prefatigue compared with postfatigue (F1,23 = 66.949, P ≤ .001). Q:H CCI did not differ between groups (F1,23 = 0.599, P = .447).

Conclusions:

The results indicate that regardless of fatigue state, ACLr individuals are capable of restoring muscle-activation patterns similar to those in healthy subjects. As a result, excessive muscle cocontraction, which has been hypothesized as a potential mechanism of posttraumatic OA, may not contribute to joint degeneration after ACLr.
Modulation of Frontal-Plane Knee Kinematics by Hip-Extensor Strength and Gluteus Maximus Recruitment During a Jump-Landing Task in Healthy Women
Authors: Hollman John H. , Hohl Jeffrey M. , Kraft Jordan L. , Strauss Jeffrey D. , Traver Katie J.
Published: August 2016

Context:

Abnormal lower extremity kinematics during dynamic activities may be influenced by impaired gluteus maximus function.

Objective:

To examine whether hip-extensor strength and gluteus maximus recruitment are associated with dynamic frontal-plane knee motion during a jump-landing task.

Design:

Exploratory study.

Setting:

Biomechanics laboratory.

Participants:

40 healthy female volunteers.

Main Outcome Measures:

Isometric hip-extension strength was measured bilaterally with a handheld dynamometer. Three-dimensional hip and knee kinematics and gluteus maximus electromyography data were collected bilaterally during a jumplanding test. Data were analyzed with hierarchical linear regression and partial correlation coefficients (α = .05).

Results:

Hip motion in the transverse plane was highly correlated with knee motion in the frontal plane (partial r = .724). After controlling for hip motion, reduced magnitudes of isometric hip-extensor strength (partial r = .470) and peak gluteus maximus recruitment (partial r = .277) were correlated with increased magnitudes of knee valgus during the jump-landing task.

Conclusion:

Hip-extensor strength and gluteus maximus recruitment, which represents a measure of the muscle’s neuromuscular control, are both associated with frontal-plane knee motions during a dynamic weight-bearing task.
The Effect of Pelvic Position on Popliteal Angle Achieved During 90:90 Hamstring-Length Test
Authors: Herrington Lee
Published: August 2016

Context:

Hamstring muscle length is commonly measured because of its perceived relationship to injury of both the hamstrings themselves and the pelvis and lumbar spine. The popliteal (knee-extension) angle measured from the starting position hip and knee at 90° is a commonly used indirect measure of hamstring muscle length. When this measure has been undertaken in the literature previously, little attention was paid to the position of the pelvis, which may significantly influence measurements taken.

Design:

Repeated-measures.

Setting:

University human performance laboratory.

Participants:

60 healthy physically active males (mean age 20.1 ± 1.8 y, range 18–24 y).

Intervention:

The 2 extremes of pelvic position (anterior and posterior).

Main Outcome Measure:

Popliteal angle (with maximal knee extension) was measured in 2 positions, 1 of full anterior and 1 of full posterior pelvic tilt.

Results:

The mean difference in popliteal angle between anterior to posterior pelvic positions was 13.4° ± 9° (range 0–26°); this was statistically significant (P = .0001).

Conclusion:

The findings of the study indicate that pelvic position has a significant effect on popliteal angle and therefore should be taken into account when measuring hamstring muscle length.
Talofibular Interval Changes After Acute Ankle Sprain: A Stress Ultrasonography Study of Ankle Laxity
Authors: Croy Theodore , Saliba Susan , Saliba Ethan , Anderson Mark W. , Hertel Jay
Published: August 2016

Introduction:

Quantifying talocrural joint laxity after ankle sprain is problematic. Stress ultrasonography (US) can image the lateral talocrural joint and allow the measurement of the talofibular interval, which may suggest injury to the anterior talofibular ligament (ATFL). The acute talofibular interval changes after lateral ankle sprain are unknown.

Methods:

Twenty-five participants (9 male, 16 female; age 21.8 ± 3.2 y, height 167.8 ± 34.1 cm, mass 72.7 ± 13.8 kg) with 27 acute, lateral ankle injuries underwent bilateral stress US imaging at baseline (<7 d) and on the affected ankle at 3 wk and 6 wk from injury in 3 ankle conditions: neutral, anterior drawer, and inversion. Talofibular interval (mm) was measured using imaging software and self-reported function (activities of daily living [ADL] and sports) by the Foot and Ankle Ability Measure (FAAM).

Results:

The talofibular interval increased with anterior-drawer stress in the involved ankle (22.65 ± 3.75 mm; P = .017) over the uninvolved ankle (19.45 ± 2.35 mm; limb × position F1,26 = 4.9, P = .035) at baseline. Inversion stress also resulted in greater interval changes (23.41 ± 2.81 mm) than in the uninvolved ankles (21.13 ± 2.08 mm). A main effect for time was observed for inversion (F2,52 = 4.3, P = .019, 21.93 ± 2.24 mm) but not for anterior drawer (F2,52 = 3.1, P = .055, 21.18 ± 2.34 mm). A significant reduction in the talofibular interval took place between baseline and week 3 inversion measurements only (F1,26 = 5.6, P = .026). FAAM-ADL and sports results increased significantly from baseline to wk 3 (21.9 ± 16.2, P < .0001 and 23.8 ± 16.9, P < .0001) and from wk 3 to wk 6 (2.5 ± 4.4, P = .009 and 10.5 ± 13.2, P = .001).

Conclusions:

Stress US methods identified increased talofibular interval changes suggestive of talocrural laxity and ATFL injury using anterior drawer and inversion stress that, despite significant improvements in self-reported function, only marginally improved during the 6 wk after ankle sprain. Stress US provides a safe, repeatable, and quantifiable method of measuring the talofibular interval and may augment manual stress examinations in acute ankle injuries.
Rehabilitation of the Surgically Repaired Achilles Tendon Using a Dorsal Functional Orthosis: A Preliminary Report
Authors: Heinrichs Kristinn I. , Haney Catherine R.
Published: August 2016

The efficacy of the nonoperative and operative approaches to Achilles tendon rapture has been debated in the literature. In addition, there is little consensus regarding postoperative immobilization with regard to immobilization type, casting position, cast time, and weight-bearing progression. The rehabilitation of the surgically repaired Achilles tendon has not been well described in the literature. The epidemiology and biomechanics of Achilles tendon rupture as well as splint fabrication and rehabilitation protocol for the surgically repaired Achilles tendon in two patients will be presented.
Scapholunate Dissociation and Dorsal Intercalated Segmental Instability in an Adolescent Football Player
Authors: Guskiewicz Kevin M. , Degnan Gregory G. , Schildwachter Thomas L.
Published: August 2016

Ligamentous injuries of the wrist and hand are the most common upper extremity injuries seen in young athletes. Unfortunately, these injuries are also the most frequently misdiagnosed. The “sprained wrist” often becomes the diagnosis of convenience, especially once a fracture has been ruled out. In many cases the athlete is treated symptomatically with cryotherapy, immobilization, and rest, and returns to activity as pain allows. Concern, however, has increased recently over potential complications related to associated ligamentous injuries in young athletes. The most common recognized, carpal instability is between the scaphoid and the lunate, the so-called scapholunate dissociation (3).
The Significance of Closed Chain Kinetics in Upper Extremity Injuries from a Physician's Perspective
Authors: Andrews James R. , Dennison James M. , Wilk Kevin E.
Published: August 2016

Most physicians, trainers, and therapists are accustomed to thinking of open and closed kinetic chain terminology in terms of exercise and its application in rehabilitation protocols. This terminology can also be used to describe the mechanism by which injuries occur. Categorizing upper extremity injuries in this way not only provides vital insight into the mechanism of the injuries and helps identify possible injured structures but also allows the clinician to better develop treatment protocols. In this article, this categorization is applied to common shoulder and elbow injuries to provide insight into the nature of these injuries.
Evaluation of Shoulder Instability Braces
Authors: DeCarlo Mark , Malone Kathy , Gerig Brad , Hunker Mike
Published: August 2016

The comparative abilities of three types of shoulder orthoses to limit motion following isokinetic exercise were studied on 10 male subjects. Maximum active abduction, forward flexion, and external rotation were measured under a control and three braced conditions. Braced conditions included Sawa, Duke Wyre, and Shoulder Subluxation Inhibitor. Subjects performed 10 repetitions each of flexion/extension and abduction/adduction exercise at isokinetic speeds of 120 and 180°/s. Data were analyzed using a pairedt-test and ANOVA. Significant differences were found for each of the devices in pre/post gonio-metric measurements of forward shoulder flexion. Only the Sawa brace demonstrated significant pre/post change for shoulder abduction. No significant differences were detected in any of the devices for external rotation. A trainer who is selecting a motion-limiting shoulder device for an athlete returning to competition following injury should consider the “loosening” effect that may occur during activity as well as the desire for overhead motion.
Vastus Medialis Obliquus and Vastus Lateralis Activity in Patients with and without Patellofemoral Pain Syndrome
Authors: Miller John P. , Sedory Daniel , Croce Ronald V.
Published: August 2016

The purpose of this study was to examine the efficacy of closed kinetic chain exercises in preferentially recruiting the oblique fibers of the vastus medialis obliquus (VMO). Fifteen athletically active females, 6 with patellofemoral pain syndrome (PFPS) and 9 without PFPS, performed two isometric and two dynamic closed kinetic chain exercises. The isometric exercises were a static lunge with 30° of knee flexion (SL@30°) and with 70° of knee flexion (SL@70°). The dynamic exercises were a step-up/step-down exercise (SUSD) and a modified wall slide (MWS). Selective recruitment of the VMO occurred during the MWS (p <.05) and the SUSD in the subjects without PFPS (p <.05). For the SL@70° (p <.01), the MWS (p <.01), and the SUSD (p <.05), subjects with PFPS had greater activity of the vastus lateralis (VL), resulting in a lower VMO: VL ratio for those exercises (p < .05). It was concluded that the closed kinetic chain exercises examined in this study do not preferentially recruit the VMO in individuals with PFPS. In addition, individuals with PFPS have a lower VMO:VL ratio during these exercises compared to individuals without PFPS.
Injury Rehabilitation Programs: “What Are We Talking About?”
Authors: Webborn Anthony D. J. , Carbon Roslyn J. , Miller Brian P.
Published: August 2016

The concept that exercise therapy is an important and integral part of rehabilitation following injury seems to be universally accepted. However, there is little information on athletes' perceptions of understanding their instructions as they relate to the rehabilitation program. A questionnaire study, involving athletes attending a number of multidisciplinary sports injury clinics over a 6-month period, was performed to examine their understanding of the rehabilitation program relating to site, frequency, and repetitions of exercises as well as reason for exercise. Although exercise prescription for injury was assumed to be commonplace, over 150 consultations were observed and only 22 athletes were prescribed rehabilitation exercises (a total of 56 exercises). Seventy-eight percent of these athletes misunderstood some aspect of their programs, although they did not perceive a problem with their instructions. Written instructions were used infrequently (14%), but when used they significantly improved the athletes' understanding. Since rehabilitation adherence is a problem, athletes should receive adequate explanation and written instructions to ensure that the program is followed correctly. Factors affecting treatment adherence are also discussed.
Evaluation-Based Protocol of the Anterior Cruciate Ligament
Authors: Mangine Robert E. , Kremchek Timothy E.
Published: August 2016

This article provides the basis for development of an evaluation-based protocol of the anterior cruciate ligament (ACL). The historical background for ACL protocols is reviewed, and the foundation for protocol development is described. Crucial to the design of a rehabilitation protocol are basic science components, including surgical technique, biomechanics of exercise application, soft tissue healing response, articular cartilage response to injury and surgery, and evaluation fundamentals. The evaluation-based protocol was designed to account for patient variation through a hierarchy approach to exercise and functional levels. To assess the effectiveness of this approach, data are provided that support this protocol format. The outcome data are consistent with data found in the literature. It is concluded that rehabilitation must revolve around intrinsic patient variables, rather than the extrinsic independent variables.
A Comparison of Two Treatment Regimens for Lateral Epicondylitis: A Randomized Trial of Clinical Interventions
Authors: Drechsler Wendy I. , Knarr John F. , Snyder-Mackler Lynn
Published: August 2016

Eighteen subjects participated in a randomized controlled clinical trial to compare the effectiveness of two physical therapy treatments for tennis elbow. The subjects were divided into two groups: In the neural tension group (NTG), the head of the radius was mobilized and specific physical therapy mobilizations were used to address hypomobility of the radial nerve. The standard treatment group (STG) received ultrasound, transverse friction massage, and stretching and strengthening exercises for the extensors of the wrist. All subjects were treated twice weekly for 6 to 8 weeks. Follow-up data were obtained at 3 months post-treatment. Subjects who received radial head mobilization improved over time (p < .05), while those who did not receive radial head mobilization did not improve. Results of the NTG treatment were linked to the radial head treatment, and isolated effects of the NTG treatment could not be determined. There were no long-term positive results in the STG.
Long-Term Use of a Softshell Prophylactic Ankle Stabilizer on Speed, Agility, and Vertical Jump Performance
Authors: Locke Alison , Sitler Michael , Aland Christopher , Kimura Iris
Published: August 2016

The purpose of this study was to determine the effect of a softshell prophylactic ankle stabilizer (PAS) on performance in events involving speed, agility, and vertical jump during long-term use. The events examined were the 24.384-m sprint, 12.192-m shuttle ran, and vertical jump. Subjects were high school basketball players who were randomly assigned to either a PAS (n= 11) or a nonbraced control (n= 13) group. Results of the study revealed that the softshell PAS had no significant effect on any of the three performance events tested over a 3-month basketball season. However, there was a significant difference in 24.384-m sprint and 12.192-m shuttle run times across test sessions regardless of treatment group. In conclusion, the softshell PAS neither enhanced nor inhibited performance in activities involving speed, agility, or vertical jump during long-term use.
Examining Psychological Factors during Injury Rehabilitation
Authors: Theodorakis Yannis , Beneca Anastasia , Malliou Parascevi , Goudas Marios
Published: August 2016

The aim of this study was to examine the effectiveness of goal setting on performance and on a number of psychological variables such as self-efficacy, pretesting anxiety, and self-satisfaction during an injury rehabilitation program. An experimental group (n = 20) and a control group (n = 17) of injured physical education students were studied. Both groups underwent a 4-week quadriceps strengthening program on an isokinetic dynamometer, with the experimental group setting specific personal goals in each training session. The experimental group improved in performance significantly more than the control group. Although both groups exhibited an increase in self-efficacy and a decrease in pretesting anxiety, only the experimental group had an increase in self-satisfaction with performance. Results confirm that incorporating goal setting in the rehabilitation process enhances rehabilitation results.
Migration and Design Characteristics of Functional Knee Braces
Authors: Brownstein Bruce
Published: August 2016

Functional braces are often used as part of a comprehensive rehabilitation protocol following ligamentous injury of the knee. One of the common problems of a functional knee brace is distal migration. This study was undertaken to identify the migration tendencies of 14 commonly used functional knee braces and the design and measurement characteristics that contribute to migration. Two subjects performed 15 min of exercise (5 min each on a treadmill, slide board, and stair machine), and brace position was measured pre-and postexercise. All 14 braces migrated somewhat. Nine of the braces had migration of less than 5 mm and were considered superior. The brace design (active or passive) had a significant effect (p <.05) on migration. No difference (p >.05) was noted for brace type (custom vs. off the shelf) or fit method (cast vs. measuring tool). Based upon this evaluation, an active brace design is recommended for functional knee braces.