bluuebunny/crossref_metadata_2025 huggingface dataset:
“Oh, the Places You'll Go”1: Transformation of the Nation's Biomedical Research Enterprise in the 21st Century
Authors: Balke C. William , Umberger Gloria H. , Mattacola Carl G.
Published: August 2016

The postgenomic era and heightened public expectations for tangible improvements in the public health have stimulated a complete transformation of the nation's biomedical research enterprise. The National Institutes of Health (NIH) “Roadmap for Medical Research” has catalyzed this transformation. The NIH roadmap consists of several interrelated initiatives, of which the Clinical and Translational Science Award (CTSA) program is the most relevant for rehabilitation specialists. This article reviews the evolution of this transformation and highlights the unprecedented opportunities the CTSA program provides rehabilitation specialists to play leadership roles in improving the clinical care of their patients.
Training and Career Development in Clinical and Translational Science: An Opportunity for Rehabilitation Scientists
Authors: Kelly Thomas H. , Mattacola Carl G.
Published: August 2016

Context:

The National Institutes of Health's Clinical and Translational Science Award initiative is designed to establish and promote academic centers of clinical and translational science (CTS) that are empowered to train and advance multi- and interdisciplinary investigators and research teams to apply new scientific knowledge and techniques to enhance patient care. Among the key components of a full-service center for CTS is an educational platform to support research training in CTS. Educational objectives and resources available to support the career development of the clinical and translational scientists, including clinical research education, mentored research training, and career development support, are described.

Objective:

The purpose of the article is to provide an overview of the CTS educational model so that rehabilitation specialists can become more aware of potential resources that are available and become more involved in the delivery and initiation of the CTS model in their own workplace. Rehabilitation clinicians and scientists are well positioned to play important leadership roles in advancing the academic mission of CTS. Rigorous academic training in rehabilitation science serves as an effective foundation for supporting the translation of basic scientific discovery into improved health care. Rehabilitation professionals are immersed in patient care, familiar with interdisciplinary health care delivery, and skilled at working with multiple health care professionals.

Conclusion:

The NIH Clinical and Translational Science Award initiative is an excellent opportunity to advance the academic development of rehabilitation scientists.
AIDS and Athletic Training
Authors: Strukel Daniel P.
Published: August 2016

Acquired Immune Deficiency Syndrome has only recently begun to receive attention in the field of athletic training. Previously, there was a preconceived notion that athletes were beyond contracting this disease. However, with the announcement of Earvin “Magic” Johnson's contraction of HIV, the virus that leads to AIDS, this concept has fallen by the wayside. Now, many clinicians recognize that the patients they treat may be carrying this virus and thus want to become more knowledgeable about the disease. This article addresses questions concerning transmission of AIDS, prevention of HIV transmission, and precautions that must be undertaken to protect both the athlete and the athletic trainer from this disease. Knowledge about this disease and use of appropriate precautions will substantially decrease the risk of HIV transmission in athletics.
Assessing Reliability and Precision of Measurement: An Introduction to Intraclass Correlation and Standard Error of Measurement
Authors: Denegar Craig R. , Ball Donald W.
Published: August 2016

The reliability and precision of measurement in sports medicine are of concern in both research and clinical practice. The validity of conclusions drawn from a research project and the rationale for decisions made about the care of an injured athlete are directly related to the precision of measurement. Through analysis of variance, estimates of reliability and precision of measurement can be quantified. The purpose of this manuscript is to introduce the concepts of intraclass correlation as an estimate of reliability and standard error of measurement as an estimate of precision. The need for a standardized set of formulas for intraclass correlation is demonstrated, and it is urged that the standard error of measurement be included when estimates of reliability are reported. In addition, three examples are provided to illustrate important concepts and familiarize the reader with the process of calculating these estimates of reliability and precision of measurement.
Unilateral Balance Training of Noninjured Individuals and the Effects on Postural Sway
Authors: Cox Emily D. , Lephart Scott M. , Irrgang James J.
Published: August 2016

The purpose of this study was to provide normative data on postural sway by comparing the mean gain score between two balance training groups and a control group. Twenty-seven recreational collegiate athletes (14 females, 13 males, 18-36 years old) with no past documented lower extremity injury or lesion of the vestibular system were randomly placed into three groups: control (nontraining), foam surface training, or hard surface training. The Chattecx Dynamic Balance System (CDB) was utilized for objective post-and pretraining recordings. CDB tests were performed on the training and nontraining extremities with subjects' eyes open and eyes closed. Results revealed no significant post to pre mean gain score differences within any group, nor was any significance revealed between group differences. Although no significant differences were revealed, trends indicated specificity of training toward testing mode. These data should assist clinicians in preventing ankle injury or compensating for ankle instability with balance training.
Effect of the Swede-O Ankle Brace on Talar Tilt in Subjects with Unstable Ankles
Authors: Carroll Michael J. , Rijke Arie M. , Perrin David H.
Published: August 2016

This study examined the effect of the Swede-O ankle brace on talar tilt in subjects with unstable ankle joints. Six college-age females with talar tilts greater than 9.5° at 15 decaNewtons (daN) of force on a Telos stress test device participated in the study. Each subject was X-rayed at five levels of force (0,6,9, 12, and 15 daN), first with a bare ankle then wearing a Swede-O ankle brace. A two-factor (Brace × Force) analysis of variance revealed a main effect for force, but no main effect for brace and no Brace × Force interaction. For the unbraced ankles, mean displacements were 8.2, 10.4, 11.9, and 13.1° at the four levels of force, respectively. After application of the brace, the talar tilts were 5.7, 8.5, 11.1, and 12.8°, respectively. These findings suggest that the Swede-O ankle brace was not effective in reducing talar tilt in subjects with unstable ankles. Any efficacy of the brace may be due to other factors, such as proprioceptive feedback during inversion.
A Rare injury in Collegiate Athletics—The Lisfranc Fracture-Dislocation
Authors: Gorse Keith M. , Johnstone Graham , Cruse Jennifer
Published: August 2016

A rare injury in collegiate athletics is the Lisfranc fracture-dislocation of the foot. This case study will give team physicians and athletic trainers an idea of what to look for in this type of injury. It will be shown how an 18-year-old college football player received the injury, how it was evaluated by the sports medicine staff, and how it was surgically treated by the team physician. Finally, the athlete's rehabilitation will be summarized and the time frame during which full activities were started again will be outlined. This case study will give sports medicine specialists a better understanding of the Lisfranc topic and how to deal with it.
A Kinematic Comparison of Spring-Loaded and Traditional Crutches
Authors: Seeley Matthew K. , Hunter Iain , Bateman Thomas , Roggia Adam , Larson Brad J. , Draper David O.
Published: August 2016

Context:

A novel spring-loaded-crutch design may provide patients additional forward velocity, relative to traditional axillary crutches; however, this idea has not yet been evaluated.

Objective:

To quantify elastic potential energy stored by spring-loaded crutches during crutch–ground contact and determine whether this energy increases forward velocity for patients during crutch ambulation. Because elastic potential energy is likely stored by the spring-loaded crutch during ambulation, the authors hypothesized that subjects would exhibit greater peak instantaneous forward velocity during crutch–ground contact and increased preferred ambulation speed during spring-loaded-crutch ambulation, relative to traditional-crutch ambulation.

Design:

Within-subject.

Setting:

Biomechanics laboratory.

Participants:

10 healthy men and 10 healthy women.

Interventions:

The independent variable was crutch type: Subjects used spring-loaded and traditional axillary crutches to ambulate at standardized and preferred speeds.

Main Outcome Measures:

The primary dependent variables were peak instantaneous forward velocity and preferred ambulation speed; these variables were quantified using high-speed videography and an optoelectronic timing device, respectively. Between-crutches differences for the dependent variables were evaluated using paired t tests (α = .05). Elastic potential energy stored by the spring-loaded crutches during crutch–ground contact was also quantified via videography.

Results:

Peak forward velocity during crutch–ground contact was 5% greater (P < .001) for spring-loaded-crutch ambulation than for traditional-crutch ambulation. Preferred ambulation speed, however, did not significantly differ (P = .538) between crutch types. The spring-loaded crutches stored an average of 2.50 ± 1.96 J of elastic potential energy during crutch–ground contact.

Conclusions:

The spring-loaded crutches appear to have provided subjects with additional peak instantaneous forward velocity. This increased velocity, however, was relatively small and did not increase preferred ambulation speed.
Rotator-Cuff Muscle-Recruitment Strategies During Shoulder Rehabilitation Exercises
Authors: Swanik Kathleen A. , Bliven Kellie Huxel , Swanik Charles Buz
Published: August 2016

Context:

There are contradictory data on optimal muscle-activation strategies for restoring shoulder stability. Further investigation of neuromuscular-control strategies for glenohumeral-joint stability will guide clinicians in decisions regarding appropriate rehabilitation exercises.

Objectives:

To determine whether subscapularis, infraspinatus, and teres minor (anteroposterior force couple) muscle activation differ between 4 shoulder exercises and describe coactivation ratios and individual muscle-recruitment characteristics of rotator-cuff muscles throughout each shoulder exercise.

Design:

Crossover.

Setting:

Laboratory.

Participants:

healthy, physically active men, age 20.55 ± 2.0 y.

Interventions:

4 rehabilitation exercises: pitchback, PNF D2 pattern with tubing, push-up plus, and slide board.

Main Outcomes Measures:

Mean coactivation level, coactivation-ratio patterns, and level (area) of muscle-activation patterns of the subscapularis, infraspinatus, and teres minor throughout each exercise.

Results:

Coactivation levels varied throughout each exercise. Subscapularis activity was consistently higher than that of the infraspinatus and teres minor combined at the start of each exercise and in end ranges of motion. Individual muscle-recruitment levels in the subscapularis were also different between exercises.

Conclusion:

Results provide descriptive data for determining normative coactivation-ratio values for muscle recruitment for the functional exercises studied. Differences in subscapularis activation suggest a reliance to resist anteriorly directed forces.
Relationships Between Eccentric Hip Isokinetic Torque and Functional Performance
Authors: de Marche Baldon Rodrigo , Lobato Daniel Ferreira Moreira , Carvalho Lívia Pinheiro , Wun Paloma Yan Lam , Presotti Cátia Valéria , Serrão Fábio Viadanna
Published: August 2016

Context:

Recently, attention in sports has been given to eccentric hip-muscle function, both in preventing musculoskeletal injuries and improving performance.

Objective:

To determine the key isokinetic variables of eccentric hip torque that predict the functional performance of women in the single-leg triple long jump (TLJ) and the timed 6-m single-leg hop (TH).

Design:

Within-subject correlational study.

Setting:

Musculoskeletal laboratory.

Participants:

32 healthy women age 18–25 y.

Intervention:

The participants performed 2 sets of 5 eccentric hip-abductor/adductor and lateral/medial-rotator isokinetic contractions (30°/s) and 3 attempts in the TLJ and TH.

Main Outcome Measurements:

The independent variables were the eccentric hip-abductor and –adductor and medial- and lateral-rotator isokinetic peak torque, normalized according to body mass (Nm/kg). The dependent variables were the longest distance achieved in the TLJ normalized according to body height and the shortest time spent during the execution of the TH.

Results:

The forward-stepwise-regression analysis showed that the combination of the eccentric hip lateral-rotator and -abductor isokinetic peak torque provided the most efficient estimate of both functional tests, explaining 65% of the TLJ variance (P < .00l) and 55% of the TH variance (P < .001).

Conclusions:

Higher values for eccentric hip lateral-rotator and hip-abductor torques reflected better performance. Thus, the eccentric action of these muscles should be considered in the development of physical training programs that aim to increase functional performance.
Production of Consistent Pain by Intermittent Infusion of Sterile 5% Hypertonic Saline, Followed by Decrease of Pain With Cryotherapy
Authors: Long Blaine C. , Knight Kenneth L. , Hopkins Ty , Parcell Allen C. , Feland J. Brent
Published: August 2016

Context:

It is suggested that postinjury pain is difficult to examine; thus, investigators have developed experimental pain models. To minimize pain, cryotherapy (cryo) is applied, but reports on its effectiveness are limited.

Objective:

To investigate a pain model for the anterior knee and examine cryo in reducing the pain.

Design:

Controlled laboratory study.

Setting:

Therapeutic modality laboratory.

Participants:

30 physically active healthy male subjects who were free from any lower extremity orthopedic, neurological, cardiovascular, or endocrine pathologies.

Main Outcome Measures:

Perceived pain was measured every minute. Surface temperature was also assessed in the center of the patella and the popliteal fossa.

Results:

There was a significant interaction between group and time (F68,864 = 3.0, P = .0001). At the first minute, there was no difference in pain between the 3 groups (saline/cryo = 4.80 ± 4.87 mm, saline/sham = 2.80 ± 3.55 mm, no saline/cryo = 4.00 ± 3.33 mm). During the first 5 min, pain increased from 4.80 ± 4.87 to 45.90 ± 21.17 mm in the saline/cryo group and from 2.80 ± 3.55 to 31.10 ± 20.25 mm in the saline/sham group. Pain did not change within the no-saline/cryo group, 4.00 ± 3.33 to 1.70 ± 1.70 mm. Pain for the saline/sham group remained constant for 17 min. Cryo decreased pain for 16 min in the saline/cryo group. There was no difference in preapplication surface temperature between or within each group. No change in temperature occurred within the saline/sham. Cooling and rewarming were similar in both cryo groups. Ambient temperature fluctuated less than 1°C during data collection.

Conclusion:

Intermittent infusion of sterile 5% hypertonic saline may be a useful experimental pain model in establishing a constant level of pain in a controlled laboratory setting. Cryotherapy decreased the induced anterior knee pain for 16 min.
Alterations in Peak Ground-Reaction Force During 60-cm Drop Landings Caused by a Single Session of Repeated Wingate Anaerobic Tests
Authors: Dominguese David J , Seegmiller Jeff , Krause B. Andrew
Published: August 2016

Context:

Lower extremity injury is prevalent among individuals participating in sports. Numerous variables have been reported as predisposing risk factors to injury; however, the effects of muscle fatigue on landing kinetics are unclear.

Objectives:

To investigate the effects of a single session of repeated muscle fatigue on peak vertical ground-reaction force (GRF) during drop landings.

Design:

Mixed factorial with repeated measures.

Setting:

Controlled laboratory.

Participants:

10 female and 10 male healthy recreational athletes.

Intervention:

Subjects performed 3 fatigued drop landings (60 cm) after four 20-s Wingate anaerobic tests (WATs) with 5 min of active recovery between fatigued conditions.

Main Outcome Measures:

Kinetic data of peak forefoot (F1) force, peak rear-foot (F2) force, and anteroposterior (AP) and mediolateral (ML) forces at both F1 and F2.

Results:

A significant main effect was observed in the nonfatigued and fatigued drop landings in respect to peak F2 force. The greatest significant difference was shown between the first fatigued drop-landing condition and the last fatigued drop-landing condition. No significant difference was observed between genders for all GRF variables across fatigue conditions.

Conclusion:

A single session of repeated conditions of anaerobic muscle fatigue induced by WATs caused an initial reduction in peak F2 force followed by an increase in peak F2 force across conditions. Muscle fatigue consequently alters landing kinetics, potentially increasing the risk of injury.
Effectiveness of Low-Level Laser Therapy Combined With an Exercise Program to Reduce Pain and Increase Function in Adults With Shoulder Pain: A Critically Appraised Topic
Authors: Thornton Aimee L. , McCarty Cailee W. , Burgess Mollie-Jean
Published: August 2016

Clinical Scenario:

Shoulder pain is a common musculoskeletal condition that affects up to 25% of the general population. Shoulder pain can be caused by any number of underlying conditions including subacromial impingement syndrome, rotator-cuff tendinitis, and biceps tendinitis. Regardless of the specific pathology, pain is generally the number 1 symptom associated with shoulder injuries and can severely affect daily activities and quality of life of patients with these conditions. Two of the primary goals in the treatment of these conditions are reducing pain and increasing shoulder range of motion (ROM).3 Conservative treatment has traditionally included a therapeutic exercise program targeted at increasing ROM, strengthening the muscles around the joint, proprioceptive training, or some combination of those activities. In addition, these exercise programs have been supplemented with other interventions including nonsteroidal anti-inflammatory drugs, corticosteroid injections, manual therapy, activity modification, and a wide array of therapeutic modalities (eg, cryotherapy, EMS, ultrasound). Recently, low-level laser therapy (LLLT) has been used as an additional modality in the conservative management of patients with shoulder pain. However, the true effectiveness of LLLT in decreasing pain and increasing function in patients with shoulder pain is unclear.

Focused Clinical Question:

Is low-level laser therapy combined with an exercise program more effective than an exercise program alone in the treatment of adults with shoulder pain?
Lack of Effect of Superficial Heat to the Knee on Quadriceps Function in Individuals With Quadriceps Inhibition
Authors: Warner Brandon , Kim Kyung-Min , Hart Joseph M. , Saliba Susan
Published: August 2016

Context:

Quadriceps function improves after application of focal joint cooling or transcutaneous electrical nerve stimulation to the knee in patients with arthrogenic muscle inhibition (AMI), yet it is not known whether superficial heat is able to produce a similar effect.

Objective:

To determine quadriceps function after superficial heat to the knee joint in individuals with AMI.

Design:

Single blinded randomized crossover.

Setting:

Laboratory.

Patients:

12 subjects (4 female, 8 males; 25.6 ± 7.7 y, 177.2 ± 12.7 cm, 78.4 ± 18.2 kg) with a history of knee-joint pathology and AMI, determined with a quadriceps central activation ratio (CAR) of <90%.

Intervention:

3 treatment conditions for 15 min on separate days: superficial heat using a cervical moist-heat pack (77°C), sham using a cervical moist pack (room temperature at about 24°C), and control (no treatment). All subjects received all treatment conditions in a randomized order.

Main Outcome Measures:

Central activation ratio and knee-extension torque during maximal voluntary isometric contraction with the knee flexed to 60° were collected at pre, immediately post, 30 min post, and 45 min posttreatment. Skin temperature of the quadriceps and knee and room temperature were also recorded at the same time points.

Results:

Three (treatment conditions) by 4 (time) repeated ANOVAs found that there were no significant interactions or main effects in either CAR or knee-extension torque (all P > .05). Skin-temperature 1-way ANOVAs revealed that the skin temperature in the knee during superficial heat was significantly higher than other treatment conditions at all time points (P < .05).

Conclusions:

Superficial heat to the knee joint using a cervical moist-heat pack did not influence quadriceps function in individuals with AMI in the quadriceps.
Difference in Ratio of Evertor to Invertor Activity Between the Dominant and Nondominant Legs During Simulated Lateral Ankle Sprain
Authors: Knight Adam C. , Weimar Wendi H.
Published: August 2016

Context:

The dominant and nondominant legs respond asymmetrically during landing tasks, and this difference may occur during an inversion perturbation and provide insight into the role of ankle-evertor and -invertor muscle activity.

Objective:

To determine if there is a difference in the ratio of evertor to invertor activity between the dominant and nondominant legs and outer-sole conditions when the ankle is forced into inversion.

Design:

Repeated-measures single-group design.

Setting:

University laboratory.

Participants:

15 physically active healthy volunteers with no previous history of an ankle sprain or lower extremity surgery or fracture.

Interventions:

An outer sole with fulcrum was used to cause 25° of inversion at the subtalar joint after landing from a 27-cm step-down task. Participants performed 10 fulcrum trials on both the dominant and nondominant leg.

Main Outcome Measures:

The ratio of evertor to invertor muscle activity 200 ms before and 200 ms after the inversion perturbation was measured using electromyography. This ratio was the dependent variable. Independent variables included outer-sole condition (fulcrum, flat), leg (dominant, nondominant), and time (prelanding, postlanding). The data were analyzed with separate 2-way repeated-measures ANOVA, 1 for the prelanding ratios and 1 for the postlanding ratios.

Results:

For the postlanding ratios, the fulcrum outer sole had a significantly greater (P < .05) ratio than the flat outer sole, and the nondominant leg had a significantly greater (P < .05) ratio than the dominant leg.

Conclusions:

These results indicate that a greater evertor response is produced when the ankle is forced into inversion, and a greater response is produced for the nondominant leg, which may function better during a postural-stabilizing task than the dominant leg.
The Effectiveness of a Gastrocnemius–Soleus Stretching Program as a Therapeutic Treatment of Plantar Fasciitis
Authors: Garrett Troy R. , Neibert Peter J.
Published: August 2016

Clinical Scenario:

Injury to the plantar fascia, whether acute or chronic, is common among many populations. A conventional multiple-treatment approach is commonly administered by health care providers, consisting of controlling inflammation, managing pain, and promoting healing. Frequently, the initial treatment for plantar fasciitis is targeted at increasing dorsiflexion range of motion by stretching the gastroc-soleus musculature. It has been theorized that inflexibility of the gastroc-soleus complex can lead to excessive pronation and overcompensation of the plantar fascia at the first metatarsal phalangeal joint, therefore increasing the stress at the medial calcaneal insertion. Therefore, it is deemed that gastrocnemius–soleus stretches are a beneficial treatment in the initial stage of a plantar fasciitis treatment or rehabilitation program.

Focused Clinical Question:

Is a gastrocnemius–soleus stretching program, as a stand-alone treatment variable, effective in the treatment of plantar fasciitis?
Effects of Two Semirigid Prophylactic Ankle Stabilizers on Speed, Agility, and Vertical Jump
Authors: Bocchinfuso Christine , Sitler Michael R. , Kimura Iris F.
Published: August 2016

The purpose of this study was to compare the effects of two semirigid prophylactic ankle stabilizers on vertical jump, 80-ft sprint, shuttle run, and four-point run performance. Eight male and seven female high school basketball players, who denied prior ankle injury and prophylactic ankle stabilizer experience, completed the four performance events under the conditions of Active Ankle Training Brace, Aircast SportStirrup, and nonbraced control. Data analyses consisted of four 1 × 3 ANOVAs with repeated measures on the independent variable of brace condition. Results of the analysis revealed no significant differences among the experimental conditions for any of the performance events tested. In conclusion, the Active Ankle Training Brace and Aircast SportStirrup did not facilitate or adversely affect performance involving speed, agility, and vertical jump of high school basketball players.
Tibial Rotation Affects Anterior Displacement of the Knee
Authors: Martin David E. , Guskiewicz Kevin M. , Perrin David H. , Kahler David M. , McCue Frank C.
Published: August 2016

The purpose of this study was to assess anterior translation of the tibia using the Tibial Fixator Device (a mechanical leg stabilizer that controls tibial alignment) with the leg in three positions: neutral (N), internal rotation of 15° (IR), and external rotation of 15° (ER). Displacement was measured using a modified KT-1000 arthrometer. Eleven subjects with anterior cruciate ligament lesions were examined bilaterally in the three positions at 45, 67, and 89 newtons of anterior force. Three-factor repeated-measures ANOVA revealed a significant position effect regardless of force (p < .001). This effect was significant in the injured and noninjured legs. Displacement was greatest in ER and least in IR. These data indicate that the position of the tibia, maintained with an external leg restraint, has a significant effect on anterior displacement of the knee. Control of tibiofemoral alignment and modifications to the KT-1000 provide new potentials for instrumented arthrometry.
The Need for Critical Thinking in Rehabilitation
Authors: Davies George J.
Published: August 2016

There is an increasing emphasis on the use of closed kinetic chain exercises in the testing and rehabilitation of many patients with various pathologies. Because of this increased emphasis, there is a need for critical thinking in rehabilitation. Therefore, the purpose of this article is to provide an overview of the application of critical thinking in the following areas: examination, specific rehabilitation protocols, the need for outcome research, and the rationale and need for the integration of open and closed kinetic chain exercises and their application to testing and rehabilitation.
Effects on Performance of Variable Eccentric Loads during Depth Jumps
Authors: Radcliffe James C. , Osternig Louis R.
Published: August 2016

Seventy subjects were tested for (a) percent body weight controlled (lowered and raised) by the lower extremities via parallel squat exercise, (b) maximum vertical jump-reach, and (c) maximal depth jump-reach from six heights ranging from 0.30 to 1.05 m. The results suggest that maximum parallel squat performance represents a small proportion (8%) of the variance contributing to controlling increasing depth jump heights and that specific improvement in jumping performance may be achieved by relatively small amplitude prestretch movements rather than large depth jump heights. The implications of the present findings for the use of depth jumping in conditioning and rehabilitative protocols are that (a) extreme care must be exercised in selecting jump heights, as there is considerable variability in individual tolerance to a given height, and (b) depth jumping should be contraindicated in cases where high impulse loads can disrupt healing tissue and, if it is used in postinjury situations, should be reserved for the end phase of rehabilitation.
Anatomic and Biomechanical Rationale for Rehabilitation of the Athlete's Shoulder
Authors: Kelley Martin J.
Published: August 2016

Rehabilitation following injury or surgery for the athlete who employs overhead motion is extremely challenging. Shoulder pathophysiology and the repetitive intense demands required during athletic activity need to be fully appreciated for successful rehabilitation. This article discusses new anatomic and biomechanical concepts that require the rehabilitation specialist to reconsider previously accepted notions. Treatment rationale is discussed based on these concepts. Rehabilitation principles and phases are described in a sequentially progressive program based on tissue reactivity and signs and symptoms.
Scapular Muscle Strengthening
Authors: Zmierski Thomas , Kegerreis Sam , Scarpaci James
Published: August 2016

The purposes of this study were (a) to determine the reliability of the Nicholas hand-held dynamometer for measuring scapular adductor strength and (b) to determine if isokinetic strengthening of the scapular adductors while horizontally abducting the shoulder is more effective than strengthening the scapular adductors while extending the shoulder. An isometric make test was used to determine scapular adductor strength before and after a 6-week training program. Intraclass correlation coefficient indicated high pretest and posttest reliability. The individuals who trained the scapular adductors while horizontally abducting the shoulder showed greater increases in mean force values (20.49 kg pretest to 31.74 kg posttest) than the group combining scapular adduction with shoulder extension (19.61 kg pretest and 25.52 kg posttest). ANOVA showed a significant interaction between group and time. It may be more effective to isokinetically strengthen the scapular adductors with shoulder horizontal abduction rather than shoulder extension as a combined movement.
Therapeutic Ultrasound and the Metastasis of a Solid Tumor
Authors: Maxwell Linda
Published: August 2016

Therapeutic ultrasound applied over tumors is thought to promote metastasis. This study was completed to test the hypothesis that repeated application of therapeutic ultrasound accelerates the spread of malignant tumors. Forty mice with subcutaneous Lewis lung cell tumors were assigned as control, sham, or treated animals. Treatment animals were given 5 min of pulsed or continuous ultrasound over the tumors for 6 consecutive days. The mice were sacrificed, the tumors and lungs were removed, and the tissue was examined for evidence of metastasis. A significant increase in the number of metastases was observed in animals treated with continuous (p < .001) and pulsed ultrasound (p < .01). The study provides experimental evidence supporting the clinical advice that therapeutic ultrasound should not be applied to tumors.
Application of Scientific Instrumentation in a Clinical Setting
Authors: Slobounov Semyon M. , Simon Robert , Sebastianelli Wayne , Carlson Angela , Buckley William E.
Published: August 2016

A variety of assessment devices have been developed for scientific investigation on human movement that can also be used to assess the progress of a rehabilitation program. The present investigation was undertaken to show how this technology can be combined with the most aggressive type of medical intervention and rehabilitation. Advanced technology was used to assess the physical rehabilitation parameters of active range of motion (AROM) and sport-specific functional progression for an Olympic-caliber diver who had bilateral wrist problems. AROM was measured for both wrists using a Flock of Birds motion-tracking device, and functional progression was assessed with an Advanced Mechanical Technology Inc. force platform for measuring the center of pressure (CP) area. The results of the treatment were clinically favorable, with an increase in AROM and a decrease in the CP area for functional motor control. The technology provided useful information about the progress of a rehabilitation program.
Incidence of Asymptomatic, Nontraumatic Unilateral Knee Hyperextension in the High School Athlete
Authors: Arangio George A. , Amour-Myers Marie St. , Reed James
Published: August 2016

Four hundred sixty-seven high school athletes were screened in apreparticipation athletic physical. Forty-six (9.8%) of these athletes presented with asymptomatic, nontraumatic unilateral hyperextension. Twenty-three athletes were reexamined and compared to a normal control group. A 2.5-cm, statistically significant heel-to-heel difference was recorded in the hyperextension group. Between the involved hyperextended and uninvolved legs, there were differences in average range of motion (132.04° vs. 130.74°, respectively), average manual anterior translation by KT-1000 (5.39 mm vs. 5.15 mm, respectively), average posterior translation (2.07 mm vs. 2.00 mm, respectively), average peak quadriceps torque (86.25 ft-lb vs. 84.06 ft-lb, respectively), and hamstring average peak torque (53.89 ft-lb vs. 52.93 ft-lb, respectively), though these differences were not statistically significant. In the control group, there was no heel-to-heel difference in the right versus the left knee. Heel-to-heel difference between the experimental and control groups was statistically significant. There was no statistically significant difference between range of motion, anterior translation, or posterior translation between the experimental and control groups.
Plantar Fasciitis in Athletes
Authors: Kaya Bradley K.
Published: August 2016

Plantar fasciitis is a common sports injury that typically presents as heel pain. The purpose of this paper is to review the literature on plantar fasciitis, with emphasis on etiologic factors and current conservative management. A combination of anatomical and biomechanicai factors, repetitive forces, and training errors can predispose an athlete to plantar fasciitis. Most people with plantar fasciitis improve with conservative treatment. Treatment should initially be aimed at decreasing pain and inflammation through rest, modification of activity, medication, orthotics, and physical therapy. Identification of predisposing factors for each athlete is necessary to effectively treat the athlete and return him or her to sports activity. Although many treatment options are suggested in the literature, few have been studied for use with plantar fasciitis. Further research is needed to determine the effectiveness of conservative methods to manage plantar fasciitis.
Clinical Implications of Eccentric Exercise in Sports Medicine
Authors: Keskula Douglas R.
Published: August 2016

Returning an athlete to functional activity is the primary goal of the sports medicine practitioner. Eccentric exercise may be used throughout the rehabilitation program to improve muscle performance and restore normal function. The selection and progression of eccentric exercise are contingent on treatment goals and the individual's tolerance to activity. Basic concepts of eccentric muscle performance are discussed, and general treatment guidelines with an emphasis on specificity and intensity are presented, to enable the clinician to organize and implement relevant, prudent eccentric exercise within the restrictions of the clinical setting. The use of eccentric exercise in the management of tendinitis is briefly discussed.
Effect of Interferential Current on Perceived Pain and Serum Cortisol Associated with Delayed Onset Muscle Soreness
Authors: Schmitz Randy J. , Martin David E. , Perrin David H. , Iranmanesh Ali , Rogol Alan D.
Published: August 2016

The purpose of this study was to assess the effect of interferential current (IFC) on perceived pain and serum Cortisol levels in subjects with delayed onset muscle soreness (DOMS). DOMS was induced in 10 subjects through repeated eccentric contractions of the elbow flexors. Forty-eight hours later subjects were evaluated. Starting at t = 0:00, blood samples were withdrawn from a superficial vein every 5 min for 65 min. At t = 0:05, subjects received IFC of 10 bps or IFC of 100 bps. Perceived pain levels were evaluated prior to catheter insertion and at t = 0:35, 0:50, and 0:65. Two mixed-model analyses of variance revealed a significant decrease in perceived pain scores across time for both treatment groups but no significant difference in serum Cortisol for the two groups. It was concluded that IFC of high and low beat frequency is effective in controlling the pain of DOMS but does not elicit a generalized stress response as indexed by increasing serum Cortisol levels.
Recent Advances in ACL Rehabilitation: Clinical Factors that Influence the Program
Authors: Irrgang James J. , Harner Christopher D.
Published: August 2016

Rehabilitation following ACL reconstruction focuses on treatment of impairments and functional limitations. Clinical pathways that have been developed for rehabilitation of the knee are useful for identifying and classifying impairments and functional limitations following ACL reconstruction. Application of these clinical pathways will enable the physical therapist or athletic trainer to select the most appropriate treatment for an individual. Knowledge of secondary pathology and concomitant surgery allows the clinician to modify application of the clinical pathway. The purpose of this manuscript is to describe modifications for rehabilitation of individuals following ACL reconstruction, based on knowledge of secondary pathology and/or concomitant surgery.
A Three-Year Follow-Up of Long-Term Injured Competitive Athletes: Influence of Psychological Risk Factors on Rehabilitation
Authors: Johnson Urban
Published: August 2016

The rehabilitation of 77 competitive athletes with long-term injuries was followed for 2–3 years from the time of the injury with the aim of identifying potential risk factors in rehabilitation. Seven athletes not returning to competitive sport despite favorable physical records were compared with 5 athletes who returned despite unfavorable records and with 65 athletes whose rehabilitation met expectations. Twelve tests were employed on four different occasions. The results suggested that being younger, being female, and having had no previous experience with injury characterized the nonreturning athlete. An insufficient mental plan for rehabilitation and a predominantly negative attitude toward it, as well as restricted social contacts with fellow athletes and a low mood level, appeared to accompany a problematic and prolonged rehabilitation. It was concluded that the nonreturning, long-term injured athlete can be identified as early as the beginning of the rehabilitation process.
The Efficacy of Modern Motion Tracking and Computer Graphics Technologies in a Clinical Setting
Authors: Slobounov Semyon , Kraemer William , Sebastianelli Wayne , Simon Robert , Poole Shannon
Published: August 2016

The primary purpose of this paper was to demonstrate how modem motion tracking technologies, i.e., the Hock of Birds, and computer visualization graphics may be used in a clinical setting. The idea that joint injury reduces proprioception was investigated, and data for injured subjects were compared to data for noninjured subjects (subjects in all experiments were college students). Two experiments showed that there were no significant losses in joint position sense in knee-injured subjects, and both injured and noninjured groups visually overestimated knee movements. However, injured subjects showed no significant differences when visual reproduction data were compared with actual movement data. In addition, these data indicated that injured subjects may have greater potential for apprehension than noninjured subjects, at least in terms of visual estimation of movement ranges. This is an idea that needs further testing.
Comparison of a New Linear Instrument and the Gravity Goniometer for Assessing Knee Extension ROM among Children
Authors: Hein Vello
Published: August 2016

The purpose of this study was to compare knee extension range of motion (ROM) as measured by a newly constructed linear instrument and by a gravity goniometer among children ages 8–14 years and to establish normative values for these children. The linear instrument recorded the distance in millimeters from the border of an uplifted heel to the measurement table. Coefficients of variation for knee extension were lower when linear measurement was used than with the gravity goniometer. The Pearson product moment correlation coefficient between the two methods of knee extension ROM was r = .79 (p < .001). Mean knee extension ROM was 13.2 ± 8.5 mm, or 2.8 ± 1.9°. Results of this study indicated that the constructed instrument was appropriate for assessing knee extension ROM and may be considered for use by rehabilitation specialists.
An Epidemiologic Survey of Injury in Golfers
Authors: Nicholas John J. , Reidy Margaret , Oleske Denise M.
Published: August 2016

In order to supplement the literature that describes individual injuries of the shoulder, carpal tunnel, and back in golfers, we administered a survey to demonstrate the incidence of golfers' injuries and describe the most frequent types. A questionnaire was administered to 1,790 members of the New York State Golf Association (amateur) under age 21. Three hundred sixty-eight players responded. Half of those responding had been struck by a golf ball at least on one occasion (47.6%), and 23% of the injuries were to the head or neck. Male golfers were 2.66 times more likely to be struck by a golf ball than females. Women and golfers with a higher handicap were at an increased risk for upper extremity problems, whereas younger and overweight golfers were more likely to have golf-related back problems. We concluded that golf is associated with a significant morbidity. Repetitious trunk and upper limb motions probably contribute to musculoskeletal disorders. However, an unexpectedly high incidence of trauma from projectile golf balls leads to the conclusion that no amount of stretching or muscular exercise is as important as increased alertness by golfers to decrease this hazard.
The Reliability of Quadriceps Muscle Stiffness in Individuals with Osgood–Schlatter Disease
Authors: Allison Garry T. , Weston Renee , Shaw Rachael , Longhurst Jocelyn , James Linda , Kyle Kathleen , Nehyba Katrina , Low Suy May , May Michelle
Published: August 2016

The purpose of this study was to assess the reliability of quadriceps muscle stiffness assessments in individuals with Osgood–Schlatter disease (OSD). Ten subjects were tested for four trials on two occasions within a 2-week period on a Kin-Com dynamometer. A regression coefficient was derived from force-angle data to determine stiffness. Intertriai and interday Intraclass correlations (ICC) and standard error of measurement (SEM) were derived from a repeated-measures ANOVA. Between-trial assessments were more reliable for the outer range 65 to 100° knee flexion (ICC = .95 & .81) than the inner range 35 to 65° knee flexion (ICC = .72 & .57) for both sessions. The average SEMs for outer and inner ranges (over 35°) were 1.1 and 1.3 N, respectively. Assessments between days were less reliable, which may reflect the weekly variation in the presentation of athletes' with- OSD. It remains unclear if the SEM lies within the limits of clinical significance.
EMG Analysis of Patients with Unilateral Neck Pain
Authors: Whalen Robert L. , Konstant Steven P. , Worrell Teddy W. , Kegerreis Sam
Published: August 2016

The purpose of this study was to determine whether differences exist in EMG activity between involved and uninvolved upper trapezius muscles in participants with unilateral neck pain. Thirteen volunteers, seen by a physical therapist, gave informed consent. Surface EMG electrodes were placed on involved and uninvolved upper trapezius muscles. Root mean squared EMG activity was measured. Visual analog scales (VASs) for pain were used for each side. Reliability data indicated high ICC (2,1) but also large SEMs and CVs. EMG activity increased from resting to shrugging to abducting positions. Participants perceived greater pain on the involved side than the uninvolved side. EMG readings for individuals were consistent, however, between participants. EMG had high variability. Although participants' VAS scores were consistent with their reports of unilateral neck pain, surface EMG readings did not support the existence of increased muscle activity on the involved side.
Can Thigh Girth Be measured Accurately? A Preliminary Investigation
Authors: Maylia Eric , Fairclough John A. , Nokes Leonard D.M. , Jones Michael D.
Published: August 2016

Thigh girth is often used as an indicator of muscle hypertrophy or atrophy during the rehabilitation process following knee surgery. The measurement of thigh girth, using a conventional plastic tape measure, in an attempt to detect muscle hypertrophy or atrophy may be misleading. It is an inaccurate measure of thigh muscle bulk. Although the sample size is small, the results show that measurements are heavily biased by the expectations of observers, with the result that a considerable change in thigh girth is likely to be ignored.
Effect of Gallium Aluminum Arsenide Triple-Diode Laser on Median Nerve Latency in Human Subjects
Authors: Bartlett William P. , Quillen William S. , Gonzalez Jeanne L.
Published: August 2016

The purpose of this study was to determine the effect of a continuous-wave gallium aluminum arsenide (GaAlAs) triple-diode laser (830 nm, 90 mW) on median nerve motor and sensory evoked potential latencies. This investigation attempted to determine whether the location of treatment, in an area where the median nerve was either superficial or deep, influenced the effectiveness of the laser treatment. Forty-two healthy adult volunteers were randomly assigned to receive 12 J of GaAlAs laser treatment or placebo laser treatment at a single point on the wrist or forearm. The results of this study indicated no difference between the pre- or posttreatment latency measurements in either the placebo laser or the GaAlAs laser group. Motor and sensory latencies varied significantly by location of treatment, but there was no significant interaction between laser treatment group and location. GaAlAs triple-diode laser treatment did not significantly affect median nerve motor or sensory latency.
Effect of Closed Kinetic Chain Training on Neuromuscular Control in the Upper Extremity
Authors: Ubinger Mary E. , Prentice William E. , Guskiewicz Kevin M.
Published: August 2016

When the upper extremity is injured, open kinetic chain (OKC) exercises are primarily used to increase strength and restore functional ability—the goals of rehabilitation. It is also imperative, however, that the receptors responsible for static and dynamic stabilization of the joint be trained. This can be done with closed kinetic chain (CKC) exercises. The purposes of this study were to investigate the effect of a 4-week CKC training program on the neuromuscular control of the upper extremity and to determine whether there was a significant difference between skill-dominant limb and nondominant limb stability indices. Thirty-two physically active participants (14 men, 18 women) were tested on the FASTEX 4 weeks apart. The training group's scores significantly improved, whereas the control group's scores remained the same. It was concluded that the CKC training significantly improved the training group's ability to remain stable. The results suggest that CKC training can increase the accuracy of joint position sense because of increased stimulation of the mechanoreceptors.