Physical Therapy in Sport

Editorial Board

2012-05-01

Lower limb functional tests

Zoe Hudson — 2012-05-01

Clinical assessment has seen a gradual shift in ‘culture’ over the last 10 years from looking predominantly at static stability to dynamic stability in athletes, on the premise that static stability tests are not demanding and discriminatory enough for use in this population. These tests evaluate a number of very different parameters, directly or indirectly and simultaneously. These include motor control, pain, athlete confidence, joint mobility and strength and power. The original research presented in this issue of Physical Therapy in Sport has a focus on these tests from different perspectives. The first study investigates the relationship between strength and landing kinematics in female athletes, a topic which continues to be very popular. The second study looks at the relationship between static and dynamic measures of postural stability and finally, the third reports on visual rating of lower limb functional tests, something we do the whole time during clinical assessment. I am sure these studies will give you pause for thought and make you consider how you use and evaluate lower limb functional tests in your clinical practice.

Clinical evaluation and rehabilitation prescription for knee motion loss

Michael F. Joseph — 2012-02-23

Abstract: Introduction: Range-of-motion (ROM) loss of the knee is commonly treated in rehabilitation settings. Variables that contribute to ROM loss include trauma to the knee joint, surrounding soft tissue, or surgery. The skilled clinician identifies how abnormalities in specific anatomic structures contribute to motion loss and then formulates a logical treatment plan to target these structures. A thorough understanding of the arthrokinematic characteristics of the knee is necessary in order to treat knee ROM loss by guiding effective mobilization techniques.Methods described: An evaluative algorithm is described for the clinical management of knee ROM loss. Methods to identify specific anatomical structures contributing to motion loss leading to the formulation of a logical and effective treatment plan that targets these structures are outlined. The rehabilitation prescription which specifies paramaters of treatment, such as frequency, duration, order, and total volume of interventions should be designed within the context of providing optimal mechanical signal to the healing tissue for remodeling and repair.Purpose: This paper describes evaluative strategies to identify how soft tissue structures contribute to ROM. Formulation of an optimal rehabilitation prescription is discussed.

Trunk muscle activity during spine stabilization exercises performed in a pool

Eadric Bressel, Dennis G. Dolny, Coby Vandenberg, John B. Cronin — 2011-07-11

Abstract: Objectives: To compare trunk muscle activity levels among a variety of therapeutic aquatic exercises designed for patients with low back pain.Study design: Quantitative observational laboratory study.Setting: Sports medicine clinic housed in a University.Participants: Eleven physically active males aged 25.7 ± 5.53 years.Main outcome measures: Surface electromyographic (EMG) data from muscles rectus abdominis (RA), external oblique (EO), lower abdominals (LA), multifidus (MT), and erector spinae (ES) were recorded and then normalized to a maximal voluntary contraction.Results: EMG values during abdominal bracing and Swiss ball exercises for muscles RA, EO, LA, and ES were significantly greater than most other exercises tested that included pelvic tilt, marching, hip abduction, and alternating arm exercises (P = .04–.001). EMG values of muscle LA were also greater for the abdominal hollowing exercise, whereas muscle MT displayed the greatest EMG values during the hip abduction exercise when compared to most other exercises tested (P = .02–.001).Conclusions: The aquatic exercises that maximize trunk muscle activity in the healthy males studied are abdominal bracing and Swiss ball exercises. Some muscles were selectively activated during abdominal hollowing (LA) and hip abduction (MT) exercises when compared to most other exercises.

Time to peak force is related to frontal plane landing kinematics in female athletes

Christopher R. Carcia, Benjamin R. Kivlan, Jason S. Scibek — 2011-07-25

Abstract: Objectives: Determine the relationship between unilateral lower extremity closed kinetic chain muscle performance and unilateral frontal plane landing kinematics.Design: Descriptive.Setting: Outpatient physical therapy clinic.Participants: Twenty adolescent female athletes.Main outcome measures: Unilateral lower extremity muscle performance was quantified at 25° of knee flexion on a computerized leg press. Unilateral frontal plane tibiofemoral kinematics were captured with a bi-axial electrogoniometer during a drop jump maneuver from a 40 cm platform.Results: Peak and average force and force normalized to body weight were not significantly related to frontal plane landing kinematics. Time to peak force however was related to both frontal plane initial contact (r = −0.54; P = 0.013) and peak angles at 100 ms post-contact (r = −0.53; P = 0.016). As time to peak force increased, tibiofemoral angles were in greater amounts of valgus.Conclusions: During an isometric closed kinetic chain unilateral squat test at 25 degrees of knee flexion, the time to peak force is related to frontal plane landing kinematics. Females who take longer to generate peak force are more likely to exhibit valgus kinematic patterns during the landing task. However, strength measures (peak force, average force or peak and average force normalized to body weight) are not associated with unilateral landing kinematics in female athletes.

An examination, correlation, and comparison of static and dynamic measures of postural stability in healthy, physically active adults

Timothy C. Sell — 2011-08-29

Abstract: Objective: To examine the relationship and differences between static and dynamic postural stability in healthy, physically active adults.Design: Descriptive laboratory study.Setting: Research laboratory.Participants: Ten females (age: 21.6 ± 1.2 yrs, mass: 60.8 ± 7.6 kg, height: 165.0 ± 5.0 cm) and ten males (age: 25.1 ± 3.0 yrs, mass: 73.9 ± 8.7 kg, height: 173.5 ± 9.0 cm).Main outcome measures: Static postural stability was measured during a single-leg standing task (standard deviation of the ground reaction forces). Dynamic postural stability was measured during a single-leg landing task using the Dynamic Postural Stability Index. Pearson’s r-coefficients were calculated to examine relationships between the two tests and a one-way ANOVA was calculated to examine potential differences in test scores (p < 0.05).Results: None of the Pearson’s r-coefficients achieved statistical significance. The one-way ANOVA and post hoc comparisons demonstrated that dynamic postural stability scores were significantly higher than static postural stability scores.Conclusions: A lack of a correlation between static and dynamic measures and increase in difficulty during dynamic measures indicates differences in the type and magnitude of challenge imposed by the different postural stability tasks. The more challenging dynamic measures of postural stability may be more suitable for prospective studies examining risk of ankle and knee injury in healthy, physically active individuals.

Physiotherapist agreement when visually rating movement quality during lower extremity functional screening tests

Chris Whatman, Wayne Hing, Patria Hume — 2011-08-29

Abstract: Objectives: To investigate physiotherapist agreement in rating movement quality during lower extremity functional tests using two visual rating methods and physiotherapists with differing clinical experience.Design: Clinical measurement.Participants: Six healthy individuals were rated by 44 physiotherapists. These raters were in three groups (inexperienced, novice, experienced).Main measures: Video recordings of all six individuals performing four lower extremity functional tests were visually rated (dichotomous or ordinal scale) using two rating methods (overall or segment) on two occasions separated by 3–4 weeks. Intra and inter-rater agreement for physiotherapists was determined using overall percentage agreement (OPA) and the first order agreement coefficient (AC1).Results: Intra-rater agreement for overall and segment methods ranged from slight to almost perfect (OPA: 29–96%, AC1: 0.01 to 0.96). AC1 agreement was better in the experienced group (84–99% likelihood) and for dichotomous rating (97–100% likelihood). Inter-rater agreement ranged from fair to good (OPA: 45–79%; AC1: 0.22–0.71). AC1 agreement was not influenced by clinical experience but was again better using dichotomous rating.Conclusions: Physiotherapists’ visual rating of movement quality during lower extremity functional tests resulted in slight to almost perfect intra-rater agreement and fair to good inter-rater agreement. Agreement improved with increased level of clinical experience and use of dichotomous rating.

Elbow isokinetic strength characteristics among collegiate baseball players

Kevin G. Laudner, James T. Wilson, Keith Meister — 2011-08-25

Abstract: Objectives: To compare the bilateral strength characteristics of the wrist flexors, extensors, pronators, and supinators among baseball players.Design: Cross-sectional.Setting: Laboratory.Participants: 30 collegiate baseball players with no recent history of upper extremity injury.Main outcome measures: Bilateral pronation, supination, wrist flexion, and wrist extension peak torque (PT) and peak torque to body weight (PT/BW) strength were measured at speeds of 90 and 180°/second.Results: Paired t-tests showed that the throwing arm of baseball players produced significantly less PT/BW strength for supination at 90°/second compared to the non-throwing arm (P = .001). The throwing arm produced significantly more PT/BW strength for pronation (P = .001) at 180°/second compared to the non-throwing arm. Furthermore, the throwing arm had more PT and PT/BW strength for wrist extension (P < .005) at 180°/second. Conversely, the throwing arm had less PT and PT/BW strength for supination (P < .004) and wrist flexion (P < .004) at 180°/second compared to the non-throwing arm.Conclusions: Significant bilateral strength differences exist in pronation, supination, wrist flexion, and wrist extension among collegiate baseball players.With the steady increase in ulnar collateral ligament injuries of the elbow among baseball players and the proven resistance to valgus force provided by the flexor-pronator mass of the elbow, the results of this study may prove beneficial in the prevention, evaluation, and rehabilitation of such dysfunctions.

Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage: Systematic review and meta-analysis

Rui Torres, Fernando Ribeiro, José Alberto Duarte, Jan M.H. Cabri — 2011-09-15

Abstract: Introduction: Exhaustive and/or unaccustomed exercise, mainly involving eccentric muscle actions, induces temporary muscle damage, evidenced by delayed onset muscle soreness (DOMS) and decreased muscle function. Different strategies to recover from its signs and symptoms have been studied and, as a result, a significant number of articles on this issue have been published.Objective: To assess whether some modalities currently used in physiotherapy such as massage, cryotherapy, stretching and low-intensity exercise are effective for treating the signs and symptoms of exercise-induced muscle damage.Methods: Randomized controlled trials (RCTs), written in English or Portuguese, that included physiotherapeutic interventions [i.e., massage, cryotherapy, stretching and low-intensity exercise, on adult human subjects (18–60 years old) of both gender] were searched on electronic databases including MEDLINE, CINHAL, EMBASE, PEDro and SPORTDiscus.Main outcome measures: “Muscle soreness” and “muscle strength” were the outcome measures included in the meta-analysis.Results: Thirty-five studies were included; nine analysed the effects of massage, 10 examined the effects of cryotherapy, nine investigated the effects of stretching and seven focused on low-intensity exercise intervention.Massage was the only intervention with positive effects, reducing soreness at 24 h, on average, 0.33 on 10 cm visual analog scale (95 percent CI: −0.59, −0.07) and increasing muscle recovery by 1.87 percent (95 percent CI: 0.30, 3.44). Additionally, there is inconclusive evidence to support the use of cryotherapy, while there is little evidence to prove the efficacy of stretching and low-intensity exercise.Conclusion: Massage proved slightly effective in the relief of symptoms and signs of exercise-induced muscle damage. Therefore, its mean effect was too small to be of clinical relevance. There is a lack of evidence to support the use of cryotherapy, stretching and low-intensity exercise.

Treatment of chronic Achilles tendon pain by Kinesio taping in an amateur badminton player

Jung-hoon Lee, Won-gyu Yoo — 2011-09-19

Abstract: Objective: To evaluate the effects of Kinesio taping on a patient with chronic Achilles tendon pain.Design: Case report.Case description: A 22-year-old male amateur badminton player slipped on the ground as he landed after jumping while playing badminton, resulting in chronic Achilles tendon pain of the dominant (right) leg. We performed Achilles tendon taping (ATT) over 5 weeks.Results: The patient’s ultrasonography showed that the tendon thickness was moderately reduced from 0.42 cm to 0.37 cm and that the angles of active dorsiflexion and active plantar flexion without pain increased from 15° to 20° and from 20° to 45°, respectively. The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire score increased from 64 to 95, and the load-induced pain assessment score decreased from 6 to 0. The pain threshold increased from 0.8 kg to 10 kg. The tenderness at 3 kg, assessed on a numeric rating scale, decreased from 7 to 0, and the patient was able to play badminton and soccer without pain.Conclusions: We verified the effect with an increase in the active ankle joint range of motion and the VISA-A questionnaire score, which was achieved by a decrease in tenderness and pain from repeated ATT application.

Diary Dates

2012-05-01