Showing papers in "Journal of Orthopaedic & Sports Physical Therapy in 1995"

The Contributions of Proprioceptive Deficits, Muscle Function, and Anatomic Laxity to Functional Instability of the Ankle

Abstract: Functional instability is a common complication following an acute ankle sprain. Three potential contributing factors underlying the ankle which chronically gives way are proprioceptive deficits, muscle weakness, and ligamentous laxity. This study's purpose was to document the presence or absence of these concerns in a sample of subjects with unilateral functional ankle instability. Both ankles of 42 subjects were randomly assessed for passive movement sense into inversion and generation of peak torque by the evertors isokinetically. Thirty-four subjects were available for documentation of talar tilt of both ankles through inversion stress radiographs. Analysis found significantly greater mean values for passive movement sense and talar tilt for the involved ankles compared with the uninvolved, while no significant strength differences in peak torque of the evertors were present. Fifty-eight percent of the sample demonstrated clinical impairments in at least one of these three categories. In conclusion, deficits in passive movement sense and anatomic stability are greater concerns than strength deficits when managing the ankle with functional instability.

Rate of temperature increase in human muscle during 1 MHz and 3 MHz continuous ultrasound.

Abstract: To achieve the thermal effects of ultrasound, the tissue temperature must be raised from 1 to ≥4°C, depending on the desired outcome of the treatment. In the past 25 years, there have been no in vivo studies that have measured rate of change in temperature during 1-MHz ultrasound treatments, and none have ever been performed with the 3-MHz frequency. Thus, we are left to pure speculation regarding how long to administer an ultrasound treatment. We performed this study to plot the rate of temperature increase during ultrasound treatments delivered at various intensities and frequencies. We inserted two 23-gauge thermistors into each subjects' medial triceps surae at the following depths: 1 MHz at depths of 2.5 and 5.0 cm (12 subjects) and 3 MHz at depths of .8 and 1.6 cm (12 subjects). Each subject received a total of four 10-minute treatments, one each at .5, 1.0, 1.5, and 2.0 W/cn2, and temperature was measured every 30 seconds. No significant difference was found in the rate of heating at the two depths...

The effects of proprioceptive ankle disk training on healthy subjects.

Abstract: According to research, proprioceptive training enables injured subjects to reduce proprioceptive deficits and increase postural control. However, the effects of proprioceptive training have not been researched in healthy subjects. This study investigated the effects of Biomechanical Ankle Platform System™ (BAPS) training on postural sway of healthy subjects (N = 28). Subjects were pretested and posttested using the Kistler force platform while performing a single limb stance. The subjects stood on their dominant leg with the opposite hip and knee held in a self-selected position. Subjects trained the dominant leg three times per week for 10 weeks on the BAPS. Experimental subjects showed significant improvements in both the medial-lateral and anterior- posterior parameters of postural sway when compared with a control group. In conclusion, 10 weeks of proprioceptive ankle disk training significantly decreased postural sway in both the medial-lateral and anterior-posterior directions.

Hitting a Baseball: A Biomechanical Description

Abstract: A tremendous amount of time and energy has been dedicated to the development of conditioning programs, mechanics drills, and rehabilitation protocols for the throwing athlete. In comparison, a significantly smaller amount has been spent on the needs of the hitting athlete. Before these needs can be addressed, an understanding of mechanics and the demands placed on the body during the swing must be developed. This study uses three-dimensional kinematic and kinetic data to define and quantify biomechanics during the baseball swing. The results show that a hitter starts the swing with a weight shih toward the rear foot and the generation of trunk coil. As the hitter strides forward, force applied by the front foot equal to 123% of body weight promotes segment acceleration around the axis of the trunk. The hip segment rotates to a maximum speed of 714° /sec followed by a maximum shoulder segment velocity of 937°/sec. The product of this kinetic link is a maximum linear bat velocity of 31 m/sec. By quantifying...

Posture in Patients With Shoulder Overuse Injuries and Healthy Individuals

Abstract: Assessment of posture is an integral component of patient evaluation with shoulder overuse injuries. However, the professional literature contains relatively few studies that have assessed the relationship between posture, function, and injury. The purpose of this study was to determine the relationship and differences in postural variables within and between subjects with overuse injuries to the shoulder of healthy subjects. Thirty patient subjects and 30 healthy subjects matched for age and gender were recruited. Scapular protraction and rotation, forward head position, midthoracic curvature, and passive humeral elevation in the plane of the scapula were measured randomly in standing. All measurement techniques were standardized and validated. lntrarater and interrater reliability for all clinical measures were established before data collection. Forward head position was significantly greater (p < .001) in the patient group than the healthy group; humeral elevation was significantly greater (p < .001) ...

The Effect of Foot Orthotics on Three-Dimensional Kinematics of the Leg and Rearfoot During Running

Abstract: Foot orthotics have been used successfully in the treatment of musculoskeletal symptoms associated with structural variations of the foot. Their effectiveness has been primarily addressed through two-dimensional, frontal plane motion studies of the subtalar joint in individuals considered "clinical pronators." Recent evidence suggests that assessment of tibial axial rotation in combination with frontal plane analysis of calcaneal inversion/eversion may provide improved understanding of subtalar joint function. The purpose of this study was to examine the effects of semi-rigid foot orthotics on three-dimensional lower limb kinematics in 20 recreational runners presenting with distinct structural foot characteristics. Radiographic measurements were used to classify subjects into a low or high rearfoot profile group. The results of the kinematic analysis showed a significant orthotic effect for rotations occurring from heel contact to peak tibial internal rotation, as well as in the coupling relationship between tibial axial rotation and calcaneal inversion/eversion. Both groups responded similarly with a mean reduction of 2 degrees in tibial internal rotation. No differences were found for the frontal plane rotations for either group when orthotics were worn. The findings suggest that the maximum effect of orthotics may be realized in the first 50% of stance and related to the changes in tibial axial rotation.

Relationship of knee extensor strength and hopping test performance in the assessment of lower extremity function.

Abstract: Traditionally, open kinetic chain rehabilitation and evaluation have been used as the primary tool to assess a patient's strength and readiness to progress to a higher functional level. More recently, closed kinetic chain activities have been developed and well documented as an alternate means to prepare and evaluate a patient's ability to return to a higher functional level. However, a dearth in recent literature comparing the correlation between an open kinetic chain isokinetic strength test and performance on a functional performance test exists. Therefore, the purpose of this study was to examine the relationship between a knee extensor strength and functional performance test, specifically the one-legged hop for distance. Twenty subjects (mean = 20.7 years), with no prior history of lower extremity injury, participated in the study consisting of isokinetic evaluation of the quadriceps muscle using a Kinetic Communicator and a one-legged hop for distance. Isokinetic testing was performed at 240 degrees/sec. All tests were performed on the dominant and nondominant limbs. Pearson product moment correlation coefficients for peak torque and distance hopped were .78 for the dominant leg and .65 for the nondominant leg (p < .05). These results support the belief that isokinetic strength does not correlate strongly with functional tasks.

Evaluation and management of foot and ankle disorders: present problems and future directions

Abstract: Recent research has raised serious concerns regarding the reliability and validity of the evaluation and treatment scheme proposed by Root et al. Although the Root et al theory is widely referenced in the physical therapy literature and commonly taught in continuing education courses, current issues of concern include: 1) measurement technique reliability, 2) the criteria proposed for normal foot alignment, and 3) the position of the subtalar joint between midstance and heel-off during walking. The intent of this paper is to review these three problem areas which have been identified with the Root et al theory as well as to propose the use of a "tissue stress model" which the authors have found to be an effective alternative for evaluating and treating foot disorders.

Shoulder kinesthesia in healthy unilateral athletes participating in upper extremity sports.

Abstract: Shoulder kinesthesia has not been extensively studied in upper extremity athletes. The purpose of this study was to determine if there were differences in threshold to detection of passive motion between dominant and nondominant shoulders of healthy overhead athletes in two positions, 0 degrees and 75 degrees of external rotation. In addition, the study attempted to determine if there was a relationship between the range of external rotation (ER) and internal rotation (IR) and the threshold to detection of passive motion values. Shoulder kinesthesia was assessed in the dominant and nondominant shoulders of 20 collegiate athletes participating in unilateral upper extremity sports. A proprioceptive testing device passively moved the shoulder into internal and external rotation. The dominant shoulder had a significantly greater difficulty detecting motion compared with the nondominant arm at both 0 degrees and 75 degrees of external rotation. Both shoulders exhibited enhanced kinesthesia (lower threshold to detection of passive motion scores) at 75 degrees of external rotation compared with 0 degrees, where the glenohumeral joint capsule is relatively taut. The results of this study suggest that healthy upper extremity athletes may have kinesthetic deficits in their throwing shoulder compared with their nondominant shoulder.

Rearfoot posture in subjects with patellofemoral pain.

Abstract: The relationship between structural foot deformities and excessive subtalar joint pronation as being contributory to patellofemoral pain has not been well documented. It was the purpose of this study to assess the rearfoot posture in patients diagnosed with patellofemoral pain compared with a normal population. In addition, the intratester reliability in obtaining rearfoot measurements was assessed for right and left sides in 21 normal subjects. A goniometer was used to measure rearfoot posture in 30 female subjects (15 with patellofemoral pain and 15 controls). Measurements were taken with the subjects prone and the subtalar joint in neutral. Intraclass correlation coefficients were good for both the right and left measurements (.87 and .86, respectively). A small but significant increase in rearfoot varus was found in the patellofemoral pain group compared with the control group (8.9 vs. 6.8 degrees; p = .0002). These results suggest that increased rearfoot varus may be a contributing factor in patellofemoral pain and should be assessed when evaluating the events at the subtalar joint and the lower extremity. In addition, it has been demonstrated that consistent rearfoot measurements can be obtained by an individual clinician.

Exercises for Chronic Low Back Pain: A Clinical Trial

Abstract: Different training models are effective for the treatment of chronic low back pain, but no consensus has been found. Earlier studies have emphasized training of spinal mobility and back strength. To evaluate if other physiological parameters, such as coordination, are of equal importance, we performed a randomized trial on 40 consecutive patients with chronic low back pain. Two training models were compared: 1) intensive training of muscle endurance and 2) muscle training, including coordination. In both groups, training was performed 1 hour twice a week for 3 months. Pain score, disability score, and spinal mobility improved in both training groups without differences between the two groups. Only intensive training of muscle endurance improved isokinetic back muscle strength. At study entry, we found a significant correlation between spinal mobility and dysfunction, but after the training, no correlation was found between improvement of spinal mobility or isokinetic back extension strength and improvemen...

Dynamic foot biomechanics.

Abstract: Since clinicians often encounter patients with symptomatic feet, a basic understanding of "normal" foot function during movement is important for comparison and to assist with treatment strategies. This article provides a selected summary of quantitative information and current research findings relevant to the dynamic function of the foot. Functional descriptions of walking and running biomechanics are provided along with quantitative findings from current biomechanical studies. A classical description of the biomechanics of gait as found in clinical literature is followed by an overview of quantitative findings which document kinematic and kinetic characteristics during walking. The foot kinematics and kinetics which occur during running are presented in the final section. Extensive databases are still not available for most of the biomechanical parameters which affect foot motion. However, as advances in biomechanical methods continue and more clinicians include quantitative techniques in their routine evaluations, more insight into dynamic foot function will be provided.

The effect of velocity and gender on load range during knee extension and flexion exercise on an isokinetic device.

Abstract: Limb acceleration and deceleration during exercise on an isokinetic device encounter no machine-offered resistance. The purpose of this study was to quantify the relationship between velocity and range of motion that is sustained at a predetermined isokinetic velocity, termed load range, during concentric knee extension and flexion exercise. Nine male and nine female subjects performed three maximal concentric reciprocal knee extension and flexion repetitions at 60, 120, 180, 240, 360, and 450 degrees/sec. Extension and flexion results revealed a significant (p < 0.05) increase in acceleration and deceleration range of motion while load range significantly decreased with increasing velocity. Males exhibited greater load range and less acceleration range of motion than females at 240, 360, and 450 degrees/sec, while deceleration range of motion was not different between genders at any speed. These results demonstrate an inverse relationship between isokinetic velocity and load range and suggest a need to carefully consider velocity selection when performing exercise on an isokinetic device.

Alignment and Joint Motion in the Normal Foot

Abstract: Biomechanical evaluation of the foot is based on the assumption that a vertical stance position of the calf and the calcaneus in subtalar neutral (the "ideal foot") provides optimal function with minimal risk of injury. The purpose of this study was to discuss the concept of the "ideal foot" with reference to a set of normative goniometric data. One-hundred and twenty-one healthy subjects (59 men and 62 women; mean age = 35 years; range = 20-50 years) participated in a standardized clinical assessment of ankle and subtalar joint motion, subtalar neutral, forefoot alignment, calcaneal stance, and the tibia to vertical angle. All subtalar measurements were referred to the neutral position. A majority had a subtalar neutral in slight valgus (overall mean = 2 degrees), a forefoot in moderate varus (overall mean = 6 degrees), and a calcaneal stance in valgus (overall mean = 7 degrees). The mean tibia to vertical angle was 6 degrees in varus. Women had a greater range of ankle and subtalar joint motion than men but age had little influence. None of the subjects conformed to the "ideal foot," which appears to be rare and should be abandoned in favor of a reference based on clinical observation rather than on theoretical considerations.

Patellofemoral Joint Compressive Forces in Forward and Backward Running

Abstract: The use of backward running is becoming more common in the rehabilitation setting. In particular, backward running has been suggested as a treatment modality in patients experiencing patellofemoral pain syndrome. To date, no study has examined the loads at the patellofemoral joint during backward running. The purpose of this study was to compare patellofemoral joint compressive forces during forward and backward running. Ground reaction force and kinematic data were collected on five male joggers during free speed forward and backward running. A floor reaction force vector model was used to calculate the stance phase knee extension moments. The distance used for the extensor muscle lever arm was 4.9 cm. Patellar mechanism angle was calculated based on knee joint angle. There was a reduction in the peak patellofemoral joint compressive forces in backward compared with forward running (2277 ± 192N vs. 4253 ± 1292N; p < 0.05) at self-selected speeds. Peak patellofemoral joint compressive force occurred signi...

Lower Quarter Screening for Skeletal Malalignment—Suggestions for Orthotics and Shoewear

Abstract: Skeletal malalignments of the lower quarter, deformities within a bone or at a joint, may be the primary cause of musculoskeletal patient problems. Skeletal malalignments also may sustain the presence of a musculoskeletal patient problem that has some other causal mechanism. A screening exam for skeletal alignment of the lower quarter may assist clinicians in identifying skeletal malalignments that are associated with a musculoskeletal complaint. The purposes of this paper are to: 1) describe components for a skeletal alignment screening exam, 2) analyze how lower quarter malalignments may influence lower quarter function and contribute to the development of musculoskeletal pathology, and 3) suggest general characteristics of foot orthoses and shoes that may assist in the management of musculoskeletal patient problems of the lower quarter.

The Effect of Unilateral Eccentric Weight Training and Detraining on Joint Angle Specificity, Cross-Training, and the Bilateral Deficit

Abstract: Eccentric resistance training is an important component of many rehabilitation protocols. The adaptations following eccentric training are poorly understood in relation to concentric training. The purpose of this investigation was to examine the effects of unilateral eccentric leg extension weight training and detraining on joint angle specificity, cross-training, and the bilateral deficit. Seventeen males volunteered to be subjects for this investigation and were divided into an eccentric training group (N = 9) and a control group (N = 8). The eccentric group performed 8 weeks of unilateral eccentric weight training with the nondominant limb three times per week (3–5 sets of six repetitions) followed by 8 weeks of detraining. These subjects were tested pretraining, posttraining, and following detraining for maximal isometric strength at three joint angles (15, 45, and 75°) in both limbs as well as for the one-repetition maximum (1-RM) eccentric strength of the trained limb, untrained limb, and bilaterall...

Prophylactic ankle bracing vs. taping: effects on functional performance in female basketball players.

Abstract: Ankle support devices are commonly used for prevention and treatment of ankle injury, but the effect of these on sport performance has not been evaluated. The purpose of this study was to evaluate the effect of different ankle support devices on four basketball-related performance tests. Eleven female basketball players underwent four performance tests (vertical jump, jump shot, sprint drill, and submaximal treadmill run) while wearing five different types of ankle support on both ankles (no support, tape, Swede-O-Universal, Active Ankle, and Aircast). Ankle support effect on overall performance was assessed using Friedman's analysis of variance (ANOVA) by ranks and on specific performance parameters using one-way ANOVA for repeated measures. Overall performance was impaired by ankle support. The Active Ankle brace impaired performance the least out of the support devices. Vertical jump was less with ankle tape as compared with no tape (p < .05), whereas jump shot accuracy was better with tape as compared with the Swede-O-Universal (p < .05). Oxygen consumption (VO2) and energy expenditure were higher with the Aircast as compared with tape (p < .05). It was concluded that the use of ankle support by female basketball players does adversely affect basketball-related performance tests, and the prophylactic benefit of bracing needs to be weighed against performance impairment.

The effects of therapeutic application of heat or cold followed by static stretch on hamstring muscle length

Abstract: Hamstring stretching is an important part of treatment programs aimed at decreasing the likelihood of hamstring injury Few studies have examined the use of superficial thermal modalities in conjunction with hamstring stretching The purpose of this study was to determine if the application of a superficial heating or cooling modality, followed by static stretch, increased the efficacy of static stretching of the hamstring muscles This study examined 12 male and 12 female subjects, ages 18-38 All subjects received each of the following treatments: heat followed by static stretch, cold followed by static stretch, and static stretch alone Each treatment was separated by at least 1 week Pre- and post-treatment measurements of hamstring length were obtained using the Active-Knee-Extension (AKE) test The data were analyzed via a 2 x 3 analysis of variance experimental design Results indicated that there was an increase in hamstring length regardless of stretch treatment used, with F(1,23) = 3549, p < 001 However, no significant differences were detected among stretch treatments, F < 10, nor among interaction effects, F < 10 The results of this study suggest that adequate hamstring stretching can occur without the use of a superficial thermal modality

Effect of positive heel inclination on posture.

Abstract: Millions of women wear high heels on a daily basis; however, few studies have analyzed the changes high heels (positive heel inclination) have on posture. The purpose of this study was to determine whether positive heel inclination changed the postural alignment of the head, spine, pelvis, and knees. Fifteen female college students (() had sagittal plane angles measured for the cervical spine, thoracic spine, lumbar spine, sacral spine, and knee joints in addition to anterior/posterior displacements of the head and pelvis. All variables were assessed by a Metrecom Skeletal Analysis System, a three-dimensional electrogoniometer. Six randomized trials, three at zero heel inclination and three at 5 cm positive heel inclination, were measured. Analysis of variance results indicated positive heel inclination of subjects brought about significantly lower anterior pelvic tilt, lumbar lordosis, and sacral base angles when compared with zero heel inclination (p < .01). Clinically, patients with low back pain may b...

The ankle ligaments: consideration of syndesmotic injury and implications for rehabilitation.

Abstract: Injury to the distal tibiofibular syndesmosis (DTFS) may be more common than previously reported. This injury is typically caused by external forces which produce sudden ankle dorsiflexion or plantar flexion in combination with external rotation of the foot. Common mechanisms include direct contact with another player or uneven physical terrain. Improper diagnosis of this injury may greatly delay the return to normal functional status and promote the development of chronic instability, degenerative joint changes, and pain. The purpose of this clinical commentary is to review the ligamentous anatomy of the ankle and the incidence of injury to the lateral ligaments of the ankle, with emphasis on DTFS injury. Special tests which enhance the recognition of DTFS injury, such as the external rotation stress test and the distal tibiofibular compression test, and a rehabilitation progression are presented.

A Reliability Study of Measurement Techniques to Determine Static Scapular Position

Abstract: Current shoulder rehabilitation programs encourage scapular stabilization components although, to date, no scientific studies have evaluated changes in scapular position following such rehabilitation. Four different measurement methods of scapular position have been reported in the literature. The purpose of this study was to examine the intratester and intertester reliability of these four methods and to also examine if significant differences exist in scapular position between dominant and nondominant extremities. Thirty-two subjects volunteered for this study. Intraclass correlation coefficients (ICC) revealed acceptable intratester reliability (ICC = 0.81–0.95) for all measurement methods. However, while one method also proved to be acceptable (ICC = 0.9I–.92) for intertester measurements, the other three methods were unacceptable (ICC = 0.18–0.69). One tester reported significant differences in scapular position of the dominant and nondominant extremities when using the most reliable method. The seco...

The Subtalar Joint: Anatomy and Joint Motion

Abstract: To fully understand the research literature on the efficacy of various clinical procedures, the physical therapist must be knowledgeable in the anatomy and biomechanics of the synovial joints. This paper presents detailed information on the bony, lligamentous, muscular, and vascular anatomy of the subtalar joint. In addition, there is a discussion of the joint axis as well as the joint motions about this axis. This information will prove valuable to the clinician as new examination and treatment procedures are considered for inclusion in the management of patients with foot-ankle dysfunction.

Complexities of Foot Architecture as a Base of support

Abstract: The human foot is a unique structure in the animal kingdom, as it is capable of supporting sustained bipedal gait. The foot facilitates upright walking in several ways: 1) load bearing, 2) leverage, 3) shock absorption, 4) balance, and 5) protection. In this article, we discuss the specialized architecture that enables the foot to accomplish these functions.

Backward walking at three levels of treadmill inclination: an electromyographic and kinematic analysis.

Abstract: Backward walking on a treadmill is a common tool for lower extremity rehabilitation in the clinical setting. The purpose of this study was to evaluate the adaptations in the gait cycle produced by walking backward on a treadmill at 0, 5, and 10% inclination. Sixteen healthy adult subjects (14 females, two males), mean age of 23.19 +/- 3.02, participated. Joint positions for hip, knee, and ankle were measured during a complete gait cycle. Values were time matched with average electromyographic (EMG) activity (surface electrode) of the rectus femoris, hamstrings, gastrocnemius, and anterior tibialis during each subphase of gait (initial contact, midstance, heel-off, and midswing). Values of joint position and average EMG were compared over the three treadmill conditions. Subjects walked for approximately 1 minute at 4.0 km/h. A simple repeated measures analysis of variance (p < .05) with a Duncan post hoc test was used to analyze for changes. Significant changes occurred in the joint positions of the knee and ankle at initial contact (ankle increased from 9.81 +/- 5.06 degrees to 13.08 +/- 3.68 degrees; knee increased from 30.94 +/- 5.25 degrees to 42.42 +/- 4.08 degrees) as the treadmill was raised from 0 to 10%. Significant changes occurred for average EMG activity for each muscle studied over the three treadmill conditions. The greatest changes occurred in the gastrocnemius at initial contact (increase from 189.76 +/- 44.29% to 293.09 +/- 79.16%) between the 0 and 10% conditions. The results of this investigation confirm that backward walking up an incline may place additional muscular demands on an individual.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of two types of foot orthoses on rearfoot mechanics.

Abstract: Little experimental data exist regarding the comparative biomechanical effects of various foot orthoses. This study evaluated the comparative effect of biomechanical orthoses and over-the-counter arch supports on controlling rearfoot pronation. Twenty-four patients with forefoot varus deformity were studied while walking on a treadmill. Two-dimensional, videotape motion analysis was used for studying rearfoot mechanics with three experimental conditions: 1) shoes only, 2) shoes plus arch supports, and 3) shoes plus biomechanical orthoses. The variables studied were: maximum pronation, calcaneal eversion, maximum pronation velocity, time-to-maximum pronation, and total pronation. No difference was noted in maximum pronation, calcaneal eversion, and total pronation between the three conditions. The data for maximum pronation velocity and time-to-maximum pronation were not reliable. Based on the results of this study, padded arch supports nor biomechanical orthoses can be preferentially recommended for their...

Proximal Tibiofibular Subluxation Relationship to Lateral Knee Pain: A Review of Proximal Tibiofibular Joint Pathologies

Abstract: Proximal tibiofibular subluxation is the symptomatic hypermobility of the proximal tibiofibular joint. Pain along the lateral aspect of the knee must be carefully evaluated as the anatomy and biomechanics of this region are very complex. Anatomical variants of the proximal tibiofibular joint may be key to understanding the pathomechanics and, thus, treatment of this joint. The “horizontal” proximal tibiofibular joint has a higher degree of mobility, while the “oblique” joint is relatively immobile to rotational forces on the fibula. Increased fibular external rotation will result in injury to the anterior capsule and ligaments of the proximal tibiofibular joint causing common complaints of “popping” and lateral knee pain. Treatment of proximal tibiofibular subluxation will involve modifications of a patient's activity level and training programs, utilization of a supportive strap, lower leg strengthening, and modifications in the lower kinetic chain biomechanics.

Patellofemoral Pain in Female Ballet Dancers: Correlation With Iliotibial Band Tightness and Tibial External Rotation

Abstract: Review of the literature reveals that ballet dancers have a high incidence of idiopathic patellofemoral pain. Twenty-four female ballet dancers were subjects in a study of the relationship between: 1) iliotibial band (ITB) tightness and patellofemoral pain, and 2) ITB tightness and degrees of tibial external rotation used in the dance demi-plie. Dancers were initially assessed by questionnaire to determine if any had knee pain. Twelve subjects met the study criteria for patellofemoral pain, and 12 dancers without knee pain served as controls for the study, Iliotibial band tightness was measured (Ober test), and degrees of tibial external rotation used during knee flexion (demi-plie) in standing were measured in both legs of all 24 subjects (48 legs). Chi-square analysis of the collected data revealed that there was an association between ITB tightness and patellofemoral pain in the dancers. Data analysis using the Wilcoxon Rank Sum test revealed that the degree of tibial external rotation used by dancers with iliotibial band tightness was significantly greater than those without ITB tightness. This study confirms the assumption that ITB tightness in dancers may be a contributing factor to patellofemoral pain. Follow-up study is indicated to determine if the preservation or restoration of functional ITB length is effective in the prevention and/or treatment of patellofemoral pain in ballet dancers.

Footwear and foot orthotic effectiveness research: a new approach.

Abstract: Measurement of calcaneal inversion and eversion during walking is limited when subjects wear shoes. The authors of this study propose the use of transverse tibial rotation as a viable alternative measurement when barefoot assessment is not possible. The purpose of this study, therefore, was to: 1) determine the relationship between transverse tibial rotation and rearfoot motion during the stance phase of normal walking and 2) demonstrate the usefulness of measuring transverse tibial rotation when evaluating the effect of footwear and insole foot orthotic devices. Part 1 consisted of eight volunteers (five women, three men) whose rearfoot and transverse tibial motion was videotaped while they walked along a 12-m walkway. The results of this study showed that although absolute values were not comparable, the two motion patterns are related to each other. The correlation between the mean rearfoot and tibial motion patterns of all 16 feet was r = .953. Part 2 investigated the effect of footwear and orthotics on transverse tibial rotation using two case presentations. A video camera was positioned in front of each subject as they walked at a self-selected speed under various footwear or orthotic conditions. The results of the case studies revealed that footwear or foot orthotics decrease maximum tibial internal rotation compared with barefoot walking. In addition, internal tibial rotation velocity and acceleration were decreased by the use of shoes, an accommodative orthosis, and an inflatable medial longitudinal arch support. A rigid orthotic produced a slight increase in transverse tibial rotation and a dramatic increase in transverse tibial acceleration.(ABSTRACT TRUNCATED AT 250 WORDS)

Reliability of the figure-of-eight method of ankle measurement.

Abstract: Physical therapists need a reliable method by which to measure ankle girth following injury so that there can be clinical quantification of the volume of edema. The purpose of this study was to examine the intratester and intertester reliability of the ankle figure-of-eight method for the measurement of ankle size. Fifty healthy subjects were positioned on a plinth in a long sitting position. Four measurements were made by each of the three testers for a total of 12 measurements per subject. The intraclass correlation coefficient was 0.99 for intertester reliability and 0.99 for intratester reliability. These results support the use of the ankle figure-of-eight method as a reliable tool for measuring ankle girth.