Showing papers in "Journal of Sport Rehabilitation in 1996"
TL;DR: The relationship between the postural control system and the kinetic chain, traditional and contemporary techniques for assessing balance, and ways in which clinicians can bridge the gap between balance research and clinical practice are reviewed.
Abstract: Returning athletes to competition following injury often creates a dilemma for athletic trainers and team physicians. Most clinicians gather as much data as possible before deciding whether to return an athlete to competition following injury. The status of the postural control system and balance is important for certain pathologies and therefore should be considered in these clinical decisions. As more high-tech balance systems become available, it is important for clinicians to understand not only what is available but what these devices measure. This paper will review the relationship between the postural control system and the kinetic chain, traditional and contemporary techniques for assessing balance, and ways in which clinicians can bridge the gap between balance research and clinical practice.
219 citations
TL;DR: A Functional Classification System has been designed to restore functional shoulder stability, which is dependent upon proper scapulothoracic and glenohumeral stability, and humeral control; all of these are in part mediated by neuromuscular mechanisms.
Abstract: The confusion between the terms open kinetic chain and closed kinetic chain becomes even greater with application to the upper extremity. Upper extremity function is very difficult to define, due to the numerous shoulder positions and the great velocities with which the shoulder can move. Classifying exercises for rehabilitation of the upper extremity is very difficult due to the complexity of the joint. Many definitions and classification systems have been proposed; however, none of these entirely encompass rehabilitation of the upper extremity. Using previous classifications we have developed a Functional Classification System that is designed to serve as a template for upper extremity rehabilitation. This system has been designed to restore functional shoulder stability, which is dependent upon proper scapulothoracic and glenohumeral stability, and humeral control; all of these are in part mediated by neuromuscular mechanisms. The objective of our new Functional Classification System is to restore func...
163 citations
TL;DR: The etiology of delayed onset muscle soreness (DOMS) is not so clear, and the effect on the recovery of muscle function is unknown, so the treatment of DOMS remains an enigma.
Abstract: Muscle soreness, a familiar phenomenon to most athletes, has been differentiated into “acute” and “delayed onset.” The etiology of acute muscle soreness has been attributed to ischemia and the accumulation of metabolic by-products. However, the etiology of delayed onset muscle soreness (DOMS) is not so clear. Six theories have been proposed: lactic acid, muscle spasm, torn tissue, connective tissue, enzyme efflux, and tissue fluid theories. The treatment of DOMS has also been investigated. Studies in which anti-inflammatory medications have been administered have yielded varying results based on the dosage and the time of administration. Submaximal concentric exercise may alleviate soreness but does not restore muscle function. Neither cryotherapy nor stretching abates the symptoms of DOMS. Transcutaneous electrical stimulation has been shown to decrease soreness and increase range of motion, but the effect on the recovery of muscle function is unknown. Therefore, the treatment of DOMS remains an enigma.
114 citations
TL;DR: Proprioception was assessed in 26 subjects by evaluating ankle joint position sense, which was determined by the subjects' ability to actively reproduce a passively positioned joint angle, and showed no significant difference between the braced and the control conditions.
Abstract: The purpose of this study was to determine the proprioceptive effects of ankle bracing and taping. Proprioception was assessed in 26 subjects by evaluating ankle joint position sense, which was determined by the subjects' ability to actively reproduce a passively positioned joint angle. Testing was performed at positions of 30° of plantar flexion and 15° of inversion. Each subject underwent four trials at each test angle under three conditions: braced, taped, and control. For the plantar flexion test, both the braced condition and the taped condition significantly enhanced joint position sense when compared to the control condition. There was no significant difference between the braced and taped conditions. For the inversion test, the taped condition significantly enhanced joint position sense compared to the control condition. There was no significant difference between the braced and the control conditions or between the braced and the taped conditions. This study demonstrates that ankle bracing and ta...
110 citations
TL;DR: Findings suggest that inhibition of the joint receptor afferent fibers adversely affected joint proprioception as assessed while subjects were weight bearing but not while they were non—weight bearing.
Abstract: The purpose of this study was to investigate the effects of induced anesthesia of the lateral ankle joint on proprioception as assessed in weight-bearing and nonweight-bearing conditions. Sixteen subjects were assessed under normal conditions and following an 8-cc injection of lidocaine into the anterior talofibular ligament of the ankle being tested. Center of balance and postural sway measurements were analyzed, revealing a significant lateral adjustment of center of balance during the stable tests compared to a medial adjustment during the dynamic tests under the anesthetized condition. ANOVA of postural sway scores revealed no main effect for condition (anesthesia vs. no anesthesia), but sway scores were higher during the two dynamic conditions as compared to the stable condition. ANOVA of joint position error scores revealed no main effect for condition. Findings suggest that inhibition of the joint receptor afferent fibers adversely affected joint proprioception as assessed while subjects were weight bearing but not while they were non—weight bearing.
68 citations
TL;DR: The purpose of this manuscript is to discuss the scientific rationale for closed kinetic chain for the upper extremity patient, and exercise drills to enhance dynamic stability of theglenohumeral joint are discussed, and a rationale for using these exercises for specific glenohUMeral joint pathologies is provided.
Abstract: The use of closed kinetic chain exercise has grown in the past several years. Closed kinetic chain exercises for the lower extremity have been firmly established in the literature and have been strongly recommended as an integral part of rehabilitation of the patient with anterior cruciate ligament injury. While the scientific and clinical rationale for using closed kinetic chain exercise for the lower extremity appears obvious, the scientific rationale for using closed kinetic chain exercise for the upper extremity is less clear. The purpose of this manuscript is to discuss the scientific rationale for closed kinetic chain for the upper extremity patient. In addition, exercise drills to enhance dynamic stability of the glenohumeral joint are discussed, and a rationale for using these exercises for specific glenohumeral joint pathologies is provided. The concepts of closed and open kinetic chain as applied to the lower extremity may not apply to the upper extremity due to the unique anatomical and biomech...
60 citations
TL;DR: The results validate the necessity for pelvic stabilization in female Division I athletes with chronic low-back pain and confirm the role of scoliosis and spondylolisthesis in CLBP.
Abstract: The purpose of this study was to identify strength and flexibility deficits in subjects with chronic low-back pain (CLBP). Subjects were 16 female Division I athletes: 8 athletes who had experienced CLBP for at least 6 months prior to testing and a control group of 8 matched subjects. Athletes with neurological symptoms, previous back operations, and leg length discrepancies and those who were diagnosed with scoliosis, spondylolisthesis, or spondylolysis were excluded from this study. Variables assessed included abdominal strength, erector spinae endurance, hip flexion and extension endurance, torso lateral flexibility, and low-back flexibility. Strength and endurance were calculated as a function of time in seconds. Goniometric measurements were used to determine flexibility. Significant mean differences were found by using dependent t tests for abdominal strength, erector Spinae endurance, hip extension, and right lateral flexion of the torso. The results validate the necessity for pelvic stabilization ...
49 citations
TL;DR: The authors examined the effect of goal setting on injury rehabilitation, specifically, differences in personal goal setting, selfefficacy, self-efficacy and self-satisfaction, and performance between injured and noninjured subjects.
Abstract: This study examined the effect of goal setting on injury rehabilitation, specifically, differences in personal goal setting, self-efficacy, self-satisfaction, and performance between injured and noninjured subjects. Two experimental groups (32 women with knee injuries and 29 noninjured women) and one control group (n = 30) were used. Subjects performed four trials of a knee extension task on an isokinetic dynamometer. Prior to the third and fourth trials, subjects in the experimental groups set personal goals and completed self-efficacy and self-satisfaction scales. There were significant performance improvements for the two experimental groups; correlation coefficients between self-efficacy, self-satisfaction, goal setting, and performance were significant at the .001 level Personal goal setting was affected by level of ability and in turn had a direct effect on performance. Self-efficacy and self-satisfaction were affected by ability or performance but had no significant effect on personal goals or perf...
49 citations
TL;DR: Reactive neuromuscular training fills the gap left by traditional Rehabilitation following injury by assuming that clinical programs alone using traditional methods will safely return the athlete to function.
Abstract: Enhancing the ability to function within one's environment and to perform activities of daily living is a common goal in rehabilitation. The entire rehabilitation process should be focused on improving the patient's functional status. A functional progression for return to activity can be developed by breaking specific activities down into a hierarchy and then performing them in a sequence that allows for acquisition or reacquisition of skill. Rehabilitation following injury has focused upon restoring muscular strength, endurance, and joint flexibility without any consideration of the role of the neuromuscular mechanism. A common error in rehabilitation is assuming that clinical programs alone using traditional methods will safely return the athlete to function. Limiting athletic rehabilitation to these traditional programs often results in an incomplete restoration of athletic ability and quite possibly an increased risk of reinjury. Reactive neuromuscular training fills the gap left by traditional rehab...
46 citations
TL;DR: In this paper, anatomy and physiology as they relate to closed chain exercise are examined to elucidate its unique contributions to rehabilitation.
Abstract: Closed kinetic chain exercise is a common component of lower extremity rehabilitation. It has virtually replaced open kinetic chain exercise in the treatment of some conditions. In this paper, anatomy and physiology as they relate to closed chain exercise are examined to elucidate its unique contributions to rehabilitation. Claims made about the specificity, functionality, and safety of closed kinetic chain exercise are discussed. Muscle action, the stretch–shortening cycle, joint position sense, and clinical cases are used to illustrate the distinct role of closed kinetic chain exercise in rehabilitation.
44 citations
TL;DR: In this article, the role of social support as a potential moderator variable in the life stress-injury relationship is explored, and the contribution of such a variable to the rehabilitation process is discussed.
Abstract: The vast majority of research dealing with athletic injuries has examined injuries from physical or environmental perspectives. However, there has been a growing awareness of the role of psychosocial factors in the injury process. Specifically, social support has been identified as a variable that may play a significant role in both the etiology of and recovery from athletic injuries. The overall purpose of this discussion is to review and integrate the literature that has examined the role of social support as it relates to athletic injuries. More specifically, this paper will (a) discuss conceptual issues related to social support, (b) explore the role of social support as a potential moderator variable in the life stress-injury relationship, (c) examine the contribution of social support to the rehabilitation process, and (d) suggest directions for future research based on the extant social support literature.
TL;DR: Investigating intratester and intertester reliability when using the Chatillon and MicroFet hand-held dynamometers to measure isometric force production of the wrist extensors, elbow flexors, ankle dorsiflexors, and knee extensor indicated that the HHDs were more reliable when used by a single examiner who had been properly trained in their use.
Abstract: The purpose of this study was to investigate intratester and intertester reliability when using the Chatillon and MicroFet hand-held dynamometers (HHDs) to measure isometric force production of the wrist extensors, elbow flexors, ankle dorsiflexors, and knee extensors. Twelve subjects participated, with each joint tested four times with each HHD. Intratester and intertester intraclass con-elation coefficients were measured for both devices separately and between the devices- Results indicated that the HHDs were more reliable when used by a single examiner who had been properly trained in their use. Reliability of the HHDs appears to be affected by both the magnitude of the force produced by the subject and the examiner's ability to resist the force. There was no correlation between examiner's stature and consistent force production values. Caution should be taken when interpreting data obtained from different testers or different HHDs. The same clinician should use the same HHD for successive tests to yie...
TL;DR: The authors found that psychological factors such as impulsiveness, risk-taking attitude, introaggression, and psychic anxiety did not differentiate multiply injured athletes from other athletes with injuries, while the first-time-injured athletes tended to experience the rehabilitation period as stressful, and they showed less self-confi...
Abstract: Research on rehabilitation of multiply injured athletes shows no convincing evidence that physiological factors exclusively can explain injury-proneness in sport. Neither can any single psychological factor characterize the injury-prone athlete. Injury-proneness seems to be best explained by a complex web of extrinsic and intrinsic risk factors. The present study focused on a comparison of mental factors and coping strategies of high-level athletes with sport injuries. A psychological profile of 25 multiply injured athletes was compared to 14 first-time seriously injured athletes. Factors such as impulsiveness, risk-taking attitude, introaggression, and psychic anxiety did not differentiate multiply injured athletes from other athletes with injuries. The first-time-injured group, however, had psychological difficulties associated with long-term injuries or other serious life crises. The first-time-injured athletes tended to experience the rehabilitation period as stressful, and they showed less self-confi...
TL;DR: The most recent, significant clinical research findings related to closed chain functional testing and rehabilitation of the ankle will be summarized and biomechanical, physiological, and neurological rationales for integrated utilization of open and closed chain rehabilitation for the ankle are discussed.
Abstract: Ankle injuries are the most common type of injury in sport worldwide, with ankle sprains accounting for 15% of all injuries. In this paper, the most recent, significant clinical research findings related to closed chain functional testing and rehabilitation of the ankle will be summarized. Biomechanical, physiological, and neurological rationales for integrated utilization of open and closed chain rehabilitation for the ankle will be discussed.
TL;DR: Treatment should initially be aimed at decreasing pain and inflammation through rest, modification of activity, medication, orthotics, and physical therapy, with emphasis on etiologic factors and current conservative management.
Abstract: 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.
TL;DR: The psychological processes of injured athletes and corresponding treatments along a continuum based on time away from sport are described, with the potential loss of identity in sport and transitions to a new lifestyle being the focus.
Abstract: This paper describes the psychological processes of injured athletes and corresponding treatments along a continuum based on time away from sport. The first level involves injuries requiring rehabilitation of 0 to 2 weeks. Athletes' reactions focus on resiliency and coping with the stress associated with injury, and treatment emphasizes stress management and development of coping strategies. The second level involves injuries requiring rehabilitation of more than 2 weeks; in this level, motivation and compliance with rehabilitation protocols are dealt with, and treatment focuses on goal setting and injury support groups. The third level pertains to injuries resulting in the termination of an athlete's sport participation. This level involves the potential loss of identity in sport and transitions to a new lifestyle, with treatment strategies focusing on grief responses and career counseling. By viewing the psychology of athletic injury rehabilitation from a perspective that is sensitive to the severity of...
TL;DR: 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.
Abstract: 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.
TL;DR: This categorization is applied to common shoulder and elbow injuries to provide insight into the nature of these injuries and help the clinician to better develop treatment protocols.
Abstract: Most physicians, trainers, and therapists are accustomed to thinking of open and closed kinetic chain terminology in terms of exercise and its application in rehabilitation protocols. This terminology can also be used to describe the mechanism by which injuries occur. Categorizing upper extremity injuries in this way not only provides vital insight into the mechanism of the injuries and helps identify possible injured structures but also allows the clinician to better develop treatment protocols. In this article, this categorization is applied to common shoulder and elbow injuries to provide insight into the nature of these injuries.
TL;DR: A trainer who is selecting a motion-limiting shoulder device for an athlete returning to competition following injury should consider the “loosening” effect that may occur during activity as w...
Abstract: The comparative abilities of three types of shoulder orthoses to limit motion following isokinetic exercise were studied on 10 male subjects. Maximum active abduction, forward flexion, and external rotation were measured under a control and three braced conditions. Braced conditions included Sawa, Duke Wyre, and Shoulder Subluxation Inhibitor. Subjects performed 10 repetitions each of flexion/extension and abduction/adduction exercise at isokinetic speeds of 120 and 180°/s. Data were analyzed using a paired t-test and ANOVA. Significant differences were found for each of the devices in pre/post gonio-metric measurements of forward shoulder flexion. Only the Sawa brace demonstrated significant pre/post change for shoulder abduction. No significant differences were detected in any of the devices for external rotation. A trainer who is selecting a motion-limiting shoulder device for an athlete returning to competition following injury should consider the “loosening” effect that may occur during activity as w...
TL;DR: Findings document a relationship between reflex inhibition and joint swelling that was previously described in experimental models where joint edema was simulated.
Abstract: The purpose of this case study was to investigate reflex inhibition of the quadriceps femoris in a subject with postsurgical edema of the left knee. The subject was a 45-year-old male with a traumatic knee injury with resultant edema who underwent elective arthroscopic surgery. Reflex inhibition was assessed by H-reflex elicitation in the femoral nerve and surface electromyography of the quadriceps. To assess the degree of edema, direct circumferential measurements were taken. On the first presurgical visit, the left knee demonstrated mild edema with a decrease in H-reflex amplitudes. Two days after surgery, a further reduction in amplitudes and more swelling were demonstrated followed by an increase in amplitudes and a reduction in edema on the 28th postoperative day. These findings document a relationship between reflex inhibition and joint swelling that was previously described in experimental models where joint edema was simulated.
TL;DR: 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 and the results were clinically favorable.
Abstract: 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.
TL;DR: In this article, the authors explored the interaction between kinematic and kinetic factors and investigated whether this relationship was affected by different speed conditions when subjects exercised on stair-climbing machines.
Abstract: The purpose of this project was to explore the interaction between kinematic and kinetic factors and to investigate whether this relationship was affected by different speed conditions when subjects exercised on stair-climbing machines A secondary purpose was to determine if there were any differences in kinematic and kinetic factors between experienced and inexperienced subjects The kinematic parameters included hip angle, knee angle, and pedal angle The kinetic parameters were maximum force applied on the pedals, maximum force applied on the handrails, maximum hip moment, and maximum knee moment Data from a two-way (Speed × Experience) analysis of variance suggested that there were significant differences in maximum force applied on the pedal maximum force applied on the handrail and maximum hip moment across the speed and experience conditions. In all the testing conditions, using a stair-climbing machine had a smaller impact force on the feet than was found in a previous study that examined impact for...
TL;DR: It is demonstrated that individuals with ACL injuries whose knees hyperextend 3 cm or more sustain significantly more joint damage at the time of injury than in those whose kneesyperextended less than 3 cm.
Abstract: The purpose of this study was to determine whether there was a relationship between knee hyperextension and intra-articular pathology in 100 consecutive patients whose sole ligament injury was an arthroscopically confirmed anterior cruciate ligament (ACL) rupture. Hyperextension of both knees was measured using a supine heel-height measurement of high reliability. There was more articular damage to the total joint, lateral joint, and lateral meniscus in patients who hyperextended than in those who did not. There was more articular damage to the total joint and medial joint in patients who were chronically ACL deficient than in those who were acutely or subacutely ACL deficient. The results demonstrate that individuals with ACL injuries whose knees hyperextend 3 cm or more sustain significantly more joint damage at the time of injury than in those whose knees hyperextend less than 3 cm. This study further defines the role of knee hyperextension in ACL injuries and offers a useful and reliable means of meas...
TL;DR: Arthroscopic abrasion chondroplasty of the knee had a favorable clinical, functional, and radiographic outcome, however, more study is needed with larger samples and longer follow-up before definitive conclusions about the efficacy are drawn.
Abstract: Chondral lesions often occur in the knee as isolated defects or part of more complex injuries. Articular cartilage defects decrease the ability of the knee to sustain weight-bearing loads and may accelerate degeneration of the joint when left untreated. The purpose of this study was to determine the clinical, functional, and radiographic outcome of arthroscopic abrasion chondroplasty of the knee. The Articular Cartilage Rating System was used to assess the location, size, depth, and description of the articular lesion. The Standard Knee Evaluation Form and Cincinnati Knee Rating Scale were used to assess the clinical, functional, and radiographic outcome of the procedure. Average time to postsurgery follow-up was 46 ± 26.69 months. Within the constraints of the present study, arthroscopic abrasion chondroplasty of the knee had a favorable clinical, functional, and radiographic outcome. However, more study is needed with larger samples and longer follow-up before definitive conclusions about the efficacy o...
TL;DR: In healthy young men, growth hormone supplementation has been shown to increase fat-free mass and to decrease fat mass, however, these changes are not accompanied by strength gains, presenting a strong case for athletes to abandon its use as an ergogenic aid.
Abstract: Growth hormone is one of the many dangerous and illegal ergogenic aids currently used by athletes. In those who suffer from a growth hormone deficiency, supplementation does produce positive results: Muscle volume increases while adipose tissue volume is significantly reduced. Growth hormone supplementation can also lead to strength increases in the deficient population (2, 6, 13) as well as in the elderly population (16, 18, 25). In healthy young men, growth hormone supplementation has been shown to increase fat-free mass and to decrease fat mass. However, these changes are not accompanied by strength gains (5, 7, 23, 24). This finding, coupled with the numerous side effects associated with the drug, presents a strong case for athletes to abandon its use as an ergogenic aid.
TL;DR: The exact mechanisms by which DMSO affects the healing process are unknown; however, several studies from the 1980s noted specific effects during various phases of the inflammatory process, such as monocyte and fibroblast activity.
Abstract: Dimethyl sulfoxide (DMSO) was introduced to the medical community in the mid-1960s as a powerful anti-inflammatory agent. Clinical studies and subjective claims abounded about its healing effects on a variety of musculoskeletal injuries. Unfortunately, soon after the incorporation of DMSO into rehabilitation routines, the American Medical Association (AMA) denounced many of the studies of DMSO as being unscientific in nature, and the possibility of toxic effects on the optical lens was noted in an experiment using primates as subjects. As a result, the use of DMSOin the medical community was halted. The exact mechanisms by which DMSO affects the healing process are unknown; however, several studies from the 1980s noted specific effects during various phases of the inflammatory process, such as monocyte and fibroblast activity. Presently, DMSO is considered an investigational drag and has not been approved by the Food and Drag Administration for use with musculoskeletal disorders.