Showing papers in "North American journal of sports physical therapy : NAJSPT in 2008"

The role of massage in sports performance and rehabilitation: current evidence and future direction.

Abstract: Background. Massage is a popular treatment choice of athletes, coaches, and sports physical therapists. Despite its purported benefits and frequent use, evidence demonstrating its efficacy is scarce. Purpose. To identify current literature relating to sports massage and its role in effecting an athlete’s psychological readiness, in enhancing sports performance, in recovery from exercise and competition, and in the treatment of sports related musculoskeletal injuries. Methods. Electronic databases were used to identify papers relevant to this review. The following keywords were searched: massage, sports injuries, athletic injuries, physical therapy, rehabilitation, delayed onset muscle soreness, sports psychology, sports performance, sports massage, sports recovery, soft tissue mobilization, deep transverse friction massage, pre-event, and post exercise.

A systematic review of the effectiveness of eccentric strength training in the prevention of hamstring muscle strains in otherwise healthy individuals.

Abstract: Background Hamstring strains are the most common soft-tissue injury observed in recreational and athletic activities, yet no consensus exists regarding appropriate primary and secondary strategies to prevent these strains. Eccentric exercise has been reported to reduce the incidence of ham-string strains but its role has not been clearly defined.

The chop and lift reconsidered: integrating neuromuscular principles into orthopedic and sports rehabilitation.

Abstract: The upper extremity bilateral PNF patterns, better known as the “chop and lift” are well known to physical therapists. These patterns which utilize spiral and diagonal motions of the upper extremity can be used for both assessment and treatment of sports and orthopedic injuries. Half kneeling and tall kneeling postures fall between low-level postures such as rolling and 4-point, and high-level postures of standing and walking. Half kneeling and tall kneeling can be considered transitional postures. When the chop and lift patterns are used in conjunction with the half and tall kneeling developmental postures, the techniques are an excellent assessment of core stability/instability. Combinations of the upper extremity patterns and the developmental postures can be powerful corrective training techniques. The combined experience of the three authors is used to describe techniques for equipment setup, testing, assessment, and treatment of athletic imbalances. These techniques require and promote instantaneous local muscular activity as developmental postures and balance reactions are incorporated. The therapeutic use of both PNF and developmental patterns has been a hallmark of rehabilitation of patients with neurologic dysfunction, but can be equally and effectively applied in the sports and orthopedic rehabilitation setting.

The effects of different stretching techniques of the quadriceps muscles on agility performance in female collegiate soccer athletes: a pilot study.

Abstract: Background Stretching has long been an integral component of pre-performance activities for a multitude of athletic endeavors. Previous research has demonstrated that stretching may have detrimental effects on performance. Specific knowledge of the precise effects of stretching may influence the decision to appropriately apply stretching techniques in the sport and therapeutic settings. Objective The purpose of this pilot study was to examine the effects of static stretching, proprioceptive neuromuscular facilitation (contract-relax) stretching, and no stretching of the quadriceps muscle group on agility performance. Methods Twelve healthy, female, collegiate soccer players aged 18 - 25 performed one of the three stretching protocols (static, contract-relax, no stretch) and the agility test (T-test) on three non-consecutive days. Agility times were recorded and compared based on stretching technique and day that each test was performed. Results No significant difference was found among the means of the different stretching techniques. The t-test agility performance times were as follows: control, =9.7 seconds; static stretch, =9.73 seconds; and contract-relax, =9.62 seconds. Conclusion The results of this study suggest that agility performance may be independent of stretching technique of the quadriceps performed in female collegiate soccer athletes. It is recommended that female soccer athletes about to engage in agility activity may perform either no stretch, static stretch, or contract-relax stretching according to individual preference.

Multiple ligament knee injury: complications.

Abstract: Non-operative and operative complications are common following multiple ligament knee injuries. This article will describe common complications seen by the surgeon and physical therapist following this complex injury. Complications include fractures, infections, vascular and neurologic complications following injury and surgery, compartment syndrome, complex regional pain syndrome, deep venous thrombosis, loss of motion and persistent laxity issues. A brief description of these complications and methods for evaluation and treatment will be described.

Multiligamentous Knee Injuries – Surgical Treatment Algorithm

Abstract: The concept of multiligamentous knee injuries encompasses a large variety of presenting combinations, and the existing published literature lacks adequately sized prospective comparative patient-reported outcome studies to guide clinical decision making. The decisions of operative versus nonoperative management, timing of surgery, repair versus reconstruction, use of allograft versus auto-graft, choice of which ligaments to treat, and rehabilitation protocols remain controversial despite the fact that multiligament injuries have been shown to represent approximately 11-20% of knee ligament sprains presenting for treatment. For the purposes of this manuscript, a multiligamentous knee injury is defined as one complete cruciate tear (grade III) plus a partial or complete collateral tear (grade II or III) or a partial or complete tear of the other cruciate (grade II or III). A surgical treatment algorithm is proposed based upon a review of case series literature and clinical experience in an academic sports medicine practice setting. Use of our proposed surgical algorithms may facilitate clinical decision making in an attempt to restore stability, preserve function, and maximize return to activity.

Management of the Patient with an ACL/MCL Injured Knee.

Abstract: The knee is a mobile functional anatomical unit which plays a key role in recreational function. In the last three decades, the knee has received a great deal of attention in the sports medicine literature, particularly in respect to isolated ligament pathology and management. In reference to combined multiple ligament pathology, a more limited number of articles exist, and indeed lead to confusing management. Although hundreds of publications address the topic of surgical correction of the anterior cruciate ligament (ACL), debate continues regarding clinical intervention for the patient with combined ACL and medial collateral ligament (MCL) management. Issues exist which the clinician must consider, including which structures require repair, timing of surgical intervention, and rehabilitation approaches. This article will attempt to define a treatment algorithm for the clinician to consider with simultaneous injury to the ACL and MCL.

Medial Foot Loading on Ankle and Knee Biomechanics

Abstract: BACKGROUND: The incidence of anterior cruciate ligament (ACL) injuries among females continues at disproportionate rates compared to males, with research indicating inconclusive multifactorial causality. Data from previous retrospective studies suggest an effect of abnormal foot and ankle biomechanics on pathology at the knee, including the ACL. OBJECTIVE: To determine if a relationship exists between plantar foot loading patterns during normal gait and high risk biomechanics purported to increase risk of ACL injury. METHODS: Dynamic barefoot plantar pressure distribution was measured on 33 female collegiate soccer players. Groups were divided according to their predominant gait loading pattern (medial or lateral). Three dimensional (3-D) motion analysis was conducted during drop vertical jumps to assess vertical ground reaction force and discrete angle and joint moment variables of the lower extremities. RESULTS: No significant differences occured in sagittal or coronal plane knee joint kinematics and kinetics between the medial and lateral loading groups. DISCUSSION: Dynamic foot and ankle biomechanics during gait do not appear to be related to lower extremity kinematics or kinetics during landing in collegiate female soccer players. CONCLUSION: The exact cause of the abnormal differences in female landing biomechanics has not been irrefutably defined. This study suggests no effect of foot and ankle biomechanics exists on the landing mechanics of female soccer players.

Increasing knee range of motion using a unique sustained method.

Abstract: In order for functional and sport specific activities to occur, knee flexion and extension range of motion (ROM) is necessary. Loss of full ROM at the knee joint can be detrimental to the function of the lower extremity and treatment is needed to regain full function of ROM. Research supports the use of the sustained force to increase knee ROM. This article presents a unique method of attaining sustained force. The technique is cost effective, involves equipment already available in most physical therapy clinics, conserves time, and provides consistent force overtime without causing the therapist fatigue. Discussion Despite the fact clinical research has been performed, a poor appreciation exists for the appropriate clinical use of sports massage.

The Effects of Two Adhesive Ankle-Taping Methods on Strength, Power, and Range of Motion in Female Athletes

Abstract: Background Taping is a ubiquitous strategy to help prevent ankle sprains. The restrictive qualities of various taping methods may impair athletic performance.

Biomechanics of Multi-ligament Knee Injuries (MLKI) and Effects on Gait

Abstract: Stability at the knee joint is provided by both the static structures, including the ligaments and joint capsule and the coordinated activation of dynamic structures surrounding the joint. These dual stabilizers allow for functional movements, such as gait, to occur safely, effectively, and efficiently. In the presence of a multi-ligament knee injury (MLKI) an absence of static stability can result in an increased reliance on the dynamic knee stabilizers. If sufficient stability is not provided, the potential for an increase in abnormal movements in the knee joint can result. These potential gait alterations that may be associated with a MLKI can result in abnormally high stresses on healing tissues and potentially high shearing forces on articular cartilage, resulting in early breakdown. Early recognition of gait abnormalities and an appropriate implementation of a gait re-training program to control abnormal forces in a patient following an MLKI or a surgical intervention for a MLKI are critical for successful long-term outcomes.

Physical examination and imaging of the acute multiple ligament knee injury

Abstract: Examination and evaluation of the patient a with multiple ligament injured knee is a complicated process and best done in a methodical, comprehensive fashion with a particular emphasis placed on assessment of supporting soft tissues. Tissues that can be damaged during this devastating injury include bones, ligaments, meniscus, articular cartilage, and neurovascular structures. Uses of diagnostic imaging and the physical examination process will be described in this article.

Functional rehabilitation after medial meniscus repair in a high school football quarterback: a case report.

Abstract: Background Rehabilitation guidelines and functional progression of isolated medial meniscus repair is not well documented in the literature. Due to the importance of the knee menisci, surgical repair of these structures has been very common. Physical therapists need to be aware of the imposed precautions and proper progression of patients post meniscus repair surgery.

Glenohumeral Joint Range of Motion in Elite Male Golfers: A Pilot Study

Abstract: Background Shoulder injuries account for up to 17% of all golf related musculoskeletal injuries. One cause may be the repetitive stresses applied to the lead shoulder during the backswing and follow-through phases, which may contribute to the frequency of these injuries. The “elite” golfer may be pre-disposed to developing a shoulder injury based upon the reported adaptations to the glenohumeral joint.

Anterior cruciate ligament tear in an athlete: does increased heel loading contribute to acl rupture?

Abstract: Rupture to the anterior cruciate ligament is a common athletic injury in American football. The lower extremity biomechanics related to increased ACL injury risk are not completely understood. However, foot landing has been purported to be a significant contributing factor to the ACL injury mechanism. In this case report, information is presented on an athlete previously tested for in-shoe loading patterns on artificial turf and subsequently went on to non-contact ACL rupture on the same surface. This case report describes the specific findings in a study participant who suffered an ACL rupture after testing and suggests that flatfoot tendency in running and cutting maneuvers might lead to an increased risk of ACL injury.

Descriptive report of shoulder range of motion and rotational strength six and 12 weeks following arthroscopic superior labral repair.

Abstract: OBJECTIVES: To measure short-term post surgery glenohumeral internal and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following arthroscopic superior labral (SLAP) repair. BACKGROUND: Physical therapists provide rehabilitation for patients following arthroscopic repair of the superior labrum. Little research has been published regarding the short-term results of this procedure while the patient is typically under the direct care of the physical therapist. METHODS: Charts from 39 patients (7 females and 32 males) with a mean age of 43.4±14.9 years following SLAP repair were reviewed. All patients underwent rehabilitation by the same therapist using a standardized protocol and were operated on and referred by the same orthopaedic surgeon. Retrospective chart review was performed to obtain descriptive profiles of shoulder ROM at 6 and 12 weeks post surgery and isokinetically documented internal and external rotation strength 12 weeks post surgery. RESULTS: At 12 weeks post-surgery, involved shoulder flexion, abduction, and external rotation active ROM values were 2-6 degrees greater than the contralateral, non-involved extremity. Isokinetic internal and external rotation strength deficits of 7-11% were found as compared to the uninjured extremity. Patients completed the self-report section of the Modified American Shoulder Elbow Surgeons Rating Scale and scored a mean of 37/45 points. CONCLUSION: The results of this study provide objective data for both glenohumeral joint ROM and rotator cuff strength following superior labral repair at time points during which the patient is under the direct care of the physical therapist. These results show a nearly complete return of active ROM and muscular strength following repair of the superior labrum and post-operative physical therapy.

Surgical treatment and rehabilitation of combined complex ligament injuries.

Abstract: This article is a description of the surgical treatment and rehabilitation of combined complex ligament injuries A background will be provided, and information on the combined complex knee injuries, selected aspects of surgical treatments, and rehabilitation strategies will be presented Combined complex ligament injuries are devastating injuries and are not very common compared to other knee injuries No meta-analysis or systematic review studies exist regarding the best treatments for these patients This article’s emphasis is on the stages in the rehabilitation program with documentation of the scientific and clinical rationale for the treatment techniques in each stage Treatment interventions are described and documented with the limited evidence available in treating these patients Guidelines for treatment, surgery, and a clinical protocol for treating patients with combined complex ligament injuries are provided for the practicing clinician to use as a template for treating these complicated patients

Concentric internal and eccentric external fatigue resistanc of the shoulder rotator muscles in female tennis players.

Abstract: BACKGROUND Shoulder muscle imbalance is a potential shoulder injury risk factor in athletes performing overhead sports. While normative functional peak strength of concentric external to concentric internal shoulder muscle fatigue data is available, comparisons of functional eccentric external to concentric internal shoulder rotator muscle fatigue resistance, which impacts muscle imbalance throughout the duration of play, have not been studied in this population. OBJECTIVES To assess fatigue resistance of the internal and external shoulder rotator muscles in female tennis players. METHODS Fifteen female collegiate tennis players were tested bilaterally for shoulder concentric internal and eccentric external peak torque production throughout 20 maximal repetitions on a Kin-Com isokinetic dynamometer. Twelve t - tests were conducted to evaluate for differences in peak torque, relative fatigue ratios, and functional peak torque ratios between extremities and mode of activation during the first, as well as, last five repetitions that were conducted. RESULTS Non-dominant concentric internal and eccentric external peak torque production significantly decreased throughout the twenty repetitions. Neither dominant concentric internal peak torque decrements and eccentric peak torque decrements were not significantly different across the twenty contractions. These changes in peak torque upon subsequent repetitions resulted in relative fatigue ratios of dominant eccentric external rotation that were significantly greater than non-dominant eccentric external rotation. Relative fatigue ratios of dominant concentric internal rotation did not differ from non-dominant concentric internal rotation. CONCLUSIONS The data suggest that eccentrically activated external shoulder rotator muscles could possibly adapt to overhead activities by becoming more fatigue resistant.

Clinical Testing for Extra-Articular Lateral Knee Pain. A Modification and Combination of Traditional Tests

Abstract: Knee pain is one of the most common problems encountered by recreational and competitive athletes. Pain over the lateral aspect of the knee can be the result of intra or extra articular conditions. The purpose of this clinical suggestion is to present the modification of a traditional clinical test to aide in the differential diagnosis of lateral knee pain. This method has not been described elsewhere and anecdotally has been helpful in the evaluation of patients with lateral knee pain.

The Effects of Loaded Versus Unloaded Activities on Foot Volumetrics in Older Healthy Adults

Abstract: Background Health care practitioners, including sports physical therapists, commonly prescribe and recommend aerobic exercise for those patients seeking to improve their cardiovascular fitness across all ages. Current literature demonstrates that weight bearing activities such as walking or running may lead to foot and ankle edema.

Immobilization in neutral rotation for a glenohumeral dislocation using a sling and splint.

Abstract: The purpose of this manuscript is to provide an expedient means of immobilizing a glenohumeral dislocation in neutral rotation. This technique for post-reduction immobilization of a glenohumeral dislocation is inexpensive and easy to fabricate. Anterior glenohumeral dislocations often involve an avulsion of the labrum from the glenoid rim. In contrast to immobilization in internal rotation, positioning the shoulder in 0-45° of external rotation approximates the labrum and glenoid rim. It is hypothesized that placing the shoulder in a more externally rotated position could allow for better healing and increased joint stability. This technique places the shoulder in neutral rotation, because 45° of external rotation is awkward and may interfere with certain activities of daily living. Structural aluminum malleable (SAM) splints are used as an alternative to a bolster sling. The SAM splints are lightweight, simply shaped, and easily stored.

Changes in Vertebral Column Height (VCH) at Different Distance Intervals During a 3-Mile Walk.

Abstract: BACKGROUND The purpose of this study was to determine the changes in vertebral column height (VCH) of males and females, at every one-half mile, for a total walking distance of 3 miles. METHODS Twenty males and twenty females between the ages of 21 and 40 years walked 3 miles on a treadmill maintaining a walking speed that the subject rated between 12 and 14 on Borg's rate of perceived exertion scale. Blood pressure, heart rate, and VCH measurements were taken initially and at each half-mile interval throughout the three-mile walk. Vertebral column height (VCH) was measured from the spinous process of C7 to S2 using a standard tape measure. RESULTS Significant differences existed in vertebral column height according to sex (F = 16.18; p < .05) and significant differences in vertebral column height at the different distances (F = 65.02: p < .0001). Significant changes occurred in the VCH between half-mile intervals only between 0.5 miles and 1.0 mile and between 1.0 mile and 1.5 miles during the walk. As found with a regression analysis, curvilinear relationship exists between the distance walked and VCH; with VCH decreasing throughout the distance of the walk. CONCLUSIONS Vertebral column height decreased in a curvilinear relationship throughout the distance of walking 3 miles in both males and females.