North American journal of sports physical therapy : NAJSPT最新文献

This invited clinical commentary summarizes the current state of knowledge in the area of prevention of anterior cruciate ligament (ACL) injuries. ACL injuries occur with a four to six fold greater incidence in female compared to male athletes playing the same high risk sports. The combination of increased risk of ACL injury and a 10-fold increase in sports participation since the enactment of Title IX in 1972 has led to an almost epidemic rise in ACL injuries in female athletes. Examination of the mechanisms responsible for this sex disparity in ACL rupture accelerated in the last two decades. A summary of these findings and a synthesis and framework for understanding the results of the intense investigation of this research are detailed herein. This clinical commentary focuses on the current understanding, identification and interventional targeting of the primary neuromuscular and biomechanical risk factors associated with the ACL injury mechanism in high-risk individuals.

Background: Contusions are common injuries that occur in athletics. If repeated, complications like myositis ossificans can occur. This case describes the examination and treatment of an athlete with an acute soft tissue injury.

Objective: To describe the treatment approach used with a hockey player who sustained a soft tissue injury in his upper extremity.

Case description: A 19 year old male sustained a soft tissue injury to his upper arm while playing hockey. The athlete complained of pain rated a 2-3 out of 10. He had a well circumscribed, firm, 8 by 5 centimeter palpable mass present along the lateral arm, and was able to passively flex his elbow from 56° to 135°, demonstrating a 56° loss of elbow extension. Functionally, he was able to perform most activities of daily living, but he was unable to play hockey. Over 29 days, the athlete was treated one time with pulsed ultrasound and ice and nine times with iontophoresis using a 2% acetic acid solution. Additionally, the athlete performed pain-free active range of motion exercises for the elbow.

Outcome: Following treatment, the athlete's pain resolved, the palpable mass disappeared, and his passive range of motion at the elbow was 0° to 135°. Most importantly, the athlete was able to resume playing hockey.

Discussion: Acetic acid iontophoresis may be a successful intervention for soft tissue injuries of the upper extremity. In this case, it appeared helpful in decreasing the athlete's impairments and contributed to quicker resumption of all functional activities in less time than previously reported in the literature using traditional treatment interventions.

Background: Representative data on typical pitch volume for collegiate pitchers functioning in their specific roles is sparse and is needed for training specificity.

Objective: To report pitch volumes in Division I collegiate pitchers. The authors hypothesize that pitcher role will result in different pitch volumes.

Methods: Pitchers from twelve Division I collegiate baseball teams pitch volume during the 2009 baseball season was retrospectively reviewed through each team's website. The number of pitches and innings pitched for each pitcher were recorded. Pitchers were categorized based on their role as "Starter-only" (n=15), "Reliever-only" (n=76), or "Combined Starter/Reliever" (n=94) and compared using ANOVA.

Results: "Starter-only" pitchers threw the most pitches (97±10) and pitched the most innings (6.0±1.0) per appearance (p=<.001). "Combined Starter/Reliever" functioning as a starter threw significantly more pitches (68±19) and pitched more innings (4.0±1.3) per appearance compared to "Combined Starter/Reliever" functioning as a reliever and "Reliever-only" pitchers (p=<.001). The cumulative volume during a 13 week regular season revealed that "Starter-only" pitchers threw significantly more total pitches (1204±387) compared to "Combined Starter/Reliever" pitchers (613±182) who threw significantly more than "Reliever-only" pitchers (254±77) (P<.001).

Discussion: Pitcher's specific roles and representative volumes should be used to design training and rehabilitation programs. Comparison of this data to reported adolescent pitch volumes reveal that adolescent pitch volume per appearance approaches collegiate levels.

Conclusions: Collegiate pitcher roles dictate their throwing volume. Starter-only pitchers (8%) throw the greatest cumulative number of pitches and should be trained differently than the majority of college pitchers (92%) who function primarily as a reliever or in combination starter/reliever roles that on average only requires approximately 40 pitches per appearance.

Purpose/background: Posterior shoulder tightness (PST) has been implicated in the etiology of numerous shoulder disorders. Therefore, clinicians and researchers must have a reliable and valid method for quantifying PST. The purpose of this study was to investigate the interrater reliability, minimal detectable change at the 90% confidence interval (MDC(90)) and construct validity of an inclinometric measurement designed to quantify PST.

Methods: Two investigators each performed sidelying PST measurements on the non-dominant shoulder of 45 asymptomatic participants in a blinded repeated measures design. Upon completion of the PST measurements, one rater assessed active internal and external rotation for the validity component of the investigation.

Results: Interrater reliability using an intraclass correlation coefficient (ICC) model 2,k was good (ICC 5 0.90). The MDC(90) indicated that a change of greater than or equal to 9 degrees would be required to be 90% certain that a change in the measurement would not be the result of inter-trial variability or measurement error. Construct validity was evaluated using active internal rotation for convergence and external rotation for discrimination. Construct validity was supported by a good to excellent relationship between PST and internal rotation (r 5 0.88) and by an inverse relationship between PST and external rotation (r 5 20.07).

Conclusion: The sidelying procedure described in this investigation appears to be a reliable and valid means for quantifying PST when strict measurement protocols are adhered to. An advantage of this procedure lies in the ability to control scapular position to ensure motion is limited to the glenohumeral joint. Moreover, the use of inclinometry provides an absolute angle of tightness that may be used for intersubject comparison, documenting change, and to determine reference values. Clinicians and researchers should consider the MDC values presented when interpreting change values during subsequent measurement sessions.

Objective: To demonstrate a comparative diagnostic approach between magnetic resonance imaging (MRI) and musculoskeletal ultrasound for detecting UCL trauma of the elbow in a collegiate baseball pitcher.

Background: A 19 year-old male baseball pitcher with no previous history of an elbow injury presented with left medial elbow pain after experiencing a popping sensation during a bull pen throwing session. Patient initially demonstrated palpable tenderness directly over the UCL and a positive milking maneuver. Minimal swelling and no observable discoloration were noted upon examination. Diagnostic ultrasound was utilized to assess the elbow anatomical structures. The differential diagnosis included medial epicondylitis, flexor pronator muscle strain, ulnar collateral ligament tear

Treatment: Initial treatment was conservative while preparing for a ligament reconstruction. Goals included pain control, restoration of range of motion, and reduction of inflammation.

Uniqueness: Accurate diagnosis of UCL disruption was made using dynamic diagnostic musculoskeletal ultrasound despite a negative MRI. The ability to accurately identify the injury contributed to the timeliness of the appropriate surgical intervention and the facilitation of a timely and successful rehabilitation program.

Conclusions: Dynamic musculoskeletal ultrasound may offer an effective option for diagnosing UCL tears of the elbow. Diagnostic musculoskeletal ultrasound is an affordable, accessible, and portable option that provides a clinician with real-time information and accurate observations in the hands of a skilled operator. Diagnostic musculoskeletal ultrasound may play an increased role as a diagnostic tool in the sports medicine community.

Study design: Clinical Measurement, Reliability, Descriptive Study

Objectives: To establish intrarater and interrater reliability of the Side-lying Thoraco-lumbar Rotation Measurement (STRM) and to explore frequencies and magnitude of rotational differences that exist in various musculoskeletal conditions.

Background: Limitation in thoracic rotation could lead to increased motion at adjacent areas (i.e., shoulders and low back). This could potentially lead to excessive strain and subsequent injury from repetitive stress. Currently, there is no well-established method to reliably measure and objectively quantify thoraco-lumbar spine rotation.

Methods: Intrarater reliability was assessed by a single investigator performing three STRM measurements on 10 participants on two consecutive days. Interrater reliability was assessed by two independent examiners, performing the STRM on 30 participants. Reliability was assessed using the intraclass correlation coefficient (ICC) statistic. To explore the incidence and magnitude of side-to-side thoraco-lumbar rotation differences, the STRM was measured on 156 participants of various musculoskeletal conditions.

Results: The intrarater reliability of the STRM was excellent (ICC=.94). The interrater reliability was good (ICC=.88). Fifty four percent of the sample exhibited greater than a 10% side-to-side difference in the STRM while twenty percent exhibited greater than a 20% side-to-side difference.

Conclusion: The STRM can be used as a reliable and objective method to quantify thoraco-lumbar spine rotation. It also appears that a large percentage of patients with varied musculoskeletal complaints may have greater than a 10-20% asymmetry in spinal rotational movement. Future research is needed to determine the clinical applicability and relevance of these findings.

Level of evidence: 4.

A number of sporting and daily activities involve rotation of the spine. The ability to quantify motion of the spine in a clinical setting usually relies on the use of a device to measure angles (goniometer or inclinometer) or visual assessment. Standardized measurement criteria exist for measuring rotation at the cervical and lumbar spine. Little has been written regarding established methods for measuring thoracic spine rotation. Thoracic rotation may be measured in a seated position, half-kneeling position, or quadruped position. Steps should be taken to minimize motion of surrounding segments such as the shoulder and hips, which may improve measurement accuracy. Key words: inclinometer, goniometer, range of motion.

The primary goal of a sports rehabilitation program is to return the injured athlete back to competition as quickly and as safely as possible. Sports physical therapists utilize a variety of exercise equipment to help an athlete restore function after an injury. An injured athlete's therapeutic exercise program frequently includes the prescription of functional strengthening and power exercises during the later stages of rehabilitation. One piece of exercise equipment, the kettlebell, has gained popularity for its ability to allow the user to perform functional power exercises. The unique exercises that can be performed with kettlebells may have utility in sports physical therapy practice. This clinical suggestion outlines the clinical rationale for the inclusion of kettlebell exercises when rehabilitating an athlete with a lower extremity injury.

Frozen shoulder syndrome, clinically known as adhesive capsulitis, is a painful and debilitating condition affecting up to 5% of the population. Adhesive capsulitis is considered fibrosis of the glenohumeral joint capsule with a chronic inflammatory response. Patients experience pain, limited range of motion, and disability generally lasting anywhere from 1 to 24 months. The purpose of this clinical suggestion is to review the pathophysiolgy of adhesive capsulitis and discuss physical therapy interventions which are supported by evidence, thereby enhancing evidence-based practice.

Chronic tendinopathy is a common musculoskeletal disorder that frequently affects athletes who train and compete at all levels. This Clinical Commentary presents a review of the etiology, incidence, and contributory factors related specifically to patellar tendinopathy. Examination and differential diagnosis considerations are provided, and an evidence-based, staged rehabilitation program is described.