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

Background: Many sports involve movements during which the lower extremity functions as a closed kinetic chain, requiring weight-bearing (WB) range of motion (ROM). Assessment of the capacity for internal and external rotation motion at the hip is typically performed with the individual in a prone, supine, or seated position. Such measurements represent ROM in a non-weight bearing (NWB) position, and, as a result, may not appropriately assess the capacity of the joint to meet the demands of the athlete's sport. To date, no research exists which documents WB hip ROM in golfers relative to the ROM demands of the golf swing or the symmetry of weight-bearing hip rotation ROM in female golfers.

Objectives: Weight-bearing hip rotation ROM was measured in female golfers and compared to the actual hip rotation ROM that occurred during a full golf swing.

Methods: Fifteen right-handed, female collegiate golfers participated in the study. The WB hip rotation ROM was measured during three different stance conditions and during full golf swings using a custom-built testing device. These actions were captured using a 3-D motion analysis system.

Results: The golfers WB ROM was symmetrical for external rotation and internal rotation, p = 0.648 and p = 0.078, respectively. During the backswing, the golfers used approximately 20-25% of their available WB right internal rotation, and 50-75% of their available WB left external rotation. For the downswing, the golfers used approximately 34-37% of their available WB right external rotation and 84-131% of their available WB left internal rotation. The golfers used significantly more external and internal hip rotation ROM on the left (lead) hip during both phases of the full golf swing (p < 0.001), demonstrating an asymmetrical movement pattern.

Discussion: In general, golfers did not exceed the measured WB ROM limits during the golf swing but did demonstrate decreased WB internal rotation on the lead hip.

Conclusion: Clinicians need to pay special attention to functional (WB) hip rotation ROM in female golfers in order to assess injury risk related to the rotational hip asymmetry present during the golf swing.

Background: There is no consensus among the existing published evidence as to whether closed kinetic chain (CKC) or open kinetic chain (OKC) exercises should be the intervention of choice following an anterior cruciate ligament (ACL) injury or reconstruction. The commonly held belief has been that OKC exercises cause increased strain on the ACL as well as increased joint laxity and anterior tibial translation.

Objective: To investigate the effects of OKC and CKC exercises on the knees of patients with ACL deficiency or reconstruction.

Data sources: MEDLINE, ProQuest Medical Library, and CINAHL STUDY SELECTION: Six articles were chosen for inclusion in the systematic review. The authors narrowed 50 articles down to 6 by review of titles and abstracts. Included articles were randomized controlled trials written in English, published during 2000-2008, that evaluated the effects of OKC and CKC exercises on ACL deficient or reconstructed knees.

Data extraction: Quality of the included studies was defined by the PEDro scale(1), which has been found to be reliable.(2)

Data synthesis: Scores on the PEDro scale(1) ranged from 4-6/10. One article found positive significant effects with inclusion of OKC exercises in the rehabilitation program and another found significant benefits with combining OKC and CKC exercises. CKC exercises alone were not found by any studies to be superior to OKC exercises.

Conclusion: These studies reveal favorable results for utilization of both open and closed kinetic chain exercises for intervention with ACL deficient or reconstructed knees. However, further research needs to be completed.

Background: Sport specific ergometers are important for laboratory testing (i.e. peak oxygen consumption (VO(2))) and out of season training.

Objectives: The purpose of this study was to compare cardiorespiratory variables during exercise on a double poling ergometer to a field test in elite sit skiers.

Methods: Three male and four female athletes from the Canadian National / Developmental team (17-54 years of age, six with complete paraplegia and one with cerebral palsy) completed a field test and a double poling ergometer protocol separated by at least 24 hours. Both protocols consisted of three maximal trials of skiing of three minutes duration separated by 1.5 minutes of rest. A wireless metabolic system and heart rate monitor were used to measure cardiorespiratory responses [peak heart rate, peak VO(2), and peak respiratory exchange ratio (RER)] during each test. Arterialized blood lactate was measured before the beginning of exercise, after each trial and at 5, 10 and 15 minutes post exercise.

Results: No significant differences existed between the field and ergometer tests for peak oxygen consumption (VO(2)) (field=34.7±5.5 mL·kg-1·min-1 vs. ergometer=33.4±6.9 mL·kg-1·min-1). Significantly higher peak heart rate and RER were found during the ergometer test. Significantly higher lactates were found during the ergometer test after trial 2 and trial 3.

Conclusion: The double poling ergometer is similar to a field test for evaluating peak VO(2) in elite cross country sit skiers; however, the ergometer test elicits a higher heart rate and anaerobic response.

Background: The transversus abdominis (TrA) is a spine stabilizer frequently targeted during rehabilitation exercises for individuals with low back pain (LBP). Performance of exercises on unstable surfaces is thought to increase muscle activation, however no research has investigated differences in TrA activation when stable or unstable surfaces are used.

Objective: The purpose of this study was to investigate whether TrA activation in individuals with LBP is greater when performing bridging exercises on an unstable surface versus a stable surface.

Methods: Fifty one adults (mean ± SD, age 23.1 ± 6.0 years, height 173.60 ± 10.5 cm, mass 74.7 ± 14.5 kg) with stabilization classification of LBP were randomly assigned to either exercise progression utilizing a sling bridge device or a traditional bridging exercise progression, each with 4 levels of increasing difficulty. TrA activation ratio (TrA contracted thickness/TrA resting thickness) was measured during each exercise using ultrasound imaging. The dependent variable was the TrA activation ratio.

Results: The first 3 levels of the sling-based and traditional bridging exercise progression were not significantly different. There was a significant increase in the TrA activation ratio in the sling-based exercise group when bridging was performed with abduction of the hip (1.48 ± .38) compared to the traditional bridge with abduction of the hip (1.22 ± .38; p<.05).

Conclusion: Both types of exercise result in activation of the TrA, however, the sling based exercise when combined with dynamic movement resulted in a significantly higher activation of the local stabilizers of the spine compared to traditional bridging exercise. This may have implications for rehabilitation of individuals with LBP.

Observed gait abnormalities are often related to a variety of foot deformities such as the cavus foot, also known as pes cavus, cavovarus, uncompensated varus, and the high arched foot. When gait abnormalities related to cavus foot deformities produce symptoms or contribute to dysfunctional movement of the lower extremity, foot orthotics are commonly used to accommodate the deformity and optimize the function of the lower extremity. In more severe cases, surgical intervention is common. Hypomobility of the many joints of the foot and ankle may be mistaken as an idiopathic cavus foot deformity. As for any other limb segment suspected of musculoskeletal dysfunction, it is suggested that joint mobility testing and mobilization, if indicated, be attempted on the foot and ankle joints before assuming the presence of a bony cavus deformity. The purpose of this clinical suggestion is to describe the use of osteopathic manipulations of the foot and ankle in the context of an illustrative case of bilateral idiopathic cavus feet to demonstrate that apparent foot deformities may actually be joint hypomobility dysfunctions.

Background: Although it is common practice to administer pre-participation examinations (PPE) of athletes prior to training, there are no clearly established formats. Elements integral to the PPE fall within the scope of physical therapist practice, and are often categorized as a form of primary prevention for musculoskeletal disorders as defined in the Guide to Physical Therapist Practice.

Purpose: The purpose of this study is to describe the design and implementation of a PPE for a women's professional (gridiron) football team. The results and findings from this PPE provide one of the first musculoskeletal profiles and information about selected physical characteristics from members of a female professional football team.

Methods: Players from the Kentucky Karma women's football team, a member of the National Women's Football League (NWFA), volunteered to participate in a PPE. Of twenty-five eligible team members, thirteen consented to participate. The PPE consisted of a health history questionnaire, a musculoskeletal screening, and a series of physical performance and agility tests.

Results: The players' average (± SD) age, height, weight, body mass index (BMI), and body fat percentage were 29.6 (± 5.6) yrs., 1.66 (± .05) m, 66.8 (± 12.6) kg, 24.1 (± 3.7), and 27.4 (± 6.6) %, respectively. Commonly reported injuries were similar to those reported in men's collegiate football.

Conclusion: This is one of the first papers to report on a model PPE for a women's professional football team. Future research is needed to establish a standard PPE, recognize common injuries, and develop prevention strategies unique to women's professional football.

Surfing is enjoyed by many people around the world. A common problem in surfers is back pain during the "take-off," specifically the "pop-up." This article describes each part of the "take-off, and introduces an alternative to the "prone pop up" - called the "knee pop-up." This alternative is a suggested technique to alleviate the stress in the lumbar spine during surfing.

Background and purpose: Limited research suggests that an effect of whole body vibration (WBV) on the central nervous system (CNS) is suppression. An indirect measure used to assess CNS level of activation is the Soleus H-reflex. If true suppression does occur, other factors such as range of motion may be impacted. The purpose of this study was to examine the impact of WBV on H-reflex amplitude and passive ankle dorsiflexion.

Subjects and methods: Twenty-seven healthy volunteers between the ages of 21-41 participated. Subjects were randomly assigned to a control group (n=13) or WBV group (n=14). H-reflex and ankle dorsiflexion measures were assessed before and after a three minute WBV perturbation (40 μHz, amplitude 2-4 mm). These measurements were repeated every five minutes up to twenty minutes following the intervention.

Results: The H-reflex amplitude showed a significant decrease (p<.05) between pre-test and initial post-test for both groups. The H-reflex returned to baseline within five minutes following the intervention. The dorsiflexion range of motion showed significant interaction (p<.05). All changes were less than 5 degrees; therefore, no clear clinical impact was evident.

Conclusions: The observed decrease in H-reflex amplitude immediately following WBV agreed with previous research indicating a lower level of CNS activation. However, since the control group also showed this change, WBV does not appear to be a key cause of suppression. Range of motion was not clinically significant for either group.

Background: Conflicting reports of range of motion (ROM) findings exist related to shoulder instability. Knowledge of range of motion findings among individuals with shoulder subluxation may aid in diagnosis and facilitate appropriate management.

Purpose: The purpose of this study was to compare passive rotation ROM and determine if a symptom-provoking activity alters ROM between patients with shoulder subluxations and healthy controls.

Methods: Seventeen symptomatic patients with shoulder subluxations and 14 healthy controls between the ages of 18 and 35 years were recruited. Lateral and medial rotation ROM measures were taken using a universal goniometer. Symptoms were assessed using a 10cm visual analog scale (VAS). Each group performed a symptom-provoking activity, and VAS and ROM measures were repeated.

Results: A two-factor analysis of variance with repeated measures on pre/post activity demonstrated lower medial rotation measures for the instability group, but no differences for lateral rotation or total range (p < 0.05). A "warm-up" effect was noted, with greater ROM found in each group post activity, with a greater increase noted among controls. Analysis of the ratio of lateral rotation to medial rotation ROM found a significantly greater ratio in the instability group. VAS pain scores were greater in the instability group.

Conclusion: Shoulder subluxation is not necessarily associated with increased rotation ROM, therefore total ROM findings should not be used to screen for instability. Imbalances in rotation ROM may be associated with symptomatic shoulder instability and may have implications for treatment.

Background: Mixed martial arts (MMA) is currently the fastest growing sport in the United States and has recently surpassed boxing as the most popular full contact sport. Due to the physical nature of the sport, MMA is associated with various types of injuries.

Objective: The purpose of this study was aimed at identifying prevalence and assessing the severity, location, and type of injuries in MMA athletes sustained during MMA related activities in the twelve month period prior to the survey.

Methods: A total of fifty-five subjects between the ages of 18 to 39 participated in the study. Participants were given a two-part questionnaire to collect demographic and injury data.

Results: Two hundred seven injuries were reported in the study. Low belt ranks had significantly more injuries more than any other belt rank, resulting in more than two times higher injury rate. Professional fighters had significantly more injuries than amateur fighters, resulting in three times higher injury rate. The most common body region injured was the head/neck/face (38.2%), followed by the lower extremities (30.4%), upper extremities (22.7%), torso (8.2%), and groin (0.5%). Injuries to the nose (6.3%), shoulder (6.3%), and toe (6.3%) were the most common. The most common type of injury was contusions (29.4%), followed by strains (16.2%), sprains (14.9%), and abrasions (10.1%).

Conclusion: Injury prevention efforts should consider the prevalence and distribution of injuries and focus on reducing or preventing injuries to the head/neck/face in MMA related activities. Preventative measures should focus on improving protective equipment during training, and possible competition rule modifications to further minimize participant injury.