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

Background: Thoracic Outlet Syndrome (TOS) involves compression of the brachial plexus, subclavius artery and vein. Many studies discuss efficacy of surgery and few discuss conservative treatment. It is unknown what specific forms of conservative treatment are best.

Objective: Describe conservative management for TOS using unique exercises.

Case description: A collegiate football player reported numbness/tingling down his right arm after a right brachial plexus stretch injury. Seven months later, he was diagnosed with recurrent cervical traction neuropraxia. Two months later, he reported bilateral symptoms and was diagnosed with functional TOS. The athlete began shoulder strengthening (deltoid, middle trapezius, rhomboids, pectoralis major, latissimus dorsi, biceps, upper trapezius and rotator cuff) and stretching (pectoralis, scalene and upper trapezius) which failed to resolve his symptoms after four weeks. Surgical resection of bilateral first ribs and quitting football was recommended by four physicians. Unique therapeutic exercises developed by the Postural Restoration Institute™ were used to optimize respiration/posture via muscle activation and inhibition. After six weeks, the athlete was asymptomatic and returned to football but still experienced paresthesia with contact. Additional exercises were prescribed and remaining symptoms were abolished.

Outcomes: The Northwick Park Neck Pain Questionnaire was 55.5% at initial and 0% at four weeks and discharge.

Discussion: Athlete did not demonstrate relief of symptoms from shoulder stretching and strengthening. Intervention designed to optimize respiration/posture by repositioning the pelvis/trunk via specific muscle inhibition and activation resulted in abolishing the athlete's symptoms. Management that aims to optimize respiration via muscle inhibition, activation, and repositioning warrants further research.

Background: The importance of the scapular stabilizing muscles has led to an increased interest in quantitative measurements of their strength. Few studies have measured isometric or concentric isokinetic forces. Additionally, limited reports exist on the reliability of objective measures for testing scapular protraction and retraction muscle strength or scapular testing that does not involve the glenohumeral joint.

Objective: To determine the reliability of four new methods of measuring the maximal isometric strength of key scapular stabilizing muscles for the actions of protraction and retraction, both with and without the involvement of the glenohumeral (GH) joint.

Methods: The Isobex® stationary tension dynamometer was used to measure the maximal isometric force (kg) on thirty healthy females (ages 22-26 years). Three measures were taken for each method that was sequentially randomized for three separate testing sessions on three nonconsecutive days.

Results: Intraclass correlations (ICC2,3) for intrasession reliability and (ICC3,3) for intersession reliability ranged from 0.95 to 0.98, and 0.94 to 0.96 respectively. The standard errors of measurement (95% confidence interval [CI]) were narrow. Scatter grams for both protraction and retraction testing methods demonstrated a significant relationship, 0.92 for protraction (95% CI 0.83 to 0.96) and 0.93 for retraction (95% CI 0.87 to 0.97). Bland-Altman plots indicated good agreement between the two methods for measuring protraction strength but a weaker agreement for the two methods measuring retraction strength.

Discussion/conclusion: The four new methods assessed in this study indicate reliable options for measuring scapular protraction or retraction isometric strength with or without involving the GH joint for young healthy females.

Background: Female athletes often have inadequate diets due to lack of nutritional knowledge and nutritional misconceptions. Poor nutrition may lead to an increased chance of developing the Female Athlete Triad, a trio of low energy availability, menstrual dysfunction, and low bone mass. Physical therapists, as part of a healthcare team, must be prepared to address nutritional issues, recognize signs and symptoms of the female athlete triad, and make the appropriate intervention or referral.

Objectives: The purpose of this study was to determine the nutritional knowledge of female collegiate swimmers and how effectively they apply their nutritional knowledge to their everyday eating habits.

Methods: Eighty-five female collegiate swimmers from six Michigan universities completed a nutritional knowledge questionnaire and a 24-hour food recall survey. Demographic, nutritional, and statistical data were analyzed.

Results: The mean score on nutritional knowledge test was 54.53/76 (71.75% correct). Mean total caloric intake of swimmers was 3229.10 calories per day. Ninety-five point nine percent did not meet the recommended dietary allowance (RDA) for all three macronutrients. No difference in total mean survey score existed between the three collegiate divisions.

Conclusion: This study suggests that athletes lack knowledge of nutrition, healthy food choices, components of a well-balanced diet, and the implications of nutrition on performance.

Background: Neuromuscular electrical stimulation initiated by a surface electromyographic biofeedback threshold (sEMG-triggered NMES) has been studied in populations of patients with neurological problems, but has not been applied to orthopedic populations.

Objectives: The purpose of this single-blinded, randomized clinical trial was to investigate sEMG-triggered NMES on knee extension active range of motion (AROM), function, and torque in patients with post-operative arthroscopic knee surgery.

Methods: Twenty-five participants were randomly assigned to either: (1) sEMG-triggered NMES with exercise group, or (2) exercise-only comparison group. Participants received outpatient physical therapy treatment 2 to 3 times a week for 12 visits. Knee AROM and function determined by the lower extremity functional scale (LEFS) were collected at the first, sixth, and twelfth visits. Peak isometric extensor torque was assessed using an electromechanical dynamometer at 3 months post surgery. Two analysis of variance tests with repeated measures were used to analyze knee AROM and LEFS data. An independent samples t-test was used to analyze the peak torque index (%) of the involved extremity compared to the uninvolved.

Results: A significant difference in AROM was found between groups. No significant difference was found between groups in the LEFS, nor in the peak isometric extensor torque. A 72.5% strength deficit was found compared to the uninvolved extremity.

Conclusion: Using sEMG-triggered NMES intervention improved extension AROM but did not improve function or torque.

Background: A paucity of literature exists related to the care of sailing athletes with knee injuries. Hiking has been examined to describe its demands, but comprehensive sources for rehabilitation recommendations based upon evidence are non-existent. Guidance and understanding of human motion are key to success in the face of limited evidence.

Objectives: Impairments and functional restrictions were identified in a Finn Sailor with MCL (medial collateral ligament) injury. A regimen of strengthening, conditioning, and functional benchmarks was devised to progress a sailing athlete from non-functional to sailing specific training and the athlete's competitive goal. Coordination with a strength/conditioning professional was key to maintaining the athlete's competitive level.

Case description: The patient is a 21 year old Finn class sailor with an acute MCL knee injury eight weeks prior to a world class and national ranking event. Following evaluation, treatment with sailing-specific functional testing coincided with training/conditioning. Common-sense functional tasks were used to replicate demands of hiking and balancing to evaluate readiness for sailing/training.

Outcomes: Return to sailing with protection occurred in 12 days, unrestricted training and competition were achieved prior to the ranking event at 8 weeks.

Discussion: Mobility, stability, control, strength, and endurance are not only crucial to performance in the boat, but sailors need to avoid pitfalls in the boatyard while safely transitioning from land to water. Competitive calendars may not allow for textbook protocol, therefore, all goals should be strongly correlated with functional ability, athlete confidence, and performance needs.

Athletes performing overhead activities are at risk of sustaining both overuse and traumatic shoulder injuries. Research studies utilizing electromyography have identified therapeutic exercises that are effective in the muscular activation of the rotator cuff and the scapular stabilizers. Sports medicine professionals routinely prescribe these traditional therapeutic exercises when rehabilitating athletes. Failing to identify and address contributing musculoskeletal dysfunctions may delay an athlete's successful return to sport. Integrating shoulder and core exercises can address potential musculoskeletal dysfunctions while serving as a transitional program between the initial therapeutic exercises and the terminal return to sport rehabilitation program.

Purpose: The primary purpose of this study was to revalidate the competencies that define the practice of sports physical therapy. Additionally, the study allowed for the comparison of responses of board certified specialists in sports physical therapy to respondents who were not specialists.

Methods: A survey instrument based the on American Board of Physical Therapy Specialties practice analysis template and The Guide to Physical Therapist Practice was developed by the Sports Specialty Council and a panel of subject matter experts in sports physical therapy. The instrument was sent to 630 physical therapists, 315 of whom were board certified specialists in sports physical therapy and 315 of whom were randomly selected members of the Sports Physical Therapy Section who were not board certified specialists in sports physical therapy. Two hundred and thirty seven subjects returned completed surveys for a 41% response rate. One hundred and fifty eight respondents were sports specialists

Results: The survey results were reviewed by the Sports Specialty Council and another panel of subject matter experts. Using a defined decision making process, the results were used to determine the competencies that define the specialty practice of sports physical therapy. Survey results were also used to develop the sports physical therapy specialty board examination blue print. A number of significant comparisons between the specialists and non-specialists were identified.

Conclusion: The competency revalidation process culminated in the publication of the Sports Physical Therapy Description of Specialty Practice. This document serves to guide the process related to the attainment and maintenance of the board certified clinical specialist in sports physical therapy.

Background: Although anterior cruciate ligament (ACL) sprains usually occur during the initial phase of the landing cycle (less than 40° knee flexion), the literature has focused on peak values of knee angles, vertical ground reaction force (VGRF), and muscle activity even though it is unclear what occurs during the initial phase of landing.

Objectives: The objectives of this study were to determine the effects of sex (male and female) and fatigue (prefatigue/post-fatigue) on knee flexion angles at the occurrence of peak values of biomechanical variables [knee valgus angle, VGRF, and normalized electromyographic amplitude (NEMG) of the quadriceps and hamstring muscles] during a bilateral drop landing task.

Methods: Knee valgus angle, VGRF, and NEMG of the quadricep and hamstring muscles were collected during bilateral drop landings for twenty-nine recreational athletes before and after a fatigue protocol.

Results: Peak values of knee valgus, VGRF, and NEMG of medial and lateral hamstring muscles occurred during the late phase of the landing cycle (>40° of knee flexion). Females in the post-fatigue condition exhibited peak VGRF at significantly less knee flexion than in the pre-fatigue condition. Males in the post-fatigue condition exhibited peak lateral hamstring muscles NEMG at significantly higher knee flexion than in the pre-fatigue condition.

Discussion and conclusion: Peak values of biomechanical variables that have been previously linked to ACL injury did not occur during the initial phase of landing when ACL injuries occur. No biomechanical variables peaked during the initial phase of landing; therefore, peak values may not be an optimal indicator of the biomechanical factors leading to ACL injury during landing tasks.

Background: Methods of measuring lower extremity function is limited for those with partial weight bearing (PWB) status in early phases of a lower extremity rehabilitation program.

Objectives: The purpose of this study was to measure intra-rater reliability of two lower extremity PWB performance measures using an incline exercise apparatus and to evaluate the concurrent validity and responsiveness to change of these two measures.

Methods: Thirty-seven adult patients with lower extremity injuries were measured on two PWB measures (PWB20 and PWB30) of lower extremity performance as well as several common measures of LE function. After initial testing, subjects were asked to return for retesting, following four to six weeks of rehabilitation intervention. Reliability of the data from the measures was tested using intraclass correlation coefficients (ICC); validity was based on bivariate correlations of the measures. The minimal detectable change (MDC) value and limb symmetry index (LSI) were used to study the responsiveness of the PWB measures.

Results: The ICC for the PWB20 and PWB30 were 0.95 and 0.98, respectively. The bivariate correlations of the PWB20 with stair climbing and walking speed were greater than those of the PWB30. Correlations ranged from r = 0.49 to 0.72 between the PWB measures and the functional measures. For most patients, their change in score between initial testing and follow-up exceeded the MDC; the LSI improved for all patients.

Conclusion: Using the incline apparatus yielded reliable PWB data. In addition, performance on the PWB measures correlated fairly well with common measures of function.

Background: The Star Excursion Balance Test (SEBT) is a dynamic test that requires strength, flexibility, and proprioception and has been used to assess physical performance, identify chronic ankle instability, and identify athletes at greater risk for lower extremity injury. In order to improve the repeatability in measuring components of the SEBT, the Y Balance Test™ has been developed.

Objective: The purpose of this paper is to report the development and reliability of the Y Balance Test™.

Methods: Single limb stance excursion distances were measured using the Y Balance Test™ on a sample of 15 male collegiate soccer players. Intraclass Correlation Coefficients (ICC) were used to determine the reliability of the test.

Results: The ICC for intrarater reliability ranged from 0.85 to 0.91 and for interrater reliability ranged from 0.99 to 1.00. Composite reach score reliability was 0.91 for intrarater and 0.99 for interrater reliability.

Discussion: This study demonstrated that the Y Balance Test™ has good to excellent intrarater and interrater reliability. The device and protocol attempted to address the common sources of error and method variation in the SEBT including whether touch down is allowed with the reach foot, where the stance foot is aligned, movement allowed of the stance foot, instantaneous measurement of furthest reach distance, standard reach height from the ground, standard testing order, and well defined pass/fail criteria.

Conclusion: The Y Balance Test™ is a reliable test for measuring single limb stance excursion distances while performing dynamic balance testing in collegiate soccer players.