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

Background: The medial collateral ligament (MCL) is one of the most frequently injured ligaments in the knee. The purpose of this case report is to describe conservative management of a 13 year-old soccer player with a one year history of untreated intermittent bilateral anterior knee pain who sustained a grade II MCL sprain while playing soccer and returned to competitive play within four weeks. The use of patellar taping as an adjunct to treatment will be introduced.

Case description: Based on the physical examination findings, the patient's injury was classified as a grade II MCL sprain. The patient was treated successfully with a combination of modalities, manual therapy, and therapeutic exercise. Specifically, patellar taping was added to the traditional physical therapy regimen. Pain scale ratings, strength assessment, and a variety of functional outcome assessment tools were used to determine progression and outcomes.

Outcomes: Following one session of modalities, manual therapy, patellar taping, and education in a home exercise program (HEP), the patient reported decreased overall left knee pain and increased comfort with knee active range of motion (AROM). Throughout the four weeks of treatment, the patient was compliant with the HEP. During this time, the patient continued to demonstrate improvement in pain, strength, AROM, and functional activities. Upon discharge, the patient was cleared for full return to sports.

Discussion: The novel intervention in this case report was the taping of the patella medially. This patient returned to sports two weeks earlier than the average athlete with a grade II MCL sprain.

Rolling is a movement pattern seldom used by physical therapists for assessment and intervention with adult clientele with normal neurologic function. Rolling, as an adult motor skill, combines the use of the upper extremities, core, and lower extremities in a coordinated manner to move from one posture to another. Rolling is accomplished from prone to supine and supine to prone, although the method by which it is performed varies among adults. Assessment of rolling for both the ability to complete the task and bilateral symmetry may be beneficial for use with athletes who perform rotationally-biased sports such as golf, throwing, tennis, and twisting sports such as dance, gymnastics, and figure skating. Additionally, when used as intervention techniques, the rolling patterns have the ability to affect dysfunction of the upper quarter, core, and lower quarter. By applying proprioceptive neuromuscular facilitation (PNF) principles, the therapist may assist patients and clients who are unable to complete a rolling pattern. Examples given in the article include distraction/elongation, compression, and manual contacts to facilitate proper rolling. The combined experience of the four authors is used to describe techniques for testing, assessment, and treatment of dysfunction, using case examples that incorporate rolling. The authors assert that therapeutic use of the developmental pattern of rolling with techniques derived from PNF is a hallmark in rehabilitation of patients with neurologic dysfunction, but can be creatively and effectively utilized in musculoskeletal rehabilitation.

Background: Altered joint arthrokinematics can affect structures distal and proximal to the site of dysfunction. Hypomobility of the proximal tibiofibular joint may limit ankle dorsiflexion and indirectly alter stresses about the knee.

Objectives: To examine the effect of addressing hypomobility of the proximal tibiofibular joint in an individual with lateral knee pain.

Case description: A 24 year old female recreational runner presented with a three month history of right lateral knee pain. Limited right ankle dorsiflexion was noted and determined to be related to decreased mobility of the proximal tibiofibular joint, as well as, the talocrural and distal tibiofibular joints. Functional movement deficits were noted during the squat test and step down test. Treatment was performed three times over the course of two weeks which included proximal tibiofibular joint manipulation and an exercise program consisting of hip strengthening, balance, and gastrocnemius/soleus muscle complex stretching.

Outcomes: Immediately following intervention, improvements were noted for ankle dorsiflexion, squat test, and step down test. One week following the initial intervention the patient reported she was able to run pain free.

Discussion: Addressing impairments distant to the site of dysfunction, such as the proximal tibiofibular joint, may be indicated in individuals with lateral knee pain.

Background: Previous studies have shown military physical therapists (PT) to have comparable clinical diagnostic accuracy (CDA) and interobserver agreement to orthopaedic surgeons (OS). However, no studies have examined hip pathology or used intraoperative findings as the reference standard for diagnosis.

Objective: To compare the CDA of physical examination findings among a PT, an OS, and two surgical orthopaedic residents (ORs) for hip labral tears.

Methods: Thirty-six patients (15 males, 21 females) aged 18-47 (mean + SD, 31.4 + 8.1 years) with 37 symptomatic hips were enrolled in a prospective study and underwent a standardized clinical examination followed by hip arthroscopy. A PT, an OS, and two ORs independently performed history and examinations with the emphasis of diagnosis on the results of six special tests.

Results: Thirty-two of 37 individuals (86%) had labral tears to the hip at arthroscopy. Analysis of agreement between clinical diagnosis and intra-operative findings of a labral tear produced a CDA of 85.3% (29/34 correct) for the PT, 84.4% (27/32 correct) for the OS, and 80.0% (24/30 correct) for ORs. No significant difference in CDA occurred in comparing the PT, OS, and ORs.

Conclusions: Using arthroscopy as the reference standard, hip labral tears were clinically suspected with 80-85% accuracy. The clinical diagnostic accuracy of the PT, OS, and ORs was high with no significant difference between examiners. In this study, an experienced PT, an OS, and two ORs demonstrated similarly high diagnostic skills.

Background: Optimal athletic performance may be dependent upon an athlete maintaining adequate iron levels through the consumption of dietary forms of iron and subsequent metabolism. Endurance athletes, especially female distance runners, have been identified as being at risk for developing iron deficiency. While iron deficiency is treatable, early diagnosis may be delayed if an adequate medical history and evaluation is not conducted.

Objective: To describe the evaluation, diagnosis, and comprehensive sports medicine treatment of a collegiate cross-country athlete with a medical diagnosis of iron deficiency with anemia and sports-related musculoskeletal pain.

Case description: A 21-year-old female collegiate cross-country athlete experienced a decline in her running performance beginning her freshman year of school. She continued to experience degradation in sports performance despite medical intervention. Two-and-a-half years after initially seeking medical attention she was diagnosed with iron deficiency with anemia by a primary care medical doctor. Additionally, the subject required rehabilitation due to the onset of sports-related musculoskeletal symptoms.

Outcomes: Comprehensive treatment for this patient consisted of iron supplementation, therapeutic exercises, manual therapy, and modalities. The athlete was able to compete during her entire cross-country season and earn All-American status at the Division-III level.

Discussion: Sports medicine professionals must consider iron deficiency as a possible differential diagnosis when evaluating endurance athletes. Subtle signs of iron deficiency may, unfortunately, be overlooked ultimately delaying treatment.

This clinical commentary outlines a new clinical model for anterior cruciate ligament (ACL) rehabilitation, the Knee Symmetry Model. This model has been developed by clinical observation, patient interaction, and by analyzing outcome measures derived from prospective follow-up of patients. More specifically, the best outcome scores occurred in patients with symmetric range of motion and strength. A thorough discussion of the details involved in the development and implementation of this rehabilitation program for this patient following ACL reconstruction is described. Included in this description is the supporting evidence and clinical rationale behind pre-operative and post-operative ACL rehabilitation. Preliminary results from a recent group of patients are presented. When using the Knee Symmetry Model 100% of patients achieved normal knee extension and 97% of patients achieved normal knee flexion.

Athletes with persistent anterolateral ankle discomfort may have developed sinus tarsi syndrome (STS). Sinus tarsi syndrome develops from excessive motions of the subtalar joint that results in subtalar joint synovitis and infiltration of fibrotic tissue into the sinus tarsi space. Physical therapists treating athletes with ankle conditions should examine the talocrural and subtalar joints for signs of hypermobility as injuries can affect both of these important articulations of the lower extremity. Localized ankle discomfort to the sinus tarsi space and feelings of instability with pronation and supination movements of the subtalar joint will help identify STS. Intervention for this condition will focus on enhancing subtalar joint stability and function of the lower extremities. The purpose of this clinical commentary is to discuss the etiologies and signs of STS and describe the components of an intervention plan appropriate for athletes with STS.

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.

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.

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.