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

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.

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.

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.

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.

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.

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.

Objectives: The objective of this case study is to describe rehabilitation guidelines, functional progression, and functional outcomes for a high school football player status post medial meniscus repair.

Case description: The rehabilitation approach started with an early protection phase, followed by progressive neuromuscular training, then aggressive functional rehabilitation utilizing functional tests and measures to gauge return to play. Data collected for this case included joint range of motion, joint effusion, neuromuscular facilitation, isokinetic strength, and functional test scores.

Outcomes: This patient was able to return to full level of participation in 140 days (20 weeks), and was without reinjury 10 months after surgery.

Discussion: The rehabilitation approach of meniscus repair described in this case study may provide guidelines in clinical decision making for a safe return to competitive athletics.

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.

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.

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.

Objective: The objective of this systematic review was to determine the effectiveness of eccentric exercise in preventing hamstring strains.

Data sources: Online databases, including MED-LINE, PubMed, CINAHL, PEDro, SPORTDiscus, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Web of Science were searched for relevant articles. Each database was searched from the earliest date to July 2007.

Study selection: Selection criteria included diagnosis of hamstring strain, otherwise healthy individuals, and at least one group receiving an eccentric exercise intervention. Seven articles {three randomized controlled trials (RCTs) and four cohort studies} met the inclusion criteria.

Data extraction: Data were extracted using a customized form. Methodological rigor of included studies was assessed using the PEDro scale and Oxford Centre for Evidence-based Medicine Levels of Evidence.

Data synthesis: STUDIES WERE GROUPED BY ECCENTRIC EXERCISE INTERVENTION PROTOCOL: hamstring lowers, isokinetic strengthening, and other strengthening. A best-evidence synthesis of pooled data was qualitatively summarized.

Conclusions: Findings suggest that eccentric training is effective in primary and secondary prevention of hamstring strains. Study heterogeneity and poor methodological rigor limit the ability to provide clinical recommendations. Further RCTs are needed to support the use of eccentric training protocols in the prevention of hamstring strains.

Unlabelled: 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.

Conclusion: Additional studies examining the physiological and psychological effects of sports massage are necessary in order to assist the sports physical therapist in developing and implementing clinically significant evidence based programs or treatments.