J Orthop Sports Phys Ther. 2008 Oct; 38(10): 586-95
Moksnes H, Snyder-Mackler L, Riseberg MA

STUDY DESIGN: Prospective cohort study. OBJECTIVES: First, to classify a group of individuals with an anterior cruciate ligament (ACL)-deficient knee as potential copers or potential noncopers, based on an established screening examination. Second, to prospectively follow a cohort of individuals with an ACL injury and characterize the nonoperatively treated subjects as true copers and true noncopers 1 year after injury, and evaluate the outcomes in operatively treated individuals 1 year after ACL reconstruction. Finally, to calculate the predictive value of the screening examination based on a 1-year follow-up of the group of subjects with ACL tears treated nonoperatively. BACKGROUND: A screening examination has been developed for early classification of individuals with ACL injuries. Potential copers have successfully been identified as rehabilitation candidates and have shown that they are able to continue preinjury activities without ACL reconstruction (true copers). However, the potential of individuals identified as noncopers to become true copers has not been studied. METHODS AND MEASURES: One hundred and twenty-five subjects with ACL injury were evaluated using a screening examination consisting of 4 single-legged hop tests, the Knee Outcome Survey activities of daily living scale, the global rating of knee function, and the numbers of episodes of giving way. Knee laxity measurements, the international knee documentation committee subjective knee form (IKDC2000), and return to sport were included as outcome measurements. RESULTS: Thirty-seven percent (n = 46) of the subjects with ACL injury were classified as potential copers at the screening examination. Of the 102 subjects examined at follow-up, 51% (n = 52) had undergone nonoperative treatment. Sixty-five percent (n = 34) of the nonoperated subjects were classified as true copers at the 1 year follow-up. Among the potential copers, 60% were true copers, while 70% of the subjects initially classified as potential noncopers were true copers at the 1 year follow-up. The positive predictive value for correctly classifying true copers at the screening examination was 60% (95% confidence interval: 41%-78%), while the negative predictive value was 30% (95% confidence interval: 16%-49%). CONCLUSION: A majority (70%) of subjects classified as potential noncopers were true copers after 1 year of nonoperative treatment. Individuals with nonoperative treatment and ACL reconstruction showed excellent knee function and were highly active at the 1 year follow-up. The prognostic accuracy of this screening examination for correctly classifying true copers was poor. ...»

J Orthop Sports Phys Ther. 2008 Nov; 38(11): 723-5
Armstrong MJ, Geiser CF, Alderink GJ, Berry J

Book reviews on the following titles:Promoting Legal and Ethical Awareness: A Primer for Health Professionals and PatientsPerspectives in Athletic TrainingPhysical Therapies in Sport and Exercise, Second EditionNo More Joint PainJ Orthop Sports Phys Ther. 2008; 38(11):723-725. ...»

J Orthop Sports Phys Ther. 2008 Nov; 38(11): 1
Cook C, Shah A, Pietrobon R

A letter to the Editor-in-Chief expresses concern about the study by Iverson et al published in the June 2008 issue of JOSPT. While the letter writers appreciate the creative exploration of the authors, they are concerned with limitations of the methods and potential transferability of the findings of this clinical prediction rule for lumbopelvic manipulation for treating patients with patellofemoral pain syndrome.J Orthop Sports Phys Ther. 2008; 38(11):722. doi:10.2519/jospt.2008.0205. ...»

J Orthop Sports Phys Ther. 2008 Nov; 38(11): 1
O'Laughlin SJ, Kokosinski E

The patient was a 38-year-old female at 34 weeks' gestation, with a 3-week history of low back pain of insidious onset. Her physician referred her to physical therapy on the assumption that her pain was typical of normal pregnancy. However, the patient's significantly worsening condition prompted the physical therapist to contact the physician who ordered lumbar magnetic resonance imaging. MRI results led to a diagnosis of cauda equina syndrome, secondary to central spinal canal stenosis from a posterocentral disc extrusion at L4-5. The patient underwent an immediate surgical discectomy at L4-5.J Orthop Sports Phys Ther. 2008; 38(11):721. doi:10.2519/jospt.2008.0411. ...»

J Orthop Sports Phys Ther. 2008 Nov; 38(11): 681-90
Escamilla RF, Zheng N, Macleod TD, Edwards WB, Hreljac A, Fleisig GS, Wilk KE, Moorman CT, Imamura R, Andrews JR

STUDY DESIGN: Controlled laboratory biomechanics study using a repeated-measures, counterbalanced design. OBJECTIVES: To compare patellofemoral joint force and stress between a short- and long-step forward lunge both with and without a stride. BACKGROUND: Although weight-bearing forward-lunge exercises are frequently employed during rehabilitation for individuals with patellofemoral joint syndrome, patellofemoral joint force and stress and how they change with variations of the lunge exercise are currently unknown. METHODS AND MEASURES: Eighteen subjects used their 12-repetition maximum weight while performing a short- and long-step forward lunge both with and without a stride. Electromyography, ground reaction force, and kinematic variables were put into a biomechanical optimization model, and patellofemoral joint force and stress were calculated as a function of knee angle. RESULTS: Visual observation of the data show that during the forward lunge, patellofemoral joint force and stress increased progressively as knee flexion increased, and decreased progressively as knee flexion decreased. Between 70 degrees and 90 degrees of knee flexion, patellofemoral joint force and stress were significantly greater when performing a forward lunge with a short step compared to a long step (P<.025). Between 10 degrees and 40 degrees of knee flexion, patellofemoral joint force and stress were significantly greater when performing a forward lunge with a stride compared to without a stride (P<.025). CONCLUSIONS: When the goal is to minimize patellofemoral joint force and stress during the forward lunge performed between 0 degrees to 90 degrees knee angles, it may be prudent to perform the lunge with a long step compared to a short step and without a stride compared to with a stride, because patellofemoral joint force and stress magnitudes were greater with a short step compared to a long step at higher knee flexion angles and were greater with a stride compared to without a stride at lower knee flexion angles.J Orthop Sports Phys Ther. 2008; 38(11):681-690, Epub 24 October 2008. doi:10.2519/jospt.2008.2694. ...»

J Orthop Sports Phys Ther. 2008 Nov; 38(11): 703-20
Smith CE, Nyland JA, Caudill P, Brosky JA, Caborn DN

SYNOPSIS: The sport of volleyball creates considerable dynamic trunk stability demands. Back injury occurs all too frequently in volleyball, particularly among female athletes. The purpose of this clinical commentary is to review functional anatomy, muscle coactivation strategies, assessment of trunk muscle performance, and the characteristics of effective exercises for the trunk or core. From this information, a conceptual progressive 3-phase volleyball-specific training program is presented to improve dynamic trunk stability and to potentially reduce the incidence of back injury among volleyball athletes. Phase 1 addresses low-velocity motor control, kinesthetic awareness, and endurance, with the clinician providing cues to teach achievement of biomechanically neutral spine alignment. Phase 2 focuses on progressively higher velocity dynamic multiplanar endurance, coordination, and strength-power challenges integrating upper and lower extremity movements, while maintaining neutral spine alignment. Phase 3 integrates volleyball-specific skill simulations by breaking down composite movement patterns into their component parts, with differing dynamic trunk stability requirements, while maintaining neutral spine alignment. Prospective research is needed to validate the efficacy of this program. LEVEL OF EVIDENCE: Level 5.J Orthop Sports Phys Ther. 2008; 38(11):703-720, Epub 24 October 2008. doi:10.2519/jospt.2008.2814. ...»

J Orthop Sports Phys Ther. 2008 Nov; 38(11): 661-667
Sigward SM, Ota S, Powers CM

STUDY DESIGN: Controlled laboratory study using a cross-sectional, single testing session. OBJECTIVE: To determine the association between frontal plane knee excursion during a drop land task and measures of hip strength, and ankle and hip range of motion. BACKGROUND: Assessment of frontal plane knee excursion during a drop land task has been advocated as a means to screen for potentially injurious lower extremity movement patterns. Accordingly, an understanding of the physical characteristics associated with the magnitude of frontal plane knee excursion could assist clinicians in developing interventions and prevention strategies to minimize injury risk. METHODS AND MEASURES: Thirty-nine female high school soccer players (mean +/- SD age, 15.5 +/- 1.0 years; height, 162.2 +/- 5.3 cm; body mass, 56.8 +/- 6.7 kg) participated. Isometric hip muscle strength as well as ankle and hip range of motion measurements were obtained using standard clinical procedures and a handheld dynamometer. Frontal plane knee excursion was assessed using a 6-camera motion analysis system during a drop land task. Using 3-dimensional coordinate data, maximum frontal plane knee excursion was defined as the difference between the distances of right and left lateral knee markers at initial contact and maximum knee flexion during the deceleration phase of landing. Independent variables found to be significantly correlated with frontal plane knee excursion were then entered into a stepwise multiple regression procedure to determine the best set of predictors of this motion. RESULTS: Hip external rotation range of motion and ankle dorsiflexion range of motion were found to be negatively correlated with frontal plane knee excursion (r=-0.40, P=.005 and r=-0.27, P=.05, respectively). Together they accounted for 27% of the variance in frontal plane knee excursion (r=0.52, P=.03). No relationships between measures of hip strength and frontal plane knee excursion were found. CONCLUSIONS: Frontal plane knee excursion during a drop land task was partially attributed to available range of motion at the hip and ankle. These results suggest that range of motion of the joints proximal and distal to the knee should be considered when evaluating individuals who present with excessive frontal plane knee excursion during this task. Given that the relationship between range of motion and frontal plane knee excursion was small, other factors, including learned motor patterns, should be considered.J Orthop Sports Phys Ther. 2008; 38(11):661-667; Epub 22 August 2008. doi:10.2519/jospt.2008.2695. ...»

J Orthop Sports Phys Ther. 2008 Nov; 38(11): 691-702
Lowry CD, Cleland JA, Dyke K

STUDY DESIGN: A case series of consecutive patients referred to physical therapy with patellofemoral pain syndrome (PFPS). BACKGROUND: Physical therapists often treat patients with PFPS, yet there is currently no consensus as to the most effective management strategies. The purpose of this case series is to describe the outcomes of patients referred to physical therapy with PFPS who were treated with a multimodal approach. CASE DESCRIPTION: Five patients were treated with a combination of thrust and nonthrust manipulation directed at the joints of the lower quarter, trunk and hip stabilization exercises, patellar taping, and foot orthotics. Outcome measures used to capture change in patient status included the Numeric Pain Rating Scale, the Kujala Anterior Knee Pain Scale, the Lower Extremity Functional Scale, and the Global Rating of Change. OUTCOMES: Five patients (median age, 15 years; range, 14-50 years) with a median duration of knee pain for 8 months (range, 3-24 months) were included in this prospective case series. Four (80%) of the 5 patients demonstrated decreased pain and a clinically significant improvement in function. These gains in function were maintained at a 6-month follow-up. DISCUSSION: Although a cause-and-effect relationship cannot be inferred from a case series, the outcomes achieved by the patients are consistent with studies incorporating manual physical therapy, exercise, patellar taping, and orthotic prescription to the management of conditions of the lower extremity. Further randomized controlled trials should be performed to determine the effectiveness of this multimodal approach for the management of individuals with PFPS. LEVEL OF EVIDENCE: Therapy, level 4.J Orthop Sports Phys Ther. 2008; 38(11):691-702, Epub 11 August 2008. doi:10.2519/jospt.2008.2690. ...»

J Orthop Sports Phys Ther. 2008 Nov; 38(11): 674-80
Lovering RM, Russ DW

STUDY DESIGN: Descritive cadaveric laboratory study. OBJECTIVE: To identify the fiber type composition of the rotator cuff and teres major muscles in human subjects. BACKGROUND: The rotator cuff is commonly injured in athletics and is a major focus of sports medicine. Although the anatomy and architecture of each muscle have been described in great detail, these muscles have never been fiber typed using immunohistochemistry or gel electrophoresis. Fiber typing is important in modeling function, exercise training, and rehabilitation. METHODS AND MEASURES: We harvested tissue samples for all 4 rotator cuff muscles, as well as the teres major muscle from cadavers. Tissues were frozen in liquid nitrogen and sectioned. Cryosections were labeled with commercially available antibodies against fast and slow isoforms of myosin heavy chain (MHC). We also harvested fresh (unembalmed) tissue from deceased subjects and labeled tissue sections with antibodies against fast or slow MHC and wheat germ agglutinin. Gel electrophoresis followed by silver staining was also used to identify and quantify MHC isoforms in fresh tissue samples. RESULTS: All of the muscles were of mixed fiber type composition. As a whole, 44% of rotator cuff fibers labeled positively for slow MHC, with slow MHC content of 54% in supraspinatus, 41% in infraspinatus, 49% in teres minor, 38% in subscapularis, and 40% in teres major. Mixed MHC isoform distribution was confirmed by SDS-PAGE, which also indicated that the IIa and IIx isoforms were roughly equally present across the muscles. CONCLUSIONS: Human rotator cuff muscles, at least in older subjects, have a mixed fiber type. Because we only examined older subjects, we must limit our interpretation to this population.J Orthop Sports Phys Ther. 2008; 38(11):674-680, Epub 18 July 2008. doi:10.2519/jospt.2008.2878. ...»

J Orthop Sports Phys Ther. 2008 Oct; 38(10): 646
Walk M

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J Orthop Sports Phys Ther. 2008 Oct; 38(10): 584-5
Davenport TE

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J Orthop Sports Phys Ther. 2008 Oct; 38(10): 647
Grimsby O

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J Orthop Sports Phys Ther. 2008 Oct; 38(10): 596-605
Teyhen DS, Rieger JL, Westrick RB, Miller AC, Molloy JM, Childs JD

STUDY DESIGN: Cross-sectional study design. OBJECTIVES: To characterize changes in muscle thickness in the transversus abdominis (TrA) and internal oblique (IO) muscles during common trunk-strengthening exercises, and to determine whether these changes differ based on age. BACKGROUND: Although trunk-strengthening exercises have been found to be useful in treating those with low back pain (LBP), our understanding of the relative responses of the TrA and IO muscles during different exercises is limited. METHODS AND MEASURES: Six commonly prescribed trunk-strengthening exercises were performed by 120 subjects (40 subjects per age group: 18-30, 31-40, and 41-50 years). Ultrasound imaging was used to measure the thickness of the TrA and IO during the resting and contracted state of each exercise. The average thickness of the muscles while in the contracted position was divided by the thickness values in the resting position for each exercise, based on 2 performances of each exercise. Two 3-by-6 repeated-measures analyses of variance were used to determine significant changes in muscle thickness of the TrA and IO, based on age group and exercise performed. RESULTS: For both muscles, the trunk exercise-by-age interaction effect (TrA, P = .358; IO, P = .217) and the main effect for age (TrA, P = .615; IO, P = .219) were not significant. A significant main effect for trunk exercise for both muscles (P<.001) was found. The horizontal side-support (mean +/- SD contracted-rest thickness ratio: TrA, 1.95 +/- 0.69; IO, 1.88 +/- 0.52) and the abdominal crunch (mean +/- SD contracted-rest thickness ratio: TrA, 1.74 +/- 0.48; IO, 1.63 +/- 0.41) exercises resulted in the greatest change in muscle thickness for both muscles. The abdominal drawing-in maneuver (mean +/- SD contracted-rest thickness ratio: TrA, 1.73 +/- 0.36; IO, 1.14 +/- 0.33) and quadruped opposite upper and lower extremity lift (mean +/- SD contracted-rest thickness ratio: TrA, 1.59 +/- 0.49; IO, 1.25 +/- 0.36) exercises resulted in changes in TrA muscle thickness with minimal changes in IO muscle thickness. CONCLUSION: Changes in TrA and IO muscle thickness differed across 6 commonly prescribed trunk-strengthening exercises among healthy subjects without LBP. These differences did not vary by age. This information may be useful for informing exercise prescription. ...»

J Orthop Sports Phys Ther. 2008 Oct; 38(10): 616-23
Vaughn DW

STUDY DESIGN: Case report. BACKGROUND: A number of pain referral patterns for sacroiliac dysfunction have been reported in the literature. However, very little has been written about pain localized to the knee joint for cases involving sacroiliac dysfunction. CASE DESCRIPTION: A 25-year-old female runner was self-referred to physical therapy for medial knee pain of 4(1/2) weeks' duration without a significant onset event. The pain completely curtailed her training for the Boston Marathon. Examination of the patient's knee and hip did not reveal any abnormal findings and there was no reproduction of pain with any test procedures except for medial knee joint tenderness to palpation. Additional, more proximal examination suggested significant asymmetry of sacral bony landmarks of the pelvic girdle without significant findings on the provocation tests of the sacroiliac joint. A single session of manual therapy procedures directed to the pubic symphysis and sacroiliac joint ipsilateral to the side of knee pain was provided. OUTCOMES: The patient was able to return to running without further incident of knee pain after a single therapy session. DISCUSSION: This case suggests the importance of regional interdependence in the examination of patients with an apparently common clinical problem. Furthermore, the case describes a previously unreported presentation of local knee pain possibly attributable to sacroiliac joint dysfunction. ...»

J Orthop Sports Phys Ther. 2008 Oct; 38(10): 606-15
Willson JD, Davis IS

STUDY DESIGN: Case-control study of females with patellofemoral pain syndrome (PFPS) and a control group. OBJECTIVES: Three different approaches were used to examine the utility of a 2-dimensional (2-D) frontal plane projection angle (FPPA) measure of knee alignment. First, we measured the FPPA association with respect to 3-dimensional (3-D) lower extremity joint rotations during single-leg squats. Second, we determined the correlation of the FPPA during single-leg squats with hip and knee joint rotations during running and single leg jumping. Third, we compared the FPPA between females with and without PFPS. BACKGROUND: PFPS is associated with altered lower extremity kinematics during weight-bearing activities that decrease retropatellar contact area and increase retropatellar stress. An objective and simple procedure to quantify altered kinematics during weight-bearing activities may help clinicians identify individuals who may likely benefit from interventions to improve lower extremity kinematics. METHODS AND MEASURES: Twenty females with PFPS and 20 healthy female controls performed single-leg squats, running, and repetitive single-leg jumps while 3-D lower extremity kinematics were recorded. The FPPA was recorded by a digital camera during single-leg stance and single-leg squats. Correlation coefficients were used to quantify the association between the FPPA and transverse and frontal plane hip and knee angles for all activities. Independent t tests were used to compare FPPA values between groups. RESULTS: FPPA values representing medial displacement of the knee during single-leg squats were associated with increased hip adduction (r = 0.32 to 0.38, P<.044) and knee external rotation (r = 0.48 to 0.55, P<.001) across activities. FPPA values for the PFPS group reveal greater medial displacement of the knee compared with those of the control group during single-leg squats (P = .012). CONCLUSION: The association between the FPPA and lower extremity kinematics that are associated with PFPS suggest that the FPPA during single-leg squats may be a useful clinical measure. However, these methods should not be used to quantify 3-D joint rotations. ...»

J Orthop Sports Phys Ther. 2008 Oct; 38(10): 640-5
Fletcher JP, Bandy WD

STUDY DESIGN: Clinical measurement, intrarater reliability study. OBJECTIVES: To determine the intrarater reliability of cervical active range of motion (AROM) measurement of subjects with and without neck pain using the cervical range-of-motion device (CROM). BACKGROUND: Cervical spine AROM data are used by physical therapists to assist in identifying movement impairment, monitor patient progress, and evaluate the effectiveness of intervention. Presently, insufficient literature exists regarding the intrarater reliability of cervical AROM measurements using the CROM. METHODS AND MEASURES: Twenty-five adult subjects without neck pain and 22 adult subjects with neck pain volunteered for the study. Two trials of cervical AROM measurement (6 movements) were performed for each subject. Practice sessions, methods of measurement, and rest time between trials were standardized; order of measurement was randomized. RESULTS: The intraclass correlation coefficients (ICC3,1) for the subjects without neck pain ranged from 0.87 for flexion (95% confidence interval [CI]: 0.76-0.95) to 0.94 for left rotation (95% CI: 0.87-0.97). The standard error of the measurement ranged from 2.3 degrees to 4.0 degrees . The ICCs for the subjects with neck pain ranged from 0.88 for flexion (95% CI: 0.73-0.95) to 0.96 for left rotation (95% CI: 0.91-0.98). The standard error of the measurement ranged from 2.5 degrees to 4.1 degrees . Minimal detectable change ranged from 5.4 degrees for left rotation in the subjects without neck pain to 9.6 degrees for flexion in the subjects with neck pain. CONCLUSION: Intrarater reliability for cervical AROM measurement of persons with and without neck pain is sufficient to consider use of the CROM in clinical practice, although changes between 5 degrees to 10 degrees are needed to feel confident that a real change in spine mobility has occurred. ...»

J Orthop Sports Phys Ther. 2008 Oct; 38(10): 632-9
Ryan ED, Beck TW, Herda TJ, Hull HR, Hartman MJ, Costa PB, Defreitas JM, Stout JR, Cramer JT

STUDY DESIGN: Repeated-measures experimental design. OBJECTIVE: To examine the acute effects of different durations of passive stretching on the time course of musculotendinous stiffness (MTS) responses in the plantar flexor muscles. BACKGROUND: Stretching is often implemented prior to exercise or athletic competition, with the intent to reduce the risk of injury via decreases in MTS. METHODS AND MEASURES: Twelve subjects (mean +/- SD age, 24 +/- 3 years; stature, 169 +/- 12 cm; mass, 71 +/- 17 kg) participated in 4 randomly-ordered experimental trials: control with no stretching, 2 minutes (2min), 4 minutes (4min), and 8 minutes (8min) of passive stretching. The passive-stretching trials involved progressive repetitions of 30-second passive stretches, while the control trial involved 15 minutes of resting. MTS assessments were conducted before (prestretching), immediately after (poststretching), and at 10, 20, and 30 minutes poststretching on a Biodex System 3 isokinetic dynamometer. RESULTS: MTS decreased (P<.05) immediately after all stretching conditions (2min, 4min, and 8min). However, MTS for the 2min condition returned to baseline within 10 minutes, whereas MTS after the 4min and 8min passive-stretching conditions returned to baseline within 20 minutes. CONCLUSIONS: Practical durations of passive stretching resulted in significant decreases in MTS; however, these changes return to baseline levels within 10 to 20 minutes. ...»

J Orthop Sports Phys Ther. 2008 Oct; 38(10): 624-31
Chleboun GS, Harrigal ST, Odenthal JZ, Shula-Blanchard LA, Steed JN

STUDY DESIGN: Experimental descriptive laboratory study. OBJECTIVES: To describe the change in fascicle length of the human vastus lateralis (VL) muscle during the stance phase of stair ascent and descent. BACKGROUND: Muscle fascicle length changes during lower limb functional activities, such as walking and jumping, do not always coincide with joint angle changes. METHODS AND MEASURES: Thirty-three healthy, college-age women walked up and down 4 standard steps. VL fascicle length and pennation angle were measured using real-time ultrasonography. Knee angle was monitored using an electrical goniometer. Foot switches indicated foot contact and release. VL muscle activity was monitored using surface electrodes. The VL muscle-tendon complex and tendon length were calculated based on published models. RESULTS: During initial weight acceptance in stair ascent, the knee joint extended only 3 degrees , VL muscle activity increased to a maximum, VL fascicles shortened, and the tendon lengthened. As the knee extended to ascend the step, the fascicles and tendon shortened throughout the movement. During weight acceptance in stair descent, VL muscle activity increased, VL fascicle length did not change significantly, but the tendon lengthened as 10 degrees of knee flexion occurred. As the knee flexed to complete descent, VL muscle activity peaked, and VL fascicles and tendon lengthened. CONCLUSION: VL fascicles shorten and lengthen as expected during the respective knee extension and knee flexion phases of stair ascent and descent. However, during initial weight acceptance in both stair ascent and descent, the fascicle length change did not coincide with the knee joint kinematics. ...»

J Orthop Sports Phys Ther. 2008 Sep; 38(9): A1-A34
Childs JD, Cleland JA, Elliott JM, Teyhen DS, Wainner RS, Whitman JM, Sopky BJ, Godges JJ, Flynn TW

The Orthopaedic Section of the American Physical Therapy Association presents this second set of clinical practice guidelines on neck pain, linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) prognosis, (3) interventions provided by physical therapists, and (4) assessment of outcome for common musculoskeletal disorders. ...»

J Orthop Sports Phys Ther. 2008 Sep; 38(9): 578
Blake CG, Ross MD

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