Research Report
Robert P. Engle, Gary C. Canner
Techniques and procedures of proprioceptive neuromuscular facilitation (PNF) are well accepted for therapeutic exercise in rehabilitation of orthopaedic problems. Specific application for the treatment of knee ligament instabilities has not been documented in the literature. Spiral and diagonal PNF patterns emphasize rotatory components of joint function and can provide emphasis in selected musculotendinous structures of the knee. This article describes the application of therapeutic exercise techniques and procedures for anterior cruciate ligament (ACL) and resultant instabilities.
J Orthop Sports Phys Ther 1989;11(6):230-236.
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Research Report
Robert P. Engle, Gary C. Canner
Anterolateral instability is a common lesion of the knee which can result in significant disability. Without treatment, this problem can typically cause recurrent meniscal tearing, increased joint laxity, progressive giving way, joint surface deterioration and restrictions of functional activities. Although surgery can be performed to improve static stability, many patients elect a nonoperative approach based on a knee rehabilitation program. The purpose of this paper is to discuss anterolateral knee instability and the authors' conservative management program. Two collegiate athletes are presented as case studies. Both had positive signs of anterolateral instability, but following arthroscopic surgery and rehabilitation, they were asymptomatic with no limitations in functional activity. One of the subjects discontinued rehabilitation prematurely and resumed sports with no recurrence of functional instability or synovitis, but continued with patellofemoral dysfunction. Nonoperative treatment can be effective in providing functional stability to the ACL-deficient knee with signs of anterolateral instability (i.e., positive pivot shift). More reports of similar cases and rehabilitation studies with long-term follow-up are necessary for comparison with surgical results, which are currently controversial and often disappointing.
J Orthop Sports Phys Ther 1989;11(6):237-244.
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Research Report
Tracy A. Greene, G. Charles Roland
The purpose of this study was to determine the effectiveness of a semirigid orthosis in restricting ankle inversion-eversion range of motion (ROM), and evaluate its effect on subjects' ability to produce muscular torque, during pre- and post-exercise test conditions. Thirty healthy subjects, 15 males and 15 females, with no history of right ankle injury were evaluated. Active ankle inversion-eversion torque and angular displacement were measured on a LIDO® isokinetic system, with the subjects' right ankle positioned in 0° of plantarflexion. T-tests for paired samples at the 0.001 confidence level revealed that the orthosis demonstrated significant inversion-eversion range restrictive capabilities; did not interfere with maximum inversion-eversion torque production; and retained its support effectiveness following 20 minutes of dynamic exercise. The results suggest that the tested orthosis may be an effective prophylactic in preventing ankle sprains and beneficial to individuals with chronic ligamentous instability.
J Orthop Sports Phys Ther 1989;11(6):245-252.
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Research Report
Edmund M. Kosmahl, Paul J. Mackarey, Shelley E. Buntz
The purpose of this study was to determine the difference in strength of the dominant quadriceps femoris muscle group among subjects utilizing a Nautilus® training system, and a traditional weight system. Eighteen college students, 18-23 years of age, volunteered for this study. Subjects were randomly assigned to one of three groups: Group N, Nautilus training system, consisted of six subjects utilizing the Nautilus knee extension machine, performing one set of 15 repetitions to failure, using a 15 RM (repetition maximum) at a count of 5 contract - 1 hold - 5 release. Group T, traditional, consisted of five subjects utilizing an NK table, performing three sets of 10 repetitions at 10 RM following a count of 1 contract - 1 release. Group C, control, consisted of seven subjects who did not undergo any training. The three groups were pre-tested for bilateral quadriceps femoris strength 1 week prior to training, and retested 7 weeks later on the Cybex® II Dynamometer. Results of this study, using an ANOVA with F-ratio, demonstrated that the strength gain of the dominant quadriceps femoris muscle is not significantly different between the three groups (p > 0.05). However, group T was significantly stronger than group N and C in average quadriceps strength (p < 0.05). In addition, there was a tendency for group T to demonstrate increased strength gains for all analyses. The authors contend that further investigation must be made to determine whether either method of exercise is superior at increasing quadriceps femoris strength.
J Orthop Sports Phys Ther 1989;11(6):253-258.
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Research Report
Craig Goodwin, Mark W. Cornwall
From the Department of Physical Therapy, Louisiana State University Medical Center, New Orleans, LA.
The purpose of this study was to determine if a shortened pedal shaft in comparison to a standard length pedal shaft significantly changed the amount of flexion required at the knee joint during cycling. In addition, was the phasic activity of the lower extremity musculature altered as a result of cycling under the two different conditions? Six healthy subjects pedaled at a steady rate of 75 rpm on a stationary bicycle with a standard (17.0 cm) and a shortened (8.9 cm) pedal shaft. The results of a paired t-test showed that significantly (p < 0.05) less knee flexion was needed with the shortened pedal shaft compared to the standard length shaft. Comparison of each muscle's phasic activity showed similar activity patterns between the two conditions. The onset of EMG activity, however, was found to be significantly later (p < 0.05) in the rectus femoris muscle while pedaling with the shortened shaft. In addition, the termination of EMG activity in the gastrocnemius muscle was found to occur significantly sooner (p < 0.05) during the shortened pedal shaft condition. The results of this study indicate that a shortened bicycle pedal shaft reduces the amount of knee flexion required for cycling without greatly altering the muscle contraction patterns of the muscles studied. It is the opinion of the authors that such a device will allow patients with moderately restricted ROM of the knee to utilize a stationary bicycle in their rehabilitation program.
J Orthop Sports Phys Ther 1989;11(6):259-262.
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