Editorial
Michael L. Voight
Knowledge applied equals a successful rehabilitation outcome and a competitive edge.
J Orthop Sports Phys Ther. 1994; 20(6):275.
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Research Report
Kent E. Timm
The professional literature contains relatively few randomized-control studies that have assessed the efficacy of physical therapy approaches to the management of patients with chronic low back pain (CLBP). The purposes of this study were: 1) to investigate the effects of physical agents, joint manipulation, low-tech exercise, and high-tech exercise on objective measures of CLBP; 2) to track the length of CLBP relief; and 3) to determine treatment cost-effectiveness. Two hundred fifty subjects (68 females, 182 males; ages 34-51 years) with CLBP following an L5 laminectomy were randomly assigned into 5 separate groups for a treatment period of 8 weeks. Chronic low back pain status was measured by modified-modified Schober, Cybex Liftask, and Oswestry procedures. Results revealed that: 1) only low-tech and high-tech exercise produced significant improvements (p<.05) in CLBP, 2) the mean period of CLBP relief ranged from 1.6 weeks (control) to 91.4 weeks (low-tech exercise), and 3) low-tech exercise was most cost-effective. It was concluded that: 1) low-tech and high-tech exercise were the only effective treatments for CLBP, 2) low-tech exercise produced the longest period of CLBP relief, and 3) low-tech exercise was the most cost-effective form of treatment. Clinically, low-tech exercise may be the treatment method of choice for the effective management of chronic low back pain.
J Orthop Sports Phys Ther 1994;20(6):276-286.
Key Words: chronic low back pain, physical therapy, therapeutic exercise
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Research Report
Kim L. Bennell, Patricia A. Goldie
Ankle supports are commonly used in an attempt to decrease the risk of ankle injury during sport. However, their use may also impair postural control, which is an integral component of sports participation. The aim of this study was to investigate the effects of 3 different ankle supports (tape, brace, and elastic bandage) on postural control in 24 normal subjects with a mean age of 24.8 years (±4.4). Two measures were used to evaluate postural control in one-legged stance with the eyes closed: variability of mediolateral ground reaction force (acquired from a force platform) and frequency of foot touchdowns by the nonsupport leg (assumed to indicate ability of the subject to maintain one-legged stance posture). Both measures revealed a differential effect for ankle support on postural control. The use of an elastic bandage had no significant effect on postural control (p>0.05), while the use of tape or a brace had a significant detrimental effect (p<0.05). While wearing the tape or a brace, subjects were less steady and touched down more frequently. Restriction of ankle movement was offered as a possible explanation for the results, since postural control was impaired only by the ankle supports, which limited ankle motion. These findings may have implications regarding impaired athletic performance.
J Orthop Sports Phys Ther. 1994;20(6):287-295.
Key Words: postural control, force platform, ankle supports
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Research Report
Vicky L. Deones, Steven C. Wiley, Teddy W. Worrell
Assessment of muscle performance is an integral component of patient evaluation. The primary purposes of this study were to examine the relationship between isokinetic dynamometer isokinetic peak force values and hand-held dynamometer isometric peak force values when assessing quadriceps muscle performance in subjects with orthopaedic knee dysfunctions (N = 21) and to test for differences in muscle performance between injured and noninjured lower extremities using a hand-held dynamometer and an isokinetic dynamometer. An analysis of variance was used to compare injured and noninjured extremities for both testing devices. A Pearson product moment correlation was used to examine the relationship between the hand-held dynamometer and isokinetic dynamometer values. No significant difference between extremities at 0° (p = 0.1224) or 60° (p = 0.8267) was revealed when testing with the hand-held dynamometer. The isokinetic dynamometer, however, revealed a significant difference between extremities at 60°/sec (p = 0.0041). Correlations between the two devices were significant, ranging from r = 0.57 to 0.80. We concluded that these correlations were misleading because more force was generated by the quadriceps muscles tested than a tester of average strength could resist. Further research is needed to validate the use of the hand-held dynamometer by a tester of average strength.
J Orthop Sports Phys Ther. 1994;20(6):296-301.
Key Words: dynamometer, muscle performance, methods
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Research Report
Elaine Trudelle-Jackson, Allen W. Jackson, Carolyn M. Frankowski, Kara M. Long, Neil B. Meske
The Nicholas Hand-Held Dynamometer (HHD) has been shown to have excellent interday and intraday reliability when using the same HHD. Since clinics may have more than one HHD with which to evaluate patients, it would be of value to know if 2 identical HHDs measure the same variable consistently. The purpose of this investigation was to assess interdevice reliability of the Nicholas HHD as well as to determine its validity. Thirty healthy female subjects between the ages of 20 and 56 years (x¯ age = 28.4) were tested for hamstring strength. Three measurements of maximum hamstring contractions were obtained using the first HHD (Device A). The average of these 3 measurements was compared with the average of 3 measurements obtained after a brief rest using a second HHD (Device B). Measurements from the 2 HHDs were also compared with measurements obtained from a Kin-Com isokinetic dynamometer. The Kin-Com measurements were used as criteria to determine validity of the HHD. An intraclass correlation coefficient (ICC) calculated to determine reliability between the 2 HHDs was low (ICC = 0.58). Pearson product-moment correlation coefficients were calculated between the Kin-Com and each of the 2 HHDs. These values were 0.85 and 0.83 for Device A and B, respectively. Analysis of variance showed no significant difference between the Kin-Com and Device A but a significant difference between the Kin-Com and Device B (p<.001). Measurements obtained from 2 identical HHDs may be significantly different and should not be compared.
J Orthop Sports Phys Ther. 1994;20(6):302-306.
Key Words: muscle strength, validity, Kin-Com
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Clinical Commentary
Marnie Allegrucci, Susan L. Whitney, James J. Irrgang
Swimming has become a popular recreational activity as well as a highly competitive sport in the United States. The repetitive nature of swimming can predispose the shoulder to mechanical impingement and microtrauma, which may lead to laxity, rotator cuff fatigue, and subsequent secondary impingement. Improper stroke mechanics can place the swimmer's shoulder at further risk. The purpose of this paper is to describe the pathology of secondary impingement in freestyle swimmers and to discuss the clinical implications for rehabilitation of swimmers with the pathology. A thorough subjective and objective evaluation is necessary to design a successful rehabilitation program. The rehabilitation program for swimmers with secondary impingement includes modification of training, flexibility, range of motion, strengthening, and mobilization as indicated. Functional and proprioceptive training may also be useful techniques in the rehabilitation of a swimmer's shoulder. Improper stroke mechanics can also have clinical implications on a swimmer's shoulders with secondary impingement. The clinical implication of secondary impingement in freestyle swimmers suggests that the primary goal of rehabilitation is to promote equilibrium of the shoulder complex while accounting for the demands of the sport.
J Orthop Sports Phys Ther. 1994;20(6):307-318.
Key Words: swimming, shoulder impingement and instability, rehabilitation
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Case Report
Tom Arild Torstensen, Helge Dyre Meen, Morten Stiris
There is an increased focus on the importance of using active exercise regimes for treating dysfunction in the musculoskeletal system. However, we have little exact knowledge on how to dose and grade exercises or the effect of exercise on the regeneration of low metabolic tissue structures in vivo. This case study deals with both topics and emphasizes the use of exercise only when treating a 73-year-old patient with a 1-year history of shoulder pain. His evaluation indicated chronic supraspinatus syndrome. Different treatment methods had no effect, and medical exercise therapy was tried as a last resort. The patient recovered after 2-1/2 months with 4 treatments per week. Diagnostic ultrasound taken before treatment and after a 5-1/2-month period showed that the supraspinatus tendon had regenerated. These findings are encouraging, supporting the possibility of tendon repair with biomechanical stresses from exercise. To our knowledge, it has never been shown in vivo that it is possible for a low metabolic structure to regenerate using exercise only. Instead of having surgery with an uncertain outcome, today the patient is free of symptoms and living a normal life enjoying his sporting activities nearly 4 years after he finished the treatment.
J Orthop Sports Phys Ther. 1994;20(6):319-327.
Key Words: therapeutic exercise, chronic supraspinatus tendinitis, diagnostic ultrasound
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Index
This index includes all authors and co-authors of manuscripts published in the Journal from July through December 1994.
J Orthop Sports Phys Ther. 1994;20(6):335.
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Index
Index by subject of all manuscripts published by the Journal from July through December 1994.
J Orthop Sports Phys Ther. 1994;20(6):336-340.
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