The high cost of health care and limited information regarding the effects of work hardening have prompted a need to further study work hardening programs. The purpose of this study was to determine the success of a work hardening program that included physical, occupational, and psychological therapies, and to determine if there are nonphysical factors associated with successful work hardening. One hundred medical records of injured workers with low back pain and other musculoskeletal disorders were retrospectively reviewed. Factors examined included months of injury, education level, sex, race, presence of an attorney, prior surgery, pain behaviors, smoking, medication use, and diagnosis severity. Seventy-six percent of the subjects successfully completed the program, and 50% of the subjects were returned to work at discharge. Nonphysical factors that limited successful work hardening were presence of pain behaviors (p < .01), attorney representation (p < .01), McAndrews score above 70 (p < .05), and education less than high school (p < .05). The author concludes that the return to work rate for injured workers in this study is comparable to rates of previous studies and that there are nonphysical factors associated with the success of work hardening.

J Orthop Sports Phys Ther. 1995;22(6):238-246.

Key Words: occupational injury, work hardening, pain behavior

Many research efforts focus on unidirectional gait. However, few functional activities are exclusively linear: people regularly change directions to evade obstructions. Directional changes have been identified as particularly hazardous, but rarely studied. The purpose of this study was to examine the kinetics of abrupt changes of direction while running. Twelve adult volunteers performed 10 trials each for 45° and 90° change-of-direction conditions. Orthogonal force and moment (torque) records were obtained using a computer-interfaced force platform system. Vertical, braking, and propulsive force and applied torque variables were extracted for statistical analysis. Significant force differences (p < .01) were identified between conditions. Applied torques were highly variable and not significantly different. Functionally, these data suggest that applied forces serve as the principal impetus of directional change.

J Orthop Sports Phys Ther. 1995;22(6):254-258.

Key Words: biomechanics, running, direction change

The anterior drawer and Lachman tests are frequently used for determining anterior cruciate ligament (ACL) instability. The Lachman test is considered to be the most accurate, yet it is difficult to perform on a large person, especially by an examiner with small hands. One procedure, the alternate Lachman test, has been used with some success by examiners who have difficulty performing the Lachman test. The purpose of this study was to compare these 3 manual tests with respect to predicting ACL stability. These findings were compared with those of the KT-1000 knee arthrometer. Seventy-four subjects (x¯ age = 22 years) volunteered for the study. Girth measurements were recorded for each subject at 8 cm above and below the midpoint of the patella. An examiner with small hands (21-cm span) performed each of the 3 tests on both knees of the subjects and then recorded which knee he believed was the more lax of the 2 with respect to each test. Another examiner then tested each subject's knees with the KT-1000. A log-linear model with terms for manual test type, category, and thigh girth was used for statistical analysis. The alternate Lachman test significantly outperformed the other 2 tests. Subjects with >2.5 mm bilateral laxity difference were correctly evaluated 100% of the time using the alternate Lachman test. In subjects with large thigh girth (>43 cm), 1) the alternate Lachman test was correct 78% of the time; 2) the anterior drawer test was correct 59% of the time; and 3) the Lachman test produced only 28% correct examinations. Based upon these results, the alternate Lachman test should be included in the regimen of manual ACL tests, especially for athletes with large thigh circumference or when performed by examiners with small hands.

J Orthop Sports Phys Ther. 1995;22(6):263-266.

Key Words: knee, anterior cruciate ligament, instability, examiner proficiency

This index includes all authors and co-authors of manuscripts published in the Journal from July through December 1995.

J Orthop Sports Phys Ther. 1995;22(6):283-285.