Although patellar taping has been reported to be effective in reducing pain, the effects of this procedure on functional outcomes, such as ambulation, have not been documented. The purpose of this study was to compare stride characteristics and joint motion in subjects with patellofemoral pain, with and without the application of patellar taping using the McConnell technique. Fifteen female subjects between the ages of 14 and 41 years with a diagnosis of patellofemoral pain participated in this study. Stride characteristics (Stride Analyzer) and sagittal plane joint motion (VICON) were recorded simultaneously during taped and untaped trials of free walking, fast walking, and ascending and descending a ramp and stairs. A repeated measures analysis of variance was used to determine differences between taped and untaped trials. Although subjects reported an average pain reduction of 78% using a visual analogue scale, the only significant change in stride characteristics was an increase in stride length during ramp ascent. Patellar taping did, however, result in a small but significant increase in loading response knee flexion across all conditions tested. We believe this finding demonstrates more willingness by the patellofemoral pain subjects to load the knee joint, thus permitting increased shock absorption, increased quadriceps activity, and tolerance of increased patellofemoral joint reaction force.

J Orthop Sports Phys Ther. 1997;26(6):286-291.

Key Words: patellofemoral pain, patellar taping, gait

Studies of the passive support provided by ankle braces have focused primarily on inversion support. The goal of this study was to develop a technique to measure the support provided by ankle braces in all rotational directions and to use this technique to compare four common braces (Ascend™, Swede-O™, Aircast™, and Active Ankle™) For this purpose, a 6 degrees-of-freedom linkage was used to measure the flexibility of the ankle complex in 10 healthy subjects. Each subject was tested without brace support and with each of the 4 braces. Testing was repeated on each subject on 2 different occasions. The angular displacement at specified moment values and the 4 segmental flexibility values obtained from the loading portion of the moment-angular displacement data were used in the data analysis. Repeated measure analysis of variance followed by a Student Neuman-Keuls test at p < 0.05 was performed. This statistical analysis was used to identify significant differences among the braces and differences between each brace and the no brace condition. Each of the 4 braces provided significant support in inversion, eversion, and internal rotation, but the amount of support varied significantly among the braces. In external rotation, only the stirrup braces provided significant support. The braces also varied significantly in the amount of interference with dorsiflexion and plantar flexion. Clinicians may be assisted by objective data on the amount and nature of passive support when prescribing braces to their patients.

J Orthop Sports Phys Ther. 1997;26(6):299-309.

Key Words: ankle, braces, passive support

Although previous investigators have observed that knowledge of performance via visual feedback tends to enhance performance during an isokinetic test, the timeframe over which visual feedback remains advantageous is unclear. The purpose of this study was to compare knee extensor torques produced by visual feedback and no visual feedback groups on 3 occasions, completed over a 2-week period, and at 4 weeks after the third test. Healthy, sedentary subjects were each randomly assigned to either a visual feedback or a no visual feedback group (N = 10 males and 10 females per group). Visual feedback consisted of viewing a computer monitor, which displayed the current and a target knee extension force. Torques produced by the visual feedback group were consistently greater (p < 0.05) and more reliable than those produced by the no visual feedback group. The effectiveness of visual feedback tended to decrease over the first 3 occasions, suggesting that visual feedback may not be as advantageous once a skill is well learned. Further research needs to examine the contribution of visual feedback to motor learning as well as retention and transfer of motor skills during more complex functional tasks.

J Orthop Sports Phys Ther. 1997;26(6):318-323.

Key Words: knee extension, resistive exercise, visual feedback

Health care reform will quite possibly change the delivery of physical therapy by demanding physical therapists to be more accountable for providing appropriate, yet cost-effective treatment. The purpose of this study was to retrospectively compare the results after anterior cruciate ligament (ACL) reconstruction between 2 groups of patients with different numbers and frequencies of physical therapy visits postoperatively. Two random samples of 100 patients from a total of 1,345 patients identified as undergoing ACL reconstruction from 1990 through 1993 were included. Group A patients attended physical therapy regularly and participated in a home exercise program, while patients in Group B attended limited physical therapy visits and also performed a prescribed home exercise program. Both groups followed the same postoperative rehabilitation program for early range of motion, early weight bearing, and muscle control. The outcome variables measured 1, 6, and 12 months postoperatively included the number of structured visits to physical therapy, range of motion, isokinetic strength testing, and subjective rating. Group A averaged 20 visits in the first 6 months while Group B averaged seven visits. The results revealed no significant difference for flexion, isokinetic strength, or subjective rating. There was a significant difference for hyperextension (Group A, 2°; Group B, 6°). The results of this investigation indicated that by following a structured physical therapy program postoperatively, it is possible for patients to achieve a successful outcome with a limited number of routine physical therapy visits.

J Orthop Sports Phys Ther. 1997;26(6):332-339.

Key Words: anterior cruciate ligament reconstruction, rehabilitation, clinical outcome, cost-effectiveness

One common approach to patient care in dealing with many musculoskeletal dysfunctions involves 2 to 3 patient visits to physical therapy per week over a period of weeks. Some patients may benefit from an alternative, graduated treatment model emphasizing a minimal number of office visits and focusing on intensive patient education, home program therapeutic exercise, and specific manual interventions. Patient education focuses on home program compliance and empowerment of the patient by adjusting office visits as needed based on patient progress rather than multiple patient contacts in the first weeks. This emphasis may improve long-term patient compliance by preventing the development of an external locus of control in which the patient is dependent upon the therapist for management of his/her condition. This case study is an example of the use of this alternative treatment model for the resolution of impingement syndrome and adhesive capsulitis in a 53-year-old female. A comprehensive program of patient education and home exercise was initiated during the first visit. Joint mobilization and active exercise were performed at each subsequent visit. The patient was seen a total of six visits over a period of approximately 10-1/2 weeks, followed up via telephone at 1 month after the last treatment and reexamined after 1 year. The objective exam revealed no abnormalities after the last visit or after 1 year. The patient subjectively reported compliance with the home program for 6 months after the last visit. This model of patient care was successful for the patient described in this case study. The treatment approach may have contributed to the development of an internal locus of control by allowing the patient to be as actively involved as possible in the treatment of her condition. In addition, this approach is timely when one considers current reimbursement systems. Though successful with this patient, this graduated treatment model is not intended to be applicable to every patient with this diagnosis.

J Orthop Sports Phys Ther. 1997;26(6):347-354.

Key Words: patient education, compliance, home program

Index by subject of all manuscripts published by the Journal from July through December 1997.

J Orthop Sports Phys Ther. 1997;26(6):378-386.