Study Design: Two-group repeated measures. Objectives: To evaluate the changes in the flexor carpi radialis H reflex after reading and neck retraction exercises and to correlate reflex changes with the intensity of radicular pain. Background: Repeated neck retraction movements have been routinely prescribed for patients with neck pain. Methods and Measures: Ten nonimpaired subjects (mean age, 27 ± 4 years) and 13 patients (mean age, 35 ± 9 years) with C7 radiculopathy volunteered for the study. The flexor carpi radialis H reflex was elicited by electrical stimulation of the median nerve at the cubital fossa before and after 20 minutes of reading and after 20 repetitive neck retractions. Subjective intensity of the radicular pain was reported before and after each condition using an analog scale. Results: For patients with radiculopathy, a repeated-measures analysis of variance showed a significant decrease in the H reflex amplitude (from 0.81 ± 0.4 to 0.69 ± 0.39 mV), an increase in radicular symptoms after reading (from 4.2 ± 1.3 to 5.6 ± 1.4 on the visual analog scale), an increase in the H reflex amplitude (from 0.69 ± 0.39 to 1.01 ± 0.49 mV), and a decrease in pain intensity (from 5.6 ± 1.4 to 1.5 ± 1.3) after repeated neck retractions. There was an association between cervical root compression (smaller H reflexes) and increased pain during reading and between cervical root decompression (larger H reflex) and reduced pain (r = -0.86 to -0.60). Exacerbation of symptoms was found with a reading posture. There were no significant changes in the H reflex amplitude in the nonimpaired group. No changes were found in reflex latency for either group. Conclusions: Neck retractions appeared to alter H reflex amplitude. These exercises might promote cervical root decompression and reduce radicular pain in patients with C7 radiculopathy. The opposite effect (an exacerbation of symptoms) was found with the reading posture.

J Orthop Sports Phys Ther. 2000;30(1):4-12.

Key Words: electromyography, H reflex, neck pain, posture

Study Design: Case study of a patient who developed plantar fasciitis after completing a triathlon. Objectives: To describe the factors contributing to the injury, describe the rehabilitation process, including the analysis of defective athletic shoe construction, and report the clinical outcome. Background: Plantar fasciitis has been found to be a common overuse injury in runners. Studies that describe causative factors of this syndrome have not documented the possible influence of faulty athletic shoe construction on the symptoms of plantar fasciitis. Methods and Measures:The patient was a 40-year-old male triathlete who was followed up for an initial evaluation and at weekly intervals up to discharge 4 weeks after injury and at 1 month following discharge. Perceived heel pain, ankle strength, and range of motion were the primary outcome measures. Shoe construction was evaluated to assess the integrity of shoe manufacture and wear of materials by visual inspection of how shoe parts were glued together, if shoe parts were assembled with proper relationship to each other, if the shoe sole was level when resting on a level surface, and if the sole allowed unstable motion. Results: The patient appeared to have a classic case of plantar fasciitis with a primary symptom of heel pain at the calcaneal origin of the plantar fascia. On initial evaluation, right heel pain was a 9 of 10, plantar flexion strength was a 3+/5, and ankle dorsiflexion motion was 10°. One month after discharge, perceived heel pain was 0, plantar flexion strength was 5/5, and dorsiflexion motion was 15° and equal to the uninvolved extremity. The right running shoe construction deficit was a heel counter that was glued into the shoe at an inward leaning angle, resulting in a greater medial tilt of the heel counter compared with the left shoe. The patient was taught how to examine the integrity of shoe manufacture and purchased a new pair of sound running shoes. Conclusions: A running shoe manufacturing defect was found that possibly contributed to the development of plantar fasciitis. Assessing athletic shoe construction may prevent lower extremity overuse injuries.

J Orthop Sports Phys Ther. 2000;30(1):21-31.

Key Words: defective athletic footwear, plantar ligament inflammatory syndrome, running