Research Report
Mitchell L. Cordova, Christopher D. Ingersoll, Mark A. Merrick, Matthew R. Mihalyov, Jennifer L. Roethemeier
Study Design: A repeated-measures design was used. The independent variable was ultrasound coupling medium with 2 levels: gel pad and traditional gel. The dependent variable was peak intramuscular (IM) tissue temperature.
Objective:To compare changes in IM temperature during similar ultrasound treatments with 2 different coupling media.
Background: Gel pads are gaining popularity as an ultrasound coupling medium. Intramuscular temperatures during ultrasound with gel pads and standard gel have not been compared.
Methods and Measures: Subjects were 13 student volunteers (21.3 ± 1.4 years of age) without lower-extremity pathology. Ultrasound treatments were administered in a laboratory on 2 separate occasions 48 hours apart, each with a different coupling medium (standard ultrasound gel or gel pad). One-MHz continuous ultrasound was administered for 7 minutes at 1.5 W/cm 2 with the transducer head moving 3 to 4 cm/s over an area approximately twice the size of the transducer head. Tissue temperature was measured every 10 seconds using implantable thermocouples inserted at a 3-cm depth to the surface of the right medial calf. Data were analyzed using an ANCOVA with pretreatment temperature as the covariate.
Results: Tissue temperatures increased during both treatments, with the mean and standard deviation peak temperature during the gel pad treatment reaching 39.4° ± 1.5°C compared to 39.2° ± 2.4°C during the normal gel treatment. Statistical analysis revealed no difference in temperature between ultrasound treatments using gel and those performed using gel pads.
Conclusions: Because temperature changes were similar with both treatments, we conclude that these coupling methods are equivalent under the ultrasound application parameters tested.
J Orthop Sports Phys Ther. 2002; 3(5):216–220.
Key Words: acoustic transmission, coupling medium, thermocouple
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Research Report
James P. Fletcher, Clayton F. Holmes, Donald Wilcox
Study Design: Single-group repeated measures design pre- and postintervention.
Objectives: To determine if the modified low-Dye medial longitudinal arch (MLA) taping procedure places the subtalar joint into the neutral position and maintains the subtalar joint neutral (STJN) position following 10 minutes of walking.
Background: Subtalar malalignment in excessive pronation is commonly accepted as a contributing factor to a variety of musculoskeletal pathologies. The modified low-Dye MLA taping procedure is often used on the plantar surface of the foot as a short-term corrective tool for excessive foot pronation. However, research that evaluates the efficacy of this taping technique during light exercise is lacking. Measurement of navicular height is commonly used as a measure of subtalar position.
Methods and Measures: Prior to the study, one tester-established reliability in the navicular drop technique measurement by initially practicing the measurements on 400 feet, followed by a reliability study performed on 29 subjects. In this study, a screening procedure excluded subjects with ankle or foot pathology, supinated feet, or neutral feet, and included only subjects with pronated feet. The study, which included 40 subjects, involved 4 steps: (1) measuring navicular height in the relaxed position; (2) measuring navicular height in the STJN position; (3) measuring navicular height after application of the modified low-Dye MLA taping procedure; and (4) measuring navicular height after subjects had walked for 10 minutes with the taping.
Results: Results indicated an intrarater intraclass correlation coefficient (ICC) for measuring navicular height of 0.96 for the right foot and 0.94 for the left foot. Repeated measures ANOVA revealed that significant differences existed (P < 0.05) among the 4 measures. A Bonferroni post hoc analysis showed a difference between relaxed stance measurements and all other measurements, and between taped-prewalking measurements and taped-postwalking measurements. In addition, no significant difference was observed between navicular height measured in STJN and the taped-prewalking and taped-postwalking conditions. The average navicular height for the taped-prewalking condition was 1.6 mm higher than that for the STJN position. For the taped-postwalking condition, the average height of the navicular was 1.2 mm lower than that of the STJN position.
Conclusion: These results demonstrate that the modified low-Dye MLA taping procedure places the subtalar joint near the neutral position. Despite a significant reduction in the height of the navicular after the subjects walked for 10 minutes with the tape on, the height of the navicular was still not significantly different than that of the STJN position.
J Orthop Sports Phys Ther. 2002; 32(5):194–201.
Key Words: medial longitudinal arch, navicular height, pronation, subtalar joint
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Research Report
Dirk C. Cambier, Ann M. Cools, Lieven A. Danneels, Geert A. De Clercq, Michael Voight, Tine M. Willems, Erik E. Witvrouw
Study Design: Test-retest reliability study and single-group repeated measures design.
Objectives: To evaluate the muscle latency times of the 3 portions of the trapezius muscle to a sudden arm movement in normal shoulders and to determine if this recruitment pattern is altered as a result of fatigue.
Background: It has been suggested that shoulder impingement may be related to altered muscle activity and muscle fatigue in the scapular stabilizers. Fatigue-induced changes in latency times of the trapezius might influence scapular stability.
Methods and Measures: Muscle latency times were investigated in 30 healthy shoulders with surface electromyography. Muscle activity was measured in all 3 sections of the trapezius and the middle deltoid muscle during a sudden downward falling movement of the arm. Subsequently the shoulder was fatigued on an isokinetic dynamometer, after which muscle latency time measurement was repeated.
Results: ANOVA for repeated measures revealed significant differences in latency times (P < 0.05) among the 4 muscles of interest. Although there were no significant differences among the 3 sections of the trapezius muscle, they all were recruited after the initialization of the deltoid muscle. The recruitment order of the shoulder muscles did not change with muscle fatigue. However, after fatigue, muscle responses were significantly slower in all muscles except for the lower trapezius (P < 0.05).
Conclusions: There is a specific recruitment sequence in the shoulder muscles in response to a sudden arm movement characterized by initial activation of the middle deltoid muscle and followed by simultaneous contraction of all 3 sections of the trapezius. This muscle activation pattern is delayed but not altered with fatigue.
J Orthop Sports Phys Ther. 2002; 32(5):221–229.
Key Words: muscle latency times, muscular balance, neuromuscular properties, scapular stabilizers
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Research Report
David Joffe, Bernard A. Pfeifer Pfeifer, Linda Steiner, Mary Watkins
Study Design: A single-subject experimental design using an A-B-A treatment protocol.
Objective:To determine whether walking on a treadmill with partial body weight support (PBWS) would be an effective adjunct treatment method to standard care for decreasing pain and increasing function in patients suffering from low back and leg pain.
Background: Mechanical low back pain (LBP) is commonly aggravated by activities that increase axial loading in the spine, such as sitting, standing, and walking. Patients with mechanical LBP usually describe relief with positions that unload the spine. One traction technique now being used in clinics to unload the spine is the PBWS system. The use of endurance exercise has also been found to be a consistent predictor of better outcomes in patients with LBP. Thus treatment that combines spinal unloading using PBWS and endurance exercise may be an effective intervention for patients with low back and leg pain.
Methods and Measures: Eleven subjects participated in this study using an A-B-A design. Phase A was defined as the baseline condition and phase B was intervention with PBWS provided by a mechanical unloading system. The Roland-Morris Questionnaire (RMQ) and Visual Analog Scale (VAS) were utilized to collect data on functional status and perceived pain, respectively. Visual Analysis and 2 standard deviation band method (2SDBM) were used to analyze the data.
Results: Pain scores between baseline and PBWS treatment phases were significantly improved for 3 out of the 6 subjects who completed the study. RMQ baseline and treatment scores revealed that 5 out of 6 subjects had significant functional improvements in the PBWS treatment phase.
Conclusion: The results suggest that ambulation with PBWS combined with the standard level of care for this population holds sufficient promise for pain relief and functional improvement to justify testing its efficacy in larger groups of subjects with these complaints.
J Orthop Sports Phys Ther. 2002; 32(5):202–215.
Key Words: back pain, endurance exercise, spinal unloading
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