Study Design: Randomized controlled 2-group, pretest-posttest, multivariate study of patients with shoulder musculoskeletal disorders. Objective: The purpose of this study was to evaluate the immediate effect of soft tissue mobilization (STM) with proprioceptive neuromuscular facilitation (PNF) to increase glenohumeral external rotation at 45° of shoulder abduction and overhead reach. Background: It is postulated that limitation in glenohumeral external rotation, when measured at 45° of shoulder abduction, represents subscapularis muscle flexibility deficits and is associated with the inability to fully reach overhead. No research, however, is available to demonstrate whether intervention strategies intended to improve subscapularis flexibility and glenohumeral external rotation range of motion at 45° of shoulder abduction will improve a patient’s ability to reach overhead. Methods and Measures: Twenty patients (10 males, 10 females; age range, 21-83 years) with limited glenohumeral external rotation and overhead reach of 1 year duration or less served as subjects. The subjects were randomly assigned to a treatment group, which consisted of soft tissue mobilization to the subscapularis and proprioceptive neuromuscular facilitation to the shoulder rotators, or a control group. Goniometric measurements of glenohumeral external rotation at 45° abduction and overhead reach were taken preintervention and immediately postintervention for the treatment group or at prerest and postrest periods for the control group. Results: The treatment group improved by a mean of 16.4° (95% confidence interval [CI], 12.5°-20.3°) of glenohumeral external rotation, as compared to less than a 1° gain (95% CI, -0.2°-2.0°) in the control group (P<.0005). Overhead reach in the treatment group improved by a mean of 9.6 cm (95% CI, 5.2-14.0 cm) in comparison to a mean gain of 2.4 cm (95% CI, -0.8-5.6 cm) for the control group (P = .009). Conclusion: These findings suggest that a single intervention session of STM and PNF was effective for producing immediate improvements in glenohumeral external rotation and overhead reach in patients with shoulder disorders.

J Orthop Sports Phys Ther. 2003;33(12):713-718.
 

Key Words: manual therapy, proprioceptive neuromuscular facilitation, range of motion, shoulder, subscapularis

Study Design: Experimental pretest-posttest control design. Objective: The purpose of the study was twofold: (1) to determine the lasting effect of static stretch on hamstring length for up to 24 hours and (2) to compare the efficacy of static stretch with and without warm-up exercise on hamstring length. Background: Research is limited on the lasting effects of static stretching and is controversial on the combined effects of warm-up activities and static stretching on muscle lengthening. Methods and Measures: Fifty-six volunteer subjects (ages 18-42 years) with limited bilateral hamstring length were assigned to 1 of 4 groups: (1) warm-up and static stretch, (2) static stretch only, (3) warm-up only, and (4) control. The warm-up was 10 minutes of stair climbing at 70% of maximum heart rate. Static stretch consisted of a single session of three 30-second passive stretches of the hamstring. Hamstring length was measured preintervention and at several intervals postintervention (immediately and then at 15 minutes, 60 minutes, 4 hours, and 24 hours) using the active knee extension (AKE) test. Data were analyzed using a mixed-model analysis of variance. Results: The warm-up-and-static-stretch group and the static-stretch-only group showed a significant increase in hamstring length between preintervention and all postintervention measurements. At 24 hours poststretch, the warm-up-and-static-stretch group had a mean increase of 10.3° (95% confidence interval, 7.7-12.9) and the static-stretch-only group had a mean increase of 7.7° (95% confidence interval, 4.7-10.7) in AKE range of motion (ROM). Both of these groups did show a significant decrease (2.9° and 4.0°, respectively) in hamstring muscle length (AKE ROM) at 15 minutes poststretch when compared to immediate poststretch values. The static-stretch-only and the warm-up-and-static-stretch groups did not differ significantly from each other. Control and warm-up-only groups showed no significant increase in hamstring length between preintervention and any of the postintervention measurements. Conclusion: A significant increase in hamstring length can be maintained for up to 24 hours when using static stretching. Muscle length gains are greatest immediately after stretching and decline within 15 minutes. The addition of a warm-up exercise prior to stretching does not appear to significantly increase the effectiveness of static hamstring stretching.

J Orthop Sports Phys Ther. 2003;33(12):727-733.

Key Words: flexibility, lower extremity, muscle length, stretching

Study Design: Cross-sectional observational design. Objective: To compare physical activity levels in men and women with end stage knee osteoarthritis to those of a comparison group and to examine the relationship between physical activity level and physical performance. Background: Osteoarthritis of the knee is associated with significant losses in functional performance and high social costs. Although reductions in physical activity are reported, they have not been quantified or explored. Methods and Measures: Fifty-nine candidates awaiting total knee arthroplasty (TKAC group) and 79 individuals without osteoarthritis (comparison group) participated. Physical activity was assessed using the Voorrips Questionnaire. Performance measures included fast self-paced walk test, timed up-and-go test, and a timed stair performance measure. A subset of subjects completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and underwent muscular strength and endurance testing. The effects of gender and group were tested using GLM ANOVA. Pearson product moment correlations were used to examine relationships between the variables. Results: All aspects of physical activity were lower (P<.001) in the TKAC group, with a moderate difference in household score (18%) and a large difference in leisure activities (63%). Unlike the comparison group, modest but significant correlations (r = 0.31-0.33, P<.03) were observed between overall physical activity and performance test scores for the TKAC group. Physical activity was not significantly related to pain reported on the WOMAC or during the performance tasks. Conclusion: The belief that pain limits the physical activity of patients with severe osteoarthritis requires further investigation. The profound differences between a comparison group and patients with end stage osteoarthritis in physical activity have critical implications for the well-being and effective treatment of this population.

J Orthop Sports Phys Ther. 2003;33(12):745-754.

Key Words: exercise, pain, physical performance, total knee replacement

Index by subject of all manuscripts published by the Journal during 2003.

J Orthop Sports Phys Ther. 2003;33(12):779-786.