Resident's Case Problem
Alison T. DeLeo, Lynn Snyder-Mackler, W. Wayne Woodzell
The purpose of this case problem was to describe an uncommon presentation and treatment of a patient with posterolateral corner instability. Table 1 of the article summarizes the physical therapy interventions and physical therapy goals for this patient. Posterolateral corner damage is typically concomitant with injury to the posterior cruciate ligament (PCL) or anterior cruciate ligament (ACL). This patient was unique because she injured the posterolateral corner in combination with a grade II lateral collateral ligament (LCL) sprain. Additionally, an uncommon feature presenting in this patient’s case was the perceived abnormal position of the fibular head. As in most knee injuries, quadriceps weakness was a major contributor to her functional level, thereby making strengthening exercises a cornerstone of treatment. In the clinical management of this patient, reassessment throughout the course of physical therapy, multiplane proprioceptive exercises, and a comprehensive home exercise program (HEP) were helpful in returning the patient to her prior level of function. J Orthop Sports Phys Ther. 2003; 33(4):185-195.
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Research Report
Kirsten Anderson, Maea Hohepa, Peter J. McNair, Harry Prapavessis
Study Design: Randomized controlled experimental design.
Objectives: To examine the effects of verbal instructions related to control of joint kinematics and auditory feedback on lowering the vertical peak ground reaction forces associated with landing from a jump in children.
Background: The majority of children’s injuries are associated with activities that involve jumping and landing. Instructions related to joint motion may assist children in decreasing landing forces and thus reduce the chances of sustaining an injury.
Methods and Measures: Sixty-one school children whose mean (±SD) age was 9 (±0.89) years participated. The children were randomly assigned (by school) to either experimental (received instruction on lower limb position and auditory cues) or control (received no instruction) groups. Participants were required to step off a box 300 mm in height and land on a force plate. The testing procedure involved 5 sessions. The first 4 sessions were performed over 3 days in the same week, while session 5 was performed approximately 3 months later to assess retention of the skill. The main outcome measure was the peak vertical ground reaction force recorded at foot strike.
Results: After instructions, subjects in the experimental group produced lower peak ground reaction forces (P<0.05) during landing compared to their control counterparts (ie, sessions 2–4). There was no significant difference (P<0.05) between groups at session 5 (3 months post instruction).
Conclusions: Children are capable of assimilating precise instruction to minimize forces on the lower limbs during landing from a jump. Providing further opportunity (ie, more than 1 session) to perform the skill does not alter the magnitude of the effect observed after the initial session of instruction. However, the improvements in landing performance were temporary.
J Orthop Sports Phys Ther. 2003; 33(4):204-207.
Key Words: falls, feedback, injury prevention, learning, performance
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Research Report
Sharon L. Kilbreath, Jacquelene Raymond, Kathryn M. Refshauge
Study Design: Observational cross-sectional design.
Objectives: To determine whether a deficit exists in the ability to perceive inversion and eversion movements among subjects with recurrent ankle sprains.
Background: Although unproven, ankle sprains are thought to recur because proprioception is impaired subsequent to the original sprain. Proprioception has been widely studied, however, the specific property of movement perception has not been rigorously examined for both inversion and eversion movements.
Methods and Measures: The ability to perceive passive inversion and eversion movements imposed at the relaxed ankle was measured in 39 subjects with recurrent ankle sprains (sprainers) and 30 subjects with no history of ankle injury (controls) by an assessor masked to subject group. The 70% detection level for movement perception was determined for 3 velocities, 0.1°/s, 0.5°/s, and 2.5°/s, tested in random order.
Results: The 70% detection level for inversion and eversion movements improved with increasing velocity in both groups. At all velocities, the 70% detection level for movements imposed at the ankle of the sprainers was significantly worse than for controls.
Conclusions: Perception of passive inversion and eversion movements imposed at the ankle was impaired in subjects with recurrent ankle sprains. The impairment was evident at the 3 velocities tested, 0.1°/s, 0.5°/s, and 2.5°/s.
J Orthop Sports Phys Ther. 2003; 33(4):166-176.
Key Words: kinesthesia, proprioception, sensory function
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Research Report
Joshua Burns, Anne-Maree Keenan, Anthony C. Redmond
Study Design: Descriptive correlational investigation.
Objectives: To assess the incidence of, and potential risk factors associated with, overuse injury in triathlon.
Background: The sport of triathlon is rapidly increasing in popularity with a concomitant rise in the prevalence of injuries sustained by triathletes.
Methods and Measures: The training and injury patterns of 131 triathletes were surveyed over a 10-week prospective period during the triathlon competition season. A complementary retrospective 6-month analysis of training history and prior overuse injuries was conducted.
Results: Fifty percent of triathletes sustained an injury in the 6-month preseason at an injury exposure rate of 2.5 per 1000 training hours. Thirty-seven percent were injured during the 10-week competition season at an injury exposure rate of 4.6 per 1000 training hours. Overuse accounted for 68% of preseason and 78% of competition season injuries reported. Increased years of triathlon experience, high running mileage, history of previous injury, and inadequate warming-up and cooling-down regimes appeared to have individual associations with injury incidence. When interactions were included in a multiple logistic regression model, increasing years of triathlon experience was the most significant predictor of preseason injury risk and a previous history of injury and high preseason running mileage increased the risk of injury during the competition season.
Conclusions: The results indicate that in assessing triathletes, a full training and competition history is required by the sports clinician for a comprehensive assessment of the factors that may contribute to overuse injury.
J Orthop Sports Phys Ther. 2003; 33(4):177-184.
Key Words: musculoskeletal injury, running, training, triathlete
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Research Report
Scott A. Banks, Kim Mitchell, David Morgan
Study Design: Prospective descriptive biomechanical analysis of shoulder motion in golf.
Objective:To characterize normal shoulder motion during the driving swing in male recreational golfers of various age groups.
Background: Shoulder trauma accounts for approximately 12% of all golf-related injuries. To design sport-specific rehabilitation programs for the injured golfer and exercise programs for the healthy golfer, clinicians and teachers need quantitative information describing range of motion requirements about the shoulder for the amateur player.
Methods and Measures: Sixty-five male golfers were divided into 3 age groups: college, middle, and senior. A high-speed, 6-camera motion analysis system recorded 3-dimensional bilateral shoulder motion (vertical elevation, horizontal adduction, external rotation, and shoulder turn) for 3 swings of the driver. Group means for ranges and functional end points of motion were compared using a single-factor 1-way ANOVA (a = 0.05).
Results: All maximum values of shoulder motion were lower in the senior group than in the other 2 groups. At peak backswing, senior golfers exhibited 38° less right-side shoulder external rotation than college golfers. However, from address, seniors horizontally abduct the right arm 18° more than college golfers. In the older golfers, total range of motion was reduced for both shoulders in the vertical plane and for the left shoulder in the horizontal plane.
Conclusions: This study describes shoulder motion for asymptomatic golfers of various age groups. These data may serve as a baseline reference for assessing disease- or injury-related changes in the golf swing and for designing sport-specific exercise and rehabilitation programs.
J Orthop Sports Phys Ther. 2003; 33(4):196-203.
Key Words: aging, golf, range of motion, shoulder kinematics, 3-dimensional motion analysis
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