Research Report
Study Design: A multicenter, single-masked study of patients with patellofemoral pain syndrome (PFPS) using a repeated-measures design.
Objective: To compare 3 different methods of patellar taping for individuals with PFPS.
Background: Patellar taping is commonly used as a treatment for PFPS. It is commonly thought that taping works by medially realigning the patella. However, comparisons have been rarely made with other methods of taping which attempt to realign the patella in different directions.
Methods and Measures: Seventy-one patients with PFPS (39 men, 32 women; average age ± SD, 34 ± 10 years) from 3 different treatment centers were tested. Each patient performed 4 single step-downs from a standard 8-inch (20.3-cm) platform, initially with the patella untaped and then with the patella taped in a medial, neutral, and lateral direction. Pain was recorded on a standard 11-point numerical pain rating scale. The sequence of taping was randomly allocated and patients were masked to the method used. The methods of taping were compared using repeated-measures generalized linear model analysis.
Results: All methods of taping significantly decreased pain when compared to the untaped condition (P<.0001). Neutral- and lateral-glide techniques produced a significantly greater degree of pain relief (P<.0001) than the medial-glide technique.
Conclusion: In this study, patellar taping produced an immediate decrease in pain in patients with PFPS, irrespective of how taping was applied. These data raise questions as to the mechanism of action of patellar taping. Furthermore, these results suggest that it is unlikely that taping works by altering patellar position. J Orthop Sports Phys Ther. 2003;33(8):437-448.
Key Words: knee, lower extremity, patella, tape
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Study Design: A descriptive study of the anatomical characteristics of the upper serratus anterior.
Objectives: To delineate the upper serratus anterior with comparison to classical descriptions of the anatomy of the muscle as a whole.
Background: Although the serratus anterior has a major role in scapulothoracic stability, description of the separate function and anatomy of the upper, middle, and lower portions of the muscle has been limited.
Methods and Measures: Bilateral anatomical dissection of 8 cadavers (3 female and 5 male) exposed 13 serratus anterior and surrounding structures for review. The number of serrations, attachment sites, length, and girth of the upper serratus anterior were measured.
Results: The upper serratus anterior presented with dual serrations and single serrations in 7 (54%) and 6 (46%) of 13 observations, respectively. Attachments to both first and second ribs were noted in 6 (46%) of the 13 observations. The remaining proximal attachments were to the second rib only, the first rib only, and dual attachments to the second and third ribs. In all cases, cranial attachments were to the superior scapular angle blending with the levator scapulae attachment. Length ranged from 4.8 to 9.0 cm (mean ± SD, 6.9 ± 1.2 cm). The girth ranged from 3.0 to 8.5 cm (mean ± SD, 6.1 ± 1.5 cm). One or more branches of the long thoracic nerve were observed to consistently innervate the upper serratus anterior fibers.
Conclusion: The upper serratus anterior demonstrated wide variation in anatomy and was noted to be distinct in appearance and peripheral innervation from the middle and lower serratus anterior. J Orthop Sport Phys Ther. 2003;33(8):449-454.
Key Words: impingement, long thoracic nerve, scapula, shoulder
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Study Design: Descriptive postoperative follow-up research.
Objectives: The purpose of this investigation was to describe the return-to-competition rate and functional outcome of overhead athletes following arthroscopic thermal-assisted capsular shrinkage (TACS).
Background: Traditional open procedures to correct instability in overhead athletes, such as capsulolabral repairs and capsular shifts, have produced less-than-favorable results, which have led to the development of TACS. Currently there are no long-term follow-up studies documenting the efficacy of this procedure in groups greater than 31 subjects or for a time period greater than 27 months.
Methods and Measures: Two hundred thirty-one consecutive overhead athletes who due to symptoms of hyperlaxity had previously undergone a TACS procedure from 1997 to 1999 were selected for inclusion in the study. During a 1-month period, 130 of these athletes (mean age ± SD, 24 ± 6 years; 113 male, 17 female) were contacted by phone for follow-up at a mean of 29.3 months postoperatively (range, 15.4-46.6 months). Of the 130, 105 participated in baseball (80 pitchers), 14 in softball, 4 in football (quarterbacks), 4 in tennis, and 3 in swimming. Fifty-four (42%) subjects were professional, 49 (38%) collegiate, 16 (12%) high school, and 11 (8%) recreational athletes. One hundred twenty-three of the 130 (95%) underwent 1 or more concomitant procedure(s) at the time of TACS. Most commonly performed were labral debridements (69%), rotator cuff debridements (65%), and superior labral repairs (35%). Subjects who returned to competition were retrospectively evaluated using a modified Athletic Shoulder Outcome Rating Scale to subjectively assess pain, strength and endurance, stability, intensity, and performance. Overall results were based on a 90-point scale with scores of 80 to 90 representing excellent, 60 to 79 good, 40 to 59 fair, and less than 40 poor results.
Results: One hundred thirteen out of 130 subjects (87%) returned to competition. Mean (±SD) time from surgery to return to competition was 8.4 ± 4.6 months. Mean outcome score for all subjects was 79/90; 75 (66%) subjects had excellent, 24 (21%) good, 11 (10%) fair, and 3 (3%) poor result. The mean outcome score for males was 80/90 and for females was 70/90.
Conclusions: The majority of overhead athletes (87%) successfully returned to competition following a TACS procedure with good-to-excellent long-term outcomes (88%). Based on the results of this study, TACS of the glenohumeral joint is a viable option for overhead athletes with pathological instability. J Orthop Sports Phys Ther. 2003;33(8):455–467.
Key Words: acquired laxity, baseball, rehabilitation, shoulder, shoulder instability
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This was the second research retreat focused on gender bias in anterior cruciate ligament (ACL) injuries, the first having taken place in Lexington, KY in April 2001. The purpose of this second retreat was to revisit the factors thought to be associated with gender bias in ACL injuries and to update the consensus statement from 2001. The retreat was again cosponsored by Kentucky Sports Medicine and Joyner Sportsmedicine Institute and was attended by both clinicians and scientists with a common interest in the ACL injury gender bias. The 50-plus participants included registrants from across the United States as well as Canada, Australia, and Norway. As with the previous retreat, the group consisted of physicians, physical therapists, athletic trainers, and scientists in the areas of biomechanics, motor control, and neuromuscular function. Thirty percent of the participants in the 2003 retreat were present for the first retreat as well.
A call for abstracts for the retreat was announced in the summer of 2002. All abstracts were then peer reviewed for scientific merit and relevance to the retreat topic. In the end, 19 abstracts were accepted for podium presentations. These were grouped into sessions addressing structural, neuromuscular, biomechanical, and hormonal factors that may influence the gender bias in ACL injury incidence. In addition, a new session on intervention programs was included.
The format of the meeting included 1 keynote presentation per day along with 20-minute podium presentations made by some of the participants. The keynote presenters were chosen for their scientific contribution to the understanding of factors associated with the gender bias seen in the incidence of ACL injuries. Bruce D. Beynnon, PhD, from the University of Vermont gave the first keynote titled "Risk Factors for Knee Ligament Trauma." The second keynote presenter was Braden C. Fleming, PhD, also from the University of Vermont, whose talk was titled "Biomechanics of the Anterior Cruciate Ligament."
This supplement includes a consensus statement, a listing of the presentations and authors, and an abstract on each of the 19 presentations made at the conference, organized by the topics listed above. J Orthop Sports Phys Ther. 2003;33(8):A1-A30.
Key Words: anterior cruciate ligament (ACL), gender bias, intervention
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Study Design: Cross-sectional study.
Objective: To determine if a difference exists in toe flexors strength and passive extension range of motion of the first metatarsophalangeal joint between individuals with unilateral plantar fasciitis and control subjects.
Background: Weakness of the dynamic longitudinal arch supporters and shortening of the plantar fascia have been suggested as etiologic factors for plantar fasciitis.
Methods and Measures: Twenty subjects with unilateral plantar fasciitis participated in the study. Subjects had had symptoms for an average (±SD) of 19.9 ± 33.2 months prior to participating in the study. Twenty control subjects matched for sex and age were also tested. Each subject was measured bilaterally for passive extension range of motion of the first metatarsophalangeal joint and peak resistance force observed during an isometric test of toe flexors strength.
Results: Subjects with unilateral plantar fasciitis demonstrated weaker toe flexors (P<.05) than the control subjects. A significant main effect for feet also indicated that the toe flexors for the involved feet were significantly weaker than the uninvolved feet (P<.05) of subjects with unilateral plantar fasciitis. Passive extension range of motion of the first metatarsophalangeal joint was not significantly different between the involved and the uninvolved feet for subjects with plantar fasciitis.
Conclusion: Results for our subjects indicate that the extensibility of soft tissues influencing extension of the first metatarsophalangeal joint was not related to the presence of plantar fasciitis. Additional research is needed to determine if toe flexors weakness is a cause or a result of plantar fasciitis and if strengthening regimes for the toe flexors are effective interventions for plantar fasciitis. J Orthop Sports Phys Ther. 2003;33(8):468-478.
Key Words: biomechanics, foot, mobility, muscle strength
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