Publication of an article in a peer-reviewed journal does not guarantee that the evidence is valid, sincere efforts of reviewers and editors notwithstanding. For the sake of our patients, clinicians must consider strengths and weaknesses of research literature, rejecting some evidence and embracing other relevant research with adequate protections against key validity threats. Although it's almost impossible to find published research without some flaw or limitation, the savvy reader will be able to distinguish the fatal flaws from lesser problems. Even when an excellent article is found, we must realize that clinical research is cumulative; a single article will rarely provide a definitive answer about a clinical topic. Academicians have an obligation to perform this same evidence-sorting and interpretive process, and to make the process transparent while teaching, so that students can learn to do it for themselves.

J Orthop Sports Phys Ther. 2005; 35(5):271-272. doi:10.2519/jospt.2005.0105

Key Words: evidence, research

Study Design: Controlled laboratory study. Objectives: To determine whether gender differences in electromyographic (EMG) activity of hip-stabilizing muscles are present during single-leg landing. Background: Numerous factors may explain the greater rate of anterior cruciate ligament (ACL) injuries in female athletes. However, gender differences in hip muscle activity during dynamic events have not been well characterized. Methods and Measures: Twenty-two Division I collegiate athletes (13 female, 9 male) performed drop landings from 30.5- and 45.8-cm heights. Surface EMG was used to examine relative muscle activity from 200 milliseconds prior to initial contact to 250 milliseconds postcontact. Peak and mean values for each muscle (gluteus maximus, gluteus medius, rectus femoris) in each time epoch were analyzed using 2 ×2 (group by height) analyses of variance (ANOVAs) to determine significance. Results: Females demonstrated lower gluteus maximus peak (mean ± SD, 69.5 ± 30.2 versus 98.0 ± 33.4 percent maximum voluntary contraction [%MVIC]; P = .019) and mean (mean ± SD, 37.5 ± 15.6 versus 53.9 ± 18.0 %MVIC; P = .018) muscle activation during the postcontact phase of landing than males. Furthermore, females demonstrated greater peak rectus femoris activity during the precontact phase (mean ± SD, 33.6 ± 18.5 versus 18.7 ± 8.2 %MVIC; P = .029). A positive effect of drop height on relative activity of all muscles was observed during both phases (P<.05). Conclusions: Females utilize different muscular activation patterns compared to males (ie, decreased gluteus maximus and increased rectus femoris muscle activity) during landing maneuvers. Decreased hip muscle activity and increased quadriceps activity may be important contributors to the increased susceptibility of female athletes to noncontact ACL injuries.

J Orthop Sports Phys Ther. 2005;35(5):292-299. doi:10.2519/jospt.2005.1734

Key Words: ACL, hip stability, knee

Study Design: Descriptive correlational study. Objectives: To determine relationships between aspects of turnout and injury history in preprofessional classical ballet dancers, and to determine the clinical utility of various methods used to assess turnout. Background: In Australia 50% of professional dancers currently have persistent or recurrent injuries, with 36% of these injuries commencing before 18 years of age (preprofessional level). Overuse or nontraumatic dance injuries are often attributed to faults in technique, with poor turnout and inappropriate compensatory strategies consistently cited as the main cause. Methods and Measures: Twenty-nine dancers (24 female), aged 15 to 22 years, were recruited from a preprofessional classical ballet program. Measurements were taken of passive and active hip external rotation (ER) range of motion (ROM) in supine, and functional turnout angles in standing. Three turnout variables were derived: active ER lag, compensated turnout, and static-dynamic turnout difference. Injury history over the previous 2 years was ascertained by interview. Pearson product moment and Spearman rank correlation coefficients were used to determine associations between turnout variables and injury history. Results: All dancers reported a history of injury, with 93.1% reporting a history of nontraumatic injuries and 41.4% reporting a history of traumatic injuries. Number and severity of nontraumatic injuries were associated with reduced functional turnout (r or rho >0.38; P<.04), but not with hip ER ROM. Number and severity of traumatic injuries were not associated with turnout. No correlation was found between hip ER ROM and functional turnout. Conclusions: Functional measures of turnout are more relevant than hip ER ROM to prevalence of nontraumatic dance injuries. Control of turnout in classical ballet dancers should be assessed dynamically and in functional positions.

J Orthop Sports Phys Ther. 2005;35(5):307-318. doi:10.2519/jospt.2005.1600

Key Words: dance, external rotation, hip, injury

The Second International Ankle Symposium was a multidisciplinary conference focused on topics related to ankle instability and associated pathologies and was held on the campus of the University of Delaware in October 2004. The first symposium was held in Ulm, Germany in 2000 and its success served as the catalyst for the second symposium. The most recent symposium brought together over 75 clinicians and scientists from disciplines such as physical therapy, athletic training, orthopedics, podiatry, and biomechanics. Participants represented many countries, including Australia, Belgium, Germany, Ireland, Japan, Sweden, and the United States. A call for abstracts was initially distributed in the fall of 2003. Members of the organizing committee reviewed all submitted abstracts for scientific merit. Thirty-two abstracts were accepted and presented at the symposium. The educational program consisted of several invited plenary lectures from internationally recognized experts and 19 podium and 13 poster presentations of original research. The symposium also provided for considerable scholarly interaction among the attendees. The meeting culminated with the formation of the International Ankle Consortium, a multidisciplinary group aiming to further the scientific understanding and to improve the clinical care of ankle instability and related pathologies. This group will work to develop standards for ankle instability research, such as guidelines for inclusion and exclusion criteria in ankle instability studies and development of a standardized clinical outcomes tool for use in ankle instability studies. Plans have already commenced for the third International Ankle Symposium to be held at University College Dublin, Dublin, Ireland, September 1-3, 2006. This special supplement to the Journal of Orthopaedic & Sports Physical Therapy includes a summary statement, synopses of 5 plenary lectures, and the abstracts of the original research presentations from the second International Ankle Symposium.

J Orthop Sports Phys Ther. 2005; 35(5):A1-A28.  doi:10.2519/jospt.2005.0301

Key Words: ankle instability, outcomes tool, clinical care