For certain patients, fear of pain can be as disabling as pain itself. Clinicians and researchers interested in reducing the societal impact of chronic musculoskeletal pain must work together to manage relevant psychological influences like fear of pain. Collaborative efforts are necessary to address the following issues in a wide range of musculoskeletal pain conditions: (1) refine current screening techniques to make them more efficient and accurate, and (2) develop and test interventions that effectively reduce pain-related fear. Otherwise, an important contributor to our patients' pain and disability will continue to be mismanaged by the same professionals trying to prevent chronic conditions.

J Orthop Sports Phys Ther. 2006; 36(5):264-266. doi:10.2519/jospt.2006.0106

Study Design: Exploratory.

Objectives: To explore whether hand dominance, gender, and body mass index (BMI) influence the thickness of the lateral abdominal muscles as measured by ultrasound imaging. To document the extent of improvement in response stability when an average of multiple measures was utilized.

Background: Ultrasound imaging is a relatively new tool used to assess the lateral abdominal muscles. A better understanding of how these muscles contract in a healthy population can provide a reference for comparison to patients with low back pain (LBP).

Methods and Measures: Thirty-two healthy participants (17 males, 15 females) aged 18 to 45 years (mean ± SD, 31.9 ± 7.8 years) were studied. Measurements of muscular thickness of the lateral abdominal muscles were obtained bilaterally while the subjects were at rest, and while they performed the abdominal drawing-in maneuver. To determine the possible influence of hand dominance and gender on muscle thickness, t tests were used. Correlation coefficients were used to assess the relationship between BMI and muscle thickness. Standard error of the measurement was used to assess response stability of the ultrasound imaging technique.

Results: No differences in the thicknesses of the transversus abdominis (TrA) muscle were measured during rest or while contracted, based on hand dominance (P≥.73). Men had greater muscular thickness (P<.01), while the TrA in women represented a greater proportion of the total lateral abdominal muscles (P<.01). BMI was positively associated with muscle thickness (r≥.66). Compared to a singular measurement, response stability improved by greater than 50% when an average of 3 measurements was used.

Conclusions: Future researchers should assess the need to control for gender and BMI as potential covariates in ultrasound imaging studies of the lateral abdominal muscles. Asymmetry in the lateral abdominal muscles in those with LBP would be in direct contrast to the bilateral symmetry measured in those without LBP. J Orthop Sports Phys Ther. 2006;36(5):289-297. doi:10.2519/ jospt.2006.2217

Key Words: low back pain, lumbar stabilization, real-time ultrasound imaging, sonography, transversus abdominis

Plyometric exercise was initially utilized to enhance sport performance and is more recently being used in the rehabilitation of injured athletes to help in the preparation for a return to sport participation. The identifying feature of plyometric exercise is a lengthening of the muscle-tendon unit followed directly by shortening (stretch-shortening cycle). Numerous plyometric exercises with varied difficulty and demand on the musculoskeletal system can be implemented in rehabilitation. Plyometric exercises are initiated at a lower intensity and progressed to more difficult, higher intensity levels. The progression to higher-intensity plyometric exercise is thought to resolve postinjury neuromuscular impairments and to prepare the musculoskeletal system for rapid movements and high forces that may be similar to the demands imposed during sport participation, thus assisting the athlete with a return to full function.

While there is a large body of scientific literature that supports the use of plyometric exercise to enhance athletic performance, evidence is sparse regarding the effectiveness of plyometric exercise in promoting a quick and safe return to sport after injury. This review will describe the mechanisms involved in plyometric exercise, discuss the considerations for implementing plyometric exercise into rehabilitation protocols, examine the evidence supporting the use of plyometric exercises, and make recommendations for future research. J Orthop Sports Phys Ther. 2006;36(5):308-319. doi:10.2519/ jospt.2006.2013

Key Words: jump training, neuromuscular, return to sport, stretch shortening

Study Design: Retrospective chart review.

Objectives: To measure short-term postsurgery glenohumeral internal rotation and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following mini-open rotator cuff repair of full-thickness rotator cuff tears.

Background: Physical therapists provide rehabilitation for patients following mini-open rotator cuff repair. Long-term outcome studies have reported a high percentage of good and excellent results following surgery; however, little has been published regarding the immediate short-term results of this procedure, during which the patient is under the direct care of the physical therapist.

Materials and Methods: Charts from 11 female and 26 male patients, with a mean ± SD age of 57.3 ± 9.9 years, were reviewed following rotator cuff repair, using an arthroscopically assisted mini-open deltoid-splitting approach. All patients underwent postsurgery rehabilitation by the same therapist using a standard protocol. Retrospective chart review was used to obtain descriptive profiles of shoulder joint ROM at 6 and 12 weeks postsurgery and isokinetically assessed shoulder strength at 12 weeks postsurgery.

Results: For the postsurgical shoulder, ROM deficits ranging between 5° to 7° were measured for shoulder abduction and external rotation and internal rotation at 90° of abduction. The postsurgical extremity had greater flexion ROM (9°) compared to the contralateral side. Isokinetic external rotation strength deficits of 5% to 7% were present at 12 weeks postsurgery, with 2% to 11% greater internal rotation shoulder strength on the operative extremity, when compared to the other side. Patients completed the self-report section of the modified American Shoulder Elbow Surgeons (ASES) Rating Scale at 12 weeks postsurgery and scored a mean of 38.7/45.0 points.

Conclusion: The application of early ROM and progressive strengthening following mini-open rotator cuff repair allows for the successful return of ROM and strength 12 weeks postsurgery. The results of this study provide objective data for both shoulder ROM and strength at time points during which patients are traditionally receiving physical therapy following surgery.

J Orthop Sports Phys Ther. 2006;36(5):326-335. doi:10.2519/jospt.2006.2191

Key Words: glenohumeral joint, rotator cuff tear, surgery