STUDY DESIGN: Controlled laboratory study using a cross-sectional, single testing session. OBJECTIVE: To determine the association between frontal plane knee excursion during a drop land task and measures of hip strength, and ankle and hip range of motion. BACKGROUND: Assessment of frontal plane knee excursion during a drop land task has been advocated as a means to screen for potentially injurious lower extremity movement patterns. Accordingly, an understanding of the physical characteristics associated with the magnitude of frontal plane knee excursion could assist clinicians in developing interventions and prevention strategies to minimize injury risk. METHODS AND MEASURES: Thirty-nine female high school soccer players (mean ± SD age, 15.5 ± 1.0 years; height, 162.2 ± 5.3 cm; body mass, 56.8 ± 6.7 kg) participated. Isometric hip muscle strength as well as ankle and hip range of motion measurements were obtained using standard clinical procedures and a handheld dynamometer. Frontal plane knee excursion was assessed using a 6-camera motion analysis system during a drop land task. Using 3-dimensional coordinate data, maximum frontal plane knee excursion was defined as the difference between the distances of right and left lateral knee markers at initial contact and maximum knee flexion during the deceleration phase of landing. Independent variables found to be significantly correlated with frontal plane knee excursion were then entered into a stepwise multiple regression procedure to determine the best set of predictors of this motion. RESULTS: Hip external rotation range of motion and ankle dorsiflexion range of motion were found to be negatively correlated with frontal plane knee excursion (r=-0.40, P=.005 and r=-0.27, P=.05, respectively). Together they accounted for 27% of the variance in frontal plane knee excursion (r=0.52, P=.03). No relationships between measures of hip strength and frontal plane knee excursion were found. CONCLUSIONS: Frontal plane knee excursion during a drop land task was partially attributed to available range of motion at the hip and ankle. These results suggest that range of motion of the joints proximal and distal to the knee should be considered when evaluating individuals who present with excessive frontal plane knee excursion during this task. Given that the relationship between range of motion and frontal plane knee excursion was small, other factors, including learned motor patterns, should be considered.

J Orthop Sports Phys Ther. 2008; 38(11):661-667; Epub 22 August 2008. doi:10.2519/jospt.2008.2695

KEY WORDS: knee injuries, kinematics, lower extremity, range of motion, strength

STUDY DESIGN: Descritive cadaveric laboratory study. OBJECTIVE: To identify the fiber type composition of the rotator cuff and teres major muscles in human subjects.  BACKGROUND: The rotator cuff is commonly injured in athletics and is a major focus of sports medicine.  Although the anatomy and architecture of each muscle have been described in great detail, these muscles have never been fiber typed using immunohistochemistry or gel electrophoresis.  Fiber typing is important in modeling function, exercise training, and rehabilitation. METHODS AND MEASURES: We harvested tissue samples for all 4 rotator cuff muscles, as well as the teres major muscle from cadavers. Tissues were frozen in liquid nitrogen and sectioned. Cryosections were labeled with commercially available antibodies against fast and slow isoforms of myosin heavy chain (MHC). We also harvested fresh (unembalmed) tissue from deceased subjects and labeled tissue sections with antibodies against fast or slow MHC and wheat germ agglutinin. Gel electrophoresis followed by silver staining was also used to identify and quantify MHC isoforms in fresh tissue samples. RESULTS: All of the muscles were of mixed fiber type composition. As a whole, 44% of rotator cuff fibers labeled positively for slow MHC, with slow MHC content of 54% in supraspinatus, 41% in infraspinatus, 49% in teres minor, 38% in subscapularis, and 40% in teres major. Mixed MHC isoform distribution was confirmed by SDS-PAGE, which also indicated that the IIa and IIx isoforms were roughly equally present across the muscles. CONCLUSIONS: Human rotator cuff muscles, at least in older subjects, have a mixed fiber type. Because we only examined older subjects, we must limit our interpretation to this population.

J Orthop Sports Phys Ther. 2008; 38(11):674-680, Epub 18 July 2008. doi:10.2519/jospt.2008.2878 

KEY WORDS: immunohistochemistry, myosin heavy chain, shoulder, supraspinatus

STUDY DESIGN: A case series of consecutive patients referred to physical therapy with patellofemoral pain syndrome (PFPS). BACKGROUND: Physical therapists often treat patients with PFPS, yet there is currently no consensus as to the most effective management strategies. The purpose of this case series is to describe the outcomes of patients referred to physical therapy with PFPS who were treated with a multimodal approach. CASE DESCRIPTION: Five patients were treated with a combination of thrust and nonthrust manipulation directed at the joints of the lower quarter, trunk and hip stabilization exercises, patellar taping, and foot orthotics. Outcome measures used to capture change in patient status included the Numeric Pain Rating Scale, the Kujala Anterior Knee Pain Scale, the Lower Extremity Functional Scale, and the Global Rating of Change. OUTCOMES: Five patients (median age, 15 years; range, 14-50 years) with a median duration of knee pain for 8 months (range, 3-24 months) were included in this prospective case series. Four (80%) of the 5 patients demonstrated decreased pain and a clinically significant improvement in function. These gains in function were maintained at a 6-month follow-up. DISCUSSION: Although a cause-and-effect relationship cannot be inferred from a case series, the outcomes achieved by the patients are consistent with studies incorporating manual physical therapy, exercise, patellar taping, and orthotic prescription to the management of conditions of the lower extremity. Further randomized controlled trials should be performed to determine the effectiveness of this multimodal approach for the management of individuals with PFPS. LEVEL OF EVIDENCE: Therapy, level 4.

J Orthop Sports Phys Ther. 2008; 38(11):691-702, Epub 11 August 2008. doi:10.2519/jospt.2008.2690

KEY WORDS: knee, manual therapy, spine, orthotics, taping, pain, patellofemoral joint

The patient was a 38-year-old female at 34 weeks' gestation, with a 3-week history of low back pain of insidious onset. Her physician referred her to physical therapy on the assumption that her pain was typical of normal pregnancy. However, the patient's significantly worsening condition prompted the physical therapist to contact the physician who ordered lumbar magnetic resonance imaging. MRI results led to a diagnosis of cauda equina syndrome, secondary to central spinal canal stenosis from a posterocentral disc extrusion at L4-5. The patient underwent an immediate surgical discectomy at L4-5.

J Orthop Sports Phys Ther. 2008; 38(11):721. doi:10.2519/jospt.2008.0411

KEY WORDS: low back pain, magnetic resonance imaging, pregnancy

Book reviews on the following titles:

• Promoting Legal and Ethical Awareness: A Primer for Health Professionals and Patients
• Perspectives in Athletic Training
• Physical Therapies in Sport and Exercise, Second Edition
• No More Joint Pain

J Orthop Sports Phys Ther. 2008; 38(11):723-725.