STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To examine the timing of the 3 portions of the trapezius muscle in relation to the posterior deltoid (PD) muscle and in relation to one another during 4 selected shoulder exercises: (1) prone extension, (2) forward flexion in side lying, (3) external rotation in side lying, and (4) prone horizontal abduction with external rotation. BACKGROUND: Deficiencies in trapezius muscle recruitment have been identified in patients with shoulder pain. Alterations in the trapezius muscle activation level and timing have been identified in previous research. Scapular muscle exercises in which the middle trapezius (MT) and lower trapezius (LT) muscle showed optimal activity with minimal upper trapezius (UT) muscle participation have been recently identified. However, it is currently unknown if these exercises also promote early activation of the scapular stabilizing musculature. METHODS: The intermuscular and intramuscular timing of muscle activation (based on an activation level of greater than 10% maximum voluntary contraction beyond basic activity) of the 3 portions of the trapezius muscle during 4 exercises were examined by surface EMG in 30 healthy subjects on the dominant side (14 males, 16 females). A 1-sample t test was used to determine which portions of the trapezius muscle were activated significantly earlier or later than the PD (intermuscular timing). An analysis of variance for repeated measures (3 levels) was used for each exercise to determine possible timing differences among the 3 portions of the trapezius muscle (intramuscular timing). RESULTS: Intermuscular and intramuscular differences in timing of the portions of the trapezius
muscle were found. The UT was activated significantly later than the PD (P<.01), and the MT was activated significantly earlier than the PD (P<.01), during the prone extension exercise. During the horizontal abduction with external rotation exercise, the MT (P<.01) and the LT (P = .01) were activated significantly earlier than the PD. During prone extension, side-lying external rotation, and prone horizontal abduction with external rotation, significant differences were found between the UT and MT, between the UT and LT, but not between the MT and LT. In these exercises the MT and LT were activated significantly earlier than the UT. During forward flexion in side lying, no significant timing differences were found between the activation of the portions of the trapezius. CONCLUSIONS: With the exception of the LT during prone extension, the prone extension exercise and the prone horizontal abduction with external rotation exercise promote early activation of the MT and LT in relation to the scapular and glenohumeral prime mover. Taking into account the limited generalizability of the results due to a narrow age range, these exercises are potentially promising for the treatment of intermuscular and intramuscular timing disorders of the trapezius muscle.

J Orthop Sports Phys Ther 2009;39(10):743-752. doi:10.2519/jospt.2009.3089

KEY WORDS: lower trapezius, middle trapezius, posterior deltoid, scapula, upper trapezius

The Fourth International Ankle Symposium (IAS4), a multidisciplinary conference focused on topics related to ankle injury, was recently held in Sydney, Australia at the University of Sydney. The conference theme was "new dimensions on old problems," with a different emphasis on each day of the symposium: new dimensions on science, new dimensions on interventions, and new dimensions in the clinic, reflecting the mix of basic science and clinical practice. This issue includes a summary statement of the conference, abstracts of the invited lectures and workshops, and the abstracts of the original research presentations, both podium and poster presentations, from IAS4.

J Orthop Sports Phys Ther 2009;39(10):A1-A24. doi:10.2519/jospt.2009.0302

STUDY DESIGN: Longitudinal single-cohort study. BACKGROUND: Athletes with longstanding groin pain associated with resisted hip adduction have been shown to have abnormal activation of the transversus abdominis (TA). Therefore, exercises targeting the TA to help stabilize the lumbopelvic area are generally used in the rehabilitation of these athletes. OBJECTIVES: To investigate if (1) changes in abdominal muscle resting thickness and changes in relative thickness during lower extremity tasks after 14 weeks of intervention are related to changes in clinical status and (2) the changes in abdominal muscle resting/relative thickness are significant postintervention. METHODS: In 21 athletes with longstanding groin pain associated with resisted hip adduction, ultrasound imaging of the abdominal musculature on the right side was performed at rest, during the active straight-leg raise (left and right), and during bilateral isometric hip adduction. Athletes then followed a 14-week rehabilitation protocol. Clinical outcome measured by self-reported sports restriction and change in abdominal muscle resting and relative thickness during lower extremity tasks were evaluated. RESULTS: There was an overall significant decrease in self-reported sports restriction after intervention for this group of athletes. Apart from a significant negative correlation for changes in TA resting thickness, no significant association between changes in abdominal muscle thickness and change in self-reported sports restriction were found. Postintervention, TA resting thickness was significantly increased but relative thickness during the lower extremity tasks was found not to be statistically different for all muscles, except for a decreased relative thickness of obliquus externus abdominus (OE) during the active straight-leg raise for the left lower extremity. CONCLUSION: There was no association between changes in abdominal muscle resting thickness and relative thickness during lower extremity tasks, and change in self-reported sports restriction after a period of physical therapy in athletes with longstanding groin pain associated with resisted hip adduction. Although this study was designed as a single-cohort longitudinal study, the data suggest that the intervention described can change TA resting thickness. The intervention did not influence abdominal muscle relative thickness during lower extremity tasks. LEVEL OF EVIDENCE: Therapy, level 4.

J Orthop Sports Phys Ther 2009;39(10):724-732. doi:10.2519/jospt.2009.3068

KEY WORDS: echography, groin injury, physical therapy, transversus

STUDY DESIGN: Prospective cohort study of 10 287 patients with foot/ankle impairments receiving outpatient physical therapy. OBJECTIVES: To describe meaningful interpretations of functional status (FS) outcomes measures, estimated using a body-part–specific computerized adaptive test (CAT). BACKGROUND: Increased use of CATs to generate outcome measures in rehabilitation has stimulated questions concerning score interpretation. Identifying meaningful intra-individual change and reporting clinical interpretation of those generated outcomes are essential to advance the quality of rehabilitation practice. METHODS: We performed 4 approaches to clinically interpret outcomes data. First, we used the standard error of the estimate to construct a 90% confidence interval for each CAT estimated score. Second, we presented the percentile rank of FS scores. Third, we used 2 threshold approaches to define individual-patient-level change: statistically reliable change and clinically important change. Last, we illustrated a functional staging method. RESULTS: Precision of a single score was estimated by an FS score of ±4. Based on score distribution, percentile ranks at 25th, 50th, and 75th percentiles corresponded to intake FS scores of 38, 47, and 57, and discharge FS scores of 52, 64, and 77, respectively. Minimal detectable change supported 7 or more FS change units out of 100 represented statistically reliable change, and ROC analyses supported 8 or more FS change units represented minimal clinically important improvement. Using a functional staging system, we established 5 hierarchical functional status levels. CONCLUSION: CAT-generated outcome measures can be interpreted to improve clinical interpretation and to assist clinicians in using patient-reported outcomes during therapy practice.

J Orthop Sports Phys Ther 2009;39(10):753-764. doi:10.2519/jospt.2009.3122

KEY WORDS: assessment of patient-reported outcomes, computerized adaptive testing, Lower Extremity Functional Scale, outpatient rehabilitation

The JOSPT offers invited reviews of current titles. The October 2009 column includes 8 reviews of the following books: Sports Medicine and Rehabilitation: A Sport-Specific Approach, Second Edition; Kinesiology: The Mechanics and Pathomechanics of Human Movement, Second Edition; Pharmacology for the Physical Therapist; Teaching Atlas of Musculoskeletal Imaging; Spine Surgery: Tricks of the Trade, Second Edition; Save Your Hands: The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists, Second Edition; Orthopedic Oncology: Diagnostic and Treatment; and Clinical Tests for the Musculoskeletal System: Examinations-Signs-Phenomena.

J Orthop Sports Phys Ther 2009;39(10):767-771.