Over the past 30 years, physiotherapists have played an important role in the continuous refinement of the classification system related to sports participation for athletes with disabilities. This guest editorial is intended to provide a brief history of this evolution, an evolution that in many respects has shifted the focus away from the medical diagnosis to concerns related more to the impact of a disease or condition on the person's function and overall health.

J Orthop Sports Phys Ther 2010;40(3):130-132. doi:10.2519/jospt.2010.0103

KEY WORDS: Paralympic Games, physical therapy

STUDY DESIGN: Randomized clinical trial. OBJECTIVES: Determine effective interventions for improving readiness to return to sports postoperatively in patients with complete, unilateral, anterior cruciate ligament (ACL) rupture who do not compensate well after the injury (noncopers). Specifically, we compared the effects of 2 preoperative interventions on quadriceps strength and functional outcomes. BACKGROUND: The percentage of athletes who return to sports after ACL reconstruction varies considerably, possibly due to differential responses after acute ACL rupture and different management. Prognostic data for noncopers following ACL reconstruction is absent in the literature. METHODS: Forty noncopers were randomly assigned to receive either progressive quadriceps strength-training exercises (STR group) or perturbation training in conjunction with strength-training exercises (PERT group) for 10 preoperative rehabilitation sessions. Postoperative rehabilitation was similar between groups. Data on quadriceps strength indices [(involved limb/uninvolved limb force) × 100], 4 hop score indices, and 2 self-report questionnaires were collected preoperatively and 3, 6, and 12 months postoperatively. Mann-Whitney U tests were used to compare functional differences between the groups. Chi-square tests were used to compare frequencies of passing functional criteria and reasons for differences in performance between groups postoperatively. RESULTS: Functional outcomes were not different between groups, except a greater number of patients in the PERT group achieved global rating scores (current knee function expressed as a percentage of overall knee function prior to injury) necessary to pass return-to-sports criteria 6 and 12 months after surgery. Mean scores for each functional outcome met return-to-sports criteria 6 and 12 months postoperatively. Frequency counts of individual data, however, indicated that 5% of noncopers passed RTS criteria at 3, 48% at 6, and 78% at 12 months after surgery. CONCLUSION: Functional outcomes suggest that a subgroup of noncopers require additional supervised rehabilitation to pass stringent criteria to return to sports. LEVEL OF EVIDENCE: Therapy, level 2b.

Note: If watching the first video, we recommend downloading and referring to the accompanying PowerPoint slides for any text that is not readable.

J Orthop Sports Phys Ther 2010;40(3):141-154, Epub 30 January 2010. doi:10.2519/jospt.2010.3168

KEY WORDS: ACL, knee, outcomes measures, rehabilitation

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To describe and compare scapular and clavicular kinematics and muscle activity during 6 retraction exercises in young healthy adults (mean ± SD age, 23.2 ± 2.4 years). BACKGROUND: Based on the association between shoulder injuries and scapular/clavicular movement, muscle activity during various exercises that target muscles surrounding the scapula have been investigated. However, the scapular and clavicular movements occurring during these exercises remain uninvestigated. Evaluation of the scapular and clavicular kinematics in addition to muscle activity provides additional information that allow clinicians to select exercises that best meet the patient’s needs. METHODS: Three-dimensional scapular and clavicular kinematics and scapular muscle activity data were collected while the participants performed 6 scapular retraction exercises. One-way repeated-measures ANOVA and post hoc analyses were used to determine differences in scapular/clavicular kinematics and activation levels of the upper, middle, and lower trapezius and serratus anterior muscles occurring during the exercises. RESULTS: The general pattern of the kinematics observed during all retraction exercises was scapular external rotation, scapular upward rotation, scapular posterior tilting, clavicular retraction, and clavicular depression. However, the exercises resulted in varying amounts of scapular movement and muscle activity. CONCLUSION: Clinicians can select appropriate exercises for their patients based on their need to strengthen specific retractor muscles and to improve specific scapular and clavicular movement patterns, pre-existing conditions, and available range of motion.

J Orthop Sports Phys Ther 2010;40(3):169-179, Epub 5 February 2010. doi:10.2519/jospt.2010.3018

KEY WORDS: rehabilitation, scapular dyskinesis, shoulder injury

Athletes who predominantly load their dominant upper extremity are useful models for investigating musculoskeletal responses to mechanical loading, as their nondominant upper extremity serves as an internal matched control. An extreme case of skeletal adaptation was recently observed in a 22-year-old collegiate male baseball pitcher assessed using peripheral quantitative computed tomography. Playing baseball for 17 years contributed to the athlete having 63% greater bone mass and cortical thickness in the dominant midshaft humerus compared to his nondominant side. These changes resulted from combined periosteal expansion and endosteal contraction, and provided the dominant midshaft humerus with a more circular cross-section,which maximizes torsional resistance. These collective changes resultedin the dominant midshaft humerus having nearly double estimated ability to resist torsional forces than in the nondominant side. These side-to-side differences set new levels for plasticity within the musculoskeletalsystem as they are the largest reported within an individual, and are 8-times larger and more than double those observed in sedentary individuals and average baseball players, respectively.

J Orthop Sports Phys Ther 2010;40(3):188. doi:10.2519/jospt.2010.0404

KEY WORDS: baseball, computed tomography, humerus, upper extremity

Patellofemoral pain syndrome (PFPS) is a clinical condition that is characterized by retropatellar and/or peripatellar pain associated with activities involving lower limb loading (eg, walking, running, jumping, stair climbing, and prolonged sitting and kneeling). PFPS is the most common overuse injury of the lower extremity, and is particularly prevalent in those who are physically active. While treatment for PFPS may be successful for the short-term, long-term results are less promising. The lack of long-term success in treating this condition may be due to the underlying etiologic factors not being addressed. While it is generally agreed that many factors can lead to PFPS, it is our contention that these factors are still not well-understood.

The mission of this first international research retreat was to bring scientists together from around the world who were conducting research aimed at understanding the factors that are related to the development, and consequently the treatment, of PFPS. These etiologic factors were classified as local, distal, and proximal. A call for abstracts for the retreat was made in the summer of 2008. All abstracts were peer-reviewed for scientific merit and relevance to the retreat. In the end, 32 abstracts were accepted for podium presentations and 11 were accepted as posters. In total, 55 participants from 10 countries, including Australia, Belgium, Brazil, Canada, Israel, Italy, the Netherlands, Singapore, United Kingdom, and the United States, contributed to the retreat.

The format of the 2-day meeting included 3 keynote presentations interspersed with 15-minute podium presentations and 5-minute poster presentations. This first retreat was held in Fells Point, Baltimore, Maryland and was hosted by the Division of Biokinesiology and Physical Therapy at the University of Southern California. Included in this PDF is a consensus statement, a listing of the presentations and authors, and abstracts of each of the presentations made at the conference.

J Orthop Sports Phys Ther 2010;40(3):A1-A48. doi:10.2519/jospt.2010.0302

KEY WORD: PFPS