Journal of Orthopaedic & Sports Physical Therapy - Frank B. Underwood, PT, PhD, ECS

Effects of Varying Electrode Site Placements on the Torque Output of an Electrically Stimulated Involuntary Quadriceps Femoris Muscle Contraction

Fri, 12 Sep 2008 00:00:00 EST

James P. Ferguson, Mark W. Blackley, Ron D. Knight, Frank B. Underwood, David G. Greathouse, Thomas G. Sutlive
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

At the time this study was performed, LTs Ferguson, Blackley, Knight, and Sutlive were students in the US. Army-Baylor University Graduate Program in Physical Therapy. This research was performed in partial fulfillment of their requirements for the Master of Physical Therapy Degrees.

The purpose of this study was to evaluate the effects of varying electrode placement on the torque output of an electrically stimulated involuntary quadriceps femoris muscle contraction. Twenty-two volunteer subjects (18 men, 4 women) with a mean age of 21.7 years received electrical stimulation according to a randomized treatment order which included: Femoral nerve and 1) vastus medialis (VM), 2) rectus femoris (RF), 3) vastus lateralis (VL), 4) opposite quadriceps (OQ), and 5) the ipsilateral vastus medialis and vastus lateralis (VM/VL). The subject's knee was placed in 60° of flexion, and the isokinetic dynamometer set at 0°/sec. The peak torque produced by the involuntary quadriceps contraction was measured as a percentage of maximum voluntary isometric contraction (MVIC). An analysis of variance with repeated measures was used to examine the data. The results indicated the mean percentages of MVIC produced by stimulating the VM, VL, and RF sites were significantly greater (p ≤ 0.05) than the means of the OQ and VM/VL sites. Post hoc testing did not reveal a significant difference in the mean percent MVIC between the VM, VL, and RF sites. The VM, VL, or RF distal electrode site placement may be used clinically in conjunction with ipsilateral femoral nerve stimulation to produce a maximum involuntary isometric contraction of the quadriceps femoris muscle when stimulated electrically.

J Orthop Sports Phys Ther 1989;11(1):24-29.

Increasing Involuntary Torque Production by Using TENS

Thu, 11 Sep 2008 00:00:00 EST

Frank B. Underwood, Gary L. Kremser, Kenn Finstuen, David G. Greathouse
The opinions and assertions contained herein are the private views of the authors, and are not to be construed as official or as reflecting the views of the Departments of the Army, Navy, or Defense.

The purpose of this study was to evaluate the effects of low-amplitude electrical stimulation (ES) on maximal tolerable ES and involuntary torque production of the quadriceps femoris muscle. Seventeen healthy volunteers (11 male, 6 female) aged 19-35 years (mean, 25.1 years) completed the study. Both quadriceps femoris muscle groups received maximal tolerated ES in all subjects. One limb was treated with 10 minutes of low-amplitude ES prior to application of the maximal tolerated ES, while the opposite limb did not receive the low-amplitude ES. Analysis of the data revealed significantly (p < 0.01) greater torque generation and current tolerated when the maximal tolerated ES was delivered following the low-amplitude ES. The clinical implication is that if ES is to be used to increase muscular strength, a low-amplitude current delivered prior to maximal tolerable current delivery allows greater involuntary torque production.

J Orthop Sports Phys Ther 1990;12(3):101-104.

A Comparison of Select Trunk Muscle Thickness Change Between Subjects With Low Back Pain Classified in the Treatment-Based Classification System and Asymptomatic Controls

Tue, 28 Aug 2007 00:00:00 EST

Kyle B. Kiesel, Arthur J. Nitz, Terry R. Malone, Frank B. Underwood, Carl G. Mattacola
STUDY DESIGN: Cross-sectional descriptive. OBJECTIVES: To investigate if muscle thickness change, as measured with rehabilitative ultrasound imaging (RUSI), is different across subgroups of patients with low back pain (LBP) classified in the Treatment-Based Cassification (TBC) system when compared to controls. BACKGROUND: Researchers have demonstrated that subgroups of patients with LBP exist and respond differently to treatment, challenging the assertion that LBP is "nonspecific." The TBC system uses 4 categories (stabilization, mobilization, direction-specific exercise, or traction) to subgroup patients. Recently, researchers have demonstrated impairments of the transverse abdominis (TrA) and lumbar multifidus (LM) in those with LBP, regardless of classification. Although distinct differences in impairments have been identified between sub-groups, TrA and LM impairments have not been studied and may be present across categories of the TBC system. METHODS AND MEASURES: RUSI was utilized to measure percent thickness change from rest to contracted state during a voluntary task of the TrA and during an upper extremity task known to activate the LM in 56 subjects classified in the TBC system and 20 controls. RESULTS: During the prone upper extremity lifting task with a hand weight, there was a significant group difference for the LM at L4-L5 (P = .03) and at L5-S1 (P = .04), and during volitional activation for the TrA (P<.01). Post-hoc testing revealed the differences were between controls and both the direction-specific and stabilization categories at the L4-L5 level, between control and direction-specific category for the L5-S1 level, and between controls and all 3 categories for the TrA. CONCLUSION: Deficits in the ability to generate muscle thickness changes in the TrA and LM occurred across categories of the TBC system. Intervention studies should be performed to determine if intervention can correct these deficits and if deficit corrections are related to outcomes.

J Orthop Sports Phys Ther. 2007;37(10):596-607, published online 28 August 2007. doi:10.2519/jospt.2007.2574. The original article was corrected in March 2008, and the amended article PDF is provided here. Please see Correction: A comparison of select trunk muscle thickness change between subjects with low back pain classified in the treatment-based classification system and asymptomatic controls. J Orthop Sports Phys Ther. 2008;38(3):161.

KEY WORDS: multifidus, sonography, spine stabilization, therapeutic exercise, transverse abdominis

Star Excursion Balance Test as a Predictor of Lower Extremity Injury in High School Basketball Players

Tue, 27 Feb 2007 00:00:00 EST

Phillip J. Plisky, Mitchell J. Rauh, Thomas W. Kaminski, Frank B. Underwood
Study Design: Prospective cohort. Objective: To determine if Star Excursion Balance Test (SEBT) reach distance was associated with risk of lower extremity injury among high school basketball players. Background: Although balance has been proposed as a risk factor for sports-related injury, few researchers have used a dynamic balance test to examine this relationship. Methods and Measures: Prior to the 2004 basketball season, the anterior, posteromedial, and posterolateral SEBT reach distances and limb lengths of 235 high school basketball players were measured bilaterally. The Athletic Health Care System Daily Injury Report was used to document time loss injuries. After normalizing for lower limb length, each reach distance, right/left reach distance difference, and composite reach distance were examined using odds ratio and logistic regression analyses. Results: The reliability of the SEBT components ranged from 0.82 to 0.87 (ICC_3,1) and was 0.99 for the measurement of limb length. Logistic regression models indicated that players with an anterior right/left reach distance difference greater than 4 cm were 2.5 times more likely to sustain a lower extremity injury (P<.05). Girls with a composite reach distance less than 94.0% of their limb length were 6.5 times more likely to have a lower extremity injury (P<.05). Conclusions: We found components of the SEBT to be reliable and predictive measures of lower extremity injury in high school basketball players. Our results suggest that the SEBT can be incorporated into preparticipation physical examinations to identify basketball players who are at increased risk for injury.

J Orthop Sports Phys Ther. 2006; 36(12):911-919. doi:10.2519/jospt.2006.2244

Key Words: female athlete, neuromuscular control, postural stability

Medial Tibial Stress Syndrome in High School Cross-Country Runners: Incidence and Risk Factors

Tue, 13 Feb 2007 00:00:00 EST

Melody S. Plisky, Mitchell J. Rauh, Robert T. Tank, Bryan C. Heiderscheit, Frank B. Underwood

STUDY DESIGN: Prospective cohort. OBJECTIVE: To determine (1) the cumulative seasonal incidence and overall injury rate of medial tibial stress syndrome (MTSS) and (2) risk factors for MTSS with a primary focus on the relationship between navicular drop values and MTSS in high school cross-country runners. BACKGROUND: MTSS is a common injury among runners. However, few studies have reported the injury rate and risk factors for MTSS among adolescent runners. METHODS AND MEASURES: Data collected included measurement of bilateral navicular drop and foot length, and a baseline questionnaire regarding the runner’s height, body mass, previous running injury, running experience, and orthotic or tape use. Runners were followed during the season to determine athletic exposures (AEs) and occurrence of MTSS. RESULTS: The overall injury rate for MTSS was 2.8/1000 AEs. Although not statistically different, girls had a higher rate (4.3/1000 AEs) than boys (1.7/1000 AEs) (P = .11). Logistic regression modeling indicated that only gender and body mass index (BMI) were significantly associated with the occurrence of MTSS. However, when controlled for orthotic use, only BMI was associated with risk of MTSS. No significant associations were found between MTSS and navicular drop or foot length. CONCLUSIONS: Our findings suggest that navicular drop may not be an appropriate measure to identify runners who may develop MTSS during a cross-country season; thus, additional studies are needed to identify appropriate preseason screening tools.

J Orthop Sports Phys Ther. 2007;37(2):40-47. doi:10.2519/jospt.2007.2343

KEY WORDS: injury risk, female athlete, navicular drop, shin splints

Prediction of 10 Repetition Maximum for Short-Arc Quadriceps Exercise From Hand-Held Dynamometer and Anthropometric Measurements

Mon, 05 Feb 2007 09:45:00 EST

Matthew K. Walsworth, Raquel Schneider, Jon Schultz, Corey Dahl, Stephen C. Allison, Frank B. Underwood, Jane Freund

Short-arc quadriceps exercises are commonly prescribed in physical therapy for strengthening knee extensor musculature. Determining the appropriate starting resistance has traditionally been a trial-and-error procedure. Therefore, developing an expedient method of estimating the correct starting resistance may lead to a more accurate exercise prescription. The primary purpose of this study was to establish a technique for predicting an individual's 10 repetition maximum (10 RM) based on hand-held dynamometer (HHD) strength recording and additional anthropometric predictor variables. Fifty healthy subjects (31 males and 19 females), aged 22-53 years, participated in the study. A prediction equation for determining 10 RM using HHD strength recording, weight, gender, and age was developed. By implementing this equation, clinicians can predict a normal, healthy, young to middle-aged adult's 10 RM within 2 ± 4.17 kg with a 95% confidence level (SEE = 2.13 kg).

J Orthop Sports Phys Ther. 1998;28(2):97-104.

Key Words: knee, muscle strength, prediction

The Conservative Radical

Mon, 05 Feb 2007 09:45:00 EST

Frank B. Underwood

Oxygen Consumption, Heart Rate, and Rating of Perceived Exertion in Young Adult Women During Backward Walking at Different Speeds

Mon, 05 Feb 2007 09:45:00 EST

Erica Clarkson, Shelley Cameron, Patricia Osmon, Christi McGraw, Michael A. Smutok, Deborah M. Stetts, Frank B. Underwood

At the time this study was completed, Ms. Clarkson, Ms. Cameron, Ms. Osmon, and Ms. McGraw were Master of Physical Therapy Students, US Army-Baylor University, Graduate Program in Physical Therapy, Fort Sam Houston, TX. Backward walking has gained popularity as an adjunct to treatment for patients undergoing rehabilitation for patellofemoral pain syndrome and anterior cruciate ligament injuries. Researchers have suggested that backward walking decreases the compressive forces at the patellofemoral joint while also preventing overstretching of the anterior cruciate ligament. Prior to this study, precise prescription of backward walking speeds for women was not possible. The purpose of this study was to determine the relationship between heart rate, oxygen consumption, and backward walking speeds. Twenty-five healthy, adult female volunteers participated in this study. Subjects were tested at speeds of 0.96, 1.20, 1.43, 1.67, and 1.91 m/sec. Subjects also performed a graded exercise stress test. Analysis revealed curvilinear relationships between oxygen consumption and speed as well as between heart rate and speed. With these results, clinicians may now prescribe specific speeds of backward walking for women to elicit a desired cardiopulmonary response.

J Orthop Sports Phys Ther. 1997;25(2):113-118.

Key Words: backward walking, gait, oxygen consumption, heart rate, knee injury

The Cardiopulmonary Cost of Backward Walking at Selected Speeds

Mon, 05 Feb 2007 09:45:00 EST

Glen Myatt, Richard E. Baxter, Roger Dougherty, Glenn N. Williams, John S. Halle, Deborah M. Stetts, Frank B. Underwood

Backward walking has been advocated as a method of maintaining cardiovascular conditioning in patients undergoing knee rehabilitation because it may decrease patellofemoral joint compressive forces. The primary purpose of this study was to determine the relationship between the rate of oxygen consumption (VO2) and backward walking speed. Twenty-five healthy males, aged 18-35 years, participated in this study. The rate of oxygen consumption and heart rate were measured at the backward walking speeds of 0.89, 1.12, 1.34, 1.56, and 1.79 m/sec (2.0, 2.5, 3.0, 3.5, and 4.0 miles/hour, respectively). Analysis revealed a direct, curvilinear relationship between VO2, and backward walking speed. This research provides information that can be used to prescribe a backward walking rehabilitation program which may be appropriate to maintain aerobic fitness levels during rehabilitation of patients with patellofemoral pain syndrome.

J Orthop Sports Phys Ther. 1995;21(3):132-138.

Key Words: gait, oxygen consumption, knee injuries