STUDY DESIGN: Case report. BACKGROUND: Postpartum low back and hip dysfunction may be caused by an incomplete recovery of abdominal musculature and impaired neuromuscular control. The purpose of this report is to describe the management of a postpartum runner with hip and low back pain through exercise training via ultrasound imaging (USI) biofeedback combined with running-form modification. CASE DESCRIPTION: A postpartum runner with hip and low back pain underwent dynamic lumbar stabilization training with USI biofeedback and running-form modification to reduce mechanical loading. Muscle thickness of transversus abdominis and internal oblique was measured with USI preintervention and 7 weeks after completion of the intervention. Additionally, 3-dimensional lower extremity joint motions, moments, and powers were calculated during treadmill running. OUTCOMES: The patient's pain with running decreased from a constant 9/10 (0, no pain; 10, worst pain) to an occasional 3/10 posttreatment. Transversus abdominis muscle thickness increased 6.3% during the abdominal drawing-in maneuver and 27.0% during the abdominal drawing-in maneuver with straight leg raise. Changes were also noted in the internal oblique. These findings corresponded to improved lumbopelvic control: pelvic list and axial rotation during running decreased 38% and 36%, respectively. The patient's running volume returned to preinjury levels (8.1-9.7 km, 3 days per week) with no hip pain and minimal low back pain, and she successfully completed her goal of running a half-marathon. DISCUSSION: The successful outcomes of this case support the consideration of dynamic lumbar stabilization exercises, USI biofeedback, and running-form modification in postpartum runners with lumbopelvic dysfunction. LEVEL OF EVIDENCE: Therapy, level 4.

J Orthop Sports Phys Ther 2012;42(7):615-624, Epub 23 March 2012. doi:10.2519/jospt.2012.3941

KEY WORDS: abdominal drawing-in maneuver, pregnancy, running mechanics, transversus abdominis

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To determine the prevalence of, and association between, disordered eating (DE), menstrual dysfunction (MD), and musculoskeletal injury (MI) among high school female athletes. BACKGROUND: Female athlete triad (Triad) syndrome is the interrelatedness of DE, MD, and low bone mass. Few studies have examined 2 or more Triad components simultaneously, or their relationship to injury, among female high school athletes. METHODS: The subject sample consisted of 311 female high school athletes competing on 33 interscholastic high school teams during the 2006-2007 school year. Athletes completed the Eating Disorder Examination Questionnaire (EDE-Q) and Healthy Wisconsin High School Female Athletes Survey (HWHSFAS). Athletes were classified by sport type as aesthetic (AES), endurance (END), or team/anaerobic (T/A). RESULTS: Of those surveyed, 35.4% reported DE, 18.8% reported MD, and 65.6% reported sustaining a sports-related musculoskeletal injury during the current sports season. Athletes reporting DE were twice as likely to be injured compared to those reporting normal eating behaviors (odds ratio [OR], 2.3; 95% confidence interval [CI]: 1.4, 4.0). Multivariate logistic regression analyses revealed that athletes who reported a history of DE (OR, 2.1; 95% CI: 1.1, 3.9) or prior injury (OR, 5.1; 95% CI: 2.9, 8.9) were more likely to be injured during the sports season. CONCLUSION: A high prevalence of DE and MD exists among high school female athletes. Additionally, athletes with DE were over 2 times more likely to sustain a sports-related injury during a sports season. Screening and intervention programs designed to identify and decrease the prevalence of DE should be implemented with high school females. LEVEL OF EVIDENCE: Prognosis, level 2b.

J Orthop Sports Phys Ther 2011;41(2):60-69, Epub 22 October 2010. doi:10.2519/jospt.2011.3312

KEY WORDS: female athlete triad, musculoskeletal disorder, sports

Study Design: Resident’s case problem. Background: A 26-year-old male sought physical therapy services via direct access secondary to a flare-up of a chronic low back pain condition. The patient complained of recent onset of lumbosacral joint pain, including (1) constant right-sided deep-bruise sensation, (2) intermittent right-sided sharp stabbing pain, and (3) constant bilateral aching. The patient’s past medical history included a hyperextension low back injury while playing football at age 17. Physical examination revealed (1) deep pain with palpation over the right lumbosacral joint region, (2) sharp right lumbosacral joint pain with 1 repetition of active trunk backward bending, and (3) a marked increase in pain and joint hypomobility with right unilateral joint assessment at the L4 and L5 spinal levels. Diagnosis: The examining therapist referred the patient for radiographic evaluation due to strong suspicions of a pars interarticularis bony defect. Lumbar plain films, oblique views, revealed an L5 bilateral pars defect, leading to a diagnosis of a longstanding bilateral L5 spondylolysis. Discussion: Patients with low back pain often seek physical therapy services. Identification of pathology requiring examination by other health care providers, leading to patient referral to other health care practitioners, is a potential important outcome of the therapist’s examination. This resident’s case problem illustrates the importance of a systematic examination scheme, including a thorough medical screening component that led to a patient referral for radiographic evaluation. The resultant diagnosis, although not representing serious pathology, did impact the therapist’s patient plan of care.

J Orthop Sports Phys Ther. 2005;35(5):319-326. doi:10.2519/jospt.2005.1564

Key Words: fracture, lumbar spine, pars interarticularis, radiograph

Elite athletes are competing for longer seasons, training more hours, and taking less time off. This schedule may predispose the elite athlete to overuse injuries. When an injury occurs, aquatic-based rehabilitation may expedite the recovery process, as effective cardiovascular and musculoskeletal training may be accomplished by aquatic exercise. The pool may be used both during rehabilitation and postrecovery as an adjunctive tool. Knowledge of the unique physical properties of water, as well as the physiological responses to immersion both at rest and during exercise, will aid the physical therapist when designing a rehabilitation or training program for the athlete. Understanding the principles of movement in water will provide a foundation for creative use of water's unique properties.

J Orthop Sports Phys Ther. 1998;27(1):32-41.

Key Words: aquatic, training, rehabilitation

Patellofemoral pain, often called patellofemoral stress syndrome or patellofemoral joint dysfunction, is a commonly seen knee pain syndrome in patients of all ages. It is often a frustrating problem for both the patient and the clinician, as the source of pain can be elusive, making treatment choices difficult. Strategies have been proposed based upon potential sources of pain, including both operative techniques as well as conservative management. Current nonoperative treatment strategies and techniques in the treatment of patellofemoral pain are reviewed. Recommendations and criteria for progression of rehabilitation and suggestions for future research regarding patellofemoral pain are suggested.

J Orthop Sports Phys Ther. 1998;28(5):336-344.

Key Words: patellofemoral, knee, athlete, nonoperative treatment

Since the passage of Title IX in 1972, women's participation in physical activity and sports has increased significantly. A concurrent expansion in the body of knowledge regarding women and sports has occurred. Questions regarding menstrual dysfunction and exercise continue, while new questions about menstrual dysfunction and its effect on bone mineral density have arisen. Physical and physiological differences between men and women not only guide treatment, but also help fuel policy decisions regarding competition between males and females. It is essential for the physical therapist to remain current on issues related to women and sports in order to better advise and treat the female athlete.

J Orthop Sports Phys Ther. 1996;23(2):134-148.

Key Words: female, athlete, menstruation

Determining whether a patient’s symptoms are associated with a condition for which physical therapy intervention is indicated is one of the important questions physical therapists attempt to answer during an initial patient visit. This resident’s case problem involves a 34-year-old homemaker and long-distance runner referred for physical therapy with a diagnosis of right sacral pain. This case illustrates that the answer to this question may not be clear until subsequent patient visits occur. Sacral stress fractures, although relatively uncommon, are a potential source of back pain, which is a common complaint in patients seeking physical therapy outpatient services. Because bony lesions can be associated with serious medical conditions, such as cancers and fractures, early detection and an accurate diagnosis is paramount to appropriate care. An important element in screening for such conditions is recognizing patients with the relevant risk factors. The presence of the risk factors associated with insufficiency and fatigue fractures, as described in this case, should alert the therapist to scrutinize symptoms and signs suggestive of a bony lesion thoroughly. As described, there is an unfortunate degree of overlap of symptoms and signs for many of the conditions causing back pain and those of sacral stress fractures. Another important element of this screening process is establishing a prognosis that carries expectations of patient progression, both from a subjective and a physical examination standpoint. If these expectations are not met, the therapist must reconsider the original diagnosis, and, as in this case, insure that the patient is referred for physician follow-up and the recommended appropriate diagnostic workup.

J Ortho Sports Phys Ther. 2002;32(12):613-621.