Journal of Orthopaedic & Sports Physical Therapy - Kathleen S. Egan, MPhil

The Effect of Static Stretching of the Calf Muscle-Tendon Unit on Active Ankle Dorsiflexion Range of Motion

James W. Youdas, David A. Krause, Kathleen S. Egan, Terry M. Therneau, Edward Laskowski

Study Design: Masked randomized trial. Objective: To examine the effects of a 6-week program of static stretching of the calf muscle-tendon unit (MTU) on active ankle dorsiflexion range of motion (ADFROM) in healthy subjects. Background: Static stretching of the calf MTU is often prescribed to increase flexibility in patients with shortened connective tissues or to maintain ADFROM in healthy individuals. Presently, physical therapists lack specific information on the optimal dosage of calf MTU stretching necessary to produce improvement in ADFROM. Methods and Measures: One hundred one adults (63 women, 38 men; mean age ± SD, 40.0 ± 10.9 years; range, 21-59) with no visual evidence of gait impairment due to lower-extremity dysfunction participated in the study. Active ADFROM was measured with a universal goniometer. Participants were randomly assigned to group 1, no stretch controls (n = 24), or to 1 of 3 experimental groups carrying out a 6-week program of standing wall stretches once per day: individuals in group 2 stretched for 30 seconds (n = 26); individuals in group 3 stretched for 1 minute (n = 24); individuals in group 4 stretched for 2 minutes (n = 27). Results: After 6 weeks, the results of an analysis of variance found no effect of treatment on active ADFROM. Conclusion: The results of this study show that a 6-week program of once-per-day static stretching for up to 2 minutes is not sufficient to increase active ADFROM in healthy subjects.

J Orthop Sports Phys Ther. 2003;33(7):408-417.

Key Words: flexibility, lower extremity, rehabilitation, triceps surae

Measurements of Temporal Aspects of Gait Obtained With a Multimemory Stopwatch in Persons With Gait Impairments

Angela L. Atwood, Kathleen S. Egan, Michael O. Harris-Love, Tricia L. Stiller, Terry M. Therneau, James W. Youdas
Study Design: Repeated measures of 14 temporal factors of gait obtained with a multimemory stopwatch from a variety of subjects with locomotor impairments. Objectives: To estimate the intratester and intertester reliability of 14 temporal factors of gait by using a multimemory stopwatch; to compare novice and expert clinicians at mastery of making these temporal measurements. Background: Temporal gait measures are useful for describing the effectiveness of treatment interventions in patients with locomotor impairments. Methods and Measures: Eleven adult subjects (mean age, 48.4 years; SD, 5.7 years), 10 with locomotor impairments and 1 elderly adult, ambulated along a 6-m walkway 3 times at a self-selected walking speed. The subjects were videotaped from the side as they walked. Four physical therapists independently analyzed the videotapes on 2 occasions; 2 examiners were recent graduates, and 2 others had 23 years of clinical experience. Intraclass correlation coefficients were used to estimate intratester reliability. A component of variance analysis quantified the sources of variation. Results: Intraclass correlation coefficients for each of the 14 variables varied from 0.88 to 0.98. The major contributor to variance was subject, followed by trial, error, and tester; the tester factor generally contributed less than 1% to the total variance. Conclusions: Reliable measurements of the temporal aspects of gait can be made by using a multimemory stopwatch and videotape in a clinical setting on patients with various locomotor problems. Our data suggest that measurements obtained by more experienced physical therapists were no more reliable than those made by recent graduates. J Orthop Sports Phys Ther. 2000;30(5):279-286. Key Words: evaluation, gait disorder, videography

Vastus Medialis Electrical Stimulation to Improve Lower Extremity Function Following a Lateral Patellar Retinacular Release

Kathleen S. Egan, Alex R. Ward
Study Design: A single-case study design. Objectives: To examine the effect of electrical stimulation of the vastus medialis muscle on stiffness, pain and function for a patient with delayed functional progress following a lateral patellar retinacular release. Background: Five months after an arthroscopic lateral patellar retinacular release, the patient, although highly motivated, had made little progress using routine exercises and taping. Methods and Measures: An electrical stimulation program producing approximately 300 contractions daily of the vastus medialis muscle was implemented. The electrical stimulation applied for 33 of the 36 days was a rectangular and balanced biphasic pulse of 625-µs duration, 70-Hz frequency, 8-second peak on-time, 3-second off-time, 1-second ramp-up, and 0.5-second ramp-down. Objective measures of stair climbing and hopping, together with the subjective measure of therapist-palpated superomedial patella displacement force, were recorded for each treatment visit. Other subjective measures were the patient’s daily recordings of knee pain and stiffness. Results: Patient-reported stiffness reduced rapidly as the actual and cumulative number of daily contractions of the vastus medialis muscle increased. After 8 days of electrical stimulation, the patient was able to ascend stairs unassisted and after another 21 days to hop unsupported. Conclusions: Stiffness rapidly reduced and function started to improve once the electrical stimulation program was implemented. Recovery during the 36 days of treatment with electrical stimulation was greater than during the previous 5 months using other methods. Compliance was not an issue, nor was muscle soreness.

J Orthop Sports Phys Ther. 2002; 32(9):437–446.

Keywords: knee, patella, patellofemoral, quadriceps