Journal of Orthopaedic & Sports Physical Therapy - Robert A. Donatelli, PT, PhD, OCS

Effects of Immobilization on the Extensibility of Periarticular Connective � Tissue

Mon, 22 Sep 2008 00:00:00 EST

Robert A. Donatelli, Helen Owens-Burkhart
Connective tissue, one of the basic components of the human body, is a focus of many treatment procedures in orthopaedic physical therapy. As physical therapists, it is important for us to understand the nature of connective tissue and the histological changes that occur when connective tissue is immobilized. These changes are directly related to the causes of joint stiffness, leading to restricted movement. A basic knowledge of connective tissue is necessary to effectively restore normal joint mobility. In addition, this basic understanding provides a rationale for the treatment programs and assists in the development of realistic goals for our patients. This article discusses the biochemical and histological changes of periarticular connective tissue resulting from immobilization of synovial joints. Conclusions derived are confined to hypotheses only, due to lack of applied research in this area

J Orthop Sports Phys Ther 1981;3(2):67-72.

Pressure Changes in the Carpal Tunnel with Movement of the Pisiform Bone

Mon, 22 Sep 2008 00:00:00 EST

Mary L. Engles, Robert A. Donatelli, Marybeth Glasheen-Way
Seven fresh cadaveric forearms were studied to investigate the effects of medial and lateral positioning of the pisiform bone on pressure within the carpal tunnel. The wick catheter, a device used to transmit interstitial fluid pressure, was inserted into the carpal tunnels of the cadavers. Pressures in the tunnel with the pisiform in a resting position, medial position, and lateral position were measured via a water manometer. A significant increase in pressure was noted between the resting position and both the medial and lateral positions ( p = 0.001). No significant difference was found between the medial and lateral positions ( p > 0.05). Findings suggest that the use of movement of the pisiform as a conservative treatment in carpal tunnel syndrome is questionable.

J Orthop Sports Phys Ther 1982;4(1):47-50.

The Influence of Hallux Extension on the Foot During Ambulation

Fri, 19 Sep 2008 00:00:00 EST

William G. Boissonnault, Robert A. Donatelli
A review of the literature, focusing on functional anatomy of components of the foot/ ankle complex, provides the rationale for normal hallux extension being a rehabilitation goal when treating patients with foot dysfunction. Hallux extension of 60 to 65 has been found to assist in transforming the foot into the rigid lever necessary for gait, allow the hallux and first metatarsal head to support normal weightbearing loads, and facilitate flexor hallicus longus action during gait.

J Orthop Sports Phys Ther 1984;5(5):240-242.

Normal Biomechanics of the Foot and Ankle

Thu, 18 Sep 2008 00:00:00 EST

Robert A. Donatelli
The biomechanics of the foot and ankle are important to the normal function of the lower extremity. The foot is the terminal joint in the lower kinetic chain that opposes external resistance. Proper arthrokinematic movement within the foot and ankle influences the ability of the lower limb to attenuate the forces of weightbearing. It is important for the lower extremity to distribute and dissipate compressive, tensile, shearing, and rotatory forces during the stance phase of gait. Inadequate distribution of these forces could lead to abnormal stress and the eventual breakdown of connective tissue and muscle. The combined effect of muscle, bone, ligaments, and normal foot biomechanics will result in the most efficient force attenuation in the lower limb. This article will look specifically at the normal biomechanics of the foot and ankle.

J Orthop Sports Phys They 1985;7(3):91-95.

Abnormal Biomechanics of the Foot and Ankle

Mon, 15 Sep 2008 00:00:00 EST

Robert A. Donatelli
The biomechanics of the foot and ankle is important to the normal function of the lower extremity. The foot is the terminal joint in the lower kinetic chain that opposes external resistance. Proper arthrokinematic movement within the foot and ankle influences the ability of the lower limb to attenuate the forces of weightbearing. It is important for the lower extremity to distribute and dissipate compressive, tensile, shearing, and rotatory forces during the stance phase of gait. Inadequate distribution of these forces could lead to abnormal stress and eventual breakdown of connective tissue and muscle. Pathologies such as heel spurs, hallux valgus, neuromas, hallux limitus, shin splints, and nonspecific knee pain result from abnormal mechanics of the foot and ankle. The use of orthotics to re-establish the normal biomechanics of the foot and ankle have profound clinical applications. The combined effect of muscle, bone, ligaments, and normal biomechanics will result in the most efficient force attenuation in the lower limb.

J Orthop Sports Phys Ther 1987;9(1):11-16.

Case Study: Rehabilitation of a Stiff and Painful Shoulder: A Biomechanical Approach

Mon, 15 Sep 2008 00:00:00 EST

Robert A. Donatelli, Bruce Greenfield
A review of the literature provides an abundance of information discussing the pathology and management of the painful, stiff shoulder. To the clinician, the treatment approach to shoulder dysfunction is confusing. The research demonstrates there are many different treatment regimes for the management of shoulder dysfunction, none of which indicate overwhelming success. Traditionally, the painful, stiff shoulder, commonly diagnosed as frozen shoulder, is assessed without consideration of the entire shoulder complex. The biomechanics of the shoulder complex must be re-evaluated before each treatment session to determine the appropriate course of treatment. This paper presents a treatment regime for the painful, stiff shoulder. The regime was developed with careful analysis of normal shoulder mechanics.

J Ortho Sports Phys Ther 1987;9(3):118-126.

Biomechanical Foot Orthotics: A Retrospective Study

Fri, 12 Sep 2008 00:00:00 EST

Robert A. Donatelli, Cindy Hurlburt, David Conaway, Rick St. Pierre

Foot orthotics are becoming recognized as an important consideration in the correction of lower extremity alignment and mechanical dysfunctions. There are many different foot orthotics on the market today claiming to relieve pain and enhance foot function. Unfortunately, minimal research has been conducted investigating the effectiveness of foot orthotics in adult patient populations. The purpose of this study was to determine the degree of pain relief experienced by patients, the ability of patients to return to their previous levels of activity associated with the duration of use of the orthotics, and patient compliance. This study also discusses the specific deformity for which the orthotic was prescribed and the degree of posting necessary to compensate for the deformity. Fifty-three subjects, 20 males and 33 females, responded to a questionnaire survey. The type of foot deformity and the orthotic prescription are also presented for each subject. The responses to the questions were correlated with an individual patient chart review. In addition, chi-square analysis was used to determine the level of significance between the specific deformity and the age and weight of the patients. The level of significance was determined between the patient's ability to adjust to the orthotics and their continued use of the orthotics. Finally, the significance of the orthotic treatment was compared to four other treatment interventions. Ninety-six percent of the patients reported relief from pain with the use of the prescribed foot orthotic. Ninety-four percent of the patients were still wearing the orthotic, and 52% reported that they would not leave home without them in their shoes at the time the survey was conducted. Seventy percent of the patients reported that they were able to return to their previous level of activity with the use of the foot orthotics.

J Orthop Sports Phys Ther 1988;10(6):205-212.

Isokinetic Measurement of Foot Invertor and Evertor Force in Three Positions of Plantarflexion and Dorsiflexion

Wed, 10 Sep 2008 00:00:00 EST

Mary Cawthorn, Gordon S. Cummings, J. Randy Walker, Robert A. Donatelli
The purpose of this study was to determine the ankle position at which the greatest peak torque occurs during isokinetic testing of inversion and eversion force. Testing of right foot invertors and evertors was performed at 10° dorsiflexion, neutral dorsiflexion and plantarflexion, and 10° plantarflexion on 25 untrained subjects with the MERAC isokinetic dynamometer. Subjects were retested to determine reliability. Results indicate that 10° plantarflexion appears better than the other positions tested because reliability was highest and torque output was greatest at this position. Reliability was assessed with a Pearson product moment test and a paired comparisons test (p ≤ .05). A randomized block design and a Scheffé post hoc test demonstrated that significant differences in peak torque of both invertor and evertor muscles were found between the three testing positions (p ≤ .01). No significant difference in the invertor to evertor force ratio wits found between the three testing positions.

J Orthop Sports Phys Ther 1991;14(2):75-81.

Key Words: muscle strength, ankle, joint position

Effects of Strength Training on Throwing Velocity and Shoulder Muscle Performance in Teenage Baseball Players

Tue, 09 Sep 2008 00:00:00 EST

Michael J. Wooden, Marie Johanson, Lisa Litzelman, Mary Mundrane, Robert A. Donatelli, Bruce Greenfield
Exercise protocols designed to improve muscle function and athletic performance are continually developed and revised, often without published research supporting their efficacy. This study compared the effects of isokinetic (IKN) and accommodative isotonic training in the individualized, dynamic, variable resistance (IDVR) mode. Twenty-seven teenage baseball players were tested isokinetically for dominant shoulder rotational peak torque and power and for throwing velocity. They were then randomly assigned to 5 weeks of IKN training, IDVR training, or a control group of no training. Following the training period, pretest protocols were repeated. Analysis of variance of differences in means and Newman-Keuls post hoc tests showed statistically significant increases in throwing velocity and external rotator torque in the IDVR group but not the IKN group. External rotator power improved in both groups. Internal rotator torque and power were not improved in either group. Results suggest that IDVR may be more effective than IKN training in improving throwing velocity and external rotator torque production. Clinicians should consider using IDVR protocols in improving shoulder muscle function and throwing performance.

J Orthop Sports Phys Ther 1992;15(5):223-228.

Key Words: throwing velocity, shoulder, muscle strength training

Electromyographic Analysis of Core Trunk, Hip, and Thigh Muscles During 9 Rehabilitation Exercises

Wed, 29 Aug 2007 00:00:00 EST

Robert A. Donatelli, Kenji C. Carp, Richard A. Ekstrom

STUDY DESIGN: Prospective, single-group, repeated-measures design. OBJECTIVE: To identify exercises that could be used for strength development and the exercises that would be more appropriate for endurance or stabilization training. BACKGROUND: The exercises analyzed are often used in rehabilitation programs for the spine, hip, and knee. They are active exercises using body weight for resistance; thus a clinician is unable to determine the amount of resistance being applied to a muscle group. Electromyographic (EMG) analysis can provide a measure of muscle activation so that the clinician can have a better idea about the effect the exercise may have on the muscle for strength, endurance, or stabilization. METHODS AND MEASURES: Surface EMG analysis was carried out in 19 males and 11 females while performing the following 9 exercises: active hip abduction, bridge, unilateral-bridge, side-bridge, prone-bridge on the elbows and toes, quadruped arm/lower extremity lift, lateral step-up, standing lunge, and using the Dynamic Edge. The rectus abdominis, external oblique abdominis, longissimus thoracis, lumbar multifidus, gluteus maximus, gluteus medius, vastus medialis obliquus, and hamstring muscles were studied. RESULTS: In healthy subjects, the lateral step-up and the lunge exercises produced EMG levels greater than 45% maximum voluntary isometric contraction (MVIC) in the vastus medialis obliquus, which suggests that they may be beneficial for strengthening that muscle. The side-bridge exercise could be used for strengthening the gluteus medius and the external oblique abdominis muscles, and the quadruped arm/lower extremity lift exercise may help strengthen the gluteus maximus muscle. All the other exercises produced EMG levels less than 45% MVIC, so they may be more beneficial for training endurance or stabilization in healthy subjects. CONCLUSION: Our results suggest these exercises could be used for a core rehabilitation or performance enhancement program. Depending on the individual needs of a patient or athlete, some of the exercises may be more beneficial than others for achieving strength.

J Orthop Sports Phys Ther 2007;37(12):754-762, published online 29 August 2007. doi:10.2519/jospt.2007.2471

KEY WORDS: endurance, lower extremity, spine, stabilization, strength

Surface Electromyographic Analysis of Exercises for the Trapezius and SerratusAnterior Muscles

Mon, 05 Feb 2007 09:45:00 EST

Robert A. Donatelli, Richard A. Ekstrom, Gary L. Soderberg
Study Design: This study used a prospective, single-group repeated-measures design to analyze differences between the electromyographic (EMG) amplitudes produced by exercises for the trapezius and serratus anterior muscles. Objective: To identify high-intensity exercises that elicit the greatest level of EMG activity in the trapezius and serratus anterior muscles. Background: The trapezius and serratus anterior muscles are considered to be the only upward rotators of the scapula and are important for normal shoulder function. Electromyographic studies have been performed for these muscles during active and low-intensity exercises, but they have not been analyzed during high intensity exercises. Methods and Measures: Surface electrodes recorded EMG activity of the upper, middle, and lower trapezius and serratus anterior muscles during 10 exercises in 30 healthy subjects. Results: The unilateral shoulder shrug exercise was found to produce the greatest EMG activity in the upper trapezius. For the middle trapezius, the greatest EMG amplitudes were generated with 2 exercises: shoulder horizontal extension with external rotation and the overhead arm raise in line with the lower trapezius muscle in the prone position. The arm raise overhead exercise in the prone position produced the maximum EMG activity in the lower trapezius. The serratus anterior was activated maximally with exercises requiring a great amount of upward rotation of the scapula. The exercises were shoulder abduction in the plane of the scapula above 120° and a diagonal exercise with a combination of shoulder flexion, horizontal flexion, and external rotation. Conclusion: This study identified exercises that maximally activate the trapezius and serratus anterior muscles. This information may be helpful for clinicians in developing exercise programs for these muscles.

J Orthop Sports Phys Ther. 2003;33(5):247-258.

Key Words: scapula, shoulder, strength, upper extremity

Assessment of Shoulder Strength in Professional Baseball Pitchers

Mon, 05 Feb 2007 09:45:00 EST

Robert A. Donatelli, Todd S. Ellenbecker, Sheila R. Ekedahl, Joseph S. Wilkes, Keith Kocher, John Adam

Study Design: A bilateral comparison of strength and range of motion testing in professional baseball pitchers. Objective: We studied 39 professional male baseball pitchers to determine if the shoulder used for throwing was weaker or had less passive range of motion, compared to the nondominant arm. Background: Shoulder muscle weakness has been proposed as a possible risk factor for developing injury. Therefore, objective quantification of the strength of glenohumeral and scapular rotator muscle groups should be studied in a population of professional baseball pitchers. Methods and Measures: Passive internal and external range of motion was bilaterally measured at 90° of abduction. Muscle strength of the following muscles was measured bilaterally with a hand-held dynamometer: external and internal glenohumeral rotators, supraspinatus, middle trapezius, lower trapezius, and serratus anterior. Results: Passive external rotation of the glenohumeral joint at 90° of abduction on the pitching side was significantly greater than on the nonpitching side. Passive internal rotation range of motion on the nonpitching side was significantly greater than on the pitching side. The pitching arm's internal rotators, when tested in abduction, were significantly stronger than the nonpitching arm. The nonpitching arm's external rotators in the plane of the scapula, and in abduction, were significantly greater than those of the pitching arm. The pitching arm's middle and lower trapezius muscles were significantly stronger than those of the nonpitching arm. Conclusion: The range of motion and strength characteristics measured in this study can assist clinicians in evaluating athletes who use overhead throwing motions.

J Orthop Sports Phys Ther. 2000;30(9):544-551.

Key Words: professional baseball pitchers, rotator cuff strength, scapular muscle strength

Relationship Between Static and Dynamic Foot Postures in Professional Baseball Players

Mon, 05 Feb 2007 09:45:00 EST

Robert A. Donatelli, Michael J. Wooden, Sheila R. Ekedahl, Joseph S. Wilkes, Jeff Cooper, Andrew J. Bush

Study Design: Observational study of static and dynamic foot postures in professional baseball players. Background: Throughout the course of a professional baseball season, running, cutting, and sprinting activities can produce a breakdown in players' foot function, causing overuse injuries. Objectives: To investigate the relationship between static and dynamic foot postures; to determine the occurrence of abnormal foot postures in professional baseball players and the incidence of overuse injuries in the lower extremity; and to compare the foot postures of pitchers to those of positional players. Methods and Measures: The foot postures of 74 professional baseball players were evaluated at rest and during gait. Measures of static foot posture were obtained with a goniometer and included the subtalar neutral position, forefoot/rearfoot position, ankle joint dorsiflexion, tibial angle in standing, and calcaneal angle in standing. The FootTrak motion analysis system provided measures of dynamic foot posture (rearfoot supination and pronation) during the stance phase of gait. A questionnaire was completed by players who reported previous lower extremity injuries. The chi-square statistic was used to determine the associations between forefoot position (varus or valgus) and the amount of foot pronation during gait. Results: The forefoot varus and calcaneal valgus in standing was significantly associated with the maximum pronation during the stance phase of gait. Of the 65 players who demonstrated excessive pronation (> 8 degrees), 28 (43%) also reported a previous lower extremity injury. No statistically significant difference occurred, however, between injured and uninjured players with respect to the mean values of static or dynamic foot posture. In addition, foot postures were not associated with a player's position. Conclusions: Selected measures of static rearfoot and forefoot postures may have value in predicting dynamic rearfoot movement during the stance phase of gait. Excessive pronation in the baseball players we studied was not found to be a significant contributing factor in the development of overuse injuries.

J Orthop Sports Phys Ther. 1999;29(6):316-330.

Key Words: forefoot varus, abnormal pronation, foot postures

The Effect of Two Types of Foot Orthoses on Rearfoot Mechanics

Mon, 05 Feb 2007 09:45:00 EST

Glenn P. Brown, Robert A. Donatelli, Pamela A. Catlin, Michael J. Wooden

Little experimental data exist regarding the comparative biomechanical effects of various foot orthoses. This study evaluated the comparative effect of biomechanical orthoses and over-the-counter arch supports on controlling rearfoot pronation. Twenty-four patients with forefoot varus deformity were studied while walking on a treadmill. Two-dimensional, videotape motion analysis was used for studying rearfoot mechanics with 3 experimental conditions: 1) shoes only, 2) shoes plus arch supports, and 3) shoes plus biomechanical orthoses. The variables studied were: maximum pronation, calcaneal eversion, maximum pronation velocity, time-to-maximum pronation, and total pronation. No difference was noted in maximum pronation, calcaneal eversion, and total pronation between the 3 conditions. The data for maximum pronation velocity and time-to-maximum pronation were not reliable. Based on the results of this study, neither padded arch supports nor biomechanical orthoses can be preferentially recommended for their ability to control maximum pronation, calcaneal eversion, and total pronation during walking. Additional research is necessary to: 1) identify the biomechanical effects that are responsible for the clinical success of foot orthoses, and 2) determine better designs for controlling rearfoot movement.

J Orthop Sports Phys Ther. 1995;21(5):258-267.

Key Words: biomechanics, foot, walking