Journal of Orthopaedic & Sports Physical Therapy - Terry R. Malone, PT, EdD, ATC

Ankle Injuries: Anatomical and Biomechanical Considerations Necessary for the Development of an Injury Prevention Program

Mon, 22 Sep 2008 00:00:00 EST

This article describes the anatomical and biomechanical principles necessary for the development of an ankle injury prevention program. The structures of the talocrural joint and the subtalar joint are discussed in detail. The biomechanics of these two joints are discussed and their relationship elucidated. The ligamentous structures of the ankle are discussed in detail. Evaluation of the ankle is discussed in conjunction with mechanisms of athletic injuries. Pertinent principles necessary for the development of an injury prevention program for the ankle are presented.

J Orthop Sports Phys Ther 1980;1(3):171-

The Superior Tibiofibular Joint: The Forgotten Joint

Mon, 22 Sep 2008 00:00:00 EST

Michael Radakovich, Terry R. Malone

Treatment Parameters of High Frequency Electrical stimulation as Established on the Electro-Stim 180

Fri, 19 Sep 2008 00:00:00 EST

Jeff Owens, Terry R. Malone

Tremendous interest has developed regarding the use of electrical stimulation in both treatment and strengthening regimens. The Electro Stim 180 (Numed, Joliet, IL) is manufactured in Canada and imported into the United States. This unit functions at 2500 cycles per second with output similar to that developed by a Russian electrical stimulation device. A paucity of treatment parameters exists regarding this apparatus. Fifteen normal subjects participated in this study to establish treatment parameters in an exercise regimen. All subjects (mean age, 24) were pretreated isometricly and isokineticly in knee extension bilaterally using a Cybex II (Cybex, Ronkonkama, NY). The subjects were divided into three groups with group one receiving stimulation each day during a 10-day period and group two receiving stimulation on alternate days of a 10-day period, while group three served as a control. All treatment sessions consisted of 10 isometric contractions of 15 seconds duration, interspaced with 50 seconds of rest. Current was applied as tolerated to the left knee extensor mechanism during each trial. Current accommodation, strength of generated contraction, other associated treatment effects and strength differences were recorded. It was concluded that the Electro- Stim 180 is capable of generating greater than 60% of the maximal isometric voluntary knee extension, that stimulation is somewhat unpleasant, and that a tremendous degree of current accommodation is possible. Although strength gains were not significant in this particular study, they approached significance and, hence, indicate the need for further study in this area.

J Orthop Sports Phys Ther 1983;4(3):162-168.

Survey of Scholastic Athletic Health Care and Sports Medicine Clinics

Fri, 19 Sep 2008 00:00:00 EST

Sam Kegerreis, Terry R. Malone, Louis Greenwald, David E. Knoeppel
The increasing number of athletes requiring health care has spurred the growth of the development of sports medicine clinics. The diversity of such clinics is readily apparent. These clinics primarily function to provide evaluative and rehabilitative measures to all groups of athletic participants. Scholastic health care for athletic participants has not proceeded in a similar pattern. Sports medicine clinics are not effectively meeting the needs of the scholastic athlete, primarily because of location and financial limitations. This survey was conducted to collect information to further delineate the problems associated with scholastic health care of athletic participants. It appears that sports medicine clinics are manned by several levels of health care professionals. Scholastic athletes are least adequately covered by insurance and also suffer from being within a somewhat isolated environment. The need for on-field care and follow-up care within the school system remains a key problem associated with scholastic health care. Further research into the relationship of insurance policies which will adequately meet the needs of the scholastic population must be pursued.

J Orthop Sports Phys Ther 1983;5(2):78-81.

A Strength Study Utilizing the Electro-Stim 180

Thu, 18 Sep 2008 00:00:00 EST

David Boutelle, Brad Smith, Terry R. Malone
lncreased interest has developed in the use of electrical stimulation as either an adjunct or a substitution for voluntary muscle contraction as a technique to improve strength in normal individuals. This study was conducted in an attempt to determine if electrical stimulation does significantly increase the strength of normal musculature. A sample using 17 normal subjects (1 0 male, 7 female) with an average mean age of 26 years was obtained. In this study the subjects were divided into two groups. Three different speeds (0, 60, and 240°/sec) with 3-5 contractions at each speed were used to determine the maximum strength of each subject's nondominant leg as measured by a Cybex® II dynamometer. Group A consisted of 8 subjects (3 male, 5 female) who served as a control group. Group B consisted of 9 subjects (7 male, 2 female) who received electrical stimulation to the nondominant leg for 20 treatment sessions (5 days/week for 4 weeks). Results indicate that group B did have a significant strength gain which was achieved after 4 weeks of stimulation. These results were only significant at an isometric mode (OO/sec) and did not carry over to dynamic measurement.

J Orthop Sports Phys Ther 1985;7(2):50-53.

Sports Physical Therapy Specialization

Thu, 18 Sep 2008 00:00:00 EST

Terry R. Malone

Clinical Use of the Johnson Anti-Shear Device: How and Why to Use It

Thu, 18 Sep 2008 00:00:00 EST

Terry R. Malone
The purpose of this paper is to describe the clinical utilization of the Johnson Anti- Shear Device. This device presents a method of controlling the anterior shear forces developed during isokinetic exercise on a Cybex® ll or Orthotrone system. The antishear device allows the therapist to alter the amount of anterior shear developed during exercise, thus allowing the therapist to individualize the rehabilitation protocol. This is of special significance following anterior cruciate injury. The clinical use of this device will allow the therapist to more safely develop quadriceps exercise programs with their anterior cruciate deficient knee patients.

J Orthop Sports Phys Ther 1986;7(6):304-309.

The Diagonal Medial Plica: An Underestimated Clinical Entity

Mon, 15 Sep 2008 00:00:00 EST

Sam Kegerreis, Terry R. Malone, Frank Johnson

Patellar plical syndrome is a commonly reported, yet controversial entity. Arguments exist as to which component of the patella plica is most commonly involved clinically. The authors describe a plical structure which is seldom identified as a source of pathology. This structure, however, can be a primary source of pain accompanying extensor mechanism dysfunction. The aforementioned structure has been identified via arthroscopic technique, cadaveric dissection, and by palpation during clinical examinations. Conservative and surgical management is discussed.

J Orthop Sports Phys Ther 1988;9(9):305-309.

Rehabilitation of Foot and Ankle Injuries in Ballet Dancers

Thu, 11 Sep 2008 00:00:00 EST

Terry R. Malone, William T. Hardaker

Classical ballet is an exacting art form with roots dating to the Italian Renaissance. The physical demands of dance class, rehearsal, and performance can predispose the dancer to injury. The foot and ankle are common sites of injury. Most injuries are caused by overuse rather than acute injuries. The purpose of this clinical report is to describe the initial treatment, as well as a structured program directed to the restoration of motion, strength, endurance, and proprioception essential for the successful return to dance. Additionally, specific rehabilitation techniques will be presented to assist the physical therapist in reducing those risk factors that may predispose a dancer to future injury.

J Orthop Sports Phys Ther 1990;11(8):355-361.

Effects of Running on Intervertebral Disc Height

Thu, 11 Sep 2008 00:00:00 EST

Tammy L. White, Terry R. Malone
Vertebral column height decreases throughout the course of the day. This decrease is the result of a loss of fluid from the intervertebral discs due to compressive loading. When the load changes during the day, as a result of varying physical activities, the rate of disc shrinkage changes in relation to those activities. The purpose of this study was to determine if there is a correlation between long distance running and an increase in the loss of vertebral column height. Thirty elite male runners, ages 17 to 29, participated in this study. Subjects' vertebral column heights were measured in the morning upon waking, in the afternoon prior to running 9 miles, and then immediately following the run. Paired t-tests revealed: 1) that the vertebral column height was significantly less following the run, and 2) that a significantly greater amount of height was lost during 1 hour of running than during 7.5 hours of relatively static activities.

J Orthop Sports Phys Ther 1990;12(4):139-146.

Commentary and Historical Perspective of Anterior Cruciate Ligament Rehabilitation

Tue, 09 Sep 2008 00:00:00 EST

Terry R. Malone, William E. Garrett
This article serves as the introduction and historical perspective of anterior cruciate ligament surgery and rehabilitation. Several physician-therapist teams have been invited to share their "state of the art" techniques and to contrast their programs to that espoused by Shelbourne and Nitz in 1990. Our commentary/review of "Accelerated Rehabilitation After Anterior Cruciate Ligament Reconstruction" (Shelbourne KD, Nitz P, Am J Sports Med 18:292-299, 1990) is provided to contextualize the reader to what most clinicians would recognize as an extremely aggressive rehabilitation approach that is being popularized in the 1990s. A comparison is then presented of the rehabilitation sequence used in the MacIntosh procedures, demonstrating how early motion/functional rehabilitation was the hallmark of this type of extraarticular rehabilitation sequence and how today's pattern has evolved to follow that philosophy. Each of the teamed authors has attempted to present his surgery and rehabilitation/techniques and highlight differences between his program and that of Shelbourne and Nitz. We hope that the readers find this glimpse of the past and present helpful in formulating their rehabilitation sequences and that the future will be predicated on excellent basic science and clinical judgment.

J Orthop Sports Phys Ther 1992;15(6):265-269.

Key Words: anterior cruciate ligament reconstruction, rehabilitation, clinical outcome

Hip Strength and Hip and Knee Kinematics During Stair Descent in Females With and Without Patellofemoral Pain Syndrome

Wed, 21 Nov 2007 00:00:00 EST

Lori A. Bolgla, Terry R. Malone, Brian R. Umberger, Timothy L. Uhl

STUDY DESIGN: Cross-sectional. OBJECTIVE: To determine if females presenting with patellofemoral pain syndrome (PFPS) from no discernable cause other than overuse demonstrate hip weakness and increased hip internal rotation, hip adduction, and knee valgus during stair descent. BACKGROUND: Historically, PFPS has been viewed exclusively as a knee problem. Recent findings have indicated an association between hip weakness and PFPS. Researchers have hypothesized that patients who demonstrate hip weakness would exhibit increased hip internal rotation, hip adduction, and knee valgus during functional activities. To date, researchers have not simultaneously examined hip and knee strength and kinematics in subjects with PFPS to make this determination. METHODS AND MEASURES: Eighteen females diagnosed with PFPS and 18 matched controls participated. Strength measures were taken for the hip external rotators and hip abductors. Hip and knee kinematics were collected as subjects completed a standardized stair-stepping task. Independent t tests were used to determine between-group differences in strength and kinematics during stair descent. RESULTS: Subjects with PFPS generated 24% less hip external rotator (P = .002) and 26% less hip abductor (P =. 006) torque. No between-group differences (P > .05) were found for average hip and knee transverse and frontal plane angles during stair descent. CONCLUSION: Subjects with PFPS had significant hip weakness but did not demonstrate altered hip and knee kinematics as previously theorized. Additional investigations are needed to better understand the association between hip weakness and PFPS etiology. LEVEL OF EVIDENCE: Symptom Prevalence, Level 4.

J Orthop Sports Phys Ther. 2008;38(1):12-18, published online 21 November 2007, doi:10.2519/jospt.2008.2462

KEY WORDS: anterior knee pain, hip abduction, hip external rotation, kinematics

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

Intrarater Reliability of Selected Clinical Outcome Measures Following Anterior Cruciate Ligament Reconstruction

Mon, 05 Feb 2007 09:45:00 EST

Joseph A. Brosky, Arthur J. Nitz, Terry R. Malone, David N. M. Caborn, Mary Kay Rayens

Study Design: Single group repeated measures following anterior cruciate ligament (ACL) reconstruction. Objectives: The purpose of this study was to evaluate the intrarater reliability of selected clinical outcome measures in patients having ACL reconstruction. Background: Several investigations have reported the reliability of isokinetic testing and knee ligament arthrometry. Fewer studies have examined the reliability of lower extremity functional tests, with most of these studies evaluating normal subjects. Methods and Measures: Fifteen physically active males with unilateral ACL-reconstructed knees were evaluated with the KT-1000, Biodex isokinetic dynamometer, and 3 functional hop tests on 5 occasions. Results: lntraclass correlation coefficients (ICCs) revealed good to high intrarater reliability (ICC >0.80) of the functional hop tests and isokinetic peak torque values. ICCs were higher for the involved limb than the uninvolved limb using the scores from the KT-1000 Manual Maximum Test. Conclusions: The outcome measures examined in this investigation have been shown to be reliable in patients with ACL reconstructions and support previous investigations in nonimpaired populations. Further research is needed to examine the validity of these postoperative outcome measures in patients with ACL reconstructions.

J Orthop Sports Phys Ther. 1999;29(1):39-48.

Key Words: functional outcomes measures, functional testing

Patellofemoral Disorders: A Classification System and Clinical Guidelines for Nonoperative Rehabilitation

Mon, 05 Feb 2007 09:45:00 EST

Kevin E. Wilk, George J. Davies, Robert E. Mangine, Terry R. Malone

Patellofemoral disorders are among the most common clinical conditions managed in the orthopaedic and sports medicine setting. Nonoperative intervention is typically the initial form of treatment for patellofemoral disorders; however, there is no consensus on the most effective method of treatment. Although numerous treatment options exist for patellofemoral patients, the indications and contraindications of each approach have not been well established. Additionally, there is no generally accepted classification scheme for patellofemoral disorders. In this paper, we will discuss a classification system to be used as the foundation for developing treatment strategies and interventions in the nonsurgical management of patients with patellofemoral pain and/or dysfunction. The classification system divides the patellofemoral disorders into eight groups, including: 1) patellar compression syndromes, 2) patellar instability, 3) biomechanical dysfunction, 4) direct patellar trauma, 5) soft tissue lesions, 6) overuse syndromes, 7) osteochondritis diseases, and 8) neurologic disorders. Treatment suggestions for each of the eight patellofemoral dysfunction categories will be briefly discussed.

J Orthop Sports Phys Ther. 1998;28(5):307-322.

Key Words: patellofemoral dysfunction, rehabilitation, classification

The Effect of Quadriceps Femoris, Hamstring, and Placebo Eccentric Fatigue on Knee and Ankle Dynamics During Crossover Cutting

Mon, 05 Feb 2007 09:45:00 EST

Robert Shapiro, David N. M. Caborn, Arthur J. Nitz, Terry R. Malone, John A. Nyland

This study attempted to determine the effect of eccentric quadriceps femoris, hamstring, and placebo fatigue on stance limb dynamics during the plant-and-cut phase of a crossover cut. Twenty female college students (task trained) were tested. Hamstring fatigue resulted in decreased peak impact knee flexion moments (p = .01), increased internal tibial rotation at peak knee flexion (p = .05), and decreased peak ankle dorsiflexion (p = .05). Quadriceps fatigue resulted in increased peak ankle dorsiflexion moments (p < .01), decreased peak posterior braking forces (p = .01), decreased peak knee extension moments (p = .01), delayed peak knee flexion (p = .01), delayed peak propulsive forces (p < .01), and delayed subtalar peak inversion moments (p = .05). Fatigue of either muscle group produced earlier peak ankle plantar flexion moments (p = .05) and decreased peak propulsive knee flexion moments (p = .05). Variables requiring further study (p = .1) provide discussion data. Soleus, gastrocnemius, tibialis anterior, and deep posterior compartment calf muscles serve as dynamic impact force attenuators, compensating for fatigued proximal muscles.

J Orthop Sports Phys Ther. 1997;25(3):171-184.

Key Words: women, muscle, fatigue, compensatory dynamics