Objectives: To compare the effectiveness of 2 types of home program instruction, videotape versus personal instruction by a physical therapist, on subjective outcomes and exercise compliance following arthroscopic repair of a full-thickness rotator cuff tear. Background: Advances in orthopedic surgery and rehabilitation have placed increased emphasis on home exercise programs. Therefore, assessing the effectiveness of different methods of home program instruction is important.

Methods and Measures: Patients who consented to undergo surgical repair were randomly assigned to either a videotape or personal instruction group. A self-reported compliance log categorized subjects as fully compliant, partially compliant, or noncompliant. The Shoulder Pain and Disability Index and the University of Pennsylvania Shoulder Scale scores were obtained from subjects preoperatively and at 12, 24, and 52 weeks postoperatively. The null hypotheses that neither group would have better outcomes as measured by 2 shoulder outcome scales at any level of compliance over 4 levels of time, were assessed by 2 separate 2×3×4 multiple analyses of variances (MANOVAs), 1 for each outcome measure (a= 0.025).

Results: Neither MANOVA was significant and the null hypotheses were not rejected. The main effect of time (number of weeks postsurgery) was significant across all time intervals for both outcome measures (P<0.0005).

Conclusions: With a therapist available for questions, patients who utilized the videotape method for their home program instruction had self-reported outcomes equal to patients instructed in their home program personally by a physical therapist. Self-reported compliance with the rehabilitation program had little effect on the outcomes.

J Orthop Sports Phys Ther 2002;32(11):548–559.

]]> http://www.jospt.org/issues/articleID.120/article_detail.asp http://www.jospt.org/issues/articleID.124/article_detail.asp Julie A. Coplan
Study Design: Retrospective cohort study.

Objectives: To compare the relationship between the degrees of turnout, passive hip external rotation range of motion, and self-reported history of low back and lower extremity injury in ballet dancers.

Background: Ballet dancers are encouraged to externally rotate their lower extremities (turnout) as far as possible. This may cause stress on the dancers’ low back and lower extremities, putting them at risk for injury.

Methods and Measures: Thirty college-level ballet dancers and instructors were evaluated. Each participant completed an injury questionnaire that placed the participant either in a group with a self-reported history of low back and lower extremity injury or in a group without a self-reported history of low back and lower extremity injury. Each dancer’s first-position turnout and passive external rotation range of motion for both hips were measured. The comparison between each dancer’s first-position turnout and the measured hip external rotation range of motion was called ‘‘compensated turnout.’’ A 2-sample t test was used to determine if the average compensated turnout was significantly different in the injured and noninjured groups.

Results: The mean (± SD) compensated turnout values for the injured and noninjured groups were 25.4° (± 21.3°) and 4.7° (± 16.3°), respectively. This difference was significant at P = 0.006.

Conclusion: Based on a self-reported history of low back and lower extremity injuries, ballet dancers have a greater risk of injury if they reach a turnout position that is greater than their available bilateral passive hip external rotation range of motion.

J Orthop Sports Phys Ther 2002;32(11):579–584.

Keywords: dancing, hip rotation, injury

]]> http://www.jospt.org/issues/articleID.124/article_detail.asp http://www.jospt.org/issues/articleID.121/article_detail.asp Mary K. Allen, Ward Mylo Glasoe, Ted Kepros, Laurie Stonewall, Paula M. Ludewig
Study Design: Retrospective case-control study.

Objective:To examine the amount of dorsal first ray mobility in subjects having a history of stress fracture of the second or third metatarsal as compared to control subjects, and to test the influence of navicular drop, length of the first ray, and generalized joint laxity on the measure of dorsal mobility.

Background: Instability of the first ray may cause the lesser metatarsals to carry greater weight and contribute to the incidence of metatarsal stress fracture. Stability of the first ray is believed to be compromised when subtalar joint pronation continues into late stance, the first metatarsal is short, or an individual has generalized joint laxity. To date, no research has assessed the relationship of these etiological factors to the measure of first ray mobility.

Methods and Measures: Fifteen women athletes having a history of a second or third metatarsal stress fracture were matched by age, body mass, and sport activity to women athletes without fracture. Dorsal first ray mobility was quantified by a device using a standard load of 55 N. Change in vertical height of the navicular during stance was the measure of foot pronation. Relative length of the first ray navicular segment compared to the length of the second ray navicular segment was measured by caliper. Generalized joint laxity was evaluated using the Beighton 9-point scale. Within-day repeated measures assessed reliability. Differences between groups were determined by independent t test. Multiple polynomial regression analysis assessed the relationship between dorsal mobility and navicular drop, length of the first ray, and joint laxity.

Results: Interrater reliability coefficients ranged from 0.36 for metatarsal length to 0.71 for navicular drop. The intrarater reliability coefficient for dorsal first ray mobility was 0.93. Dorsal first ray mobility was not significantly different between the 2 groups. With regression analysis, the Beighton score was the only variable retained as a significant predictor of dorsal mobility (R 2=0.24). Conclusion: Results do not support the theory that describes the unstable first ray as a common cause of metatarsal stress fracture. In addition, this investigation found generalized joint laxity to be a significant predictor of dorsal first ray mobility.

J Orthop Phys Ther 2002;32(11):560–567.

Keywords: dorsal mobility, first metatarsal, generalized joint laxity

]]> http://www.jospt.org/issues/articleID.121/article_detail.asp http://www.jospt.org/issues/articleID.122/article_detail.asp Jacek Cholewicki, Marc T. Galloway, Gert K. Polzhofer, Andrea Radebold, Riaz A. Shah
Study Design: Observational case control design.

Objectives: To examine muscle response to sudden trunk loading in athletes with and without a recent history of acute low back injury (LBI).

Background: Impaired neuromuscular function is associated with chronic low back pain. This study examined whether such impairment persists after recovery from an acute LBI.

Methods and Measures: Seventeen athletes who had a recent history of acute LBI and 17 matched healthy controls were tested. At the time of testing (mean = 56 days postinjury, range = 7–120 days postinjury), all athletes were symptom free and had returned to regular competition. Subjects performed isometric exertions in trunk flexion, extension, and left and right lateral bending against a trunk restraining cable. Upon reaching the target isometric force, the cable was released to impose sudden loading on the lumbar spine. Surface EMG signals from 12 major trunk muscles were recorded. The shut-off and switch-on latencies and number of muscles responding to sudden loading were compared between the 2 groups.

Results: In all 4 testing directions, the athletes with a recent history of acute LBI shut off significantly fewer muscles and did so with delayed latency. On average, the injured subjects shut off 4.0 out of 6.0 (SD = 1.3) muscles compared to 4.6 out of 6.0 (SD = 1.3) muscles in the control group. The average muscle shut-off latency was 71 (SD = 31) milliseconds for the injured and 50 (SD = 21) milliseconds for the control subjects. No differences were found in number or latency of muscles switching on.

Conclusions: These objective measures of neuromuscular function indicated an altered muscle response pattern to sudden trunk loading in athletes following their clinical recovery from a recent acute LBI.

J Orthop Sports Phys Ther 2002;32(11):568–575.

Keywords: lumbar spine, motor control, sudden loading

]]> http://www.jospt.org/issues/articleID.122/article_detail.asp http://www.jospt.org/issues/articleID.119/article_detail.asp Guy G. Simoneau
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