• Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ. Knee pain and mobility impairments: meniscal and articular cartilage lesions. J Orthop Sports Phys Ther 2010;40(6):A1-A35. doi:10.2519/jospt.2010.0304
  

J Orthop Sports Phys Ther 2010;40(9):597.

J Orthop Sports Phys Ther 2010;40(9):598-601.

The patient was a 32-year-old male who sustained a noncontact left knee injury during a quick pivot on a planted left foot, while playing flag football. Radiographs of the left knee revealed findings consistent with a tibial spine avulsion fracture, while magnetic resonance imaging confirmed a medial tibial spine avulsion fracture. Bone marrow edema was noted in a pivot shift injury pattern involving the lateral femoral condyle and the lateral tibial plateau, and there was also a fracture of the posterior lateral tibial cortex at the site of the bone marrow edema. To determine the best course of treatment, a computed tomography scan was ordered to better visualize the extent of the avulsion fracture. The computed tomography scan demonstrated a comminuted fracture through the tibial spine.

J Orthop Sports Phys Ther 2010;40(9):594. doi:10.2519/jospt.2010.0414

KEY WORDS: computed tomography, knee, magnetic resonance imaging, radiography

The patient was a 14-year-old female with a 4-year history of left anterolateral foot and ankle pain of insidious onset that was first noticed while playing soccer. After a lack of progress with conservative measures for her left foot and ankle pain, the patient was evaluated by an orthopaedic surgeon. While conventional radiographs of the foot and ankle were normal, magnetic resonance imaging revealed generalized bone marrow edema in the navicular bone with irregularity along the lateral margin of the navicular bone and adjacent anterior margin of the anterior process of the calcaneus. These findings suggested possible sequelae of osteonecrosis or a partial coalition between the lateral margin of the navicular bone and anterior process of the calcaneus. Computed tomography scanning revealed focal osteochondral bone changes along the lateral margin of the navicular bone and anterior process of the calcaneus. Surgery was performed 3 months later, which involved excision of a fibrous calcaneonavicular tarsal coalition.

J Orthop Sports Phys Ther 2010;40(9):595. doi:10.2519/jospt.2010.0415

KEY WORDS: ankle, computed tomography, foot, magnetic resonance imaging

The Orthopaedic Section of the American Physical Therapy Association presents this sixth set of clinical practice guidelines on Achilles pain, stiffness, and muscle power deficits that are characteristic of Achilles Tendinitis. These clinical practice guidelines are linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) interventions provided by physical therapists, (3) and assessment of outcome for common musculoskeletal disorders.

J Orthop Sports Phys Ther. 2010:40(9):A1-A26. doi:10.2519/jospt.2010.0305

KEY WORDS: APTA, clinical practice guidelines, ICD, ICF, Orthopaedic Section

STUDY DESIGN: Controlled cohort repeated-measures experimental design. OBJECTIVES: To determine if a neuromuscular training program (NMTP) focused on core stability and lower extremity strength would affect performance on the star excursion balance test (SEBT). We hypothesized that NMTP would improve SEBT performance in the experimental group and there would be no side-to-side differences in either group. BACKGROUND: The SEBT is a functional screening tool that is used to assess dynamic stability, monitor rehabilitation progress, assess deficits following an injury, and identify athletes at high risk for lower extremity injury. The SEBT requires lower extremity coordination, balance, flexibility, and strength. METHODS: Twenty uninjured female soccer players (13 experimental, 7 control) participated. Players trained together as a team, so group allocation was not randomized. The SEBT was administered prior to and following 8 weeks of NMTP in the experimental group and 8 weeks of no NMTP in the control group. A 3-way mixed-model ANOVA was used to determine the effect of group (experimental versus control), training (pretraining versus posttraining), and limb (right versus left). RESULTS: After participation in a NMTP, subjects demonstrated a significant improvement in the SEBT composite score (mean ± SD) on the right limb (pretraining, 96.4% ± 11.7%; posttraining, 104.6% ± 6.1%; P = .03) and the left limb (pretraining, 96.9% ± 10.1%; posttraining, 103.4% ± 8.0%; P = .04). The control group had no change on the SEBT composite score for the right (pretraining, 95.7% ± 5.2%; posttraining, 94.4% ± 5.2%; P = .15) or the left (97.4% ± 7.2%; 93.6% ± 5.0%; P = .09) limb. Further analysis identified significant improvement for the SEBT in the posterolateral direction on both the right (P = .008) and left (P = .040) limb and the posteromedial direction of the left limb (P = .028) in the experimental group. CONCLUSION: Female soccer players demonstrated an improved performance on the SEBT after NMTP that focused on core stability and lower extremity strength. LEVEL OF EVIDENCE: Performance enhancement, level 2b-.

J Orthop Sports Phys Ther 2010;40(9):551-558, Epub 6 August 2010. doi:10.2519/jospt.2010.3325

KEY WORDS: core stability, core strengthening, injury prevention training, trunk neuromuscular control

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To measure changes in muscle strength, range of motion, and function from 2 weeks before to 6 months after total knee arthroplasty (TKA) and compare outcomes with data from a control group consisting of healthy adults. BACKGROUND: Total knee arthroplasty successfully alleviates pain from knee osteoarthritis, but deficits in function can persist long term. How impairments and functional limitations change over the first 6 months after TKA, compared to data from healthy adults, has not been well reported in the literature. METHODS: Twenty-four patients who underwent a primary unilateral TKA were compared to healthy adults (n = 17). All patients participated in a standardized rehabilitation program following surgery. Isometric quadriceps torque was assessed using an electromechanical dynamometer. Range of motion was measured actively and passively. Functional performance was assessed using the stair-climbing test, timed up-and-go test, 6-minute walk test, and single-limb stance time. Patients underwent testing at 2 weeks preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: Compared to healthy older adults, patients performed significantly worse at all times for all measures (P<.05), except for single-limb stance time at 6 months (P>.05). One month postoperatively, patients experienced significant losses from preoperative levels in all outcomes. Patients recovered to preoperative levels by 6 months postoperatively on all measures, except knee flexion range of motion, but still exhibited the same extent of limitation they did prior to surgery. CONCLUSION: The persistent impairments and functional limitations 6 months after TKA with standard rehabilitation suggest that more intensive therapeutic approaches may be necessary to restore function of patients following TKA to the levels of healthy adults. LEVEL OF EVIDENCE: Therapy, level 2b.

J Orthop Sports Phys Ther 2010;40(9):559-567, Epub 6 August 2010. doi:10.2519/jospt.2010.3317

KEY WORDS: joint replacement, older adults, osteoarthritis, rehabilitation

Letters to the Editor-in-Chief of JOSPT as follows:

• "Manual Magic: The Method Is Not the Trick" and Authors' Response
• "Moving Past Sleight of Hand" and Authors' Response
• "Core Muscle Activation During Swiss Ball and Traditional Abdominal Exercises" and Authors' Response

J Orthop Sports Phys Ther 2010;40(8):535-541. doi:10.2519/jospt.2010.0201

J Orthop Sports Phys Ther 2010;40(8):542-549.

Traditionally, placebo has been associated with using an inert substance, in part so the subsequent response could
be attributed to the target treatment, controlling for the confound of a “placebo effect.” Placebo’s link with inert substances is so strong that “sham treatment” is a common synonym, and widespread placebo use is discouraged—even when there is supporting evidence for its effectiveness. Recent research has helped to redefine placebo, and this editorial will highlight key information supporting a contemporary view of placebo.

J Orthop Sports Phys Ther 2010;40(8):452-454. doi:10.2519/jospt.2010.0107

KEY WORDS: placebo effect, study design

STUDY DESIGN: Case series. BACKGROUND: Few studies have defined the dosage and specific techniques of manual therapy and exercise for rehabilitation for patients with subacromial impingement syndrome. This case series describes a standardized treatment program for subacromial impingement syndrome and the time course and outcomes over a 12-week period. CASE DESCRIPTION: Ten patients (age range, 19-70 years) with subacromial impingement syndrome defined by inclusion and exclusion criteria were treated with a standardized protocol for 10 visits over 6 to 8 weeks. The protocol included a 3-phase progressive strengthening program, manual stretching, thrust and nonthrust manipulation to the shoulder and spine, patient education, activity modification, and a daily home exercise program of stretching and strengthening. Patients completed a history and measures of impairments and functional disability at 2, 4, 6, and 12 weeks. OUTCOMES: Treatment success was defined as both a 50% improvement on the Disabilities of the Arm, Shoulder, and Hand (DASH) score and a global rating of change of at least “moderately better.” At 6 weeks, 6 of 10 patients had a successful (mean ± SD) DASH outcome score (initial, 33.9 ± 16.2; 6 weeks, 8.1 ± 9.2). At 12 weeks, 8 of 10 patients had a successful DASH outcome score (initial, 33.1 ± 14; 12 weeks, 8.3 ± 6.4). As a group, the largest improvement was in the first 2 weeks. The most common impairments for all 10 patients were rotator cuff and trapezius muscle weakness (10 of 10 patients), limited shoulder internal rotation motion (8 of 10 patients), and reduced kyphosis of the midthoracic area (7 of 10 patients). DISCUSSION: A program aimed at strengthening rotator cuff and scapular muscles, with stretching and manual therapy aimed at thoracic spine and the posterior and inferior soft-tissue structures of the glenohumeral joint appeared to be successful in the majority of patients. This case series describes a comprehensive impairment-based treatment which resulted in symptomatic and functional improvement in 8 of 10 patients in 6 to 12 weeks. LEVEL OF EVIDENCE: Therapy, level 4.

J Orthop Sports Phys Ther 2010;40(8):474-493. doi:10.2519/jospt.2010.3223

KEY WORDS: manipulation, pain, rotator cuff, shoulder, supraspinatus

STUDY DESIGN: Case report. BACKGROUND: Cognitive behavioral therapy (CBT) is an effective intervention for patients with persistent pain. Recent research indicates that physical therapists self-perceive a lack of knowledge, skills, and time to provide this intervention. The purpose of this case report is to describe how specific CBT strategies can be integrated with multimodal physical therapist management of a patient with persistent low back pain. CASE DESCRIPTION: The patient was a 70-year-old female with activity limitations of walking, standing, and forward bending. Oswestry Disability Questionnaire score was 19/50 and Fear-Avoidance Belief Questionnaire physical activity subscale was 23/24. The Low Back Activity Confidence Scale revealed 19%, 100%, and 84% for function, symptom self-regulation, and exercise, respectively. CBT-based patient education was provided in combination with manual therapy and exercise. CBT techniques included cognitive restructuring, goal setting, activity pacing, problem-solving strategies, graded exposure, encouraging exposure to pleasant experiences, and maintenance strategies. OUTCOMES: The patient was discharged after 7 visits distributed over 21 weeks. Her Oswestry Disability Questionnaire score was reduced 10% and Fear-Avoidance Belief Questionnaire physical activity subscale score reduced 48%. On the Low Back Activity Confidence Scale the patient’s scores were 19%, 87%, and 94% for function, symptom self-regulation, and exercise, respectively. DISCUSSION: This case report describes the use of CBT techniques during patient education by a physical therapist. The patient demonstrated clinically measurable and significant improvements in disability. Improvements in both self-efficacy beliefs related to exercise and activity avoidance beliefs were associated with improvement in disability. Additional research is needed to determine best practices for CBT-based patient education by physical therapists. LEVEL OF EVIDENCE: Therapy, level 4.

J Orthop Sports Phys Ther 2010;40(8):494-501. doi:10.2519/jospt.2010.3264

KEY WORDS: chronic pain, graded exposure, lumbar spine

The patient was a 33-year-old woman with a chief complaint of midthoracic spine pain. Anterior-posterior and lateral radiographs of the thoracic spine revealed superior and inferior endplate deformities and a mild reduction of stature of the T9 vertebral body, which were suspicious for a fracture. Computed tomography scans revealed cortical irregularity of the vertebral body of T9, however, magnetic resonance imaging of the thoracic spine was negative. Given the magnetic resonance imaging findings, the smooth, well-defined cortical defect, and the absence of paraspinal hemorrhaging on the computed tomography scan, it was hypothesized that this may not have been an acute fracture. Rather, the cortical irregularity of the anterior vertebral body of T9 seen on computed tomography could have instead represented normal nutrient vascular channels. The patient was referred to an orthopaedic surgeon, who recommended conservative management by a physical therapist.

J Orthop Sports Phys Ther 2010;40(8):533. doi:10.2519/jospt.2010.0412

KEY WORDS: computed tomography, magnetic resonance imaging, radiographs

The patient was a 13-year-old male soccer player who was referred to a physical therapist with complaints of persistent worsening left medial knee pain with weight-bearing activity. Physical examination revealed no signs of joint effusion, lower extremity range-of-motion or strength discrepancies, ligamentous compromise, or tenderness to palpation. However, the patient reported discomfort with weight bearing, and a slightly antalgic gait was observed. Knee radiographs revealed a concave lucency involving the medial femoral condyle, consistent with an osteochondritis dissecans lesion. Magnetic resonance imaging confirmed an osteochondritis dissecans lesion of the medial femoral condyle, and the patient was diagnosed with stage I juvenile osteochondritis dissecans of the knee. Conservative management by a physical therapist was the recommended treatment, and after 6 months, the patient no longer complained of left knee pain, and repeat knee radiographs demonstrated evidence of a healing osteochondritis dissecans lesion.

J Orthop Sports Phys Ther 2010;40(8):534. doi:10.2519/jospt.2010.0413

KEY WORDS: magnetic resonance imaging, medial femoral condyle, radiographs

The JOSPT offers invited reviews of current titles. The July 2010 column includes 5 reviews of the following books: Against the Tide: Back Pain Treatment —The Breakthrough; Solutions for Complex Upper Extremity Trauma; Biomechanical Analysis of Fundamental Human Movements; AO Manual of Fracture Management: Elbow and Forearm; and Color Atlas of Human Anatomy Volume 1: Locomotor System.

J Orthop Sports Phys Ther 2010;40(7):448-450.

The patient was a 27-year-old male pilot referred to a physical therapist for a suspected left acromioclavicular joint injury following a fall 3 weeks prior. Physical examination revealed decreased active shoulder flexion, decreased supraspinatus strength, and a positive Hawkins test. Radiographs were ordered and the anterior-posterior radiographic view showed an incomplete nondisplaced fracture in the superior aspect of the greater tuberosity. The patient was placed in a sling for 4 weeks and performed passive range-of-motion exercises to maintain shoulder mobility. Radiographs at 7 weeks following the injury revealed a healed greater tuberosity fracture.

J Orthop Sports Phys Ther 2010;40(7):447. doi:10.2519/jospt.2010.0411

KEY WORDS: radiographs, shoulder

The editorial announces JOSPT's new mobile edition and describes the features of the mobile website.

J Orthop Sports Phys Ther 2010;40(6):334-335. doi:10.2519/jospt.2010.0106

KEY WORDS: JOSPT, website

J Orthop Sports Phys Ther 2010;40(6):378-381.

The Orthopaedic Section of the American Physical Therapy Association presents this fifth set of clinical practice guidelines on knee pain and mobility impairments, linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) interventions provided by physical therapists, (3) and assessment of outcome for common musculoskeletal disorders.

J Orthop Sports Phys Ther 2010:40(6):A1-A35. doi:10.2519/jospt.2010.0304

The reviewer list on page A1 and the Affiliations and Contacts on page A31 of the original article were amended in the September 2010 Erratum, and the article PDF with the Erratum page included is provided here. Please see: September 2010 Erratum

KEY WORDS: APTA, clinical practice guidelines, ICD, ICF, Orthopaedic Section

The patient was a 68-year-old man who had undergone a right total hip arthroplasty 3 years prior. He complained of progressively worsening right hip pain. Physical examination findings were consistent with a positive sign of the buttock. A triple-bone scan showed increased radio-pharmaceutical activity, which is consistent with infection. Subsequent aspiration of the right hip revealed infection, which was treated with antibiotics before the patient underwent a revision total hip arthroplasty.

J Orthop Sports Phys Ther 2010;40(6):377. doi:10.2519/jospt.2010.0410

KEY WORDS: computed tomography, hip, triple-phase bone scan

The patient was a 53-year-old male with a chief complaint of right wrist pain of insidious onsent for the past month. The patient reported no recent trauma, but said he had multiple falls while skiing and mountain biking. Wrist radiographs and magnetic resonance imaging revealed ulnar variance and signs of osteonecrosis of the lunate, or Kienbock's disease. The patient underwent a radial shortening osteotomy in an effort to reduce compressive forces on the lunate and further fragmentation and collapse.

J Orthop Sports Phys Ther 2010;40(6):376. doi:10.2519/jospt.2010.0409

KEY WORDS: magnetic resonance imaging, radiography, wrist

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To clarify whether differences in surface stability influence trunk muscle activity. BACKGROUND: Lumbar stabilization exercises on unstable surfaces are performed widely. One perceived advantage in performing stabilization exercises on unstable surfaces is the potential for increased muscular demand. However, there is little evidence in the literature to help establish whether this assumption is correct. METHODS: Nine healthy male subjects performed lumbar stabilization exercises. Pairs of intramuscular fine-wire or surface electrodes were used to record the electromyographic signal amplitude of the rectus abdominis, the external obliques, the transversus abdominis, the erector spinae, and lumbar multifidus. Five exercises were performed on the floor and on an unstable surface: elbow-toe, hand-knee, curl-up, side bridge, and back bridge. The EMG data were normalized as the percentage of the maximum voluntary contraction, and data between doing each exercise on the stable versus unstable surface were compared using a Wilcoxon signed-rank test. RESULTS: With the elbow-toe exercise, the activity level for all muscles was enhanced when performed on the unstable surface. When performing the hand-knee and side bridge exercises, activity level of the more global muscles was enhanced when performed on an unstable surface. Performing the curl-up exercise on an unstable surface, increased the activity of the external obliques but reduced transversus abdominis activation. CONCLUSION: This study indicates that lumbar stabilization exercises on an unstable surface enhanced the activities of trunk muscles, except for the back bridge exercise.

J Orthop Sports Phys Ther 2010;40(6):369-375. doi:10.2519/jospt.2010.3211

KEY WORDS: electromyography, lumbar spine, multifidus, transversus abdominis

STUDY DESIGN: Controlled laboratory study using a cross-sectional design. OBJECTIVES: To evaluate knee joint dynamics in elite volleyball players with and without a history of patellar tendinopathy, focusing on mechanical energy absorption and generation. We hypothesized that tendinopathy would be associated with
reduced net joint work and net joint power. BACKGROUND: Patellar tendinopathy is a common, debilitating injury affecting competitive volleyball players. METHODS: Thirteen elite male players with and without a history of patellar tendinopathy (mean ± SD age, 27 ± 7 years) performed maximum-effort volleyball approach jumps. Sagittal plane knee joint kinematics, kinetics, and energetics were quantified in the lead limb, using data obtained from a force platform and an 8-camera motion analysis system. Vertical ground reaction forces and pelvis vertical velocity at takeoff were examined. Independent sample t tests were used to evaluate group differences (α = .05). RESULTS: The tendinopathy group, compared to controls, demonstrated significant reductions (approximately 30%) in net joint work and net joint power during the eccentric phase of the jump, with no differences in the concentric phase. Positive to-negative net joint work and net joint power ratios were significantly higher in the tendinopathy group, which had a net joint work ratio of 1.00 (95% CI: 0.77, 1.24) versus 0.76 (95% CI: 0.64, 0.88) for controls, and a net joint power ratio of 1.62 (95% CI: 1.15, 2.10) versus 1.00 (95% CI: 0.80, 1.21) for controls. There were no significant differences in net joint moment, angular velocity, or range of motion. Peak vertical ground reaction forces were lower for the tendinopathy group, while average vertical ground reaction forces and pelvis vertical velocity were similar. CONCLUSION: Patellar tendinopathy is associated with differences in sagittal plane mechanical energy absorption at the knee during maximum-effort volleyball approach jumps. Net joint work and net joint power may help define underlying mechanisms, adaptive effects, or rehabilitative strategies for individuals with patellar tendinopathy.

J Orthop Sports Phys Ther 2010;40(9):568-576, Epub 27 May 2010. doi:10.2519/jospt.2010.3313

KEY WORDS: biomechanics, eccentric, energetics, joint kinetics, tendon

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To evaluate the relationship between the occurrence of falls and muscle strength, flexibility, and balance in postmenopausal women with and without osteoporosis. BACKGROUND: Osteoporosis and falls are common problems encountered in the elderly. METHODS: A total of 133 women with and 133 without osteoporosis, aged 60 years or greater, were included in the study. Women were interviewed about clinical and social demographic characteristics and the occurrence of falls in the previous 12 months. The variables evaluated were presence of osteoporosis, muscle strength, flexibility, and balance. RESULTS: A significantly higher percentage of women with osteoporosis (51%) compared to those without osteoporosis (29%) had a history of at least 1 fall within the previous 12 months. There was a significant and inverse association between trunk extension strength and trunk flexion range of motion with falls. Logistic regression analyses showed that the variables associated with falls were trunk extension strength and presence of osteoporosis. Greater trunk extension strength was associated with a lower risk for falls (odds ratio, 0.97), while the presence of osteoporosis increased fall risk by a factor of 2.17. CONCLUSIONS: A greater percentage of women with postmenopausal osteoporosis had a history of 1 or more falls within the previous year and a higher risk of recurrent falls than women without osteoporosis. Muscle strength of the lumbar spine and the presence of osteoporosis are intrinsic factors associated with the risk of falls.

J Orthop Sports Phys Ther 2010;40(9):582-588, Epub 27 May 2010. doi:10.2519/jospt.2010.3239

KEY WORDS: balance, bone density, flexibility, muscle strength, postmenopausal

STUDY DESIGN: Cross-sectional investigation. BACKGROUND: There is some evidence that interventions directed to improving back muscle endurance (BME) in adolescents are effective in reducing low back pain, with anecdotal evidence of improved performance. However, the mechanisms responsible for this improvement remain unclear. OBJECTIVE: To identify the relationship between physical, lifestyle, and psychological variables and BME in a large adolescent population, while controlling for back pain and gender. METHODS: One thousand four-hundred thirty-five adolescents (702 females, 733 males; mean ± SD age, 14.0 ± 0.2 years) completed a range of physical, lifestyle, and psychological assessments. The group mean ± SD height and body mass were 164 ± 8 cm and 57.1 ± 12.6 kg, respectively. Linear regression was used to investigate the univariate association between each of the physical, lifestyle, and psychological variables and BME. Backwards stepwise multivariate linear regression was used to determine statistically significant independent correlates of BME. RESULTS: The final multivariate model explained 15.3% of the variance in BME and included at least 1 variable from the physical, lifestyle, and psychological domains. Adolescents who exercised less, watched more television, had a higher body mass index, sat in a more flexed trunk posture (more slumped), and had lower self-efficacy had lower BME. CONCLUSIONS: All the physical and lifestyle variables linked with poorer BME performance in this investigation are indicative of reduced back muscle activation and/or deconditioning. Psychological predictors may have direct and/or indirect links with BME.

J Orthop Sports Phys Ther 2010;40(8):517-523; Epub 27 May 2010. doi:10.2519/jospt.2010.3369

KEY WORDS: adolescents, back muscle endurance, exercise, performance, Raine study

STUDY DESIGN: Clinical measurement, criterion standard. OBJECTIVES: To investigate the validity of real-time ultrasound imaging (USI) to measure individual anterior hip muscle cross-sectional area. BACKGROUND: The hip flexor muscles are important for hip joint function and could be affected by joint pathology or injury. Objectively documenting individual anterior hip muscle size can be useful in identifying muscle size asymmetry and monitoring treatment efficacy for patients with hip problems. USI offers a novel method of measuring individual muscle size in the clinic, but its validity in measuring the anterior hip muscles has not been investigated. METHODS: Nine healthy participants (5 males, 4 females) underwent imaging of their iliopsoas, sartorius, and rectus femoris muscles with USI and magnetic resonance imaging. Bilateral muscle cross-sectional areas were measured on images from both modalities. RESULTS: There was no significant difference (P>.05) in mean cross-sectional area measurements from USI and magnetic resonance imaging for each muscle. Agreement between measurements was high for the iliopsoas (left: intraclass correlation coefficient [ICC_3,1] = 0.86; 95% confidence interval [CI]: 0.51, 0.97; right: ICC_3,1 = 0.88; 95% CI: 0.57, 0.97), sartorius (left: ICC_3,1 = 0.82; 95% CI: 0.41, 0.96; right: ICC_3,1 = 0.81; 95% CI: 0.39, 0.95), and rectus femoris (left: ICC_3,1 = 0.85; 95% CI: 0.49, 0.96; right: ICC_3,1 = 0.89; 95% CI: 0.61, 0.97). Reliability of measuring each muscle with USI was high between 2 trials (ICCs_3,1 = 0.84 to 0.94). CONCLUSION: USI is a valid measure of iliopsoas, sartorius, and rectus femoris muscle size in healthy people, as long as a strict measurement protocol is followed.

J Orthop Sports Phys Ther 2010;40(9):577-581, Epub 13 May 2010. doi:10.2519/jospt.2010.3286

KEY WORDS: iliopsoas, MRI, rectus femoris, reliability, sartorius