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VOLUME EIGHT, NUMBER THREE

June, 2013

ORIGINAL RESEARCH

Lower extremity functional tests and risk of injury in Division III collegiate athletes.

Authors:  Brumitt J, Heiderscheit BC, Manske RC, Niemuth PE, Rauh MJ

Functional tests have been used primarily to screen an athlete’s fitness or for readiness to return to sport.  The purpose of this prospective cohort study was to determine the utility of the standing long jump test (SLJ), the single-leg hop for distance test (SLH), and the lower extremity functional test (LEFT) as preseason screening tools to identify collegiate athletes who may be at increased risk for a time-loss sport-related low back or lower extremity injury.  The authors concluded that the LEFT and the SLH tests appear to be useful in identifying Division III athletes at risk for a low back or lower extremity sports injury.  Thus, these tests warrant further consideration as preparticipartory screening examination tools for athletes in this population.

Roller-massager application to the hamstrings increases sit-and reach range of motion within five to ten seconds without performance impairments.

Authors:  Sullivan KM, Silvey D, Batton DC, Behm DG

Foam rollers are used to mimic manually applied myofascial release techniques and have been used by therapists, athletes, and the general public alike to increase range of motion (ROM) and alleviate pressure points. The roller-massager was designed to serve a similar purpose but is a more portable device that uses the upper body rather than body mass to provide the rolling force.  A commercial roller massager fixed in a specialized apparatus was used in this study to examine the acute effects on lower extremity ROM (via the sit and reach test) and subsequent muscle strength effects. The authors concluded that the use of the roller-massager had no significant effect on muscle strength, and can provide statistically significant increases in ROM, particularly when used for a longer duration. 

The comparison of the empty can and full can techniques and a new diagonal horizontal adduction test for supraspinatus muscle testing using cross-sectional analysis through ultrasonography.

Authors:  Forbush SW, White DM, Smith W

Several examination tests are currently used for diagnosing a supraspinatus lesion. The empty can (EC) test is currently considered the gold standard for testing, but full can (FC) testing is also utilized. Both of these tests do not fully eliminate the synergistic action of the deltoid when resistance is applied.  A new diagonal horizontal adduction (DHA) technique has been developed for evaluation of the supraspinatus that has not yet been compared with the existing techniques (EC/FC).  Cross-sectional analysis (CSA) change during contraction using an ultrasonographic means of visualizing and measuring contraction of the supraspinatus has been reported previously. Therefore the purpose of this study was to use diagnostic musculoskeletal ultrasound (MSK) to compare CSA of the supraspinatus during the FC, EC, and the DHA tests. In this study, MSK was used to visualize and objectify the activity of the supraspinatus muscle during resistance testing, as evidenced through increased mean CSA.  All the testing positions (FC, EC, and DHA) demonstrated significantly increased mean CSA of the muscle when isometrically contracted as compared to the resting control.  The DHA procedure also elicited significant increase in CSA of the supraspinatus. However, no significant difference was found between the CSA of the DHA when compared to the FC and EC tests.

Reliability of the Myotonometer® for assessment of posterior shoulder tightness.

Authors:  Kerins CM, Moore SD, Butterfield TA, McKeon PO, Uhl TL

The Myotonometer® is an electronic tissue compliance meter that has been used to quantify the compliance of soft tissues.  The Myotonometer® may be a valuable tool to measure the effectiveness of commonly used interventions believed to increase tissue compliance in individuals with posterior shoulder tightness (PST).  Limited data exist on reliability and responsiveness of the Myotonometer® for assessment of soft tissues about the shoulder; therefore, the purpose of this study was to determine the intra- and inter-session reliability and responsiveness of the Myotonometer® in measuring tissue compliance of the posterior shoulder musculature in asymptomatic subjects with PST.  The authors results determined that clinicians can reliably detect relatively small changes in tissue compliance within a single treatment session utilizing the Myotonometer®.  The Myotonometer® can reliably detect changes between sessions for tissues overlying the posterior deltoid; however, observed change in the infraspinatus and teres musculature must be above 1 mm in order to achieve meaningful change and account for decreased inter-session reliability.  

Early regeneration determines long-term graft site morphology and function after reconstruction of the anterior cruciate ligament with semitendinosus-gracilis autograft: a case series.

Authors:  MacLeod T, Synder-Mackler L, Axe MJ, Buchanan TS

The semitendinosus-gracilis tendon autograft is often used to reconstruct the anterior cruciate ligament.  Tendon regeneration appears to occur for most individuals in the short term, but little is known about long-term effects of graft harvest.  The purpose of this study was to describe the effect of semitendinosus-gracilis tendon graft harvest on muscle and tendon morphology at least five years following reconstruction in a case series.  The authors found that muscle and tendon regeneration continued in those that had begun regeneration at the time of return-to-sports.  There was significant additional degeneration in those muscles whose tendons had not regenerated at the time of return-to-sport.  Compensatory hypertrophy of the remaining knee flexors restored the knee flexor group to near preoperative peak cross-sectional area and volume across each of the three subjects. 

A survey of exercise-related leg pain in community runners.

Authors:  Reinking MF, Austin TM, Hayes AM

Exercise-related leg pain (ERLP) is a common problem in runners.  The purposes of this study were to:  1) report ERLP occurrence among community runners; 2) determine ERLP impact on daily activities; and 3) determine if there is a relationship between ERLP occurrence and selected potential risk factors including sex, age, years of running, ERLP history, body mass index (BMI), orthotic use, menstrual function, and training variables.  The authors concluded that interfering ERLP was common among a group of community runners.  Risk factors included previous history of ERLP, training mileage < 15 miles/week and < 3 years running experience.  

Effectiveness of the emergency response course in improving student physical therapists and licensed physical therapist decision-making related to acute sports injuries and medical conditions.

Authors:  Karges JR, Cross PS, Hauer PL, Blom H, Burcham J, Myers AK, Grimsrud C

The purpose of this study was to analyze the effectiveness of the American Red Cross Emergency Response Course (ARC ERC) in improving decision-making skills of physical therapists (PTs) and third semester clinical doctorate student physical therapists (SPTs) when assessing acute sports injuries and medical conditions. The authors concluded that the ARC ERC appears to be effective in improving both PTs’ and SPTs’ decision-making skills related to acute sports injuries and medical conditions, as both the frequency of “appropriate” responses and perceived level of preparedness improved in both groups of subjects.

 

CASE REPORT

Rehabilitation of a partially torn distal triceps tendon after platlet rich plasma injection: a case report

Authors:  Cheatham SW, Kolber MJ, Salamh PA, Hanney WJ

Platlet Rich Plasma (PRP) is an emerging non-surgical intervention used for the treatment of tendon and ligament pathology.  Despite the growing popularity of PRP in musculoskeletal medicine, there is a paucity of research that describes appropriate rehabilitation procedures following this intervention.  This case report presents the rehabilitation strategy used following a PRP injection for a patient with a partially torn distal triceps tendon who had previously failed physical therapy interventions. 

All-epiphyseal ACL reconstruction:  a three-year follow-up

Authors:  Akinleye SD, Sewick A, Wells L

With an increasing number of pre-adolescents participating in sports, anterior cruciate ligament injuries and resultant reconstruction in the skeletally immature athlete are becoming more common.  Many different surgical techniques and rehabilitation protocols have been proposed for the treatment of anterior cruciate ligament (ACL) injuries, but there is a lack of agreement as to which approach results in the best outcome.  Rehabilitation protocols have marked variation regarding postoperative weight bearing, immobilization, bracing, and length.  This is a case of a ten year-old female who sustained bilateral ACL tears within the period of a year.  The purpose of this case report is to describe the early result and subsequent rehabilitation following bilateral physeal-sparing all-epiphyseal ACL reconstructions on a skeletally immature patient with a three-year follow-up.  This innovative physeal-sparing technique has huge implications as; historically, professionals have feared the adverse outcomes of growth disturbance and angular deformity that can occur after transphyseal ACL reconstruction.  Such complications have complicated the management of ACL injuries in children and pre-adolescents. This case report demonstrates the success of this technique and the authors suggested rehabilitation, as this patient did not experience a reduction in long-term bone growth. 

Rehabilitation and functional outcomes after extensive surgical debridement of a knee infected by fusobacterium necrophorum: a case report

Authors:  Naylor AR, Briggs MS, Kegelmeyer DK, Kloos AD

Joint infection is a rare but serious complication after knee injury that should be part of physical therapist differential diagnosis.  This case report presents the case of a 17 year old female athlete who developed septic arthritis after a fusobacterium infection occurring after sustaining a right lateral meniscus tear.  Joint pathology combined with the aggressive infectious agent led to arthrofibrosis of her knee joint and resultant activity limitations and participation restrictions.  The purpose of this case report is to highlight a rare and unique pathology, the serious effects that a joint infection can have on musculoskeletal function, and the challenges encountered during the rehabilitation process. 

Treatment of hamstring strain in a collegiate pole-vaulter integrating dry needling with an eccentric training program: a resident’s care report

Authors:  Demkowski SC, Westrick RB, Zylstra E, Johnson MR

Hamstring strain injuries are among the most common injuries seen in sports.  Management is made difficult by the high recurrence rates.  Typical time to return to sport varies but can be prolonged with recurrence.  Biomechanical deficits remain after injury with regard to eccentric hamstring strength.  Eccentric training has shown to be an effective method at prevention of hamstring injury in multiple systematic reviews and prospective RCT’s.  Functional dry needling is a technique that has been reported to be beneficial in the management of pain and dysfunction after muscle strains, but there is limited published literature on its effects on rehabilitation or recurrence of injury.  The purpose of this case study is to present the management and outcomes of a patient with hamstring strain treated with functional dry needling and eccentric exercise.  The case illustrates the use of functional dry needling and eccentric exercise with a favorable outcome in a patient with hamstring strain.

 

CLINICAL COMMENTARY – DIAGNOSTIC CORNER

Cysts of the lateral meniscus

Author:  Crowell MS, Westrick RB, Fogarty BT

Accurate diagnosis and management of knee pain with or without mechanical symptoms challenges the physical therapist’s clinical reasoning skills.  Meniscal cysts are one relatively rare disorder of the knee that can cause both pain and mechanical symptoms and are frequently associated with a meniscal tear.  In patients with suspected meniscal cysts, systematic differential diagnosis and sound clinical reasoning encourages appropriate integration of  clinical examination skills with diagnostic imaging.  These case reports describe two different presentations of lateral parameniscal cysts where integration of the clinical examination with appropriate imaging allowed the physical therapist to provide a timely and appropriate intervention.

 

CLINICAL SUGGESTION

Clinical application of the right side-lying respiratory left adductor pull back exercise.

Authors:  Boyle KL

Lumbopelvic-femoral conditions are common and may be associated with asymmetrical musculoskeletal and respiratory impairments and a postural malalignment called a Left Anterior Interior Chain (AIC) pattern.  An inherent pattern of asymmetry involves the trunk/ribs/spine/pelvis/hip joints and includes the tendency to stand on the right leg and shift the center of gravity to the right which may result for example, in a tight left posterior hip capsule, poorly approximated left hip, long/weak left adductors, internal obliques (IO) and transversus abdominis (TA), short/strong/over active paraspinals and muscles on the right anterior outlet (adductors, levator ani and obturator internus), a left rib flare and a decreased respiratory diaphragm zone of apposition (ZOA).  The author describes a therapeutic exercise technique that can address impairments associated with postural asymmetry which may be beneficial in improving function, reducing and/or eliminating pain causation, and improving breathing.  The Right Sidelying Left Respiratory Adductor Pull Back is an exercise designed to affect alignment of the lumbopelvic-femoral region by influencing the left posterior ischiofemoral ligament, ZOA and right anterior outlet and left anterior inlet (rectus femoris, sartorius), activating/shortening the left adductors, left IO/TA’s and inhibiting/lengthening the paraspinals, bilaterally.