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TABLE OF CONTENTS
Use of the Tissue Compliance Algometer Outcome Assessment System on Quadriceps Muscles of Healthy Rugby Players
David O. Draper, EdD, ATC, FNATA;
Wayne Johnson, PhD, PT;
J. Chris Castel, PhD;
Joseph Shurtz;
Kazunori Mosozumi, APT, RPT, PhD;
T. Fujiwara, MD, PhD, PT
Originally submitted December 13, 2009.; Accepted for publication May 19, 2010; Posted online August 31, 2010
Our study's objective was to test the ability of the Tissue Compliance Algometer Outcome Assessment System (TCAS) to measure muscle stiffness. A 3x6 repeated measures design was used. Participants included 20 male rugby players. While each participant was seated in a Biodex, a 90.9-kg strain gauge was strapped to his leg with the knee flexed to 60°. Tissue compliance was measured using the TCAS. Measurements were taken on the quadriceps muscle as the participant performed isometric knee extension at 4.5 kg, 9.07 kg, 13.61 kg, 18.14 kg, 27.22 kg, and a max load. The average tissue compliance reading for each contraction was the dependant variable. A hierarchal linear model was fit to repeated measures from each participant. The graph was linear; at every increase in 1 kg, the reading increased 0.5 units. The TCAS was found to be an objective way to measure tissue stiffness in the quadriceps muscles.
doi:10.3928/19425864-20100831-01
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Management of a Stage III Lisfranc Ligament Injury in a Collegiate Football Player: A Case Review
Chris H. Hummel, MS, ATC;
Todd Lazenby, MA, ATC;
Paul R. Geisler, EdD, ATC
Originally submitted April 1, 2010; Accepted for publication July 14, 2010; Posted online August 30, 2010
The diagnosis and management of the Lisfranc joint injury is a complicated and sometimes frustrating endeavor. Some consensus exists on the diagnosis of Lisfranc injuries; however, the proper management of these subtle injuries is still debated and poorly reported. This case review highlights a unique management of a stage III Lisfranc injury, in that the athlete was able to successfully return to full participation after 3 weeks of rest and conservative, nonsurgical treatment.
doi:10.3928/19425864-20100831-02
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Neuromuscular Responses to Initial Contact Following Hamstrings Anterior Cruciate Ligament Reconstruction: A Case Review
Giampietro L. Vairo, MS, ATC, ACI
Originally submitted September 21, 2009; Accepted for publication May 19, 2010; Posted online July 30, 2010
Two patients having undergone ipsilateral hamstrings autograft anterior cruciate ligament (ACL) reconstruction reported decreased hamstrings performance and random perceived episodes of instability at initial contact of gait. Neuromuscular characteristics of the loading response phase profiled during walking demonstrated less hamstrings reactive activation but greater gastrocnemius reactive activation in the involved leg, compared with the uninvolved leg. Decreased hamstrings reactive motoneuron excitability suggests insufficiencies to restrain joint perturbation and ACL antagonistic nature of the gastrocnemius in these patients. The unilateral onset suggests reactive reflex pathway deficits may have potentially ensued from donor-site morbidity or insufficient physical rehabilitation.
doi:10.3928/19425864-20100730-01
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Considering the Intrinsic Foot Musculature in Evaluation and Rehabilitation for Lower Extremity Injuries: A Case Review
Lindsay D. Sauer, PhD, ATC;
James Beazell, PT, DPT, OCS;
Jay Hertel, PhD, ATC
Originally submitted August 12, 2009; Accepted for publication May 12, 2010; Posted online July 30, 2010.
The intrinsic foot musculature may have an important, stabilizing role in the foot during weight bearing, dynamic activities. The purpose of the article is to discuss a clinical test for evaluating the intrinsic foot muscles following lower extremity injuries and to describe a rehabilitation exercise targeting the intrinsic foot muscles in rehabilitation.
doi:10.3928/19425864-20100730-02
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Initial Neuromotor and Postural Effects After Continual Use of Augmented Low-Dye Taping
Melinda Franettovich, PhD, BPhty (HonsI);
Peter Blanch, MAppSc, Bphty;
Bill Vicenzino, PhD, MSc, Grad Dip Sports Phty, BPhty
Originally submitted October 30, 2009; Accepted for publication May 12, 2010; Posted online July 30, 2010.
Augmented low-dye (ALD) tape increases medial longitudinal arch height, reduces calcaneal eversion and tibial internal rotation, alters plantar pressure distribution, and reduces leg muscle activity. This study evaluated continual wear of ALD tape and its initial effect on foot posture and mobility, three-dimensional motion, and muscle recruitment patterns of the lower limb in 28 individuals. Participants were then randomly allocated for an intervention period to either a group that was exposed to ALD tape continually or a group that was not exposed. Following the intervention period, all participants attended a second test session, which reevaluated the initial physiological effects of tape. Analysis of differences in exposure status revealed minimal changes in the initial physiological effects of ALD tape, and those differences were likely due to natural variation. The initial physiological effects of ALD tape appear to be consistent, even after continual use over approximately 11 days.
doi:10.3928/19425864-20100730-03
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Implementation of a Core Stability Program for Elementary School Children
Gretchen D. Oliver, PhD, ATC;
Heather R. Adams-Blair, PhD;
Christopher P. Dougherty, DO
Originally submitted May 11, 2009. Accepted for publication April 7, 2010. Posted online June 30, 2010.
Youth are at risk for sustaining musculoskeletal injury through physical activity. Core muscle activation has been shown to assist in decreasing injury rates. Given the importance of core musculature, the purpose of this study was to determine whether implementing a core stability program into an elementary physical education curriculum would increase core strength and endurance. A total of 182 children participated in the program during the first 5 minutes of every fourth grade physical education class in 5 public schools. A pretest-posttest design was conducted. A one-way analysis of variance with repeated measures revealed a significant effect for the core stability treatment, F(5, 1000) = 20.50, P < .01. Therefore, it was concluded that the core stability program was beneficial for all children and was a no-cost alternative that the children reported they enjoyed more than performing typical sit-up exercises.
doi:10.3928/19425864-20100630-01
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Self-Reported History of Concussion Affects Health-Related Quality of Life in Adolescent Athletes
Tamara C. Valovich McLeod, PhD, ATC;
R. Curtis Bay, PhD;
Alison R. Snyder, PhD, ATC
Originally submitted January 8, 2010. Accepted for publication March 18, 2010. Posted online June 30, 2010.
This study examined the relationship between self-reported concussion history and health-related quality of life (HRQOL) in adolescent athletes. Participants completed a concussion history questionnaire, the Medical Outcomes Short-Form (SF-36), and the Headache Impact Test (HIT-6) during one session. Participants were grouped as "positive" or "negative" according to their concussion history. Dependent variables included 8 subscale scores of the SF-36, two composite SF-36 scores, and the HIT-6 score. On the SF-36, the positive concussion group reported significantly lower HRQOL for the bodily pain, general health, vitality, and mental health subscales and the mental composite score. On the HIT-6, the positive concussion group reported a greater impact of headache on HRQOL. Adolescents with a self-reported concussion history demonstrated lower HRQOL on several SF-36 subscales, including those related to mental health, and a greater impact of headache on their general health. These results suggest that a concussion history may have lasting effects on adolescents' HRQOL
doi:10.3928/19425864-20100630-02
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Physician Management of Sport-Related Concussions at the Collegiate Level
Tamerah Nicole Hunt, PhD, ATC;
Amir Trombley, MS, ATC, PA-C
Originally submitted October 20, 2009. Accepted for publication April 7, 2010. Posted online June 30, 2010.
Using a cross-sectional survey design, this study investigated the practice patterns of concussion assessment and return-to-play decisions among physicians. One hundred twenty team physicians from 43 colleges or universities were asked to complete a 19-item survey. The survey evaluated specialty, years of experience in that specialty, and primary method for return to play. An association was found between the type of medical specialty and number of concussions evaluated per year (x24 = 61.56, P < .01), with family practice physicians evaluating the most concussions per year. The clinical examination (40%) was the most frequently reported method used when deciding return to play. The clinical examination, symptom checklist, and self-report symptoms were most frequently used; however, a standard approach to concussion assessment and management was not demonstrated among collegiate team physicians. Understanding the concussion protocol team physicians are using aids in producing the best clinical protocol for all sports medicine professionals.
doi:10.3928/19425864-20100630-03
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Effects of Class IV Laser Therapy on Exercise-Induced Muscle Injury
Jeffrey J. Parr, MS, ATC;
Kelly A. Larkin, MS, CAT(c);
Paul A. Borsa, PhD, ATC
Originally submitted July 29, 2009. Accepted for publication April 28, 2010. Posted online June 30, 2010.
Research has failed to support the effectiveness of class III therapeutic lasers for controlling acute pain and dysfunction in humans following musculoskeletal injury. Published clinical studies that use class III laser therapy to treat musculoskeletal injuries have shown conflicting results. Participants were randomly allocated under strict double-blind conditions to 1 of 3 experimental groups (N = 20 participants per group). The treating laser contains wavelengths of 800 nm and 970 nm. A greater reduction in muscular strength was found in our 2-dose group (20.7%) and single-dose group (22.3%) on day 2 (P < .01) compared with our sham group (13.6%). No significant differences between either of our treatment groups or the sham group were identified for any dependent variable. The data suggest that a 3-J/cm2 laser therapy treatment during the acute inflammatory stage may be too intense given the greater strength loss seen in our treatment groups on day 2.
doi:10.3928/19425864-20100630-04
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Transient Axillary Neuropraxia in a Collegiate Baseball Pitcher: A Case Review
Paul R. Geisler, EdD, ATC;
Todd Lazenby, MA, ATC
Originally submitted January 7, 2010. Accepted for publication April 7, 2010. Posted online June 30, 2010.
Idiopathic shoulder injuries are common in overhead throwers, yet they present significant diagnostic and managerial challenges. In atraumatic cases, peripheral nerve injuries are rare, but they should be considered when certain features exist. The authors present a case of glenohumeral multidirectional instability induced intermittent traction of the axillary nerve in a collegiate baseball pitcher.
doi:10.3928/19425864-20100630-05
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Concurrent Validity of the Anterior Drawer Test and an Arthrometer in Evaluating Ankle Laxity
C. Buz Swanik, PhD, ATC;
Thomas J. Disanto, MEd, ATC, CSCS;
Kathleen A. Swanik, PhD, ATC;
Stephen J. Straub, PhD, ATC;
Alan R. Needle, MS, ATC, CSCS
Originally submitted October 15, 2009. Accepted for publication April 21, 2010. Posted online June 30, 2010.
This study focused on the concurrent validity and reliability of an ankle arthrometer and clinical tests of ankle laxity. A posttest-only control group design was used to compare anterior-posterior (AP) displacement in participants with clinically graded laxity (mechanical instability) and a control group. Forty-four individuals with no recent ankle sprains participated in this study. An ankle arthrometer measured AP displacement, and one investigator clinically graded the anterior drawer test. Pearson correlations were significant (r = 0.48, P < .05) between the anterior drawer and arthrometer measurements of AP displacement. Independent t tests revealed significantly greater AP displacement (P < .05) in mechanically unstable ankles on the anterior drawer test. The intraclass correlation coefficients [2,1] for arthrometer AP displacement ranged from 0.44 to 0.87, with reliability decreasing as the laxity grade increased. The ankle arthrometer is a reliable measure of AP laxity and has concurrent validity with a standardized clinical grading system in differentiating levels of joint laxity.
doi:10.3928/19425864-20100630-06
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Eversion Force Sense Characteristics in Individuals with Functional Ankle Instability: A Systematic Review
Cynthia J. Wright, MEd, ATC, LAT;
Brent L. Arnold, PhD, ATC, FNATA
Originally submitted February 25, 2010. Accepted for publication April 7, 2010. Posted online June 30, 2010.
This article aims to determine whether there are eversion force sense deficits in individuals with functional ankle instability. Database searches resulted in 7 studies that met the inclusion criteria of testing ankle eversion force sense in participants with functional ankle instability. For each study, effect sizes were calculated separately for ipsilateral and contralateral reference ankles, and for each possible outcome variable: absolute error, constant error, and variable error. For ipsilateral variable error, 8 of 9 measures favored participants with functional ankle instability (effect size range = 0.217 to 0.706); however, only 3 confidence intervals did not cross zero. All 3 measures of ipsilateral constant error favored the uninjured group (effect size range = -0.532 to -0.254), although all confidence intervals crossed zero. There were no consistent trends for ipsilateral absolute error or for any contralateral error measure. Individuals with functional ankle instability may have different ipsilateral eversion force sense characteristics than uninjured individuals.
doi:10.3928/19425864-20100630-07
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Awareness and Recognition of Concussion by Youth Athletes and Their Parents
Meganne M. Gourley, MS, ATC, EMT-B;
Tamara C. Valovich McLeod, PhD, ATC;
R. Curtis Bay, PhD
Originally submitted August 28, 2009. Accepted for publication March 10, 2010. Posted online May 24, 2010.
Assessing the awareness and recognition of concussion is important at all levels of athletics, especially youth sports. This study assessed the knowledge base of youth athletes and their parents regarding concussion and their ability to recognize it. Seventy-three youth athletes (age range, 10-14 years) and 100 parents responded to the survey. An athlete or parent version of a previously published survey about concussion was completed by each participant. Athletes and parents did not differ (P = .94) in their ability to recognize concussion symptoms. Youth athletes who reported having their "bell rung" did no better (P = .36) in recognizing concussion symptoms than those who had not. Parents with first aid certification or general medical training recognized significantly more symptoms (P = .01 and .01, respectively) than those without training. A knowledge deficit exists regarding symptom recognition and issues about sport-related concussion among youth athletes and their parents.
doi:10.3928/19425864-20100524-03
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Acupuncture and Knee Conditions: A Review of the Literature
Gun Chung, MS;
Helen Binkley, PhD
Originally submitted July 20, 2009. Accepted for publication March 3, 2010. Posted online May 24, 2010.
This article reviews acupuncture and its use with knee conditions. A brief review of what acupuncture is, where it was developed, how it may be integrated into sports medicine, and its safety, efficacy, and cost-effectiveness are explained. Relevant literature is reviewed and summarized about acupuncture, acupoints, and the use of transcutaneous electrical nerve stimulation in the treatment and management of different conditions, particularly in the knee. Recommendations for clinical practice of incorporating acupuncture within athletic training are described.
doi:10.3928/19425864-20100524-04
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