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Salter-Harris Type III Fracture of the Medial Femoral Condyle in an Adolescent Football Player

Thomas W. Kaminski and Thomas L. Schildwachter

Epiphyseal injuries present a special challenge to the sports medicine professional Salter-Harris Type III fractures involving the physis, epiphysis, and articular surface are uncommon (1). Because of the proximity of this fracture site to the knee joint, it is especially important that the clinician be aware of this type of injury when working with the adolescent athlete. This case adds to others previously reported in the English literature.

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Theme Introduction

Thomas W. Kaminski

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The History and Current Use of Ankle Brace Technology

Thomas W. Kaminski

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Theme Introduction

Thomas W. Kaminski

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Statistical Power—So What?!

Column-editor : Thomas W. Kaminski

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Does Low-Level Laser Therapy Decrease Muscle-Damaging Mediators After Performance in Soccer Athletes Versus Sham Laser Treatment? A Critically Appraised Topic

Jordan Bettleyon and Thomas W. Kaminski

Clinical Scenario: Low-level laser therapy (LLLT) is a controversial topic for its use in athletic recovery, mainly due to inconsistency in research regarding the application of LLLT. Articles on LLLT have assessed its effectiveness in untrained humans through pain scales, functional scales, and blood draws, and it has been found capable in nonathletic rehabilitative use. The controversy lies with LLLT in the recovering athlete. Not only do athletes need to perform at high levels, but each sport is unique in the metabolic demands placed on the athletes’ bodies. This modality can alter chemical mediators of the inflammatory process, specifically blood lactate (BL) and creatine kinase (CK). During soccer contests, it is a common problem for athletes to have an average CK level of 800 U/L and BL of 8 mmol·L, increasing delayed-onset muscle soreness and fatigue. Micro-CK level elevation is associated with cellular membrane damage, localized hypoxia, and electrolyte imbalances, hindering the recovery process. Clinical Question: Does LLLT decrease muscle-damaging mediators effecting player fatigue and delayed-onset muscle soreness after performance in soccer athletes versus sham treatment? Summary of Key Findings: In 3 studies, preperformance, postperformance, or preperformance and postperformance LLLT was performed and evaluated BL (2 of 3) and CK (2 of 3). In each article, BL and CK showed a significant decrease (P < .05) when performed either preperformance or postperformance versus the control group. The greatest decrease in these mediators was noticed when postperformance laser therapy was performed. Clinical Bottom Line: LLLT at 10, 30, or 50 J performed at a minimum of 2 locations on the rectus femoris, vastus lateralis, and vastus medialis bilaterally for 10 seconds each is significant in decreasing blood serum levels of BL and CK when performed postexercise. Strength of Recommendations: All 3 articles obtained a Physiotherapy Evidence Database score of ≥8/10.

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Comparing Computer-Derived and Human-Observed Scores for the Balance Error Scoring System

Jaclyn B. Caccese and Thomas W. Kaminski

Context:

The Balance Error Scoring System (BESS) is the current standard for assessing postural stability in concussed athletes on the sideline. However, research has questioned the objectivity and validity of the BESS, suggesting that while certain subcategories of the BESS have sufficient reliability to be used in evaluation of postural stability, the total score is not reliable, demonstrating limited interrater and intrarater reliability. Recently, a computerized BESS test was developed to automate scoring.

Objective:

To compare computerderived BESS scores with those taken from 3 trained human scorers.

Design:

Interrater reliability study.

Setting:

Athletic training room.

Patients:

NCAA Division I student athletes (53 male, 58 female; 19 ± 2 y, 168 ± 41 cm, 69 ± 4 kg).

Interventions:

Subjects were asked to perform the BESS while standing on the Tekscan (Boston, MA) MobileMat® BESS. The MobileMat BESS software displayed an error score at the end of each trial. Simultaneously, errors were recorded by 3 separate examiners. Errors were counted using the standard BESS scoring criteria.

Main Outcome Measures:

The number of BESS errors was computed for the 6 stances from the software and each of the 3 human scorers. Interclass correlation coefficients (ICCs) were used to compare errors for each stance scored by the MobileMat BESS software with each of 3 raters individually. The ICC values were converted to Fisher Z scores, averaged, and converted back into ICC values.

Results:

The double-leg, single-leg, and tandem-firm stances resulted in good agreement with human scorers (ICC = .999, .731, and .648). All foam stances resulted in fair agreement.

Conclusions:

Our results suggest that the MobileMat BESS is suitable for identifying BESS errors involving each of the 6 stances of the BESS protocol. Because the MobileMat BESS scores consistently and reliably, this system can be used with confidence by clinicians as an effective alternative to scoring the BESS.

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Reliability of Inversion and Eversion Peak- and Average-Torque Measurements from the Biodex System 3 Dynamometer

Thomas W. Kaminski and Geoff C. Dover

Objective:

To determine the reliability of inversion and eversion concentric isokinetic-strength measurements from the Biodex System 3 isokinetic dynamometer.

Setting:

University biomechanics research laboratory.

Subjects:

Thirty-five volunteers free from any lower leg and ankle injuries within the preceding year.

Measurements:

Peak (PT) and average (AT) isokinetic torque at 30°/s and 120°/s for subtalar-joint inversion and eversion.

Results:

PT intraclass correlation coefficients (ICC2,1) ranged from .54 to .92. AT ICC2,1 ranged from .55 to .91. These ICCs were good to excellent for both PT and AT at each speed and motion tested, except for fair ICCs produced from right-foot-eversion measurements at 30°/s.

Conclusions:

Inversion and eversion subtalar-joint strength measurements from the Biodex System 3 isokinetic dynamometer are reliable.

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Applications of the H Reflex and Transcranial Magnetic Stimulation

Christopher A. Knight

Column-editor : Thomas W. Kaminski

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Electromyography and Muscle Force: Caution Ahead

Todd D. Royer

Column-editor : Thomas W. Kaminski