Returning athletes to competition following injury often creates a dilemma for athletic trainers and team physicians. Most clinicians gather as much data as possible before deciding whether to return an athlete to competition following injury. The status of the postural control system and balance is important for certain pathologies and therefore should be considered in these clinical decisions. As more high-tech balance systems become available, it is important for clinicians to understand not only what is available but what these devices measure. This paper will review the relationship between the postural control system and the kinetic chain, traditional and contemporary techniques for assessing balance, and ways in which clinicians can bridge the gap between balance research and clinical practice.
Kevin M. Guskiewicz and David H. Perrin
Michael J. Higgins and David H. Perrin
In this study, joint reposition sense of the knee in a non-weight-bearing (NWB) state and that in a weight-bearing (WB) state were compared, and it was determined whether a significant relationship existed between knee displacement (KD) and joint reposition sense. The dominant knees of 8 male and 12 female subjects (age 19–26 years, M ± SD = 21.5 ± 2.06) who had no previous history of knee dysfunction were tested for accuracy of angular reproduction in the WB and NWB states. There was a significant difference in the accuracy of angular repositioning between the two conditions, with the WB test having less deviation from the predetermined angle. There was a weak relationship between KD and the ability to reproduce specific angles of the knee. These results suggest that the WB or closed chain state of the knee was more accurate in the determination of joint position sense than the NWB or open chain condition.
William Romani, David H. Perrin and Tim Whiteley
A case of tarsal tunnel syndrome in a male collegiate lacrosse player is presented. The subject reported symptoms consistent with tarsal tunnel syndrome following two incidents of medial ankle sprain in one lacrosse season. Conservative treatment was successful following the first ankle sprain but failed to relieve pain and paresthesia in his heel and medial arch following the second injury. Laboratory tests provided an inconclusive diagnosis, and the subject underwent a retinacular release 5 months after the second ankle sprain. Following a 13-week rehabilitation program, the subject returned to full participation in his sport.
Brent L. Arnold
Edited by David H. Perrin
Michael J. Carroll, Arie M. Rijke and David H. Perrin
This study examined the effect of the Swede-O ankle brace on talar tilt in subjects with unstable ankle joints. Six college-age females with talar tilts greater than 9.5° at 15 decaNewtons (daN) of force on a Telos stress test device participated in the study. Each subject was X-rayed at five levels of force (0,6,9, 12, and 15 daN), first with a bare ankle then wearing a Swede-O ankle brace. A two-factor (Brace × Force) analysis of variance revealed a main effect for force, but no main effect for brace and no Brace × Force interaction. For the unbraced ankles, mean displacements were 8.2, 10.4, 11.9, and 13.1° at the four levels of force, respectively. After application of the brace, the talar tilts were 5.7, 8.5, 11.1, and 12.8°, respectively. These findings suggest that the Swede-O ankle brace was not effective in reducing talar tilt in subjects with unstable ankles. Any efficacy of the brace may be due to other factors, such as proprioceptive feedback during inversion.
Andrew G. Baker, William G. Webright and David H. Perrin
The purpose of this study was to examine the effects of a resistive tubing kick training protocol on postural sway in uninjured collegiate wrestlers. An experimental group (n = 10) performed a progressive resistive tubing kick training protocol three times per week for 6 weeks. A control group (n = 9) performed no resistive tubing training during the 6 weeks. Postural sway (stability index) was assessed before and after the 6-week training period. ANOVAs demonstrated no significant interactions, although significant main effects were found for group and eye condition. The experimental group demonstrated less postural sway than the control group regardless of training, and postural sway was greater with the eyes closed than with the eyes open. Resistive tubing kick training does not significantly improve postural sway in healthy collegiate wrestlers. Further research should examine the potential benefits of proprioceptive training using a greater intensity of training and/or using subjects who have a greater potential for improvement.
David E. Martin, Kevin M. Guskiewicz, David H. Perrin, David M. Kahler and Frank C. McCue III
The purpose of this study was to assess anterior translation of the tibia using the Tibial Fixator Device (a mechanical leg stabilizer that controls tibial alignment) with the leg in three positions: neutral (N), internal rotation of 15° (IR), and external rotation of 15° (ER). Displacement was measured using a modified KT-1000 arthrometer. Eleven subjects with anterior cruciate ligament lesions were examined bilaterally in the three positions at 45, 67, and 89 newtons of anterior force. Three-factor repeated-measures ANOVA revealed a significant position effect regardless of force (p < .001). This effect was significant in the injured and noninjured legs. Displacement was greatest in ER and least in IR. These data indicate that the position of the tibia, maintained with an external leg restraint, has a significant effect on anterior displacement of the knee. Control of tibiofemoral alignment and modifications to the KT-1000 provide new potentials for instrumented arthrometry.
Barton P. Buxton, David H. Perrin, Ronald K. Hetzler, Kwok W. Ho and Joe H. Gieck
The purpose of this investigation was to determine the relationship between ethnicity and acute pain response in male athletes. Subjects included 93 male athletes (age = 18.65 ± .58 years) of differing ethnicity. Each subject performed a Cold Pressor Test (CPT) and was evaluated for pain threshold and pain tolerance times. Two one-way analyses of variance were performed to analyze the data. The results indicated that significant differences existed in pain tolerance times between ethnic groups (p<.05). However, no differences were observed in pain threshold times. These findings support the existence of a difference in pain tolerance between ethnic groups in collegiate athletes.
Jay N. Hertel, Kevin M. Guskiewicz, David M. Kahler and David H. Perrin
The purpose of this study was to investigate the effects of induced anesthesia of the lateral ankle joint on proprioception as assessed in weight-bearing and non-weight-bearing conditions. Sixteen subjects were assessed under normal conditions and following an 8-cc injection of lidocaine into the anterior talofibular ligament of the ankle being tested. Center of balance and postural sway measurements were analyzed, revealing a significant lateral adjustment of center of balance during the stable tests compared to a medial adjustment during the dynamic tests under the anesthetized condition. ANOVA of postural sway scores revealed no main effect for condition (anesthesia vs. no anesthesia), but sway scores were higher during the two dynamic conditions as compared to the stable condition. ANOVA of joint position error scores revealed no main effect for condition. Findings suggest that inhibition of the joint receptor afferent fibers adversely affected joint proprioception as assessed while subjects were weight bearing but not while they were non-weight bearing.
Jayd M. Grossman, Brent L. Arnold, David H. Perrin and David M. Kahler
This study evaluated the effectiveness of ibuprofen in treating delayed onset muscle soreness (DOMS) of the elbow flexors when taken prior to and following exercise. Twenty subjects received either 2,400 mg/day ibuprofen or a placebo four times per day. Subjects performed intense eccentric exercise of the elbow flexors to elicit DOMS. Concentric and eccentric peak torque production against an isokinetic resistance of 0.52 radls, range of motion at the elbow, and subjective soreness of the elbow flexors were measured. ANOVA indicated no significant group-by-time interaction for concentric peak torque, eccentric peak torque, or pain. A significant interaction was revealed for range of motion. There was a significant difference within each group's ROM but no interaction between groups. It was concluded that the use of 2,400 mg/day ibuprofen prior to and following intense eccentric exercise was no more effective than a placebo in treating DOMS of the elbow flexors.