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Edited by Christopher D. Ingersoll

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Edited by Christopher D. Ingersoll

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Edited by Christopher D. Ingersoll

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Christopher D. Ingersoll

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Christopher D. Ingersoll

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J. Ty Hopkins and Christopher D. Ingersoll

Objectives:

To define the concept of arthrogenic muscle inhibition (AMI), to discuss its implications in the rehabilitation of joint injury, to discuss the neurophysiologic events that lead to AMI, to evaluate the methods available to measure AM1 and the models that might be implemented to examine AMI, and to review therapeutic interventions that might reduce AMI.

Data Sources:

The databases MEDLINE, SPORTDiscus, and CIHNAL were searched with the terms reflex inhibition, joint mechanoreceptor, Ib interneuron, Hoffmann reflex, effusion, and joint injury. The remaining citations were collected from references of similar papers.

Conclusions:

AMI is a limiting factor in the rehabilitation of joint injury. It results in atrophy and deficiencies in strength and increases the susceptibility to further injury. A therapeutic intervention that results in decreased inhibition, allowing for active exercise, would lead to faster and more complete recovery.

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Teddy W. Worrell, Christopher D. Ingersoll, and Jack Farr

The purpose of this case study was to determine the effect of patellar taping, patellar bracing, and control condition on (a) patellofemoral congruence angle (PFC), (b) lateral patellar angle (LPA), (c) lateral patellar displacement (LPD), and (d) pain, as determined by the visual analog scale (VAS) during an 8-in. step-down. The subject was a 15-year-old female with a 3-year history of recurrent patellar subluxations and anterior knee pain syndrome. Results revealed the following: control condition—PFC 41.4-1.1°, LPA 19.9-6.9°, LPD 18.6-8.3 mm, VAS 8.8 cm; tape—PFC 46.2-2.3°, LPA 25.1-2.9°, LPD 24.2-7.5 mm, VAS 0.8 cm; brace—PFC 3.4-16.5°, LPA 7.9-0.8°, LPD 9.4-4.7 mm, VAS 0.3 cm. Patellar bracing was effective in centralizing the patella as revealed by the PFC, LPA, and LPD measures; however, patellar taping did not improve patellar position, and in some positions taping actually worsened patellar position. A large reduction in pain as measured by the VAS occurred during an 8-in. step-down for both taping and bracing. More research is necessary to explain the pain reduction without a change in patellar position using tape.

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Kyung-Min Kim, Christopher D. Ingersoll, and Jay Hertel

Context:

Focal ankle-joint cooling (FAJC) has been shown to increase Hoffmann (H) reflex amplitudes of select leg muscles while subjects lie prone, but it is unknown whether the neurophysiological cooling effects persist in standing.

Objective:

To assess the effects of FAJC on H-reflexes of the soleus and fibularis longus during 3 body positions (prone, bipedal, and unipedal stances) in individuals with and without chronic ankle instability (CAI).

Design:

Crossover.

Setting:

Laboratory.

Participants:

15 young adults with CAI (9 male, 6 female) and 15 healthy controls.

Intervention:

All subjects received both FAJC and sham treatments on separate days in a randomized order. FAJC was accomplished by applying a 1.5-L plastic bag filled with crushed ice to the ankle for 20 min. Sham treatment involved room-temperature candy corn.

Main Outcome Measures:

Maximum amplitudes of H-reflexes and motor (M) waves were recorded while subjects lay prone and then stood in quiet bipedal and unipedal stances before and immediately after each treatment. Primary outcome measures were Hmax:Mmax ratios for the soleus and fibularis longus. Three-factor (group × treatment condition × time) repeated-measures ANOVAs and Fisher LSD tests were performed for statistical analyses.

Results:

Significant interactions of treatment condition by time for prone Hmax:Mmax ratios were found in the soleus (P = .001) and fibularis longus (P = .003). In both muscles, prone Hmax:Mmax ratios moderately increased after FAJC but not after sham treatment. The CAI and healthy groups responded similarly to FAJC. In contrast, there were no significant interactions or main effects in the bipedal and unipedal stances in either muscle (P > .05).

Conclusions:

FAJC moderately increased H-reflex amplitudes of the soleus and fibularis longus while subjects were prone but not during bipedal or unipedal standing. These results were not different between groups with and without CAI.

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Joseph M. Hart, Jamie L. Leonard, and Christopher D. Ingersoll

Context:

Despite recent findings regarding lower extremity function after cryotherapy, little is known of the neuromuscular, kinetic, and kinematic changes that might occur during functional tasks.

Objective:

To evaluate changes in ground-reaction forces, muscle activity, and knee-joint flexion during single-leg landings after 20-minute knee-joint cryotherapy.

Design:

1 × 4 repeated-measures, time-series design.

Setting:

Research laboratory.

Patients or Other Participants:

20 healthy male and female subjects.

Intervention:

Subjects performed 5 single-leg landings before, immediately after, and 15 and 30 minutes after knee-joint cryo-therapy.

Main Outcome Measures:

Ground-reaction force, knee-joint flexion, and muscle activity of the gastrocnemius, hamstrings, quadriceps, and gluteus medius.

Results:

Cryotherapy did not significantly (P > .05) change maximum knee-joint flexion, vertical ground-reaction force, or average muscle activity during a single-leg landing.

Conclusion:

Knee-joint cryotherapy might not place the lower extremity at risk for injury during landing.

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Daniel Gilfeather, Grant Norte, Christopher D. Ingersoll, and Neal R. Glaviano

Context: Central activation ratio (CAR) is a common outcome measure used to quantify gross neuromuscular function of the quadriceps using the superimposed burst technique, yet this outcome measure has not been validated in the gluteal musculature. Objective: To quantify gluteus medius (GMed) and gluteus maximus (GMax) CAR in a healthy population and evaluate its validity and reliability over a 1-week period. Design: Descriptive. Setting: Laboratory. Patients or Other Participants: A total of 20 healthy participants (9 males and 11 females; age 22.2 [1.4] y, height 173.4 [11.1] cm, mass 84.8 [25.8] kg) were enrolled in this study. Interventions: Participants were assessed at 2 sessions, separated by 1 week. Progressive electrical stimuli (25%, 50%, 75%, and 100%) were delivered to the GMed and GMax at rest, and 100% stimuli were delivered during progressive hip abduction and extension contractions (25%, 50%, 75%, and 100% maximal voluntary isometric contraction). Main Outcome Measures: GMed and GMax CAR, and hip abduction and hip extension maximal voluntary isometric contraction torque. Line of best fit and coefficient of determination (r2) were used to assess the relationship between torque output and CAR at varying levels of stimuli. Intraclass correlation coefficients, ICCs(3,k), were used to assess the between-session reliability. Results: GMed CAR was 96.1% (3.4%) and 96.6% (3.2%), on visits 1 and 2, respectively, whereas GMax CAR was 86.5% (7.5%) and 87.2% (10.7%) over the 2 sessions. A third-order polynomial demonstrated the best line of fit between varying superimposed burst intensities at rest for both GMed (r2 = .156) and GMax (r2 = .602). Linear relationships were observed in the CAR during progressive contractions with a maximal superimposed burst, GMed (r2 = .409) and GMax (r2 = .639). Between-session reliability was excellent for GMed CAR, ICC(3,k) = .911, and moderate for GMax CAR, ICC(3,k) = .704. Conclusion: CAR appears to be an acceptable measure of GMed and GMax neuromuscular function in healthy individuals. Gluteal CAR measurements are reliable measures over a 1-week test period.