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  • Author: David A. Krause x
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Katrine Moreale, Jay Smith, David A. Krause and Diane L. Dahm

Objective:

To examine the accuracy and reliability of upper limb target pointing among normal subjects.

Design:

Prospective observational.

Setting:

Community sports-medicine practice.

Participants:

28 male and female normal right-handed volunteers age 22–35 years.

Intervention:

8-point target-pointing task completed with both upper limbs.

Main Outcome Measures:

Accuracy of point reproduction (cm error) and reliability over time (ICC2,1).

Results:

Target-pointing errors were 4.8–9.9 cm. Subject error and reach height explained 88% of performance variability. Error was greater when pointing to the lower half of the target (P < .05) and to ipsilateral points (P < .05). Gender, test day, reach length, and arm dominance did not affect accuracy. Test–retest reliability ranged from .30 to .71.

Conclusion:

Target-pointing tasks might be useful to assess upper limb neuromuscular control. Points with lower errors and greater reliabilities might be useful to differentiate normal vs abnormal performances, whereas a battery of reliable points over a spectrum of errors might be useful to document changes over time.

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David A. Krause, Beth A. Cloud, Lindsey A. Forster, Jennifer A. Schrank and John H. Hollman

Context:

Limited ankle DF (DF) range of motion (ROM) resulting from restricted gastrocnemius and soleus mobility is associated with a variety of lower extremity pathologies. Several techniques are used clinically to measure ankle DF.

Objectives:

To evaluate the reliability and minimal detectable change of DF ROM measurement, determine whether there is a difference in measured DF between techniques, and quantify the electromyographic (EMG) activity of the soleus and tibialis anterior muscles associated with the techniques.

Design:

Repeated measures.

Setting:

Controlled laboratory setting.

Participants:

39 healthy subjects, age 22–33.

Main Outcome Measures:

DF measurements using 5 different techniques including active and passive DF with the knee extended and flexed to 90° and a modified lunge. EMG activity of the soleus and anterior tibialis muscles.

Results:

Intrarater reliability values (ICC3,1) ranged from .68 to .89. Interrater reliability (ICC2,1) ranged from .55 to .82. ICCs were the greatest with the modified lunge. The minimal detectable change (MDC95) ranged from 6° to 8° among the different techniques. A significant difference in DF ROM was found between all methods. Measurements taken with active DF were greater than the same measures taken passively. The lunge position resulted in greater DF ROM than both active and passive techniques. EMG activity of the soleus was greater with active DF and the lunge than with passive DF.

Conclusions:

The modified lunge, which demonstrated excellent intrarater and interrater reliability, may best represent maximal DF. Active end-range DF was significantly greater than passive end-range DF when measured at either 0° or 90° knee flexion. Greater active DF was not explained by inhibition of the soleus. Finally, using the modified lunge, a difference between 2 measurements over time of 6° or more suggests that a meaningful change has occurred.

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John H. Hollman, Kimberly E. Kolbeck, Jamie L. Hitchcock, Jonathan W. Koverman and David A. Krause

Context:

Hip-muscle weakness might be associated with impaired biomechanics and postures that contribute to lower extremity injuries.

Objective:

To examine relationships between hip-muscle strength, Q angle, and foot pronation.

Design:

Correlational study.

Setting:

Academic laboratory.

Participants:

33 healthy adults.

Main Outcome Measures:

Maximal isometric hip abduction (Abd), adduction (Add), external-rotation (ER) and internal-rotation (IR) strength; Q angle of the knee; and longitudinal arch angle of the foot. We analyzed Pearson product– moment (r) correlation coefficients between the Abd/Add and ER/IR force ratios, Q angle, and longitudinal arch angle.

Results:

The hip Abd/Add force ratio was correlated with longitudinal arch angle (r = .35, P = .025).

Conclusions:

Reduced strength of the hip abductors relative to adductors is associated with increased pronation at the foot. Clinicians should be aware of this relationship when examining patients with lower extremity impairments.

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James W. Youdas, Timothy J. McLean, David A. Krause and John H. Hollman

Context:

Posterior calf stretching is believed to improve active ankle dorsiflexion range of motion (AADFROM) after acute ankle-inversion sprain.

Objective:

To describe AADFROM at baseline (postinjury) and at 2-wk time periods for 6 wk after acute inversion sprain.

Design:

Randomized trial.

Setting:

Sports clinic.

Participants:

11 men and 11 women (age range 11–54 y) with acute inversion sprain.

Intervention:

Standardized home exercise program for acute inversion sprain.

Main Outcome Measure:

AADFROM with the knee extended.

Results:

Time main effect on AADFROM was significant (F 3,57 = 108, P < .001). At baseline, mean active sagittal-plane motion of the ankle was 6° of plantar flexion, whereas at 2, 4, and 6 wk AADFROM was 7°, 11°, and 11°, respectively.

Conclusions:

AADFROM increased significantly from baseline to week 2 and from week 2 to week 4. Normal AADFROM was restored within 4 wk after acute inversion sprain.

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David A. Krause, Mathew D. Neuger, Kimberly A. Lambert, Amanda E. Johnson, Heather A. DeVinny and John H. Hollman

Context:

Hip-muscle impairments are associated with a variety of lower-extremity dysfunctions. Accurate assessment in the clinical setting can be challenging due to the strength of hip muscles relative to examiner strength.

Objective:

To examine the influence of examiner strength and technique on manual hip-strength testing using a handheld dynamometer.

Design:

Repeated measures.

Setting:

Research laboratory.

Participants:

30 active adults (age 24 ± 1.4 y).

Interventions:

Three examiners of different strength performed manual muscle tests (MMT) in 2 different positions for hip extension, abduction, and external rotation using a MicroFet handheld dynamometer. Examiner strength was quantified via a 1-repetition-maximum leg press and chest press with a Keiser A420 pneumatic resistance machine.

Main Outcome Measures:

Intrarater reliability (ICC3,1), interrater reliability (ICC2,1), and measured torque values.

Results:

Intrarater reliability for all measurements ranged from .82 to .97. Interrater reliability ranged from .81 to .98. Main effects for hip extension revealed a significant difference in torque values between examiners and between techniques. For the short-lever hip-abduction and seated hip-external-rotation tests, there was a significant difference between examiners. There was no significant difference in measured torque values between examiners with the long-lever hip-abduction or the prone hip-external-rotation tests.

Conclusions:

MMT of the hip may be performed with high reliability by examiners of different strength. To obtain valid MMT measurements of hip muscles, examiners must consider their own strength and testing techniques employed. The authors recommend a long-lever technique for hip abduction and a prone position for testing hip external rotation to minimize the influence of examiner strength. Both positions appear to provide mechanical advantages to the examiner compared with the alternative techniques. The authors are unable to recommend a preferred hip-extension-testing technique to minimize the influence of examiner strength.

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John H. Hollman, Barbara E. Ginos, Jakub Kozuchowski, Amanda S. Vaughn, David A. Krause and James W. Youdas

Context:

Reduced strength and activation of hip muscles might correlate with increased weight-bearing knee valgus.

Objective:

To describe relationships among frontal-plane hip and knee angles, hip-muscle strength, and electromyographic (EMG) recruitment in women during a step-down.

Design:

Exploratory study.

Setting:

Laboratory.

Participants:

20 healthy women 20 to 30 years of age.

Interventions:

Frontal-plane hip and knee angles were measured. Gluteus maximus and medius recruitment were examined with surface EMG. Hip-abduction and -external-rotation strength were quantified with handheld dynamometry.

Main Outcome Measurements:

The authors analyzed correlation coefficients between knee and hip angles, gluteus maximus and medius EMG, and hip-abduction and -external-rotation strength.

Results:

Hip-adduction angles (r = .755, P = .001), gluteus maximus EMG (r = −.451, P = .026), and hip-abduction strength (r = .455, P = .022) correlated with frontal-plane projections of knee valgus.

Conclusions:

Gluteus maximus recruitment might have greater association with reduced knee valgus in women than does external-rotation strength during step-down tasks. Gluteus medius strength might be associated with increased knee valgus.