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Michael F. Joseph, Kristin L. Holsing and David Tiberio

Kinematic differences have been linked to the gender discrepancies seen in knee injuries. A medially posted orthotic decreases frontal and transverse plane motions in the lower extremity during ambulation, squatting and landing. This study investigated the effect of a medial post on amount and timing of lower extremity motions during a single-leg squat in male and female athletes. We hypothesized there would be differences in these kinematic variables dependent upon sex and post conditions. Twenty male and female athletes performed single-leg squats with and without a five degree full-length medial post. Maximum joint angles were analyzed using a two-way, repeated-measures analysis of variance to determine if the differences created by post condition were statistically significant, whether there were gender differences, or interactions. Differences in maximum motion values and the time at which they occurred were found between men and women at the hip, knee and ankle. The post decreased all frontal plane measures in both sexes and resulted in earlier attainment of maximum ankle eversion and delayed maximum knee valgus. A medially posted orthotic may be beneficial not only in limiting motion, but in affecting the time in which stressful motions occur.

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Michael F. Joseph, Kathryn Taft, Maria Moskwa and Craig R. Denegar

Study Design:

Systematic literature review.

Objective:

To assess the efficacy of deep friction massage (DFM) in the treatment of tendinopathy.

Context:

Anecdotal evidence supports the efficacy of DFM for the treatment of tendinopathy. An advanced understanding of the etiopathogenesis of tendinopathy and the resultant paradigm shift away from an active inflammatory model has taken place since the popularization of the DFM technique by Cyriax for the treatment of “tendinitis.” However, increasing mechanical load to the tendinopathic tissue, as well as reducing molecular cross-linking during the healing process via transverse massage, offers a plausible explanation for observed responses in light of the contemporary understanding of tendinopathy.

Evidence Acquisition:

The authors surveyed research articles in all languages by searching PubMed, Scopus, Pedro, CINAHL, PsycINFO, and the Cochrane Library using the terms deep friction massage, deep tissue massage, deep transverse massage, Cyriax, soft tissue mobilization, soft tissue mobilisation, cross friction massage, and transverse friction massage. They included 4 randomized comparison trials, 3 at the extensor carpi radialis brevis (ECRB) and 1 supraspinatus outlet tendinopathy; 2 nonrandomized comparison trials, both receiving DFM at the ECRB; and 3 prospective noncomparison trials—supraspinatus, ECRB, and Achilles tendons. Articles meeting inclusion criteria were assessed based on PEDro and Centre for Evidence-Based Medicine rating scales.

Results:

Nine studies met the inclusion criteria.

Evidence Synthesis:

The heterogeneity of dependent measures did not allow for meta-analysis.

Conclusion:

The varied locations, study designs, etiopathogenesis, and outcome tools used to examine the efficacy of DFM make a unified conclusion tenuous. There is some evidence of benefit at the elbow in combination with a Mills manipulation, as well as for supraspinatus tendinopathy in the presence of outlet impingement and along with joint mobilization. The examination of DFM as a single modality of treatment in comparison with other methods and control has not been undertaken, so its isolated efficacy has not been established. Excellent anecdotal evidence remains along with a rationale for its use that fits the current understanding of tendinopathy.

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Michael F. Joseph, Jeffrey M. Anderson, Thomas H. Trojian and John Crowley

Context:

Achilles tendon rupture is often the result of a long-term degenerative process, frequently occurring asymptomatically.

Objective:

To determine the prevalence of asymptomatic Achilles tendinopathy in an active, asymptomatic, young-adult population and to compare these findings across gender.

Design:

Convenience sample, cohort study.

Setting:

Research laboratory

Participants:

A sample of 52 (28 male, 24 female) healthy, active subjects were recruited from the student body at the University of Connecticut. Images of 104 Achilles tendons were made.

Intervention:

Ultrasound images made with a Phillips HD11 with a 15-MHz real-time linear-array transducer were collected on both the longitudinal and transverse axes of the Achilles tendon. Activity level was measured with the International Physical Activity Questionnaire Short Form (IPAQ-SF).

Main Outcome Measure:

Presence of ultrasound evidence of Achilles tendinopathy as agreed on by 2 blinded assessors highly skilled in ultrasonography.

Results:

More subjects were categorized as highly active (57.4%) on the IPAQ-SF than moderately active (42.6%). One female and one male subject were found to have ultrasound evidence of asymptomatic Achilles tendinopathy, equaling 3.8% prevalence in this study.

Conclusion:

We found a low prevalence of asymptomatic Achilles tendinopathy in an active, young-adult population. Further work is necessary to identify an optimal group warranting ultrasound screening for asymptomatic tendinopathy.

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Michael F. Joseph, Katherine Histen, Julia Arntsen, Lauren L’Hereux, Carmine Defeo, Derek Lockwood, Todd Scheer and Craig R. Denegar

Context:

Achilles tendons (ATs) adapt to increased loading generated by long-term adoption of a minimalist shoe running style. There may be difference in the chronology and extent of adaptation between the sexes.

Objective:

To learn the chronology of AT adaptations in female and male runners who transitioned to a minimalist running style through a planned, progressive 12-wk transition program.

Design:

Prospective cohort study of well-trained, traditionally shod runners who transitioned to minimalist shoe running.

Setting:

Repeated laboratory assessment at baseline and 3, 12, and 24 wk after initiating transition program.

Participants:

Fifteen women and 7 men (of 29 enrolled) completed the study.

Main Outcome Measures:

The authors used diagnostic ultrasound and isokinetic dynamometry to generate a force elongation curve and its derivatives at each time point.

Results:

Greater adaptations were observed in men than in women, with men generating more force and having greater increases in CSA, stiffness, and Young’s modulus and less elongation after 12 wk of training.

Conclusion:

Men demonstrated changes in AT properties that were consistent with increased loading of the triceps surae during exercise. The women demonstrated far smaller changes. Further investigation is warranted to understand when adaptations may occur in women and the implications of altered AT mechanical properties for performance and injury risk.

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Jeffrey B. Driban, Nicole Cattano, Easwaran Balasubramanian, Michael R. Sitler, Mamta Amin, Joseph Glutting and Mary F. Barbe

Context: To better understand why a knee develops osteoarthritis after joint trauma we need to assess the local biochemical changes. Unfortunately, it is challenging to obtain synovial fluid from a knee with no effusion. Objective: To describe the authors' protocol for aspirating synovial fluid from noneffused knees. Second, they demonstrate the validity of this method by evaluating the relationships between normalized and raw biomarker concentrations among knees with effusion (undergoing a traditional aspiration) and without effusion (requiring a saline-assisted aspiration). Design: Validation study based on secondary analyses from 2 cohort studies. Setting: Outpatient orthopedic clinic and basic-science laboratory. Participants: Participants had moderate to severe radiographic knee osteoarthritis (n = 15 with and 11 without effusion) and no osteoarthritis or effusion (n = 4). Interventions: The same orthopedic surgeon performed all synovial-fluid joint aspirations, including saline-assisted aspirations. Main Outcome Measures: The authors used multiplex enzyme-linked immunosorbent assays to determine 7 synovial-fluid biomarker concentrations. They then calculated correlations between raw and normalized (to total synovial-fluid protein content) biomarker concentrations. Results: The authors excluded 1 sample collected with a saline-assisted aspiration because it contained blood. Normalized biomarker concentrations had positive associations with raw biomarker concentrations (r = .77-99), with the exception of interleukin-13 and interleukin-1Β among knees that underwent a saline-assisted aspiration. Excluding interleukin-1Β, associations between normalized and raw biomarker concentrations were consistent between knees that had a saline-assisted or traditional aspiration. Conclusions:Saline-assisted aspiration is a valid technique for assessing the local biochemical changes in knees without effusion.

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Michael F. Bergeron, Carl M. Maresh, Lawrence E. Armstrong, Joseph F. Signorile, John W. Castellani, Robert W. Kenefick, Kent E. LaGasse and Deborah A. Riebe

Twenty (12 male and 8 female) tennis players from two Division I university tennis teams performed three days of round-robin tournament play (i.e., two singles tennis matches followed by one doubles match per day) in a hot environment (32.2 ± 1.5 C° and 53.9 ± 2.4% rh at 1200 hr), so that fluid-electrolyte balance could be evaluated. During singles play, body weight percentage changes were minimal and were similar for males and females (males -1.3 ± 0.8%, females -0.7 ± 0.8%). Estimated daily losses (mmol · day1) of sweat sodium (Na+) and potassium (K+) (males, Na+ 158.7, K+ 31.3; females, Na+ 86.5, K+ 18.9) were met by the players' daily dietary intakes (mmol · day1) of these electrolytes (males, Na+ 279.1 ± 109.4, K+ 173.5 ± 57.7; females, Na+ 178.9 ± 68.9, K+ 116.1 ± 37.5). Daily plasma volume and electrolyte (Na+, K+) levels were generally conserved, although, plasma [Na+] was lower (p < .05) on the morning of Day 4. This study indicated that these athletes generally maintained overall fluid-electrolyte balance, in response to playing multiple tennis matches on 3 successive days in a hot environment, without the occurrence of heat illness.

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Christine L. LaLanne, Michael S. Cannady, Joseph F. Moon, Danica L. Taylor, Jeff A. Nessler, George H. Crocker and Sean C. Newcomer

Participation in surfing has evolved to include all age groups. Therefore, the purpose of this study was to determine whether activity levels and cardiovascular responses to surfing change with age. Surfing time and heart rate (HR) were measured for the total surfing session and within each activity of surfing (paddling, sitting, wave riding, and miscellaneous). Peak oxygen consumption (VO2peak) was also measured during laboratory-based simulated surfboard paddling on a modified swim bench ergometer. VO2peak decreased with age during simulated paddling (r = –.455, p < .001, n = 68). Total time surfing (p = .837) and time spent within each activity of surfing did not differ with age (n = 160). Mean HR during surfing significantly decreased with age (r = –.231, p = .004). However, surfing HR expressed as a percent of age-predicted maximum increased significantly with age. Therefore, recreational surfers across the age spectrum are achieving intensities and durations that are consistent with guidelines for cardiovascular health.

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Katherine Histen, Julia Arntsen, Lauren L’Hereux, James Heeren, Benjamin Wicki, Sterling Saint, Giselle Aerni, Craig R. Denegar and Michael F. Joseph

Context:

Tendon adapts to load through alterations in its composition and mechanical properties. Mechanical adaptation to increased load often involves increases in cross-sectional area (CSA), stiffness, and modulus. Runners exhibit these adaptations.

Objective:

To determine if runners wearing minimalist shoes had larger and stiffer Achilles tendons (AT) than traditionally shod runners.

Design:

Cross-sectional study of well-trained, traditionally and minimally shod runners.

Setting:

Laboratory assessment of trained runners.

Participants:

23 men (11 traditional, 12 minimalist) and 8 women (6 traditional, 2 minimalist). Runners wearing minimalist shoes had 4.2 ± 1.6 y of training experience in minimalist shoes.

Main Outcome Measures:

The authors used diagnostic ultrasound and isokinetic dynamometry to generate a force-elongation curve and its derivatives.

Results:

Minimalist runners had a greater CSA: mean difference (MD) = 9.2 mm2, stiffness (MD = 268.1 N/mm), and modulus (MD = 202.9 MPa). ATs of minimalist runners experienced greater stress (MD 8.6 N/mm2) during maximal voluntary isometric contraction of the plantar-flexor muscles due to greater force of contraction (MD 798.9 N).

Conclusion:

The AT in minimalist runners adapts by increasing size, stiffness, and modulus, which is consistent with our understanding of mechanical adaptation of tendon to increased loading. Increased stress to the AT likely requires a slow transition to minimalist running to allow the AT to adapt without evidence of injury.

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Stephen D. Anton, Michael G. Perri, Joseph Riley III, William F. Kanasky Jr., James R. Rodrigue, Samuel F. Sears and A. Daniel Martin

This study examined whether specific participant characteristics (age, sex, BMI, exercise history, and self-efficacy) differentially predicted adherence to exercise programs of moderate vs. higher levels of intensity and frequency. Sedentary adults (N = 379) were randomly assigned in a 2 × 2 design to walk 30 min/day at a frequency of either 3 to 4 days/week or 5 to 7 days/week, at an intensity of either 45–55% or 65–75% of maximum heart rate reserve. Exercise adherence was assessed via daily exercise logs completed during Months 2–6 of the exercise program. The major finding of this study was that participants with higher levels of past exercise showed better adherence to higher intensity exercise but tended to have poorer adherence to moderate intensity exercise. Our results suggest that a person’s previous experience with exercise should be considered when prescribing higher intensity exercise, and that individuals with an extensive exercise history can be prescribed higher intensity exercise.