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  • Author: Michelle A. Sandrey x
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Michelle A. Sandrey

Objective:

To present the basic concepts of normal composition and structure of tendons and indicate how they are affected by acute and chronic tendon-injury pathomechanics.

Data Sources:

MEDLINE (1970-1999) and SPORTDiscus (1970-1999) were searched using the key words pathoanatomic, tendinitis, tendinosis, biomechanics, pathomechanics, histology, chronic, and mechanical behavior.

Data Synthesis:

Acute loading modes to tendons are based on the response of tendons to tensile and compressive stress. Chronic loading modes are based on frictional forces and repetitive movement.

Conclusions and Recommendations:

With an appreciation of the pathologic changes in acute tendon injuries, the clinician can better understand injury mechanics and the healing process. Until we know more about what is happening in and around the tendon, principally in the early and late phases of chronic injury we will not be able to adequately address injury classification of structures and, hence, the pathomechanics of chronic injury

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Michelle A. Sandrey

Objective:

Tendons have biomechanical properties based on collaborative remodeling of all their cells through normal lysis and synthesis. This review assesses factors that affect the healing response and presents solutions for rehabilitating acute and chronic tendon injuries.

Data Sources:

MEDLINE (1970–2002) and SPORTDiscus (1970–2002). Key words searched were tendon, tendinitis, tendinosis, tendinopathy, rehabilitation, ultrasound, NSAIDs, exercise, mobilization, aging, immobilization, and healing.

Data Synthesis:

The biomechanical roles tendons play change throughout one’s lifetime and are influenced by maturation and aging, injury and healing, immobilization, exercise, medications, and therapeutic modalities. Suggestions from animal, case, and clinical studies are varied but provide solutions in the treatment of acute and chronic tendon injuries.

Conclusions and Recommendations:

All factors that affect the tendon structure should be considered in a rehabilitation program. Therapeutic exercise, medications, or therapeutic modalities should never be used as a stand-alone therapy.

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Michelle A. Sandrey and Jonathan G. Mitzel

Context:

Core training specifically for track and field athletes is vague, and it is not clear how it affects dynamic balance and core-endurance measures.

Objective:

To determine the effects of a 6-week core-stabilization-training program for high school track and field athletes on dynamic balance and core endurance.

Design:

Test–retest.

Setting:

High school in north central West Virginia.

Participants:

Thirteen healthy high school student athletes from 1 track and field team volunteered for the study.

Interventions:

Subjects completed pretesting 1 wk before data collection. They completed a 6-wk core-stabilization program designed specifically for track and field athletes. The program consisted of 3 levels with 6 exercises per level and lasted for 30 min each session 3 times per week. Subjects progressed to the next level at 2-wk intervals. After 6 wk, posttesting was conducted

Main Outcome Measures:

The subjects were evaluated using the Star Excursion Balance Test (SEBT) for posteromedial (PM), medial (M), and anteromedial (AM) directions; abdominal-fatigue test (AFT); back-extensor test (BET); and side-bridge test (SBT) for the right and left sides.

Results:

Posttest results significantly improved for all 3 directions of the SEBT (PM, M, and AM), AFT, BET, right SBT, and left SBT. Effect size was large for all variables except for PM and AM, where a moderate effect was noted. Minimal-detectable-change scores exceeded the error of the measurements for all dependent variables.

Conclusion:

After the 6-wk core-stabilization-training program, measures of the SEBT, AFT, BET, and SBT improved, thus advocating the use of this core-stabilization-training program for track and field athletes.

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Michelle A. Sandrey and Timothy E. Kent

Context:

There is limited information on fatigue of the evertors on frontal plane joint position sense (JPS).

Objective:

To examine the effects of isokinetic concentric-eccentric fatigue of the evertors on frontal plane JPS of the ankle.

Design:

A 2 × 4 factorial design.

Setting:

Research Laboratory.

Patients or Other Participants:

40 male and female healthy subjects.

Interventions:

JPS was tested at 10° and 20° of inversion and 5° and 10° of eversion in a nonfatigued/fatigued condition. After fatigue of evertors was determined on an isokinetic device, post fatigue testing of JPS occurred.

Main Outcome Measures:

JPS absolute error (AE) for inversion and eversion.

Results:

Main effect for condition and angle were significant with pre/post fatigue. There were overestimation of angles postfatigue with AE greater at 20° of inversion (P = .003), followed by 10° of inversion (P < .001), 10° of eversion (P = .005), and 5° of eversion (P = .005).

Conclusion:

When the ankle evertors were fatigued, the AE for JPS was significantly higher at all test angles.

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Jessica L. Schaefer and Michelle A. Sandrey

Context:

A dynamic-balance-training (DBT) program supplemented with the Graston instrument-assisted soft-tissue mobilization (GISTM) technique has not been evaluated collectively as a treatment in subjects with chronic ankle instability (CAI).

Objective:

To examine the effects of GISTM in conjunction with a DBT program on outcomes associated with CAI, including pain and disability, range of motion (ROM), and dynamic postural control.

Design:

Pretest/posttest, repeated measures.

Setting:

High school and a Division I mid-Atlantic university.

Participants:

Thirty-six healthy, physically active individuals (5 female, 31 male; age 17.7 ± 1.9 y; height 175.3 ± 14.6 cm) with a history of CAI as determined by an ankle-instability questionnaire volunteered to be in this study.

Interventions:

Subjects were randomly assigned to 1 of 3 intervention groups: both treatments (DBT/GISTM, n = 13), DBT and a sham GISTM treatment (DBT/GISTM-S, n = 12), or DBT and control—no GISTM (DBT/C, n = 11). All groups participated in a 4-wk DBT program consisting of low-impact and dynamic activities that was progressed from week to week. The DBT/GISTM and DBT/GISTM-S groups received the GISTM treatment or sham treatment twice a week for 8 min before performing the DBT program. Pretest and posttest measurements included the Foot and Ankle Ability Measure (FAAM), FAAM Sport, the visual analog scale (VAS), ankle ROM in 4 directions, and the Star Excursion Balance Test (SEBT) in 3 directions.

Main Outcome Measures:

FAAM and FAAM-Sport scores, VAS, goniometric ROM (plantar flexion, dorsiflexion, inversion, eversion), and SEBT (anterior, posteromedial, posterolateral).

Results:

Subjects in all groups posttest demonstrated an increase in FAAM, FAAM Sport, ROM, and SEBT in all directions but not in VAS, which decreased. No other results were significant.

Conclusion:

For subjects with CAI, dynamic postural control, ROM, pain and disability improved pretest to posttest regardless of group membership, with the largest effects found in most measures in the DBT/GISTM group.

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Nathan J. Crockett and Michelle A. Sandrey

Context:

Few studies have evaluated the long-term effects of prophylactic ankle-brace use during a sport season.

Objective:

To determine the effects of prophylactic ankle-brace use during a high school basketball season on dynamic postural control and functional tests.

Design:

Prospective repeated-measures design.

Setting:

High school athletic facility.

Participants:

21 healthy high school basketball athletes (13 girls, 8 boys).

Interventions:

The order of testing was randomized using the Star Excursion Balance Test (SEBT) for posteromedial (PM), medial (M), and anteromedial (AM) directions and 3 functional tests (FT) consisting of the single-leg crossover hop, single-leg vertical jump, and the single-leg 6-m hop for time at pre-, mid-, and postseason. After pretesting, the ankle brace was worn on both limbs during the entire 16-wk competitive basketball season.

Main Outcome Measures:

SEBT for PM, M, and AM and 3 single-leg FTs.

Results:

Dynamic postural control using the SEBT and the 3 FTs improved over time, notably from pretest to posttest. The left limb was different from the right limb during the single-leg vertical jump. Effect sizes were large for pretest to posttest for the 3 SEBT directions and 2 of the 3 FTs.

Conclusions:

The 16-wk basketball prophylactic ankle-brace intervention significantly improved dynamic postural control and single-limb FTs over time.

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Michelle A Sandrey, Carole J Zebas and Joseph D Bast

Context:

Soccer is a sport that includes running in several different directions. For this reason, it is important for the shoe to control the motion of the foot.

Objective:

This study was undertaken to compare rear-foot motion in high school soccer players with excessive pronation under the experimental conditions of barefoot (BF), experimental shoe (ESS), experimental shoe with arch support (ESSAS), and the experimental shoe with pronated lacing technique (ESSPLT).

Design:

1 × 4 factorial.

Setting:

Biomechanics laboratory.

Patients or Other Participants:

20 male and female subjects with excessive pronation in both feet (N = 40) as determined by navicular height and arch index.

Interventions:

The subjects were filmed with a 2D Peak Performance video system as they ran a specified course. Rear-foot motion was determined by rear-foot angle measurements from the point of foot-fat to heel off.

Main Outcomes Measures:

There would be a difference with rear-foot motion between the three experimental conditions.

Results:

Results of the study indicated significant (P ≤ .05) differences between the conditions of BF and ESS, BF and ESSAS, BF and ESSPLT, and ESS and ESSPLT.

Conclusions:

In the experimental conditions, the shoe with the pronated lacing technique was superior in its effectiveness to control rear-foot motion.

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Vincent J. Leavey, Michelle A. Sandrey and Greg Dahmer

Context:

There are few outcomes-based studies that address hip strategy and gluteus medius strength (GMS) for maintaining dynamic postural control.

Objective:

To determine whether GMS training, proprioception training, or a combination of the 2 has an effect on dynamic postural control.

Design:

Pretest-posttest, repeated measures.

Setting:

Sports-medicine clinic.

Participants:

48 healthy male and female college students obtained via sample of convenience.

Interventions:

Three 6-wk programs including exercises for proprioception, GMS, and combined.

Main Outcomes Measures:

Eight Star Excursion Balance Test (SEBT) reach distances and GMS for the dominant leg.

Results:

There was no significant difference between groups. The combination group demonstrated the most improvements in SEBT reach distances, whereas the GMS group demonstrated the most improvement in GMS.

Conclusion:

Use of exercises for proprioception, GMS, or a combination of the 2 will help improve dynamic postural control in healthy, active individuals.

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Jeffery L. Huston, Michelle A. Sandrey, Mathew W. Lively and Kevin Kotsko

Context:

There is limited information on the effect of dynamic fatiguing of the plantar flexors on joint-position sense (JPS).

Objective:

To examine the effects of fatigue on JPS for ankle plantar flexion (PF) and dorsiflexion (DF).

Design:

A 2 × 2 factorial design.

Setting:

Research laboratory.

Participants:

20 healthy subjects (10 men, 10 women; age 21.75 ± 1.48 years).

Interventions:

The subjects were tested at 10° DF and 20° PF in the nonfatigued and fatigued conditions on a custom-built JPS device. To induce fatigue, subjects stood with both feet in the plantar-flexed position until they could no longer hold the posture.

Main Outcome Measures:

JPS absolute error was measured at 10° DF and 20° PF.

Results:

There was no significant main effect for condition, measurement, or interaction between condition and measurement.

Conclusion:

With no difference between conditions, the main controller of conscious JPS of the lower extremity might be the tibialis anterior.

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Michelle A. Sandrey

Column-editor : Jeff G. Konin