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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

Focused Clinical Question: Does a passive stretching protocol, whether immediate or long-term, improve range of motion and decrease posterior shoulder tightness in overhead athletes? Clinical Bottom Line: There is moderate level 2 evidence to support the incorporation of passive stretching for overhead athletes to increase range of motion or decrease posterior shoulder tightness.

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Michelle A. Sandrey

Clinical Question: Is there sufficient evidence to determine which low back instability tests should be incorporated into a stabilization classification exam for athletes? Clinical Bottom Line: There is moderate level 2 evidence to include, but not to use in isolation, the prone instability test along with other instability tests in a stabilization classification exam.

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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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Michelle A. Sandrey, Cody Lancellotti and Cory Hester

Context: Soft tissue restrictions have been linked to poor flexibility and decreased range of motion (ROM). To decrease the soft tissue restrictions and ultimately increase ROM/flexibility, myofascial release techniques, such as foam rolling (FR) and instrument-assisted soft tissue mobilization (IASTM), have been used. However, the benefit regarding which technique is more beneficial remains unknown. Objective: To examine the effects of myofascial release techniques (FR vs the instrumented portion of IASTM) on knee joint ROM, rectus femoris (RF) and biceps femoris (BF) fascial displacement, and patient satisfaction. Design: Randomized controlled clinical trial. Setting: Mid-Atlantic University. Participants: Twenty moderately active participants (age 21.1 [2.0] y) with variable levels of soft tissue restriction in the quadriceps and hamstrings started and completed the study. Participants were randomly assigned to 2 groups, FR or IASTM. Interventions: All participants completed the same warm-up prior to the intervention. The FR group followed the proper FR protocol for gluteals/iliotibial band, quadriceps, and hamstrings/adductors, and the participants were monitored while the protocol was completed. The IASTM group received treatment on the gluteals/iliotibial band followed by the quadriceps, adductors, and hamstrings. Participants in both groups attended intervention sessions twice per week for 3 weeks. Prior to the start, knee ROM measurements were taken, along with fascial displacement measured via ultrasound. Upon completion of the study, posttest measurements were completed. A patient satisfaction survey was also administered at this time. Main Outcome Measures: Pretest to posttest knee ROM measurements, RF and BF fascial displacement, and patient satisfaction. Results: Both groups improved pretest to posttest for knee-extension ROM, with a slight trend toward increased knee-extension ROM for the FR group. Both groups improved pretest to posttest for BF and RF fascial displacement, in favor of the IASTM group for BF fascial displacement. Both groups were equally satisfied. Conclusions: As both groups improved pretest to posttest, either treatment could be used.

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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 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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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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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.