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Scott M. Lephart

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Edited by Scott M. Lephart

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Scott M. Lephart and Timothy J. Henry

The confusion between the terms open kinetic chain and closed kinetic chain becomes even greater with application to the upper extremity. Upper extremity function is very difficult to define, due to the numerous shoulder positions and the great velocities with which the shoulder can move. Classifying exercises for rehabilitation of the upper extremity is very difficult due to the complexity of the joint. Many definitions and classification systems have been proposed; however, none of these entirely encompass rehabilitation of the upper extremity. Using previous classifications we have developed a Functional Classification System that is designed to serve as a template for upper extremity rehabilitation. This system has been designed to restore functional shoulder stability, which is dependent upon proper scapulothoracic and glenohumeral stability, and humeral control; all of these are in part mediated by neuromuscular mechanisms. The objective of our new Functional Classification System is to restore functional stability of the shoulder by reestablishing neuromuscular control for overhead activities.

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Paul A. Borsa, Scott M. Lephart, Mininder S. Kocher, and Susan P. Lephart

Following injury to the articular ligaments, disruption of mechanoreceptors results in partial deafferentation of the joint. This has been shown to inhibit normal neuromuscular joint stabilization, and it contributes to repetitive injuries and the progressive decline of the joint. Assessment of proprioception is valuable in identification of proprioceptive deficits and subsequent planning of the rehabilitation program. A shoulder rehabilitation program must address both the mechanical and sensory functions of articular structures by incorporating a proprioceptive training element within the normal protocol. The objective of proprioception rehabilitation is to enhance cognitive appreciation of the respective joint relative to position and movement, and to enhance muscular stabilization of the joint in the absence of structural restraints. If these objectives are properly addressed, the restoration of the proprioceptive mechanism will prevent further disability of the shoulder joint.

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Joseph Myers, John Jolly, Takashi Nagai, and Scott Lephart

Context:

In vivo scapular kinematics during humeral movements are commonly assessed with electromagnetic tracking devices despite few published data related to reliability and precision of these measurements.

Objective:

To determine the intrasession reliability and precision of assessing scapular kinematics using an electromagnetic tracking device.

Design:

Scapular position and orientation were measured with an electromagnetic tracking device during humeral elevation/depression in several planes. Intrasession reliability and precision were established by comparing 2 trials performed in succession.

Setting:

A human-movement research laboratory.

Participants:

15 healthy individuals.

Main Outcome Measures:

Intrasession intraclass correlation coefficients and standard error of measurement of all scapular variables were established.

Results:

The mean intrasession reliability for all variables was ICC = .97 ± .03. The mean intrasession precision was .99° ± .36°.

Conclusions:

In vivo scapular kinematics can be measured with high reliability and precision during intrasession research designs.

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Paul A. Borsa, Scott M. Lephart, and James J. Irrgang

We compared the outcome measures of three knee scoring systems currently used to measure disability in anterior cruciate ligament (ACL)–deficient athletes. Twenty-nine ACL-deficient athletes completed three scoring systems (the Lysholm Knee Scoring System, a modified version of the Cincinnati Knee Scoring System, and the Knee Outcome Survey). Results demonstrate statistically significant mean differences and linear relationships between the outcome measures for the three scoring systems. The Knee Outcome Survey appears to provide valid measures of disability and indicates that our subjects functioned well with activities of daily living but became symptomatic and functionally limited with sports. The outcome measures also indicate that the Lysholm system is more specific to activities of daily living, while the modified Cincinnati is more specific to sports. We recommend that standard scoring systems be developed to provide measures of functional disability in athletes who experience knee injuries.

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Paul A. Borsa, Eric L. Sauers, and Scott M. Lephart

Functional training for the purpose of restoring dynamic joint stability has received considerable interest in recent years. Contemporary functional training programs are being designed to complement, rather than replace, traditional rehabilitation protocols. The purpose of this clinical commentary is to present a management strategy for restoring dynamic stability in the posterior cruciate ligament (PCL)-injured knee. The strategy presented integrates five key concepts: (a) planned variation of exercise, (b) outcomes-based assessment, (c) kinetic chain exercise, (d) proprioception and neuromuscular control, and (e) specificity of activity. Pertinent research findings and a clinical rationale are provided for using functional training in the restoration of dynamic stability in the PCL-injured knee.

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Bryan L. Riemann, Nancy Caggiano Tray, and Scott M. Lephart

Objectives:

To determine the physiological adaptations that might occur with a 4-week unilateral multiaxial training program in lower leg kinesthesia, peak torque, and postural control.

Study Design:

True experimental pretest-posttest control-group design.

Setting:

Research laboratory.

Subjects:

26 healthy, active subjects (14 men, 12 women).

Interventions:

Subjects were assigned to an experimental or control group. The experimental group performed multiaxial coordination training 3 days/wk for 4 weeks.

Main Outcome Measures:

Both groups were tested 3 times, pretest and 2 and 4 weeks after training was initiated. Outcome measures included conscious appreciation of ankle kinesthesia, eversion and dorsiflexion isokinetic peak torque, and static and functional postural control.

Results:

Results revealed a significant Group × Test interaction only for inversion kinesthesia.

Conclusions:

Four weeks of multiaxial coordination training did not significantly improve any of the dependent variables in healthy individuals. Further research should consider the effects of such a program on injured subjects.

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Emily D. Cox, Scott M. Lephart, and James J. Irrgang

The purpose of this study was to provide normative data on postural sway by comparing the mean gain score between two balance training groups and a control group. Twenty-seven recreational collegiate athletes (14 females, 13 males, 18-36 years old) with no past documented lower extremity injury or lesion of the vestibular system were randomly placed into three groups: control (nontraining), foam surface training, or hard surface training. The Chattecx Dynamic Balance System (CDB) was utilized for objective post-and pretraining recordings. CDB tests were performed on the training and nontraining extremities with subjects' eyes open and eyes closed. Results revealed no significant post to pre mean gain score differences within any group, nor was any significance revealed between group differences. Although no significant differences were revealed, trends indicated specificity of training toward testing mode. These data should assist clinicians in preventing ankle injury or compensating for ankle instability with balance training.

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Kathleen J. Ashmen, C. Buz Swanik, and Scott M. Lephart

The purpose of this study was to identify strength and flexibility deficits in subjects with chronic low-back pain (CLBP). Subjects were 16 female Division I athletes: 8 athletes who had experienced CLBP for at least 6 months prior to testing and a control group of 8 matched subjects. Athletes with neurological symptoms, previous back operations, and leg length discrepancies and those who were diagnosed with scoliosis, spondylolisthesis, or spondylolysis were excluded from this study. Variables assessed included abdominal strength, erector spinae endurance, hip flexion and extension endurance, torso lateral flexibility, and low-back flexibility. Strength and endurance were calculated as a function of time in seconds. Goniometric measurements were used to determine flexibility. Significant mean differences were found by using dependent t tests for abdominal strength, erector Spinae endurance, hip extension, and right lateral flexion of the torso. The results validate the necessity for pelvic stabilization and indicate that strength and flexibility deficits vary among populations.