Edited by Scott M. Lephart
Scott M. Lephart
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.
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.
Bryan L. Riemann, Nancy Caggiano Tray, and Scott M. Lephart
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.
True experimental pretest-posttest control-group design.
26 healthy, active subjects (14 men, 12 women).
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 revealed a significant Group × Test interaction only for inversion kinesthesia.
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.
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.
Bryan L. Riemann, Nancy A. Caggiano, and Scott M. Lephart
Postural control and functional performance tests are often used separately during orthopedic postinjury assessments. The purpose of this investigation was to examine a clinical method of assessing postural control during a functional performance task. Thirty participants were divided into two groups. The first group was tested three times, the second group only once. The same tester evaluated each participant's performance during all testing sessions, and during the first two testing sessions (Group 1) two additional testers evaluated each performance. Intraclass correlational coefficients between the three testers ranged from .70 to .92. Session 1 (Group 1) scores were pooled with Group 2 scores, and correlational analyses were conducted between participant height and performance; no significant relationships were revealed. The scores from Group 1 were analyzed using between-days repeated-measures ANOVAs. Results revealed significant improvement between Sessions 1 and 3 for the static portion of the test. The results suggest that the multiple single-leg hop-stabilization test offers a method of assessing postural control during a functional performance task.
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.
Eric J. Heit, Scott M. Lephart, and Susan L. Rozzi
The purpose of this study was to determine the proprioceptive effects of ankle bracing and taping. Proprioception was assessed in 26 subjects by evaluating ankle joint position sense, which was determined by the subjects' ability to actively reproduce a passively positioned joint angle. Testing was performed at positions of 30° of plantar flexion and 15° of inversion. Each subject underwent four trials at each test angle under three conditions: braced, taped, and control. For the plantar flexion test, both the braced condition and the taped condition significantly enhanced joint position sense when compared to the control condition. There was no significant difference between the braced and taped conditions. For the inversion test, the taped condition significantly enhanced joint position sense compared to the control condition. There was no significant difference between the braced and the control conditions or between the braced and the taped conditions. This study demonstrates that ankle bracing and taping improve joint position sense in the stable ankle.
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.