Snapping scapula syndrome is a symptom, not a diagnosis. Soft tissue pathology and bony abnormalities can lead to scapular noise. Anatomy and biomechanics of the scapulothoracic mechanism are reviewed prior to discussion of the possible pathology that may lead to scapular noise and pain. Key points concerning the differential diagnosis are covered briefly. Guidelines are presented for rehabilitation of the patient with soft tissue lesions causing scapular pain and noise.
Larry W. Mattocks and Susan L. Whitney
James J. Irrgang, Susan L. Whitney and Christopher D. Harner
Shoulder pain in throwing athletes is reviewed. The anatomy and function of the rotator cuff and the biomechanics of the throwing mechanism are described. Physical examination for rotator cuff injuries, treatment considerations, and a protocol are presented. Failure to recognize glenohumeral instability may limit the success of nonoperative management of rotator cuff injuries in throwing athletes. This article provides a comprehensive review of some of the underlying causes of rotator cuff pathology in throwing athletes. Rotator cuff injuries in throwing athletes are closely associated with glenohumeral instability. The role of glenohumeral instability in the pathogenesis of rotator cuff injuries is described.
Abdulazeem Kamkar, Candice Cardi-Laurent and Susan L. Whitney
First rib subluxation is one possible cause of neck, shoulder, and arm pain. The anatomy and biomechanics of the first rib contribute to its tendency to sublux superiorly. Management of first rib subluxation may include manipulative therapy, therapeutic exercises, pharmaceutical agents, and physical modalities to correct joint dysfunction, decrease soft tissue tension, and prevent recurrence.
David J. Pezzullo, James J. Irrgang and Susan L. Whitney
Patellar tendonitis is a common pathology seen in athletes involved in activities requiring forceful eccentric muscle contractions or repeated flexion and extension of the knee. This article reviews the related anatomy, biomechanics, mechanism of injury, and diagnosis of patellar tendonitis. It also presents several treatment approaches and suggestions to help identify athletes at risk.
James J. Irrgang, Susan L. Whitney and Emily D. Cox
Recently there has been emphasis on including balance and proprioceptive training in the rehabilitation of sports-related lower extremity injuries. It is believed that injury to joint and musculotendinous structures results in altered somatosensory information that adversely affects motor control. This may result in increased risk for recurrent injury, decreased performance, or both. Balance and proprioceptive training have been advocated to restore motor control to the lower extremity. This paper will review the current scientific rationale for use of balance and proprioceptive training in the rehabilitation of sports-related lower extremity injuries. Additionally, guidelines for training to improve balance and proprioception will be discussed.
Susan L. Whitney and Jill L. Unico
Susan L. Whitney, Larry Mattocks, James J. Irrgang, Pamela A. Gentile, David Pezzullo and Abdulazeem Kamkar
The purpose of this two-part study was to determine if lower extremity girth measurements are repeatable. Sixteen males and 14 females participated in the intra- and intertester reliability portion of this study. Girth was assessed at five different lower extremity sites by two physical therapists using a standard tape measure. Thirty measures (15 by each examiner) were collected on the subject's right leg, and a mean of the three measures was used in the analysis. The measurements were repeated 7 days later. It was found that by using a simple standardized procedure, girth measurements in the clinic can be highly repeatable in experienced clinicians. Part 2 of the study involved testing the right and left legs of 22 subjects to determine if girth of the right and left legs was similar. All subjects had their girth assessed at five sites on their right and left legs during one session. It was found that girth measures on the right and left lower extremities are comparable. In an acutely injured lower extremity, it might be assumed that the girth of both lower extremities is similar.
Saud F. Alsubaie, Susan L. Whitney, Joseph M. Furman, Gregory F. Marchetti, Kathleen H. Sienko and Patrick J. Sparto
The reliability of balance exercises performance in experimental and clinical studies has typically been confined to a small set of exercises. To advance the field of assessing balance exercise intensity, establishing the reliability of performance during a more diverse array of exercises should be undertaken. The purpose of this study was to investigate the test–retest reliability of postural sway produced during performance of 24 different balance tasks and to evaluate the reliability of different measures of postural sway. Sixty-two healthy subjects between the ages of 18 and 85 years (50% female and mean age = 55  y) participated. Subjects were tested during 2 visits 1 week apart and performed 2 sets of the 24 randomized standing tasks per visit. The tasks consisted of combinations of the following factors: surface (firm and foam); vision (eyes open and eyes closed); stance (feet apart and semitandem); and head movement (no movement, yaw, and pitch). Angular position displacement, angular velocity, and linear acceleration postural sway in the pitch and roll planes were recorded by an inertial measurement unit. The postural sway measures demonstrated at fair to good test–retest reliability with few exceptions, and angular velocity measures demonstrated the greatest reliability. The between-visit reliability of 2 averaged trials was excellent for most tasks. The study indicates that the performance of most balance tasks used as part of balance rehabilitation is reliable and that quantitative assessment could be used to document change.
Lindsay P. Toth, Susan Park, Whitney L. Pittman, Damla Sarisaltik, Paul R. Hibbing, Alvin L. Morton, Cary M. Springer, Scott E. Crouter and David R. Bassett
Purpose: To examine the effect of brief, intermittent stepping bouts on step counts from 10 physical activity monitors (PAMs). Methods: Adults (N = 21; M ± SD, 26 ± 9.0 yr) wore four PAMs on the wrist (Garmin Vivofit 2, Fitbit Charge, Withings Pulse Ox, and ActiGraph wGT3X-BT [AG]), four on the hip (Yamax Digi-Walker SW-200 [YX], Fitbit Zip, Omron HJ-322U, and AG), and two on the ankle (StepWatch [SW] with default and modified settings). AG data were processed with and without the low frequency extension (AGL) and with the Moving Average Vector Magnitude algorithm. In Part 1 (five trials), walking bouts were varied (4–12 steps) and rest intervals were held constant (10 s). In Part 2 (six trials), walking bouts were held constant (4 steps) and rest intervals were varied (1–10 s). Percent of hand-counted steps and mean absolute percentage error were calculated. One sample t-test was used to compare percent of hand-counted steps to 100%. Results: In Parts 1 and 2, the SWdefault, SWmodified, YX, and AGLhip captured within 10% of hand-counted steps across nearly all conditions. In Part 1, estimates of most methods improved as the number of steps per bout increased. In Part 2, estimates of most methods decreased as the rest duration increased. Conclusion: Most methods required stepping bouts of >6–10 consecutive steps to record steps. Rest intervals of 1–2 seconds were sufficient to break up walking bouts in many methods. The requirement for several consecutive steps in some methods causes an underestimation of steps in brief, intermittent bouts.