Noncompliance to rehabilitation programs presents a significant challenge to clinicians. Noncompliant athletes are at greater risk for re-injury and slower return to activity. There is a paucity of information concerning compliance to sports rehabilitation. This paper advocates the use of behavioral and cognitive techniques to facilitate achievement of rehabilitation goals. Behavioral techniques involve the use of specific short-term functional goals to achieve the long-term goal of return to activity. Cognitive techniques involve the relationship between thoughts and action, that is, if athletes are thinking negatively, they are less compliant to rehabilitation programs. Specific examples of both techniques are presented to the clinician that are proposed to increase rehabilitation goal attainment.
Peter A. Schaub and Teddy W. Worrell
During knee rehabilitation, squats are a commonly used closed kinetic chain exercise. We have been unable to locate data reporting electromyographic (EMG) activity of lower extremity musculature during maximal effort squats and the contribution of gastrocnemius and gluteus maximus muscles. Therefore, the purposes of this study were (a) to quantify EMG activity of selected lower extremity muscles during a maximal isometric squat and during a maximal voluntary isometric contraction (MVIC), and (b) to determine ratios between the vastus medialis oblique (VMO) and vastus lateralis (VL) during maximal isometric squat and MVIC testing. Twenty-three subjects participated in a single testing session. Results are as follows: intraclass correlations for MVIC testing and squat testing ranged from .60 to .80 and .70 to .90, respectively. Percentage MVIC during the squat was as follows: rectus femoris 40 ± 30%, VMO 90 ± 70%, VL 70 ±40%, hamstrings 10 ± 10%, gluteus maximus 20 ± 10%, and gastrocnemius 30 ± 20%. No statistical difference existed in VMO:VL ratios during MVIC or squat testing. We conclude that large variations in muscle recruitment patterns occur between individuals during isometric squats.
Diane C. Westfall and Teddy W. Worrell
Anterior knee pain syndrome (AKPS) represents a significant problem for patients and sports medicine clinicians. Many predisposing factors have been associated with AKPS. Considerable attention has been given to quadriceps strengthening. Specifically the vastus medialis oblique (VMO) muscle is targeted for selective strengthening. Because of the VMO's oblique attachment to the patella, researchers report that proper dynamic alignment of the patella is dependent on VMO control. Given the lack of scientific information and agreement concerning the rehabilitation of patients with AKPS, the clinician and patient often become frustrated with the lack of progress during rehabilitation. Therefore the purpose of this paper is to clarify the current literature concerning the role of the VMO.
Lynne Neiers and Teddy W. Worrell
Assessment of posture is an integral component of the evaluation of patients with neck and shoulder dysfunctions. Protraction of the scapulae has been postulated to produce weakness of the shoulder musculature. Therefore, an accurate method is needed to assess scapular position in order to determine the effect of therapeutic intervention and classify dysfunction. The purpose of this study was to determine if an experienced clinician would accurately determine scapular position. Fifty subjects (age = 26 ±5.7 years, weight = 69.2 ±14.09 kg; height = 173.9 ±13.91 cm) participated in this study. The results revealed the following reliability coefficients: scapular distance (SD) intraclass correlation coefficient (ICC) = .80, scapular size (SS) ICC = .96, and normalized scapular abduction (NSA) (SD/SS) ICC = .34. These data demonstrate that NSA was not reproducible in this study. The authors hypothesize that NSA contains more measurement error because NSA is a ratio value in which both the numerator and denominator contain measurement error. Further study is needed before NSA values are used to determine scapular position or correlated NSA is used to force development of shoulder musculature.
Teddy W. Worrell, Steven Connelly, and John Hilvert
The purpose of this study was to determine the intrasession and intersession reliability of EMG vastus medialis oblique:vastus lateralis (VMO:VL) ratios at four knee positions (0, 45, 60, and 90°) at 100 and 60% of maximal voluntary isometric contraction (MVIC). Once reliability was established, the second purpose was to determine VMO:VL ratios and torque at each knee position. Thirty-two subjects participated in two sessions; 19 subjects were tested at 100% MVIC and 13 were tested at .60% MVIC. Results revealed the following intraclass correlations: 100% MVIC intrasession .40-.80, intersession .40-.70; 60% MVIC intrasession .60-.90, intersession .50-.80. A significant difference in torque occurred at all knee positions except 60 versus 90°. No significant difference existed in VMO:VL ratios at the four positions of knee flexion. Pain and measurement error significantly increased during 100% MVIC testing. It was concluded that no selective VMO recruitment occurred as revealed by the VMO: VL ratios in asymptomatic subjects. Future study is needed that reports EMG reliability data during exercises that theorize selective VMO recruitment.
Stephanie Somes, Teddy W. Worrell, Barbara Corey, and Christopher D. Lngersol
Although patellar taping has been advocated in the treatment of patellofemoral pain syndrome to decrease pain, to enhance vastus medialis control, and to facilitate patellar alignment, limited radiological data exist to support the use of patellar taping. The purpose of this study was to determine the effects of patellar taping on patellar position in the open and closed kinetic chains (OKC and CKC) and to quantify the effect of taping on patellar pain. Nine subjects (10 knees; 7 female, 2 males) with patellofemoral pain syndrome were x-rayed in the OKC and CKC at a 45° angle of knee flexion with and without tape applied. Subjects also completed a visual analog pain scale after performing an 8-in. step-down both pre- and posttaping. Results revealed a significant increase in lateral patellofemoral angle with patellar taping in the CKC, which indicates a more medially tilted patella. No change occurred in the patellofemoral congruence angle. Pain was reduced 45% with patellar taping during the 8-in. step-down. It was concluded that in these subjects, patellar taping decreased patellar pain and improved patellar medial tilt as defined by the lateral patellofemoral angle.
Teddy W. Worrell, Christopher D. Ingersoll, and Jack Farr
The purpose of this case study was to determine the effect of patellar taping, patellar bracing, and control condition on (a) patellofemoral congruence angle (PFC), (b) lateral patellar angle (LPA), (c) lateral patellar displacement (LPD), and (d) pain, as determined by the visual analog scale (VAS) during an 8-in. step-down. The subject was a 15-year-old female with a 3-year history of recurrent patellar subluxations and anterior knee pain syndrome. Results revealed the following: control condition—PFC 41.4-1.1°, LPA 19.9-6.9°, LPD 18.6-8.3 mm, VAS 8.8 cm; tape—PFC 46.2-2.3°, LPA 25.1-2.9°, LPD 24.2-7.5 mm, VAS 0.8 cm; brace—PFC 3.4-16.5°, LPA 7.9-0.8°, LPD 9.4-4.7 mm, VAS 0.3 cm. Patellar bracing was effective in centralizing the patella as revealed by the PFC, LPA, and LPD measures; however, patellar taping did not improve patellar position, and in some positions taping actually worsened patellar position. A large reduction in pain as measured by the VAS occurred during an 8-in. step-down for both taping and bracing. More research is necessary to explain the pain reduction without a change in patellar position using tape.
Teddy W. Worrell, Laurie D. Booher, and Karla M. Hench
The purpose of this study was to compare the injured versus noninjured lower extremity on three single-leg hop tests following inversion ankle sprain. Twenty-two subjects with a history of unilateral inversion ankle sprain participated in this study. Subjects performed the three single-leg hop tests (hop for distance, hop for time, and agility hop). An independent t test was used to compare extremities. No significant differences existed on any hop test for the 22 subjects. In 8 of the 22 subjects who reported pain with activities of daily living and/or sports activities, an independent t test revealed no significant difference on hop test performance between extremities. We conclude that these three single-leg hop tests lack sensitivity (validity) in detecting lower extremity performance deficits as reported by the subjects following inversion ankle sprain.
Michael Ross and Teddy W. Worrell
Teddy W. Worrell, Michael K. Sullivan, and Joseph J. DeJulia
This study examined the intratester and intertester reliability of an active-knee-extension test (AKET) for determining hamstring muscle length (flexibility). Three testers performed repeated AKET measurements on 22 subjects. Intraclass correlation coefficients (ICC were used to calculate intratester and intertester reliability. Also, standard error of measurements (SEM) were calculated. The ICC and SEM were .96 and 1.82°, respectively, for Tester 1, .99 and 1.75° for Tester 2, and .99 and 1.80° for Tester 3. Intratester 95% confidence intervals ranged from 60.54 to 69.82°. Intertester ICC and SEM for two testers were .93 and 4.81°, respectively. A 95% intertester confidence interval ranged from 56.35 to 75.21 °; this reveals that intertester AKET values contained more error and suggests that only intratester AKET values should be used when comparing hamstring flexibility values. The AKET may provide a more accurate method for determining hamstring flexibility and quantifying changes that occur as a result of injury and stretching procedures.