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Todd A. Evans

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Rachel E. Brinkman and Todd A. Evans

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Kelli R. Snyder and Todd A. Evans

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Todd A. Evans and Kenneth C. Lam

Evidence-based practice is an established guiding principle in most medical and health care disciplines. Central to establishing evidence-based practice is the assessment of clinical outcomes. Clinical outcomes represent a form of evidence on which to base medical decisions, as well as providing the mechanism for assessing the effectiveness of evidence-based interventions. However, clinical outcomes are not routinely assessed in sport rehabilitation. If sport rehabilitation clinicians fail to incorporate clinical outcomes assessment and, as a result, evidence into daily practice, they may be missing an opportunity to improve patient care and putting their professional reputation at risk within the medical community. The purposes of the article are to highlight the emergence of clinical outcomes assessment in the medical community and the current health care system, illustrate the role of clinical outcomes assessment as it pertains to providing the best patient care, and identify challenges that could potentially impede the implementation of outcomes assessment in sport rehabilitation.

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Tricia Majewski-Schrage, Todd A. Evans and Brian Ragan

Context:

Despite widespread acceptance, there is currently no consensus on the definition, components, and the specific techniques most appropriate to measure and quantify core stability.

Objective:

To develop a comprehensive core-stability model addressing its definition, components, and assessment techniques.

Design:

Delphi technique.

Setting:

University laboratory.

Participants:

15 content experts from United States and Canada, representing a variety of disciplines.

Main Outcome Measure:

The authors distributed an open-ended questionnaire pertaining to a core-stability definition, components, and assessment techniques specific to each expert. They collected data over 2 rounds of telephone interviews. They concluded data collection once a consensus was achieved that equated with 51% agreement among respondents.

Results:

The authors developed a working definition of core stability as the ability to achieve and sustain control of the trunk region at rest and during precise movement. Eighty-three percent of the experts considered the definition satisfactory. Therefore, the definition was accepted. Furthermore, the experts agreed that muscles (14/15 = 93.3%) and neuromuscular control (8/12 = 66.7%) were components of core stability. Assessment techniques were identified and inconsistencies were highlighted; however, no consensus was established.

Conclusions:

A consensus core-stability definition was created and 2 components were identified. However, of the initial definitions provided by the experts, no 2 were identical, which revealed the inconsistencies among experts and the importance of this study. Nonetheless, the goal of obtaining a consensus definition was obtained. Although a consensus for the assessment techniques of core stability could not be reached, it was a beneficial starting point to identify the inconsistencies that were discovered among the content experts.

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Todd A. Evans, Jennifer R. Kunkle, Krista M. Zinz, Jessica L. Walter and Craig R. Denegar

Objective:

To assess the efficacy of lidocaine iontophoresis on myofascial trigger-point pain.

Setting:

University athletic training facility.

Design:

Randomized, double-blind, placebo-controlled, repeated-measures.

Subjects:

Twenty-three subjects with sensitive trigger points over the trapezius.

Intervention:

Placebo iontophoresis treatment without current or lidocaine, control treatment using distilled water and normal current dose, medicated treatment using 1% lidocaine and normal current dose.

Main Outcome Measure:

Trigger-point pressure threshold assessed with an algometer.

Results:

ANOVA revealed a significant difference among treatments (F 2,40 = 7.38, P < .01). Post hoc comparisons revealed a significant difference in pressure threshold between the lidocaine treatment and the control (P = .01) and placebo (P = .001) treatments. Effect sizes of .28 and .39, respectively, were found for these comparisons.

Conclusions:

Although the data revealed significant differences between treatments, the small effect sizes and magnitude of the pressure-sensitivity deviation scores suggest that iontophoresis with 1% lidocaine is ineffective in treating trigger points.

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Todd A. Evans, Sharon N. Domorski, Wayne J. Sebastianelli, Margot Putukian and Jay N. Hertel

Idiopathic forefoot pain, often termed metatarsalgia, is a common complaint among running athletes. Whereas several causes are often included in the differential diagnosis, Freiberg’s infraction is rarely considered. The signs and symptoms present with Freiberg’s infraction however, can mimic those present with more common forefoot injuries. The article presents the case of a female Division-I college soccer player who developed and was successfully treated for bilateral Freiberg’s infraction. Her initial complaint of unilateral forefoot pain, induced only by vigorous running, progressed to intolerable bilateral forefoot pain with light exercise. Conservative treatment was unsuccessful, and therefore surgery was required to enable her continued athletic participation. As with all weight-bearing joints, clinicians need to be aware of the potential for progressive degenerative changes at the metatarsal heads and the steps used in the evaluation and subsequent treatment of Freiberg’s infraction

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William J. Evans, Todd A. Trappe, James D. Fluckey and Charlotte Peterson

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Alison C. Jozsi, Esther E. Dupont-Versteegden, Jane M. Taylor-Jones, William J. Evans, Todd A. Trappe, Wayne W. Campbell and Charlotte A. Peterson

Studies have been performed in humans to identify changes in gene expression that may account for the relatively weak and variable response of aged muscle to resistance exercise. The gene expression profile of skeletal muscle from elderly (62–75 years old) compared to younger (20–30 years old) men demonstrated elevated expression of genes typical of a stress or damage response. The expression of the majority of these genes was unaffected by a single bout of high-intensity resistance exercise in elderly subjects but was altered acutely by exercise in younger subjects so as to approach the pre-exercise levels observed in older subjects. The inability of muscle from elderly subjects to respond to resistance exercise was also apparent in the expression of inflammatory response genes, which increased within 24 hours of the exercise bout only in younger subjects. Other genes with potentially important roles in the adaptation of muscle to exercise, showed a similar or even more robust response in older compared to younger subjects. Taken together, these results may help to explain the variable hypertrophic response of muscle from older individuals to resistance training.