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William E. Prentice

Various techniques of manual therapy are available to the sports therapist supervising a rehabilitation program. Joint mobilization and proprioceptive neuromuscular facilitation (PNF) techniques can be effectively used in rehabilitation of the injured knee for achieving normal joint range of motion and for strengthening the weak components of a movement pattern. Joint mobilization is used to restore normal accessory motion to the joint. The PNF strengthening techniques are used for improving normal physiological motion. These manual therapy techniques allow the sports therapist to concentrate on the rotational component of motion at the knee joint, which is often neglected in rehabilitation programs.

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Scott Ross, Kevin Guskiewicz, William Prentice, Robert Schneider and Bing Yu

Objective:

T o determine differences between contralateral limbs’ strength, proprio-ception, and kinetic and knee-kinematic variables during single-limb landing.

Setting:

Laboratory.

Subjects:

30.

Measurements:

Hip, knee, and foot isokinetic peak torques; anterior/posterior (AP) and medial/lateral (ML) sway displacements during a balance task; and stabilization times, vertical ground-reaction force (VGRF), time to peak VGRF, and knee-flexion range of motion (ROM) from initial foot contact to peak VGRF during single-limb landing.

Results:

The kicking limb had significantly greater values for knee-extension (P = .008) and -flexion (P = .047) peak torques, AP sway displacement (P = .010), knee-flexion ROM from initial foot contact to peak VGRF (P < .001), and time to peak VGRF (P = .004). No other dependent measures were significantly different between limbs (P > .05).

Conclusion:

The kicking limb had superior thigh strength, better proprioception, and greater knee-flexion ROM than the stance limb.

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Mary E. Ubinger, William E. Prentice and Kevin M. Guskiewicz

When the upper extremity is injured, open kinetic chain (OKC) exercises are primarily used to increase strength and restore functional ability—the goals of rehabilitation. It is also imperative, however, that the receptors responsible for static and dynamic stabilization of the joint be trained. This can be done with closed kinetic chain (CKC) exercises. The purposes of this study were to investigate the effect of a 4-week CKC training program on the neuromuscular control of the upper extremity and to determine whether there was a significant difference between skill-dominant limb and nondominant limb stability indices. Thirty-two physically active participants (14 men, 18 women) were tested on the FASTEX 4 weeks apart. The training group's scores significantly improved, whereas the control group's scores remained the same. It was concluded that the CKC training significantly improved the training group's ability to remain stable. The results suggest that CKC training can increase the accuracy of joint position sense because of increased stimulation of the mechanoreceptors.

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Elizabeth E. Hibberd, Sakiko Oyama, Jeffrey T. Spang, William Prentice and Joseph B. Myers

Context:

Shoulder injuries are common in swimmers because of the demands of the sport. Muscle imbalances frequently exist due to the biomechanics of the sport, which predispose swimmers to injury. To date, an effective shoulder-injury-prevention program for competitive swimmers has not been established.

Objective:

To assess the effectiveness of a 6-wk strengthening and stretching intervention program on improving glenohumeral and scapular muscle strength and scapular kinematics in collegiate swimmers.

Design:

Randomized control trial.

Setting:

University biomechanics research laboratory.

Participants:

Forty-four Division I collegiate swimmers.

Interventions:

The intervention program was completed 3 times per week for 6 wk. The program included strengthening exercises completed using resistance tubing—scapular retraction (Ts), scapular retraction with upward rotation (Ys), scapular retraction with downward rotation (Ws), shoulder flexion, low rows, throwing acceleration and deceleration, scapular punches, shoulder internal rotation at 90° abduction, and external rotation at 90° abduction—and 2 stretching exercises: corner stretch and sleeper stretch.

Main Outcome Measurements:

Scapular kinematics and glenohumeral and scapular muscle strength assessed preintervention and postintervention.

Results:

There were no significant between-groups differences in strength variables at pre/post tests, although shoulder-extension and internal-rotation strength significantly increased in all subjects regardless of group assignment. Scapular kinematic data revealed increased scapular internal rotation, protraction, and elevation in all subjects at posttesting but no significant effect of group on the individual kinematic variables.

Conclusions:

The current strengthening and stretching program was not effective in altering strength and scapular kinematic variables but may serve as a framework for future programs. Adding more stretching exercises, eliminating exercises that overlap with weight-room training and swim training, and timing of implementation may yield a more beneficial program for collegiate swimmers.

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Darin A. Padua, Kevin M. Guskiewicz, William E. Prentice, Robert E. Schneider and Edgar W. Shields

Objective:

To determine whether select shoulder exercises influence shoulder-rotation strength, active angle reproduction (AAR), single-arm dynamic stability, and functional throwing performance in healthy individuals.

Design:

Pretest–posttest.

Setting:

Laboratory.

Participants:

54, randomly placed in 4 training groups.

Intervention:

Four 5-week training protocols.

Main Outcome Measures:

Average shoulder-rotation torque, AAR, single-arm dynamic stability, and functional throwing performance.

Results:

Repeated-measures ANOVAs revealed a significant group-by-test interaction for average torque (P > .05). Post hoc analyses revealed significantly increased average torque in the open kinetic chain and proprioceptive neuromuscular facilitation (PNF) groups after training. AAR and sway velocity were not affected in any of the groups (P > .05), but functional performance revealed a significant group-by-test interaction (P < .05). Post hoc analysis demonstrated that the PNF group significantly improved after training (P < .05).

Conclusions:

Shoulder strength can be improved in healthy individuals, but improvements depend on the exercise performed. Shoulder proprioception and neuromuscular control were unchanged in all groups, but functional performance improved in the PNF group

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Troy Blackburn, Kevin M. Guskiewicz, Meredith A. Petschauer and William E. Prentice

Objectives:

To determine whether proprioception or muscular strength is the dominant factor in balance and joint stability and define what type of ankle rehabilitation is most effective for these purposes.

Setting:

The University of North Carolina Sports Medicine Research Laboratory.

Subjects:

Thirty-two healthy volunteers free of head injury, dominant leg injury, and vestibular deficits.

Design:

Subjects were divided into control, strength-training, proprioceptive-training, and strength-proprioception combination training groups. Balance was assessed before and after 6-week training programs.

Measurements:

Static, semidynamic, and dynamic balance were assessed.

Results:

Subjects showed no improvement for static balance but improved significantly for semidynamic (P = .038) and dynamic (P = .002) balance. No significant differences were observed between groups.

Conclusions:

Enhancement of proprioception and muscular strength are equally effective in promoting joint stability and balance maintenance. In addition, no 1 type of training program is superior to another for these purposes.

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Phillip A. Gribble, Kevin M. Guskiewicz, William E. Prentice and Edgar W. Shields

The purposes of this study were to determine the effects of static and hold-relax stretching on hamstring range of motion and to examine the reliability of the FlexAbility LE1000 compared with the goniometrically measured active knee-extension test. Forty-two participants (18–25 years old) were assigned to either a control, static, or hold-relax training group. Participants were stretched four times a week over a 6-week period, with four 30-s stretches per session using a straight-leg-raise method on the FlexAbility LE1000. It was determined that both static and hold-relax techniques significantly improved hamstring flexibility (ISLR: +33.08° ± 9.08° and +35.17° ± 10.39°, respectively). Participants of both techniques reached a plateau in flexibility improvement between Weeks 4 and 5. Thus, static and hold-relax stretching are equally effective in improving hamstring ROM. The FlexAbility LE1000 and the goniometer were both found to be highly reliable. Therefore, either measurement technique could be used successfully to measure hip-flexion ROM.

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Luke M. Ross, Johna K. Register-Mihalik, Jason P. Mihalik, Karen L. McCulloch, William E. Prentice, Edgar W. Shields and Kevin M. Guskiewicz

Context:

Recent evidence has revealed deficiencies in the ability to divide attention after concussion.

Objective:

To examine the effects of a single vs a dual task on cognition and balance in healthy subjects and to examine reliability of 2 dual-task paradigms while examining the overall feasibility of the tasks.

Design:

Pretest–posttest experimental design.

Setting:

Sports medicine research laboratory.

Patients:

30 healthy, recreationally active college students.

Intervention:

Subjects performed balance and cognitive tasks under the single- and dual-task conditions during 2 test sessions 14 d apart.

Main Outcome Measures:

The procedural reaction-time (PRT) test of the Automated Neuropsychological Assessment Metrics (eyes-closed tasks) and an adapted Procedural Auditory Task (PAT; eyes-open tasks) were used to assess cognition. The NeuroCom Sensory Organization Test (SOT) and the Balance Error Scoring System (BESS) were used to assess balance performance. Five 2-way, within-subject ANOVAs and a paired-samples t test were used to analyze the data. ICCs were used to assess reliability across 2 test sessions.

Results:

On the SOT, performance significantly improved between test sessions (F 1,29 = 35.695, P < .001) and from the single to the dual task (F 1,29 = 9.604, P = .004). On the PRT, performance significantly improved between test sessions (F 1,29 = 57.252, P < .001) and from the single to the dual task (F 1,29 = 7.673, P = .010). No differences were seen on the BESS and the PAT. Reliability across test sessions ranged from moderate to poor for outcome measure.

Conclusions:

The BESS appears to be a more reliable and functional tool in dual-task conditions as a result of its increased reliability and clinical applicability. In addition, the BESS is more readily available to clinicians than the SOT.