An 18-year-old, male collegiate basketball athlete complained of right testicular pain following basketball activities. The patient’s imaging denoted edema within the pubis at the insertion of the adductor longus tendon and rectus sheath aponeurosis consistent with inguinal disruption. The patient underwent conservative rehabilitation and attempted to return to participation with increased pain. Subsequently, the patient underwent surgery. Following surgical intervention, the patient underwent 6 weeks of rehabilitation with basketball-specific considerations. On conclusion, the patient was pain free and returned to activity. This case is unique due to the insidious onset, sport in which the patient participated, and failed conservative management.
Zachary K. Winkelmann and Kenneth E. Games
Lori Bolgla and Terry Malone
To provide evidence regarding the therapeutic effects of exercise on subjects with patellofemoral-pain syndrome (PFPS).
Evidence was compiled with data located using the Medline, CINAHL, and SPORTDiscus databases from 1985 to 2004 using the key words patellofemoral pain syndrome, exercise, rehabilitation, and strength.
The literature review examined intervention studies evaluating the effectiveness of exercise in subjects specif-cally diagnosed with PFPS. Articles were selected based on clinical relevance to PFPS rehabilitation that required an intervention of a minimum of 4 weeks.
The review supports using exercise as the primary treatment for PFPS.
Evidence exists regarding the use of isometric, isotonic, isokinetic, and closed kinetic chain exercise. Although clinicians have advocated the use of biofeedback and patella taping, there is limited evidence regarding the efficacy of these interventions on subjects diagnosed with PFPS.
Tania Pizzari, Helen McBurney, Nicholas F. Taylor and Julian A. Feller
To investigate the subjective experience of anterior cruciate ligament (ACL) rehabilitation and identify variables that influence adherence as perceived by ACL-reconstructed patients.
A qualitative study using in-depth interviews to gather data and thematic coding to analyze findings.
Participants were interviewed at home or in their workplace.
Eleven patients were interviewed at an average of 4.8 months (SD = 0.8) after ACL reconstruction.
Using thematic coding of the interview data, 3 categories of variables influencing adherence emerged: environmental factors, physical factors, and psychological factors. Variables specifically affecting adherence to home exercise were perceived lack of time and a lack of self-motivation. Fear of reinjury emerged as a significant consideration for those who were nonadherent. Factors such as therapist support, the rehabilitation clinic, and the progression of exercises were identified as being important for attendance at physiotherapy appointments and adherence during appointments.
J. Ty Hopkins and Christopher D. Ingersoll
To define the concept of arthrogenic muscle inhibition (AMI), to discuss its implications in the rehabilitation of joint injury, to discuss the neurophysiologic events that lead to AMI, to evaluate the methods available to measure AM1 and the models that might be implemented to examine AMI, and to review therapeutic interventions that might reduce AMI.
The databases MEDLINE, SPORTDiscus, and CIHNAL were searched with the terms reflex inhibition, joint mechanoreceptor, Ib interneuron, Hoffmann reflex, effusion, and joint injury. The remaining citations were collected from references of similar papers.
AMI is a limiting factor in the rehabilitation of joint injury. It results in atrophy and deficiencies in strength and increases the susceptibility to further injury. A therapeutic intervention that results in decreased inhibition, allowing for active exercise, would lead to faster and more complete recovery.
Lee E. Brown, Michael Whitehurst and David N. Buchalter
A 67-year-old male underwent bilateral total knee replacement surgery and was subsequently placed on a bilateral isokinetic knee rehabilitation program. Isokinetic knee testing was performed on unilateral dominant (UD; right) and nondominant (UND; left) limbs as well as bilateral limbs (BLs) before and after a three-times-per-week, 8-week protocol during which the patient followed a bilateral isokinetic velocity spectrum (60 to 300°/s) rehabilitation program. The protocol was made possible by the introduction of a new bilateral isokinetic knee attachment developed by the authors. The BL extension and flexion peak torque increased 41% and 51% at 60°/s, respectively. The UD and UND extension peak torque increased 22% and 37%, respectively, while flexion peak torque increased 68% and 52%, respectively. The bilateral deficit decreased with increasing velocity for both extension and flexion. These results demonstrate that a bilateral isokinetic approach to rehabilitation may be a legitimate technique to increase knee extension and flexion peak torque both unilaterally and bilaterally following bilateral total knee replacement surgery.
Audrey R.C. Elias, Curt D. Hammill and Ryan L. Mizner
Though essential to athletic performance, the ability to land from a jump often remains limited following injury. While recommended, jump training is difficult to include in rehabilitation programs due to high impact forces. Body weight support (BWS) is frequently used in rehabilitation of gait following neurological and orthopedic injury, and may also allow improved rehabilitation of high-impact tasks. There is a differential effect of BWS on walking and running gaits, and the effect of BWS on movements with relatively large vertical displacement is unknown. The current study evaluates the effect of BWS on a replicable singleleg hopping task. We posited that progressive BWS would decrease limb loading while maintaining the joint kinematics of the task. Twenty-eight participants repetitively hopped on and off a box at each of four BWS levels. Peak vertical ground reaction forces decreased by 22.5% between 0% and 30% BWS (P < .001). Average hip, knee, and ankle internal moments decreased by 0.5 N·m/kg each. Slight kinematic changes across BWS levels were clinically insignificant. The high level of task specificity evidenced by consistent kinematics coupled with a similar reduction of internal moment at each joint suggests that BWS may be a useful strategy for rehabilitation of jumping tasks.
Justin M. Stanek, John Meyer and Rob Lynall
Balance training is widely used by rehabilitation professionals and has been shown to be effective at reducing risk of injury, as well as improving function after injury. However, objective evidence for the difficulty of commonly available equipment is lacking.
To assess center-of-pressure (COP) area and average sway velocity in healthy subjects while performing a single-limb stance on 4 commonly available rehabilitation devices to determine their level of difficulty.
Single-session, randomized, repeated-measures design to assess COP area and average sway velocity while performing a single-limb stance on 4 devices positioned on a force platform.
A convenience sample of 57 healthy college-age subjects.
Each participant balanced on the dominant limb in a nonshod single-limb stance with eyes open for 20 s during 4 conditions. The 4 conditions were randomized and included the Both Sides Up (BOSU) trainer, Airex balance pad, half-foam roller, and DynaDisc.
Main Outcome Measure:
Means and standard deviations were calculated for maximum displacement in each direction. In addition, the means and standard deviations for COP area and average sway velocity were calculated for the 4 conditions and compared using a 1-way repeated-measure ANOVA.
Significant differences were found for both COP area and average sway velocity between the BOSU trainer and the other 3 devices. A significant difference was also found between the DynaDisc and the half-foam roller.
Level of difficulty, as measured by COP area and average sway velocity, is different for commonly available rehabilitation equipment. Clinicians may find these results a useful guide when progressing patients through balance training.
Liam Anderson, Graeme L. Close, Matt Konopinski, David Rydings, Jordan Milsom, Catherine Hambly, John Roger Speakman, Barry Drust and James P. Morton
; Waldén et al., 2016 ), with factors affecting the length of recovery, including concomitant damage (e.g., chondral defect or posterolateral corner damage) and achieving the necessary exit criteria as part of the rehabilitation program (e.g., strength, power, range of motion, biomechanics, and load
Christina Davlin and Jody Jenike
To present the case of a Division I female college basketball player with a complete Achilles tendon rupture.
A 19-year-old, female college basketball player ruptured her right Achilles tendon during preseason conditioning. She had no previous history of heel cord symptoms.
The athlete underwent open surgical repair of Achilles tendon. The athlete successfully progressed through a functional rehabilitation program focused on early mobilization and weight bearing. The rehabilitation program was continually modified to address deficiencies and to keep the athlete actively engaged. She was cleared for full, unrestricted activity 15 weeks and 3 days after surgery and returned to game participation in 16 weeks.
This case provides evidence that early mobilization and weight bearing can be used while still protecting the repaired tendon.
Kathleen A. Swanik, Kellie Huxel Bliven and Charles Buz Swanik
There are contradictory data on optimal muscle-activation strategies for restoring shoulder stability. Further investigation of neuromuscular-control strategies for glenohumeral-joint stability will guide clinicians in decisions regarding appropriate rehabilitation exercises.
To determine whether subscapularis, infraspinatus, and teres minor (anteroposterior force couple) muscle activation differ between 4 shoulder exercises and describe coactivation ratios and individual muscle-recruitment characteristics of rotator-cuff muscles throughout each shoulder exercise.
healthy, physically active men, age 20.55 ± 2.0 y.
4 rehabilitation exercises: pitchback, PNF D2 pattern with tubing, push-up plus, and slide board.
Main Outcomes Measures:
Mean coactivation level, coactivation-ratio patterns, and level (area) of muscle-activation patterns of the subscapularis, infraspinatus, and teres minor throughout each exercise.
Coactivation levels varied throughout each exercise. Subscapularis activity was consistently higher than that of the infraspinatus and teres minor combined at the start of each exercise and in end ranges of motion. Individual muscle-recruitment levels in the subscapularis were also different between exercises.
Results provide descriptive data for determining normative coactivation-ratio values for muscle recruitment for the functional exercises studied. Differences in subscapularis activation suggest a reliance to resist anteriorly directed forces.