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Elizabeth Lawinger, Tim L. Uhl, Mark Abel and Srinath Kamineni

Objective:

The overarching goal of this study was to examine the use of triaxial accelerometers in measuring upper-extremity motions to monitor upper-extremity-exercise compliance. There were multiple questions investigated, but the primary objective was to investigate the correlation between visually observed arm motions and triaxial accelerometer activity counts to establish fundamental activity counts for the upper extremity.

Study Design:

Cross-sectional, basic research.

Setting:

Clinical laboratory.

Participants:

Thirty healthy individuals age 26 ± 6 y, body mass 24 ± 3 kg, and height 1.68 ± 0.09 m volunteered.

Intervention:

Participants performed 3 series of tasks: activities of daily living (ADLs), rehabilitation exercises, and passive shoulder range of motion at 5 specific velocities on an isokinetic dynamometer while wearing an accelerometer on each wrist. Participants performed exercises with their dominant arm to examine differences between sides. A researcher visually counted all arm motions to correlate counts with physical activity counts provided by the accelerometer.

Main Outcome Measure:

Physical activity counts derived from the accelerometer and visually observed activity counts recorded from a single investigator.

Results:

There was a strong positive correlation (r = .93, P < .01) between accelerometer physical activity counts and visual activity counts for all ADLs. Accelerometers activity counts demonstrated side-to-side difference for all ADLs (P < .001) and 5 of the 7 rehabilitation activities (P < .003). All velocities tested on the isokinetic dynamometer were shown to be significantly different from each other (P < .001).

Conclusion:

There is a linear relationship between arm motions counted visually and the physical activity counts generated by an accelerometer, indicating that arm motions could be potentially accounted for if monitoring arm usage. The accelerometers can detect differences in relatively slow arm-movement velocities, which is critical if attempting to evaluate exercise compliance during early phases of shoulder rehabilitation. These results provide fundamental information that indicates that triaxial accelerometers have the potential to objectively monitor and measure arm activities during rehabilitation and ADLs.

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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

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Kathleen A. Swanik, Kellie Huxel Bliven and Charles Buz Swanik

Context:

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.

Objectives:

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.

Design:

Crossover.

Setting:

Laboratory.

Participants:

healthy, physically active men, age 20.55 ± 2.0 y.

Interventions:

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.

Results:

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.

Conclusion:

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.

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Teddy W. Worrell

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.

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W. Steven Tucker, Charles W. Armstrong, Erik E. Swartz, Brian M. Campbell and James M. Rankin

Context:

Closed kinetic chain exercises are reported to provide a more functional rehabilitation outcome.

Objective:

To determine the amount of muscle activity in 4 shoulder muscles during exercise on the Cuff Link.

Design:

Repeated measures.

Setting:

Laboratory.

Subjects:

10 men and 10 women, age 18–50.

Intervention:

Subjects performed 3 sets of 5 revolutions on the Cuff Link in non-weight-bearing, partial-weight-bearing, and full-weight-bearing positions.

Main Outcome Measures:

Electromyography data were collected from the upper trapezius, anterior deltoid, serratus anterior, and pectoralis major and were expressed as percentage of maximal isometric contractions.

Results:

Significant differences were found across the weight-bearing conditions for all 4 muscles. Exercise on the Cuff Link required minimal to significant amounts of muscle recruitment.

Conclusions:

Muscle recruitment increases as weight bearing increases during use of the Cuff Link, suggesting an increase in dynamic stabilization of the glenohumeral joint.

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Joseph J. Godek

The key players in sports health care in the '90s will be physicians, athletic trainers, and physical therapists. The social and economic forces affecting our health care delivery system today must be considered by these professions as they assume their roles in sports health care. Athletic trainers are qualified to treat athletes in any setting but are best used in the traditional environment. Physical therapists should reemphasize the rehabilitation of the sick, infirm, and disabled and should take the lead in providing care for disabled athletes. Physicians must be the leaders in sports health care. They are best prepared to arbitrate the ongoing conflict between athletic trainers and physical therapists and to decide which of these professionals can treat recreational athletes.

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Lynne H. Johnston and Douglas Carroll

Objectives:

To examine the coping strategies used after injury and the provision of and satisfaction with social support as functions of sport involvement and stage of rehabilitation.

Design/Patiesits:

Complete data were available at 3 points (beginning, middle, and end of formal rehabilitation) for 93 patients, all of whom had sustained injury restricting normal functioning for at least 21 days.

Results/Conclusions:

Coping varied as a function of stage in rehabilitation, with patients deploying all strategies more at the beginning of rehabilitation. There was little variation in coping and social support, although those more involved in sport adopted a support-seeking coping strategy to a greater extent. Irrespective of sports-involvement status, women were more satisfied with practical and emotional support. Those who were more involved in sport were judged by their physiotherapists to be better adherents. Adoption of an emotional discharge coping strategy was negatively associated with adherence throughout rehabilitation.

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Lori A. Michener, Alison R. Snyder and Brian G. Leggin

Context:

The Numeric Pain Rating Scale (NPRS) is commonly used to assess pain. Change in the NPRS across time can be interpreted with responsiveness indices.

Objective:

To determine the minimal clinically important difference (MCID) of the NPRS.

Design:

Single-group repeated measures.

Setting:

Outpatient rehabilitation clinics.

Patients:

Patients with shoulder pain (N = 136).

Main Outcome Measures:

At the initial evaluation patients completed the Penn Shoulder Score (PSS), which includes pain, satisfaction, and function sections. Pain was measured using an 11-point NPRS for 3 conditions of pain: at rest, with normal daily activities, and with strenuous activities. The NPRS average was calculated by averaging the NPRS scores for 3 conditions of pain. The final PSS was completed after 3–4 wk of rehabilitation. To determine the MCID for the NPRS average, the minimal detectible change of 8.6 points for the PSS function scale (0–60 points) was used as an external criterion anchor to classify patients as meaningfully improved (≥8.6 point change) or not improved (<8.6-point change). The MCID for the NPRS average was also determined for subgroups of surgical and nonsurgical patients. Cohen’s effect sizes were calculated as a measure of group responsiveness for the NPRS average.

Results:

Using a receiver-operating-characteristic analysis, the MCID for the average NPRS for all patients was 2.17, and it was 2.17 for both the surgical and nonsurgical subgroup: area-under-the-curve range .74–.76 (95%CI: .55–.95). The effect size for all patients was 1.84, and it was 1.51 and 1.94 for the surgical and nonsurgical groups, respectively.

Conclusions:

The NPRS average of 3 pain questions demonstrated responsiveness with an MCID of 2.17 in patients with shoulder pain receiving rehabilitation for 3–4 wk. The effect sizes indicated a large effect. However, responsiveness values are not static. Further research is indicated to assess responsiveness of the NPRS average in different types of patients with shoulder pain.

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Luke Donovan, Joseph M. Hart and Jay Hertel

Context:

Ankle-destabilization devices are rehabilitation tools that may improve neuromuscular control by increasing lower-extremity muscle activation. Their effects should be tested in healthy individuals before being implemented in rehabilitation programs.

Objective:

To compare EMG activation of lower-extremity muscles during walking while wearing 2 different ankle-destabilization devices.

Design:

Crossover.

Setting:

Laboratory.

Participants:

15 healthy young adults (5 men, 10 women).

Intervention:

Surface EMG activity was recorded from the anterior tibialis, peroneus longus, lateral gastrocnemius, rectus femoris, biceps femoris, and gluteus medius as subjects walked on a treadmill shod, with an ankle-destabilization boot (ADB), and an ankle-destabilization sandal (ADS).

Main Outcome Measures:

Normalized amplitudes 100 ms before and 200 ms after initial heel contact, time of onset activation relative to initial contact, and percent of activation time across the stride cycle were calculated for each muscle in each condition.

Results:

The precontact amplitudes of the peroneus longus and lateral gastrocnemius and the postcontact amplitudes of the lateral gastrocnemius were significantly greater in the ADB and ADS conditions. In the ADB condition, the rectus femoris and biceps femoris postcontact amplitudes were significantly greater than shod. The peroneus longus and lateral gastrocnemius were activated significantly earlier, and the anterior tibialis, lateral gastrocnemius, and rectus femoris were activated significantly longer across the stride cycle in the ADB and the ADS conditions. In addition, the peroneus longus was activated significantly longer in the ADB condition when compared with shod.

Conclusions:

Both ankle-destabilization devices caused an alteration in muscle activity during walking, which may be favorable to an injured patient. Therefore, implementing these devices in rehabilitation programs may be beneficial to improving neuromuscular control.

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Anna R. Cruz and Kenneth Mautner

In this case series, three elite college-level female volleyball players between 21 and 22 years old experienced acute abdominal pain during an overhead swinging motion. All three athletes were diagnosed with acute rectus abdominis (RA) muscle strain using musculoskeletal ultrasound, without the need for MRI. Each athlete sustained severe RA injury resulting in substantial loss of playing time and warranted a focused rehabilitation program, which emphasized core strengthening, physical modalities, and altering athletes’ hitting technique. RA muscle strain is a relatively infrequent, yet potentially severe, injury in elite volleyball players that necessitates early diagnosis and treatment to avoid prolonged or incomplete recovery.