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Stefan C. Garcia, Jeffrey J. Dueweke and Christopher L. Mendias

Context: Manual isometric muscle testing is a common clinical technique used to assess muscle strength. To provide the most accurate data for the test, the muscle being assessed should be at a length in which it produces maximum force. However, there is tremendous variability in the recommended positions and joint angles used to conduct these tests, with few apparent objective data used to position the joint such that muscle-force production is greatest. Objective: To use validated anatomically and biomechanically based musculoskeletal models to identify the optimal joint positions in which to perform manual isometric testing. Design: In silico analysis. Main outcome measure: The joint position which produces maximum muscle force for 49 major limb and trunk muscles. Results: The optimal joint position for performing a manual isometric test was determined. Conclusion: Using objective anatomical models that take into account the force-length properties of muscles, the authors identified joint positions in which net muscle-force production was predicted to be maximal. This data can help health care providers to better assess muscle function when manual isometric strength tests are performed.

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Tricia Majewski-Schrage and Kelli Snyder

Clinical Scenario:

Managing edema after trauma or injury is a primary concern for health care professionals, as it is theorized that delaying the removal of edema will increase secondary injury and result in a longer recovery period. The inflammatory process generates a series of events, starting with bleeding and ultimately leading to fluid accumulation in intercellular spaces and the formation of edema. Once edema is formed, the lymphatic system plays a tremendous role in removing excess interstitial fluid and returning the fluid to the circulatory system. Therefore, rehabilitation specialists ought to use therapies that enhance the uptake of edema via the lymphatic system to manage edema; however, the modalities commonly used are ice, compression, and elevation. Modalities such as these may be effective at preventing swelling but present limited evidence to suggest that the function of the lymphatic system is enhanced. Manual lymphatic drainage (MLD) is a manual therapy technique that assists the lymphatic system function by promoting variations in interstitial pressures by applying light pressure using different hand movements.

Focused Clinical Question:

Does MLD improve patient- and disease-oriented outcomes for patients with orthopedic injuries?

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ZáNean McClain and E. Andrew Pitchford

present a conceptual model for the interaction between individuals with MS and their health care providers to promote physical activity. The conceptual model includes three layers: the base level is health care provider training and support, the intermediate level is patient–provider interaction, and the

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Michelle Cleary


To present strategies for identifying predisposing conditions, susceptibility, and incidence reduction for the most common exertional heat illnesses (EHI): heat cramps, heat exhaustion, and most importantly, heat stroke.

Data Sources:

A comprehensive literature review of MEDLINE and 1996 to 2006, including all retrospective, controlled studies of EHI risk using the following keywords: exertional heat illness risk, exertional heat stroke risk, and exercise-induced dehydration risk. Search limits included the following: English language, published in the last 10 years, clinical trial, meta-analysis, practice guideline, randomized controlled trial, review, and humans. A manual review was conducted of relevant position statements and book chapters including the reference lists.

Data Extraction:

To evaluate the quality of the empirical studies to be included in this review, each study must have scored at least 17/22 or 77% of items included when reporting a randomized trial using the CONSORT checklist.

Data Synthesis:

Many cases of EHI are preventable and can be successfully treated if the ATC® identifies individuals at increased relative risk and implement appropriate prevention strategies. The ability to objectively identify individuals at increased relative risk of EHI and to provide appropriate monitoring is critical in EHI prevention and reduction of repeated incidents of EHI.


For any heat illness prevention program to be effective, greater attention and continued observation is needed for athletes at high risk for EHI. For many athletic teams or programs, because of the sheer numbers and associated catastrophic injury potential, health care professionals must implement a system by which high-risk individuals are monitored during activity with the highest level of vigilance for prevention of EHI.

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Mark Stanbrough

Coaches play an extremely valuable role in a profession that offers the opportunity to help develop young people. The purpose of this study, which assessed the state of coaching education, was two-fold: 1) to determine coaching education knowledge and skills in meeting the National Coaching Standards, and 2) to determine the application of effective coaching principles in meeting the National Coaching Standards. An email containing a website link for an online survey was sent to all athletic directors in Kansas middle and high schools asking them to forward the website link to all coaches they worked with. A total of 1,414 surveys were returned. The current state of coaching education assessment listed the national coaching standards developed by NASPE and used a Likert scale to ask how prepared and successful the coaches are in meeting the standard. Results of the survey indicated that coaches feel highly prepared and successful in the following coaching standard topics: teaching positive behavior (Standard 2), demonstrating ethical conduct (Standard 4), environmental conditions (Standard 7), positive learning environments (Standard 19), and skills of the sport (standard 27). Coaches indicated that they felt least prepared and least successful in the following standards: coordinated health care program (Standard 10), psychological implications (Standard 11), conditioning based on exercise physiology (Standard 12), teaching proper nutrition (Standard 13), conditioning to return to play after injury (Standard 15), mental skill training (Standard 24), managing human resources (Standard 32), managing fiscal resources (Standard 33) and emergency action plans (Standard 34). Findings from the study can be used to direct coaching education in the areas coaches feel they are less prepared and less successful.

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Johanna M. Hurtubise, Cheryl Beech and Alison Macpherson


There is a lack of research on sex differences for severe injuries across a variety of sports at the collegiate level.


To compare differences in injury severity and concussion between sexes and collegiate sports.


Descriptive epidemiological study.


1,657 injuries were analyzed from collegiate teams at York University.

Data Collection and Analysis:

Injuries were assessed by a certified or student athletic therapist and were categorized based on degree of tissue and/or joint damage as either severe or nonsevere. Severe injuries included those with third degree damage, while all others were classified as nonsevere. Injury severity was compared between the sexes and across different sports using Pearson chisquare analysis. Logistic regression was used to assess the relative contribution of each covariate.


Males sustained 1,155 injuries, with 13.3% of them being severe, while females sustained only 502 injuries, 17.7% of which were severe. The odds of sustaining severe injuries among female athletes are 1.4 times the odds of male athletes (OR: 1.40, CI 1.05−1.86). Eleven percent of all female injuries were concussions—significantly more than males (χ2 = 11.03, p = .001). The odds of female athletes having a concussion are 1.9 times the odds of a male athlete (OR: 1.85, CI 1.28−2.67).


Based on our analysis, females are at an increased risk of sustaining a severe injury, particularly concussions. These findings highlight the need for future research into sex and sport-specific risk factors. This may provide information for health care professionals, coaches, and athletes for the proper prevention, on-field care, and treatment of sport injuries.

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Jason S. Scibek and Christopher R. Carcia


The efficacy of a variety of noninvasive, conservative management techniques for calcific tendinopathy has been investigated and established for improving pain and function and/or facilitating a decrease in the size or presence of calcium deposits. Surprisingly, few have reported on the use of traditional therapeutic exercise and rehabilitation alone in the management of this condition, given the often spontaneous resorptive nature of calcium deposits. The purpose of this case is to present the results of a conservative approach, including therapeutic exercise, for the management of calcific tendinopathy of the supraspinatus, with an emphasis on patient outcomes.

Case Description:

The patient was a self-referred 41-y-old man with complaints of acute right-shoulder pain and difficulty sleeping. Imaging studies revealed liquefied calcium deposits in the right supraspinatus. The patient reported constant pain at rest (9/10) and tenderness in the area of the greater tuberosity. He exhibited a decrease in all shoulder motions and had reduced strength. The simple shoulder test (SST) revealed limited function (0/12). Conservative management included superficial modalities and medication for pain and a regimen of scapulothoracic and glenohumeral range-of-motion (ROM) and strengthening exercises.


At discharge, pain levels decreased to 0/10 and SST scores increased to 12/12. ROM was full in all planes, and resisted motion was strong and pain free. The patient was able to engage in endurance activities and continue practicing as a health care provider.


The outcomes with respect to pain, function, and patient satisfaction provide evidence to support the use of conservative therapeutic interventions when managing patients with acute cases of calcific tendinopathy. Successful management of calcific tendinopathy requires attention to outcomes and an understanding of the pathophysiology, prognostic factors, and physical interventions based on the current stage of the calcium deposits and the patient’s status in the healing continuum.

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Shirleeah D. Fayson, Alan R. Needle and Thomas W. Kaminski


The use of Kinesio Tape among health care professional has grown recently in efforts to efficiently prevent and treat joint injuries. However, limited evidence exists regarding the efficacy of this technique in enhancing joint stability and neuromuscular control.


To determine how Kinesio Tape application to the ankle joint alters forces and muscle activity during a drop-jump maneuver.


Single-group pretest– posttest.


University laboratory.


22 healthy adults with no previous history of ankle injury.


Participants were instrumented with electromyography on the lower-leg muscles as they jumped from a 35-cm platform onto force plates. Test trials were performed without tape (BL), immediately after application of Kinesio Tape to the ankle (KT-I), and after 24 h of continued use (KT-24).

Main Outcome Measures:

Peak ground-reaction forces (GRFs) and time to peak GRF were compared across taping conditions, and the timing and amplitude of muscle activity from the tibialis anterior, peroneus longus, and lateral gastrocnemius were compared across taping conditions.


No significant differences in amplitude or timing of GRFs were observed (P > .05). However, muscle activity was observed to decrease from BL to KT-I in the tibialis anterior (P = .027) and from BL to KT-24 in the PL (P = .022).


The data suggest that Kinesio Tape decreases muscle activity in the ankle during a drop-jump maneuver, although no changes in GRFs were observed. This is contrary to the proposed mechanisms of Kinesio Tape. Further research might investigate how this affects participants with a history of injury.

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Rebecca M. Hirschhorn, Cassidy Holland, Amy F. Hand and James M. Mensch

affect physicians’ perceptions of athletic trainers’ skills. In recent years, health care has shifted more to an interprofessional collaboration (IPC) paradigm regarding patient care. Interprofessional collaboration occurs when professionals from a variety of disciplines and backgrounds work together

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, Management and Rehabilitation of Injuries in Elite Upper Extremity Athletes will provide attendees with an in-depth, evidence-based approach that will advance their ability to care for patients in multiple settings. Health care practitioners from the United States and United Kingdom will share their