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Peter R. Blanpied

Closed kinetic chain exercises are commonly used in strengthening and rehabilitation programs. Altering positions of body segments and supports might affect the way these exercises are performed. The purpose of this study was to compare gluteal, quadriceps, hamstring, and plantar flexor muscle activations during wall-slide (WS) vs. squat-machine (SM) exercise. In addition, the effects of support location and foot position were investigated. Twenty women performed 8 exercises, to 60° of knee flexion. Results indicated that placing the foot forward caused an increase in all muscle activations except in the plantar flexors, which showed an increase with the foot placed in line with the hip. This effect was exaggerated during WS for the plantar flexors and quadriceps and during SM for the hamstrings. When the support was located at the scapular level, hamstring and gluteal activations were greater, and quadriceps activity was less during SM than during WS. These results could be used to target specific muscle groups during strengthening exercise.

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Fraser Carson and Remco C. J. Polman

The aim of this case study was to investigate the emotional factors and coping strategies used by a professional rugby union player during rehabilitation from anterior cruciate ligament (ACL) injury. A dominant (qualitative) - less dominant (quantitative) mixed methodological approach was established concurrent with the athlete’s rehabilitation. Twice monthly interviews and a self-report diary were completed throughout the rehabilitation process. Six questionnaires were used to assess specific aspects of injury rehabilitation identified from previous literature, including emotional response, coping, social support, and perceived autonomy. Content analysis of each phase of the rehabilitation process established 34 higher-order themes split into two general dimensions: Influential Emotions or Coping Strategies. Findings highlight the benefit of problem-focused coping to improve autonomy and confidence. A sequential movement through a series of emotions (shock, depression, relief, encouragement, and confidence building) was also identified.

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Judith A. Rock and Marc V. Jones

Objectives:

To explore the usefulness of counseling skills for 3 athletes undergoing rehabilitation from anterior-cruciate-ligament-reconstruction surgery.

Design:

A series of 3 case studies explored the impact of a counseling-skills intervention over 12 weeks postsurgery. Semistructured interviews were conducted 12 weeks postsurgery for triangulation and social validation of intervention.

Participants:

3 athletes meeting selection criteria, recruited from a hospital waiting list and receiving standardized rehabilitation regime.

Intervention:

Participants each received 6 counseling skills interventions at 2-week intervals.

Main Outcome Measures:

Mood, perceived rehabilitation, pain ratings, social support.

Results:

Triangulation of interview data and outcome measures provided some evidence of the beneficial impact of counseling skills on psychological outcomes. It also indicated that setbacks could present challenges to rehabilitation.

Conclusions:

Counseling skills can enhance psychological well-being of athletes during rehabilitation and be especially important during setbacks.

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Megan D. Granquist, Leslie Podlog, Joanna R. Engel and Aubrey Newland

Context:

Adherence to sport-injury rehabilitation protocols may be pivotal in ensuring successful rehabilitation and return-to-play outcomes.

Objectives:

To investigate athletic trainers' perspectives related to the degree to which rehabilitation adherence is an issue in collegiate athletic training settings, gain insight from certified athletic trainers regarding the factors contributing to rehabilitation nonadherence (underadherence and overadherence), and ascertain views on the most effective means for promoting adherence.

Design:

Crosssectional, mixed methods.

Setting:

Collegiate athletic training in the United States.

Participants:

Certified athletic trainers (n = 479; 234 male, 245 female).

Main Outcome Measures:

Online survey consisting of 3 questions regarding rehabilitation adherence, each followed by an open-ended comments section. Descriptive statistics were calculated for quantitative items; hierarchical content analyses were conducted for qualitative items.

Results:

Most (98.3%) participants reported poor rehabilitation adherence to be a problem (1.7% = no problem, 29.2% = minor problem, 49.7% = problem, 19.4% = major problem), while most (98.96%) participants reported that they had athletes who exhibited poor rehabilitation adherence (1% = never, 71.4% = occasionally, 22.5% = often, 5% = always). In addition, the majority (97.91%) of participants reported that overadherence (eg, doing too much, failing to comply with activity restrictions, etc) was at least an occasional occurrence (2.1% = never, 69.3% = occasionally, 26.3% = often, 1.9% = always). Hierarchical content analyses regarding the constructs of poor adherence and overadherence revealed 4 major themes: the motivation to adhere, the development of good athletic trainer–athlete rapport and effective communication, athletic trainers' perception of the coaches' role in fostering adherence, and the influence of injury- or individual- (eg, injury severity, sport type, gender) specific characteristics on rehabilitation adherence.

Conclusions:

These results suggest that participants believe that underadherence (and to a lesser extent overadherence) is a frequent occurrence in collegiate athletic training settings. Strategies for enhancing rehabilitation adherence rates and preventing overadherence may therefore be important for optimizing rehabilitation outcomes.

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Pascal David, Mohamad Halimi, Isabelle Mora, Pierre-Louis Doutrellot and Michel Petitjean

Ankle sprains are among the most common sport-related injuries and can lead to chronic ankle instability. Impaired sensorimotor function of the ankle musculature is often suggested as a cause. The current study sought to assess and compare the isokinetic performance and electromyographic patterns of evertor and invertor muscles in patients with chronic ankle instability and in a control group. Twelve patients with chronic ankle instability and twelve healthy subjects were included. Isokinetic eccentric and concentric testing at various angular velocities was performed for eversion and inversion movements. The corresponding myoelectric activities of the fibularis longus and tibialis anterior muscles were quantified from surface electromyographic recordings by computing average root mean square values. Patients had lower myoelectric activity of the evertor and invertor muscles than controls did; this difference could account for the eccentric weakness associated with ankle instability. Functional strength ratios revealed a dynamic strength imbalance in unstable ankle patients and that may contribute to recurrent injury. Our findings suggest that rehabilitation programs for unstable ankle patients must be focused on the motor control of eccentric contractions of the ankle evertors and invertors, to boost these muscles’ contribution to ankle stabilization.

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Sung-min Ha, Oh-yun Kwon, Su-jung Kim and Sung-dae Choung

Context:

A normal breathing pattern while performing the abdominal-hollowing (AH) maneuver or spinal-stabilization exercise is essential for the success of rehabilitation programs and exercises. In previous studies, subjects were given standardized instructions to control the influence of respiration during the AH maneuver. However, the effect of breathing pattern on abdominal-muscle thickness during the AH maneuver has not been investigated.

Objective:

To compare abdominal-muscle thickness in subjects performing the AH maneuver under normal and abnormal breathing-pattern conditions and to investigate the effect of breathing pattern on the preferential contraction ratio (PCR) of the transverse abdominis.

Design:

Comparative, repeated-measures experimental study.

Setting:

University research laboratory.

Participants:

16 healthy subjects (8 male, 8 female) from a university population.

Measurement:

A real-time ultrasound scanner was used to measure abdominal-muscle thickness during normal and abnormal breathing patterns. A paired t test was used to assess the effect of breathing pattern on abdominal-muscle thickness and PCR.

Results:

Muscle thickness in the transverse abdominis and internal oblique muscles was significantly greater under the normal breathing pattern than under the abnormal pattern (P < .05). The PCR of the transverse abdominis was significantly higher under the normal breathing pattern compared with the abnormal pattern (P < .05).

Conclusion:

The results indicate that a normal breathing pattern is essential for performance of an effective AH maneuver. Thus, clinicians should ensure that patients adopt a normal breathing pattern before performing the AH maneuver and monitor transverse abdominis activation during the maneuver.

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Dominic James Farris, Erica Buckeridge, Grant Trewartha and Miranda Polly McGuigan

This study assessed the effects of orthotic heel lifts on Achilles tendon (AT) force and strain during running. Ten females ran barefoot over a force plate in three conditions: no heel lifts (NHL), with 12 mm heel lifts (12HL) and with 18 mm heel lifts (18HL). Kinematics for the right lower limb were collected (200 Hz). AT force was calculated from inverse dynamics. AT strain was determined from kinematics and ultrasound images of medial gastrocnemius (50 Hz). Peak AT strain was less for 18HL (5.5 ± 4.4%) than for NHL (7.4 ± 4.2%) (p = .029, effect size [ES] = 0.44) but not for 12HL (5.8 ± 4.8%) versus NHL (ES = 0.35). Peak AT force was significantly (p = .024, ES = 0.42) less for 18HL (2382 ± 717 N) than for NHL (2710 ± 830 N) but not for 12HL (2538 ± 823 N, ES = 0.21). The 18HL reduced ankle dorsiflexion but not flexion-extension ankle moments and increased the AT moment arm compared with NHL. Thus, 18HL reduced force and strain on the AT during running via a reduction in dorsiflexion, which lengthened the AT moment arm. Therefore, heel lifts could be used to reduce AT loading and strain during the rehabilitation of AT injuries.

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Robert C. Manske and George J. Davies

Context:

Most patients on an index concentric isokinetic test of the shoulder internal and external rotators have significant torque-acceleration-energy (TAE) deficits.

Objective:

To assess the effectiveness of rehabilitation on muscle power in patients with shoulder dysfunctions.

Design:

Prospective, pretest–posttest.

Setting:

Physical therapy clinic.

Participants:

67, mean age 28.7 ± 12.89 years.

Main Outcome Measures:

Concentric shoulder internal and external rotators measured with arm at 90° of abduction, 90° of elbow flexion. Isokinetic velocities tested: 60°, 180°, and 300°/s.

Results:

A paired t test (P < .05) compared the differences from index to discharge test for involved and uninvolved internal and external shoulder rotators. Percentages of TAE deficits involved vs uninvolved on discharge and change in TAE from index to discharge were also analyzed. Significant improvement of the involved shoulder for all velocities for both internal and external rotators was seen. The uninvolved extremity saw statistically significant improvements at all velocities for external rotators yet only at 300°/s for internal rotators. Involved-extremity TAE deficits returned to within 10% on discharge.

Conclusions:

The study demonstrated improved muscle power as measured by TAE in shoulder internal and external rotators in a sample of patients treated in an outpatient clinic.

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Jeffrey A. Borgmeyer, Bradley A. Scott and Jerry L. Mayhew

Context:

The effect of ice massage on muscle-strength performance is equivocal.

Objective:

To determine the effects of ice massage on maximum isokinetic torque produced during a 20-minute interval.

Design:

Participants performed a maximal isokinetic contraction of the right arm at 30°/s every 2 minutes for 20 minutes, once after a 10-minute ice massage over the right biceps brachii muscle belly and once without ice treatment. Sessions were randomized.

Participants:

11 college men.

Measurements:

Torque was measured with a Cybex® II dynamometer. Biceps skinfold was measured with a Harpenden caliper.

Results:

A repeated-measures ANCOVA revealed no significant interaction between time and treatment condition when the effect of skinfold thickness was held constant. A main effect for time indicated that torque production was significantly higher at 4 and 8 minutes and declined thereafter.

Conclusions:

A 10-minute ice massage neither enhanced nor retarded muscle-force output and thus may be used for its pain-reducing effect to allow resistance exercise during the rehabilitation process

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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.