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Jerry Mayo, Brian Lyons, Kendal Honea, John Alvarez and Richard Byrum

Context:

Rehabilitation specialists should understand cardiovascular responses to different movement patterns.

Objective:

To investigate physiological responses to forward- (FM), backward- (BM), and lateral-motion (LM) exercise at self-selected intensities.

Design:

Within-subjects design to test independent variable, movement pattern; repeated-measures ANOVA to analyze oxygen consumption (VO2), heart rate (HR), respiratory-exchange ratio (RER), and ratings of perceived exertion (RPE).

Participants:

10 healthy women.

Results:

VO2 and HR were significantly higher during LM than during FM and BM exercise. The respective VO2 (ml · kg · min–1) and HR (beats/min) values for each condition were FM 25.19 ± 3.6, 142 ± 11; BM 24.24 ± 2.7, 145 ± 12; and LM 30.5 ± 4.6, 160 ± 13. No differences were observed for RER or RPE.

Conclusions:

At self-selected intensities all 3 modes met criteria for maintaining cardiovascular fitness. Practitioners can use these results to develop rehabilitation programs based on clients’ perception and level of discomfort

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Tristan Rodik and Brendon McDermott

Clinical Scenario:

Lateral epicondylitis (LE) is a relatively common pathology capable of producing chronic debilitation in a variety of patients. A newer treatment for orthopedic conditions is platelet-rich plasma (PrP) local injection.

Focused Clinical Question:

Is PrP a more appropriate injection therapy for LE than other common injections such as corticosteroid or whole blood?

Summary of Key Findings:

Four studies were included: 1 randomized controlled trial (RCT), 2 double-blind RCTs, and 1 cohort study. Two studies involved comparisons of PrP injection to corticosteroid injection. One of the studies involved a 2-y follow-up while another involved a 1-y follow-up. Another study involved the comparison of PrP injection with whole-blood injection with a 6-mo follow-up. The final study included a PrP-injection group and control group. The 2 studies involving PrP vs corticosteroid injections with 2-y and 1-y follow-ups both favored PrP over corticosteroid injection in terms of pain reduction and function increases. The third study favored PrP injections over whole-blood injections at 6 mo regarding pain reduction. All studies demonstrated significant improvements with PrP over comparison injections or no injection.

Clinical Bottom Line:

PrP injections provide more favorable pain and function outcomes than whole blood and corticosteroid injections for 1–2 y after injection.

Strength of Recommendation:

Consistent findings from RCTs suggest level 1b evidence in support of PrP injection as a treatment for LE.

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Pamela J. Hoyes Beehler

Hand laterality research efforts have shown a performance advantage in terms of pointing accuracy and limb speed (movement time—MVT) for the preferred hand (right-hand), and a slight reaction time (RT) performance advantage for the non-preferred hand (left-hand) for rapid manual aiming movements (Flowers, 1975; Roy, 1983; Roy & Elliott, 1986). These performance advantages for the right and left-hands, respectively, are considered an enigma in the motor behavior literature (Magill, 1993) and were investigated. The purpose of this study was to determine the effects of skill level, hand laterality, and movement direction during visuomotor processing of female athletes performing manual aiming tasks. Results showed that skill level and hand laterality did not influence the initiation of manual aiming movements; but, left direction movements were initiated faster than right direction movements. Right-hand MVT was faster than left-hand MVT; but, main effects skill level and movement direction were not significant for MVT. Skill level did interact with hand laterality and movement direction for MVT. Also, right-hand right direction movements were the easiest manual aiming tasks to complete while left-hand right direction movements were the most difficult manual aiming tasks to complete. Differences in hemispheric visuomotor processing when performing manual aiming movements based on skill level and hand laterality were discussed. Training implications for manual aiming movements were also discussed.

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Paul F. Greene, Christopher J. Durall and Thomas W. Kernozek

Context:

A torso-elevated side support (TESS) has previously been described for measuring endurance of the lateral trunk muscles. In some individuals, however, TESS performance may be hindered by upper extremity pain or fatigue. For this reason a novel test, the feet-elevated side-support test (FESS), was examined.

Objective:

To determine intersession reliability of a FESS and a TESS on the left and right sides using a single examiner, to evaluate the relationship between tests, and to compare reasons for test termination.

Design:

Nonexperimental prospective repeated measures.

Setting:

University laboratory.

Participants:

A convenience sample of 60 healthy participants from a university community (17 men, 43 women; age 21.1 ± 2.2 y; height 169.9 ± 9.5 cm; weight 67.1 ± 11.9 kg).

Results:

Intraclass correlation coefficient between 3 testing sessions = .87 with right FESS, .86 with left FESS, .78 with right TESS, and .91 with left TESS. Pearson correlation coefficients ranged from .59 (between left FESS and left TESS in women) to .75 (between left FESS and left TESS in men). Upper extremity pain or fatigue was the reason given for test termination in 42.5% of participants during the TESS and 5.0% during the FESS (P = .000, Fisher exact test).

Conclusions:

FESS and TESS had comparable intersession reliability by the same evaluator. Moderate to high correlations were found between FESS and TESS scores, suggesting that the tests assess similar qualities. Far fewer participants terminated the FESS because of upper extremity pain or fatigue. Thus, the FESS may be a suitable alternative to the previously validated TESS, particularly for individuals with upper extremity pain or weakness.

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Anthony P. Marsh, W. Jack Rejeski, Stacy L. Hutton, Cristal L. Brown, Edward Ip and Jack M. Guralnik

Lateral mobility is integral to many activities of daily living involving transfer from one position to another. The objective of this study was to develop and evaluate the validity and test–retest reliability of a lateral-mobility (LATMOB) task for older adults. Measurements of lateral mobility, balance, and strength and self-reported and performance-based physical functioning were obtained in 63 women and 77 men ≥50 years of age. The LATMOB task was significantly correlated with age, knee-extensor strength, grip strength, functional reach, and one-leg-stance time. Test–retest reliability of the task was excellent. The LATMOB task was highly correlated with the car task. Balance was significantly correlated with time to get into and out of a car and performance on the LATMOB task. The LATMOB task was significantly correlated with the Short Physical Performance Battery score. The LATMOB task is valid and reliable, but additional work is needed to assess its sensitivity to change and predictive validity.

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Nicole M. Livecchi, Charles W. Armstrong, Mitchell L. Cordova, Mark A. Merrick and James M. Rankin

Objective:

To compare average electromyogram (EMG) activity of the vastus medialis obliquus (VMO) and vastus lateralis (VL) during straight-leg raise (SLR) and knee extension (KE) with the hip in neutral and lateral rotation.

Design:

1 × 4 factorial repeated-measures.

Setting:

Laboratory.

Participants:

13 male college students.

Intervention:

SLR with hip flexed at 40°, in neutral position, and maximally laterally rotated and KE with hip in neutral and maximally laterally rotated.

Main Outcome Measure:

Average EMG activity during each of the 4 conditions, normalized against peak muscle activity during that trial.

Results:

No differences were observed between exercises in VMO activity (F 3,36 = 0.646, P > .05), VL activity (F 3,36 = 1.08, P > .05), or VMO:VL ratio (F 3,36 = 0.598, P > .05).

Conclusions:

Electrical activity of the VMO or VL and VMO:VL ratio do not change with hip position or exercise.

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Raymond Chronister, George C. Balazs, Adam Pickett, John-Paul H. Rue and David J. Keblish

Context:

Acute lateral patellar dislocation is a common injury sustained by athletes, and often requires several months to recover and return to play.

Objective:

To describe a novel protocol for the treatment of acute lateral patellar dislocation that returns patients to play far sooner than traditional treatment protocols.

Design:

Case series and review of the literature.

Setting:

Division I NCAA institution.

Patients:

Two collegiate athletes who sustained first-time acute lateral patellar dislocations.

Interventions:

Traditional standard of care for acute lateral patellar dislocation after reduction involves 1–7 weeks of immobilization in full extension. Knee stiffness commonly results from this method, and return to full activity typically takes 2–4 months. We used a protocol involving immobilization in maximal flexion for 24 hr, with early aggressive range of motion and quadriceps strengthening in the first week after injury.

Main Outcome Measures:

Time to return to play.

Results:

Immediate on-site reduction of the patella followed by 24 hr of immobilization in maximal knee flexion was performed. Following an accelerated rehabilitation regimen, patients were able to return to sport an average of 3 days postinjury. Neither patient has experienced a recurrent dislocation.

Conclusions:

Our protocol is based on anatomic studies demonstrating reduced tension on the medial patellofemoral ligament, reduced hemarthrosis, and reduced soft tissue swelling in maximal knee flexion. This method apparently bypasses the knee stiffness and deconditioning commonly seen with traditional nonoperative regimens, allowing return to sport weeks or months sooner.

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Eric Yiou and Manh-Cuong Do

This study examined how the central nervous system organizes mediolateral (ML) “anticipatory postural adjustments” (APAs) for stepping initiation (SI) to take into account the postural perturbation induced by voluntary lateral arm raising. Subjects purposely stepped in isolation (“isolated stepping”) or in combination with lateral raising of dominant arm (“motor sequence”). SI was carried out with the leg ipsilateral or controlateral to raising arm. Results showed that APA amplitude increased from “ipsilateral isolated stepping” to “ipsilateral sequence”, but did not change in conditions involving controlateral leg; ML instability increased from “ipsilateral isolated stepping” to “ipsilateral sequence”, but decreased from “controlateral isolated stepping” to “controlateral sequence”. These changes were exacerbated when inertia was added at the hand during raising. These results suggest that APAs for SI are globally scaled as a function of the biomechanical consequences of forthcoming arm movement on ML postural stability.

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Ronald V. Croce, John P. Miller, Robert Confessore and James C. Vailas

The purpose of this study was to examine coactivation patterns of the lateral and medial quadriceps and the lateral and medial hamstrings during low- and moderate-speed isokinetic movements. Twelve female athletes performed isokinetic knee assessments at 60 and 180°/s. Root mean square electromyographic (rmsEMG) activity and the median frequency of the EMG (mfEMG) were determined by placing bipolar surface electrodes on the vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), and medial hamstrings (MH). Results of rmsEMG indicated that the VM showed almost twice the coactivation of the VL (p < .05), and that the BF showed almost four times the coactivation of the MH (p < .05). Finally, differences were noted in the mfEMG (p < .05), with the VM displaying different recruitment patterns at 180°/s as an agonist compared to that as an antagonist. Results indicated that when acting as antagonists, the VM and BE display the greatest EMG patterns during isokinetic knee joint movement.

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Stephen C. Cobb, Mukta N. Joshi and Robin L. Pomeroy

In-vitro and invasive in-vivo studies have reported relatively independent motion in the medial and lateral forefoot segments during gait. However, most current surface-based models have not defined medial and lateral forefoot or midfoot segments. The purpose of the current study was to determine the reliability of a 7-segment foot model that includes medial and lateral midfoot and forefoot segments during walking gait. Three-dimensional positions of marker clusters located on the leg and 6 foot segments were tracked as 10 participants completed 5 walking trials. To examine the reliability of the foot model, coefficients of multiple correlation (CMC) were calculated across the trials for each participant. Three-dimensional stance time series and range of motion (ROM) during stance were also calculated for each functional articulation. CMCs for all of the functional articulations were ≥ 0.80. Overall, the rearfoot complex (leg–calcaneus segments) was the most reliable articulation and the medial midfoot complex (calcaneus–navicular segments) was the least reliable. With respect to ROM, reliability was greatest for plantarflexion/dorsiflexion and least for abduction/adduction. Further, the stance ROM and time-series patterns results between the current study and previous invasive in-vivo studies that have assessed actual bone motion were generally consistent.