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Tania Pizzari, Helen McBurney, Nicholas F. Taylor and Julian A. Feller

Objective:

To investigate the subjective experience of anterior cruciate ligament (ACL) rehabilitation and identify variables that influence adherence as perceived by ACL-reconstructed patients.

Design:

A qualitative study using in-depth interviews to gather data and thematic coding to analyze findings.

Setting:

Participants were interviewed at home or in their workplace.

Participants:

Eleven patients were interviewed at an average of 4.8 months (SD = 0.8) after ACL reconstruction.

Results:

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.

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Jeff Konin, Michael J. Axe and Ron Courson

The implementation of interval throwing programs during rehabilitation has been suggested in the literature to allow for a quicker and safer return of the throwing athlete to competition. Many programs have clearly focused on baseball players. This program is specifically designed for the football quarterback. The program encompasses a sound flexibility and strength training regime and provides for a supervised step-by-step progression of throwing. Although the authors have found success with early results, practitioners should apply this program with caution, as it may need to be modified for each athlete. The purpose of this paper is to establish a foundation for future work in the area of the throwing shoulder for the football quarterback.

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Lori A. Bolgla, Scott W. Shaffer and Terry R. Malone

Context:

Knee extension exercise is an important part of knee rehabilitation. Clinicians prescribe non-weight bearing exercise initially and progress patients to weight bearing exercise once they can perform a straight leg raise (SLR).

Objective:

Compare VM activation during a SLR and weight bearing exercises.

Design:

One-way repeated measures design.

Setting:

University Laboratory.

Subjects:

Fifteen healthy subjects.

Intervention:

One SLR exercise and 6 weight-bearing knee extension exercises.

Main Outcome Measures:

Electromyographic amplitudes for the VM expressed as a percent maximum voluntary isometric contraction.

Results:

The SLR had greater activation than the single leg stance and bilateral squat exercises. The step-up and unilateral leg press exercises had the greatest activation.

Conclusions:

SLR performance can be an important indicator for exercise progression. These results provide foundational knowledge to assist clinicians with exercise prescription.

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Casper de Boer, Johannes van der Steen, Francesco Mattace-Raso, Agnita J.W. Boon and Johan J.M. Pel

The early stages of neurodegenerative disorders such as Alzheimer’s disease (AD) and Parkinson’s disease (PD) involve deterioration of specific (visuo)motor functions. The aim of the current study was to investigate differences in visuomotor behavior between age-matched groups of 17 patients with AD, 17 patients with PD, and 20 healthy control subjects across three eye-hand-coordination tasks of different cognitive complexity. In two of three tasks, timing and execution parameters of eyes and hand significantly differed between groups. Timing and execution parameters of the eyes and hands could potentially give a quantitative description of disease specific deficits in the spatial and temporal domains and may serve as a tool to monitor disease progression in AD and PD populations.

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Todd G. Goldbeck and George J. Davies

Context:

Functional testing of patients is essential to clinicians because it provides objective data for documentation that can be used for serial reassessment and progression through a rehabilitation program. Furthermore, new tests should require minimal time, space, and money to implement.

Purpose:

To determine the test-retest reliability of the Closed Kinetic Chain (CKC) Upper Extremity Stability Test.

Participants:

Twenty-four male college students.

Methods:

Each subject was tested initially and again 7 days later. Each subject performed 1 submaximal test followed by 3 maximal efforts. A 45-second rest was given after each 15-second test. The 2 maximal-test scores were averaged and compared with those from the retest.

Results:

The intraclass correlation coefficient was .922 for test-retest reliability. A paired-samples t test (.927) was conducted, and the coefficient of stability was .859. The results indicate that the CKC Upper Extremity Stability Test is a reliable evaluation tool.

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William C. Whiting, Robert J. Gregor and Marie Halushka

Eight male javelin throwers were filmed while throwing new-rules javelins during competition at five meets over a 2-year period. Body segment kinematics and javelin release parameters were assessed relative to their contribution to throwing performance. The data suggest that successful throws, as judged by distance thrown, are characterized by higher release speeds, longer last-step lengths, less flexion of the front-leg knee during the final plant phase, and an orderly progression of peak speeds at the hip, shoulder, and elbow from the onset of double leg support until release. Individual variability in performance was associated with differences measured between several throwing variables. Limitations inherent to two-dimensional analysis were identified that highlighted the need for three-dimensional investigation of the javelin throw.

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Marc J. Philippon, Jesse C. Christensen and Michael S. Wahoff

Objective:

To report the 4-phase rehabilitation progression of a professional athlete who underwent arthroscopic intra-articular repair of the hip after injury during the 2006–07 season.

Design:

Case study; level of evidence, 4.

Main Outcome Measures:

Objective values were obtained by standard goniometric measurements, handheld dynamometer, dynamic sports testing, and clinical testing for intra-articular pathology.

Results:

This case report illustrates improvements in hip mobility, muscle-force output, elimination of clinical signs of intra-articular involvement, and ability to perform high-level sport-specific training at 9 wk postsurgery. At 16 wk postsurgery, the patient was able to return to full preparation for sport for the following season.

Conclusion:

After the 4-phase rehabilitation program, the patient demonstrated improvement in all areas of high-level function after an arthroscopic intra-articular repair of the hip. The preoperative management to return to sport is outlined, with clinical outcomes and criteria for return to competition.

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Alexandra Milligan, Chris Mills and Joanna Scurr

More and more studies are emerging reporting breast kinematics. These studies rarely present effect sizes, power, and variance in the data. Important inferences are drawn from these data, including applications to product design, breast pain assessment, sports performance effects, and more. The aim of the study was to explore the within-participant variance in breast kinematic data during a 5 km run. Multiplanar breast kinematics and within-participant variance, defined by the coefficient of variation, for 10 female participants wearing a low and high level breast support were calculated during a 5 km run. Greater within-participant variance was reported in the high level (mean = 15%) breast support compared with the low level (mean = 12%). Within-participant variance in breast kinematics did not change over the 5 km run. Differences in the magnitude of within-participant variance in breast kinematics were reported between directions of breast movement, with greater levels in the anteroposterior direction compared with mediolateral and vertical. It is important for the progression of this research area that the presence and sources of within-participant variance in breast kinematics are quantified and acknowledged, ensuring that the margin for meaningful differences can be reported.

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Gilbert M. Willett, Gregory M. Karst, Ellen M. Canney, Derrick Gallant and Jodene M. Wees

The purpose of this study was to investigate the electromyographic (EMG) activity of selected lower limb muscles during forward- and backward-facing stair-stepping exercises using a hydraulic step ergometer and during step aerobics using a standard 8 in. high step. Surface electrodes recorded EMG data from the vastus lateralis (VL), vastus medialis obliquus (VMO), and biceps femoris (BF) muscles on the right lower limbs of 13 healthy subjects under each of the four exercise conditions. Normalized mean EMG amplitude data were used to test for activity-dependent differences. Results indicated that (a) the VL and VMO were significantly (p < .05) more active during step ergometry than during step aerobics, (b) the BF was significantly (p < .05) more active during step aerobics than during step ergometry, and (c) when forward- versus backward-facing positions were compared, there were no statistically significant differences in mean EMG activity for either of the activities. These findings provide information relevant to the use and progression of stepping exercises commonly used for knee muscle strengthening and knee injury rehabilitation programs.

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Rachel S. Johnson, Mia K. Provenzano, Larynn M. Shumaker, Tamara C. Valovich McLeod and Cailee E. Welch Bacon

Clinical Scenario:

It is hypothesized that cognitive activity following a concussion may potentially hinder patient recovery. While the recommendation of cognitive rest is often maintained and rationalized, a causal relationship between cognitive activity and symptom duration has yet to be established.

Clinical Question:

Does the implementation of cognitive rest as part of the postconcussion management plan reduce the number of days until the concussed adolescent patient is symptom free compared to a postconcussion management plan that does not incorporate cognitive rest?

Summary of Key Findings:

A thorough literature search returned 7 possible studies; 5 studies met the inclusion criteria and were included. Three studies indicated that increased cognitive activity is associated with longer recovery from a concussion, and, therefore, supported the use of cognitive rest. One study indicated that the recommendation for cognitive rest was not significantly associated with time to concussion symptom resolution. One study indicated that strict rest, defined as 5 days of no school, work, or physical activity; might prolong symptom duration.

Clinical Bottom Line:

There is moderate evidence to support the prescription of moderate cognitive rest for concussed patients. Clinicians who intend on implementing cognitive rest in their concussion protocols should be aware of inconsistencies and be open-minded to alternative treatment progressions while taking into consideration each individual patient and maintaining adequate patient-centered care principles.

Strength of Recommendation:

Grade B evidence exists that prescription of moderate cognitive rest for concussed patients may be beneficial as a supplement to physical rest as treatment for symptom reduction in adolescents.