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Melissa DiFabio, Lindsay V. Slater, Grant Norte, John Goetschius, Joseph M. Hart and Jay Hertel

series of functional tests used to assess lower extremity function after ACLR, provided unique information regarding limb performance and symmetry. The factor loading for involved/nondominant limb, uninvolved/dominant limb, and LSI were different based on group. Within the ACLR group, the loadings of the

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Robert C. Manske, Barbara Smith and Frank Wyatt

Context:

Athletes are often examined for return to sports using a functional-testing algorithm. No research has determined whether a closed kinetic chain (CKC) isokinetic testing bout influences the reliability of functional tests.

Objective:

To determine whether a concentric CKC isokinetic test bout alters test–retest reliability of lower extremity functional testing.

Design:

Subjects participated in velocity-spectrum CKC isokinetic bouts on 2 days 1 week apart.

Setting:

Hospital-based clinic.

Participants:

28 normal subjects (mean age 26.7 years, height 27.2 cm, weight 75.8 kg).

Analysis and Results:

Means and SDs were determined. Intraclass correlation coefficients were used to calculate test–retest reliability and between days 1 and 2 ranged from .91 to .98.

Conclusions:

Even after a CKC isokinetic test bout, test–retest reliability of functional tests is very high. Future research should determine test–retest reliability of functional tests for patients with lower extremity pathology.

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Rod A. Harter

Ankle injuries are the most common type of injury in sport worldwide, with ankle sprains accounting for 15% of all injuries. In this paper, the most recent, significant clinical research findings related to closed chain functional testing and rehabilitation of the ankle will be summarized. Biomechanical, physiological, and neurological rationales for integrated utilization of open and closed chain rehabilitation for the ankle will be discussed.

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Michael A. Tabor, George J. Davies, Thomas W. Kernozek, Rodney J. Negrete and Vincent Hudson

Context:

Many clinicians use functional-performance tests to determine an athlete’s readiness to resume activity; however, research demonstrating reliability of these tests is limited.

Objective:

To introduce the Lower Extremity Functional Test (LEFT) and establish it as a reliable assessment tool.

Design:

Week 1: Subjects participated in a training session. Week 2: Initial maximal-effort time measurements were recorded. Week 3: Retest time measurements were recorded.

Setting:

The University of Wisconsin–La Crosse (UW-L) and the University of Central Florida (UCF).

Subjects:

27 subjects from UW-L and 30 from UCF.

Main Outcome Measures:

Time measurements were analyzed using intraclass correlation coefficients (ICCs).

Results:

ICC values of .95 and .97 were established at UW-L and UCF, respectively.

Conclusions:

The LEFT is a reliable assessment tool.

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Terttu Parkatti, Jarmo Perttunen and Phyllis Wacker

This study examined the effects of an instructed structured Nordic walking (NW) exercise program on the functional capacity of older sedentary people. Volunteers were randomly assigned to an NW group (68.2 ± 3.8 yr old) or control group (69.9 ± 3.0 yr old). Before and at the end of the 9-wk intervention, functional tests and 2-dimensional ground-reaction-force (GRF) patterns of normal (1.40 m/s) and fast (1.94 m/s) walking speeds were measured. The intervention included a 60-min supervised NW session on an inside track twice a week for 9 wk. The mean changes in functional tests differed between groups significantly. Gait analyses showed no significant differences between the groups on any GRF parameters for walking speed either before or after the intervention. The study showed that NW has favorable effects on functional capacity in older people and is a suitable form of exercise for them.

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Jason Brumitt, Bryan C. Heiderscheit, Robert C. Manske, Paul Niemuth, Alma Mattocks and Mitchell J. Rauh

Context:

The Lower-Extremity Functional Test (LEFT) has been used to assess readiness to return to sport after a lowerextremity injury. Current recommendations suggest that women should complete the LEFT in 135 s (average; range 120–150 s) and men should complete the test in 100 s (average; range 90–125 s). However, these estimates are based on limited data and may not be reflective of college athletes. Thus, additional assessment, including normative data, of the LEFT in sport populations is warranted.

Objective:

To examine LEFT times based on descriptive information and off-season training habits in NCAA Division III (DIII) athletes. In addition, this study prospectively examined the LEFT’s ability to discriminate sport-related injury occurrence.

Design:

Descriptive epidemiology.

Setting:

DIII university.

Subjects:

189 DIII college athletes (106 women, 83 men) from 15 teams.

Main Outcome Measures:

LEFT times, preseason questionnaire, and time-loss injuries during the sport season.

Results:

Men completed the LEFT (105 ± 9 s) significantly faster than their female counterparts (117 ± 10 s) (P < .0001). Female athletes who reported >3–5 h/wk of plyometric training during the off-season had significantly slower LEFT scores than those who performed ≤3 h/wk of plyometric training (P = .03). The overall incidence of a lower-quadrant (LQ) time-loss injury for female athletes was 4.5/1000 athletic exposures (AEs) and 3.7/1000 AEs for male athletes. Female athletes with slower LEFT scores (≥118 s) experienced a higher rate of LQ time-loss injuries than those with faster LEFT scores (≤117 s) (P = .03).

Conclusion:

Only off-season plyometric training practices seem to affect LEFT score times among female athletes. Women with slower LEFT scores are more likely to be injured than those with faster LEFT scores. Injury rates in men were not influenced by performance on the LEFT.

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Nathan J. Crockett and Michelle A. Sandrey

Context:

Few studies have evaluated the long-term effects of prophylactic ankle-brace use during a sport season.

Objective:

To determine the effects of prophylactic ankle-brace use during a high school basketball season on dynamic postural control and functional tests.

Design:

Prospective repeated-measures design.

Setting:

High school athletic facility.

Participants:

21 healthy high school basketball athletes (13 girls, 8 boys).

Interventions:

The order of testing was randomized using the Star Excursion Balance Test (SEBT) for posteromedial (PM), medial (M), and anteromedial (AM) directions and 3 functional tests (FT) consisting of the single-leg crossover hop, single-leg vertical jump, and the single-leg 6-m hop for time at pre-, mid-, and postseason. After pretesting, the ankle brace was worn on both limbs during the entire 16-wk competitive basketball season.

Main Outcome Measures:

SEBT for PM, M, and AM and 3 single-leg FTs.

Results:

Dynamic postural control using the SEBT and the 3 FTs improved over time, notably from pretest to posttest. The left limb was different from the right limb during the single-leg vertical jump. Effect sizes were large for pretest to posttest for the 3 SEBT directions and 2 of the 3 FTs.

Conclusions:

The 16-wk basketball prophylactic ankle-brace intervention significantly improved dynamic postural control and single-limb FTs over time.

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Mina Samukawa, David Magee and Masaki Katayose

Context:

The effects of tibial rotation after ACL injury have not yet been well determined.

Objective:

To show whether clinical outcomes such as the amount of tibial rotation can affect functional outcomes in normal and ACL deficient knees.

Design:

Case control study.

Setting:

Research laboratory.

Participants:

Twenty normal subjects (Control) and 20 subjects with ACL deficient knees (ACL).

Main Outcome Measures:

Tibial rotation at 30 and 90 degrees of knee flexion was measured using an inclinometer. One-legged hop, crossover hop, figure-of-eight running and 10-m running tests were used and determined the effect(s) of tibial rotation on the outcome of the functional tests.

Results:

There were significant between-group differences in internal and external rotation. The relationship between external tibial rotation and the figure-of-eight index was significantly negatively correlated.

Conclusions:

The amount of tibial rotation is greater in ACL ruptured knees than in uninjured knees, and these greater amounts of tibial rotation affected the figure-of-eight running index.

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Helga T. Tucci, Lilian R. Felicio, Kevin J. McQuade, Debora Bevilaqua-Grossi, Paula Maria Ferreira Camarini and Anamaria S. Oliveira

Context:

The closed kinetic chain upper-extremity stability (CKCUES) test is a functional test for the upper extremity performed in the push-up position, where individuals support their body weight on 1 hand placed on the ground and swing the opposite hand until touching the hand on the ground, then switch hands and repeat the process as fast as possible for 15 s.

Objective:

To study scapular kinematic and kinetic measures during the CKCUES test for 3 different distances between hands.

Design:

Experimental.

Setting:

Laboratory.

Participants:

30 healthy individuals (15 male, 15 female).

Main Outcome Measures:

Participants performed 3 repetitions of the test at 3 distance conditions: original (36 in), interacromial, and 150% interacromial distance between hands. Participants completed a questionnaire on pain intensity and perceived exertion before and after the procedures. Scapular internal/external rotation, upward/downward rotation, and posterior/anterior tilting kinematics and kinetic data on maximum force and time to maximum force were measured bilaterally in all participants. Percentage of body weight on upper extremities was calculated. Data analyses were based on the total numbers of hand touches performed for each distance condition, and scapular kinematics and kinetic values were averaged over the 3 trials. Scapular kinematics, maximum force, and time to maximum force were compared for the 3 distance conditions within each gender. Significance level was set at α = .05.

Results:

Scapular internal rotation, posterior tilting, and upward rotation were significantly greater in the dominant side for both genders. Scapular upward rotation was significantly greater in original distance than interacromial distance in swing phase. Time to maximum force in women was significantly greater in the dominant side.

Conclusion:

CKCUES test kinematic and kinetic measures were not different among 3 conditions based on distance between hands. However, the test might not be suitable for initial or mild-level rehabilitation due to its challenging requirements.

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Maude Bastien, Hélène Moffet, Laurent Bouyer, Marc Perron, Luc J. Hébert and Jean Leblond

The Star Excursion Balance Test (SEBT) has frequently been used to measure motor control and residual functional deficits at different stages of recovery from lateral ankle sprain (LAS) in various populations. However, the validity of the measure used to characterize performance—the maximal reach distance (MRD) measured by visual estimation—is still unknown.

Objectives:

To evaluate the concurrent validity of the MRD in the SEBT estimated visually vs the MRD measured with a 3D motion-capture system and evaluate and compare the discriminant validity of 2 MRD-normalization methods (by height or by lower-limb length) in participants with or without LAS (n = 10 per group).

Results:

There is a high concurrent validity and a good degree of accuracy between the visual estimation measurement and the MRD gold-standard measurement for both groups and under all conditions. The Cohen d ratios between groups and MANOVA products were higher when computed from MRD data normalized by height.

Conclusion:

The results support the concurrent validity of visual estimation of the MRD and the use of the SEBT to evaluate motor control. Moreover, normalization of MRD data by height appears to increase the discriminant validity of this test.