Posterior glenohumeral dislocations are rare, comprising only 4 percent of all shoulder dislocations. While early and accurate diagnosis of a posterior dislocation increases the likelihood of success with non-operative management, traditional rehabilitation may not adequately address the sensorimotor deficits that are evident following dislocation. Restoration of the sensorimotor system is critical to successfully return a throwing athlete safely to sports. The use of functional neuromuscular rehabilitation (FNR) attempts to address deficits in the compromised sensorimotor system. With a good understanding of the specific demands placed on the overhead athlete’s shoulder, knowledge of glenohumeral and scapulothoracic joints’ biome-chanics, respect for the athlete’s level of symptoms and pain, adherence to soft tissue healing, and application of a rehabilitation program that incorporates FNR, an athlete can successfully return to a high level of competition following an acute posterior glenohumeral dislocation.
Taegyu Kim, Eunkuk Kim and Hokyung Choi
To determine whether a neuromuscular rehabilitation program can improve postural stability and ankle-evertor strength and to examine the temporal changes and persistence of the rehabilitation effects in athletes with chronic ankle instability (CAI).
A total of 21 national women field hockey players participated in this study (CAI, n = 12; control, n = 9).
Main Outcome Measures:
Isokinetic ankle-evertor strength (peak torque [PT], total work [TW]) at 30°/s, 60°/s, 90°/s, and 120°/s, mediolateral stability index (MSI), and dynamic stability test (TCT). Data were recorded at baseline, 6 wk, and 24 wk.
At baseline, isokinetic evertor strength was comparable between groups. At 6 wk, the CAI group demonstrated significantly increased eccentric PT and TW at 30°/s and 60°/s and increased concentric/eccentric TW at 90°/s. The control group showed significantly increased concentric TW at 30°/s and increased concentric PT and TW at 90°/s. At 24 wk, except for eccentric PT at 60°/s and 120°/s, concentric/eccentric PT and TW were significantly increased in the CAI group. The control group showed significantly increased TW at all angular velocities regardless of contraction mode. The CAI group exhibited significant increases in concentric/eccentric evertor PT and TW at 120°/s in comparison with the control group. MSI and TCT decreased in both groups at 6 wk; however, the CAI group demonstrated significant increases in both measures at 24 wk, whereas the control group showed no significant change.
The results suggest that the neuromuscular rehabilitation program had an immediate effect on gaining eccentric evertor strength and improving postural control and appeared to contribute to enhancing the evertor strength of unstable ankles in the longer term. On the other hand, improved postural stability did not seem to persist.
Gulcan Harput, H. Erkan Kilinc, Hamza Ozer, Gul Baltaci and Carl G. Mattacola
There is lack of information related to quadriceps and hamstring strength recovery during the early period of rehabilitation after anterior cruciate ligament reconstruction (ACLR) using hamstring-tendon graft (HTG).
To investigate quadriceps and hamstring isometric strength at 4-, 8-, and 12-wk time points after ACLR and to document the strength changes of these muscles over time.
24 patients (age 28.1 ± 8.1 y) who underwent unilateral single-bundle anatomic ACLR with 4-strand semitendinosus and gracilis tendon graft.
Main Outcome Measures:
The isometric strength of quadriceps and hamstring muscles was measured on an isokinetic dynamometer at a 60° knee-flexion angle 4, 8, and 12 wk after surgery.
Quadriceps and hamstring strength significantly increased over time for both the involved limb (quadriceps F 2,46 = 58.3, P < .001; hamstring F 2,46 = 35.7, P < .001) and uninvolved limb (quadriceps F 2,46 = 17.9, P < .001; hamstring F 2,46 = 56.9, P = .001). Quadriceps and hamstring indexes significantly changed from 4 wk (QI 57.9, HI 54.4) to 8 wk (QI 78.8, HI 69.9) and from 8 wk to 12 wk (QI 82, HI 75.7) (P < .001); however, there was no difference between indexes at the 12-wk time point (P = .17).
The results of this study serve as a reference for clinicians while directing a rehabilitation protocol for HTG ACLR patients to better appreciate expected strength changes of the muscles in the early phase of recovery.
Jonathon R. Staples, Kevin A. Schafer, Matthew V. Smith, John Motley, Mark Halstead, Andrew Blackman, Amanda Haas, Karen Steger-May, Matthew J. Matava, Rick W. Wright and Robert H. Brophy
Context: Patients with anterior cruciate ligament (ACL) tears are likely to have deficient dynamic postural stability compared with healthy sex- and age-matched controls. Objectives: To test the hypothesis that patients undergoing ACL reconstruction have decreased dynamic postural stability compared with matched healthy controls. Design: Prospective case-control study. Setting: Orthopedic sports medicine and physical therapy clinics. Patients or Other Participants: Patients aged 20 years and younger with an ACL tear scheduled for reconstruction were enrolled prospectively. Controls were recruited from local high schools and colleges via flyers. Interventions: Patients underwent double-stance dynamic postural stability testing prior to surgery, recording time to failure and dynamic motion analysis (DMA) scores. Patients were then matched with healthy controls. Main Outcome Measures: Demographics, time to failure, and DMA scores were compared between groups. Results: A total of 19 females and 12 males with ACL tears were matched with controls. Individuals with ACL tears were more active (Marx activity score: 15.7 [1.0] vs 10.8 [4.9], P < .001); had shorter times until test failure (84.4 [15.8] vs 99.5 [14.5] s, P < .001); and had higher (worse) DMA scores (627  vs 481 , P < .001), indicating less dynamic postural stability. Six patients with ACL deficiency (1 male and 5 females) demonstrated lower (better) DMA scores than their controls, and another 7 (4 males and 3 females) were within 20% of controls. Conclusions: Patients undergoing ACL reconstruction had worse global dynamic postural stability compared with well-matched controls. This may represent the effect of the ACL injury or preexisting deficits that contributed to the injury itself. These differences should be studied further to evaluate their relevance to ACL injury risk, rehabilitation, and return to play.
Gulcan Harput, Volga B. Tunay and Matthew P. Ithurburn
-landing mechanics . Am J Sports Med . 2015 ; 43 ( 11 ): 2727 – 2737 . PubMed ID: 26359376 doi: 10.1177/0363546515602016 26359376 19. Harput G , Kilinc HE , Ozer H , Baltaci G , Mattacola CG . Quadriceps and hamstring strength recovery during early neuromuscular rehabilitation after ACL hamstring
Afshin Moghadasi, Gholamali Ghasemi, Ebrahim Sadeghi-Demneh and Masoud Etemadifar
functional training approach for older adults—development, training control and feasibility . Int J Exerc Sci . 2015 ; 8 ( 3 ): 224 – 233 . PubMed ID: 27182415 27182415 11. Lederman E . Neuromuscular Rehabilitation in Manual and Physical Therapies Principles to Practice . 1st ed. Edinburgh
Alif Laila Tisha, Ashley Allison Armstrong, Amy Wagoner Johnson and Citlali López-Ortiz
. Sharan D , Rajkumar J , Balakrishnan R , Kulkarni A . Ch 7: Neuromusculoskeletal rehabilitation of severe cerebral palsycerebral palsy – current steps . In: Gunel K , ed. Neuromuscular Rehabilitation of Severe Cerebral Palsy . Bangalore, Karnataka : RECOUP Neuromusculoskeletal
Fatemeh Ehsani, Rozita Hedayati, Rasool Bagheri and Shapour Jaberzadeh
, 36 Participants were excluded if they had any history of spinal surgery, spinal or pelvic fracture, deformity of spine, severe trauma, and any nerve root pain. Participants were recruited during the first half of 2016, and this study was performed in the Neuromuscular Rehabilitation Research Center