Anterior knee pain: a clinical comparison of rehabilitation methods.

OBJECTIVE: To compare different types of rehabilitation for anterior knee pain. DESIGN: Prospective, randomized, blinded, and controlled study of 64 participants with anterior knee pain. SETTING: Outpatient rehabilitation clinic and testing laboratory. PARTICIPANTS: Participants were assigned in randomized fashion to three rehabilitation groups: traditional home rehabilitation (n = 20); physical therapy (n = 21); and home rehabilitation with a modified vastus medialis obliquis (VMO) specific straight leg raise (Muncie method; n = 23). INTERVENTIONS AND MAIN OUTCOME MEASURES: Clinical data was obtained at 0, 2, 6, and 12 weeks. Cybex testing was performed at 0, 6, and 12 weeks. RESULTS: Clinical outcome for the Muncie method indicated a statistically significant improvement in subjective pain and functional impairment ratings. Cybex testing in patients using the Muncie method demonstrated a statistically significant improvement in pain-free isometric contractions and maximum voluntary contraction. There were no significant differences between traditional home therapy and physical therapy. CONCLUSION: Findings suggest that the Muncie method results in improved clinical outcome at a lower cost than traditional home and physical therapy and possibly improved VMO/quadriceps muscle balance. Patients with anterior knee pain may benefit from applying the Muncie method in a home therapy program.

Fibroblast responses to variation in soft tissue mobilization pressure.

UNLABELLED: Augmented soft tissue mobilization therapy (ASTM), a newly developed massage therapy, has been successfully used in the treatment of chronic tendinitis patients. We theorized that the ASTM technique promotes healing through a controlled application of microtrauma. PURPOSE: The purpose of this study was to determine morphologic changes in the rat Achilles tendon after enzyme-induced injury with collagenase and subsequent pressure variations in ASTM therapy. METHODS: Thirty male white rats were randomly assigned to one of five groups with six animals per group: tendinitis (A), tendinitis plus light ASTM (B), tendinitis plus medium ASTM (C), tendinitis plus extreme ASTM (D), and control with surgery only (E). ASTM was performed for 3 min, for a total of six treatment sessions. The Achilles tendons of each group were harvested 1 wk after the last ASTM treatment. Fibroblast numbers were assessed by light microscopy. An electron microscope was used to observe enlargement of fibroblasts. RESULTS: Statistical analysis of the number of fibroblasts present indicated a significant difference (P<0.00) between group D and all other groups. CONCLUSION: The morphological evidence indicated that the application of heavy pressure promoted the healing process to a greater degree than light or moderate pressure.

Rat tendon morphologic and functional changes resulting from soft tissue mobilization.

Augmented Soft Tissue Mobilization (ASTM) is a new non-invasive soft tissue mobilization technique which has been used successfully to treat a variety of musculoskeletal disorders. The purpose of this study was to determine the effects of ASTM therapy on the morphological and functional characteristics of enzyme induced injured rat Achilles tendons. Four groups of five rats were allocated as follows: (A) control, (B) tendinitis, (C) tendinitis plus ASTM, and (D) ASTM alone. Collagenase injury was induced, and the surgical site was allowed to heal for 3 wk. ASTM was performed on the Achilles tendon of groups C and D for 3 min on postoperative days 21, 25, 29, and 33 for a total of four treatments. Gait data were gathered prior to each treatment. The Achilles tendons of each group were harvested 1 wk after the last treatment. Specimens were prepared for light and electron microscopy, and immunostaining for type I and type III collagen and fibronectin was performed. Light microscopy showed increased fibroblast proliferation in the tendinitis plus ASTM treatment group. Although healing in rats may not translate directly to healing in humans, the findings of this study suggest that ASTM may promote healing via increased fibroblast recruitment.

Effects of viral upper respiratory illness on running gait.

OBJECTIVE: To determine the kinematic changes that may occur during running with a cold of known etiology and to assess the impact of select accompanying upper respiratory illness symptoms. DESIGN AND SETTING: In this nonrandomized study, subjects with colds and subjects without colds were videotaped while exercising on a treadmill. Three weeks later, the trials were repeated. SUBJECTS: Eighteen young adults (5 females, 13 males; mean age = 20.4+/- 2.4 yr) with naturally acquired moderate to severe (total symptom score) colds were screened and selected for inclusion in the illness group (ILL). A control group (CRL) of 20 subjects (2 females, 18 males) was also examined. Virologic confirmation of specific viral infections, unprecedented in this line of research, revealed that 12 of the 18 subjects in the ILL group (67%) were infected with human rhinoviruses. None of the subjects had a fever. MEASUREMENTS: All subjects exercised on a treadmill for 5 minutes at a heart rate of approximately 85% of their age-predicted maximum. Both groups were videotaped kinematically during two running trials 3 weeks apart. All subjects in the ILL group displayed upper respiratory illness symptoms for the first running trial and were asymptomatic by the second. RESULTS: We identified significant differences in mean changes between the ILL and CRL group stride lengths (p <.01), stride frequencies (p <.05), and ankle maximum angle displacement (p <.01). Mean changes in stride length (p <.03) and in stride frequency (p <.04) were larger for ILL subjects who felt feverish. CONCLUSIONS: Alterations in running gait during a rhinovirus-caused upper respiratory illness, and possibly increases in injury incidence, may be associated with feeling feverish. Gait alterations may increase injury incidence or decrease athletic performance, or both.

A multidisciplinary investigation of the relation of state sport confidence with preference and velocity of swimming starts.

This study investigated the relations of state sport confidence with preference of swimming start, i.e., pike or flat, and vertical velocity for male and female NCAA Division I swimmers. Ten male and 10 female swimmers who had a minimum of five years competitive swimming experience participated. Men generated greater vertical velocity on both the pike and flat starts. Analyses of variance indicated a relationship foc gender with the most confident swimming start and vertical velocity for the pike and flat starts. In addition, a significant interaction between gender, preferred swimming start, and most confident swimming start was found. Discriminant function analysis using gender as the grouping variable and the dependent variables of vertical velocity and state sport confidence indicated that gender was an indicator of swimmers' performance and state sport confidence on the pike and flat starts.

Electromyographic evaluation of closed and open kinetic chain knee rehabilitation exercises.

The use of closed kinetic chain knee rehabilitation exercises has been advocated in recent years. The primary reason cited for employing closed kinetic chain exercises is that these exercises result in less anteroposterior (A/P) shear force at the knee joint, when compared with traditionally used open kinetic chain exercises. The purpose of this study was to determine the electromyographical (EMG) activity ratio of quadriceps to hamstrings occurring in the following exercises: unilateral one quarter squats, leg extensions (N-K Table), lateral step-ups, and movements on the Fitter (Fitter International, Inc), Stair-master 4000 (Randal Sports/Medical Products, Inc), and slideboard. Ten female student-athletes participated in this study. EMG surface electrodes were applied over the rectus femoris and biceps femoris muscles. The subjects completed three maximum isometric contractions for both muscle groups to obtain baseline EMG data. They then performed repetitions of each exercise. These movements were videotaped simultaneously with a stationary shuttered video camera operating at 30 Hz. A computer program was used to analyze the videotaped performances for knee joint range of motion (ROM). Three trials of data were averaged. Baseline EMG activity was used to determine percentage of maximum EMG activity for each exercise. There were significant differences (p.<01) among the exercises for the following dependent variables: ROM, maximum angle, percent of maximum contraction, time of contraction, and total EMG (EMG area under the curve). This study suggests that the five closed kinetic chain exercises studied result in minimal A/P shear forces at the knee joint.

Falls in the elderly: Part I, Gait.

The aim of this study was to determine a gait profile of two groups of elderly adults: one with a history of falls and one without a history of falls. The following gait characteristics were identified: step frequency, stance time, swing time, double support time, step length, heel width, heel height, toe height, and hip, knee, and ankle angular excursion. The history of falls group was composed of 25 subjects (seven men and 18 women), and the no history of falls group was composed of 30 subjects (12 men and 18 women). Two 16-mm Locam cameras were used to film the subjects. Each subject was filmed while walking on a motorized treadmill at 4 km/h and 6 km/h. The film data were digitized on a sonic digitizer interfaced to a VAX computer. The ANOVA statistic indicated significant (p less than .05) difference between the two independent variables for heel width. There appears to be no significant relationship between the studied gait characteristics (other than heel width) and falls in apparently healthy elderly individuals.

Falls in the elderly: Part II, Balance, strength, and flexibility.

The purpose of this study was to determine and compare the balance, muscular strength, and flexibility of two groups of elderly adults: one with a history of falls (HF) and one with no history of falls (NHF). Subjects were 19 men and 36 women. Static and dynamic balance was determined by a one-foot stance balance test and a backwards walking test. Hip, knee, and ankle joint muscular strength were assessed on a Cybex Leg Press Dynamometer. A goniometer was used to determine hip, knee, and ankle joint range of motion (flexibility), ANOVA indicated a significant difference between the two groups for static balance (p less than .001), leg strength (p less than .01), and hip and ankle flexibility (p less than .01). The results suggest that balance, leg strength, and flexibility may be factors contributing to falls in the elderly.

Knee kinematics: the effects of running on cambers.

The purpose of this study was to determine the three-dimensional kinematics of the knee joint during running on level surfaces and surfaces of different degrees of camber. Fifteen college-age students (eight males, seven females) having no previous history of knee injury were subjects. A triaxial elgon was used to measure the movement of each subject's right and left knees when running on a horizontal or laterally inclined treadmill at 2.4 m.s-1 during each experimental condition (on the horizontal surface and on cambers of +0.087, +0.174, -0.087, and -0.174 radians). There was a significant difference (P less than 0.05) between +0.174 and -0.174 rad camber mean values for all six dependent variables (i.e., support and swing, flexion-extension, internal and external rotation, and valgus-varus range of motion). There was also a significant difference (P less than 0.05) when +0.174 and -0.174 rad camber were compared to 0 rad camber during both the support and swing phases of flexion-extension. Surface camber mean values for +0.087 and -0.087 rad were significantly different (P less than 0.05) during the swing phase for internal and external rotation. This study showed that the kinematics of the knee joint are significantly altered when running on a laterally inclined surface.

Gait characteristics in multiple sclerosis: progressive changes and effects of exercise on parameters.

This study determines the characteristics of the multiple sclerosis gait, identifies the progressive gait changes associated with this degenerative disease, and determines the effects of an aquatic exercise program on gait parameters. Eleven patients with multiple sclerosis volunteered to participate and were filmed three times during a 10 week period with a Locam camera at 100 frames/s. During the testing period, subjects participated in an aquatic exercise program. In addition, they were rated according to the Kurtzke Scale for Evaluating Disability in Multiple Sclerosis. Results indicated that these patients with MS have shorter stride lengths, slower free speed walking rates, and higher cadence than do persons without MS. Knee and ankle joint rotation were characterized by lower than normal excursion with less vertical lift of the center of gravity and greater trunk lean than normal. Significant correlations between the Kurtzke Scale and gait parameters were indicated for step length and hip and ankle joint excursion. The aquatic exercise program appeared to have had no effect on the studied gait parameters.

Effects of an aquatic fitness program on the muscular strength and endurance of patients with multiple sclerosis.

This study quantified the effects of an aquatic exercise program on muscular strength, endurance, work, and power of patients with multiple sclerosis. Ten individuals with a mean age of 40 years participated in a 10-week aquatic exercise program. Two types of isokinetic dynamometers were used to assess the muscular variables studied. A Cybex II dynamometer was used to measure peak torque, work, and fatigue in the knee flexor and extensor muscles and a biokinetic swim bench was used to measure muscular force, work, fatigue, and power in the upper extremities. Five velocity settings were selected for each of three testing trials (pretrial, midtrial, and posttrial). For the lower extremities, analysis of variance indicated a significant improvement of peak torque for knee extensor muscles from the pretrial to midtrial (p less than .05). Peak torque values from pretrial to midtrial for knee flexors and from midtrial to posttrial for both the knee extensor and flexor muscles indicated a nonsignificant difference at each velocity studied. Fatigue and work values in the lower extremities improved significantly between the pretrial and posttrial (p less than .05). For the upper extremities, an analysis of variance indicated a significant increase in all force measurements from pretrial to posttrial (p less than .05). Power and total work values also improved significantly (p less than .05). No significant difference in fatigue measurements for the upper extremities was found. The results of this investigation indicated that an aquatic exercise program may induce positive changes in muscular strength, fatigue, work, and power in patients with multiple sclerosis.

Using isokinetic dynamometry to test ambulatory patients with multiple sclerosis.

This study was designed to 1) determine whether isokinetic dynamometry is appropriate and safe for ambulatory patients with multiple sclerosis and 2) describe the idiosyncrasies the patients with multiple sclerosis exhibited during testing. Ten patients with multiple sclerosis and 20 healthy subjects were matched for age, sex, and weight. The isokinetic peak torque and endurance measurements of knee extensor and knee flexor muscles were recorded at selected angular velocities ranging from 0 to 275 degrees/sec and extensor:flexor muscle strength ratios were calculated. Statistical analysis (t tests) revealed that both the extensor and flexor muscle peak torque values for patients with multiple sclerosis were significantly lower than those for healthy subjects at all angular velocities (p less than .005 to p less than .001), and yet were similar in shape and slope. Mean extensor:flexor ratios for healthy subjects and for patients with multiple sclerosis were not significantly different at 70, 190, and 230 degrees/sec. Individual chart recordings identified any contractile difficulties or increased contraction time. Isokinetic testing is judged to be a safe and reliable form of objective neuromuscular testing for ambulatory patients with multiple sclerosis.

Hemispheric superiority for processing a mirror image.

39 adult subjects were administered a test using tachistoscopic half-field presentations to determine hemispheric dominance and a mirror-tracing task to determine if an hemispheric superiority exists for processing a mirror-image. The results indicate superiority of the nondominant hemisphere for this task.