Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points.

BACKGROUND AND PURPOSE: Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs. SUBJECTS: Forty adults (17 male, 23 female), aged 23 to 58 years (mean=30.6, SD=9.3), with one or more TPs in the neck or upper back participated in this study. METHODS: Subjects were randomly divided into 2 groups receiving a 5-day home program of either ischemic pressure followed by general sustained stretching of the neck and upper back musculature or a control treatment of active range of motion. Measurements were obtained before the subjects received the home program instruction and on the third day after they discontinued treatment. Trigger point sensitivity was measured with a pressure algometer as pressure pain threshold (PPT). Average pain intensity for a 24-hour period was scored on a visual analog scale (VAS). Subjects also reported the percentage of time in pain over a 24-hour period. A multivariate analysis of covariance, with the pretests as the covariates, was performed and followed by 3 analyses of covariance, 1 for each variable. RESULTS Differences were found between the treatment and control groups for VAS scores and PPT. No difference was found between the groups for percentage of time in pain. CONCLUSION AND DISCUSSION: A home program, consisting of ischemic pressure and sustained stretching, was shown to be effective in reducing TP sensitivity and pain intensity in individuals with neck and upper back pain. The results of this study indicate that clinicians can treat myofascial TPs through monitoring of a home program of ischemic pressure and stretching.

Total head excursion and resting head posture: normal and patient comparisons.

OBJECTIVE: To determine whether significant differences existed between normal and patient groups on three postural measurements: anterior-posterior total head excursion (THE), resting head posture in sitting (RHPsit), and resting head posture in standing (RHPstd). SUBJECTS: Forty-two healthy subjects, 13 men and 29 women between the ages of 20 and 60 years, were matched to 42 patients according to gender and age. DESIGN: Measurements of THE, RHPsit, and RHPstd were taken for each subject. Patients were measured during their initial evaluation and had neck pain as a primary or secondary complaint. RESULTS: A two-way multivariate analysis of variance followed by two-way analyses of variance showed that normal subjects had a significantly (p<.05) greater THE than did the patients and that men (patients and controls) scored significantly higher (p<.05) than women (patients and controls) on both THE and RHPstd. CONCLUSION: Clinical assessment of patients with cervical pain should focus on cervical mobility rather than resting head posture. Head/neck posture is different for males and females and they should not be judged by the same standard.

Maximum grip strength in normal subjects from 20 to 64 years of age.

The purposes of this study were to develop normative maximum grip strength (GRIP) data for men and women aged 20 to 64 years, separated into nine five-year age groups, and to develop prediction equations for GRIP using gender, age, height, weight, and hand dominance. A total of 1,182 volunteers (553 men and 629 women) participated in the study. Maximum hand grips were obtained using the Jamar dynamometer with standardized positioning and instructions. The hand to be tested first was chosen randomly. Each hand was then tested alternately. Three trials were performed on each hand. The highest GRIP for each hand was used for analysis. Two-way analyses of variance showed significant differences between the right and left hands and across the age groups for both genders. Follow-up analyses showed that significant decreases occurred between the age groups of 50-54 and 55-59 years in men and between the age groups of 50-54 and 60-64 years in women. The data also indicated that right and left GRIPs were highly correlated with each other (r = 0.93). Gender, height, and weight moderately correlated with both GRIPS (r = 0.52-0.73. Age correlated weakly with both GRIPs (r = -0.17). If either the right or the left GRIP was known, the other GRIP could be predicted easily from the known GRIP, with 87% of variance accounted for. Without the knowledge of the other GRIP, either GRIP could be predicted through gender, height, weight, age, and hand dominance, with 61% to 62% of the explained variance. The norms and prediction equations of GRIP developed in this study for men and women aged 20 to 64 years will help clinicians with decision making regarding grip strength.

Craniosacral rhythm: reliability and relationships with cardiac and respiratory rates.

Craniosacral rhythm (CSR) has long been the subject of debate, both over its existence and its use as a therapeutic tool in evaluation and treatment. Origins of this rhythm are unknown, and palpatory findings lack scientific support. The purpose of this study was to determine the intra- and inter-examiner reliabilities of the palpation of the rate of the CSR and the relationship between the rate of the CSR and the heart or respiratory rates of subjects and examiners. The rates of the CSR of 40 healthy adults were palpated twice by each of two examiners. The heart and respiratory rates of the examiners and the subjects were recorded while the rates of the subjects' CSR were palpated by the examiners. Intraclass correlation coefficients were calculated to determine the intra- and inter-examiner reliabilities of the palpation. Two multiple regression analyses, one for each examiner, were conducted to analyze the relationships between the rate of the CSR and the heart and respiratory rates of the subjects and the examiners. The intraexaminer reliability coefficients were 0.78 for examiner A and 0.83 for examiner B, and the interexaminer reliability coefficient was 0.22. The result of the multiple regression analysis for examiner A was R = 0.46 and adjusted R2 = 0.12 (p = 0.078) and for examiner B was R = 0.63 and adjusted R2 = 0.32 (p = 0.001). The highest bivariate correlation was found between the CSR and the subject's heart rate (r = 0.30) for examiner A and between the CSR and the examiner's heart rate (r = 0.42) for examiner B. The results indicated that a single examiner may be able to palpate the rate of the CSR consistently, if that is what we truly measured. It is possible that the perception of CSR is illusory. The rate of the CSR palpated by two examiners is not consistent. The results of the regression analysis of one examiner offered no validation to those of the other. It appears that a subject's CSR is not related to the heart or respiratory rates of the subject or the examiner.

Effects of myofascial release leg pull and sagittal plane isometric contract-relax techniques on passive straight-leg raise angle.

Experimental evidence does not currently exist to support the claims of clinical effectiveness for myofascial release techniques. This presents an obvious need to document the effects of myofascial release. The purpose of this study was to compare the effects of two techniques, sagittal plane isometric contract-relax and myofascial release leg pull for increasing hip flexion range of motion (ROM) as measured by the angle of passive straight-leg raise. Seventy-five nondisabled, female subjects 18-29 years of age were randomly assigned to contract-relax, leg pull, or control groups. Pretest hip flexion ROM was measured for each subject's right hip with a passive straight-leg raise test using a fluid-filled goniometer. Subjects in the treatment groups received either contract-relax or leg pull treatment applied to the right lower extremity; subjects in the control group remained supine quietly for 5 minutes. Following treatment, posttest straight-leg raise measurements were performed. A one-way analysis of variance followed by a Newman-Keuls post hoc comparison of mean gain scores showed that subjects receiving contract-relax treatment increased their ROM significantly more than those who received leg pull treatment, and the increase in ROM of subjects in both treatment groups was significantly higher than those of the control group. The results suggest that while both contract-relax and leg pull techniques can significantly increase hip flexion ROM in normal subjects, contract-relax treatment may be more effective and efficient than leg pull treatment.

Changes in torque and electromyographic activity of the quadriceps femoris muscles following isometric training.

BACKGROUND AND PURPOSE: The purpose of this study was to examine the effect of isometric training of the quadriceps femoris muscles, at different joint angles, on torque production and electromyographic (EMG) activity. SUBJECTS: One hundred seven women were randomly assigned to one of four groups. Three groups trained with isometric contractions three times per week at a knee flexion angle of 30, 60, or 90 degrees. The fourth group, which served as a control, did not exercise. METHODS: Isometric torque was measured using a dynamometer, and EMG activity was measured using a multichannel EMG system. Measurements were obtained during maximal isometric contraction of the quadriceps femoris muscles at 15-degree increments from 15 to 105 degrees of knee flexion. Measurements were taken before and after 8 weeks of training. RESULTS: Following isometric exercise, increased torque and EMG activity occurred not only at the angle at which subjects exercised, but also at angles in the range of motion at which exercise did occur. Further analyses indicated that exercising in the lengthened position for the quadriceps femoris muscles (90 degrees of knee flexion) produced increased torque across all angles measured and appeared to be the more effective position for transferring strength and EMG activity to adjacent angles following isometric training as compared with the shorter positions of the muscle (30 degrees and 60 degrees of knee flexion). CONCLUSION AND DISCUSSION: These findings suggest that an efficient method for increasing isometric knee extension torque and EMG activity throughout the entire range of motion is to exercise with the quadriceps femoris muscles in the lengthened position.

Assessment of total head excursion and resting head posture.

Clinicians typically evaluate head posture and cervical range of motion in both standing and sitting positions. There are currently few quantitative data available regarding resting head posture (RHP) or total head excursion (THE), a retraction-protraction gliding range of head motion in the sagittal plane, and where the RHP lies within THE. The purposes of this study were to describe quick and simple methods to determine quantitative measurements of THE, RHP while sitting, and RHP while standing, to provide preliminary data on these postural measurements for men and women in four age categories; and to determine the effects of gender and age on these measurements. Subjects included 218 able-bodied adults. Measurements of THE, RHP while sitting, and RHP while standing were taken. A two-way multivariate analysis of variance followed by two-way analyses of variance showed only the main effect of gender to be significant (p less than .05) for each of the dependent measurements. Across the age groups, men had a greater excursion distance from retraction to protraction than women. Within THE, women held their heads more forward than men. Men held their heads farther from the vertical than women while standing. These results indicate that normal head and neck posture is different for men and women and should not be judged by the same standard. The methods used in this study are clinically advantageous in that they produce objective, quantitative measurements of THE and RHP that may be obtained quickly and with minimal equipment.

Exercise effect on electromyographic activity of the vastus medialis oblique and vastus lateralis muscles.

The purpose of this study was to determine whether the vastus medialis oblique muscle (VMO) had greater electrical activity than the vastus lateralis muscle (VL) when hip adduction and medial (internal) tibial rotation exercises were performed. Electrical activity of the VMO and VL was measured on 25 healthy subjects during maximal-effort isometric contractions of hip adduction and medial tibial rotation. The results showed that the electromyographic activity of the VMO was significantly greater than that of the VL during the hip adduction exercise. Differences noted with medial tibial rotation were not significant. The results suggest that the VMO may be selectively activated by performing hip adduction exercises. Resistive hip adduction exercises, therefore, may be advisable in the treatment of patients with lateral malalignment of the patella with accompanying pain or instability.

Effect of stabilization on maximal isokinetic torque of the quadriceps femoris muscle during concentric and eccentric contractions.

The purpose of this study was to investigate the effect of stabilization on the maximal isokinetic torque generated by the quadriceps femoris muscle during concentric and eccentric contractions at different velocities using the KIN/COM isokinetic dynamometer. Fifteen female volunteers between the ages of 18 and 32 years were trained to perform maximal isokinetic concentric and eccentric contractions. Each subject participated in two testing sessions. In one testing session, subjects were stabilized maximally, and in the other testing session, subjects were stabilized minimally. Subjects were tested both concentrically and eccentrically at velocities of 30 degrees, 60 degrees, 90 degrees, 120 degrees, 150 degrees, 180 degrees, and 200 degrees/sec. The velocity sequence and stabilization procedure used were randomly assigned. Two nested model analyses of variance followed by post hoc comparisons were used to analyze the data. Results revealed no significant difference between the maximal stabilization procedure and the minimal stabilization procedure for concentric and eccentric contractions. The results of this study should aid rehabilitation specialists in the development of testing and rehabilitation procedures when using the KIN/COM.

Reliability of measuring anterior laxity of the knee joint using a knee ligament arthrometer.

The purpose of this study was to determine examiner reliability with the use of a knee ligament arthrometer to measure the anterior-posterior (A-P) laxity of the right knee. Two clinicians performed an A-P laxity measurement on 43 healthy, male subjects. The first examiner positioned the arthrometer, recorded the subject's A-P laxity, removed the instrument, and repeated the measurement. A second examiner performed the same procedure. Subsequently, we computed interexaminer, intraexaminer, and intraclass reliability coefficients. Our results indicated relatively high reliability coefficients. We believe a clinician can use the knee ligament arthrometer to obtain objective and reliable measurements of A-P laxity of the knee.

Blood pressure response to inversion traction.

The purpose of this study was to determine blood pressure response to two minutes of inversion traction. Sixty female volunteers aged 20 to 30 years were assigned randomly to an Experimental or Control Group. After resting blood pressure was measured in the standing position, the Experimental Group was inverted for two minutes. Blood pressure was measured before the subjects dismounted. The Control Group remained standing for two minutes, after which blood pressure was measured again. The results of a Hotelling's T2 analysis and subsequent post hoc tests revealed a significant difference between the mean gain scores of the Experimental and Control Groups (p less than .05). Both systolic and diastolic blood pressures increased significantly. This increase with inversion indicates a need for caution when using inversion traction as a treatment technique for low back pain. Hypertensive individuals may need to avoid its use.

Differentiation of learning disabled children from normal children using four coordination tasks.

Fifty 8-year-old children, 25 classified as normal and 25 as learning disabled, participated in a study to determine whether they could be differentiated into their respective groups by using four tasks from the Devereux Test of Extremity Coordination: opposition, foot patting, finger wiggling, and heel-toe walking with the eyes closed. Each chilld received numerical scores based on the number of times he could perform a task in 10 seconds. A stepwise discriminant function analysis revealed that two tasks, opposition and foot patting, were significant discriminating variables. A resulting discriminant function prediction equation showed that, according to the results of the tasks tested, 78 percent of the sample had been correctly classified by previous methods.