Snapping iliopsoas tendon in a recreational athlete: a case report.

OBJECTIVE: To describe the evaluation, diagnosis, and conservative treatment of a 31-year-old female recreational athlete with a snapping iliopsoas tendon. BACKGROUND: The iliopsoas tendon has been implicated as an inflamed structure in this unique form of snapping hip. Hip pain, limitation of motion, or both may severely restrict vocational and recreational function and activities of daily living. DIFFERENTIAL DIAGNOSIS: Left snapping hip syndrome secondary to the iliopsoas tendon or the iliotibial band. TREATMENT: The treatment goal was to restore the athlete's pain-free, functional abilities. The primary focus of the treatment program was stretching of the left hip flexors. The patient demonstrated reduced pain and improved function following a 4-week stretching program and was fully functional and symptom free at 6 months. UNIQUENESS: Snapping hip syndrome is a clinical entity that may be described as hip pain associated with an audible snap of the hip during motion. The most common and well-known cause of this syndrome involves the snapping of the iliotibial band over the greater trochanter. A less common cause is the snapping of the iliopsoas tendon over the iliopectineal eminence. CONCLUSIONS: Understanding the anatomy and function of the iliopsoas tendon and related structures provides a basis for evaluation and treatment of this unique problem.

Reliability of lower extremity functional performance tests.

Clinicians routinely have used functional performance tests as an evaluation tool in deciding when an athlete can safely return to unrestricted sporting activities. These practitioners assumed that these tests provide a reliable measure of lower extremity performance; however, little research has been reported on the reliability of these measures. The purpose of this investigation was to determine the reliability of lower extremity functional performance tests. Five male and 15 female volunteers were evaluated using the single hop for distance, triple hop for distance, 6-m timed hop, and cross-over hop for distance as described by Noyes (10). One clinician measured each subject's performance using a standardized protocol and retested subjects in the same manner approximately 48 hours later. The order of testing was randomly determined. Subjects' average and individual scores on each functional performance test were used for statistical analysis. Intraclass correlation coefficients (ICCs) and standard error of measurement (SEM) values based on average day 1 and day 2 scores were used to estimate the reliability of each functional performance test. Intraclass correlation coefficients were .96, .95, and .96, and SEMs were 4.56 cm, 15.44 cm, and 15.95 cm, respectively, for the single hop, triple hop, and cross-over hop for distance tests. An ICC of .66 and SEM of .13 seconds for the 6-m timed hop resulted from limited variability between measurements; however, its small SEM value inferred that the inconsistency of measurement would occur in an acceptably small range. A repeated measures analysis of variance revealed no significant difference ( p > .05) between individual trial scores except for the single hop for distance. We concluded that this difference represented a learning effect not found with the other tests. The results of this investigation demonstrate that clinicians can use functional performance testing to obtain reliable measures of lower extremity performance when using a standardized protocol.

The effect of a computer assisted instructional program on physical therapy students.

The purpose of this study was to assess the efficacy and efficiency of CAI for students learning evaluation and treatment skills for carpal tunnel syndrome (CTS). Ten volunteer physical therapy students were randomly assigned into either CAI or interactive lecture instructional groups. Each student completed a 36-item pretest on CTS. The CAI group used the Physical Therapy Patient Simulator CAI and the instructional group participated in lecture/discussion to complete the case studies. Following completion of instruction, an identical 36 item posttest was administered to all students. Individual start and finish times for the two groups were recorded by the instructor. A 2 x 2 ANOVA revealed no significant difference in pretest/posttest scores between CAI and interactive lecture. A t-test determined the CAI group completed the case assignment 30 minutes (24% faster than the interactive group. The findings suggest that using a CAI simulation program may be as effective and more efficient than traditional methods of instruction.

Functional outcome measures for knee dysfunction assessment.

Maximizing the functional abilities of the individual is the primary objective of any therapeutic intervention. Functional outcome data are valuable to those involved in the care of the athlete because such data provides information that helps facilitate the clinical decision-making process and, therefore, helps insure a safe and efficient return to athletics. Functional outcome measures also provide useful data for assessing therapeutic intervention efficacy. The clinician/researcher must consider various factors when selecting an appropriate outcome measure, such as: the patient population, pathology, specific test parameters, psychometric properties, and practicality of the measure. The primary purpose of this paper is to provide the reader with guidelines for either assessing existing measures or developing new measures of functional outcomes for use in clinical practice and research.

Interrater reliability of isokinetic measures of knee flexion and extension.

The purpose of this investigation was to determine the interrater reliability of peak torque and total work values obtained with isokinetic measures of knee flexion and extension. Eight male and eight female students were evaluated on four occasions by four different examiners (range of isokinetic test experience: 0 to 10 yrs) using a standardized isokinetic measurement protocol. Subjects were randomly assigned to participate in a test sequence determined by a 4 x 4 balanced Latin square. Peak torque and total work values at 60 degrees /sec and 180 degrees /sec were obtained for the concentric measures of knee extension and flexion. The measures of peak torque and total work were corrected for the effects of gravity. Intraclass correlation coefficients and standard error of measurement estimates were used to estimate the interrater reliability for each test condition (test speed x muscle group). Intraclass correlation coefficient values ranged from .90 to .96 for peak torque and .90 to .95 for total work. Standard error of measurement estimates ranged from 8.9 to 13.3 Nm for peak torque and 11.3 to 16.8 Nm for total work. The results of this investigation demonstrate that reliable measures of isokinetic muscle performance of knee extension and flexion may be obtained by four clinicians with varied experience when following a standardized measurement protocol.

Effect of running on anterior knee laxity in collegiate-level female athletes after anterior cruciate ligament reconstruction.

Agility running activities are commonly used in the latter stages of rehabilitation for anterior cruciate ligament (ACL) reconstruction. However, the effects of agility running on anterior knee laxity in these patients have not been examined. The purpose of this study was to examine changes in anterior knee laxity before and after 30 minutes of agility running exercise. Subjects (N = 9) were female athletes (mean age = 20.1 +/- 1.5 years; height = 171.7 +/- 10.4 cm; weight = 65.7 +/- 8.6 kg) with unilateral ACL reconstruction (central 1/3 patella tendon graft, postoperation range = 9-52 months, mean = 24.2 months). Measurements were made at 20 degrees and 90 degrees of knee flexion bilaterally with KT-1000 arthrometry (MEDmetric, San Diego, CA) and recorded in millimeters of displacement. Data were analyzed with an analysis of variance (ANOVA) with repeated measures (p < 0.05). Results showed no statistical differences between the ACL-reconstructed knee and the normal knee at 20 degrees and 90 degrees knee flexion. The authors conclude that the central 1/3 patella tendon graft performs comparable to the normal knee when stressed with agility running exercise; therefore, agility exercise is an appropriate, safe, short-term activity.

Prediction of Academic Achievement in an NATA-Approved Graduate Athletic Training Education Program.

The Purpose of this investigation was to determine which information used in the applicant selection process would best predict the final grade point average of students in a National Athletic Trainers Association (NATA) graduate athletic training education program. The criterion variable used was the graduate grade-point average (GPAg) calculated at the completion of the program of study. The predictor variables included: 1) Graduate Record Examination-Quantitative (GRE-Q) scores; and 2) Graduate Record Examination-Verbal (GRE-V) scores, 3) preadmission grade point average (GPAp), 4) total athletic training hours (hours), and 5) curriculum or internship undergraduate athletic training education (program). Data from 55 graduate athletic training students during a 5-year period were evaluated. Stepwise multiple regression analysis indicated that GPAp was a significant predictor of GPAg, accounting for 34% of the variance. GRE-Q, GRE-V, hours, and program did not significantly contribute individually or in combination to the prediction of GPAg. The results of this investigation suggest that, of the variables examined, GPAp is the best predictor of academic success in an NATA-approved graduate athletic training education program.

Comparison of N-k table offset angles with the human knee flexor torque curve.

The purpose of this study was to dynamically examine various offset angles on the N-K table to determine which offset produces a torque pattern corresponding most closely to the isokinetic torque curve of the knee flexor musculature when tested at 60%. Subjects for the study were five college-age male volunteers (age=21.8+/-1.8 yrs, ht=181.9+/-4.3 cm, wt=88.4+/-12.6 kg). Mean peak isokinetic torque values for the five subjects were measured at 5 degrees increments to represent the human knee flexor torque curve. These were converted to relative mean values by dividing each value by the maximum mean peak torque. Torque curves from four offset angles (90 degrees ,110 degrees ,135 degrees , and 160 degrees ) for the N-K table were obtained by using the Kin Com in the passive mode at 20 degrees /s to push the exercise arm of the N-K table through a range of motion of 0 degrees to 90 degrees while recording torque and angular position. The four torque curves were converted to relative values in a similar manner as for the subjects. Qualitative analysis reveals that the 160 degrees offset angle most closely corresponded to the representative knee flexor isokinetic torque curve, while the 90 degrees offset angle corresponded least. Although these findings would seem to support reconsideration of common clinical practice relative to the use of the N-K table for knee flexor strength development, the 160 degrees offset angle is awkward because it has a tendency to force the user into hyperextension at the beginning phase of motion. As such, practical compromises might include the use of the 110 degrees or 135 degrees offset angle in lieu of the traditionally employed 90 degrees offset angle, or the development of an extension stop that would prevent hyperextension of the knee.

Conservative management of piriformis syndrome.

Piriformis syndrome is a questionable clinical entity that has been cited as a cause of buttock pain and sciatica. The intimate relationship between the piriformis and the sciatic nerve has been suspected as being the source of the signs and symptoms that often appear following minor trauma to the pelvic or buttock region. Muscle function is an important consideration in the evaluation and treatment of the athlete with suspected piriformis syndrome. The action of the piriformis muscle on the hip varies as the hip moves from a neutral to a flexed position. While in a flexed position, the piriformis internally rotates and abducts the hip; however, in a neutral position, the piriformis acts as an external rotator of the hip. A comprehensive evaluation provides the information necessary to design a treatment plan specific to the involved structures, while meeting the functional needs of the individual athlete. This paper describes the anatomy, pathomechanics, physical examination, and treatment options relevant to the piriformis syndrome. Treatment protocols stressing exercises that promote strength, flexibility, and functional activities are believed to be essential in restoring the athlete's ability to return to pain-free competition.