Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users.

PURPOSE: To analyze the effectiveness of a 6-month exercise protocol on shoulder pain experienced by wheelchair users during functional activities. SUBJECTS: Forty-two wheelchair users, 35 males and seven females: average age of 35 years and an average duration of wheelchair use of 14 years. METHODS: Subjects were randomly assigned to treatment (n=21) and control (n=21) groups. The treatment group received instruction in five shoulder exercises which they performed daily for 6 months. The exercise protocol included two exercises for stretching anterior shoulder musculature and three exercises for strengthening posterior shoulder musculature. OUTCOME MEASURES: All subjects completed a self-report questionnaire and the Wheelchair Users Shoulder Pain Index (WUSPI) initially and at bimonthly intervals during the 6-month intervention. RESULTS: Seventy-five per cent of the subjects reported a history of shoulder pain since beginning wheelchair use. The average initial performance-corrected (PC-WUSPI) score of the 42 subjects was 17.7 (+/-21.3) with a range of 0-103.2 points. Over 83% of the subjects (35 of 42) completed the 6-month study. Subjects in the treatment group decreased their PC-WUSPI score by an average of 39.9%, compared to decreases of only 2.5% in the control group. CONCLUSIONS: These findings supported the effectiveness of this exercise protocol in decreasing the intensity of shoulder pain which interferes with functional activity in wheelchair users.

The contributions of proprioceptive deficits, muscle function, and anatomic laxity to functional instability of the ankle.

Functional instability is a common complication following an acute ankle sprain. Three potential contributing factors underlying the ankle which chronically gives way are proprioceptive deficits, muscle weakness, and ligamentous laxity. This study's purpose was to document the presence or absence of these concerns in a sample of subjects with unilateral functional ankle instability. Both ankles of 42 subjects were randomly assessed for passive movement sense into inversion and generation of peak torque by the evertors isokinetically. Thirty-four subjects were available for documentation of talar tilt of both ankles through inversion stress radiographs. Analysis found significantly greater mean values for passive movement sense and talar tilt for the involved ankles compared with the uninvolved, while no significant strength differences in peak torque of the evertors were present. Fifty-eight percent of the sample demonstrated clinical impairments in at least one of these three categories. In conclusion, deficits in passive movement sense and anatomic stability are greater concerns than strength deficits when managing the ankle with functional instability.

The use of thermal agents to influence the effectiveness of a low-load prolonged stretch.

This study was funded in part by a Minigrant award from California State University, Fresno. The use of thermal modalities to enhance stretching procedures is not well documented clinically. This study documented the effectiveness of applying superficial heat and cold in conjunction with a low-load prolonged stretch (LLPS) for increasing shoulder flexibility. Ninety-two healthy males were randomly assigned to one of five groups: 1) an LLPS alone, 2) heat applied in the initial phase of an LLPS, 3) cold applied in the final phase of stretch, 4) a combination of heat initially followed by cold, and 5) no intervention. Subjects received three, 40-minute treatments across a 5-day period. A follow-up measurement was taken 3 days later. Results demonstrated that an LLPS associated with the use of heat, ice, or a combination of both facilitated greater long-term improvements in flexibility compared with controls. However, only subjects receiving heat in the initial phase of an LLPS showed significant gains when compared with those who received stretching alone (p

A comparison of the passive support provided by various ankle braces.

This research was funded in part by a grant from the Ferrante and Jackson Physical Therapy Research Fund. Recent criticism in the literature regarding the effectiveness and costs of ankle taping has lead to an increased use of commercial ankle braces. This study compared the effectiveness of four commercially available ankle braces in limiting range of motion at the ankle before and after a brief exercise session. Twenty-seven healthy subjects, ages 18-36, were tested across all four bracing conditions. For each brace application, a combined passive inversion-eversion movement was evaluated three times: 1) prebrace application, 2) immediate postbrace application, and 3) following a 10 min exercise session. Subjective ratings of brace comfort, support, and preference were also documented. All four braces significantly limited more motion compared to the unbraced ankle, both before and after exercise (p

The Relationship between Muscle Function and Ankle Stability.

The purpose of this investigation was to document the degree of weakness present in the medial and lateral muscle groups of individuals with chronically unstable ankles. Peak isometric and isokinetic torque measurements were collected bilaterally during the motion of inversion-eversion from 33 subjects, ages 17 to 54, reporting unilateral chronic lateral instability. Values were then compared between the involved and uninvolved sides. A modified Romberg test was also performed bilaterally to determine gross balance differences between the involved and uninvolved lower extremities. No significant difference in muscle strength was documented either isometrically or isokinetically, but balance differences were found between the two extremities in a majority of subjects. The findings suggest that muscular weakness is not a major contributing factor to the chronically unstable ankle. The findings do support the presence of proprioceptive deficits associated with this condition. Based on the results, proprioceptive activities should be a primary consideration in management of the chronically unstable ankle. J Orthop Sports Phys Ther 1990;11(12):605-611.

Reliability of isokinetic muscle testing at the ankle.

The purpose of this study was to determine the intrarater and interrater reliability of mean peak torque values for the reciprocal motions of plantarflexion/dorsiflexion (PF/DF) and inversion/eversion (INV/EVER), generated isokinetically at 60 and 120 degrees /sec. Forty-one healthy subjects, ranging in age from 20-75, were tested on three different occasions. The three test sessions were performed at the same time of day and separated by at least 24 hours. Pearson product-moment correlations were used to determine reliability for all ankle motions tested. Intrarater reliability of peak torque values for PF/DF and INV/EVER at both speeds ranged from 0.78-0.94, while the range of interrater coefficients was from 0.82-0.94. The results of this study suggest that when using a well defined clinical protocol, acceptable reliability for both test-retest and interrater situations can be obtained for isokinetic peak torque values of the ankle musculature at low and relatively high test speeds. J Orthop Sports Phys Ther 1989;11(4):150-154.

Intertester reliability for measuring pelvic tilt in standing.

The purpose of this study was to examine intertester reliability using a method of measuring the relaxed standing pelvic-tilt angle, active anterior and posterior pelvic-tilt angles and ranges of motion, and the total pelvic-tilt ROM in the sagittal plane. After an instructional session, 6 testers measured the pelvic-tilt angles of the right side of 12 subjects. Pelvic-tilt angles were calculated using trigonometric functions. Degrees of ROM were determined from the pelvic-tilt angles obtained. The intraclass correlation coefficient was .95 for standing pelvic-tilt angle, .93 for the anterior pelvic-tilt angle, .93 for the posterior pelvic-tilt angle, .88 for the anterior pelvic-tilt ROM, .93 for the posterior pelvic-tilt ROM, and .90 for the total pelvic-tilt ROM. We concluded that intertester reliability, using this method, was very high for measuring pelvic tilt in the sagittal plane.

The effect of knee position on torque output during inversion and eversion movements at the ankle.

The purpose of this study was to compare the effect of knee position on the magnitude of torque generated during the isokinetic movements of inversion and eversion at the ankle. Mean peak torque values at 30 and 120 degrees /sec were collected from 12 subjects, ages 21-31, from two test positions. The knee was stabilized in 10 degrees of flexion for the first test position and 70 degrees for the second. Additionally, mean peak amplitude of hamstring motor unit action potentials was compared between the two test positions to demonstrate differences in hamstring activity. At both speeds, mean peak torque values of the inversion-eversion movements, as well as mean peak amplitude of hamstring motor unit action potentials, was significantly lower in 10 degrees compared to 70 degrees of knee flexion (p < 0.01). It was concluded that isokinetic testing at the ankle with the knee in a close packed position, near full extension, provides a more valid representation of isolated muscular performance than testing with the knee in a loose packed position of midrange flexion.J Orthop Sports Phys Ther 1988;10(5):177-183.