Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018.

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to midportion Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(5):A1-A38. doi:10.2519/jospt.2018.0302.

Restricted hip mobility: clinical suggestions for self-mobilization and muscle re-education.

UNLABELLED: Restricted hip mobility has shown strong correlation with various pathologies of the hip, lumbar spine and lower extremity. Restricted mobility can consequently have deleterious effects not only at the involved joint but throughout the entire kinetic chain. Promising findings are suggesting benefit with skilled joint mobilization intervention for clients with various hip pathologies. Supervised home program intervention, while lacking specifically for the hip joint, are demonstrating promising results in other regions of the body. Application of an accompanying home program for the purpose of complementing skilled, in clinic intervention is advisable for those clients that respond favorably to such methodology. LEVEL OF EVIDENCE: 5.

Core stabilization exercise prescription, part I: current concepts in assessment and intervention.

CONTEXT: Injury to the low back can cause significant pain and dysfunction, which can affect an athlete's performance and result in time lost from sport. A common conservative treatment is therapeutic core stabilization exercises, which can address pain and musculoskeletal dysfunction in patients with low back pathology. EVIDENCE ACQUISITION: MEDLINE and CINAHL were searched (from 1966 to March 2013) to identify relevant research. Keywords and keyword combinations searched included motor control exercise, segmental stabilization, core stabilization, transversus abdominis, multifidi, and low back pain. RESULTS: There are 2 popular rehabilitation strategies to assess core function and promote core stabilization. Each has been developed based on biomechanical models of lumbar segmental stability and observed motor control dysfunction in patients with low back pain. CONCLUSION: Controversy exists among clinical and research groups as to the optimal strategy for an athlete with low back pain.

Core stabilization exercise prescription, part 2: a systematic review of motor control and general (global) exercise rehabilitation approaches for patients with low back pain.

CONTEXT: Therapeutic exercises are frequently prescribed to patients with low back pain. Numerous exercise programs for patients with low back pain have been described. Many of these treatment programs are based on 1 of 2 popular rehabilitation strategies: a motor control exercise approach or a general exercise approach. DATA SOURCES: PubMed clinical queries from 1966 to March 2013 for keyword combinations including motor control exercise, core stability exercise, therapeutic exercise, general exercise, global exercise, local exercise, transversus abdominis, segmental stabilization, and low back pain. STUDY SELECTION: Randomized controlled trials that assessed the effects of a motor control exercise approach, a general exercise approach, or both for patients with low back pain that were published in scientific peer-reviewed journals. DATA EXTRACTION: Included studies underwent appraisal for exercise intervention and outcomes. RESULTS: Fifteen studies were identified (8, motor control exercise approach without general exercise comparison; 7, general exercise approach with or without motor control exercise approach comparison). Current evidence suggests that exercise interventions may be effective at reducing pain or disability in patients with low back pain. CONCLUSION: Stabilization exercises for patients with low back pain may help to decrease pain and disability. It may not be necessary to prescribe exercises purported to restore motor control of specific muscles.

Seat-interface pressures on various thicknesses of foam wheelchair cushions: a finite modeling approach.

OBJECTIVE: To investigate the effect of cushion thickness on subcutaneous pressures during seating by using a finite element modeling approach. DESIGN: Seat-interface pressure measurements were used in a computational model. SETTING: Biomechanics laboratory. PARTICIPANT: A single healthy man (weight, 70 kg). INTERVENTIONS: Subject sat upright either with or without cushions of various heights. Seat-interface pressures measured by using a sensor mat interfaced to a personal computer sampling at 15 Hz. MAIN OUTCOME MEASURES: Peak seat-interface pressure; finite-element software was used to model the buttock, ischial tuberosity, and seat cushion. Subcutaneous stresses were calculated from the model. RESULTS: The region of highest subcutaneous stress in the soft tissue was concentrated within 1 or 2 cm of the ischial tuberosity, with the maximum compressive stress inferior to the bottom surface of the ischial tuberosity. The maximum subcutaneous stress, maximum seat-interface pressure, and maximum subcutaneous shear stress each changed with cushion thickness. Subcutaneous pressures decreased with thicker cushions, but almost all of the reduction was obtained with an 8-cm cushion. The amount of subcutaneous shear stress increased slightly for thicker cushions. The maximum subcutaneous stress was greater than the maximum interface pressure but not by a constant factor. Instead, the former was consistently larger by 0.7 to 0.8 N/cm(2). CONCLUSIONS: Cushion use reduced the maximum subcutaneous stress inferior to the ischial tuberosity. However, increasing the cushion thickness beyond 8 cm was ineffective in further reducing subcutaneous stress. It was also found that seat-interface pressures were a good indicator of the subcutaneous stress reduction in seating.

Electromyographic activity and applied load during seated quadriceps exercises.

PURPOSE: The aim of this study was to quantify and compare mean quadriceps muscle activity and applied load for eight seated quadriceps exercises using four types of resistance. METHODS: Using surface electromyography (EMG), the right rectus femoris (RF), vastus lateralis (VL), and vastus medialis oblique (VMO) muscles of 52 university students aged 23.5 +/- 3.4 yr (35 female and 17 male subjects) were examined during the exercises. Resistance devices included an ankle weight (78 N), blue Thera-Band tubing, a Cybex 340 isokinetic dynamometer, and an Inertial Exercise Trainer (IET). Electrogoniometer data were collected to determine the range of motion (ROM), angular velocity, and phase (concentric/eccentric) of exercise. Load cell data were analyzed to determine tubing and IET applied loads during exercise. A within-subjects criterion was used to improve intrasubject EMG reliability. All EMG values were normalized to a 100% maximum voluntary isometric contraction. Repeated measures ANOVAs with Bonferroni comparisons were used for statistical analysis. RESULTS: Within-subject effects of muscle and exercise were significant (P < 0.05) for both the concentric and eccentric muscle activity. The interaction effect of mean average EMG amplitude across exercises for the concentric phases of knee extension was significant (P = 0.001). No significant interactions were found for the eccentric phases of all seated quadriceps exercises. None of the exercises selectively isolated the VMO over the VL; however, the VMO/VL ratio was less (P < 0.05) during the concentric phases of the free weight and elastic tubing exercise when compared with the others. Eccentric phase VMO/VL ratios revealed that inertial resistance elicited greater muscle activity than other forms of resistance exercise. CONCLUSION: These findings suggest clinicians should consider biomechanical and resistance data when developing a strengthening program for the quadriceps muscle. Some seated quadriceps exercises may be more appropriate for certain rehabilitation goals than others.