A Treatment-Based Profiling Model for Physical Therapy Management of Patients Following a Concussive Event.

SYNOPSIS: Concussions are a public health concern that affects individuals across the life span. The multifaceted effects of concussion warrant an interdisciplinary management strategy that may include physical therapy. However, physical therapists may feel underprepared for clinical decision making following a concussive event. We propose a new treatment-based profiling model to help physical therapists manage patients following a concussive event. This profiling model, based on symptom type and intensity, disability status, and response to movement, prioritizes treatment emphasis on (1) symptom management, (2) movement system optimization, or (3) performance optimization. We consider contextual factors that modify treatment decision making and present examples of each treatment-based profile. J Orthop Sports Phys Ther 2019;49(11):829-841. doi:10.2519/jospt.2019.8869.

Differences in hip range of motion among collegiate pitchers when compared to youth and professional baseball pitcher data.

The purpose of this study was to measure passive hip internal (IR) and external rotation (ER) range of motion (ROM) in collegiate baseball pitchers and compare to published youth and professional values. Measures were taken on the bilateral hips of 29 participants (mean age 20.0±1.4, range 18-22 years). Results identified no significant differences between the stance and stride hip in collegiate right handed pitchers for IR (p= 0.22, ES 0.23) and ER (p=.08, ES= 0.25). There was no significant difference in left handed pitchers for IR (p= 0.80, ES= 0.11) and ER (p= 0.56, ES= 0.15). When comparing youth to collegiate, IR increased in the stance (2º) and stride (5º) hip and an increase in the stance (5º) and stride (5º) hip were present for ER as well. From collegiate to professional, IR increased in the stance (4º) and stride (3º) hip whereas a decrease in the stance (9º) and stride (12º) hip was present for ER. The data suggests an increase in passive ROM from youth to collegiate and a decrease from collegiate to professional. Understanding passive hip ROM values among the different levels of pitchers may assist clinicians in developing time dependent interventions to prevent future injury and enhance performance.

Le but de cette étude était de mesurer l'amplitude de mouvement passif de la hanche en rotation interne (RI) et en rotation externe (RE) chez les lanceurs de baseball au niveau collégial et la comparer aux valeurs publiées chez les jeunes et les professionnels. Des mesures ont été prises sur les deux hanches de 29 participants (moyenne d'âge de 20,0 ± 1,4, tranche d'âge de 18 à 22 ans). Les résultats n'ont révélé aucune différence significative entre la posture et la foulée de la hanche chez les lanceurs droitiers collégiaux pour la RI (p = 0,22, AE = 0,23) et la RE (p = 0,08, AE = 0,25). Il n'y avait pas non plus de différence significative chez les lanceurs gauchers pour la RI (p = 0,80, AE = 0,11) et la RE (p = 0,56, AE = 0,15). Lorsque l'on compare les jeunes aux joueurs collégiaux, la RI a augmenté dans la posture (2º) et la foulée (5º) de la hanche, et une augmentation était également constatée pour la RE : posture (5º) et foulée (5º) de la hanche. Par rapport aux professionnels, la RI a augmenté pour la posture (4º) et la foulée (3º) de la hanche, alors qu'une diminution de la posture (9º) et la foulée (12º) de la hanche était constatée pour la RE. Les données indiquent une augmentation de l'amplitude de mouvement passif des joueurs de niveau collégial par rapport aux jeunes et une diminution par rapport aux joueurs professionnels. La compréhension des valeurs d'amplitude de mouvement passif de la hanche chez les différents niveaux de lanceurs peut aider les cliniciens à développer des interventions ponctuelles pour prévenir les blessures futures et améliorer la performance.

The Effectiveness of Nonoperative Rehabilitation Programs for Athletes Diagnosed With Osteitis Pubis.

Clinical Scenario: The differential diagnosis of groin pain can be very challenging due to the many causative pathologies. Osteitis pubis is a pathology that is becoming more recognized in athletes who participate in sports such as soccer, ice hockey, rugby, and football. Conservative nonoperative treatment is often prescribed first before surgical intervention. Of particular interest are the outcomes of nonoperative rehabilitation programs and their effectiveness to return athletes to preinjury levels of participation. The most recent systematic review in 2011 examined the spectrum of treatments for osteitis pubis and found only level 4 (case report or case series) evidence with varying approaches to treatment. Due to the amount of time since the last published review, there is a need to critically appraise the recent literature to see if more high-quality research has been published that measured nonoperative interventions for athletes with osteitis pubis. Focused Clinical Question: Is there evidence to suggest that nonoperative rehabilitation programs for osteitis pubis are effective at returning athletes to their preinjury levels of participation? Summary of Key Findings: Four studies met the inclusion criteria. Only level 4 evidence was found. All studies reported using a structured nonoperative rehabilitation program with a successful return to preinjury participation between 4 and 14 wk, except for 1 study reporting a successful return at 30 wk. Successful long-term follow-up was reported at 6-48 mo for all patients. Clinical Bottom Line: There is weak evidence to support the efficacy of nonoperative rehabilitation programs at returning athletes to their preinjury levels of participation. Strength of Recommendation: There is grade D evidence that a nonoperative program for osteitis pubis is effective at helping athletes return to their preinjury level of participation. The Centre of Evidence Based Medicine recommends a grade D for level 4 evidence with consistent findings.

Regional interdependence of the hip and lumbo-pelvic region in divison ii collegiate level baseball pitchers: a preliminary study.

BACKGROUND: Pitchers may be at greater risk of injury in comparison to other overhead throwing athletes due to the repetition of the pitching motion. It has been reported that approximately 30% of all baseball injuries occur in the lower body. This may be related to limited hip mobility, which can compromise pitching biomechanics while placing excessive stress on the trunk and upper quarter. Hip motion and strength measurements have been reported in professional baseball pitchers but have not been reported in collegiate pitchers. PURPOSE: The purpose of this study was to report preliminary findings for passive hip motion and isometric hip muscle strength in collegiate pitchers and compare them to previously published values for professional level pitchers. STUDY DESIGN: Cross sectional study. METHODS: Twenty-nine collegiate baseball pitchers (age = 20.0 + 1.4 years, height = 1.88 + 0.06 m; weight = 89.3 + 10.7 kg; body mass index = 25.3 + 2.5 kg/m2) were recruited. Subjects were assessed for hip internal rotation (IR) and external rotation (ER) passive motion, hip anteversion or retroversion, gluteus maximus, gluteus medius, hip internal rotator, hip external rotator strength, and lumbo-pelvic control with the prone active hip rotation test as described by Sahrmann. Statistical analysis included calculation of subject demographics (means and SD) and use of a two-tailed t-test (p >0.05). RESULTS: Fifty-two percent of the right-handed and 50% of the left-handed pitchers demonstrated poor lumbo-pelvic motor control with an inability to stabilize during active hip IR and ER even though isolated strength deficits were not detected at a significant level. There were no significant differences in hip passive motion or gluteus medius strength between right and left-handed pitchers. Differences did exist between collegiate data and previously published values for professional pitchers for IR motion measured in prone and gluteus maximus strength. Hip retroversion was present in 55% of the pitchers primarily in both limbs with four of the pitchers presenting with retroversion singularly in either the stride or trail limb where the ER rotation motion was greater than the IR. CONCLUSION: Assessing mobility and muscle strength of the lower quarter in isolation can be misleading and may not be adequate to ensure the potential for optimal pitching performance. These findings suggest that lumbo-pelvic control in relation to the lower extremities should be assessed as one functional unit. This is the first study to explore hip motion, strength, and lumbo-pelvic control during active hip rotation in collegiate baseball pitchers. EVIDENCE LEVEL: 2.