The effects of muscle fatigue on and the relationship of arm dominance to shoulder proprioception.

It is hypothesized that proprioceptive information plays an important role in joint stabilization and that muscle fatigue may alter proprioceptive ability. The purpose of this study was to determine what effect shoulder muscle fatigue has on glenohumeral proprioception and to examine the relationship between arm dominance and shoulder proprioception. Eighty subjects without a history of glenohumeral pathology participated. Each was seated on an isokinetic dynamometer with a randomly selected shoulder positioned in 90 degrees of abduction and elbow flexion. With vision blinded, the arm was passively positioned in 75 degrees of external rotation for 10 seconds, then passively returned to the neutral starting position. Three trials each of active and passive repositioning (2 degrees/sec) were recorded. Following a fatigue protocol, both active and passive repositioning were reassessed. Testing order was randomized. A significant difference was detected between pre- and post-fatigue scores. No significant difference was detected between dominant and nondominant extremities. No relationship between arm dominance and shoulder proprioception was established. It is concluded that shoulder proprioception is diminished in the presence of shoulder muscle fatigue, suggesting clinical rehabilitation protocols must emphasize increasing muscular endurance.

Referred knee pain in a young athlete: a case study.

Parapatellar pain is a common complaint in the active adolescent patient population. Patello-femoral pain syndrome, Osgood-Schlatter disease, Sinding-Larsen-Johansson syndrome, patellar tendinitis, and other stress failure conditions are the primary causes of these parapatellar symptoms. Not all cases of knee discomfort are related to knee pathology. This case study discusses hip pathology as a source of referred knee pain in an 8-year-old male athlete. Care must be taken to evaluate all possible sources of both primary and referred pain in all cases.

Bleeding in early pregnancy.

Bleeding in pregnancy is a distressing experience for any woman, particularly if she has had a previous miscarriage. Though often offered, hospital admission is thought to have no prognostic advantage over home management. A factor not always considered is the need for administration of anti-D immunoglobulin to rhesus-negative women.

Measurement of isokinetic strength prepubertal males*.

* Supported in part by a grant from Hydra-Fitness Industries, Belton, TX. Twenty-nine prepubertal males ( age = 8.2 +/- 1.3 years) were evaluated for concentric isokinetic strength at the knee, shoulder, and elbow joints, [at the dominant (D) and nondominant (ND) sides]. At each joint, flexion (F) was compared with extension (E) at two speeds of 30 degrees /sec (30) versus 90 degrees /sec (90) over each 10% of the range of motion (ROM). Reliability was estimated between identical motions at the D versus ND side. Results for work at the knee joint indicated slightly higher work output at the ND side (23.5 versus 25.0 joules for D versus ND), significantly higher work output for extension compared to flexion (19.0 versus 29.2 joules for F versus E) and for the slower compared to the faster speed (26.2 versus 21.9 joules for 30 versus 90). At the shoulder joint, extension resulted in significantly greater work compared to flexion (14.2 versus 22.0 joules for F versus E) and the slower speed was associated with significantly greater work (1 9.7 versus 16.7 joules for 30 versus 90). At the elbow joint, the only significant difference observed for work occurred for speed, with the faster speed resulting in greater work (10.8 versus 9.5 joules for 30 versus 90). Analysis for torque scores at each of the three joints revealed that extension resulted in greater torque than flexion, 30 degrees /sec resulted in greater torque than 90 O/sec and that peak torque scores occurred during the first 50% of ROM. Correlations to estimate reliability exceeded r = 0.70 for comparisons of torque and work scores for D versus ND. Age, height, and weight correlated r = 0.50 < r < 0.90 with peak torque during each of the motions. It was concluded that prepubertal males have similar patterns of concentric isokinetic strength measured at the knee, shoulder, and elbow joints compared to adults, because strength was greater during E versus F, for slower versus faster speeds, and during the initial phase of ROM.J Ortho Sports Phys Ther 1988;9(10):345-351.

Strength training for prepubescent males: is it safe?

This study examined the safety of one type of strength training for prepubescent males. Eighteen males (average age, 8.3 +/- 1.2 years) participated in a 45 min/session, three session/week, 14 week supervised strength training program with an attendance rate of 91.5%. Concentric work was done almost exclusively. KinCom analysis showed significant strength gain in this group (P less than 0.05), while an age, sex, and activity matched control group did not gain strength. Safety was evaluated by injury surveillance, blood pressure and heart rate monitoring, scintigraphy, and creatine phosphokinase measurement. Effects on growth and development, flexibility, and motor performance were also investigated, as these are factors with an impact on sports injury occurrence. Results showed that in the short term, supervised concentric strength training results in a low injury rate and does not adversely affect bone, muscle, or epiphyses; nor does it adversely affect growth, development, flexibility, or motor performance. As the safety question is multifaceted, this should not lead to the conclusion that strength training for prepubescents is uniformly safe. Further research is needed.

Lower Extremity Strength and Active Range of Motion in College Baseball Pitchers: A Comparison between Stance Leg and Kick Leg.

The role of the lower extremities and torso is vital in the pitching mechanism. However, a review of the literature reveals information primarily dealing with the upper extremity's role in throwing. This pilot study was conducted to: 1) determine selected lower extremity strength and range of motion measurements in sixteen college baseball pitchers, and 2) compare measurements in the stance leg to the kick leg. When preseason profiling is not possible, clinical norms for those treating college pitchers can be valuable in proper rehabilitation of the lower extremity. Also, by determining trends in lower extremity strength and motion when comparing kick (plant) leg to stance (drive) leg, a better understanding of lower extremity kinematics in the pitching act can be appreciated. Statistically significant differences were found in the active range of motion in plantarflexion, hip internal rotation, and hip extension of the stance leg, as well as hip flexion of the kick leg. lsokinetic evaluations at slow and fast speeds revealed significant differences in the strength of ankle dorsiflexors and hip flexors at slow speeds of the kick leg. Strength of the hamstrings on the kick leg was significant at fast speeds as was strength of the hip external rotators on the stance leg. J Orthop Sports Phys Ther 1986;8(1):10-14.

A case study: lennox hill bracing for postoperative total knee replacement.

Traditionally, the use of the Lennox Hill derotation brace has primarily been for the management of sports related injuries. From the professional to the weekend athlete, or the patient who must return to a demanding occupation, the Lennox Hill brace has been utilized preoperatively and/or postoperatively to manage various knee disorders. In this case report, the Lennox Hill derotation brace was employed to manage post-total knee replacement pain and instability in a geriatric patient. Of particular interest in this case, also, is an increase in quadriceps strength with the Lennox Hill brace being worn versus quadriceps strength with traditional hinge bracing and without brace being worn.J Orthop Sports Phys Ther 1984;5(5):265-268.

A case study: the need for evaluation and reevaluation of acute ankle injury.

Although physical therapists are not trained to "diagnose, " it is essential that they possess competent evaluation skills and the ability to form accurate impressions which are then treated accordingly. This is especially true when the physical therapist is the first line of professional intervention in treating injury. Emphasis of this case report is not on new or unusual evaluation-treatment techniques. Rather, the key to efficient care of the athlete lies in the perseverance of the health care professional in reevaluation, appropriate precautions, and adequate follow-up. J Orthop Sports Phys Ther 1982;4(1):44-46.