Moderate reliability of the lateral step down test amongst experienced and novice physical therapists.

BACKGROUND/INTRODUCTION: The lateral step-down test is used to appraise movement quality in patients with patellofemoral pain (PFP), however, it is unclear if reliability of the test is affected by physical therapist experience. OBJECTIVE: Determine if there is a difference in reliability between 'experienced' and 'novice' physical therapists appraising movement quality of patients with PFP during the lateral step-down test. METHODS: Three 'experienced' and 3 'novice' physical therapists analyzed movement quality of 22 participants [mean age (SD) 28.25 (6.5) years] with PFP. Physical therapists viewed two-dimensional videos of participants performing the lateral step-down test and appraised the quality with a score (0-1 = 'good'; 2-3 = 'fair', and 4-5 = 'poor') at baseline and 1 week. Inter- and intra-rater reliability were calculated with kappa and percent agreement. Differences between the groups were assessed with the chi-square test with an a priori alpha level of < 0.05. RESULTS: Inter- and intra-rater reliability ranged from fair to moderate (ĸ = 0.40-0.65). There was no difference in reliability between 'experienced' and 'novice' physical therapists at baseline (p = .13) or 1 week post testing (p = .94). CONCLUSIONS: There was no difference in reliability between 'experienced' and 'novice' physical therapists using categories to appraise movement quality during the lateral step-down test for patients with chronic PFP.

Performance on the modified star excursion balance test at the time of return to sport following anterior cruciate ligament reconstruction.

STUDY DESIGN: Cross-sectional. Objectives To compare performance on the modified Star Excursion Balance Test (SEBT) between participants with anterior cruciate ligament reconstruction (ACLR) at the time of return to sport and uninjured control participants. BACKGROUND: The modified SEBT is a clinical tool to assess neuromuscular control deficits. Deficits in dynamic stability and neuromuscular control persist after ACLR, but assessment with the modified SEBT in this population at the time of return to sport has not been reported. METHODS: Sixty-six participants (mean age, 17.6 years) at the time of return to sport following unilateral primary ACLR (ACLR group) and 47 uninjured participants (mean age, 17.0 years) serving as a control group participated. For the modified SEBT, the anterior, posteromedial, and posterolateral reach distances were recorded. Lower extremity muscle strength was quantified with isokinetic dynamometry. Independent-sample t tests were used to evaluate performance differences between the ACLR group and the control group and between the ACLR subgroups. In the ACLR group, bivariate correlations determined the association of modified SEBT performance with time since surgery and lower extremity muscle strength. RESULTS: The ACLR group had lower anterior reach distances on the involved and uninvolved limbs compared to the control group. There were no differences observed between groups in reach distances for the posteromedial and posterolateral directions or in limb symmetry indices for any of the reach directions. In the ACLR group, time from surgery and meniscal status at the time of ACLR did not influence modified SEBT performance, whereas participants with patellar bone-tendon-bone grafts had a lower posterolateral reach distance compared to those with hamstring grafts. In the ACLR group, involved-limb hip abduction strength positively correlated with all reach distances, and quadriceps strength positively correlated with posterolateral reach. CONCLUSION: At the time of return to sport, participants post-ACLR demonstrated reduced modified SEBT anterior reach in both involved and uninvolved limbs compared to uninjured participants, with no other group differences. In the ACLR group, modified SEBT reach distance was associated with lower extremity muscle strength, but not with time from reconstruction or meniscal status at the time of ACLR. Lower extremity muscle strength and graft type may interact to influence modified SEBT posterior reach performance, but this requires further study. LEVEL OF EVIDENCE: Prognosis level 2b-.

Kinetic analyses of maximal effort soccer kicks in female collegiate athletes.

To determine the effect of plant leg and approach condition on the torques of the hip, knee, and ankle in soccer kicking tasks, nine female collegiate soccer players performed a series of kicking tasks from three different approach conditions. Kinematic data of the hip, knee, and ankle were recorded and joint torques of the plant leg were calculated. Peak flexor torque of the hip and ankle was greater for the dominant than the non-dominant plant leg for center and off-axis approach conditions (P < 0.05), while the opposite was true for peak extension torque for the hip and knee (P < 0.05). Similar effects of plant leg dominance emerged for peak internal and external rotation torques as well for peak abduction and adduction torques. In summary, these results indicate that participants use greater pulling torques and smaller braking torques in the dominant plant leg compared with the non-dominant plant leg. Thus, even in collegiate athletes who train to be able to kick efficiently with either leg, differences in peak joint torques emerge between the dominant and non-dominant plant legs, particularly when participants kick from an off-axis approach.