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1.  Lumbopelvic Joint Manipulation and Quadriceps Activation of People With Patellofemoral Pain Syndrome 
Journal of Athletic Training  2012;47(1):24-31.
Context:
Quadriceps weakness and inhibition are impairments associated with patellofemoral pain syndrome (PFPS). Lumbopelvic joint manipulation has been shown to improve quadriceps force output and inhibition, but the duration of the effect is unknown.
Objective:
To determine whether quadriceps strength and activation are increased and maintained for 1 hour after high-grade or low-grade joint mobilization or manipulation applied at the lumbopelvic region in people with PFPS.
Design:
Randomized controlled clinical trial.
Setting:
University laboratory.
Patients or Other Participants:
Forty-eight people with PFPS (age = 24.6±8.9 years, height = 174.3 ± 11.2 cm, mass = 78.4 ± 16.8 kg) participated.
Intervention(s):
Participants were randomized to 1 of 3 groups: lumbopelvic joint manipulation (grade V), side-lying lumbar midrange flexion and extension passive range of motion (grade II) for 1 minute, or prone extension on the elbows for 3 minutes.
Main Outcome Measure(s):
Quadriceps force and activation were measured using the burst superimposition technique during a seated isometric knee extension task. A 2-way repeated-measures analysis of variance was performed to compare changes in quadriceps force and activation among groups over time (before intervention and at 0, 20, 40, and 60 minutes after intervention).
Results:
We found no differences in quadriceps force output (F5,33,101,18 = 0.65, P = .67) or central activation ratio (F4.84,92.03 = 0.38, P= .86) values among groups after intervention. When groups were pooled, we found differences across time for quadriceps force (F2.66,101.18 = 5.03, P = .004) and activation (F2.42,92.03 = 3.85, P = .02). Quadriceps force was not different at 0 minutes after intervention (t40 = 1.68, P = .10), but it decreased at 20 (t40 = 2.16, P = .04), 40 (t40 = 2.87, P = .01) and 60 (t40 = 3.04, P = .004) minutes after intervention. All groups demonstrated decreased quadriceps activation at 0 minutes after intervention (t40 = 4.17, P <.001), but subsequent measures were not different from preintervention levels (t40 range, 1.53–1.83, P >.09).
Conclusions:
Interventions directed at the lumbopelvic region did not have immediate effects on quadriceps force output or activation. Muscle fatigue might have contributed to decreased force output and activation over 1 hour of testing.
PMCID: PMC3418111  PMID: 22488227
force output; knee pain; manual therapy; muscle activation
2.  Lower Extremity Neuromuscular Control Immediately After Fatiguing Hip-Abduction Exercise 
Journal of Athletic Training  2011;46(6):607-614.
Context:
Fatigue of the gluteus medius (GMed) muscle might be associated with decreases in postural control due to insufficient pelvic stabilization. Men and women might have different muscular recruitment patterns in response to GMed fatigue.
Objective:
To compare postural control and quality of movement between men and women after a fatiguing hip-abduction exercise.
Design:
Descriptive laboratory study.
Setting:
Controlled laboratory.
Patients or Other Participants:
Eighteen men (age = 22 ± 3.64 years, height = 183.37 ± 8.30 cm, mass = 87.02 ±12.53 kg) and 18 women (age = 22 ± 3.14, height = 167.65 ± 5.80 cm, mass = 66.64 ± 10.49 kg) with no history of low back or lower extremity injury participated in our study.
Intervention(s):
Participants followed a fatiguing protocol that involved a side-lying hip-abduction exercise performed until a 15% shift in electromyographic median frequency of the GMed was reached.
Main Outcome Measure(s):
Baseline and postfatigue measurements of single-leg static balance, dynamic balance, and quality of movement assessed with center-of-pressure measurements, the Star Excursion Balance Test, and lateral step-down test, respectively, were recorded for the dominant lower extremity (as identified by the participant).
Results:
We observed no differences in balance deficits between sexes (P > .05); however, we found main effects for time with all of our postfatigue outcome measures (P ≤ .05).
Conclusions:
Our findings suggest that postural control and quality of movement were affected negatively after a GMed-fatiguing exercise. At similar levels of local muscle fatigue, men and women had similar measurements of postural control.
PMCID: PMC3418937  PMID: 22488185
gluteus medius muscle; postural control; balance
3.  Quadriceps Function After Exercise in Patients with Anterior Cruciate Ligament–Reconstructed Knees Wearing Knee Braces 
Journal of Athletic Training  2011;46(6):615-620.
Context:
Knee braces and neoprene sleeves are commonly worn by people with anterior cruciate ligament reconstructions (ACLRs) during athletic activity. How knee braces and sleeves affect muscle activation in people with ACLRs is unclear.
Purpose:
To determine the effects of knee braces and neoprene knee sleeves on the quadriceps central activation ratio (CAR) before and after aerobic exercise in people with ACLRs.
Design:
Crossover study.
Patients or Other Participants:
Fourteen people with a history of ACLR (9 women, 5 men: age = 23.61 ± 4.44 years, height = 174.09 ± 9.82 cm, mass = 75.35 ± 17.48 kg, months since ACLR = 40.62 ± 20.41).
Intervention(s):
During each of 3 sessions, participants performed a standardized aerobic exercise protocol on a treadmill. The independent variables were condition (brace, sleeve, or control) and time (baseline, pre-exercise with brace, postexercise with brace, postexercise without brace).
Main Outcome Measure(s):
Normalized torque measured during a maximal voluntary isometric contraction (TMVIC) and CAR were measured by a blinded assessor using the superimposed burst technique. The CAR was expressed as a percentage of full muscle activation. The quadriceps CAR and TMVIC were measured 4 times during each session: baseline, pre-exercise with brace, postexercise with brace, and postexercise without brace.
Results:
Immediately after the application of the knee brace, TMVIC decreased (P = .01), but no differences between bracing conditions were observed. We noted reduced TMVIC and CAR (P < .001) after exercise, both with and without the brace. No differences were seen between bracing conditions after aerobic exercise.
Conclusions:
The decrease in TMVIC immediately after brace application was not accompanied by differences between bracing conditions. Wearing a knee brace or neoprene sleeve did not seem to affect the deterioration of quadriceps function after aerobic exercise.
PMCID: PMC3418938  PMID: 22488186
neuromuscular function; aerobic exercise; central activation ratio
4.  Electrode Type and Placement Configuration for Quadriceps Activation Evaluation 
Journal of Athletic Training  2011;46(6):621-628.
Context:
The ability to accurately estimate quadriceps voluntary activation is an important tool for assessing neuromuscular function after a variety of knee injuries. Different techniques have been used to assess quadriceps volitional activation, including various stimulating electrode types and electrode configurations, yet the optimal electrode types and configurations for depolarizing motor units in the attempt to assess muscle activation are unknown.
Objective:
To determine whether stimulating electrode type and configuration affect quadriceps central activation ratio (CAR) and percentage-of-activation measurements in healthy participants.
Design:
Crossover study.
Setting:
Research laboratory.
Patients and Other Participants:
Twenty participants (13 men, 7 women; age = 26 ± 5.3 years, height = 173.85 ± 7.3 cm, mass = 77.37 ± 16 kg) volunteered.
Intervention(s):
All participants performed 4 counter-balanced muscle activation tests incorporating 2 different electrode types (self-adhesive, carbon-impregnated) and 2 electrode configurations (vastus, rectus).
Main Outcome Measure(s):
Quadriceps activation was calculated with the CAR and percentage-of-activation equations, which were derived from superimposed burst and resting torque measurements.
Results:
No differences were found between conditions for CAR and percentage-of-activation measurements, whereas resting twitch torque was higher in the rectus configuration for both self-adhesive (216 ± 66.98 Nm) and carbon-impregnated (209.1 ± 68.22 Nm) electrodes than in the vastus configuration (209.5 ± 65.5 Nm and 204 ± 62.7 Nm, respectively) for these electrode types (F1,19 = 4.87, P = .04). In addition, resting twitch torque was greater for both electrode configurations with self-adhesive electrodes than with carbon-impregnated electrodes (F1,19 = 9.33, P = .007). Bland-Altman plots revealed acceptable mean differences for agreement between electrode type and configuration for CAR and percentage of activation, but limits of agreement were wide.
Conclusions:
Although these electrode configurations and types might not necessarily be able to be used interchangeably, differences in electrode type and configuration did not seem to affect CAR and percentage-of-activation outcome measures.
PMCID: PMC3418939  PMID: 22488187
burst superimposition; interpolated twitch technique; central activation ratio; knee; motor neurons
5.  Neuromuscular Changes After Aerobic Exercise in People with Anterior Cruciate Ligament– Reconstructed Knees 
Journal of Athletic Training  2011;46(5):476-483.
Context:
Anterior cruciate ligament (ACL) reconstructions are common, especially in young, active people. The lower extremity neuromuscular adaptations seen after aerobic exercise provide information about how previously injured patients perform and highlight deficits and, hence, areas for focused treatment. Little information is available about neuromuscular performance after aerobic exercise in people with ACL reconstructions.
Objective:
To compare dynamic balance, gluteus medius muscle activation, vertical jump height, and hip muscle strength after aerobic exercise in people with ACL-reconstructed knees.
Design:
Case-control study.
Setting:
Research laboratory.
Patients or Other Participants:
Of 34 recreationally active volunteers, 17 had a unilateral primary ACL reconstruction at least 2 years earlier and 17 were matched controls.
Intervention(s):
All participants performed 20 minutes of aerobic exercise on a treadmill.
Main Outcome Measure(s):
We recorded dynamic, single-legged balance electromyographic gluteus medius muscle activation, single-legged vertical jump height, and maximum isometric strength for hip abduction, extension, and external rotation preexercise and postexercise.
Results:
Participants with ACL reconstructions exhibited shorter reach distances during dynamic balance tasks, indicating poorer dynamic balance, and less gluteus medius muscle electromyographic activation. Reductions in hip abduction and extension strength after exercise were noted in all participants; however, those with ACL reconstructions displayed greater hip extensor strength loss after aerobic exercise than did the control group.
Conclusions:
Neuromuscular changes after aerobic exercise exist in both patients with ACL reconstructions and controls. The former group may experience greater deficits in hip extensor strength after aerobic exercise. Reduced reach distances in people with ACL reconstructions may represent a protective mechanism against excessive tibiofemoral rotation during dynamic balance. Clinicians should identify weaknesses in the resting state and after aerobic exercise in recreationally active patients and those with ACL reconstructions.
PMCID: PMC3418953  PMID: 22488134
skeletal muscle adaptations; fatigue; strength; isometric activity; isokinetic activity
7.  Motor-Neuron Pool Excitability of the Lower Leg Muscles After Acute Lateral Ankle Sprain 
Journal of Athletic Training  2011;46(3):263-269.
Context:
Neuromuscular deficits in leg muscles that are associated with arthrogenic muscle inhibition have been reported in people with chronic ankle instability, yet whether these neuromuscular alterations are present in individuals with acute sprains is unknown.
Objective:
To compare the effect of acute lateral ankle sprain on the motor-neuron pool excitability (MNPE) of injured leg muscles with that of uninjured contralateral leg muscles and the leg muscles of healthy controls.
Design:
Case-control study.
Setting:
Laboratory.
Patients or Other Participants:
Ten individuals with acute ankle sprains (6 females, 4 males; age = 19.2 ± 3.8 years, height = 169.4 ± 8.5 cm, mass = 66.3 ±11.6 kg) and 10 healthy individuals (6 females, 4 males; age = 20.6 ± 4.0 years, height = 169.9 ± 10.6 cm, mass = 66.3 ± 10.2 kg) participated.
Intervention(s):
The independent variables were group (acute ankle sprain, healthy) and limb (injured, uninjured). Separate dependent t tests were used to determine differences in MNPE between legs.
Main Outcome Measure(s):
The MNPE of the soleus, fibularis longus, and tibialis anterior was measured by the maximal Hoffmann reflex (Hmax) and maximal muscle response (Mmax) and was then normalized using the Hmax:Mmax ratio.
Results:
The soleus MNPE in the ankle-sprain group was higher in the injured limb (Hmax:Mmax = 0.63; 95% confidence interval [CI], 0.46, 0.80) than in the uninjured limb (Hmax:Mmax = 0.47; 95% CI, 0.08, 0.93) (t6 = 3.62, P = .01). In the acute ankle-sprain group, tibialis anterior MNPE tended to be lower in the injured ankle (Hmax:Mmax = 0.06; 95% CI, 0.01, 0.10) than in the uninjured ankle (Hmax:Mmax = 0.22; 95% CI, 0.09, 0.35), but this finding was not different (t9 = −2.01, P = .07). No differences were detected between injured (0.22; 95% CI, 0.14, 0.29) and uninjured (0.25; 95% CI, 0.12, 0.38) ankles for the fibularis longus in the ankle-sprain group (t9 = −0.739, P = .48). We found no side-to-side differences in any muscle among the healthy group.
Conclusions:
Facilitated MNPE was present in the involved soleus muscle of patients with acute ankle sprains, but no differences were found in the fibularis longus or tibialis anterior muscles.
PMCID: PMC3419554  PMID: 21669095
arthrogenic muscle response; Hoffmann reflex; fibularis longus; soleus; tibialis anterior
8.  The Hoffmann Reflex: Methodologic Considerations and Applications for Use in Sports Medicine and Athletic Training Research 
Journal of Athletic Training  2004;39(3):268-277.
Objective:
To discuss the proper methods used to elicit the Hoffmann reflex (H-reflex) and to present different situations in which this tool can be used in sports medicine research.
Data Sources:
We searched MEDLINE and SPORT Discus from 1960 to 2004 using the key words Hoffmann reflex, H-reflex, and methodology. The remaining citations were collected from references of similar papers.
Data Synthesis:
Numerous authors have used the H-reflex as a tool to examine neurologic conditions. However, few have used the H-reflex to examine neuromuscular impairments after sport injuries. Several studies were available describing the appropriate methods to elicit the H-reflex and examining the reliability of this measurement in different muscles.
Conclusions/Recommendations:
The H-reflex is a valuable tool to evaluate neurologic function in various populations. However, because of the sensitivity of this measurement to extraneous factors, care must be taken when eliciting the H-reflex. We discuss recommendations on how to elicit the H-reflex and how to appropriately present methods in a manuscript.
PMCID: PMC522151  PMID: 16558683
H-reflex; neuromuscular system; motor neuron; injury; muscle
9.  The Spectral Qualities of Postural Control are Unaffected by 4 Days of Ankle-Brace Application 
Journal of Athletic Training  2002;37(3):269-274.
Objective: To determine if the spectral qualities of medial-lateral (ML) and anterior-posterior (AP) center of pressure during a 1-legged stance are affected by 4 days of ankle-brace application.
Design and Setting: The study, which consisted of a pretest-posttest randomized group design, took place in the Sports Injury Research Laboratory at Indiana State University.
Subjects: Twenty-eight Indiana State University students, who had not suffered from any ankle injuries within the past 2 years and were free of any neurologic or vestibular disorders, participated in the study.
Measurements: The effects of 3 independent variables on mean frequency amplitude for both ML and AP center of pressure were examined: (1) treatment (brace, control), (2) frequency bin (0%–20%, 20%–40%, 40%–60%, 60%–80%, and 80%–100% of area), and (3) time (pretest, immediately after brace application, and after 1, 2, 3, or 4 days of brace wear).
Results: We detected no difference (P > .05) for the ML or AP mean frequency when comparing the brace and control groups.
Conclusions: Application of an ankle brace may not require modifications in the postural-control strategies during a 1-legged stance in subjects with healthy ankles.
PMCID: PMC164355  PMID: 12937584
fast Fourier transformation; somatosensation; frequency analysis; balance
10.  Sex Differences in Concussion Symptoms of High School Athletes 
Journal of Athletic Training  2011;46(1):76-84.
Abstract
Context:
More than 1.6 million sport-related concussions occur every year in the United States, affecting greater than 5% of all high school athletes who participate in contact sports. As more females participate in sports, understanding possible differences in concussion symptoms between sexes becomes more important.
Objective:
To compare symptoms, symptom resolution time, and time to return to sport between males and females with sport-related concussions.
Design:
Descriptive epidemiology study.
Setting:
Data were collected from 100 high schools via High School RIO (Reporting Information Online).
Patients or Other Participants:
Athletes from participating schools who sustained concussions while involved in interscholastic sports practice or competition in 9 sports (boys' football, soccer, basketball, wrestling, and baseball and girls' soccer, volleyball, basketball, and softball) during the 2005–2006 and 2006–2007 school years. A total of 812 sport concussions were reported (610 males, 202 females).
Main Outcome Measure(s):
Reported symptoms, symptom resolution time, and return-to-play time.
Results:
No difference was found between the number of symptoms reported (P  =  .30). However, a difference was seen in the types of symptoms reported. In year 1, males reported amnesia (exact P  =  .03) and confusion/disorientation (exact P  =  .04) more frequently than did females. In year 2, males reported more amnesia (exact P  =  .002) and confusion/disorientation (exact P  =  .002) than did females, whereas females reported more drowsiness (exact P  =  .02) and sensitivity to noise (exact P  =  .002) than did males. No differences were observed for symptom resolution time (P  =  .40) or return-to-play time (P  =  .43) between sexes.
Conclusions:
The types of symptoms reported differed between sexes after sport-related concussion, but symptom resolution time and return-to-play timelines were similar.
doi:10.4085/1062-6050-46.1.76
PMCID: PMC3017493  PMID: 21214354
epidemiology; mild traumatic brain injuries; symptom resolution; return to play
11.  Efficacy of Prophylactic Ankle Support: An Experimental Perspective 
Journal of Athletic Training  2002;37(4):446-457.
Objective: To provide a comprehensive review of the literature regarding the role of external ankle support on joint kinematics, joint kinetics, sensorimotor function, and functional performance.
Data Sources: We searched MEDLINE and SPORT Discus databases from 1960–2001 for the key words ankle bracing, ankle support, ankle taping, and ankle prophylaxes. We also used personal libraries based on our own research to complement the existing literature.
Data Synthesis: The effects of external ankle support have been studied on a plethora of dependent measures. Here, we specifically discuss the role of external ankle support on joint kinematics, joint kinetics, sensorimotor function, and functional performance and present a general consensus regarding the overall effects of these prophylactic devices.
Conclusions/Recommendations: The effects of ankle support on joint kinematics during static joint assessment and on traditional functional-performance measures (ie, agility, sprint speed, vertical jump height) are well understood. However, the potential effects of ankle support on joint kinetics, joint kinematics during dynamic activity (eg, a cutting maneuver), and various sensorimotor measures are not well known. Future research investigating the role of external ankle bracing needs to focus on these areas.
PMCID: PMC164376  PMID: 12937566
ankle bracing; joint mechanics; sensorimotor function; functional performance
12.  The Bactericidal And Cytotoxic Effects Of Antimicrobial Wound Cleansers 
Journal of Athletic Training  2002;37(1):51-54.
Objective: Wound care is a part of daily activity for many athletic trainers. Knowing which cleansers are effective against the bacteria that most commonly cause infection and whether they are toxic to healthy cells enables athletic trainers to make educated decisions on which cleanser to use. We compared the bactericidal effectiveness and cytotoxicity to human fibroblast cells of 4 cleansers at various dilutions.
Design and Setting: A 4 × 4 factorial design was used for the cytotoxicity testing. The independent variables were type and dilution of cleanser. The dependent variable was cell viability of the human fibroblast cells. We used a 2 × 3 × 4 × 4 factorial design for the bacterial testing. The independent variables were type and dilution of bacteria and type and dilution of cleanser. The dependent variable was the bactericidal action of the cleanser on the bacteria.
Subjects: Human foreskin samples were used to obtain a line of fibroblast cells. Bacterial samples were obtained from an athletic training clinic, isolated from swabs of a whirlpool water supply valve (Pseudomonas aeruginosa) or skin surface (Staphylococcus aureus).
Measurements: We obtained bactericidal measurements by testing isolated Gram-negative (Pseudomonas aeruginosa) and Gram-positive (Staphylococcus aureus) bacteria. Minimum and maximum concentrations were identified according to bactericidal effectiveness. Cytotoxicity measurements were obtained from spectrophotometer readings of a neutral red assay for fibroblast cell viability. Final dilutions tested were determined by pilot testing.
Results: At the 1:5 dilution of product in sterile 0.9% saline, both Cinder Suds and Nitrotan and hydrogen peroxide were different from the control with regard to Pseudomonas aeruginosa. At the 1:10 dilution, both Betadine and hydrogen peroxide were different from the control with regard to Pseudomonas aeruginosa. These 2 cleansers were also different from each other. At the 1:10 dilution, only Betadine was not different from the control for the cytotoxicity testing.
Conclusions: Betadine was both effective against bacteria and not harmful to human fibroblast cells at a 1:10 dilution of a commercially purchased solution.
PMCID: PMC164308  PMID: 12937444
wound cleansers; cytotoxicity; bactericidal; antimicrobial
13.  Cryotherapy and Transcutaneous Electric Neuromuscular Stimulation Decrease Arthrogenic Muscle Inhibition of the Vastus Medialis After Knee Joint Effusion 
Journal of Athletic Training  2002;37(1):25-31.
Objective: Arthrogenic muscle inhibition (AMI) is a presynaptic, ongoing reflex inhibition of joint musculature after distension or damage to the joint. The extent to which therapeutic interventions affect AMI is unknown. The purpose of this study was to verify that the vastus medialis (VM) is inhibited using the knee joint effusion model and to investigate the effects of cryotherapy and transcutaneous electric nerve stimulation (TENS) on AMI using this model.
Design and Setting: A 3 × 6 analysis of variance was used to compare Hoffmann-reflex data for treatment groups (cryotherapy, TENS, and control) across time (preinjection, postinjection, and 15, 30, 45, and 60 minutes after injection).
Subjects: Thirty neurologically sound volunteers (age = 21.8 ± 2.4 years; height = 175.6 ± 9.6 cm; mass = 71.5 ± 13.3 kg) participated in this study.
Measurements: Hoffmann-reflex measurements were collected using a percutaneous stimulus to the femoral nerve and surface electromyography of the VM.
Results: Hoffmann-reflex measurements from the cryotherapy and TENS groups were greater than measurements from the control group at 15 and 30 minutes after injection. Measurements from the cryotherapy group were greater than for the TENS group, and measurements for the TENS group were greater than those for the control group at 45 minutes. At 60 minutes, the cryotherapy group measurements were greater than the TENS and control group measures. Measurements at 15, 30, 45, and 60 minutes after injection were reduced compared with the preinjection and postinjection measurements in the control group. Measurements in the cryotherapy group at 30, 45, and 60 minutes were greater than the preinjection, postinjection, and 15-minute data. No differences between time intervals existed in the TENS group.
Conclusions: Artificial knee joint effusion results in VM inhibition. Cryotherapy and TENS both disinhibit the quadriceps after knee joint effusion, and cryotherapy further facilitates the quadriceps motoneuron pool. Cryotherapy treatment resulted in facilitation of the VM motoneuron pool during the post-treatment phase. The TENS treatment failed to disinhibit the VM motoneuron pool by 30 minutes postinjection.
PMCID: PMC164304  PMID: 12937440
Hoffmann reflex; joint effusion; neuromuscular
14.  Scholarly Productivity of Athletic Training Faculty Members 
Journal of Athletic Training  2001;36(2):156-159.
Objective:
To compare the scholarly productivity index (SPI) among the levels of academic appointment, degree type, and percentage of academic appointment of athletic training faculty members.
Design and Setting:
We used a 5 × 6 × 4 factorial design for this study. A survey instrument was used to determine the number of publications and the number of years in their current appointment.
Subjects:
Subjects were faculty members in Commission on Accreditation of Allied Health Education Programs-accredited athletic training education programs.
Measurements:
The SPI was calculated by dividing the total number of publications (peer-reviewed and non–peer-reviewed journal articles, peer-reviewed abstracts, books written or edited, book chapters, platform presentations, published book reviews, and external funding) by the number of years in the productivity period.
Results:
The SPIs were different for the levels of academic rank. Full professors had a higher SPI than all other groups (Tukey honestly significant difference, P ≤ .05). Associate professors had higher SPIs than instructors or lecturers and clinical specialists, equivalent SPIs to assistant professors, and lower SPIs than full professors. Assistant professors had lower SPIs than full professors but were equivalent to all other groups. There were no differences among the levels of degree type or percentage of academic appointment.
Conclusions:
The scholarly productivity of athletic training educators was affected by their academic rank but not by the percentage of time they were assigned to academics or their academic degree type.
PMCID: PMC155527  PMID: 12937457
scholarly productivity index; athletic training education; tenure; promotion
15.  An Investigation of Undergraduate Athletic Training Students' Learning Styles and Program Admission Success 
Journal of Athletic Training  2001;36(2):130-135.
Objective:
The phrase learning style refers to the method one uses to obtain and use information to learn. Personal learning styles can be assessed by specifically designed inventories. We conducted this study to determine if undergraduate athletic training students possess a dominant learning style, according to the Kolb Learning Style Inventory IIA (KLSI IIA), the newest version of the Kolb Learning Style Inventory (KLSI), and whether this style is related to education program admission success.
Design and Setting:
A 1 × 4 factorial design was used. The independent variable was learning style type with 4 levels (converger, diverger, assimilator, or accommodator). The dependent variable was successful versus unsuccessful admission into selected programs.
Subjects:
Forty undergraduate students (21 men, 19 women) from 3 institutions (mean ± SD age, 20.7 ± 1.7 years; mean ± SD grade point average, 3.26 ± 0.43) participated in this study. No subjects had previously taken the KLSI IIA, and none had a diagnosed learning disability.
Measurements:
The KLSI IIA was administered to the participants at their respective institutions. We used 2 separate χ2 analyses to determine if the observed distribution of learning styles differed from the expected distribution. Additionally, a Mann-Whitney U test was performed to determine if the learning style distributions of those subjects who were successfully admitted to the selected programs differed from those who were not.
Results:
No significant differences existed between the observed distribution and the expected distribution for those admitted and those not admitted (χ23 = 3.8, P = .28; and χ23 = 3.1, P = .4, respectively). Also, no significant differences existed between the learning style distributions of the groups when compared with each other (Mann-Whitney U = 158, P = .5).
Conclusions:
Learning styles can be easily identified through the use of the KLSI IIA. We found no dominant learning style among undergraduate athletic training students and no particular learning style led to program admission.
PMCID: PMC155522  PMID: 12937452
inventory; athletic training education program
16.  Therapeutic Magnets Do Not Affect Tissue Temperatures 
Journal of Athletic Training  2001;36(1):27-31.
Objective:
Manufacturers of commercially available “therapeutic” magnets claim that these magnets cause physiologic thermal effects that promote tissue healing. We conducted this study to determine if skin or intramuscular temperatures differed among magnet, sham, and control treatments during 60 minutes of application to the quadriceps muscle.
Design and Setting:
A 3 × 3 mixed-model, factorial design with repeated measures on both independent variables was used. The first independent variable, application duration, had 3 random levels (20, 40, and 60 minutes). The second independent variable, treatment, had 3 fixed levels (magnet, sham, and control). The dependent variable was tissue temperature (°C). Measurement depth served as a control variable, with 2 levels: skin and 1 cm below the fat layer. Data were collected in a thermoneutral laboratory setting and analyzed using a repeated-measures analysis of variance.
Subjects:
The study included 13 healthy student volunteers (8 men, 5 women; age, 20.5 ± 0.9 years; height, 176.8 ± 10.4 cm; weight, 73.8 ± 11.8 kg; anterior thigh skinfold thickness, 16.9 ± 6.5 mm).
Measurements:
Temperatures were measured at 30-second intervals using surface and implantable thermocouples. Temperature data at 20, 40, and 60 minutes were used for analysis. Each subject received all 3 treatments on different days.
Results:
Neither skin nor intramuscular temperatures were different across the 3 treatments at any time. For both skin and intramuscular temperatures, a statistically significant but not clinically meaningful temperature increase (less than 1°C), was observed over time within treatments, but this increase was similar in all treatment groups.
Conclusions:
No meaningful thermal effect was observed with any treatment over time, and treatments did not differ from each other. We conclude that flexible therapeutic magnets were not effective for increasing skin or deep temperatures, contradicting one of the fundamental claims made by magnet distributors.
PMCID: PMC155398  PMID: 12937511
intramuscular temperature; Hall voltage; biomagnetism
17.  Transcranial Magnetic Stimulation and Volitional Quadriceps Activation 
Journal of Athletic Training  2010;45(6):570-579.
Abstract
Context:
Quadriceps-activation deficits have been reported after meniscectomy. Transcranial magnetic stimulation (TMS) in conjunction with maximal contractions affects quadriceps activation in patients after meniscectomy.
Objective:
To determine the effect of single-pulsed TMS on quadriceps central activation ratio (CAR) in patients after meniscectomy.
Design:
Randomized controlled clinical trial.
Setting:
University laboratory.
Patients or Other Participants:
Twenty participants who had partial meniscectomy and who had a CAR less than 85% were assigned randomly to the TMS group (7 men, 4 women; age  =  38.1 ± 16.2 years, height  =  176.8 ± 11.5 cm, mass  =  91.8 ± 27.5 kg, postoperative time  =  36.7 ± 34.9 weeks) or the control group (7 men, 2 women; age  =  38.2 ± 17.5 years, height  =  176.5 ± 7.9 cm, mass  =  86.2 ± 15.3 kg, postoperative time  =  36.6 ± 37.4 weeks).
Intervention(s):
Participants in the experimental group received TMS over the motor cortex that was contralateral to the involved leg and performed 3 maximal quadriceps contractions with the involved leg. The control group performed 3 maximal quadriceps contractions without the TMS.
Main Outcome Measure(s):
Quadriceps activation was assessed using the CAR, which was measured in 70° of knee flexion at baseline and at 0, 10, 30, and 60 minutes posttest. The CAR was expressed as a percentage of full activation.
Results:
Differences in CAR were detected over time (F4,72  =  3.025, P  = .02). No interaction (F4,72  =  1.457, P  =  .22) or between-groups differences (F1,18  =  0.096, P  =  .76) were found for CAR. Moderate CAR effect sizes were found at 10 (Cohen d  =  0.54, 95% confidence interval [CI]  =  −0.33, 1.37) and 60 (Cohen d  =  0.50, 95% CI  =  −0.37, 1.33) minutes in the TMS group compared with CAR at baseline. Strong effect sizes were found for CAR at 10 (Cohen d  =  0.82, 95% CI  =  −0.13, 1.7) and 60 (Cohen d  =  1.06, 95% CI  =  0.08, 1.95) minutes in the TMS group when comparing percentage change scores between groups.
Conclusions:
No differences in CAR were found between groups at selected points within a 60-minute time frame, yet moderate to strong effect sizes for CAR were found at 10 and 60 minutes in the TMS group, indicating increased activation after TMS.
doi:10.4085/1062-6050-45.6.570
PMCID: PMC2978008  PMID: 21062180
central activation ratio; arthrogenic muscle inhibition; knee; meniscus
18.  Development of a 3D immersive videogame to improve arm-postural coordination in patients with TBI 
Background
Traumatic brain injury (TBI) disrupts the central and executive mechanisms of arm(s) and postural (trunk and legs) coordination. To address these issues, we developed a 3D immersive videogame-- Octopus. The game was developed using the basic principles of videogame design and previous experience of using videogames for rehabilitation of patients with acquired brain injuries. Unlike many other custom-designed virtual environments, Octopus included an actual gaming component with a system of multiple rewards, making the game challenging, competitive, motivating and fun. Effect of a short-term practice with the Octopus game on arm-postural coordination in patients with TBI was tested.
Methods
The game was developed using WorldViz Vizard software, integrated with the Qualysis system for motion analysis. Avatars of the participant's hands precisely reproducing the real-time kinematic patterns were synchronized with the simulated environment, presented in the first person 3D view on an 82-inch DLP screen. 13 individuals with mild-to-moderate manifestations of TBI participated in the study. While standing in front of the screen, the participants interacted with a computer-generated environment by popping bubbles blown by the Octopus. The bubbles followed a specific trajectory. Interception of the bubbles with the left or right hand avatar allowed flexible use of the postural segments for balance maintenance and arm transport. All participants practiced ten 90-s gaming trials during a single session, followed by a retention test. Arm-postural coordination was analysed using principal component analysis.
Results
As a result of the short-term practice, the participants improved in game performance, arm movement time, and precision. Improvements were achieved mostly by adapting efficient arm-postural coordination strategies. Of the 13 participants, 10 showed an immediate increase in arm forward reach and single-leg stance time.
Conclusion
These results support the feasibility of using the custom-made 3D game for retraining of arm-postural coordination disrupted as a result of TBI.
doi:10.1186/1743-0003-8-61
PMCID: PMC3214849  PMID: 22040301
virtual reality; motor rehabilitation; postural control; brain injury
19.  Tibiofemoral Joint Positioning for the Valgus Stress Test 
Journal of Athletic Training  2010;45(4):357-363.
Abstract
Context:
Recommendations on the positioning of the tibiofemoral joint during a valgus stress test to optimize isolation of the medial collateral ligament (MCL) from other medial joint structures vary in the literature. If a specific amount of flexion could be identified as optimally isolating the MCL, teaching and using the technique would be more consistent in clinical application.
Objective:
To determine the angle of tibiofemoral joint flexion between 0° and 20° that causes a difference in the slope of the force-strain line when measuring the resistance to a valgus force applied to the joint.
Design:
Cross-sectional study.
Setting:
University research laboratory.
Patients or Other Participants:
Twelve healthy volunteers (6 men, 6 women: age  =  26.4 ± 5.6 years, height  =  170.9 ± 8.4 cm, mass  =  75.01 ± 14.6 kg).
Intervention(s):
Using an arthrometer, we applied a valgus force, over a range of 60 N, to the tibiofemoral joint in 0°, 5°, 10°, 15°, and 20° of flexion.
Main Outcome Measure(s):
Force-strain measurements were obtained for 5 positions of tibiofemoral joint flexion.
Results:
As knee flexion angle increased, slope values decreased (F4,44  =  17.6, P < .001). The slope at full extension was not different from that at 5° of flexion, but it was different from the slopes at angles greater than 10° of flexion. Similarly, the slope at 5° of flexion was not different from that at 10° of flexion, but it was different from the slopes at 15° and 20° of flexion. Further, the slope at 10° of flexion was not different from that at 15° or 20° of flexion. Finally, the slope at 15° of flexion was not different from that at 20° of flexion.
Conclusions:
When performing the manual valgus stress test, the clinician should fully extend the tibiofemoral joint or flex it to 5° to assess all resisting medial tibiofemoral joint structures and again at 15° to 20° of joint flexion to further assess the MCL.
doi:10.4085/1062-6050-45.4.357
PMCID: PMC2902029  PMID: 20617910
knee; collateral ligaments; joint angle; valgus force
20.  Treatment of a female collegiate rower with costochondritis: a case report 
Rib injuries are common in collegiate rowing. The purpose of this case report is to provide insight into examination, evaluation, and treatment of persistent costochondritis in an elite athlete as well as propose an explanation for chronic dysfunction. The case involved a 21 year old female collegiate rower with multiple episodes of costochondritis over a 1-year period of time. Symptoms were localized to the left third costosternal junction and bilaterally at the fourth costosternal junction with moderate swelling. Initial interventions were directed at the costosternal joint, but only mild, temporary relief of symptoms was attained. Reexamination findings included hypomobility of the upper thoracic spine, costovertebral joints, and lateral ribs. Interventions included postural exercises and manual therapies directed at the lateral and posterior rib structures to improve rib and thoracic spine mobility. Over a 3-week time period pain experienced throughout the day had subsided (visual analog scale – VAS 0/10). She was able to resume running and elliptical aerobic training with minimal discomfort (VAS 2/10) and began to reintegrate into collegiate rowing. Examination of the lateral ribs, cervical and thoracic spine should be part of the comprehensive evaluation of costochondritis. Addressing posterior hypomobility may have allowed for a more thorough recovery in this case study.
doi:10.1179/106698110X12640740712653
PMCID: PMC3101071  PMID: 21655387
Costochondritis; Joint mobilization; Rib; Thoracic spine
21.  CONTRALATERAL EFFECTS OF DISINHIBITORY TENS ON QUADRICEPS FUNCTION IN PEOPLE WITH KNEE OSTEOARTHRITIS FOLLOWING UNILATERAL TREATMENT 
Background:
Quadriceps activation failure is common in patients with tibiofemoral osteoarthritis (TFOA) and has been reported to occur bilaterally following acute and chronic knee injuries. Sensory transcutaneous electrical stimulation (TENS) applied to the knee has increased ipsilateral quadriceps activation, yet it remains unknown if repeated sensory TENS treatments affect activation in the contralateral quadriceps.
Objective:
To determine the effects of unilateral TENS treatment to the involved leg, in conjunction with 4-weeks of therapeutic exercise, on volitional quadriceps activation in the contralateral leg.
Methods:
Thirty-three patients with radiographically diagnosed TFOA were randomly assigned to the TENS, placebo, and the control groups. The involved leg was defined as the knee with highest degree of radiographically assessed TFOA. All participants completed a supervised 4-week lower extremity exercise program for the involved leg only. TENS and placebo TENS were worn throughout the rehabilitation sessions as well as during daily activities for those groups on the involved leg. Quadriceps central activation ratio (CAR), a measure of volitional muscular activation, was assessed in the uninvolved leg at baseline, 2-weeks and 4-weeks following the initiation of the intervention.
Results:
There were no differences between groups for quadriceps CAR (P=0.3).
Discussion:
Although significant differences were not found, strong to moderate within group effect sizes were calculated for the TENS group at 2 (d = .87) and 4 weeks (d = .54), suggesting that significant differences may be found in a larger population.
Conclusions:
Contralateral quadriceps CAR was not affected following a 4-week unilateral disinhibitory intervention in this sample.
PMCID: PMC2971644  PMID: 21589667
Voluntary activation; Arthrogenic muscle inhibition; Pain; Strength
22.  Quadriceps Activation Following Knee Injuries: A Systematic Review 
Journal of Athletic Training  2010;45(1):87-97.
Abstract
Context:
Arthrogenic muscle inhibition is an important underlying factor in persistent quadriceps muscle weakness after knee injury or surgery.
Objective:
To determine the magnitude and prevalence of volitional quadriceps activation deficits after knee injury.
Data Sources:
Web of Science database.
Study Selection:
Eligible studies involved human participants and measured quadriceps activation using either twitch interpolation or burst superimposition on patients with knee injuries or surgeries such as anterior cruciate ligament deficiency (ACLd), anterior cruciate ligament reconstruction (ACLr), and anterior knee pain (AKP).
Data Extraction:
Means, measures of variability, and prevalence of quadriceps activation (QA) failure (<95%) were recorded for experiments involving ACLd (10), ACLr (5), and AKP (3).
Data Synthesis:
A total of 21 data sets from 18 studies were initially identified. Data from 3 studies (1 paper reporting data for both ACLd and ACLr, 1 on AKP, and the postarthroscopy paper) were excluded from the primary analyses because only graphical data were reported. Of the remaining 17 data sets (from 15 studies), weighted mean QA in 352 ACLd patients was 87.3% on the involved side, 89.1% on the uninvolved side, and 91% in control participants. The QA failure prevalence ranged from 0% to 100%. Weighted mean QA in 99 total ACLr patients was 89.2% on the involved side, 84% on the uninvolved side, and 98.5% for the control group, with prevalence ranging from 0% to 71%. Thirty-eight patients with AKP averaged 78.6% on the involved side and 77.7% on the contralateral side. Bilateral QA failure was commonly reported in patients.
Conclusions:
Quadriceps activation failure is common in patients with ACLd, ACLr, and AKP and is often observed bilaterally.
doi:10.4085/1062-6050-45.1.87
PMCID: PMC2808760  PMID: 20064053
arthrogenic muscle inhibition; voluntary activation; twitch interpolation; superimposed burst; central activation ratio
23.  Jogging Kinematics After Lumbar Paraspinal Muscle Fatigue 
Journal of Athletic Training  2009;44(5):475-481.
Abstract
Context:
Isolated lumbar paraspinal muscle fatigue causes lower extremity and postural control deficits.
Objective:
To describe the change in body position during gait after fatiguing lumbar extension exercises in persons with recurrent episodes of low back pain compared with healthy controls.
Design:
Case-control study.
Setting:
Motion analysis laboratory.
Patients or Other Participants:
Twenty-five recreationally active participants with a history of recurrent episodes of low back pain, matched by sex, height, and mass with 25 healthy controls.
Intervention(s):
We measured 3-dimensional lower extremity and trunk kinematics before and after fatiguing isometric lumbar paraspinal exercise.
Main Outcome Measure(s):
Measurements were taken while participants jogged on a custom-built treadmill surrounded by a 10-camera motion analysis system.
Results:
Group-by-time interactions were observed for lumbar lordosis and trunk angles (P < .05). A reduced lumbar spine extension angle was noted, reflecting a loss of lordosis and an increase in trunk flexion angle, indicating increased forward trunk lean, in healthy controls after fatiguing lumbar extension exercise. In contrast, persons with a history of recurrent low back pain exhibited a slight increase in spine extension, indicating a slightly more lordotic position of the lumbar spine, and a decrease in trunk flexion angles after fatiguing exercise. Regardless of group, participants experienced, on average, greater peak hip extension after lumbar paraspinal fatigue.
Conclusions:
Small differences in response may represent a necessary adaptation used by persons with recurrent low back pain to preserve gait function by stabilizing the spine and preventing inappropriate trunk and lumbar spine positioning.
doi:10.4085/1062-6050-44.5.475
PMCID: PMC2742456  PMID: 19771285
gait analysis; spine
25.  Immediate Effects of Anterior-to-Posterior Talocrural Joint Mobilization after Prolonged Ankle Immobilization: A Preliminary Study 
Ankle dorsiflexion range of motion (ROM) typically decreases after prolonged immobilization. Anterior-to-posterior talocrural joint mobilizations are purported to increase dorsiflexion ROM and decrease joint stiffness after immobilization. The purpose of this study was to determine if a single bout of Grade III anterior-to-posterior talocrural joint mobilizations immediately affected measures of dorsiflexion ROM, posterior ankle joint stiffness, and posterior talar translation in ankles of patients who had been immobilized at least 14 days. Ten physically active patients (5 males, 5 females; age=21.4±3.3 years) participated. Each had the ankle immobilized following a lower extremity injury for at least 14 days and presented with at least a 5° dorsiflexion ROM deficit compared to the contralateral ankle. A crossover design was employed so that half of the subjects received joint mobilizations first and half of the subjects received the control intervention (no treatment) first. All subjects ultimately received both treatments. Active dorsiflexion ROM was assessed with a bubble inclinometer, and posterior ankle stiffness and talar translation were assessed with an instrumented ankle arthrometer. After a single application of grade III anterior-to-posterior talocrural joint mobilization, dorsiflexion ROM and posterior ankle joint stiffness were significantly increased. There was also a trend toward less posterior talar translation immediately after mobilization. The trend toward decreased posterior talar translation and increased posterior ankle joint stiffness supports the positional fault theory. Correction of an anterior talar positional fault offers a possible explanation for these results.
PMCID: PMC2565111  PMID: 19119395
Dorsiflexion; Grade III Mobilization; Positional Fault; Tibiotalar Joint

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