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1.  REHABILITATION OF A SURGICALLY REPAIRED RUPTURE OF THE DISTAL BICEPS TENDON IN AN ACTIVE MIDDLE AGED MALE: A CASE REPORT 
Background:
Complete rupture of the distal tendon of the biceps brachii is relatively rare and there is little information to guide therapists in rehabilitation after this injury. The purposes of this case report are to review the rehabilitation concepts used for treating such an injury, and discuss how to modify exercises during rehabilitation based on patient progression while adhering to physician recommended guidelines and standard treatment protocols.
Case Presentation:
The patient was an active 38‐year old male experienced in weight‐training. He presented with a surgically repaired right distal biceps tendon following an accident on a trampoline adapted with a bungee suspension harness. The intervention focused on restoring range of motion and strengthening of the supporting muscles of the upper extremity without placing undue stress on the biceps brachii.
Outcomes:
The patient was able to progress from a moderate restriction in ROM to full AROM two weeks ahead of the physician's post‐operative orders and initiate a re‐strengthening protocol by the eighth week of rehabilitation. At the eighth post‐operative week the patient reported no deficits in functional abilities throughout his normal daily activities with his affected upper extremity.
Discussion:
The results of this case report strengthen current knowledge regarding physical therapy treatment for a distal biceps tendon repair while at the same time providing new insights for future protocol considerations in active individuals. Most current protocols do not advocate aggressive stretching, AROM, or strengthening of a surgically repaired biceps tendon early in the rehabilitation process due to the fear of a re‐rupture. In the opinion of the authors, if full AROM can be achieved before the 6th week of rehabilitation, initiating a slow transition into light strengthening of the biceps brachii may be possible.
Level of evidence:
4‐Single Case report
PMCID: PMC3537453  PMID: 23316429
Distal biceps tendon surgical repair; rehabilitation guidelines
2.  THE MANAGEMENT OF MID‐PORTION ACHILLES TENDINOPATHY WITH ASTYM® AND ECCENTRIC EXERCISE: A CASE REPORT 
Background and purpose:
Mid‐portion Achilles tendinopathy (AT) is a common injury among runners and recreational athletes. The conservative management of mid‐portion AT typically includes eccentric exercise as recommended in multiple systematic reviews and practice guidelines. However, an eccentric program typically requires 12 weeks for satisfactory results and problems with compliance have been reported. Astym® is a non‐invasive instrument assisted soft tissue treatment that can be used in the management of tendinopathies but there is limited published research on this treatment approach. The purpose of this case report is to present the management and outcomes of a patient with AT who was treated with eccentric exercise and Astym®.
Case Description:
The patient was a 56‐year‐old recreational tennis player referred to physical therapy with mid‐portion AT of 6 weeks duration. Her primary complaints were pain with walking and an inability to play tennis. She was treated in physical therapy 2 times per week for 10 visits with treatment focused on Astym® and eccentric exercise.
Outcomes:
By her 6th visit she subjectively reported being 75% functionally normal and was able to play a doubles tennis match. After 10 visits she reported that she was pain‐free and able to play singles and doubles tennis without limitation.
Discussion:
The patient in this case report was able to return to her normal activities after 5 weeks of treatment with Astym® and eccentric exercise. These results were achieved in less than half of the time commonly reported with eccentric exercise alone.
Conclusion:
This case suggests that Astym® combined with eccentric exercise may be a beneficial treatment approach for patients with AT.
PMCID: PMC3537454  PMID: 23316430
3.  COMPARISON OF THE EFFECTS OF AN EIGHT‐WEEK PUSH‐UP PROGRAM USING STABLE VERSUS UNSTABLE SURFACES 
Background and Purpose:
Recently, the trend among physical training and rehabilitation professionals is the use of resistance exercise on unstable equipment in order to increase the effort of the agonist and stabilizing muscles. It is unknown if performing exercises on unstable surfaces provides a greater training stimulus as compared to training on a stable training surface. Therefore, the purpose of this research was to compare the effect that push‐up training on stable and unstable surfaces had on strength performance in healthy young men.
Methods:
Thirty subjects with experience in resistance training participated in push‐up training two days per week for eight weeks on one of three different surfaces: the floor (Tp), the T‐Bow® (TBp) or the BOSU® (Bp).
Results:
Strength, as measured by one repetition maximum (1‐RM) and muscle endurance, as measured by number of pushups performed did not improve significantly (p>0.05) for any of the intervention groups.
Conclusions:
The addition of unstable surfaces in push‐up training does not provide greater improvement in muscular strength and endurance than push up training performed on a stable surface in young men.
Levels of Evidence:
3b
PMCID: PMC3537455  PMID: 23316422
BOSU®; push‐up; T‐Bow®; unstable surfaces
4.  INTRA AND INTERSESSION RELIABILITY OF A POSTURAL CONTROL PROTOCOL IN ATHLETES WITH AND WITHOUT ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A DUAL‐TASK PARADIGM 
Background:
Quantification of dynamic balance is essential to assess a patient's level of injury or ability to function so that a proper plan of care may commence. In spite of comprehensive utilization of dual‐tasking in balance assessment protocols, a lack of sufficient reliability data is apparent.
Purpose:
The purpose of the present study was to determine the intra‐ and inter‐session reliability of dynamic balance measures obtained using the Biodex Balance System® (BBS) for a group of athletes who had undergone anterior cruciate ligament reconstruction (ACLR) and a matched control group without ACLR, while using a dual‐task paradigm.
Methods:
Single‐limb postural stability was assessed in 15 athletes who had undergone ACLR and 15 healthy matched controls. The outcome variables included measures of both postural and cognitive performance. For measuring postural performance, the overall stability index (OSI), anterior‐posterior stability index (APSI), and medial‐lateral stability index (MLSI), were recorded. Cognitive performance was evaluated by measuring error ratio and average reaction time. Subjects faced 4 postural task difficulty levels (platform stabilities of 8 and 6 with eyes open and closed), and 2 cognitive task difficulty levels (with or without auditory Stroop task). During dual task conditions (conditions with Stroop task), error ratio and average reaction time were calculated.
Results:
Regarding intrasession reliability, ICC values of test session were higher for MLSI [ACL‐R group (0.83‐0.95), control group (0.71‐0.95)] compared to OSI [ACL‐R group (0.80‐0.92), control group (0.67‐0.95)] and APSI [ACL‐R group (0.73‐0.90), control group (0.62‐0.90)]. Furthermore, ICC values of first test session were higher in reaction time [ACL‐R group (0.92‐0.95), control group (0.80‐0.92)] than error ratio [ACL‐R group (0.72‐0.88), control group (0.61‐0.83)]. ICC values of retest session were higher for MLSI [ACL‐R group (0.83‐0.94), control group (0.87‐0.93)] than OSI [ACL‐R group (0.81‐0.91), control group (0.83‐0.93)] and APSI [ACL‐R group (0.73‐0.90), control group (0.53‐0.90)]. Moreover, ICC values of retest session were higher in reaction time [ACL‐R group (0.89‐0.98), control group (0.80‐0.92)] equated with error ratio [ACL‐R group (0.73‐0.87), control group (0.57‐0.79)].
With respect to intersession reliability, ICC values were higher for MLSI [ACL‐R group (0.72‐0.96), control group (0.75‐0.92)] than OSI [ACL‐R group (0.55‐0.91), control group (0.64‐0.87)] and APSI [ACL‐R group (0.55‐0.79), control group (0.46‐0.89)]. Additionally, ICC values were higher in reaction time [ACL‐R group (0.87‐0.95), control group (0.68‐0.81)] in contrast to error ratio [ACL‐R group (0.42‐0.64), control group (0.54‐0.74)].
Conclusion:
Biodex Balance System® measures of postural stability demonstrated moderate to high reliability in athletes with and without ACLR during dual‐tasking. Results of the current study indicated that assessment of postural and cognitive performance in athletes with ACLR may be reliably incorporated into the evaluation of functional activity.
Level of Evidence:
2b
PMCID: PMC3537456  PMID: 23316426
Anterior cruciate ligament reconstruction; attention; Biodex Balance System®; dual‐task paradigm; reliability
5.  EFFECTIVENESS OF PHYSICAL THERAPIST ADMINISTERED SPINAL MANIPULATION FOR THE TREATMENT OF LOW BACK PAIN: A SYSTEMATIC REVIEW OF THE LITERATURE 
Background Context:
Low back pain (LBP) is a prevalent disorder in society that has been associated with increased loss of work time and medical expenses. A common intervention for LBP is spinal manipulation, a technique that is not specific to one scope of practice or profession.
Purpose:
The purpose of this systematic review was to examine the effectiveness of physical therapy spinal manipulations for the treatment of patients with low back pain.
Methods:
A search of the current literature was conducted using PubMed, CINAHL, SPORTDiscus, Pro Quest Nursing and Allied Health Source, Scopus, and Cochrane Controlled Trials Register. Studies were included if each involved: 1) individuals with LBP; 2) spinal manipulations performed by physical therapists compared to any control group that did not receive manipulations; 3) measurable clinical outcomes or efficiency of treatment measures, and 4) randomized control trials. The quality of included articles was determined by two independent authors using the criteria developed and used by the Physiotherapy Evidence Database (PEDro).
Results:
Six randomized control trials met the inclusion criteria of this systematic review. The most commonly used outcomes in these studies were some variation of pain rating scales and disability indexes. Notable results included varying degrees of effect sizes favoring physical therapy spinal manipulations and minimal adverse events resulting from this intervention. Additionally, the manipulation group in one study reported statistically significantly less medication use, health care utilization, and lost work time.
Conclusion:
Based on the findings of this systematic review there is evidence to support the use of spinal manipulation by physical therapists in clinical practice. Physical therapy spinal manipulation appears to be a safe intervention that improves clinical outcomes for patients with low back pain.
PMCID: PMC3537457  PMID: 23316428
Low back pain; manipulation; manual therapy; spine
6.  ANTERIOR CRUCIATE LIGAMENT INJURY DIAGNOSIS AND MANAGEMENT IN A PEDIATRIC PATIENT: A CASE REPORT 
The management of the skeletally immature athlete sustaining injury to the anterior cruciate ligament and other knee structures provides multiple challenges for both the treating clinicians and parents of the injured child. The diagnostic process and subsequent decision making present additional complexities because of the developmental anatomy and the potential for disturbance of normal growth patterns by some surgical interventions. In the following case report, the course to appropriate management of a young athlete is detailed, including the contributions of imaging results. The reconstructive options available to orthopedic surgeons and the patient's post‐operative progression are also briefly discussed. Rehabilitation practitioners require an understanding of the unique issues present when providing care for pediatric and adolescent athletes with knee injuries in order to assist in optimal decision making in the phases during which they are involved.
Level of Evidence:
5 (Single Case Report)
PMCID: PMC3537458  PMID: 23316431
Anterior cruciate ligament; adolescent; open physis; pediatric; skeletal immaturity
7.  EFFECTS OF A MOVEMENT TRAINING PROGRAM ON HIP AND KNEE JOINT FRONTAL PLANE RUNNING MECHANICS 
Background/Purpose:
Frontal plane running mechanics may contribute to the etiology or exacerbation of common running related injuries. Hip strengthening alone may not change frontal plane hip and knee joint running mechanics. The purpose of the current study was to evaluate whether a training program including visual, verbal, and tactile feedback affects hip and knee joint frontal plane running mechanics among females with evidence of altered weight bearing kinematics.
Methods:
The knee frontal plane projection angle of 69 apparently healthy females was determined during a single leg squat. The twenty females from this larger sample who exhibited the most acute frontal plane projection angle (medial knee position) during this activity were chosen to participate in this study (age = 20 ± 1.6 years, height = 167.9 ± 6.0 cm, mass = 63.2 ± 8.3 kg, Tegner Activity Rating mode = 7.0). Participants engaged in a 4‐week movement training program using guided practice during weight bearing exercises with visual, verbal, and tactile feedback regarding lower extremity alignment. Paired t‐tests were used to compare frontal plane knee and hip joint angles and moments before and after the training program.
Results:
After training, internal hip and knee abduction moments during running decreased by 23% (P=0.007) and 29% (P=0.033) respectively. Knee adduction and abduction excursion decreased by 2.1° (P = 0.050) and 2.7° (P=0.008) respectively, suggesting that less frontal plane movement of the knee occurred during running after training. Peak knee abduction angle decreased 1.8° after training (P=0.051) although this was not statistically significant. Contralateral peak pelvic drop, pelvic drop excursion, peak hip adduction angle, hip adduction excursion, and peak knee adduction angle were unchanged following training.
Conclusions:
A four week movement training program may reduce frontal plane hip and knee joint mechanics thought to contribute to the etiology and exacerbation of some running related injuries.
Level of Evidence:
Level 4
PMCID: PMC3537459  PMID: 23316427
female; kinematics; kinetics; neuromuscular training; rehabilitation
8.  ELECTROMYOGRAPHIC ASSESSMENT OF MUSCLE ACTIVITY BETWEEN GENDERS DURING UNILATERAL WEIGHT‐BEARING TASKS USING ADJUSTED DISTANCES 
Purpose/Background:
Researchers have observed differences in muscle activity patterns between males and females during functional exercises. The research methods employed have used various step heights and lunge distances to assess functional exercise making gender comparisons difficult. The purpose of this study was to examine core and lower extremity muscle activity between genders during single‐limb exercises using adjusted distances and step heights based on a percentage of the participant's height.
Methods:
Twenty men and 20 women who were recreationally active and healthy participated in the study. Two‐dimensional video and surface electromyography (SEMG) were used to assess performance during three exercise maneuvers (step down, forward lunge, and side‐step lunge). Eight muscles were assessed using SEMG (rectus abdominus, external oblique, erector spinae, rectus femoris, tensor fascia latae, gluteus medius, gluteus maximus, biceps femoris). Maximal voluntary isometric contractions (MVIC) were used for each muscle and expressed as %MVIC to normalize SEMG to account for body mass differences. Exercises were randomized and distances were normalized to the participant's lower limb length. Descriptive statistics, mixed‐model ANOVA, and ICCs with 95% confidence intervals were calculated.
Results:
Males were taller, heavier, and had longer leg length when compared to the females. No differences in %MVIC activity were found between genders by task across the eight muscles. For both males and females, the step down task resulted in higher %MVIC for gluteus maximus compared to lunge, (p=0.002). Step down exercise produced higher %MVIC for gluteus medius than lunge (p=0.002) and side step (p=0.006). ICC3,3 ranged from moderate to high (0.74 to 0.97) for the three tasks.
Conclusions:
Muscle activation among the eight muscles was similar between females and males during the lunge, side‐step, and step down tasks, with distances adjusted to leg length. Both males and females elicited higher muscle activity for gluteus maximus and gluteus medius as compared to the trunk, hip flexors, or hamstring muscles. However these values were well below the recruitment levels necessary for strengthening in both genders.
Level of evidence:
4
PMCID: PMC3537460  PMID: 23316423
electromyography; functional exercises; gender; gluteus medius; gluteus maximus
9.  RECOGNITION AND MANAGEMENT OF TRAUMATIC SPORTS INJURIES IN THE SKELETALLY IMMATURE ATHLETE 
Over the last decade, participation in organized youth sports has risen to include over 35 million contestants.1 The rise in participation has brought about an associated increase in both traumatic and overuse injuries in the youth athlete, which refers to both children and adolescents within a general age range of seven to 17. Exposure rates alone do not account for the increase in injuries. Societal pressures to perform at high levels affect both coaches and athletes and lead to inappropriate levels of training intensity, frequency, and duration. In this environment high physiologic stresses are applied to the immature skeleton of the youth athlete causing injury. Typically, since bone is the weakest link in the incomplete ossified skeleton, the majority of traumatic injuries result in fractures that occur both at mid‐shaft and at the growth centers of bone. The following clinical commentary describes the common traumatic sports injuries that occur in youth athletes, as well as those which require rapid identification and care in order to prevent long term sequelae.
PMCID: PMC3537461  PMID: 23316432
Emergency care; immature skeleton; traumatic injuries; youth sports injuries
10.  AN ELECTROMYOGRAPHIC STUDY OF THE VASTII MUSCLES DURING OPEN AND CLOSED KINETIC CHAIN SUBMAXIMAL ISOMETRIC EXERCISES 
Background:
Rehabilitation programs for patients with patellofemoral dysfunction aim to recruit the vastus medialis obliquus muscle (VMO) in an attempt to reduce pain and to improve patellar tracking.
Objectives:
The aim of the present study was to use surface EMG to assess the effectiveness of two isometric submaximal contractions (10% and 60% of maximal voluntary contraction, MVC) in promoting preferential activation of VMO over vastus medialis longus (VML) and vastus lateralis (VL) in open and closed kinetic chain isometric exercises with the knee joint fixed at 30, 60 and 90 degrees of flexion.
Methods and Measures:
Surface electromyography (EMG) signals were recorded with linear adhesive arrays of four electrodes from fourteen healthy young men (age 23.5±3.2, mean±SD) during isometric knee extension contractions at 10% and 60% of the maximum voluntary contraction (MVC) for 1 min and 20 s respectively at 30, 60 and 90 degrees of knee flexion. Initial values and rate of change (slope) of mean frequency (MNF), average rectified value (ARV) and conduction velocity (CV) of the EMG signal were calculated.
Results:
Comparisons between the force levels produced at 10% and 60% MVC revealed that the initial values of ARV and CV for the VL, VML and VMO muscle were greater at 60% MVC compared to 10% MVC (3‐way ANOVA; F=536; p<0.001, F=49: p<0.01 for ARV and CV respectively). Comparisons between the different muscles demonstrated lower initial values of CV for VMO compared to VL and VLM at 10% and 60% of MVC (F=15; p<0.05). In addition, initial estimates of ARV were higher for VMO compared to VML at both force levels (F=66; p<0.05). Comparisons between open and closed kinetic chain exercises revealed higher initial estimates of ARV for open kinetic chain knee extension at both force levels (F=62; p<0.01). In addition, the absolute value of MNF slope appeared to increase at higher angles for closed kinetic chain at 60% MVC while it was minimum at 60° degrees for open kinetic chain. No significant differences were observed in the rate of change of CV and MNF among the three muscles.
Conclusions:
Based on the results of this study, both open and closed kinetic chain exercise similarly activate the three portions of the quadriceps muscle, suggesting that selective training of the vastii muscle is not achievable in these conditions.
PMCID: PMC3537462  PMID: 23316425
Electromyography; patellofemoral joint; quadriceps; strength training
11.  THE RELIABILITY, MINIMAL DETECTABLE CHANGE AND CONSTRUCT VALIDITY OF A CLINICAL MEASUREMENT FOR QUANTIFYING POSTERIOR SHOULDER TIGHTNESS IN THE POST‐OPERATIVE POPULATION 
Background:
Posterior shoulder tightness (PST) has been implicated in the etiology of numerous shoulder disorders. Although reliable and valid measures have been described for the non‐operative population one does not exist for the post‐operative population.
Study Design:
Blinded repeated measures design.
Purpose:
Investigate the intrarater reliability, minimal detectable change at the 90% confidence interval (MDC90) and construct validity of an inclinometric measurement designed to quantify PST in the post‐operative population.
Methods:
One investigator performed PST measurements on the operative shoulder of 23 participants. Passive internal and external rotation measurements were performed for the validity component of the investigation.
Results:
Intrarater reliability using an intraclass correlation coefficient (ICC) model 3,k was good (ICC = 0.79). The MDC90 indicated that a change of greater than or equal to 8 degrees would be required to be 90% certain that a change in the measurement would not be the result of inter‐trial variability or measurement error. Construct validity was supported by a statistically significant relationship between PST and internal rotation r = 0.54 and by a relationship between PST and external rotation r = 0.30 which was not statistically significant.
Conclusion:
The sidelying procedure described in this investigation appears to be a reliable and valid means for quantifying PST in the post‐operative population. Moreover, the use of inclinometry provides an absolute angle of tightness that may be used for intersubject comparison, documenting change, and to determine reference values.
Level of Evidence:
Therapy, level 2b
PMCID: PMC3537463  PMID: 23316420
capsule; flexibility; mobility; range of motion
12.  GLENOHUMERAL ROTATIONAL RANGE OF MOTION DIFFERENCES BETWEEN FAST BOWLERS AND SPIN BOWLERS IN ELITE CRICKETERS 
Background:
The shoulder, particularly the glenohumeral joint with its predominant reliance upon soft tissues for stability is prone to injury among the cricketers who bowl regularly. These shoulder injuries are more common in spin bowlers than fast bowlers. A decreased internal rotational difference and increased external rotational difference exist when comparing the dominant shoulder with non‐dominant shoulder between overarm cricketers and non‐throwing wicket keepers.
Purpose:
To compare the glenohumeral internal and external rotation range of motion differences between fast bowlers and spin bowlers.
Methods:
A cross‐sectional design was utilized for this study. Thirty‐five fast bowlers and 31 spin bowlers from an elite group were recruited based on the selection criteria. Glenohumeral passive internal and external rotational differences between dominant and non‐dominant shoulders were measured using a standardized mechanical inclinometer.
Results:
Independent t‐tests revealed a statistically significant difference for external rotational difference (p=0.005) between fast and spin bowlers and no such difference for internal rotational difference (p=0.549) between them at 0.05 level.
Conclusion:
External rotational difference is significantly different between fast bowlers and spin bowlers but not internal rotational difference.
Level of Evidence:
Level 4
PMCID: PMC3537464  PMID: 23316421
External rotational difference; glenohumeral internal rotational deficit; glenohumeral joint; internal rotational difference.
13.  MUSCLE ACTIVITY DURING KNEE‐EXTENSION STRENGTHENING EXERCISE PERFORMED WITH ELASTIC TUBING AND ISOTONIC RESISTANCE 
Background/Purpose:
While elastic resistance training, targeting the upper body is effective for strength training, the effect of elastic resistance training on lower body muscle activity remains questionable. The purpose of this study was to evaluate the EMG‐angle relationship of the quadriceps muscle during 10‐RM knee‐extensions performed with elastic tubing and an isotonic strength training machine.
Methods:
7 women and 9 men aged 28‐67 years (mean age 44 and 41 years, respectively) participated. Electromyographic (EMG) activity was recorded in 10 muscles during the concentric and eccentric contraction phase of a knee extension exercise performed with elastic tubing and in training machine and normalized to maximal voluntary isometric contraction (MVC) EMG (nEMG). Knee joint angle was measured during the exercises using electronic inclinometers (range of motion 0‐90°).
Results:
When comparing the machine and elastic resistance exercises there were no significant differences in peak EMG of the rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM) during the concentric contraction phase. However, during the eccentric phase, peak EMG was significantly higher (p<0.01) in RF and VM when performing knee extensions using the training machine. In VL and VM the EMG‐angle pattern was different between the two training modalities (significant angle by exercise interaction). When using elastic resistance, the EMG‐angle pattern peaked towards full knee extension (0°), whereas angle at peak EMG occurred closer to knee flexion position (90°) during the machine exercise. Perceived loading (Borg CR10) was similar during knee extensions performed with elastic tubing (5.7±0.6) compared with knee extensions performed in training machine (5.9±0.5).
Conclusion:
Knee extensions performed with elastic tubing induces similar high (>70% nEMG) quadriceps muscle activity during the concentric contraction phase, but slightly lower during the eccentric contraction phase, as knee extensions performed using an isotonic training machine. During the concentric contraction phase the two different conditions displayed reciprocal EMG‐angle patterns during the range of motion.
Level of Evidence:
5
PMCID: PMC3537465  PMID: 23316424
Electromyography; strength training; quadriceps; perceived exertion
14.  EVIDENCE – BASED MEDICINE/PRACTICE IN SPORTS PHYSICAL THERAPY 
A push for the use of evidence‐based medicine and evidence‐based practice patterns has permeated most health care disciplines. The use of evidence‐based practice in sports physical therapy may improve health care quality, reduce medical errors, help balance known benefits and risks, challenge views based on beliefs rather than evidence, and help to integrate patient preferences into decision‐making. In this era of health care utilization sports physical therapists are expected to integrate clinical experience with conscientious, explicit, and judicious use of research evidence in order to make clearly informed decisions in order to help maximize and optimize patient well‐being. One of the more common reasons for not using evidence in clinical practice is the perceived lack of skills and knowledge when searching for or appraising research. This clinical commentary was developed to educate the readership on what constitutes evidence‐based practice, and strategies used to seek evidence in the daily clinical practice of sports physical therapy.
PMCID: PMC3474298  PMID: 23091778
Evidence‐Based Medicine; Sports Physical Therapy; Rehabilitation
15.  AVOIDING MANUSCRIPT MISTAKES 
Writing a scientific manuscript can be a consuming, but rewarding task with a number of intrinsic and extrinsic benefits. The ability to write a scientific manuscript is typically not an emphasized component of most entry‐level professional programs. The purpose of this overview is to provide authors with suggestions to improve manuscript quality and to provide mechanisms to avoid common manuscript mistakes that are often identified by journal reviewers and editors.
PMCID: PMC3474299  PMID: 23091784
manuscript; scientific writing
16.  THE ACUTE EFFECTS OF VARIOUS TYPES OF STRETCHING STATIC, DYNAMIC, BALLISTIC, AND NO STRETCH OF THE ILIOPSOAS ON 40‐YARD SPRINT TIMES IN RECREATIONAL RUNNERS 
Background and Purpose:
The potential adverse effects of static stretching on athletic performance are well documented, but still appears to be controversial, especially as they relates to sprinting. The prevalence of this practice is demonstrated by the number of competitive and recreational athletes who regularly engage in stretching immediately prior to sprinting with the mindset of optimizing their performance. The purpose of this study was to examine the effects of acute static, dynamic, and ballistic stretching, and no stretching of the iliopsoas muscle on 40‐yard sprint times in 18‐37 year‐old non‐competitive, recreational runners.
Methods:
Twenty‐five healthy recreational runners (16 male and 9 female) between the ages of 24 and 35 (Mean = 26.76 yrs., SD = 2.42 yrs.) completed this study. A repeated measures design was used, which consisted of running a 40‐yard sprint trial immediately following each of 4 different stretching conditions aimed at the iliopsoas muscle and lasting 1 minute each. The 4 conditions were completed in a randomized order within a 2‐week time period, allowing 48‐72 hours between each condition. Prior to each 40‐yard sprint trial, a 5‐minute walking warm‐up was performed at 3.5 mph on a treadmill. The subject then ran a baseline 40‐yard sprint. After a 10‐minute self‐paced walk, each subject performed one of the 4 stretching conditions (ballistic, dynamic, static, and no stretch) and then immediately ran a timed 40‐yard sprint.
Results:
There was a significant interaction between stretching conditions and their effects on sprint times, F(3,72) = 9.422, p<.0005. To break down this interaction, simple main effects were performed with 2 repeated measures ANOVAs and 4 paired t‐tests using a Bonferroni corrected alpha (α = .0083). There were no significant differences between the 4 pre‐condition times, p = 0.103 (Greenhouse‐Geisser) or the post‐condition times, p = 0.029. In the no stretch condition, subjects improved significantly from pre‐ to post‐ sprint times (p<0.0005). There were no statistically significant differences in pre‐ and post‐stretch condition sprint times among the static (p = 0.804), ballistic (p = 0.217), and dynamic (p = 0.022) stretching conditions.
Conclusions:
Sprint performance may show greatest improvement without stretching and through the use of a walking generalized warmup on a treadmill. These findings have clinically meaningful implications for runners who include iliopsoas muscle stretching as a component of the warm‐up.
Level of Evidence:
Level 2
PMCID: PMC3474300  PMID: 23091787
Recreational runners; sprinting; stretching; warm‐up
17.  HOW TO WRITE A SCIENTIFIC ARTICLE 
Successful production of a written product for submission to a peer‐reviewed scientific journal requires substantial effort. Such an effort can be maximized by following a few simple suggestions when composing/creating the product for submission. By following some suggested guidelines and avoiding common errors, the process can be streamlined and success realized for even beginning/novice authors as they negotiate the publication process. The purpose of this invited commentary is to offer practical suggestions for achieving success when writing and submitting manuscripts to The International Journal of Sports Physical Therapy and other professional journals.
PMCID: PMC3474301  PMID: 23091783
Journal submission; scientific writing; strategies and tips
18.  SYSTEMATIC REVIEW AND META‐ANALYSIS: A PRIMER 
The use of an evidence‐based approach to practice requires “the integration of best research evidence with clinical expertise and patient values”, where the best evidence can be gathered from randomized controlled trials (RCTs), systematic reviews and meta‐analyses. Furthermore, informed decisions in healthcare and the prompt incorporation of new research findings in routine practice necessitate regular reading, evaluation, and integration of the current knowledge from the primary literature on a given topic. However, given the dramatic increase in published studies, such an approach may become too time consuming and therefore impractical, if not impossible. Therefore, systematic reviews and meta‐analyses can provide the “best evidence” and an unbiased overview of the body of knowledge on a specific topic. In the present article the authors aim to provide a gentle introduction to readers not familiar with systematic reviews and meta‐analyses in order to understand the basic principles and methods behind this type of literature. This article will help practitioners to critically read and interpret systematic reviews and meta‐analyses to appropriately apply the available evidence to their clinical practice.
PMCID: PMC3474302  PMID: 23091781
evidence‐based practice; meta‐analysis; systematic review
19.  RESEARCH DESIGNS IN SPORTS PHYSICAL THERAPY 
Research is designed to answer a question or to describe a phenomenon in a scientific process. Sports physical therapists must understand the different research methods, types, and designs in order to implement evidence‐based practice. The purpose of this article is to describe the most common research designs used in sports physical therapy research and practice. Both experimental and non‐experimental methods will be discussed.
PMCID: PMC3474303  PMID: 23091780
Research design; research methods; scientific process
20.  ACUTE MANAGEMENT CONCEPTS OF THE ACROMIOCLAVICULAR JOINT: A CASE REPORT 
Acromioclavicular injuries are quite common and approaches to early management of those that are described as a Type III are controversial. The Rockwood Type III classification implies complete disruption of the acromioclavicular and coracoclavicular ligaments, resulting in inferior positioning of the scapula and, thus, the glenohumeral complex while the clavicle appears more superiorly prominent. Clinical management can include surgical or conservative techniques. This case report outlines the decision making process related to this type of injury, as applied in the diagnosis and management of 61 year‐old recreational athlete.
Level of Evidence
5 (Single Case report)
PMCID: PMC3474304  PMID: 23091789
Acromioclavicular injury; functional outcomes; shoulder separation; Type III management
21.  COMPARISON OF DIFFERENT TRUNK ENDURANCE TESTING METHODS IN COLLEGE‐AGED INDIVIDUALS 
Objective:
Determine the reliability of two different modified (MOD1 and MOD2) testing methods compared to a standard method (ST) for testing trunk flexion and extension endurance.
Participants:
Twenty‐eight healthy individuals (age 26.4 ± 3.2 years, height 1.75 ± m, weight 71.8 ± 10.3 kg, body mass index 23.6 ± 3.4 m/kg2).
Method:
Trunk endurance time was measured in seconds for flexion and extension under the three different stabilization conditions. The MOD1 testing procedure utilized a female clinician (70.3 kg) and MOD2 utilized a male clinician (90.7 kg) to provide stabilization as opposed to the ST method of belt stabilization.
Results:
No significant differences occurred between flexion and extension times. Intraclass correlations (ICCs3,1) for the different testing conditions ranged from .79 to .95 (p <.000) and are found in Table 3. Concurrent validity using the ST flexion times as the gold standard coefficients were .95 for MOD1 and .90 for MOD2. For ST extension, coefficients were .91 and .80, for MOD1 and MOD2 respectively (p <.01).
Conclusions:
These methods proved to be a reliable substitute for previously accepted ST testing methods in normal college‐aged individuals. These modified testing procedures can be implemented in athletic training rooms and weight rooms lacking appropriate tables for the ST testing.
Level of Evidence:
3
PMCID: PMC3474305  PMID: 23091786
Core; stabilization; trunk endurance
22.  LEVELS OF EVIDENCE IN MEDICINE 
Levels of evidence allow clinicians to appreciate the quality of a particular research paper quickly. The levels are generally set out in a hierarchical order, which is based largely upon the experimental design. While there are ideal designs for studies examining the effects of interventions, risk factors for a clinical condition or diagnostic testing, in most instances researchers have had to make compromises and these subsequently decrease the quality of their work. This paper provides information concerning how those compromises relate to subsequent levels that are given to a piece of research. It also provides an understanding of issues related to evaluating papers, and suggest ways in which the reader might discern how relevant a paper might be to one's clinical practice.
PMCID: PMC3474306  PMID: 23091779
levels of evidence; research design; study quality
23.  STATISTICAL PRINCIPLES FOR PROSPECTIVE STUDY PROTOCOLS: 
In the design of scientific studies it is essential to decide on which scientific questions one aims to answer, just as it is important to decide on the correct statistical methods to use to answer these questions. The correct use of statistical methods is crucial in all aspects of research to quantify relationships in data. Despite an increased focus on statistical content and complexity of biomedical research these topics remain difficult for most researchers. Statistical methods enable researchers to condense large spreadsheets with data into means, proportions, and difference between means, risk differences, and other quantities that convey information. One of the goals in biomedical research is to develop parsimonious models ‐ meaning as simple as possible. This approach is valid if the subsequent research report (the article) is written independent of whether the results are “statistically significant” or not. In the present paper we outline the considerations and suggestions on how to build a trial protocol, with an emphasis on having a rigorous protocol stage, always leading to a full article manuscript, independent of statistical findings. We conclude that authors, who find (rigorous) protocol writing too troublesome, will realize that they have already written the first half of the final paper if they follow these recommendations; authors simply need to change the protocols future tense into past tense. Thus, the aim of this clinical commentary is to describe and explain the statistical principles for trial protocols in terms of design, analysis, and reporting of findings.
PMCID: PMC3474307  PMID: 23091782
analysis; research design; statistics
24.  SHOULDER RANGE OF MOTION, PITCH COUNT, AND INJURIES AMONG INTERSCHOLASTIC FEMALE SOFTBALL PITCHERS: A DESCRIPTIVE STUDY 
Background/Purpose:
Injury rates for softball players are similar to baseball players yet information regarding risk factors, pitching, and physical characteristics for high school windmill softball pitchers is limited. This information is needed to guide prevention, training, and rehabilitation efforts. The purpose of this study was to report descriptive data regarding the physical characteristics and pitching volume experienced by high school softball pitchers during one academic season. A secondary aim was to track and describe upper extremity injuries suffered by high school softball pitchers throughout the course of the 2009 season.
Methods:
Twelve uninjured female softball pitchers (13‐18y) from 5 Greenville, South Carolina high schools participated. Prior to the 2009 season, the pitchers' shoulder internal, external, total arc of rotation and horizontal adduction PROM was measured. During the 10‐week season, aggregate pitch counts (pitch volume) and occurrence of upper extremity injury were tracked for each pitcher.
Results:
Mean preseason internal, external, and total arc of rotation PROM was observed to be similar between the pitchers' dominant and non‐dominant shoulders. The PROM measures of horizontal abduction (HA) appear to demonstrate a side‐to‐side difference with less HA on the dominant arm of the pitchers who were examined. Subjects threw in an average of 10.1 games (±4.9) during the season. Six pitchers threw in 60% or more of the team's games and 3 of 12 pitchers pitched less than 25% of games. Pitchers averaged 61.8 pitches per game (±31.5) and 745.8 (±506.4) per season. Pitch count data did not appear to be different between injured and non‐injured pitchers.
Conclusions:
Knowledge of pitch volume can be used to prepare windmill softball pitchers for the seasonal stresses, guide establishment of goals when recovering from injury, or assist in training for an upcoming season. Further research is needed to examine larger samples of pitchers over multiple seasons and years.
Level of Evidence:
III
PMCID: PMC3474308  PMID: 23091788
Pitch count; shoulder; softball
25.  CHANGES IN LOWER EXTREMITY MOVEMENT AND POWER ABSORPTION DURING FOREFOOT STRIKING AND BAREFOOT RUNNING 
Purpose/Background:
Both forefoot strike shod (FFS) and barefoot (BF) running styles result in different mechanics when compared to rearfoot strike (RFS) shod running. Additionally, running mechanics of FFS and BF running are similar to one another. Comparing the mechanical changes occurring in each of these patterns is necessary to understand potential benefits and risks of these running styles. The authors hypothesized that FFS and BF conditions would result in increased sagittal plane joint angles at initial contact and that FFS and BF conditions would demonstrate a shift in sagittal plane joint power from the knee to the ankle when compared to the RFS condition. Finally, total lower extremity power absorption will be least in BF and greatest in the RFS shod condition.
Methods:
The study included 10 male and 10 female RFS runners who completed 3‐dimensional running analysis in 3 conditions: shod with RFS, shod with FFS, and BF. Variables were the angles of plantarflexion, knee flexion, and hip flexion at initial contact and peak sagittal plane joint power at the hip, knee, and ankle during stance phase.
Results:
Running with a FFS pattern and BF resulted in significantly greater plantarflexion and significantly less negative knee power (absorption) when compared to shod RFS condition. FFS condition runners landed in the most plantarflexion and demonstrated the most peak ankle power absorption and lowest knee power absorption between the 3 conditions. BF and FFS conditions demonstrated decreased total lower extremity power absorption compared to the shod RFS condition but did not differ from one another.
Conclusions:
BF and FFS running result in reduced total lower extremity power, hip power and knee power and a shift of power absorption from the knee to the ankle.
Clinical Relevance:
Alterations associated with BF running patterns are present in a FFS pattern when wearing shoes. Additionally, both patterns result in increased demand at the foot and ankle as compared to the knee.
PMCID: PMC3474309  PMID: 23091785
barefoot running; biomechanics; running; strike pattern

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