Elaine Trudelle-Jackson

Landing Mechanics between Noninjured Women and Women with Anterior Cruciate Ligament Reconstruction during 2 Jump Tasks

Background Women with anterior cruciate ligament reconstruction have different neuromuscular strategies than noninjured women during functional tasks after ligament reconstruction and rehabilitation. Hypothesis Landing from a jump creates high loads on the knee creating dynamic instability in women with anterior cruciate ligament reconstruction, whereas noninjured women have stable knee landing mechanics. Study Design Controlled laboratory study. Methods Fifteen noninjured women and 13 women with anterior cruciate ligament reconstruction performed 5 trials of a single-legged 40-cm drop jump and 2 trials of a 20-cm up-down hop task. Multivariate analyses of variance were used to compare hip and knee joint kinematics, knee joint moments, ground-reaction forces, and electromyographic findings between the dominant leg in noninjured women and reconstructed leg in women with anterior cruciate ligament reconstruction. Results No statistically significant differences between groups were found for peak hip and knee joint angles for the drop jump task. Statistically significant differences in neuromuscular activity (P = .001) and anterior-posterior knee shear forces (P < .001) were seen in women with anterior cruciate ligament reconstruction compared with noninjured women in the drop jump task. However, no statistically significant differences (P > .05) between groups were found for either peak hip and knee joint angles, peak joint kinetics, or electromyographic findings during the up-down hop task. Conclusion Women with anterior cruciate ligament reconstruction have neuromuscular strategies that allow them to land from a jump similar to healthy women, but they exhibit joint moments that could predispose them to future injury if they participate in sports that require jumping and landing.

Interrater Reliability of a Movement Impairment-Based Classification System for Lumbar Spine Syndromes in Patients With Chronic Low Back Pain

STUDY DESIGN A prospective methodological study of interrater reliability. OBJECTIVES To examine the interrater reliability of a movement impairment-based classification system for patients with chronic low back pain (LBP). BACKGROUND Movement impairment-based classification for the lumbar spine categorizes LBP based on the findings derived from a patient history and standardized examination. Though many presume this classification to be useful for directing treatment of individuals with LBP, agreement between examiners for assigning a lumbar spine category to a patient has not been studied thoroughly. METHODS AND MEASURES Two physical therapists independently examined 24 patients (8 men, 16 women) with chronic LBP (pain duration greater than 12 weeks). All patients enrolled in the study had been diagnosed with LBP that was believed to be due to mechanical causes, and the duration of their symptoms ranged from 20 to 1040 weeks. The examiners used a standardized examination to assess patients and classify them into 1 of 5 lumbar spine categories. Percent agreement and kappa coefficients were calculated between the examiners for the lumbar movement impairment-based classifications. RESULTS Percent agreement between examiners was 75% and the kappa coefficient was 0.61. The most prevalent lumbar spine categories identified by both examiners were lumbar extension rotation syndrome (41.7% of patients by examiner 1, 37.5% of patients by examiner 2) and lumbar rotation syndrome (41.7% of patients by both examiners). CONCLUSIONS Interrater reliability between 2 physical therapists classifying patients with chronic LBP patients into 1 of 5 lumbar spine movement impairment categories had substantial agreement.

Landing Mechanics During Side Hopping and Crossover Hopping Maneuvers in Noninjured Women and Women With Anterior Cruciate Ligament Reconstruction

To compare, landing mechanics and electromyographic activity of the lower extremities during side hopping and crossover hopping maneuvers, in noninjured women and women with anterior cruciate ligament (ACL) reconstruction.

Long-Term Tracking of Physical Activity Behaviors in Women: The WIN Study

PURPOSE Interest lies in the prevalence of community-living women meeting the 2008 Department of Health and Human Services physical activity guidelines across time. The purpose was to report prevalence and stability of long-term (up to 125 wk) tracking of physical activity behaviors and to compare self-reported physical activity behaviors using different measures. METHODS The WIN study tracks nearly real-time physical activity behaviors in community-living women. At baseline, 918 women began weekly Internet reporting of physical activity behaviors, accessing a secure Internet site and answering eight questions about physical activity behaviors for the previous week. Measures included days and minutes of moderate, vigorous, walking, and strengthening activities, and pedometer steps were recorded weekly. RESULTS Prevalence of meeting physical activity guidelines depended on the criterion used. Weekly averages across the surveillance period indicated 25% reported ≥150 min of moderate physical activity, 47% reported ≥75 min of vigorous physical activity, 57% reported ≥150 min of moderate-to-vigorous physical activity, 63% conducted ≥500 MET·min of physical activity, 15% reported ≥2 d of strengthening activities per week, and 39% reported ≥7500 steps per week. Alpha coefficients (≥0.97) indicated stable physical activity behaviors across all measures. CONCLUSIONS Across reporting methods, it is estimated that approximately 50% or more of these community-living women engage in sufficient physical activity for health benefits weekly across long-term follow-up. Self-report physical activity behaviors are stable across long periods in these community-living women not participating in a specific physical activity intervention.

Comparison of customized versus standard exercises in rehabilitation of shoulder disorders

Objective(s): (1) To compare the effectiveness of customized exercises with that of standard exercises for the treatment of patients with shoulder disorders. (2) To determine whether four weeks or eight weeks would be needed to see improvement in outcome measures. Design: A single-blinded randomized clinical trial. Setting: An outpatient physical therapy clinic affiliated with an academic institution. Subjects: Thirty patients with shoulder disorders were tested and treated between February 2003 and December 2004. Interventions: Patients were randomized to a customized or standard exercise group. Each patient first underwent a standardized physical therapy assessment. Based on the results of the assessment, a classification was determined and a classification-specific exercise programme was instructed to the patients in the customized exercise group. The standard exercise group, regardless of classification, received preselected standard exercises. Both groups were followed for eight weeks. Main measures: Shoulder range of motion, strength, pain intensity and function were assessed three times (weeks 0, 4 and 8). Results: There were no significant differences between the customized and standard exercise groups in measures of shoulder range of motion, strength, pain intensity and function after four or eight weeks of exercise. Patients in both groups had significant improvements in shoulder strength, pain intensity and function. Significant improvements occurred at week 8, but not at week 4. Conclusion: The customized shoulder exercises did not provide additional benefit to our shoulder patients than the standard exercises.

Lumbar Spine Flexion and Extension Extremes of Motion in Women of Different Age and Racial Groups The WIN Study

Study Design. Observational. Objective. To provide normative values of lumbar flexion and extension for women of different age and racial groups. Summary of Background Data. Spinal range of motion (ROM) is one of the AMA Guides criteria used to estimate level of impairment and subsequent compensation entitlement. Studies show that spinal ROM varies with age, gender, and possibly race/ethnicity, but adequate normative values for different age and racial/ethnic groups do not exist. Methods. A cohort of free-living women was recruited for the Womens Injury Study at The Cooper Institute in Dallas. Originally, 917 women between the ages of 20 and 83 (M = 52 ± 13) underwent an orthopedic examination including lumbar spine flexion and extension measurement using an electronic inclinometer. Measurements were taken in the fully extended and flexed positions, respectively. This removes the influence of initial resting posture and is termed “extreme of motion” (EOM) as opposed to ROM. Age and racial groups were compared using a 2-way multivariate analysis of variance (MANOVA) followed with post hoc tests. Results. Means (±SD) were calculated for racial (white, N = 619, African-American, N = 147) and age groups (young, 20–39 years, n = 126; middle, 40–59 years, n = 412; older, ≥60 years, n = 228). Lumbar extension for African-American women (60.1°) was significantly greater (P < 0.05) than for white women (52.6°), but flexion was not different (15.2° and 17.0°), respectively. Extension EOM for the young group (61.6°) was greater (P < 0.05) than the middle (56.6°) and older (50.8°) groups. Extension difference between the middle and older groups was significant. Flexion EOM for the young group (20.1°) was greater (P < 0.05) than the middle (15.2°) and older (12.8°) groups. The difference in flexion between the middle and older groups was not significant. Conclusion. Normative values of lumbar extension are different for white and African-American women. Values for lumbar flexion and extension are different between age groups. Different criteria should be used to estimate impairment level in women of different racial and age groups.

Relations of Meeting National Public Health Recommendations for Muscular Strengthening Activities With Strength, Body Composition, and Obesity: The Women's Injury Study

OBJECTIVES We examined the relations of meeting or not meeting the 2008 Physical Activity Guidelines for Americans recommendations for muscular strengthening activities with percentage of body fat, body mass index (BMI; defined as weight in kilograms divided by height in meters, squared), muscular strength, and obesity classification in women. METHODS We analyzed data on 918 women aged 20 to 83 years in the Womens Injury Study from 2007 to 2009. A baseline orthopedic examination included measurement of height, body weight, skinfolds, and muscle strength. RESULTS Women who met muscle strengthening activity recommendations had significantly lower BMI and percentage of body fat and higher muscle strength. Women not meeting those recommendations were more likely to be obese (BMI ≥ 30) compared with women who met the recommendations after we adjusted for age, race, and aerobic physical activity (odds ratio = 2.28; 95% confidence interval = 1.61, 3.23). CONCLUSIONS There was a small but significant positive association between meeting muscle strengthening activity recommendations and muscular strength, a moderate inverse association with body fat percentage, and a strong inverse association with obesity classification, providing preliminary support for the muscle strengthening activity recommendation for women.

Meeting physical activity guidelines and musculoskeletal injury: the WIN study.

INTRODUCTION The United States Department of Health and Human Services disseminated physical activity (PA) guidelines (PAGs) for Americans in 2008. The guidelines are based on appropriate quantities of moderate-to-vigorous aerobic PA and resistance exercise (RE) associated with decreased morbidity and mortality risk and increased health benefits. However, increases in PA levels are associated with increased risk of musculoskeletal injuries (MSIs). We related the amount and type of PA conducted on a weekly basis with the risk of MSI. METHODS A prospective, observational study using weekly Internet tracking of moderate-to-vigorous PA and RE behaviors and MSIs in 909 community-dwelling women for up to 3 yr was conducted. The primary outcome was self-reported MSIs (total, PA related, and non-PA related) interrupting typical daily work and/or exercise behaviors for ≥ 2 d or necessitating health care provider visit. RESULTS Meeting versus not meeting PAGs was associated with more MSIs during PA (HR = 1.39, 95% confidence interval [CI] = 1.05-1.85, P = 0.02) but was not associated with MSIs unrelated to PA (HR = 0.99, 95% CI = 0.75-1.29, P = 0.92) or with MSIs overall (HR = 1.15, 95% CI = 0.95-1.39, P = 0.14). CONCLUSIONS The results illustrate the risk of MSI with PA. MSI risk rises with increasing PA. Despite this modest increase in MSIs, the known benefits of aerobic and resistance PAs should not hinder physicians from encouraging patients to meet current PAGs for both moderate-to-vigorous exercise and RE behaviors with the intent of achieving health benefits.

Effect of stretch positions on hamstring muscle length, lumbar flexion range of motion, and lumbar curvature in healthy adults

Hamstring stretching is a common practice in physical therapy to change not only hamstring muscle length (HML), but also lumbar flexion range of motion (LROM) or lumbar curvature (LC). Yet limited published research compares the effectiveness of two commonly used hamstring stretch positions, sitting and standing. The purposes of this study were to determine the effect of (1) stretch position on HML; and 2) HML on LROM and LC. Thirty-six participants (M=44.8 years, SD=17.1) with short HML (i.e., with shortness for men ≥45° and for women ≥24° of active knee flexion with 90° hip flexion) were measured for HML, LROM, and LC; randomly allocated to one of three groups: (1) hamstring stretching in sitting (SI); (2) standing (ST); or (3) no stretching (control); and remeasured after 4 weeks. Participants in the stretching groups performed two 30-second static stretches 4 days per week for 4 weeks. Multivariate analysis of covariance (MANCOVA) showed significance between the stretching groups and nonstretching group for HML only. Nonsignificance was shown for HML between the stretch positions (i.e., SI–active knee extension (AKE) and ST-AKE), indicating that both were equally effective for increasing HML. However, there was no change in LROM or in LC even though HML increased.

Muscle Strength and Postural Stability in Healthy, Older Women: Implications for Fall Prevention

BACKGROUND Effect of muscle strength and balance on falls has not been well researched in healthy older women. The purpose of this study was to compare lower extremity strength and balance in older healthy women during each decade of life and to investigate which factors are different in women with a history of falling. METHODS We retrospectively studied 240 women age 50-89 y. Measures of muscle strength, postural stability, and incidence of falls over the past year were obtained from client charts at Texas Womans Universitys Health Promotion & Research Center from 1996 to 2002. RESULTS Strength declined significantly with age in all muscle groups except knee extensors. Age, hip flexor and abductor strength, and postural stability were significantly different in women who had fallen. CONCLUSIONS Strength decline was not consistent across muscle groups. Women who were older, had less hip flexor or abductor strength, or less balance were more likely to have fallen.