Eric M. Magrum

Effects of lumbopelvic joint manipulation on quadriceps activation and strength in healthy individuals

Lumbopelvic joint manipulation has been shown to increase quadriceps force output and activation, but the duration of effect is unknown. It is also unknown whether lower grade joint mobilisations may have a similar effect. Forty-two healthy volunteers (x+/-SD; age=28.3+/-7.3 yr; ht=172.8+/-9.8 cm; mass=76.6+/-21.7 kg) were randomly assigned to one of three groups (lumbopelvic joint manipulation, 1 min lumbar passive range of motion (PROM), or prone extension on elbows for 3 min). Quadriceps force and activation were measured using the burst-superimposition technique during a seated isometric knee extension task before and at 0, 20, 40, and 60 min following intervention. Collectively, all groups demonstrated a significant decrease (p<0.001) in quadriceps force output without changes in activation (p>0.05) at all time intervals following intervention. The group that received a lumbopelvic joint manipulation demonstrated a significant increase in quadriceps force (3%) and activation (5%) (p<0.05) immediately following intervention, but this effect was not present after the 20 min interval. Since participants in this study were free of knee joint pathology, it is possible that they did not have the capacity to allow for large changes in quadriceps muscle activation to occur.

Immediate effects of a tibiofibular joint manipulation on lower extremity H-reflex measurements in individuals with chronic ankle instability

Persistent muscle inhibition of the fibularis longus and soleus muscles and altered joint arthrokinematics may play a role in chronic ankle instability (CAI). Joint mobilization has been shown to improve ankle joint motion, but effects on surrounding musculature is unknown. The purpose of this study was to determine the change in fibularis longus and soleus activation following tibiofibular joint manipulation in individuals with CAI. Forty-three subjects were randomized to one of three groups (proximal tibiofibular manipulation, distal tibiofibular manipulation, or control). A two-way mixed model ANOVA was used to compare changes in the ratio of the maximum H-reflex and maximum M-wave measurements (H/M ratio) of the fibularis longus and soleus between groups over time (pre, post 0, 10, 20, 30 min). The distal tibiofibular joint manipulation group demonstrated a significant increase (P<.05) in soleus H/M ratio at all post-intervention time periods except 20 min post-intervention (P=.48). The proximal tibiofibular joint manipulation and control groups did not demonstrate a change in soleus H/M ratios. All groups demonstrated a decrease (P<.05) from baseline values in fibularis longus (10-30 min post-intervention) and soleus (30 min post-intervention) H/M ratios. Interventions directed at the distal tibiofibular joint acutely increase soleus muscle activation.

Effects of a proximal or distal tibiofibular joint manipulation on ankle range of motion and functional outcomes in individuals with chronic ankle instability.

STUDY DESIGN Randomized clinical trial. OBJECTIVES To determine whether manipulation of the proximal or distal tibiofibular joint would change ankle dorsiflexion range of motion and functional outcomes over a 3-week period in individuals with chronic ankle instability. BACKGROUND Altered joint arthrokinematics may play a role in chronic ankle instability dysfunction. Joint mobilization or manipulation may offer the ability to restore normal joint arthrokinematics and improve function. METHODS Forty-three participants (mean ± SD age, 25.6 ± 7.6 years; height, 174.3 ± 10.2 cm; mass, 74.6 ± 16.7 kg) with chronic ankle instability were randomized to proximal tibiofibular joint manipulation, distal tibiofibular joint manipulation, or a control group. Outcome measures included ankle dorsiflexion range of motion, the single-limb stance on foam component of the Balance Error Scoring System, the step-down test, and the Foot and Ankle Ability Measure sports subscale. Measurements were obtained prior to the intervention (before day 1) and following the intervention (on days 1, 7, 14, and 21). RESULTS There was no significant change in dorsiflexion between groups across time. When groups were pooled, there was a significant increase (P<.001) in dorsiflexion at each postintervention time interval. No differences were found among the Balance Error Scoring System foam, step-down test, and Foot and Ankle Ability Measure sports subscale scores. CONCLUSIONS The use of a proximal or distal tibiofibular joint manipulation in isolation did not enhance outcome effects beyond those of the control group. Collectively, all groups demonstrated increases in ankle dorsiflexion range of motion over the 3-week intervention period. These increases might have been due to practice effects associated with repeated testing. LEVEL OF EVIDENCE Therapy, level 2b-.

Lumbopelvic Joint Manipulation and Quadriceps Activation of People With Patellofemoral Pain Syndrome

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 (F(5.33,101.18) = 0.65, P = .67) or central activation ratio (F(4.84,92.03) = 0.38, P = .86) values among groups after intervention. When groups were pooled, we found differences across time for quadriceps force (F(2.66,101.18) = 5.03, P = .004) and activation (F(2.42,92.03) = 3.85, P = .02). Quadriceps force was not different at 0 minutes after intervention (t(40) = 1.68, P = .10), but it decreased at 20 (t(40) = 2.16, P = .04), 40 (t(40) = 2.87, P = .01) and 60 (t(40) = 3.04, P = .004) minutes after intervention. All groups demonstrated decreased quadriceps activation at 0 minutes after intervention (t(40) = 4.17, P < .001), but subsequent measures were not different from preintervention levels (t(40) 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.

Changes in Lateral Abdominal Muscle Thickness During an Abdominal Drawing-In Maneuver in Individuals With and Without Low Back Pain

The purpose of this study was to compare lateral abdominal muscle thickness changes in individuals with and without low back pain (LBP) during an abdominal drawing-in maneuver (ADIM) using ultrasound imaging. Twenty individuals (13 females and 7 males, average age 40.1 ± 13.4) with stabilization classification LBP and 19 controls (10 females and 9 males, average age 30.3 ± 8.7) participated in this study. Bilateral measurements were made using ultrasound imaging to determine changes in thickness of the transversus abdominus (TrA) and external and internal oblique (EO+IO) muscles during an ADIM. There were no significant differences in relaxed muscle thickness values or contraction ratios for the TrA or EO+IO between groups or side. Individuals with stabilization classification LBP demonstrated no difference in lateral abdominal muscle thickness during an ADIM when compared with controls without LBP when using a pressure biofeedback device to monitor stability.

Patellofemoral Pain Syndrome: An Update

Patellofemoral pain syndrome (PFPS) is one of the most prevalent musculoskeletal conditions seen in sports medicine clinics. The pathophysiology of PFPS is multifactorial. These factors include both extrinsic risk factors, such as changes in training frequency or intensity, training surfaces and inappropriate shoe wear, and intrinsic risk factors, including lower extremity malalignment and muscle and soft tissue imbalances. A combination of biomechanical factors and tissue imbalances causes improper tracking of the patella in the trochlea of the femur, leading to increased stress at the patellofemoral joint. A thorough history and static and dynamic examination can aid the diagnosis of PFPS. Physical therapy continues to be the mainstay of conservative management of patients with PFPS, with a focus on a multimodal treatment approach with an individualized therapy plan based on anatomic and biomechanical factors.

Changes in Muscle Thickness After Exercise and Biofeedback in People With Low Back Pain

CONTEXT Individuals with low back pain (LBP) have reduced function of the transversus abdominis (TrA) and lumbar multifidus (LM) muscles. Biofeedback during exercise may increase the ability to contract the TrA and LM muscles compared with exercise alone. OBJECTIVE To compare TrA preferential activation ratio (PAR) and the percent change in LM-muscle thickness in patients with LBP history before and after exercise with or without biofeedback. DESIGN Controlled laboratory study. SETTING University research laboratory. PATIENTS 20 LBP individuals, 10 exercise alone and 10 exercise with biofeedback. INTERVENTIONS Patients were allotted to tabletop exercises in isolation or tabletop exercises with visual, auditory, and tactile biofeedback. MAIN OUTCOME MEASURES TrA PAR and percent change in LM-muscle thickness. RESULTS There were no differences between groups at baseline (all P > .05). Nonparametric statistics showed decreased resting muscle thickness for total lateral abdominal-wall muscles (P = .007) but not TrA (P = .410) or LM (P = .173). Percent TrA thickness increased from table to standing positions before (P = .006) and after exercise (P = .009). TrA PAR increased after exercise (pre 0.01 ± 0.02, post 0.03 ± 0.04, P = .033) for all patients and for exercise with biofeedback (pre 0.02 ± 0.01, post 0.03 ± 0.01, P = .037) but not for exercise alone (pre 0.01 ± 0.02, post 0.02 ± 0.05, P = .241). No group differences were observed for TrA PAR before (exercise 0.01 ± 0.02, exercise with biofeedback 0.02 ± 0.01, P = .290) or after exercise (exercise 0.02 ± 0.05, exercise with biofeedback 0.03 ± 0.01, P = .174). There were no group differences in LM percent change before exercise (P = .999) or after exercise (P = .597). In addition, no changes were observed in LM percent change as a result of exercise among all participants (P = .391) or for each group (exercise P = .508, exercise with biofeedback P = .575). CONCLUSION TrA PAR increased after a single session of exercises, whereas no thickness changes occurred in LM.

Rehabilitation of head and neck injuries in the athlete

This article has given a general overview of a specific and reproducible physical therapy evaluation that can be used to assess progress toward and achievement of goals of treatment. General descriptions of types of presentations that can be seen clinically were also delineated. General treatment goals were discussed and some specific exercises were introduced to help in developing a comprehensive program for the athlete. The main emphasis of the treatment of the athlete requires application of clinical reasoning to the evaluation, treatment, and reassessment process in order to achieve the athletes goal of full return to sport.

Poster 292 Correlating Knee Frontal Angle of the Drop-Jump and Single-Leg Step-Down Tests with Three-Dimensional Kinematics of Midstance Running Gait

Disclosures: R. M. Lazaro: I Have No Relevant Financial Relationships To Disclose. Objective: To determine whether knee varus/valgus during the single-leg step-down (SLSD) and drop-jump (DJ) tests correlates with three-dimensional (3-D) measurements of running gait kinetics and kinematics. Design: Retrospective cross-sectional study. Setting: University-based gait and motion analysis lab. Participants: Previously collected data from 40 adult runners (26 females and 14 males) were analyzed. Interventions: Three-dimensional joint kinematics and kinetics were measured as subjects performed a running trial, SLSD, and DJ. Frontal knee angles during SLSD and DJ were compared to 3-D joint angles, body segment alignment, and ground reaction forces during the midstance phase of running. Main Outcome Measures: Strength and direction of these relationships between frontal knee angles during the SLSD and DJ tests and 3-D variables during midstance running were measured by calculating Pearson product-moment correlation coefficients. Results or Clinical Course: For the correlations between SLSD knee varus/valgus and midstance running for the right knee frontal (RKF), right hip transverse (RHT), left knee frontal (LKF), and left hip transverse (LHT) angles, r values were .749, .683, .737, and .524, respectively (P < .001 for all). In the DJ test, r values for LKF, LHT, and RKF were .556 (P < .001), .507 (P < .001), and .405 (P < .009), respectively. RHT angle did not show a strong correlation between DJ and running as it did between SLSD and running (r 1⁄4 .294, P 1⁄4 .065). Conclusion: Knee varus during the SLSD showed moderate to strong correlations with both knee varus and hip internal rotation during midstance running. Knee varus during the DJ showed weak to moderate correlations with midstance knee varus and hip internal rotation. Both the SLSD and DJ tests may be used to evaluate an athlete’s biomechanics, though the SLSD more accurately reflects biomechanics during running than the DJ does.