Janice K. Loudon

A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises

Recently, clinicians have focused much attention on the importance of hip strength for the rehabilitation of not only patients with low back pain but also lower extremity pathology. Properly designing a rehabilitation program for the gluteal muscles requires careful consideration of biomechanical principles, such as length of the external moment arm, gravity, and subject positioning. Understanding the anatomy and function of these muscles also is essential. Electromyography (EMG) provides a useful means to determine muscle activation levels during specific exercises. Descriptions of specific exercises, as they relate to the gluteal muscles, are described. The specific performance of these exercises, the reliability of such EMG measures, and descriptive figures are also detailed. Of utmost importance to practicing clinicians is the interpretation of such data and how it can be best used in exercise prescription when formulating a treatment plan.

The effectiveness of active exercise as an intervention for functional ankle instability: a systematic review.

Functional ankle instability (FAI) is a term used to describe an ankle that easily ‘gives way’ with activity. There have been many proposed causes of FAI including joint proprioceptive deficiency, muscle weakness, balance control impairments, and delayed muscle reaction time, none of which has proven to be the exclusive cause of FAI. Treatment becomes difficult when the causative factor of the injury is obscure. This systematic review evaluates the clinical trials involving conservative exercise interventions in FAI and examines the changes induced by the exercise treatments to the various potential FAI factors. Sixteen articles describing the active exercise treatment of FAI were analysed using Sackett’s levels of evidence and were examined for scientific rigor. From this review, it can be concluded that conservative treatment interventions including balance, proprioceptive and muscle strengthening exercises are effective for patients with FAI in decreasing the incidence of giving-way episodes, improving balance stability, and improving function.

Use of Foot Orthoses and Calf Stretching for Individuals With Medial Tibial Stress Syndrome

Use of orthotics and calf stretching may alleviate symptoms in runners with medial tibial stress syndrome (MTSS). The objective of this study was to determine which patients with MTSS have a positive response to off-the-shelf foot orthoses and calf stretching based on selected clinical tests to establish a clinical prediction rule. This prospective cohort/predictive validity study enrolled 23 women and men aged 22 to 44 years with symptoms of MTSS. Interventions included off-the-shelf basic foot orthotics and calf stretching. Fifteen of the 23 runners had a 50% reduction of pain in 3 weeks of intervention. Duration was a significant factor that differentiated groups. Although an initial treatment for runners with MTSS may include off-the-shelf orthotics and calf stretching, this regimen should be only one component of an individualized rehabilitation program.

Validity of a total body recumbent stepper exercise test to assess cardiorespiratory fitness.

Billinger, SA, Loudon, JK, and Gajewski, BJ. Validity of a total body recumbent stepper exercise test to assess cardiorespiratory fitness. J Strength Cond Res 22(5):1556-1562, 2008-Maximum oxygen consumption (&OV0312;o2max) is the primary measure for cardiorespiratory fitness, and the &OV0312;o2max value achieved on the treadmill using the Bruce protocol is considered the gold standard. A novel exercise test using a total body recumbent stepper (TBRS) would be an alternative for measuring &OV0312;o2max in healthy individuals. Furthermore, the TBRS exercise test (TBRS-XT) may be beneficial for individuals such as those with stroke, who cannot tolerate a treadmill or cycle ergometer test due to hemiparesis, increased tone in the extremities, or balance deficits. The purpose of the study was to assess the validity and reliability of the TBRS-XT in determining &OV0312;o2max in healthy adults. Twenty-two healthy adults (9 women, 13 men; 26.9 ± 6.1 years of age) participated in 2 maximum exercise tests in random order. One exercise test was performed on the treadmill using the Bruce protocol and the other exercise test was the TBRS-XT. Statistical analysis of the data was conducted using simple linear regression where the response variable was the &OV0312;o2max from the Bruce protocol and the predictor variable was the &OV0312;o2max from the TBRS-XT. A 95% prediction interval was used to assess the strength of the prediction of &OV0312;o2 from the Bruce protocol with R2 = 0.851. Preliminary data suggest that the TBRS-XT may be a valid test to predict &OV0312;o2max when treadmill testing is not feasible. This would allow clinicians an alternative method for exercise testing and prescription to promote healthy lifestyle interventions for a variety of patient populations.

Conservative management of femoroacetabular impingement (FAI) in the long distance runner

Femoroacetabular impingement (FAI) is one cause of anterior hip pain that may occur in a long distance runner. By definition FAI is due to bony abutment of the femoral neck and the acetabulum. This occurs primarily with end-ranges of hip flexion and adduction. An understanding of running mechanics and performing a thorough examination will help the clinician provide an appropriate intervention for these athletes. A course of conservative treatment that includes patient education, manual therapy and strengthening should be tried prior to surgical management.

Functional movement screen scores in a group of running athletes.

Abstract Loudon, JK, Parkerson-Mitchell, AJ, Hildebrand, LD, and Teague, C. Functional movement screen scores in a group of running athletes. J Strength Cond Res 28(4): 909–913, 2014—The purpose of this study was to determine the mean values of the functional movement screen (FMS) in a group of long-distance runners. The secondary aims were to investigate whether the FMS performance differed between sexes and between young and older runners. Forty-three runners, 16 women (mean age = 33.5 years, height = 165.2 cm, weight = 56.3 kg, and body mass index [BMI] = 20.6) and 27 men (mean age = 39.3 years, height = 177.6 cm, weight = 75.8 kg, and BMI = 24.2) performed the FMS. All the runners were injury-free and ran >30 km·wk−1. Independent t-tests were performed on the composite scores to examine the differences between men and women and also between young (<40 years) and older runners (>40 years). Contingency tables (2 × 2) were developed for each of the 7 screening tests to further look at the differences in groups for each single test. The &khgr;2 values were calculated to determine significant differences. Statistical significance was set at p ⩽ 0.05. There was no significant difference in the composite score between women and men. There were significant differences between the sexes in the push-up and straight leg test scores, with the women scoring better on each test. A significant difference was found in the composite scores between younger and older runners (p < 0.000). Additional score differences were found for the squat, hurdle step, and in-line lunge tests with the younger runners scoring better. This study provided mean values for the FMS in a cohort of long-distance runners. These values can be used as a reference for comparing FMST scores in other runners who are screened with this tool.

Anterior cruciate ligament injury in female and male athletes: the relationship between foot structure and injury.

BACKGROUND It has been shown that anterior cruciate ligament (ACL) injuries are more prevalent in female athletes than in male athletes. Soccer and basketball are considered high-risk sports for ACL injury in female athletes. Several studies have reported a relationship between ACL injury and measures of foot structure. This study was conducted to investigate the relationship between foot structure and ACL injury rates in female and male soccer and basketball players. METHODS One hundred five soccer and basketball players (53 women and 52 men) were recruited and divided into an ACL-normal group (n=89) and an ACL-injured group (n=16). Two measures of foot structure (subtalar joint neutral position and navicular drop test values) were recorded for each subject. An independent t test and a paired t test were used to analyze differences in ACL status, foot structure, and sex. A chi2 analysis determined whether the prevalence of ACL injury was independent of sport. RESULTS No statistically significant differences were found in the foot structure measures between women and men. Female soccer and basketball players had an ACL injury rate seven times that of male players. CONCLUSIONS Values derived from subtalar joint neutral position measurement and the navicular drop test were not associated with ACL injury in collegiate female and male soccer and basketball players.

Diagnostic Accuracy of Clinical Tests for Assessment of Hamstring Injury: A Systematic Review

STUDY DESIGN Systematic literature review. BACKGROUND The diagnosis of a hamstring injury has traditionally relied on various clinical measures (eg, palpation, swelling, manual resistance), as well as the use of diagnostic imaging. But a few studies have suggested the use of specific clinical tests that may be helpful for the diagnostic process. OBJECTIVE To summarize the current literature on the diagnostic accuracy of orthopaedic special tests for hamstring injuries and to determine their clinical utility. METHODS A computer-assisted literature search of the MEDLINE, CINAHL, and Embase databases (along with a manual search of grey literature) was conducted using key words related to diagnostic accuracy of hamstring injuries. To be considered for inclusion in the review, the study required (1) patients with hamstring or posterior thigh pain; (2) a cohort, case-control, or cross-sectional design; (3) inclusion of at least 1 clinical examination test used to evaluate hamstring pathology; (4) comparison against an acceptable reference standard; (5) reporting of diagnostic accuracy of the measures (sensitivity [SN], specificity [SP], or likelihood ratios); and (6) publication in English. SN, SP, and positive and negative likelihood ratios were calculated for each diagnostic test. RESULTS The search strategy identified 602 potential articles, of which only 3 articles met the inclusion criteria, with only 1 of these 3 articles being of high quality. Two of the studies investigated a single special test, whereas the third article examined a composite clinical assessment employing various special tests. The SN values ranged from 0.55 (95% confidence interval [CI]: 0.46, 0.69) for the active range-of-motion test to 1.00 (95% CI: 0.97, 1.00) for the taking-off-the-shoe test. The SP values ranged from 0.03 (95% CI: 0.00, 0.22) for the composite clinical assessment to 1.00 (95% CI: 0.97, 1.00) for the taking-off-the-shoe test, active range-of-motion test, passive range-of-motion test, and resisted range-of-motion test. The use of a single special test demonstrated stronger SP than SN properties, whereas the composite clinical assessment demonstrated stronger SN than SP properties. CONCLUSION Very few studies have investigated the utilization of clinical special tests for the diagnosis of hamstring injuries. Further studies of higher quality design are suggested prior to advocating independent clinical utilization of these special tests. LEVEL OF EVIDENCE Diagnosis, level 3b.

Static Progressive Stretch Brace as a Treatment of Pain and Functional Limitations Associated With Plantar Fasciitis A Pilot Study

Plantar fasciitis is a common and hard-to-treat disorder of the foot. Numerous studies have compared various stretching exercises, but the use of a day-wear static progressive stretch brace has not been studied. A randomized, single-blinded trial was conducted to compare the effectiveness of a static progressive stretch brace to standard care of active stretching exercises. Thirteen subjects (12 women and 1 man; mean age, 42 ± 9.0 years) with plantar fasciitis participated in this study between January 2004 and March 2007. Subjects were randomized to either an exercise group (static stretch group, n = 8) or a brace group (static progressive stretch group, n = 9) for an 8-week treatment period and 1-month follow up. Both groups received basic off-the-shelf foot orthoses. Data were available for 7 subjects in the exercise group and 6 in the brace group. Pain and functional limitations were evaluated with the Foot Functional Index pain subscale, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, and great toe extension motion. Overall pain and morning pain improved in both groups as compared with baseline measures (repeated-measures analysis of variance, P = .04 and P = .02, respectively). Functional rating also improved in both groups (repeated-measures analysis of variance, P = .005). No changes were found in either group with great toe extension range of motion. In addition, there was no significant group difference or interaction with time and group with any measures. Both interventions (static, exercise, and brace stretching) were beneficial for treating pain and functional limitations, suggesting that static progressive stretch brace is an effective alternative option to static stretching exercises for people with plantar fasciitis.

Return to sport after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation: a systematic review with meta-analysis

Background Lumbar disc herniation has a prevalence of up to 58% in the athletic population. Lumbar discectomy is a common surgical procedure to alleviate pain and disability in athletes. We systematically reviewed the current clinical evidence regarding athlete return to sport (RTS) following lumbar discectomy compared to conservative treatment. Methods A computer-assisted literature search of MEDLINE, CINAHL, Web of Science, PEDro, OVID and PubMed databases (from inception to August 2015) was utilised using keywords related to lumbar disc herniation and surgery. The design of this systematic review was developed using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Methodological quality of individual studies was assessed using the Downs and Black scale (0–16 points). Results The search strategy revealed 14 articles. Downs and Black quality scores were generally low with no articles in this review earning a high-quality rating, only 5 articles earning a moderate quality rating and 9 of the 14 articles earning a low-quality rating. The pooled RTS for surgical intervention of all included studies was 81% (95% CI 76% to 86%) with significant heterogeneity (I2=63.4%, p<0.001) although pooled estimates report only 59% RTS at same level. Pooled analysis showed no difference in RTS rate between surgical (84% (95% CI 77% to 90%)) and conservative intervention (76% (95% CI 56% to 92%); p=0.33). Conclusions Studies comparing surgical versus conservative treatment found no significant difference between groups regarding RTS. Not all athletes that RTS return at the level of participation they performed at prior to surgery. Owing to the heterogeneity and low methodological quality of included studies, rates of RTS cannot be accurately determined.