Jason Brumitt

Influence of the Hip on Patients With Patellofemoral Pain Syndrome A Systematic Review

Context: Patellofemoral pain syndrome (PFPS) is one of the most common conditions limiting athletes. There is a growing body of evidence suggesting that dysfunction at the hip may be a contributing factor in PFPS. Data Sources: MEDLINE (1950–September 2010), CINAHL (1982–September 2010), and SPORTDiscus (1830–September 2010) were searched to identify relevant research to this report. Study Selection: Studies were included assessing hip strength, lower extremity kinematics, or both in relation to PFPS were included. Data Extraction: Studies included randomized controlled trials, quasi-experimental designs, prospective epidemiology, case-control epidemiology, and cross-sectional descriptive epidemiology in a scientific peer-reviewed journal. Results: PFPS is associated with decreased hip strength, specifically at the abductors and external rotators. There is a correlation between PFPS and faulty hip mechanics (adduction and internal rotation). Conclusions: There is a link between the strength and position of the hip and PFPS. These patients have a common deficit once symptomatic. Hip strengthening and a coordination program may be useful in a conservative treatment plan for PFPS.

Self-Reported Musculoskeletal Pain in Latino Vineyard Workers

ABSTRACT The agricultural economy in the United States is dependent on millions of Latino migratory workers. Despite the health risks associated with this line of work, many agricultural workers lack health insurance or access to health care services. The purpose of this study was to collect demographic data and investigate the musculoskeletal health of Latino migratory vineyard workers. A physical therapy team collected demographic data at health clinics held at vineyards in Oregon. Nearly half (48.4%) of all vineyard workers reported experiencing musculoskeletal symptoms (MSS) in at least one region of the body. The primary region of reported MSS was the back (32% of all men and 43.7% of all women). In most cases, those who reported MSS were significantly older than those who did not report MSS. Future research is necessary to identify personal and work related injury risk factors in order to develop prevention programs.

Minimizing Injuries and Enhancing Performance in Golf Through Training Programs

Context: Golf is a popular sport, particularly in older populations. Regardless of age and skill level, golfers risk injury to the back, shoulder, wrist and hand, elbow, and knee. Because of the unique compressive, shear, rotational, and lateral bending forces created in the lumbar region during the golf swing, the primary sport-related malady experienced by amateurs and professionals is low back pain. Extrinsic and intrinsic injury risk factors have been reported in the literature. A growing body of evidence supports the prescription of strength training routines to enhance performance and reduce the risk of injury. Evidence Acquisition: Relevant studies were reviewed on golf injuries, swing mechanics, training routines, and general training program design. The following electronic databases were used to identify research relevant to this report: MEDLINE (from 1950–November 2009), CINAHL (1982–November 2009), and SPORTDiscus (1830–November 2009). Results: Injuries may be associated with lack of warm-up, poor trunk flexibility and strength, faulty swing technique, and overuse. Conclusions: Implementing a training program that includes flexibility, strength, and power training with correction of faulty swing mechanics will help the golfer reduce the likelihood of injury and improve overall performance.

Core Stabilization Exercise Prescription, Part I: Current Concepts in Assessment and Intervention

Context: Injury to the low back can cause significant pain and dysfunction, which can affect an athlete’s performance and result in time lost from sport. A common conservative treatment is therapeutic core stabilization exercises, which can address pain and musculoskeletal dysfunction in patients with low back pathology. Evidence Acquisition: MEDLINE and CINAHL were searched (from 1966 to March 2013) to identify relevant research. Keywords and keyword combinations searched included motor control exercise, segmental stabilization, core stabilization, transversus abdominis, multifidi, and low back pain. Results: There are 2 popular rehabilitation strategies to assess core function and promote core stabilization. Each has been developed based on biomechanical models of lumbar segmental stability and observed motor control dysfunction in patients with low back pain. Conclusion: Controversy exists among clinical and research groups as to the optimal strategy for an athlete with low back pain.

Core Stabilization Exercise Prescription, Part 2 A Systematic Review of Motor Control and General (Global) Exercise Rehabilitation Approaches for Patients With Low Back Pain

Context Therapeutic exercises are frequently prescribed to patients with low back pain. Numerous exercise programs for patients with low back pain have been described. Many of these treatment programs are based on 1 of 2 popular rehabilitation strategies: a motor control exercise approach or a general exercise approach. Data Sources PubMed clinical queries from 1966 to March 2013 for keyword combinations including motor control exercise, core stability exercise, therapeutic exercise, general exercise, global exercise, local exercise, transversus abdominis, segmental stabilization, and low back pain. Study Selection Randomized controlled trials that assessed the effects of a motor control exercise approach, a general exercise approach, or both for patients with low back pain that were published in scientific peer-reviewed journals. Data Extraction Included studies underwent appraisal for exercise intervention and outcomes. Results Fifteen studies were identified (8, motor control exercise approach without general exercise comparison; 7, general exercise approach with or without motor control exercise approach comparison). Current evidence suggests that exercise interventions may be effective at reducing pain or disability in patients with low back pain. Conclusion: Stabilization exercises for patients with low back pain may help to decrease pain and disability. It may not be necessary to prescribe exercises purported to restore motor control of specific muscles.

Successful rehabilitation of a recreational endurance runner: Initial validation for the Bunkie test

This case report details the musculoskeletal evaluation and the successful rehabilitation of a 24-year-old female recreational distance runner who self-referred to physical therapy with an acute bout of low back pain (LBP). Her LBP was provoked during each distance run. The patients musculoskeletal evaluation revealed core weakness, especially on the left. A recently reported functional test, the Bunkie test, was administered as part of the physical evaluation. The scores from the Bunkie test correlated with other quantitative and qualitative findings. A therapeutic exercise program emphasizing core stabilization was prescribed. The patient was able to shortly return to running pain-free.

A return to running program for the postpartum client: A case report

The purpose of this case report is to present a return to running program for a postpartum client who had delivered via cesarean section. The client, a 29-year-old female health care professional who was 8 months postcesarean section, was referred to physical therapy for a return to running exercise program. The client had three live births during a 30-month time period (February 2004 to August 2006). During her last labor she underwent an emergency cesarean section because of a low fetal heart rate. Since her surgery the client had not participated in an exercise routine. Following an 8-week training program the client was able to demonstrate both quantitative and qualitative functional improvements, including running a 12-minute mile. This case describes a successful return to running program for a postpartum client who delivered her child via cesarean section. Future research is warranted to determine the optimal evaluation strategy and exercise training programs for this population.

Plyometric Training Considerations to Reduce Knee Injuries

emale athletes participating in cutting or jumping sports are 4 to 6 times more likely to experience a serious knee injury than are their male counterparts (1). The mechanism of injury is usually noncontact and occurs when the athlete is making a sudden stop, making sharp cuts, or landing and pivoting. But why are women more susceptible to anterior cruciate ligament (ACL) tears? Three theories explain why women sustain more injuries: hormonal, anatomical, and neuromuscular. First, female sex hormones increase ligamentous laxity, potentially affecting joint stability. Controversy exists on whether this joint laxity increases the incidence of injury. Second, anatomical considerations include lower tensile strength of the ligament, a narrower femoral notch, and pelvic and lower-extremity malalignments. These anatomical and hormonal factors are unavoidable. However, the third and final theory regarding neuromuscular control can be addressed in a proper strength and conditioning program. Plyometric Training Considerations to Reduce Knee Injuries

Musculoskeletal Healthcare for Latino Migrant Farmworkers: Interprofessional Collaboration to Provide Service and Educate Future Healthcare Providers

The inability to access health care services is a significant issue in the United States (US). The US Census Bureau reports that as of 2009 over 50 million individuals (16.7% of the population) lacked health insurance. The number of people who became uninsured has also increased over time. One segment of the US population that is particularly vulnerable to health care inequities is Latinos. Failure to access timely primary medical services may increase the risk of disease transmission, morbidity, and mortality. In addition, failing to address health care needs at the primary provider level may contribute to an overutilization of potentially unnecessary emergency room services. To address health care disparities and inequalities, community partners must collaborate to provide the needed services. This report will describe the collaboration between community health nurses and physical therapists when providing services to address the musculoskeletal health of the workers. In addition, this report will describe the service and experiential opportunities for physical therapy students including the opportunity to provide care within an interprofessional setting, practice techniques and provide service in a unique environment, and to develop aspects of professionalism.

In-season rehabilitation of a division III female wrestler after a glenohumeral dislocation

OBJECTIVE Wrestling is a popular sport in the United States at both the high school and collegiate levels. Traditionally a mens sport, participation by female athletes in wrestling is increasing. There exists a paucity of literature regarding injury incidence in womens wrestling. This lack of information challenges the ability of sports medicine and strength training professionals to design optimal injury prevention programs, training routines, and rehabilitation strategies. The objective of this report is to detail the successful conservative rehabilitation of a female wrestler after an initial glenohumeral dislocation. DESIGN Case report. CASE DESCRIPTION A 20-year-old female wrestling student-athlete presented to the universitys sports medicine team after sustaining an anteriorly dislocated right shoulder. The patient had the goal to return back to competition in time for the National Championships. An evidenced-supported, non-traumatic glenohumeral instability rehabilitation protocol combined with weight-bearing exercises simulating functional sport positions was implemented with the goal of returning the injured collegiate female wrestler back to sport. RESULTS At the end of the rehabilitation program the athlete demonstrated full active range of motion, good strength in the right shoulder, and reported her pain rating at a 1/10. The conservative rehabilitation strategy utilized in this case enabled the patient to return to wrestling and successfully compete at the National Championships.