Jeffrey L. Young

The influence of the spine on the shoulder in the throwing athlete

Analysis of shoulder dysfunction in throwing and overhead athletes can no longer be restricted to evaluation of the glenohumeral joint alone. The isolated shoulder is incapable of generating the force necessary to hurl a baseball at velocities of 90-100 miles per hour or serve a tennis ball in excess of 120 miles per hour. The purpose of this paper is to provide a literature based theoretical framework for the role of the spine during these activities. The spine is a pivotal component of the kinematic chain which functions as a transfer link between the lower and upper limbs, a force generator capable of accelerating the arm, and a force attenuator which dampens shear forces at the glenohumeral joint during the deceleration phase of the pitching motion. Side bending and rotation of the cervical spine facilitates visual acquisition of the intended target. Inflexibility of the hip musculature and weakness of the muscles which attach to the thoracolumbar fascia have profound effects upon spine function which secondarily places greater stress upon the glenohumeral joint and rotator cuff. Shoulder rehabilitation and injury prevention programs should include evaluation of and exercise regimens for the lumbar, thoracic and cervical spine.

The disc at risk in athletes : perspectives on operative and nonoperative care

Low back pain is the most common cause of disability in individuals below the age of 45 and the third most common cause of disability overall. Although acute back pain is generally felt to have a high probability of spontaneous resolution, the high recurrence rate of low back pain challenges the notion that resolution of symptoms is accompanied by restitution of function. Athletes who have lumbar spine dysfunction represent a particular challenge to the treating physician due to their high levels of activity and expectation of return to sport. Injuries to the intervertebral disc in the lumbar spine are a particular subset of spine injury. Management of intervertebral disc injuries, which is the focus of this section, is fraught with controversy. Although the majority of intervertebral disc injuries can be treated conservatively, the decision to follow an aggressive conservative versus surgical course in any given athlete must be made on an individual case basis.

Aerobic fitness in women with chronic discogenic nonradicular low back pain.

Hoch AZ, Young J, Press J: Aerobic fitness in women with chronic discogenic nonradicular low back pain. Am J Phys Med Rehabil 2006;85:607–613. Objective:The purpose of this study was to determine if aerobic fitness varies between women with and without chronic discogenic nonradicular low back pain. Design:Prospective cross-sectional descriptive study. Results:Analysis of variance revealed that maximal oxygen consumption was lower (P = 0.05) in women with low back pain compared with the control group. In addition, there was a significant reduction (P = 0.05) in reported exercise training duration and frequency but no change in exercise intensity (P = 0.1) in the study group after the onset of low back pain. The low back pain group had minimal disability (19%) based on the Oswestry Disability Questionnaire. Conclusions:Women with chronic discogenic nonradicular low back pain have lower maximal oxygen consumption than age-matched controls. However, this study group continued to exercise safely at the same exercise training intensity as before their low back pain and had minimal disability and above-average aerobic fitness.

Biomechanical and Clinical Correlates of Stance-Phase Knee Flexion in Persons With Spastic Cerebral Palsy

To identify biomechanical and clinical parameters that influence knee flexion (KF) angle at initial contact (IC) and during single limb stance phase of gait in children with spastic cerebral palsy (CP) who walk with flexed‐knee gait.

Infected total ankle arthroplasty following routine dental procedure.

Level of Evidence: V, Case Report

Athletic performance — must it decline with age?

Many individuals continue to exercise train and experience athletic success well into the eighth and ninth decades of their lives. This paper examines the interaction between aging and athletic performance with specific reference to how regular exercise training attenuates the decrements in performance typically attributed to the aging process. The importance of rehabilitation of musculoskeletal injuries to facilitate continued participation in athletics is also addressed.

Physical medicine and rehabilitation approaches to pain management

Abstract This chapter describes the physical medicine and rehabilitation approach to acute and chronic painful musculoskeletal complaints. It highlights the importance of treating the whole patient with the goal of restoring maximal function through therapeutic exercise. The role of passive modalities, including cryotherapy, heat, and ultrasound, are discussed as adjunctive treatment to the active flexibility, strength, and cardiovascular exercise being performed by the patient under the supervision of physical therapists. Specific physical therapy approaches to low back pain including mechanical diagnosis and treatment and neurodynamic therapy are also discussed. Comprehensive interdisciplinary treatment programs can be helpful for those patients that develop more chronic musculoskeletal complaints.

Complex Foot Deformities: Correction with the Taylor Spatial Frame

The Taylor Spatial Frame (TSF) is a hexapod multiplanar circular external fixator that is able to correct a wide variety of complex foot deformities. The frame configurations are as diverse as the deformities they treat, but they are built from three basic frames: the standard (long bone) frame, the butt frame, and the miter frame. The “PonseTaylor” frame is a novel application of a standard frame and is described here to demonstrate the flexibility of the TSF.

A retrospective review of the incidence and rehabilitation outcome of concomitant traumatic brain injury and ligamentous knee injury

OBJECTIVES To estimate the incidence of ligamentous knee injuries in patients with traumatic brain injury (TBI) involved in pedestrian versus motor vehicle collisions (PVMVC), to identify associated risk factors, and to compare rehabilitation outcomes and costs in TBI patients with and without ligamentous knee injury. DESIGN Retrospective, case control. SETTING An academic rehabilitation hospital with a large metropolitan referral base. PATIENTS Twenty-three consecutive adolescent and adult subjects admitted for acute inpatient rehabilitation after a PVMVC from January 1, 1994, to January 1, 1996. RESULTS Five subjects (22%) were found to have a ligamentous knee injury, one with bilateral injuries. Two of these six injuries were diagnosed only after presentation to the rehabilitation setting. The most common injury was an anterior cruciate ligament (ACL) disruption in 5 of 6 knees. A coupled ACL and medial collateral ligament injury was identified in 4 of 6 injured knees. The risk of ligamentous knee injury was most closely associated with the presence of a tibial plateau fracture (n=3) (chi2=12.420, p < .001). There was no statistical difference between groups with and without ligamentous knee injuries with respect to age, gender, inpatient acute or rehabilitation length of stay, admission, discharge, or change in motor Functional Independence Measure (FIM) interval measures, or rehabilitation costs. Four of the 5 patients with ligamentous knee injuries were successfully managed nonoperatively. A case illustrating longitudinal management is presented. CONCLUSIONS TBI and ligamentous knee injuries, in particular ACL injuries, are common comorbidities after PVMVC. Physicians must maintain a high index of suspicion for ligamentous knee injuries in this population, particularly when a tibial plateau fracture is present. TBI patients with and without ligamentous knee injuries can have comparable functional outcomes when the ligament injuries are identified and appropriately managed, without incurring undue cost or length of inpatient rehabilitation.

Vague upper-extremity symptoms? Consider thoracic outlet syndrome

In brief Thoracic outlet syndrome is a brief commonly missed cause of upper-extremity pain and musculoskeletal symptoms. Understanding the anatomy of the cervicoaxillary canal and proximal limb, etiology of the syndrome, evaluation of clinical symptoms, and differential diagnosis of thoracic outlet pain can lead to proper rehabilitation of the disorder.