Josef H. Moore

Dynamic vs. static-stretching warm up: the effect on power and agility performance.

The purpose of this study was to compare the effect of a dynamic warm up (DWU) with a static-stretching warm up (SWU) on selected measures of power and agility. Thirty cadets at the United States Military Academy completed the study (14 women and 16 men, ages 18–24 years). On 3 consecutive days, subjects performed 1 of the 2 warm up routines (DWU or SWU) or performed no warm up (NWU). The 3 warm up protocols lasted 10 minutes each and were counterbalanced to avoid carryover effects. After 1–2 minutes of recovery, subjects performed 3 tests of power or agility. The order of the performance tests (T-shuttle run, underhand medicine ball throw for distance, and 5-step jump) also was counterbalanced. Repeated measures analysis of variance revealed better performance scores after the DWU for all 3 performance tests (p < 0.01), relative to the SWU and NWU. There were no significant differences between the SWU and NWU for the medicine ball throw and the T-shuttle run, but the SWU was associated with better scores on the 5-step jump (p < 0.01). Because the results of this study indicate a relative performance enhancement with the DWU, the utility of warm up routines that use static stretching as a stand-alone activity should be reassessed.

Operative stabilization of posterior shoulder instability.

Background Symptomatic, traumatic posterior shoulder instability is often the result of a posteriorly directed blow to an adducted, internally rotated, and forward-flexed upper extremity. Operative repair has been shown to provide favorable results. Current arthroscopic techniques with suture anchors and the ability to plicate the capsule using a nonabsorbable suture may provide favorable outcomes with reduced morbidity. Purpose To evaluate the results of operative shoulder stabilization in patients with traumatic posterior shoulder instability. Study Design Case series; Level of evidence, 4. Methods A consecutive series of patients who underwent arthroscopic or open posterior stabilization for traumatic posterior shoulder instability were evaluated using subjective assessments, physical examinations, the Single Assessment Numeric Evaluation, Rowe score, Simple Shoulder Test, and the Western Ontario Shoulder Instability Index. Results Between May 1996 and February 2002, 31 shoulders (30 patients) underwent posterior stabilization (19 arthroscopically, 12 open). There were 29 men and 1 woman (mean age, 23 years). Preoperatively, all patients had a distinct traumatic cause for the instability. On physical examination, all patients had posterior apprehension and increased (2+, 3+) posterior load-shift testing. Preoperative radiographs and/or magnetic resonance imaging revealed posterior rim calcification or reverse Bankart lesions in 29 cases (94%). At arthroscopy, posterior labral injuries, reverse Bankart lesions, or humeral head defects were identified. Follow-up averaged 40 months, and the mean duration between injury and surgery was 21 months. The mean Single Assessment Numeric Evaluation, Rowe score, Simple Shoulder Test, and Western Ontario Shoulder Instability Index scores, respectively, for the entire group were 89, 87, 11, and 346; for the open group, they were 81, 80, 10.5, and 594; for the arthroscopic group, they were 92, 92, 11.4, and 190. The Western Ontario Shoulder Instability Index (P <. 03) and Rowe score (P <. 04) outcomes scores for the arthroscopic group were statistically better than those of the open group. Twenty-nine of 31 shoulders were rated as excellent or good. Conclusion In the case of traumatic posterior shoulder subluxation, posterior lesions of the labrum (“reverse Bankart”), articular edge, and capsule are observed. Surgical treatment addressing these lesions led to satisfactory results for both the open and arthroscopic treated groups. In this study, an arthroscopic technique utilizing suture anchor repair with capsular placation provided the most favorable outcomes.

Lumbopelvic Manipulation for the Treatment of Patients With Patellofemoral Pain Syndrome: Development of a Clinical Prediction Rule

STUDY DESIGN Prospective cohort/predictive validity study. OBJECTIVE To determine the predictive validity of selected clinical exam items and to develop a clinical prediction rule (CPR) to determine which patients with patellofemoral pain syndrome (PFPS) have a positive immediate response to lumbopelvic manipulation. BACKGROUND Quadriceps muscle function in patients with PFPS was recently shown to improve following treatment with lumbopelvic manipulation. No previous study has determined if individuals with PFPS experience symptomatic relief of activity-related pain immediately following this manipulation technique. METHODS AND MEASURES Fifty subjects (26 male, 24 female; age range, 18-45 years) with PFPS underwent a standardized history and physical examination. After the evaluation, each subject performed 3 typically pain-producing functional activities (squatting, stepping up a 20-cm step, and stepping down a 20-cm step). The pain level perceived during each activity was rated on a numerical pain scale (0 representing no pain and 10 the worst possible pain). Following the assessment, all subjects were treated with a lumbopelvic manipulation, which was immediately followed by retesting the 3 functional activities to determine if there was any change in pain ratings. An immediate overall 50% or greater reduction in pain, or moderate or greater improvement on a global rating of change questionnaire, was considered a treatment success. Likelihood ratios (LRs) were calculated to determine which examination items were most predictive of treatment outcome. RESULTS Data for 49 subjects were included in the data analysis, of which 22 (45%) had a successful outcome. Five predictor variables were identified. The most powerful predictor of treatment success was a side-to-side difference in hip internal rotation range of motion greater than 14 masculine (+LR, 4.9). If this variable was present, the chance of experiencing a successful outcome improved from 45% to 80%. CONCLUSION A CPR was developed to predict an immediate successful response to lumbopelvic manipulation in patients with PFPS. However, in light of a limited sample size and omission of potentially meaningful predictor variables, future studies are necessary to validate the CPR.

Clinical and electrodiagnostic abnormalities of the median nerve in dental assistants.

STUDY DESIGN Descriptive. OBJECTIVES To determine the presence of clinical and electrodiagnostic abnormalities of the median and ulnar nerves in both upper extremities of dental assistants. BACKGROUND A high prevalence of median neuropathies at, or distal to, the wrist have been reported in dentists and dental hygienists. But there is a paucity of literature on the incidence of abnormalities of the median or ulnar nerves in dental assistants. METHODS Thirty-five United States Army dental assistants (24 female, 11 male; age range, 18-41 years) volunteered for the study. Subjects completed a standardized history and physical examination. Nerve conduction status of the median and ulnar nerves of both upper extremities was obtained by performing motor, sensory, and F-wave (central) nerve conduction studies. RESULTS All electrophysiological variables were normal for motor, sensory, and F-wave (central) values when compared to a chart of normal values. Based on comparison studies of median and ulnar motor latencies within the same hand, 9 subjects (26%) involving 14 hands (20%) were found to have electrodiagnostic abnormalities of the median nerve at, or distal to, the wrist. The other 26 dental assistants demonstrated normal comparison studies of the median and ulnar nerves in both upper extremities. CONCLUSIONS In this descriptive study of 35 dental assistants, 9 subjects (26%) were found to have electrodiagnostic abnormalities of the median nerve at, or distal to, the wrist (when compared to the ulnar nerve of the same hand). Ulnar nerve electrophysiological function was within normal limits for all subjects examined.

Diagnose en behandeling van acute inspanningsrabdomyolyse

Acute inspanningsrabdomyolyse is een potentieel levensbedreigende aandoening. In deze casus worden de diagnose, medische behandeling en revalidatie van een 20-jarige man beschreven die zich 36 uur voor het ontstaan van de klachten honderd keer op verschillende manieren had opgedrukt. Na 73 dagen was de patient volledig hersteld. De casus illustreert dat patienten met inspanningsrabdomyolyse een uitstekende prognose hebben als de aandoening vroeg wordt ontdekt en agressief wordt behandeld.