Joseph A. Brosky

Methodological Report: Dynamic Field Tests Used in an NFL Combine Setting to Identify Lower-Extremity Functional Asymmetries

Hickey, KC, Quatman, CE, Myer, GD, Ford, KR, Brosky, JA, and Hewett, TE. Methodological report: dynamic field tests used in an NFL combine setting to identify lower-extremity functional aysmmetries. J Strength Cond Res 23(9): 2500-2506, 2009-Side-to-side differences in lower-extremity biomechanics may be predictive of increased risk of lower-extremity injuries in athletes. The purpose of this report is to provide field testing methodology for tests designed to isolate lower-extremity asymmetry and to demonstrate the potential for these tests to provide reliable measures. Six athletes (3 females, 3 males) were tested on 2 consecutive days for activities incorporated into a replicated National Football League (NFL) combine setting. Vertical hop power (VHP) and jump height were measured on a portable force platform as athletes performed maximum effort hops for 10 seconds. The modified agility T-test (MAT) incorporates two 90-degree single-leg cuts during the trial and was measured as total time for completion. Intraclass correlations (within ICC [3,k], between ICC [3,1]) were calculated. The VHP test had good to excellent within-session reliability for peak power of both the right (ICC = 0.942) and left (ICC = 0.895) sides. Jump height showed excellent within-session reliability for both the right (ICC = 0.963) and left (ICC = 0.940) sides. The between-session reliability for peak power between jumps was good for the right (ICC = 0.748) and left (ICC = 0.834) sides. Jump height showed good to excellent between-session reliability on the right (ICC = 0.794) and left (ICC = 0.909) sides. The MAT also showed good reliability between days (ICC = 0.825).The results indicate that the VHP test provides reliable assessment of both within- and between-session jump height and power production. The MAT also provides good reliability between testing days. Both the VHP and the MAT may be useful for clinicians to identify the presence of lower-limb asymmetry and potential injury risk factors in athletic populations.

Dynamic Trunk Stabilization: A Conceptual Back Injury Prevention Program for Volleyball Athletes

The sport of volleyball creates considerable dynamic trunk stability demands. Back injury occurs all too frequently in volleyball, particularly among female athletes. The purpose of this clinical commentary is to review functional anatomy, muscle coactivation strategies, assessment of trunk muscle performance, and the characteristics of effective exercises for the trunk or core. From this information, a conceptual progressive 3-phase volleyball-specific training program is presented to improve dynamic trunk stability and to potentially reduce the incidence of back injury among volleyball athletes. Phase 1 addresses low-velocity motor control, kinesthetic awareness, and endurance, with the clinician providing cues to teach achievement of biomechanically neutral spine alignment. Phase 2 focuses on progressively higher velocity dynamic multiplanar endurance, coordination, and strength-power challenges integrating upper and lower extremity movements, while maintaining neutral spine alignment. Phase 3 integrates volleyball-specific skill simulations by breaking down composite movement patterns into their component parts, with differing dynamic trunk stability requirements, while maintaining neutral spine alignment. Prospective research is needed to validate the efficacy of this program.

Prehabilitation and Quality of Life Three Months after Total Knee Arthroplasty: A Pilot Study

Knee osteoarthritis (OA), which affects over 27 million Americans, decreases the individuals quality of life through decreasing mobility, deconditioning, reducing functional ability, and increasing knee pain. The present aim was to assess whether such patients engaging in exercise prior to surgery (“prehabilitation”; preoperative exercise intervention) rate higher quality of life 3 mo. after their surgery compared with ratings by patients who did not engage in prehabilitation. Standard populations consist of OA patients that do not participate in any preoperative exercise programs, such as a prehabilitation exercise intervention. 18 knee osteoarthritis patients were randomly assigned to a control or a prehabilitation group. The latter group participated in an exercise intervention three times per week, once at home and twice at the physical therapy lab, for 8 wk. prior to their surgery. The control group participated in their usual preoperative care prescribed by the physician for all patients. Eight health-related quality of life domains were assessed at 3 mo. post surgery. These preliminary findings suggest efficacy of prehabilitation in facilitating quality of life of total knee arthroplasty (TKA) patients 3 mo. after surgery.

Determining the minimal number of cyclic passive stretch repetitions recommended for an acute increase in an indirect measure of hamstring length

The purpose of this study was to determine the minimal number of cyclic passive stretch repetitions required to induce an acute increase in hamstring length via an indirect measure of hamstring length. Eighteen healthy males (aged 19–37 years) were placed in a standardized position. Knee flexion range of motion (ROM) measurements were recorded following ten 15-second passive stretch repetitions. Analysis of variance measures (p<0.05) and post hoc analysis showed that significant increases in knee extension ROM diminished at the fifth stretch repetition. The greatest single increase in knee extension ROM occurred after the first stretch. The results of this study indicate that passive stretching beyond five repetitions results in insignificant gains in hamstring length (measured via knee extension ROM) and are probably unnecessary.

The Effect of Either Topical Menthol or a Placebo on Functioning and Knee Pain Among Patients With Knee OA

Osteoarthritis (OA) is a common health problem with symptoms including reduced functioning and joint pain. Protracted pharmacological management of knee OA is associated with side effects including gastrointestinal, renal, and neurological dysfunction.Menthol gels have been used with limited empirical support to relieve pain and improve functioning among individual with OA. The purpose of this study was to compare the ability to complete functional tasks and knee pain while completing functional tasks among patients with knee OA after topical application of either 3.5% menthol gel or an inert placebo gel. Twenty individuals with knee OA volunteered to complete 2 data collection visits 1 week apart. Subjects underwent the same data collection at each visit including the performance of functional tasks and self-reporting knee pain while performing each task. The functional tasks included a 6-Minute Walk (6-MW), the Timed Get Up and Go (TUG), 30-second timed chair stand (TCS), and time to ascend (Up stairs) and descend (Down stairs) a flight of stairs. Subjects reported their knee pain immediately following each functional task using a 100-mm visual analog scale. These assessments of pain and functioning were measured twice at each subject visit: upon arrival at the facility without any intervention and again during the same visit after random application to the OA knee of 5 mL of 3.5% menthol gel or 5 mL of an inert gel.There were no significant between-group differences or time by treatment interaction in performance of any of the functional tasks, or measures of pain, at any of the data collection time points. However, there were significant within-group differences. Scores on the 6-MW, TCS, and Down stairs functional tasks improved significantly following the application of menthol gel. Scores on the Down stairs functional task improved significantly following application of the placebo gel. The menthol intervention resulted in significant reductions in pain during the TUG, TCS, Up stairs, and Down stairs tasks. The placebo condition did not result in any significant changes in pain during the functional tasks. There were no differences detected in functional tasks or pain following the placebo and menthol conditions. These findings provide partial support regarding the efficacy of menthol gel to improve functioning and reduce pain among knee OA patients.

Prehabilitation Influences Exercise-Related Psychological Constructs Such as Self-efficacy and Outcome Expectations to Exercise

Abstract Brown, K, Loprinzi, PD, Brosky, JA, and Topp, R. Prehabilitation influences exercise-related psychological constructs such as self-efficacy and outcome expectations to exercise. J Strength Cond Res 28(1): 201–209, 2014—Osteoarthritis (OA) is a clinical condition affecting more than 27 million Americans. There is no known cure for OA other than replacing the diseased joint with a joint prosthesis, a process called total knee arthroplasty (TKA). The TKA projections for the year 2016 are 1,046,000, and this number is predicted to increase by 600% to more than 3.4 million cases by 2030. The purpose of this study was to determine whether knee OA patients who engage in guided exercise (prehabilitation) before their TKA report higher levels of self-efficacy to exercise (SEE) and higher outcome expectations for exercise (OEE) than those who do not. Thirty-one participants were randomized into 2 groups (16 in prehabilitation group [PRE] and 15 in control group [CON]), all participants completed the protocol (22 women and 9 men). The PRE group participated in an exercise intervention (prehabilitation) 3 times per week for 8 weeks before TKA. One-way repeated measures analysis of variance was used to investigate the effects of group (PRE vs. CON), time (baseline T1, T2, T3, and T4), and the interaction of group and time on the dependent variables of SEE and OEE. This analysis indicated that SEE did not change over time (p = 0.62) or between the groups (p = 0.86). The analysis of the OEE indicated a significant time effect (p = 0.008). Post hoc analysis indicated that the CON group significantly declined between T2 and T4. The PRE group did not significantly change their OEE over the 4 data collection points of the study.

Objectively measured physical activity and balance among U.S. adults.

Abstract Loprinzi, PD and Brosky Jr, JA. Objectively measured physical activity and balance among U.S. adults. J Strength Cond Res 28(8): 2290–2296, 2014—The purpose of this study was to examine the association between objectively measured physical activity (PA) and balance in a nationally representative sample of U.S. adults 40 years of age and older. Data from the 2003–2004 National Health and Nutrition Examination Survey were used. Physical activity was measured over a 7-day period using accelerometry, and balance was assessed using the Romberg test. Participants completed a questionnaire regarding their subjective views on difficulty with falling in the past 12 months. For every 60-minute increase in light-intensity PA, participants were 10% (p = 0.04) more likely to have functional balance. Similarly, for every 1-minute increase in log-transformed moderate-to-vigorous physical activity, participants were 23% (p = 0.04) more likely to have functional balance. Regular PA, regardless of intensity, may have health benefits for older adults and is associated with functional balance.

Rehabilitation following anterior approach total hip arthroplasty in a 49-year-old female: A case report

Over 230,000 total hip arthroplasties (THA) are performed annually, and many of these patients will seek or be referred to a physical therapist to assist them in their recovery. Improvements in understanding of joint replacement technology have allowed earlier weight bearing and return to function. With the anterior surgical approach, patients are permitted weight bearing as tolerated immediately after surgery and can resume nearly all prior activities upon returning home. This case report describes the home-based physical therapy management of a 49-year-old female following a left THA using an anterior surgical approach. This report also includes a description of the functional based protocol and hip assessment scale used. The rehabilitation program was initiated 4 days postoperatively and consisted of a patient-oriented and functional approach. Seventeen days after surgery and seven home visits, the patient exhibited a normal gait pattern, was walking 20 minutes continuously, safely negotiating stairs, and had resumed normal household activities. The subject of this case report was relatively young, highly motivated, and the outcomes presented may not be generalized or expected of other patients following anterior approach THA. Additional studies are needed to determine long-term effects of this surgical approach and postoperative home-based rehabilitation program.

Relationship between scores from the Knee Outcome Survey and a single assessment numerical rating in patients with patellofemoral pain

Objective: To determine the relationship between patient-reported single numeric ratings and actual scores obtained from a validated instrument, the Knee Outcome Survey (KOS). Background: Patient-reported outcome (PRO) measures are an important component of patient management. Information obtained from PRO measures can be used to prioritize goal setting, assist with clinical decision-making, provide evidence for effectiveness of interventions, monitor progress, and assess organizational or clinician performance. Methods: Scores from the KOS activity of daily living (ADL) and Sports subscales completed at the time of initial examination of patients with patellofemoral pain (n = 29) were retrospectively analyzed and compared to a single assessment numerical rating. Results: Bi-variate Pearson product correlation was used to determine association between the KOS-ADL and KOS-Sports with respective single assessment numerical ratings. A high correlation was observed between the KOS-ADL (0.85, p < 0.01) and KOS-Sports (0.88, p < 0.01) with a single assessment numerical rating. Conclusions: Administration and scoring of standardized outcome measures such as the KOS-ADL and KOS-Sports require several minutes to administer but correlate well with a single assessment numerical ratings. The high correlation of single assessment numerical scores to actual KOS-ADL and KOS-Sports scores may provide support for discretionary use of single numerical ratings during interim patient care visits and/or in instances when time is limited. Additional studies are needed with larger patient populations and specific diagnostic subgroups to determine additional clinical relevance.

An Off-Season Brace-Free Neuromuscular Ankle Training Program Among Brace Reliant and Nonbrace-Reliant Division II Female Athletes

Background: Neuromuscular training (NMT) has been shown to be effective in preventing recurrent ankle injuries. However, the NMT effect during the off-season in athletes who wear and those who do not wear an ankle brace during their sport season remains undetermined. Purpose: The purpose of this study was to determine the effect of an off-season bracefree neuromuscular ankle training program on ankle functional ability among female athletes who wore and those who did not wear an ankle brace during the sport season. Study Design: This study included a preand posttest 2-group cohort. Methods: In this study, division II female athletes (n = 31) participated: 15 wore an ankle brace during their competitive sports season (brace-reliant), whereas the remaining 16 had never worn an ankle brace (brace-naïve). Subjects completed a 4-phase, 6-week neuromuscular ankle training program incorporated into an off-season conditioning program. Subjects were provided instruction and were asked to complete the 10-minute progressive program 3 times per week for 6 weeks. Subjective and objective measures of ankle functional ability were collected before and after the 6-week intervention. Subjective measures involved the subjects completing the Foot and Ankle Ability Measures, including a global rating of condition and the TAMPA Scale for Kinesiophobia. Objective measures of ankle functional ability included single-leg hop distance and single-leg balance with eyes closed duration.