Julie K. Wilson

Anterior knee pain: a clinical comparison of rehabilitation methods.

ObjectiveTo compare different types of rehabilitation for anterior knee pain. DesignProspective, randomized, blinded, and controlled study of 64 participants with anterior knee pain. SettingOutpatient rehabilitation clinic and testing laboratory. ParticipantsParticipants were assigned in randomized fashion to three rehabilitation groups: traditional home rehabilitation (n = 20); physical therapy (n = 21); and home rehabilitation with a modified vastus medialis obliquis (VMO) specific straight leg raise (Muncie method; n = 23). Interventions and Main Outcome MeasuresClinical data was obtained at 0, 2, 6, and 12 weeks. Cybex testing was performed at 0, 6, and 12 weeks. ResultsClinical outcome for the Muncie method indicated a statistically significant improvement in subjective pain and functional impairment ratings. Cybex testing in patients using the Muncie method demonstrated a statistically significant improvement in pain-free isometric contractions and maximum voluntary contraction. There were no significant differences between traditional home therapy and physical therapy. ConclusionFindings suggest that the Muncie method results in improved clinical outcome at a lower cost than traditional home and physical therapy and possibly improved VMO/quadriceps muscle balance. Patients with anterior knee pain may benefit from applying the Muncie method in a home therapy program.

Methods Utilized in Treating Lateral Epicondylitis

Abstract Lateral epicondylitis is a common condition treated by many physical therapists. Although multiple treatment methods exist, scientific research has found that few have been consistently effective in treating lateral epicondylitis. Initially, lateral epicondylitis is often treated with rest, ice, braces and/or injections. When the condition is chronic or not responding to initial treatment, physical therapy is introduced. Common therapeutic modalities often utilized are ultrasound, phonophoresis, electric stimulation, manipulation, soft tissue mobilization, neural tension, friction massage, ASTM AdvantEDGE™, in addition to stretching and strengthening exercises. ASTM AdvantEDGE™ is becoming a more standard treatment process owing to its ability to help with the detection in changes in the soft tissue texture as the patient progresses through the therapeutic process. Laser and acupuncture are also becoming more popular. Finally, in resistant cases of lateral epicondylitis, patients can receive surgery. In all, there are over 40 different treatment methods reported in the literature. Further research efforts are needed to determine which methods are most effective.

Orthostatic Intolerance and Autonomic Dysfunction in Youth With Persistent Postconcussion Symptoms: A Head-Upright Tilt Table Study.

Objective:To explore head-upright tilt table (HUT) signs of autonomic dysfunction in a cohort of youth with persistent postconcussion symptoms (PCSs) that include light-headedness and to correlate repeat tilt table results with symptom improvements for those patients found to have postural tachycardia syndrome (POTS) on initial testing. Design:Prospective cohort design. Setting:Nationwide Childrens Hospital, Neurology Clinic. Participants:Thirty-four patients (13-18 years of age) with persistent PCSs. Main Outcome Measures:All patients underwent at least 1 tilt table test. The PCS Interview (PCS-I) and patient ratings of light-headedness and vertigo were used to measure symptom burden. Patients found to have POTS were asked to repeat tilt table testing when PCSs improved or 3 to 6 months after the initial test if symptoms persisted. Results:Twenty-four of the 34 (70.6%) patients had abnormal tilt table results with patients categorized as normal (n = 10), isolated syncope (n = 10), and POTS (n = 14). Patients with POTS had higher PCS-I scores than normal patients (P < 0.001) and higher ratings of light-headedness than both normal patients (P = 0.015) and syncope patients (P = 0.04). Twelve POTS patients underwent repeat tilt table testing, and 9 of 12 (75%) no longer met POTS diagnostic criteria. All patients with resolution of POTS had corresponding improvements in PCSs, including light-headedness and vertigo. Conclusions:Our study demonstrates a high rate of tilt table abnormalities among youth with persistent PCSs. Several patients with POTS had normalization of tilt table testing when PCSs improved. These findings warrant further research of autonomic dysfunction related to concussion. Clinical Relevance:Our study is the first to prospectively characterize autonomic dysfunction in patients with persistent PCSs using HUT testing and to show that the tilt test abnormalities normalize in some patients as PCSs improve.

Evaluation of a simple test of reaction time for baseline concussion testing in a population of high school athletes.

Objective:A common sequela of concussions is impaired reaction time. Computerized neurocognitive tests commonly measure reaction time. A simple clinical test for reaction time has been studied previously in college athletes; whether this test is valid and reliable when assessing younger athletes remains unknown. Our study examines the reliability and validity of this test in a population of high school athletes. Design:Cross-sectional study. Setting:Two American High Schools. Participants:High school athletes (N = 448) participating in American football or soccer during the academic years 2011 to 2012 and 2012 to 2013. Interventions:All study participants completed a computerized baseline neurocognitive assessment that included a measure of reaction time (RTcomp), in addition to a clinical measure of reaction time that assessed how far a standard measuring device would fall prior to the athlete catching it (RTclin). Main Outcome Measures:Validity was assessed by determining the correlation between RTclin and RTcomp. Reliability was assessed by measuring the intraclass correlation coefficients (ICCs) between the repeated measures of RTclin and RTcomp taken 1 year apart. Results:In the first year of study, RTclin and RTcomp were positively but weakly correlated (rs = 0.229, P < 0.001). In the second year, there was no significant correlation between RTclin and RTcomp (rs = 0.084, P = 0.084). Both RTclin [ICC = 0.608; 95% confidence interval (CI), 0.434-0.728] and RTcomp (ICC = 0.691; 95% CI, 0.554-0.786) had marginal reliability. Conclusions:In a population of high school athletes, RTclin had poor validity when compared with RTcomp as a standard. Both RTclin and RTcomp had marginal test-retest reliability. Before considering the clinical use of RTclin in the assessment of sport-related concussions sustained by high school athletes, the factors affecting reliability and validity should be investigated further. Clinical Relevance:Reaction time impairment commonly results from concussion and is among the most clinically important measures of the condition. The device evaluated in this study has previously been investigated as a reaction time measure in college athletes. This study investigates the clinical generalizability of the device in a younger population. Video Abstract:A video abstract showing how the RTclin device is used in practice is available as Supplemetal Digital Content 1, http://links.lww.com/JSM/A43.