Marie A. Johanson

Subtalar joint position during gastrocnemius stretching and ankle dorsiflexion range of motion.

CONTEXT Gastrocnemius stretching exercises often are prescribed as part of the treatment program for patients with overuse injuries associated with limited ankle dorsiflexion. However, little is known about how the position of the subtalar joint during gastrocnemius stretching affects ankle dorsiflexion range of motion (ROM). OBJECTIVE To determine the effect of subtalar joint position during gastrocnemius stretching on ankle dorsiflexion ROM. DESIGN This study was a 3-way mixed-model design. The 3 factors were subtalar joint position (supinated, pronated), lower extremity (experimental, control), and time (pretest, posttest). Lower extremity and time were the repeated measures. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-three healthy volunteers (29 women, 4 men). INTERVENTION(S) Participants performed a gastrocnemius stretching exercise 2 times daily for 3 weeks with the subtalar joint of the randomly assigned experimental side (dominant or nondominant) in the randomly assigned position (supination or pronation). The contralateral lower extremity served as the control. MAIN OUTCOME MEASURE(S) Before and after the 3-week gastrocnemius stretching program, we used goniometers to measure ankle dorsiflexion ROM in weight-bearing and non-weight-bearing positions with the subtalar joint positioned in anatomic 0 degrees . RESULTS Ankle dorsiflexion ROM measured in weight-bearing and non-weight-bearing positions increased after the gastrocnemius stretching program (P = .034 and .003, respectively), but the increase in ROM did not differ based on subtalar joint position (P = .775 and .831, respectively). CONCLUSIONS Subtalar joint position did not appear to influence gains in ankle dorsiflexion ROM after a gastrocnemius stretching program in healthy volunteers.

The Relationship Between Forefoot and Rearfoot Static Alignment in Pain-Free Individuals With Above-Average Forefoot Varus Angles

This study used a within-subjects correlational design to determine the relationship between forefoot varus angle and standing rearfoot angle among individuals with above-average forefoot varus angles. Clinicians have long theorized that forefoot position is related to the standing rearfoot angle and that both may be related to pronation during gait. More recently, data suggest that the association between static forefoot and rearfoot position may be limited to those individuals with forefoot varus angles larger or smaller than average. However, little data are available on the association between static forefoot and rearfoot angles among individuals with larger than average forefoot varus angles. Twenty-three healthy participants (mean age = 27.04 ± 6.24 years) with at least 8 degrees of forefoot varus bilaterally were recruited for this study. Goniometric measurements of forefoot varus angle and standing rearfoot angle of each foot were taken. Intraclass correlation coefficients (ICCs) were used to assess intrarater and interrater reliability of the static forefoot and rearfoot angle measurements. The Pearson product moment coefficient was used to assess the association between the forefoot and rearfoot static angles. ICCs for intrarater and interrater reliability of the forefoot and rearfoot angles were equal to or greater than 0.98 and 0.92, respectively. Forefoot varus angle was significantly correlated with standing rearfoot angle (P = .034). Among healthy individuals with larger than average forefoot varus angles, static forefoot varus and standing rearfoot valgus angles demonstrate a positive association.

Effect of heel lifts on plantarflexor and dorsiflexor activity during gait.

Background: Previous investigators have shown that high heels decrease the muscle activity of the gastrocnemius muscle during gait. However, it is not known whether commonly used in-shoe heel lifts of lower heights will demonstrate similar effects on muscle activity. The aim of this study was to determine whether heel lifts alter the muscle activity of the ankle plantarflexors and dorsiflexors during the stance phase of gait among individuals with limited gastrocnemius extensibility. Materials and Methods: This study used a repeated measures design. Twenty-four healthy volunteers (12 males and 12 females) with less than 5 degrees of passive ankle dorsiflexion with the knee extended participated in the study. Electromyography (EMG), computerized motion analysis, and a force plate were used to measure mean muscle activity of the lateral gastrocnemius, medial gastrocnemius, soleus and tibialis anterior muscles during the stance phase of gait across three walking conditions. Muscle activity was measured as participants ambulated at a self-selected speed in athletic shoes alone and with heel lifts of 6 mm and 9 mm inserted in athletic shoes. Results: Between heel-strike and heel-off, the mean EMG amplitude of the medial gastrocnemius increased with both 6 and 9 mm heel lifts and the amplitude of the tibialis anterior increased with 9 mm heel lifts compared to shoes alone. Between heel-strike and heel-off, there were no significant differences in mean EMG amplitude of the lateral gastrocnemius or soleus muscles walking in heel lifts compared to shoes alone. Between heel-off and toe-off, there were no significant differences in mean EMG amplitude of the lateral gastrocnemius, medial gastrocnemius, soleus, or tibialis anterior muscles when walking in heel lifts compared to shoes alone. Conclusion: Heel lifts increase muscle activity of the medial gastrocnemius and tibialis anterior muscles between heel-strike and heel-off among individuals with limited gastrocnemius extensibility. Clinical Relevance: We were unable to confirm a decrease in muscle activity when using heel lifts.

Sex Differences in Career Expectations of Physical Therapist Students

Background and Purpose: There are some sex differences in the career activities of physical therapists. The purpose of this study was to determine whether these sex differences are reflected in the career expectations of physical therapist students. Subjects: Participants were 919 physical therapist students. Methods: Faculty at 34 physical therapist education programs distributed questionnaires to 1,172 of their students. The 919 returned questionnaires generated a response rate of 78.4%. Sex differences in career expectations were statistically analyzed with logistic regression. Results: Men showed statistically significantly higher odds than women of expecting to own a private practice, to become a faculty member, to become a physical therapist manager or administrator, to publish articles in professional journals, and to have a higher income in the first year of employment. Discussion and Conclusion: At the outset of physical therapist education, there are sex differences in the career expectations of physical therapist students.

Factors Influencing Professional Master of Physical Therapy and Doctor of Physical Therapy Studentsʼ Program Selection

Background and Purpose. In the mid 1990s, the number of applicants to physical therapist education programs began declining just as the first professional (entry‐level) Doctor of Physical Therapy programs began. The decline in numbers of applicants prompted interest from physical therapy faculty regarding the factors applicants used to select programs. However, there is little data on what influences physical therapy applicants to choose a particular program. The purpose of this study was to determine if the factors students consider when selecting physical therapist education programs differs between Master of Physical Therapy (MPT) and Doctor of Physical Therapy (DPT) students. Subjects. Participants were 919 professional physical therapist students in 34 physical therapist education programs. Methods. Faculty members at 34 physical therapist education programs distributed questionnaires to 1,172 professional physical therapist students within the first 2 weeks of matriculation into programs in 2002. Faculty members returned 919 questionnaires, generating a response rate of 78.4 %. The data were statistically analyzed using chi‐square analysis, independent t tests, and logistic regression to determine differences in the importance of program selection factors based on degree level. Results. Length of the program, matriculation date, size of the physical therapy class, and marketability of a degree from the institution were more important selection factors for MPT students than DPT students. Degree conferred, reputation of the program, reputation of the faculty, and the curriculum were more important selection factors for DPT students than MPT students. Discussion and Conclusion. There were differences between masters degree and doctoral degree physical therapy students in the factors deemed important for selection of physical therapist education programs, especially among factors related to specific program characteristics. Regardless of degree level, the majority of students appeared to select programs on the bases of degree conferred and cost prior to the application process.

The Effect of Goniometric Alignment on Passive Ankle Dorsiflexion Range of Motion among Patients Following Ankle Arthrodesis or Arthroplasty

Goniometric measurement is a standard method used to quantify limited ankle dorsiflexion (DF). However, compensatory motion at the subtalar and midtarsal joints might also contribute to the amount of ankle DF obtained by goniometric measurements. The purpose of this study was to examine the effect of goniometric alignment on DF range of motion measurement among patients following ankle arthrodesis or arthroplasty and age- and gender-matched controls. A total of 22 participants were recruited to participate in this observational cohort study, including 7 patients following total ankle arthroplasty (2 male, 5 female; mean age = 67.5 years, standard deviation [SD] = 9.6 years), 4 patients following ankle arthrodesis (2 male, 2 female; mean age = 70.5 years, SD = 5.2 years), and 11 age- and gender-matched controls (4 male, 7 female; mean age 67.5 years, SD = 9.0 years). Two investigators measured and recorded ankle DF passive range of motion (PROM) using a randomly determined sequence of 2 alignment methods: (1) the distal aspect of the lateral calcaneus, and (2) the fifth metatarsal. One-sample t tests were performed to assess differences in ankle DF between the 2 different alignment methods. Significantly greater degrees of DF were obtained when aligning with the fifth metatarsal versus the lateral calcaneus on the patients’ uninvolved sides and the randomly selected side of matched controls (P < .05) but not on the patients’ operative side (P > .05). This study found that more degrees of DF PROM are measured when aligning a goniometer with the fifth metatarsal versus the calcaneus on the uninvolved side of patients and matched controls. Levels of Evidence: Diagnostic, Level IV

The Effect of Subtalar Joint Position on Dorsiflexion of the Ankle/Rearfoot Versus Midfoot/Forefoot During Gastrocnemius Stretching

Background: Limited ankle joint dorsiflexion passive range of motion (PROM) has been associated with common chronic lower extremity conditions, and clinicians often instruct patients in stretching exercises to increase dorsiflexion. However, little is known about how subtalar joint (STJ) position affects dorsiflexion at the midfoot/forefoot versus ankle/rearfoot during gastrocnemius stretching. The purpose of this study was to determine if more dorsiflexion occurs at the ankle/rearfoot and less at the midfoot/forefoot during gastrocnemius stretching with the STJ positioned in supination versus pronation. Methods: In this repeated measures design, 27 participants (23 females, 4 males; mean age = 31.3 years, SD = 10.7) with current or recent history of lower extremity chronic conditions and less than 10 degrees ankle dorsiflexion measured with the knee in extension on the involved side(s) performed five 30-second gastrocnemius stretching trials in pronation and supination on each side in a randomly determined sequence. A 7-camera Vicon Motion Analysis System and an AMTI force plate were used to measure midfoot/forefoot dorsiflexion, ankle/rearfoot dorsiflexion, knee extension, and normalized vertical ground reaction force. Results: Two-way repeated measures ANOVA revealed a significant increase in midfoot/forefoot dorsiflexion when stretching in pronation compared to supination (P < .001). ANOVAs also demonstrated significantly more extension of the knee when stretching in supination compared to pronation (P < .001), and increased normalized vertical ground reaction force when stretching in supination compared to pronation (P = .032). With the numbers available, no significant difference in ankle/rearfoot dorsiflexion when stretching in supination compared to pronation could be detected (P > .05). Conclusion: Gastrocnemius stretching in pronation resulted in more dorsiflexion at the midfoot/forefoot than stretching in supination. Clinical Relevance: Clinicians may want to consider STJ position during gastrocnemius stretching to either facilitate or limit recruitment of dorsiflexion motion at the midfoot/forefoot.

Factors Influencing Studentsʼ Selection of Physical Therapist Programs: Differences Between Men and Women and Racial/Ethnic Groups

Background and Purpose. The American Physical Therapy Association (APTA) has identified increasing the diversity of the physical therapy profession as 1 of 6 actions necessary to fulfill its mission statement. While faculty at professional physical therapist education programs may be interested in increasing the racial/ethnic diversity and the number of men among their students, there is little information on what influences minority applicants and men to choose a physical therapist education program. The purpose of this study was to determine whether the factors students consider when selecting a physical therapist education program differ between men and women and different racial/ethnic groups. Subjects. Participants were 919 professional (entry‐level) physical therapist students. Methods. In 2002, faculty members at 34 physical therapist education programs distributed questionnaires to 1,172 professional physical therapist students within the first 2 weeks of matriculation into programs in 2002. Faculty members returned 919 questionnaires, generating a response rate of 78.4%. To determine differences in the importance of program selection factors based on sex and racial/ethnic identity, the data were statistically analyzed using chi‐square analysis and logistic regression. Results. The bivariate analysis indicates that location, cost, availability of financial aid, and campus environment were more important to women than to men, while reputation of the faculty was more important to men. Program ranking by U.S. News & World Report, availability of financial aid, number of prerequisites, and positive interaction with students were more important selection factors for minority applicants than for white applicants, while reputation of the faculty was more important for whites than minority applicants. In multivariate analysis, minority students had higher odds than white students of identifying positive interaction with students as an important program selection factor. Included in the multivariate analyses were some control variables related to socioeconomic status, other demographic attributes, and academic factors that significantly predicted important selection factors. Discussion and Conclusion. Nonwhite students have higher odds than white students of identifying positive interaction with students as an important factor in their decision to enroll in the program of their choice. Other differences in importance of program selection factors, by sex and race/ethnicity, can be attributed to socioeconomic status, other demographic variables, and academic factors. The findings from this study may be useful for physical therapist education program faculty members interested in recruiting minority applicants and students into their professional programs.

Orthopaedic Physical Therapy: Update to the Description of Specialty Practice

STUDY DESIGN Descriptive, cross-sectional observational study. BACKGROUND In the physical therapist profession, the outcomes of specialty practice analyses are used to determine content areas for specialty board examinations and for American Physical Therapy Association (APTA)-accredited residency curricula. To maintain currency for specialty practices, the American Board of Physical Therapy Specialties (ABPTS) requires any approved specialty area to revalidate its Description of Specialty Practice (DSP) a minimum of every 10 years. OBJECTIVES The purpose of this article was to describe the most recent practice analysis process and to report revisions to the DSP for orthopaedic physical therapists. METHODS A survey instrument was developed by a group of subject matter experts, following guidelines established by the ABPTS. The survey was sent electronically to a random sample of 800 orthopaedic certified specialists (OCSs). The survey contained 5 sections: (1) knowledge areas (eg, human anatomy and physiology); (2) professional roles, responsibilities, and values (eg, consultation); (3) patient/client management model (eg, examination); (4) percentage of body regions treated; and (5) demographic information. RESULTS A total of 224 completed surveys and 43 partially completed surveys were submitted, for a response rate of 33.4%. Based on a priori decision rules regarding survey data, consensus of the group of subject matter experts, and ABPTS suggestions, the DSP for orthopaedic physical therapy was revised. CONCLUSION The revised DSP will be used to reconstruct the blueprint for future OCS examinations, APTA-accredited orthopaedic residency program curricula, as well as professional development activities related to recertification in orthopaedic physical therapy.

Clinical Effects of Dry Needling Among Asymptomatic Individuals With Hamstring Tightness: A Randomized Controlled Trial

STUDY DESIGN Randomized controlled trial. OBJECTIVES The aim of this study was to determine the effects of dry needling on hamstring extensibility and functional performance tests among asymptomatic individuals with hamstring muscle tightness. BACKGROUND Dry needling has been shown to increase range of motion in the upper quarter and may have similar effects in the lower quarter. METHODS 27 subjects with hamstring extensibility deficits were randomly assigned to side of treatment (dominant or nondominant) and group (blunt needling or dry needling). The first session included measurement of hamstring extensibility and performance on 4 unilateral hop tests, instruction in home hamstring stretching exercises and needling distal to the ischial tuberosity and midbellies of the medial and lateral hamstrings. A second session, 3-5 days following the first session, included outcome measures and a second needling intervention, and a third session, 4-6 weeks following the first session, included outcome measures only. A 2 × 3 × 2 ANOVA was used to statistically analyze the data. RESULTS Hamstring extensibility showed a significant side × time interaction (P < .05). The single hop for distance, timed 6-meter hop, and the crossover hop test had a significant main effect of time (P < .05). The triple hop for distance showed a significant side × time × group interaction (P < .05). CONCLUSIONS It does not appear dry needling results in increased extensibility beyond that of stretching alone in asymptomatic individuals. Our study findings suggest that dry needling may improve certain dimensions of functional performance, although no clear conclusion can be made. LEVEL OF EVIDENCE Intervention, level 2b.