Christopher R. Carcia

A commonly utilized operational definition of lower extremity (LE) dominance assumes the LE with which a participant prefers to kick a ball with is the same preferred LE a participant would choose for a unilateral landing task. The purpose of this study was to determine the relationship between the preferred lower extremity (LE) when performing a unilateral landing and kicking task. The authors hypothesized a strong correlation between the LE the participant chose for the landing task and the LE the participant chose for the kicking task would be evident. Repeated measures. A convenience sample of 50 (age = 21.9 ± 0.9 years; sex = 27 female; 23 male; height = 170.6 ± 10.8 cm; weight = 73.3 ± 18.3 kg) healthy, recreationally active college aged students performed two tasks (kicking a ball; unilateral drop jump landing) in a counterbalanced order. Thirty-three participants kicked and landed with their right LE; 14 kicked with the right and landed on their left; two kicked and landed with their left and one participant kicked with their left and landed on their right LE. The Phi Coefficient (ϕ = 0.18; p = 0.18) indicated little to no relationship between the preferred LE for kicking a ball and landing from a drop jump. Similarly, the Chi-squared statistic revealed no differences between observed and expected frequencies (χ2 = 1.76; p = 0.23). When studying anterior cruciate ligament injury mechanisms in the laboratory, most investigators examine characteristics of the dominant LE. Dominance is frequently defined by which LE the individual kicks a ball with. The majority of ACL injuries however occur to the landing or plant LE. Hence, LE limb selection based on this approach may be flawed. A significant relationship was not evident between the preferred LE for kicking a ball and a unilateral landing in a group of healthy recreationally active college aged students. The data suggests the preferred LE for kicking a ball and a unilateral landing task is not necessarily the same. Level 3.

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to midportion Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(5):A1–A38. doi:10.2519/jospt.2018.0302

Astym® therapy is a manual therapy intervention used to stimulate tissue healing, decrease pain, improve mobility, and improve muscle performance associated with musculoskeletal pathology. The purpose of this study was to determine if Astym therapy administered to the lower extremity would result in an immediate change of maximal force output during a unilateral isometric squat test among individuals with a lower extremity injury. Forty-five subjects (14 males; 31females) between 18 and 65 years of age were randomized into 3 treatment groups: 1) Control group – received no treatment 2) Placebo group – received a sham Astym treatment 3) Astym therapy group– received Astym therapy to the lower extremity. A baseline measure of maximal force output (pre-test) during a unilateral isometric squat was performed. The subjects then received the designated treatment intervention. Immediately following the treatment intervention, maximal force output (post-test) was retested using identical testing procedures by an investigator who was blinded to the treatment intervention received by the subjects. The percent change of maximal force output from pre-test to post-test measures was compared using a one-way analysis of variance. A Tukey’s post-hoc analysis determined the statistical differences between the groups. The treatment intervention had a significant effect on the percent change of maximal force output [F(2,42) = 7.91, p = 0.001]. Tukey’s post hoc analysis demonstrated that the percent change of maximal force output was significantly greater in the Astym group (15 ± 18 % change of Newtons) compared to the placebo (−6 ± 11 % change of Newtons; p = 0.0001) and control (−1 ± 17 % change of Newtons; p = 0.0014) groups. No significant difference (p = 0.68) was noted between the control and placebo groups. Astym therapy to the involved lower extremity increased maximum force output during an isometric squat test immediately following treatment. The results of this study suggest that Astym therapy can immediately improve muscle performance (maximal force output) for patients presenting with muscular weakness caused by a lower extremity musculoskeletal injury. Clinicaltrials.gov NCT02349230 . Registered 23 January 2015.

The sleeper stretch is a common intervention prescribed for individuals with decreased glenohumeral internal rotation. Passive glenohumeral internal rotation (GHIR) when quantified in sidelying has been suggested to be a more reliable measure as compared to measurments performed in supine with the humerus abducted to 908. Recently, the sidelying position has also been proposed as an evaluative measure to quantify GHIR. Minimal work however has described mean GHIR values in sidelying. Therefore, the objective of this study was to establish preliminary mean passive GHIR values in sidelying for a healthy, college-age population. Secondary purposes were to ascertain if mean values were affected by upper extremity dominance or sex. Using a standardized protocol, passive GHIR was measured using a digital inclinometer on the dominant and non-dominant shoulders of 60 healthy, college-age participants (32 female [20.66±1.15 years, 170.70±14.38 cm, 63.34±7.51 kg] and 28 male [21.50±1.40 years, 183.81±13.17 cm, 90.04±17.91 kg]). The sidelying passive GHIR grand mean for all participants bilaterally was 50.4 ± 11.78. Mean passive GHIR values on the non-dominant side (52.7 ± 10.28) were greater than those on the dominant side (48.0 ± 12.58) (p = 0.002). There was no difference when GHIR values were compared by sex (p = 0.327) and a significant interaction between UE dominance and sex was not apparent (p = 0.693). In a healthy college age population, these preliminary data suggest GHIR values are statistically greater on the non-dominant side and that sex does not significantly affect GHIR measures in a sidelying position. Level 3c.

The purpose of this review is to update the reader on contemporary theory related to the cause of calcific periarthritis and provide the latest evidence associated with treating recalcitrant cases. Contemporary theory suggests calcific periarthritis is the result of a cellular-mediated process in which calcium is deposited and resorbed via a multiple phase process. Resorption is associated with an acute inflammatory response and is often the factor that prompts one to seek medical care. The majority of cases require nothing more than a combination of symptomatic care and benign neglect. A small percentage of cases require intervention to further stimulate deposit resorption. Moderate evidence exists for extracorporeal shock wave therapy in the treatment of chronic cases related to deposits about the shoulder. Numerous case studies support the use of NSAIDs as an effective intervention for retropharyngeal periarthritis. If conservative interventions fail, surgery appears to be a viable option for symptom relief associated with rotator cuff calcific deposits. Periarthritis is typically a symptom-limiting condition that resolves spontaneously. Numerous conservative treatment modalities each with varying levels of evidence exist for use in refractory cases. Future study is necessary to further refine the efficacy and parameters associated with available interventions.

Female athletes continue to injure their anterior cruciate ligaments at a greater rate than males in comparable sports. During landing activities, females exhibit several different kinematic and kinetic traits when compared to their male counterparts including decreased knee flexion angles as well as decreased lower extremity (LE) strength. While open kinetic chain strength measures have not been related to landing kinematics, given the closer replication of movement patterns that occur during closed kinetic chain (CKC) activity, it is possible that lower extremity strength if measured in this fashion will be related to landing kinematics. To determine if unilateral isometric CKC lower extremity (LE) strength was related to sagittal plane tibiofemoral kinematics during a single leg landing task in competitive female athletes. We hypothesized females who demonstrated lesser CKC LE strength would exhibit decreased sagittal plane angles during landing. 20 competitive female athletes (age = 16.0 ± 1.8 yrs; height = 166.5 ± 8.3 cm; weight = 59.7 ± 10.2 kg) completed CKC LE strength testing followed by 5 unilateral drop landings on the dominant LE during one test session at an outpatient physical therapy clinic. Closed kinetic chain LE strength was measured on a computerized leg press with an integrated load cell while sagittal plane tibiofemoral kinematics were quantified with an electrogoniometer. No significant relationships between absolute or normalized isometric CKC strength and sagittal plane landing kinematics were identified. Closed kinetic chain lower extremity isometric strength tested at 25 degrees of knee flexion is not related to sagittal plane landing kinematics in adolescent competitive female athletes. Analytic, Observational.

The Orthopaedic Section of the American Physical Therapy Association presents this sixth set of clinical practice guidelines on Achilles pain, stiffness, and muscle power deficits that are characteristic of Achilles Tendinitis. These clinical practice guidelines are linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) interventions provided by physical therapists, (3) and assessment of outcome for common musculoskeletal disorders. J Orthop Sports Phys Ther 2010:40(9):A1–A26. doi:10.2519/jospt.2010.0305

Context: The Foot and Ankle Ability Measure (FAAM) is a region-specific, non–disease-specific outcome instrument that possesses many of the clinimetric qualities recommended for an outcome instrument. Evidence of validity to support the use of the FAAM is available in individuals with a wide array of ankle and foot disorders. However, additional evidence to support the use of the FAAM for those with chronic ankle instability (CAI) is needed. Objective: To provide evidence of construct validity for the FAAM based on hypothesis testing in athletes with CAI. Design: Between-groups comparison. Setting: Athletic training room. Patients or Other Participants: Thirty National Collegiate Athletic Association Division II athletes (16 men, 14 women) from one university. Main Outcome Measure(s): The FAAM including activities of daily living (ADL) and sports subscales and the global and categorical ratings of function. Results: For both the ADL and sports subscales, FAAM scores were greater in healthy participants (100 ± 0.0 and 99 ± 3.5, respectively) than in subjects with CAI (88 ± 7.7 and 76 ± 12.7, respectively; P < .001). Similarly, for both ADL and sports subscales, FAAM scores were greater in athletes who indicated that their ankles were normal (98 ± 6.3 and 96 ± 6.9, respectively) than in those who classified their ankles as either nearly normal or abnormal (87 ± 6.6 and 71 ± 11.1, respectively; P < .001). We found relationships between FAAM scores and self-reported global ratings of function for both ADL and sports subscales. Relationships were stronger when all athletes, rather than just those with CAI, were included in the analyses. Conclusions: The FAAM may be used to detect self-reported functional deficits related to CAI.

To compare the effect of knee angle on muscle response times and neuromuscular recruitment patterns between sexes following a perturbation in single leg stance at 10°, 20°, and 30°. We hypothesized that response times would be faster at lesser knee flexion angles and that females would recruit their quadriceps faster than males at all angles. A repeated-measures design. Motion analysis laboratory. Twenty (10 female; 10 male) healthy, recreationally active volunteers. A rotary perturbation in single leg stance. Response times of the medial and lateral quadriceps, hamstrings, and gastrocnemius. There was a trend toward faster response times for all muscles closer toward extension. A consistent neuromuscular recruitment pattern for both males and females was evident for each knee angle tested. Females, however, contracted their quadriceps faster than males at all knee flexion angles. Small changes in knee angle near extension do not alter muscle response times and hence neuromuscular recruitment patterns in males and females. Regardless of knee flexion angle, following a perturbation in single leg stance, females contract their quadriceps faster than males. Earlier contraction of the quadriceps in females may increase anterior tibial translation and hence anterior cruciate ligament strain, thereby heightening injury risk.