A Nation-Wide Survey of High School Baseball Coaches' Perceptions Indicates their Arm Care Programs Play a Role in Injury Prevention.

BACKGROUND: Arm care programs consisting of upper extremity strengthening and stretching have been recommended for injury prevention for pitchers of all ages. There has been no investigation into high school baseball coaches' usage and perceptions of arm care programs to mitigate physical impairments associated with injuries in baseball players. HYPOTHESIS/PURPOSE: The purpose of this study was to investigate the current usage of arm care programs by high school baseball coaches. The primary objective was to determine if coaches use group-based or individualized arm care programs. The secondary objective sought to determine if the use of arm care programs is influenced by coaches' age, education, and experience level. Finally, this study explored the potential barriers to arm care implementation and high school baseball coaches' current awareness and beliefs of injury prevention. STUDY DESIGN: Descriptive cross-sectional survey. METHODS: A 29-item online survey was emailed to 18,500 high school baseball coaches throughout the United States. Data were collected for three months, and the response rate was 3.7%. RESULTS: A total of 87.3% (n=571/654) of responding coaches use arm care programs with their players. Of coaches performing arm care, only 18.5% of 571 individualize their arm care exercises based on specific player needs. However, older and more experienced coaches are more likely to individualize their programs. Among the 12.7% (n=83/654) of coaches who do not use arm care programs, the two most commonly cited reasons for not implementing arm care were lack of observed benefit (41%) and insufficient staff (31%). Although 42% of 654 coaches recognized reduced shoulder mobility as a major contributor to injury, risk factors such as throwing with a fatigued arm, previous injury history, and throwing > 8 months per year were not consistently identified as primary risk factors. CONCLUSION: The results of this study suggest that the majority high school baseball coaches implement group-based arm care exercise programs to prevent injury. Lack of confidence in the effectiveness and staffing limitations were major barriers to implementation of arm care programming. However, the responding coaches exhibited inconsistent risk factor awareness and dated injury prevention beliefs. Therefore, better educational collaboration between rehabilitation professionals and high school coaches regarding injury risk factors and preventative strategies is warranted. LEVEL OF EVIDENCE: Level 3.

Intrarater reliability of selected clinical outcome measures following anterior cruciate ligament reconstruction.

STUDY DESIGN: Single group repeated measures following anterior cruciate ligament (ACL) reconstruction. OBJECTIVES: The purpose of this study was to evaluate the intrarater reliability of selected clinical outcome measures in patients having ACL reconstruction. BACKGROUND: Several investigations have reported the reliability of isokinetic testing and knee ligament arthrometry. Fewer studies have examined the reliability of lower extremity functional tests, with most of these studies evaluating normal subjects. METHODS AND MEASURES: Fifteen physically active males with unilateral ACL-reconstructed knees were evaluated with the KT-1000, Biodex isokinetic dynamometer, and 3 functional hop tests on 5 occasions. RESULTS: Intraclass correlation coefficients (ICCs) revealed good to high intrarater reliability (ICC > 0.80) of the functional hop tests and isokinetic peak torque values ICCs were higher for the involved limb than the uninvolved limb using the scores from the KT-1000 Manual Maximum Test. CONCLUSIONS: The outcome measures examined in this investigation have been shown to be reliable in patients with ACL reconstructions, and support previous investigations in nonimpaired populations. Further research is needed to examine the validity of these postoperative outcome measures in patients with ACL reconstructions.

Patellofemoral disorders: a classification system and clinical guidelines for nonoperative rehabilitation.

Patellofemoral disorders are among the most common clinical conditions managed in the orthopaedic and sports medicine setting. Nonoperative intervention is typically the initial form of treatment for patellofemoral disorders; however, there is no consensus on the most effective method of treatment. Although numerous treatment options exist for patellofemoral patients, the indications and contraindications of each approach have not been well established. Additionally, there is no generally accepted classification scheme for patellofemoral disorders. In this paper, we will discuss a classification system to be used as the foundation for developing treatment strategies and interventions in the nonsurgical management of patients with patellofemoral pain and/or dysfunction. The classification system divides the patellofemoral disorders into eight groups, including: 1) patellar compression syndromes, 2) patellar instability, 3) biomechanical dysfunction, 4) direct patellar trauma, 5) soft tissue lesions, 6) overuse syndromes, 7) osteochondritis diseases, and 8) neurologic disorders. Treatment suggestions for each of the eight patellofemoral dysfunction categories will be briefly discussed.

The effect of quadriceps femoris, hamstring, and placebo eccentric fatigue on knee and ankle dynamics during crossover cutting.

This study attempted to determine the effect of eccentric quadriceps femoris, hamstring, and placebo fatigue on stance limb dynamics during the plant-and-cut phase of a crossover cut. Twenty female college students (task trained) were tested. Hamstring fatigue resulted in decreased peak impact knee flexion moments (p < or = .01), increased internal tibial rotation at peak knee flexion (p < or = .05), and decreased peak ankle dorisflexion (p < or = .05). Quadriceps fatigue resulted in increased peak ankle dorsiflexion moments (p < .01), decreased peak posterior braking forces (p < or .01), decreased peak knee extension moments (p < or = .01), delayed peak knee flexion (p < or = .01), delayed peak propulsive forces (p < .01), and delayed subtalar peak inversion moments (p < or = .05). Fatigue of either muscle group produced earlier peak ankle plantar flexion moments (p < = .05) and decreased peak propulsive knee flexion moments (p < or = .05). Variables requiring further study (p < or = .1) provide discussion data. Soleus, gastrocnemius, tibialis anterior, and deep posterior compartment calf muscles serve as dynamic impact force attenuators, compensating for fatigued proximal muscles.

Cryotherapy-induced nerve injury.

Cryotherapy is a frequently used therapeutic modality in the treatment of athletic injuries. Peripheral nerve injury can result from the use of cryotherapy and cause temporary disability for the athlete. Six cases of peripheral nerve injury are reviewed. All cases resolved spontaneously. To avoid this complication, one should consider the location of major peripheral nerves, the thickness of the overlying subcutaneous fat, and the duration of tissue cooling.

Long-term functional results in patients with anterolateral rotatory instability treated by iliotibial band transfer.

The purpose of this paper is to define the use of the extraarticular, lateral reconstruction in the spectrum of patients with cruciate deficiency. A review was conducted of 112 consecutive patients with a MacIntosh-type iliotibial band transfer done between 1972 and 1986. Fifty-six of the patients had a partial or complete meniscectomy, and 24% had failed a previous extraarticular procedure. Eighty-one percent were men, with a mean age of 23. Twenty-five percent of the patients had radiographic degenerative changes at the knee at the outset. Ninety-eight percent had an anterior drawer of 1+ or greater; 97% had a pivot shift greater than trace. All patients had symptomatic knee instability. Seventy-seven of the 112 patients (69%) were available for followup (range, 24 months to 15.5 years; median, 7.6). Twenty-three patients (21%) returned for examination, KT-1000 and Cybex testing, and radiographs. An additional 54 patients (48%) were seen by their local physicians or returned a detailed questionnaire that included the Cincinnati knee rating scale. At final followup, 38% complained of some knee instability, 36% had recurrent effusions, 61% had intermittent pain, 79% had radiographic gonarthrosis, and 25% had undergone additional surgery. Forty-two percent had a positive Lachman after surgery, and only 15% had a pivot shift. The mean knee score was 81.1. Previous extraarticular anterior cruciate ligament reconstruction, meniscectomy, and generalized ligamentous laxity were associated with a significant decrement in the knee rating (P = 0.05). Ligamentous laxity strongly correlated with symptoms of giving way.(ABSTRACT TRUNCATED AT 250 WORDS)

Commentary and historical perspective of anterior cruciate ligament rehabilitation.

This article serves as the introduction and historical perspective of anterior cruciate ligament surgery and rehabilitation. Several physician-therapist teams have been invited to share their "state of the art" techniques and to contrast their programs to that espoused by Shelbourne and Nitz in 1990. Our commentary/review of "Accelerated Rehabilitation After Anterior Cruciate Ligament Reconstruction" (Shelbourne KD, Nitz P, Am J Sports Med 18:292-299, 1990) is provided to contextualize the reader to what most clinicians would recognize as an extremely aggressive rehabilitation approach that is being popularized in the 1990s. A comparison is then presented of the rehabilitation sequence used in the MacIntosh procedures, demonstrating how early motion/functional rehabilitation was the hallmark of this type of extraarticular rehabilitation sequence and how today's pattern has evolved to follow that philosophy. Each of the teamed authors has attempted to present his surgery and rehabilitation/techniques and highlight differences between his program and that of Shelbourne and Nitz. We hope that the readers find this glimpse of the past and present helpful in formulating their rehabilitation sequences and that the future will be predicated on excellent basic science and clinical judgment. J Orthop Sports Phys Ther 1992;15(6):265-269.

Nerve injury in athletes caused by cryotherapy.

Cryotherapy is a therapeutic modality frequently used in the treatment of athletic injuries. In very rare circumstances, inappropriate use in some individuals can lead to nerve injury resulting in temporary or permanent disability of the athlete. Six cases of cold-induced peripheral nerve injury from 1988 to 1991 at the Sports Medicine Center at Duke University are reported. Although disability can be severe and can render an athlete unable to compete for several months, each of these cases resolved spontaneously. Whereas the application of this modality is typically quite safe and beneficial, clinicians must be aware of the location of major peripheral nerves, the thickness of the overlying subcutaneous fat, the method of application (with inherent or additional compression), the duration of tissue cooling, and the possible cryotherapy sensibility of some individuals.

Effects of running on intervertebral disc height.

Vertebral column height decreases throughout the course of the day. This decrease is the result of a loss of fluid from the intervertebral discs due to compressive loading. When the load changes during the day, as a result of varying physical activities, the rate of disc shrinkage changes in relation to those activities. The purpose of this study was to determine if there is a correlation between long distance running and an increase in the loss of vertebral column height. Thirty elite male runners, ages 17 to 29, participated in this study. Subjects' vertebral column heights were measured in the morning upon waking, in the afternoon prior to running 9 miles, and then immediately following the run. Paired t-tests revealed: 1) that the vertebral column height was significantly less following the run, and 2) that a significantly greater amount of height was lost during 1 hour of running than during 7.5 hours of relatively static activities. J Orthop Sports Phys Ther 1990;12(4):139-146.

Rehabilitation of foot and ankle injuries in ballet dancers.

Classical ballet is an exacting art form with roots dating to the Italian Renaissance. The physical demands of dance class, rehearsal, and performance can predispose the dancer to injury. The foot and ankle are common sites of injury. Most injuries are caused by overuse rather than acute injuries. The purpose of this clinical report is to describe the initial treatment, as well as a structured program directed to the restoration of motion, strength, endurance, and proprioception essential for the successful return to dance. Additionally, specific rehabilitation techniques will be presented to assist the physical therapist in reducing those risk factors that may predispose a dancer to future injury. J Orthop Sports Phys Ther 1990;11(8):355-361.

Injury to the lateral ligaments of the ankle.

Ankle sprains are common and often are treated inadequately. Unstable lateral ankle ligaments cause abnormal ankle motion and can lead to degenerative changes. Arthrography is the superior radiographic study in acutely injured ankles. Stress tests are useful if positive; however, because false-negative tests are common, general anesthesia should be considered. Chronic injuries may be evaluated well with stress testing. Conservative treatment (that is, mobilization) with aggressive rehabilitation is probably the best treatment for all lateral ligament injuries, unless certain mechanical stability is of paramount importance. Finally, the results of late reconstruction equal those of early repair.

The diagonal medial plica: an underestimated clinical entity.

Patellar plical syndrome is a commonly reported, yet controversial entity. Arguments exist as to which component of the patella plica is most commonly involved clinically. The authors describe a plical structure which is seldom identified as a source of pathology. This structure, however, can be a primary source of pain accompanying extensor mechanism dysfunction. The aforementioned structure has been identified via arthroscopic technique, cadaveric dissection, and by palpation during clinical examinations. Conservative and surgical management is discussed.J Orthop Sports Phys Ther 1988;9(9):305-309.

Clinical use of the johnson anti-shear device: how and why to use it.

The purpose of this paper is to describe the clinical utilization of the Johnson Anti- Shear Device. This device presents a method of controlling the anterior shear forces developed during isokinetic exercise on a Cybex(R) ll or Orthotrone system. The antishear device allows the therapist to alter the amount of anterior shear developed during exercise, thus allowing the therapist to individualize the rehabilitation protocol. This is of special significance following anterior cruciate injury. The clinical use of this device will allow the therapist to more safely develop quadriceps exercise programs with their anterior cruciate deficient knee patients. J Orthop Sports Phys Ther 1986;7(6):304-309.

Evaluating research literature: the educated clinician.

The purpose of this article is to present a framework for reader evaluation of research literature. The elements of a research article are outlined by citing examples from the January 1984 issue of Physical Therapy. We present concrete suggestions that clinicians can use to develop competence in evaluating research literature and include an annotated bibliography of research references. Better patient care and increased professional growth will result when clinicians learn to evaluate and make use of the research literature.

A strength study utilizing the electro-stim 180.

lncreased interest has developed in the use of electrical stimulation as either an adjunct or a substitution for voluntary muscle contraction as a technique to improve strength in normal individuals. This study was conducted in an attempt to determine if electrical stimulation does significantly increase the strength of normal musculature. A sample using 17 normal subjects (1 0 male, 7 female) with an average mean age of 26 years was obtained. In this study the subjects were divided into two groups. Three different speeds (0, 60, and 240 degrees /sec) with 3-5 contractions at each speed were used to determine the maximum strength of each subject's nondominant leg as measured by a Cybex(R) II dynamometer. Group A consisted of 8 subjects (3 male, 5 female) who served as a control group. Group B consisted of 9 subjects (7 male, 2 female) who received electrical stimulation to the nondominant leg for 20 treatment sessions (5 days/week for 4 weeks). Results indicate that group B did have a significant strength gain which was achieved after 4 weeks of stimulation. These results were only significant at an isometric mode (OO/sec) and did not carry over to dynamic measurement. J Orthop Sports Phys Ther 1985;7(2):50-53.

Survey of scholastic athletic health care and sports medicine clinics.

The increasing number of athletes requiring health care has spurred the growth of the development of sports medicine clinics. The diversity of such clinics is readily apparent. These clinics primarily function to provide evaluative and rehabilitative measures to all groups of athletic participants. Scholastic health care for athletic participants has not proceeded in a similar pattern. Sports medicine clinics are not effectively meeting the needs of the scholastic athlete, primarily because of location and financial limitations. This survey was conducted to collect information to further delineate the problems associated with scholastic health care of athletic participants. It appears that sports medicine clinics are manned by several levels of health care professionals. Scholastic athletes are least adequately covered by insurance and also suffer from being within a somewhat isolated environment. The need for on-field care and follow-up care within the school system remains a key problem associated with scholastic health care. Further research into the relationship of insurance policies which will adequately meet the needs of the scholastic population must be pursued. J Orthop Sports Phys Ther 1983;5(2):78-81.

Treatment Parameters of High Frequency Electrical stimulation as Established on the Electro-Stim 180.

Tremendous interest has developed regarding the use of electrical stimulation in both treatment and strengthening regimens. The Electro Stim 180 (Numed, Joliet, IL) is manufactured in Canada and imported into the United States. This unit functions at 2500 cycles per second with output similar to that developed by a Russian electrical stimulation device. A paucity of treatment parameters exists regarding this apparatus. Fifteen normal subjects participated in this study to establish treatment parameters in an exercise regimen. All subjects (mean age, 24) were pretreated isometricly and isokineticly in knee extension bilaterally using a Cybex II (Cybex, Ronkonkama, NY). The subjects were divided into three groups with group one receiving stimulation each day during a 10-day period and group two receiving stimulation on alternate days of a 10-day period, while group three served as a control. All treatment sessions consisted of 10 isometric contractions of 15 seconds duration, interspaced with 50 seconds of rest. Current was applied as tolerated to the left knee extensor mechanism during each trial. Current accommodation, strength of generated contraction, other associated treatment effects and strength differences were recorded. It was concluded that the Electro- Stim 180 is capable of generating greater than 60% of the maximal isometric voluntary knee extension, that stimulation is somewhat unpleasant, and that a tremendous degree of current accommodation is possible. Although strength gains were not significant in this particular study, they approached significance and, hence, indicate the need for further study in this area.J Orthop Sports Phys Ther 1983;4(3):162-168.