Effects of two different types of ankle-foot orthoses on gait outcomes in patients with subacute stroke: a randomized crossover trial.

OBJECTIVE: To identify whether patients in the subacute stage of stroke, with foot drop, would have better gait outcomes when using a double-adjustable AFO (DA AFO) or a posterior leaf spring AFO (PLS AFO) at baseline without practice and to determine whether one week of practice would significantly change gait outcomes with either of the AFOs. DESIGN: Within-subject 2 × 2 repeated measures design. SETTING: Postacute and outpatient rehabilitation center. PARTICIPANTS: Twenty individuals with mean age of 57 years (SD: 12.0 years) with subacute stroke. INTERVENTIONS: Participants were measured using DA AFO and PLS AFO at baseline. Follow-up measurements were taken after one week of practice with each type of AFO in randomly assigned order. OUTCOME MEASURES: Gait endurance (6-Minute Walk Test (6MWT)), gait symmetry, and gait velocity at self-selected and fast-paced velocity measured using GAITRite gait analysis system and patient report of AFO preference. RESULTS: At baseline, no significant differences were found between the 2 AFOs (P > 0.05). There was no significant interaction (P > 0.05) of AFO and practice for gait endurance, symmetry, and velocity. Main effect of practice was significant for gait endurance (P < 0.001), self-selected velocity (P = 0.001), and fast-paced velocity (P < 0.001). In all, 16 participants preferred using DA AFO for walking. CONCLUSIONS: No difference between DA AFO and PLS AFO was found on measures of gait endurance, symmetry, and velocity at baseline or after practice. With practice over time, participants improved in gait endurance and velocity regardless of AFO type.

Spinal Stabilization Exercise Effectiveness for Low Back Pain in Adolescent Idiopathic Scoliosis: A Randomized Trial.

PURPOSE: To compare 8 weeks of weekly supervised spinal stabilization exercises with 1-time treatment in participants with low back pain and adolescent idiopathic scoliosis. METHODS: Participants were randomly assigned to the supervised or unsupervised group. Seventeen participants in the supervised group received weekly physical therapy, and 17 participants in the unsupervised group received a 1-time treatment followed by home exercises. RESULTS: Significant between-group differences were found in the Numeric Pain Rating Scale and the Patient-Specific Functional Scale scores after 8 weeks (P < .01), indicating the supervised group had significantly more pain reduction and functional improvements than the unsupervised group. However, no between-group differences were found in back muscle endurance, the revised Oswestry Back Pain Disability Questionnaire scores, or the Global Rating of Change scores. CONCLUSIONS: Supervised physical therapy may be more effective than 1-time treatment in reducing pain and improving function in patients with adolescent idiopathic scoliosis and low back pain. VIDEO ABSTRACT: For more insights from the authors, access Supplemental Digital Content 1, at http://links.lww.com/PPT/A85.

Relations of meeting national public health recommendations for muscular strengthening activities with strength, body composition, and obesity: the Women's Injury Study.

OBJECTIVES: We examined the relations of meeting or not meeting the 2008 Physical Activity Guidelines for Americans recommendations for muscular strengthening activities with percentage of body fat, body mass index (BMI; defined as weight in kilograms divided by height in meters, squared), muscular strength, and obesity classification in women. METHODS: We analyzed data on 918 women aged 20 to 83 years in the Women's Injury Study from 2007 to 2009. A baseline orthopedic examination included measurement of height, body weight, skinfolds, and muscle strength. RESULTS: Women who met muscle strengthening activity recommendations had significantly lower BMI and percentage of body fat and higher muscle strength. Women not meeting those recommendations were more likely to be obese (BMI ≥ 30) compared with women who met the recommendations after we adjusted for age, race, and aerobic physical activity (odds ratio = 2.28; 95% confidence interval = 1.61, 3.23). CONCLUSIONS: There was a small but significant positive association between meeting muscle strengthening activity recommendations and muscular strength, a moderate inverse association with body fat percentage, and a strong inverse association with obesity classification, providing preliminary support for the muscle strengthening activity recommendation for women.

Hip- and thigh-muscle activation during the star excursion balance test.

CONTEXT: The Star Excursion Balance Test (SEBT) is often used to train and assess dynamic balance and neuromuscular control. Few studies have examined hip- and thigh-muscle activation during the SEBT. OBJECTIVE: To quantify hip- and thigh-muscle activity during the SEBT. DESIGN: Repeated measures. SETTING: Laboratory. PARTICIPANTS: 22 healthy individuals, 11 men and 11 women. METHODS: EMG measurements were taken as participants completed 3 trials of the anterior (A), medial (M), and posteromedial (PM) reach directions of the SEBT. MAIN OUTCOME MEASURES: Mean EMG data (% maximal voluntary isometric contraction) from the gluteus medius (Gmed), gluteus maximus (Gmax), and vastus medialis (VM) were measured during the eccentric phase of each SEBT reach direction. Test-retest reliability of EMG data across the 3 trials in each direction was calculated. EMG data from each muscle were compared across the 3 reach directions. RESULTS: Test-retest reliability ranged from ICC3,1 values of .91 to .99. A 2-way repeated-measure ANOVA revealed a significant interaction between muscle activation and reach direction. One-way ANOVAs showed no difference in GMed activity between the A and M directions. GMed activity in the A and M directions was greater than in the PM direction. There was no difference in GMax and VM activity across the 3 directions. CONCLUSION: GMed was recruited most effectively when reaching was performed in the A and M directions. The A, M, and PM directions elicited similar patterns of muscle recruitment for the GMax and VM. During all 3 SEBT directions, VM activation exceeded the 40-60% threshold suggested for strengthening effects. GMed activity also exceeded the threshold in the M direction. GMax activation, however, was below the 40% threshold for all 3 reach directions, suggesting that performing dynamic lower extremity reaching in the A, M, and PM directions may not elicit strengthening effects for the GMax.

Test-Retest Reliability and Minimal Detectable Change of the Instrumented Modified Clinical Test of Sensory Interaction on Balance in Healthy, Older Adults.

BACKGROUND AND PURPOSE: Test-retest reliability has not been previously reported for the instrumented modified Clinical Test of Sensory Interaction on Balance (i-mCTSIB) utilizing the Neurocom Very Simple Rehab (VSR) Sport force plate. The VSR Sport is a portable, relatively inexpensive force plate system utilized to assess postural stability in various populations. Therefore, the purpose of this study is to determine the test-retest reliability, standard error of measurement (SEM), and minimal detectable change (MDC) of the i-mCTSIB when assessed using the VSR Sport in a sample of healthy, older adults. METHODS: This was a methodological study with 20 healthy, older adults between the ages of 65 and 85 years. Participants were tested twice in a single session on the i-mCTSIB utilizing the VSR Sport force plate. The mean sway velocity (°/s) measurements for the 2 trials were compared for each test condition to compute intraclass correlation coefficients (ICCs) for each measurement. Standard error of measurements and minimal detectable change at the 90% confidence level (MDC90) were also calculated. RESULTS AND DISCUSSION: The test-retest reliability for each of the test conditions ranged from 0.762 to 0.909, which can be broadly interpreted as good-to-excellent reliability. The ICC(2,k) value of 0.898 for the composite score can also be interpreted as excellent reliability. Our results revealed small SEM for all test conditions (SEM = 0.060-0.101) except for the foam surface, eyes closed condition, with an SEM of 0.481. The MDC90 results for all testing conditions ranged from 0.140 to 0.285 except for the foam surface, eyes closed condition, which had an MDC90 = 1.12. CONCLUSIONS: The i-mCTSIB measurements utilizing the VSR Sport demonstrated good-to-excellent test-retest reliability. The clinical relevance of this study is that it demonstrates that the VSR Sport is a feasible alternative to other more expensive computerized systems used for the assessment of postural sway. MDC90 scores allow interpretation of change in i-mCTSIB scores following intervention. Practice effects may have contributed to the larger MDC90 for sway scores in the foam surface, eyes closed condition.

Differences in predictors for gait speed and gait endurance in Parkinson's disease.

INTRODUCTION: Both gait speed and gait endurance directly impact independence and community engagement for individuals with Parkinson's disease (PD). However, factors accounting for variability in gait speed and gait endurance performance are unclear. The purpose of this study was to investigate whether key factors associated with gait speed in individuals with PD also predicted gait endurance. METHODS: Community dwelling ambulatory individuals with PD were recruited for a single session. Key measures included 10 Meter Walk Test (10MWT) and 6 Minute Walk Test (6MWT) and key factors: age, disease severity [Movement Disorders Society United Parkinson's Disease Rating Scale (motor scale only) (MDS-UPDRS motor)], plantar flexor strength [Calf Raise Senior (CRS)], fatigue [Fatigue Severity Scale (FSS)], cognition [Montreal Cognitive Assessment (MoCA)], and balance [Four Square Step Test (FSST)]. Multiple linear regression analyses were conducted to determine clinical relationships. RESULTS: Seventy-two individuals with PD (mean (standard deviation) (age = 70.83 (7.91) years; 50 males; MDS-UPDRS motor = 30.67 (13.50)) completed all assessments. The model predicting gait speed was significant, F(6, 65) = 15.143, p <.001, accounting for 54 % of the variance. Of the predictor variables age, MDS-UPDRS motor, CRS, MoCA and FSST scores were significant predictors. The model predicting gait endurance was significant, F(6, 65) = 15.608, p <.001, accounting for 55 % of the variance. Of the predictor variables, age, MDS-UPDRS motor scale, and CRS scores were significant predictors. DISCUSSION: Gait speed and gait endurance are similarly influenced by age, motor impairment, and plantarflexion strength. However, cognition and balance were predictors only of gait speed, which may suggest unique task differences exist between gait speed and gait endurance.

Plantarflexor strength, gait speed, and step length change in individuals with Parkinson's disease.

Parkinson's disease affects the ability to walk often resulting in decreased independence and low quality of life. The purpose of this study was to examine differences in plantarflexor strength (PFS), gait speed, and step length in persons with Parkinson's disease (PwP) and healthy peers using clinical measures. A secondary purpose was to examine the relationship between these gait components across disease severity. The study was a convenience sample of 71 PwP and 25 community healthy peers. Outcome measures included 10-Meter Walk, step length, and Calf-Raise Senior Test. PwP were separated into mild and moderate impairment groups using the Movement Disorders Society United Parkinson's Disease Rating Scale Motor Subscale. Between group differences for gait speed (F2,93 = 24.560, P = 0.000), step length (F2,93 = 21.93, P = 0.000) and PFS (F2,93 = 19.49, P < 0.000) were observed. Post hoc testing determined a difference (P < 0.00) in gait speed, step length, and PFS testing between moderate impairment versus healthy peers and mild impairment. A difference (P = 0.045) in step length and a trend towards significance (P = 0.064) for PFS was found between healthy peers and mild impairment group. This study revealed that PwP with mild impairment also have significant changes in step length and trends toward plantarflexor weakness without a significant difference in gait speed. These early changes may warrant early assessment and intervention to prevent decline. This study may bring clinical focus onto the plantarflexor and step length for early comprehensive assessment and treatment of gait and mobility for PwP.

Fatigue effects on knee joint stability during two jump tasks in women.

Dynamic knee joint stability may be affected by the onset of metabolic fatigue during sports participation that could increase the risk for knee injury. The purpose of this investigation was to determine the effects of metabolic fatigue on knee muscle activation, peak knee joint angles, and peak knee internal moments in young women during 2 jumping tasks. Fifteen women (mean age: 24.6 +/- 2.6 years) participated in one nonfatigued session and one fatigued session. During both sessions, peak knee landing flexion and valgus joint angles, peak knee extension and varus/valgus internal moments, electromyographic (EMG) muscle activity of the quadriceps and hamstrings, and quadriceps/hamstring EMG cocontraction ratio were measured. The tasks consisted of a single-legged drop jump from a 40-cm box and a 20-cm, up-down, repeated hop task. The fatigued session included a Wingate anaerobic protocol followed by performance of the 2 tasks. Although participants exhibited greater knee injury-predisposing factors during the fatigued session, such as lesser knee flexion joint angles, greater knee valgus joint angles, and greater varus/valgus internal joint moments for both tasks, only knee flexion during the up-down task was statistically significant (p = 0.028). Metabolic fatigue may perhaps predispose young women to knee injuries by impairing dynamic knee joint stability. Training strength-endurance components and the ability to maintain control of body movements in either rested or fatigued situations might help reduce injuries in young women athletes.

Effectiveness of a 6-week injury prevention program on kinematics and kinetic variables in adolescent female soccer players: a pilot study.

BACKGROUND: Incidence of knee injuries in female soccer players is 2-6 times that of male counterparts. The objective was to determine whether an injury prevention program incorporated into the athlete's regular soccer practice is effective for improving landing mechanics. METHODS: Two competitive adolescent female soccer teams (n = 30) participated in the study. One team served as the control group while the other team participated in a 6-week injury prevention program. Muscle strength, muscle length, and 3-dimensional kinematics and kinetics during a single legged drop jump and single legged squat task were measured pre and post-intervention. A 2 x 2 repeated measures multivariate analyses of variance (MANOVA's) were used to compare strength and flexibility measures as well as knee joint kinematics and kinetics. Significant multivariate results were followed with appropriate univariate analyses. RESULTS: Quadriceps strength increased significantly (p = .004) following the injury prevention program while other strength and flexibility measurements were unchanged. Differences in knee joint angles and moments during the drop jump and squat tasks showed varied results with a tendency for improvement in the intervention group. CONCLUSIONS: Flexibility and strength do not appear to be affected by a short injury prevention program. Knee joint injury predisposing factors improved minimally but did not reach statistical significance with a short injury prevention program integrated as warm-up into soccer practice. Further research with a larger sample size is needed to explore the effectiveness of such programs.

Exploration of Habitual Walking Behavior and Home-Based Muscle Power Training in Individuals With Total Knee Arthroplasty.

BACKGROUND: The purpose of this study was to investigate the effects of a home-based muscle power training program on muscle strength and power, functional performance, and physical activity behavior in individuals at least 6 months posttotal knee arthroplasty. METHODS: Twelve men and women, mean age 63.9 (6.8) and 6 months to 2 years posttotal knee arthroplasty unilateral or bilateral), completed this study. Participants were randomly assigned to the home-based power training intervention or step-monitoring comparison group. Quadriceps muscle strength and power, 6-minute walk test, functional leg power, and habitual walking behavior (average daily steps, minutes per week of moderate to vigorous physical activity) were assessed before and after intervention and then compared between and within groups. RESULTS: The authors found no significant differences between the groups on amount of change in any of the outcomes, but mixed results on differences within each of the groups on the outcome measures. CONCLUSION: There were no differences between the groups for amount of change on the outcome measures the authors selected. Although within group differences varied slightly for each group, it was not enough to justify the more expensive home-based power training over the simpler step-monitoring intervention.

Reliability and clinical feasibility of measuring dual-task gait in the inpatient rehabilitation setting following traumatic brain injury.

Background: To prepare patients with traumatic brain injury (TBI) for discharge from inpatient rehabilitation, physical therapists may incorporate dual-task gait activities. Reliability of common dual-task measures for people with TBI in inpatient rehabilitation is undetermined. Our purpose was to assess inter-rater and intra-rater reliability and clinical feasibility of dual-task measures [Walking While Talking Test (WWTT), Modified Walking and Remembering Task (mWART), Timed Up and Go-cognitive (TUG-COG)] in inpatient rehabilitation for patients with TBI. Methods: A total of 22 individuals with TBI completing the dual-task measures (WWTT, Walking and Remembering Task (WART), and TUG-COG) in inpatient rehabilitation were rated concurrently by two physical therapists in a single testing session. Sessions were video recorded and rated by the same raters viewing the video 7-10 days later. Raters completed a survey assessing feasibility of conducting the dual-task measures in patients with TBI in inpatient rehabilitation. Data were analyzed by calculating ICC(2,1) for inter-rater reliability and ICC(3,1) for intra-rater reliability. Results: All dual-task measures (WWTT, mWART, TUG-COG) had excellent inter-rater and intra-rater reliability. Raters considered dual-task measures feasible for patients with TBI during inpatient rehabilitation. Conclusions: The WWTT, mWART, and TUG-COG have excellent reliability and appear clinically feasible for incorporation into clinical practice in inpatient rehabilitation following TBI.

Interrater reliability of a movement impairment-based classification system for lumbar spine syndromes in patients with chronic low back pain.

STUDY DESIGN: A prospective methodological study of interrater reliability. OBJECTIVES: To examine the interrater reliability of a movement impairment-based classification system for patients with chronic low back pain (LBP). BACKGROUND: Movement impairment-based classification for the lumbar spine categorizes LBP based on the findings derived from a patient history and standardized examination. Though many presume this classification to be useful for directing treatment of individuals with LBP, agreement between examiners for assigning a lumbar spine category to a patient has not been studied thoroughly. METHODS AND MEASURES: Two physical therapists independently examined 24 patients (8 men, 16 women) with chronic LBP (pain duration greater than 12 weeks). All patients enrolled in the study had been diagnosed with LBP that was believed to be due to mechanical causes, and the duration of their symptoms ranged from 20 to 1040 weeks. The examiners used a standardized examination to assess patients and classify them into 1 of 5 lumbar spine categories. Percent agreement and kappa coefficients were calculated between the examiners for the lumbar movement impairment-based classifications. RESULTS: Percent agreement between examiners was 75% and the kappa coefficient was 0.61. The most prevalent lumbar spine categories identified by both examiners were lumbar extension rotation syndrome (41.7% of patients by examiner 1, 37.5% of patients by examiner 2) and lumbar rotation syndrome (41.7% of patients by both examiners). CONCLUSIONS: Interrater reliability between 2 physical therapists classifying patients with chronic LBP patients into 1 of 5 lumbar spine movement impairment categories had substantial agreement.

Do Older Adults Who Meet 2008 Physical Activity Guidelines Have Better Physical Performance Than Those Who Do Not Meet?

BACKGROUND AND PURPOSE: An observed consequence of aging is a decline in muscle performance that includes a loss in both muscle strength and muscle power. This decline can lead to loss of function and independence and is a predictor of disability in older adults. Although the 2008 Physical Activity (PA) Guidelines for Americans provides a guideline for muscle strengthening, there is no evidence that performing muscle strengthening 2 times a week for all major muscle groups is related to better performance on measures known to be important factors in development or progression of frailty in older adults. The purposes of this study were to assess muscle-strengthening and aerobic PA behaviors in older adults and to determine the relationship between the PA behaviors and physical performance measures. METHODS: This was a cross-sectional study of 85 community-dwelling, ambulatory adults (50 women, 35 men) with a mean (standard deviation) age of 67.5 (5.6) years. All used an internet-based survey, TREST (Tracking Resistance Exercise and Strength Training), to report muscle-strengthening and aerobic PA behavior. Physical performance measures of grip strength, 10-m walk test (10-MWT), five-time sit-to-stand test (FTSST), and stair climb test (SCT) were obtained following completion of the survey. Participants were grouped by whether they met 2008 PA Guidelines for (1) muscle strengthening 2 or more days per week, (2) muscle strengthening 2 or more days per week using all major muscle groups, or (3) 150 minutes or more per week of aerobic moderate to vigorous physical activity. Comparisons of physical performance measures were conducted between participants who met and did not meet guidelines using multivariate analyses. Significant multivariate results were followed with one-tailed t tests. RESULTS AND DISCUSSION: The participants meeting muscle strengthening 2 or more days per week performed significantly better on measures of grip strength and SCT. Only 27% of participants met the more stringent-strengthening guideline of 2 or more days per week using all major muscle groups, and these individuals performed significantly better on the SCT and FTSST. The participants meeting the aerobic activity guideline performed significantly better on the SCT, the FTSST, and the 10-MWT.However, participants who met both the strengthening and aerobic activity guidelines performed significantly better on all 4 physical performance measures than participants who met neither of the guidelines. CONCLUSIONS: Meeting guidelines for both aerobic and muscle-strengthening activities may be the most effective way of preserving muscle strength, muscle power, and gait velocity in older adults, but this conclusion must be tested with an intervention study.

Outcomes of Botulinum Toxin Type A for equinovarus deformity in patients with CVA: A case series.

BACKGROUND: There is evidence that Botulinum Toxin-A (BTX-A) reduces focal spasticity associated with equinovarus to improve gait in patients poststroke. However, there is little research examining whether gait improvements are maintained after the effectiveness period of BTX-A injections. The purpose of this observational study was to determine whether there was a difference in gait parameters in three patients before BTX-A injection versus four and ten weeks after. CASE SERIES: Three women, ages 63, 60, and 42 postischemic stroke with hemiparesis and equinovarus underwent measurements for: plantar flexor spasticity, ankle dorsiflexion ROM, temporal-spatial gait parameters, and gait endurance. All participants improved in ankle ROM. At week 10, spasticity had returned to initial measurement levels in participants A and C. Base of support and step length symmetry ratios did not improve following injections. Participants A and B, who received physical therapy during the study, showed modest gains in gait endurance and velocity. CONCLUSION: Although BTX-A injections improved spasticity, this improvement did not translate to gait outcomes. Addition of physical therapy interventions appeared to improve gait outcomes in this case series. We suggest future randomized control studies to compare effects of physical therapy alone to BTX-A combined with physical therapy on gait outcomes.

COMPARISON OF ECCENTRIC AND CONCENTRIC EXERCISE INTERVENTIONS IN ADULTS WITH SUBACROMIAL IMPINGEMENT SYNDROME.

BACKGROUND: Researchers have demonstrated moderate evidence for the use of exercise in the treatment of subacromial impingement syndrome (SAIS). Recent evidence also supports eccentric exercise for patients with lower extremity and wrist tendinopathies. However, only a few investigators have examined the effects of eccentric exercise on patients with rotator cuff tendinopathy. PURPOSE: To compare the effectiveness of an eccentric progressive resistance exercise (PRE) intervention to a concentric PRE intervention in adults with SAIS. STUDY DESIGN: Randomized Clinical Trial. METHODS: Thirty-four participants with SAIS were randomized into concentric (n = 16, mean age: 48.6 ± 14.6 years) and eccentric (n = 18, mean age: 50.1 ± 16.9 years) exercise groups. Supervised rotator cuff and scapular PRE's were performed twice a week for eight weeks. A daily home program of shoulder stretching and active range of motion (AROM) exercises was performed by both groups. The outcome measures of the Disabilities of the Arm, Shoulder, and Hand (DASH) score, pain-free arm scapular plane elevation AROM, pain-free shoulder abduction and external rotation (ER) strength were assessed at baseline, week five, and week eight of the study. RESULTS: Four separate 2x3 ANOVAs with repeated measures showed no significant difference in any outcome measure between the two groups over time. However, all participants made significant improvements in all outcome measures from baseline to week five (p < 0.0125). Significant improvements also were found from week five to week eight (p < 0.0125) for all outcome measures except scapular plane elevation AROM. CONCLUSION: Both eccentric and concentric PRE programs resulted in improved function, AROM, and strength in patients with SAIS. However, no difference was found between the two exercise modes, suggesting that therapists may use exercises that utilize either exercise mode in their treatment of SAIS. LEVEL OF EVIDENCE: Therapy, level 1b.

Outcomes of total hip arthroplasty: a study of patients one year postsurgery.

STUDY DESIGN: Ex post facto research using prospective analysis of differences between the involved hip and uninvolved hip. OBJECTIVES: To assess outcomes of total hip arthroplasty (THA) by comparing range of motion (ROM), muscle strength, and postural stability in the surgical hip to those of the uninvolved hip 1 year postsurgery. An additional objective was to assess degree of relationship among ROM, strength, and postural stability impairments to a measure of self-assessed function. BACKGROUND: Most patients who have THA receive physical therapy that consists mainly of self-care instructions and an exercise protocol that emphasizes mobility during the acute phase of recovery. But, outcomes of THA 1 year postsurgery indicate that current physical therapy programs used during the acute phase of recovery do not effectively restore physical and functional performance. METHODS AND MEASURES: Subjects consisted of 11 women and 4 men (mean age +/- standard deviation = 62 +/- 8 years) with unilateral THA performed 1 year prior to data collection. Assessment variables consisted of self-assessment of function and measures of postural stability, muscle strength, and hip ROM. The 12-Item Hip Questionnaire was used for self-assessment of function. Three separate repeated measures MANOVA were used to compare the involved side to the uninvolved side in measures of postural stability, strength, and ROM. The Spearman's rho was used to assess degree of association between the subjects' score of self-assessed function and impairments in strength and postural stability. RESULTS: Measures of postural stability were significantly lower (P < or = 0.01) on the side of the replaced hip. Differences in strength values between the involved and uninvolved sides were not statistically significant. Correlations between scores of self-assessed function and hip abductor and knee extensor strength were statistically significant (r = 0.56, P < or = 0.03). Self-assessed function was not significantly correlated to postural stability impairments. CONCLUSION: The brief postsurgical rehabilitation program received by patients with THA may not be sufficient. A second phase of rehabilitation implemented 4 months or more after surgery that emphasizes weight bearing and postural stability may be advisable.

Musculoskeletal risk factors as predictors of injury in community-dwelling women.

BACKGROUND: Participating in health-related physical activity (PA) may increase risk for musculoskeletal injury (MSI). PURPOSE: This study aimed to estimate the prevalence of structural/biomechanical risk factors in community-dwelling women and associated risk for incidence of MSI in women who are physically active. METHODS: The Women's Injury study is a surveillance of PA behaviors and MSI in women age 20-83 yr. An orthopedic examination was performed before entry into the study to assess presence of structural/biomechanical risk factors. A total of 886 women completed data collection by reporting weekly PA behavior and MSI for up to 3 yr (2007-2009), with the average participant enrolled for 98 wk. To estimate MSI risk associated with each risk factor separately, time to first MSI was modeled using proportional hazard regression with time-dependent PA covariates, controlling for age, body mass index, and previous injury. RESULTS: Over the course of the study, 236 of the women (26.6%) reported at least one MSI that was PA related. We found a significant association between the number of high flexibility risk factors and PA-related injury at all levels of PA exposure (HR = 1.15 and confidence interval (CI) = 1.04-1.27 for moderate-to-vigorous PA; HR = 1.16 and CI = 1.05-1.28 for moderate PA; HR = 1.15 and CI = 1.04-1.27 for vigorous PA). CONCLUSIONS: When participating at any level of PA for health benefits, women with hypermobility in multiple muscle groups or joints should be watchful for musculoskeletal symptoms and should be counseled not to ignore symptoms when they first occur.

Prevalence of muscle-strengthening activities in women: the WIN study.

BACKGROUND: Aerobic and muscle-strengthening activities are related to morbidities and mortality. Resistance exercise/strength training items are included in national surveys, but the manner in which muscle-strengthening activity is queried varies among these surveys. PURPOSE: The purpose of this study was to use different self-report measures to examine the prevalence of meeting the 2008 Physical Activity Guidelines for Americans regarding muscle-strengthening activities among women. METHODS: We surveyed 606 community-dwelling women at 4 points in time across a 1.5- to 3-year time period to determine whether the respondents met the national physical activity guidelines for performing muscle-strengthening activities ≥ 2 days per week. RESULTS: Results were consistent across time but depended on the manner in which the question was asked. If asked to reflect over the past month or a general question about the typical number of days engaged, approximately 40% of women reported engaging in ≥ 2 days per week of resistance exercise/strength training. However, when reports were obtained weekly for 13 weeks, only approximately 18% of respondents met the guidelines. CONCLUSION: Results indicate that the timing and nature of questioning can substantially influence the self-reported prevalence of muscle-strengthening physical activities for community-dwelling women.

Meeting physical activity guidelines and musculoskeletal injury: the WIN study.

INTRODUCTION: The United States Department of Health and Human Services disseminated physical activity (PA) guidelines (PAGs) for Americans in 2008. The guidelines are based on appropriate quantities of moderate-to-vigorous aerobic PA and resistance exercise (RE) associated with decreased morbidity and mortality risk and increased health benefits. However, increases in PA levels are associated with increased risk of musculoskeletal injuries (MSIs). We related the amount and type of PA conducted on a weekly basis with the risk of MSI. METHODS: A prospective, observational study using weekly Internet tracking of moderate-to-vigorous PA and RE behaviors and MSIs in 909 community-dwelling women for up to 3 yr was conducted. The primary outcome was self-reported MSIs (total, PA related, and non-PA related) interrupting typical daily work and/or exercise behaviors for ≥ 2 d or necessitating health care provider visit. RESULTS: Meeting versus not meeting PAGs was associated with more MSIs during PA (HR = 1.39, 95% confidence interval [CI] = 1.05-1.85, P = 0.02) but was not associated with MSIs unrelated to PA (HR = 0.99, 95% CI = 0.75-1.29, P = 0.92) or with MSIs overall (HR = 1.15, 95% CI = 0.95-1.39, P = 0.14). CONCLUSIONS: The results illustrate the risk of MSI with PA. MSI risk rises with increasing PA. Despite this modest increase in MSIs, the known benefits of aerobic and resistance PAs should not hinder physicians from encouraging patients to meet current PAGs for both moderate-to-vigorous exercise and RE behaviors with the intent of achieving health benefits.

Effect of stretch positions on hamstring muscle length, lumbar flexion range of motion, and lumbar curvature in healthy adults.

Hamstring stretching is a common practice in physical therapy to change not only hamstring muscle length (HML), but also lumbar flexion range of motion (LROM) or lumbar curvature (LC). Yet limited published research compares the effectiveness of two commonly used hamstring stretch positions, sitting and standing. The purposes of this study were to determine the effect of (1) stretch position on HML; and 2) HML on LROM and LC. Thirty-six participants (M=44.8 years, SD=17.1) with short HML (i.e., with shortness for men ≥45° and for women ≥ 24° of active knee flexion with 90° hip flexion) were measured for HML, LROM, and LC; randomly allocated to one of three groups: (1) hamstring stretching in sitting (SI); (2) standing (ST); or (3) no stretching (control); and remeasured after 4 weeks. Participants in the stretching groups performed two 30-second static stretches 4 days per week for 4 weeks. Multivariate analysis of covariance (MANCOVA) showed significance between the stretching groups and nonstretching group for HML only. Nonsignificance was shown for HML between the stretch positions (i.e., SI-active knee extension (AKE) and ST-AKE), indicating that both were equally effective for increasing HML. However, there was no change in LROM or in LC even though HML increased.