Relationships between Running Biomechanics, Hip Muscle Strength, and Running-Related Injury in Female Collegiate Cross-country Runners.

Background: Female collegiate cross-country (XC) runners have a high incidence of running-related injury (RRI). Limited reports are available that have examined potential intrinsic factors that may increase RRI risk in this population. Purpose: To examine the relationships between RRI, hip muscle strength, and lower extremity running kinematics in female collegiate XC runners. Study Design: Prospective observational cohort. Methods: Participants included twenty female NCAA collegiate XC runners from Southern California universities who competed in the 2019-20 intercollegiate season. A pre-season questionnaire was used to gather demographic information. Hip muscle strength was measured with isokinetic dynamometry in a sidelying open-chain position and normalized by the runner's body weight (kg). Running kinematic variables were examined using Qualisys 3D Motion Capture and Visual 3D analysis. RRI occurrence was obtained via post-season questionnaires. Independent t-tests were used to determine mean differences between injured and non-injured runners for hip abductor muscle strength and selected running kinematics. Pearson correlation coefficients were calculated to examine relationships between hip muscle performance and kinematic variables. Results: End-of-the-season RRI information was gathered from 19 of the 20 participants. During the 2019-20 XC season, 57.9% (11 of 19) of the runners sustained an RRI. There were no significant differences between mean hip abductor normalized muscle strength (p=0.76) or mean normalized hip muscle strength asymmetry (p=0.18) of injured and non-injured runners during the XC season. Similarly, no significant differences were found between mean values of selected kinematic variables of runners who did and who did not report an RRI. Moderate relationships were found between hip abductor strength variables and right knee adduction at footstrike (r=0.50), maximum right knee adduction during stance (r=0.55), left supination at footstrike (r=0.48), right peak pronation during stance (r=-0.47), left supination at footstrike (r=0.51), and right peak pronation during stance (r=-0.54) (all p≤0.05). Conclusions: Hip abduction muscle strength, hip abduction strength asymmetry, and selected running kinematic variables were not associated with elevated risk of RRI in female collegiate XC runners.

Prospective Assessment of Clinical Tests Used to Evaluate Tibial Stress Fracture.

Background: Tibial stress fracture (SFx) is the most common SFx of the lower extremity. Presently, diagnostic accuracy of clinical examination techniques for tibial SFx remains suboptimal. Purpose: To assess the diagnostic effectiveness of 5 clinical tests for tibial SFx individually versus a test item cluster. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 50 patients with tibial pain (17 with bilateral symptoms) were assessed with 5 clinical examination tests (tibial fulcrum test, focal tenderness to palpation, heel percussion test, therapeutic ultrasound test, and 128-Hz tuning fork test) before they underwent diagnostic imaging (radionuclide bone scan). The application of the clinical tests was counterbalanced to minimize the likelihood of carryover effects. Patients provided a pain rating immediately before and after the application of each clinical test. Results: The prevalence of tibial SFx among the study participants was 52.2%. High levels of specificity were produced by the therapeutic ultrasound test (93.8%), tuning fork test (90.6%), and percussion test (90.6%). The fulcrum test had moderate to high specificity (84.4%). All tests demonstrated low levels of sensitivity, with the highest levels found for focal tenderness to palpation (48.6%) and fulcrum (45.7%). The fulcrum test provided the highest positive likelihood ratio (2.93), followed by the therapeutic ultrasound test (2.30). The fulcrum test had the lowest negative likelihood ratio (0.64), with the focal tenderness to palpation and tuning fork tests having negative likelihood ratios >1.0. Combinations of these clinical tests did not improve the prediction of tibial SFx above that observed among the individual tests. Conclusion: The clinical tests evaluated were generally highly specific, but all had low sensitivity. The fulcrum test provided the highest level of diagnostic accuracy; however, it was inadequate for definitive clinical management. Combining tests did not improve the diagnostic accuracy of tibial SFx.

Improving Access and Decreasing Healthcare Utilization for Patients With Acute Spine Pain: Five-Year Results of a Direct Access Clinic.

INTRODUCTION: Spine pain is one of the largest and costliest burdens to our healthcare systems. While evidence-based guidelines for spine pain have been established, and continue to evolve, the actual management of this condition continues to burden the healthcare system. This has led to increased costs due to inefficient entry to healthcare, utilization of treatments unsupported by clinical guidelines, and patient navigation through our healthcare systems. The purpose of this study was to assess the healthcare utilization and related outcomes for Active Duty Service Members (ADSM) receiving healthcare services in a novel acute spine pain clinic (ASPC) during the first 5 years of operation at a large Military Treatment Facility. MATERIALS AND METHODS: In 2014 the Physical Medicine and Rehabilitation and Physical Therapy (PT) services designed a novel acute spine clinic intended to directly receive ADSM with acute spine symptoms for an initial evaluation by a Physical Therapist. The inclusion criteria into the ASPC were: ADSM, pain less than or equal to 7 days, no more than three prior episodes of acute spine pain in the past 3 years, and not currently receiving care from Chiropractic, Pain Management, or PT services. The exclusion criteria were: significant and/or progressive neurological deficits, bowel or bladder dysfunction, unstable vital signs or fever, hematuria or extensive trauma. RESULTS: A total of 1,215 patients presented to the ASPC for evaluation between 2014 and 2019. The most common chief complaint was acute pain in the lumbar spine (73%), followed by cervical spine pain (15%), and thoracic spine pain (12%) represented the fewest. The average number of PT visits per patient was 3.5 (range 1-13) with 61.1% utilizing three or fewer visits. Over 95% of cases returned to work the same day as their initial evaluation. Sixty-six percent returned to work without restriction the same day as their initial evaluation. Light duty recommendations were provided to 412 (33.9%) patients ranging from one to 30 days, with greater than 85% of the light duty being less than 14 days. Recommendations to not return to work (sick-in-quarters) were issued to 56 (4.6%) patients. The sick-in-quarters recommendations were for a 24-hour period in 48 cases, 48 hours for seven cases, and 72 hours for one case. All encounters in which the patient first sought care at the ASPC for low back pain met the Healthcare Effectiveness Data Set standard for low back pain care of having no imaging within 28 days of the first encounter for nonspecific low back pain. A medical record review of 100 randomly selected patients within 12 months of the initial evaluation demonstrated decreased utilization of medication, imaging, and referral to surgical services. CONCLUSIONS: This innovative approach demonstrates the potential benefits of rapid access to treatment and education for patients with acute spine pain by a Physical Therapist. Modeling this approach at Military Treatment Facilities may lead to decreased utilization of medications, radiology services, specialty care referrals, and reduced cost of care provided to individuals with acute spine pain.

Attitudes and beliefs of little league baseball parents regarding sport specialization and college scholarship availability.

OBJECTIVES: Previous studies of parents of adolescent athletes identified a belief among parents of the importance of early specialization for skill development. However, it is unclear if these attitudes and beliefs are also held among parents of baseball athletes, which is the second-most popular boy's sport in the United States. The purpose of this study was to describe the knowledge, attitudes, and beliefs of parents of Little League baseball players regarding sport specialization and college scholarships. METHODS: Two-hundred and forty-four parents of Little League baseball players (female parents: 60.7%, parent age: 41.1 ± 6.2 years old, male children: 98.0%, child age: 9.5 ± 1.6 years old) completed an anonymous online questionnaire regarding parent attitudes and beliefs on sport specialization and college scholarships. RESULTS: Most parents (72.4%) felt that specialization would increase their child's baseball ability either 'quite a bit' or 'a great deal.' Fewer than half of all parents (42.0%) reported that specialization was either 'quite a bit' or 'a great deal' of a problem. Parents underestimated the availability of Division I college baseball scholarship availability (median [IQR]: 5 [4-10]), compared to the actual value of 11.7 scholarships per Division I roster. Only 10.2% of parents (N = 25) reported that they believed it was 'somewhat' or 'very' likely that their child would receive a college baseball scholarship. CONCLUSION: Further efforts are needed to understand parent attitudes and beliefs regarding sport specialization and college scholarships in various sports to better understand current trends in youth sport participation.

Knowledge, Attitudes, and Beliefs of Parents of Youth Basketball Players Regarding Sport Specialization and College Scholarship Availability.

BACKGROUND: Previous surveys of youth sport parents have revealed that while parents believe early sport specialization is beneficial for improving sport ability, they also overestimate their child's chances of receiving a college scholarship. PURPOSE: To (1) describe knowledge, attitudes, and beliefs of parents of youth basketball players regarding sport specialization and college scholarships and (2) examine potential differences in child basketball participation characteristics based on parent income. STUDY DESIGN: Cross-sectional study. METHODS: A total of 805 parents (mean age, 39.9 ± 7.1 years; 353 female [43.9%]) of youth basketball players (mean age, 12.9 ± 2.5 years; 241 female [29.9%]) were recruited via Qualtrics Online Panels to complete an anonymous online questionnaire. Participants were required to be a parent of a child between 8 and 18 years of age who participated in organized youth basketball (ie, school, club, or recreational/local league). Participants were recruited to be nationally representative with regard to race/ethnicity (White, 62.7%; Hispanic/Latino of any race, 15.3%; African American/Black, 13.3%; Asian, 4.6%; ≥2 races, 2.9%; American Indian/Alaskan Native, 1.1%; Native Hawaiian/other Pacific Islander, 0.1%). The questionnaire was adapted from previous research on parent knowledge, attitudes, and beliefs and consisted of 3 sections: (1) parent and child characteristics; (2) child basketball participation information (months per year of basketball participation, sport specialization status, receiving private coaching, traveling regularly for basketball competitions, participating on multiple teams at the same time); and (3) parent attitudes, beliefs, and knowledge regarding sport specialization and college basketball scholarships. RESULTS: Most parents believed specialization increased their child's chances of making a high school (71.4%) or college team (69.7%). Parents underestimated the availability of college basketball scholarships at the National Collegiate Athletics Association (NCAA) Division I and II levels (8.9 ± 5.1 vs reality of 13-15 per team) but overestimated availability at the Division III level (8.6 ± 5.7 vs reality of 0 per team). High-income parents spent significantly more money ($4748 USD [$1214-$10,246]) than middle-income ($2250 USD [$727-$5079]; P < .001) and low-income ($1043 USD [$368-$2444]; P < .001) parents. CONCLUSION: Parents believed specialization was important for sport success, but they underestimated college scholarship availability at the NCAA Division I and II levels while overestimating scholarship availability at the Division III level.

Sport Specialization Behaviors Are Associated With History of Reported Injury in Youth Basketball.

BACKGROUND: There is significant emerging evidence that early sport specialization is a potential risk factor for injury in youth sports. Despite basketball being the most popular youth team sport in the United States, sport specialization research, specifically in youth basketball players, has been limited. The purpose of this paper was to examine the association of sport specialization behaviors with injury history by surveying a nationally representative sample of parents of youth basketball athletes. We hypothesized that athletes who specialized in basketball, participated on multiple teams at the same time, and traveled regularly for basketball competitions would be more likely to report a basketball-related injury in the previous year. METHODS: A nationally representative sample of 805 parents of 805 youth basketball players (female N=241, 29.9%; age: 12.9±2.5 y old) completed an online questionnaire that had 3 sections: (1) parent/child demographics, (2) child basketball participation information for the previous year, and (3) child basketball injury history in the previous year. Multivariate logistic regression examined the associations between variables of interest and injury history, adjusting for covariates. Odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated for the variables of interest from the logistic regression model. RESULTS: Highly specialized athletes were more likely than low specialization athletes to report history of basketball injury in the previous year [OR (95% CI): 2.47 (1.25-4.88), P=0.009]. The odds of reporting an injury in the previous year were twice as great among athletes who played on a basketball team at the same time as another sport team compared with those who played basketball only [OR (95% CI): 1.98 (1.30-3.01), P=0.001]. The odds of reporting an injury in the previous year were 3 times greater among athletes who received private coaching compared with those who did not receive private coaching [OR (95% CI): 2.91 (1.97-4.31), P<0.001]. CONCLUSION: Specialization in basketball, along with several other behaviors that have become typical of modern youth sport participation, were associated with reported injury history. Further prospective research is necessary to determine whether sport specialization behaviors increase the risk of injury in youth basketball. LEVEL OF EVIDENCE: Level III-cross-sectional study.

Comparison of blood flow restriction devices and their effect on quadriceps muscle activation.

OBJECTIVES: Blood flow restriction training (BFRT) provides an alternative approach to traditional strength training. The purpose of this study was to determine differences in quadriceps muscle activation, subject reported pain, and perceived exertion between three exercise conditions: low-load resistance BFRT with (1) regulated and (2) standardized devices, and (3) high-load resistance exercise without BFRT. DESIGN: Randomized cross over study. SETTING: XX University Biomechanics laboratory. PARTICIPANTS: Thirty-four healthy subjects (18 male/16 female) each completed three randomized sessions of knee extensions using Delfi's Personalized Tourniquet System (R) at 30% of 1 repetition maximum (1RM), the B-Strong™ device (S) at 30% 1RM, and high-load resistance exercise (HL) at 80% 1RM. MAIN OUTCOME MEASURES: Quadriceps EMG activity, numeric pain rating scale (NPRS), and perceived exertion (OMNI-RES) were recorded. RESULTS: Average and peak EMG were greater in HL sessions than both S and R (p < .001). NPRS was greater in the R sessions compared to both S (p < .001) and HL (p < .001). OMNI-RES was greater in the R sessions compared to S (p < .02) and HL (p < .001). No differences (p > .05) in average or peak EMG activation were found between S and R sessions. CONCLUSIONS: Quadriceps EMG amplitude was greater during high-load resistance exercise versus low-load BFR exercise and there were no differences in EMG findings between BFRT devices.

Prevalence and Consequences of Sport Specialization Among Little League Baseball Players.

BACKGROUND: Baseball is one of the most popular boy's youth sports, and there has been a rise in the rates of certain overuse injuries among players. Specialization has been identified as a risk factor for overuse injury in high school athlete populations, but there is little understanding of the prevalence or consequences of sport specialization in Little League baseball players. HYPOTHESIS: Sport specialization will be highly prevalent among Little League baseball players and specialization will be associated with worse throwing arm health. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 246 Little League baseball players (male; N = 241; age, 9.5 ± 1.6 years) between 7 and 12 years old completed an anonymous, online questionnaire with their parent's assistance. The questionnaire consisted of participant demographics and baseball participation information, including sport specialization status and the Youth Throwing Score (YTS), a valid and reliable patient-reported outcome measure for youth baseball players. RESULTS: Only 29 (11.8%) players met the criteria for high specialization. Approximately one-third of all players (n = 77; 31.3%) reported participating in baseball year-round or receiving private coaching outside of their league (n = 81; 32.9%). Highly specialized athletes demonstrated worse scores on the YTS on average compared with low-specialization athletes (mean [SE]: 56.9 [1.6] vs 61.1 [1.2]; P = 0.01). Similarly, pitching in the previous year (P < 0.01) or traveling overnight regularly for showcases (P = 0.01) were associated with a worse score on the YTS. CONCLUSION: While the prevalence of high sport specialization was low among Little League baseball players, other behaviors associated with specialization such as year-round play and the receiving of private coaching were more common. Highly specialized Little League players demonstrated worse throwing arm health compared with low-specialization players. CLINICAL RELEVANCE: Little League players and their parents may represent a potential target audience for dissemination campaigns regarding sport specialization.

The association of sport participation behaviors with throwing-arm health in Little League Baseball pitchers.

Background and Hypothesis: There is increasing concern about the role sport specialization might play in the increasing injury rates observed among youth baseball pitchers. However, existing research on specialization in baseball has focused on high school and professional baseball populations. We hypothesized that pitchers who were highly specialized, reported pitching more than eight months in the past year, received private coaching, or pitched with pain or fatigue in the previous year would report worse throwing-arm health. Methods: One-hundred eighty-four Little League pitchers (boys N = 181, age 9.8 ± 1.6 years old) between 7 and 12 years of age completed an anonymous, online questionnaire with their parents' assistance. The questionnaire consisted of participant demographics, sport specialization status, months of pitching per year, whether they traveled regularly to participate in showcases, if they received private coaching, whether they pitched with elbow or shoulder pain, whether they pitched with fatigue, and the Youth Throwing Score (YTS), a valid and reliable patient-reported outcome measure for youth baseball players. The associations between variables of interest and YTS were examined using multivariable linear regression, adjusting for covariates. Results: Sport specialization, pitching year-round, and receiving private coaching were not associated with the YTS (P > .05). Pitching with pain in the previous year was associated with a worse YTS score than pitching without pain (least square mean [standard error]: 49.6 [1.8] vs. 57.8 [1.1], P < .001). Similarly, pitching with fatigue in the previous year was associated with worse YTS scores (least square mean [standard error]: 52.1 [1.4] vs. 55.3 [1.3], P = .01). Pitchers who reported traveling regularly for showcases scored worse on the YTS compared with those who did not travel regularly for showcase events (least square mean [standard error]: 51.0 [2.0] vs. 56.4 [0.9], P = .01). Conclusions: Pitching with pain or fatigue was associated with worse throwing-arm health in Little League baseball pitchers. While traveling at least once a month to participate in showcases was also associated with worse throwing-arm health, specialization and private coaching were not related to worse throwing health. Clinicians working with pediatric patient populations should be aware that while the factors examined in this article were reported relatively infrequently, screening for Little League pitchers who participate in showcases or pitch with pain or fatigue may be an effective strategy for identifying these individuals who are at higher risk of injury.

Sport Specialization and Low Bone Mineral Density in Female High School Distance Runners.

CONTEXT: Sport specialization may contribute to sport injury and menstrual dysfunction in female high school distance runners. Despite the recent growth in sport specialization, including among high school-aged runners, the association of sport specialization with bone mineral density (BMD) remains poorly described. OBJECTIVE: To evaluate whether sport specialization was associated with BMD in female high school distance runners. DESIGN: Cross-sectional study. SETTING: Six high schools. PATIENTS OR OTHER PARTICIPANTS: Sixty-four female runners (age = 15.6 ± 1.4 years) who competed in cross-country or track distance events and were not currently on birth control medication. MAIN OUTCOME MEASURE(S): Each runner completed a survey on menstrual history and sport participation. Height and weight were measured, and dual-energy x-ray absorptiometry was used to measure whole-body, spine, and hip BMD. Each runner was assigned a sport specialization status: low (participation in ≥1 nonrunning sport and distance-running sport(s) for ≤8 mo/y); moderate (participation in both distance-running sport(s) ≥9 mo/y and ≥1 nonrunning sport(s) or limited to distance-running sport(s) for ≤8 mo/y); or high (participation only in distance-running sport(s) for ≥9 mo/y). Multivariable logistic regression was performed to determine the adjusted odds ratio and 95% confidence interval for sport specialization to BMD values, adjusting for body mass index and gynecological age. RESULTS: Overall, 21.9%, 37.5%, and 40.6% of participants were high, moderate, or low sport specializers, respectively. Low BMD (spine or whole-body BMD z score < -1.0 [standardized by age and sex normative values]) was present in 23 (35.9%) runners. Compared with low sport specializers, high sport specializers were 5 times more likely (adjusted odds ratio = 5.42, 95% confidence interval = 1.3, 23.3; P = .02) to have low BMD. CONCLUSIONS: A high level of sport specialization in high school female distance runners may be associated with a heightened risk for low BMD. Further investigation of this association is warranted due to the health concerns about low BMD in adolescent female runners.

Upper Extremity Effort Thrombosis.

A 23-year-old, right hand-dominant, male active-duty Marine self-referred to physical therapy with dull right anterior shoulder pain. The physical therapist referred the patient for a diagnostic ultrasound to rule out effort thrombosis of the axillary and subclavian veins. Same-day Doppler ultrasonography revealed an occlusive thrombus in the middle subclavian and axillary veins. J Orthop Sports Phys Ther 2020;50(9):532. doi:10.2519/jospt.2020.9585.

Popliteal Artery Entrapment Syndrome.

A 37-year-old military service-member was referred to physical therapy with a greater-than-6-month history of low back pain with intermittent and worsening left posterolateral lower-leg pain and paresthesia with activity. He was diagnosed by his primary care physician with exertional compartment syndrome and referred to orthopaedic services. Following examination, the physical therapist ordered a duplex ultrasound, which demonstrated an anomaly at the popliteal artery, resulting in a diagnosis of popliteal artery entrapment syndrome, confirmed by computed tomography angiography and magnetic resonance imaging. J Orthop Sports Phys Ther 2020;50(9):531. doi:10.2519/jospt.2020.9568.

Attitudes and Beliefs towards Sport Specialization, College Scholarships, and Financial Investment among High School Baseball Parents.

Adolescent athletes are increasingly encouraged to specialize in a single sport year-round in an effort to receive a college scholarship. For collegiate baseball, only 11.7 scholarships are available for a 35-player team. The beliefs of the parents of baseball athletes towards sport specialization are unknown, along with whether they have an accurate understanding of college baseball scholarship availability. The parents of high school baseball athletes were recruited to complete an anonymous questionnaire that consisted of (1) parent and child demographics, (2) child baseball participation information, and (3) parent attitudes and beliefs regarding sport specialization and college baseball scholarships. One hundred and fifty-five parents participated in the questionnaire (female: 52.9%, age: 49.4 ± 5.5 years old). The parents spent a median of 3000 USD [Interquartile Range (IQR): 1500-6000] on their child's baseball participation. Most parents believed that specialization increased their child's chances of getting better at baseball (N = 121, 79.6%). The parents underestimated the number of college baseball scholarships available per team (median [IQR]: 5 [0-5]), but 55 parents (35.9%) believed it was likely that their child would receive a college baseball scholarship. Despite having a realistic understanding of the limited college scholarships available, the parents were optimistic that their child would receive a baseball scholarship.

LOWER QUARTER- AND UPPER QUARTER Y BALANCE TESTS AS PREDICTORS OF RUNNING-RELATED INJURIES IN HIGH SCHOOL CROSS-COUNTRY RUNNERS.

BACKGROUND: While cross-country running is a popular interscholastic sport, it also has a high incidence of running-related injuries (RRIs). Recent literature suggests that functional tests may identify athletes at increased risk of injury. The Y-Balance Test (YBT) is an objective measure used to assess functional muscle strength, balance, and expose asymmetries between tested limbs. PURPOSE/HYPOTHESIS: The purpose of this study was to determine if the YBT could predict RRI in high school cross-country runners. It was hypothesized that an asymmetric right (R)/left (L) YBT reach distance for the lower or upper extremities would be associated with an increased risk of RRI. STUDY DESIGN: Prospective observational cohort. METHODS: One hundred forty-eight athletes (80 girls, 68 boys) who competed in interscholastic cross-country in Southern California during the 2015 season participated in the study. Prior to the cross-country season, the runners completed Lower-Quarter YBT (LQ-YBT) and Upper-Quarter YBT (UQ-YBT) testing to assess lower and upper extremity asymmetry, respectively. The runners were prospectively monitored for RRI occurrence throughout the season using the Daily Injury Report form. RESULTS: Forty-nine runners (33.1%) incurred a RRI during the 2015 season, with the lower leg (shin/calf) and knee the most common RRI sites. Girls had a higher RRI occurrence (38.8%) than boys (26.5%) (p = 0.12). Boys had greater raw scores for LQ-YBT R and L anterior (ANT), posteromedial (PM), posterolateral (PM) and composite reach distances than girls (p<0.05). With the exception of normalized superolateral reach distance, boys had significantly greater scores for raw and normalized R and L UQ-YBT reach distances and raw composite scores than girls (p<0.05). After adjusting for prior RRI, while boy runners with a LQ-YBT PM reach difference ≥4.0 cm were five times more likely to incur a RRI (Adjusted odds ratio [AOR] = 5.05, 95% CI: 1.3-19.8; p = 0.02), girl runners with a UQ-YBT inferolateral (IL) reach difference ≥ 4.0 cm were 75% less likely to incur a RRI (AOR = 0.25, 95% CI: 0.1-0.7; p = 0.005). By lower extremity body region, boy runners with a UQ-YBT superolateral (SL) reach difference ≥ 4.0 cm were seven times more likely to incur a hip/thigh/knee RRI [AOR] = 7.20, 95% CI: 1.1-45.6; p = 0.002). CONCLUSION: Greater lower extremity (PM) or upper extremity (SL) reach distance asymmetry, as measured by the LQ-YBT or UQ-YBT, respectively, were associated with RRI in boy high school cross-country runners. LEVEL OF EVIDENCE: 2b.

The effects of cryotherapy on quadriceps electromyographic activity and isometric strength in patient in the early phases following knee surgery.

PURPOSE: To determine the effects of cryotherapy on quadriceps electromyographic (EMG) activity and isometric strength in early postoperative knee surgery patients. METHODS: Twenty-two volunteers with recent knee surgeries were included. EMG readings of the vastus medialis (VM), rectus femoris (RF), and vastus lateralis (VL) from the surgical leg were collected during a maximal voluntary quadriceps setting (QS) activity. Maximum isometric knee extension force measurements were also recorded. Subjects were randomly assigned to receive an ice bag or a sham room-temperature bag to the front of their postsurgical knee for 20 min. After treatment, the subjects repeated the above mentioned maximum QS and isometric knee extension force measurements. The subjects returned 24 h later to conduct the same test protocol but received the treatment (ice or sham) not applied during their first test session. RESULTS: A 38% increase in VM EMG activity during QS and a 30% increase in maximum isometric knee extension strength were found after cryotherapy treatment. No significant differences were found in RF or VL EMG activity during QS after cryotherapy. No significant differences were found in any measurements after the sham treatment. CONCLUSION: Clinicians should consider applying ice to knee joints prior to exercise for patients following knee surgery with inhibited quadriceps.

Physical Therapists Forward Deployed on Aircraft Carriers: A Retrospective Look at a Decade of Service.

Introduction: Navy physical therapists (PTs) have been a part of ship's company aboard Aircraft Carriers since 2002 due to musculoskeletal injuries being the number one cause of lost duty time and disability. This article describes a decade of physical therapy services provided aboard aircraft carriers. Materials and Methods: A retrospective survey was conducted to evaluate the types of services provided, volume of workload, value of services provided, and impact of PTs on operational readiness for personnel aboard Naval aircraft carriers. Thirty-four reports documenting workload from PTs stationed onboard aircraft carriers were collected during the first decade of permanent PT assignment to aircraft carriers. Results: This report quantifies a 10-yr period of physical therapy services (PT and PT Technician) in providing musculoskeletal care within the carrier strike group and adds to existing literature demonstrating a high demand for musculoskeletal care in operational platforms. A collective total of 144,211 encounters were reported during the 10-yr period. The number of initial evaluations performed by the PT averaged 1,448 per assigned tour. The average number of follow-up appointments performed by the PT per tour was 1,440. The average number of treatment appointments per tour provided by the PT and PT technician combined was 1,888. The average number of visits per patient, including the initial evaluation, was 3.3. Sixty-five percent (65%) of the workload occurred while deployed or out to sea during training periods. It was estimated that 213 medical evacuations were averted over the 10-yr period. There were no reports of adverse events or quality of care reviews related to the care provided by the PT and/or PT technician. Access to early PT intervention aboard aircraft carriers was associated with a better utilization ratio (lower average number of visits per condition) than has been reported in prior studies and suggests an effective utilization of medical personnel resources. Conclusions: The impact of Navy PTs serving afloat highlights the importance of sustaining these billets and indicates the potential benefit of additional billet establishment to support operational platforms with high volumes of musculoskeletal injury. Access to early PT intervention can prevent and rehabilitate injuries among operational forces, promote human performance optimization, increase readiness during war and peace time efforts, and accelerate rehabilitation from neuromusculoskeletal injuries. With the establishment of Electronic Health Records within all carrier medical groups a repeat study may provide additional detail related to musculoskeletal injuries to guide medical planners to staff sea-based operational platforms most effectively to care for the greatest source of battle and disease non-battle injuries and related disability in the military.

Differences in Knee and Hip Adduction and Hip Muscle Activation in Runners With and Without Iliotibial Band Syndrome.

BACKGROUND: Iliotibial band syndrome has been associated with altered hip and knee kinematics in runners. Previous studies have recommended further research on neuromuscular factors at the hip. The frontal plane hip muscles have been a strong focus in strength comparison but not for electromyography investigation. OBJECTIVE: To compare hip surface electromyography, and frontal plane hip and knee kinematics, in runners with and without iliotibial band syndrome. DESIGN: Observational cross-sectional study. SETTING: Biomechanics research laboratory within a university. PARTICIPANTS: Thirty subjects were recruited consisting of 15 injured runners with iliotibial band syndrome and 15 gender-, age-, and body mass index-matched controls. In each group, 8 were male runners and 7 were female runners. Inclusion criteria for the injured group were pain within 2 months related to iliotibial band syndrome and a positive Noble compression test. Participants were excluded if they reported other lower extremity diagnoses within the last year or active lower extremity or low back pain not related to iliotibial band syndrome. Controls were excluded if they reported a history of iliotibial band syndrome. Convenience sampling was used based on referrals from local running clinics and orthopedic clinics. METHODS: Three-dimensional motion capture was performed with 10 high-speed cameras synchronized with wireless surface electromyography during a 30-minute run. The first data point was at 3 minutes, using a constant speed of 2.74 meters per second. A second data point was at 30 minutes, using a self-selected pace by the participant to allow for a challenging run until completion at 30 minutes. MAIN OUTCOME MEASUREMENTS: Motion capture was reported as peak kinematic values from heel strike to peak knee flexion for hip adduction and knee adduction. Surface electromyography was reported as a percentage of maximal voluntary contraction for the gluteus maximus, gluteus medius and tensor fascia latae muscles. RESULTS: Injured runners demonstrated increased knee adduction compared with control runners at 30 minutes (P = .002, control = -1.48°, injured = 3.74°). Tensor fasciae latae muscle activation in injured runners was increased compared with control runners at 3 minutes (P = .017, control = 7% maximal voluntary isometric contraction, injured = 11% maximal voluntary isometric contraction). CONCLUSION: The results of this study suggest that lateral knee pain in runners localized to the distal iliotibial band is associated with increased knee adduction at 30 minutes. Increased tensor fasciae latae muscle activation at 3 minutes is noted, but more investigation is needed to better understand the clinical meaning. These findings are consistent with but not conclusive evidence supporting the theory that neuromuscular factors of the hip muscles may contribute to increased knee adduction in runners with iliotibial band syndrome. We advise caution using these findings to support treatments intended to modify tensor fasciae latae activation, given the small differences of 4% in muscle activation. Increased knee adduction in runners at 30 minutes was over 5° and beyond the minimal detectable difference. Additional research is needed to confirm whether the degree of knee adduction changes earlier versus later in a run and whether fatigue is a clinically relevant factor. LEVEL OF EVIDENCE: III.

Cervical Spine Fracture With Vertebral Artery Dissection.

A 51-year-old man presented to a direct-access physical therapy clinic with persistent neck pain for 5 days after a fall in shallow water while surfing. Based on "dangerous mechanism of injury" from the Canadian cervical spine rule as being a high risk factor, the physical therapist ordered radiographs of the cervical spine, which were suggestive of a more serious injury. Computed tomography suggested and magnetic resonance imaging confirmed vertebral artery dissection. J Orthop Sports Phys Ther 2016;46(10):929. doi:10.2519/jospt.2016.0416.

Chondrosarcoma of the Hip.

The patient was a 27-year-old woman who was being evaluated by a physical therapist 1 month following a right Achilles tendon repair. She reported the presence of a painful firm mass in her left hip that she first noticed approximately 6 months prior. As an initial assessment of the mass, the physical therapist ordered radiographs of the left hip, which revealed a mass projecting off the left lateral iliac bone. The radiologist recommended contrast-enhanced magnetic resonance imaging for further characterization, which revealed a large lobulated mass that was consistent with an osteochondroma.

Upper extremity deep venous thrombosis.

The patient was a 34-year-old man currently serving in the military who was referred to a physical therapist by his primary care physician for a chief complaint of worsening right shoulder pain and paresthesias of the first, second, and third digits of his right hand, as well as right upper extremity swelling. Doppler ultrasonography was performed, and the presence of an occlusive thrombus in the right distal subclavian and axillary veins was revealed.