The Impact of Tennis and Golfer's Elbow on Shoulder External Rotators and Abductors' Peak Torque.

CONTEXT: Upper limb activities require a repetitive movement of the shoulder external rotator and abductor muscles. The malfunction of the proximal part of the upper limb kinetic chain tends to change the mechanics of the distal part and increase the risk of injuries. OBJECTIVES: To compare the normalized eccentric peak torque (NEPT) of the shoulder external rotator and abductor muscles among healthy athletes and those with tennis elbow and golfer's elbow. DESIGN: An experimental cross-sectional study. SETTING: Isokinetic laboratory, Faculty of Physical Therapy, Cairo University. PARTICIPANTS: A total of 30 male athletes participated voluntarily in this study. INTERVENTION: Participants were distributed into 3 groups: healthy group, tennis elbow group, and golfer's elbow group. MAIN OUTCOME MEASURES: NEPT of shoulder abductors and external rotators. The Biodex Isokinetic Dynamometer was used to measure the variables of interest. RESULTS: There was a significant increase in the NEPT of shoulder abductors and external rotators in healthy control group compared with both tennis elbow and golfer's elbow groups at an angular velocity of 60°/s (P < .05). Moreover, there was a significant increase in the NEPT of shoulder external rotators and abductors at an angular velocity of 120°/s in healthy control group compared with tennis elbow group and in golfer's elbow group compared with tennis elbow group (P < .05). CONCLUSION: Tennis elbow and golfer's elbow are associated with decreased NEPT of shoulder external rotators and abductors compared with those of healthy athletes. This tends to decrease the external stability of the shoulder joint and put high stress on the distal joints of the upper kinetic chain.

Axillary Ultrasound and Laser Combined With Postisometric Facilitation in Treatment of Shoulder Adhesive Capsulitis: A Randomized Clinical Trial.

OBJECTIVES: The purpose of this study was to compare axillary ultrasound, laser, and postisometric facilitation technique with standard care in the management of shoulder adhesive capsulitis. METHODS: This is a randomized clinical trial study. Fifty-nine participants with shoulder adhesive capsulitis were selected and randomly assigned for eligibility. Forty-five participants were assigned into 3 equal groups of 15, and 14 participants were excluded from the study. The participants were blinded to their group allocation. Standard care group (A) received traditional physical therapy treatment in the form of pulsed ultrasound, scanning laser, supervised exercise program, and home exercise program; group B received the same physical therapy program as group A, except that the ultrasound and scanning laser were applied to the axillary region of the painful shoulder; and group C received the same modified physical therapy program as group B plus postisometric facilitation technique to the painful shoulder. All dependent variables were measured by the second author, who was blinded to the participant's intervention group. The first author administered treatment to all 3 groups. All participants received 12 sessions (3 times/wk for 4 weeks). Pain level and shoulder range of motion (ROM; flexion, abduction, and external rotation) were recorded 3 times (pretreatment, immediately posttreatment, and 4 weeks of treatment). RESULTS: Mixed-design multivariate analysis of variance indicated significant pain reduction with significant ROM increase in all groups posttreatment and after 4 weeks. Post hoc analysis for within groups revealed that shoulder ROM and pain levels improved significantly posttreatment compared with pretreatment ROM in all groups, with the greatest improvement in group C. Between-group analysis revealed that pain-free shoulder flexion, abduction, external rotation, and pain level improved significantly in group C compared with groups A and B immediately after treatment and after 4 weeks of follow-up (P < .05). Improvements reported in group B is more than in group A, and C is more than in groups A and B. CONCLUSIONS: Combining axillary ultrasound and laser with postisometric facilitation had a greater effect in reducing pain and improving shoulder ROM in patients with shoulder adhesive capsulitis compared with axillary ultrasound and laser with traditional exercise.

Efficacy of virtual reality-based balance training versus the Biodex balance system training on the body balance of adults.

[Purpose] This study investigated efficacy of virtual reality (VR)-based balance training on enhancing balance and postural reactions of adults as a low-cost new modality compared to the established Biodex Balance System (BBS). [Subjects] Thirty normal adults of both genders were divided randomly into two equal-sized experimental groups of 15: BBS balance training and VR balance training. [Methods] The training programmes were conducted in 12 sessions, three 15-min sessions per week. The Nintendo(®) Wii Fit Plus (NWFP) and its balance board were used to train of the VR group. Each participant answered a questionnaire concerning usability, enjoyment, balance improvement, and fatigue at the end of the training programs. [Results] The study found a significant increase the measure of mean overall balance (OLB) in both groups. No significant difference was found between the groups, but a significant decrease in the mean balance-test time was found for both groups, with no significant difference between the two training methods. The VR programme was rated highly enjoyable by 81.8% of the group. [Conclusion] The Wii Fit Plus system with the balance board as a new VR balance-training technique, can be considered an effective and enjoyable tool for the training of adults' body balance.

Effect of Wiihabilitation on strength ratio of ankle muscles in adults.

[Purpose] This study was conducted to investigate the effect of Wiihabilitation on the ankle dorsiflexion/plantar flexion strength ratio in adults. [Subjects and Methods] Thirty-two healthy male volunteers were randomly assigned to two equal groups (experimental and control). Participants in the experimental group received a Wiihabilitation training program for six weeks. Data were collected using a Biodex system 3 Isokinetic dynamometer. Peak torques of the dorsiflexors and plantar flexors were measured at an angular velocity of 60°/sec which in turn were used to derive the ankle dorsiflexion/plantar flexion strength ratio. [Results] The mean values of the ankle dorsiflexion/plantar flexion strength ratio decreased significantly between before and after the training in the experimental group, meanwhile there was no significant difference between before and after the training period in the control group . [Conclusion] Wiihabilitation has an impact on the ankle dorsiflexion/plantar flexion strength ratio, so it can be considered an effective training tool in terms of the ankle strength ratio. Thus, it could be recommended for both prevention and rehabilitation of ankle instability patients.

Validity and reliability of the Arabic version of the Identification of Functional Ankle Instability questionnaire (IdFAI-Ar) in college-aged population.

OBJECTIVES: The aims of this work are to culturally adapt the Identification of Functional Ankle Instability questionnaire (IdFAI) into Arabic language and to examine its psychometrics. DESIGN: Cross-sectional study. SETTING: This research took place at Cairo University in Egypt. PARTICIPANTS: Twenty eight college-aged students participated in the translation and cultural adaptation, while another 86 college-aged students participated in the measurements (validity and reliability). MAIN OUTCOME MEASURES: The original IdFAI was translated into Arabic language using standard guidelines. The Arabic version of the IdFAI (IdFAI-Ar) and the Arabic version of the Lower Extremity Functional Scale (LEFS-Ar) were applied to 86 college-aged students with and without functional ankle instability. The IdFAI-Ar was tested on two occasions with an interval of one week to investigate its psychometrics. RESULTS: The IdFAI-Ar had a moderate correlation with LEFS-Ar and a strong correlation with ankle status classification. The reliability and internal consistency were excellent. The accuracy, sensitivity, and specificity were 0.91, 0.80, and 0.99 respectively. CONCLUSION: The IdFAI-Ar has high validity and reliability. It can be used in clinical and research practices as a region-specific tool to discriminate between participants with and without functional ankle instability in the Arabic-speaking countries.

Percentage Contribution of Lower Limb Moments to Vertical Ground Reaction Force in Normal Gait.

OBJECTIVE: The purpose of this study was to investigate how the hip, knee, and ankle moments in the sagittal plane contribute to the vertical ground reaction force (GRF) in healthy participants during normal speed of walking. METHODS: Forty healthy male individuals volunteered to participate in this study. They were filmed using 6 high-speed (120 Hz) Pro-Reflex infrared cameras (Qualisys) while walking on an Advanced Mechanical Technology Incorporation force platform. The data collected were the percentage contribution of the moments of the hip, knee, and ankle joints in the sagittal plane at the instant of occurrence of the first peak, second peak, and trough of the vertical GRF. RESULTS: The results revealed that at the first peak of the GRF (loading response), the highest contribution was generated from the knee extension moment followed by the hip extension moment. Knee flexion and ankle plantar flexion moments produced a high contribution to the trough of the GRF (midstance) with approximately equal values. The second peak of the GRF was mainly produced by the ankle plantar flexion moment. CONCLUSION: The role of hip extension moment is secondary to knee extension moment in the first peak of GRF. Knee flexion moment is secondary to ankle plantar flexion moment in the second peak of GRF. Both knee flexion and ankle plantar flexion moments have equal contribution during midstance.