The Effects of Whole Body Vibration on the Limits of Stability in Adults With Subacute Ankle Injury.

BACKGROUND: Limited research exists on the effects of both high and low frequency whole body vibration (WBV) on individuals with subacute lateral ankle sprains. HYPOTHESIS/PURPOSE: To examine the difference in the effects of high and low frequency WBV on limits of stability (LOS) in adults with a subacute ankle sprain. It was hypothesized that WBV would improve effects on outcome variables for LOS as a component of dynamic balance. STUDY DESIGN: Quasi-experimental, pretest-posttest design. METHODS: Fifteen participants ages 19-27 years (Mean age 22±2.36) with either a Grade I or Grade II lateral ankle sprain received WBV in bilateral stance under three randomized conditions (high frequency-25 Hz, low frequency-6 Hz, and control, which consisted of bilateral stance with machine off) for six minutes over three sessions (one time per week). The LOS test, consisting of 5 variables, were assessed using the NeuroCom® Balance Manager-SMART EquiTest® (Natus Medical Incorporated, Pleasanton, CA) at baseline and after the intervention period. The participants completed a practice LOS test and then had a six-minute standing rest break. After the rest break, they completed the pre-LOS (baseline) test. Intervention was administered using the Galileo® Med L Chip Research (Novotec Medical GmbH, Pforzheim, Germany) for six minutes for the appropriate condition of either high or low frequency WBV or control. Data analysis was performed using 2-Way (2x3) Repeated Measures ANOVAs with additional post hoc testing as needed. RESULTS: Significant interactions were found for reaction time (RT), movement velocity (MVL), and maximal excursion (MXE) composite scores with a decrease in RT of 0.117 seconds (p=0.022) between control and high frequency conditions during the post LOS. For composite MVL, an increase of 0.547 degrees/second (p=0.002) between pre- and post-high frequency WBV occurred. For composite MXE, an increase of 2.13% p=0.031 (when comparing pre- and post-high frequency WBV. CONCLUSION: Findings suggest that a single session of high frequency WBV in individuals with a subacute lateral ankle sprain may result in improvement in several components of postural stability. WBV is a quick intervention that could be implemented in physical therapy clinics, athletic training rooms, and workout facilities to improve an individual's LOS as a component of dynamic balance one to eight weeks post lateral ankle sprain. LEVEL OF EVIDENCE: 2b.

Sport simulation as a form of implicit motor training in a geriatric athlete after stroke: a case report.

Background and Purpose: To describe the use of sport simulation activities as a form of implicit motor learning training with a geriatric former athlete following a stroke.Case Report: An active 76-year-old former professional male softball player presented to outpatient physical therapy with medical history of right stroke with left hemiparesis 2 weeks following onset of symptoms of impaired balance, coordination, gait, and motor planning. Initial physical therapy included gait, balance, and coordination training. Additional sport-related balance and coordination activities were later added to the treatment plan.Outcomes: After approximately 3 weeks of treatment, the patient was able to return to work and had dramatically improved balance, coordination, and gait with sport simulation activities.Discussion: Implicit motor learning techniques were incorporated through sport and job task simulation activities along with task-oriented neuromuscular reeducation. The patient demonstrated improvements with gait, balance, gross motor function, and decreased fall risk.

THE EFFECTS OF WHOLE BODY VIBRATION ON VERTICAL JUMP, POWER, BALANCE, AND AGILITY IN UNTRAINED ADULTS.

BACKGROUND: Despite the increased use of whole body vibration among athletes, there is limited literature on its acute effects within heterogeneous populations such as untrained adults or recreational athletes. HYPOTHESIS/PURPOSE: The purpose of this study was to investigate the acute effects of whole body vibration on vertical jump, power, balance, and agility for untrained males and females. It was hypothesized that there would be an effect on each outcome variable. STUDY DESIGN: Quasi-experimental, pretest-posttest design. METHODS: Twenty males and sixteen females, mean age 24.5 years, were assessed for vertical jump height and power as measured by the Myotest accelerometer, balance as measured by the NeuroCom Balance Master System, and agility as measured by a modified T-test. Each session consisted of a five-minute treadmill warm-up, a practice test, a baseline measurement, a two-minute rest period, whole body vibration at 2 mm and 30 Hz for 60 seconds, and a final measurement. Three different counterbalanced testing sessions were separated by a minimum of 48 hours in between sessions to minimize fatigue. RESULTS: Significant differences existed for both genders for main effect of time for Agility (p = 0.022); end point excursion Left (p = 0.007); and maximum endpoint excursion Left (p = 0.039). Differences for main effect of gender revealed females performed better than males in the following respects: end point excursion Right (p = 0.035); end point excursion Left (p = 0.014); maximum endpoint excursion Right (p = 0.024); and maximum endpoint excursion Left (p = 0.005). Males performed better than females in two respects: Agility (p < 0.0005) and Power (p < 0.0005). A significant interaction was observed between time and gender for vertical jump (p = 0.020). Simple main effects revealed males jumped higher than females during both pre and post intervention, p < 0.0005. Females had a significant decrease in the vertical jump post intervention (p = 0.05). CONCLUSION: Results indicated that whole body vibration produced significant differences in the main effect of time and agility, and end point and maximum end point excursion Left for both genders, acutely. Females performed better in balance compared to males and poorer in vertical jump, but males performed better in agility and power.

Differential diagnosis of knee pain following a surgically induced lumbosacral plexus stretch injury. A case report.

Background and Purpose: Knee joint biomechanics requires an understanding of lower extremity (LE) segmental interactions. In some cases, knee pain may arise as a result of altered LE biomechanics; while in other cases, knee pain may stem from other causes, such as a peripheral nerve injury. Case Description: A 33-year-old woman presented via direct access for physical therapist (PT) examination with a chief complaint of left knee pain. The day after undergoing a dilation and curettage (D&C) procedure the patient had an acute onset of gait dysfunction. Over the next few days, the patient developed left anterior knee pain (7/10 at worst) in addition to a significant change in physical functioning (Lower Extremity Functional Scale [LEFS] 38/80). Physical examination revealed left LE weakness, altered sensation, and an absent Achilles deep tendon reflex. Outcomes: The patient's presentation was consistent with a lumbosacral plexus stretch injury, with S1 being most affected. A physiatrist was consulted and recommended initiating PT treatment with bi-weekly re-examination. The 6-week (14 visits) re-examination revealed abolished left knee pain and improved physical functioning (LEFS 66/80). Conclusion: Stretch injuries are a known complication of lithotomy positioning. Knowledge of this and the addition of a thorough examination allowed the PT to identify the possible cause of the patient's abrupt onset of left LE dysfunction. Regardless of mode of patient access, screening for referral is crucial and may include referral or, as in this case, consultation with other professionals.

Relative and Absolute Reliability of the Professionalism in Physical Therapy Core Values Self-Assessment Tool.

Development of professional behaviors in Doctor of Physical Therapy (DPT) students is an important part of professional education. The American Physical Therapy Association (APTA) has developed the Professionalism in Physical Therapy Core Values Self-Assessment (PPTCV-SA) tool to increase awareness of personal values in practice. The PPTCV-SA has been used to measure growth in professionalism following a clinical or educational experience. There are few studies reporting psychometric properties of the PPTCV-SA. The purpose of this study was to establish properties of relative reliability (intraclass correlation coefficient, iCC) and absolute reliability (standard error of measurement, SEM; minimal detectable change, MDC) of the PPTCV-SA. in this project, 29 first-year students in a DPT program were administered the PPTCVA-SA on two occasions, 2 weeks apart. Paired t-tests were used to examine stability in PPTCV-SA scores on the two occasions. iCCs were calculated as a measure of relative reliability and for use in the calculation of the absolute reliability measures of SEM and MDC. Results of paired t-tests indicated differences in the subscale scores between times 1 and 2 were non-significant, except for three subscales: Altruism (p=0.01), Excellence (p=0.05), and Social Responsibility (p=0.02). iCCs for test-retest reliability were moderate-to-good for all subscales, with SEMs ranging from 0.30 to 0.62, and MDC95 ranging from 0.83 to 1.71. These results can guide educators and researchers when determining the likelihood of true change in professionalism following a professional development activity.

SCREENING FOR REFERRAL BY A SPORTS PHYSICAL THERAPIST REVEALS AN EFFORT THROMBOSIS IN A COLLEGIATE PITCHER: A CASE REPORT.

BACKGROUND AND PURPOSE: Screening for referral, regardless of setting, is the responsibility of all physical therapists. A serious condition that sports physical therapists may encounter is upper extremity (UE) deep venous thrombosis (DVT), which can result in the important and sometimes fatal complication of pulmonary embolism. CASE DESCRIPTION: A 22 year-old male right-hand dominant collegiate pitcher was referred for physical therapist evaluation and treatment secondary to acute right UE pain and swelling. The athlete described the onset of these symptoms as insidious, denying any form of trauma. The athlete had undergone testing, which included UE Doppler ultrasound of the bilateral UE veins and a computed tomography (CT) scan of the chest without contrast; both of which were deemed negative. He was subsequently diagnosed with thoracic outlet syndrome and referred to the team physical therapist. After examination, the physical therapist hypothesized the athlete was presenting with a possible vascular compromise. Findings leading to this decision were: 1) insidious onset, 2) inability to account for the athlete's pain with ROM, strength, neurological, or provocation testing, 3) significant swelling of the right UE (arm and forearm), 4) increased discomfort with palpation in the supraclavicular region, and 5) history of strenuous UE use. OUTCOMES: The athlete was referred back to the orthopedist. A venogram CT was ordered, which revealed an axillary and subclavian DVT and the presence of venous collaterals. The athlete was referred to a vascular surgeon who performed a right first rib removal. The athlete was able to complete post-operative rehabilitation and successfully return to competitive throwing the following spring. DISCUSSION: The delay in the initial diagnosis may have been due to the vague symptomology associated with venous complications and negative findings upon initial diagnostic testing. CONCLUSION: This case report highlights the importance of subjective and physical examination findings and use of diagnostic testing for timely identification of an UE DVT. Ultimately, the physical therapist in this case was able to screen for referral, which led to the correct diagnosis and allowed the athlete to safely and successfully return to sport. Physical therapists should include effort thrombosis in their upper quarter differential diagnosis list for athletes who perform strenuous UE activity. LEVEL OF EVIDENCE: 4.

Validity of measuring leg length with a tape measure compared to a computed tomography scan.

A frequently used technique to measure leg length (LL) is the supine tape measure method (TMM). However, radiographic imaging, more recently computed tomography (CT) scans, has been considered the most accurate. The purpose of this study was to assess the validity of the TMM for measuring LL compared to CT scans. Additionally, intrarater and interrater reliability of the TMM were assessed. LL measurements of 30 adults (mean  =  38.4 years, SD  =  13.1 years) were obtained by two physical therapists (PT) using the TMM method, anterior superior iliac spine (ASIS) to medial malleoli. Lower extremity CT scans were completed and subsequent LL measurements were obtained. The validity of a single TMM LL compared to CT scan was ICC(2,1) of 0.984 for examiner 1 and 0.978 for examiner 2, while the ICC(2,2) validity of the mean of two measures was 0.992 and 0.990, respectively. Excellent intrarater (ICC3,2 of 0.990 and 0.985) and interrater reliability (ICC2,1 of 0.991) were also found. The supine TMM for measuring LL was shown to have excellent validity when compared to CT scans and excellent intrarater and interrater reliability. These results indicate that the supine TMM is a valid and reliable clinical measurement for PTs when measuring LL.

Effects of foot strike on low back posture, shock attenuation, and comfort in running.

PURPOSE: Barefoot running (BF) is gaining popularity in the running community. Biomechanical changes occur with BF, especially when initial contact changes from rearfoot strike (RFS) to forefoot strike (FFS). Changes in lumbar spine range of motion (ROM), particularly involving lumbar lordosis, have been associated with increased low back pain. However, it is not known if changing from RFS to FFS affects lumbar lordosis or low back pain. The purpose of this study was to determine whether a change from RFS to FFS would change lumbar lordosis, influence shock attenuation, or change comfort levels in healthy recreational/experienced runners. METHODS: Forty-three subjects performed a warm-up on the treadmill where a self-selected foot strike pattern was determined. Instructions on running RFS/FFS were taught, and two conditions were examined. Each condition consisted of 90 s of BF with RFS or FFS, order randomly assigned. A comfort questionnaire was completed after both conditions. Fifteen consecutive strides from each condition were extracted for analyses. RESULTS: Statistically significant differences between FFS and RFS shock attenuation (P < 0.001), peak leg acceleration (P < 0.001), and overall lumbar ROM (P = 0.045) were found. There were no statistically significant differences between FFS and RFS in lumbar extension or lumbar flexion. There was a statistically significant difference between FFS and RFS for comfort/discomfort of the comfort questionnaire (P = .007). There were no statistically significant differences between other questions or the average of all questions. CONCLUSION: Change in foot strike from RFS to FFS decreased overall ROM in the lumbar spine but did not make a difference in flexion or extension in which the lumbar spine is positioned. Shock attenuation was greater in RFS. RFS was perceived a more comfortable running pattern.

The acute effects of various types of stretching static, dynamic, ballistic, and no stretch of the iliopsoas on 40-yard sprint times in recreational runners.

BACKGROUND AND PURPOSE: The potential adverse effects of static stretching on athletic performance are well documented, but still appears to be controversial, especially as they relates to sprinting. The prevalence of this practice is demonstrated by the number of competitive and recreational athletes who regularly engage in stretching immediately prior to sprinting with the mindset of optimizing their performance. The purpose of this study was to examine the effects of acute static, dynamic, and ballistic stretching, and no stretching of the iliopsoas muscle on 40-yard sprint times in 18-37 year-old non-competitive, recreational runners. METHODS: Twenty-five healthy recreational runners (16 male and 9 female) between the ages of 24 and 35 (Mean = 26.76 yrs., SD = 2.42 yrs.) completed this study. A repeated measures design was used, which consisted of running a 40-yard sprint trial immediately following each of 4 different stretching conditions aimed at the iliopsoas muscle and lasting 1 minute each. The 4 conditions were completed in a randomized order within a 2-week time period, allowing 48-72 hours between each condition. Prior to each 40-yard sprint trial, a 5-minute walking warm-up was performed at 3.5 mph on a treadmill. The subject then ran a baseline 40-yard sprint. After a 10-minute self-paced walk, each subject performed one of the 4 stretching conditions (ballistic, dynamic, static, and no stretch) and then immediately ran a timed 40-yard sprint. RESULTS: There was a significant interaction between stretching conditions and their effects on sprint times, F(3,72) = 9.422, p<.0005. To break down this interaction, simple main effects were performed with 2 repeated measures ANOVAs and 4 paired t-tests using a Bonferroni corrected alpha (α = .0083). There were no significant differences between the 4 pre-condition times, p = 0.103 (Greenhouse-Geisser) or the post-condition times, p = 0.029. In the no stretch condition, subjects improved significantly from pre- to post- sprint times (p<0.0005). There were no statistically significant differences in pre- and post-stretch condition sprint times among the static (p = 0.804), ballistic (p = 0.217), and dynamic (p = 0.022) stretching conditions. CONCLUSIONS: Sprint performance may show greatest improvement without stretching and through the use of a walking generalized warmup on a treadmill. These findings have clinically meaningful implications for runners who include iliopsoas muscle stretching as a component of the warm-up. LEVEL OF EVIDENCE: Level 2.

Research and Critical Thinking : An Important Link for Exercise Science Students Transitioning to Physical Therapy.

Critical thinking skills are increasingly necessary for success in professional health care careers. Changes in the contemporary healthcare system in the United States arguably make these critical thinking skills more important than they have ever been, as clinicians are required on a daily basis to evaluate multiple bits of information about patients with multiple-systemic health concerns and make appropriate treatment decisions based on this information. We believe the IJES, with its emphasis on engaging undergraduate and graduate students in research and scholarly activity, is a valuable resource for promoting the higher-order critical thinking skills necessary for preparing exercise science students with an interest in professional healthcare careers such as physical therapy.

Safety of cervical spine manipulation: are adverse events preventable and are manipulations being performed appropriately? A review of 134 case reports.

BACKGROUND: Cervical spine manipulation (CSM) is a commonly utilized intervention, but its use remains controversial. PURPOSE: To retrospectively analyze all available documented case reports in the literature describing patients who had experienced severe adverse events (AEs) after receiving CSM to determine if the CSM was used appropriately, and if these types of AEs could have been prevented using sound clinical reasoning on the part of the clinician. DATA SOURCES: PubMed and the Cumulative Index to Nursing and Allied Health were systematically searched for case reports between 1950 and 2010 of AEs following CSM. STUDY SELECTION: Case reports were included if they were peer-reviewed; published between 1950 and 2010; case reports or case series; and had CSM as an intervention. Articles were excluded if the AE occurred without CSM (e.g. spontaneous); they were systematic or literature reviews. Data extracted from each case report included: gender; age; who performed the CSM and why; presence of contraindications; the number of manipulation interventions performed; initial symptoms experienced after the CSM; and type of resultant AE. DATA SYNTHESIS: Based on the information gathered, CSMs were categorized as appropriate or inappropriate, and AEs were categorized as preventable, unpreventable, or unknown. Chi-square analysis with an alpha level of 0.05 was used to determine if there was a difference in proportion between six categories: appropriate/preventable, appropriate/unpreventable, appropriate/unknown, inappropriate/preventable, inappropriate/unpreventable, and inappropriate/unknown. RESULTS: One hundred thirty four cases, reported in 93 case reports, were reviewed. There was no significant difference in proportions between appropriateness and preventability, P = .46. Of the 134 cases, 60 (44.8%) were categorized as preventable, 14 (10.4%) were unpreventable and 60 (44.8%) were categorized as 'unknown'. CSM was performed appropriately in 80.6% of cases. Death resulted in 5.2% (n = 7) of the cases, mostly caused by arterial dissection. LIMITATIONS: There may have been discrepancies between what was reported in the cases and what actually occurred, since physicians dealing with the effects of the AE, rather than the clinician performing the CSM, published many of the cases. CONCLUSIONS: This review showed that, if all contraindications and red flags were ruled out, there was potential for a clinician to prevent 44.8% of AEs associated with CSM. Additionally, 10.4% of the events were unpreventable, suggesting some inherent risk associated with CSM even after a thorough exam and proper clinical reasoning.

Rehabilitation following lumbosacral percutaneous nucleoplasty: a case report.

STUDY DESIGN: Case report. BACKGROUND: Lumbar spine nucleoplasty is a new surgical option for patients with disc pathology. There are no reports in the literature describing the role of physical therapy in postoperative lumbar nucleoplasty management. The purpose of this case is to describe the postoperative physical therapy management of a patient who underwent this procedure. CASE DESCRIPTION: A 50-year-old male, 7 weeks following a L5/S1 lumbar nucleus replacement, completed 6 weeks of rehabilitation. The focus of the treatment was controlled reloading of the spine through a spinal stabilization progression in weight-bearing and non-weight-bearing activities. In addition, education, spinal manual therapy techniques, and a home exercise program were also incorporated. OUTCOMES: The patient's Oswestry Disability Index decreased from 56% to 4% over 6 weeks of treatment. When contacted at 6, 12, 18, and 24 months posttherapy, his Oswestry Disability Index was 2%, 2%, 0%, and 0%, respectively, and he had returned to all previous activities without recurrence of symptoms. DISCUSSION: This case report outlines the clinical decision-making process during the postoperative management of an individual who had undergone a single-level lumbar nucleoplasty. A postoperative regimen of education, segmental spinal stabilization, and a home exercise program might have contributed to the observed improvement in pain and disability levels in this patient. The role of these postoperative interventions warrants further research. LEVEL OF EVIDENCE: Therapy, level 4.

Body weight supported treadmill training at very low treatment frequency for a young adult with incomplete cervical spinal cord injury.

INTRODUCTION: Body weight supported treadmill training (BWSTT) using high treatment frequency has been shown to improve gait after spinal cord injury (SCI). This case report describes the use of BWSTT at a very low treatment frequency. SUBJECT: The subject was a 19 y.o. female with an incomplete C6 SCI, one year post-injury, with multiple gait deficits. INTERVENTION: BWSTT was combined with conventional rehabilitation. Mean treatment frequency was 1.16 days/wk over 28.5 wks. A BWSTT progression algorithm based on observational gait analysis guided progressive changes in support levels, treadmill speed, and session length. OUTCOMES: During the first 3 sessions, the subject tolerated an average of 15.7 minutes of BWSTT with 26% BWS at 0.8 m/s, improving to an average of 28 minutes of BWSTT with 10% BWS at 1.6 m/s in the last 3 sessions. Following 28.5 wks of very low frequency BWSTT, the subject displayed improved kinematics, walking speed, endurance, and distance during overground gait. CONCLUSION: Very low frequency BWSTT combined with conventional treatment improved quality and endurance of walking for a person with incomplete cervical SCI. Further work is needed to evaluate the long-term outcome of very low frequency BWSTT and the interaction of BWSTT with other interventions.

The effect of a senior jazz dance class on static balance in healthy women over 50 years of age: a pilot study.

The purpose of this pilot study is to assess the impact of a senior jazz dance class on static balance for healthy women over 50 years of age using the NeuroCom Smart Balance Master System (Balance Master). A total of 12 healthy women aged 54-88 years completed a 15-week jazz dance class which they attended 1 time per week for 90 min per class. Balance data were collected using the Sensory Organization Test (SOT) at baseline (pre), at 7 weeks (mid), and after 15 weeks (post). An equilibrium score measuring postural sway was calculated for each of six different conditions. The composite equilibrium score (all six conditions integrated to 1 score) was used as an overall measure of balance. Repeated measures analyses of variance (ANOVAs) were used to compare the means of each participant's SOT composite equilibrium score in addition to the equilibrium score for each individual condition (1-6) across the 3 time points (pre, mid, post). There was a statistically significant difference among the means, p < .0005. Pairwise (Bonferroni) post hoc analyses revealed the following statistically significant findings for SOT composite equilibrium scores for the pre (67.33 + 10.43), mid (75.25 + 6.97), and post (79.00 + 4.97) measurements: premid (p = .008); prepost (p < .0005); midpost (p = .033). In addition, correlational statistics were used to determine any relationship between SOT scores and age. Results indicated that administration of a 15-week jazz dance class 1 time per week was beneficial in improving static balance as measured by the Balance Master SOT.

Competency revalidation study of specialty practice in sports physical therapy.

PURPOSE: The primary purpose of this study was to revalidate the competencies that define the practice of sports physical therapy. Additionally, the study allowed for the comparison of responses of board certified specialists in sports physical therapy to respondents who were not specialists. METHODS: A survey instrument based the on American Board of Physical Therapy Specialties practice analysis template and The Guide to Physical Therapist Practice was developed by the Sports Specialty Council and a panel of subject matter experts in sports physical therapy. The instrument was sent to 630 physical therapists, 315 of whom were board certified specialists in sports physical therapy and 315 of whom were randomly selected members of the Sports Physical Therapy Section who were not board certified specialists in sports physical therapy. Two hundred and thirty seven subjects returned completed surveys for a 41% response rate. One hundred and fifty eight respondents were sports specialists RESULTS: The survey results were reviewed by the Sports Specialty Council and another panel of subject matter experts. Using a defined decision making process, the results were used to determine the competencies that define the specialty practice of sports physical therapy. Survey results were also used to develop the sports physical therapy specialty board examination blue print. A number of significant comparisons between the specialists and non-specialists were identified. CONCLUSION: The competency revalidation process culminated in the publication of the Sports Physical Therapy Description of Specialty Practice. This document serves to guide the process related to the attainment and maintenance of the board certified clinical specialist in sports physical therapy.

Surface electromyographic assessment of the effect of dynamic activity and dynamic activity with static stretching of the gastrocnemius on vertical jump performance.

The purpose of this study was to investigate the effects of dynamic activity and dynamic activity/static stretching of the gastrocnemius muscle on vertical jump (VJ) performance. Additionally, muscle activity was recorded using electromyography. Thirteen healthy adults (7 men and 6 women) with a mean age of 26 +/- 4 years served as subjects. The average jump height and muscle activity from 3 separate maximal VJ attempts were performed at the start of each session to be used as baseline measures using the Kistler force plate and the Noraxon telemetry EMG unit. Subjects then performed 1 of 2 protocols: dynamic activity only or dynamic activity with static stretching. Each protocol was followed by 3 maximal VJ trials. Average VJ height was analyzed using a 2 (time: pre, post) x 2 (prejump protocol: dynamic activity, dynamic activity + stretching) analysis of variance with repeated measures on both factors. A paired-samples t-test was used to compare the intraday difference scores for EMG activity between the 2 conditions. Jump height was not influenced by the interaction of pre-post and protocol (p = 0.0146. There was no difference for the main effects of time (p = 0.274) and pre-jump protocol (p = 0.595). Gastrocnemius muscle activity was likewise not different for the 2 prejump protocols (p = 0.413). The results from this study imply that the use of static stretching in combination with dynamic activity of the gastrocnemius muscle does not appear to have an adverse affect on VJ height performance. The practical importance concerns the warm-up routine that coaches and athletes employ; that is, they may want to consider including an aerobic component when statically stretching the gastrocnemius immediately prior to a vertical jumping event.

Workers' compensation and litigation status influence the functional outcome of patients with neck pain.

OBJECTIVES: The purpose of this study was to determine if workers' compensation (WC) and litigation status were associated with long-term functional limitation in patients with neck pain. Understanding what physical and psychologic variables are related to long-term functional limitation is an important aspect of clinical decision-making and understanding illness behavior in patients with neck pain. METHODS: Seventy-nine patients reporting neck pain participated in this study. Of these, 27 had either a WC case or had injury-related litigation (WC=9, motor vehicle accident litigant=14, and personal injury litigant=4). Upon initial presentation to physical therapy and 12 weeks later, the patient's functional status was evaluated using the Neck Disability Index (NDI). An NDI score of 15 or more at 12-weeks was operationally defined as long-term functional limitation. RESULTS: Mean NDI scores at initial presentation and at 12-weeks were significantly higher for those with WC/litigation involvement (mean=18.9, SD=9.7) than for those without (mean=9.4, SD=7.3). Those with WC/litigation involvement also had a higher percentage of long-term functional limitation than those who did not have WC/litigation involvement, 70.4% and 19.2%, respectively. The odds for developing long-term functional limitation were 9.5 times greater for those with WC/litigation involvement than for those without. DISCUSSION: Results from this study suggest that patients with WC/litigation involvement exhibit more long-term functional limitation than patients who do not have WC/litigation involvement. These results underscore a need for future research in this area.

Surface electromyographic assessment of the effect of static stretching of the gastrocnemius on vertical jump performance.

The purpose of this study was to investigate the effects of static stretching of the gastrocnemius muscle on maximal vertical jump performance using electromyographic activity (EMG) of the gastrocnemius musculature to record muscle activation during vertical jump performance. Fourteen healthy adults (8 men and 6 women) aged 18-34 years, who were familiar with the vertical jumping task and had no lower extremity injuries or any bone or joint disorders within the past year, served as participants for this study. After a brief warm-up, participants performed the following sequence: (a) three baseline maximal vertical jump trials, (b) 15 minutes of quiet sitting and three 30-second bilateral static stretches of the gastrocnemius muscles, and (c) 3 maximal vertical jump trials. Jump height data were collected using the Kistler force plate, while muscle activity was recorded during the jumping and stretching trials using a Noraxon telemetry EMG unit. Vertical jump height data as well as EMG values were averaged for the 3 trials and analyzed using paired t-tests for pre- and poststretching (alpha = 0.05). Vertical jump height was 5.6% lower when poststretch heights were compared with prestretch heights (t = -4.930, p < 0.005). Gastrocnemius EMG was 17.9% greater when the EMG during poststretch jumps was compared with prestretch jumps (t = 2.805, p < 0.02). The results from this study imply that, despite increased gastrocnemius muscle activity, static stretching of the gastrocnemius muscles had a negative effect on maximal jumping performance. The practical importance concerns coaches and athletes, who may want to consider the potential adverse effects of performing static stretching of the gastrocnemius muscles only before a jumping event, as jump height may be negatively affected. Future research is required to identify the mechanisms that affect vertical jump performance.

Analysis of postural stability in collegiate soccer players before and after an acute bout of heading multiple soccer balls.

The aim of our study was to determine if any immediate changes in balance were discernable in college soccer players after a specially designed heading session. Eight male and two female skilled collegiate soccer players had a baseline balance pre-test using the Balance Master, followed by heading 20 balls kicked consecutively by a teammate from the touchline to a point near the goal, which was followed by a post-test using the same testing technique. Paired t-tests were used to compare balance ability between pre- and post-test conditions. There was no difference in balance pre- to post-test (85.3% and 86.2% respectively). No significant difference was noted from pre- to post-test in the mean equilibrium scores for conditions three through six on the Sensory Organization Test, with the exception of condition four, which revealed a significant increase from pre- to post-test. We concluded that an acute session of heading soccer balls may not result in balance changes in collegiate soccer players.

The obese child: motivation as a tool for exercise.

The purpose of this article is to describe the importance of motivation in enhancing the participation of obese children in exercise activities. Recognizing the different influence that are important determinants of exercise behavior in children may help pediatric nurse practitioners play a significant role in advising parents and others of the need to offer positive, constructive, and immediate feedback without being evaluative, critical, or demanding. By addressing the problems of obesity and low fitness levels early in the child's life, a significant step can be taken toward reversing the negative trends of this unhealthy and potentially dangerous condition.