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Background and Purpose The aim of the present study was to evaluate the immediate effects of therapeutic mobilization of the talocrural and subtalar joints on ankle mobility and postural control in elderly subjects. Methods Nineteen subjects (83.1 ± 6 years, 159 ± 1 cm; 56.1 ± 9.7 kg − mean ± standard deviation) participated in this study. The centre of pressure (COP) displacements along the anterior-posterior and medial-lateral axes was recorded in static and dynamic conditions on a force platform before and after therapeutic mobilization of the feet and ankles without blinding the subjects. Results In static conditions, the sway area is reduced contrarily to dynamic conditions where the sway area is increased. In the two experimental sessions, subjects showed comparable COP displacements and the total length of the oscillations. Results demonstrated a significant improvement immediately after mobilization for ankle range of motion in dorsal flexion (right +4.7°; left +3.2°) and plantar flexion (right 5.2°; left +4.2°). Conclusion These results suggested that postural control is improved in static conditions and decreased in dynamic conditions. Therapeutic mobilization of feet and ankles in the elderly provides an immediate improvement in joint range of movement in dorsal and plantar flexion. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Purpose. Patellofemoral pain (PFP) is associated with a wide range of local and global physical factors possibly contributing to pain and thus requires detailed assessment and individualized treatment. Yet, no cohort study was found that assessed the value of individualized physiotherapy, probably because this approach lends itself to clinical practice but not to scientific research. Most studies focus on a 'knee' or 'hip' treatment approach irrespective of individual global differences in lower limb alignment, movement patterns and muscle tightness. Therefore, this study aimed to determine the effectiveness of supplementing local treatment of PFP with individualized treatment targeting global contributing factors. Secondarily it aimed to subgroup the patients according to variations in lower limb alignment/laxity, movement patterns, biarticular muscle tightness and joint degeneration. Method. Forty-one patients (60 knees) with PFP who had followed a programme of local quadriceps strengthening, quadriceps stretching and taping for one fortnight were prescribed an individualized programme based on assessment. This global assessment included lower limb postural alignment, movement patterns, muscle tightness and range of motion. Another fortnights treatment was prescribed accordingly and included specific, individualized postural and movement retraining, stretching and functional weight-bearing, strengthening exercises. Seven outcome measures, namely four pain measures, isokinetic quadriceps strength, quadriceps length and eccentric knee control, assessed improvement. Results. All outcome measures showed further significant improvement following individualized treatment ( p < 0.03). Patients fell into four broad physical subgroups: hypermobility (often with malalignment), hypomobility (with three of four tight muscle groups), faulty movement patterns (mostly dynamic knee valgus) and patellofemoral osteoarthritis. Conclusions. Individualized treatment supplementing local standard physiotherapy for PFP leads to further significant improvement over 2 weeks. This study highlights the importance of assessing patients globally in order to optimize treatment and ongoing improvement. Recognition of different subgroups may guide treatment that should include both local and deficit-targeted global treatment. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to evaluate the goniometric measurements of the forelimb and hind limb joints in two species of Neotropical primates maintained in captivity. Methods Eighteen intact monkeys organized into two groups were studied: Group 1-9 brown howlers ( Alouatta fusca), and Group 2-9 tufted capuchins ( Sapajus apella). Results Significant differences were observed in the maximum flexion of the shoulder, elbow, carpus, stifle, and tarsus (G1>G2); maximum extension and abduction of the shoulder (G1G2) and adduction (G1G2). The ROM was significantly different in all joints: shoulder (G1G2), hip (G1>G2), stifle (G1

Background and Purpose Ultrasound (US) and low-level laser therapy (LLLT) are commonly employed for myofascial trigger points (MTP) despite lack of evidence for usage as stand-alone treatments. The aim of the study was to determine, on MTP of the upper trapezius muscle (uTM), the effects of US and LLLT per se, as delivered in accordance with the procedures reported by surveys about their usage among physiotherapists. Methods Design was set as a double-blind, randomized, placebo-controlled study. Sixty participants with at least one active MTP in uTM (28 women and 32 men; mean age 24.5 ± 1.44 years) were recruited and randomly assigned to one out of five groups: active US ( n = 12), placebo US ( n = 12), active LLLT ( n = 11), placebo LLLT ( n = 11) and no therapy (control, n = 14). The participants and outcome assessor were blinded to the group assignment and therapy delivered. Three outcome measures were assessed at baseline, after a 2-week treatment and 12 weeks after the end of the intervention (follow-up): pressure pain threshold, subjective pain on a numerical rating scale and muscle extensibility performing a cervical lateral flexion. All subjects assigned to the intervention groups were treated five times weekly for overall 10 treatments given. Two-way ANOVA was used to compare differences before and after intervention and among groups at each time-point. Results After the 2-week intervention, all groups showed pressure pain threshold, numerical rating scale and cervical lateral flexion significant improvements ( p < 0.05), which were confirmed at the follow-up. When performing multiple comparisons, controls scored significantly less than both the active therapies and placebos, whereas no differences were detected between active therapies and placebos. Conclusions Ultrasound and LLLT provided significant improvements in pain and muscle extensibility, which were superior to no therapy but not to placebos, thus raising concerns about the suitability, both economically and ethically, of administering such common physical modalities as stand-alone treatments in active MTP of the uTM. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Limitation of ankle movement may contribute to calf muscle pump failure, which is thought to contribute to venous leg ulcer formation, which affects nearly 1 million Americans. We therefore wished to study ankle movement in patients with venous leg ulcers and its effect on healing. Using goniometry, we measured baseline ankle range of motion in venous leg ulcer patients from a Phase 2 dose-finding study of an allogeneic living cell bioformulation. Two hundred twenty-seven patients were enrolled in four active treatment groups and one standard-care control group, all receiving compression therapy. Goniometry data from a control group of 49 patients without venous disease, from a previous study, was used for comparison. We found patients with active venous leg ulcers had significantly reduced ankle range of motion compared with the control group ( p = 0.001). After 12 weeks of therapy, baseline ankle range of motion was not associated with healing, as there was no significant difference between healed and nonhealed groups, suggesting that ankle range of motion is not important in venous leg ulcer healing or, more likely, is overcome by compression. However, patients with venous ulcers located on the leg (as opposed to the ankle) had significantly higher ankle range of motion for plantar flexion and inversion ( p = 0.021 and p = 0.034, respectively) and improved healing with both cell bioformulation and standard care ( p = 0.011), suggesting that wound location is an important variable for ankle range of motion as well as for healing outcomes. [ABSTRACT FROM AUTHOR]

There are currently no generally accepted, consistent results that clearly characterize factors causing Achilles tendon pain ( AT) in runners. Therefore, we carried out a prospective study to evaluate the multifactorial influence of clinical, biomechanical (isometric strength measurements and three-dimensional kinematics) and training-related risk factors on the development of AT. Two hundred sixty-nine uninjured runners were recruited and underwent an initial examination. One hundred forty-two subjects completed their participation by submitting training information on a weekly basis over a maximal period of 1 year. Forty-five subjects developed an overuse injury, with 10 runners suffering from AT. In an uninjured state, AT runners already demonstrated decreased knee flexor strength and abnormal lower leg kinematics (sagittal knee and ankle joint) compared with a matched control group. A relationship between years of running experience or previous overuse injuries and the development of new symptoms could not be established. The interrelationship of biomechanical and training-specific variables on the generation of AT is evident. A combination of alterations in lower leg kinematics and higher impacts caused by fast training sessions might lead to excessive stress on the Achilles tendon during weight bearing and thus to AT in recreational runners. [ABSTRACT FROM AUTHOR]

Aim The aims of this study were to (1) determine whether an instrumented measure will reduce measurement error to less than 5° in children with cerebral palsy ( CP), (2) determine agreement and reliability of this instrumented measure in both conscious and anaesthetized participants, and (3) compare the method with previously reported measures. Method Thirty-four ambulant children (15 males, 19 females), aged 3 to 9 years, with spastic CP were studied in a tertiary-care paediatric hospital (21 with hemiplegia, 11 with diplegia, and two with quadriplegia). The majority of children functioned at Gross Motor Function Classification System level I ( n=11) or II ( n=18), with five children at level III. Ankle dorsiflexion at 50% bodyweight was photographed and measured. Each child was measured when conscious and when under mask anaesthesia by two experienced assessors. Results The standard error of measurement ( SEM) ranged from 3.9° (anaesthetized; 95% confidence interval [ CI] 3.3-4.0°) to 6.7° (conscious; 95% CI 5.3-8.0°). This compared favourably with previously reported dorsiflexion measures ( SEM range 6.5-7.8°) in conscious children with CP. Intrarater reliability was good in both conditions (intraclass correlation coefficient [ ICC]: range 0.95 [anaesthetized; 95% CI 0.92-0.98] to 0.86 [conscious; 95% CI 0.76-0.95]). The ICC for interrater reliability ranged from 0.87 (anaesthetized; 95% CI 0.81-0.93) to 0.65 (conscious; 95% CI 0.50-0.81). Interpretation Passive ankle dorsiflexion using an instrumented measure has face validity and may assist in the improvement of reproducibility under anaesthesia for clinical research. When an individual is conscious, this technique is not better than trained assessors using conventional goniometry reported in the literature and is not recommended for routine clinical use. [ABSTRACT FROM AUTHOR]

The aim of the present study was to profile shoulder passive range of motion ( ROM) and isometric strength for external ( ER) and internal ( IR) rotation as part of a preseason screening in adolescent national badminton players. Passive external range of motion ( EROM) and internal range of motion ( IROM) were examined on the dominant and nondominant shoulder in 31 adolescent national badminton players (12 females and 19 males) with a standard goniometer. Muscle strength was examined with a hand-held dynamometer in ER and IR. Total range of motion ( TROM = EROM+ IROM) was lower on the dominant side compared with the nondominant side in both groups ( P < 0.001). Males were generally stronger than females in all strength measurements except for IR on the dominant side ( P < 0.01). In females, IR dominant side strength was greater compared with IR on the nondominant side ( P < 0.05). TROM was reduced on the dominant side compared with the nondominant side in young elite badminton players, irrespective of gender. No rotational strength differences existed between the dominant and nondominant side in male players, but in female players a higher IR strength on the dominant side was not balanced by a higher ER strength. [ABSTRACT FROM AUTHOR]

Computed tomography ( CT) was used to explore if changes in muscle cross-sectional area and quality after anterior cruciate ligament ( ACL) injury and reconstruction would be related to knee function. Fourteen females and 23 males (16-54 years) underwent clinical tests, subjective questionnaires, and CT 1 week before and 1 year after ACL surgery with semitendinosus-gracilis ( STG) graft and rehabilitation. Postoperatively, knee laxity was decreased and functional knee measures and subjective patient scores improved. The most obvious remaining deficit was the quadriceps atrophy, which was significantly larger if the right leg was injured. Right-leg injury also tended to cause larger compensatory hypertrophy of the combined knee flexor and tibial internal rotator muscles (preoperatively). The quadriceps atrophy was significantly correlated with the scores and functional tests, the latter also being related to the remaining size of the gracilis muscle. Biceps femoris hypertrophy and, in males only, semimembranosus hypertrophy was observed following the ACL reconstruction. The lack of semimembranosus hypertrophy in the women could, via tibial internal rotation torque deficit, contribute to the less favorable functional and subjective outcome recorded for the women. The results indicate that the quadriceps, the combined knee flexor/tibial internal rotator muscles, side of ACL injury, and sex are important to consider in rehabilitation after STG graft. [ABSTRACT FROM AUTHOR]

Clinical experience indicates that a substantial number of handball players may suffer from shoulder pain, but they continue to play despite having shoulder pain problems. The aim of this study was to evaluate the prevalence and consequences of shoulder pain problems among Norwegian female elite handball players. In the preseason of the 2007-2008 season, 179 players from all 12 teams of the Norwegian elite league went through the following tests: internal and external shoulder range of motion, apprehension, relocation test, and shooting velocity. All players completed the Fahlström questionnaire and, for players with current pain, the Western Ontario shoulder instability index questionnaire. Sixty-five (36%) players reported shoulder pain on the test day, and 40 (22%) players reported previous shoulder pain. Two thirds of the players with pain reported a gradual onset. For players with current or previous pain, 22 (36%) and 14 (36%) had missed match play, and 43 (68%) and 28 (76%) reported changing their training habits. A positive apprehension and relocation test was found among 51 (29%) of the players. In conclusion, a high proportion of female elite handball players experience shoulder pain and problems and have an unstable shoulder. [ABSTRACT FROM AUTHOR]

Rotator cuff tears are the leading cause of shoulder pain and shoulder-related disability and account for 4.5 million physician visits in the United States annually. A careful history and structured physical examination are often sufficient for diagnosing rotator cuff disorders. We are not aware of a clinical review article that presents a structured physical examination protocol of the rotator cuff for the interested clinician. To fill this void, we present a physical examination protocol developed on the basis of review of prior literature and our clinical experience from dedicated shoulder practices. Our protocol includes range of motion testing by using a goniometer, strength testing by using a dynamometer, and select special tests. Among the many tests for rotator cuff disorders that have been described, we chose ones that have been more thoroughly assessed for sensitivity and specificity. This protocol can be used to isolate the specific rotator cuff tendon involved. The protocol can typically be completed in 15 minutes. We also discuss the clinical implications and limitations of the physical examination maneuvers described in our protocol. This protocol is thorough yet time efficient for a busy clinical practice. It is useful in the diagnosis of rotator cuff tears, impingement syndrome, and biceps pathology. [ABSTRACT FROM AUTHOR]

The aim was to compare viscoelastic properties of Achilles tendons between legs in elite athletes with unilateral tendinosis, and to investigate relationships between the properties and explosive performance and clinical severity. Seventeen male athletes (mean ± standard deviation age, 27.3 ± 2.0 years) who had unilateral, chronic middle-portion tendinopathy of the Achilles tendon were assessed by the Victorian Institute of Sport Assessment questionnaire, measurements of tendon viscoelastic properties, voluntary electromechanical delay ( EMD), normalized rate of force development ( RFD), and one-leg hopping distance. Compared with the non-injured leg, the tendinopathic leg showed reduced tendon stiffness (−19.2%. P < 0.001), greater mechanical hysteresis (+21.2%, P = 0.004), lower elastic energy storage and release (−14.2%, P = 0.002 and −19.1%, P < 0.001), lower normalized RFD at one-fourth (−16.3%, P = 0.02), 2/4 (−17.3%, P = 0.006), and three-fourths maximal voluntary contraction (−13.7%, P = 0.02), longer soleus and medial gastrocnemius voluntary EMD (+26.9%, P = 0.009 and +24.0%, P = 0.004), and shorter hopping distances (−34.1%, P < 0.001). Tendon stiffness was correlated with normalized RFD, voluntary EMD in the medial gastrocnemius, and hopping distances ( r ranged from −0.35 to 0.64, P < 0.05). Hysteresis was correlated to the soleus voluntary EMD and hopping distances ( r = 0.42 and −0.39, P < 0.05). We concluded that altered tendon viscoelastic properties in Achilles tendinosis affect explosive performance in athletes. [ABSTRACT FROM AUTHOR]

There is an ongoing discussion about how to improve jump performance most efficiently with plyometric training. It has been proposed that drop height influences the outcome, although longitudinal studies are missing. Based on cross-sectional drop jump studies showing height-dependent Hoffmann (H)-reflex activities, we hypothesized that the drop height should influence the neuromuscular activity and thus, the training result. Thirty-three subjects participated as a control or in one of two stretch-shortening cycle (SSC) interventions. Subjects either trained for 4 weeks doing drop jumps from 30, 50, and 75 cm drop heights (SSC1) or completed the same amount of jumps exclusively from 30 cm (SSC2). During training and testing (from 30, 50, and 75 cm), subjects were instructed to minimize the duration of ground contact and to maximize their rebound height. Rebound heights were significantly augmented after SSC1, but a trend was only observed after SSC2. In contrast, the duration of ground contact increased after SSC1 but decreased after SSC2. The performance index (rebound height/duration of ground contact) improved similarly after SSC1 (+14%) and SSC2 (+14%). Changes in performance were accompanied by neuromuscular adaptations: for SSC1, activity of the soleus increased toward take-off (between 120 and 170 ms after touchdown), whereas SSC2-trained subjects showed enhanced activity shortly after ground contact (20-70 ms after touch down). The present study demonstrates a strong link among drop height, neuromuscular adaptation, and performance in SSC training. As the improvement in the performance index was no different after SSC1 or SSC2, the decision whether to apply SSC1 or SSC2 should depend on the specific requirements of the sports discipline. [ABSTRACT FROM AUTHOR]

The aims of this applied field study were (1) to provide descriptive data on the biomechanical variables of parallel ski steering, carving in long radii and individual technique skiing modes of older recreational skiers and (2) to determine the relationships between biomechanical and physiological variables during these skiing modes. The mean knee angle (MKA), range of knee angle (RKA), ground reaction forces (GRF), co-loading of the inner leg, mean heart rate (HRave), blood lactate (LA) and mean arterial pressure were determined for 14 older skiers (61.1 ± 5.4 years). The mean GRF did not differ between the skiing modes. Parallel ski steering resulted in a greater MKA, lower RKA and lower peak GRF compared with carving in long radii and individual technique. LA correlated positively to RKA during carving in long radii and individual technique, while HRave correlated negatively to MKA during parallel ski steering and carving in long radii. No significant relationships were found between the physiological and kinetic variables. In conclusion, dynamic skiing styles may result in increased muscle fiber recruitments, hence greater LA levels. Along with potentially greater loading of knee extensor muscles, lower MKAs may reduce perfusion and hinder substrate metabolism, consequently making ski turning more strenuous. Skiing with less knee flexion and a reduced RKAs could be recommended for older recreational skiers. [ABSTRACT FROM AUTHOR]

The objective of the study was to examine the risk factors and prognostic indicators for medial tibial stress syndrome (MTSS). In total, 35 subjects were included in the study. For the risk factor analysis, the following parameters were investigated: hip internal and external ranges of motion, knee flexion and extension, dorsal and plantar ankle flexion, hallux flexion and extension, subtalar eversion and inversion, maximal calf girth, lean calf girth, standing foot angle and navicular drop test. After multivariate regression decreased hip internal range of motion, increased ankle plantar flexion and positive navicular drop were associated with MTSS. A higher body mass index was associated with a longer duration to full recovery. For other prognostic indicators, no relationship was found. [ABSTRACT FROM AUTHOR]

The aim was to investigate injury risk factors in junior tennis players. Fifty-five players, 35 boys and 20 girls, answered a questionnaire about training habits, time of exposure, previous injuries and equipment factors. A battery of clinical tests and functional performance tests were also carried out. All tennis-related injuries that occurred during a 2-year period were identified and recorded. An injury was defined as an injury if it was impossible to participate in regular tennis training or playing matches during at least one occasion, a time loss injury. Potential injury risk factors were tested in a forward stepwise logistic regression model for injury. Thirty-nine players sustained totally 100 new and recurrent injuries. Injuries to the lower extremity were the most common ones (51%) followed by the upper extremity (24%) and the trunk (24%). Injured players performed more singles per week ( P<0.0001) and played more tennis hours per year ( P=0.016) than the uninjured players. Playing tennis more than 6 h/week was found to be a risk factor for back pain. A previous injury regardless of location was identified as an injury risk factor, and a previous injury to the back was a risk factor for back pain. [ABSTRACT FROM AUTHOR]

Objectives: To investigate: (1) the passive and dynamic shoulder internal (IR) and external (ER) rotation range of motion (ROM) of 2 groups of asymptomatic overhead throwing athletes: one group who had never experienced shoulder symptoms and another who had shoulder symptoms >12 months ago, (2) the effect of taping on the passive and dynamic IR-ER ROM in both these groups. Design: A within-subject repeated measures analysis of variance design to determine the differences in passive and dynamic shoulder rotation range and the effect of shoulder taping on the rotation range in a group of uninjured and previously injured overhead throwing athletes. Setting: Academic institution sports medicine setting. Participants: Twenty-six overhead throwing collegiate athletes: 17 with no history of shoulder injury and 9 with previous shoulder injury. Methods: Passive shoulder ROM was measured with a goniometer with the subject in the supine position. To measure dynamic ROM, the subjects sat on a chair and threw a handball into a net. An 8-camera Vicon Motion Capture system recorded markers placed on the upper limb and trunk. Dynamic ROM was calculated with inverse kinematics by using OpenSim. Main Outcome Measurement: Shoulder IR-ER ROM. Results: Dynamic IR-ER ROM was significantly greater than passive IR-ER ROM (P < .0001). There was no difference in passive IR-ER ROM between the uninjured and previously injured overhead throwing athletes. However, there was a significant difference in the total dynamic IR-ER ROM, whereby the overhead throwing athletes who had never experienced shoulder symptoms had less IR-ER ROM than the previously injured group (173.9° versus 196.9°, respectively; P = .049). Taping the shoulder increased the passive ROM in both groups of subjects (P < .001), increased the dynamic IR-ER ROM in the uninjured subjects, but decreased the dynamic IR-ER ROM in the previously injured subjects, although this was not statistically significant (P = .07). Conclusions: Passive IR-ER ROM is a poor indication of dynamic shoulder function. Athletes who have had a previous shoulder injury demonstrate a greater dynamic IR-ER ROM than athletes who have never had a shoulder injury. Shoulder taping decreased the dynamic range of the previously injured athlete, so that it was nearer the dynamic range of the uninjured athlete. Shoulder taping might provide increased protection for the injured athlete by decreasing the dynamic IR-ER ROM and by facilitating better shoulder and scapular muscle control. Further studies are necessary to demonstrate whether this finding is clinically significant. [Copyright &y& Elsevier]

Different types of contractile fatiguing tasks ('force/position tasks') have shown that the rate of neuromuscular impairment is task dependent. Whether fatigue resistance is uniform across different types of limb joints is poorly understood because the force-position paradigm has mainly been applied to upper extremity joints under unstable conditions. Therefore, the purpose of the present study was to investigate task dependency in the more stable knee joint. Fourteen subjects performed two sustained isometric knee extensor contractions to failure. In the force task, 20% of maximal voluntary contraction force was maintained for as long as possible with visual feedback of the force, while in the position task, the load was similar, but subjects received visual joint angle feedback. No significant difference was observed in time to failure (force task: 423±61 s, position task: 379±48 s), increase in electromyographic amplitude or perceived exertion between tasks. The force-position paradigm has not been applied previously to the quadriceps, and the difference between the present and the previous results may partly be attributed to joint stability and the volume of co-contracting muscles, such that in addition to the previously noted mechanisms of muscle fatigue, the mechanical design of the relevant joint and muscle actuators may influence task dependency during sustained submaximal contractions. [ABSTRACT FROM AUTHOR]

Quadriceps strengthening, quadriceps stretching and patellar taping are commonly prescribed together for patellofemoral pain patients. This study aimed to examine the effectiveness of each of these techniques in isolation for one week and in combination for one week. A prospective double-blind randomized control study was designed involving 41 subjects with 60 knees diagnosed with patellofemoral pain. The knees were randomized in onto one of four groups (n = 15): infrapatellar taping, quadriceps strengthening, quadriceps stretching and control. The taping was worn continually for the week; the strengthening group followed a programme of non-weight-bearing terminal range quadriceps exercises, the stretching group performed rectus femoris stretches. The control group did not receive treatment. All subjects received advice. Seven pre- and post-treatment measures included isokinetic quadriceps strength, quadriceps length, pain measured during four activities and maximum eccentric, posturally controlled, pain-free knee flexion angle during a step-down. Results showed significant changes over time (p < 0.01) in two out of seven measures for the taping group, in five out of seven for the strengthening group and five out of seven for the stretching group and none in the control group. When the three modalities were combined for one week, (n = 60) all seven measures improved significantly (p < 0.01). In isolation, quadriceps stretching and quadriceps strengthening resulted in more improvements than taping. Combining these treatments is recommended as the initial approach to treating patellofemoral pain but further individualized more functional, global treatment is essential. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To: (1) report passive hip range of motion (ROM) in asymptomatic young adults, (2) report the intratester and intertester reliability of hip ROM measurements among testers of multiple disciplines, and (3) report the results of provocative hip tests and tester agreement. Design: Descriptive epidemiology study. Setting: Tertiary university. Participants: Twenty-eight young adult volunteers without musculoskeletal symptoms, history of disorder, or surgery involving the lumbar spine or lower extremities were enrolled and completed the study. Methods: Asymptomatic young adult volunteers completed questionnaires and were examined by 2 blinded examiners during a single session. The testers were physical therapists and physicians. Hip ROM and provocative tests were completed by both examiners on each hip. Main Outcome Measurements: Inter-rater and intrarater reliability for ROM and agreement for provocative tests were determined. Results: Twenty-eight asymptomatic adults, mean age 31 years (range, 18-51 years), with a mean modified Harris Hip Score of 99.5 ± 1.5 and UCLA activity score of 8.8 ± 1.2 completed the study. Intrarater agreement was excellent for all hip ROM measurements, with intraclass correlation coefficients (ICCs) ranging from 0.76 to 0.97, with similar agreement if the examiner was a physical therapist or a physician. Excellent inter-rater reliability was found for hip flexion ICC 0.87 (95% confidence interval [95% CI] 0.78-0.92), supine internal rotation ICC 0.75 (95% CI 0.60-0.84), and prone internal rotation ICC 0.79 (95% CI 0.66-0.87). The least reliable measurements were supine hip abduction (ICC 0.34) and supine external rotation (ICC 0.18). Agreement between examiners ranged from 96% to 100% for provocative hip tests, which included the hip impingement, resisted straight leg raise, Flexion Abduction External Rotation/Patrick, and log roll tests. Conclusions: Specific hip ROM measures show excellent inter-rater reliability, and provocative hip tests show good agreement among multiple examiners and medical disciplines. Further studies are needed to assess the use of these measurements and tests as a part of a hip screening examination to assess for young adults at risk for intra-articular hip disorders before the onset of degenerative changes. [Copyright &y& Elsevier]

Background and Purpose. Two of the most utilized outcome measures to assess knee joint range of motion (ROM) and intra-articular effusion are goniometry and circumference, respectively. Neither goniometry nor circumference of the knee joint have been examined for both intra-tester and inter-tester in patients with total knee arthroplasty (TKA). The purpose of this study was to determine the intra-tester and inter-tester reliability of active and passive knee joint ROM and circumference in patients with TKA when administered by physiotherapists (testers) with different clinical experience. Method. The design was an intra-tester, inter-tester and intra-day reliability study. Nineteen outpatients (10 females) having received a TKA were examined by an inexperienced and an experienced physiotherapist. Following a standardized protocol, active and passive knee joint ROM and circumference measurements were obtained using a universal goniometer and a tape measure, respectively. To establish reliability, intraclass correlation coefficients (ICC2,1) and smallest real difference (SRD) were calculated. Results. The knee joint ROM and circumference measurements were generally reliable (ICC > 0.8) within and between physiotherapists (except passive knee extension). Changes in knee joint ROM of more than 6.6° and 10° (except active knee flexion) and knee joint circumference of more than 1.0 cm and 1.63 cm represent a real clinical improvement (SRD) or deterioration for a single individual within and between physiotherapists, respectively. Generally, the experienced tester recorded larger knee joint ROM and lower circumference values than that of the inexperienced tester. Conclusions. In clinical practice, we suggest that repeated knee goniometric and circumferential measurements should be recorded by the same physiotherapist in individual patients with TKA. Tester experience appears not to influence the degree of reliability. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate the effect of localised tibialis posterior muscle fatigue on foot kinematics during walking. It was hypothesised that following fatigue, subjects would demonstrate greater forefoot and rearfoot motion during walking. It was also postulated that the magnitude of the change in rearfoot motion would be associated with standing anatomical rearfoot posture. Methods: Twenty-nine subjects underwent an exercise fatigue protocol aimed at reducing the force output of tibialis posterior. An eight camera motion analysis system was used to evaluate 3D foot kinematics during treadmill walking both pre- and post-fatigue. The anatomical rearfoot angle was measured during standing prior to the fatigue protocol using a goniometer. Results: Peak rearfoot eversion remained unchanged following the fatigue protocol. Although increases in rearfoot eversion excursion were observed following fatigue, these changes were of a magnitude of questionable clinical significance (<1.0°). The magnitude of the change in rearfoot eversion due to fatigue was not associated with the anatomical measurement of standing rearfoot angle. No substantial changes in forefoot kinematics were observed following the fatigue protocol. Conclusions: These data indicate that reduced force output of the tibialis posterior muscle did not alter rearfoot and forefoot motion during gait. The anatomical structure of the rearfoot was not associated with the dependence of muscular activity that an individual requires to maintain normal rearfoot kinematics during gait. [ABSTRACT FROM AUTHOR]

This study aimed to determine simultaneously the effects of plyometric training on the passive stiffness of the ankle joint musculo-articular complex, the gastrocnemii muscle–tendon complex (MTC) and the Achilles tendon in order to assess possible local adaptations of elastic properties. Seventeen subjects were divided into a trained (TG) group and a control (CG) group. They were tested before and after 8 weeks of a plyometric training period. The ankle joint range of motion (RoM), the global musculo-articular passive stiffness of the ankle joint, the maximal passive stiffness of gastrocnemii and the stiffness of the Achilles tendon during isometric plantar flexion were determined. A significant increase in the jump performances of TG relative to CG was found (squat jumps: +17.6%, P=0.008; reactive jumps: +19.8%, P=0.001). No significant effect of plyometric training was observed in the ankle joint RoM, musculo-articular passive stiffness of the ankle joint or Achilles tendon stiffness ( P>0.05). In contrast, the maximal passive stiffness of gastrocnemii of TG increased after plyometric training relative to CG (+33.3%, P=0.001). Thus, a specific adaptation of the gastrocnemii MTC occurred after plyometric training, without affecting the global passive musculo-articular stiffness of the ankle joint. [ABSTRACT FROM AUTHOR]

There is an interest in identifying the intrinsic risk factors, including altered musculotendinous flexibility, that may be associated with musculotendinous injuries. We have recently shown that a sequence variant, namely the BstUI restriction fragment length polymorphism (RFLP), within the COL5A1 gene is associated with chronic Achilles tendinopathy. Mutations within COL5A1 have been implicated in Ehlers Danlos syndrome, a condition that is characterized by joint hypermobility. The aim of this study was to investigate the association of sequence variants within COL5A1 and musculotendinous range of motion (ROM). The sit and reach (SR) and the passive straight leg raise (SLR) were measured on 119 Caucasian subjects with either a past, current or no history of Achilles tendon injuries. The subjects were genotyped for four sequence variants within the 3′-UTR of the COL5A1 gene. Gender ( P=0.016), age ( P=0.011) and the BstUI RFLP ( P=0.010) jointly contributed significantly to the optimal SLR model which accounted for 19.3% of the variance. The factors contributing significantly to SR, which accounted for 28.8% of the variance, were weight ( P=0.004), age ( P<0.001) and the BstUI RFLP ( P=0.001). These data suggest that the COL5A1 BstUI RFLP is independently associated with lower limb ROM within the cohort investigated in this study. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the relationship between hamstring flexibility and knee flexion angle–torque relationship. Hamstring flexibility was assessed in 20 subjects (10 men, 10 women) using the straight leg raise (SLR) and active knee extension (AKE) tests. Isometric knee flexion strength was measured at five knee flexion angles while subjects were seated with the test thigh flexed 40° and the trunk flexed 80°. Lower extremities were classified as tight or normal based on the SLR and AKE tests. Peak knee flexion torque, angle of peak torque, and angle–torque relationship were compared between flexibility groups. Peak knee flexion torque was not different between tight and normal groups (SLR P=0.82; AKE P=0.68) but occurred in greater knee flexion (shorter muscle length) in the tight group compared with the normal group (SLR P<0.01; AKE P<0.05). The tight group had higher torque than the normal group at the shortest muscle length tested but lower torque at longer muscle lengths (SLR P<0.001; AKE P<0.001). In conclusion, the angle–torque relationship was shifted to the left in less flexible hamstrings such that knee flexion torque was increased at short muscle lengths and decreased at long muscle lengths when compared with more flexible hamstrings. [ABSTRACT FROM AUTHOR]

The aims of this study were to compare proprioception in knee rotation in Olympic-level soccer players ( N=18) with non-athletes ( N=18), to explore between-limb differences in soccer players, and examine correlations between proprioception and years of playing, function, physical measures and skill level. The knee rotatory kinaesthetic device was used to present stimuli of different magnitudes to determine proprioceptive acuity for internal and external active rotation, and to measure active and passive rotation range of motion (ROM). Knee rotation strength was measured using a dynamometer. Proprioceptive acuity of the athletes was significantly ( P=0.004) better than that of the non-athletes. Athletes displayed significantly less passive ROM ( P=0.001), higher isometric muscle strength ( P=0.006) and greater hop for distance ( P=0.001) than non-athletes. No significant between-limb differences were found in the athletes in any objective outcome measure. Internal rotation proprioceptive acuity was negatively correlated with coach-rated ball skill ( r=−0.52) and positively correlated with internal rotation ROM ( r=0.59). Our findings suggest that highly trained athletes possess enhanced proprioceptive acuity and muscle strength that may be inherent, or may develop as a result of long-term athletic training. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the influence of soccer-specific fatigue on the kinematics of an agility sprint. Ten male professional soccer players (age 24.7±4.4 years, body mass 77.1±8.3 kg) completed an intermittent treadmill protocol replicating the activity profile of match-play, comprising two 45-min halves separated by a 15-min passive half-time interval. Pre-exercise and at 15-min intervals each player completed an agility sprint that consisted of a 180° cutting manoeuvre. Knee joint kinematics in the frontal and sagittal planes were determined for both the support and turning leg using a nine-camera automated motion analysis system operating at 200 Hz. During the penultimate foot contact, knee kinematics were characterized by joint flexion and increased varus alignment. Knee flexion at touchdown decreased significantly (P<0.05) as a function of exercise duration from 57.4±15.5° before exercise to 37.0±5.9° at the end of the second half. The range of joint movement during the knee flexion phase increased significantly during the first half (T45=66.6±18.2°) and remained elevated during the second half (T75=66.4±18.1°; T90=65.7±20.4°; T105=70.2±19.4°) relative to pre-exercise values (51.8±18.8°). During the final foot contact, knee kinematics were also characterized by flexion and increased varus alignment. Knee flexion at touchdown decreased during each half, with the knee angle at the end of the first half (30.6±7.0°) significantly (P=0.02) straighter than before exercise (39.5±6.3°), and significantly straighter at the end of the second half (30.2±2.9°) than after the half-time interval (37.7±7.8°) or before exercise. The range of knee flexion during ground contact increased significantly during each half. The range of knee varus during flexion changed from a varus displacement during the first 15 min to a valgus displacement thereafter. Peak valgus observed at the end of each half (T45=4.7±7.9°; T105=6.9±7.4°) was significantly (P<0.05) greater than before exercise. The range of valgus movement during knee extension was greatest following the passive half-time interval (T60=6.2±7.3°), and tended to increase throughout the second half. Prolonged exposure to soccer-specific intermittent exercise therefore induced changes in knee kinematics that may have implications for injury incidence. The increased varus alignment and time-dependent decrease in knee flexion at touchdown represent two potential mechanisms for increased injury risk. [ABSTRACT FROM AUTHOR]

Objective To compare abduction angles of shoulders with medial instability and unaffected shoulders in the same dogs and in age- and breed-matched dogs. Study Design Case–control study. Animals Dogs with medial instability of the shoulder (n=33) and 26 control dogs. Methods Dogs were sedated and positioned in lateral recumbency with both scapulas parallel to the table. With the elbow and shoulder in extension, the non-recumbent limb was maximally abducted and the angle between the scapular spine and lateral aspect of the brachium measured with a goniometer; a digital image was taken from the cranial aspect. Both techniques were performed in triplicate by 2 examiners. Mean abduction angles for each shoulder were determined from goniometric measurements and image analysis. Data were analyzed for significant differences between affected and unaffected shoulders, measurement techniques, and examiners. Strength of correlation between measurement techniques was determined. Results Mean abduction angles for shoulders with instability (53.7±4.7° goniometric, 51.2±4.9° image) were significantly ( P<.001) larger than for all unaffected shoulders (32.6±2.0° goniometric, 30.9±2.3° image). In dogs diagnosed with instability, affected shoulders had significantly ( P<.001) larger abduction angles than the contralateral (unaffected) shoulders. No significant differences were identified between right and left shoulders for control dogs, measurement techniques, or examiners. A strong (r=0.90) significant ( P<.001) positive correlation between measurement techniques was noted. Conclusions Shoulder abduction angles measured under sedation provide objective data for diagnosis of shoulder instability in dogs. Shoulders with clinical and arthroscopic evidence of medial instability have significantly higher abduction angles than shoulders that are considered normal. Clinical Relevance Determination of shoulder abduction angles should be included in the diagnostic protocol for forelimb lameness assessment in dogs. [ABSTRACT FROM AUTHOR]

To compare the knee‐alignment angle from a full‐limb radiograph (mechanical axis) with the anatomic‐axis angle as measured by physical examination using a goniometer and by 2 other radiographic methods.The knee‐alignment angle was measured in 114 knees of 57 subjects who had radiographic osteoarthritis (OA), with a Kellgren/Lawrence grade of ≥1 in at least one knee. The mechanical axis was defined as the angle formed by the intersection of 2 lines, one from the center of the head of the femur to the center of the tibial spines, and a second from the center of the talus to the center of the tibial spines. The anatomic axis was defined as the angle formed by 2 lines, each originating from a point bisecting the femur and tibia and converging at the center of the tibial spine tips. The anatomic‐axis angle was measured by 3 methods: 1) physical examination using a goniometer, 2) a posteroanterior (PA) fixed‐flexion knee radiograph (anatomicPA axis), and 3) an anteroposterior (AP) full‐limb radiograph (anatomicAP axis).Significant correlations were found between the mechanical‐axis angle and the anatomic‐axis angle measured by each of the 3 methods: by goniometer (r = 0.70, P < 0.0001), by anatomicPA axis (r = 0.75, P < 0.0001), and by anatomicAP axis (r = 0.65, P < 0.0001). The anatomic axis was offset a mean 4.21° valgus from the mechanical axis (3.5° in women, 6.4° in men), which was consistent across all methods.Knee alignment assessed clinically by goniometer or measured on a knee radiograph is correlated with the angle measured on the more cumbersome and costly full‐limb radiograph. These alternative measures have the potential to provide useful information regarding the risk of progression of knee OA when a full‐limb radiograph is not available. [ABSTRACT FROM AUTHOR]

To assess the reliability of physical examination of the osteoarthritic (OA) knee by rheumatologists, and to evaluate the benefits of standardization. Forty-two physical signs and techniques were evaluated using a 6 × 6 Latin square design. Patients with mild to severe knee OA, based on physical and radiographic signs, were examined in random order prior to and following standardization of techniques. For those signs with dichotomous scales, agreement among the rheumatologists was calculated as the prevalence-adjusted bias-adjusted kappa (PABAK), while for the signs with continuous and ordinal scales, a reliability coefficient (Rc) was calculated using analysis of variance. A PABAK of >0.60 and an Rc of >0.80 were considered to indicate adequate reliability. Adequate poststandardization reliability was achieved for 30 of 42 physical signs/techniques (71%). The most highly reliable signs identified by physical examination of the OA knee included alignment by goniometer (Rc = 0.99), bony swelling (Rc = 0.97), general passive crepitus (Rc = 0.96), gait by inspection (PABAK = 0.78), effusion bulge sign (Rc = 0.97), quadriceps atrophy (Rc = 0.97), medial tibiofemoral tenderness (Rc = 0.94), lateral tibiofemoral tenderness (Rc = 0.85), patellofemoral tenderness by grind test (Rc = 0.94), and flexion contracture (Rc = 0.95). The standardization process resulted in substantial improvements in reliability for evaluation of a number of physical signs, although for some signs, minimal or no effect of standardization was noted. After standardization, warmth (PABAK = 0.14), medial instability at 30° flexion (PABAK = 0.02), and lateral instability at 30° flexion (PABAK = 0.34) were the only 3 signs that were highly unreliable. With the exception of physical examinations for instability, a comprehensive knee examination can be performed with adequate reliability. Standardization further improves the reliability for some physical signs and techniques. The application of these findings to future OA studies will contribute to improved outcome assessments in OA. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and Purpose. Range of motion (ROM) measurements have been included in several hip scores evaluating the results after hip surgery. The clinical pro-cedures of performing these measurements vary and disagreement exists about the accu-racy of visual estimatess compared to goniometer measurements. The purpose of this study was to study the reliability of goniometric measurements and visual estimates of hip ROM in patients with osteoarthrosis. Method. Hip ROM measurements (abduction, adduction, extension, flexion and internal/external rotation) were recorded by four different teams on the same day and were repeated one week later. Teams 1, 2 and 3 consisted of physiother-apists using standardized goniometric measurements. Team 4 involved an experienced orthopaedic surgeon making the assessments from visual estimates only. Twenty-five patients (6 M, 19 F; mean age 68.5 years, range 46-76 years) with osteoarthrosis of the hip, verified both clinically and radiologically, participated in the study. Results. With the exception of abduction (p=0.03), there were no significant differences between the mea-surements recorded on the first and the second occasions for the same teams. The coeffi-cient of variance was 5.5% for flexion (lowest) and 26.1% for extension (highest). Reproducibility was best for flexion. There was also high reliability when all the arcs of motion were summed up (abuction + adduction + extension + flexion + internal/external rotation). With the exception of internal rotation, there were highly significant differences between the teams when two people performed the measurements compared to the values measured by a single individual. Concordance, expressed as the standardized agreement index, between visual estimates made by one individual (the orthopaedic surgeon) and goniometric measurements made by two experienced physiotherapists, were 0.77-0.83 which indicates good agreement. Conclusion. The reproducibility... [ABSTRACT FROM AUTHOR]

Ten labrador retrievers and their owners undertook a programme to determine the effect of passive stretching on the dogs' osteoarthritic joints, which had a restricted range of motion. The range of motion of the joints was measured before and after the 21-day study, during which the owners performed 10 passive stretches for a hold of 10 seconds twice daily. Goniometric measurements showed that the passive stretching had significantly increased the range of motion of the joints. [ABSTRACT FROM AUTHOR]

The recruitment pattern of lower limb muscles during cycling is known to alter because of changes in workload and seat height. The effect of foot/pedal position is not well understood but may be useful in the prevention and management of injury. Seven healthy female subjects participated in a study. Three-foot positions on the pedal were tested in a random order: neutral, back and fore. Each subject cycled for 5 minutes at a set cadence and resistance during which 30 seconds of electromyogram data were recorded for gastrocnemius (Gast.) and tibialis anterior (TA). An electrogoniometer was located across the knee to concurrently record pedal revolutions. To test the effect of position, an ANOVA and Tukey's post-hoc were used for Gast. However, the data from the TA were not normally distributed; therefore, a Kruskal-Wallis was used for this muscle instead. No statistical significant relationship was found between foot position and TA activity ( p = 0.128). However, there was a significantly ( p = 0.000) lower level of activity in Gast. when the pedal was placed in the back foot position. Altering the position of the foot on a pedal changes the muscle activity of Gast. This is likely to be caused by the change in moment arm and may be exploited as a strategy to progress resistance during a training programme or as a method of protecting the muscle during a period of recovery. These conclusions should be interpreted with caution because of the small sample size. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The aims of this study were to 1) determine if hypergravity squats can produce foot forces similar to those measured while performing 10-repetition maximum (10-RM) squats under normal 1 Gz condition, and 2) compare the integrated EMG (iEMG) and goniometry of selected muscles and joints, respectively between hypergravity and 10-RM squats of similar foot forces. Six healthy young men [25 ± 2 yr (mean ± SD), 76 ± 5 kg] completed ten 10-RM squats (97 ± 12 kg) and 10 hypergravity squats (3.2 ± 0.3 Gz; range of 3-3.75 Gz) under similar average total foot force conditions (104% 10-RM) in the same visit. Hypergravity squats were performed on a human powered short-arm centrifuge. Foot forces were monitored using insole force sensors. Hip and knee flexion/extension, plantar/dorsi flexion, and EMG of the erector spinae, bicep femoris, rectus femoris and gastrocnemius were also monitored during the squats. There were no differences in average total foot forces, average duration per repetition, and iEMG and range of motion of the selected muscles and joints, respectively between hypergravity and 10-RM squats except a 60% greater iEMG of the gastrocnemius muscles during hypergravity squats (P < 0.05). These results suggest that hypergravity squats are comparable to squats performed at 1 Gz, and may represent an important countermeasure to microgravity. [ABSTRACT FROM AUTHOR]