Rehabilitation and Therapy Commons^™

Altered Tendon Characteristics And Mechanical Properties Associated With Insertional Achilles Tendinopathy, Ruth L. Chimenti, Adolph S. Flemister, Joshua Tome, James M. Mcmahon, Marie A. Flannery, Ying Xue, Jeff R. Houck

Faculty Publications - College of Physical Therapy

Study Design: Case-control laboratory study.

Objectives: To compare tendon characteristics (shape, composition) and mechanical properties (strain, stiffness) on the involved side of participants with insertional Achilles tendinopathy (IAT) to the uninvolved side and to controls, and to examine if severity of tendon pathology is associated with severity of symptoms during function.

Background: Despite the severity and chronicity of IAT, the quality of theoretical evidence available to guide the development of exercise interventions is low. While tendon pathology of midportion Achilles tendinopathy has been described, there are few studies specific to IAT.

Methods: Twenty individuals with unilateral IAT and 20 age- …

Lower Extremity Functional Tests And Risk Of Injury In Division Iii Collegiate Athletes, Jason Brumitt, Bryan C. Heiderscheit, Robert C. Manske, Paul E. Niemuth, Mitchell J. Rauh

Faculty Publications - College of Physical Therapy

Purpose/Background: Functional tests have been used primarily to assess an athlete’s fitness or readiness to return to sport. The purpose of this prospective cohort study was to determine the ability of the standing long jump (SLJ) test, the single-leg hop (SLH) for distance test, and the lower extremity functional test (LEFT) as preseason screening tools to identify collegiate athletes who may be at increased risk for a time-loss sports-related low back or lower extremity injury.

Methods: A total of 193 Division III athletes from 15 university teams (110 females, age 19.1 ± 1.1 y; 83 males, age 19.5 ± 1.3 …

Clinical Outcomes And Static And Dynamic Assessment Of Foot Posture After Lateral Column Lengthening Procedure, Heather Barske, Ruth Chimenti, Josh Tome, Elizabeth Martin, Adolph S. Flemister, Jeff Houck

Faculty Publications - College of Physical Therapy

Background: Lateral column lengthening (LCL) has been shown to radiographically restore the medial longitudinal arch. However, the impact of LCL on foot function during gait has not been reported using validated clinical outcomes and gait analysis.

Methods: Thirteen patients with a stage II flatfoot who had undergone unilateral LCL surgery and 13 matched control subjects completed self-reported pain and functional scales as well as a clinical examination. A custom force transducer was used to establish the maximum passive range of motion of first metatarsal dorsiflexion at 40 N of force. Foot kinematic data were collected during gait using 3-dimensional motion …

Core Stabilization Exercise Prescription, Part I: Current Concepts In Assessment And Intervention, Jason Brumitt, J. W. Matheson, Erik P. Meira

Faculty Publications - College of Physical Therapy

Context: Injury to the low back can cause significant pain and dysfunction, which can affect an athlete’s performance and result in time lost from sport. A common conservative treatment is therapeutic core stabilization exercises, which can address pain and musculoskeletal dysfunction in patients with low back pathology.

Evidence Acquisition: MEDLINE and CINAHL were searched (from 1966 to March 2013) to identify relevant research. Keywords and keyword combinations searched included motor control exercise, segmental stabilization, core stabilization, transversus abdominis, multifidi, and low back pain.

Results: There are 2 popular rehabilitation strategies to assess core function and promote core stabilization. Each has …

Total And Distributed Plantar Loading In Subjects With Stage Ii Tibialis Posterior Tendon Dysfunction During Terminal Stance, Christopher Neville, A. Samuel Flemister, Jeff Houck

Faculty Publications - College of Physical Therapy

Background: In subjects with stage II tibialis posterior tendon dysfunction (TPTD), the function of the tibialis posterior muscle is altered and may be associated with a change in total and distributed loading.

Methods: Thirty subjects with a diagnosis of stage II TPTD and 15 matched control subjects volunteered to participate in a study to examine the total and distributed plantar loading under the foot during the terminal stance phase of gait. Plantar loading, measured as the subject walked barefoot, was assessed using instrumented flexible insoles. A secondary analysis was done to explore the contribution of flatfoot kinematics to plantar loading …

Abstract: Functional Testing And Prediction Of Lower Extremity Or Low Back Injury Among Division Iii Collegiate Athletes, Jason Brumitt

Faculty Publications - College of Physical Therapy

No abstract provided.

Core Stabilization Exercise Prescription, Part 2: A Systematic Review Of Motor Control And General (Global) Exercise Rehabilitation Approaches For Patients With Low Back Pain, Jason Brumitt, J. W. Matheson, Erik P. Meira

Faculty Publications - College of Physical Therapy

Context: Therapeutic exercises are frequently prescribed to patients with low back pain. Numerous exercise programs for patients with low back pain have been described. Many of these treatment programs are based on 1 of 2 popular rehabilitation strategies: a motor control exercise approach or a general exercise approach.

Data Sources: PubMed clinical queries from 1966 to March 2013 for keyword combinations including motor control exercise, core stability exercise, therapeutic exercise, general exercise, global exercise, local exercise, transversus abdominis, segmental stabilization, and low back pain.

Study Selection: Randomized controlled trials that assessed the effects of a motor control exercise approach, a …

Influence Of Upper Extremity Assistance On Lower Extremity Force Application Symmetry In Individuals Post–Hip Fracture During The Sit-To-Stand Task, Janet A. Kneiss, Jeff R. Houck, Susan A. Bukata, J. Edward Puzas

Faculty Publications - College of Physical Therapy

STUDY DESIGN: Controlled laboratory study using a cross-sectional design.

OBJECTIVES: To compare lower extremity force applications during a sit-to-stand (STS) task with and without upper extremity assistance in older individuals post–hip fracture to those of age matched controls.

BACKGROUND: A recent study documented the dependence on upper extremity assistance and the uninvolved lower limb during an STS task in individuals post–hip fracture. This study extends this work by examining the effect of upper extremity assistance on symmetry of lower extremity force applications.

METHODS: Twenty-eight community-dwelling elderly subjects, 14 who had recovered from a hip fracture and 14 controls, participated in …

A Systematic Review Of Sensorimotor Function During Adolescence: A Developmental Stage Of Increased Motor Awkwardness?, Catherine C. Quatman-Yates, Carmen Quatman, Andrew Mezsaros, Mark V. Paterno, Timothy E. Hewett

Faculty Publications - College of Physical Therapy

No abstract provided.

Comprehensive Strength Training Program For A Recreational Senior Golfer 11-Months After A Rotator Cuff Repair, Jason Brumitt, Erik P. Meira, Hui En Gilpin, Meredith Brunette

Faculty Publications - College of Physical Therapy

Background and Purpose: Golf is a popular sport played by hundreds of thousands of individuals of all ages and of varying skill levels. An orthopedic or sports-related injury and/or surgery may limit an individual’s sport participation, require him/her to complete a course of rehabilitation, and initiate (or resume) a sportspecific training program. Unlike the availability of evidence to guide postsurgical rehabilitation and sportspecific training of athletes from sports other than golf, there have only been two reports describing outcomes after surgery and for golfers. The purpose of this case report is to present a post-rehabilitation return to sporttraining program for …

Analysis Of Vertical Ground Reaction Force Variables During A Sit To Stand Task In Participants Recovering From A Hip Fracture, Jeff R. Houck, Janet Kneiss, Susan V. Bukata, J. Edward Puzas

Faculty Publications - College of Physical Therapy

Background: A Sit to Stand task following a hip fracture may be achieved through compensations (e.g. bilateral arms and uninvolved lower extremity), not restoration of movement strategies of the involved lower extremity. The primary purpose was to compare upper and lower extremity movement strategies using the vertical ground reaction force during a Sit to Stand task in participants recovering from a hip fracture to control participants. The secondary purpose was to evaluate the correlation between vertical ground reaction force variables and validated functional measures.

Methods: Twenty eight community dwelling older adults, 14 who had a hip fracture and 14 control …

Successful Rehabilitation Of A Recreational Endurance Runner: Initial Validation For The Bunkie Test, Jason Brumitt

Faculty Publications - College of Physical Therapy

This case report details the musculoskeletal evaluation and the successful rehabilitation of a 24-year-old female recreational distance runner who self-referred to physical therapy with an acute bout of low back pain (LBP). Her LBP was provoked during each distance run. The patient’s musculoskeletal evaluation revealed core weakness, especially on the left. A recently reported functional test, the Bunkie test, was administered as part of the physical evaluation. The scores from the Bunkie test correlated with other quantitative and qualitative findings. A therapeutic exercise program emphasizing core stabilization was prescribed. The patient was able to shortly return to running pain-free.

Exercise Habits And Tobacco Use Among Male Latino Farmworkers, Jason Brumitt, Leda I. Garside, Rebecca Reisch, Talina Marshall, Hui En Gilpin, Jessica Kinsey, Kelsey Imondi, Heather Robinson

Faculty Publications - College of Physical Therapy

Migrant farmworkers risk occupational injury and are at risk for developing chronic health conditions. Exercise may enhance health and help to reduce the risk of occupational injury and/or reduce the risk of developing a chronic health condition. Little is known, however, about the exercise habits of Latino migrant farmworkers. Male Latino migrant farmworkers completed an exercise and health habits questionnaire at health screening clinics. One hundred fifty-three (58.2%) subjects reported exercising during the week. There was no difference in age between those who reported exercising and those who did not (p = .78). Only 42 (16%) of all workers reported …

Self-Reported Musculoskeletal Pain In Latino Vineyard Workers, Jason Brumitt, Rebecca Reisch, Karla Krasnoselsky, Amy Welch, Richard Rutt, Leda I. Garside, Carolyn Mckay

Faculty Publications - College of Physical Therapy

The agricultural economy in the United States is dependent on millions of Latino migratory workers. Despite the health risks associated with this line of work, many agricultural workers lack health insurance or access to health care services. The purpose of this study was to collect demographic data and investigate the musculoskeletal health of Latino migratory vineyard workers. A physical therapy team collected demographic data at health clinics held at vineyards in Oregon. Nearly half (48.4%) of all vineyard workers reported experiencing musculoskeletal symptoms (MSS) in at least one region of the body. The primary region of reported MSS was the …

Influence Of The Hip On Patients With Patellofemoral Pain Syndrome: A Systematic Review, Erik P. Meira, Jason Brumitt

Faculty Publications - College of Physical Therapy

Context: Patellofemoral pain syndrome (PFPS) is one of the most common conditions limiting athletes. There is a growing body of evidence suggesting that dysfunction at the hip may be a contributing factor in PFPS.

Data Sources: MEDLINE (1950–September 2010), CINAHL (1982–September 2010), and SPORTDiscus (1830–September 2010) were searched to identify relevant research to this report. Study Selection: Studies were included assessing hip strength, lower extremity kinematics, or both in relation to PFPS were included.

Data Extraction: Studies included randomized controlled trials, quasi-experimental designs, prospective epidemiology, case-control epidemiology, and cross-sectional descriptive epidemiology in a scientific peer-reviewed journal.

Results: PFPS is associated …

Patellofemoral Pain Syndrome Alters Neuromuscular Control And Kinetics During Stair Ambulation, Naoko Aminaka, Brian G. Pietrosimone, Charles W. Armstrong, Andrew Mezsaros, Phillip A. Gribble

Faculty Publications - College of Physical Therapy

The aim of the study was to investigate differences in frontal plane knee kinetics, onset timing and dura-tion of the gluteus medius (GMed), adductor longus (AL), and vastus medialis oblique (VMO) during stair ambulation between those with and without patellofemoral pain syndrome (PFPS). Twenty PFPS patients and twenty healthy participants completed stair ambulation while surface electromyography (EMG), video, and ground reaction forces were collected. PFPS patients had a higher peak internal knee abduction moment during stair ascent, and a higher internal knee abduction impulse for both ascent and descent. During stair ascent, PFPS patients displayed earlier onset of the AL …

Musculoskeletal Healthcare For Latino Migrant Farmworkers: Interprofessional Collaboration To Provide Service And Educate Future Health Care Providers, Jason Brumitt, Leda Garside, Rebecca Reisch, Talina Marshall, Hu En Gilpin, Jessica Kinsey, Kelsey Imondi

Faculty Publications - College of Physical Therapy

The inability to access health care services is a significant issue in the United States (US). The US Census Bureau reports that as of 2009 over 50 million individuals (16.7% of the population) lacked health insurance. The number of people who became uninsured has also increased over time. One segment of the US population that is particularly vulnerable to health care inequities is Latinos. Failure to access timely primary medical services may increase the risk of disease transmission, morbidity, and mortality. In addition, failing to address health care needs at the primary provider level may contribute to an overutilization of …

Incorporating Kettlebells Into A Lower Extremity Sports Rehabilitation Program, Jason Brumitt, Hui En Gilpin, Merideth Brunette, Erik P. Meira

Faculty Publications - College of Physical Therapy

The primary goal of a sports rehabilitation program is to return the injured athlete back to competition as quickly and as safely as possible. Sports physical therapists utilize a variety of exercise equipment to help an athlete restore function after an injury. An injured athlete’s therapeutic exercise program frequently includes the prescription of functional strengthening and power exercises during the later stages of rehabilitation. One piece of exercise equipment, the kettlebell, has gained popularity for its ability to allow the user to perform functional power exercises. The unique exercises that can be performed with kettlebells may have utility in sports …

Achilles Pain, Stiffness, And Muscle Power Deficits: Achilles Tendinitis, Christopher C. Carcia, Robroy L. Martin, Jeff Houck, Dane K. Wukich

Faculty Publications - College of Physical Therapy

The Orthopaedic Section of the American Physical Therapy Association presents this sixth set of clinical practice guidelines on Achilles pain, stiffness, and muscle power deficits that are characteristic of Achilles Tendinitis. These clinical practice guidelines are linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) interventions provided by physical therapists, (3) and assessment of outcome for common musculoskeletal disorders.

Minimizing Injuries And Enhancing Performance In Golf Through Training Programs, Erik P. Meira, Jason Brumitt

Faculty Publications - College of Physical Therapy

Context: Golf is a popular sport, particularly in older populations. Regardless of age and skill level, golfers risk injury to the back, shoulder, wrist and hand, elbow, and knee. Because of the unique compressive, shear, rotational, and lateral bending forces created in the lumbar region during the golf swing, the primary sport-related malady experienced by amateurs and professionals is low back pain. Extrinsic and intrinsic injury risk factors have been reported in the literature. A growing body of evidence supports the prescription of strength training routines to enhance performance and reduce the risk of injury.

Evidence Acquisition: Relevant studies were …

Deep Posterior Compartment Strength And Foot Kinematics In Subjects With Stage Ii Posterior Tibial Tendon Dysfunction, Christopher Neville, Adolph S. Flemister, Jeff Houck

Faculty Publications - College of Physical Therapy

Background: Tibialis posterior muscle weakness has been documented in subjects with Stage II posterior tibial tendon dysfunction (PTTD) but the effect of weakness on foot structure remains unclear. The association between strength and flatfoot kinematics may guide treatment such as the use of strengthening programs targeting the tibialis posterior muscle.

Materials and Methods: Thirty Stage II PTTD subjects (age; 58.1 ± 10.5 years, BMI 30.6 ± 5.4) and 15 matched controls (age; 56.5 ± 7.7 years, BMI 30.6 ± 3.6) volunteered for this study. Deep Posterior Compartment strength was measured from both legs of each subject and the strength ratio …

Oasis Inter-Rater Reliability And Reimbursement: A Study Of Inter-Rater Reliability Of The Outcome And Assessment Information Set (Oasis): Its Effects On The Home Health Resource Group (Hhrg) And Reimbursement, Paul A. Shew

Faculty Publications - College of Physical Therapy

One of the outcomes of the initial Outcome and Assessment Information Set (OASIS) is to establish a level of reimbursement through the Medicare Prospective Payment System (PPS). Several inter-rater reliability (IRR) studies have noted differences in responses to individual questions within the OASIS but little is known about how variations in scoring might affect the final reimbursement projection. In a one-way repeated measures design study, the OASIS was completed on 52 patients by both an RN and a PT within a 24-hour timeframe and the projected reimbursement rates were compared. Fifty-four percent of the outcomes of the assessment pairs were …

Repetitive Eccentric Muscle Contractions Increase Torque Unsteadiness In The Human Triceps Brachii, Andrew Mezsaros, Masaki Iguchi, Shuo-Hsiu Chang, Richard K. Shields

Faculty Publications - College of Physical Therapy

Torque steadiness and low-frequency fatigue (LFF) were examined in the human triceps brachii after concentric or eccentric fatigue protocols. Healthy young males (n = 17) performed either concentric or eccentric elbow extensor contractions until the eccentric maximal voluntary torque decreased to 75% of pre-fatigue for both (concentric and eccentric) protocols. The number of concentric contractions was greater than the number of eccentric contractions needed to induce the same 25% decrease in eccentric MVC torque (52.2 ± 2.9 vs. 41.5 ± 2.1 for the concentric and eccentric protocols, respectively, p < .01). The extent of peripheral fatigue was 12% greater after the concentric compared to the eccentric protocol (twitch amplitude), whereas LFF (increase in double pulse torque/single pulse torque), was similar across protocols. Steadiness, or the ability for a subject to hold a submaximal isometric contraction, was 20% more inpaired during the Ecc protocol (p = .052). Similarly, the EMG activity required to hold the torque steady was nearly 20% greater after the eccentric compared to concentric protocol. These findings support that task dependent eccentric contractions preferentially alter CNS control during a precision based steadiness task.

Patient Factors In The Selection Of Operative Versus Nonoperative Treatment For Posterior Tibial Tendon Dysfunction, Kathryn O'Connor, Judith Baumhauer, Jeff R. Houck

Faculty Publications - College of Physical Therapy

Background: The influence of demographic, medical history, and treatment variables on the maintenance of nonoperative care or progression to operative intervention in Posterior Tibial Tendon Dysfuction (PTTD) was explored. This retrospective study compared demographic, medical history and treatment variables between operative and nonoperative care in subjects with PTTD.

Materials and Methods: Charts with the ICD-9 codes (726.72, 726.90) and brace distribution records for 2005 and 2006 were used to identify subjects. From these, 166 of 606 charts included documentation of PTTD. Variables were grouped into three categories including demographics (Age, body mass index, gender and working status), medical (stage, symptom …

Clinically Applicable Paper: Land-Based Versus Pool-Based Exercise For People Awaiting Joint Replacement Surgery Of The Hip Or Knee: Results Of A Randomized Controlled Trial, Cheryl Rudisile-Smith, Marissa Loosli, Jason Brumitt

Faculty Publications - College of Physical Therapy

Landbased versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial

Integrating Shoulder And Core Exercises When Rehabilitating Athletes Performing Overhead Activities, Jason Brumitt, R. Barry Dale

Faculty Publications - College of Physical Therapy

Athletes performing overhead activities are at risk of sustaining both overuse and traumatic shoulder injuries. Research studies utilizing electromyography have identified therapeutic exercises that are effective in the muscular activation of the rotator cuff and the scapular stabilizers. Sports medicine professionals routinely prescribe these traditional therapeutic exercises when rehabilitating athletes. Failing to identify and address contributing musculoskeletal dysfunctions may delay an athlete’s successful return to sport. Integrating shoulder and core exercises can address potential musculoskeletal dysfunctions while serving as a transitional program between the initial therapeutic exercises and the terminal return to sport rehabilitation program.

Comprehensive Sports Medicine Treatment Of An Athlete Who Runs Cross-Country And Is Iron Deficient, Jason Brumitt, Linda Mcintosh, Richard Rutt

Faculty Publications - College of Physical Therapy

Background: Optimal athletic performance may be dependent upon an athlete maintaining adequate iron levels through the consumption of dietary forms of iron and subsequent metabolism. Endurance athletes, especially female distance runners, have been identified as being at risk for developing iron deficiency. While iron deficiency is treatable, early diagnosis may be delayed if an adequate medical history and evaluation is not conducted.

Objective: To describe the evaluation, diagnosis, and comprehensive sports medicine treatment of a collegiate cross-country athlete with a medical diagnosis of iron deficiency with anemia and sports-related musculoskeletal pain.

Case Description: A 21-year-old female collegiate crosscountry athlete experienced …

Choosing Among 3 Ankle-Foot Orthoses For A Patient With Stage Ii Posterior Tibial Tendon Dysfunction, Christopher Neville, Jeff Houck

Faculty Publications - College of Physical Therapy

No head-to-head comparisons of different orthoses for patients with stage II posterior tibial tendon dysfunction (PTTD) have been performed to date. Additionally, the cost of orthoses varies considerably, thus choosing an effective orthosis that is affordable to the patient is largely a trial-and-error process. Case Description: A 77-year-old woman was seen with complaints of abnormal foot posture (“my foot is out”), minimal medial foot and ankle pain, and a 3-year history of conservatively managed stage II PTTD. The patient was not able to complete 1 single-limb heel rise on the involved side, while she could complete 3 on the uninvolved …

A Return To Running Program For The Postpartum Client: A Case Report, Jason Brumitt

Faculty Publications - College of Physical Therapy

The purpose of this case report is to present a return to running program for a postpartum client who had delivered via cesarean section. The client, a 29-year-old female health care professional who was 8 months postcesarean section, was referred to physical therapy for a return to running exercise program. The client had three live births during a 30-month time period (February 2004 to August 2006). During her last labor she underwent an emergency cesarean section because of a low fetal heart rate. Since her surgery the client had not participated in an exercise routine. Following an 8-week training program …

Clinical Report: Land-Based Versus Pool-Based Exercise For People Awaiting Joint Replacement Surgery Of The Hip Or Knee: Results Of A Randomized Controlled Trial, C. Rudisile-Smith, M. Loosli, J. Brumitt

Faculty Publications - College of Physical Therapy

Background: Individuals with either knee or hip osteoarthritis are at risk of experiencing pain and developing functional limitations (Bennell 2005). In many cases, to alleviate pain and improve one's quality of life, an individual may require a total joint replacement. Despite advances in surgical technique and joint replacement hardware, surgical procedures are not without risk. Conservative treatments, including therapeutic exercise programmes, may improve a patient's status while avoiding the potential risks associated with surgery (pain, medication utilisation, long bouts of rehabilitation, and/ or death). Researchers have demonstrated that some patients may experience improvements in pain and functional abilities after participating …