Physical Therapy Commons^™

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.

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 …

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 …

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.

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 …

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.

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 …

Injury Prevention For High School Female Cross-Country Athletes, Jason Brumitt

Faculty Publications - College of Physical Therapy

Female athletes are at greater risk for certain injuries and conditions than are their male counterparts due to unique anatomic, physiologic, and psychological factors.1-4 Injury to the female high school student athlete may significantly impact her physical and mental well-being, disrupt the athlete’s family life with medical appointments, and affect her team’s success.5 Athletic trainers and therapists (ATs) should consider these injury risk factors when developing injury prevention programs for female student athletes.

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 …

Effects Of The Airlift Pttd Brace On Foot Kinematics In Subjects With Stage Ii Posterior Tibial Tendon Dysfunction, Christopher Neville, A. Samuel Flemister, Jeff Houck

Faculty Publications - College of Physical Therapy

Study Design: Experimental laboratory study.

Objectives: To investigate the effect of inflation of the air bladder component of the AirLift PTTD brace on relative foot kinematics in subjects with stage II posterior tibial tendon dysfunction (PTTD).

Background: Orthotic devices are commonly recommended in the conservative management of stage II PTTD to improve foot kinematics.

Methods and Measures: Ten female subjects with stage II PTTD walked in the laboratory wearing the AirLift PTTD brace during 3 testing conditions (air bladder inflation to 0, 4, and 7 PSI [SI equivalent: 0, 27 579, and 48 263 Pa]). Kinematics were recorded from the …

In-Season Rehabilitation Of A Division Iii Female Wrestler After A Glenohumeral Dislocation, Jason Brumitt, Alma Sproul, Philip Lentz, Linda Mcintosh, Richard Rutt

Faculty Publications - College of Physical Therapy

Objective: Wrestling is a popular sport in the United States at both the high school and collegiate levels. Traditionally a men’s sport, participation by female athletes in wrestling is increasing. There exists a paucity of literature regarding injury incidence in women’s wrestling. This lack of information challenges the ability of sports medicine and strength training professionals to design optimal injury prevention programs, training routines, and rehabilitation strategies. The objective of this report is to detail the successful conservative rehabilitation of a female wrestler after an initial glenohumeral dislocation.

Design: Case report

Case description: A 20-year-old female wrestling student–athlete presented to …

Glenohumeral Joint Range Of Motion In Elite Male Golfers: A Pilot Study, Jason Brumitt, Erik Meria, Bob Nee, Greg Davidson

Faculty Publications - College of Physical Therapy

Background: Shoulder injuries account for up to 17% of all golf related musculoskeletal injuries. One cause may be the repetitive stresses applied to the lead shoulder during the backswing and follow-through phases, which may contribute to the frequency of these injuries. The “elite” golfer may be predisposed to developing a shoulder injury based upon the reported adaptations to the glenohumeral joint.

Objective: To examine and compare bilateral glenohumeral joint rotational range of motion in elite golfers using standard goniometric procedures.

Methods: Twenty-four “elite” male golfers were recruited for this study. Glenohumeral internal (IR) and external rotation (ER) passive range of …

Functional Rehabilitation Exercise Prescription For Golfers, Jason Brumitt, R. Barry Dale

Faculty Publications - College of Physical Therapy

No abstract provided.

The Role Of Massage In Sports Performance And Rehabilitation: Current Evidence And Future Direction, Jason Brumitt

Faculty Publications - College of Physical Therapy

Background: Massage is a popular treatment choice of athletes, coaches, and sports physical therapists. Despite its purported benefits and frequent use, evidence demonstrating its efficacy is scarce.

Purpose: To identify current literature relating to sports massage and its role in effecting an athlete’s psychological readiness, in enhancing sports performance, in recovery from exercise and competition, and in the treatment of sports related musculoskeletal injuries.

Methods: Electronic databases were used to identify papers relevant to this review. The following keywords were searched: massage, sports injuries, athletic injuries, physical therapy, rehabilitation, delayed onset muscle soreness, sports psychology, sports performance, sports massage, sports …

Low Frequency Fatigue In Human Quadriceps Is Fatigue Dependent And Not Task Dependent, Masaki Iguchi, Kris Baldwin, Charles Boeyink, Carol Engle, Michael Kehoe, Anish Ganju, Andrew J. Meszaros, Richard Shields

Faculty Publications - College of Physical Therapy

It is well accepted that a low intensity/long duration isometric contraction induces more low frequency fatigue (LFF) compared to a high-intensity/short-duration contraction. However, previous reports examined the intensity/duration of the contraction but did not control the level of fatigue when concluding fatigue is task dependent. The purpose of this study was to determine whether a long duration/low intensity fatiguing contraction would induce greater LFF than a short duration/high-intensity contraction when the quadriceps muscle was fatigued to similar levels. Eighteen healthy male subjects performed quadriceps contractions sustained at 35% and 65% of maximal voluntary contraction (MVC) on separate days, until the …

The Effect Of Anterior Versus Posterior Glide Joint Mobilization On External Rotation Range Of Motion In Patients With Shoulder Adhesive Capsulitis, Jason Brumitt

Faculty Publications - College of Physical Therapy

No abstract provided.

The Relationship Between Ankle, Hindfoot, And Forefoot Position And Posterior Tibial Muscle Excursion, Adolph S. Flemister, Christopher G. Neville, Jeff Houck

Faculty Publications - College of Physical Therapy

Background: The purpose of this study was to examine the relationship of forefoot position in the transverse plane (abduction/adduction), hindfoot position in the frontal plane (eversion/inversion), and ankle position in the sagittal plane (plantarflexion/dorsiflexion) with posterior tibialis (PT) muscle excursion using an in vitro cadaver model.

Methods: Seven fresh-frozen cadaver specimens were potted and mounted on a frame. The PT tendon was dissected 15 cm proximal to the medial malleolus, and a 5-kg weight was sutured to the tendon. A six-camera motion analysis system (Optotrak, Northern Digital, Inc.) was used to track three-dimensional (3D) motion of the tibia, calcaneus (hindfoot) …

Influence Of Anticipation On Movement Patterns In Subjects With Acl Deficiency Classified As Noncopers, Jeff R. Houck, Kenneth E. De Haven, Mike Maloney

Faculty Publications - College of Physical Therapy

Study Design: Two-factor, mixed experimental design.

Objectives: To compare movement patterns of subjects who are anterior cruciate ligament (ACL) deficient and classified as noncopers to controls during early stance of anticipated and unanticipated straight and cutting tasks.

Background: Altered neuromuscular control of subjects that are ACL deficient and noncoper theoretically influences movement patterns during unanticipated tasks.

Methods and Measures: The study included 16 subjects who are ACL deficient, classified as noncopers, and 20 healthy controls. Data were collected using an Optotrak Motion Analysis System and force plate integrated with Motion Monitor Software to generate knee joint angles, moments, and power. …

Point/Counterpoint: Are Specific Spine Stabilization Exercises Necessary For Athletes?, J. Gray, Jason Brumitt, Loren Z.F. Chiu

Faculty Publications - College of Physical Therapy

The issue of spine stabilization has received considerable attention in recent years; although there are many proponents for specific training of spinal musculature, there is debate as to whether it is beneficial and required for athletes.

Comparison Of Frontal Plane Trunk Kinematics And Hip And Knee Moments During Anticipated And Unanticipated Walking And Side Step Cutting Tasks, Jeff R. Houck, Andrew Duncan, Kenneth E. De Haven

Faculty Publications - College of Physical Therapy

Background: Frontal plane trunk and lower extremity adjustments during unanticipated tasks are hypothesized to influence hip and knee neuromuscular control, and therefore, contribute to anterior cruciate ligament (ACL) injury risk. The aims of this study were to examine frontal plane trunk/hip kinematics and hip and knee moments (measures of neuromuscular control) during unanticipated straight and side step cut tasks.

Methods: Kinematic and kinetic variables were collected while subjects performed two anticipated tasks, including walking straight (ST) and side step cutting (SS), and two unanticipated tasks (STU and SSU). Foot placement, thorax–pelvis–hip kinematic variables and hip and knee moments were calculated …

Scapular-Stabilization Exercises: Early-Intervention Prescription, Jason Brumitt

Faculty Publications - College of Physical Therapy

This article highlights exercise prescription to enhance scapular stabilization during the initial phase of rehabilitation, with additional tips for subsequent progression to exercises incorporating the kinetic chain.