Recognition and Management of Traumatic Sports Injuries in the Skeletally Immature Athlete.

Recognition and management of traumatic sports injuries in the skeletally immature athlete.

Filed under: Rehab Centers

Int J Sports Phys Ther. 2012 Dec; 7(6): 691-704
Merkel DL, Molony JT

Over the last decade, participation in organized youth sports has risen to include over 35 million contestants.(1) The rise in participation has brought about an associated increase in both traumatic and overuse injuries in the youth athlete, which refers to both children and adolescents within a general age range of seven to 17. Exposure rates alone do not account for the increase in injuries. Societal pressures to perform at high levels affect both coaches and athletes and lead to inappropriate levels of training intensity, frequency, and duration. In this environment high physiologic stresses are applied to the immature skeleton of the youth athlete causing injury. Typically, since bone is the weakest link in the incomplete ossified skeleton, the majority of traumatic injuries result in fractures that occur both at mid-shaft and at the growth centers of bone. The following clinical commentary describes the common traumatic sports injuries that occur in youth athletes, as well as those which require rapid identification and care in order to prevent long term sequelae.
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Anterior cruciate ligament injury diagnosis and management in a pediatric patient: a case report.

Filed under: Rehab Centers

Int J Sports Phys Ther. 2012 Dec; 7(6): 678-90
Hazle C, Duby C

The management of the skeletally immature athlete sustaining injury to the anterior cruciate ligament and other knee structures provides multiple challenges for both the treating clinicians and parents of the injured child. The diagnostic process and subsequent decision making present additional complexities because of the developmental anatomy and the potential for disturbance of normal growth patterns by some surgical interventions. In the following case report, the course to appropriate management of a young athlete is detailed, including the contributions of imaging results. The reconstructive options available to orthopedic surgeons and the patient’s post-operative progression are also briefly discussed. Rehabilitation practitioners require an understanding of the unique issues present when providing care for pediatric and adolescent athletes with knee injuries in order to assist in optimal decision making in the phases during which they are involved. LEVEL OF EVIDENCE: 5 (Single Case Report).
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Rehabilitation of a surgically repaired rupture of the distal biceps tendon in an active middle aged male: a case report.

Filed under: Rehab Centers

Int J Sports Phys Ther. 2012 Dec; 7(6): 663-71
Horschig A, Sayers SP, Lafontaine T, Scheussler S

Complete rupture of the distal tendon of the biceps brachii is relatively rare and there is little information to guide therapists in rehabilitation after this injury. The purposes of this case report are to review the rehabilitation concepts used for treating such an injury, and discuss how to modify exercises during rehabilitation based on patient progression while adhering to physician recommended guidelines and standard treatment protocols.The patient was an active 38-year old male experienced in weight-training. He presented with a surgically repaired right distal biceps tendon following an accident on a trampoline adapted with a bungee suspension harness. The intervention focused on restoring range of motion and strengthening of the supporting muscles of the upper extremity without placing undue stress on the biceps brachii.The patient was able to progress from a moderate restriction in ROM to full AROM two weeks ahead of the physician’s post-operative orders and initiate a re-strengthening protocol by the eighth week of rehabilitation. At the eighth post-operative week the patient reported no deficits in functional abilities throughout his normal daily activities with his affected upper extremity.The results of this case report strengthen current knowledge regarding physical therapy treatment for a distal biceps tendon repair while at the same time providing new insights for future protocol considerations in active individuals. Most current protocols do not advocate aggressive stretching, AROM, or strengthening of a surgically repaired biceps tendon early in the rehabilitation process due to the fear of a re-rupture. In the opinion of the authors, if full AROM can be achieved before the 6(th) week of rehabilitation, initiating a slow transition into light strengthening of the biceps brachii may be possible.4-Single Case report.
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Intra and intersession reliability of a postural control protocol in athletes with and without anterior cruciate ligament reconstruction: a dual-task paradigm.

Filed under: Rehab Centers

Int J Sports Phys Ther. 2012 Dec; 7(6): 627-36
Mohammadirad S, Salavati M, Takamjani IE, Akhbari B, Sherafat S, Mazaheri M, Negahban H

Quantification of dynamic balance is essential to assess a patient’s level of injury or ability to function so that a proper plan of care may commence. In spite of comprehensive utilization of dual-tasking in balance assessment protocols, a lack of sufficient reliability data is apparent.The purpose of the present study was to determine the intra- and inter-session reliability of dynamic balance measures obtained using the Biodex Balance System® (BBS) for a group of athletes who had undergone anterior cruciate ligament reconstruction (ACLR) and a matched control group without ACLR, while using a dual-task paradigm.Single-limb postural stability was assessed in 15 athletes who had undergone ACLR and 15 healthy matched controls. The outcome variables included measures of both postural and cognitive performance. For measuring postural performance, the overall stability index (OSI), anterior-posterior stability index (APSI), and medial-lateral stability index (MLSI), were recorded. Cognitive performance was evaluated by measuring error ratio and average reaction time. Subjects faced 4 postural task difficulty levels (platform stabilities of 8 and 6 with eyes open and closed), and 2 cognitive task difficulty levels (with or without auditory Stroop task). During dual task conditions (conditions with Stroop task), error ratio and average reaction time were calculated.Regarding intrasession reliability, ICC values of test session were higher for MLSI [ACL-R group (0.83-0.95), control group (0.71-0.95)] compared to OSI [ACL-R group (0.80-0.92), control group (0.67-0.95)] and APSI [ACL-R group (0.73-0.90), control group (0.62-0.90)]. Furthermore, ICC values of first test session were higher in reaction time [ACL-R group (0.92-0.95), control group (0.80-0.92)] than error ratio [ACL-R group (0.72-0.88), control group (0.61-0.83)]. ICC values of retest session were higher for MLSI [ACL-R group (0.83-0.94), control group (0.87-0.93)] than OSI [ACL-R group (0.81-0.91), control group (0.83-0.93)] and APSI [ACL-R group (0.73-0.90), control group (0.53-0.90)]. Moreover, ICC values of retest session were higher in reaction time [ACL-R group (0.89-0.98), control group (0.80-0.92)] equated with error ratio [ACL-R group (0.73-0.87), control group (0.57-0.79)]. With respect to intersession reliability, ICC values were higher for MLSI [ACL-R group (0.72-0.96), control group (0.75-0.92)] than OSI [ACL-R group (0.55-0.91), control group (0.64-0.87)] and APSI [ACL-R group (0.55-0.79), control group (0.46-0.89)]. Additionally, ICC values were higher in reaction time [ACL-R group (0.87-0.95), control group (0.68-0.81)] in contrast to error ratio [ACL-R group (0.42-0.64), control group (0.54-0.74)].Biodex Balance System® measures of postural stability demonstrated moderate to high reliability in athletes with and without ACLR during dual-tasking. Results of the current study indicated that assessment of postural and cognitive performance in athletes with ACLR may be reliably incorporated into the evaluation of functional activity.2b.
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An electromyographic study of the vastii muscles during open and closed kinetic chain submaximal isometric exercises.

Filed under: Rehab Centers

Int J Sports Phys Ther. 2012 Dec; 7(6): 617-26
Spairani L, Barbero M, Cescon C, Combi F, Gemelli T, Giovanetti G, Magnani B, D’Antona G

Rehabilitation programs for patients with patellofemoral dysfunction aim to recruit the vastus medialis obliquus muscle (VMO) in an attempt to reduce pain and to improve patellar tracking.The aim of the present study was to use surface EMG to assess the effectiveness of two isometric submaximal contractions (10% and 60% of maximal voluntary contraction, MVC) in promoting preferential activation of VMO over vastus medialis longus (VML) and vastus lateralis (VL) in open and closed kinetic chain isometric exercises with the knee joint fixed at 30, 60 and 90 degrees of flexion.Surface electromyography (EMG) signals were recorded with linear adhesive arrays of four electrodes from fourteen healthy young men (age 23.5±3.2, mean±SD) during isometric knee extension contractions at 10% and 60% of the maximum voluntary contraction (MVC) for 1 min and 20 s respectively at 30, 60 and 90 degrees of knee flexion. Initial values and rate of change (slope) of mean frequency (MNF), average rectified value (ARV) and conduction velocity (CV) of the EMG signal were calculated.Comparisons between the force levels produced at 10% and 60% MVC revealed that the initial values of ARV and CV for the VL, VML and VMO muscle were greater at 60% MVC compared to 10% MVC (3-way ANOVA; F=536; p<0.001, F=49: p<0.01 for ARV and CV respectively). Comparisons between the different muscles demonstrated lower initial values of CV for VMO compared to VL and VLM at 10% and 60% of MVC (F=15; p<0.05). In addition, initial estimates of ARV were higher for VMO compared to VML at both force levels (F=66; p<0.05). Comparisons between open and closed kinetic chain exercises revealed higher initial estimates of ARV for open kinetic chain knee extension at both force levels (F=62; p<0.01). In addition, the absolute value of MNF slope appeared to increase at higher angles for closed kinetic chain at 60% MVC while it was minimum at 60° degrees for open kinetic chain. No significant differences were observed in the rate of change of CV and MNF among the three muscles.Based on the results of this study, both open and closed kinetic chain exercise similarly activate the three portions of the quadriceps muscle, suggesting that selective training of the vastii muscle is not achievable in these conditions. HubMed – rehab


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