Physiospot Sports

The lumbar spine and low back pain in golf: a literature review of swing biomechanics and injury prevention

George S. Gluck, John A. Bendo and Jeffrey M. Spivak

This article provides a review of lumbar spine forces during the golf swing and other research available on swing biomechanics and muscle activity during trunk rotation.  Prospective, randomized studies have shown that focus on the transversus abdominus (TA) and multifidi (MF) muscles is a necessary part of physical therapy for LBP. Some studies also suggest that the coaching of a “classic” golf swing and increasing trunk flexibility may provide additional benefit.

There is a notable lack of studies separating the effects of swing modification from physical rehabilitation, and controlled trials are necessary to identify the true effectiveness of specific swing modifications for reducing LBP in golf. Guidelines for returning to golf after spine surgery are also discussed.

The Spine Journal, 2008, 8(5), 778-788

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Rotator cuff coactivation ratios in participants with subacromial impingement syndrome

Joseph B. Myers, Ji-Hye Hwang, Maria R. Pasquale, J. Troy Blackburn, Scott M. Lephart

The purpose of this study was to determine if abnormal rotator cuff coactivation and deltoid activation patterns exist in participants with subacromial impingement. Rotator cuff coactivation and middle deltoid activation was assessed during an elevation task. Participants with impingement exhibited decreased rotator cuff coactivation and increased middle deltoid activation at the initiation of elevation. The participants with impingement also had higher subscapularis–infraspinatus and supraspinatus–infraspinatus coactivation above the level of the shoulder where pain is typically present.

Individuals with subacromial impingement exhibit rotator cuff muscle coactivation and deltoid activation abnormalities during humeral elevation that might contribute to the encroachment of the subacromial structures associated with subacromial impingement.

Journal of Science and Medicine in Sport, 31 August 2008, online article ahead of print

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A prospective study of iliotibial band strain in runners

Joseph Hamill, Ross Miller, Brian Noehren, Irene Davis

The purpose of this study was to investigate mechanical strain in the iliotibial band as a possible causative factor in the development of iliotibial band syndrome.  From a large prospective study, female runners who incurred iliotibial band syndrome during the study were compared to a control group who incurred no injuries. Strain, strain rate and duration of impingement were determined from a musculoskeletal model of the lower extremity.  The results indicated that the iliotibial band syndrome subjects exhibited greater strain throughout the support period, but particularly at midsupport compared to the control group. Strain rate was significantly greater in the iliotibial band syndrome group compared to the control group and was greater in the involved limb of the iliotibial band syndrome group compared to their contralateral limb.

This study indicates that a major factor in the development of iliotibial band syndrome is strain rate. Therefore, we suggest that strain rate, rather than the magnitude of strain, may be a causative factor in developing iliotibial band syndrome.

Clinical Biomechanics, 2008, 23(8), 1018-1025

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A manual therapy technique for chronic adductor-related groin pain in athletes: a case series.

Weir A, Veger SA, Van de Sande HB, Bakker EW, de Jonge S, Tol JL

The objective was to retrospectively examine whether a manual therapy technique is effective in the treatment of chronic adductor-related groin pain in athletes. The technique is described as 'one hand is used to control the tension in the adductor muscles and the other hand is used to move the hip into abduction and external rotation'. 30 patients were treated with this flowing, circular motion that is proposed to stretch the adductor muscle group. The movement is repeated three times in one treatment session.  83% reported a good or excellent satisfaction, 90% had resumed sport and the pain score for during or after activity decreased significantly after the treatment.

This manual therapy treatment might be a promising treatment for chronic adductor-related groin pain in athletes.

Scandinavian Journal of Medicine & Science in Sports, 2008 Aug 5, online article ahead of press

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Strength deficits identified with concentric action of the hip extensors and eccentric action of the hamstrings predispose to hamstring injury in elite sprinters.

Sugiura Y, Saito T, Sakuraba K, Sakuma K, Suzuki E

In this prospective cohort study of elite sprinters, muscle strength of the hip extensors, as well as of the knee extensors and flexors, was measured to determine a possible relationship between strength deficits and subsequent hamstring injury within 12 months of testing. Hamstring injury occurred in 6 subjects during the 1-year period. Isokinetic testing at a speed of 60 degrees /s revealed weakness of the injured limb with eccentric action of the hamstring muscles and during concentric action of the hip extensors. When performing a side-to-side comparison for the injured sprinters, the hamstring injury always occurred on the weaker side. Differences in the hamstrings-quadriceps and hip extensors-quadriceps strength ratios were also evident between uninjured and injured limbs, and this was attributable to deficits in hamstring strength.

Hamstring injury in elite sprinters was associated with weakness during eccentric action of the hamstrings and weakness during concentric action of the hip extensors, but only when tested at the slower speed of 60 degrees /s

Journal of Orthopaedic and Sports Physical Therapy, 2008, 38(8), 457-64

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Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run.

Dierks TA, Manal KT, Hamill J, Davis IS

The objective of this study was to investigate the relationships between hip strength and hip kinematics, and between arch structure and knee kinematics during prolonged treadmill running in runners with and without patellofemoral pain syndrome (PFPS). Hip abduction and hip external rotation isometric strength measurements were collected in 20 recreational runners with PFPS before and after a prolonged run, while the arch height index was recorded on all runners before the run. Both groups displayed decreases in hip abductor and external rotator strengths at the end of the run. The PFPS group displayed significantly lower hip abduction strength compared to controls. At the end of the run, the level of association between hip abduction strength and the peak hip adduction angle for the PFPS group was statistically significant. Arch height did not differ between groups and no significant association was observed between arch height and peak knee adduction angle during running.

Runners with PFPS displayed weaker hip abductor muscles that were associated with an increase in hip adduction during running. This relationship became more pronounced at the end of the run.

Journal of Orthopaedic and Sports Physical Therapy, 2008, 38(8), 448-56

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MACP/PPA Collaborative Study Day 2007 - Online Now!

The Manipulation Association of Chartered Physiotherapists (MACP) have released their first online course. It is an online version of the 2007 MACP/PPA collaborative study day and is very much an evidence-based programme where both manual therapy and pain based approaches to treatment were respected and represented. The online course includes audiovisual presentaions plus related learning activities using materials from the sessions that were presented at this study day and provides a course certificate on completion of the course.

 

Session 1 - The Evidence for Manual Therapy presented by Dries Hettinga
Session 2 -CBT: What is it and can physios do it? presented by Zara Hansen
Session 3 - Exercise: Making It Happen presented by Zara Hansen
Session 4 - The Physiology of Manual Therapy presented by Stephanie Griffiths.

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Do Practical Durations of Stretching Alter Muscle Strength? A Dose-Response Study.

Ryan, Eric D; Beck, Travis W; Herda, Trent J; Hull, Holly R; Hartman, Michael J; Stout, Jeffery R; Cramer, Joel T

The purpose of this study was to examine the time course (immediate, 10, 20, and 30 min) for the acute effects of passive stretching on several different outcome measures for the plantarflexors.  Thirteen volunteers participated in four randomly ordered experimental trials: control (CON) with no stretching, 2 min, 4 min, and 8 min of passive stretching. Testing was conducted before, immediately after and at 10, 20, and 30 min poststretching.

Practical durations of stretching (2, 4, or 8 min) of the plantarflexors did not decrease isometric peak torquecompared with the control but caused temporary improvements in the ROM, thereby questioning the overall detrimental influence of passive stretching on performance.

Medicine & Science in Sports & Exercise, 2008, 40(8), 1529-1537

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Biomechanics of Ankle Instability. Part 2: Postural Sway-Reaction Time Relationship.

Mitchell, Andrew; Dyson, Rosemary; Hale, Tudor; Abraham, Corinne

The purpose of this study was to test the hypothesis that ankles with functional instability will demonstrate greater single-limb postural sway (PS) than their contralateral stable joint and stable healthy controls and to examine the relationship between single-limb postural sway and muscular reaction time to a simulated ankle sprain mechanism.  Nineteen male volunteers with a history of unilateral ankle sprain and functional ankle instability (FAI) and 19 healthy male controls performed 12 single-limb PS tests, 3 on each leg with and without vision. Results reveal postural sway deficits in ankles with FAI. They also demonstrate a significant relationship between PL and PB reaction times and postural sway in UA.

Individuals who sustain an acute ankle sprain and those with FAI require rehabilitation that improves proprioception, strengthens the evertors and dorsiflexors, and restores peroneal reaction time.

Medicine & Science in Sports & Exercise, 2008,    40(8), 1522-1528

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Biomechanics of Ankle Instability. Part 1: Reaction Time to Simulated Ankle Sprain.

Mitchell, Andrew; Dyson, Rosemary; Hale, Tudor; Abraham, Corinne

The purpose of this study was to test the hypothesis that ankles with functional instability will demonstrate slower muscular reaction times than their contralateral stable ankle (SA) and stable healthy controls to a simulated nonpathological ankle sprain mechanism.  Nineteen male volunteers with a history of unilateral ankle sprain and functional ankle instability (FAI) and 19 healthy male controls performed reaction time tests on a purpose-built platform that simulated a nonpathological combined inversion/plantarflexion ankle sprain mechanism.  Results demonstrate a deficit (slower reaction time) in ankles with FAI when acting in support and when exposed to a simulated sprain compared to stable healthy controls. As a result of slower reaction times, acting to support the UA may put the contralateral SA at an increased risk of ankle sprain.

Rehabilitation of a lateral ankle sprain should include strengthening the evertors (peroneals and EDL) at the subtalar joint and the dorsiflexors (TA and EDL) at the talocrural joint.

Medicine & Science in Sports & Exercise, 2008,    40(8), 1515-1521

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