Susan Saliba
University of Virginia, Kinesiology, Faculty Member
Research Interests:
The ability to accurately estimate quadriceps voluntary activation is an important tool for assessing neuromuscular function after a variety of knee injuries. Different techniques have been used to assess quadriceps volitional activation,... more
The ability to accurately estimate quadriceps voluntary activation is an important tool for assessing neuromuscular function after a variety of knee injuries. Different techniques have been used to assess quadriceps volitional activation, including various stimulating electrode types and electrode configurations, yet the optimal electrode types and configurations for depolarizing motor units in the attempt to assess muscle activation are unknown. To determine whether stimulating electrode type and configuration affect quadriceps central activation ratio (CAR) and percentage-of-activation measurements in healthy participants. Crossover study. Research laboratory. Twenty participants (13 men, 7 women; age = 26 ± 5.3 years, height = 173.85 ± 7.3 cm, mass = 77.37 ± 16 kg) volunteered. All participants performed 4 counter-balanced muscle activation tests incorporating 2 different electrode types (self-adhesive, carbon-impregnated) and 2 electrode configurations (vastus, rectus). Quadrice...
Research Interests:
Methicillin resistant Staphylococcus aureus (MRSA), is a problematic infection which is becoming more common in a variety of athletic related environments. Early recognition, diagnosis, and timely management of infection can help minimize... more
Methicillin resistant Staphylococcus aureus (MRSA), is a problematic infection which is becoming more common in a variety of athletic related environments. Early recognition, diagnosis, and timely management of infection can help minimize the severity of infection and decrease the rate of transmission. Since most sports physical therapists typically lack adequate knowledge and ability to identify cases of MRSA infection, the pur-pose of this review is to provide a background for associated risk factors, recognition, treatment, and prevention of community associated-MRSA in athletic environments.
Understanding the demographics of patellofemoral pain is important to determine the best practices in diagnosis and treatment of this difficult pathology. The occurrence of patellofemoral pain has been reported from isolated sports... more
Understanding the demographics of patellofemoral pain is important to determine the best practices in diagnosis and treatment of this difficult pathology. The occurrence of patellofemoral pain has been reported from isolated sports medicine clinics and from within the military, but its incidence has never been examined in the general population within the United States. The purpose of this study was to examine the reported occurrence of patellofemoral pain for those individuals seeking medical care and to compare that to all other pathologies that result in anterior knee pain, such as tendinopathies, patella subluxation, osteoarthritis, or meniscal and bursal conditions. Occurrence rates were examined across sex, age and region within a large healthcare provider database that contains over 30 million individuals. Data were queried with the PearlDiver Patient Record Database, a national database containing orthopedic patient records. Two common International Classification of Disease...
Research Interests:
Among US collegiate soccer players, the incidence rate and the event characteristics of hamstrings strains differ between sexes, but comparisons in the return-to-participation (RTP) time have not been reported. To compare the RTP time... more
Among US collegiate soccer players, the incidence rate and the event characteristics of hamstrings strains differ between sexes, but comparisons in the return-to-participation (RTP) time have not been reported. To compare the RTP time between male and female collegiate soccer players and analyze the influence of event characteristics on the RTP time for each sex. Descriptive epidemiology study. Data were collected from collegiate teams that voluntarily participated in the National Collegiate Athletic Association Injury Surveillance System. Collegiate soccer athletes who sustained 507 hamstrings strains (306 men, 201 women) during the 2004 through 2009 fall seasons. Nonparametric statistics were used to evaluate RTP time differences between sexes and among categories of each event characteristic (ie, time of season, practice or competition, player position). Negative binomial regression was used to model the RTP time for each sex. All analyses were performed separately fo...
Research Interests:
Phonophoresis is purported to represent a method to apply topical medications through the skin to treat soft tissue injuries and inflammatory conditions. Few data are available to demonstrate the clinical effectiveness of the treatment.... more
Phonophoresis is purported to represent a method to apply topical medications through the skin to treat soft tissue injuries and inflammatory conditions. Few data are available to demonstrate the clinical effectiveness of the treatment. To determine the effect of ultrasound on the transcutaneous absorption of dexamethasone when occluded with a dressing. Crossover design. University general clinical research center. Ten healthy subjects (age = 29.2 +/- 8.8 years; height = 170.0 +/- 3.9 cm; mass = 67.5 +/- 18.4 kg). Two grams of 0.33% dexamethasone cream were applied to a 10-cm (2) area on the anterior forearm. The drug was applied to the skin and occluded with a dressing for 30 minutes before the ultrasound and sham ultrasound treatments. The treatments were applied over the drug and occlusive dressing. Ultrasound treatments were delivered at an intensity of 1.0 W/cm (2) (50% pulsed) at an output frequency of 3 MHz for 5 minutes and compared with sham ultrasound treatments that were ...
Research Interests:
Iontophoresis is a method of administering medications transcutaneously using galvanic current. Dose is the product of current amplitude and treatment duration. It is assumed that higher doses of iontophoresis are more effective in... more
Iontophoresis is a method of administering medications transcutaneously using galvanic current. Dose is the product of current amplitude and treatment duration. It is assumed that higher doses of iontophoresis are more effective in delivering medication, yet research supporting this claim is insufficient. To compare high-dose lidocaine iontophoresis (80 mA-min), standard-dose lidocaine iontophoresis (40 mA-min), and 2 sham treatments indirectly by measuring skin anesthesia. Double-blind crossover study. Research laboratory. 15 healthy volunteers (10 women, 5 men: age 24.06 ± 2 y, height 169.7 ± 8.3 cm, weight 72.5 ± 14.2 kg). Four treatments were counterbalanced and applied on the anterior forearm: 2 true interventions (40 and 80 mA-min) and 2 sham interventions separated by at least 24 h. The true-intervention doses were applied at a current of 2 mA with 2.5 ml 2% lidocaine HCL for 20 and 40 min. The sham treatments were 2.5 ml of lidocaine without galvanic current (intensity = 0 m...
Research Interests:
Chronic ankle instability (CAl) is a term used to identify a condition associated with recurrent ankle sprains and persistent symptoms. Balance deficits, evaluated using center-of-pressure (COP) force-plate measurements, have been shown... more
Chronic ankle instability (CAl) is a term used to identify a condition associated with recurrent ankle sprains and persistent symptoms. Balance deficits, evaluated using center-of-pressure (COP) force-plate measurements, have been shown to occur in people with CAl. To determine the differential abilities of selected force-plate postural-control measures to assess CAl. Case-control study. Laboratory. A total of 63 individuals with CAl (30 men, 33 women: age= 22.3± 3.7 years, height= 169.8 ±9.6 cm, mass= 70.7± 14.3 kg) and 46 healthy controls (22 men, 24 women: age= 21.2± 4.1 years, height= 173.3± 9.2 cm, mass =69.2± 13.2 kg) volunteered. Participants performed 3 10-second trials of quiet, single-limb stance on a force plate under 2 conditions: eyes open and eyes closed. Measures of COP area, COP velocity, COP SO, COP range of excursion, percentage of COP range used, time-to-boundary absolute minimum, time-to-boundary mean of the minima, and time-to-boundary SO of the minima were calc...
Research Interests:
Individuals with low back pain (LBP) are thought to benefit from interventions that improve motor control of the lumbopelvic region. It is unknown if therapeutic exercise can acutely facilitate activation of lateral abdominal musculature.... more
Individuals with low back pain (LBP) are thought to benefit from interventions that improve motor control of the lumbopelvic region. It is unknown if therapeutic exercise can acutely facilitate activation of lateral abdominal musculature. To investigate the ability of 2 types of bridging-exercise progressions to facilitate lateral abdominal muscles during an abdominal drawing-in maneuver (ADIM) in individuals with LBP. Randomized control trial. University research laboratory. 51 adults (mean ± SD age 23.1 ± 6.0 y, height 173.6 ± 10.5 cm, mass 74.7 ± 14.5 kg, and 64.7% female) with LBP. All participants met 3 of 4 criteria for stabilization-classification LBP or at least 6 best-fit criteria for stabilization classification. Participants were randomly assigned to either traditional-bridge progression or suspension-exercise-bridge progression, each with 4 levels of progressive difficulty. They performed 5 repetitions at each level and were progressed based on specific criteria. Muscle ...
Research Interests:
Ultrasonography (US) may aid the assessment of the anterior talofibular ligament (ATFL) injury after lateral ankle sprains by allowing the clinician to visualize and measure talocrural laxity. Comparison of US against another objective... more
Ultrasonography (US) may aid the assessment of the anterior talofibular ligament (ATFL) injury after lateral ankle sprains by allowing the clinician to visualize and measure talocrural laxity. Comparison of US against another objective method of ankle laxity assessment, such as ankle arthrometry (AA), is needed. The purpose was to evaluate the relationship between the ATFL length measurements measured from stress US images to the inversion and anterior drawer displacement measured with AA in healthy subjects. This descriptive laboratory study included 26 ankles from healthy subjects. The apparent length of the ATFL was measured using US during anterior drawer (USAD) and inversion (USINV) stress and the translation of the talocrural joint was measured using AA during anterior drawer (AAAD) and inversion (AAINV) stress. Percent change in length for USAD and USINV were quantified. Intraclass correlation coefficients and pearson product moment correlations Bland-Altman limits of agreeme...
Research Interests:
The reliability of clinical techniques to quantify thoracic spine rotation range of motion (ROM) has not been evaluated. To determine the intratester and intertester reliability of 5 thoracic rotation measurement techniques. Descriptive... more
The reliability of clinical techniques to quantify thoracic spine rotation range of motion (ROM) has not been evaluated. To determine the intratester and intertester reliability of 5 thoracic rotation measurement techniques. Descriptive laboratory study. University research laboratory. Forty-six healthy volunteers (age = 23.6 ± 4.3 years, height = 171.0 ± 9.6 cm, mass = 71.4 ± 16.7 kg). We tested 5 thoracic rotation ROM techniques over 2 days: seated rotation (bar in back and front), half-kneeling rotation (bar in back and front), and lumbar-locked rotation. On day 1, 2 examiners obtained 2 sets of measurements (sessions 1, 2) to determine the within-session intertester reliability and within-day intratester reliability. A single examiner obtained measurements on day 2 (session 3) to determine the intratester reliability between days. Each technique was performed 3 times per side, and averages were used for data analysis. Reliability was determined using intraclass correlation coeff...
Research Interests:
The purpose of this study was to assess microvascular perfusion immediately after eccentric exercise using contrast-enhanced sonography. An intravenous catheter was placed in the antecubital vein of the arm contralateral to the leg being... more
The purpose of this study was to assess microvascular perfusion immediately after eccentric exercise using contrast-enhanced sonography. An intravenous catheter was placed in the antecubital vein of the arm contralateral to the leg being tested for the delivery of microbubbles to 18 healthy volunteers (mean age ± SD, 22.2 ± 2.2 years; height, 166.0 ± 11.9 cm; weight, 69.4 ± 25.0 kg). Eccentric exercises were performed unilaterally in a randomized leg. Calf-lowering repetitions off a raised step were performed to the beat of a metronome over 3 seconds in the sequence of 50 repetitions, 5 minutes of rest, and 50 repetitions. Microvascular perfusion (blood volume, blood flow, and blood flow velocity) was measured before and immediately after exercise using replenishment kinetics. Blood volume and flow both significantly increased after exercise (P < .001). Baseline measurements were 5.88 ± 1.33 dB and 2.34 ± 0.41 dB/s and increased to 12.20 ± 3.31 dB and 4.52 ± 1.05 dB/s, respective...
Research Interests:
Quadriceps function improves after application of focal joint cooling or transcutaneous electrical nerve stimulation to the knee in patients with arthrogenic muscle inhibition (AMI), yet it is not known whether superficial heat is able to... more
Quadriceps function improves after application of focal joint cooling or transcutaneous electrical nerve stimulation to the knee in patients with arthrogenic muscle inhibition (AMI), yet it is not known whether superficial heat is able to produce a similar effect. To determine quadriceps function after superficial heat to the knee joint in individuals with AMI. Single blinded randomized crossover. Laboratory. 12 subjects (4 female, 8 males; 25.6 ± 7.7 y, 177.2 ± 12.7 cm, 78.4 ± 18.2 kg) with a history of knee-joint pathology and AMI, determined with a quadriceps central activation ratio (CAR) of <90%. 3 treatment conditions for 15 min on separate days: superficial heat using a cervical moist-heat pack (77 °C), sham using a cervical moist pack (room temperature at about 24 °C), and control (no treatment). All subjects received all treatment conditions in a randomized order. Central activation ratio and knee-extension torque during maximal voluntary isometric contraction with the k...
Research Interests:
Context : The most common modality used to address acute inflammation is cryotherapy. Whereas pain decreases with cryotherapy, evidence that changes occur in perfusion of skeletal muscle is limited. We do not know whether ice attenuates... more
Context : The most common modality used to address acute inflammation is cryotherapy. Whereas pain decreases with cryotherapy, evidence that changes occur in perfusion of skeletal muscle is limited. We do not know whether ice attenuates the increases in perfusion associated with acute inflammation. Objective : To examine the effects of repeated applications of ice bags on perfusion of the gastrocnemius muscle after an eccentric exercise protocol. Design : Controlled laboratory study. Setting : Laboratory. Patients or Other Participants : Eighteen healthy participants (3 men, 15 women; age = 22.2 ± 2.2 years, height = 166.0 ± 11.9 cm, mass = 69.4 ± 25.0 kg). Intervention(s) : To induce eccentric muscle damage, participants performed 100 unilateral heel-lowering exercises off a step to the beat of a metronome. A randomized intervention (cryotherapy, sham, control) was applied to the exercised lower extremity immediately after the protocol and again at 10, 24, and 34 hours after ...
Research Interests:
The abdominal draw-in maneuver (ADIM) with cocontraction has been shown to be a more effective method of activating the transversus abdominis (TrA) in healthy adults than the ADIM alone. Whether such an augmented core stabilization... more
The abdominal draw-in maneuver (ADIM) with cocontraction has been shown to be a more effective method of activating the transversus abdominis (TrA) in healthy adults than the ADIM alone. Whether such an augmented core stabilization exercise is effective in managing low back pain (LBP) remains uncertain. To determine the effect of 2 weeks of ADIM and cocontraction training on abdominal muscle thickness and activation timing and to monitor pain and function in patients with LBP. Case-control study. Local orthopaedic clinic and research laboratory. Twenty patients with mechanical LBP (age = 27.20 ± 6.46 years, height = 166.25 ± 8.70 cm, mass = 58.10 ± 11.81 kg) and 20 healthy, age-matched people (age = 24.25 ± 1.59 years, height = 168.00 ± 8.89 cm, mass = 60.65 ± 11.99 kg) volunteered for the study. Both the LBP and control groups received ten 30-minute sessions of ADIM and cocontraction training of the tibialis anterior (TA) and rectus femoris (RF) muscles over a 2-week period. A sepa...
Research Interests:
To compare baseline scores of middle and high school students on the Sport Concussion Assessment Tool 2 (SCAT2) by sex and age. Cross-sectional study. Single private school athletic program. Three hundred sixty-one middle and high school... more
To compare baseline scores of middle and high school students on the Sport Concussion Assessment Tool 2 (SCAT2) by sex and age. Cross-sectional study. Single private school athletic program. Three hundred sixty-one middle and high school student-athletes. Preseason SCAT2 was administered to student-athletes before athletic participation. Total SCAT2 score, symptoms, symptom severity, Glasgow coma scale, modified Balance Error Scoring System (BESS), coordination, and Standardized Assessment of Concussion (SAC) with subsections: Orientation, Immediate Memory, Concentration, and Delayed Recall. No differences were found in total SCAT2 scores between sex (P = 0.463) or age (P = 0.21). Differences were found in subcomponents of the SCAT2. Twelve year olds had significantly lower concentration scores (3.3 ± 1.2) than 15 and 18 year olds (3.9 ± 1.0 and 4.2 ± 1.0, respectively). The 12 year olds also had the lowest percentage of correct responses for the SAC&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s concentration 5-digit (46%), 6-digit (21%), and months&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; backward (67%) tasks. Females presented with more symptoms (20.0 ± 2.2 vs 20.6 ± 2.1 P = 0.007) better immediate memory (14.6 ± 0.9 vs 14.3 ± 1.0, P = 0.022) and better BESS scores (27.2 ± 2.3 vs 26.6 ± 2.6, P = 0.043) than their male counterparts. Normative values for total SCAT2 and subscale scores show differences in concentration between ages, whereas symptoms, BESS, and immediate memory differed between sexes. We also found that 12 year olds have increased difficultly with the advanced concentration tasks, which lends support to the development of a separate instrument, such as the Child-SCAT3. The presence of developmental differences in the younger age groups suggests the need for annual baseline testing. Subtle differences between age and sex have been identified in many components of the SCAT2 assessment. These differences may support the current evolution of concussion assessment tools to provide the most appropriate test. Baseline testing should be used when available, and clinicians should be aware of potential differences when using normalized values.
Context : Chronic ankle instability (CAI) occurs in some people after a lateral ankle sprain and often results in residual feelings of instability and episodes of the... more
Context : Chronic ankle instability (CAI) occurs in some people after a lateral ankle sprain and often results in residual feelings of instability and episodes of the ankle&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s giving way. Compared with healthy people, patients with CAI demonstrated poor postural control and used a more anteriorly and laterally positioned center of pressure (COP) during a single-limb static-balance task on a force plate. Balance training is an effective means of altering traditional COP measures; however, whether the overall location of the COP distribution under the foot also changes is unknown. Objective : To determine if the spatial locations of COP data points in participants with CAI change after a 4-week balance-training program. Design : Randomized controlled trial. Setting : Laboratory. Patients or Other Participants : Thirty-one persons with self-reported CAI. Intervention(s) : Participants were randomly assigned to a 4-week balance-training program or no balance training. Main Outcome Measure(s) : We collected a total of 500 COP data points while participants balanced using a single limb on a force plate during a 10-second trial. The location of each COP data point relative to the geometric center of the foot was determined, and the frequency count in 4 sections (anteromedial, anterolateral, posteromedial, posterolateral) was analyzed for differences between groups. Results : Overall, COP position in the balance-training group shifted from being more anterior to less anterior in both eyes-open trials (before trial = 319.1 ± 165.4, after trial = 160.5 ± 149.5; P = .006) and eyes-closed trials (before trial = 387.9 ± 123.8, after trial = 189.4 ± 102.9; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The COP for the group that did not perform balance training remained the same in the eyes-open trials (before trial = 214.1 ± 193.3, after trial = 230.0 ± 176.3; P = .54) or eyes-closed trials (before trial = 326.9 ± 134.3, after trial = 338.2 ± 126.1; P = .69). Conclusions : In participants with CAI, the balance-training program shifted the COP location from anterolateral to posterolateral. The program may have repaired some of the damaged sensorimotor system pathways, resulting in a more optimally functioning and less constrained system.
Research Interests:
Quantifying talocrural joint laxity after ankle sprain is problematic. Stress ultrasonography (US) can image the lateral talocrural joint and allow the measurement of the talofibular interval, which may suggest injury to the anterior... more
Quantifying talocrural joint laxity after ankle sprain is problematic. Stress ultrasonography (US) can image the lateral talocrural joint and allow the measurement of the talofibular interval, which may suggest injury to the anterior talofibular ligament (ATFL). The acute talofibular interval changes after lateral ankle sprain are unknown. Twenty-five participants (9 male, 16 female; age 21.8 ± 3.2 y, height 167.8 ± 34.1 cm, mass 72.7 ± 13.8 kg) with 27 acute, lateral ankle injuries underwent bilateral stress US imaging at baseline (<7 d) and on the affected ankle at 3 wk and 6 wk from injury in 3 ankle conditions: neutral, anterior drawer, and inversion. Talofibular interval (mm) was measured using imaging software and self-reported function (activities of daily living [ADL] and sports) by the Foot and Ankle Ability Measure (FAAM). The talofibular interval increased with anterior-drawer stress in the involved ankle (22.65 ± 3.75 mm; P = .017) over the uninvolved ankle (19.45 ± 2...
Research Interests:
Understanding how muscles activate in a population with a previous glenohumeral joint(GH) injury may help clinicians understand how to build a conservative treatment plan to strengthen or activate the specific muscles in an attempt to... more
Understanding how muscles activate in a population with a previous glenohumeral joint(GH) injury may help clinicians understand how to build a conservative treatment plan to strengthen or activate the specific muscles in an attempt to reduce recurrent shoulder injury and development of GH laxity. To investigate muscle activation differences between the previously injured limb of individuals with a history of glenohumeral joint injury and healthy, matched controls during functional isometric contractions. Case control. University research laboratory. 17 individuals (8 women, 9 men, age: 22.3±2.6 years, height: 172.4±8.8 cm, mass: 75.4±16.5 kg) with previous unilateral shoulder pain and 17 individuals (8 women, 9 men, age 22.9±3.9 years, height: 170.9±11.3 cm, mass: 73.6±22.9 kg) with no history of shoulder pain or injury. Diagnostic ultrasound (US) measurements of the supraspinatus were completed in both resting and contracted states to assess changes in muscle thickness. Manual muscle tests (anterior deltoid, upper trapezius, infraspinatus, lower trapezius, serratus anterior) and functional isometric contractions (forward flexion, scaption, abduction) were measured using electromyography (EMG) recordings. Peak, normalized activation of each muscle and supraspinatus thickness activation ratio were compared between groups and bilaterally within groups using separate ANOVAs. The anterior deltoid was significantly less activated during all functional isometric tasks in previously injured subjects compared to healthy subjects (P=0.024). In previously injured subjects, the involved limb lower trapezius was significantly less activated during scaption and abduction tasks compared to the contralateral side (P=0.022 and P=.031, respectively). There were decreases in muscle activation in the anterior deltoid between previously injured and healthy people as well as in the lower trapezius within a previously injured person. Understanding the source of muscle activation deficits can help clinicians focus rehabilitation exercises on specific muscles.
Research Interests:
Chronic ankle instability is characterized by repetitive lateral ankle sprains. Prophylactic ankle taping is a common intervention used to reduce the risk of ankle sprains. However, little research has been conducted to evaluate the... more
Chronic ankle instability is characterized by repetitive lateral ankle sprains. Prophylactic ankle taping is a common intervention used to reduce the risk of ankle sprains. However, little research has been conducted to evaluate the effect ankle taping has on gait kinematics. To investigate the effect of taping on ankle and knee kinematics during walking and jogging in participants with chronic ankle instability. Controlled laboratory study. Motion analysis laboratory. A total of 15 individuals (8 men, 7 women; age = 26.9 ± 6.8 years, height = 171.7 ± 6.3 cm, mass = 73.5 ± 10.7 kg) with self-reported chronic ankle instability volunteered. They had an average of 5.3 ± 3.1 incidences of ankle sprain. Participants walked and jogged in shoes on a treadmill while untaped and taped. The tape technique was a traditional preventive taping procedure. Conditions were randomized. Frontal-plane and sagittal-plane ankle and sagittal-plane knee kinematics were recorded throughout the entire gait cycle. Group means and 90% confidence intervals were calculated, plotted, and inspected for percentages of the gait cycle in which the confidence intervals did not overlap. During walking, participants were less plantar flexed from 64% to 69% of the gait cycle (mean difference = 5.73° ± 0.54°) and less inverted from 51% to 61% (mean difference = 4.34° ± 0.65°) and 76% to 81% (mean difference = 5.55° ± 0.54°) of the gait cycle when taped. During jogging, participants were less dorsiflexed from 12% to 21% (mean difference = 4.91° ± 0.18°) and less inverted from 47% to 58% (mean difference = 6.52° ± 0.12°) of the gait cycle when taped. No sagittal-plane knee kinematic differences were found. In those with chronic ankle instability, taping resulted in a more neutral ankle position during walking and jogging in shoes on a treadmill. This change in foot positioning and the mechanical properties of the tape may explain the protective aspect of taping in preventing lateral ankle sprains.
Research Interests:
Research Interests:
Severe brachial plexus injuries are rare in sports, but they have catastrophic results with a significant loss of function in the involved upper extremity. Nerve root avulsions must be timely managed with prompt evaluation, accurate... more
Severe brachial plexus injuries are rare in sports, but they have catastrophic results with a significant loss of function in the involved upper extremity. Nerve root avulsions must be timely managed with prompt evaluation, accurate diagnosis, and surgical treatment to optimize the potential for a functional outcome. This case report describes the mechanism of injury, diagnostic evolution, surgical management, and rehabilitation of a college football player who sustained a traumatic complete nerve root avulsion of C5 and C6 (upper trunk of the brachial plexus). Diagnostics included clinical evaluation, magnetic resonance imaging, computed tomography myelogram, and electromyogram. Surgical planning included nerve grafting and neurotization (nerve transfer). Rehabilitation goals were to bring the hand to the face (active biceps function), to stabilize the shoulder for abduction and flexion, and to reduce neuropathic pain. Direct current stimulation, bracing, therapeutic exercise, and biofeedback were used to maximize the use of the athlete&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s upper extremity. Although the athlete could not return to sport or normal function by most standards, his results were satisfactory in that he regained an ability to perform many activities of daily living.
Research Interests:
The transversus abdominis (TrA) is a spine stabilizer frequently targeted during rehabilitation exercises for individuals with low back pain (LBP). Performance of exercises on unstable surfaces is thought to increase muscle activation,... more
The transversus abdominis (TrA) is a spine stabilizer frequently targeted during rehabilitation exercises for individuals with low back pain (LBP). Performance of exercises on unstable surfaces is thought to increase muscle activation, however no research has investigated differences in TrA activation when stable or unstable surfaces are used. The purpose of this study was to investigate whether TrA activation in individuals with LBP is greater when performing bridging exercises on an unstable surface versus a stable surface. Fifty one adults (mean ± SD, age 23.1 ± 6.0 years, height 173.60 ± 10.5 cm, mass 74.7 ± 14.5 kg) with stabilization classification of LBP were randomly assigned to either exercise progression utilizing a sling bridge device or a traditional bridging exercise progression, each with 4 levels of increasing difficulty. TrA activation ratio (TrA contracted thickness/TrA resting thickness) was measured during each exercise using ultrasound imaging. The dependent vari...
Research Interests:
Research Interests:
Ankle braces can protect the ankle joint from ligament sprains and fractures during high-risk military activities such as physical training and parachuting. Although braces are recommended for injury prevention purposes, the impact of... more
Ankle braces can protect the ankle joint from ligament sprains and fractures during high-risk military activities such as physical training and parachuting. Although braces are recommended for injury prevention purposes, the impact of braces on physical performance is unknown. This study evaluated lace-up ankle braces, worn inside the boots, across three conditions: no brace, unilateral brace, and bilateral brace on the dependent variables of dynamic lower extremity reach and obstacle course performance. Thirty-seven military cadets were tested over 3 days. Ankle bracing had a small effect upon anterior and composite lower extremity reach distances. Bracing had no effect upon obstacle course performance times. Inside-the-boot ankle bracing restricts lower extremity reaching and mildly impacts mobility, however, no restrictions were observed with running, climbing, jumping, or negotiating obstacles. Lace-up ankle braces can be used in conjunction with combat boots to protect the ankle during high-risk activities without having an impact upon tactical movements.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
To determine whether transcutaneous electrical nerve stimulation (TENS) and focal knee joint cooling will affect the quadriceps central activation ratio (CAR) in patients with tibiofemoral osteoarthritis. Thirty-three participants with... more
To determine whether transcutaneous electrical nerve stimulation (TENS) and focal knee joint cooling will affect the quadriceps central activation ratio (CAR) in patients with tibiofemoral osteoarthritis. Thirty-three participants with diagnosed tibiofemoral osteoarthritis were randomly allocated to the 45-min TENS treatment (six males and four females, 56 +/- 10.1 yr, 174.11 +/- 10.78 cm, 89.34 +/- 21.3 kg), the 20-min focal knee joint cooling treatment (six males and five females, 58 +/- 8.4 yr, 176.41 +/- 8.29 cm, 83.18 +/- 17.97 kg), or the control group (five males and seven females, 54 +/- 9.9 yr, 166.37 +/- 13.07 cm, 92.14 +/- 25.37 kg). Volitional quadriceps activation, maximal voluntary isometric contraction, and subjective pain measurements were conducted at baseline and at 20, 30, and 45 min. The 20-min focal knee joint cooling intervention consisted of two 1.5-L ice bags to the anterior and posterior aspects of the knee. The TENS group received 45 min of a sensory, biphasic square wave stimulation (150-mus phase duration and 150 pps) from four 2 x 2-inch electrodes positioned around the patella. : TENS resulted in a significantly higher percent change in CAR scores compared with control at 20 min (6.4 +/- 4.8 vs -3.5 +/- 8, P = 0.006), 30 min (9.7 +/- 10.16 vs -1 +/- 7.9, P = 0.025), and 45 min (11.25 +/- 6.96 vs 0.81 +/- 9.4, P = 0.029). Focal knee joint cooling resulted in significantly higher percent change scores compared with the control group at 20 min (5.75 +/- 7.25 vs -3.5 +/- 8, P = 0.009) and trended to be higher at 45 min (9.06 +/- 9.63 vs 0.81 +/- 9.4, P = 0.098). No significant differences in percent change for CAR were found between the TENS and the focal knee joint cooling group. Both TENS and focal knee joint cooling increased the quadriceps CAR immediately after application in participants with tibiofemoral osteoarthritis.
Research Interests: Cryotherapy, Medicine Science, Humans, Female, Male, and 10 moreConfidence intervals, Transcutaneous Electrical Nerve Stimulation, Middle Aged, Analysis of Variance, Time Factors, Knee Osteoarthritis, Medicine and Science In Sports and Exercise, Knee Joint, Pain Measurement, and Isometric Contraction
Range of motion (ROM) exercises are accepted as being an essential part of post-operative knee rehabilitation but there is little research to support this treatment. Our purpose was to determine whether a specific early, active ROM... more
Range of motion (ROM) exercises are accepted as being an essential part of post-operative knee rehabilitation but there is little research to support this treatment. Our purpose was to determine whether a specific early, active ROM intervention using a bicycle ergometer equipped with an adjustable pedal arm offered measurable benefit to post-operative partial meniscectomy patients. Thirty-one subjects were randomly assigned to experimental or control groups. The experimental group rode a stationary bicycle equipped with the pedal arm device six times over 2 weeks post-operatively under the supervision of a physical therapist while the control group did not. Subjective measures of gait were significantly different with a positive experimental group response to the supervised exercise with improved gait performance at weeks 1, 2 and 4 after surgery (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 0.05). Early, protected active ROM exercise on a bicycle ergometer equipped with an adjustable pedal arm demonstrated promising results in patients after partial meniscectomy.
Research Interests:
Research Interests:
Throwing is a complex motion that involves the entire body and often puts an inordinate amount of stress on the shoulder and the arm. Warm-up prepares the body for work and can enhance performance. Sling-based exercise (SE) has been... more
Throwing is a complex motion that involves the entire body and often puts an inordinate amount of stress on the shoulder and the arm. Warm-up prepares the body for work and can enhance performance. Sling-based exercise (SE) has been theorized to activate muscles, particularly the stabilizers, in a manner beneficial for preactivity warm-up, yet this hypothesis has not been tested. Our purpose was to determine if a warm-up using SE would increase throwing velocity and accuracy compared to a traditional, thrower&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s 10 warm-up program. Division I baseball players (nonpitchers) (16 men, age: 19.6 ± 1.3, height: 184.2 ± 6.2 cm, mass: 76.9 ± 19.2 kg) volunteered to participate in this crossover study. All subjects underwent both a warm-up routine using a traditional method (Thrower&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s 10 exercises) and a warm-up routine using closed kinetic chain SE methods (RedCord) on different days separated by 72 hours. Ball velocity and accuracy measures were obtained on 10 throws after either the traditional and SE warm-up regimens. Velocity was recorded using a standard Juggs radar gun (JUGS; Tualatin, OR, USA). Accuracy was recorded using a custom accuracy target. An Analysis of covariance was performed, with the number of throws recorded before the testing was used as a covariate and p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 was set a priori. There were no statistical differences between the SE warm-up and Thrower&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s 10 warm-up for throwing velocity (SE: 74.7 ± 7.5 mph, Thrower&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s 10: 74.6 ± 7.3 mph p = 0.874) or accuracy (SE: 115.6 ± 53.7 cm, Thrower&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s 10: 91.8 ± 55 cm, p = 0.136). Warming up with SE produced equivalent throwing velocity and accuracy compared to the Thrower&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s 10 warm-up method. Thus, SE provides an alternative to traditional warm-up.
Research Interests: Strength & Conditioning, Pain, Baseball, Humans, Shoulder, and 6 moreMale, Young Adult, Exercise, The, Athletic performance, and Wrist
Research Interests:
Research Interests:
Cross-sectional. To use stress ultrasonography to measure the change in anterior talofibular ligament length during the simulated anterior drawer and ankle inversion stress tests. In approximately 30% of individuals, ankle sprains may... more
Cross-sectional. To use stress ultrasonography to measure the change in anterior talofibular ligament length during the simulated anterior drawer and ankle inversion stress tests. In approximately 30% of individuals, ankle sprains may eventually develop into chronic ankle instability (CAI) with recurrent symptoms. Individuals with CAI and those who have a history of ankle sprain (greater than 1 year prior) without chronic instability (copers) may or may not have mechanical laxity. Sixty subjects (n=60 ankles) were divided into 3 groups: 1) Control subjects without ankle injury history (n=20; mean ± SD age; 24.8 ± 4.8 years; height, 173.7 ± 9.4 cm; weight, 77.2 ± 19.5 kg), ankle sprain copers (n=20; 22.3 ± 2.9 years; 172.8 ± 11.3 cm; 72.4 ± 14.3 kg), and subjects with CAI (n=20; 23.5 ± 4.2 years; 174.6 ± 9.6 cm; 74.8 ± 17.3 kg). Ligament length change with the anterior drawer and end range ankle inversion was calculated from ultrasound images. The Foot and Ankle Ability Measure (FAAM) was used to quantify self-reported function on activities-of-daily living (ADL) and sports. The anterior drawer test resulted in length changes that were greater (F₂,₅₇=6.2, P=.004) in the CAI (mean ± SD length change, 15.6 ± 15.1%, P=.006) and the coper groups (14.0 ± 15.9%, P=.016) compared to the control group (1.3 ± 10.7%); however the length change for the CAI and coper groups were not different (P=.93). Ankle inversion similarly resulted in greater ligament length change (F₂,₅₇=6.5, P=.003) in the CAI (25.3 ± 15.5%, P=.003) and coper groups (20.2 ± 19.6%, P=.039) compared to the control group (7.4 ± 12.9%); with no difference in length change between the copers and CAI groups (P=.59). The CAI group had a lower score on the FAAM-ADL (87.4 ± 13.4%) and FAAM-Sports (74.2 ± 17.8%) when compared to the control (98.8 ± 2.9% and 98.9 ± 3.1%, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.0001) and coper groups (99.4 ± 1.8% and 94.6 ± 8.8%, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.0001). Stress ultrasonography identified greater length changes of the anterior talofibular ligament in both the coper and CAI groups compared to the control group. Only subjects with CAI had reductions in self-reported function.
Research Interests:
Research Interests:
Endothelial dysfunction occurs early in atherosclerosis in response to cardiovascular risk factors. The occurrence of endothelial dysfunction is primarily the result of reduced nitric oxide (NO) bioavailabilty. It represents an... more
Endothelial dysfunction occurs early in atherosclerosis in response to cardiovascular risk factors. The occurrence of endothelial dysfunction is primarily the result of reduced nitric oxide (NO) bioavailabilty. It represents an independent predictor of cardiovascular events and predicts the prognosis of the patient. Therefore, endothelial function has been identified as a target for therapeutic intervention. Regular exercise training is a nonpharmacological option to improve endothelial dysfunction in patients with cardiovascular disease by increasing NO bioavailability.
Research Interests:
Research Interests:
Authors request their Abstract not to be published.
Research Interests:
Research Interests:
Research Interests:
To investigate the effects of a combination of visual biofeedback and ankle pressure on ankle position sense in elderly adults with and without impaired ankle joint position sense (JPS). Independent 2 x 3 factorial design with an... more
To investigate the effects of a combination of visual biofeedback and ankle pressure on ankle position sense in elderly adults with and without impaired ankle joint position sense (JPS). Independent 2 x 3 factorial design with an experimenter-blind study. University motion laboratory. Older adults (N=40) were recruited from local community centers. Among them, 21 elderly subjects had relatively normative score, whereas 19 subjects had impaired ankle position sense. Both the normative and impaired elderly subjects underwent either ankle JPS visual feedback training alone or a combination of ankle JPS visual feedback training and circumferential ankle pressure for one 30-minute training session. The outcome measures included ankle JPS errors measured in absolute constant error (ACE) and variable error (VE) during standing at pretest, posttest, and 1-week follow-up test. A separate repeated measures analyses of variance was performed to evaluate the differential training effects on ACE and VE, respectively. The Pearson chi-square test and Bonferroni test were performed. Significance was assigned at P less than .05 for all analyses. Regardless of intervention conditions, older adults with and without ankle position sense impairment showed immediate treatment benefits, which relatively remained stable even at the follow-up test. These effects were reflected in significant improvements of JPS accuracy and consistency (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). Our findings may suggest that both interventions were equally effective in increasing ankle JPS accuracy and consistency in older adults with and without impairments, and therapeutic effects lasted for a week, reflecting long-term effect.