Gregory Stewart - Academia.edu (original) (raw)

Papers by Gregory Stewart

International Journal of Sports Physical Therapy, Aug 1, 2012

Currently, the popular approach to post-concussion management of the athlete relies upon the use ... more Currently, the popular approach to post-concussion management of the athlete relies upon the use of a multidisciplinary team of healthcare providers, all typically coordinated by a physician. That core team is often supplemented by nurses, psychotherapists, coaches, teachers, the athletic director, and, of course, family members. However, access to such a model is frequently limited by financial, geographical, and numerous other factors. In the absence of such resources, a thorough clinical evaluation and management by an available, ongoing healthcare provider, quite often the sports physical therapist, becomes necessary. The authors recommend that the professional who coordinates the athlete's post-concussion healthcare should focus efforts upon a comprehensive assessment and tailored treatment plan specific to the athlete's post-concussive symptoms. Assessment of both pre-morbid function and post-injury physical, cognitive, psychosocial, emotional, and behavioral issues, including the patient's support system, can assist the clinician with identifying specific constraints to sport, academic, social, and vocational activity participation. Hence, the assessment provides structure to the athlete's individualized treatment plan. Successful specialized interventions that address the multi-faceted impairments of sport related concussion frequently require knowledge of resources in a variety of other healthcare professions, in order to facilitate appropriate and necessary treatment referrals. Initial assessment should be followed by repeat monitoring throughout treatment, and spanning a variety of environments, in order to ensure the athlete's full recovery prior to return, not only to sport participation, but also to involvement in social, academic, and/or employment related life activities.

The Physician and Sportsmedicine, 1999

Spine, Jan 15, 2002

A case report of a sacral stress fracture causing low back pain in an athlete. To document the oc... more A case report of a sacral stress fracture causing low back pain in an athlete. To document the occurrence of sacral stress fractures in athletes and to recommend it in the differential diagnosis of low back pain, especially in runners and volleyball players. Low back pain is common both in the general population and in athletes. Athletes place high physical demands on their bodies, which often lead to stress fractures. Sacral stress fractures can cause back pain and are often not included in the differential diagnosis of back pain. The authors were involved in the care and treatment of this patient and reviewed all medical records, radiologic tests, and related literature. In a 16-year-old volleyball player with a 4-week history of low back pain, magnetic resonance imaging of her pelvis revealed a stress fracture of the left sacral ala. She was treated with nonsteroidal anti-inflammatory agents, rest, and conditioning exercises and had a good functional outcome. Sacral stress fractu...

American Journal of Sports Medicine, 2005

Background: Limited research attention has been paid to the potentially harmful windmill softball... more Background: Limited research attention has been paid to the potentially harmful windmill softball pitch. No information is available regarding lower extremity kinetics in softball pitching.Hypothesis: The stresses on the throwing arm of youth windmill pitchers are clinically significant and similar to those found for college softball pitchers.Study Design: Descriptive laboratory study.Methods: Three-dimensional, high-speed (240-Hz) video and stride foot force plate

Medicine & Science in Sports & Exercise, 1992

Journal of Shoulder and Elbow Surgery, 2007

Clinical Journal of Sport Medicine, 2005

To determine if the use of a second-generation biphosphonate, pamidronate, is an effective treatm... more To determine if the use of a second-generation biphosphonate, pamidronate, is an effective treatment option for stress fractures in intercollegiate athletes. Pamidronate is successfully used to increase bone mass in patients with Charcot arthropathy and osteoporosis. Case series. Academic sports medicine clinic with primary responsibility for intercollegiate athletics. Five intercollegiate female athletes. Intravenous pamidronate administered weekly for a total of 5 treatments. Athletes' ability to continue training without restrictions. Four of 5 treated athletes were able to continue training and competition within 1 week of treatment. Pamidronate may be a useful adjunct to the treatment of stress fractures.

Archives of Physical Medicine and Rehabilitation, 1995

Because sports medicine is a rapidly expanding field within many specialties, it is important to ... more Because sports medicine is a rapidly expanding field within many specialties, it is important to gauge how active physiatrists have become in this arena. A nationwide survey of program directors and chief residents of physical medicine and rehabilitation residency programs was conducted to determine such prevalence. For the purposes of this study, sports medicine was defined as the routine care of athletes involved in organized sporting activities at any level of competition. Questionnaires were mailed to program directors and chief residents with response rates of 79.7% each. Overall, correlation of the answers between groups was high. The level of interest of residents was rated at 46%. Data was also obtained regarding research, clinical rotations, lectures, fellowships, association with academic departments of other specialties, and affiliations with professional sports medicine organizations. The actual level of educational opportunities available was much lower than might be expected given the high level of interest expressed. It is reasonable to conclude that more opportunities should exist for education in sports medicine.

American Journal of Sports Medicine, 2005

Background Limited research attention has been paid to the potentially harmful windmill softball ... more Background Limited research attention has been paid to the potentially harmful windmill softball pitch. No information is available regarding lower extremity kinetics in softball pitching. Hypothesis The stresses on the throwing arm of youth windmill pitchers are clinically significant and similar to those found for college softball pitchers. Study Design Descriptive laboratory study. Methods Three-dimensional, high-speed (240-Hz) video and stride foot force plate (1200 Hz) data were collected on fastballs from 53 youth softball pitchers. Kinematic parameters related to pitching mechanics and resultant kinetics on the throwing-arm elbow and shoulder joints were calculated. Kinetic parameters were compared to those reported for baseball pitchers. Results Elbow and shoulder joint loads were similar to those found for baseball pitchers and college softball pitchers. Shoulder distraction stress averaged 94% body weight for the youth pitchers. Stride foot ground reaction force patterns w...

The American Journal of Sports Medicine, 2010

Left-handed individuals make up about 10% of the general population, yet left-handers comprise ap... more Left-handed individuals make up about 10% of the general population, yet left-handers comprise approximately 30% of the pitching staffs in Major League and Division I college baseball. Despite speculation regarding differences between right- and left-handed pitchers, distinction between right- and left-handed pitching mechanics has not been documented in the literature at any level of play. Left-hand-dominant pitchers display similar pitching mechanics and upper extremity joint loads when compared to their right-hand-dominant counterparts. Controlled laboratory study. Three-dimensional, high-speed (240-Hz) video data were collected on fastballs from 84 collegiate baseball pitchers. Kinematic parameters related to pitching mechanics and resultant kinetics on the throwing shoulder and elbow were calculated. The 28 left-handed pitchers in the database were matched with 28 right-handed pitchers for age, height, mass, and ball velocity, and paired t tests were used to compare the kinematic and kinetic parameters. Six parameters were found to have statistically significant differences between left- and right-handed pitchers. Passive nonthrowing shoulder external rotation (right, 113 degrees +/- 9 degrees ; left, 124 degrees +/- 8 degrees ), elbow flexion at stride-foot contact (right, 79 degrees +/- 16 degrees ; left, 94 degrees +/- 20 degrees ), and shoulder abduction during acceleration (right, 72 degrees +/- 11 degrees ; left, 105 degrees +/- 8 degrees ) were greater in left-handed pitchers than right-handed pitchers. Shoulder abduction at stride-foot contact (right, 115 degrees +/- 13 degrees ; left, 73 degrees +/- 10 degrees ), shoulder horizontal abduction at stride-foot contact (right, 25 degrees +/- 12 degrees ; left, 15 degrees +/- 12 degrees ), and peak horizontal adduction angular velocity (right, 707 +/- 185 deg/s; left, 551 +/- 160 deg/s) were less for the left-handed pitchers. Biomechanical differences between left- and right-handed pitchers have been demonstrated in a collegiate population. The results of the current study indicate that left-handed pitchers may be at increased risk for certain shoulder injuries compared with their right-handed counterparts. Information has been provided for athletes, coaches, and sports medicine providers to further improve preventive and rehabilitative protocols for college pitchers. The results of the study also suggest that different normative data sets may need to be developed for left- and right-handed pitchers, independently of one another.

American Journal of Physical Medicine & Rehabilitation, 1998

Pressure ulcers are a prevalent and potentially serious medical problem encountered in both the m... more Pressure ulcers are a prevalent and potentially serious medical problem encountered in both the medical and rehabilitation settings. Because the progress of rehabilitation is often interrupted by the presence of pressure ulcers, the efficient care of these wounds is of great interest to the rehabilitation team. Patients in two acute care facilities with Stage III or IV pressure ulcers were identified and consented to participate in the study contained herein. All wounds were mechanically debrided of necrotic tissue, and then the patients were randomly assigned to the conservative treatment group (A; n = 18) or the conservative treatment plus whirlpool group (B; n = 24). Conservative treatment included measures to maximize pressure relief and wound care with wet-to-wet dressings using normal saline. The dressings were changed twice daily and when they became soiled. Whirlpool was administered for 20 min per day in Group B patients. Only those patients whose ulcers were followed-up for 2 or more wk were included in the study. Ulcers were then measured by a physician who was blinded as to the treatment groups. Ulcer dimension changes over time were compared between groups. The results indicate that the conservative treatment plus whirlpool group improved at a significantly faster rate than did the conservative treatment only group (P < 0.05).

International Journal of Sports Physical Therapy, Aug 1, 2012

Currently, the popular approach to post-concussion management of the athlete relies upon the use ... more Currently, the popular approach to post-concussion management of the athlete relies upon the use of a multidisciplinary team of healthcare providers, all typically coordinated by a physician. That core team is often supplemented by nurses, psychotherapists, coaches, teachers, the athletic director, and, of course, family members. However, access to such a model is frequently limited by financial, geographical, and numerous other factors. In the absence of such resources, a thorough clinical evaluation and management by an available, ongoing healthcare provider, quite often the sports physical therapist, becomes necessary. The authors recommend that the professional who coordinates the athlete's post-concussion healthcare should focus efforts upon a comprehensive assessment and tailored treatment plan specific to the athlete's post-concussive symptoms. Assessment of both pre-morbid function and post-injury physical, cognitive, psychosocial, emotional, and behavioral issues, including the patient's support system, can assist the clinician with identifying specific constraints to sport, academic, social, and vocational activity participation. Hence, the assessment provides structure to the athlete's individualized treatment plan. Successful specialized interventions that address the multi-faceted impairments of sport related concussion frequently require knowledge of resources in a variety of other healthcare professions, in order to facilitate appropriate and necessary treatment referrals. Initial assessment should be followed by repeat monitoring throughout treatment, and spanning a variety of environments, in order to ensure the athlete's full recovery prior to return, not only to sport participation, but also to involvement in social, academic, and/or employment related life activities.

The Physician and Sportsmedicine, 1999

Spine, Jan 15, 2002

A case report of a sacral stress fracture causing low back pain in an athlete. To document the oc... more A case report of a sacral stress fracture causing low back pain in an athlete. To document the occurrence of sacral stress fractures in athletes and to recommend it in the differential diagnosis of low back pain, especially in runners and volleyball players. Low back pain is common both in the general population and in athletes. Athletes place high physical demands on their bodies, which often lead to stress fractures. Sacral stress fractures can cause back pain and are often not included in the differential diagnosis of back pain. The authors were involved in the care and treatment of this patient and reviewed all medical records, radiologic tests, and related literature. In a 16-year-old volleyball player with a 4-week history of low back pain, magnetic resonance imaging of her pelvis revealed a stress fracture of the left sacral ala. She was treated with nonsteroidal anti-inflammatory agents, rest, and conditioning exercises and had a good functional outcome. Sacral stress fractu...

American Journal of Sports Medicine, 2005

Background: Limited research attention has been paid to the potentially harmful windmill softball... more Background: Limited research attention has been paid to the potentially harmful windmill softball pitch. No information is available regarding lower extremity kinetics in softball pitching.Hypothesis: The stresses on the throwing arm of youth windmill pitchers are clinically significant and similar to those found for college softball pitchers.Study Design: Descriptive laboratory study.Methods: Three-dimensional, high-speed (240-Hz) video and stride foot force plate

Medicine & Science in Sports & Exercise, 1992

Journal of Shoulder and Elbow Surgery, 2007

Clinical Journal of Sport Medicine, 2005

To determine if the use of a second-generation biphosphonate, pamidronate, is an effective treatm... more To determine if the use of a second-generation biphosphonate, pamidronate, is an effective treatment option for stress fractures in intercollegiate athletes. Pamidronate is successfully used to increase bone mass in patients with Charcot arthropathy and osteoporosis. Case series. Academic sports medicine clinic with primary responsibility for intercollegiate athletics. Five intercollegiate female athletes. Intravenous pamidronate administered weekly for a total of 5 treatments. Athletes' ability to continue training without restrictions. Four of 5 treated athletes were able to continue training and competition within 1 week of treatment. Pamidronate may be a useful adjunct to the treatment of stress fractures.

Archives of Physical Medicine and Rehabilitation, 1995

Because sports medicine is a rapidly expanding field within many specialties, it is important to ... more Because sports medicine is a rapidly expanding field within many specialties, it is important to gauge how active physiatrists have become in this arena. A nationwide survey of program directors and chief residents of physical medicine and rehabilitation residency programs was conducted to determine such prevalence. For the purposes of this study, sports medicine was defined as the routine care of athletes involved in organized sporting activities at any level of competition. Questionnaires were mailed to program directors and chief residents with response rates of 79.7% each. Overall, correlation of the answers between groups was high. The level of interest of residents was rated at 46%. Data was also obtained regarding research, clinical rotations, lectures, fellowships, association with academic departments of other specialties, and affiliations with professional sports medicine organizations. The actual level of educational opportunities available was much lower than might be expected given the high level of interest expressed. It is reasonable to conclude that more opportunities should exist for education in sports medicine.

American Journal of Sports Medicine, 2005

Background Limited research attention has been paid to the potentially harmful windmill softball ... more Background Limited research attention has been paid to the potentially harmful windmill softball pitch. No information is available regarding lower extremity kinetics in softball pitching. Hypothesis The stresses on the throwing arm of youth windmill pitchers are clinically significant and similar to those found for college softball pitchers. Study Design Descriptive laboratory study. Methods Three-dimensional, high-speed (240-Hz) video and stride foot force plate (1200 Hz) data were collected on fastballs from 53 youth softball pitchers. Kinematic parameters related to pitching mechanics and resultant kinetics on the throwing-arm elbow and shoulder joints were calculated. Kinetic parameters were compared to those reported for baseball pitchers. Results Elbow and shoulder joint loads were similar to those found for baseball pitchers and college softball pitchers. Shoulder distraction stress averaged 94% body weight for the youth pitchers. Stride foot ground reaction force patterns w...

The American Journal of Sports Medicine, 2010

Left-handed individuals make up about 10% of the general population, yet left-handers comprise ap... more Left-handed individuals make up about 10% of the general population, yet left-handers comprise approximately 30% of the pitching staffs in Major League and Division I college baseball. Despite speculation regarding differences between right- and left-handed pitchers, distinction between right- and left-handed pitching mechanics has not been documented in the literature at any level of play. Left-hand-dominant pitchers display similar pitching mechanics and upper extremity joint loads when compared to their right-hand-dominant counterparts. Controlled laboratory study. Three-dimensional, high-speed (240-Hz) video data were collected on fastballs from 84 collegiate baseball pitchers. Kinematic parameters related to pitching mechanics and resultant kinetics on the throwing shoulder and elbow were calculated. The 28 left-handed pitchers in the database were matched with 28 right-handed pitchers for age, height, mass, and ball velocity, and paired t tests were used to compare the kinematic and kinetic parameters. Six parameters were found to have statistically significant differences between left- and right-handed pitchers. Passive nonthrowing shoulder external rotation (right, 113 degrees +/- 9 degrees ; left, 124 degrees +/- 8 degrees ), elbow flexion at stride-foot contact (right, 79 degrees +/- 16 degrees ; left, 94 degrees +/- 20 degrees ), and shoulder abduction during acceleration (right, 72 degrees +/- 11 degrees ; left, 105 degrees +/- 8 degrees ) were greater in left-handed pitchers than right-handed pitchers. Shoulder abduction at stride-foot contact (right, 115 degrees +/- 13 degrees ; left, 73 degrees +/- 10 degrees ), shoulder horizontal abduction at stride-foot contact (right, 25 degrees +/- 12 degrees ; left, 15 degrees +/- 12 degrees ), and peak horizontal adduction angular velocity (right, 707 +/- 185 deg/s; left, 551 +/- 160 deg/s) were less for the left-handed pitchers. Biomechanical differences between left- and right-handed pitchers have been demonstrated in a collegiate population. The results of the current study indicate that left-handed pitchers may be at increased risk for certain shoulder injuries compared with their right-handed counterparts. Information has been provided for athletes, coaches, and sports medicine providers to further improve preventive and rehabilitative protocols for college pitchers. The results of the study also suggest that different normative data sets may need to be developed for left- and right-handed pitchers, independently of one another.

American Journal of Physical Medicine & Rehabilitation, 1998

Pressure ulcers are a prevalent and potentially serious medical problem encountered in both the m... more Pressure ulcers are a prevalent and potentially serious medical problem encountered in both the medical and rehabilitation settings. Because the progress of rehabilitation is often interrupted by the presence of pressure ulcers, the efficient care of these wounds is of great interest to the rehabilitation team. Patients in two acute care facilities with Stage III or IV pressure ulcers were identified and consented to participate in the study contained herein. All wounds were mechanically debrided of necrotic tissue, and then the patients were randomly assigned to the conservative treatment group (A; n = 18) or the conservative treatment plus whirlpool group (B; n = 24). Conservative treatment included measures to maximize pressure relief and wound care with wet-to-wet dressings using normal saline. The dressings were changed twice daily and when they became soiled. Whirlpool was administered for 20 min per day in Group B patients. Only those patients whose ulcers were followed-up for 2 or more wk were included in the study. Ulcers were then measured by a physician who was blinded as to the treatment groups. Ulcer dimension changes over time were compared between groups. The results indicate that the conservative treatment plus whirlpool group improved at a significantly faster rate than did the conservative treatment only group (P < 0.05).