Arthur Nitz | University of Kentucky College of Medicine (original) (raw)

Papers by Arthur Nitz

Spine, Mar 1, 1994

Abstract Electromyographic (EMG) activity of selected hip and turnk luscle swas recorded diring a... more Abstract Electromyographic (EMG) activity of selected hip and turnk luscle swas recorded diring a squat lift, and the effects of two differnt lumber spine postures were examined. Seven muscles were anlyzed: rectus abdomlnis (RA), abdominal obliques (AO), erector ...

Military Medicine, Apr 6, 2020

Introduction Post-traumatic stress disorder (PTSD) and chronic pain are frequently co-morbid cond... more Introduction Post-traumatic stress disorder (PTSD) and chronic pain are frequently co-morbid conditions in the U.S. veteran population. Although several theories about the cause of increased pain prevalence in individuals with PTSD have been presented, no synthesis of primary data informing the impact of co-morbid PTSD and pain has been completed. The purpose of this study was to systematically review the literature and quantify disability, function, and pain-related beliefs and outcomes in veterans with PTSD compared to veterans without PTSD. Materials and Methods A systematic search of three electronic databases was conducted. Inclusion criteria required pain-related comparison of veterans with PTSD to those without PTSD. Primary outcome measures and standardized mean differences (SMDs) were assessed for pain, function, disability, pain beliefs, and healthcare utilization using a random effects model. Results 20 original research studies met inclusion criteria and were assessed for quality and outcomes of interest. The majority of studies were cross-sectional. Veterans with PTSD and pain demonstrated higher pain (SMD = 0.58, 95% CI 0.28-0.89), disability (SMD = 0.52, 95%CI 0.33-0.71), depression (SMD = 1.40, 95%CI 1.2-1.6), catastrophizing beliefs (SMD = 0.95, 95% CI 0.69-1.2), sleep disturbance (SMD = 0.80, 95% CI 0.57-1.02), and healthcare utilization; they had lower function (SMD = 0.41, 95% CI 0.25-0.56) and pain self-efficacy (SMD = 0.77, 95% CI 0.55-0.99) compared to veterans without PTSD. Conclusion In veterans with chronic pain, PTSD symptomology has a large effect for many negative health-related outcomes. This review supports the need for clinicians to screen and understand the effects of PTSD symptoms on patients with pain. Clinicians should recognize that veterans with PTSD and pain likely have elevated pain catastrophizing beliefs and decreased self-efficacy that should be targeted for intervention.

International Journal of Athletic Therapy and training, 2021

Athletic preinjury function is typically determined via patient recall, however obtaining preinju... more Athletic preinjury function is typically determined via patient recall, however obtaining preinjury function before injury occurs should be attempted. The purpose of this study was to obtain preinjury physical function baseline values using the Knee Injury and Osteoarthritis Outcome Score (KOOS), single-leg hop for distance (SLH), and Star Excursion Balance Test (SEBT) anterior reach to determine if athletes return to those baseline values following knee injury. Out of 27 qualifying injuries, KOOS scores were significantly reduced at initial injury compared to baseline and all follow-up points (p ≤ .02). In most instances, baseline KOOS scores were not met at the discharge time point. SLH and SEBT recovered to baseline values by discharge. Injury severity and previous injury created variations in KOOS scores across multiple time points. Subjective and objective preinjury function can be re-established following knee injury but recovery may not occur at discharge from rehabilitation.

Military Medicine, Feb 22, 2019

Introduction: Co-morbid post-traumatic stress disorder (PTSD) and low back pain (LBP) are common ... more Introduction: Co-morbid post-traumatic stress disorder (PTSD) and low back pain (LBP) are common reasons for increased disability in the Veteran communities. Medical discharge from the military represents a considerable financial cost to society. Little is currently known about the impact of LBP and PTSD as longitudinal risk factors for medical discharge from Active Duty military service. Materials and Methods: A retrospective analysis of US Army Active Duty Soldiers from 2002 to 2012 was performed to determine the risk for medical discharge. Four levels of exposure for were identified as independent variables: no chronic LBP or PTSD, chronic LBP only, PTSD only, and co-morbid PTSD present with chronic LBP. Statistical analysis utilized modified Poisson regression controlling for sex, age, rank, time in service, deployment, mental health, sleep disorders, alcohol use, tobacco use, obesity, and military occupation. This study was approved by a Department of Defense Institutional Review Board. Results: After controlling for potential confounding variables, the RR for chronic LBP and PTSD independently was 3.65 (95% CI: 3.59-3.72) and 3.64 (95% CI: 3.53-3.75), respectively, and 5.17 (95% CI: 5.01-5.33) when both were present. Conclusions: This is the first study to identify a history of both chronic LBP and PTSD as substantial risk factors for medical discharge from the US Army. PTSD and chronic LBP may mutually reinforce one another and deplete active coping strategies, making Soldiers less likely to be able to continue military service. Future research should target therapies for co-morbid PTSD and chronic LBP as these conditions contribute a substantial increase in risk of medical discharge from the US Army.

Journal of Arthroplasty, Oct 1, 2009

Weakness of the hip abductors after total hip arthroplasty may result in pain and/or functional l... more Weakness of the hip abductors after total hip arthroplasty may result in pain and/or functional limitation. Non-weight-bearing (NWB) exercises are often performed to target the hip abductors; however, muscle activation of NWB exercises has not been compared to weight-bearing (WB) exercises. Our purpose was to evaluate gluteus medius activation during 2 WB and 2 NWB hip abductor strengthening exercises. Fifteen patients at least 6 weeks post unilateral total hip arthroplasty volunteered for the study. Electromyographic amplitude for each exercise was normalized to each patient's maximal voluntary isometric contraction. There were no significant differences in gluteus medius electromyographic amplitudes between the 4 exercises (P = .15). Based on our results, NWB exercises provided no clear benefit in terms of gluteus medius activation when compared to potentially more functional WB exercises in the early postoperative period.

Journal of Sport Rehabilitation, Feb 1, 1994

Ankle proprioception is widely regarded as an important factor that affects susceptibility to ank... more Ankle proprioception is widely regarded as an important factor that affects susceptibility to ankle sprain, but the precise mechanisms by which proprioceptive abilities may enhance ankle stability are not well understood. Pertinent literature is reviewed and theoretical interrelationships among factors that may affect dynamic ankle function are discussed. Topics addressed include mechanoreceptor function, muscle spindle function, postural balance, ankle edema, joint capsule distension, synovial hypertrophy, capsuloligamentous laxity, anterolateral rotary instability, ankle giving way, reflexive muscle splinting, articular deafferentation, neurogenic inflammation, muscular de-efferentation, and enhancement of compensatory neuromuscular mechanisms. Recommendations for future research are presented in the form of questions that cannot be adequately answered at present concerning the role of proprioceptively mediated mechanisms in the maintenance of dynamic ankle stability.

Physical therapy, Nov 1, 1992

Elsevier eBooks, 2017

1. What is the body’s initial response to soft tissue injury? How is it identified? The inflammat... more 1. What is the body’s initial response to soft tissue injury? How is it identified? The inflammatory response is characterized by a chemically mediated amplification cascade that represents the body’s initial reaction to injury, whether caused by trauma, surgery, or metabolic or infectious disease. The principal signs of the inflammatory response are erythema (rubor), swelling (tumor), elevated tissue temperature (calor), and pain (dolor). Local vasodilation, fluid leakage into the extracellular and extravascular spaces, and impaired lymphatic drainage are responsible for the erythema, swelling, and increased tissue temperature. The fourth cardinal sign of inflammation—pain—is the result of mechanical distention and pressure of the soft tissues and chemical irritation of pain-sensitive nerve receptors.

Physical Therapy in Sport, 2021

Main Outcome Measures: Time to failure (TTF) was the primary outcome measure to determine reliabi... more Main Outcome Measures: Time to failure (TTF) was the primary outcome measure to determine reliability of the PSET. Discriminant validity identified with receiver operator characteristic (ROC) curves utilized TTF separately in men and women since they used different loads. Results: There were 25/30 subjects (painful=12; non-painful=13) tested a second time. ICC, SEM, and MDC90 ranged respectively from 0.77, 13.1 seconds, 30.6 seconds in the painful group to 0.85, 7.3 seconds, 17 seconds in the non-painful group. The male ROC curve AUC was 0.833 with 47 seconds resulting in the best combination of sensitivity = 0.833, and specificity = 0.80. The female ROC curve AUC was 0.633 with 46 seconds resulting in the best combination of sensitivity = 0.600 and specificity = 0.889 at 46 seconds. 4 Conclusion: The PSET is a reliable way to measure shoulder girdle muscular endurance. These data suggest that the PSET discriminates painful and nonpainful individuals better in men compared to women.

Rehabilitation Research and Practice, 2012

This study examines if electromyographic (EMG) amplitude differences exist between patients with ... more This study examines if electromyographic (EMG) amplitude differences exist between patients with shoulder instability and healthy controls performing scaption, prone horizontal abduction, prone external rotation, and push-up plus shoulder rehabilitation exercises. Thirty nine subjects were categorized by a single orthopedic surgeon as having multidirectional instability (n = 10), anterior instability (n = 9), generalized laxity (n = 10), or a healthy shoulder (n = 10). Indwelling and surface electrodes were utilized to measure EMG activity (reported as a % of maximum voluntary isometric contraction (MVIC)) in various shoulder muscles during 4 common shoulder exercises. The exercises studied effectively activated the primary musculature targeted in each exercise equally among all groups. The serratus anterior generated high activity (50-80% MVIC) during a push-up plus, while the infraspinatus and teres major generated moderate-to-high activity (30-80% MVIC) during both the prone horizontal and prone external rotation exercises. Scaption exercise generated moderate activity (20-50% MVIC) in both rotator cuff and scapular musculature. Clinicians should feel confident in prescribing these shoulder-strengthening exercises in patients with shoulder instability as the activation levels are comparable to previous findings regarding EMG amplitudes and should improve the dynamic stabilization capability of both rotator cuff and scapular muscles using exercises designed to address glenohumeral joint instability.

Mosby Year Book, 1997

... Orthopedic and sports physical therapy. Post a Comment. CONTRIBUTORS: ... VOLUME/EDITION: 3rd... more ... Orthopedic and sports physical therapy. Post a Comment. CONTRIBUTORS: ... VOLUME/EDITION: 3rd edition. PAGES (INTRO/BODY): xiii, 633 p. SUBJECT(S): Orthopedics; Physical therapy; Sports physical therapy; Sports Medicine; methods. DISCIPLINE: No discipline assigned. ...

Journal of Manipulative and Physiological Therapeutics, Jul 1, 2023

Military Psychology, Mar 15, 2023

Physiotherapy Practice and Research, 2015

Purpose: Scapular muscle performance is potentially influenced by arm dominance. The purpose of t... more Purpose: Scapular muscle performance is potentially influenced by arm dominance. The purpose of this study was to investigate the effect of arm dominance on clinical measures of scapulohumeral muscle strength and endurance. Methods: Thirty-two healthy individuals between the ages of 30 and 65 years were recruited to participate. Scapular muscle strength of the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) were recorded with a hand held dynamometer. One scapulohumeral isometric muscle endurance task was performed in prone. The order of testing (strength and endurance) was randomized for each individual. Dominant to non-dominant strength and endurance measures were compared with paired t-tests. Results: Arm dominance was significantly higher for UT strength (p \u3c 0.001) and endurance (p = 0.015). However, the differences between the dominant and non-dominant limbs were not beyond minimal detectable change values. Conclusion: It does not appear that scapulohumeral muscle strength and endurance is clinically different for the dominant and non-dominant limbs in a middle age healthy population

Journal of Bodywork and Movement Therapies, Apr 1, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Journal of neurological surgery, May 2, 2012

Physiotherapy, May 1, 2015

Abandonment rates of prosthesis are 8.5% for TTA, 10.5% for TFA and 8.4% for bilateral amputees. ... more Abandonment rates of prosthesis are 8.5% for TTA, 10.5% for TFA and 8.4% for bilateral amputees. Conclusion(s): The use of the SPARG national database allows evaluation of service provision at a local and National level with targeted research projects to adapt the services provided. Implications: The ability to record the numbers of amputations, demographics of the population, outcomes regarding fitting with a prosthesis and trends in early walking aid and compression therapy provision is vital for benchmarking services.

Physiotherapy Theory and Practice, Jul 16, 2019

ABSTRACT Patients with chronic ankle instability (CAI) experience a dynamic interplay between imp... more ABSTRACT Patients with chronic ankle instability (CAI) experience a dynamic interplay between impaired mechanical structures and sensorimotor deficiencies that contribute to recurrent sprains and sensations of instability. Concomitantly, muscular trigger points (MTrPs) are known to occur following trauma, maximal or submaximal concentric contractions, and unaccustomed eccentric loads. Additionally, MTrPs are theorized to be exacerbated in low-load and repetitive strain activities. MTrPs located within a muscle are associated with altered motor control, reaction delay, and decreased strength, deficits also found among those with CAI. Dry needling (DN) is reported to improve muscle range of motion, motor control, and pain in a myriad of neuromusculoskeletal conditions by decreasing spontaneous electrical activity and stiffness of taut muscle bands while improving filament overlap. Building on evidence supporting neuromechanical decoupling in chronic ligamentous injury with what is known about the development of MTrPs, this paper proposes a centrally mediated mechanism for improved sensorimotor function following DN for individuals with CAI. Dry needling equilibration theory (DNET) states that proprioception is improved following DN in the lower extremity by changing the muscle’s length–tension relationship and leveraging minor acute discomfort to improve muscle spindle afferent information via the gamma motor system. The application of DNET for individuals with CAI may provide a mechanistic explanation for improved descending cortical output, resulting in enhanced sensorimotor function.

International Journal of Athletic Therapy and Training, 2021

Athletic preinjury function is typically determined via subjective recall; however, obtaining pre... more Athletic preinjury function is typically determined via subjective recall; however, obtaining preinjury function before injury occurs should be attempted in order to establish an individual baseline for postinjury comparison. The purpose of this study was to obtain preinjury baseline values for the Foot and Ankle Disability Index (FADI) and Foot and Ankle Disability Index sport version (FADISP), single-leg hop for distance, and Star Excursion Balance Test anterior reach and determine if athletes returned to those values following ankle injury. Out of 41 qualifying injuries, FADI/FADISP scores were significantly reduced at initial injury compared with baseline and all other time points (p