Susan Saliba | University of Virginia (original) (raw)

Papers by Susan Saliba

Research paper thumbnail of Clinimetric analysis of pressure biofeedback and transversus abdominis function in individuals with stabilization classification low back pain

The Journal of orthopaedic and sports physical therapy, 2013

Descriptive laboratory study. To determine if a proposed clinical test (pressure biofeedback) cou... more Descriptive laboratory study. To determine if a proposed clinical test (pressure biofeedback) could detect changes in transversus abdominis (TrA) muscle thickness during an abdominal drawing-in maneuver. Pressure biofeedback may be used to assess abdominal muscle function and TrA activation during an abdominal drawing-in maneuver but has not been validated. Forty-nine individuals (18 men, 31 women) with low back pain who met stabilization classification criteria underwent ultrasound imaging to quantify changes in TrA muscle thickness while a pressure transducer was used to measure pelvic and spine position during an abdominal drawing-in maneuver. A paired t test was used to compare differences in TrA activation ratios between groups (able or unable to maintain pressure of 40 ± 5 mmHg). The groups were further dichotomized based on TrA activation ratio (high, greater than 1.5; low, less than 1.5). Sensitivity, specificity, and likelihood ratios were calculated. There was not a signif...

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Research paper thumbnail of Contralateral effects of disinhibitory tens on quadriceps function in people with knee osteoarthritis following unilateral treatment

North American journal of sports physical therapy (NAJSPT)

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Research paper thumbnail of Electrode type and placement configuration for quadriceps activation evaluation

Journal of athletic training

The ability to accurately estimate quadriceps voluntary activation is an important tool for asses... 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...

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Research paper thumbnail of Community-associated methicillin-resistant Staphylococcus aureus

North American journal of sports physical therapy (NAJSPT)

Methicillin resistant Staphylococcus aureus (MRSA), is a problematic infection which is becoming ... 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.

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Research paper thumbnail of DEMOGRAPHIC AND EPIDEMIOLOGICAL TRENDS IN PATELLOFEMORAL PAIN

International journal of sports physical therapy, 2015

Understanding the demographics of patellofemoral pain is important to determine the best practice... 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...

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Research paper thumbnail of Days to Return to Participation After a Hamstrings Strain Among American Collegiate Soccer Players

Journal of athletic training, Jan 15, 2015

Among US collegiate soccer players, the incidence rate and the event characteristics of hamstri... 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...

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Research paper thumbnail of Phonophoresis and the absorption of dexamethasone in the presence of an occlusive dressing

Journal of athletic training

Phonophoresis is purported to represent a method to apply topical medications through the skin to... 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 ...

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Research paper thumbnail of No difference between doses in skin anesthesia after lidocaine delivered via iontophoresis

Journal of sport rehabilitation, 2011

Iontophoresis is a method of administering medications transcutaneously using galvanic current. D... 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...

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Research paper thumbnail of Differential ability of selected postural-control measures in the prediction of chronic ankle instability status

Journal of athletic training

Chronic ankle instability (CAl) is a term used to identify a condition associated with recurrent ... 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...

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Research paper thumbnail of The effect of traditional bridging or suspension-exercise bridging on lateral abdominal thickness in individuals with low back pain

Journal of sport rehabilitation, 2012

Individuals with low back pain (LBP) are thought to benefit from interventions that improve motor... 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 ...

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Research paper thumbnail of Comparison of ankle arthrometry to stress ultrasound imaging in the assessment of ankle laxity in healthy adults

International journal of sports physical therapy, 2011

Ultrasonography (US) may aid the assessment of the anterior talofibular ligament (ATFL) injury af... 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...

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Research paper thumbnail of Reliability of thoracic spine rotation range-of-motion measurements in healthy adults

Journal of athletic training

The reliability of clinical techniques to quantify thoracic spine rotation range of motion (ROM) ... 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...

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Research paper thumbnail of Microvascular perfusion increases after eccentric exercise of the gastrocnemius

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2013

The purpose of this study was to assess microvascular perfusion immediately after eccentric exerc... 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...

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Research paper thumbnail of Lack of effect of superficial heat to the knee on quadriceps function in individuals with quadriceps inhibition

Journal of sport rehabilitation, 2013

Quadriceps function improves after application of focal joint cooling or transcutaneous electrica... 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...

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Research paper thumbnail of Injury-Related Fear in Acutely Injured Interscholastic and Intercollegiate Athletes

Athletic Training & Sports Health Care, 2013

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Research paper thumbnail of Blood Flow After Exercise-Induced Muscle Damage

Journal of athletic training, Jan 6, 2015

Context : The most common modality used to address acute inflammation is cryotherapy. Whereas pa... 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 ...

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Research paper thumbnail of Cocontraction of ankle dorsiflexors and transversus abdominis function in patients with low back pain

Journal of athletic training

The abdominal draw-in maneuver (ADIM) with cocontraction has been shown to be a more effective me... 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...

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Research paper thumbnail of Baseline SCAT2 Assessment of Healthy Youth Student-Athletes

Clinical Journal of Sport Medicine, 2014

To compare baseline scores of middle and high school students on the Sport Concussion Assessment ... 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.

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Research paper thumbnail of Balance Training and Center-of-Pressure Location in Participants With Chronic Ankle Instability

Journal of Athletic Training, 2015

Context : Chronic ankle instability (CAI) occurs in some people after a lateral ankle sprain and... 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.

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Research paper thumbnail of Talofibular interval changes after acute ankle sprain: a stress ultrasonography study of ankle laxity

Journal of sport rehabilitation, 2013

Quantifying talocrural joint laxity after ankle sprain is problematic. Stress ultrasonography (US... 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...

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Research paper thumbnail of Clinimetric analysis of pressure biofeedback and transversus abdominis function in individuals with stabilization classification low back pain

The Journal of orthopaedic and sports physical therapy, 2013

Descriptive laboratory study. To determine if a proposed clinical test (pressure biofeedback) cou... more Descriptive laboratory study. To determine if a proposed clinical test (pressure biofeedback) could detect changes in transversus abdominis (TrA) muscle thickness during an abdominal drawing-in maneuver. Pressure biofeedback may be used to assess abdominal muscle function and TrA activation during an abdominal drawing-in maneuver but has not been validated. Forty-nine individuals (18 men, 31 women) with low back pain who met stabilization classification criteria underwent ultrasound imaging to quantify changes in TrA muscle thickness while a pressure transducer was used to measure pelvic and spine position during an abdominal drawing-in maneuver. A paired t test was used to compare differences in TrA activation ratios between groups (able or unable to maintain pressure of 40 ± 5 mmHg). The groups were further dichotomized based on TrA activation ratio (high, greater than 1.5; low, less than 1.5). Sensitivity, specificity, and likelihood ratios were calculated. There was not a signif...

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Research paper thumbnail of Contralateral effects of disinhibitory tens on quadriceps function in people with knee osteoarthritis following unilateral treatment

North American journal of sports physical therapy (NAJSPT)

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Research paper thumbnail of Electrode type and placement configuration for quadriceps activation evaluation

Journal of athletic training

The ability to accurately estimate quadriceps voluntary activation is an important tool for asses... 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...

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Research paper thumbnail of Community-associated methicillin-resistant Staphylococcus aureus

North American journal of sports physical therapy (NAJSPT)

Methicillin resistant Staphylococcus aureus (MRSA), is a problematic infection which is becoming ... 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.

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Research paper thumbnail of DEMOGRAPHIC AND EPIDEMIOLOGICAL TRENDS IN PATELLOFEMORAL PAIN

International journal of sports physical therapy, 2015

Understanding the demographics of patellofemoral pain is important to determine the best practice... 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...

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Research paper thumbnail of Days to Return to Participation After a Hamstrings Strain Among American Collegiate Soccer Players

Journal of athletic training, Jan 15, 2015

Among US collegiate soccer players, the incidence rate and the event characteristics of hamstri... 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...

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Research paper thumbnail of Phonophoresis and the absorption of dexamethasone in the presence of an occlusive dressing

Journal of athletic training

Phonophoresis is purported to represent a method to apply topical medications through the skin to... 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 ...

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Research paper thumbnail of No difference between doses in skin anesthesia after lidocaine delivered via iontophoresis

Journal of sport rehabilitation, 2011

Iontophoresis is a method of administering medications transcutaneously using galvanic current. D... 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...

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Research paper thumbnail of Differential ability of selected postural-control measures in the prediction of chronic ankle instability status

Journal of athletic training

Chronic ankle instability (CAl) is a term used to identify a condition associated with recurrent ... 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...

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Research paper thumbnail of The effect of traditional bridging or suspension-exercise bridging on lateral abdominal thickness in individuals with low back pain

Journal of sport rehabilitation, 2012

Individuals with low back pain (LBP) are thought to benefit from interventions that improve motor... 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 ...

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Research paper thumbnail of Comparison of ankle arthrometry to stress ultrasound imaging in the assessment of ankle laxity in healthy adults

International journal of sports physical therapy, 2011

Ultrasonography (US) may aid the assessment of the anterior talofibular ligament (ATFL) injury af... 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...

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Research paper thumbnail of Reliability of thoracic spine rotation range-of-motion measurements in healthy adults

Journal of athletic training

The reliability of clinical techniques to quantify thoracic spine rotation range of motion (ROM) ... 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...

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Research paper thumbnail of Microvascular perfusion increases after eccentric exercise of the gastrocnemius

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2013

The purpose of this study was to assess microvascular perfusion immediately after eccentric exerc... 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...

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Research paper thumbnail of Lack of effect of superficial heat to the knee on quadriceps function in individuals with quadriceps inhibition

Journal of sport rehabilitation, 2013

Quadriceps function improves after application of focal joint cooling or transcutaneous electrica... 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...

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Research paper thumbnail of Injury-Related Fear in Acutely Injured Interscholastic and Intercollegiate Athletes

Athletic Training & Sports Health Care, 2013

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Research paper thumbnail of Blood Flow After Exercise-Induced Muscle Damage

Journal of athletic training, Jan 6, 2015

Context : The most common modality used to address acute inflammation is cryotherapy. Whereas pa... 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 ...

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Research paper thumbnail of Cocontraction of ankle dorsiflexors and transversus abdominis function in patients with low back pain

Journal of athletic training

The abdominal draw-in maneuver (ADIM) with cocontraction has been shown to be a more effective me... 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...

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Research paper thumbnail of Baseline SCAT2 Assessment of Healthy Youth Student-Athletes

Clinical Journal of Sport Medicine, 2014

To compare baseline scores of middle and high school students on the Sport Concussion Assessment ... 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.

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Research paper thumbnail of Balance Training and Center-of-Pressure Location in Participants With Chronic Ankle Instability

Journal of Athletic Training, 2015

Context : Chronic ankle instability (CAI) occurs in some people after a lateral ankle sprain and... 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.

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Research paper thumbnail of Talofibular interval changes after acute ankle sprain: a stress ultrasonography study of ankle laxity

Journal of sport rehabilitation, 2013

Quantifying talocrural joint laxity after ankle sprain is problematic. Stress ultrasonography (US... 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...

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