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Summary of the Top 2009 APTA CSM Abstracts

Posted Jan 26 2009 5:36pm

CSM2009_land Can’t make it to the APTA Combined Sections Meeting next month but still want to find  out about all the great new research that is being presented?  I always enjoy the research platforms and posters and in my formal life was able to attend and present our research every year.  I have been seeping through mounds of abstracts from the Orthopedic and Sports Physical Therapy Sections and have found quite a few gems.  In effort to share the research and all advance our clinical practice I have hand-selected my favorite abstracts and will provide a brief 2-3 sentence synopsis of the clinical implications.  Enjoy!

Research takes so much time and effort, we should all be truly grateful for all these researchers.  Let’s help them out and spread the word of their excellent research, please see the “Share This” button at the end of this post to email this to colleague or share this information on Stumbleupon, Digg, Delicious, Facebook, Twitter, or other websites!  Thanks for your help with this.

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Shoulder

  • Relationship of shoulder rotation to shoulder strength and scapula position in professional baseball pitchers. Thigpen CT.  My lone study at this years conference!  Two big findings: 1) Greater total rotation motion results in decreased strength, and 2) anterior tilted scapula results in decreased shoulder ROM.  Thanks for all your help Chuck!  
  • Interrater reliability of a scapula classification system in the examination of professional baseball pitchers. Ellenbecker TS.  Todd’s study this year shows that classification of scapular dyskinesis is not reliable.  I’ve never been a big fan of scapular dyskinesis classification.
  • Shoulder strength and function in subjects with and without forward head rounded shoulder posture. Harrington SE.  Similar research from my friend Chuck Thigpen that we discovered in overhead athletes.  People with poor posture have greater chance for cervical injuries and have decreased lower trapezius strength.  The upper body cross syndrome.
  • Plyometric training of the core and effects on trunk and shoulder outcome measures. Griffith TK.  Subjects improved in core strength and stability after a core medicine ball program for 8 weeks, however their was no carryover to shoulder strength.  Still good outcomes for the core.
  • Middle and lower trapezius manual muscle testing. Robel SJ.  The arm should be positioned in external rotation while performing manual muscle testing for the middle and lower trapezius.
  • Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. Tyler T.  This is the 2009 Excellence in Research Award.  Great study Tim, I am jealous I can’t perform a study like this because I don’t let my players get tight!  But seriously, we may completely disagree why your patients improved (it is not the posterior capsule…), but great job showing that symptoms resolved with the normalization of range of motion, that is a pretty cool finding.

Elbow

  • Alteration exists in elbow joint active replication in college pitchers following a simulated game. Manske RC.  Significant decrease in elbow proprioception after pitching.  An amazing lack of research on the elbow this year, by the way.

Spine

  • The immediate effects of upper thoracic translatoric spinal manipulation on cervical pain and range of motion: A randomized clinical trial. Krauss JR.  Manipulation of the upper thoracic spine increases cervical range of motion and reduces cervical pain at end range.
  • The effect of thoracic stretching and mobilization on shoulder range of motion. Ditzler MD.  Thoracic manipulations resulted in greater active and passive ROM for flexion, ER, and IR.  Internal rotation had the most significant increase.  It appears that scapula position and posture has an incredible effect on shoulder ROM.
  • Thoracic manipulations may show promise in the conservative management of thoracic outlet syndrome. Sions JM.  Seriously, is there anything that thoracic manipulations doesn’t seem to help.  I am going to be doing a lot of thoracic manipulations this year!
  • Effect of a progressive core stabilization program on lumbar stability and abdominal strength. Appling SA.  A 6-week program was effective in enhancing lumbar stability but not abdominal strength.  May be due to neuromuscular enhancement,
  • The effect of 2 commonly prescribed abdominal muscle contraction techniques on lower trunk strength. Reiman MP.  Abdominal bracing is effective.  Abdominal hollowing is not.

Knee

  • The utility of objective measurements in return to sports after ACL reconstruction. Lynch AD.  Several factors should be assessed before allowing athletes to return to sport, including isokinetic strength, hop tests, KOS-ADLS scale, and subjective rating rather than relying just on an arbitrary date after surgery.  Many athletes are not ready at a specific time.  Should be individualized.
  • Effect of patellofemoral strapping on medial formal rotation, patellofemoral joint alignment, and pain response in females with patellofemoral pain: Assessment using weight-bearing MRI.   Souza RB.  DonJoy SERF strap is effective in reducing medial femoral rotation, improves patellofemoral alignment, and decreases pain in females with patellofemoral symptoms.  Pretty big implications for the use of this device that has been around for only a few years.
  • Does diminished hip muscle strength influence medial-lateral dynamic stability in females with patellofemoral pain? Lee SP.  Females with patellofemoral pain had diminished hip abduction and external rotation strength and decreased dynamic stability.  This study also showed efficacy of the above DonJoy SERF brace that normalized medial-lateral dynamic stability.  Would say that we should all be looking into the SERF braces.
  • Patellofemoral joint stress during weight-bearing and non-weight-bearing exercises. Ho KY.  Authors recommend squatting to avoid 75-90 degrees of flexion, open chain knee extension with ankle weight from 0-15 degrees.  Nothing new here but then they suggest that open chain knee extension in a machine can be performed from 0-90 degrees.  Seems to contradict, I would have to see the entire study before recommending these guidelines.

Hip

  • Diagnostic accuracy of a clinical examination when compared to surgical findings in hip arthroscopy candidates. Martin RL.  I am shocked that this is a poster and was not accepted as a platform, especially considering the authors are some of the most respected hip surgeons.  Study notes that history and clinical exam were not accurate to detect labral pathology, femoroacetabular impingement, or capsular injury. This needs to be an area we continue to improve on.
  • Which exercises target the gluteal muscles while limiting activation of the tensor fascia lata?  EMG assessment using fine-wire electrodes. Selkowitz DM.  Best exercises to recruit gluteal muscles and minimizing TFL involve hip extension and external rotation.  These were the clam, bridging, and quadruped hip extension.  Hip abduction alone recruited both gluteus medius and TFL.
  • Electromyographic analysis of the gluteus medius in weight-bearing exercises. Krause DA.  An ordinal scale of activities is presented.  Double leg stance < single leg stance < single leg squat < single leg squat on unstable surface.  Looks like we have the perfect exercise progression.
  • Comparison of selected stretch positions of the piriformis muscle using computerized tomography and biomodeling: A pilot study.Marcellin-Little D.  Piriformis stretching significant increases the length of the muscle.  To maximize stretch, the order is important: flex hip to 90 degrees, adduct leg, then externally rotate.
  • Clinical measure of hip internal/external rotation: Supine does not equal prone. Moreside J.  Hip internal rotation range of motion was significantly less in supine and external rotation greater in supine.  It appears that the joint is tensioned differently in different positions and that prone allows for a greater amount of total motion.
  • Strength differences of hip external rotators using 2-different methods of assessing isometric strength. Reutman PF.  Greater hip strength was found when measuring strength in 90 degrees of hip flexion than 20 degrees of hip flexion.
  • Hip rotator muscle strength tested with the hip flexed compared to hip extended. Cornbleet SL.  This appears to be a popular topic this year.  This study showed no difference in ER strength (the opposite of the above study) but greater internal rotation strength when sitting.  My recommendation would be that you perform testing in a position that is most specific to your patient as it looks like position matters.

Foot and Ankle

  • Should range of motion exercises be initiated early or late after talus and calcaneus fractures? Albin SR.  The early ROM group had greater motion and similar outcome scores with no complications.  Early range of motion is recommended.
  • Custom foot orthotics support the medial longitudinal arch during the stance phase of gait. Rodrigues P.  Custom orthotics are able to maintain the arch during gait and help lower extremity kinematics.

Manual Therapy

  • Factors associated with utilizing mobilization and manipulation techniques by physical therapists in the outpatient setting. Bollinger M.  Utilization of mobilization and manipulation techniques are more common in those that received specialized training in their school curriculum or through continuing education.  We need to beef up our entry-level education in this area in my mind.  I know there are still programs where this area is lacking.  It is a shame.
  • The effectiveness of ischemic pressure and stretch on myofascial trigger points. Lake DA.  Both ischemic pressure (for 90 seconds) and pressure with stretch (for 30 seconds after pressure applied) improved trigger points and decrease referral pain.

Modalities

  • The effect of low-intensity pulsed ultrasound on fracture healing: A Review. Mikhail AS.  Pulsed ultrasound at 1.5 MHz and 20-30 mW/cm2 for 20 minutes a day for greater than 14 days can improve bone fracture healing.
  • Transmission of dexamethasone through swine skin in vitro via phonophoresis.   Vore ME.  Phonophoresis was net effective in medication transmission.  This doesn’t bode well for the next pig you treat in the clinic (just thought if you actually read this far you deserved a good laugh!).

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