A prospective, randomized clinical investigation of the treatment of first-time ankle sprains.

Background: Acute ankle ligament sprains are treated with the use of controlled mobilization with protection provided by external support (eg, functional treatment); however, there is little information regarding the best type of external support to use.

Hypothesis: There is no difference between elastic wrapping, bracing, bracing combined with elastic wrapping, and casting for treatment of acute, first-time ankle ligament sprains in terms of the time a patient requires to return to normal function.

Study Design: Randomized controlled clinical trial; Level of evidence, 1.

A neural network approach to motor-sensory relations during postural disturbance.

This study explored whether artificial neural networks (ANN) can be used to quantify the motor-sensory relationship during postural disturbance. An ANN model was constructed with seven mechanical stimuli to the visual, vestibular and somatosensory systems (i.e.

Validity and reliability of an internet-based temporal gait assessment tool with healthy adults: a pilot study.

Objectives: To assess in healthy adults the validity and the inter- and intrarater reliability of the Internet-based Shaw Gait Assessment (SGA).

Design: Concurrent test-retest reliability and validity study with participants, 4 raters, and the Elite motion analysis system (used as the criterion standard).

Setting: Motion analysis laboratory in a university physical therapy department.

Radiographic measurement of anterior talar translation in the ankle: determination of the most reliable method.

Background: Although most would agree that stress radiography is an important research tool to evaluate the integrity of the ankle ligaments in studies of chronic ankle instability, there is little agreement with regard to the best technique to make these measurements. The primary objective of this study was to establish the most reliable method for measuring anterior displacement of the talus relative to the tibia using stress radiographs of the ankle. This information is necessary to standardize radiographic evaluation of injured ankles and for biomechanical studies of the ankle joint, but has never been investigated.

Comparison of three lumbar orthoses using motion assessment during task performance.

Study Design: Four conditions (three orthoses, one no orthosis), full cross-over, randomized order, 12 subjects tested 3 months after a lumbar surgical arthrodesis.

Objectives: To assess whole torso and lumbar motions and comfort for each orthoses condition during performance of activities of daily living.

Summary Of Background Data: Previous noninvasive studies measured whole torso (not just lumbar) movement.

A new device to measure knee laxity during weightbearing and non-weightbearing conditions.

The Vermont knee laxity device (VKLD) was developed to evaluate anterior-posterior (A-P) displacement of the tibia relative to the femur (A-P laxity) during weightbearing and non-weightbearing conditions. The purposes of this study were to determine the repeatability and reliability of the VKLD measurements of A-P laxity and to compare them with two devices currently in clinical use: the KT-1000 knee arthrometer and planar stress radiography. Two independent examiners tested six subjects with no history of knee injury.

A controlled trial of an educational pamphlet to prevent disability after occupational low back injury.

Study Design: Randomized controlled trial.

Objective: To test the ability of an educational pamphlet to improve recovery in terms of pain, work status, and health care utilization after occupational low back injury.

Background: Low back pain and disability persist as occupational health problems of epidemic proportions.

Epidural analgesia for postoperative pain control in children.

Ninety-eight continuous postoperative epidurals were administered to 87 children. The patients were divided into two groups: group I included 63 cases in which a 0.0625-0.

Early physician notification of patient disability risk and clinical guidelines after low back injury: a randomized, controlled trial.

Study Design: Back-injured workers with high disability risk scores on a predictive questionnaire participated in a randomized, controlled trial of physician notification, with outcomes follow-up 3 months after injury.

Objectives: To test whether physician intervention improves return to work and self-assessment outcomes for people at relatively high risk for disability.

Summary Of Background Data: Only a small number of back-injured workers suffer significant disability.

Laxity and flexibility of the ankle following reconstruction with the Chrisman-Snook procedure.

The effect of reconstruction of the anterior talofibular ligament with the Chrisman-Snook procedure on neutral zone laxity (anterior-posterior displacement at low loads) and flexibility (a measure of the nonlinear load-displacement response) of the ankle was investigated in vitro during the anterior drawer test. Neutral zone laxity was defined as the magnitude of anterior-posterior displacement of the ankle joint at +/- 2.5 N of applied load.

Effect of test environment on intervertebral disc hydration.

Study Design: Water content of fresh human lumbar intervertebral discs (with adjacent endplates) was assessed in three studies: 1) after each of seven specimen preparation steps. 2) during exposure to either saline spray or a saline bath, and 3) during exposure to a saline bath and 445 N axial compression, either without or with previous exposure to the bath and no compression ("free swelling").

Objective: To assess the effect on disc hydration of various aspects of specimen preparation and testing environments.

A sagittal plane model of the knee and cruciate ligaments with application of a sensitivity analysis.

In this investigation the complex multi-bundle structure of the cruciate ligaments and their interaction with the tibiofemoral joint was modeled analytically by representing the different regions of the cruciates with ligament elements. A sensitivity analysis was then performed to describe the effect that variations of the model input parameters had on the model variables (outputs). The effect that the cruciate ligament bundles had in controlling joint kinematics was dependent on knee flexion angle, and the load applied to the tibiofemoral joint.

Early prediction of chronic disability after occupational low back injury.

Study Design: An inception cohort design was used to study a consecutive sample of back-injured workers.

Objective: To refine and to test the Vermont Disability Prediction Questionnaire's ability to indicate an individual's relative risk for chronic disability after occupational low back injury.

Summary Of Background Data: Although most back-injured workers return to work quickly, the minority who do not account for the majority of associated costs and health care.

Workers' Compensation and return-to-work in low back pain.

The relationship of Workers' Compensation and litigation to low back pain (LBP) outcome is not established in the literature. Our study investigated the characteristics of disabled persons applying for Worker's Compensation or employing a lawyer, the factors predicting receipt of compensation, and the effects of compensation and litigation on employment outcome. One hundred sixty-nine unemployed persons with LBP were assessed by medical history, physical exam, biomechanical testing, psychiatric interview, and MMPI.

The response of the flexion-relaxation phenomenon in the low back to loading.

Fick hypothesized in 1911 that the erector spinae muscles are not active when the trunk is in the fully flexed position. This effect was later called the flexion-relaxation phenomenon (FRP) and is believed to be the result of the ligaments and other passive elements of the spine taking over the load of the muscles. This study examined the effect of loading on the EMG activity of five males and five females during postures of standing at 45 degrees, 90 degrees, and full flexion.

A prospective randomized three-week trial of spinal manipulation, transcutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain.

Study Design: A randomized prospective trial of manipulation, massage, corset and transcutaneous muscle stimulation (TMS) was conducted in patients with subacute low back pain.

Objectives: The authors determined the relative efficacy of chiropractic treatment to massage, corset, and TMS.

Summary Of Background Data: Although all of these treatments are used for subacute low back pain treatment, there have been few comparative trials using objective outcome criteria.

Some endurance measures in persons with chronic low back pain.

Muscle fatigue and lack of endurance are complaints of persons with chronic low back pain, but there are no standard ways to assess endurance in this population. The purposes of this study were to examine three measures of endurance; to determine relationships of these measures to each other; and to describe effects of gender, obesity, smoking, and self-reported fitness on the clinical measures. The measures of endurance selected were not dependent on maximal voluntary muscular contractions.

Distinguishable groups of musculoskeletal low back pain patients and asymptomatic control subjects based on physical measures of the NIOSH Low Back Atlas.

Study Design: The authors performed an empirical prospective study of 115 patients referred to physical therapy for low back pain and 112 control subjects of similar age and gender.

Objectives: The authors defined and compared subgroups based on physical tests and described demographic and psychosocial characteristics by group.

Summary Of Background Data: Prospective studies of intervention for persons with low back pain are limited by inability to randomize subjects into distinguishable groups.

Chronic low back pain: The relationship between patient satisfaction and pain, impairment, and disability outcomes.

Study Design: Treatment outcomes for low back pain have been measured by varying standards of pain, impairment, and disability. This study examines the relationship between these three outcomes and treatment satisfaction in patients with chronic low back pain (CLBP).

Methods: Ninety CLBP patients underwent initial pain (VAS), impairment (PIS), and disability (OPQ) evaluations.

The measurement of elongation of anterior cruciate-ligament grafts in vivo.

Many investigators who have studied the mechanical behavior of anterior cruciate-ligament grafts have attributed the increase in anterior translation of the tibia relative to the femur (an increase in the anterior laxity of the knee joint) to the temporal changes in the material behavior (strength and elastic properties) of the graft that occur throughout the process of remodeling. However, with the onset of motion of the joint, it is unclear whether the repeatable mechanical behavior of the graft remains unchanged immediately after fixation, if the fixation slips, or if the length of the graft changes and produces an increase in anterior translation of the tibia relative to the femur. It is also unknown if procedures performed by different surgeons, using similar graft material and similar operative techniques, can produce similar mechanical behavior of the graft, or if the behavior of the graft is similar to that of the normal anterior cruciate ligament.

A dynamic material parameter estimation procedure for soft tissue using a poroelastic finite element model.

A three-dimensional finite element model for a poroelastic medium has been coupled with a least squares parameter estimation method for the purpose of assessing material properties based on intradiscal displacement and reactive forces. Parameter optimization may be based on either load or displacement control experiments. In this paper we present the basis of the finite element model and the parameter estimation process.

A poroelastic-swelling finite element model with application to the intervertebral disc.

The swelling process that occurs in soft tissue is incorporated into a poroelastic finite element model. The model is applied to a spinal segment consisting of two vertebrae and a single intervertebral disc. The theory is an extension of the poroelastic theory developed by Biot and the model is an adaptation of an axisymmetric poroelastic finite element model of the intervertebral disc by Simon.

Endurance training of trunk extensor muscles.

Background And Purpose: The purpose of this study was to assess the effects of an endurance exercise protocol on the isometric holding time of the trunk extensor muscles (mechanical fatigue measure) and on the recorded median frequency (MF) measurements from the surface electromyogram (physiological fatigue measure).

Subjects: Twenty-eight healthy female volunteers were selected to participate in the study.

Methods: The subjects were stratified by activity level and then assigned to an exercise or a control group and tested at weeks 0, 3, and 6.