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Physical Therapy in Sport 13 (2012) 55–56

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Physical Therapy in Sport

journal homepage: www.elsevier .com/ptsp

Lower limb functional tests

Clinical assessment has seen a gradual shift in ‘culture’ over thelast 10 years from looking predominantly at static stability todynamic stability in athletes, on the premise that static stabilitytests are not demanding and discriminatory enough for use inthis population. These tests evaluate a number of very differentparameters, directly or indirectly and simultaneously. Theseinclude motor control, pain, athlete confidence, joint mobility andstrength and power. The original research presented in this issueof Physical Therapy in Sport has a focus on these tests from differentperspectives. The first study investigates the relationship betweenstrength and landing kinematics in female athletes, a topic whichcontinues to be very popular. The second study looks at the rela-tionship between static and dynamic measures of postural stabilityand finally, the third reports on visual rating of lower limb func-tional tests, something we do the whole time during clinical assess-ment. I am sure these studies will give you pause for thought andmake you consider how you use and evaluate lower limb functionaltests in your clinical practice.

Reduced range of motion (ROM) is one of the most commonlypresenting clinical challenges. Dr Michael Joseph from the Univer-sity of Connecticut presents the Masterclass on reduced ROMwith respect to the knee. The authors discuss the possible causesof hypomobility with respect to specific anatomical structuresand the typical patterns that present as a consequence of traumato these structures. For those of you not familiar with the conceptof articular and non-articular patterns originally described byJames Cyriax, this is also covered. A thorough understanding ofthe respective kinematics will enhance the restoration of move-ment at any joint. The authors go on to discuss the complex kine-matics of both the tibiofemoral and patellofemoral joints and thisincludes a revision of concepts such as the concave-convex ruleand the unique screw-home mechanism resulting from the shapeof the femoral condyles. The article concludes with mobilizationtechniques that can be employed to increase ROM, and importantly,the frequency, duration, intensity and total volumes that should beconsidered. This Masterclass will appeal to both student and expe-rienced clinicians alike, as it covers many basic principles and theclinical reasoning underpinning the clinicians’ practical application.

Hydrotherapy is not a new concept, nor are spinal stabilisationexercises for the management and prevention of low back pain(LBP). Exercise therapy in water is an attractive intervention forathletes with LBP where spinal loads maybe reduced and thehydrostatic pressure may afford improved control and reducedpain. Whilst many studies have explored muscle activation in themany land-based exercises used for the management of LBP, fewhave investigated what happens when these are conducted in an

1466-853X/$ – see front matter � 2012 Elsevier Ltd. All rights reserved.doi:10.1016/j.ptsp.2012.03.015

aquatic environment. Dr Eadric Bressel and colleagues from UtahState University and AUT University present a study examiningmuscle activity levels during 11 different aquatic exercises target-ing specific or global muscles in a cohort of healthy male subjects.The sample size is small but valid (note the sample size calculation)and abdominal bracing and Swiss ball exercises produced the great-est muscle activity levels. It would be interesting to repeat thisstudy on a cohort with LBP, but the findings are useful for directingclinicians using hydrotherapy for the management of thiscondition.

The following three pieces of original research all focus on anaspect of single leg functional tests. Biomechanical factors andACL injury in female athletes have been extensively investigatedand continue to warrant further investigation. Dynamic kneevalgus has been shown to be predictive of ACL injury (Hewettet al., 2005). Lower extremity strengthmeasures in the open kineticchain have been poorly associated with landing kinematics. DrChristopher Carcia and colleagues fromDuquesne University inves-tigate the association between lower extremity strength measuresin the closed kinetic chain and frontal plane kinematics duringa unilateral landing task in healthy female athletes. Whilst theresults did not show an association, this study does add to whatis currently known in this area and themanuscript covers a compre-hensive background into the many biomechanical risk factors infemale athletes. The subsequent study investigates the relationshipbetween static and dynamic postural stability in healthy subjects.Dr Timothy Sell and colleagues from the University of Pittsburghfound no relationship between two commonly used static anddynamic tests in a group of healthy subjects. The possible mecha-nisms that could account for these findings are discussed andrecommendations are made for clinical assessment. In the finalstudy, ChrisWhatman and colleagues fromAUT University considerthe evaluation of lower extremity tests. A continual conflict withclinical research lies in the translation of findings to clinical appli-cation ‘in the field’. The product of laboratory based researchdependent on sophisticated kinematic, kinetic and EMG systemsmay provide explanatory answers to clinical questions but havelimited clinical application. Evaluation of movement remains atthe core of clinical assessment, and visual rating remains the singletool available to the majority of clinicians. It is therefore importantto evaluate how good we are at this skill if we are making decisionson management based on this outcome. In this study, forty-fourphysiotherapists of various experience assessed the movement onvideos of four commonly used lower limb functional tests. The find-ings may not surprise many and it would be interesting to repeatthe study on subjects with pathology. However, have a look at

Editorial / Physical Therapy in Sport 13 (2012) 55–5656

how the movements have been assessed, it may give you ideas foryour own practice.

Research into the differences between dominant and non-dominant sides has mainly been conducted on the lower limb.Where the upper limb has been studied, in overhead and throwingathletes, the focus has been on the muscles of the glenohumeraljoint and scapular stability. Elbow injuries pose a significantproblem for baseball players. In the final article, Dr Laudner andcolleagues from Illinois State University and the Texas MetroplexInstitute for Sports Medicine and Orthopedics investigate thedifferences in muscle strength of the major muscle groups in thedistal arm in the dominant and non-dominant arms of collegiatebaseball players. The results showed significantly greater peak tor-que/body weight strength for both the pronators and wrist exten-sors in the throwing arm, and the clinical implications of this arediscussed.

Optimising methods of recovery during intense training orbetween competitions continues to be a hot topic in sports andexercise medicine. Rui Torres and colleagues from the North Poly-technic Institute of Health, Technical University of Lisbon andUniversity of Porto present a systematic review on the effect of

physiotherapy interventions following exercise-induced muscledamage. Interventions considered include massage, cryotherapy,stretching and low-intensity exercise.

Studies investigating Kinesio taping are still few and farbetween despite its high visibility in many sports and seen onmany high performance athletes. In the final article, Jung-hoonLee and Wongyu Yoo from Inje University present a case studydescribing a 5 week intervention period of taping in an amateurbadminton player with chronic achilles tendon pain.

I hope you all enjoy this issue of Physical Therapy in Sport.

Reference

Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Jr., Colosimo, A. J., McLean, S.G., et al. (2005). Biomechanical measures of neuromuscular control andvalgus loading of the knee predict anterior cruciate ligament injury riskin female athletes: a prospective study. American Journal of Sports Medicine,33, 492–501.

Zoe HudsonEditor