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Evidence in Action Archive

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The Research Committee discusses a current research article for each issue of MN APTA's bi-monthly newsletter, MN Moving Forward.  These summaries and discussions are authored on a rotating basis by Research Committee members.  To find a specific topic or author, use CTRL+F to search for a specific term.

April 2010

Plantar Heel Pain

Reviewed by John Schmitt, PT (APTA Member Since 1985) and the MN APTA Research Comm.

Background: Plantar heel pain, often referred to as plantar fasciitis, is a common diagnosis in outpatient physical therapy practice.  Typical interventions include various modalities, stretching, and orthotic inserts.  Very few studies have investigated the effectiveness of manual therapy for plantar heel pain.

Clinical Question:  For a patient with plantar heel pain, is manual therapy more effective than commonly used modalities to reduce pain and disability in the short and long term?

Evidence:  In the August, 2009, Journal of Orthopaedic and Sports Physical Therapy, Cleland and colleagues reported on the results of a randomized controlled trial comparing the effectiveness of a manual therapy approach including 6 visits for aggressive soft tissue mobilization, calcaneal eversion mobilization, and other lower extremity mobilizations as indicated by the examination, along with a home self-mobilization program, compared to a control group that received ultrasound, iontophoresis with dexamethasone, and ice.  Patients in both groups were instructed to stretch the calf muscles at home.  Primary outcome measures were the Lower Extremity Functional Scale (LEFS), Foot and Ankle Ability Measure (FAAM), and a Numeric Pain Rating Scale (NPRS). Results:  While both groups improved, the manual therapy group had significantly greater improvements in self-rated foot function (LEFS and FAAM scores) at 4 weeks and at 6 month follow-up.  Between group differences were judged to be both statistically and clinically significant.  Pain scores were significantly better for the manual therapy group at 4 weeks, but not at 6 months. 

Clinical Decision:  The results of this randomized controlled trial support a manual therapy and exercise approach over a combination of commonly used physical modalities and exercise.

Reference: Cleland JA, et al. Manual physical therapy and exercise versus electrophysiological agents and exercise in the treatment of plantar heel pain:  A multicenter randomized clinical trial.   Journal of Orthopaedic & Sports Physical Therapy.  2009;39(8):573-85.

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December 2009

Screening Occupations for Low Back Pain?

Reviewed by Karen Swanson, PT (APTA Member Since 1989) and the MN APTA Research Committee

Background: Low back pain (LBP) is considered the single most expensive orthopedic condition and a major contributor to increasing healthcare costs in North America (i.e. 90 billion dollars per year paid on back pain alone). Epidemiological studies have shown that there is a strong association between standing occupations and the development of LBP. Previous work has also shown that 40 to 65% of asymptomatic individuals will develop significant levels of LBP during common, sustained functional tasks such as standing. In addition, numerous clinical groups and researchers have noted differences in motor control patterns of the trunk, pelvis and hip in patients who develop LBP vs. those who do not.

Clinical Question: Can a simple screening test predict LBP development during prolonged standing in previously asymptomatic individuals and could this test be used  to identify "at-risk” workers in certain occupations? 

Evidence: In the September, 2009, Journal of Orthopaedic and Sports Physical Therapy, Nelson-Wong and associate described the active hip abduction (AHAbd) test as a simple screening tool to assess an individual’s ability to maintain trunk and pelvis control and alignment during lower extremity movement when placed in an unstable position (sidelying). Forty-three subjects with no prior history of LBP underwent a standard clinical LB assessment in addition to the AHAbd test prior to a 2-hour standing protocol designed to induce LBP. Subjects rated LBP throughout the test with a VAS and were classified into "pain developers” or "non-pain developers”. Subjects also self-rated the difficulty of the AHAbd test. The standing protocol induced LBP in 40% of the participants. The self-rated and examiner-scored AHAbd test was the only clinical assessment that discriminated between the pain-developer groups. The odds ratio for the examiner scored test was 3.85, indicating that individuals who scored a 2 or greater (0-3 scale) on the test were 3.85 times more likely to develop LBP during occupational standing.

Clinical Decision: The active hip abduction test did discriminate between pain developer groups and appears to be moderately effective in predicting the occurrence of LBP during a functional standing task. While some current movement impairment theories (i.e. Sahrmann, Postural Restoration Institute) already utilize active hip abduction tests to assess LB, pelvis and hip function, future work is needed to assess the reliability and validity of these tests to specific patient populations.


Nelson-Wong, E., Flynn, T., & Callaghan, J. (2009). Development of active hip abduction as a screening test for identifying occupational low back pain.

Journal of Orthopaedic & Sports Physical Therapy, 39,


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August 2009

Exercise in a Pill?

Reviewed by Nathan Hellyer, PT (APTA Member Since 1998)  and the MN APTA Research Committee

Clinical Question: A great number of individuals in our society are developing obesity, type II diabetes, and cardiovascular diseases secondary to a low level of physical activity and exercise.   Several barriers prevent people from being physically active such as long hours spent at sedentary jobs, health conditions, safety concerns, or a lack of motivation.  Is it possible for these individuals to mimic physical activity or exercise by taking a pill?

Evidence: Narkar and colleagues (2008) recently reported that administration of an oral drug called AICAR increases running endurance in unexercised mice.  Not only did the AICAR-treated mice run longer and farther on a treadmill than sham-treated control mice, they also demonstrated reduced epididymal fat mass relative to body weight and increased oxygen consumption during exercise.  Therefore it appears that the drug AICAR can mimic the effects of endurance exercise in mice.

Clinical Decision: Can we look forward to AICAR prescriptions to replace exercise prescriptions for our sedentary patients?  Do not look for it anytime soon.  Long term administration of AICAR results in increased lactic and uric acids in the blood.  Additionally, AICAR can act on several organs of the body, not just skeletal muscle, and these effects are not all desirable.  Therapists will also quickly realize that exercise improves much more than just muscle endurance.  Exercise improves muscle strength, motor learning, and cardiovascular function; all necessary for optimal function and health.  Drugs-like AICAR may be developed in the future to enhance the benefits of exercise, but likely will never be able to replace the multiple benefits of exercise. Therefore, keep optimizing your exercise prescriptions and motivating your patients to be physically active. 

Narkar VA, Downes M, Yu RT, et al. AMPK and PPARdelta agonists are exercise mimetics. Cell 2008;134:405-15.

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June 2009

United Parkinson Disease Rating Scale Validity

Reviewed by Jennifer Sherman, PT,  and the MN APTA Research Committee

Clinical Question: The United Parkinson Disease Rating Scale (UPDRS) is a common tool used by neurologists to assess the severity of Parkinson disease.  Much of the motor portion of the UPDRS examines activity at the impairment level.  Currently, there is a lack of evidence to demonstrate that the UPDRS adequately measures balance, walking, and mobility performance in people with Parkinson disease.  Which functional tests commonly used in PT practice demonstrate concurrent validity with the UPDRS when evaluating motor function in persons with Parkinson disease? 

Evidence: Brusse and colleagues reported the findings of their prospective cohort study testing functional performance in people with Parkinson disease in the February 2005 addition of Physical Therapy.   They tested 23 subjects between the ages of 61 and 86 years with an average Hoehn and Yahr Stage Scale score of 2 indicating early to middle stages of Parkinson disease.  Raters administered the UPDRS, Berg Balance Scale (BBS), Forward Functional Reach (FFR), Backward Functional Reach (BFR), Timed "Up & Go” Test (TUG), and measured gait speed for all of the participants in a single session.  Analysis was then performed to explore concurrent validity of the UPDRS with the BBS, FFR, BFR, TUG, and gait speed using the Spearman rho statistic.  It was found that the motor portion and UPDRS total score had moderate correlation with the BBS, FFR, and TUG data, but not gait speed or BFR.  The BBS was the only test of functional performance that significantly (P<.05) correlated with all other functional tests and the UPDRS.

Clinical Decision: Although the UPDRS is impairment based, it was shown to correlate with other more functional assessment tools. The addition of the Berg Balance Scale to traditional examination of people with Parkinson disease may provide a more comprehensive representation of balance, walking and mobility performance than the UPDRS alone. 

Reference: Brusse KJ, Zimdars S, Zalewski KR, Steffen TM.  Testing function performance in people with Parkinson Disease.  Physical Therapy. 2005;85(2):134-141.

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April 2009

Thoracic Spine Manipulation and Neck Pain

Reviewed by John Schmitt, PT and the MN APTA Research Committee

Clinical Question: Neck pain is one of the more common musculoskeletal conditions in outpatient physical therapy practice.  Recent authors have suggested that grade V thrust manipulation of the adjacent thoracic spine may be a safe and effective way to treat patients with neck pain.  Is there evidence to support the use of thoracic spine manipulation in reducing pain and disability for patients with neck pain?

Evidence: In the January 2009 Journal of Orthopaedic and Sports Physical Therapy, Gonzalez-Iglesias and colleagues reported the results of a randomized controlled trial on the effectiveness of a standardized thoracic spine manipulation approach.   Forty-five patients with mechanical neck pain less than 1 month in duration were randomized to either thoracic manipulation group or a control group.  Both groups received superficial heat with TENS application adjacent to the C7 spinous process for 5 visits over a 3 week period.  In addition, at one session per week the manipulation group received a standardized seated thoracic spine distraction manipulation.  If no audible "pop” were heard, the manipulation was repeated one additional time.  Outcome measures included cervical ROM, a pain visual analog scale (VAS), and the Northwick Neck Pain Questionnaire (NPQ) disability measure, taken at the final PT visit and at 2 week follow-up.  Results showed statistically significant between group differences in ROM, pain, and disability at the end of treatment that persisted at 2 weeks.  Effect sizes exceeded 2.0, indicating a large, clinically significant treatment effect.

Clinical Decision: The addition of thoracic spine distraction manipulation once per week to a twice weekly superficial heat and TENS regimen was significantly more effective then heat/TENS alone in increasing ROM and decreasing subacute neck pain and self-reported disability.  This study adds to a growing body of literature supporting the use of thoracic spine manipulation for patients with neck pain.

Reference: Gonzalez-Iglesias J, Fernández-de-las-Peñas C, Cleland JA, Gutiérrez-Vega Mdel R.  Thoracic spine manipulation for the management of patients with neck pain:  A randomized clinical trial.  Journal of Orthopaedic and Sports Physical Therapy. 2009;39(1):20-27.

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February 2009

Low Back Pain Exercises

Reviewed by Jason Lunden, PT (APTA Member Since 2003) and the MN APTA Research Committee

Clinical Question:  Which exercises for low back pain are most effective in activating the transversus abdominis (TrA) and internal oblique muscles (IO)?

Evidence:  Using ultrasound imaging, Teyhen et al investigated the response of the TrA and IO during 6 commonly prescribed exercises for low back pain.  One hundred and twenty-nine healthy subjects ages 18-50 performed the following 6 exercises: the abdominal drawing-in maneuver, abdominal crunch, abdominal sit-back, side plank, supine lower extremity extender, and the quadruped opposite arm and leg lift.  Muscle thickness for the TrA and IO was obtained with ultrasound imaging at rest and during the exhalation phase of each exercise.   The results of the study indicate that the side plank elicited a greater change in muscle thickness for the TrA (p < .05) and IO (p £ .001) than the other exercises.  In addition, the abdominal crunch exercise demonstrated a greater change in IO muscle thickness (p£ .001) than all of the other exercise, except the side plank.  Moreover, the results indicate that the abdominal drawing-in maneuver and quadruped opposite arm and leg lift seem to preferentially activate the TrA.  The results of this study should be interpreted with caution as only healthy subjects were involved in the study and the relationship between changes in muscle thickness and muscle activation patterns have not been fully elucidated.

Clinical Decision:  When selecting an exercise aimed at activating both the TrA and IO, the side plank exercise has been shown to produce the greatest change in muscle thickness, and theoretically muscle activation.

Reference:  Teyhen DS, Rieger JL, Westrick RB, Miller AC, Molloy JM, Childs JD. Changes in deep abdominal muscle thickness during common trunk-strengthening exercise using ultrasound imaging. J Orthop Sports Phys Ther. 2008; 38(10): 596-605.

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December 2008

Gastric Bypass Surgery

Reviewed by Deidre Lindstrom, PT (APTA Member Since 2004), and the MN APTA Research Committee

Clinical Question: A patient is referred to you for exercise following gastric bypass surgery.  What changes are noted in functional mobility, specifically walking distance, and health-related quality of life in patients following this procedure? 

Evidence: In the prospective study by Tompkins et al, 25 subjects undergoing gastric bypass surgery completed the 36-Item Short Form Health Survey (SF-36) and the 6-minute walk test (6MWT) pre-surgically and at the 3-month and 6-month follow-up visits.  The results following gastric bypass surgery indicated that subjects significantly increased the distance walked during the 6MWT (p<.001) and scores on the Physical Component Summary of the SF-36 (p<.01).  The results also indicated a significant positive correlation (p<.05) between the distance walked on the 6MWT and scores on the SF-36.  Two limitations of this study include a small sample size and the fact that exercise was not monitored.  

Clinical Decision/Practical Implications: This study presents evidence that improvements are noted in health-related quality of life and walking distance following gastric bypass surgery.  At 6 months, walking distances were at 75% of those for age-matched persons who had normal weight.  In patients following gastric bypass surgery, it is important to assess each patient’s current activity level and then develop a patient-specific exercise and walking program.  

Reference: Tompkins J, Bosch PR, Chenowith R, Tiede JL, Swain JM.  Changes in functional walking distance and health-related quality of life after gastric bypass surgery.  Phys Ther.  2008;88 (8):928-935.

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October 2008

Low Back Pain

Reviewed by Jena Ogston, PT (APTA Member Since 1994), and the MN APTA Research Committee

Clinical Question:  What are the effects of a supervised Swiss ball stability exercise program compared to a home based exercise program in persons with chronic low back pain?  Chronic low back pain is one of the leading causes of disability, absenteeism from work, disablement and medical expenses.  Therapeutic exercise is one of the most common physical therapy interventions for chronic back pain, but there is little agreement on the best method of exercise. 

Evidence:  This study involved a follow-up of patients with non-specific chronic low back pain following four weeks of self-selected manipulative or non-manipulative treatment.  After completion of the initial intervention, the 60 subjects were randomized into a supervised Swiss ball stability exercise program, or a general home exercise program.  The authors found that at 16 weeks, the subjects in the Swiss ball program significantly decreased their self-reported functional disability and significantly improved their back extensor EMG activation of the back extensor group compared to the home based program.  These measures continued to improve at nine months following termination of the program.  There were no differences between the manipulative and non-manipulative groups.

Clinical Decision:   A supervised, stability exercise program may be a more rapid and effective means of increasing back extensor activation and reducing functional disability than an unsupervised exercise program. Both methods showed significant improvement from onset of the program and continued improvement following program termination.

Reference: Marshall PW, Murphy BA. Muscle activation changes after exercise rehabilitation for chronic low back pain.  Arch Phys Med Rehabil. 2008, 89(7):1305-13.

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August 2008

Long-Term Effects of Prilosec and Nexium

Reviewed by Nathan Hellyer, PT (APTA Member since 1998), and the MN APTA Research Committee

Clinical Question: A large number of patients take over-the-counter drugs such as Prilosec (omeprazole) and Nexium (esomeprazole) to manage gastric reflux and heartburn.  These drugs are also commonly prescribed by physicians to manage ulcer risk associated with chronic aspirin and ibuprofen use.  What are the long-term side effects of taking these medications?

Evidence: A large nested case-control study by Yang et al. (2006) revealed that proton pump inhibitors, such as Nexium and Prilosec, increased the risk of hip fracture.  Hip fracture risk was significantly increased when patients were prescribed these drugs for greater than one year (adjusted odds ratio, 1.44; 95% CI, 1.30-1.59; p<0.001) and at high doses (adjusted odds ratio, 2.65; 95% CI, 1.80-3.90; p<0.001).  Although mechanisms were not explored in this study, the authors speculate that these medications may increase osteoporosis by causing calcium malabsorption in the gastrointestinal tract.

Clinical Decision: Patients taking proton pump inhibitors such as Nexium and Prilosec should consider taking supplemental calcium and be educated on osteoporosis risk associated with these agents.  Clinicians should incorporate osteoporosis precautions and preventative measures into their plan of care when managing patients taking chronic high doses of proton pump inhibitors.

Reference: Yang, Y-X., Lewis, J.D., Epstein, S., Metz, D.C.  Long-term proton pump inhibitor therapy and risk of hip fracture.  JAMA. 2006;296(24):2947-2953.

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June 2008

Plantar Fasciitis

Clinical Question:  What is the best current evidence to guide the care of patients with plantar fasciitis?

Evidence: In the April 2008 Journal of Orthopaedic and Sports Physical Therapy, McPoil and colleagues summarize the literature relating to patients with plantar fasciitis.  These clinical practice guidelines are intended to reflect the best available evidence for care, with the caveat that the interpretation and application of the evidence may be influenced by any bias on the part of the content experts.  Their findings indicate moderate to strong evidence for short term benefit from the use of iontophoresis with Dexamethasone or acetic acid, calf or plantar fascia specific stretching, and either prefabricated or custom made foot orthotics.  Night splints were recommended for chronic cases of greater than 6 months duration.  The current available evidence was not as supportive of manual therapy or taping.  The authors also offer a summary of evidence for the pathoanatomical findings, risk factors, diagnosis, and outcome measures for this common condition.

Clinical Decision: The clinical guidelines for patients with plantar fasciitis support the use of iontophoresis, stretching, and orthotic devices.  The authors caution that the guidelines do not serve as standards of care, and that each patient must be evaluated and the plan of care must be appropriate to that patient’s findings.

Reference: McPoil T, et al.  (2008). Clinical practice guidelines liked to the International Classification of Function, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association.  Journal of Orthopaedic and Sports Physical Therapy, 38(4), A1-A18.

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April 2008

Increasing Walking Speed After a Stroke

Text: Coming soon!

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February 2008

Ankylosing Spondylitis

Reviewed by Kim Peters, PT, and the MN APTA Research Committee

Clinical Question: What types of exercises are most beneficial for patients with ankylosing spondylitis?

Evidence: A sample of 30 patients with ankylosing spondylitis (mean age 34.9 years) participated in the study.   Subjects had disease duration of nine years + 6.02 years.   Subjects were randomly assigned to either an exercise group or to a control group.  Both groups received medical treatment and were informed about what exercises would be beneficial; however, only the exercise group received supervised exercise training.  The exercise group participated in 50 minutes of multimodal exercises, including aerobics, stretching, and pulmonary exercises, three times a week for three months.  The outcome measurements of chest expansion, chin-to-chest distance, Modified Schober Flexion test, and occiput-to-wall distance were significantly better for subjects in the exercise group than for those in the control group.  Spinal movements, physical work capacity, and vital capacity were also significantly improved for the exercise group at the end of the exercise program.

Clinical Decision: This research study demonstrated that patients with ankylosing spondylitis may benefit from a multimodal exercise program that includes aerobics, stretching, and pulmonary exercises.

Reference: Ince G, Sarpel T, Durgun B, Erdogan S.  Effects of a Multimodal Exercise Program for People With Ankylosing Spondylitis.  Phys Ther. 2006;86:924-935.

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December 2007

Overweight Children and High-Intensity, Structured Exercise Programs

Reviewed by Katherine Ites, PT, and the MN APTA Research Committee

Clinical Question: Can overweight children gain lasting benefits from a high-intensity, structured exercise program?

Evidence: Childhood obesity, type 2 diabetes, hyperlipidemia, and hypertension are increasing at a significant rate.  Many overweight children become overweight adults, increasing their risk for diabetes, heart disease, and stroke. Physical therapists are in a unique position to promote overall wellness in this population by encouraging physical activity. Low to moderate intensity aerobic exercise has traditionally been used for weight loss programs.   Two recent studies examined the effects of a biweekly high intensity exercise program lasting 3-6 months.   These studies reported significant reductions in BMI and total cholesterol, and increased leisure time physical activity in groups of overweight children participating in structured high intensity exercise programs.  In both studies, the positive results were maintained at a 1-year follow-up as the participants continued with physical activity independently.

Clinical Decision: Supervised exercise is an important component of a multidisciplinary approach to minimize the impact of childhood obesity.  Physical therapists can play a central role by developing structured exercise programs and teaching children how to exercise in order to maintain a healthy lifestyle.

References:  Nemet D, Barkan S, Epstein Y, Friedland O, Kowen G, Eliakim O.  Short- and long-term beneficial effects of a combined dietary-behavioral-physical activity intervention for the treatment of childhood obesity. Pediatrics. 2005;115(4):443-449.
Savoye M, Shaw M, Dziura J, et al. Effects of a weight management program on body composition and metabolic parameters in overweight children: A randomized controlled trial. JAMA. 2007;297:2697-2704.

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October 2007

Post-Op Mobility in Coronary Artery Bypass Graft Patients

Reviewed by the MN APTA Research Committee

Clinical Question: You are asked to evaluate a patient who has undergone a coronary artery bypass graft (CABG).  She must follow typical sternal precautions such as no lifting over 10 pounds, no excessive movements at shoulder end range of motion, and no pushing or pulling with the upper extremities.  Is there evidence to guide what upper extremity movements or factors may place her at higher risk for post-operative sternotomy complications?

Evidence: Two recent articles published in Acute Care Perspectives examined the effects of upper extremity movement on sternal skin stress.  In the first study1, measurements of sternal skin tension were taken just superior to the xiphoid process while healthy subjects performed full shoulder flexion, extension, and horizontal abduction range of motion.  The second study2 measured skin distortion inferior to the sternal angle during shoulder flexion, extension, abduction, external rotation at 90o of abduction, external rotation at neutral, and horizontal abduction.  This study also included the anthropometric variables of body mass index (BMI) and breast size.  Measurements were taken during bilateral and unilateral arm movements in both studies.

Results: In both studies, significantly greater skin stress occurred with bilateral than unilateral movements.  Skin stress was also found to be significantly greater with shoulder flexion and abduction than the other movements tested, with flexion creating the most skin distortion.  A significant correlation was found between breast size and sternal stress during movement in the second study.

Clinical Decision: The patient was educated in traditional sternal precautions with emphasis on avoiding excessive shoulder flexion and abduction.  She was taught to utilize unilateral arm movements as able to assist with transfers and bed mobility within the constraints of her precautions.

1: Irion G, Benefield P, Bolton R, et al.  Effects of shoulder range of motion on sternal skin stress.  Acute Care Perspectives. 2005;14(1):13-14.
2: Irion G, Boyer S, McGinnis T, et al.  Effect of upper extremity movement on sternal skin stress.  Acute Care Perspectives.  2006;15(3):1-6.

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August 2007

Eccentric Exercise for Mid-Portion Achilles Tendon Pain

Reviewed by the MN APTA Research Committee

Clinical Question: A patient presents to physical therapy with a painful mid-portion Achilles tendon that has progressively gotten worse over the past 6 months.  What is the evidence for supporting an eccentric exercise program?

Evidence: Conservative management of chronic tendinopathy is typically the first line of treatment where eccentric exercises have been suggested to be a part of these rehabilitation programs.  Shalabi et al investigated the effects of a three-month eccentric exercise program on twenty-five subjects with chronic Achilles tendinopathy.  Each subject was instructed by a physical therapist on how to correctly perform 3 sets of 15 eccentric loading exercises that were to be done twice daily.  Outcome measures taken prior to and after three months included tendon volume and an intratendinous signal of the Achilles tendon as evaluated by MRI.  A questionnaire regarding pain and functional impairment was also administered.  

Results: Three months of eccentric training of the Achilles tendon resulted in a 14% decrease of tendon volume and a 23% decrease in proton density-weighted images as evaluated by MRI.  These changes were significantly different than seen in the asymptomatic contralateral tendon at the three-month follow-up.  A significant decrease in the pain and function questionnaire score was also observed, which was significantly correlated with a decrease in the intratendinous signal. 

Clinical Application: A three-month eccentric exercise program can reduce pain and improve function in persons with chronic Achilles tendinopathy, which is supported by pathological changes as evaluated by MRI.

References: Shalabi A, Kristoffersen-Wilber M, Svensson L, Aspelin P, Movin T.  Eccentric training of the gastrocnemius-soleus complex in chronic Achilles tendinopathy results in decreased tendon volume and intratendinous signal as evaluated by MRI.  Am J Sports Med. 2004;32(5):1286-1296.

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June 2007

Strengthening Cervical Flexor Muscles for Patients with Chronic Neck Pain

Text: Coming soon!

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April 2007

Decreasing Elderly Hospital Time with a Walking Program

Text: Coming soon!

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February 2007

Does Hand Placement During a Push-Up Strengthen Muscle Weakness?

Text: Coming soon!

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August 2006

Dizziness & Acoustic Neuroma Resection

Text: Coming soon!

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June 2006

Acute DVT & Patient Mobility Assessment

Text: Coming soon!

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April 2006

Improving Hand Function with NMES in a Post-Stroke Patient

Text: Coming soon!

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February 2006

Does Hip Weakness Predispose Runners to Lower Extremity Overuse?

Reviewed by the MN APTA Research Committee


Clinical Question: Does hip weakness predispose runners to lower extremity overuse?

Evidence in the Literature: A recent article by Niemuth and colleagues [1] examined strength differences between 30 runners with unilateral lower extremity overuse injuries and a matched control group of 30 healthy runners chosen from a local running club. After controlling for body weight, they found that injured runners were significantly weaker in hip abduction and flexion, and significantly stronger in hip adduction. Although he case-control design does not give conclusive evidence that the hip weakness preceded the overuse injury, it is interesting that the adductors were stronger in the injured group. This suggests that hip weakness or muscle imbalance could be risk factors for the development of overuse injuries.

Clinical Implications: Hip weakness and/or muscle imbalances may predispose athletes to lower extremity overuse. Physical therapists may want to include hip muscle strength testing in the evaluation of patients with these injuries. Future research is warranted to examine the effectiveness of hip strengthening exercises to treat and reduce the risk of overuse.

Reference: Niemuth PE, Johnson JJ, Myers MJ, Thieman TJ. Hip muscle weakness and overuse injuries in recreational runners. Clin J Sports Med. 2005;15(1):14-21.

Paul Niemuth, PT, DSc, OCS, SCS, ATC, is an Associate Professor at the College of St. Catherine DPT Program.

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