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Context: Exercising intrinsic foot muscles (IFMs) can improve dynamic balance and foot posture. The exercises are not intuitive and electrotherapy (neuromuscular electrical stimulation [NMES]) has been suggested to help individuals execute the exercises. The aim of this study was to evaluate the effects of training IFM program on dynamic balance and foot posture and compare traditional training methods (TRAIN) with traditional training plus NMES on the perceived workload of the exercises, balance, and foot posture. Design: Randomized controlled trial. Methods: Thirty-nine participants were randomized to control, TRAIN, or NMES. TRAIN and NMES performed IFM exercises daily for 4 weeks; NMES received electrotherapy during the first 2 weeks of training. The Y-Balance test and arch height index were measured in all participants at baseline. The training groups were measured again at 2 weeks; all participants were measured at 4 weeks and 8 weeks, after 4 weeks of no training. Perceived workload (National Aeronautics and Space Administration Task Load Index) of exercises was assessed throughout the first 2 weeks and at 4 weeks. Results: A 4-week IFM training program demonstrated increases in Y-Balance (P = .01) for TRAIN and in arch height index (seated P = .03; standing P = .02) for NMES, relative to baseline. NMES demonstrated improvement in Y-Balance (P = .02) and arch height index standing (P = .01) at 2 weeks. There were no significant differences between the training groups. Groups were similar in the number responding to exercises in excess of minimal detectable change on all clinical measures. Perceived workload of the exercises decreased during the first 2 weeks of training (P = .02), and more notably at 4 weeks (P Conclusions: A 4-week IFM training program improved dynamic balance and foot posture. Adding NMES in early phases of training provided early improvement in dynamic balance and foot posture, but did not affect perceived workload.

Patients and clinicians have expressed frustration when learning or teaching intrinsic foot muscle exercises. However, there is limited information on how patients perceive the workload of an exercise. This study evaluates participants’ perceptions of workload while learning intrinsic foot muscle exercises with or without neuromuscular electrical stimulation. Twenty-six individuals completed a 4-week supervised intrinsic foot muscle training program. Thirteen participants utilized neuromuscular electrical stimulation during the initial 2 weeks of training. Participant perceptions of workload, measured by the National Aeronautics and Space Administration Task Load Index, revealed decreasing load over 2 weeks and minimal load at 4 weeks. Inclusion of neuromuscular electrical stimulation did not affect perception of load of skill acquisition.

Performance enhancement is a multibillion dollar industry, with little known about the efficacy or safety of many practices. Many sport governing bodies have banned certain equipment, supplements, and drugs, yet, some athletes use anyway. This use may pose a danger to the individual user, as well as to other participants, and can challenge the integrity of the sport. We must consider how we, as health care professionals, balance personal autonomy, individual safety, and the integrity of sport in fulfilling our social contract.

The omega-3 fatty acid docosahexaenoic acid (DHA) has anti-inflammatory and anti-nociceptive (pain inhibiting) effects. Because strenuous exercise often results in local inflammation and pain, we hypothesized that DHA supplementation attenuates the rise in markers of local muscle inflammation and delayed onset muscle soreness (DOMS) that occur after eccentric strength exercise. Twenty-seven, healthy women (33 ± 2 y, BMI 23.1±1.0 kg·m-2) were randomized to receive 9d of 3000 mg/d DHA or placebo in a double-blind fashion. On day 7 of the supplementation period, the participants performed 4 sets of maximal-effort eccentric biceps curl exercise. Before and 48h after the eccentric exercise, markers of inflammation were measured including measures of muscle soreness (10-point visual analog pain scale, VAS), swelling (arm circumference), muscle stiffness (active and passive elbow extension), skin temperature, and salivary C-reactive protein (CRP) concentrations. As expected, muscle soreness and arm circumference increased while active and passive elbow extension decreased. The increase in soreness was 23% less in the DHA group (48h increase in VAS soreness ratings: 4.380.4 vs. 5.600.5, p=0.02). Furthermore, the number of subjects who were able to achieve full active elbow extension 48h after eccentric exercise was greater in the DHA group (71% vs. 15%, p = 0.006), indicating significantly less muscle stiffness. No between-group differences were observed for passive elbow extension (p = 0.78) or arm swelling (p = 0.75). Skin temperature and salivary CRP concentrations did not change from baseline to 48h after exercise in either group. These findings indicate that short-term DHA supplementation reduces exercise-induced muscle soreness and stiffness. Therefore, in addition to other health benefits that n-3 fatty acids have been associated with, DHA supplementation could be beneficial for improving tolerance to new and/or strenuous exercise programs and thereby might facilitate better training adaptations and exercise adherence.

Context:Exercise-related medial leg pain (ERMLP) is a common complaint among athletes, and efforts toward rehabilitation are often unsuccessful.Objective:To evaluate the efficacy of a therapeutic intervention in ERMLP localized to soft tissue.Design:A quasi-experimental, nonequivalent control-group study.Setting:Athletic training facility.Patients:20 volunteer male and female athletes (18–22 y old) with ERMLP. Complete data were available for 13 participants.Intervention:Treatment group (TRE, n = 7) received therapeutic intervention focused on relieving muscle hypertonicity in the deep compartment of the lower leg and restoring balance of the toe flexors and extensors. Control group (CON, n = 6) received no intervention.Main Outcome Measures:Self-reported pain intensity, pain threshold, and extensor hallucis longus to extensor digitorum brevis (EHL:EDB) electromyography ratio.Results:There were no significant differences in age, duration of symptoms, or pain measures between the 2 groups at baseline. CON demonstrated no significant changes in any of the outcome measures in posttreatment testing, but significant between-groups differences were identified for pain during activity (CON mean = 6.5, 95% CI 5.05, 7.95; TRE mean = 3.5, 95% CI 1.67, 5.33; P = .01), change scores for pain during activity (CON mean = 0.33, 95% CI −1.25, 1.91; TRE mean = −3.43, 95% CI:−4.6, −2.25; P < .001), change scores in pressure threshold (CON mean = −0.25, 95% CI −0.74, 0.23; TRE mean = 0.72, 95% CI 0.22, 1.37; P = .006), and change in EHL:EDB ratios (CON mean = 0.05, 95% CI −0.22, 0.33; TRE mean = 1.07, 95% CI 0.75, 2.07; P < .046).Conclusion:Therapeutic interventions focused on restoring muscle balance appear to be effective in resolving ERMLP.

Background and Purpose. Most physical therapists recognize that spirituality and religion can influence health and patient outcomes, providing hope and tools for coping with pain, chronic illness, and aging. However, they are hesitant to include religion and spirituality in physical therapy patient care. Barriers to exploring spiritual issues with patients include lack of time, lack of training in addressing spiritual issues, and discomfort with the spiritual domain. The purpose of this study was to explore physical therapist students' perceptions of spirituality and religion relative to patient care and to identify their comfort level in addressing these issues with patients. Subjects. Students (n = 186) from a physical therapist education program in the Midwest United States. Methods. A survey was distributed to 3 cohorts of physical therapist students. Data analysis included descriptive statistics (demographics) and frequencies (survey item reporting). Comparisons between groups were analyzed through analysis of variance (ANOVA) and point-biserial correlation. Results. With 92% responding, participants agreed that spirituality and religion could provide a patient with hope (> 95%), and could help patients cope with injury, illness, and pain (> 80%). There was less agreement in regard to the roles of spirituality (86.5%) and religion (52.7%) in overall health. Knowledge of patient's spiritual or religious needs was identified as having positive effects on patient-therapist relationship (> 85%). Self-reported religious/ spiritual orientation demonstrated a weak, but significant, correlation with comfort in addressing spiritual needs of patients. The older student cohort expressed more comfort than the youngest cohort in talking with patients about hope and accepting differing beliefs. Discussion and Conclusion. Students perceived religion as having less influence than spirituality on health, helping a patient cope with injury, illness and pain, and potentially strengthening the patient-therapist relationship. They agreed that both spirituality and religion can provide a patient with hope. The percentage of students who were unsure of their comfort level in some aspects of spiritual care suggested that they may not have the knowledge to apply these beliefs to patient care at this time. Students in the older cohort reported increased comfort in talking with patients about hope and in accepting beliefs different from their own compared to the youngest cohort. The results of this study seem to indicate that students may require formal training in recognizing and addressing the spiritual needs of patients and clients. Key Words: Spirituality, Religion, Physical therapist students, Spiritual domain, Patients. BACKGROUND AND PURPOSE Spirituality and religious beliefs can influence overall health and patient outcomes.1-5 The mechanisms by which spirituality and religion influence patient outcomes are not clear, though it appears that spirituality and religion- as components of the spiritual domain-are useful tools for patients/clients attempting to cope with pain, chronic illness, and aging.4,6-16 Physical therapy patients experience a range of health challenges including temporary, chronic, and permanent states of pain and disability. These challenges may relate to the ability to participate in desired work and leisure activities, perform activities of daily living, or continued independent living. Physical therapists seeking the best outcome for individual patients use a variety of approaches and select the tools most appropriate for each case, which may include addressing spirituality and religion with a patient as a component of cultural competence. The importance of incorporating spirituality in patient care has been recognized by the Joint Commission on the Accreditation of Healthcare Organizations17 and the value of incorporating a patient's customs and beliefs as part of a physical therapy patient care is addressed in the (Atide to Physical Therapy Practice18 and the Blueprint for Teaching Cultural Competence in Physical Therapy Education. …

The omega-3 fatty acid docosahexaenoic acid (DHA) has anti-inflammatory and anti-nociceptive (pain inhibiting) effects. Because strenuous exercise often results in local inflammation and pain, we hypothesized that DHA supplementation attenuates the rise in markers of local muscle inflammation and delayed onset muscle soreness (DOMS) that occur after eccentric strength exercise. Twenty-seven, healthy women (33 ± 2 y, BMI 23.1±1.0 kg·m(-2)) were randomized to receive 9d of 3000 mg/d DHA or placebo in a double-blind fashion. On day 7 of the supplementation period, the participants performed 4 sets of maximal-effort eccentric biceps curl exercise. Before and 48h after the eccentric exercise, markers of inflammation were measured including measures of muscle soreness (10-point visual analog pain scale, VAS), swelling (arm circumference), muscle stiffness (active and passive elbow extension), skin temperature, and salivary C-reactive protein (CRP) concentrations. As expected, muscle soreness and arm circumference increased while active and passive elbow extension decreased. The increase in soreness was 23% less in the DHA group (48h increase in VAS soreness ratings: 4.380.4 vs. 5.600.5, p=0.02). Furthermore, the number of subjects who were able to achieve full active elbow extension 48h after eccentric exercise was greater in the DHA group (71% vs. 15%, p = 0.006), indicating significantly less muscle stiffness. No between-group differences were observed for passive elbow extension (p = 0.78) or arm swelling (p = 0.75). Skin temperature and salivary CRP concentrations did not change from baseline to 48h after exercise in either group. These findings indicate that short-term DHA supplementation reduces exercise-induced muscle soreness and stiffness. Therefore, in addition to other health benefits that n-3 fatty acids have been associated with, DHA supplementation could be beneficial for improving tolerance to new and/or strenuous exercise programs and thereby might facilitate better training adaptations and exercise adherence. Key pointsSeven days of 3000 mg/day supplementation with algae-derived docosahexaenoic acid (DHA) attenuates the delayed onset muscle soreness and stiffness, and protects against the loss of joint range of motion that is caused by strenuous eccentric exercise.This benefit was observed in women, and supports the findings from other studies that were conducted on men or a combination of men and womenThe benefits from algae-derived DHA appear to be similar to those reported in other studies that used a combination of DHA and eicosapentaenoic acid (EPA) derived from fish oilThe findings of better recovery from strenuous exercise with DHA supplementation, paired with other research which demonstrated that DHA and EPA protect against chronic diseases suggest that DHA is an attractive optionThese findings have relevance to athletic populations, in that DHA would be expected to facilitate recovery and allow for better performance during training and competition. However, DHA supplementation might also benefit non-athletic populations, such as individuals starting new exercise programs and patient populations that are prone to muscle soreness (e.g. physical therapy patients).

Purpose: Shortness of breath or difficulty breathing during exercise is referred to as exercise-induced dyspnea (EID), and is a common complaint from athletes. The purpose of this study was to assess the prevalence of EID among college aged athletes and to explore the medical encounters, including diagnostic testing, arising from this complaint. Method: We surveyed intercollegiate (n=122) and club sport (n=103) athletes regarding their experience with EID, including medical diagnoses, diagnostic procedures, environmental factors, and treatment effectiveness. Results: Fifty-two percent of respondents (n=112) reported episodes of EID. Intercollegiate and club sport athletes did not differ in regard to the prevalence of EID, utilization of health provider services, or diagnoses. Sixty-six percent of respondents with EID reported a physician visit secondary to EID with resulting diagnoses of asthma, EIB, allergies, stress reaction, and vocal cord dysfunction, or a combination of two or more of these conditions. Less than 30% of those diagnosed with asthma and/or EIB reported a diagnosis based on a pulmonary function test. Conclusions and Recommendations: EID is a common, yet complex, condition that appears to be as prevalent in club sports as it is in intercollegiate athletics. Asthma and exercise-induced bronchospasm (EIB) are the most familiar diagnoses associated with EID, though many conditions present with similar symptoms. Objective diagnostic testing was not commonly reported among college-aged athletes with asthma or EIB in this study. This finding conflicts with recent evidence-based recommendations for objective testing for athletes with EID to ensure appropriate and effective treatment plans.

Popliteal cysts are typically secondary to an intra-articular pathology in adults but may occur as primary lesions unrelated to knee injury. Careful examination of any mass forming on the posterior aspect of the knee is needed to differentiate benign from malignant conditions. Asymptomatic cysts are often treated conservatively, whereas surgical intervention is recommended for troublesome cysts and for those related to intra-articular derangements. Surgical intervention focused on amelioration of intra-articular derangements and the communication between the knee and the popliteal cyst results in cyst recurrence of less than 5%. A report of a recurrent popliteal cyst, in spite of aggressive surgical intervention, is presented.

Health care education programs, regardless of the discipline, will face similar challenges and issues related to students with disabilities. These are likely to include issues related to admission, retention, and academic adjustments, auxiliary aids, and services. A review of the literature reveals limited information beyond medical and nursing education programs, although students with disabilities are enrolled in education programs in other health care disciplines. Recent research indicates that students with disabilities are enrolling in health care education programs with increasing frequency. Educators and administrators will benefit from a better understanding of disability law and how it impacts education programs. Further, this knowledge should allow health care educators to be more proactive in regard to students with disabilities and to maintain a greater degree of autonomy over their respective programs. This report reviews pertinent legislation and case law as it applies to students with disabilities in health care education.

After presenting with chronic low back pain, a male track athlete was diagnosed with bilateral lysis at L5, slight listhesis at L5 on S1; asymmetrical lysis at L4; and right L5/S1 disc bulge with minimal S1 nerve root contact. Conservative treatment was chosen. After participating in a bone density pilot study using dual-energy X-ray absorptiometry (DEXA) investigating alcohol consumption patterns in intercollegiate athletes, he was diagnosed with osteopenia and osteoporosis in his lumbar spine. Therapeutic drug intervention and rehabilitation were initiated.Athletes with normal physiologic functions can have idiopathic osteoporosis, which may or may not be related to alcohol consumption. Although the relationship among chronic alcoholism (South-Paul, 2001), weight-bearing exercise (Kalsson, 2001), and bone density have been established, the relationship among binge drinking, intercollegiate athletic participation, and bone density has not. Despite suspected normal presentation, nonresponsive low back pain should be investigated thoroughly for advanced bone conditions.

OBJECTIVE: To describe a treatment strategy for paradoxical vocal-cord dysfunction (PVCD) as it applies to an athletic population. BACKGROUND: Paradoxical vocal-cord dysfunction has been identified as a cause of dyspnea and stridor in athletes. The basic element of PVCD is an inappropriate closure of the vocal cords during respiration, resulting in airway obstruction. This condition is familiar to speech-language pathologists and otolaryngologists yet remains poorly understood in the sports medicine community. Treatment strategies are even less understood. A therapeutic exercise program designed to promote diaphragmatic breathing may allow an athlete to gain control during episodes of dyspnea. Elimination of contributing or concomitant conditions is critical to resolution of the condition. DESCRIPTION: The treatment of PVCD requires an understanding of the pathoanatomy of the condition. The focus of the exercise program is on relaxation of the larynx and conscious activation of the diaphragm and abdominal muscles during respiration. The athlete must have a sense of laryngeal control while performing the exercises. In addition, the patient and practitioner must realize the amount of neuromuscular reeducation required to change breathing patterns. CLINICAL ADVANTAGES: This therapy may allow the athlete to gain control over episodic dyspnea, participate in athletic activities with fewer complications, and, perhaps, reduce or eliminate medications prescribed to treat suspected bronchospasm.

Heat-related deaths are among the most preventable injuries in athletics. We sought to examine two methods of monitoring body temperature during exercise as a means of preventing heat-related illnesses.Ten adult subjects exercised in hot, humid conditions while body temperature was monitored by rectal (Tre) and tympanic (Tty) thermometry.Our results indicate that increase in Tty was significantly greater than increase in Tre during exercise. However, rectal temperatures continued to increase after exercise cessation and peak temperatures were not significantly different. Temperature readings of the two devices during exercise had a strong correlation. There was a poor correlation between the two methods of measurement in the recovery phase.Tympanic thermometry is reliable for monitoring changes in body temperature during exercise. This could be valuable for monitoring individuals during long exercise in an effort to prevent heat exhaustion or heat stoke.

The purpose of this study was to develop further normative data for an isokinetic profile for intercollegiate baseball pitchers at 180, 300, and 450 degrees.s-1. Information on isokinetic performance at 450 degrees.s-1 was not found in previously published literature.Sixteen intercollegiate baseball pitchers volunteered for isokinetic strength testing of internal and external rotators of the shoulder. The testing was conducted at 180, 300, and 450 degrees.s-1; with the pitchers in a position of function (90 degrees/90 degrees).The subjects were able to reach maximal velocity for each of the speeds tested, including 450 degrees.s-1. These pitchers demonstrated no significant difference between dominant and nondominant arms for peak torque, torque/body weight, work/body weight, or average power (P0.05). Torque produced at 0.2 s was significantly greater in the dominant arm compared with the nondominant arm at 450 degrees.s-1 only. Internal rotation values were significantly greater than external rotation values for all areas of comparison. External rotation/internal rotation ratios remained consistent for each speed tested (approximately 0.65).There is minimal difference in strength values between dominant and nondominant arms of intercollegiate baseball pitchers, with the exception of significantly greater internal rotation peak torque at 0.2 s at 450 degrees.s-1 in the dominant arm. Dominant arm, as well as nondominant arm, ER/IR ratios remain consistent throughout the velocity spectrum. A valid test speed for intercollegiate baseball pitchers appears to be 450 degrees.s-1 when tested before the start of throwing from the pitcher's mound.