Search

Background Variations in vertical loading rates have been associated with overuse injuries of the lower extremity; however, they are typically collected using 3-dimensional motion capture systems and in-ground force plates not available to most clinicians because of cost and space constraints. Purpose The purpose of this study was to determine if kinetic measures commonly used to describe lower extremity loading characteristics could be estimated from step rate and specific sagittal plane kinematic variables captured using 2-dimensional motion analysis during treadmill running. Study design Observational Study. Methods Ten high school cross-country runners (4 men and 6 women) voluntarily consented to participate in this study. Reflective markers were placed on each lower extremity over multiple anatomical landmarks. Participants were then asked to run on the instrumented treadmill at their preferred running speed. When the participants indicated they were in their typical running pattern, they continued to run at their preferred speed for a minimum of five minutes. After three minutes of running at their preferred running speed, the participant's step rate was counted and after running for four minutes, video and ground reaction force data were recorded for 60 sec. All running motion data were recorded using a single high-speed camera at 240 frames per second and ground reaction force data were sampled at 1000 Hz. Results Mean kinematic values between the left and right extremities for all 10 participants were not significantly different. Consequently, data for the left and right extremities were grouped for all further analyses. The stepwise forward regression to predict vertical ground reaction force resulted in a five-variable model (step rate and four kinematic variables) with R2 = 0.56. The stepwise forward regression to predict average loading rate also resulted in a five kinematic variable model with R2 = 0.51. Conclusions Step rate and sagittal plane kinematic variables measured using a simplified 2-dimensional motion analysis approach with a single high-speed camera can provide the clinician with a reasonable estimate of ground reaction force kinetics during treadmill running. Level of evidence 4, Controlled laboratory study.

Background While previous research has assessed running kinematics for age-related differences that could increase the risk of a running-related injury, none of these studies have included high school aged runners or assessed running kinematics using 2-dimensional video analysis. Purpose The purpose of this study was to compare sagittal plane kinematics during treadmill running in high school cross-country and young adult recreational runners using 2-dimensional motion analysis techniques. Methods Twenty-five high school cross-country runners (13 women, 12 men) and 25 young adult recreational runners (12 women, 13 men) consented to participate in this study. Reflective markers were placed on each lower extremity over multiple anatomical landmarks. After a five-minute acclimation period in which the participants ran on a treadmill at their preferred running speed, video data were recorded at 240 frames per second for all participants while they continued to run on the treadmill. Results There were no significant differences between left and right extremities. The young adult recreational runners exhibited significantly greater vertical excursion of the center of mass (t = 4.64, p = .0001) compared to the high school runners. There was no significant difference between the two age groups regarding the six other sagittal plane variables. Conclusions The young adult recreational runners demonstrated an increased center-of-mass vertical excursion in comparison to high school cross-country runners. In addition, the results obtained in this study for kinematic variables using 2-dimensional motion analysis were similar to previously reported studies using 3-dimensional motion analysis, demonstrating that 2-dimensional motion analysis could be used for analyzing sagittal plane running kinematics in clinical settings. Level of Evidence 4, Controlled laboratory study, This study looks at comparing sagittal plane kinematics during treadmill running in high school cross-country and young adult recreational runners using 2-D video analysis.

Context:Medial tibial stress syndrome (MTSS) is a common condition in active individuals and presents as diffuse pain along the posteromedial border of the tibia.Objective:To use cross-sectional, case-control, and cohort studies to identify significant MTSS risk factors.Data Sources:Bibliographic databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE, EBM Reviews, PEDRo), grey literature, electronic search of full text of journals, manual review of reference lists, and automatically executed PubMed MTSS searches were utilized. All searches were conducted between 2011 and 2015.Study Selection:Inclusion criteria were determined a priori and included original research with participants’ pain diffuse, located in the posterior medial tibial region, and activity related.Study Design:Systematic review with meta-analysis.Level of evidence:Level 4.Data Extraction:Titles and abstracts were reviewed to eliminate citations that did not meet the criteria for inclusion. Study characteristics identified a priori were extracted for data analysis. Statistical heterogeneity was examined using the I2index and Cochran Q test, and a random-effects model was used to calculate the meta-analysis when 2 or more studies examined a risk factor. Two authors independently assessed study quality.Results:Eighty-three articles met the inclusion criteria, and 22 articles included risk factor data. Of the 27 risk factors that were in 2 or more studies, 5 risk factors showed a significant pooled effect and low statistical heterogeneity, including female sex (odds ratio [OR], 2.35; CI, 1.58-3.50), increased weight (standardized mean difference [SMD], 0.24; CI, 0.03-0.45), higher navicular drop (SMD, 0.44; CI, 0.21-0.67), previous running injury (OR, 2.18; CI, 1.00-4.72), and greater hip external rotation with the hip in flexion (SMD, 0.44; CI, 0.23-0.65). The remaining risk factors had a nonsignificant pooled effect or significant pooled effect with high statistical heterogeneity.Conclusion:Female sex, increased weight, higher navicular drop, previous running injury, and greater hip external rotation with the hip in flexion are risk factors for the development of MTSS.

Background While two-dimensional (2D) video running analysis is commonly performed in the clinical setting, the reliability of quantitative measurements as well as effect of clinical experience has not been studied. Purpose The purpose of this study was to assess the intra-rater and inter-rater reliability of six different raters using 2D video analysis of sagittal and frontal plane kinematic variables while running on a treadmill. Study design Cross-sectional Study. Methods Running videos from 10 individuals (five female, five male) with a mean age of 22.8 years were selected for analysis. Two raters had over 10 years of experience with running video analysis and the other four raters had no prior experience. Before beginning analyses, the senior investigator conducted two hours of training with all raters to review the measurement procedures and the movement analysis software program. After completing training and one practice analysis, each rater assessed four 60-second video clips for the 10 runners twice (20 total). A minimum of one week separated the two assessments on each runner. The order of the runner analyses were randomly assigned and each rater completed a single analysis within 24 hours. After the rater had completed their initial assessment on all 10 runners, a second analysis was completed one week later with a different order of randomization. Eight sagittal plane (SAG) and four frontal plane (FRT) quantitative variables were measured for the left and right lower extremities on all 10 runners. Intra- and inter-rater reliability was assessed using intraclass correlation coefficients (ICC) and standard error of the measurement (SEM). Results The intra-rater ICC values for experienced raters ranged from 0.75 to 0.98 for the SAG and 0.45 to 0.96 for FRT variables. The inter-rater ICC values between the experienced raters ranged from 0.76 to 0.99 for the SAG and 0.82 to 0.98 for FRT variables. The intra-rater ICC values for inexperienced raters ranged from 0.54 to 0.99 for the SAG and 0.08 to 0.97 for FRT variables. The inter-rater ICC values between the inexperienced raters ranged from 0.93 to 0.99 for the SAG and 0.79 to 0.98 for FRT variables. Intra-rater SEM values based on average means of all raters ranged from 1 to 47% of the mean values obtained for the SAG and from 6 to 158% for the FRT variables. Conclusions The intra-rater and inter-rater reliability levels were higher for SAG quantitative variables assessed in this study in comparison to FRT variables. Experience does not appear to be a factor when consistency is required with repeated analyses on the same runner. Level of evidence 4, Controlled laboratory study.

Overuse related tendon pain is a significant problem in sport and can interfere with and, in some instances, end an athletic career. This article includes a consideration of the biology of tendon pain including a review of tendon anatomy and histopathology, risk factors for tendon pain, semantics of tendon pathology, and the pathogenesis of tendon pain. Evidence is presented to guide the physical therapist in clinical decision-making regarding the examination of and intervention strategies for athletes with tendon pain.

PET is a molecular imaging modality used to assess metabolic activity. Little is known about the physiologic uptake of radiopharmaceuticals such as 18F-FDG in healthy subjects. This study was designed to identify and describe normal patterns of physiologic uptake of 18F-FDG in healthy adult subjects and to examine the influence of low-level muscle activity during the 18F-FDG uptake phase. Methods: Twenty healthy adults received an intravenous injection of 18F-FDG and were subsequently scanned with a combined PET/CT scanner. The CT scan was used to accurately identify the location of 18F-FDG uptake. Of the 20 subjects, 10 were randomly selected to perform a low-level muscle activity during the 1-h 18F-FDG uptake phase. The PET/CT images were fused, and the location and intensity of metabolic activity were described for all subjects. Results: Muscle activity during the 18F-FDG uptake phase affected the pattern of 18F-FDG distribution on PET scans. In addition, the tissue uptake of 18F-FDG, although variable, showed some consistency among tissue types. Conclusion: The data suggested that technologists should be aware of low-level muscle activity before and during uptake to avoid potential false-positive interpretations. The data also showed that there is some variability in the normal physiologic uptake of 18F-FDG across subjects. Finally, the results suggested that 18F-FDG uptake may be used for the evaluation of muscle activity.

Prospective cohort design.To determine in a sample of collegiate cross-country athletes (1) the percentage of athletes with history of exercise-related leg pain (ERLP) associated with running, (2) the incidence of ERLP during 1 season, (3) if factors including years of collegiate running, training distance, and gender are associated with ERLP, and (4) if there is a relationship between foot type and ERLP.ERLP is a common overuse pain syndrome, but little evidence exists regarding the prevalence, incidence, and risk factors.Eighty-eight collegiate cross-country athletes (44 male, 44 female) from 5 Midwest universities consented to participate, Prior to the season, athletes completed a questionnaire and 3 measures of foot type were performed: navicular drop, medial longitudinal arch angle, and visual assessment of foot type. Athletes completed a postseason questionnaire regarding the season incidence of ERLP Statistical analyses of differences (t test, proportion test) and relationships (chi-square, relative risk) were conducted.Prior to the season, 60 of the 88 athletes (68%) reported a history of ERLP with bilateral medial leg pain the most common ERLP presentation. Over 50% of the athletes with a history of ERLP reported that the pain had interfered with cross-country participation. Of the 67 postseason respondents, 38.8% reported ERLP incidence during the season. Most athletes (80.8%) who reported season incidence of ERLP had a previous history of ERLP There were no differences between athletes with and without a history of ERLP or season incidence of ERLP regarding years of collegiate running, training distance, gender, and foot measures.ERLP history and season incidence was common among these cross-country athletes. The only risk factor identified for season incidence of ERLP was a history of ERLP.

Background Exercise-related leg pain is a common complaint among athletes, but there is little evidence regarding risk factors for this condition in female collegiate athletes. Purpose To examine prospectively the effect of selected extrinsic and intrinsic factors on the development of exercise-related leg pain in female collegiate athletes. Study Design Cohort study; Level of evidence, 2. Methods Subjects were 76 female collegiate athletes participating in fall season sports, including cross-country running, field hockey, soccer, and volleyball. Athletes were seen for a preseason examination that included measures of height, weight, foot pronation, and calf muscle length as well as a questionnaire for disordered eating behaviors. Body mass index was calculated from height and weight (kg/m2). Those athletes who developed exercise-related leg pain during the season were seen for followup. All athletes who developed the condition and a matched group without such leg pain underwent bone mineral density and body composition testing. Statistical analyses of differences and relationships were conducted. Results Of the 76 athletes, 58 (76%) reported a history of exercise-related leg pain, and 20 (26%) reported occurrence of exercise-related leg pain during the season. A history of this condition was strongly associated with its occurrence during the season (odds ratio, 13.2). Exercise-related leg pain was most common among field hockey and cross-country athletes and least common among soccer players. There were no differences between athletes with and without such leg pain regarding age, muscle length, self-reported eating behaviors, body mass index, menstrual function, or bone mineral density. Athletes with exerciserelated leg pain had significantly (P < .05) greater navicular drop compared with those without. Conclusion Exercise-related leg pain was common among this group of female athletes. The results suggest that there are certain factors, including foot pronation, sport, and a history of this condition, that are associated with an increased risk of exerciserelated leg pain.

This study (1) examined the occurrence of exercise-related leg pain (ERLP) in collegiate cross-country athletes and (2) compared structural factors in runners with and without ERLP history.Cross-sectional design comparing 2 groups of cross-country athletes (with and without ERLP history).Intercollegiate athletics.A total of 63 athletes (30 males, 33 females) representing 2 cross-country teams consented to participate.Athlete examination included self-report of ERLP history, active ankle dorsiflexion with knee extended and flexed, navicular drop (ND), and 1st ray length. ND index was calculated by dividing ND by 1st ray length. Athletes on 1 team (n = 32) were followed through 1 season to identify incidence of ERLP over the course of 1 season. Independent t tests were used to compare structural measures of those with and without ERLP history, and chi2 was used to examine frequencies.Of the 63 athletes, 33 (52%) reported ERLP history; most reported medial leg pain and also bilateral symptoms. No differences in structural measures were found between those with and without ERLP history. Ten of 32 athletes (31%) reported the occurrence of ERLP during the fall season, 8 of whom had a history of ERLP.Exercise-related leg pain was a common complaint among these athletes, usually occurring bilaterally and located along the medial leg. Athletes with ERLP history did not have a greater foot pronation as measured by ND, nor was there limited ankle range of motion as compared with those without ERLP history. Further research is needed to identify factors associated with the development of ERLP.

Every ten years the American Board of Physical Therapy Specialties conducts a practice analysis to revalidate and revise the description of specialty practice for sports physical therapy (SPT). The primary purpose of this paper is to describe the process and results of the most recent analysis, which defines the competencies that distinguish the subspecialty practice of (SPT). Additionally, the study allowed for the comparison of responses of board certified specialists in SPT to respondents who were not specialists while reflecting on demographic changes and evolving trends since the previous analysis of this physical therapy specialty practice was conducted 10 years ago.A survey instrument based on guidelines from the American Board of Physical Therapy Specialties was developed by the Sports Specialty Council (SSC) and a panel of subject matter experts (SME) in SPT to re-evaluate contemporary practice. The instrument was pilot tested and following revisions, was sent to 1780 physical therapists, 930 of whom were board certified specialists in SPT and 850 of whom were randomly selected members of the Sports Physical Therapy Section (SPTS) who were not board certified specialists in SPT. 414 subjects returned completed surveys for a 23% response rate. 235 of the respondents were known to be board certified sports specialists, 120 did not indicate their specialty status, and 35 were non-specialists in SPT. All were members of the SPTS of the American Physical Therapy Association. The survey responses were analyzed using descriptive statistics. Univariate comparisons were performed using parametric and nonparametric statistical tests in order to evaluate differences between specialist and non-specialist item responses.The survey results were reviewed by the SSC and a panel of SME. Using a defined decision making process, the results were used to determine the competencies that define the specialty practice of SPT. Survey results were also used to develop the SPT specialty board examination blueprint and define the didactic curriculum required of accredited SPT residency programs. A number of significant comparisons between the specialists and non-specialists were identified.The competency revalidation process culminated in the publication of the 4th edition of the Sports Physical Therapy Description of Specialty Practice in November of 2013. This document serves to guide the process related to the attainment and maintenance of the board certified clinical specialization in SPT. In anticipation of the continued evolution of this specialty practice, this process will be repeated every 10 years to reassess the characteristics of these providers and the factors they consider critically important and unique to the practice of SPT.

Exercise-related leg pain (ERLP) is a common problem in runners. The purposes of this study were to 1) report ERLP occurrence among adult community runners; 2) determine ERLP impact on daily activities; and 3) determine if there is a relationship between ERLP occurrence and selected potential risk factors including sex, age, years of running, ERLP history, body mass index (BMI), orthotic use, menstrual function, and training variables.Community runners registered for a local race were invited to complete a questionnaire including demographics and potential risk factors. Analyses of differences (t-test) and relationships (Chi-square) were conducted and relative risk (RR) values were calculated.225 registered runners (105 male, 120 female) participated; 63.6% reported ERLP history, and 35.1% reported ERLP in the 3 months preceding the race with bilateral medial ERLP as the most common presentation. Of the 79 runners who experienced ERLP during the 3 months preceding the race, ERLP caused 41.8% to reduce their running and interfered with walking or stair climbing in10%. Chi square analyses showed no significant association of sex, menstrual function, orthotic use, or BMI with ERLP occurrence. Significant associations were observed between ERLP history and ERLP occurrence in the previous year (RR=3.39; 2.54-4.52 95% CI), and between ERLP in the 3 months preceding the race and both years running and training mileage. Greater ERLP occurrence was observed in runners with less than 3 years experience (RR = 1.53; 1.08-2.17 95% CI) and runners who ran fewer than 15 miles/week (RR = 1.47; 1.04-2.08 95% CI). Those runners with3 years running experience and a race pace of 9 min/mile orwere at greater risk for ERLP when compared to other participants (RR=1.53; 1.07-2.18 95% CI).Interfering ERLP was common among this group of community runners. Risk factors included ERLP history, training mileage15 miles/week, and3 years running experience. Further investigation is warranted to identify factors which may increase a community runner's risk of developing ERLP.2b.

Recently, there has been attention to the clinical application of closed kinetic chain and joint isolation exercise. Our purpose was to compare the effect of joint isolation and closed kinetic chain exercise on quadriceps muscle performance and perceived function in patients with patellofemoral pain. Twenty-three patients participated in an 8-week training period and were assigned to either a closed kinetic chain or a joint isolation exercise training group. An 8-inch (20.3 cm) retro step-up test was performed at baseline, 8 weeks, and 1 year. Seated knee extension testing was measured at baseline and at 8 weeks using peak concentric torque on an isokinetic dynamometer at 90 degrees/sec, 180 degrees/sec, and 360 degrees/sec. Perceived functional status was rated as excellent, good, fair, or poor based on questionnaire response. Statistical analysis showed that both groups had significant improvement in peak torque at all speeds, but only the closed kinetic chain group showed significant improvement in closed kinetic chain testing and perceived functional status. We concluded that closed kinetic chain training may be more effective than joint isolation exercise in restoring function in patients with patellofemoral dysfunction.

The primary purpose of this study was to revalidate the competencies that define the practice of sports physical therapy. Additionally, the study allowed for the comparison of responses of board certified specialists in sports physical therapy to respondents who were not specialists.A survey instrument based the on American Board of Physical Therapy Specialties practice analysis template and The Guide to Physical Therapist Practice was developed by the Sports Specialty Council and a panel of subject matter experts in sports physical therapy. The instrument was sent to 630 physical therapists, 315 of whom were board certified specialists in sports physical therapy and 315 of whom were randomly selected members of the Sports Physical Therapy Section who were not board certified specialists in sports physical therapy. Two hundred and thirty seven subjects returned completed surveys for a 41% response rate. One hundred and fifty eight respondents were sports specialistsThe survey results were reviewed by the Sports Specialty Council and another panel of subject matter experts. Using a defined decision making process, the results were used to determine the competencies that define the specialty practice of sports physical therapy. Survey results were also used to develop the sports physical therapy specialty board examination blue print. A number of significant comparisons between the specialists and non-specialists were identified.The competency revalidation process culminated in the publication of the Sports Physical Therapy Description of Specialty Practice. This document serves to guide the process related to the attainment and maintenance of the board certified clinical specialist in sports physical therapy.

Reference/Citation: Collins N, Bisset L, McPoil T, Vicenzino B. Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis. Foot Ankle Int. 2007;28(3):396–412. Clinical Question: Among patients with or at risk for musculoskeletal overuse conditions, (1) do foot orthoses provide clinically meaningful improvements, and (2) are foot orthoses cost-effective? Data Sources: Studies published through September 28, 2005, were identified by using MEDLINE, EMBASE, CINAHL and Pre-CINAHL, Physiotherapy Evidence Database (PEDro), PubMed, SPORTDiscus, Biological Abstracts, Web of Science, Allied Health and Complementary Medicine Database, and the full Cochrane Library. The authors did not provide the search strategy used. Reference lists of included randomized controlled trials (RCTs) and identified systematic reviews were searched by hand. Study Selection: Studies were included if (1) they were RCTs that included the use of foot orthoses (either custom or prefabricated) in 1 of the intervention groups, (2) the clinical problem was an overuse condition as defined by the American College of Foot and Ankle Orthopedics and Medicine guidelines for which foot orthoses were recommended, and (3) at least 1 clinically relevant outcome was measured for a minimum of 1 week. Limits were not placed on year of publication, status of publication, or language. Data Extraction: The journal, authors, and author affiliations of included RCTs were masked from 2 of the reviewers who independently assessed the included RCTs for methodologic quality using a modified PEDro scale plus 3 additional items (justification of sample size, use of outcome measures with known validity and reliability, and reporting of adverse or side effects). Disagreements on methodologic quality were resolved with consensus or by a third reviewer. The effect sizes for the included RCTs were represented by relative risk (RR) for dichotomous outcomes and standardized mean difference (SMD) for continuous data. Confidence intervals (CIs) were reported for RR and SMD. Study data were extracted directly from each of the included studies. If provided, data from intention-to-treat analysis were extracted. Study authors were contacted when insufficient data were reported. A meta-analysis (random-effects model) was conducted using Review Manager (version 4.2; The Nordic Cochrane Centre, Copenhagen, Denmark). Main Results: The search identified 3192 potentially relevant studies. Full articles were retrieved for 327 studies. Twenty-two of the 327 studies met the inclusion criteria. Because the authors of 1 study used the same methods to report on 2 populations, a total of 23 RCTs were included in the systematic review. Prevention of lower limb overuse conditions with the use of foot orthoses was reported in 8 RCTs (7 studies). The effect of foot orthoses in the treatment of lower limb overuse conditions was reported in 15 RCTs. Of the 23 RCTs, the cost-effectiveness of foot orthoses was reported in 2 and the adverse effects of foot orthoses were reported in 8. Across the prevention RCTs, data were available for analysis for a range of 47 to 417 participants with 8 to 16 weeks of follow-up. Based on 4 RCTs in which the researchers examined prevention of lower limb overuse conditions with foot orthoses versus control in military personnel, the RR was 1.49 (95% CI = 1.07, 2.08). A clinically beneficial effect size was set a priori at 1.5 or greater for the foot-orthoses group or at 0.7 or less for the comparison group. Based on 2 RCTs reported in 1 study of the use of custom versus prefabricated foot orthoses for prevention of lower limb overuse conditions, no significant difference in risk was found (RR = 1.14, 95% CI = 0.90, 1.44). In their calculating and reporting of RR, the authors do not appear to have followed convention. Across the treatment RCTs, data were available for analysis for a range of 18 to 133 participants with 8 to 52 weeks of follow-up. The authors of the treatment RCTs reported a variety of outcome measures. Two of these, patient-perceived treatment effect (PPE) and pain on the visual analog scale (VAS), were used to calculate an overall treatment effect (PPE as RR and VAS as SMD). Based on 2 RCTs examining foot orthoses versus control, no significant difference in PPE was found (RR = 1.01, 95% CI = 0.61, 1.68). Based on 2 RCTs in which custom versus prefabricated foot orthoses were examined, no significant difference in PPE was found (RR = 0.88, 95% CI = 0.42, 1.81). The VAS data reported in the text appear to contradict the VAS data reported in Figure 2 for foot orthoses versus control for the treatment of lower limb overuse conditions. Specifically, the lower limit of the CI in the text was negative (−0.28) and in Figure 2 was positive. Because of this apparent contradiction, we did not interpret these data. Authors of 2 RCTs reported cost-effectiveness, but the data could not be pooled. Adverse events were reported in 8 of the 22 studies. The most common adverse effect reported was discomfort, which was the main reason for discontinuing foot-orthoses use in 2 studies. Conclusions: The evidence supports the use of foot orthoses to prevent a first occurrence of lower limb overuse conditions and shows no difference between custom and prefabricated foot orthoses. The evidence was insufficient to recommend foot orthoses (custom or prefabricated) for the treatment of lower limb overuse conditions.

Objectives The purposes of this research were to (1) investigate the effect of foot orthotic use on exercise related leg pain (ERLP) in cross-country (XC) athletes, and (2) determine if an association between foot type and foot orthotic use exists. Design Prospective cohort design. Setting High schools and colleges in a Midwestern metropolitan region. Participants 213 high school and college XC athletes (107 male, 106 female). Materials/Methods Participants were seen before the fall XC season for classification of foot type, visual orthotic inspection, and questionnaire completion regarding foot orthotic use and ERLP. Statistical analysis of relationships (chi-square) was conducted. Results 37 of the 213 XC athletes (17.4%) used foot orthotics; 31 of the 37 athletes using foot orthotics (83.8%) reported a history of ERLP. Of these 31 athletes, 17 (54.8%) were using orthotics for ERLP and 15 reported a decrease in ERLP with orthotic use. Fourteen athletes were using orthotics for a reason other than ERLP and only 2 reported a decrease in ERLP with orthotic use. Athletes using orthotics included all three foot types (pronated, neutral, supinated) with no relationship between orthotic use and foot type. Conclusion One-sixth of the XC athletes used foot orthotics and most using orthotics for ERLP reported a decrease in ERLP symptoms. The majority of athletes using orthotics for reasons other than ERLP reported no change in ERLP symptoms. There was no association between foot type and orthotic use.

Context: Prevention of exercise-related leg pain (ERLP) has not been successful because ERLP risk factors are not well known. Objective: To determine the percentage of high school cross-country (XC) athletes who reported a history of ERLP in their running careers, to identify the percentage of athletes who reported an occurrence of ERLP during 1 XC season, and to investigate the association of selected factors (age, high school year, years of high school running, sex, ERLP history, body mass index [BMI], foot type, and training distance) and the occurrence of ERLP. Design: Prospective cohort study. Setting: Six local high schools. Patients or Other Participants: One hundred twenty-five high school XC athletes (62 females, 63 males). Main Outcome Measure(s): All athletes completed an initial ERLP questionnaire, and foot type was visually assessed. After the season, athletes were asked to complete a Web-based questionnaire regarding the seasonal occurrence of ERLP. Statistical analyses of differences (t tests) and associations (χ2, relative risk) were conducted. Results: A total of 103 of the 125 athletes (82.4%) reported a history of ERLP, with 81 athletes reporting ERLP occurrence within the month preceding completion of the initial questionnaire. Bilateral medial leg pain was the most common ERLP presentation. More than half of the athletes (58.4%) with an ERLP history reported that the pain had interfered with XC participation. Ninety-three athletes responded to the postseason questionnaire, and 45 (48.0%) reported ERLP seasonal occurrence. Most athletes (97.8%) who experienced the seasonal occurrence of ERLP had a history of ERLP. No associations were noted between ERLP history or seasonal occurrence and age, high school year, years of high school running, sex, BMI, foot type, or training distance. Conclusions: Both a history of ERLP and the seasonal occurrence of ERLP were common among these XC athletes. The only risk factor identified for ERLP season occurrence was ERLP history.

UNLABELLED Menstrual function in adolescent athletes has received limited investigation. OBJECTIVE In a sample of female high school cross-country (XC) athletes, the purposes of the investigation were to (1) describe menstrual function (history and inseason), (2) describe the relationship between menstrual function and variables including body mass index (BMI), high school year, current year of running, total years running, training distance, racing pace, additional organized sport participation other than XC, and participation in XC practices and races, (3) determine the relationship between menstrual function and self-reported interfering exercise related leg pain (ERLP), and (4) determine the relationship between menstrual function history and menstrual function during a XC season. STUDY GROUP 62 female high school XC athletes. METHODS A prospective cohort design was used. Athletes were asked to complete an initial questionnaire querying several variables including menstrual function and ERLP history. At the end of the XC season, athletes were asked to complete a postseason questionnaire regarding menstrual function and ERLP during the XC season. RESULTS Of the athletes, 25.8% (16/62) reported abnormal menstrual function history and 34.9% reported abnormal menstrual function inseason. Abnormal menstrual function history was a risk for previous interfering ERLP (RR = 3.00, CI: 1.09, 8.29), and abnormal menstrual function history was a risk for abnormal menstrual function inseason (RR = 4.11, CI: 1.75, 9.62). CONCLUSIONS Abnormal menstrual function was present in this sample of athletes and was a risk for previous interfering ERLP and future episodes of abnormal menstrual function.

This study was devised to assess the different effects of concentric and eccentric actions on the tibialis anterior in a short-term strengthening regimen. It was hypothesized that any changes that may emerge in a pre- and posttest strength assessment would be from primarily neurologic alterations. Forty-four subjects were randomly divided into a control (n = 15), eccentric training (n = 14), and concentric training (n = 15) groups. The training groups performed eight training sessions over a 3-week period, allowing at least 1 day of rest between sessions. The training employed a modified daily adjusted progressive resistive exercise technique that used Thera-Band (Hygenic Corp., Akron, OH) as the resistance mode. Pre- and posttest data were collected via a Biodex dynamometer (Shirley, NY) of the ankle dorsiflexion pattern (30 and 90 deg/sec). No significant changes were observed in peak torque, and only the eccentrically trained group exhibited significant change of the total work performed of an eccentric pattern at 30 deg/sec. No significant changes were seen at 90 deg/sec. The results show a significant increase in total work at 30 deg/sec without an increase in peak torque. An alteration of the shape of the generated curve was seen with a "smoothing" occurring during the posttest. This finding is supportive of an enhancement of neuromuscular integration and an enhancement of neural function in the recruitment of muscle fibers during eccentric activation.

With the advancement of computers and access to the Internet, surveys using the web are becoming increasingly popular. Such surveys save money by eliminating postage costs and save time by providing immediate access to returned surveys and improved data processing. This primer describes some considerations and suggestions related to the use of web surveys. In addition to issues of sampling error, question writing, and question sequencing, successful use of web surveys requires determining if a web survey is appropriate, determining the desired level of security and confidentiality, selecting design options that enhance the survey, conducting rigorous pilot testing, and implementing strategies to maximize response rate.

Predictive correlational study.To identify the incidence of medial tibial stress syndrome (MTSS) in a group of high school cross-country runners and to determine if a relationship exists between lower extremity structural measures and the incidence of MTSS.Medial tibial stress syndrome is an overuse injury that occurs in long-distance runners. Literature exists that implicates structural deformity as a contributor to MTSS, but no studies have developed a predictive model.We measured 125 high school cross-country runners for tibiofibular varum, resting calcaneal position during stance, and gastrocnemius length. Runners developing MTSS over an 8-week period were placed in the injured group (2 men, 13 women; age 15.3 years 1.0), and 21 randomly selected uninjured runners were placed in the uninjured group (13 men, 8 women; age 15.7 years +/-1.5). Navicular drop was measured for runners in both groups. Reliability of measures was determined using an intraclass correlation coefficient (ICC 3,1). Paired t tests were used to compare the injury and noninjury groups. A logistic regression analysis was used to establish if the descriptive data could accurately predict the development of MTSS.Paired t tests showed a significant difference in navicular drop test measures between the injured (6.8 mm 3.7) and noninjured (3.6 mm 3.3) groups. Logistic regression analysis revealed navicular drop test measurements and sex correctly identified athletes who developed MTSS with 76% accuracy.Our study supported the hypothesis that a pronatory foot type is related to MTSS. The combination of sex and navicular drop test measures provides an accurate prediction for the development of MTSS. Clinical measures that identify biomechanical risk factors for MTSS may allow prevention or early intervention.

One component of patient evaluation is muscle performance assessment. The purpose of this study was: 1) to determine the difference and correlation between hand-held, isometric, and isokinetic dynamometry test results in patients with knee dysfunction and 2) to determine the effect of pain during such testing. Bilateral quadriceps strength in 23 subjects with unilateral knee dysfunction was tested using concentric and eccentric isokinetic dynamometry at 60 degrees/sec, isometric dynamometry, and hand-held dynamometry, both at 60 degrees of knee flexion. Pain ratings were obtained before, during, and after each test. Statistical analysis revealed a significant difference between involved and uninvolved limbs for eccentric isokinetic dynamometry (p = 0.002) and hand-held dynamometry (p = 0.005); no difference was found between limbs for the concentric isokinetic and isometric dynamometry (p > 0.05). Mean percent deficits in quadriceps strength ranged from 11 to 18%, with no significant difference found between testing modes. Pearson product moment correlations ranged from 0.34 to 0.76 when comparing testing modes. No significant difference existed in pain scores before, during, and after each mode of testing. It was concluded that large variation existed between different testing modes, which results in different conclusions regarding the strength of the quadriceps in patients with knee dysfunction.