The Effects of Saddle Alignment and Pedal Stroke Training on a Competitive Cyclist with Anterior Knee Pain: A Case Report

Background: Among competitive cyclists, anterior knee pain is a common overuse injury. Alignment of the rider on the bicycle and the loading pattern on the pedals are proposed as factors in this pain. The patient was a 23-year-old competitive female cyclist who was riding up to 200 miles weekly and had developed bilateral anterior knee pain within the 3 months preceding our examination. The purpose of this case report is to demonstrate the effectiveness of adjusting this patient’s static alignment (ie. position while seated on bicycle, but not actively pedaling) on the bike and modifying her habitual pedaling pattern. Methods: The patient was analyzed using both static and dynamic measures of alignment while on her bicycle. Her bicycle seat was raised and moved rearward, and her pedaling force output was analyzed using a Computrainer™. Over a 4-week period, she was taught to modify her pedaling force using video biofeedback. Outcomes: After adjustments and training, she could ride for over 3.5 hours without knee pain. Visual analog scale pain score improved from 6/10 to 0/10; Lower Extremity Functional Score improved from 65 to 79; and Knee Injury and Osteoarthritis Outcome Score improved from 81 to 98.5. Clinical Relevance: This case illustrates how application of biomechanical principles and training in pedaling movement patterns can be effective at eliminating knee pain in competitive cyclists. While rest, decreased training volume, and appropriate medication should be considered as treatment components, we believe the initial treatment for competitive cyclists should include biomechanical evaluation of alignment and pedaling pattern

Church Pew Exercise Integrated With Conventional Physical Therapy Following Total Knee Arthroplasty (TKA): Case Report

Background and Purpose: Physical therapy treatment following Total knee Arthroplasty (TKA) consists of a combination of strengthening and range of motion exercises. The exercise technique, church pew exercise (CPE), has been proposed to enhance quadriceps facilitation and improve function. This is a technique that has the patient standing and rocking forward/back. The backward motion is arrested by engagement of the upper calf against a solid object, creating a sudden flexion torque at the knee and a sudden extension torque at the hip. The combination of CPE with standard physical therapy is claimed to provide better quadriceps control and faster walking post TKA. In this case study, a 51-year-old female with decreased knee active and passive range of motion (ROM), decreased lower extremity (LE) muscle strength, and limited ambulation post left knee TKA, received conventional physical therapy treatment plus CPE. Methods: The patient received 11 physical therapy home sessions. The first 8 sessions were used to strengthen her knee and increase active and passive ROM. The CPE intervention was performed 3 weeks post-surgery, during the last 3 physical therapy sessions. At these three sessions the patient performed the Timed Up and Go (TUG) before and after CPE. Outcomes: At initial evaluation, 4 days post left knee TKA, this patient’s left knee active ROM was only 15 to 76 degrees, and manual muscle testing at her hip and knee indicated strengths of 2- (hip flexors), 3- (hamstrings and quadriceps), and 3+ (hip abductors), all out of 5, and her times on two trials of the TUG were 30.31 and 30.65 sec, indicating impaired functional ability. At all CPE sessions (3 weeks post-surgery) the patient demonstrated increased gait speeds (i.e. shorter times) on the TUG after the CPE (pre CPE mean = 13.2 sec; post CPE mean = 11.2), increased stance time on her affected lower extremity, and increased step length on her contra-lateral lower extremity. The patient reported increased knee stability. Clinical Relevance: Rationale for CPE is based on neurological facilitation of quadriceps and other lower extremity muscles. However, to engage in this exercise the patient must have the ability to balance and to control the hip and knee joints. This patient required several weeks of strengthening and active and passive ROM exercises before she could perform the CPE. Once able to perform the CPE, she demonstrated improvements in her walking ability, and she expressed greater confidence. Conclusion: Provided a minimal level of strength and active and passive ROM has been attained, CPE may be a valuable short-term supplement to current strengthening regimens addressing quadriceps functional deficits following TKA. Other conditions that involve gait problems related to quadriceps insufficiency might also benefit. The long-term efficacy of CPE remains to be determined

Church Pew Exercise Integrated With Conventional Physical Therapy Following Total Knee Arthroplasty (TKA): Case Report

Background and Purpose: Physical therapy treatment following Total knee Arthroplasty (TKA) consists of a combination of strengthening and range of motion exercises. The exercise technique, church pew exercise (CPE), has been proposed to enhance quadriceps facilitation and improve function. This is a technique that has the patient standing and rocking forward/back. The backward motion is arrested by engagement of the upper calf against a solid object, creating a sudden flexion torque at the knee and a sudden extension torque at the hip. The combination of CPE with standard physical therapy is claimed to provide better quadriceps control and faster walking post TKA. In this case study, a 51-year-old female with decreased knee active and passive range of motion (ROM), decreased lower extremity (LE) muscle strength, and limited ambulation post left knee TKA, received conventional physical therapy treatment plus CPE. Methods: The patient received 11 physical therapy home sessions. The first 8 sessions were used to strengthen her knee and increase active and passive ROM. The CPE intervention was performed 3 weeks post-surgery, during the last 3 physical therapy sessions. At these three sessions the patient performed the Timed Up and Go (TUG) before and after CPE. Outcomes: At initial evaluation, 4 days post left knee TKA, this patient’s left knee active ROM was only 15 to 76 degrees, and manual muscle testing at her hip and knee indicated strengths of 2- (hip flexors), 3- (hamstrings and quadriceps), and 3+ (hip abductors), all out of 5, and her times on two trials of the TUG were 30.31 and 30.65 sec, indicating impaired functional ability. At all CPE sessions (3 weeks post-surgery) the patient demonstrated increased gait speeds (i.e. shorter times) on the TUG after the CPE (pre CPE mean = 13.2 sec; post CPE mean = 11.2), increased stance time on her affected lower extremity, and increased step length on her contra-lateral lower extremity. The patient reported increased knee stability. Clinical Relevance: Rationale for CPE is based on neurological facilitation of quadriceps and other lower extremity muscles. However, to engage in this exercise the patient must have the ability to balance and to control the hip and knee joints. This patient required several weeks of strengthening and active and passive ROM exercises before she could perform the CPE. Once able to perform the CPE, she demonstrated improvements in her walking ability, and she expressed greater confidence. Conclusion: Provided a minimal level of strength and active and passive ROM has been attained, CPE may be a valuable short-term supplement to current strengthening regimens addressing quadriceps functional deficits following TKA. Other conditions that involve gait problems related to quadriceps insufficiency might also benefit. The long-term efficacy of CPE remains to be determined

The various perceptions of distance: An alternative view of how effort affects distance judgments

D. R. Proffitt and colleagues (e. g., D. R. Proffitt, J. Stefanucci, T. Banton, & W. Epstein, 2003) have suggested that objects appear farther away if more effort is required to act upon them (e.g., by having to throw a ball). The authors attempted to replicate several findings supporting this view but found no effort-related effects in a variety of conditions differing in environment, type of effort, and intention to act. Although they did find an effect of effort on verbal reports when participants were instructed to take into account nonvisual (cognitive) factors, no effort-related effect was found under apparent- and objective-distance instruction types. The authors\u27 interpretation is that in the paradigms tested, effort manipulations are prone to influencing response calibration because they encourage participants to take nonperceptual connotations of distance into account while leaving perceived distance itself unaffected. This in no way rules out the possibility that effort influences perception in other contexts, but it does focus attention on the role of response calibration in any verbal distance estimation task

Using the Inverse Maximum Ratio-Λ as a Technique to Quantify Surface Uniformity

Background Techniques used in data variability assessment are subsequently used to draw conclusions regarding the “spread”/uniformity of data curves. Due to the limitations of these techniques, they are not adequate for circumstances where data manifest with multiple peaks (bimodal, multi-modal). As such manifestations of data are common in various fields, a sound mathematical approach to quantify the uniformity of such data could prove to be useful in a number of different ways. Extrapolating such an approach to quantify the uniformity of surfaces in 3-dimensional space could further expand its utility. Methods We proposed and validated a new mathematical metric, the Inverse Maximum Ratio, to quantify the uniformity behavior of bimodal and multi-modal data in 2 dimensions. Firstly, a universal mathematical definition of the Inverse Maximum Ratio (Λ) was derived and its expected value and variance were examined under various conditions. The performance of Λ was then assesed under various uni-modal, bimodal and multimodal data conditions, and the finite bounds of the metric were examined. The utility of Λ in quantifying the uniformity of surfaces in 3-dimensional space was then examined using several simulated surfaces with various ‘non-uniformity’ manifestations. Results In both 2 and 3-dimensions, Λ performed consistently across all tested conditions. The range of the metric was determined to be within [0, 1] and estimates closer to the upper bound indicated more ‘uniform’ presentations of data. From derivations of its expected value and variance as well as from graphical assessments, it’s performance was determined to be distribution independent and reliabile across various manifestations of data (unimodal, bimodal, multi-modal in 2 dimensional conditions). Λ was also determined to be superior to commonly used variability assessment techniques in capturing the uniformity of data curves. Further, Λ was also determined to be equivalently useful in 3-dimensional space to quantify the uniformity of various surfaces. The bounds, behavior and consistency of the metric was identical in 2 and 3-dimensional conditions. Conclusion We believe that the proposed metric not only performs consistently across all presentations of data in both 2 and 3-dimentions, but also that it outperforms the standard techniques in bimodal and multi-modal presentations of data. This metric’s consistent performance in all tested conditions make it a reliable tool for use in fields such as biomechanics, immunology, material sciences etc. where such presentations of data are common

Genetic Disorders: Implications for Allied Health Professionals: Two Case Studies

With advances in study of the human genome, increasingly accurate genetic testing has become available. Genetic-based birth defects may result in progressive dysfunction. Consequently, because of the negative associations, many people do not want to consider prognostication testing or accept the most appropriate treatments. The allied health practitioner may see this as counter to the goal of optimal health care. However, consideration must be given to the patient’s comfort with advanced knowledge. In this paper we discuss ethical, legal, and social implications of genetic testing and how these relate to patients seen in an allied health environment. First, background on genetic disorders, their causes, and how they are characterized is presented. Then two case studies are described. One is a 50-year female with Huntington’s disease (chorea), an inherited autosomal dominant condition leading to central nervous system deterioration. The second is a 5-year boy with Stickler syndrome, a hereditary autosomal dominant connective tissue disorder affecting Type II collagen. Symptoms, therapeutic approaches, and long term prognoses are discussed. Working with patients having genetic disorders presents unique challenges for allied health professionals because of the social and political implications of these maladies. Suggestions are provided on how allied health professionals may respond to these issues

Innovative Methodology An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle

An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle