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Kulig K, Joiner D, Chang YJ. Landing Limb Posture in Volleyball Athletes with Patellar Tendinopathy: A Pilot Study. Int J Sports Med 2015; 36:400-6. [DOI: 10.1055/s-0034-1395586] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kulig K, Lee SP, Reischl SF, Noceti-DeWit L. Effect of posterior tibial tendon dysfunction on unipedal standing balance test. Foot Ankle Int 2015; 36:83-9. [PMID: 25212864 DOI: 10.1177/1071100714551020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Foot pain and diminished functional capacity are characteristics of tibialis posterior tendon dysfunction (TPTD). This study tested the hypotheses that women with TPTD would have impaired performance of a unipedal standing balance test (USBT) and that balance performance would be related to the number of single limb heel raises (SLHR). METHODS Thirty-nine middle-aged women, 19 with early stage TPTD (stage I and II), were instructed to perform 2 tasks; a USBT and repeated SLHR. Balance success was defined as a 10-second stance. For those who were successful, center of pressure (COP) data in anterior-posterior (AP) and medial-lateral (ML) directions were recorded as a measure of postural sway. SLHR performance was divided into 3 bins (≤2; 3-9 and > 10 repetitions). The between-balance success on performing the SLHR test was analyzed using the Fisher's exact test (2 × 3). Independent t tests were used to compare between-group differences in postural sway. Relationship of postural sway to the number of heel raises was assessed using Spearman's rho. RESULTS The success rate of the USBT was significantly lower in women with TPTD than the controls (47% vs 85%, P = .041). In addition, women with TPTD who completed the USBT exhibited increased AP COP displacement (14.0 ± 7.4 vs 8.4 ± 1.3 mm, P = .008), and a strong trend of increased ML COP displacement (8.3 ± 4.5 vs 6.1 ± 1.2 mm, P = .050). The success rate of USBT was correlated with the number of SLHR (P = .01). The AP and ML COP displacement were correlated with SLHR (r = -.538 and .495), respectively. CONCLUSIONS Women with TPTD have difficulty in performing the USBT. Performance of the USBT and SLHR are highly correlated and predictive of each other. CLINICAL RELEVANCE A unipedal balance test may be used as a proxy TPTD assessment tool to the heel raising test when pain prevents performance. LEVEL OF EVIDENCE Level III, case control study.
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Kulig K, Oki KC, Chang YJ, Bashford GR. Achilles and patellar tendon morphology in dancers with and without tendon pain. MEDICAL PROBLEMS OF PERFORMING ARTISTS 2014; 29:221-228. [PMID: 25433259 DOI: 10.21091/mppa.2014.4044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To examine Achilles and patellar tendon morphology in dancers with and without tendon pain. METHODS Fifty-three dancers with and without Achilles and/or patellar tendon pain participated. Eleven age-matched non-dancers served as controls. Longitudinal ultrasound images of the middle and distal Achilles and proximal and distal patellar tendons were acquired. To assess macromorphology, the thickness of the middle and distal Achilles and proximal and distal patellar tendons were measured. Micromorphology was analyzed by selecting 2 x 2-mm2 regions of interest in the tendons; spectral analysis using the fast Fourier transform was run for several kernels (2 x 2-mm2 subimages) within each image, and the peak spatial frequency (PSF) was extracted. A one-way ANOVA compared asymptomatic, symptomatic, and control tendon thickness and PSF. RESULTS Macromorphology: There was no significant difference between asymptomatic and symptomatic dancers in middle or distal Achilles tendon thickness and distal patellar tendon thickness. Proximal patellar tendons in control subjects were thinner than those in asymptomatic (p=0.036) and symptomatic (p=0.003) dancers. Micromorphology: There was no significant difference in PSF between asymptomatic and symptomatic dancers and controls in the Achilles or patellar tendon. CONCLUSION Increased proximal patellar tendon thickness without changes in tendon micromorphology suggests that tendon adaptations are more likely activity-related and less likely influenced by degeneration.
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Kulig K, De Moor C, Korytowsky B, Halperin M, Danese M. Potential Impact of New Generation Immunotherapy on Years of Life Lost and Lifetime Earnings in Metastatic Melanoma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu341.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Davenport TE, Cleland JA, Yamada KA, Kulig K. Measurement Properties of the Low Back Activity Confidence Scale (LoBACS). Eval Health Prof 2014; 39:204-14. [DOI: 10.1177/0163278714527757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to determine the measurement properties of the Low Back Activity Confidence Scale (LoBACS) in individuals with post-acute low back pain (LBP) receiving nonsurgical intervention, including construct validity, factorial validity, and internal consistency reliability. Data were analyzed from an existing randomized clinical trial involving 112 patients with LBP. Evidence for convergent validity was observed through significant correlations between LoBACS subscale scores and other function, pain, and psychobehavioral measures. LoBACS subscales accounted for 36% of the unique variance in dependent variable measurements, suggesting a satisfactory level of statistical divergence between the LoBACS and other psychobehavioral measurements in this study. Cronbach’s α ranged from .88 to .92 for LoBACS subscales, and item-total correlations exceeded .6, indicating high internal consistency reliability. Principal axis factoring confirmed the hypothesized three-subscale structure by correctly classifying 14 of the 15 items. These findings indicate the LoBACS is valid and internally consistent to measure domain-specific self-efficacy beliefs.
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Beneck GJ, Popovich JM, Selkowitz DM, Azen S, Kulig K. Intensive, progressive exercise improves quality of life following lumbar microdiskectomy: a randomized controlled trial. Clin Rehabil 2014; 28:892-901. [DOI: 10.1177/0269215514525059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: The purpose of the study was to examine changes in quality of life measures in patients who have undergone an intensive exercise program following a single level microdiskectomy. Design: Randomized controlled trial with blinded examiners. Setting: The study was conducted in outpatient physical therapy clinics. Subjects: Ninety-eight participants (53 male, 45 female) who had undergone a single-level lumbar microdiskectomy allocated to receive exercise and education or education only. Interventions: A 12-week periodized exercise program of lumbar extensor strength and endurance training, and mat and upright therapeutic exercises was administered. Outcome measures: Quality of life was tested with the Short Form 36 (SF-36). Measurements were taken 4–6 weeks postsurgery and following completion of the 12-week intervention program. Since some participants selected physical therapy apart from the study, analyses were performed for both an as-randomized (two-group) design and an as-treated (three-group) design. Results: In the two-group analyses, exercise and education resulted in a greater increase in SF-36 scales, role physical (17.8 vs. 12.1) and bodily pain (13.4 vs. 8.4), and the physical component summary (13.2 vs. 8.9). In the three-group analyses, post-hoc comparisons showed exercise and education resulted in a greater increase in the SF-36 scales, physical function (10.4 vs. 5.6) and bodily pain (13.7 vs. 8.2), and the physical component summary (13.7 vs. 8.9) when compared with usual physical therapy. Conclusions: An intensive, progressive exercise program combined with education increases quality of life in patients who have recently undergone lumbar microdiskectomy.
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Kulig K, Landel R, Chang YJ, Hannanvash N, Reischl SF, Song P, Bashford GR. Patellar tendon morphology in volleyball athletes with and without patellar tendinopathy. Scand J Med Sci Sports 2012; 23:e81-8. [PMID: 23253169 DOI: 10.1111/sms.12021] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2012] [Indexed: 11/29/2022]
Abstract
Appropriate management of patellar tendinopathy requires distinguishing between inflammatory and degenerative conditions, often difficult because tendon thickening can be a normal or pathological adaptation, and micromorphology is not observable on clinical imaging. The purpose of this study was to quantitatively examine patellar tendon micro- and macromorphology in volleyball athletes and relate those findings to reported symptoms. Longitudinal ultrasound images of proximal and distal patellar tendons were acquired from 84 male elite volleyball athletes (44 symptomatic, 40 asymptomatic) and 10 asymptomatic nonathlete controls. Micromorphology was determined using two-dimensional Fast Fourier Transform analysis providing a discriminating peak spatial frequency parameter (PSF). Macromorphology (patellar tendon thickness) was measured using Image J software. All athletes regardless of symptoms had thicker proximal tendons compared to nonathletes, suggesting a normal adaptation to training loads. However, symptomatic athletes demonstrated lower PSF than asymptomatic athletes and nonathletes at the proximal tendon, suggesting greater collagen disorganization, and tendon degeneration rather than inflammation. Only symptomatic athletes had thicker distal tendons than nonathletes, but there was no difference in PSF distally. Diagnostic ultrasound enhances the understanding of the micromorphology of patellar tendons, supporting the rationale for management that remodels the degenerated tendon instead of treating inflammation.
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Beneck GJ, Baker LL, Kulig K. Spectral analysis of EMG using intramuscular electrodes reveals non-linear fatigability characteristics in persons with chronic low back pain. J Electromyogr Kinesiol 2012; 23:70-7. [PMID: 22883392 DOI: 10.1016/j.jelekin.2012.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/22/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022] Open
Abstract
Greater fatigability across lumbar extensors has been reported in persons with chronic low back pain (LBP), however, extensor atrophy tends to be local to the site of pain. Therefore, specific ultrasound guided local and remote intramuscular electromyographic recordings were undertaken during an isometric horizontal trunk hold in two carefully matched cohorts; persons with and without LBP. The test was performed to self-determined maximal hold time, and the control group held the horizontal position longer (P < 0.001). A power spectral analysis was performed to calculate the normalized median frequency (NMF) slope for both the first and last 30s of the fatigue test due to the group difference in hold times. There were no significant group differences in NMF slope at the first 30s of testing (P = 0.650). The NMF slope for the first and last 30s was not different in healthy subjects (P = 0.688), but was different in persons with LBP, illustrated by shallowing of the slope at the last 30s of the test (P = 0.008). A between muscle comparison in the LBP group showed greater non-linear behavior in the deep multifidus (painful region) in contrast to T10 longissimus thoracis (nonpainful region) (P = 0.013). Possible explanations for these findings are discussed.
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Fietzer AL, Chang YJ, Kulig K. Dancers with patellar tendinopathy exhibit higher vertical and braking ground reaction forces during landing. J Sports Sci 2012; 30:1157-63. [PMID: 22758398 DOI: 10.1080/02640414.2012.695080] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Dancers are exposed to the effects of repetitive jumping and leaping as are other athletes that tend to develop patellar tendinopathy. Greater vertical ground reaction forces occur during landing from a dance leap than during takeoff and during other common athletic activities. The purposes of this study were: (1) to compare the landing ground reaction force profiles of participants with and without clinically diagnosed patellar tendinopathy, and (2) to determine the strength of the relationship between landing angle, and braking impulse. Eighteen elite pre-professional dancers (12 healthy, 6 with patellar tendinopathy; both groups 50% male) performed sauts de chat for kinetic and kinematic analysis. Dancers with patellar tendinopathy demonstrated greater peak vertical ground reaction force and impulse (36% and 15% greater, respectively). Dancers with patellar tendinopathy demonstrated greater peak braking ground reaction force and impulse (82% and 126% greater, respectively). Landing angle explained 67% of the braking impulse. Dancers with patellar tendinopathy exhibited greater vertical and braking impulses than healthy dancers. Braking impulse was strongly correlated with landing angle. While there was no difference between groups in landing angle, dancers with patellar tendinopathy exhibited greater braking impulse than their non-tendinopathic counterparts, even at similar landing angles.
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Beneck GJ, Kulig K. Multifidus atrophy is localized and bilateral in active persons with chronic unilateral low back pain. Arch Phys Med Rehabil 2012; 93:300-6. [PMID: 22289241 DOI: 10.1016/j.apmr.2011.09.017] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 09/06/2011] [Accepted: 09/06/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the lumbar multifidi muscle volume devoid of fat local to the site of pain in persons with and without chronic unilateral lower lumbar pain. DESIGN Prospective cross-sectional design. SETTING University biokinesiology laboratory. PARTICIPANTS Active individuals (n=14) with chronic unilateral lower lumbar pain (>1 y) were matched for age, height, weight, and activity level with healthy individuals (n=14). Individuals with back pain had minimal disability (Oswestry Disability Index [mean ± SD], 14.9%±6.3%) at the time of testing. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Multifidus and erector spinae muscle volumes at the L5-S1 levels, multifidus muscle volumes at the L4 and S2-3 levels. RESULTS Average multifidus volume was diminished by 18.1% between groups (P=.026) only at the L5-S1 levels. There was no difference between painful and pain-free sides. There were no volume differences between groups above L5, below S1, or in erector spinae at the L5-S1 levels. CONCLUSIONS The results of this study indicate that despite a low level of disability and an activity level similar to that of matched control subjects, considerable localized, bilateral multifidus atrophy is present. Such impaired size of the multifidus will likely reduce its capacity to control intersegmental motion, thus increasing the susceptibility to further injury. Unlike acute unilateral low back pain (LBP), muscle size is reduced bilaterally in persons with chronic unilateral LBP.
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Armour Smith J, Siemienski A, Popovich JM, Kulig K. Intra-task variability of trunk coordination during a rate-controlled bipedal dance jump. J Sports Sci 2012; 30:139-47. [DOI: 10.1080/02640414.2011.624541] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Shaw AT, Yeap BY, Solomon BJ, Riely GJ, Iafrate AJ, Shapiro G, Costa DB, Butaney M, Ou SI, Maki RG, Bang Y, Varella-Garcia M, Salgia R, Wilner KD, Kulig K, Selaru P, Tang Y, Kwak EL, Clark JW, Camidge DR. Impact of crizotinib on survival in patients with advanced, ALK-positive NSCLC compared with historical controls. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7507] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kim D, Lee JK, Park HS, Kulig K, Kim TM, Lee S, Jeon Y, Chung DH, Heo DS, Kim WH, Bang Y. Comparative analyses of overall survival of anaplastic lymphoma kinase (ALK)–positive advanced non-small cell lung cancer (NSCLC) patients who did not receive ALK inhibitors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fietzer AL, Chang YJ, Kulig K. Knee Joint Angular Stiffness during Landing in Males With and Without Patellar Tendinopathy. Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000402909.53588.ea] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kulig K, Fietzer AL, Popovich JM. Ground reaction forces and knee mechanics in the weight acceptance phase of a dance leap take-off and landing. J Sports Sci 2010; 29:125-31. [PMID: 21170801 DOI: 10.1080/02640414.2010.534807] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Aesthetic constraints allow dancers fewer technique modifications than other athletes to negotiate the demands of leaping. We examined vertical ground reaction force and knee mechanics during a saut de chat performed by healthy dancers. It was hypothesized that vertical ground reaction force during landing would exceed that of take-off, resulting in greater knee extensor moments and greater knee angular stiffness. Twelve dancers (six males, six females; age 18.9 ± 1.2 years, mass 59.2 ± 9.5 kg, height 1.68 ± 0.08 m, dance training 8.9 ± 5.1 years) with no history of low back pain or lower extremity pathology participated in the study. Saut de chat data were captured using an eight-camera Vicon system and AMTI force platforms. Peak ground reaction force was 26% greater during the landing phase, but did not result in increased peak knee extensor moments. Taking into account the 67% greater knee angular displacement during landing, this resulted in less knee angular stiffness during landing. In conclusion, landing was accomplished with less knee angular stiffness despite the greater peak ground reaction force. A link between decreased joint angular stiffness and increased soft tissue injury risk has been proposed elsewhere; therefore, landing from a saut de chat may be more injurious to the knee soft tissue than take-off.
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Davenport TE, Kulig K, Fisher BE. Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2010; 10:59. [PMID: 20958995 PMCID: PMC2967502 DOI: 10.1186/1472-6882-10-59] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 10/19/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND Ankle sprains are common within the general population and can result in prolonged disablement. Limited talocrural dorsiflexion range of motion (DF ROM) is a common consequence of ankle sprain. Limited talocrural DF ROM may contribute to persistent symptoms, disability, and an elevated risk for re-injury. As a result, many health care practitioners use hands-on passive procedures with the intention of improving talocrural joint DF ROM in individuals following ankle sprains. Dosage of passive hands-on procedures involves a continuum of treatment speeds. Recent evidence suggests both slow- and fast-speed treatments may be effective to address disablement following ankle sprains. However, these interventions have yet to be longitudinally compared against a placebo study condition. METHODS/DESIGN We developed a randomized, placebo-controlled clinical trial designed to test the hypotheses that hands-on treatment procedures administered to individuals following ankle sprains during the post-acute injury period can improve short-, intermediate-, and long-term disablement, as well as reduce the risk for re-injury. DISCUSSION This study is designed to measure the clinical effects of hands-on passive stretching treatment procedures directed to the talocrural joint that vary in treatment speed during the post-acute injury period, compared to hands-on placebo control intervention. TRIAL REGISTRATION http://www.clinicaltrials.gov identifier NCT00888498.
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Cleland JA, Fritz JM, Kulig K, Davenport TE, Eberhart S, Magel J, Childs JD. Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a clinical prediction rule: a randomized clinical trial. Spine (Phila Pa 1976) 2009; 34:2720-9. [PMID: 19940729 DOI: 10.1097/brs.0b013e3181b48809] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized clinical trial. OBJECTIVE The purpose of this randomized clinical trial was to examine the generalizability of 3 different manual therapy techniques in a patient population with low back pain that satisfy a clinical prediction rule (CPR). SUMMARY OF BACKGROUND DATA Recently a CPR that identifies patients with LBP who are likely to respond rapidly and dramatically to thrust manipulation has been developed and validated. The generalizability of the CPR requires further investigation. METHODS A total of 112 patients were enrolled in the trial and provided demographic information and completed a number of self-report questionnaires including the Oswestry Disability Questionnaire (ODQ) and the Numerical Pain Rating Scale (NPRS) at baseline, 1-week, 4-weeks, and 6-months. Patients were randomly assigned to receive 1 of the 3 manual therapy techniques for 2 consecutive treatment sessions followed by exercise regimen for an additional 3 sessions. We examined the primary aim using a linear mixed model for repeated measures, using the ODQ and NPRS as dependent variables. The hypothesis of interest was the group by time interaction, which was further explored with pair-wise comparisons of the estimated marginal means. RESULTS There was a significant group x time interaction for the ODQ (P < 0.001) and NPRS scores (P = 0.001). Pair-wise comparisons revealed no differences between the supine thrust manipulation and side-lying thrust manipulation at any follow-up period. Significant differences in the ODQ and NPRS existed at each follow-up between the thrust manipulation and the nonthrust manipulation groups at 1-week and 4-weeks. There was also a significant difference in ODQ scores at 6-months in favor of the thrust groups. CONCLUSION The results of the study support the generalizability of the CPR to another thrust manipulation technique, but not to the nonthrust manipulation technique that was used in this study. In general, our results also provided support that the CPR can be generalized to different settings from which it was derived and validated. However, additional research is needed to examine this issue.
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Arya S, Kulig K. Tendinopathy alters mechanical and material properties of the Achilles tendon. J Appl Physiol (1985) 2009; 108:670-5. [PMID: 19892931 DOI: 10.1152/japplphysiol.00259.2009] [Citation(s) in RCA: 252] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to investigate the in vivo material and mechanical properties of the human Achilles tendon in the presence of tendinopathy. Real-time ultrasound imaging and dynamometry were used to assess Achilles tendon stiffness, Young's modulus, stress, strain, and cross-sectional area (CSA) in 12 individuals with Achilles tendinopathy and 12 age- and gender-matched controls. The results of this study suggest that tendinopathy weakens the mechanical and material properties of the tendon. Tendinopathic tendons had greater CSA, lower tendon stiffness, and lower Young's modulus. These alterations in mechanical characteristics may put the Achilles tendon at a higher risk to sustain further injury and prolong the time to recovery. Results from this study may be used to design treatment strategies that specifically target these deficits, leading to faster and permanent recovery from tendinopathy.
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Kulig K, Lederhaus ES, Reischl S, Arya S, Bashford G. Effect of eccentric exercise program for early tibialis posterior tendinopathy. Foot Ankle Int 2009; 30:877-85. [PMID: 19755073 DOI: 10.3113/fai.2009.0877] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Morphology and vascularization of painful tibialis posterior (TP) tendons before and after an intervention targeting the degenerated tendon were examined. Functional status and pain level were also assessed. MATERIALS AND METHODS A10-week twice daily, progressive eccentric tendon loading, calf stretching program with orthoses was implemented with ten, early stage TP tendinopathy subjects. TP tendons were imaged by grayscale and Doppler ultrasound at INITIAL and POST evaluations to assess the tendon's morphology and signs of neovascularization. The Foot Functional Index (FFI), Physical Activity Scale (PAS), 5-Minute Walk Test, and single heel raise (SHR) test were completed at INITIAL and POST evaluations. The Global Rating Scale (GRS) was completed at 6 months followup. One-way ANOVA was used to compare the FFI at INITIAL, POST, and 6-MONTH time points. Paired t-tests were used to compare means between the remaining variables. The level of significance was p = 0.05. RESULTS There was a significant difference in FFI total, pain, and disability at the three time-points. Post-hoc paired t-tests revealed that the FFI scores were lower for the total score and pain and disability subcategories when comparing from INITIAL to POST and INITIAL to 6-MONTH evaluations (p < 0.05 for all). The number of SHR increased significantly on the involved side from INITIAL to POST evaluation (p = 0.041). The GRS demonstrated minimum clinically important differences for improvements in symptoms at 6-MONTH. Tendon morphology and vascularization remained abnormal following the intervention. CONCLUSION A 10-week tendon specific eccentric program resulted in improvements in symptoms and function without changes in tendon morphology or neovascularization.
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Fisher BE, Davenport TE, Kulig K, Wu AD. Identification of potential neuromotor mechanisms of manual therapy in patients with musculoskeletal disablement: rationale and description of a clinical trial. BMC Neurol 2009; 9:20. [PMID: 19460169 PMCID: PMC2694757 DOI: 10.1186/1471-2377-9-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 05/21/2009] [Indexed: 12/26/2022] Open
Abstract
Background Many health care practitioners use a variety of hands-on treatments to improve symptoms and disablement in patients with musculoskeletal pathology. Research to date indirectly suggests a potentially broad effect of manual therapy on the neuromotor processing of functional behavior within the supraspinal central nervous system (CNS) in a manner that may be independent of modification at the level of local spinal circuits. However, the effect of treatment speed, as well as the specific mechanism and locus of CNS changes, remain unclear. Methods/Design We developed a placebo-controlled, randomized study to test the hypothesis that manual therapy procedures directed to the talocrural joint in individuals with post-acute ankle sprain induce a change in corticospinal excitability that is relevant to improve the performance of lower extremity functional behavior. Discussion This study is designed to identify potential neuromotor changes associated with manual therapy procedures directed to the appendicular skeleton, compare the relative effect of treatment speed on potential neuromotor effects of manual therapy procedures, and determine the behavioral relevance of potential neuromotor effects of manual therapy procedures. Trial Registration identifier NCT00847769.
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Taylor D, Nyambose J, Kulig K, Earle CC, Thompson D. Impact of mortality due to malignant melanoma versus other cancers. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bashford GR, Tomsen N, Arya S, Burnfield JM, Kulig K. Tendinopathy discrimination by use of spatial frequency parameters in ultrasound B-mode images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2008; 27:608-615. [PMID: 18450534 DOI: 10.1109/tmi.2007.912389] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The structural characteristics of a healthy tendon are related to the anisotropic speckle patterns observed in ultrasonic images. This speckle orientation is disrupted upon damage to the tendon structure as observed in patients with tendinopathy. Quantification of the structural appearance of tendon shows promise in creating a tool for diagnosing, prognosing, or measuring changes in tendon organization over time. The current work describes a first step taken towards this goal-classification of Achilles tendon images into tendinopathy and control categories. Eight spatial frequency parameters were extracted from regions of interest on tendon images, filtered and classified using linear discriminant analysis. Resulting algorithms had better than 80% accuracy in categorizing tendon image kernels as tendinopathy or control. Tendon images categorized wrongly provided for an interesting clinical association between incorrect classification of tendinopathy kernels as control and the symptom and clinical time history based inclusion criteria. To assess intersession reliability of image acquisition, the first 10 subjects were imaged twice during separate sessions. Test-retest of repeated measures was excellent (tau = 0.996, ICC = (2, 1) = 0.73 with one outlier) indicating a general consistency in imaging techniques.
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Arya S, Souza RB, Pollard CD, Sorenson SC, Salem GJ, Kulig K. Energetics of Single-Legged Hopping in the Presence of Patellar Tendinopathy. Med Sci Sports Exerc 2008. [DOI: 10.1249/01.mss.0000323025.20302.7f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sorenson SC, Arya S, Souza RB, Pollard CD, Harper KL, Paulseth SG, Salem GJ, Kulig K. Altered Knee Extensor Dynamics in the Volleyball Approach Jump: The Influence of Patellar Tendinopathy. Med Sci Sports Exerc 2008. [DOI: 10.1249/01.mss.0000321662.68874.1d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kulig K, Burnfield JM. The role of biomechanics in orthopedic and neurological rehabilitation. Acta Bioeng Biomech 2008; 10:3-14. [PMID: 19031992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Movement is fundamental to human well-being, function and participation in work and leisure activities. As a result, regaining optimal movement abilities and independence frequently become central foci of rehabilitation programs developed for individuals recovering from serious orthopedic and neurologic injuries. Further, preventing additional injury to the locomotor system becomes essential for effective long-term management of chronic medical conditions such as tendon dysfunction and diabetes. The primary aim of this perspective is to illustrate the role of biomechanics in orthopedics, musculoskeletal and neurological rehabilitation. Specifically, this paper discusses selected examples, ranging from the tissue to whole body biomechanics level, that highlight how scientific evidence from the theoretical and applied sciences have merged to address common and sometimes unique clinical problems.
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