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Bober T, Dziuba A, Kobel-Buys K, Kulig K. Gait characteristics following Achilles tendon elongation: the foot rocker perspective. Acta Bioeng Biomech 2008; 10:37-42. [PMID: 18634352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The action of three functional rockers, namely the heel, ankle and forefoot rocker, assist the progression of the leg over the supporting foot. The purpose of this case series was to analyze the occurrence of foot rockers during gait in three children with cerebral palsy (CP) who had undergone the tendo-Achilles lengthening (TAL), procedure followed by a clinic- or home-based intervention and in one child with CP without history of surgery. Self-selected gait was video-recorded in a laboratory during six testing sessions at half-year intervals rendering a 3 year period of observation. One child had pre- and post-surgical gait data and the other two had post surgical data only. Sagittal plane knee angular velocity, as well as foot to ground positions, and foot rocker occurrence were analyzed. In a child with history of CP, and without history of surgery, mean angular velocities of the 1st, 2nd and 3rd foot rocker were 3.7, 0.57 and 6.67 rad/s, respectively, and the step length and cadence were normal. In children who underwent TAL the 1st and 2nd rocker was absent, as the initial contact of the foot with the ground was either with foot-flat or forefoot. The mean velocity of the 3rd rocker in children who underwent TAL was lower by approximately 50-80% than that of the nonsurgical case. Furthermore, the characteristic pattern of the knee joint to foot-floor position during gait was not observed in these cases. Foot rocker analysis identified children with abnormal gait characteristics. Following surgery these gait characteristics remained abnormal.
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Flanagan SP, Kulig K. Assessing musculoskeletal performance of the back extensors following a single-level microdiscectomy. J Orthop Sports Phys Ther 2007; 37:356-63. [PMID: 17710904 DOI: 10.2519/jospt.2007.2366] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A descriptive and exploratory investigation of lumbar extensor performance in persons with a recent history of single-level microdiscectomy. OBJECTIVE To provide a justification for and outline the procedure of assessing lumbar extensor musculature performance. BACKGROUND The time of holding an unsupported trunk horizontally, also called the Sorensen test (ST), is often used to test the lumbar extensor endurance of healthy and patient populations, but may need to be modified for some patients. METHODS AND MEASURES Sixty-eight participants completed a modified ST procedure, along with several questionnaires and performance measures, approximately 4 to 6 weeks after a single-level microdiscectomy. Participants were classified as either able to complete or unable to complete the final position of the modified ST procedure (trunk horizontal). RESULTS Fifty-one point five percent of the participants could not attain the final position of the modified ST procedure due to either pain or perceived exertion. Those who could not attain the final position of the modified ST procedure had significantly lower scores (compared to those who could) on most measures. A majority (78.8%) of the participants in this study who were unable to complete the ST were correctly classified using the Fear-Avoidance Belief Questionnaire Work Subscale and a 24-hour activity questionnaire. CONCLUSION The ability to attain the final position of the modified ST procedure was closely associated with fear-avoidance beliefs and physical activity level, suggesting that this test may be too intense (either real or perceived) for many patients within 4 to 6 weeks following a single-level microdiscectomy.
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Kalan M, Hosein H, Fogel R, Stearns K, Kulig K, Paulson R, Sokol R. Volumetric Measurement of Pituitary Adenomas Using the Slice-O-Matic Software Program, a Novel Approach to Evaluation of Pituitary Tumors. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.01.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kulig K, Powers CM, Landel RF, Chen H, Fredericson M, Guillet M, Butts K. Segmental lumbar mobility in individuals with low back pain: in vivo assessment during manual and self-imposed motion using dynamic MRI. BMC Musculoskelet Disord 2007; 8:8. [PMID: 17261197 PMCID: PMC1794409 DOI: 10.1186/1471-2474-8-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Accepted: 01/29/2007] [Indexed: 11/17/2022] Open
Abstract
Background Altered spinal mobility is thought to be related to current or past episodes of low back pain; however evidence of that relationship in younger subjects has not been established. The purpose of this study was to compare lumbar segmental mobility in asymptomatic and symptomatic subjects during posterior to anterior (PA) manual spinal mobilization and a self-initiated prone press-up (PU) maneuver. We hypothesized that persons with central low back pain would have an altered lumbar segmental mobility pattern compared to those without pain. Method Forty-five individuals (age 32.1 ± 8.5) with non-specific low back pain and 20 persons (age 31.1 ± 7.0) without low back pain participated. Each subject underwent dynamic imaging of the lumbar spine during a PA mobilization procedure and while performing a PU. Segmental motion was quantified as the change in the intervertebral angle between the resting and end-range vertebral positions. Results The symptomatic group had a larger percentage of subjects with evidence of single level segmental hypermobility than the asymptomatic group during the PA (40.0% vs. 5%) and PU (26.7% vs. 15%) procedures. Single lumbar motion-segment analysis revealed hyper-mobility in symptomatic subjects at L5 – S1 (Chi-square = 10.0, p ≤ 0.01) and L4 – L5 (Chi-square = 4.18, p ≤ 0.05) during the PA test. Conclusion Persons with non-specific low back pain have a tendency to demonstrate single level lumbar segmental hypermobility when compared to age specific asymptomatic subjects.
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Arya S, Kulig K. MECHANICAL PROPERTIES OF THE ACHILLES TENDON IN THE PRESENCE OF TENDINOSIS. J Biomech 2007. [DOI: 10.1016/s0021-9290(07)70717-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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81
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Beneck G, Kurihara D, Garvin R, Samudrala S, Chen T, Kulig K. THE EFFECT OF AN INTENSIVE TRAINING PROGRAM ON LUMBAR MULTIFIDUS FOLLOWING MICRODISCECTOMY. J Biomech 2007. [DOI: 10.1016/s0021-9290(07)70406-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Selkowitz DM, Kulig K, Poppert EM, Flanagan SP, Matthews ND, Beneck GJ, Popovich JM, Lona JR, Yamada KA, Burke WS, Ervin C, Powers CM. The immediate and long-term effects of exercise and patient education on physical, functional, and quality-of-life outcome measures after single-level lumbar microdiscectomy: a randomized controlled trial protocol. BMC Musculoskelet Disord 2006; 7:70. [PMID: 16934143 PMCID: PMC1599723 DOI: 10.1186/1471-2474-7-70] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2006] [Accepted: 08/25/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain remains a costly quality-of-life-related health problem. Microdiscectomy is often the surgical procedure of choice for a symptomatic, single-level, lumbar disc herniation in younger and middle-aged adults. The question of whether a post-microdiscectomy exercise program enhances function, quality of life, and disability status has not been systematically explored. Thus, the overall purpose of this study is to assess immediate and long-term outcomes of an exercise program, developed at University of Southern California (USC), targeting the trunk and lower extremities (USC Spine Exercise Program) for persons who have undergone a single-level microdiscectomy for the first time. METHODS/DESIGN One hundred individuals between the ages of 18 and 60 who consent to undergo lumbar microdiscectomy will be recruited to participate in this study. Subjects will be randomly assigned to one of two groups: 1) one session of back care education, or 2) a back care education session followed by the 12-week USC Spine Exercise Program. The outcome examiners (evaluators), as well as the data managers, will be blinded to group allocation. Education will consist of a one-hour "one-on-one" session with the intervention therapist, guided by an educational booklet specifically designed for post-microdiscectomy care. This session will occur four to six weeks after surgery. The USC Spine Exercise Program consists of two parts: back extensor strength and endurance, and mat and upright therapeutic exercises. This exercise program is goal-oriented, performance-based, and periodized. It will begin two to three days after the education session, and will occur three times a week for 12 weeks. Primary outcome measures include the Oswestry Disability Questionnaire, Roland-Morris Disability Questionnaire, SF-36 quality of life assessment, Subjective Quality of Life Scale, 50-foot Walk, Repeated Sit-to-Stand, and a modified Sorensen test. The outcome measures in the study will be assessed before and after the 12-week post-surgical intervention program. Long-term follow up assessments will occur every six months beginning one year after surgery and ending five years after surgery. Immediate and long-term effects will be assessed using repeated measures multivariate analysis of variance (MANOVA). If significant interactions are found, one-way ANOVAs will be performed followed by post-hoc testing to determine statistically significant pairwise comparisons. DISCUSSION We have presented the rationale and design for a randomized controlled trial evaluating the effectiveness of a treatment regimen for people who have undergone a single-level lumbar microdiscectomy.
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Cobb P, Schwartzberg LS, Kulig K, Johns A, Fortner B. Patterns of adjuvant hormonal therapy (AHT) usage in early stage breast cancer (ESBC). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10695 Background: Aromatase inhibitors (AIs) are recommended as first line agents or after tamoxifen (T) as extended adjuvant therapy in hormone receptor positive ESBC. Little is known about adherence, adverse events, toxicity, duration of therapy, or change in agents in the community setting. Disparities between actual usage and clinical guideline recommendations could have a significant impact on outcomes. Methods: This retrospective observational study reviewed charts of 200 ESBC patients (pts) receiving AHT from 4 US community oncology clinics. To be eligible, each patient must have completed >1 patient care monitor (PCM) survey, a validated electronic self-report measure that produces indices related to physical symptoms, psychological symptoms, functional status and overall health-related QOL. Baseline symptoms and toxicities prior to initiation of AHT and during and/or after are available on all evaluable patients. Pt charts were identified consecutively in reverse chronological order starting from 3/01/05. Results: Data are available on 42 pts. The mean age of the patients was 63.6 (range 43–86). First line AHT was T in 24 and AI in 18. Of available AIs, 14 pts received anastrozole, 3 letrozole and 1 exemestane. 18 pts continue AHT as per guidelines and 7 completed planned therapy (median duration, 58.8 months). Switching from 1st line AHT to another agent occurred in 13 pts; 10 switched from TAM to an AI, mean duration of TAM 31.0 months and 3 pts to another AI. 8 pts (19%) changed for an adverse event (AE), and 5 changed due to MD/pt preference. AEs included eye problems (2), weight changes (2), GYN complaints (2), vasomotor symptoms (1), muscle/joint aches (2), and increased alkaline phosphatase (1). Of pts receiving 2nd line AHT, 4 had discontinuation for an AE: muscle/joint aches (2), vasomotor symptoms (1), and eye problems (1). Conclusion: Switching of first line AHT is common for reasons of AEs or MD/pt decision. Pts with AEs to AHT often experience additional AEs after exposure to another agent. [Table: see text]
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Kulig K, Pomrantz AB, Burnfield JM, Reischl SF, Mais-Requejo S, Thordarson DB, Smith RW. Non-operative management of posterior tibialis tendon dysfunction: design of a randomized clinical trial [NCT00279630]. BMC Musculoskelet Disord 2006; 7:49. [PMID: 16756656 PMCID: PMC1513568 DOI: 10.1186/1471-2474-7-49] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 06/06/2006] [Indexed: 11/10/2022] Open
Abstract
Background Posterior tibialis tendon dysfunction (PTTD) is a common cause of foot pain and dysfunction in adults. Clinical observations strongly suggest that the condition is progressive. There are currently no controlled studies evaluating the effectiveness of exercise, orthoses, or orthoses and exercise on Stage I or IIA PTTD. Our study will explore the effectiveness of an eccentric versus concentric strengthening intervention to results obtained with the use of orthoses alone. Findings from this study will guide the development of more efficacious PTTD intervention programs and contribute to enhanced function and quality of life in persons with posterior tibialis tendon dysfunction. Methods/design This paper presents the rationale and design for a randomized clinical trial evaluating the effectiveness of a treatment regime for the non-operative management of Stage I or IIA PTTD. Discussion We have presented the rationale and design for an RCT evaluating the effectiveness of a treatment regimen for the non-operative management of Stage I or IIA PTTD. The results of this trial will be presented as soon as they are available.
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Cleland JA, Fritz JM, Childs JD, Kulig K. 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: study protocol of a randomized clinical trial [NCT00257998]. BMC Musculoskelet Disord 2006; 7:11. [PMID: 16472379 PMCID: PMC1421401 DOI: 10.1186/1471-2474-7-11] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Accepted: 02/10/2006] [Indexed: 11/15/2022] Open
Abstract
Background Recently a clinical prediction rule (CPR) has been developed and validated that accurately identifies patients with low back pain (LBP) that are likely to benefit from a lumbo-pelvic thrust manipulation. The studies that developed and validated the rule used the identical manipulation procedure. However, recent evidence suggests that different manual therapy techniques may result similar outcomes. The purpose of this study is to investigate the effectiveness of three different manual therapy techniques in a subgroup of patient with low back pain that satisfy the CPR. Methods/Design Consecutive patients with LBP referred to physical therapy clinics in one of four geographical locations who satisfy the CPR will be invited to participate in this randomized clinical trial. Subjects who agree to participate will undergo a standard evaluation and complete a number of patient self-report questionnaires including the Oswestry Disability Index (OSW), which will serve as the primary outcome measure. Following the baseline examination patients will be randomly assigned to receive the lumbopelvic manipulation used in the development of the CPR, an alternative lumbar manipulation technique, or non-thrust lumbar mobilization technique for the first 2 visits. Beginning on visit 3, all 3 groups will receive an identical standard exercise program for 3 visits (visits 3,4,5). Outcomes of interest will be captured by a therapist blind to group assignment at 1 week (3rd visit), 4 weeks (6th visit) and at a 6-month follow-up. The primary aim of the study will be tested with analysis of variance (ANOVA) using the change in OSW score from baseline to 4-weeks (OSWBaseline – OSW4-weeks) as the dependent variable. The independent variable will be treatment with three levels (lumbo-pelvic manipulation, alternative lumbar manipulation, lumbar mobilization). Discussion This trial will be the first to investigate the effectiveness of various manual therapy techniques for patients with LBP who satisfy a CPR.
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Davenport TE, Kulig K, Resnik C. Diagnosing pathology to decide the appropriateness of physical therapy: what's our role? J Orthop Sports Phys Ther 2006; 36:1-2. [PMID: 16494067 DOI: 10.2519/jospt.2006.0101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Arya S, Solnik S, Kulig K. Influence of achilles tendinopathy on lower extremity joint stiffness strategies during single-legged hopping. J Biomech 2006. [DOI: 10.1016/s0021-9290(06)85057-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Davenport TE, Kulig K, Matharu Y, Blanco CE. The EdUReP model for nonsurgical management of tendinopathy. Phys Ther 2005; 85:1093-103. [PMID: 16180958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Tendinopathy is a common and substantial source of morbidity worldwide. Various anatomical and functional predispositions combine with abrupt changes in mechanical loading to cause characteristic histological maladaptations in tendons. The nature and latency of cellular changes in tendinopathy makes many common treatments less-than-optimal options. This Perspective presents the EdUReP model for nonsurgical management of tendinopathy, a model that considers sources of pathology at the cellular, anatomical, and functional levels. The EdUReP model addresses possible sources of symptoms at the levels of pathology, impairment, functional limitation, and disability through Educational interventions, periods of tendon Unloading and controlled Reloading, and implementation of Prevention strategies. The EdUReP model is an evidence-based treatment construct that aims to reduce functional limitation and disability through amelioration of tissue pathology.
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Davenport TE, Watts HG, Kulig K, Resnik C. Current status and correlates of physicians' referral diagnoses for physical therapy. J Orthop Sports Phys Ther 2005; 35:572-9. [PMID: 16268244 DOI: 10.2519/jospt.2005.35.9.572] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized multicenter retrospective chart review of medical referral diagnoses and corresponding referral, patient, and physician demographic data. OBJECTIVE To examine the information content of medical referral diagnoses provided to outpatient physical therapists with respect to physician and patient characteristics. BACKGROUND Previous studies indicate that physicians commonly provide nonspecific referral diagnoses to physical therapists. The effects of patient and physician characteristics on information contained in referral diagnoses are not well elucidated. METHODS AND MEASURES A team of blinded raters categorized the information content of referral diagnoses (n = 2183) using a classification system adapted from a previous study. RESULTS One third (32%) of analyzed diagnoses were anatomically oriented and reported specific pathology. These specific diagnoses were provided significantly more commonly by specialist physicians (odds ratio [OR], 3.4; 95% confidence interval [CI], 2.7-4.2; P < .001), male physicians (OR, 2.2; 95% CI, 1.6-3.1; P < .001), both early- and late-career physicians (P < .001), and for male patients (OR, 1.3; 95% CI, 1.1-1.6; P < .05). CONCLUSION Nonspecific referral diagnoses are frequently provided to physical therapists by physicians. The practice of evidence-based physical therapy seems challenged by the high rate of nonspecific referral diagnoses. Physical therapists may also have the responsibility to conduct differential diagnosis of pathology more commonly than formally recognized by many state practice acts and third-party payers.
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Blakely J, Fortner BV, Kulig K, Mao Q, Wagner S, Schwartzberg LS. Patient-reported symptom complaints associated with 5FU + irinotecan (IRI) or oxaliplatin (OXALI) in colorectal cancer (CRC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3649] [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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Beneck GJ, Kulig K, Landel RF, Powers CM. The relationship between lumbar segmental motion and pain response produced by a posterior-to-anterior force in persons with nonspecific low back pain. J Orthop Sports Phys Ther 2005; 35:203-9. [PMID: 15901121 DOI: 10.2519/jospt.2005.35.4.203] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVE To investigate the association between lumbar segmental motion and pain response during the application of a posterior-to-anterior (PA) force to the lumbar spinous processes in persons with nonspecific low back pain. BACKGROUND Although low back pain is believed to be associated with altered segmental motion of the lumbar spine, the relationship between subjective reports of pain and objective measurements of segmental motion has not been established. METHODS AND MEASURES Thirty-five individuals between 18 and 45 years of age with nonspecific low back pain (less than 3 months' duration) participated. All subjects participated in 2 separate procedures: (1) segmental motion assessment during a PA force application over the lumbar spinous processes using dynamic magnetic resonance imaging (MRI), and (2) pain assessment during a PA force application procedure outside of the MRI environment. Frequency counts were used to determine the lumbar segments that were most painful, and which functional spinal units had the most and least motion. Fisher exact tests were performed to determine if an association existed between the most painful segment and the functional spinal unit with the most or least motion. RESULTS L5 was deemed the most painful segment in nearly half of the participants (48.1%). The L1-2 and L3-4 functional spinal units most frequently had the most motion (25.9% each) and the L4-5 functional spinal units most frequently had the least motion (29.6%). No association was found between the most painful segment and the functional spinal units with either the most or least motion. CONCLUSION The results of this study indicate that an assumption regarding segmental motion cannot be inferred from the pain response when using a PA force application procedure.
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Abstract
Gastric lavage should not be employed routinely, if ever, in the management of poisoned patients. In experimental studies, the amount of marker removed by gastric lavage was highly variable and diminished with time. The results of clinical outcome studies in overdose patients are weighed heavily on the side of showing a lack of beneficial effect. Serious risks of the procedure include hypoxia, dysrhythmias, laryngospasm, perforation of the GI tract or pharynx, fluid and electrolyte abnormalities, and aspiration pneumonitis. Contraindications include loss of protective airway reflexes (unless the patient is first intubated tracheally), ingestion of a strong acid or alkali, ingestion of a hydrocarbon with a high aspiration potential, or risk of GI hemorrhage due to an underlying medical or surgical condition. A review of the 1997 Gastric Lavage Position Statement revealed no new evidence that would require a revision of the conclusions of the Statement.
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Kulig K, Burnfield JM, Reischl S, Requejo SM, Blanco CE, Thordarson DB. Effect of Foot Orthoses on Tibialis Posterior Activation in Persons with Pes Planus. Med Sci Sports Exerc 2005; 37:24-9. [PMID: 15632663 DOI: 10.1249/01.mss.0000150073.30017.46] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine the influence of footwear on tibialis posterior (TP) activation in persons with pes planus. METHODS Six asymptomatic adults with pes planus (arch index of < or =0.16) participated. Subjects performed a resisted foot adduction with plantar flexion exercise (3 sets of 30 repetitions). The exercise was performed barefoot and shod with foot orthoses. The two testing conditions were separated by a week. Magnetic resonance image signal intensity of the tibialis posterior, tibialis anterior, soleus, medial gastrocnemius, and peroneus longus was measured immediately before and after each exercise. Multivariate analyses of variance followed by paired Student's t-test were performed for the signal intensity of each muscle assessed to determine whether TP was selectively activated during the barefoot and shod exercises. RESULTS When barefoot, five of the six subjects activated other lower-leg muscles in addition to TP. When wearing the foot orthoses and shoes, all five participants activated only TP. Additionally, activation of TP was higher when exercises were performed in shoes with orthoses than when barefoot (P = 0.019). CONCLUSION Wearing the foot orthoses and shoes improved selective activation of the TP in persons with flat feet. In cases where selective activation of TP is desirable, such as persons with flat feet or TP tendon dysfunction, use of shoes and an arch supporting foot orthoses may enhance selective activation of the muscle.
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Kulig K, Nowicki P, Malawska B. Influence of the absolute configuration on pharmacological activity of antihypertensive and antiarrhythmic drugs. POLISH JOURNAL OF PHARMACOLOGY 2004; 56:499-508. [PMID: 15591637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Revised: 06/06/2004] [Indexed: 05/01/2023]
Abstract
Chirality is a fundamental property of biological systems and reflects the underlying asymmetry of matter. Interactions of drugs with receptors, enzymes or binding sites have long been known to be stereoselective, and it is increasingly recognized that both pharmacodynamic and pharmacokinetic events contribute to the overall clinically observed stereoselectivity. The pharmacological activity may reside only in one enantiomer, while the second one may be inactive or have desirable or undesirable activity. Two isomers may be nearly identical both in qualitative and quantitative aspects of pharmacological activity. The activity of particular enantiomers may differ only at the quantitative level. It is also possible that a particular enantiomer displays qualitatively different mode of action than the second one. This review describes the influence of the absolute configuration on pharmacological activity of the selected currently used or being under investigation drugs acting on cardiovascular system, especially as the antihypertensive and antiarrhythmic agents.
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Kulig K, Burnfield JM, Requejo SM, Sperry M, Terk M. Selective Activation of Tibialis Posterior: Evaluation by Magnetic Resonance Imaging. Med Sci Sports Exerc 2004; 36:862-7. [PMID: 15126722 DOI: 10.1249/01.mss.0000126385.12402.2e] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine which exercise most selectively and effectively activates tibialis posterior. METHODS Five healthy adults (two men, three women; mean age 31 yr) with an Arch Index (AI) within 1 SD from norm performed three exercises, separated by 1-wk intervals. The exercises were: 1) closed chain resisted foot adduction (foot adduction), 2) unilateral heel raise (heel raise), and 3) open chain resisted foot supination (foot supination). Magnetic resonance transaxial images were obtained immediately before and after exercise using a 1.5-T MRI system. Changes in pre-to postexercise signal intensity were compared across five muscles: tibialis posterior, tibialis anterior, medial gastrocnemius, soleus, and peroneus longus. Postexercise signal intensity was normalized to baseline preexercise signal intensity. RESULTS Tibialis posterior signal intensity increased after each exercise. The greatest TP increase (50 +/- 6%) occurred after foot adduction, whereas the mean increase in the other muscles was less than 5%. After the heel raise exercise, the signal intensity increase in TP was 27% (+/- 11%), soleus 39% (+/- 8%), peroneus longus 57% (+/- 14%), and medial gastrocnemius 99% (+/- 12%). The signal intensity of tibialis anterior decreased 4% (+/- 2%). After foot supination, the TP signal intensity increased 26% (+/- 7%), whereas the mean change in the other muscles was less than 10%. Multivariate analyses of variance revealed a significant difference in muscle activation between exercises. Posthoc analysis showed greater activation of TP during foot adduction than foot supination (P = 0.021). CONCLUSION In individuals with a normal AI, TP was activated selectively and most effectively during foot adduction. Knowledge of selective activation of a muscle is necessary to provide an optimal environment for muscle strengthening and/or tendon rehabilitation.
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Placzek JD, Roubal PJ, Kulig K, Pagett BT, Wiater JM. Theory and technique of translational manipulation for adhesive capsulitis. AMERICAN JOURNAL OF ORTHOPEDICS (BELLE MEAD, N.J.) 2004; 33:173-9. [PMID: 15132324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Manipulation of the glenohumeral joint with the patient under anesthesia has long been used as a treatment modality for refractory shoulder stiffness. Recently, translational manipulation of the glenohumeral joint under interscalene brachial plexus regional block has been shown to be efficacious in the treatment of adhesive capsulitis and to present a low risk of iatrogenic injury. The theory and technique of glenohumeral translational manipulation for the treatment of adhesive capsulitis are presented here.
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Kulig K, Landel R, Powers CM. Assessment of lumbar spine kinematics using dynamic MRI: a proposed mechanism of sagittal plane motion induced by manual posterior-to-anterior mobilization. J Orthop Sports Phys Ther 2004; 34:57-64. [PMID: 15029938 DOI: 10.2519/jospt.2004.34.2.57] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Descriptive study. OBJECTIVE The purpose of this study was to describe the segmental motion of the lumbar spine during a posterior-to-anterior (PA) mobilization procedure using dynamic magnetic resonance imaging and to propose a mechanism of the lumbar spine's motion as a result of a PA force to a lumbar spinous process. BACKGROUND Studies reporting kinematic descriptions of PA mobilization are in agreement that motion takes place at all lumbar vertebrae. However, these studies differ in the reported direction of motion. METHODS AND MEASURES Twenty asymptomatic subjects (mean age +/- SD, 31.1 +/- 7.0 years) participated in this study. For each subject, a PA mobilization force was manually applied at each lumbar spinous process while sagittal plane magnetic resonance images were simultaneously obtained. Intervertebral motion was defined as the change in the intervertebral angle between the resting and end range vertebral positions imparted by the PA pressure. RESULTS PA force applied at 1 spinous process caused motion at the target vertebra and this motion was propagated caudally and cranially. Motion at the target segment was always into extension. CONCLUSIONS A PA force applied at a single lumbar spinous process caused motion of the entire lumbar region. The magnitude and direction of intervertebral motions varied with the segment at which the PA force was applied. We postulated that the intervertebral motion induced by a PA force on a spinous process could be in part explained by the morphology of the lumbar spine.
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Doubleday KL, Kulig K, Landel R. Treatment of testicular pain using conservative management of the thoracolumbar spine: a case report11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2003; 84:1903-5. [PMID: 14669201 DOI: 10.1016/s0003-9993(03)00283-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Unsuccessful recognition of the origin of testicular pain and a high failure rate of surgical interventions lead to poor outcomes, psychologic distress, and increased costs of care. A frequently overlooked cause of testicular and buttock pain is irritation of the T10-L1 sensory nerve roots, the genitofemoral nerve, and the ilioinguinal nerve. We present the case of a 36-year-old policeman with a 5-year history of back pain and testicular pain of unknown origin. Physical examination of the thoracolumbar region revealed that active movement provoked the patient's buttock symptoms, and local mobility restrictions were present in the thoracolumbar region. A central disk protrusion at T12-L1 was noted on upper lumbar spine magnetic resonance imaging, which supports dysfunction of this region. The diagnosis of thoracolumbar stiffness led to implementation of passive and active mobilization of that region and to specific hip stretching and strengthening exercises. After a course of direct and guided physical therapy, the patient attained complete symptom resolution. The patient returned to full work duties as a police officer and resumed his full recreational activity. The excellent outcome achieved in managing this patient was attributed to identifying the origin of referred pain from the thoracolumbar junction.
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Powers CM, Kulig K, Harrison J, Bergman G. Segmental mobility of the lumbar spine during a posterior to anterior mobilization: assessment using dynamic MRI. Clin Biomech (Bristol, Avon) 2003; 18:80-3. [PMID: 12527251 DOI: 10.1016/s0268-0033(02)00174-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To quantify segmental mobility of the lumbar spine during a posterior to anterior spinal mobilization procedure. DESIGN Descriptive study using dynamic magnetic resonance imaging. BACKGROUND The posterior to anterior spinal mobilization procedure is frequently used in the assessment and management of spinal dysfunction. How this procedure influences segmental spinal motion however, is not known. METHODS Eleven asymptomatic subjects were positioned prone within a vertically open double donut design magnetic resonance imaging system. An anteriorly directed force was applied manually at each lumbar spinous process while magnetic resonance images were obtained continuously in the sagittal plane. The intervertebral angle was used to quantify segmental motion. RESULTS The direction of motion at the tested segment was always extension, with values ranging from 1.2 (SD 2.2) at L2 to 3.0 (SD 2.3) degrees at L5. When the force was applied at L3, L4 and L5, the non-tested (adjacent) segments also were observed to move into extension. However, when the posterior to anterior force was applied at L1 and L2 the three caudal segments moved into flexion. CONCLUSIONS Posterior to anterior spinal mobilization consistently caused extension at the tested segment, while the motion of the collective lumbar spine was either an increase or decrease in lordosis depending on the segment at which the force was applied. RELEVANCE Passive movement techniques are commonly used to identify the symptomatic lumbar segment(s) and can be used as a treatment aimed at increasing mobility and/or decreasing pain. Knowledge of how this procedure influences segmental motion of healthy spines is important in understanding how altered mobility is related to symptoms.
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Requejo SM, Barnes R, Kulig K, Landel R, Gonzalez DS. The use of a modified classification system in the treatment of low back pain during pregnancy: a case report. J Orthop Sports Phys Ther 2002; 32:318-26. [PMID: 12113466 DOI: 10.2519/jospt.2002.32.7.318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case study. OBJECTIVE To describe the use of a classification approach in the evaluation and treatment of a pregnant patient with low back pain (LBP). BACKGROUND The patient was a 28-year-old primigravida in her 20th week of pregnancy. She presented with a chief complaint of LBP without precipitating trauma. Her pain limited her sitting to 20 minutes or less and restricted her ability to bend forward. METHODS AND MEASURES This patient was treated 4 times during a period of 2 weeks. The patient was classified as stage 1 extension syndrome. Because of the patient's pregnancy, treatment with active extension exercises commonly prescribed for this syndrome was deemed inadequate. Therefore, manual joint mobilization was applied to the symptomatic vertebral segment. Additional intervention included moist heat, soft tissue mobilization to the thoracolumbar paraspinals, manual stretching of the hip flexors, abdominal bracing, and wall squat exercises. RESULTS After 4 treatments, the patient was able to bend forward without pain, sit longer than 1 hour without discomfort, and work with minimal discomfort. She improved from a stage 1 classification to a stage 3 classification. CONCLUSION This case illustrates the use of a classification system to guide physical therapy intervention. It also demonstrates an effective and safe use of manual techniques in the treatment of a pregnant patient.
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