Prophylactic ankle bracing reduces rearfoot motion during sudden inversion

The purpose of this study was to evaluate the effects of ankle bracing on rearfoot angular displacement and angular velocity during a sudden inversion movement. A 1 x 3 factorial design was used. The single independent variable was ankle brace condition with three levels: semi-rigid, lace-up and control. The two dependent variables were rearfoot average angular displacement and average angular velocity. Twenty-four healthy volunteers participated in this study. A motion analysis system was used to capture, model and calculate two-dimensional rearfoot motion while the subjects' ankle/foot complex was inverted to 35 degrees on a platform device. All subjects performed five trials of each ankle brace condition, and the average of these trials was used for statistical analysis. The semi-rigid brace significantly reduced rearfoot angular displacement and angular velocity compared with the lace-up (P<0.05) and control conditions (P<0.05). Additionally, the lace-up style brace demonstrated significantly less rearfoot angular displacement and angular velocity compared with the control condition (P<0.05). These results demonstrate that a semi-rigid ankle brace is more superior then a lace-up style brace in limiting rearfoot angular displacement and angular velocity. Moreover, the lace-up style brace offers significant restriction of these measures compared with no support.

Arthrogenic muscle response to a simulated ankle joint effusion

BACKGROUND

Arthrogenic muscle inhibition (AMI) is a continuing reflex reaction of the musculature surrounding a joint after distension or damage to the structures of that joint. This phenomenon has been well documented after knee joint injury and has been generalised to occur at other joints of the human body, yet minimal research has been conducted in this regard. The response of the muscles crossing the ankle/foot complex after ankle injury and effusion is not well understood. AMI may occur after an ankle sprain contributing to residual dysfunction.

OBJECTIVE

To determine if AMI is present in the soleus, peroneus longus, and tibialis anterior musculature after a simulated ankle joint effusion.

METHODS

Eight neurologically sound volunteers (mean (SD) age 23 (4) years, height 171 (6) cm, mass 73 (10) kg) participated. Maximum H-reflex and maximum M-wave measurements were collected using surface electromyography after delivery of a percutaneous stimulus to the sciatic nerve before its bifurcation into the common peroneal and posterior tibial nerves.

RESULTS

The H-reflex and M-wave measurements in all muscles increased (p< or =0.05) after the simulated ankle joint effusion.

CONCLUSIONS

Simulated ankle joint effusion results in facilitation of the soleus, peroneus longus, and tibialis anterior motoneurone pools. This may occur to stabilise the foot/ankle complex in order to maintain posture and/or locomotion.

Peroneus longus stretch reflex amplitude increases after ankle brace application

BACKGROUND

The use of external ankle support is widespread throughout sports medicine. However, the application of ankle bracing to a healthy ankle over a long period has been scrutinised because of possible neuromuscular adaptations resulting in diminished dynamic support offered by the peroneus longus.

OBJECTIVE

To investigate the immediate and chronic effects of ankle brace application on the amplitude of peroneus longus stretch reflex.

METHODS

Twenty physically active college students (mean (SD) age 23.6 (1.7) years, height 168.7 (8.4) cm, and mass 69.9 (12.0) kg) who had been free from lower extremity pathology for the 12 months preceding the study served as subjects. None had been involved in a strength training or conditioning programme in the six months preceding the study. A 3 x 3 x 2 (test condition x treatment condition x time) design with repeated measures on the first and third factor was used. The peroneus longus stretch reflex (% of maximum amplitude) during sudden foot inversion was evaluated under three ankle brace conditions (control, lace up, and semi-rigid) before and after eight weeks of ankle brace use.

RESULTS

A 3 x 3 x 2 repeated measures analysis of variance showed that peroneus longus stretch reflex amplitude increased immediately after application of a lace up brace (67.1 (4.4)) compared with the semi-rigid (57.9 (4.3)) and control (59.0 (5.2)) conditions (p<0.05). Peroneus longus stretch reflex also increased after eight weeks of use of the semi-rigid brace compared with the lace up and control conditions (p<0.05).

CONCLUSIONS

Initial application of a lace up style ankle brace and chronic use of a semi-rigid brace facilitates the amplitude of the peroneus longus stretch reflex. It appears that initial and long term ankle brace use does not diminish the magnitude of this stretch reflex in the healthy ankle.

Intra- and intersession reliability of acoustic rhinometry in measuring nasal cross-sectional area

We evaluated the intrasession and intersession reliability of acoustic rhinometry in measuring nasal cross-sectional areas in 10 subjects. Subjects were measured under three conditions: with a Breathe Right nasal strip in place, with a sham strip in place, and with no strip in place. Two sets of three measurements were taken 1 week apart. The intrasession reliability both with and without the Breathe Right strip was very good (intraclass correlation coefficient [ICC] [2,1]: 0.97 and 0.98, respectively). The intersession reliability with and without the Breathe Right strip was not nearly as good (ICC [2,1]: 0.62 and 0.67). The Breathe Right strip increased the mean nasal cross-sectional area by 0.10 cm2 (17.4%). We conclude that acoustic rhinometry is a reliable way to measure nasal cross-sectional area during a single session of multiple tests, but it is not as reliable across sessions. We also determined that the Breathe Right nasal strip significantly increases nasal cross-sectional area.

The relationship between intramuscular temperature, skin temperature, and adipose thickness during cryotherapy and rewarming

OBJECTIVE

To describe the relationships among muscle temperature, skin temperature, room temperature, body core temperature, time, and subcutaneous adipose thickness during cryotherapy and rewarming.

DESIGN

A multiple linear regression with 5 independent variables (skin temperature, body core temperature, subcutaneous adipose thickness, room temperature, time) predicting intramuscular (IM) temperature.

SETTING

A sports injury research laboratory.

PARTICIPANTS

Fifteen volunteers with thigh skinfold measurements smaller than 40 mm.

INTERVENTIONS

Thirty-minute cryotherapy treatment (ice bag) followed by a 120-minute rewarming period.

MAIN OUTCOME MEASURES

The relationship between skin and IM temperature was described, and an equation predicting IM temperature by using room temperature, skin temperature, body core temperature, time, and adipose thickness was developed.

RESULTS

Pearson's correlations between each predictor variable of IM temperature during cryotherapy were skin temperature, r = .46; skinfold, r = .37; time, r = -.59; core temperature, r =.21; and room temperature, r = -.47. During rewarming, the correlations were skin temperature, r = .71; skinfold, r = .27; time, r = .76; core temperature, r = - .05; and room temperature, r = - .21. A multiple regression equation (R(2) = .76) was developed to predict IM temperature during cryotherapy. A separate equation (R(2) =.81) was developed to predict muscle temperatures during rewarming.

CONCLUSIONS

During and after ice application, no single predictor adequately explained the change in IM temperature. Skin surface temperature was a weak predictor of IM temperature during cryotherapy and should not be used as the sole dependent measure in cryotherapy efficacy studies.

Effects of shoe sole thickness on joint position sense

The objective of this study was to determine the effects of shoe sole thickness on joint position sense in the sagittal and frontal plane by determining the estimate angle error. Joint position sense was measured by manipulating angle and direction of a slope surface board (30 cm x 30 cm x 1.5 cm) to perform the movements of dorsiflexion, plantar flexion, inversion and eversion. Sandwiching wooden wedges with pre-determined angles between 0 and 25 degrees between the slope surface boards made the slope surface angles. Twenty healthy college male students were asked to estimate the angle and direction of movements under each of the shod conditions while standing on the slope surface board. Estimate angle error was calculated for each movement under all shod conditions. For all shod conditions, estimate angle error was the greatest for plantar flexion and inversion compared to dorsiflexion and eversion. Independent of shod condition, subjects had the most difficulty estimating plantar flexion and inversion movements.

Effect of knee joint effusion on quadriceps and soleus motoneuron pool excitability

PURPOSE

To examine changes in quadriceps and soleus MN pool activity resulting from knee joint effusion over a 4-h period and assess the relationship between the muscles.

METHODS

A repeated measures before-after trial design was used for this study. Eight, neurologically sound volunteers (age 23.3+/-2.1 yr, height 171.8+/-15.9 cm, mass 65.5+/-17.7 kg) participated in this study. An area superomedial to the patella was cleaned and anesthetized, and 30 mL of sterile saline was injected into the knee joint capsule to mimic mechanical joint effusion. The Hoffman reflex (H-reflex) was elicited by applying a percutaneous stimulus to the appropriate nerve and recording the response through surface electromyography. Soleus and vastus medialis H-reflex measures were collected from each volunteer before, at 30 min, 90 min, 150 min, and 210 min intervals over a 4-h period after knee effusion.

RESULTS

All soleus H-reflex measures after effusion (30 min 5.89+/-0.92 V; 90 min 6.16+/-0.48 V; 150 min 6.59+/-0.50 V; 210 min 6.70+/-0.56 V) were increased in relation to the preeffusion measure (5.01+/-0.79 V). All vastus medialis H-reflex measures after effusion (30 min 4.23+/-0.94 V; 90 min 4.15 +/-1.11 V; 150 min 4.16+/-0.57 V; and 210 min 4.99+/-1.23) were decreased in relation to the preeffusion measure (5.88+/-1.44 V; P < or = 0.05).

CONCLUSIONS

Afferent activity from the knee joint capsule resulted in an inhibitory effect on the vastus medialis and a facilitatory effect on the soleus. Facilitation of the soleus in cooperation with other lower extremity musculature could be a mechanism for compensation of the inhibited quadriceps to maintain lower kinetic chain function.

Long-term ankle brace use does not affect peroneus longus muscle latency during sudden inversion in normal subjects

OBJECTIVE

External ankle supports are widely used in sports medicine. However, ankle bracing in a healthy ankle over a sustained period has been scrutinized due to possible neuromuscular adaptations resulting in diminished dynamic support offered by the peroneus longus muscle. Although this claim is anecdotal in nature, we sought to investigate the effects of long-term ankle bracing using 2 commonly available appliances on peroneus longus latency in normal subjects. Our second purpose was to evaluate the effects of ankle bracing on peroneus longus latency before a period of extended use.

DESIGN AND SETTING

A 3 x 3 x 2 design with repeated measures on the first and third factors was used in this study. All data were collected in the Sports Injury Research Laboratory.

SUBJECTS

Twenty (12 men and 8 women) physically active college students (age = 23.6 +/- 1.7 years; height = 168.7 +/- 8.4 cm; weight = 69.9 +/- 12.0 kg) free of ankle or lower extremity injury in the 12 months before the study and not involved in a strength-training or conditioning program in the 6 months before the study.

MEASUREMENTS

We evaluated peroneus longus latency by studying the electromyogram of the muscle after sudden foot inversion.

RESULTS

Application of a lace-up or semirigid brace did not affect peroneus longus latency. Additionally, 8 weeks of longterm ankle appliance use had no effect on peroneus longus latency.

CONCLUSIONS

The duration of the peroneus longus stretch reflex (latency) is neither facilitated nor inhibited with extended use of an external ankle support. Proprioceptive input provided by the muscle spindles within the peroneus longus does not appear to be compromised with the long-term use of ankle braces.

Changes in soleus motoneuron pool excitability after artificial knee joint effusion

OBJECTIVE

To compare changes in the magnitude of soleus motoneuron excitability before and over a 4-hour period following artificial knee effusion.

DESIGN

Before-after trial.

SETTING

All measurements were collected in the Sports Injury Research Laboratory, Indiana State University.

PARTICIPANTS

Eleven healthy and neurologically sound volunteers (mean age +/- SD, 24 +/- 3yr; height, 173.2 +/- 9.6cm; weight, 72.9 +/- 8.7kg) with no history of lower-extremity surgery and no lower extremity pathology in the last year.

INTERVENTIONS

An area superolateral to the patella was cleaned and injected subcutaneously with 2mL of lidocaine for anesthetic purposes. With a second disposable syringe, 25mL of sterile saline was injected through the superolateral knee joint capsule into the joint space to mimic mechanical joint effusion.

MAIN OUTCOME MEASURE

Hoffmann's reflex (H-reflex) was elicited by applying a percutaneous stimulus to the tibial nerve in the popliteal fossa. Seven to 12 stimuli were delivered at 20-second intervals with varying intensities to find the maximal H-reflex. The maximal H-reflex was measured five times at the same stimulus intensity with 20-second rest intervals. This measurement was recorded before injection and at 1-hour intervals following the injection for 4 hours.

RESULTS

An overall difference between groups was found. Measurements from hours 3 and 4 were significantly higher than the preinjection measurements (p < or = .05).

CONCLUSIONS

The soleus motoneuron pool was not inhibited as expected. The soleus was facilitated beyond the preinjection level, showing that the quadriceps and soleus do not respond in the same way to artificial knee effusion. Because the quadriceps are normally inhibited during knee effusion, this facilitation could be the result of a compensatory reaction by the soleus in response to inhibited quadriceps. Further studies must be performed to determine the extent and duration of soleus motoneuron pool excitability in relation to quadriceps inhibition elicited by artificial knee effusion.

Influence of ankle support on joint range of motion before and after exercise: a meta-analysis

STUDY DESIGN

Meta-analysis.

OBJECTIVE

To evaluate the effects of different types of ankle support on ankle and foot joint range of motion before and after activity using meta-analysis procedures.

BACKGROUND

The effects of ankle support on joint range of motion before and after exercise has been extensively studied, but the results among studies are not consistent. Obtaining knowledge from synthesizing the available literature with a meta-analysis can provide a greater understanding of these effects.

METHODS AND MEASURES

A total of 253 cases from 19 studies were examined and included in this analysis. The treatment variables were ankle support with 3 levels (tape, lace-up, and semirigid) and time with 2 levels (before exercise and after exercise). Standardized effect sizes were computed for inversion, eversion, dorsiflexion, and plantar flexion range of motion to measure the difference between control and treatment groups at each point in time. Effect sizes were analyzed using a mixed-model factorial analysis of variance.

RESULTS

Before exercise, the semirigid condition (-2.97 +/- 0.63) demonstrated greater restriction compared with the tape (-2.33 +/- 0.38) and lace-up conditions (-2.18 +/- 0.86) for inversion range of motion. After exercise, the semirigid condition (-3.85 +/- 0.64) restricted inversion range of motion more than the tape (-1.07 +/- 0.20) and lace-up (-1.56 +/- 0.29) conditions. No differences were found between the mean effect sizes for the tape and lace-up conditions before and after exercise. With respect to eversion range of motion, the semirigid support (-2.69 +/- 0.43) provided greater restraint compared with the tape (-1.00 +/- 0.21) and lace-up (-1.40 +/- 0.47) conditions. The lace-up condition also displayed greater support compared with tape alone. For dorsiflexion range of motion, greatest overall support was provided by the tape condition (-0.94 +/- 0.06) compared with the lace-up condition (-0.51 +/- 0.06).

CONCLUSIONS

The greatest restriction of motion in the frontal plane was offered by the semirigid support condition, whereas taping offered the most support for limiting dorsiflexion range of motion. The results of this study may help clinicians make rational decisions concerning the selection of ankle appliances for preventing acute or chronic reinjury.

Intrasession and intersession reliability of the soleus H-reflex in supine and standing positions

The Hoffmann reflex (H-reflex) is a measure of motoneuron pool excitability, which is valuable in determining muscle inhibition caused by joint damage (arthrogenic muscle inhibition). In order to detect changes in H-reflex due to injury, the reliability of such a measurement must be established. The purpose of this study was to establish the intrasession and intersession reliability of soleus H-reflex in a supine and standing position. Thirteen healthy volunteers (age 10 +/- 2.63 yr, height 171.35 +/- 10.19 cm, mass 69.62 +/- 13.03 Kg) with no lower extremity orthopedic or neurological disorders within the past year participated in this study. To determine the intrasession and intersession reliability of this measure in a supine resting position and a one-leg standing position, EMG data were collected from the soleus while the tibial nerve was stimulated in the popliteal space. A high voltage (120-200 V), short duration (1.0 msec) stimulus was automatically triggered, eliciting a reflex twitch detected by surface EMG. Several of these measurements were performed with 20 second rest intervals to find the maximum H-reflex. The maximum H-reflex was located by adjusting the intensity of the stimulus. Once a maximum H-reflex was found, 12 measurements were taken in that position with 20 second rest intervals. These steps were repeated for each position (supine and standing) at the same time for 5 consecutive days. Intrasession reliability was computed using 12 measurement trials (12), 12 measurement trials dropping the high and low score (12x), the first 7 measurement trials dropping the high and low score (7x), and the first 5 measurement trials (5). Intrasession and intersession reliability over five consecutive days was estimated using intraclass correlation coefficients (ICC (3, 1)). The supine intrasession reliability measurements were as follows: 0.932 (12), 0.932 (12x), 0.935 (7x), and 0.932 (5). The standing intrasession reliability was 0.853 (12), 0.852 (12x), 0.865 (7x), and 0.862 (5). The intersession reliability was 0.938 in the supine position and 0.803 in the standing position. These results indicate that the H-reflex measured using our protocol in a supine and standing position is a reliable assessment within sessions and between sessions. Five measurements are sufficient to observe reliable measurements within a single session. Most importantly, this data shows that the H-reflex is a reliable assessment that may be used to measure small changes in motoneuron pool excitability over time.

An electromyographic comparison of 4 closed chain exercises

OBJECTIVE

Closed chain exercises are used in the clinical setting to safely strengthen the muscles about the knee. We compared the EMG activity of 3 muscles (vastus lateralis, vastus medialis, and biceps femoris) during 4 closed chain exercises (unilateral one-quarter squat, lateral step-up, FlexCord front pull, and FlexCord back pull) to determine which exercise produced the most muscle activity.

DESIGN AND SETTING

We used a 4 x 3 x 2 factorial design with repeated measures on exercise, muscle, and movement (knee flexion and extension). Muscle and movement were the control variables for post hoc comparisons. Data were collected in a sports injury research laboratory.

SUBJECTS

Thirty-eight healthy, active female college students aged 21.97 +/- 2.8 years, with height 166.9 +/- 6.3 cm and weight 61.9 +/- 8.5 kg. Subjects had no history of lower extremity pathology that resulted in surgery and no lower extremity pathology within the last year.

MEASUREMENTS

We placed surface electrodes on the vastus lateralis, vastus medialis, and biceps femoris muscles. Synchronized with a metronome, subjects performed 3 repetitions of 4 exercises between 5 degrees and 30 degrees of knee flexion. Electromyographic measurements were taken from the middle third of the flexion and extension phase of each repetition.

RESULTS

The FlexCord front pull and back pull produced higher levels of biceps femoris activity than the quarter squat and step-up. The FlexCord front pull also produced a higher level of vastus medialis activity during knee extension than the quarter squat, lateral step-up, or FlexCord back pull.

CONCLUSIONS

The high levels of biceps femoris activity during the FlexCord exercises indicate that a greater cocontraction exists. With a greater cocontraction, the FlexCord exercises could be safely used during ACL rehabilitation. The high levels of vastus medialis activity during the FlexCord front pull suggest that it may be a beneficial exercise for patellofemoral rehabilitation.

Developing scholarship in athletic training

OBJECTIVE

To outline the essential elements of scholarship, identify its role in the development of the athletic training profession, and encourage athletic trainers to increase scholarly activities.

BACKGROUND

In the process of writing 2 manuscripts for the Journal of Athletic Training about how to write journal manuscripts, we felt something needed to be said concerning why one should write such manuscripts and how individual manuscripts should tie together to advance knowledge. This led us to search the scientific literature for information concerning scholarship and its attainment. Finding no comprehensive discussion on the topic, we then began to investigate components of scholarship and activities that lead to its attainment.

DESCRIPTION

Scholarship, knowledge, truth, and theory are defined. The attributes or characteristics of a scholar delineated and discussed include seeking to establish truth and develop new knowledge, developing and refining theory, being focused in one's work, being honest about one's work, communicating ideas and stirring thinking, being open minded, and recognizing the difference between scholarship and pseudoscholarship. It is important to promote scholarship among undergraduate and graduate students; numerous suggestions are outlined.

APPLICATION

Scholarship is essential to our survival as a profession. The guidelines presented here will help individuals examine and improve their scholarship.

Comparison of the effects of selected dressings on the healing of standardized abrasions

OBJECTIVE

To find out which type of dressing (semipermeable film, hydrocolloid, conventional method, or no dressing) allowed abrasions to heal in the least amount of time and had the greatest decrease in wound area.

DESIGN AND SETTING

A 4 x 9 factorial was used for this study. There were two independent variables with four levels and two dependent variables. Research was performed at the Athletic Training Research Laboratory at Indiana State University.

SUBJECTS

Fourteen subjects (eight males, six females), ages 23 to 34 years, participated in this study.

MEASUREMENTS

From daily photographs, the day the wounds were healed was determined. The photographs were also used to measure wound area on the first and last days of the study. Subjects received four treatments (dressings and control), and placement of the dressings was determined by random assignment.

RESULTS

Data were analyzed using a repeated-measures multivariate analysis of variance to determine if differences existed among treatment groups for healing time and change in area. Student-Newman-Keuls post hoc testing was performed to determine specifically where the differences occurred. Our results indicate that healing time is affected by covering the wound, and area is decreased by using DuoDerm or Bioclusive.

CONCLUSIONS

Bioclusive should be used in the athletic training setting. Bioclusive and DuoDerm are equally effective, but Bioclusive is less expensive. Bioclusive is more expensive than Coverlet, but it is also more effective in reducing the area of the wound.

Effect of patellar taping and bracing on patellar position as determined by MRI in patients with patellofemoral pain

OBJECTIVE

To determine the effects of patellar taping, bracing, and not taping on patellar position.

DESIGN AND SETTING

An experimental design was used to compare patellar taping, bracing, and not taping on patellar position as determined by magnetic resonance imaging (MRI).

SUBJECTS

Twelve subjects with a diagnosis of patellofemoral pain participated in this study.

MEASUREMENTS

Static MRI images were taken at 8 angles of knee flexion (10, 16, 25, 30, 34, 39, 41, and 45 degrees ). Patellofemoral congruence angle (PFC), lateral patellar displacement (LPD), and lateral patellar angle (LPA) were determined by digitization.

RESULTS

A repeated-measures multivariate analysis of variance was used to compare experimental conditions. Across all angles of knee flexion, a more lateral PFC existed for the control condition (-4.1 degrees ) than the brace condition (-7.1 degrees ) or tape condition (-6.1 degrees ). Post hoc testing revealed that this difference was statistically different only at 10 degrees of knee flexion. Across all knee angles, LPD was more medial for the braced condition (1.7 mm) than for the tape (2.7 mm) or control (2.6 mm) condition. Post hoc testing revealed that this difference was statistically different only at 10 degrees of knee flexion. No differences existed between conditions for LPA.

CONCLUSIONS

We conclude that patellar bracing and taping influenced patellar position (PFC and LPD) at 10 degrees of knee flexion during a static MRI condition.

The effects of selected ankle appliances on postural control

OBJECTIVE

Although ankle braces supposedly protect the ankle by providing mechanical support of the joint and enhancing proprioceptive input, their proprioceptive effects are unclear. Measuring the center of pressure during posture provides a reasonably well-controlled evaluation of proprioceptive input at the ankle. We, therefore, compared the changes in the center of pressure resulting from wearing ankle braces and wearing no brace (control).

DESIGN AND SETTING

Center-of-pressure variables were measured during a one-legged modified Romberg test with six variations. The six test conditions systematically altered the three sensory modalities that control posture: visual input, vestibular input, and proprioceptive input. Subjects performed three 16-second trials of each Romberg variation for each brace condition.

SUBJECTS

Twenty-four male volunteers (age = 18 to 26 yr) with no history of ankle injuries in the past 5 years and no difficulty with balance.

MEASUREMENTS

Center of pressure, transmitted through the bottom of the foot, was monitored during each trial and transformed into total distance traveled, anterior-posterior (AP) position, and medial-lateral (ML) position.

RESULTS

Average AP and ML center-of-pressure positions were increased only during brace wearing when all sensory modalities were functioning normally (control condition). Total center-of-pressure distance was the same for all three brace conditions.

CONCLUSIONS

Our results do not support or refute the concept that bracing enhances proprioception. The fact that subjects relocated their center of pressure only during the control condition is perplexing. If braces were to enhance proprioception, one would expect to see lower average ML and average AP center-of-pressure values when comparing the braced with the unbraced conditions. Alternatively, the relocated position may represent a more stable position resulting from enhanced proprioception.

Optimizing scholarly communication: 30 tips for writing clearly

OBJECTIVE

To share with potential authors tips for communicating their ideas more clearly in a scholarly manuscript.

DESCRIPTION

Communicating scientific, technical, or medical information so that readers can understand its meaning requires logical organization and proper use of language. These 30 tips review basic English grammar and suggest ways authors can clearly and concisely present their material. We admonish authors to avoid common errors such as writing in the passive voice, overusing abbreviations, and emphasizing unimportant facts.

CONCLUSION

Attention to matters of writing style enhances clear communication, which must be the prime objective of scientific writing.

Structure of a scholarly manuscript: 66 tips for what goes where

OBJECTIVE

TO SHARE WITH POTENTIAL AUTHORS TIPS FOR CONSTRUCTING A SCHOLARLY MANUSCRIPT AND FOR ORGANIZING INFORMATION IN VARIOUS TYPES OF SCHOLARLY MANUSCRIPTS: experimental reports, literature reviews, case reports, and clinical techniques.

DESCRIPTION

The goal of writing a scientific/technical/ medical article is to communicate new information that hopefully has clinical relevance and will improve health care. This information must be organized and presented clearly and logically. We present 66 tips for organizing a scholarly manuscript. We tell not only what goes where in the manuscript but also how to construct each of the elements so as to logically communicate the author's message. The tips are numbered to facilitate referencing.

CONCLUSION

By becoming familiar with these tips, potential authors can avoid making mistakes that may hinder publication of their manuscripts.

Cooling does not affect knee proprioception

The effect of cooling on proprioception of the knee has not been studied extensively. In this study, we investigated the movement reproduction (timing and accuracy) aspect of proprioception. Subjects were tested under two conditions: a 20-minute application of ice and control. Proprioceptive accuracy and timing were measured by passively moving the knee, then comparing the subject's active reproduction of the passive movement. Subjects were blindfolded, then tested in three sectors of the knee's range of motion: 90 degrees to 60 degrees , 60 degrees to 30 degrees , and 30 degrees to full extension. Ice application had no apparent effect on the subject's ability to perform accurate movement reproductions in the sectors tested. However, accuracy of the subject's final angle reproduction varied between the sectors as did the total time of the movement. One possible explanation for the difference between sectors is that different receptors are active at different points in the knee's range of motion. We conclude that cooling the knee joint for 20 minutes does not have an adverse effect on proprioception.

A comparison of isokinetic and isotonic predictions of a functional task

Controversy still exists regarding the use of isokinetic and isotonic exercise in rehabilitation. Many authors have compared these two types of training methods on various strength measures and functional activity, but have used open kinetic chain training. The purposes of this investigation were to determine: 1) which form of closed kinetic chain training, isokinetic or isotonic, would produce the greatest increase in one-legged jump reaction force, and 2) which training method most accurately predicts peak force produced during a one-legged jump. Forty-two legs from 21 female volunteer subjects were used. Each subject had her dominant and nondominant extremities identified, and then each extremity was randomly assigned to either isokinetic training, isotonic training, or control. Both training groups trained using a leg press exercise 3 days a week for 5 weeks, while the control extremities did not train. The isokinetic extremities were trained using a velocity spectrum (two sets of 10 repetitions at each speed: 60 degrees , 180 degrees and 240 degrees /sec) and the isotonic extremities trained using the DAPRE technique. Data were analyzed with an analysis of variance (ANOVA). There was no difference between the three groups for change in one-legged jump force. Both isokinetic and isotonic groups increased strength after training, but these changes did not correlate with changes in one-legged jump reaction force. These results suggest that changes in neither isokinetic force nor isotonic weight lifted developed in a nonweight-bearing closed kinetic chain, directly translate into increased force production during a functional activity.

Sensory information can decrease cold-induced pain perception

Specific terms are often used to describe the pain athletes typically experience during cold treatments. It is not clear whether providing athletes with such descriptive sensory information will decrease their perceived pain during treatments. The purpose of this study was to determine if subjects' perceptions of cold-induced pain could be influenced by the type of information provided before treatment, such as "pain will be cursing" or "pain will be flickering." Ninety Division I intercollegiate athletes were randomly assigned to one of five groups: traditional terms (cold, burning, aching, numbness), high-level terms (freezing, crushing, pounding, heavy), moderate-level terms (cold, gnawing, pulsing, aching), or low-level terms (cool, pinching, flickering, dull) from the McGill Pain Questionnaire, or no terms at all (control). The four groups that received a set of terms were told that those terms described the sensations they would feel during cold immersion of the ankle. Pain was measured with the McGill Pain Questionnaire every 3 minutes during a 21-minute immersion (1 degrees C) of the foot and ankle. Sensory, affective, evaluative, and miscellaneous pain measures were derived. The control group experienced greater sensory and affective pain than did any of the other groups and experienced greater evaluative pain than did the groups receiving low-level or traditional terms. We conclude that providing athletes with some type of sensory information to describe their cold-pain experience will decrease their perceived pain during cold immersion, although it does not seem to matter what terms are used.

Hip isometric strength following knee surgery

Hip exercises are frequently prescribed following knee injury and subsequent surgery based on the assumption that hip weakness exists. No data, however, are available that support hip weakness following knee trauma or surgery. Therefore, the purpose of this study was to compare hip strength in patients after knee surgery. Twenty-seven patients who had undergone unilateral knee surgery were tested for hip flexor, extensor, abductor, and adductor isometric strength prior to initiation of rehabilitation. Multivariate analysis of variance revealed significant hip weakness in all four hip muscle groups of the surgical extremities (11.9-25.3%, p < or = 0.05) when compared with nonsurgical extremities. Both peak and endurance force were affected. The greatest percent difference between the surgical and nonsurgical extremity occurred for hip extension peak (25.3%) and endurance (22.6%) force development. We recommend assessment of hip strength following knee surgery and appropriate resistive exercises if weakness exists.

Long term effects of closed head injuries in sport

Closed head injury has been defined by several authors, but is not agreed upon. The incidence of closed head injury in sports is relatively small, but because the effects may be catastrophic it is an important topic. Forces may be applied to the head from different directions, which results in different types of lesions. The anatomical and physiological changes with head injury have been suggested to explain head injury outcomes. Effects on intelligence and memory have also been reported. Posture had been proposed as a model to examine the subtle effects of head injury. Vision, vestibular input, and somatosensory input are all involved in maintenance of posture. The interaction of these sensory modalities is also pertinent to posture maintenance. Somatosensory input appears to be improperly processed, while vision and vestibular input seem to compensate for lost somatosensation. Attention to regaining the somatosensory component, rather than waiting for compensation to occur, should be addressed in rehabilitation programmes.

Effects of patella taping on patella position and perceived pain

Anterior knee pain syndrome (AKPS) represents a significant challenge for the sports medicine clinician. One proposed etiological factor for AKPS is poor vastus medialis obliquus (VMO) control, resulting in lateral glide of the patella. Patella taping has been advocated to increase VMO control. The purpose of this study was to determine the effects of patella taping on patella position and perceived pain. Twelve subjects (age = 29 +/- 9 yr; weight = 70.9 kg +/- 17.8; height = 174.0 cm +/- 8.1) with AKPS currently using patella taping procedures with a decrease in their symptoms participated. Each subject had Merchant's view x-rays taken pre- and post-taping while performing an isometric quadriceps contraction to determine patella rotation and patella congruency angles. Subjects also completed a visual analog pain scale after performing a 0.2 m (8") step-down both pre- and post-taping. Paired t-tests revealed no significant change in patellofemoral congruency (P = 0.98) and patella rotation angles (P = 0.80). Significant reduction (50%) in subject pain level was revealed by the visual analog scale (t(15) = 4.99; P < 0.0005). Results demonstrate that patella taping significantly reduced the perceived pain levels during a 0.2-m step-down; however, this reduction in pain was not associated with patella position changes.

The effects of ice and compression wraps on intramuscular temperatures at various depths

While ice and compression wraps are commonly used to treat musculoskeletal injuries, the literature describing intramuscular temperatures has not addressed the combination of ice and compression wraps. The purpose of this study was to evaluate intramuscular temperatures at three sites on the anterior thigh (skin surface, 1 cm below the fat layer, and 2 cm below the fat layer) using both ice and compression wraps. Temperatures were recorded in 11 subjects with an isothermex, using implantable and surface thermocouples. Each subject was tested under four conditions: control, compression only, ice only, and ice + compression according to a balanced Latin square. Surface and intramuscular temperatures were recorded at 30 second intervals during 5 minutes of preapplication, 30 minutes application, and 20 minutes postapplication. A repeated measures ANOVA and Duncan post hoc tests were used to evaluate peak temperature differences between the treatment conditions and the depths of measurement. Both ice alone and ice + compression produced significant cooling at all three depths (F(6,60) = 168.5, p<.0005). Likewise, during the 20-minute postapplication period, these temperatures did not return to their preapplication levels. The compression-only condition produced significant warming at the skin surface, but did not have any effect on intramuscular temperature. At all depths, the ice + compression condition produced significantly cooler temperatures than ice alone. We suggest that compression increases the effectiveness of ice in reducing tissue temperatures. Therefore, ice combined with compression should be more effective than ice alone in reducing the metabolism of injured tissue. This provides an additional rationale for combining ice with compression in treating acute musculoskeletal injuries.

The effects of closed-head injury on postural sway

The purpose of this study was to determine the effects of closed-head injury upon postural sway. Forty-eight subjects (26 males and 22 females) between the ages of 18 and 45 were equally divided into four groups corresponding to their level of head injury. Group 1 had not incurred a head injury, group 2 members incurred head injuries but did not lose consciousness, group 3 lost consciousness for less than 6 h, and group 4 lost consciousness for greater than 6 h. All subjects were at least 1 yr postinjury. Each subject performed three trials of six variations of the Romberg test. The center of pressure transmitted through the bottom of the feet was monitored during each 30-s trial. Total, anterior-posterior (AP), and medial-lateral (ML) sway was calculated from center of pressure data. The severely head-injured group generally evidenced greater AP sway than the other three experimental groups for all but one test condition. It was concluded that closed-head injury, particularly when associated with relatively long periods of unconsciousness, results in postural instability.

Habituation to the perception of the qualities of cold-induced pain

This study was conducted in order to measure the reported pain caused by cold immersions over a 5-day period to determine if habituation to the perception of cold pain occurs. Numerous authors have described a habituation phenomenon to therapeutic ice bath immersions. Athletic trainers often explain to athletes that their perceptions of the pain induced by a therapeutic ice bath will decrease each day as they proceed through therapy. Essentially, it is assumed that there is a habituation to the perception of cold-induced pain shortly after initiation of the treatment regime. The subjects were 22 male and female college students who had limited experience with cold immersion. The subjects' right feet and ankles were immersed in an ice bath for 21 minutes on 5 consecutive days followed by a 21-minute recovery period. The McGill Pain Questionnaire (MPQ) was used to measure pain during the immersions. Sensory, affective, evaluative, and miscellaneous qualities of pain were determined from the MPQ. During the testing session, each subject completed the MPQ 30 seconds following immersion and then every 3 minutes until completion of the test. Repeated measures analyses of variance (ANOVAs) adjusted according to the Bonferroni correction revealed no significant differences for any of the qualities of pain over a 5-day period. The subjects' perception of cold-induced pain did appear to decrease during the immersion and there was a trend towards decreasing pain during day five, but a habituation effect was not documented in this study.

Sensory perception of the foot and ankle following therapeutic applications of heat and cold

Many athletes are treated with hot and cold modalities prior to therapeutic exercise, but the effects of these treatments on sensory perception are not clear. The purpose of this study was to examine the effects of hot and cold treatments on sensory perception. We recruited 21 volunteer subjects, who reported for testing on three separate occasions. One of three treatments was applied to the left ankle and foot each day for 20 minutes: cold immersion, hot immersion, or quiet sitting (control). Three variables were measured following treatment: topagnosis, two-point discrimination, and one-legged balance. We assigned treatments and the testing order according to a Greco Latin square. Data were analyzed using a multivariate analysis of variance (MANOVA). No significant differences were detected for the three dependent measures, suggesting that therapeutic applications of heat and cold do not affect sensory perception. These findings indicate that heat and cold applications can be used prior to therapeutic exercise programs without interfering with normal sensory perception as do other analgesic and anesthetic agents. For example, the hypalgesic effect of cold, which is essential to cryokinetics, can be realized without fear of altered sensory perception.

Patellar location changes following EMG biofeedback or progressive resistive exercises

Changes in the patellofemoral congruence (PFC) angle, the patellar rotation (PR) angle, and the sulcus angle following EMG biofeedback training that emphasized vastus medialis obliquus strengthening, the Daily Adjustable Progressive Resistive Exercise (DAPRE) technique, or no exercise were studied. Subjects were 30 normal, college females. The EMG biofeedback group and the DAPRE group followed established protocols for a 3-wk training period. The control group refrained from exercise. Patellar angles were determined with x-rays both pre- and posttest with the quadriceps relaxed and contracted. Reliability of the x-rays was determined with a correlation matrix of pre- and posttest sulcus angle measurements (P less than 0.001). EMG biofeedback training resulted in significant changes in the PFC angle with the quadriceps contracted (P less than 0.05). DAPRE resulted in significant changes in the PR angle with the quadriceps contracted (P less than 0.05). The results of this study suggest that quadriceps group strength changes are not enough to fully rehabilitate patellar tracking dysfunctions. The use of EMG biofeedback training to selectively strengthen the vastus medialis obliquus appears to be essential in correcting faulty patellar tracking.