Physiotherapy Practice and Research

Background: The current evidence base pertaining to the use of ice water immersion in the treatment and prevention of delayed onset muscle soreness (DOMS) remains inconsistent and controversial. Although little scientific support exists, many athletes continue to acknowledge it as an important treatment modality in DOMS management. The purpose of this study is to determine the effectiveness of ice water immersion in the treatment of DOMS induced in the lower leg in a group of untrained volunteers. Method: An experimental inter-subject design was employed, using convenience sampling, to recruit 16 untrained volunteers (11 females, 5 males). Each performed a bilateral DOMS inducing protocol, in the plantar flexors, to exhaustion. Each leg was then randomly assigned to a control (no treatment) or intervention (ice immersion) group. The ice protocol consisted of a 10 minute water immersion, superior to the knee joint, at 10°C. Range of movement (ROM), using a standard plastic goniometer, and soreness, using a Visual Analogue Scale (VAS), were assessed. Measurements were taken prior to, and 48 hours post exercise. Results were analyzed using a related t-test. Results: Statistical analysis of the results was performed using SPSS 14.0, where p≤0.05. The related t-test detected significant differences between the control and intervention group at 48 hours post exercise in both soreness (p=0.007) and ROM (p=0.002), where p<0.05. Conclusion: The results suggest that a single bout of ice water immersion, immediately after exercise of the Triceps Surae musculature, resulted in significantly less muscle soreness and greater ROM at the ankle, in comparison to a control, 48 hours post exercise. The results offer scientific support to this popular recovery modality.

Background: Little work has been undertaken on the biomechanical effects of patellofemoral taping and bracing in cycling. Objective: The purpose of the study was to assess the three-dimensional movement of the knee joint at different levels of resistance, across four treatment conditions, in experienced cyclists and discuss the clinical implications of the findings. Method: 15 healthy male subjects were asked to conduct four separate tests at three separate resistances on a static trainer. Each test used a different treatment modality. The order of testing was randomised a) no intervention, b) placebo patella taping, c) a patellofemoral brace, d) McConnell patella taping. Kinematic data were collected using a 10 camera ProReflex motion analysis system. Reflective markers were placed on the foot, shank, thigh and pelvis using the CAST technique. Results: A repeated measures two-way ANOVA test was performed together with posthoc Pairwise comparison with Bonferroni adjustment to examine the difference in three dimensional movement under the different conditions. Results (small significant differences) were presented in ROM tables for clinical application and relevance. Extension (1-2 p=0.002, 1-3 p=0.003, 2-3 p=0.004). Coronal plane between brace and neutral taping (p=0.033) also between resistances 1 & 3 and 2 & 3 (p=0.035, p=0.011). Transverse plane (p=0.028) between Brace and McConnell taping. Conclusion: If changes in the cycling movement patterns are required in clinical treatment, then taping or bracing may possibly affect this. However, a full understanding of an individual's biomechanical movement and cycling position is required as generic adaptations that do not take into account position, cadence, skin/fabric movement and power, and may be counterproductive. This study provides some initial understanding of the possible effects of bracing and taping in experienced cyclists, the application of taping may alter the biomechanics of the cycling action. Taping seems to initiate changes in ROM but as yet it is unclear as to its implication with respect to pain reduction. This study also helps us to understand that bracing is both impractical and any resultant changes during cycling are unlikely to be measurable.

Background: Hamstring injuries are common in Gaelic football and have been associated with reduced flexibility in other sports. The aim of this study was to examine the relationship between lower-limb-flexibility and previous hamstring injury in male Gaelic footballers as this has not been previously investigated. Methods: Eighteen male club-level Gaelic footballers (9 previously injured, 9 non-injured) underwent four different muscle length tests bilaterally, using standard goniometry or a tape measure. Hamstring muscle length was measured using the passive-knee-extension test. Gastrocnemius muscle length was measured using the dorsi-flexion lunge test. Iliopsoas and rectus femoris muscle lengths were measured using the modified Thomas test. Results: Hamstring and gastrocnemius flexibility were significantly greater (p < 0.05) in the non-injured limb compared to the injured limb in the injured group. There were no significant differences in flexibility (p > 0.05) for any of the other named muscle groups for within-subject or between subject comparisons. Conclusion: This group of Gaelic footballers with a history of hamstring injury who had returned to full sporting participation demonstrated significantly reduced hamstring and gastrocnemius flexibility of their injured limb when compared to their non-injured limb. The retrospective study design did not allow for interpretation of whether these changes were present before or after injury. Prospective research on a larger sample size is needed to examine the association of lower limb flexibility and hamstring injury further.

Background: Proprioception may be defined as a specialised sensory modality that gives information about joint position sense (JPS), kinaesthesia and vibratory perception. Vibratory Perception Threshold (VPT) testing has been suggested as an alternative means for assessing proprioception at the knee, as it is believed to travel through the same type of large afferent nerve fibres as JPS. Methods: This study examines the strength of relationship between vibration sense and JPS at the knee in healthy participants and determines the minimum number of trials required for each method to attain constant stable data. Stability was determined by 3 consecutive cumulative standard deviations varying less than 5%. Twenty healthy adults (11 females, 9 males) were tested for VPT at five lower limb positions and JPS at two angles of knee flexion (20° and 60°) using Active Angle Reproduction (AAR). Results: Results showed no significant correlations between VPT and JPS, suggesting the two modalities measure different facets of proprioception. VPT (at all 5 sites) and AAR 20° required 4 repetitions to attain data stability, whereas AAR 60° required five repetitions. There were significant differences (p<0.005) between the five sites tested for VPT with increasing thresholds at more proximal sites. No significant differences were seen between the two angles tested for JPS. Conclusions: The two testing modalities are not interchangeable when testing proprioception, requiring at least 4 repetitions to attain consistent stable data. These findings have implications for clinicians and researchers, encouraging the use of broader proprioceptive assessments and increased repetitions.

The aim of this review is to present some of the emerging evidence concerning the application of Neuromuscular Electrical Stimulation (NMES) in knee rehabilitation and offer theoretical justification as to the efficacy of this novel treatment approach. Over the past two decades, numerous researchers have investigated the concept of electrical stimulation as a modality to prevent or retard disuse muscle atrophy associated with knee injury and pathology. Indeed a growing body of evidence would suggest that NMES offers a highly effective adjunctive therapy that can increase muscle strength, improve function and ultimately enhance patient outcomes. The primary muscle group stimulated has been the quadriceps femoris. Key topics that will be discussed will be the role of electrical stimulation in addressing arthrogenic muscle inhibition, the training load provided by electrical stimulation, the limitations of this training technique, the evidence for application of electrical stimulation in specific knee conditions and the overall clinical implications of this treatment approach. This review will identify the research literature on these topics, presenting some critical treatment requirements and suggested clinical implications for optimum treatment application.