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Scarvell, Jennifer. "Kinematics and degenerative change in ligament-injured knees." University of Sydney, 2004. http://hdl.handle.net/2123/4139.
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Doctor of PhilosophyThe aim of the work presented in this thesis was to examine the associations between the kinematics of the knee characterised by the tibiofemoral contact pattern, and degenerative change, in the context of anterior cruciate ligament (ACL) injury. While the natural history of degenerative change following knee injury is well understood, the role of kinematics in these changes is unclear. Kinematics of the knee has been described in a variety of ways, most commonly by describing motion according to the six degrees of freedom of the knee. The advantage of mapping the tibiofemoral contact pattern is that it describes events at the articular surface, important to degenerative change. It was hypothesised that the tibiofemoral contact pattern would be affected by injury to the knee. A model of ACL injury was chosen because the kinematics of the knee have been shown to be affected by ACL injury, and because the majority of chronic ACL-deficient knees develop osteoarthritis, the associations between kinematics and degenerative change could be explored. A technique of tibiofemoral contact pattern mapping was established using MRI, as a quantifiable measure of knee kinematics. The tibiofemoral contact pattern was recorded from 0º to 90º knee flexion while subjects performed a leg-press against a 150N load, using sagittal magnetic resonance imaging (MRI) scans. The technique was tested and found to be reliable, allowing a description of the tibiofemoral contact pattern in 12 healthy subjects. The tibiofemoral contact patterns of knee pathology were then examined in a series of studies of subjects at a variety of stages of chronicity of ligament injury and osteoarthritis. Twenty subjects with recent ACL injury, 23 subjects with chronic ACL deficiency of at least 10 years standing, and 14 subjects with established osteoarthritis of the knee were recruited. The 20 subjects with recent ACL injury were examined again at 12 weeks and 2 years following knee reconstruction. The tibiofemoral contact patterns were examined for each group of subjects and the associations between changes in the contact patterns and evidence of joint damage explored. Evidence of joint damage and severity of osteoarthritis were recorded from xrays, diagnostic MRI, operation reports and bone densitometry at the tibial and femoral condyles of the knee. Each of the three groups with knee pathology exhibited different characteristics in the tibiofemoral contact pattern, and these differences were associated with severity of joint damage and osteoarthritis. The recently ACL-injured knees demonstrated a tibiofemoral contact pattern that was posterior on the tibial plateau, particularly in the lateral compartment. Those with chronic ACL deficiency demonstrated differences in the contact pattern in the medial compartment, associated with severity of damage to the knee joint. Osteoarthritic knees showed reduced femoral roll back and longitudinal rotation that normally occur during knee flexion. Two years following knee reconstruction there was no difference between the contact pattern of the reconstructed and healthy contralateral knees. This technique of tibiofemoral contact pattern mapping is sensitive to the abnormal characteristics of kinematics in ligament injury and osteoarthritis. This is the first time the tibiofemoral contact characteristics of chronic ACL-deficient and osteoarthritis knees have been described and links examined between tibiofemoral contact patterns and degenerative change.
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Pretorius, Jaco. "The effect of fatigue protocols on knee control during functional activities." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/96861.
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Thesis (MScPhysio)--Stellenbosch University, 2015.ENGLISH ABSTRACT: Introduction ACL injuries are among the most serious injuries that professional and amateur sports men and women sustain. More than 120 000 ACL injuries occur annually in the USA alone. The highest incidence of ACL injuries are seen in multi-directional and multi-factorial sports such as soccer, basketball, lacrosse, American football, rugby and Australian rules football. It is hoped that the proposed review will clarify issues relating to the effect of fatigue on knee control, as it will focus on multiple movements found in different sporting codes. By including both studies on healthy adults as well as subjects who have sustained ACL injuries, a clearer picture can be formed on the global effect of fatigue on knee control. Objective The objective of this review was to identify, collate and analyse the current evidence on the effect of fatigue protocols on knee control during functional tasks, such as side-stepping, bilateral jumping/landing and crossover-cutting. Methodology A comprehensive search of electronic databases was conducted between April 2013 and August 2013 (updated in April 2014) for eligible articles for inclusion in the review. Methodological quality was assessed using a modified Downs and Black checklist. Results Ten studies met the eligibility criteria and were included in the review. The included studies reported a wide variety of fatigue protocols. Several different test movements were utilised in the studies. The test movements included cutting movements, drop jumps, stop jumps, vertical jumps, bilateral drop landing and rotational movements. The overall results indicated that fatigue had a negative impact on knee control. There were however studies which reported conflicting results. Gender differences were also highlighted in the results of included studies where it became evident that females tend to be more susceptible to knee injuries due to altered kinematics as a result of fatigue. Conclusion Fatigue generally seems to affect knee control negatively across various fatigue protocols. Future research should investigate using a standardised fatigue protocol to achieve more accurate and consistent results during the different functional activities.
AFRIKAANSE OPSOMMING: Nie beskikbaar
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Aderem, Jodi. "The biomechanical risk factors associated with preventing and managing iliotibial band syndrome in runners : a systematic review." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/96803.
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Thesis (MScPhysio)--Stellenbosch University, 2015.ENGLISH ABSTRACT: Introduction: Iliotibial band syndrome (ITBS), an overuse injury, is the second most common running injury and the main cause of lateral knee pain in runners. Due to the increasing number of runners worldwide there has been an increase in its occurrence. Runners with ITBS typically experience symptoms just after heel strike at approximately 20°-30° of knee flexion (impingement zone) during the stance phase of running. A variety of intrinsic and extrinsic risk factors may be responsible for why some runners are more prone to developing symptoms during the impingement zone as opposed to others. Abnormalities in running biomechanics is an intrinsic risk factor which has been most extensively described in literature but little is known about its exact relationship to ITBS. Objectives: The purpose of this systematic review was to provide an up to date evidence synthesis of the biomechanical risk factors associated with ITBS. These risk factors may need to be considered in the prevention or management of ITBS in runners. A clinical algorithm is also presented. Methods: A systematic review with meta-analysis was conducted. An electronic search was performed in PubMed, PEDro, SPORTSDisc and Scopus of literature published up-until May 2014. Cross-sectional and cohort studies were eligible for inclusion if they evaluated the lower limb biomechanics of runners with ITBS or those who went onto developing it. All studies included in the review were methodologically appraised. Evidence was graded according to the level of evidence, consistency of evidence and the clinical impact. Data was described narratively using tables or narrative summaries where appropriate. A meta-analysis was conducted for biomechanical risk factors which were reported in at least two studies, provided that homogeneity in the outcomes and samples were present. Results: A total of 11 studies were included (1 prospective and 10 cross-sectional). Overall the methodological score of the studies was moderate. Increased peak hip adduction and knee internal rotation during the stance phase may predict the development of ITBS in female runners. These biomechanical risk factors may need to be screened for ITBS prevention, despite the evidence base being limited to a single study. Currently there is no conclusive evidence that any of the biomechanical parameters need to be considered when managing runners with ITBS. Stellenbosch University https://scholar.sun.ac.za iii Conclusion: Biomechanical differences may exist between runners with ITBS and those who may develop ITBS compared to healthy runners. Although a large variety of biomechanical risk factors were evaluated, the evidence base for screening or managing these risk factors for runners with ITBS is limited. This is due to a small evidence base, small clinical effect and heterogeneity between study outcomes and findings. Further prospective and cross-sectional research is required to ascertain if abnormalities in running biomechanics may be related to why runners develop ITBS or to ascertain which risk factors may be involved when managing these runners.
AFRIKAANSE OPSOMMING: Inleiding: Iliotibiale-band-sindroom (ITBS), ’n besering vanweë oormatige gebruik, is die tweede algemeenste hardloopbesering en die hoofoorsaak van laterale kniepyn by hardlopers. Namate die getal hardlopers wêreldwyd toeneem, neem die voorkoms van hierdie toestand ook toe. Hardlopers met ITBS ervaar tipies simptome ná die hakslag met die knie ongeveer 20-30° gebuig (die wrywingsone of “impingement zone”) gedurende die staanfase van hardloop. Verskeie intrinsieke en ekstrinsieke risikofaktore kan ’n rol speel in waarom sommige hardlopers meer geneig is as ander om gedurende die wrywingsone simptome te ervaar. Abnormaliteite in hardloopbiomeganika is ’n intrinsieke risikofaktor wat reeds omvattend in die literatuur beskryf is. Tog is weinig bekend oor presies hoe dit met ITBS verband hou. Oogmerke: Die doel van hierdie stelselmatige ondersoek was om ’n sintese te bied van die jongste bewyse van die biomeganiese risikofaktore van ITBS. Hierdie risikofaktore kan dalk oorweeg word om ITBS by hardlopers te voorkom of te bestuur. ’n Kliniese algoritme word ook aangebied. Metodes: ’n Stelselmatige ondersoek is met behulp van meta-ontleding onderneem. PubMed, PEDro, SPORTSDisc en Scopus is elektronies deurgesoek vir literatuur wat tot en met Mei 2014 verskyn het. Deursnee en kohortstudies is ingesluit indien dit gehandel het oor die biomeganika in die onderste ledemate van hardlopers wat ITBS het of later ontwikkel het. Alle studies wat deel was van die ondersoek is metodologies geëvalueer. Bewyse is aan die hand van bewysvlak, bewyskonsekwentheid en kliniese impak beoordeel. Data is narratief beskryf met behulp van tabelle of narratiewe opsommings waar dit toepaslik was. ’n Meta-ontleding is onderneem waar biomeganiese risikofaktore in minstens twee studies aangemeld is, mits daar homogeniteit in die uitkomste sowel as die steekproewe was. Resultate: Altesaam 11 studies is ingesluit (een prospektief en tien deursnee). Die metodologiese telling van die studies was oorwegend gemiddeld. Verhoogde spitsheupadduksie en interne knierotasie gedurende die staanfase kan op die ontwikkeling van ITBS by vrouehardlopers dui. Hierdie biomeganiese risikofaktore kan dalk nagegaan word vir ITBS-voorkoming, al was die bewysbasis beperk tot ’n enkele studie. Daar is tans geen afdoende bewys dat enige van die biomeganiese parameters oorweeg behoort te word in die bestuur van langafstandatlete met ITBS nie. Gevolgtrekking: Daar bestaan dalk biomeganiese verskille tussen hardlopers wat ITBS het of kan ontwikkel en gesonde hardlopers. Hoewel ’n groot verskeidenheid biomeganiese risikofaktore beoordeel is, is die bewysbasis vir die toets of bestuur daarvan by atlete met ITBS beperk. Dít is vanweë die klein hoeveelheid bewyse, die klein kliniese impak, en heterogeniteit tussen studie-uitkomste en bevindinge. Verdere prospektiewe en deursneenavorsing word vereis om te bepaal of abnormaliteite in hardloopbiomeganika ’n rol kan speel in waarom langafstandhardlopers ITBS ontwikkel, of om vas te stel watter risikofaktore ter sprake kan wees in die bestuur van hierdie hardlopers.
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黃若虹 and Yeuk-hung Wong. "Kinematic analysis of rotation pattern of ACL deficient knee, ACL reconstructed knee and normal knee during single leg hop and pivotshift test." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B31225378.
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Wallace, Linda S. "Self-efficacy expectations and functional ability in everyday activities in clients undergoing total knee arthroplasty." Virtual Press, 2000. http://liblink.bsu.edu/uhtbin/catkey/1180777.
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This longitudinal, descriptive study based on Bandura's self-efficacy theory (1977), examined the effects of educational activities on self-efficacy and of self-efficacy on functional ability in everyday activities in clients undergoing elective, primary, unilateral, total knee arthroplasty (TKA). Educational activities included: attending a joint replacement class and a physical therapy session, performing exercises, and reading educational materials. Other sources of client information were also discussed. Self efficacy was assessed regarding confidence in ability to perform activities required for discharge home. Cronbach's alpha for the self-efficacy scale was .94 (pre-education) and .81 (post-education). Functional ability in everyday activities was operationalized as length of hospital stay, discharge placement, and perceived health status. Perceived health status was assessed using the three-scale Western Ontario McMasters University Osteoarthritis Index (WOMAC). Cronbach's alpha was: pain .85, joint stiffness .76, and physical function .94 (preoperatively); and pain .86, joint stiffness .80, and physical function .94 (postoperatively).Evidence was collected from a convenience sample of 31 participants: (a) when the process of scheduling surgery began; (b) before surgery, after the client had opportunities to participate in educational activities, and (c) approximately six weeks after surgery. The orthopedic surgeon and professional staff reviewed instruments for validity. Five clients reviewed the questionnaires for understandability and readability. Data were analyzed using Pearson r correlation coefficients, independent samples t-tests, analyses of variance and chi-square tests. An alpha level of .05 was designated as significant.Higher self-efficacy scores were associated with more expected benefits, previous TKA, and greater pain relief. Lower self-efficacy scores correlated with greater improvement in self-efficacy. Shorter lengths of hospital stay were associated with greater joint stiffness reduction, younger age and previous TKA. Discharge home was associated with younger age and living with someone else. Participants that were "very sure" of the need for TKA exhibited higher self-efficacy scores than participants that were "unsure". Improved outcomes were not associated with any one type of educational activity.This study highlighted the need for further refinement of context sensitive self-efficacy instruments, more sophisticated means of assessing the impact of an increasing array of information sources and more longitudinal studies with larger sample sizes.Department of Educational Leadership
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Durieux, Susan C. "An evaluation of three diagnostic tests for an anterior cruciate insufficiency /." Thesis, McGill University, 1989. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=55594.
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Simmonds, Michael John. "Instantaneous center of rotation shifts in symptomatic anterior cruciate ligament deficient knee joints." Thesis, McGill University, 1990. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=60105.
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The purpose of this investigation was to document the influence of the anterior cruciate ligament (ACL) in controlling the dynamic interaction between the femur and tibia. Twenty subjects were initially selected to participate based on the results of arthroscopic and proprioceptive tests which established the presence of a uni-lateral, third degree rupture of the ACL. A spline function established the best fitting curve of the instant center (IC) coordinates obtained throughout the ROM. Displacement variables were extrapolated from joint rotation profiles generated from these coordinates. Abnormal displacement migrations of the IC parameter were demonstrated to occur in extension. Migration displacements evaluated between 30$ sp circ$ and 0$ sp circ$ shifted anteriorly 5.07 $ pm$ 1.86 mm for intact knees and 6.97 $ pm$ 2.06 mm for involved knees. This was determined to be significant at the 0.05 level of confidence and correlated well with clinical findings. Mean migration displacements evaluated in flexion (between 100$ sp circ$ and 70$ sp circ)$ were not found to differ significantly between knee conditions.
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Neethling-du, Toit Marle. "Ultrasound features of the deep infrapatellar bursa." Thesis, Cape Peninsula University of Technology, 2006. http://hdl.handle.net/20.500.11838/1556.
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Thesis (MTech (Sports Science Radiology))--Cape Peninsula University of Technology, 2006The knee is one ofthe most complicated joints in the body. The deep infrapatellar bursa being only a small water-pocket and forming a small part of the knee. The deep infrapatellar bursa can get inflamed and cause great discomfort, especially to professional sportsmen and -women. If such a inflammation is present, a common treament option are to inject a cortisone solution into the bursa for quick relieve and healing. This study was performed to investigate the specific ultrasound features of a normal deep infrapatellar bursa. Thus enableing more specific and accurate diagnosis of deep infrapatellar bursitis or not, which in turn leads to quicker recovery ofthe patients. A total of280 males and females from various population groups were recruited for the study. Subjects were categorized into different subgroups depending on their gender, ethnicity, competitiveness in sport, sport type practised and previous knee problems. These subgroups enabled a more individual specific DIB measurement. A high frequency ultrasound examination ofboth knees ofall recruits were performed. The deep infrapatellar bursa was located by slightly flexing the knee and applying not to much pressure with the probe whilst scanning. Three measurements, antero-posterio (AP), cranio-caudal (CC) and width measurements, were recorded ofeach individuals left and right deep infrapatellar bursa (DIB). The results ofthe DIB measurements were compared to results from a ultrasound study perfonned in Gennany and a favourable comparison could be made. MRI studies of the DIB performed in Turkey and Switzerland differed greatly from those of this study and Germany. This study could serve as a valuable source ofreference to sonographer, radiologist and orthopaedic surgeons when investigating the deep infrapatellar bursa. A statistical significant difference was shown for males having a larger DIB than female, for competitive sports people having a larger Dill than non-competitive sports people and also inactive people; and rugby players (as a sport type) have larger DIBs than cricketers, runners, soccer players and cyclists. Another surprising factor was the amazing ultrasound detection rate of the deep infrapatellar bursa, which allows for future easy and confident assessing of the DIB by ultrasound.
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Cogger, Naomi. "Epidemiology of musculoskeletal injuries in two- and three-year-old Australian Thoroughbred racehorses." University of Sydney, 2006. http://hdl.handle.net/2123/1611.
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Doctor of PhilosophyThe aim of this research was to describe the epidemiology of musculoskeletal (MS) injuries in two- and three-year-old Thoroughbred racehorses. A 27 month longitudinal study commencing in May 2000 was conducted. The study convenience sampled 14 trainers with facilities at metropolitan and provincial racetracks in New South Wales, Australia. In the 2000/01 and 2001/02 racing season, 323 and 128 two-year-olds, respectively, were enrolled in the study. The 451 Thoroughbred horses contributed, 1, 272 preparations and 78, 154 training days to the study. Of the 323 horses enrolled in the 2000/01 racing season, 219 contributed three-year-old data to the study. During the study period 8%, of training days had missing training data and 3% of the 1, 986 starts in the races or barrier trials were incorrectly recorded. The rate of incorrect entries varied with both study month and trainer. Similarly, the rate of training days with missing data varied between trainers and with study month. Four hundred and twenty-eight MS injuries were recorded in association with 395 preparations in 248 two- and three-year-old Thoroughbred racehorses. The IR for all categories of MS injuries, except for tendon and ligament injuries, were higher in twoyear- olds than three-year-olds, although the differences were only significant for shin soreness. Seventy-eight percent of horses enrolled in the study started, in a barrier trial or race, within one year on entering the study. After accounting for other confounders, horses that had sustained a MS injury were 0.50 times less likely to start, in a race or trial, race than those that did not sustain an injury. Seventy percent of horses returned to training after their first MS injury, and the cumulative percentage of these horses that had recovered within six months of the initial MS injury was 55%. After adjusting for clustering at the level of the trainer, the analysis showed that horses that exercised at a gallop pace ≥ 890 m/minute (but had not started in a race) prior to the onset of MS injury, were 2.14 times more likely to recover than horses whose maximum speed, prior to the onset of the first MS injury, was less than 890 m/minute. Similarly, horses that had started in a race or barrier trial were 4.01 times more likely to recover than horses whose maximum speed was less than 890 m/minute. 8 Training days were grouped into units referred to as preparations. A preparation began on the day that the horse was enrolled in the study, or when a horse returned to training after an absence of more than seven days from the stable. The preparation continued until the horse was lost to follow-up or left the stable for a period of more than seven consecutive days. Univariable and multivariable analytical methods were used to examine the association between a range of independent variables and four preparationlevel measures of performance: (i) the duration of preparations, (ii) length of time from the beginning of the preparation until the first start in a race or barrier trial, (iii) length of time from the first start until the end of the preparation and (iv) rate of starts in races or barrier trials. After adjusting for confounders, younger horses tended to have shorter preparations, took longer to start in a race or barrier trial, had a shorter interval from the first start to the end of the preparation and fewer starts per 100 training days. MS injury was not conditionally associated with any of the outcomes considered in this chapter. Multivariate statistical models were used to explore risk factors for MS injuries. The results suggest that MS injuries involving structures in the lower forelimb (carpus to fetlock inclusive) could be reduced by limiting exposure to high-speed exercise. This supports the proposition that training injuries are caused by the accumulation of micro damage. The results suggest there are a number of other factors that vary at the trainer level that may be risk factors for injuries, in particular joint injuries. These include unmeasured variables such as the rate of increase in distance galloped at high-speed, conformation of the horse, skill of the riders and farrier and veterinary involvement.
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Ebert, Jay Robert. "Post-operative load bearing rehabilitation following autologous chondrocyte implantation." University of Western Australia. School of Sport Science, Exercise and Health, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0196.
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[Truncated abstract] Autologous Chondrocyte Implantation (ACI) has shown early clinical success as a repair procedure to address focal articular cartilage defects in the knee, and involves isolating and culturing a patient's own chondrocytes in vitro and re-implantation of those cells into the cartilage defect. Over time, repair tissue can develop and remodel into hyaline-like cartilage. A progressive partial weight bearing (PWB) program becomes the critical factor in applying protection and progressive stimulation of the implanted cells, to promote best chondrocyte differentiation and development, without overloading the graft. The aim of this thesis was to investigate whether patients could replicate this theoretical load bearing model to possibly render the best quality tissue development. In addition, this proposed external load progression is only a means to loading the articular surface. Several factors, including those that may result from pathology, have the potential to influence gait patterns, and therefore, articular loading. The association between increasing external loads (ground reaction forces - GRF) and knee joint kinetics during partial and full weight bearing gait was, therefore, investigated in the ACI patient group, as was the contribution of other gait variables to these knee joint kinetics which may be modified by the clinician. Finally, current weight bearing (WB) protocols have been based on early ACI surgical techniques. With advancement in the surgical procedure and ongoing clinical experience, we employed a randomised controlled clinical trial to assess the effectiveness of an 'accelerated' load bearing program, compared with the traditionally 'conservative' post-operative protocol. ... Although similar spatio-temporal, knee kinematic and external loading parameters were observed between the traditional and accelerated rehabilitation groups, the accelerated group was 'more comparable' to the controls in their external knee adduction and flexion moments, where the traditional group had lower knee moments. Knee moments greatly affect knee articular loading, and large adduction moments have been related to poor clinical outcomes after surgery. Therefore, the return of normal levels may be ideal for graft stimulation, however, may overload the immature chondrocytes. Acceleration of the intensive rehabilitation program will enable the patient to return to normal activities earlier, whilst reducing time and expenses associated with the rehabilitative process, and may enhance long-term tissue development. However, continued follow-up is required to determine if there are any detrimental effects that may emerge as a result of the accelerated load bearing program, and assess the recovery of normal gait patterns and whether longer term graft outcomes are affected by the recovery time course of normal gait function, and/or abnormal loading mechanics in gait. Furthermore, analysis at all levels of PWB is needed to identify a more complete set of variables attributing to the magnitude of external knee joint kinetics and, therefore, knee articular loading, while the influence muscle activation patterns may have on articular loading needs to be investigated. This becomes critical when you consider loads experienced by the articular surface throughout the early post-operative period following ACI may be important to short- and long-term graft development.
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Kosiuk, Monica. "Quantitative analysis of functional knee appliances in controlling anterior cruciate ligament deficient knees." Thesis, McGill University, 1990. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=60013.
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The purpose of this investigation was to evaluate and compare the efficacy of three functional knee braces in stabilizing anterior cruciate ligament (ACL) deficient knees. The subject sample consisted of eighteen males and females with a unilateral ACL deficiency.The criterion variables consisted of the ability of each brace in controlling internal rotation and knee extension during active movement and knee extension during a high velocity activity (dynamic task). Total displacement of the knee brace during a running test was also evaluated.
The results of this study demonstrated significant differences between the efficacy of the three braces for control of knee extension during active movement, knee extension during a dynamic task and brace migration during a running task. There was no significant difference between the efficacy of the three braces in controlling internal rotation during active movement.
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Matthews, Sonya Lynn. "An evaluation of the efficacy of three functional de-rotational knee braces in controlling instabilities characteristic of an ACL deficiency /." Thesis, McGill University, 1990. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=59623.
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The purpose of this investigation was to objectively evaluate whether three functional de-rotational knee braces stabilize an anterior cruciate ligament (ACL) deficiency. The subject sample consisted of fifteen males and females with a unilateral ACL deficiency. The data for each subject was obtained using the Genucom Knee Analyzer. A right knee-left knee anterior laxity difference of 3mm or greater served as a subject inclusion parameter for protocol completion. The inclusion criteria reduced the subject sample to a total of eleven.The study consisted of a randomized block design. The experimental design consisted of three parts: (1) an investigation of translational stability, (2) an investigation of rotatory stability, and (3) a comparison between the three braces.
The analysis involved a one way ANOVA of the criterion variables; anterior laxity (ALAX), anterior midrange stiffness (AMRS), anterior endrange stiffness (AERS), internal laxity (ILAX), and translation of the lateral tibial plateau (TLTP).
The AMRS characteristics differed significantly (alpha = 0.05) at 20$ sp circ$ flexion. The results were the following: $-$10.00 $ pm$ 9.78 N/mm for brace 1, $-$2.86 $ pm$ 7.2 N/mm for brace 2 and $-$41.02 $ pm$ 14.79 N/mm for brace 3. The values evaluated for ALAX, AERS, ILAX, and TLTP profiles did not differ significantly between knee braces.
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Neethling-Du, Toit Merle. "Ultrasound features of the deep infrapatellar Bursa." Thesis, Cape Peninsula University of Technology, 2006. http://hdl.handle.net/20.500.11838/2584.
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Thesis (MTech (Radiography))--Cape Peninsula University of Technology, 2006.The knee is one of the most complicated joints in the body. The deep infrapatellar bursa being only a small water-pocket and forming a small part of the knee. The deep infrapatellar bursa can get inflamed and cause great discomfort, especially to professional sportsmen and -women. If such a inflammation is present, a common treament option are to inject a cortisone solution into the bursa for quick relieve and healing. This study was performed to investigate the specific ultrasound features of a normal deep infrapatellar bursa. Thus enableing more specific and accurate diagnosis of deep infrapatellar bursitis or not, which in turn leads to quicker recovery of the patients.
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Basey, Adriana L. "Effects of a traditional and modified straight straight leg raise on EMG characteristics." Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1048378.
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The purpose of this study was to determine the vastus medialis oblique muscular electromyographical (EMG) activity during two therapeutic exercises: the modified straight leg raise and the traditional straight leg raise. Two subject groups of 10 subjects each, one with anterior knee pain (PHY) and the other group with no history of patellofemoral pathology (NORM), performed the traditional straight leg raise (SLR) and a modified straight leg raise with external hip rotation (MOD). Each subject performed an isometric maximum voluntary contraction and three trials of each of the two therapeutic exercises. The EMG variables analyzed were the percent of the maximum voluntary contraction for each muscle, vastus medialis oblique, vastus lateralis, and rectus femoris: the percent of the maximum voluntary contraction of the ratio between the vastus medialis oblique and the vastus lateralis; the percent of the maximum voluntary contraction for the integrated EMG for each muscle; and the percent of the maximum voluntary contraction for the root mean square for each muscle. The statistical analysis was conducted with two-way analysis of variance procedures. The statistical analysis revealed no significant differences; however, the data appeared to illustrate a trend toward more electromyographical activity in the vastus medialis oblique in the PHY subject group during the MOD therapeutic exercise. This suggests that the MOD therapeutic exercise may be able to isolate the vastus medialis oblique muscle in persons with anterior knee pain and allow them to regain strength and normal function earlier than with the use of the SLR therapeutic exercise.School of Physical Education
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Robertson, William Brett. "Functional and radiological evaluation of autologous chondrocyte implantation using a type I/III collagen membrane: from single defect treatment to early osteoarthritis." University of Western Australia. Orthopaedics Unit, 2007. http://theses.library.uwa.edu.au/adt-WU2007.0172.
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[Truncated abstract] Hyaline articular cartilage is a highly specialised tissue consisting of chondrocytes embedded in a matrix of proteoglycan and collagens. Hyaline articular cartilage withstands high levels of mechanical stress and continuously renews its extracellular matrix. Despite this durability, mature articular cartilage is vulnerable to injury and disease processes that cause irreparable tissue damage. Native hyaline articular cartilage has poor regenerative capacity following injury, largely due to the tissue's lack of blood and lymphatic supply, as well as the inability of native chondrocytes to migrate through the dense extracellular matrix into the defect site. Articular cartilage injuries that fail to penetrate the subchondral bone plate evoke only a short-lived metabolic and enzymatic response, which fails to provide sufficient new cells or matrix to repair even minimal damage. Clinically, it has previously been accepted that treatment of such defects does not result in the restoration of normal hyaline articular cartilage, which is able to withstand the mechanical demands that are placed on the joint during every day activities of daily living. ... Historically, rehabilitation following ACI has not kept pace with the advances in cell culture and surgical technique. Subsequently, there exists a significant gap in knowledge regarding `best practice' in post operative rehabilitation following ACI. The importance of structured rehabilitation in ACI should not be underestimated when evaluating the clinical success of this chondral treatment. Patients should not be left to their own devices following ACI surgery, as the risk of damage to their implant (via delamination) is high if immediate postoperative movement is not controlled. Furthermore, the biological longevity and clinical success of the graft is dependent on a controlled and graduated return to ambulation and physical activity, and the biomechanical stimulation of the implanted chondrocytes.
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Schriml, Carla M. "Exploring the impact of an imagery/relaxation program on athletes with a knee injury requiring surgery." Virtual Press, 2000. http://liblink.bsu.edu/uhtbin/catkey/1178349.
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The primary purpose of this study was to examine the impact of an imagery/relaxation program on athletes with a surgical knee injury. More specifically the study examined changes in state and trait anxiety, locus of control, and attitude/opinion as a result of the imagery/relaxation program. A qualitative design was used to allow for an in-depth examination into each participant's behavior. Since a qualitative design was utilized, the procedures were slightly different for each participant.The following is a general outline for the procedures used. One week prior to surgery the participant was taught progressive relaxation. One week post-surgery the participant was administered the STAI, LCRS, and ERAIQ. The participant was also given a different imagery/relaxation script each week to rehearse beginning one week post-surgery to 11 weeks post-surgery. The participant also completed journal worksheets weekly. At each session the researcher asked interview questions. Twelve weeks post-surgery the participant was given the STAI, LCRS, ERAIQ, and exit questionnaire. Due to the lack of adherence to the program there were no conclusive results.School of Physical Education
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Steele, Brian E. "Gender differences in the cutting maneuver in intercollegiate basketball." Virtual Press, 1999. http://liblink.bsu.edu/uhtbin/catkey/1125154.
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Female intercollegiate basketball players experience a three times greater rate of ACL injuries than their male counterparts. This investigation hypothesized that women and men perform the cutting maneuver differently with respect to ground reaction forces and knee range of motion.The subjects performed a ninety degree cut on a force platform while being video taped. The male subjects exhibited a 23.1 percent greater (p=.0167) knee flexion angle than did the female subjects. The female subjects exhibited a 25.5 percent greater (p=.0022) braking force than did the male subjects. The impact maximum was not statistically significant (p=.3290).The performance characteristics exhibited by the female subjects in this study would suggest that the cutting maneuver is more dangerous for female basketball player. Female athletes should be taught correct performance of the cutting maneuver. I addition to technique, strength training should be encouraged to develop a stronger secondary stabilization mechanism for the knee.School of Physical Education
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Wilson, Timm. "Effects of a modified straight leg raise on strength and muscle activity of the vastus medialis oblique in patients with patellofemoral malalignment." Virtual Press, 1993. http://liblink.bsu.edu/uhtbin/catkey/865942.
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The purpose of this study was to determine the effectiveness of a modified sitting position straight leg raise on vastus medialis oblique (VMO) strength and EMG activity as compared to a traditional straight leg raise. A total of twenty-three subjects were recruited for this study. The subjects were randomly assigned to one of the following groups: (group I) modified straight leg raise (MSLR), and (group II) straight leg raise (SLR). The exercise program was three weeks long. University procedures for the protection of human subjects were followed. The subjects began with a 5 minute warm-up on a Cybex stationary bike set at 90 revolutions / minute. The subject then had electrodes placed on the Vastus Lateralis (VL) and Vastus Medialis Oblique (VMO). A Macintosh computer was used to record the EMG data. The subject then performed a standard Cybex test for knee flexion and extension. The Cybex dynamometer was placed at the knee joint line, the chair back tilt was at 85 degrees, the hip, chest, and thigh restraints were all fastened. The subjects in group I (Modified sitting SLR) and II (SLR) then returned the next day for their first rehabilitation lesson. Each subject group then participated in their respected exercise program for a total of three weeks. After three weeks of rehabilitation, the subjects retested using the same procedures followed in the pretest. A two tailed t-test was used to determine significance of the difference between means of the two groups. No significant differences were found between the two groups.School of Physical Education
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Visser-Maritz, Karien. "Knee kinematics during a single-leg drop-landing in sports participants with chronic groin pain." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86507.
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Thesis (MScPhysio)--Stellenbosch University, 2014.ENGLISH ABSTRACT: Introduction: Groin injuries are among the top six injuries in contact sports and may lead to career ending chronic pain. Research on the role of knee kinematics in developing chronic groin pain in sport is scarce. Objective: The purpose of this study was to determine if there are differences in knee kinematics during a single-leg drop-landing in sports participants with chronic groin pain compared to asymptomatic controls. Methodology: A descriptive study was conducted. Twenty active sports’ participants were recruited from soccer and rugby clubs situated around the Cape Peninsula area, Western Cape, South Africa. The three-dimensional (3D) knee kinematics of ten cases with chronic groin pain and ten asymptomatic controls was analysed. Knee kinematics was analysed in the FNB-3D Vicon Laboratory at Stellenbosch University, using an eight camera Vicon system. A positive adductor squeeze test was used as a diagnostic test to include cases with chronic groin pain. Each participant performed six single-leg drop landings. The main outcome measure was 3D knee kinematics at initial foot contact and at the lowest vertical position of the drop landing. The following sub-groups were analysed: seven unilateral groin pain cases compared to their seven matched controls; three bilateral groin pain cases where their most painful leg and least painful leg were compared to their matched controls, respectively. Descriptive statistical techniques were used for all outcome measures; means and standard deviations (SD) were calculated, followed by a Student’s t-test to determine significant differences between the cases and controls. For all outcomes with p-values equal to or below 0.05, the effect size was calculated using the Cohen’s D. Results: The findings of this study indicated a significant difference (p=0.0001) between cases with unilateral groin pain having less knee internal rotation compared to the controls at the lowest vertical position of the drop landing in the transverse plane. Significantly less internal rotation (p<0.0001), was also noted in the cases with bilateral groin pain (in the most painful leg and the less painful leg), although this was noted at foot contact. Cases with bilateral groin pain also had significantly (p<0.001) more knee varus (adduction) during the landing phase. Conclusion: Differences in knee kinematics between sports participants with chronic groin pain and asymptomatic controls were found. These findings imply that the knee joint should be included during assessment and rehabilitation of individuals suffering with chronic groin pain. Due to the cross-sectional study design of the current study, it cannot be stated for certain whether the knee kinematics noted in the groin pain group are causative or as a result of groin pain. Future prospective studies are thus recommended; these studies should focus on the effect of contralateral knee kinematics on the hip adductors and may include exploration of the muscular components during a single-leg drop landing.
AFRIKAANSE OPSOMMING: Inleiding: Lies beserings is een van die top ses beserings in kontak sport en kan lei tot chroniese lies pyn en selfs die be-eindigging van ‘n sportloopbaan. Navorsing oor die rol van knie kinematika in die ontwikkeling van chroniese liesbeserings in sport is skaars. Doelwit: Die doel van hierdie studie was om te bepaal of daar verskille in die knie kinematika is tydens 'n enkel been val landing in sport deelnemers met chroniese lies pyn in vergelyking met gesonde kontroles. Metode: 'n Beskrywende studie was uitgevoer. Twintig aktiewe sport deelnemers is gewerf van rugby en sokker sportklubs geleë rondom die Kaapse Skiereiland, Wes-Kaap, Suid-Afrika. Die 3D knie kinematika van tien gevalle met chroniese lies pyn en tien asimptomatiese bypassende kontroles is ontleed. Knie kinematika was ontleed in die FNB-3D Vicon Laboratorium by die Universiteit van Stellenbosch, met behulp van 'n agt-kamera Vicon stelsel. 'n Positiewe Adduktor druk toets was gebruik as 'n diagnostiese toets om gevalle met chroniese lies pyn in te sluit. Om die knie kinematika te analiseer, het elke deelnemer ses enkel been val landings uitgevoer . Die belangrikste uitkomsmeting was 3D knie kinematika by die aanvanklike voet kontak en by die laagste vertikale posisie van die enkel-been val landing. Die volgende sub-groepe was ontleed: sewe unilaterale lies pyn gevalle in vergelyking met hul sewe bypassende kontroles; drie bilaterale lies pyn gevalle waar hul mees pynlike been, sowel as minder pynlike been onderskeidelik vergelyk was met hul bypassende kontroles. Beskrywende statistiese tegnieke was gebruik vir alle uitkoms maatreëls; gemiddeldes en standaardafwykings (SA) was bereken, gevolg deur 'n Studente’s t-toets om beduidende verskille tussen die gevalle en kontroles te bepaal. Vir al die uitkomste met p-waardes gelyk of onder 0.05, is die effekgrootte bereken deur die Cohen’s D. Resultate: Die bevindings van hierdie studie dui op 'n beduidende verskil (p=0,0001) tussen gevalle met unilaterale lies pyn met minder interne knie rotasie in vergelyking met die kontroles by die laagste vertikale posisie van die val landing in die dwars vlak. Aansienlik minder interne rotasie (p<0,0001), is ook opgemerk in gevalle met bilaterale lies pyn (in die mees pynlike been en die minder pynlik been), alhoewel tydens voet kontak. Gevalle met bilaterale lies pyn het ook betekenisvol (p <0.001) meer knie varus (adduksie) tydens die landingsfase gehad. Gevolgtrekking: Verskille bestaan in die knie kinematika tussen sport deelnemers met chroniese liesbesering pyn en gesonde kontroles. Hierdie bevindinge impliseer dat die knie behoort ingesluit te word tydens die assessering en rehabilitasie van individue met chroniese lies pyn. As gevolg van die deursnee-studie ontwerp van hierdie studie, kan dit nie bevestig word of die knie kinematika die oorsaak van die chroniese pyn is nie. Toekomstige voornemende studies word dus aanbeveel, hierdie studies moet fokus op die effek van die kinematika van die kontralaterale knie op die heup adduktore en kan moontlik die ondersoek van die spier kinetika tydens hierdie aktiwiteit insluit.
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Myer, Gregory D. "The effect of three selected exercises on electromyographic root mean square values and vastus medialis oblique to vastus lateralis ratio." Virtual Press, 1998. http://liblink.bsu.edu/uhtbin/catkey/1101588.
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The primary purpose of this study was to determine the ratio of activation between the VMO and VL while performing three selected knee exercises (drop squat, modified lateral squat, Muncie Method). Additionally, the data was analyzed to determine if a correlation existed between the muscle's activation rate per set and whether or not the rates are affected by Q-angle or gender. Twenty Ball State University subjects (10 male, 10 female) who were asymptomatic to Patellofemoral Syndrome (PFS), provided electroymyographic (EMG) data while performing the three selected exercises. A one-way ANOVA found no statistical significance (p=0.500) on any of the tested variables except the Drop Squat VL Root Mean Square (RMS). Significant correlations were found between: VL RMS to set number during drop squat, and VMO and VL RMS to set number during Muncie Method performance. Based on the results of this study, each of these exercises could be used to selectively strengthen the VMO in treatment of PFS.School of Physical Education
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Eades, Anne. "Factors that influence participation in self-management of wound care in three indigenous communities in Western Australia : clients' perspectives /." Murdoch University Digital Theses Program, 2008. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20090702.111437.
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Cochrane, Jodie L. "Training to alter the risk of anterior cruciate ligament injuries in sporting manoeuvres." University of Western Australia. School of Human Movement and Exercise Science, 2006. http://theses.library.uwa.edu.au/adt-WU2007.0035.
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[Truncated abstract] Anterior cruciate ligament injuries are a major problem in sport. The purpose of this thesis was to investigate the causative factors of ACL injuries and to study the effect of various types of lower-limb training on underlying neuromuscular mechanisms involved in stabilisation and risk of ACL injury. Investigation of the mechanisms was conducted on controlled balance and strength tests as well as in sporting manoeuvres. It was aimed to assess if the neuromuscular changes map over into the performance of sporting manoeuvres and if potential for loading on the ACL and risk of injury was reduced or exacerbated . . . ACL strain can be decreased through reduction in the applied loads and greater knee flexion. Further to this, muscle activation has the ability to reduce loading on the ACL through co-contraction and selective activation patterns. This thesis demonstrated differing neuromuscular adaptations from various training types that map over into the performance of sporting manoeuvres. The research indicated that the Balance-Training was the most favourable in reducing potential for injury risk on the ACL. Alternatively strength training elicited neuromuscular changes that were likely to increase the risk of force on the ACL. The Machine+Balance training resulted in some negative and positive outcomes with the balance training tending to counteract the negative affects of machine weights training resulting in small improvements in muscular support and load reduction. This study provides us with better understanding of the underlying mechanisms from various training types and their potential affect on risk of ACL injury.
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Bogner, Jo-Anne Lesley Lee. "Discrimination between sincere and deceptive isokinetic knee extension response using segmental curve analysis." Thesis, This resource online, 1991. http://scholar.lib.vt.edu/theses/available/etd-08182009-040334/.
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Monteleone, Gina Marie. "The effects three different anterior knee pain treatments have on strength and performance." Virtual Press, 1999. http://liblink.bsu.edu/uhtbin/catkey/1129635.
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The purposes of this study is to determine: (a) the relationship between the dependant variables, (b) the relationship between the Borg pain scale and the performance tests, (c) the difference in performance between involved and uninvolved extremities, and (d) the effects of the three different therapeutic exercise treatments on selected performance tests and pain free isometric strength testing. Fifty subjects with physician diagnosed anterior knee pain (AKP), completed initial performance testing and 14 subjects completed initial testing, therapy and six weeks later final performance testing. The 14 subjects were randomly assigned to one of three therapeutic exercise treatment groups. The performance tests included; pain free isometric strength tests (90, 60, 45, and 15 degrees knee flexion), stair test, timed hop, triple hop, crossover hop, Figure 8 and Borg pain scale rating for each performance test. The results indicated a significant correlation between performance tests and pain free isometric strength tests. There was no relationship indicated between the performance tests, Borg pain scale ratings. The contrast between the injured and uninjured extremities performance test values of the fifty subjects that completed the initial testing indicated no significant (p< 0.05) difference. The results of this study indicated that there was no significant difference between the therapeutic exercise treatment groups. In conclusion, the three anterior knee pain treatments had no effect on strength and performance.School of Physical Education
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Leibbrandt, Dominique Claire, and Quinette Louw. "The effect of McConnell taping on knee biomechanics : what is the evidence?" Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/96949.
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Thesis (MScPhysio)--Stellenbosch University, 2015.ENGLISH ABSTRACT: This review aims to present the available evidence for the effect of McConnell taping on knee biomechanics in individuals with Anterior Knee Pain (AKP). Pubmed, Medline, Cinahl, Sportdiscus, Pedro and Science Direct electronic databases were searched from inception until September 2014. Experimental research into knee biomechanical or EMG outcomes of McConnell taping compared to no tape or placebo tape were included. Two reviewers completed the searches, selected the full text articles and assessed the risk of bias of eligible studies. Authors were contacted for missing data. Eight heterogeneous studies with a total sample of 220 were included in this review. All of the studies had a moderate to low risk of bias and compared taping to no tape and/ or placebo tape. Pooling of data was possible for three outcomes; average knee extensor moment, average VMO/VL ratio and average VMO-VL onset timing. None of these outcomes revealed significant differences. The evidence is currently insufficient to justify the routine use of the McConnell Taping technique in the treatment of Anterior Knee Pain. There is a need for more evidence on the aetiological pathways of Anterior knee Pain; level one evidence and studies investigating other potential mechanisms of McConnell taping.
AFRIKAANSE OPSOMMING: Die objektief van hierdie resensie was om te bepaal wat die effekte van McConnell Patellar Vasbinding is op knie kinematika, kinetiek en spier aktivering in diegene met Voorafgaande Knie Pyn (VKP). Die navorsers het elektroniese databases soos Pubmed, Medline, Cinahl, Sportdiscus, Pedro en Science Direct, van aanvang tot September 2014, ondersoek. Eksperimenteel studie ontwerpe wat biomeganiese of EMG gevolge van McConnell Vasbinding vergelyk met geen vasbinding of placebo vasbinding, is ingesluit. Twee resente het die ondersoek voltooi, die volle tekse artikels gekies en die partydigheid risiko van die ingeslote studies, geskat. Skrywers is gekontak vir enige verlore data. Agt heterogeen studies uit ‘n totalle monster van 220 is in hierdie resensie ingesluit. Al die studies het ‘n gematigde tot laag risiko vir eensydigheid en vergelyk vasbinding met geen of placebo vasbinding. Data saamvoeging was moontlik vir drie uitslae, naamlik: gemiddelde knie ekstensor moment; gemiddelde VMO/VL ratio en gemiddelde aanval tydmeting. Geen gevolge het veelseggende verskille of afwykings vertoon. Tans is die bewys nie genoegsaam om die routiene gebruik van McConnell Vasbinding tegniek te regverdig nie in die behandeling van VKP. Meer bewyslewering op die etiologiese paaie van VKP; Graad een bewys en studies wat ander moontlike meganisme van Mc Connell Vasbinding ondersoek, is noodsaaklik.
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Boerem, David L. "Peak isokinetic torque of knee flexors and extensor muscles of college football players." Scholarly Commons, 1987. https://scholarlycommons.pacific.edu/uop_etds/499.
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The problem of the study addressed knee injuries in college football. Imbalance of the musculature surrounding the knee would predispose the athlete to knee injury. Recognition of those who have muscular deficiencies would be a primary way of preventing knee injuries. The focus of the study was to determine if there was a significant difference in peak isokinetic torque of knee flexor and extensor muscles across speeds (60 degrees/second, 180 degrees/ second and 300 degrees/second) of a college football team subsequent to participation in a spring football season.
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Atkinson, Judy. "Lifting the blankets: The transgenerational effects of trauma in Indigenous Australia." Thesis, Queensland University of Technology, 2001. https://eprints.qut.edu.au/35841/1/35841_Digitised%20Thesis.pdf.
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The two specific aims of the fieldwork were to understand: (a) the phenomena of violence in the lives of a group of Aboriginal and non-Aboriginal people (the later by invitation of the Aboriginal people), living within a central coastal region of Queensland; and (b) cultural and individual processes of recovery or healing from violence related trauma. More specifically the questions that guided the field studies were:
* What is the experience of violence?
* How do experiences of violence contribute to experiences/behaviours that influence situations of inter-and transgenerational trauma?
* What assists change or healing in such behaviours?
* What is healing and how do people heal?
* What cultural tools promote change or healing, and how can these be supported to promote individual, family and community well-being?
Through the literature review the thesis considers cultural processes Aboriginal peoples previously used to deal with the trauma of natural disaster or man induced conflict. The literature review is then used to consider the impacts of trauma on the lives of people general. Finally the literature make links to locate the violence of contemporary Aboriginal communal environment to levels of trauma transmitted across generations from colonising processes.
The thesis is based on evolving Indigenous research methodological approaches, as it uses an Aboriginal listening/learning process called *dadirri* which is described as a cyclic process of listening and observing, reflecting and learning, acting and evaluating, re-listening and re-learning, and acting with insight and responsibility both in the field and with integrity and fidelity within the dissertation.
The thesis demonstrates *dadirri* in Chapter Four as it allows the voices of six participants to tell their stories of trauma and of healing in meaningful painful conversation with each other. These six participants represent some of the six hundred people who participated in the fieldwork over the years of the study. It is from this conversation that the data for the explication of the trauma experience and the healing processes has been drawn.
Chapter Five of the thesis is the explication of the trauma experience. In this chapter links are made between the violence experience, thoughts and feelings and resulting behaviour; feelings of inadequacy as a result of childhood experiences; victim perpetrator survivor roles in family and community violence; the relationships between alcohol and drugs to trauma; suicidal behaviours as a result of trauma; the fractured self, and finally the trans generational effects of trauma.
Chapter Six is the explication of the healing processes as they were narrated by the participants. Healing was defined by participants as educating them selves about who they are. The themes on healing that emerged in chapter Four are: healing as an awakening to inner (unmet) needs; healing as an experience of safety; healing as community support; rebuilding a sense of family and community in healing; healing as an ever-deepening self-knowledge; the use of ceremony in healing; strengthening cultural and spiritual identity in healing; healing as transformation, and transcendence and integration in healing.
Chapter Seven presents a synthesis and integration of the material and a model proposed for understanding trauma and healing from an Aboriginal perspective.
The thesis is an exploratory study. The findings and conclusions will be of use in the development and delivery of programs for community action in primary prevention and critical intervention in family violence, alcohol and drug programs, social and emotional well-being programs and crime prevention strategies. The thesis could be used as a foundation for future studies into violence and into healing within Aboriginal situations within Australia.
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Almeida, Adriano Marques de. "Avaliação da função aeróbia em atletas profissionais de futebol de campo submetidos a reconstrução do ligamento cruzado anterior." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-27092017-133302/.
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INTRODUÇÃO: A lesão do ligamento cruzado anterior (LCA) é considerada uma lesão grave e pode afetar a carreira de um jogador de futebol profissional. O tratamento cirúrgico é frequentemente necessário para o tratamento da instabilidade. Embora a reconstrução do LCA seja considerada um procedimento eficaz em restaurar a estabilidade articular, a literatura mostra que apenas 55% dos atletas retornam à prática de esportes competitivos após a cirurgia. Jogadores de futebol profissional dependem de habilidades técnicas, táticas e físicas, como boa função do joelho e capacidade aeróbia. O objetivo deste trabalho é avaliar a capacidade aeróbia em jogadores profissionais de futebol de campo com lesão do LCA e após seis meses de reabilitação pós-operatória. MÉTODOS: Vinte jogadores profissionais de futebol de campo com lesão do LCA foram submetidos a reconstrução do LCA com tendões flexores autólogos e foram comparados com 20 jogadores profissionais de futebol de campo em atividade, sem histórico de lesão no joelho. Avaliamos a capacidade aeróbia máxima pelo consumo máximo de oxigênio (VO2max) e submáxima pelos limiares ventilatórios (LV1 e LV2), avaliados por ergoespirometria em esteira utilizando o protocolo de Heck modificado. Os testes foram realizados no pré-operatório e aos seis meses de pós-operatório e os resultados comparados ao grupo controle de jogadores profissionais em plena atividade. Também realizamos questionários de função subjetiva do joelho (Lysholm e IKDC), dinamometria isocinética computadorizada e avaliação da composição corporal por bioimpedância. RESULTADOS: No grupo com lesão do LCA a média da idade foi de 21,7 anos, enquanto no grupo controle foi de 22,1 anos (p=0,99). O intervalo de tempo a lesão e a cirurgia foi, em média, cinco meses. No pré-operatório, o VO2max, em mL/kg/min, foi em média ? desvio padrão de 45,2 +- 4,3, aos seis meses de pós-operatório 48,9 +- 3,8 (p < 0,001) e no grupo controle 56,9 +- 4,2 (p < 0,001 comparado ao pré-operatório e pós-operatório). A porcentagem de gordura corporal, em média +- desvio padrão, no pré-operatório foi de 14,7+- 3,7, no pós-operatório 14,9 +- 5,4 e no grupo controle 12,8 +- 4, sem diferença estatisticamente significativa entre os grupos. Os resultados do questionário Lysholm no pré-operatório, pós-operatório e no grupo controle foram, em média, 77,25, 94,12 e 97,5 (p < 0,05 em todas as comparações) e do questionário IKDC subjetivo foram 59,46, 87,75 e 97,28 (p < 0,001 em todas as comparações). O déficit de pico de torque de extensão do joelho a 60 O/s, foi de 21,5% no pré-operatório, 15,7% no pós-operatório (p=0,63) e 3,1% no grupo controle (p < 0,001 com relação ao pré-operatório e pós-operatório). CONCLUSÃO: Os jogadores profissionais de futebol de campo avaliados seis meses após a reconstrução do LCA apresentaram VO2max significativamente inferior aos resultados do grupo controle, embora os resultados pós-operatórios tenham sido significativamente superiores aos observados no pré-operatório. Houve uma melhora significativa nos scores de função do joelho no pós-operatório com relação ao pré-operatório e a composição corporal dos indivíduos não apresentou diferenças estatisticamente significativasINTRODUCTION: Anterior cruciate ligament (ACL) injury is a severe injury and may impact a professional football player\'s career. Surgical treatment is often indicated due to knee instability. Although ACL reconstruction (ACLR) is considered a successful procedure in restoring knee stability in athletes, it has been shown that only 55% return to competitive sports after surgery. Professional football players need technical, tactical and physical skills to succeed, including adequate knee function and aerobic capacity. Our purpose is to evaluate aerobic capacity in professional football players with ACL injury and six months after ACL reconstruction. METHODS: Twenty professional football players underwent ACL reconstruction with autologous hamstring grafts and were compared to 20 active, uninjured professional football players. We assessed maximal aerobic capacity with maximal oxygen consumption (VO2max) and submaximal with ventilatory thresholds, measured by ergoespirometric test performed in a treadmill with a modified Heck protocol. The tests were performed pre-operatively and six months after ACLR, and compared to the control group. We also performed knee function questionnaires (Lysholm and IKDC), isokinetic strength test and body composition evaluation with electric bioimpedance. RESULTS: ACL group average age was 21.7 y.o., and control group 22.1 y.o.(p=.99). Time span between injury and surgery was 5 months, in average. Pre-operative VO2max was 45.2 +- 4.3 mL/kg/min, post-operative was 48.9 +- 3.8 (p > .001) and control group was 56.9 +- 4.2 (p < 001 in both comparisons). Pre-op body fat percentage was 14.7+-3.7, post-op was 14.9 +- 5.4 and control 12.8 +- 4 (n.s.). Lysholm questionnaire results were 77.25, 94.12, and 97.5 (pre-op, post-op and control, respectively, p <. 05 in all comparisons). IKDC results were 59.46, 87.75 and 97.28 (pre-op, post-op and control, respectively, p < .001 in all comparisons). Preop peak torque isokinetic knee extension deficit at 60°/s was 21.5%, postop 15.7% (p=.63) and control 3.1% (p <. 001). CONCLUSION: Professional football players had significantly lower VO2max six months after ACLR compared to controls, although their results were significantly higher than observed pre-operatively. There was a significant improvement in knee function scores after ACLR. Body composition evaluation was not significant different among the groups evaluated
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McGarry, Sarah. "Pediatric medical traumatic stress : the impact on children, parents and staff." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2013. https://ro.ecu.edu.au/theses/605.
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Burns are one of the most painful and traumatising injuries an individual can sustain and constitute a serious global health threat to children. Despite the magnitude of this public health problem, little research has examined the psychological burden of these injuries. This study used a mixed-methods approach to investigate the effect of paediatric medical trauma on children who have sustained a burn, their parents and the healthcare professionals caring for these patients. The paediatric medical traumatic stress model provided a theoretical framework for this study.
Firstly, this study aimed to gain an understanding of the lived experience of children who sustain a burn. Using phenomenology as a methodology, the first paper in this thesis provided an in-depth understanding of children’s perceptions, thoughts and feelings about the lived experience of sustaining a burn. The findings identified two phases of trauma that are central to the burn experience. The paper found that children experience ongoing trauma in addition to the initial trauma of sustaining the burn, resulting in a cumulative trauma experience. Six themes were identified in the data describing the child’s experience: ongoing recurrent trauma; return to normal activities; behavioural changes; scarring-the permanent reminder; family functioning and adaptation. The methodology of this research provided a voice for the child’s perspective of the burn experience and the findings can be used to inform clinical care at all stages of the burn journey.
The second paper, a cross-sectional study, aimed to investigate the impact of exposure to paediatric trauma on parents of children with a burn and to identify risk factors and relationships between psychological distress and resilience. The results indicated that parents experienced significantly more symptoms of post-traumatic stress disorder than a comparative population. Factors including having a daughter, witnessing the event, feeling helpless or having past traumatic experiences significantly influenced symptoms of psychological distress and resilience. Findings from this study highlight that health professionals should screen parents to identify those at greatest risk and provide effective evidence-based interventions aimed at improving resilience and reducing stress, as part of standard, routine care.
The aim of the third paper was to gain an understanding of the lived experience of parents of a child with a burn injury. Using a phenomenological, qualitative methodology allowed aspects of the parents’ experience not collected in standardised outcome measures to be identified, enabling triangulation with the quantitative results found in the second study. The findings demonstrated that the experience of parents reflected a journey that was represented by three phases: the event, the inpatient phase and the return to the community. Within the three phases, themes of external stressors, emotional and behavioural responses and coping strategies were identified. These findings can be used for the development of protocols to underpin a comprehensive information and social support management plan for families. This would complement the surgical and medical treatment plan, providing direction for comprehensive service delivery.
Children, parents and health professionals are interconnected in a professional relationship. The aim of the fourth paper was to investigate the effect of exposure to paediatric medical trauma on multidisciplinary teams and the relationships between psychological distress, resilience and coping skills. Health professionals experienced significantly more symptoms of psychological distress and less resilience than comparative groups. Non-productive coping was associated with adverse psychological outcomes and younger health professionals were more vulnerable to psychological distress than those aged 25 years and above. Findings from this study may assist in developing organisational systems to facilitate optimal mental health and coping strategies in health professionals, with the aim of the maintenance of a healthy workforce.
Overall findings from this research provide evidence for health professionals to optimise a holistic clinical service at all stages of the burn journey. These findings provide previously unknown knowledge about the impact of paediatric medical trauma on children, parents and health professionals within a paediatric hospital.
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Farrimond, Claire. "The inter-examiner reliability and comparison of motion palpation findings of the knee joint in patellofemoral pain syndrome and asymptomatic knee joints." Thesis, 2010. http://hdl.handle.net/10321/583.
Full textAbstract:
Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010.Motion palpation is used to assess the functional status of a joint and is defined as “The manual palpation of bony structures and soft tissues, through pressure applied in various directions of joint motion to ascertain areas of joint hypomobility and hypermobility.” Motion palpation is a collection of manual examination procedures, used to identify the site and characteristics of altered joint motion and which has been an important part of chiropractic since its inception. One of the most important goals for any clinical instrument is for it to have good reliability and reproducibility, this is because the clinical value of a test must be demonstrated before the results are considered valid. The extent to which a repeated test will produce the same result when evaluating an unchanged characteristic is its reliability. Reliability is evaluated by multiple blinded measurements performed on a sample of subjects. Inter-examiner reliability evaluates the consistency of different examiners and is determined through repeated assessment by two or more raters. Objective The aim of this study was to determine the inter-examiner reliability of motion palpation of knee joints with patellofemoral pain syndrome and asymptomatic knee joints, and to compare the inter-examiner reliability of motion palpation between the two groups. Method This quantitative, inter-examiner, clinical reliability study, included 30 patients each with one knee with patellofemoral pain syndrome and one asymptomatic knee. Each patient had both of their knees motion palpated by three independent examiners blinded to which was the symptomatic knee. The examiners were senior student interns at the DUT Chiropractic Clinic. The motion palpation findings were recorded and statistically analyzed through the SPSS statistical package. Fleiss Kappa statistic was used to give a Kappa score for each direction of motion palpation and these scores evaluated the inter-examiner reliability of motion palpation in the symptomatic and the asymptomatic knee. A comparison of the inter-examiner reliability of motion palpation between the two groups was performed using a paired Wilcoxin signed ranks test. Results The Kappa scores for motion palpation ranged from -0.2081 to 0.1802 for the symptomatic knee joint and -0.2836 to 0.0339 for the asymptomatic knee. This shows poor agreement in both cases. There was no significant difference in Kappa values (p= 0.609) for the two groups for the Wilcoxin signed ranks test and the number of positive and negative ranks were similar. This indicates that the reliability of motion palpation in both groups was similar. Conclusion It was concluded that inter-examiner reliability of motion palpation of the knee joint was poor in knees with patellofemoral pain syndrome and in knees that were asymptomatic. Motion palpation was found to be equally reliable in both groups, indicating that motion palpation of a symptomatic joint does not improve its reliability. This research suggests that motion palpation should be used together with other diagnostic tests to identify patellofemoral pain syndrome as it is not a reliable tool when used in isolation.
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"A new approach to apply and develop biomechanical techniques to quantify knee rotational stability and laxity." Thesis, 2011. http://library.cuhk.edu.hk/record=b6075507.
Full textAbstract:
Lam, Mak Ham.Thesis (Ph.D.)--Chinese University of Hong Kong, 2011.
Includes bibliographical references (leaves 110-131).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese.
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Chandrasekaran, Sivashankar. "Magnetic resonace imaging kinematics of the Posterior Cruciate deficient knee." Master's thesis, 2013. http://hdl.handle.net/1885/156120.
Full textAbstract:
The aim of this thesis is to compare the sagittal plane articulation of the Tibiofemoral joint of the Posterior Cruciate Ligament (PCL) deficient knee with the healthy knee and the contralateral uninjured knee. Difference in the articulation profile may help to explain the predominance of medial compartment degeneration seen arthroscopically in PCL injured knees. Analysis of the kinematics of the contralateral knee may help elicit predisposing kinematic abnormalities to PCL injuries and also test the validity of using the contralateral knee as a control. Magnetic resonance was used to generate sagittal images of ten healthy knees and ten knees with isolated PCL injuries. The subjects performed a supine leg press against a 150N load. Images were generated at 15 degree intervals as the knee flexed from 0 to 900. The Tibiofemoral Contact (TFC) and the Flexion Facet Centre (FFC) were measured from the posterior tibial cortex. The contact pattern and FFC was significantly more anterior in the injured knee from 45 to 900 of knee flexion in the medial compartment compared to the healthy knee. The greatest difference between the mean TFC points of both groups occurred at 75 and 900, the difference being 4 mm and 5 mm respectively. The greatest difference between the mean FFC of both groups occurred at 750 of flexion, which was 3 mm. There was no significant difference in the contact pattern and FFC between the injured and healthy knees in the lateral compartment. There was no significant difference in the TFC and FFC between the healthy knee and contralateral knee of subjects with acute and chronic PCL injuries in the medial and lateral compartments of the knee. The study demonstrates that there is a significant difference in the medial compartment sagittal plane articulation of the tibiofemoral joint in subjects with an isolated PCL injury. Further, this study suggests there is no predisposing articulation abnormality to PCL injury. That is, in the setting of chronic injury the contralateral knee does not modify its articulation profile and the contralateral knee can be used as a valid control when evaluating the articulation of the PCL deficient knee.
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Fish, Denham. "The effectiveness and relative effectiveness of combining a topical capsaicin cream and knee joint mobilization in the treatment of osteoarthritis of the knee." Thesis, 2002. http://hdl.handle.net/10321/2708.
Full textAbstract:
A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, 2002.The purpose of this study was to determine the effectiveness and relative effectiveness of a topical Capsaicin cream and knee joint mobilization in the treatment of Osteoarthritis (OA) of the knee.
M
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McClure, Roderick. "The public health impact of minor injury." Phd thesis, 1994. http://hdl.handle.net/1885/144086.
Full text
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Damon, Chantelle Ann. "The role of plain film radiography in the diagnosis and management of knee pain." Thesis, 2012. http://hdl.handle.net/10321/711.
Full textAbstract:
Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012.Background: Attempts to determine the association between the radiographic and clinical findings of knee pathology have produced conflicting results. It is also not yet known how knee radiographs influence the conservative management of patients with knee pain. Objectives: 1. To determine the association between the clinical and radiographic diagnoses of knee pain. 2. To record the consultation at which a radiograph of the knee was requested by the student or clinician and the reasons thereof. 3. To record the suspected clinical diagnoses and management of the patients prior to referral for radiographs of the knee. 4. To determine the number of incidental radiographic findings in the selected radiographs. 5. To determine any change in the clinical diagnoses and management following radiographic reporting of the selected radiographs. Method: Radiographic and clinical data from 1 January 1997 to 31 December 2010 were retrospectively collected from knee radiographs and corresponding patient files from the archives of the Chiropractic Day Clinic (CDC). Statistical analysis included the use of percentages, mean, standard deviation, range and frequency counts for the descriptive objectives. Diagnoses were categorized into specific groups and to construct two-by-two tables of absence or presence of radiographic vs. clinical diagnosis for each specific diagnosis to determine the association indicator variables were used. Results: The overall agreement between the clinical and radiographic diagnoses was 85.5%. For degenerative joint disease there was a 97.8% agreement while in Osgood Schlatter’s disease the agreement was 100%, and in chondromalacia patella the agreement was 50%. However, there was no agreement between the clinical and radiographic diagnoses for each of the other specific conditions. Degenerative changes were the most common radiographic findings. The iv majority of the knee radiographs were requested at the initial consultation and as the length of treatment increased, the frequency of radiograph requests decreased. The most common reasons for referral for radiographs were to identify degenerative changes (47.5%) and to assess for unspecified pathology (37.4%). Of the 146 patients in this study, 125 patients did not have a change in diagnosis after radiographs were obtained which means that 85.6% of the diagnoses remained the same after radiographic examination. There was a wide range of treatment modalities utilized in the management of patients with knee pain, including soft tissue therapy, electrotherapeutic modalities and manual therapy (manipulation and mobilization). The use of manual therapy increased from 67.8% prior to radiographs being taken to 82.9% after radiographs were obtained. Conclusion: Knee radiographs were over-utilized at the CDC and the findings on radiography did not have much influence on the diagnosis and the management of the patient presenting with knee pain. The majority of the clinical diagnoses were degenerative causes of knee pain.
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Turnbull, Grant S. D. "The effectiveness of three treatment protocols in the treatment of iliotibial band friction syndrome." Thesis, 2010. http://hdl.handle.net/10321/549.
Full textAbstract:
Mini-dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010.Iliotibial Band Friction Syndrome (ITBFS) is an overuse injury induced by friction of the iliotibial band (ITB) over the lateral epicondyle of the femur (LFE) with secondary inflammation. ITBFS is a prevalent condition and is the most common cause of lateral knee pain in long distance runners and cyclists. There are a significant number of aetiological factors related to ITBFS. As a result of this the general chiropractic approach to the treatment of ITBFS is multimodal and include interventions such as joint manipulation, cryotherapy, orthotics, massage, electrical stimulation, acupuncture type procedures and therapeutic exercise. Dry-needling is an effective therapy in the treatment of active Myofascial Trigger Points (MFTP’s) that are associated with ITBFS. However, the available literature suggests that to determine its efficacy, it should be performed in isolation. The association of sacroiliac joint dysfunction in ITBFS has also been addressed and are thought to co-exist and perpetuate one another. It is recommended that chiropractors include pelvic manipulation in their treatment protocol for ITBFS however there is a paucity of literature showing its effectiveness in the treatment of this condition. There appears to be a need for further research in the form of randomized controlled clinical trials with regard to chiropractic specific procedures, performed in isolation, in the treatment of ITBFS. Therefore this study aimed to add to the literature by assessing the effect of the sacroiliac joint manipulation and dry needling in the treatment of ITBFS. Objectives The study aimed to determine the comparative effectiveness of dry needling alone versus manipulation alone, as well as a combination of the two interventions in the treatment of ITBFS. Methods This study was a randomised, open label trial. 47 participants with ITBFS were divided into three groups, each group receiving a different intervention i.e.: group one received dry needling of the active MFTP’s in the Tensor Fascia Lata (TFL) and ITB, group two received sacroiliac joint manipulation, group three received a combination of the two interventions. Subjective measurements, in the form of the Numerical Pain Rating Scale-101 (NRS-101), and objective measurements, in the form of algometer readings in the TFL, ITB and Nobles Compression test as well as digital inclinometer readings of Modified Obers test, were utilised to determine the effects of the respective interventions. These measurements were recorded twice, once prior to commencing the treatment programme. These values were then evaluated to compare the efficacy of the different treatment interventions. Each participant received four treatments over a two week period. Results There were no statistically significant differences between the three treatment groups as they all seemed to parallel one another with regards to overall improvement in subjective and objective measurements (P<0.5). However on closer examination subtle differences between the groups were noted. An interesting endpoint is that the combination group did not fair the best throughout the study, which was contrary to the original hypothesis. The groups receiving only the single intervention appeared to fair marginally better over the combination group. A secondary endpoint that became evident during the study and on analysis of the data, was that hip joint instability must also be considered when treating ITBFS when there is concomitant sacroiliac joint dysfunction. Conclusion A decision needs to be made with regard to which intervention best suits the individual at the time. A combination therapy, which originally was thought to be the best treatment option, should possibly be reconsidered. Perhaps a single intervention of manipulation or dry needling should be decided upon. In totality, all intervention proved to be effective in the treatment of ITBFS.
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Harris, Kelly Jayne. "The state of current knowledge regarding evidence-based conservative management of iliotibial band syndrome : a systematic review." Thesis, 2014. http://hdl.handle.net/10321/1103.
Full textAbstract:
Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013.Background : It has become practically impossible for practitioners to remain current with clinical developments. Additionally the demand from patients and third party payors for quality evidence is increasing. A systematic review is one manner in which information can be graded, summarised and presented in a succinct format for use by practitioners, patients and third party payors. Objectives : To identify the current knowledge available on the conservative management of iliotibial band syndrome (ITBS) and to evaluate the scientific and methodological rigor of that knowledge. The systematic review of these studies identified the level and type of evidence that currently exists in the support of conservative management of ITBS and the specific interventions and combinations of interventions currently employed. Method : A systematic review of ITBS studies was conducted. ITBS studies were identified using key indexing terms (iliotibial band syndrome, treatment, conservative and intervention) on several databases (EBSCOhost, Google Scholar, Metalib, Pubmed, Science Direct and Springerlink), all studies were included up until the date of ethics approval (21st May 2012) . The gathered studies were screened for compliance with the inclusion criteria, and then reviewed by blinded independent reviewers (reviewer criteria included qualification, clinical experience, academic experience, research experience and discipline). Data collection and analysis : The reviewers rated the methodological rigour of the ITBS studies utilising an appropriate scale (e.g. PEDro Scale). Feedback was collated and analysed for discordance. Studies were then analysed, ranked and followed by a discussion in the context of their clinical outcomes, thus formulating a structured summary of the known clinical data with regards to the clinical management of ITBS. Results: The identified citations (4130) were screened and sorted by study type. This resulted in 167 citations that were reviewed by abstract for compliance with the inclusion criteria. A final total of 23 studies meet eligibility criteria. Eight articles reported on a combination of interventions, four discussed biomechanical and causative factors, and the remaining eleven articles investigated individual interventions in the treatment of ITBS. After review and analysis, combination interventions were supported by the strongest level of evidence, thus advocating the use of a combination of interventions in the management of ITBS in providing better clinical outcomes. Moderate evidence favoured the use of customised orthoses, injectable corticosteroids, phonophoresis and addressing biomechanical and causative factors. However, there was moderate evidence against the use of deep tissue frictions, as no improvement was found. This outcome suggests a need for further evidence to advocate the appropriateness of these interventions in clinical care of ITBS. Hip abductor strengthening and stretch therapy were found to have limited evidence. However, no evidence was found to support the application of active release technique, corrective neuromuscular approach, custom dry floatation cushions and talar joint manipulation in the management of ITBS. This latter outcome indicated a need for studies to investigate their appropriateness or inappropriateness in clinical care. Conclusion : The systematic review of ITBS studies revealed that use of a combination of conservative therapies was found to have the strongest level of evidence, which may indicate its appropriateness in the management of patients suffering from ITBS. Specific combinations of conservative therapies and the use of individual therapies require future research in order to better delineate their contribution to the management of ITBS. Randomised controlled trials are the gold standard for research, as they have the greatest level of methodological quality, and should be used where possible when investigating the efficiency of interventions in the treatment of ITBS. Studies, which were not randomised controlled trials, but adopted the principles of a randomised controlled trial structure, contributed positively towards the methodological rigor of these studies.
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Fraser, Donna Francoise. "A prospective clinical trial to determine the relative effectiveness of cross friction massage versus Graston instrument assisted soft tissue mobilisation in treating patellar tendinopathy." Thesis, 2008. http://hdl.handle.net/10321/515.
Full textAbstract:
Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2008.There are mechanical loads applied to the patella tendon in almost all sporting activities and as a result is commonly injured (Peterson and Renström, 2003:321). Patellar tendinopathy is a common chronic tendinopathy (Hamilton and Purdman, 2004) and occurs commonly in athletes who impose rapid eccentric loading of the knee extensor mechanism (Norris, 2004:246). Deep Transverse Friction Massage (DTFM) and soft tissue mobilization are the two most common forms of manual therapy used to treat patellar tendinopathy (Rees et al., 2006). DTFM is considered the most effective treatment for patellar tendinopathy (Brunker and Khan, 2002:487). It is theorised that DTFM causes the softening of scar tissue and the breakdown of adhesions, promoting the realignment of disrupted connective tissue fibrils within the affected tendon (Stasinopoulos and Johnson, 2007). Graston Instrument Assisted Soft Tissue Mobilization (GIASTM) consists of a set of stainless steel instruments (Carey 2003:2) and is an advanced form of soft tissue mobilization used in detecting and releasing scar tissue, adhesions and fascial restrictions (Carey, 2003:7). The controlled microtrauma created by these instruments is hypothesised to create a localised inflammatory response (Hammer, 2004) in a similar mechanism to that of DTFM. The aim of this study was to determine the relative effectiveness of GIASTM versus DTFM in treating patellar tendinopathy. The study included a total of twenty-six knees among twenty-one patients. Patients were placed randomly into either the GIASTM group or the DTFM group. Each patient received a total of twelve treatments over a three month period. Algometer and inclinometer readings were recorded at set intervals and compromised objective measures. Two questionnaires and a numerical pain rating scale (NRS) were administered at set intervals and compromised subjective measures. SPSS version 13.0 (SPSS Inc., Chicago, Illinois, USA) was used to analyse the data. Repeated measures ANOVA was used to examine changes in quantitative outcomes over the time points (intragroup analysis) and a treatment effect (intergroup analysis). To control for the partial pairing in the intergroup analysis, a variable which classified each subject as paired (both left and right knee used in study) or non-paired (only used once in study) was used as a factor in the model. Correlations between the intragroup changes in the various outcome variables were assessed using Pearson’s correlation coefficients. Statistical analysis of both objective and subjective data revealed significant improvements for most outcome measures in the study. Findings imply that GIASTM is as effective as DTFM in treating patellar tendinopathy.
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Brown, Scott R. "The relationship between leg dominance and knee mechanics during the cutting maneuver." 2012. http://liblink.bsu.edu/uhtbin/catkey/1675898.
Full textAbstract:
The purpose of this study was to examine the relationship between leg dominance and knee mechanics to provide further information about the etiology of ACL injury. Sixteen healthy females between the ages of 18 and 22 who were NCAA Division I varsity soccer players participated in this study. Subjects were instructed to perform a cutting maneuver; where they sprinted full speed and then performed an evasive maneuver (planting on one leg and pushing off to the other leg in a new direction) at a 45° angle with their dominate leg (DL) and non-dominate leg (NDL). Subjects were required to perform five successful cuts on each side given in a random order. Bilateral kinematic and kinetic data were collected during the cutting trials. After the cutting trials, subjects performed bilateral isometric and isokinetic testing using a Cybex Norm dynamometer at a speed of 60°/sec to evaluate knee muscle strength. During the braking phase the NDL showed greater (P=0.003) power absorption, greater (P=0.01) peak internal rotation angle and greater (P=0.005) peak flexion velocity. During the propulsive phase the DL showed greater (P=0.01) power production, greater (P=0.038) peak internal adductor moment and greater (P=0.02) peak extension velocity. In addition, no differences (P>0.05) in knee extensor and flexor isometric and isokinetic torques between the two limbs were shown. The results of this study show that a difference in knee mechanics during cutting does exist between the DL and NDL. The findings of this study will increase the knowledge base of ACL injury in females and aid in the design of more appropriate neuromuscular, plyometric and strength training protocols for injury prevention.School of Physical Education, Sport, and Exercise Science
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Dwyer, Lauren. "The relative effectiveness of three full kinetic chain treatment protocols for osteoarthritis of the knee : manual therapy, rehabilitation and a combination thereof." Thesis, 2014. http://hdl.handle.net/10321/970.
Full textAbstract:
Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013.Background : Many treatment options provide symptomatic improvement of joint function for osteoarthritis (OA) of the knee. Research suggests full kinetic chain (FKC) manual and manipulative therapy (MMT) and rehabilitation yields greater benefits than home rehabilitation alone. However this treatment combination has never been compared against FKC MMT alone. Objectives : Objectives: To determine the effectiveness of three FKC treatment protocols in the management of knee OA. Method : A single-blinded, randomised comparative trial of sixty-six patients with knee OA, equally allocated to three treatment groups: manipulation only, rehabilitation only or manipulation plus rehabilitation (a.k.a. combination group). Manipulation groups received bi-weekly FKC treatment, while a daily at-home stretching and exercise programme was prescribed to the groups receiving rehabilitation. Treatment lasted three weeks, with outcomes measure taken at baseline, pre-visit 4 and 1-week follow up. Primary outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and McMaster Overall Therapeutic Effectiveness (OTE) Tool. Results : There was a drop-out rate of 7.6% (n=5), with intent to treat analysis providing the missing data. All three treatment groups showed clinically and statistically significant changes in overall WOMAC scores from baseline to 1-week follow up. The combination group showed the largest improvement (50.5%), followed by manipulation (44.4%) and rehabilitation (33.6%). However, this difference between group improvement was not statistically significant (p= 0.156). Conclusion : All three intervention protocols showed statistically significant improvement in most outcome measures at 1-week follow-up. However, there was no statistically significant difference between groups and therefore it is concluded that the interventions appear to be equally effective in the short-term management of knee OA.
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Weyer-Henderson, Donna. "An investigation into the effectiveness of dry needling of myofascial trigger points on total work and other recorded measurements of the vastus lateralis and vastus medialis muscles in patellofermoral pain syndrome in long distance runners." Thesis, 2005. http://hdl.handle.net/10321/169.
Full textAbstract:
Thesis (M.Thec.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005
xiii, 110 leaves ; ill. ; 30 cmAccording to Wood (1998), patellofemoral pain syndrome (PFPS) refers to a syndrome that comprises of the following signs and symptoms: anterior knee pain, inflammation, imbalance, instability, or any combination thereof. Prevailing literature suggests that the presence of myofascial trigger points (MFTP’s) in quadriceps femoris (QF) muscle could result in a combination of the following signs and symptoms: - Retro- or peripatella pain, - Weakness of the quadriceps muscle (Chaitow and DeLany, 2002) - Loss of full lengthening (Travell and Simons, 1983:248-250) The aetiology of PFPS is poorly understood (Kannus et al. 1999). The current trend in literature suggests an extensor mechanism dysfunction as the most probable aetiology (Galantly et al., 1994; Juhn, 1999). There appears to be a clinical overlap between the two syndromes, in terms of an extensor mechanism dysfunction and of signs and symptoms. The aim of this investigation was to evaluate the role of active myofascial trigger points in the vastus lateralis (VL) muscle as perpetuating, causative or concomitant factors in the alteration of VL/VM Total Work (TW) in PFPS in distance runners.
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Daly, Gail. "The relationship between myofascial trigger points, total work and other recorded measurements of the vastus lateralis and vastus medialis, in long-distance runners with patellofermoral pain syndrome." Thesis, 2005. http://hdl.handle.net/10321/230.
Full textAbstract:
Thesis (M.Tech,: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2005
xiii, 62, 19 leaves :|bill. ;|c30 cmTo document the relationship between total work and myofascial trigger points in the vastus lateralis and vastus medialis portion of the quadriceps femoris muscle, whilst providing baseline graphs of these muscles with the use of a Cybex 700 Isokinetic Dynanometer in long distance runners both with and without patellofemoral pain syndrome. Methods: A quantitative, non-intervention clinical exploratory study. Fifty participants were divided into two groups, Group A (40 symptomatics) and Group B (10 asymptomatics). Both groups were screened for vastus lateralis and vastus medialis trigger points. Subjective data was obtained from Group A only, using the Numerical Pain Rating Scale and the Patient Specific Functional Scale. Objective data was obtained from both groups using the algometer, Myofascial Diagnostic Scale, and the Cybex 700 Isokinetic Dynanometer. For descriptive analysis frequency tabulations, box and whisker plots were used to display distributions graphically. Comparisons of categorical and quantitative variables between independent groups were run using chi square and Mann-Whitney testing consecutively. Finally Spearman’s correlation, multivariate generalized linear modelling and repeated measures ANOVA were also used. All statistical analysis was completed at the 95% (p<0.05) level of confidence.
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Hu, Yizhong. "Microstructure and Biomechanics of the Subchondral Bone in the Development of Knee Osteoarthritis." Thesis, 2021. https://doi.org/10.7916/d8-1mm7-z788.
Full textAbstract:
Osteoarthritis (OA) of the knee, a musculoskeletal disease characterized by degenerations in multiple joint tissues including the articular cartilage and subchondral bone, is a major clinical challenge worldwide that currently has no cure. Traumatic knee injuries such as anterior cruciate ligament (ACL) tear predispose subjects to early onset of post-traumatic OA (PTOA), necessitating the development of effective disease modifying therapies as total knee replacement surgeries have a limited lifetime. Significant knowledge gap remains in the pathogenesis of OA, while recent evidence suggests the important role of subchondral bone microstructure and mechanics in OA development. Subchondral bone is composed of the subchondral bone plate, a thin layer of cortical lamella, and the subchondral trabecular bone, composed of individual plate-like and rod-like trabeculae. These trabecular plates and rods determine the microstructure and mechanics of trabecular bone entirely and can be quantitatively analyzed using individual trabecula segmentation (ITS). Recent application of ITS showed that changes in the plate-and-rod microstructure of subchondral trabecular bone precede cartilage damage and are implicated to play a role in disease pathogenesis.
Studies presented in this thesis aim to provide a deeper understanding of subchondral bone in knee OA scientifically and clinically, which may ultimately be used to improve diagnosis, prevention and treatment of this prevalent and disabling disease. In the first study, we comprehensively quantified microstructural and tissue biomechanical properties of the subchondral bone and articular cartilage in human knee specimens with advanced OA and control knees without OA. We found reduced tissue modulus in trabecular plates and rods in regions with moderate OA, where cartilage is still intact, that persisted in severe OA regions, where cartilage is severely damaged. These observations suggest that tissue biomechanical changes in the subchondral trabecular bone may precede cartilage damage in OA development. Furthermore, we found strong correlations between structural and mechanical parameters of the cartilage and subchondral bone in CT knees, suggesting cross-talk at the tissue level. This coupling persisted in moderate OA regions but disappeared in severe OA regions, suggesting that loss of tissue crosstalk may be an additional indicator of disease progression.
In the second study, we quantified subchondral bone microstructural changes after ACL tear in vivo in human subjects using the second-generation high resolution peripheral quantitative computed tomography (HR-pQCT). We examined short-term longitudinal changes during the acute phase (~18 days to ~141 days) after injury, as well as long-term adaptations (~5 years post injury) in the injured knee relative to the contralateral knee in a cross-sectional cohort. We found subchondral bone loss within 1 month from injury that primarily targeted trabecular rods, especially at the distal femur. We also found increased spatial heterogeneity in subchondral trabecular microstructure within the injured knees compared to the contralateral knees in the long-term after injury. These findings indicate that ACL tear results in both short-term and long-term microstructural adaptations in the subchondral bone. ITS based on HR-pQCT knee scans may be a valuable tool to monitor disease progression in vivo.
Finally, we quantified subchondral bone microstructural changes after ACL-transection in a canine model of PTOA and investigated the effects of bisphosphonate and NSAID treatment on subchondral bone changes and OA progression. Studies were conducted in skeletally-mature and juvenile animals to investigate the effect of injury age. We found that subchondral bone adaptations after surgery and treatment effects depended on skeletal maturity of animals. In mature animals, changes in the microstructure of trabecular plates and rods occurred 1-month post-op and persisted until 8-months post-op. Bisphosphonate treatment attenuated these microstructural changes and cartilage degeneration while NSAID treatment did not. In juvenile animals that have not reached skeletal maturity, transient changes in trabecular plate and rod microstructure occurred at 3-months post-op but disappeared by 9-months post-op. Neither bisphosphonate nor NSAID treatment attenuated bone microstructural changes or cartilage damages. These findings suggest that age and skeletal maturity at time of injury may need to be considered as additional factors in studying PTOA progression and developing preventative treatments.
Taken together, these studies highlight the importance of microstructural and tissue biomechanical changes of subchondral bone in the development of OA. In vivo quantification of subchondral bone using advanced imaging modalities enable longitudinal monitoring of disease progression. Therapeutic agents targeting subchondral bone changes after traumatic injury may be effective preventative strategies for PTOA.
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Littleton, Susannah. "Outcomes in musculoskeletal injuries following road traffic crashes : an evaluation of an early intervention programme." Phd thesis, 2011. http://hdl.handle.net/1885/150200.
Full textAbstract:
Introduction
This thesis evaluates the effect of an early intervention programme on the physical and psychological health status of people with mild to moderate musculoskeletal injuries following road traffic crashes, and examines the influence of accident fault status and compensation claim status on recovery.
Methods
A sequential cohort of patients presenting to emergency departments in the Australian Capital Territory for treatment of mild to moderate musculoskeletal injuries sustained in road traffic crashes were recruited.
A control group of 95 patients received the usual care provided. An Intervention group of 98 patients were referred to a specialist clinic for assessment, during which an individualised, proactive rehabilitation plan was established.
Both physical and psychological health status were measured at baseline, six months and 12 months post-crash using the Short Form 36 (SF-36; Physical Component Score and Mental Component Score); the Hospital Anxiety and Depression Scale (HADS); and Functional Rating Index (FRI).
Three analyses were performed using the health outcome data obtained. Firstly, the influence of fault status on baseline physical and psychological health was evaluated by comparing the health outcomes scores of patients who caused the crash in which they were involved with scores from patients who were not at fault. Secondly, the effect of claiming compensation was evaluated for the control group by comparing SF-36, HADS and FRI scores between patients of the control group who had claimed compensation and those who did not claim compensation. Finally, the effect of the early intervention programme was evaluated by comparing health outcome scores of the control and intervention groups.
Results
Patients were enrolled a mean of 9.3 days following the crash. In the immediate post-crash period, the cohort was characterised by severe disability (FRI 55.5, SD 21.04), moderate levels of pain (pain intensity sub-scale of the FRI 2.0, SD 0.81) and high levels of anxiety (HADS-a9.1, SD 4.55).
Fault status had no effect on physical health; however, people that were not at fault had significantly worse psychological health at baseline as measured by SF-36 Mental Component Score.
Claiming compensation was associated with a worse SF-36 Physical Component Score, greater HADS-anxiety and worse FRI. Retention of a lawyer was significantly associated with a lower SF-36 Mental Component Score at 12 months.
The early intervention programme resulted in a statistically significant reduction in anxiety at 12 months. However, neither anxiety, nor any of the other measures of physical or psychological health were considered to be improved to a clinically significant level by the intervention.
Conclusion
Compensation status and psychological factors are independent determinants of longer term health following mild to moderate musculoskeletal injuries sustained in road traffic crashes. The early specialist assessment and proactive treatment planning implemented as part of this thesis, failed to improve health outcomes over usual care alone. Overall, recovery is influenced by both physical and psychological factors, and models of care need to address both of these components.
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Rudzki, Stephan J. "The cost of injury to the Australian army." Phd thesis, 2009. http://hdl.handle.net/1885/110379.
Full textAbstract:
This thesis is the first study to have determined a comprehensive estimate of the
cost of injury to the Australian Army. The approach used was that of a cost of illness
study, which summarised the economic burden of injury and provides information for
stakeholders, allowing them to make informed decisions on the allocation of scarce
healthcare resources. Cost of illness (COI) studies serve a different purpose to that of
health economic evaluations which are focused on evaluating the cost of an
intervention rather than estimating the cost of a particular disease. A "top down"
approach to analysis was adopted utilising high level organisational databases to obtain
cost data. This thesis adopted the primary perspective of government, but also
considered costs from a societal and individual perspective.
Estimating the economic burden of injury in a defined population is dependant
on the availability of data of sufficient quality and scope, which is often lacking. This
was the case in this thesis where available datasets contained data of poor quality or
insufficient detail to provide accurate injury cost data. A number of assumptions were
required in order to develop estimates of the contribution of injury to different sources
of cost. There is a clear requirement for Defence to improve it injury surveillance and
introduce an electronic health record to facilitate this. Efforts must also be made to link
clinical data with cost data to better inform decision makers about the relative benefits
achieved from the considerable cost resulting from injury.
The cost of injury has three components; direct costs; indirect costs; and
intangible costs. Direct costs considered in this analysis included external medical and
compensation costs, as well as compensation liabilities calculated by the Australian
Government Actuary. Indirect costs included productivity losses, with invalid pensions
also included because they constitute a significant cost to Government not usually
included in (COI) studies. An additional analysis of the net present value of lost wages
was conducted on those soldiers who were invalided from the Army. A novel approach,
termed the Capital Investment Model, was used to estimate the loss of training
investment as a result of premature separation from the Army due to injury. Intangible
costs were not included in this study because of the difficulty in placing a monetary
value on these aspects of injury.
Direct injury costs in 1996 were estimated to be between $40.75 and $42.36M
with outstanding compensation liabilities of $270M. Indirect costs were estimated to be
$10.74M with invalid pension liabilities of $63.82M. Capital losses due to premature
separation from the Army due to injury were estimated to be $10.1 OM. The total cost of
injury to the Australian Army (in 1996 dollars) was estimated to be between $61.59M
and $63.20M, with estimated pension and compensation liabilities of $333.82M. Injury
causes a significant financial impost.
This is also the first study to compare the cost and outcomes of a range of spinal
surgical procedures reflective of general orthopaedic community practice. It adopted a
"bottom up" approach to analysis, where detailed data was obtained from individual
records and a patient survey. This allowed for outcome and cost analysis by subgroup.
A number of findings were consistent with the literature, in particular the dissociation
between pain score and functional capacity. Increasing complexity of surgical
intervention increased costs with no improvement in clinical outcome and alarming levels of radiological exposure was found. Radiation exposure could not be compared
to other studies as they did not report the distribution of radiological investigations. The
decision to undergo surgery appears to be based on the baseline level of pain and the
fear of it worsening rather than specific clinical indications. The use of effective nonoperative
methods of reducing pain offers the prospect of significantly reducing the
patient demand for surgery and its attendant cost.
The greatest injury-related cost savings from a societal perspective are obtained
from interventions that promote early return to work and minimize lost productivity.
Preventing an injury prevents the associated cost, so efforts in the area of injury
prevention are critical in reducing the burden of injury. The significant reduction in
injury observed from the Defence Injury Prevention Program highlights the benefit of
effective primary prevention programs. Equally, once an injury occurs, secondary
prevention efforts seek to achieve maximum restoration of function with minimal
morbidity and cost. The results of the spinal surgery study have shown that
improvement in primary outcome measures are not effect by the cost of the chosen
intervention and efforts to achieve pain relief through non-operative means,in order to
prevent surgical intervention, should be a high priority for research, not just in Army
but in the broader community.
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Botes, Jacques Andre. "The effect of four different manipulative techniques on Iliotibial Band Friction Syndrome (ITBFS) in terms of primary and secondary outcome measures." Thesis, 2016. http://hdl.handle.net/10321/1626.
Full textAbstract:
Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016.Background: Iliotibial band friction syndrome is a common dysfunction seen in athletes. Athletes develop biomechanical changes yet still continue with their sport. However, this syndrome limits their ability to participate at peak performance. This study determined which participants benefitted in terms of biomechanical and clinical outcomes in one of four groups: ankle joint, superior tibio-fibular joint, sacroiliac joint or a combination manipulation group (which contained any two of the three joint restrictions). Methods: This Durban University of Technology Institutional Research and Ethics Committee approved prospective clinical trial, utilised stratified sampling, with 48 participants across four groups: ankle (14); superior tibio-fibular (11), sacroiliac (12) and combination (11). The participants underwent six treatments in three weeks. Data collection occurred before consultations one, three, five and seven. The data included primary measures of the knee score questionnaire (KSQ), the algometer, the visual analogue scale (VAS) and the secondary measures of the Feiss line, the heel leg alignment, bilateral leg length, Q angle and tibio-femoral angle. All data was computed utilising the ANOVA testing, with a p-value <0.05 being significant and a 95% confidence interval. Pearson’s correlations were completed for intragroup associations between primary and secondary outcome measures. Results: The intragroup analysis revealed that all groups had significant changes in the KSQ and VAS, with the exception of the sacroiliac joint manipulation group (KSQ outcome not significant). Intergroup analysis revealed no differences between the groups with the exception of the combination group, which showed a significant increase in the tibio-femoral angle. Most commonly, the Pearson’s correlation revealed that changes in leg length were related to differences in primary outcome measures, irrespective of the group being tested. Conclusion: The outcomes of this study indicated that manipulation of the distal kinematic chain improved alignment and clinical outcomes to a greater degree than manipulating proximal restrictions. It is suggested with caution (due to limited sample size) that patients should first have their distal kinematic chain manipulated before more proximal joints are manipulated to achieve better outcomes.
M
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Dollard, Joanne. "Comparative optimism about falling amongst community-dwelling older South Australians: a mixed methods approach." 2009. http://hdl.handle.net/2440/55404.
Full textAbstract:
People aged ≥65 years (older people) have a higher chance of falling than other age groups. However, based on qualitative research, older people do not believe that falls prevention information and strategies have personal relevance. This suggests that older people believe that falls are more likely to happen to other older people than themselves, that is, they might be comparatively optimistic about their chance of falling. It is important to understand comparative optimism about falling as it is a consistent reason given by older people for not participating in falls prevention activity. This thesis used a mixed methods design with a sequential strategy to investigate community-dwelling older people's comparative optimism about falling. Three studies were undertaken, using semi-structured interviews, cognitive interviews and telephone interviews to collect data. The semi-structured interview study, guided by the tenets of grounded theory, aimed to develop an explanation of why older people might be comparatively optimistic. A sampling frame (age, sex and direct and indirect history of falling) was used to guide recruiting respondents. Older people (N = 9) were interviewed about their chance and other older people's chance of falling. Interviews were analysed using the constant comparison method. The cognitive interview study investigated potential problems in survey items in order to refine them for the telephone interview study. Items were developed to measure older people's comparative optimism about falling. Older people (N = 13) were cognitively interviewed, and interviews were content analysed. The telephone interview study aimed to determine whether older people were comparatively optimistic about falling, and whether the direct and indirect experience of falling was associated with comparative optimism. A random sample of older people (N = 389) living in South Australia were telephone interviewed (response rate = 75%). The semi-structured interview study identified that it was a 'threat to identity' for respondents to say they had a chance of falling because of intrinsic risk factors. Respondents used strategies to maintain or protect their identity when discussing their chance of falling in the future or their reasons for falling in the past. In the cognitive interview study, respondents reported difficulty in rating their chance of falling, as they believed falls were unexpected and unpredictable. They reported difficulty in rating other people's chance of falling, as they believed they did not know other people their age, did not have enough information and/or did not know the answer. In the telephone interview study, most respondents believed they had the same chance (42%), or a lower chance (48%) of falling in the next 12 months, than other older people. Having fallen in the last 12 months was significantly associated with a lowered comparative optimism, but knowing other older people who had fallen was not associated with comparative optimism. This is the first quantitative study to report that the majority of a representative sample of community-dwelling older people were comparatively optimistic about their chance of falling. Self-presentation concerns about having a chance of falling support the core category to emerge from the semi-structured interview study. Messages such as 'you can reduce your risk of falls' may be ignored by older people. Alternative messages should promote identities that are relevant to older people, such as being independent, mobile and active, but these messages should be tested in further research.http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374964
Thesis (Ph.D.) - University of Adelaide, School of Psychology and School of Population Health and Clinical Practice, 2009
48
Johnson, Samuel T. "Spinal control differences between the sexes." Thesis, 2008. http://hdl.handle.net/1957/10406.
Full textAbstract:
Despite years of research, females continue to have a higher incidence of non-contact ACL injuries. One of the major findings of this research is that males and females perform certain tasks, such as, cutting, landing, and single-leg squatting, differently. In particular, females tend to move the knee into a more valgus position; a motion putting the ACL at risk for injury. Yet the underlying spinal control mechanisms modulating this motion are unknown. Additionally, the mechanisms regulating the ability to rapidly initiate and produce maximal torque are also unknown. Therefore, the purpose was to: 1) determine if the sexes modulate spinal control differently, 2) examine the contributions of spinal control mechanisms to valgus knee motion, and 3) identify contributions of spinal control to the ability to rapidly produce force. The spinal control variables were the first derivative of the Hoffmann (H)-reflex, the first derivative of extrinsic pre-synaptic inhibition (EPI), the first derivative of intrinsic pre-synaptic inhibition (IPI), recurrent inhibition (RI), and V-waves. To assess the neuromuscular system’s ability to rapidly activate, rate of torque development (RTD) and electromechanical delay (EMD) were measured. Lastly, valgus motion was determined by the frontal plane projection angle (FPPA). The results reveal males and females do modulate spinal control differently; specifically males had an increased RTD, which is the slope of the torque-time curve, and increased RI, which is a post-synaptic regulator of torque output. However, the spinal control mechanisms did not significantly contribute to FPPA at the knee. EMD which is the time lag from muscle activity to torque production was significantly predicted by the spinal control mechanisms. Specifically, EPI, a modulator of afferent inflow from peripheral and descending sources, IPI, a regulator of Ia afferent inflow, and sex significantly contributed to EMD. Lastly, the spinal control mechanisms significantly contributed to RTD. Specifically, IPI, sex, and V-waves, a measure of supraspinal drive, all significantly contributed to RTD.Graduation date: 2009