2009 APA Conference Week Abstracts - Australian Physiotherapy ...

Sports Physiotherapy Australia
disappear and the believers break out the crystals and
snake oil? Perhaps rather than being at different ends of a
spectrum most of us are more towards the middle, but within
ourselves are often paradoxical. We will frequently use the
‘no evidence’ sword when talking of practices we don’t use
and vehemently protect with the ‘clinical art’ shield those
practices of our own that we believe to be highly effective.
Now after using derivations of the word belief five times
in six sentences, perhaps we need to include this in our
examination of the evidence and practice. What we believe,
what our patients believe and what we can convince them
to believe are all powerful contributors to a positive clinical
outcome in the often not so black and white world of ‘it
hurts when I do this’.
4
Do manual muscle tests (maximal isometric
contractions) isolate shoulder muscle activity?
Boettcher CE, Ginn KA, Cathers I
The University of Sydney, Sydney
The aims of this study were to identify a series of tests that
could be used to produce maximal activation for muscles
of the shoulder and to quantify the relative EMG activation
of these muscles during maximum effort isometric
contractions. The dominant shoulder of 15 normal subjects
between the ages of 18 and 50 years was examined. EMG
activity was recorded from rotator cuff, scapulothoracic,
and axio/scapulohumeral muscles using a combination of
surface and intramuscular electrodes. Maximum isometric
contractions were performed in 15 randomised shoulder
positions. Maxima of rectified and low pass filtered (8th
order, 3Hz) EMG were determined for all muscles during
all test positions. Repeated measure ANOVAs were used
to compare the activity level in all the muscles in all
test positions. Results indicated that many test positions
maximally activated many shoulder muscles and no single
maximum isometric task activated any one muscle in all
subjects. Isometric contractions in four test positions were
adequate to reliably generate a maximum contraction from
all 12 muscles examined, with many tests performed in midrange
shoulder positions requiring high levels of activity in
torque producing axio/scapulohumeral muscles as well as in
muscles that stabilize the humerus and in those that maintain
the position of the scapula. These results would suggest that
the use of manual muscle tests to infer individual shoulder
muscle pathology is not valid.
Physiocise for medium level core control
Bouvier AL
Physiocise
The Physiocise Circle of Rehab provides a simple
framework for the assessment and progression of athletes
as they move through rehabilitation from acute hands-on to
return to function. The tool was specifically designed as a
practical clinical tool, derived from the results of evidence
based research, which facilitated communication between
clinician and athlete as to status and progression. The
Circle is based on the integration of evidence based tests
in increasingly functional positions. There are three broad
categories: low, medium and high level control. Low level
failure on testing e.g. aberrant patterning of LMS would
indicate need for specific LMS retraining with one-on-one
supervision with their physiotherapist. Mid level failure on
testing such as in single leg stance would indicate need for
functional motor control retraining and exercises involving
lumbopelvic integration and gluteal control in increasingly
dynamic positions. High level failure such as inability to
maintain neutral spine in a loaded position such as a squat
would suggest the need for increased S and C supervision
and a possible reassessment of program load and technique.
Athletes may move back and forth through the levels
depending on factors such as symptoms, training load,
intensity and fatigue. This session focuses on the type of
exercises which would be appropriate in the rehabilitation
and progression of athletes displaying failure in medium
level control activites.
New evidence for physical therapies for anterior knee
pain: a systematic review and meta-analysis
Collins N, 1 Bisset L, 2,3 Crossley K, 4 Vicenzino B 1
1
The University of Queensland, Brisbane, 2 Griffith University, Gold
Coast, 3 Royal Brisbane and Women’s Hospital, Brisbane, 4 The
University of Melbourne, Melbourne
While a variety of physical therapy interventions have been
advocated for anterior knee pain, it remains one of the most
challenging musculoskeletal conditions managed by sports
physiotherapists. In light of recent publications since the last
published systematic review (2003), an updated systematic
review and meta-analysis was conducted of the evidence for
physical therapies in anterior knee pain. A highly sensitive
search strategy yielded 42 randomised controlled trials,
whose methodological quality rated between 2–13 out of
14 on a modified version of the PEDro rating scale. Studies
were grouped based on their primary intervention of interest
(multimodal physiotherapy, exercise, manual techniques,
knee braces, foot orthoses, tape, electrotherapy and
acupuncture). Follow-up times were predominantly within
3 months. Up to date findings of meta-analyses will be
presented. The best evidence from individual studies is for
multimodal physiotherapy (quadriceps muscle retraining,
patellofemoral joint mobilisation and patellar taping). There
is new evidence from a 12-month randomised controlled
trial (n = 179) supporting the use of prefabricated foot
orthoses. Moderate evidence was also found in favour of
patellar taping and a specialised knee brace. This updated
systematic review has found increasing evidence to support
physical therapies for anterior knee pain, which highlights
the fundamental role of sports physiotherapists in its
management. However, more clinical trials incorporating
larger participant numbers, longer follow-up times, and
more consistent use of reliable and valid outcome measures
are needed to provide further high-level evidence and
more opportunities for meta-analysis for conservative
interventions for anterior knee pain.
Management of anterior knee pain: local contributors
Crossley KM
University of Melbourne, Victoria, Australia, National ICT Australia,
Victoria, Australia
The vastus medialis obliquus (VMO) is considered to be
implicated in patellofemoral joint dysfunction and pain. As
such, many physiotherapy interventions have focused on
VMO retraining as part of a rehabilitation program. Research
has identified a relationship between vasti dysfunction
and patellofemoral pain. However, conjecture over the
relationship between vasti dysfunction and PFP remains.
The e-AJP Vol 55: 4, Supplement