APTA is a sponsor of the Decade, an international, multidisciplinary initiative to improve health-related quality of life for people with musculoskeletal disorders.Background and Purpose. Stretching protocols for elderly people (Ն65 years of age) have not been studied to determine the effectiveness of increasing range of motion (ROM). The purpose of this study was to determine which of 3 durations of stretches would produce and maintain the greatest gains in knee extension ROM with the femur held at 90 degrees of hip flexion in a group of elderly individuals. Subjects. Sixty-two subjects (mean ageϭ84.7 years, SDϭ5.6, rangeϭ 65-97) with tight hamstring muscles (defined as the inability to extend the knee to less than 20°of knee flexion) participated. Subjects were recruited from a retirement housing complex and were independent in activities of daily living. Methods. Subjects were randomly assigned to 1 of 4 groups and completed a physical activity questionnaire. The subjects in group 1 (nϭ13, mean ageϭ85.1 years, SDϭ6.4, rangeϭ 70 -97), a control group, performed no stretching. The randomly selected right or left limb of subjects in group 2 (nϭ17, mean ageϭ85.5 years, SDϭ4.5, rangeϭ80 -93), group 3 (nϭ15, mean ageϭ85.2 years, SDϭ6.5, rangeϭ65-92), and group 4 (nϭ17, mean ageϭ83.2 years, SDϭ4.6, rangeϭ68 -90) was stretched 5 times per week for 6 weeks for 15, 30, and 60 seconds, respectively. Range of motion was measured once a week for 10 weeks to determine the treatment and residual effects. Data were analyzed using a growth curve model. Results. A 60-second stretch produced a greater rate of gains in ROM (60-second stretchϭ2.4°per week, 30-second stretchϭ1.3°per week, 15-second stretchϭ0.6°per week), which persisted longer than the gains in any other group (group 4 still had 5.4°more ROM 4 weeks after treatment than at pretest as compared with 0.7°and 0.8°for groups 2 and 3, respectively). Discussion and Conclusion. Longer hold times during stretching of the hamstring muscles resulted in a greater rate of gains in ROM and a more sustained increase in ROM in elderly subjects. These results may differ from those of studies performed with younger populations because of age-related physiologic changes. [Feland JB, Myrer JW, Schulthies SS, et al. The effect of duration of stretching of the hamstring muscle group for increasing range of motion in people aged 65 years or older. Phys Ther. 2001;81:1100 -1117 Key Words: Age, Elderly, Flexibility, Hamstring muscles, Lower extremity. [1][2][3][4][5] Stretching is important because it is believed to provide many physical benefits, including improved flexibility, 3,6,7 improved muscle or athletic performance, 8,9 improved running economy (decreased energy expenditure at a given speed), 10,11 injury prevention, 3,11 promotion of healing, and possibly decreased delayed-onset muscle soreness. 12,13 Although evidence to support these beliefs is limited, stretching appears to us to be in widespread use.Researchers have looked at the effect of different variables associated wit...

A proposed benefit of minimalist shoe running is an increase in intrinsic foot muscle strength. This study examined change in intrinsic foot muscle size in runners transitioning to Vibram FiveFingers™ minimalist shoes compared to a control group running in traditional running shoes. We compare pre-transition size between runners who developed bone marrow edema to those who did not. 37 runners were randomly assigned to the Vibram FiveFingers™ group (n=18) or control group (n=19). Runners' bone marrow edema and intrinsic foot muscle size were measured at baseline and after 10 weeks. Total running volume was maintained by all runners. A significant increase in abductor hallucis cross-sectional area of 10.6% occurred in the Vibram FiveFingers™ group compared to the control group (p=0.01). There was no significant change in any of the other muscles examined (p>0.05). 8 of the Vibram FiveFingers™ runners, and 1 control runner developed bone marrow edema. Those who developed bone marrow edema, primarily women, had significantly smaller size in all assessed muscles (p≤0.05). Size of intrinsic foot muscles appears to be important in safely transitioning to minimalist shoe running. Perhaps intrinsic foot muscle strengthening may benefit runners wanting to transition to minimalist shoes.

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There are few treatment options in managing restless legs syndrome (RLS); the most frequently used are dopaminergic drugs and movement. New treatment options are highly sought after. This study evaluated the effectiveness of monochromatic near-infrared light treatment in decreasing symptoms associated with RLS. The design used was 2×6 repeated-measures design with two groups (treatment and control) and six repeated measures (baseline, weeks 1-4, and posttreatment). Data collection took place in the university modalities laboratory. Thirty-four volunteers with symptoms of RLS were randomly assigned to a treatment or control group. Over a 4-week period subjects underwent twelve 30-min treatments to their lower legs with near-infrared light. The International RLS rating scale (IRLS) was used to assess and track patient symptoms. There was a steady decrease in symptoms associated with RLS over the 4 weeks in the treatment group. After 4 weeks of treatment the treatment group had a significantly greater improvement in restless legs syndrome symptoms than the control group (p<0.001); improvement was still significant after 4 weeks posttreatment compared to baseline (p<0.001). Treatment with near-infrared light does decrease symptoms associated with RLS as demonstrated in lower IRLS scores. This new noninvasive method of treating RLS might become a valuable new management option. More research is needed to determine the mechanism(s) behind infrared light treatment and RLS.

We assessed the reliability of the KT-2000 knee arthrometer at 67, 89, 134, and 178 N and at manual maximum forces on 30 college students who were free from present or previous knee injuries. Two examiners tested all subjects on two occasions. Anterior laxity (P < 0.0001) and side-to-side difference (P < 0.05) significantly increased as force increased. There was a significant difference (P < 0.0001) between testers for anterior laxity but not for side-to-side difference. We used intraclass correlation coefficients to estimate relative reliability. Anterior laxity intraclass correlation coefficients (2,1) between testers ranged from 0.81 to 0.86 and within tester correlations ranged from 0.92 to 0.95. Intraclass correlation coefficients for between testers for side-to-side differences ranged from 0.38 to 0.58 and within tester correlations ranged from 0.53 to 0.64. Subject-to-subject variability needs to be taken into account when interpreting intraclass correlation coefficient values. Our absolute reliability estimates (95% confidence intervals) were small, indicating little variability. Our data demonstrate the KT-2000 arthrometer to be reliable. Researchers should present both relative and absolute reliability estimates, although we believe absolute estimates are of greater clinical value. Side-to-side differences are better discriminators than individual absolute values. We recommend that a < 3 mm side-to-side difference be used to indicate stable knees.

Objective: To investigate the temperature changes in subcutaneous and intramuscular tissue during a 20-minute coldand hot-pack contrast therapy treatment.Design and Setting: Subjects were randomly exposed to 20 minutes of contrast therapy (5 minutes of heat with a hydrocollator pack followed by 5 minutes of cold with an ice pack, repeated twice) and 20 minutes of cold therapy (ice pack only) in a university laboratory.Subjects: Nine men and seven women with no history of peripheral vascular disease and no allergy to cephalexin hydrochloride volunteered for the study.Measurements: Subcutaneous and intramuscular tissue temperatures were measured by 26-gauge hypodermic needle microprobes inserted into the left calf just below the skin or 1 cm below the skin and subcutaneous fat, respectively. C ontrast therapy, the repeated alternation of thermotherapy and cryotherapy, is a common treatment for postacute soft tissue injury.'1-3 Though long used, scientifically validated parameters for temperature, sequence order, time for heat and cold, and total treatment time have not been established. Myrer et al'4 was the only previous study found that investigated the effects of contrast therapy on intramuscular temperature. Myrer et al studied the intramuscular temperature change experienced 1 cm below the skin and subcutaneous fat in the lower leg over a 20-minute treatment. The treatment was a 4-minute hot immersion (40.6°C) followed by a 1-minute cold immersion (15.6°C) repeated four times. They concluded that "contrast therapy as studied is incapable of producing any significant physiological effect on the intramuscular tissue temperature 1 cm below the skin and subcutaneous tissue."14 We propose that, for most of the physiologic effects attributed to contrast therapy to occur, substantial fluctuations in tissue temperature must be produced with the alternations from the heat to the cold or vice versa. Because our primary investigation failed to prove the effectiveness of the most accepted regimen for contrast therapy, it is critical to determine whether other protocols produce the fluctuations we feel are necessary to manifest the physiologic effects attributed to contrast therapy. The purpose of this in vivo study was to investigate the temperature change in subcutaneous and intramuscular tissue during a 20-minute cold-and hot-pack contrast therapy treatment. METHODSSixteen college students (9 men, age = 25.2 ± 3.4 yr, wt = 82.9 ± 12.7 kg, calf skinfold = 17.2 7.5 mm, calf girth = 38.8 ± 2.4 cm; 7 women, age = 21.1 2.5 yr, wt = 58.3 ± 9.6 kg, calf skinfold = 20.9 + 8.0 mm, calf girth = 35.2 ± 2.4 cm) volunteered as subjects and signed Brigham Young University's approved consent form. We verbally screened subjects for a history of peripheral vascular disease or allergy to cephalexin hydrochloride (Keftab, Dista Products, Indianapolis, IN). To minimize the risk of infection, we administered one 500-mg dose of cephalexin hydrochloride immediately before the experiment. Each subject was instructed to take three similar d...

This study investigated the use of whole-body vibration (WBV) as an alternative strengthening regimen in the rehabilitation of individuals with total knee arthroplasty (TKA) compared with traditional progressive resistance exercise (TPRE). Individuals post TKA (WBV n = 8; TPRE n = 8) received physical therapy with WBV or with TPRE for 4 weeks. Primary dependent variables were knee extensor strength, quadriceps muscle activation, mobility, pain, and range of motion (ROM). There was a significant increase in knee extensor strength and improvements in mobility, as measured by maximal volitional isometric contraction and the Timed Up and Go Test (TUG), respectively, for both groups (p < 0.01). The WBV knee extensor strength improved 84.3% while TPRE increased 77.3%. TUG scores improved 31% in the WBV group and 32% for the TPRE group. There were no significant differences between groups for strength or muscle activation (Hotelling's T(2) = 0.42, p = 0.80) or for mobility (F = 0.54; p = 0.66). No adverse side effects were reported in either group. In individuals with TKA, both WBV and TPRE showed improved strength and function. Influence of WBV on muscle activation remains unclear, as muscle activation levels were near normal for both groups.