w omen commonly experience back pain during and after pregnancy. Incidence of back pain during pregnancy has been reported to range from 47 to 82% (3,6, 10,19,23-25). At the time of delivery, Ostgaard and Andersson (22) found that 67% of 817 pregnant women reported back pain directly after delivery and 37% experienced back pain 18 months postpartum. In another study involving 855 pregnant women, Ostgaard et al (23) found that back pain began early in pregnancy, with a prevalence of 25% at 12 weeks. The sacroiliac area has been described as the most common location of back pain in pregnant women (3,23). Berg et a1 (3), in a study of 862 pregnant women, identified two-thirds of the back pain experienced during pregnancy as sacroiliac in origin.The etiology of back pain during and after pregnancy remains unproven. An excellent review of the different theories has been written by Rungee (26). These theories include hormonal influences causing laxity of joints in the pelvis, vascular changes, postural changes from increasing growth of the fetus, herniated nucleus pulposus, tumors, and infection (26).Although never substantiated, postural changes have often been implicated as a major cause of back pain in pregnant women (2,5,7,9,12, 15,30). In 1949, Bushnell (7) described a parietal neuralgia of preg- Greenville, NC nancy that he stated was from "high heels, corsets, and a laissez faire attitude of posture that produced a generation of women whom were not ideal subject. for parturition." Bushnell (7) further stated that this vanity caused abnormal postures that produced the parietal neuralgia. Few studies have assessed postural changes that occur during pregnancy. Bullock et a1 (6) found that in 34 pregnant women lumbar lordosis and thoracic kyphosis increased between the fourth and ninth month of pregnancy. In a case study involving a 31-year-old pregnant woman, Fries and Hellebrandt (14) determined that the center of gravity was displaced posteriorly, the head elevated, the cervical spine hyperextended, and the knee and ankle joints extended over a total of nine observations taken every 2 weeks during pregnancy. In contrast, O s t p r d et a1 (24) measured 855 pregnant women from the 12th to 36th week of gestation and found no change in lumbar lordosis. However, lumbar lordosis was measured by an unvalidated method which involved assessing the perpendicular distance to the apex of the lumbar lordosis from a straight line connecting the apex of the thoracic kyphosis and the posterior part of the sacrum. Snijders et a1 (29) measured 16 women a few weeks before childbirth and then a few weeks after childbirth and found that the

The purpose of this study was to determine if static and ballistic stretching would induce significant amounts of delayed onset muscle soreness (DOMS) and increases in creatine kinase (CK). Twenty males were randomly assigned to a static (STATIC) or ballistic stretching (BALLISTIC) group. All performed three sets of 17 stretches during a 90-min period, the only group difference being that STATIC remained stationary during each 60-s stretch while BALLISTIC performed bouncing movements. Subjective ratings of DOMS (scale: 1-10) and serum CK levels were assessed before and every 24 hours post stretching, for 5 days. A repeated measures ANOVA revealed a significant main effect due to time (p < 0.05), with peak soreness occurring at 24 hours after (M = 2.8 +/- 1.6). Surprisingly, a group effect (p < .05) demonstrated that DOMS was significantly greater for STATIC than for BALLISTIC. At 24 hours there was a 62% (p < .05) increase in CK for combined groups. These findings indicate that similar bouts of static and ballistic stretching induce significant increases in DOMS and CK in subjects unaccustomed to such exercise. Furthermore, static stretching induced significantly more DOMS than did ballistic.

osture is the relative art rangement of the various parts of the body. Physical therapists typically perform postural assessment5 as a part of a patient's musculoskeletal evaluation. Individuals experiencing low back pain are often told by physical therapists not to wear high heels because of the lordotic effects that heels have on the lumbar spine area. Recognizing that millions of women wear high heels to be fashionable, several studies have analyzed the changes high heels have on gait and static posture. Gollnick et al (8) found that in a electrogoniometric study of lowheeled (range = -3-7 cm) and highheeled (range = 7-11 cm) gait, an average increase of 20" occurred in ankle plantar flexion, while the knee flexion angle range of motion (ROM) increased during stance phase and decreased during swing phase. In addition to confirming Gollnick et al's results, demonstrated that women in high heels (X = 6.1 cm) have reduced gait velocity, stride lengths, swing phase hip ROM of flexion/ extension and abduction/adduction, heel strike external rotation, pelvic tilt, and upper trunk ROM when compared with low-heeled (X = 1.6 cm) gait. Further, found increased stance phase time and tibia1 internal rotation in highheeled gait when compared with lowheeled gait. In contrast, de Lateur et al (5) ' Staff Physical Therapist, Craven Regional Medical Center, New Bern, NC Staff Physical Therapist, Department of Physical Therapy, Baptist Hospital Medical Center, Winston Salem, NC Staff Physical Therapist, Nash General Hospital, Rocky Mount, NC between the gait kinematics of women in high heels (X = 8.9 cm) compared with low heels (R = 2.2 an).Joseph (1 1) demonstrated that during high-heeled (range = 5.5-8 cm) gait, the electromyographic (EMG) muscle activity was altered, and there was continuous firing of the tibialis anterior, increased activity of the soleus and prolonged continuous firing of the quadriceps in stance phase, and an additional phase of gluteus medius activity in swing phase when compared with low-heeled (range = 1-2.5 cm) gait. In support of Joseph's (1 1) increased muscle activity results, Mathews and Wooten (14) found that oxygen consumption was significantly increased when subjects walked in 7.6-cm high heels compared with saddle shoes and loafers.Static posture analysis has demonstrated that high-heel (X = 6.4 cm) stance moved the knee and ankle joint axis closer and displaced the head and thoracic spine more posterior to the line of gravity when compared with barefoot stance (10,18). A decreased lumbar lordosis and a decreased angle of pelvic inclination have also been shown to occur in women standing and wearing high heels (X = 6.4 cm) (18) and standing on a 4.5-cm wooden heel block (3) when compared with women standing and wearing no heels. However, de Lateur et a1 (5) found that

This article discusses the cultural and educational needs of African-American learners with disabilities. Six theoretical assumptions establish some basic suppositions about culturally and linguistically diverse learners and effective instructional practices. A review of the literature describes African-American cultural practices, interests, and cognitive styles; highlights the attitudes, perceptions, and instructional practices of effective teachers of African-American students; and includes patterns of teacher-student and peer-group interactions that promote high academic achievement among African-American learners. Recommendations include organizing teaching, learning, and performance in ways that are compatible with the social structure of African-American students with disabilities.

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