Evidence-based practice emphasizes the examination and application of evidence from clinical research into diagnosis, prognosis, and outcomes based on a formal set of rules 1 . One method of evaluating evidence is to assign levels of evidence 2 . In this evidence hierarchy, extrapolations from basic science research are classified as the lowest level of evidence. However, especially in situations where higher-level research evidence is insufficient, such extrapolation based on a thorough knowledge of relevant anatomy often still serves to guide clinical reasoning. This importance of anatomy remains recognized within physical therapy education in the United States, both as part of program entrance requirements 3 and as a part of the required basic sciences content in entry-level curricular content 4 . In those circumstances where clinical diagnosis is solely based on anatomical extrapolation, knowledge of anatomical deviations with a potential impact on interpretation of test results becomes even more important.The lumbar plexus originates from the ventral rami of the L1-L4 nerve roots and projects laterally and caudally from the intervertebral foramina, posterior to the psoas major muscle. A communicating branch from the T12, also known as the subcostal nerve, often joins the first lumbar nerve [5][6][7][8][9][10] . The L2-L4 ventral rami first bifurcate into an anterior and posterior primary division. The T12 and L1 nerves and the L2-L4 anterior primary divisions supply muscular branches to the psoas major and quadratus lumborum. Both primary divisions then enter the lumbar plexus and give rise to six peripheral nerves. Within this plexus, the L1 nerve splits into a cranial and caudal branch. The cranial branch bifurcates into the iliohypogastric and ilioinguinal nerves, the former also formed by the subcostal nerve in people where this nerve contributes to the lumbar plexus. The caudal branch of the L1 nerve unites with the anterior division of the L2 nerve to form the genitofemoral nerve. The anterior divisions of the L2-L4 roots form the obturator nerve. The lateral femoral cutaneous nerve arises from the posterior divisions of the L2 and L3 roots; the posterior divisions of L2, L3, and L4 join to create the femoral nerve (Figure 1). Table 1 presents a summary of the normal presentation of nerves of the lumbar plexus based upon a review of several authoritative anatomical texts commonly used in physical therapy education [5][6][7][8][9][10] . The purpose of this study was to describe the anatomical variations in the lumbar plexus from the origin at the ventral roots of (T12) L1-L4 to the exit from the pelvic cavity based on our descriptive anatomy study of human cadavers as compared to the above description of normal anatomy [5][6][7][8][9][10] . Comparing our findings to anatomical variation described elsewhere in the literature, we will also suggest possible clinical implications ABSTRACT: This study used dissection of 34 lumbar plexes to look at the prevalence of anatomical variations in the lumbar plexu...
Background:The throwing motion results in unilateral increases in dominant arm external rotation (ER) range of motion (ROM). Trunk forward tilt at ball release is related to ball velocity. The relationship between lower quarter flexibility and dominant arm ROM is not known.Hypothesis:There is a relationship between lower extremity flexibility and dominant arm ER ROM and total rotation ROM.Study Design:Prospective cohort study.Methods:Forty-two collegiate baseball pitchers were studied. Demographics, dominant arm, and bilateral glenohumeral ER and internal rotation (IR) ROM were measured. Lower quarter flexibility was assessed via sit-and-reach test. Total rotation motion (TRM) was calculated as ER + IR = TRM. Paired t tests examined differences between the dominant and nondominant arms for ER, IR, and TRM; Pearson product-moment correlation coefficients, shoulder ROM and lower extremity flexibility variables (α = 0.05).Results:ER mean value was significantly greater, and IR mean value significantly less, in the dominant arm. TRM mean values were not significantly different bilaterally. Sit-and-reach results were strongly correlated with TRM and ER of the dominant arm.Conclusions:There was a significant shift in TRM toward ER in collegiate baseball players. Lower quarter flexibility was strongly correlated with dominant arm ER and total rotation ROM but not in the nondominant arm.Clinical Relevance:The sit-and-reach test may be useful to identify a pitcher’s potential to achieve an appropriate amount of trunk forward tilt. This may maximize the lag effect necessary to achieve maximum ER of the dominant arm and increased ball velocity.
Study Design Case report. Background Acute traumatic avulsion of the rectus abdominis and adductor longus is rare. Chronic groin injuries, often falling under the athletic pubalgia spectrum, have been reported to be more common. There is limited evidence detailing the comprehensive rehabilitation and return to sport of an athlete following surgical or conservative treatment of avulsion injuries of the pubis or other sports-related groin pathologies. Case Description A 29-year-old National Basketball Association player sustained a contact injury during a professional basketball game. This case report describes a unique clinical situation specific to professional sport, in which a surgical repair of an avulsed rectus abdominis and adductor longus was combined with a multimodal impairment- and outcomes-based rehabilitation program. Outcomes The patient returned to in-season competition at 5 weeks postoperation. Objective measures were tracked throughout rehabilitation and compared to baseline assessments. Measures such as the Copenhagen Hip and Groin Outcome Score and numeric pain-rating scale revealed progress beyond the minimal important difference. Discussion This case report details the clinical reasoning and evidence-informed interventions involved in the return to elite sport. Detailed programming and objective assessment may assist in achieving desired outcomes ahead of previously established timelines. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2016;46(8):697-706. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6352.
Recent research has demonstrated body mass (M) bias in military physical fitness tests favoring lighter, not just leaner, service members. Mathematical modeling predicts that a distance run carrying a backpack of 30 lbs would eliminate M-bias. The purpose of this study was to empirically test this prediction for the U.S. Army push-ups and 2-mile run tests. Two tests were performed for both events for each of 56 university Reserve Officer Training Corps male cadets: with (loaded) and without backpack (unloaded). Results indicated significant M-bias in the unloaded and no M-bias in the loaded condition for both events. Allometrically scaled scores for both events were worse in the loaded vs. unloaded conditions, supporting a hypothesis not previously tested. The loaded push-ups and 2-mile run appear to remove M-bias and are probably more occupationally relevant as military personnel are often expected to carry external loads.
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