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The purpose of this study was to determine whether the vastus medialis oblique muscle (VMO) had greater electrical activity than the vastus lateralis muscle (VL) when hip adduction and medial (internal) tibial rotation exercises were performed. Electrical activity of the VMO and VL was measured on 25 healthy subjects during maximal-effort isometric contractions of hip adduction and medial tibial rotation. The results showed that the electromyographic activity of the VMO was significantly greater than that of the VL during the hip adduction exercise. Differences noted with medial tibial rotation were not significant. The results suggest that the VMO may be selectively activated by performing hip adduction exercises. Resistive hip adduction exercises, therefore, may be advisable in the treatment of patients with lateral malalignment of the patella with accompanying pain or instability.

Background and Purpose. Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs. Subjects. Forty adults (17 male, 23 female), aged 23 to 58 years (Xϭ30.6, SDϭ9.3), with one or more TPs in the neck or upper back participated in this study. Methods. Subjects were randomly divided into 2 groups receiving a 5-day home program of either ischemic pressure followed by general sustained stretching of the neck and upper back musculature or a control treatment of active range of motion. Measurements were obtained before the subjects received the home program instruction and on the third day after they discontinued treatment. Trigger point sensitivity was measured with a pressure algometer as pressure pain threshold (PPT). Average pain intensity for a 24-hour period was scored on a visual analog scale (VAS). Subjects also reported the percentage of time in pain over a 24-hour period. A multivariate analysis of covariance, with the pretests as the covariates, was performed and followed by 3 analyses of covariance, 1 for each variable. Results. Differences were found between the treatment and control groups for VAS scores and PPT. No difference was found between the groups for percentage of time in pain. Conclusion and Discussion. A home program, consisting of ischemic pressure and sustained stretching, was shown to be effective in reducing TP sensitivity and pain intensity in individuals with neck and upper back pain. The results of this study indicate that clinicians can treat myofascial TPs through monitoring of a home program of ischemic pressure and stretching. [Hanten WP, Olson SL, Butts NL, Nowicki AL. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Phys Ther. 2000;80:997-1003.]

Background and Purpose. Shoulder scales are often used to evaluate treatment efficacy, yet little is known about the psychometric properties of these scales. Only one scale has undergone psychometric scrutiny: the Shoulder Pain and Disability Index (SPADI). This study compared 2 shoulder measures—the University of California-Los Angeles (UCLA) Shoulder Scale and the Simple Shoulder Test (SST)—with the SPADI. Subjects. One hundred ninety-two patients with shoulder disorders were recruited from one physician's office to complete the self-report sections of the 3 scales. Methods. Cronbach alpha values and standard errors of measurement (SEM) were calculated for each of the multi-item subscales. Validity was examined through calculation of correlation coefficients among the 3 scales. Factor analysis was completed to assess the underlying constructs of the SPADI and the SST. Results. Cronbach alpha values ranged from .85 to .95. The SEM values for the multi-item scales ranged from 4.75 to 11.65. Evidence for validity to reflect function was indicated by the correlation between the SST and the SPADI disability subscale. The factor analysis of the SPADI revealed loading on 1 factor, whereas the SST loaded on 2 factors. Conclusion and Discussion. All scales demonstrated good internal consistency, suggesting that all items for each scale measure the same construct. However, the SEMs for all scales were high. Factor loading was inconsistent, suggesting that patients may not distinguish between pain and function.

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These findings suggest that an efficient method for increasing isometric knee extension torque and EMG activity throughout the entire range of motion is to exercise with the quadriceps femoris muscles in the lengthened position.

Study Design: A prospective unblinded randomized clinical trial. Objectives: To compare the effectiveness of 2 types of home program instruction, videotape versus personal instruction by a physical therapist, on subjective outcomes and exercise compliance following arthroscopic repair of a full-thickness rotator cuff tear. Background: Advances in orthopedic surgery and rehabilitation have placed increased emphasis on home exercise programs. Therefore, assessing the effectiveness of different methods of home program instruction is important. Methods and Measures:Patients who consented to undergo surgical repair were randomly assigned to either a videotape or personal instruction group. A self-reported compliance log categorized subjects as fully compliant, partially compliant, or noncompliant. The Shoulder Pain and Disability Index and the University of Pennsylvania Shoulder Scale scores were obtained from subjects preoperatively and at 12, 24, and 52 weeks postoperatively. The null hypotheses that neither group would have better outcomes as measured by 2 shoulder outcome scales at any level of compliance over 4 levels of time, were assessed by 2 separate 2×3×4 multiple analyses of variances (MANOVAs), 1 for each outcome measure (␣ = 0.025). Results: Neither MANOVA was significant and the null hypotheses were not rejected. The main effect of time (number of weeks postsurgery) was significant across all time intervals for both outcome measures (PϽ0.0005). Conclusions: With a therapist available for questions, patients who utilized the videotape method for their home program instruction had self-reported outcomes equal to patients instructed in their home program personally by a physical therapist. Self-reported compliance with the rehabilitation program had little effect on the outcomes.