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Im Rahmen der vorliegenden Arbeit wurden kapselumhüllte Hüftgelenkmodelle mit 22 – 44 mm Durchmesser durch Hebelwirkung luxiert, wobei die wirkende Kraft, die resultierende Dislokation und der intraartikuläre Absolutdruck kontinuierlich gemessen wurden. Parallel dazu wurde die technische Range of Motion bis zum Impingement und bis zur Luxation bestimmt. Die durchgeführten Hebelversuche ergaben bei Zunahme des Kopfdurchmessers eine erhebliche Zunahme des Luxationswiderstandes der untersuchten Gelenkmodelle. Im Gegensatz dazu ergab die Messung der technischen Range of Motion bei größerem Gelenkdurchmesser einen geringen Zuwachs, dessen praktische Wirksamkeit durch existierende Literatur auf Grund von Knochen-Knochen-Impingement in Zweifel gezogen wird (Burroughs et al. 2005). Die Hypothese ist somit anzunehmen. Die starke Zunahme des Luxationswiderstandes und die gering erweiterte techROM sprechen neben anderen Argumenten dafür, dass die permanente hüftstabilisierende Wirkung des atmosphärischen Druckes, die auch als Weber-Effekt bezeichnet werden kann, die Hauptursache für die deutlich verminderte Luxationsneigung größerer Köpfe nach hüftendoprothetischen Eingriffen darstellt. Daraus können folgende Konsequenzen für die Hüftendoprothetik abgeleitet werden: 1. Die Schonung und Rekonstruktion der Gelenkkapsel ist eine wichtige Voraussetzung für die Wirksamkeit des Weber-Effektes. Zahlreiche Studien belegen, dass durch die Kapselrekonstruktion die Anzahl der von Luxationen betroffenen Patienten um 90 % gesenkt werden kann (Pellicci et al. 1998; Bottner und Pellicci 2006; Prietzel et al. 2014), weshalb die Kapselrekonstruktion zu empfehlen ist. 2. Gelenkköpfe mit größerem Durchmesser besitzen in Folge des Weber-Effektes eine wesentlich größere Gelenkstabilität bzw. einen höheren Luxationswiderstand. Daraus resultiert offensichtlich die klinisch nachgewiesene wesentlich geringere Luxationsra-te (Bistolfi et al. 2011; Howie et al. 2012, Zajonz et al. 2015). Gegenwärtige Nachteile größerer Köpfe wie höherer Abrieb und vermehrte Belastung von Pfannenveranke-rung und Konus müssen jedoch berücksichtigt werden. Der Einsatz größerer Gelenk-köpfe ist zukünftig in der Hüftendoprothetik anzustreben. Gegenwärtig ist bei normalem Luxationsrisiko und somit bei primären HTEP-Implantationen der Einsatz von Gelenkköpfen bis 36 mm Durchmesser vertretbar. Bei erhöhtem Luxationsrisiko (z. B. bei bestimmten HTEP-Revisionen) sind dagegen 40-mm- und 44-mm-Köpfe gerechtfertigt, soweit diese in Abhängigkeit vom Pfannendurchmesser realisierbar sind (Zajonz et al. 2015). 3. Der Einsatz einer intrakapsulären Redondrainage beschleunigt durch die Eliminierung eingedrungener Luft und durch die Minimierung des postoperativen Hämatoseroms die Restitution physiologischer Gelenkverhältnisse. Dies ist gleichfalls eine wichtige Voraussetzung für die Wirksamkeit des Weber-Effektes und daher zu empfehlen (Prietzel et al. 2007).

[Truncated abstract] First metatarsophalangeal joint (MTPJ1) motion is an important factor in normal weight transference during walking. Disruptions to normal range can influence joints both proximal and distal to the MTPJ1, potentially leading to pain and dysfunction. Whilst the MTPJ1 has been investigated significantly, the numerous methodologies described to quantify range of motion can be questioned and makes comparisons difficult. Range of MTPJ1 motion is commonly assessed in a clinical setting to determine pathology as well as to make decisions on appropriate intervention. The anatomical and biomechanical influence of tendo Achilles load and MTPJ1 motion has been well described; however few studies measuring MTPJ1 range control for Achilles load or describe ankle joint positioning. Further to this the effects of reducing tendo Achilles stiffness on MTPJ1 extensions has yet to be investigated. The purpose of this study was to describe a technique to quantify passive MTPJ1 extension and to determine the influence of ankle joint position on joint range. Secondly the effect of calf muscle stretching on MTPJ1 range was also investigated. The information gathered will assist both research and clinical protocols for quantifying MTPJ1 range, and provide a greater understanding of the anatomic and biomechanical relationship between tendo Achilles load and MTPJ1 extension. In order to fulfil the purposes of the study it was necessary to establish a reliable methodology to quantify non weight bearing MTPJ1 extension. Reliability testing was undertaken in three parts. '...' The results demonstrated a statistically significant increase in joint range immediately following a one minute stretch for variables ankle joint range of motion as well as MTPJ1 extension for ankle joint plantar flexed at 10 Newton's and ankle joint neutral and plantar flexed at 30 Newtons. No significant differences were noted in ankle or MTPJ1 range of motion in either the control group on immediate re-testing, or in both groups after a one week stretch program. The findings of this study support those documented in the literature pertaining to the ankle joint position, tendo Achilles load and plantar fascial stiffness to MTPJ1 range of motion. Increased stiffness at the MTPJ1 was noted dependant on ankle joint position from ankle joint plantar flexion through to ankle joint dorsiflexion. This appears most likely due to increases in tendo Achilles load and subsequent forces transmitted to the plantar aponeurosis. The present study also demonstrated a trend towards increased joint extensibility and limb dominance. The study also supports previous literature into gender differences and joint extensibility, with a positive trend towards increased MTPJ1 range evident in the female subjects tested. The study also demonstrated the immediate effect of calf muscle stretching on ankle and MTPJ1 range of motion. It remains however unclear as to the exact mechanisms involved in producing increased joint range be it reflex inhibition or actual changes to the viscoelastic properties of the soft tissues. Despite this, no changes were evident following a one week stretching program, which supports previous literature describing a short lag time before soft tissues revert to baseline length properties following a single stretch session.

M.Tech. (Chiropractic) / Background: In sporting activity, especially rugby, soccer, cricket and hockey, re-occurring hamstring injuries are a common sight that suggests that there is an opening for an improvement in the treatment and management of these injuries. This can be debilitating to any sportsman as it results in recurrent time away from his/her sporting activity. A study by Fyfer, Yelverton and Sher (2005), found that sacroiliac manipulation alone had a positive effect in the treatment of recurrent hamstring injuries. Cibuklka, Rose, Delitto and Sinacore (1986), proposed a possible link between hamstring muscle injuries and sacroiliac joint dysfunction. A study conducted by Donahue, Docherty and Schrader (2010), on the effects of Graston technique on pressure pain threshold, revealed a significant improvement in the patient’s pain threshold due to the fact that the instrument assisted technique effectively broke down scar tissue and correct fascial restrictions. The FAKTR approach to soft tissue dysfunction combines instrument-assisted soft tissue mobilization (Graston Technique) with proprioceptive (functional) techniques to reduce pain and return to function (Hyde and Doerr, 2012). Objective: This blinded, randomised pilot study was done to investigate the effects of sacroiliac joint manipulative therapy versus functional and kinetic treatment with rehabilitation on hamstring flexibility in previously injured hamstring muscle. Design: The study consisted of 30 participants recruited from the University of Johannesburg by word of mouth and posters, which met the inclusion criteria. They were equally and randomly divided into 2 groups. Group 1 received chiropractic therapy of the sacroiliac joint. Group 2 received functional and kinetic treatment with rehabilitation. Objective measurements consisted of digital inclinometer which measured the flexibility and range of motion of the hamstring muscle. The pressure algometry was used to measure pain pressure threshold. Procedure: Both group participants hamstring flexibility and ranges of motion were tested. Group 1 participants were motion palpated to determine sacroiliac joint dysfunction and treated with a high velocity, low amplitude trust to restricted segment, group 2 received functional and kinetic treatment with rehabilitation. Results: The statistical results should be viewed with regards that this study only represent a small group of thirty participants and therefore no assumption can be made with respect to whole population. The p-value was set at 0.05 and represents the level of significance of the results. If the p-value was less or equal to 0.05 (p≤0.05) there was a statistical significance finding. If the p-value is greater than 0.05 (p>0.05) vi there was no statistical finding. Statistical significance only means that a given result is unlikely to have occurred by chance. Analysis included demographic data analysis of age and gender. Objective data were collected using Digital Inclinometer and Pressure Algometry. Intra-group and inter-group analysis was done on straight leg raise, passive knee extension, hip extension, lateral rotation of the hip and medial rotation of the hip. The Shapiro-Wilk test was performed to determine normality. As normality could not be assumed, non-parametric testing were used to do intra-group analysis. The Non-parametric Friedman test was used to determine if a change occurred over time. As change did occur over time the Wilcoxon Signed Rank Test was use to determined where the change within each group occurred. The Mann-Whitney U test was also used to determine if any difference between the groups were present at any given time. At the end of the study both test groups showed significant clinical as well as statistical improvement over the three week course of the study. Conclusion: The FAKTR treatment did clinically have the greatest improvement, however the changes seen was not statistically superior to those seen with the sacroiliac joint manipulation treatment. A statistical significant improvement was seen in both treatment protocols, concluding that both the spinal manipulative therapy and the functional and kinetic treatment with rehabilitation could be proficient protocols in treating hamstring flexibility.

by Choi Man. / Year shown on spine: 1997. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 146-153). / Abstract --- p.1 / Chapter 1 --- Introduction --- p.3 / Chapter 1.1 --- Anatomy --- p.4 / Chapter 1.2 --- Kinematics of the overhead sports --- p.6 / Chapter 1.3 --- Isokinetics assessment of the shoulder rotators --- p.8 / Chapter 1.4 --- Objectives of the study --- p.10 / Chapter 1.5 --- Method of investigation --- p.11 / Chapter 1.5.1 --- Subject --- p.12 / Chapter 1.5.2 --- Equipment --- p.13 / Chapter 1.5.3 --- Protocol --- p.14 / Chapter 1.6 --- Data Management --- p.17 / Chapter 1.7 --- Clinical application --- p.18 / Chapter 1.8 --- Definition of terms --- p.18 / Chapter 2 --- Literture Review --- p.20 / Chapter 2.1 --- Anatomy --- p.20 / Chapter 2.1.1 --- Ligament --- p.21 / Chapter 2.1.2 --- Muscles --- p.24 / Chapter 2.2 --- Biomechanics of the overhead movement --- p.30 / Chapter 2.2.1 --- Wind up Phase --- p.32 / Chapter 2.2.2 --- Cocking Phase --- p.33 / Chapter 2.2.3 --- Acceleration Phase --- p.36 / Chapter 2.2.4 --- Deceleration Phase --- p.38 / Chapter 2.3 --- Eccentric contraction --- p.40 / Chapter 2.3.1 --- Physiology of eccentric contraction --- p.40 / Chapter 2.3.2 --- Mechanical trauma in eccentric contraction & DOMS --- p.41 / Chapter 2.3.3 --- Eccentric contraction in Plyometric --- p.43 / Chapter 2.3.4 --- Role of eccentric contraction in overhead sports --- p.44 / Chapter 2.3.5 --- Comparison with concentric contraction --- p.45 / Chapter 2.4 --- Isokinetics --- p.46 / Chapter 2.4.1 --- Introduction to isokinetics --- p.46 / Chapter 2.4.2 --- Reliability of isokinetic assessment on Shoulder rotator --- p.48 / Chapter 2.4.3 --- Agonist / Antagonist Ratio --- p.51 / Chapter 2.4.4 --- Variation of torques with testing protocols --- p.52 / Chapter 2.4.5 --- Comparison of muscle torques in different groups --- p.56 / Chapter 2.4.6 --- Isokinetic eccentric contraction of shoulder Rotators --- p.62 / Chapter 3 --- Method of Investigation --- p.63 / Chapter 3.1 --- Subject --- p.64 / Chapter 3.1.1 --- Part One --- p.64 / Chapter 3.1.2 --- Part Two --- p.65 / Chapter 3.1.3 --- Criteria of subject recruitment --- p.65 / Chapter 3.2 --- Equipment --- p.66 / Chapter 3.2.1 --- Collection of medical history and general informations --- p.66 / Chapter 3.2.2 --- Test for general laxity --- p.66 / Chapter 3.2.3 --- Test for shoulder impingement --- p.72 / Chapter 3.2.4 --- Test for shoulder instability --- p.73 / Chapter 3.2.5 --- Joint range measurement --- p.76 / Chapter 3.2.6 --- Isokinetic strength of shoulder rotators --- p.78 / Chapter 3.3 --- Calibration --- p.79 / Chapter 3.4 --- Testing procedure --- p.79 / Chapter 3.4.1 --- "Explanation,warning & consent" --- p.79 / Chapter 3.4.2 --- Warming up --- p.80 / Chapter 3.4.3 --- Screening --- p.81 / Chapter 3.4.4 --- Isokinetic testing of the rotational strength of both shoulders --- p.81 / Chapter 3.5 --- Operator --- p.87 / Chapter 3.6 --- Data Management --- p.88 / Chapter 3.6.1 --- Part One --- p.88 / Chapter 3.6.2 --- Part Two --- p.89 / Chapter 4 --- Result --- p.91 / Chapter 4.1 --- Part One --- p.89 / Chapter 4.1.1 --- Intra-class correlation coefficient --- p.90 / Chapter 4.1.2 --- Correlation between the PTR & the ASMSTR --- p.92 / Chapter 4.2 --- Part Two --- p.94 / Chapter 4.2.1 --- Comparison between the Members in the Hong Kong Badminton Team with the Non-athlete Subjects --- p.94 / Chapter 4.2.2 --- Comparison between the Badminton Players in the Hong Kong Team and the Hong Kong National Junior Team --- p.105 / Chapter 5 --- Discussion --- p.111 / Chapter 5.1 --- General discussion of the design of the study --- p.111 / Chapter 5.1.1 --- Subject --- p.111 / Chapter 5.1.2 --- Specific test --- p.112 / Chapter 5.1.3 --- Warming up --- p.112 / Chapter 5.1.4 --- Testing protocol --- p.113 / Chapter 5.2 --- Part One --- p.116 / Chapter 5.2.1 --- Test-retest reliability --- p.117 / Chapter 5.2.2 --- Correlation between the PTR and the ASMSTR --- p.120 / Chapter 5.3 --- Part two --- p.122 / Chapter 5.3.1 --- Comparison between the HKT and the non- athletes --- p.123 / Chapter 5.3.2 --- Presentation of torque ratio in the HKJ --- p.133 / Chapter 5.3.3 --- Performance in those with history of shoulder problem --- p.134 / Chapter 5.4 --- Clinical application and suggestion for further study --- p.139 / Chapter 6 --- Conclusion --- p.144 / Chapter 7 --- Reference --- p.146 / Chapter 8 --- Appendix

INTRODUCTION: Arthrofibrosis, which occurs in a substantial portion of the population, is a pathologic accumulation of scar tissue that presents in patients as a painful decrease in joint range of motion. Since an individual’s quality of life can be significantly impacted by arthrofibrosis and because there are limitations in current treatments, this thesis focuses on examining the use of the hormone relaxin to alleviate shoulder arthrofibrosis. METHODS: A set of 20 Sprague Dawley rats were given secondary shoulder contractures and separated into groups to examine the efficacy of relaxin using intravenous delivery, intra-articular delivery, and different treatment frequencies. The differences across groups were examined through mechanical range of motion testing as well as histologic sampling. RESULTS: Multiple doses of intra-articular injections of relaxin showed a complete return to the normal range of motion (P < 0.01) when compared with the surgical control, whereas other delivery methods and frequencies failed to show meaningful improvements. This was further confirmed in histologic analysis through the lack of fibrotic adhesions within the capsular space after multiple intra-articular relaxin treatments when compared with the surgical control. DISCUSSION: Although significant improvements to range of motion were seen after multiple doses of intra-articular relaxin, potential tissue degradation was also observed within the joint space after histologic examination. Further research is necessary to fully understand the proper dosing needed to avoid potential negative side effects caused by excess use of relaxin.

Joint Position Sense (JPS) of the shoulder as determined by repeated repositioning tasks has been performed under different constrained testing conditions. The variability in the testing protocols for JPS testing of the gleno-humeral joint may incorporate different movement patterns, numbers of trials used to derived a specific JPS variable and range of motion. All of these aspects may play an important role in the assessment of G-H JPS testing. When using a new instrument for assessing JPS all of these issues need to be examined to document the optimal testing protocols for subsequent clinical assessments. By undertaking these studies future clinical trials may be more optimally assessed to determine if there are differences between dominant and non-dominant arms as well as the presence of JPS changes in performance associated with pathology and rehabilitation. This study used a 3-dimensional tracking system to examined gleno-humeral JPS using 2 open kinetic chain movement patterns. The 'conventional' 90 degree abducted, externally rotated movement was compared to the hypothetically more functional D2 movement pattern used in proprioceptive neuromuscular facilitatory techniques. These two patterns were tested at different ranges (low and high). Two cohorts (n=12, n=16) of normal healthy athletic males aged 17-35 years, performed matching tasks of both left and right arms. The second cohort (n=16) were assessed with and without strapping the gleno-humeral joint with sports tape. Accuracy (overall bias) and precision (variability) scores were determined for progressively greater numbers of trials. The findings of the study show that estimates of JPS accuracy and precision become more stable from data derived from 5 to 6 matching trials. There were no statistical differences between sides [95%CI ± 1.5cm]. The accuracy but not precision improved as subjects approximated the 'high' end of range in the 'conventional' or D2 pattern. Furthermore, no systematic differences were detected at different ranges of movement or movement patterns with or without the application of sports tape. These findings provide a guide to the number of trials that optimise the testing of the gleno-humeral joint and also suggest that in normal controls the magnitude of differences between sides and movement patterns is similar. These findings also iii indicate that sports tape applied to the shoulder may not significantly change the JPS performance in healthy, athletic males.

<p>Snowboarding is a relatively young sport and has grown since the birth in the 1960-70.</p><p>Today, snowboarding still is a lifestyle to many, but also an accepted mainstream sport and has been an Olympic sport since the Olympic Winter Games in Nagano, Japan 1998 (18,35,36). The movement pattern and body position is asymmetric, since you stand sideways with the front foot ahead of the rear foot in the line of direction (14,18,28). Several studies that have investigated the biomechanics of snowboarding have showed that the loading of the lower extremities are different in the front leg compared to the rear leg during riding (14,18, 22,23,28).</p><p>The purpose of this study was to investigate if the asymmetric body position in snowboarding causes differences between front and rear leg considering; circumference of thigh, range of motion (ROM) in the hip joints, power in lower extremities, or causes asymmetrical ROM in the spine in the test group compared to the control group.</p><p>Two groups were used, one test group consisting of ten elite snowboarders (n=10) with an average age of 18 years, and one control group consisting of eight high level skiers (n=8), average age 17,25 years. All subjects were students at Malung/Sälen Alpine Elite Gymnasium. Measurements of ROM in hip and spine were made with a myrin incline goniometer and universal plastic goniometer. A one leg countermovement jump (CMJ) was made as a test of power in the lower extremities using Ivar ump & speed analyzer. Measurements of circumference of thighs were made using a soft tape measure.</p><p>The results show significant differences in four of the ten measurements in test group and in two of the ten measurements in the control group. There are significant differences in hip passive flexion (P<0,05) and adduction(P<0,05) in both groups (Tables 2,3) suggesting that in these movements there are individual differences. The one leg CMJ and circumference of thigh shows significant differences, (P>0,05) and (P<0,001), between front and rear leg in the test group (Table 2), but no such differences can be seen in the control group (Table 3) suggesting that these differences may be caused by the asymmetrical body position during snowboarding.</p>

Function of the shoulder complex is highly dependent on the relationship between the scapula and the humerus. Etiologies for the disruption of the glenohumeral relationship include impaired or abnormal scapular function, motion, or position. The lateral scapular slide test (LSST) has been developed as a clinical tool to assess this phenomenon, also known as scapular dyskinesis. The primary purpose of this study was to determine the validity of the LSST by comparing the clinical measurements on the skin surface to the actual anatomical distance between the scapula and the spine as seen on radiographic images. The secondary purpose of this study was to determine the intra-rater and inter-rater reliability of the LSST. Nine subjects (18 shoulders) were assessed with the clinical LSST and radiographic images in three test positions (0��, 45��, and 90�� of glenohumeral abduction). Comparison of the clinical LSST measurements with the radiographs revealed the LSST to be valid (>0.80) in only the 0�� and 45�� test positions with respective Pearson correlation values of 0.91 and 0.98. Excellent (>0.75) intra-rater ICC (2,1) reliability (0.91-0.97) was found for all three test positions. Inter-rater ICC (2,1) reliability values were excellent for the 0�� (0.87) and 45�� (0.83) test positions, and fair to good for the 90�� position (0.71). This study demonstrated that the LSST is an accurate and consistent measure of scapular movement and position for the 0�� and 45�� test positions. Clinicians should exercise caution when interpreting measurements obtained at the 90�� test position because the validity and reliability values did not reach established standards. / Graduation date: 2002

Ankle injuries comprise more than 15% of all sports injuries worldwide. The efficacy of the ankle taping for injury prevention has long been under scrutiny as numerous studies have shown that tape rapidly loses its ability to constrain ankle motion with exercise. Consequently, ankle braces (orthoses) are being used with increasing frequency for the prevention and functional management of ankle injuries. However, the motion restraining qualities of ankle orthoses have not been widely evaluated in closed kinetic chain environments under physiologic loads. The primary purpose of this study was to compare the abilities of four ankle orthoses (ankle taping, lace-up brace, semirigid orthosis and hybrid brace) against a control condition (no brace or tape) to control subtalar and talocrural motion during running on a laterally-tilted treadmill at 16.2 km/h before and after exercise. It has been hypothesized that ankle orthoses make a secondary contribution to injury prevention through enhanced proprioception. The secondary purpose of this study was to quantify the effects of the aforementioned ankle orthoses on postural stability during single-limb stance following a bout of exercise. Fifteen healthy university students (8 men and 7 women) with no history of significant ankle injuries (age, mean �� SD: 22.9 �� 3.9 years) volunteered to participate in this study. Three-dimensional kinematic data were captured with an active infrared digital camera system sampling at 120 Hz. To address the first question, data analyses were performed using 2way univariate (Ankle Orthoses x Pre/Post-Exercise x Subjects) (5 x 2 x 15) repeated measures analysis of variance (ANOVA) to determine the existence of differences among three closed and four open kinematic chain dependent measures before and after exercise. Maximum inversion angles (MAXINV) were similar for all ankle orthoses, with no orthosis limiting inversion during tilted treadmill running significantly more than another, or compared to the control condition, either before or after exercise (p>.05). Pre-exercise MAXINV group means and standard deviations during treadmill running ranged from 6.8 �� 3.4 deg with the Royce Medical Speed Brace to 9.5 �� 4.1 deg in the tape condition; post-exercise MAXINV mean values ranged from 7.6 �� 3.2 deg for the Aircast Sport Stirrup to 9.1 �� 4.6 deg with closed basketweave tape. While not statistically significant (p=0.10), ankle taping provided the least amount of inversion restraint, both before and after the exercise bout. The MAXINV angles measured during treadmill running (8.2 �� 4.0 deg) and open chain inversion AROM measured with a goniometer (34.5 �� 6.2 deg) were not related (r=-0.0003). The compressive forces present during closed kinetic chain activity are known to increase joint stability and thus may explain why MAXINV under dynamic varus loads was so much less in magnitude than inversion AROM measured under open kinetic chain conditions. The nonlinear relationship of these two variables supports our contention that reports of the motion controlling properties of ankle orthoses measured in open kinetic chain environments should not be used to infer the response characteristics of these same orthoses under dynamic, physiologic loads. To address the second question, data were analyzed using 3-way univariate (Ankle Orthoses x Pre/Post-Exercise x Eyes Open/Closed x Subjects) (5 x 2 x 2 x 15) repeated measures ANOVAs. Subjects' postural stability was assessed using a Biodex Balance System with eyes open and eyes closed conditions, before and after an exercise bout. The ankle orthoses evaluated did not influence postural stability as measured by mediolateral sway index, anteroposterior sway index, and overall sway index. Removal of visual perception via blindfolding resulted in significant decreases in all three measures of postural stability (p=.001). There was poor association among the closed chain postural stability parameters and the open chain AROM measures. These correlations ranged from r=.04 to .17, indicating minimal relationship between the amount of AROM permitted by the orthoses and postural stability as quantified by this method. / Graduation date: 2000