Comparison of Two Post-Operative Rehabilitation Programs after an Ulnar Collateral Ligament Reconstruction and Timelines for Return to Competitive Baseball Pitching
Rodgers Clay, Jr., SPT1; Derek Charles, PT, DPT, OCS1
1Tennesse State University, Dept. of Physical Therapy
Abstract
Study Design: Literature Review
Objectives: The objective of this review was to compare the guidelines for two commonly used rehabilitation programs and the length of time for return to competitive pitching in baseball players after an ulnar collateral ligament reconstruction.
Background: Approximately 50% of baseball pitchers at all levels of competition report experiencing elbow pain severe enough to prevent them from throwing at some point in their career. The pitching motion can lead to repetitive microtrauma and eventually a tear of the ulnar collateral ligament (UCL), requiring a surgical reconstruction. Physical therapy protocols routinely involve post-operative bracing, normalization of elbow range of motion, rotator cuff strengthening, lower extremity and trunk conditioning, and a progressive throwing program. The original protocols were developed by Dr. Frank Jobe and Dr. James Andrews and are considered the gold standard for UCL rehabilitation. The variability in the two programs includes the progression of range of motion, resistance activities, and integration of throwing. It is unknown whether these differences impact the time needed to return to competitive pitching.
Methods: Article searches were conducted using the databases PubMed, Google Scholar, and EBSCOhost. The inclusion criteria included English-language, peer-reviewed journals; baseball pitchers at the high school, collegiate, or professional level undergoing UCL reconstruction; use of either the Andrews or Jobe rehabilitation protocol; and a report of the time required to return to competitive pitching.
Results: The research showed the timelines for progression into each stage of the protocols were the primary differences regarding parameters for early range of motion, resistance exercise prescription, and initiation of the standardized interval throwing program. The Andrews’ protocol produced a return to unrestricted pitching by 9 months postoperative on average while the Jobe protocol produced a return to unrestricted pitching at 1 year after surgery on average.
Conclusion: There was neither a clinically significant difference in time required to return to competition nor a statistically significant difference in the occurrence of re-injury using either protocol. Both protocols are effective and neither appear to have a higher rate of re-injury, giving the rehabilitation professional leeway in deciding which program to employ.
Affecting Functional Outcomes through Patient Perspectives: A Case Report
Joshua Bloodworth, PT, DPT1; Beth Collier, PT, DPT, EdD(c)
1Mercer University, Dept. of Physical Therapy and College of Health Professions
Abstract
Study Design: Case Report
Background: Healthcare professionals across the medical field often view patients through their pathology and seek to address the pathology by treating pain. However, patients present with more complexity than just their pathology and pain. The purpose of this case report is to explore how utilizing patient perspectives through the power dynamic of the therapist-patient relationship and motivational factors affect overall recovery in an outpatient setting.
Case Description: The patient is a 65-year-old female presenting with low back pain, limited lumbar range of motion (ROM) in all planes, and a recent diagnosis of Sjögren’s Disease. She is a retired chiropractor who has a negative view of physical therapy as a profession, she demonstrates a heightened focus on movement deficits, and demonstrates a strong desire to be independent in her health. The treating therapist utilized a familiar task to the patient in order to achieve patient interest and consistency with therapy. Progress was tracked by utilizing the Dallas Pain Questionnaire, functional movements, and lumbar range of motion.
Postural Changes among Physical Therapy Students: Results from a three-year study
Giedrė Gaučaitė1; Selen Razon, PhD2; Vilma Tamulionytė, PhD1; Kristina Berškienė, PhD1; Agnė Slapšinskaitė, PhD1,3
1Department of Sports Medicine, Faculty of Nursing, Medical Academy, Lithuanian University of Health Sciences
2College of Health Sciences, Department of Kinesiology, West Chester University
3Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences
Abstract
Study Design: Longitudinal Study
Purpose: To investigate postural dynamics in a cohort of college students.
Methods: Subjects – 33 participants (N= 33 (24 females, 9 males); Mage=19.15, SD= 0.4).
Results: Participants’ normal posture and ideal posture in the sagittal plane did not change in the course of 3 years. No differences between normal (0.219) and ideal posture (0.549) were found between baseline and follow-up. The proportions of objective and subjective assessment of body posture were not statistically significant (p=1). The frequency of asymmetry of the shoulder and pelvic position between the two assessments changed (p=0.012 and p<0.001). In the follow-up, shoulder position asymmetry and pelvic position asymmetry were less frequent as compared to baseline. The strength endurance of abdomen and back muscles declined in the course of 3 years (Z=-4.76; p<0.001 and Z=-3.30; p=0.001).
Conclusion: In the course of 3 years, although the participants’ sagittal plane posture did not, their frontal plane posture improved: shoulder and pelvic position asymmetry became less frequent. During the 3 year period participants’ sagittal plane posture did not improve and frontal plane posture improved: shoulder and pelvic position asymmetry became less frequent. Also participants’ trunk muscle static strength endurance declined.
