Sports and Orthopedic Physical Therapy Research :: Nationwide Children's Hospital

Sports and Orthopedic Physical Therapy Research

Nationwide Children's Hospital's Sports and Orthopedic Physical Therapy department strives to provide the best possible care for your child. Our therapists are experienced in working with pediatric athletes and orthopedic rehabilitation, using the best evidence to improve recovery.

We are expanding our research program to continue providing the best care and become a leader in the field of pediatric sports and orthopedic rehabilitation. Our goal in performing clinical research is to advance knowledge, improve patient outcomes and decrease the impact of injury. Clinical research involves the scientific investigation of the prevention, diagnosis or treatment of pediatric sports and orthopedic injuries in our patients. We thank all patients and parents who participate in clinical research.

Our Research Studies

Lumbar Manipulation for Adolescent Low Back Pain

Study Investigators: Mitchell Selhorst, DPT, OCS, Brittany Selhorst DPT, OCS.

Low back pain is an extremely common complaint in teenagers. Studies show that the number of teens needing care for their back pain has steadily increased over the past few decades. Lumbar manipulation or “popping the low back” can reduce pain and increase function in adults with back pain. We do not know if lumbar manipulation will help teenagers like it does in adults. To best treat our patients with low back pain, we are assessing how manipulation affects younger patients. In this study, either a real or fake manipulation is done on the patient and then physical therapy continues as normal. We are monitoring patients involved in this study to see how lumbar manipulation affects their low back pain at 1 week, 4 weeks and at 6 months. This study has been completed and published in the Journal of Manual and Manipulative Therapy.

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Band Traction for Acute Ankle Sprains

Study Investigators: Linda Lowes, PT, PhD, James Marrie, PT, Kathryn Iammarino, DPT.

Ankle sprains are a common injury in most sports that can keep athletes from playing for weeks and sometimes months. The current recommendation of rest, ice, compression, and elevation (RICE) is an effective treatment, but even so, athletes take weeks to return to full potential. Band traction is a treatment that uses thick elastic bands to gently stretch out the ankle following an ankle sprain. The goal of this treatment is to reduce swelling, increase pain free ankle motion and get the athlete back onto the field faster. Currently, no research has been performed assessing the effectiveness of band traction. This study evaluates patients with acute (<7 days) ankle sprains and assesses if band traction works better than the RICE treatment alone. The results of this study will allow our staff to return athletes to the field as quickly and safely as possible following an ankle sprain.

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Does the Addition of Manual Therapy Increase Calf Flexibility more than stretching alone?

Study Investigators: Melissa Tatman, MPT, Mitchell Selhorst, DPT, OCS.

Decreased calf muscle flexibility has been found to impair people’s body mechanics. This lack of motion can cause the knee to collapse inward (excessive dynamic valgus) during squatting, running, and jumping. The risk of knee injury increases dramatically when the knee collapses inwards during sports. In an effort to improve a patient’s body mechanics, stretching exercises are prescribed when they have tight calf muscles. Stretching can take up to 1-2 months to see noticeable improvements in flexibility. In an effort to increase calf flexibility faster this study assessed if adding manual therapy techniques before stretching would result in better flexibility gains. We looked at 2 different manual therapy techniques and compared both to stretching alone. The 2 techniques were a talocrural manipulation and Instrument Assisted Soft Tissue Mobilization. Talocrural manipulation is where the physical therapist quickly pulls on the ankle resulting in a quick stretch. Instrument Assisted Soft Tissue Mobilization is a strong massage of the calf muscle using a tool that helps break up adhesions and scar tissue. All patients involved in the study performed calf stretches every day for 2 weeks. After comparing changes in flexibility between all 3 groups we found no differences between the groups. Although these manual techniques are useful in many other conditions, adding manual therapy to calf stretching did not help increase flexibility.

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Assessing Dynamic Knee Valgus using an Ipod Inclinometer

Study Investigators: Kristine Graft, DPT, Mitchell Selhorst, DPT, OCS.

Dynamic knee valgus occurs when the knee collapses inward during activity. When an athlete has excessive dynamic knee valgus the risk of injuring their knee dramatically increases. It is fairly easy to see if an athlete has excessive dynamic knee valgus during a slow activity such as a squat. It becomes significantly more difficult to see during the fast activities of sport, such as running or jumping. Currently, we use slow-motion video analysis to assess our patient’s dynamic knee valgus for high speed sport activity. This process is quite accurate allowing us to analyze the athlete’s motion frame by frame. The problem is slow-motion video analysis is time consuming and can take an entire therapy session to analyze the athlete’s dynamic knee valgus. Using an IPod inclinometer application we can quickly get readings for dynamic knee valgus. The IPod is attached to the athlete’s thigh and the application measures the angle of dynamic knee valgus 10 times per second. The IPod is less time consuming than the slow-motion video analysis, but we do not know if the IPod’s measurements are accurate. In this study we are comparing the measurements from the IPod inclinometer to those found during slow-motion video analysis. The athlete’s dynamic knee valgus will be assessed simultaneously with the IPod and the video analysis during 3 activities (Single leg squat, box drop jump, and single leg box drop). If we find that the dynamic knee valgus measurement from the IPod strongly agrees with the slow-motion video analysis we can start using the IPod in the clinic. Although, the value of assessing an athlete’s form with slow-motion video analysis cannot be replaced, the IPod inclinometer may help us quickly assess dynamic knee valgus.

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Patellofemoral Pain Syndrome Treatment Algorithm: Full Randomized Trial

Patellofemoral pain is an injury that causes pain around your kneecap. This pain is a result of multiple factors including poor body mechanics, leg weakness, overuse, and lack of flexibility. A large amount of research shows that addressing each of these impairments improves patellofemoral pain. There is some evidence to suggest treating all of these issues at once may not be the best approach. Patients with poor flexibility have greater difficulty improving their body mechanics. They have more pain while performing knee strengthening exercises if they have weak hips or poor mechanics. We believe that sequentially treating patients’ impairments with an ordered approach will result in less pain and faster return to full activity. We performed a pilot study assessing a small number of patients (30) with patellofemoral pain to see if it would be worthwhile to perform a much larger study to test our hypothesis. Our results suggest that patients treated sequentially have a faster return to full function and are more satisfied with their progress than patients whose impairments were addressed all at once. Although the results of this small study are promising we cannot change our clinical practice based on these limited results. We are currently performing a full randomized trial further assessing an ordered approach to treating patellofemoral pain.

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Manual Therapy to the Gluteus Medius for Patients with Anterior Knee Pain

Weakness in the hip muscles is extremely common in patients with anterior knee pain, and this weakness may contribute to ongoing anterior knee pain. This study is assessing short term effects of manual therapy techniques on hip strength. We will be studying 2 forms of manual therapy; soft tissue mobilization, and dry needling. Soft tissue mobilization is a type of massage used to try release knots in the hip muscles. In dry needling a fine, flexible and sterile needle is inserted into the hip muscles. The purpose of dry needling is to release shortened bands of muscle caused by abnormal functioning of the nervous system. Patients involved in this study will have their hip strength tested before and after the manual therapy. They will also have their strength tested one more time at the end of the physical therapy session after they have finished their exercise. The results of this study may help our therapists improve hip strength faster, helping to resolve the symptoms of patients with anterior knee pain.

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Rest Before Physical Therapy in Adolescents with Active Spondylolysis and Spondylolisthesis

Spondylolysis is a stress fracture most commonly occurring in the lumbar spine. This injury is extremely common in adolescent athletes, accounting for as much as 40% of all low back pain in this population. Currently, there is no evidence to guide physicians on when to make a safe referral to physical therapy [PT] for these patients. There are two primary objectives of this study: (1) to determine if the amount of time prior to referral to PT affects the time to make a full return to activity for patients with an acute spondylolysis (2) To assess the safety of an early referral to PT compared with a longer rest period prior to PT in patients with an acute spondylolysis. This study consists of the review of each patient’s medical chart and lumbar imaging. By looking back into our charts we can see the outcomes of 5 years’ worth of patients. The results of this study can help better guide physicians referral’s to PT and help guide future research.

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