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Introduction
Education
August 2012 - August 2016
June 2008 - July 2009
January 2005 - May 2008
Publications
Publications (79)
Purpose: The purpose of this investigation was to compare the quality of neural drive and recruited quadriceps motor units’ (MU) action potential amplitude (MUAPAMP), and discharge rate (mean firing rate (MFR)) relative to recruitment threshold (RT) between individuals with anterior cruciate ligament reconstruction
(ACLR) and controls.
Methods: Fou...
OBJECTIVE: To summarize the evidence on reliability and criterion validity of hip muscle strength testing using portable dynamometers. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: Five databases were searched from inception to March 2023. STUDY SELECTION CRITERIA: We included studies investigating reliability or criterion validi...
Context: Alterations in hamstrings neuromuscular function have been identified after ACL reconstruction (ACLR). To appropriately assess and treat such impairments, it is essential to accurately understand their neural origins. The corticospinal pathway has been extensively studied relative to quadriceps function, with deficiencies in corticospinal...
Background:
Previous studies have examined the effect of whole body (WB) parameters on anterior cruciate ligament (ACL) strain and loads, as well as knee joint kinetics and kinematics. However, articular cartilage damage occurs in relation to ACL failure, and the effect of WB parameters on ACL strain and articular cartilage biomechanics during dyn...
For adults, increasing cadence reduces ground reaction forces, but a lower preferred cadence does not predispose adults to experience higher ground reaction forces. Pubertal growth and motor control changes influence running mechanics, but it is unknown if preferred cadence or step length are associated with ground reaction forces for pre-adolescen...
Objectives:
Despite the growing use of whole-body vibration (WBV) to enhance quadriceps neuromuscular function, the hamstrings-specific response is unclear among those without neuromuscular impairment, which is important to inform performance-based recommendations. Our objective was to determine the immediate and prolonged effects of WBV on hamstr...
Objective:
To compare brain activity between individuals with anterior cruciate ligament reconstruction (ACLR) and controls during balance. To determine the influence of neuromodulatory interventions (external focus of attention [EF] and transcutaneous electrical nerve stimulation [TENS]) on cortical activity and balance performance.
Methods:
In...
Recording transcranial magnetic stimulation-derived measures during a closed kinetic chain task can serve as a functional technique to assess corticomotor function, which may have implications for activities of daily living or lower extremity injury in physically active individuals. Given the novelty of TMS use in this way, our purpose was to first...
Objectives:
Our purpose was to investigate the immediate and prolonged effects of hamstrings fatigue on quadriceps neuromuscular function in individuals with anterior cruciate ligament reconstruction (ACLR) and matched uninjured controls.
Design:
Cross-Sectional.
Setting:
Laboratory.
Participants:
16 participants with a history of ACLR and 1...
OBJECTIVE: To describe age-, sex-, and graft source-specific reference values for patient-reported, physical function, and strength outcome measures in adolescents at 5-7 months after anterior cruciate ligament reconstruction (ACLR). DESIGN: Cross-sectional study METHODS: Data were collected at 3 universities and 2 children's hospitals. Participant...
Purpose
To compare cortical motor planning activity during response selection and motor execution processes between individuals with ACLR and uninjured controls during a reaction time and response selection task.
Methods
Individuals with ACLR (n = 20) and controls (n = 20) performed a lateralized choice reaction time (e.g., Go/NoGo) task. Electr...
Background
The outcome after ACL reconstruction (ACLR) is in general disappointing with unacceptable number of athletes that do not return to pre-injury level of sports, high re-injury rates, early development of osteoarthritis and shorter careers. Athletes after ACLR have high expectation to return to sports which is in contrast with the current o...
Background
Patients with knee joint pathology present with variable muscular responses across the muscles of the lower limb and pelvis. Conventional approaches to characterizing muscle function are limited to gross strength assessments that may overlook subtle changes both in the thigh, hip and shank musculature.
Purpose
To describe individualized...
Runners and coaches are often interested in identifying the “ideal” running form to reduce the risk of injury and improve performance. While differences in pelvis and hip motion have been reported among adolescent female and male long-distance runners of different stages of physical maturation, the influence of sex and/or maturation on temporal-spa...
Purpose
To compare quadriceps corticomuscular coherence (CMC) and force steadiness between individuals with anterior cruciate ligament reconstruction (ACLR) and uninjured controls during a force tracing task.
Methods
Individuals with ACLR (n = 20) and controls (n = 20) performed a knee extension force-control task at 50% of maximal voluntary eff...
The purpose of this study was to compare neuromuscular function in the upper extremity musculature between individuals with glenohumeral labrum repair and uninjured controls. This cross‐sectional study examined 16 individuals with a primary, unilateral glenohumeral labral repair (male/female: 13/3, age: 24.1±5.0 years, time from surgery: 36.7±33.3...
Reliable techniques to assess centrally mediated function in healthy individuals are essential to understand the origins of neuromuscular dysfunction in pathologic populations. This study examined the test–retest reliability of corticospinal excitability in the upper extremity musculature of 21 healthy individuals using transcranial magnetic stimul...
Arthrogenic muscle inhibition (AMI) is a common impairment in individuals who sustain an anterior cruciate ligament (ACL) injury. The AMI causes decreased muscle activation, which impairs muscle strength, leading to aberrant movement biomechanics. The AMI is often resistant to traditional rehabilitation techniques, which leads to persistent neuromu...
To determine the association between cortical activity and postural control performance changes with differing soma- tosensory perturbations. Healthy individuals (n = 15) performed a single-limb balance task under four conditions: baseline, unstable surface (foam), transcutaneous electrical nerve stimulation (TENS) applied to the stance-limb knee,...
Background
Sources of physical activity (PA) and motivation for return to sport after anterior cruciate ligament reconstruction (ACLR) differ between adolescents and adults. It is unclear whether these differences influence participation in PA during the first year after ACLR when individuals are transitioning from rehabilitative care to unrestrict...
Context:
Gluteus medius (GMed) weakness is a common impairment seen across multiple lower-extremity pathologies. Greater GMed weakness is moderately associated with greater frontal plane motion, often termed dynamic knee valgus during functional tasks which may increase risk of lower-extremity injury. Neuromuscular electrical stimulation (NMES) su...
Context:
Arthrogenic muscle inhibition (AMI) impedes the recovery of muscle function following joint injury, and in a broader sense, acts as a limiting factor in rehabilitation if left untreated. Despite a call to treat the underlying pathophysiology of muscle dysfunction more than three decades ago, the continued widespread observations of post-t...
Context:
Lesser hip muscle strength is commonly observed in females with patellofemoral pain (PFP) compared with females without PFP and is associated with poor subjective function and single-leg squat (SLS) biomechanics. Hip muscle weakness is theorized to be related to PFP, suggesting centrally mediated muscle inhibition may influence the observ...
Context:
Arthrogenic muscle inhibition (AMI) is a common neurophysiological response to joint injury. While athletic trainers (ATs) are constantly treating patients with AMI, it is unclear how clinicians are using the available evidence to treat the condition.
Objective:
To investigate ATs' general knowledge, clinical practice, and barriers for...
Objective
External focus (EF) of attention leads to improved balance performance. Consideration of the neuromodulatory effects of EF may inform its clinical utility in addressing neuroplastic impairments after musculoskeletal injuries. We aimed to determine whether electrocortical activity and balance performance changed with attentional foci that...
Background
Hamstrings neuromuscular function is a crucial component of functional movement, and changes after anterior cruciate ligament (ACL) injury contribute to risk factors for secondary injury and long-term sequelae. To effectively treat muscular impairments, an accurate understanding of hamstrings neuromuscular function in patients with ACL r...
Background
Hamstrings muscle morphology is determinant of muscle function (i.e. strength). Among individuals with ACL reconstruction (ACLR), less cross-sectional area (CSA) and volume in the ACLR-limb are associated with muscle weakness, and may contribute to lower rates of return to preinjury activity level and an increased risk for long-term sequ...
Background
Differences in the excitability of motor generating neural pathways are reported following anterior cruciate ligament reconstruction (ACLR) that is associated with quadriceps dysfunction and theorized to prevent the full recovery of muscle function.
Objective
The aims of this systematic review and meta-analysis were to compare quadricep...
Background
While traditionally viewed as a beneficial adaptation to preserve stability in the presence of knee pathology, excessive muscle co-activation may be detrimental for joint health when extrapolated to repetitive movement patterns over time. Lesser hamstrings strength relative to the quadriceps (low H:Q strength ratio) may influence neuromu...
Context:
The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation is the most frequently used patient-reported measure of subjective knee function among individuals with ACL reconstruction (ACLR). Yet, limitations with traditional validation approaches leave it unclear whether the IKDC measures knee function as intended. Ra...
Purpose
Restricted ankle dorsiflexion can promote aberrant biomechanics associated with risk for knee injury during dynamic activities. Attentionally focused instructions have been used to improve high-risk knee biomechanics during landing tasks. Yet, it is unknown whether attentionally focused instruction can effectively improve landing patterns i...
Context
Biomechanical analyses of cutting tasks have demonstrated kinematic differences associated with the noncontact knee-injury risk when the movement direction is unanticipated. Motor-motor dual tasks occur within dynamic environments and change the demand for attentional resources needed to complete athletic maneuvers, which may contribute to...
Context
Patient-reported function is an important outcome in anterior cruciate ligament rehabilitation. Identifying which metrics of thigh-muscle function are indicators of normal patient-reported function can help guide treatment.
Objective
To identify which metrics of thigh-muscle function discriminate between patients who meet and patients who...
Objectives
To investigate validity and between-session reliability of frontal plane trunk, hip, and knee kinematics during three functional tasks in females with patellofemoral pain (PFP).
Design
Observational
Setting
Research Laboratory
Participants
20 females with PFP (22.7±3.2 years, 69.9±9.2kg, 167.7±9.6cm).
Main outcome measures
Trunk, hip...
Objective
To compare inter-limb differences in hamstring strength, muscle volume, and neural activity between individuals with anterior cruciate ligament reconstruction (ACLR) and healthy controls, and to identify associations between hamstring neuromuscular function and subjective knee function.
Design
Cross-sectional.
Setting
Laboratory.
Parti...
Impaired corticomotor function arising from altered intracortical and corticospinal pathways are theorized to impede muscle recovery following anterior cruciate ligament (ACL) surgery, yet functional implications of centrally driven adaptations remain unclear. We aimed to assess relationships between quadriceps corticomotor and neuromechanical func...
Objective:
To identify the frequency of passing return-to-activity tests after anterior cruciate ligament reconstruction (ACLR) and to investigate the influence of patient-specific factors on pass rates. We hypothesized that isolated strength tests would be most difficult to pass and that graft type would be the most influential factor.
Design:...
Context:
Central activation ratio (CAR) is a common outcome measure used to quantify gross neuromuscular function of the quadriceps using the superimposed burst technique, yet this outcome measure has not been validated in the gluteal musculature.
Objective:
To quantify gluteus medius (GMed) and gluteus maximus (GMax) CAR in a healthy population...
Objectives:
To investigate whether relationships between kinesiophobia, lower extremity function, and patient-reported function differ by self-reported physical activity engagement after ACL reconstruction (ACLR).
Design:
Cross-sectional.
Setting:
Laboratory.
Participants:
Seventy-seven patients with a primary, unilateral ACLR.
Main outcome...
Background
Patellofemoral pain is common in the young and active populations. Nonoperative management is limited and focuses on physical therapy. Hyaluronic acid (HA) is an injectable device that has been used for the treatment of knee osteoarthritis.
Hypothesis
A single injection of HA would reduce pain and improve function in patients with patel...
Context:
Impaired scapular kinematics is commonly reported in patients with subacromial impingement syndrome (SIS). Various therapeutic interventions designed to improve scapular kinematics and minimize pain and disability have been described in the literature. However, the short- and long-term benefits of these interventions are unclear.
Objecti...
Purpose
To investigate relationships between quadriceps strength and neural activity, and to establish a clinical threshold of corticospinal excitability able to discriminate between patients with quadriceps strength indicative of satisfactory and unsatisfactory knee function after ACLR.
Methods
29 patients following primary, unilateral ACL recons...
Muscle weakness is a common impairment in females with patellofemoral pain (PFP), clinically seen in both the quadriceps and gluteal muscles. These weaknesses have been suggested to result in poor movement patterns, which results in the clinical presentation of pain due to increased stress on the patellofemoral joint. While quadriceps weakness have...
Context:
Recent recommendations have emphasized return-to-learn (RTL) protocols to aid athletes in recovery from sport-related concussion (SRC) but have been based primarily on anecdotal evidence.
Objective:
To investigate the RTL practices of certified athletic trainers (ATs) after an SRC.
Design:
Cross-sectional study.
Setting:
Online surv...
Context: :
Relationships between quadriceps function and patient-reported outcomes after anterior cruciate ligament reconstruction (ACLR) are variable and may be confounded by including patients at widely different time points after surgery. Understanding these relationships during the clinically relevant phases of recovery may improve our knowled...
Objective:
The flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) provide dynamic stabilization to the medial elbow. It remains unclear how these muscles function during progressive throwing exercises. Our objective was to compare FCU and FDS surface electromyography (sEMG) during a throwing progression.
Design:
Crossover.
Sett...
Context:
Central and peripheral neural adaptations have been identified after anterior cruciate ligament (ACL) injury and reconstruction (ACLR) and are hypothesized to contribute to posttraumatic muscle dysfunction. Limited evidence exists about the temporal nature of neuromuscular adaptations during early and late-term phases of recovery after AC...
Background:
Following anterior cruciate ligament reconstruction (ACLR), patients undergo a battery of performance assessments to determine progression of return to sport activity. Rates of reinjury following ACLR are high, indicating that current assessments may not accurately identify deficits at the time point of return to sport progression.
Re...
Background
Many clinicians release patients to return to activity after anterior cruciate ligament reconstruction (ACLR) based on time from surgery despite deficits in muscle strength and function. It is unclear whether symmetry or unilateral performance is the best predictor of subjective outcomes after ACLR.
Purpose
To determine physical perform...
Background
The National Athletic Trainers’ Association (NATA) advocates for cervical spine immobilization on a rigid board or vacuum splint and for removal of athletic equipment before transfer to an emergency medical facility.
Purpose
To (1) compare triplanar cervical spine motion using motion capture between a traditional rigid spine board and a...
Context:
Post-operative rehabilitation is critical to optimize outcomes after anterior cruciate ligament reconstruction (ACLR). However, the relationship between physical therapy (PT) and clinical outcomes is unclear.
Objective:
To describe PT characteristics following ACLR, and assess the relationships between PT characteristics, surgical proce...
Context:
Assessment of physical function for individuals after ACL reconstruction (ACL-R) is complex and warrants the use of diverse evaluation strategies. To maximize the efficiency of assessment, there is a need to identify tests that provide the most meaningful information about this population.
Objective:
To investigate underlying constructs...
Context:
Study of muscle volumes in patients after anterior cruciate ligament (ACL) injury and reconstruction (ACL-R) is largely limited to cross-sectional assessment of the thigh musculature, which may inadequately describe post-traumatic and post-surgical muscle function. No studies have prospectively examined the influence of ACL injury and rec...
Context:
After ACL reconstruction (ACLR), deficits are often assessed using a variety of functional tests, which can be time consuming. It is unknown whether these tests provide redundant or unique information.
Objective:
To explore relationships between components of a battery of functional tests, the Lower Extremity Assessment Protocol (LEAP),...
Objective: To objectively compare outcomes of nonoperative management and posterior tibial tendon (PTT) transfer for peroneal nerve injury due to multiligament knee injury (MLI). Design: Retrospective cohort study with prospective follow-up. Setting: Tertiary care institution. Patients: Ten patients with peroneal nerve injury due to MLI (5 managed...
Context:
The superimposed-burst (SIB) technique is commonly used to quantify central activation failure after knee-joint injury, but its reliability has not been established in pathologic cohorts.
Objective:
To assess within-session and between-sessions reliability of the SIB technique in patients with patellofemoral pain.
Design:
Descriptive...
To investigate non-thermal therapeutic ultrasound on quadriceps spinal reflex excitability in patients with neuromuscular impairment.
Randomized controlled laboratory study, pre-test post-test.
University laboratory.
Thirty recreationally active volunteers with a self-reported history of diagnosed intra-articular knee joint injury and documented qu...
The superimposed burst technique is used to estimate quadriceps central activation ratio during a maximal voluntary isometric contraction, which is calculated from force data during an open-chain knee extension task. Assessing quadriceps activation in a closed-chain position would more closely simulate the action of the quadriceps during activity....
Common methods of volumetric measurement include magnetic resonance imaging (MRI), bioelectrical impedance, Perometer, tape measure, and water volumetry. Methods driven with technology, i.e., MRI, provide results with high levels of precision while requiring sophisticated equipment and associated costs. More basic techniques, i.e., tape measure and...
Glenohumeral dislocations are prevalent injuries in an athletic population, and proper, acute on-field management remains a topic of debate among health care professionals.Objective: Firstly, to provide a systematic approach to the on-field management of acute anterior glenohumeral dislocations for on-field health care professionals. Secondly, to p...
To determine the relationship between quadriceps central activation ratios (CARs) derived from a percutaneous electrical stimulation (CAR(SIB)) and a transcranial magnetic stimulation (CAR(TMS)) in healthy participants.
Nineteen healthy participants (5 men, 14 women, 23.7 ± 4.8 yrs, 66.8 ± 10.0 kg, and 170.1 ± 7.0 cm) qualified for this descriptive...