Timothy F Tyler's research while affiliated with American Sports Medicine Institute and other places

Publications (76)

Article
Full-text available
Introduction Opioid prescription to treat pain among orthopedic surgery patients remains common practice in the United States but overprescribing opioids can lead to abuse. The purpose of this study was to determine the effect of a multimodal non-pharmacological ‘pain relief kit’ on pain, function, and opioid consumption in individuals recovering f...
Article
Full-text available
Background/purpose: The Elastic band pull-apart exercise is commonly used in rehabilitation. It involves pulling an elastic resistance band with both hands in horizontal abduction or diagonal arm movements. The extent of muscle activation during this exercise is unknown. The purpose of this study was to measure the electromyographic (EMG) activity...
Article
Full-text available
Background The diagnosis of lateral epicondylitis is typically made on the basis of clinical history and examination. However, magnetic resonance imaging (MRI) is often used to supplement evaluation of the patient with a painful elbow and can identify extensor carpi radialis brevis (ECRB) tendon tears. The objective of this study was to determine i...
Article
Full-text available
Groin pain is a common symptom in hip and pelvic pathology and differentiating between the two remains a challenge. The purpose of this study was to examine whether a test combining resisted adduction with a sit-up (RASUT) differentiates between pelvic and hip pathology. The RASUT was performed on 160 patients with complaints of hip or groin pain w...
Article
Full-text available
Introduction/purpose: Currently there is little evidence supporting the use of objective tests, measures, or imaging to help predict time to return to sport (RTS) following a hamstring strain. The purpose of this study is to investigate the predictive value of tenderness to palpation (TTP) as measured by area and location following hamstring strai...
Chapter
To effectively rehabilitate hamstring muscle injuries, it is imperative that the clinician perform efficient history taking and a physical assessment. The physical assessment evaluates findings of palpation, range of motion, muscle function, and athletic performance. The information garnered during this process is integrated with the patient’s subj...
Article
Full-text available
Muscle strain injury and exercise‐induced muscle damage have been described as a continuum of injury whereby micro tears (muscle damage) lead to muscle strain injury. However, the clinical scenario is one of two mutually exclusive conditions that differ markedly in terms of site of injury, mechanism of injury, associated symptoms, repair process, a...
Article
Full-text available
Background Disproportionate end-range plantar flexion weakness, decreased passive stiffness, and inability to perform a heel rise on a decline after Achilles tendon repair are thought to reflect increased tendon compliance or tendon lengthening. Since this was first noted, we have performed stronger repairs and avoided stretching into dorsiflexion...
Article
Full-text available
Background: Traditionally, shoulder isometrics are introduced in the early stages of shoulder rehabilitation. A patient's isometric torque output is based on a subjective perception of force generation. By utilizing elastic resistance elongation (strain) to standardize force output, clinicians could prescribe shoulder therapeutic isometrics based...
Article
Full-text available
Background: The functional benefits of double-row (DR) versus single-row (SR) rotator cuff repair are not clearly established. Purpose: To examine the effect of DR versus SR rotator cuff repair on functional outcomes and strength recovery in patients with full-thickness tears. Study design: Randomized controlled trial; Level of evidence, 2. M...
Article
Full-text available
Background: Shoulder range of motion and strength adaptations occur at an early age in baseball pitchers. Purpose/hypothesis: The purpose of this study was to examine the effect of pitch volume on in-season and year-to-year range of motion (ROM) and strength adaptations in high school baseball pitchers. The hypothesis was that a high pitch volum...
Article
Full-text available
Context: Hamstring strain injuries have a high recurrence rate. Objective: To determine if a protocol emphasizing eccentric strength training with the hamstrings in a lengthened position resulted in a low recurrence rate. Design: Longitudinal cohort study Setting: Sports medicine physical therapy clinic. Participants: 50 athletes with hamstr...
Article
Full-text available
Objectives: The effect of single row (SR) versus double row (DR) rotator cuff repair on functional outcomes was examined in a prospective randomized design. Methods: Fifty patients were randomized to DR or SR repairs; 39 patients (13 women, 26 men, 23 SR, 16 DR, age 62±7 yr) were assessed at an average of 2.2±1.6 yr after surgery (range 1-7 yr; te...
Article
Full-text available
Unlabelled: Soft tissue injuries of the hip and pelvis are common among athletes and can result in significant time loss from sports participation. Rehabilitation of athletes with injuries such as adductor strain, iliopsoas syndrome, and gluteal tendinopathy starts with identification of known risk factors for injury and comprehensive evaluation o...
Article
Background: Evaluation and treatment of groin pain in athletes is challenging. The anatomy is complex, and multiple pathologies often coexist. Different pathologies may cause similar symptoms, and many systems can refer pain to the groin. Many athletes with groin pain have tried prolonged rest and various treatment regimens, and received differing...
Article
Full-text available
Objectives: Hamstring injuries are among the most common injuries in sports involving sprinting and have a high recurrence rate (20-33% recurrence rates reported in the literature). Rehabilitation protocols that can prevent recurrences are needed. The purpose of this study was to determine if a protocol emphasizing eccentric strength training with...
Article
Full-text available
Background: Shoulder strength and motion deficits in high school baseball pitchers have been implicated in injury risk. Purpose/hypothesis: To prospectively determine if preseason strength and range of motion (ROM) are predictive of injury in high school baseball pitchers. It was hypothesized that ROM asymmetries and weakness would be predictive...
Article
Full-text available
Introduction and purpose: Eccentric training of the wrist extensors has been shown to be effective in treating chronic lateral epicondylosis. However, its efficacy in the treatment of medial epicondylosis has yet to be demonstrated. The objective of this study was to assess the effectiveness of a novel eccentric wrist flexor exercise added to stan...
Article
Evaluation and treatment of groin pain in athletes is challenging. The anatomy is complex, multiple pathologies often coexist, different pathologies may cause similar symptoms, and many systems can refer pain to the groin. Many athletes with groin pain have tried prolonged rest and various treatment regiments, and have received differing opinions a...
Article
Articular cartilage injuries of the knee can be debilitating if not treated properly. Once an articular cartilage injury is sustained there are a variety of surgical interventions depending on the severity of the injury. The most common of these procedures are: osteochondral autograft transplantation (OATS), autologous chondrocyte implantation (ACI...
Article
Full-text available
Specific guidelines for therapeutic exercises following an Achilles tendon repair are lacking. A hierarchical progression of triceps surae exercises can be determined on the basis of electromyographic (EMG) activity. Randomized laboratory trial. Bipolar surface electrodes were applied over the medial and lateral heads of the gastrocnemius as well a...
Article
An important synergistic relationship exists between the scapular stabilizers and the glenohumeral rotators. Information on the relative contribution of the scapular stabilizers to glenohumeral rotation would be useful for exercise prescription for overhead athletes and for patients with shoulder pathology. We hypothesized that the scapular stabili...
Article
Full-text available
Isokinetic eccentric training of the wrist extensors has recently been shown to be effective in treating chronic lateral epicondylosis. However, isokinetic dynamometry is not widely available or practical for daily exercise prescription. Therefore, the objective of this study was to assess the efficacy of a novel eccentric wrist extensor exercise a...
Article
Full-text available
The clinical use of digital levels, for joint measurement, may be a viable alternative to standard goniometry. The purpose of this study was to determine the intra- and intertester reliability of a construction grade digital level compared to the standard universal goniometer for measurements for active assisted shoulder range of motion (ROM). Two...
Article
Full-text available
An in-season groin injury may be debilitating for the athlete. Proper diagnosis and identification of the pathology are paramount in providing appropriate intervention. Furthermore, an adductor strain that is treated improperly can become chronic and career threatening. Any one of the 6 muscles of the adductor muscle group can be involved. The degr...
Article
An athlete often presents to the rehabilitation specialist with either a nonspecific referral, such as "hip pain," or with a diagnosis of a more specific hip pathology. The highly skilled clinician is trained to look at the "linkage" between the trunk and all parts of the lower extremity. Why is the hip not transferring the load well? Where is the...
Article
Full-text available
Glenohumeral internal rotation deficit (GIRD) and posterior shoulder tightness have been linked to internal impingement. To determine if improvements in GIRD and/or decreased posterior shoulder tightness are associated with a resolution of symptoms. Cohort study; Level of evidence, 3. Passive internal rotation and external rotation (ER) range of mo...
Article
Full-text available
Scapular strengthening is thought to be an important component of the rehabilitation of patients with internal impingement. To determine the effect of scapular-retractor-muscle fatigue on internal- and external-rotation-torque production in patients with internal impingement. Case control study. Outpatient clinic. 15 patients and 18 healthy subject...
Article
Full-text available
The purpose of this study was to examine the relationship between hamstring flexibility and knee flexion angle-torque relationship. Hamstring flexibility was assessed in 20 subjects (10 men, 10 women) using the straight leg raise (SLR) and active knee extension (AKE) tests. Isometric knee flexion strength was measured at five knee flexion angles wh...
Article
Full-text available
Numerous techniques for reconstruction of the coracoclavicular ligaments have been developed to treat acromioclavicular joint separations. A new, stronger method to reconstruct the coracoclavicular ligaments using semitendinosus tendon allografts has been previously described. No outcome studies have been published on this new procedure. Reconstruc...
Article
Among people who participate in sports, extra-articular soft tissue injuries around the hip are common. The hamstring, quadriceps, adductor, and abductor muscle groups are often the site of soft tissue injury. Overlapping conditions make it difficult to identify the primary cause of hip pain and dysfunction. A proper evaluation and diagnosis of the...
Article
Full-text available
A high body mass index and previous ankle sprains have been shown to increase the risk of sustaining noncontact inversion ankle sprains in high school football players. Stability pad balance training reduces the incidence of noncontact inversion ankle sprains in football players with increased risk. Cohort study; Level of evidence, 2. Height, body...
Article
Full-text available
Upper extremity weight-bearing exercises are routinely used in physical therapy for patients with shoulder pathology. However, little evidence exists regarding the demand on the shoulder musculature. To examine changes in shoulder muscle activity and center of pressure during upper extremity weight-bearing exercises of increasing difficulty. Electr...
Article
Full-text available
Separation of tendon ends after Achilles tendon repair may affect the tendon repair process and lead to postoperative end-range plantarflexion weakness. Patients will have disproportionate end-range plantarflexion weakness after Achilles tendon repair. Descriptive laboratory study. Four-strand core suture repairs of Achilles tendon were performed o...
Article
Codman's pendulum exercises are commonly prescribed after shoulder surgery and injury to provide grade I and II distraction and oscillation resulting in decreased pain, increased flow of nutrients into the joint space, and early joint mobilization. Many shoulder protocols suggest that weight may be added to these pendulum exercises as rehabilitatio...
Article
Full-text available
Previous literature has associated hip weakness with patellofemoral pain syndrome. Improvements in hip strength and flexibility are associated with a decrease in patellofemoral pain. Cohort study; Level of evidence, 2. Thirty-five patients with patellofemoral pain syndrome, aged 33 +mn; 16 years (29 women, 6 men; 43 knees), were evaluated and place...
Article
Full-text available
In a previous study, we noted a possible connection between an athlete's weight and risk of ankle sprain. A high body mass index and a history of a previous ankle sprain increase the risk of a subsequent noncontact sprain. Cohort study; Level of evidence, 2. One hundred fifty-two athletes from 4 football teams were observed (2 varsity and 2 junior...
Article
Full-text available
Ankle sprains are among the most common sports injuries. Poor balance as measured on a balance board and weakness in hip abduction strength are associated with an increased risk of noncontact ankle sprains in high school athletes. Cohort study; Level of evidence, 2. One hundred sixty-nine high school athletes (101 male athletes, 68 female athletes)...
Article
Full-text available
The purpose of this study was to determine whether strength deficits could be detected in individuals with and without shoulder impingement, all of whom had normal shoulder strength bilaterally according to grading of manual muscle testing. Strength of the internal rotators and external rotators was tested isokinetically at 60 degrees /s and 180 de...
Article
Full-text available
No consensus exists on the amount of tension that should be applied to anterior cruciate ligament grafts to best facilitate graft incorporation and re-create normal knee mechanics. Differences in initial graft tension will affect postoperative knee stability. Prospective, randomized, double-blind clinical trial. Forty-nine patients undergoing bone-...
Article
Full-text available
Creatine supplementation has been shown to augment training-induced strength gains. The purpose of this study was to examine the effect of creatine supplementation on recovery of muscle strength after anterior cruciate ligament (ACL) reconstruction. Creatine supplementation will facilitate strength gains after ACL reconstruction. Double-blind, pros...
Article
Background Creatine supplementation has been shown to augment training-induced strength gains. The purpose of this study was to examine the effect of creatine supplementation on recovery of muscle strength after anterior cruciate ligament (ACL) reconstruction. Hypothesis Creatine supplementation will facilitate strength gains after ACL reconstruct...
Article
Full-text available
Adductor strains are among the most common injuries in ice hockey. Hip adductor weakness has been identified as a strong risk factor. An intervention program including muscle strengthening can reduce the incidence of adductor strains in professional ice hockey players. Prospective risk factor prevention study. Thirty-three of 58 players from the sa...
Article
Full-text available
A number of clinical conditions of the patellofemoral joint have been correlated with abnormal patellofemoral radiographic measurements. An abnormal anteroposterior patellar-tilt angle may be a contributing factor to pathologic conditions of the knee. Prospective nonrandomized clinical trial. The anteroposterior patellar-tilt angle was measured in...
Article
Full-text available
Despite the high prevalence of residual quadriceps muscle weakness after anterior cruciate ligament reconstruction, specific predictive factors have not been identified. Electromyographic analysis is a better predictor of residual muscle weakness than is preoperative strength. Prospective cohort study. The quadriceps muscle strength of 37 patients...
Article
Full-text available
Previous studies analysing electromyograms (EMGs) from indwelling electrodes have indicated that fast-twitch motor units are selectively recruited for low-intensity eccentric contractions. The aim of this study was to compare the frequency content of surface EMGs from quadriceps muscles during eccentric and concentric contractions at various contra...
Article
An in-season adductor muscle strain may be debilitating for the athlete. Furthermore, an adductor strain that is treated improperly could become chronic and career threatening. Any one of the six muscles of the adductor group could be involved. The degree of injury can range from a minor strain (Grade I), where minimal playing time is lost, to a se...
Article
Full-text available
Case study. To demonstrate the unique aspects of rehabilitating a female athlete participating in ice hockey following anterior cruciate ligament (ACL) reconstruction. The patient was a 28-year-old female who sustained a traumatic injury to her left knee while playing ice hockey. After 6 weeks of rehabilitation (15 visits), the athlete elected to u...
Article
Study Design: Case study. Objective: To demonstrate the unique aspects of rehabilitating a female athlete participating in ice hockey following anterior cruciate ligament (ACL) reconstruction. Background: The patient was a 28-year-old female who sustained a traumatic injury to her left knee while playing ice hockey. After 6 weeks of rehabilitation...
Article
Full-text available
The purpose of this study was to prospectively evaluate the effect of tourniquet use during endoscopic anterior cruciate ligament (ACL) reconstruction surgery on dorsiflexion strength, plantarflexion strength, quadriceps strength, and calf and thigh girth. The study was a prospective, double-blind, randomized clinical trial. Forty-eight patients we...
Article
Full-text available
This prospective study was conducted to determine whether hip muscle strength and flexibility play a role in the incidence of adductor and hip flexor strains in National Hockey League ice hockey team players. Hip flexion, abduction, and adduction strength were measured in 81 players before two consecutive seasons. Thirty-four players were cut, trad...
Article
Full-text available
Prospective, observational study. To document changes in surface electromyographic activity during sustained maximum quadriceps contractions in patients before and 5 weeks after anterior cruciate ligament (ACL) reconstruction. Quadriceps weakness after injury and reconstruction of the ACL is well documented. The effect of weakness on muscle fatigue...
Article
The relationship between posterior capsule tightness and dysfunction has long been recognized clinically but has not been biometrically quantified. The purpose of this study was to quantify changes in range of motion and posterior capsule tightness in patients with dominant or nondominant shoulder impingement. Measurements of posterior capsule tigh...
Article
Knowledge of current surgical procedures and the effect they have on healing tissue is important when developing rehabilitation guidelines. Recently, clinicians have been asked to treat patients who have undergone Electrothermally-Assisted Capsulorrhaphy (ETAC) for shoulder instability. The ultimate tensile strength of the tightened capsule is unkn...
Article
The relationship between posterior capsule tightness and dysfunction has long been recognized clinically but has not been biometrically quantified. The purpose of this study was to quantify changes in range of motion and posterior capsule tightness in patients with dominant or nondominant shoulder impingement. Measurements of posterior capsule tigh...
Article
Full-text available
Prospective, observational study. To determine the association between KT-1000 measurements with an anterior translation force of 89 N and other measures of outcome (the Tegner activity score, the modified Lysholm score, subjective rating of instability, Lachman test, and pivot-shift test) 1 year following anterior cruciate ligament (ACL) reconstru...
Article
Repeated measures of shoulder flexibility on nonimpaired subjects and intercollegiate baseball pitchers. To present a new objective method of measuring posterior shoulder tightness, define the intratester and intertester reliability of the measurement, and assess its construct validity. Posterior shoulder tightness has been linked to anterior humer...