Papers by David Logerstedt
Supplemental material, DS_10.1177_0363546519825500 for Coper Classification Early After Anterior ... more Supplemental material, DS_10.1177_0363546519825500 for Coper Classification Early After Anterior Cruciate Ligament Rupture Changes With Progressive Neuromuscular and Strength Training and Is Associated With 2-Year Success: The Delaware-Oslo ACL Cohort Study by Louise M. Thoma, Hege Grindem, David Logerstedt, Michael Axe, Lars Engebretsen, May Arna Risberg and Lynn Snyder-Mackler in The American Journal of Sports Medicine
Sports Medicine, 2021
Mechanical loading to the knee joint results in a differential response based on the local capaci... more Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, musculotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient's response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions, and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and specificity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation. Key Points Mechanical loads encountered during high-risk cutting, pivoting, and jumping sports predispose the structures of the knee to risk of injury. Individual tissues of the knee respond and adapt differently to various mechanical load stimuli. Appropriate selection of exercises, functional activities, and mobility tasks based on their mechanical load profile can be utilized during rehabilitation to systematically and progressively load the structure of the knee to promote tissue healing and repair.
Physical Therapy, 2020
A clinical practice guideline on total knee arthroplasty was developed by an American Physical Th... more A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty.
International Journal of Sports Physical Therapy, 2019
Background: Performing physical activities on compliant surfaces alters joints kinematics by decr... more Background: Performing physical activities on compliant surfaces alters joints kinematics by decreasing joint motions. However, the effect of administering a training program on a compliant surface on muscle activities after anterior cruciate ligament (ACL) injury is unknown. Hypothesis/Purpose: To compare the effects of training on a compliant surface and manual perturbation training on individual muscle activation and muscle co-contraction indexes after an ACL injury. It was hypothesized that patients who received training on the compliant surface would demonstrate higher individual and combined muscle activities compared to the manual group. Method: Sixteen patients (participated in level I/II sports) who sustained an ACL injury and had not undergone reconstructive surgery participated in this preliminary study. Eight patients received training on a compliant surface (Compliant group) and data of eight patients matched by age and sex from a previous study who received manual perturbation training were used as a control group (Manual group). Patients in both groups completed standard three-dimensional gait motion analysis with surface electromyography (EMG) of several lower extremity muscles during gait. Muscle co-contraction index and individual muscle activations were computed during weight acceptance (WA) and mid-stance (MS) intervals. A 2x2 analysis of variance (ANOVA) was used with an alpha level of p<0.10 to account for the high EMG variability. Results: The compliant group significantly increased muscle co-contraction of vastus lateralis-lateral hamstring (VL-LH), vastus medialisgastrocnemius medialis (VM-MG), and vastus lateralis (VL) muscle activity during WA (p ≤ 0.035) and manual group significantly decreased VM-MG muscle co-contraction during WA (p=0.099) after training. Conclusion: Administering training on a compliant surface provides different effects on muscle activation compared to manual perturbation training after an ACL injury. Training on a compliant surface caused increased muscle co-contraction indexes and individual muscle activation, while manual perturbation training decreased the VM-MG muscle co-contraction index.
Journal of Orthopaedic & Sports Physical Therapy, 2018
A Clinicians should recommend use of exercise-based knee injury prevention programs in athletes f... more A Clinicians should recommend use of exercise-based knee injury prevention programs in athletes for the prevention of knee and anterior cruciate ligament (ACL) injuries. Programs for reducing all knee injuries include 11+ and FIFA 11, HarmoKnee, and Knäkontroll; and those used by Emery and Meeuwisse, 14 Goodall et al, 20 Junge et al, 34 LaBella et al, 36 Malliou et al, 41 Olsen et al, 49 Pasanen et al, 51 Petersen et al, 52 and Wedderkopp et al. 78 Programs for reducing ACL injuries include HarmoKnee, Knäkontroll, Prevent Injury and Enhance Performance (PEP), and Sportsmetrics; and those used by Caraffa et al, 5 Heidt et al, 27 LaBella et al, 36 Myklebust et al, 46 Olsen et al, 49 and Petersen et al. 52 IDENTIFY EXERCISE-BASED KNEE INJURY PREVENTION PROGRAMS THAT ARE EFFECTIVE FOR SPECIFIC SUBGROUPS OF ATHLETES A Clinicians, coaches, parents, and athletes should implement exercise-based knee injury prevention programs prior to athletic training sessions/practices or games in female athletes to reduce the risk of ACL injuries, especially in female athletes younger than 18 years of age. Programs that should be implemented include PEP, Sportsmetrics, Knäkontroll, Har-moKnee, and those used by Olsen et al 49 and Petersen et al. 52 A Soccer players, especially women, should use exercisebased knee injury prevention programs to reduce the risk of severe knee and ACL injuries. Programs that could be beneficial for preventing severe knee injuries include PEP, Knäkontroll, and Har-moKnee. Programs that could be beneficial for specifically preventing ACL injuries include those used by Caraffa et al 5 and Sportsmetrics. B Male and female team handball players, particularly those 15 to 17 years of age, should implement exercise-based knee injury prevention programs. Programs that could be beneficial for preventing knee injuries include those used by Olsen et al 49 and Achenbach et al. 1 DESCRIBE THE EVIDENCE FOR COMPONENTS, DOSAGE, AND DELIVERY OF EXERCISE-BASED KNEE INJURY PREVENTION PROGRAMS A Exercise-based knee injury prevention programs used for women should incorporate multiple components, proximal control exercises, and a combination of strength and plyometric exercises. A Exercise-based knee injury prevention programs should involve training multiple times per week, training sessions that last longer than 20 minutes, and training volumes that are longer than 30 minutes per week. A Clinicians, coaches, parents, and athletes should start exercise-based knee injury prevention programs in the preseason and continue performing the program through the regular season. A Clinicians, coaches, parents, and athletes must ensure high compliance with exercise-based knee injury prevention programs, particularly in female athletes. B Exercise-based knee injury prevention programs may not need to incorporate balance exercises, and balance should not be the sole component of a program. PROVIDE SUGGESTIONS FOR IMPLEMENTATION OF EXERCISE-BASED KNEE INJURY PREVENTION PROGRAMS A Clinicians, coaches, parents, and athletes should implement exercise-based knee injury prevention programs in all young athletes, not just those athletes identified through screening as being at high risk for ACL injury, to optimize the numbers needed to treat while reducing cost. A For the greatest reduction in future medical costs and prevention of ACL injuries, osteoarthritis, and total knee replacements, clinicians, coaches, parents, and athletes should encourage implementation of exercise-based ACL injury prevention programs in athletes 12 to 25 years of age and involved in sports with a high risk of ACL injury. B Clinicians, coaches, parents, and athletes should support implementation of exercise-based knee injury prevention programs led by either coaches or a group of coaches and medical professionals. Summary of Recommendations* *These recommendations and clinical practice guidelines are based on the scientific literature published prior to October 2017. Internet links to the individual programs (when available) are provided in TABLE 4. In addition, the authors of this clinical practice guideline have created 2 videos (one for field sports and one for court sports, available at https://www.jospt.org/doi/suppl/10.2519/jospt.2018.0303) that incorporate key elements of the various programs reviewed in this clinical practice guideline.
The American Journal of Sports Medicine, 2019
Background: Some athletes demonstrate excellent dynamic stability after anterior cruciate ligamen... more Background: Some athletes demonstrate excellent dynamic stability after anterior cruciate ligament (ACL) rupture and return to sport without ACL reconstruction (ACLR) (copers). Others demonstrate persistent instability despite rehabilitation (noncopers) and require surgical stabilization. Testing to determine coper classification can identify potential copers early after rupture. It is unclear how coper classification changes after a brief intervention and how early classification relates to long-term outcomes. Purpose: (1) To evaluate the consistency of early coper classification (potential coper vs noncoper) before and after progressive neuromuscular and strength training (NMST) among athletes early after acute ACL rupture and (2) to evaluate the association of early coper classification with 2-year success after ACL rupture. Study Design: Cohort study; Level of evidence, 2. Methods: This was a prospective analysis from the Delaware-Oslo ACL Cohort Study, composed of athletes cons...
British journal of sports medicine, 2018
Assessing athletes' readiness is a key component for successful outcomes after ACL reconstruc... more Assessing athletes' readiness is a key component for successful outcomes after ACL reconstruction (ACLR). To investigate whether return-to-activity criteria, individually or in combination, at 6 months after ACLR can predict return to participation in the same preinjury activity level at 12 and 24 months after ACLR. Ninety-five level I/II participants completed return-to-activity criteria testing (isometric quadriceps index, single-legged hop tests, Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and Global Rating Score (GRS)) at 6 months after ACLR. The PASS group was defined as scoring 90% on all criteria and the FAIL group as scoring <90% on any criteria. At 12 and 24 months after ACLR, participants were asked if they had returned to participate in the same preinjury activity level or not. All return-to-activity criteria, except quadriceps index, were entered into the logistic regression model. 81% and 84.4% of the PASS group returned to participation in th...
Gait & posture, Jan 23, 2018
Performing physical activities on a compliant surface alters joint kinematics and increases joint... more Performing physical activities on a compliant surface alters joint kinematics and increases joints stiffness. However, the effect of compliant surface on joint kinematics after ACL-rupture is yet unknown. To compare the effects of mechanical perturbation training with a compliant surface to manual perturbation training on joint kinematics after ACL-rupture. Sixteen level I/II athletes with ACL-rupture participated in this preliminary study. Eight patients received mechanical perturbation with compliant surface (Mechanical) and 8 patients received manual perturbation training (Manual). Patients completed standard gait analysis before (Pre) and after (Post) training. Significant group-by-time interactions were found for knee flexion angle at initial contact (IC) and peak knee flexion (PKF) (p<0.004), with manual group significantly increased knee flexion angle at IC and PKF (p<0.03). Main effects of group were found for hip flexion angle at IC (Manual:34.34+3.51°, Mechanical:27....
The American Journal of Sports Medicine, 2016
Background: The variability in outcomes after anterior cruciate ligament reconstruction (ACLR) mi... more Background: The variability in outcomes after anterior cruciate ligament reconstruction (ACLR) might be related to the criteria that are used to determine athletes’ readiness to return to their preinjury activity level. A battery of return-to-activity criteria (RTAC) that emphasize normal knee function and movement symmetry has been instituted to quantitatively determine athletes’ readiness to return to preinjury activities. Purpose: To investigate performance-based and patient-reported measures at 12 and 24 months after ACLR between patients who passed or failed RTAC at 6 months after ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 108 patients who had participated in International Knee Documentation Committee level 1 or 2 sports activities completed RTAC testing at 6, 12, and 24 months after surgery. The RTAC included the isometric quadriceps strength index (QI), 4 single-legged hop tests, the Knee Outcome Survey–activities of daily living subscale (KOS...
The American Journal of Sports Medicine, 2016
Background: Rehabilitation before anterior cruciate ligament (ACL) reconstruction (ACLR) is effec... more Background: Rehabilitation before anterior cruciate ligament (ACL) reconstruction (ACLR) is effective at improving postoperative outcomes at least in the short term. Less is known about the effects of preoperative rehabilitation on functional outcomes and return-to-sport (RTS) rates 2 years after reconstruction. Purpose/Hypothesis: The purpose of this study was to compare functional outcomes 2 years after ACLR in a cohort that underwent additional preoperative rehabilitation, including progressive strengthening and neuromuscular training after impairments were resolved, compared with a nonexperimental cohort. We hypothesized that the cohort treated with extended preoperative rehabilitation would have superior functional outcomes 2 years after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: This study compared outcomes after an ACL rupture in an international cohort (Delaware-Oslo ACL Cohort [DOC]) treated with extended preoperative rehabilitation, including neuromus...
Sports health, Jan 30, 2015
Many coaches, parents, and children believe that the best way to develop elite athletes is for th... more Many coaches, parents, and children believe that the best way to develop elite athletes is for them to participate in only 1 sport from an early age and to play it year-round. However, emerging evidence to the contrary indicates that efforts to specialize in 1 sport may reduce opportunities for all children to participate in a diverse year-round sports season and can lead to lost development of lifetime sports skills. Early sports specialization may also reduce motor skill development and ongoing participation in games and sports as a lifestyle choice. The purpose of this review is to employ the current literature to provide evidence-based alternative strategies that may help to optimize opportunities for all aspiring young athletes to maximize their health, fitness, and sports performance. Nonsystematic review with critical appraisal of existing literature. Clinical review. Level 4. Based on the current evidence, parents and educators should help provide opportunities for free unst...
Brazilian Journal of Physical Therapy, 2015
Injuries to the knee, including intra-articular fractures, ligamentous ruptures, and meniscal and... more Injuries to the knee, including intra-articular fractures, ligamentous ruptures, and meniscal and articular cartilage lesions, are commonplace within sports. Despite advancements in surgical techniques and enhanced rehabilitation, athletes returning to cutting, pivoting, and jumping sports after a knee injury are at greater risk of sustaining a second injury. The clinical utility of objective criteria presents a decision-making challenge to ensure athletes are fully rehabilitated and safe to return to sport. A system centered on specific indicators that can be used to develop a comprehensive profile to monitor rehabilitation progression and to establish return to activity criteria is recommended to clear athletes to begin a progressive and systematic approach to activities and sports. Integration of a sports knee injury performance profile with return to activity criteria can guide clinicians in facilitating an athlete's safe return to sport, prevention of subsequent injury, and lifelong knee joint health.
Orthopaedic Journal of Sports Medicine, 2015
Objectives: At least 175,000 Anterior Cruciate Ligament Reconstructions (ACLR) are performed year... more Objectives: At least 175,000 Anterior Cruciate Ligament Reconstructions (ACLR) are performed yearly in the United States, with the goal of restoring static knee stabilization for full return to previous level of function. Large data registries have reported general population outcomes after ACLR, but less is known about the athletic population. The purpose of this study is to evaluate functional outcomes, return to sport rates, and re-injury rates 2 years after ACLR from an all athlete cohort and make comparisons to outcomes reported in the literature. Methods: Three hundred subjects were prospectively enrolled after ACL injury. All subjects sustained an isolated ACL injury and were enrolled within 7 months of injury. Subjects regularly participated in level I or II sports greater than 50 hours per year. All subjects underwent preoperative neuromuscular training. 201 of these subjects underwent ACLR. 157 patients returned for follow-up 2 years after surgery for performance-based and...
Sports Health: A Multidisciplinary Approach, 2015
Context: There is increased growth in sports participation across the globe. Sports specializatio... more Context: There is increased growth in sports participation across the globe. Sports specialization patterns, which include year-round training, participation on multiple teams of the same sport, and focused participation in a single sport at a young age, are at high levels. The need for this type of early specialized training in young athletes is currently under debate. Evidence Acquisition: Nonsystematic review. Study Design: Clinical review. Level of Evidence: Level 4. Conclusion: Sports specialization is defined as year-round training (greater than 8 months per year), choosing a single main sport, and/or quitting all other sports to focus on 1 sport. Specialized training in young athletes has risks of injury and burnout, while the degree of specialization is positively correlated with increased serious overuse injury risk. Risk factors for injury in young athletes who specialize in a single sport include year-round single-sport training, participation in more competition, decreas...
Archives of physical medicine and rehabilitation, 2014
To quantify the differences in physical impairments and in performance-based measures and patient... more To quantify the differences in physical impairments and in performance-based measures and patient-reported outcomes in men and women seeking nonoperative management of symptomatic moderate knee osteoarthritis (OA) and those with symptomatic end-stage knee OA scheduled for total knee arthroplasty compared with healthy controls. Cross-sectional analysis of individuals referred to physical therapy, community participants, and subjects from a 2-year longitudinal study. University research department. Cross-sectional analysis of participants (N=289) consisting of a moderate OA group (n=83), a severe OA group (n=143), and a healthy control group (n=63). Not applicable. Quadriceps strength, timed Up and Go test, stair-climbing test, 6-minute walk test, Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), and Physical Component Summary (PCS) of the Medical Outcomes Study 36-Item Short-Form Health Survey. Women had worse scores than men for physical impairment and performance-bas...
Orthopaedic journal of sports medicine, Jan 25, 2013
After anterior cruciate ligament reconstruction (ACLR), motivation to return to previous levels o... more After anterior cruciate ligament reconstruction (ACLR), motivation to return to previous levels of activity is high. Very few studies have used return-to-activity criteria to determine when to permit athletic play. Return-to-activity measures objectively evaluate functional limb symmetry; however, previous biomechanical studies have found gait deviations in these individuals that persist up to 2 years after surgery. To evaluate gait biomechanics in a specific cohort of ACL patients 1 year after surgery and retrospectively compare individuals who pass return-to-activity criteria 6 months after surgery with those who fail. Prospective analysis. A total of 40 athletes who participated regularly (>50 h/y) in cutting, jumping, and pivoting activities and who sustained an isolated, unilateral ACL rupture were included in this study. All participants underwent reconstruction by the same surgeon and received individualized postoperative rehabilitation. Performance-based and self-report d...
Osteoarthritis and Cartilage, 2013
to treatment (p¼0.001); effect size 0.76. There was a statistically significant increase in HOOS ... more to treatment (p¼0.001); effect size 0.76. There was a statistically significant increase in HOOS of 12.4 at 52 weeks (p<0.0005); effect size 0.76 when comparing the treatment and control groups. The UCLA activity score showed an increase of 0.66 (p¼0.019); effect size 0.43 in favour of the treatment group at 52 weeks. The EQ5D summary index increased by 0.85 (p¼0.005); effect size 0.76 at 52 weeks when moving from the control group to the treatment group. Hip flexion (increase of 17.9, p<0.0005) and hip extension (increase of 5.7, p¼.004) also showed a marked improvement between the treatment group and the control group. Muscle strength improved more in the intervention group but was not statistically significant. Eighty percent (32 of 40) of the intervention group fully met their self-selected goal compared to 55% (22 of 40) of the control group. Conclusions: A simple tailored exercise programme resulted in marked increases in hip range of motion and self reported function than the previous conventional rehabilitation programme. A change in the emphasis of post-operative rehabilitation could improve outcome for patients after hip resurfacing arthroplasty
Journal of Orthopaedic & Sports Physical Therapy, 2014
Osteoarthritis and Cartilage, 2012
not significantly different between HOA patients and the control group [Table]. However, obesity ... more not significantly different between HOA patients and the control group [Table]. However, obesity was significantly more frequent in the HOA group (13/70 (18.6%) vs. 23/254 (9.1%), p <0.05), as was metabolic syndrome (9/70 (12.9%) vs. 13/254 (5.1%), p <0.05). When analyzing the presence of metabolic syndrome among patients with obesity in both groups, patients with HOA still showed a significantly higher rate as compared with the control group (8/13 (61.5%) vs. 5/23 (38.3%), p <0.05). [Table] Conclusions: These data suggest that obesity and metabolic syndrome, but no other conditions associated with cardiovascular risk such as hypertension, diabetes or dyslipemia, are relatively frequent in patients with HOA. Metabolic syndrome was highly prevalent in patients with HOA and obesity compared with obese control patients, suggesting the implication of additional systemic factors in this subpopulation.
Osteoarthritis and Cartilage, 2012
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Papers by David Logerstedt