Peter C. Douris, EdD, PT

Journal of Orthopaedic and Sports Physical Therapy Vol.13;1:1991

 Peter C. Douris, EdD, PT

Journal of Orthopaedic and Sports Physical Therapy Vol.17;1:1993

The Effect of Thoracic Spine Mobilization on Lower Trapezius Strength Testing

Ethan John Liebler, Lisa Tufano-Coors, Peter Douris, Howard W. Makofsky, Raymond McKenna, Christopher Michels, Shawlyn Rattray

The Journal of Manual & Manipulative Therapy Vol.9;4:2001

Evidence shown that muscle strength and function become altered due to motion restrictions. Strengthening muscles with tradition therapeutic exercise will not be completely successful unless inhibition is removed by restoring normal joint mechanics. This study investigates the effect of Grade-IV thoracic spine mobilizations on lower trapezius strength testing in normal subjects. The mobilization for the treatment group (n=20) consisted of posterior-anterior (P-A) oscillations performed from T6-T12 at each segment’s end range (Grade-IV). This technique is aimed at restoring normal joint play. The control group (n=20) received a Grade-I mobilization consisting of P-A oscillations performed at the beginning of the joint’s range, which is not expected to have articular reflexogenic effects. Before and after the mobilizations, isometric muscle strength of the lower trapezius was measured using a Nicholas Manual Muscle Tester. An independent group t-test comparing the groups demonstrated a statistically significant effect of thoracic spine mobilizations on lower trapezius strength testing (P<.05).

Recovery of Maximal Isometric Grip Strength Following Cold Immersion

Peter Douris,Raymond McKenna,Kathrine Madigan, Brian Cesarski, Robert Costiera, and Michael Lu

Journal of Strength and Conditioning Research Vol. 17;3:2003

Peter Douris, Veronica Southard, Celia Varga, William Schauss, Charles Gennaro, Arthur Reiss

Journal of Geriatric Physical Therapy Vol.26;1:2003

P Douris, A Chinan, M Gomez, A Aw, D Steffens and S Weiss

British Journal of Sports Medicine Vol. 38:2004

Objectives: To quantify and compare fitness levels of middle aged practitioners of soo bahk do (SBD; a Korean martial art similar to karate) with those of sedentary subjects. Methods: Eighteen volunteers, 14 men and four women (aged 40–60 years), participated. Nine sedentary subjects (mean age 46.7 years) and nine SBD practitioners (mean age 46.8 years) were matched for sex and age. All subjects participated in a one day battery of fitness tests. The following dependent variables were tested: body composition, balance, flexibility, quadriceps strength, grip strength, muscle endurance, and aerobic capacity. Results: All dependent variables were analysed using paired t tests. Body composition (% body fat) for the SBD group was 18.9% v 30.8% for the sedentary group (p = 0.004). The SBD group was able to balance for 61.8 seconds v 26.2 seconds for the sedentary group (p = 0.02). The result for the sit and reach flexibility test was 22.3 cm for the SBD group v 10.4 cm for the sedentary group (p = 0.01). The number of push ups performed in one minute was 47.0 for the SBD group v 18.6 for the sedentary group (p = 0.0003), and the number of sit ups performed was 66.1 for the SBD group and 37.3 for the sedentary group (p = 0.00006). Aerobic capacity was 41.0 ml/kg/min v 31.1 ml/kg/min for the sedentary group (p = 0.04). Quadriceps strength was 99.5% (peak torque/body weight) v 83.0% for the sedentary group (p = 0.02). Only grip strength was not significantly different. Conclusions: There were significant differences between the groups for most of the physical fitness tests. The SBD practitioners displayed greater aerobic capacity, balance, flexibility, muscle endurance, and strength, and less body fat than the sedentary controls matched for age and sex. SBD can be considered an excellent form of exercise for the promotion of fitness in adults. Health professionals should be aware that there are alternative methods to traditional exercise that can increase the physical fitness and health of the middle aged population.

The Relationship Between Maximal Repetition Performance and Muscle Fiber Type as Estimated by Noninvasive Technique in the Quadriceps of Untrained Women

Abstract: The relationship between maximal repletion performance and muscle fiber type as estimated by noninvasive technique in the quadriceps of untrained women. The purpose of this investigation was to establish a relationship between the number of repetitions an individual can complete at a predetermined load and their percentage of type II muscles fibers in their quadriceps. Subjects included 22 untrained women between the ages of 18 and 34. Day 1 consisted of noninvasive anthropologic testing, 1 repetition maximum (1RM) testing, and recording repetition performance at 70% 1RM. Day 2 consisted of isokinetic dynamometry to determine muscle fiber composition. Results were obtained and analyzed using the Pearson product correlation coefficient (r). The results demonstrated a fair-to-moderate relationship (Pearson r = -0.48, p = 0.02) that individuals with greater percentages of type II muscle fibers performed fewer repetitions at 70% 1RM. The results of this study demonstrate that muscle fiber type composition is an important variable to consider when designing training or rehabilitation programs.

Effect of Phototherapy on Delayed Onset Muscle Soreness

Photomedicine and Laser Surgery Vol.24; 3:2006

Abstract: The purpose of this study was to investigate the effects of phototherapy on delayed onset muscle soreness (DOMS) as measured using the Visual Analog Scale (VAS), McGill Pain Questionnaire Resting Angle (RANG), and girth measurements. Background Data: Previous research has failed to prove the beneficial effects of phototherapy on DOMS. Methods: This was a randomized double-blind controlled study with 27 subjects (18-35 years) assigned to one of three groups. The experimental group received 8 J/cm2 of phototherapy each day for five consecutive days using super luminous diodes with wavelengths of 880 and visible diodes of 660 nm at three standardized sites over the musculotendinous junction of the bicep.  The sham group received identical treatment from a dummy cluster. The controls did not receive treatment.  The study was completed over five consecutive days: on day one baseline measurements of RANG and upper arm girths were recorded prior to DOMS induction. On days 2-5, RANG, girth, and pain were assessed using VAS and the McGill Pain Questionnaire. Results: The experimental group exhibited a significant decrease in pain associated with DOMS compared to the control (p = 0.01) and sham groups (p = 0.03) based upon the VAS at the 48-h period. The McGill Pain Questionnaire showed a significant difference in pain scores at the 48-h period between the experimental and the sham groups (p = 0.01). There were no significant differences day to day and between the groups with respect to girth and RANG. Conclusion: The results of this study provide scientific evidence that phototherapy as used in this study provides a beneficial effect to patients who may experience DOMS after a novel exercise session.

Comparison of Once-Weekly and Twice-Weekly Strength Training in Older Adults

 Background: Strength training has been shown to benefit the health and function of older adults. Objective: To investigate whether one set of exercises performed once a week was as effective in increasing muscle strength as training twice a week. Methods: 18 subjects (7 women and 11 men) aged 65-79 years were randomly assigned to two groups. Both groups performed one set of exercises to muscular fatigue; group 1 trained 1 day/week and group 2-trained two days/week on three lower and three upper body exercises for 9 weeks.  The data were analyzed using a mixed model 2x2 analysis of variance. Results: A significant main effect of time (p<0.001), but not group, on one-repetition maximum scores was observed. No significant interaction was observed between time and group and therefore no differences in strength changes between training once a week versus twice a week after 9 weeks. Conclusions: One set of exercises performed once weekly to muscle fatigue improved strength as week as twice a week in the older adult. Our results provide information that will assist in designing strength-training programmes that are more time and cost efficient in producing health and fitness benefits for older adults.

Use of the Occivator for the Correction of Forward Head Posture, and the Implications for Temporomandibular Disorders: A Pilot Study

 Catherine Augustine, Howard Makofsky, Christina Britt, Barbara Adomsky, Jennifer Martire Deshler, Paula Ramirez, and Peter Douris

 Cranio Vol.26; 2:2008

 Abstract: Numerous studies suggest that temporomandibular disorders may be associated with forward head posture. The current study presents a need for an intervention that will effectively facilitate an ideal postural alignment of the head. The Occivator (Posteocentric Systems, Mastic Beach, NY) is an intervention speculated to improve forward head posture (FHP). However there has not been a randomized study to correlate use of the Occivator with improvement of FHP. The purpose of this study was to evaluate the effectiveness off the Occivator as a therapeutic intervention for the correction of FHP. Using a plumb line, twenty-nine (29) subjects were selected on the basis of having FHP. The CROM (cervical range of motion) device was used to determine measurement of forward head position for each group, pre and post an eight-week period. The experimental group followed a specific protocol of 20 minutes of stretches and exercises on the Occivcator, two times a week for eight weeks. The control group did not receive any intervention. The experimental group as compared to the control group demonstrated significant improvement for forward head posture (p=. 02). Further research is needed to evaluate the effectiveness of the Occivator.

Martial Art Training Enhances the Glutathione Antioxidant System in Middle Aged Adults

 Peter C Douris, Ahmed S Elokda, John P Handrakis, Suze Principal Eleni Rondo, Juan Bovell, William P Coughlin, Charles N Mastroianni, Michael J Wong and Thomas Zimmerman

 Journal of Strength and Conditioning Research 23(5)1518-1523 2009

 The purpose of this study was to compare the antioxidant capacity of physically active middle-aged martial artists to age-matched sedentary controls. Nine sedentary subjects (mean age 52.9) and 9 martial artists (mean age 51.8), who practice Soo Bahk Do, a Korean martial art, were age and sex-matched, performed a graded exercise test (GXT) utilizing a modified Bruce protocol. Ages ranged from 41 to 58 years. A GXT has been shown to be an effective technique for inducing oxidative stress. Glutathione (GSH) is the body’s most highly concentrated antioxidant, is the central component of the antioxidant system, and plays an essential role in protecting tissues against oxidative stress. Free radical oxidation leads to the transformation of GSH to glutathione disulfide (GSSG).  Venous blood samples for GSH and GSSG were collected prior to and immediately following the GXT. Repeated measures ANOVA were performed on the resting baseline values and immediate post-GXT values of GSH, GSSG and GSH:GSSG in order to compare both groups. The blood GSH, GSSG, and GSH:GSSG levels were significantly different (p<0.001), between the 2 groups at rest and after the GXT. The Soo Bahk Do practitioners had higher resting levels of GSH, lower levels of GSSG and responded more effectively to acute oxidative stress than the age-matched sedentary controls. Soo Bahk Do appears to enhance the antioxidant defense system and may be an effective intervention for improving overall health by protecting against the adverse effects of oxidative stress that is associated with free radical theory of aging. Health professionals should be aware of alternative methods of training, conditioning and exercise that can improve the general adaptation response to oxidative stress.

A Meta-analysis of the Efficacy of Phototherapy in Tissue Repair

 Fulop AM, Dhimmer S, Deluca JR, Johanson DD, Lenz RV, Patel KB, Douris PC, Enwemeka CS

 Photomedicne and Laser Surgery Oct;27(5):695-702.2009

 OBJECTIVE: The effect of phototherapy on tissue repair was determined by aggregating the literature and using statistical meta-analysis to analyze pertinent studies published between 2000 and 2007. Background Data: Phototherapy has been used for more than 40 y; however, its efficacy on tissue repair remains contentious. METHOD: Related original studies were gathered from every available source. The papers were then screened and coded; those meeting pre-established inclusion criterion were subjected to meta-analysis, using Cohen's d statistic to determine treatment effect size. RESULTS: Seventy effect sizes were computed from the 23 papers that met the inclusion criteria. The overall mean effect obtained was highly significant, d = +1.94 (95% confidence interval = 0.58-2.50). Further analyses revealed a similarly positive effect of phototherapy on tissue repair in experimental animal studies, d = +2.60, and a small to moderately positive effect in human cases of tissue repair, d = +0.34. The fail-safe number associated with the overall effect was 869; i.e., the number of additional studies in which phototherapy has negative or no effect on wound healing needed to negate the overall large effect size of + 1.94. The corresponding fail-safe numbers for experimental animal and human tissue repair studies were 612 and 64, respectively. CONCLUSION: These findings indicate that phototherapy is a highly effective form of treatment for tissue repair, with stronger supporting evidence resulting from experimental animal studies than human studies.

Static Stretching Does Not Impair Performance in Active Middle-aged Adults

 Handrakis JP, Southard VN, Abreu JM, Aloisa M, Doyen MR, Echevarria LM, Hwang H, Samuels C, Venegas SA, Douris PC.

 Journal of Strength and Conditioning Research 24(3):825-30.2010

 Recent investigations with young, healthy adult subjects suggest that static stretching before activity decreases performance and should, therefore, be avoided. The purpose of this study was to assess the effects of an acute static stretching protocol on balance and jump/hop performance in active middle-aged adults. Ten subjects (6 men and 4 women aged 40-60 yr) from a martial arts school volunteered to take part in this research study. This was a repeated measures design. Subjects who stretched for 10 minutes using a 30-second hold during 1 session sat quietly for 10 minutes during the alternate session. Sessions were randomly assigned. The following dependent variables were compared: Dynamic Stability Index (DSI) for single-leg dynamic balance (smaller DSI = improved balance); distances for broad jump, single hop, triple hop, and crossover hop; elapsed time for a 6-m timed hop. Group means for balance were significantly different between the stretch and no-stretch conditions (3.5 +/- 0.7 vs. 4.3 +/- 1.4 DSI, respectively; p < 0.05). No significant differences were found between the group means of the stretch and no-stretch conditions for the dependent measures of broad jump, single hop, triple hop, crossover hop, and 6-m timed hop performance. Ten minutes of acute static stretching enhances dynamic balance and does not affect jump/hop performance in active middle-aged adults. Static stretching should be included before competition and before exercise in fitness programs of active middle-aged adults.

Exploring the role of BMI on Balance Reactions and Gait in Overweight Sedentary Middle-Aged Adults: A Pilot Study

 Veronica Southard, Arti Dave and Peter Douris

 Journal of Primary Care & Community Health 1:178-183, 2010

 Background/Purpose: Being overweight is defined as having a body mass index (BMI) greater than 25. Reduced postural control has been implicated in the presence of increased BMI .The purpose of this study was to assess the effects of BMI on postural stability in healthy sedentary middle-aged adults. Based on BMI we divided subjects into 2 groups (25.00-27.49 27.50-29.99) to assess f or differences in postural control. Methods: Twenty healthy sedentary subjects between 40-64 years; (13 females and 7 males) with a mean age of 52.45 years, were recruited by convenience. After determination of BMI, postural control was assessed on all subjects using the Activities Specific Balance Confidence Scale, Berg Balance Scale, TUG, gait speed measurement, and Biodex Stability Index testing. Results: Timed Up and Go duration was increased in these subjects when compared to normative data. Gait speed was also reduced in those subjects in the 5th and 6th decades when compared with established norms. Biodex ™ SD balance system scores demonstrated reduced postural stability. A 2 tailed T-Test revealed no significant difference between BMI ranges of 25.0 - 27.5 and BMI 27.6 – 29.99. Conclusion: There may be increased risk for falls with increases in body mass short of obesity thresholds of BMI 30% for this sedentary middle aged adult population. Future studies, with larger groups of subjects that address postural stability and BMI are necessary. Although these subjects are younger, falls screening measures may prove beneficial as a prevention strategy for sedentary overweight middle aged adults.

A Meta-analysis of the Efficacy of Phototherapy on Pain Relief

Abstract:The overall treatment effect of phototherapy on pain control was determined by aggregating the literature and using statistical meta-analysis to analyze the studies. Phototherapy has been widely used in the clinical setting for more than 40 years; its efficacy on pain control remains controversial. Relevant original studies were collected from every available source and coded. Papers that met pre-established inclusion criteria were subjected to meta-analysis, using Cohen’s d statistic to determine the overall treatment effect size. Ninety-six effect sizes were computed from 22 papers that met the inclusion criteria. The overall mean effect size was highly significant; d = +0.84 (95% confidence interval = 0.44 – 1.23). Exclusion of outlier data revealed a moderately positive effect of phototherapy on pain control; d = +0.66 (95% confidence interval = 0.46 – 0.86). The Fail-Safe number associated with the overall effect was 348. The Fail-safe number is the number of additional studies in which phototherapy has negative or no effect on pain control needed to negate the overall large effect size of +0.84. These findings suggest that phototherapy is a highly effective form of treatment for controlling pain in a variety of conditions; including arthritis, tendonitis, and myofacial pain syndrome.

The Effect of the PostureJac on Deep Cervical Flexor Endurance: Implications in the Management of Cervicogenic Headache and Mechanical Neck Pains

Cranio Volume 29 Issue 3 July 2011

Abstract: The convergence of cervical and trigeminal afferents on second-order neurons in the trigeminocervical nucleus may refer pain from the upper cervical spine into the head and face. Furthermore, bi-directional interactions between trigeminal and upper cervical afferents may also explain neck symptoms of trigeminal origin (e.g., migraine). It is known that cervicogenic headache sufferers present with several musculoskeletal changes including poor endurance of the deep cervical flexor muscles. These intrinsic muscles of the neck contribute to stabilization and protection of the cervical spine and are critical for the control of both intervertebral motion and the cervical lordosis. The purpose of this study was to determine whether the use of the PostureJac (SomatoCentric Systems, Inc., Toronto, Ontario, Canada), a posture support and exercise jacket, was effective in enhancing deep cervical muscle endurance. Forty-five (45) female subjects, between the ages of 18 and 40 years, were randomly assigned to three groups consisting of the no-treatment control, the treatment-control (table stabilization), and the experimental (PostureJac) group. The outcome measure of deep cervical flexor muscle endurance was based on the Flexor Endurance Test and was recorded in seconds. The results indicated that the PostureJac group was superior to the no-treatment control (p=.001) and the treatment-control (p=.004) groups in terms of increasing endurance of the deep cervical flexors. Consequently, the PostureJac may be a useful therapeutic tool in the management of cervicogenic headache and mechanical neck pain. 

Fatiguing Upper Body Aerobic Exercise Impairs Balance

Journal of Strength and Conditioning Research

Abstract: There are many studies that have examined the effects of selectively fatiguing lower extremity muscle groups with various protocols and they have all shown to impair balance. There is limited research regarding the effect of fatiguing upper extremity exercise on balance. Muscle fiber type recruitment patterns may be responsible for the difference between balance impairments due to fatiguing aerobic and anaerobic exercise. The purpose of our study was to investigate the effect that aerobic vs. anaerobic fatigue, upper vs. lower body fatigue will have on balance, and if so, which combination will affect balance to a greater degree. Fourteen healthy subjects, 7 men and 7 women (mean age 23.5 ±1.7 years) took part in this study. Their mean BMI was 23.6±3.2. The study utilized a repeated measures design. The effect on balance was documented following the four fatiguing conditions: Aerobic lower body (ALB), Aerobic upper body (AUB), Anaerobic lower body (WLB), Anaerobic upper body (WUB). The aerobic conditions utilized an incremental protocol performed to fatigue and the anaerobic utilized the Wingate protocol. Balance was measured as a single leg stance stability score using the Biodex Balance System. A stability score for each subject was recorded immediately after each of the four conditions. A repeated measures ANOVA with the pretest score as a covariate was utilized in order to analyze the effects of the four fatiguing conditions on balance. There were significant differences between the four conditions (p=. 001). Post hoc analysis revealed there were significant differences between the AUB, mean score 4.98±1.83, and the WUB, mean score 4.09±1.42 (p=. 014) and between AUB and ALB mean score 4.33±1.40 (p=. 029). Normative data for single leg stability testing for this age group is 3.9±1.9. Higher scores reflect greater balance deficits. The aerobic upper body condition produced the greatest balance deficit. Our data provides evidence of the important role of the upper body in maintaining unilateral standing balance and supports its inclusion as part of rehabilitation and training protocols designed to improve balance.

Comparison Between Nintendo Wii FitTM Aerobics and Traditional Aerobic Exercise in Sedentary Young Adults

Journal of Strength and Conditioning Research

Abstract: Exergaming is becoming a popular recreational activity for young adults. The purpose was to compare the physiologic and psychological responses of college students playing Nintendo Wii Fit,TM an active videogame console, versus an equal duration of moderate-intensity brisk walking. Twenty one healthy sedentary college age students (mean age 23.2 + 1.8) participated in a randomized, double cross-over study, which compared physiologic and psychological responses to 30 minutes of brisk walking exercise on a treadmill versus 30 minutes playing Nintendo Wii FitTM Free Run program. Physiologic parameters measured included: heart rate, rate pressure product, respiratory rate, and rating of perceived exertion. Participants positive well-being, psychological distress, and level of fatigue associated with each exercise modality were quantified utilizing the Subjective Exercise Experience Scale. The mean maximum heart rate (HRmax) achieved when exercising with Wii FitTM (142.4 ± 20.5 bpm) was significantly greater (p=0.001) compared to exercising on the treadmill (123.2 ± 13.7 bpm). Rate pressure product was also significantly greater (p=0.001) during exercise on the Wii FitTM. Participants rating of perceived exertion, when playing Wii FitTM (12.7 ± 3.0) was significantly greater (p=0.014) when compared to brisk walking on the treadmill (10.1 ±3 .3). However, psychologically when playing Wii FitTM, participants positive well being decreased significantly (p=0.018) from pre-exercise to post-exercise when compared to exercising on the treadmill. College students have the potential to surpass exercise intensities achieved when performing a conventional standard for moderate intensity exercise when playing Nintendo Wii FitTM Free Run with a self-selected intensity. We concluded that Nintendo Wii FitTM Free Run may act as an alternative to traditional moderate intensity aerobic exercise in fulfilling the American College of Sports Medicine requirements for physical activity.

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