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Specialized Neuromuscular Training to Improve Neuromuscular Function and Biomechanics in a Patient With Quiescent Juvenile Rheumatoid Arthritis

GD Myer, MS, CSCS, is Sports Biomechanist, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 10001, Cincinnati, OH 45229 (USA) (greg.myer{at}cchmc.org)
HI Brunner, MD, MSc, FAAP, FACR, is Assistant Professor of Pediatrics, Cincinnati Children's Hospital Medical Center
PG Melson, PT, MMSc, is Rehab Coordinator for Rheumatology, Cincinnati Children's Hospital Medical Center
MV Paterno, PT, MS, SCS, ATC, is Coordinator of Orthopaedic and Sports Physical Therapy, Sports Medicine Biodynamics Center and Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center
KR Ford, MS, is Research Biomechanist, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children's Hospital Medical Center
TE Hewett, PhD, is Director, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children's Hospital Medical Center, and University of Cincinnati College of Medicine, Pediatrics, Orthopaedic Surgery and Rehabilitation Sciences

Address all correspondence to Mr Myer

Background and Purpose. The purpose of this case report is to describe a novel multidisciplinary approach for evaluating and preparing a patient with quiescent juvenile rheumatoid arthritis (JRA) for safe sports participation. Case Description. The patient was a 10-year-old girl with a history of bilateral knee arthritis who desired to participate in soccer and basketball. Range of motion and manual muscle testing of the lower extremity were within normal limits. Neuromuscular testing included kinematic and kinetic testing, isokinetic assessment, and postural stability testing. The patient's gait was near normal; however, she had narrowed step width and increased knee flexion at heel-strike. Landing analysis during a box drop vertical jump task showed increased and imbalanced (right versus left lower extremity) peak impact forces. The testing was followed by specialized neuromuscular training (SNT). Outcomes. Following SNT, heel-strike and step width were within normal limits, peak impact forces on the box drop test decreased by 31%, imbalance decreased by 46%, and vertical jump increased 15%. The isokinetic strength ratio between knee flexors and extensors and the overall balance measures were within normal limits and equal bilaterally. Discussion. Patients with quiescent JRA may have abnormal biomechanics, which could place them at increased risk for injury or future articular cartilage damage. Specialized neuromuscular training may have helped to decrease the patient's risk for future injury or disease progression.

Key Words: Biomechanics • Gait • Injury prevention • Juvenile rheumatoid arthritis • Neuromuscular training • Sport participation

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