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The purpose of this study was to compare the preliminary effects of movement pattern training (MoveTrain) versus strengthening/flexibility (standard) treatment on hip and pelvic biomechanics in patients with chronic hip-related groin pain. This is a secondary analysis of data collected during a pilot randomized clinical trial. Thirty patients with hip pain, between the ages of 15 and 40 years, were randomized to MoveTrain or standard. Both groups completed 10 treatment sessions over 12 weeks along with a daily home exercise program. Three-dimensional motion analysis was used to collect kinematic and kinetic data of the pelvis and hip during a single-leg squat task at pretreatment and immediately posttreatment. Compared with the standard group, the MoveTrain group demonstrated smaller hip adduction angles (P =.006) and smaller hip external adduction moments (P =.008) at posttreatment. The desired changes to hip joint biomechanics, as found in this study, may require specificity in training that could allow health care professionals to better customize the rehabilitation of patients with hip pain. These findings can also be applied to the design and implementation of future clinical trials to strengthen our understanding of the long-term implications of different rehabilitation techniques for patients with hip pain. [ABSTRACT FROM AUTHOR]

BACKGROUND: Test selection during the return to sport evaluation is an important aspect of ensuring athletes are safe to return to competition. OBJECTIVE: To assess the test-retest and inter-rater reliability of two new single leg hamstring bridge tests (SLHBT) and the relationships between these new tests and isokinetic strength of the quadriceps and hamstrings. METHODS: Thirty healthy college students completed the study. Two testing sessions were held three to seven days apart. Session one, participants performed two SLHBT as well as concentric isokinetic strength tests for the hamstring and quadriceps at 60, 180 and 300∘/sec. The participants performed only the two SLHBT during the second session. The first SLHBT, participants performed as many repetitions as possible of the SLHBT in 30-sec, while the second test measured how quickly the participants could perform five repetitions. Intraclass Correlation Coefficients (ICC2,1) were used to assess test-retest reliability while ICC(3,1) were used to test inter-rater reliability. RESULTS: The test-retest reliability for the SLHBTs was moderate to good, with ICC(2,1) ranging from 0.68 to 0.75, while the inter-rater reliability were excellent with ICC(3,1) all above 0.98. There were significant correlations between the SLHBT and the isokinetic tests, but all correlations were low to moderate. CONCLUSION: This study found good to excellent reliability with the new SLHBT and poor to moderate correlations were noted Therefore, SLHBT may not be an alternative to test hamstring test during the RTS evaluation due to the multiple compensatory strategies athletes may have. [ABSTRACT FROM AUTHOR]

Scientific thinking skills are a key to learning science. The current research aims to analyze: (1) if the design of the Learning Implementation Plan (RPP) contains indicators of students' critical thinking skills and (2) class IV learning activities leading to critical thinking skills. The research is qualitative. The research samples used were fifth-grade teachers and students of classes IVA and IVB. The research object used is the RPP and the science learning activities. Data collection techniques were interviews, observation, and documentation. The instruments used in the study were interview sheets and observation sheets validated through content and construct validity tests. The results showed that: (1) the design of the RPP leads to indicators of critical thinking skills and (2) it can be implemented through the learning process. [ABSTRACT FROM AUTHOR]

The 4-Element Movement Model (4EMM) has been proposed as framework to guide clinical decision making in the physical therapy management of individuals with movement disorders. The model is centered on the primary elements of movement, including motion, force, control, and energy. Clinical application of the model begins with the selection of a movement task, followed by systematic observation of the performance of the task, including control, amount, speed, symmetry, and symptoms provoked during the movement. Testable hypotheses about the impairments contributing to movement problems are then generated, which inform the examination and intervention. A major advantage of the model is its broad applicability to a range of patient populations and settings. In this clinical perspective, we describe the application of the 4EMM to patients with cardiac, vascular, and pulmonary impairments. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to assess the feasibility of completing a randomized clinical trial (RCT) and examine the preliminary effects of 2 interventions for hip-related groin pain (HRGP). Methods In this pilot RCT, patients with HRGP, who were 18 to 40 years old, were randomized (1:1 ratio) to a joint mobilization (JtMob) group or a movement pattern training (MoveTrain) group. Both treatments included 10 supervised sessions and a home exercise program. The goal of JtMob was to reduce pain and improve mobility through peripherally and centrally mediated pain mechanisms. The key element was physical therapist-provided JtMob. The goal of MoveTrain was to reduce hip joint stresses by optimizing the biomechanics of patient-specific tasks. The key element was task-specific instruction to correct abnormal movement patterns displayed during tasks. Primary outcomes were related to future trial feasibility. The primary effectiveness outcome was the Hip Disability and Osteoarthritis Outcome Score. Examiners were blinded to group; patients and treatment providers were not. Data collected at baseline and immediately after treatment were analyzed with analysis of covariance using a generalized linear model in which change was the dependent variable and baseline was the covariate. The study was modified due to the coronavirus disease 2019 (COVID-19) pandemic. Results The COVID-19 pandemic affected participation; 127 patients were screened, 33 were randomized (18 to the JtMob group and 15 to the MoveTrain group), and 29 (88%) provided posttreatment data. Treatment session adherence was 85%, and home exercise program component adherence ranged from 71 to 86%. Both groups demonstrated significant mean within-group improvements of ≥5 points on Hip Disability and Osteoarthritis Outcome Score scales. There were no between-group differences in effectiveness outcomes. Conclusions A large RCT to assess the effects of JtMob and MoveTrain for patients with HRGP may be feasible. Preliminary findings suggested that JtMob or MoveTrain may result in improvements in patient-reported pain and activity limitations. Impact The COVID-19 pandemic interfered with participation, but a randomized controlled trial may be feasible. Modification may be needed if the trial is completed during future pandemics. [ABSTRACT FROM AUTHOR]

Scientific literacy skills are still low, and students' lack of interest in getting to know culture is a current educational issue, so innovative, creative and interesting learning media are needed to increase interest in reading and the formation of national cultural character in students. The development of digital comics in the field of science has been carried out by many researchers, but there are still few who combine the material with local wisdom to form cultural characters. This ethnoscience- based digital comic designed to be a pilot project and learning resource for teachers and students in Indonesia in mastering science, technology, skills and attitudes based on the Independent Learning Curriculum. The data was analyzed by processing validator response data with a Likert scale which was converted into qualitative data . The research subjects were media, material and language experts, 60 high school students in class XI high school science, and 6 biology teachers. The instruments used were expert validation tests and questionnaires. The data was analyzed by processing validator response data with a Likert scale which was converted into qualitative data. The purpose of this research can measure the effectiveness of the ethnoscience -based digital comic "Tari Saman" on movement system material to improve students' scientific literacy skills and national cultural character according to P5 (Strengthening Pancasila Student Profile Project). This research uses the 4D method (Define, Design, Develop, Disseminate). The validity test results show that ethnoscience-based digital comics “tari saman” have a moderate level of validity with an Aiken index value > 0.4. the results of the feasibility test were 88% by the teachers and 90% by students and media practicability were 88% by teachers and 89% by students. It can be concluded that ethnoscience-based digital comics “tari saman” are valid, feasible and practical to use as supporting media for Biology learning.

Leaders and scholars from multiple academies of the American Physical Therapy Association are developing and defining movement system diagnoses to guide practice. However, there is no consensus on the need for or content of such frameworks. This Perspective describes current thought about movement system diagnoses in physical therapy and summarizes the work of the Academy of Geriatrics (APTA Geriatrics) Movement System Diagnosis Task Force (GMS-TF) as it contributes to the movement system diagnosis discussion within the profession. Initially convened to define movement system diagnostic labels unique to older adults, the GMS-TF's developmental process identified the need for a clearer diagnostic framework onto which specific diagnoses will later be added. Although The World Health Organization International Classification of Functioning, Disability and Health model is a strong foundation for the patient–client management model, the GMS-TF proposes formal incorporation of the Geriatric 5Ms (mobility, medications, memory, multi-complexity, and "what matters most") into a movement system framework for older adults. The GMS-TF concurs with the APTA Academy of Neurology Movement System Task Force proposal that observation and analysis of key functional tasks are the foundation of any examination of older adults. The GMS-TF suggests adding several additional movement tasks that are important for older adults. The GMS-TF believes that this strategy highlights the health care needs of older adults and prioritizes physical therapist care for older adults with complex needs. This Perspective is the foundation for a future movement system diagnosis model for older adults that will complement and facilitate the development of models of care to be applied across the lifespan. [ABSTRACT FROM AUTHOR]

Introduction Low back pain (LBP) is a musculoskeletal disorder that affects more than 80% of people in the United States at least once in their lifetime. LBP is one of the most common complaints prompting individuals to seek medical care. The purpose of this study was to determine the effects of spinal stabilization exercises (SSEs) on movement performance, pain intensity, and disability level in adults with chronic low back pain (CLBP). Methods Forty participants, 20 in each group, with CLBP were recruited and randomly allocated into one of two interventions: SSEs and general exercises (GEs). All participants received their assigned intervention under supervision one to two times per week for the first four weeks and then were asked to continue their program at home for another four weeks. Outcome measures were collected at baseline, two weeks, four weeks, and eight weeks, including the Functional Movement ScreenTM (FMSTM), Numeric Pain Rating Scale (NPRS), and Modified Oswestry Low Back Pain Disability Questionnaire (OSW) scores. Results There was a significant interaction for the FMSTM scores (p = 0.016), but not for the NPRS and OSW scores. Post hoc analysis showed significant between-group differences between baseline and four weeks (p = 0.005) and between baseline and eight weeks (p = 0.026) favor SSEs over GEs. Further, the results demonstrated that all participants, regardless of group, had significant improvements in movement performance, pain intensity, and disability level over time. Conclusion The results of the study favor SSEs over GEs in improving movement performance for individuals with CLBP, specifically after four weeks of the supervised SSE program. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 15-year-old right-handed high school baseball catcher with right-sided ulnar elbow pain. Topics include discussing the unique presentation, management, and outcomes of an adolescent baseball player with a chronic history of VEOS experienced during hitting; and rehabilitation emphasized addressing impairments contributing to excessive humeral external rotation with reintegration into batting.

Background Forward and side lunge exercises strengthen hip and thigh musculature, enhance patellofemoral joint stability, and are commonly used during patellofemoral rehabilitation and training for sport. Hypothesis/Purpose The purpose was to quantify, via calculated estimates, patellofemoral force and stress between two lunge type variations (forward lunge versus side lunge) and between two step height variations (ground level versus 10 cm platform). The hypotheses were that patellofemoral force and stress would be greater at all knee angles performing the bodyweight side lunge compared to the bodyweight forward lunge, and greater when performing the forward and side lunge at ground level compared to up a 10cm platform. Study Design Controlled laboratory biomechanics repeated measures, counterbalanced design. Methods Sixteen participants performed a forward and side lunge at ground level and up a 10cm platform. Electromyographic, ground reaction force, and kinematic variables were collected and input into a biomechanical optimization model, and patellofemoral joint force and stress were calculated as a function of knee angle during the lunge descent and ascent and assessed with a repeated measures 2-way ANOVA (p<0.05). Results At 10° (p=0.003) knee angle (0° = full knee extension) during lunge descent and 10° and 30° (p<0.001) knee angles during lunge ascent patellofemoral joint force and stress were greater in forward lunge than side lunge. At 40°(p=0.005), 50°(p=0.002), 60°(p<0.001), 70°(p=0.006), 80°(p=0.005), 90°(p=0.002), and 100°(p<0.001) knee angles during lunge descent and 50°(p=0.002), 60°(p<0.001), 70°(p<0.001), 80°(p<0.001), and 90°(p<0.001) knee angles during lunge ascent patellofemoral joint force and stress were greater in side lunge than forward lunge. At 60°(p=0.009) knee angle during lunge descent and 40°(p=0.008), 50°(p=0.009), and 60°(p=0.007) knee angles during lunge ascent patellofemoral joint force and stress were greater lunging at ground level than up a 10cm platform. Conclusions Patellofemoral joint loading changed according to lunge type, step height, and knee angle. Patellofemoral compressive force and stress were greater while lunging at ground level compared to lunging up to a 10 cm platform between 40° - 60° knee angles, and greater while performing the side lunge compared to the forward lunge between 40° -100° knee angles. [ABSTRACT FROM AUTHOR]

Background Low back pain is a condition present during both adulthood and adolescence. Adolescents with low back pain may benefit from treatment focused on improving abdominal muscle performance and motor control. The supine double leg lowering test (SDLLT) may be a reliable measure to assess core stability in adults, but adolescent performance on the SDLLT has not yet been established in the literature. Purpose To examine performance on the SDLLT in healthy adolescents ages 13 to 18 years and describe influences of gender, age, body mass index, and participation in sport. Study Design Cross-Sectional Study Methods Four licensed physical therapists administered the SDLLT with a Stabilizer pressure biofeedback cuff and inclinometer in 90 adolescents without low back pain (females = 41, males = 49) from three schools in a mid-western metropolitan area. Descriptive statistics, independent sample t-tests, two-way analysis of variance, and Pearson correlation coefficients were utilized to analyze the data. Results Average SDLLT score was 72.36 +/- 12.54 degrees. A significant difference between SDLLT score was present between genders with males performing better than females. No interactions between performance and involvement in sport were demonstrated. Conclusions Female and male adolescents appear to perform differently on the SDLLT with a stabilizer and appear to perform worse than scores recorded for adults. The SDLLT may be used to measure motor control in adolescents, but clinicians should utilize age-appropriate data for clinical decision making. [ABSTRACT FROM AUTHOR]

Background The Functional Movement Screen™ (FMS™) is a tool designed to screen a series of movements that aids in the identification of compensatory fundamental movement patterns, functional limitations, and asymmetrical movement patterns. A previous systematic review and meta-analysis has shown that athletes with an FMStm score <13-14 are considered "high-risk" and are more likely to be injured. There are discrepancies regarding the efficacy of physical intervention programs in improving FMS™ scores. Purpose The aim of this systematic review was to assess the role of physical intervention programs in increasing functional movement in "high-risk" athletes as measured by the FMS™. Study Design Systematic Review Methods A computerized search was performed in 2019 according to PRISMA guidelines searching Embase, Science Direct, Ovid, and PubMed. The studies were assessed for quality and risk of bias using the Modified Downs and Black checklist. Participant demographics, intervention routines, and FMS™ scores were extracted from the included studies. Results Six studies met the inclusion criteria and demonstrated a fair methodological quality. Comparisons across all studies revealed significant improvement in FMS™ scores following implementation of a variety of physical intervention programs. These programs included those that utilized functional training, foot muscle strengthening, Pilates, core stability training, and resistance movements. Despite variations in the corrective exercises performed, the number of training sessions, and the length of the intervention program, all studies demonstrated an increase in the total FMS™ score following program implementation. Conclusion The included intervention programs significantly improved total FMS™ scores in "high-risk" athletes. Despite variations in the corrective exercises (interventions) performed, the number of training sessions, and the length of the program, all studies demonstrated a significant increase in the total FMS™ score following program implementation. [ABSTRACT FROM AUTHOR]

Shoulder and elbow injuries in overhead athletes, especially baseball pitchers, have become more common and result in limited participation. Upper extremity injuries in baseball can occur secondary to high velocity repetitive loading at extreme ranges of motion causing microtrauma to the musculoskeletal structures. With the vast number of youth and young adult baseball players in the United States and the increasing number of throwing related injuries, it is crucial that clinicians can perform a movement system evaluation of the throwing motion. An adequate evaluation of the movement system as it relates to the throwing motion can provide insight into abnormal throwing mechanics and provide rationale for selecting appropriate interventions to address identified impairments that may lead to injury. The purpose of this clinical commentary is to present a recommended movement system evaluation that can be utilized during both pre-season and in-season to assess for modifiable injury risk factors in youth and young adult baseball players. [ABSTRACT FROM AUTHOR]

Diagnostic classification is a foundational underpinning of providing care of the highest quality and value. Diagnosis is pattern recognition that can result in categories of conditions that ideally direct treatment. While pathoanatomic diagnoses are common and traditional in orthopaedic practice, they often are limited with regard to directing best practice physical therapy intervention. Replacement of pathoanatomic labels with non-specific regional pain labels has been proposed, and occurs frequently in clinical practice. For example non-specific low back pain or shoulder pain of unknown origin. These labels avoid some disadvantages of tissue specific pathoanatomic labels, but are not specific enough to direct treatment. A previously introduced movement system diagnostic framework is proposed and updated with application to shoulder conditions. This framework has potential for broad development and application across musculoskeletal physical therapist practice. Movement system diagnostic classification can advance and streamline practice if considered while recognizing the inherent movement variability across individuals. [ABSTRACT FROM AUTHOR]

Despite the prevalence of forefoot related problems in athletes, there are few comprehensive summaries on examination and intervention strategies for those with forefoot related symptoms. While many factors may contribute to pathology and injury, the presence of abnormal foot alignment can negatively affect lower extremity biomechanics and be associated with injuries. Physical therapists may use the characteristics associated abnormal pronation or abnormal supination to describe the movement system disorder and serve as a guide for evaluating and managing athletes with forefoot pathologies. Athletes with an abnormal pronation movement system diagnosis typically demonstrate foot hypermobility, have decreased strength of the tibialis posterior muscle, and present with a medially rotated lower extremity position. Athletes with abnormal supination movement system diagnosis typically demonstrate foot hypomobility, decreased strength of the fibularis muscles, and a laterally rotated lower extremity position. Interventions of manual therapy, taping, strengthening exercises, and neuromuscular reeducation can be directed at the identified impairments and abnormal movements. The purpose of this clinical commentary is to integrate a movement system approach in pathoanatomical, evaluation, and intervention considerations for athletes with common forefoot pathologies, including stress fractures, metatarsalgia, neuroma, turf toe, and sesamoiditis. By applying a prioritized, objective problem list and movement system diagnosis, emphasis is shifted from a pathoanatomical diagnosis-based treatment plan to a more impairment and movement focused treatment. [ABSTRACT FROM AUTHOR]

Postoperative management of anterior cruciate ligament (ACL) reconstruction has traditionally focused on the evaluation and intervention of musculoskeletal components such as range of motion and patients' reports of function. The integumentary system can provide early indications that rehabilitation may be prolonged due to protracted or poor healing of the incision sites. Full evaluation of the reconstruction over time, including direction of the incisions, appearance of surgical sites, level of residual innervation, and health of the individual should be considered when determining time-based goals and plans for returning an athlete to activity. Skin care techniques should be used to minimize strain and promote wound healing at the surgical sites, which in turn allows for implementation of other interventions that target other body systems such as locomotion, strength training, and cardiopulmonary conditioning. The integration of the integumentary system with cardiovascular, neurological, and muscular systems is required for a successful return to activity. A multi-physiologic systems approach may provide a unique viewpoint when aiming to attain a greater appreciation of the integumentary system and its integration with other body systems following ACL reconstruction. The purpose of this clinical commentary is to discuss integumentary considerations within a multi-physiologic systems approach to human movement after ACL reconstruction, including an anatomical review, key elements of assessment, and integrated intervention strategies. [ABSTRACT FROM AUTHOR]

The cardiopulmonary system plays a pivotal role in athletic and rehabilitative activities following anterior cruciate ligament reconstruction, along with serving as an important support for the functioning of other physiologic systems including the integumentary, musculoskeletal, and nervous systems. Many competitive sports impose high demands upon the cardiorespiratory system, which requires careful attention and planning from rehabilitation specialists to ensure athletes are adequately prepared to return to sport. Cardiopulmonary function following anterior cruciate ligament reconstruction (ACLR) can be assessed using a variety of methods, depending on stage of healing, training of the clinician, and equipment availability. Reductions in cardiovascular function may influence the selection and dosage of interventions that are not only aimed to address cardiopulmonary impairments, but also deficits experienced in other systems that ultimately work together to achieve goal-directed movement. The purpose of this clinical commentary is to present cardiopulmonary system considerations within a multi-physiologic systems approach to human movement after ACLR, including a clinically relevant review of the cardiopulmonary system, assessment strategies, and modes of cardiopulmonary training to promote effective, efficient movement. [ABSTRACT FROM AUTHOR]

Postoperative rehabilitation of anterior cruciate ligament (ACL) reconstruction mainly focuses on the restoration of strength and range of motion with a long-term goal to return athletes to their prior level of activity. Of those wanting to return to sport, many are either unable and/or experience protracted recovery despite extensive rehabilitation. To holistically care for patients recovering from ACL reconstructions, reframing rehabilitation to consider a comprehensive systems approach (including musculoskeletal, cardiovascular, endocrine, and neurologic systems) may help improve treatment outcomes. The American Physical Therapy Association has adopted a vision statement that embraces the concept of a 'movement system,' but validation of the movement system has been challenging. Application of a multi-physiologic systems approach may provide a unique perspective to better understand the nervous system and its interactions after ACL reconstruction. The purpose is to focus on the nervous system contributions to a multi-physiologic system approach to rehabilitation from ACL reconstruction. [ABSTRACT FROM AUTHOR]

Several negative adaptations to the musculoskeletal system occur following anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) such as arthrogenic muscle inhibition, decreased lower extremity muscle size, strength, power, as well as alterations to bone and cartilage. These changes have been associated with worse functional outcomes, altered biomechanics, and increased risk for re-injury and post-traumatic osteoarthritis. After ACL injury and subsequent ACLR, examination and evaluation of the musculoskeletal system is paramount to guiding clinical decision making during the rehabilitation and the return to sport process. The lack of access many clinicians have to devices necessary for gold standard assessment of muscle capacities and force profiles is often perceived as a significant barrier to best practices. Fortunately, testing for deficits can be accomplished with methods available to the clinician without access to costly equipment or time-intensive procedures. Interventions to address musculoskeletal system deficits can be implemented with a periodized program. This allows for restoration of physical capacities by adequately developing and emphasizing physical qualities beginning with mobility and movement, and progressing to work capacity and neuromuscular re-education, strength, explosive strength, and elastic or reactive strength. Additional considerations to aid in addressing strength deficits will be discussed such as neuromuscular electrical stimulation, volume and intensity, eccentric training, training to failure, cross-education, and biomechanical considerations. The American Physical Therapy Association adopted a new vision statement in 2013 which supported further development of the profession's identity by promoting the movement system, yet validation of the movement system has remained a challenge. Application of a multi-physiologic systems approach may offer a unique understanding of the musculoskeletal system and its integration with other body systems after ACLR. The purpose of this clinical commentary is to highlight important musculoskeletal system considerations within a multi-physiologic system approach to human movement following ACLR. [ABSTRACT FROM AUTHOR]

The 4-Element Movement System Model describes primary elements (motion, force, motor control, and energy) essential to the performance of all movements. The model provides a framework or scaffolding which allows for consistent processes to be used in examination and intervention decisions. The process starts with task identification followed by a systematic observation of control, amount, speed, symmetry, and symptoms during movement. Testable hypotheses are generated from the observations which inform the examination and the interventions. This commentary describes the use of the 4-Element Movement System Model in entry level and post-graduate residency educational programs and in clinical care with three common sports-related diagnoses. [ABSTRACT FROM AUTHOR]

Background and Purpose: Examining and treating movement dysfunction is a cornerstone of physical therapist practice. Consequently, physical therapist education programs should prepare students to effectively analyze movement to inform clinical decision making. Current practice methods fall short due to variability in demonstration and realistic portrayal of movement disorders. Virtual reality (VR) is an alternative modality for high-fidelity simulation for learning movement system examination. the purpose of this study was to describe the development of a VR module to be used as part of a Doctor of Physical therapy (DPT) curriculum, and to evaluate student reaction and attitudes regarding utilizing VR for practicing movement analysis skills. Method/Model Description and Evaluation: An original VR module consisting of 3 virtual patients performing a sit-to-stand transfer was created for students to practice movement observation and analysis. Fifteen first-year DPT students volunteered to experience the VR module and provide feedback. Students observed 3 different patients performing sit-to-stand transfers and performed a movement analysis on each. Students' performance was assessed using a checklist developed from current physical therapy literature and curricular content. Participants also completed pre- and post-VR surveys to capture their opinions and attitudes regarding VR. Outcomes: After the VR module, all participations strongly agreed that they enjoyed using the VR module. All participants agreed that the animations were realistic enough to practice movement analysis skills. the average checklist score was 87.7%, indicating most benchmark behaviors for movement analysis were met. Most students disagreed that VR could replace face-to-face training opportunities. Discussions and Conclusion: the VR module was received favorably by DPT students; however, they felt strongly that VR should not replace traditional face-to-face laboratory opportunities. Notably, the VR environment provided a reliable space to practice movement examination skills. Utilizing this innovation would advance current concepts in simulation-based learning in DPT curricula and provide a unique platform for practicing movement examination. [ABSTRACT FROM AUTHOR]

Background Collegiate distance runners often suffer from running overuse injuries (ROI). The Y-Balance Test (YBT) has the potential to predict ROI risk in collegiate runners. Purpose To investigate whether a preseason clinical assessment of dynamic balance, through a modified version of the YBT (mYBT), can predict risk of ROIs during one NCAA Division I cross-country (XC) season. Study Design Prospective case-control study Methods Participants from a Division I XC team were screened for mYBT performance in four directions: anterior (AN), posteromedial (PM), posterolateral (PL), and posterior (PO). ROIs were tracked over the course of the XC season. Receiver operating characteristic (ROC) curve analysis (α = 0.05) was utilized to investigate the effectiveness of the mYBT in predicting injury risk. Results Nine (5 female, 4 male) of 29 runners developed an ROI during the XC season. Five components of the mYBT were found to predict injuries, including normalized nondominant PO score (AUC = 0.756, p = 0.03; RR = 1.90), AN raw difference and limb asymmetry (AUC = 0.808, p = 0.01), and PM raw difference and limb asymmetry in males (AUC = 0.958, p = 0.02). Conclusion Specific components of the mYBT can help predict the risk of developing a running overuse injury over one Division I XC season. Level of Evidence Screening, Level 3 [ABSTRACT FROM AUTHOR]

Background Preseason movement screening can identify modifiable risk factors, deterioration of function, and potential for injury in baseball players. Limited resources and time intensive testing procedures prevent high school coaches from accurately performing frequent movement screens on their players. Purpose To establish the intra-rater and inter-rater reliability of a novel arm care screening tool based on the concepts of the Functional Movement Screen (FMS™) and Selective Functional Movement Assessment (SFMA™) in high school coaches. Study Design Methodological intra- and inter-rater reliability study Methods Thirty-one male high school baseball players (15.9 years ± 1.06) were independently scored on the Arm Care Screen (ACS) by three examiners (two coaches, one physical therapist) in real-time and again seven days later by reviewing video recordings of each players' initial screening performance. Results from each examiner were compared within and between raters using Cohen's kappa and percent absolute agreement. Results Substantial to excellent intra-rater and inter-rater reliability were established among all raters for each component of the ACS. The mean Cohen's kappa coefficient for intra-rater reliability was 0.76 (95% confidence interval, 0.54-0.95) and percent absolute agreement ranged from 0.82-0.94 among all raters. Inter-rater reliability demonstrated a mean Cohen's kappa value of 0.89 (95% confidence interval, 0.77-0.99) while percent absolute agreement between raters ranged from 0.81-1.00. Intra- and inter-rater reliability did not differ between raters with various movement screening experience (p>0.05). Conclusions High school baseball coaches with limited experience screening movement can reliably score all three components of the ACS in less than three minutes with minimal training. Level of Evidence Level 3, Reliability study [ABSTRACT FROM AUTHOR]

Background Knee function deficits may persist after anterior cruciate ligament reconstruction (ACLR). Return to sport (RTS) testing batteries assess recovery after ACLR and can guide RTS progression, but the ideal test components are debatable. The single leg vertical hop for height (SLVH) test using a commercially available jump mat may provide a valuable assessment of knee function. Hypothesis/Purpose The purpose of this study was to compare the limb symmetry index (LSI) of SLVH to horizontal hop testing in a cohort of National Collegiate Athletic Association (NCAA) Division 1 collegiate athletes after ACLR. The hypothesis was the SLVH would elicit significantly lower LSI than horizontal hop tests. Study design Cross-Sectional Study Methods Eighteen National Collegiate Athletic Association (NCAA) Division 1 collegiate athletes (7 males, 11 females) at 7.33 ± 2.05 months after ACLR were included in this retrospective study. LSI was calculated for single hop for distance (SHD), triple hop for distance (THD), cross-over hop for distance (CHD), timed 6-meter hop (T6H), and SLVH. A repeated measures ANOVA was performed to identify differences in LSI for each test. Spearman's Rho correlation coefficient was calculated to examine the relationship between LSIs for each test. Results The LSI for SLVH (84.48% ± 11.41%) was significantly lower than LSI for SHD (95.48 ± 8.02%, p = 0.003), THD (94.40 ± 3.70%, p = 0.002), CHD (95.85 ± 7.00, p = 0.007), and T6H (97.69 ± 6.60%, p = 0.001). The correlation of LSI between SLVH and the horizontal hop tests was weak and non-significant for SHD (rs = 0.166, p = 0.509), CHD (rs = 0.199, p = 0.428), and T6H (rs = 0.211, p = 0.401) and moderate and non-significant for THD (rs = 0.405, p = 0.096). Conclusions Individuals after ACLR had lower LSI on the SLVH than on horizontal hop tests and weak to moderate correlations between the tests suggest SLVH detects performance deficits not identified by the horizontal hop tests. Level of evidence 3 [ABSTRACT FROM AUTHOR]

Background The gluteals have unique morphology related to muscle endurance, including moderate fiber sizes and a majority of Type I endurance fibers. Evidence suggests gluteal endurance is related to low back pain, running kinematics, balance, posture, and more. However, reliable and valid measures specific to gluteal endurance are lacking in the literature. Hypothesis/Purpose The purpose of this study was to examine the intra- and inter-rater reliability of two gluteal endurance measures (GEMs) for clinical use. It also aimed to examine validity for the two measures by using electromyography (EMG), recording reasons for task failure, and analyzing differences between demographic groups. Study Design Cross-Sectional Methods Sixty-eight males and females with and without recurrent low back pain aged 18-35 years were recruited from a university population. Electromyography electrodes were placed on subjects' gluteus maximus and gluteus medius, and each subject performed three trials of GEM-A (abduction endurance) and GEM-B (bridging endurance). Hold times, EMG median frequency (MF) data, and subjective reasons for task failure were analyzed. Results Both GEMs demonstrated high intra-rater reliability (ICC = 0.87-0.94) and inter-rater reliability (ICC = 0.99). Mean hold times were 104.83 ± 34.11 seconds for GEM-A (abduction endurance) and 81.03 ± 24.79 seconds for GEM-B (bridging endurance). No statistically significant difference was found between subjects with and without recurrent LBP. Median frequency data validated the onset of gluteal fatigue during both measures. Posterolateral hip (gluteal) fatigue was reported as the primary reason for task failure in 93% and 86% of subjects for GEM-A and GEM-B, respectively. Conclusion This seminal study of GEM-A (abduction endurance) and GEM-B (bridging endurance) found both measures to be reliable and valid measures of gluteal endurance. Further examination of the GEMs in samples with different types of LBP or hip pain is recommended. Level of Evidence 3 [ABSTRACT FROM AUTHOR]

Background Many studies have been done on the strength and mobility of the shoulder and hip in baseball players, but fewer studies have examined these metrics in softball players. Purpose The purpose of this study was to observe and analyze changes in range of motion (ROM) and strength at the hip and shoulder that occur over the course of a competitive season, to describe preseason ROM and strength at the hip and shoulder in healthy college softball players through side-to-side comparison, and to compare measurements between pitchers and position players. Study Design Descriptive Cohort Study Methods Data was collected over the course of six seasons, and a total of fifty-four healthy softball athletes (including pitchers and postiion players) who completed at least one set of preseason and postseason measurements were included. Subjects underwent passive ROM (External rotation [ER], internal rotation [IR], total arc of motion [TAM]) and strength (ER/ IR at the shoulder, abduction/extension at the hip) measurements at preseason and postseason timepoints. Results Over a season, position players demonstrated an increase in all ROM metrics in both shoulders, except dominant IR, and a decrease in ER strength at the shoulder bilaterally (p<0.05). They also showed decreased ROM in all metrics across both hips (p<0.05). Pitchers had increased IR and TAM ROM in the dominant shoulder, decreased strength in both shoulders (ER throwing; ER and IR non-throwing), decreased ROM in both hips, and decreased abduction strength in the non-dominant hip (p<0.05). Position players showed less preseason IR in the dominant shoulder compared to non-dominant IR (Dominant: 31.7 ± 1.6°, Non-dominant: 37.0 ± 2.3°; p<0.05). Conclusion Softball pitchers and position players both show increased ROM at the shoulder and decreased ROM at the hip over the course of a season. Position players demonstrated side-to-side discrepancies and seasonal changes at the throwing shoulder similar to those seen in baseball players. The preseason mobility of the dominant shoulder of pitchers increased over the season while strength of hip abduction in the non-dominant side was reduced. Level of Evidence 3 [ABSTRACT FROM AUTHOR]

Evidence related to physical therapist‐led intervention for patients with chronic hip‐related groin pain (HRGP) is limited. The purpose was to assess sustainability of treatment effects for people with HRGP undergoing two physical therapist‐led interventions. We completed an ancillary analysis of a pilot multicenter, randomized clinical trial. Forty‐six patients with chronic HRGP, 15–40 years, were enrolled. Patients were randomized to participate in 10 sessions over 12 weeks of either movement pattern training (MoveTrain) or traditional strength/flexibility (Standard). Participants completed self‐report questionnaires before treatment and 6 and 12 months after treatment completion. Outcome measures included Hip disability and Osteoarthritis and Outcome Score (HOOS), Patient Specific Functional Scale and Numeric Pain Rating Scale for average and worst pain. Continuous data were analyzed with mixed model repeated measures analysis of variance (RM‐ANOVA) within each group. Numeric pain rating scale (NPRS) was analyzed using multinomial generalized estimating equations (GEE) with a cumulative logit. Reported p values are from statistical contrasts within the RM‐ANOVAs and GEEs testing a priori hypotheses regarding change from pretest to month 6, and pretest to month 12. A total of 43/46 (93.5%) participants completed treatment, 40 (87.0%) completed 6 and 38 (82.6%) completed 12 month questionnaires. At 6 and 12 months, both groups demonstrated clinically significant improvements, compared to pretest, in all subscales of HOOS (p < 0.01), Patient Specific Functional Scale (p < 0.001), and NPRS (p < 0.0001). Among patients with chronic HRGP, both MoveTrain and Standard resulted in improved outcomes that were sustained 12 months after treatment. Further investigation in a larger sample is needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Background The incidence of sports-related concussion in the US is between 1.6-3.8 million annually. Identification of ongoing impairment post-concussion continues to be challenging, as research indicates many patients are cleared for return to activity while still suffering subclinical impairment of function. Purpose: To identify and review the current literature on the use of center of mass (COM) during gait as a potential indicator variable after concussive injury. Study Design: Systematic Review Methods A Pubmed search was undertaken utilizing search terms involving gait performance and concussion. Study inclusion criteria included: (1) COM used as a variable in data analysis, (2) study population included individuals diagnosed with concussion, (3) postural control was evaluated throughout the recovery process. Articles were excluded if they were systematic reviews, unedited manuscripts, meta-analyses, or were more than 15 years old. Results Search of the PubMed database identified six articles which matched the determined criteria. The average STROBE score was 26.5/34 (range from 23-30). The areas that had the poorest scoring were bias, study size, statistical methods, participants, descriptive data, and main results. Results of the review indicate that COM displacement was higher in concussion groups with a sufficiently taxing task, such as a dual task paradigm. Conclusion Center of mass measures during gait may be an indicator of ongoing concussive injury involvement after clinical indications have subsided. [ABSTRACT FROM AUTHOR]

Pelvic tilt refers to the spatial position or motion of the pelvis about a frontal horizontal axis on the rest of the body in the sagittal plane. It is relevant for several musculoskeletal conditions commonly seen in physical therapist practice, particularly conditions affecting the hip and groin. Despite the relevance of pelvic tilt identified in biomechanical studies, and the historical precedence for assessing pelvic tilt, there is a lack of clarity regarding the utility of clinical measures that are practical in a rehabilitation setting. There are several options available to assess pelvic tilt which are discussed in detail in this commentary. All of these options come with potential benefits and considerable limitations. The purpose of this commentary is to provide an overview of the relevance of understanding pelvic tilt in the pathology and rehabilitation of conditions affecting the hip joint, with a focus applying evidence towards identifying clinical measures that may be useful in the rehabilitation setting and considerations that are needed with these measures. [ABSTRACT FROM AUTHOR]

Background The Landing Error Scoring System (LESS) is a clinical test that assesses landing biomechanics during a drop-jump task. Performance measures such as jump height, power, contact time and reactive strength index are used commonly in athletic populations. Comparing results from the LESS against these performance measures has not been reported in elite rugby union. Purpose To report i.) normative LESS scores for elite rugby union players ii.) correlations between LESS scores and performance measures and iii.) differences in performance measures between LESS scoring groups. A secondary purpose was to report the intra- and inter-rater reliability of the LESS test when used in elite rugby union players. Study Design Cross-sectional design. Methods Thirty-six male, elite rugby union players participated. Each participant completed three trials of the LESS and performance measures were recorded concurrently using the Optojump™. LESS trials were scored independently by the authors. Statistical analyses were used to confirm reliability, data normality, and between group differences (p<0.05). Results The LESS test is a reliable testing tool in elite rugby union players (excellent intra-(ICC=0.96) and inter-rater (ICC=0.94) reliability). One player demonstrated an excellent LESS score, six players had good scores, eight players moderate scores and the majority of the group, 21 players, scored poorly. LESS scores were correlated to contact time (r = -0.461, p = 0.005) only. Participants with moderate to poor LESS scores (a score ≤5) produced greater power (p=0.036, η2 = 0.139), contact time (p=0.002, η 2 = 0.268) and reactive strength index (p=0.016, η 2 = 0.180). There were no differences in jump height (p=0.842) between players scoring excellent to good and moderate to poor. Conclusion The results of the current study demonstrate excellent intra- and inter-rater reliability for the LESS, supporting its use as a clinical assessment tool in elite rugby union players. The majority of players presented with moderate to poor LESS scores, indicating an area of concern in this population. Participants scoring moderate to poor in the LESS recorded significantly higher power and reactive strength index, increased contact time but not jump height. This suggests participants with high-risk landing biomechanics may also produce higher performance measures, but these do not necessarily result in an improved jump height. [ABSTRACT FROM AUTHOR]

The movement system was identified as the focus of our expertise as physical therapists in the revised vision statement for the profession adopted by the American Physical Therapy Association in 2013. Attaining success with the profession's vision requires the development of movement system diagnoses that will be useful in clinical practice, research, and education. To date, only a few movement system diagnoses have been identified and described, and none of these specifically address balance dysfunction. Over the past 2 years, a Balance Diagnosis Task Force, a subgroup of the Movement System Task Force of the Academy of Neurologic Physical Therapy, focused on developing diagnostic labels (or diagnoses) for individuals with balance problems. This paper presents the work of the task force that followed a systematic process to review available diagnostic frameworks related to balance, identify 10 distinct movement system diagnoses that reflect balance dysfunction, and develop complete descriptions of examination findings associated with each balance diagnosis. A standardized approach to movement analysis of core tasks, the Framework for Movement Analysis developed by the Academy of Neurologic Physical Therapy Movement Analysis Task Force, was integrated into the examination and diagnostic processes. The aims of this perspective paper are to (1) summarize the process followed by the Balance Diagnosis Task Force to develop an initial set of movement system (balance) diagnoses; (2) report the recommended diagnostic labels and associated descriptions; (3) demonstrate the clinical decision-making process used to determine a balance diagnosis and develop a plan of care; and (4) identify next steps to validate and implement the diagnoses into physical therapist practice, education, and research. Impact The development and use of diagnostic labels to classify distinct movement system problems is needed in physical therapy. The 10 balance diagnosis proposed can aid in clinical decision making regarding intervention. [ABSTRACT FROM AUTHOR]

The American Physical Therapy Association's Vision Statement of 2013 asserts that physical therapists optimize movement in order to improve the human experience. In accordance with this vision, physical therapists strive to be recognized as experts in movement analysis. However, there continues to be no accepted method to conduct movement analysis, nor an agreement of key terminology to describe movement observations. As a result, the Academy of Neurologic Physical Therapy organized a task force that was charged with advancing the state of practice with respect to these issues, including the development of a proposed method for movement analysis of tasks. This paper presents the work of the Task Force, which includes (1) development of a method for conducting movement analysis within the context of the movement continuum during 6 core tasks (sitting, sit to stand, standing, walking, step up/down, and reach/grasp/manipulate); (2) glossary of movement constructs that can provide a common language for movement analysis across a range of tasks: symmetry, speed, amplitude, alignment, verticality, stability, smoothness, sequencing, timing, accuracy, and symptom provocation; and (3) recommendations for task and environmental variations that can be systematically applied. The expectation is that this systematic framework and accompanying terminology will be easily adapted to additional patient or client-specific tasks, contribute to development of movement system diagnostic labels, and ultimately improve consistency across patient/client examination, evaluation, and intervention for the physical therapy profession. Next steps should include validation of this framework across patient/client groups and settings. [ABSTRACT FROM AUTHOR]

BACKGROUND The Functional Movement Screen™ (FMS™) is a clinical instrument designed to use movement behaviors to screen individuals for injury risk. Current rater certification programs focus on extensive, individualized training, which may not be appropriate in all screening contexts. PURPOSE The purpose of this research was to examine the effect of a two-hour FMSTM training seminar on measures of reliability between previously untrained scorers. STUDY DESIGN Repeated measures, descriptive cohort study. METHODS Four novice raters completed a two-hour training course administered by an FMS™-certified, licensed physical therapist. The novices and the instructor then scored a group of 16 individuals on the seven FMS™ component tests on two separate occasions. Interrater reliability was assessed for FMS™ component scores using Fleiss' kappa and Krippendorff's α. Interrater reliability for the FMS™ composite score was assessed using a two-way ICC for agreement (a priori significance level=0.05). RESULTS Reliability ranged from fair to almost perfect (kappa) for Deep Squat (0.61 Day 1, 0.79 Day 2), Shoulder Mobility (0.90 Day 1, 1.00 Day 2), Active Straight Leg Raise (0.53 Day 1, 0.69 Day 2), and Trunk Stability Push Up (0.48 Day 1, 0.49 Day 2) on both testing occurrences (p<0.05). Reliability (kappa) was fair for Inline Lunge (0.24 Day 1, 0.39 Day 2), and poor for Hurdle Step (Day 1 -0.01, Day 2 no result) and Rotary Stability (Day 1 -0.03, Day 2 -0.01). Results for Krippendorff's α were similar, with unacceptable interrater reliability for Hurdle Step (Day 1 -0.01, Day 2 1.00), Inline Lunge (Day 1 0.31, Day 2 0.39), and Rotary Stability (Day 1 -0.02, Day 2 -0.01). Interrater composite score reliability (ICC) was good (0.79 Day 1, 0.84 Day 2; both p<0.05). CONCLUSIONS Findings suggest that a brief training seminar may be sufficient to ensure acceptable reliability in many, but not all, of the FMS™ component tests and composite score. Levels of Evidence Level 2b [ABSTRACT FROM AUTHOR]

Background Adolescent females are at much greater risk for ACL injury than their male counterparts when participating in the same sports. Preventative and pre-operative rehabilitation neuromuscular (NM) exercise programs are often recommended to improve knee function and reduce injury rates. The effectiveness of perturbation-based NM training program has been established in an adult population but has yet to be investigated in the at-risk adolescent female population. Purpose To determine the effectiveness of a perturbation-based NM exercise program in a group of physically active adolescent females. Study Design Prospective randomized trial. Methods Twenty-four healthy and an exploratory group of 10 ACL-injured females (ages 12-18) were equally randomized into a perturbation-based NM training or control group and evaluated before and after a five-week intervention period. The primary outcome of dynamic balance was measured using the Y-Balance test (YBT); secondary outcome measures included lower limb strength, proprioception, and flexibility. Results The perturbation-based NM training intervention was safely completed by all participants but had no significant effect on YBT scoring, lower limb strength, proprioception or flexibility in either the healthy or ACL-injured groups. Conclusions Perturbation-based NM training is safe, but may offer little preventative benefit for healthy or pre-operative rehabilitation benefit for ACL-injured adolescent females. Future research should examine whether the effectiveness of perturbation-based NM training is influenced by the length of the training intervention, training intensity, or when it is combined with other forms of prophylactic or pre-surgical rehabilitation frequently used with at-risk adolescent females who regularly participate in sport. Level of Evidence Level 3. [ABSTRACT FROM AUTHOR]

Background Fatigue may play a role in anterior cruciate ligament (ACL) injury, but has not been incorporated into objective test batteries for return to sport decisions following ACL reconstruction (ACLR) surgery. The effect of fatigue on muscle function and performance following surgery and rehabilitation has been poorly studied. Purpose/Hypothesis The purpose of this study was to assess the effect of fatigue on performance of various hop tests used in clinical rehabilitation settings by examining LSI scores. The authors hypothesized that participants will have worse limb symmetry index scores following the fatigue protocol and that the operative limb (ACLR) will have a greater decline in function than the non-operative limb (CON). Study Design Cross-Sectional Study. Methods Participants (n=21 [Male = 15, Female = 6]; AGE = 24.6 ± 9.3) were at least six months post ACLR and in rehabilitation. Testing was performed over two separate sessions in either a non-fatigued (NFS) or fatigued state (FS). In the FS, individuals performed a series of exercises to exhaust muscular endurance, strength, and power systems, after which they performed as battery of seven hop tests (single hop for distance, triple hop for distance, crossover hop for distance, 6-meter timed hop, lateral rotation hop for distance, medial rotation hop for distance, and vertical jump for height). A 2(limb) x 2(time) ANOVA was used to compare limbs between each state. Results Differences between limbs (CON vs ACLR) were observed for all hop tests in the NFS whereby the ACLR limb was observed to have reduced performance (↓5.4-9.1%, p <0.05). When tested in the FS, significant differences in performance between limbs remained for only the crossover (↓4.9%), medial rotation (↓7.1%), lateral rotation (↓5.5%), and vertical hop (↓10.0%) (p<0.05). When comparing the NFS and FS states, only the CON limb was observed to have significant decreases in performance of the Triple Hop (↓7.4%), Crossover (↓8.7%), and Lateral Rotation (↓5.2%) (p<0.05). Conclusions Following ACL reconstruction, there appears to be a greater loss in jump performance in the CON limb in the FS. These findings suggest it may be crucial to consider and assess the endurance of both limbs rather than just the ACLR limb when determining readiness for return to play. Level of Evidence Level 3 [ABSTRACT FROM AUTHOR]

Patients and physicians have long looked to physical therapists to help determine an athlete's readiness to return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR). This is a complex decision that must take into account biological healing, joint stability, functional performance, and psychological readiness. Considering that the vast majority of medical professionals use time as the sole determinant of an athlete's readiness, and few are using performance-based criteria, it appears as though our profession is failing to capture the necessary information to make this weighty recommendation. The time is now to take a hard look at current practice patterns with RTS testing and push the envelope forward. The purpose of this clinical commentary is challenge our failing status quo by disseminating a robust model for RTS testing that incorporates temporal and criterion-based factors, as well as intrinsic and extrinsic data. Level of Evidence 5 [ABSTRACT FROM AUTHOR]

Background Limited research exists on the effects of both high and low frequency whole body vibration (WBV) on individuals with subacute lateral ankle sprains. Hypothesis/Purpose To examine the difference in the effects of high and low frequency WBV on limits of stability (LOS) in adults with a subacute ankle sprain. It was hypothesized that WBV would improve effects on outcome variables for LOS as a component of dynamic balance. Study Design Quasi-experimental, pretest-posttest design. Methods Fifteen participants ages 19-27 years (Mean age 22±2.36) with either a Grade I or Grade II lateral ankle sprain received WBV in bilateral stance under three randomized conditions (high frequency-25 Hz, low frequency-6 Hz, and control, which consisted of bilateral stance with machine off) for six minutes over three sessions (one time per week). The LOS test, consisting of 5 variables, were assessed using the NeuroCom® Balance Manager-SMART EquiTest® (Natus Medical Incorporated, Pleasanton, CA) at baseline and after the intervention period. The participants completed a practice LOS test and then had a six-minute standing rest break. After the rest break, they completed the pre-LOS (baseline) test. Intervention was administered using the Galileo® Med L Chip Research (Novotec Medical GmbH, Pforzheim, Germany) for six minutes for the appropriate condition of either high or low frequency WBV or control. Data analysis was performed using 2-Way (2x3) Repeated Measures ANOVAs with additional post hoc testing as needed. Results Significant interactions were found for reaction time (RT), movement velocity (MVL), and maximal excursion (MXE) composite scores with a decrease in RT of 0.117 seconds (p=0.022) between control and high frequency conditions during the post LOS. For composite MVL, an increase of 0.547 degrees/second (p=0.002) between pre- and post-high frequency WBV occurred. For composite MXE, an increase of 2.13% p=0.031 (when comparing pre- and post-high frequency WBV. Conclusion Findings suggest that a single session of high frequency WBV in individuals with a subacute lateral ankle sprain may result in improvement in several components of postural stability. WBV is a quick intervention that could be implemented in physical therapy clinics, athletic training rooms, and workout facilities to improve an individual's LOS as a component of dynamic balance one to eight weeks post lateral ankle sprain. [ABSTRACT FROM AUTHOR]

Background Arm care programs consisting of upper extremity strengthening and stretching have been recommended for injury prevention for pitchers of all ages. There has been no investigation into high school baseball coaches' usage and perceptions of arm care programs to mitigate physical impairments associated with injuries in baseball players. Hypothesis/Purpose The purpose of this study was to investigate the current usage of arm care programs by high school baseball coaches. The primary objective was to determine if coaches use group-based or individualized arm care programs. The secondary objective sought to determine if the use of arm care programs is influenced by coaches' age, education, and experience level. Finally, this study explored the potential barriers to arm care implementation and high school baseball coaches' current awareness and beliefs of injury prevention. Study Design Descriptive cross-sectional survey Methods A 29-item online survey was emailed to 18,500 high school baseball coaches throughout the United States. Data were collected for three months, and the response rate was 3.7%. Results A total of 87.3% (n=571/654) of responding coaches use arm care programs with their players. Of coaches performing arm care, only 18.5% of 571 individualize their arm care exercises based on specific player needs. However, older and more experienced coaches are more likely to individualize their programs. Among the 12.7% (n=83/654) of coaches who do not use arm care programs, the two most commonly cited reasons for not implementing arm care were lack of observed benefit (41%) and insufficient staff (31%). Although 42% of 654 coaches recognized reduced shoulder mobility as a major contributor to injury, risk factors such as throwing with a fatigued arm, previous injury history, and throwing > 8 months per year were not consistently identified as primary risk factors. Conclusion The results of this study suggest that the majority high school baseball coaches implement group-based arm care exercise programs to prevent injury. Lack of confidence in the effectiveness and staffing limitations were major barriers to implementation of arm care programming. However, the responding coaches exhibited inconsistent risk factor awareness and dated injury prevention beliefs. Therefore, better educational collaboration between rehabilitation professionals and high school coaches regarding injury risk factors and preventative strategies is warranted. [ABSTRACT FROM AUTHOR]

Background Repetitive pitching places tremendous forces on the shoulder and elbow which can lead to upper extremity (UE) or lower extremity (LE) overuse injuries. Purpose The purpose of this study was to evaluate pre-season physical measurements in collegiate baseball players and track in-season baseball throwing volume to determine which factors may predict throwing overuse injuries. Study Design Retrospective Cohort study. Methods Baseline preseason mobility, strength, endurance, and perception of function were measured in 17 collegiate baseball pitchers. Participants were then followed during the course of the season to collect rate of individual exposure, estimated pitch volume, and rating of perceived exertion in order to determine if changes in workload contributed to risk of injury using an Acute-to-Chronic Workload ratio (ACWR). Results Participants developing an injury had greater shoulder internal rotator strength (p=0.04) and grip strength in a neutral position (p=0.03). A significant relationship was identified between ACWR and UE injuries (p <0.001). Athletes with an ACWR above or below 33% were 8.3 (CI95 1.8-54.1) times more likely to suffer a throwing overuse injury occurring to the upper or lower extremity in the subsequent week. Conclusion ACWR change in a positive or negative direction by 33% was the primary predictor of subsequent injury. This finding may assist sports medicine clinicians by using this threshold when tracking pitch volume to ensure a safe progression in workload during a baseball season to reduce the risk of sustaining overuse upper or lower extremity injuries. [ABSTRACT FROM AUTHOR]

Anterior Cruciate Ligament (ACL) injuries are common in athletic populations and there are many factors that contribute to a return to play decision. Human movement is diverse and variable, and it is important for patients recovering from an ACL injury to develop a variety of movement strategies for athletic performance. Variability of movement during sport may help to decrease injury risk by preparing the individual to handle many different situations and improve problem solving. ACL injuries result in neurophysiological dysfunction due to a disruption of the afferent information from the native mechanoreceptors in the ligament. Following injury, the brain enters a neuroplastic state and can adapt and change positively or negatively based on the rehabilitation or lack thereof. This commentary presents a novel framework for rehabilitation called the Neuroplastic Adaptation Trident Model that takes into account respected methods for attempting to achieve positive neuroplastic changes. This structured framework provides clinicians with reproducible methods to employ as part of the rehabilitation process to maximize motor control and motor learning. Suggested dosage and implementation are proposed to lead to a consistent and gradually progressive challenge throughout the entire rehabilitation process that takes advantage of the time from surgery until return to play. The purpose of this clinical commentary is to describe the Neuroplastic Adaptation Trident model and provide examples for clinical implementation. This method should be studied further to determine true effectiveness; currently, it is presented as a theoretical model based on best current evidence regarding ACL injury and rehabilitation of neurophysiologic dysfunction. [ABSTRACT FROM AUTHOR]

Background Inclusion of resistance training as part of a general fitness program to improve health, and lower risk of disease and injury is well established. Two common options to improve strength are elastic bands and weights. Comparison between elastic bands (as the sole resistance) to isotonic strengthening for concentric and eccentric strength outcomes following the use of low repetitions/heavy resistance has not been reported. Hypothesis/Purpose The purpose was to examine the effects of a four-week isotonic low repetitions/heavy resistance strengthening program compared to a low repetitions/heavy resistance elastic band strengthening program on shoulder external rotation, hip abduction, and elbow flexion concentric and eccentric isokinetic force production in college aged untrained females. Study Design Randomized Trial Methods Twenty healthy females performed pre-and-post isokinetic (60 degrees/second) concentric/eccentric testing of the elbow flexors, shoulder external rotators, and hip abductors. Participants were randomly assigned to a four-week independent low repetitions/heavy resistance strengthening program performed with either elastic bands or isotonic exercises. Results A significant (p < 0.05) effect of time was found for eccentric elbow flexor and concentric and eccentric hip abduction force production in the elastic band group with post-test values greater than pre-test values. A significant (p < 0.05) effect of time was found for elbow flexor concentric and eccentric force production in the isotonic group with post-test values greater then pre-test values. No significant (p>0.05) effect of time was found for shoulder external rotator concentric and eccentric forces for both groups, the isotonic group's hip abduction concentric and eccentric force production and elastic band group's elbow flexion concentric force production. No significant effect of intervention (p >0.05) on concentric or eccentric elbow flexors, shoulder external rotators, or hip abductors force production was found, with pre-test and post-test values being similar between groups. Conclusion Health care practitioners and coaches can consider the prescription of a heavy resistance training program with elastic bands or isotonic exercises for an independent exercise program and expect similar concentric and eccentric muscle force changes. [ABSTRACT FROM AUTHOR]

Background Functional training and testing are an important part of a comprehensive rehabilitation program stressing the neuromuscular system in ways that simulate athletic performance to help determine criteria for return to sport. There are numerous single leg hop tests that have been used for these purposes, however, the validity and clinical relevance has been questioned. Many of the functional performance tests assess only the sagittal plane or forward direction and may only partially assess a person's athletic abilities. There is a need for reliable and valid functional tests to assess in a multi-directional manner. Purpose/Hypothesis The purpose of this study is to determine the test re-test reliability of a novel multi-directional timed single leg hop test (T-Drill Hop Test) for use in rehabilitation and performance assessments. Study Design Cross-sectional reliability study. Methods Fifty healthy recreationally active college age subjects, (23 males and 27 females) between the ages of 18 and 35, (mean age 23.48 with SD 3.82) consented to perform the test. The subjects hopped along a 10ft. x 10ft. "T" shaped course. Subjects performed two timed maximum effort trials of the T-Drill Hop Test on each leg with an interval of 3-7 days between the two testing days. Intraclass Correlation Coefficients (ICC) were calculated to determine intersession reliability. Results The inter-rater reliability (ICC's) for the entire group of 50 subjects ranged between .98 and 1.00 suggesting excellent reliability. The bilateral comparison, utilizing paired t-tests, of the T-Drill Hop Test demonstrated no significant differences between the time scores for the dominant and non-dominant legs for either males or females (p>.05). Conclusion This study demonstrates the T-Drill Hop Test has excellent test re-test reliability. These results are important prior to validation and utilization as a clinical functional performance test. [ABSTRACT FROM AUTHOR]

Background More than fifty percent of people with limb amputations participate in sports or physical activity following amputation. Athletes with limb amputations may face additional challenges including phantom limb pain (PLP), psychological barriers, prosthetic complications, and gait abnormalities. Prevalence of PLP in the general amputee population is estimated to be as high as 85%. Despite the high prevalence of PLP, there is little research regarding the use of gait training as a treatment for PLP among both the general amputee population and athletes. Case Description A 20-year old female collegiate track and field athlete presented with phantom knee pain brought on with running. The athlete demonstrated deficits in core and hip strength as well as decreased single leg stability bilaterally. Running gait analysis revealed circumduction with the prosthesis for limb advancement and increased vaulting with push off on the sound (uninvolved) limb. Gait retraining strategies were implemented to address video analysis findings and create a more efficient running gait and address phantom limb pain symptoms. Outcomes Rehabilitation and gait retraining strategies were effective in improving several clinical and functional outcomes in this case. Significant improvements were noted in PLP, running gait mechanics, and the patient's psychological and functional status as measured with a standardized outcome tool, the Patient-Reported Outcomes Measurement Information System® (PROMIS®). Discussion Running gait training following amputation could be a crucial component of rehabilitation for athletes in an attempt to lessen pain while running, especially in those experiencing phantom limb pain (PLP). Utilization of a multidisciplinary team in the gait retraining process is recommended. There is a need for further research to determine the effects of running gait retraining for management of PLP in athletes with amputation. [ABSTRACT FROM AUTHOR]

Background A forefoot strike (FFS) could be a safer landing technique than a rearfoot strike (RFS) during a cutting motion to prevent anterior cruciate ligament (ACL) injury. Purpose This study aimed to determine the joint angles, ground reaction force (GRF), and muscle activity levels associated with FFS and RFS landings during 180° turns. Study design Cross-sectional study Methods Fourteen male soccer players from the University of Tsukuba football (soccer) club participated in this study. The FFS consisted of initial contact with the toes on the force plates followed by the rearfoot; meanwhile, the initial contact was performed with the heels on the force plates followed by the forefoot for the RFS. Ankle, knee, and hip joint angles were recorded using a three-dimensional motion capture system. GRFs were measured using a force plate. Gluteus medius (GM), rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL), semitendinosus (ST), biceps femoris (BF), tibialis anterior (TA), and lateral gastrocnemius (GL) activities were measured by electromyography. Results The activities of GM, GL, and ST from initial contact to early periods during landing into the ground with the FFS are larger than those with RFS. In addition, the results showed significant differences in lower-limb angles and GRFs between the FFS and RFS. Conclusion These results suggest that there might be differences in ACL injury risk during a 180° turn between the FFS and the RFS pattern. An investigation into the grounding method that prevents injury is necessary in future studies. [ABSTRACT FROM AUTHOR]

Background and Purpose Low back pain is one of the most common conditions occurring in the golfing population. Many approaches have been utilized throughout the years to address this condition including the concept of regional interdependence. The purpose of this case report is to describe the evaluation process and treatment approach of a golfer with low back pain using the principles of regional interdependence. Case Description A thirty-year-old male with right-sided low back pain was evaluated using a comprehensive approach including golf specific movement screening and a swing evaluation. The patient had mobility restrictions in his thoracic spine and hips that appeared to be contributing to a hypermobility in the lower lumbar spine. Based on the evaluation, he was placed into the treatment-based classification (TBC) of stabilization but would also benefit from mobilization/manipulation techniques. Outcomes After seven visits over a four-week span, the patient's mobility and core stability both improved and he was able to play golf and workout pain free. His outcome measures also improved, including the revised Oswestry Disability index from 26% disabled to 10%, the Fear Avoidance Behavior Questionnaire (FABQ) Work from 10/42 to 3/42, and the FABQ Physical Activity from 19/24 to 6/24. Discussion Evaluating and developing a plan of care to address low back pain in an avid golfer can be challenging as a variety of demands are placed on the spine during the movement. This case report describes the evaluation process and treatment approach to specifically target the demands that are required during the golf swing. Utilizing a targeted approach that includes golf specific movement screening and a swing evaluation can help guide the therapist in their treatment and improve the patient's outcome. [ABSTRACT FROM AUTHOR]

Background Individuals with chronic low back pain (CLBP) may demonstrate reduced ability to perform dynamic tasks due to fear of additional pain and injury in response to the movement. The Y-balance test (YBT) is a functional and inexpensive test used with various populations. However, the reliability and validity of the YBT used for assessing dynamic balance in young adults with CLBP have not yet been examined. Purpose To determine the inter-rater reliability of the YBT and to compare dynamic balance between young adults with CLBP and an asymptomatic group. Study Design Reliability and validity study. Methods Fifteen individuals with CLBP (≥ 12 weeks) and 15 age- and gender-matched asymptomatic adults completed the study. Each group consisted of 6 males and 9 females who were 21-38 years of age (27.47 ± 5.0 years). The YBT was used to measure participant's dynamic balance in the anterior (ANT), posteromedial (PM) and posterolateral (PL) reach directions. The scores for each participant were independently determined and recorded to the nearest centimeter by two raters. Both the YBT reach distances and composite scores were collected from the dominant leg of asymptomatic individuals and the involved side of participants with CLBP and were used for statistical analysis. Results The YBT demonstrated excellent inter-rater reliability, with intraclass correlation coefficients ranging from 0.99 to 1.0 for the YBT scores of both asymptomatic and CLBP groups. The CLBP group had lower scores than those of the asymptomatic group in the reach distances of the ANT (p = 0.023), PM (p < 0.001), and PL (p = 0.001) directions, and the composite scores (p < 0.001). Conclusions The results demonstrated excellent inter-rater reliability and validity of the YBT for assessing dynamic balance in the CLBP population. The YBT may be a useful tool for clinicians to assess dynamic balance deficits in patients with CLBP. [ABSTRACT FROM AUTHOR]

BACKGROUND In orthopaedic practice, it is well established that weak scapular stabilizers and an unstable scapula is related to shoulder dysfunction. Faulty scapular position has been linked to decreased scapular stability and is thought to be a result of weak or unbalanced timing in the recruitment of scapulothoracic dynamic stabilizing muscles. Kibler has described a four-type classification of scapulothoracic dysfunction. Functional performance testing is used to objectively measure activities that simulate various desired activities. The reliability of assessing the four static scapular positions may be important in diagnosing shoulder dysfunction. An understanding of the scapular position and its relationship to functional performance testing is needed. PURPOSE The purpose of this study was to determine if a static scapular test, the Kibler scapula classification, in healthy participants affects the ability to perform a closed chain functional test that involves the use of the scapula and the upper extremity, the Davies Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). A secondary analysis was performed to evaluate the reliability of a student physical therapist and an experienced physical therapist to identify scapular type by observation. STUDY DESIGN Multicenter, single session descriptive cohort METHODS Sixty-one healthy participants (33 males, 28 females; mean age 24.19±2.61) completed testing across two locations in one testing session. Blood pressure and heart rate as well as height and weight were measured for each participant. Participants were classified by visual observation of Kibler scapular classification. The average number of CKUEST touches, a normalized score, and a power score were calculated for each participant. Three trials were performed and participants were required to take a 45-second rest break between each CKCUEST trial. RESULTS One way analysis of variance (ANOVA) showed statistically significant differences in Type I and Type IV Kibler scapula classification for the CKCUEST power score, however when an ANCOVA controlled for body mass index, there was no statistically significant difference. A strong correlation r=.94 was observed between student and experienced physical therapist in evaluating all four types of Kibler scapular classification. CONCLUSIONS Visually observed Kibler scapular position does not affect the ability to perform the Davies CKCUEST in healthy young adults. The ability to identify Kibler scapular position was reliable between student and experienced physical therapists. Additional studies are required to identify the usefulness of the Kibler scapular position classification. [ABSTRACT FROM AUTHOR]

Background Restoration of quadriceps strength following anterior cruciate ligament reconstruction (ACL-R) continues to challenge both patients and clinicians. Failure to adequately restore quadriceps strength has been linked to decreased patients' self-reported outcomes and an increased risk for re-injury. Early identification of quadriceps strength deficits may assist in tailoring early interventions to better address impairments. Purpose The purpose of this study was to assess the relationship between early (12 weeks following ACL-R) isokinetic peak torque and isokinetic peak torque at time of return to sport (RTS) testing. Study Design Cohort Study Methods A total of 120 participants (males = 55; females =65) were enrolled in the study (age = 16.1±1.4 yrs; height = 1.72±10.5 m; mass = 70.7±16.3 kg). All participants were level 1 or 2 cutting and pivoting sport athletes who underwent a primary bone-patellar tendon-bone autograft ACL-R. Participants were tested at two time points: 12 weeks following surgery and again at time of RTS testing. A linear regression model was carried out to investigate the relationship between age, sex, and isokinetic peak torque at 12 weeks following ACL-R and isokinetic peak torque at time of RTS testing. Results When 12-week isokinetic peak torque was entered first for the hierarchy regression analysis, this factor was predictive of the peak torque at the time of RTS testing, F(1, 118) = 105.6, p < 0.001, R2 = 0.472, indicating that the 12-week quadriceps strength accounted for 47% of the variance in the quadriceps strength at the time of RTS testing. When age and sex were added in the regression analysis, both factors only added 0.8% of variance for the quadriceps strength at the time of RTS testing. Conclusion Isokinetic peak torque at 12 weeks following surgery was shown to be a significantly strong predictor (47%) for isokinetic quadriceps strength recovery at time of RTS. This finding underscores the importance of early restoration of quadriceps strength and that while non-modifiable factors such as sex and age are important, early restoration of quadriceps strength most strongly influences late stage quadriceps strength. [ABSTRACT FROM AUTHOR]