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Playing a musical instrument necessitates stability in the hands, neck, shoulders, and trunk, involving both isotonic and isometric movements, muscular endurance, and various other physical demands. Musicians, especially those engaged in professional or educational pursuits, often dedicate several hours each day to practicing and performing. Despite the substantial physical challenges associated with musical performance, the realm of performing arts medicine lacks comprehensive research and practical methodologies tailored to adequately address the conditioning requirements of musicians. Musculoskeletal discomfort is prevalent among professional musicians, predominantly affecting the upper body. Instrumental players encounter issues such as musculoskeletal overuse, nerve entrapment, focal dystonia, and other playing-related musculoskeletal disorders, which can persist for extended periods. Consequently, this article aims to present a specialized strength and conditioning regimen tailored for instrumental musicians participating in large music ensembles, specifically symphony orchestras and wind bands. The guide will identify the mechanics inherent to playing these instruments and the prevalent injuries associated with them. Using this information, a strength and conditioning protocol suitable for the application within a symphony orchestra and wind band music classrooms will be presented. [ABSTRACT FROM AUTHOR]

Objectives: Irritability is a foundational clinical reasoning concept in rehabilitation to evaluate reactivity of the examination and treatment. While originally theorized to reflect tissue damage, a large body of evidence supports pain is a biopsychosocial experience impacted by pain sensitivity and psychological factors. Therefore, the purpose of this study was to examine biopsychosocial contributors to irritability. Methods: 40 patients with shoulder (n = 20) and low back (n = 20) pain underwent Quantitative Sensory Testing (QST) (Pressure Pain Threshold, Heat Pain Threshold, Conditioned Pain Modulation, Temporal Summation), completed pain-related psychological questionnaires, an Exercise-Induced Hypoalgesia protocol, and standardized irritability assessment based on Clinical Practice Guidelines. Participants were then categorized as irritable or not irritable based on Maitland's criteria and by irritability level based on Clinical Practice Guidelines. An independent samples t-test examined for differences in QST and psychological factors by irritability category. A MANOVA examined for differences in QST and psychological factors by irritability level (high, moderate, low). Results: Significantly lower heat and pressure pain thresholds at multiple locations (p < 0.05), as well as less efficient conditioned pain modulation (p = 0.02), were demonstrated in individuals categorized as irritable. Heat and pressure pain thresholds were also significantly lower in patients with high irritability compared to other levels. Significantly higher depression and anger, as well as lower self-efficacy, were reported in individuals with an irritable presentation. Discussion/Conclusion: Biopsychosocial factors, including widespread hyperalgesia and elevated psychological factors, may contribute to an irritable presentation. [ABSTRACT FROM AUTHOR]

Skeletal muscle is the largest organ system in the human body and plays critical roles in athletic performance, mobility, and disease pathogenesis. Despite growing recognition of its importance by major health organizations, significant knowledge gaps remain regarding skeletal muscle health and its crosstalk with nearly every physiological system. Relevant public health challenges like pain, injury, obesity, and sarcopenia underscore the need to accurately assess skeletal muscle health and function. Feasible, non-invasive techniques that reliably evaluate metrics including muscle pain, dynamic structure, contractility, circulatory function, body composition, and emerging biomarkers are imperative to unraveling the complexities of skeletal muscle. Our concise review highlights innovative or overlooked approaches for comprehensively assessing skeletal muscle in vivo. We summarize recent advances in leveraging dynamic ultrasound imaging, muscle echogenicity, tensiomyography, blood flow restriction protocols, molecular techniques, body composition, and pain assessments to gain novel insight into muscle physiology from cellular to whole-body perspectives. Continued development of precise, non-invasive tools to investigate skeletal muscle are critical in informing impactful discoveries in exercise and rehabilitation science. [ABSTRACT FROM AUTHOR]

Amplitude-based exercise training has been shown to be effective in the motor performance of individuals with idiopathic Parkinson's disease, with limited research investigating its effects on Parkinson plus syndromes such as olivopontocerebellar atrophy (OPCA). The purpose of this clinical case report is to examine the effects of amplitude-based training exercises on an individual with OPCA. A 68-year-old man with a 14-month history of OPCA presented to physical therapy with bradykinesia, rigidity, and postural instability. The individual participated in 34 intervention sessions. Pre- and post-test measurements were collected for the following outcome measures: Five Times Sit to Stand (FTSTS); Functional Gait Assessment (FGA); Activities-Specific Balance Confidence Scale (ABC-6); 9 Hole Peg Test (9HPT); preferred and maximal gait speed. Improvements reaching Minimum Detectable Change (MDC) or Minimal Clinically Important Difference (MCID) were recorded with a pre (Week 1) and post (Week 20) intervention: FGA score (4-point improvement (MDC95 = 4 points), preferred gait speed (0.09 meters/second improvement (MCID = 0.05 meters/second)), FTSTS (6-second improvement (MDC95 = 2.3 seconds)), and 9HPT on the dominant hand (3-second improvement (MDC95 = 2.6 seconds)). Fluctuations during the plan of care were observed for these measures, and additional outcomes did not demonstrate a worsening of function. In an individual with OPCA, amplitude-based exercise training as a component of the plan of care increased dynamic balance in walking, gait speed, and hand dexterity. However, these results need to be validated on a larger sample of individuals with OPCA through randomized controlled trials. [ABSTRACT FROM AUTHOR]

BACKGROUND: Therapeutic alliance improves pain, disability, and quality of life outcomes. The purpose of this study was to investigate the effectiveness of a training protocol aimed at enhancing the therapeutic alliance in patients with chronic low back pain. METHODS: 19 physical therapists (DPT) and 16 student physical therapists (SPT) completed a therapeutic alliance training course with a quantitative questionnaire completed before and after the training along with a follow-up qualitative interview. Quantitative results were analyzed for differences resulting from participation in the training, while qualitative results were analyzed via interview transcription analysis by independent researchers blinded to the participants. RESULTS: All three groups (SPT/DPT combined, SPT, DPT) demonstrated a significant improvement in feeling comfortable in building a strong therapeutic alliance (p<0.01). The themes of Training Enhances Consciousness, Communication is Key, and Personalized Approach emerged from qualitative interviews indicating that the course was valuable in improving their approach to therapeutic alliance, communication, and individualized interventions contribute to a successful therapeutic alliance. CONCLUSION: The results of this study demonstrate the efficacy of therapeutic alliance training and suggest potential to enhance therapeutic alliance through a training protocol. [ABSTRACT FROM AUTHOR]

Pain-inducing massage produces comparable changes in pain sensitivity as a cold pressor task, suggesting shared neurophysiological mechanisms of conditioned pain modulation. Manual therapy and conditioned pain modulation are influenced by positive and negative expectations. Therefore, the purpose of this study was to examine the effects of positive and negative expectations on pain-free and pain-inducing massage. 56 healthy participants were randomly assigned to receive a positive or negative expectation instructional set followed by a pain-inducing or a pain-free massage. Pressure pain threshold (PPT) was measured followed by each interval of massage. A repeated measures ANCOVA controlling for post-randomization differences in sex tested for massage x expectation set x PPT interaction effects, as well as two-way interaction effects. A significant three-way interaction effect (p = 0.04) and time x expectation interaction effect was observed for individuals receiving pain inducing massage (p = 0.02). Individuals who received the positive expectation instructional set demonstrated significantly higher PPT at minutes 3 and 4 of massage compared to individuals who received the negative expectation instructional set. Expectations impact pain sensitivity changes produced during massage. Clinicians planning to provide pain-inducing massage should consider the role of expectations in modulating pain sensitivity changes. [ABSTRACT FROM AUTHOR]

Purpose: There is conflicting evidence related to the prevalence and magnitude of exercise-induced muscle damage (EIMD) following four sets to volitional failure with BFR (BFR-F) or 75 total repetitions with BFR (1 × 30, 3 × 15, BFR-75). The purpose of this investigation was to examine muscle swelling, peak torque, and neuromuscular responses following BFR-75 and BFR-F. Methods: Thirteen untrained women completed unilateral isokinetic (120°s−1) leg extensions concentric-eccentric at 30% of their maximal voluntary isometric contraction (MVIC) using BFR-75 and BFR-F protocols, separated by 15 minutes. Ultrasound was used to assess muscle thickness, cross sectional area, and echo intensity of the rectus femoris and vastus lateralis before, 0-, 24-, 48-, 72-, and 96-hours post-exercise. Peak torque and surface electromyography (sEMG) were recorded during MVICs before, 24-, 48-, 72-, and 96-hours post-exercise to determine sEMG amplitude, frequency, and neuromuscular efficiency. Results: There were no differences between conditions. Collapsed across conditions, muscle thickness and cross-sectional area increased at 0-hours for the rectus femoris (2.5 ± 0.4, 2.8 ± 0.4 cm, 10.6 ± 1.8, 12.1 ± 1.8 cm2, respectively) and vastus lateralis (2.1 ± 0.5, 2.5 ± 0.7 cm; 22.2 ± 3.9, 25.1 ± 4.5 cm2, respectively), but returned to baseline at 24-hours. There were no changes in echo intensity, sEMG amplitude, sEMG frequency, or neuromuscular efficiency. MVIC peak torque increased relative to pre-exercise at 24-, 48-, 72-, and 96-hours (159.9 ± 34.9, 171.4 ± 30.1–179.1 ± 35.6 Nm). Conclusion: These results suggest that BFR-75 and BFR-F did not cause EIMD but caused an acute increase in muscle swelling that returned to baseline 24-hours post-exercise. [ABSTRACT FROM AUTHOR]

Abstract: Hanney, WJ, Perez, A, Collado, G, Palmer, AC, Wilson, AT, Richardson, RM, and Kolber, MJ. J Strength Cond Res 38(11): 1854-1859, 2024-Kettlebell swings (KBSs) are commonly used to target the lumbar erector spinae and lower body musculature. This exercise exhibits distinct loading properties that requires cyclical contraction of the trunk extensors and posterior chain, potentially explaining its novel influence on muscle contractility. Tensiomyography (TMG) is a reliable, noninvasive, passive technique that may be used to examine muscular fatigue produced by exercises such as KBSs. The purpose of this randomized control trial was to determine the extent of muscle fatigue in the lumbar erector spinae musculature following the performance of a previously published high-intensity interval KBS protocol. Forty-one adults between the ages of 18 and 45 years were recruited. Inclusion criteria included subjects with no recent history of low back pain and clearance by the physical activity readiness questionnaire. Subjects were randomly allocated to either a KBS group ( n = 21) or a control group (CON; n = 20) who only performed the unloaded warm-up. Subjects were assessed at baseline, postintervention, and 24-hours postintervention for bilateral erector spinae fatigue, measured by 5 TMG parameters (Dm, Tc, Tr, Td, and Ts). The results were evaluated through a 2 × 3 (group × time) repeated-measures analysis of variance. The level of significance was set at p ≤ 0.05. There was no significant difference in lumbar erector spinae fatigue, measured by the 5 TMG parameters ( p ≥ 0.079), following the interval KBS protocol in comparison with the CON group at 3 assessment periods. A high-intensity interval KBS protocol failed to produce significant differences in erector spinae fatigue compared with the control group that did not perform a KBS. These findings warrant further investigation into muscle fatigue produced with higher intensity protocols and possibly suggest, depending on the programming goals, the need for an alternate KBS training parameters., (Copyright © 2024 National Strength and Conditioning Association.)

Background and Purpose: Pressure Pain Threshold (PPT) is used to objectively assess pain in clinical settings and is a recommended part of physical therapist education. An individual who is experienced in administering PPT will frequently train a student on the technique; however, optimal educational approaches for this instruction have not yet been identified. Therefore, the purpose of this case report is to describe 2 educational approaches (unstructured lecture and structured feedback with clinical relevance) in training 2 separate cohorts of Doctor of Physical Therapy students in PPT. The primary outcome of interest was the inter-rater reliability of PPT between an experienced and novice examiner., Case Description: Cohort 1 (n = 37) received a traditional lecture approach consisting of watching a prerecorded video online, an in-person lecture with demonstration of the technique, and time to practice. Cohort 2 (n = 34) received the prerecorded video online and lecture with demonstration; however, key additions included a clinical relevance discussion along with structured peer-to-peer and instructor-to-student feedback using a competency-based checklist. PPT was assessed by each student (novice examiner) and one instructor (experienced examiner). Inter-rater reliability of PPT between a novice and experienced examiner was evaluated., Outcomes: Inter-rater reliability improved from poor/moderate (intraclass correlation coefficient low back = 0.46 [0.16-0.68], quadriceps = 0.54 [0.26-0.73]) to good (low back = 0.84 [0.67-0.92], quadriceps = 0.90 [0.79-0.95]) after the addition of structured feedback., Discussion: Structured feedback from peers and instructors may be useful when learning PPT and improving inter-rater reliability, which has implications for training students within a laboratory or classroom. However, this case study would need to be replicated in an experimental design to examine the effects of varying types of feedback on learning outcomes., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Academy of Physical Therapy Education, APTA.)