VOLUME FOURTEEN, NUMBER FIVE

 
2019Masthead_V14N5_rev-1

OCTOBER 2019

SYSTEMATIC REVIEW – META ANALYSIS
The Reliability Of The Star Excursion Balance Test and Lower Quarter Y-Balance Test in Healthy Adults: A Systematic Review
Authors:  Powden CJ, Dodds TK, Gabriel EH
Dynamic balance is often an important criterion used during lower extremity musculoskeletal injury prediction, prevention, and rehabilitation processes. Methods to assess lower extremity dynamic balance include the Star-Excursion Balance Test (SEBT) and Lower Quarter Y-Balance Test (YBT). Due to the importance of dynamic balance, it is imperative to establish reliable quantification techniques. The purpose of this article was to conduct a systematic review to assess the reliability and responsiveness of the SEBT/YBT. Electronic databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus) were searched from inception to August 2018. Included studies examined the intra- and inter-rater reliability of the SEBT/YBT in healthy adults. Two investigators independently assessed methodological quality, level of evidence and strength of recommendation with the Qualtiy Appraisal of Reliability Studies (QAREL) scale. Relative intra- and inter-rater reliability was examined through intraclass correlation coefficients (ICC) and responsiveness was evaluated through minimal detectable change (MDC). Data were analyzed based on reach direction (anterior, posteromedial, and posterolateral) and normalization (normalized and non-normalized). Additionally, data were then synthesized using the strength of recommendation taxonomy to provide a grade of recommendation. A total of nine studies were included in this review. Six studies examined the inter-rater reliability and seven assessed intra-rater reliability. The included studies had a median QAREL score of 66.89 percent (range = 55.56% to 75.00 percent) and 59.03 percent (range = 33.33 to 66.67 percent) for inter and intra-rater reliability respectively. Median ICC values for inter-rater reliability were 0.88 (Range = 0.83 – 0.96), 0.87 (range = 0.80 – 1.00), and 0.88 (range = 0.73 – 1.00) for the anterior, posteromedial, and posterolateral directions respectively. Median ICC values for intra-rater reliability were 0.88 (Range = 0.84 – 0.93), 0.88 (Range = 0.85 – 0.94), and 0.90 (Range = 0.68 – 0.94) for the anterior, posteromedial, and posterolateral directions, respectively. There is grade A evidence to support that the SEBT/YBT have excellent inter and intra-rater reliability when used in healthy adults. Furthermore, minimal detectable change values have been provided that can be used in practice to aid clinical decision making. Future research is needed to assess the reliability, responsiveness, and validity of the SEBT/YBT in pathologic populations.

Abstract  |  Full article (subscribers only)  |  Purchase article

ORIGINAL RESEARCH
Lower Quarter- And Upper Quarter Y-Balance Tests As Predictors of Running-Related Injuries in High School Cross-Country Runners.

Authors:  Ruffe NJ, Sorce SR, Rosenthal MD, Rauh MJ

While cross-country running is a popular interscholastic sport, it also has a high incidence of running-related injuries (RRIs). Recent literature suggests that functional tests may identify athletes at increased risk of injury. The Y-Balance Test (YBT) is an objective measure used to assess functional muscle strength, balance, and expose asymmetries between tested limbs. The purpose of this study was to determine if the YBT could predict RRI in high school cross-country runners. It was hypothesized that an asymmetric right (R)/left (L) YBT reach distance for the lower or upper extremities would be associated with an increased risk of RRI.  One hundred forty-eight athletes (80 girls, 68 boys) who competed in interscholastic cross-country in Southern California during the 2015 season participated in the study. Prior to the cross-country season, the runners completed Lower-Quarter YBT (LQ-YBT) and Upper-Quarter YBT (UQ-YBT) testing to assess lower and upper extremity asymmetry, respectively. The runners were prospectively monitored for RRI occurrence throughout the season using the Daily Injury Report (DIR) form. Forty-nine runners (33.1 percent) incurred a RRI during the 2015 season, with the lower leg (shin/calf) and knee the most common RRI sites. Girls had a higher RRI occurrence (38.8 percent) than boys (26.5 percent) (p=0.12). Boys had greater raw scores for LQ-YBT R and L anterior (ANT), posteromedial (PM), posterolateral (PM) and composite reach distances than girls (p<0.05). With the exception of normalized superolateral reach distance, boys had significantly greater scores for raw and normalized R and L UQ-YBT reach distances and raw composite scores than girls (p<0.05). After adjusting for prior RRI, while boy runners with a LQ-YBT PM reach difference ≥4.0 cm were five times more likely to incur a RRI (Adjusted odds ratio [AOR]=5.05, 95% CI: 1.3-19.8; p=0.02), girl runners with a UQ-YBT inferolateral (IL) reach difference ≥4.0 cm were 75 percent less likely to incur a RRI (AOR=0.25, 95 percent CI: 0.1-0.7; p=0.005). By lower extremity body region, boy runners with a UQ-YBT superolateral (SL) reach difference ≥4.0 cm were seven times more likely to incur a hip/thigh/knee RRI [AOR]=7.20, 95 percent CI: 1.1-45.6; p=0.002). Greater lower extremity (PM) or upper extremity (SL) reach distance asymmetry, as measured by the LQ-YBT or UQ-YBT, respectively, were associated with RRI in boy high school cross-country runners.

Abstract  |  Full article (subscribers only)  |  Purchase article

Intra- and Inter-Rater Reliability for Limb Length Measurement and Trial Error Assessment of the Upper Quarter Y-Balance Test in Healthy Adults.
Authors:  Williamson JD, Lawson B, Sigley D, Nasypany A, Baker RT
There has been an increased emphasis placed on outcome measures in healthcare recently. This emphasis, coupled with a limited amount of clinically meaningful upper extremity closed-kinetic chain performance-based measures, has led to the development of the Upper Quarter Y-Balance Test (YBT-UQ). Current literature has reported the established reliability of the test-retest and interrater reliabilities of the YBT-UQ, but not the intra-rater and inter-rater reliability of limb length (LL) measurement and trial error assessment (assessing whether a subject committed an error during the trial thus negating the results of that trial). These components are important to the output of the measure and therefore need to be examined. The purpose of this study was to examine the intra-rater and inter-rater reliability of LL measurement and trial error assessment for the YBT-UQ. A convenience sample of healthy college students had their right upper extremity LL measured and performed the YBT-UQ in order to establish intra-rater and inter-rater reliability of LL measurement and YBT-UQ trial error assessment. LL was measured from the C7 spinous process to the distal end of the third digit of the right hand per protocol for the YBT-UQ. Two YBT-UQ practice trials were performed for each stance hand followed by three trials for each stance hand. The trial reach measurements were recorded by each rater. A video recording device was used to record each trial and the video was viewed by each rater for trial error assessment. The Intraclass Correlation Coefficient (ICC) values for intra-rater reliability for LL measurements were 0.986, 0.987, and 0.990 for each of the three raters respectively, indicating excellent reliability. The ICC value for inter-rater reliability for LL measurements was 0.990, also indicating excellent reliability. Trial error assessment intra-rater reliability Kappa values were 0.917, 0.869, and 0.951 for each of the three raters respectively, indicating very good agreement. The Kappa value for trial error assessment for all three raters, collectively, was 0.658 for the first assessment of trial errors and 0.643 for the second assessment of trial errors, indicating good agreement between raters for each assessment of trial errors. Overall, the YBT-UQ demonstrates a high degree of reliability in measurement of LL and agreement regarding trial errors assessment on the population studied.

Abstract  |  Full article (subscribers only)  |  Purchase article

Measures Of Hip Muscle Strength And Rate of Force Development Using A Fixated Handheld Dynamometer: Intra-Tester Intra-Day Reliability Of A Clinical Set-Up.
Authors:   Ishoi L, Holmich P, Thorborg K
Evaluation of hip muscle function is considered an important part of the examination and treatment of physically active subjects with hip and groin pain. However, methods to reliably measure explosive hip muscle strength are lacking. The purpose was to investigate the reliability of a clinically available set-up using a fixated handheld dynamometer to test isometric peak force and rate of force development of the hip abductors, adductors, flexors, and extensors. Seventeen subjects (males: 9, females: 8, mean age 25.4 (+/- 4.2) y, mean body mass of 73.9 (+/- 15.2) kg, and mean height 174.2 (+/- 12.4) cm) were included. One experienced tester performed all measures in a randomized order. Three trials of isometric peak force and early- (0-100 ms) and late-phase (0-200 ms) rate of force development for the hip abductors, adductors, flexors, and extensors were obtained using a fixated handheld dynamometer. The trial with the highest value for each measure was used for analysis. Test-retest sessions were separated by 30 minutes of rest.  No systematic between between-session bias were observed for any of the measures. The relative intra-tester reliability (ICC2,1) for peak force, 0-100 ms rate of force development, and 0-200 ms rate of force development ranged from 0.93-0.96, 0.82-0.93, and 0.85-0.92, respectively, corresponding to good reliability for all force measures. The present study shows that assessment of isometric hip muscle peak force, including early- (0-100 ms) and late-phase (0-200 ms) rate of force development using a fixated handheld dynamometer have good intra-tester reliability for testing of the hip adductors, abductors, flexors and extensors. Thus, in clinical research settings where an isokinetic dynamometer may not always be readily accessible, the described test procedure can be used as a feasible alternative to reliably provide objective assessment of hip muscle function relevant for rehabilitation of patients with hip and groin pain.

Abstract  |  Full article (subscribers only)  |  Purchase article

The Use Of Microsoft Kinect™ For Assessing Readiness Of Return to Sport And Injury Risk Exercises: A Validation Study.
Authors:  Tipton CC, Telfer S, Cherones A, Gee AO, Kweon CY
Assessing readiness of return to sport after procedures such as anterior cruciate ligament (ACL) reconstruction is a complex process, complicated by the pressures that athletes face in returning to sport as quickly as possible. Advances in motion analysis have been able to demonstrate movements that are risk factors for initial ACL injury and subsequent re-injury after reconstruction. An inexpensive, objective measure is needed to determine when athletes are ready to return to sport after ACL reconstruction. The aim of this study was to compare the use of a single camera, markerless motion capture technology to 3D motion capture during lower extremity movements that pose as risk factors for ACL injury. This study assessed the validity of the Microsoft Kinect™ against an established three-dimensional motion analysis system in twenty healthy subjects. Knee kinematics were assessed during impact activity in the coronal and sagittal plane specifically evaluating peak knee valgus and peak knee flexion during single leg hop and jump from box exercises. Intraclass correlation coefficients and 95 percent limits of agreement (LoA) were determined for each kinematic variable. For the single leg hop, the mean absolute difference in the sagittal plane was 10.4 degrees (95 percent LoA [-11.7 degrees, 26.8 degrees]), and in the frontal plane was 5.31 degrees (95 percent LoA [-8 degrees, 13.9 degrees]). Similarly, for the jump from box landing on one leg, there was a difference of 7.96 degrees (95 percent LoA [-17.7 degrees, 21.3 degrees]) and 4.69 degrees (95 percent LoA [-6.3 degrees, 12.6 degrees]) respectively. For the jump from box, two-foot land, turn and pivot, the mean absolute difference between the systems was 7.39 degrees (95 percent LoA [-17.8 degrees, 19.7 degrees]) in the sagittal and 4.22 degrees (95 percent LoA [-5.9 degrees, 11.6 degrees]) in the frontal plane respectively. Intraclass correlation coefficients for each activity ranged from 0.553 to 0.759. The results from the Microsoft Kinect™ were found to be in poor agreement with those from a standard motion capture system. Measuring complex lower extremity movements with the Microsoft Kinect™ does not provide adequate enough information to use as an assessment tool for injury risk and return to sport timing.

Abstract  |  Full article (subscribers only)  |  Purchase article

Spatiotemporal Comparison of Overground and Treadmill Running with Pressure Sensor Insoles in Division I Collegiate Runners
Authors:  Tao H, Joyce L, Kozak B, Luiken J, Wendt N
Both clinicians and researchers often utilize treadmills to analyze spatiotemporal and biomechanical factors during running. However, there is question of whether or not treadmill running mimics overground running. The development of new wearable technology, such as pressure sensor insoles, presents an opportunity to compare the two running conditions. The purpose of this study was to compare the spatiotemporal factors between overground and treadmill running in collegiate runners, using pressure sensor insoles. Twenty-one collegiate runners (age 20.1 ± 1.5 years, 81 percent female) were recruited from a Division I Cross Country team. Subjects participated in two fifteen-minute testing sessions. During the first session, subjects ran at their “easy run pace” for 200 meters, while wearing pressure sensor insoles. During the second session, subjects ran at a speed-matched pace on a treadmill for one minute at a level grade, and one minute at a one percent incline. Cadence, stance duration and swing duration were processed using Moticon Science Pro+ software (Munich, DE). Data between overground and treadmill running was compared using repeated measures analysis of variance with α= 0.05. Compared to overground running, level and incline treadmill running was associated with increased cadence (mean difference [MD]=3.55-3.22 strides per minute; p< 0.01), decreased stance duration (MD=14-16 ms; p< 0.01), and decreased swing duration (MD=11-12 ms; p< 0.05).  the authors concluded that in collegiate runners, overground and treadmill running differ in spatiotemporal comparisons.

Abstract  |  Full article (subscribers only)  |  Purchase article

Athlete Perceptions and Physical Performance Effects of the FIFA 11+ Program in 9-11 Year-Old Female Soccer Players: A Cluster Randomized Trial.
Authors:  Parsons JL, Carswell J, Nwoba IM, Stenberg H
Strong evidence supports the use of the FIFA 11+ injury risk reduction warm-up program among soccer players, but few studies have investigated its impact on physical performance and movement control in athletes younger than twelve years of age, or the athletes’ opinions of participating in the program. The primary purpose of this study was to measure the impact of the FIFA 11+ program on movement control [Landing Error Scoring System (LESS) and Y-Balance test (YBT)], agility, vertical jump (VJ) height, and trunk muscle endurance compared to a standard warm-up in pre-teen female athletes over one indoor soccer season. A secondary purpose was to assess the athletes’ tolerance and enjoyment of the program. All six teams in the U10 and U11 female divisions of a developmental-level soccer club were cluster randomized to the FIFA 11+ program intervention group or the control group. Participants in the control group continued with a coach-determined warm-up for the duration of a five-month indoor soccer season. Pre- and post-season participants underwent physical testing using the agility T-test, Belt Mat vertical jump (VJ), and static plank tests; and two measures of neuromuscular control (LESS, YBT). Following the soccer season, the athletes in the intervention group also completed a bespoke Tolerance and Enjoyment questionnaire. The 11+ group (n=25) increased their mean static plank hold time by 26.1 ± 38.5 seconds compared to the control group (n=18), who only increased by 2.1 ± 37.1 seconds (p=0.047). For all athletes, there were improvements in mean LESS score (0.6 ± 1.3, p=0.003), and T-test time (0.4 ± 0.7, p=0.001); however, YBT scores worsened by approximately two percent from pre- to post-season. No differences were found for VJ. Athletes tolerated the program well, but the majority described the enjoyment of completing the program as moderately low. This study suggests that the 11+ program may improve some aspects of physical performance in nine to eleven year-old female soccer players, but the low enthusiasm for the program could have longer term adherence implications.

Abstract |  Full article (subscribers only)  |  Purchase article

Spatiotemporal Parameters Of Adolescent Gait When Performing A Visuospatial Memory Task.

Authors:  Lowe LM, Gokun Y, Williams DK, Yates C
Accurate assessment of recovery following mild traumatic brain injury in adolescents can be difficult. When compared to single-task models, dual-task models that combine cognitive and motor demands may more accurately identify residual deficits that manifest during daily life and athletic play in adolescents with concussion. Previous studies have examined gait changes during a concurrent auditory task, or cognitive task. The purpose of this study was to collect and present data from a sample of healthy fourteen to eighteen year old male and female athletes on spatiotemporal parameters of gait for walking with and without a concurrent visuospatial memory task presented on a hand-held tablet. Subjects comprised a total of 178 adolescent athletes (128 males; 50 females) ages fourteen to eighteen years old at six area high schools. Subjects were instructed to walk “how you normally do” on the GAITRite® portable gait analysis walkway for three undivided and three divided attention trials performing a visuospatial memory task on a hand-held tablet. Significant differences (p< 0.0001) were present between males and females during typical gait in each of the measured parameters except step length (p> 0.0715). Female participants walked with a significantly faster gait velocity (by 0.21 m/s) than male participants (p< 0.0001). The females spent a significantly smaller (-2.27 percent) percent of the gait cycle in double limb support (p< 0.0001) and a significantly greater (+1.10 percent) percent of the gait cycle in single limb support (p< 0.0001) than did the males. Both groups experienced a similar, dual-task cost during the divided attention trials (p< 0.0001) for each of the four gait parameters. Previous studies have shown that adults decrease their gait velocity by approximately 33% when performing a task on a hand-held device. The current study revealed that adolescents decreased their gait velocity by eight to nine percent by shortening their step length by 7.4 centimeters (p< 0.0001), increased the percent of the gait cycle spent in double limb support (2.73 percent, p< 0.0001) and decreased the percent of the gait cycle spent in single limb support (1.38 percent, p< 0.0001) during the dual-task. These data provide preliminary reference values specific to the adolescent population for the dual-task cost during a visuospatial memory task. More research is needed to determine the dual-task cost during a visuospatial memory task for adolescents with concussion. 
 
Abstract  |  Full article (subscribers only)  |  Purchase article

Frequency Of Pathology On Diagnostic Ultrasound And Relationship To Patient Demographics In Individuals With Insertional Achilles Tendinopathy.
Authors:  Zellers JA, Bley BC, Pohlig RT, Alghamdi NH, Silbernagel KG
Insertional tendinopathy is likely caused by different pathologies. This variation could account for the recalcitrant nature of this condition to treatment. Ultrasound imaging may assist in identifying underlying pathology to inform patient management. The primary purpose of this study was to quantify the presence of underlying pathology using ultrasound in individuals with a clinical diagnosis of insertional Achilles tendinopathy. Secondarily, the authors sought to examine the relationship of abnormal ultrasound findings to age and body mass index (BMI). Fifty-six individuals with insertional tendinopathy were included in this study. B-mode ultrasound imaging was used to descriptively and quantitatively describe tendon pathology.  A greater proportion of bone defect (p<0.001), intratendinous calcifications (p=0.01) and midportion tendinosis (p<0.001) were observed on the injured side compared to the uninjured side. Higher BMI was associated with presence of bone deformity, intratendinous calcifications and distal tendinosis (p=0.001-0.04); adding age did not significantly improve the regression model. Patients with insertional tendinopathy present with multiple underlying pathologies. This may account for variable response to treatment. It may be helpful to include imaging to better identify underlying pathology when trying to determine an appropriate treatment strategy.  

Abstract  |  Full article (subscribers only)  |  Purchase article

Shoulder Range Of Motion Characteristics In Division III Collegiate Softball And Baseball Players.

Authors:  Schilling DT, Mallace AJ, Elazzazi AM
Adaptive changes may occur to the throwing shoulder of overhead athletes that can influence range-of-motion (ROM).  Shoulder ROM characteristics of Division III softball (SB) and baseball (BB) players are unique. The purpose of this study was to report the passive ROM characteristics of Division III SB and BB players and identify similarities and differences between these two populations. Participants included healthy Division III BB (n=50) and SB (n=24) players. Passive shoulder internal rotation (IR) and external rotation (ER) ROM were measured in the supine position with the arm in 90° of abduction and the scapula stabilized. Descriptive statistics and frequency distributions were used to describe ROM. Paired and independent t-tests were also used to compare throwing and non-throwing shoulder ROM for athletes of each sport and to compare the shoulder ROM of SB and BB players, respectively. The IR and ER ROM for BB players throwing shoulders (IR 54.1 ± 10.9 degrees; ER 94.1 ± 9.1 degrees) were significantly different (p < 0.001) from their non-throwing shoulders (IR 63.3 ± 11.1 degrees; ER 87.6 ± 9.2 degrees) while SB players were not (p= .06 & .08, respectively). Compared to the BB players, the throwing shoulder of SB players demonstrated statistically significantly higher IR ROM (p < .001, mean difference = 11.8 degrees, 95 percent CI: 6.4-17.2 degrees) as well as higher total range of motion (TRM) (p < .001, mean difference = 14.4 degrees, 95 percent CI: 8.6-20.2 degrees) when compared to BB players. Glenohumeral internal rotation deficit (GIRD was significantly higher in BB players when compared to SB players (p = .042, 95 percent CI: .2-10.8 degrees). There were no significant differences in IR, ER, TRM, GIRD and ER gain between SB or BB pitchers and all other field positions (p > .05). The authors concluded that SB players have more ROM and bilateral symmetry when compared to BB players. TRMD occurred more often than GIRD in BB players, indicating that they did not adaptively gain the same amount of ER while losing IR. The throwing shoulder ROM characteristics of both SB and BB players in this study were not influenced by the player's position (pitcher vs. field player).

Abstract  |  Full article (subscribers only)  |  Purchase article

Translation And Validation Of The Dutch Injury Psychological Readiness To Return to Sport Scale (I-PRRS)

Authors:  Vereijken A, Aerts I,  van Trijffel E, Meeusen R
In facilitating and predicting successful return to sport (RTS), not only are physical factors important, but also the athlete’s psychological status. No questionnaire in the Dutch language exists for measuring psychological readiness for RTS after injuries in general. The purpose of this study was to translate and validate the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale into the Dutch language.  One hundred and sixty-eight athletes, returning to high impact sports after lower extremity injuries, completed the Dutch I-PRRS twice. Another 162 athletes who visited their physical therapist for initial intake also completed the questionnaire. Floor and ceiling effects, internal consistency, reproducibility, construct validity, and divergent validity were analyzed. The I-PRRS was successfully translated into Dutch and showed no floor or ceiling effects. It had good internal consistency (0.85) and good test-retest reproducibility (ICC 0.74, 95 percent CI 0.43-0.86) where the lower bound of 95 percent CI indicates at least fair reproducibility. The SEM was 2.02 and the MDC 5.58 points. There was a significant fair correlation between total scores on the I-PRRS and TSK (rs=0.41, p<0.001). Athletes who RTS and those who initially visited their physical therapist differed significantly on all items and on total scores (p<0.001). The I-PRRS was successfully translated into Dutch and can be administered to athletes with lower extremity injuries who have clearance to RTS. The MDC of 5.58 on the total score indicated that with a score below six, there is no noticeable change outside the measurement error. For measuring and monitoring psychological readiness for RTS, the use of the Dutch I-PRRS scale is recommended for Dutch physical therapists.

Abstract  |  Full article (subscribers only)  |  Purchase article

CASE SERIES / CASE REPORT
Pain and Physical Performance Among Recreational Runners Who Receive A Correction For An Iliac Crest Height Difference:  A Case Series.
Authors:  Cahanin RL, Jefferson JR, Flynn TW, Goyeneche N
Leg-length inequality (LLI) is a musculoskeletal condition where one lower extremity is longer than the other. There is conflicting evidence on the relevance of LLI and conservative treatment options. Iliac crest height difference (ICHD) is a good estimate of LLI. The pupose of this case series was to observe changes in pain and performance among recreational runners with running-induced lower extremity pain who received ICHD correction. A twelve-week case series with multiple baseline and intervention (A-B-A-B) phases was used to observe the effects of ICHD correction on pain and performance among three symptomatic recreational runners. Primary outcome measures included the Lower Extremity Functional Scale (LEFS), the Visual Analog Scale –Worst Pain (VAS-W), symptom-free running distance, and average running speed. A standardized procedure for fabricating an in-shoe shim was utilized for ICHD correction. There were no clinically important differences in functional capacity for any subject between any phases. Also, two subjects demonstrated trends towards increased pain over the twelve-week experimental period, whereas one subject demonstrated a decrease. One subject demonstrated a statistically significant increase in running distance during intervention phases, but the others demonstrated reductions. All subjects demonstrated trends towards increased running speed, but none were statistically significant. The correction of small ICHD < 9mm did not improve pain or performance among recreational runners.  Individuals with small ICHD may be able to effectively compensate for lower extremity asymmetries; therefore, correction seems to be unnecessary and potentially harmful in short-term.    

Abstract  |  Full article (subscribers only)  |  Purchase article

Return to Advanced Strength Training and Weight Lifting in an Athlete Post-Lumbar Discectomy Utilizing Pain Neuroscience Education and Proper Progression: Resident's Case Report.
Authors:  Afzal Z, Mansfield CJ, Bleacher J, Briggs M
The use of pain neuroscience education (PNE) is indicated when there are psychosocial contributions to a person’s pain experience. The scientific literature has established the efficacy of the use of PNE in a population with chronic pain but there is a paucity of evidence to support the use of PNE in athletic populations. The purpose of this case report is to describe the use of PNE and graded exposure exercises specific to an athlete returning to Olympic weightlifting. The case is unique because it describes the implementation of PNE in an athlete returning to weightlifting, and the scientific literature for use of PNE in this population is lacking. The identification of kinesiophobia and implementation of PNE and graded exposure exercises led to an optimal outcome for this patient.  

Abstract  |  Full article (subscribers only)  |  Purchase article

CLINICAL COMMENTARY
A Comprehensive Rehabilitation Program for Treating Lateral Elbow Tendinopathy.

Authors:  Day JM, Lucado AM, Uhl TL
Scapular muscle weakness in patients with lateral elbow tendinopathy is an identified impairment and is part of a multimodal rehabilitation approach. The published literature provides little information regarding specific rehabilitation guidelines that address both the proximal scapular muscle weakness and local elbow/wrist dysfunctions common in patients with lateral elbow tendinopathy. The purpose of this clinical commentary is to describe a comprehensive rehabilitation strategy for individuals with lateral elbow tendinopathy. This program emphasizes a phased therapeutic strategy that addresses proximal and local dysfunction along the kinetic chain. This clinical protocol is currently being tested for efficacy as part of a randomized controlled trial. The information in this commentary is intended to provide clinicians with sufficient detail to comprehensively guide the rehabilitation of a patient with lateral elbow tendinopathy.

Abstract  |  Full article (subscribers only)  |  Purchase article
 
Symptom Instability And A Proposed Classification System For The Physical Therapy Management of Sports-Related Concussion.
Author:  Lundblad M
Individuals can experience headaches, dizziness, cervical dysfunction, balance disturbances, fatigue, and oculomotor impairments following a concussion. Patients with sports-related concussions are not a homogenous group but rather heterogenous groups with mixed clinical findings. The purpose of this clinical commentary is to propose a classification system developed specifically for the physical therapy management of sports-related concussions. The concept of “symptom instability” in relationship to concussion was introduced to assist with classifying patients. The time period post-concussion, symptom instability, and the ability to identify symptom triggers were used as defining criteria. The end result was a classification system with five clinical subgroups. The classification system assists in forming homogeneous groups. The grouping of patients into these subgroups can allow for improved efficiency of organizing treatment plans. 

Abstract  |  Full article (subscribers only)  |  Purchase article