An Examination of the Gluteal Muscle Activity Associated With Dynamic Hip Abduction and Hip External Rotation Exercise: A Systematic Review
Authors: Macadam P, Cronin J, Contreras B
A wide variety of hip abduction and hip external rotation exercises are used for training, both in athletic performance and in rehabilitation programming. Though several different exercises exist, a comprehensive understanding of which exercises best target the gluteus maximus (Gmax) and gluteus medius (Gmed) and the magnitude of muscular activation associated with each exercise is yet to be established. Therefore the purpose of this systematic review to quantify the electromyographic (EMG) activity of exercises that utilize the Gmax and Gmed muscles during hip abduction and hip external rotation. Twenty-three studies met the inclusion criteria and were retained for analysis. The highest Gmax activity was elicited during the lateral step up, cross over step up and rotational single leg squat (ranging from 79 to 113 % MVIC). Gmed activity was highest during the side bridge with hip abduction, standing hip abduction with elastic resistance at the ankle and side lying hip abduction (ranging from 81 to 103 % MVIC). The findings from this review provide data regarding the amount of muscle activity generated by basic strengthening and rehabilitation exercises, which may assist practitioners in making decisions for Gmax and Gmed strengthening and injury rehabilitation programs.
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The Influence of Hip Strength on Knee Kinematics during a Single-Legged Medial Drop Landing Among Competitive Collegiate Basketball Players
Authors: Suzuki H, Omori G, Uematsu D, Nishino K, Endo N
A smaller knee flexion angle and larger knee valgus angle during weight-bearing activities have been identified as risk factors for non-contact anterior cruciate ligament (ACL) injuries. To prevent such injuries, attention has been focused on the role of hip strength in knee motion control. However, gender differences in the relationship between hip strength and knee kinematics during weight-bearing activities in the frontal plane have not been evaluated. Therefore, the purpose of this study was to determine the influence of hip strength on knee kinematics in the frontal plane in males and females during a single-legged landing task. Significant correlations between hip strength and knee kinematics during SML were observed in both genders. Hip strength may, therefore, play an important role in knee motion control during sports activities, suggesting that increased hip strength may help to prevent non-contact ACL injuries in athletes of both genders. Moreover, gender-specific programs may be needed to control abnormal knee motion, as the influence of hip strength on knee kinematics may differ based on gender.
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Y Balance Test™ Anterior Reach Symmetry at Three Months is related to Single Leg Functional Performance at Time of Return to Sports Following Anterior Cruciate Ligament Reconstruction
Authors: Garrison JC, Bothwell JM, Wolf G, Aryal S, Thigpen CA
Restoration of symmetrical strength, balance, and power following anterior cruciate ligament reconstruction (ACL-R) are thought to be important factors for successful return to sports. Little information is available regarding early rehabilitation outcomes and achieving suggested limb indices of 90% on functional performance measures at the time of return to sports (RTS). The purpose of this study was to examine the relationship between symmetry of the anterior reach of the Y Balance Test™ (YBT-ANT) at 12 weeks and functional performance (Vail Sport Test™) measures at time of return to sports after anterior cruciate ligament (ACL) reconstruction. The authors found that in participants following ACL-R who demonstrated >4cm YBT-ANT deficits at 12 weeks on their involved limb did not tend to achieve 90% LSI for the single hop for distance and triple hop for distance at time of return to sports. The YBT-ANT at 12 weeks and Vail Sport Test™ appear to measure different constructs following ACL-R.
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Modified Functional Movement Screening as a Predictor of Tactical Performance Potential in Recreationally Active Adults
Authors: Glass SM, Ross SE
Failure to meet minimum performance standards is a leading cause of attrition from basic combat training. A standardized assessment such as the Functional Movement Screen™ (FMS™) could help identify movement behaviors relevant to physical performance in tactical occupations. Previous work has demonstrated only marginal association between FMS™ tests and performance outcomes, but adding a load challenge to this movement assessment may help highlight performance-limiting behaviors. The purposes of this investigation were to quantify the effect of load on FMS™ tests and determine the extent to which performance outcomes could be predicted using scores from both loaded and unloaded FMS conditions. Thirteen female and six male recreationally college students (21 ± 1.37 years, 168 ± 9.8cm, 66 ± 12.25kg) completed the FMS under (1) a control condition (FMS-C), and (2) an 18.10kg weight vest condition (FMS-W). Balance was assessed using a force plate in double-legged stance and tactical physical performance was evaluated via completion times in a battery of field tests. For each condition, penalized regression was used to select models from the seven FMS component tests to predict balance and performance outcomes. The authors found that with balance, significant predictors were identified from both conditions but primarily predicted poorer balance with increasing FMS scores. For tactical performance, models were retained almost exclusively from FMS-W and generally predicted better performance with higher item scores. The authors concluded that FMS™ screening with an external load could help predict performance relevant to tactical occupations. Sports medicine and fitness professionals interested in performance outcomes may consider assessing movement behaviors under load.
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Overhead Deep Squat Performance Predicts Functional Movement Screen™ Score
Authors: Clifton DR, Grooms DR, Onate JA
The Functional Movement Screen (FMS™) has been suggested for use in predicting injury risk in active populations, but time constraints may limit use of the entire screening test battery. Identifying one component of the FMS™ that can predict which individuals may perform poorly on the entire test, and therefore should undergo the full group of screening maneuvers, may reduce time constraints and increase pre-participation screening utilization. The purpose of this study was to determine if performance on the FMS™ overhead deep squat test (DS) could predict performance on the entire FMS™. One hundred and three collegiate athletes underwent offseason FMS™ testing. The DS and adjusted FMS™ composite scores were dichotomized into low performance and high performance groups with athletes scoring below 2 on the DS categorized as low performance, and athletes with adjusted FMS™ composite scores below 12 categorized as low performance. Scores of 2 or above and 12 or above were considered high performances for the DS test and adjusted FMS™ composite score respectively, and therefore low risk for movement dysfunction and potentially, injury. The authors found that in individuals categorized as low performance as a result of the DS test had lower adjusted FMS™ composite scores (p < 0.001). DS scores were positively correlated with adjusted FMS™ composite scores (ρ = 0.50, p < 0.001). Binomial logistic regression identified an odds ratio of 3.56 (95% CI: 1.24, 10.23, p = 0.018) between DS and FMS™ performance categories. Therefore, the authors concluded that performance on the DS test may predict performance on the FMS™ and help identify individuals who require further musculoskeletal assessment.
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Relationships Between Functional Movement Tests and Performance Tests in Young Elite Male Basketball Players.
Authors: Gonzalo-Skok O, Serna J, Rhea MR, Marín PJ
Sprinting and jumping are two common and important components of high-level sport performance. The weight-bearing dorsiflexion test (WB-DF) and Star Excursion Balance Test (SEBT) are tools developed to identify athletes at risk for lower extremity injury and may be related to running and jumping performance among athletes. The purposes of this study were: 1) to identify any relationships between functional movement tests (WB-DF and SEBT) and performance tests (jumping, sprinting and change of direction); 2) to examine any relationships between asymmetries in functional movements and performance tests. Fifteen elite male basketball players (age: 15.4 ± 0.9 years) were assessed during a three-week period to determine the reliability of functional screening tools and performance tests and to examine the relationships between these tests. Relative (intraclass correlation coefficient) and absolute (coefficient of variation) reliability were used to assess the reproducibility of the tests. Significant correlations were detected between certain functional movement tests and performance tests. Both left and right excursion composite scores related to slower performance times in sprint testing, demonstrating that greater dynamic reach relates to decreased quickness and acceleration among these elite basketball athletes. The various relationships between dynamic functional movement testing, speed, and jump performance provide guidance for the strength and conditioning professional when conducting and evaluating data in an effort to improve performance and reduce risk of injury. Therefore, the results of the present study suggest that these functional and performance tests do not measure the same components of human movement, and could be paired as outcome measures for the clinical and sport assessment of lower extremity function.
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The Minimum Clinically Important Difference on the VISA-A and LEFS for Patients with Insertional Achilles Tendinopathy.
Authors: McCormack J, Underwood F, Slaven E, Cappaert T
The VISA-A and LEFS are two measures commonly utilized for patients with insertional Achilles tendinopathy (IAT). Previous authors have estimated the MCID for the VISA-A, but a MCID has not been formally established. The MCID for the LEFS has been established for patients with lower extremity conditions in general, but it is not clear if this MCID is applicable to patients with IAT. Therefore, the purpose of this study was to establish the minimum clinically important difference (MCID) on the Victorian Institute of Sport Assessment - Achilles Questionnaire (VISA-A) and the Lower Extremity Functional Scale (LEFS) for patients with IAT. The MCID for the VISA-A was 6.5 points and the MCID for the LEFS was 12 points. The authors concluded that the VISA-A and LEFS are both useful outcome measures to assess response in patients with IAT.
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Electromyographic Analysis of Shoulder Girdle Muscles during Common Internal Rotation Exercises
Authors: Alizadehkhaiyat O, Hawkes DH, Kemp GJ, Frostick SP
High level throwing performance requires the development of effective muscle activation within shoulder girdle muscles, particularly during forceful internal rotation (IR) motions. The purpose of this study was to investigate activation pattern of 16 shoulder girdle muscles/muscle sub-regions during three common shoulder IR exercises. Electromyography (EMG) was used to record muscular activity in 30 healthy subjects from 16 shoulder girdle muscles/muscle sub-regions (surface electrode: anterior, middle and posterior deltoid, upper, middle and lower trapezius, serratus anterior, teres major, upper and lower latissimus dorsi, upper and lower pectoralis major; fine wire electrodes: supraspinatus, infraspinatus, subscapularis and rhomboid major) using a telemetric EMG system. Three IR exercises (standing IR at 0 degrees abduction and 90 degrees of abduction, and IR at Zero-Position [zero rotation of the humerus, arm elevated to 155 degrees]) were studied. EMG amplitudes were normalized to EMGmax (EMG at maximal IR force in a standard position) and compared using one-way repeated-measures analysis of variance (ANOVA). The result demonstrated significant differences in muscles’ activation across IR exercises (p<0.05–p<0.001). Rotator cuff and deltoid muscles were highly activated during IR at 90° of Abduction. Latissimus dorsi exhibited markedly higher activation during IR at Zero-Position. While upper trapezius had the highest activation during IR at Zero-Position, middle and lower trapezius were activated at highest during IR at 90 degrees of abduction. The highest activation of serratus anterior and rhomboid major occurred in IR at Zero-Position and IR at 90 degrees of abduction, respectively. Studied exercises have the potential to effectively activate glenohumeral and scapular muscles involved in throwing motions which helps to provide further evidence for developing rehabilitation, injury prevention, and training strategies.
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Reliability of Strength and Performance Testing Measures and Their Ability to Differentiate Persons with and without Shoulder Symptoms
Authors: Sciascia A, Uhl T
Upper extremity physical performance measures exist but none have been universally accepted as the primary means of gauging readiness to return to activity following rehabilitation. Few reports have described reliability and/or differences in outcome with physical performance measures between individuals with and without shoulder symptoms. Therefore, the purpose of this study was to establish the reliability of traditional upper extremity strength testing and the closed kinetic chain upper extremity test (CKCUEST) in persons with and without shoulder symptoms as well as to determine if the testing maneuvers could discriminate between individuals with and without shoulder symptoms. Male and female subjects 18-50 years of age were recruited for testing. Subjects were screened and placed into groups based on the presence (Symptomatic Group) or absence of shoulder symptoms (Asymptomatic Group). Each subject performed an isometric strength task, a task designed to estimate 1-repetition maximum (RM) lifting in the plane of the scapula, and the closed kinetic chain upper extremity stability test (CKCUEST) during two sessions 7-10 days apart. Test/re-test reliability was calculated for all three tasks. Independent t-tests were utilized for between group comparisons to determine if a performance task could discriminate between persons with and without shoulder symptoms. Test/re-test reliability for each task was excellent for both groups (intraclass correlations ≥.85 for all tasks). Neither strength task could discriminate between subjects in either group. Subjects with shoulder symptoms had 3% less touches per kilogram of body weight on the CKCUEST compared to subjects without shoulder symptoms but this was not statistically significantly different (p=.064). The excellent test/re-test reliability has now been expanded to include individuals with various reasons for shoulder symptoms. Traditional strength testing does not appear to be the ideal assessment method for making discharge and/or return to activity decisions due to the inability to discriminate between the groups. The CKCUEST could be utilized to determine readiness for activity as it was trending towards being discriminatory between known groups.
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Effects of a Season of Sub-concussive Contact on Child- SCAT3 Scores in 8-12 Year-Old Male Athletes
Authors: Jennings D, Sells P, Allison J, Boyd K, Frommert D, Kessler C, Merryman L, Muchmore J, Odom TJ, Salmon R, Robinson K
Each year, over 173,000 children and adolescents visit emergency departments due to sports and recreation related concussions, an increase of 60% over the last decade due to the rise in the number of children participating in sport. While numerous authors have sought to address the epidemiology of concussions across multiple age groups who participate in contact sports, a recent review of literature did not reveal a substantial amount of published articles that addressed the issue of sub-concussive contact. Multiple tools have been developed to assess acute episodes of concussion. Among the assessment protocols many include an assessment of balance, short and long term memory recall, and balance. The Child-SCAT3 was designed specifically to evaluate concussions in children 5-12 years of age. The purpose of this study was to determine the effect of a season of sub-concussive contact on modified Child-SCAT3 scores in 8-12 year old males compared to their age matched peers who participated in non-contact sports. A secondary purpose was to evaluate how scores of the sub- components of the Child-SCAT3 compare between contact and non-contact athletes. No statistically significant differences were found in group, time or time and group interaction for any of the utilized portions of the Child-SCAT3. Statistically significant differences were found between groups for preseason cognitive orientation and postseason immediate memory. Cognitive orientation and coordination were also found to be statistically significantly improved across both groups over the course of the season. The authors concluded that a season of sub-concussive contact in football was not detrimental to cognitive and balance scores on the Child-SCAT3.
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Physical Therapy Intervention Strategies for Patients with Prolonged Mild Traumatic Brain Injury Symptoms: A Case Series
Author: Hugentobler JA, Vegh M, Janiszewski B, Quatman-Yates C
Although most patients recover from a mild traumatic brain injury (mTBI) within 7-14 days, 10-30% of people will experience prolonged mTBI symptoms. Currently, there are no standardized treatment protocols to guide physical therapy interventions for this population. The purpose of this case series was to describe the unique, multimodal evaluation and treatment approaches for each of the patients with post-concussion syndrome (PCS). Patients were treated for a mean of 6.8 treatment sessions over 9.8 weeks. Four of six patients returned to their pre-injury level of activity while two returned to modified activity upon completion of physical therapy. Improvements were observed in symptom scores, gaze stability, balance and postural control measures, and patient self-management of symptoms. All patients demonstrated adequate self-management of symptoms upon discharge from physical therapy. Physical therapy interventions for pediatric athletes with PCS may facilitate recovery and improve function.
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A Novel Approach to Treating Plantar Fasciitis – Effects of Primal Reflex Release Technique: A Case Series
Authors: Hansberger BL, Baker RT, May J, Nasypany A
Plantar fasciitis (PF), a common condition affecting physically active individuals, is typically treated with orthotics, two to four months of stretching programs, and/or surgery. Primal Reflex Release Technique (PRRT) is thought to reduce over-arousal of the nervous system through down-regulation of the primal reflexes. The technique has been suggested as a novel treatment method for patients suffering from PF. The purpose of this case series was to examine the effects of PRRT on patients with PF. The PRRT technique was applied in eight consecutive cases of PF in physically active subjects. The Numeric Pain Rating Scale (NPRS), the Disability in the Physically Active (DPA) Scale, and the Patient Specific Functional Scale (PSFS) were administered to identify patient-reported pain and dysfunction. PRRT was an effective treatment for subjects with either acute or chronic PF. The use of the PRRT treatment resulted in an average reduction in plantar fascial pain across all subjects that was both statistically significant and clinically following a single treatment. Statistically and clinically significant improvements on averaged measures of function, such as the DPA Scale and PSFS, were also found over the course of treatment. In this case series, the use of PRRT produced positive changes in terms of improvements in reported pain and dysfunction and a shorter time to resolution, when compared to traditional treatment methods for PF reported in the literature. Subjects who undergo PRRT treatment for both acute and chronic PF may experience reduction in pain and improvement of function that exceeds what is experienced in traditional conservative therapy programs found in the available literature. Clinicians should consider the regional interdependence model in order to identify underlying related factors when evaluating and treating plantar fasciitis. The autonomic nervous system may play a role in the perception of pain and should be addressed during treatment.
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Posterior Sternoclavicular Joint Dislocation in a Division I Football Player: A Case Report
Author: Cruz MF, Erdeljac J, Williams R, Brown M, Bolgla L
Posterior dislocation of the sterno-clavicular (SC) joint is a rare injury in athletes. It normally occurs in high collision sports such as American football or rugby. Acute posterior dislocations of the SC joint can be life-threatening as the posteriorly displaced clavicle can cause damage to vital vascular and respiratory structures such as the aortic arch, the carotid and subclavian arteries, and the trachea. The potential severity of a posterior SC joint dislocation provides multiple challenges for clinicians involved in the emergency care and treatment of this condition. Integration of clinical examination observations, rapid critical thinking, and appropriate diagnostic imaging are often required to provide the best management and outcome for the injured athlete. The criterion for return-to-play and participation in collision sports after suffering a posterior dislocation of the SC joint are unclear due to the rarity of this injury. The purpose of this case report is to describe the management, from the initial on-field evaluation through the return-to-sport, of a collegiate Division I football player following a traumatic sports-related posterior SC joint dislocation. The rehabilitation process and the progression to return to participation are also presented and briefly discussed.
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Differential Diagnostic Process and Clinical Decision Making in a Young Adult Female With Lateral Hip Pain: A Case Report.
Author: Livingston JI, Deprey SM, Hensley CP
Young adults with lateral hip pain are often referred to physical therapy. A thorough examination is required to obtain a diagnosis and guide management. The purpose of this case report is to describe the physical therapist’s differential diagnostic process and clinical decision making for a subject with the referring diagnosis of trochanteric bursitis. A thorough examination and appropriate clinical decision making by the physical therapist at the initial examination led to the diagnosis of an acetabular stress fracture in this subject. Clinicians must be aware of symptoms and signs which place the subject at risk for stress fracture for timely referral and management.
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A Novel Approach for the Reversal of Chronic Apparent Hamstring Tightness: A Case Report
Author: Baker RT, Hansberger BL, Warren L, Nasypany A
Movement dysfunction in the trunk and lower extremity (e.g., apparent hamstring tightness) may produce pain, as well as decrease range of motion, function, and performance in athletes. Novel treatments not frequently studied in the literature, such as Total Motion Release® (TMR®) and instrument-assisted soft-tissue mobilization (IASTM), have anecdotal claims of immediate, gross gains of mobility that far exceed conventionally reported results. The purpose of this case report was to examine the efficacy of TMR® in treating an apparent tissue tightness/extensibility dysfunction and to determine if IASTM would improve outcomes if TMR® techniques failed to produce maintained improvement. The subject in this case report demonstrated the potential use of TMR® in classifying apparent hamstring tightness and provided evidence to support the use of TMR® and IASTM in addressing mobility deficits associated with hamstring inflexibility/tightness. Based on these findings, clinicians should consider the use of TMR® and IASTM to improve classification and treatment of patients with a chief complaint of hamstring “tightness.”
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