VOLUME TWELVE NUMBER SEVEN

 
2017Masthead_V12N7

December 2017

SYSTEMATIC REVIEW
Gait Deficits Under Dual–Task Conditions in the Concussed Adolescent and Young Athlete Population: A Systematic Review
Authors:  Grants L, Powell B, Gessel C, Hiser F, Hassen A
doi: 10.16603/ijspt20171011
There are no current sport concussion assessments that capture the effects of dual-task conditions on gait. Multiple studies have evaluated changes, but none have comprehensively examined literature related to the adolescent and young adult population. The purpose of this systematic review is to synthesize documented changes in gait under dual-task conditions in adolescents and young adults after sustaining a concussion. Six databases were searched: Cinahl, ProQuest, PubMed, Scopus, SPORTdiscus, and Web of Science. Concussion, gait, and dual-task, along with their synonymous terms were the search terms used. Inclusion criteria consisted of adolescent and young adult age groups, acute concussion, dual-tasking, and matched controls. Ten full-text articles were selected for inclusion. Concussed individuals demonstrated longer stride times with shorter stride lengths, increased mediolateral displacement with corresponding increases in sagittal and frontal plane peak velocity, and decreased sagittal plane Center of Mass (COM) and Center of Pressure (COP) displacement. The majority of included studies demonstrated moderate to large effect sizes in these gait characteristics. Concussed individuals demonstrated decreased gait stability while ambulating with a dual-task condition. Though statistically significant differences between concussed individuals and matched controls lasted only 72 hours, concussed individuals demonstrated continued improvements in gait for up to two months post-injury, which has the potential to affect an athlete’s ability to perform. Further research is needed to determine if a gait examination with a dual-task condition is a realistic, reliable, and valid measure to be included in return to sport testing.

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The Influence of Extrinsic Factors on Knee Biomechanics during Cycling: A Systematic Review of the Literature.
Authors:  Johnston TE, Baskins TA, Koppel RV, Oliver SA, Stieber DJ, Hogland LT
doi: 10.16603/ijspt20171023
The knee is susceptible to injury during cycling due to the repetitive nature of the activity while generating torque on the pedal. Knee pain is the most common overuse related injury reported by cyclists, and intrinsic and extrinsic factors can contribute to the development of knee pain.  Due to the potential for various knee injuries, this purpose of this systematic review of the literature was to determine the association between biomechanical factors and knee injury risk in cyclists.  Literature searches were performed using CINAHL, Ovid, PubMed, Scopus and SPORTDiscus. Fourteen papers were identified that met inclusion and exclusion criteria. Only four studies included cyclists with knee pain.  Studies were small with sample sizes ranging from 9-24 participants, and were of low to moderate quality. Biomechanical factors that may impact knee pain include cadence, power output, crank length, saddle fore/aft position, saddle height, and foot position. Changing these factors may lead to differing effects for cyclists who experience knee pain based on specific anatomical location. Changes in cycling parameters or positioning on the bicycle can impact movement, forces, and muscle activity around the knee. While studies show differences across some of the extrinsic factors included in this review, there is a lack of direct association between parameters/positioning on the cycle and knee injury risk due to the limited studies examining cyclists with and without pain or injury. The results of this review can provide guidance to professionals treating cyclists with knee pain, but more research is needed.

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Spinal and Peripheral Dry Needling Versus Peripheral Dry Needling Alone Among Individuals with a History of Lateral Ankle Sprain: A Randomized Controlled Trial.
Authors: Rossi A, Blaustein S, Brown J, Dieffenderfer K, Ervin E, Griffen S, Frierson E, Geist K, Johanson M
doi: 10.16603/ijspt20171034
In addition to established interventions, dry needling may reduce impairments leading to improved functional abilities for individuals following ankle sprain. The purpose of this study was to compare the effects of spinal and peripheral dry needling (DN) with peripheral DN alone on impairments and functional performance among individuals with a history of lateral ankle sprain. Twenty individuals with a history of lateral ankle sprain (18 bilateral, 2 unilateral) participated in this study (4 males, 16 females; mean age 28.9 +/- 9.2 years). During the first of two sessions, participants completed the Foot and Ankle Disability Index (FADI) and the Cumberland Ankle Instability Tool (CAIT) and their strength, unilateral balance, and unilateral hop test performance was assessed. Participants were randomly assigned to a spinal and peripheral DN group (SPDN), or a peripheral only DN group (PDN). Participants in the SPDN site group received DN to bilateral L5 multifidi and fibularis longus and brevis muscles on the involved lower extremity. Participants in the PDN group received DN to the fibularis muscles alone. Participants’ strength, balance and hop test performance were reassessed immediately following the intervention, and at follow-up 6-7 days later, all outcome measures were reassessed. There was a significant group by time interaction (p<0.05) for invertor strength, significant side by group and time by group interactions (p<0.05) for plantarflexor-evertor strength, no significant findings for dorsiflexor-invertor strength, significant side by time interaction (p<0.05) for unilateral balance, significant main effect of time (p<0.05) for triple hop for distance test, and significant main effect of side (p<0.05) for the CAIT. There were no significant differences between groups (p>0.05) for the side hop test or FADI.  The results suggest that DN of the multifidi in addition to fibularis muscles does not result in improvements in strength, unilateral balance or unilateral hop test performance, compared to DN the fibularis muscles alone among individuals with a history of ankle sprain.

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ORIGINAL RESEARCH
Transversus Abdominis Activation and Timing Improves Following Core Stability Training: A Randomized Trial.
Authors:  Selkow NM, Eck MR, Rivas S
10.16603/ijspt20171048
Patients with non-specific low back pain (LBP) often present with a decrease in transversus abdominis (TrA) muscle activation and delayed onset of contraction with extremity movements, potentially contributing to recurrent LBP. Core stability is required for extremity movement and if the timing of when the TrA contracts is not corrected patients may continue to experience LBP.  The purpose of this study was to assess the effects of a four-week core stability rehabilitation program on TrA activation ratio and when the TrA initiates contraction during upper extremity movements in subjects with and without LBP. It was hypothesized that those with LBP would experience greater changes in TrA activation and onset of contraction by the TrA compared to the healthy group. Forty-two participants volunteered (21 healthy and 21 LBP). Ultrasound imaging measured the TrA activation ratio and time of initial contraction of the TrA during upper extremity movement into flexion. Half of the healthy and LBP participants were assigned to the exercise group.  Participants reported twice a week to the athletic training facility to complete an exercise progression of three exercises. After four weeks, all participants returned to have TrA activation and timing measured again. There were no demographic differences between the healthy and LBP participants. There was a group interaction for both TrA activation ratio (p=.049) and onset of initial contraction (p=.008). Those in the exercise group showed an increase in TrA activation ratio (1.85 ± 0.09) compared to the control group (1.79 ± 0.08), as well as an improvement in the onset of contraction (2.07 ± 0.08 seconds) compared to the control group (2.23 ± 0.09 seconds) after the four-week rehabilitation program. Strong effect sizes for TrA activation ratio (0.71 [0.06-1.35]) and initial onset of TrA contraction (-1.88 [-2.63 - -1.11]) were found indicating clinical differences related to the interventions.  The authors concluded that TrA activation and timing were altered following a four-week core stability program in people with and without LBP. Clinicians should consider incorporating these exercises for improving the function of the TrA.

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The Diagnostic Accuracy of the Lever Sign for Detecting Anterior Cruciate Ligament Injury.
Authors:  Mulligan EP, Anderson A, Watson S, Dimeff RJ
10.16603/ijspt20171057
An alternative physical examination procedure for evaluating the integrity of the anterior cruciate ligament (ACL) has been proposed in the literature but has not been validated in a broad population of patients with a symptomatic complaint of knee pain for its diagnostic value. The purpose of this study was to investigate the diagnostic accuracy of the Lever Sign to detect ACL tears and compare the results to Lachman testing in both supine and prone positions. Sixty-two consecutive patients with a complaint of knee pain were independently evaluated for the status of the ACL's integrity with the Lever Sign and the Lachman test (in both prone and supine) by a blinded examiner before any other diagnostic assessments were completed.  Twenty-four of the 60 patients included in the analysis had a torn ACL resulting in a prevalence of 40%. The sensitivity of the Lever Sign, prone, and supine Lachman tests were 38, 83, and 67 % respectively and the specificity was 72, 89, and 97%, respectively, resulting in positive likelihood ratios of 1.4, 7.5, and 24 and negative likelihood ratios of 0.86, 0.19, and 0.34 respectively. The positive predictive values were 47, 83, and 94% and the negative predictive values were 63, 89, and 81% respectively. The diagnostic odds ratios were 1.6, 40, and 70 with a number needed to diagnose of 10.3, 1.4, and 1.6 respectively. The results of this study suggest that Lever Sign, in isolation, does not accurately detect the status of the ACL. During the clinical examination, the Lever Sign should be used as an adjunct to the gold standard assessment technique of anterior tibial translation assessment as employed in the Lachman tests in either prone or supine position.

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Length Change of the Short External Rotators of the Hip in Common Stretch Positions: A Cadaveric Study.
Authors:  McGovern RP, Kivlan BR, Martin RL
doi: 10.16603/ijspt20171068
Stretching of the deep rotators of the hip is commonly employed in patients with lumbosacral, sacroiliac, posterior hip, and buttock pain. There is limited research demonstrating the effectiveness of common stretching techniques on the short external rotators of the hip. The objective of this study was to evaluate length change during stretching of the superior and inferior fibers of the piriformis, superior gemellus, obturator internus, and inferior gemellus. Seventeen hip joints from nine embalmed cadavers (5 male; 4 female) with an age between 49-96 years were skeletonized. Polypropylene strings were attached from the origin to insertion sites of the short external rotators. The change of length (mm) noted by excursion of the strings was used as a proxy for change in muscle length, when the hip was moved from the anatomical position to four specific stretch positions: 1) 45 degrees internal rotation from hip neutral flexion/extension, 2) 45 degrees external rotation from 90 degrees hip and knee flexion, 3) 30 degrees adduction from 90 degrees of hip and knee flexion, and 4) 30 degrees of adduction with the hip and knee flexed so the lateral malleolus contacted the lateral femoral epicondyle of the contralateral limb , were recorded.  There was a significant effect on string displacement by stretch position, F (15,166) = 14.67, p < .0005; Wilk’s Ʌ = .097, partial n2 = .540.  The greatest displacement of the strings corresponding to the superior piriformis, inferior piriformis, and the superior gemellus occurred in 30 degrees adduction from 90 degrees of hip and knee flexion. The obturator internus and inferior gemellus had the largest string displacement with 45 degrees internal rotation from neutral flexion/extension.  While all stretch positions caused a significant string displacement indicating length changes of the deep rotators of the hip, the three stretch positions that caused the greatest change were: 1) 30 degrees adduction from 90 degrees of hip and knee flexion, 2) 45 degrees internal rotation from neutral flexion/extension, and 3) 45 degrees external rotation with 90 degrees hip and knee flexion. This study has clinical implications for the effectiveness of specific stretching techniques on the short external rotators of the hip with the potential to improve the validity of stretching protocols for patients with posterior hip or buttock pain. The piriformis and superior gemellus had a larger change in length when adducting the hip from 90 degrees degrees of hip and knee flexion.  The obturator internus and inferior gemellus had a greater length change when internally rotating the hip from neutral flexion/extension.

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Clinical Measures of Hip Range of Motion Do Not Correlate With the Degree of Cam Morphology In Semi-Elite Australian Footballers: A Cross-Sectional Study.
Authors:  Murphy M, Kemp J, Smith A, Charlesworth J, Briffa K
doi: 10.16603/ijspt20171078
Clinical testing to determine the presence of a cam morphology is becoming more common however the correlation between hip range of motion and the degree of cam morphology remains controversial in the literature. The prevalence of a cam morphology in athletes has been reported as higher than in the general population but the prevalence of cam morphology has not been reported in Australian Football (AF). The purpose of this study was to determine the correlation between hip range of motion and hip alpha angle and report the proportion of players with a cam morphology in a sample of AF players. Twenty-one semi-elite AF players (42 hips) from the Peel Thunder Football Club were included in this study. A hip Flexion Internal Rotation (IR) test and a modified maximal squat test using the difference in depth of squat in hip internal and external rotation were used. These measures were then compared to alpha angles on 90 degree Dunn view x-rays. Four of the 42 hips (9.5%) had a cam morphology (alpha angle >60 degrees). There was no significant correlation between alpha angle and ROM in a Flexion IR test or the difference in modified maximal squat test depth within this sample of players. The authors found that the proportion of cam morphology seems to be lower in this sample than the previously reported prevalence in other sports. The lack of correlations between hip range and hip alpha angle in players means that screening hips using clinical measures to detect cam morphology associated with poor hip range of motion may be inaccurate.

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Collegiate Male Soccer Players Exhibit Between-Limb Symmetry in Body Composition, Muscle Strength, and Range Of Motion.
Authors:  DeLang MD, Kondratek M, DiPLace LJ, Butler TH
doi: 10.16603/ijspt20171087
Functional and structural asymmetries attributed to limb dominance are equivocal in soccer players.  Previous authors hypothesize the existence of between-limb asymmetry secondary to the repetitive unilateral nature of kicking. However, symmetry is often present, particularly in measures of muscle strength. The purpose of the present study was to determine if lateral dominance is accompanied by corresponding between-limb asymmetries in a comprehensive assessment of body composition, muscle strength, and range of motion in healthy soccer players. Seventeen healthy male NCAA Division One collegiate soccer players participated (age 19.6±1.5 years; BMI 23.9±1.4 kg/m2). Footedness was attained via participant self-report. Lower limb muscle strength (hand held dynamometry), range of motion (goniometry), and body composition (dual energy x-ray absorptiometry scan) were measured.  Lower-leg symmetry was analyzed comparing the dominant versus non-dominant limb using paired t-tests.  Comparisons revealed no statistically different differences in outcomes, indicating remarkable symmetry in all measures of body composition, muscle strength, and range of motion (p>0.05) between the dominant and non-dominant lower limbs. The authors speculate that the prevalence of running versus kicking, the longitudinal effects of playing careers, and/or functional compensation attenuates the expected asymmetries in healthy male collegiate soccer players.  

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Comparison of Functional Activities on Structural Changes of the Inferior Patellar Pole.
Authors:  McKinney K, Wallman H, Stalcup P, DiTommaso K
doi: 10.16603/ijspt20170000
It is well known that eccentric and concentric exercise produce varied amounts of stress on the connective tissues. Diagnostic ultrasound has been used to measure these structural changes by observing fascicle length, angle, and thickness; however, there is a lack of evidence comparing the structural changes as it relates to eccentric, concentric, and stretching protocols. The purpose of this study was to compare the acute effects of static stretching, eccentric, concentric, and a combination of eccentric/concentric exercises on structural changes of the muscle tendon unit at the inferior patellar pole utilizing the diagnostic ultrasound. Forty-seven healthy subjects were screened for any lower extremity deficits or orthopaedic pathology. Forty-four (N=44) subjects completed all four protocols; the attrition was due to injuries to the lower extremity, occurring unrelated to the study. A baseline measurement of the anterior inferior patellar tendon was performed with the diagnostic ultrasound prior to each participant completing one of the four interventions per week over a four-week period. Interventions completed by each participant included static stretching, concentric, eccentric, and combined concentric and eccentric exercises. Immediately following each intervention, a post-intervention inferior patellar tendon measurement was recorded using the diagnostic ultrasound. Significant differences in anterior to posterior tendon thickness of the inferior patellar tendon were observed between pre (4.983±0.041mm) and post (5.198±0.055mm) measurements (p<0.0005) for the main effect of time. However, no differences in tendon thickness were noted comparing each intervention to one another (p=0.351).  Differences in tendon thickness were noted acutely for pre- to post measurements across all interventions. Further research is needed to determine if differences in tendon thickness exist with a longer duration of exercise over time and with different types of intervention.

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Isokinetic Knee Muscle Strength Profile in Brazilian Male Soccer, Futsal, and Beach Soccer Players: A Cross-Sectional Study.
Authors:  deLira CAB, Mascarin NC, Vargas VZ, Vancini RL, Andrade MS
doi: 10.16603/ijspt20171103
Anterior cruciate ligament injury is higher in soccer athletes as compared to athletes of other sports. Risk factors for anterior cruciate ligament injury include low knee hamstring/quadriceps strength ratio and bilateral strength deficits.  The purpose of this study was to investigate isokinetic thigh muscles strength, hamstring/quadriceps strength ratio, and bilateral strength comparisons in athletes who participate in professional soccer, futsal, and beach soccer.  Brazilian professional soccer (n=70), futsal (n=30), and beach soccer (n=12) players were isokinetically assessed to examine strength of knee extensors and flexors at 60 degrees/second in concentric mode, to measure peak torque of dominant and non-dominant limbs.  In the dominant limb, for extensors muscles, futsal players presented significantly lower peak torque values (223.9±33.4 Nm) than soccer (250.9±43.0 Nm; p=0.02) and beach soccer players (253.1±32.4 Nm; p=0.03). Peak torque for extensor muscles in the non-dominant limb was significantly lower in futsal (224.0±35.8 Nm) than in beach soccer players (256.8±39.8 Nm; p=0.03). Hamstring/quadriceps strength ratio for dominant limbs for futsal (57.6±10.1%), soccer (53.5±8.8%), and beach soccer (56.3±8.4%) players presented no significant differences between groups; however, the mean values were lower than recommended values found in the literature. There were no strength deficits for any of the evaluated groups when compared bilaterally. The authors concluded that futsal athletes presented lower values for quadriceps strength than soccer and beach soccer athletes. Futsal, soccer, and beach soccer players presented no strength asymmetries, but they presented with strength imbalance in hamstring/quadriceps strength ratio.

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Postural Alterations in Patients with Subacromial Impingement Syndrome.
Authors:  Alizadehkhaiyat O, Roebuck MM, Makki AT, Frostick SP
doi: 10.16603/ijspt20171111
An aberrant upper body posture has been proposed as one of the etiological factors contributing to the development of subacromial impingement syndrome (SAIS). Clinicians have translated this supposition into assessment and rehabilitation programs despite insufficient and conflicting evidence to support this approach. The purpose of this study was to compare several postural variables between SAIS patients and asymptomatic healthy controls. A total of 75 participants including 39 patients (20 females; 19 males) and 36 healthy controls (15 females; 21 males) participated in the study. Study evaluated several postural variables including forward head posture (FHP), forward shoulder posture (FSP), thoracic kyphosis index (TKI), scapular index (SI), normalized scapular protraction (NSP), and the lateral scapular slide test (LSST). The variables were compared between patient and control groups according to sex.  Significant differences were observed in the female patients compared to asymptomatic controls for the FHP (49.3o+9.6o vs 55.5o+8.3o, p=0.03), FSP (45.5o+10.1o vs 53.6o+7.0o, p=0.02), and LSST in third position (10.2+2.1cm vs 11.5+0.7cm, p=0.01). Male patients showed a significant difference only in the FSP compared to controls (61.9o+9.4o vs 49.7o+9.2o, p<0.001).  The authors concluded that while inadequate data on the relationship between dysfunctional posture and SAIS has led to broad variations in current rehabilitation strategies, the results of the present study revealed different patterns of postural aberrations in female and male patients with SAIS. This clarifies the need to develop individualized or sex-specific approaches for assessing posture in men and women with SAIS and rehabilitation programs based on the assessment results.

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Shoulder External Rotator Eccentric Training versus General Shoulder Exercise for Subacromial Pain. Syndrome: A Randomized Controlled Trial.
Authors:  Chaconas EJ, Kolber MJ, Hanney WJ, Daugherty ML, Wilson SH, Sheets C
doi: 10.16603/ijspt20171121
Shoulder pain affects up to 67% of the population at some point in their lifetime with subacromial pain syndrome (SAPS) representing a common etiology. Despite a plethora of studies there remains conflicting evidence for appropriate management of SAPS. The purpose of this study was to compare outcomes, for individuals diagnosed with SAPS, performing a 6-week protocol of eccentric training of the shoulder external rotators (ETER) compared to a general exercise (GE) protocol. Forty-eight individuals (mean age 46.8 years +/-17.29) with chronic shoulder pain, and a clinical diagnosis of SAPS were randomized into either an experimental group performing ETER or a control group performing a GE program. The intervention lasted for six weeks, and outcomes were measured after three weeks, six weeks, and again at six months post intervention. The primary outcome of function, measured by the Western Ontario Rotator Cuff Index, demonstrated a significant interaction effect derived from a multilevel hierarchical model accounting for repeated measures favoring the experimental group at week 3: 14.65 (p=.003), Week 6: 17.04 (p<.001) and six months: 15.12 (p=.007).  After six months, secondary outcome measures were improved for Numeric Pain Rating Scale levels representing pain at worst (p=.006) and pain on average (p=0.02), external rotator (p<.001), internal rotator (p=0.02), and abductor strength (p<.001).  There were no statistically significant differences in secondary outcome measures of Global Rating of Change, Active Range of Motion, the Upper Quarter Y Balance Test and strength ratios after six months.  The authors concluded that an eccentric program targeting the external rotators was superior to a general exercise program for strength, pain, and function after six months. The findings suggest eccentric training may be efficacious to improve self-report function and strength for those with SAPS.

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Reliability of Ankle-Foot Morphology, Mobility, Strength, and Motor Performance Measures.
Authors:  Fraser JJ, Koldenhoven RM, Saliba SA, Hertel J
doi: 10.16603/ijspt20171134
Assessment of foot posture, morphology, intersegmental mobility, strength and motor control of the ankle-foot complex are commonly used clinically, but measurement properties of many assessments are unclear.  The purpose of this study was to determine test-retest and inter-rater reliability, standard error of measurement, and minimal detectable change of morphology, joint excursion and play, strength, and motor control of the ankle-foot complex. Twenty-four healthy, recreationally-active young adults without history of ankle-foot injury were assessed by two clinicians on two occasions, three to ten days apart. Measurement properties were assessed for foot morphology (foot posture index, total and truncated length, width, arch height), joint excursion (weight-bearing dorsiflexion, rearfoot and hallux goniometry, forefoot inclinometry, 1st metatarsal displacement) and joint play, strength (handheld dynamometry), and motor control rating during intrinsic foot muscle (IFM) exercises. Clinician order was randomized using a Latin Square. The clinicians performed independent examinations and did not confer on the findings for the duration of the study.  Test-retest and inter-tester reliability and agreement was assessed using intraclass correlation coefficients (ICC2,k) and weighted kappa (Kw). Test-retest reliability ICC were as follows: morphology: .80-1.00, joint excursion: .58-.97, joint play: -.67-.84, strength: .67-.92, IFM motor rating: KW -.01-.71. Inter-rater reliability ICC were as follows: morphology: .81-1.00, joint excursion: .32-.97, joint play: -1.06-1.00, strength: .53-.90, and IFM motor rating: Kw .02-.56. The authors concluded that  measures of ankle-foot posture, morphology, joint excursion, and strength demonstrated fair to excellent test-retest and inter-rater reliability. Test-retest reliability for rating of perceived difficulty and motor performance was good to excellent for short-foot, toe-spread-out, and hallux exercises and poor to fair for lesser toe extension. Joint play measures had poor to fair reliability overall. The findings of this study should be considered when choosing methods of clinical assessment and outcome measures in practice and research.

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CASE STUDIES
The Rehabilitation of a Runner with Iliopsoas Tendinopathy using an Eccentric-biased Exercise-A Case Report.
Authors:  Rauseo C
doi: 10.16603/ijspt20171150
While there is much discussion about tendinopathy in the literature, there is little reference to the less common condition of iliopsoas tendinopathy, and no documentation of the condition in runners. The iliopsoas is a major decelerator of the hip and eccentric loading of the iliopsoas is an important component of energy transfer during running. Eccentric training is a thoroughly researched method of treating tendinopathy and but has shown mixed results. The purpose of this case report is to describe the rehabilitation of a runner with the rare condition of iliopsoas tendinopathy, and demonstrate a creative eccentric-biased technique to assist with treatment. A secondary objective is to illustrate how evidence on intervention for other tendinopathies was used to guide rehabilitation of this seldom described condition.  The eccentric-biased exercise in conjunction with exercises addressing the kinetic chain and a progressive tendon loading program, were successful in the rehabilitation of this subject with iliopsoas tendinopathy. This case report is the first to provide a description on the rehabilitation of iliopsoas tendinopathy, and offers clinicians suggestions and guidance for treatment and exercise choice in the clinical environment.

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CLINICAL COMMENTARY
Nerve Entrapment in the Hip Region: Current Concepts Review.
Authors: Martin R, Martin HD, Kivlan BR    
doi: 10.16603/ijspt20171163
Nerve entrapment can occur around musculotendinous, osseous, and ligamentous structures because of the potential for increased strain and compression on the peripheral nerve at those sites. The sequela of localized trauma may also result in nerve entrapment if normal nerve gliding is prevented. Nerve entrapment can be difficult to diagnose because patient complaints may be similar to and coexist with other musculoskeletal conditions in the hip and pelvic region. The sciatic, pudendal, obturator, femoral, and lateral femoral cutaneous are nerves that can be entrapped and serve a source of hip pain in the athletic population. Manual therapy, stretching and strengthening exercises, aerobic conditioning, and cognitive-behavioral education are potential interventions. The purpose of this clinical commentary is to review the anatomy, etiology, evaluation, and treatment techniques for nerve entrapments of the hip region.

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