Volume Thirteen, Number Five

 
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October 2018

ERRATUM
DOI: 10.26603/ijspt20180773
IJSPT-13_5-01-Erratum


SYSTEMATIC REVIEW – META ANALYSIS

Accuracy of the Lever Sign to Diagnose Anterior Cruciate Ligament Tear: A Systematic Review with Meta-Analysis.
Authors:  Reiman MP, Reiman CK, Decary S
The Lever Sign has gained recent notoriety for its purported anterior cruciate ligament (ACL) diagnostics and simplicity of performance.  The purpose of this systematic review with meta-analysis is to summarize the diagnostic accuracy of the Lever sign for use during assessment of the knee for an ACL tear in subjects with suspected acute and chronic knee injury.  A computer-assisted literature search of MEDLINE, CINAHL, and EMBASE databases using keywords related to diagnostic accuracy of the knee joint was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the search and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies (QUADAS). Mixed effects models were used to summarize accuracy.  Eight articles, with only two demonstrating high quality, were included. Six of the articles were included in a meta-analysis. Diagnostic values, utilizing arthroscopy as a gold standard, were: pooled SN 0.55 (95% CI 0.22 to 0.84), pooled SP 0.89 (95% CI 0.44 to 0.99), positive likelihood ratio (+LR) 9.2 (95% CI 0.70 to 46.1), negative likelihood ratio (-LR) 0.58 (95% CI 0.18 to 1.28). Post-test probability with a positive finding (57% sampling prevalence) reached 92% (95% CI 83 to 97%). Post-test probability with a negative finding (57% sampling prevalence) reached 43% (95% CI 39 to 47%).   Based on limited evidence of heterogeneous methodological quality, the Lever Sign can moderately change post-test probability to rule in an ACL tear. These results should be interpreted cautiously due to a limited number of studies, with small sample sizes and study quality affecting test accuracy.  

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Is Pre-Performance Massage Effective To Improve Maximal Muscle Strength and Functional Performance? A Systematic Review.
Authors:  Mine K, Lei D, Nakayama T
Although pre-performance massage is frequently used in sports settings, the evidence regarding it’s effects on muscle strength and functional performance is equivocal. The purpose of this systematic review was to synthesize the findings of randomized controlled trials (RCTs) investigating the effects of pre-performance massage on strength and functional performance.  Eight electronic databases were searched from inception until June 2017.  Nine crossover RCTs with varied methodological qualities met inclusion criteria. Six out of nine studies had low quality, while two were of moderate-quality and one was high-quality. Following the descriptive analysis using within-group effect sizes of interventions used in included studies, no evidence was found to support the use of any kind of massage interventions (passive manual massage or self-massage) to enhance maximal strength, sprint or jump performances of young healthy subjects. In fact, there appears to be limited evidence which implies the negative effects of passive manual massage. In particular, longer-duration (> 9 minutes) of massage interventions tended to result in negative effects on lower-limb maximal strength, sprint performance and jump height.  In conclusion, the use of longer-duration pre-performance massage cannot be recommended for enhancing young athletes’ strength and performance in sprint and vertical jump.

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ORIGINAL RESEARCH
Test-retest Reliability of the Limits of Stability Test Performed by Young Adults Using NeuroCom® VSR Sport.
Authors:  Lininger MR, Leahy TE, Haug EC, Bowman TG
A reliable measure of dynamic postural control is needed for inclusion in the sports-related concussion assessment battery. Currently, there is not a clinical gold standard. The Limits of Stability (LOS) test has potential to be a useful tool to collect objective data on important dynamic postural stability variables. Psychometric properties of the LOS test with healthy young adults are yet to be established. The purpose of this study was to examine the intra-session and test-retest reliability for the LOS on the NeuroCom® VSR Sport when performed by young adults. Twenty-seven healthy university students completed four trials of the LOS in each of two testing sessions one week apart. Relative reliability was measured within each session with an intraclass correlation coefficient (ICC[3,k]) for Session 1 and Session 2, respectively, on each of the five dependent variables (movement velocity [MVL], directional control [DCL], maximum excursion [MXE], endpoint excursion [EPE], and reaction time [RT]) provided by the Neurocom. Test-retest reliability was assessed using a repeated-measures analysis of variance along with an ICC (3,k) for relative reliability. An ICC value of 0.90 or higher was defined as having a high reliability, moderate reliability for ICC values between 0.80-0.89, and below 0.80 as questionable.  The reliability within each session for LOS composite scores for MVL, DCL, and MXE was moderate to high (ICC[3,k]=0.89-0.95). These same three variables also had high levels of test-retest reliability (ICC[3,k]=0.95-0.96). EPE and RT had moderate reliability over time (ICC[3,k]=0.88) but differences for within session reliability. The authors concluded that the LOS provides a reliable measure of dynamic postural control for young adults. Two trials are recommended at baseline with the first being an adaptation trial to ensure accuracy of findings. Care needs to be taken when interpreting EPE and DCL scores on post-injury tests due to a learning effect for those variables.

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Evaluation of Vertical and Horizontal Saccades using the Developmental Eye Movement Test Compared to the King-Devick Test.
Authors:   Heick JD, Bay C, McLeod TCV
Oculomotor function is impaired when an individual has a concussion and as such, it is important to identify tests that are able to assess oculomotor impairment. The King-Devick (K-D) test assesses horizontal saccadic eye movement and attention. The Developmental Eye Movement (DEM) test is designed to identify oculomotor dysfunction in children. It measures both horizontal and vertical saccades. The K-D test shows promise as a concussion-screening tool and part of a multifactorial assessment. The DEM has not been tested as a concussion assessment tool, but the neuroanatomical control of horizontal and vertical saccades originates from different areas of the brain, so one might expect to see differences in performance on the K-D and DEM tests when administered to concussed patients. First, it is important to determine if performance on the DEM and K-D tests, particularly with respect to the measurement of vertical and horizontal saccades, is similar in a healthy population. Therefore, the primary purpose was to evaluate the relationship between horizontal and vertical saccade tests over repeated trials in normal, healthy subjects. A secondary purpose of this study was to determine the number of trials needed to reach a performance plateau for both the DEM and K-D tests.  Forty-two healthy non-concussed participants (22 males, 20 females; mean age, 24.2±2.92 years) completed the six repeated trials of the DEM or K-D tests in a single testing session. All trials were performed in random order and participants were offered short rest breaks as needed between test administrations. Results indicate strong correlations, r=.67, or greater, between measurements of horizontal and vertical saccades.  Performance plateaued on the K-D at trial three and on the DEM at trial two for both horizontal and vertical saccades. It appears that the DEM and K-D tests measure similar constructs in healthy individuals and that no additional information is provided by assessment of vertical saccades. Additional studies are required to investigate the usefulness of the DEM in concussed individuals.

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The Relationship Between Trunk Rotation, Upper Quarter Dynamic Stability, and The Kerlan-Jobe Orthopaedic Clinic Overhead Athlete Shoulder and Elbow Score in Division I Collegiate Pitchers.
Authors:  Chasse P. Bullock GS, Schmitt AC, Little BA, Diehl LH, Butler RJ
The Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score is an overhead athlete self-report measure. Investigations into relationships between the KJOC and clinical measures are lacking. The purpose of this study was to assess relationships between active trunk rotation range of motion (TROM), upper quarter dynamic stability, and composite and individual item KJOC scores in collegiate baseball pitchers. A secondary purpose was to determine whether differences exist between baseball pitchers with and without an injury history in terms of their performance on TROM, upper quarter dynamic stability, and composite and individual KJOC scores. It was hypothesized that increased TROM and upper quarter dynamic stability are associated with better (higher) KJOC scores and pitchers with an injury history would exhibit lower KJOC scores compared to uninjured pitchers.  Thirty-six college pitchers were assessed for TROM, performance on the Upper Quarter Y-Balance Test (YBT-UQ) and they also completed the KJOC. Subjects were grouped based on previous injury history: injured, required surgery, (IS, n=9), injured, no surgery, (INS, n=6), and uninjured (UI, n=21). Pearson’s Correlations were used to assess relationships between clinical measurements and the KJOC. One-way ANOVAs were used to assess differences in TROM, YBT-UQ, and KJOC scores between groups (P<0.05).   No significant relationships were detected between TROM measures and KJOC composite scores (throwing arm: r= .239, p= 0.16; non-throwing arm:  r=.291, p= 0.09). A moderate relationship was found between the YBT-UQ and the KJOC scores (throwing arm:  r= .413, p= 0.01; non-throwing arm:  r=.380, p= 0.02).  The mean KJOC scores for item 1 (warm-up limitations) were significantly different between all three groups (IS: 6.7, INS: 9.7, UI: 9.1; p= 0.015). Mean scores on item 5 (strain on relationships with coaches) and item 8 (limitations in competition endurance) were significantly different between the IS and UI groups (Item 5= IS: 7.8, UI: 9.5, p= 0.02; Item 8=IS: 6.4, UI: 8.8, p= 0.04).  A positive moderate association was found between upper quarter dynamic stability as measured by the YBT-UE and the KJOC. Pitchers with no surgical history had better KJOC scores for warm up time, competitive endurance, and impact on team relationships.

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The Impact of Warm-Up on Youth Golfer Clubhead Speed and Self-Reported Shot Quality.
Authors:  Coughlan D, Taylor MJD. Jackson J
Physical preparation in golf is now considered a key component of the game. With players becoming more athletic, warm-up has become an important area in a player’s preparation for practice and competition. Much of the research to date has focused on the adult golfer, showing potential for improvements in clubhead speed, driving distance and shot quality, as well as reduction in injury risk. However, there is currently no work specifically investigating the impact of warm-up in youth golf. The aim of this study was to examine the impact of a club only warm-up and a dynamic exercise routine followed by a club warm-up on club head speed and self-reported shot quality. Using a counterbalanced repeated measures design, eight male and 13 female youth golfers completed a control (no warm-up), the club only warm-up, and an exercise based dynamic warm-up followed by club warm-up on three non-consecutive days. After each session, players were required to hit 10 maximal effort shots with a driver and clubhead speed (CHS) was recorded using a launch monitor as well as self-reported shot quality scores. Statistically significant improvements in clubhead speed and self-reported shot quality were seen in the dynamic warm-up combined with club warm-up. No significant differences were seen in the club-warm up only or control groups for either clubhead speed or self-reported shot quality. A combined dynamic physical warm-up and club warm-up improves clubhead speed and self-reported shot quality in youth golfers. However, a club warm-up alone does not seem to be sufficient in eliciting these same improvements.

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Four Weeks of Roller Massage Training Did Not Impact Range Of Motion, Pain Pressure Threshold, Voluntary Contractile Properties Or Jump Performance.
Authors:  Hodgson DD, Lima CD, Low JL, Behm DG
Roller massagers are popular devices that are used to improve range of motion (ROM), enhance recovery from muscle soreness, and reduce pain under acute conditions. However, the effects of roller massage training and training frequency are unknown. The objective was to compare two different roller massage training frequencies on muscle performance. Twenty-three recreationally active university students were randomly allocated to three groups: control (n=8;), rolling three (3/W; n=8;) and six (6/W; n=7) times per week for four weeks. The roller massage training consisted of unilateral, dominant limb, quadriceps and hamstrings rolling (4 sets x 30 seconds). Both legs of participants were tested pre- and post-training for active and passive hamstrings and quadriceps range of motion (ROM), electromyography (EMG) activity during a lunge movement, unilateral countermovement jumps (CMJ), as well as quadriceps and hamstrings maximum voluntary isometric contraction (MVIC) forces and electromechanical delay. Finally, they were tested for pain pressure threshold at middle and distal segments of their quadriceps and hamstrings. There were no significant training interactions for any measure with the exception that 3/W group exhibited 6.2% (p=0.03; Effect Size: 0.31) higher CMJ height from pre- (38.6 ± 7.1 cm) to post-testing (40.9 ± 8.1 cm) for the non-dominant limb. Whereas the literature has demonstrated acute responses to roller massage, the results of the present study demonstrate no consistent significant training-induced changes. The absence of change may highlight a lack of muscle and myofascial morphological or semi-permanent neurophysiological changes with rolling.

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Acute Effects of Two Hip Flexor Stretching Techniques on Knee Joint Position Sense and Balance.
Authors:  Aslan HIY, Buddhadev HH, Suprak DN, San Juan JG
Tightness of hip flexor muscles has been recognized as a risk factor for various musculoskeletal injuries in the lower extremities. The purpose of this study was to examine the acute effects of two hip flexor stretching techniques (dynamic and hold-relax proprioceptive neuromuscular facilitation [HR-PNF]) on hip extension (ROM), knee joint position sense (JPS) and balance in healthy college age students who exhibit tightness in hip flexor muscles. Thirty-six healthy college age students (mean = 22.37 years) with tight hip flexors participated in this study. Hip extension ROM, knee joint position sense and dynamic balance were tested pre- and post-stretching using a digital inclinometer, an iPod touch and the Y-Balance test respectively. Subjects were randomly divided into dynamic and HR-PNF stretching groups. Three-way mixed analysis of variance was utilized to explore if an interaction existed between the groups in tested variables. There was a significant effect of time on hip extension ROM in both groups (p < 0.001). There was also a significant effect of stretch type on hip extension ROM (p = 0.004) favoring hold-relax over dynamic stretching group. There was a non-significant effect of time on mean knee joint position replication error in both groups. There was a significant main effect of time on the Y-Balance test’s mean distance of reach to posteromedial and posterolateral directions (p < 0.001). There was also a significant main effect of directions of reach on distances achieved (p < 0.001) favoring posterolateral over posteromedial, and the latter over anterior direction. The results of this study demonstrated the effectiveness of both HR-PNF and dynamic stretching techniques which resulted in a significant acute improvement in hip extension ROM and dynamic balance measures,  with HR-PNF being more effective than dynamic stretch. However, there were no significant improvements in knee joint position replication over time in either stretching group.

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Validity and Reliability of the Fitbit Flex™ and ActiGraph GT3X+ at Jogging and Running Speeds.
Authors:  Jones D, Crossley K, Dascombe B, Hart HF, Kemp J
Monitoring levels of physical activity, as an outcome or in guiding rehabilitation, is challenging for clinicians. Personal activity monitors are increasing in popularity and provide potential to enhance rehabilitation protocols. However, research to support the validity and reliability of these devices at jogging and running speeds is limited. The purpose of this study was to evaluate the validity of the Fitbit Flex™ and ActiGraph GT3X+ for measuring step count at jogging and running speeds. A secondary purpose was to examine inter-device reliability of the Fitbit Flex™. Thirty healthy participants aged between 19 and 50 years, completed a treadmill protocol at jogging and running speeds (8 km/h to 16 km/h). Treadmill speed was progressively increased by intervals of 2 km/h. Each interval was four minutes in duration with a two minute rest period between stages. Participants were encouraged to continue through the graded exercise test until they reached the maximum running speed that they felt they could maintain for four minutes. Step count data was collected for Fitbit Flex™ devices and the ActiGraph GT3X+. Video analysis of step count was used as the criterion measure. At speeds of 8 to 14 km/h Mean Absolute Percentage Errors were ≤1% for the Fitbit Flex™ and the ActiGraph GT3X+ when compared to step count via video analysis. Standard Error of Measurement between the three Fitbit Flex™ devices was ≤7 steps for speeds of 8 to 14 km/h and varied between 9 to 19 steps at 16 km/h. Fitbit Flex™ devices showed good to excellent between device reliability at speeds of 8 to14 km/h (ICC 0.723 to 0.999; p ≤0.001). Greater variability was evident with the low participant numbers at 16 km/h (ICC 0.527 to 0.896; p ≥0.02). Both the Fitbit Flex™ and the ActiGraph GT3X+ provide a valid account of steps taken jogging and running speeds up to 14 km/hr, attainable by non-elite runners on a treadmill. Fitbit Flex™ devices provide equivalent step count output to each other, enabling comparison between devices during treadmill jogging and running.

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Comparison Of Bilateral and Unilateral Squat Exercises On Barbell Kinematics And Muscle Activation.
Authors:  Eliassen W, Saeterbakken AH, van den Tillaar RVD
Bilateral squats are commonly used in lower body strength training programs, while unilateral squats are mainly used as additional or rehabilitative exercises. Little has been reported regarding the kinetics, kinematics and muscle activation in unilateral squats in comparison to bilateral squats. Therefore, the purpose of this study was to compare muscle activity, kinetics, and barbell kinematics between unilateral and bilateral squats with the same external load per leg in experienced resistance-trained participants.  Fourteen resistance-trained males (age 23±4years, body mass 80.5±8.5kg and height 1.81±0.06m) participated. Barbell kinematics and surface electromyography (EMG) activity of eleven muscles were measured during the descending and ascending phase of each repetition of the squat exercises. Total lifting time was longer and average and peak velocity were lower for the bilateral squat (p<0.001). Furthermore, higher muscle activity was found in the three quadriceps muscles, biceps femoris (ascending phase) and the erector spinae (ascending phase) in the bilateral squat, while greater activation for the semitendinosis (descending phase) (p=0.003) was observed for the unilateral squat with foot forwards. In the ascending phase, the prime movers showed increased muscle activity with repetition from repetition 1 to 4 (p≤0.034).  Unilateral squats with the same external load per leg produced greater peak vertical ground reaction forces than bilateral squats, as well as higher barbell velocity, which is associated with strength development and rate of force development, respectively. The authors suggest using unilateral rather than bilateral squats for people with low back pain and those enrolled in rehabilitation programs after ACL ruptures, as unilateral squats are performed with small loads (28 vs. 135 kg) but achieve similar magnitude of muscle activity in the hamstring, calf, hip and abdominal muscles and create less load on the spine.

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Isokinetic Muscle Performance After Anterior Cruciate Ligament Reconstruction: A Case-control Study.
Authors:  Pelegrinelli ARM, Guenka LC, Dias JM, Bela LFD, Silva MF, Moura FA, Brown LE, Cardoso JR
Knee muscle strength deficits have been reported in individuals who have undergone anterior cruciate ligament reconstruction (ACLR). Isokinetic testing is a valid way to assess muscle strength. Some isokinetic variables, including the range of motion in the phases to attain a specific velocity, load range (sustained specific velocity), time to achieve deceleration, and qualitative analysis of the torque-angle velocity relationship, may contribute to understanding recovery of these individuals after surgery. Thus, the purpose of this study was to compare the load range (LR), time to attain velocity (TTAV), deceleration time (DT) phases, total range of motion (ROM), peak torque/body mass (PT/BM), angle of peak torque (AngPT) during LR and torque-angle-velocity relationships (TAV3D) between post ACLR and matched control subjects. Seven men who underwent ACLR and seven matched controls were evaluated from four to six months after surgery. Testing was performed on a Biodex System 4 isokinetic dynamometer in concentric mode at 60, 120 and 300 °/s, for knee flexion and extension. Statistically significant differences were seen for extension ROM at 60 °/s where ROM was greater in the control group. PT/BM for extensors was also significantly greater in controls by 20 % compared to ACLR at 60 and 120 °/s. PT/BM for flexors was significantly greater for controls at 60 °/s (~15 %). TAV3D showed differences in torque and, specifically, the control group sustained knee flexion torque for a greater range of motion when compared to the ACLR group. The ACL group presented with lower ROM and PT/BM, therefore exhibiting worse muscle performance in comparison to the control group.

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Acute Effect of Low-Intensity Eccentric Exercise on Angle of Peak Torque in Subjects With Decreased Hamstring Flexibility.
Authors:  Nishida S, Tomoto T, Maehara K, Miyakawa S
Decreased hamstring flexibility and the angle of peak torque (APT) occurring at a shorter muscle length are considered risk factors for hamstring strain injury. Subjects with decreased hamstring flexibility have an APT that occurs at a shorter muscle length; hence, the susceptibility to hamstring strain injury could be associated with the APT occurring at a shorter muscle length. Low-intensity eccentric exercise (ECC-Ex) may reduce hamstring strain injury risk in the subjects with decreased hamstring flexibility by allowing the APT to occur a longer muscle length. However, the acute effect of low-intensity ECC-Ex on the subjects with decreased hamstring flexibility has not been established. The purpose of this study was to investigate the acute effect of low-intensity ECC-Ex on the peak torque, APT, and hip flexion angle in the subjects with decreased hamstring flexibility. The authors hypothesized that low-intensity ECC-Ex would shift the APT, allowing it to occur at a longer muscle length with a minimum decrease of peak torque and hip flexion angle in the subjects with decreased hamstring flexibility. Twelve male college students were categorized into normal group [n = 6 (12 legs)] and decreased hamstring flexibility group [n = 6 (12 legs)] based on the median value of the baseline hip flexion angle (i.e., 80.8°) measured by passive straight leg raise test. Peak torque and APT during maximal voluntary eccentric knee flexion (via isokinetic dynamometer) and hip flexion angle were evaluated before and after the low-intensity ECC-Ex in both groups. Low-intensity ECC-Ex shifted the APT, causing it to occur at a longer muscle length in the decreased hamstring flexibility group. Low-intensity ECC-Ex increased the hip flexion angle and did not change the peak torque in both groups. The results of the present study demonstrated that low-intensity ECC-Ex shifts the APT to occur at a longer muscle length and increases the hip flexion angle without a decrease in peak torque in the subjects with the decreased hamstring flexibility.

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Testing Infraspinatus and Deltoid Muscles with A New Technique to Decrease Deltoid Activity During Testing Using EMG Analysis.
Authors:  Forbush SW, Bandy WD, Garrison MK, Graves LC, Roberts R
Muscle strength testing of an injured infraspinatus muscle (IM) is confounded by actions of synergistic muscles such as the posterior deltoid (PD). The purpose of this study was to describe a condition for testing of the IM that results in less EMG activity of the PD musculature. The researchers hypothesized that greater inhibition of the PD could be achieved through active adduction (AA), creating reciprocal inhibition of the PD. Thirty-four (19 females and 15 males) right-handed subjects between the ages of 22- 31 (mean 24.2 years +/- 6.2) with no previous history of shoulder surgery or pathology participated.  Surface electrodes were placed over the muscle bellies of the IM and PD of the right shoulder along with a ground electrode over the C7 spinous process. EMG activity was recorded during resisted external rotation in four different testing conditions (seated active and passive adduction, and side-lying active and passive adduction). The order of test positions was randomly assigned, and each subject completed all four positions with appropriate rest.  During AA conditions, subjects were asked to adduct the humerus against a sphygmomanometer (using 80% maximum force output) while maximal effort external rotation was manually resisted. PD activity was significantly less during AA than with no AA (p<0.05) in both test positions. No significant difference occurred between IM EMG activity in the various test conditions. The results of this study suggest that clinicians can reduce activity of the PD without reducing activity of the IM by using AA of the humerus before applying manual resistance to test the IM during manual muscle testing.

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CASE SERIES / STUDIES

A Novel Approach to Treatment Utilizing Breathing and a Total Motion Release® Exercise Program in a High School Cheerleader with a Diagnosis of Frozen Shoulder: A Case Report.
Authors:  Tyree KA, May J
Frozen shoulder (FS) is a condition of the shoulder that is characterized by gradual loss of passive and active range of motion of the glenohumeral joint. Current treatment recommendations remain unclear due to the elusive etiology of FS and absence of nomenclature in the literature. The purpose of this case report is to describe the effects of treatment guided by the assessment and treatment of a breathing pattern disorder (BPD) coupled with Total Motion Release® on a 17-year high school cheerleader with a diagnosis of frozen shoulder. In this case report, breathing treatments, coupled with a TMR® exercise program, were beneficial for this patient and provided a clinically meaningful resolution of her condition.

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CLINICAL COMMENTARY
Roller Massage: Survey of Physical Therapy Professionals and A Commentary On Clinical Standards- Part II.
Authors:  Cheatham SW, Stull KR, Wright TA
Roller massage (RM) has become a popular intervention prescribed by physical therapy (PT) professionals. While this popularity has stimulated an increase in research and product development, the trends in the use of RM among PT professionals remain undocumented. It is unknown how professionals are using RM and integrating the research into their clinical practice. The purpose of this clinical commentary was to survey and document responses in the knowledge, clinical application methods, and use of RM devices among PT professionals in the United States. A 20-question online survey related to personal and professional demographics, beliefs about RM, preferred RM devices, RM exercise prescription, and client education was emailed to PT members of the Orthopedic and Sports Physical Therapy Sections. A total of 685 sports and orthopedic PT professionals completed the survey. Most professionals surveyed believe that RM decreases pain (80%), increases mobility (68%), and increases range of motion (ROM) (40%). Fifty-one percent believed moderate density rollers have the greatest effect. Eighty percent of professionals use a foam roller in their practice and 51% recommend to clients. A high proportion of professionals prescribe RM for injury treatment (82%) and for pre and post-exercise interventions (55%). Most professionals recommend rolling daily for 30 seconds to two minutes (55%), per muscle group (64%), at a self-paced cadence (47%). A high proportion of professionals use patient reported outcomes (80%), followed by joint ROM (59%), and movement-based testing (42%) to measure effects of RM. Eighty-seven percent of professionals use live instruction to educate clients and 91% believe there is a gap in the research. The results of this survey should be considered descriptive and a starting point for future research to establish consensus on optimal RM programming, devices, and application parameters for different musculoskeletal conditions. The observed responses provide some insight into how PT professionals are using RM in their practice and highlight the existing gap between the research and professional practice.

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