QUANTIFYING FRONTAL PLANE KNEE MOTION DURING SINGLE LIMB SQUATS: RELIABILITY AND VALIDITY OF 2‐DIMENSIONAL MEASURES

Background:

Clinical assessment of lower limb kinematics during dynamic tasks may identify individuals who demonstrate abnormal movement patterns that may lead to etiology of exacerbation of knee conditions such as patellofemoral joint (PFJt) pain.

Purpose:

The purpose of this study was to determine the reliability, validity and associated measurement error of a clinically appropriate two‐dimensional (2‐D) procedure of quantifying frontal plane knee alignment during single limb squats.

Methods:

Nine female and nine male recreationally active subjects with no history of PFJt pain had frontal plane limb alignment assessed using three‐dimensional (3‐D) motion analysis and digital video cameras (2‐D analysis) while performing single limb squats. The association between 2‐D and 3‐D measures was quantified using Pearson''s product correlation coefficients. Intraclass correlation coefficients (ICCs) were determined for within‐ and between‐session reliability of 2‐D data and standard error of measurement (SEM) was used to establish measurement error.

Results:

Frontal plane limb alignment assessed with 2‐D analysis demonstrated good correlation compared with 3‐D methods (r = 0.64 to 0.78, p < 0.001). Within‐session (0.86) and between‐session ICCs (0.74) demonstrated good reliability for 2‐D measures and SEM scores ranged from 2° to 4°.

Conclusion:

2‐D measures have good consistency and may provide a valid measure of lower limb alignment when compared to existing 3‐D methods.

Clinical Relevance:

Assessment of lower limb kinematics using 2‐D methods may be an accurate and clinically useful alternative to 3‐D motion analysis when identifying individuals who demonstrate abnormal movement patterns associated with PFJt pain.

Level of Evidence:

2b     

CLINICAL EFFECTIVENESS OF KINESIOLOGICAL TAPING ON PAIN AND PAIN‐FREE SHOULDER RANGE OF MOTION IN PATIENTS WITH SHOULDER IMPINGEMENT SYNDROME: A RANDOMIZED,DOUBLE BLINDED,PLACEBO‐CONTROLLED TRIAL

Background:

Kinesiological taping (KT) is commonly used to improve symptoms associated with musculoskeletal disorders. However, review of the literature revealed minimal evidence to support the use of KT in treatment of shoulder disorders and controversy exists regarding the effect of KT in patients with shoulder impingement syndrome (SIS).

Objective:

The purpose of this study was to investigate the effect of KT on pain intensity during movement, pain experienced during the night (nocturnal pain), and pain‐free shoulder range of motion (ROM) immediately after taping, after three days and after one week, in patients with SIS.

Design:

Randomized, Double blinded, Placebo‐controlled design.

Participants:

A total of 30 patients with SIS participated in this study. Patients were assigned randomly to a control (N = 15) and an experimental group (N = 15).

Methods:

The patients in the experimental group received a standardized therapeutic KT. The standardized, placebo neutral KT was applied for control group. KT was applied two times with a three day interval, remaining on during the 3 day interval. Both groups followed the same procedures. Pain‐free active ROM during shoulder abduction, flexion, and elevation in the scapular plane was measured. Visual analogue scale (VAS) for pain intensity during movement or nocturnal pain and was assessed at baseline, immediately after KT, after three days, and one week after KT.

Results:

The result of repeated measures ANOVA showed a significant change in pain level during movement, nocturnal pain, and pain‐free ROM (p = 0.000) after KT in the experimental group. In the ANCOVA, controlling for pre‐test scores, change in pain level at movement (p = 0.009) and nocturnal pain (p = 0.04) immediately after KT was significantly greater in the experimental group than in control group. There was no significant difference in ROM measures (p > 0.05) between groups immediately after KT. No significant differences were found between the two groups in the after one week measurements of pain intensity and shoulder ROM.

Conclusion:

The KT produces an immediate improvement in the pain intensity at movement and nocturnal pain in patients with SIS.

Level of Evidence:

1     

A TOTAL MOTION RELEASE WARM‐UP IMPROVES DOMINANT ARM SHOULDER INTERNAL AND EXTERNAL ROTATION IN BASEBALL PLAYERS

Context:

Current literature indicates a correlation between decreased total shoulder range of motion (ROM) and internal rotation (IR) of the dominant arm and increased injury risk in throwers. The optimal method for increasing shoulder ROM, improving performance, and preventing injury is unknown. It is also unknown if treating the non‐dominant arm may affect ROM on the dominant side.

Purpose:

To explore the effect of the Total Motion Release (TMR®) Trunk Twist (TT) and Arm Raise (AR) on IR and external rotation (ER) of the dominant shoulder in baseball players compared to a traditional dynamic warm‐up.

Design:

Cohort study.

Setting:

University athletic training clinic and baseball field.

Participants:

Pitchers (males, n = 10; age, 18.6 ± 1.3) recruited from local baseball teams were randomly assigned two one of two groups: TMR® treatment group (TMRG; n = 5) or traditional warm‐up group (TWG; n = 5).

Interventions:

Baseline IR and ER goniometry range of motion (ROM) measurements were recorded. The TMRG then completed the TMR® exercises and post‐intervention measurements. The TWG completed a traditional static and dynamic warm‐up (e.g., lunges, power skips, sprints, sleeper stretch) and then completed post‐intervention measurements. Following the completion of those measurements, the TWG completed the TMR® Trunk Twist and Arm Raise protocol and had post‐intervention measurements recorded once more.

Main Outcome Measures:

ROM measures for IR and ER of the dominant shoulder. Alpha level was set at p ≤ 0.05.

Results

Significant differences were present for IR (p = 0.025) and ER (p = 0.014) between the TMRG and the TWG after initial intervention. Significant differences for IR were present in the TWG between baseline and TMR® intervention and traditional warm‐up and TMR® intervention. For the TWG, changes in ER were not statistically significant at baseline, post‐warm‐up, or post‐ TMR® intervention. Significant differences were not present for IR (p = 0.44) or ER (p = 0.23) between groups once TMR® had been completed by both groups.

Conclusions:

TMR® produced larger increases in IR and ER of the throwing shoulder when compared to the TWG. Generalizability is limited, however, by the low number of participants in each group and a potential ceiling effect of attainable ROM gains. Future studies should examine if using a full TMR® treatment process is more beneficial. Additionally, future research should compare TMR® intervention to other warm‐up activities or stretching protocols (e.g. resistance tubing, weighted balls) and examine its effect across other variables (e.g., injury rates, throwing velocity).

Level of Evidence:

Clinical Evidence Based Level 2b     

THE EFFECTS OF CONVENTIONAL PHYSICAL THERAPY AND ECCENTRIC STRENGTHENING FOR INSERTIONAL ACHILLES TENDINOPATHY

Study Design:

Single‐blind, randomized, clinical trial.

Background:

The effect of eccentric training for mid‐portion Achilles tendinopathy is well documented; however, its effect on insertional Achilles tendinopathy is inconclusive. The primary purpose of this study was to investigate the effect of eccentric training on pain and function for individuals with insertional Achilles tendinopathy.

Methods:

All patients received a 12‐week conventional strengthening protocol. Patients who were randomly assigned to the experimental group received additional eccentric exercises. Patients completed the Short Form‐36 Health and Bodily Pain Surveys, the Foot and Ankle Outcomes Questionnaire, and the Visual Analog Scale at initial evaluation, after 6 weeks of therapy, and at 12 weeks after therapy.

Results:

Thirty‐six patients (20 control and 16 experimental; average age 54 years; 72% women) completed the study. Both groups experienced statistically significant decreases in pain and improvements in function. No statistically significant differences were noted between the groups for any of the outcome measures.

Conclusion:

Conventional physical therapy consisting of gastrocnemius, soleus and hamstring stretches, ice massage on the Achilles tendon, and use of heel lifts and night splints with or without eccentric training is effective for treating insertional Achilles tendinopathy.

Level of Evidence:

Level 2