INTRA‐RATER AND INTER‐RATER RELIABILITY OF THE FIVE IMAGE‐BASED CRITERIA OF THE FOOT POSTURE INDEX‐6

Purpose/Background:

The Foot Posture Index‐6 (FPI‐6) is considered a simple quantification tool to assess static foot alignment. Palpation of the foot is required for assessment of one of the six criteria that comprise the FPI‐6; the remaining five criteria may be evaluated using still‐frame photographs. Using only the image‐based criteria may allow multiple clinicians to evaluate large groups of patients quickly. Reliability using only these five image‐based criteria has not been established. The purposes of the current study were to establish the inter‐ and intra‐rater reliability using five image‐based criteria from the Foot Posture Index‐6 (FPI‐6) as well as to examine the agreement between the raters in identifying foot type using the composite five FPI scores.

Methods:

Forty participants (23 females, 17 males; 23.67 ± 8.49 years; 64.59 ± 14.43 kg; 166.07 ± 11.79 cm) volunteered for this study. An investigator took three photos with a digital camera of the medial longitudinal arch, posterior ankle, and of the talonavicular joint approximately 45° from the posterior calcaneus for both right and left feet. Two investigators assessed the five image‐based criteria of the FPI‐6 for both feet of 40 participants on three occasions separated by a day. Inter‐and intra‐rater reliability were assessed with Intraclass Correlation Coefficients (ICC_3,2). The amount of agreement for classification of foot posture type between the two raters was assessed with Cohen''s kappa coefficient. Significance was set a priori at P < 0.05.

Results:

The inter‐rater reliability was poor to moderate for all three sessions (ICC_3,2 = 0.334‐0.634). For the foot posture classification, the amount of agreement between two raters was poor for left (κ= 0.12) and right (κ= 0.19) feet. The intra‐rater reliability was excellent for left (ICC_3,2=0.956) and right feet (ICC_3,2=0.959).

Conclusions:

Excellent intra‐rater and poor to moderate inter‐rater reliability was found using only the five image‐based criteria of the FPI‐6. However, the classification of foot posture did not improve the amount of agreement between raters. Therefore, caution is needed when interpreting FPI scores from five image‐based criteria.

Levels of Evidence:

3b     

CROSS‐CULTURAL ADAPTATION AND VALIDATION OF THE KOREAN VERSION OF THE CUMBERLAND ANKLE INSTABILITY TOOL

Background

The Cumberland Ankle Instability Tool (CAIT) is a valid and reliable patient reported outcome used to assess the presence and severity of chronic ankle instability (CAI). The CAIT has been cross‐culturally adapted into other languages for use in non‐English speaking populations. However, there are no valid questionnaires to assess CAI in individuals who speak Korean.

Purpose

The purpose of this study was to translate, cross‐culturally adapt, and validate the CAIT, for use in a Korean‐speaking population with CAI.

Study Design

Cross‐cultural reliability study.

Methods

The CAIT was cross‐culturally adapted into Korean according to accepted guidelines and renamed the Cumberland Ankle Instability Tool‐Korean (CAIT‐K). Twenty‐three participants (12 males, 11 females) who were bilingual in English and Korean were recruited and completed the original and adapted versions to assess agreement between versions. An additional 168 national level Korean athletes (106 male, 62 females; age = 20.3 ± 1.1 yrs), who participated in ≥ 90 minutes of physical activity per week, completed the final version of the CAIT‐K twice within 14 days. Their completed questionnaires were assessed for internal consistency, test‐retest reliability, criterion validity, and construct validity.

Results

For bilingual participants, intra‐class correlation coefficients (ICC_2,1) between the CAIT and the CAIT‐K for test‐retest reliability were 0.95 (SEM=1.83) and 0.96 (SEM=1.50) in right and left limbs, respectively. The Cronbach''s alpha coefficients were 0.92 and 0.90 for the CAIT‐K in right and left limbs, respectively. For native Korean speakers, the CAIT‐K had high internal consistency (Cronbach''s α=0.89) and intra‐class correlation coefficient (ICC_2,1 = 0.94, SEM=1.72), correlation with the physical component score (rho=0.70, p = 0.001) of the Short‐Form Health Survey (SF‐36), and the Kaiser‐Meyer‐Olkin score was 0.87.

Conclusions

The original CAIT was translated, cross‐culturally adapted, and validated from English to Korean. The CAIT‐K appears to be valid and reliable and could be useful in assessing the Korean speaking population with CAI.     

KINESIOLOGY TAPING AND THE WORLD WIDE WEB: A QUALITY AND CONTENT ANALYSIS OF INTERNET‐BASED INFORMATION

Background:

Due to limited regulation of websites, the quality and content of online health‐related information has been questioned as prior studies have shown that websites often misrepresent orthopaedic conditions and treatments. Kinesiology tape has gained popularity among athletes and the general public despite limited evidence supporting its efficacy. The primary objective of this study was to assess the quality and content of Internet‐based information on Kinesiology taping.

Methods:

An Internet search using the terms “Kinesiology tape” and “kinesiology tape” was performed using the Google search engine. Websites returned within the first two pages of results, as well as hyperlinks embedded within these sites, were included in the study. These sites were subsequently classified by type. The quality of the website was determined by the Health On the Net (HON) score, an objective metric based upon recommendations from the United Nations for the ethical representation of health information. A content analysis was performed by noting specific misleading versus balanced features in each website.

Results:

A total of 31 unique websites were identified. The majority of the websites (71%) were commercial. Out of a total possible 16 points, the mean HON score among the websites was 8.9 points (SD 2.2 points). The number of misleading features was significantly higher than the balanced features (p < 0.001). Fifty‐eight percent of sites used anecdotal testimonials to promote the product. Only small percentages of websites discussed complications, alternatives, or provided accurate medical outcomes. Overall, commercial sites had a greater number of misleading features compared to non‐commercial sites (p = 0.01).

Conclusions:

Websites discussing Kinesiology tape are predominantly of poor quality and present misleading, imbalanced information. It is of ever‐increasing importance that healthcare providers work to ensure that reliable, balanced, and accurate information be available to Internet users.

Level of Evidence:

IV     

RELIABILITY OF VIDEO‐BASED QUANTIFICATION OF THE KNEE‐ AND HIP ANGLE AT FOOT STRIKE DURING RUNNING

Introduction:

In clinical practice, joint kinematics during running are primarily quantified by two‐dimensional (2D) video recordings and motion‐analysis software. The applicability of this approach depends on the clinicians’ ability to quantify kinematics in a reliable manner. The reliability of quantifying knee‐ and hip angles at foot strike is uninvestigated.

Objective:

To investigate the intra‐ and inter‐rater reliability within and between days of clinicians’ ability to quantify the knee‐ and hip angles at foot strike during running.

Methods:

Eighteen recreational runners were recorded twice using a clinical 2D video setup during treadmill running. Two blinded raters quantified joint angles on each video twice with freeware motion analysis software (Kinovea 0.8.15)

Results:

The range from the lower prediction limit to the upper prediction limit of the 95% prediction interval varied three to eight degrees (within day) and nine to 14 degrees (between day) for the knee angles. Similarly, the hip angles varied three to seven degrees (within day) and nine to 11 degrees (between day).

Conclusion:

The intra‐ and inter rater reliability of within and between day quantifications of the knee‐ and hip angle based on a clinical 2D video setup is sufficient to encourage clinicians to keep using 2D motion analysis techniques in clinical practice to quantify the knee‐ and hip angles in healthy runners. However, the interpretation should include critical evaluation of the physical set‐up of the 2D motion analysis system prior to the recordings and conclusions should take measurement variations (3‐8 degrees and 9‐14 degrees for within and between day, respectively) into account.

Level of evidence:

3     

IMMEDIATE EFFECTS OF A DYNAMIC ROTATION‐SPECIFIC WARM‐UP ON X‐FACTOR AND X‐FACTOR STRETCH IN THE AMATEUR GOLFER

Background

Recent evidence suggests performing a warm‐up prior to golf can improve performance and reduce injuries. While some characteristics of effective golf warm‐ups have been determined, no studies have explored the immediate effects of a rotational‐specific warm‐up with elements of motor control on the biomechanical aspects of the full X‐Factor and X‐Factor Stretch during the golf swing.

Methods

Thirty‐six amateur golfers (mean ± SD age: 64 ± 8 years old; 75% male) were randomized into a Dynamic Rotation‐Specific Warm‐up group (n=20), or a Sham Warm‐up group (n=16). X‐Factor and X‐Factor Stretch were measured at baseline and immediately following the warm‐up. Mixed model ANCOVAs were used to determine if a Group*Time interaction existed for each variable with group as the between‐subjects variable and time as the within‐subjects variable.

Results

The mixed model ANCOVAs did not reveal a statistically significant group*time interaction for X‐Factor or X‐Factor Stretch. There was not a significant main effect for time for X‐Factor but there was for X‐Factor Stretch. These results indicate that neither group had a significant effect on improving X‐Factor, however performing either warm‐up increased X‐Factor Stretch without significant difference between the two.

Conclusions

The results of this study suggest that performing the Dynamic Rotation‐Specific Warm‐up did not increase X‐Factor or X‐Factor Stretch when controlled for age compared to the Sham Warm‐up. Further study is needed to determine the long‐term effects of the Dynamic Rotation‐Specific Warm‐up on performance factors of the golf swing while examining across all ages.

Level of Evidence

2b     

STUDIES ON THE MECHANISM OF IMMUNITY IN TUBERCULOSIS : THE R?LE OF EXTRACELLULAR FACTORS AND LOCAL IMMUNITY IN THE FIXATION AND INHIBITION OF GROWTH OF TUBERCLE BACILLI

1. The fate of bacilli of reinfection at the portal of entry and in metastatic foci, and also the associated host responses, are essentially similar in rabbits and guinea pigs. 2. However, in the guinea pig tubercle bacilli of reinfection are more effectively fixed at the portal of entry than in the rabbit. 3. The guinea pig fixes at the site of reinfection unrelated substances, such as trypan blue and agar particles, more effectively than the rabbit. 4. At the site of a local non-specific inflammation precipitins from the circulating blood accumulate in higher concentration in tuberculous guinea pigs than in tuberculous rabbits. 5. These differing fixing capacities of the two species are associated with differences of extracellular character in the inflammation resulting from reinfection. (a) In the guinea pig, whose tissues are highly sensitized and greatly injured by the tubercle bacillus, the lymphatics adjoining the site of reinfection become thrombosed. In the rabbit whose tissues are moderately sensitized and less injured by the tubercle bacillus the corresponding lymphatics remain open. (b) In the guinea pig the fibrinous network at the site of inflammation forms a fine sieve-like structure. In the rabbit this network forms a coarse sieve-like barrier. 6. In rabbits and guinea pigs primarily infected, the destruction of tubercle bacilli takes place first and most extensively at the portal of entry. At this time they are less effectively destroyed in the nearest metastatic foci. Simultaneously they are still growing without hinderance in such foci in remote internal organs. 7. The cell-free body fluids of normal animals support the growth of tubercle bacilli in vivo. The body fluids of tuberculous animals under the same conditions are bacteriostatic for this microorganism. 8. Tubercle bacilli often multiply by preliminary subdivision into non-acid-fast granules, from which the acid-fast rods sprout. This confirms the work of Kahn.     

INTRA‐ AND INTER‐RATER RELIABILITY OF THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT (SFMA)

Purpose/Background:

The Selective Functional Movement Assessment (SFMA) is a clinical assessment system designed to identify musculoskeletal dysfunction by evaluation of fundamental movements for limitations or symptom provocation. The purpose of this study was to determine the intra‐ and inter‐rater reliability of the ten fundamental movement patterns of the SFMA in a healthy population using the SFMA categorical and criterion checklist scoring tools.

Methods:

35 healthy subjects (22.9 years +/− 1.9) were recorded with two digital video cameras (1‐frontal view/1‐sagittal view) while they performed the ten fundamental movements patterns that comprise the SFMA. Evaluators with varying experience with the SFMA (rater A, > 100 hours; rater B, 25 hours; and rater C, 16 hours) and not present at the initial data collection evaluated each video using categorical and criterion checklist scoring tools. Evaluators repeated this process at least one week later. The evaluators'' composite results were compared between and within raters using the kappa coefficient and ICC''s for categorical scoring and criterion checklist scoring, respectively.

Results

Substantial to almost perfect intra‐rater reliability of the SFMA (kappa, % agreement) was observed for all raters using the categorical scoring tool (rater A: .83, .91; rater B: .78, .88; and rater C: .72, .85). The criterion checklist scoring tool yielded intra‐rater ICCs (3,1; 95% confidence interval) ranging from good to poor with rater A demonstrating the highest reliability (ICC [SEM]) (.52 [2.36]) and rater C the lowest reliability (.26 [3.42]). Inter‐rater reliability of the categorical scoring tool was slight to substantial (.41‐.61, .69‐.79) while the criterion checklist tool (ICC 2,1) demonstrated unacceptable inter‐rater reliability when assessed in all raters together (.43 [2.7]).

Conclusions

As hypothesized, intra‐and inter‐rater reliability of categorical scoring and criterion checklist scoring of the ten fundamental movements of the SFMA was higher in raters with greater experience.     

THE EFFICACY OF TAPING FOR ROTATOR CUFF TENDINOPATHY: A SYSTEMATIC REVIEW AND META‐ANALYSIS

Background

Rotator cuff (RC) tendinopathy is a highly prevalent musculoskeletal disorder. Non‐elastic taping (NET) and kinesiology taping (KT) are common interventions used by physiotherapists. However, evidence regarding their efficacy is inconclusive.

Objective

To examine the current evidence on the clinical efficacy of taping, either NET or KT, for the treatment of individuals with RC tendinopathy.

Study Design

Systematic review and meta‐analysis

Methods

A literature search was conducted in four bibliographical databases to identify randomized controlled trials (RCT) that compared NET or KT to any other intervention or placebo for treatment of RC tendinopathy. Internal validity of RCTs was assessed with the Cochrane Risk of Bias tool. A qualitative or quantitative synthesis of evidence was performed.

Results

Ten trials were included in the present review on overall pain reduction or improvement in function. Most RCTs had a high risk of bias. There is inconclusive evidence for NET, either used alone or in conjunction with another intervention. Based on pooled results of two studies (n=72), KT used alone resulted in significant gain in pain free flexion (MD: 8.7 ° 95%CI 8.0 ° to 9.5 °) and in pain free abduction (MD: 10.3 ° 95%CI 9.1 ° to 11.4 °). Based on qualitative analyses, there is inconclusive evidence on the efficacy of KT when used alone or in conjunction with other interventions on overall pain reduction or improvement in function.

Conclusion

Although KT significantly improved pain free range of motion, there is insufficient evidence to formally conclude on the efficacy of KT or NET used alone or in conjunction with other interventions in patients with RC tendinopathy.

Level of Evidence

Therapy, level 1a     

ROLLER‐MASSAGER APPLICATION TO THE HAMSTRINGS INCREASES SIT‐AND‐REACH RANGE OF MOTION WITHIN FIVE TO TEN SECONDS WITHOUT PERFORMANCE IMPAIRMENTS

Background:

Foam rollers are used to mimic myofascial release techniques and have been used by therapists, athletes, and the general public alike to increase range of motion (ROM) and alleviate pressure points. The roller‐massager was designed to serve a similar purpose but is a more portable device that uses the upper body rather than body mass to provide the rolling force.

Objectives/Purpose:

A roller massager was used in this study to examine the acute effects on lower extremity ROM and subsequent muscle length performance.

Methods:

Seven male and ten female volunteers took part in 4 trials of hamstrings roller‐massager rolling (1 set – 5 seconds, 1 set – 10 seconds, 2 sets – 5 seconds, and 2 sets – 10 seconds) at a constant pressure (13 kgs) and a constant rate (120 bpm). A group of 9 participants (three male, six female) also performed a control testing session with no rolling intervention. A sit and reach test for ROM, along with a maximal voluntary contraction (MVC) force and muscle activation of the hamstrings were measured before and after each session of rolling.

Results:

A main effect for testing time (p<0.0001) illustrated that the use of the roller‐massager resulted in a 4.3% increase in ROM. There was a trend (p=0.069) for 10s of rolling duration to increase ROM more than 5s rolling duration. There were no significant changes in MVC force or MVC EMG activity after the rolling intervention.

Conclusions:

The use of the roller‐massager had no significant effect on muscle strength, and can provide statistically significant increases in ROM, particularly when used for a longer duration.     

THE EFFECTS OF ANTICIPATION ON THE MECHANICS OF THE KNEE DURING SINGLE‐LEG CUTTING TASKS: A SYSTEMATIC REVIEW

Background

ACL injuries are common in sports, which has resulted in the development of risk screening and injury prevention programs to target modifiable neuromuscular risk factors. Previous studies which have analyzed single‐leg cutting tasks have reported that the anticipation status of the task (pre‐planned vs. unanticipated) has a significant effect on the mechanics of the knee.

Hypothesis/Purpose

The purpose of this systematic review is to assess the effect of anticipation on the mechanics of the knee in the sagittal, frontal, and transverse planes during tasks which athletes frequently perform during competition.

Study Design

Systematic Review

Methods

The following databases were searched using relevant key words and search limits: Pub Med, SPORTDiscus, CINAHL, and Web of Science. A modified version of the Downs and Black checklist was used to assess the methodological quality of the articles by two independent reviewers.

Results

284 articles were identified during the initial database search. After a screening process, 34 articles underwent further review. Of these articles, 13 met the criteria for inclusion in this systematic review.

Conclusions

It appears that tasks which do not allow a subject to pre‐plan their movement strategy promote knee mechanics which may increase an athlete''s risk of injury.

Clinical Relevance

Clinicians involved in the development and implementation of ACL injury risk screening and prevention programs may want to consider incorporating tasks which do not allow time for pre‐planning. These unanticipated tasks may more closely mimic the demands of the sports environment and may promote mechanics which increase the risk of injury.

Level of Evidence

Level 1b     

THE ACUTE EFFECTS OF VARIOUS TYPES OF STRETCHING STATIC,DYNAMIC, BALLISTIC,AND NO STRETCH OF THE ILIOPSOAS ON 40‐YARD SPRINT TIMES IN RECREATIONAL RUNNERS

Background and Purpose:

The potential adverse effects of static stretching on athletic performance are well documented, but still appears to be controversial, especially as they relates to sprinting. The prevalence of this practice is demonstrated by the number of competitive and recreational athletes who regularly engage in stretching immediately prior to sprinting with the mindset of optimizing their performance. The purpose of this study was to examine the effects of acute static, dynamic, and ballistic stretching, and no stretching of the iliopsoas muscle on 40‐yard sprint times in 18‐37 year‐old non‐competitive, recreational runners.

Methods:

Twenty‐five healthy recreational runners (16 male and 9 female) between the ages of 24 and 35 (Mean = 26.76 yrs., SD = 2.42 yrs.) completed this study. A repeated measures design was used, which consisted of running a 40‐yard sprint trial immediately following each of 4 different stretching conditions aimed at the iliopsoas muscle and lasting 1 minute each. The 4 conditions were completed in a randomized order within a 2‐week time period, allowing 48‐72 hours between each condition. Prior to each 40‐yard sprint trial, a 5‐minute walking warm‐up was performed at 3.5 mph on a treadmill. The subject then ran a baseline 40‐yard sprint. After a 10‐minute self‐paced walk, each subject performed one of the 4 stretching conditions (ballistic, dynamic, static, and no stretch) and then immediately ran a timed 40‐yard sprint.

Results:

There was a significant interaction between stretching conditions and their effects on sprint times, F(3,72) = 9.422, p<.0005. To break down this interaction, simple main effects were performed with 2 repeated measures ANOVAs and 4 paired t‐tests using a Bonferroni corrected alpha (α = .0083). There were no significant differences between the 4 pre‐condition times, p = 0.103 (Greenhouse‐Geisser) or the post‐condition times, p = 0.029. In the no stretch condition, subjects improved significantly from pre‐ to post‐ sprint times (p<0.0005). There were no statistically significant differences in pre‐ and post‐stretch condition sprint times among the static (p = 0.804), ballistic (p = 0.217), and dynamic (p = 0.022) stretching conditions.

Conclusions:

Sprint performance may show greatest improvement without stretching and through the use of a walking generalized warmup on a treadmill. These findings have clinically meaningful implications for runners who include iliopsoas muscle stretching as a component of the warm‐up.

Level of Evidence:

Level 2     

THE INFLUENCE OF CHOLINE,CYSTINE, AND OF α-TOCOPHEROL UPON THE OCCURRENCE OF CEROID PIGMENT IN DIETARY CIRRHOSIS OF RATS

1. Five per cent l-cystine in a stock or low protein diet produces ceroid deposits in rat liver. This effect of l-cystine is much greater in low protein than in stock diets. 2. One per cent choline has an inhibiting effect on deposition of liver ceroid resulting from a low protein diet containing excess cystine. 3. The occurrence of ceroid pigment in the livers of rats on a low protein diet, with or without the addition of excess l-cystine, is transiently inhibited by the administration of α-tocopherol. Five per cent cod liver oil in the diet did not prevent this effect of α-tocopherol. 4. On low protein, vitamin E-deficient diets, there occurs after 4 months, a rapid and progressive weight loss. This does not happen when α-tocopherol is added to the diet.     

COMPARING THE EFFECTS OF SELF‐MYOFASCIAL RELEASE WITH STATIC STRETCHING ON ANKLE RANGE‐OF‐MOTION IN ADOLESCENT ATHLETES

Background:

Increased flexibility is often desirable immediately prior to sports performance. Static stretching (SS) has historically been the main method for increasing joint range‐of‐motion (ROM) acutely. However, SS is associated with acute reductions in performance. Foam rolling (FR) is a form of self‐myofascial release (SMR) that also increases joint ROM acutely but does not seem to reduce force production. However, FR has never previously been studied in resistance‐trained athletes, in adolescents, or in individuals accustomed to SMR.

Objective:

To compare the effects of SS and FR and a combination of both (FR+SS) of the plantarflexors on passive ankle dorsiflexion ROM in resistance‐trained, adolescent athletes with at least six months of FR experience.

Methods:

Eleven resistance‐trained, adolescent athletes with at least six months of both resistance‐training and FR experience were tested on three separate occasions in a randomized cross‐over design. The subjects were assessed for passive ankle dorsiflexion ROM after a period of passive rest pre‐intervention, immediately post‐intervention and after 10, 15, and 20 minutes of passive rest. Following the pre‐intervention test, the subjects randomly performed either SS, FR or FR+SS. SS and FR each comprised 3 sets of 30 seconds of the intervention with 10 seconds of inter‐set rest. FR+SS comprised the protocol from the FR condition followed by the protocol from the SS condition in sequence.

Results:

A significant effect of time was found for SS, FR and FR+SS. Post hoc testing revealed increases in ROM between baseline and post‐intervention by 6.2% for SS (p < 0.05) and 9.1% for FR+SS (p < 0.05) but not for FR alone. Post hoc testing did not reveal any other significant differences between baseline and any other time point for any condition. A significant effect of condition was observed immediately post‐intervention. Post hoc testing revealed that FR+SS was superior to FR (p < 0.05) for increasing ROM.

Conclusions:

FR, SS and FR+SS all lead to acute increases in flexibility and FR+SS appears to have an additive effect in comparison with FR alone. All three interventions (FR, SS and FR+SS) have time courses that lasted less than 10 minutes.

Level of evidence:

2c     

THE USE OF THE FINAL HYDROGEN ION CONCENTRATION IN DIFFERENTIATION OF STREPTOCOCCUS H?MOLYTICUS OF HUMAN AND BOVINE TYPES

1. Under the conditions of these experiments, there appears to be a distinct and constant difference in the final hydrogen ion concentration of Streptococcus hæmolyticus from human and bovine sources. 2. Of 124 strains of Streptococcus hæmolyticus from known human origin, 116 reached a final hydrogen ion concentration of from pH 5.0 to 5.3. Only 8 reached a pH more acid than 5.0 and none more acid than pH 4.8. 3. Of 45 strains of Streptococcus hæmolyticus from bovine sources, including 26 strains isolated from milk and the udder of cows, and 19 from cream cheese, 40 reached a final hydrogen ion concentration of pH 4.3 to 4.5. Of the remaining 5 which reached a pH of 5.0 to 5.2, two were of known human type and three of uncertain diagnosis. 4. A rapid and practical application of this method is proposed as a presumptive test in the differentiation of human and bovine types of Streptococcus hæmolyticus.     

THE VALIDITY OF 2‐DIMENSIONAL MEASUREMENT OF TRUNK ANGLE DURING DYNAMIC TASKS

Purpose/Background:

Injury screening methods that use three‐dimensional (3D) motion analysis accurately predict the risk of injuries, yet are expensive. There is great need for valid, cost‐effective techniques that can be used in large‐scale assessments. Utilizing two‐dimensional (2D) measures of lateral trunk motion may identify athletes at risk for lower extremity injury. The purpose of this research was to determine the strength of the relationships between 2D and 3D calculations of lateral trunk angle for female athletes performing a single‐leg cross drop landing.

Methods:

Twenty‐one high‐school female volleyball players performed a single‐leg cross drop landing onto a force plate. The 3D angular trunk motion was calculated, and four different 2D measures of lateral trunk angle were calculated for both left and right landing leg. A one‐way multivariate analysis of variance was used to compare 2D measures to the 3D measurements, and Pearson correlations were used to determine the strength of these relationships.

Results:

The angle formed by the medial shoulder joint center, medial ASIS, and vertical line (LTA4) was similar to the 3D measures of lateral trunk angle during landing (r‐values ≥ 0.62; p‐values ≤ 0.003; mean differences, ‐1.0° to 1.2°).

Conclusions:

Given the recent focus on the role of the trunk in lower extremity injury, using the 2D LTA4 assessment may expand existing assessments into a composite model that can more accurately assess female athletes at risk for injury than models that do not include trunk analysis.

Clinical Relevance:

Existing models that enable clinicians to effectively identify female athletes at risk for lower extremity injury may be enhanced by including accurate assessments of lateral trunk motion.     

COMPARISON OF THE EFFECTS OF AN EIGHT‐WEEK PUSH‐UP PROGRAM USING STABLE VERSUS UNSTABLE SURFACES

Background and Purpose:

Recently, the trend among physical training and rehabilitation professionals is the use of resistance exercise on unstable equipment in order to increase the effort of the agonist and stabilizing muscles. It is unknown if performing exercises on unstable surfaces provides a greater training stimulus as compared to training on a stable training surface. Therefore, the purpose of this research was to compare the effect that push‐up training on stable and unstable surfaces had on strength performance in healthy young men.

Methods:

Thirty subjects with experience in resistance training participated in push‐up training two days per week for eight weeks on one of three different surfaces: the floor (Tp), the T‐Bow® (TBp) or the BOSU® (Bp).

Results:

Strength, as measured by one repetition maximum (1‐RM) and muscle endurance, as measured by number of pushups performed did not improve significantly (p>0.05) for any of the intervention groups.

Conclusions:

The addition of unstable surfaces in push‐up training does not provide greater improvement in muscular strength and endurance than push up training performed on a stable surface in young men.

Levels of Evidence:

3b     

THE COMPARISON OF THE EMPTY CAN AND FULL CAN TECHNIQUES AND A NEW DIAGONAL HORIZONTAL ADDUCTION TEST FOR SUPRASPINATUS MUSCLE TESTING USING CROSS‐SECTIONAL ANALYSIS THROUGH ULTRASONOGRAPHY

Purpose/Background:

Several examination tests are currently used for diagnosing a supraspinatus lesion. The empty can (EC) test is currently considered the gold standard for testing, but full can (FC) testing is also utilized. Both of these tests do not fully eliminate the deltoid synergistic when resistance is applied. A new diagonal horizontal adduction (DHA) technique has been developed for evaluation of the supraspinatus that has not yet been compared with the existing techniques (EC/FC). Cross‐sectional analysis (CSA) change during contraction as an ultrasonographic means of visualizing and measuring contraction of the supraspinatus has been reported previously.

Objective:

The purpose of this study was to use diagnostic musculoskeletal ultrasound (MSK) to compare CSA of the supraspinatus during the FC, EC, and the DHA tests.

Methods:

The supraspinatus muscle of 37 healthy, uninjured volunteers (21 males and 16 females, mean age of 26.9) were visualized and CSA was captured during 4 randomly assigned test positions (including control) using MSK.

Results:

A one‐way Analysis of Variance with repeated measures of the mean CSA obtained in the testing positions was performed followed by least significant difference (LSD) for post‐hoc analysis. Significant differences (p < 0.05) were found between the mean CSA of the controls and the CSA of each of the three testing procedures analyzed using the MSK. There were no significant differences (p < 0.05) in CSA between any of the three testing procedures.

Conclusions:

In this study, MSK visualized and objectified activity of the supraspinatus muscle as evidenced through increased mean CSA when resisted. All the testing positions (FC, EC, and DHA) demonstrated significantly increased mean CSA of the muscle when isometrically contracted when compared to the resting control. The DHA procedure also elicited significant increase in CSA of the supraspinatus. However, no significant difference was found between the CSA of the DHA when compared to the FC and EC tests.

Level of Evidence:

Level 2     

THE IMMEDIATE AND LONG-TERM EFFECTS OF KINESIOTAPE? ON BALANCE AND FUNCTIONAL PERFORMANCE

Background

The application of Kinesio Tex® tape (KT) results, in theory, in the improvement of muscle contractibility by supporting weakened muscles. The effect of KT on muscle strength has been investigated by numerous researchers who have theorized that KT facilitates an immediate increase in muscle strength by generating a concentric pull on the fascia. The effect of KT on balance and functional performance has been controversial because of the inconsistencies of tension and direction of pull required during application of KT and whether its use on healthy individuals provides therapeutic benefits.

Hypotheses/Purpose

The purpose of the present study was to investigate the immediate and long-term effects of the prescribed application (for facilitation) of KT when applied to the dominant lower extremity of healthy individuals. The hypothesis was that balance and functional performance would improve with the prescribed application of KT versus the sham application.

Study Design

Pretest-posttest repeated measures control group design.

Methods

Seventeen healthy subjects (9 males; 8 females) ranging from 18-35 years of age (mean age 23.3 ± 0.72), volunteered to participate in this study. KT was applied to the gastrocnemius of the participant''s dominant leg using a prescribed application to facilitate muscle performance for the experimental group versus a sham application for the control group. The Biodex Balance System and four hop tests were utilized to assess balance, proprioception, and functional performance beginning on the first day including pre- and immediately post-KT application measurements. Subsequent measurements were performed 24, 72, and 120 hours after tape application. Repeated measures ANOVA''s were performed for each individual dependent variable.

Results

There were no significant differences for main and interaction effects between KT and sham groups for the balance and four hop tests.

Conclusion

The results of the present study did not indicate any significant differences in balance and functional performance when KT was applied to the gastrocnemius muscle of the lower extremity.

Level of evidence

Level 1- Randomized Clinical Trial     

THE RELIABILITY,MINIMAL DETECTABLE CHANGE AND CONSTRUCT VALIDITY OF A CLINICAL MEASUREMENT FOR QUANTIFYING POSTERIOR SHOULDER TIGHTNESS IN THE POST‐OPERATIVE POPULATION

Background:

Posterior shoulder tightness (PST) has been implicated in the etiology of numerous shoulder disorders. Although reliable and valid measures have been described for the non‐operative population one does not exist for the post‐operative population.

Study Design:

Blinded repeated measures design.

Purpose:

Investigate the intrarater reliability, minimal detectable change at the 90% confidence interval (MDC₉₀) and construct validity of an inclinometric measurement designed to quantify PST in the post‐operative population.

Methods:

One investigator performed PST measurements on the operative shoulder of 23 participants. Passive internal and external rotation measurements were performed for the validity component of the investigation.

Results:

Intrarater reliability using an intraclass correlation coefficient (ICC) model 3,k was good (ICC = 0.79). The MDC₉₀ indicated that a change of greater than or equal to 8 degrees would be required to be 90% certain that a change in the measurement would not be the result of inter‐trial variability or measurement error. Construct validity was supported by a statistically significant relationship between PST and internal rotation r = 0.54 and by a relationship between PST and external rotation r = 0.30 which was not statistically significant.

Conclusion:

The sidelying procedure described in this investigation appears to be a reliable and valid means for quantifying PST in the post‐operative population. Moreover, the use of inclinometry provides an absolute angle of tightness that may be used for intersubject comparison, documenting change, and to determine reference values.

Level of Evidence:

Therapy, level 2b