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Background/purpose Interventions including posterior glenohumeral mobilizations (PGM), sleeper stretches, and thoracic manipulation are commonly used to address posterior shoulder tightness. The purpose of this study was to assess the effects of adding thoracic manipulation to PGM and sleeper stretches on passive range of motion (PROM), joint mobility, and infraspinatus electromyographic (EMG) activity in shoulders with decreased internal rotation (IR) PROM. Design Randomized Sequential Intervention Laboratory Study Methods Forty individuals with clinically significant IR loss attended two study sessions. Participants were randomized to receive five 30 seconds bouts of either grade III PGM or sleeper stretching. Following a seven-day washout period, all participants attended a second session and received a prescriptive supine HVLA manipulation targeting the T3-4 segment, followed by the previously randomized intervention. Outcome measures included internal rotation PROM, horizontal adduction PROM, posterior glenohumeral joint translation assessed via ultrasound imaging, and EMG activity of the infraspinatus during a PGM. All outcome measures were assessed pre- and immediately post-intervention and compared statistically. Results There were significant within-group, but not between-group, differences for IR and horizontal adduction PROM following a single session of PGM or sleeper stretch. When combined with thoracic manipulation, significantly smaller within session changes of IR PROM were observed for both PGM (mean difference 4.4, p=0.017) and sleeper stretches (mean difference 6.4, p=0.0005). There were no significant between group differences for horizontal adduction PROM, humeral head translation, or EMG activity across all time points. Discussion Both GH posterior mobilizations and sleeper stretches improved IR and horizontal adduction PROM in a single session. The addition of thoracic manipulation prior to local shoulder interventions resulted in smaller gains of both IR and horizontal adduction ROM. [ABSTRACT FROM AUTHOR]

Background Low back pain (LBP) is a leading cause of disability. Recurrent low back pain (rLBP) is defined as two or more episodes of LBP in a 12-month period, each lasting more than 24 hours and separated by at least one pain-free month. Many studies have shown that hip and trunk variables have an influence on LBP. However, most of these are studies of participants with acute or chronic LBP rather than rLBP. Purpose To examine the difference between hip and trunk variables of university students with and without rLBP. Study Design Cross-Sectional Methods Participants with and without rLBP between 18 and 35 years of age not currently undergoing clinical orthopedic care were recruited for this cross-sectional study. Bilateral hip range of motion (ROM) and trunk ROM were measured with a goniometer or measuring tape (hip motions in all planes along with trunk flexion, extension, and lateral flexion). Strength of the hip extensors, abductors, and external rotators was measured using a handheld dynamometer, and a single-leg bridge endurance test was performed to assess differences and correlations between outcomes. Results Twenty-six subjects aged 18 to 35 years with rLBP (n=10) and without rLBP (n=16) participated. Statistically significant differences between the two groups were found for right and left hip flexion (p = 0.029 and 0.039, respectively), right hip adduction (p = 0.043), and right hip extension (p = 0.021). No significant differences were found between groups for strength, endurance, or other ROM measures. Conclusion The findings of this study show statistically significant although clinically non-meaningful differences in hip flexion, extension, and adduction ROM in the rLBP group compared to the control group. This lack of clinically meaningful difference may be relevant to testing procedures and treatment of patients or athletes with rLBP. This study also suggests that hip strength and endurance may not play a major role in the development or treatment of rLBP. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Objectives: Subacromial impingement syndrome is one of the most prevalent causes of shoulder pain in dialysis patients. The aim of this study is to evaluate the effectiveness of Kinesio tape in combination with mobilization versus mobilization alone on rest pain, shoulder abduction pain, shoulder abduction range of motion (ROM), and... [ABSTRACT FROM AUTHOR]

Copyright of Kinesiologia Slovenica is the property of Faculty of Sport and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Hip adduction and abduction muscle function plays an important role for risk of groin pain in athletes. Maximal isometric strength can be obtained clinically using a handheld dynamometer. However, in very strong athletes this is challenging, as external fixation of the dynamometer is needed for reliable measures. An alternative to unilateral testing, is the long-lever hip adduction squeeze test and a novel bilateral hip abduction press test. While promising intra-tester reliability has been found for maximal strength during the long-lever hip adduction squeeze test, inter-tester reliability may be more challenging during both maximal and explosive strength measurements. Hypothesis/purpose The aim of the present study was to assess intra- and inter-tester reliability of maximal, and explosive strength during the long lever hip adduction squeeze test and the long lever hip abduction press test in healthy adults using a hand-held dynamometer. Study design Intra- and interrater reliability study. Methods Forty-nine healthy subjects were included for intra- (n=20) and inter-tester reliability (n=29). Subjects performed the hip adduction long lever squeeze test and the bilateral hip abduction press test in a randomized order. Maximal isometric strength and early (0-100 ms) and late (0-200 ms) phase rate of force development (explosive muscle strength) was obtained using a hand-held dynamometer. Relative reliability for all tests was assessed using ICC2,1 two-way mixed model with absolute agreement, thereby taking bias between testers into account. Results Maximal isometric strength showed good intra- and inter-tester reliability for adduction (ICC: 0.93-0.97) and abduction (ICC: 0.88-0.92). For 0-200 ms rate of force development, both the squeeze and press test showed good intra-tester reliability (ICC: 0.85-0.87), whereas inter-tester reliability was good for hip adduction squeeze (ICC: 0.75) and moderate for hip abduction press (ICC: 0.71). For 0-100 ms rate of force development, the hip abduction press test showed good intra-tester reliability (ICC: 0.78). Remaining tests for intra- and inter-tester reliability showed moderate reliability (ICC: 0.50-0.71). Conclusion Assessment of maximal isometric strength in hip adduction squeeze and abduction press test showed good intra- and inter-tester reliability, whereas only 0-200 ms rate of force development demonstrated good intra-tester reliability of both tests. Therefore, rate of force development should preferably be conducted by the same tester, while the long lever squeeze and press test can reliably be used within- and between testers to measure maximal isometric strength. Level of Evidence 3 [ABSTRACT FROM AUTHOR]

Introduction: Posterior shoulder tightness is the extensibility limitations of the soft tissue, due to repetitive tensile loading in overhead athletes such as cricket and other sports. Bowling is the main cause for Posterior shoulder tightness. Hence the Sleeper stretch with muscle energy technique is proposed to be effecting in improving range, flexibility and functional ability. Purpose: To examine the effectiveness of Sleeper stretch with Muscle energy technique on posterior shoulder tightness among college level cricket bowlers. Materials and Methods: The study design was a single group experimental study design. On inclusion criteria one hundred and thirty one subjects were selected through convenient sampling technique. The subjects were given sleeper stretch combined with muscle energy technique for 8 consecutive weeks for 5 times in a week, post-test assessment was taken and the data analysis was done respectively. Results: The result of the study post intervention of internal rotation is (72.29° ± 3.73°, P = 0.001<0.05), Horizontal adduction (38.51° ± 2.70°. P = 0.001<0.05), flexibility of posterior capsule (109.81° ± 2.65° P = 0.001<0.05), DASH score for functional ability is (4.43 ± 1.53). Through Pearson chi square test there is a significant association in internal rotation (χ² = 61.38, P = 0.001<0.005), Horizontal adduction (χ² = 16.11, P = 0.001<0.05) and no significant association in flexibility of posterior capsule (χ² = 0.98, P = 0.806>0.05) and DASH Score (χ² = 4.25, P = 0.120>0.05). Conclusion: Effect of sleeper stretch with MET on PST showed effective results in improving internal rotation range, horizontal adduction, flexibility, functional ability among college level cricket bowlers. [ABSTRACT FROM AUTHOR]

Background Significant effort has gone into the identification and quantification of the underlying mechanisms of primary ACL injury. Secondary ACL injury is observed in approximately 1/4 to 1/3 of athletes who return to sport following ACL reconstruction. However, little has been done to evaluate the mechanisms and playing circumstances surrounding these repeat injuries. Hypothesis/Purpose The purpose of this study was to characterize the mechanisms of non-contact secondary ACL injuries using video analysis. It was hypothesized that in video recordings of secondary ACL injury, athletes would exhibit greater frontal plane hip and knee angles, but not greater hip and knee flexion, at 66 ms following initial contact (IC) as compared to at IC and 33ms following IC. Study Design Cross-Sectional Study Methods Twenty-six video recordings of competitive athletes experiencing secondary ACL ruptures via noncontact mechanisms were analyzed for lower extremity joint kinematics, playing situation, and player attention. Kinematics were assessed at IC as well as 33 ms (1 broadcast frame) and 66 ms (2 broadcast frames) following IC. Results Knee flexion and knee frontal plane angles were greater at 66 ms than IC (p ≤ 0.03). Hip, trunk, and ankle frontal plane angles were not greater at 66 ms than IC (p ≥ 0.22). Injuries were distributed between attacking play (n=14) and defending (n=8). Player attention was most commonly focused on the ball (n=12) or an opponent (n=7). A single-leg landing accounted for just over half of the injuries (54%), while a cutting motion accounted for the remainder of the injuries (46%). Conclusion Secondary ACL injury was most likely to occur during landing or a sidestep cut with player attention external to their own body. Knee valgus collapse combined with limited hip motion was identified in the majority of secondary injuries. Level of Evidence Level IIIb [ABSTRACT FROM AUTHOR]

Copyright of Kinesiologia Slovenica is the property of Faculty of Sport and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article aims to equip voice teachers with pedagogic techniques and exercises that parallel those used in speech pathology practices and to help voice teachers work in collaboration with voice clinicians, to rectify a vocal trend that has caused vocal damage to many of this generation's young singers. It focuses on helping voice teachers to address hyperadduction and muscle tension dysphonia. Mentions primary and secondary hyperadductive and vocal fatigue practices.

Copyright of Revista Brasileira de Medicina do Esporte is the property of Redprint Editora Ltda. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Adductor strains are the most common non-contact musculoskeletal injury sustained in ice hockey. Systematic reviews have determined higher level of play and lower hip adduction to abduction strength ratios to be associated with an increased risk of adductor strain across multiple sports. Limited research exists regarding hip adduction and abduction strength profiles across various levels of ice hockey players. Purpose To compare isometric hip adduction and abduction strength profiles among bantam, high school, tier one juniors, and NCAA Division I collegiate ice hockey players. A secondary purpose was to identify whether differences in strength profiles between dominant and non-dominant limbs exist. Study Design Cross-sectional cohort study. Methods A questionnaire of demographic data, hockey, and injury specific information was completed by all subjects. The mean of three reps of maximal hip isometric adduction and abduction strengths were quantified using a handheld dynamometer with external belt-fixation. Ratios of hip adduction-to-abduction strength were calculated and normalized for body weight. Results A total of 87 uninjured skaters were included in this study with a mean age of 17 years. Mean hip adductor-to-abductor ratios for Bantam hockey players were 121% followed by collegiate (115%), Juniors (111%), and high school (109%) hockey players. No statistically significant differences were found between peak hip adduction and abduction isometric strength and playing level. In addition, there was no difference between unilateral hip strength ratios and shooting hand or leg dominance. While 34.5% of subjects reported a history of adductor injury, no significant differences existed regarding strength ratios during bilateral comparison or when compared to their team norms. Three subjects were found to have unilateral ratios of less than 80%, while two subjects demonstrated bilateral ratios of less than 80%. Conclusions Symmetry is illustrated between dominant and non-dominant legs in ice hockey players with and without a history of adductor injury. Results align well with previously established cross-sectional data from Australian football, with ratios of 103% in high school players, 107% in semi-professional players, and 113% in collegiate players. Level of Evidence Level 3 [ABSTRACT FROM AUTHOR]

Background Previous research has demonstrated the benefits of both stabilization and non-stabilization of the scapula during stretching in individuals with posterior shoulder tightness, but limited evidence exists in patients with shoulder pain. Hypothesis/Purpose The aim of this study was to determine the effect of stabilized scapular stretching on patients with shoulder pain. The primary hypothesis of this study is that stabilized scapular stretching will improve glenohumeral motion and pain compared to non-stabilized stretch program. A secondary hypothesis of this study is that stabilized scapular stretching will produce greater improvement in function compared to the non-stabilized stretching program. Study Design Randomized Clinical Trial Methods Sixteen patients with sub-acromial pain associated with tendinopathy and associated pathologies presenting to physical therapy were randomized into two groups (stabilized or non-stabilized scapular stretching). Baseline pain and range of motion were measured prior to and following each treatment session for three visits that occurred over the course five to seventeen days depending on the patients availability. The dependent measurements were stabilized horizontal adduction, stabilized internal rotation, stabilized shoulder flexion, non-stabilized shoulder flexion, and current pain level. Results Patients in the scapular stabilization stretching group increased horizontal adduction 40° (CI95 31, 48°) compared to the non-stabilization stretching group increase of 8° (CI95 0, 17°) over the course of the three treatments (p<0.001). Similarly, the stabilized stretching group increased internal rotation 48° (CI95 26, 69°) compared to the non-stabilized stretching group increase of 26° (CI95 4, 48°) (p=0.001). Pain decreased in the stabilized stretching group by 1.4 points (CI95 -0.4, 3.2) but increased slightly in non-stabilized group by -0.5 points (CI95 -2.3, 1.3) which was not a clinically meaningful change. (p=0.03) Conclusion Stabilized scapular stretching was more effective than non-stabilized stretching at gaining shoulder mobility in patients with shoulder pain. Benefits were immediate and sustained between treatment sessions. Stretching interventions improved range of motion but had limited effect on shoulder pain. Level of Evidence 2 [ABSTRACT FROM AUTHOR]

Background Deficits in shoulder range of motion (ROM) and strength are associated with risk of arm injury in baseball players. Purpose The purpose of this study was to assess the effectiveness of a standardized exercise program, during the fall season, on shoulder ROM and rotational strength in collegiate baseball players. Study Design Prospective cohort study Methods Passive shoulder internal rotation (IR), external rotation (ER), and horizontal adduction ROM were measured with an inclinometer. Shoulder IR and ER strength was assessed using a hand-held dynamometer and normalized to body weight. Players performed a program of shoulder stretching and strengthening exercises, three times/week for one month and then one time/week for two months. Paired sample t-tests compared pre-intervention to post-intervention outcome measures. Results Division I baseball players (n=43; 19.6±1.2years, 185.8±5.5cm, 90.5±7.0kg) volunteered. From pre- to post-intervention, there were increases in horizontal adduction ROM in the throwing (Mean Difference (MD)=6.1°, 95%CI=3.7,8.5; p<0.001) and non-throwing arm (MD=8.0°, 95%CI=5.6,10.3; p<0.001), and a decrease in non-throwing arm ER ROM (MD=2.8°, 95%CI= 0.2,5.5; p=0.039). The ER ROM surplus (throwing - non-throwing) increased (MD=5.6°, 95%CI= 1.1,10.2; p=0.016). Throwing arm (MD=1.3%BW, 95%CI=0.5-2.1, p=0.003) and non-throwing arm (MD=1.2%BW, 95%CI=0.4,2.0; p=0.004) ER strength decreased. A notable, but non-significant increase in IR strength on the throwing arm (MD=1.6%BW, 95%CI=0.1,3.0; p=0.055) and decrease on the non-throwing arm (MD=1.2%BW, 95%CI=0.0,2.4; p=0.055) occurred. Additionally, throwing arm ER:IR strength ratio (MD=0.16, 95%CI=0.08,0.25; p<0.001) also decreased. Conclusion Changes in shoulder horizontal adduction ROM, IR strength and relative ER surplus on the throwing arm were noted at the end of the season. The lack of change in IR and ER ROM and may be related to the lack of deficits at the start of the fall season. [ABSTRACT FROM AUTHOR]

Reverse total shoulder arthroplasty (rTSA) improves shoulder elevation in patients treated for cuff tear arthropathy (CTA) or irreparable massive cuff tears. Patient satisfaction can be limited by reduced active external rotation (AER). Rotator cuff muscles that externally rotate the shoulder are infraspinatus and teres minor (TM). The purpose of this study was to assess the correlation between preoperative TM fatty degeneration and postoperative AER after rTSA performed for CTA or irreparable cuff tears. Constant scores and active range of motion were consecutively collected for 109 shoulders in 97 patients (mean: 75.73 ± 8.94 years; 31 male, 66 female) over a 10-year period. AER was evaluated with the humerus in adduction (AER1) and in abduction. TM muscle atrophy was scored according to Goutallier's classification, assessed on preoperative computed tomography scans. Multivariate analysis showed that TM fatty infiltration was a predictor of AER1. AER1 decreased by 4.9 degrees preoperatively and by 6.4 degrees at the final follow-up, for each increment in Goutallier grade (P =.02). Postoperatively, AER evaluated with humerus in abduction improved significantly (P <.001), but did not correlate with TM Goutallier grade. At a mean follow-up of 38 months (range: 24 to 96), mean Constant score improved from 20.5 ± 11.1 to 68.4 ± 14.9 (P <.001), as did shoulder active range of motion in all planes including AER1 (P <.001). This is the first study to quantify the inverse correlation between AER and TM Goutallier grade, both preoperatively and after rTSA; this information guides prognosis for patients with TM degeneration undergoing rTSA. Further studies are necessary to have a better understanding and find reliable solutions. Level III; Case Series [ABSTRACT FROM AUTHOR]

Following reverse total shoulder arthroplasty, a short scapular neck length (SNL) decreases postoperative impingement-free adduction, and impingement between the neck of the scapula and the humeral polyethylene cup may cause scapular notching. However, no reports have evaluated the influence of SNL on impingement-free adduction. The purposes of this study were to evaluate the influence of SNL on impingement-free adduction and to examine the effect of glenoid component lateralization and inferiorization on impingement-free adduction. By use of 3-dimensional templating software, a virtual reverse total shoulder arthroplasty model was created in 15 patients who had no osteoarthritic change or any other bony deformity. We measured SNLs separately before implant placement (preoperative SNL) and after implant placement (postoperative SNL). The implant used was the Comprehensive Reverse Shoulder System (Zimmer Biomet, Warsaw, IN, USA), and baseplate bony lateralization of 0, 5, and 10 mm, with inferior eccentricity of 0.5 or 4.5 mm, was tested for impingement-free adduction. Correlations between the preoperative and postoperative SNLs and impingement-free adduction were analyzed. The mean preoperative SNL was 8.2 ± 1.9 mm (range, 5.0-11.7 mm), and the mean postoperative SNL was 6.0 ± 2.0 mm (range, 2.1-9.8 mm). There was a moderate correlation between the preoperative SNL and impingement-free adduction (r = 0.628, P =.12) and a strong correlation between the postoperative SNL and impingement-free adduction (r = 0.771, P =.001). Use of the model with 10 mm of bony lateralization and 4.5 mm of inferior eccentricity provided the best results in terms of impingement-free adduction. There were correlations between both the preoperative and postoperative SNLs and impingement-free adduction. Although the lateralized and inferiorized center of rotation may increase the risk of loosening of the glenoid component, this offset significantly increased impingement-free adduction. [ABSTRACT FROM AUTHOR]

Copyright of Kinesiologia Slovenica is the property of Faculty of Sport and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Importance: Scapular protraction and retraction are often essential for occupational performance; however, clinical assessment of these movements is uniquely challenging. Objective: To analyze the interrater reliability of a novel goniometric method to measure scapular protraction and retraction. Design: An observational, descriptive design was implemented to evaluate interrater reliability between two experienced occupational therapists who were also certified hand therapists. Setting: Academic institution. Participants: Convenience sample of graduate students (N = 80). Outcomes and Measures: The hypothesis, developed before study implementation, was that the technique would demonstrate clinically acceptable interrater reliability, defined as a standard error of measurement (SEM) <8°. Goniometric measurements of the scapula at rest, in maximal protraction, and in maximal retraction were independently obtained from each participant by each evaluator. The goniometer was aligned on the scapula using the superior angle as the axis of motion to measure the movement of the acromion relative to the frontal plane. The SEM was calculated in each position using the intraclass correlation coefficient values and the average of the standard deviations from the two raters. Results: The SEM values between the two evaluators for the resting, protracted, and retracted positions were 3.46°, 2.93°, and 2.74°, respectively. Conclusions and Relevance: The SEM between the two evaluators for each scapular position was <4°, suggesting that the technique may be clinically reliable. However, additional research regarding the reliability and validity of the technique is recommended. What This Article Adds: The findings of this study support the use of goniometry to measure scapular protraction and retraction in relation to occupational performance. The technique provides a way to quantify baseline scapular mobility and track progress. The findings of this study support the use of goniometry to measure scapular protraction and retraction in relation to occupational performance. [ABSTRACT FROM AUTHOR]

Background Iliotibial Band Syndrome (ITBS) is a common clinical condition likely caused by abnormal compressive forces to the iliotibial band (ITB). Stretching interventions are common in ITBS treatment and may predominantly affect tensor fascia latae (TFL). Another ITBS treatment is foam rolling, which may more directly affect the ITB. Shear wave ultrasound elastography (SWUE) measures real-time soft tissue stiffness, allowing tissue changes to be measured and compared. Purpose To examine effects of foam rolling and iliotibial complex stretching on ITB stiffness at 0' and 10' of hip adduction and hip adduction passive range of motion (PROM). Study Design Randomized controlled trial. Methods Data from 11 males (age = 30.5 ± 9.0 years, Body Mass Index (BMI) = 27.8 ± 4.0) and 19 females (age = 23.5 ± 4.9, BMI = 23.2 ± 2.1) were analyzed for this study. Subjects were randomly assigned to one of three groups: control, stretching, and foam rolling. Shear wave ultrasound elastography measurements included ITB Young's modulus at the mid-thigh, the distal femur and the TFL muscle belly. ITB-to-femur depth was measured at mid-thigh level. Hip adduction PROM was measured from digital images taken during the movement. Results No significant interactions or main effects were found for group or time differences in ITB Young's modulus at the three measured locations. The ITB stiffness at the mid-thigh and distal femur increased with 10° adduction, but TFL stiffness did not increase. A main effect for adduction PROM was observed, where PROM increased 0.8' post-treatment (p = 0.02). Conclusion A single episode of stretching and foam rolling does not affect short-term ITB stiffness. The lack of ITB stiffness changes may be from an inadequate intervention stimulus or indicate that the interventions have no impact on ITB stiffness. [ABSTRACT FROM AUTHOR]

Background Calf muscle strain injuries are a common running injury affecting male runners and are known to have high reoccurrence rates. Currently, limited evidence exists investigating factors associated with this injury with no previous study investigating the running kinematics of male runners with a history of repeat calf muscle strain injuries. Purpose To investigate whether male runners with a history of repeat calf muscle strain injury demonstrate differences in stance phase running kinematics when compared to healthy controls. Study Design Case-control investigation Level of Evidence 3b Methods Stance phase kinematics were compared between 15 male runners with a history of calf muscle strain injury and 15 male control participants during treadmill running at 3.2m/s. Independent t-tests were used to compare differences in stance phase kinematic parameters between groups and effect sizes were calculated using Cohen's d. Results The group with a history of calf muscle strain injury demonstrated a significant 2.1 and 3.1 increase in contralateral pelvic drop and anterior pelvic tilt during mid stance. In addition, this group exhibited longer stance times and a more anterior tilted pelvis, flexed hip and a greater distance between the heel and centre of mass at initial contact. Large effect sizes, greater than 0.8, were observed for all differences. No significant differences were observed for ankle and knee joint kinematics between the groups. Conclusion This is the first study to identify kinematic characteristics associated with recurrent calf muscle strain injury. While it is not possible to determine causality, the observed kinematic differences may contribute to recurrent nature of this injury. Specifically, it is possible that neuromuscular deficits of the hip and calf muscle complex may lead to increased strain on the calf complex. Rehabilitation interventions which focus on addressing pelvis and hip kinematics may reduce the demands placed upon the calf complex and could prove clinically effective. [ABSTRACT FROM AUTHOR]

Introduction: Knee osteoarthritis (OA) is characterized by pain and functional deficits. Common conservative strategies include medications, physical therapy, and intra‐articular injections. Recently, treatment using autologous cell injections has increased. Objective: To characterize the cellular content of bone marrow aspirate (BMA) and to evaluate the effect of intra‐articular autologous BMA injections in patients with mild knee OA. Design: Prospective pilot observational study. Setting: Academic institution. Patients: Eleven patients with unilateral or bilateral mild knee OA (15 knees) were included in the cellular analysis. Ten patients (13 knees) were included in the overall (cellular and clinical) analysis. Interventions: BMA was aspirated from patients' iliac crests and then injected intra‐articularly under fluoroscopic and/or ultrasound guidance. BMA samples were analyzed using flow cytometry, colony forming unit (CFU) assays, and enzyme‐linked immunosorbent assays. Questionnaires assessing pain and function were administered preinjection and at 1, 3, 6, and 12 months postinjection. Side effects and satisfaction were assessed. Main Outcome Measures: Total nucleated cell (TNC) concentration, mesenchymal stem cell (MSC) concentration, CFU count, and interleukin‐1 receptor antagonist (IL‐1Ra) concentration. Results: BMA sample analyses revealed wide ranges in TNC concentration (173300‐4 491 050 cells/mL), MSC concentration (0‐500 cells/mL), CFUs (0‐19), and IL‐1Ra concentration (2806‐29 394 pg/mL). Improvements in Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement were observed throughout the 12‐month follow‐up period (F[4,12] = 12.29, P <.001). Additionally, current, usual, best, and worst numerical rating scale pain scores significantly decreased over time (P <.001). Patient satisfaction was high (range: 8.1 ± 2.1‐8.8 ± 1.9), and side effects were uncommon. Conclusions: The cellular content of BMA samples varied widely between patients and was lower than the anticipated yield reported by the device's manufacturer. However, intra‐articular BMA injections for knee OA in a small pilot cohort appeared to be safe with potential therapeutic value. Larger, prospective, double‐blinded studies are warranted. [ABSTRACT FROM AUTHOR]

Human exposure to furan-containing pollutants (FCPs) has raised concerns due to their high risk of toxicity. A substantial number of approximately 8500 recorded compounds containing a furan ring exist which have been analytically or in biologically studied. A significant portion of these compounds is found in the everyday environments of individuals, particularly when ingested through food. Consequently, there is a need for a universal approach to rapidly predict the potential toxicity trends of FCPs. In this study, we developed a bromine labeling-based platform that combines LC-ICP-MS and LC-ESI-MS techniques to absolutely quantify FCP-induced protein adduction. The LC-ESI-MS approach facilitated the identification of FCP-derived protein adducts and optimized liquid chromatographic conditions for analyte separation. By employing a well-designed bromine-containing compound as a general internal standard, LC-ICP-MS-based technique enabled to absolutely assess bromine-labeled protein adduction. The protein adduction efficiencies of furan, 2-methylfuran, and 2,5-dimethylfuran were found to be 2.68, 2.90, and 0.37 molecules per 10,000 FCP molecules that primary hepatocytes received, respectively. Furthermore, we observed that 2-methylfuran exhibited the highest cytotoxicity, followed by furan and 2,5-dimethylfuran, which aligned with the order of their protein adduction. Thus, the protein adduction efficiency of FCPs could serve as a potential index for predicting their toxicity trends. [Display omitted] • Protein adduction efficiency is introduced to predict toxicity trends of furan pollutants. • A novel platform is established to determine protein adduction efficiency. • Protein adduction derived from furans is assessed by bromine labeling and LC-ICP-MS. • This platform allows to evaluate toxicity of the entire family of furans. [ABSTRACT FROM AUTHOR]

• High-speed videolaryngoscopy analysis revealed a significant influence of Estill qualities on vocal fold oscillations. • The first glottal vibration factor was influenced by posterior adduction and suggested a significant influence of the aryepiglottic sphincter. • The second glottal factor contained parameters derived from glottal length and amplitude, suggesting a relationship with vocal registers and with laryngeal height. • The third glottal factor was best related to body-cover setup and phonation type. Estill Voice Training (EVT) is an effective educational system for developing and controlling distinct voice qualities used in contemporary commercial singing. EVT teaches six vocal qualities that differ at 13 levels. This study aims to investigate whether the distinct vocal qualities taught by EVT can be systematically differentiated based on laryngoscopic observations and vocal fold oscillation parameters. To investigate the differences in six EVT qualities, laryngeal dimensions and glottal area waveform parameters were measured in a single female subject who performed it in one-octave scale. Glottis Analysis Tools (GAT) were used to measure these parameters and phonovibrograms were obtained from the analysis. The resulting data were subjected to factor analysis to identify the systematic differences between EVT qualities. High-speed videolaryngoscopy analysis revealed a significant influence of vocal qualities on vocal fold oscillations. The factor analysis of the data identified three factors based on laryngeal dimension and four factors derived from GAT parameters. The first GAT factor was influenced by posterior adduction and distinguished belt quality from other qualities, suggesting a significant influence of the aryepiglottic sphincter. The second GAT factor contained parameters derived from glottal length and amplitude, suggesting a relationship not only with vocal registers but also with laryngeal height. The third GAT factor was best related to body-cover figure and phonation type (membranous medialization), while the fourth GAT factor was related to the amplitude-length-ratio. These findings suggest that vocal fold oscillations can be used to distinguish between Estill voice qualities. [ABSTRACT FROM AUTHOR]

Background Gait asymmetries after anterior cruciate ligament reconstruction (ACLR) may lead to radiographic knee osteoarthritis. Slower walking speeds have been associated with biomarkers suggesting cartilage breakdown. The relationship between walking speed and gait symmetry after ACLR is unknown. Hypothesis/Purpose To determine the relationship between self-selected walking speeds and gait symmetry in athletes after primary, unilateral ACLR. Study Design Secondary analysis of a clinical trial. Methods Athletes 24±8 weeks after primary ACLR walked at self-selected speeds as kinematics, kinetics, and electromyography data were collected. An EMG-driven musculoskeletal model was used to calculate peak medial compartment contact force (pMCCF). Variables of interest were peak knee flexion moment (pKFM) and angle (pKFA), knee flexion and extension (KEE) excursions, peak knee adduction moment (pKAM), and pMCCF. Univariate correlations were run for walking speed and each variable in the ACLR knee, contralateral knee, and interlimb difference (ILD). Results Weak to moderate positive correlations were observed for walking speed and all variables of interest in the contralateral knee (Pearson's r=.301-.505, p≤0.01). In the ACLR knee, weak positive correlations were observed for only pKFM (r=.280, p=0.02) and pKFA (r=.263, p=0.03). Weak negative correlations were found for ILDs in pKFM (r=-0.248, p=0.04), KEE (r=-.260, p=0.03), pKAM (r=-.323, p<0.01), and pMCCF (r=-.286, p=0.02). Conclusion Those who walk faster after ACLR have more asymmetries, which are associated with the development of early OA. This data suggests that interventions that solely increase walking speed may accentuate gait symmetry in athletes early after ACLR. Gait-specific, unilateral, neuromuscular interventions for the ACLR knee may be needed to target gait asymmetries after ACLR. Level of Evidence III [ABSTRACT FROM AUTHOR]

This study evaluated a standardized and personalized approach to verify the effects of conditions on intrarater and interrater reliability, standard error of measurement, and minimal detectable difference for provocative tests and range-of-motion (ROM) tests used in hip pain assessment: flexion-adduction-internal rotation (FADIR), flexion-abduction-external rotation-extension (FABER), and hip internal rotation with 90° of hip flexion (hip IR). Nineteen participants (mean [± SD] age = 24 ± 2 years; 10 women and 9 men) without lower limb or back pain were recruited. Three raters evaluated each participant during 2 testing sessions, 1 day apart. Raters performed the 3 tests in 4 conditions: classic (C), controlled pressure duration (CPD), subject-specific position (SSP), and mixed (M = CPD + SSP). For intrarater reliability, the CPD condition showed the highest intraclass correlation coefficients (ICCs; mean and 95% confidence interval [CI]) for hip IR ROM (0.83; 95% CI, 0.53-0.94) and FADIR ROM (0.75; 95% CI, 0.60-0.89). The SSP condition showed the highest ICCs for FABER height (0.71; 95% CI, 0.42-0.87) and FABER ROM (0.62; 95% CI, 0.27-0.83). Concerning interrater reliability, the classic condition presented the highest ICCs for FABER variables (height: 0.54; 95% CI, 0.28-0.76; ROM: 0.58; 95% CI, 0.32-0.79) and hip IR ROM (0.72; 95% CI, 0.51-0.87). The CPD condition showed the highest ICC for FADIR ROM (0.57; 95% CI, 0.32-0.78). In the conditions of this study, CPD showed the highest ICCs for hip IR ROM and FADIR ROM , and SSP showed the highest ICCs for FABER height and FABER ROM. [ABSTRACT FROM AUTHOR]

Background: Decelerating and cutting are two common movements during which non-contact anterior cruciate ligament (ACL) injuries occur in soccer players. Retrospective video analysis of ACL injuries has demonstrated that players are often in knee valgus at the time of injury. Purpose: To determine whether prospectively measured components of valgus collapse during a deceleration and 90° cut can differentiate between collegiate women's soccer players who go on to non-contact ACL injury. Design: Secondary analysis of prospectively collected data. Methods: 51 NCAA women's soccer players completed motion analysis of a deceleration and 90° before the competitive season. Players were classified as Injured (noncontact ACL injury during the season) or Uninjured at the end of the season. Differences between groups for peak hip adduction, internal rotation, and knee abduction angles, and knee valgus collapse were analyzed with a MANOVA. Results: Four non-contact ACL injuries were reported at the end of the season. There was a significant difference between groups for hip adduction angle during the 90° cut (p=0.02) and deceleration (p=0.03). Players who went on to ACL injury were in more hip adduction. Conclusions: Hip adduction angle is larger in players who go on to ACL injury than those who do not during two sport-specific tasks. The components of knee injury prevention programs that address proximal control and strength are likely crucial for preventing ACL injuries. Level of Evidence: 2b [ABSTRACT FROM AUTHOR]

A 67-year-old woman presented with a left hypotropia and eye pain after a traumatic fall. She had multiple left orbital wall fractures and an acquired limitation to elevation in all gazes, worse in adduction, suggestive of Brown syndrome. During strabismus surgery, a white nodule on the superior oblique tendon was identified and excised. Histopathology of the nodule revealed densely aggregated inflamed fibrovascular and fibrocollagenous scar tissue. Superior oblique rupture with spontaneous reparative reapproximation resulting in nodular formation is uncommon. We speculate that resulting tendon shortening may have contributed to the apparent Brown syndrome in this patient. [ABSTRACT FROM AUTHOR]

Background: Dynamic knee valgus (DKV) is defined as a combination of excessive femoral adduction, internal rotation, tibial internal torsion, and the medial movement of the knee. It appears that the athletes with DKV are at higher risk of developing knee injuries. Objective: The aim of this study was to evaluate whether the reactive neuromuscular training would improve whole-body dynamic balance and knee joint position sense (JPS) in women with the dynamic knee valgus. Methods: A controlled laboratory study was conducted on 28 female athletes with DKV. The single leg squat test was used to assess the DKV. All participants performed the reactive neuromuscular training, stationary cycling and resting sessions on three different days in a random order. The knee JPS and balance in the participants were measured immediately before and after the interventions. Kinematic analysis was used to measure the knee JPS in sagittal and frontal planes. In this regard, captured photos in the sagittal and frontal planes were analyzed using Kinovea software. The Y-balance test was applied to measure the balance. The data were analyzed by the repeated measures analysis of variance with a Bonferroni correction. Results: The results of the repeated measures analysis of variance showed that there was a significant difference between the sessions with respect to knee JPS in sagittal (F(2, 54) = 3.323, p = .047) and frontal (F(2, 54) = 23.83, p = .001) planes, respectively. Also, a significant difference in Y-balance test scores was observed between the sessions (F(2, 54) = 9.12, p = .001). Conclusions: The results of this study showed that reactive neuromuscular training improved joint position sense and balance in individuals with DKV. The findings of this study may provide a basis for developing injury prevention and rehabilitation strategies in athletes with DKV. [ABSTRACT FROM AUTHOR]

Lateral rectus transposition to the medial rectus muscle has recently generated interest in the management of oculomotor nerve palsy. We report 4 cases of complete oculomotor nerve palsy with a large-angle exotropia that were treated with a modified adjustable nasal transposition of the split lateral rectus muscle. Forced duction testing for the lateral rectus muscle showed good adduction in all 4 cases. Postoperative alignment within 10Δ in straight-ahead gaze was achieved in all 4 cases; adjustment was required in 2 cases. [ABSTRACT FROM AUTHOR]

Background: Strains of the adductor muscle group of the hip are common amongst ice hockey players. The ratio of isometric strengths between the hip adductors and abductors has been offered as a risk factor for hip adductor strain; however, there is no description for how the ratio between hip adductor and abductor strength varies as a function of hip abduction angle. Hypothesis/Purpose: The aim of this study was to determine the influence of hip joint abduction angle on measured ratios of hip adduction to abduction torque in experienced, recreational, male hockey players. The primary null hypothesis for this study was that hip joint abduction angle would not influence hip adduction-to-abduction torque ratios in male hockey players. Study Design: Counterbalanced observational cohort. Methods: Twelve uninjured, male, recreational hockey players, with a minimum experience level of midget AAA/minor competitive or equivalent. Participants performed maximal isometric side-lying hip adduction and abduction exertions against a rigidly constrained load cell at 0, 10, and 20 degrees of hip abduction. Measured peak torques from each exertion were used to derive the hip adductor-to-abductor torque ratio. Kinematics of the trunk, pelvis, and lower limbs were monitored using an optoelectronic motion capture system. Results: Adductor-to-abductor torque ratio increased from 1.49 (SD = 0.20), to 1.92 (SD = 0.20) and to 2.30 (SD = 0.54) with successively increasing hip abduction angle (p < 0.001). Peak torque was significantly different between all angles (p ≤ 0.016) except between adduction exertions performed at 10 and 20 degrees of abduction (p = 0.895). Small changes in hip angle during the exertion were coincident with exertion direction, which confirmed the isometric nature of the task. Conclusion: Hip abduction angle has a significant impact on the measured adductor-to-abductor torque ratio. The ratio increased due to a combination of increased adductor torque and decreased abductor torque as the hip abduction angle increased. [ABSTRACT FROM AUTHOR]

Background: Due to the lack of verifiable iliotibial band elongation in response to stretching, the anatomical, biomechanical, and physiological responses to treatment of iliotibial band syndrome remain unclear. The lateral intermuscular septum, consisting of multiple myofibroblasts, firmly anchors the iliotibial band to the femur. Purpose and Hypothesis: The purpose of this in-situ study was to examine the constraining effect of the lateral intermuscular septum on available passive hip adduction range of motion in un-embalmed cadavers. It was hypothesized that an iliotibial bandseptum- complex release would significantly increase passive hip adduction Design: Within-specimen repeated measures in-situ design. Setting: Anatomy laboratory. Methods: Metal markers were inserted into selected anatomical landmarks in eleven (11) un-embalmed human cadavers. With the specimen supine, the test-side lower limb was passively adducted until maximum passive hip adduction was reached. This movement was repeated three times each within two conditions: (1) band-septum-complex intact and (2) band-septum-complex dissected. Digital video of marker displacement was captured throughout each trial. Still images from a start and an end position were extracted from each video sequence. A custom Matlab program was used to calculate frontal plane hip adduction angle changes from obtained images. Results: Mean change in passive hip adduction after band-septum-complex release was -0.3° (SD 1.6°;95% CI: -1.33,0.76). A paired samples t-test revealed a non-significant difference (t=-.611; p=.555) in passive hip adduction for the band-septum-dissected condition (18.8±3.9°) versus the band-septum-intact condition (18.5°±4.7°). Conclusion: The lateral intermuscular septum does not appear to have a constraining effect on passive hip adduction in unembalmed cadavers. Future research should evaluate the constraining effect of other selected tissues and conditions on hip adduction. Furthermore, inflammatory, metabolic, viscoelastic, and sensorimotor control properties within the iliotibial band in response to stretching should be investigated. [ABSTRACT FROM AUTHOR]

We present a case of exotropia secondary to a lost medial rectus muscle managed using a novel surgical approach, consisting of nasal belly transposition of the superior rectus muscle combined with lateral rectus recession on adjustable sutures. Postoperatively, the patient was orthotropic in primary position and had slight improvement in adduction. Compared to other techniques, this minimal transposition had a relatively low risk of anterior segment ischemia. [ABSTRACT FROM AUTHOR]

Orbital myositis is a rare, commonly idiopathic, inflammatory condition that affects one or more extraocular muscles. We present a case of unilateral orbital myositis affecting the lateral rectus muscle presenting with gaze-evoked amaurosis, pain, and diplopia, with restrictive limitation of adduction. With improvement in adduction after initiating treatment, we noted narrowing of the palpebral fissure on attempted adduction, mimicking Duane retraction syndrome (DRS). Reported cases of "pseudo-DRS" are associated with multiple etiologies and are characterized by retraction on attempted abduction rather than adduction, as occurs in true DRS. In this case, pseudo-DRS occurred in the setting of idiopathic orbital inflammatory syndrome (orbital myositis) with a motility pattern more consistent with true DRS. [ABSTRACT FROM AUTHOR]

Highlights • Vocal onset is defined as the process occurring between the first detectable oscillatory glottal movement and the steady-state vocal fold vibration. • High speed imaging, photoglottography, flowglottography, EGG and ultrasonoglottography are suitable for identifying and analyzing hard, soft and breathy onsets. • Flow- and photoglottography are the most sensitive for detecting the first glottal movements in soft and breathy onsets. • The onset phase may comprise up to 30 cycles, depending to some extent on vocal fold adduction speed and expiratory flow. • From the first onset cycles on, the intraglottal pressure during the opening phase of the glottis exceeds that during the closing phase. Abstract Vocal onset is the process occurring between the first detectable oscillatory glottal movement and the steady state vibration of the vocal folds. To some extent, the voice onset mirrors the voice offset. High speed imaging, photo-, electro-, flow- and ultrasonoglottography and sound analysis have been used in combinations to allow detailed qualitative insight into the phenomenon. Moreover, the instantaneous intraglottal pressure can be computed from the combined records of transglottal airflow and glottal area. A large number of vocal onsets of different types were analysed in various conditions of modal healthy phonation. Vocal folds (VF) vibration can start either from a closed glottis (hard onset) or from an open glottis (soft/breathy onset). In a soft onset, the amplitude of oscillations progressively increases over 2 to more than 30 cycles, before the first clear closed plateau is achieved. It is not possible to define whether the first movement of VF is towards medial or lateral. Hard, soft and breathy onsets can be clearly identified. Flow- and photoglottography are the most sensitive signals in detecting the first glottal movements in soft and breathy onsets. The shape of the EGG signal depends on the contact of the VF edges. The duration of the onset phase is to some extent related to VF adduction speed and peak expiratory flow. The ultrasound technique is sensitive, but lacks physiological interpretation. From the first onset-cycles on, the intraglottal pressure during the opening phase of the glottis exceeds that during the closing phase. During soft/breathy onsets with a sufficiently large number of cycles, when the vibrating mass increases, a trend appears toward a slight progressive decrease of the fundamental frequency of the oscillations, likely related to the increasing vibrating mass. [ABSTRACT FROM AUTHOR]

Abstract Study Design Cross-sectional study. Purpose of the Study The study aims to determine the effects of force direction and arm position in differentiating the clavicular (PMc) and sternal (PMs) parts of the pectoralis major (PM) muscle during maximal voluntary isometric contraction (MVIC) to provide basic evidence to support the clinical thinking behind muscle strength testing of PM. Methods Nine experimental conditions with 3 force directions of horizontal adduction (+30° oblique, horizontal, and −30° oblique to the transverse plane) and 3 arm rotation positions (0°, 45°, and 90° shoulder external rotation from the transverse plane) were randomly tested for 26 healthy male participants. The MVIC force level was monitored and measured with a fixed dynamometer, and the surface electromyographic (EMG) signals of the PMc, PMs, anterior deltoid, middle deltoid, and latissimus dorsi were collected during the test for each condition. The PMc/PMs EMG ratio and normalized EMG amplitude were used to quantify the contribution of the tested muscles. Results The MVIC force level significantly declined when the arm's external rotation increased (P <.01; the grand mean decreased from 106.7 N ± 27.8 N to 89.5 N ± 22.6 N). The PMc/PMs EMG ratio showed that the best test condition to differentiate the PMc and PMs was the force direction of +30° oblique to the transverse plane and the 45° arm rotation position. Other muscles contributed less than 40% of their MVIC activity levels, with a higher activation level found in the anterior deltoid muscle (P <.01). Conclusions Arm rotation position should be considered as a predominant factor when clinically examining the strength of horizontal adduction movement. All tested conditions failed to fully separate PMc and PMs activation during MVIC and suggested that functional differentiation of the PM might not be applicable to maximal exertion. Level of Evidence NA. [ABSTRACT FROM AUTHOR]

Background: Posterior shoulder tightness (PST), defined as limited glenohumeral (GH) horizontal adduction and internal rotation motion, is a common occurrence in overhead athletes, particularly baseball and softball players, as a result of the extreme forces on the GH joint and the high number of throwing repetitions. Despite clinical evidence suggesting the use of joint mobilizations and muscle energy techniques (MET) for treating PST, there currently are no data examining the overall effectiveness of joint mobilizations and MET to determine optimal treatment for posterior shoulder tightness. Purpose: To compare the acute effectiveness of MET and joint mobilizations for reducing posterior shoulder tightness, as measured by passive GH horizontal adduction and internal rotation ROM, among high school baseball and softball players. Study Design: Randomized controlled study Methods: Forty-two asymptomatic high school baseball and softball players were randomly assigned to one of three groups (14 MET, 14 joint mobilization, 14 control). Glenohumeral passive adduction and internal rotation ROM were measured in all participants in a pre-test post-test fashion. Between testing, the joint mobilization group received one application of GH posterior joint mobilizations. The MET group received one cycle of MET applied to the GH horizontal abductors. The control group received no intervention. Posttests measures were completed immediately following intervention or a similar amount of time resting for the control group and then again 15 minutes later. Results: One-way analyses of covariance showed that the MET group had significantly more horizontal adduction ROM post-treatment compared to the control group (p=0.04). No significant differences existed between groups in horizontal adduction (p>0.16) or internal rotation (p>.28) or at the 15-minute posttests (p>0.70). Conclusion: The results of this study indicate the application of MET to the horizontal abductors provides acute improvements to GH horizontal adduction ROM in high school baseball and softball players, while joint mobilizations provide no improvements. [ABSTRACT FROM AUTHOR]

• Currently, there is no method for goniometer measurement of scapular protraction or retraction described in the literature. • The superior angle and acromion may provide anatomical landmarks for consistent measurement of protraction and retraction of the scapula from a superior approach. • This technique requires further investigation to determine reliability and validity before implementation as a clinical technique. [ABSTRACT FROM AUTHOR]

Myectomy of the four horizontal rectus muscles for infantile nystagmus syndrome without a null point may improve visual acuity and quality of life. Exotropia and adduction loss are complications of this procedure, although abduction is typically preserved. We investigated whether adduction loss may be rescued by reestablishing the attachment of the anterior intermuscular septum (AIMS) to the globe at the medial rectus insertion. We present 2 cases of exotropia and adduction loss following myectomy and transposition surgery, where the nasal AIMS and the medial rectus insertion site were joined with nonabsorbable polyester suture. Both patients experienced improvements in eye alignment and adduction. Based on radiologic observations of the posterior displacement of the pulley, or posterior intermuscular septum (PIMS), with medial rectus contraction, we hypothesize that adduction and alignment were improved by providing an anterior site of action for the posterior movement of the PIMS. [ABSTRACT FROM AUTHOR]

We report the case of a 73-year-old woman diagnosed with heavy eye syndrome who underwent loop myopexy of the superior rectus and lateral rectus muscles after suffering pulled-in-two syndrome caused by exploration of the medial rectus muscle, which could not be recovered. Given that intraoperative forced ductions remained positive after loss of the muscle, a loop myopexy of the superior rectus muscle and lateral rectus muscles was performed. Postoperatively the patient regained full adduction, and her esotropia improved notably. [ABSTRACT FROM AUTHOR]

Study Design Cross-sectional clinical measurement study. Introduction Scapular winging is a frequent complaint among children with brachial plexus birth palsy (BPBP). Therapeutic taping for scapular stabilization has been reported to decrease scapular winging. Purpose of the Study This study aimed to determine which therapeutic taping construct was most effective for children with BPBP. Methods Twenty-eight children with BPBP participated in motion capture assessment with 4 taping conditions: (1) no tape, (2) facilitation of rhomboid major and rhomboid minor, (3) facilitation of middle and lower trapezius, and (4) facilitation of rhomboid major, rhomboid minor, and middle and lower trapezius (combination of both 2 and 3, referred to as combined taping). The participants held their arms in 4 positions: (1) neutral with arms by their sides, (2) hand to mouth, (3) hand to belly, and (4) maximum crossbody adduction (CBA). The scapulothoracic, glenohumeral and humerothoracic (HT) joint angles and joint angular displacements were compared using multivariate analyses of variance with Bonferroni corrections. Results Scapular winging was significantly decreased in both the trapezius and combined taping conditions in all positions compared with no tape. Rhomboids taping had no effect. Combined taping reduced HT CBA in the CBA position. Conclusions Rhomboid taping cannot be recommended for treatment of children with BPBP. Both trapezius and combined taping approaches reduced scapular winging, but HT CBA was limited with combined taping. Therefore, therapeutic taping of middle and lower trapezius was the most effective configuration for scapular stabilization in children with BPBP. Resting posture improved, but performance of the positions was not significantly improved. Level of Evidence Level II. [ABSTRACT FROM AUTHOR]

Introduction Up to 35% of orbital floor fractures extend to the medial wall. This results in restriction of both abduction and adduction, leading to horizontal diplopia. The greater the defect, the more pronounced the enophthalmos. Aim of the study The aim of the study was to determine the influence of concomitant medial wall defects on enophthalmos and diplopia, and the influence of intraoperative revision on the results of surgical reconstruction in patients with orbital floor fracture. Material and methods 78 cases of orbital floor fracture, with or without concomitant medial wall defect, were retrospectively analyzed. Reconstruction surgeries were performed in a similar fashion, but with variation in the alloplastic materials used. Careful investigation of the area was performed during the surgery. Results Patients with associated medial wall defects had significantly more pronounced enophthalmos than those with isolated floor fracture, with no such difference after the orbital reconstruction. Postoperative vertical diplopia was more common in patients with an associated medial defect. Conclusions Associated medial wall defect leads to more severe enophthalmos at presentation. However, if the medial aspect of the orbital wall is revised properly, postoperative outcomes are not inferior to those in cases of isolated floor fracture. [ABSTRACT FROM AUTHOR]

Background: The lateral step-down test is an established clinical evaluation tool to assess quality of movement in patients with knee disorders. However, this test has not been investigated in individuals after anterior cruciate ligament reconstruction (ACLR) in association with quantitative 3D motion analysis. Purposes: The purpose of this study was to determine the strength of association between visually-assessed quality of movement during the lateral step-down test and 3D lower limb kinematics in patients with history of ACLR. A second purpose was to compare kinematics between subgroups based on the presence or absence of faulty alignments during the task. The final purpose was to compare visually-assessed quality of movement scores between box heights during lateral step-down testing. Methods: Twenty subjects at least one year status post-ACLR (18 females, age of 24.5±4.6 years and body mass index of 23.4±2.3 kg/m²) performed the lateral step-down test unilaterally on the surgical limb atop four and six inch boxes. A board-certified orthopedic physical therapist scored overall quality of movement during the lateral step-down test using established criteria during 2D video playback. Lower limb kinematics were simultaneously collected using 3D motion capture. An alpha level of 0.05 was used for all statistical treatments. Results: Overall 2D quality of movement score significantly correlated (r = 0.47-0.57) with 3D hip adduction and hip internal rotation across box heights. Across box heights, the presence of faulty pelvic alignment differentiated a subgroup exhibiting less peak knee flexion, and the presence of faulty knee alignment differentiated a subgroup exhibiting greater peak hip adduction. The six inch box elicited worse quality of movement compared to the four inch box. Conclusions: These results suggest that visually-assessed quality of movement is associated with several kinematic variables after ACLR. 2D movement deviations at the pelvis appear to consistently relate to less knee flexion, and 2D deviations at the knee appear to suggest greater hip adduction. Generally, poorer quality of movement was observed for the six inch box height. Clinically, these data suggest that interventions targeting hip abductor and knee extensor strength and neuromuscular control may be useful in the presence of poor quality of movement during lateral step- down testing. Level of Evidence: 2b [ABSTRACT FROM AUTHOR]

Background: Training intensity is an important variable in strength training and above 80% of one repetition maximum is recommended for promoting strength for athletes. Four dynamic and two isometric on-field exercises are included in the Hölmich groin-injury prevention study that initially failed to show a reduction in groin injuries in soccer players. It has been speculated that exercise-intensity in this groin-injury prevention program was too low to induce the strength gains necessary to protect against groin-related injuries. Purpose: To estimate the intensity of the six exercises from the Hölmich program using electromyography (EMG) and possibly categorize them as strength-training exercises. Study Design: Cross-sectional study. Methods: 21 adult male soccer players training >5 hours weekly were included. Surface-EMG was recorded from adductor longus, gluteus medius, rectus abdominis and external obliques during isometric adduction against a football placed between the ankles (IBA), isometric adduction against a football placed between the knees (IBK), folding knife (FK), cross-country skiing on one leg (CCS), adduction partner (ADP) and abduction partner (ABP). The EMG-signals were normalized (nEMG) to an isometric maximal voluntary contraction for each tested muscle. Results: Adductor longus activity during IBA was 84% nEMG (95% CI: 70-98) and during IBK it was 118% nEMG (95% CI 106-130). For the dynamic exercises, ADP evoked 87% nEMG (95% CI 69-105) in adductor longus, ABP evoked 88% nEMG (95% CI 76-100) in gluteus medius, FK evoked 82% nEMG (95% CI 68-96) rectus abdominis, and 101% nEMG (95% CI 85-118) in external obliques. During CSS <37% nEMG was evoked from all muscles. Conclusion: These data suggest that exercise-intensity of all the six investigated exercises in the Hölmich groin injury prevention program, except cross-county skiing, is sufficient to be considered strength-training for specific muscle groups in and around the groin region. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Background: Only a small amount of evidence exists linking hip abductor weakness to dynamic knee valgus during static and dynamic activities. The associations of hip extensor strength and hip kinematics during the landing of a single leg hop are not known. Purpose: To determine if relationships exist between hip extensor and abductor strength and hip kinematics in both involved and uninvolved limb during the landing phase of a single leg hop in recreational athletes post anterior cruciate ligament (ACL) reconstruction. The presence of similar associations was also evaluated in healthy recreational athletes. Study Design: Controlled Laboratory Study; Cross-sectional Methods: Twenty-four recreational college-aged athletes participated in the study (12 post ACL reconstruction; 12 healthy controls). Sagittal and frontal plane hip kinematic data were collected for five trials during the landing of a single leg hop. Hip extensor and abductor isometric force production was measured using a hand-held dynamometer and normalized to participants' height and weight. Dependent and independent t-tests were used to analyze for any potential differences in hip strength or kinematics within and between groups, respectively. Pearson's r was used to demonstrate potential associations between hip strength and hip kinematics for both limbs in the ACL group and the right limb in the healthy control group. Results: Independent t-tests revealed that participants post ACL reconstruction exhibited less hip extensor strength (0.18 N/Ht*BW vs. 0.25 N/ Ht*BW, p=<.01) and landed with greater hip adduction (9.0 ° vs. 0.8°, p=<.01) compared with their healthy counterparts. In the ACL group, Pearson's r demonstrated a moderate and indirect relationship (r = -.62, p = .03) between hip extensor strength and maximum hip abduction/adduction angle in the involved limb. A moderate and direct relationship between hip abductor strength and maximum hip flexion angle was demonstrated in the both the involved (r=.62) and uninvolved limb (r = .65, p = .02). No significant associations were demonstrated between hip extensor or abductor strength and hip flexion and/or abduction/adduction angles in the healthy group. Conclusion: The results suggest that hip extensors may play a role in minimizing hip adduction in the involved limb while the hip abductors seem to play a role in facilitating hip flexion during the landing phase of a single leg hop for both limbs following ACL reconstruction. Researchers and clinicians alike should consider the importance of the hip extensors in playing a more prominent role in contributing to frontal plane motion. Levels of Evidence: Level 2a [ABSTRACT FROM AUTHOR]

Lateral ankle sprains (LAS) and chronic ankle instability (CAI) are common musculoskeletal injuries that are a result of inversion injury during sport. The midfoot and forefoot is frequently injured during a LAS, is often overlooked during clinical examination, and maybe contributory to the development of CAI. The purpose of part two of this clinical commentary and current concept review is to increase clinician's awareness of the contribution of midfoot and forefoot impairment to functional limitation and disability of individuals who experience LAS and CAI and to facilitate future research in this area. The importance of multisegmented foot and ankle assessment from a clinical and research perspective is stressed. Select physical assessment and manual therapeutic techniques are presented to assist the clinician in examination and treatment of the ankle-foot complex in patients with LAS and CAI. [ABSTRACT FROM AUTHOR]