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Playing a musical instrument necessitates stability in the hands, neck, shoulders, and trunk, involving both isotonic and isometric movements, muscular endurance, and various other physical demands. Musicians, especially those engaged in professional or educational pursuits, often dedicate several hours each day to practicing and performing. Despite the substantial physical challenges associated with musical performance, the realm of performing arts medicine lacks comprehensive research and practical methodologies tailored to adequately address the conditioning requirements of musicians. Musculoskeletal discomfort is prevalent among professional musicians, predominantly affecting the upper body. Instrumental players encounter issues such as musculoskeletal overuse, nerve entrapment, focal dystonia, and other playing-related musculoskeletal disorders, which can persist for extended periods. Consequently, this article aims to present a specialized strength and conditioning regimen tailored for instrumental musicians participating in large music ensembles, specifically symphony orchestras and wind bands. The guide will identify the mechanics inherent to playing these instruments and the prevalent injuries associated with them. Using this information, a strength and conditioning protocol suitable for the application within a symphony orchestra and wind band music classrooms will be presented. [ABSTRACT FROM AUTHOR]

Enhancing the therapeutic alliance has been associated with improved outcomes for patients with chronic low back pain (CLBP). Qualitatively trust has been described to be part of the therapeutic alliance, but it has not been measured quantitatively within the physical therapy literature. Examine the relationship between trust and outcomes during physical therapy for CLBP. Observational study of patients with CLBP being seen for physical therapy were assessed through self-report measures. The Primary Care Assessment Survey (PCAS) trust measurement scale was completed by patients at initial, post-initial, and discharge visit. These measurements were compared for correlations with patient reported outcome measures for pain and function recorded at initial visit and discharge. A convenience sample of 29 patients (49.3 ± 15 years old) with CLBP were measured. The PCAS showed correlations for changes in trust throughout treatment for improvements in pain and discharge pain rating. Average discharge pain rating correlated to changes in the PCAS (rs = −0.692, p <.001), with lower pain ratings relating to higher changes in trust over time. Average change in pain (rs = 0.745, p <.001) throughout treatment also correlated with higher changes in trust. Higher trust scores at discharge also correlated with improved Global Rating of Change and Oswestry Disability Index scores at discharge. The linear regression model showed adjusted R2 values for the trust scores and outcomes varied between 0.247 and 0.642. Both increases in trust throughout the treatment and end trust scores during physical therapy were related to improved outcomes for patients with CLBP. [ABSTRACT FROM AUTHOR]

The purpose of this case series was to observe physical performance changes following an 8-week nonlinear periodization training program on firefighters currently on light duty who were cleared to participate in full physical activities. Two firefighters underwent an 8-week nonlinear periodization program. Participant 1 was returning from anterior cruciate ligament reconstruction and participant 2 from a non-surgical low back injury. The Incumbent Physical Ability Test (IPAT), 2-minute push-up test, 300-yard shuttle, and Gerkin protocol testing were assessed at baseline, week 4, and week 8. Both participants demonstrated improvement in assessments of physical performance and fitness across each assessment point, with exception of the Gerkin protocol, and were able to return to full duty at the conclusion of their rehabilitation training program. The physical demands of tactical professionals such as firefighters exceed those of the general population. As such, these individuals require both job-specific programming and assessments when transitioning from an injury to full duty. An 8-week nonlinear periodization program yielded improvements in performance of firefighting tasks and physical fitness in two firefighters returning to full duty after injury and highlighted effective interprofessional collaboration between the physical therapy and fitness team. [ABSTRACT FROM AUTHOR]

BACKGROUND: Therapeutic alliance improves pain, disability, and quality of life outcomes. The purpose of this study was to investigate the effectiveness of a training protocol aimed at enhancing the therapeutic alliance in patients with chronic low back pain. METHODS: 19 physical therapists (DPT) and 16 student physical therapists (SPT) completed a therapeutic alliance training course with a quantitative questionnaire completed before and after the training along with a follow-up qualitative interview. Quantitative results were analyzed for differences resulting from participation in the training, while qualitative results were analyzed via interview transcription analysis by independent researchers blinded to the participants. RESULTS: All three groups (SPT/DPT combined, SPT, DPT) demonstrated a significant improvement in feeling comfortable in building a strong therapeutic alliance (p<0.01). The themes of Training Enhances Consciousness, Communication is Key, and Personalized Approach emerged from qualitative interviews indicating that the course was valuable in improving their approach to therapeutic alliance, communication, and individualized interventions contribute to a successful therapeutic alliance. CONCLUSION: The results of this study demonstrate the efficacy of therapeutic alliance training and suggest potential to enhance therapeutic alliance through a training protocol. [ABSTRACT FROM AUTHOR]

The editorial discusses the necessity of clinical trial registration beyond journal requirements, emphasizing the importance of transparency and validity in evidence-based practice. It clarifies the definition of a clinical trial as a research study that assigns human participants to health-related interventions to evaluate their effects on health outcomes. The editorial highlights the benefits of trial registration in preventing research fraud, outcome selection bias, and promoting transparency in reporting outcomes. Researchers are encouraged to submit a pre-analysis plan as part of the clinical trial registry to maintain transparency and prevent publication bias. [Extracted from the article]

Background: Roller massage (RM) has become a common intervention among health and fitness professionals. Recently, manufacturers have merged the science of vibration therapy and RM with the development of vibration rollers. Of interest, is the therapeutic effects of such RM devices. Purpose: The purpose of this study was to compare the effects of a vibration roller and nonvibration roller intervention on prone knee-flexion passive range of motion (ROM) and pressure pain threshold (PPT) of the quadriceps musculature. Methods: Forty-five recreationally active adults were randomly allocated to one of 3 groups: vibration roller, nonvibration roller, and control. Each roller intervention lasted a total of 2 minutes. The control group did not roll. Dependent variables included prone knee-flexion ROM and PPT measures. Statistical analysis included parametric and nonparametric tests to measure changes among groups. Results: The vibration roller demonstrated the greatest increase in PPT (180 kPa, P <.001), followed by the nonvibration roller (112 kPa, P <.001) and control (61 kPa, P <.001). For knee flexion ROM, the vibration roller demonstrated the greatest increase in ROM (7°, P <.001), followed by the nonvibration roller (5°, P <.001) and control (2°, P <.001). Between groups, there was a significant difference in PPT between the vibration and nonvibration roller (P =.03) and vibration roller and control (P <.001). There was also a significant difference between the nonvibration roller and control (P <.001). For knee ROM, there was no significant difference between the vibration and nonvibration roller (P =.31). A significant difference was found between the vibration roller and control group (P <.001) and nonvibration roller and control group (P <.001). Conclusion: The results suggest that a vibration roller may increase an individual's tolerance to pain greater than a nonvibration roller. This investigation should be considered a starting point for future research on this technology. [ABSTRACT FROM AUTHOR]

Context: Foam rolling is a popular intervention used by allied health professionals and the general population. Current research suggests that foam rolling may have an effect on the ipsilateral antagonist muscle group and produce a cross-over effect in the muscles of the contralateral limb. The purpose of this study was to examine the acute effects of foam rolling to the left quadriceps on ipsilateral antagonist hamstrings and contralateral quadriceps muscle group pressure pain threshold (PPT). Through this research, we sought to gather data to further develop the methodology for future studies of this intervention. Design: A pretestposttest exploratory study. Setting: University kinesiology laboratory. Participants: 21 healthy adults (age = 27.52 ±8.9 y). Intervention: Video-guided foam roll intervention on the left quadriceps musculature. Main Outcome Measures: Ipsilateral hamstring (antagonist) and contralateral quadriceps muscle PPT. Results: A significant difference was found between pretest to posttest measures for the ipsilateral hamstrings (i[20] = -6.2, P < 0.001) and contralateral quadriceps (i[20] = -9.1, P < 0.001) suggesting an increase in PPT. Conclusions: These findings suggest that foam rolling of the quadriceps musculature may have an acute effect on the PPT of the ipsilateral hamstrings and contralateral quadriceps muscles. Clinicians should consider these results to be exploratory and future investigations examining this intervention on PPT is warranted. [ABSTRACT FROM AUTHOR]

Negrete, R J, Hanney, W J, Kolber, M J, Davies, G J, Ansley, MK, McBride, AB, and Overstreet, AL. Reliability, minimal detectable change, and normative values for tests of upper extremity function and power. J Strength Cond Res 24(12): 3318-3325, 2010-The purpose of this study was to examine the test-retest reliability, minimal detectable change (MDC), and determine normative values of 3 upper extremity (UE) tests of function and power. One hundred eighty participants, men (n = 69) and women (n = 111), were tested on 3 UE strength and power maneuvers in a multicenter study to determine baseline normative values. Forty-six subjects returned for a second day of testing within 5 days of the initial assessment for the reliability component of the investigation. Explosive power was assessed via a seated shot-put test for the dominant and nondominant arms. Relationships between the dominant and nondominant arms were also analyzed. A push-up and modified pull-up were performed to measure the amount of work performed in short (15-second) bursts of activity. The relationship between the push-up and modified pull-up was also determined. Analysis showed test-retest reliability for the modified pull-up, timed push-up, dominant single-arm seated shot-put tests, and nondominant single-arm seated shot-put tests to be intraclass correlation (coefficient.sub.(3,1)] 0.958, 0.989, 0.988, and 0.971, respectively. The MDC for both the push-up and modified pull-up was 2 repetitions. The MDCs for the shot put with the dominant arm and the nondominant arm were 17 and 18 in., respectively. The result of this study indicates that these field tests possess excellent reliability. Normative values have been identified, which require further validation. These tests demonstrate a practical and effective method to measure upper extremity functional power. KEY WORDS upper limb, functional tests, upper body strength and power

The popularity of resistance training (RT) is evident by the more than 45 million Americans who engage in strength training regularly. Although the health and fitness benefits ascribed to RT are generally agreed upon, participation is not without risk. Acute and chronic injuries attributed to RT have been cited in the epidemiological literature among both competitive and recreational participants. The shoulder complex in particular has been alluded to as one of the most prevalent regions of injury. The purpose of this manuscript is to present an overview of documented shoulder injuries among the RT population and where possible discern mechanisms of injury and risk factors. A literature search was conducted in the PUBMED, CINAHL, SPORTDiscus, and OVID databases to identify relevant articles for inclusion using combinations of key words: resistance training, shoulder, bodybuilding, weightlifting, shoulder injury, and shoulder disorder. The results of the review indicated that up to 36% of documented RT-related injuries and disorders occur at the shoulder complex. Trends that increased the likelihood of injury were identified and inclusive of intrinsic risk factors such as joint and muscle imbalances and extrinsic risk factors, namely, that of improper attention to exercise technique. A majority of the available research was retrospective in nature, consisting of surveys and descriptive epidemiological reports. A paucity of research was available to identify predictive variables leading to injury, suggesting the need for future prospective-based investigations. KEY WORDS shoulder pain, resistance training injury, bodybuilding, weightlifting

The purpose of this study was to examine the test-retest reliability and minimal detectable change ([MDC.sub.95]) of the hexagon test. The hexagon test is a routinely used measure of agility in the sports and rehabilitation professions, yet its reliability has not been investigated in prior research. A total of 26 college-aged men (n = 1 7) and women (n = 9) of various activity levels were recruited to participate in 3 testing sessions: baseline, 1 hour after baseline, and 48 hours after baseline. The results of this study indicated excellent test-retest reliability for both same-day intraclass correlation coefficient (ICC) model 3,1 = 0.938 and between-day ICC (3,1) = 0.924 analyses. The [MDC.sub.95] for the hexagon test was 1.015 seconds. A significant difference in the mean times was identified during the same-day test-retest sessions (p < 0.001) but not the between-day test-retest sessions (p = 0.18). The significant differences identified between the baseline and the same-day retest session suggests a learning effect. The hexagon test shows excellent reliability for measuring agility, which supports its use as a tool to assess athletic performance and lower-extremity agility. Evidence of reliability, in addition to its ease of administration, makes the hexagon test a practical and effective method to measure agility. When using this test as a measure of agility, a change of greater than 1.015 seconds is necessary to be 95% certain that the change in time reflects improvement and exceeds measurement error. A practice trial is recommended prior to recording scores to attenuate the possibility of a learning effect. KEY WORDS agility, sport performance, measurement, functional outcome

Shoulder disorders attributed to weight training are well documented in the literature; however, a paucity of evidence-based research exists to describe risk factors inherent to participation. Shoulder joint and muscle characteristics in the recreational weight training (RWT) population were investigated to determine specific risk-related adaptations that may occur from participation. Ninety participants, men between the ages of 19 and 47 (mean age 28.9), including 60 individuals who participated in upper-extremity RWT and 30 controls with no record of RWT participation, were recruited. Active range of motion (AROM), posterior shoulder tightness (PST), body weight-adjusted strength values, and agonist/antagonist strength ratios were compared between the RWT participants and the control group. Statistical analysis identified significant differences (p < 0.001) between the groups when analyzing shoulder mobility. The RWT participants had decreased mobility when compared with the control group for all AROM measurements except external rotation, which was greater. Strength ratios were significantly greater in the RWT group when compared with the control group (p [less than or equal to] 0.001), implying agonist/antagonist muscle imbalances. The findings of this investigation suggest that RWT participants are predisposed to strength and mobility imbalances as a result of training. The imbalances identified have been associated with shoulder disorders in the general and athletic population; thus, these imbalances may place RWT participants at risk for injury. Common training patterns are biased toward large muscle groups such as the pectorals and deltoids but neglect muscles responsible for stabilization such as the external rotators and lower trapezius. Exercise selection that mitigates strength and mobility imbalances may serve to prevent injury in this population. Clinicians and strength and conditioning professionals should consider the biomechanical stresses and adaptations associated with RWT when prescribing upper-extremity exercises. Key Words shoulder complex, weight lifting, shoulder disorders, muscle imbalance