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The fitness benefits ascribed to weight training (WT) are well known; however, participation is not without risk. Common WT exercises often place the shoulder in unfavorable positions such as end-range external rotation (high-five position), predisposing the shoulder to anterior instability. This column presents WT exercise modifications designed to mitigate anterior shoulder instability. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to review the literature pertaining to subacromial impingement syndrome and lateral epicondylalgia (LE) in tennis players. The mechanisms of joint and muscular imbalances that lead to functional impingement of the shoulder joint may impair the stabilization and power function of the shoulder resulting in overcompensation of the wrist extensors during the tennis swing. This may contribute to microtrauma at the soft tissue structures at the lateral epicondyle thus causing symptoms of LE. Recent interest in the regional interdependence model as well as case studies published in the literature suggests that the relationship of proximal or distal joints should not be overlooked. Compensatory strategies at the distal upper extremity due to changes at the shoulder may overload smaller muscles in the forearm which cannot safely handle the extra stress, especially under repetitive conditions. Conditions of the shoulder and elbow that were previously considered to be independent, specifically subacromial impingement syndrome and lateral epicondylalgia, need to be critically reexamined in the context of regional interdependence given the potential association between the conditions. Specific studies examining the muscle and joint characteristics of the shoulder and elbow are needed as they relate to subacromial impingement syndrome and LE. Anatomic adaptations and biomechanical alterations in the upper extremity could result in abnormal stress loads and microtrauma at the shoulder and lateral elbow. [ABSTRACT FROM AUTHOR]

Background: Neck pain is common and results in considerable economic burden. Deficits in motor control of the deep neck muscles are well documented in those with neck pain. The efficacy of strengthening exercises for individuals with neck pain has been established; however, it is unclear if motor control exercises offer a similar benefit. Objectives: The purpose of this manuscript is to systematically review the literature for randomized controlled trials that evaluate the outcomes for motor control exercise interventions in those with persistent neck pain. Methods: A computerized electronic search was performed to locate articles. Inclusion criteria consisted of studies that were randomized controlled trials, appeared in a peer reviewed journal, published in the English language, identified neck pain as the primary treatment focus, identified motor control exercise of the neck as the primary treatment in at least one group and included subjects who had had neck pain for 6 weeks. Two reviewers independently reviewed the articles for eligibility and results were cross-referenced. Results: The initial search of the electronic database revealed a total of 684 articles and hand searching of the reference lists revealed an additional two. Of those, 30 were selected as potentially meeting the inclusion criteria. Ultimately four articles were retained for final inclusion. Conclusions: The addition of motor control exercise to an exercise programme does not appear to be more effective than a standard exercise programme. Motor control exercise however was demonstrated to be superior to passive treatments alone. [ABSTRACT FROM AUTHOR]

Posterior shoulder tightness (PST) is a common impairment implicated in the etiology of shoulder pain. Individuals participating in athletics have a predilection for PST, thus interventions to mitigate such tightness should be incorporated into training programs. This column presents exercises to address PST applicable to the asymptomatic and injured population. [ABSTRACT FROM AUTHOR]

Background: The intervertebral disc (IVD) has been implicated in the etiology and pathogenesis of spine pain. Examination and treatment approaches directed at the IVD often cite a biomechanical principle referred to as the dynamic disc model (DDM), which is hypothesised to account for positional changes of the nucleus pulposus (NP). The DDM proposes a predictable pattern of NP migration in response to movements and positioning; consequently, this model has served the basis for many clinical decisions. Objectives: The purpose of this manuscript was to systematically review the available research pertaining to the DDM in human discs. Methods: A literature review was conducted by two investigators independently using the MEDLINE, SPORTDiscus, EMBASE.com and CINAHL databases and the following key words independently and in combination: intervertebral disc, nucleus pulposus, nucleus migration, disc model, disc loading and dynamic disc model. Results from each researcher were pooled and studies were manually cross-referenced yielding 12 articles. Results: A predictable in vitro and in vivo pattern of NP movement was identified with the NP migrating anterior during extension and posterior during flexion in the normal IVD. Limited and contradictory data were available to support this model in the symptomatic and degenerative IVD. No studies were identified in the cervical and thoracic spine above the T10 level. Discussion: Available research supports the DDM of NP migration; however, an inconsistent pattern of migration may exist in patients with symptomatic and/or degenerative intervertebral discs. Future research is needed to evaluate the DDM in the cervical and thoracic spine and in abnormal discs. [ABSTRACT FROM AUTHOR]

RESEARCHERS HAVE REPORTED THAT UP TO 67% OF THE POPULATION WILL EXPERIENCE SHOULDER PAIN AT SOME POINT IN THEIR LIFETIME. SHOULDER REHABILITATION PROGRAMS ARE OFTEN INCLUSIVE OF EXERCISES DESIGNED TO STRENGTHEN THE EXTERNAL ROTATOR MUSCULATURE. THIS MANUSCRIPT PRESENTS SPECIFIC RECOMMENDATIONS FOR SHOULDER POSITIONING DURING STRENGTHENING OF THE EXTERNAL ROTATORS THAT IS APPLICABLE TO BOTH THE ASYMPTOMATIC AND INJURED POPULATION. [ABSTRACT FROM AUTHOR]

LOW BACK PAIN IS A COMMON CONDITION IN ATHLETIC POPULATIONS. PARTICIPATION IN ATHLETICS HAS BEEN LINKED TO SPECIFIC ANATOMICAL CHANGES TO THE LUMBER SPINE (SPONDYLOLYSIS AND SPONDYLOLISTHESIS). PRACTICAL GUIDELINES FOR STRENGTH AND CONDITIONING PROFESSIONALS SHOULD RECOGNIZE THE BIOMECHANICAL STRESSES ASSOCIATED WITH ATHLETIC PARTICIPATION IN THIS POPULATION. PROGRAM MODIFICATIONS CAN BE MADE IN ATHLETES WITH SPONDYLOLITIC DISORDERS. CONDITIONING ROUTINES SHOULD EMPHASIZE SPINAL STABILIZATION AND SPORT-SPECIFIC FLEXIBILITY. THIS ARTICLE MAKES RECOMMENDATIONS FOR ATHLETES WITH SPONDYLOLITIC DISORDERS THAT SHOULD ALLOW PARTICIPATION IN LUMBAR CONDITIONING WHILE PROTECTING THE BACK FROM UNDUE STRESS. [ABSTRACT FROM AUTHOR]

This manuscript presents an overview of spinal stabilization for the lumbar spine. Emphasis is placed on the local stabilization musculature, which has received considerable support in the literature. A progressive stabilization program targeting the local stabilizing musculature is recommended for the diverse athletic population. [ABSTRACT FROM AUTHOR]

Methods used to achieve hamstring flexibility may require modification in the athlete with discogenic lower back pain. Maintaining a natural lumbar lordosis with an anterior pelvic tilt during stretching facilitates the most efficient flexibility gains and protects the intervertebral disc from undue stress. [ABSTRACT FROM AUTHOR]

Training programs often include preventive exercises designed to strengthen the rotator cuff musculature. The 'empty can' is one of the more common rotator cuff exercises advocated to strengthen the supraspinatus muscle. Implications specific to the empty can exercise are discussed in this column. [ABSTRACT FROM AUTHOR]

Abstract: Hanney, WJ, Perez, A, Collado, G, Palmer, AC, Wilson, AT, Richardson, RM, and Kolber, MJ. J Strength Cond Res 38(11): 1854-1859, 2024-Kettlebell swings (KBSs) are commonly used to target the lumbar erector spinae and lower body musculature. This exercise exhibits distinct loading properties that requires cyclical contraction of the trunk extensors and posterior chain, potentially explaining its novel influence on muscle contractility. Tensiomyography (TMG) is a reliable, noninvasive, passive technique that may be used to examine muscular fatigue produced by exercises such as KBSs. The purpose of this randomized control trial was to determine the extent of muscle fatigue in the lumbar erector spinae musculature following the performance of a previously published high-intensity interval KBS protocol. Forty-one adults between the ages of 18 and 45 years were recruited. Inclusion criteria included subjects with no recent history of low back pain and clearance by the physical activity readiness questionnaire. Subjects were randomly allocated to either a KBS group ( n = 21) or a control group (CON; n = 20) who only performed the unloaded warm-up. Subjects were assessed at baseline, postintervention, and 24-hours postintervention for bilateral erector spinae fatigue, measured by 5 TMG parameters (Dm, Tc, Tr, Td, and Ts). The results were evaluated through a 2 × 3 (group × time) repeated-measures analysis of variance. The level of significance was set at p ≤ 0.05. There was no significant difference in lumbar erector spinae fatigue, measured by the 5 TMG parameters ( p ≥ 0.079), following the interval KBS protocol in comparison with the CON group at 3 assessment periods. A high-intensity interval KBS protocol failed to produce significant differences in erector spinae fatigue compared with the control group that did not perform a KBS. These findings warrant further investigation into muscle fatigue produced with higher intensity protocols and possibly suggest, depending on the programming goals, the need for an alternate KBS training parameters., (Copyright © 2024 National Strength and Conditioning Association.)

Background: Temporomandibular disorders are a source of orofacial pain. Understanding clinimetric properties of evaluation procedures is necessary for assessing impairments and determining response to interventions., Purpose: Reliability, minimal detectable change (MDC 95 ), and 95% limits of agreement of TMJ examination procedures were investigated., Methods: Occlusion (central incisor alignment, overjet, overbite), mandibular dynamics (maximal incisor opening, laterotrusion, protrusion active range of motion (AROM)), auscultation, tenderness, and joint play were measured on 50 asymptomatic adults (30 females), mean age 24.8. The inter-rater reliability assessment used an intra-session design. Participants returned 24-48 h later for intra-rater assessments. Intraclass correlation coefficients (ICC) and Kappa values were used to determine reproducibility., Results: Intra-rater reliability for occlusion and AROM was ICC 3,1 ≥ 0.75, whereas interrater reliability was ICC 2,1 ≥ 0.68. Kappa values for inter-rater agreement of joint mobility was K = .18, whereas auscultation and palpation were K ≥ 0.48. Intra-rater Kappa values were ≥ 0.24, with lateral pterygoid region palpation having poor agreement. The MDC 95 for occlusion was 1 mm, whereas AROM ranged from 3 to 6 mm. Mean AROM differences between raters were -1.16, -0.42, -0.18, and -0.8 mm for maximal incisor opening, left and right laterotrusion, and protrusion, respectively., Conclusion: AROM and occlusion measurements may be used with confidence; however, poor agreement for joint mobility measurements and lateral pterygoid region palpation must be recognized. When re-assessing measurements, a 3-6 and 1-mm change in AROM and occlusion, respectively, is required to be 95% certain change is not due to error. Future symptomatic population research is needed (250/250).

Introduction: 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., Objective: Examine the relationship between trust and outcomes during physical therapy for CLBP., Methods: 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., Results: 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 (r s  = -0.692, p < .001), with lower pain ratings relating to higher changes in trust over time. Average change in pain (r s  = 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 R 2 values for the trust scores and outcomes varied between 0.247 and 0.642., Conclusion: Both increases in trust throughout the treatment and end trust scores during physical therapy were related to improved outcomes for patients with CLBP.

Objective: The Staged Approach for Rehabilitation Classification for the Shoulder (STAR-Shoulder) has been proposed as a model to guide management and improve outcomes for patients with shoulder pain; however, the effect of its utilization on patient outcomes has not been established. Therefore, the primary purpose of this study was to determine whether patient outcomes were improved if care was matched to the STAR-Shoulder system compared with unmatched care., Methods: Collected and reviewed demographic, examination, and intervention data for all patients receiving physical therapist treatment for shoulder pain during a 1-year period within a single health care system. Outcome variables included the numeric pain rating scale, the Quick Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH), and the number of visits. Clinical records from patients receiving care at the discretion of the therapist were systematically audited to determine whether care provided was considered matched or unmatched., Results: A total of 692 patient records were examined. The interrater reliability of classifying care as matched or unmatched was substantial (κ = 0.6; 95% CI = 0.4 to 0.9), with 82% agreement. Changes in patient outcome scores were significantly better for those patients whose care matched the STAR-Shoulder system for pain changes (mean difference = -1.2; 95% CI = 0.8 to 1.6; effect size [d] = 0.5) and QuickDASH score (mean difference = 12.7; 95% CI = 9.9 to 15.5; d = 0.7). No difference was noted for number of visits., Conclusion: The STAR-Shoulder system appears to be a meaningful way to classify patients and guide intervention to improve patient outcomes., Impact: Application of the STAR-Shoulder system to help align physical therapist interventions more closely with tissue irritability and physical impairments appears to improve patient outcomes. These findings support this model as a promising approach to advance evidence-based practice for shoulder pain., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Approximately 50% of firefighter injuries occur in the musculoskeletal system. Poor movement quality increases injury risk, while movement-based interventions may reduce injuries., Purpose: Investigate the effectiveness of auto-generated exercise programming on movement literacy scores among firefighters with lower baseline Functional Movement System (FMS™) scores., Methods: Eleven male firefighters (mean age 44) with FMS™ scores less than 14/21 were included. Detailed explanations of the seven movement screens, five clearing procedures, and scoring were provided prior to baseline FMS™ assessments. Firefighters attempted each test up to three times, with highest scores retained. Scores ranged from 0 to 3 for each of the seven movement screens, with a maximum composite score of 21. Completed test scores were reviewed, and a report was provided to each firefighter through the FMS™PRO App. Additionally, auto-generated programs from the FMS™PRO App with exercise figures, descriptions, and videos to be performed prior to routine conditioning programs were provided. On average, participants were followed up after 262 days for a re-assessment., Results: Mean composite scores significantly improved ( p  = .003) from 11.2 to 15.6/21, with a large effect size ( r  = 0.9). Individual item scores significantly improved for the deep overhead squat, hurdle, shoulder mobility, and rotary stability ( p  ≤ .046), with effect sizes of r  = 0.3-0.8. Significant changes were not present for the inline lunge, active straight leg raise, and trunk stability push-up ( p  ≥ .083)., Conclusion: An auto-generated corrective exercise program individualized to scores on the FMS™ was effective and exceeded error thresholds based on a minimal detectable change of 2.5/21.

Background: Previous qualitative research has listed trust as a component of the therapeutic alliance in physical therapy., Objective: Quantitatively correlate trust and therapeutic alliance in physical therapy care for patients with chronic low back pain. The secondary aim was to investigate the relation of trust and therapeutic alliance with outcomes over the course of treatment., Methods: The Primary Care Assessment Survey was used to measure trust and the Working Alliance Inventory-Short Revised tool measured therapeutic alliance. The patient recorded these measures after the initial visit and at discharge. Self-report patient outcome measures for pain, function, and global rating of change were also measured at the same time points., Results: A strong correlation (rs = 0.747 and rs = 0.801) was found between trust scores and therapeutic alliance measures post-initial visit and at discharge, respectively. In addition, there were moderate to strong correlations between trust and therapeutic alliance scores with the various improved outcome measures of pain, function, and global rating of change., Conclusion: There appears to be a connection between trust and therapeutic alliance along with improved patient outcomes related to higher trust and therapeutic alliance scores in a cohort with chronic low back pain.

Objective: 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., Methods: 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., Outcomes: 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., Conclusion: 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.

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.

Background: Low back pain (LBP) has been shown to have various biological, psychological, and social factors that affect prognosis. However, it is unclear how personality may influence self-reported outcome measures and therapeutic alliance (TA)., Methods: Eysenck's personality inventory was used to assess personality, while the numeric pain rating scale (NPRS), Oswestry Disability Index (ODI), Tampa Scale of Kinesiophobia (TSK), Global Rating of Change (GROC), and the Working Alliance Inventory (WAI) measured patient progress and relationship strength. All outcome measures were formulated in a single survey that both the therapist and patient completed electronically., Results: Sixty-seven patients with LBP and twenty-two licensed physical therapists participated. For personality measures, there was a significant positive correlation between neuroticism and GROC (rho = 0.295, p = 0.015) and a significant negative correlation between extraversion and WAI (rho = -0.243, p = 0.048). Significant correlations were found between ODI and TSK (rho = 0.462, p ≤ 0.001) and between ODI and GROC (rho = -0.416, p ≤ 0.001). A significant negative correlation was found between TSK and GROC (rho = -0.301, p = 0.013)., Conclusions: Patients with higher levels of disability seemed to report higher levels of kinesiophobia and less overall improvement in physical therapy. Patients classified as neurotic reported higher levels of improvement while extraverted patients demonstrated a weaker therapeutic alliance with their therapist., Competing Interests: Conflicts of InterestThe authors declare no conflict of interest., (© 2023 by the authors.)

Background: Up to 67% of adults experience shoulder pain in their lifetime. Numerous factors are related to the etiology of shoulder pain, one of which is thought to be scapular dyskinesis (SD). Given the prevalence of SD among the asymptomatic population a concern is that the condition is being medicalized (clinical findings suggested to require treatment but is ultimately a normal finding). Therefore, the purpose of this systematic review was to investigate the prevalence of SD among both symptomatic and asymptomatic populations., Methods: A systematic review of the literature up to July of 2021. Relevant studies identified from PubMed, EMBASE, Cochrane and CINAHL were screened utilizing the following inclusion and exclusion criteria; inclusion: (a) individuals being assessed as having SD, including reliability and validity studies (b) subjects aged 18 or older; (c) sport and non-sport participants; (d) no date restriction; (e) symptomatic, asymptomatic, or both populations; (f) all study designs except case reports. Studies were excluded if: (a) they were not published in the English language; (b) they were a case report design; (c) the presence of SD was part of the studies inclusion criteria; (d) data were not present distinguishing the number of subjects with or without SD; (e) they did not define participants as having or not having SD. Methodological quality of the studies was assessed utilizing the Joanna Briggs Institute checklist., Results: The search resulted in 11,619 after duplicates were removed with 34 studies ultimately retained for analysis after three were removed due to low quality. A total of 2,365 individuals were studied. Within the studies for the symptomatic athletic and general orthopedic population there were 81% and 57% individuals with SD, respectively, and a total of 60% among both symptomatic groups (sport and general orthopedic population). Within the studies for the asymptomatic athletic and general population there were 42% and 59% individuals with SD, respectively, and a total of 48% among both asymptomatic groups (sport and general orthopedic population)., Limitation: A strict inclusion and exclusion criteria was used to identify studies that provided the appropriate data for the purpose of this study. There was a lack of consistency for measuring SD across studies., Conclusion: A considerable number of individuals with shoulder symptoms do not present with SD. More revealing is the number of asymptomatic individuals who do present with SD, suggesting that SD may be a normal finding among nearly half of the asymptomatic population., Level of Evidence: 2a., Competing Interests: The authors declare no conflict of interest.

Background: Prognostic variables for assessing people with whiplash associated disorder (WAD) following a motor vehicle collision (MVC) have been evaluated in numerous studies. However, there is minimal evidence assessing how these variables may differ between males and females., Question/purpose: 1) To assess if the sex of a person interacts with known prognostic variables within the development of chronic WAD. 2) To determine if commonly used outcome measures used in the assessment of chronic WAD differ between sexes., Methods: The study was a secondary analysis of an observational study with an inception cohort immediately following an MVC in an emergency department in Chicago, IL, USA. Ninety-seven adults aged 18 to 60 (mean 34.7 years old; 74% female) participated in the study. The primary outcome was long-term disability as determined by Neck Disability Index (NDI) scores at 52-weeks post-MVC. Data was collected at baseline (less than 1-week), 2, 12, 52-weeks post MVC. Hierarchal linear regression was used to determine significance (ΔF-score, p < 0.05) and R2 for each of the variables. The primary variables of interest were sex of the participant, age, baseline scores on the numeric pain rating scale (NPRS) and NDI and created interaction terms for sex x z-baseline NPRS and sex x z-NDI., Results: From analysis 1, both NDI (R2 = 8.7%, p < 0.01) and NPRS (R2 = 5.7%, p = 0.02) collected at baseline predicted significant variance in NDI score at 52-weeks. The interaction term of sex x z-NPRS was also significant (R2 = 3.8%, p = 0.04). In analysis 2 the regression models when disaggregated by sex showed that baseline NDI was the significant predictor of 52-week outcome in males (R2 = 22.4%, p = 0.02) while it was the NPRS as the significant predictor in females (R2 = 10.5%, p < 0.01)., Competing Interests: The authors have declared no competing interests exist., (Copyright: © 2023 Callan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Personality type plays a key role in how individuals respond to a variety of stimuli; however, it is unclear if there is a significant influence on pain perception. While pain is associated with many conditions, chronic low back pain (cLBP) is one of the most prevalent and debilitating problems in modern society. Treating this condition can be a challenge and clinicians must understand all factors that can influence pain perception., Purpose: The present study investigated the relationship between personality type and pain experience in patients experiencing cLBP., Methods: One hundred twenty-four participants completed the Eysenck Personality Inventory (EPI), which identifies two major components of the human personality, neuroticism, and extraversion. Participants also completed the Oswestry Disability Index (ODI), the Tampa Scale for Kinesiophobia (TSK), the Numeric Pain Rating Scale (NPRS), and the Pain Catastrophizing Scale (PCS). The association between pain and personality was determined with a Spearman Rank Correlation Coefficient. A hierarchical cluster analysis with Ward's clustering method examined for subgroups of individuals based on these variables., Results: The neuroticism score (EPI-N) was found to have a statistically significant relationship with all pain outcome measures. This suggests that people exhibiting a neurotic personality type are likely to have more fear of movement ( p = 0.001), greater catastrophizing behavior ( p < 0.001), higher self-reported levels of disability ( p < 0.001), and higher overall reported levels of pain ( p = 0.046) than those with other, more stable personality types. Three clusters were derived with varying levels of pain-related factors and personality., Conclusions: Personality type appears to have an influence on many of the attributes associated with cLBP and may be a useful determinate in both prognosis and interventions., Competing Interests: Conflicts of InterestThe authors declare no conflict of interest., (© 2022 by the authors.)

Background: Low back pain (LBP) affects up to 84% of adults and physical therapy (PT) has been reported to be an effective approach to conservative care. For those individuals with LBP referred to PT, the decision to initiate and follow through with care is influenced by numerous factors. Currently, a paucity of evidence exists to identify barriers for patients with LBP to access PT care. Thus, the purpose of this study was to investigate perceived barriers influencing the decision to pursue PT care in the state of Florida., Methods: A purposive survey was administered via Qualtrics ESOMAR. Screener questions ensured candidates had LBP, resided in Florida, and were referred to PT. Participants that met the screener questions were offered an opportunity to participate in the full survey. Once a participant completed the full survey, variables assessing LBP, access to PT services, and potential barriers were analyzed. A partial least squares structural equation model (PLS-SEM) via WarpPLS 7.0 was used to explore which of the perceived barriers had the greatest influence on whether an individual with LBP was able to pursue PT care., Results: The conceptual framework that demonstrated the best fit of direct effects of potential barriers to accessing care included six independent exogenous latent variables: (a) unaware of a PT clinic near their home or work, (b) had children but no childcare for them, (c) had long PT sessions (e.g., 60 min), (d) had more than one PT session per week, (e) had fewer days active per week, and (f) exercised fewer times per day. Together the six variables explained 19% of the variance related to following through with care ( R 2  = 0.19)., Conclusions: The ability of an individual with LBP to access PT care in the state of Florida is multifactorial. There appears to be three broad factors that are the primary barriers, which include (a) the logistic ability (location and access to childcare) to attend PT treatment, (b) how much time is dedicated to the PT treatment, and (c) activity frequency of the individual seeking care. These findings support previous conceptual frameworks for predicting PT treatment. Practitioners and policy makers should consider these barriers when developing plans for conservative management of LBP in Florida., Competing Interests: MDM was employed by Orblytics, LLC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Hanney, Munyon, Mangum, Rovito, Kolber and Wilson.)

Background: Range of motion (ROM) impairments of the overhead athletes' shoulder are commonly addressed through mobility-based treatments, however, adaptations from humeral torsion (HT) are not amenable to such interventions. A clinical measurement to quantify HT has been proposed, however, the validity is not conclusive., Purpose: The primary aim of this study is to determine the intrarater reliability and standard error of measurement (SEM) of the biceps forearm angle (BFA) measurement. The secondary aim of this study is to investigate the convergent validity of the BFA compared to diagnostic ultrasound., Study Design: Cross Sectional Reliability and Validity Study., Methods: HT measurements, utilizing diagnostic ultrasound, were compared to BFA in 74 shoulders (37 subjects) over two sessions. Each measurement was performed three times and a third investigator recorded measures to ensure blinding. Reliability was investigated using utilizing an intraclass correlation coefficient (ICC 3,k)., Results: Intrarater reliability values were 0.923 and 0.849 for diagnostic ultrasound and BFA methods respectively. Convergent validity was r = 0.566. The standard error of measurement for diagnostic ultrasound and BFA was 3° and 5°, respectively. The 95% limits of agreement between the two measurement methods were -24.80° and 19.80° with a mean difference of -2.50° indicating that on average the diagnostic ultrasound measurement was lower than that of the BFA method., Conclusion: The BFA is a reliable clinical method for quantifying HT, however, demonstrates moderate to poor convergent validity when compared to diagnostic ultrasound., Level of Evidence: 2b., Competing Interests: The authors report no conflicts of interest.

Objectives: The purpose of this study was to investigate the construct validity and overall appropriateness of test score interpretation of 4 shoulder-related patient-reported outcome (PRO) measures for use in a population of patients with head and neck cancer using Rasch analysis., Methods: One hundred eighty-two individuals who had received a neck dissection procedure within the past 2 weeks to 18 months were recruited for this cross-sectional psychometric study. Rasch methodologies were used to investigate scale dimensionality, scale hierarchy, response scale structure, and reliability of Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH, Shoulder Pain and Disability Index (SPADI), and Neck Dissection Impairment Index (NDII)., Results: DASH did not meet criteria for unidimensionality and was deemed inappropriate for use in this sample. The QuickDASH, SPADI, and NDII were all determined to be unidimensional. All scales had varying issues with person and item misfit, differential item functioning, coverage of ability levels, and optimal rating scale requirements. The NDII met most requirements. All measures were found to meet thresholds for person and item separation as well as reliability statistics., Conclusions: Rasch analysis indicates the NDII is the most appropriate measure studied for this population. The QuickDASH and SPADI are recommended with reservation, whereas the DASH is not recommended., Impact: This study demonstrates the use of objective methodologies, using Rasch analysis, to validate PRO recommendations provided by clinical experts in forums such as the Evaluation Database to Guide Effectiveness (EDGE) TaskForce, which are based upon a comprehensive literature review, consideration of published psychometric properties, and expert consensus. Use of Rasch methodologies demonstrates weaknesses in this model and provides opportunities to strengthen recommendations for clinicians., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Low back pain (LBP) is a common problem that places a major burden on individuals and society. It has been proposed that patients treated by biomedically oriented clinicians will have worse outcomes than those treated by biopsychosocially oriented clinicians., Objective: To investigate the impact of physical therapist LBP related attitudes and beliefs on the outcomes of patients with LBP., Design: Retrospective cohort design., Method: United States based physical therapists utilizing the Focus on Therapeutic Outcomes, Inc. (FOTO) database were surveyed using the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Outcomes were measured using average Computerized Lumbar Functional Scale change scores (CLFS) and CLFS residual scores., Results: Analysis was performed on outcome data from 78 physical therapist and included 2345 patients. HC-PAIRS was a univariate predictor of average CLFS change scores and average CLFS residual scores. PABS-PT Biomedical subscale was a univariate predictor of average CLFS change scores. After adjusting for confounding variables, higher HC-PAIRS scores and PABS-BM scores were associated with a greater change in average CLFS score, and higher PABS-BM scores were associated with higher CLFS residual scores., Conclusion: Physical therapists who believed in a stronger relationship between pain and disability had improved patient outcomes., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Biomechanical muscle stiffness has been linked to musculoskeletal disorders. Assessing changes in muscle stiffness following DN may help elucidate a physiologic mechanism of DN. This study characterizes the effects of dry needling (DN) to the infraspinatus, erector spinae, and gastrocnemius muscles on biomechanical muscle stiffness., Method: 60 healthy participants were randomized into infraspinatus, erector spinae, or gastrocnemius groups. One session of DN was applied to the muscle in standardized location. Stiffness was assessed using a MyotonPRO at baseline, immediately post DN, and 24 h later. The presence of a localized twitch response (LTR) during DN was used to subgroup participants., Results: A statistically significant decrease in stiffness was observed in the gastrocnemius, the LTR gastrocnemius, and the LTR erector spinae group immediately following DN treatment. However, stiffness increased after 24 h. No significant change was found in the infraspinatus group., Conclusions: DN may cause an immediate, yet transitory change in local muscle stiffness. It is unknown whether these effects are present in a symptomatic population or related to improvements in clinical outcomes. Future studies are necessary to determine if a decrease in biomechanical stiffness is related to improvement in symptomatic individuals., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Mechanical percussion devices have become popular among sports medicine professionals. These devices provide a similar effect as manual percussion or tapotement used in therapeutic massage. To date, there are few published studies or evidence-based guidelines for these devices. There is a need to understand what professionals believe about this technology and how they use these devices in clinical practice., Purpose: To survey and document the knowledge, clinical application methods, and use of mechanical percussion devices among healthcare professionals in the United States., Design: Cross-sectional survey study., Methods: A 25 question online survey was emailed to members of the National Athletic Trainers Association, Academy of Orthopedic Physical Therapy, and American Academy of Sports Physical Therapy., Results: Four hundred twenty-five professionals completed the survey. Most professionals (92%, n=391) used devices from two manufacturers: Hyperice® and Theragun®. Seventy-seven percent directed clients to manufacturer and generic websites (n=329) to purchase devices. Most respondents used a medium and low device speed setting for pre- and post-exercise (62%, n=185), pain modulation (59%, n=253), and myofascial mobility (52%, n=222). A large proportion of respondents preferred a total treatment time between 30 seconds and three minutes (36-48%, n=153-204) or three to five minutes (18-22%, n=76-93). Most respondents (54-69%, n=229-293) believed that mechanical percussion increases local blood flow, modulates pain, enhances myofascial mobility, and reduces myofascial restrictions. Most respondents (72%, n=305) were influenced by other colleagues to use these devices. Sixty-six percent used patient reported outcomes (n=280) to document treatment efficacy. Live instruction was the most common mode of education (79%, n=334)., Conclusion: These results are a starting point for future research and provide insight into how professionals use mechanical percussion devices. This survey also highlights the existing gap between research and practice. Future research should examine the efficacy of this technology and determine consensus-based guidelines., Level of Evidence: 3., Competing Interests: The authors have no conflict of interest with this manuscript.

Purpose: Kinesiology taping is a common intervention used to treat individuals with shoulder pain. While there have been several studies published to date evaluating the effectiveness of this intervention, a systematic review with meta-analysis synthesizing the collective effectiveness of kinesiology taping is not available. Therefore, the purpose of this study was to perform a systematic review with meta-analysis investigating the efficacy and treatment fidelity of kinesiology taping (KT) in combination with conservative interventions for shoulder pain., Methods: Databases (PubMed, EMBASE, SportDiscus, CINAHL) of studies published in English meeting criteria were searched to October 2019. Methodologic quality was assessed utilizing the Modified Downs and Black checklist. Treatment fidelity was evaluated using a modified fidelity tool. Random effects meta-analyses were performed when an outcome (disability, pain, range of motion (ROM)) was reported by two or more studies. Overall effect size (pooled random effects) was estimated for studies with acceptable clinical homogeneity., Results: When KT was used with conservative treatments, meta-analysis revealed large effect sizes for improvements in disability (standard mean difference (SMD) = -1.35; 95% CI, -2.09 to -0.60) and ROM (SMD = 0.96; 95% CI, 0.60-1.33) with no significant effects for pain. The average Modified Downs & Black score for bias was 11.5 ± 3.9. Of 10 retained studies, only two had good treatment fidelity., Conclusions: Adding KT to interventions performed in clinical settings appears to demonstrate efficacy regarding disability and ROM when compared to conservative interventions alone. However, despite reasonably good methodologic quality, fidelity was lacking in a majority of studies. Because of its impact on the implementation of evidence-based practice, lower fidelity should be considered when interpreting results., Competing Interests: The authors report no conflicts of interest.

Background: Sports rehabilitation professionals often prescribe unstable objects for balance training. Unfortunately, there is a lack of measurement of balance confidence when incorporating these objects. Currently, there is no consensus on the optimal balance confidence measure or proposed progression of unstable objects. Understanding the influence of balance confidence on task performance using unstable objects may help professionals better prescribe a balance training program., Purpose: The primary purpose of this investigation was to explore the correlation between anticipated and actual balance confidence on different unstable objects during static double leg and single leg stance. The secondary purpose was to explore the correlation between anticipated and actual unstable object difficulty rankings., Study Design: Repeated measure observational, controlled trial., Methods: Sixty-five active, healthy adults (M = 35, F = 30) (mean age = 24.38 ± 3.56) underwent two testing sessions. During session one, participants took an online survey, rating their anticipated balance confidence after observing images of different unstable objects. During session two, participants stood on each unstable object under two conditions (static double leg stance and single leg stance) and rated their actual balance confidence. The main outcome measure was an ordinal balance confidence score adapted from the activities-specific balance confidence scale. Statistical analysis included subject demographic calculations and appropriate non-parametric tests., Results: For the double leg stance and single leg stance conditions, there was a very strong correlation between anticipated and actual balance confidence scores on the stable surface (ρ = 1.0, p = <.001). There was a weak correlation between scores for foam pad, air-filled discs, Bosu® (dome up), Bosu® (dome down), and wobble board for both conditions. For unstable object rankings, there was a very strong correlation between scores (ρ=1.0, p = <.001). The objects were ranked by perceived difficulty as follows: Level 1 (easy)- ground, Level 2- foam pad, Level 3- air-filled discs, Level 4- Bosu®, and Level 5 (difficult)- wobble board., Conclusion: Study findings suggest that actual measures of balance confidence may provide insight into a patient's confidence level and may help with prescribing and progressing their program. The suggested unstable object difficulty rankings may help professionals better match the objects to their patients to produce optimal outcomes., Level of Evidence: 2c., (© 2020 by the Sports Physical Therapy Section.)

Background: Muscle length is a common component of the physical therapy examination, which may include the prone knee flexion (Ely) and active knee extension (AKE) tests. Clinicians using these tests should understand the clinimetric properties., Purpose: To investigate the reliability and minimal detectable change (MDC 95 ) of the Ely and AKE tests., Study Design: Reliability analysis., Methods: Seventy-one asymptomatic adults (mean age 24.6 + /- 2.8 years) were recruited based on a convenience sample. Two examiners each performed the Ely and AKE test one time each in an intrasession design for the interrater reliability component, with one examiner repeating the tests one time 48 hours later to determine the intra-rater reliability. Results were recorded based on one trial per test and utilized a pelvic strap for the Ely test and an adjustable bolster for the AKE test. A separate researcher recorded measurements and results were blinded from the examiners., Results: The Ely test had excellent intra-rater and inter-rater reliability with an intraclass correlation coefficient (ICC) (3,1) of 0.900 and ICC (2,1) of 0.914 respectively. The intra-rater and inter-rater reliability of the AKE test was good with ICC (3,1) of 0.882 and ICC (2,1) 0.886 respectively. The MDC 95 indicated that a change greater than or equal to 8° and 12° is required to exceed the threshold of error for the Ely and AKE test respectively., Conclusion: The Ely and AKE tests have good to excellent inter-rater and intra-rater reliability for measuring rectus femoris and hamstring muscle length when stabilization of the pelvis and hip is accounted for. The MDC should be considered as a threshold for true change in the asymptomatic adult population., Levels of Evidence: 2b., (© 2020 by the Sports Physical Therapy Section.)

Objective: This study sought to determine if a mammogram performed in a multi-sensory environmental upgraded room (UR) is associated with improved image quality when compared to a standard room (SR)., Methods: A retrospective analysis (interrupted time series design) of compression force and posterior nipple line (PNL) measurements was performed on 303 women (mean age 60.9 years) who underwent screening mammography for 2 consecutive years (year 1 in SR, year 2 in UR) at a single outpatient facility. Using the Picture Archiving Communication System (PACS), craniocaudal (CC) and mediolateral oblique (MLO) images for the two years were reviewed. The PNL was measured for the CC and MLO images bilaterally using the embedded tools in the PACS software. Posterior nipple line and compression force were analyzed using a paired t-test. Bland-Altman plots were used to obtain 95% limits of agreement (LOA) between the UR and SR., Results: Image quality as determined by PNL measurement distance was greater in the UR (P < 0.001) when compared with the SR, with similar compression force (P ≥ 0.14). Mean PNL measurement differences ranged from 5.0 to 6.2 mm greater in the UR, whereas mean compression force differences ranged from -2.4 to 1.5 newtons. The 95% LOA suggest that PNL measurement differences between the UR and SR can vary by -11.0 to 27.0 mm., Conclusion: Environmentally modifying mammography rooms may improve image quality with regard to PNL measurements without increasing compression force., (© Society of Breast Imaging 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To determine the immediate and short-term effects of adding cervical spine high-velocity, low-amplitude thrust (HVLAT) to behavioral education, soft tissue mobilization, and a home exercise program on pain and dysfunction for people with a primary complaint of temporomandibular disorder (TMD) with myalgia., Design: Randomized clinical trial., Methods: Fifty individuals with TMD were randomly assigned to receive cervical HVLAT or sham manipulation for 4 visits over 4 weeks. Participants in both groups received other treatments, including standardized behavioral education, soft tissue mobilization, and a home exercise program. Primary outcomes included maximal mouth opening, the numeric pain-rating scale, the Jaw Functional Limitation Scale (JFLS), the Tampa Scale of Kinesiophobia for TMD (TSK-TMD), and a global rating of change (GROC). Self-report and objective measurements were taken at baseline, immediately after initial treatment, and follow-ups of 1 week and 4 weeks. A 2-by-4 mixed-model analysis of variance was used, with intervention group as the between-subjects factor and time as the within-subject factor. Separate analyses of variance were performed for dependent variables, and the hypothesis of interest was the group-by-time interaction., Results: There was no significant interaction for maximal mouth opening, the numeric pain-rating scale, or secondary measures. There were significant 2-way interactions for the JFLS ( d = 0.60) and TSK-TMD ( d = 0.80). The HVLAT group had lower fear at 4 weeks and improved jaw function earlier (1 week). The GROC favored the HVLAT group, with significant differences in successful outcomes noted immediately after baseline treatment (thrust, 6/25; sham, 0/25) and at 4 weeks (thrust, 17/25; sham, 10/25)., Conclusion: Both groups improved over time; however, differences between groups were small. There were significant differences between groups for the JFLS, TSK-TMD, and GROC. The additive clinical effect of cervical HVLAT to standard care remains unclear for treating TMD. J Orthop Sports Phys Ther 2020;50(8):455-465. Epub 6 Jan 2020. doi:10.2519/jospt.2020.9175 .

Background: Intrinsic factors including altered joint motion in the upper extremity may lead to altered biomechanics in tennis players and could result in symptoms of lateral elbow tendinopathy., Purpose: To compare upper extremity passive motion and elbow carrying angle between three groups of women: recreational tennis players with LET, non-symptomatic recreational tennis players, and a control group of non-tennis players., Study Design: Cross-sectional., Methods: A convenience sample of 63 women was recruited and placed into one of the three groups: non-symptomatic tennis players (NSTP), symptomatic tennis players (STP), and a control group. Elbow carrying angle, passive range of motion of the shoulder, elbow, forearm, and wrist were measured during a single session., Results: A significant difference was found between the groups for wrist flexion ( p < 0.00), forearm pronation ( p = 0.002), elbow flexion ( p = 0.020) and extension ( p = 0.460), as well as shoulder internal rotation ( p < 0.00). No significant differences were found in other motions or carrying angle between the three groups ( p =0.059). Post-hoc comparisons indicated that shoulder internal rotation and wrist flexion was less in both STP and NSTP groups compared with the control group. Elbow flexion and forearm pronation were greater in STP than the other two groups., Conclusion: Impairments including loss of shoulder internal rotation and wrist flexion and greater motion at the elbow and forearm were found in the UE of symptomatic tennis players. Evaluation of passive motion and muscle length should be performed prior to establishing a rehabilitation plan for symptomatic tennis players., Levels of Evidence: 3., (© 2020 by the Sports Physical Therapy Section.)

Background: Posterior shoulder tightness (PST) has been implicated in the etiology of numerous shoulder disorders and is a source of stiffness in both postoperative and nonsurgical cohorts. Identifying efficacious interventions to address PST has the potential to impact patient outcomes in both operative and nonoperative cohorts. Our purpose was to analyze the efficacy of nonoperative clinician-assisted interventions used to mitigate PST., Methods: We performed a systematic review and meta-analysis. Relevant studies were assessed for inclusion, and selected studies were identified from the PubMed, Embase, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases by a biomedical librarian. Data extracted from the selected studies underwent quality appraisal using Grading of Recommendations, Assessment, Development, and Evaluation analysis; fidelity assessment; and meta-analysis., Results: The search identified 374 studies, with 13 ultimately retained. Grading of Recommendations, Assessment, Development, and Evaluation analysis revealed areas of concern regarding consistency and imprecision of reporting within the included studies overall. Treatment fidelity assessment showed that only 3 of the 13 studies received a rating of good to excellent, indicating a high risk of bias. When clinician-assisted interventions were compared with no treatment, meta-analysis showed a moderate effect size in favor of clinician-assisted interventions for improving range of motion. When a multimodal treatment approach for PST was compared with active comparator interventions, a small effect size was present for improving range of motion in favor of the multimodal approach., Conclusion: The efficacy of clinician-assisted interventions for reducing PST was identified when using both a single treatment and multimodal treatments. Current evidence focuses mostly on populations with PST who were not seeking care and the immediate- to short-term effects of clinician-assisted interventions, which may limit generalization of findings., (Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Objectives: To determine the efficacy of IASTM of the gastrocnemius-soleus complex in comparison to a traditional stretching intervention on dorsiflexion ROM., Methods: Sixty healthy participants were randomly allocated to one of 3 groups: IASTM (n = 20), stretching (n = 20), or control group (n = 20). The dependent variables for this study was dorsiflexion range of motion (ROM) via three measurement methods which included Modified root position 1- knee extended (MRP1), Modified root position 2- knee flexed (MRP2), and weight bearing lunge test (WBLT). A multivariate analysis of variance (MANOVA) was utilized to analyze the ROM differences between the groups (IASTM, stretching, and control groups), with a post-hoc Tukey and pairwise least significant difference tests to assess individual pairwise differences between the groups., Results: The MANOVA found significant ROM differences between the three intervention groups (F 6,110  = 2.40, p = .032). Statistically significant differences were identified between both the IASTM and control as well as the stretching and control group through the WBLT and MRP2 assessments, but not in the MRP1 assessment. Further, there was no statistically significant difference between the IASTM and stretching groups using any of the three methods., Conclusion: A single session of IASTM or stretching increased ankle dorsiflexion ROM in WBLT and MRP2. No significant difference was noted in the MRP1. Both IASTM and stretching appear to have a greater effect on soleus muscle flexibility as evidenced by ROM gains measured with the knee in a flexed position. No clinically significant difference was identified between the intervention groups in weight-bearing conditions; thus empowering patients with the use of self-stretching would seemingly be reasonable and efficient. Combined effects of stretching and IASTM warrant further investigation for increasing dorsiflexion range of motion as a summative effect is unknown., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Hypothesis and Background: Posterior shoulder tightness (PST) has been linked to numerous shoulder pathologies in both the general and athletic populations. Several methods for documenting PST have been described in the literature, which may lend to variability in clinical practice and research. The purpose of this study was to perform a systematic review with meta-analysis to investigate the reliability, validity, and methodologic quality of methods used to quantify PST., Methods: Relevant studies were assessed for inclusion, and selected studies were identified from the PubMed, Embase, Cochrane, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. Data were extracted from the selected studies and underwent methodologic quality assessment and meta-analysis., Results: The search resulted in 1006 studies identified, with 18 ultimately retained. Intrarater reliability was reported in 12 studies with a summary intraclass correlation coefficient of 0.93 (95% confidence interval, 0.90-0.95), whereas inter-rater reliability was reported in 6 studies with a summary intraclass correlation coefficient of 0.89 (95% confidence interval, 0.80-0.94). Validity was reported in 10 studies, all using internal rotation as the convergent standard, and was found to be significant in all but 1 study., Conclusion: Current methods used to quantify PST have good reliability but are primarily limited to measures of horizontal adduction of the glenohumeral joint with scapular stabilization. Limitations in using a single measurement technique exist particularly as there may be multiple contributing factors to PST. A more comprehensive approach for quantifying PST is necessary, and suggested components include a cluster of techniques composed of horizontal adduction, internal rotation, and total glenohumeral joint range of motion., (Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

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.

This investigation measured the reliability of the numeric pain rating scale (NPRS) for roller massage (RM) over two sessions and compared it to pressure pain threshold (PPT) during a third session. Twenty-five subjects participated. Session one, subjects rolled on 3 different rollers and filled out the NPRS for each roller then chose their preferred roller. Session two, subjects repeated the testing blind-folded to eliminate visual biases. Session three, subjects repeated testing but were measured with PPT. For the NPRS, there was poor to moderate reliability for the soft roller (ICC=0.60) and good reliability for the moderate (ICC=0.82) and hard density (ICC= 0.90) rollers. For preferred roller, there was no significant difference between sessions (t (24) =.00, p=1.00). For NPRS and PPT, there was a fair relationship for all rollers (Rho=0.34-0.49, p = 0.11-0.28). The NPRS appears to be a reliable measure and may help direct individuals to a specific roller. The NPRS and PPT should be used independently., Competing Interests: The authors have no disclaimers, competing interests, or sources of support or funding to report in the preparation of this manuscript.

Background: Physical therapy is an important treatment option for patients with low back pain (LBP). However, whether to refer patients for physical therapy and the timing of initiation remain controversial., Objective: The objective of this study was to evaluate the impact of receiving physical therapy and the timing of physical therapy initiation on downstream health care utilization and costs among patients with acute LBP., Design: The design was a retrospective cohort study., Methods: Patients who had a new onset of LBP between January 1, 2009, and December 31, 2013, in New York State were identified and grouped into different cohorts on the basis of whether they received physical therapy and the timing of physical therapy initiation. The probability of service use and LBP-related health care costs over a 1-year period were analyzed., Results: Among 46,914 patients with acute LBP, 40,246 patients did not receive physical therapy and 6668 patients received physical therapy initiated at different times. After controlling for patient characteristics and adjusting for treatment selection bias, health care utilization and cost measures over the 1-year period were the lowest among patients not receiving physical therapy, followed by patients with immediate physical therapy initiation (within 3 days), with some exceptions. Among patients receiving physical therapy, those receiving physical therapy within 3 days were consistently associated with the lowest health care utilization and cost measures., Limitations: This study was based on commercial insurance claims data from 1 state., Conclusions: When referral for physical therapy is warranted for patients with acute LBP, immediate referral and initiation (within 3 days) may lead to lower health care utilization and LBP-related costs.

Objective: Clinicians and researchers often use the numeric pain rating scale (NPRS) and visual analog scale (VAS) to measure and track pain in individuals with myofascial pain syndrome (MPS) and fibromyalgia (FM). The VAS is often used as a reference standard in chronic pain research. To date, no studies have specifically measured the concurrent validity of the NPRS and VAS in these individuals. The purpose of this investigation was to determine the concurrent validity of the NPRS when compared to the reference standard VAS in patients with MPS and FM., Methods: This investigation explored the concurrent validity of the NPRS and VAS in sixty participants with MPS (N = 30) and FM (N = 30). All participants underwent one day of testing using the American College of Rheumatology criteria for classifying FM. For each tender point (18-total), participants graded tenderness using the NPRS and VAS., Results: An excellent relationship was found between the NPRS and VAS for the MPS group (rho≥0.81, 95% CI 0.79-0.85, p < 0.001) and the FM group (rho ≥0.96, 95% CI 0.92-0.97, p < 0.001)., Conclusion: The results of this study suggest that the NPRS has good concurrent validity with the referenced standard VAS among individuals with MPS and FM., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Study Design Randomized clinical trial. Background The comparative effectiveness between nonthrust manipulation (NTM) and thrust manipulation (TM) for mechanical neck pain has been investigated, with inconsistent results. Objective To compare the clinical effectiveness of concordant cervical and thoracic NTM and TM for patients with mechanical neck pain. Methods The Neck Disability Index (NDI) was the primary outcome. Secondary outcomes included the Patient-Specific Functional Scale (PSFS), numeric pain-rating scale (NPRS), deep cervical flexion endurance (DCF), global rating of change (GROC), number of visits, and duration of care. The covariate was clinical equipoise for intervention. Outcomes were collected at baseline, visit 2, and discharge. Patients were randomly assigned to receive either NTM or TM directed at the cervical and thoracic spines. Techniques and dosages were selected pragmatically and applied to the most symptomatic level. Two-way mixed-model analyses of covariance were used to assess clinical outcomes at 3 time points. Analyses of covariance were used to assess between-group differences for the GROC, number of visits, and duration of care at discharge. Results One hundred three patients were included in the analyses (NTM, n = 55 and TM, n = 48). The between-group analyses revealed no differences in outcomes on the NDI (P = .67), PSFS (P = .26), NPRS (P = .25), DCF (P = .98), GROC (P = .77), number of visits (P = .21), and duration of care (P = .61) for patients with mechanical neck pain who received either NTM or TM. Conclusion NTM and TM produce equivalent outcomes for patients with mechanical neck pain. The trial was registered with ClinicalTrials.gov (NCT02619500). Level of Evidence Therapy, level 1b. J Orthop Sports Phys Ther 2018;48(3):137-145. Epub 6 Feb 2018. doi:10.2519/jospt.2018.7738.

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 pretest-posttest 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 (t[20] = -6.2, P < 0.001) and contralateral quadriceps (t[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.

Background: Manual pressure palpation is an examination technique used in the classification of myofascial pain syndrome (MPS) and fibromyalgia (FM). Currently, there are no validated systems for classifying results. A valid and reliable pressure pain threshold scale (PPTS) may provide a means for clinicians to grade, document, and report findings. The purpose of this investigation was to validate a PPTS in individuals diagnosed with MPS and FM. Intra-rater reliability, concurrent validity, minimum cut-off value, and patient responses were evaluated., Methods: Eighty-four participants who met the inclusion criteria were placed into three groups of 28 ( N = 84): MPS, FM, and asymptomatic controls. All participants underwent a two-part testing session using the American College of Rheumatology criteria for classifying FM. Part-1 consisted of manual palpation with a digital pressure sensor for pressure consistency and part 2 consisted of algometry. For each tender point (18 total), participants graded tenderness using the visual analog scale (VAS) while the examiner concurrently graded response using a five-point PPTS., Results: The PPTS had good intra-rater reliability (ICC ≥ .88). A moderate to excellent relationship was found between the PPTS and VAS for all groups with the digital pressure sensor and algometer ( ρ  ≥ .61). A minimum cut-off value of 2 on the PPTS differentiated participants with MPS and FM from asymptomatic controls., Discussion: The results provide preliminary evidence validating the PPTS for individuals with MPS and FM. Future research should further study the clinimetric properties of the PPTS with other chronic pain and orthopedic conditions., Levels of Evidence: 2c., Clinical Trial Registration: ClinicalTrials.gov registration No. NCT02802202.

Background: Two-dimensional (2D) analysis has the potential to identify individuals at risk for knee injury by measuring genu valgus during sport related tasks. The reliability of 2D mobile motion analysis in measuring genu valgus during a single leg hop test on individuals with anterior knee pain has not been examined., Purpose: To assess the reliability and concurrent validity of 2D mobile motion analysis and compare it to visual observation while analyzing dynamic genu valgus during a single leg hop test in subjects with anterior knee pain., Study Design: Cohort study; repeated measures., Methods: Nineteen subjects experiencing anterior knee pain completed a single leg hop test with both lower extremities. Two investigators independently estimated the degrees of genu valgus with visual observation alone during the subjects' single leg hop. After the visual estimation, the investigators watched the video again using the 2D Spark Motion Pro™ application to pause the video and measured the amount of knee valgus with a virtual goniometer tool on the application. Interrater reliability was calculated using intraclass correlation coefficients (ICC) model 2, k and intrarater rater reliability using model 3, k. Minimal detectable change, concurrent validity and limits of agreement were calculated., Results: Visual observation alone demonstrated interrater reliability ICCs of 0.682-0.685 on the symptomatic and non-symptomatic lower extremities respectively. The interrater reliability using the 2D application had ICC's of 0.927 and 0.792 on the symptomatic and non-symptomatic lower extremities respectively. The concurrent validity for 2D analysis and visual observation on the symptomatic lower extremity had ICC values of 0.96 (rater A) and 0.85 (rater B). The non-symptomatic lower extremity demonstrated concurrent validity ICC values of 0.95(rater A) and 0.65(rater B). The standard error of measurement(SEM) was 3.898 and 3.258 for the symptomatic and non-symptomatic lower extremity(LE) respectively for visual observation. When using the Spark Motion Pro™ application the SEM was 1.648 and 2.718 for the symptomatic and non-symptomatic LE respectively. The minimal detectable change (MDC) using visual observation alone was 5.58 and 4.68. When using the application, it was noted at 2.328 and 3.838 on the symptomatic and non-symptomatic LE respectively., Conclusion: The results of this study support the use of a 2D mobile application as a reliable tool for measuring knee valgus in symptomatic subjects and offers reduced error (SEM = 1.648) when compared to visual observation alone (SEM = 3.898)., Level of Evidence: 2B.