Subtalar joint (STJ) dysfunction can contribute to movement disturbances. Vibration energy with color Doppler imaging (VECDI) may be useful for detecting STJ stiffness changes.
(1) Support ...proof-of-concept that VECDI could detect STJ stiffness differences; (2) Establish STJ stiffness range in asymptomatic volunteers; (3) Examine relationships between STJ stiffness and foot mobility; and (4) Assess VECDI precision and reliability for examining STJ stiffness.
After establishing cadaveric testing model proof-of-concept, STJ stiffness (threshold units, ΔTU), ankle complex passive range-of-motion (PROM) and midfoot-width-difference (MFWDiff) data were collected in 28 asymptomatic subjects in vivo. Three reliability measurements were collected per variable; Rater-1 collected on all subjects and rater-2 on the first ten subjects. Subjects were classified into three STJ stiffness groups.
Cadaveric VECDI measurement intra-rater reliability was 0.80. A significantly lower STJ ΔTU (p = .002) and ankle complex PROM (p < .001) was observed during the screw fixation versus normal condition. A fair correlation (r = 0.660) was observed between cadaveric ΔTU and ankle complex PROM. In vivo VECDI measurements demonstrated good intra-rater (0.76-0.84) versus poor inter-rater (-3.11) reliability. Significant positive correlations were found between STJ stiffness and both dorsum (r = .440) and posterior (r = .390) PROM. MFWDiff exhibited poor relationships with stiffness (r = .103) and either dorsum (r = .256) or posterior (r = .301) PROM. STJ stiffness ranged from 2.33 to 7.50 ΔTUs, categorizing subjects' STJ stiffness as increased (n = 6), normal (n = 15), or decreased (n = 7). Significant ANOVA main effects for classification were found based on ΔTU (p< .001), dorsum PROM (p = .017), and posterior PROM (p = .036). Post-hoc tests revealed significant: (1) ΔTU differences between all stiffness groups (p < .001); (2) dorsum PROM differences between the increased versus normal (p = .044) and decreased (p = .017) stiffness groups; and (3) posterior PROM differences between the increased versus decreased stiffness groups (p = .044). A good relationship was found between STJ stiffness and dorsum PROM in the increased stiffness group (r = .853) versus poor, nonsignificant relationships in the normal (r = -.042) or decreased stiffness (r = -.014) groups.
PROM may not clinically explain all aspects of joint mobility. Joint VECDI stiffness assessment should be considered as a complimentary measurement technique.
ABSTRACT
Introduction
Musculoskeletal (MSK) injuries make up a significant proportion of conditions treated by military healthcare providers during wartime. Though many common MSK injuries may ...benefit from corticosteroid injection (CSI), a shortage of qualified military clinicians has led to diminished access to appropriate care. Longer wait times to receive treatment pose detrimental effects on military readiness and have garnered the attention of military leaders. One solution was the development of advanced training for United States Air Force physical therapists (USAF PTs) to gain clinical privileges in administering CSI. The objectives of this study were to determine in USAF PTs (1) the prevalence of those with privileges to administer CSI; (2) the type and (3) safety of MSK CSI administered; (4) incidence of CSI complications; (5) healthcare utilization following CSI; and (6) barriers to obtaining and practicing CSI privileges.
Materials and Methods
United States Air Force PTs with CSI privileges received instructions to follow a link to an anonymous Google survey. Electronic medical record reviews were conducted by three USAF PTs to determine the occurrence and severity of CSI complications provided by USAF PTs and advanced healthcare providers (AHPs). The principal investigator conducted further review of the patients’ electronic medical records to calculate healthcare utilization following CSI administered by USAF PTs. A hospital administrator selected cases of similar diagnoses treated with CSI by USAF AHPs. The number selected cases treated by AHPs are similar to the number of CSI cases treated by USAF PTs.
Results
Eleven USAF PTs held CSI privileges. No major complications associated with CSI were recorded. Of the 95 CSI cases treated by USAF PTs, 27 (28.4%) reported increased pain compared to 24 (27.9%) of 86 CSI cases treated by AHPs (P = .94). Healthcare utilization for the number of follow-up visits, imaging, and additional laboratory tests following CSI by USAF PTs was lower compared to AHPs (chi-square; P < .0069).
Conclusion
Nine percentage of USAF PTs held CSI privileges. United States Air Force PTs were equally safe as AHPs who administered CSI and associated with a lower rate of healthcare utilization following the intervention. Training USAF PTs to administer CSI could be the standard for all USAF PTs who meet qualification requirements. Adoption of similar training and credentialing policies for civilian PTs warrants further exploration.
Purpose To compare humeral head translation (HHT) during shoulder elevation between dominant and non-dominant shoulders in participants with limited dominant shoulder internal rotation range of ...motion (ROM). To determine if joint mobilization alters HHT, and if relationships exist between the bicipital forearm angle and HHT. Participants and Methods Fifteen (9 female) participants (age 25.7 ± 6.8 years) with a minimum 15-degree dominant shoulder internal rotation ROM deficit compared to the opposite shoulder participated. All participants underwent bicipital forearm angle (BFA) measurements and ultrasound imaging to measure acromiohumeral and posterior glenohumeral distances in 3 positions: Resting, 90 degrees of shoulder flexion, and 60 degrees of shoulder abduction with full external rotation. Ultrasound images were used to calculate HHT. Participants’ dominant shoulders underwent posterior glide mobilization, followed immediately by repeated ultrasound images and ROM measures. Results There was no dominant to non-dominant shoulder, or before and after mobilization HHT differences. No correlations existed between bicipital forearm angles and HHT or ROM gains after mobilization. Conclusion Participants with internal rotation ROM loss demonstrated symmetrical HHT. Joint mobilization increased ROM, but HHT was unchanged. No relationships existed between BFA and HHT.
The purpose of this study was to investigate in cadaveric specimens the reliability of measuring cervical intradiscal pressure (CIDP) and if posterior-anterior (PA) mobilizations targeting the ...cervical spine were associated with CIDP changes.
Cervical PA mobilizations were performed on the spinous processes of 7 (3 men, 4 women) cadaveric specimens using a servo-controlled linear actuator to provide 25N and 45N forces. CIDP measurements were performed at C4-5, C5-6, C6-7, and C7-T1 intervertebral discs (IVDs) using a fiberoptic catheter system that recorded CIDP for each IVD cervical segment. To assess CIDP measurement reliability, the intraclass correlation coefficient (ICC 3,k) was calculated. Repeated measures Friedman analysis of variance assessed effect of cervical mobilizations on CIDP for before, during, and immediately after mobilization at 25N and 45N forces for each cervical IVD segment.
All CIDP measurements demonstrated excellent reliability (ICC >0.98). During the 25N mobilizations, the median CIDP varied from -0.12 to 0.91 (interquartile range, 5.22-5.36), while for 45N mobilizations the median ranged from -0.94 to 1.21 (interquartile range, -7.74 to 43.49). These changes were not statistically significant (P > .40) during 25N and 45N PA mobilizations, with the exception of C5-6 CIDP at 25N and 45N (P = .05 and .018, respectively).
There was high CIDP variability between cadavers during and after mobilization. Mobilizations of 1 cervical vertebra resulted in both CIDP increase or decrease at adjacent and remote cervical IVD segments that were not consistent. Cervical PA mobilizations produced variable CIDP changes at adjacent and remote cervical segments in cadavers.
Low back pain and lower extremity injuries affect athletes of all ages. Previous authors have linked a history of low back pain with lower extremity injuries. Fatigue is a risk factor for lower ...extremity injuries, some of which are known to affect female athletes more often than their male counterparts.
To determine the effects of lower extremity fatigue and sex on knee mechanics, neuromuscular control, and ground reaction force during landing in people with recurrent low back pain (LBP).
Cross-sectional study.
A clinical biomechanics laboratory.
Thirty-three young adults with recurrent LBP but without current symptoms.
Fatigue was induced using a submaximal free-weight squat protocol with 15% body weight until task failure was achieved.
Three-dimensional knee motion, knee and ankle moments, ground reaction force, and trunk and lower extremity muscle-activity measurements were collected during 0.30-m drop vertical-jump landings.
Fatigue altered landing mechanics, with differences in landing performance between sexes. Women tended to have greater knee-flexion angle at initial contact, greater maximum knee internal-rotation angle, greater maximum knee-flexion moment, smaller knee-adduction moment, smaller ankle-inversion moment, smaller ground reaction force impact, and earlier multifidus activation. In men and women, fatigue produced a smaller knee-abduction angle at initial contact, greater maximum knee-flexion moment, and delays in semitendinosus, multifidus, gluteus maximus, and rectus femoris activation.
Our results provide evidence that during a fatigued 0.30-m landing sequence, women who suffered from recurrent LBP landed differently than did men with recurrent LBP, which may increase women's exposure to biomechanical factors that can contribute to lower extremity injury.
Abstract Objectives To determine the effects of current LBP (cLBP) and LBP history (hxLBP) on Y-Balance Test (YBT) reach and establish relationships between YBT performance and demographic, ...behavioral, and disability measures. Design Cross-sectional comparative study. Setting Research laboratory. Participants Forty-two participants (24 males, 18 females) aged 18-50 years (30.9±8.2 yr) in three groups: cLBP, hxLBP, and healthy controls. Interventions Three YBT trials in anterior (ANT), posterolateral (PL), and posteromedial (PM) directions. Main Outcome Measures YBT reach (relative to leg length) was measured and compared amongst groups. Pearson correlations were calculated between reach distances and pain, disability, and fear avoidance scores in the cLBP and hxLBP groups and age and activity level in all participants. Results For PL reach, cLBP (94.7±10.6 cm) and hxLBP (94.2±9.2 cm) groups demonstrated shorter distances versus controls (105.8±6.6 cm). For PM reach, cLBP (100.7±8.4 cm) and hxLBP (102.3±7.6 cm) groups’ distances were shorter versus controls (109.3±6.7 cm). No significant difference was found for ANT reach (control=66.4±7.0 cm; cLBP=66.2±6.2 cm; hxLBP=66.4±3.1 cm). No significant correlations were identified. Conclusion YBT performance is reduced in individuals with cLBP and hxLBP in the PL and PM directions but not ANT. The YBT is useful for measuring balance deficits in these populations.
Suboccipital myofascial trigger points are common in tension-type headaches.
Compare the influence of clinical experience on the accuracy and safety of dry needle placement on the C2 laminar arch ...using a cranial-medial and caudal-medial technique to target obliquus capitus inferior in unembalmed cadavers.
Three physical therapists inserted three 50 mm dry needles, per technique, individually toward the C2 laminar arch targeting the obliquus capitus inferior. Ultrasound video of each trial was recorded, and an investigator trained in ultrasound interpretation and blinded to experience level recorded needling accuracy.
The novice, experienced and expert clinicians were accurate on 73.8%, 59.5% and 71.4% of caudal-medial trials, and 14.3%, 16.7% and 66.7% of cranial-medial trials, respectively, with each clinician striking the spinal cord at least once. The expert clinician was 10 times more likely to accurately reach the C2 laminar arch using the cranial-medial direction than the experienced and novice clinicians.
Increased clinical experience improved accuracy reaching the C2 laminar arch, with all investigators being more accurate with the caudal-medial technique. Greater experience did not eliminate risk as all investigators recorded at least one incident of striking the spinal cord. Fewer spinal cord strikes occurred with the cranial-medial than the caudal-medial technique.
This study examined the effects of abdominal bracing maneuver (ABM) performance on stable and unstable surfaces on active forward reach (AFR) distance as a measure of trunk control, measuring changes ...in reach distance and muscle activation patterns.
Single-group, repeated measures design.
Twenty-eight subjects (mean age 25 ± 5.09 years) performed an AFR with and without ABM while on stable and unstable surfaces. Lower quarter muscle activity and forward reach distances were recorded.
Forward reach distances on the unstable surface were significantly decreased compared to the stable condition with and without ABM (p < .001). The surface-by-contraction interaction was significant for the tibialis anterior (TA) and gastrocnemius (GS). Significant main effects were found for internal oblique, external oblique, gluteus maximus, biceps femoris, TA, and GS, where muscle activity significantly increased during the ABM trials. The interaction between surface and contraction was significant for the TA and GS muscles. TA (p = .007) and GS (p < .001) activity increased with ABM on the unstable surface. TA activity increased with ABM on the stable surface (TA: p < .001).
Reach distances decreased on the unstable surface, but ABM did not change reaching distance. Ankle muscle co-contraction occurred during ABM trials and posterior chain activity increased. These changes suggest ABM may be beneficial during forward reaching activities.
Iliotibial Band Syndrome (ITBS) is a common clinical condition likely caused by abnormal compressive forces to the iliotibial band (ITB). Stretching interventions are common in ITBS treatment and may ...predominantly affect tensor fascia latae (TFL). Another ITBS treatment is foam rolling, which may more directly affect the ITB. Shear wave ultrasound elastography (SWUE) measures real-time soft tissue stiffness, allowing tissue changes to be measured and compared.
To examine effects of foam rolling and iliotibial complex stretching on ITB stiffness at 0˚ and 10˚ of hip adduction and hip adduction passive range of motion (PROM).
Randomized controlled trial.
Data from 11 males (age = 30.5 ± 9.0 years, Body Mass Index (BMI) = 27.8 ± 4.0) and 19 females (age = 23.5 ± 4.9, BMI = 23.2 ± 2.1) were analyzed for this study. Subjects were randomly assigned to one of three groups: control, stretching, and foam rolling. Shear wave ultrasound elastography measurements included ITB Young's modulus at the mid-thigh, the distal femur and the TFL muscle belly. ITB-to-femur depth was measured at mid-thigh level. Hip adduction PROM was measured from digital images taken during the movement.
No significant interactions or main effects were found for group or time differences in ITB Young's modulus at the three measured locations. The ITB stiffness at the mid-thigh and distal femur increased with 10° adduction, but TFL stiffness did not increase. A main effect for adduction PROM was observed, where PROM increased 0.8˚ post-treatment (p = 0.02).
A single episode of stretching and foam rolling does not affect short-term ITB stiffness. The lack of ITB stiffness changes may be from an inadequate intervention stimulus or indicate that the interventions have no impact on ITB stiffness.
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