Clinical Scenario: Approximately 30% of all first-time patients with LAS develop chronic ankle instability (CAI). CAI-associated impairments are thought to contribute to aberrant gait biomechanics, which increase the risk of subsequent ankle sprains and the development of posttraumatic osteoarthritis. Alternative modalities should be considered to improve gait biomechanics as impairment-based rehabilitation does not impact gait. Taping and bracing have been shown to reduce the risk of recurrent ankle sprains; however, their effects on CAI-associated gait biomechanics remain unknown. Clinical Question: Do ankle taping and bracing modify gait biomechanics in those with CAI? Summary of Key Findings: Three case-control studies assessed taping and bracing applications including kinesiotape, athletic tape, a flexible brace, and a semirigid brace. Kinesiotape decreased excessive inversion in early stance, whereas athletic taping decreased excessive inversion and plantar flexion in the swing phase and limited tibial external rotation in terminal stance. The flexible and semirigid brace increased dorsiflexion range of motion, and the semirigid brace limited plantar flexion range of motion at toe-off. Clinical Bottom Line: Taping and bracing acutely alter gait biomechanics in those with CAI. Strength of Recommendation: There is limited quality evidence (grade B) that taping and bracing can immediately alter gait biomechanics in patients with CAI.
Kimmery Migel and Erik Wikstrom
Mohammadreza Pourahmadi, Hamid Hesarikia, Ali Ghanjal and Alireza Shamsoddini
Context: Advent of smartphones has brought a wide range of clinical measurement applications (apps) within the reach of most clinicians. The vast majority of smartphones have numerous built-in sensors such as magnetometers, accelerometers, and gyroscopes that make the phone capable of measuring joint range of motion (ROM) and detecting joint positions. The iHandy Level app is a free app which has a visual display alike with the digital inclinometer in regard to numeric size. Objective: The purpose of this systematic review was to evaluate available evidence in the literature to assess the psychometric properties (ie, reliability and validity) of the iHandy Level app in measuring lumbar spine ROM and lordosis. Methods: PubMed/MEDLINE, Scopus, Ovid, Google Scholar, and ScienceDirect were searched from inception to September 2018 for single-group repeated-measures studies reporting outcomes of lumbar spine ROM or lordosis in adult individuals without symptoms of low back pain (LBP) or patients with LBP. The quality of each included study was assessed using the Quality Appraisal of Reliability Studies checklist. Results: A total of 4 studies with 273 participants were included. Two studies focused on measuring active lumbar spine ROM, and 2 studies evaluated lumbar spine lordosis. Three studies included asymptomatic subjects, and one study recruited patients with LBP. The results showed that the iHandy Level app has sufficient psychometric properties for measuring standing thoraco-lumbo-sacral flexion, extension, lateral flexion, isolated lumbar spine flexion ROM, and lumbar spine lordosis in asymptomatic subjects. One study reported poor concurrent validity with a bubble inclinometer (r = .19–.53), poor intrarater reliability (intraclass correlation coefficient = .19–.39), and poor to good interrater reliability (intraclass correlation coefficient = .24–.72) for the measurement of active lumbar spine ROM using the iHandy Level app in patients with LBP. Conclusions: This review provided a valuable summary of the research to date examining the psychometric properties of the iHandy Level app for measuring lumbar spine ROM and lordosis.
Scott W. Cheatham and Russell Baker
Context: Floss bands are a popular intervention used by sports medicine professionals to enhance myofascial function and mobility. The bands are often wrapped around a region of the body in an overlapping fashion (eg, 50%) and then tensioned by stretching the band to a desired length (eg, 50%). To date, no research has investigated the stretch force of the bands at different elongation lengths. Objective: The purpose of this clinical study was to quantify the Rockfloss® band stretch force at 6 different elongation lengths (ie, 25%–150%) for the 5.08- and 10.16-cm width bands. Design: Controlled laboratory study. Setting: University kinesiology laboratory. Participants: One trained researcher conducted all measurements. Procedures: The stretch force of a floss band was measured at 6 different elongation lengths with a force gauge. Main Outcome Measures: Band tension force at different band elongation lengths. Results: The stretch force values for the 5.08-cm width (2 in) were as follows: 25% = 13.53 (0.25) N, 50% = 24.57 (0.28) N, 75% = 36.18 (0.39) N, 100% = 45.89 (0.62) N, 125% = 54.68 (0.26) N, and 150% = 62.54 (0.40) N. The stretch force values for the 10.16-cm width (4 in) were as follows: 25% = 16.70 (0.35) N, 50% = 31.90 (0.52) N, 75% = 47.45 (0.44) N, 100% = 57.75 (0.24) N, 125% = 69.02 (0.28) N, and 150% = 81.10 (0.67) N. Both bandwidths demonstrated a linear increase in stretch force as the bands became longer. Conclusion: These values may help professionals to understand and document the tension force being applied at different lengths to produce a more beneficial application during treatment. Future research should determine how the different length/tensions effect the local myofascia, arterial, and vascular systems.
Donald F. Kessler
Gemma N. Parry, Lee C. Herrington and Ian G. Horsley
Context: Muscular power output of the upper limb is a key aspect of athletic and sporting performance. Maximal power describes the ability to immediately produce power with maximal velocity at the point of release, impact, or takeoff, with research highlighting that the greater an athlete’s ability to produce maximal power, the greater the improvement in athletic performance. Despite the importance of upper-limb power for athletic performance, there is presently no gold-standard test for upper-limb force development performance. Objective: The aim of this study was to investigate the test–retest reliability of force plate–derived measures of the countermovement push-up in active males. Design: Test–retest design. Setting: Controlled laboratory. Participants: Physically active college athletes (age 24  y, height 1.79 [0.08] m, body mass 81.7 [9.9] kg). Intervention: Subjects performed 3 repetitions of maximal effort countermovement push-up trials on Kistler force plates on 2 separate test occasions 7 days apart. Main Outcome Measures: Peak force, mean force, flight time, rate of force development, and impulse were analyzed from the force–time curve. Results: No significant differences between the 2 trial occasions were observed for any of the derived performance measures. Intraclass correlation coefficient and within-subject coefficient of variation calculations indicated performance measures to have moderate to very high reliability (intraclass correlation coefficient = .88–.98), coefficient of variation = 5.5%–14.1%). Smallest detectable difference for peak force (7.5%), mean force (8.6%), and rate of force development (11.2%) were small to moderate. Conclusion: Force platform–derived kinetic parameters of countermovement push-up are reliable measurements of power in college-level athletes.
Natalie Cook and Tamerah N. Hunt
Clinical Scenario: Concussions are severely underreported, with only 47.3% of high school athletes reporting their concussion. The belief was that athletes who were better educated on the signs and symptoms and potential dangers of concussion would be more likely to report. However, literature has shown inconsistent evidence on the efficacy of concussion education, improving reporting behaviors. Factors such as an athlete’s attitude, subjective norms, and perceived behavioral control have shown promise in predicting intention to report concussions in athletes. Focused Clinical Question: Do attitudes, subjective norms, and perceived behavioral control influence adolescent athletes’ intention to report? Summary of Key Findings: Three studies (1 randomized control and 2 cross-sectional surveys) were included. Across the 3 studies, attitudes, subjective norms, and perceived behavioral control positively influenced athletes’ reporting intention. The studies found that attitude toward concussion reporting and perceived behavioral control were the most influential predictors of reporting intention. Clinical Bottom Line: There is moderate evidence to suggest that positive attitudes, supportive subjective norms, and increased perceived behavioral control influence reporting intention in secondary school athletes. Strength of Recommendation: Grade B evidence exists that positive attitudes, supportive subjective norms, and increased perceived behavioral control positively influence concussion reporting intention in secondary school athletes.
Eric P. Scibek, Matthew F. Moran and Susan L. Edmond
Context: The deep squat (DS) test is a component of the functional movement screen, which is used to assess the quality of fundamental movement patterns; however, the accuracy of the DS has not been studied. The DS is a complex, total body movement pattern with evaluation required at several points along the kinematic chain. Objective: To assess the accuracy of DS scoring by an athletic trainer, physical therapist, and exercise science professional via a comparative analysis with kinematic data (KD) and to identify scoring criteria that would improve agreement between raters and KD scores. Design: Cross-sectional study. Setting: Motion analysis laboratory. Participants: A rater from each of 3 movement science disciplines rated the DS of 23 male college athletes (20.3 [1.2] y; 70.5 [3.5] kg). Interventions: Subjects were outfitted with reflective markers and asked to perform the DS. The DS performance was scored by 3 raters and kinematic analysis. Subsequently, the optimal set of criteria that minimized the difference between mode rater score and KD was determined via a Nelder–Mead simplex optimization routine. Main Outcome Measures: Intraclass correlation coefficients (ICCs) were calculated using SPSS (version 23; IBM, Armonk, NY) to determine tester agreement with the KD score and between the mode score and KD score. Results: Agreement was poor for the athletic trainer (ICC = .387), physical therapist (ICC = .298), exercise science professional (ICC = .378), and raters’ DS scores when compared with the KD. Agreement was poor for the mode score when compared with KD prior to optimization and good following optimization (ICC = .830), thereby allowing identification of specific scoring errors. Conclusions: Agreement for DS scores is poor when compared with KD; however, it may be improved with optimization of DS scoring criteria.
Jessica St Aubin, Jennifer Volberding and Jack Duffy
Clinical Question: How does early return to physical activity impact return-to-play recovery time in patients 5–30 years old after an acute concussion as compared to the current best practice of resting? Clinical Bottom Line: Based on the information gathered, there is moderate evidence to support the incorporation of light to moderate physical activity within 7 days after a concussion in order to decrease recovery time and symptoms.
Emily A. Hall, Dario Gonzalez and Rebecca M. Lopez
Clinical Question: Does the medical model of organizational structure compared to either the academic or traditional models have a greater influence on job satisfaction and quality of life in collegiate athletic trainers? Clinical Bottom Line: Based on the quality of the person-oriented evidence available, the recommendation to adopt the medical model for athletic training staff would receive a Strength of Recommendation Taxonomy (SORT) grade of B.
Stef Feijen, Angela Tate, Kevin Kuppens, Thomas Struyf, Anke Claes and Filip Struyf
Context: The latissimus dorsi plays a major role in generating the propulsive force during swimming. In addition, stiffness of this muscle may result in altered stroke biomechanics and predispose swimmers to shoulder pain. Measuring the flexibility of the latissimus dorsi can be of interest to reduce injury. However, the reliability of such measurement has not yet been investigated in competitive swimmers. Objective: To assess the within-session intrarater and interrater reliability of a passive shoulder flexion range of motion measurement for latissimus dorsi flexibility in competitive swimmers. Design: Within-session intrarater and interrater reliability. Setting: Competitive swimming clubs in Flanders, Belgium. Participants: Twenty-six competitive swimmers (15.46 [2.98] y; 16 men and 10 women). Intervention: Each rater performed 2 alternating (eg, left-right-left-right) measurements of passive shoulder flexion range of motion twice, with a 30-second rest period in between. Main Outcome Measures: The intraclass correlation coefficients were calculated to assess intrarater and interrater reliability. Results: Interrater intraclass correlation coefficient ranged from .54 (95% confidence interval [CI], −.16 to .81) to .57 (95% CI, −.24 to .85). Results for the intrarater reliability ranged from .91 (95% CI, .81 to .96) to .94 (95% CI, .87 to .97). Conclusion: Results of this study suggest that shoulder flexion range of motion in young competitive swimmers can be measured reliably by a single rater within the same session.