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Kyle Matsel, Claire Davies and Tim Uhl

Clinical Scenario: Shoulder pain is a very common symptom encountered in outpatient physical therapy practice. In addition to therapeutic exercise and manual therapy interventions, trigger point dry needling (TDN) has emerged as a possible treatment option for reducing shoulder pain and improving function. Dry needling consists of inserting a thin stainless-steel filament into a myofascial trigger point with the intention of eliciting a local twitch response of the muscle. It is theorized that this twitch response results in reduced muscle tension and can aid in reduced pain and disability. To this point, multiple studies have found TDN to be effective at reducing pain and improving function in the short-term, but the long-term outcomes remain unknown. Clinical Question: Does the addition of TDN to an exercise program result in better long-term pain intensity and disability reduction in patients with shoulder pain? Summary of Findings: Improvement in long-term pain and function can be expected regardless of the addition of TDN to an evidence-based exercise program for patients with shoulder pain. Clinical Bottom Line: Either TDN or an evidence-based therapeutic exercise program elicits improved long-term pain and disability reduction in patients with shoulder pain, which suggests that clinicians can confidently use either approach with their patients. Strength of Recommendation: Strong evidence (level 2 evidence with PEDro scores >8/10) suggesting that TDN does not outperform therapeutic exercise regarding long-term pain reduction.

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Barbara Baker, Eric Koch, Kevin Vicari and Kyle Walenta

Introduction: Sports-related concussions (SRCs) have received attention due to their prevalence in youth. An SRC results from a strong force causing neurological impairment. Recent research has recommended rehabilitation within the first week post-SRC after 24 to 48 hours of rest. The postacute phase is defined as 48 hours to 7 days post-SRC. It is imperative to evaluate the most effective mode and intensity of physical activity to reduce symptoms and improve outcomes. Methods: CINAHL, PubMed, SPORTDiscus, and Web of Science databases were used to search the terms “brain concussion” AND “exercise” and variations of these terms. The evidence level for each study was evaluated using the 2011 Oxford Center for Evidence-Based Medicine Guide. The methodological rigor of each study was evaluated using a scale adapted from Medlicott and Harris. Results: Two thousand sixty-eight records were identified. Six studies were included in this systematic review. Three studies were classified as moderately strong. The remaining 3 studies were considered weak. Five of the studies used either a cycle ergometer or a treadmill. The sixth study used walking, cycling, and swimming, as well as sports drills. All of these modes of exercise were determined to be safe. All studies utilized low- and moderate-intensity interventions, which were found to be nondetrimental and showed improved recovery time and symptom resolution. Five of the studies also incorporated components of high-intensity exercise that was also found to be nondetrimental, and they showed a positive influence on recovery time and symptom resolution. However, all activity in each of the reviewed studies started at a low level and progressed up to a higher level only as each individual client’s symptoms permitted. Discussion: Overall, this review found that various modes of activity at light-, moderate-, and high-intensity levels are efficacious and can be safely used during the postacute phase of SRC. Conclusion: Though the volume of literature at this time is limited, therapists should consider prescribing closely monitored individualized exercise programs utilizing progressive intensities when treating patients during the postacute phase of SRC.

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Christopher J. Stevens, Megan L.R. Ross, Amelia J. Carr, Brent Vallance, Russ Best, Charles Urwin, Julien D. Périard and Louise Burke

Purpose: Hot-water immersion (HWI) after training in temperate conditions has been shown to induce thermophysiological adaptations and improve endurance performance in the heat; however, the potential additive effects of HWI and training in hot outdoor conditions remain unknown. Therefore, this study aimed to determine the effect of repeated postexercise HWI in athletes training in a hot environment. Methods: A total of 13 (9 female) elite/preelite racewalkers completed a 15-day training program in outdoor heat (mean afternoon high temperature = 34.6°C). Athletes were divided into 2 matched groups that completed either HWI (40°C for 30–40 min) or seated rest in 21°C (CON), following 8 training sessions. Pre–post testing included a 30-minute fixed-intensity walk in heat, laboratory incremental walk to exhaustion, and 10,000-m outdoor time trial. Results: Training frequency and volume were similar between groups (P = .54). Core temperature was significantly higher during immersion in HWI (38.5 [0.3]) than CON (37.8°C [0.2°C]; P < .001). There were no differences between groups in resting or exercise rectal temperature or heart rate, skin temperature, sweat rate, or the speed at lactate threshold 2, maximal O2 uptake, or 10,000-m performance (P > .05). There were significant (P < .05) pre–post differences for both groups in submaximal exercising heart rate (∼11 beats·min−1), sweat rate (0.34–0.55 L·h−1) and thermal comfort (1.2–1.5 arbitrary units), and 10,000-m racewalking performance time (∼3 min). Conclusions: Both groups demonstrated significant improvement in markers of heat adaptation and performance; however, the addition of HWI did not provide further enhancements. Improvements in adaptation appeared to be maximized by the training program in hot conditions.

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Matthew D. Watson, George J. Davies and Bryan L. Riemann

Context: A recent report demonstrated moderate to strong relationships between seated single-arm shot-put (SSASP) test performance and isokinetic pushing forces at varying velocities, directly supporting the SSASP test as a reflection of multijoint upper-extremity strength. Yet, no previous work appears to have assessed whether the SSASP test is more reflective of shoulder flexion or elbow extension strength. Objective: To examine the relationship between isokinetic shoulder flexion and elbow extension strength and SSASP test performance and to compare limb symmetry indices (LSI) between the 2 tests. Design: Correlational design. Setting: Biomechanics laboratory. Patients (or Other Participants): A total of 30 healthy and physically active young adults. Intervention(s): Participants completed the SSASP test and concentric isokinetic (60°/s and 180°/s) shoulder flexion and elbow extension using their dominant and nondominant arms. Main Outcome Measures: SSASP test performance and isokinetic shoulder flexion and elbow extension peak torques as well as LSI between the 2 tests. Results: Strong relationships were observed between SSASP ranges and isokinetic peak torques at each velocity for both shoulder and elbow (r ≥ .804, P < .001). While the Bland–Altman results on the LSI only demonstrated a significant bias for the shoulder (60°/s, P = .009), limits of agreement results demonstrated extremely wide intervals (32.5%–52.1%). Conclusions: The SSASP test is a multijoint upper-extremity functional performance test that is reflective of equal shoulder flexion and elbow extension contributions; however, there was large variability regarding the agreement between the SSASP LSI and isokinetic shoulder and elbow strength LSI.

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Bradford C. Bennett

Thomas Hanna’s somatic work has been essential to the development of the field of somatic education. From redefining the word “somatic” and developing the concept of somatics as a field of study, to starting the magazine/journal Somatics, to developing theories and practices of somatic education, Hanna greatly influenced this fledgling area of work. This article presents the somatic philosophy, theories, and education techniques of Hanna, focusing on the aspects that are unique to this somatic explorer. Hanna’s techniques are contrasted to the traditional somatic movement training of Tai Chi. The difficulties of researching a learning such as somatic education are discussed. Ideas are presented on how kinesiology and somatic education can inform each other.