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Aliaa M. Elabd, Salah-Eldin B. Rasslan, Haytham M Elhafez, Omar M. Elabd, Mohamed A. Behiry and Ahmed I. Elerian

Although current lumbar stabilization exercises are beneficial for chronic mechanical low back pain, further research is recommended focusing on global spinal alignment normalization. This randomized, controlled, blinded trial was conducted to determine the effects of adding cervical posture correction to lumber stabilization on chronic mechanical low back pain. Fifty adult patients (24 males) with chronic mechanical low back pain and forward head posture received 12 weeks treatment of either both programs (group A) or lumbar stabilization (group B). The primary outcome was back pain. The secondary outcomes included the craniovertebral angle, Oswestry Disability Index, C7-S1 sagittal vertical axis, and sagittal intervertebral movements. The multivariate analysis of variance indicated a significant group-by-time interaction (P = .001, partial η 2 = .609). Pain, disability, C7-S1 sagittal vertical axis, and l2-l3 intervertebral rotation were reduced in group A more than B (P = .008, .001, .025, and .001). Craniovertebral angle was increased in A when compared to B (P = .001). However, there were no significant group-by-time interactions for other intervertebral movements. Within-group comparisons were significant for all outcomes except for craniovertebral angle within patients in the control group. Adding cervical posture correction with lumber stabilization for management of chronic low back pain seemed to have better effects than the application of a stabilization program only.

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Paul J. Read, Theodosia Palli and Jon L. Oliver

Context: Single-leg hop tests are used to assess functional performance following anterior cruciate ligament (ACL) reconstruction. Recording 6-m timed hop scores using a stopwatch increases the potential for misclassification of patient status due to the number of error sources present. Objective: To examine the consistency of pass/fail (>90% limb symmetry index [LSI]) decisions in athletes tested at discharge following ACL reconstruction during the 6-m timed hop and the agreement between different human raters using a stopwatch and an electronic timing system. Setting: Clinic, rehabilitation. Participants: A total of 20 professional soccer players (age 24.6 [4.2] y; height 175.3 [10.2] cm; mass 73.6 [14.5] kg; 36 [10.5] wk following ACL reconstruction) volunteered to take part in this study. Main Outcome Measures: Two individual raters recorded each trial of the 6-m timed hop test on each limb with a stopwatch and an electronic timing system acted as the criterion measure. LSI scores were also computed with a pass score >90% LSI. Results: No significant differences were observed between limbs for any scoring method (P > .05). Mean differences indicated the electronic timing system was slower than both human raters (P < .05). Five participants failed the test (<90% LSI) but on each occasion this was only recorded by one method of rating. Kappa statistics showed no agreement in LSI scores across all 3 methods of scoring (κ = −.13) and no agreement when comparing the light gates to individual raters and rater 1 versus 2 (κ < 0). 95% limits of agreement in LSI scores recorded values of approximately ±20%. Conclusions: The 6-m timed hop test recorded using a stopwatch is not a valid measure to make clinical decisions following ACL reconstruction. Systematic bias between methods also suggests that a stopwatch and electronic timing system cannot be used interchangeably.

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Corey A. Pew, Sarah A. Roelker, Glenn K. Klute and Richard R. Neptune

The coupling between the residual limb and the lower-limb prosthesis is not rigid. As a result, external loading produces movement between the prosthesis and residual limb that can lead to undesirable soft-tissue shear stresses. As these stresses are difficult to measure, limb loading is commonly used as a surrogate. However, the relationship between limb loading and the displacements responsible for those stresses remains unknown. To better understand the limb motion within the socket, an inverse kinematic analysis was performed to estimate the motion between the socket and tibia for 10 individuals with a transtibial amputation performing walking and turning activities at 3 different speeds. The authors estimated the rotational stiffness of the limb-socket body to quantify the limb properties when coupled with the socket and highlight how this approach could help inform prosthetic prescriptions. Results showed that peak transverse displacement had a significant, linear relationship with peak transverse loading. Stiffness of the limb-socket body varied significantly between individuals, activities (walking and turning), and speeds. These results suggest that transverse limb loading can serve as a surrogate for residual-limb shear stress and that the setup of a prosthesis could be individually tailored using standard motion capture and inverse kinematic analyses.

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Brian T. Tomblin, N. Stewart Pritchard, Tanner M. Filben, Logan E. Miller, Christopher M. Miles, Jillian E. Urban and Joel D. Stitzel

The objective of this research was to characterize head impacts with a validated mouthpiece sensor in competitive youth female soccer players during a single season with a validated mouthpiece sensor. Participants included 14 youth female soccer athletes across 2 club-level teams at different age levels (team 1, ages 12–13 y; team 2, ages 14–15 y). Head impact and time-synchronized video data were collected for 66 practices and games. Video data were reviewed to characterize the type and frequency of contact experienced by each athlete. A total of 2216 contact scenarios were observed; heading the ball (n = 681, 30.7%) was most common. Other observed contact scenarios included collisions, dives, falls, and unintentional ball contact. Team 1 experienced a higher rate of headers per player per hour of play than team 2, while team 2 experienced a higher rate of collisions and dives. A total of 935 video-verified contact scenarios were concurrent with recorded head kinematics. While headers resulted in a maximum linear acceleration of 56.1g, the less frequent head-to-head collisions (n = 6) resulted in a maximum of 113.5g. The results of this study improve the understanding of head impact exposure in youth female soccer players and inform head impact exposure reduction in youth soccer.

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Brady M. Smith, David O. Draper, Robert D. Hyldahl and Justin H. Rigby

Context: Low current intensity iontophoresis treatments have increased skin perfusion over 700% from baseline potentially altering drug clearance from or diffusion to the targeted area. Objective: To determine the effects of a preceding 10-minute ice massage on subcutaneous dexamethasone sodium phosphate (Dex-P) concentration and skin perfusion during and after a 4-mA iontophoresis treatment. Design: Controlled laboratory study. Setting: Research laboratory. Patients or Other Participants: Twenty-four participants (male = 12, female = 12; age = 25.6 [4.5] y, height = 173.9 [8.51] cm, mass = 76.11 [16.84] kg). Intervention(s): Participants were randomly assigned into 2 groups: (1) pretreatment 10-minute ice massage and (2) no pretreatment ice massage. Treatment consisted of an 80-mA·minute (4 mA, 20 min) Dex-P iontophoresis treatment. Microdialysis probes (3 mm deep in the forearm) were used to assess Dex-P, dexamethasone (Dex), and its metabolite (Dex-Met) concentrations. Skin perfusion was measured using laser Doppler flowmetry. Main Outcome Measure(s): Microdialysis samples were collected at baseline, at conclusion of treatment, and every 20 minutes posttreatment for 60 minutes. Samples were analyzed to determine Dex-Total (Dex-Total = Dex-P + Dex + Dex-Met). Skin perfusion was calculated as a percentage change from baseline. A mixed-design analysis of variance was used to determine Dex-Total and skin perfusion difference between groups overtime. Results: There was no difference between groups (P = .476), but [Dex-Total] significantly increased over the course of the iontophoresis and posttreatment time (P < .001). Dex-P was measured in 18 of 24 participants with a mean concentration of 0.67 (1.09) μg/mL. Skin perfusion was significantly greater in the no ice treatment group (P = .002). Peak skin perfusion reached 27.74% (47.49%) and 117.39% (103.45%) from baseline for the ice and no ice groups, respectively. Conclusions: Ice massage prior to iontophoresis does not alter the tissue [Dex-Total] even with less skin perfusion.