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Background: One possible factor contributing to low back pain is hip range of motion (ROM). However, there is inconstancy in published studies, which may be due to the heterogeneity of patients. Therefore, the present study focuses on the relationship between hip ROM and lower lumbar disc herniation (LLDH). Method: A cross-sectional study involved 52 participants between 18 and 65 years old. Two digital inclinometers were utilized to measure the ROM of the lumbar and hip joints in all study participants. For each outcome, 2 measurements were conducted, and the mean of the 2 measurements was utilized for analysis. The level of statistical significance was established at P ≤ .05. Results: The difference in all ROM between the 2 groups is significant except for dominant hip flexion (P < .05). Lumbar flexion was reduced in LLDH compared with healthy individuals (P = .003). The findings manifested a significant correlation between right lumbar rotation and nondominant hip abduction (P = .05, R = .388) and between left lumbar lateral bending and nondominant hip flexion (P = .008, R = .510). Conclusion: Patients with LLDH have reduced hip ROM and lumbar flexion compared with healthy individuals. The study showed correlations between hip and lumbar ROM and emphasized the significance of evaluating hip ROM in LLDH for assessment and treatment planning.

Context: Although cranial distant effects occur in self-myofascial release interventions for lower-extremity muscles and fascia, the results of caudal distant effects are still unclear. The aim of this study was to examine the distant effects of myofascial release applied to the thoracolumbar fascia together with exercise training on balance, lower-extremity flexibility, and muscular endurance in healthy young adults. Design: Single-blinded randomized control trial design. Methods: Thirty-six healthy participants aged 18–35 years were randomly divided into 3 groups: myofascial release and exercise group (group 1, n = 12), exercise group (group 2, n = 12), and control group (group 3, n = 12). Three days a week for 4 weeks, group 1 applied the thoracolumbar fascia foam roller massage together with the warm-up, muscular endurance, balance, and stretching exercise program, and group 2 applied the same exercise program except for the foam roller massage. No intervention was made in group 3. Flexibility was assessed with sit and reach test, muscular endurance with the 1-minute sit to stand test, and balance with star excursion balance test before the intervention and at the end of the fourth week. Results: Flexibility, muscular endurance, and dynamic balance values increased significantly in groups 1 and 2 after the intervention (P < .05). When the difference values (Δ) of groups 1 and 2 were compared, there was a difference in favor of group 1 for flexibility, muscular endurance, and dynamic balance (P < .05). Conclusions: The results of the study showed that the effect of the distant myofascial release technique added to the exercise training on flexibility, muscular endurance, and dynamic balance was greater than the exercise training alone.

Context: Intermittent floor trunk extensions are popular exercises in group fitness programs. The aim of this study was to investigate whether fewer repetitions of longer isometric trunk extension efforts compared with more repetitions of shorter isometric contractions have different acute effects on muscle thickness and activation as well as perceived exertion. Design: This study followed a cross-sectional design. Methods: Twenty healthy young males performed floor prone trunk extension exercises using 3 different exercise protocols of repetition and duration: 10 × 5 seconds (D10 × 5), 2 × 25 seconds (D2 × 25), and 5 × 10 seconds (D5 × 10). Ultrasound multifidus thickness and rate of perceived exertion on a 10-point scale were measured immediately after each protocol. Electromyographic activation from the erector spinae, multifidus, and gluteus maximum during each protocol was measured using bipolar surface electrodes. Results: The longer duration (D2 × 25) protocol showed a significant greater rate of perceived exertion (6.22 [0.73]) and rest multifidus thickness change (median: 8.04%) compared with the other protocols (P < .05). Within each protocol, root mean square of all muscles increased from trial to trial in the D2 × 25 and D5 × 10 (P < .05), but not during the D10 × 5 protocol (P > .05). The maximum root mean square was achieved in the shorter duration (D10 × 5) protocol compared with the other ones (P < .05). Conclusion: If trunk extension exercises on the floor are used in a training setting, then using exercises with long duration and fewer repetitions may elicit a greater metabolic response.

Objective: Sports-related concussions (SRCs) are commonly occurring injuries among athletic and recreationally active populations. SRCs can result in vestibular dysfunction that should resolve before returning to activity. It has been suggested that vestibular impairment is a factor that may influence recovery time. The objective of this study was to evaluate the effect of vestibular function on recovery following SRC. Design: Retrospective chart review. Setting: Multidisciplinary Concussion Clinic. Intervention: A total of 32 patient charts (21 males, 15.34 [1.47] y, 171.29 [8.44] cm, 68.37 [15.47] kg) from patients diagnosed with SRC presenting to a concussion clinic between August of 2016 and July 2017 with clinician-identified vestibular involvement were included. Main Outcome Measures: Scores on the Post-Concussion Symptom Scale, Dynamic Visual Acuity Test, Gaze Stabilization Test, Concussion Balance Test (COBALT), and other clinical data were used for analysis. Descriptive statistics were calculated for all variables. Pearson correlations were used to identify variables related to time to recovery. Variables were entered into a forward linear regression model. Results: Moderate to good relationships were identified between days to recovery and Dynamic Visual Acuity Test lines lost in the leftward direction (1.17 [0.52]; r = .39, P = .04), COBALT-condition 8 sway velocity (1.20 [0.18]; r = .44, P = .01), and days to successful completion of the COBALT (14.72 [8.35]; r = .63, P < .001). Patients’ predicted time to recover was equal to 14.61 (0.86) (days to successful COBALT). The model was significant (P < .001, R ² = .30). Conclusion: The single predictor of time to recover was the number of days to successful completion of the COBALT. Thus, the ability to complete the task may be more informative than the performance on the task in predicting recovery time.

Context: Sport injury is a prevalent setback experienced by athletes, wherein they are required to spend time in rehabilitation and interact with sport medicine staff. Sport medicine staff are a frequent line of contact line of contact for athletes at this time and represent an important part of their support network. There is little exploration surrounding the interactions that female athletes have with sport medicine staff during injury rehabilitation and how these interactions may impact the rehabilitation process. The purpose of this research is to explore the experiences of injured female athletes and their interactions with sport medicine staff during injury rehabilitation. Design: Qualitative study using semistructured qualitative interviews and audio diaries. Interpretive descriptive methodology. Methods: A total of 11 injured female varsity athletes who had sustained a musculoskeletal injury within 2 to 4 weeks of being recruited participated. A total of 6 upper body injuries and 5 lower body injuries are represented. Athletes completed 2 semistructured interviews and weekly audio diary entries across 6 weeks. Data were analyzed using reflexive thematic analysis. Results: Results demonstrated that female athletes felt supported by sport medicine staff when provided with clear information about rehabilitation, when they perceived sport medicine staff as competent, and when sport medicine staff made a personal connection. An overarching theme of mattering was identified as underpinning the athletes’ experiences of feeling supported by sport medicine staff during rehabilitation. Conclusions: When sport medicine staff made female athletes feel that they mattered, they were perceived as more supportive during rehabilitation. Sport medicine staff can help athletes to feel that they matter by engaging in supportive behaviors during the rehabilitation process.

Clinical Scenario: Critical appraisal of whole-body metabolism as a measure of concussion recovery is lacking in the available evidence. There has been extensive exploration of options for a gold standard assessment for concussion, including blood biomarkers, electroencephalogram, and neuroimaging, but none have yet to demonstrate good empirical evidence of efficacy. Clinical Question: In patients with sport-related concussion (SRC), can resting metabolic rate (RMR), as measured through indirect calorimetry, be used as a physiologic assessment of recovery? Summary of Key Findings: Three studies demonstrated relevance to the clinical question. Of the selected studies, 2 studies were case–control, and 1 was a case series. All studies observed reduced total energy expenditure and increased energy balance when initially assessed between 24 and 72 hours after injury. Clinical Bottom Line: Evidence exists to suggest that RMR as measured with indirect calorimetry is a poor indicator of SRC recovery. All 3 articles found that RMR was not affected by SRC, even when compared with healthy controls. One article did observe a between sex difference in RMR, but a very small sample size was included in the case series. Strength of Recommendation: The findings of this critically appraised topic suggest a strength of recommendation of grade B, demonstrating that RMR is a poor indicator of recovery from SRC.

Context: Sensorimotor impairments are common sequela following concussion, but recovery following a concussion is often determined through examiner scored clinical testing. There are emerging technologies that provide objective methods to determine physiological impairment after concussion, but the psychometrics of these tools are lacking and must be established for use in clinical practice. Objective: The purpose of this study was to examine the test–retest reliability and provide reliable change estimates in healthy young adults for outcomes from 3 emerging technologies providing objective assessments of sensorimotor function in healthy young adults. Design: Test–retest reliability design in a laboratory setting. Methods: Healthy, young adults completed testing at 2 time points 4 weeks apart on the Bertec Vision Trainer, the Concussion Balance Test (COBALT), and the Neurolign Dx-100 eye-tracking system. We determined test–retest reliability using intraclass correlation coefficients with a 2-way mixed-effects model absolute agreement. Reliable change estimates were calculated for 70%, 80%, 90%, and 95% CIs. Results: Participants included 30 healthy young adults (age = 25 [5] y, interquartile range = 20–29; range = 18–38; 17% [57%] women). Test–retest reliability for the Bertec Vision Trainer outcomes ranged from 0.56 to 0.88, with 45% of the outcomes being classified as clinically acceptable (>.70 intraclass correlation coefficients ); for COBALT conditions, sway velocity ranged from 0.50 to 0.95, 95% ellipse area ranged from −0.22 to 0.88, and Sway Score ranged from 0.07 to 0.85, with 50% of COBALT metrics being clinically acceptable; and for the Dx-100, outcomes ranged from −0.20 to 0.89, with 52% being clinically acceptable. Conclusions: Overall, test–retest reliability was moderate-to-good for the Bertec Vision Trainer assessment outcomes but were highly variable for outcomes of postural control using the COBALT and eye-tracking metrics using the Dx-100. This study adds clinically relevant test–retest reliability and reliable change estimates in healthy adults for 3 commercially available sensorimotor assessments.

Context: Handheld dynamometers provide clinicians an objective measure of lower-extremity force production at the hip and knee. While push-based dynamometers are common in clinical practice, they can be associated with patient discomfort, and standardization of methods is challenging when patient forces can exceed the ability of the rater. Development of novel, pull-based dynamometers allow for better patient comfort, but validity between dynamometers must be established before integration into clinical practice. Therefore, the purpose of this study was to compare measurement of lower-extremity force between push- and pull-based handheld dynamometers. Design: Descriptive laboratory study. Methods: Twenty-one healthy triathletes performed isometric hip abduction, hip external rotation, and knee extension testing against 2 separate handheld dynamometers. Pearson product correlations were calculated for the relationship between devices, while Bland–Altman plots were used to measure agreement with limit of agreement to assess systematic bias. Results: Correlations between devices were strong for hip abduction and knee extension (r = .743–.767, P < .001) and moderate for hip external rotation (r = .429, P = .052). Additionally, there was good agreement between the 2 devices, with acceptable limits of agreement across the 3 force tasks. The pull-based dynamometer resulted in greater torque values for knee-extension and hip external rotation, with a mean difference of −0.37 and −0.19 N·m/kg, but there was no difference in hip abduction with a mean difference of 0.03 N·m/kg. Conclusion: The results demonstrate that pull-based dynamometers are an acceptable alternative to push-based dynamometers for hip abduction and knee extension, but some caution may exist for hip external rotation. Clinicians should be aware of differences in lower-extremity force across multiple handheld dynamometers when assessing muscle function in practice.

Context: Guidelines for various movement assessments often instruct clinicians to conduct testing without a warm-up. Warm-ups are commonly performed to increase heart rate, decrease stiffness, and prepare for sport-specific demands. Since athletes typically complete a warm-up prior to sport participation, evaluating biomechanics in this condition may provide a better indication of their bodies’ physical capabilities. The primary purpose of this study was to compare scores on the Titleist Performance Institute (TPI) screen before and after a dynamic warm-up in adult golfers. Design: Twenty-four adult golfers (19 male/5 female, age 44.0 [15.4] y, height 171.3 [8.6] cm, weight 82.5 [16.3] kg, average 18-hole score 90.7 [10.3] strokes) completed a single-session crossover laboratory study. Methods: Participants completed the TPI screen, which included 15 simple tests scored based on their ability to properly complete the movement. Following a rest and washout period, participants performed a brief dynamic warm-up including exercises for the extremities and trunk, followed by 30 seconds of practice golf swings. Participants immediately retested the TPI screen, following the same procedures. Composite and individual test scores were compared before and after the warm-up with Wilcoxon signed-rank tests and r effect sizes at a significance of P ≤ .05. Results: TPI composite scores were significantly higher following the warm-up (median: 36, interquartile range 31/40) than before the warm-up (median: 33, interquartile range 28/36) (P < .001), with a large effect size (r = .81). Conclusions: Our findings suggest a warm-up leads to higher scores on the TPI screen, and that an athlete’s warm-up condition should be considered when interpreting their performance.