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Julia Spellman, Rachel Eldredge, Melissa Nelson, Jennifer Ostrowski, and Jennifer Concannon

Clinical Scenario: There are a variety of therapeutic modalities used to treat flexibility issues in athletes, which can be the main cause of hamstring injuries. Myofascial decompression is one modality used to treat these patients. Focused Clinical Question: Is myofascial decompression effective at increasing hamstring flexibility in the athletic population? Summary of Search, “Best Evidence” Appraised, and Key Findings: The literature was searched for studies of level 2 evidence or higher that investigated the use of myofascial decompression to increase hamstring flexibility, that were published in the last 5 years. Two high-quality randomized controlled trials were included and one cohort study. Clinical Bottom Line: There is not enough consistent, clinically significant, high-level evidence to support the use of myofascial decompression to increase hamstring flexibility. Strength of Recommendation: There is level B evidence to support that myofascial decompression is effective at increasing hamstring flexibility.

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Emily R. Hunt, Shelby E. Baez, Anne D. Olson, Timothy A. Butterfield, and Esther Dupont-Versteegden

Massage is a common therapeutic modality utilized by clinicians in a variety of settings to help treat injuries, reduce pain, and return function to patients. Massage benefits the patients both psychologically and physiologically, as patients report less pain and anxiety along with better mood and even decreased blood pressure following massage. Additionally, on the cellular level, massage has the ability to modulate the damaging inflammatory process and, in some cases, influence protein synthesis. Although massage has not been linked to a rehabilitation theory to date, this paper will propose how massage may influence fear-avoidance beliefs, or the patient’s inability to cope with pain that then leads to a pain tension cycle. Pain will often result in use avoidance, which creates muscle tension that further exacerbates the pain. Massage can affect the Fear-Avoidance Model because the beneficial effects of massage can break the cycle by either relieving the patient’s pain or eliminating the muscle tension. A modified Fear-Avoidance Model is presented that conceptualizes how pain and fear-avoidance lead to tension and muscle dysfunction. Massage has been incorporated into the model to demonstrate its potential for breaking the pain tension cycle. This model has the potential to be applied in clinical settings and provides an alternate treatment to patients with chronic pain who present with increased levels of fear-avoidance beliefs.

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Philip A. Szlosek, John Taggart, Julie M. Cavallario, and Johanna M. Hoch

Clinical Scenario:

Many therapeutic modalities have been used to treat the pain and inflammation commonly associated with tendinopathies. One modality that has been used to treat patients with tendinopathies is diathermy.

Focused Clinical Question:

Is there evidence to suggest that diathermy is more or equally as effective at reducing pain in patients with tendinopathy when compared with ultrasound or corticosteroid treatments?

Summary of Search, “Best Evidence” Appraised, and Key Findings:

The literature was searched for randomized control trials (RCTs) that investigated the effects of diathermy treatments in comparison with ultrasound or corticosteroid treatments on pain in patients with tendinopathy. Three RCTs were selected from the search results and included in this critically appraised topic.

Clinical Bottom Line:

There is moderate evidence to support that diathermy is more effective at reducing pain in patients with tendinopathy than ultrasound and equally as effective as corticosteroid treatments.

Strength of Recommendation:

There is grade B evidence to support that diathermy is more effective at reducing pain in patients with tendinopathy than ultrasound and equally effective at reducing pain as corticosteroid treatments.

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Robert W. Morton, Sara Y. Oikawa, Stuart M. Phillips, Michaela C. Devries, and Cameron J. Mitchell

Purpose:

Self–myofascial release (SMR) is a common exercise and therapeutic modality shown to induce acute improvements in joint range of motion (ROM) and recovery; however, no long-term studies have been conducted. Static stretching (SS) is the most common method used to increase joint ROM and decrease muscle stiffness. It was hypothesized that SMR paired with SS (SMR+SS) compared with SS alone over a 4-wk intervention would yield greater improvement in knee-extension ROM and hamstring stiffness.

Methods:

19 men (22 ± 3 y) with bilateral reduced hamstring ROM had each of their legs randomly assigned to either an SMR+SS or an SS-only group. The intervention consisted of 4 repetitions of SS each for 45 s or the identical amount of SS preceded by 4 repetitions of SMR each for 60 s and was performed on the respective leg twice daily for 4 wk. Passive ROM, hamstring stiffness, rate of torque development (RTD), and maximum voluntary contraction (MVC) were assessed pre- and postintervention.

Results:

Passive ROM (P < .001), RTD, and MVC (P < .05) all increased after the intervention. Hamstring stiffness toward end-ROM was reduced postintervention (P = .02). There were no differences between the intervention groups for any variable.

Conclusion:

The addition of SMR to SS did not enhance the efficacy of SS alone. SS increases joint ROM through a combination of decreased muscle stiffness and increased stretch tolerance.

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Kara N. Gange, Michael C. Kjellerson, and Christiane J. Berdan

extensibility. 1 – 6 Many therapeutic modality textbooks provide the rate of muscle heating per minute with associated intensities and frequencies to allow clinicians to set the appropriate parameters to reach their treatment goals. 13 – 16 Although textbooks provide clinical parameters, it is imperative to

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Rebecca M. Hirschhorn, Cassidy Holland, Amy F. Hand, and James M. Mensch

appropriately administer therapeutic modalities ( p  = .005). Physicians that practiced in a state with AT licensure were more likely to agree that ATs can formulate a clinical diagnosis to determine the appropriate course of action ( p  = .046). Physicians who reported working in an urban environment were more

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Amy Mauro and Blaine C. Long

range of motion (ROM) gains. 3 When assessing the impact on stretching, various therapeutic modalities such as cryotherapy 4 and thermal modalities 5 – 7 have been reported to be beneficial on facilitating ROM when applied prior to static stretching. 8 – 10 Another stretching technique, often used in

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Dana P. Golden and Jay N. Hertel

multiple interventions that can be implemented by the clinician to address these concerns. 23 Electrical stimulation, 24 cryotherapy, 25 compression, 26 and massage 27 have been shown to decrease pain and muscle soreness. Utilizing a therapeutic modality can provide the athlete physical relief when

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Courtney R. Anderson, Kara N. Gange, Bryan Christensen, and Rachelle Vettern

injury by determining which cryotherapy method is best to use during each stage of the injury repair process. References 1. Knight K , Draper D . Therapeutic Modalities . Philadelphia, PA : The Art and Science ; 2008 . 2. Merrick MA , Knight KL , Ingersoll CD , Potteiger JA . The

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Cordial M. Gillette and Mark A. Merrick

Kinetics ; 1995 . 2. Denegar CR . Therapeutic Modalities for Athletic Injuries . Champaign, IL : Human Kinetics ; 2000 . 3. Prentice WE . Therapeutic Modalities for Sports Medicine and Athletic Training . 5th ed. Boston, MA : McGraw-Hill ; 2003 . 4. Prentice WE . Arnheim’s Principles of