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Justin M. Stanek

Clinical Scenario:

The popularity of compression socks has increased substantially among athletes, particularly those participating in endurance events such as running and triathlon. Companies are increasingly marketing compression stockings to runners, triathletes, and other endurance athletes for the benefits of improved performance and/or decreased recovery time. Originally developed for the treatment of deep-vein thrombosis, compression socks are now marketed as a tool to improve venous return, thus believed to improve both performance and recovery in athletes. The use of compression socks during training aims to help the skeletal-muscle pump, increase deep venous velocity, and/or decrease blood pooling in the calf veins and alleviate delayed-onset muscle soreness. The scenario is a 28-y-old recreational triathlete seeking your advice while training for her first half-Ironman. She occasionally complains of tightness in the calves both during and after running. She wants your opinion on the effectiveness of using compression socks to help her performance and recovery.

Focused Clinical Question:

What is the effectiveness of using graduated compression socks for improving athletic performance and decreasing recovery time in healthy endurance athletes?

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Justin M. Stanek, John Meyer, and Rob Lynall

Context:

Balance training is widely used by rehabilitation professionals and has been shown to be effective at reducing risk of injury, as well as improving function after injury. However, objective evidence for the difficulty of commonly available equipment is lacking.

Objective:

To assess center-of-pressure (COP) area and average sway velocity in healthy subjects while performing a single-limb stance on 4 commonly available rehabilitation devices to determine their level of difficulty.

Design:

Single-session, randomized, repeated-measures design to assess COP area and average sway velocity while performing a single-limb stance on 4 devices positioned on a force platform.

Setting:

University laboratory.

Subjects:

A convenience sample of 57 healthy college-age subjects.

Intervention:

Each participant balanced on the dominant limb in a nonshod single-limb stance with eyes open for 20 s during 4 conditions. The 4 conditions were randomized and included the Both Sides Up (BOSU) trainer, Airex balance pad, half-foam roller, and DynaDisc.

Main Outcome Measure:

Means and standard deviations were calculated for maximum displacement in each direction. In addition, the means and standard deviations for COP area and average sway velocity were calculated for the 4 conditions and compared using a 1-way repeated-measure ANOVA.

Results:

Significant differences were found for both COP area and average sway velocity between the BOSU trainer and the other 3 devices. A significant difference was also found between the DynaDisc and the half-foam roller.

Conclusions:

Level of difficulty, as measured by COP area and average sway velocity, is different for commonly available rehabilitation equipment. Clinicians may find these results a useful guide when progressing patients through balance training.

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Kevin G. Laudner, Justin M. Stanek, and Keith Meister

Context:

Deficiencies in scapular upward rotation and periscapular strength have been associated with various shoulder pathologies and decreased athletic performance. Therefore, proper periscapular strength and concomitant scapular upward rotation are important factors among overhead athletes, such as baseball players.

Objective:

To assess the relationships between lower trapezius and serratus anterior strength and the quantity of scapular upward rotation.

Design:

Descriptive study.

Setting:

Laboratory.

Participants:

24 professional baseball pitchers.

Measures:

Scapular upward rotation was measured at 0°, 60°, 90°, and 120° of humeral elevation. The maximum isometric strength of the lower trapezius and serratus anterior were measured.

Results:

There was a moderate-good positive relationship between lower trapezius strength and scapular upward rotation at 90° (r 2 = .56, P = .001) and 120° (r 2 = .53, P = .001). The relationships between scapular upward rotation and serratus anterior strength were all poor.

Conclusion:

A moderate-good relationship existed between lower trapezius strength and scapular upward rotation.

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Holly M. Bush, Justin M. Stanek, Joshua D. Wooldridge, Stephanie L. Stephens, and Jessica S. Barrack

Context: Limited dorsiflexion (DF) range of motion (ROM) is commonly observed in both the athletic and general populations and is a predisposing factor for lower extremity injury. Graston Technique® (GT) is a form of instrument-assisted soft tissue mobilization (IASTM), used commonly to increase ROM. Evidence of the long-term effects of GT on ROM is lacking, particularly comparing the full GT protocol versus IASTM alone. Objective: To evaluate the effectiveness of 6 sessions of the GT or IASTM compared with a control (CON) group for increasing closed-chain DF ROM. Design: Cohort design with randomization. Setting: Athletic training clinic. Patients or OtherParticipants: A total of 23 physically active participants (37 limbs) with <34° of DF. Participants’ limbs were randomly allocated to the GT, IASTM, or CON group. Intervention: Participants’ closed-chain DF ROM (standing and kneeling) were assessed at baseline and 24–48 hours following their sixth treatment. Participants in the CON group were measured at baseline and 3 weeks later. The intervention groups received 6 treatments during a 3-week period, whereas the CON group received no treatment. The GT group received a warm-up, instrument application, stretching, and strengthening of the triceps surae. The IASTM group received a warm-up and instrument application. Main Outcome Measures: Closed-chain DF was assessed with a digital inclinometer in standing and kneeling. Results: A significant difference between groups was found in the standing position (P = .03) but not in kneeling (P = .15). Post hoc testing showed significant improvements in DF in standing following the GT compared with the control (P = .02). Conclusions: The GT significantly increases ankle DF following 6 treatments in participants with DF ROM deficits; however, no differences were found between GT and IASTM. The GT may be an effective intervention for clinicians to consider when treating patients with DF deficits.

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Marissa J. Basar, Justin M. Stanek, Daniel D. Dodd, and Rebecca L. Begalle

Context: The functional movement screen (FMS) is a tool designed to identify limitations between sections of the body during fundamental movements. However, there is limited evidence on the effectiveness of corrective exercises to improve FMS scores. Objective: To examine the effects of individualized corrective exercises on improving FMS scores in Reserve Officers’ Training Corps cadets and to correlate these changes with physical fitness performance as established with the standard Army Physical Fitness Test (APFT). Design: Cluster randomized, cohort study. Setting: Controlled laboratory setting (FMS) and a field-based setting (APFT). Participants: Forty-four healthy, physically active cadets met all inclusion and exclusion criteria. Intervention: Participants were randomly assigned to the experimental (n = 24) or control (n = 20) group by cluster. Personalized intervention programs were developed through the FMS Pro360 system, a subscription-based software that generates corrective exercises based on individual FMS test scores. The experimental group performed the individualized programs 3 times per week for 4 weeks prior to morning physical training regime. The control group continued to participate in the standard warm-up drills as part of morning physical training. Main Outcome Measures: The dependent variables included the individual and composite FMS and APFT scores. Scores were reported and analyzed in several ways to determine the efficacy of corrective exercises. Results: Group FMS and APFT scores were similar at pretest. The experimental group had a significantly greater improvement in FMS composite score at 4 weeks post (U = 87; z = −3.83; P = .001; effect size = 1.33; 95% confidence interval, 0.69–1.98). No significant changes in APFT scores were found (U = 237.5, z = −0.33, P = .74). A nonsignificant weak correlation between the FMS and APFT scores (r = .25, P = .10) was found. Conclusion: Individualized corrective exercises improved FMS scores, but did not change physical fitness performance. FMS composite scores and APFT performance are not related.

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Justin M. Stanek, Todd A. McLoda, Val J. Csiszer, and A.J. Hansen

Context:

Selected muscles in the kinetic chain may help explain the body’s ability to avert injury during unexpected perturbation.

Objective:

To determine the activation of the ipsilateral rectus femoris (RF), gluteus maximus (MA), gluteus medius (ME), and contralateral external obliques (EO) during normal and perturbed gait.

Design:

Single-factor, repeated measures.

Setting:

University research laboratory.

Participants:

32 physically active, college-age subjects.

Intervention:

Subjects walked a total of 20 trials the length of a 6.1-m custom runway capable of releasing either side into 30° of unexpected inversion. During 5 trials, the platform released into inversion.

Main Outcome Measures:

Average, peak, and time to peak EMG were analyzed across the 4 muscles, and comparisons were made between the walking trials and perturbed trials.

Results:

Significantly higher average and peak muscle activity were noted for the perturbed condition for RF, MA, and EO. Time to peak muscle activity was faster during the perturbed condition for the EO.

Conclusion:

Rapid contractions of selected postural muscles in the kinetic chain help explain the body’s reaction to unexpected perturbation.

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Justin M. Stanek, Jake Parish, Richard Rainville, and Jeffrey G. Williams

Rotational motion at the tibia is important for proper lower extremity function, however, normative values vary, and the motion is seldom assessed. Clinicians are increasingly using smartphones for assessing range of motion. The purpose of the study was to assess the reliability of the embedded iPhone 6 compass app and universal goniometer for measuring tibial rotation range of motion. Secondarily, the purpose was to compare readings for the devices. Both devices demonstrated excellent reliability despite systematic bias between the two devices. Assessing tibial rotation with a goniometer results in greater values of motion when compared to using the smartphone compass app. Some of the differences in normative values may be the device or measurement technique utilized. These results show tibial rotation can be reliably assessed with either a smartphone or goniometer, however, the deviations between the two devices may require a scaling factor to be developed for between-instrument comparisons.

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Brittany R. Crosby, Justin M. Stanek, Daniel J. Dodd, and Rebecca L. Begalle

Functional screening tools are popular to help determine deficiencies in mobility or stability. The Functional Movement Screen® (FMS) is commonly used, however, the instructions fail to indicate if the participant should be shod while tested. The objective was to compare static balance and the weight bearing FMS test scores between shod and unshod conditions. Twenty-five healthy participants performed bilateral single-leg balance and the FMS in both shod and unshod conditions. Forceplate measures of center of pressure (COP) area, sway velocity, and displacement, along with the FMS composite scores, were used for analysis. Results showed no significant difference between the two conditions for FMS scores, however, significant differences between footwear conditions were found for forceplate measures. Findings suggest participants could be tested in either condition without affecting the results of the screen.