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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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Jordan Anderson and Justin Stanek

Clinical Scenario:

Plantar fasciitis is a debilitating and painful problem present in the general population. It most often presents with moderate to severe pain in the proximal inferior heel region and is most commonly associated with repeated trauma to the plantar fascia. Plantar fasciitis, itself, is an injury at the site of attachment at the medial tubercle of the calcaneus, often due to excessive and repetitive traction. Plantar fasciitis is the most common cause of heel pain and is estimated to affect 2 million people in the United States alone.

Focused Clinical Question:

For adults suffering from plantar fasciitis, are foot orthoses a viable treatment option to reduce pain?

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Adam Kelly and Justin Stanek

Context: The influence of custom and over-the-counter foot orthoses on dynamic balance has been investigated in the past. However, there has not been an exploration of the use of a foot-toe orthosis for improving balance. The ability of clinicians to influence balance could have important implications for injury prevention and rehabilitation. Objective: To determine the impact of a foot-toe orthosis on dynamic balance in healthy, young adults. Design: Randomized control trial. Setting: Athletic training laboratory. Participants: In total, 64 healthy, recreationally active participants aged 18–29 years were randomly allocated to one of the following groups: the foot-toe orthosis and laboratory-issued shoe group, the laboratory-issued shoe only (SO) group, or the control group. Interventions: Subjects in the intervention group wore the foot-toe orthosis and laboratory-issued shoe with activities of daily living for 4 weeks. Subjects in the SO intervention group wore the laboratory-issued shoe with activities of daily living for 4 weeks. Participants in the control group did not receive any intervention. Main Outcome Measures: The instrumented version of the Star Excursion Balance Test, known as the Lower Quarter Y-Balance Test, was used to quantify the dynamic balance at baseline and follow-up. Reaches were normalized for leg length. Results: There were statistically significant differences in postintervention scores on the Lower Quarter Y-Balance Test for both the dominant (P = .03, effect size = 0.84; 95% confidence interval, 0.25 to 1.43) and nondominant (P = .002, effect size = 0.74; 95% confidence interval, 0.15 to 1.32) legs when comparing dynamic balance scores of the foot-toe orthosis and laboratory-issued shoe group with the SO and control groups. No significant differences were observed when comparing dynamic balance between the SO and control groups. Conclusions: A 4-week intervention with a foot-toe orthosis and laboratory-issued shoe resulted in improved dynamic balance in a healthy young adult population. These findings suggest a novel intervention for increasing balance.

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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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Landon Lempke, Rebecca Wilkinson, Caitlin Murray and Justin Stanek

Clinical Scenario: Stretching is applied for the purposes of injury prevention, increasing joint range of motion (ROM), and increasing muscle extensibility. Many researchers have investigated various methods and techniques to determine the most effective way to increase joint ROM and muscle extensibility. Despite the numerous studies conducted, controversy still remains within clinical practice and the literature regarding the best methods and techniques for stretching. Focused Clinical Question: Is proprioceptive neuromuscular facilitation (PNF) stretching more effective than static stretching for increasing hamstring muscle extensibility through increased hip ROM or increased knee extension angle (KEA) in a physically active population? Summary of Key Findings: Five studies met the inclusion criteria and were included. All 5 studies were randomized control trials examining mobility of the hamstring group. The studies measured hamstring ROM in a variety of ways. Three studies measured active KEA, 1 study measured passive KEA, and 1 study measured hip ROM via the single-leg raise test. Of the 5 studies, 1 study found greater improvements using PNF over static stretching for increasing hip flexion, and the remaining 4 studies found no significant difference between PNF stretching and static stretching in increasing muscle extensibility, active KEA, or hip ROM. Clinical Bottom Line: PNF stretching was not demonstrated to be more effective at increasing hamstring extensibility compared to static stretching. The literature reviewed suggests both are effective methods for increasing hip-flexion ROM. Strength of Recommendation: Using level 2 evidence and higher, the results show both static and PNF stretching effectively increase ROM; however, one does not appear to be more effective than the other.

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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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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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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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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.