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Scott W. Cheatham and Russell Baker

Context: Floss bands are a popular intervention used by sports medicine professionals to enhance myofascial function and mobility. The bands are often wrapped around a region of the body in an overlapping fashion (eg, 50%) and then tensioned by stretching the band to a desired length (eg, 50%). To date, no research has investigated the stretch force of the bands at different elongation lengths. Objective: The purpose of this clinical study was to quantify the Rockfloss® band stretch force at 6 different elongation lengths (ie, 25%–150%) for the 5.08- and 10.16-cm width bands. Design: Controlled laboratory study. Setting: University kinesiology laboratory. Participants: One trained researcher conducted all measurements. Procedures: The stretch force of a floss band was measured at 6 different elongation lengths with a force gauge. Main Outcome Measures: Band tension force at different band elongation lengths. Results: The stretch force values for the 5.08-cm width (2 in) were as follows: 25% = 13.53 (0.25) N, 50% = 24.57 (0.28) N, 75% = 36.18 (0.39) N, 100% = 45.89 (0.62) N, 125% = 54.68 (0.26) N, and 150% = 62.54 (0.40) N. The stretch force values for the 10.16-cm width (4 in) were as follows: 25% = 16.70 (0.35) N, 50% = 31.90 (0.52) N, 75% = 47.45 (0.44) N, 100% = 57.75 (0.24) N, 125% = 69.02 (0.28) N, and 150% = 81.10 (0.67) N. Both bandwidths demonstrated a linear increase in stretch force as the bands became longer. Conclusion: These values may help professionals to understand and document the tension force being applied at different lengths to produce a more beneficial application during treatment. Future research should determine how the different length/tensions effect the local myofascia, arterial, and vascular systems.

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Jena A. Hansen-Honeycutt, Alan M. Nasypany and Russell T. Baker

Two physically active patients presented with low back pain (LBP) and were previously diagnosed with a herniated disc. A unique treatment combination of a muscle energy technique (MET) and MyoKinesthetic (MYK) treatments were used to decrease pain and improve function. The treatment combination displayed clinically significant short-term improvements in four treatments or less and both patients reported no recurrence of pain at their 1-year follow-up. It is questionable if the presence of an anatomical abnormality, such as a herniated disc, is truly the source or unrelated to those experiencing LBP; utilizing a MET and MYK treatment may be beneficial for other patients reporting similar symptoms.

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James May, Ryan Krzyzanowicz, Alan Nasypany, Russell Baker and Jeffrey Seegmiller

Context:

Although randomized controlled trials indicate that the Mulligan Concept (MC) of mobilization with movement can improve pain-free grip strength and pressure pain threshold in patients with lateral epicondylalgia of the elbow, improve ankle dorsiflexion in patients with subacute ankle sprains, and decrease the signs and symptoms of patients with cervicogenic headache, little is known about the clinical application, use, and profile of certified Mulligan practitioners (CMPs) in America.

Objective:

To better understand the use and value of applying the MC philosophy in clinical-care environments from the perspective of American CMPs while establishing a clinical profile of a CMP.

Design:

Quantitative descriptive design. Setting: Online survey instrument.

Participants:

American CMPs.

Data Collection and Analysis:

Online survey instrument.

Results:

CMPs use the MC to treat a broad spectrum of spinal and peripheral clinical pathologies in primarily outpatient clinics with an active and athletic population. American CMPs also find value in the MC.

Conclusions:

American CMPs continue to use and find value in the MC intervention strategy to treat a broad spectrum of spinal and peripheral conditions in their clinical practices.

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Kimberly D. Johnston, Russell T. Baker and Jayme G. Baker

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Christy L. Hancock, Russell T. Baker and Eric A. Sorenson

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Lindsay Warren, Russell Baker, Alan Nasypany and Jeffrey Seegmiller

The core is central to almost all extremity movements, especially in athletics. Running, jumping, kicking, and throwing are dependent on core function to create a stable base for movement. Poor core strength, endurance, stiffness, control, coordination, or a combination thereof can lead to decreased performance and increased risk of injury. Due to the core’s many complex elements, none of which are more or less important than the next, it is imperative that athletic trainers have a systematic and comprehensive plan for assessing and treating patients with stability or motor control dysfunctions of the entire spinal stabilizing system. The purpose of this clinical commentary is to outline the structural (anatomical) components of the core and their functions, establish the elements of core stability (functional), review these elements’ importance in decreasing the risk of injury, and discuss the application of this information in athletic training.

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Robert W. Cox, Rodrigo E. Martinez, Russell T. Baker and Lindsay Warren

Context: Range of motion is a component of a physical examination used in the diagnostic and rehabilitative processes. Following ankle injury and/or during research, it is common to measure plantar flexion with a universal goniometer. The ease and availability of digital inclinometers created as applications for smartphones have led to an increase in using this method of range of motion assessment. Smartphone applications have been validated as alternatives to inclinometer measurements in the knee; however, this application has not been validated for plantar flexion in the ankle. Objectives: The purpose of this study was (1) to assess the validity of the Clinometer Smartphone Application™ produced by Plaincode App Development for use in the ankle (ie, plantar flexion) and (2) to assess the validity of the inclinometer procedures used to measure ankle dorsiflexion for measuring ankle plantar flexion. Design: Blinded repeated measures correlational design. Setting: University-based outpatient rehabilitative clinic. Participants: A convenience sample (N = 50) of participants (27 females and 23 males) who reported to the clinic (mean age = 30.48 y). Intervention: Patients were long seated on a plinth, with the knee in terminal extension. Three plantar flexion measurements were taken with a goniometer on each foot by the primary researcher. The primary researcher then conducted 3 blinded measurements with The Clinometer Smartphone Application™ following the same procedure. A second researcher, who was blinded to the goniometer measurements, recorded the inclinometer measurements. After data were collected, a Pearson’s correlation was calculated to determine the validity of the clinometer app compared with goniometry. Main Outcome Measure: Degrees of motion for ankle plantar flexion. Results: Measurements produced using the Clinometer Smartphone Application™ were highly correlated for right foot (r = .92, P < .001), left foot (r = .92, P < .001), and combined (r = .92, P < .001) with goniometer measurements using a plastic universal goniometer. Conclusion: The Clinometer Smartphone Application™ is a valid instrument for measuring plantar flexion of the ankle.

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James M. May, Alan Nasypany, Julie Paolino, Russell Baker and Jeffrey Seegmiller

Context:

While the incidence and reinjury rates of lateral ankle sprain (LAS) continue to persist at high rates across many sporting activities, further exploration of assessment and treatment beyond the traditional ligamentous and strength/proprioceptive model is warranted. Further, assessing and treating both arthrokinematic and osteokinematic changes associated with LAS can provide insight into a more diverse approach to treating ankle pathology.

Objective:

To examine the clinical use of the Mulligan Concept mobilization with movement (MWM) while treating patients diagnosed with an acute grade I or II LAS through authentic patient care.

Design:

An a priori case series.

Setting:

Intercollegiate athletic training clinic.

Patients:

Intercollegiate patients diagnosed with an acute grade I or II LAS.

Intervention:

The Mulligan Concept distal fibular anterior to posterior MWM.

Main Outcome Measures:

Pain-Intensity Numeric Rating Scale (NRS) with Non-Weight Bearing (NRS-NWB) and Weight Bearing (NRS-WB), Disablement of the Physically Active Scale (DPAscale), Foot and Ankle Ability Measure (FAAM) with Activity of Daily living (FAMM-ADL) and Sport (FAAM-Sport), Client Specific Impairment Measure (CSIM), Y-Balance Composite (YBC), and Weight Bearing Measure for Dorsiflexion (WBDF).

Results:

Patients who are diagnosed with an acute grade I or II LAS and are treated with the Mulligan Concept report immediate and long-lasting minimal clinically important differences in patient outcome measures.

Conclusion:

Clinicians who examine and use the Mulligan Concept MWM to treat acute LAS can expect immediate positive results that are progressively retained over time specific to patient-centered outcome measures as well as functional clinicianbased measures. Based on the immediate and positive results, clinicians should examine associated osteokinematic and arthrokinematic changes beyond that of the traditional ligamentous model.