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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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Mackenzie Holman, Madeline P. Casanova and Russell T. Baker

Context: Patient-reported outcomes are widely used in health care. The Disablement in the Physically Active (DPA) Scale Short Form-8 (SF-8) was recently proposed as a valid scale for the physically active population. However, further psychometric testing of the DPA SF-8 has not been completed, and scale structure has not been assessed using a sample of adolescent athletes. Objective: To assess scale structure of the DPA SF-8 in a sample of adolescent high-school athletes. Main Outcome Measure(s): Adolescent athletes (n = 289) completed the DPA SF-8. Confirmatory factor analysis (CFA) was conducted to assess the psychometric properties of the scale. Results: The CFA of the DPA SF-8 indicated that the model exceeded recommended fit indices (Comparative Fit Index = .976, Tucker–Lewis Index = .965, Root Mean Square Error of Approximation = .061, and Bollen’s Incremental Fit Index = .976). All factor loadings were significant and ranged from .62 to .86. Modification indices did not suggest that meaningful cross-loadings were present or additional specifications that could further maximize fit or parsimony. Conclusions: The CFA of the DPA SF-8 met contemporary model fit recommendations in the adolescent athlete population. The results confirmed initial findings supporting the psychometric properties of the DPA SF-8 as well as the uniqueness of the quality-of-life and physical summary factors in an adolescent population. Further research (eg, reliability, invariance between groups, minimal clinically important differences, etc) is warranted to inform scale use in clinical practice and research.

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Alex T. Strauss, Austin J. Parr, Daniel J. Desmond, Ashmel T. Vargas and Russell T. Baker

Context: The Functional Movement Screen (FMS) provides clinicians with objective criteria to assess movement patterns and overall movement quality. A relationship between low FMS composite scores and increased risk of injury has been reported, and researchers have begun to test the effect of interventions to improve FMS composite scores. Total Motion Release (TMR®), a novel active movement intervention, has been found to produce improvements in range of motion, as well as patient-reported pain and dysfunction. The effect of TMR® on movement patterns or movement quality is unknown. Objective: To assess the effect of a single treatment application of TMR® on FMS composite scores in participants with low baselines FMS composite scores. Design: Single-blind randomized controlled study. Setting: Athletic training laboratory. Participants: Twenty-four participants (12 males and 12 females) with FMS composite scores of 13 or lower were randomly assigned to either a treatment group or control group. The FMS screening procedure was completed on all participants in a pretest and posttest design. Interventions: In between FMS testing sessions, participants assigned to the treatment group completed the TMR® FAB 6-treatment protocol, whereas the control group participants did not receive an intervention. Following the treatment period (ie, 20 min), participants again completed the FMS. Main Outcome Measure: FMS composite scores. Results: The improvement in FMS composite scores was significantly better (P ≤ .001, Cohen’s d = 1.69) in the TMR® group (mean change = 3.7 [2.2]) compared with the control group (mean change = 0.7 [1.2]). Conclusions: A single application of the TMR® FAB 6 protocol produced immediate acute improvements in FMS composite scores in a young, physically active population compared with no intervention. Clinical Relevance: Research evidence exists to suggest impaired or dysfunctional movement patterns or movement quality increases risk of injury. The FMS is commonly utilized to assess movement quality and risk of injury. This study provides initial evidence that the use of TMR® rapidly produces acute improvements in movement quality, as measured by the FMS.

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

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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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Erica S. Albertin, Emilie N. Miley, James May, Russell T. Baker and Don Reordan

Clinical Scenario: Hip osteoarthritis currently affects up to 28% of the population, and the number of affected Americans is expected to rise as the American population increases and ages. Limited hip range of motion (ROM) has been identified as a predisposing factor to hip osteoarthritis and limited patient function. Clinicians often apply therapy techniques, such as stretching and strengthening exercises, to improve hip ROM. Although traditional therapy has been recommended to improve hip ROM, the efficiency of the treatments within the literature is questionable due to lack of high-quality studies. More recently, clinicians have begun to utilize joint mobilization and the Mulligan Concept mobilization with movement techniques to increase ROM at the hip; however, there is a paucity of research on the lasting effects of mobilizations. Given the difficulties in improving ROM immediately (within a single treatment) and with long-lasting results (over the course of months), it is imperative to examine the evidence for the effectiveness of traditional therapy techniques and more novel manual therapy techniques. Focused Clinical Question: Is there evidence to suggest manual mobilizations techniques at the hip are effective at treating hip ROM limitations? Summary of Clinical Findings: 5 Randomized Controlled Studies, improved patient function and ROM with the Mulligan concept, high velocity low amplitude improved. Clinical Bottom Line: We found moderate evidence to suggest favorable outcomes following the use of hip mobilizations aimed at improving hip ROM and patient function. Strength of Recommendation: Strength of the studies identified are 1B.

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

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Marcie B. Fyock, Jeffrey G. Seegmiller, Alan M. Nasypany and Russell T. Baker

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Monica A. Matocha, Russell T. Baker, Alan M. Nasypany and Jeff G. Seegmiller

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Monica A. Matocha, Russell T. Baker, Alan M. Nasypany and Jeff G. Seegmiller